Missouri Medical Malpractice Laws

A Missouri medical malpractice case involving a 3-year-old patient resulted in a million-dollar payout in 2019. The victim developed kidney failure, among other life-threatening conditions, after a delayed diagnosis at a children’s hospital affiliated with St. Louis University. The jury awarded over $18 million to the victim, who now requires lifelong dialysis because of the incident.  

In 2022, another million-dollar malpractice lawsuit involving negligence that resulted in a patient's death rocked a hospital associated with the same university.

Medical malpractice cases like these may not always result in favor of the patient or yield significant payouts. Missouri's own set of legislation enables patients to pursue compensation for their injuries, but it also allows medical professionals to defend themselves from claims of negligence. Navigating these laws can be tricky for the public in general. 

This article helps Missourians understand the basic laws governing medical malpractice and personal injury. It provides information such as important legal deadlines, the costs of pursuing a case, and factors affecting financial recovery. 

What Qualifies as Medical Malpractice in Missouri?

Medical malpractice happens when a Missouri health professional fails to provide the expected standard of medical care, leading to the patient’s injury. 

Although malpractice and negligence sound almost the same to Missourians, these terms have some differences. Negligence is the general term used when someone acts without due care, leading to another person’s injuries. Malpractice, on the other hand, is defined by Missouri courts as a professional’s conduct that lacks due care and causes injury to the patient. 

To have a successful medical malpractice claim, the patient must establish that their injuries stemmed from the medical professional’s negligent conduct. 

Some common types of medical malpractice are:

• Misdiagnosis or failure to diagnose. This happens when a doctor does not diagnose the patient’s condition in a timely manner or overlooks the patient's medical history. 

• Negligent medical advice. A medical professional may fail to warn the patient of any risks involved in taking medication or undergoing treatment. 

• Negligent medical treatment. Cases like this include an anesthesiologist administering the wrong dose or a doctor who fails to consider the patient’s risk factors. 

There are also different levels of liability in malpractice:

• Individual. A healthcare provider is personally liable for their direct actions. 

• Manager or supervisor. The individual’s direct superior may be liable if they were negligent in their supervisory or managerial capacity, which led to the individual’s negligent actions.  

• Employer. An employer can be held liable for the actions of their employees if they are found negligent with hiring practices, facility safety, service operations, and other related matters. 

Who Can You Sue for Medical Malpractice in Missouri?

Doctors and specialists, such as surgeons, internists, and oncologists, are not the only healthcare professionals who can be sued for malpractice in Missouri. They also include:

• Nurses.

• Physical therapists.

• Mental healthcare professionals.

• Dentists.

• Pharmacists.

• Phlebotomists.

• Chiropractors.

• Emergency medical technicians.

In addition, entities such as hospitals, primary care clinics, and medical device manufacturers can also be held liable for a patient’s injuries.

Exemptions

There are some cases where a medical professional can be exempt from general negligence. These are:

• Charitable medical care. A volunteer doctor or physician who provides free services at a public health center or non-profit clinic may not be liable for malpractice. This is unless the medical professional acted with gross negligence.

• Government defendants. Most of the time, it may be difficult to bring a malpractice lawsuit against a government entity because of government tort immunity. On rare occasions, however, sovereign immunity is denied to a nursing home district, such as in the case of the Senior Citizens Nursing Home District of Ray County. However, this may not be the case if it involves negligent doctors or nurses employed in public facilities. 

Medical Malpractice Liability Insurance Requirements

No Missouri law requires professionals to carry medical malpractice liability insurance, but many healthcare facilities require practitioners to have one. Nonetheless, having insurance is a prudent move for any medical professional to protect both their reputation and financial assets. 

According to most online insurers, the costs of insurance premiums do not matter much by location but by medical specialty. For instance, the average base rate for an internal medicine specialist is around $10,000, while for an OB-GYN, it is around $44,000. 

The most common liability coverage in Missouri is $1 million per claim, with an annual aggregate limit of $3 million. 

What Is the Statute of Limitations in Missouri for Medical Malpractice Cases?

Various deadlines exist for filing a medical malpractice lawsuit in Missouri. 

A victim of medical malpractice in Missouri usually has two years to bring legal action against the healthcare provider. This is called the statute of limitations, and it starts from the date the negligence happened. 

Another important deadline to take note of is the statute of repose, which is 10 years. After this absolute deadline, the victim may lose all the legal opportunity to bring a lawsuit against the defendant. 

There are different deadlines, too, for various cases, including:

• Minor victims - If the Missouri victim is a minor, they have until their 20th birthday to file a medical malpractice lawsuit.

• Wrongful death - When the medical malpractice victim dies, a wrongful death lawsuit must be filed within three years from the date of death. 

Tolling of the Statute of Limitations

Tolling, in legal terms, means the stopping of a running time period. In certain Missouri cases, the statute of limitations is tolled, such as:

• Discovery rule: The two-year statute of limitations does not start until the victim discovers the injury or the negligence. Examples include a surgeon who left a surgical tool inside the patient or a healthcare provider who negligently failed to inform the patient of a medical result.

