Etheridge v. Medical Center Hospitals

Decision Date13 January 1989
Docket NumberNo. 860194,860194
Parties, 57 USLW 2432 Louise ETHERIDGE, et al., etc. v. MEDICAL CENTER HOSPITALS, et al. Record
CourtVirginia Supreme Court

Donald I. Marlin (Alan J. Konigsberg, New York City, Stephen C. Swain, Frederick T. Stant, Jr., Virginia Beach, Levy, Phillips & Konigsberg, New York City, Clark & Stant, P.C., Virginia Beach, on briefs), for appellants.

Stanley G. Barr, Jr., Thomas J. Harlan, Jr. (David J. Pierce, William M. Sexton, Michael F. Bergan, Philip N. Kabler, Kaufman & Canoles, P.C., Harlan, Knight, Dudley & Pincus, Norfolk, on briefs), for appellees.

Com. of Va. (Mary Sue Terry, Atty. Gen., Gail Starling Marshall, Deputy Atty. Gen., James T. Moore, III, Sr. Asst. Atty. Gen., William L. Thurston, Asst. Atty. Gen., Gregory E. Lucyk, Asst. Atty. Gen., on brief), amici curiae, for appellees.

Medical Society of Virginia (Allen C. Goolsby, III, Patricia M. Schwarzschild, W. Jeffrey Edwards, Robert Acosta-Lewis, Hunton & Williams, Richmond, on brief), amici curiae, for appellees.



The principal issue in this appeal is whether Code § 8.01-581.15, which limits the amount of recoverable damages in a medical malpractice action, violates either the Federal or Virginia Constitution. Two other issues involve the interpretation of statutes.


Louise Etheridge and Larry Dodd, co-committees of the estate of Richie Lee Wilson (Wilson), sued Medical Center Hospitals (the hospital) and Donald Bedell Gordon, executor of the estate of Clarence B. Trower, Jr., deceased (Trower), alleging that the hospital and Trower were liable, jointly and severally, for damages Wilson sustained as a result of their medical malpractice. Evidence at trial revealed that, prior to her injuries, Wilson, a 35-year-old mother of three children, was a normal, healthy woman. On May 6, 1980, however, Wilson underwent surgery at the hospital to restore a deteriorating jaw bone. The surgery consisted of the removal of five-inch-long portions of two ribs by Trower, a general surgeon, and the grafting of the reshaped rib bone to Wilson's jaw by an oral surgeon. The jury found that both Trower and the hospital were negligent and that their negligence proximately caused Wilson's injuries.

Wilson's injuries are severe and permanent. She is brain damaged with limited memory and intelligence. She is paralyzed on her left side, confined to a wheelchair, and unable to care for herself or her children.

At the time of trial, Wilson had expended more than $300,000 for care and treatment. She will incur expenses for her care the remainder of her life. Her life expectancy is 39.9 years. Wilson, a licensed practical nurse, earned almost $10,000 in 1979, the last full year she worked. She contends that she proved an economic loss "in excess of $1.9 million."

The jury returned a verdict for $2,750,000 against both defendants. The trial court, applying the recovery limit prescribed in Code § 8.01-581.15 (1977 Repl.Vol.), reduced the verdict to $750,000 and entered judgment in that amount. Wilson appeals.

At all times pertinent to this case, Code § 8.01-581.15 provided that in an action for malpractice against a health care provider, "the total amount recoverable for any injury ... shall not exceed seven hundred fifty thousand dollars." 1 Wilson challenges the validity of this legislation on multiple grounds. She contends that Code § 8.01-581.15 violates the Virginia Constitution's due process guarantee, jury trial guarantee, separation of powers doctrine, prohibitions against special legislation, and equal protection guarantee, as well as certain parallel provisions of the Federal Constitution.


On February 6, 1975, the General Assembly adopted House Joint Resolution No. 174, authorizing a study and report on malpractice insurance premiums for physicians. H.R.Res. 174, Va.Gen.Assem. (1975). The study was conducted by the State Corporation Commission's Bureau of Insurance.

Upon completion of its study in November 1975, the Bureau of Insurance submitted its report to the General Assembly. The report showed that since 1960 medical malpractice insurance rates had increased nationwide more than 1000 percent. The increase resulted from the number and severity of medical malpractice claims. Significantly, the report stated that 90 percent of all medical malpractice claims ever pursued originated after 1965. Bureau of Insurance, State Corporation Commission, Medical Malpractice Insurance in Virginia, the Scope and Severity of the Problem and Alternative Solutions. The information in the report was incorporated into Senate Document No. 29, entitled Interim Report of the Commission to Study the Costs and Administration of Health Care Services to the Governor and the General Assembly of Virginia.

