Georgia Supreme Court Hears the Case for Medical Malpractice Damages Cap

Georgia’s Supreme Court justices raised questions about recent arguments to cap damages in medical malpractice cases. Though a decision isn’t expected for several months, health care insurers and litigators should prepare for an environment where noneconomic damages remain uncapped and high‑value verdicts are possible.

On Feb. 3, the Supreme Court of Georgia heard oral arguments in two consolidated appeals focused on the state’s statutory caps on noneconomic damages in medical malpractice cases. During oral argument, the Supreme Court of Georgia appeared hesitant to overturn its landmark 2010 decision in Atlanta Oculoplastic Surgery v. Nestlehutt, which struck down the state’s statutory damages cap on noneconomic damages in medical malpractice cases.

The two consolidated appeals involved approximately $75 million in total jury awards, each presenting the question of whether the General Assembly’s $350,000 noneconomic damages cap can be revived.

Background: The Path Back to Damages Caps

In 2005, the Georgia General Assembly enacted a $350,000 cap on noneconomic damages in medical malpractice cases. Five years later, in Nestlehutt, the Supreme Court held that the cap violated the Georgia Constitution’s guarantee of a jury trial, reasoning that the cap infringed on the jury’s role as factfinder by limiting damages they could award in a personal injury context.

Supporters of the damages cap have urged the court to reconsider the Nestlehutt ruling, arguing that Nestlehutt expanded the jury‑trial right beyond its historical scope. Many expected the court to either expand Nestlehutt to definitively include medical malpractice claims in a wrongful death context or to overrule the decision in Medical Center of Central Georgia, Inc. v. Turner. Only Justice Verda Colvin authored an opinion calling into question the Nestlehutt decision.

However, during oral argument, Justice Colvin walked back those earlier signals, stating that her prior concerns “may be misguided.”

The Cases Before the Court

Clark, et al. v. Leigh, et al.; Leigh, et al. v. Clark, et al.: April Clark died following complications from an ovarian cyst removal. Her family sued two physicians who were alleged to have botched the procedure and failed to identify a bowel perforation. A Bibb County jury later awarded the family $33 million, including over $29 million in noneconomic damages for the value of Clark’s life. The defendants persuaded the trial court to apply the damages cap, arguing that wrongful death claims did not carry a jury-trial right at common law, meaning a damages cap didn’t violate the Georgia Constitution.

Hospitalist Services of Georgia PC v. Advocacy Trust, LLC, et al.; Cayamcela v. Advocacy Trust, LLC, et al.:  Holly Baumstark died from complications following a C-section in 2019 in an Atlanta area hospital. Her family sued seven of the physicians who were involved in her care and Hospitalist Services of Georgia PC. Of the providers, six settled prior to trial, leaving only Dr. Luis Cayamcela and Hospitalist Services of Georgia PC. A jury awarded Baumstark’s family a $42 million verdict, including $32 million in noneconomic damages for the value of Baumstark’s life. Defendants argued that wrongful death claims fall outside of Nestlehutt, or, alternatively, that Nestlehutt should be overruled.

Key Issues from Oral Argument

1. Historical Basis for Jury‑Trial Rights

The Constitution of Georgia states that “[t]he right to trial by jury shall remain inviolate[.]” In Nestlehutt, the Georgia Supreme Court held that jury trials existed at the time Georgia adopted its first constitution in 1798 for claims involving the negligence of health care providers, with an attendant right to the full measure of damages, including noneconomic damages. This served as the basis for their decision to declare the noneconomic damages cap unconstitutional.

In the present appeals before the court, the defendants argued that because wrongful death claims did not exist in early common law, the legislature may limit damages without violating constitutional guarantees. Plaintiffs countered with historical examples of wrongful‑death‑type claims recognized in 19th‑century Georgia and early American common law. During the recent oral argument, several justices appeared open to plaintiffs’ broader historical framing.

2. The Role of the Jury in Determining Damages

Multiple justices questioned the argument that determining damages is distinct from jury fact finding. Justice Andrew Pinson noted that separating the two seemed “artificial,” expressing concern that capping damages necessarily restricts the jury’s traditional role. Justice Colvin echoed similar concerns. 

3. Revisiting Nestlehutt

Despite previous signals, Justice Colvin expressed doubt about overturning the precedent. Her comments suggested that the historical continuity underlying Nestlehutt may be more robust than previously thought. This shift appeared to influence the tone of the full bench.

What This Means for Health Care Providers, Insurers and Litigators

• High Exposure, High Premiums: If Nestlehutt remains intact, Georgia will remain a jurisdiction with no cap on noneconomic damages in all medical malpractice cases. This means that Georgia medical providers could face higher premiums, while insurers will carry larger risks insuring hospitals and providers in Georgia.
• Increased Settlement Pressures: Without caps, settlement values — especially in catastrophic injury and wrongful death cases — may continue to rise.
• Uphill Legislative and Electoral Obstacles: If the court declines to revive the damages caps, the Georgia General Assembly will be hampered in passing other damages caps in other types of claims, not limited to medical malpractice. This leaves only one avenue available: a constitutional amendment. To pass a constitutional amendment to cap noneconomic damages, the provision must pass with a two-thirds majority in both General Assembly chambers. Then a simple majority of voters must approve the provision during the next general election. This could be a significant hurdle.
• Case Strategy Implications: Defense counsel should continue framing constitutional arguments carefully while preparing for trial in an environment where seven- and eight-figure verdicts remain possible.

Next Steps

The court typically issues opinions within several months following oral argument. The forthcoming decisions in these consolidated cases will determine whether Georgia returns to a capped‑damages regime in wrongful death cases or continues under Nestlehutt’s expansive interpretation of jury‑trial protections.

Please contact George Morris, Maggie Arellano, Anderson Blackmon or any member of the Phelps insurance, litigation and health care teams with questions or for advice or guidance.