author: PARIENTE, J.

text:
    Stuart HOROWITZ, etc., et al., Petitioners, v. PLANTATION GENERAL HOSPITAL LIMITED PARTNERSHIP, etc., Respondent.
    No. SC05-331.
    Supreme Court of Florida.
    May 24, 2007.

      H. Mark Purdy and Rose-Ann Flynn of Purdy and Flynn, P.A., Fort Lauderdale, FL, for Petitioners.
    Arthur J. England, Jr. and Edward G. Guedes of Greenberg Traurig, P.A., Miami, FL, Hal B.. Anderson and Kevin M. Van-natta of Billing, Cochran, Heath, Lyles, Mauro and Anderson, Fort Lauderdale, FL, for Respondents.
    Joel S. Perwin of Joel S. Perwin, P.A., Miami, FL, on behalf of the Academy of Florida Trial Lawyers; and Gail Leverett Parenti of Parenti and Parenti, PA., Miami, FL, and William A. Bell, General Counsel, Florida Hospital Association, Tallahassee, FL, on behalf of the Florida Hospital Association, as Amicus Curiae.
   PARIENTE, J.

In this case, a patient with an unsatisfied money judgment against a physician for medical malpractice seeks recovery from a hospital where the physician had staff privileges, alleging that the hospital should be liable to her for failing to ensure that the physician complied with statutory financial responsibility requirements. The issue is whether section 458.320, Florida Statutes (2006), which outlines the financial responsibility requirements for physicians practicing in Florida, imposes civil liability on the hospital under these circumstances. See Plantation Gen. Hosp. Ltd. P’ship v. Horowitz, 895 So.2d 484 (Fla. 4th DCA 2005).

The Fourth District Court of Appeal held that there was no indication of legislative intent to impose civil liability on hospitals anywhere in the statutory scheme. See id. at 488. This decision expressly and directly conflicts with Robert v. Paschall, 767 So.2d 1227 (Fla. 5th DCA 2000), Baker v. Tenet Healthsystem Hospitals, Inc., 780 So.2d 170 (Fla. 2d DCA 2001), and Mercy Hospital, Inc. v. Baumgardner, 870 So.2d 130 (Fla. 3d DCA 2003), all of which recognized a statutory cause of action based on section 458.320. We accepted jurisdiction to resolve this conflict. See art. V, § 3(b)(3), Fla. Const.

We conclude, based on a review of the applicable statutory provisions, that the Legislature did not intend to impose civil liability on hospitals for failing to ensure that physicians who are granted staff privileges comply with the financial responsibility requirements of section 458.320. We therefore approve the Fourth District’s decision in this case and disapprove the decisions in Robert, Baker, and Baumgardner.

FACTS AND PROCEDURAL HISTORY

In January 1996, Lena Horowitz visited the office of Derek V. Jhagroo, M.D., for examination and treatment of her infected right thumb. On January 22, 1996, Dr. Jhagroo admitted her to Plantation General Hospital (“Plantation”), where it became necessary to amputate her thumb. Lena Horowitz and her husband, Max Horowitz, filed a malpractice suit against Dr. Jhag-roo, alleging that he committed malpractice while examining and treating her right thumb in his office. The complaint alleged that Dr. Jhagroo was negligent in the treatment he provided in his office and did not involve any allegations arising from the admission and surgery conducted at Plantation. Dr. Jhagroo was the only defendant and there was no allegation that Dr. Jhagroo was an employee of the hospital.

The malpractice action resulted in a verdict in the Horowitzes’ favor and a final judgment against Dr. Jhagroo in the amount of $859,200.73. However, the judgment was uncollectible because Dr. Jhagroo failed to maintain malpractice insurance or otherwise comply with the financial responsibility requirements of section 458.320, owned no real property in the United States, and resided in another country.

In February 2001, after unsuccessfully attempting to collect the judgment from Dr. Jhagroo, the Horowitzes filed suit against Plantation. The amended complaint alleged that Plantation breached a statutory duty under section 458.320(2) in failing to ensure the financial responsibility of Dr. Jhagroo as a physician who had been granted staff privileges at the hospital. Specifically, Horowitz asserted that because of that failure, Plantation was liable for the first $250,000 of the unsatisfied judgment. Horowitz and Plantation each filed motions for summary judgment.- The issue on summary judgment was whether the holdings of the Second, Third, and Fifth Districts would apply to a case in which the underlying malpractice occurred in the physician’s office rather than the hospital. See Horowitz, 895 So.2d at 485.

In Robert, one of the conflict cases, the Fifth District determined- that section 458.320(2) mandates financial responsibility as a condition to maintaining staff privileges and therefore imposes a duty on the hospital to ensure physician compliance. 767 So.2d at 1228. The Fifth District reasoned that the “obvious intent of the legislature was to make sure that a person injured by the medical malpractice of a doctor with staff privileges would be able to ultimately recover at least $250,000 of compensable damages.” Id. The court then held that the cause of action against the hospital would accrue only after the injured person obtained a judgment against the physician for medical malpractice, and that the hospital’s liability would be limited to $250,000. Id. at 1228-29. The Second District in Baker, 780 So.2d at 171-72, and the Third District in Baum-gardner, 870 So.2d at 131-32, agreed with the Fifth District’s opinion in Robert.

The trial court, relying on the decisions of these district courts of appeal, granted summary judgment in favor of Horowitz and awarded him $250,254. This amount represented the minimum level of financial responsibility required by the statute, $250,000, plus taxable costs.

On appeal, the Fourth District reversed the judgment of the trial court without drawing a distinction between malpractice that occurs in a hospital and malpractice that occurs" in a physician’s office. The Fourth District rejected the assertion that section 458.320 creates a statutory cause of action against a hospital “whether it be based on strict liability, negligence, surety-ship, contract, contribution, indemnification, criminal punishment, or any other legal theory the creative minds of lawyers can discern.” Horowitz, 895 So.2d at 488. The Fourth District determined that the intent of the statute was to ensure that physicians maintain financial responsibility to satisfy judgments against them and not to make hospitals liable for the unsatisfied malpractice judgments of their staff-privileged physicians. Id. at 487. The court noted that its decision conflicted with Robert, Baker and Baumgardner. Id. at 488.

ANALYSIS

Our determination of whether section 458.320 imposes civil liability on hospitals is a question of statutory interpretation. Therefore, our review is de novo. See Aramark Unif. & Career Apparel, Inc. v. Easton, 894 So.2d 20, 23 (Fla.2004). We first address whether hospitals have a duty under the common law to ensure the financial responsibility of staff-privileged physicians. The analysis of the common law provides a basis upon which to determine whether the statute codifies, modifies, or supplants legal principles that previously existed. See id. Then, we discuss how this Court determines whether a statute imposes civil liability when the Legislature has not expressly provided for a private remedy. Finally, with this framework in mind, we examine the primary purpose of chapter 458, the language of section 458.320, other provisions in chapter 458, and related provisions in other chapters to determine legislative intent.

A. Common Law

At common law, a hospital was not vicariously liable for the tortious acts of an independent contractor such as a physician in private practice to whom it had granted staff privileges. See Insinga v. LaBella, 543 So.2d 209, 212-13 (Fla.1989). However, consistent with decisions in a number of other jurisdictions, this Court recognized a common law duty on the part of Florida hospitals to exercise reasonable care in granting staff privileges to physicians. See id. at 213-14. We held that when a hospital breaches that duty by granting staff privileges to a medically incompetent physician, the hospital is liable based on a theory of negligence. See id. In Insinga, we referred to this theory of liability as the “corporate negligence doctrine,” whereby the “hospital’s liability is founded on the independent duty it owes to its patients” to “be responsible for proper medical treatment on its premises.” Id. at 214. Accordingly, we stated:

While the term “corporate negligence” may have a much broader connotation, we construe it here to mean that a hospital’s liability is founded on the independent duty it owes to its patients. The public policy which justifies placing the expanded responsibility and duty of care on a hospital is based on the present day view that a hospital is a multifaceted health care facility that should be responsible for proper medical treatment on its premises. This view is justified because the hospital is in a superior position to supervise and monitor physician performance and is, consequently, the only entity that can realistically provide quality control.
... [W]e find, as a matter of public policy, that hospitals are in the best position to protect their patients and, consequently, have an independent duty to select and retain competent independent physicians seeking staff privileges. We note that the hospital’s liability extends only to the physician’s conduct while rendering treatment to patients in the hospital and does not extend to his conduct beyond the hospital premises. Moreover, the hospital will only be responsible for the negligence of an independent physician when it has failed to exercise due care in the selection and retention of that physician on its staff.

Id. at 214 (citations omitted).

The common law duty recognized in In-singa was limited to the selection and retention of medically competent physicians for actions occurring in the hospital. We have never recognized a common law duty on the part of a hospital to ensure the financial responsibility of its staff-privileged physicians, who are independent contractors.

In Beam v. University Hospital Building, Inc., 486 So.2d 672, 673 (Fla. 1st DCA 1986), the First District rejected the argument that a hospital had a duty at common law to ensure the financial responsibility of its staff-privileged physicians. As explained by the First District:

It is true that the corporate negligence doctrine is premised on the notion that it is foreseeable that a hospital’s failure to properly investigate an applicant for staff privileges would present a foreseeable risk of harm to the hospital’s patients. However, there is nothing in the case law on corporate negligence suggesting that this foreseeability of harm extends to conceivable risks of financial harm a patient might suffer should he sue a physician financially incapable of paying a malpractice judgment.

