California Changes to Medical Malpractice Lawsuits Cap Initiative (2022)

California Changes to Medical Malpractice Lawsuits Cap Initiative
Election date November 8, 2022
Topic Tort law and Healthcare
Status Not on the ballot
Type State statute	Origin Citizens

The California Changes to Medical Malpractice Lawsuits Cap Initiative was not on the ballot in California as an initiated state statute on November 8, 2022.

Overview

What would the ballot initiative have changed about medical malpractice lawsuits in California?

The ballot initiative would have increased California's cap on noneconomic damages in medical malpractice lawsuits based on changes in inflation since 1975, which is when the cap on noneconomic damages was enacted. In 1975, the cap was set at $250,000. The ballot initiative would have required an annual adjustment of the cap based on inflation.

The ballot initiative would have allowed judges and juries to award damages above the cap for catastrophic injuries, defined as death, permanent physical impairment, permanent disfigurement, permanent disability, or permanent loss of consortium.

The ballot initiative would have also replaced language about noneconomic damages with quality of life damages and survivor damages.

Who was behind the campaigns surrounding the ballot initiative?

The Fairness for Injured Patients Act Coalition led the campaign in support of the ballot initiative. Through December 31, 2021, the campaign received $5.6 million, including $3.9 million from trial lawyer Nicolas Rowley and $500,000 from Trial Lawyers for Justice.

Californians to Protect Patients and Contain Health Care Costs led the campaign in opposition to the ballot initiative. Through December 31, 2021, the campaign received $29.70 million, including $6.15 million from The Doctors Company and $5.00 million from Kaiser Foundation Health Plan, Inc.

Text of measure

Ballot title

The official ballot title would have been as follows:

“

Adjusts Limitations in Medical Negligence Cases. Initiative Statute.

”

Petition summary

The summary provided for inclusion on signature petition sheets was as follows:

“

In medical negligence cases, adjusts for inflation: (1) $250,000 limit established in 1975 on quality-of-life and survivor damages (which include pain and suffering); and (2) contingent attorney’s fees limits established in 1987. In cases involving death or permanent injury, allows judge or jury to exceed these limits and requires judge to award attorney’s fees. Requires attorneys filing medical negligence cases to certify reasonable basis for claims or good faith attempt to obtain medical opinion; attorneys who file meritless lawsuits must pay defendant’s expenses. Extends deadlines for filing medical negligence lawsuits.

”

Fiscal impact

The fiscal impact statement was as follows:

“

Increased state and local government health care costs predominantly from raising or removing the cap on noneconomic damages in medical malpractice cases, likely ranging from the low tens of millions of dollars to the high hundreds of millions of dollars annually.

”

Full text

The full text of the ballot initiative is below:

Support

The Fairness for Injured Patients Act Coalition led the campaign in support of the ballot initiative.

Supporters

• Former U.S. Sen. Barbara Boxer (D)
• Consumer Watchdog
• Trial Lawyers for Justice
• Nicolas Rowley

Opposition

Californians to Protect Patients and Contain Health Care Costs led the campaign in opposition to the ballot initiative.

Opponents

• Medical Insurance Exchange of California
• The Doctors Company
• California Medical Association
• Kaiser Foundation Health Plan, Inc.

Campaign finance

See also: Campaign finance requirements for California ballot measures

The campaign finance information on this page reflects the most recent scheduled reports that Ballotpedia has processed, which covered through March 31, 2022. The deadline for the next scheduled reports was August 1, 2022.

Two PACs—Fairness for Injured Patients Act Coalition and Consumer Watchdog Campaign for the Fairness for Injured Patients Act—were registered to support the ballot initiative. The committees had raised over $6 million, including $3.9 million from lawyer Nicolas Rowley.

The Californians to Protect Patients and Contain Health Care Costs PAC was registered to oppose the ballot initiative. The committee had raised $29.70 million, including $6.15 million from The Doctors Company.

