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Non-economic damages caps, including medical malpractice caps, are controversial tort reforms to limit (i.e., "cap") damages in lawsuits for non-pecuniary harms such as permanent disability, disfigurement, blindness, loss of a limb, paralysis, trauma, or physical pain and suffering.^[1] This is opposed to economic damages, which encompasses pecuniary harms such as medical bills, lost wages, and lost future income.^[2]

Non-economic damages, sometimes described as quality-of-life damages, compensate injury victims and their families for injuries and losses that are not easily quantified by a dollar amount.^[3]

Medical malpractice damages caps

In the area of medical malpractice, tort reform advocates have claimed that with the imposition of damages caps insurance premiums would decrease, both making medical care more affordable and eliminating a disincentive for doctors to practice. Critics responded that high medical malpractice insurance rates are a result of the cyclical nature of the insurance industry, lack of competition, mismanagement of reserves and a decline in investment income.

History

Many jurisdictions, including U.S. states, have debated, passed legislation or amended their constitutions to impose caps on non-economic damages. Former President George W. Bush proposed a nationwide $250,000 cap in medical malpractice cases.^[4]

Impact on healthcare costs

From the start, some disputed whether damages caps would reduce overall medical costs for patients. A study by the U.S. Congressional Budget Office published in 2004 found that "Malpractice costs account for less than 2 percent of health care spending."^[5] Proponents of caps suggested other possible effects of limiting tort liability, such as reducing the extent to which physicians practice “defensive medicine”, the provision of unnecessary medical care in order to avoid potential liability, and would increase access to health care.^[6]^[7] There is scant evidence, either anecdotal^[8] or empirical,^[9]^[10]^[11] that doctors significantly change their approach to providing health care services as a result of tort reform measures.

Impact on malpractice insurance premiums

Although proponents of damages caps in medical malpractice cases argue that the caps reduce malpractice insurance premiums for doctors,^[12] despite a considerable amount of research on the subject the data in support of that argument is not compelling.^[13]

Within the United States, the impact of damages caps on the number of malpractice claims paid out by insurance companies varies by state.^[14] In many states, reviews of malpractice premiums following the implementation of damages caps showed that the caps had no effect on premiums.^[15]

Impact on patients

In a personal injury lawsuit, the two basic forms of compensatory damages that may be awarded are economic damages, compensation for the injured person's past and future financial costs and losses, and non-economic damages, compensation for the pain and suffering that results from an injury.^[16] Non-economic damages are thus the only compensation an injured person can receive for the injury itself, as opposed to reimbursement of out-of-pocket expenses such as lost wages, medical bills, and court costs. Non-economic damages can be especially important for injured people who do not work outside the home, including the elderly, children, and homemakers. The "worth" of a homemaker's work inside the home is not easily measured by a dollar amount, and a claim of lost capacity to earn income may not have much value.^[17]

Tort reform supporters argue that it is difficult for juries to assign a dollar value to these losses with the guidance they are normally given. They argue that there is no basis for non-economic damages, and uncapped non-economic damages violate the equitable principles of justice by being inherently quite random, because different juries will always come to different results. Because of the highly charged environment of personal injury trials, they contend that some awards will inevitably be unreasonable.^[18] For example, in Ernst v. Merck, a Texas Vioxx products liability case, the jury issued a verdict of $24 million in compensatory damages, which includes non-economic damages, for a widow of a 59-year-old triathlete who died from arrhythmia, or an irregular heartbeat, that could have been prevented had Merck provided warnings about the drug.^[19] Tort reform supporters argue that the widow had not been married a long time, and suggest that the damage award was excessive. However, since the basis for non-economic damages are not easily measured by a dollar amount (which tort reform supporters themselves argue), by the same logic there is no basis to assume that the award was, in fact, excessive.^[20]

Tort reform supporters argue that juries give arbitrary non-economic damage awards, but fail to argue that the legislature's assignment of non-economic damage caps is any less arbitrary. Opponents of tort reform would argue that members of the legislature are at a greater risk for assigning arbitrary dollar values to non-economic damages than juries;^[21] members of the legislature are not present at trial and do not get to observe evidence, witness testimony, and other factors that contribute to a verdict.

Opponents of tort reform contend that jurors should assess damages on a case-by-case basis, that the risk of loss should not be shifted from those who cause harm or could prevent harm onto the innocent victim, and that damages should not be arbitrarily capped by a legislature.^[22]

United States

Overall, non-economic damages throughout the United States cover pain, suffering, and other nonpecuniary injuries, and in medical malpractice cases many states have imposed caps that range from $250,000 to $750,000 or more.^[23] Damage caps have various purposes; for instance, they can discourage malicious lawsuits and prevent the costs of transacting business from being overly inflated, but have also been criticized as unjust.^[24]

Many jurisdictions with non-economic damage caps have defined non-economic damages by statute.

Constitutionality of caps

Right to trial by jury

Opponents of caps on damages argue that caps on the amount of damages jurors can award violate the right to a trial by jury.^[25] Because tort law has historically been a question of state law, states have the power to establish a constitutional right to a trial by jury in civil cases. Historically, juries have decided both the question of liability and the question of how much damages to award in tort cases, subject to instructions on the law by a judge. Several state appellate courts that have considered the issue have struck down damages caps as a violation of state constitutions.

Separation of powers

Some tort reform supporters, such as the conservative Federalist Society, have criticized court decisions that overturn damages caps legislation as a violation of the concept of separation of powers.

In contrast, critics of caps contend and state courts have held that legislatures violate the principle of separation of powers when they attempt to impose arbitrary damage caps on juries, who function as part of the judicial branch of government. In Best v. Taylor Machine Works, the Illinois Supreme Court ruled that a $500,000 cap on non-economic damages functioned as a "legislative remittitur" and invaded the power of the judiciary, in violation of the separation of powers clause. The court noted that courts are empowered to reduce excessive verdicts where appropriate in light of the evidence. The cap, however, reduced damages by operation of law, without regard to the specific circumstances of the case.

