Marilyn Tennissen Jul. 30, 2013, 12:20pm

Ten years ago, Texas had one of the lowest doctor-to-citizen ratios in the country. But after reforms to the state’s civil litigation system, the number of licensed physicians in Texas has doubled, according to a recent report on the results of tort reform.

The Texas Public Policy Foundation Center for Economic Freedom recently released “Ten Years of Tort Reform-A Review,” which looks at the decade since the state passed House Bill 4, which revamped the civil justice process for medical malpractice claims.

The report, authored by senior fellow Joe Nixon, summarized the reforms as a success. The findings show that the number of doctors in Texas has doubled in 10 years, and that the rate of physician growth is two times the rate of the state’s population growth, the report states.

Nixon gives an example of the Memorial Hermann Healthcare System, which added 26 pediatric subspecialists in one year, whereas a typical year before reforms would add one or two pedes subspecialists.

The report gives a historical overview of the state of the Texas medical malpractice system as it was in 2003, before HB 4’s passage. According to Nixon, one in four Texas doctors had a malpractice claim each year, and although 85 percent of the claims failed, the cost to defend the suits still cost the doctors more than $50,000 to defend. The costs were so high, that between 2000 and 2003, the number of insurers dropped from 17 to only four, including the State of Texas as the insurer of last resort.

In addition to medical liability, there were problems in other areas of civil jurisprudence. In class actions, trial court judges had wide latitude in certifying the class. Once a class was certified, defendants almost always settled.

In 2003, the Texas House of Representatives had a Republican majority for the first time since Reconstruction, and Republican Gov. Rick Perry declared medical malpractice reform to be an emergency.

The result was legislation that included common sense reforms, according to Nixon’s report, like allowing juries to hear more evidence about who may really be at fault, having only those that caused harm pay for damages and only to the extent of their fault and limiting damages to what the actually plaintiff paid or incurred thus eliminating “phantom damages.”

In medical malpractice cases, HB 4 provided for an expert report by a physician in the same field as the defendant to be submitted within 120 days. The expert report will clearly identify the standard of care and how the defendant violated the standard.

And most importantly, non-economic damages were capped at $250,000.

The report said the bill was debated in the House for eight days, “the longest debated bill in the history of the state.” It finally passed the House with 98 votes in favor, and made it through the state Senate with 27 in favor. Gov. Rick Perry signed the bill into law on June 11, 2003.

Nixon gives examples of positive results since then, including the city of El Paso. The south Texas city has added 200 physicians in the past 10 years, with many in much needed specialties like orthopedics, emergency medicine, pulmonology, pediatrics, internal medicine, anesthesiology, family medicine, oncology and pediatric cardiology.

He points out that not only have the number of physicians grown, but so have the facility expansion projects. Statewide there have been more than $10 billion spent on expanding facilities such as Texas Children’s Hospital.

The reforms have worked, Nixon wrote, and Texas today is home to more Fortune 500 companies than any state except California.

He concludes by urging Texans to stay vigilant, as many members of the plaintiffs bar still want to undo the reforms.

A copy of the report can be found at

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