Texas House Bill 4

• HB 4 (2003) imposed strict caps on “noneconomic damages” in medical malpractice lawsuits in Texas.

  • $250k cap against individual doctors/providers

  • Up to $250k per healthcare institution

  • Maximum generally capped around $750k total for pain-and-suffering damages

• Economic damages were not capped.
  Patients could still recover actual medical expenses, lost wages, rehabilitation costs, etc.

• The legislation was designed to reduce malpractice insurance costs and discourage lawsuits that lawmakers considered excessive.

• Supporters argued the reforms:

  • lowered malpractice insurance premiums

  • attracted more physicians to Texas

  • improved access to healthcare, especially in rural areas

• Critics argued the caps:

  • made it harder for severely injured patients to obtain fair compensation

  • disproportionately harmed children, elderly patients, and non-working victims

  • reduced accountability for negligent healthcare providers

• The report notes malpractice insurance rates in Texas generally declined after reform, though debate continued over whether tort reform alone caused that decline.

• HB 4 worked together with Proposition 12, a constitutional amendment approved by Texas voters in 2003, which protected the caps from being struck down by courts.

• The reforms became part of Texas Civil Practice & Remedies Code Chapter 74, which still governs Texas medical liability law today.

https://lrl.texas.gov/scanned/archive/2012/18086.pdf