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	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Support	$5,913,950.19	$160,000.00	$6,073,950.19	$5,402,932.75	$5,562,932.75
Oppose	$29,706,294.00	$155,005.57	$29,861,299.57	$5,948,342.72	$6,103,348.29

Support

The following table includes contribution and expenditure totals for the committees in support of the ballot initiative.

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Committees in support of California Changes to Medical Malpractice Lawsuits Cap Initiative (2022)
Committee	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Fairness for Injured Patients Act Coalition	$5,223,430.00	$160,000.00	$5,383,430.00	$5,118,656.13	$5,278,656.13
Consumer Watchdog Campaign for the Fairness for Injured Patients Act	$690,520.19	$0.00	$690,520.19	$284,276.62	$284,276.62
Total	$5,913,950.19	$160,000.00	$6,073,950.19	$5,402,932.75	$5,562,932.75

Donors

The following were the top donors to the support committees.

Donor	Cash Contributions	In-Kind Contributions	Total Contributions
Nicolas Rowley	$3,807,000.00	$140,000.00	$3,947,000.00
Trial Lawyers for Justice	$500,000.00	$0.00	$500,000.00
Consumer Watchdog	$190,495.19	$0.00	$190,495.19
Alder Law - A Professional Corporation	$100,000.00	$0.00	$100,000.00
Arash Homampour	$100,000.00	$0.00	$100,000.00
Christopher B. Dolan	$100,000.00	$0.00	$100,000.00
John Carpenter	$100,000.00	$0.00	$100,000.00
Lalezary Law Firm, LLP	$100,000.00	$0.00	$100,000.00

Opposition

The following table includes contribution and expenditure totals for the committee in opposition to the ballot initiative.

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Committees in opposition to California Changes to Medical Malpractice Lawsuits Cap Initiative (2022)
Committee	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Californians to Protect Patients and Contain Health Care Costs	$29,706,294.00	$155,005.57	$29,861,299.57	$5,948,342.72	$6,103,348.29
Total	$29,706,294.00	$155,005.57	$29,861,299.57	$5,948,342.72	$6,103,348.29

Donors

The following was the top donors to the opposition committee.

Donor	Cash Contributions	In-Kind Contributions	Total Contributions
The Doctors Company	$6,150,000.00	$0.00	$6,150,000.00
Kaiser Foundation Health Plan, Inc.	$5,000,000.00	$0.00	$5,000,000.00
California Hospitals Committee on Issues (CHCI)	$4,000,000.00	$0.00	$4,000,000.00
Mutual Protection Trust	$3,500,000.00	$0.00	$3,500,000.00
California Medical Association - Physicians' Issues Committee	$1,400,000.00	$25,312.70	$1,425,312.70

Background

MICRA

The Medical Injury Compensation Reform Act (MICRA) was signed in 1975 by Gov. Jerry Brown (D). MICRA capped noneconomic pain and suffering damages, as a result of medical malpractice, at $250,000. Under MICRA, there is no cap on economic damages, such as compensation for medical bills or lost wages.

California Proposition 46 (2014)

See also: California Proposition 46, Medical Malpractice Lawsuit Cap and Drug Testing of Doctors Initiative (2014)

In 2014, voters rejected a ballot initiative, titled Proposition 46, that would have increased the cap on noneconomic damages from $250,000 to $1.00 million and required drug and alcohol testing of doctors. The vote was 33.24% to 66.76%.

Supporters of Proposition 46 received $13.31 million, including $2.29 million from the Consumer Attorneys Issue PAC. Opponents received $59.60 million, including $11.00 million from the Norcal Mutual Insurance Company, $10.50 million from The Doctors Company, and $10.20 million from the Cooperative of American Physicians.

Caps on noneconomic damages in medical cases

As of August 2021, 31 states had caps on noneconomic damages in medical malpractice cases. The other 19 states did not have caps, meaning there was no maximum amount that someone could receive in a medical malpractice case. Of the 31 states with caps on noneconomic damages, the range was $250,000 to $2.5 million. The average state cap was $597,445, and the median state cap was $450,000. California had a noneconomic cap of $250,000.

