In March 2021, the Supreme Court of Missouri, in Rhoden v. Mo. Delta Med. Ctr., affirmed a jury award of $300,000 in punitive damages against a healthcare provider defendant. The majority held that the facts – which arose before Missouri’s punitive damages statute was amended - met the plaintiff’s burden of proving the defendant “showed a complete indifference to or conscious disregard for the safety of others.” Fortunately, this case should have limited impact, because 2020 changes to Missouri law on punitive damages in § 538.210.8, RSMo., made clear the legislature’s intent that a higher standard applies to healthcare provider defendants. Rather than dwell on the underlying facts of Rhoden, we will instead focus on the debate among the majority, concurring, and dissenting opinions regarding the appropriate standard for the imposition of punitive damages against healthcare providers.
In Rhoden, the Court applied a pre-amendment version of § 538.210 that permitted punitive damages against a healthcare provider only “upon a showing by a plaintiff that the healthcare provider demonstrated willful, wanton or malicious misconduct.” As discussed in our July 30, 2020 blog article, that statutory standard was undefined and has proved problematic in its application. The Rhoden Court followed opinions from lower appellate courts finding that, for purposes of punitive damages, acting “willfully, wantonly or maliciously” is the legal equivalent to acting with “a complete indifference to or conscious disregard for the rights or safety of others.” Thus, the Court held it was not a misstatement of the law or otherwise error for the trial court to have given a jury instruction with the “complete indifference to or conscious disregard for the safety of others” standard as opposed to § 538.210.8’s standard of “willful, wanton or malicious misconduct,” as the two standards were equivalent and not in conflict.
Two separate dissenting opinions criticize the majority’s position. The first focuses on the fact that punitive damages are imposed not to compensate plaintiffs, but for the purpose of punishment and deterrence, and they should rarely be recoverable in medical negligence actions and reserved solely for truly extraordinary cases. One judge observed that the healthcare provider's conduct might have been a negligent error, as the jury determined, but there was no credible claim that the physician’s conduct was tantamount to intentional wrongdoing or that the patient’s death was the natural and probable result of the physician’s treatment decisions.
A second dissenting opinion focuses on the legislative intent to establish a higher standard for healthcare provider defendants. With the 1986 amendments to § 538.210, the General Assembly intended for a higher standard for punitive damages claims against healthcare providers than the lesser standard applicable to defendants generally. In this judge’s opinion, it was unfortunate that the Missouri intermediate appellate courts (and the Supreme Court majority) failed to recognize the General Assembly’s intentional modification of the common law by holding the two standards equivalent. As mentioned above, this confusion led the General Assembly to further clarify its intent by amending § 538.210 in 2020, and state specifically that “evidence of negligence including, but not limited to, indifference to or conscious disregard for the safety of others shall not constitute intentional conduct or malicious misconduct” sufficient for punitive damages.The 2020 amendments to § 538.210 should limit the precedential value of Rhoden. However, the robust discussion in this opinion underscores the former confusion about the proper standard for punitive damages in medical negligence cases and the need for greater clarity. The 2020 amendments should bring that clarity, with a return to the original common law concept of intentional misconduct being a prerequisite for an award of punitive damages. The new law should bring into focus the heretofore blurred line between merely negligent conduct and conduct that justifies an award of punitive damages. This new law appears to offer significant protections for healthcare provider defendants, while also allowing for the possibility of a punitive damages claim, but only in the rare circumstance where the evidence would support it.