Why Are There So Few Medical Malpractice Lawyers in Texas?
Texas has some of the toughest medical malpractice laws in the country. These laws were designed to protect healthcare providers from what lawmakers saw as a flood of lawsuits in the 1970s and early 2000s—but they’ve also made it incredibly difficult for injured patients and their families to find justice. Between strict filing deadlines, procedural hurdles, and severe limits on recoverable damages, few attorneys in Texas are willing—or able—to take on medical malpractice cases.
History of Texas Medical Malpractice Laws
In 1977, the Texas Legislature passed the Medical Liability and Insurance Improvement Act (MLIIA) to address what was described as a “crisis” in medical malpractice insurance. This law, originally Article 4590i of the Texas Revised Civil Statutes, introduced sweeping changes, including requirements for pre-suit notice, expert reports, caps on damages, and strict statutes of limitation.
In 2003, Texas lawmakers overhauled and recodified the statute as Chapter 74 of the Texas Civil Practice and Remedies Code, further tightening restrictions on medical malpractice claims.
Statute of Limitations and Repose
Under Section 74.251, no medical malpractice action may be brought more than two years from the date of the negligent act or from the completion of treatment. There is also a 10-year statute of repose, meaning that no claim can be filed more than ten years after the alleged negligence—no matter when it was discovered.
For minors, the law has changed over time. Although the statute once limited claims to a child’s 14th birthday, courts later found this unconstitutional. Generally, the two-year period begins when a child turns 18.
Importantly, the law does not recognize the discovery rule—meaning even if the malpractice wasn’t discovered until later, the two-year clock still applies. Only in cases of fraudulent concealment can the limitation period be extended.
The statute can also be extended by 75 days if a notice of intent to sue is filed.
Expert Report Requirements
Perhaps the most significant procedural barrier is the expert report requirement under Section 74.351.
Within 120 days of filing suit, the plaintiff must serve an expert report and curriculum vitae on each defendant. This report must explain:
The applicable standard of care,
How the healthcare provider breached that standard, and
How the breach caused the injury or death.
If the report isn’t filed in time—or is found deficient—the court must dismiss the claim with prejudice and order the plaintiff to pay the defendant’s attorney’s fees and court costs.
The court may grant only one 30-day extension to cure a deficient report. Until an adequate expert report is served, discovery is stayed—meaning plaintiffs can’t take depositions or gather most evidence.
Notice Requirements
Before filing suit, plaintiffs must give 60 days’ written notice by certified mail to each healthcare provider or physician involved, along with a HIPAA-compliant authorization for the release of medical records. Failure to comply can delay or even bar the claim.
Expert Testimony Rules
Only certain experts may testify about medical standards of care. To qualify, the expert must:
Be a practicing physician (at the time of the claim or the testimony),
Have knowledge of accepted medical standards for the condition at issue, and
Be qualified by training or experience to give such an opinion.
This high bar often makes it difficult to find experts willing to testify against their peers—especially within Texas.
Damage Caps
The statutory caps on damages in medical malpractice cases:
Non-economic damages (for pain, suffering, and emotional distress) are capped at $250,000 per claimant against all physicians combined.
If multiple healthcare institutions are involved, an additional $250,000 cap applies collectively to those entities.
In wrongful death cases, total damages are limited to $500,000 in 1977 dollars, adjusted annually for inflation.
These limits mean that even in catastrophic cases—such as permanent disability or death—the potential recovery often doesn’t justify the massive cost and risk of litigation.
Why So Few Lawyers Handle These Cases
All of these rules combine to create an environment that heavily favors hospitals and insurers. For plaintiffs’ lawyers, the risk is enormous:
The cost of expert witnesses and medical review alone can exceed $50,000–$100,000.
A single missed deadline or inadequate expert report can get the case dismissed—and even require the attorney to pay the defense’s legal fees.
Even a successful case may result in limited recovery because of the damages caps.
As a result, many law firms simply cannot afford to take these cases, and those that do must be extremely selective—usually focusing only on the most severe and clearly provable malpractice injuries.