Path to the ballot

See also: Laws governing the initiative process in California

Process in California

In California, the number of signatures required for an initiated state statute is equal to 5 percent of the votes cast in the preceding gubernatorial election. Petitions are allowed to circulate for 180 days from the date the attorney general prepares the petition language. Signatures need to be certified at least 131 days before the general election. As the verification process can take multiple months, the secretary of state provides suggested deadlines for ballot initiatives.

The requirements to get initiated state statutes certified for the 2022 ballot:

• Signatures: 623,212 valid signatures were required.
• Deadline: The deadline for signature verification was 131 days before the general election, which was around June 30, 2022. However, the process of verifying signatures can take multiple months and proponents are recommended to file signatures at least two months before the verification deadline.

Signatures are first filed with local election officials, who determine the total number of signatures submitted. If the total number is equal to at least 100 percent of the required signatures, then local election officials perform a random check of signatures submitted in their counties. If the random sample estimates that more than 110 percent of the required number of signatures are valid, the initiative is eligible for the ballot. If the random sample estimates that between 95 and 110 percent of the required number of signatures are valid, a full check of signatures is done to determine the total number of valid signatures. If less than 95 percent are estimated to be valid, the initiative does not make the ballot.

Stages of this initiative

On September 25, 2019, James Harrison filed the ballot initiative. Attorney General Xavier Becerra (D) released petition language for the initiative on December 2, 2019, which allowed proponents to begin collecting signatures. The deadline to file signatures for the initiative was June 1, 2020.

On January 14, 2020, proponents announced that the number of collected signatures surpassed the 25-percent threshold (155,803 signatures) to require legislative hearings on the ballot initiative. In 2014, Senate Bill 1253 was enacted into law, which required the legislature to assign ballot initiatives that meet the 25-percent threshold to committees to hold joint public hearings on the initiatives not later than 131 days before the election.

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On April 30, 2020, Jamie Court, president of Consumer Watchdog, announced that the campaign had collected signatures but chose not to file them before the recommended deadline on April 21, 2020, due to the coronavirus pandemic. Instead, the campaign filed 910,667 signatures to place the ballot initiative on the ballot for November 8, 2022. Scott Olsen, a board member of Consumer Watchdog, stated, "Voters are overwhelmed with trying to keep their families safe and deal with the economic impacts of COVID-19. While we are constantly hearing from more Californians harmed by medical negligence who have been denied accountability because of this 45-year-old law, it will be more productive to have this conversation when everything stabilizes." Court commented, "This has been a really tough decision, but it’s really foggy out there now, with all the concern about the coronavirus. No one really knows how that will affect the November elections. … The medical negligence cap hasn’t changed in 45 years. We didn’t want to blow our chance."

On July 21, 2020, the office of Secretary of State Alex Padilla (D) announced that 75.56 percent of the submitted signatures were projected to be valid. At least 68.43 percent of the signatures needed to be valid.

On April 27, 2022, the sponsors of the initiative announced that a legislative compromise was going to be introduced that would raise the legal cap on pain and suffering awards to $350,000 beginning January 1, 2023. The proposed law would also increase the cap over 10 years to a maximum of $750,000. The cap for cases involving a patient's death would increase to $500,000 beginning January 1, 2023, and increase up to $1 million over 10 years. Following the decade increase, the cap would be adjusted by 2% annually. Assembly Bill 35 was amended on April 27 to include the reforms to medical malpractice lawsuits. On May 5, the state Senate passed AB 35 in a vote of 37-1 with two absent. On May 12, the state Assembly passed the bill in a vote of 66-0 with 12 absent. On May 23, 2022, Gov. Gavin Newsom (D) signed the bill.

On May 19, 2022, the sponsors withdrew the initiative.

