Noneconomic damage caps in medical malpractice cases are a topic of ongoing debate, especially in Ohio where such limits have significantly impacted injured patients by preventing patients from recovering the full amount of damages awarded by a jury. Noneconomic damages are intended to compensate victims for their pain and suffering. The caps in medical malpractice cases can restrict compensation to amounts far below a jury award. While intended to stabilize medical malpractice insurance markets and reduce healthcare costs, noneconomic damage caps often fail to achieve these goals and instead disproportionately harm the most vulnerable victims of medical negligence.
The Real-World Consequences of Noneconomic Damage Caps
Imagine undergoing routine surgery only to wake up paralyzed from the waist down due to a medical error. Despite your life-altering injury, daily pain, and inability to participate in normal activities, your noneconomic damages in Ohio are capped at $500,000 regardless of the damages the jury finds you have suffered. In fact, it’s unlikely that the jury would ever even find out that the amount they awarded you was reduced after the trial.
If the same surgeon from this scenario instead caused you to suffer the exact same injury by negligently hitting you with their car, there would be no cap on the amount of money that the jury could award to you for noneconomic damages.
This inconsistency reveals a fundamental flaw in Ohio’s tort reform cases and laws: the arbitrary distinction between victims of medical malpractice and other tort victims. This distinction exists because medical claims are governed by an entirely different statute (R.C. § 2323.43) than the statute that governs the damages caps for all other tort claims (R.C. § 2315.18). For patients with catastrophic injuries—those experiencing permanent disability, disfigurement, or loss of bodily functions—the caps applicable only to medical claims impose an unjust limit on recovery, leaving many patients without adequate compensation for their suffering.
A Legacy of Unconstitutional Legislation
Ohio’s journey with noneconomic damage caps has been contentious since the beginning. Initial attempts to impose caps in the 1980s and 1990s were struck down by the Ohio Supreme Court for violating constitutional protections, including the due process clause of the Ohio Constitution. The Court’s reasoning was clear: imposing the financial burden of public healthcare benefits on the most severely injured patients is arbitrary and unreasonable.
Despite these rulings, the Ohio General Assembly enacted new caps in the early 2000s, specifically targeting medical malpractice cases. Unlike caps for general tort claims, which exempt catastrophic injuries, Ohio’s medical malpractice caps apply universally, even to those with permanent and debilitating injuries. This approach has been criticized as both inequitable and unconstitutional, as it disproportionately affects marginalized groups such as children, the elderly, minorities, and the disabled — individuals who are more likely to have limited economic damages but who still suffer significant noneconomic losses.
Caps Undermine Justice and Healthcare Reform
Noneconomic damage caps undermine the legal and healthcare systems by limiting access to justice for victims and reducing accountability for medical providers. These caps not only restrict fair compensation but also perpetuate systemic inequities, discouraging meaningful reforms that could improve patient safety and care outcomes.
Barriers to Justice: Medical malpractice claims are notoriously expensive to litigate, often exceeding $100,000 in costs before attorney fees. For victims with limited economic damages, the capped recovery may not justify these costs, effectively barring access to the courts. This also creates a chilling effect where providers may feel less pressure to adhere to the highest standards of care.
Disparate Impact: Noneconomic caps disproportionately affect groups already marginalized in society. For example, a retired individual or a stay-at-home parent’s economic damages might be minimal, but their noneconomic losses—such as pain and suffering—are often profound.
Missed Opportunities for Reform: Instead of incentivizing patient safety and reducing preventable medical errors, noneconomic caps shield negligent providers from full accountability. This lack of accountability can perpetuate systemic issues in healthcare quality and transparency.
Erosion of Public Trust: By prioritizing cost-containment for insurers over justice for victims, noneconomic caps can erode public confidence in the fairness of the legal and healthcare systems. Patients and families may feel that their suffering is undervalued and their voices unheard.
The Case Law Behind the Debate
The legal history surrounding noneconomic damage caps in Ohio highlights a recurring struggle between legislative intent and constitutional protections. The Ohio Supreme Court has repeatedly scrutinized such caps, finding many iterations unconstitutional due to their arbitrary and disproportionate effects on the most vulnerable plaintiffs.
In Morris v. Savoy (1991), the Court addressed a $200,000 cap on noneconomic damages in medical malpractice cases. The justices struck down the cap, ruling it unconstitutional under the due process clause of the Ohio Constitution. The court emphasized that it is irrational and arbitrary to impose the cost of public healthcare benefits solely on the most severely injured victims. The ruling underscored that such caps fail to balance public welfare with individual rights, as they disproportionately burden those who suffer catastrophic injuries.
