Should a woman who lost four limbs to malpractice collect more than $750,000 for her suffering?

Wisconsin's burgeoning $1.4 billion insurance fund for doctors and state-mandated caps on damages in malpractice cases will go on trial Thursday when the state Supreme Court wrestles with the question of whether a woman who lost all four limbs to malpractice should collect millions of dollars for pain and suffering.

"It's a remarkably fascinating case," said Peter Rofes, a Marquette University law professor. "This case serves as the next exceedingly important moment in the constitutional battle of (medical malpractice) caps in the state of Wisconsin."

The narrow question before the seven justices is whether Ascaris Mayo, who at age 50 had all four limbs amputated as the result of medical malpractice, should receive the full $25.3 million that a Milwaukee County jury awarded her and her husband in 2014.

At issue is the $16.5 million awarded to the Milwaukee couple for pain and suffering and the loss of companionship — the portion known as non-economic damages. The remainder of the award is for economic damages, such as past and future medical and related costs.

RELATED: No Relief | Medical malpractice lawsuits plummet in Wisconsin

RELATED: No malpractice lawyers will take case in death of Wisconsin baby

RELATED: Grieving father urges lawmakers to reform medical malpractice laws

The defendants, led by the state's mammoth Injured Patients and Families Compensation Fund, argue the non-economic award should be limited to $750,000, the state-mandated cap on non-economic damages in medical malpractice cases. The health of the $1.4 billion fund and much of Wisconsin's health care system is dependent on keeping the caps in place, they argue.

"We have a system that is working very well for the health care community and all patients," said John Rather, general counsel at the Wisconsin Medical Society.

The Mayos argue the cap is unconstitutional and that it punishes the most severely injured patients like Ascaris Mayo — a mother of four who was an active community and church member and played numerous musical instruments.

"The sole issue is the constitutionality of the cap," said Daniel Rottier, Mayo's attorney.

The case, which will be argued Thursday, has attracted widespread attention. More than a dozen groups, including those representing doctors, lawyers, insurance companies and businesses, have joined in friend of the court briefs that have flooded the justices' chambers.

"It is the most significant medical liability case in at least a decade," Rather said.

Attorney General Brad Schimel is going so far as to ask the Supreme Court to make the cap bullet-proof.

The court should "hold that the amount of the cap is quintessentially legislative judgment, which courts have no authority to second-guess," states the AG's brief written by Misha Tseytlin, state solicitor general.

The case started in 2011 when Ascaris Mayo went to Columbia St. Mary's Hospital in 2011 complaining of severe abdominal pain, a rapid heartbeat and a fever.

Medical personnel did not diagnose her Strep A infection — the kind that causes strep throat — which ultimately led to septic shock and sepsis. She was not offered antibiotics to treat the infection.

Instead, she was discharged after nine hours and told to contact her gynecologist.

The following day, she went to a second hospital where doctors correctly diagnosed her condition.

By then it was too late.

"Her sepsis went unchecked, resulting in a 'medical tsunami' making nearly every organ fail and causing dry gangrene in her extremities," Mayo's attorney, Susan Tyndall, wrote in a brief. Mayo was comatose for about a month and "gangrene caused her extremities to 'mummify,' turning them hard, brittle and black."

A jury in 2014 did not find negligence. Rather, they found that Wyatt Jaffe and Donald Gibson, the physician and physician's assistant who treated her at Columbia St. Mary's, failed to tell her about the availability of antibiotics, Tyndall noted.

RELATED: Wisconsin's cap on medical malpractice awards unconstitutional, court rules

Milwaukee County Circuit Judge Jeffrey Conen upheld the overall constitutionality of the cap but ruled the Mayos should collect the full jury award because the cap was unconstitutional as applied in the Mayo case.

A state appellate court last year took Conen's decision a step further and ruled the cap was unconstitutional.

Rottier argues the caps affect few patients. "Maybe three or four cases are impacted by the cap," Rottier said. "But they're each impacted in a very serious way."

Adds Michael End, a Milwaukee malpractice lawyer who co-authored a friend of the court brief for the trial lawyer's association: "All it's doing is screwing the handful of people who are the most badly injured."

The Mayos, for example, will receive less than 5% of the money for non-economic damages that the jury said they deserved if the court allows the caps to survive.

Proponents say the caps and the strength of the state Injured Patients and Families Compensation Fund fund are a reason that high-quality physicians stay in Wisconsin. Besides, they argue, Wisconsin malpractice victims are guaranteed to receive every dime awarded them for economic damages — that is, past and anticipated costs for medical care and related treatment.

RELATED: Jury awards Milwaukee woman $25.3 million in medical malpractice case

"This is the only state where every cent for economic damages" is guaranteed, Rather said. Physicians must carry $1 million in malpractice insurance and the state-managed fund covers all economic damages above that amount.

The fund has paid the Mayos' $9 million economic award plus $750,000 for pain and suffering. About $2.4 million went to legal fees and expenses, Rottier said.

"The cap is an integral part of a comprehensive and carefully balanced system the Legislature began constructing in 1975 to ensure the affordability and availability of quality health care," Kevin St. John, the fund's attorney, wrote in a Supreme Court brief.

St. John, Wisconsin's deputy attorney general from 2011-'15, added that "by striking down the cap, the appellate court put the system in jeopardy."

Cap opponents argue the fund has become an embarrassment of riches and could cover any potential damage awards even if the cap were lifted. The fund is sitting on a $1 billion surplus, meaning that if it paid every pending and anticipated claim it would still have that amount in the bank, state records show.

In 2016 just two people were paid by the fund and only one person was paid last year, according to state statistics cited in End's trial lawyer's brief.

Premiums paid by physicians have dropped each fiscal year since 2014, records show. It dropped by 34% in 2016, 30% last year and is set to fall by another 30% in the fiscal year that begins in the summer.

The fund "is likely overfunded for the risks" it faces, said Michael Matray, editor of the Medical Liability Monitor, a trade publication for the malpractice insurance industry.

Rather and other cap proponents argue that a few large awards could still drain the fund if the caps were not in place.

Not likely, argue cap opponents, who point to the dwindling number of malpractice cases that are even filed.

Few lawyers are willing to take the cases because they are expensive to bring and because physicians win nine out of every 10 cases that go to trial, according to industry records.

In Wisconsin there were 116 requests for mediation filed in medical malpractice cases, down from 251 in 2000 and 410 in 1987, state records show. State law requires people to file for mediation before they could file a medical malpractice suit.

Despite the size of the insurance fund and the dwindling number of claims, Rofes, the Marquette professor, sees little chance of the court, which is dominated by conservative justices by a 5-2 margin, striking down the caps.

The court today is seen as more conservative than it was in 2005 when it struck down an earlier cap on a 4-3 vote. That cap was replaced a year later by the $750,000 ceiling.

The odds of that occurring are "probably longer odds than they were for Loyola making it to the Final Four," Rofes said, referring to the small Chicago university that did just that in the NCAA basketball tournament.

The professor said the court will either keep the caps in place or follow Conen's lead and allow the Mayos to collect the full award by saying the caps are unconstitutional as applied to their case.

No matter how the justices rule this year, this year's decision will not end the issue, Rofes said.

"The cap controversy has taken on sort of a proxy function in political, constitutional law and culture," Rofes said. No decision by the court in the Mayo case "will permanently end the politics of the cap. ... The justices are going to be answering the same questions again."