Miller v. Johnson

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IN THE SUPREME COURT OF THE STATE OF KANSAS

No. 99,818

AMY C. MILLER,
Appellant/Cross-appellee,

v.

CAROLYN N. JOHNSON, M.D.,
Appellee/Cross-appellant.


SYLLABUS BY THE COURT

1.
Determining whether a statute violates the constitution is a question of law subject
to unlimited review. Under our state's separation of powers doctrine, courts presume a
statute is constitutional and resolve all doubts in favor of the statute's validity. A statute
must clearly violate the constitution before it may be struck down.

2.
Section 5 of the Kansas Constitution Bill of Rights preserves the right to jury trial
as it historically existed at common law when the Kansas Constitution came into
existence. The right to a trial by jury for personal injury is protected by Section 5. A
statutory limit on the amount that may be recovered for noneconomic damages by a
personal injury plaintiff, such as K.S.A. 60-19a02, may not unconstitutionally obstruct
the right to jury trial.

3.
Section 18 of the Kansas Constitution Bill of Rights provides an injured party a
constitutional right to be made whole and a right to damages for economic and
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noneconomic losses. K.S.A. 60-19a02 is subject to Section 18's protections because it
prohibits personal injury plaintiffs from recovering more than $250,000 for noneconomic
damages. But this court has never recognized a vested right in common-law rules
governing negligence actions, and the legislature may modify those rights as long as an
adequate substitute remedy is provided.

4.
A court of last resort will follow the rule of law it established in its earlier cases
unless clearly convinced the rule was originally erroneous or is no longer sound because
of changing conditions and that more good than harm will come by departing from
precedent.

5.
The test used to determine whether a statute unconstitutionally obstructs the right
to jury trial under Section 5 of the Kansas Constitution Bill of Rights is the same
adequate substitute remedy analysis used to decide challenges under Section 18. The first
step is to determine whether the modification to the right to jury trial or common-law
remedy is reasonably necessary in the public interest to promote the public welfare. The
second step is to determine whether the legislature substituted an adequate statutory
remedy for the modification to the individual right at issue.

6.
Under the facts of this case, it is held: (a) The comprehensive legislation
comprising the Health Care Provider Insurance Availability Act, K.S.A. 40-3401 et seq.,
and K.S.A. 60-19a02 carry a valid public interest objective; and (b) the legislature
substituted an adequate statutory remedy for modification of a medical malpractice
plaintiff's common-law rights under Sections 5 and 18 of the Kansas Constitution Bill of
Rights.

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7.
Equal protection rights derive from Section 1 of the Kansas Constitution Bill of
Rights, which states: "All men are possessed of equal and inalienable natural rights,
among which are life, liberty, and the pursuit of happiness." When a statute's
constitutionality is challenged as an equal protection violation, the first step is to
determine the nature of the legislative classifications and examine whether those
classifications result in arguably indistinguishable classes of individuals being treated
differently. Equal protection is implicated only if there is differing treatment of similarly
situated individuals. In the second step, a court examines the rights affected by the
classifications, which dictates the level of scrutiny to be applied—either strict scrutiny,
intermediate scrutiny, or the deferential scrutiny of the rational basis test. The final step
requires determining whether the relationship between the classifications and the object
desired to be obtained withstands the applicable level of scrutiny.

8.
The statutory restriction on noneconomic damages in K.S.A. 60-19a02 is social
and economic legislation triggering application of the rational basis test. When a party
attacks a statute as facially unconstitutional for failing to satisfy the rational basis
standard, that party must demonstrate that no set of circumstances exists that survives
constitutional muster. In other words, the party has the burden to negate every
conceivable rational basis that might support the classification.

9.
The doctrine of separation of powers is an inherent and integral element of the
republican form of government. By dividing the government into three branches, each of
which is given the powers and functions appropriate to it, a dangerous concentration of
power is avoided and the respective powers are assigned to the branch best fitted to
exercise them. This doctrine prevents one branch of government from usurping another
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branch's powers. Usurpation occurs when one branch of government significantly
interferes with the operations of another branch.

10.
The statutory cap on noneconomic damages imposed by K.S.A. 60-19a02 does not
violate the separation of powers doctrine, although the cap does limit when it would be
sensible for a trial court to order a new trial. This court has long recognized that the
legislature may regulate the granting of new trials.

11.
The decision to grant a motion to alter or amend a judgment under K.S.A. 2011
Supp. 60-259(f) is within the district court's sound discretion and will not be disturbed
unless there is an abuse of discretion.

12.
Judicial discretion is abused if judicial action is: (a) arbitrary, fanciful, or
unreasonable, i.e., if no reasonable person would have taken the view adopted by the trial
court; (b) based on an error of law, i.e., if the discretion is guided by an erroneous legal
conclusion; or (c) based on an error of fact, i.e., if substantial competent evidence does
not support a factual finding on which a prerequisite conclusion of law or the exercise of
discretion is based.

13.
In a negligence action, recovery may be had only when there is evidence showing
with reasonable certainty that the damage was sustained as a result of the complained-of
negligence. Recovery may not be had when the alleged damages are too conjectural or
speculative to form a basis for measurement. To warrant recovery of damages, there must
be some reasonable basis for computation that will enable the trier of fact to arrive at an
estimate of loss.
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14.
When considering a motion for judgment as a matter of law under K.S.A. 60-250,
the district court must resolve all facts and inferences reasonably to be drawn from the
evidence in favor of the party against whom the ruling is sought. When reasonable minds
can reach different conclusions based on that evidence, the motion must be denied. When
no evidence is presented on a particular issue or the evidence presented is undisputed and
is such that reasonable persons may not draw differing inferences and arrive at opposing
conclusions, the matter becomes a question of law for the court's determination.
Appellate courts apply a similar analysis when reviewing the grant or denial of such a
motion.

15.
To establish a medical malpractice claim, a plaintiff must show: (a) the health care
provider owes the patient a duty of care and was required to meet or exceed a certain
standard of care to protect the patient from injury; (b) the health care provider breached
this duty or deviated from the applicable standard of care; (c) the patient was injured; and
(d) the injury was proximately caused by the health care provider's breach of the standard
of care.

16.
Granting a new trial under K.S.A. 2011 Supp. 60-259(a) is within the trial court's
discretion, and that ruling will not be disturbed on appeal unless that discretion was
abused.

17.
K.S.A. 60-237(c) provides that a party's failure to disclose witness information
required by a court's scheduling order entered under K.S.A. 60-226(b)(6)(C) precludes
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that testimony unless the court finds the failure was substantially justified or harmless.
An abuse of discretion standard applies to decisions made under K.S.A. 60-237(c).

18.
The trial court is vested with broad discretion in supervising the course and scope
of discovery.

19.
Claims made in passing without argument or citations to authority are deemed
waived.

Appeal from Douglas District Court; STEVE SIX, judge. Opinion filed October 5, 2012. Judgment
of the district court is affirmed in part and reversed in part, and the case is remanded with directions to the
district court.

William J. Skepnek, of Skepnek Fagan Meyer & Davis, of Lawrence, argued the cause in the
original argument and on reargument; Ned I. Miltenberg, of Center for Constitutional Litigation, P.C., of
Washington, D.C., argued the cause in the original argument, and Trey T. Meyer, of Skepnek Fagan
Meyer & Davis, of Lawrence, was with them on the briefs for appellant/cross-appellee. Lynn R. Johnson,
of Shamberg, Johnson & Bergman, of Kansas City, Missouri, and Robert S. Peck, of Center for
Constitutional Litigation, P.C., of Washington, D.C., argued the cause on reargument for appellant/cross-
appellee.

Bruce Keplinger, of Norris & Keplinger, of Overland Park, argued the cause in the original
argument and on reargument, and John Hicks, of the same firm, was with him on the brief for
appellee/cross-appellant. Steven C. Day, of Woodard, Hernandez, Roth & Day, L.L.C., of Wichita, argued
the cause on reargument for appellee/cross-appellant.

Cathy J. Dean, Douglas J. Kramer, and Lauren E. Tucker McCubbin, of Polsinelli Shughart PC,
of Kansas City, Missouri, were on the brief for amicus curiae Kansas Medical Society and Kansas
Hospital Association.

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Timothy J. Finnerty and Ryan D. Weltz, of Wallace, Saunders, Austin, Brown & Enochs,
Chartered, of Wichita, were on the brief for amicus curiae Kansas Association of Defense Counsel.

Toby Crouse, Scott C. Nehrbass, and James D. Oliver, of Foulston Siefkin, LLP, of Overland
Park, were on the brief for amicus curiae Kansas Chamber of Commerce.

James R. Howell and Derek Casey, of Prochaska, Giroux & Howell, of Wichita, and Lynn R.
Johnson, and David Morantz, of Shamberg, Johnson & Bergman, of Kansas City, Missouri, were on the
brief for amicus curiae Kansas Association for Justice.

William Rich and James M. Concannon were on the amici curiae brief pro se.

Molly Wood, of Stevens & Brand, LLP, of Lawrence, was on the brief for amici curiae AARP; El
Centro, Inc.; Kansas AFL-CIO, Kansas Advocates for Better Care, Inc.; The Disability Rights Center of
Kansas; Kansas Coalition Against Sexual and Domestic Violence; and Linda Henry Elrod, Director of
Children and Family Law Center of the Washburn University School of Law.

Steven C. Day, of Woodard, Hernandez, Roth & Day, LLC, of Wichita, was on the brief for
amicus curiae Estephan N. Zayat, M.D.

The opinion of the court was delivered by

BILES, J.: Amy C. Miller sued her doctor, who mistakenly removed her left ovary
during a laparoscopic surgery intended to take the right ovary, and a jury awarded her
$759,679.74 in damages. But the district court reduced that amount by $425,000 because
of a state law limiting noneconomic damages in personal injury lawsuits and a posttrial
ruling finding her evidence of future medical expenses insufficient. Both sides appeal,
with each claiming the district court erred at various points in the proceedings.

Our initial focus is the constitutionality of K.S.A. 60-19a02, which operated to cap
Miller's jury award for noneconomic damages. This statute is one of several enacted to
"reform" our state's tort laws, and it has been a subject this court has visited—and
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revisited—in prior cases with conflicting outcomes. It represents a long-standing and
highly polarizing question nationwide. See, e.g., Samsel v. Wheeler Transport Services,
Inc., 246 Kan. 336, 338, 789 P.2d 541 (1990) (Samsel II) (referring to "the stormy
controversy which currently surrounds the liability insurance and tort systems"); see also
Kansas Malpractice Victims Coalition v. Bell, 243 Kan. 333, 354-55, 757 P.2d 251
(1988) (McFarland, J., dissenting) ("Many physicians truly believe that the legal
profession is out to destroy them for personal gain. Many lawyers believe, with equal
sincerity, that the medical profession is attempting, through legislation, to avoid its
responsibility for harm done by its members. Companies providing medical malpractice
insurance are attacked by both groups."). The continuation of this controversy no doubt
contributed to the larger-than-usual volume of briefs received in this appeal from the
parties and their allied interests.

In resolving the four constitutional issues in this case, a majority of the court
upholds K.S.A. 60-19a02 as applied to Miller—a medical malpractice victim. A minority
would hold the statute unconstitutional.

As to the trial errors alleged, we unanimously reverse the district court's decision
to strike the jury's award for Miller's future medical expenses and remand the case with
instructions to reinstate that award. As for the doctor's cross-appeal, it is argued the trial
court erred by denying a motion for judgment as a matter of law and motion for new trial.
We unanimously deny the doctor's trial error claims.

FACTUAL AND PROCEDURAL BACKGROUND

The essential facts are straightforward. Miller began seeing Dr. Carolyn N.
Johnson in 1994 with a history of painful and irregular menstrual periods. In 2002, after
continued suffering from severe pain in her right lower quadrant, Miller, who was 28
years old at the time, consented to having her right ovary removed. Johnson performed a
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laparoscopic procedure for that purpose. The surgical report, signed by Johnson, stated
that the right ovary had been removed. Miller, however, continued to experience severe
pain.

Three months after the surgery, Miller discovered during an examination with
another doctor that Johnson had mistakenly removed her left ovary instead of the right. A
different physician attempted to manage Miller's continuing pain with nonsurgical
options, but the pain persisted and Miller decided to have another surgeon remove her
remaining ovary. She sued Johnson for medical malpractice in 2004, alleging the doctor
violated the appropriate standard of medical care. Johnson vigorously contested the
lawsuit, claiming Miller's preexisting medical conditions would have required eventual
removal of both ovaries and her uterus, even if the left ovary was taken first in error.

The case went to trial and a jury found the doctor completely at fault. It awarded
Miller $759,679.74 in total monetary damages, comprised as follows: (1) $84,679.74 for
medical expenses to date; (2) $100,000 for future medical expenses; (3) $250,000 for
noneconomic loss to date; (4) $150,000 for future noneconomic loss; and (5) $175,000
noneconomic loss for impairment of services as a spouse. But the district court reduced
the jury's award in two postverdict decisions.

In its first ruling, the district court enforced the statutory limitation on
noneconomic damages required by K.S.A. 60-19a02. This cut the jury's total award of
$575,000 in noneconomic damages by $325,000 to conform to the $250,000 statutory
cap. In so ruling, the district court rejected Miller's efforts to avoid the statute's
restrictions by challenging its constitutionality. Miller argued the cap violated her right to
trial by jury, the right to remedy by due course of law, equal protection, and the doctrine
of separation of powers. The primary basis for the district court's ruling was the 1990
decision in Samsel II, which was this court's most recent decision on the issue and which
the lower court was bound to follow. In addition, the district court denied Miller's request
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for an evidentiary hearing to attack the legislature's basis for enacting the cap. Instead,
Miller filed a written motion proffering the testimony she would have submitted. Highly
summarized, Miller's experts would have testified there was no empirical evidence to
support a claimed medical malpractice crisis to justify the legislation, that the
noneconomic damages cap has a disparate impact on women and the elderly, and that
there is little support for believing that juries award damages for frivolous claims out of
sympathy for a plaintiff.

In its second ruling, the district court struck the $100,000 jury award for future
medical expenses. The court held that Miller offered insufficient evidence for the jury to
make findings about her future medical or counseling needs, how much future care she
would require, or what that cost would be over the next several decades until she reached
menopause.

Combining the reductions resulting from these two determinations, the district
court entered a final monetary judgment against Johnson for $334,679.74.

In rulings made against the doctor that are also the subject of this appeal, the
district court denied Johnson's motion for judgment as a matter of law, which was
premised on a defense claim that Miller failed to prove causation due to her preexisting
medical conditions. The district court held there was sufficient evidence to support the
jury's finding on causation. It further found there was no medical indication to remove the
left ovary at the time Johnson performed the laparoscopic procedure and that the
evidence was sufficient to show Miller experienced a variety of problems as a result of
her having both ovaries removed. The district court acknowledged that Johnson presented
conflicting evidence but held those inconsistencies were best resolved by the jury, which
found against the doctor.

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Regarding the motion for new trial, the district court rejected the doctor's
argument that it had improperly prevented Miller's treating physicians from testifying that
it would have been necessary to eventually remove both ovaries. Johnson claimed this
evidence supported the defense theory and would have been significant to jury
deliberations. But the district court disagreed and held the treating physicians' testimony
was properly limited to those matters stated in their medical records, their care and
treatment of Miller, and inquiries reasonably related to that treatment.

Both sides appeal the rulings adverse to their respective interests. This court
transferred the case from the Court of Appeals. See K.S.A. 20-3018(c) (transfer of cases
on court's motion). Thereafter, we conducted oral arguments on two separate dockets.
This unusual occurrence was necessitated by changes to the court's composition after the
original oral arguments. Reargument was held February 18, 2011.

We address first the four constitutional attacks leveled against K.S.A. 60-19a02 by
Miller, and then we will discuss the trial error claims. But before doing so, the court
acknowledges the contributions to our analysis made by the parties and amici curiae.
Their deeply rooted concerns about these important constitutional questions are evident,
even though they disagree in the rationale that might drive the outcomes.

THE STATUTE'S CONSTITUTIONALITY

K.S.A. 60-19a02 was enacted in 1988. L. 1988, ch. 216, sec. 3. It limits the total
amount recoverable to $250,000 for noneconomic loss in any personal injury action,
including medical malpractice claims. "Noneconomic losses include claims for pain and
suffering, mental anguish, injury and disfigurement not affecting earning capacity, and
losses which cannot be easily expressed in dollars and cents." Samsel II, 246 Kan. 336,
Syl. ¶ 6. The statute provides:

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"(a) As used in this section 'personal injury action' means any action seeking
damages for personal injury or death.

"(b) In any personal injury action, the total amount recoverable by each party
from all defendants for all claims for noneconomic loss shall not exceed a sum total of
$250,000.

"(c) In every personal injury action, the verdict shall be itemized by the trier of
fact to reflect the amount awarded for noneconomic loss.

"(d) If a personal injury action is tried to a jury, the court shall not instruct the
jury on the limitations of this section. If the verdict results in an award for noneconomic
loss which exceeds the limit of this section, the court shall enter judgment for $250,000
for all the party's claims for noneconomic loss. Such entry of judgment by the court shall
occur after consideration of comparative negligence principles in K.S.A. 60-258a and
amendments thereto.

"(e) The provisions of this section shall not be construed to repeal or modify the
limitation provided by K.S.A. 60-1903 and amendments thereto in wrongful death
actions.

"(f) The provisions of this section shall apply only to personal injury actions
which are based on causes of action accruing on or after July 1, 1988." (Emphasis added.)
K.S.A. 60-19a02.

This was not the first restraint on noneconomic damages imposed by the
legislature in common-law tort cases in Kansas. The first was enacted in 1986 and
applied exclusively to medical malpractice lawsuits. K.S.A. 1986 Supp. 60-3407. It
restricted noneconomic damages to $250,000 but also imposed an overall cap of $1
million for total damages. K.S.A. 1986 Supp. 60-3407(a). It further provided for annual
adjustments to the noneconomic damages cap based on the consumer price index. K.S.A.
1986 Supp. 60-3407(d). This 1986 statute was enacted in response to continued efforts
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from health care professionals and the insurance industry to improve insurance rates for
medical malpractice coverage and make insurance more readily available. K.S.A. 1987
Supp. 60-3405. In 1988, a majority of this court declared the 1986 cap on noneconomic
damages unconstitutional. Kansas Malpractice Victims, 243 Kan. at 346, 352 (statute
violated both the Section 5 right to jury trial and Section 18 remedy provision of the
Kansas Constitution Bill of Rights).

But even before the Kansas Malpractice Victims decision was announced, the
1987 legislature enacted a $250,000 noneconomic damages cap limiting recovery for pain
and suffering in all other personal injury actions. L. 1987, ch. 217, sec. 1. That statute did
not apply to medical malpractice actions and did not include a cost-of-living adjustment.
K.S.A. 1987 Supp. 60-19a01. The following year, the legislature merged these two
damages caps into the statute at issue in this case. L. 1988, ch. 216, sec. 3. The cost-of-
living adjustment in the earlier medical malpractice cap was removed. Cf. K.S.A. 60-
19a02; K.S.A. 1986 Supp. 60-3407(d). K.S.A. 60-19a02 now places a $250,000
limitation on noneconomic damages in all personal injury actions, including medical
malpractice claims, accruing on or after July 1, 1988. K.S.A. 60-19a02(f).

In 1990, a majority of this court upheld the 1988 statute's constitutionality. Samsel
II, 246 Kan. at 338. Since then, this court has considered other "tort reform" statutes, as
they are commonly characterized, upholding some and declaring others unconstitutional.
See Bair v. Peck, 248 Kan. 824, 845, 811 P.2d 1176 (1991) (K.S.A. 40-3403[h] does not
violate the right to jury trial, right to remedy, or equal protection by eliminating vicarious
liability of health care providers in certain circumstances); Thompson v. KFB Ins. Co.,
252 Kan. 1010, 1022-23, 850 P.2d 773 (1993) (K.S.A. 60-3802 violated equal protection
by allowing evidence of collateral source benefits in personal injury cases when plaintiff
sought more than $150,000 in damages); Smith v. Printup, 254 Kan. 315, 332-33, 866
P.2d 985 (1993) (K.S.A. 60-3701 et seq., does not violate right to jury trial by requiring
courts to decide punitive damages); Aves v. Shah, 258 Kan. 506, 524, 527, 906 P.2d 642
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(1995) (K.S.A. 40-3403[e] and K.S.A. 40-3412[c] do not violate Section 18 due process
or equal protection by prohibiting bad faith actions against the Health Care Stabilization
Fund); Bonin v. Vannaman, 261 Kan. 199, 217-19, 929 P.2d 754 (1996) (K.S.A. 60-
515[a] does not violate Section 18 right to remedy or equal protection by setting an 8-
year statute of repose for minors or persons with legal disability); Lemuz v. Fieser, 261
Kan. 936, 960, 933 P.2d 134 (1997) (K.S.A. 65-442[b] does not violate Section 18 right
to remedy by abrogating corporate negligence claims against any medical care facility for
allowing a physician, who is not an agent or employee, to work on its staff).

Miller argues the statutory cap violates: (1) the right to jury trial under Section 5
of the Kansas Constitution Bill of Rights; (2) the right to remedy by due course of law
under Section 18 of the Kansas Constitution Bill of Rights; (3) the equal protection
provision of Section 1 of the Kansas Constitution Bill of Rights; and (4) the doctrine of
separation of powers. Miller urges us to revive the reasoning in Kansas Malpractice
Victims, which struck down the 1986 cap and found that statute unconstitutional. Johnson
counters that our 1990 Samsel II decision, which more recently upheld the current
statute's constitutionality, is the binding precedent that should resolve future court rulings
on this subject. The amici take various positions in concert with their respective interests,
which we address when necessary.

Standard of Review for Challenges to a Statute's Constitutionality

"Courts are only concerned with the legislative power to enact statutes, not with
the wisdom behind those enactments." Samsel II, 246 Kan. at 348. Our standard of
review is well known. When a statute's constitutionality is attacked, the statute is
presumed constitutional and all doubts must be resolved in favor of its validity. If there is
any reasonable way to construe that statute as constitutionally valid, this court has the
authority and duty to do so. Rural Water District No. 2 v. City of Louisburg, 288 Kan.
811, 817, 207 P.3d 1055 (2009) (citing Martin v. Kansas Dept. of Revenue, 285 Kan.
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625, 629-30, 176 P.3d 938 [2008]). Appellate courts conduct unlimited review of
questions regarding a statute's constitutionality because they are issues of law. Brennan v.
Kansas Insurance Guaranty Ass'n, 293 Kan. 446, 450, 264 P.3d 102 (2011).

Section 5 Analysis—the Right of Trial by Jury

Section 5 of the Kansas Constitution's Bill of Rights protects the right to trial by
jury. It states: "The right of trial by jury shall be inviolate." This right is "a basic and
fundamental feature of American jurisprudence." Gard v. Sherwood Construction Co.,
194 Kan. 541, 549, 400 P.2d 995 (1965). "It is a substantial and valuable right and should
never be lightly denied. The law favors trial by jury, and the right should be carefully
guarded against infringements." 194 Kan. at 549.

Our court has consistently held that Section 5 preserves the jury trial right as it
historically existed at common law when our state's constitution came into existence.
State ex rel. v. City of Topeka, 36 Kan. 76, 85-86, 12 P. 310 (1886) (Section 5 means "the
right of trial by jury shall be and remain as ample and complete as it was at the time when
the constitution was adopted."); Kimball and Others v. Connor, Starks and Others, 3
Kan. 414, 432 (1866). And the parties correctly do not dispute that common-law tort
actions, including medical malpractice claims, were historically triable to a jury. See,
e.g., Kansas Malpractice Victims, 243 Kan. at 342-43. There is also correctly no dispute
that the amount of damages, including noneconomic damages, was a question of fact
determined by the jury in common-law tort actions. See Samsel II, 246 Kan. at 350-52,
358.

