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Capping catastrophe: Is Ohio’s catastrophic-injury limit constitutional?

2/16/26

By: A.J. Miller and Spencer Sukel

Last week, the Supreme Court of Ohio was asked if Ohio’s cap on noneconomic damages in medical malpractice actions was constitutional. On one side, John Paganini argued it was not as applied to him and asked the Court to affirm. On the other, The Cataract Eye Center of Cleveland (and Ohio Attorney General Dave Yost) argued that it was and asked the Court to reverse. The following summarizes the underlying litigation. FMG will provide another update once the Court issues its ruling, which may set significant precedent for all future malpractice claims in Ohio.

In 2021, an Ohio doctor (“Doctor”) performed cataract surgery on Paganini. Paganini presented to Doctor a day later. There, Doctor failed to diagnose Paganini with endophthalmitis—an aggressive eye infection requiring referral to a retina specialist. As a result, Paganini’s retina detached causing permanent loss of vision. Paganini then sued Doctor for medical malpractice.

At trial, the jury found in favor of Paganini and awarded him noneconomic damages in excess of Ohio’s cap finding Paganini’s injuries were sufficiently severe to satisfy one of the limit’s exceptions. Prior to entry of that judgment, Paganini moved the trial court not to apply Ohio’s cap. Trial court granted that motion and thus entered judgment in Paganini’s favor for the full amount of the jury’s verdict. In doing so, the trial court held that Ohio’s cap was unconstitutional as applied to Paganini, which Doctor then appealed.

On appeal, the Eighth Appellate District affirmed trial court in part holding that Ohio’s cap was unconstitutional as it applied to Paganini. Paganini v. The Cataract Eye Ctr. of Cleveland, 2025-Ohio-275 (8th Dist.). The appellate court reasoned that because the cap—if applied—required Paganini to forfeit 66.4% of the damages awarded to him by the jury in exchange for the public’s benefit through lower medical-malpractice insurance rates, the cap is arbitrary. Further, when imposed on severely injured people, the cap conflicts with the legislature’s objective because it places the cost of lowering medical-malpractice insurance rates on a small group of individuals who sustained catastrophic injuries arising from medical malpractice. In support of its decision, the appellate court cited other Ohio courts who made similar rulings based on similar reasons.

The appellate court’s holding was significant because it further cemented Ohio courts march away from applying the cap and toward finding it unconstitutional on an as-applied basis in individual cases. And that is also significant because when a court holds that the cap is unconstitutional as applied to an individual case, it prevents the cap’s application in future cases that present the same set of circumstances.

In another recent case, however, a plaintiff raised the same argument as Paganini, but the Sixth Appellate District held that the plaintiff raised a facial challenge—not an as-applied challenge. McNalley v. Keiser, 2025-Ohio-5561 (6th Dist.). Thus, the cap applied. In contrast to the Paganini Court, the McNalley Court reasoned that an as-applied challenge requires a plaintiff to demonstrate by clear and convincing evidence that the law is unconstitutional when applied to the plaintiff’s unique set of facts. But a plaintiff’s forfeiture of an award due to statutory reductions is not unique as it would apply to all persons catastrophically injured. Therefore, the challenge is facial rather than as-applied and fails.

Hopefully, the Supreme Court’s ruling will provide some much-needed clarity to guide Ohio courts’ future application of the cap. Until then, however, the question of whether capping catastrophe in Ohio is constitutional remains fuzzy—at least as applied to individual cases.

For assistance defending claims for medical negligence, please contact Spencer Sukel at Spencer.Sukel@fmglaw.com, A.J. Miller at Andrew.Miller@fmglaw.com, or your local FMG attorney.

Information conveyed herein should not be construed as legal advice or represent any specific or binding policy or procedure of any organization. Information provided is for educational purposes only. These materials are written in a general format and not intended to be advice applicable to any specific circumstance. Legal opinions may vary when based on subtle factual distinctions. All rights reserved. No part of this presentation may be reproduced, published or posted without the written permission of Freeman Mathis & Gary, LLP.