Texas Alliance for Patient AcCess

P. O. Box 684157 | Austin, Texas 78768-4157

2301 South Capital of Texas Highway  |  Building J-101 Austin, Texas 78746





U.S. doctors on the coronavirus frontline seek protections from malpractice suits

Thomson Reuters

April 2,2020

(Reuters) - U.S. medical professionals on the front line of the coronavirus pandemic are lobbying policymakers for protection from potential malpractice lawsuits as hospitals triage care and physicians take on roles outside their specialties.

State chapters of the powerful American Medical Association and other groups representing healthcare providers have been pressing governors for legal cover for decisions made in crisis-stricken emergency rooms.

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Use Simple Economics to Contain Healthcare Costs

Medical costs can also be cut by limiting malpractice insurance premiums, a major outlay for medical providers. Texas placed a $250,000 cap on non-economic damages, i.e., pain and suffering, in 2003. Texas Department of Insurance data reveals that medical malpractice claims, including lawsuits, fell by two-thirds between 2003 and 2011, and the average payout declined 22% to $199,000.

Also, average malpractice insurance premiums plunged 46%, according to the Texas Alliance for Patient Access, a coalition of health care providers and physician liability insurers. And physicians ...


Pro-Life doesn't mean artificially keeping Tinslee Lewis alive forever

Cases like Tinslee’s are not easy for anybody. Medical interventions are prolonging her death and causing her further pain and suffering without the hope of improving her condition.

What do we do when there are disagreements between doctors and families in these rare end-of-life scenarios?  Should doctors follow the wishes of a family even when it means inflicting medical torture on a dying patient?

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Link to: TAPA Brief


Baby Tinslee Lewis case attracts attention from anti-abortion groups

Cases like Tinslee’s are not easy for anybody. Medical interventions are prolonging her death and causing her further pain and suffering without the hope of improving her condition.

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Medical complexities of Ebstein Anomaly

Link to: TAPA COALITION brief

Texas Right to Life 1999 Testimony


For the eighth successive legislative session, Texas’s 2003 medical liability reforms emerged unscathed. Most importantly, we defeated a bill that would have indexed the non-economic damage cap.

This session was the most challenging and gratifying since 2003. Challenging because we were confronted with several troublesome bills; many of them filed by Republicans. Gratifying, because we were equal to the challenge by working together with trust, integrity, forward-thinking, and fair-mindedness.



Bringing Transparency to lawyer Health Care Advertising, Texas Lawmakers Hear testimony on HB 2251

Any daytime television watcher has most likely seen a lawyer advertisement, warning viewers of the dangers of a prescription drug. Concerned such ads might lead some to stop taking their meds, Texas lawmakers are now considering a bill that would bring transparency.


Video Testimony favoring HB 2251, (8 minutes 53 seconds)


Challenge to Texas' Advance Directives Act ruled moot

Texas Advance Directives Act, passed in 1999, was a collaborative effort among many stakeholders. One of those original stakeholders, Texas Right to Life, attempted to invalidate the very statute they helped construct. The purpose of the law is to promote dignity at the end of life and protect physicians and hospitals from being forced to...

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Link to: TAPA brief

Link to Houston Chronicle:

Judge lets one-of-a-kind “futile care’ law stand


Texas licenses a record number of new physicians at the 16-year mark of liability reforms

The Texas Medical Board licensed a record 4,760 new physicians for the fiscal year that ended in August.

The board licensed 246 more doctors this year than last, said Austin internist Howard Marcus, M.D, chairman of Texas Alliance For Patient Access.

“The number of new physicians applying for a Texas license also reached a near all-time high,” said Dr. Marcus, “topping 5,000 applicants for the fifth successive year,” he said.

“The state medical board is now licensing twice as many doctors per year than in the medical crisis years before lawsuit reforms were enacted,” said Marcus.

“Texas needs all of the high-quality doctors we can get, and we’re doing a good job of attracting them, “said Marcus.


In The Legislature HB 1693- Medical Expense Affidavit

Presently, the Texas statute relating to medical expense affidavits has a timeline that is advantageous to plaintiffs and unfair to defendants. The imbalance exists because plaintiffs can file medical affidavits early in the case and start a clock ticking for defendants to object to their admissibility before the defendant really understands the appropriateness of those medical bills.