Miller argues the cap unconstitutionally supplants the jury's role in assessing
damages according to the evidence adduced at trial with an arbitrary number picked by
legislators. Johnson disagrees, claiming the jury's function is unimpeded by the statute
because the jury is not told to award damages up to $250,000. Instead, it is instructed to
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determine the amount of money that will "fairly and adequately compensate" the plaintiff.
See PIK Civ. 4th 171.02. Johnson further contends the statutory cap simply operates to
prevent the district court from entering a judgment against a defendant that is more than
$250,000 for noneconomic damages. Johnson argues this postverdict exercise does not
infringe on the jury's actual function, so the right to jury trial is not implicated by the
statute and there is no constitutional issue presented under Section 5. See also Justice
McFarland's concurrence in Samsel II, 246 Kan. at 363 (right to jury trial does not extend
to remedy phase of trial).

But we need not engage these contentions for long because our caselaw already
makes clear that Miller's personal injury claims against her doctor are subject to Section 5
protections. See Samsel II, 246 Kan. at 358 (damages are a jury issue under Section 5);
Kansas Malpractice Victims, 243 Kan. at 342-43 (actions for recovery of damages for
negligent injury were triable to a jury under the common law, so Section 5 guarantees the
right to a trial by jury in medical malpractice actions); Gard, 194 Kan. at 549 (parties
entitled to jury trial as a matter of right in common law action for damages based on
negligence claim). And given the jury's historic role in determining noneconomic
damages based on the facts of each case, we follow our existing caselaw and hold that
K.S.A. 60-19a02 encroaches upon the rights preserved by Section 5. This encroachment,
however, does not necessarily render K.S.A. 60-19a02 unconstitutional under Section 5.

Our court has long recognized that the legislature may modify the common law in
limited circumstances without violating Section 5. See Samsel II, 246 Kan. at 358;
Kansas Malpractice Victims, 243 Kan. at 344; Manzanares v. Bell, 214 Kan. 589, 616,
522 P.2d 1291 (1974); Shade v. Cement Co., 93 Kan. 257, 260, 144 Pac. 249 (1914). And
neither party challenges the legislature's authority to modify the common law without
violating Section 5—an argument that would have been contrary to our prior caselaw.
Instead, Miller and Johnson dispute the extent of the limitations that exist on this
legislative power.
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We begin our analysis by examining how this court has previously addressed the
limitations on the legislative power to modify common-law rights under Section 5 by
tying that determination to the substitute remedy analysis used in Section 18 right-to-
remedy cases—commonly referred to as a "quid pro quo" (this for that). Our caselaw
derives from decisions upholding the state's workers compensation system and no-fault
automobile insurance, as well as conflicting decisions dealing with health care provider
insurance availability and general tort litigation. We consider this next.

In Shade, the first decision addressing Section 5, this court considered a
constitutional challenge to the state's original workers compensation system, which was
enacted early in the 20th century. This statutory scheme represented a significant public
policy shift in how injured workers could recover for on-the-job injuries because it
abolished a worker's common-law right to sue an employer or fellow employee and
denied the worker the right to have a jury determine damages. See Injured Workers of
Kansas v. Franklin, 262 Kan. 840, 852, 942 P.2d 591 (1997) ("In 1911, the legislature
abolished a plaintiff's right to sue an employer for damages caused by the negligence of
the employer. In place of this right, the legislature gave employees the Workers
Compensation Act."). The Shade court expressly held that Section 5 was not an
impediment to the legislature's authority to enact the workers compensation system.
Shade, 93 Kan. at 260 ("The objection based upon the supposed deprivation of a right of
trial by jury is equally untenable, as determined in many adjudicated cases.").

But the Shade court's holding did not articulate the analytical basis for its decision
on the Section 5 challenge. This has led some post-Shade decisions and the dissenters in
this case to interpret Shade as upholding the legislation solely upon an opt-out provision
that permitted employees and employers to elect out of the system prior to a claim
occurring. See Kansas Malpractice Victims, 243 Kan. at 344 (commenting that Shade
"upheld the validity of worker's compensation legislation because coverage under the act
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was elective"). This view, however, can be criticized as an oversimplification of the
statute. The opt-out provision in the original workers compensation law was entirely
passive in nature, and its effect was not based on a knowing and voluntary waiver or
affirmative consent. Instead, the law upheld in Shade abolished an injured worker's
"inviolate" right to a jury trial as stated in Section 5 even though the worker had done
nothing to accept the benefits under the statute or forego his or her constitutional right to
a jury trial. The statute simply took away this inviolate right unless the worker performed
an intentional act to preserve it by opting out of the statutory provisions. Thus, the Shade
decision's influence on any Section 5 analysis cannot be as easily discarded as the dissent
argues.

Regardless, the opt-out provision was removed in 1974, making the system
mandatory for both employees and employers. L. 1974, ch. 204, sec. 8 (amending K.S.A.
44-505). And our more recent decisions emphasize that the Workers Compensation Act
constitutionally balances the interests of employees and employers—a balance described
as an adequate quid pro quo. See, e.g., Injured Workers of Kansas, 262 Kan. at 852 ("In
place of [an employee's right to sue the employer], the legislature gave employees the
Workers Compensation Act, which is supposed to provide a quick, set amount of money,
without proof of employer negligence, for all employees injured on the job."); Rajala v.
Doresky, 233 Kan. 440, 441, 661 P.2d 1251 (1983) ("The Workmen's Compensation Act
removes certain common law remedies for injured employees but provides a statutory
substitute therefor. This is basically a matter of public policy . . . ."). Most recently in
Scott v. Hughes, 294 Kan. 403, 275 P.3d 890 (2012), this court noted the act's quid pro
quo by explaining:

"The Kansas Workers Compensation Act nullifies employee common-law rights
to sue in tort in exchange for guaranteed but limited recovery in an administrative system
with judicial review. Covered workers no longer may exercise their common-law rights
to sue employers for work-related injuries, but they can count on certain, limited
compensation. The Act also makes a trade for covered employers: They need no longer
19

fear unlimited liability on employee claims, but they must purchase insurance or
otherwise provide for guaranteed payment of the compensation amounts dictated." 294
Kan. at 413.

Similar reasoning in Section 5 challenges has been applied to other comprehensive
legislation impacting a litigant's common-law rights. In Manzanares, this court
considered the statutory scheme commonly known at the time as the Kansas No-Fault
Insurance Act. Among other provisions, the Act denied a Section 5 right-to-jury trial and
recovery for pain and suffering resulting from a motor vehicle accident unless the injured
party incurred more than $500 in medical services or suffered a statutorily designated
injury. In deciding there was no Section 5 violation, the Manzanares court followed
Shade by recognizing the legislature's limited power to modify the common law without
infringing on the right to jury trial. 214 Kan. at 599 ("The decisions of this court are
replete with instances of common-law rights being modified or abolished."). As the
Manzanares court put it, "We have previously held the Legislature has the power to
modify the common law. Section 5 of our Bill of Rights does not bar those changes." 214
Kan. at 616.

Manzanares also held that modifications of common-law rights were acceptable so
long as the due process requirements of Section 18 were satisfied. 214 Kan. at 599;
Kansas Malpractice Victims, 243 Kan. at 343-44 (explaining Manzanares). And it is
noteworthy that no member of the Manzanares court dissented from its Section 5
holding, even though three justices wrote separately to concur with or dissent from other
portions of the decision.

Fourteen years after Manzanares, this court determined that the Section 5 right to
jury trial was violated in Kansas Malpractice Victims. In that decision, the majority
declared unconstitutional K.S.A. 1986 Supp. 60-3407, which limited noneconomic
damages in medical malpractice actions to $250,000 and total damages to $1 million and
20

required an annuity for payment of future noneconomic loss. Kansas Malpractice
Victims, 243 Kan. 333, Syl. In arriving at this outcome, the analytical model the court
used applied the prior quid pro quo caselaw that developed in the areas of workers
compensation and no-fault automobile insurance. Relying on Manzanares, the majority
acknowledged again that the legislature had the limited power to modify the right to jury
trial within the confines of due process, stating:

"[T]he legislature can modify the right to a jury trial through its power to change the
common law. [Citation omitted.] This power, however, is not absolute. Under
Manzanares, any statutory modification of the common law must meet due process
requirements and be 'reasonably necessary in the public interest to promote the general
welfare of the people of the state.' [Citation omitted.] Due process requires that the
legislative means selected have a real and substantial relation to the objective sought.
[Citation omitted.] One way to meet due process requirements is through substitute
remedies. 'We have never held one to have a vested right in the common-law rules
governing negligence actions so as to preclude substituting a viable statutory remedy.'
Manzanares v. Bell, 214 Kan. at 599." (Emphasis added.) Kansas Malpractice Victims,
243 Kan. at 343-44.

The court agreed that due process constraints were satisfied when the legislature
provides an adequate substitute remedy, or "quid pro quo," when modifying common-law
rights. And for this holding, the Kansas Malpractice Victims court referred its analysis
back to Rajala, noting that although the workers compensation system removed certain
common-law remedies for injured workers, it also provided a statutory substitute for
those changes. 234 Kan. at 344 ("The Rajala court upheld the [workers compensation]
legislation because the legislature provided, as a substitute, a viable statutory remedy.").
The Kansas Malpractice Victims majority stated:

"Just as the rights secured by Section 5 are not absolute, neither are the rights
secured by Section 18 [remedy by due course of law]. Over the years, the court has
allowed the legislature to modify remedies when required by public policy. [Citation
21

omitted.] However, as with Section 5, the court looks to insure that due process
requirements are met and, when a common-law remedy is modified or abolished, an
adequate substitute remedy must be provided to replace it." (Emphasis added.) 243 Kan.
at 346-47.

In other words, Kansas Malpractice Victims, which was the first case by this court
to consider a Section 5 challenge to a statutory cap on jury-assessed damages, applied a
quid pro quo analysis as it found had been done explicitly in Rajala and Manzanares, and
implicitly in Shade. But the difference was that the majority in Kansas Malpractice
Victims determined that the legislature's substitution of remedies was inadequate—on
balance—after applying the quid pro quo analytical model. This outcome, however, was
short-lived.

In Samsel II, this court revisited the adequate substitute remedy issue when
addressing the current statutory cap on noneconomic damages, which was applicable to
all personal injury plaintiffs, including medical malpractice. The Samsel II court
concluded that K.S.A. 1988 Supp. 60-19a01 did not violate a personal injury plaintiff's
right to jury trial under Section 5 or the right to remedy under Section 18. The majority
followed the process set out in Kansas Malpractice Victims to decide the adequacy of the
substituted rights, specifically: (1) the modification must be reasonably necessary in the
public welfare, and (2) "the legislature [must] substitute the viable statutory remedy of
quid pro quo (this for that) to replace the loss of the right." Samsel II, 246 Kan. at 358,
361.

The difference in outcomes from Kansas Malpractice Victims is that Samsel II
held that tort victims did receive an adequate substitute benefit in exchange for the
legislative cap because the statute restricted a trial court's common-law power of
remittitur to reduce a noneconomic damages award in excess of $250,000. Samsel II
reasoned that Kansas Malpractice Victims had "left unanswered" the question of whether
22

this limitation on the trial court's power to reduce an award below $250,000 provided a
sufficient quid pro quo but concluded the two decisions were consistent in their
approaches to the legal question presented. 246 Kan. at 358-59.

Moving now to Miller's right to jury trial argument, we face two questions in light
of our Section 5 caselaw. First, should this court continue to use a quid pro quo analysis
to determine whether the legislature properly exercised its power to modify a common-
law jury trial right? If the answer to that question is yes, then we consider a second
question: Has the legislature provided an adequate substitute for the jury trial right
obstructed by the noneconomic damages cap? On the first question, the majority of this
court holds the quid pro quo analysis should continue to apply to a Section 5 claim of
encroachment on the right to jury trial to remain consistent with our caselaw. We explain
that holding next.

The doctrine of stare decisis maintains that once a point of law has been
established by a court, it will generally be followed by the same court and all courts of
lower rank in subsequent cases when the same legal issue is raised. A court of last resort
will follow that rule of law unless clearly convinced it was originally erroneous or is no
longer sound because of changing conditions and that more good than harm will come by
departing from precedent. Rhoten v. Dickson, 290 Kan. 92, 112, 223 P.3d 786 (2010).
Stare decisis "'"promote[s] system-wide stability and continuity by ensuring the survival
of decisions that have been previously approved by a court."'" Crist v. Hunan Palace,
Inc., 277 Kan. 706, 715, 89 P.3d 573 (2004) (quoting Samsel II, 246 Kan. at 356).
"Judicial adherence to constitutional precedent ensures that all branches of government,
including the judicial branch, are bound by law." Samsel II, 246 Kan. at 356.

A quid pro quo analysis in Section 5 challenges to the legislature's limitations on
recovery for personal injuries has been employed by this court in varied contexts,
including workers compensation (Rajala), no-fault automobile insurance coverage
23

(Manzanares), medical malpractice (Kansas Medical Malpractice Victims), and general
tort litigation (Samsel II). To retreat from that analysis now, our court would have to
overrule those cases and embark on a new analytical model that would collaterally create
uncertainty about the constitutionality of the Workers Compensation Act, which has been
upheld since our 1914 decision in Shade, and what is now known as the Kansas
Automobile Injury Reparations Act, upheld since our 1974 decision in Manzanares. See
Samsel II, 246 Kan. at 361.

In addition, there is a link between Section 5 and Section 18 issues in a damages
case such as this, so it seems logical when dealing with statutory caps to have Section 5
and Section 18 encroachments measured against the same standard as has been done in
our prior caselaw. As discussed in greater detail below, our caselaw dealing with Section
18 right-to-remedy issues is well entrenched using a quid pro quo analysis and it simply
makes sense to have the same analytical model for Section 5. After all, noneconomic
damages are a subset of compensatory damages; therefore, the statutory cap impacts a
plaintiff's compensatory damages, which is a category of remedy at common law
protected by Section 18. Smith v. Printup, 254 Kan. 315, 325, 866 P.2d 985 (1993).
Moreover, the quid pro quo model readily allows the legislature to understand that it must
provide an adequate and viable substitute when modifying a common-law jury trial right
under Section 5 or right to remedy under Section 18.

Accordingly, we are not clearly convinced use of the quid pro quo model was
originally erroneous or is no longer sound because of changing conditions, or that more
good than harm would come by departing from this precedent. See Rhoten, 290 Kan. at
112. And while our court has come to different outcomes after employing the quid pro
quo analysis in Section 5 challenges, this does not detract from its viability as an
analytical model to determine such challenges. See Bair v. Peck, 248 Kan. 824, 844, 811
P.2d 1176 (1991) (Adequacy of the substitute remedy as it applies to comprehensive
remedial legislation must be made on a case-by-case basis.); Lemuz v. Fieser, 261 Kan.
24

936, Syl. ¶ 6, 933 P.2d 134 (1997) (In considering the adequacy of the quid pro quo of
comprehensive legislation that substitutes a statutory remedy for one that formerly
existed at common law, "no hard and fast rule can apply to all cases.").

We hold that a quid pro quo analysis is appropriate for determining Miller's
Section 5 right-to-jury trial claims against K.S.A. 60-19a02. We will employ that analysis
below after discussing the Section 18 challenge next.

Section 18 Analysis—the Right to Remedy

Section 18 of the Kansas Constitution Bill of Rights guarantees the right to a
remedy. It states: "All persons, for injuries suffered in person, reputation or property,
shall have remedy by due course of law, and justice administered without delay." This
right has been found since our early caselaw to mean "reparation for injury, ordered by a
tribunal having jurisdiction, in due course of procedure and after a fair hearing." Hanson
v. Krehbiel, 68 Kan. 670, Syl. ¶ 2, 75 Pac. 1041 (1904).

As with Section 5, there is no dispute that Section 18 guarantees are implicated
when the legislature imposes statutory caps on noneconomic damages for personal injury
plaintiffs, such as medical malpractice victims like Miller. Section 18 provides "an
injured party . . . a constitutional right to be made whole and a right to damages for
economic and noneconomic losses suffered." Samsel II, 246 Kan. at 353. The purpose of
economic and noneconomic damages is to make the injured party whole by restoring the
person to the position he or she was in prior to the injury. See Samsel II, 246 Kan. at 352-
53; Kansas Medical Malpractice Victims, 243 Kan. at 350 (right to a remedy is infringed
by statute limiting recovery for noneconomic loss, overall loss, and forcing plaintiffs to
accept their award over a number of years through an annuity contract); Neely v. St.
Francis Hospital & School of Nursing, 192 Kan. 716, 720-21, 391 P.2d 155 (1964)
25

(Section 18 applied to recovery for personal injuries suffered from negligent
administration of a vaccination).

The issue here is whether the statutory cap on noneconomic damages violates
Section 18 by denying Miller a remedy by due course of law because she cannot recover
more than $250,000 for her noneconomic damages. We have previously employed in
Section 18 challenges the same quid pro quo analysis as discussed above regarding
Section 5 to determine whether the legislature provided an adequate substitute remedy for
the common-law right affected. See, e.g., Manzanares, 214 Kan. at 599. In Manzanares,
this court upheld the mandatory no-fault automobile insurance laws against a Section 18
attack, stating:

"While Section 18 of the Bill Rights provides a broad field for the protection of
persons, property and reputation, the vested rights contained therein are subject to change
by legislative power, where the change is reasonably necessary in the public interest to
promote the general welfare of the people of the state. We have never held one to have a
vested right in the common-law rules governing negligence actions so as to preclude
substituting a viable statutory remedy for common law causes of action." (Emphasis
added.) 214 Kan. at 599.

We have repeated this language, or referred back to it, on numerous occasions.
See, e.g., Bair, 248 Kan. at 839; State ex rel. Schneider v. Liggett, 223 Kan. 610, 613,
576 P.2d 221 (1978). And in more recent years, the quid pro quo test for a Section 18
analysis has articulated the second part of the test as requiring an "adequate" substitute
remedy instead of a "viable" statutory remedy, but there appears to be little substantive
difference in the terminology. Cf. Lemuz, 261 Kan. 936, Syl. ¶ 4; Bonin v. Vannaman,
261 Kan. 199, Syl. ¶ 11, 929 P.2d 754 (1996). Accordingly, we apply next the quid pro
quo analysis for both Section 5 and Section 18 purposes.

26

Sections 5 and 18 Quid Pro Quo Analysis

A two-step analysis is required for the quid pro quo test. For step one, we
determine whether the modification to the common-law remedy or the right to jury trial is
reasonably necessary in the public interest to promote the public welfare. This first step is
similar to the analysis used to decide equal protection questions under the rational basis
standard. Lemuz, 261 Kan. at 948. For step two, we determine whether the legislature
substituted an adequate statutory remedy for the modification to the individual right at
issue. This step is more stringent than the first because even if a statute is consistent with
public policy, there still must be an adequate substitute remedy conferred on those
individuals whose rights are adversely impacted. Lemuz, 261 Kan. at 948; Bonin, 261
Kan. at 217-18; Aves v. Shah, 258 Kan. 506, 521-22, 906 P.2d 642 (1995); Samsel II, 246
Kan. at 358, 361; Manzanares, 214 Kan. at 599.

In Samsel II, which was the last time we considered whether the $250,000 cap on
noneconomic damages passed the quid pro quo test, this court held that it did in a case
involving a personal injury plaintiff. And because of that, we must decide first whether
we can simply accept the Samsel II rationale and perform the quid pro quo analysis to
result in Johnson's favor. We are urged to do that by Johnson and several amici, but there
are three principal reasons we will not rely on Samsel II for this case.

First, Samsel II was not a medical malpractice case affected by the Health Care
Provider Insurance Availability Act, K.S.A. 40-3401 et seq. That Act requires health care
providers to carry a minimum amount of insurance in order to practice in Kansas and also
makes available additional excess coverage through the Health Care Stabilization Fund.
See K.S.A. 40-3402 (mandatory coverage); K.S.A. 40-3408 (excess coverage). This
mandated coverage for her doctor arguably gives Miller an individualized substitute
remedy in the form of a guaranteed source of recovery for some of her damages, and
these same source-of-recovery provisions have been found to give other medical
27

malpractice plaintiffs an adequate substitute remedy in other cases. Bair, 248 Kan. at 844;
Aves, 258 Kan at 523-24; Lemuz, 261 Kan. at 959. This is something general tort litigants
(such as the plaintiff in Samsel II) do not have, and these provisions should be considered
as part of the quid pro quo analysis when applied to Miller's constitutional challenge to
K.S.A. 60-19a02.

Second, the $250,000 cap on noneconomic damages has not increased since
Samsel II. And as Miller points out without any real contradiction, the cap today provides
less commensurate remedy than when the legislature set it in 1988. This is due, of course,
to the reduction in buying power that accompanies inflation, and our court has made clear
that it is possible for a substitute remedy that was adequate when originally enacted to
become inadequate over time or because of changed circumstances. As we noted in Bair:
"The legislature, once having established a substitute remedy, cannot constitutionally
proceed to emasculate the remedy, by amendments, to a point where it is no longer a
viable and sufficient substitute remedy." (Emphasis added.) Bair, 248 Kan. at 844. The
same can be said for inflationary effects and legislative inaction over time when dealing
with a fixed dollar amount. Samsel II does not address this, and it is a legitimate issue for
reflection in this case.

Third, Samsel II premised its inquiry at step two on an interpretation of K.S.A. 60-
19a02(d)'s impact on a trial court's authority to order a new trial that we cannot accept.
K.S.A. 60-19a02(d) states in part that "[i]f the verdict results in an award for
noneconomic loss which exceeds the limits of this section, the court shall enter judgment
for $250,000 for all the party's claims for noneconomic loss." (Emphasis added.) The
Samsel II court held the italicized language prohibits trial courts from awarding "less than
$250,000 when higher damages are awarded by the jury." Samsel II, 246 Kan. at 362.
And from that construction, the court reasoned that the cap protected personal injury
plaintiffs from "conservative" judges, who might more drastically reduce a verdict below
$250,000, and in that manner statutorily substituted an adequate remedy for the rights
28

taken away by the cap. 246 Kan. at 361-62. But we hold that Samsel II erred on this
point.

K.S.A. 2011 Supp. 60-259(a)(1)(C) and (D) authorize a trial court to order a new
trial when it finds a verdict is the result of passion or prejudice, or is contrary to the
evidence. The purpose for this authority is to allow a district court to remedy an improper
jury verdict. Samsel II did not address this express statutory authority or consider whether
there was any reason to believe K.S.A. 60-19a02 was intended to override K.S.A. 2011
Supp. 60-259(a)(1)(C) and (D).

As noted in the amici brief by Professors Rich and Concannon, the Samsel II
analysis went beyond the plain language of K.S.A. 60-19a02(d) to speculate that the
legislature intended to substitute those provisions as a remedy for the cap on
noneconomic damages. For example, they point out that if a jury awards $400,000 in
noneconomic damages, it is illogical to believe the legislature expected a trial court to
simply reduce the award to a flat $250,000—if the trial court believed the evidence
supported an award less than $250,000. Otherwise, it would mean the legislature intended
for that plaintiff to receive more than the evidence supported, which is highly unlikely.
And nothing in the legislative history demonstrates a trial court was not supposed to
continue exercising its ordinary powers of remittitur over excessive jury awards
unsupported by the evidence. Samsel II read too much into K.S.A. 60-19a02(d) . We
reject this portion of Samsel II's holding.

For these reasons, we determine that Samsel II does not resolve whether an
adequate substitute remedy exists for the encroachments on the Section 5 right to jury
trial and Section 18 right to remedy caused by the $250,000 noneconomic damages cap
set out in K.S.A. 60-19a02. Accordingly, we move next to the first step in the two-step
analysis to consider whether the noneconomic damages cap is reasonably necessary in the
public interest to promote the public welfare. Lemuz, 261 Kan. at 949. We hold that it is.
29


As noted in several of our prior cases, the legislature's expressed goals for the
comprehensive legislation comprising the Health Care Insurance Provider Availability
Act and the noneconomic damages cap have long been accepted by this court to carry a
valid public interest objective. 261 Kan. at 949 (ensuring quality health care availability
in the state is a valid legislative objective that promotes the general welfare); Bonin, 261
Kan. at 216 (affordable and available malpractice insurance for doctors and the continued
availability of health care in Kansas are legitimate state interests); Aves, 258 Kan. at 526
(same); State ex rel. Schneider, 223 Kan. at 620 (same). And in Farley v. Engelken, 241
Kan. 663, 684-85, 740 P.2d 1058 (1987) (Holmes, J., dissenting), the dissent more
declaratively stated that it is "clear the court has accepted the legitimacy of the state's
interest in assuring the continued availability of health care to the citizenry and the
legislature's determination that a medical malpractice insurance crisis exists."

