NOTICE: This opinion is subject to modification resulting from motions for reconsideration under Supreme Court Rule 27, the Court’s reconsideration, and editorial revisions by the Reporter of Decisions. The version of the opinion published in the Advance Sheets for the Georgia Reports, designated as the “Final Copy,” will replace any prior version on the Court’s website and docket. A bound volume of the Georgia Reports will contain the final and official text of the opinion.
In the Supreme Court of Georgia
Decided: August 26, 2025
S25G0276. WILLIAMS v. REGENCY HOSPITAL COMPANY, LLC et al.
LAND, Justice.
Andreana Williams, as conservator for her mother Michelle
Hewett, filed a medical malpractice action against Regency Hospital
Company, LLC, Regency Hospital Company of Macon, LLC
`(collectively “Regency”), and Regency’s employee Jacquita Baldwin,
APRN (collectively “Appellees”). Appellees moved to dismiss based
on the expiration of the two-year statute of limitation for medical
malpractice actions. In response, Williams argued that the statute
of limitation was tolled because Hewett “meets the definition of
incompetency under OCGA § 9-30-90 (a)” and that OCGA § 9-3-
73(b),1 which provides that the statute of limitation for medical
1 OCGA § 9-3-73(b) provides, in relevant part, that notwithstanding malpractice claims shall not be tolled for plaintiffs who are “legally
incompetent,” violates Hewett’s rights under the Equal Protection
Clause of the Fourteenth Amendment to the United States
Constitution. The trial court granted Appellees’ motion to dismiss,
ruling that this Court had already decided the constitutional issue
contrary to Hewett’s position in Deen v. Stevens, 287 Ga. 597 (2010).
The Court of Appeals affirmed. See Williams v. Regency Hosp. Co.,
LLC, 373 Ga. App. 83, 85–86 (2024). We granted certiorari to
consider whether Deen controls this case, and if not, whether OCGA
§ 9-3-73(b) violates Hewett’s rights under the Equal Protection
Clause by arbitrarily treating mentally incompetent medical-
malpractice plaintiffs differently than mentally incompetent
plaintiffs in other kinds of lawsuits. 2
OCGA § 9-3-90, “all persons who are legally incompetent because of intellectual disability or mental illness ... shall be subject to the periods of limitation for actions for medical malpractice provided in this article.” OCGA § 9-3-90(a) provides: “Individuals who are legally incompetent because of intellectual disability or mental illness, who are such when the cause of action accrues, shall be entitled to the same time after their disability is removed to bring an action as is prescribed for other persons.” 2 Specifically, we posed the following questions:
1. Did the Court of Appeals correctly determine that the
2 We conclude that Williams’s contentions are largely controlled
by Deen; that Deen was correctly decided; and that the contentions
she makes that were not addressed in Deen have no merit.
Accordingly, we affirm.
1. This Court reviews de novo a trial court’s ruling on a motion
to dismiss and construes the pleading being challenged, i.e., the
complaint, in favor of the party who filed it. Northway v. Allen, 291
Ga. 227, 229 (2012). So viewed, Williams’s complaint alleges that
her mother, Hewett, suffered a stroke and became permanently
disabled in early September 2020. She was treated at Atrium
Health and, on September 23, 2020, was discharged to Regency for
long-term care. Between September 23, 2020, and October 22, 2020,
Regency’s staff noted that Hewett was suffering from macroglossia,
petitioner’s claim here was the same as the plaintiff’s claim in Deen v. Stevens, 287 Ga. 597 (2010), such that it rejected the petitioner’s challenge on the ground that it was bound by Deen? 2. Does OCGA § 9-3-73(b) arbitrarily treat similarly situated mentally incompetent medical malpractice plaintiffs differently from incompetent plaintiffs in other kinds of lawsuits by not allowing the benefit of tolling to the medical malpractice plaintiffs in violation of the Equal Protection Clause of the United States Constitution? 3 or an enlarged tongue, and that the condition worsened over time.
On October 22, 2020, Hewett was transferred back to Atrium, where
she was admitted and a doctor documented that Hewett “had
sever[e] unalleviated chronic dental trauma to the tongue from
chewing and biting without deterrents at outside facility.” Hewett’s
tongue was amputated while at Atrium, and on December 9, 2020,
she was discharged to a different long-term care facility.
