title: Malpractice risk and cost are significantly reduced after tort reform.
abstract: BACKGROUND
  Rising medical malpractice premiums have reached a crisis point in many areas of the United States. In 2003 the Texas legislature passed a comprehensive package of tort reform laws that included a cap at $250,000 on noneconomic damages in most medical malpractice cases. We hypothesized that tort reform laws significantly reduce the risk of malpractice lawsuit in an academic medical center. We compared malpractice prevalence, incidence, and liability costs before and after comprehensive state tort reform measures were implemented.
  
  
  METHODS
  Two prospectively maintained institutional databases were used to calculate and characterize malpractice risk: a surgical operation database and a risk management and malpractice database. Risk groups were divided into pretort reform (1992 to 2004) and post-tort reform groups (2004 to the present). Operative procedures were included for elective, urgent, and emergency general surgery procedures.
  
  
  RESULTS
  During the study period, 98,513 general surgical procedures were performed. A total of 28 lawsuits (25 pre-reform, 3 postreform) were filed, naming general surgery faculty or residents. The prevalence of lawsuits filed/100,000 procedures performed is as follows: before reform, 40 lawsuits/100,000 procedures, and after reform, 8 lawsuits/100,000 procedures (p < 0.01, relative risk 0.21 [95% CI 0.063 to 0.62]). Virtually all of the liability and defense cost was in the pretort reform period: $595,000/year versus $515/year in the postreform group (p < 0.01).
  
  
  CONCLUSIONS
  Implementation of comprehensive tort reform in Texas was associated with a significant decrease in the prevalence and cost of surgical malpractice lawsuits at one academic medical center.
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, and University Hospital, San Antonio, TX 78229, USA. stewartr@uthscsa.edu
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Stewart
authors.forename: Kathy
authors.initials: K
authors.lastname: Geoghegan
authors.forename: John G
authors.initials: JG
authors.lastname: Myers
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Sirinek
authors.forename: Michael G
authors.initials: MG
authors.lastname: Corneille
authors.forename: Deborah
authors.initials: D
authors.lastname: Mueller
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Dent
authors.forename: Steven E
authors.initials: SE
authors.lastname: Wolf
authors.forename: Basil A
authors.initials: BA
authors.lastname: Pruitt
mesh_terms: D000046:Academic Medical Centers; D015331:Cohort Studies; D013502:General Surgery / Q000458:organization & administration*; D018166:Health Care Reform / Q000458:organization & administration*; D006801:Humans; D007351:Insurance, Liability / Q000191:economics* / Q000331:legislation & jurisprudence; D016365:Liability, Legal / Q000191:economics*; D008318:Malpractice / Q000191:economics* / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013781:Texas