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Question: Would you give up a fundamental civil right in order to protect negligent doctors and insurance companies?

Seems like a simple question with a simple answer… No.

But this question will garner much discussion today in the Missouri Senate’s Small Business, Insurance and Industry Committee.

The committee will consider whether or not to re-institute unconstitutional damages caps.  And there’s a reason this bill – SB 589 – will be heard by the Insurance and Industry Committee – that’s who it is designed to protect.  The bill sacrifices the fundamental right to jury trial in order to protect negligent doctors and their insurance companies.

What if the the 1st Amendment right to free speech was sacrificed to protect negligent doctors and insurance companies?  Would you answer yes or no?

What if the 1st Amendment right to freedom of religion was sacrificed to protect negligent doctors and insurance companies?  Yes or no?

What if the 2nd Amendment right to bear arms was sacrificed to protect negligent doctors and insurance companies?  Yes or no?

What if the 5th Amendment right to due process was sacrificed to protect negligent doctors and insurance companies?  Yes or no?

What Does the Constitution Say?

The 7th Amendment to the US Constitution guarantees that “the right of trial by jury shall be preserved….”

The Missouri Constitution guarantees “[t]hat the right of trial by jury as heretofore enjoyed shall remain inviolate….”  The “as heretofore enjoyed” phrase refers to the common law.  The common law system refers to those areas of the law developed through decisions of courts and other tribunals as opposed to laws issued by statute.  Many statutes, in fact, codify the common law.

A number of actions, including actions for negligence, developed under the common law.  Jury trials on such claims have been guaranteed under both the US and Missouri Constitutions, with Missouri going so far as to declare this right “inviolate”.  According to Webster’s Dictionary, the term “inviolate” means “not harmed or changed”.

So, putting it all together:  The right to jury trial as enjoyed under the common law shall not be harmed or changed.  That’s what the constitution says.

What would SB 589 do?

SB 589 would unquestionably “harm or change” the right to jury trial in Missouri.

You see, in order to get around the Constitutional protections, SB 589 would attempt to legislatively erase this history of common law as if it did not exist.

2.  The general assembly expressly excludes from this section the common law of England as it relates to claims arising out of the rendering of or failure to render health care services by a health care provider, it being the intent of the general assembly to replace those claims with statutory causes of action.

SB 589

The Missouri legislature is trying to an end-run around the Constitution.

Doubt me?  Here’s an easy way to prove it:  Ask any Senator supporting this bill if they would offer an amendment to apply this language to (a) the freedom of speech; (b) the freedom of religion; and/or (c) the right to bear arms.

The 7th Amendment is no different and no less important than the 1st Amendment, 2nd Amendment, or any other amendment.  A fundamental right is a fundamental right.

SB 589 Protects Negligent Doctors and Insurance Companies

SB 589 doesn’t protect you and me.  It doesn’t prevent “frivolous” lawsuits.  It doesn’t make health care better.  It doesn’t keep doctors in our state.

This bill does one thing:  It protect insurance companies and negligent doctors who injure innocent people.

Let’s examine the arguments.

(1) Damage Caps Do Not Prevent Frivolous Lawsuits

Supporters of the bill claim it will prevent frivolous lawsuits.

AMedNews Tweet

It won’t.  It can’t.  To say otherwise is not just wrong, it’s a pants-on-fire lie.

This bill doesn’t protect good doctors, it protects bad ones.

By definition, damages caps can only apply to cases with merit and which the plaintiff not only wins, but has suffered and is awarded substantial non-economic damages.

In order for unconstitutional damages caps, the following must occur:

(1) The jury must find the doctor, hospital, or other health care provider was liable for the injury (an actual cause-in-fact of the injury); and

(2) The jury must find that the injured victim suffered some non-economic loss or injury (an incomplete list of non-economic damages includes pain, suffering, mental anguish, disfigurement, loss of consortium, loss of care, loss of comfort, loss of support, lost enjoyment of life, etc.) that was caused by No. (1); and

(3) The jury must find that the value of the injured victim’s non-economic loss is greater than $350,000 over the victim’s lifetime.

These caps have absolutely nothing to do with frivolous lawsuits and it is disingenuous and outright misleading for anyone to suggest otherwise.