Johnson correctly points out that Miller does not argue the legislature's goals in
making medical malpractice insurance readily available for the state's health care
providers do not fall within the public interest rubric. Instead, Miller contends the cap
was—and is—not necessary to achieve those goals. But it is not necessary for a court to
make a factual determination whether the cap definitely would lower insurance
premiums, or has lowered them. The potential is enough. Lemuz, 261 Kan. at 949 ("Peer
review has the potential to lower malpractice incidents, thereby lowering malpractice
rates and thereby encouraging doctors to practice in Kansas."). Given this, our caselaw
generally settles the first step in the quid pro quo analysis in favor of the statute's
constitutionality.

Moving to the second step, we must determine whether the legislature substituted
an adequate statutory remedy for the modification of the individual rights at issue, which
in this case concerns the constitutional protections afforded to Miller by Section 5 and
Section 18. Lemuz, 261 Kan. at 948. We hold that it does.
30


We begin by considering what Miller has lost and try to put that loss in
perspective with our prior caselaw and the legislation that impacts her recovery in this
litigation. For Miller, the noneconomic damages cap unquestionably functions to deprive
her of a portion of her noneconomic damages, which the jury awarded based upon the
evidence presented at trial. Miller's loss must be viewed as being significantly more
serious than deprivations found in some of our cases that previously embarked on the
quid pro quo analysis. See e.g., Lemuz, 261 Kan. 936 (abrogation of corporate negligence
action); Aves, 258 Kan. 506 (prohibiting bad faith actions against the Health Care
Stabilization Fund); Bair, 248 Kan. 824 (eliminating vicarious liability of employer
health care providers); Manzanares v. Bell, 214 Kan. 589, 522 P.2d 1291 (1974)
(prohibiting suit below a minimum threshold). But she has not been left without any
compensation for her loss as other plaintiffs in some of our other cases. See Bonin, 261
Kan. 199 (special statute of repose for minors and persons with legal disability); Rajala v.
Doresky, 233 Kan. 440, 440, 661 P.2d 1251 (1983) (fellow employee immunity in
workers compensation statutes); Neely, 192 Kan. at 716 (immunity from judgment for
nonprofit hospitals).

It is also noteworthy that there is no cap on total damages awarded in the verdict.
This is not true in all states, as some jurisdictions limit the total damages receivable. See,
e.g., Colo. Rev. Stat. § 13-64-302 (2011) ($300,000 limit on noneconomic damages in
medical malpractice actions; $1 million total cap); Ind. Code § 34-18-14-3 (2008)
($1,250,000 total cap); Neb. Rev. Stat. § 44-2825 (2010) ($1.75 million total cap in
medical malpractice actions). Therefore, the deprivation caused by K.S.A. 60-19a02,
although very real, is limited in its scope. This is a substantial consideration when
deciding how adequate the substitute remedy provided by the legislature must be.

In addition, major statutory enactments establishing a broad, comprehensive
statutory remedy or scheme of reparations in derogation of a previously existing
31

common-law remedy may be subsequently amended or altered without each such
subsequent change being supported by an independent and separate quid pro quo. Lemuz,
261 Kan. at 955 (citing Bair, 248 Kan. at 842). Our caselaw does not require us to look
only to a contemporaneous quid pro quo within the same statutory enactment containing
the noneconomic damages cap.

As a medical malpractice plaintiff, Miller's damages cap operates within the
context of the comprehensive statutory scheme created in the Health Care Provider
Insurance Availability Act. And as mentioned, the Act mandates that all health care
providers—as a condition to providing health care services in Kansas—maintain
professional liability insurance with an approved company of not less than $200,000 per
claim, subject to not less than a $600,000 annual aggregate for all claims made during the
policy period. K.S.A. 40-3402(a). It also requires that health care providers elect one of
three levels of excess coverage from the Health Care Stabilization Fund, ranging from
$100,000 to $800,000. K.S.A. 40-3403(l). And it requires that every health care insurer
participate in an apportionment plan so that health care providers who are entitled to
insurance, but unable to acquire it through ordinary methods, may obtain insurance.
K.S.A. 40-3413(a). These provisions make the prospects for recovery of at least the
statutory minimums directly available as a benefit to medical malpractice plaintiffs when
there is a finding of liability. This is something many other tort victims do not have.

In both Bair and Lemuz, we found these mandatory insurance and excess coverage
provisions gave an adequate substitute remedy for the modification of common-law
remedies at issue in those cases. See Bair, 248 Kan. 824 (abrogation of corporate
negligence action); Lemuz, 261 Kan. 949 (eliminating vicarious liability of employer
health care providers). And in the context of our workers compensation and no-fault
automobile insurance caselaw, we have found the requirement of reliable sources of
partial recovery for serious injuries to be significant in the quid pro quo analysis in
deciding what constituted an adequate substitute remedy. See, e.g., Rajala, 233 Kan. 440.
32


For Miller, having an available source of recovery of the statutorily mandated
minimums provides her with a significant, individualized substitute remedy. And as
pointed out by more than one amici, a judgment that cannot be collected is worthless. So
under this statutory scheme, Miller has an obvious direct benefit not available to all
others. But this alone does not necessarily settle the question whether the legislatively
substituted remedy is adequate. Also important is the amount of the cap; and as to this,
there is a reasonable question as to the continued adequacy of the $250,000 limitation
that has admittedly devalued over time due to the legislature's failure to adjust it. We
must consider this question next.

Miller cites the Consumer Price Index Inflation Calculator to argue that in 2007
dollars, the cap was equivalent to $142,223.37, which represents a 57 percent erosion in
buying power since 1988. And we note the original 1986 cap on noneconomic damages
in medical malpractice actions provided for annual adjustments based on the consumer
price index. K.S.A. 1986 Supp. 60-3407(d). But this cost-of-living adjustment is no
longer part of the statutory scheme. See K.S.A. 60-19a02.

Johnson urges the court to reject the argument that inflation has rendered the quid
pro quo to Miller inadequate. Drawing from the language in Manzanares, 214 Kan. at
611, the doctor argues that, "'[w]hen it is seen that a line or point there must be, and there
is no mathematical or logical way of fixing it precisely, the decision of the legislature
must be accepted unless we can say that it is very wide of any reasonable mark.'" Johnson
also points out that other states' legislative bodies have more recently considered enacting
a noneconomic damages cap of $250,000, suggesting that this shows "Miller cannot
establish that inflation has rendered $250,000 'very wide of any reasonable mark' in
2008." Similarly, some amici briefs point out that our legislature has considered—but
rejected—increasing the cap on numerous occasions, which they argue implies a
substantive determination by lawmakers that the cap remains adequate.
33


But Johnson's reliance on Manzanares occurs out of context. The passage the
doctor recites was considering the $500 threshold the legislature set for denying a
plaintiff's ability to file a claim for nonpecuniary damages. It was not considering a
legislatively determined amount that would serve as the adequate substitute remedy for
the deprivation of rights caused by that threshold. 214 Kan. at 611. Instead, what was
decided in Manzanares to be the adequate substitute remedy was the direct benefit to
motor vehicle accident victims of ready payment for certain damages that were
guaranteed by the statutorily required insurance levels. 214 Kan. at 599 ("T]he Kansas
No-Fault Act assures all motor vehicle accident victims of prompt, efficient payment of
certain economic losses. To the extent there is a limitation on a person's ability to receive
non-pecuniary damages, the rights received in exchange are no less adequate."). Johnson
seriously misreads Manzanares as to this point.

Moreover, the "wide of any reasonable mark" standard from our caselaw
referenced by Johnson derives from the rational basis standard applied in equal protection
cases. See, e.g., Peden v. Kansas Dept. of Revenue, 261 Kan. 239, 258-59, 930 P.2d 1
(1996) (discussing equal protection); State ex rel. Schneider, 223 Kan. at 619. And while
we already give deference to the legislature in step one of the quid pro quo analysis when
determining whether a modification to a common-law right is reasonably necessary in the
public interest to promote the public welfare, the analysis in step two is a more stringent
test. And the issue is whether there is an adequate substitute right in the place of the
Section 5 and Section 18 rights diluted by the legislation—not whether the legislature
acted wide of any reasonable mark. To give the same deference to legislative decision-
making at the second step of the quid pro quo test as the first would reduce the analysis to
one step. The protections afforded by Section 5 and Section 18 are not simply
aspirational statements easily vulnerable to legislative encroachment. Samsel II, 246 Kan.
at 348 ("Our constitution does not make this court the critic of the legislature; rather, this
34

court is the guardian of the constitution . . . ."); Tri-State Hotel Co. v. Londerholm, 195
Kan. 748, 760, 408 P.2d 877 (1965) (same).

As to the fact that there are other states with a $250,000 cap on noneconomic
damages and other jurisdictions that recently considered setting a cap at that amount, our
review of other states' legislation shows it is difficult to accurately—and fairly—compare
what other states do in this regard. For example, there are wide variations in specific
provisions, such as method of computation, statutory exceptions for permanent
disfigurement or gross negligence, annual adjustments for inflation, and applicability per
occurrence, per claimant, and per defendant. See Hubbard, The Nature and Impact of the
"Tort Reform" Movement, 35 Hofstra L. Rev. 437, 497-99 (Winter 2006) (attempting to
summarize various state caps provisions and providing examples of the unique variations
and ranges involved). We find Johnson's argument based on other states' legislation
unpersuasive.

This leads us to Miller's argument that the passage of time has rendered the
statutory cap unconstitutional. And admittedly, the legislature's failure to increase the
$250,000 cap on noneconomic damages over the more than 20 years since it first set that
amount is troubling to this court. To be sure, the legislature has periodically increased
other statutorily mandated limits on liability. For example, the legislature has increased
an employer's liability for workers compensation benefits under K.S.A. 44-510f. Cf. L.
1974, ch. 203, sec. 16 ($50,000); L. 1979, ch. 156, sec. 8 (increasing employer's liability
to either $75,000 or $100,000); L. 1987, ch. 187, sec. 8 (increasing it to $100,000 and
$125,000 respectively); L. 2011, ch. 55, sec. 10 (increasing some benefit limits to
$130,000 and $155,000). The legislature has also increased the limits on damages
recoverable in wrongful death actions under K.S.A. 60-1903. Cf. L. 1984, ch. 214, sec. 1
($100,000 limitation on nonpecuniary loss); L. 1998, ch. 68, sec. 1 (increased to
$250,000 limit on nonpecuniary loss). The legislature has also tied a fixed dollar amount
to a consumer price index in other circumstances. See, e.g., K.S.A. 20-2609 (adjusting
35

judicial retirement benefits after disability benefits by considering consumer price index
for urban consumers); K.S.A. 74-4927 (same for public employees retirement system).

But despite our concern, we cannot say at this time that the legislature's failure to
increase the statutory cap has sufficiently diluted the substitute remedy to render the
present cap clearly unconstitutional when viewed in light of the other provisions in the
Act that directly and exclusively benefit a medical malpractice plaintiff. As we have
noted previously, "[e]ach case must be decided on its own merit, for our law does not
require a complete balance and equality between the benefits conferred by statute in the
place of the common-law remedy." KPERS v. Reimer & Koger Assocs., Inc., 261 Kan.
17, 39, 926 P.2d 466 (1996). We hold that the legislature has substituted an adequate
statutory remedy for the modification of the individual rights at issue, which in this case
concern the constitutional protections afforded to Miller by Section 5 and Section 18.

Equal Protection Analysis

Equal protection rights derive from Section 1 of the Kansas Constitution Bill of
Rights, which states: "All men are possessed of equal and inalienable natural rights,
among which are life, liberty, and the pursuit of happiness." Section 1 and the Fourteenth
Amendment to the United States Constitution provide virtually the same protections.
Board of Miami County Comm'rs v. Kanza Rail-Trails Conservancy, Inc., 292 Kan. 285,
315, 255 P.3d 1186 (2011). An equal protection analysis has three steps.

The first is to determine the nature of the statutory classification and whether that
classification results in arguably indistinguishable classes of individuals being treated
differently. The Section 1 Equal Protection Clause is only implicated if there is differing
treatment among similarly situated individuals. Kanza Rail-Trails Conservancy, 292 Kan.
at 315. The party challenging the statute's constitutionality has the burden of
demonstrating he or she is similarly situated to others treated differently. State v. Huerta,
36

291 Kan. 831, 834, 247 P.3d 1043 (2011). The second step examines the rights affected
by the classification because the nature of those rights dictates the level of scrutiny
applied to justify the classification. There are three levels of scrutiny: (1) the rational
basis standard to determine whether a statutory classification bears some rational
relationship to a valid legislative purpose; (2) a heightened or intermediate scrutiny to
determine whether a statutory classification substantially furthers a legitimate legislative
purpose; and (3) the strict scrutiny standard to determine whether a statutory
classification is necessary to serve some compelling state interest. Kanza Rail-Trails
Conservancy, 292 Kan. at 316. The final step requires determining whether the
relationship between the classifications and the object desired to be obtained withstands
the applicable scrutiny. 292 Kan. at 316.

Miller begins her equal protection attack by arguing that the cap disparately
impacts women and the elderly. And in the amici brief submitted by AARP et al., this
argument is expanded to allege the cap has a disproportionate impact on children, racial
and ethnic minority groups, and low-income persons. But as Johnson correctly points out,
a facially neutral statute challenged under equal protection on the basis it has a
discriminatory effect requires "not only that there is a disparate impact, but also that the
impact can be traced to a discriminatory purpose." Montoy v. State, 278 Kan. 769, 771,
120 P.3d 306 (2005) (quoting Personnel Administrator of Mass. v. Feeney, 442 U.S. 256,
272, 99 S. Ct. 2282, 60 L. Ed. 2d 870 [1979]). If we simply jump to that latter point,
Miller offers nothing to show the cap was motivated by an intent to discriminate against
women or the elderly, and neither does the AARP et al. Our own review of the legislative
history fails to disclose any such discriminatory purpose. We hold the cap "is not
unconstitutional based solely on its 'disparate impact.'" Montoy, 278 Kan. at 771.

Next, Miller argues the statutory cap treats personal injury plaintiffs differently
based on whether their noneconomic damages are higher or lower than $250,000. This is
obviously true. A plaintiff who sustains less serious injuries is entitled to full
37

compensation, while a plaintiff who sustains more than $250,000 in noneconomic
damages is not. Therefore, step one is satisfied.

Moving to step two regarding the nature of the right affected and the level of
scrutiny required, Miller contends the noneconomic damages cap should be evaluated
under the strict scrutiny standard because it affects her fundamental rights of trial by jury
and remedy by due course of law. But the problem with this strict scrutiny argument is
that the jury trial right under Section 5 and the right to remedy under Section 18 have
never been held to be fundamental rights for equal protection purposes. And while Miller
cites Gard v. Sherwood Construction Co., 194 Kan. 541, 549, 400 P.2d 995 (1965), for
the statement that the right to jury trial is "a fundamental feature of American
jurisprudence" and Adams v. St. Francis Regional Med. Center, 264 Kan. 144, 173, 955
P.2d 1169 (1998), for a statement that the right to a remedy is fundamental, these cases
do not concern equal protection and neither supports declaring such rights "fundamental"
for equal protection purposes. Thus, Miller's rationale for applying strict scrutiny is not
persuasive.

But we also take issue with Johnson's claim that the rational basis test obviously
applies based on our previous caselaw. For this claim, Johnson relies on language in
Samsel II in which the court considered whether the cap met the "reasonably necessary"
prong of the quid pro quo analysis. But neither Samsel II nor Kansas Malpractice Victims
addressed whether the noneconomic damages caps in controversy violated equal
protection. See Samsel II, 246 Kan. at 337, 363 (court's decision addressed only Sections
5 and 18); Kansas Malpractice Victims, 243 Kan. at 352 ("We agree with the trial court
that it makes no real sense to apply an equal protection argument analysis . . . when the
result in the case is controlled by Sections 5 and 18 of the Kansas Bill of Rights."). We
decline to read such a holding into the Samsel II court's analysis when addressing
constitutional challenges not expressly addressed in that decision. Nevertheless, and for
38

different reasons, we agree the rational basis standard applies to Miller's equal protection
challenge. We apply it because K.S.A. 60-19a02 is economic legislation.

It is well-established that statutes limiting liability and recovery of damages, like
the restriction on noneconomic damages in K.S.A. 60-19a02, are considered social and
economic legislation that trigger application of the rational basis test. See, e.g., Duke
Power Co. v. Carolina Env. Study Group, 438 U.S. 59, 83, 98 S. Ct. 2620, 57 L. Ed. 2d
595 (1978) (statute limiting licensed nuclear power plants is "classic example" of
economic regulation because it "accommodate[s] the 'burdens and benefits of economic
life'" and the rational basis test applies); KPERS v. Reimer & Koger Assocs., Inc., 261
Kan. 17, 41-43, 927 P.2d 466 (1996) (applying rational basis standard because statutory
liability limitations for parties entering KPERS settlement agreement are social and
economic legislation); Leiker v. Gafford, 245 Kan. 325, 363, 778 P.2d 823 (1989) (statute
capping nonpecuniary damages in wrongful death action is economic legislation
reviewed under rational basis standard). To satisfy the rational basis standard under step
three of the analysis, the statutory classification must bear some rational relationship to a
valid legislative purpose. Kanza Rail-Trails Conservancy, 292 Kan. at 316. The party
attacking a statute as facially unconstitutional for failing to satisfy the rational basis
standard has the burden to negate every conceivable rational basis that might support the
classification challenged. Downtown Bar and Grill v. State, 294 Kan. 188, Syl. ¶ 10, 273
P.3d 709 (2012).

Miller argues K.S.A. 60-19a02 fails to meet the rational basis standard, citing the
information she proffered to the district court alleging there was no credible evidence of a
medical malpractice insurance crisis or that it was caused by medical malpractice and tort
litigation awards. From this, she argues no rational relationship exists between the
statutory cap on noneconomic damages and the legislature's objective of curing the
medical malpractice insurance and liability insurance "crises" by lowering malpractice
and liability insurance premiums.
39


But as we stated above in discussing the quid pro quo analysis, the legislative
history and evidence offered by the parties and the amici show there was—and still is—
conflicting evidence regarding the existence and causes of the medical malpractice
insurance and liability insurance "crises" and whether there is any necessity for, or
efficacy of, a cap on noneconomic damages. See Minnesota v. Clover Leaf Creamery
Co., 449 U.S. 456, 464, 101 S. Ct. 715, 66 L. Ed. 2d 659 (1981) ("Where there was
evidence before the legislature reasonably supporting the classification, litigants may not
procure invalidation of the legislation merely by tendering evidence in court that the
legislature was mistaken."); United States v. Carolene Products Co., 304 U.S. 144, 154,
58 S. Ct. 778, 82 L. Ed. 1234 (1938) ("[if] it is evident from all the considerations
presented to Congress, and those of which we may take judicial notice, that the question
is at least debatable[,] . . . that decision was for Congress, [and a] finding of a court
arrived at by weighing the evidence . . . can[not] be substituted for it"). See also
Downtown Bar, 294 Kan. at 198 (citing Peden, 261 Kan. at 263) (legislative choice may
be based on rational speculation unsupported by evidence or empirical data).

The legislature enacted K.S.A. 60-19a02 in an attempt to reduce and stabilize
liability insurance premiums by eliminating both the difficulty with rate setting due to the
unpredictability of noneconomic damages awards and the possibility of large
noneconomic damage awards. See Report of the Citizens Committee on Legal Liability,
pp. 5-7, 64 (1986) (insurers were setting premiums based on worst-case scenarios,
resulting in high premiums and unavailability because some were reluctant to assume the
liability risk); House Judiciary Committee Minutes, March 3, 1987 (testimony concerning
the difficulty insurers had setting rates because noneconomic damages are unpredictable
and limitless; the possibility of large awards hinders settlements; and reasonable cap
would stabilize cost and availability over the long term); House Judiciary Committee
minutes, January 21, 1986, January 22, 1986, and January 23, 1986 (testimony
concerning effects of the severity of medical malpractice insurance claims on premium
40

increases and unavailability of insurance; problems included the unpredictability of large
awards, which hampers insurers' ability to accurately predict losses and price their
product accordingly; a cap on damages was necessary to stabilize premium rates and
bring more insurers back into the market); Report on Kansas Legislative Interim Studies
to the 1986 Legislature, pp. 846, 847 (Table VIII) (1985) (actuaries presented evidence
concerning effect of various caps on Fund surcharges; estimated that a $1 million total
cap with a cap of $500,000 on noneconomic damages could reduce Fund surcharge for
1986-87 by 3 percent and by 10 percent for 1987-88).

And although the applicable standard does not require it, there is evidence within
the legislative history of K.S.A. 60-19a02 demonstrating a rational basis for limiting
noneconomic damages and treating more egregiously injured plaintiffs differently by the
setting of a statutory cap on such damages. We hold that it is "reasonably conceivable"
under the rational basis standard that imposing a limit on noneconomic damages furthers
the objective of reducing and stabilizing insurance premiums by providing predictability
and eliminating the possibility of large noneconomic damages awards. See Downtown
Bar, 294 Kan. at 195-99. We hold the statutory cap of K.S.A. 60-19a02 does not violate
the equal protection guarantees of Section 1.

Separation of Powers Analysis

"The doctrine of separation of powers is not expressly set forth in either the United
States or Kansas Constitutions. However, it has long been recognized that the very
structure of our three-branch system gives rise to the doctrine." State v. Beard, 274 Kan.
181, 185, 49 P.3d 492 (2002). "[T]he doctrine of separation of powers is an inherent and
integral element of the republican form of government . . . ." Van Sickle v. Shanahan, 212
Kan. 426, 447, 511 P.2d 223 (1973). Miller argues that the noneconomic damages cap
enacted by the legislature abolishes the judiciary's authority to order new trials and robs
41

judges of their judicial discretion by functioning as a statutory remittitur effectively
usurping the court's power to grant remittiturs. We disagree.

In State ex rel. Stephan v. Kansas House of Representatives, 236 Kan. 45, Syl. ¶ 5,
687 P.2d 622 (1984), this court held that the legislative branch impermissibly intruded
upon the executive branch's power by enacting a statute giving the legislature control
over administrative rules and regulations. We struck down the offending legislation,
stating:

"The doctrine of separation of powers is an outstanding feature of the American
constitutional system. The governments, both state and federal, are divided into three
branches, i.e., legislative, executive and judicial, each of which is given the powers and
functions appropriate to it. Thus, a dangerous concentration of power is avoided through
the checks and balances each branch of government has against the other. [Citations
omitted.] Generally speaking, the legislative power is the power to make, amend, or
repeal laws; the executive power is the power to enforce the laws; and the judicial power
is the power to interpret and apply the laws in actual controversies. [Citation omitted.]"
State ex rel. Stephan, 236 Kan. at 59.

And while these general descriptions of the power held by a branch of government
suggests each occupies a separate sphere, "[i]n reality, there is an overlap and blending of
functions, resulting in complementary activity by the different branches that makes
absolute separation of powers impossible." State ex rel. Morrison v. Sebelius, 285 Kan.
875, 883, 179 P.3d 366 (2008). Therefore, we have held that a usurpation of powers
exists when one branch of government significantly interferes with the operations of
another branch. And to make this determination, a reviewing court considers: (1) the
essential nature of the power being exercised; (2) the degree of control by one branch
over another; (3) the objective sought to be attained; and (4) the practical result of
blending powers as shown by actual experience over a period of time. State ex rel.
Morrison, 285 Kan. at 884.
42


Article 3, section 1 of the Kansas Constitution establishes the source and extent of
the judicial power that Miller contends is abrogated by the noneconomic damages cap. It
states:

"The judicial power of this state shall be vested exclusively in one court of justice . . . .
The supreme court shall have general administrative authority over all courts in this
state." Kan. Const. art. 3, § 1.