State law

Roughly half of U.S. states have imposed damages caps in medical malpractice litigation.^[26] Eleven states impose damages caps for all general tort and personal injury cases.^[27]

Illinois

The Illinois Supreme Court found in the 1997 case Best v. Taylor Machine Works found that a $500,000 cap on noneconomic damages was (in addition to serving as a "legislative remittitur") special legislation that made an arbitrary distinction between those who sustained major noneconomic damages in a single tort versus multiple tortious actions and between those that suffered minor amounts of noneconomic damages versus amounts about the $500,000 cap (such as a plaintiff who becomes permanently disabled).^[28]

In the 2010 case Lebron v. Gottlieb Memorial Hospital, the Illinois Supreme Court ruled that Section 2-1706.5 of Public Act 94-677, which placed caps on non-economic damages in medical malpractice actions, violated the separation of powers clause in the Illinois Constitution and was therefore facially invalid. Additionally, because Public Act 94-677 contains an inseverability provision, the entire Act was held void and invalid in its entirety.^[29]

California

In California, non-economic damages awarded in medical malpractice actions are capped at $250,000. Non-economic damages are meant "to compensate for pain, suffering, inconvenience, physical impairment, disfigurement and other nonpecuniary damage."^[30]

Maryland

In Maryland, non-economic damages are capped at $800,000. In personal injury cases, non-economic damages are defined as "pain, suffering, inconvenience, physical impairment, disfigurement, loss of consortium, or other nonpecuniary injury" . In wrongful death cases non-economic damages are defined as "mental anguish, emotional pain and suffering, loss of society, companionship, comfort, protection, care, marital care, parental care, filial care, attention, advice, counsel, training, guidance, or education, or other noneconomic damages authorized under Title 3, Subtitle 9 of this article." ^[31]

Michigan

Michigan normally has a cap of $280,000 for "noneconomic loss," which is defined as "damages or loss due to pain, suffering, inconvenience, physical impairment, or physical disfigurement, loss of society and companionship, whether claimed under section 29222 or otherwise, loss of consortium, or other noneconomic loss.^[32] However, the cap is increased to $500,000 where the plaintiff, due to physician negligence, is made "hemiplegic, paraplegic, or quadriplegic resulting in a total permanent functional loss of 1 or more limbs caused by [either] injury to the brain [or] injury to the spinal cord"; "when the plaintiff has permanently impaired cognitive capacity rendering him or her incapable of making independent, responsible life decisions and permanently incapable of independently performing the activities of normal, daily living"; or "there has been permanent loss of or damage to a reproductive organ resulting in the inability to procreate." ^[33]

West Virginia

In West Virginia, non-economic damages are capped at $500,000. Non-economic damages are "(1) wrongful death; (2) permanent and substantial physical deformity, loss of use of a limb or loss of a bodily organ system; or (3) permanent physical or mental functional injury that permanently prevents the injured person from being able to independently care for himself or herself and perform life sustaining activities."^[34]

Wisconsin

In 2005, a Wisconsin court ruled that a $350,000 cap on non-economic damages in medical malpractice cases violates the state's equal protection guarantee. In Ferdon v. Wisconsin Patient's Compensation Fund,^[35] the court ruled that there was no rational relationship between the objectives identified by the legislature that were intended to prevent a medical liability crisis in Wisconsin and treating people with more severe injuries and higher non-economic damage awards different from people with lower non-economic damage awards.^[35]

In Wisconsin, non-economic damages for medical malpractice are capped at $750,000. Non-economic damages means "moneys intended to compensate for pain and suffering; humiliation; embarrassment; worry; mental distress; noneconomic effects of disability including loss of enjoyment of the normal activities, benefits and pleasures of life and loss of mental or physical health, well-being or bodily functions; loss of consortium, society and companionship; or loss of love and affection.".^[36]

