Ten years after tort reform means more doctors, more care

By Drs. Justin and Katherine Hensley —

The young emergency physician and his pediatrician wife were
completing their medical residencies in North Carolina. Without medical
liability reform similar to what Texas passed in 2003, Dr. Justin
Hensley routinely had to test his patients — for the wrong reason.

“I had a 30-year-old patient who'd already had 20 CT scans. It's
difficult for me to understand how that many scans could be justified on
someone so young. But because of the liability climate in North
Carolina, residents were instructed to order tests, regardless of their
necessity,” said

Dr. Justin Hensley, a member of the Texas Medical Association (TMA) Committee on Emergency Medical Services and Trauma.

When they completed their residency training, the couple searched the
country for a place to which they could move and begin caring for
patients. They chose Texas.

“I knew I didn't want to live and practice in a state that lacks tort
reform, where physicians are liability targets. That environment forces
physicians to make medical decisions based on protecting themselves
instead of doing what's actually right for the patients,” Dr. Katherine
Hensley told TMA's Texas Medicine magazine. The September issue of the
magazine celebrates the 10th anniversary of the passage of Texas'
historic 2003 liability reforms.

North Carolina's loss was Texas' gain. The husband-and-wife
physicians selected Corpus Christi for their practice location in 2011.
They believe they made the right decision; they serve patients there and
admire the patient-first attitude of their local physician colleagues.

“My experience in Texas has been that surgeons will proceed with the
appropriate procedure based on a clinical diagnosis,” said Dr. Katherine
Hensley. “In Texas, I get to practice medicine according to what's
right for the patient, not based on what keeps me from getting sued.”

These physicians are among the many doctors who, along with their
patients, enjoy the positive effects of Texas' medical liability reform:
More doctors to care for patients, deciding on care based on those
patients' best interest.

Ten years ago, TMA physicians and medical students banded together to
push for passage of landmark medical liability reforms. The Medical
Malpractice and Tort Reform Act of 2003, House Bill 4, went into effect
Sept. 1 that year. Twelve days later, Texas voters approved Proposition
12, an amendment to the Texas Constitution that validated the
legislature's actions. HB 4 caps noneconomic damages in medical
liability cases. Texas' $750,000 total cap includes a $250,000 liability
limit per physician for noneconomic damages such as pain and suffering.

The tort reform act doesn't restrict economic damages.

Record numbers of physicians have relocated here to care for Texas
patients since the passage of that law. Physicians already practicing
here say they can recruit more specialists trained in Texas and from out
of state, thanks to tort reform.

In the fiscal year that ended Aug. 31, 2012, the Texas Medical Board
received 4,253 medical license applications and processed 3,630. Compare
that with 2003, when the board received only 2,561 applications and
processed 2,513.

“Tort reform has done wonders for the state by attracting more
physicians to practice here, improving access to care, and making it
economically possible for physicians to continue caring for patients,”
Dr. Justin Hensley said.

He's talking about physicians like Sandra Williams, DO, an emergency
physician at Houston's Ben Taub Hospital, who attended medical school in
Florida and also chose to relocate to Texas due to its liability
protections.

She saw the struggles to provide good patient care in the Sunshine
State, compared with the access to care she sees for Texas patients.

“The attending physicians and faculty members in Florida had to call
multiple hospitals to find a specialist to treat a patient needing
immediate medical attention.

In Texas, specialists aren't afraid to take call, and I'm able to transfer patients to the care they need,” Dr. Williams said.

Texas patients needing physician specialists of all types can more
easily find the care they need now. David Teuscher, MD, a Beaumont
orthopedic surgeon and former member of the TMA Board of Trustees, says
reform has made a big difference in his practice's ability to recruit
doctors.

“My group finally was successful in recruiting a fellowship-trained
foot and ankle orthopedic surgeon after a long drought. That was
impossible before HB 4 and Proposition 12,” he said.

Before reform it was tougher for women to have a baby in Texas too,
even in a city the size of Austin. Albert Gros, MD, an
obstetrician-gynecologist, recalls serving on an Austin hospital board
and losing about one-third of the hospitals obstetricians prior to 2003.
He says the liability climate and expensive medical liability insurance
premiums demanded by the four carriers in the state at the time forced
doctors out.

“When doctors give up obstetrics prematurely, it creates a shortage
of physicians who can care for pregnant women,” he said. “Tort reform
made it possible for me to continue practicing [longer].”