Incremental Tort Reform Survives Equal Protection: Williams v. Regency Hospital Reaffirms Georgia’s Non‑Tolling Rule for Mentally Incompetent Medical‑Malpractice Plaintiffs

Incremental Tort Reform Survives Equal Protection: Williams v. Regency Hospital Reaffirms Georgia’s Non‑Tolling Rule for Mentally Incompetent Medical‑Malpractice Plaintiffs

Introduction

In Williams v. Regency Hospital Company, LLC, the Supreme Court of Georgia reaffirmed the constitutionality of OCGA § 9-3-73(b), Georgia’s “non‑tolling” rule for medical malpractice actions brought by individuals who are “legally incompetent because of intellectual disability or mental illness.” The Court held that Deen v. Stevens, 287 Ga. 597 (2010), largely controls the equal protection challenge and that the additional arguments advanced—most notably, that the expert affidavit requirement in OCGA § 9-11-9.1 and the five‑year statute of repose in OCGA § 9-3-71(b) render the non‑tolling rule irrational—do not change the constitutional analysis.

The case presents a recurring and consequential question in Georgia malpractice litigation: whether mentally incompetent plaintiffs must still file medical‑malpractice suits within the two‑year limitations period (OCGA § 9-3-71(a)) despite the general tolling protection in OCGA § 9-3-90(a). The Court answered yes, emphasizing rational-basis review and legislative prerogatives in line‑drawing within social and economic policy.

Background and Parties

Plaintiff-petitioner Andreana Williams, as conservator/guardian of her mother, Michelle Hewett, sued Regency Hospital entities and a nurse practitioner employee for alleged malpractice occurring between September 23 and October 22, 2020, after Hewett suffered a stroke and later developed severe macroglossia that culminated in a partial tongue amputation. Williams was appointed conservator/guardian on August 2, 2022, and filed suit on April 7, 2023—more than two years after the alleged malpractice.

Defendants moved to dismiss as time-barred under OCGA § 9-3-71(a). Williams countered that Hewett’s legal incompetence tolled the limitations period under OCGA § 9-3-90(a), or alternatively that OCGA § 9-3-73(b)’s non‑tolling rule violated the Equal Protection Clause by treating mentally incompetent medical‑malpractice plaintiffs differently from mentally incompetent plaintiffs in other civil actions.

Issues Presented

  • Whether Deen v. Stevens controls the equal protection challenge to OCGA § 9-3-73(b).
  • Whether OCGA § 9-3-73(b) violates the Equal Protection Clause by excluding mentally incompetent medical‑malpractice plaintiffs from tolling available to mentally incompetent plaintiffs in other types of suits.
  • Whether the expert affidavit rule (OCGA § 9-11-9.1) and the medical‑malpractice statute of repose (OCGA § 9-3-71(b)) undermine any rational basis for OCGA § 9-3-73(b).

Summary of the Judgment

The Supreme Court of Georgia affirmed dismissal of the complaint as untimely. The Court held that:

  • Deen largely controls and remains good law: mentally incompetent persons do not constitute a suspect class; therefore, rational basis review applies.
  • OCGA § 9-3-73(b) is rationally related to legitimate state interests, including ensuring affordable access to quality healthcare and preventing stale malpractice suits.
  • The existence of other malpractice-screening mechanisms—such as the expert affidavit requirement (OCGA § 9-11-9.1) and the five-year statute of repose (OCGA § 9-3-71(b))—does not render the non‑tolling classification irrational; the legislature may adopt multiple, incremental tools to address the same policy problem.
  • Arguments relying on empirical debates about healthcare costs and malpractice litigation, or characterizing the impact as “largely theoretical,” do not defeat rational basis review.
  • Additional contention that societal views have evolved such that mental incompetence should be treated as a suspect class was not preserved below and was not considered.

Consequently, the two-year statute of limitations applied without tolling, and Williams’s claims were time‑barred. The Court did not revisit the Court of Appeals’ separate determination that the claims did not sound in ordinary negligence.

