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

Pennsylvanians’ health care is being threatened.

In 2022, the Pennsylvania Supreme Court abruptly eliminated a rule that had stabilized the state’s medical liability system and protected Pennsylvanians’ health care for nearly two decades.

The decision, which took effect January 1, 2023, reverts to a 20-year-old 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” and puts Pennsylvanians’ access to health care at risk—particularly care for maternal health and in rural communities.

HAP urges the governor, General Assembly, and the courts to revive their good work to protect Pennsylvania health care by again stopping venue shopping.

Venue shopping has already returned to Pennsylvania.

There were 544 medical malpractice cases filed in Philadelphia during 2023, nearly double the number from 2022 and well above the pre-pandemic average of about 410 cases per year.¹ An analysis by the Pennsylvania Coalition for Civil Justice Reform found that 41 percent of the 2023 Philadelphia cases could not have been filed prior to the venue rule change.²

Venue shopping hurts Pennsylvania’s ability to attract health care providers.

We’ve been here before, with bad outcomes—particularly for obstetrics and specialty care. The last time venue shopping was allowed in 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

Pennsylvania has stopped venue shopping before.

In 2002, 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 distorts 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 percent³
• 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 trials⁴
• In 2002, medical liability jury verdicts in Philadelphia were more than twice the national average, nearly a quarter were for $1 million or more⁵
• 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 years⁶
• In 2022, Philadelphia’s medical liability cases accounted for only 21 percent of the medical malpractice filings statewide, a 77 percent drop in Philadelphia filings from when venue shopping ended in 2002⁷

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
• The reduction in court filings cited by the Civil Procedural Rules Committee reflects an increase in less-costly and faster resolution strategies to settle claims, such as arbitration and mediation
• There have been many positive advancements for patients since venue shopping was eliminated in 2002, including 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. The report predicted alarming premium increases in some parts of the state that could result in another medical liability crisis⁸
• Pennsylvania cannot afford policies that create additional challenges for obstetric units or that cause physicians to leave the state. From 2000–2023, the number of obstetric units in Pennsylvania hospitals fell 42 percent⁹ and current estimates suggest that, by 2025, Pennsylvania will need at least 1,000 more primary care physicians to care for its aging population¹⁰
• Since 2000, the number of hospitals affiliated with health systems has grown by 150 percent. 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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¹ The First Judicial District of Pennsylvania. One year later: Update on Philadelphia’s Medical Malpractice Case Management Program. February 27,2024. Last accessed: 03/20/2024.
² Pennsylvania Coalition for Civil Justice Reform. One Year In and the Medical Liability Venue Rule Change Has Had Major Impact. January 28, 2024. Last accessed: 03/20/2024.
³ Prepared 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 03/025/2024.
⁴ Courtstatistics.org. Medical Malpractice on Appeal. December 2009. Accessed: 03/25/2024.
⁵ Bovbjerg 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: 03/25/2024.
⁶ Ibid
⁷ The Unified Judicial System of Pennsylvania. Pennsylvania Medical Malpractice Filings. Accessed: 03/25/2024.
⁸ OliverWyman. ACTUARIAL REVIEW OF THE PROPOSED AMENDMENT TO THE MEDICAL PROFESSIONAL LIABILITY VENUE RULE. Accessed: 03/25/2024.
⁹ HAP analysis of Pennsylvania Department of Health, Division of Health Informatics Annual Hospital Survey data, 2000 through 2024.
¹⁰ Petterson, Stephen M; Cai, Angela; Moore, Miranda; Bazemore, Andrew. State-level projections of primary care workforce, 2010-2030-Pennsylvania. September 2013, Robert Graham Center, Washington, D.C. Last accessed: 03/25/2024.

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Topics: Access to Care, Medical Liability, State Advocacy, Workforce

Revision Date: 6/24/2024

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