This provision makes clear that judicial power is exclusively vested in the unified
court system, but it does not define what constitutes "judicial power." Our caselaw has
traditionally summarized the term as "the power to hear and determine a cause and the
rights of the parties to a controversy, and to render a binding judgment or decree based on
present or past facts under existing laws." State v. Mitchell, 234 Kan. 185, 194, 672 P.2d
1 (1983). In addition, the constitution grants this court administrative authority over the
Kansas court system, which has been described as the power to "promulgate and enforce
reasonable rules regulating judicial administration and court procedure as necessary for
the administration of justice." Mitchell, 234 Kan. at 194.

But before turning to the merits of Miller's separation of powers argument, we
address first Johnson's threshold contention that this court already ruled against Miller on
this challenge in Samsel I—the preliminary opinion released to inform the parties of the
case's outcome before the full Samsel II opinion could be prepared and filed. Johnson
refers in isolation to the Samsel I answer to the certified question posed by the federal
court: "Neither the original nor the amended version of 60-19a01 violates the
Constitution of the State of Kansas." (Emphasis added.) Samsel v. Wheeler Transport
Services, Inc., 244 Kan. 726, 727, 771 P.2d 71 (1989). Johnson then stretches this court's
simple advisory to argue that by so broadly stating the statute did not violate the Kansas
Constitution, this court "presumably" considered whether the statute violated the
43

separation of powers and determined it did not. Such an argument, however, denies
reality and ignores this court's more complete analysis that followed in Samsel II, which
clearly stated the constitutional claims the court reviewed. Samsel II did not address
separation of powers. It held only that the statute did not violate Sections 5 (right to jury
trial) and 18 (right to remedy by due process of law). Samsel II, 246 Kan. at 363. The
doctor's attempt to seize on the general language in Samsel I to extend its holding to the
four corners of the Kansas Constitution is without merit.

Returning now to the arguments Miller advances, she contends K.S.A. 60-19a02
violates separation of powers because it abolishes the judiciary's authority to order new
trials if the jury's award is inadequate, and because it is an inflexible cap that robs judges
of their judicial discretion by functioning as a statutory remittitur effectively usurping the
court's inherent, exclusive, and constitutionally protected power to grant remittiturs.
Miller specifically argues that the cap "completely abolishes judicial discretion to award
noneconomic damages in any amount above or below $250,000." Johnson counters that
the court's authority to grant remittitur or order a new trial exists only in the absence of a
statute to the contrary and that "a general modification of the damages recoverable in
personal injury cases is within the legislative power, not the judiciary." The doctor also
notes that a majority of courts considering this issue have held damages caps do not
violate separation of powers.

Miller's claim that K.S.A. 60-19a02 violates separation of powers because it
unconstitutionally limits the trial court's authority to order a new trial unless remittitur is
accepted is premised upon this court's holding in Samsel II that K.S.A. 60-19a02
prohibits a trial court from entering an award for less than $250,000, even if the evidence
supports less. We overruled the Samsel II court's analysis as to this issue in our quid pro
quo discussion above, so this claimed violation of separation of powers is without merit.
K.S.A. 60-19a02(d) imposes a cap on noneconomic damages that prevents the trial court
44

from awarding more than $250,000, but it does not prevent a trial court from granting a
new trial when permitted by K.S.A. 2011 Supp. 60-259 and the evidence.

As to Miller's second argument that K.S.A. 60-19a02 violates separation of powers
because it is an "inflexible cap" that robs judges of their judicial discretion, we hold this
argument to be without merit because we disagree with Miller's characterization of the
cap as a statutory remittitur. The power of remittitur is incident to the power to grant a
new trial after the verdict is determined to be excessive under K.S.A. 2011 Supp. 60-259
because it is based upon prejudice, passion, or insufficient evidence. When a verdict is
excessive for any of these reasons, the trial court as a matter of law refuses to accept it
and offers the prevailing party the option of a reduced verdict more in line with the
evidence. And if the party refuses, the court orders a new trial. Dixon v. Prothro, 251
Kan. 767, 770, 840 P.2d 491 (1992). The cap is not a "statutory remittitur" because it is
not conditioned on an erroneous verdict, nor is it conditioned on the prevailing party's
acceptance. We hold that Miller's second argument is without merit.

Miller's third argument is that the cap violates the separation of powers doctrine
because it can prevent a trial court from ordering a new trial unless the losing party
accepts an increased award through additur when the jury awards less than $250,000 and
the evidence supports a greater award. But that assertion is not entirely true. The trial
court may still order a new trial so long as the losing party accepts a higher award up to
the $250,000 limitation. It would only be when a trial court sought to use additur or
remittitur to create an award greater than $250,000 that the statutory cap intercedes to
prevent it.

In this respect, K.S.A. 60-19a02 does create some limitation on when it would be
sensible for a trial court to exercise its authority to order a new trial under K.S.A. 2011
Supp. 60-259 in lieu of additur or remittitur. If the verdict is greater than $250,000 and
the court determines that, as a matter of law, the verdict would be more in line with the
45

evidence if reduced to another dollar value greater than $250,000, the court will forgo
ordering a new trial because the cap would render such effort futile. Similarly, it would
be pointless for the trial court to order a new trial unless the losing party consents to a
higher verdict through additur of more than $250,000.

It is this de facto restriction on the trial court's exercise of the power to order a
new trial in lieu of additur or remittitur that is at the heart of Miller's separation of powers
claims. But Miller overlooks that this judicial power depends upon the trial court's
determination that the jury verdict is inappropriate on some basis. This means that the
question presented is whether it violates the separation of powers doctrine when the
legislature enacts statutes that restrict when a trial court may order a new trial in lieu of
additur or remittitur.

The powers to grant a new trial or offer additur or remittitur originally stemmed
from the common law. See Samsel II, 246 Kan. at 359 (discussing the court's common-
law authority to grant a new trial when the verdict is inadequate). But since the enactment
of the Code of Civil Procedure, the statutory basis for granting a new trial is exclusive.
Thus, a trial court has no jurisdiction to grant a new trial for a reason not provided in the
statute. See, e.g., Mettee v. Urban Renewal Agency, 219 Kan. 165, 167-68, 547 P.2d 356
(1976). And, as this court noted in Samsel II, at one time the new trial statute prohibited
granting a new trial because a verdict was inadequate, which as a practical matter
prohibited a trial court from ordering a new trial in lieu of additur. Samsel II, 246 Kan. at
359 (citing G.S. 1901, 4755). In Railway Co. v. O'Neill, 68 Kan. 252, 254, 74 P. 1105
(1904), this court recognized the legislature could "regulate the matter of the granting of
new trials" in this manner.

The long-standing legislative influence in these matters weighs against finding the
separation of powers doctrine is violated by K.S.A. 60-19a02 when considered in light of
the four factors articulated in State ex rel. Morrison v. Sebelius that guide consideration
46

of whether the doctrine was violated. The legislature has exercised some control over the
judicial power to grant a new trial if a party does not accept the court's offer of additur or
remittitur over many years. In actual experience, this has not yielded significant adverse
results.

Finally, and as we have already noted, the judiciary has "tolerated" the legislature's
regulation of the court's power to grant new trials since at least 1904, when the court in
Railway Co., 68 Kan. at 254, recognized that the legislature could "regulate the matter of
the granting of new trials," including the power to prohibit new trials based on the
inadequacy of an award of damages. This court has also recognized that a court's
authority to grant a new trial is limited to the six enumerated grounds provided by the
legislature in K.S.A. 60-259(a), which became effective January 1, 1964. Mettee, 219
Kan. at 168; L. 1963, ch. 303, sec. 60-259. The balance of the applicable factors weighs
against finding that the cap's implicit prohibition on granting a new trial when an award
of noneconomic damages is inadequate below the $250,000 cap significantly interferes
with judicial power. Accordingly, we hold the cap does not violate the separation of
powers doctrine.

TRIAL ERROR CLAIMS

We address next the parties' claims that the district court erred in posttrial rulings.
Miller argues the trial court erred by striking the jury's $100,000 award for future medical
expenses by granting Johnson's motion to alter or amend the judgment. Johnson argues
through a cross-appeal that she was entitled to judgment as a matter of law because
Miller failed to prove causation of damage for the negligence allegations. Alternatively,
Johnson argues she was entitled to a new trial based on three evidentiary errors. We begin
by deciding Miller's claim that the jury's $100,000 award for future medical expenses
should be reinstated.

47

Miller's Future Medical Expenses

The district court granted Johnson's motion to alter or amend the judgment,
striking Miller's $100,000 jury award for her claimed future medical expenses. The court
held that Miller offered insufficient evidence for the jury to make findings about her
future medical or counseling needs, how much future care she would require, or what that
cost would be over the next several decades until she reached menopause. Miller
challenges that ruling, pointing out that the district court denied a similar claim during
trial when the doctor raised it in a motion for directed verdict. By granting Johnson's
motion to alter or amend judgment, the district court changed its position more than a
year after the evidence had been heard.

Miller argues substantial competent evidence supports the jury's verdict by citing
the trial testimony of Dr. Richard Derman and Dr. John Spiridigliozzi, along with Miller's
medical records and bills. Miller argues the jury could have estimated the reasonable cost
of her future medical expenses using the testimony and medical bills admitted into
evidence. She also notes the award provides only $2,000 a year for her future health care
and is reasonable given Miller's age and life expectancy. Johnson counters that this
evidence is too conjectural or speculative to form a reasonable basis to measure Miller's
future medical needs and the expenses required to meet those needs.

Standard of Review

The decision to grant a motion to alter or amend a judgment pursuant to K.S.A.
2011 Supp. 60-259(f) is within the district court's sound discretion and will not be
disturbed on appeal unless there is an abuse of that discretion. Exploration Place, Inc. v.
Midwest Drywall Co., 277 Kan. 898, 900, 89 P.3d 536 (2004); Mitchell v. City of
Wichita, 270 Kan. 56, 66-67, 12 P.3d 402 (2000). Judicial discretion is abused if judicial
action is: (1) arbitrary, fanciful, or unreasonable, i.e., if no reasonable person would have
48

taken the view adopted by the trial court; (2) based on an error of law, i.e., if the
discretion is guided by an erroneous legal conclusion; or (3) based on an error of fact, i.e.,
if substantial competent evidence does not support a factual finding on which a
prerequisite conclusion of law or the exercise of discretion is based. State v. McCullough,
293 Kan. 970, 980-81, 270 P.3d 1142 (2012) (quoting State v. Ward, 292 Kan. 541, 550,
256 P.3d 801 [2011]). In this case, we must focus our attention on the third inquiry—
whether the trial court's ruling was based on an error of fact concerning the detail within
Miller's evidence of her future medical expenses.

Sufficiency of the Evidence for Future Medical Expenses

In assessing the doctor's motion to alter or amend the jury's $100,000 award for
future medical expenses, the district court was required to stay within certain parameters,
which this court articulated in McKissick v. Frye, 255 Kan. 566, 591, 876 P.2d 1371
(1994), as follows:

"In a negligence action, recovery may be had only where there is evidence
showing with reasonable certainty the damage was sustained as a result of the negligence.
Recovery may not be had where the alleged damages are too conjectural or speculative to
form a basis for measurement. To warrant recovery of damages, therefore, there must be
some reasonable basis for computation which will enable the trier of fact to arrive at an
estimate of the amount of loss."

Within these constraints, we must examine the medical records and billings
submitted to the jury and consider the trial testimony of Miller's experts to determine
whether there was a reasonable basis for the jury to compute Miller's future medical
expenses.

Miller begins by noting Derman's testimony on her future medical needs. Derman
is an obstetrician gynecologist with a practice "focused on preventive health care." And
49

his expertise is with women who are becoming menopausal and postmenopausal. Derman
testified in part:

"[DERMAN] . . . [B]ased upon [Miller's] history and her symptoms I determined that she
would need long term estrogen therapy and because of the need to have estrogen therapy
she would be regulated to long term blood thinners or Coumadin, which means that she
would be getting approximately monthly blood draws [and] would be seeing the
hematologist for frequent visits. That she would continue to see the gynecologist at least
a couple of times a year, in terms of her—both her quality of life issues the tight traction
or changing doses and needs of her hormones, the issues associated with sexual
dysfunction. I also said that she possibly would require some visits with an
endocrinologist to check out thyroid function. . . . I was concerned about shifting body
weight. Difficulty in weight loss being certain that we were to monitor her good and bad
cholesterol and triglyceride. . . . I was concerned with long term blood thinners, and the
fact that she went through surgical menopause, that there might be an increased risk of
bone loss and osteoporosis. I talked about the importance of getting what we call a bone
test or DXA test, as well as, getting her routine mammography and all of her
immunizations up-to-date, as well as her need for psychiatric or psychological consult. I
think somewhere . . . I pointed out the fact that her internist may want to get an
echocardiogram, but people who have these types of conditions, these types of genetic
effects may have a propensity of showing false blood clots, and in the valves of the heart,
develop small clots. So, pretty much that is a summary of what I indicated would be
necessary for [Miller]."

Derman explained that Miller would be dealing with being menopausal and
postmenopausal, with the associated symptoms of hot flashes, insomnia, mood swings,
and vaginal dryness for approximately 20 years longer than an average woman in the
United States. He also discussed Miller's long-term consequences with respect to a
unique blood condition, including his estimate that her blood clotting risk was
approximately 60 times that of an average woman. Derman also believed Miller would
need continued estrogen therapy over the next 20 to 30 years, and as a result of her blood
condition would require a blood thinning agent.
50


Johnson's defense counsel, on the other hand, had Derman admit during cross-
examination that some of Derman's recommendations applied to all women. That
exchange stated:

"[DEFENSE COUNSEL]: And these are test[s] that you say that in your opinion [Miller]
needs in the future, the evaluation an[d] visits?

"[DERMAN]: Yes.

"[DEFENSE COUNSEL]: Some of those things. Perhaps not as frequently and perhaps
not as soon, but some of those things you recommend for all women?

"[DERMAN]: That's correct.

"[DEFENSE COUNSEL]: So, you're not trying to tell the jury only because of her
condition does she need a mammogram?

"[DERMAN]: No.

"[DEFENSE COUNSEL]: Or because only because of her condition she would need a
DEXA?

"[DERMAN]: But the DEXA would be done earlier.

"[DEFENSE COUNSEL]: [O]f the test that you mentioned which would you
recommend to any wom[an], although maybe not as soon or not as frequently?

"[DERMAN]: Well . . . certainly a pelvic examination, a gynecological test and
mammography. I would recommend to all of my patients a DEXA test at one point."

Later in the trial, Spiridigliozzi, a psychologist, provided additional testimony
about Miller's future medical needs, stating:
51


"[SPIRIDIGLIOZZI]: Well, I think that [Miller] would benefit from seeing a
professional psychologist or someone that is trained; has experience or expertise in
dealing with anxiety disorders. . . . I think that she can probably use a medication
evaluation too. So she could see a psychiatrist, I think that could help her reduce her
anxiety[.] . . .

"Marital counseling clearly to help her and her husband deal with some of the
things that have come up for them. . . . How to deal with early menopause for a wom[an].
. . . And eventually maybe the marital therapy could also incorporate the children, and
become family therapy at some stage because she does say that she's very short with the
children. . . . [S]he could [also] benefit from seeing a nutritionist or dietician.

"I think also she could learn more about her condition and maybe see a physical
therapist, perhaps, or an occupational therapist."

With respect to the need for treatment with a psychologist, Spiridigliozzi estimated
such therapy with a licensed doctoral-level psychologist at an approximate cost of $120
per hour. Spiridigliozzi also testified that the intensity and frequency of family therapy
and occupation or physical therapy would depend on Miller's progress with her one-on-
one counseling. Spiridigliozzi further testified that in his professional judgment, Miller
was unlikely to improve with her anxiety disorder without professional assistance.

With this expert testimony as a foundation, the final element in Miller's case for
future medical expenses came from her medical records and bills that reflected her course
of treatment both before and after her left ovary was mistakenly removed when she was
28 years old. Miller argues these components when viewed together gave the jury a
sufficient understanding to use her medical bills and records as indicative of what the
reasonable costs of her future medical expenses would be. Miller then notes that $2,000
annual average over the remainder of her life expectancy, without any adjustment for
inflation, is neither excessive nor without any basis in the evidence.
52


In McKissick, this court upheld an award of $30,000 for future medical services
based solely on a chiropractor's testimony that the plaintiff would require weekly
treatment at a cost of $34 per visit. Similarly, in Cott v. Peppermint Twist Mgt. Co., 253
Kan. 452, 466, 856 P.2d 906 (1993), this court upheld a jury's award of damages for
future medical expenses even though the experts who testified at trial could not agree on
the plaintiff's future medical needs. And because both expert theories were supported by
some evidence showing the costs associated with their corresponding medical treatments,
this court concluded that each jury had a reasonable basis for computation of the award
and was not based on mere speculation. Both of these decisions establish that the jury has
a reasonable evidentiary basis to calculate future medical services if there is evidence of
costs and testimony about possible future services. Certainty about the exact future
services an individual will need is not required.

In Smith v. Massey-Ferguson, Inc., 256 Kan. 90, 116, 883 P.2d 1120 (1994), this
court approved a jury award for future medical expenses based largely upon medical
expenses incurred to date. The evidence in Smith is comparable to the evidence Miller
offered and that the jury accepted as credible. For example, the jury was aware of Miller's
life expectancy and expert opinion regarding both her short-term and long-term future
medical needs and had detailed information about her medical expenses incurred since
both of her ovaries were removed—resulting in surgical menopause. The cost
information included expenses for office visits and some of her medications. Taken
together, the evidence provided a general range of costs similar to what was used in Smith
to form an adequate evidentiary basis. See 256 Kan. at 116-17. In addition, the jury was
aware of Spiridigliozzi's specific testimony about Miller's need for psychological
services, the possible duration, and costs ($120 per hour) typically associated with that
therapy.

53

The district court erred by determining there was an insufficient factual basis for
the jury's future medical expenses award. It mischaracterized Derman's testimony as
being only about "possible" future needs, when Derman testified as to Miller's actual
medical and therapeutic needs without equivocation. Similarly, the district court miscast
Spiridigliozzi's testimony as being speculative concerning the benefits Miller would
receive from future psychological services, when the doctor actually testified Miller
would benefit from such services. In this manner, the testimony offered by Derman and
Spiridigliozzi was similar in character to the expert's testimony in McKissick. See 255
Kan. at 591-92 (chiropractor testified plaintiff "'would have to have treatment about once
a week right up until she could either overcome [the injury] or it would gradually get
worse, and we may have to slide it up where it would be twice a week treatment
program'"). Finally, when deciding that Miller had offered no evidence as to costs, the
district court did not consider the medical records and billings offered into evidence,
which Miller explained was a component of her future medical expense claims.

We hold that the district court based its ruling to alter or amend the judgment on
factual mischaracterizations of the evidence and a failure to consider all the evidence
Miller presented to support her claim for future medical expenses. The district court
premised its decision to strike the jury's award on these errors of fact. The district court's
posttrial order constitutes an abuse of discretion under our standard of review. We
remand the case to the district court with instructions to reinstate the jury's $100,000
award for future medical expenses.

Johnson's Motion for Judgment as a Matter of Law

Johnson filed a motion for judgment as a matter of law under K.S.A. 60-250,
arguing that Miller failed to prove causation because Miller's medical condition often
requires the removal of both ovaries. The district court denied the doctor's motion,
holding that there was sufficient evidence to create a jury question. More specifically, the
54

district court found the evidence sufficient that there was no medical indication to remove
Miller's left ovary at the time Johnson performed the laparoscopic procedure and that
Miller experienced a variety of problems as a result of having both ovaries removed. The
district court conceded in its posttrial ruling that the evidence offered by both sides
conflicted as to these points but held those inconsistencies were best resolved by the jury,
which found against the doctor.

Standard of Review

When ruling on a motion for judgment as a matter of law under K.S.A. 60-250, the
district court must resolve facts and inferences reasonably drawn from the evidence in
favor of the party the directed verdict is sought against. If reasonable minds could reach
different conclusions based on the evidence, the motion must be denied. An appellate
court applies a similar analysis when reviewing the denial of a motion for judgment as a
matter of law. The motion's consideration becomes a question of law if no evidence is
presented on an issue or if evidence is undisputed and the minds of reasonable persons
may not draw differing inferences or arrive at opposing conclusions. Deal v. Bowman,
286 Kan. 853, 858, 188 P.3d 941 (2008).

Analysis of the Motion for Judgment as a Matter of Law

Johnson argued to the district court after the verdict that the evidence at trial
proved Miller suffered from chronic pelvic pain, which was a preexisting condition that
often required removal of both ovaries and the uterus. Johnson asserted that because
Miller suffered from this preexisting condition, it was outside a juror's common
knowledge and experience to determine whether removal of Miller's right ovary as
planned with the first surgery would have resolved Miller's problems without later
removal of her left ovary. Johnson concluded that Miller failed to prove causation
because no one testified that Miller's "left ovary would not have been removed even if her
55

right ovary had been removed [as originally planned]." In response, Miller argued that
Johnson's logic was flawed because the evidence at trial proved she would be functioning
well with one ovary had Johnson removed the right ovary as intended.

The district court denied Johnson's motion for judgment as a matter of law,
concluding:

"Miller presented evidence through Dr. Andrew Brill that it was below the standard of
care to remove the left ovary when the indication and planned surgery was for the right
ovary. [Brill] testified that there was no indication for removal of the left ovary. . . . Dr.
Richard Derman testified that once both ovaries were removed, Miller would experience
a variety of problems, all related to the fact she did not have any ovaries. Miller
established, through expert testimony, negligence and causation. Dr. Johnson presented
alternative expert testimony; however, that testimony was not followed by
the jury."

On appeal, the doctor continues to press the same argument made to the trial court.
Johnson claims that because of Miller's preexisting medical conditions, both of her
ovaries and uterus needed to be removed eventually, even if the left ovary was
mistakenly taken first. The doctor argues Miller had the burden to prove that her left
ovary would never have needed to be removed. Miller responds that it is sufficient she
proved there was no medical justification to remove her left ovary.

To establish a medical malpractice claim, a plaintiff must show: (1) the health care
provider owes the patient a duty of care and was required to meet or exceed a certain
standard of care to protect the patient from injury; (2) the health care provider breached
this duty or deviated from the applicable standard of care; (3) the patient was injured; and
(4) the injury was proximately caused by the health care provider's breach of the standard
of care. Puckett v. Mt. Carmel Regional Med. Center, 290 Kan. 406, 420, 228 P.3d 1048
(2010).
56


Johnson argues Miller failed to establish the proximate cause of injury element.
There are two categories of proximate cause: causation in fact and legal causation. To
demonstrate causation in fact, a plaintiff must prove a cause-and-effect relationship
between the defendant's conduct and the plaintiff's loss by presenting sufficient evidence
from which a jury could conclude that more likely than not, but for the defendant's
conduct, the plaintiff's injuries would not have occurred. Puckett, 290 Kan. at 420. Miller
points to the testimony of her expert witness, Dr. Andrew Brill, and to the defendant
doctor's testimony as establishing that there was no medical justification for the removal
of her left ovary.

This court's review of that testimony shows Miller is correct. Brill repeatedly
responded to counsel's questions by testifying there was no medical reason or
justification for Johnson to have removed Miller's left ovary. Likewise, Johnson agreed
with Brill's assessment that there was no medical justification for removal of the left
ovary. And the district court correctly noted that Johnson's expert witnesses offered a
contrary view regarding Miller's preexisting medical conditions, but this simply led to a
jury question of fact that got resolved against the doctor.

We hold that the district court did not err in denying Johnson's motion for
judgment was a matter of law.

Johnson's Motion for New Trial

The final issue concerns the district court's rejection of Johnson's motion for new
trial. Johnson argued she was entitled to a new trial because the district court: (1)
prevented two of Miller's treating physicians from testifying that it would have been
necessary to eventually remove Miller's left ovary; (2) prevented cross-examination of a
plaintiff's expert regarding professional disciplinary actions; and (3) permitted
57

questioning of Miller about Johnson's statements in certain pleadings in which Johnson
denied liability. We will address each in this order.

Standard of Review

Granting a new trial under K.S.A. 60-259(a) is within the trial court's discretion,
and that ruling will not be disturbed on appeal unless that discretion was abused. City of
Mission Hills v. Sexton, 284 Kan. 414, 421, 160 P.3d 812 (2007). As discussed above,
judicial discretion is abused if judicial action is (1) arbitrary, fanciful, or unreasonable;
(2) based on an error of law; or (3) based on an error of fact. McCullough, 293 Kan. at
980-81.