While these caps don’t restrict frivolous lawsuits, they do fundamentally restrict valid lawsuits and, instead of protecting innocent victims, these caps protect negligent doctors and hospitals from being held accountable and accepting responsibility for the damage they cause.  One legislator, Rep. Eric Burlison, admitted as much in a Springfield News-Leader article, when he said that he saw “caps as a way of keeping the number of claims down.”

(2) Damage Caps Do Not Reduce Defensive Medicine or Lower Health Care Costs

The New England Journal of Medicine concluded that arbitrary damages caps do not lower health care costs, may result in more negative outcomes as doctors would not be held accountable for the full cost of medical errors.

Strategies to control costs associated with medical malpractice and defensive medicine must be responsible and targeted. These strategies must not impose arbitrary caps on damages for patients who are injured as a result of malpractice. According to the Congressional Budget Office, arbitrary caps on damages would reduce national health spending by only 0.5%. But although such caps would have a barely measurable effect on costs, they might adversely affect health outcomes.

– A Systematic Approach to Containing Health Care SpendingThe New England Journal of Medicine

As the NEJM alluded, damage caps actually threaten to make the malpractice problem worse. Shirley Svorny, of the conservative Cato Institute (founded by in part by the Koch brothers, Charles and David Koch), has written, “[m]uch of the protection consumers have against irresponsible and negligent behavior on the part of health care providers hinges on oversight and incentives created by the medical professional liability insurance industry.” Thus, she concludes, damage caps “could result in more cases of negligence and substandard care.”

(3) Damage Caps Do Not Affect Doctor Retention

Supporters of SB 589 suggest that, without the unconstitutional damage caps, doctors will flee the state.  Again, this kind of statement is not just wrong, it’s a pants-on-fire lie.

With or without damage caps, doctors have never fled Missouri.

Statistics from the Missouri State Board of Registration for the Healing Arts:

Missouri Doctor Registrations Data: Mo. Bd. Reg. for Healing Arts
Missouri Doctor Registrations
Data: Mo. Bd. Reg. for Healing Arts

There never a mass exodus.  In fact, in-state physician renewals actually jumped 4.23% from the previous reporting period in 2004 – just before the “boiling point” imagined by tort reform supporters and before the unconstitutional damage caps were enacted in the fall of 2005.

The broader numbers also show there was no exodus of doctors before tort reform and no mass return of doctors once unconstitutional restrictions were enacted.  This is a true fact based on the per capita number of doctors and also for the per capita number of doctors in so-called “high risk” specialties that include neurosurgery and Ob-Gyn.

Doctor-Patient Ratio MO - Vidmar  Doctor-Patient Ratio MO - High Risk - Vidmar

Not only have doctors not fled Missouri, they haven’t fled anywhere else either.

“Before Texas adopted tort reform in 2003, proponents claimed that physicians were deserting Texas in droves.  After tort reform was enacted, proponents claimed there had been a dramatic increase in physicians moving to Texas due to the improved liability climate.  We find no evidence to support either claim.”

– Does Tort Reform Affect Physician Supply?  Evidence from Texas

Even staunch tort reform advocate Ted Frank of the Manhattan Institute agreed that the Texas study “substantially undermines the empirical case for the conventional wisdom that Texas’ 2003 reforms against medical malpractice lawsuits attracted more doctors to Texas.”  Frank agreed the report is so damning he is “going to stop claiming that Texas tort reform increased doctor supply without better data demonstrating that.”

One medical malpractice insurance company produced an info-graphic that demonstrated unequivocally that there is no medical malpractice crisis.  It showed that nearly half of all medical malpractice payouts came from only 5 states (Florida, New Jersey, California, Pennsylvania, and New York).  It also showed that overall medical malpractice payments have been declining steadily since 2003.  The data from the insurance company also showed that “runaway juries” or “excessive” jury awards are not part of any alleged “crisis”.  Only 5% of all medical malpractice awards in 2012 resulted from a verdict at trial.  More than 90% of all malpractice payments were made voluntarily by the defendant doctor, hospital, or health care provider by way of settlement.

(4) Verdicts Do Not “Skyrocket” Without Damage Caps

The average non-economic verdict paid out before the unconstitutional damage caps were put into effect was $314,000 and has not changed significantly under that law.

Some claim without unconstitutional damage caps, “there is no limit on what a jury can award a plaintiff”.  It’s not true.