References

^ "Hot Coffee - FAQs About Caps". Susan Saladoff. Retrieved 3 October 2017.
^ "Ending the Confusion: Economic, Non-Economic, and Punitive Damages". American College of Surgeons. Retrieved 2 July 2017.
^ Thomas, Tracy A. (2006). "Restriction of tort remedies and the constraints of due process: The right to an adequate remedy". Akron Law Review. 39: 975. Retrieved 3 October 2017.
^ "Bush outlines medical liability reform". CNN. 16 January 2003. Retrieved 3 October 2017.
^ "Limiting Tort Liability for Medical Malpractice" (PDF). Congressional Budget Office. 8 January 2004. Retrieved 15 April 2015.
^ Packer-Tursman, Judy (9 January 2015). "The defensive medicine balancing act". Medical Economics. UBM Media, LLC. Retrieved 3 October 2017.
^ Herner, Laura D.; Brody, Howard (May 2010). "Defensive Medicine, Cost Containment, and Reform". Journal of General Internal Medicine. 25 (5): 470–473. doi:10.1007/s11606-010-1259-3. PMC 2855004. PMID 20143176.
^ Gawande, Atul (1 June 2009). "The Cost Conundrum". Conde Nast. The New Yorker. Retrieved 3 October 2017.
^ Waxman, Daniel A; et al. (16 October 2014). "The Effect of Malpractice Reform on Emergency Department Care". New England Journal of Medicine. 371 (16): 1518–1525. doi:10.1056/nejmsa1313308. PMID 25317871.
^ Millman, Jason (15 October 2014). "Study: Don't expect big health-care savings from medical malpractice reform". Washington Post. Retrieved 3 October 2017.
^ Waxman, Daniel (20 January 2015). "Threat of Malpractice Lawsuits May Not Be Driving Defensive Medicine". ACEP Now. Wiley. Retrieved 3 October 2017.
^ See, e.g., Leonard, J. Nelson, III; Morrisey, Michael A; Kilgore, Meredith L. (June 2007). "Damages Caps in Medical Malpractice Cases". Milbank Quarterly. 85 (2): 259–86. doi:10.1111/j.1468-0009.2007.00486.x. PMC 2690332. PMID 17517115.{{cite journal}}: CS1 maint: multiple names: authors list (link), Seabury, Seth A.; Helland, Eric; Anupam, B. Jena (22 October 2014). "Medical Malpractice Reform: Noneconomic Damages Caps Reduced Payments 15 Percent, With Varied Effects By Specialty". Health Affairs. 33 (11): 2048–2056. doi:10.1377/hlthaff.2014.0492. PMC 4278571. PMID 25339633. Retrieved 3 October 2017.
^ Zeiler, Kathryn; Hardcastle, Lorian (2013). Do Damages Caps Reduce Medical Malpractice Insurance Premiums?: A Systematic Review of Estimates and the Methods Used to Produce Them. Northampton, Massachusetts: Edward Elgar Publishing. ISBN 978-1781006177. Retrieved 3 October 2017.
^ Muhlestein, David B.; Shoben, Abigail; Wickizer, Thomas (2016). "Caps on noneconomic damages' effect on the number of paid malpractice claims in various American states". International Journal of Healthcare. 2 (2): 45. doi:10.5430/ijh.v2n2p45. Retrieved 3 October 2017.
^ "'Caps' Do Not Lower Insurance Premiums for Doctors" (PDF). Center for Justice & Democracy. New York Law School. Retrieved 3 October 2017.
^ Larson, Aaron (19 September 2017). "How Are Damages Calculated After an Injury or Lawsuit". ExpertLaw. Retrieved 3 October 2017.
^ See, e.g., "Andler v. Clear Channel Broadcasting, Inc., 670 F. 3d 717 (6th Cir. 2012)". Google Scholar. Retrieved 3 October 2017.
^ Studdert, D.M.; Kachalia, A.; Saloman, J.A.; Mello, M.M. (2011). "Rationalizing noneconomic damages: a health-utilities approach" (PDF). Law and Contemporary Problems. 74 (3): 57–101. Retrieved 3 October 2017.
^ "Merck & Co., Inc. v. Ernst, 296 SW 3d 81 - Tex: Court of Appeals 2009". Google Scholar. 4 June 2009. Retrieved 15 April 2015.
^ Hensler, Deborah R. (Winter 2008). "Jurors in the Material World: Putting Tort Verdicts in Their S ocial Context". Roger Williams University Law Review. 13 (1): 8. Retrieved 3 October 2017.
^ Emison, Brett (13 March 2014). "The Legal Examiner". Langdon & Emison. Retrieved 3 October 2017.
^ Richards, R.J. (2012). "Capping Non-Economic Medical Malpractice Damages: How the Florida Supreme Court Should Decide the Issue" (PDF). Stetson Law Review. 42: 113. Retrieved 3 October 2017.
^ Morgenstern, Michael (9 September 2015). "Medical Malpractice Damages Caps: A State By State Comparison". The Expert Institute. Retrieved 2 July 2017.
^ Andrews, Michelle (28 June 2017). "This GOP Health Bill Proposes New Limits To Medical Malpractice Awards". NPR. Kaiser Health News. Retrieved 2 July 2017.
^ Leonard W. Schroeter. "The Jurisprudence of Access to Justice: From Magna Carta to Romer v. Evans via Marbury v. Madison". Schroeter, Goldmark & Bender. Retrieved 7 May 2012.
^ Larson, Aaron (31 May 2017). "Medical Malpractice Law By State". ExpertLaw.com. Retrieved 3 October 2017.
^ "Fact Sheet: Caps On Compensatory Damages: A State Law Summary". Center for Justice & Democracy. New York Law School. 22 June 2017. Retrieved 3 October 2017.
^ "Best v. Taylor Mach. Works 689 NE 2d 1057, 179 Ill. 2d 367 (1997)". Google Scholar. Retrieved 3 October 2017.
^ "Illinois Supreme Court Strikes Down Statutory Cap on Non-Economic Damages in Medical Malpractice Actions". The National Law Review. Troutman Sanders LLP. 2010-02-16. Retrieved 2012-01-09.
^ Ann.Cal.Civ.Code § 3333.2(a) (West)
^ Md. Code Ann., Cts. & Jud. Proc. § 11-108 (West)
^ Mich. Comp. Laws Ann. § 600.1483 (West)
^ Mich. Comp. Laws Ann. § 600.1483 (West)
^ W. Va. Code Ann. § 55-7B-8 (West)
^ ^a ^b "Ferdon ex rel. Petrucelli v. Wisconsin Patients Compensation Fund, 284 Wis.2d 573, 701 N.W.2d 440 (2005)". Google Scholar. Retrieved 3 October 2017.
^ Wis. Stat. Ann. § 893.55 (West)

[1] "Hot Coffee - FAQs About Caps". Susan Saladoff. Retrieved 3 October 2017.

[2] "Ending the Confusion: Economic, Non-Economic, and Punitive Damages". American College of Surgeons. Retrieved 2 July 2017.

[3] Thomas, Tracy A. (2006). "Restriction of tort remedies and the constraints of due process: The right to an adequate remedy". Akron Law Review. 39: 975. Retrieved 3 October 2017.

[4] "Bush outlines medical liability reform". CNN. 16 January 2003. Retrieved 3 October 2017.

[5] "Limiting Tort Liability for Medical Malpractice" (PDF). Congressional Budget Office. 8 January 2004. Retrieved 15 April 2015.

[6] Packer-Tursman, Judy (9 January 2015). "The defensive medicine balancing act". Medical Economics. UBM Media, LLC. Retrieved 3 October 2017.

