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Ohio appellate decision places statutory cap on non-economic damages in medical negligence cases at risk.

9/24/25

By: Aaron N. Kaeser and Paul-Michael La Fayette

In a major appellate decision, the Tenth District affirmed a trial court ruling in Lyon v. Riverside Methodist Hospital, 2025-Ohio-2991 (10^th Dist.), declaring Ohio’s cap on noneconomic damages in medical malpractice cases unconstitutional as applied.

The plaintiff suffered injuries after physicians failed to timely diagnose a thiamine deficiency, leading to Wernicke-Korsakoff syndrome and severe neurological damage. A jury awarded the plaintiff over $5 million for medical expenses and $20 million for past and future non-economic damages (i.e., pain and suffering). The defendants sought to reduce her recovery of non-economic damages, pursuant to Ohio Revised Code 2323.43, to $500,000, the statutory cap in medical malpractice cases. However, the trial court rejected the statutory cap as unconstitutional, “as-applied,” for violating the plaintiff’s right to due process and equal protection.

The Tenth District was confronted with both a facial challenge and an as-applied challenge to the statutory cap on non-economic damages. A facial challenge asserts that, beyond a reasonable doubt, there is no circumstance under which the statute would be constitutionally valid. An “as-applied” challenge requires a showing, by clear and convincing evidence, that the statute is unconstitutional when applied to the specific circumstances of the case.

In its decision, the Tenth District explored the various historical incarnations of tort reform in Ohio, including those that were previously found unconstitutional. The decision also delved into the public policy cited by each General Assembly as to the need for such caps to include significant increases in non-economic damage awards and the impacts on premium increases and corresponding impacts on the cost and access to health care. The Lyon Court held, with respect to the facial challenge, that “[g]iven the General Assembly’s rationale for enacting the statute, R.C. 2323.43 bears a real and substantial relationship to the general welfare to the public.”  The application of a $500,000 cap, in some instances, would not be unreasonable or arbitrary. As such, the Court found that the statute was facially constitutional.

However, as to the “as-applied” challenge, the Court compared medical malpractice plaintiffs to plaintiffs of other torts. Under Ohio law, catastrophic injury plaintiffs in auto accidents and other tort cases can recover the full value of their noneconomic damages. Medical malpractice plaintiffs, however, are treated differently and capped at $500,000. The appellate court found this disparity unjustified, concluding that the reduction of noneconomic damages, solely because her injury occurred in a medical setting was, as applied to this case, “clearly and convincingly unreasonable and arbitrary.” The Court also noted, in support of its conclusion that the cap is unreasonable and arbitrary, that the $500,000 cap was enacted in 2003 and based upon inflation, the present value of the cap is $286,475.79. Given the severity of the plaintiff’s injuries and the significance of the reduction in her noneconomic damage award, the Court found R.C. 2323.43 unconstitutional “as-applied.”

The Tenth District’s decision, holding that the medical malpractice statute is unconstitutional “as-applied” as opposed to facially unconstitutional, is a distinction with a difference. It essentially recognizes the facial constitutionality of the public policy behind the adoption of tort caps, such as ensuring the viability of the medical profession, the cost of healthcare and ensuring access to quality healthcare. However, holding that the statute was unconstitutional “as-applied,” under the facts and circumstances specific to this case, the Court leaves the statute susceptible to continued attack on a case-by-case basis until resolved by the Ohio Supreme Court. There is always the potential that the Ohio Supreme Court could affirm the Tenth District’s decision, as other districts have made similar holdings. In such a circumstance, the new normal will be extensive post-trial litigation concerning whether the cap is unconstitutional “as-applied,” with such a decision being left to the trial judge in a friendly or unfriendly jurisdiction, depending on the perspective of the litigant.

This case is likely to reverberate across Ohio’s medical malpractice communities. Hospitals, physicians and insurers warn that striking down damages caps could raise malpractice premiums, dramatically increase healthcare costs and have a significant net impact on access to quality healthcare. On the other hand, patient advocates argue that the ruling restores fairness by allowing plaintiffs to receive full compensation for injury. A potential clash before the Ohio Supreme Court looms on the horizon, but for now, Lyon v. Riverside Methodist Hospital chips away at the efficacy of Ohio’s statutory damages caps.

For more information, please contact Aaron N. Kaeser at aaron.kaeser@fmglaw.com, Paul-Michael La Fayette at paul.lafayette@fmglaw.com or your local FMG attorney.

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