Williams was appointed as Hewett’s conservator and guardian
on August 2, 2022. On April 7, 2023, more than two years after the
medical care and injury at issue in the case, Williams filed suit
against Appellees, asserting claims for medical malpractice and
ordinary negligence. In her complaint, Williams alleged that the
statute of limitation was tolled until August 2, 2022, by OCGA § 9-
3-90. OCGA § 9-3-90(a) provides that “[i]ndividuals who are legally
incompetent because of intellectual disability or mental illness, who
are such when the cause of action accrues, shall be entitled to the
same time after their disability is removed to bring an action as is
prescribed for other persons.” Appellees filed motions to dismiss all
4 claims, arguing that the claims were barred by the two-year statute
of limitation for medical malpractice claims under OCGA § 9-3-
71(a); that OCGA § 9-3-90 was inapplicable; and that the “non-
tolling” provision of OCGA § 9-3-73(b) applied, citing this Court’s
holding in Deen.
In response to the motions, Williams argued that OCGA § 9-3-
73(b) violated Hewett’s equal protection rights under the United
States Constitution because the statute “treats mentally
incompetent Plaintiffs in medical malpractice actions differently,
and unequally, from mentally incompetent Plaintiffs in non-medical
malpractice actions.” While acknowledging that in Deen, this Court
held that OCGA § 9-3-73(b) did not violate the Equal Protection
Clause, Williams attempted to characterize her challenge to the
statute differently and argued that the rationale underlying Deen
“has been rendered constitutionally invalid as it is arbitrary, and
thus no longer serves a rational purpose.”
Specifically, Williams argued that the General Assembly’s
stated objectives of the non-tolling provision to “ensure its citizens
5 affordable access to quality healthcare” and to limit “the filing of
stale medical malpractice suits” are no longer “reasonably furthered
by discriminating against mentally incompetent medical
malpractice Plaintiffs” and that “empirical studies have
demonstrated that the effect of medical malpractice lawsuits on the
affordability of healthcare is ‘largely theoretical.’” Additionally,
Williams contended that the expert affidavit requirement for
professional malpractice actions, OCGA § 9-11-9.1, 3 and the five-
year statute of repose for medical malpractice actions, OCGA § 9-3-
71(b), serve the same purpose as OCGA § 9-3-73(b) (according to
Williams, the reduction of medical malpractice claims and the
corresponding benefit of ensuring affordable access to quality
healthcare), thereby rendering the latter statute unnecessary and
without a rational basis. Finally, Williams argued that given the
relatively small amount of medical malpractice cases involving
3 OCGA § 9-11-9.1(a) provides, in relevant part: “In any action for damages alleging professional malpractice ... the plaintiff shall be required to file with the complaint an affidavit of an expert competent to testify, which affidavit shall set forth specifically at least one negligent act or omission claimed to exist and the factual basis for each such claim.” 6 mentally incompetent plaintiffs, “OCGA § 9-3-73(b)’s limitation on
tolling of such cases could not logically reduce healthcare costs so as
to warrant disparate treatment.”
In its order granting the motions to dismiss, the trial court
determined that Williams’s constitutional challenge to OCGA § 9-3-
73(b) was foreclosed by this Court’s decision in Deen. The trial court
thus concluded that Hewett’s incapacity did not toll the statute of
limitation for her medical malpractice claims and that Hewett’s
claims were therefore barred. The trial court also ruled that none of
Williams’s claims sounded in ordinary negligence. 4
Williams directed her appeal to this Court, but we transferred
the case to the Court of Appeals. See Williams v. Regency Hosp. Co.,
LLC, 318 Ga. 145, 147 (2024). The Court of Appeals affirmed,
holding that Williams’s equal protection challenge to OCGA § 9-3-
73(b) was controlled by Deen and that it was bound by that decision.
4 The Court of Appeals affirmed the trial court’s ruling that Williams’s
claims did not sound in ordinary negligence. See Williams, 373 Ga. App. at 86– 89. Williams raised that issue in her petition for certiorari, but the Court did not grant certiorari on that question. Thus, we do not address it here. 7 See Williams, 373 Ga. App. at 85–86. We granted Williams’s petition
for certiorari, posing the questions above.
2. We first address whether Deen controls the outcome of this
case without any need for further analysis or whether Williams has
raised additional arguments that must be addressed because they
were not raised in Deen. We conclude that while Deen addressed and
rejected most of the arguments made by Williams and therefore
largely controls the outcome of this case, it did not address all of
them. We address and reject those arguments below.
“Duly enacted statutes enjoy a presumption of
constitutionality, and the party challenging the statute bears the
burden to show that the statute manifestly infringes upon a
constitutional provision or violates the rights of the people.” Taylor
v. Devereux Found., Inc., 316 Ga. 44, 52 (2023) (cleaned up). In Deen,
this Court held that mental incompetence is not a suspect
classification for equal protection purposes and therefore, applied
rational-basis review to the Deen plaintiff’s constitutional challenge
8 to OCGA § 9-3-73(b). Deen, 287 Ga. at 602–04. Williams concedes
that rational basis review is the correct standard here.