A few years later, in State ex rel. Ohio Academy of Trial Lawyers v. Sheward (1999), the Court reviewed a revised set of tort reforms introduced by the legislature in 1996. These reforms reintroduced noneconomic damage caps, including a tiered system that allowed for higher caps in cases of severe injury. However, the Court struck down the reforms in their entirety, citing violations of the separation of powers doctrine and again highlighting the arbitrary nature of imposing financial limitations on the most injured plaintiffs.
In Arbino v. Johnson & Johnson (2007), the Ohio Supreme Court upheld a general noneconomic damage cap applicable to most tort claims. The key difference between the general noneconomic damages cap and the medical malpractice noneconomic damages cap is a provision exempting catastrophic injuries from the general noneconomic damages cap, which allowed the court to find the law constitutionally permissible. The Court’s decision reinforced the idea that while caps may be valid in some contexts, they cannot arbitrarily limit recovery for those suffering the most significant harm. Importantly, while the Court did not address the noneconomic damages cap applicable to medical malpractice claims, the court’s reasoning and holding in Arbino suggested that caps without exceptions for catastrophic injuries, like those in medical malpractice cases, could fail constitutional scrutiny.
At least eight trial courts in Ohio have also weighed in on the constitutionality of medical malpractice caps and found that the caps violate the due process clause of the Ohio Constitution. For example, in Wells v. Call, D.O. (2010), the Summit County Court of Common Pleas, relying on the reasoning of Morris and Sheward, held that the cap on noneconomic damages for the severely injured was unreasonable and arbitrary and thus violated due process. Similarly, in Metts v. Nationwide Children’s Hospital (2014), the Franklin County Court of Common Pleas found the state’s medical malpractice caps unconstitutional, citing due process and equal protection violations. In Haggins v. Biyani (2019), a different Franklin County judge determined that the caps created arbitrary distinctions between medical malpractice victims and other tort victims, further highlighting their inequitable application.
To date, just one Ohio appellate court has addressed the constitutionality of noneconomic caps in medical malpractice cases. In Paganini v. Cataract Eye Center of Cleveland (2025), the Eighth District Court of Appeals found that, pursuant to the due process clause, the caps were unconstitutional as applied to a plaintiff who lost his eye. The Eighth District explained that, in enacting R.C. § 2323.43, the General Assembly sought to lower the cost of health care by lowering medical malpractice insurance rates. The court, however, found no evidence that capping noneconomic damages available to severely injured plaintiffs had any effect on medical malpractice insurance rates or health care costs, citing statistics from the Ohio Department of Insurance. Additionally, following the reasoning of the Metts court, the Eighth District found the flat cap of $500,000 to be arbitrary and unreasonable, burdening “those most severely injured by medical malpractice in order to provide some unrealized benefit to the general public….” 2025-Ohio-275 at ¶ 66.
While no other appellate court has had opportunity to evaluate the constitutionality of noneconomic damage caps for medical malpractice claims, the growing body of case law underscores the persistent constitutional challenges faced by this statute and demonstrates a clear pattern: caps that impose arbitrary limits on recovery for the most vulnerable plaintiffs often fail constitutional scrutiny. Yet Ohio’s caps on noneconomic damages in medical malpractice cases continue to defy this precedent, disproportionately affecting those with catastrophic injuries.
The Call for Change
For more than two decades, noneconomic damage caps have been in place with almost no evidence of any substantial impact on professional liability insurance premiums or retaining healthcare providers in Ohio. The little evidence that is available is largely anecdotal and findings are inconsistent. For example, the Ohio Medical Malpractice Commission was created by the General Assembly in part to analyze the effect of the caps, but the Commission disbanded in 2005 concluding in its final report that there was not sufficient evidence to “conclusively evaluate the effects of the new law on the Ohio market, or on medical malpractice cases in Ohio.” While meaningful impacts on healthcare costs or access to care have not been achieved, the caps have created significant barriers to justice, failed to improve healthcare outcomes, and harmed patients who are most injured by the broken system. Reform is needed to address these shortcomings.
Ohio’s noneconomic damage caps in medical malpractice cases are not only inequitable but also counterproductive to meaningful healthcare reform. By prioritizing systemic accountability and patient safety over arbitrary limits on recovery, Ohio can ensure fair treatment for all victims of medical negligence and foster a healthcare system that truly serves patients.
Plakas Mannos is dedicated to advocating for the rights of patients who have been harmed by medical negligence. Our malpractice tort firm believes that every victim deserves full and fair compensation for their suffering, and we are committed to challenging unjust laws that limit recovery. Through our work, we aim to uphold justice, improve patient safety, and ensure accountability within the healthcare system. The experienced medical malpractice team at Plakas Mannos is here to help guide you through the process, advocate for your rights, and stand by your side every step of the way. If you or a loved one has been injured by medical negligence, contact Plakas Mannos today for a consultation.
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Garrett Lloyd is Plakas Mannos' RN law clerk.
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