Paper finds Texas tort reform didn't draw more doctors to state

Black/Hyman/Silver have a new draft paper, "Does Tort Reform Affect Physician Supply? Evidence from Texas," (via Robinette) that substantially undermines the empirical case for the conventional wisdom that Texas's 2003 reforms against medical malpractice lawsuits attracted more doctors to Texas. The result is highly counterintuitive: after all, even the authors acknowledge that the reforms dramatically decreased malpractice expenses for doctors. Are we to conclude that doctors do not respond to economic incentives?
Alas, the authors do not suggest any explanation for the phenomenon they describe. Possibilities:

• The supply of doctors is inelastic relative to after-expense income. This is a testable hypothesis, and would have dramatic implications for "bending the cost curve" of health-care expenditures if true.
• Employers of doctors offset the decrease in medical-malpractice expenditures by decreasing wages paid to doctors. This seems somewhat implausible, as many doctors are independent, and the ones that aren't probably aren't paying for their own malpractice insurance. But it is also a testable hypothesis. Too, if the health-care market in Texas responded to such a wage decrease by reducing costs to patients (or, at least, reducing costs to patients relative to the nationwide trend of rising costs to patients), that is also worth studying, and would be a benefit that may refute the overstated conclusion of the authors that "tort reform is a small idea, when it comes to the larger and linked questions of health care access and affordability."
• The quantity of doctors did not increase, but the doctors responded to the incentives by changing the mix and quality of services provided in any given year: more OB/GYNs willing to deliver babies rather than restricting themselves to less risky work; more doctors willing to work in emergency rooms; doctors spending more time seeing patients and less time in medical-malpractice-related activities like defending themselves in lawsuits, cover-your-ass documentation, and (for better or worse) defensive medicine. If the average practicing doctor is spending more hours with patients post-tort-reform than pre-tort-reform, doctor supply is increasing, even if the raw numbers aren't. I am not aware of any evidence for this, but economic theory would predict this result. It's not clear whether the data exists to test this hypothesis, but as in the parable of the drunk looking for his lost keys under the streetlamp, one should avoid drawing conclusions that contradict economic theory just because it is too difficult to test an alternative hypothesis consistent with economic theory. Too, if defensive medicine practices changed, as one predicts they would, have health outcomes changed for better or worse? (Professor Silver has argued elsewhere his concern that Texas doctors would take less care post-reform.) Again, this is difficult to test, especially since the adverse consequences of many defensive-medicine decisions, such as excessive CAT scans, won't be known until the additional cancers show up decades later. But it is both a potential benefit and a potential cost of tort reform, as we don't know to what extent doctors are properly weighing benefits and costs (including opportunity costs of more intensive treatment of a particular patient) at the margin. Kessler's study, backed to a lesser extent by the CBO, certainly suggests defensive medicine is wasted money at the margin in the state of the world without damages caps, but defensive medicine is surely different today than in the 1980s.
• For many doctors with low-risk practices, malpractice liability is not a large factor in their practice decision. But the malpractice liability crisis most heavily hit high-risk practices, like neurosurgery or OB/GYN or emergency-room care. Did Texas tort reform materially affect the supply of doctors in high-risk specialties, while the effect on low-risk specialties was overwhelmed by noise? This should be a testable hypothesis, but the data is poor because of a change in the way statistics were collected. The authors try to get around this by comparing 1997-2000 growth to 2008-2010 growth, but there's not necessarily a reason that one would predict a post-tort reform world to have a different post-equilibrium effect than a pre-tort reform world. One cannot rule out the hypothesis that doctors overreacted to the new incentive when tort reform was first imposed and that depressed new demand in later years. Of course, one cannot rule out the null hypothesis that a dramatic decrease in malpractice-insurance rates caused by tort reform did not increase the supply of high-risk doctors, though, again, one wishes for an alternative explanation for why doctors are not responding to economic incentives. (Note, too, that the authors' decision of excluding 2001-07 from the data has dramatic effects on the data. It's unclear to me why a reporting change in 2001 that would artificially increase the 2001-02 numbers relative to the 1999-2000 numbers should have an effect on the 2003-07 numbers, especially given the 2000-2003 declines that are being excluded.)

