Ascaris Mayo v. Wisconsin Injured Patients and Families Compensation Fund
914 N.W.2d 678, 383 Wis. 2d 1, 2018 WI 78 (2018)
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Rule of Law:
A statutory cap on noneconomic damages in medical malpractice cases does not violate the equal protection and due process clauses of the Wisconsin Constitution when the classification is rationally related to legitimate government interests, such as ensuring affordable and accessible healthcare.
Facts:
- In May 2011, Ascaris Mayo went to an emergency room at Columbia St. Mary's Hospital with abdominal pain and a high fever.
- A physician and a physician's assistant saw Mayo and advised her to follow up with her gynecologist, suspecting her condition was related to a history of uterine fibroids.
- The next day, Mayo went to a different emergency room due to her worsening condition.
- She was diagnosed with sepsis resulting from an untreated infection.
- As a consequence of the severe sepsis, Mayo's organs began to fail and all four of her limbs developed dry gangrene.
- This condition ultimately necessitated the amputation of all four of her limbs.
Procedural Posture:
- Ascaris Mayo and Antonio Mayo sued healthcare providers in Milwaukee County Circuit Court (a court of first instance), alleging medical malpractice.
- A jury found the providers had failed to provide adequate information and awarded the Mayos over $8.8 million in economic damages and a total of $16.5 million in noneconomic damages.
- The Wisconsin Injured Patients and Families Compensation Fund (the Fund) moved the trial court to reduce the noneconomic damage award to the statutory cap of $750,000.
- The Mayos moved for a declaratory judgment that the statutory cap was unconstitutional facially and as applied.
- The circuit court held the cap was facially constitutional but found it unconstitutional as applied to the Mayos.
- The Fund appealed to the Wisconsin Court of Appeals (an intermediate appellate court).
- The Court of Appeals affirmed the trial court's judgment but on different grounds, holding that the statutory cap was facially unconstitutional.
- The Fund petitioned the Wisconsin Supreme Court (the state's highest court) for review.
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Issue:
Does Wisconsin's statutory cap of $750,000 on noneconomic damages in medical malpractice cases violate the equal protection and due process clauses of the Wisconsin Constitution, either facially or as applied?
Opinions:
Majority - Patience Drake Roggensack, C.J.
No. Wisconsin's statutory cap of $750,000 on noneconomic damages in medical malpractice cases does not violate the equal protection and due process clauses of the Wisconsin Constitution. The court holds that the rational basis standard of review is the proper test, and under this deferential standard, the cap is constitutional both on its face and as applied to the Mayos. The court explicitly overrules its prior decision in Ferdon, which had invalidated a lower cap using a 'rational basis with teeth' analysis, finding that heightened standard to be an erroneous invasion of the legislature's policy-making role. The legislature's stated objectives—ensuring affordable and accessible healthcare, controlling insurance costs, reducing defensive medicine, and protecting the financial integrity of the state compensation fund—are legitimate government interests. The cap is a rational means to achieve these goals, and it does not violate equal protection because it applies equally to all plaintiffs whose noneconomic damages exceed $750,000. Applying the cap to the Mayos is constitutional because they were treated no differently than any other similarly situated plaintiff, and the severity of an injury does not render a neutral law unconstitutional in its application.
Dissenting - Ann Walsh Bradley, J.
Yes. The statutory cap violates the constitutional guarantee of equal protection. The dissent argues that the majority wrongly overrules the court's precedent in Ferdon, as merely increasing the cap amount does not remedy its fundamental constitutional flaws. The cap remains unconstitutional because it irrationally and unfairly imposes the heaviest burden on the most catastrophically injured victims, like Ascaris Mayo, who receives only a small fraction of the compensation a jury deemed appropriate for her suffering. The dissent contends there is still no rational basis for the cap because the legislative justifications—such as retaining physicians, curbing defensive medicine, lowering insurance premiums, and ensuring the fund's solvency—are not supported by evidence. The dissent concludes that it is senseless and unconstitutional for the law to provide the least proportionate recovery to those who have suffered the most.
Concurring - Rebecca Grassl Bradley, J.
No. The statutory cap on noneconomic damages is constitutional. This concurrence joins the majority's conclusion but writes separately to critique the 'beyond a reasonable doubt' standard used to review a statute's constitutionality, arguing it is an abdication of the judiciary's duty to 'say what the law is.' The concurrence agrees with rejecting the 'rational basis with teeth' test. It emphasizes that rational basis review is appropriate here because the recovery of noneconomic damages is a common law right, not a fundamental constitutional right, and the legislature has the authority to alter or eliminate such common law claims. Therefore, because the cap does not implicate a fundamental right and treats all similarly situated plaintiffs equally, it survives the necessary constitutional scrutiny.
Analysis:
This decision marks a significant shift in Wisconsin's tort law jurisprudence, strengthening the legislature's power to enact tort reform by explicitly overruling the heightened 'rational basis with teeth' standard from Ferdon. By reinstating the highly deferential traditional rational basis test for economic regulations, the court makes it substantially more difficult for plaintiffs to challenge damage caps and similar laws on constitutional grounds. The ruling provides greater certainty and predictability for the healthcare industry and medical malpractice insurers but curtails the potential recovery for the most severely injured victims, shifting a greater portion of the economic burden of catastrophic injury from negligent actors to the victims themselves.