There is a limit.  It’s called evidence.

The jury is constitutionally constrained by the evidence.  In addition to the jury, the trial judge stands as a gatekeeper to ensure the jury is constrained by the evidence.  In addition to the jury and the judge, the Court of Appeals panel of three judges stand as a gatekeeper to ensure the jury and trial court are constrained by the evidence.  In addition to the jury, the trial judge and the Court of Appeals panel, the Court of Appeals en banc stands as a gatekeeper to ensure the jury, trial court, and appellate panel are constrained by the evidence.  In addition to the jury, the trial judge, the Appeal panel, and the Appeals Court en banc, the Supreme Court stands as a gatekeeper to ensure that everyone is constrained by the evidence.

If the jury, trial judge, Appellate panel, Appellate Court en banc, and the Supreme Court all agree… then maybe they got it right.

There are no fewer than five levels of limits and protections to properly constrain damages in medical malpractice cases.

(5) The Founding Fathers Believed in the Right to Trial by Jury

“Representative government and trial by jury are the heart and lungs of liberty.  Without them we have no other fortification against being ridden like horses, fleeced like sheep, worked like cattle, and fed and clothed like swine and hounds.”

– John Adams

“I consider trial by jury as the only anchor ever yet imagined by man, by which a government can be held to the principles of its constitution.”

– Thomas Jefferson

“In suits at common law, between man and man, the trial by jury, as one of the best securities to the rights of the people, ought to remain inviolate.

– James Madison

“The civil jury is a valuable safeguard to liberty.”

– Alexander Hamilton

(6) You Cannot Have a Strong 2nd Amendment Without a Strong 7th Amendment

If you’re going to support the 2nd Amendment… or the 1st Amendment… or any other amendment, you must support the 7th Amendment right to jury trial.

As Tea Party Nation founder, Judson Phillips and Tea Party advocate Andrew Cochran have said, “Real conservatives need to defend each and every God-given right enumerated in the Bill of Rights, and fight to maintain the limits on central power inherent in the Constitution.”

Too many Americans who claim to base their political decisions on the Constitution and Bill of Rights fold like a paper airplane when push comes to shove.  Too many of us pick our founding documents apart to choose which of the limits on power in the Constitution, or which of the ten amendments in the Bill of Rights, we back at any given moment.

– Andrew Cochran, “Capping Gun Rights & Jury Trials Equally Wrong

Cochran also wrote that “Liberals who love civil jury trials for their causes need to protect our right to bear arms, and conservatives need to protect the right to civil jury trials from crony capitalists who would abridge our right to a civil jury trial through ‘tort reform.’”

The sad fact is that not only is this kind of selective enforcement of constitutional principles illogical and indefensible, it’s completely unnecessary.  As the myths above show, damage caps like those supported by Rep. Burlison just don’t work.

We must preserve and protect each fundamental right if we are to protect any of them. Constitutional rights should not be attacked, demeaned, or trivialized for the political gain of an isolated lobbying group. Constitutional rights are the cornerstone of our society and, as Missouri’s founders explicitly said, should remain inviolate.

What Is SB 589 Really About?

This bill isn’t about protecting patients.  It’s not about lowering health care costs.

SB 589 is about 2 things:  (1) Fear; and (2) the Insurance Company’s Bottom Line.

A policy paper supporting SB 589 and other damage cap proposals said doctors “fear” the status quo.  This “fear” might be real, but as described above, it’s unwarranted.  The bases of this “fear” have been disproved.  Much like a child’s fear of the monster in her closet, the coalition’s fear has no basis in fact, logic, or reality.

This “fear” has been empirically and undeniably refuted and disproved.

And so that leaves the insurance company’s bottom line.  Insurance companies – understandably – do not like paying for the damages caused by a negligent doctor’s misconduct.  Insurance companies are in the business of making money.  The less money insurance companies pay out equals greater profits for the company.

But insurance company profits are no reason to give up a fundamental right.

The Missouri Constitution ensures that “the right to trial by jury as heretofore enjoyed shall remain inviolate….”  [Mo. Const. Art. 1, sec. 22(a)].

