Navigating a Complex Legal Landscape in Health Care

Recent Colorado Supreme Court Decisions and Their Impacts on Physicians  

Two recent Colorado Supreme Court rulings, Bianco v. Rudnicki and Gresser v. Banner Health, bring significant changes to the state’s medical liability environment. These decisions clarify language in Colorado’s Health Care Availability Act (HCAA). In doing so, they broaden financial liability for physicians, insurers and health systems. As health care professionals adapt to the consequences of these cases, Coloradans Protecting Patient Access (CPPA) and its members are stepping up to lead research, education and advocacy efforts to address growing challenges in medical liability law. 

Here’s a breakdown of what these cases mean and how Colorado’s health care community can respond moving forward. 

The Cases: Bianco v. Rudnicki and Gresser v. Banner Health 

Bianco v. Rudnicki 

This is the follow-along case to the 2021 decision in Rudnicki v. Bianco, in which the Colorado Supreme Court concluded minors and their parents have a joint right to pursue an injured minor’s pre-majority medical expenses.  

In this case, the Colorado Supreme Court addressed whether Alexander was entitled to prefiling, prejudgment interest in excess of the HCAA’s then-$1 million damages cap on his pre-majority medical expenses. In concluding he is, the Court determined that pre-filing, prejudgment interest is part of the “past and future economic damages” the HCAA allows to exceed the damages cap.   

The practical effect of this ruling is that it increases damages awards. Pre-filing, prejudgment interest is the interest that accrues from the time of the alleged injury to the time the plaintiff files the lawsuit. While the statute of limitations for bringing a claim for medical negligence is typically two years, the statute of limitations may be as much as twenty years in cases, like this one, concerning obstetric negligence. In this case, Alexander did not file his claim until he was nine years old. This resulted in an award of approximately $319,000 in pre-filing, prejudgment (which accrues at 9% simple interest) on Alexander’s $391,000 pre-majority medical expenses damages award. Physicians and insurers should therefore be aware of these additional damages when evaluating medical negligence claims. 

Gresser v. Banner Health 

This case also involved obstetrics negligence. The Colorado Supreme Court addressed the question of whether, in those cases where the plaintiff is allowed to exceed the damages cap in the HCAA, the plaintiff is allowed to recover the full amount the jury originally awarded.  

As background, in HCAA cases, the trial court judge will typically reduce a jury’s award in compliance with the HCAA, awarding the plaintiff no more than $300,000 in noneconomic damages and no more overall than the damages cap that applies. The plaintiff then has an opportunity to ask the trial court judge to exceed the damages cap for “good cause shown” to receive additional “past and future economic damages.”  

In this case, the Colorado Supreme Court determined that when a plaintiff successfully shows good cause, the trial court judge is required to reinstate the jury’s verdict as to the past and future economic damages (plus interest). The only way to reduce this award is for the defendant to argue that there is no evidence in the record to support the jury’s award (a hard argument to win).  

The practical effect of this ruling is that damages awards in medical negligence cases will be allowed to the full amount of economic damages a jury awards, with little ability to reduce them once the jury awards them.  

What These Cases Mean for Physicians 

Together, these rulings create ripple effects that alter Colorado’s medical liability landscape, with potential consequences for both physicians and patients. 

Balancing Compassionate Care and a Sustainable Liability System 

Physicians, health care organizations and members of CPPA share a core belief: every individual injured by medical negligence should have access to the resources they need to receive care and support, within the framework of the law. At the heart of CPPA’s mission is the principle of ensuring injured patients are fairly compensated and receive the help they need while preserving a liability system that remains stable, predictable and sustainable for everyone in the health care ecosystem. 

However, these court rulings significantly raise the stakes for defendants in medical malpractice cases. By allowing judgments to exceed the $1 million economic cap — with substantial amounts of prejudgment interest layered on top — these rulings make it increasingly expensive to resolve claims. The costs are especially burdensome for physicians and insurers already facing pressures in the current health care environment. 

Incentivizing Delayed Claims 

Another growing concern is the unintended incentive for plaintiffs to delay filing claims. In birth injury cases, for example, families can wait until the injured child reaches adulthood (due to Colorado’s statute of limitations for minors) to initiate legal action. If a claim is delayed 18–20 years, pre-filing, significant amounts of prejudgment interest — which accrues at 9% simple interest — will accumulate. This means the eventual final award is exponentially larger than the actual damages.  

Take the Bianco matter, for example. Colorado law further provides for 9% interest compounding annually from the date a lawsuit is filed until the date a judgment enters. And this post-filing interest runs on the damages the jury awards plus the pre-filing, prejudgment interest. This means that Alexander was entitled to $391,000 in pre-majority medical expenses, plus $319,000 in pre-filing, prejudgment interest — but that post-filing, prejudgment interest accrued at 9% compounding annually on $710,000 from the case’s inception to judgment. This results in a judgment of approximately $1.3 million.  

Impacts on Physician Workforce and Patient Access 

One of the greatest risks of larger judgments is the potential impact on access to care. Rising judgments often result in higher malpractice insurance premiums for physicians, especially those in high-risk specialties such as obstetrics. As insurance costs increase, some providers may limit the types of care they offer, avoid higher-liability cases or even leave the specialty altogether. These shifts could lead to reduced access to critical care services for Coloradans, creating challenges for patients who require these specialized services. 

What’s Next: Research, Education and Advocacy 

In the wake of these decisions, it’s critical for Colorado’s health care community to collaborate on solutions that strike a balance between fair compensation for injured patients and protecting access to care. Here’s what’s ahead: 

• Research: We’re committed to studying the broader implications of these court rulings, including their impact on physician liability, insurance premiums and patient care costs. This research will serve as the foundation for evidence-based policy recommendations. 

• Education: Communicating the impact of these rulings is vital. We are focused on educating not only our physician members, but also others within the defense and insurance communities. Physicians need to understand how these changes may affect their practice and what they can do to reduce potential risks. 

• Advocacy: Future focused advocacy efforts will emphasize the importance of maintaining balanced medical liability laws to protect care access across Colorado. 

What Physicians Can Do 

While these legal changes may feel daunting, physicians in Colorado play a critical role in shaping the future: 

1. Stay Informed – Educate yourself on these rulings, their implications and existing liability protections. 

2. Engage with Advocacy Efforts – When asked, join CPPA’s push for legislative reform to ensure a balanced liability environment. Your voice and experiences as a provider matter. 

3. Focus on Risk Mitigation – Continue prioritizing patient safety, strong communication and thorough documentation to help minimize liability risks and improve outcomes. 

Moving Forward Together 

The Bianco and Gresser decisions underscore the complexity and sensitivity of Colorado’s medical liability system. Physicians want injured patients to receive the care and resources they need, yet these rulings raise questions of sustainability and fairness in how liability awards are determined. 

Colorado’s health care community can confront these challenges both thoughtfully and with purpose. Through research, education and advocacy, we will work together toward a fairer system — one that supports both patients and the physicians who care for them.