Medical Malpractice Insurance (Tort Reform in Missouri Part Two)

Today we will be discussing Tort Reform in Missouri and the impact it has had on Doctors in Missouri, specifically the cause of the escalation in medical malpractice insurance costs.  Dr. Hagen has been fighting to build tort reform policies in Missouri that benefit patients and the Doctors that treat them.  Medical malpractice insurance costs rise and fall due to many factors, one of those being litigation costs from frivolous lawsuits.  Again MoDocs believes the best way to combat frivolous lawsuits, medical negligence and  rising medical malpractice insurance costs is through continuing medical education by way of Risk Management.

The following is a fairly dated article but details out nicely the impact Tort Reform has had on keeping and bringing Doctors to Missouri from


In 2003, medicine in Missouri was on life support. Physicians were leaving in droves to practice in states with affordable malpractice insurance and a less predatory tort bar. Despite seven medical schools in Missouri and Kansas City, Kansas, few residents and fellows could afford to set up a practice in Missouri or to join state medical groups. Huge areas of the Show-Me State were left without neurosurgical or high-risk obstetrics coverage. This article reviews the enactment and effect of tort reform in Missouri and our related thoughts on health care reform at the national level.

Many Missouri physicians headed west to Kansas in 2003. The contrast between the states is worth noting. Kansas politics are dominated by commercial and agricultural interests, and legislation is generally business friendly. The Kansas Trial Lawyers Association, the executive director/lobbyist of which from 1977 to 1986 was current Health and Human Services Secretary Kathleen Sebelius, does not have nearly the power or influence of its Missouri counterpart. The Sunflower State has created a stabilization fund that provides reinsurance against large adverse judgments. Consequently, Kansas physicians had malpractice premiums as much as 30% to 50% lower than their colleagues in Missouri (Discover Vision Centers, unpublished data).

Missouri trial lawyers are one of the major forces in the state’s politics. They dominate the Democratic Party and, in areas, hold sway with the Republican Party as well. Their fundraising for politicians is legendary and prodigious. Inner-city juries in St. Louis and Kansas City are much more sympathetic to plaintiff ’s cases than out-of-state juries.11 The US Chamber of Commerce declared 2003 Missouri one of the most hostile states in which to conduct business.2

In full crisis mode, Missouri physicians mobilized as never before for the 2004 state elections. Previously somewhat parsimonious with their time and money, physicians became major contributors to the campaigns of Republican gubernatorial candidate Matt Blunt and numerous candidates for the State Senate and House, all of whom included in their platforms the enactment of tort reform. Physicians handed out campaign materials in their offices, let their patients know how runaway junk lawsuits imperiled their care, and identified which candidates were pledged to tort reform. Doctors advertised the cause on radio and television and in newspapers. Ophthalmologists were especially engaged in the effort; our practice, Discover Vision Centers, donated more money than any other state physician group. The election handed Governor Blunt a victory and ushered in Senate and House majorities committed to changing the status quo.

In 2005, physicians’ political activism contributed to the passage of House Bill 393, a sweeping tort reform law. A $350,000 cap was set on non-economic damages, change of venue was abolished, and numerous other provisions had an immediate effect on Missouri’s malpractice rates.2 The exodus of physicians slowed. Our practice’s malpractice premiums per Missouri ophthalmologist dropped from $22,718 in 2006 to $16,406 in 2009—a 28% reduction. (In 2009, however, the premiums for our Kansas-based ophthalmologists were only $8,937.) New physicians and new insurance carriers opened for business in Missouri. The number of malpractice lawsuits filed and judgments paid in the state plummeted to a 30-year low; the average payout is now about $50,000 below that of 2005.2

Not surprisingly, Missouri’s trial lawyers have mounted an effort to overturn tort reform by the judicial process, as executed successfully in Wisconsin.3 Their test case, carefully researched and lavishly financed, Klotz v St. Anthony’s, is presently before the Missouri Supreme Court.

The unprecedented scope and speed of health care legislation at the national level is putatively driven by the costs and unavailability of medical care. The Manhattan Institute, a nonpartisan think tank, in addition to physicians and other thoughtful parties recognize that both the measurable cost of malpractice litigation and the much larger (but more difficult to compute) costs of defensive medicine are significant expenditures. Ultimately, the price of defensive medicine and unrestrained tort litigation will be paid by unsustainable inflationary monetary policies and confiscatory taxes on US citizens and businesses.4

We believe that the flagrant omission of tort reform in the health care bills before Congress at the time of this writing can be explained by the fact that the American Association of Justice (the refurbished name of the American Trial Lawyers Association) and wealthy individual trial lawyers are top political donors to the Democratic Party.5

Physicians should start raising opposition to health care bills that do not contain tort reform or that they find otherwise pernicious. The 2010 elections are important. Physicians should discuss the issues and candidates with their patients, who, in our experience, are mostly sympathetic and respect doctors’ judgment. Physicians can distribute information in their office. Those in states with a US Senate race should find the best candidate and assist his or her campaign. Our practice has made a major commitment to US Representative Roy Blunt in his bid for a Senate seat.

We suggest meeting with state and national candidates, educating them, and—if they agree with tort reform—supporting them early in their campaigns. Based on the Missouri experience, we believe that motivated medical professionals can help shape positive health care legislation and enact tort reform.
[Hagen, John MD C., III, John MD F. Doane, and Jim Denning. “Show Me Tort Reform: The Missouri Experience.” BMC Today., 1 Jan. 2010. Web. 15 Aug. 2014.]


At any time feel free to contact MoDocs Here, call us at 816.901.9950 or fill out the Rapid Quote form at the bottom of this or any page to discuss how we can help reduce your Medical Malpractice Insurance Costs.

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