Can anyone think of other alternative hypotheses in the comments?
I remain skeptical that a wealth transfer from lawyers to doctors and patients didn't have positive externalities, but I, for one, am going to stop claiming that Texas tort reform increased doctor supply without better data demonstrating that. More study is needed to explain Black/Hyman/Silver's counterintuitive result, and partisans on both sides need to be more conservative with their policy claims. Earlier.


[source: Point-of-Law, Frank]

City won't pay when poles crash on property

AUSTIN - Joyce Thompson had just been diagnosed with breast cancer and was receiving radiation treatments when her only method of transportation was destroyed.

A city light pole fell on her car while it was parked in her driveway.

"I had to get one of my kids to take me and wait for me, pick me up, take me back home, take me back for radiation," said Thompson, recalling her ordeal that was three years in the making. "And it's just been really hard."

Thompson and her family thought the city would take responsibility for the falling pole, which photographs show was clearly rotted at the core.

"We've been at this address 20-plus years," Thomson said. "And the whole time that we have been there, that pole has never been changed."

Her son Bryan added, "We thought they were going to take a good position and say to themselves, 'OK, let's do something right.' But nothing. Nothing but a 'Go away. Go buy another car. You're a little person,' and 'Get over it.'"

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By the numbers

• 200,000 light poles are in place citywide
• 1,700 complaints about street lights have been logged with the city of Austin since 2009
• 144 of the complaints were for poles that had already fallen
• 2,500 light poles were replaced around the city

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When the city officials made clear they would not take responsibility for the damage to Thompson's Buick Roadmaster, she and her family sought out attorneys Ifeoma Ibekwe and Holly Claghorn.

"This case, it's just a matter of right vs. wrong," said Ibekwe. "It pulls on your heartstrings, and it's just one we couldn't walk away from."

Ibekwe and Claghorn took the case to court, where the justice of the peace ruled that the city was not liable for the damage. The reason is because lawmakers, as part of the Texas Tort Claims Act, have said that cities are not liable for damage caused while performing certain government functions, such as providing lighting for safety.

The pole that fell on the Thompson's car was a light pole and had no utility lines attached to it.

Immune from liability

"They're saying, 'We're not going to touch that. That's not our area. We're immune from liability,'" said Ibekwe. "However, if it was a utility pole and not just a light pole, they would have paid for that.

"And we can't find a way to distinguish why it's OK for a utility poll to fall down and for them to receive compensation," she added. "And yet if it's a light pole -- same type of pole maintained by the city except it just provides lighting -- they call it safety and security."

Meghan Riley, an attorney for the city of Austin, said the city is only following the law and trying to protect taxpayers from frivolous lawsuits.

"Its a sympathetic situation, but it's something the Legislature has made a determination on," Riley said. "And so it's something that the city doesn't have a choice to determine.

"I'm really sorry for her situation," she added. "It's certainly unfortunate that it happened."

But the Thompsons are not the only victims of this kind of situation.

KXAN News uncovered seven cases since January 2009 where light poles have fallen and damaged someone's property. In each case, the city has denied responsibility.

In a case from December 2010, a couple was driving near the Arboreteum in North Austin when a metal light pole fell on their car. Photos of that pole show rust at the base.

The couple was told the city was not responsible.

What about inspections?

"The city has an inspection program for the light poles that run electric wires but not for the ones that have lighting on them. But if you're a citizen walking around the street and you see a light pole, that's a distinction that doesn't matter to you and if it falls on your car it doesn't matter what kind of wires were connected to it," said Claghorn.

The Thompson family and their attorneys want the city to do a better job of inspecting the poles, but that presents a challenge for the city.

"It's similar to the city sidewalk.  We have, however, many miles of sidewalks, and we can't possibly inspect them in an organized way to take care of all that, so we rely on the public to let us know when they see something," said Riley.

That's small comfort to Joyce Thompson and others who found themselves having to pay for damage that was caused by city equipment. Thompson was finally able to replace her car about a month ago, nearly three years after the city's pole fell on it.

"I just really want them to do their job," she said, "not, not just -- you know --  not do anything about it."

What can you do?

If you see a dangerous light poll, call 311, and advise the call-taker of the pole's location and condition

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source:  KXAN (Wolfson, 5/1)

Editor says tort-reform law hasn't benefitted Texas

(commentary by Tony Floyd, Managing Editor of Henderson Daily News)

Texas may not have been the first state to welcome tort reforms but I can’t imagine anyone embracing it with such wild enthusiasm as Texans over the past 20 years or so.

