Message from the chair: Proposed changes to MICRA

Dr. Laurie C. GreggLaurie C. Gregg, MD

What would medicine in California be like if a patient with health insurance had great difficulty finding an obstetrician to take care of a high-risk pregnancy or a neurosurgeon to resect a potentially malignant brain tumor? How would our system, especially emergency rooms, handle the flood of patients if community clinics were to close? Would you, as a physician, move out of state or retire early if your liability coverage premiums doubled?

Unfortunately, we may have to investigate answers to these perplexing questions. On July 26, a ballot measure to change the Medical Injury Compensation Reform Act (MICRA), raising the noneconomic damages cap from $250,000 to $1.2 million with a mandated cost of living adjustment each year, was filed for November 2014.

Our district will be working closely with Californians Allied for Patient Protection (CAPP) to educate the public on the potential harms of such an initiative. According to CAPP, filing a ballot measure with the attorney general is the first step in a long and expensive process to qualify a measure for the ballot.

Patients need to know that this proposal is almost certainly going to limit their access to important medical care. California is already facing a shortage of doctors, and health care reform will undoubtedly bring many more insured patients into our system. If MICRA is changed, doctors may consider leaving California or retiring early from medicine. Patients could suffer with longer emergency room waits and less access to their physicians.

A higher limit on noneconomic damages will tax the medical and legal systems with potentially meritless lawsuits from an increasing number of patients seeking compensation for adverse outcomes associated with presumed negligence. This issue is one reason the Civil Justice Association of California, a coalition dedicated to improving California’s civil justice system, criticizes the initiative.  

Some say that raising the noneconomic damages cap will motivate medicine to be safer. However, since MICRA has been in place, District IX has been exceptionally productive in the arena of patient safety and quality improvement. Rather than encouraging continued productivity, the initiative will likely increase the cost of medical care as doctors practice more defensive medicine.

A nonpartisan legislative analyst estimated that increasing the cap from $250,000 to $500,000 would raise health care costs in California by at least $9.5 billion annually. If that cost is passed on to consumers, it would mean $1,000 more per year for a family of four. Imagine what those numbers would be if the cap were raised to $1.2 million and allowed to increase each year.

In the midst of health care reform, there couldn’t be a worse time for such an initiative. Our district, in partnership with CAPP, the California Medical Association, and many others will fight to keep medical care intact in California. If you would like to help, please contact Michelle Clark, District IX manager, at or Shannon Smith-Crowley, JD, MHA, District IX director of government relations, at

American Congress of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188 | Mailing Address: PO Box 70620, Washington, DC 20024-9998