Id. at 673 (citations omitted) (emphasis supplied). The court affirmed the dismissal of the plaintiffs common law negligence action and noted “that no case, either in Florida or elsewhere, has recognized the tort of negligent selection of a financially ‘incompetent’ physician.” Beam, 486 So.2d at 673. Although the Fifth District in Robert recognized a statutory duty under section 458.320(2), the court declined to equate a duty to ensure physician compliance with the statutory financial responsibility requirements with a duty to ensure a physician’s professional competence, namely, the common law duty of hospitals to select and retain professionally competent staff physicians. See 767 So.2d at 1228.

We agree with Beam and Robert that there is no recognized common law duty on the part of hospitals to monitor the financial responsibility of physicians and thus no common law cause of action against hospitals for breaching that duty. If such a duty and cause of action exist, they do so by virtue of statutory modification of the common law. Cf. Aramark, 894 So.2d at 23 (“A statute creates a new cause of action if it provides a remedy unavailable under the common law.”).

B. Statutory Causes pf Action

The seminal Florida case on whether a statutory cause of action exists without an express provision imposing civil liability is this Court’s decision in Murthy v. N. Sinha Corp., 644 So.2d 983 (Fla.1994). In Murthy, the issue was whether chapter 489, Florida Statutes (1991), the licensing and regulatory chapter governing construction contracts, created a statutory cause of action against an agent who failed to supervise a corporation’s construction project: See id. at 984. Because the relevant statute did not expressly provide for a civil cause of action, the question was whether one should be judicially implied. See id. at 985.

The Court explained that historically, when determining whether to judicially imply a cause of action, the primary focus was on whether the statute “imposed a duty to benefit a class of individuals” and that a “cause of action arose when a class member was injured by a breach of that duty.” Id. However, we concluded that legislative intent had become the primary factor that most courts, including the United States Supreme Court, used to determine whether a cause of action exists when a statute does not expressly provide for one. See id. (citing Transamerica Mortgage Advisors, Inc. (TAMA) v. Lewis, 444 U.S. 11, 15-16, 100 S.Ct. 242, 62 L.Ed.2d 146 (1979), and Freehauf v. Sch. Bd. of Seminole County, 623 So.2d 761, 763 (Fla. 5th DCA1993)).

In determining whether the Legislature intended to provide a private cause of action against a qualifying agent in chapter 489, we first recognized that the applicable statutes had imposed a duty on agents to supervise a corporation’s construction projects. However, we explained that the recognition of a duty did not answer the question of whether a breach of that duty would give rise to civil liability. Id. at 985-86. To determine the existence of civil liability, we turned to the stated scope of chapter 489, which established licensing procedures and regulatory duties for the construction industry and created a licensing board to enforce the procedures and duties. See id. at 986. We concluded that there was “no evidence in the language of the statute or the statutory structure that a private cause of action against a qualifying agent was contemplated by the legislature in enacting this statute.” Id. Rather, the “language of chapter 489 indicates that it was created merely to secure the safety and welfare of the public by regulating the construction industry.” Id.

Importantly, we noted that “[i]n general, a statute that does not purport to establish civil liability but merely makes provision to secure the safety or welfare of the public as an entity, will not be construed as establishing a civil liability.” Id. Further, we looked to prior statutory enactments and explained that the “sole provision ... authorizing private suits” had authorized them only against unlicensed or uncertified contractors and that even that provision had been removed. Id. Without evidence of legislative intent in the “language or the legislative history” of chapter 489, we declined to recognize a private remedy against a qualifying agent. Id.

Since Murthy, we have reaffirmed the principle that whether a statutory cause of action should be judicially implied is a question of legislative intent. See Aramark, 894 So.2d at 23; Villazon v. Prudential Health Care Plan, Inc., 843 So.2d 842, 852 (Fla.2003). We agree with the Fourth District that legislative intent, as used in Murthy and its progeny, is a “shorthand reference to the ordinary tools for discerning statutory meaning: text, context, and purpose.” Horowitz, 895 So.2d at 486. Moreover, we agree with the overarching principle that judges lack the power “to construe an unambiguous statute in a way which would extend, modify, or limit, its express terms or its reasonable and obvious implications: To do so would be an abrogation of legislative power.” Holly v. Auld, 450 So.2d 217, 219 (Fla.1984).

The primary guide to our analysis of whether the Legislature intended to impose civil liability is, as in all cases of statutory construction, the “actual language used in the statute.” Borden v. East-European Ins. Co., 921 So.2d 587, 595 (Fla.2006). In determining the meaning of the language used, we look not only to the words themselves but also to “the context in which the language lies.” Miele v. Prudential-Bache Sec., Inc., 656 So.2d 470, 472 (Fla.1995).

C. Chapter 458, Florida Statutes

Horowitz relies on section 458.320, entitled “Financial Responsibility,” to assert that the Legislature intended to impose a duty on, and create a cause of action against, the hospital. . Chapter 458, in which this provision is located, primarily regulates the practice of physicians and medical practitioners, not hospitals. This is evident not only from the substance of the chapter but from the title itself— “Medical Practice.” Cf. City of Boca Raton v. State, 595 So.2d 25, 29 n. 3 (Fla.1992) (stating that the title of a chapter reflects the Legislature’s intent). In this chapter, the Legislature established procedures and requirements relating to practitioner licensing, specialized certification, physician financial responsibility, discipline, and physician supervision over assistants and created the Board of Medicine. Furthermore, the regulations in chapter 458 are intended to safeguard the public from unsafe and unqualified physicians. See § 458.301, Fla. Stat. (2006). This is evidenced by the Legislature’s statement “that physicians who fall below minimum competency or who otherwise present a danger to the public shall be prohibited from practicing in this state.” Id. With this overview in mind, we turn to the pertinent provisions of chapter 458.

Section 458.320 sets forth the statutory financial responsibility requirements for physicians practicing in Florida. The first subsection of this provision applies to all physicians and requires, as a condition of licensure, that physicians demonstrate a financial ability to pay medical malpractice claims. See § 458.320(1), Fla. Stat. (2006). Specifically, section 458.320(1) provides:

As a condition of licensing and maintaining an active license, and prior to the issuance or renewal of an active license or reactivation of an inactive license for the practice of medicine, an applicant must by one of the following methods demonstrate to the satisfaction of the board and the [Department [of Health ] financial responsibility to pay claims and costs ancillary thereto arising out of the rendering of, or the failure to render, medical care or services....

The physician’s alternative options for compliance are: (a) establishing and maintaining an escrow account in the per claim amounts specified in paragraph (b); (b) maintaining professional liability coverage in an amount not less than $100,000 per claim and $300,000 in total; or (c) obtaining and maintaining an unexpired, irrevocable letter of credit in an amount not less than $100,000 per claim and $300,000 in total. § 458.320(l)(a)-(c), Fla. Stat.

Subsection (2) of section 458.320 applies only to physicians who perform ambulatory surgery and physicians who are granted staff privileges at a hospital. This subsection provides that “[pjhysicians who perform surgery in an ambulatory surgical center licensed under chapter 395 and, as a continuing condition of hospital staff privileges, physicians who have staff privileges must also establish financial responsibility.” § 458.320(2), Fla. Stat. (emphasis supplied). The methods for establishing financial responsibility in subsection (2) parallel those in subsection (1) except that the minimum amount per claim is $250,000 rather than $100,000.

Based on the single statement in subsection (2) requiring physicians with staff privileges to establish financial responsibility “as a continuing condition of hospital staff privileges,” Horowitz asserts that the Legislature intended to both impose a statutory duty on hospitals to monitor compliance and create a statutory cause of action against hospitals for a breach of this duty. However, we conclude that there is no indication in this single statement of legislative intent to impose civil liability on hospitals. This determination is reinforced by reading this statutory provision in conjunction with other subsections of section 458.320, and within the greater context of chapter 458 and related statutory provisions discussing hospital responsibilities. Examination of these other provisions is appropriate because, as we have previously stated, “[i]t is axiomatic that all parts of a statute must be read together in order to achieve a consistent whole.” Forsythe v. Longboat Key Beach Erosion Control Dist., 604 So.2d 452, 455 (Fla.1992).

Although section 458.320(2) requires staff-privileged physicians to comply with the statutory financial responsibility requirements, section 458.320(5)(g) authorizes physicians to “opt out” of these requirements. Section 458.320(5)(g) states that any licensed practitioner who, among other things, agrees to “pay the judgment creditor ... $250,000, if the physician is licensed pursuant to this chapter and maintains hospital staff privileges, within 60 days after the date such judgment [becomes] final,” is exempt from the financial responsibility requirements of ■ section 458.320(2). Thus, this provision allows a physician to maintain hospital staff privileges without having to establish financial responsibility as required by section 458.320(2). See id.

