Medical malpractice claims are
usually among the most hard fought and expensive of all types
of personal injury cases. Procedural and substantive law
provide that a sufficient case is not established simply by
submitting the injured patient’s story to the jury. Instead,
expert witnesses must be hired to review all the records of
past treatment, scrutinize the care that was provided, and
testify whether the defendant was causally negligent by action
or omission. The standard of care that is required of all
Wisconsin health care providers is defined as the degree of
skill, care, and judgment which reasonable healthcare providers
who practice the same specialty as the defendant would exercise
in the same or similar circumstances, having due regard for the
state of medical science at the time the plaintiff was treated.
Nowatske v. Osterloh, 198 Wis.2d 419, 543 N.W.2d 25 (1996);
Wis. J.I. Civil No. 1023. The burden of proof is on the patient
to convince the jury by expert testimony that the defendant was
negligent by failing to live up to that standard, and that such
failure was a cause of injury. In the vast majority of cases,
the standard of care can only be established by the competent
testimony of a qualified expert who practices in the same
specialty as the defendant. Froh v. Milwaukee Medical
Clinic, S.C., 85 Wis.2d 308, 270 N.W.2d 83 (Ct. App. 1978);
Kuehnemann v. Boyd, 193 Wis.588, 214 N.W. 326 (1927). As
required in the Wisconsin Civil Jury Instruction number 1023,
there is no case unless the expert testifies to a reasonable
degree of medical certainty that the defendant failed to comply
with the applicable standard of care.
In what may be
perceived as a surprise to patients, the law provides that a
doctor is not negligent simply because a bad result may have
followed the treatment. Bad results do not create any
inference or presumption of negligence. Hoven v.
Kelble, 79 Wis.2d 444, 256 N.W.2d 379 (1976). The
question is whether the doctor complied with the appropriate
standard of care, and not whether there was a bad result, bad
judgment or mistake.
The requirement of
expert testimony creates the expense problem. The last thing
most physicians or other health care professionals want to do
in their free time is to review claims against their
colleagues, or to testify against them. Such activity is often
seen as traitorous, and as potentially raising the insurance
premiums for all similarly situated professionals. It has long
been said that there is a so-called "conspiracy of silence" in
regard to the mere mention of malpractice among health care
professionals. It is obvious that physicians who are acquainted
with each other, live in the same community, or are members of
the same professional associations would be reluctant to
criticize each other publicly. Such physicians will often
refuse to speak to malpractice victims or their attorneys about
the merits of their claims against other local physicians. For
this reason, patients are usually resorted to consulting
physicians from far away, who have no organizational or
personal ties to the defendant, for the expert testimony
required in a lawsuit.
Finding, hiring and
preparing experts in medical malpractice cases is extremely
difficult and expensive for attorneys.
In addition to the
difficulty encountered by injured patients in locating willing
expert witnesses, the matter of cost is a deterrent. Competent,
successful, and busy medical practitioners ordinarily make an
excellent living practicing their trade. They enjoy what they
are doing in their offices or hospitals. They often are
compensated at an annual rate well into six figures. A
lawyer’s office or courtroom is foreign territory to them,
fraught with the dangers of the unknown. They are loath to
wander there. If they do venture forth into forensic medicine
at all, they customarily charge at an hourly rate that would
shock the conscience of the uninitiated (i.e., it is not
unusual for a malpractice plaintiff's attorney to have to pay
$500 per hour or more to obtain expert review of records and
testimony by qualified physicians).
Principally because of
the high cost of eliciting expert testimony, the total out-of-
pocket expense, excluding attorney’s fees, of preparing a
medical malpractice case from start to finish is usually not
less than $50,000.00.
It
is easy to see why malpractice cases with minor injuries simply
cannot be pursued economically, no matter how strong the
liability case may be. If we assume a $100,000 recovery, a 33
1/3% attorney fee, and $50,000 in costs, the patient would have
a net recovery of only $16,667 ($100,000 minus $83,333).
