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October 3, 2002     (512) 463-0300

Medical Malpractice Reform Studied in Rio Grande Valley

A Texas Senate committee in Edinburg today heard that the limiting of extraordinarily large medical insurance claims does not mean that Texans will be denied due process in the courts.

The Senate Committee on Prompt Payment of Health Care Providers was at UT-Pan American in Edinburg, October 3, 2002, and heard testimony on another part of the state's insurance crisis. Today the group heard from local medical and legal professionals as well as experts from other states.

Dr. Richard Anderson is Chairman of the Board of California's The Doctors Company, and testified regarding how that state capped jury awards in an effort to reform the legal system in Medical Malpractice. He called previous efforts at tort reform in Texas ineffective, saying that they limited punitive damages but did not attack the reasons for those high damage awards. He said doctors who are afraid of getting sued practice "defensive medicine" ordering expensive, unneeded tests in an effort to eliminate any possible missed diagnosis that could later lead to a lawsuit. Then, when lawsuits do occur, high dollar verdicts discourage doctors and insurance companies from going to court, leading to high cost out of court settlements. This, in turn, leads to Texas having some of the highest medical malpractice premiums in the country. In the Rio Grande Valley in particular, the frequency of claims is increasing by an unprecedented 60 percent per year.

David Durden from the Texas Department of Insurance followed, reviewing the agency's current rules and how they identify the responsibilities of everyone involved in the current liability system. Regarding the prompt payment of claims, he said that Health Maintenance Organizations are ultimately responsible for paying claims to their doctors, even though their claim may have been assigned to a third party, which failed to pay. He said that new rules soon to be promulgated would simplify the claims process.

Durden's agency is also involved with the medical malpractice insurance question. He said the average annual loss for the insurance companies, as a percent of premiums paid, is about 15 percent, with an annual loss per doctor of $23 thousand dollars. However, in the Rio Grande Valley, the annual loss per doctor is as high as $70 thousand dollars and continues to increase. Durden didn't have any information as to why there are so many claims in the Valley, but Representative Juan Hinojosa, sitting in with the committee today, said that a few large class-action claims in Hidalgo County may have skewed those numbers.

Louis Garcia from the McAllen Medical Center described hospital conditions in McAllen, saying that his is a general care facility that tries to be "all things to all people, and we don't always make it." He said they have only limited medical malpractice coverage right now and they are searching for more. The greatest risk for malpractice liability comes out of the emergency room and that's the source of 40 percent of the McAllen hospital's patients. The result is that physicians leave hospital medical staffs, leading to a shortage of highly trained trauma specialists.

Kathy Julia, President of the Hidalgo County Trial Lawyers Association said that the insurance problem is not just limited to medical malpractice, but also coverage for health, legal malpractice, and the entire range of insurance in Texas. She suggested complete reform of the insurance industry itself, not just the way claims are litigated.

Dr. Carlos Cardenas testified that for the bottom line is that poor residents simply do not have access to health care. He said local doctors must care not only for the insured, but also the local indigent and they cannot deny care to Mexican nationals who simply turn up at the emergency rooms without insurance of any kind. He called for greater equity in the system, saying that doctors' fixed costs are rising, while their compensation, determined by Medicare, Medicaid and insurance companies, is decreasing.

Public testimony followed and included doctors who told of their peers who had chosen to leave Hidalgo County due to high malpractice premiums, other hospital administrators who decried the local lack of neurosurgeons, and complaints about state agencies that some say don't act quickly against incompetent physicians and other medical personnel.

In November, the Senate Special Committee on Prompt Payment of Health Care Providers will issue its report to the Lieutenant Governor for presentation to the next Legislature. Committee members include Chair Jane Nelson, John Carona, Troy Fraser, Mario Gallegos and Judith Zaffirini. Also sitting in with the committee today was Representative Juan Hinojosa of McAllen. The committee recessed subject to call of the chair, with the time and place of its next meeting to be announced at a later date.

You can access the archived audio webcast from the Senate's web page of the Senate Committee on Prompt Payment of Health Care Providers .

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