Texas operates one of the USA's most restrictive medical malpractice damages cap systems.
While many states have implemented inflation adjustments or higher statutory limits, Texas maintains the original $250,000 provider cap on noneconomic damages, established over two decades ago.
This article covers Texas medical malpractice damages caps, including fixed noneconomic limits, CPI-indexed wrongful death caps, key legal precedents, and procedural requirements.
Legal Framework & Constitutional Authority in Texas
Texas’s medical malpractice caps are established through a constitutional framework that distinguishes between different types of damages and sets specific legislative authority.
Proposition 12, ratified September 13, 2003, amended Texas Constitution Article III, Section 66 to authorize legislative damages caps on health care liability claims. The resulting framework operates through the Texas Civil Practice and Remedies Code Chapter 74.
Under Chapter 74, Health Care Liability Claims (HCLCs) include any cause of action against a health care provider for treatment, lack of treatment, or departure from accepted standards that proximately results in injury or death.
2025 Texas Medical Malpractice Caps
Texas implements a comprehensive statutory framework that differentiates between various damages types.
Noneconomic damages are capped at fixed dollar values:
- $250,000 per claimant against all physicians/individual providers combined.
- $250,000 per claimant per health care institution (capped at $500,000 total across all institutions).
- $750,000 in cases involving both providers and multiple institutions.
Wrongful death cases operate under Section 74.303, which establishes an "all damages (including exemplary damages)" cap per claimant indexed by CPI and adjusted annually.
- The current operative limit exceeds $2.5 million.
Economic damages caps (medical expenses, lost wages, earning capacity, custodial care, and funeral expenses) are prohibited by the Texas Constitution.
Recent Developments & Pending Medical Malpractice Legislation
Recent legislative sessions have included proposals related to health care liability claims, though none successfully modified damages caps.
- Senate Bill 30 (89th Legislature, 2025) was a broader tort reform measure addressing evidence of medical expenses and damages limits in civil actions, but did not pass.
- House Bill 1088 (89th Legislature, 2025) proposed amending limitations periods in Section 74.251 specifically for claims involving gender modification procedures for minors, but failed to pass.
Future reforms require legislative action and likely constitutional amendment through voter approval, given Proposition 12's constitutional entrenchment.
Texas practitioners preserve constitutional challenges in high-economic-damage wrongful death cases where the CPI-indexed cap may conflict with constitutional protections for economic damages.
Key Texas Medical Malpractice Precedents
Two key Texas Supreme Court decisions have shaped how damage caps operate in practice, establishing both the constitutional foundation and the mechanics of cap application.
Lucas v. United States: Constitutional Foundation
Lucas v. United States (1988) struck down Texas's first statutory medical malpractice damages caps, ruling they violated the state constitution's Open Courts provision. The decision invalidated all statutory malpractice caps in Texas from 1988 until 2003.
This ruling directly prompted the legislature and medical community to pursue a constitutional amendment through Proposition 12 in 2003. The amendment added Article III, Section 66, to explicitly authorize caps on noneconomic damages in health care liability claims.
Tenet Hospitals v. Rivera: Multiple Claimant Rules
Tenet Hospitals v. Rivera (2014) resolved uncertainty about how caps apply when multiple family members bring claims from a single medical incident. The case involved a child with severe brain damage and parents seeking their own derivative damages.
The Texas Supreme Court held that caps apply per claimant, not per occurrence, meaning each family member has a separate $250,000 noneconomic cap against providers. Institutional caps still apply the $500,000 aggregate maximum across all claimants.
Procedural Requirements for Health Care Liability Claims in Texas
Chapter 74 imposes strict procedural obligations that claimants must satisfy before and during a medical malpractice lawsuit.
- Pre-Suit Notice
Under § 74.051, a claimant must provide written notice of a health care liability claim at least 60 days before filing suit.
The notice must be sent by certified mail to each health care provider or institution being sued and must include an authorization form allowing the release of the patient’s relevant medical records. Failure to provide proper notice can result in dismissal of the claim.
- Expert Report Requirement
§ 74.351 mandates that within 120 days of filing a petition, the claimant must serve each defendant with an expert report outlining the applicable standard of care, the manner in which it was allegedly breached, and the causal link to the patient’s injury.
If the report is deficient or late, the trial court must dismiss the claim with prejudice. Courts have consistently enforced this rule as a gatekeeping device to prevent unsupported claims from moving forward.
- Limitations Period and Statute of Repose
§ 74.251 sets clear time limits for initiating health care liability claims under:
- A two-year statute of limitations from the date of the alleged negligent act or omission, or from the completion of the medical treatment or hospitalization that is the subject of the claim.
- A ten-year statute of repose: Regardless of discovery or delayed manifestation of injury, no health care liability claim may be brought more than ten years after the date of the act or omission that gave rise to the claim.
Together, these provisions reflect the Legislature’s intent to balance patient access to the courts with predictability for health care providers.
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