The Missouri Supreme Court has tossed out the state’s caps on malpractice claims, touching off a strong reaction from supporters and opponents of the caps, put in place in 2005.

The Missouri State Medical Association issued a strongly worded statement saying that the ruling “eviscerates one of the nation's most successful tort reform laws” and could result in physicians leaving the state.

The president of the Missouri Association of Trial Attorneys lauded the court's action as "a good day for anyone in Missouri who believes in the constitution."

In the 4-3 ruling, written by Chief Justice Richard B. Teitelman, the state court ruled that Missouri’s cap on non-economic damages violates the state constitution’s right to a fair trial because courts would have to reduce such jury-awarded damages if they were larger than the state’s cap.

The cap doesn’t allow any flexibility based on a particular case, the court ruled.

The case that prompted the decision was Watts vs. Cox Medical Center,  in which a woman gave birth to a son in 2006 with serious brain damage. She sued the medical center and her doctors, alleging medical malpractice, citing warning signs several days before the birth that she and her lawyers maintained should have prompted swifter medical action.

The jury subsequently agreed and awarded the woman $1.45 million in non-economic damages and $3.37 million in future damages, which were later reduced to $1.747 million based on present value. Half of the future damages were to be paid out over 50 years.

The $1.45 million in non-economic damages was reduced by the court, without the jury’s knowledge, to Missouri’s cap of $350,000.

The high court noted that the jury had made the multimillion dollar award to pay for the child’s future care and said that the $350,000 cap would certainly not cover such costs over the boy’s lifetime. The court tossed out the cap, reinstating the entire $1.45 million award.

The court also told the lower court to reconsider its action to reduce the $3.37 million limit by almost half and faulted the use of the “present value’’ formula, noting that part of the award was to be paid out over 50 years. Spreading out the payments, while reducing the award, would also make it less likely that the amount would cover the boy’s lifetime care, the court ruled.

Missouri's $350,000 cap was put in place in 2005, replacing an inflation-adjusted cap that then was slightly under $600,000.

Opposition, supporters swiftly weigh in

The state medical association asserted that the court “ignored more than 25 years of precedent by striking down the state's cap on non-economic damages in medical liability lawsuits.”

"The ruling is an immeasurable disappointment," said association president  Stephen Slocum, a physician. "It turns back the clock to a time when a medical lawsuit crisis had pushed Missouri doctors to the breaking point.  Scores of physicians moved away, and access to health care was threatened in every corner of the state."

The association said that many Missouri physicians had seen premiums for their malpractice insurance skyrocket before the cap was in place, forcing some to drop their practices – especially those involving childbirth -- or leave the state.

Since the cap has been in place, the association said, “the number of lawsuits filed against physicians has fallen almost 58 percent, the state has added nearly 1,000 physicians, and Missouri has seen a $27 million decrease in lawsuit insurance premiums.”

Slocum called on the General Assembly to take action to “repair what the Supreme Court has done."

There have been court fights in a number of the roughly 30 states with caps on non-economic damages in malpractice cases, with mixed results. Some states have upheld the caps, and some have not.

Tim Dollar, president of the Missouri Association of Trial Lawyers, said the Missouri court's decision reflected what his members has been saying for years -- that the cap on non-economic damages was unfair to the victims and families in malpractice cases where health care services may be needed indefinitely.

"The legislature attempted to encroach on our constitutional rights,'' Dollar said, and failed to comprehend "what this (cap) means to children, such as this boy, whose lives are forever altered'' by a mistake in medical care.

Added Dollar: "The right of a fair trial is just as important as the right to free speech and the right to bear arms."

Even so, Missouri's political figures also are weighing in -- particularly the Republicans, who so far appear solidly against the ruling.

Sarah Steelman, a Republican and former state senator running for the U.S. Senate, blasted the court’s decision as an example of judicial overreach.

Steelman said the decision "opens the door to more lawsuits that hurt our small businesses and job creators."

"As a state senator, I supported and sponsored legislation that included caps on non-economic damage awards to cut down on frivolous lawsuits in Missouri," Steelman said. "Businesses and consumers need relief from those who seek to game the legal system for their own personal gain.“

Kirkwood businessman Dave Spence, a Republican running for governor, also issued a statement attacking the ruling. So did Missouri Lt. Gov. Peter Kinder, a fellow Republican, and his GOP rival in next Tuesday's primary, state Sen. Brad Lager, R-Savannah.