Under section 458.320(5)(g), a physician could be in compliance with the provision when he or she receives staff privileges by agreeing to be personally liable for malpractice judgments in the future, but nevertheless be unable to satisfy the judgment when it becomes due. Accordingly, even if the hospital confirms that the physician is in compliance with the “opt out” provision when the physician receives staff privileges, the hospital cannot ensure that the physician will be able to satisfy the malpractice judgment once it is entered. Additionally, if the physician fails to pay the first $250,000 of the judgment and therefore falls out of compliance with section 458.320(5)(g), he or she is only subject to discipline by the Department of Health. Clearly, the Legislature could not have intended to require the hospital to guarantee the future financial responsibility of a physician who makes an election under section 458.320(5)(g). Given this logical interpretation of the “opt-out” provision in section 458.320(5)(g), it would be inconsistent to read section 458.320(2) as requiring a hospital to ensure or guarantee payment of the first $250,000 of a malpractice judgment against a physician.

Beyond the alternative methods for establishing financial responsibility, the statutory enforcement mechanisms for noncompliance indicate that the Legislature did not intend tó hold a hospital liable for a physician’s failure to comply with the requirements of section 458.320. Section 458.320(3)(a) provides that the physician must meet the “financial responsibility requirements of this section ... at the time of issuance or renewal of a license.” Under this provision, it is the physician’s responsibility to comply with the requirements of section 458.320. A physician who violates the financial responsibility requirements in section 458.320 is subject to significant administrative penalties, including the possible revocation of his or her license and other discipline. See § 458.331(l)(nn), Fla. Stat. (2006) (stating that “[violating] any provision of this chapter” is grounds for revocation of a license or discipline). The prospect of such administrative penalties provides a strong incentive to ensure physician compliance.

Further, pursuant to section 458.320(4)(a), it is the obligation of each insurer, self-insurer, risk retention group or joint underwriting association to “promptly notify the [Department [of Health] of cancellation or non-renewal of insurance.” Unless the physician “demonstrates that he or she is otherwise in compliance with the requirements of this section, the department shall suspend the license of the physician” and “notify all health care facilities” of such action. Id. In contrast to the notification obligations that are placed on the insurer and the department, no statutory duty is placed on the hospital to notify the department of a staff-privileged physician’s noneompliance with the financial responsibility requirements.

Moreover, the one provision in chapter 458 that affirmatively imposes duties on hospitals does not address physician financial responsibility. See § 458.337, Fla. Stat. (2006). Rather, the provision states that “the department shall be notified when any physician ... [h]as been disciplined by a licensed hospital,” § 458.337(l)(a)(2), Fla. Stat., and that “[a]ny organization taking action as set forth in this section shall report that action to the department.” § 458.337(2), Fla. Stat. We conclude that the failure to impose additional duties on hospitals in chapter 458, such as notifying the department when one of its staff-privileged physicians is out of compliance with the statutory financial responsibility requirements, further indicates that the Legislature did not intend to impose civil liability on hospitals in section 458.320.

Lastly, in contrast to the language used in 458.320(2), two provisions in chapter 458 expressly impose civil liability. Section 458.3475(11), Florida Statutes (2006), makes an anesthesiologist liable for any act or omission of an anesthesiologist assistant under the anesthesiologist’s supervision. Section 458.3295(3), Florida Statutes (2006), specifically holds a physician liable for damages that the hospital or patient sustains from the physician’s concerted effort not to treat a patient in an emergency room. The fact that both of these provisions impose physician liability in clear and express terms provides additional support for the conclusion that the Legislature did not intend to impose civil liability on hospitals in section 458.320. Our reasoning is similar to that in Murthy, where we noted that the sole provision in the chapter that imposed civil liability applied only to unlicensed or uncertified contractors, indicating .a lack of legislative intent to create a private remedy against a qualifying agent. See Murthy, 644 So.2d at 986; see also Cason v. Fla. Dep’t of Mgmt. Services, 944 So.2d 306, 315 (Fla.2006) (concluding that when the Legislature includes a requirement in one provision and excludes a similar requirement in a related provision, it intends a distinction because the Legislature “ ‘knows how to’ accomplish what it has omitted” in a particular statute) (quoting Rollins v. Pizzarelli, 761 So.2d 294, 298 (Fla.2000)).

Our analysis of chapter 458, specifically the text, context, and purpose of the relevant provisions, leads us to conclude that the Legislature did not intend to impose a duty on, or create a cause of action against, hospitals in section 458.320. An examination of related provisions in chapters 395 and 766, Florida Statutes, further supports this conclusion.

D. Chapters 395 and 766, Florida Statutes

Just as chapter 458 regulates medical practice, chapter 395, titled “Hospital Licensing and Registration,” regulates hospital practice. Significantly, there is nothing in the provisions of chapter 395 that regulate hospital staff privileges that addresses physician compliance with the financial responsibility requirements of section 458.320. First, section 395.0191, Florida Statutes (2006), which outlines the rules pertaining to hospital staff privileges, does not require the hospital to ensure physician compliance with section 458.320. Second, sections 395.0193(2)-(4), Florida Statutes (2006), which outline the hospital’s duties in denying, suspending, or revoking staff privileges, do not require the hospital to take action when a physician fails to maintain financial responsibility. See § 395.0193(2)-(4), Fla. Stat. (requiring hospitals and their boards to review, and if necessary, take action in situations where staff-privileged physicians are incompetent, using drugs, have mental impairments, are found liable for medical negligence, or fail to abide by hospital policies). If the Legislature intended to impose an affirmative duty on a hospital to “condition” the grant of staff privileges on a physician’s establishing financial responsibility, it would have included this requirement in the sections governing a hospital’s grant of staff privileges.

Like section 458.320, section 766.110, Florida Statutes (2006), was enacted as part of the Comprehensive Medical Malpractice Reform Act of 1985. See ch. 85-175, §§ 23, 28, Laws of Fla. Section 766.110(1) provides that all health care facilities have “a duty to assure comprehensive risk management and the competence of their medical staff and personnel through careful selection and review, and are hable for a failure to exercise due care in fulfilling these duties.” Conspicuously absent from section 766.110 is any mention of civil liability for a hospital’s failure to ensure the financial competence of its staff-privileged physicians.

The fact that section 766.110 expressly imposes a duty on and creates a cause of action against hospitals for a breach of that duty provides a strong indication that the Legislature did not intend to impose civil liability on hospitals in section 458.320. Cf. Golf Channel v. Jenkins, 752 So.2d 561, 564 (Fla.2000) (indicating that when sections are enacted as part of the same session law they “should be construed together so that they illuminate each other and are harmonized”) (internal quotation marks omitted). Had the Legislature intended to hold hospitals liable for failing to ensure physician financial responsibility, it would have either included such a duty and cause of action within section 766.110 or used parallel language to impose civil liability in section 458.320. See Cason, 944 So.2d at 315; Murthy, 644 So.2d at 986.

CONCLUSION

Although it may be sound public policy for the Legislature to impose an obligation on hospitals to monitor the financial responsibility of physicians who are granted staff privileges, it is outside this Court’s purview to imply a statutory cause of action against hospitals where none was intended by the Legislature. Given the text of the provision, the stated intent, purpose, and general regulatory scheme of chapter 458, the applicable penalties, and the comparison to other provisions in the same statutory scheme that clearly impose civil liability, we hold that section 458.320 neither imposes a duty on nor creates a cause of action against hospitals for failing to ensure the financial responsibility of their staff-privileged physicians. Therefore, we approve the Fourth District’s decision in this case and disapprove the Fifth District’s decision in Robert, the Second District’s decision in Baker, and the Third District’s decision in Baumgardner.

It is so ordered.

LEWIS, C.J., and WELLS, ANSTEAD, QUINCE, CANTERO, and BELL, JJ., concur.

      . After the amended complaint was filed, the parties stipulated to dismissal with prejudice as to Max Horowitz. Subsequently, in October 2001, Lena Horowitz passed away and Stuart Horowitz, as personal representative to Lena Horowitz's estate, became the substituted party.

      . Section 458.320(2) sets forth the following financial responsibility requirements for physicians with hospital staff privileges:
      (2) Physicians who perform surgery in an ambulatory surgical center licensed under chapter 395 and, as a continuing condition of hospital staff privileges, physicians who have staff privileges must also establish financial responsibility by one of the following methods:
      (a) Establishing and maintaining an escrow account ... in the per claim amounts specified in paragraph (b)....
      (b) Obtaining and maintaining professional liability coverage in an amount not less than $250,000 per claim, with a minimum annual aggregate of not less than $750,000....
      (c) Obtaining and maintaining an unexpired irrevocable letter of credit, established pursuant to chapter 675, in an amount not less than $250,000 per claim, with a minimum aggregate availability of credit of not less than $750,000.

      . The cases from these courts each involved malpractice that occurred in the hospitals.

      . Although Beam was decided after section 458.320 was enacted, the court did not refer to this or any other statutory provision.

      . The First District's reasoning is consistent with our recognition in McCain v. Florida Power Corp., 593 So.2d 500, 503 (Fla.1992), that "[fjoreseeability clearly is crucial in defining the scope of the general duty placed on every person to avoid negligent acts or omissions.” In general, foreseeability as used in McCain and its progeny extends to the foreseeable risk of injury resulting from a negligent act, and not to the risk of financial injury that may result if the tortfeasor is unable to pay the monetary judgment awarded because of that negligent act.

      . Horowitz argued for the first time on appeal, at oral argument before this Court, that a breach of the alleged statutory duty here could form the basis of a common law negligence claim. We need not decide whether this alternative theory is applicable because we conclude, based on our analysis below, that section 458.320 does not impose a statutory duty on hospitals to ensure the financial competence of staff-privileged physicians.

