King v. Virginia Birth-Related Neurological Injury Compensation Program

• Decision Date: 08 November 1991
• Docket Number: BIRTH-RELATED,No. 910213,910213
• Citation: 242 Va. 404,410 S.E.2d 656
• Parties: C. Sidney KING, M.D., et al. v. VIRGINIANEUROLOGICAL INJURY COMPENSATION PROGRAM, et al. Record
• Court: Virginia Supreme Court

Page 656

410 S.E.2d 656

242 Va. 404

C. Sidney KING, M.D., et al. v. VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM, et al.

Record No. 910213.

Supreme Court of Virginia.

Nov. 8, 1991.

Henry C. Devening, Lynchburg (Petty, Livingston, Dawson & Devening, on brief), for appellants.

Guy W. Horsley, Jr., Sr. Asst. Atty. Gen. (Mary Sue Terry, Atty. Gen., K. Marshall Cook, Deputy Atty. Gen., Janice M. Sigler, Asst. Atty. Gen., on brief), for appellees.

Present: All the Justices.

HASSELL, Justice.

In this appeal, we consider State and Federal constitutional challenges to the Virginia Birth-Related Neurological Compensation Act, Code § 38.2-5000, et seq.

I.

This suit was filed by 29 doctors, licensed to practice medicine in this Commonwealth, against the Virginia Birth-Related Neurological Injury Compensation Program, the Virginia Birth-Related Neurological Injury Compensation Board, and the State Corporation Commission. The doctors allege that the Birth-Related Neurological Compensation Act is unconstitutional because it violates their rights to due process and equal protection guaranteed by the State and Federal Constitutions, and violates Article IV, § 14, of the Virginia Constitution which prohibits special legislation.

The Program and the Board filed demurrers, and the State Corporation Commission filed a motion to dismiss. The doctors filed a motion for summary judgment. The trial court sustained the demurrers.

II.

The Virginia Birth-Related Neurological Injury Compensation Act was enacted by the General Assembly in 1987. Under the Act, an infant who incurs a birth-related neurological injury caused by the negligence of a participating physician cannot maintain a common law tort action against the participating physician other than as provided by the Act, or when there is clear and convincing evidence that the participating physician willfully or intentionally caused such injury. Code § 38.2-5002(B) and (C). The Act defines "birth-related neurological injury" as an

injury to the brain or spinal cord of an infant caused by the deprivation of oxygen or mechanical injury occurring in the course of labor, delivery or resuscitation in the immediate post-delivery period in a hospital which renders the infant permanently motorically disabled and (i) developmentally disabled or (ii) for infants sufficiently developed to be cognitively evaluated, cognitively disabled.

Code § 38.2-5001. A "participating physician" is a physician licensed to practice medicine in Virginia and who practices obstetrics or performs obstetrical services full or part-time as authorized in a plan of operation. Code § 38.2-5001. ¹

An infant who incurs a birth-related neurological injury may file a claim against a participating physician with the Industrial Commission, which has jurisdiction to decide all claims made pursuant to the Act. Code §§ 38.2-5003 and -5004. The Industrial Commission is authorized to determine whether the injury is a birth-related neurological injury, whether the obstetrical services were delivered by a participating physician at birth, and how much compensation, if any, is awardable pursuant to the Act. Code §§ 38.2-5008 and -5009.

Each participating physician is required to pay an annual assessment of $5,000 to the Program. Code § 38.2-5020(A). All licensed non-participating physicians in Virginia, with certain limited exceptions, are required to pay an annual assessment of $250, even though they may not be obstetricians or may not perform any obstetrical services. ² Code § 38.2-5020(D). These assessments are used to fund the Program.

III.

The doctors, who are all "non-participating physicians," argue that the $250 annual assessment imposed upon non-participating physicians violates Article IV, §§ 14 and 15, of the Virginia Constitution. They contend that the Act constitutes a special or private law because it removes certain claims against physicians who practice obstetrical medicine from the traditional tort system and requires that physicians who cannot participate in the Program pay an annual assessment which is used to fund the Program.

A.

All statutes enacted by the General Assembly are presumed to be constitutional. Etheridge v. Medical Center Hospitals, 237 Va. 87, 94, 376 S.E.2d 525, 528 (1989); Riddleberger v. Chesapeake Railway, 229 Va. 213, 215, 327 S.E.2d 663, 664 (1985); Waterman's Association v. Seafood, Inc., 227 Va. 101, 110, 314 S.E.2d 159, 164 (1984). The doctors, who assail the legislation, have the burden of proving that the Act is unconstitutional, Riddleberger, 229 Va. at 215, 327 S.E.2d at 664, and any reasonable doubt as to the statute's constitutionality must be resolved in favor of its validity. Blue Cross v. Commonwealth, 221 Va. 349, 358, 269 S.E.2d 827, 832 (1980).

