Tuesday, December 11, 2007

Tort Reform in Texas

We are very fortunate in Texas because tort reform successfully passed the legislature and has been guaranteed by changes to our state constitution. The need for tort reform is being questioned nationally and being strongly advocated for by physicians and hospitals in many states.

The importance of tort reform in Texas can be seen by reflecting on the results it has had in the CHRISTUS Health system. We have always believed that if a true error occurs in our delivery processes, the patient and his or her family should be told the truth and should be financially reimbursed for those costs which have been caused by the error. This is the foundation for true transparency, which has driven CHRISTUS since it was formed almost nine years ago.

However, prior to tort reform, the size of payments required to resolve litigation claims both inside and outside the courtroom were--in our estimation--excessive, and in fact continued to rise year after year. In addition, the major cause for these increases had to do with pain and suffering or loss of quality of life, including relationships with spouses, etc. These are both areas which are fairly subjective, in contrast to physical disabilities, which certainly need to be compensated for, and are fairly objective.

With tort reform, caps are placed on these settlements, and as a result, lawyers and jurors are forced to focus more on the objective results of medical errors. Specifically in CHRISTUS Health, since tort reform was passed, our expenses for litigation have been reduced dramatically. During this period of time, we also focused a great deal of energy on improving our quality and safety initiatives throughout the entire system. And as a result, we believe both the number of claims and the size of the claims have been even reduced further than as a result of tort reform alone.

Both of these outcomes are justification for other states as well as the federal government to continue to seek ways to support tort reform nationally. However, perhaps the greatest outcome of tort reform for CHRISTUS was that we were able to utilize a significant portion of our savings to fund and accelerate further improvements in our quality and safety programs. Each of our 13 regions can submit projects which they believe, if implemented, would accelerate improvements in their quality of care. Based on competitive reviews, several of these are funded each year from these savings. Programs in the past which have received such support include certifying all nurses in the reading of fetal monitors, providing standardized competency testing for all nurses, and providing the latest and safest way to lift heavy patients from one location to another. These programs were designed, funded and piloted and are now being universally implemented across the entire system.

We have known for years that the legal system put into place to deal with less-than-favorable quality outcomes in health care were necessary but inappropriate as long as the potential settlements were uncapped and limitless. Supporting tort reform means that you support paying what is due, admitting what was done incorrectly and doing everything possible to mitigate the negative outcomes and create the positive solution for patients and their families. Achieving tort reform in Texas, therefore, was a high priority for CHRISTUS leadership, and its success has given us the opportunity to not only create significant savings while being fair to our patients and their families, but also to utilize these savings to accelerate our improvement processes.

In the end, when we talk to patients who have had less-than-favorable outcomes, we believe that they truly want to be treated fairly and to do whatever is necessary to make sure the error does not recur. Tort reform makes both of these goals possible and creates a win-win situation for both the health care providers and the patients who receive our care. Therefore, it is our hope that tort reform continues to be high on the agenda of other state and federal leaders, for based on our experience, it has provided some of the best outcomes possible as outlined above.

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