by Howard Marcus and Bruce Malone

Texas' 2003 health care liability reforms and voter approval of Proposition 12 have delivered on their promise: increased patient access to care. Sick or injured Texans today can see far more medical specialists and emergency care physicians. That's welcome news for Central Texans who count on Austin physicians and hospitals for everyday and emergency care.

One would expect that a progressive city of Austin's size would have a cadre of medical specialists on call at any time of the day or night to meet any health care need. But that was not always the case. Before Proposition 12, we were losing high-risk specialists such as orthopedic surgeons, neurosurgeons and obstetricians.

To avoid the risk of a lawsuit, many physicians cut back on high-risk and life-saving care or steered clear of emergency calls. Even worse, some doctors found it prudent to step away from their practice. In the two years before Proposition 12 passed, 16 obstetricians retired, left the community or stopped delivering babies.

Hospitals across the state were turning away ambulances because of a critical shortage of doctors and nurses as liability costs rose as much as 50 percent in a single year. This was especially true in medically underserved areas of the state such as Beaumont, Corpus Christi, Victoria and the Rio Grande Valley.

But Austin patients were also affected. For example, on May 19, 2002, the American-Statesman reported on the front page about a Central Texas man who "fell from an oak tree and broke his back (and then) took a bewildering journey that ended nearly nine hours later in a city 65 miles away" because a neurosurgeon was not on-call for an Austin hospital emergency room that day.

In its lead editorial on July 20, 2003, the Statesmanendorsed Proposition 12 "in hopes that it would work as advertised and reduce medical malpractice insurance premiums . . . that have limited the willingness of some doctors to practice in certain areas of the state or certain types of high-risk medicine."

Those hopes have been realized. Austin has regained the 16 obstetricians we lost, and we have added, among others, three pediatric cardiologists, two cardiovascular surgeons, a neurosurgeon and 24 emergency medicine specialists.

This amazing turnaround is occurring across Texas, with a statewide gain of 93 orthopedic surgeons, 81 obstetricians and 32 neurosurgeons. We've also seen substantial increases in hard-to-recruit children's doctors such as pediatric cancer physicians, pediatric endocrinologists, child neurologists and doctors who specialize in newborns and premature infants.

The ranks of Texas physicians are on the rise primarily because the liability rates they pay are on the decline. All five of Texas' leading physician liability carriers have cut their rates in the past years, most by double-digits. No other state in the nation can make that claim. In May, the American Medical Association removed Texas from its list of states in liability crisis. Texas is the only state ever to be removed from the list.

Be assured, patients are free to seek the services of attorneys now just as they were before the passage of the 2003 reforms. The new law has no effect on damages for past and future medical bills, lost earnings or in-home assistance. It only affects the loss for subjective harm such as physical pain and emotional distress. That component had increased dramatically before the 2003 reforms. The state's largest insurer of physicians reports that its average paid claim falls well below the new non-economic cap. If plaintiff attorneys have decided to take fewer cases it is because the chances for a runaway verdict have been reduced.

Physicians want to take on the challenge of caring for the seriously ill. Obstetricians want to deliver babies and trauma specialists want to help injured patients. Austin doctors today can confidently do what we do best: treat patients.

Marcus is an Austin internist and chairman of the Texas Alliance For Patient Access. Malone is an Austin orthopedic surgeon and member of the Texas Medical Association Board of Trustees.