Breathtaking reporting by Pro Publica tells the story of a butcher of a neurosurgeon in Texas who damaged or killed so many patients it led to a groundbreaking criminal prosecution. Thanks to Texas’ “tort reform” law to limit damages in malpractice cases, civil court restitution was limited if available at all to the patients and families. Save this article for the next time Chamber of Commerce boss Randy Zook, the medical and nursing home lobbies and others try again to make Arkansas a legal safe haven for butcher doctors and negligent nursing homes.

Christopher Duntsch, now in prison, operated on 37 people during two years in practice in Dallas. 33 were injured, many grievously. Two died. The quality of his work and his apparent abuse of drugs were no secret, but the butchery continued. Why?

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Neurosurgeons are worth millions in revenue for hospitals, so Duntsch was able to get operating privileges at a string of Dallas-area institutions. Once his ineptitude became clear, most chose to spare themselves the hassle and legal exposure of firing him outright and instead let him resign, reputation intact.

At least two facilities that quietly dumped Duntsch failed to report him to a database run by the U.S. Department of Health and Human Services that’s supposed to act as a clearinghouse for information on problem practitioners, warning potential employers about their histories.

This passage, after all the horrors of the story, is extremely relevant to Arkansas, where the Supreme Court recently disqualified a ballot measure that would have given Arkansas Texas-style limits on civil lawsuits through caps on non-economic damages and legal fees and legislative control of court rules.

For some of his patients, the criminal case offered a last chance at justice they couldn’t get through the civil courts.

Since Texas capped damages in medical malpractice lawsuits, limiting the amount plaintiffs can be awarded for pain and suffering in most cases to $250,000, the number of suits filed and amounts paid out have plummeted.

The suits that go forward often ride on economic damages, such as lost earning power, which the law does not limit in non-death cases. But many of Duntsch’s patients were disabled when they came to him, or older, or had lower incomes. Some had pain that was hard to economically quantify. Despite having clear-cut claims and serious, irreversible injuries, three patients I talked to said they had trouble finding attorneys to take their cases.

“It is not worth an attorney’s time and energy to take on a malpractice case in the state of Texas,” Morguloff said.

Ultimately, at least 19 of Duntsch’s patients or their survivors obtained settlements, but 14 of them were represented by Van Wey, who said she’s taken them on more out of a sense of outrage than out of any financial upside.

Morguloff was told no so often, he was surprised when attorney Mike Lyons finally took his case. He received a confidential settlement but said, “It wasn’t much.” He took more solace from the criminal case.

“To get this guy off the streets so nobody else got hurt again was important,” he said. “The public needed to know that there was a monster out there.”