Iowa Legislature passes $2M cap on medical malpractice damages. Here's the likely impact:

Iowans who sue over severe cases of medical malpractice will face new limits on how much money they can receive for pain, suffering and emotional distress under a bill approved Wednesday by the Iowa Legislature.

The legislation, House File 161, would limit noneconomic damages to $2 million in medical malpractice lawsuits against hospitals and $1 million in lawsuits against clinics and individual doctors.

The bill would not limit economic damages, such as money awarded for financial losses, or punitive damages in cases of "willful and wanton disregard" for a patient's safety.

Gov. Kim Reynolds made the issue one of her top legislative priorities for the year. She and other supporters described the bill as a lifeline for rural medical providers facing rising insurance rates and difficulty attracting doctors wary of large jury verdicts.

"This bill is absolutely necessary for our state to continue to train future physicians to serve every part of Iowa," said Rep. Ann Meyer, R-Fort Dodge, the bill's House floor manager.

More:Which Iowa lawmakers voted for Kim Reynolds' medical malpractice cap? Our maps lay it out

But Republican legislative leaders had to overcome opposition among their own members who said the caps would hurt Iowans.

"These are people," said Rep. Megan Jones, R-Sioux Rapids, who opposed the bill. "These are our families. These are our friends, our neighbors and our loved ones. These are our babies. And we’re not protecting them."

In an effort to win over reluctant Republicans who thought the limits were too low, an amendment to the bill Wednesday raised the cap on damages for lawsuits against hospitals to $2 million, an increase from an original $1 million cap.

The Iowa House voted 54-46 to pass the measure Wednesday afternoon, with 11 Republicans joining most Democrats in opposing the legislation. One Democrat, Rep. Ken Croken, D-Davenport, voted for the bill.

One Republican, Rep. Stan Gustafson, R-Norwalk, was recorded as a yes vote but meant to vote no, according to the House Journal. The vote officially remains counted as a "yes."

The Iowa Senate voted 29-20 to pass the bill, with five Republicans joining every Democrat in opposition. The bill now goes to Reynolds for her signature.

“I’m grateful to the Legislature for passing reasonable medical malpractice reform, allowing Iowa’s health care industry to become stronger and more accessible," Reynolds said in a statement. "To the OB-GYNs and physicians who have been worried about practicing in Iowa, we are ready for you!"

More:'What is the value of life?' Iowa bills to cap lawsuits pit Republicans against Republicans

Republicans disagree in deeply personal debate

Several Republicans stood to speak against the bill or defend it during the House debate, casting the issue in deeply personal terms.

"What amount would you accept if your spouse was killed, or your child?" said Rep. Mark Cisneros, R-Muscatine, who opposed the bill. "No amount of money can right that wrong, but when justice is owed, can you say $1 million is just? Can you say $2 million is just? I can’t."

Meyer, whose 5-year-old son died because of a medical error, said "his life is invaluable, and I miss him every day." She said the bill's intention is to preserve access to health care in Iowa.

"I don’t think any of us have the right to put a value on life," she said. "We do have an obligation as a legislature to make sure our health care system is intact. This is not about the value of life."

Cisneros urged members of his party to defy Republican leaders and vote against the bill.

"There are several of you in this body who are prepared to vote for this bill despite knowing in your heart it is immoral and unjust," he said. "Why? Because this bill was labeled a priority by leadership. Will you seriously allow yourselves to be bullied into bending your moral compass away from the people of Iowa?"

Rep. Brian Lohse, R-Bondurant, who opposed the bill, said lawmakers should trust juries to do their jobs and decide individual cases based on the evidence.

"It’s not our right to set a limit on a person’s pain and suffering," Lohse said. "And I find it incredibly arrogant of us to even think that we should."

Rep. Norlin Mommsen, R-DeWitt, said if someone can't get health care, their right to a jury trial "doesn't mean anything."

"I’m going to err on the side of giving us all a chance to get to that hospital to try to get that care because if you don’t get there it doesn’t matter what the limit is," he said.

What does the legislation do?

Iowa law already caps noneconomic damages in medical malpractice lawsuits at $250,000 ― with exceptions for cases when patients suffer permanent impairment or death. The new legislation would place a limit on the money awarded in those cases for the first time.