Treating Physicians' Testimony

Johnson argues the trial court abused its discretion by restricting the testimony of
Drs. Daniel Stewart and Christopher Lynch. Both doctors took over Miller's medical care
after Miller's left ovary was mistakenly removed in 2002. Johnson argues on appeal that
these two treating physicians should have been permitted to testify that Miller would
eventually have had both ovaries removed anyway because of her preexisting medical
conditions. The point of the testimony apparently was to support Johnson's argument that
Miller was not damaged by Johnson's surgical error. This was a hotly contested issue
before, during, and after trial.

The question first was presented as a pretrial motion in limine in which Miller
objected to the proposed testimony after learning about it shortly before trial. Miller
claimed Johnson had failed to properly disclose the proposed testimony during discovery,
which violated prior court orders. Miller also argued that, as treating physicians, Stewart
and Lynch could not offer such testimony without full expert disclosure because those
58

opinions were outside of what was incidental to the doctors explaining their care and
treatment of Miller.

The record does not provide us with the district court's pretrial ruling on the
motion in limine, but it does suggest the trial court indicated it would preliminarily limit
the doctors to testifying only about those matters stated in their medical records, their
care and treatment of Miller, and inquiries reasonably related to that treatment, with an
understanding to return to the issue as testimony developed at trial. This handling is
consistent with the usual accepted trial court practice for considering motions in limine.
See Manhattan Ice and Cold Storage, Inc. v. City of Manhattan, 294 Kan. 60, 69-70, 274
P.3d 609 (2012) (summarizing a district court's discretion and necessary considerations
when ruling on a pretrial motion in limine).

As expected, the issue resurfaced at trial when the first doctor appeared to testify.
At that time, the district court had a lengthy colloquy with counsel outside of the jury's
presence during which the matter was reargued. The district court then held it would not
allow either doctor's testimony that the ovary Johnson removed would have needed to be
removed eventually. The district court gave two reasons for its ruling. First, the court
found that its pretrial orders had obligated Johnson to disclose the proposed testimony
from these two doctors sooner than actually occurred—about 1 month before trial. The
court found this violation of its discovery schedule and order had prejudiced Miller's
ability to address the proposed testimony because the disclosure came after much of the
expert discovery. Second, the district court held the limitations on these two physicians'
testimony derived from K.S.A. 60-226(b)(6). At the time of Miller's trial that statute
provided:

59

"(6) Disclosure of expert testimony.

"(A) A party shall disclose to other parties the identity of any person who may be
used at trial to present expert testimony.

"(B) Except otherwise stipulated or directed by the court, this disclosure, with
respect to a witness (i) whose sole connection with the case is that the witness is retained
or specially employed to provide expert testimony in the case or (ii) whose duties as an
employee of the party regularly involves giving expert witness testimony, shall state the
subject matter on which the expert is expected to testify, the substance of the facts and
opinions to which the expert is expected to testify and a summary of the grounds for each
opinion.

"(C) These disclosures shall be made at the times and in the sequence directed by
the court. . . .

"(D) Unless otherwise ordered by the court, all disclosures under this subsection
shall be made in writing, signed and served. Such disclosures shall be filed with the court
in accordance with subsections (d) of K.S.A. 60-205 and amendments thereto."

After trial, Johnson argued the district court had mistakenly restricted the
testimony from Stewart and Lynch, that the limitation was prejudicial to the verdict
against Johnson, and that a new trial should be ordered. In denying the motion for new
trial, the district court simply referred back to its earlier decisions regarding this
testimony and reaffirmed the rationale explained at that time, stating:

"As treating physicians the Court limited these doctors' testimony, pursuant to K.S.A. 60-
226(b)(6), to matters set forth in their records, their care and treatment of Miller and
subjects that were reasonably related to that treatment. After review and consideration of
the Court's previous decision in limine to exclude this testimony as well as consideration
of Dr. Johnson's current motion, Dr. Johnson's motion for new trial is denied."

60

On appeal, Johnson argues she is entitled to a new trial because K.S.A. 60-
226(b)(6) applies only to expert witnesses "whose 'sole connection with the case is that
the witness is retained or specially employed to provide expert testimony . . . .'" And from
that perspective, Johnson contends K.S.A. 60-226(b)(6) did not apply to the testimony of
Stewart and Lynch because they were Miller's treating physicians. In the alternative,
Johnson argues her supplementation of expert disclosures was timely filed under K.S.A.
60-226(e)(1), providing Miller with sufficient time to address the new testimony to be
offered.

Although both parties invite us to delve more deeply into the statutory disclosure
requirements for opinions that may be given by treating physicians, we find that the
district court's order may be upheld on other grounds. The first justification, which is
founded upon the trial court's interpretation of its own pretrial orders concerning the
parties' discovery obligations, is sufficient to affirm the ruling denying the new trial. As
the district court noted, it held conferences with the parties shortly before the scheduled
trial and Johnson did not indicate that this subject matter would be addressed by these
two witnesses. The court further noted that Johnson should have disclosed the proposed
testimony even earlier pursuant to its case management order through the required
witness factual summaries. The district court also specifically found that Miller was
prejudiced by this delay because her expert witnesses' trial testimony had already been
secured and Johnson's dilatory disclosure resulted in "unfair surprise."

K.S.A. 60-237(c) provides that a party's failure to disclose witness information
required by a court's scheduling order entered pursuant to K.S.A. 60-226(b)(6)(C)
precludes that testimony unless the court finds the failure was substantially justified or
harmless. In this case, the district court found neither exception supported the delay. An
abuse of discretion standard applies to decisions made under K.S.A. 60-237(c). Divine v.
Groshong, 235 Kan. 127, 142, 679 P.2d 700 (1984). Additionally, we have always held
61

that a trial court is vested with broad discretion in supervising the course and scope of
discovery. In re Care & Treatment of Hay, 263 Kan. 822, 839, 953 P.2d 666 (1998).

In the doctor's appellate briefs, Johnson does not address how, or even whether,
the trial court misinterpreted its own scheduling orders or erred in its determinations that
Johnson failed to comply with those orders, had no justification for such failure, and that
the failure prejudiced Miller. Our own review of the record shows the district court had
entered scheduling orders requiring disclosure regarding the substance of witness
testimony. We are convinced the district court acted well within its discretion in limiting
the doctors' testimony because of Johnson's failure to comply with the previously entered
discovery schedule.

Limitation of Expert Cross-examination

Johnson next argues in very general terms that the district court erred by
preventing her from cross-examining one of Miller's expert witnesses regarding that
witness' medical license. Johnson claims this questioning would have been relevant to
that witness' credibility. In denying a new trial on this basis, the district court specifically
ruled this did not prejudicially affect Johnson and did not rise to the level of granting a
new trial.

The first obvious problem with Johnson's argument is that it is not adequately
briefed or argued. Johnson does not cite to the record on appeal where she entered her
trial objection to demonstrate the issue was preserved, and she cites no legal authority
supporting her argument. And Johnson does not address in any manner the district court's
holding that no prejudice resulted from this claimed error. We find the two paragraphs of
Johnson's brief inadequate to properly raise this issue on appeal. Claims made in passing
without argument or citations to authority are deemed waived and abandoned. Frick
Farm Properties v. Kansas Dept. of Agriculture, 289 Kan. 690, 714, 216 P.3d 170
62

(2009). We hold that Johnson has inadequately presented this issue on appeal for this
court's consideration of it.

Questioning Miller about Johnson's Legal Pleadings

Johnson does only slightly better than the previous issue at briefing her claim that
Miller should not have been questioned about the impact on her of Johnson's general
denial in the legal pleadings that medical malpractice had been committed. Johnson
contends only generally that the evidence was irrelevant and "highly prejudicial," but she
offers no caselaw support or deeper discussion as to how the admission of this
testimony—in the context of the other evidence—adversely impacted the jury's outcome
or denied Johnson a fair trial.

We note again that the district court specifically found no prejudice from the
admission of this testimony, and Johnson's only contention to this court is the bald
counter that the evidence was "highly prejudicial." Any effort to demonstrate prejudice
would necessarily include consideration of the other evidence presented at trial and
Johnson has not attempted to make this showing. This is insufficient to argue such an
issue to this court. As with the previous claim, we hold Johnson has waived it.

Affirmed in part, reversed in part, and remanded with directions.

ROSEN, J., not participating.
KNUDSON, J., assigned.
1

1
REPORTER'S NOTE: Senior Judge Knudson was appointed to hear case No. 99,818
vice Justice Rosen pursuant to the authority vested in the Supreme Court by K.S.A. 20-
2616.

63

* * *

BEIER, J., concurring in part and dissenting in part: I agree with the majority's
resolution of the nonconstitutional issues in this case. I also agree with the majority's
determination that the statutory cap on noneconomic damages does not violate the
doctrine of separation of powers. I would, however, reverse and remand to the district
court because K.S.A. 60-19a02, as applied to plaintiff Amy C. Miller, violates the right to
trial by jury of Section 5 and the right to remedy provision of Section 18 of the Kansas
Constitution Bill of Rights. Given my certainty about these constitutional infirmities, I
reserve judgment on the merit of Miller's equal protection challenge.

The majority's decision to uphold the cap flows from what I believe to be its
misunderstanding and underperformance of this court's duty to police legislative
infringement of Kansas citizens' constitutional rights. Although my colleagues are honest
and hardworking judges for whom I have great respect, today we disagree.

On the jury trial issue, in particular, the majority apparently starts with what it
views as a palatable result and works backward to articulate a substitute rationale for
demonstrably infirm precedent. This approach is mystifying, as this court normally prides
itself on doing exactly the opposite, following the law and logic to their natural
conclusion. I see no reason to deviate from this practice in this case. Nor is there a reason
for the majority to cling to analytical errors infecting certain of our precedents, at times
inflating the support they can provide to its chosen outcome. It is more honorable to
repair a wrong than to persist in it. Thomas Jefferson, The Batture at New Orleans
(1812), in 18. The Writings of Thomas Jefferson 123 (Bergh, ed. 1907).

On the right to remedy issue, the majority correctly recognizes that we permit the
legislature to abolish a common-law remedy protected by Section 18 as long as it
provides an adequate substitute remedy reasonably necessary in the public interest to
64

promote the general welfare of the people of the state. But, in my view, the majority fails
to recognize the hollowness of the purported substitute here and neglects its responsibility
to demand that even the illusory remedy be adequate. Indeed, its only adequacy
discussion shifts its focus from the purported remedy on which it has relied to the amount
of the cap. In short, the cap and the other legislation relied upon by the majority take
from injured Kansans; these measures give nothing in return.

HISTORY OF K.S.A. 60-19a02

Before I can discuss the reasons I depart from the majority, I pause to fill in its
incomplete review of the relevant history behind the cap statute. The majority's more
casual approach to context may partly enable what I see as its later analytical missteps.

In 1976, the legislature enacted a package of health-care-related reforms. The
Health Care Provider Insurance Availability Act (HCPIAA) was the main component of
those reforms. See K.S.A. 40-3401. It had three key features.

First, the Act demanded that all health care providers, as a condition to practice in
Kansas, must carry professional liability insurance coverage of not less than $100,000 per
occurrence with a $300,000 annual aggregate. K.S.A. 1976 Supp. 40-3402. Second, the
Act created the Health Care Stabilization Fund (Fund), a state-run excess insurer, to
provide coverage for judgments and settlements above the limits of a provider's primary
coverage. K.S.A. 1976 Supp. 40-3403; see Aves v. Shah, 258 Kan. 506, 509, 906 P.2d
642 (1995). Third, the Act established the Joint Underwriting Association Plan, a high-
risk insurance pool for those providers unable to obtain the required primary insurance on
the private market. K.S.A. 1976 Supp. 40-3413; see Aves, 258 Kan. at 508-09.

These three provisions were supposed to work together toward the goal of
"guaranteeing to all Kansas citizens that all health care providers in the state would have
65

primary insurance coverage with at least a $100,000 policy limit plus unlimited excess
malpractice insurance coverage." Lemuz v. Fieser, 261 Kan. 936, 951, 933 P.2d 134
(1997).

In addition to the HCPIAA, the 1976 legislation package included changes to tort
litigation procedures in medical malpractice actions, among them: (1) elimination of
corporate negligence claims against medical care facilities for granting/allowing staff
privileges to a non-agent or non-employee physician, K.S.A. 1976 Supp. 65-442(b); (2)
requirement of court approval for attorney fees in medical malpractice actions, K.S.A.
1976 Supp. 7-121b; (3) establishment of medical malpractice screening panels, K.S.A.
1976 Supp. 65-4901 et seq.; (4) allowance of evidence of collateral source benefits in
medical malpractice cases, K.S.A. 60-471 (Weeks 1976); and (5) shortening of the statute
of repose in medical malpractice actions from 10 years to 4 years, K.S.A. 60-513(c)
(Weeks 1976).

By 1984, problems with the Fund prompted changes to the mandatory insurance
provisions of the Act. As initially established, providers were to pay surcharges based on
a percentage of their primary coverage premiums into the Fund to build its balance until
it reached $10 million. That balance was reached by 1981, and thus no surcharges were
levied on health care providers from 1981 to 1983. But the Fund's unlimited liability for
excess coverage soon left it upside down, as more than $27 million in settlements and
awards arose during the same time period. See Kansas Malpractice Victims Coalition v.
Bell, 243 Kan. 333, 336, 757 P.2d 251 (1988).

The legislature addressed this problem by eliminating the $10 million limitation
on the Fund's balance; by capping the Fund's liability at $3 million for any single
judgment or settlement and at $6 million for the annual aggregate for any one provider;
and by raising the mandatory primary coverage limits from $100,000 per
occurrence/$300,000 annual aggregate to $200,000 per occurrence/$600,000 annual
66

aggregate. See L. 1984, ch.178, sec. 1; ch. 238, secs. 2, 4; see also Lemuz, 261 Kan. at
951; Kansas Malpractice Victims Coalition, 243 Kan. at 336.

Meanwhile, medical liability insurers and health care providers continued to push
for additional reform. They claimed that rising medical malpractice insurance premiums
had created a problem of affordability which, if left unaddressed, would drive health care
providers from their businesses, affecting the availability and delivery of health care
services for Kansas citizens. Report on Kansas Legislative Interim Studies to the 1986
Legislature, pp. 858-59 (1985). In response to these claims, in 1986, the legislature
enacted House Bill 2661. This legislative initiative, for the first time, included caps on
damages available to medical malpractice plaintiffs. Kansas Malpractice Victims
Coalition, 243 Kan. at 337.

The caps were set out in K.S.A. 1986 Supp. 60-3407. That statute imposed a
$250,000 cap on noneconomic loss and a $1 million cap on total recovery. L. 1986, ch.
229, sec. 13; K.S.A. 1986 Supp. 60-3407. The noneconomic damages cap was designed
to be adjusted annually for inflation. L. 1986, ch. 229, sec. 13(d). In addition, H.B. 2661
again adjusted certain procedures for medical malpractice actions. It instituted mandatory
settlement conferences, L. 1986, ch. 229, sec. 18; it introduced restrictions on expert
witness testimony on the standard of care, targeting "professional" expert witnesses, L.
1986, ch. 229, sec. 17; and it required an evidentiary hearing before a court could
approve attorney fees, L. 1986, ch. 229, sec. 22; see K.S.A. 7-121b. The legislation also
further reduced the limits of the Fund's excess coverage from $3 million per claim/$6
million annual aggregate to $1 million per claim/$3 million annual aggregate. K.S.A.
1986 Supp. 40-3403(f).

As H.B. 2661 worked its way through the legislative process, certain policy
advocates began raising concerns that there was a crisis in liability insurance generally,
not just in the medical malpractice area. The legislature responded to these concerns in
67

1987 by enacting a series of tort reforms. These included a $250,000 cap on pain and
suffering damages in all personal injury actions other than medical malpractice. K.S.A.
1987 Supp. 60-19a01. Unlike the medical malpractice caps applicable to all noneconomic
damages and to total awards, the personal injury cap applied only to pain and suffering, a
subset of noneconomic damages. See Kansas Malpractice Victims Coalition, 243 Kan. at
337.

In July of 1987, this court decided Farley v. Engelken, 241 Kan. 663, 740 P.2d
1058 (1987), in which we held the statute allowing evidence of collateral source benefits
in medical malpractice actions impermissibly singled out negligent health care providers
"for preferential treatment not extended to any other tortfeasor, professional or otherwise"
in violation of equal protection. Farley, 241 Kan. 663, Syl. ¶ 6.

Then, in January 1988, in Kansas Malpractice Victims Coalition, Shawnee County
District Court Judge Franklin Theis declared the damages caps and certain annuity
provisions of the 1986 malpractice legislation package, H.B. 2661, unconstitutional.
Judge Theis ruled that these elements of the law violated the right to jury trial of Section
5 and the right to remedy provision of Section 18. An appeal of Judge Theis' decision was
pending before this court during the 1988 legislative session.

The Farley decision and Judge Theis' ruling fostered a belief among health care
providers and medical liability insurers that tort reforms must be applied to all personal
injury actions to withstand constitutional challenge. Specifically, they feared that the
medical malpractice caps at issue in the Kansas Malpractice Victims Coalition appeal
would be held to violate equal protection. They thus began a push to expand the medical
malpractice provisions to all personal injury actions. See Testimony of Jerry Slaughter,
House Judiciary Committee Minutes, February 8, 1988; Testimony of Tom Bell, Kansas
Hospital Association, House Judiciary Committee Minutes, February 9, 1988; Testimony
68

of Ron Smith, Kansas Bar Association, House Judiciary Committee Minutes, February
10, 1988.

The legislature responded by passing House Bill 2692, which amended K.S.A.
1987 Supp. 60-19a01 to make it applicable only to non-medical malpractice personal
injury actions based on causes of action that accrued after July 1, 1987, and "before July
1, 1988." L. 1988, ch. 216, sec. 2. Section 3 of H.B. 2692 contained what would become
K.S.A. 60-19a02, the statute at issue in this case. Its language remains unchanged through
today:

"(a) As used in this section 'personal injury action' means any action seeking
damages for personal injury or death.
"(b) In any personal injury action, the total amount recoverable by each party
from all defendants for all claims for noneconomic loss shall not exceed a sum total of
$250,000.
"(c) In every personal injury action, the verdict shall be itemized by the trier of
fact to reflect the amount awarded for noneconomic loss.
"(d) If a personal injury action is tried to a jury, the court shall not instruct the
jury on the limitations of this section. If the verdict results in an award for noneconomic
loss which exceeds the limit of this section, the court shall enter judgment for $250,000
for all the party's claims for noneconomic loss. Such entry of judgment by the court shall
occur after consideration of comparative negligence principles in K.S.A. 60-258a and
amendments thereto.
"(e) The provisions of this section shall not be construed to repeal or modify the
limitation provided by K.S.A. 60-1903 and amendments thereto in wrongful death
actions.
"(f) The provisions of this section shall apply only to personal injury actions
which are based on causes of action accruing on or after July 1, 1988."

By combining the two previous caps into one, the legislature made each more restrictive
of potential jury awards. The cap that applied to personal injury actions now applied to all
noneconomic damages, not merely the subset of pain and suffering. The cap on
noneconomic damages in medical malpractice actions no longer included an inflation
adjustment provision.

69

Shortly after K.S.A. 60-19a02 was enacted, this court issued its decision in Kansas
Malpractice Victims Coalition, holding that the 1986 medical malpractice caps on
noneconomic damages ($250,000) and total damages ($1 million) violated the right to
jury trial under Section 5 and the right to remedy under Section 18. Kansas Malpractice
Victims Coalition, 243 Kan. 333, Syl.

Later in 1988, a judge of the federal District of Kansas certified a question to this
court on whether the 1987 cap on pain and suffering damages in non-medical malpractice
personal injury actions violated the right to jury trial and right to remedy provisions of
the Kansas Constitution. Samsel v. Wheeler Transport Services, Inc., 244 Kan. 726, 771
P.2d 71 (1989) (Samsel I). This court issued a preliminary decision in the case, Samsel I,
on March 30, 1989. The court rejected the constitutional challenges without articulating
an analysis, stating only: "A majority of this court has determined that the answer to the
certified question is no. Neither the original nor the amended version of [K.S.A.] 60-
19a01 violates the Constitution of the State of Kansas." A "formal opinion expressing the
views of the members of the court" was to be filed "when . . . prepared." Samsel I, 244
Kan. at 727. This highly unusual accelerated procedure was expressly driven by the
issue's concurrent politicization, by "widespread interest and statewide effect of the
court's determination of this question." Samsel I, 244 Kan. at 727. Justices Harold S. Herd
and Donald L. Allegrucci were shown as dissenters. Samsel I, 244 Kan. at 727.

Having received an abbreviated blessing from this court, the legislature wasted no
time in again lowering the Fund's liability limits. Under a May 1989 provision, providers
would be free to choose one of three different levels of excess coverage. The minimum
level would now be $100,000 per judgment with a $300,000 annual aggregate. L. 1989,
ch. 143, sec. 3. The relevant substance of this provision has also remained exactly the
same through today. See K.S.A. 40-3403(l)(1).

70

This court filed its formal opinion in Samsel, in March 1990. Samsel v. Wheeler
Transport Services, Inc., 246 Kan. 336, 789 P.2d 541 (Samsel II). Although the initial
certified question was confined to K.S.A. 1987 Supp. 60-19a01—the cap on pain and
suffering damages in non-medical malpractice actions that applied to plaintiff Douglas
Samsel's cause of action arising out of his May 16, 1988, injury—Samsel II accepted the
parties' invitation to rule upon 1988's K.S.A. 1988 Supp. 60-19a02 as well. The majority
rejected Samsel's challenges to its constitutionality under Section 5 on jury trial and
Section 18 on right to remedy. Justice Tyler Lockett, writing for the five-member
majority, characterized the differences between 60-19a01 and 60-19a02 as minor and said
that they gave "rise to no additional issues"; thus "no purpose would be served by
requiring [a plaintiff in Samsel's position whose cause of action accrued after July 1,
1988,] to argue the same issues resolved in this case." 246 Kan. at 346-47.

RIGHT TO TRIAL BY JURY

Section 5 of the Kansas Constitution Bill of Rights could not be simpler or more
plain: "The right to trial by jury shall be inviolate."

This language preserves the right to jury trial in those causes of action that were
triable to a jury under the common law extant in 1859, when the Kansas Constitution was
ratified by the people of our state. In re Rolfs, 30 Kan. 758, 762, 1 P. 523 (1883); see In
re L.M., 286 Kan. 460, 476, 186 P.3d 164 (2008) (Luckert, J., concurring) ("[T]he
uncompromising language of [Section 5] applies if an examination of history reveals
there was a right at common law to a jury trial under the same circumstances.").
Moreover, the right is more than a right to impanel a jury. It is a process that includes the
right to assemble a jury, a right to present evidence, a right to have the jury determine and
award damages, and the right to a judgment for the full damages as determined by the
jury and supported by the evidence. See Hasty v. Pierpont, 146 Kan. 517, 520, 72 P.2d 69
(1937) (right to jury trial preserves substantive incidents of common-law jury trial, not
71

"mere matters of form and procedure"); see also Colgrove v. Battin, 413 U.S. 149, 157
n.11, 93 S. Ct. 2448, 37 L. Ed. 2d 522 (1973) (substantive incidents of common-law jury
trial include functions "regarded as fundamental, as inherent in and of the essence of the
system of trial by jury") (quoting Scott, Trial by Jury and the Reform of Civil Procedure,
31 Harv. L. Rev. 669, 671 [March 1918]).

Today's majority has no quibble with the historical applicability of Section 5 to
common-law tort actions and to medical malpractice actions in particular. Such matters
were triable to a jury as a matter of right at common law when the Kansas Constitution
was ratified, and thus Section 5 guarantees the parties the right to a jury trial in this case.
See Samsel II, 246 Kan. at 358; Kansas Malpractice Victims Coalition, 243 Kan. at 342-
43.

