In a consequential ruling with far-reaching implications for medical malpractice practitioners, a Florida trial court judge denied a defendant health care provider’s effort to apply statutory caps on non-economic damages in a malpractice case involving a Medicaid recipient, thereby allowing a substantial award to stand against a nursing staffing agency in excess of $41 million.
The decision underscores current tensions between statutory limitations on damages, traditional doctrines of negligence liability, and equal protection principles, issues that are increasingly playing out in Florida malpractice litigation. For attorneys representing victims of medical negligence, this case highlights both substantive and strategic considerations in handling claims involving publicly insured plaintiffs.
Facts of the Case
In July 2021, Chiaka Stewart, a resident of Brandon, Florida, presented to a freestanding emergency department operated by Tampa General Hospital with acute and severe headache symptoms. According to the complaint, the nursing provider failed to order a computed tomography (CT) scan despite Stewart’s clinical risk factors for cerebrovascular pathology, which included diabetes, obesity, and recent initiation of hormonal contraceptives.
Two days following her discharge, Stewart suffered a catastrophic ischemic stroke that left her with significant, permanent disabilities. Her legal team alleged that the advanced practice registered nurse (APRN) deployed through a medical staffing agency breached the standard of care by failing to recognize the need for urgent neuroimaging and further evaluation.
After a two-week civil jury trial, the jury returned a verdict in Stewart’s favor, awarding total damages of approximately $71.8 million based on findings of negligence and resulting harm.
Statutory Cap on Damages: Florida’s Medicaid Limit
Florida statutory law contains specific provisions that limit “non-economic” damages for medical negligence claims brought by Medicaid recipients. Under Section 766.118 of the Florida Statutes, this cap, commonly referred to as the Medicaid cap, restricts awards for pain and suffering to $300,000 in negligence cases involving patients enrolled in Medicaid at the time of injury. Opposing parties frequently seek to invoke this limitation to significantly reduce verdicts in catastrophic injury cases.
In this instance, defendants, including Tampa General Hospital and the staffing agency, filed post-trial motions seeking to apply the cap and reduce the jury’s award by tens of millions of dollars. Their legal argument rested primarily on the statutory language and the well-established legislative intent to contain malpractice payouts involving publicly subsidized patients.
Trial Court Ruling: Cap Does Not Apply
In a pivotal ruling, the trial court rejected the defense’s effort to impose the statutory non-economic damages cap on Stewart’s claim. The judge concluded that the specific circumstances of the case, particularly the involvement of an independent contracted nursing agency and the nature of the liability findings, precluded application of the Medicaid cap.
Although the court’s detailed written order is not yet publicly available, the ruling signals judicial skepticism toward broad application of the cap where a defendant’s conduct or legal status diverges from traditional “physician-patient” paradigms. Attorneys on both sides of malpractice litigation should note that trial courts may scrutinize underlying statutory language rather than reflexively reducing awards under the Medicaid exception.
Equal Protection and Constitutional Challenges
This case also sits within a broader legal backdrop in which judges in both Florida state and federal courts have questioned the constitutionality of the Medicaid damages cap on equal protection grounds. Defense filings in similar cases have cited Section 766.118, while plaintiffs’ counsel have argued that singling out plaintiffs based on public insurance status violates the Equal Protection Clause of the Fourteenth Amendment.
While those constitutional arguments remain contested and have not yet been definitively resolved by the Florida Supreme Court, trial judges in various counties have increasingly expressed reservations about enforceability of the cap where it would effectively nullify a jury’s verdict based on statutory classification. This evolving jurisprudence is critically important for counsel representing patients on public insurance, as it may provide an avenue for resisting post-verdict reductions.
Strategic Takeaways for Attorneys
1. Scrutinize Defendant Status
A key factor in this case was the defendant’s status as a nursing agency rather than a traditional hospital or individual physician. Counsel should carefully evaluate whether statutory language governing caps applies to all defendants named in a malpractice action, especially when liability stems from non-traditional clinical providers, independent contractors, or staffing entities, as opposed to directly licensed practitioners.
2. Preserve Challenges to Damages Caps
Plaintiffs’ attorneys should proactively anticipate and preserve constitutional challenges to statutory limitations in medical negligence cases involving Medicaid or other public insurance programs. Early briefing on equal protection grounds, even before trial, can help structure appellate review and preserve arguments for post-trial proceedings.
Conversely, defense counsel must craft robust arguments grounded in statutory interpretation and legislative intent to support cap applications where appropriate, while also considering jurisdictional variations in how courts have treated public insurance status.
3. Jury Instructions and Liability Allocation
Given the magnitude of this jury’s award, it is critical for both sides to ensure that jury instructions clearly differentiate between economic and non-economic damages. Plaintiffs’ counsel should seek comprehensive instructions that enable jurors to fully account for future care needs, loss of earning capacity, diminished quality of life, and other elements of compensable harm.
Defense counsel must remain vigilant to ensure that juries understand the scope of their deliberative powers, particularly in jurisdictions where statutory caps might later be imposed.
4. Prepare for Extended Litigation
High-stakes medical negligence cases involving public insurance often extend beyond trial verdicts into lengthy post-trial and appellate litigation. Attorneys on both sides should be prepared for protracted legal battles over damages reduction, constitutional issues, and potentially accelerated appeals to higher courts, including the state supreme court.
Broader Implications for Medical Negligence Law
This ruling highlights an ongoing policy debate in medical negligence law: how to balance legislative concerns about limiting payouts in publicly funded health care with traditional tort principles that compensate injured plaintiffs for full losses attributable to negligence. The legal community will be watching subsequent appellate decisions closely, as they may reshape how caps are applied in future Medicaid malpractice suits.
For plaintiffs’ counsel, this case demonstrates that statutory caps are not automatic sentence reducers; indeed, trial courts may exercise discretion when statutory language or the identity of defendants places the cap in question. For defense counsel, the decision serves as a caution that reliance on statutory limitations must be supported by clear legal authority and strategy, particularly where constitutional challenges are advanced.
Conclusion
The Tampa General nursing agency case represents a significant development in the medical negligence landscape, especially regarding statutory damage caps for Medicaid patients. Attorneys representing both plaintiffs and defendants should take note of the legal reasoning,
procedural posture, and strategic lessons from this case as they prepare for similar disputes in their own practices.
As the litigation progresses and additional court rulings are published, this case may well become a bellwether for how Florida and potentially other jurisdictions reconcile statutory constraints with jury verdicts in medical negligence matters involving vulnerable, publicly insured populations.