Personal injury attorneys who specialize in malpractice cases
customarily decline to prosecute any case unless there is a
verdict potential of substantially more than $100,000.
MEDIATION
Pursuant to Wis.
Stat. § 655.43, before any malpractice lawsuit may proceed,
the parties are required to submit the claim to mediation.
Mediation tolls the statute of limitations until thirty days
after the last day of the mediation period.
One public lay
person, one physician and one attorney comprise the mediation
panel. The panel reviews the evidence, excluding expert
reports, meets with the parties and their attorneys. No lay or
expert witnesses may participate or be subpoenaed. A
stenographic record of the proceedings is not kept. The panel
makes a non-binding recommendation. The results of mediation
are not admissible in a subsequent court action.
The number of
Requests for Mediation filed in Wisconsin over the past five
years is as follows:
Year Cases
2008 148
2009 181
2010 169
2011 139
2012 140
There is no
available information on the number of medical malpractice
cases that were filed in circuit court. Typically 60-70% of
the Requests for Mediation result in the commencement of a
circuit court action.
The results of the
medical malpractice verdicts following jury trial in Wisconsin
over the last five years is as follows:
Medical
Malpractice Verdicts in
Wisconsin
2012
2011 2010 2009 2008 Total
Plaintiff
4 4 1
5 9 23
Defense 10
11 18 21
19 79
Total
14 15 19
26 28 102
The current jury
sentiment against personal injury claimants, fostered by
insurance companies, heightens in medical malpractice cases.
When this reality is coupled with the cost of prosecution, it
becomes evident that only a very few medical malpractice cases
meet the criteria for a good chance of a substantial net
recovery.
There are numerous
powerful defenses conjured up by health care providers to
defeat claims of malpractice. These include the
well-intentioned, good-doctor-should-not-be-sued defense; the
recognized alternative treatment defense; the no-causation
defense that the natural progression of a pre-existing
condition would have led to the same result, even if due care
had been administered; and the
error-in-judgment-does-not-equal-malpractice defense. Doctors
and hospitals have easy access to defense experts who are eager
to thwart claims.
For all these
reasons, malpractice insurers often make no settlement offers
at all when they believe that they have a chance to win at
trial. They operate under the assumption that by making it
difficult for one plaintiff to recover, no matter how
legitimate the claim, the next plaintiff may be deterred from
prosecuting his or her case.
Only the most
egregious medical malpractice liability cases involving clear
liability and catastrophic damages are now economically
feasible from the perspective of plaintiffs’ attorneys.
Anyone who says otherwise has not been there or done
that.
WHO CAN
SUE
Under Wisconsin
law, there is a difference between the class of persons allowed
to bring a wrongful death claim arising out of medical
malpractice, versus the class of persons allowed to bring a
wrongful death claim arising out of any other tort. In
wrongful death cases arising out of medical malpractice, if the
victim is an adult, only a spouse or minor child may sue, but
an adult child may not sue. Czapinski v. St. Francis
Hosp., 236 Wis.2d 316, 613 N.W.2d 120 (2000); Ziulkowski
v. Nierengarten, 210 Wis.2d 98, 565 N.W.2d 164 (Ct. App.
1997). The classification of claimants entitled to sue for loss
of society and companionship damages resulting from the
wrongful death of a medical malpractice victim is limited to
those listed in Wis. Stats. §655.007, which includes only a
spouse, parent, minor sibling or minor child. Adult children
simply lack standing to sue.
On July 10, 2007,
the Wisconsin Supreme Court held that Wis. Stats. § 655.007
limits the survival of a cause of action for wrongful death
arising from medical malpractice to a spouse, parent, minor
sibling or minor child. Lornson v. Siddiqui, 2007 WI
92, 735 N.W.2d 55 (2007). Contrary to the hierarchical list
of wrongful death claimants in Wis. Stats. § 895.04(2), which
includes adult children as lineal heirs, an adult child lacks
standing to recover for a derivative claim, such as loss of
society and companionship, in a wrongful death case involving
medical malpractice. The Supreme Court held that the intended
exclusivity of ch. 655, Wis. Stats., prohibits the application
of Wis. Stats. § 895.04(2), governing other wrongful death
claims.