[7] Herner, Laura D.; Brody, Howard (May 2010). "Defensive Medicine, Cost Containment, and Reform". Journal of General Internal Medicine. 25 (5): 470–473. doi:10.1007/s11606-010-1259-3. PMC 2855004. PMID 20143176.

[8] Gawande, Atul (1 June 2009). "The Cost Conundrum". Conde Nast. The New Yorker. Retrieved 3 October 2017.

[9] Waxman, Daniel A; et al. (16 October 2014). "The Effect of Malpractice Reform on Emergency Department Care". New England Journal of Medicine. 371 (16): 1518–1525. doi:10.1056/nejmsa1313308. PMID 25317871.

[10] Millman, Jason (15 October 2014). "Study: Don't expect big health-care savings from medical malpractice reform". Washington Post. Retrieved 3 October 2017.

[11] Waxman, Daniel (20 January 2015). "Threat of Malpractice Lawsuits May Not Be Driving Defensive Medicine". ACEP Now. Wiley. Retrieved 3 October 2017.

[12] See, e.g., Leonard, J. Nelson, III; Morrisey, Michael A; Kilgore, Meredith L. (June 2007). "Damages Caps in Medical Malpractice Cases". Milbank Quarterly. 85 (2): 259–86. doi:10.1111/j.1468-0009.2007.00486.x. PMC 2690332. PMID 17517115.{{cite journal}}: CS1 maint: multiple names: authors list (link), Seabury, Seth A.; Helland, Eric; Anupam, B. Jena (22 October 2014). "Medical Malpractice Reform: Noneconomic Damages Caps Reduced Payments 15 Percent, With Varied Effects By Specialty". Health Affairs. 33 (11): 2048–2056. doi:10.1377/hlthaff.2014.0492. PMC 4278571. PMID 25339633. Retrieved 3 October 2017.

[13] Zeiler, Kathryn; Hardcastle, Lorian (2013). Do Damages Caps Reduce Medical Malpractice Insurance Premiums?: A Systematic Review of Estimates and the Methods Used to Produce Them. Northampton, Massachusetts: Edward Elgar Publishing. ISBN 978-1781006177. Retrieved 3 October 2017.

[14] Muhlestein, David B.; Shoben, Abigail; Wickizer, Thomas (2016). "Caps on noneconomic damages' effect on the number of paid malpractice claims in various American states". International Journal of Healthcare. 2 (2): 45. doi:10.5430/ijh.v2n2p45. Retrieved 3 October 2017.

[15] "'Caps' Do Not Lower Insurance Premiums for Doctors" (PDF). Center for Justice & Democracy. New York Law School. Retrieved 3 October 2017.

[16] Larson, Aaron (19 September 2017). "How Are Damages Calculated After an Injury or Lawsuit". ExpertLaw. Retrieved 3 October 2017.

[17] See, e.g., "Andler v. Clear Channel Broadcasting, Inc., 670 F. 3d 717 (6th Cir. 2012)". Google Scholar. Retrieved 3 October 2017.

[18] Studdert, D.M.; Kachalia, A.; Saloman, J.A.; Mello, M.M. (2011). "Rationalizing noneconomic damages: a health-utilities approach" (PDF). Law and Contemporary Problems. 74 (3): 57–101. Retrieved 3 October 2017.

[19] "Merck & Co., Inc. v. Ernst, 296 SW 3d 81 - Tex: Court of Appeals 2009". Google Scholar. 4 June 2009. Retrieved 15 April 2015.

[20] Hensler, Deborah R. (Winter 2008). "Jurors in the Material World: Putting Tort Verdicts in Their S ocial Context". Roger Williams University Law Review. 13 (1): 8. Retrieved 3 October 2017.

[21] Emison, Brett (13 March 2014). "The Legal Examiner". Langdon & Emison. Retrieved 3 October 2017.

[22] Richards, R.J. (2012). "Capping Non-Economic Medical Malpractice Damages: How the Florida Supreme Court Should Decide the Issue" (PDF). Stetson Law Review. 42: 113. Retrieved 3 October 2017.

[23] Morgenstern, Michael (9 September 2015). "Medical Malpractice Damages Caps: A State By State Comparison". The Expert Institute. Retrieved 2 July 2017.

[24] Andrews, Michelle (28 June 2017). "This GOP Health Bill Proposes New Limits To Medical Malpractice Awards". NPR. Kaiser Health News. Retrieved 2 July 2017.

[25] Leonard W. Schroeter. "The Jurisprudence of Access to Justice: From Magna Carta to Romer v. Evans via Marbury v. Madison". Schroeter, Goldmark & Bender. Retrieved 7 May 2012.

[26] Larson, Aaron (31 May 2017). "Medical Malpractice Law By State". ExpertLaw.com. Retrieved 3 October 2017.

[27] "Fact Sheet: Caps On Compensatory Damages: A State Law Summary". Center for Justice & Democracy. New York Law School. 22 June 2017. Retrieved 3 October 2017.

[28] "Best v. Taylor Mach. Works 689 NE 2d 1057, 179 Ill. 2d 367 (1997)". Google Scholar. Retrieved 3 October 2017.

[29] "Illinois Supreme Court Strikes Down Statutory Cap on Non-Economic Damages in Medical Malpractice Actions". The National Law Review. Troutman Sanders LLP. 2010-02-16. Retrieved 2012-01-09.

[30] Ann.Cal.Civ.Code § 3333.2(a) (West)

[31] Md. Code Ann., Cts. & Jud. Proc. § 11-108 (West)

[32] Mich. Comp. Laws Ann. § 600.1483 (West)

[33] Mich. Comp. Laws Ann. § 600.1483 (West)

[34] W. Va. Code Ann. § 55-7B-8 (West)

[ferndon-35] "Ferdon ex rel. Petrucelli v. Wisconsin Patients Compensation Fund, 284 Wis.2d 573, 701 N.W.2d 440 (2005)". Google Scholar. Retrieved 3 October 2017.

