The biggest medical malpractice case ever recorded is a $951 million Utah judgment against Steward Health Care, though most record-setting awards are reduced by damage caps, appeals, or settlement before anything is paid.
These cases cluster around birth injury, delayed diagnosis, emergency-response failure, surgical error, and institutional misconduct. These cases create lifetime-care cost structures that push reported awards into eight or nine figures.
This ranking covers publicly reported verdicts and disclosed settlements, with notes on caps, reductions, and the documentation issues that shaped each outcome. Many of these matters trace back to how thoroughly the underlying medical records were gathered and reconstructed before trial.
What Drives the Biggest Malpractice Awards?
Every malpractice claim rests on four elements: duty, breach, causation, and damages. The Cornell Legal Information Institute defines malpractice as a tort committed when a professional breaches a duty to a client.
Damages drive the headline numbers. Economic damages cover lifetime care, medical expenses, lost earning capacity, and other financial loss. Noneconomic damages compensate pain, suffering, and loss of enjoyment, and the NCSL identifies noneconomic damages as the most common cap target.
Punitive damages occupy a separate category. They punish egregious conduct and can increase reported awards when the record supports conduct beyond ordinary negligence. Reported amounts are often pre-cap and pre-final, so the headline figure rarely confirms final paid recovery.
The 20 Largest Verdicts and Settlements, Ranked
The ranking includes publicly reported verdicts and disclosed settlements, ordered by reported award amount. Mass institutional settlements are flagged because they do not benchmark cleanly against single-claimant negligence cases.
The reported verdict, entered judgment, appellate status, settlement resolution, and final paid recovery often remain distinct. Each entry should be read as a reported public amount, not confirmed final recovery, unless a reduction, appeal, or settlement resolution is specifically described.
- Zancanella v. Steward Health Care ($951 million)
A Utah judge entered a $951 million judgment against Steward Health Care in August 2025, the largest medical malpractice award in Utah history. In-training nurses administered excessive Pitocin and missed signs of fetal distress during a 36-hour labor at Jordan Valley Medical Center while the on-call physician slept, and the child, Azaylee McMicheal, sustained a hypoxic-ischemic brain injury. The figure carries heavy caveats: it was a default judgment after Steward, now in Chapter 11 bankruptcy, withdrew from the case, Utah's $450,000 noneconomic cap could cut roughly $410 million, and collectibility is uncertain.
What drove the verdict was the record itself. The fetal heart monitor strips showed the baby in distress for hours, but the nurses assigned to the labor had just finished orientation and could not read what the record was telling them. That contrast between what the strips captured and how the staff responded is the spine of the case, and it only becomes visible when the monitoring record is reconstructed minute by minute.
- USC / George Tyndall Aggregate Settlement ($852 million)
USC reached an $852 million settlement in 2021, resolving California state-court claims by roughly 710 former patients of campus gynecologist George Tyndall. The matter involved intentional misconduct and negligent supervision claims against the university, making it an aggregate institutional settlement rather than a single-claimant negligence benchmark.
- Kowalski v. Johns Hopkins All Children's Hospital ($261 million)
A Florida jury returned a $261 million verdict in November 2023 in Kowalski v. Johns Hopkins All Children's Hospital, the case behind the "Take Care of Maya" documentary. The award was largely for false imprisonment, battery, and wrongful death rather than clinical negligence. A Florida appeals court vacated the entire judgment in October 2025 on child-abuse-reporting immunity grounds, and the family has taken the case to the Florida Supreme Court, so no amount has been paid.
- Byrom v. Johns Hopkins Bayview Medical Center ($229.6 million)
A Baltimore jury awarded $229.6 million in Zubida Byrom v. Johns Hopkins Bayview Medical Center in July 2019 after a teenage mother allegedly received inaccurate delivery counseling, and her daughter developed cerebral palsy. Maryland's cap first reduced the award to roughly $205 million, but the Maryland Court of Special Appeals then overturned the verdict entirely in February 2021, finding the evidence insufficient to prove negligence.
- Hagans v. Hospital of the University of Pennsylvania ($207.6 million)
A Philadelphia jury awarded $182.7 million in Hagans v. Hospital of the University of Pennsylvania, raised to $207.6 million with delay damages, after a delayed cesarean during a 2018 delivery left a child with cerebral palsy. Unlike most large birth-injury awards, this one was affirmed on appeal by the Pennsylvania Superior Court in July 2025, making it among the largest malpractice judgments to survive appellate review. The plaintiff's team-negligence theory proved liability across multiple clinicians without isolating a single negligent provider.
The case is notable for how the plaintiff proved liability across a multi-clinician delivery team rather than pinning it to one named provider. That approach depends on a complete delivery record showing each handoff, order, and response time, so that the jury can see the collective failure even where no single chart entry is decisive on its own.
- Dr. Nikita Levy / Johns Hopkins Aggregate Settlement ($190 million)
Johns Hopkins agreed to a $190 million settlement in July 2014 resolving claims by roughly 8,000 former patients of gynecologist Nikita Levy, who secretly recorded patients during exams. The claim against Hopkins centered on negligent supervision and credentialing, making this an aggregate institutional settlement rather than a one-plaintiff malpractice verdict.