      . See § 458.305(2), Fla. Stat. (2006).

      . Prior to 2003, section 458.320(2) provided that “[a]s a continuing condition of hospital staff privileges, physicians with staff privileges shall also be required to establish financial responsibility.” Ch.2003-416, § 23, 27, Laws of Fla.

      . This is the reasoning of North Miami Medical Center, Ltd. v. Miller, 896 So.2d 886 (Fla. 3d DCA 2005), in which the Third District concluded that a hospital could not be liable for failing to ensure a physician’s compliance with the statutory financial responsibility requirements if that physician made an election under section 458.320(5)(g).

      . Section 395.0191 was originally enacted as section 395.011, Florida Statutés (Supp. 1982), but has been revised several times since. However, the provision has never imposed a duty on hospitals to ensure financial responsibility as a condition of granting staff privileges.

      . Section 395.0193 was originally codified at section 395.0115, Florida Statutes (Supp. 1982), and has been revised several times since. However, the provision has never included a duty on the hospitals to discipline or revoke the staff privileges of physicians who fail to maintain financial responsibility.

      .Section 766.110 was originally codified at section 768.60, Florida Statutes (1985). The language of this section has remained unchanged.


source: Caselaw Access Project

author: PER CURIAM.

license: Public Domain

text:
    Christopher OFFORD, Appellant, v. STATE of Florida, Appellee.
    No. SC05-1611.
    Supreme Court of Florida.
    May 24, 2007.

      Nancy A. Daniels, Public Defender, and Nada M. Carey, Assistant Public Defender, Second Judicial Circuit, Tallahassee, FL, for Appellant.
    Bill McCollum, Attorney General, and Ronald A. Lathan, Jr., Assistant Attorney General, Tallahassee, FL, for Appellee.
   PER CURIAM.

Christopher Offord pled guilty to first-degree murder and was sentenced to death after a penalty-phase trial. The only issue Offord raises on appeal is whether death is a proportionate punishment in his case, where the trial court weighed one aggravating circumstance against two statutory mitigators demonstrating that Offord suffers from serious mental illness. This Court has mandatory jurisdiction over all death penalty appeals. See art. V, § 3(b)(1), Fla. Const. The reason for our mandatory review was first explained in State v. Dixon, 283 So.2d 1 (Fla.1973), in which this Court upheld the constitutionality of Florida’s death penalty statute:

Review by this Court guarantees that the reasons present in one case will reach a similar result to that reached under similar circumstances in another case. No longer will one man die and another live on the basis of race, or a woman live and a man die on the basis of sex. If a defendant is sentenced to die, this Court can review that case in light of the other decisions and determine whether or not the punishment is too great.

Id. at 10 (emphasis supplied).

For the reasons that follow, we conclude that when the totality of the circumstances of this case is compared to other capital cases, death is a disproportionate punishment. We therefore reduce Offord’s sentence to life in prison without the possibility of parole.

FACTS AND PROCEDURAL HISTORY

During the early morning of July 31, 2004, Offord, who was twenty-nine years old, killed his wife by beating her with the claw end of a hammer. Offord, who had a lifelong history of serious mental illness, confessed to the murder in a videotaped statement taken by police and pled guilty to first-degree murder. Offord’s statement and the testimony of the penalty-phase witnesses established the following facts.

Offord moved from Texas to Panama City, Florida, in February 2004. A short time later he ran out of money and moved in with David and Lisa Leasher, a couple he met at the motel where he had been staying. In March or April 2004, Offord met Dana Noser at a bar and they married four days later. Offord and Noser lived together until that June, when they decided to separate. However, they continued to see each other regularly.

On July 31, 2004, Noser took Offord to Granny’s Kitchen, where he was a dishwasher. Noser returned to the restaurant at 11 p.m. to take Offord home when his shift ended. After Noser dropped Offord off at his apartment, she and some friends went to several bars. She returned at 3 a.m. and woke Offord. They went to a bar where Offord drank a few beers and shot pool. The waitress at the bar testified that Offord and Noser seemed to be getting along with each other. Around 4 a.m., Offord and Noser went to a Waffle House and ate breakfast. Several employees who knew the couple from previous visits testified that Offord and Noser were very affectionate.

At 7 a.m., Offord showed up at the Leashers’ motel room and told them that he had killed Noser. The Leashers did not believe Offord, so he returned to his apartment. Twelve hours later, around 6:45 p.m., Offord went to a bar where he told both the bartender, Arthur Sencil, and a part-time employee, Bill Yohe, that he had killed Noser. Sencil called the police, and Offord was arrested and taken to the police station. Offord confessed to the murder during a videotaped interview conducted by Detective Joe Cherry.

At the beginning of the interview, Offord stated that he is schizophrenic and ran out of his medication. He said that he did not intend to kill Noser but that he was hearing voices and just kept hitting her. According to Offord’s statement, after leaving the Waffle House, he and Noser returned to his apartment and engaged in consensual sex. Offord took a shower and Noser became angry when he refused to return to bed. Offord went to the front room of his apartment to calm down but heard voices telling him to kill Noser. He retrieved a knife and duct tape from the kitchen and went back to the bedroom. Offord sat down on the bed next to Noser and she continued to insist that he lie down. Offord took a piece of duct tape, put it over Noser’s mouth, and began to hit her with his fist. The duct tape did not cover her entire mouth so he grabbed a pillow to muffle her. He repeatedly told Noser to “shut up.” He grabbed the knife and began to stab Noser in the face and chest. Offord then saw the hammer beside the bed and started hitting her face with it. Offord stated that he hit Noser about fifty times with the hammer and that he believed he eventually broke her neck.

Offord also stated that after he returned from the Leashers’ hotel room, he drank a bottle of whiskey and took twenty Xanax pills in an attempt to commit suicide. He slept for a few hours and then went to the bar where he told Sencil and Yohe that he had killed Noser.

Dr. Charles Siebert, the Chief Medical Examiner for the Fourteenth District, testified that Noser died of blunt head trauma. Dr. Siebert stated that Noser suffered at least thirty blows to the face and numerous blows to her lower extremities. He opined that the amount of bruising and the fact that most of her facial wounds were superficial indicated that Noser was alive during much of the beating — for at least fifteen to twenty minutes — and suffered a high degree of pain.

The defense presented two witnesses. Jill Rowan, a clinical psychologist, examined Offord for competency, and reviewed and summarized his medical records from Texas and Florida. Rowan explained the documented history of Offord’s mental illness, which showed that Offord has been troubled by mental health issues since the age of five. His Texas medical records revealed that at eighteen, Offord was transferred from county jail to a state hospital where he was diagnosed with impulse control disorder and marijuana, cocaine, and speed abuse. When he was nineteen, Offord was charged with robbery, found incompetent to stand trial and given antipsychotic drugs. While in prison at age twenty-four, Offord had urges to cut himself. Shortly thereafter, he was evaluated for social security disability and was diagnosed with schizoaf-fective illness, which is a combination of schizophrenia and mood -disorder. Rowan further testified that Offord’s medical records indicated he had a history of auditory hallucinations, which are a symptom of schizophrenia.

Offord’s Florida medical records showed that he was admitted to Bay Medical Behavioral Health Center (“Bay Behavioral”) four times — February, March, April, and July — since his arrival in Florida in early 2004. During his last admission to Bay Behavioral, just three weeks before the murder, he was diagnosed with alcohol and cocaine dependency and schizophrenia. He was given medication and checked himself out against medical advice. Nurses’ notes stated that Offord threatened to choke Noser if she came to a family therapy session and that Offord was so upset about Noser’s continued calls to the hospital that he said he felt like killing her. Rowan explained that hospital staff may not have taken Offord’s threats seriously because schizophrenia is a major mental illness and a person with this disease may not be grounded in reality and may be delusional, have hallucinations, and hear voices. She also stated that schizophrenics often ramble and are unable to communicate effectively.

Rowan concluded that Offord suffers from a mood disorder (bipolar disorder), a personality disorder (schizophrenia), and a substance abuse problem. She stated that Offord had a pattern of first being admitted to a mental health facility, where he would be prescribed psychotropic drugs and weaned off street drugs. Then, when he left the hospital, Offord would stop using his prescribed medicine and would return to using narcotics and alcohol, which eventually led to rehospitalization. She also stated that it was difficult to determine whether Offord voluntarily stopped taking his medications or whether this was involuntary as a result of his mental illness.

The second defense witness was Nancy Watson, a licensed clinical social worker. She met with Offord, reviewed his medical records, and spoke with his mother and one of his “careworkers.” Watson testified that Offord lived with his parents until he was about five years old. At that time, his parents divorced and he lived with his father for a short period. There were some allegations of sexual and physical abuse and he was brought back to live with his mother and her new husband. Offord’s mother told Watson that Offord was a very easy-going child until he was eight months old. He then became easily agitated and overactive, demanded attention, and had impulse control problems. Offord did not get along with other children, was teased and rejected, and started running away from home. Offord’s mother also stated that when he was five, Offord began pulling the skin off his fingernails and at six he threatened to kill her, chasing her with a butcher knife. Offord was institutionalized for the first time when he was six years old and since that time he has lived outside an institution for only short periods of time. By age fourteen Offord was hearing voices and by age seventeen he was drinking very heavily.