• Continuing Treatment: If a patient is still undergoing treatment from a negligent healthcare professional, the statute of limitations only starts when the patient stops receiving treatment. This is a deadline that Missouri courts have considered, such as in the Court of Appeals’ decision on the Norman v. Lehman case. In this case, the patient sued the doctor for a negligent operation, but it was unclear when the treatment period ended. 

Bear in mind that even though the statute of limitations is paused, the 10-year absolute deadline or statute of repose still stands. 

What Do You Need to Prove in a Missouri Medical Malpractice Case?

To be successful in a medical malpractice lawsuit, a Missouri plaintiff (the person suing) must be able to prove the following elements:

• The defendant owed the plaintiff the duty of care expected from their profession.

• There was a violation of the duty of care.

• The violation led to the plaintiff’s harm.

• There was resulting harm, which led the plaintiff to suffer losses like injuries and financial expenses.

For example, a doctor who carelessly fails to check the patient’s medical history may prescribe a medication that the patient is allergic to. This goes to say that the doctor owed the patient the duty to carefully check their medical files like any prudent doctor would do under the same circumstances. Because the patient suffered a life-threatening reaction to the medication, the breach of duty led to the patient’s harm.

In addition to proving these elements, several requirements also have to be followed, and these will be discussed in the following sections.

Healthcare Affidavit

Another crucial requirement in any Missouri medical malpractice case is an affidavit signed by a legally qualified healthcare professional certifying the merit of the case. It must be submitted in court within 90 days after filing the lawsuit, but an extension of 90 days is allowed for a good cause. 

The qualifications of the healthcare provider are:

• Possessing the same medical license as the defendant. The license can be issued in Missouri or another state. 

• Having an active practice the same as the defendant’s. It also applies to a retired healthcare provider, so long as it has only been five years since their retirement. 

Be aware that this is a stringent requirement of Missouri courts, without which a lawsuit will most likely be dismissed. A case in point is the Hink v. Helfrich case, which was the subject of battles at various court levels because the affidavit requirement was not fulfilled. Finally, the Missouri Supreme Court upheld the validity of the affidavit requirement after the plaintiff challenged its constitutionality. 

Admissibility of Expert Witness Testimony

Many medical malpractice cases utilize expert witness testimony to strengthen the claim against the defendant. Unlike in many states, Missouri laws do not have specific qualifications for who may be an expert witness. 

These laws only state that the expert witness must have the necessary qualifications, such as education, skills, and training. Additionally, their testimony must be based on sound scientific methods. 

Loss of Chance Claim

Missouri courts have long recognized the loss-of-chance doctrine, a concept unique to medical malpractice. Under this doctrine, a healthcare provider can be sued if their negligence leads to a lower chance of survival for the patient. 

A real-life example of this was the case of the LaRose estate, which claimed that the physicians’ failure to timely diagnose cancer led to the patient and her family’s losses. The jury decided that the patient lost a 57% chance of survival because of the said negligence. It awarded the estate $690,908.56, which includes $114,000.00 for future expenses such as medical bills. In addition, $71,250.00 was awarded for the husband’s loss of consortium.

How Much Can You Sue For Medical Malpractice in Missouri

In general, it may be difficult to determine how much you can sue for medical malpractice in Missouri. Several factors affect the value of medical malpractice cases:

• Age and health of the patient.

• The severity of the injuries and their impact on the patient’s life.

• Skills of the plaintiff’s legal counsel and the strength of their evidence.

• The gravity of negligence.

• The defendant’s insurance coverage and their legal counsel’s skills.

• State law limits on damages (recoverable compensation) and the plaintiff’s fault.

As can be gleaned from this information, the importance of being represented by a lawyer cannot be overlooked. If you suspect you may be a victim of negligence, consult with a medical malpractice lawyer promptly. 

Types of Damages

One important method of estimating how much you can recover in a Missouri medical malpractice lawsuit is to determine the types of damages available in your case. 

These are generally the types of damages under a malpractice lawsuit based on a personal injury claim:

• Economic damages - These are the financial losses that the patient suffered because of the negligence. Examples are past and future medical bills, rehabilitation costs, lost income, and injury-related out-of-pocket expenses. 

• Non-economic damages - These are compensation for intangible losses difficult to place a dollar value on, such as pain and suffering, lost earning capacity, and quality of life reduction.

• Punitive damages -  In rare cases, punitive damages may be awarded to the plaintiff if the defendant acted egregiously. 

Wrongful death and survival damages

For medical malpractice claims based on wrongful death, the following damages may be recovered:

• Wrongful death damages - Surviving family members may be able to obtain compensation for their financial losses because of the victim’s death. Losses include funeral expenses and future income loss from the victim’s contributions.  

• Survival damages - These are the financial losses incurred from the start of the victim’s injury until their death. This is similar to the damages recoverable in a personal injury claim if the victim filed the lawsuit before dying. It is important because it is the only way to recover punitive damages in this case. 