[36] Wis. Stat. Ann. § 893.55 (West)

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@@ Line 15: / Line 15: @@
 ===Impact on healthcare costs===
-From the start, some disputed whether damages caps would reduce overall medical costs for patients.  A study by the U.S. [[Congressional Budget Office]] published in 2004 found that "Malpractice costs account for less than 2 percent of [[health care]] spending."<ref>{{cite web | url=http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/49xx/doc4968/01-08-medicalmalpractice.pdf | title=Limiting Tort Liability for Medical Malpractice | publisher=Congressional Budget Office | date=8 January 2004 | accessdate=15 April 2015}}</ref> Proponents of caps suggested other possible effects of limiting tort liability, such as reducing the extent to which physicians practice “defensive medicine”, the provision of unnecessary medical care in order to avoid potential liability, and would increase access to health care.<ref>{{cite web|last1=Packer-Tursman|first1=Judy|title=The defensive medicine balancing act|url=http://medicaleconomics.modernmedicine.com/medical-economics/news/defensive-medicine-balancing-act?page=full|website=Medical Economics|publisher=UBM Media, LLC|accessdate=3 October 2017|date=9 January 2015}}</ref><ref>{{cite journal|last1=Herner|first1=Laura D.|last2=Brody|first2=Howard|title=Defensive Medicine, Cost Containment, and Reform|journal=Journal of General Internal Medicine|date=May 2010|volume=25|issue=5|pages=470-473|pmc=2855004|pmid=20143176|doi=10.1007/s11606-010-1259-3}}</ref> There is scant evidence, either anecdotal<ref>{{cite news|last1=Gawande|first1=Atul|title=The Cost Conundrum|url=https://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum|accessdate=3 October 2017|agency=The New Yorker|publisher=Conde Nast|date=1 June 2009}}</ref> or empirical,<ref>{{cite journal|last1=Waxman|first1=Daniel A|display-authors=etal|title=The Effect of Malpractice Reform on Emergency Department Care|journal=New England Journal of Medicine|date=16 October 2014|volume=371|pages=1518–1525|url=http://www.nejm.org/doi/full/10.1056/NEJMsa1313308#t=article|accessdate=3 October 2017|doi=10.1056/nejmsa1313308}}</ref><ref>{{cite news|last1=Millman|first1=Jason|title=Study: Don’t expect big health-care savings from medical malpractice reform|url=https://www.washingtonpost.com/news/wonk/wp/2014/10/15/study-dont-expect-big-health-care-savings-from-medical-malpractice-reform/|accessdate=3 October 2017|publisher=Washington Post|date=15 October 2014}}</ref><ref>{{cite web|last1=Waxman|first1=Daniel|title=Threat of Malpractice Lawsuits May Not Be Driving Defensive Medicine|url=http://www.acepnow.com/article/threat-malpractice-lawsuits-may-not-driving-defensive-medicine/|website=ACEP Now|publisher=Wiley|accessdate=3 October 2017|date=20 January 2015}}</ref> that doctors significantly change their approach to providing health care services as a result of tort reform measures.
+From the start, some disputed whether damages caps would reduce overall medical costs for patients.  A study by the U.S. [[Congressional Budget Office]] published in 2004 found that "Malpractice costs account for less than 2 percent of [[health care]] spending."<ref>{{cite web | url=http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/49xx/doc4968/01-08-medicalmalpractice.pdf | title=Limiting Tort Liability for Medical Malpractice | publisher=Congressional Budget Office | date=8 January 2004 | accessdate=15 April 2015}}</ref> Proponents of caps suggested other possible effects of limiting tort liability, such as reducing the extent to which physicians practice “defensive medicine”, the provision of unnecessary medical care in order to avoid potential liability, and would increase access to health care.<ref>{{cite web|last1=Packer-Tursman|first1=Judy|title=The defensive medicine balancing act|url=http://medicaleconomics.modernmedicine.com/medical-economics/news/defensive-medicine-balancing-act?page=full|website=Medical Economics|publisher=UBM Media, LLC|accessdate=3 October 2017|date=9 January 2015}}</ref><ref>{{cite journal|last1=Herner|first1=Laura D.|last2=Brody|first2=Howard|title=Defensive Medicine, Cost Containment, and Reform|journal=Journal of General Internal Medicine|date=May 2010|volume=25|issue=5|pages=470–473|pmc=2855004|pmid=20143176|doi=10.1007/s11606-010-1259-3}}</ref> There is scant evidence, either anecdotal<ref>{{cite news|last1=Gawande|first1=Atul|title=The Cost Conundrum|url=https://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum|accessdate=3 October 2017|agency=The New Yorker|publisher=Conde Nast|date=1 June 2009}}</ref> or empirical,<ref>{{cite journal|last1=Waxman|first1=Daniel A|display-authors=etal|title=The Effect of Malpractice Reform on Emergency Department Care|journal=New England Journal of Medicine|date=16 October 2014|volume=371|issue=16|pages=1518–1525|doi=10.1056/nejmsa1313308|pmid=25317871}}</ref><ref>{{cite news|last1=Millman|first1=Jason|title=Study: Don’t expect big health-care savings from medical malpractice reform|url=https://www.washingtonpost.com/news/wonk/wp/2014/10/15/study-dont-expect-big-health-care-savings-from-medical-malpractice-reform/|accessdate=3 October 2017|publisher=Washington Post|date=15 October 2014}}</ref><ref>{{cite web|last1=Waxman|first1=Daniel|title=Threat of Malpractice Lawsuits May Not Be Driving Defensive Medicine|url=http://www.acepnow.com/article/threat-malpractice-lawsuits-may-not-driving-defensive-medicine/|website=ACEP Now|publisher=Wiley|accessdate=3 October 2017|date=20 January 2015}}</ref> that doctors significantly change their approach to providing health care services as a result of tort reform measures.
 ===Impact on malpractice insurance premiums===
