By Patricia Ares-Romero, MD
Recently, I had the opportunity to explore the issue of nuclear verdicts with Bob White, President of The Doctors Company (TDC). I was perplexed to learn that, over the past decade, the United States has seen a dramatic rise in the size of medical malpractice verdicts.
According to TDC -the nation’s largest physician-owned medical malpractice insurer-, from 2013 to 2023, the number of verdicts exceeding $10 million surged by 67%, with many topping $25 million. Last year, the average award among the top 50 malpractice verdicts rose by a staggering 50%, from $32 million in 2022 to $48 million in 2023. These so-called “nuclear verdicts” are reshaping the landscape of healthcare, with consequences reaching far beyond the courtroom.
Surprisingly, this surge in verdict amounts has not been accompanied by an increase in the frequency of malpractice claims. Instead, a phenomenon known as “social inflation” is driving this trend. Social inflation encompasses societal and economic factors—such as desensitization to large numbers, the erosion of tort reform, and emotional appeals in courtrooms—that inflate the costs of resolving claims. The repercussions are felt throughout the healthcare system.
Massive malpractice awards have far-reaching implications. For physicians, they lead to skyrocketing liability premiums and the proliferation of defensive medicine practices—unnecessary tests or procedures ordered solely to shield against potential litigation. Studies estimate that defensive medicine adds at least $55 billion annually to U.S. healthcare costs. These inflated costs inevitably trickle down to patients, increasing the price of care and straining an already burdened system.
Nuclear verdicts also impose a “tort tax” on society. The U.S. Chamber of Commerce Institute for Legal Reform estimates this burden at 2.1% of GDP, equivalent to $3,621 per American household. This hidden tax underscores how legal outcomes in a courtroom can influence household budgets, business operations, and the broader economy.
A key contributor to these astronomical verdicts is what researchers call “number numbness.” In a society accustomed to billion-dollar lottery jackpots and multimillion-dollar sports contracts, large figures lose their shock value. This detachment, coupled with emotional courtroom dynamics, can lead juries to issue outsized awards in malpractice cases.
Adding to the complexity, many jurors are unaware that significant portions of these awards—sometimes as much as 40%—are funneled to attorneys or third-party litigation funders, who invest in lawsuits for financial gain. These dynamics distort the intent of the legal system and harm the very patients it seeks to protect.
Florida has made strides in tort reform in the past, but these efforts are under constant attack. Caps on noneconomic damages, which compensate for subjective claims like pain and suffering, are essential to containing costs and ensuring that liability judgments remain fair and predictable. Without these caps, jurors can be swayed by emotional appeals in malpractice cases, leading to excessive punitive awards that destabilize the healthcare system.
The Dade County Medical Association is committed to addressing these challenges. The association’s advocacy efforts are driven by the belief that physicians should focus on delivering high-quality care without the constant fear of crippling litigation. A concerted effort is needed to advocate for common-sense reforms that preserve the integrity of the legal system while safeguarding the future of physician-led healthcare.
Dr. Patricia Ares-Romero is President, Dade County Medical Association, Inc.
