The Ohio Supreme Court is poised to consider if a 2003 law designed to reduce the cost of medical malpractice insurance can bar a 94-year-old Marine veteran from taking home the entirety of his $1.5 million jury award.
After John Paganini, of Mentor, lost an eye due to an ophthalmologist’s error following routine cataract surgery, a Cuyahoga County jury found him entitled to $1.5 million in damages. A three-panel Eighth District Court of Appeals affirmed Paganini’s judgment in January, refusing to apply an Ohio statute, R.C. 2323.42(A)(3), that would have capped his verdict at $500,000 — a 66.4% reduction to the original award.
Striking down the state’s $500,000 cap on noneconomic damages for severely injured medical patients as it applied to Paganini and other elderly plaintiffs, the Eighth District allowed Paganini’s $1.5 million verdict to stand.
But after the medical providers were found liable for Paganini’s lost eye, the Cataract Eye Center of Cleveland and Dr. Louis appealed the Eighth District’s decision. In March, the medical providers filed a motion to the Ohio Supreme Court, arguing that the Eighth District acted more like a “Northwest D.C. think tank” than an “Ohio court” when they disregarded the legislature’s damages cap.
“[B]ecause the Eighth District’s decision scuttles two decades of medical malpractice and endangers affordable healthcare, this Court must intervene,” appellants’ counsel wrote.
Setting the stage for a widely anticipated challenge to a decades-old statute, in late May, the Ohio Supreme Court agreed to review the case in a 6-1 vote, with Justice Jennifer Brunner in the dissent. The Court will soon review the Eighth District’s decision — as applied specifically to Paganini — to overturn the state’s $500,000 cap on the amount of noneconomic damages (i.e., damages for pain and suffering) that catastrophically injured patients can recover in medical malpractice actions.
Although the Ohio Supreme Court has previously granted as-applied challenges to the state’s damages caps in other contexts — for instance, tort claims on behalf of child sexual abuse survivors — Paganini’s case is the first to reach the state’s highest court on the issue of a medical malpractice damages cap.
Paganini’s lawyers urged the Court to keep his $1.5 million verdict in place. Ohio’s damages cap, they argued, is an “arbitrary and irrational” law that plays a “de minimis” role in reducing healthcare costs, strips the jury of its factfinding responsibilities, and violates Paganini’s due process rights under the Ohio Constitution.
“In the General Assembly’s estimation, the pain and suffering that [Paganini] has experienced and will continue to endure from losing a critical bodily organ is worth not a penny more [than $500,000],” Paganini’s counsel wrote in an April motion to the Court. “Can this stand?”
Why did Ohio lawmakers implement the $500,000 damages cap?
The Ohio General Assembly, backed by a coalition of physicians, hospitals, and insurance groups, believed R.C. § 2323.43 was a necessary response to what they perceived as a healthcare “crisis” across the state, according to an Ohio Medical Malpractice Commission report published in 2003.
Rising medical malpractice insurance rates, an “exodus” of insurance providers, and increasingly large jury verdicts against doctors in the late ‘90s and early 2000s caused healthcare costs to surge, state lawmakers concluded.
“Litigation fear led to expensive, unnecessary defensive mechanisms. Practitioners were overprescribing and overtreating — which was driving up costs for all Ohioans,” counsel for the Cataract Eye Center and Dr. Louis wrote in a March motion to the Court.
So, in 2003, state lawmakers passed and Gov. Bob Taft signed into law Senate Bill 281, codified under R.C. 2323.43(A)(3), to establish two tiers of recovery for medical malpractice plaintiffs: a $500,000 cap on noneconomic damages for catastrophic injuries and a $250,000 cap on noneconomic damages for non-catastrophic injuries.
Lawmakers did not implement a cap on economic damages, which cover more tangible items like medical bills and lost wages. Instead, they were more concerned with noneconomic damages — items like conscious pain and suffering — which are typically more subjective and harder for a jury to quantify.