Tort “reforms” like damage caps have the perverse effect of bloating government and penalizing tax payers through government funded bailouts of negligent actors. If the negligent person or company is not responsible for the damages, then the burdens must be borne by tax payers through Medicare, Medicaid, and assistance programs. Or it must be borne by the public through charitable institutions. Or it goes uncompensated and must be borne by the victim and their families

The right to trial by jury – whether under the Missouri Constitution or the 7th Amendment of the United States Constitution – is the ultimate lynch pin for all other constitutional rights. Freedom of speech, freedom to keep and bear arms, freedom to contract, freedom of religion — all are ultimately protected by the freedom – inviolate in Missouri – to have your case heard in a trial by jury.

Tell these special interests to stop messing with our constitution just to protect negligent doctors and insurance companies.

© Copyright 2014 Brett A. Emison

Follow @BrettEmison on Twitter.



  1. Brett, excellent post. Instituting caps on damages is not only dangerous for the American citizen, it's unconstitutional. The 7th Amendment was created to protect the individual, not those who commit acts of negligence, and we must fight to protect that right. Thanks for drawing attention to this issue, and for providing such a thorough argument.

  2. Excellent post. Consumers are harmed by caps and those that are the cause get away with great harm and damage. Keep up the fight.

  3. Gravatar for jc

    Brett, John, and Mike: I totally disagree with you views and I totally support Missouri SB 589. I see no legitimate reason that damage caps on "pain and suffering" damages should not be applied and they are available in the majority of states in the USA. First off, there are no "pain and suffering" damages in a workers compensation case. Why should these damages only apply to medical malpractice? Secondly, I believe that it does reduce frivolous lawsuits. According to The Doctors Company, the number of medical malpractice lawsuits decreased in Ohio by 50% after "pain and suffering" damages were recognized as being Constitutional in Ohio. Brett, what does $50,000 of pain and suffering damages look like compared to $350,000 of pain and suffering damages. Brett, I do not get your argument that malpractice plaintiffs do not get their day in court. In all 30 states that have caps on "pain and suffering" damages, plaintiffs get their day in court and they can get full damage awards for their actual damages including lost wages, medical expenses, etc. Pain and suffering damages are often used as a hammer to try and force innocent doctors to settle cases because of the certianty of settlement vs the uncertianity of the corrupt court system in this country.

  4. Doctor JC,

    You're just plain wrong. You make the same tire comments in post after post after post. Let me address your concerns yet again.

    (1) I know you disagree with me. You've told me that at least a dozen times now. It's like a broken record.

    (2) I know you support SB 589.

    (3) Workers compensation is completely different system - it's like comparing apples to oranges. The WC system is part of larger social contract between employers and employees in which the employer agrees to take on the risk to pay every employee for every injury on the job regardless of whether it was the employer or the employee at fault for the injury. This is commonly called "no-fault" liability, meaning the employer is liable even if not at fault. In exchange for the employer accepting the fault for every single on-the-job injury, the employee is limited in the damages he/she is entitled to recover.

    There is no such social contract or trade-off in negligence cases or medical malpractice cases. For your comparison to work, every single doctor must be willing to accept responsibility for every single injury or negative outcome regardless of whether the doctor was actually at fault. I don't think you're willing to go there. I'm positive the med mal insurance companies aren't willing to go there. If they were willing, we'd be there already.

    (4) If you believe damage caps prevent frivolous lawsuits you should see a physician yourself. By definition, damage caps affect only legitimate lawsuits in which the doctor has already been found liable and in which the jury has already awarded damages.

    By definition, damage caps cannot apply to a frivolous lawsuit.

    (5) You never, ever have shown your work, so I have no way of verifying whether or not med mal lawsuits dropped by 50% in Ohio. Let's assume that's true. Nothing in your statement suggests that 50% of the med mal cases filed in Ohio were frivolous. That means that LEGITIMATE cases - not frivolous ones - were effectively prohibited by unconstitutional damage caps.

    (6) The right to trial by jury is meaningless unless the jury determines all of the damages. It's a ridiculous statement to say partial damages are enough or to suggest that pain and suffering damages aren't real or they aren't legitimate.

    Just because you believe non-economic damages to be difficult to determine doesn't mean they aren't real. It doesn't mean the jury can't determine them.

    We ask juries to make hard decisions in many types of cases. Antitrust cases are hard, but juries get the job done. Constitutional cases are hard, but juries get the job done. Intellectual property cases are hard, but juries get the job done. Murder cases are hard, but juries get the job done.