To evaluate whether OCGA § 9-3-73(b) violates the equal-
protection rights of mentally incompetent plaintiffs with medical
malpractice claims, as compared to mentally incompetent plaintiffs
with other types of civil claims, we apply the same standard that
was applied in Deen: “In areas of social and economic policy, a
statutory classification that neither proceeds along suspect lines nor
infringes fundamental constitutional rights must be upheld against
equal protection challenge if there is any reasonably conceivable
state of facts that could provide a rational basis for the
classification.” Deen, 287 Ga. at 604 (citation omitted). The critical
question is whether Williams has met her burden of showing that
“suspending the tolling provisions for mental incompetence in
medical malpractice cases is not rationally related to the General
Assembly’s stated objectives.” Id. at 605. See also Gliemmo v.
Cousineau, 287 Ga. 7, 12 (2010) (holding that the burden on a
plaintiff in an equal protection challenge is to show that “the
9 legislative facts on which the classification is apparently based could
not reasonably be conceived to be true by the government
decisionmaker.” (cleaned up)).
In Deen, the plaintiff, on behalf of herself and her mentally
incompetent husband, filed a medical malpractice action against her
husband’s endodontist more than two years after the husband had
received treatment. 287 Ga. at 598–99. The plaintiff argued that the
two-year statute of limitation for her medical malpractice claim
should be tolled under OCGA §§ 9-3-90(a) and 9-3-91 5 and that
applying the anti-tolling provision of OCGA § 9-3-73(b) violated the
Equal Protection Clause of the Fourteenth Amendment to the
United States Constitution and Article I, Section I, Paragraph II of
the Georgia Constitution of 1983 by arbitrarily discriminating
against mentally incompetent adults as a class. 287 Ga. at 599.
Applying rational-basis review, this Court held that the General
5 OCGA § 9-3-91 provides, in relevant part: “If any person suffers a disability specified in Code Section 9-3-90 after his right of action has accrued and the disability is not voluntarily caused or undertaken by the person claiming the benefit thereof, the limitation applicable to his cause of action shall cease to operate during the continuance of the disability.” 10 Assembly’s decision to not have a tolling provision for mental
incompetence in medical malpractice cases was rationally related to
its stated objectives of ensuring “affordable access to quality
healthcare” and “stem[ming] … the filing of stale medical
malpractice lawsuits.” Id. at 604–08 (citation omitted). We
accordingly upheld the constitutionality of the statute and rejected
the equal-protection challenge.
Williams attempts to distinguish Deen on the basis that it
focused on discrimination against mentally incompetent adults as a
class whereas her challenge is more narrowly focused on
discrimination against mentally incompetent plaintiffs in medical
malpractice cases. However, because our Court’s analysis in Deen
focused on the statute’s treatment of mentally incompetent adults
with respect to the very issue in this case (the non-tolling of the
statute of limitations in the medical malpractice context), this is a
distinction without a legal difference. We conclude that Deen is
virtually indistinguishable from this case and that the comparative
classifications are essentially the same in both cases – mentally
11 incompetent plaintiffs who assert medical malpractice claims versus
mentally incompetent plaintiffs who assert non-medical malpractice
claims. For this reason, we reject Williams’s argument that her
challenge is materially different than the challenge in Deen.
Deen also addressed and rejected other arguments that are the
same as the arguments Williams now makes. Although Williams
argues that “empirical studies have demonstrated that the effect of
medical malpractice lawsuits on the affordability of healthcare is
‘largely theoretical,’” the majority opinion in Deen declined to “wade
deeply into the ongoing debate over healthcare reform,” 287 Ga. at
605, emphasizing that as long as there is a rational basis for the
statute, these types of policy decisions fall within the purview of the
legislature and not the courts. Thus, the argument made by
Williams regarding the “largely theoretical” effect that medical
malpractice lawsuits have on health care costs was considered and
rejected in Deen. See 287 Ga. at 605 (“[W]e do not determine whether
medical malpractice lawsuits are a significant driver of rising
healthcare costs, nor whether tort reform has proved effective at
12 improving access to quality care”).