-Although proponents of damages caps in medical malpractice cases argue that the caps reduce malpractice insurance premiums for doctors,<ref>See, e.g., {{cite journal|last1=Leonard|first1=J. Nelson, III|last2=Morrisey|first2=Michael A|last3=Kilgore|first3=Meredith L.|title=Damages Caps in Medical Malpractice Cases|journal=Milbank Quarterly|date=June 2007|volume=85|issue=2|pmc=2690332|pmid=17517115|doi=10.1111/j.1468-0009.2007.00486.x|pages=259–86}}, {{cite journal|last1=Seabury|first1=Seth A.|last2=Helland|first2=Eric|last3=Anupam|first3=B. Jena|title=Medical Malpractice Reform: Noneconomic Damages Caps Reduced Payments 15 Percent, With Varied Effects By Specialty|journal=Health Affairs|date=22 October 2014|volume=33|issue=11|pages=2048–2056|url=http://content.healthaffairs.org/content/33/11/2048|accessdate=3 October 2017|doi=10.1377/hlthaff.2014.0492|pmc=4278571}}</ref> despite a considerable amount of research on the subject the data in support of that argument is not compelling.<ref>{{cite book|last1=Zeiler|first1=Kathryn|last2=Hardcastle|first2=Lorian|title=Do Damages Caps Reduce Medical Malpractice Insurance Premiums?: A Systematic Review of Estimates and the Methods Used to Produce Them|date=2013|publisher=Edward Elgar Publishing|location=Northampton, Massachusetts|isbn=1781006172|url=http://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=2140&context=facpub|accessdate=3 October 2017}}</ref>
+Although proponents of damages caps in medical malpractice cases argue that the caps reduce malpractice insurance premiums for doctors,<ref>See, e.g., {{cite journal|last1=Leonard|first1=J. Nelson, III|last2=Morrisey|first2=Michael A|last3=Kilgore|first3=Meredith L.|title=Damages Caps in Medical Malpractice Cases|journal=Milbank Quarterly|date=June 2007|volume=85|issue=2|pmc=2690332|pmid=17517115|doi=10.1111/j.1468-0009.2007.00486.x|pages=259–86}}, {{cite journal|last1=Seabury|first1=Seth A.|last2=Helland|first2=Eric|last3=Anupam|first3=B. Jena|title=Medical Malpractice Reform: Noneconomic Damages Caps Reduced Payments 15 Percent, With Varied Effects By Specialty|journal=Health Affairs|date=22 October 2014|volume=33|issue=11|pages=2048–2056|url=http://content.healthaffairs.org/content/33/11/2048|accessdate=3 October 2017|doi=10.1377/hlthaff.2014.0492|pmid=25339633|pmc=4278571}}</ref> despite a considerable amount of research on the subject the data in support of that argument is not compelling.<ref>{{cite book|last1=Zeiler|first1=Kathryn|last2=Hardcastle|first2=Lorian|title=Do Damages Caps Reduce Medical Malpractice Insurance Premiums?: A Systematic Review of Estimates and the Methods Used to Produce Them|date=2013|publisher=Edward Elgar Publishing|location=Northampton, Massachusetts|isbn=978-1781006177|url=http://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=2140&context=facpub|accessdate=3 October 2017}}</ref>
-Within the United States, the impact of damages caps on the number of malpractice claims paid out by insurance companies varies by state.<ref>{{cite journal|last1=Muhlestein|first1=David B.|last2=Shoben|first2=Abigail|last3=Wickizer|first3=Thomas|title=Caps on noneconomic damages’ effect on the number of paid malpractice claims in various American states|journal=International Journal of Healthcare|date=2016|volume=2|issue=2|page=45|url=http://www.sciedupress.com/journal/index.php/ijh/article/download/8863/5836|accessdate=3 October 2017|doi=10.5430/ijh.v2n2p45}}</ref> In many states, reviews of malpractice premiums following the implementation of damages caps showed that the caps had no effect on premiums.<ref>{{cite web|title='Caps' Do Not Lower Insurance Premiums for Doctors|url=https://centerjd.org/sites/default/files/ckfinder/userfiles/files/CapsDontWorkF(1).pdf|website=Center for Justice & Democracy|publisher=New York Law School|accessdate=3 October 2017}}</ref>
+Within the United States, the impact of damages caps on the number of malpractice claims paid out by insurance companies varies by state.<ref>{{cite journal|last1=Muhlestein|first1=David B.|last2=Shoben|first2=Abigail|last3=Wickizer|first3=Thomas|title=Caps on noneconomic damages' effect on the number of paid malpractice claims in various American states|journal=International Journal of Healthcare|date=2016|volume=2|issue=2|page=45|url=http://www.sciedupress.com/journal/index.php/ijh/article/download/8863/5836|accessdate=3 October 2017|doi=10.5430/ijh.v2n2p45}}</ref> In many states, reviews of malpractice premiums following the implementation of damages caps showed that the caps had no effect on premiums.<ref>{{cite web|title='Caps' Do Not Lower Insurance Premiums for Doctors|url=https://centerjd.org/sites/default/files/ckfinder/userfiles/files/CapsDontWorkF(1).pdf|website=Center for Justice & Democracy|publisher=New York Law School|accessdate=3 October 2017}}</ref>
 ===Impact on patients===
-In a [[personal injury]] lawsuit, the two basic forms of compensatory damages that may be awarded are economic damages, compensation for the injured person's past and future financial costs and losses, and non-economic damages, compensation for the pain and suffering that results from an injury.<ref>{{cite web|last1=Larson|first1=Aaron|title=How Are Damages Calculated After an Injury or Lawsuit|url=https://www.expertlaw.com/library/damages/damages.html|website=ExpertLaw|accessdate=3 October 2017|date=19 September 2017}}</ref> Non-economic damages are thus the only compensation an injured person can receive for the injury itself, as opposed to reimbursement of [[out-of-pocket expenses]] such as lost wages, medical bills, and court costs. Non-economic damages can be especially important for injured people who do not work outside the home, including the elderly, children, and homemakers.  The "worth" of a homemaker's work inside the home is not easily measured by a dollar amount, and a claim of lost capacity to earn income may not have much value.<ref>See, e.g., {{cite web|title=Andler v. Clear Channel Broadcasting, Inc., 670 F. 3d 717 (6th Cir. 2012)|url=https://scholar.google.com/scholar_case?case=18347765375943966241|website=Google Scholar|publisher=Google|accessdate=3 October 2017}}</ref>
