Researchers Find Texas’ Bases For Medical Malpractice Reform In 2003 Were Bogus

The University of Texas School of Law, Law and Economics Research Paper No. 284 entitled “Fictions and Facts: Medical Malpractice Litigation, Physician Supply, and Health Care Spending in Texas Before and After HB4,” which was posted on February 7, 2019, found:

(1) there were no major changes in the frequency of medical malpractice claims, payout per claim, total payouts, defense costs, or jury verdicts that can explain the spike in premiums for medical malpractice liability insurance that occurred in Texas in the years before the 2003 reforms;

(2) Texas’ supply of direct patient care physicians grew steadily, at similar rates, in both the pre- and post-reform periods, despite politician’s claims that physicians fled Texas before reform and flocked back thereafter;

(3) although the damage caps adopted in Texas and other states greatly reduced the volume of malpractice litigation and payouts to patients, neither in Texas nor in other states have damage caps moderated the growth of health care spending;

(4) the savings in liability costs generated by the Texas reforms were shared between physicians and their insurers, with the former paying lower premiums and the latter collecting more premium dollars relative to dollars paid out on claims; and

(5) there is evidence that when liability rules are relaxed, hospital safety records gradually deteriorate.

Texas Medical Malpractice Reform

As the research paper described, the Texas legislature responded to the dramatic spike in medical malpractice insurance premiums in Texas that began in 2000 by adopting in 2003 the package of lawsuit restrictions known as HB 4. The centerpiece of HB 4 was a cap on non-economic damages in Texas medical malpractice cases, which the Texas Supreme Court had previously declared unconstitutional. The supporters of HB launched a campaign to amend the Texas Constitution. On September 13, 2003, the Texas Limit on Damages in Medical Lawsuits Amendment passed by a 2.26% margin.

The research paper concluded: The political case for HB 4 was built on statements about the causes and adverse effects of the med mal liability insurance crisis of 1999-2003, and on predictions about the future effects of tort reform. The statements that could have been factually verified at the time were false. Premiums for med mal liability insurance had risen dramatically, but there was no underlying crisis in the tort system. Physicians were not fleeing Texas either. Texas supply of direct patient care physicians grew at the same rate during the crisis period as it had in preceding years. The reform proponents’ predictions about the future fared no better. Following the enactment of HB 4, physicians did not flock to Texas and healthcare costs did not fall or even rise less quickly.

The only consequence HB 4 could accurately and reliably have been expected to have was to make liability insurance cheaper by reducing the frequency and severity of med mal claims. That is exactly what it did, and it accomplished that result on the backs of injured patients, who would otherwise have been compensated more often and more fully. HB 4 appears to have reduced providers’ efforts to protect patients from avoidable harms too, as suggested by the erosion of patient safety that occurred following its enactment.


We have found that in the years following the 2003 enactment of medical malpractice reforms in Texas, lawyers who used to handle medical malpractice cases on behalf of injured victims of medical negligence in Texas left the field and now it is very difficult for Texas medical malpractice victims to find lawyers who are willing to represent them. In short, many medical malpractice victims in Texas are without recourse in seeking just and fair compensation for the harms they suffered.

If you or a loved one may have been injured as a result of medical negligence in Texas, you should promptly find a Texas medical malpractice attorney who may investigate your medical malpractice claim for you and represent you or your loved one in a Texas medical malpractice case, if appropriate.

Click here to visit our website or call us toll-free in the United States at 800-295-3959 to find medical malpractice lawyers in Texas, or in your U.S. state, who may assist you.

Turn to us when you don’t know where to turn.

This entry was posted on Friday, March 8th, 2019 at 5:22 am. Both comments and pings are currently closed.

    Easy Free Consultation

    Fill out the form below for a free consultation or contact us directly at 800.295.3959

      Easy Free Consultation

      Fill out the form below for a free consultation or contact us directly at 800.295.3959