Note that a legal action can be filed separately or in conjunction to recover both damages. 

Caps in the damages

Missouri’s caps on damages also impact the plaintiff’s compensation. While there are no caps for economic damages, there are caps on non-economic damages in Missouri medical malpractice cases. 

The caps are further categorized for non-catastrophic and catastrophic injuries. The latter is defined in Missouri laws as injuries such as loss of two limbs, paraplegia, and irreversible major organ failure, among others. 

As of 2024, the caps for non-catastrophic injuries are at $465,531, while for catastrophic injuries, they are at $814,679. These amounts change each year. 

Negligence System

Missouri follows the doctrine of pure comparative negligence, which may also affect the financial recovery in a medical malpractice lawsuit. This is true if the victim is found to have contributed in any way to their injuries. Under the said doctrine, the plaintiff may only recover compensation for the defendant’s proportion of fault. 

Let’s say a patient was awarded damages of $100,000 for injuries sustained from their physician’s negligence in failing to make a timely diagnosis. However, the jury also found that the patient missed an appointment, thereby making a 10% contribution to the injuries. In this case, the patient’s final payout is reduced by $10,000, which brings the total to $90,000.

Missouri’s adoption of the said doctrine came about as a result of the landmark case, Gustafson v. Benda. The doctrine also applies even if the plaintiff is found to be 99% at fault.

Collateral Source Reforms

Missouri's enactment of collateral source reforms in 2017 affects medical malpractice payouts. The reforms allow defendants to present evidence in court of any payments made by a third party for the patient’s injuries. Examples of such payments would be coverage from personal health plans, government benefits, and workers’ compensation insurance. 

Because of these changes, there may be a reduction in the economic damages awarded to the plaintiff. In some situations, the claim may even be pursuing what is considered phantom damages. 

Methods of Obtaining Compensation

Most of the time, plaintiffs in a medical malpractice case can obtain compensation through a settlement with the defendant. This may happen between the time the defendant is notified of the lawsuit and right before trial. Defendants usually settle if they want to avoid trial or if they think the plaintiff has a good chance of winning at trial. 

Sometimes, the settlement may not be fair for the plaintiff, who, together with their legal counsel, may take the case through trial. If the plaintiff wins, the jury or judge will award them the damages. When the defendant files an appeal and is successful, there may be a new round of trial. Settlement may also happen anywhere between these situations.

There are also alternative ways of resolving a medical malpractice dispute, including:

• Arbitration: The process involves a professional arbitrator who will hear the details of the case and issue a decision, which may be legally binding. It is a confidential and private proceeding that will not make its way into public records. 

• Mediation: A neutral third party or mediator will guide disputing parties to reach a mutually satisfactory agreement. It is less costly and stressful, and may not be made public compared to litigation.

How Much Does It Cost to Pursue a Medical Malpractice Case in Missouri?

Medical malpractice cases are costly owing to their complexity, especially with the burden of proof and the technicality of the claim’s scientific basis. 

The following lists the costs incurred in medical malpractice:

• Lawyer’s fees - Most medical malpractice lawyers take cases on a contingency fee basis, meaning they only get paid if the client recovers compensation. The contingency fee usually ranges from 33% to 40%, according to law firm websites. No laws in Missouri currently limit such a percentage. 

• Expert witness fees - Expert witnesses typically bill their clients on an hourly basis for tasks such as initial case review, deposition preparation, and report creation. Their hourly fees depend on the specialty, according to service provider Expert Institute. For example, it starts at $175 for geriatrics and $800 for neurosurgery.

• Other costs -Some additional costs to consider are court filing fees, documentation costs, and logistics. 

Contingency payment arrangements are not only for the attorney’s fees. Many law firms shoulder most of these upfront costs or split them with the client, depending on the arrangement. Again, they will be compensated once the client makes a financial recovery. 

Legal Resources for Medical Malpractice Victims in Missouri

MissouriLawyersHelp.org

Created by the Missouri Bar, MissouriLawyersHelp.org helps Missourians find a lawyer for their medical malpractice case. Plaintiffs can check the website for informational guides on meeting with the lawyer, fees, and understanding the attorney-client relationship. They can also find more information on client-protection programs, legal glossaries, and alternative dispute resolution programs. 

Missouri Department of Health and Senior Services

Victims of surgery-related negligence in hospitals may seek help from the DHSS. They can learn more by calling 1-800-392-0210 or filling out the complaint form and sending it by email to hospitalcomplaints@health.mo.gov. If possible, the incident must be reported within 24 hours after it happened. 

Missouri Division of Professional Registration

For complaints about various types of healthcare professionals, get in touch with the Missouri Division of Professional Registration. These professionals can be acupuncturists, anesthesiologist assistants, and doctors, among others. The Division’s phone numbers are 573-751-0293, 800-735-2966 (TTY), and 800-735-2466 (Voice Relay). Its address is 3605 Missouri Boulevard, P.O. Box 1335, Jefferson City, MO 65102-1335.