Tam v. Eighth Jud. Dist. Ct.

Citation: 2015 NV 80Docket: 66346

Court: Nevada Supreme Court; October 1, 2015; Nevada; State Supreme Court

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The Supreme Court of Nevada addressed a petition for a writ of mandamus regarding the constitutionality of NRS 41A.035, which limits recovery of noneconomic damages in medical malpractice cases to $350,000. The court concluded that the district court incorrectly ruled the statute unconstitutional, asserting it does not violate the right to trial by jury. Additionally, the court found that the statutory cap applies as a single limit for the case rather than separately for each plaintiff and defendant. It also determined that NRS 41A.035 applies to medical malpractice claims. The background involves a complaint from Sherry Cornell, who alleged professional negligence and medical malpractice after the death of Charles Thomas Cornell, Jr., due to inadequate medical care. The district court had dismissed several claims and defendants and denied Dr. Tam's motion to limit noneconomic damages based on its constitutional ruling. The Supreme Court granted the petition, indicating that writ relief was appropriate to correct the district court's errors.

Writ relief under NRS 34.160 is generally unavailable when there is an adequate and speedy legal remedy, such as an appeal. However, the court may exercise discretion to grant writ relief in urgent circumstances or when important legal issues require clarification for judicial economy. In this case, although an appeal seems sufficient for the parties, granting Dr. Tam's petition for writ of mandamus is warranted to address significant legal questions affecting the litigation.

The district court incorrectly found NRS 41A.035 unconstitutional, which limits noneconomic damages for healthcare negligence cases to $350,000, arguing it infringes on the right to a jury trial by removing the determination of damages from the jury. The court reviews constitutional issues de novo, presuming statutes to be valid, with challengers bearing the burden of proof for unconstitutionality. The Nevada Constitution guarantees the right to jury determination of factual issues, but for a statute to violate this right, it must make it practically unavailable. The court has previously held that caps on damages do not infringe on this constitutional right.

In the case of Arnesano v. State, the court affirmed that it is the jury's role to assess injury extent, while legal consequences are determined by the Legislature. Similar rulings in other jurisdictions, like California, support the constitutionality of statutory damage caps in professional negligence actions.

The Yates court determined that while the statute might lead to a lower judgment than a jury's award, the Legislature has broad authority to control damages awarded to plaintiffs and owed by defendants, provided that such control is rationally connected to a legitimate state interest. NRS 41A.035's cap on noneconomic damages, which is applied after the jury determines damages, does not infringe upon a plaintiff's right to a jury trial or violate equal protection rights. Although Cornell contended that the statute lacks a rational basis and violates the Equal Protection Clause, the district court did not address this argument. However, the court may consider constitutional issues for the first time on appeal. To withstand an equal protection challenge, NRS 41A.035 must be rationally related to a legitimate governmental purpose. The right to sue for malpractice does not constitute a fundamental constitutional right. The statute’s intent, articulated during its voter support campaign, was to stabilize Nevada's health care crisis and protect both doctors and patients. Legislative history can inform the statute's purpose, but the court can uphold the statute if any rational basis exists. The court concluded that the aggregate cap on noneconomic damages serves the legitimate governmental interest of ensuring adequate and affordable health care in Nevada by promoting predictability and reducing costs for healthcare insurers, providers, and patients. This reasoning aligns with California's Supreme Court decision that upheld a similar cap on noneconomic damages as rationally related to combating rising medical malpractice insurance costs. Thus, NRS 41A.035 is constitutional and does not violate equal protection.

The district court incorrectly determined that the cap on noneconomic damages in NRS 41A.035 applies separately for each plaintiff against each defendant. Cornell contends that the statute's language and legislative history support a separate cap for each plaintiff, drawing a parallel to the wrongful death statute where actions can be joined but remain distinct. However, NRS 41A.035 specifies a $350,000 limit on noneconomic damages for actions based on professional negligence against healthcare providers, leading to a dispute over the interpretation of "action." Dr. Tam argues that "action" refers to the case as a whole, while Cornell asserts it pertains to individual claims against each defendant. Given the reasonable ambiguity of the statute, the court must consider legislative history for clarification.

The 2004 amendments to NRS Chapter 41A, which replaced NRS 41A.031(3)(a) with NRS 41A.035, suggest that the cap is intended to be per incident rather than per plaintiff or defendant. Legislative history and discussions indicate that the cap applies "per incident" and not per claimant or provider. Testimonies during legislative hearings reinforced this interpretation, asserting a unified cap for noneconomic damages per action. Consequently, the court concludes that the cap in NRS 41A.035 applies per incident, thus reversing the district court's ruling and stating that the plaintiffs' noneconomic damages should be limited to $350,000 collectively.

The district court incorrectly interpreted NRS 41A.035 as applying solely to claims of professional negligence, excluding medical malpractice. The court cited Egan v. Chambers to assert that professional negligence and medical malpractice are mutually exclusive; however, Dr. Tam contends that professional negligence encompasses medical malpractice. He argues that as a licensed physician, he falls under the definition of professional negligence set forth in NRS 41A.035. Cornell counters that her claims are strictly for medical malpractice, which she asserts is distinct from professional negligence, thereby making the statute inapplicable to her case.

NRS 41A.035 pertains to actions for injury or death against healthcare providers due to professional negligence, defined as negligent acts or omissions by healthcare providers that proximate cause personal injury or wrongful death. The statute includes physicians licensed under Nevada law. Definitions in NRS 41A.009 indicate that medical malpractice involves a physician's failure to exercise reasonable care, skill, or knowledge. While the definitions of professional negligence and medical malpractice share similarities, the former is broader and encompasses the latter.

Legislative history reveals that in 2004, Nevada voters approved the Keep Our Doctors in Nevada initiative, which added NRS 41A.035, using the terms professional negligence and medical malpractice interchangeably. The initiative aimed to limit attorney fees in medical malpractice cases and established a cap on noneconomic damages. Discussion regarding the statute indicated it was intended to apply to medical malpractice actions, reinforcing the notion that the terms are interconnected, with professional negligence as a broader category that includes acts contributing to patient injury or death in medical malpractice cases.

The district court incorrectly interpreted the applicability of NRS 41A.035, which governs professional negligence and medical malpractice claims. The court relied on Egan, asserting that medical malpractice and professional negligence are mutually exclusive. However, the Supreme Court clarified that NRS 41A.071, requiring an affidavit of merit for medical malpractice claims, applies solely to medical malpractice and does not extend to professional negligence, as defined under NRS 41A.035. Medical malpractice is defined as claims against physicians licensed under specific NRS chapters, excluding podiatrists, who are licensed under a different chapter. The court concluded that medical malpractice is a subset of professional negligence and therefore NRS 41A.035 applies to medical malpractice actions as well. The Supreme Court determined that the district court erred in ruling NRS 41A.035 unconstitutional, in its application of the cap for noneconomic damages, and in its interpretation that NRS 41A.035 does not apply to medical malpractice claims. Consequently, the court granted Dr. Tam's petition and ordered the district court to vacate its prior order and proceed in accordance with this ruling.