VIDEO TESTIMONY presented in committee regarding HB 1693, (15 minutes and 32 seconds)


Tort refORm saved texas Nursing Homes

San Antonio Express

September 30, 2018

Back in 2002, Manor Park, a not-for-profit in west Texas was paying $150,000 a year for a $1 million insurance policy. A year later they were quoted $465,000 for the same coverage. The board fully realized that they were one broken hip away from bankruptcy.  This community was rated highly by state and national agencies and had a clean record regarding lawsuits.   Alan Hale, CEO of Manor Park says without equivocation, "Texas tort reform saved our organization and the residents that we serve."

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A fear of lawsuits really does seem to result in extra medical tests

New York Times

July 23, 2018

Doctors are known for complaining about how the malpractice systems adds costs. But it has been hard to prove, until now.

Researchers from Duke and M.I.T. found the possibility of a lawsuit increased the intensity of health care that patients received by about 5 percent –and that those patients who get the extra cost were no better off.

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Medical Liability Reform Delivering Results for Texas Patients

Because of Proposition 12, medical care is more readily available. More Texans have more treatment options. Frivolous lawsuits have declined. Our courts are less burdened with suspect lawsuits. And what voters passed 15 years this month has become a model for the rest of the nation.

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TMLT, Texas, and "Ten-Gallon Tort Reform

TMLT had the moral imperative to act both because it was the largest carrier in Texas and because of its relationship with the Texas Medical Association and Texas physician leadership. As chair of TMLT, I felt it was time to act. My prior personal experience with the injustice and imbalance of the medical liability tort system, when I had fought off a frivolous lawsuit, also played a major role in my decision to step up to the plate.

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Texas continues to attract large number of new physicians

The Texas Medical Board received a record 5,717 new physician applications and licensed a near-record number of new doctors for the fiscal year that ended last month. The 4,514 new licensees are the second highest on record, eclipsed only by the 4,719 new doctors licensed a year ago.

Texas has approved more than 50,000 new physicians since the passage of lawsuit reforms 15 years ago. This equates to 1,283 more new licensees per year than occurred during the medical liability crisis years of 2000-2003.

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Medical Liability Reforms Key to Texas Patient Access

 “Texas’ medical liability reforms have been nationally considered the gold standard for medical liability legislation,” said Governor Greg Abbott. “Tort reform has significantly reduced lawsuits and liability costs in our state and contributed greatly to the increasing number of doctors practicing in Texas.”

See the chart chronicling the biggest gainers and losers of obstetricains.


Employment Protections Preserved in Landmark Court Ruling

Medical school employees do not lose their immunity from lawsuits when providing patient care at private facilities, according to a ruling earlier this month by the Texas Supreme Court. The high court denied the plaintiff’s appeal on April 6, thus preserving the current law.

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Read TAPA's "friend of the court" brief

Hundreds of new residents planned could ease doctor shortage in Texas


June 18, 2018

Texas turns out plenty of medical school graduates, but there are not enough residencies to help retain them, a local doctor says. And that imbalance is contributing to a shortage of physicians in the state.

That's why Medical City Healthcare, UNT Health Science Center and HCA Healthcare are joining forces to create about 500 new residencies over the next five to seven years.

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Why Texas needs more doctors

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Texas Tort Reform continue to pay dividends for quality of long-term care services

Back in 2002, Manor Park, a not-for-profit in west Texas was paying $150,000 a year for a $1 million insurance policy. A year later they were quoted $465,000 for the same coverage. The board fully realized that they were one broken hip away from bankruptcy.  This community was rated highly by state and national agencies and had a clean record regarding lawsuits.   Alan Hale, CEO of Manor Park says without equivocation, "Texas tort reform saved our organization and the residents that we serve."

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Does immunity from medical malpractice lead to improved patient care?

The incidence of adverse medical events decreased significantly when physicians received sovereign immunity from medical malpractice claims at a Florida hospital, according to a study published in Health Management, Policy and Innovation.

For this study, researchers examined safety events involving 900 University of Miami medical.....

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Improper jury charge nixes $1.9 million verdict

On May 25 the Texas Supreme Court tossed a $1.9 million judgment in a medical liability lawsuit over a botched hysterectomy. The high court ruled that the judge’s jury instructions improperly allowed the jury to consider an invalid theory of liability.

The Benge case marks the first instance where TAPA filed briefs not only in the Supreme Court but also in the court of appeals.  Because the focus of the TAPA amicus brief was on the jury charge error, much of the arguments and citations to record cited in the Supreme Court opinion were taken directly from the TAPA brief. The TAPA amicus brief was instrumental in ensuring that Texas law on informed consent remains intact.