At the conclusion of the penalty phase, the jury recommended the death penalty by a vote of twelve to zero. The trial court held a Spencer hearing to allow both the State and Offord to present additional evidence and arguments concerning sentencing. The State presented the testimony of Amy Sweat, Noser’s sister. Sweat testified that Noser was loved by her family and the most tragic consequence of Of-ford’s actions was that Noser’s seven-year-old daughter had lost her mother.

Offord then testified. Regarding the night of the murder, Offord’s version of events was consistent with his taped statement. However, Offord did not testify that he heard voices telling him to kill Noser. He also insisted that he could “fool any doctor you put in [his] face” and is not “crazy at all.”

The trial court found one aggravating circumstance — that the murder was especially heinous, atrocious or cruel (HAC)— and gave this factor great weight. The trial court found two statutory mitigators: (1) that the murder was committed while Offord was under the influence of extreme mental or emotional disturbance; and (2) that Offord’s capacity to appreciate the criminality of his conduct or conform his conduct to the requirements of law was substantially impaired. The trial court assigned these mitigating factors some weight and moderate weight, respectively. The trial court found two nonstatutory mitigators: (1) marital discord (little weight); and (2) drug and alcohol abuse (little weight). After weighing the aggravating and mitigating circumstances, the trial court imposed a sentence of death. The court found that although Offord experienced “some mental health issues, they did not outweigh the brutish, violent beating [Noser] endured while he attempted to remove her face with the' claw end of a hammer.”

ANALYSIS

The only issue before the Court is whether death is a proportionate punishment. In deciding whether death is a proportionate penalty, “we make a comprehensive analysis in order to determine whether the crime falls within the category of both the most aggravated and the least mitigated of murders, thereby assuring uniformity in the application of the sentence.” Anderson v. State, 841 So.2d 390, 407-08 (Fla.2003) (citation omitted). We consider the totality of the circumstances of the case and compare the case to other capital cases. See Urbin v. State, 714 So.2d 411, 417 (Fla.1998). This entails “a qualitative review by this Court of the underlying basis for each aggravator and mitigator rather than a quantitative analysis.” Id. at 416. In other words, proportionality review “is not a comparison between the number of aggravating and mitigating circumstances.” Sexton v. State, 775 So.2d 923, 935 (Fla.2000) (quoting Porter v. State, 564 So.2d 1060, 1064 (Fla.1990)).

In this case, the trial court found one aggravating circumstance — that the murder was heinous, atrocious, or cruel. HAC is a weighty aggravator that has been described by this Court as one of the most serious in the statutory sentencing scheme. See Larkins v. State, 739 So.2d 90, 95 (Fla.1999). It “applies in physically and mentally torturous murders which can be exemplified by the desire to inflict a high degree of pain or utter indifference to or enjoyment of the suffering of another.” Belcher v. State, 851 So.2d 678, 683 (Fla.2003). Offord does not dispute the trial court’s finding of HAC.

The trial court also found two statutory mitigators-that the murder was committed while Offord was under the influence of extreme-mental or emotional disturbance and that Offord’s capacity to appreciate the criminality of his conduct or conform his conduct to the requirements of law was substantially impaired. This finding was based on extensive documented evidence of Offord’s history of severe mental illness. Offord asserts that this substantial mental mitigation makes the death penalty inappropriate even though the HAC aggravator has been proved.

We have found death to be a proportionate punishment in three cases in which HAC was the only aggravating factor. See Butler v. State, 842 So.2d 817 (Fla.2003); Blackwood v. State, 111 So.2d 399 (Fla.2000); Cardona v. State, 641 So.2d 361 (Fla.1994). However, we have also explained that “[a]s a general rule, ‘death is not indicated in a single-aggravator case where there is substantial mitigation.’ ” Almeida v. State, 748 So.2d 922, 933 (Fla.1999) (quoting Jones v. State, 705 So.2d 1364, 1367 (Fla.1998)). After reviewing the mitigation evidence presented at Of-ford’s penalty phase and his videotaped confession, we conclude in this case that Offord’s lifelong history of severe mental illness makes the death sentence in this single-aggravator murder a disproportionate punishment.

Although we found death to be a proportionate punishment in Butler, Blackwood, and Cardona, they are distinguishable from this case because each involved less weighty mitigation. In Butler, the defendant stabbed and strangled his ex-girlfriend. See 842 So.2d at 821. In imposing the death penalty, the trial court did not find any statutory mitigators and found minor nonstatutory mitigation — that the defendant was reared without his natural mother, was a loving and good son, was well thought of by neighbors and coworkers, and had a long-term substance abuse problem. See id. at 823. The defendant in Blackwood strangled his pregnant ex-girlfriend. See 111 So.2d at 402. The trial court found only one statutory mitigator, that the defendant had no significant history of prior criminal conduct, and eight nonstatutory mitigators, the most significant of which was that the defendant was suffering from an emotional disturbance at the time of the crime. See id. at 405. In Cardona, although the trial court did find the two statutory mental health mitigators, this finding was based on the defendant’s cocaine use. See 641 So.2d at 365. Qualitatively, the severe mental illness underlying the impaired capacity and extreme mental disturbance mitigators in Offord’s case is more compelling than the cocaine addiction underlying this mitigation in Cardona.

Cardona is further distinguished by the fact that the victim was the defendant’s three-year-old son, who died after suffering eighteen months of neglect and abuse. See id. at 362. In concluding that death was a proportionate punishment, we focused on the “extended period of time [the three-year-old victim] was subjected to the torturous abuse leading to his death.” Id. at 365.

The circumstances of this case are more akin to those presented in cases in which this Court has reversed death sentences on proportionality grounds despite the presence of the HAC aggravator. See Robertson v. State, 699 So.2d 1343 (Fla.1997); Kramer v. State, 619 So.2d 274 (Fla.1993); Nibert v. State, 574 So.2d 1059 (Fla.1990). Robertson involved a strangulation murder committed by a nineteen-year-old in the course of a burglary. 699 So.2d at 1344-45. The Court vacated the defendant’s death sentence “in light of the substantial mitigation present,” which included the defendant’s age, impaired capacity, abused and deprived childhood, history of mental illness, and borderline intelligence. Id. at 1347. In vacating the death sentence in Kramer, this Court concluded that “[t]he factors establishing alcoholism, mental stress, severe loss of emotional control, and potential for productive functioning in the structured environment of prison are dispositive.” 619 So.2d at 278. In Nibert, this Court ruled that the trial court erred in failing to weigh substantial mitigation and that there was no need to remand for the trial court to reweigh the aggravating and mitigating circumstances because the death penalty was a disproportionate punishment. 574 So.2d at 1063. The Court noted that “substantial mitigation may make the death penalty inappropriate even when the aggravating circumstance of heinous, atrocious, or cruel has been proved.” Id.

In this case, there is no question that Offord committed a brutal murder. However, the murder was unaccompanied by any motivation such as pecuniary gain or avoiding arrest, and without the aggravating circumstance of a prior violent felony. Further, Offord presented substantial mental health mitigation that is uncontro-verted. Offord’s mental illness undoubtedly contributed to this tragic crime as indicated by the trial court’s finding of the statutory mitigators that the murder was committed while Offord was under the influence of extreme mental or emotional disturbance and that Offord’s capacity to appreciate the criminality of his conduct or to conform his conduct to the requirements of law were substantially impaired. Although the trial court gave some credence to Offord’s Spencer hearing testimony that he did not think he was “crazy at all” and that he “could fool any doctor you put in [his] face,” this testimony was contrary to the extensive documented history of Of-ford’s lifelong mental illness and repeated institutionalization.

In fact, Offord’s case is notable because it is one of the most documented cases of serious mental illness this Court has reviewed. Through the uncontradicted medical records, a picture emerges of an individual with two serious mental illnesses— schizophrenia and bipolar disorder — who has been in and out of institutions since he was just five or six years old. During a 2001 hospitalization in Texas, the staff considered Offord’s prognosis poor and predicted that he would be unable to function well outside of a facility. This proved to be an accurate assessment because Offord was admitted to hospitals numerous times during 2002, 2003, and 2004. After coming to Florida, he was admitted to Bay Behavioral four times, the last on July 4, 2004, only weeks before the murder. In addition, Offord was receiving permanent social security disability payments because of his mental illness. Although Offord also has a substance abuse problem, his medical history indicates that his mental health significantly contributed to the murder.

As this Court observed over 34 years ago in Dixon:

It is necessary at the outset to bear in mind that all defendants who will face the issue of life imprisonment or death will already have been found guilty of a most serious crime, one which the Legislature has chosen to classify as capital. After his adjudication, this defendant is nevertheless provided with five steps between conviction and imposition of the death penalty — each step providing concrete safeguards beyond those of the trial system to protect him from death where a less harsh punishment might be sufficient.

283 So.2d at 7. The final step is the mandatory review by this Court, which we found was one indication of “legislative intent to extract the penalty of death for only the most aggravated, the most indefensible of crimes.” Id. at 8. For all the reasons we have explained, we conclude that this is not among “the most aggravated and unmitigated of most serious crimes” for which the death penalty is reserved. Id. at 7. Imposition of the death penalty would thus be a disproportionate punishment. We therefore vacate the death sentence and remand for the imposition of a life sentence without the possibility of parole.

