Condon v. St. Alexius Med. Ctr.

926 N.W.2d 136

Chenille CONDON, Plaintiff and Appellee

v.ST. ALEXIUS MEDICAL CENTER and Allen Michael Booth, M.D., Defendants and Appellants

No. 20180297

Supreme Court of North Dakota.

Filed April 22, 2019

Thomas J. Conlin (argued), Stacy D. Stennes (appeared), Minneapolis, MN, and Robert V. Bolinske Jr. (on brief), Bismarck, ND, for plaintiff and appellee.

Tracy Vigness Kolb (argued), Bismarck, ND, and Rodger A. Hagen (on brief), Minneapolis, MN, for defendants and appellants.

Matthew A. Sagsveen, Office of Attorney General, Bismarck, ND, for amicus curiae State of North Dakota.

Courtney Koebele, Bismarck, ND, Mark A. Behrens and Cary Silverman, Washington, DC, for amicus curiae North Dakota Medical Association.

Timothy Q. Purdon, Bismarck, ND, and Glenn A. Danas, Los Angeles, CA, for amicus curiae North Dakota Association for Justice.

Jensen, Justice.

[¶1] Dr. Allen Booth and St. Alexius Medical Center appeal from a district court judgment finding North Dakota’s noneconomic damages cap in medical malpractice cases unconstitutional. Dr. Booth and St. Alexius also argue the district court erred in denying a motion for a new trial. We reverse in part, affirm in part, and remand for a reduction of the award of noneconomic damages.

I.

[¶2] On May 29, 2012, Chenille Condon gave birth to a child at St. Alexius Medical Center. Within hours, Condon complained about chest discomfort and shortness of breath. A pulmonary embolism was suspected and testing was ordered in an effort to diagnose the issue. Testing revealed multiple pulmonary nodules in Condon’s mediastinum. Condon was eventually referred to Dr. Booth for a mediastinoscopy for the purpose of collecting a larger tissue sample. The larger tissue sample was necessary for a definitive diagnosis.

[¶3] Not long into the procedure, an injury occurred to Condon’s right innominate artery, resulting in life-threatening bleeding. Dr. Booth called for the assistance of a surgeon, and they repaired the injured vessel. After surgery, Condon was placed in intensive care where she had a stroke. The stroke was related to the injury that occurred during surgery. Condon underwent rehabilitation for several months.

[¶4] Condon filed a medical malpractice claim against Dr. Booth. After nine days of proceedings, the jury returned a verdict finding negligence and awarding Condon $265,000 in past economic loss, $1.735-million in future economic loss, $150,000 in past noneconomic loss, and $1.350-million in future noneconomic loss.

[¶5] Dr. Booth sought a reduction of noneconomic damages under N.D.C.C. § 32-42-02, the noneconomic damages cap in medical malpractice actions, and a reduction of the past economic damages pursuant to the collateral-source rule, N.D.C.C. § 32-03.2-06. Condon opposed the reductions and challenged the constitutionality of N.D.C.C. § 32-42-02. The district court granted Dr. Booth’s motion with regard to the collateral-source reduction and, after finding N.D.C.C. § 32-42-02 unconstitutional on equal-protection grounds, denied the remainder of Dr. Booth’s motion.

[¶6] Dr. Booth also sought a new trial or, in the alternative, a reduction in the verdict. The district court denied the motion for a new trial, but granted the request to reduce the past-economic-loss award to $150,000.

II.

[¶7] Dr. Booth argues the district court erred in holding N.D.C.C. § 32-42-02 to be unconstitutional. In determining whether a statute is constitutional, we have stated:

Whether a statute is unconstitutional is a question of law, which is fully reviewable on appeal. All regularly enacted statutes carry a strong presumption of constitutionality, which is conclusive unless the party challenging the statute clearly demonstrates that it contravenes the state or federal constitution. The justice, wisdom, necessity, utility and expediency of legislation are questions for legislative, and not for judicial determination. This Court exercises the power to declare legislation unconstitutional with great restraint. Under N.D. Const. art. VI, § 4, this Court shall not declare a legislative enactment unconstitutional unless at least four of the members of the court so decide.

Teigen v. State , 2008 ND 88, ¶ 7, 749 N.W.2d 505 (citations and quotations omitted).

[¶8] "[A]n Act of the legislature is presumed to be correct and valid, and any doubt as to its constitutionality must, where possible, be resolved in favor of its validity." S. Valley Grain Dealers Ass’n v. Bd. of Cty. Comm’rs , 257 N.W.2d 425, 434 (N.D. 1977). "A statute enjoys a conclusive presumption of constitutionality unless it is clearly shown that it contravenes the state or federal constitution." Richter v. Jones , 378 N.W.2d 209, 211 (N.D. 1985).