A parent of an
adult child does not have a cause of action for loss of society
and companionship arising out of the medical malpractice -
wrongful death of the adult child. See Wells Estate v. Mt.
Sinai Medical Center, 183 Wis.2d 667, 515 N.W.2d 705
(1996), which held that no such cause of action is allowed for
medical malpractice causing injuries, as opposed to the death
of an adult child. The Wisconsin Supreme Court held in the
Czapinski case that the difference in the classes of
allowable plaintiffs in medical malpractice wrongful death
cases compared to other wrongful death cases is not a violation
of the Equal Protection Clause of the Fourteenth Amendment to
the U.S. Constitution.
Brusa v.
Mercy Health System, 301 Wis.2d 138, 737 N.W.2d 1 (Ct. App.
2007), held that a fetus conceived but not yet born prior to
malpractice committed upon a parent was entitled to sue. The
crux of the dispute is the right of a child to pursue a
derivative medical malpractice claim for the death of the
parent. The right to bring a derivative claim for medical
malpractice is determined by the claimant's status at the time
of the victim's injury. A child who has been conceived but not
yet born at the time of the injury may bring a derivative claim
for loss of society and companionship when medical malpractice
causes the death of a parent. Lefevre by Grapentin v.
Schrieber, 167 Wis.2d 733, 739, 482 N.W.2d 904 (1992) (a
posthumously born legitimate child can bring a wrongful death
claim, even though the child was not born at the time of the
accident).
RES IPSA LOQUITUR
In Fehrman v.
Smirl, 20 Wis.2d 1, 121 N.W.2d 255, 122 N.W.2d 439 (1963),
the Wisconsin Supreme Court held that res ipsa loquitur may be
invoked in medical malpractice actions when a layman is able to
say as a matter of common knowledge that the consequences of
the professional treatment are not those which ordinarily
result if due care is exercised, and the defendant has
exclusive control of the instrumentality that caused harm. See
also Hoven v. Kelble, 79 Wis.2d 444256 N.W.2d 379 (1977). When
these two conditions are present, they give rise to a
permissive inference of negligence on the part of the defendant
which the jury is free to accept or reject. When there is no
basis of common knowledge for such a conclusion, a jury
instruction embodying res ipsa loquitur may be grounded on
expert medical testimony. Shurpit v. Brah, 30 Wis.2d
388, 141 N.W.2d 266 (1966); Knief v. Sargent, 40 Wis.2d
4, 161 N.W.2d 232
(1968).
INFORMED CONSENT
Trogun v.
Fruchtman, 58 Wis.2d 569, 596-600, 207 N.W.2d 297 (1973),
is the seminal case. It involved a physician’s failure to
inform the patient about the side effects of a drug for
tuberculosis. The modern doctrine has been codified under
Wis. Stat. § 448.30, which sets forth in general terms what
type of information a doctor should provide to a patient.
Under current Wisconsin law, an informed consent claim is now
treated as a subset of medical malpractice actions under
negligence theory, the elements of which are: (1) the patient
was not informed of the risks in the proposed treatment or
procedure of which a reasonable person in the patient's
position would wish to be made aware; (2) a reasonable person
in the patient's position presented with such information would
not have chosen to submit to the treatment or procedure; and
(3) the failure to disclose such information was a cause of the
patient's injuries.
In Scaria v.
St. Paul Fire & Marine Ins. Co., 68 Wis.2d 1, 227
N.W.2d 647 (1975), the claim was that a physician failed to
inform a patient that a contrast die used for radiation could
cause paralysis or death. The Supreme Court concluded that a
physician's duty to reveal the risks and benefits of available
treatment options extended to the information a reasonable
patient would need to know in order to make an informed
decision.
