But by 2025, his lawsuit, now appealed to the Ohio Supreme Court, has evolved into an argument about the constitutionality of a state law cap on pain and suffering damages. The usual heavy hitters have lined up against Paganini, including the Ohio Hospital Association, Ohio State Medical Association, Ohio Association of Civil Trial Attorneys and the Ohio Attorney General Dave Yost.
Routine surgery gone very wrong
Cataract surgery is one of the most common surgical procedures in the United States. According to the American Academy of Ophthalmology, approximately 3.5 million cataract surgeries are performed annually in the U.S. That amounts to nearly 1 percent of the population over the age of 65.
Paganini had cataract surgery on December 9, 2021. The morning after the procedure, he saw black dots, also known as “floaters.” When he met with Dr. Louis the day after the surgery, he also reported pain in his eye and foggy vision. Louis observed some symptoms consistent with endophthalmitis, a severe infection of the eye, but did not refer Paganini to a specialist because his symptoms were common among patients after cataract surgery.
Days later, still experiencing eye pain, Paganini saw Dr. Thomas Hull, a retina specialist in Akron, Ohio, who diagnosed him with acute endophthalmitis. Despite undergoing surgery to treat the infection a short time later, the condition ultimately led to the loss of his eye.
Jury award
After trial, the jury awarded damages to Paganini in the amount of $1,487,500 for past and future noneconomic damages. It found that Paganini’s injury constituted the loss of a “bodily organ system” and a “substantial physical deformity.” Paganini asked the court not to apply an Ohio statute that limited noneconomic damages resulting from medical malpractice to $500,000. The court granted the motion and entered judgment in Paganini’s favor for the full amount of the jury’s verdict. Further, the trial court determined that the statutory cap on noneconomic damages violated Paganini’s rights under the Ohio Constitution.
In January 2025, the Cuyahoga County Appellate Court affirmed the trial court’s decision. It held that the cap on non-economic damages provided is unconstitutional as applied in a medical matter with catastrophic injuries. The appeals court called the rule arbitrary and unreasonable and offered an analogy: if a man was run over by a doctor and lost his leg, there would be no limit on the damages, but if he lost his leg in surgery, there would be a cap.
As of late August, the Ohio Supreme Court had yet to schedule oral arguments.
The statutory cap on pain and suffering awards
In enacting R.C. 2323, Section 43, the law that caps malpractice awards, the Ohio General Assembly expressly stated that the statute was designed to “stabiliz[e] the cost of health care delivery by limiting the amount of compensatory damages representing noneconomic loss awards in medical malpractice actions.” The legislature found, among other things, that “[t]he overall cost of health care to the consumer has been driven up by the fact that malpractice litigation causes health care providers to over prescribe, over treat, and over test their patients.” The goal of lowering medical-malpractice insurance rates was, in their view, related to the general welfare of the public.
The defendants’ challenge to the constitutional argument advanced by John Paganini relies heavily on this economic rationale.
Due course of law rights under the Ohio Constitution
Article 1, Section 16 of the Ohio Constitution provides that:
“All courts shall be open, and every person, for an injury done him in his land, goods, person, or reputation, shall have remedy by due course of law, and shall have justice administered without denial or delay.”
This is generally seen as analogous to the provisions of the U.S. Constitution’s Fourteenth Amendment, which guarantees the rights of equal protection and due process under the law to all persons.
The usual standard for challenging a law as unconstitutional is the “rationale basis” test. Under the rational basis test, courts will uphold a statute if it:
- bears a real and substantial relation to the public health, safety, morals, or general welfare of the public, and
- is not unreasonable or arbitrary.
Rather than take aim at the statute in general, Paganini argues the law is unconstitutional in his unusual circumstances, namely that the statute would deprive him of 66.4 percent of the damages awarded to him by the jury in order to lower medical-malpractice insurance rates for the public’s benefit. Paganini argues that imposing a damage cap on one of the most severely injured people is arbitrary and not reasonably calculated to obtain the legislature’s objective of reducing medical-malpractice insurance premiums.
Efforts to cap medical malpractice damages are nothing new, and the outcome of Paganini will affect only Ohio lawsuits. Nonetheless, hospitals and medical associations throughout the country will be watching carefully.
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