You’re reading State Court Report Every other week newsletter. Subscribe to receive in your inbox.
Medical malpractice and other personal injury cases may not be the first thing that comes to mind when it comes to state constitutional rights. But state efforts in tort reform, including damages and changing periods of restrictions, have spurred constitutional challenges for hundreds of states over decades, with many state laws being ultimately broken or restricted. These cases also oppose the background to the fascinating, high-stakes political narrative. How the fight over tort reform has changed the structure of judicial elections and the state courts across the country.
The Ohio and North Carolina courts of appeal have recently reached a variety of conclusions on the challenges of legal caps regarding non-economic damages (such as pain and distress) in the case of medical malpractice. The case gives a good sense of how the courts are addressing the question of tort reform and suggests some political narratives.
in Lyon v. Riverside Methodist Hospitalthe Ohio Court of Appeals ruled that Ohio’s damages CAP, if applied to plaintiffs, violated the legitimate process and equal protection provisions of the state constitution. The problem was $2.2 million non-economic damages awarded to Lyon by the ju apprentice after the health care provider failed to diagnose her thiamine deficiency, resulting in brain condition and severe neurological damage. Under the associated damages cap, Lyon only received $965,527.
The court explained that the law was apparently constitutional because Congress determined that CAP would help raise healthcare costs and that it was reasonable to apply it. However, given the scale of Lyon’s award and the “extreme and lasting harm” caused by her injuries, the court ruled that applying the cap in her case violated her rights.
First, CAP reduced Lyon’s damages by more than 57%. It effectively placed the cost of public interest (reducing insurance costs) on Lyon’s shoulder. Such a significant reduction was unreasonable and arbitrary, the court concluded, violating Lyon’s rights to the rights of the process. The law also treated Lyon in a different way than other victims of tort. Because it was only applied in cases of medical malpractice. If Lyon’s damages were attributed to a car accident, she would have been awarded a full award. Thus treating Lyon “in a different way based on the nature of her sacrifice” the court denied her equal protection of the law.
In the second case, Mohebaliin. Hayesthe North Carolina Court of Appeals refused to challenge similar laws under different legal theories. Mohebari caused a negligence case against the obstetrician. The obstetrician allowed the pregnancy to advance well beyond the normal 40-week gestation period, resulting in the death of the fetus. The ju apprentice awarded $7.5 million in her non-economic damages, which was cut to $656,730 at the state cap. Mohebari alleged that the law violated her rights to a trial trial.
It was a matter of first impressions for North Carolina, but not for state courts elsewhere. The court has identified five state Supreme Courts whose deadlines for non-economic damages violated the rights of the plaintiffs’ trial trials (Alabama, Georgia, Kansas, Missouri and Washington) and violated nine people who rejected such claims (Alaska, Idaho, Massachusetts, Massachusetts, Maryland, Michigan, Michigan, Wesia, Virginia, Virginia, Virginia, Virginia, Virginia, Virginia, Virginia, Virginia, Virginia, Utasia and Virginia). Turning to the state constitution, North Carolina courts rejected the motion, highlighting case law that found legislature generally had the power to determine when relief measures are legally recognized.
These two cases illustrate some of the legal theories that have been used to challenge the Tort Reform Act, as well as the economic and emotional interests of these cases. However, legal stories are also intertwined with political stories. A series of state Supreme Court decisions that robbed the Tort Reform Act in the 1990s led to a transformation of the National Supreme Court elections from sleepy, low-cost races into highly politicized contests of major special interest.
There were several well-known Supreme Court election battles in the 1990s, but in 2000 a modern electoral environment was formed. After the Illinois Supreme Court repealed the Tort Reform Act, in 1997, the Ohio Supreme Court announced in 1999 that the US Chamber of Commerce was involved in elections in seven states. The army race continued. Between 2000 and 2009, both business profits and plaintiff trial lawyers dramatically increased spending, which doubled the average candidate funding compared to the previous decade. In some states, a more business-friendly Supreme Court majority took root.
Certainly, this story can be seen unfolding in the Ohio Supreme Court case cited Lyon. Throughout the 1990s, courts repeatedly deleted laws restricting damages. However, in 2007, the court highlighted the previous case, supporting a new cap on non-economic damages for facial challenges, as there were sculptures for those suffering catastrophically injured. What has changed? Court membership, including the $4.4 million spent by the Chamber of Commerce in the 2000s after a multi-million-dollar election in the 2000 Ohio Supreme Court election.
It was the first iteration of the highly politicized judicial election battles we see all over the country today. And even today, business groups and trial lawyers continue to be key forces as issues such as abortion rights and constituency changes are becoming more prominent in judicial elections. It is a reminder of the political battles that often fall under the surface of legal rulings.
Alicia Bannon is Editor-in-Chief State Court Report. She is also the director of the Brennan Judicial Center’s Judicial Program.
Suggested Quote: Alicia Bannon, How the War of Tort has become a Court Warsᴛᴀᴛᴇcᴏᴜʀᴛrᴇᴘᴏʀᴛ (September 12, 2025), https://statecourtreport.org/our-work/analysis-opinion/state-courts-divated-medical-malpractice-damages-caps
