Big gain to Texas from malpractice reforms

In Texas, it can be a long wait for a doctor: up to six months. That is not for an appointment. That is the time it can take the Texas Medical Board to process applications to practice. Four years after Texas voters approved a constitutional amendment limiting awards in medical malpractice lawsuits, doctors are responding as supporters predicted, arriving from all parts of the country to swell the ranks of specialists at Texas hospitals and bring professional health care to some long-underserved rural areas.

The influx, raising the state’s abysmally low ranking in physicians per capita, has flooded the medical board’s offices in Austin with applications for licenses, close to 2,500 at last count. “It was hard to believe at first; we thought it was a spike,” said Dr. Donald W. Patrick, executive director of the medical board and a neurosurgeon and lawyer. But Dr. Patrick said the trend — licenses up 18 percent since 2003, when the damage caps were enacted — has held, with an even sharper jump of 30 percent in the last fiscal year, compared with the year before. “Doctors are coming to Texas because they sense a friendlier malpractice climate,” he said.

Some experts say the picture may be more complicated and less positive. They question how big a role the cap on malpractice awards has played, arguing that awards in malpractice lawsuits showed little increase in the 12 years before the law changed. And some critics, including liability lawyers, question whether the changes have left patients more vulnerable. With doctors facing reduced malpractice exposure, they say, many have cut back on their insurance, making it harder for plaintiffs to collect damages. Moreover, the critics say that some rural areas have fewer doctors than before.

The measure changing Texas’ malpractice landscape, Proposition 12, was narrowly approved in a constitutional referendum on Sept. 12, 2003. It barred the courts from interfering in limits set by the Legislature on medical malpractice recoveries. For pain and suffering, so-called noneconomic damage, patients can sue a doctor and, in unusual cases, up to two health care institutions for no more than $250,000 each, under limits adopted by the Legislature. Plaintiffs can still recover economic losses, like the cost of continuing medical care or lost income, but the amount they can win was capped at $1.6 million in death cases.

All but 15 states have adopted some limits on medical damage awards, according to the National Conference of State Legislatures. But the restrictions in Texas go further than in many states, where the limits are often twice as high as they are here. “Other states have passed tort reform, but Texas implemented big changes all at once,” said Lisa Robin, a vice president for government relations at the Federation of State Medical Boards, a national umbrella group based in Dallas.

Some experts say that the lack of a state income tax, combined with what William M. Sage, a law professor at the University of Texas in Austin, called a “relatively rapid transition in its tort reputation as a plaintiff-friendly state,” has contributed to the state’s appeal to doctors. Dr. Timothy George, 47, a pediatric neurosurgeon, credits the measure in part with attracting him and his sought-after specialty last year to Austin from North Carolina. “Texas made it easier to practice and easier to take care of complex patients,” he said.

The increase in doctors — double the rate of the population increase — has raised the state’s ranking in physicians per capita to 42nd in 2005 from 48th in 2001, according to the American Medical Association. It is most likely considerably higher now, according to the medical association, which takes two years to compile the standings. Still, the latest figures show Texas with 194 patient-care physicians per 100,000 population, far below the District of Columbia, which led the nation with 659.

The Texas Medical Board reports licensing 10,878 new physicians since 2003, up from 8,391 in the prior four years. It issued a record 980 medical licenses at its last meeting in August, raising the number of doctors in Texas to 44,752, with a backlog of nearly 2,500 applications. Of those awaiting processing, the largest number, after Texas, come from New York (145), followed by California (118) and Florida (100). In some medical specialties, the gains have been especially striking, said Jon Opelt, executive director of the Texas Alliance for Patient Access, a medical advocacy group: 186 obstetricians, 156 orthopedic surgeons and 26 neurosurgeons. Adding to the state’s allure for doctors, Mr. Opelt said, was an average 21.3 percent drop in malpractice insurance premiums, not counting rebates for renewal.

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It's not only Britain that has poor public hospital hygeine

MORE than 7000 patients die and billions of dollars worth of health care is wasted every year in Australia because doctors and nurses do not wash their hands enough. And now they risk being sued for negligence for failing to prevent the spread of infectious disease.

The startling revelations have come from evidence and background documents given at public hearings last week of the Queensland Parliamentary select committee on health. Health Quality and Complaints Commission chief John Youngman said in evidence that half of all healthcare providers did not have appropriate hand hygiene processes in place. Surgery was a high-risk area in Queensland hospitals because of poor hand hygiene, he said. Dr Youngman said poor hand hygiene "is a major cause of healthcare-associated infection". He said research confirmed that "over half the adverse events that occurred were related to the operating theatre". Dr Youngman said the new health commission had published guidelines to fight infection outbreaks.

The report points to a lack of education, a lack of recognition and a lack of understanding of good hand hygiene. It said there was a lack of commitment and awareness at government level. The guidelines stress the need for hand washing with antiseptic rubs to reduce transmission of antimicrobial-resistant organisms such as methicillin-resistant staphylococcus aureus, or "golden staph".

It is estimated there are as many as 150,000 healthcare-associated infections in Australia a year. Yet compliance with hand washing guidelines "remains universally low", according to the report. "These infections can result in a prolonged hospital stay, culminating in significant financial and health outcome implications for both the patient and the hospital," the report says.

A companion report warned health professionals they risked claims for civil damages and criminal actions. "It is conceivable that medical administrators could be charged with offences if they were to permit the spread of infectious disease," the report warned. During the inquiry into the Bundaberg Hospital, whistleblower Toni Hoffman said infamous surgeon Jayant Patel did not wash his hands regularly.

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