In 1981 the
legislature enacted Wis. Stat. §448.30, which provides as
follows:
INFORMATION ON ALTERNATE MODES OF
TREATMENT
Any physician who treats a patient
shall inform the patient about the availability of all
alternate, viable medical modes of treatment and about the
benefits and risks of these treatments. The physician's duty to
inform the patient under this section does not require
disclosure of:
(1) Information beyond what a
reasonably well-qualified physician in a similar medical
classification would know.
(2) Detailed technical information
that in all probability a patient would not
understand.
(3) Risks apparent or known to the
patient.
(4) Extremely remote possibilities
that might falsely or detrimentally alarm the
patient.
(5) Information in emergencies where
failure to provide treatment would be more harmful to the
patient than treatment.
(6) Information in cases where the
patient is incapable of consenting.
In Martin by
Scopter v. Richards, 192 Wis.2d 156, 531 N.W.2d 70 (1995),
the parents of a minor child who suffered brain damage and
spastic quadriplegia caused by intracranial bleeding following
a concussion in a vehicular accident, brought a medical
malpractice action against a Fort Atkinson hospital and
physicians, alleging that the emergency room physician who
examined child, and the physician who admitted the child based
on information provided by the emergency room physician, should
have informed the parents that a CT scanner was available to
diagnose the extent of injuries, and that there would be
significant delay in the hospital’s ability to treat the
child if she developed intracranial bleeding, because she would
have had to be transferred to a facility that had a
neurosurgeon. The hospital had a CT scanner but no
neurosurgeon. The hospital admitted the patient without
informing the family that a transfer would have been a better
option. When she later developed intracranial hemorrhaging, she
had to be transported by flight for life to a Madison hospital,
where she underwent brain surgery, which was too late to avoid
major disability. The case proceeded to trial and the jury
found for the patient, awarding $5,000,000. On appeal, the
Supreme Court held that the emergency room physician was
required to inform parents as to alternate forms of treatment,
and the failure to do so was a violation of informed consent
law.
Johnson v.
Kokemoor, 199 Wis.2d 615, 545 N.W.2d 495 (1996), involved a
claim that the informed consent discussion that took place
between the provider and patient before a medical procedure had
not adequately informed the patient of the morbidity rates and
the physician's lack of experience in performing the procedure.
The patient brought an action against the surgeon alleging that
his failure to provide sufficient relevant information vitiated
her consent to basilar bifurcation aneurysm surgery, and was a
violation of the conformed consent law. The court held that:
(1) evidence regarding the neurosurgeon's lack of experience
with the particular surgical procedure and difficulty of
proposed procedure was properly admitted; (2) statistical
evidence concerning morbidity and mortality rates when the
surgery at issue was performed by a physician of limited
experience, such as defendant surgeon, and by acknowledged
masters in field was properly admitted; and (3) evidence that
the surgeon should have advised patient of the possibility of
undergoing surgery at a tertiary care facility with a more
experienced surgeon in a better-equipped facility was properly
admitted at trial.
In Schreiber
v. Physicians Ins. Co. of Wisconsin, 223 Wis. 2d 417, 433,
588 N.W.2d 26, 33 (1999), a patient, her husband, and their
quadriplegic child brought a medical malpractice action against
physician, alleging that the physician's refusal to perform
cesarean delivery violated the informed consent statute. The
woman, who was undergoing a difficult labor and delivery, had
previously delivered two children by caesarean section but had
elected a vaginal birth for her third child. After originally
consenting to vaginal delivery, she changed her mind and
withdrew her consent. Because alternative viable modes of
medical treatment existed at that time, the court determined
that her withdrawal constituted a substantial change in
circumstances, obligating the doctor under Wis. Stat. § 448.30
to conduct a new informed consent discussion affording the
patient the opportunity for a choice of treatment. The
doctor’s failure to conduct such a discussion deprived the
patient of the opportunity to proceed with her actual and
clearly expressed choice, a cesarean delivery. In applying the
subjective test to causation, the court concluded that the
plaintiffs' damages flowed from the doctor’s failure to
conduct the informed consent discussion.
