No claims are being made that tort reform efforts have cured all the medical liability insurance ills, but positive signs are reported in three states where legislation was enacted in 2003.

Signs range from lower liability insurance premiums - or at least less-dramatic premium increases - to more insurers entering the market. doctors report they are starting to see some of the results they hoped for in supporting reforms.

Texas is one of the states enacting reforms, and every insurer in the state but one lowered liability premiums in 2005, and the last one soon may follow suit, said Texas Medical Association President Bohn D. Allen.

Another state, West Virginia, has seen an increase in new physicians and a decline in defense costs for liability insurance companies. The third state, Ohio, reports a moderation of premium increases and two new insurers have entered the market.

The three states are three of 20 the American Medical Association declared to be in crisis because of rising medical liability insurance premiums, based on results of a March 2004 survey, a report by Michael Norbut of the Heartland Institute.

In those 20 states, some physicians were retiring early and others were forced to discontinue high-risk procedures or move to states not in crisis as a result of high liability premiums.

Progress attributed to reforms in all three states has been gradual, medical association representatives said, but the signs of what may come are encouraging. It was compared to taking medication. It takes time to see the effects.

Texas voters in 2003 approved a constitutional amendment capping awards for non-economic damages at $250,000 beginning in September of that year. Observers say access to care seems to be improving as a result.

Obstetrics groups around the state that had stopped delivering babies have gone back into that practice, said Allen. "One group in Fredericksburg put a big ad in the newspaper saying, 'We're back.' I think we've turned the corner."

Medical liability insurers also are responding. Texas Medical Liability Trust, which insures more than one-third of the state's physicians, followed its 12 percent cut in rates last year with another 5 percent drop this year.

Maury Magids, president of the American Physicians Insurance Exchange, said premiums for Texas physicians insured by the company would decrease by $3.5 million this year. Effective May 1, he said, 2,200 of the 3,500 physicians insured by the company will have seen an average drop of 5 percent. Other firms also have announced premium reduction plans.

Since the Texas reform is in the form of a constitutional amendment, Allen said, it can't be struck down by a court or challenged by subsequent laws.

That is not the case in West Virginia where physicians have seen their fight shift from the state legislature to the courts. So far, tort reform efforts there, including a $250,000 cap on non-economic damage, have stood up to court challenges.

Tort reform efforts haven't produced miraculous cures for medical liability insurance ailments, but that was not expected.

Positive signs of significant improvement in insurance premium costs in reform states, however, indicate the prescription is working.