TAPA brief in Benge v. Williams

Lien on me: Reimbursement rates ruling seen as game-changer for medical billing litigation

A recent Texas Supreme Court decision that forces a Houston hospital to disclose reimbursement rates charged to insured patients versus uninsured patients will almost certainly be felt in so-called hospital lien cases, some Texas attorneys believe the decision could be applied to a range of other civil cases in which the reasonableness of a party’s charges is at issue.

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Judge lets one-of-a-kind 'futile care' law stand

By Todd Ackerman

September 22, 2017

Updated: September 23, 2017 1:23pm

In a victory for Texas' medical community, a Harris County state district judge Friday rejected a lawsuit challenging the constitutionality of a state law that allows doctors to withdraw life-sustaining...

TAPA Amicus Brief in Kelly v. Houston Methodist

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Are payout increases in Texas a bridf upturn or a growing trend?

For the fifth consecutive year, Texas ranked near the bottom nationally in medical liability payouts per capita.

Last year only five states prouduced lower per capita payouts than Texas, according to data gleaned from the National Practitioner's Data Bank.

But that trend may be reversing.  A just-released study by Diedrick Healthcare reported total medical liability payout...

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Texas Physicians inject billions into lone star state's economy

Texas Medical Association

January 8, 2018

New study shows physicians support more than 670,000 Texas jobs, and generate nearly $118 billion in economic activity “Whether in small towns or large cities, Texas doctors care for our Communities, ...

See Study PDF

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Medical school on the cheap: why becoming a doctor in Texas is a bargain

Texas Tribune

October 30, 2017

When Caitlin Comfort decided to go to medical school, the Yale grad had her heart set on staying on the East Coast. But her wallet had different ideas. Facing $90,000 per year price tags for tuition, she said no thanks, and started applying to schools back home in Texas.

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Publication Ranks Texas Second Nationally as Best Place to Practive Medicine

With rising rates of physician burnout, changing state legislation governing healthcare, and numerous other factors weighing heavily on the profession, many doctors are looking for a change to continue practicing medicine.

2017 Best States to Practice: The Top Five


Best States to Practice Interactive Map


Telemedicine services aid emergency care in rural Texas

By Joseph Goedert

Published October 30 2017, 7:51am EDT

A pilot program in Texas that went live 10 months ago is linking ambulance paramedics with five small hospitals in five expansive counties across a vast rural area of the state.

Initially funded for $500,000 over two years by legislation, the funds actually...

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Texas continues to attract large numbers of new physicians

The Texas Medical Board licensed a record 4,719 new physicians for the fiscal year that ended last month. This year’s total is nearly 10% greater than the previous historic high of 4,295 set two years ago.

Texas has licensed 48,908 new physicians since the passage of lawsuit reforms 14 years ago. This equates to 1,283 more new licensees per year than occurred during the medical liability crisis years of 2000-2003.

“The trends are irrefutable,” said Austin internist Howard Marcus, chairman of Texas Alliance for Patient Access. “The number of licenses granted continues at record levels,” he said. “Physicians per capita continue to show significant gains which is no easy accomplishment given our fast-growing population.

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Plaintiffs Avoiding Tort Reform

Court decision helps ensure patient access to care across state lines


A recent New Mexico Supreme Court decision has huge professional liability ramifications for physicians treating patients from another state. The March 13, 2017, ruling is of importance to emergency physicians who, under EMTALA, are unable to deny a patient care due to illness, injury, inability to pay, or lack of health history.

The issue at stake in Montano v. Frezza was which state's laws claim legal jurisdiction when a patient who resides in one state (New Mexico, in this case) receives care in another (Texas, in this case).

See published article in ACEPNow


Texas relaxes rules to allow out-of-state doctors to help Harvey victims

In the aftermath of Hurricane Harvey, some 213 out-of-state doctors have come to Texas working under a temporary license to provide disaster relief.

News accounts report doctors and nurses have traveled from as far as Oregon, Ohio, and New Jersey to assist in the disaster response.

“Not only have these healthcare workers aided patients, but they’ve provided welcome relief to hard-working doctors and nurses in need of a break,” said Dr. Howard Marcus, chairman of Texas Alliance for Patient Access. “Often the care is rendered in less than ideal conditions due to damage from the storm,” he said.

On August 30, the governor waived all necessary statutes and rules allowing out-of-state doctors to obtain a temporary license.

Healthcare workers employed by a hospital, licensed and in good standing in another state are eligible for temporary licensure. The temporary permit is good for 30 days.

The governor’s suspension will remain in effect until the disaster declaration is lifted or expires.