In Hannemann
v. Boyson, 282 Wis.2d 664, 698 N.W.2d 714 (2005), a patient
claimed that a chiropractor had negligently performed a
cervical spinal manipulation, which caused a stroke, and that
the chiropractor had failed to provide sufficient information
about the risks and alternative treatments necessary to
constitute informed consent. The Supreme Court agreed, holding
that chiropractors have the same duties as medical doctors to
comply with the informed consent statute. The special verdict
questions that go to the jury must inquire not only about
negligent treatment, but also lack of informed consent.
In Bubb v.
Brusky, 2009 WI 91, 321 Wis. 2d 1, 38, 768 N.W.2d 903, a
patient who suffered a stroke within two days of an emergency
room visit occasioned by a transient ischemic attack (TIA),
filed medical malpractice action against the emergency room
physician. He claimed that the physician failed to obtain
informed consent by sending him home rather than discussing the
alternative of being admitted, have a carotid ultrasound and
other tests, an a timely consultation with a neurologist. The
Supreme Court held that by failing to adequately inform the
patient of the availability of all alternate, viable medical
modes of treatment, the physician was subject to liability and
that the jury should decide whether he had violated the
statute.
In Jandre v.
Wisconsin Injured Patients and Families Compensation Fund,
2012 WI 39, 340 Wis. 2d 31, 813 N.W.2d 627, a patient brought a
medical negligence and informed consent claims against an
emergency room physician, alleging that the physician
negligently diagnosed Bell's palsy and failed to inform the
patient of a test to rule out a stroke. The doctor had ordered
a CT scan to rule out a hemorrhagic stroke, and also a clinical
test to listen for carotid bruits with a stethoscope, but the
doctor did not discuss with the patient: (1) that he had an
atypical presentation of Bell's palsy; (2) that his symptoms
were also consistent with an ischemic stroke event; (3) that
the doctor’s method of eliminating an ischemic stroke event
from the differential diagnosis was “very poor”; (4) that
the doctor could have ordered a carotid ultrasound or other
tests to definitively rule out the possibility of an ischemic
stroke event; and (5) that an event such as a transient
ischemic attack (TIA) or a reversible ischemic neurologic
deficit (RIND) is often a harbinger of a full-blown ischemic
stroke. Eleven days later the patient suffered a full-blown
stroke, which impaired his physical and cognitive abilities.
The Supreme Court upheld a verdict for the patient on the
informed consent claim, holding that the physician had a duty
to inform the patient of the availability of a carotid
ultrasound, an alternative, non-invasive, viable means of
determining whether he had suffered an ischemic stroke, rather
than an attack of Bell's palsy.
JOINT
AND SEVERAL LIABILITY
Under a
traditional rule of joint and several liability, where more
than one defendant is found liable for the injury suffered by a
plaintiff, each defendant is individually liable for the entire
amount of the judgment, such that if one defendant is unable to
pay the other defendant or defendants are liable for the entire
amount of the judgment. Pursuant to Wis. Stat. § 895.045,
Wisconsin has modified this rule such that, unless a defendant
is more than 50% responsible for a plaintiff's injury or acted
in concert with other defendants to cause the plaintiff's
injury, each defendant is liable for damages in an amount
proportionate to that defendant's fault for the plaintiff's
injuries.
VICARIOUS LIABILITY
Common law
vicarious liability rules apply to malpractice claims. The
liability of an employer for the negligence of an employee is
still very much the law. An obvious example is the liability of
a hospital for the negligence of nurse-employees. The theory of
apparent agency can also be applied in circumstances where
there is an independent contractor relationship between the
principal and the agent, but the principal has the right to
control the activities of the agent. This can be applied to the
liability of a hospital for the negligence of independent
radiologists, anesthesiologists, hospitalists, contracting
nurses, and other providers. Kashishian v. Port, 167
Wis. 2d 24, 33, 481 N.W.2d 277, 280 (1992)(independent
contracting nuclear cardiologist); Pamperin v. Trinity
Memorial, 144 Wis.2d 188, 199, 423 N.W.2d 848
(1988) (independent contracting emergency room
physicians). An employer of an independent contracting
physician may be subject to liability under the doctrine of
apparent authority when all of the following apply:
(1): the
hospital, or its agent, acted in a manner that would lead a
reasonable person to conclude that the individual who was
alleged to be negligent was an employee or agent of the
hospital;
(2): where the acts of the agent create the appearance of
authority, the plaintiff must also prove that the hospital had
knowledge of and acquiesced in them; and
(3): the plaintiff acted in reliance upon the conduct of the
hospital or its agent, consistent with ordinary care and
prudence.
