Legislators, lobbyists, and laws – Oh my! Iowa’s 2023 Legislative Session kicked off on January 10, 2023, with Governor Kim Reynolds’ Condition of the State Address. This address marks Iowa’s ceremonial start to its legislative session each year. In her address, Governor Reynolds informed Iowans about her priorities for the coming year.
One of Governor Reynolds’ stated priorities is enacting “common-sense tort reform to stop the out-of-control verdicts” that are driving physicians and medical school graduates out of the state. Governor Reynolds recognized that Iowa is in the minority of states that “don’t protect their health care system by placing reasonable caps on non-economic damages.”
Today in Iowa, subjective damages are softly capped at $250,000 under Iowa Code Section 147.136A. Subjective damages include items such as pain and suffering. It is referred to as a soft cap because it does not apply if a jury “determines that there is a substantial or permanent loss or impairment of a bodily function, substantial disfigurement, or death, which warrants a finding that imposition of such a limitation would deprive the plaintiff of just compensation for the injuries sustained.” This provision has, in recent years, become the exception that swallowed the rule. It has made Iowa’s medical malpractice damages cap largely ineffective because in the most serious cases, where a cap is most likely to be needed, there is no cap at all.
Stronger caps on damages in medical malpractice lawsuits in other states have led to increased numbers of practicing physicians in those states. An influx of practicing physicians would assist Iowa greatly, as Iowa ranks 44th when it comes to the number of active physicians per capita. In her address, Governor Reynolds recalled one hospital administrator’s statement that jury verdicts have “gotten so bad… that he’s often asked about Iowa’s large jury verdicts during recruiting trips.”
Clear and strong capped damages not only bring more physicians, but also have been shown to lower premiums for medical malpractice insurance, that in turn can lower health care costs. Where the goals are increasing the availability and lowering the cost of health care, Iowa’s soft cap will predictably fall short.
That is not to say tort reform in Iowa has had no effect. At the same time it enacted its soft cap, Iowa put in place measures that strengthened expert witness standards, enacted certificate of merit requirements for all medical liability suits, and expanded candor protections for physicians. It is likely that this legislation assisted in eliminating marginal cases from the courts. However, without a hard cap, Iowa has continued to experience a “significant increase in the size of malpractice awards in select cases.” Big jury awards and their financial effects – especially on small, rural hospitals — put Iowa health care at risk.
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