Thought Leadership

On January 30, 2025, the Ohio 8th District Court of Appeals held that Ohio’s medical malpractice non-economic damages cap is unconstitutional as applied to the plaintiff-appellee who permanently lost his eye as the result of an infection he contracted after cataract surgery. The statute, R.C. 2323.43(A)(3), states that the amount recoverable for non-economic loss in a medical claim shall not exceed $500,000 if the loss includes a permanent and substantial physical deformity or loss of bodily organ system or a permanent physical functional injury.

Paganini v. Cataract Eye Center of Cleveland, 2025-Ohio-275 (8th Dist.), involves a 90-year-old man who received routine cataract surgery from the defendants-appellants. The morning after his surgery, Mr. Paganini was experiencing some pain, blurry vision and floaters. He was seen by one of the defendants, Dr. Louis, who misdiagnosed him with a vitreous hemorrhage. Ultimately, Mr. Paganini was diagnosed with an infection that caused him to permanently lose his eye. 

He filed a lawsuit, claiming Dr. Louis failed to diagnose the infection and should have referred him to a retina specialist sooner. The trial court (Cuyahoga County Common Pleas, CV-22-971901) found in favor of Mr. Paganini and awarded him $1,487,500.00. After the verdict, Mr. Paganini requested the court not apply the R.C. 2323.43 damages cap on the grounds that the statute was unconstitutional as applied him.¹ The trial court agreed, and the defendants appealed that decision. 

The trial court found that 2323.43(A) was unconstitutional as applied because it violates Ohio’s due process clause. Applying the rational-basis test, the 8th District Court considered whether the statute “bears a real and substantial relation to the public health, safety, morals, or general welfare of the public” and whether it is unreasonable or arbitrary. They cited Morris v. Savoy, 61 Ohio St.3d 684 (1991), where the Ohio Supreme Court held that a $200,000 cap on general damages in medical malpractice cases was unconstitutional because it did not bear a real and substantial relation to the general health and welfare of the public and because it was unreasonable and arbitrary. 

The 8th District Court also cited the General Assembly that enacted 2323.43, stating the statute was designed to “stabiliz[e] the cost of health care delivery by limiting the amount of compensatory damages representing noneconomic loss awards in medical malpractice actions.”² Yet, the court was not convinced that the damages cap in 2323.43(A) has a significant impact on lowering the cost of health care in Ohio. The court stated: “The legislature has failed to demonstrate how capping noneconomic damages for a very small group of highly injured people, which includes Paganini, will have any impact on malpractice insurance rates beyond those provided by the cap on less severe injuries.” Therefore, the court held that for Mr. Paganini, 2323.43 does not bear a real and substantial relationship to malpractice insurance rates. 

In determining whether the statute is arbitrary and unreasonable, the 8th District applied the following analogy from Arbino v. Johnson & Johnson, 116 Ohio St.3d 468 (2007):

"If a man’s leg were cut off by a doctor in surgery and he sought non-economic for the catastrophic injury, the damages would be limited to $500,000 under R.C. 2323.43(A)(3). Yet, if the same man were to be run over and lose his leg by the same doctor on the way home from the hospital after a successful surgery, that man could recover all non-economic damages for his catastrophic injury because R.C. 2315.18 has no additional limit. This is not reasonable or logical. The exact same injury inflicted by the same person should yield the exact same damages, but under the current statutory scheme it does not."

The 8th District reasoned that R.C. 2323.43(A)(C) burdens those who are severely injured by medical malpractice by attempting to “provide some unrealized benefit to the general public.” Thus, the court held that the statute is arbitrary and unreasonable as applied to Mr. Paganini.

This ruling is currently controlling precedent for those defending actions in Cuyahoga County. It is anticipated that the defendants-appellants will appeal to the Ohio Supreme Court.

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[1] A party may challenge the constitutionality of a statute in two ways: facially or as applied. A facial challenge applies to every conceivable circumstance in which the statute would be valid. An as-applied challenge only applies to the specific set of circumstances in the current matter. An as-applied challenge does not render the statute unconstitutional as a whole. In Paganini, plaintiff-appellee asserts that the statute is unconstitutional as applied.

[2] The General Assembly also found: “The overall cost of health care to the consumer has been driven up by the fact that malpractice litigation causes health care providers to over prescribe, over treat, and over test their patients.” The 8th District reasoned that the “reduced risk of large noneconomic damage awards is aimed at keeping medical malpractice insurers in Ohio and thus also keeping good doctors in Ohio. Obviously, the goal of lowering medical malpractice insurance rates is related to the general welfare of the public.” 

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