Capping noneconomic damages at $500,000 and $250,000, depending on the severity of injury, could help prevent unpredictable jury awards and the rising healthcare costs associated with them, lawmakers concluded.
“For two decades, the cap brought stability to Ohio healthcare. The statute permitted claimants, medical providers, and their insurers to more predictably assess their risks (and resolve claims),” appellants wrote to the Court. “Furthermore . . . the once pervasive talk of an Ohio healthcare crisis has diminished.”
Lower courts invalidate $500,000 cap as applied to Paganini
But at trial in January 2024, Paganini’s counsel persuaded Cuyahoga County Common Pleas Judge Timothy McCormick to disregard the application of the $500,000 damages cap.
Paganini argued that, as a severely injured senior citizen whose jury verdict was at risk of being legislatively reduced by 66.4%, the statute posed a particularly adverse effect upon him and similarly situated patients since, as a retired 94-year-old, “damages are disproportionately noneconomic due to lower claims for lost income.”
Judge McCormick agreed, finding that the General Assembly failed to demonstrate a meaningful connection, if any, between the capping of catastrophically injured patients’ damages and the reduction of healthcare costs.
While Judge McCormick found that Ohio’s damages cap had a substantial relationship, as a general matter, to the legislature’s goal of reducing medical malpractice rates, he found no such relationship in the context of catastrophic injuries.
On appeal in March 2025, the Eighth District affirmed the trial court’s decision. Although the Eighth District acknowledged state lawmakers’ efforts to reduce healthcare costs and increase the predictability of civil jury verdicts, the Eighth District unanimously held that R.C. 2323.43(A)(3) violated the due process rights of Paganini and the small sliver of similarly situated, catastrophically injured patients.
“The legislature has failed to demonstrate,” Judge Boyle wrote on behalf of the Eighth District, “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.”
The Eighth District appeared to be persuaded by Paganini’s counsel, who, in citing the results of a 2019 Ohio Department of Insurance study mandated by the General Assembly, emphasized that only 30 medical malpractice claims filed in Ohio from 2005 to 2019 resulted in a jury verdict that exceeded the statutory cap.
The study also found that less than 1% of medical malpractice actions during the same period resulted in a trial judgment for plaintiff — a statistic that Paganini’s counsel argued further “annihilates any justification for capping such verdicts.”
“It would be the height of arbitrariness and wildly unreasonable for a law to remain in place once a legislatively mandated study discovers that it serves no purpose, particularly where the law takes hundreds-of-thousands of dollars away from those a jury determined are entitled to full justice for their injuries,” Paganini’s counsel wrote in an April memo to the Court.
But on appeal to the Ohio Supreme Court, counsel for appellants Cataract Eye Center and Dr. Louis disputed Plaintiff’s use of a 2019 study as a means of invalidating a 2003 statute.
“The Eighth District improperly acted as a super-legislature when it sifted between different data points; selected the one it liked best; and invalidated R.C. 2323.43(A)(3) on due process grounds,” appellants wrote.
Appellants’ counsel further cautioned the Court that the Eighth District’s opinion — if upheld — will affect a “sea change” of broader implications beyond Paganini’s individual case and render R.C. 2323.43(A)(3) facially, entirely moot.
The Eighth District’s ruling, appellants’ counsel argued, “returns Ohio to the days of jackpot justice — when juries could award unlimited and unpredictable damages for noneconomic loss and malpractice premiums soared to account for the possibility of subjective windfalls.”
Paganini’s counsel, on the other hand, warned the Court that referring to “full recovery for an old man who lost his entire eye as ‘jackpot justice’ will send the wrong message to Ohioans.”
In an amicus brief filed in support of Paganini, the National and Ohio Associations of Justice argued that the “artificial” $500,000 damages cap has only “whittled away” Ohioans’ rights to a remedy and jury trial, while making little, if any, difference in the cost of healthcare.
