insurance became prohibitive due to the number of frivolous lawsuits and their economic impact. In response to this cri- sis, the Texas Medical Professional Lia- bility Study Commission called for wide- spread changes in the judicial process, including the state’s first cap on medical malpractice damages, in December 1976. The Texas Legislature passed its first tort reform law in 1977. Physicians and the TMA Alliance played an important role through the Texas Medical Association Political Ac- tion Committee (TEXPAC) by urging passage of this legislation. Over the next decade, the plaintiff’s lawyers re- sponded by supporting the election of Texas Supreme Court members who dismantled each part of that legislation with decisions that could charitably be called imaginative and that amounted to the court’s usurping the function of the legislative branch of government. This process culminated in 1988 when the court ruled that the 1977 cap on dam- ages “violated the Texas Constitution’s open courts provision.” I recall commenting on an apparently frivolous case I was asked to review by the defense counsel. The lawyer’s re- sponse was, “You will never be able to change the system until Texas has a new Supreme Court!”


That is exactly what TMA and TEX-


Carlos R. Hamilton Jr., MD


PAC set about to help accomplish. With the leadership of Drs. Max Butler, Alan Baum, John Coppedge, and many oth- ers, the Clean Slate for ’88 campaign turned the tide for the Texas Supreme Court. After two more election cycles, the rout was well under way as such jus- tices as Tom Phillips, Nathan Hecht, Eu- gene Cook, and Raul Gonzalez replaced predecessors whose minds (and elec- tion finances) were influenced by the plaintiff bar. By the mid-1990s, with the addition of Jus- tices John Cornyn, Craig Enoch, Pris- cilla Owen, Jim Baker, and Greg Ab- bott, the rout was complete.


Now came the 8 TEXAS MEDICINE November 2013


daunting task of passing legislation to re- form the broken tort system. Two occur- rences greatly enhanced these chances. First was the election of Gov. George W. Bush, who had expressed a strong com- mitment to tort reform. Second was new organizations of businessmen, manu- facturers, community leaders, and citi- zens who knew such legislation meant progress for the entire Texas economy, as well as the delivery of health care. These groups, such as Texans for Lawsuit Reform, TMA, and other like-minded groups, proved to be an unbeatable team, and the winning touchdown was scored in 2003 with the enactment of HB 4 and Prop 12.


I was always told that one should


learn from his or her mistakes, but per- haps we can learn even more from our successes. Hopefully, the medical com- munity and our society in general can apply some of these lessons to the on- going battle over general health care re- form. The first lesson is that to succeed in the public arena we must build coali- tions with larger, well-funded groups representing employers, businesses, communities, and the general public. Secondly, we must have patience, as the wheels of public policy change turn slowly. Thirdly, we must not be fickle friends to other groups, as entities with diverse interests rarely agree on 100 per- cent of the issues.


Examples of the latter can be found in the medical community’s conflicts with the managed care industry that came center stage in the 1990s with the HMOs’ attempt to deny patients’ access to care that physicians had ordered or that the patients felt was needed. Once that issue seemed under control, the health insurance industry changed its tactics and instead of denying care, sim- ply delayed or avoided paying for the care after the fact. Again, legislation to address this issue was the result of TMA and TEXPAC efforts. We should all remember the adage


“The price of freedom is eternal vigi- lance,” as future legislatures and courts can change laws and judicial opinions. We must continue to support decision- makers who adhere to the principles that make possible the most effective medi-


cal care that physicians can provide for their patients, sustain our economy, and enhance our quality of life. The present and future generations of medical professionals will have health care reform and other issues that will challenge their abilities to interact ef- fectively with our government and other public entities. The future of our profes- sion will be in their hands. n


Dr. Hamilton was president of the Harris County Medical Society in 1999, was on the TEXPAC Board of Directors from 1989 to 2003, and served as its chair from 1994 to 1996.


The Texas Medical Association Political Action Committee (TEXPAC) is a bipartisan political action committee of TMA and affiliated with the American Medical Association Political Action Committee (AMPAC) for congressional contribution purposes only. Its goal is to support and elect pro-medicine candidates on both the federal and state level. Voluntary contributions by individuals to TEXPAC should be written on personal checks. Funds attributed to individuals or professional associations (PAs) that would exceed legal contribution limits will be placed in the TEXPAC administrative account to support political education activities. Contributions are not limited to the suggested amounts. TEXPAC will not favor or disadvantage anyone based on the amounts or failure to make contributions. Contributions are subject to the prohibitions and limitations of the Federal Election Campaign Act. Contributions or gifts to TEXPAC or any CMS PAC are not deductible as charitable contributions or business expenses for federal income tax purposes. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and name of the employer of individuals whose contributions exceed $200 in a calendar year. Contributions from a practice business account must disclose the name of the practice and the allocation of contributions for each contributing owner. Should you have any questions, call TEXPAC at (512) 370-1361.


All articles in Texas Medicine that mention Texas Medical Association’s stance on state legislation are defined as “legislative advertising,” according to Texas Govt. Code Ann. §305.027. That law requires disclosure of the name and address of the person who contracts with the printer to publish the legislative advertising in Texas Medicine: Louis J. Goodman, PhD, Executive Vice President, TMA, 401 W. 15th St., Austin, TX 78701.


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