The majority also correctly concludes that the determination of noneconomic
damages was a fundamental part of a jury trial at common law. This point is also well-
settled. See Smith v. Printup, 254 Kan. 315, 324, 866 P.2d 985 (1993) ("There is no
question in Kansas that the right to trial by jury includes the right to have a jury
determine actual damages."); Samsel II, 246 Kan. at 350-52, 358 (under Kansas
Constitution, common law, right to jury trial includes right to have jury determine
economic, noneconomic damages); Kansas Malpractice Victims Coalition, 243 Kan. at
343 ("The jury's traditional role is to decide issues of fact. . . . The determination of
damages is an issue of fact. Therefore, it is the jury's responsibility to determine
damages."); accord Watts v. Lester E. Cox Medical Centers, ___ S.W.3d ___, 2012 WL
3101657 (No. SC 91867, Mo. July 31, 2012) (Missouri Constitution's "inviolate" right to
jury trial includes right to have jury determine facts, including noneconomic damages).

It is after its agreement on these two irrefutable points that the majority first goes
astray. The next question that must be answered is whether K.S.A. 60-19a02 impairs the
right to jury trial by interfering with the jury's fundamental function in determining
72

noneconomic damages. See Markman v. Westview Instruments, Inc., 517 U.S. 370, 376,
116 S. Ct. 1384, 134 L. Ed. 2d 577 (1996) (after determining applicability, court
considers impairment; Seventh Amendment jury trial analysis asks whether "particular
trial decision must fall to the jury . . . to preserve the substance of the common law right
as it existed" at ratification); 9 Wright & Miller, Federal Practice & Procedure: Civil §
2302.4 (3rd ed. 2008) (analysis of whether procedure violates Seventh Amendment "must
look to whether that procedure obstructs or interferes with the jury's substantive role as
the fact-finder"). Rather than stating in a straightforward way that K.S.A. 60-19a02 does
impair the Section 5 right to jury trial, the majority feints toward then-Justice Kay
McFarland's position in her concurrence in Samsel II that the right to jury trial does not
extend to the remedy phase of trial. Samsel II, 246 Kan. at 363 (McFarland, J.,
concurring). It does not, however, endorse this position. Rather, it merely announces
summarily that it need not "engage these contentions for long," stating that the cap
"encroaches" upon Section 5's jury trial right.

This "encroachment" holding should end the matter, and the cap should be struck
down as unconstitutional. Although the majority does not define "encroachment" as
impairment, I discern no analytical daylight between the two concepts, and the majority
suggests none. The noneconomic damages cap "necessarily infringes" on the inviolate
right to trial by jury in a medical malpractice action as the right existed at common law
and was made constitutional in 1859. Watts, 2012 WL 3101657, at *6. "The individual
right to trial by jury cannot 'remain inviolate' when an injured party is deprived of the
jury's constitutionally assigned role of determining damages according to the particular
facts of the case." Watts, 2012 WL 3101657, at *6. Giving the jury "a practically
meaningless opportunity to assess damages simply 'pays lip service to the form of the
jury but robs it of its function.'" Watts, 2012 WL 3101657, at *7 (quoting Sofie v.
Fibreboard Corp., 112 Wash. 2d 636, 655, 771 P.2d 711 [1989] [en banc]); see also
Atlanta Oculoplastic Surgery, P.C. v. Nestlehutt, 286 Ga. 731, 735-36, 691 S.E.2d 218
(2010) (striking down damages cap for infringing state constitution's inviolate right to
73

jury trial); Lakin v. Senco Products, Inc., 329 Or. 62, 78-79, 987 P.2d 463, 473 (1999)
(same); Moore v. Mobile Infirmary Ass'n, 592 So. 2d 156, 164 (Ala. 1991) (same); Smith
v. Department of Ins., 507 So. 2d 1080, 1089 (Fla. 1987) (same); Arneson v. Olson, 270
N.W.2d 125, 136 (N.D. 1978) (same).

The majority does not stop at this place, as it should, instead deciding that the
legislature may "constitutionally obstruct" Kansans' right to jury trial if, in the court's
judgment, the two-part due process-based quid pro quo test applicable to Section 18
analysis is satisfied. I believe the quid pro quo test to be a senseless and unsupported
overlay that transforms what the people made inviolate into something violable at will.
My colleagues' insistence upon this step overlooks long-standing limitations on the
legislature's power to modify the common law; overestimates the persuasive force of
prior Kansas cases; and shortcuts the necessary cost-benefit evaluation. In the end, all of
this means that sound analysis is sacrificed in favor of condescension toward the
legislature.

These are marked flaws in the majority's approach, and I address each express
error in the subsections below. But first I am compelled to point out three other problems
arising from what the majority does not say. These problems mark dramatic departures
from our usual patterns and practices in countless cases of many types. These more
general criticisms spotlight errors in the majority's reasoning and decision that are at least
as bad, if not worse, than its express and specific errors because of their tendency to
undermine the overall predictability and stability in Kansas law that should always be
among the paramount goals of this court.

Three Problems

First, the majority ignores the plain "inviolate" language chosen by Kansas
citizens for Section 5's jury trial provision. Inviolate means not "disturbed or limited." In
74

re Rolfs, 30 Kan. at 762. It is defined as "'[n]ot violated; unimpaired; unbroken;
unprofaned.'" Samsel II, 246 Kan. at 368 (Herd, J., dissenting); see also Watts, 2012 WL
3101657, at *3 ("inviolate" means free from change or blemish, pure, unbroken) (citing
Webster's Third New International Dictionary 1190 [1993]); Sofie, 112 Wash. 2d at 656
(citing same) ("inviolate" connotes deserving of highest protection, free from assault,
trespass, untouched, intact). This inviolate right to jury trial is "a basic and fundamental
feature of American jurisprudence." Gard v. Sherwood Construction Co., 194 Kan. 541,
549, 400 P.2d 995 (1965); see also Parklane Hosiery Co. v. Shore, 439 U.S. 322, 340-41,
343, 99 S. Ct. 645, 58 L. Ed. 2d 552 (1979) (Rehnquist, J., dissenting) (right so important
that denial of "right of jury trial was listed among the specific offensive English acts
denounced in the Declaration of Independence"; right a "bulwark" of liberties, so
essential that it "'was probably the only one universally secured by the first American
state constitutions'") (quoting Levy, Legacy of Suppression: Freedom of Speech and
Press in Early American History 281 [1960]).

The language of Section 5 is "uncompromising." In re L.M., 286 Kan. at 476
(Luckert, J., concurring). Section 5 imposes a "clear, precise and definite limitation[]
upon the powers of the legislature." Atchison Street Rly. Co. v. Mo. Pac. Rly. Co., 31
Kan. 660, 665, 3 P. 284 (1884). It was chosen precisely because the people recognized
that the right to jury trial required protection from legislative efforts to modify it in ways
that destroy the substance of that right. See Wyandotte Const. Convention 462-63 (July
25, 1859) ("[T]hat very valuable right we propose to secure to the citizen in retaining the
right of trial by jury, intact, will be accomplished by the words, 'The right of trial by jury
shall be inviolate.'"); see also State ex rel. v. City of Topeka, 36 Kan. 76, 85-86, 12 P. 310
(1886) (by preserving the right as "inviolate," framers intended that the right of trial by
jury "shall be and remain as ample and complete as it was at the time when the
[C]onstitution was adopted").

75

This court's deliberately chosen and carefully cultivated habit, when doing
comparatively lowly statutory interpretation intended only to discern the intent of the
legislature and not the people, is to start with the text. See Board of Leavenworth County
Comm'rs v. Whitson, 281 Kan. 678, 685, 132 P.3d 920, 926 (2006) ("[t]he most
fundamental rule of statutory interpretation and construction, to which all other rules are
subordinate, is that the intent of the legislature governs"; "the legislature is initially
presumed to have expressed [its intent] through the language it used"); see also O'Brien v.
Leegin Creative Leather Products, Inc., 294 Kan. 318, 331, 277 P.3d 1062 (2012);
Graham v. Dokter Trucking Group, 284 Kan. 547, 554, 161 P.3d 695 (2007); Pieren-
Abbott v. Kansas Dept. of Revenue, 279 Kan. 83, 88, 106 P.3d 492 (2005). If the text is
clear, we mightily resist going beyond it to arrive at an authoritative interpretation. See
Whitson, 281 Kan. at 685 ("[a]n appellate court merely interprets the language as it
appears; it is not free to speculate and cannot read into the statute language not readily
found there"); see also O'Brien, 294 Kan. at 331; Graham, 284 Kan. at 554; GT, Kansas,
L.L.C. v. Riley County Register of Deeds, 271 Kan. 311, 316, 22 P.3d 600 (2001). Even a
learned Court of Appeals colleague has not persuaded us to do otherwise. See Board of
Miami County Comm'rs v. Kanza Rail-Trails Conservancy, Inc., 292 Kan. 285, 326-35,
255 P.3d 1186 (2011) (Leben, J., concurring) (urging discernment of legislative intent by
any means necessary rather than employment of strict textualism). This habit is the
conservative choice. It respects the legislature's ability to say what it means about its
public policy choices, conforming to its and our recognized institutional competencies.
Should we not be at least as careful, at least as respectful when interpreting the people's
document? And should that care and that respect not reach their zeniths when we
examine that portion of the document, the Bill of Rights, specifically designed to make
clear those individual freedoms that cannot be infringed by majoritarian government? It is
virtually inconceivable that any of my colleagues in the majority would answer "no" to
these questions. Their failure even to ask them is a mystery.

76

Second, the majority's decision to tighten prior courts' misguided embrace of the
quid pro quo test in Section 5 jury trial examination—rather than kick it to the curb where
it always belonged—demonstrates a completely uncharacteristic lack of curiosity about
the guidance to be found in the experience of our sister states. Not one—not one—of the
19 states that have considered whether damages caps violate their state constitutional
right to jury trial has given the quid pro quo test any role in the decision; this is true
regardless of the particular wording of the state constitutional provision at issue and
regardless of the ultimate outcome on the constitutional question. See Moore, 592 So. 2d
at 159-65 (right to jury trial "inviolate"); Evans ex rel. Kutch v. State, 56 P.3d 1046,
1050-51 (Alaska 2002) (right to jury trial "preserved"); Smith, 507 So. 2d at 1088-89
(right to jury trial "inviolate"); Atlanta Oculoplastic Surgery P.C., 286 Ga. at 733 (right
to jury trial "inviolate"); Kirkland v. Blaine County Medical Center, 314 Idaho 464, 466-
69, 4 P.3d 1115 (2000) (right to jury trial "inviolate"); Johnson v. St. Vincent Hospital,
237 Ind. 374, 382-86, 404 N.E.2d 585 (1980) (right to jury trial "inviolate"), overruled on
other grounds In re Stephens, 867 N.E.2d 148 (Ind. 2007); Murphy v. Edmonds, 325 Md.
342, 351 n.3, 601 A.2d 102 (1992) (right to jury trial "inviolably preserved"); Zdrojewski
v. Murphy, 254 Mich. App. 50, 75-76, 657 N.W.2d 721 (2002) (right to jury trial "shall
remain"); Watts, 2012 WL 3101657, at *6-7 (right to jury trial "inviolate"); Gourley v.
Nebraska Methodist Health Sys., 265 Neb. 918, 953, 663 N.W.2d 43 (2003) (right to jury
trial "inviolate"); Arneson, 270 N.W.2d at 137 (right to jury trial "inviolate"); Arbino v.
Johnson & Johnson, 116 Ohio St. 3d 468, 473-77, 880 N.E.2d 420 (2007) (right to jury
trial "inviolate"); Lakin, 329 Or. at 73-79 (right to jury trial "inviolate"); Matter of Certif.
of Question of Law, 544 N.W.2d 183, 202-03 (S.D. 1996) (right to jury trial "inviolate");
Judd v. Drezga, 103 P.3d 135, 144-45 (Utah 2004) (right to jury trial "inviolate" only in
capital cases; right to jury trial guaranteed in civil cases); Etheridge v. Medical Center
Hospital, 237 Va. 87, 376 S.E.2d 525 (1989) (jury trial "preferable," "sacred"); Sofie, 112
Wash. 2d at 642-67 (right to jury trial "inviolate"); Robinson v. Charleston Area Med.
Center, 186 W. Va. 720, 730-31, 414 S.E.2d 877 (1991) (right to jury trial "preserved");
Guzman v. St. Francis Hospital, Inc., 240 Wis. 2d 559, 573-78, 623 N.W.2d 776, 783-85
77

(Wis. App. 2000) (right to jury trial "inviolate"); overruled on other grounds Ferdon v.
Wisconsin Patients Comp. Fund, 284 Wis. 2d 573, 701 N.W.2d 440 (2005). One has
expressly rejected such an approach: The Oregon Supreme Court in Lakin. 329 Or. at 80-
82.

Lakin involved a challenge to the constitutionality of a cap on noneconomic
damages in personal injury actions. The defendant argued that the cap did not violate the
plaintiff's right to jury trial because the plaintiff received a substantial recovery. Lakin,
329 Or. at 80 (citing Hale v. Port of Portland, 308 Or. 508, 523, 783 P.2d 506 [1989])
(state constitutional right to remedy provision not violated when legislature modifies,
abolishes cause of action, as long as injured party left with some substantial remedy). The
Lakin court held that the "substantial remedy" analysis was completely irrelevant to its
consideration of the constitutional right to jury trial:

"We do not find Hale's [right to remedy analysis] relevant to our analysis of Article I,
section 17. This court's Article I, section 17, jurisprudence never has established a
'substantial' remedy test in defining the scope and meaning of the right of jury trial.
Moreover, we do not assess the constitutionality of [the cap] under Article I, section 17,
based on the amount of the statutory cap; rather we assess its constitutionality because it
is a cap on the jury's determination of noneconomic damages." 329 Or. at 81.

The majority's apparent indifference to other jurisdictions' cases is remarkably
atypical, as our cases consulting and considering the wisdom of other states are myriad.
See, e.g., Gaumer v. Rossville Truck & Tractor Co., 292 Kan. 749, 758, 257 P.3d 292
(2011) (interpreting Kansas product liability statute, noting positions of sister states with
similar product liability statutes); In re K.M.H., 285 Kan. 53, 63, 169 P.3d 1025 (2007)
(interpreting Kansas statute on presumptions of paternity, noting decisions by sister states
regarding related statutes); In re L.M., 286 Kan. at 471; see also Custer, Citation
Practices of the Kansas Supreme Court and Kansas Court of Appeals, 8 Kan. J.L. & Pub.
Pol'y 126, 127 (Spring 1999) (providing data on out-of-state citation by Kansas Supreme
78

Court; noting Supreme Court cited to other states' opinions 14.4 percent in 1935, 5.8
percent in 1965, 13.9 percent in 1995).

This has been true, even when the issue before us has been one of state
constitutional law. See In re Ontiberos, 295 Kan. __, __ P.3d __, 2012 WL 3537845, at
*10 (Kan. Aug. 17, 2012) (referring to Virginia Supreme Court's interpretation of
Virginia Constitution); State v. Sanchez-Loredo, 294 Kan. 50, 58, 272 P.3d 34 (2012)
(citing multiple cases from other jurisdictions interpreting their state constitutions under
similar challenges); In re K.M.H., 285 Kan. at 72-79 (discussing treatment of
constitutional questions in several out-of-state cases with similar factual, legal issues);
Montoy v. State, 279 Kan. 817, 826-28 112 P.3d 923 (2005) (same); Canaan v. Bartee,
276 Kan. 116, 131, 72 P.3d 911 (2003) (same); see also Baude, Interstate Dialogue in
State Constitutional Law, 28 Rutgers L.J. 835, 838, 847-64, 852 (1997) (collecting
"comprehensive" list of occasions on which state high courts refer to constitution of other
states; suggesting Kansas Supreme Court decisions had, at time of article's publication,
made at least 94 references to constitutions of other states including 9 references to
Constitution of California; 6 references each to Kentucky and Ohio constitutions; 5 to
Colorado and Florida; 4 to Alaska and Indiana; 3 references each to the constitutions of
Arizona, Arkansas, Illinois, Iowa, Michigan, Missouri, Oklahoma, Wisconsin; 2
references each to constitutions of Connecticut, Maryland, Massachusetts, Montana,
Nebraska, New Jersey, New Mexico, Pennsylvania, South Carolina, Texas; 1 reference to
constitutions of Delaware, Idaho, Louisiana, Minnesota, Nevada, New Hampshire,
Tennessee, Utah, Virginia, West Virginia, and Wyoming); see generally Gardner, Whose
Constitution Is It? Why Federalism and Constitutional Positivism Don't Mix, 46 Wm. &
Mary L. Rev. 1245, 1263-64 (2005) ("American courts have a long tradition of
consulting related rulings from other jurisdictions when analyzing issues arising under
the law of their own jurisdictions[, even] in constitutional law despite the fact that the
answers to constitutional questions are in principle to be found exclusively within the
four corners of the relevant constitution."); Cauthen, Horizontal Federalism in the New
79

Judicial Federalism: A Preliminary Look at Citations, 66 Alb. L. Rev. 783, 788, 790-94
(2003) (study of 13 state supreme courts' citation to other state supreme court decisions
when interpreting state constitutional rights); see also State v. Geisler, 222 Conn. 672,
684-85, 610 A.2d 1225 (1992) (listing "sister state decisions" as "tool[] of analysis" for
interpreting Connecticut constitution); State v. Wheaton, 121 Idaho 404, 408, 825 P.2d
501 (1992) (Bistline, J., concurring) (court receptive to reliance on sister state decisions
in interpreting Idaho Constitution); Davenport v. Garcia, 834 S.W.2d 4, 20 (Tex. 1992)
(encouraging citation to sister state constitutional decisions); State v. Zaccaro, 154 Vt.
83, 87, 574 A.2d 1256 (1990) (when interpreting Vermont Constitution, the court "may
look for guidance to persuasive holdings . . . from . . . sister-state jurisdictions"). Again,
the majority offers us no clue why it foregoes the usual practice its members have so
routinely employed.

Third, and perhaps most revealing, my colleagues in today's majority make no
mention of defense counsel's repeated statements during oral argument that the quid pro
quo test does not apply to analysis of Section 5's right to jury trial. The majority's
complete silence about this capitulation, its failure even to attempt to explain it away, is
another mystery—especially given several members' near-total inflexibility when asked
to consider issues and arguments not previously made or preserved by the parties. See
State v. Kelly, No. 102,210, filed September 28, 2012 (Nuss, C.J., dissenting, joined by
Biles and Moritz, JJ.) (contemporaneous objection to evidence required, even in bench
trial on stipulated facts designed only to preserve right to appeal suppression issue); State
v. Dukes, 290 Kan. 485, 488, 231 P.3d 558 (2010) (court has "consistently been refusing
to review an evidentiary issue without a timely and specific objection even if the issue
involves a fundamental right"); State v. King, 288 Kan. 333, 348-49, 204 P.3d 585 (2009)
(legislature clearly intended K.S.A. 60-404 to require timely, specific objection in order
to preserve evidentiary issues for appeal). I simply cannot fathom why today's majority
elects to leave its ordinary path on preservation, at the same time not recognizing that
when "neither party defends the reasoning of a precedent, the principle of adhering to that
80

precedent through stare decisis is diminished." Citizens United v. Federal Election
Com'n, 558 U.S. 310, ___, 130 S. Ct. 876, 912, 175 L. Ed. 2d 753 (2010).

Having addressed what is left out of the majority's decision, I turn to the
substantial damage done by what it does discuss.

Limitations on Modification of Common Law

The majority's first expressed reason for applying the quid pro quo test to excuse
K.S.A. 60-19a02's impairment of Kansans' right to jury trial is that the legislature can
modify the common law. I do not dispute this general proposition. In certain
circumstances, the legislature may modify the common law, although the practice was
initially viewed with enough skepticism that it gave rise to a well-known canon of
construction holding that statutes in derogation of the common law should be strictly
construed. See Popkin, Materials on Legislation—Political Language and the Political
Process 65-67, 74-75 (4th ed. 2005). What the majority fails to appreciate is that what
may have been a mere common-law right to jury trial on the day before ratification of
Section 5 was no longer a mere common-law right from ratification onward. Ratification
expressed the people's choice to elevate the common-law right to jury trial to enumerated
constitutional status. That status put it beyond everyday legislative meddling. The people
entrusted juries with the task of deciding damages. The legislature's unwillingness to do
so—because it has been persuaded by one side with a dog in the fight—requires
endorsement by the people before it can enjoy the force of law.

The critical distinction between common and constitutional law is hornbook
material, as the United States Supreme Court emphasized long ago in Dimick v. Schiedt,
293 U.S. 474, 487, 55 S. Ct. 296, 79 L. Ed. 603 (1935):

81

"It is said that the common law is susceptible of growth and adaptation to new
circumstances and situations, and that the courts have power to declare and effectuate
what is the present rule in respect of a given subject without regard to the old rule; and
some attempt is made to apply that principle here. The common law is not immutable, but
flexible, and upon its own principles adapts itself to varying conditions. [Citation omitted.]
But here we are dealing with a constitutional provision which has in effect adopted the
rules of the common law in respect of trial by jury as these rules existed in 1791. To
effectuate any change in these rules is not to deal with the common law, qua common law,
but to alter the Constitution. The distinction is fundamental, and has been clearly pointed
out by Judge Cooley in 1 Const. Limitations (8th Ed.) 124."

See also Watts, 2012 WL 3101657, at *8 (allowing legislature to modify constitutional
rights makes protections "of only theoretical value . . . [s]uch rights would not be rights at
all but merely privileges that could be withdrawn"); Atlanta Oculoplastic Surgery, P.C.,
286 Ga. at 735 (general legislative authority to modify common law does not permit
abrogation of constitutional rights); Sofie, 112 Wash. 2d at 652-54.

Justice Herd made the same point in his dissent in Samsel II:

"Giving the legislature the authority to limit damages by changing the common law, or
otherwise, violates § 5 of the Kansas Bill of Rights by taking the damage question away
from the jury. A written constitution is adopted for the purpose of limiting the power of
government. Providing that trial by jury shall be inviolate is a limitation on government
as a protection of individual rights. There is no question the legislature has the power to
change or abolish the common law. That, however, does not change the Kansas
Constitution. A later change in the common law does not affect the meaning of § 5. Its
meaning was fixed in 1859. The proper method of constitutional change is by
amendment, not legislation." 246 Kan. at 369-70 (Herd, J., dissenting).

Even the case that is generally considered the source of recognition of legislative
power to modify common law, Munn v. Illinois, 94 U.S. 113, 134, 24 L. Ed. 77 (1876), is
explicit about constitutional limitations on the power: "Rights of property which have
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been created by the common law cannot be taken away without due process; but the law
itself, as a rule of conduct, may be changed at the will, or even at the whim, of the
legislature, unless prevented by constitutional limitations." See also In re Tax Appeal of
ANR Pipeline Co., 276 Kan. 702, 725, 79 P.3d 751 (2003) (Kansas Constitution limits
otherwise plenary power of legislature); Harris v. Shanahan, 192 Kan. 183, 207, 387
P.2d 771 (1963) ("It is axiomatic that [any] act of the legislature[] is subject to the
limitations contained in the Constitution, and where such act exceeds the bounds of
authority vested in the legislature and violates the limitations of the Constitution, it is null
and void and it is the duty of courts to so declare."); Lemons v. Noller, 144 Kan. 813,
817, 63 P.2d 177 (1936) (citing State v. Weiss, 84 Kan. 165, 168, 113 P. 388 [1911];
Ratcliff v. Stock-yards Co., 74 Kan. 1, 16, 86 P. 150 [1906]) (legislature free to act except
where Kansas Constitution restricts).

Today's majority violates the basic rule of these cases. This violation compounds
earlier error in Kansas Malpractice Victims Coalition and Samsel II, as well as
Manzanares v. Bell, 214 Kan. 589, 522 P.2d 1291 (1974) (examining constitutionality of
no-fault automobile insurance legislation), by focusing on what the legislature can do
rather than on what it cannot. I further discuss the weakness of the majority's stare decisis
argument in the next subsection.

