Arkansas enjoyed moderate premiums until the early 2000s, when rates began to climb upwards due to increased claims frequency and unpredictable jury verdicts. In 2001, Arkansas saw the largest tort verdict in the stateâ€™s history when a jury awarded $78 million to the Estate of Margaretha Sauer, a resident of the Rich Mountain Nursing & Rehabilitation Center who died from dehydration after receiving no food or water for a 24-to-48 hour period. The verdict included $63 million in punitive damages. The following year, the nationâ€™s healthcare community suffered a shock when the St. Paul Companies exited the medical malpractice insurance market. At the time, St. Paul was the largest insurer of medical liability in the United States, and the company held a 55-percent market share in Arkansas. Many smaller insurers followed suit, and with fewer carriers competing, malpractice insurance premiums began to climb at a rate not seen in more than 25 years.
In response to the looming crisis, the Arkansas Medical Society took it upon itself to draft legislation to deflate premiums, boost the number of doctors practicing in the state and improve patient access to medical care. The resulting Civil Justice Reform Actâ€”or HB 1038â€”was embraced in bipartisan fashion, being sponsored by two Democrats in the legislature and signed into law by a Republican governor. The act put limits on venue shopping and raised the standard for the imposition of punitive damages to â€śclear and convincing evidenceâ€ť of actual fraud, malice or willful and wanton conduct, among other reforms. The Act also capped punitive damages to $250,000 or three times compensatory damages, whichever was greaterâ€”not to exceed $1 million. The punitive damage cap was declared unconstitutional by the Arkansas Supreme Court in 2011. In April 2016, the Arkansas attorney general certified a ballot title for a proposed constitutional amendment that would limit damages in medical malpractice lawsuits. However, the Arkansas Supreme Court ruled on October 13, 2016 that the measure should be left off the ballot, as important terms such as “non-economic damages” were left undefined and would not be readily understood by voters. The measure did ultimately appear on the November 8th ballot, but the Arkansas Secretary of State was instructed to neither count nor certify the results.