Liability Reforms Helping Sick and Injured Texans

Prop 12 Anniversary Survey Shows More Texas Doctors Now Offering More Services


Contact: Pam Udall 
phone: (512) 370-1382 
cell: (512) 413-6807

Contact: Brent Annear 
phone: (512) 370-1381 
cell: (512) 656-7320 
Brent Annear 

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Sick and injured Texans now have more physicians who are more willing and able to give them the medical care they need, closer to home thanks to the state's 2003 health care liability reforms, according to the results of a new survey the Texas Medical Association (TMA) released today.

"This week marks the third anniversary of the liability reforms and Proposition 12," said TMA President Ladon W. Homer, MD, a pathologist from Fort Worth. "This is our 'anniversary present' to the people of Texas: The reforms have worked. They've lived up to their promise."

The online survey of 1,154 physician members of TMA found that since September 2003:

  • Doctors find it much easier to recruit new physicians to their communities, even among high-risk specialties and in the "lawsuit war zones" of south and east Texas.
  • Texas physicians are much more likely to accept patients with complex or high-risk problems, and many feel comfortable offering their patients new services.

"From the Uvalde family physician who is still delivering babies to the Tyler ophthalmologist providing charity care to the huge Houston clinic that has invested millions in a state-of-the-art electronic medical record system, Texas physicians rushed to tell us how the liability reforms have helped them help their patients," Dr. Homer said.

"As it should be, Texas physicians' No. 1 challenge is how to cure the patient, not how to avoid a frivolous lawsuit," he said.

In 2003, the Texas Legislature responded to the state's health care liability crisis by enacting new laws intended to reduce the number of meritless lawsuits filed against physicians and hospitals. The lawsuits and jackpot-sized judgments had led physicians' professional liability insurance premiums to skyrocket. As a result, many doctors reported they were drastically reducing their services, especially for the most severely sick or injured Texans, or were planning early retirement.

The centerpiece of the reforms was a $750,000 cap ($250,000 for physicians, $250,000 for the first hospital or health care facility, and $250,000 for any additional facilities) on judgments for noneconomic damages, such as pain and suffering, in health care liability cases. There is no cap on actual damages such as medical bills or lost income. The new law took effect Sept. 1, 2003. On Sept. 13, 2003, Texas voters approved Proposition 12 in a statewide constitutional election, ratifying the legislature's authority to adopt the caps.

"The 2003 liability reforms were good medicine, the right medicine, for Texas," Dr. Homer said. "Gov. Rick Perry, the Texas Legislature, and the voters reined in the epidemic of health care lawsuit abuse. We now have a much healthier and robust system that is much better able to give Texans the medical care they need."

The Texas Medical Board is anticipating a record 4,500 applications for new physician licenses this year. That is more than 40 percent greater than in 2005, which had been the board's busiest year on record. Texas Medical Board Executive Director Donald Patrick, MD, JD, says the success of Texas' liability reforms is the "only one viable hypothesis" to explain the huge increase.

The TMA survey bolsters that analysis. Of the 117 survey respondents who were not practicing in Texas in September 2003, 90 percent say the Texas professional liability climate was "very important" or "somewhat important" in their decision to begin practicing in Texas. And 83 percent say the current liability climate for physicians in Texas is "much better" or "better" than the state from which they came.

The Texas Alliance for Patient Access has documented many of the healthy benefits  of the 2003 reforms. For more details on the liability crisis and the impact of the reforms, see the TMA Professional Liability Insurance Reform Resource Center .

The following physicians are willing to share with the news media the details of how liability reform has helped them better care for their patients. Please contact TMA Media Relations to arrange an interview or to obtain a regional breakdown of survey findings.

  • A family physician from San Antonio who kept his vow to resume volunteering on Saturdays at a community health clinic in rural South Texas if Proposition 12 passed. He provides care for patients with no insurance or who are on Medicaid.
  • An emergency medicine specialist in Houston who says the reforms allow his group practice to perform less "defensive medicine," conserving precious health care resources for those who need them the most. With lower liability insurance premiums, the group also is able to provide more care to uninsured patients in the emergency room. Another emergency physician in Houston says his emergency room is now able to provide coverage from nearly all medical specialties.
  • An El Paso surgeon who says he has been able to recruit two neurosurgeons and other specialists to that medically underserved urban area.
  • An ophthalmologist in Tyler who now provides more charity care, including free exams to residents of homeless shelters and evacuees from Hurricane Katrina.
  • A family physician in Uvalde who "was rescued from giving up practicing in obstetrics" by the liability reforms. He is looking forward to delivering his 4,000th baby.
  • The managing physician of a large multispecialty clinic in Houston who says his group used its savings from liability insurance premiums to purchase a comprehensive electronic medical record system. Such systems improve patient care, improve patient safety, and increase the efficiency of medical practices.
  • An orthopedic surgeon in Beaumont who says his community now is able to provide wide-ranging medical services locally rather than having to transfer severely sick or injured patients to hospitals 100 miles away. He reports Beaumont has seen tremendous improvements in its ability to recruit physicians to serve in what some consider a "lawsuit war zone."
  • A Dallas urologist whose practice serves all types of patients, "from CEOs to people who live under bridges," who reports that he can now care for many more uninsured or underinsured patients.
  • An Austin family physician who decided to buy a new office and stay in private practice for 15 more years.

