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  • Writer's pictureSaundra Smyrski

Florida Birth-Related Neurological Injury Compensation Plan (NICA)

“What does the hospital care about? All the hospital cares about is that this child walks away with nothing. That they beat us,” Littky-Rubin said. “The hospital has been unrelenting,” Littky-Rubin said. “The time has come, Your Honor, for this to end,” she said.

The Florida Birth-Related Neurological Injury Compensation Plan (“Plan”) is an example of provisions of Florida law that is working. Known as NICA, the Plan provides a wide range of benefits to a child who has sustained a brain or spinal cord injury caused by oxygen deprivation or mechanical injury during labor, delivery, or in the immediate post-delivery period (NICA, 2006).

The Plan was initiated to:

  1. Stabilize and reduce malpractice insurance premiums for providers of obstetric services in Florida; and

  2. Provide compensation, on a no-fault basis, for a limited class of catastrophic injuries which result in unusually high costs for custodial care and rehabilitation.

The benefits of the Plan are limited to “medically necessary and reasonable expenses”


  • medical and hospital

  • habilitative and training

  • residential or custodial care

  • professional residential and

  • custodial care and service

  • for medically necessary special equipment

  • facilities and

  • for related travel.”

Contrary to the belief of NICA's supporters, the opinions of many mothers, fathers, family, and friends alike, who have been affected by the claim they support, feel otherwise.

One individual mentions, "What NICA doesn’t provide is any kind of accountability or explanation to the parents of what went wrong during childbirth."

Another, “We got no justice,” Lindsey said. “I don’t want this to happen to anybody else.”


Is Is Time For A Change?

In the budget year ending June 30, 2020, NICA earned six times as much in investment income, $124.6 million, as it spent on families of brain-damaged children, $19.8 million (Miller, 2021)

On 4/8/2021, Chief Financial Officer Jimmy Patronis said that the Office of Insurance Regulation, which he supervises, will examine the books of the state’s Birth-Related Neurological Injury Compensation Association, or NICA. Patronis’ office already has begun an “inspection” of the program.

“We need to make sure these kids and their families aren’t being nickel-and-dimed,” Patronis said in his statement, echoing the language of two parents quoted in the Herald. “This program needs to treat these children with kindness instead of treating them as though they are a liability for shareholders.”

In appropriate consideration, NICA Executive Director Kenney Shipley mentioned, “We have worked tirelessly to address issues that have arisen over the years, including making processes more responsive to families’ needs, while fulfilling our obligation as fiscal stewards."

NICA defended its mission to reduce malpractice premiums for doctors and said it had followed through on the Legislature’s intent to “provide catastrophically brain-damaged infants with the medical care they need without subjecting their families to protracted legal battles.

Since its inception, the program has never included the parent of a disabled or medically fragile child or an advocate for such families on its five-member, unpaid board of directors. The current board, all men, represents only health care and insurance industry interests.

In his statement, Patronis said that his wife, Katie, had sustained complications during childbirth for both of the couple’s sons. “I know that every loving parent is stressed out and undergoing an intense amount of emotions when their children are at risk,” Patronis wrote. “I cannot imagine or understand how difficult things are for families of children with neurological injuries.”

He added: “We’ve got to figure out a way to make things easier for them.”


Now What?

Cases involving neonates can be very challenging for many reasons, including but not limited to the following:

  • highly emotional

  • specialized and complex

  • statute of limitations (Pediatric vs. adult, and state differences)

  • single neonatal case- one patient (baby) vs. two patients (mother and baby)

  • volume of patient records to review/analyze

  • newborn and maternal patient records

  • prior maternal medical and obstetrical history

  • related prenatal and antepartum history

  • labor and delivery records

  • location of neonatal admission

  • maternal and neonatal transport

  • multiple hospital admissions

Allow us to do what we do best! For your brain damaged neonatal cases, call us at Saundra Smyrski LLC today! 727.225.4358

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