Senator Eliot Shapleigh - El Paso, Texas

The limits on malpractice damages moved the bulk of the responsibility for watching over the state's medical practitioners from the courts to government regulators.

When the limit on pain-and-suffering damages was put into place in 2003, the state also gave the Texas Medical Board increased policing powers and more lawyers to investigate bad doctors.

Its budget swelled to $8.8 million in fiscal year 2004, from $5.5 million the year before. The board completed 1,866 investigations of doctors in 2006, compared with 1,448 in 2002.

Whether plaintiff's lawyers or bureaucrats are best equipped to root out bad doctors is at the heart of the debate.

There is also debate over whether the lawsuit limits encourage better doctors or more careless doctors to come to Texas. It's difficult to know, in part because the medical board does not release data on the professional history of doctors applying to practice in Texas.

The board is fulfilling its increased watchdog role, spokeswoman Jill Wiggins said, but no organization can eliminate the possibility of medical errors.

"There are always individuals who are not getting the kind of satisfaction they want," she said.

The board anticipated a surge of complaints after the law changed in 2003, she said, and credits that to its expanded resources, not to a deterioration in the quality of medical providers.

Complaints to the board rose to 6,090 in 2004 from 4,942 in 2003, but fell back in 2006 to 5,211.

Disciplinary actions jumped to 335 in 2006 from 187 in 2002. In 2006, disciplinary actions ranged from 41 license revocations to 11 temporary suspensions and 89 administrative penalties. 

Critics say the modest increase in investigations doesn't make up for the estimated 50 percent drop in the number of medical liability lawsuits being filed statewide.

"It's not nearly enough," said Bernard Black, a University of Texas law and finance professor who has studied malpractice issues. "You may get the really bad doctors out, but they'll never touch all the small mistakes that are done by nurses and other employees."

The board, previously called the Texas State Board of Medical Examiners, has been in the spotlight before. A 2002 investigation by The Dallas Morning News showed the board failed to investigate and punish many of the bad doctors, who kept their licenses despite actions such as sexual assaults and substance abuse.

The Federation of State Medical Boards calculates its composite action index to measure the regulatory activity of boards. In 2006, among the 12 states with more than 20,000 licensed doctors, Texas scored third-highest in the frequency that it takes action against a doctor.

The federation discourages comparisons between states, because each medical board has different resources and mandates.

Texas' index score has grown from 4.71 in 2000 to as high as 9.08 in 2005, indicating increased activity. 

In addition to investigating the doctors practicing in Texas, the board is responsible for screening doctors coming into the state.

It currently faces a backlog of 2,500 applications for medical licenses – about the same as the 2,516 licenses it granted all of last fiscal year. The Legislature approved $1.22 million in emergency funding to help process the backlog.

Despite the deluge, bad doctors aren't getting past the TMB, Ms. Wiggins said. "We're not being any less vigorous in reviewing applications."

While only "a very small percentage" of doctors who apply are rejected, that has always been the case, she said.

If anything, "The surge of applicants allows the board to be more selective," said Jon Opelt of the Texas Alliance for Patient Access, a group that backed the awards limits.

It's difficult to objectively gauge the quality of doctors coming into Texas.

In some states, doctors have to voluntarily report to medical boards information such as arrests or convictions that would show up on the federation's databases. If the doctors fail to own up to problems, their records may appear clean.

The News asked to review the board's records of past disciplinary actions for the doctors now applying to practice in Texas, but the board denied that request, saying the records are private.

The TMB relies on the Federation of State Medical Boards for information about disciplinary actions against doctors. The federation also said its databases are private.

Patients can check their own doctors' records for free through the board, but they must look up the doctors one at a time, making a systematic study impossible.

Still, consumers appear to be interested in the information. The board processed 3.3 million inquiries in 2006, up from 516,341 in 2002.