Medical Malpractice Reform Proven to Not Reduce Medical Costs

Taking Away Rights Of Injured Patients To Sue Careless Doctors Does Not Reduce Medical Costs

Many states have laws which severely limit the rights of injured patients to sue physicians for malpractice. These laws typically say that if a trial is held and the jury finds that a doctor did provide substandard care to a patient and issues a damages verdict in favor of the patient, the judge is required to ignore the jury’s verdict and reduce the damages to a preset maximum amount. Think about that for a minute. These laws only apply to cases where a jury found that the doctor had actually acted carelessly. In other words, these laws don’t even apply to frivolous lawsuits, because if the jury made up of the general public finds that the doctor acted carelessly, then the lawsuit obviously isn’t frivolous.

The 7th Amendment to United States Constitution guarantees every citizen the right to a jury trial. The Missouri Constitution also guarantees every citizen the right to a jury trial. Many of these laws have been found to be unconstitutional because in fact they take away the right to a jury trial. A jury trial is meaningless if the judge is going to overrule the jury’s decision and reduce the verdict, which is what these laws require.

Many people who argue in favor of those laws claim that it’s necessary to limit verdicts because doing so will reduce medical costs, the theory being that without those limits doctors will be required to “practice defensive medicine” so as to protect themselves. The theory goes that because of the fear of lawsuits doctors will order unnecessary tests to use to defend themselves in case they get sued, driving up medical expenses. There has never been any evidence to support that position, but they have made that argument for many years anyway.

Today, the New England Journal of Medicine, the most prestigious medical journal in the United States, published an article completely disproving that theory and showing that these laws do not produce any significant reductions in medical expenses. The article is entitled “The Effect Of Malpractice Reform On Emergency Department Care.” The following summary of the article is quoted directly from the New England Journal of Medicine’s website as it exists today, October 16, 2014 (

The Effect Of Malpractice Reform On Emergency Department Care

Daniel A. Waxman, M.D., Ph.D., Michael D. Greenberg, J.D., Ph.D., M. Susan Ridgely, J.D., Arthur L. Kellermann, M.D., M.P.H., and Paul Heaton, Ph.D.  N Engl J Med 2014; 371:1518-1525October 16, 2014DOI: 10.1056/NEJMsa1313308


Many believe that fear of malpractice lawsuits drives physicians to order otherwise unnecessary care and that legal reforms could reduce such wasteful spending. Emergency physicians practice in an information-poor, resource-rich environment that may lend itself to costly defensive practice. Three states, Texas (in 2003), Georgia (in 2005), and South Carolina (in 2005), enacted legislation that changed the malpractice standard for emergency care to gross negligence. We investigated whether these substantial reforms changed practice.


Using a 5% random sample of Medicare fee-for-service beneficiaries, we identified all emergency department visits to hospitals in the three reform states and in neighboring (control) states from 1997 through 2011. Using a quasi-experimental design, we compared patient-level outcomes, before and after legislation, in reform states and control states. We controlled for characteristics of the patients, time-invariant hospital characteristics, and temporal trends. Outcomes were policy-attributable changes in the use of computed tomography (CT) or magnetic resonance imaging (MRI), per-visit emergency department charges, and the rate of hospital admissions.


For eight of the nine state–outcome combinations tested, no policy-attributable reduction in the intensity of care was detected. We found no reduction in the rates of CT or MRI utilization or hospital admission in any of the three reform states and no reduction in charges in Texas or South Carolina. In Georgia, reform was associated with a 3.6% reduction (95% confidence interval, 0.9 to 6.2) in per-visit emergency department charges.


Legislation that substantially changed the malpractice standard for emergency physicians in three states had little effect on the intensity of practice, as measured by imaging rates, average charges, or hospital admission rates.”

As this study shows, these unconstitutional laws also don’t do anything to reduce medical expenses.   All laws overriding jury decisions should be eliminated, in accordance with the requirements of the United States Constitution.  Holding people accountable is the only way to get them to change their conduct, in order to protect all of us.