Sept. 10, 2018
In the 15 years this month since Texas passed landmark medical liability reform, the state’s patients have enjoyed greater access to physicians’ care, as more doctors practice medicine throughout the state. House Bill 4, the Medical Malpractice and Tort Reform Act, and passage of Proposition 12, a constitutional amendment, lessened the likelihood of frivolous lawsuits against physicians and hospitals. HB 4 took effect on Sept. 1, 2003, and the same month, Texas voters approved the amendment to the Texas Constitution that authorized the state legislature to limit noneconomic damages in health care liability cases. Physicians say the strength of the two acts empowered physicians to provide better care for their patients, and it has attracted more physicians to Texas.
Before passage, many Texas doctors commonly were sued in cases without merit. So many suits were filed that TMA Immediate Past President Carlos J. Cardenas, MD, called it the “lawsuit bonanza for the trial bar.” Parts of Texas saw 300 medical liability suits filed for every 100 physicians during the peak before reform, according to one report. While the vast majority of those suits were unsuccessful, the report says, defending them still cost physicians thousands of dollars and time away from seeing patients. Some doctors could not buy liability insurance, as only four carriers remained in the state. Many doctors left Texas to practice elsewhere. Reform changed all that. First, the number of lawsuits without merit dropped. “Those frivolous lawsuits, by and large, are no longer occurring, because the system is now fair and balanced,” said Austin internal medicine physician Howard Marcus, MD. “We understand that it’s our job to practice good medicine. We don’t need a lawyer to tell us that, or the threat or intimidation … of a lawsuit for that.” Soon Companies started selling medical liability insurance again, and premiums became reasonable. Doctors returned at record rates to care for patients in all parts of the state.HB 4 sets a $250,000 limit on noneconomic damages against individual physicians, and a total noneconomic cap of $750,000 if health care institutions are found liable. The law features other crucial protections, such as providing personal immunity to physicians working for governmental entities, including state medical schools. Under HB 4, there is no cap on a patient’s economic damage claims.
In the 15 years since HB 4 became law, the number of licensed physicians in Texas has nearly doubled, September’s Texas Medicine magazine reports. In 2017, Texas set a record for new medical licenses, at almost twice the number issued during 2003. Plus, more specialists are practicing in communities where they’re needed. Without the threat of frivolous legal action, it’s easier for physicians to obtain liability coverage in Texas than in other states. Six of eight medical specialties saw a statewide increase in physicians per capita since tort reform passed, according to a 2017 post-tort reform study by the Texas Alliance for Patient Access (TAPA). TAPA says emergency medicine had the highest increase in number of physicians at 120 percent.
Justin Hensley, MD, an emergency physician and president of the Nueces County Medical Society, moved to Texas with his wife, pediatrician Katherine Hensley, MD — because of the state’s reforms. They treat patients who might have had trouble finding care in 2003. “It’s no longer just me; it’s the people that I supervise. They’re touching people every day,” said Dr. Justin Hensley. “They’re seeing people in every situation, from car wreck to heart attack to children [nearly] drowning, and things like that. Knowing that I’m protected from frivolity has made me really improve our protocols and our standards for pre-hospital medicine.”
Dr. Katherine Hensley agreed it’s not just better access to doctors’ care; it’s also an improvement in care quality. “It allows us to make decisions based on what’s actually best for our patients, and not what’s going to keep us out of court,” she said.
Preserving medical liability reform is a continuing battle. The law passed over the opposition of trial lawyers, and since 2003, plaintiff attorneys have fought the law both in the courthouse and at the Capitol. Efforts to weaken it legislatively have failed, and it has withstood numerous court challenges as well. It was worth the fight, said Dr. Cardenas. “What we ended up with was what’s been declared some of the best tort reform laws in the country. It’s created the ability for us to recruit in our state and retain in our state the physicians and talent that we need in different areas in our state — both rural and urban.”
TMA is the largest state medical society in the nation, representing more than 51,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.
Contact: Brent Annear (512) 370-1381; cell: (512) 656-7320; email: brent.annear[at]texmed[dot]org
Marcus Cooper (512) 370-1382; cell: (512) 650-5336; email: marcus.cooper[at]texmed[dot]org
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