    Tell me this doc... how much would you ask for if a negligent doctor brain damaged your child? Or cut off the wrong leg? Or left you paralyzed. Would the cost of your medical bills and lost wages would fully compensate your loss?

    Thanks for reading but let me guess... you totally disagree.

  5. Gravatar for jc

    Brett Emison:

    You're just plain wrong. You make the same tired comments in post after post after post. Let me address your concern yet again:

    1. I know you disagree with me. You've told me that at least a dozen times now. It's like a broken record.

    2 I know you do not support SB 589.

    3. Workers compensation is a completely different yet similar system. It is like comparing red apples with green apples. The WC system is part of a larger social contract between employers and employees in which the employer assumes "no-fault" liability. Currently there is no social contract with medical liability. But there should be. Doctors are dealing with human beings who do not function like machines. Moreover, to be on staff at a hospital, doctors are forced to care for patients whom they otherwise would not accept as patients for either personal or financial reasons. Because we require that doctors perform this social good, doctors should be able to get a reasonable liability benefit from this sometimes forced relationship. Damage caps on non-economic damages preserve part of this social contract, by allowing decreased malpractice insurance rates for doctors, and the assurance that a life time of work and saving will not vanish due to an inadvertent mistake.

    4. I personally have experienced a significant decrease in malpractice inquiries. This has also been noted by my malpractice carrier, who has seen at least a 50% decrease in frivolous litigation since tort reform was enacted and upheld in Ohio since about 2005.

    I believe that damage caps here in Ohio have led to a significant decrease in frivolous litigation.

    5. Brett, the work you produce is dated. All but 20 states in the USA have enacted some form of damage caps according to the 2011 AMA Advocacy Resource Center Paper. The states without damages caps are as follows:

    1. Alabama

    2. Arizona

    3. Arkansas

    4. Connecticut

    5. Delaware

    6. D.C.

    7. Iowa

    8. Kentucky

    9. Minnesota

    10. New Jersy

    11.New York

    12.North Carolina


    14.Rhode Island





    19.New Hampshire $875K cap on non-economic damages overturned (Branniganv. Usitalso, 587 A.2d 1232 (N.H. 1991)

    20. Missouri apparently had a $350K cap on non-economic damages which has been declared unconstitutional by the Missouri Supreme Court. What Brett apparently objects to is that the Missouri Legislature is trying to re-instate that cap. Brett apparently does not think that democratically elected legislators should have the ability to enact laws that benefit their constituents. On a previous post, Brett has stated that he is against voters electing State Supreme Court Justices because they might invalidate laws that Brett favors. Brett apparently believes that only lawyers, like him, and the Missouri State Bar, should be allowed to select State Supreme Court Justices. The problem with Brett's views are that this sets State Supreme Court Justices up as unaccountable legislators who enact laws and raise taxes to suit their personal political agendas. A few years back, the Nevada Supreme Court decided that increased school funding was necessary so they unilaterally enacted a state income tax. At the next election, those justices were thrown off the Nevada Supreme Court. Missouri also needs public election of State Supreme Court Justices for the same reason.

    Brett, I believe that every medical malpractice case which goes to trial and is a defense verdict is a frivolous case. Otherwise, the jury would have found for the plaintiff. You may not like the jury's decision, but in Ohio, about 85% of malpractice verdicts are for the defense.

    The right to a jury trial is very meaningful if you have true economic damages including work loss damages and medical damages which can cost hundreds of thousands of dollars. During your previous post you did not address the difference between what $50,000 and $350K non-economic damages would look like. So if you cannot address that, why would you expect a jury to address that adequately? I feel that non-economic damages are subjectively adjusted by the jury according to how egregious the medical error was. That should be addressed with punitive damages, and punitive damages are uncapped in all states! So if you have that drunk doctor who amputates the wrong leg, punitive damages are an alternative.

    One final note, Brett. You and the other lawyers on this site do not understand that I have substantial knowledge and experience in the medical legal malpractice system, as an expert witness, a practicing physician, an OSMA delegate and last week, I testified before the Ohio House Judiciary Committee re: a malpractice issue. I believe that doctors need to be aggressive and take a stand against rogue judges and Justices and plaintiff attorneys. Although your points are interesting, my understanding is that neither you nor your firm handles medical malpractice cases. So what real world experience do you have in how these issues should be handled?

