Fact Sheet: Protect Pennsylvanians’ Health Care, Stop Venue Shopping

HAP Resource Center

Fact Sheet: Protect Pennsylvanians’ Health Care, Stop Venue Shopping

Pennsylvanians’ health care is being threatened.

Physician with suitcase leaving hospital

During August 2022, the Pennsylvania Supreme Court made an abrupt public policy change by eliminating a rule that has stabilized the state’s medical liability system and protected Pennsylvanians’ health care for nearly two decades.

The decision reverts to a pre-2003 legal framework that allows personal injury lawyers to move medical liability claims from the counties in which the event occurred to counties that have histories of higher payouts. This practice is called “venue shopping.”

The change takes effect for lawsuits filed on or after January 1, 2023. The court will review the decision after two years. HAP is urging the General Assembly to take action to protect Pennsylvania health care and ensure venue shopping does not return to the commonwealth.

When venue shopping was allowed in Pennsylvania, the state was one of the least attractive places for health care providers to practice.

We’ve been here before, with bad outcomes—particularly for obstetrics and specialty care. When venue shopping was allowed Pennsylvania:

It was difficult for the commonwealth to attract and keep health care providers
Hospitals were forced to cut services
Health care providers couldn’t afford skyrocketing premiums
Insurers left the market

All branches of the Pennsylvania state government worked together to end venue shopping in 2002.

Twenty years ago, Pennsylvania’s governor, General Assembly, and Supreme Court commissioned a study that concluded venue shopping was the leading cause of a medical liability crisis. Together, they agreed to end the practice. Through law and judicial rule, they required that claims be considered in the county where the alleged medical liability occurred.

Venue shopping distorted liability trials.

Certain specialties, such as obstetrics and gynecology, were hit particularly hard. From 1999–2000—just one year—median medical liability awards increased nearly 43 percent¹
In 2001, Philadelphia’s 117 medical liability trials totaled a higher number than any other county in the nation, even higher than New York, which had 72 trials²
In 2002, medical liability jury verdicts in Philadelphia were more than twice the national average, nearly a quarter were for $1 million or more³
From 1999–2001, Philadelphia had 87 medical liability cases of $1 million or more, only slightly fewer than the entire state of California during those same years⁴
In 2020, Philadelphia’s medical liability cases accounted for only 24 percent of the medical malpractice filings statewide, a 71 percent drop in Philadelphia filings from when venue shopping ended in 2002⁵

There is no evidence that verdicts have been unfair, but plenty to suggest venue shopping will worsen Pennsylvania’s health care workforce crisis.

There is no evidence—and, for 20 years, has been no public outcry—that counties in which liability actions are being litigated are not rendering fair results. In fact, from 2003 (when venue shopping ended) through June 2022, Pennsylvania’s average medical malpractice payment reported to the National Practitioner Data Bank was $468,311, nearly 16 percent higher than the national average during that same time⁶
There have been many positive advancements for patients since venue shopping was eliminated in 2002, including, but not limited, to creating the Patient Safety Authority, passing an apology law, expanding disclosure requirements, and evolving health care quality improvements
A 2022 actuarial study commissioned by the state Senate Judiciary Committee forecasted the devastating effect should venue shopping return for medical liability cases.⁷ The report predicts alarming premium increases in some parts of the state that could result in another medical liability crisis.
Pennsylvania cannot afford policies that create additional challenges for obstetric units or that cause physicians to leave the state. From 1999–2020, the number of obstetric units in Pennsylvania hospitals fell 40 percent⁸ and current estimates suggest that, by 2025, Pennsylvania will need at least 1,000 more primary care physicians to care for its aging population⁹
Since 2000, the number of hospitals affiliated with health systems has grown by 146 percent.¹⁰ Reinstating venue shopping will encourage lawyers to pull even more cases to Philadelphia and Allegheny counties in search of higher payouts

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¹Prepared statement of Shelby L. Wilbourn, MD, representing the American College of Obstetricians and Gynecologists, on “Patient Access Crisis: The Role of Medical Litigation,” a joint hearing before the Committee on the Judiciary and the Committee on Health, Education, Labor, and Pensions (Senate Hearing 108-253) on “Examining the Status of Patient Access to Quality Health Care, Focusing on the Role of Medical Litigation and Malpractice Reform.” 2/11/2003. Last accessed 03/01/2022.
²Courtstatistics.org. Medical Malpractice on Appeal. Deecember 2009. Accessed: 03/01/2022.
³Bovbjerg RR and Bartow A. Understanding Pennsylvania’s Medical Malpractice Crisis: Facts about Liability Insurance, the Legal System, and Health Care in Pennsylvania. Pew Charitable Trusts Project on Medical Liability in Pennsylvania. 2003. Accessed: 03/01/2022.
⁴Ibid
⁵The Unified Judicial System of Pennsylvania. Pennsylvania Medical Malpractice Filings. Accessed: 03/01/2022.
⁶HAP analysis of U.S. Department of Health and Human Services, National Practicioner Data Bank's medical malpractice payment report data, 2003 through 2022.
⁷OliverWyman. ACTUARIAL REVIEW OF THE PROPOSED AMENDMENT TO THE MEDICAL PROFESSIONAL LIABILITY VENUE RULE. Accessed: 08/26/2022.
⁸HAP analysis of Pennsylvania Department of Health, Division of Health Informatics Annual Hospital Survey data, 1999 through 2020.
⁹U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Workforce, “State-Level Projections of Supply and Demand for Primary Care Practitioners: 2013-2025,” (Nov. 2016), p. 11.
¹⁰HAP’s March 2022 analysis of Pennsylvania Department of Health, Division of Health Informatics’ Annual Hospital Survey data, 2000 through 2020.