Advocacy Is Our Roots: 50 Years of Supporting Medical Liability Reform

Elizabeth Y. Healy, Vice President, Government and Community Relations, The Doctors Company

Summary

Since the enactment of MICRA in 1976, we’ve helped lead the charge to enact and defend medical liability reforms nationwide.

The Doctors Company has been advocating for medical liability reform and patient access to care since before we were The Doctors Company.

In 1975, California was gripped by a medical malpractice insurance crisis—with skyrocketing judgments, drastic increases in malpractice insurance premiums, and diminishing access to healthcare. That year, two malpractice insurance companies made major announcements. One notified 2,000 Southern California physicians that their insurance would not be renewed, and the other notified 4,000 Northern California physicians that their premiums would increase by 380 percent. These companies had determined that the California medical malpractice insurance market had become too risky and unstable for financially sound underwriting: 80 percent of all malpractice suits filed in California in the first three-quarters of the 20th century were filed between 1970 and 1975.

Leading physicians came together to address the crisis. Founders of The Doctors Company were among those advocates who took the fight to the capitol as the California Physicians Crisis Committee, participating in sit-ins in government offices to keep the pressure on. Thanks to their efforts, the legislature passed the bipartisan Medical Injury Compensation Reform Act (MICRA). One of our founders, Charles O’Brien, was legal counsel to the committee and coauthor of the MICRA legislation.

In the wake of this achievement, The Doctors Company emerged on April 15, 1976, as an entirely new type of insurer—a carrier founded, led, and owned by doctors, on a mission to advance, protect, and reward the practice of good medicine.

Advocacy is at the core of our founding, and our national headquarters in Napa, California, features a rotunda reminiscent of the state capital as an homage to our roots and to our never-ending dedication to advocating for medical liability reform.

Dedicated to Government Relations Since Day One

Since MICRA, The Doctors Company has been a founding member of every major coalition formed to advance and protect medical liability reform nationwide.

We have had an advocacy program since the first day of the company, and we remain the only medical liability carrier in the industry with a dedicated in-house advocacy team that covers all 50 states and the federal level. Most other carriers tend to have one nonspecialist staff member, who can only dedicate part of their time to government relations work. Our professional Government Relations team has no focus other than being committed to legislative, regulatory, and judicial advocacy on a full-time basis.

We dedicate ourselves to this calling so that those caring for our communities can make decisions based on the best outcomes for patients, rather than the ever-present threat of litigation, invasive regulation, or financial loss.

Leading the Fight for Reforms From State to State

More than 30 states have enacted medical liability reform laws to promote access to healthcare, and these laws have been constantly under attack. Here are some highlights of efforts to enact and defend reforms since 1976:

