Medical Malpractice in Texas

Texas Medical Malpractice: Overview

Texas House Bill 4, enacted in 2003, constitutes the most comprehensive malpractice tort reform package in Texas history. Chapter 74 of the Texas Civil Practice and Remedies Code (CPRC) — the Texas Medical Liability Act — governs all healthcare liability claims in Texas.

The 2003 reforms, confirmed by voters through Proposition 12, introduced:

• A $250,000 per-defendant non-economic damage cap
• A mandatory 120-day expert report requirement (with automatic dismissal with prejudice for failure)
• A 60-day pre-suit notice requirement
• An occurrence-based statute of limitations

Texas malpractice reform is credited by proponents with reducing malpractice insurance premiums and increasing physician supply in Texas, particularly in rural areas and high-risk specialties. Critics argue the reforms have effectively closed the courthouse to many legitimate malpractice victims whose non-economic damages are disproportionately affected.

Texas Statute of Limitations

Texas Civil Practice and Remedies Code § 74.251 provides:

Standard rule: 2 years from occurrence

The limitations period is 2 years from the date of the healthcare liability claim — typically the date of the negligent act. Texas applies an occurrence rule, not a discovery rule, in the vast majority of malpractice cases.

The discovery rule has extremely limited application in Texas malpractice. The Texas Supreme Court has held that the discovery rule does not apply to healthcare liability claims under Chapter 74 unless the injury was inherently undiscoverable and objectively verifiable.

10-year outside limit

No action may be brought after 10 years from the date of the act or omission giving rise to the claim — even for minors.

Minors

The limitations period is tolled for minors until the minor's 18th birthday, but the 10-year outside limit still applies. This means a child injured at age 9 or older may have a claim expire before reaching majority.

Pre-suit notice tolling

Timely service of the 60-day pre-suit notice tolls the limitations period for 75 days (notice period plus 15 days).

Texas Non-Economic Damage Caps

Texas Civil Practice and Remedies Code § 74.301–74.303 imposes non-economic damage caps:

• Per physician / individual healthcare provider: $250,000
• Per health care institution (first institution): $250,000
• Per health care institution (second institution): $250,000

In a case with a physician defendant and two hospital defendants, the maximum non-economic recovery is $750,000.

These caps apply to all non-economic damages — pain and suffering, mental anguish, disfigurement, and loss of consortium. Economic damages (medical costs, lost earnings, future care) are uncapped.

What constitutes a "health care institution"?

Under Texas law, hospitals, nursing facilities, medical clinics, ambulatory surgery centers, and similar entities are "health care institutions." Independent physician practice groups may or may not qualify depending on their corporate structure — this is frequently litigated.

Constitutionality

The Texas non-economic damage caps have been consistently upheld by Texas courts since 2003. No successful constitutional challenge has overturned the Chapter 74 caps to date.

Pre-Suit Requirements in Texas

60-Day Pre-Suit Notice

At least 60 days before filing a healthcare liability claim, the plaintiff must provide written notice to each defendant and their insurer. The notice must include:

• Notice of the specific healthcare liability claim
• An authorization permitting disclosure of protected health information relating to the claim (HIPAA-compliant)

Failure to provide proper notice is not a bar to the lawsuit but does affect tolling and may have cost consequences.

120-Day Expert Report — The Most Critical Requirement

Within 120 days of filing the lawsuit, the plaintiff must serve on each defendant an expert report from a qualified expert who is:

• Actively practicing medicine or retired within 5 years
• Board certified or practicing in the same specialty as the defendant
• Knowledgeable in the specific area of healthcare at issue

The expert report must provide a fair summary of:

• The expert's opinions on the standard of care
• How the defendant deviated from that standard
• The causal relationship between the deviation and the plaintiff's claimed injuries

Consequences of failure

If no adequate expert report is served within 120 days, the defendant is entitled to dismissal with prejudice and an award of attorney's fees against the plaintiff. There is no judicial discretion to extend the 120-day period absent an agreement of the parties.

This is the most strictly enforced procedural requirement in Texas malpractice litigation.

Expert Qualifications in Texas

Texas Civil Practice and Remedies Code § 74.401–74.402 imposes strict expert qualification requirements:

For standard of care testimony against a physician:

• Must be a physician licensed to practice medicine in Texas or another state
• Must be board certified in the same specialty as the defendant (if defendant is board certified)
• Must be actively practicing or have retired within 5 years of the relevant standard of care

For standard of care testimony against a healthcare institution:

• Must be actively practicing healthcare at the time of testimony or retired within 5 years
• Must be knowledgeable of the standard of care for the specific issue in the claim

Texas Court System for Malpractice

Texas medical malpractice cases are filed in the district courts — the Texas trial courts of general jurisdiction. Cases are filed in the county where the defendant resides or where the healthcare services were provided. Appeals go to the Texas Courts of Appeals and the Texas Supreme Court (civil matters).

Common Defendants in Texas Malpractice

Major hospital systems: HCA Healthcare, Ascension Health, CHRISTUS Health, Baylor Scott & White Health, Memorial Hermann Health System, Texas Health Resources, and Methodist Health System are the dominant healthcare defendants in Texas.

Government hospitals: Claims against UT Health, Texas A&M Health, county hospital districts, and state-operated facilities may be subject to the Texas Tort Claims Act, which imposes additional notice requirements and damage limitations under Texas Civil Practice and Remedies Code § 101.

Notable Texas Malpractice Law

Chapter 74 — Complete framework

Chapter 74 CPRC is the comprehensive statutory framework governing all healthcare liability claims. It defines healthcare liability claims broadly — including claims against any licensed healthcare provider that are directly related to healthcare services.

No medical review panel

Unlike Indiana and Louisiana, Texas does not require pre-suit review by a medical panel. The 120-day expert report serves a similar screening function.

Defensive medicine concerns

Texas post-2003 reform experience is frequently cited in national malpractice reform debates. Texas saw significant increases in physician supply following the reforms, though whether this was caused by the tort reforms is debated.

Finding a Medical Malpractice Attorney in Texas

Texas malpractice attorneys are licensed by the State Bar of Texas. Board Certification in Personal Injury Trial Law by the Texas Board of Legal Specialization identifies attorneys with demonstrated specialist experience. The Texas Trial Lawyers Association (TTLA) member directory is an additional resource.