In a decision reach last week, The California Supreme Court will not hear an appeal that tried to overturn the state’s cap on noneconomic damages in medical malpractice lawsuits ($250,000 for pain and suffering).

A recent 5th District Court of Appeal decision upheld the constitutionality of the cap. In the case in question, the jury awarded the plaintiff $2.5 million in noneconomic damages after a botched perianal cyst operation.

The state’s damage cap, which was signed into law in 1975, cut the jury award by 90%. The plaintiff appealed the reduction, arguing that it violated his constitutional rights.

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California was the first state to enact a damage cap on medical malpractice lawsuits. Today, at least 30 states have followed suit.

Critics argue that the state’s cap violates injury victims’ rights. After all, the argument goes, the cap amount has not changed since 1975. Supporters of the law claim it keeps clinicians from being driven out of business by high insurance premiums.

The California Supreme Court’s decision will likely lead to a showdown in the state legislature.

There are currently ongoing battles to raise or repeal medical malpractice caps in several states, including Nevada, Colorado, and Tennessee.