- Allan Navarro Verdict ($216.7 million)
A Hillsborough County, Florida jury returned a $216.7 million verdict in October 2006 in Allan Navarro v. Michael P. Austin, et al., after emergency providers misdiagnosed a stroke as sinusitis, leaving the patient permanently disabled. The award combined roughly $116.7 million in compensatory and $100.1 million in punitive damages, but the case settled before appeal in March 2007 for an undisclosed amount, so the headline figure was never paid. The verdict turned on emergency-medicine credentialing failures, where an unlicensed assistant performed the initial exam that missed the stroke.
- Applewhite v. Accuhealth, Inc. ($172 million)
A Bronx jury returned a $172 million verdict in May 2014 in Applewhite v. Accuhealth, Inc., the largest EMS-related judgment in U.S. history, after city paramedics without proper equipment advised a mother to wait rather than transport her daughter during anaphylaxis, causing brain damage. The City indicated it would appeal. Liability rested on the special-duty doctrine, the narrow exception that overcomes the governmental immunity normally shielding municipal EMS.
What turned the case was evidence that the city had internally disciplined the two EMTs for their handling of the call. That kind of admission lives in incident records and personnel documentation, not in the clinical chart, which is a reminder that the decisive evidence in a municipal-liability claim often sits outside the medical file entirely.
- Spyros Panos Aggregate Settlement ($140 million)
A New York arbitrator awarded $140 million in 2019 to resolve 255 lawsuits against orthopedic surgeon Spyros Panos, who pleaded guilty to health care fraud after faking and botching surgeries. Only about $46 million in insurance coverage existed, so individual plaintiffs recovered a fraction of the reported total.
- Faith DeGrand v. Detroit Medical Center ($135 million)
A Wayne County, Michigan jury awarded $135 million in July 2018 after a scoliosis surgery on 10-year-old Faith DeGrand compressed her spinal cord and the surgeon went on vacation while she lay paralyzed for ten days, leaving her with quadriparesis. Detroit Medical Center said it would appeal.
The damning detail was timing: the record showed clear signs the spinal hardware was compressing her cord, yet ten days passed before another physician intervened and removed it. A care timeline that lays out when the symptoms appeared against when anyone acted turns an abstract negligence claim into a concrete, day-by-day account a jury can follow.
- Reilly v. St. Charles Hospital ($130 million)
A Suffolk County, New York jury awarded $130 million in April 2013 in Reilly v. St. Charles Hospital and Rehabilitation Center after a labor nurse failed to escalate signs of fetal distress, and the child was born with cerebral palsy. The family reached the verdict only after rejecting an $8 million offer and enduring a defense verdict and a hung jury across two prior trials.
- New York Stevens-Johnson Syndrome Verdict ($120 million)
A Bronx jury awarded roughly $120 million in May 2012 to Jacqueline Martin after three hospitals were slow to recognize and treat Stevens-Johnson Syndrome triggered by an anti-seizure medication, leaving her brain damaged. Liability was apportioned across the hospitals and a neurologist, and the defendants signaled they would appeal.
- William R. Lee v. Westchester County Health Care Corporation ($120 million)
A Westchester County jury awarded $120 million in November 2023 in William R. Lee et al. v. Westchester County Health Care Corporation after inexperienced on-call doctors delayed diagnosing a basilar artery stroke in a 41-year-old, causing permanent brain damage. This is a diagnostic-failure case, the largest malpractice verdict in Westchester County history.
The plaintiff's theme was "time is brain," and proving it meant pinning down exactly when the imaging was done, when residents reviewed it, and how long passed before an experienced radiologist caught the stroke. In a delayed-diagnosis case, mapping the imaging and consult sequence against the clock is what separates a survivable claim from a defense verdict.
- Drake v. Henry Ford Health System ($120.7 million)
A Wayne County, Michigan jury awarded $120,654,000 in March 2024 in Drake v. Henry Ford Health System after a cesarean was delayed more than two hours despite documented fetal distress, causing asphyxiation and cerebral palsy. Henry Ford said it would appeal. The fetal-monitoring record documented distress well before the delivery team acted, fixing the delay that drove causation.
The cord-blood gas results and the gap in fetal monitoring after the patient was moved to the operating room were central to proving causation. When the chart shows a C-section ordered and then a two-hour delay with no documented clinical reason, that unexplained gap becomes the case, which is why pinning down the order of events matters so much in delayed-delivery claims.
- Illinois Hospital Birth Injury Verdict ($100.6 million)
A Cook County, Illinois jury returned a $100.6 million verdict in November 2019 after West Suburban Medical Center staff ignored fetal monitoring strips for hours, and baby Gerald Sallis was born with a hypoxic brain injury. A high-low agreement reached during deliberations capped the family's actual recovery at $50 million in exchange for the hospital not appealing.