It was never hard to sell to the public because of all the promises of savings on insurance premiums touted by tort reform proponents, proving once again that everyone votes in their own self-interest when they pull the voting booth curtain.

During his failed presidential bid, Texas Gov. Rick Perry perpetuated the myth that implementing Texas-style tort reforms would go a long way toward curing what’s wrong with the healthcare system. Perry was polling at 1 percent going into the South Carolina primary.

He recommended that all states to do as Texas did in 2003 when lawmakers enacted legislation aimed at limiting the amount of money juries can award patients who win malpractice lawsuits against doctors and hospitals. The law capped non-economic (pain and suffering) damages at $250,000 in lawsuits against doctors and $750,000 against hospitals. Voters overwhelmingly approved a like-minded constitutional amendment later the same year.

Texans for Lawsuit Reform (TLR), whose political action committee has become a dominant financial engine for legislative races, has been at the forefront of tort reform efforts.

Its money tended to push out Democrats who, when considering civil justice issues, were more likely to side with the state’s trial lawyers.

Plus, tort reform’s battlefields have changed over the years, from trucking deregulation to workers’ compensation insurance reform, through the political campaigns that swung the Texas Supreme Court from a nine-member Democratic panel beholden to plaintiffs to a nine-member Republican panel beholden to TLR and like-minded people and business groups.

In the mid-1990s, TLR became a powerhouse, overshadowing older business groups and interests. When George W. Bush ran for governor in 1994, one of the four planks in his platform was tort reform. After he took office in 1995, he and the Legislature rewrote some of the state’s basic civil laws, changing the economics of suing for civil damages in Texas and putting serious hurt on trial lawyers.

According to media critic and news analyst Wendell Potter’s website, as a result of the 2003 tort reform law, malpractice liability insurers reduced their rates in Texas and, tort reform proponents say, the number of doctors applying to practice medicine in the state “skyrocketed.”

Reform proponents contend that in the first five years after tort reform was enacted, 14,498 doctors either returned to practice in Texas or began practicing here for the first time.

That’s impressive until one notes how Texas stacks up with the rest of the country in terms of physician growth in direct patient care. It appears that tort reform has not given Texas an advantage in competiting with other states for doctors, Potter wrote in his piece “The Myth of Tort Reform Benefits in Texas” on the website.

In 2008, the number of physicians in patient care per 10,000 civilian population in the United States was 25.7. At just 20.2 doctors per 10,000 people, Texas ranked near the bottom of the 50 states.

In fact, only nine states did worse. In 2000, three years before tort reform, Texas was still bringing up the rear, but not quite as badly. Back then, 11 states did worse.

It is true that medical malpractice insurance rates dropped in Texas after tort reform was enacted, but Texans would be hard pressed to claim any direct benefit — except, that is, for Texans who are doctors. Medical liability premiums have declined by nearly 30 percent since tort reforms were enacted.

A study published in The Dallas Morning News showed the average malpractice rate charged ob/gyns in Texas by the state’s largest domestic insurer of physicians fell from $53,752 in 2003 to $33,881 in 2011. Drops of similar percentages were found for doctors in family practice and general surgery.

Advocates of tort reform have long claimed that one of the reasons for escalating health care costs is that doctors over-treat and prescribe more medications and diagnostic tests than necessary out of fear of being sued. If Texans believed their own health insurance rates would go down once tort reform made these practices less prevalent, they have by now abandoned that notion, Potter wrote.

Truth is, chances of a Texas family saving a few bucks on premiums would be greater if they moved to another state.

According to Potter’s website, the average premium for family coverage in Texas was $14,526 in 2010. That’s $655 higher than the U.S. average. Those numbers indicate that doctors have not passed on their own insurance savings to patients and they are not practicing medicine any differently than before tort reform was enacted.

Not only are Texans paying more for their own insurance while doctors are paying less for theirs, their chances of getting employer-subsidized coverage is less than it would be if they lived elsewhere in the U.S.

Other new studies have found that a smaller percentage of employers in Texas offered coverage to their workers last year than in the U.S. as a whole (51 percent and 53.8 percent, respectively).

And the Texans who do have coverage through the workplace are contributing far more out of their own pockets for that coverage than people who live in most other states. In Texas last year, the average employee contribution toward company-sponsored coverage was $4,500. The U.S. average was $3,721.