Other key findings from the survey include the following:

Texas physicians say the 2003 liability reforms have made it much easier for them to recruit new physicians to their communities, even among high-risk specialties.  

  • Compared with TMA's 2004 survey results, more physicians (45 percent vs. 37 percent) have tried to recruit new physicians to their practice, hospital, or community.
  • 87 percent of those who tried to recruit found the recruitment process easier since 2003. Only 13 percent found it more difficult. That compares with 2004, when 39 percent found it easier and 34 percent more difficult to recruit.
  • While fewer than one-quarter of the respondents who tried to recruit new physicians said they tried to recruit certain high-risk specialists, those who did try were extremely successful:
    • Emergency medicine specialists - 94 percent successful,
    • Obstetricians - 94 percent successful,
    • Orthopedic surgeons - 94 percent successful,
    • Pediatric subspecialists - 88 percent successful,
    • Neurosurgeons - 84 percent successful, and
    • Trauma surgeons - 84 percent successful.

Since the 2003 liability reforms and the passage of Proposition 12, Texas physicians are much more likely to accept high-risk patients and offer new services or procedures.  

  • About one in six (16 percent) of respondents say they now accept complex or high-risk cases they previously referred or denied. That is four times the 4-percent figure reported in the 2004 survey.
    • 81 percent said the improved liability climate played a "very important" role in their decision to begin accepting complex or high-risk cases. That compares with 73 percent in the 2004 survey.
  • Only 7 percent of respondents say that they have begun denying or referring high-risk cases since 2003. That compares with 20 percent in the 2004 survey. In TMA's prereform survey of March 2003, 62 percent said they had begun denying or referring complex or high-risk cases in the previous two years.
  • 23 percent of respondents say they have started providing new services to their patients since Sept. 1, 2003. That compares with only 9 percent who reported offering new services as of the one-year anniversary of Proposition 12.
    • The improved liability climate is largely responsible for the new services. 87 percent of respondents this year - vs. 77 percent in 2004 - say the perceived or expected change in the liability climate was a "very important" or "somewhat important" factor in their decision to offer new services.
  • Only 7 percent of respondents say they have stopped providing certain services to their patients since Sept. 1, 2003. That compares with 13 percent in the 2004 survey. In TMA's prereform survey of March 2003, 51 percent said they had stopped providing certain services to their patients in the previous two years.

The professional liability climate for Texas physicians has improved significantly since the passage of the 2003 liability reforms and Proposition 12.  

  • 67 percent of respondents rate the current liability climate for physicians in Texas as "excellent" or "good."
  • 90 percent of respondents rate the professional liability climate for physicians in Texas today as "much better" or "better" than it was in 2003.
  • 85 percent of respondents "strongly agree" or "agree" that compared with 2003, they now feel more comfortable practicing medicine in Texas in the manner in which they were trained.
  • 28 percent of those physicians with the same liability insurance protection and practicing in the same region of Texas say their annual professional liability insurance premiums have dropped by more than 20 percent since 2003. And half say their premiums declined by up to 20 percent. Only 10 percent reported their premiums had increased.

Survey technical details:  

The online survey measuring physicians' attitudes and practice habits was conducted from Aug. 22 to Aug. 30, 2006 and 1,154 completed responses were received. Invitations to participate in the survey were sent via e-mail to 10,000 randomly selected physician members of TMA. Of those e-mails, 9,442 were delivered to the potential respondents' e-mail address. The response rate was 12.2 percent. The survey results accurately reflect the opinions of Texas physicians in general, with an overall margin of error for questions answered by all respondents of plus or minus 2.8 percent

TMA is the largest state medical society in the nation, representing more than 41,000 physician and medical student members. It is located in Austin and has 120 component county medical societies around the state. TMA's key objective since 1853 is to improve the health of all Texans.

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