Appeal on Limit in Malpractice Award Rejected

Over a single dissent, the Supreme Court on Tuesday rejected a challenge to a hotly debated California law limiting damage awards for pain and suffering in medical malpractice cases.

The court dismissed an appeal of a 4-3 ruling last February by the California Supreme Court that affirmed a $250,000 maximum on so-called “non-economic” damages as a means of controlling medical malpractice awards and insurance costs.

Justice Byron R. White cast the only vote to hear the case, saying the justices should resolve the constitutional issues surrounding such limits before more states enact similar legislation in the wake of “continued national concern over the ‘malpractice crisis.’ ” Four votes are required for the court to hear a case.

Given Green Light

The court’s action provided at least a temporary green light to states to impose limits on medical malpractice awards. By recent count, five other states currently place limits on pain and suffering awards of $200,000 to $500,000 and three others now limit total malpractice awards.

More than three dozen states are considering a wide range of medical malpractice bills.

At issue in the California case was a key provision of the state’s far-ranging Medical Injury Compensation Reform Act, passed in 1975 over concern about growing consumer medical costs brought on by increasing monetary awards and soaring malpractice insurance premiums. Many doctors said at the time that they were being forced out of business.

The state Supreme Court upheld the limit on pain and suffering awards as a legitimate way for the state to curb medical costs. In a sharp dissent, Chief Justice Rose Elizabeth Bird assailed the limit as “fundamentally unjust,” saying it unfairly singled out the most severely injured victims of medical negligence to bear the burden that should be carried by doctors, hospitals and insurers.

The case began in 1976, when Lawrence Fein, then a 34-year-old attorney for the state Legislature in Sacramento, suffered chest pains and sought medical attention. He was examined at the Permanente Medical Group, an affiliate of the Kaiser Health Foundation, where he was first diagnosed as suffering a muscle spasm. The pains persisted and physicians subsequently found that he had suffered a heart attack. Fein was hospitalized.

Works, Exercises

By the next year, however, Fein had resumed work and was able to jog, swim, bicycle and ski. But he brought suit against the medical group for failing to diagnose and prevent a myocardial infarction that he said reduced his life expectancy by 10 years.

A jury awarded him total damages of $1.3 million, including $500,000 for non-economic damages--pain, suffering, inconvenience and other intangibles. A trial court reduced the non-economic damages to $250,000, citing the limits in the state law.

After the state Court of Appeal and the state Supreme Court upheld the limits, Fein brought an appeal to the justices (Fein vs. Permanente Medical Group, 85-216), saying that the restrictions violated the due process and equal protection clauses of the Constitution by unfairly singling out the worst-injured victims.

Control Over Costs

“This decision means we will have some control over medical malpractice costs,” said Curtis A. Cole, a Los Angeles lawyer for the Permanente Medical Group, a partnership of several thousand doctors who treat Kaiser patients. “I understand those costs are going up again, but they would be going up faster without (the malpractice limits).”

Medical group spokesmen pointed to one study showing that in California trial courts, awards against physicians and hospitals in 1983 reached $32 million--double the previous year. They also quoted an American Medical Assn. estimate that extra tests and treatment--ordered by doctors in defensive moves to guard against malpractice suits--added up to $40 billion annually to national health care costs.

Morten L. Friedman, who represented Fein, called the decision “a travesty.”

Charges Discrimination

Friedman, a Sacramento lawyer, charged that the malpractice law upheld Tuesday allows discrimination against malpractice victims by limiting the amount they can collect.

“The ones who get the advantage of this discrimination are the insurance companies,” Friedman said.

White, in a four-page dissent from the court’s refusal to grant review, noted that only California and Indiana courts thus far had upheld the constitutionality of limits on malpractice damage awards. Courts in four states--Texas, New Hampshire, North Dakota and Ohio--have struck them down.

“The issue is important and is deserving of this court’s review,” White wrote.