The Superior Court of the Virgin Islands Division of St. Thomas and St John, in its Memorandum Opinion dated October 19, 2020, held in a Virgin Islands medical malpractice case: “The MMA’s [the Virgin Islands Medical Malpractice Act] $250,000 cap on total damages represents a legislative decision to limit awards in order to lower the government-paid malpractice insurance premiums and judgments. From the record, it appears the Legislature acted with proper motives and the best interest of Virgin Islands citizens in mind. The limitation on damages is a rational means of minimizing government costs and ensuring the availability of healthcare, supported by evidence that it is working. On these rounds, the Court finds that section 166b does not infringe on [the plaintiff’s] equal protection, due process, or trial by jury rights guaranteed by the ROA [the Virgin Islands Revised Organic Act], and the United States Constitution.”

The Underlying Facts

On July 8, 2015, the plaintiff was involved in a motor vehicle accident and sustained severe injuries. She was transported by ambulance to the Roy Lester Schneider Regional Medical Center (“SRMC”) in St. Thomas, Virgin Islands. At the hospital emergency room, the defendant physician’s assistant (“PA”) and defendant doctor treated the plaintiff. The plaintiff alleged that she complained about pain in her left leg and hip but the defendant PA only examined her left knee laceration and the associated swelling. The PA ordered an x-ray of the plaintiff’s left knee to determine if it was fractured. The x-ray results did not show bone damage, so the PA sutured the plaintiff’s knee, provided her with crutches, and discharged her on the same day. The defendant doctor signed off on the records but never actually saw or treated the plaintiff during the visit.

The plaintiff alleged that she remained in excruciating pain and was bedridden after being discharged. Due to the pain, she was not able to walk and had to use a bedpan as her pelvis was not stabilized and was severely broken and dislocated. On July 13, 2015, the plaintiff returned to the hospital where she again complained of lower extremity pain in her left leg. This time, the defendants ordered an x-ray of her left femur and pelvis which revealed a pelvic fracture and a dislocated femoral head. The defendant doctor personally treated the plaintiff and recommended she travel to the mainland for surgery. The plaintiff underwent hip surgery at Jackson Memorial Hospital and received rehabilitative care in Miami, Florida. A medical expert opined that the plaintiff will suffer from chronic pain in her left hip and leg for the rest of her life and will need additional surgeries in the years to come.

The plaintiff alleged that the ongoing chronic pain and the need for future medical care resulted from the defendants’ failure to initially diagnose her fractured pelvis. She claims this delayed diagnosis led to a significantly worse outcome that could have been mitigated by proper care during her first visit to SRMC after the accident. The plaintiff filed her Virgin Islands medical malpractice case on June 19, 2017, alleging three counts of negligence against the defendant doctor, the defendant PA, and SRMC for failing to properly diagnose, treat, and perform the minimally acceptable care while treating her, seeking compensatory damages in the amount of $2 million.

Virgin Islands Health Care Provider Malpractice Act

The Virgin Islands Health Care Provider Malpractice Act (“MMA” or “the Act”), codified at 27 V.I.C. § 166 et seq., was enacted on November 18, 1975. It sets up a comprehensive scheme for the regulation of health care providers and the compensation of malpractice victims. The MMA expands the Virgin Islands Government’s waiver of sovereign immunity beyond the limits prescribed by the Virgin Islands Tort Claims Act. Id. at 999; 33 V.I.C. § 3411. Section 166b limits the amount of damages recoverable in a medical malpractice action. Section 166b caps medical malpractice plaintiffs’ total recovery, of economic and non-economic damages, at $250,000, further capping non-economic damages at $75,000. It also requires the plaintiff to join the Government of the Virgin Islands as a party-­defendant.

In upholding the Virgin Islands cap on medical malpractice damages, the Court stated “medical malpractice insurance is provided and largely paid for by the Virgin Islands government. The MMA mandates providers have coverage up to the exact amount of the cap. By ensuring that liability is coextensive with coverage, the MMA ensures victims will be compensated; and by limiting liability to $250,000, the MMA stabilizes premiums in a relatively small and volatile insurance market … When examining the MMA, the legislative purpose behind the damages cap becomes clear-it reduces the cost of the insurance premiums paid by the government. Further, it helps to stabilize what would otherwise be a geographically isolated and volatile coverage area … The cap seeks to ensure the fund is not depleted by a few large claims, thereby providing compensation to a greater number of victims. Reducing government costs while attempting to foster greater availability of healthcare services to the territory is, of course, a permissible legislative objective … In addition to reducing government costs and drawing healthcare providers to the Virgin Islands, the MMA seeks to ensure greater healthcare access for residents … While it is not known exactly how the $250,000 limit was arrived at, the Court is satisfied that the Legislature deliberated and considered the amount of the cap … [t]he Legislature’s refusal to increase the cap when revisiting section 166b, demonstrates the intent, or at least acquiescence, that the cap remain flat at $250,000 in 1993, and into perpetuity or until new legislation is introduced. Defendants stated that the cost of malpractice premiums in the Virgin Islands has not increased since 1993.”

The Court further stated: “[the plaintiff’s] procedural due process argument fails at the initial step. She alleges the cap on damages constitutes a taking of her property but fails to establish a constitutionally protected property interest in the hypothetical $2 million dollar award. She cites no caselaw in support of finding a constitutionally protected property interest in a potential jury verdict … [t]here is no identifiable property interest in a potential damages award, so the $250,000 medical malpractice damages cap does not infringe on [the plaintiff’s] procedural due process rights guaranteed by the ROA … Having already concluded section 166b survives heightened rational basis review, the Court holds that the $250,000 medical malpractice damages cap does not violate the due process provision of the Virgin Islands Bill of Rights.”

The Court further held: “By enforcing the $250,000 damages cap, a judge is merely applying the law to the facts already determined by the jury in accordance with statutory limitations prescribed by the Virgin Islands Legislature.”

Gumbs v. Schneider Regional Medical Center, 2020 VI Super 87.

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