Tort reforms that limit the amount that can be awarded for such noneconomic damages, as well as those that decrease awards by the amount of payments from third-party sources, aim to make it less worthwhile to pursue marginal cases, thereby reducing the number of such cases and inefficiencies in the tort system.

Other tort reforms seek to limit liability by making it more difficult to pursue cases against multiple defendants. Still other reforms focus on procedural changes, again making it less likely that marginal cases will be pursued.

In some cases, tort reforms have had the desired impact on Texas’ litigious business climate. As for when savings on insurance premiums will finally trickle down to the average working family, we could be in for a long, long wait.

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source: Henderson Daily News (Floyd, 1/23)

An idea to tackle tort reform, defensive medicine in Georgia

It’s been 20 months since the Georgia Supreme Court threw out a key plank of the state’s 2005 tort reform: a $350,000 cap on noneconomic damages for medical malpractice. During that time there’s been some hopeful talk among supporters of the cap, but precious little action by legislators.

Here’s a thought: Why not scrap the medical tort system entirely, saving several billion dollars in the process?

Before every trial lawyer within 200 miles heads for my office, let me explain.

The idea is to replace the current legal system for medical malpractice with an administrative law system that draws heavily on the current arrangement for workers compensation claims.

No more lawsuits, no more juries, no more jackpot justice. Instead, patients injured while undergoing medical treatment would file a no-fault claim. Independent experts then would determine whether there was negligence and, if so, award the patient compensation based on national norms for the type of injury suffered.

The potential results: More patients receiving payments, in a fraction of the time lawsuits take today. Doctors no longer facing the specter of ruinous lawsuits. Even trial lawyers would stand to make more money on the whole.

“Our approach is basically fair compensation — quickly, and more of it,” says Richard L. Jackson, who is pushing this plan through his advocacy group called, well, Patients for Fair Compensation.

The group’s name is straightforward enough, except that Jackson isn’t only or mostly a patient. He’s a longtime health-care executive whose Alpharetta-based medical-staffing company, Jackson Healthcare, employs doctors in all 50 states.

Nor did he come at the issue of tort reform only or mostly from a legal perspective. Rather, his interest is reducing the practice of “defensive medicine” by doctors eager to avoid lawsuits.

During the 2008 presidential primaries, Jackson told me by phone this week, his firm surveyed its doctors about various candidates’ health reform plans. “What happened,” he said, “was we kept hearing the defensive medicine issue being a huge problem. We didn’t ask them about it. It just came out unsolicited.”

Jackson took another survey of 3,000 doctors nationally about “totally unnecessary medicine for the purpose of avoiding a lawsuit.” A whopping 92 percent said they had practiced it in the previous 12 months, and the respondents attributed 34 percent of all health-care costs to defensive medicine.

“I was really caught off-guard by that,” Jackson said.

Last year, he hired Gallup to poll 500 doctors. A similar proportion of them said they practiced defensive medicine, to which they attributed 26 percent of health costs.

Even using that lower estimate, Jackson said, defensive medicine may account for as much as $650 billion in health spending nationally and $13.25 billion in Georgia. That’s roughly $100 a month for every American, or almost 4.5 percent of the U.S. gross domestic product.

Reducing that cost is what sparked Jackson’s interest in medical malpractice reform. But he believes it would be good for patients, too.

“Patients really don’t have access to justice in our [current] system,” Jackson said. If a claim is for less than $150,000, “you can’t find an attorney to represent you. They have to basically go for the big deals. And that’s why they’re so vehemently opposed to caps and those kinds of tort reforms, because it eliminates the ability to go after the big claims so they can fund the other ones.”

Jackson’s group is awaiting a final actuarial study, but he said he is confident that four times as many patients as today will receive some sort of compensation, which, combined, will total two to three times the current sum.

The “extra” money, as well as the funds to operate the new system, would come from existing med-mal insurance premiums, with savings from lowering costs of administration and not having to defend against lawsuits.

The next step will come soon, as Georgia and Florida are the first states where Jackson will try to get legislation passed. I’ll withhold final judgment until there’s an actual bill with actual details. For now, it’s a promising solution to a vexing problem.

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source: Atlanta Journal-Constitution (Wingfield, 12/1)

Analysis: Tort reform in Texas has not resolved physician shortages in some areas

PRESIDIO, Texas (AP) — Presidio County is bigger than Delaware and has just one practicing physician who doesn't deliver babies or treat emergencies. It's the kind of underserved region that Gov. Rick Perry suggested would benefit when he proposed a crackdown on medical malpractice lawsuits in 2003.

