OPINION: HB 99 must deliver real medical liability reform to protect patient access

New Mexico is trying to keep doctors. That goal is not rhetorical — it is urgent and central to whether patients across our state can access timely, high-quality care. House Bill 99 was introduced to address foundational failures in New Mexico's medical malpractice system that contribute to rising insurance costs, physician departures and worsening access, particularly in rural communities. As amended in committee, however, HB 99 no longer achieves that purpose.

The health care community supports policies that retain physicians and strengthen patient access. After extensive review by health care providers, hospitals and legal counsel, there is broad consensus that the Rep. Liz Thomson, D-Albuquerque, committee amendment — described as a compromise protecting physicians from punitive damages — fails to deliver meaningful reform. In practice, it does not materially improve the liability or insurance environment physicians face. Instead, it preserves the existing litigation model while introducing additional uncertainty. The appearance of reform without real change does nothing to stabilize a fragile system.

As originally introduced, HB 99 was designed to address structural problems in New Mexico's medical malpractice framework. It aimed to modernize the system in a way that reflects how medicine is practiced today and how insurance risk is priced, while preserving access to justice for patients. That balance is essential. New Mexico already faces one of the most challenging malpractice environments in the region, with higher paid claims per capita than neighboring states and substantially higher malpractice premiums across multiple specialties. At the same time, the state is losing physicians — especially independent and rural providers — at an alarming rate. These trends directly undermine patient access to care.

The Thomson committee amendment worsens the conditions driving physician attrition and limiting patient access to care. New Mexicans deserve better than symbolic fixes.

Recent commentary has suggested that concerns about "fear" in this debate are overstated. But it is important to be clear about what fear actually looks like in New Mexico's malpractice system. Today, roughly 92% of malpractice complaints include punitive damage claims from the outset. Punitive damages are intended to address conduct that is wanton, reckless or reflects a conscious disregard for patient safety — an extraordinarily high legal standard. It is neither credible nor responsible to suggest that this threshold is met in nearly every adverse outcome. Yet the routine invocation of punitive damages creates intense pressure to settle even non-meritorious claims, driving up costs, distorting risk and injecting fear into the system — particularly for independent physicians and small practices.

The consequences of that pressure are not theoretical. Moral injury among physicians is costing lives. Doctors already face one of the highest suicide rates of any profession — nearly twice that of the general population — with emergency physicians, anesthesiologists and primary care physicians at greatest risk. A 2023 JAMA analysis found suicide rates among health care workers rose 24% in recent years, three times faster than in the general public. Nearly 1 in 4 physicians reports having suicidal thoughts in the past year, and 1 in 100 has attempted suicide. Research consistently shows that malpractice litigation and sustained liability pressure significantly increase depression, anxiety, trauma symptoms and suicidal ideation — often doubling risk. In New Mexico, where malpractice exposure is among the highest in the nation, these pressures collide.

If lawmakers are serious about addressing New Mexico's health care access crisis, HB 99 must return to its original purpose. The committee amendment should be removed so the bill can deliver real, data-driven medical liability reform. New Mexico does not need a symbolic fix. It needs policy grounded in clarity and real-world practice — policy that helps keep doctors here so patients can get the care they need.

Robert M. Underwood, MD, MHCDS, CPE, is an emergency and urgent care physician and serves as the chief medical officer at San Juan Regional Medical Center. He completed his residency in emergency medicine at Wake Forest University and holds a master's degree.