How to cast a vote

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How to cast a vote in California

Poll times All polls in California are open from 7:00 a.m. to 8:00 p.m. Pacific Time. An individual who is in line at the time polls close must be allowed to vote. Registration Check your voter registration status here. To vote in California, an individual must be a U.S. citizen and California resident. A voter must be at least 18 years of age on Election Day. Pre-registration is available at 16 years of age. Pre-registered voters are automatically registered to vote when they turn 18. Automatic registration California automatically registers eligible individuals to vote when they complete a driver's license, identification (ID) card, or change of address transaction through the Department of Motor Vehicles. Learn more by visiting this website. Online registration See also: Online voter registration California has implemented an online voter registration system. Residents can register to vote by visiting this website. Same-day registration California allows same-day voter registration. Californians must be registered to vote at least 15 days before Election Day. If the registration deadline has passed for an upcoming election, voters may visit a location designated by their county elections official during the 14 days prior to, and including Election Day to conditionally register to vote and vote a provisional ballot, which are counted once county election officials have completed the voter registration verification process. The state refers to this process as Same Day Voter Registration. Residency requirements To register to vote in California, you must be a resident of the state. State law does not specify a length of time for which you must have been a resident to be eligible. Verification of citizenship See also: Laws permitting noncitizens to vote in the United States California's constitution requires that voters be U.S. citizens. When registering to vote, proof of citizenship is not required. Individuals who become U.S. citizens less than 15 days before an election must bring proof of citizenship to their county elections office to register to vote in that election. An individual applying to register to vote must attest that they are a U.S. citizen under penalty of perjury. As of November 2024, two jurisdictions in California had authorized noncitizen residents to vote for local board of education positions through local ballot measures. Only one of those jurisdictions, San Francisco, had implemented that law. Noncitizens voting for board of education positions must register to vote using a separate application from the state voter registration application. Verifying your registration The secretary of state's My Voter Status website allows residents to check their voter registration status online. Voter ID requirements California does not require voters to present identification before casting a ballot in most cases. However, some voters may be asked to show a form of identification when voting if they are voting for the first time after registering to vote by mail and did not provide a driver license number, California identification number, or the last four digits of their social security number. On September 29, 2024, Gov. Gavin Newsom (D) signed SB 1174 into law prohibiting any jurisdiction in the state from adopting a local law that requires voters to present ID before voting. The following list of accepted ID was current as of October 2024. Click here for the California Secretary of State page to ensure you have the most current information. “ Current and valid photo identification provided by a third party in the ordinary course of business that includes the name and photograph of the individual presenting it. Examples of photo identification include, but are not limited to, the following documents: driver's license or identification card of any state; passport; employee identification card; identification card provided by a commercial establishment; credit or debit card; military identification card; student identification card; health club identification card; insurance plan identification card; or public housing identification card. Any of the following documents, provided that the document includes the name and address of the individual presenting it, and is dated since the date of the last general election…: utility bill; bank statement; government check; government paycheck; document issued by a governmental agency; sample ballot or other official elections document issued by a governmental, agency dated for the election in which the individual is providing it as proof, of residency or identity; voter notification card issued by a governmental agency; public housing identification card issued by a governmental agency; lease or rental statement or agreement issued by a governmental agency; student identification card issued by a governmental agency; tuition statement or bill issued by a governmental agency; insurance plan card or drug discount card issued by a governmental agency; discharge certificates, pardons, or other official documents issued to the individual by a governmental agency in connection with the resolution of a criminal case, indictment, sentence, or other matter; public transportation authority senior citizen and disabled discount cards issued by a governmental agency; identification documents issued by governmental disability agencies; identification documents issued by government homeless shelters and other government temporary or transitional facilities; drug prescription issued by a government doctor or other governmental health care provider; (R) property tax statement issued by a governmental agency; vehicle registration issued by a governmental agency; or vehicle certificate of ownership issued by a governmental agency. ”

See also

2022 measures

• 2022 ballot measures
• Tort law on the ballot
• Healthcare on the ballot
• 2022 legislative sessions

California

• California ballot measures
• California ballot measure laws

News and analysis

• Ballot measure lawsuits
• Ballot measure readability
• Ballot measure polls

External links

• Petition #19-0018