In support of appellants’ counsel, the Ohio Association of Civil Trial Attorneys filed an amicus brief, along with a brief joined by the Ohio Hospital Association, Ohio State Medical Association, Ohio Osteopathic Association, Ohio Alliance for Civil Justice, and Academy of Medicine of Cleveland & Northern Ohio.
The amici backing appellants argued that Paganini fails to assert sufficiently “unique” circumstances to qualify for an as-applied exemption from the $500,000 cap. Instead, his claim more closely resembles a facial challenge — a distinction the amici urged the Court to clear up.
“[T]here is nothing ‘unusual’ about these circumstances,” amici for appellants wrote. “This rationale is applicable to every single Ohio medical malpractice plaintiff awarded noneconomic damages in excess of the statutory cap — in other words, every single plaintiff affected by any statutory cap on noneconomic damages can make this very same constitutional argument.”
Other as-applied challenges to damages caps
Although it remains unclear when or how the Ohio Supreme Court plans to rule on the case, the Court has in recent years accepted other as-applied challenges to caps on noneconomic damages awards — albeit outside of the medical malpractice context.
In Brandt v. Pompa, for instance, the Ohio Supreme Court in December 2022 struck down the legislature’s $250,000 cap on non-economic damages as it applied to child victims “who suffer traumatic, extensive, and chronic psychological injury as a result of intentional criminal acts and who sue their abusers for civil damages.”
There, a 4-3 Court upheld a Cuyahoga County jury’s $134 million verdict — including $20 million in noneconomic damages — unanimously awarded to a Brook Park woman who, at the ages of 11 and 12, was repeatedly drugged and sexually abused by an adult neighbor.
In doing so, the Court invalidated a 2005 statute, R.C. 2315.18, to the extent that its $250,000 noneconomic damages cap for tort claims failed to include a carve-out for child victims like Brandt. While the statute included an exception for permanent and substantial physical injuries, no such exception existed for permanent and substantial psychological injuries.
Because Brandt did not suffer permanent physical injuries, her $20 million award for non-economic damages was statutorily capped at $250,000.
Then-Chief Justice Maureen O’Connor, writing for the Court’s majority, acknowledged that the Court had previously ruled in a 2005 case that found the legislature’s “tort reform” provision was, in fact, constitutional.
But to the extent that the law failed to include an exception for an “even smaller group of people” — namely, child victims like Brandt “who suffered traumatic, extensive, and chronic psychological injury as a result of intentional criminal acts” — it effectively violated Brandt’s due process rights under the Ohio Constitution.
“Subjecting this group to the compensatory-damages caps for noneconomic loss has little to no connection to improving the tort system in Ohio,” O’Connor wrote. “This group comprises victims who are entitled to the full range of constitutional remedies, regardless of whether their severe injuries are physical or psychological.”
In a dissenting opinion, Justices Sharon Kennedy, Patrick Fischer, and R. Patrick DeWine found that the legislature acted within its policy-making authority by enacting the damages caps for “inherently subjective” pain-and-suffering awards.
Because state lawmakers recognized that “damages for things like pain and suffering and mental anguish are inherently subjective,” the dissent argued that the damages cap served to protect the legislature’s substantial interest in protecting the predictability of Ohio’s civil justice system and the state’s economy.
“What happened to Brandt is horrific and deeply saddening, as are the stories of every child victim — really any victim — of sexual assault,” Justice Fischer wrote for the dissent. “But that reality does not bestow upon this court the constitutional authority to invade the purview of the General Assembly by questioning its policy decisions and fashioning remedies for victims we deem worthy.”
Now in the Court’s majority on Paganini’s case, Chief Justice Sharon Kennedy and Justices Patrick Fischer, R. Patrick DeWine, joined by Justices Joe Deters, Megan Shanahan, and Daniel Hawkins, voted to accept the medical providers’ appeal. Justice Jennifer Brunner departed from her colleagues and voted against accepting the case for review. The Court has yet to schedule a date for oral arguments. Ohio Court Watch will monitor the Court’s docket for updates.