Dear CMA Members,

For decades, California’s landmark medical malpractice laws have successfully struck a balance between compensatory justice for injured patients while maintaining an overall health care system that is accessible and affordable for Californians.


During that time, California’s physician and provider communities, through Californians Allied for Patient Protection (CAPP), have defended the Medical Injury Compensation Reform Act (MICRA) through expensive battles at the ballot, in the courtroom, and in the legislature. CAPP is the large and diverse coalition working to protect access to health care through MICRA. Its membership includes the California Medical Association (CMA), California Hospital Association, California Dental Association, CMA’s component medical societies, medical malpractice insurance carriers, community clinics, Planned Parenthood Affiliates of California and many more.  

This year, with the so-called Fairness for Injured Patients Act (FIPA) slated for the November ballot, we are again facing another costly initiative battle that could obliterate existing safeguards for out-of-control medical lawsuits and result in skyrocketing health care costs.

Now, for the first time in a generation, we were met with an opportunity to achieve a meaningful consensus between competing interests through a revised framework that could protect both the rights of injured patients while keeping MICRA’s essential guardrails solidly in place for patients and providers alike.

At times like these, we have an obligation to protect patient care and to seize a historic opportunity for a brighter future for California’s health delivery system.

To that end and at long last, a historic agreement to modernize MICRA is on the horizon. The two sides of the ballot measure campaign have committed to putting patients first, to prioritizing the stability of affordable access to health care, and to set aside differences to do what’s right for all Californians.

As part of this modernization of MICRA, it was important that the underlying principles be preserved – ensuring access to care and protecting our health care delivery system from runaway costs. Important guardrails of MICRA will continue unchanged, including advance notice of a claim, the one-year statute of limitations to file a case, the option of binding arbitration, early offer of proof for making punitive damage allegations and allowing other sources of compensation to be considered in award determinations.


The element likely to garner the most interest surrounds changes to the limit on non-economic damages in medical malpractice cases, which is currently $250k. As opposed to the ballot measure, which would have effectively eliminated the cap on non-economic damages entirely, under the agreement:

  • Cases not involving a patient death will have a limit of $350k on the effective date of January 1, 2023, with an incremental increase over the next 10 years to $750k and a 2.0% annual inflationary adjustment thereafter.
  • Cases involving a patient death will have a limit of $500k on the effective date of January 1, 2023, with an incremental increase over the next 10 years to $1 million and a 2.0% annual inflationary adjustment thereafter.

Critical MICRA guardrails that will remain in place with modest updates include the ability to pay awards of future damages over time and limits on plaintiff’s attorney’s contingency fees.

Our coalition is working with the Newsom Administration and leaders of the California Legislature to pass legislation that will make this new policy California law. Under the agreement, the initiative will be withdrawn from the ballot and this watershed agreement will preclude another costly fight.

Click here to read the joint statement from our coalition, CAPP, and proponents of FIPA.

Best wishes for a healthy future,

Robert E. Wailes, M.D.

President, California Medical Association