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2017's Best and Worst States For Doctors


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Texas isn't just great for doctors; professionals across the medical field are thriving in the Lone Star State. In fact, Austin, Houston, Dallas, and San Antonio rank among the best cities for registered nurses.


Texas doctor can't be sued in New Mexico, court rules

Albuquerque Journal March 14, 2017

A former Texas Tech University surgeon accused of botching a Curry County woman’s gastric bypass surgery in 2004 can’t be sued for malpractice in New Mexico, the state Supreme Court has ruled.  The state’s high court issued its decision Monday.  “We reverse the Court of Appeals and the district court,” Justice Edward L. Chávez wrote in his majority opinion, which was signed onto by Justices Petra Jimenez Maes and Judith K. Nakamura and Judge Linda M. Vanzi, a Court of Appeals judge designated to hear the case. “The district court shall dismiss Montaño’s suit without prejudice.”

The case has garnered significant attention in both New Mexico and Texas, with three dozen doctor groups and hospitals in both states signing on to a friend of the court brief in 2015. They argued that allowing the lawsuit to move forward could have a disastrous effect on patient care in eastern New Mexico – where doctors are scarce – because it might make Texas providers reluctant to care for New Mexico patients.

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High court ruling applauded

Albuquerque Journal, March 26, 2017

As a physician in Curry County, I often see the need for rural patients to seek care in nearby Texas. In some cases, care that is available less than an hour away in Texas could mean the difference between life and death.

There is only one hospital with a Level I trauma center that can provide comprehensive service – University of New Mexico Hospital in Albuquerque. New Mexico has no Level II trauma centers to collaborate with UNMH. When patients in rural parts of New Mexico receive emergency treatment and have been stabilized, they have two choices: A 3½-hour drive to Albuquerque, or about half that to two Level I trauma centers in Texas.

That’s why I applaud the New Mexico Supreme Court’s recent decision that recognizes that cross-border medical services in Texas are essential to New Mexico residents. This is the outcome of the court’s ruling that Texas physicians serving New Mexico patients in Texas will be able to serve...

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Bill seeking to inflate Texas' med-mal cap first of its kind

SE Texas Record, April 24, 2017

AUSTIN – Since the courts were apparently no help, those wishing to inflate Texas’ medical malpractice cap on non-economic damages are now turning to the state legislature.

Without little to no fanfare, state Rep. Gene Wu (D-Houston) introduced House Bill 719 on Dec. 21, a piece of legislation seeking to collapse the fixed med-mal cap and adjust it for inflation each year.

“This is an issue of fundamental fairness,” said Wu, a private practice attorney. “If there’s no recovery, a lawyer won’t take the case. It’s a matter of justice for people. If people cannot have their grievances settled in the courts, then our system breaks down.”

The prospect of an inflated cap, which was set at $250,000 per medical defendant in 2003, has rallied some groups into action.

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Study ranks Texas 6th best state for docs, expert points to tort reform

A recent study found Texas is one of the best states for physicians to practice medicine, a high ranking made possible in part due to the passage of tort...

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HB 270, the Out-of-State Access Provider Bill, signed into law by New Mexico Gov. Susana Martinez

New Mexico lawmakers crafted a legislative solution to protect access to medical care for the residents of Eastern and Southern New Mexico. For a Texas health care provider to benefit from the statute, it will be necessary for the health care provider to have in its agreement with the patient a choice of law and choice of forum provision. If the agreement with the patient does not contain such a provision, then HB 270 will not apply.

Summary of House Bill 270

Proposed patient consent for voluntary care

Proposed consent regarding emergency care

The footnotes pertain to why we chose to include or exclude language.

This information should be used only in consultation with your attorney, who will advise you on how the language should be crafted for and used by your hospital, nursing home or physician practice.


New Mexico Legislature Acts to Protect Patients’ Access to Care in Texas

Texas doctors and hospitals will continue to receive a full range of liability protections even when treating New Mexico patients. That issue was in doubt until the New Mexico Legislature took decisive action February 17.

The legislation preserves vital access to Texas physicians and hospitals for residents of Eastern New Mexico who routinely cross the state line for care.

Clearly, the New Mexico legislature recognized that access to health care is a public policy priority. Without legislation, thousands of patients would lose ready access to primary and specialized care, said Dr. Howard Marcus, chairman of Texas Alliance for Patient Access.

