Texas debate focuses on medical liability reforms
DALLAS – Texas is mired in a debate over whether medical liability reforms have benefited the state’s emergency departments.
Since the passage of the state’s healthcare reforms in 2003, 799 emergency and critical care physicians have moved to the state, giving more people access to medical care and increasing patient safety, according to Sandra Schneider, president of the American College of Emergency Physicians.
This has contributed to a significant drop in patient wait times and an improvement in patient safety from 2006 to 2009, according to the 2009 National Report Card on the State of Emergency Medicine. Texas has achieved the second biggest improvement in emergency patient wait times among all states, according to a 2010 report from Press Ganey.
“Despite growing demand and the highest uninsured population in the nation, Texas provides greater access to medical care for patients, often closer to home, and patients harmed by acts or omissions of ED physicians are able to go to court and collect damages,” said Schneider.
This was in response to what Joanne Doroshow, of the Center for Justice and Democracy, said at a January 20 hearing on medical liability reforms,
“In Texas, for emergency room injuries, they made the burden of proof so incredibly difficult that it’s knocked out every single emergency room negligence case, so what has happened there is that the state of care in emergency rooms has become much more unsafe,” Doroshow said.
One citizens advocacy group agrees.
“The reforms have been horrendous for patients,” said Alex Winslow, executive director for Texas Watch. “Benefit is all in the eye of the beholder.”
The accountability to protect the patient is almost non-existent with the reforms, he said.
When reforms were instituted in 2003, lawmakers promised improved care all around, but this has proven to be false, according to Winslow. The cost of care has gone up faster than the national average, as has the state’s Medicare spending. Rural areas are still hurting for physicians, she said, and the state is ranked 43rd in the nation in per-capita physicians.
Despite an influx of physicians, the reforms have made it harder for patients to go to court for legitimate cases.
“The reforms seem to have exacerbated the problems (in Texas),” said Winslow. “They have just been a distraction to other things that need to be fixed.”
According to the Texas Alliance for Patient Access, 82 counties have seen net gains in emergency physicians, 33 rural counties have added at least one emergency physician (including 24 counties that previously had none), hospitals are no longer closing or limiting their emergency services and many have expanded their emergency services.
ACEP argues that this is benefit enough from the reforms.
Schneider said the Texas law “addresses the unique challenges of diagnosing and treating emergency patients.”
“Often there is no prior medical history, and many times emergency physicians must make snap decisions with limited information under the most dire circumstances,” she said. “Without this law, there would be fewer emergency physicians in the state and specialists needed to care for you, beyond what the emergency physician can do. They simply would not perform high-risk procedures out of fear of lawsuits.”
