How Doctors Cured Texas

Physicians are the Rodney Dangerfield of American politics. They get no respect.

For example, in my home state of Maryland, you would think our elected officials would want to do something about the 70 percent hike we've seen in medical malpractice premiums over the past two years. It's driving OB/GYNs and other specialists from practice.

 Publicly, our governor and other leaders express alarm. But they can smell power -- and lack of it. Because doctors are not sufficiently organized, it is unlikely lawmakers will tackle the problem. Good policymaking will be left for another day.

It's even worse just down the road in Washington, D.C. Over the past year, Republicans allied with President Bush, the AMA, and other business groups failed nine times to pass various changes
to tort laws, some affecting medical malpractice.

Some of the defeats raised eyebrows. On one vote, lobbyists for the American Trial Lawyers Association (ATLA) convinced Utah Sen. Orrin Hatch (R) -- typically a reliable supporter of physician organizations on tort reform -- to join them against the administration.  

As reported by The Wall Street Journal, ATLA played to Hatch's sympathies as a former plaintiffs' lawyer. "They know I will support them when they are right," Hatch told the Journal.

Don't kid yourself: on public issues that affect your practice, there are strong arguments to be made for both sides. Power and influence often determine who gets respect and what's "right" in politics.

That's what physicians in Texas learned over the past decade as they worked to overcome a vicious cycle: Aggressive advertising campaigns for "injured plaintiffs" led to an increasing number of rising jury verdicts against physicians, which led to higher malpractice premiums. "Jackpot Texas justice" seemed out of control. By the early 1990s, Texas physicians were becoming an endangered species.

In the mid '90s, at the urging of the Texas Medical Association (TMA), the state did curb punitive damage awards and placed restrictions on where lawsuits could be filed. Then the TMA, joined by the business community, pushed for more. 

In 2003 the physicians and the highly respected Texas trial lawyers faced off in a protracted battle over caps on medical malpractice damages.

Ultimately the physicians won. The victory happened because physicians personally and aggressively pushed the reforms. Dallas endocrinologist Jonathan Leffert, one of the grassroots activists, explains, "We learned politics is a contact sport."

To win legislative approval of caps, Leffert says that he and other physicians worked their Rolodexes and Outlook files, contacting every elected official who would listen.

But the physicians also needed passage of a statewide voter referendum -- and they would need to secure it despite a ferocious campaign by trial lawyers who reportedly had more than $10 million to spend and who'd just been humbled in the state legislature.

Calculating how many votes it would take to win the referendum, the lesser-funded TMA directed its 35,000 physician members to recruit 21 voters each to go to the polls on election day. The referendum passed by less than 2 percentage points, with voter turnout surpassing projections.

Texas physicians were given credit for the win and accomplishing the unthinkable: beating the Lone Star lawyers.

They also provide lessons for other physicians:

• First, almost all of these issues are important for better patient care. So, as Leffert explains, "Talk about the impact on patients and they will benefit. We speak about ensuring patient access to physicians, as opposed to lowering our malpractice premiums."
  
• Second, remember that politics is a contact sport. All physicians must be active in lobbying, talking directly to legislators and to voters.
  
• Third, get focused. The AMA and state medical societies need to support and build alliances with other groups. As one experienced lobbyist recently told me, "during the next election, physicians need to target just one of their opponents with all their financial and grassroots might. And win."

Then they'd get some respect.

To share your views on this subject and others -- or to join other physicians of all political persuasions who want to change healthcare, sign up for our free e-newsletter "Politics and Your Practice." E-mail me at kkarpay@physicianspractice.com

This article originally appeared in the September 2004 issue of Physicians Practice.