Classic cesarean section in the operating theater.
Introduction to Lebron v. Gottlieb Memorial Hospital, 237 Ill.2d 217 (2010): A Battle over Litigation Costs
On a cold night in the end of October of 2005, Francis Lebron entered Gottlieb Memorial Hospital in Cook County, Illinois to undergo a Caesarean section. After being admitted, she was placed under the care of Dr. Levi D’Ancona and Florence Martinoz, a registered nurse. However, things did not go swimmingly. Her child, Abigaile Lebron, was born with severe brain injury and impairment as well as cerebral palsy. Consequently, doctors discovered that she would not develop brain functions normally or be able to eat without the assistance of a feeding tube. For the economic and noneconomic damages (i.e. trauma, medical costs, and reduced quality of life to name a few), the Lebrons sued the hospital as well as the attending doctor and nurse.
The family soon ran into the wall of existing laws. Just in that same year, through 735 ILCS 5/2-1706.5, the Illinois state legislature had put a cap on non-economic damages at $500,000 for doctors and $1,000,000 for hospitals for “any medical malpractice action or wrongful death action based on medical malpractice.” The Lebrons’ claim asked for a lot more than that. Based off of the Illinois Supreme Court’s ruling in Best v. Taylor Machine Works (179 Ill.2d 367 (1997)), the circuit court held that 2-1706.5 was unconstitutional as an improper exercise of legislative power and declared the entire act void. Unhappy with the result, the defendants appealed to the Supreme Court.
Lebron Case Analysis
In Best, the court analyzed the constitutionality of a cap on noneconomic damages arising out of negligence or product liability claims. Noneconomic damages included those intangible aspects such as pain and suffering, loss of consortium, and loss of society. Despite finding rationality within the act, the court held it was unconstitutional because it violated the separation of powers in that it acted as a “legislative remittitur.”
Illustrating how a remittitur is supposed to work will illuminate where the legislature went wrong in Best and instruct why the court ruled the way it did eventually in Lebron. Sometimes, for a variety of reasons, juries return awards to plaintiffs that many view as excessive or unreasonable. Most people cannot do anything about it, except for judges. With the consent of the plaintiffs, the judge has the right in Illinois to lower the amount of the award to an amount that he or she believes is reasonable. Judges are supposed to use all the facts and circumstances of the case as well as their reasoned judgment in deciding the appropriate figure to lower the jury award to. By placing a cap in the particular instances relative to the act in question in Best, the Illinois Supreme Court thought that this impermissibly invaded the province of judicial authority and, thus, violated separation of powers principles. The court articulated this reasoning in the following passage:
“Unlike the traditional remittitur power of the *235 judiciary, the legislative remittitur of section 2–1115.1 disregards the jury’s careful deliberative process in determining damages that will fairly compensate injured plaintiffs who have proven their causes of action. The cap on damages is mandatory and operates wholly apart from the specific circumstances of a particular plaintiff’s noneconomic injuries. Therefore, section 2–1115.1 unduly encroaches upon the fundamentally judicial prerogative of determining whether a jury’s assessment of damages is excessive within the meaning of the law.” Best, 179 Ill.2d at 413–14, 228 Ill.Dec. 636, 689 N.E.2d 1057.”
Interestingly, had the court not thought that this act violated separation of powers principles, it still probably would have struck it down anyways. This is true because the court found the law was arbitrary and not related to a legitimate state interest. Yet, since the court initially found the law was an unconstitutional encroachment upon the judicial “sphere of authority,” it did not actually rule on this matter.
This slight tangent into Illinois judicial case law brings us to Lebron. As mentioned above, the defendants brought this case all the way to the highest court in Illinois. There, they presented both procedural and substantive arguments for why the cap found in 2-1706.5 was appropriate and constitutional. Their first procedural argument was that the court’s ruling in Best on the separation of powers issue should not even be followed. They argued it was dicta. Rebutting this common legal point, the court distinguished between two types of dictum: obiter and judicial. The former is merely an aside by the court, a remark on a matter not crucial to the eventual outcome of the case. The latter involves mattes that both sides’ lawyers debated and the court intentionally passed on; while not crucial to the outcome, it is entitled to be followed unless it is determined to be erroneous later. The court in Lebron determined that its remarks in Best on the separation of powers issue were judicial dicta entitled to respect. Thus, the defendants could not short-circuit the case in this manner but they tried a few others.
