The University of Texas at Austin   School of Law

Main menu:

March 10, 2005

Press Contacts:
Kirston Fortune, Assistant Dean for Communications, (512) 471.7330 or Jodi Bart, UT Law Communications Coordinator, (512) 471-7330.

False Diagnosis

Don't mess with Texas's tort system.

By Bernard Black, Charles Silver, David Hyman and William Sage
Published March 10, 2005, in The New York Times Op-Ed section.
Reprinted with the authors' permission.

AUSTIN, Texas — Medical malpractice litigation reform is a high priority for President Bush, who contends that juries are running amok, multimillion-dollar settlements are on the rise and greedy trial lawyers are filing frivolous suits. The results, Mr. Bush and others argue, include skyrocketing insurance prices, abandoned medical practices, defensive medicine and a crisis of access to care. Their proposed solution: caps on jury awards to patients and on lawyers' contingent fees.

No one disputes that insurance premiums have risen significantly. The question is whether a crisis in states' tort systems accounts for the increase. Consider Mr. Bush's home state of Texas, America's second most populous state and the third largest in terms of total health care spending. After studying a database maintained by the Texas Department of Insurance that contains all insured malpractice claims resolved between 1988 and 2002, we saw no evidence of a tort crisis. Adjusting for inflation and rising population, we arrived at the following findings:

Large claims (with payouts of at least $25,000 in 1988 dollars) were roughly constant in frequency.

The percentage of claims with payments of more than $1 million remained steady at about 6 percent of all large claims.

The number of total paid claims per 100 practicing physicians per year fell to fewer than five in 2002 from greater than six in 1990-92.

Mean and median payouts per large paid claim were roughly constant.

Jury verdicts in favor of plaintiffs showed no trend over time.

The total cost of large malpractice claims was both stable and a small fraction (less than 1 percent) of total health care expenditures in Texas.

In short, as far as medical malpractice cases are concerned, for 15 years the Texas tort system has been remarkably stable. Texas's situation is not unique. One study of Florida's experience from 1990 to 2003 also found declines in paid claims per 100 practicing physicians as well as per 100,000 population. Over the same period in Missouri, the total number of malpractice claims fell by about 40 percent and the number of paid claims dropped almost by half.

Malpractice premiums have risen sharply in Texas and many other states. But, at least in Texas, the sharp spikes in insurance prices reflect forces operating outside the tort system.

The medical malpractice system has many problems, but a crisis in claims, payouts and jury verdicts is not among them. Thus, the federal "solution" that Mr. Bush proposes is both overbroad and directed at the wrong problem.


Bernard Black and Charles Silver are law professors at the University of Texas at Austin. David Hyman is a professor of law and medicine at the University of Illinois. William Sage is a law professor at Columbia.

Related Link:
UT Law Professors Release Major Study of Medical Malpractice Claims: http://www.utexas.edu/law/news/2005/031005_malpractice.html