B.

Article IV, § 14, of the Constitution of Virginia provides, in part, that "[t]he General Assembly shall not enact any local, special, or private law ... [g]ranting to any private corporation, association, or individual any special or exclusive right, privilege, or immunity." Va. Const. art. IV, § 14(18). Article IV, § 15, Va. Const., provides, in pertinent part:

In all cases enumerated in the preceding section, ... the General Assembly shall enact general laws. Any general law shall be subject to amendment or repeal, but the amendment or partial repeal thereof shall not operate directly or indirectly to enact, and shall not have the effect of enactment of, a special, private, or local law.

....

No private corporation, association, or individual shall be specially exempted from the operation of any general law, nor shall a general law's operation be suspended for the benefit of any private corporation, association, or individual.

The constitutional prohibition against special laws does not prohibit legislative classifications. Holly Hill Farm Corp. v. Rowe, 241 Va. 425, 430, 404 S.E.2d 48, 50 (1991). Rather, the prohibitions require that such classifications be "natural and reasonable, and appropriate to the occasion." Benderson Development Company v. Sciortino, 236 Va. 136, 140-41, 372 S.E.2d 751, 753 (1988); Holly Hill, 241 Va. at 430, 404 S.E.2d at 50. "Taken together, the pervading philosophy of Article IV, sections 14 and 15 reflects an effort to avoid favoritism, discrimination, and inequalities in the application of the laws." Benderson at 147, 372 S.E.2d at 756. Additionally, "the necessity for and the reasonableness of classification are primarily questions for the legislature. If any state of facts can be reasonably conceived, that would sustain it, that state of facts at the time the law was enacted must be assumed." Etheridge, 237 Va. at 102, 376 S.E.2d at 533 (quoting Martin's Ex'rs v. Commonwealth, 126 Va. 603, 612-13, 102 S.E. 77, 80 (1920).

In Etheridge, we considered several constitutional challenges to Code § 8.01-581.15. That Code provision imposes a monetary limitation on the amount recoverable in a medical malpractice action against a health care provider. The plaintiff in Etheridge contended that the limitation violated Article IV, § 14 of the Virginia Constitution because the limitation "confer[s] special privileges and immunities upon a small segment of the population--physicians and their insurers--while at the same time arbitrarily distinguishing between severely injured victims of medical malpractice and less severely injured malpractice claimants as well as all other tort plaintiffs." Etheridge, 237 Va. at 102, 376 S.E.2d at 533.

We held in Etheridge that the challenged classification was permissible because the classification bore a reasonable and substantial relation to the object sought to be accomplished by the legislation. Id. at 103, 376 S.E.2d at 533. Moreover, we held that "[w]hether a classification is arbitrary 'depends upon the purpose and subject of the particular act and the circumstances and conditions surrounding its passage.' " Id. at 102, 376 S.E.2d at 533 (citation omitted). We also observed that the General Assembly had determined that a medical malpractice crisis existed in this Commonwealth because health care providers faced increasing difficulty in obtaining affordable malpractice insurance coverage. This situation tended to reduce the number of health care providers available to serve Virginia's citizens, thereby resulting in a significant problem adversely affecting the public health, safety, and welfare. We said that the monetary limitation imposed upon plaintiffs in medical malpractice actions would make medical malpractice insurance coverage available to health care providers. Etheridge, 237 Va. at 102-03, 376 S.E.2d at 533.

The trial judge, applying the aforementioned principles and the rationale discussed in Etheridge, held that the Act did not violate the prohibition against special legislation. We agree. It is reasonably conceivable that the General Assembly concluded that the removal of the claims of neurologically injured infants from the tort system would decrease the cost of medical malpractice insurance premiums for all physicians and, thus, make medical malpractice insurance available to all physicians practicing in Virginia, including the doctors in this proceeding. ³ Accordingly, we hold that the classification is not arbitrary and that it bears a reasonable and substantial relation to a legitimate object sought to be accomplished by the legislation.

IV.

The doctors argue that the Act violates the Equal Protection Clause in the Fourteenth Amendment of the United States Constitution. The doctors contend that the Act creates two classifications: licensed physicians who are practicing in Virginia and a specified subclass of physicians which includes obstetricians and physicians providing obstetrical services. The doctors argue that these classifications are invalid because non-participating physicians must pay an assessment to fund the Program, yet, they purportedly receive no benefit from it. The Equal Protection...