The Weakness of Precedent

The majority invokes stare decisis to further support its application of the quid pro
quo test to save K.S.A. 60-19a02 from violation of plaintiff Miller's Section 5 jury trial
right. It cites Rhoten v. Dickson, 290 Kan. 92, 112, 223 P.3d 786 (2010), for the general
principle that a "court of last resort will follow the rule of law it established in its earlier
cases unless clearly convinced the rule was originally erroneous or is no longer sound
because of changing conditions and more good than harm will come by departing from
precedent." 290 Kan. at 112.
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I agree that Rhoten lays out the governing rule and its recognized exceptions, but I
emphasize that it excuses us from following precedent that is "plainly and unmistakably
the result of mistake and error." Prowant, Administratrix v. Kings-X, 184 Kan. 413, 416-
17, 337 P.2d 1021 (Jackson, J., dissenting), rev'd on rehearing, 185 Kan. 602, 347 P.2d
254 (1959); see also Arizona v. Gant, 556 U.S. 332, 129 S. Ct. 1710, 173 L. Ed. 2d 485
(2009) (quoting Lawrence v. Texas, 539 U.S. 558, 577, 123 S. Ct. 2472, 156 L. Ed. 2d
508 [2003]) (Stare decisis does not require adherence to "a past decision when its
rationale no longer withstands 'careful analysis.'"); Bergstrom v. Spears Manufacturing
Co., 289 Kan. 605, 610, 214 P.3d 676 (2009) ("This court is not inexorably bound by
precedent; it will reject rules that were originally erroneous or are no longer sound.").
When faced with such a "mistake and error," Rhoten demands only that we also assess
the costs and benefits of a decision to abandon an erroneous precedent, requiring the
benefits to outweigh the costs.

We have also recognized that stare decisis is at its weakest in constitutional cases
because our mistakes cannot be easily corrected by ordinary legislation. State v. Hoeck,
284 Kan. 441, 463, 163 P.3d 252 (2007); see also Agostini v. Felton, 521 U.S. 203, 235-
36, 117 S. Ct. 1997, 138 L. Ed. 2d 391 (1997) (erroneous court interpretations in such
cases "can be altered only by constitutional amendment or by overruling our prior
decisions"); Watts, 2012 WL 3101657, at *10 (quoting Mountain Grove Bank v. Douglas
County, 146 Mo. 42, 54, 47 S.W. 944 [Mo. 1898]) (if people disagree with court
interpretation of constitution, opportunity to change organic law more remote than
opportunity to repeal, alter statute; "[m]oreover, no set of judges ought to have the right
to tie the hands of their successors on constitutional questions, any more than one [set of
legislators] should those of its successors on legislative matters"). And the principle of
stare decisis is weaker still when the prior decision involved an erroneous "application of
a constitutional principle rather than an interpretation of the Constitution to extract the
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principle itself." Smith v. Allwright, 321 U.S. 649, 665-66, 64 S. Ct. 757, 88 L. Ed. 987
(1944).

Finally, the majority also overlooks another consideration mitigating strict
application of stare decisis in constitutional cases: Our allegiance must be to the
Constitution itself, "not what we have said about it." Graves v. N.Y. ex rel. O'Keefe, 306
U.S. 466, 491-92, 59 S. Ct. 595, 83 L. Ed. 927 (1939) (Frankfurter, J., concurring); see
also Harris v. Anderson, 194 Kan. 302, 314, 400 P.2d 25 (1965) (Fatzer, J., dissenting)
(quoting 3 Warren, The Supreme Court in United States History, p. 470: "'However the
court may interpret the provisions of the Constitution, it is still the Constitution which is
the law and not the decision of the court. "To the decision of an underlying question of
constitutional law no . . . finality attaches. To endure, it must be right."'").

The majority relies on Kansas Malpractice Victims Coalition and Samsel II, both
of which applied the quid pro quo test to excuse impairment of the right to jury trial.
Samsel II, 246 Kan. at 358, 362; Kansas Malpractice Victims Coalition, 243 Kan. at 344-
52. Samsel II followed Kansas Malpractice Victims Coalition on this point, Samsel II,
246 Kan. at 351-62; and Kansas Malpractice Victims Coalition, in turn, relied on
Manzanares, saying that Manzanares "found, in substance, that the injured person
entitled to benefits under the statute received a sufficient quid pro quo for the limitation
placed on his right to a jury trial." Kansas Malpractice Victims Coalition, 243 Kan. at
344. In none of these three cases, however, did this court see fit to explain how or why
the quid pro quo test, a due process-based rule originally relating to whether legislation
impairs a vested right, can excuse legislation's impairment of a constitutional right to jury
trial.

Moreover, it appears that the initial reliance Kansas Malpractice Victims Coalition
placed on Manzanares in order to apply quid pro quo arose out of a misreading. Nowhere
in Manzanares' one-paragraph discussion of the right to jury trial claim before it did this
85

court "require that the legislature provide an adequate substitute of the right to trial by
jury[.]" Note, Testing the Constitutionality of Tort Reform with a Quid Pro Quo Analysis:
Is Kansas' Judicial Approach an Adequate Substitute for a More Traditional
Constitutional Requirement?, 31 Washburn L.J. 314, 332 (1992).

Today's majority, perhaps feeling the Manzanares sand shift beneath its feet,
attempts to bolster its position by reaching still farther back to Shade v. Cement Co., 93
Kan. 257, 144 P. 249 (1914), for support.

Shade involved multiple constitutional challenges to the original workers
compensation law. The claims were based on federal due process and equal protection,
and on the Kansas Constitution Bill of Rights' Section 5 right to jury trial and Section 18
right to remedy. Shade, 93 Kan. at 258-59. Shade's notable pithy rationale for rejecting
these claims lumps the state constitutional theories together; and the only thing it makes
clear is the determinative weight given to the elective nature of the original workers
compensation system.

"The objection based upon the supposed deprivation of a right of trial by jury is
equally untenable, as determined in many adjudicated cases. The same is true of the
arbitration feature and the rules for determining compensation. Without reviewing
seriatim all the specific objections made to this statute under the general charge that it
violates constitutional safeguards, it is sufficient to say that they have all been met in
judicial decisions in other jurisdictions after the most thorough and patient examination.
. . . Briefly, it may be said that the operation of the system of compensation provided by
the statute rests upon the free consent of employer and employee, given in the manner
provided by the act. Without such consent on his part the employee retains all his
remedies under common and statutory law. It is a matter of election." 93 Kan. at 260
(citing Matheson v. Minneapolis St. Ry. Co., 148 N.W. 71 [Minn. 1914] [election to be
subject to system constitutes waiver of jury trial]; Deibeikis v. Link-Belt Co., 261 Ill. 454,
104 N.E. 211 [1914] [same]).

86

In my view, today's majority takes this passage in Shade and stretches it well
beyond its breaking point, contending it applied the quid pro quo test to reject the Section
5 challenge. This is inaccurate, as we have previously recognized in multiple cases. See
Baker v. St. Louis Smelting & Refining Co., 145 Kan. 273, 279, 65 P.2d 284 (1937)
(quoting Shade, 93 Kan. at 259-60; emphasizing workers compensation system "'rests
upon the free consent of the employer and employee'"; thus "the liability of an employer
to his employee under the act is a liability arising on contract'"); Potocan v. Hamilton
Coal & Mercantile Co., 120 Kan. 326, 329, 243 P. 537 (1926) (citing Shade, 93 Kan.
257, for proposition workers compensation act subject to no constitutional infirmity
because not compulsory); Smith v. Packing Co., 115 Kan. 874, 875, 225 P. 110 (1924)
(citing Shade, 93 Kan. at 260; "[Q]uestions as to whether various features of a workmen's
compensation act were violative of the Fourteenth Amendment have frequently been
disposed of by reference to the fact that its application was made optional.").

Our Court of Appeals, the United States Supreme Court, the Missouri appellate
courts, and commentators also would be surprised by what today's majority professes to
find in Shade. See Boyd v. Barton Transfer & Storage, 2 Kan. App. 2d 425, 429, 580
P.2d 1366 (1978) (in first case to consider Shade since workers compensation system
made mandatory, court cites Shade among cases upholding earlier system "against
constitutional challenges on the ground that it was optional with the employer and
employee"); Middleton v. Texas Power & Light Co., 249 U.S. 152, 160, 395 S. Ct. 227,
63 L. Ed. 527 (1919) (citing Shade for upholding act because voluntary); Mosely v.
Empire Gas & Fuel Co., 313 Mo. 225, 233-34, 281 S.W. 762 (1926) (same); Harbis v.
Cudahy Packing Co., 211 Mo. App. 188, 191, 241 S.W. 960 (1921) (quoting Shade, 93
Kan. at 260; observing "Kansas courts have held that the relation between employer and
employee" under workers compensation law "is contractual"); Phillips, The
Constitutional Right to a Remedy, 78 N.Y.U. L. Rev. 1309, 1330 n.92 (2003) (citing
Shade, 93 Kan. 257; "Decisions to uphold the statutes frequently were based on the fact
that the employee or employer, or both, had the ability to opt out of the scheme.");
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Comment, Workers' Compensation Benefits Go From Bad to Worse: The Kansas
Supreme Court Eliminates the Parallel Injury Rule, 48 Washburn L.J. 705, 710 n.42
(2009) (describing Shade as upholding original workers compensation law on ground that
employers, employees consented to coverage).

Even weaker is the majority's assertion that Rajala v. Doresky, 233 Kan. 440, 661
P.2d 1251 (1983), "explicitly" applied the quid pro quo test in considering a right to jury
trial challenge. The only issue in Rajala was whether the workers compensation law's
abrogation of fellow-employee liability violated the Section 18 right to remedy provision.
Rajala, 233 Kan. at 441-42. Likewise, the majority's citation of Injured Workers of
Kansas v. Franklin, 262 Kan. 840, 942 P.2d 591 (1997), and Scott v. Hughes, 294 Kan.
403, 275 P.3d 890 (2012), for their discussion of the exchanges of rights and remedies
between employers and employees inherent in the Kansas workers compensation scheme
cannot help it. These cases did not have anything to do with a jury trial challenge to the
scheme. Thus neither suggests, let alone stands for, the proposition that the quid pro quo
test can be applied to rescue a statute from its violation of Section 5.

To summarize, none of the cases the majority forwards as controlling precedent
for using the quid pro quo test to excuse K.S.A. 60-19a02's impairment of plaintiff
Miller's right to jury trial withstands examination. Manzanares, Kansas Malpractice
Victims Coalition, and Samsel II give no explanation, much less an analytically sound
one, of why the due process-based concept should be imported from Section 18.
Furthermore, the majority's efforts to press Shade and Rajala into service as substitutes
for Manzanares, Kansas Malpractice Victims Coalition, and Samsel II are singularly
unconvincing. Shade relied on an entirely different rationale to reject the jury trial and the
other state constitutional challenge to the original workers compensation system before
the court. Rajala did not involve any jury trial challenge at all. Under these
circumstances, I can say I am clearly convinced that the majority's application of the quid
pro quo test to Section 5 was originally erroneous and remains so.
88


I now move to my criticism of the majority's conclusion that we must nevertheless
maintain this erroneous rule because of our inability to cope with the consequence of its
abandonment.

Cost-benefit Examination

Yet another weakness in the majority's decision is its failure to engage in the
comprehensive cost-benefit examination that Rhoten requires as the final step when we
contemplate whether to keep or to jettison originally erroneous precedent. See Rhoten,
290 Kan. at 112. The parade of horribles it trots out, apparently as costs, is insubstantial
and unconvincing, and the majority does not account properly for significant benefits.

Leading the parade of horribles is the majority's assertion that overruling our past
application of the quid pro quo test to excuse violation of the right to jury trial would
require dismantling of the workers compensation and no-fault automobile insurance
systems. See Rajala, 233 Kan. at 440 (workers compensation); Manzanares, 214 Kan. at
589 (no-fault). I do not believe this is true for several reasons.

First, as discussed above, Rajala was a Section 18 decision that did not address the
right to jury trial in any way. See Rajala, 233 Kan. at 441. Nothing about refusal to apply
the quid pro quo test to save a statute impairing the right to jury trial has any bearing on
Rajala's Section 18 holding.

Second, the comprehensive workers compensation system at issue in Rajala is
totally distinct from the noneconomic damages cap applied to reduce plaintiff Miller's
damages in this case. Miller's common-law cause of action for medical malpractice as it
existed in 1859 was not wholly replaced with a comprehensive statutory scheme of
compensation not employing jury trials at all. Far from it. Miller and all personal injury
89

plaintiffs in Kansas are still required to file civil lawsuits; conduct necessary discovery;
obtain required expert testimony; and prove negligence, causation, and damages to a jury
by a preponderance of the evidence. The only thing changed by K.S.A. 60-19a02 is
whether the district court judge can give effect to the jury's discharge of its constitutional
assignment. In the workers compensation arena, although recoveries are fixed, they are
directly proportional to the nature and extent of each claimant's injury and income. In
addition, distinct Section 18 jurisprudence permitted wholesale abolition and replacement
of a common-law cause of action because both sides received clear and comparable
benefits from the legislative transaction. The new administrative system of no-fault
compensation for injured workers left no common-law cause of action upon which
Section 5's jury trial right could act. See Watts, 2012 WL 3101657, at *7 (constitutional
right to jury trial contingent upon existence of civil action for damages). The cap at issue
in this action did nothing of the sort, and its rejection on Section 5 grounds would not
cause the collapse of the workers compensation system, much less make it inevitable or
imminent.

Much of the same can be said of the no-fault automobile insurance system. It is
markedly distinct from the damages cap at issue here. In order to receive prompt personal
injury protection payments after a car accident, an injured person no longer needs to file a
lawsuit to prove another's fault and the causal relationship between that fault and
damages. Rather, the personal injury protection claimant simply submits a claim to the
insurance company. The third-party common-law cause of action for those suffering
relatively minor injury was replaced with a first-party insurance contract claim. As with
workers compensation, the no-fault automobile insurance system means that every
claimant's opportunity to recover is directly proportional to the seriousness of his or her
case.

In short, all of the performers in the parade labor under a fallacy of relevance.

90

On the benefit side, the majority claims that following Kansas Malpractice
Victims Coalition and Samsel II by applying the quid pro quo test to rescue K.S.A. 60-
19a02 from invalidity under Section 5 fosters certainty. In fact, it does exactly the
opposite.

Uncertainty is created when error is compounded by blind adherence to precedent
that is analytically unsound. Certainty, predictability, stability, and respect for the rule of
law are enhanced when this court does what it has otherwise insisted upon doing in every
other case calling a legislative act into constitutional question. This is what every Kansan
expects of us, and properly so. "We do more damage to the rule of law by obstinately
refusing to admit errors, thereby perpetuating injustice, than by overturning an erroneous
decision." Johnson Controls, Inc. v. Employers Ins. of Wausau, 264 Wis. 2d 60, 121, 665
N.W.2d 257 (2003). That is why "[i]t is more important that the court should be right
upon later and more elaborate consideration of the cases than consistent with previous
declarations." Barden v. Northern Pacific Railroad, 154 U.S. 288, 322, 14 S. Ct. 1030, 38
L. Ed. 992 (1894); see also Watts, 2012 WL 3101657, at *10 ("[d]eviations from clear
constitutional commands—although longstanding—do not promote respect for the rule of
law") (quoting Independence-Nat. v. Independence School, 223 S.W.3d 131, 137 [Mo.
2007]).

The majority's final move in support of its application of the quid pro quo test to
plaintiff Miller's jury trial challenge is its declaration that it simply "seems logical" and
"makes sense" to forgive impairment of the inviolate individual right to jury trial under
the same standard that governs Section 18 right to remedy.

In fact, there is no logic or common sense to support this aspect of the majority's
opinion. The Section 5 right to jury trial is distinct in every conceivable dimension from
the Section 18 due process-based right to remedy. They share no language; the majority
points to no shared drafting rationale. Indeed, the rights' placement in separate sections of
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the Bill of Rights makes it clear that they articulate different concepts aimed to achieve
different purposes, and thus merit unique analyses. The majority cites not a single case in
which this court or any other has ever excused violation of one obviously nonidentical
constitutional right because the statute in question did not happen to violate another
constitutional right. It has not done so because there are no such cases.

Why does the majority depart so radically from its usual patterns of analysis? One
reason appears to be its doubt that legislators can comprehend anything more
complicated. It states: "[T]he quid pro quo model readily allows the legislature to
understand that it must provide an adequate and viable substitute when modifying a
common-law jury trial right under Section 5 or right to remedy under Section 18." This is
mere condescension. I am willing to trust that legislators (and the Kansans they represent)
can understand that Bill of Rights provisions with different language placed by the people
in different sections of our Constitution are interpreted and applied differently.

Conclusion

As a court of last resort, we are "the sole arbiter of the question whether an act of
the legislature is invalid under the Constitution of Kansas. However delicate that duty
may be, we are not at liberty to surrender, or to ignore, or to waive it. [Citation omitted.]"
Harris, 192 Kan. at 207. We must therefore be especially careful not to extend a doubtful
precedent where the result is to "to weaken or subvert" a fundamental constitutional right,
Dimick v. Schiedt, 293 U.S. 474, 485, 55 S. Ct. 296, 79 L. Ed. 603 (1935), and cannot
hide behind stare decisis to abdicate "our duty to reconsider constitutional interpretations
that 'depar[t] from a proper understanding' of the Constitution. [Citations omitted.]"
Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833, 954, 112 S. Ct. 2791,
120 L. Ed. 2d 674 (1992) (Rehnquist, J., concurring in judgment in part and dissenting in
part). Our allegiance is always to the Constitution itself, not to our caselaw. As the
Missouri Supreme Court did recently in its Watts case, we should demonstrate that
92

allegiance by admitting the error in our precedent applying the quid pro quo test to a
Section 5 jury trial challenge. See Watts, 2012 WL 3101657, at *11 (overruling Adams v.
Children's Mercy Hosp., 832 S.W.2d 898 [Mo. 1992]; striking down damages cap for
violating right to jury trial). I therefore dissent from the majority's decision upholding
K.S.A. 60-19a02 under Section 5. The statute's cap on noneconomic damages violates
plaintiff Miller's right to jury trial. Even if I accepted that Section 18's quid pro quo test is
met, which, as discussed in the next section, I do not, the test cannot excuse impairment
of this inviolate, individual constitutional right.

RIGHT TO REMEDY

The majority holds that the K.S.A. 60-19a02 cap on noneconomic damages does
not violate the right to remedy provision of Section 18 because it survives the two-part
quid pro quo test. Although I agree that the quid pro quo test applies to Section 18 claims,
I disagree that the test is met in this case. I also would invalidate the cap under Section
18.

Under the quid pro quo test, if a statute abolishes or restricts a remedy protected
by Section 18, it is unconstitutional unless (1) the modification was reasonably necessary
in the public interest to promote the general welfare of the people of the state; and (2) the
legislature has provided an adequate substitute remedy for the right that has been
abolished or limited. Lemuz v. Fieser, 261 Kan. 936, 946-47, 933 P.2d 134 (1997); Bonin
v. Vannaman, 261 Kan. 199, 217, 929 P.2d 754 (1996).

I agree with the majority's rejection of the defense argument that Samsel II's
"fictitious" quid pro quo—the statute's purely imaginary restriction of district court
judges' power to reduce a noneconomic damages award greater than $250,000 to less
than $250,000—controls. See Samsel II, 246 Kan. at 367 (Herd, J., dissenting). A fresh
look at the quid pro quo test is required.
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That fresh look begins with the threshold question: Does the cap impair a remedy
protected by Section 18? The majority admits early that Section 18 is designed to ensure
an injured plaintiff is made "whole." See PIK Civ. 4th 171.02 (jury instructed to establish
noneconomic damages at "amount that will fairly and adequately compensate the
plaintiff"). But for reasons undisclosed, the majority is squeamish about declaring that the
cap impairs the right to remedy. Instead, it says the cap "is subject to Section 18's
protections" and that it "implicate[s] the right secured by Section 18," burying the lede by
placing it in a parenthetical appended to a Kansas Malpractice Victims Coalition citation.
I would start with a clear statement that the right to remedy is infringed by the cap on
noneconomic loss. See Kansas Malpractice Victims Coalition, 243 Kan. at 350.

Having established the answer to the threshold question, I agree that we must
move to the first part of the quid pro quo test, which demands that the cap be reasonably
necessary in the public interest to promote the general welfare of the people of the state.
This poses an obstacle similar, if not identical, to the rational basis standard familiar from
equal protection analysis. Injured Workers of Kansas, 262 Kan. at 881 (quoting Lemuz,
261 Kan. at 948); Bonin, 261 Kan. at 218 (same). Rational basis imposes "'two
substantive limitations on legislative choice: legislative enactments must implicate
legitimate goals, and the means chosen by the legislature must bear a rational relationship
to those goals.'" Stephenson v. Sugar Creek Packing, 250 Kan. 768, 775, 830 P.2d 41
(1992) (quoting Lyng v. Automobile Workers, 485 U.S. 360, 375, 108 S. Ct. 1184, 99 L.
Ed. 2d 380 [1988] [Marshall, J., dissenting]).

The plaintiff and her supporters have argued that the first part of the quid pro quo
test cannot be met, because the medical malpractice insurance and liability insurance
"crises" that eventually gave rise to the cap at issue here were nonexistent. For purposes
of the extremely forgiving rational basis analysis of plaintiff Miller's as-applied
challenge, any conceivable rational basis is sufficient. If the legislature's goal is worthy,
94

as certainly access to affordable malpractice insurance and health care undoubtedly is,
then merely a logical possibility that the legislature's action will help to achieve the goal
is enough. See, e.g., Barrett v. U.S.D. No. 259, 272 Kan. 250, 256-57, 32 P.3d 1156
(2001) (application of recreational use exception under Kansas Torts Claims Act to
coaching negligence cases in public schools passes rational basis test; distinguishing
between injuries occurring on public versus nonpublic recreational property reasonably
advances legitimate goal of encouraging development of public recreational property);
Chiles v. State, 254 Kan. 888, 869 P.2d 707 (1994) (limited retroactivity provision of
Sentencing Guidelines Act, distinguishing inmates convicted of more serious offenses
from those with less serious convictions, rationally related to legitimate objective of
reducing prison population, maintaining public safety); see also State ex rel. Tomasic v.
Unified Gov't of Wyandotte County/Kansas City, 265 Kan. 779, 791-93, 962 P.2d 543
(1998) (inclusion of auto racetrack facility in definition of "major tourism area" bears
rational relationship to furtherance of economic development of the state). The provisions
of the HCPIAA, as amended, assert at least some control over malpractice insurance
rates, and may encourage certain health care providers to settle or remain in Kansas. I
therefore agree with the majority that the first part of the quid pro quo test is met in this
case. But see Ferdon v. Wisconsin Patients Comp. Fund, 284 Wis. 2d 573, 629-30, 701
N.W.2d 440 (2005) (after 10 years' experience, holding cap violates equal protection
because rational basis touted by proponents unsupported); Plank v. Community Hospitals
of Indiana, Inc., 956 N.E.2d 731, 736-37 (Ind. App. 2011) (case remanded to trial court
to allow plaintiff evidentiary hearing on whether cap still bears rational relationship to
legitimate government interest) vacated on transfer to Indiana Supreme Court, 963
N.E.2d 1120 (Ind. 2012).

I cannot likewise join the majority's further holding on the second step of the quid
pro quo test. K.S.A. 60-19a02 and other malpractice law reforms did not provide an
adequate substitute remedy for the cap's modification of plaintiff Miller's right to remedy
under Section 18.
95


I begin with the question plaintiff Miller has squarely raised: Can the adequate
substitute remedy requirement be satisfied with benefits that accrue to society in general
or must there be an individual quid, i.e., a direct benefit to each person in the class forced
to surrender a remedy? Again, I do not see a clear answer to this question in the
majority's opinion. I would provide one today, because our earlier caselaw on this point
has been inconsistent.

Many of our precedents suggest that a substitute remedy must provide a direct
benefit to individuals. See, e.g., Injured Workers of Kansas, 262 Kan. at 883 ("when the
legislature abolished the employees' common-law right to sue employers for injuries, the
legislature provided employees with an adequate substitute remedy"); Samsel II, 246
Kan. at 358-62 (describing substitute remedy as "quid pro quo to the individual");
Manzanares, 214 Kan. at 596-97, 599-600 (mandatory first-party insurance benefits
providing motor vehicle accident victim with system of "prompt, efficient payment" of
medical expenses, lost wages, other economic losses without proof of fault constitutes
adequate exchange for impairment of Section 18 remedy); Hanson v. Krehbiel, 68 Kan.
670, Syl. ¶¶ 1, 3, 674, 75 P. 1041 (1904) (right to remedy affords "one injured in his
reputation . . . opportunity to show the extent of his injury"; statute specifying reparation
"the same in all cases," bearing "no relation to the injury suffered," insufficient).