Plaintiffs could seek $2 million in noneconomic damages from hospitals or $1 million from doctors and clinics if they suffered "a substantial or permanent loss or impairment of a bodily function, substantial disfigurement, loss of pregnancy or death."

The limit would increase by 2.1% per year beginning in 2028 to account for inflation.

Opponents said the higher limit for hospitals would incentivize plaintiffs to make sure their lawsuits include hospitals.

"Every single lawsuit that gets filed will include a hospital if at all possible," Lohse said. "Every single one of them. I hope your hospitals back home know that."

An amendment Wednesday would create a task force to review ways to reduce Iowa's medical error rate.

The amendment also allows all punitive damages to be paid directly to plaintiffs. Under current law, 75% of punitive damages go to a state trust fund.

The legislation will take effect immediately once signed by Reynolds, and the limits would apply to any medical errors that occur after the bill's signing.

Democrats said the bill doesn't do anything to improve patient safety.

“Rather than peeking behind the curtain and actually getting our arms around what’s happening with patient safety and how can we really get better results, you’re telling the victims of horrifying and heartbreaking situations that they are actually the problem. Their dead children are the problem. Their dead husbands and wives are the problem," said Sen. Nate Boulton, D-Des Moines.

How many medical malpractice verdicts are decided in Iowa each year?

Iowa juries have reached verdicts in only a few dozen medical malpractice cases in the last five years, with the vast majority of those decisions in favor of the defendant.

From 2018 to 2022, Iowa has seen 56 verdicts in medical and dental malpractice lawsuits. Of those, 48 verdicts have been in favor of the defendants, seven have been in favor of the plaintiffs and one resulted in a split verdict, according to data from the Iowa Judicial Branch.

That means medical providers being sued for malpractice have had roughly an 86% success rate at trial in recent years, Judicial Branch data shows.

Six Iowa cases in the last five years have resulted in verdicts for plaintiffs with damages greater than $1 million, including two cases in 2022, three in 2019 and one in 2018.

A few of those verdicts have gotten disproportionate media attention and dominated debate about the legislation.

A Johnson County jury awarded $97.4 million last March to the parents of a young boy who was severely brain-damaged during birth. The medical clinic on the hook for most of that award later filed for bankruptcy, although it remains in business.

Over the same period, there have been 749 medical malpractice lawsuits filed in Iowa — an average of 150 per year. The vast majority of those suits do not reach trial.

The most recent report from the Iowa Insurance Division shows there were more than 500 claims handled by medical malpractice insurance companies in 2021 for allegations of misdiagnoses and treatment, delays in diagnoses and inappropriate surgical treatment, among a variety of other malpractice claims.

The 192 claims “closed” by insurers in 2021 totaled nearly $35 million. Of those, about a dozen claims had a total loss of at least $1 million, with the largest paid loss exceeding $4.5 million, the report states.

How do Iowa's medical malpractice insurance rates compare with other states'?

The Medical Liability Monitor, a specialty publication that focuses on medical malpractice insurance rates, lists Iowa as the fifth-lowest state in the country for medical malpractice insurance rates across all medical specialties.

The organization also reports Iowa is the fifth-lowest state when looking specifically at insurance rates for OB-GYNs and internal medicine doctors, and sixth-lowest for general surgery malpractice insurance rates.

"Iowa’s insurance climate is actually very stable," Lohse said. "We have some of the lowest rates in the country. We have rates that have remained steady. We have more insurers now in Iowa than we have in the past several years. Insurers are entering the market. If this was such a bad environment, they wouldn’t be."

Rep. Shannon Lundgren, R-Peosta, said health care providers in her area are telling her it's hard to recruit physicians because of Iowa's medical malpractice insurance climate.

"If you haven’t done your due diligence, shame on you," she said. "But for those of us that have and been having this conversation for several years now, I will tell you that it is a real boots-on-the-ground problem."

Des Moines Register reporter Katie Akin contributed to this article.

Stephen Gruber-Miller covers the Iowa Statehouse and politics for the Register. He can be reached by email at sgrubermil@registermedia.com or by phone at 515-284-8169. Follow him on Twitter at @sgrubermiller.

This article originally appeared on Des Moines Register: Iowa lawmakers pass controversial $2M medical malpractice cap