The liability finding rested on the fetal monitoring strips going unread for roughly six hours despite the mother reporting she could not feel the baby move. A documented complaint from the patient sitting alongside monitoring data that no one acted on is a powerful pairing, and surfacing it requires reading the nursing notes and the strips together rather than in isolation.
- Kromphardt v. Mercy Iowa City ($97.4 million)
A Johnson County, Iowa jury returned a $97.4 million verdict in March 2022 in Kromphardt v. Mercy Iowa City after a physician's forceps and vacuum use during delivery fractured the infant's skull and caused brain damage. The Iowa Supreme Court vacated the verdict in November 2024, citing an evidentiary error, and ordered a new trial.
- Reported Bronx Neurocognitive Injury Award ($80 million)
A Bronx jury returned an $80 million verdict in October 2022 against Jacobi Medical Center, a public hospital, for profound neurocognitive injuries tied to the premature birth of a child in 2003. A settlement reached mid-deliberation reduced the actual recovery below the reported figure.
The claim hinged on whether providers should have delivered roughly 18 hours earlier given a documented infection, a question answered only by tracing the prenatal and labor records against the clinical guidance for that situation. Where the alleged failure is a delay measured in hours, what was known and when is the whole dispute.
- Nicholson-Upsey v. Pottstown Memorial Medical Center ($78.5 million)
A Philadelphia jury awarded $78.5 million in May 2012 after an obstetrician at Pottstown Memorial Medical Center wrongly concluded a baby had died in utero and delayed an emergency cesarean by roughly 81 minutes, and the child developed spastic quadriplegic cerebral palsy. Outdated ultrasound equipment and the absence of an on-site technician contributed to the delay.
- Powell Verdict ($70 million)
A Dougherty County, Georgia jury awarded $70 million in April 2025 to Jessica Powell after physicians administered Vasopressin at more than twice the maximum dose for over 40 hours during sepsis treatment, restricting blood flow and leading to both legs being amputated above the knee. The hospital settled separately before trial; three physicians and their practices remained.
- David Gangaram Verdict ($60 million)
A Nassau County, New York jury returned a $60,033,041 verdict in May 2025 in David Gangaram v. Pain Institute of Long Island after a routine lumbar epidural steroid injection caused a spinal cord infarction, leaving a 64-year-old electrical mechanic paralyzed from the waist down. It is the largest malpractice verdict in Nassau County history.
What the Failure Patterns Reveal
The ranked cases cluster into four recurring categories: birth injury, diagnostic failure, surgical or procedural error, and institutional misconduct. The highest awards concentrate in the first two because they often involve permanent disability, long care horizons, and contested treatment timing.
Surgical and procedural cases generate large awards when the injury is permanent, such as paralysis or severe neurocognitive impairment. Institutional cases become larger when the claim involves repeated misconduct, multiple claimants, or a system-wide failure rather than a single clinical error.
How Do Damage Caps Reduce the Biggest Verdicts?
Caps create much of the gap between a reported verdict and the final judgment. The same injury can produce different recoveries depending on whether the jurisdiction caps noneconomic damages, total damages, or neither.
Maryland illustrates the mechanism. In the Martinez case, the Maryland record shows the trial court reduced a $26 million noneconomic award to $680,000 under § 3-2A-09. Economic damages survived, which is why birth injury verdicts can retain substantial value even in noneconomic-cap states.
Florida struck down its medical malpractice noneconomic cap in Kalitan. New York has no statutory malpractice cap, which is why several New York verdicts appear in the ranking. Texas applies a noneconomic limit, while Virginia applies a total recovery cap.
Texas caps noneconomic damages at $250,000 per claimant against a physician under § 74.301. Virginia’s total recovery cap reaches $2.75 million effective July 1, 2026, under Va. Code § 8.01-581.15. Constitutional challenges can also affect cap durability, as shown by Hilburn v. Enerpipe and ongoing Ohio cap decisions.
Why Documentation Quality Matters in High-Value Cases
Across the ranking, the case-decisive evidence was usually documentary. A chronology, monitoring strip, medication record, or diagnostic timeline fixed the moment care allegedly fell below standard, and disciplined records review is what surfaces that moment.
Gaps in the record cut the same way. Missing progress notes, absent vital-sign entries, and suspicious late additions create factual disputes juries can grasp, and EMR audit trails can expose when a note was really written or changed. The largest verdicts reward preparation that reconstructs the clinical timeline with precision, which in turn supports liability analysis, expert review, settlement posture, and trial presentation.
What These Outcomes Mean for Case Preparation
The largest medical malpractice awards share a consistent profile: catastrophic injury, substantial economic damages, favorable cap treatment, and documentation that fixes breach and causation to a specific moment. Reported verdicts still require careful review because caps, appeals, settlement, and collectibility can change the amount ultimately paid.
For firms managing record-heavy malpractice matters, disciplined chronology development moves legal teams from raw records to case analysis with less manual delay, and that capacity gain compounds across a caseload. Martay Law Office grew case filings 65% after automating the records and documentation work that high-value matters demand.
