Doctors laud 5 years of malpractice relief
By Vic Kolenc
EL PASO — Doctors here and across Texas said dollar limits on medical malpractice lawsuits put into state law five years ago have made a big difference in how they practice medicine.
The reduced threat of frivolous malpractice lawsuits have made doctors more willing to accept high-risk patients, and have helped bring more doctors into Texas, including to El Paso, the Texas Medical Association found in a recent online survey of 1,391 Texas doctors.
Almost 90 percent of the doctors responding to the survey said they felt more comfortable practicing medicine in Texas now than before medical liability laws changed in September 2003, the TMA reported.
“It definitely takes off a big weight. I can take care of patients without worrying that anything could lead to a lawsuit,” said Dr. Luis Linan, 48, an El Paso obstetrician-gynecologist who had three lawsuits filed against him in his 13-year-old practice. No lawsuits have been filed against him since the new laws took effect in 2003, he said.
The reduced liability exposure has allowed Linan to “take care of higher-risk patients rather than send them out” to a specialist as he was doing before the laws changed, he said. That allows patients to get more-complex care more quickly, he said.
The new laws put a $750,000 cap ($250,000 for doctors, $250,000 for the first hospital or other health-care facility and $250,000 for any additional health-care facilities) on lawsuit judgments for non-economic damages, such as pain and suffering. There is no cap on actual damages, such as medical bills or lost income.
Jay Harvey, past president of the Texas Trial Lawyers Association, said the limits have reduced the number of medical mal-
practice lawsuits because the cost of preparing complex medical malpractice lawsuits exceeds what people can recover.
“This is only hurting people badly injured” by medical malpractice, Harvey said. “A number of states have not enacted caps on lawsuits, and insurance rates have gone down there just like in states with caps.”
Linan’s liability insurance costs have been reduced from $32,000 a year to $18,000 a year, a 44 percent decline. The reduced costs have allowed him to buy equipment and expand medical procedures done in his practice, he said.
The Texas Medical Liability Trust, the state’s largest medical liability insurance provider, has reduced insurance rates for Texas doctors every year since the new laws took effect, it reported. Doctors insured by the trust will have saved $380 million in insurance costs since 2003 after the latest rate reductions take effect in January, the trust reported in a news release.
Dr. Dino Saracino, 51, said he moved his general surgery practice from Bedford, Pa., to El Paso in 2005 because of the growing cost of medical liability insurance in Pennsylvania.
His insurance cost dropped from $96,000 a year in Pennsylvania to $20,000 a year in El Paso, nearly an 80 percent decline.
“When you know you have to come up with $8,000 a month” for insurance costs alone, then “low-reimbursed procedures get removed” from the practice and high-risk cases have to be referred elsewhere, Saracino said. He had two lawsuits filed against him while practicing medicine in Pennsylvania for 20 years, Saracino said.
“I am able to take care of sicker patients (in El Paso) because I don’t have the high cost of malpractice insurance,” Saracino said.
“Ninety-four percent of physicians trained in Pennsylvania leave” the state because of the malpractice insurance crisis there, Saracino said.
Texas has recently seen a surge of new doctors coming into the state. The Texas Medical Board issued a record number of new licenses for doctors in the past two years: 3,621 in fiscal year 2008, which ended Aug. 31, and 3,324 in fiscal year 2007.
The number of licensed doctors in Texas has increased by 8,836 doctors since May 2003, an increase of 17.5 percent, board data show. Texas had 59,385 licensed doctors in May.
“The increase in applications did come after tort reform, but other things also could have played a factor,” said Patrick Shaughnessy, a spokesman for the Medical Board in Austin. “We do not ask doctors why they want a Texas license.”
El Paso has added 132 doctors since May 2003, an increase of 15 percent, board data show. El Paso had 1,029 licensed doctors in May.
“El Paso is adding doctors at a clip much faster than pre-reform years, and the state is picking up steam at a record pace in the last two years,” said Jon Opelt, executive director of the Texas Alliance for Patient Access, a statewide coalition of doctors, hospitals and malpractice insurance carriers that lobbied to get medical liability reforms passed by the state Legislature.
El Paso’s doctor growth rate increased from 8.2 percent for May 1999 to May 2003 to 14.5 percent for May 2003 to May 2007, the Texas Alliance calculated. The statewide growth rate rose from 15.3 percent to 15.7 percent in those periods, it reported. An understaffed Medical Board slowed doctor licensing in 2005 and 2006, Opelt said. The board’s staff was increased and its license backlog erased this year.
Harvey, at the Trial Lawyers Association, said, “Empirical studies have shown that the increase in doctors is expected because the population in Texas is increasing.”
Dr. David Taber, an El Paso urologist and president of the El Paso County Medical Society, said that tort reform has helped bring more doctors to El Paso and other areas of Texas, but that Texas continues to be one of the worst states in the nation for doctor-patient ratios. El Paso and the rest of the border continue to have the lowest doctor-patient ratios in Texas, he said.
Medicare reimbursements are lower along the border than other areas of Texas and that hurts doctor recruitment here, Taber said.
Much of El Paso County is still designated as a medically underserved area by the Texas Department of State Health Services.
The population growth projected from Fort Bliss expansion won’t help El Paso improve its doctor-patient ratios, Taber said.
But, Taber said, patient accessibility to doctors has improved since 2003 because more doctors are willing to see higher-risk patients and more doctors are now willing to provide some free medical services to indigent people.
The Texas Hospital Association also reported last week that a survey of 10 independent hospitals and 10 health-care systems representing 176 Texas hospitals found that tort reform significantly dropped insurance costs at many hospitals and made it easier to recruit medical specialists.
Lupe Rodriguez, administrative director of risk management and medical staff services at Las Palmas Medical Center in El Paso, said in an e-mail that the hospital has not seen its medical liability insurance costs decline after the state’s tort reform.
“In the future, I think we will see less frivolous suits,” Rodriguez wrote. However, she said, more nurses are being named in lawsuits, instead of just the entire hospital, as a way of increasing the amount of total damages that could be collected.
Vic Kolenc may be reached at firstname.lastname@example.org, 546-6421
For more information: www.texmed.org
Some findings from survey on how Texas tort reforms enacted in 2003 have affected Texas doctors:
Source: Texas Medical Association online survey of 1,391 Texas doctors.
Annual medical liability insurance costs for El Paso doctors covered by the Texas Medical Liability Trust in selected specialties in 2003 and on Jan. 1, 2009.
Note: Rates based on policy covering $500,000 single claim and $1 million aggregate claims.
Source: Texas Alliance for Patient Access