Detailed Analysis

1) Precedents Cited and Their Influence

  • Deen v. Stevens, 287 Ga. 597 (2010): The cornerstone precedent. In Deen, the Court upheld OCGA § 9-3-73(b) against equal protection challenges (under both the U.S. and Georgia Constitutions), applied rational basis review, and accepted the legislature’s stated objectives—affordable access to quality healthcare and avoiding stale claims—as legitimate and rationally furthered by non‑tolling for medical malpractice actions. Williams reiterates Deen’s key propositions:
    • Mentally incompetent persons are not a suspect class for equal protection purposes.
    • Rational basis review is highly deferential; courts uphold classifications if any reasonably conceivable state of facts could provide a rational basis.
    • Legislative line‑drawing (e.g., two‑year limitations vs. five‑year repose) is for policymakers, not courts.
    • Court need not assess empirical efficacy of tort reforms under rational basis review.
  • Gliemmo v. Cousineau, 287 Ga. 7 (2010): Cited for the burden in equal protection challenges: the challenger must show that the legislative facts on which the classification is based could not reasonably be conceived to be true.
  • Taylor v. Devereux Foundation, Inc., 316 Ga. 44 (2023): Reinforces the presumption of constitutionality and the challenger’s burden to demonstrate manifest constitutional infirmity.
  • Northway v. Allen, 291 Ga. 227 (2012): Standard of review for motions to dismiss—de novo, construing the complaint in favor of the plaintiff.
  • RCC Wesley Chapel Crossing, LLC v. Allen, 313 Ga. 69 (2021): Cited for the preservation rule; issues not raised below (e.g., treating mentally incompetent persons as a suspect class due to changed societal views) are not considered on certiorari.

2) The Court’s Legal Reasoning

The Court conducted a structured equal protection analysis:

  • Classification at issue: Mentally incompetent medical‑malpractice plaintiffs vs. mentally incompetent plaintiffs in other civil actions. OCGA § 9-3-90(a) generally tolls limitations for those legally incompetent “because of intellectual disability or mental illness,” but OCGA § 9-3-73(b) carves out medical malpractice, rendering these plaintiffs “subject to the periods of limitation for actions for medical malpractice.”
  • Standard of review: Rational basis. Mentally incompetent persons are not a suspect class; no fundamental right is implicated by a repose or limitations regime. The question is whether any reasonably conceivable set of facts could justify the classification.
  • Legitimate governmental interests: The legislature articulated interests in ensuring affordable access to quality healthcare and in preventing stale medical‑malpractice suits. The Court accepted these as legitimate.
  • Rational relationship / legislative fit: Non‑tolling directly advances the goal of curtailing stale claims and potentially contributes to cost containment and predictability. Under rational basis review, the legislature may choose incremental or partial solutions without proving empirical effectiveness or exclusivity.
  • Addressing plaintiff’s “new” arguments:
    • Expert affidavit rule (OCGA § 9-11-9.1): Even if the affidavit requirement filters weak claims, the legislature may combine multiple procedural screens. The existence of one screen does not negate the rationality of another; “more than one tool” to address the same policy concern is permissible.
    • Statute of repose (OCGA § 9-3-71(b)): Deen already rejected the contention that the five‑year repose makes the two‑year non‑tolling arbitrary. Choosing two years with no tolling (subject to the outer five‑year bar) is classic legislative line‑drawing.
    • Empirical debates: Courts do not referee healthcare policy efficacy under rational basis review. The statute need not be the best or most effective means—only a rational one.
    • Suspect class re‑ask: Any argument that evolving societal views warrant treating mental incompetence as a suspect class was not preserved; the Court declined to consider it.

3) Why Deen “largely controls”

The petitioner attempted to reframe the equal protection challenge as targeting disparate treatment among mentally incompetent plaintiffs across case types (medical vs. non‑medical), rather than discrimination against mentally incompetent adults as a class. The Court found this to be a distinction without a constitutional difference. Deen already evaluated the same carve‑out and upheld it; Williams does not alter the pertinent classification or the operative standard of review.