Now running for president, Perry says his tort reform plan proved the wisdom of his business-friendly policies by expanding health care across the state.

Yet none of the 23,000 doctors Perry says Texas has newly licensed have come this way.

"Some patients, when they find out they're pregnant, bam — they're out of here," said Dr. Darrell Parsons, whose practice in Presidio is just across the Rio Grande from Ojinaga, Mexico.

An analysis of Perry's tort reform initiative in Texas reveals a more complicated bottom line than his campaign rhetoric on the issue would suggest. State medical data show that the number of physicians practicing in Texas has increased since the initiative passed in 2003, though by considerably less than the total Perry cites. And the bulk of that influx has come in larger cities where health care was already abundant, leaving large rural swaths of Texas still without doctors.

In many ways, the growth in the health industry in Texas adds more fodder to a larger debate surrounding Perry's record: How effective were his conservative policies in solving problems and increasing jobs, which is the core issue of his presidential campaign? And how much of Texas' economic growth during his 11 years in office mostly reflected a state with a booming energy industry and an increasing population?

Discussing his malpractice reforms in a speech in Georgia in September, Perry said, "Pregnant women have better access to OB-GYNs. People in need of trauma care have better access to neurosurgeons and other specialists. That's what tort reform is really all about. About how to give better access to the people of my home state. We need to spread lawsuit reform across all economic sectors of this country."

However, medical records in Texas show that of the state's 254 counties, only 106 have an obstetrician/gynecologist — just six more than in 2003. In Presidio County, which has 8,000 residents and is growing, some of Parsons' patients move 240 miles away to live with relatives in Odessa or Midland when they become pregnant.

Overall, the increase in physicians in Texas roughly tracked the state's population growth. Medical rolls increased by 24 percent since 2003, while Texas' population was soaring by 20 percent during the decade. Texas also saw rapid growth of physicians per capita before tort reform, according to the Texas Department of State Health Services.

The statistic Perry most often cites — 23,000 newly licensed doctors after tort reform — includes about 10,000 who sought licenses in Texas but took jobs elsewhere and physicians practicing telemedicine in other states.

Tort reform lobbyists point to a surge in the number of doctors in some high-risk specialties like surgery and emergency room care, particularly in the growing Rio Grande Valley.

"By no means do we claim that all doctors new to Texas are because of tort reform. But we absolutely claim that the accelerated growth is because of tort reform," said Jon Opelt, executive director of the Texas Alliance for Patient Access.

Perry spokeswoman Allison Castle said tort reform ended "abusive oversuing" and played a role in Texas today having a record number of doctors per capita.

"Tort reform has resulted in better access to care, which includes more specialized care that is now available in more Texas communities thanks to these reforms, and that is absolutely a success," Castle said.

Health care shortages have plagued rural Texas for decades and few regions struggle more than West Texas. In Pecos, about a four-hour drive north of Presidio through sprawling ranchland and mountains, Mayor Venetta Seals recalled the wife of a California couple who became ill while traveling through the area earlier this year. By the time they reached the closest hospital nearly 200 miles away, the woman had died in the car.

Seals joked that the region perhaps needed signs on the Interstate informing drivers they're nowhere near a hospital. "Think about if you had a wreck, and just to get an ambulance took an hour," Seals said. "And that's one-way."

Perry made access to health care a major argument for tort reform in the initiative's advertising campaign in 2003, saying the state was hemorrhaging doctors because of lawsuits and malpractice insurance costs. The ballot issue, Proposition 12, became the most expensive campaign ever waged to amend the Texas Constitution. More than $15 million was spent in the showdown between trial lawyers and health care interests.

In a speech to the conservative Heritage Foundation that year, Perry told a New York audience how three out of five Texas counties lacked an obstetrician.

"That's a hardship for many pregnant women in certain areas of our state, but especially women with high-risk pregnancies," Perry said.

Eight years later, that ratio is the same.

In rural areas, doctors, including Parsons, nevertheless insist the lawsuit limit capping noneconomic damages at $250,000 was justified. Doctors statewide have seen their liability rates drop by an average of 27 percent, according to the Texas Medical Association. Parsons said he wouldn't have stayed in Presidio without the new caps.

"You don't have that hanging over your head," Parsons said.