+In a [[personal injury]] lawsuit, the two basic forms of compensatory damages that may be awarded are economic damages, compensation for the injured person's past and future financial costs and losses, and non-economic damages, compensation for the pain and suffering that results from an injury.<ref>{{cite web|last1=Larson|first1=Aaron|title=How Are Damages Calculated After an Injury or Lawsuit|url=https://www.expertlaw.com/library/damages/damages.html|website=ExpertLaw|accessdate=3 October 2017|date=19 September 2017}}</ref> Non-economic damages are thus the only compensation an injured person can receive for the injury itself, as opposed to reimbursement of [[out-of-pocket expenses]] such as lost wages, medical bills, and court costs. Non-economic damages can be especially important for injured people who do not work outside the home, including the elderly, children, and homemakers.  The "worth" of a homemaker's work inside the home is not easily measured by a dollar amount, and a claim of lost capacity to earn income may not have much value.<ref>See, e.g., {{cite web|title=Andler v. Clear Channel Broadcasting, Inc., 670 F. 3d 717 (6th Cir. 2012)|url=https://scholar.google.com/scholar_case?case=18347765375943966241|website=Google Scholar|accessdate=3 October 2017}}</ref>
-Tort reform supporters argue that it is difficult for juries to assign a dollar value to these losses with the guidance they are normally given.  They argue that there is no basis for non-economic damages, and uncapped non-economic damages violate the equitable principles of [[justice]] by being inherently quite random, because different juries will always come to different results. Because of the highly charged environment of personal injury trials, they contend that some awards will inevitably be unreasonable.<ref>{{cite journal|last1=Studdert|first1=D.M.|last2=Kachalia|first2=A.|last3=Saloman|first3=J.A.|last4=Mello|first4=M.M.|title=Rationalizing noneconomic damages: a health-utilities approach|journal=Law and Contemporary Problems|date=2011|volume=74|issue=3|pages=57-101|url=https://cdn1.sph.harvard.edu/wp-content/uploads/sites/487/2012/09/damages_pdf.pdf|accessdate=3 October 2017}}</ref> For example, in ''Ernst v. Merck'', a Texas [[Vioxx]] products liability case, the jury issued a verdict of $24 million in compensatory damages, which includes non-economic damages, for a widow of a 59-year-old triathlete who died from arrhythmia, or an irregular heartbeat, that could have been prevented had Merck provided warnings about the drug.<ref>{{cite web | url=https://scholar.google.com/scholar_case?case=352067741109998327&q=ernst+v.+merck+&hl=en&as_sdt=2,37 | title=Merck & Co., Inc. v. Ernst, 296 SW 3d 81 - Tex: Court of Appeals 2009 | publisher=Google Scholar | date=4 June 2009 | accessdate=15 April 2015}}</ref> Tort reform supporters argue that the widow had not been married a long time, and suggest that the damage award was excessive. However, since the basis for non-economic damages are not easily measured by a dollar amount (which tort reform supporters themselves argue), by the same logic there is no basis to assume that the award was, in fact, excessive.<ref>{{cite journal|last1=Hensler|first1=Deborah R.|title=Jurors in the Material World: Putting Tort Verdicts in Their S ocial Context|journal=Roger Williams University Law Review|date=Winter 2008|volume=13|issue=1|page=8|url=http://docs.rwu.edu/cgi/viewcontent.cgi?article=1376&context=rwu_LR|accessdate=3 October 2017}}</ref>
+Tort reform supporters argue that it is difficult for juries to assign a dollar value to these losses with the guidance they are normally given.  They argue that there is no basis for non-economic damages, and uncapped non-economic damages violate the equitable principles of [[justice]] by being inherently quite random, because different juries will always come to different results. Because of the highly charged environment of personal injury trials, they contend that some awards will inevitably be unreasonable.<ref>{{cite journal|last1=Studdert|first1=D.M.|last2=Kachalia|first2=A.|last3=Saloman|first3=J.A.|last4=Mello|first4=M.M.|title=Rationalizing noneconomic damages: a health-utilities approach|journal=Law and Contemporary Problems|date=2011|volume=74|issue=3|pages=57–101|url=https://cdn1.sph.harvard.edu/wp-content/uploads/sites/487/2012/09/damages_pdf.pdf|accessdate=3 October 2017}}</ref> For example, in ''Ernst v. Merck'', a Texas [[Vioxx]] products liability case, the jury issued a verdict of $24 million in compensatory damages, which includes non-economic damages, for a widow of a 59-year-old triathlete who died from arrhythmia, or an irregular heartbeat, that could have been prevented had Merck provided warnings about the drug.<ref>{{cite web | url=https://scholar.google.com/scholar_case?case=352067741109998327&q=ernst+v.+merck+&hl=en&as_sdt=2,37 | title=Merck & Co., Inc. v. Ernst, 296 SW 3d 81 - Tex: Court of Appeals 2009 | publisher=Google Scholar | date=4 June 2009 | accessdate=15 April 2015}}</ref> Tort reform supporters argue that the widow had not been married a long time, and suggest that the damage award was excessive. However, since the basis for non-economic damages are not easily measured by a dollar amount (which tort reform supporters themselves argue), by the same logic there is no basis to assume that the award was, in fact, excessive.<ref>{{cite journal|last1=Hensler|first1=Deborah R.|title=Jurors in the Material World: Putting Tort Verdicts in Their S ocial Context|journal=Roger Williams University Law Review|date=Winter 2008|volume=13|issue=1|page=8|url=http://docs.rwu.edu/cgi/viewcontent.cgi?article=1376&context=rwu_LR|accessdate=3 October 2017}}</ref>
