Texas tort reform advocates dispute critical report

Doctors and other advocates of Texas tort reforms are speaking out against an October report that says the measures have worsened health care in the state.

The report, issued by consumer advocacy group Public Citizen, claims that the rate of new doctors in Texas has fallen since the state's $250,000 noneconomic damages cap was enacted in 2003. Medicare spending has grown since the reforms, and health insurance costs are higher than the national average, the report said.

"Despite the sales campaign to promote Texas as an exhibit of the merits of limiting doctors' liability for mistakes, the real world data tell the opposite story," said Taylor Lincoln, research director of Public Citizen's Congress Watch division. "Health care in Texas has become more expensive and less accessible since the state's malpractice caps took effect."

The Texas Medical Assn. called the report misleading.

"First of all, we never promised the tort reform bill would lower the cost of medical care. We said it would increase access to medical care," said TMA President C. Bruce Malone, MD. "The hospitals are saving hundreds of millions a year in medical liability costs that can be applied directly to patient care."

Dr. Malone rebutted the report finding that the number of new doctors practicing in the state has decreased. The report based its figures on the rate of new physicians per capita. It claims that in the seven years before the cap took effect, the per capita number of doctors grew by 9.3% compared with an increase of 4.2% after the reforms.

The number of primary care physicians rose by 11.8% in the seven years leading to reforms but has remained flat since, the report said.

But comparing the rate of doctors against population growth is not an adequate assessment, Dr. Malone said. Texas has seen a rapid rise in residents in the last few years, he said.

Each year, about 4,000 doctors apply for a license in Texas, he said. In the past four years, license applications for physicians have increased 83% compared with the four years before tort reform, according to data from the TMA and the Texas Medical Board.

"We're keeping up with our huge population growth. The tort reform has allowed us to keep doctors' offices open that we might not have been able to do with the increasing liability" before reform, he said.

Data contradict report

Texas Gov. Rick Perry, who signed the reforms into law, released data contradicting the Public Citizen report.

Since the reforms were enacted, 23,520 doctors have been licensed in Texas, and physician growth has outpaced population growth by 84%, according to the governor's office. In El Paso, physician growth has outpaced population growth by 177%, while in Houston the figure is 124%.

The governor cited a national report from the Commonwealth Fund that found Texas' premiums for employer-sponsored coverage for individuals are lower than those in 34 states. The Commonwealth Fund is a private foundation that advocates better health care access and quality.

The cost of medical liability insurance has declined by nearly 30% since reforms were enacted, according to Perry's office.

"In Texas, comprehensive medical liability reform has improved access to medical care, particularly in underserved areas, restored balance to the Texas judicial system, keeping doctors in the exam room instead of the courtroom, and has removed a large threat to job creation and economic growth that had been created by excessive litigation," said Allison Castle, a spokeswoman for Perry.

Patients have benefited dramatically from reform measures, said Jon Opelt, executive director of the Texas Alliance for Patient Access, a coalition of medical professionals who advocate improved access to care through lawsuit reforms. An increase in Texas doctors has led to 6.4 million more patient visits than would have occurred if reforms were not enacted, he said. Texas Alliance arrived at that figure by measuring the accelerated growth rate of physicians and factoring in the average number of patients seen annually by doctors, he said.

"What you have is more care available to more patients closer to home," he said.

Data from the governor's office show that since reforms, 23 rural counties have added at least one emergency physician and 18 counties have added their first emergency doctor. Fifteen rural counties have added either a cardiologist or cardiovascular surgeon, including 11 counties that added their first heart specialist.

In addition, the number of pediatric specialists and geriatricians has doubled in the past five years after showing no growth in two years preceding reforms, data show.

"I would venture to say there's not a state in the country that [has] seen the turnaround that we have seen," Opelt said.