It is so ordered.

LEWIS, C.J., and WELLS, ANSTEAD, PARIENTE, QUINCE, CANTERO, and BELL, JJ., concur.

      . Spencer v. State, 615 So.2d 688 (Fla.1993).

      . Blackwood’s sentence was recently vacated due to trial counsel’s ineffective assistance for failing to investigate and prepare mental mitigation evidence. See Blackwood v. State, 946 So.2d 960, 976 (Fla.2006).

      . Cardona's conviction and sentence were vacated in 2002 because the State withheld exculpatory evidence in violation of Brady v. Maryland, 373 U.S. 83, 83 S.Ct. 1194, 10 L.Ed.2d 215 (1963). See Cardona v. State, 826 So.2d 968, 969 (Fla.2002).


author: PER CURIAM. BELL, J.,

text:
    Nickulis GILLIS, Petitioner, v. STATE of Florida, Respondent.
    No. SC06-1207.
    Supreme Court of Florida.
    May 31, 2007.
    Bennett H. Brummer, Public Defender, Eleventh Judicial Circuit, Miami, FL, and Dorothy F. Easley, Special Assistant Public Defender, Coral Gables, FL, for Petitioner.
    Bill McCollum, Attorney General, Tallahassee, FL, Richard L. Polin, Bureau Chief, and Maria T. Armas, Assistant Attorney General, Miami, FL, for Respondent.
   PER CURIAM.

We initially accepted review of the decision in Gillis v. State, 930 So.2d 802 (Fla. 3d DCA 2006), based on alleged express and direct conflict with Ripley v. State, 898 So.2d 1078 (Fla. 4th DCA 2005), and West v. State, 876 So.2d 614 (Fla. 4th DCA 2004). Upon further consideration we conclude that jurisdiction was improvidently granted, because these cases are factually distinguishable. The Miami-Dade Police Department’s Miranda rights form at issue in Gillis is substantially and materially different from the Broward County Sheriffs Office’s Miranda rights form at issue in Ripley and West. Accordingly, we hereby discharge jurisdiction and dismiss this review proceeding.

It is so ordered.

LEWIS, C.J., and WELLS, ANSTEAD, PARIENTE, QUINCE, and CANTERO, JJ., concur.

BELL, J., dissents with an opinion.

BELL, J.,

dissenting.

I respectfully dissent to the discharge of this case. I agree that the Miranda forms are substantially different. However, I do not believe that this difference is material to the express holdings in the cases. In other words, this factual distinction does not negate the express and direct conflict between the holding in Gillis and the holdings in Ripley and West. There is interdis-trict conflict concerning whether Miranda requires that an accused be advised that he or she may terminate questioning at any time. See Gillis, 930 So.2d at 806 (holding that the Miranda rights form was not legally inadequate and that Gillis was properly advised of his rights “because the Miranda form used informs the accused that he/she does not have to answer any questions posed by the officer, [and] implicit in this warning is the fact that the accused may invoke his right to remain silent at any time during the interrogation or to terminate further questioning during the interrogation”); but see Ripley, 898 So.2d at 1081 (holding that Miranda rights form was legally inadequate in part because the Miranda warning “did not advise Ripley ... that he could stop the interrogation at any time during questioning”); West, 876 So.2d at 616 (holding that appellant’s confession should be suppressed, in part, because the Miranda rights form was inadequate to inform the appellant “that she could stop the interrogation at any time”). The decisions from the Fourth District also expressly and directly conflict with this Court’s decision in Brown v. State, 565 So.2d 304, 306 (Fla.1990) (holding, in part, that the Miranda rights form was legally sufficient although it did not mention the right to terminate questioning, because “[t]he right to cut off questioning is implicit in the litany of rights which Miranda requires to be given to a person being questioned [but] is not ... among those that must be specifically communicated to such a person”), abrogated on other grounds by Jackson v. State, 648 So.2d 85 (Fla.1994). Given this clear decisional conflict, I would retain jurisdiction and decide this important issue.

      . Miranda v. Arizona, 384 U.S. 436, 86 S.Ct. 1602, 16 L.Ed.2d 694 (1966).

      . The text of the Broward County Sheriff’s Office’s Miranda rights form at issue in Ripley and West is found in Roberts v. State, 874 So.2d 1225, 1226 (Fla. 4th DCA 2004). Compare Gillis, 930 So.2d at 805-06, with Roberts, 874 So.2d at 1226.


text:
    ADVISORY OPINION TO the ATTORNEY GENERAL RE FUNDING OF EMBRYONIC STEM CELL RESEARCH.
    Nos. SC06-2183, SC06-2261.
    Supreme Court of Florida.
    May 31, 2007.
    Bill McCollum, Attorney General, Louis F. Hubener, Chief Deputy Solicitor General, Lynn C. Hearn, and Deputy Solicitor General, Tallahassee, FL, for Petitioner.
    Stephen H. Grimes of Holland and Knight, LLP, Tallahassee, FL, and Henry B. Handler of Weiss, Handler, Angelos and Cornwell, P.A., Boca Raton, FL, for Floridians for Stem Cell Research and Cures, Inc., sponsor.
    Major B. Harding and Stephen C. Emmanuel of Ausley and McMullen, Tallahassee, FL, on behalf of interested party Citizens for Science and Ethics, Inc., as Opponents.
   PER CURIAM.

The Attorney General of Florida has requested this Court’s opinion as to the validity of an initiative petition circulated pursuant to article XI, section 3 of the Florida Constitution, including the corresponding financial impact statement. We have jurisdiction. See art. IV, § 10, art. V, § 3(b)(10), Fla. Const. For the reasons expressed below, we approve the amendment, ballot title and summary, and the financial impact statement for placement on the ballot.

I. FACTS

On October 9, 2006, the Attorney General received a ballot initiative from the Secretary of State seeking to amend the Florida Constitution to provide for the funding of embryonic stem cell research. This amendment is sponsored by Floridians for Stem Cell Research and Cures, Inc. The full text of the proposed amendment reads as follows:

Article X of the Florida Constitution is hereby amended by inserting at the end thereof the following section:
Funding of embryonic stem cell research. (a) There is hereby appropriated from the General Revenue Fund to the Department of Health the sum of $20 million in each of the ten fiscal years beginning with the year in which this amendment is adopted. With such funds the Department of Health shall make grants for embryonic stem cell research using, or using the derivatives of, human embryos that, before or after formation, have been donated to medicine under donor instructions forbidding intrauterine embryo transfer.
(b) For this purpose, an embryo is “donated to medicine” if and only, under conditions that satisfy applicable requirements for informed consent and do not involve financial inducement to any donor, the persons from whose cells the embryo originates give the embryo to another under written instructions that the recipient shall use the embryo in biomedical research or therapy. “Financial inducement” includes any valuable consideration but excludes (1) reimbursement for reasonable costs incurred in connection with a donation, and (2) reasonable compensation to a donor from whom an oocyte is recovered, and to the donor of any other cell recovered by an invasive procedure, for the preparation for and time, burden, and risk of such recovery.
(c) The funds appropriated hereby shall be granted to nonprofit academic and other research institutions situated within the state. Grantees shall be chosen on the basis of a recommended ordering of applications by scientific merit as reckoned in a peer review process by disinterested experts in the relevant fields.
(d)This provision shall be self-executing and effective immediately upon adoption. This appropriation shall be nonlapsing such that any portion of a yearly appropriation not distributed shall accumulate for distribution in subsequent years. The Department of Health is authorized to promulgate administrative rules for the implementation hereof.

The ballot title for the proposed amendment is “FUNDING OF EMBRYONIC STEM CELL RESEARCH.” The summary for the proposed amendment states:

This amendment appropriates $20 million annually for ten fiscal years for grants by the Department of Health to Florida nonprofit institutions to conduct embryonic stem cell research using, or using derivatives of, human embryos that, before or after formation, have been donated to medicine under donor instructions forbidding intrauterine embryo transfer. An embryo is “donated to medicine” only if given without receipt of consideration other than cost reimbursement and compensation for recovery of donated cells.

The Financial Impact Statement for this proposed amendment, as prepared by the Financial Impact Estimating Conference, provides: “This amendment requires the state to spend $20 million a year for ten years.”

II. GOVERNING LAW

The citizen ballot initiative process is recognized in the Florida constitution:

The power to propose the revision or amendment of any portion or portions of this constitution by initiative is reserved to the people, provided that, any such revision or amendment, except for those limiting the power of government to raise revenue, shall embrace but one subject and matter directly connected therewith.

Art. XI, § 3, Fla. Const.

The process begins when the sponsoring party files a petition and copy of the proposed amendment with the custodian of state records, the Secretary of State. Id. Accompanying this petition are signatures collected from electors across the state. Id. Once the Secretary of State verifies that the threshold number of valid signatures has been reached, notice of the initiative is sent to the Attorney General, who then must request an advisory opinion from this Court. Art. IV, § 10, Fla. Const.; § 16.061, Fla. Stat. (2006). The advisory opinion is to address the ballot initiative’s compliance with article XI, section 3 of the Florida Constitution, which requires that an amendment by ballot touch upon “one subject and matter directly connected therewith.” Art. IV, § 10, Fla. Const.