STATUTE OF
LIMITATIONS
Pursuant to Wis.
Stat. § 893.55, medical malpractice actions must be filed
within three years of the date of the act or omission resulting
in injury, or one year from the date the injury was or
reasonably should have been discovered, whichever is later.
However no medical malpractice action may be filed more than
five years from the date of the act or omission underlying the
claim unless a health care provider conceals from a patient a
prior act or omission of the provider that has resulted in
injury to the patient, in which event the action shall be
commenced within one year from the date the patient discovers
the concealment or, in the exercise of reasonable diligence,
should have discovered the concealment, or within the time
limitation described above, whichever is later. For medical
malpractice cases involving minors, a lawsuit must be filed by
the minor's tenth birthday or within the general medical
malpractice limitations period, whichever is later.
In Phelps v.
Physicians Ins. Co. of Wisconsin, Inc., 319 Wis.2d 1, 768
N.W.2d 615 (2009) the Supreme Court held that, for purposes of
both the estate of the patient-decedent’s medical malpractice
survival action and the patient-decedent’s estate and
heirs’ wrongful death action following the patient’s death,
the statute of limitations accrued on the date that a sponge
was left in a wound, causing symptoms of which the patient was
aware.
LIMITS ON ATTORNEY’S
FEES
Pursuant to Wis.
Stat. § 655.013, Attorney fees are limited to one-third of the
first $1 million, or 25% of the first $1 million if the
defendant stipulates to liability within a specified timeframe.
Attorney fees are limited to 20% for any recovery in excess of
$1 million.
COMPENSATORY
DAMAGES
The damages
recoverable in a malpractice case include the following
components:
(a) Pain,
suffering and noneconomic effects of disability;
(b) Loss of
consortium, society and companionship or loss of love and
affection;
(c) Loss of earnings
or earning capacity;
(d) Medical
expenses.
(e) Other economic
injuries and damages.
On July 14,
2005, the Wisconsin Supreme Court ruled that the $350,000 cap
on non-economic damages in medical malpractice cases, Wis.
Stats., § 893.55(4)(d) violated the equal protection clause of
the Wisconsin Constitution and was therefore void. Ferdon
v. Wisconsin Patients Compensation Fund, 2005 WI 125, 284
Wis.2d 573, 701 N.W.2d 440 (2005). This decision removed the
cap on non-economic damages in medical malpractice cases that
do not result in death.
Thereafter, the
Wisconsin legislature enacted a new cap for damages in medical
malpractice cases, which was signed by the governor into law
effective April 6, 2006, creating a maximum limit of $750,000
for non-economic damages. See Wis. Stat. §§ 655.017 and
893.55(4)(d). If the malpractice results in death, the old
$350,000 cap applicable under Wis. Stat. § 895.04 still
applies, subject to inflationary additions. See Wis. Stat. §
893.55(4)(f). Future medical expenses in excess of $100,000 are
paid into a special fund, rather than directly to the patient.
§655.015.
On July 7, 2006, the
Wisconsin Supreme court overruled in part its earlier decision
in Maurin v. Hall, 2004 WI 100, 274 Wis. 2d 28, 682
N.W.2d 866 and held that that the cap on non-economic damages
in medical malpractice cases that result in death should
separately be applied to: (1) the two types of pre-death
claims: (a) to the estate of the decedent for the pain and
suffering of the decedent, and (b) to the surviving spouse for
the loss of society and companionship of the decedent; and (2)
the loss of society and companionship of the spouse, children
or parents of the deceased, or to the siblings of the deceased,
if they were minors at the time of the death.
