By Trenton W. Gill

Indiana’s Medical Malpractice Act’s caps on damages have survived constitutional challenges since their inception in 1975. In 1980, the Indiana Supreme Court, in Johnson v. St. Vincent Hosp., Inc., 273 Ind. 374, 404 N.E.2d 585 (1980), held that they were constitutional. The Indiana Court of Appeals followed the Johnson precedent and upheld those caps in a series of cases in the 1990s. Those caps had built-in escalators: The initial cap of $500,000 was increased to $750,000 in 1990, and again in 1999 to $1.25 million. But no additional escalators were established. They remained there until just recently. Constitutional challenges started to mount with aggressive collaboration among the plaintiff’s bar. As explained below, while the Johnson opinion is still reliable law, there are outliers, and the plaintiff’s bar can be expected to continue to challenge them with cases involving catastrophic injuries until the Indiana Supreme Court definitively upholds the recent compromise.  

In 2013, the Indiana Supreme Court reviewed a constitutional challenge in Plank v. Cmty. Hosps. of Indiana, Inc., 981 N.E.2d 49 (Ind. 2013). The plaintiff received a verdict for $8.5 million. The plaintiff challenged the caps as a violation of the Due Process and Equal Protection clauses of the 14th Amendment and the Indiana Constitution; the Rights and Privileges Clause; and the right to a jury trial. Defense counsel opposed these arguments in the same fashion that had served them well in prior challenges: that the constitutionality has long been settled; the state has a legitimate sufficiently and specifically-tailored interest in creating an environment where health care providers can practice with the freedom of consistently reliable malpractice premiums and cost-controlling measures. This, in turn, provided the state’s citizens with access to good, convenient health care. While the Plank court dismissed this particular challenge for procedural reasons (holding that the plaintiff had waited too long to move to provide notice and build a case for a challenge), it said that these arguments were not “well established” or “settled” -- possibly providing plaintiffs a roadmap for future challenges in cases that may be unconstitutional based on current social and/or economic conditions.

Meanwhile, Bobbitt v. St. Mary’s Hospital was working its way through the Vanderburgh County Circuit Court and ultimately, likely served as the catalyst for a legislative compromise between the plaintiff’s bar and various health-care associations trying to keep the caps low. Filed in 2005, the case involves allegations of negligent delay causing catastrophic injuries to a patient born with cerebral palsy and is a quadriplegic. A life-care planner for the plaintiff testified that the medical care alone would cost several million dollars. A jury found in Bobbitt’s favor and calculated the damages at $15 million in August 2013. Since that verdict, Bobbitt’s attorneys have been challenging the caps.

The Indiana Legislature took notice and a compromise was reached with an effort to avoid a court ruling that the caps were unconstitutional. In early 2016, the legislature increased the caps effective July 1, 2017 to $1.65 million and then $1.8 million in July 2019. Bobbitt agreed to dismiss her constitutional challenge presumably as a part of this compromise.  But not all plaintiffs’ lawyers appear willing to accept this compromise and stand down.

Recently, in Elkhart Circuit Court, a judge, following a bench trial, found the defendant health care providers negligent and ordered them to pay damages in the amount of $4.7 million dollars. The judge did this despite recognition of the caps. This case, like Bobbitt, involved catastrophic injuries to a patient who is permanently paralyzed and a life-care plan of more than $1 million. Presumably, there will be an appeal and it may serve as a test case for whether Indiana’s appellate courts have accepted this recent compromise with increased caps. After all, no appellate courts have looked at this new escalator, and the Indiana Supreme Court has not specifically revisited the caps since its decision in Johnson in 1980.

Despite Plank and other cases like it, Indiana’s Supreme Court is likely to accept this compromise as an appropriate balancing of the needs of the state’s citizens’ access to good health care and encouraging those practitioners to remain in the state versus compensating injured patients. Still the defense bar, health care providers, and insurers are wise to continue to guard against constitutional arguments – especially in those cases involving catastrophic injuries with life-care plans alone exceeding current caps.  

If you have any question regarding the issue of damage caps or any other issue of medical malpractice liability in the State of Indiana, Kentucky or Ohio,  please call one of our Medical Malpractice and Health Care Practice Group members.

This has been prepared for informational purposes only. It does not contain legal advice or legal opinion and should not be relied upon for individual situations. Nothing herein creates an attorney-client relationship between the Reader and Reminger. The information in this document is subject to change and the Reader should not rely on the statements in this document without first consulting legal counsel. 

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