Missouri has reformed its medical liability system many times. In 1986, the state capped noneconomic damages at $350,000, with built in adjustments for inflation. By 2005, the noneconomic damages cap had ballooned to $579,000. With malpractice rates continuing to rise, the Missouri General Assembly took action in 2005, passing HB 393, which modified 19 sections of the Revised Statutes of Missouri relating to tort damages, with the greatest impact on medical malpractice tort actions.
HB 393 revised the stateâ€™s cap on noneconomic damages, making it a â€śhard capâ€ť of $350,000 and removing the provision to adjust the cap for inflation. Unfortunately for Missouri physicians, this cap was overturned in 2012, with the Missouri Supreme Court declaring it unconstitutional because it violated the right to have a jury determine compensation. Because of this decision, Missouri no longer has a cap on noneconomic damages.
Other provisions of HB 393 are still in place, including restrictions to joint-and-several liability so that a defendant can only be held jointly liable if he or she is found to be more than 51 percent at fault. A defendant found to be less than 51 percent at fault can only be held responsible for damages in proportion to his or her degree of fault. HB 393 also restricted venue shopping, requiring that the trial be located wherever the plaintiff was residing when the injury first occurred.
In 2017, Missouri enacted collateral source reform. Previously, defendant physicians were barred from introducing evidence that part of a plaintiffâ€™s loss was paid for by a party independent of the defendant (e.g., healthcare insurance or public benefits). Under the new reform, the law provides that where the defendant or the defendantâ€™s insurer has paid a portion of the plaintiffâ€™s medical expenses, these sums are not recoverable from the defendant. The new law also relies on the â€śactual costâ€ť of medical care, rather than â€śvalueâ€ť of medical care.
Also in 2017, Missouri adopted the more strict Daubert Standard for what expert testimony can be introduced at a medical liability trial.