4) Impact and Practical Consequences

  • No tolling for legal incompetence in medical malpractice: Plaintiffs alleging medical malpractice cannot rely on OCGA § 9-3-90(a) tolling due to mental illness or intellectual disability. Claims must be filed within two years of accrual (typically from the date of injury), subject to the five‑year repose.
  • Guardians and conservators: Appointment does not revive or extend the two‑year period for malpractice claims on account of pre‑existing incompetence. Early appointment and immediate preservation of claims are essential.
  • Plaintiffs’ litigation strategy:
    • Docket the two-year limitation from the date of the alleged malpractice or accrual event; do not assume disability tolling applies in medical malpractice actions.
    • Secure the OCGA § 9-11-9.1 expert affidavit early; the affidavit requirement remains in force and does not substitute for timeliness.
    • Evaluate other tolling doctrines only if independently applicable (e.g., fraudulent concealment or statutory exceptions not at issue here), and always account for the five‑year repose ceiling.
  • Defense posture: This decision reinforces a robust limitations defense against malpractice suits filed beyond two years, even where plaintiffs allege mental incompetence during the accrual period.
  • Equal protection doctrine in Georgia: Williams cements that incremental tort reforms addressing malpractice exposure will generally withstand federal equal protection review when supported by any rational policy justification. Courts will not second‑guess legislative efficacy or prefer one mechanism over another.

Complex Concepts Simplified

  • Statute of limitations vs. statute of repose:
    • Limitations set the time to file after a claim accrues (here, generally two years for medical malpractice, OCGA § 9-3-71(a)). They can sometimes be tolled.
    • Repose sets an outer boundary tied to the defendant’s act or omission (here, five years, OCGA § 9-3-71(b)). Repose is generally not subject to tolling and can bar a claim even if the limitations period has not yet run after accrual.
  • Tolling for legal incompetence (OCGA § 9-3-90(a)): Ordinarily pauses limitations while a person is legally incompetent due to intellectual disability or mental illness. But for medical malpractice, OCGA § 9-3-73(b) overrides this tolling and keeps the two‑year clock running.
  • Rational basis review: The most deferential equal protection test. A law will be upheld if any conceivable rational connection exists between the classification and a legitimate governmental goal. Courts do not require empirical proof, optimal tailoring, or exclusive means; “good enough” rationality suffices.
  • Expert affidavit requirement (OCGA § 9-11-9.1): A plaintiff alleging professional malpractice must file an expert affidavit with the complaint identifying at least one specific negligent act or omission and its factual basis. It is a screening mechanism, not a tolling device.
  • Preservation of issues: Arguments not presented to the trial court (e.g., elevating mental incompetence to a suspect class) will not be considered for the first time on certiorari.

Key Statutes and How They Interact

  • OCGA § 9-3-71(a): Two-year statute of limitations for medical malpractice actions.
  • OCGA § 9-3-71(b): Five-year statute of repose for medical malpractice actions.
  • OCGA § 9-3-90(a): General tolling for persons legally incompetent due to intellectual disability or mental illness when the cause of action accrues.
  • OCGA § 9-3-73(b): “Non‑tolling” rule for medical malpractice: notwithstanding § 9-3-90, legally incompetent persons remain subject to the medical malpractice limitation periods.
  • OCGA § 9-11-9.1: Expert affidavit required with a professional malpractice complaint.

Conclusion

Williams v. Regency Hospital reaffirms—and subtly extends—the holding of Deen v. Stevens: OCGA § 9-3-73(b)’s non‑tolling rule for medically incompetent plaintiffs withstands an equal protection challenge under rational basis review. The Court expressly rejects the notion that the presence of other statutory screening mechanisms (the expert affidavit requirement and the statute of repose) undermines the rationality of non‑tolling. The decision underscores three themes:

  • Equal protection review of tort reform measures is highly deferential when no suspect class or fundamental right is at stake.
  • Legislatures may employ multiple, overlapping, incremental tools to address complex policy problems, including the perceived costs of malpractice litigation and the risks of stale claims.
  • For medical malpractice in Georgia, legal incompetence does not pause the two‑year limitations clock; timely filing and early guardianship action are essential.

In the broader legal context, Williams stabilizes Georgia’s malpractice limitations framework and signals continued judicial deference to legislative line‑drawing in the domain of healthcare and tort policy. Unless and until the legislature changes course or a different constitutional theory is preserved and sustained, the non‑tolling rule remains firmly in place.

Case Details

Year: 2025
Court: Supreme Court of Georgia

Comments