Changing the Medical Malpractice Dispute Process: What Have We Learned from California's MICRA

摘要

In 1975, amid growing concern over the price and availability of medical malpractice insurance, California changed the laws that govern how personal injury claims arising from health care treatment are litigated and resolved. Today, the same concerns are fueling a vigorous national debate, and Congress is considering various proposals that would impose new rules on all states that have not already adopted restrictions on malpractice litigation. Many proponents of such new rules point to California's Medical Injury Compensation Reform Act (MICRA) as a model for change. MICRA limits to $250,000 the amount a plaintiff can recover at trial for noneconomic damages such as pain, suffering, emotional distress, or mental anguish. (Economic damage awards, for out-of-pocket expenses such as medical care costs and wage loss, are not capped.) A jury can award whatever amount it believes is appropriate for noneconomic loss, but following the verdict the judge will reduce that portion of the award to $250,000 (if necessary) prior to entering the final judgment in the case. MICRA also limits plaintiffs' attorney fees in malpractice cases according to a sliding scale based on the size of the recovery, with the fee percentage decreasing as the plaintiff's recovery increases. Prior to the enactment of the law, neither trial awards nor plaintiffs' attorney fees in California medical malpractice cases had any statutory limitations on their size. This brief summarizes the results of a new RAND study that examined the effects of MICRA on litigants in actual trials. Analysis of data from 257 plaintiff verdicts from 1995 to 1999 showed that the MICRA cap on noneconomic awards was imposed in 45% of the trials; awards most likely to be capped involved death cases, cases with the severest nonfatal injuries, and plaintiffs less than 1 year old; defendants' liabilities were reduced by 30%; attorney fees were reduced by 60%; and plaintiffs' net recoveries were reduced by 15%. (2 figures).