As opposed to questioning the authority of the court or the merits of its prior decisions, the defendants next tried two procedural arguments that involved the legislature’s sphere of influence. They claimed that the legislature (i.e. the Illinois General Assembly) has had authority to amend the common law even in the province of limiting plaintiff’s damages, and this authority has been upheld by the court. See Bernier v. Burris, 113 Ill.2d 219 (1986); Siegall v. Solomon, 19 Ill.2d 145 (1960); Smith v. Hill, 12 Ill.2d 588 (1958). Also, they pointed to the caps on noneconomic damages that other states had enacted and illustrated that Illinois’ fit within a reasonable range of all of them. Plus, those courts had upheld them as a proper exercise of constitutional power. To all of these procedural claims, the court reasoned that even if the Illinois legislature has this power at all, it is not infinite, and must fit rationally within the three-branches system of government (which has will be seen later, it does not). Further, while persuasive, the legislative and judicial bodies of other states are not dispositive, the court ruled. Therefore, the defendants then turned to several substantive arguments to support the constitutionality of 2-1706.5.
The first substantive device that the defendants proffered went to the construction of 2-1706.5. Unlike 2-1115.1 in Best, the act in focus in Lebron they urged was narrowly tailored. 2-1115.1 effectively sought to unilaterally reduce litigation costs without much context or exception, but they distinguished 2-1706.5 as focusing on a sole issue: sandbagging exploding health-care costs (2-1115.1 limited damages “On account of death, bodily injury, or physical damage to property based on negligence,” whereas 2-1706.5 limited those for “Any medical malpractice action or wrongful death action based on medical malpractice.”). The court conceded that the scope of 2-1115.1 in Best was by far broader than that of 2-1706.5 in Lebron. However, it found the trespass onto the judicial sphere in both just as grave and unconstitutional. It intimated as much when it said, “Notwithstanding this difference, the encroachment upon the inherent power of the judiciary is the same in the instant case as it was in Best.”
The defendants then distinguished their case from Best by arguing that 2-1706.5 was rationally related to a legitimate governmental interest, whereas the limitations in the former where found to be arbitrary, capricious, and poorly drawn. Here, the defendants argued that the confines of 2-1706.5 were tightly circumscribed around a very definitive problem, health care costs. They said they were responding to a “Mounting crisis in access to health care by stemming the cost of malpractice insurance.” The court sympathized with this concern but found it missing the point; it said that the separation of powers was first and fundamental to anything else. It reasoned that “The inquiry under the separation of powers clause is not whether the damages cap is rationally related to a legitimate government interest but, rather, whether the legislature, through its adoption of the damages cap, is exercising powers properly belonging to the judiciary.”
Losing on the first two substantive grounds-2-1706.5 being narrowly tailored and rationally related-the defendants contended that separation of powers principles also permitted the legislature to pass laws with legitimate goals. Here, the defendants, exasperated in their futility, cried that nothing could be further in the bounds of legitimate goals than fighting a health-care crises. To buttress their claim, they offered Burger v. Lutheran General Hospital in support of their contention. 198 Ill.2d 21 (2001). There the court upheld an Illinois law regarding medical disclosures and denied a separation of powers argument. Again, the court sympathized with the defendants but found their focused misplaced. The court distinguished Burger from Lebron because the law at question in the former did not affect the internal processes of litigation and, as such, did not “impinge upon the power of the judiciary.” However, if finding a legitimate goal existed for the promulgation of 2-1706.5, this would not absolve it of the sin of encroaching upon the constitutional power of the judiciary. Thus, the defendants struck out on all of their substantive arguments. The court held that 2-1706.5, which limited medical malpractice claims against doctors to $500,000 and against hospitals to $1,000,000, violated the separation of powers clause of the Illinois Constitution (article 2, section 1).
The dissent in Lebron wrote a long and vigorous opinion. Most of it aped the defendants’ storyline in that they charged the majority with being a roadblock to fixing the health-care crises. Also, they claimed that the plaintiffs in this case did not have standing and the issue itself was not ripe for review. Without either of these two factors, they discerned, the court should not have ruled on the matter because, constitutionally, it must only decide cases of controversy and avoid issuing opinions on non-ripe items. To this, the majority said that it was not the responsibility of the court to be an advocate for health-care reform, it must only decide what is proper under the constitution for better or worse. Also, the standing and ripeness claims were waived by the defendants because they did raise them in the lower courts.
Aftermath of Lebron. What it Means for Plaintiff’s in Illinois Medical Malpractice Cases Today.
The subject matter of this case predetermined that it would be of crucial importance to the Illinois legal and health-care communities. Many across the state and across the country believe that litigation costs have gotten out of hand and that this is having a negative effect on the quality of and access to health care. By taking the ruling in Best to a broad level and striking down 2-1706.5 in Lebron, the Illinois Supreme Court took a legal, reasoned position on the opposite side of those critics, stating that the legislature could not cap noneconomic damages in this manner. The well-thought arguments of the defendants did not work. In Illinois, it does not matter if legislation the General Assembly passes is well-tailored to a solution, rationally related to a problem, or serves a legitimate goal. If it encroaches upon the judicial sphere at all, it operates as an impermissible “legislative remittitur” and is unconstitutional. Therefore, all suits filed after the effective date of this case will operate under the pre-2-1706.5 law, when no cap existed.