Does the MICRA cap of $250,000 for medical malpractice cases apply to a physician’s assistant?

Does the MICRA cap of $250,000 for medical malpractice cases apply to a physician’s assistant?

This was the question that was taken up (and answered) in Lopez v. Ledesma (2022) 46 Cal App 5th 980.

In that case, plaintiff’s daughter was diagnosed with metastatic malignant melanoma and eventually died from the disease – she was three years old when she died.  The parents had brought their newborn to the medical offices with complaints of “lesions” on the top of her head.  These lesions were misdiagnosed up until shortly before she died of skin cancer.

The parents (plaintiffs) sued several defendants, two of whom were physician assistants (PAs), for medical negligence and wrongful death.

The trial court found in favor of plaintiff on her negligence claims against the PAs, holding that the PAs did not take adequate steps to diagnose the daughter’s condition and did not seek guidance from a supervising physician. The trial court awarded plaintiff $4.25 million in noneconomic damages but reduced this amount to $250,000 pursuant to Civ. Code, § 3333.2, subd. (b), part of the Medical Injury Compensation Reform Act (MICRA), which places a cap on such damages.

The plaintiffs appealed arguing that MICRO should not apply to PAs as they are not doctors and should not fall under the umbrella of MICRA.  The Court of Appeal, Second Dist., Div. Two, No. B284452, affirmed the trial court’s reduction in damages. The Court of Appeal held that a PA acts within the scope of his or her license for purposes of § 3333.2, subd. (c)(2), if the PA has a legally enforceable agency agreement with a supervising physician, regardless of the quality of actual supervision.

The plaintiffs appealed to the Supreme Court of California.  The Supreme Court affirmed the judgment of the Court of Appeal, holding that Civ. Code, § 3333.2, applies to a PA who has a legally enforceable agency relationship with a supervising physician and provides services within the scope of that agency relationship, even if the physician violates his or her obligation to provide adequate supervision. A PA practices within the scope of his or her license for purposes of MICRA’s cap on noneconomic damages when the PA acts as the agent of a licensed physician, performs the type of services authorized by that agency relationship, and does not engage in an area of practice prohibited by the Physician Assistant’s Practice Act. That the fact that the PAs’ conduct could give rise to professional discipline or criminal liability did not render MICRA inapplicable.

As a result of the Supreme Court’s affirmation of the lower rulings, the plaintiffs’ award of $4,250,000 from a jury was reduced to $250,000.00.  The Courts cut $4,000,000.00 from the jury’s award for the life of their 3 year old daughter.  The $250,000 cap was arrived at and set in 1975 and has never been adjusted or revised.  I think it’s clear that it’s time that the MICRA cap be revisited and updated to, at the very least, match inflation.