In addition, Williams argues that the expert affidavit
requirement for professional malpractice actions, OCGA § 9-11-9.1,
and the five-year statute of repose for medical malpractice actions,
OCGA § 9-3-71(b), serve the same purpose as OCGA § 9-3-73(b) by
reducing the number of medical malpractice claims and ensuring
affordable access to quality healthcare and that these statutes
therefore render OCGA § 9-3-73(b) unnecessary and without a
rational basis. However, Williams’s contentions regarding the
statute of repose’s effect on the constitutional analysis were likewise
considered and rejected in Deen. The Deen majority squarely
rejected the assertion that the statute of repose fulfilled the General
Assembly’s goal of preventing stale medical-malpractice claims and
rendered OCGA § 9-3-73(b) without a rational basis, stating: “[T]he
dissent would find that allowing the mentally incompetent only two
years to file a medical malpractice action is utterly ‘arbitrary and
unreasonable,’ ... but allowing them only five years to file suit is just
fine. Under rational basis review, such line-drawing is the work of
13 legislators, not judges.” Deen, 287 Ga. at 607. The majority opinion’s
analysis of this issue in Deen controls, and Williams has provided us
with no reason to depart from it here.
3. Williams’s argument concerning the effect of OCGA § 9-11-
9.1 was not addressed by Deen. Therefore, we address it now to
resolve her Equal Protection challenge. Williams contends that the
expert affidavit requirement found in OCGA § 9-11-9.1 undercuts
the stated objective of OCGA § 9-3-73(b)’s non-tolling provision,
presumably because both statutes are designed to reduce the
number of medical malpractice actions that are filed in Georgia,
thereby furthering the legislative goal of ensuring affordable access
to quality healthcare. Williams’s argument appears to be that
because OCGA § 9-11-9.1 restricts the filing of professional
negligence actions by generally requiring that they be accompanied
by an expert affidavit, OCGA § 9-3-73(b)’s additional restriction on
the filing of medical malpractice actions (specifically, its non-tolling
provision) is without a rational basis. We reject this contention and
14 conclude that Williams’s equal protection challenge to OCGA § 9-3-
73(b) fails. 6
The expert affidavit requirement is not new. OCGA § 9-11-9.1
was originally enacted as part of the Medical Malpractice Act of
1987, well before this Court’s decision in Deen. 1987 Ga. Laws, p.
887 et seq. Moreover, the fact that the General Assembly has chosen
to incrementally address what it perceives to be a problem by taking
multiple approaches to address the same issue – in this case, its
desire to ensure affordable access to quality healthcare by placing
restrictions on medical malpractice claims – does not necessarily
mean that one or more of the approaches is not rationally related to
a legitimate government objective. See Deen, 287 Ga. at 605
(applying rational basis review and noting that the General
6 Additionally, Williams argues that her challenge to OCGA § 9-3-73(b)
differs from that made in Deen due to a change in societal views of the mentally incompetent since Deen was decided, suggesting that we should treat the mentally incompetent as a suspect class for purposes of our equal protection analysis. However, because this issue was not raised before the trial court, we do not answer it. See RCC Wesley Chapel Crossing, LLC v. Allen, 313 Ga. 69, 72 n.4 (2021) (after granting certiorari, declining to address issues not raised in the trial court or the Court of Appeals).
15 Assembly, “concerned about the proliferation of medical malpractice
suits and their adverse impact on the quality of healthcare, is
lawfully permitted to fashion a partial solution to a far more general
problem” (cleaned up)).
Williams has not cited any case where this Court, or any other
court, has held that a legislative solution is not rationally related to
a legitimate government objective simply because there may be
other viable approaches to address the problem or simply because
there may be another, broader, and perhaps even “better” solution
to the problem. These are policy decisions which the General
Assembly is uniquely situated to address, and under federal rational
basis review, courts may not substitute our policy preferences for
theirs. See Deen, 287 Ga. at 606 (“It is not the role of the courts,
however, to weigh those policy arguments and decide on that course
which is most prudent; instead, it is quite enough to note the
existence of a viable, ongoing debate and to find … that the General
Assembly’s approach to a particularly thorny legislative problem—
embodied in its statutes of limitations—is rational.” (cleaned up)).
16 Thus, like the plaintiff in Deen, Williams has failed to meet the high
burden required to demonstrate that the statute is unconstitutional.
We therefore conclude that Deen largely controls Williams’s
constitutional challenge to OCGA § 9-3-73(b); that the expert
affidavit requirement found in OCGA § 9-11-9.1 does not change the
analysis or aid Williams’s position; and that Williams has not met
her burden of showing that OCGA § 9-3-73(b) is not rationally
related to a legitimate legislative objective. For these reasons, we
affirm the judgment of the Court of Appeals.
Judgment affirmed. All the Justices concur.