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New Mexico Lawsuit Threatens Access to Care

News story produced by and aired on Fox 34 @ Nine, Lubbock, TX

November 24, 2015


Austin ranks among America’s best cities for registered nurses

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The 10 Best Cities For Registered Nurses

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Goodbye Standard of Care, Hello Reasonable Practice

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The term “standard of care” has been misused and abused. It is time to replace it with a phrase which more accurately conveys the realities of modern medicine.

The legal definition of the “standard of care” is that which a reasonably competent and skilled physician would administer under the same or similar circumstances. Failing to meet the standard of care, one might argue, is simply another way of stating that a physician was negligent. However, it seems that many people don’t understand the nuance.

For these reasons, we propose that the term “standard of care” be retired and replaced with “reasonable practice.” The terms are legally equivalent, but “reasonable practice” is far less prone to misinterpretation by experts and juries.


Rape is not Health Care

The stunning headline might have caught your eye; it certainly caught mine. A big piece of it, though, is flat out wrong. “Doctor accused in rape unlikely to be held liable in civil court,” the Houston Chronicle headline read. “The Texas Supreme Court has ruled that rape in some circumstances is covered by medical malpractice laws,” the author wrote further down in the story. Wrong. Texas Alliance for Patient Access Chair Howard Marcus, MD, set her straight. Here’s his statement in full: “Rape is reprehensible". Neither the legislature not the courts gave medical liability protections to this criminal offense. Most recently, in Ross v. St. Luke’s Episcopal Hospital, the Texas Supreme Court set forth a seven-factor test to determine whether an injury was or wasn’t a health care claim. The Ross decision makes clear that rape is not related to the provision of health care, and is not a protected act simply because it occurred in a health care setting. The court has left no room for confusion.”

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Historic Senate Vote Provides Medical Liability Protections

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Standard of Care Language Included in Medicare 'Doc Fix' Bill / Soaring Eagle Award

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The Effect of Malpractice Reform on Emergency Department Care

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12-Years Post-Liability Reform, Texas Hits another Record in New Physicians

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RAND researchers say California's Prop 46 would likely reduce the state's physicians

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Texas Near the Top in U.S. Physician Recruitment

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Health Affairs Blog:

Dissecting the argument for and against California’s Proposition 46.

Academics say raising the cap would more likely increase health care costs than increase patient safety or quality of care.

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Tort Reformers and Trial Lawyers agree on bill that helps the injured

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Texas Hospital Association: Celebrating 10 years of health care liability

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Physician Growth Spiking, Especially in Central Texas

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Tort reform has had just the impact we desired

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Study shows increase in Texas doctors due to liability reforms

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Healthy Signs: Record number of new doctors is good news in East Texas

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Federal Judge Finds Texas Cap Constitutional

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Texas physician population surges since Tort Reform Legislation in 2003

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Healthy Benefits of Medical Liability Reform

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A Tale of Two States

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Absurd and easily refutable: Refuting Texas Watch's claims

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Increase in Texas physicians due to more than population growth

South Texas Record

Jon Opelt

     An opinion piece issued by Alex Winslow of Texas Watch entitled "Spin-doctoring by doctors" (Dec. 1) is making its way around the state. The op/ed makes the absurd and easily refutable claim that "growth in (the number of Texas) physicians tracks population increases."

     In 2003 Texas passed a series of medical lawsuit reforms. Since then the growth in in-state physicians has outpaced population growth by 84 percent.



Thanks for the doctors, New York

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Better Care, Thanks to Tort Reform

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Texas tort reform lures doctors

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Texas hospitals reinvesting savings from Medical Liability Reform

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Tort reform will rescue doctors

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More doctors in Texas after Malpractice Caps

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More doctors means tort reform efforts worked

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Influx of doctors overwhelms Texas Board

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Study: 4 in 10 medical malpractice cases groundless

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Doctors face Texas medical board's watchful eye

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Contrary to what study says, malpractice lawsuits drive costs

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AMA takes Texas off its liability crisis list

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Law school review produces 'Legislative Intent Roadmap' on Texas' landmark lawsuit reforms

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Texas Alliance for Patient ACcess

P. O. Box 684157 | Austin, Texas 78768-4157

2301 South Capital of Texas Highway  |  Building J-101 Austin, Texas 78746


Contact: Jon Opelt at opelt@tapa.info


Texas Alliance

for Patient AcCess

2301 South Capital of Texas Highway

Building J-101 Austin, Texas 78746


Texas Alliance for Patient AcCess

P. O. Box 684157 | Austin, Texas 78768-4157

2301 South Capital of Texas Highway

Building J-101 Austin, Texas 78746


Contact: Jon Opelt at opelt@tapa.info