Punitive Damages in Medical Malpractice Cases

Punitive damages are rare in medical malpractice cases. Learn when they may be an option.


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In a medical malpractice case, most damages are designed to compensate a patient for harm caused by a doctor’s mistake. In fact, the main category of damages in these cases is "compensatory damages," which includes compensation for lost wages, medical bills, and pain and suffering. The purpose of compensatory damages is to make the patient whole again. (Learn more about Types of Compensation for Medical Malpractice.)

There is another category of compensation called "punitive damages," which serves a fundamentally different purpose. Punitive damages ask the question, “should the health care provider be punished for what happened?” In the sections below, this article will explore the following issues:

  • when punitive damages are available in a medical malpractice case
  • why punitive damages are controversial, and
  • efforts to reform or eliminate punitive damages.

When are Punitive Damages Available?

A doctor (usually through an insurer) must compensate a patient for harm caused by medical neglgience that occurs in the treatment setting. For a court to go beyond compensation and require punitive damages, the doctor must have done something so deplorable that the doctor (or hospital or individual defendant) would get off lightly by merely having to compensate the patient for the injuries.

This usually requires intentional or particularly reckless behavior. For example, imagine a doctor is struggling to find patients, and needs money to keep his practice open. The doctor performs a knee surgery on a patient, but does something (or fails to do something) that ensures that the patient will be forced to return for costly follow-up care.

That situation would call for punitive damages. The doctor did not merely make a mistake. The doctor intentionally harmed the patient, which warrants punishment. This kind of conduct may even warrant the filing of criminal charges, but in any case punitive damages would likely be appropriate in a civil action.

Another example of when punitive damages might be available would be if a hospital were to make an economic calculation to trade lives for profits. Imagine a hospital administration discovers that a hamrful virus is spreading in the hospital’s elderly care ward. The administration understands that the virus could kill all twenty patients in the elderly care ward. However, the administration determines that since the virus can be contained to that ward, it should not be reported. The administration reasons that even if all of the patients in the ward die, the facility's medical malpractice liability exposure will be relatively small because the patients are all old and many are terminally ill. On the other hand, reporting the problem could cost billions of dollars in lost revenue because all sorts of patients might begin avoiding the hospital.

In this sort of case punitive damages might be the only way for a court to force the hospital to value the lives of patients more highly than it values profits. Punitive damages would also send a message to other health care providers, that they will pay a very steep price for this kind of conduct.  

Why are Punitive Damages Controversial?

Medical malpractice lawsuits increase the costs of malpractice insurance for doctors and hospitals. That in turn increases the costs of treatment (and therefore health insurance) for consumers. For tort reformers, who are looking to cut all unnecessary costs associated with medical malpractice cases, punitive damages are an easy target because they are ancillary to the primary purpose of medical malpractice law (to compensate the patient for harm caused by medical mistakes).

Critics of punitive damages would argue that other means exist to satisfy the goals of punitive damages, including regulatory action by medical licensing boards and governmental agencies.

Furthermore, critics contend that punitive damages make little sense because the resulting awards should not go to the harmed patients. A patient who has already been made whole with compensatory damages receives a windfall when punitive damages are awarded in addition to compensatory damages.

Learn more about The Debate Over Medical Malpractiec Reform.

Limits on Punitive Damages

Many medical malpractice reform efforts involve caps on punitive damages (or the elimination of these kinds of damages altogether). Moreover, even in states that do not have statutory limits on punitive damages, judges have discretion to limit them. Thus, if a jury awards a patient $500,000 in compensatory damages and $50,000,000 in punitive damages, a judge will likely adjust the award. There is no magic number, but most judges consider a punitive damages award to be excessive if it's greater than ten times the amount of compensatory damages.

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