 Tort reform supporters argue that juries give arbitrary non-economic damage awards, but fail to argue that the legislature's assignment of non-economic damage caps is any less arbitrary. Opponents of tort reform would argue that members of the legislature are at a greater risk for assigning arbitrary dollar values to non-economic damages than juries;<ref>{{cite news|last1=Emison|first1=Brett|title=The Legal Examiner|url=http://kansascity.legalexaminer.com/medical-malpractice/florida-overturns-arbitrary-unconstitutional-damage-caps/|accessdate=3 October 2017|publisher=Langdon & Emison|date=13 March 2014}}</ref> members of the legislature are not present at trial and do not get to observe evidence, witness testimony, and other factors that contribute to a verdict.
@@ Line 53: / Line 53: @@
 ====Illinois====
-The [[Illinois Supreme Court]] found in the 1997 case ''Best v. Taylor Machine Works'' found that a $500,000 cap on noneconomic damages was (in addition to serving as a "legislative remittitur") special legislation that made an arbitrary distinction between those who sustained major noneconomic damages in a single tort versus multiple tortious actions and between those that suffered minor amounts of noneconomic damages versus amounts about the $500,000 cap (such as a plaintiff who becomes permanently disabled).<ref>{{cite web|title=Best v. Taylor Mach. Works 689 NE 2d 1057, 179 Ill. 2d 367 (1997)|url=https://scholar.google.com/scholar_case?case=16924074404448677591|website=Google Scholar|publisher=Google|accessdate=3 October 2017}}</ref>
+The [[Illinois Supreme Court]] found in the 1997 case ''Best v. Taylor Machine Works'' found that a $500,000 cap on noneconomic damages was (in addition to serving as a "legislative remittitur") special legislation that made an arbitrary distinction between those who sustained major noneconomic damages in a single tort versus multiple tortious actions and between those that suffered minor amounts of noneconomic damages versus amounts about the $500,000 cap (such as a plaintiff who becomes permanently disabled).<ref>{{cite web|title=Best v. Taylor Mach. Works 689 NE 2d 1057, 179 Ill. 2d 367 (1997)|url=https://scholar.google.com/scholar_case?case=16924074404448677591|website=Google Scholar|accessdate=3 October 2017}}</ref>
 In the 2010 case ''Lebron v. Gottlieb Memorial Hospital'', the Illinois Supreme Court ruled that Section 2-1706.5 of Public Act 94-677, which placed caps on non-economic damages in medical malpractice actions, violated the separation of powers clause in the Illinois Constitution and was therefore facially invalid.  Additionally, because Public Act 94-677 contains an inseverability provision, the entire Act was held void and invalid in its entirety.<ref>{{cite web |title=Illinois Supreme Court Strikes Down Statutory Cap on Non-Economic Damages in Medical Malpractice Actions|url=http://www.natlawreview.com/article/illinois-supreme-court-strikes-down-statutory-cap-non-economic-damages-medical-malpractice-a|publisher=Troutman Sanders LLP|work=The National Law Review|date=2010-02-16|accessdate=2012-01-09}}</ref>
@@ Line 75: / Line 75: @@
 ====Wisconsin====
-In 2005, a Wisconsin court ruled that a $350,000 cap on non-economic damages in medical malpractice cases violates the state's [[equal protection]] guarantee.  In ''Ferdon v. Wisconsin Patient's Compensation Fund'',<ref name="ferndon">{{cite web|title=Ferdon ex rel. Petrucelli v. Wisconsin Patients Compensation Fund, 284 Wis.2d 573, 701 N.W.2d 440 (2005)|url=https://scholar.google.com/scholar_case?case=15788507432628914384|website=Google Scholar|publisher=Google|accessdate=3 October 2017}}</ref> the court ruled that there was no rational relationship between the objectives identified by the legislature that were intended to prevent a medical liability crisis in Wisconsin and treating people with more severe injuries and higher non-economic damage awards different from people with lower non-economic damage awards.<ref name="ferndon"/>
+In 2005, a Wisconsin court ruled that a $350,000 cap on non-economic damages in medical malpractice cases violates the state's [[equal protection]] guarantee.  In ''Ferdon v. Wisconsin Patient's Compensation Fund'',<ref name="ferndon">{{cite web|title=Ferdon ex rel. Petrucelli v. Wisconsin Patients Compensation Fund, 284 Wis.2d 573, 701 N.W.2d 440 (2005)|url=https://scholar.google.com/scholar_case?case=15788507432628914384|website=Google Scholar|accessdate=3 October 2017}}</ref> the court ruled that there was no rational relationship between the objectives identified by the legislature that were intended to prevent a medical liability crisis in Wisconsin and treating people with more severe injuries and higher non-economic damage awards different from people with lower non-economic damage awards.<ref name="ferndon"/>
 In Wisconsin, non-economic damages for medical malpractice are capped at $750,000. Non-economic damages means "moneys intended to compensate for pain and suffering; humiliation; embarrassment; worry; mental distress; noneconomic effects of disability including loss of enjoyment of the normal activities, benefits and pleasures of life and loss of mental or physical health, well-being or bodily functions; loss of consortium, society and companionship; or loss of love and affection.".<ref>Wis. Stat. Ann. § 893.55 (West)</ref>