There are no data showing that the quality of health care services or medical errors has decreased since tort reform passed, Mr. Winslow said. "Nationwide, this is still a real problem, and in Texas there is no evidence that the quality of care has gotten better."
While the statewide statistics may not be in evidence, Dr. Stewart described his institution’s experience with quality improvement since tort reform. "At least within our system, these malpractice cost savings have translated directly into spending on patient quality and safety initiatives – hopefully, directly benefiting our patients and improving the quality of care."
Proponents of the law say the more favorable legal climate has expanded health care services and drawn more physicians to the state – a claim Mr. Winslow contested. "Underserved areas continue to struggle to attract physicians to serve their population, and Texas ranks close to the bottom in terms of physicians per capita." Doctors are coming, he said, but only to metropolitan areas that already have a good supply. "We continue to lag well behind the rest of the country in per capita physician supply. Physician supply is failing to keep up with population growth."
However, the Texas Alliance for Patient Access – a statewide coalition of doctors, hospitals, clinics, nursing homes, and physician liability insurers – asserts that physician supply and medical services have increased since 2003. "Overall, Texas has enjoyed a 62% greater growth rate in newly licensed physicians in the past 3 years, compared to 3 years preceding reform," according to TAPA documents supplied by spokesman Jon Opelt. Other statistics he provided support the claim that underserved areas are benefiting from the law.
• Twenty-four rural counties added at least one general surgeon, and 11 added their first general surgeon.
• Twelve rural counties added at least one orthopedic surgeon, and nine counties added their first orthopedic surgeon.
• Six Texas counties added their first neurosurgeon; two of those counties are rural.
• Fifteen rural counties added a cardiologist or cardiovascular surgeon, including 11 that added their first cardiologist.
• The ranks of rural obstetricians have grown by 27%. Twenty-two rural counties added an obstetrician and 10 counties added their first OB.
Twenty-three rural counties have added at least one emergency medicine physician, and 18 added their first emergency room doctor.
Texas voters seem to favor the law, according to a survey of 501 randomly selected registered voters conducted in September by the group Texans Against Lawsuit Abuse. Most survey respondents (62%) thought recent legal reforms have been a good thing because they have helped bring thousands of new physician specialists to Texas, allowed hospitals to provide expanded medical care, and reduced questionable lawsuits so people with legitimate malpractice claims could have their cases heard, a press release stated.
Dr. Stewart said his study can’t address these complex political issues, but he believes that "tort reform in Texas sets the stage for improved access to surgical care, reduces cost, and allows more effective quality and performance improvement initiatives."
Dr. Stewart had no relevant financial disclosures.