Recruiting doctors in rural areas, however, is difficult. And another aspect of Texas' government philosophy — a low Medicaid reimbursement rate, ranking 49th in the nation, and sparse public spending — makes practicing in rural areas here less appealing than in other states. "Obstetricians want good education for their children and reasonable reimbursement for their services," said James Scroggs, director of health economics for the American Congress of Obstetricians and Gynecologists.

Parsons, a Kansas City native who began practicing in nearby Alpine in 1999, says it takes a "missionary spirit" to become a doctor in a place like this. And residents get used to doing without much health care.

"Out here, you get sick or hurt on Monday or Thursday. That's the day the clinic is open," said Zachary Zniewski, a carpenter in neighboring Brewster County. He looks down at his hand, which is missing a finger.

He accidentally sliced it off on a Wednesday.

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source: Associated Press (11/7)

Texas' tort law has failed to reduce health costs, attract doctors

A national report released Wednesday says the 2003 Texas law that limited damage awards in malpractice suits has caused health care spending to rise and has not significantly increased the number of doctors in Texas.

The report comes as Gov. Rick Perry has touted the benefits of the law on the presidential campaign trail, boasting that it has added 21,000 Texas doctors — a claim the report disputes. Supporters of the law also urged Congress to enact a similar provision for the nation as part of the federal health care law that passed in March 2010. That provision was not included.

The 24-page report by Public Citizen, "A Failed Experiment," says that using Texas as a model would benefit doctors and insurers — not residents.

The report claims that Medicare spending in Texas has risen faster than the national average, and so have private health insurance premiums. It also says that, contrary to Perry's claims, the per capita increase in the number of doctors practicing in the state has been much slower since the state passed the so-called tort reform law than it was before the law.

Organizations that support the 2003 law — the Texas Medical Association and the Texas Alliance for Patient Access — disputed the report's assertions on the number of physicians who have come to the state. As for health care costs, "we never said consumer costs would go down," Jon Opelt, the alliance's executive director, said Wednesday.

Before the state limited damage awards that patients and their families could collect in malpractice cases, doctors were leaving the state in droves, and malpractice insurance rates were about double what they are today for most doctors, said Dr. Howard Marcus, an internist at Austin Regional Clinic. Marcus, a member of the medical association and chairman of the alliance, said that it took several years for tort reform to have an effect and that since 2007, Texas has licensed 60 percent more new doctors each year than it did before tort reform.

The report by Public Citizen, a nonprofit consumer advocacy group, examines the number of direct patient care and primary care doctors in Texas between 1996 and 2010. It says that in the seven years before the lawsuit limits, the per capita number of doctors increased by 9.3 percent. In the seven subsequent years, the increase was 4.2 percent.

Perry's 21,000 figure was disputed by a PolitiFact check, which Public Citizen cited. PolitiFact said that Perry was counting all physicians licensed in Texas — the number actually practicing was 12,788 — since 2003. Experts said most of that increase was due to population growth, not tort reform.

Marcus said that Public Citizen erred by using a seven-year range before and after the 2003 law took effect. He said that it took until about 2007 for the law's effects to be felt, adding that it would be better to examine 2007 to 2011 and compare those years with the period before the tort changes.

Perry spokeswoman Allison Castle said Wednesday that tort reform has greatly expanded access to care, especially in underserved rural areas. For example, she said, the number of obstetricians in rural areas of Texas has grown by 27 percent.

Castle added that from 2003 to 2009, Texas premiums for employer-sponsored health coverage increased at a lower rate than the national average and 27 other states.

The Public Citizen report counters that doctors in rural areas of Texas have decreased by 1 percent since tort reform after increasing by 23.9 percent in the seven years before the 2003 law.

It also says that health care coverage is unaffordable to more Texans since the law took effect. In 2010, 24.6 percent of Texans were uninsured — the highest rate in the nation — compared with 23.6 percent in 2003.

Regarding Medicare costs, the Public Citizen report says that proponents of lawsuit limits say that doctors would order fewer tests and practice less "defensive medicine" if they didn't have to fear as many lawsuits. "In fact," the report says, "Medicare diagnostic testing expenditures in Texas not only increased during this time frame (2003 to 2007), but rose 25.6 percent faster than the national average."

Marcus and Opelt said many factors drive such costs and that they have no bearing on changes in the medical malpractice law.

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source: www.statesman.com (Roser, 10/12)