Bartholomew v. Wisconsin Patients’ Compensation Fund,
2006 WI 91, 293 Wis.2d 38, 717 N.W.2d 216 (2006).
Therefore, under
current law, if the malpractice results in death, there is a
$350,000 cap for non-economic damages for the death of an
adult, and a $500,000 cap for non-economic damages for the
death of a minor, subject to inflationary additions. There is
$750,000 cap for pre-death non-economic damages in medical
malpractice cases, but if the malpractice results in death,
there is still a $350,000 cap for non-economic damages for the
death of an adult, and a $500,000 cap for non-economic damages
for the death of a minor, subject to inflationary additions.
PUNITIVE DAMAGES
Punitive damages
are not recoverable in medical malpractice cases. Lund v.
Kokemoor, 195 Wis.2d 727537 N.W.2d 21 (Ct. App. 1995).
However, Wis. Stats. § 895.441, specifically provides that
punitive damages are recoverable in actions based on a
physician's sexual exploitation of a patient. Those types of
claims would be subject to a requirement, under Wis. Stat.
895.043(3), that the plaintiff prove “that the defendant
acted maliciously toward the plaintiff or in an intentional
disregard of the rights of the plaintiff.”
If you have a
question about Wisconsin medical malpractice law, do not
hesitate to contact Attorney James A. Pitts japitts@pittslaw.com or
Gregory A. Pitts gapitts@pittslaw.com
INSURANCE
COVERAGE
Physicians are
responsible for their own personal underlying medical
malpractice insurance coverage for the first $1,000.000. Wis.
Stat. § 655.23.
The Injured
Patients and Families Compensation Fund provides umbrella
coverage for all physicians for any liability over $1,000,000
if a premium is paid. Wis. Stat. § 655.27.
COLLATERAL SOURCE RULE AND SUBROGATION
Under a
traditional collateral source rule, a defendant may not seek to
reduce its liability by introducing evidence that the plaintiff
has received compensation from other sources, such as the
plaintiff's own health insurance coverage. For medical
malpractice cases in Wisconsin, evidence of payment from
collateral sources is admissible at trial pursuant to Wis.
Stat. § 893.55(7). See Lagerstrom v. Myrtle Werth
Hospital - Mayo Health System, 285 Wis.2d 1, 700 N.W.2d 201
(2005).
The insurance
companies that pay the patient’s medical expenses are
entitled to reimbursement out of any recovery the plaintiff
obtains from the at fault health care providers, under ordinary
subrogation rules. By virtue of and to the extent of payments
made on behalf of the injured party, the payor, or subrogated
party, generally obtains a right of recovery in an action
against the tortfeasor and is a necessary party in such action.
Lagerstrom, 285 Wis.2d 1, ¶ 64, 700 N.W.2d 201; Koffman v.
Leichtfuss, 246 Wis.2d 31, ¶ 33, 630 N.W.2d 201.
Alternatively,
the payor may waive its right to subrogation in favor of
reimbursement. Lagerstrom, 285 Wis.2d 1, ¶ 64, 700
N.W.2d 201. In either case, the policy goals are the same:
subrogation helps to ensure that the loss is ultimately placed
upon the tortfeasor and prevents the injured party from being
unjustly enriched through a double recovery, i.e., recovery
from both the subrogated party and the tortfeasor. The trial
court must first determine whether the evidence of collateral
source payments is relevant before allowing the evidence to be
admissible. Weborg v. Jenny, 341 Wis.2d 668, 816 N.W.1d
191 (2012). An erroneous admission of such evidence is not
necessarily reversible error.
In Konkol v.
Acuity Insurance, A Mutual Company, 321 Wis.2d 306, 775
N.W.2d 258 (Ct. App. 2009), the court held that a
tortfeasor’s insurer was not entitled to subrogate against a
tort victim’s negligent health care provider with respect to
the cost of allegedly unnecessarily incurred medical expenses
paid by the insurer for treatment of injuries sustained in an
automobile accident.
|