Through prior case law and advisory opinions, this Court has explained its standard of review as follows:

The Court’s inquiry, when determining the validity of initiative petitions, is limited to two legal issues: whether the petition satisfies the single-subject requirement of article XI, section 3, Florida Constitution, and whether the ballot titles and summaries are printed in clear and unambiguous language pursuant" to section 101.161, Florida Statutes.

Advisory Op. to the Att’y Gen. re Amendment to Bar Gov’t from Treating People Differently Based on Race in Pub. Educ., 778 So.2d 888, 890 (Fla.2000) (citing Advisory Op. to the Att’y Gen. re Right of Citizens to Choose Health Care Providers, 705 So.2d 563, 565 (Fla.1998); Advisory Op. to the Att’y Gen. re Prohibiting Pub. Funding of Political Candidates’ Campaigns, 693 So.2d 972, 974 (Fla.1997)).

When reviewing a proposed amendment to determine compliance with the single subject and ballot summary requirements, this Court has stated that it will “not address the merits or wisdom of the proposed amendment.” Advisory Op. to the Att’y Gen. re Fla. Marriage Prot. Amendment, 926 So.2d 1229, 1233 (Fla.2006) (citing Amendment to Bar Gov’t from Treating People Differently Based on Race in Pub. Educ., 778 So.2d at 891). Additionally:

[W]e have recognized that we “must act with extreme care, caution, and restraint before [we] remove[ ] a constitutional amendment from the vote of the people.” Askew v. Firestone, 421 So.2d 151, 156 (Fla.1982). In elaborating on this latter principle, we have noted that “the Court has no authority to inject itself in the process, unless the laws governing the process have been ‘clearly and conclusively’ violated.” Advisory Opinion to the Attorney Gen. re Right to Treatment & Rehab, for Nom-Violent Drug Offenses, 818 So.2d 491, 498-99 (Fla. 2002). It is within the framework of these fundamental principles that we review ... proposed amendments] and ballot language.

Fla. Marriage Prot. Amendment, 926 So.2d at 1233 (second and third alterations in original).

A. Single-Subject Rule

The single-subject requirement has two components: “(1) it prevents ‘logrolling,’ a practice that combines separate issues into a single proposal to secure passage of an unpopular issue; and (2) it ‘prevents] a single constitutional amendment from substantially altering or performing the functions of multiple aspects of government.’ ” Id. (alteration in original) (quoting Adviso ry Op. to the Att’y Gen. re the Med. Liab. Claimant’s Comp. Amendment, 880 So.2d 675, 677 (Fla.2004)). To comply with the single-subject requirement, “a proposed amendment must manifest a ‘logical and natural oneness of purpose’ in order to satisfy the single-subject requirement.” Med. Liab. Claimant’s Comp. Amendment, 880 So.2d at 677 (quoting Fine v. Firestone, 448 So.2d 984, 990 (Fla.1984)). “This determination requires the Court to consider whether the proposed amendment affects separate functions of government, as well as how it affects other provisions of the constitution.” Id. (citing In re Advisory Op. to the Att’y Gen. — Restricts Laws Related to Discrimination, 632 So.2d 1018, 1020 (Fla.1994)).

1. Logrolling

Logrolling occurs when “several separate issues are rolled into a single initiative in order to aggregate votes or secure approval of an otherwise unpopular issue.” In re Advisory Op. to Att’y Gen. — re Save Our Everglades, 636 So.2d 1336, 1339 (Fla.1994). Thus, part of the goal of this Court’s single-subject scrutiny is to “avoid voters having to accept part of a proposal which they oppose in order to obtain a change which they support.” Fine, 448 So.2d at 993. The Court uses a “oneness of purpose” standard, which looks at whether a proposed amendment “may be logically viewed as having a natural relation and connection as component parts or aspects of a single dominant plan or scheme. Unity of object and plan is the universal test....” Id. at 990 (quoting City of Coral Gables v. Gray, 154 Fla. 881, 19 So.2d 318, 320 (1944)).

The amendment’s opponents, Citizens for Science and Ethics, Inc. (“Citizens”), argue that the proposed amendment does logroll, combining the questions of state funding for the research with embryo and cell donor compensation and cloning. Specifically, Citizens argues that voters will be forced to decide if they want the state to fund stem cell research at all, if the state should fund it at the specified level, if the donors should be compensated, and finally if the state should also support “therapeutic cloning.”

We find that the proposed amendment only addresses one subject, embryonic stem cell research. While the amendment mandates a specific level of state funding for such research, and also provides definitions and directions as to how the Department of Health will award grants in this respect, including issues of compensation, these provisions are “logically related to [the amendment’s] purpose.” Advisory Op. to the Att’y Gen. re Patient’s Right to Know about Adverse Med. Incidents, 880 So.2d 617, 620 (Fla.2004); see Advisory Op. to the Att’y Gen. re Voluntary Universal Pre-Kindergarten Educ., 824 So.2d 161, 165 (Fla.2002) (holding that proposed amendment’s details regarding funding did not constitute logrolling since they merely “provide! ] the details of how the amendment will be implemented”). We conclude, therefore, that the proposed amendment does not reach any other subject and thus does not constitute logrolling.

2. Altering or Performing the Functions of Multiple Branches of Government

A single-subject violation can also occur when a proposed amendment “alters or performs the functions of multiple branches of government.” Fla. Marriage Prot. Amendment, 926 So.2d at 1235. We have clarified that “[a] proposal that affects several branches of government will not automatically fail; rather, it is when a proposal substantially alters or performs the functions of multiple branches that it violates the single-subject test.” Advisory Op. to the Att’y Gen. re Fish & Wildlife Conservation Comm’n, 705 So.2d 1351, 1353-54 (Fla.1998) (emphasis added) (citing Save Our Everglades, 636 So.2d at 1340). This Court has also repeatedly emphasized that the rationale of the single-subject restriction in general is to guard against “precipitous” or “cataclysmic” changes to the government structure. See, e.g., Advisory Op. to Att’y Gen. re Additional Homestead Tax Exemption, 880 So.2d 646, 650 (Fla.2004).

The amendment’s opponents argue that the $20 million annual funding requirement impinges on both the legislative appropriations process and the executive veto power and is similar to the initiative this Court struck in Advisory Op. to the Att’y Gen. re Requirement for Adequate Public Educ. Funding 703 So.2d 446 (Fla.1997). Furthermore, Citizens argues that the affected governing agency in this instance is not left with wide discretion in implementing the new grants.

In Public Education Funding, this Court found that a proposed amendment requiring that the Legislature spend forty percent of its annual budget on education, not including lottery proceeds and federal funds, violated the single-subject rule. 703 So.2d at 447. In finding that the proposed amendment addressed more than one subject, the majority concluded that the “amendment would substantially alter the legislature’s present discretion in making value choices as to appropriations among the various vital functions of State government.” Id. at 449. In addition, the Court found that the Governor’s line-item veto power would be limited since he would be unable to veto any specific appropriation within the education appropriation if the veto would reduce the education appropriation to less than the required 40 percent. Id. Thus, since the amendment was found to “substantially affect more than one function of government and multiple provisions of the Constitution,” it was stricken from the ballot. Id. at 450. We later commented on these restrictions in Advisory Opinion to the Attorney General re Protect People, Especially Youth, From Addiction, Disease, . and Other Health Hazards of Using Tobacco, 926 So.2d 1186, 1194 (Fla.2006). “This massive restriction on appropriations also limited the entirety of the State’s other functions to the remaining sixty percent of the budget, rendering many other government functions impossible to fund.” 926 So.2d at 1193.

However, given the disparity between the required appropriations in the respective amendments, we find that the “massive restriction” at issue in Public Education Funding can be distinguished from the instant initiative because the substantial impact on the Legislature’s function we found in Public Education Funding is simply not present in this proposed amendment. The amount required for research is relatively nominal when compared to the State’s annual budget overall and cannot be characterized as substantially restricting the Legislature’s ability to fund other programs. Further, mandating some specific annual appropriation is an essential ingredient necessary to accomplish the narrow goal set forth in the amendment: the state financing of embryonic stem cell research. Mandating research without designating a funding level would leave the goal of the amendment solely to legislative discretion.

We find the proposed amendment more closely resembles the one we approved in Protect People, Especially Youth. The amendment at issue in that case also specifically required the Legislature to appropriate a fixed amount annually, equal to fifteen percent of the tobacco settlement funds paid to the state in 2005, for the purposes of fulfilling the anti-tobacco programs detailed in the amendment. 926 So.2d at 1189-90. The appropriation required greatly exceeded the amount mandated in the subject amendment. However, we concluded that the amendment in that case was not “impermissibly rigid and restrictive to the legislative and executive branches.” Id. at 1193. Consistent with our decision in Protect People, Especially Youth, we conclude that the subject proposed amendment does not “substantially” alter or perform the functions of multiple aspects of government, and thus does not violate the single-subject rule. See, e.g., Save Our Everglades, 636 So.2d at 1340.

We also note that section 100.371(5), Florida Statutes (2006), now requires the Financial Impact Estimating Conference to provide a statement to the Attorney General and the Secretary of State for inclusion on the ballot detailing the costs stemming from a proposed constitutional amendment. Hence, the fact that an amendment contains a specific funding requirement is not necessarily dispositive of whether it substantially alters or performs the duties of the Legislature.

