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LEGISLATIVE
ACCOMPLISHMENTS

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sparse (coverage); one guy is half-retired,” he said. “If you have a head The 2017 TAPA report noted that in the two years before the
trauma or a head bleed, you’re probably not going to survive, because reforms, 14 of Texas’ 17 medical liability insurers disappeared.
those critical 30 minutes to an hour, by the time you’re flighted out, TMA General Counsel Donald “Rocky” Wilcox recalls being on
you won’t survive that.” the phone with physicians crying because their liability insurance
Still, he views the reforms as important protections. carrier had dropped them, and they couldn’t find anyone else to
“It would kill any type of … neurosurgeon [practice] if tort re- insure them. And TAPA’s report notes the average hospital pre-
form is not in Texas. You would have to practice in academics, and mium had spiked to $870,000 in 2003, more than double what it
then everybody’s kind of well-protected,” Dr. Alexander said. “But was in 2000, according to Texas Hospital Association figures.
when we’re three hours – or two hours – flight to Houston or San For Dr. Cardenas, one of the most memorable signs of those
Antonio, you endanger a lot of people.” times came from a would-be lawsuit he stopped. After the U.S. Food

and Drug Administration pulled a heartburn drug off the market
THE DARK AGES in 2000, a law firm representing one of Dr. Cardenas’ patients who
Many of the younger guard of Texas physicians, and some who had taken the drug warned him a suit was coming. Then, the pa-
moved to Texas after 2003, may have no sense of what it was like tient’s brother called Dr. Cardenas. He recalls the brother essentially
in the bad old days. But McAllen gastroenterologist and TMA Im- told him, “‘I can make it all go away for a certain amount of money.’
mediate Past President Carlos J. Cardenas, MD, is one who will never “I couldn’t believe my ears,” said Dr. Cardenas, who then noted
forget what he calls the “lawsuit bonanza for the trial bar.” the shakedown attempt in the patient’s chart. The law firm later
In a TAPA-commissioned October 2017 report on the impact of stopped pursuing the case.
tort reform on Texans’ health care access, researchers noted some “That was the atmosphere. That’s kind of what was going on; it
areas of Texas saw 300 medical liability suits for every 100 physi- was open [season] on physicians down here,” Dr. Cardenas said. “We
cians. While the vast majority of those suits were unsuccessful, the were having difficulty recruiting and retaining [doctors]. Medical lia-
report says, defending them still cost physicians thousands of dollars bility coverage had basically gone away for some subspecialties.”
and time away from their practice. The lawsuits grew to epidemic proportions for Texas physicians,
“Things had gotten to the point to where there were people that and the push for change began. On April 8, 2002, Dr. Cardenas and
were hiring staff just to do nothing
but copy records, because back
then it was all Xerox machines. And
you were getting a duces tecum
[subpoena] almost every week to
every other week,” Dr. Cardenas re-
called. “If it was a patient you had
seen, even if it wasn’t directly af-
fecting you, you had to provide
records because somebody else is
being named in a liability claim.
“It was rampant, and things were
worse, I think, in South Texas than
they were in other parts of the state.
We were kind of the canary in the
coal mine, in that we were seeing it
here before it became a problem
across the rest of the state.”

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14 San Antonio Medicine • January 2019