[¶9] Article I, § 21, N.D. Const., has long been "viewed as our state constitutional guarantee of equal protection under the law." Matter of Adoption of K.A.S. , 499 N.W.2d 558, 563 (N.D. 1993). Under N.D. Const. art. I, § 21, not all legislative classifications are unlawful. This Court reviews the lawfulness of legislative classifications under three separate standards of review explained below.

[¶10] The standard of review of a question under equal-protection analysis is dependent on the type of classification. Hanson v. Williams Cty. , 389 N.W.2d 319, 323 (N.D. 1986). When a classification involves a "fundamental interest" or is "inherently suspect," we will analyze these classifications under strict scrutiny. Id. When there is "an important substantive right" involved in the classification, an intermediate standard of review is applied. Id . at 325. Lastly, if there is no fundamental or important substantive interest involved, we will consider the classification under a rational basis standard, where the legislation will be sustained unless it is "patently arbitrary and bears no rational relationship to a legitimate government interest." Id . at 323. This level of scrutiny is generally applied when "statutory classifications [ ] involve economic or social matters and do not deprive a class of plaintiffs from access to the courts." Bismarck Pub. Sch. Dist. 1 v. State , 511 N.W.2d 247, 257 (N.D. 1994).

III.

[¶11] In Arneson v. Olson , this Court held a previous statutory damage cap of $300,000 in medical malpractice actions violated equal protection under the intermediate level of scrutiny. 270 N.W.2d 125, 135-36 (N.D. 1978). The legislative goals of the prior statute included the availability of competent medical and hospital services at reasonable costs, the elimination of the expenses involved in non-meritorious malpractice claims, the allowance of adequate compensation for patients with meritorious claims, and the encouragement of physicians to practice medicine in North Dakota. Id. at 127. We concluded there was not a sufficiently close correspondence between those goals and the statutory classification treating seriously injured victims of medical negligence different than other victims of medical negligence.

[¶12] Section 32-42-02, N.D.C.C., the damage cap currently before this Court, reads:

With respect to a health care malpractice action or claim, the total amount of compensation that may be awarded to a claimant or members of the claimant’s family for noneconomic damage resulting from an injury alleged under the action or claim may not exceed five hundred thousand dollars, regardless of the number of health care providers and other defendants against whom the action or claim is brought or the number of actions or claims brought with respect to the injury. With respect to actions heard by a jury, the jury may not be informed of the limitation contained in this section. If necessary, the court shall reduce the damages awarded by a jury to comply with the limitation in this section.

Condon argues N.D.C.C. § 32-42-02 is virtually identical to the damage cap invalidated in Arneson . However, there are fundamental distinctions. The Arneson cap limited a plaintiff’s entire recovery to a maximum of $300,000 for all damages incurred. Under N.D.C.C. § 32-42-02, there is no limit on the amount of damages a jury may award for economic damages such as future medical expenses or loss of wages. The Arneson Court was primarily concerned about the damage cap preventing injured individuals from recovering an amount that would satisfy their medical bills. See Arneson , 270 N.W.2d at 135-36. Because N.D.C.C. § 32-42-02 does not limit economic damages, the recovery of medical bills is not an issue under the current damage cap.

[¶13] Regardless of the distinctions between the prior and current damage caps, N.D.C.C. § 32-42-02 does limit recovery in a personal injury action. We have repeatedly recognized the right to recover for personal injuries is an important substantive right subject to the intermediate standard of equal-protection analysis. Larimore Pub. Sch. Dist. No. 44 v. Aamodt , 2018 ND 71, ¶ 49, 908 N.W.2d 442 ; Olson v. Bismarck Parks & Recreation Dist. , 2002 ND 61, ¶ 17, 642 N.W.2d 864 ; Bouchard v. Johnson , 555 N.W.2d 81, 87-88 (N.D. 1996) ; Hanson , 389 N.W.2d at 328 ; Arneson , 270 N.W.2d at 135-36. The intermediate level of scrutiny applies to our analysis of the damage cap in N.D.C.C. § 32-42-02 and requires a close correspondence between the statutory classification and legislative goals.

[¶14] The legislature enacted N.D.C.C. § 32-42-02 in 1995 after a five-year study by a task force created to analyze and make recommendations regarding improvements to North Dakota’s health care system. The goals of the task force were to (1) increase access; (2) control costs; and (3) to maintain or increase quality of health care in the state. Initially, the recommendation was to cap noneconomic damages at $250,000, but was then changed to $500,000 to "provide more equity" for seriously injured individuals who did not have significant wage losses to recoup. There was also testimony suggesting the goal of the cap was to stabilize the risk for insurance providers which would potentially have a beneficial...