    Thanks for reading - -but you are right, I totally disagree.

  6. Ok doc, last time.

    (1) Work Comp. It's an invalid (apples-to-oranges) comparison. Unless you and other doctors are willing to accept liability for every single negative outcome in order to incentivize victims to accept a reduced amount of compensation, then there's nothing to talk about. Since you are, apparently, unwilling to accept responsibility for even the injuries actually caused by negligent doctors, I suspect you're unwilling to accept responsibility for those not caused by the doctor. Assuming that's correct, it ends the discussion.

    Instead, what you want is for victims to be limited in compensation without upholding your side of the social contract.

    (2) Most studies show that malpractice rates do not go down substantially after tort reform is enacted. Instead, the insurance companies simply roll their savings into company profits. If your malpractice rates have gone down because caps and other tort reform prevent legitimate claims - which the insurance company ought to be paying. When the insurance company doesn't pay, the taxpayers do.

    (3) You say our insurance company has seen a 50% decrease in frivolous claims - that's a ridiculous and meaningless statistic without context. So, if they had 2 frivolous claims before and 1 after, that would be a 50% reduction - and also completely meaningless. If they consider ever plaintiff's loss a "frivolous" claim, that's also meaningless. You say 50% reduction, I say prove it.

    (4) I don't know how many times I have to say it, by definition, damage caps apply to only legitimate claims, not frivolous ones. Frivolous claims get dismissed. Or the jury finds for the doctor. If the jury finds for the plaintiff and awards damages, by definition, it cannot be a frivolous claim.

    (5) I've address the issue of state damages caps with you before. I'm not going to do it all again. If folks want to read it, they can go here. All of the data is from your American Medical Association. If you have a beef, it's with the AMA, not me.

    (6) Doc, you may be a very good doctor... I don't claim to know one way or the other. But you should really consider going back and taking a basic civics lesson.

    We have three co-equal branches of government. The judicial system is just as valid and powerful - hence, coequal - as the executive and the legislative. The judiciary acts as a fundamental check on abuses of power by the executive and legislature.

    So, when the legislature exceeds the scope of the constitution by - for example - imposing arbitrary and unconstitutional damage caps that infringe on fundamental rights and liberties, it is the judicial systems job to uphold the constitution.

    The right to jury trial is very meaningful no matter what type of damages you suffer.

    (7) You "feel that non-economic damages are subjectively adjusted by the jury according to how egregious the medical error was." Doc, your feeling is wrong. Again, please go back and take a basic civics lesson. The jury must be constrained by the evidence. If they happens to get it wrong - which doesn't happen very often - there are at least 4 additional levels of protection. If everybody agrees, then my bet is the jury got it right.

    Your feeling doesn't really matter much when compared to the reality. The reality is that damages are awarded according to the evidence of the damage.

    With respect to a $50,000 vs. a $350,000 non-economic damage, it depends on the evidence. It depends on the circumstances. It's why we have judges and juries. My guess is that if you that were the victime, you'd think it was closer to the $350,000 side.

    (8) The fact that you believe every defense verdict equals a "frivolous" claims says everything we need to know. It's not only wrong, it's a ridiculous position.

    (9) Punitive damages are not uncapped on all states. In fact, they are capped in many states. Punitive damages were not available at common law and are a function of statute. In Missouri they are capped at the greater of $500,000 or 5 times compensatory damages. The US Supreme Court has said that punitive damages should in most instances be capped a single-digit multiplier of compensatory damages.

    Once again, JC, you're just wrong.

    (10) You say you have knowledge about the legal malpractice areas, but your positions suggest otherwise.

    (11) I don't do malpractice work. I've never tried a malpractice case. But I do understand the constitution. And I do understand the civil justice system. I do understand basic physics.

    I understand you don't trash the constitution to protect a negligent doctor. I understand you don't eviscerate a fundamental right to protect an insurance company's bottom line. I understand that when you do something wrong, you should accept responsibility and be accountable.

    What you want, JC, is a free pass. You want negligent doctors to ignore their responsibility.

    I understand it doesn't work that way - at least it shouldn't. I understand that we should play by the same set of rules.

Comments are closed.

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