Based upon its study, the General Assembly found that the increase in medical malpractice claims was directly affecting the premium cost for, and the availability of, medical malpractice insurance. Without such insurance, health care providers could not be expected to continue providing medical care for the Commonwealth's citizens. Because of this threat to medical care services, the General Assembly, in 1976, enacted the Virginia Medical Malpractice Act (the Act). Acts 1976, c. 611.

The need and reasons for the legislation are stated in the Preamble to the Act:

Whereas, the General Assembly has determined that it is becoming increasingly difficult for health care providers of the Commonwealth to obtain medical malpractice insurance with limits at affordable rates in excess of $750,000; and

Whereas, the difficulty, cost and potential unavailability of such insurance has caused health care providers to cease providing services or to retire prematurely and has become a substantial impairment to health care providers entering into practice in the Commonwealth and reduces or will tend to reduce the number of young people interested in or willing to enter health care careers; and

Whereas, these factors constitute a significant problem adversely affecting the public health, safety and welfare which necessitates the imposition of a limitation on the liability of health care providers in tort actions commonly referred to as medical malpractice cases[.]

The General Assembly concluded, therefore, that escalating costs of medical malpractice insurance and the availability of such insurance were substantial problems adversely affecting the health, safety, and welfare of Virginia's citizens. Id. Thus, the General Assembly made a judgment that passage of the Act, including Code § 8.01-581.15, was an appropriate means of addressing the problem. Code § 8.01-581.15 (originally Code § 8-654.8), as originally enacted and in effect at all times pertinent to the present case, provided as follows:

In any verdict returned against a health care provider in an action for malpractice where the act or acts of malpractice occurred on or after April one, nineteen hundred seventy-seven, which is tried by a jury or in any judgment entered against a health care provider in such an action which is tried without a jury, the total amount recoverable for any injury to, or death of, a patient shall not exceed seven hundred fifty thousand dollars.


It is firmly established that all actions of the General Assembly are presumed to be constitutional. Riddleberger v. Chesapeake Railway, 229 Va. 213, 215, 327 S.E.2d 663, 664 (1985); Waterman's Assoc. v. Seafood, Inc., 227 Va. 101, 110, 314 S.E.2d 159, 164 (1984); Blue Cross v. Commonwealth, 221 Va. 349, 358, 269 S.E.2d 827, 832 (1980); Peery v. Board of Funeral Directors, 203 Va. 161, 165, 123 S.E.2d 94, 97 (1961); Dean v. Paolicelli, 194 Va. 219, 227, 72 S.E.2d 506, 511 (1952); Ex Parte Settle, 114 Va. 715, 719, 77 S.E. 496, 497 (1913). Therefore, the party assailing the legislation has the burden of proving that it is unconstitutional, Riddleberger, 229 Va. at 215, 327 S.E.2d at 664, and if a reasonable doubt exists as to a statute's constitutionality, the doubt must be resolved in favor of its validity, Blue Cross, 221 Va. at 358, 269 S.E.2d at 832. Indeed, because "[a] judgment as to the wisdom and propriety of a statute is within the legislative prerogative," id., courts will declare legislation invalid only when it is "plainly repugnant to some provision of the state or federal constitution," id. Thus, Wilson's multiple claims of unconstitutionality must be examined in the light of these long-standing principles.


One of Wilson's primary contentions is that Code § 8.01-581.15 violates her right under the Virginia Constitution to a trial by jury. She asserts that "legislation may not override the findings of a jury by prescribing an absolute limit upon the amount of damages, irrespective of the facts and the jury verdict."

Article I, § 11, of the Constitution of Virginia provides, inter alia, "[t]hat in controversies respecting property, and in suits between man and man, trial by jury is preferable to any other, and ought to be held sacred." It is "well settled that ... the State ... Constitution [neither] guarantees [nor] preserves the right of trial by jury except in those cases where it existed when" the Constitution was adopted. Bowman v. Va. State Entomologist, 128 Va. 351, 372, 105 S.E. 141, 148 (1920). Accord Pillow v. Southwest Va. Imp. Co., 92 Va. 144, 149, 23 S.E. 32, 33 (1895). See also 1 A. Howard, Commentaries on the Constitution of Virginia, at 246-48 (1974). Therefore, in determining whether the cap prescribed in Code § 8.01-581.15 violates the jury trial guarantee, "[w]e must look to the law as it existed when the Constitution was adopted and as it has been uniformly construed since that time." Forbes & Co. v. So. Cotton Oil Co., 130 Va. 245, 260, 108 S.E. 15, 20 (1921).

When the Virginia Constitution first was adopted in 1776, a jury's role was defined by three...

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