## Facts

- Twelve-day-old Kris Knowles was admitted to an Air Force base hospital for treatment of a fever.
- Enlisted medical services specialists took vital signs but allegedly failed to report a dangerous decline in Kris’s temperature to nurses or physicians.
- After discharge, Kris was found to have a critically low temperature and was readmitted for hypothermia.
- Kris later developed hypoglycemia and suffered respiratory arrest, causing severe and irreversible brain damage.
- Kris’s parents sued the United States under the Federal Tort Claims Act for medical malpractice on Kris’s behalf and for their own derivative damages (including emotional distress and loss of consortium).
- The United States admitted liability but sought to limit total recovery to $1 million under South Dakota’s medical-malpractice damages cap, SDCL 21-3-11.
- The federal district court upheld the cap’s constitutionality; on appeal, the Eighth Circuit certified state-law questions to the South Dakota Supreme Court.

## Issues

1. Whether SDCL 21-3-11’s $1 million cap on medical-malpractice damages violates the South Dakota Constitution’s due process guarantee.
2. If the amended cap is unconstitutional, whether the prior (1985) version of SDCL 21-3-11 is revived and governs.
3. Whether, given the state constitutional rulings, the United States may enforce the amended $1 million cap to limit damages in this FTCA action.
4. How the damages-limitation regime applies to the categories of claimed damages in this case once state constitutional constraints are applied.

## Decision

- The court held SDCL 21-3-11’s amended $1 million medical-malpractice damages cap unconstitutional under the South Dakota Constitution on due process grounds.
- The court determined that invalidation of the amendatory cap revived the 1985 version of SDCL 21-3-11.
- Because the amended cap was unconstitutional, it could not be applied to limit the Knowles family’s recovery in the pending FTCA action; damages instead had to be evaluated under the revived statutory scheme and other applicable state law.

## Legal Principles

- A legislative cap on tort damages may violate South Dakota substantive due process if it arbitrarily and fundamentally unfairly restricts recovery, particularly for catastrophically injured plaintiffs after liability is established.
- When an amendatory act to a statute is unconstitutional, South Dakota law may treat the prior version as revived rather than leaving a void, depending on statutory-construction and severability principles.
- In FTCA medical-malpractice litigation, state law supplies the rule of decision for liability and damages, so state constitutional invalidation of a damages cap controls the federal case’s damages analysis.

## Conclusion

South Dakota’s Supreme Court concluded that the amended $1 million medical-malpractice damages cap denied due process under the state constitution, revived the statute’s 1985 version, and thereby prevented the United States from enforcing the amended cap to restrict damages in the FTCA action arising from the infant’s catastrophic injury.


Knowles v. United States, 544 N.W.2d 183 (S.D. 1996)