B. Ballot Title and Summary

The title and ballot summary of any proposed amendment must comply with section 101.161, Florida Statutes, which states:

Whenever a constitutional amendment or other public measure is submitted to the vote of the people, the substance of such amendment or other public measure shall be printed in clear and unambiguous language on the ballot ... followed by the word “yes” and also by the word “no,” .... Except for amendments and ballot language proposed by joint resolution, the substance of the amendment ... shall be an explanatory statement, not exceeding 75 words in length, of the chief purpose of the measure.... The ballot title shall consist of a caption, not exceeding 15 words in length, by which the measure is commonly referred to or spoken of.

§ 101.161(1), Fla. Stat. (2006).

The “clear and unambiguous” requirement ensures that a voter has notice of the subject matter and issues addressed by the proposed amendment. Fla. Marriage Prot. Amendment, 926 So.2d at 1236 (quoting Save Our Everglades, 636 So.2d at 1341). In evaluating a proposed amendment:

The proper analysis to assess whether [the] ballot title and summary meet this requirement focuses on two questions: (1) whether the ballot title and summary, in clear and unambiguous language, fairly inform the voter of the chief purpose of the amendment; and (2) whether the language of the title and summary, as written, misleads the public.

Id. at 1236 (citing Advisory Op. to the Att’y Gen. re Additional Homestead Tax Exemption, 880 So.2d 646, 651-52 (Fla.2004)). The ballot title and summary do not have to discuss every detail or consequence of the amendment, but they must be sufficiently “accurate and informative.” Advisory Op. to the Att’y Gen. re Protect People, Especially Youth, 926 So.2d at 1194.

Opponents of the proposed amendment argue that the abbreviated discussion of compensation in the final sentence of the ballot summary violates both prongs of the ballot summary analysis: first, it does not provide a fair notice of the contents of the amendment, and furthermore it is vague and misleading. Specifically, Citizens argues that the summary does not provide fair notice of what constitutes “compensation” or who would receive it, and also that it misleads the public regarding what, exactly, is compensable. We disagree.

The issue of compensation arises within the definition of the term “donated to medicine,” which is defined in both the summary and the amendment. The summary provides that “[a]n embryo is ‘donated to medicine’ only if given without receipt of consideration other than cost reimbursement and compensation for recovery of donated cells.” The text of the actual amendment further explains that an embryo is “donated to medicine” if it does not involve “financial inducement.” “Financial inducement” is then defined as excluding reasonable cost reimbursement for donations and reasonable compensation for the recovery of cells. The amendment states that this can include compensation for the preparation, time, burden and risk of cells recovered through invasive procedures. The summary makes clear that donors will be reimbursed for costs and compensated for the recovery of the embryos under the proposed amendment.

This Court has previously approved summaries that omit certain details that are otherwise included in the full amendment. As explained in Carroll v. Firestone, 497 So.2d 1204, 1206 (Fla.1986), “[i]t is not necessary to explain every ramification of a proposed amendment, only the chief purpose.” See also Med. Liab. Claimant’s Comp. Amendment, 880 So.2d at 679 (“We also note -that it is not necessary for the title and summary to explain every detail or ramification of the proposed amendment.”) (citing Public Funding of Political Candidates’ Campaigns, 693 So.2d at 975). In Advisory Opinion to the Attorney General re Physician Shall Charge the Same Fee for the Same Health Care Service to Every Patient, 880 So.2d 659 (Fla.2004), we emphasized in approving a ballot summary, “Given the seventy-five word limit contained in section 101.161(1), it would be impossible for sponsors to detail all possible effects or ramifications of the proposed amendment.... The statute itself requires only that the voter be made aware of the chief purpose of the amendment.” Id. at 664. Accordingly, despite the fact that the summary does not detail how potential donors might be compensated and for what expenses they could be reimbursed, the summary nevertheless fairly informs the voter of the chief purpose of the amendment, the state funding of embryonic stem cell research.

Regarding the second prong of the inquiry into the summary, opponents also claim that the explanation regarding compensation is ambiguous and misleading since voters are informed only that donors will be compensated, but not how much they will be compensated. Opponents further argue that if the summary is attempting to address a concern that state funds should not encourage the donation of cells for money, it misleads voters by implying that the consideration given in exchange for the embryos will be more limited than the amendment actually provides. However, as explained above, this Court has repeatedly upheld summaries that do not detail every facet of an amendment’s proposal. The language in the summary closely tracks that which is used in the amendment itself, and the summary also does not contain the type of political rhetoric this Court rejected in such summaries as Marriage Protection and Homestead Tax Exemption.

Accordingly; we conclude the instant summary fulfills the basic purpose of section 101.161, Florida Statutes, in that it “provide[s] fair notice of the content of the proposed amendment so that the voter will not be misled as to its purpose, and can cast an intelligent and informed ballot.” Advisory Op. to Att’y Gen. — Fee on Ever glades Sugar Prod., 681 So.2d 1124, 1127 (Fla.1996).

C. Financial Impact Statement

This Court must also determine whether the financial impact statement complies with the requirements provided in the Florida Constitution and the statute. Article XI, section 5, Florida Constitution, addresses financial impact statements and provides in relevant part:

(c) The legislature shall provide by general law, prior to the holding of an election pursuant to this section, for the provision of a statement to the public regarding the probable financial impact of any amendment proposed by the initiative pursuant to section 3.

Section 100.371(5), Florida Statutes (2006), now addresses the financial impact statement as follows:

(5)(a) Within 45 days after receipt of a proposed revision or amendment to the State Constitution by initiative petition from the Secretary of State, the Financial Impact Estimating Conference shall complete an analysis and financial impact statement to be placed on the ballot of the estimated increase or decrease in any revenues or costs to state or local governments resulting from the proposed initiative. The Financial Impact Estimating Conference shall submit the financial impact statement to the Attorney General and Secretary of State.
(b)3. Principals of the Financial Impact Estimating Conference shall reach a consensus or majority concurrence on a clear and unambiguous financial impact statement, no more than 75 words in length, and immediately submit the statement to the Attorney General. Nothing in this subsection prohibits the Financial Impact Estimating Conference from setting forth a range of potential impacts in the financial impact statement.

§ 100.371(5), Fla. Stat. (2006). In deciding the validity of a financial impact statement, the Court has limited itself only to addressing whether the statement is clear, unambiguous, consists of no more than seventy-five words, and is limited to addressing the estimated increase or decrease in any revenues or costs to the state or local governments. See Advisory Op. re Protect People from Health Hazards of Using Tobacco, 926 So.2d 1186, 1194 (Fla.2006). In the cases where this Court found the financial impact statement to be defective, it was because the statement did not comply with these specific requirements. See, e.g., Advisory Op. to Att’y Gen. re Repeal of High Speed Rail Amendment, 880 So.2d 628, 629 (Fla.2004) (rejecting the proposed financial impact statement because certain provisions were not expressed in terms of the “probable financial impact” and because the statement went beyond addressing “revenues or costs to state or local governments”); Advisory Op. to the Att’y Gen. re Pub. Prot. from Repeated Med. Malpractice, 880 So.2d 686, 687 (Fla.2004) (rejecting the proposed financial impact statement because phrase “range of potential impacts” in section 100.371(6)(b)(3) must relate to the phrase “probable financial impact” set forth in the constitution and the proposed statement included potential impacts beyond monetary estimates); Advisory Op. to the Att’y Gen. re Authorizes Miami-Dade & Broward County Voters to Approve Slot Machines in Parimutuel Facilities, 880 So.2d 689 (Fla.2004) (same).

The financial impact statement for this proposed amendment provides as follows: “This amendment requires the state to spend $20 million a year for ten years.” The instant financial impact statement is well within the 75-word limit and it clearly and unambiguously conveys that the amendment will cost the state $20 million a year for ten years. We find no basis to reject the financial impact statement under section 100.371(6).

III. CONCLUSION

For the reasons stated, we hold that the initiative petition and proposed ballot title and summary for the “Funding of Embryonic Stem Cell Research” meet the legal requirements of article XI, section B of the Florida Constitution and section 101.161(1), Florida Statutes (2006). Likewise, the accompanying financial impact statement is in accordance with section 100.371(5). Accordingly, we approve the amendment and financial impact statement for placement on the ballot.

It is so ordered.

LEWIS, C.J., and WELLS, ANSTEAD, PARIENTE, and QUINCE, JJ„ concur.

BELL, J., concurs in part and dissents in part with an opinion, in which CANTERO, J., concurs.

BELL, J.,

concurring in part and dissenting in part.

I concur with the approval of the initiative petition. However, I dissent as to this Court’s review and approval of the financial impact statement. I do so because I conclude that we do not have jurisdiction to render advisory opinions concerning the validity of financial impact statements. See art. TV, § 10, art. V, § 3(b)(10), art. XI, §§ 3, 5, Fla. Const. In other words, I believe that this Court’s jurisdiction to render an advisory opinion is limited to the initiative petition itself and does not encompass the separate financial impact statement.

CANTERO, J., concurs.

      . We take judicial notice of the fact that the budget for the State of Florida for fiscal year 2007-2008 is approximately $72 billion. See Fla. Conf. Report on SB 2800 (2007) at 428 (General Appropriations Act for Fiscal Year 2007-2008).