1980: The Doctors Company testified before the Nevada State Legislature on medical malpractice law reform. Nevada’s reform law, passed in 2002, is modeled after MICRA, and we helped successfully defend the damage cap in Nevada in 2023.
1985: We were integral to the passage of tort reform in Montana.
1985/1986: MICRA faced challenges from the plaintiff’s bar, but The Doctors Company’s successful efforts led the California Supreme Court to uphold four major provisions of MICRA. Proposition 51, restricting joint and several liability, was overwhelmingly passed by Californians.
1989: The Doctors Company Board of Governors authorized the creation of a Doctors’ Political Action Committee (DOCPAC). We now have a nationwide political program at both the state and federal levels.
1990: At the request of the Washington State Insurance Commissioner, we relayed our experience with Washington’s 1986 state tort reform law, demonstrating that this legislation was instrumental in our decision to begin service in Washington and, later, to reduce premium rates. Unfortunately, these reforms were later struck down by the courts.
1991: We were a founding member of Californians Allied for Patient Protection, the coalition to protect MICRA.
1992: The Doctors Company successfully convinced the Physician Insurers Association of America (now known as the MPL Association) to establish a congressional lobby effort to adopt California MICRA statutes at the federal level. We also joined Citizens for Civil Justice Reform and the American Tort Reform Association.
1993: We sponsored a House amendment for tort reform in federal healthcare legislation, resulting in the first action on this matter in the history of Congress.
1995: The Doctors Company played a key role in forming the Health Care Liability Alliance, a Capitol Hill force for national medical liability reform advocacy. It is now known as the Health Coalition on Liability and Access, and we remain a member to this day.
1996: The Manhattan Institute published “An ‘Epidemic’ of Malpractice? A Commentary on the Harvard Medical Practice Study,” a pioneering discussion on the medical malpractice litigation system by Richard E. Anderson, MD, FACP, The Doctors Company Chairman and CEO.
1998/1999: The Doctors Company helped defeat California legislation that would have created exceptions to MICRA statutes and raised the cap on noneconomic damages.
Late 1990s/Early 2000s: A new malpractice crisis emerged across several states, featuring increasing claim severity. Dr. Anderson testified in several states, including in the Texas legislature, to encourage the passage of medical liability reform. The Texas reform, passed in 2004, is widely considered the next-best reform in the nation after California’s MICRA law. The Doctors Company is a founding member of the Texas Alliance for Patient Access, which works to preserve these hard-won reforms.
2001: We helped successfully defend Utah’s medical liability reforms in state courts.
2010: We successfully preserved Oregon’s personal injury and wrongful death noneconomic damage caps in statute and continued to do so for more than a decade.
2013: We were a founding member of the Coloradans Protecting Patient Access coalition to preserve the state’s medical liability reforms.
2014: We co-led a coalition in California to help defeat the Proposition 46 ballot initiative, which would have increased the damage cap from $250,000 to $1.1 million.
2015: The Doctors Company helped successfully re-enact Missouri’s noneconomic damages cap, and its constitutionality was upheld by the state’s supreme court in 2021.
2022 to 2026: In each of these years, we have helped defeat an expansion of wrongful death claims in New York.
2022: For the first time in a generation, stakeholders came together to modernize MICRA in a way that balances appropriate compensation with preserving the core protections that allow practitioners to continue practicing in California. This modernization of MICRA incrementally raises the cap on noneconomic damages over the next decade while keeping MICRA’s essential guardrails in place. It is a major step toward achieving accessible and affordable healthcare for all Californians.
2024: We helped successfully defend medical liability reforms and damage caps in Colorado against ballot initiatives and defeated similar legislation in Michigan.
2025: We helped successfully defend and modernize the damage cap in Montana and supported a Utah bill that was the first in the nation to provide asset protection for physicians.
2026: We successfully defended the medical liability damage cap in Virginia.

Dr. Anderson has long been a leading national advocate for medical liability reform, including presenting to Senate leaders in 1998.

Why Medical Liability Reform Matters Nationwide

What happens in the legislature in one state—good and bad—will easily spread to nearby states. Because the health of the practice environment in one state can affect clinicians across state lines, The Doctors Company is committed to advocating for healthcare professionals however and wherever they practice. That’s why our national Government Relations presence is key. Our award-winning Government Relations team is unmatched—they are recognized national experts and the leaders of the coalitions that are making meaningful changes for clinicians and their patients every day.

Medical liability reforms preserve access to healthcare by keeping doctors, nurses, dentists, and healthcare professionals in practice and hospitals and clinics open, while ensuring injured patients receive fair compensation. Reforms protect patients and preserve access to the courts, as well as maintain access to care and protect the most vulnerable and under-resourced communities from increasing healthcare costs.

Our dedication to advocacy has always come from our leadership, starting with our founders and their fight for MICRA. Dr. Anderson has continued that legacy as one of the leading advocates for reform across his entire career, publishing and speaking widely on the topic nationwide.

As Deepika Srivastava, Chief Operating Officer, says about The Doctors Company: “Advocacy is who we are.”

A History of Government Relations in The Doctor’s Advocate

Our advocacy work has been a key component of The Doctor’s Advocate since its inception—this “Legislative Update” was a featured piece in the first-ever issue of the publication in 1993.

An article in the Second Quarter 1997 edition of The Doctor’s Advocate noted the constant attacks on MICRA because of its standing as the leading medical liability reform in the nation: “That MICRA works and works well is evidenced by the fact that plaintiffs’ attorneys are so insistent upon undoing it before Congress makes it the law of all 50 states.”

The Doctors Company Government Relations team has a 50-year history of leading coalitions and expanding awareness of the need for reforms, including our Annual Tort Reform Summits in the early 2000s.

We have been protecting medical liability reforms since our founding, including addressing attacks like this in Oregon in 2016.

The rise of social inflation, impacting jury awards and leading to nuclear malpractice verdicts—first reported in The Doctor’s Advocate in this 2017 article—has been a new frontier for our Government Relations team to monitor and respond to.

The Doctor’s Advocate is published by The Doctors Company to advise and inform its members about loss prevention and insurance issues.

The guidelines suggested in this newsletter are not rules, do not constitute legal advice, and do not ensure a successful outcome. They attempt to define principles of practice for providing appropriate care. The principles are not inclusive of all proper methods of care nor exclusive of other methods reasonably directed at obtaining the same results.

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