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Texas

Recent Reforms Enacted (since 2003) Caps on non-economic damages are: $250,000 per physician per claimant, $250,000 per health care institution per claimant, and a second $250,000 per health care institution per claimant if the second institution is completely separate from the first. Periodic payments are mandatory for future medical expenses and discretionary for others. If either party in a medical lawsuit makes a reasonable settlement offer which is rejected, and the rejecting party loses the court judgment, the rejecting party may be liable for the offering party’s attorney fees and court costs. Plaintiff attorneys must file a report from an expert substantiating their charges within 90 days of filing the suit. Emergency care protection. (2003)
Emergency Care Provision In emergency care cases, the claimant bringing the suit may prove that the treatment departed from accepted standards of care only if the claimant shows by a preponderance of the evidence that the physician, with willful and wanton negligence, deviated from the degree of care and skill reasonably expected of prudent physician in the same/similar circumstances. Juries must also be instructed in such cases to consider factors including the availability of medical history, whether a physician patient relationship existed and the nature of the emergency.
Reform Elements In Law $250K Cap
Periodic Payments
Affidavit of Merit
Joint Liability
Expert Witness
Willful and Wanton negligence standard in emergency care cases
Constitutional Status of Reforms Constitutional amendment passed ensuring right of the legislature to cap noneconomic damages. (2003)
Change in Insurance Rates TMLT cut rates by 12% after liability reform enactment, and reduced rates again by 5% in 05 and 06.  APIE announced a 13% rate cut in August of 05 after a 5% cut 6 months earlier.  Doctors Company announced a 9 to 14% cut effective May of 05. JUA  cut rates by 10% in 05.  In 05,  TMA reported every carrier had cut rates since reform, saving doctors $50M in premiums.  TMLT rate trends available at http://www.texmed.org/Template.aspx?id=3868  The NY Times reported in October 2007 that average rates fell 21.3% since reforms. In July 2009, Medicus announced an 11% rate cut in its 3rd year in TX, including large cuts for emergency medicine.
Insurance Availability The Texas Department of Insurance reported that there were 17 insurers writing policies in 1999, which fell to 4 in 2002. As of February of 2005, news reports stated that 15 new insurance companies have started selling malpractice insurance in Texas or would do so soon.
Change in Physician Availability From May 2003 to August 2005, more than 3000 physicians established practices in the state, according to the TX Tech Law Review.  TAPA says more than 600 new physicians began practicing in TX in the two years after reforms.   TMA says more than half of physicians reported stopping some high risk services in 2003.  By 2005, that dropped to 13%.  In 2006, new physician applications jumped to 4,026, up 35 percent from 2005, according to the Texas Medical Board, with applications increasing by about 100% since reforms were passed in 2003. According to an October 2007 New York Times article, the growth in physicians from 2001 to 2005 was twice as high as the growth in population.   The Office of Rural Community Affairs and other sources revealed that 82 counties had a net gain in EPs from 2003 to 2008, including 43 medically underserved counties and 26 counties added more OB/GYNs. In September 2010, the TMB reported receiving a record 4,128 new physician applications during the 09-10 fiscal year, the fifth consecutive year applications exceeded 4,000.  TAPA reported 3,630 new physicians were licensed druing the 11-12 fiscal year.
Change in Cases Filed/Awards In Harris County, which includes Houston, 40 medical liability lawsuits were filed between January and March of 2004, compared with an avg. of 120 filed during the same period each of the prior three years, (Texas Medical Association.) There were 204 cases filed in the county in 2004 compared with 441 in 2001 and 550 in 2002. 1154 were filed in 2003 before reforms went into effect. The Dallas Morning News reported that the rate of liability filings in most major Texas cities dropped by 80% after the reforms. 1075 paid claims in 2003 or 22.3 per 1000 active nonfederal physicians. US avg. was 18.8 per 1000. 1018 paid claims in 2005 or 20.7 per 1000 active nonfederal physicians. US avg. was 17.1 per 1000. (Kaiser) 628 total number of paid claims for 2006 or 11.1 per 1,000 active, non-federal physicians. 538 paid claims in 2007.
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