Overturning decades of prior legal rulings, the Missouri Supreme Court ruled this week that the state Legislature's $350,000 cap on noneconomic medical malpractice damages is an illegal violation of residents' constitutional right to a trial by jury.

A divided court on Tuesday overturned (PDF) the court's own 20-year-old decision to uphold caps on noneconomic damages, ruling that "while this court always is hesitant to overturn precedent, it nonetheless has followed its obligation to do so where necessary to protect the constitutional rights of Missouri's citizens."

The court ruled that the mother of Naython Watts, who was born in 2006, was entitled to the full $1.45 million in noneconomic damages that a jury awarded her after concluding that physicians for Cox Medical Centers provided negligent care that led to disabling brain injuries in the child. A trial court judge reduced the verdict to $350,000 after the jury decision, as required by state law.

Mother Deborah Watts appealed, saying the caps violated the state constitution. Attorneys for Cox Health argued in court that a 1992 decision from the Missouri Supreme Court, Adams By and Through Adams vs. Children's Mercy Hospital, had already upheld the constitutionality of 2005 tort reforms limiting medical malpractice awards for claims such as pain and suffering.

But writing for the majority on Tuesday, Chief Justice Richard Teitelman said Adams was wrong and overruled it, citing similar court decisions to overturn legislative malpractice damage caps in states such as Washington (1989), Oregon (1999), Alabama (1991) and Florida (1987).

Specifically, Teitelman said, the state's 1820 constitution grants citizens an "inviolable right" to a trial by jury for noneconomic damages in medical malpractice cases, and the cap on damages violated that right by removing a jury's ability to decide the magnitude of damage done to a litigant.

In an e-mailed statement, Cox Health officials said they were disappointed in the decision.

"Nearly every physician and every hospital in the state will be adversely affected by this ruling," Cox Health said in the statement. "Our greatest concern lies with how this will affect physicians in our state."