In contrast to the language used in these cases, our decision in Lemuz relied on a
combination of individual and societal benefits to hold that there was an adequate
substitute remedy. 261 Kan. at 959. We said that the plaintiffs would "personally receive
the benefit" of the mandatory primary medical malpractice insurance and guaranteed
excess coverage and "[f]urther, all plaintiffs will generally receive the benefit of the
supplemental quid pro quo—risk management requirements that protect patients from
incompetent doctors." 261 Kan. at 959. And, in Bonin we relied solely on the societal
96

benefit of health care access to hold that the substitute remedy was adequate. 261 Kan. at
219.

I would hold today that an adequate substitute remedy is one that provides an
individual benefit to each person in the class of plaintiffs whose constitutional right to
remedy is impaired. Section 18 protects an individual right—the right of every person to
the remedies that existed at common law for injuries to his or her person, property, or
reputation. See Noel v. Menninger Foundation, 175 Kan. 751, 763, 267 P.2d 934 (1954)
(Section 18 guarantees "every person a remedy by due course of law for injury done him
in person or property.").

The requirement of an individual quid also is imperative because the first step of
the Section 18 quid pro quo test focuses only on the public necessity for the legislation.
Standing alone, it provides no protection for the individual right at stake. It is only the
second step of the test that ensures the right to remedy cannot be "wholly sacrificed to the
popular will." Note, Restrictive Medical Malpractice Compensation Schemes: A
Constitutional "Quid Pro Quo" Analysis to Safeguard Individual Liberties, 18 Harv. J. on
Legis. 143, 201 (1981); see also Bair v. Peck, 248 Kan. 824, 845, 811 P.2d 1176 (1991)
(Herd, J., dissenting) (if requirement of substitute remedy ignored, "[o]ur written
constitution loses its meaning and affords no barrier to the enactment of unjust laws
resulting from transitory public pressures of the moment"). If some amorphous or even
illusory public good is enough to satisfy the second step, then it effectively dissolves into
the first. Retention of the distinct vitality of both the "minimum rationality" step and the
adequate substitute step balances the legislature's freedom to modify "common-law tort
remedies to accommodate the exigencies of contemporary society" and "meaningful
protection" for the individual's right to remedy. 18 Harv. J. on Legis. at 200-01.

We implicitly recognized this necessity in Lemuz, when we held that the adequate
substitute remedy requirement imposes an additional and more stringent limitation than
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rational basis. 261 Kan. at 948; see also Kansas Malpractice Victims Coalition, 243 Kan.
at 350 (rejecting argument that "removal of a remedy can be justified any time by public
need"); Comment, The Kansas Remedy by Due Course of Law Provision: Defining a
Right to a Remedy, 47 U. Kan. L. Rev. 655, 675, 677, 679 (1999) (substitute remedy step
must require that "the quid pro quo . . . directly benefit those affected rather than simply
benefitting the general welfare of society"; if public-welfare benefit satisfies both steps of
Section 18 analysis, "the quid pro quo fades into the state's general police power—the
legitimate government end becomes the quid pro quo").

Several of our sister states also have recognized that societal benefits cannot
satisfy the substitute remedy requirement. See Smith v. Department of Ins., 507 So. 2d
1080, 1087-89 (Fla. 1987) (argument that cap intended to assure affordable, available
insurance to all "fails to recognize that we are dealing with a constitutional right which
may not be restricted simply because the legislature deems it rational to do so"); Lucas v.
United States, 757 S.W.2d 687, 690 (Tex. 1988) (societal quid pro quo not valid factor in
assessing whether adequate substitute has been provided for restriction on right to
remedy; "alleged benefits to society generally," such as lower insurance premiums, lower
medical costs for all, do not provide quid pro quo); compare Wright v. Central Du Page
Hosp. Ass'n, 63 Ill. 2d 313, 328, 347 N.E.2d 736 (1976) (maximum cap on damages
violates constitutional provision on special legislation; societal benefits do not provide
adequate substitute).

Today's majority, having failed to establish a clear baseline on the necessary direct
and individual nature of a substitute for the Section 18 right to remedy, holds that the
mandatory minimum primary and excess malpractice insurance coverage provisions of
the HCPIAA meet the second part of the quid pro quo test. In the majority's view,
because a judgment that cannot be collected is worthless, the mere prospect or
availability of some source of recovery provides medical malpractice plaintiffs such as
Miller a benefit that other tort victims do not have. I disagree. HCPIAA's insurance
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requirements do not qualify as a substitute remedy at all, and definitely not an adequate
one.

A "remedy" is a judicial means or method for enforcing a right or redressing a
wrong. Neely v. St. Francis Hospital & School of Nursing, 192 Kan. 716, 720-21, 391
P.2d 155 (1964). As we said in Noel v. Menninger Foundation:

"The constitutional provision guaranteeing to every person a remedy by due course of
law for injury done him in person or property means that for such wrongs that are
recognized by the law of the land the court shall be open and afford a remedy, or that
laws shall be enacted giving a certain remedy for all injuries or wrongs. 'Remedy by
due course of law,' so used, means the reparation for injury ordered by a tribunal
having jurisdiction in due course of procedure after a fair hearing. It is the primary
duty of the courts to safeguard the declaration of right and remedy guaranteed by the
constitutional provision insuring a remedy for all injuries.' [Citation omitted.]" Noel,
175 Kan. at 762-63.

And Kansans' broad right to remedy under Section 18 includes many aspects of the
judicial process. See, e.g., Lemuz, 261 Kan. at 946 (abrogation of corporate negligence
doctrine preventing plaintiffs from seeking remedy against hospitals for breach of a duty
owed under common law implicates Section 18); Bonin, 261 Kan. at 214 (statute of
repose abrogating minor's right of action for injuries before their discovery implicates
Section 18); Bair, 248 Kan. at 838 (statute eliminating vicarious liability of health care
provider for negligent acts of another when both providers covered by Fund impairs right
to remedy under Section 18); Kansas Malpractice Victims Coalition, 243 Kan. at 352
(requirement of annuity contract purchase for payment of award for future economic
damages violates right to remedy); Ernest v. Faler, 237 Kan. 125, 134, 697 P.2d 870
(1985) (notice of claim statute barring right to suit for negligent injuries caused by
pesticide application denies remedy in courts to injured person); Rajala v. Doresky, 233
Kan. 440, 441, 661 P.2d 1251 (1983) (workers compensation law implicates Section 18
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by removing certain common-law remedies for injured employees, including right of
action against fellow employees); Neely, 192 Kan. at 723 (statute exempting assets of
certain charitable institutions from attachment, garnishments, executions, other process
for enforcing judgments violates Section 18). Section 18 also covers full reparation for
injuries to person, reputation, or property. Kansas Malpractice Victims Coalition, 243
Kan. at 349 (all injuries, not just a few) (citing Neely, 192 Kan. at 722-23); see also
Manzanares v. Bell, 214 Kan. 589, 599, 522 P.2d 1291 (1974) (Section 18 includes right
to recover noneconomic losses); Hanson, 68 Kan. at 677 (same).

Mere access to a source of recovery is not a remedy within the meaning of Section
18. Kansas Malpractice Victims Coalition, 243 Kan. at 351. This is a rule of long
standing. In 1904's Hanson v. Krehbiel, where we held that a statutorily required
published retraction was not a substitute remedy for the right to recover noneconomic
damages for libel, we said:

"The right to a remedy by due course of law is not satisfied by the requirement contained
in a statute to make specific reparation for the injury done, which reparation is the same
in all cases, and bears no relation to the injury suffered, and has not been decreed by a
tribunal after ascertainment of the extent of such injury." 68 Kan. 670, Syl. ¶ 3.

Despite this, the majority asserts that Bair and Lemuz, as well as workers
compensation and no-fault automobile insurance caselaw, support its adequate substitute
remedy holding. Again, I am not persuaded by this invocation of precedent.

Bair involved a statute that eliminated vicarious liability of one health care
provider for the acts of another when both are covered by the Fund. Bair, 248 Kan. at
828. Eliminating vicarious liability affected only the right to pursue a secondarily liable
party for a single tortfeasor's injury-causing negligence and would come into play only if
the tortfeasor employee was financially unable to pay the damages. This context of
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duplicative insurance coverage essentially made the employer's liability of little
consequence; either way, a plaintiff would have only one source of recovery. Even
assuming that, in conflict with Hanson, a source of recovery could qualify as a remedy,
Bair's holding that HCPIAA's mandatory insurance provisions qualified as an adequate
substitute remedy was unnecessary, because the statute took no source of recovery away.

Lemuz involved a statute that granted medical care facilities immunity from
corporate negligence claims. It never actually wrestled with the question of whether
access to a source of recovery can qualify as a substitute remedy, because the plaintiff
accepted that the mandatory insurance provisions provided such a remedy, arguing only
that statutory amendments reducing the amount of primary and excess coverage from
unlimited coverage to $3.2 million, as addressed in Bair, and then to $300,000 made the
remedy inadequate. 261 Kan. at 951-56.

With regard to our workers compensation and no-fault automobile insurance
cases, again, both systems provide genuine, wholesale replacement compensation
mechanisms in exchange for the loss of the common-law right to remedy involved. See
Manzanares, 214 Kan. at 596-99. The workers compensation claimant does not have to
prove that his or her work-related injury was caused by the employer's negligence, and an
administrative claims procedure has been substituted for the burdens of a traditional
personal injury lawsuit. The personal injury protection claimant in a no-fault automobile
insurance matter simply submits a claim to the insurance company, rather than filing a
lawsuit to prove that a tortfeasor caused the injury. The HCPIAA does not provide a
medical malpractice plaintiff such as Miller with anything remotely similar to what the
workers compensation and no-fault automobile insurance systems provide. She has been
relieved of none of the burdens of traditional litigation of her claim, only of her ability to
recover all of her damages. Her route to compensation has been made no more straight,
no more level. Today a medical malpractice action must be prosecuted exactly as it was
when our Kansas Constitution first guaranteed citizens a right to remedy.
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This brings me to the adequacy question. Even if I were to assume that the
majority's "available source of recovery" qualified as a substitute remedy less fanciful
than Samsel II's floor under judicial remittitur, every individual plaintiff who is
successful at trial still runs the risk that the mandatory coverages will be wholly or
partially unavailable to pay a judgment because other claims during the policy period
have already exhausted them. The shrinking mandatory limits have no doubt exacerbated
this problem. The less skilled and careful a provider, the more likely there will be
multiple lawsuits, and the more likely any individual plaintiff will get absolutely nothing
in exchange for his or her Section 18 right to be made whole. The money will already
have gone to those who won the race to the courthouse. Although I am sure that the
members of our legislature did not intend to make Kansas a haven for incompetent and/or
insolvent providers, the majority's protective approach may mean that the legislature has
done exactly that.

Another serious adequacy issue is the inverse proportion between the cap and
sinking mandatory insurance minimums on the one hand and the seriousness of a
plaintiff's injuries on the other. As long as the cap remains in place, we know with
absolute certainty that no plaintiff, no matter how grievously injured, will ever be finally
awarded more than $250,000 in noneconomic damages. It is also therefore beyond
question that the most seriously injured plaintiff is likely to be most insufficiently
compensated by a system with a K.S.A. 60-19a02 cap. He or she is more likely to be
awarded noneconomic damages in excess of $250,000, bringing the cap into play to take
away a larger percentage of any larger jury award. In addition, such a malpractice victim
also is likely to have the highest economic damages because of greater medical and
rehabilitation or life care expenses. The youth of a victim also can increase these
damages amounts exponentially. See Ferdon, 284 Wis. 2d at 625. The higher these
victims' economic damages, the more likely it is that the mandatory insurance coverages
will be completely depleted before they see a dime of noneconomic recovery. It is
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dramatically unfair to place the burden of supporting the state's medical care industry
solely upon those most severely injured by a provider. See Carson v. Maurer, 120 N.H.
925, 941, 424 A.2d 825 (1980); see also Brannigan v. Usitalo, 134 N.H. 50, 57-58, 587
A.2d 1232 (1991) (increase in amount of cap increases unfairness of burden on few most
badly injured). The inverse proportion of seriousness of injury/damages to likelihood of
recovery inherent in the cap and the mandatory insurance minimums stands in stark
contrast to the genuinely adequate substitute remedies the legislature fashioned in the
workers compensation and no-fault automobile insurance arenas.

Given the criticisms I have already detailed, I do not address plaintiff's argument
that the amount of the cap, even if adequate at the time of its passage, has been driven
down to an unconstitutional level of purchasing power by inflation. I note only that the
majority provides little cover for the defense position on this point. Indeed, the majority
strongly suggests that future legislative refusal to adjust the amount of the cap for
inflation endangers today's adequacy ruling.

Conclusion

For all of these reasons, I would hold that the legislature has failed to provide any
substitute remedy—much less an adequate one—in exchange for its elimination of
plaintiff Miller's right to her award of noneconomic damages greater than $250,000.

One final point bears mention. The majority's use of mandatory medical
malpractice insurance and its illusory enhanced source of some recovery as the adequate
substitute remedy to satisfy the second part of the quid pro quo test it applies to both
Section 5 and Section 18 leaves open the question whether the K.S.A. 60-19a02 cap can
survive scrutiny under those provisions when applied to other personal injury plaintiffs.
Plaintiff Miller has conceded that she cannot mount a facial challenge to the cap if her as-
applied-to-her challenge fails to persuade a majority of this court. See Cross v. Kansas
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Dept. of Revenue, 279 Kan. 501, 507-08, 110 P.3d 438 (2005). This is exactly what has
come to pass. Thus the reach of the majority's holding and rationale is limited to the
malpractice setting, and our unanimous desertion of Samsel II's only rationale to support
upholding the cap in other personal injury cases means it is vulnerable to a renewed
attack. This is another reason why I regard the majority's uncomfortable contortions to
reach the outcome it reaches here as far too high a price to pay.

EQUAL PROTECTION

Plaintiff Miller's initial equal protection argument centers on our level of review.
She asserts that the fundamental rights at issue mean the legislature's interference with
them demands strict scrutiny.

Miller relies on a line of cases in which we describe the right to trial by jury and
the right to remedy as fundamental rights. See Ernest, 237 Kan. at 132 ("[T]he right of a
person injured by the tortious act of another to a remedy for his injuries is one of the
basic constitutional rights guaranteed protection by the Kansas courts."); Gard v.
Sherwood Construction Co., 194 Kan. 541, 549, 400 P.2d 995 (1965) (right to jury trial
"a basic and fundamental feature of American jurisprudence"); Noel, 175 Kan. at 763 ("It
is the primary duty of the courts to safeguard the declaration of right and remedy
guaranteed by the constitutional provision insuring a remedy for all injuries."); Hasty v.
Pierpont, 146 Kan. 517, 521, 72 P.2d 69 (1937) (quoting Parsons v. Bedford, 28 U.S.
433, 446, 7 L. Ed. 732 [1830]) (by securing right to trial by jury in civil cases in Bill of
Rights, framers "'establish[ed] its importance as a fundamental guarantee of the rights and
liberties of the people'").

I believe Miller's strict scrutiny argument worthy of greater consideration than the
majority gives it here, although I reserve ultimate judgment on its merit. We have never
provided a reasoned explanation for how and why either of these two significant and
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fundamental constitutional rights should be subject to only the minimal level of
protection afforded by the rational basis test. See Neily, No Such Thing: Litigating
Under the Rational Basis Test, 1 NYU J. L. & Liberty 898, 909 (2005) (criticizing
"yawning chasm" between United States Supreme Court rhetoric referring to
occupational freedom as constitutional right, Court holdings that no longer provide any
meaningful protection for that right; legislators permitted to trample right "with near total
impunity").

Because I would hold that K.S.A. 60-19a02's cap on noneconomic damages
violates the right to jury trial and the right to remedy, I do not further pursue this issue
today. See Rotunda and Nowak, 4 Treatise on Const. Law - Substance and Procedure, §
18.40 (4th ed. 2008) (if statute violates enumerated constitutional right, generally no need
to resort to equal protection analysis; substantive guarantees of constitutional right serve
as its strongest protection against limitation).

JOHNSON, J., joins in the foregoing concurring and dissenting opinion.

* * *

JOHNSON, J., concurring in part and dissenting in part: I wholeheartedly join with
Justice Beier's concurrence and dissent and fully embrace her well-reasoned legal
analysis. I write separately only to share some of my observations about K.S.A. 60-
19a02, viewed through the lens of practicality and common-sense, rather than
constitutional jurisprudence. For simplicity, I will use the term "doctor" to refer to all
medical care providers covered by the statute.

As I understand it, the rationalization for imposing the statutory cap (Cap) on
recoverable noneconomic damages in a medical malpractice action was to address a
perceived crisis created by the nonavailability and high cost of medical malpractice
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insurance. It would seem abundantly clear that the reason that an insurance company
would quit writing policies in Kansas or would raise premiums to an exorbitant level is
that the amount of money the company had to pay out in claims was too high in relation
to the amount of premiums it had collected from its policyholders, i.e., the insurance
company was not making a suitable profit selling medical malpractice insurance in
Kansas. Supposedly, then, doctors did not want to practice in Kansas because of the
limited availability and high cost of malpractice insurance. So the legislative solution to
the doctor shortage (or threat of a doctor shortage) was to establish the Cap, the apparent
purpose of which was to fix a limit on the amount of money that a medical malpractice
insurer would have to pay on each claim, thereby helping the company make more
money and perhaps enticing it to lower its premiums and maybe attract more doctors to
this state. Regardless of whether one believes that the "crisis" existed, the legislative "fix"
to the stated problem is illogical and counterproductive, as well as making a statement
that Kansas citizens do not possess sufficient intelligence, wisdom, and judgment to
perform the duties of jurors.

First, I believe it is important to review when a medical malpractice insurer will be
called upon to pay a claim under such a policy. Consistent with all liability insurance, a
medical malpractice claim is only payable where the doctor is legally liable for a patient's
injuries. A doctor is legally liable—commits malpractice—only when the doctor fails to
exercise an appropriate degree of care and skill. If the doctor has not been careless or
medically inept, the doctor has not committed malpractice for insurance purposes, even if
the patient suffers a horribly bad result. And who says what degree of care and skill the
doctor must satisfy to avoid a malpractice claim? Other doctors practicing in the same
field as the defendant doctor set those standards.

In other words, malpractice insurance companies only have to pay for injuries that
are caused by an insured doctor's carelessness or ineptitude, as measured by other
doctors. I am convinced that Kansas enjoys an abundance of wonderfully skilled, careful,
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and professional doctors. But just as we observe in the legal profession, some
practitioners are simply incapable or unwilling to consistently perform in compliance
with the minimum standards of the profession. One would naturally expect that group of
perennially underperforming doctors to be responsible for a disproportionate number of
the egregiously injured patients being paid by malpractice insurers.

Perhaps, then, a more effective means of solving a malpractice insurance crisis
would be to address its root problem and reduce the number of doctors who are
chronically careless and/or unskilled. That is the tack the legislature took when it
determined there was a crisis of too many alcohol-related highway deaths. It passed
tougher driving under the influence laws to try to get the drunks off of Kansas roads.
Why not try to get the unskilled and careless doctors out of their Kansas offices and
hospitals?

That course of action would have the added benefit of reducing the number of
malpractice claims. In contrast, the Cap only addresses the amount of damages to be paid
in any one claim. A particular doctor could suffer any number of malpractice judgments
in any timeframe, thus exposing the malpractice carrier to the possibility of paying
multiple $250,000 noneconomic claims. How is that effective to reduce the overall cost
of malpracticing doctors?

For a method of achieving an actual solution to the stated crisis, one need only
look at how automobile liability insurance carriers operate. Those companies perform an
underwriting function each policy renewal to separate the bad risks from good risks,
looking at certain factors such as the number of accidents the insured driver has caused.
A driver labeled as a bad risk will not be offered a policy at normal rates, but rather will
have to pay a substantial premium on a "high-risk" policy for minimum coverage. If that
person cannot afford the exorbitant premiums, he or she simply cannot legally drive a
vehicle. The very careful driver—one with a long history of driving without an
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accident—will be rewarded with a preferential policy, providing such things as a good-
driver discount or a disappearing deductible. In other words, good drivers do not
subsidize the bad drivers' insurance. Likewise, the injured persons are third-party victims,
not parties to the bad drivers' automobile insurance contracts, and they should not have to
subsidize the bad drivers' premiums through a reduction in compensation.

In short, if the problem to be solved here really is the availability and cost of
medical malpractice insurance, a solution exists that would place the burden on those
directly responsible for the problem rather than on their victims. The overall quality of
medical care for Kansas citizens would be enhanced because unskilled and careless
doctors would be priced out of the malpractice insurance market and unable to practice
legally in this State. In contrast, the Cap creates the ultimate irony: Chronically inept and
careless doctors are encouraged to locate in Kansas and continue to maim and injure their
patients, because those injured patients will help subsidize affordable malpractice
premiums through an artificial and arbitrary reduction in collectible damages.
Remembering that doctors who exercise the appropriate level of skill and care do not
commit malpractice and do not create malpractice insurance crises, one has to wonder
whether the legislative goal in fixing the Cap was to increase the availability of doctors
who frequently get sued. That is the effect, if not the intent, and I am amazed that the
electorate in Kansas is content to let that circumstance continue.

Another concept that I find incomprehensible is the argument that the Cap is
needed in order for insurers to have a limit on their exposure. The majority repeats the
defense argument that the Cap is needed to "[eliminate] both the difficulty with rate
setting due to the unpredictability of noneconomic damages awards and the possibility of
large noneconomic damage awards." Miller, slip op. at 39. This is a rationalization that
must be addressed lest it hoodwink the uninformed. Malpractice insurance policies, like
other liability insurance policies, provide for limits of liability. The term "limit of
liability" means exactly what it says: a fixed limit on the amount that the insurance
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company will have to pay in the event of a loss. In other words, the company is protected
against an unpredictably high noneconomic jury award by its contract requiring it to pay
only the limit of liability for which a premium was charged. That is why the higher the
limits of liability on a policy, the higher the insured's premiums. Moreover,
"unpredictability" is the touchstone of insurance; companies never know when a tornado
or hailstorm may hit a particular Kansas town or when an insured driver may cause a 20-
car pile-up on Interstate 70. In short, I fail to discern any unique actuarial dilemma for a
medical malpractice liability risk. Likewise, as previously noted, the Cap does not
provide any stability to the overall exposure of insurers, because it does not prevent
multiple, successive claims against a doctor. For instance, a doctor with four malpractice
incidents on which the Cap applied could present claims for noneconomic damages
totaling a million dollars. How does a Cap make that more predictable?

What I do discern is that the Cap will protect a malpracticing doctor against an
excess judgment, over and above the insurance policy limits of liability, which might be
collectible against the doctor's personal assets. Perhaps that is a risk to be avoided, but, if
so, I would prefer that the Cap proponents be candid about this purpose.

Finally, to state the obvious for us in the legal profession, the amount of
noneconomic damages that will compensate a malpractice victim is determined by a jury
composed of regular Kansas citizens—not by a "liberal activist judge" or a "greedy
plaintiff's attorney." Our friends and neighbors who are doing their civic duty of serving
as jurors, and who have no personal interest in the outcome of the case, assess the
evidence and fix the amount of damages that are appropriate. Having been called to jury
duty myself, I am offended by the legislature's suggestion that Kansas citizens cannot be
trusted to determine the appropriate amount of damages on the facts before them. It is at
least curious that those legislators who crow about serving in the "people's body of
government" would effectively disenfranchise the people they represent by negating their
votes as jurors.
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Unfortunately, the most affluent and advantaged people in our society often get
what they want at the expense of the least fortunate among us whose voice is not loud
enough to be heard. Sometimes, juries and the courts will act as life preservers for these
burdened minorities. Today, in my view, this court has incorrectly and unnecessarily
limited jury involvement and allowed a segment of unfairly burdened Kansans to drown
while maintaining higher profits for insurance companies and lower expenses for doctors.
Shame on us.