When TMC Physicians Need Individual Malpractice Insurance – Hotaling Insurance Services

Need Medical Malpractice Insurance and work at TMC in Houston? Even with comprehensive institutional coverage, most TMC physicians need supplemental individual policies for:

TMC salaries for junior faculty and fellows often necessitate supplemental income through moonlighting. Common moonlighting scenarios include:

Emergency department coverage at community hospitals on nights and weekends. ED moonlighting generates significant claims due to high patient volume, limited information, time pressure, and diagnostic uncertainty. A single misdiagnosed MI or stroke during a 12-hour ED shift can result in a $2 million claim.

Institutional TMC coverage does not extend to outside moonlighting. Community hospitals may provide coverage, but their policies often include provisions requiring physicians to reimburse the hospital for settlements if care fell below standards.

Urgent care clinics staffed by TMC physicians on off-days. Urgent care creates liability for missed diagnoses, inadequate follow-up, and prescription errors. Institutional coverage doesn’t apply.

Locum tenens assignments filling temporary coverage needs at understaffed facilities. Locums work creates significant exposure because you’re practicing in unfamiliar environments with patients you’ve never met and no continuity of care.

Telemedicine platforms offering after-hours consultations. Telemedicine across state lines creates licensing and malpractice jurisdiction issues. TMC institutional coverage is state-specific and doesn’t cover telemedicine to patients in other states.

A Methodist Hospital cardiologist moonlighted at a suburban emergency department two nights per month. The ED’s institutional policy covered him, but with only $1 million per occurrence limits—half his Methodist coverage. When he faced a $2.3 million claim for a missed PE diagnosis, the ED policy paid $1 million and he was personally liable for $1.3 million. His Methodist policy didn’t apply because the care occurred outside his employment. He had no individual supplemental policy. The judgment attached his home equity, investment accounts, and future earnings.

Expert Witness and Consulting Work

TMC physicians are frequently recruited for expert testimony in malpractice cases, regulatory proceedings, and industry consulting.

Medical-legal expert testimony creates unique liability. Testifying physicians can be sued for:

• Defamation by defendant physicians who claim testimony was biased or false
• Negligence for opinions that fall outside accepted standards
• Breach of contract if testimony deviates from retained scope

Neither institutional TMC coverage nor standard individual malpractice policies cover expert witness activities. You need separate expert witness liability insurance, typically costing $2,000-$5,000 annually for $1-2 million limits.

Consulting for medical device and pharmaceutical companies is common among TMC physician-researchers. Consulting agreements often include indemnification clauses shifting liability to the consulting physician for advice that leads to product defects, regulatory violations, or patient injuries.

An MD Anderson oncologist consulted for a biotechnology company developing a CAR-T cell therapy. His research expertise informed protocol design. When the Phase II trial experienced unexpected adverse events, plaintiff attorneys named him personally in lawsuits claiming the protocol was negligently designed. His MD Anderson institutional policy excluded consulting work. The biotech company’s coverage included provisions requiring him to contribute to defense costs. He needed separate professional liability coverage for consulting activities.

Board Service and Medical Directorships

TMC physicians serve on boards for healthcare companies, medical device manufacturers, hospital systems, and healthcare technology startups.

Board service creates fiduciary liability exposure separate from malpractice. Directors & Officers (D&O) insurance covers governance activities, but standard D&O policies exclude medical decision-making.

You need hybrid coverage addressing both governance and professional activities when board service involves:

• Clinical protocol recommendations
• Credentialing or peer review decisions
• Treatment guideline development
• Quality metrics establishment

A Texas Heart Institute cardiothoracic surgeon served on the board of a cardiovascular device company. The company’s flagship heart valve received FDA warnings for higher-than-expected thrombosis rates. Shareholder lawsuits alleged the board knew about safety signals and failed to act. The company’s D&O policy covered governance claims but excluded medical judgments about device safety. The surgeon needed separate coverage for his professional opinions about thrombosis risk that informed board decisions.

Volunteer Medical Activities

TMC physicians regularly volunteer for:

International medical missions providing surgical care in developing countries. Medical mission claims arise from:

• Inadequate pre-operative assessment
• Limited post-operative monitoring
• Equipment failures in under-resourced settings
• Complications discovered after returning to the U.S.

Texas Volunteer Protection Act provides limited immunity for domestic volunteer medical services but doesn’t cover international missions or gross negligence.

Free clinics and community health centers where TMC physicians donate time. Volunteer clinic coverage varies by facility. Federal Tort Claims Act (FTCA) provides coverage for volunteer services at HRSA-funded health centers, but not all volunteer clinics qualify.

Disaster response and emergency medical teams activated during hurricanes, floods, or public health emergencies. State and federal emergency management acts provide limited immunity for emergency responders, but coverage gaps exist for gross negligence and for services provided outside official emergency declarations.

A Baylor College of Medicine pediatric surgeon volunteered with an NGO providing cleft palate repair surgery in Guatemala. A 4-year-old patient developed severe post-operative infection leading to sepsis and prolonged hospitalization in Guatemala. The family sued the surgeon and the NGO in U.S. federal court. The NGO’s liability coverage had lapsed due to financial difficulties. The surgeon’s Baylor institutional policy excluded international volunteer work. He had no coverage and paid $130,000 in defense costs plus a $75,000 settlement personally.

Research Activities and Clinical Trials

TMC’s research enterprise generates unique liability exposures beyond standard malpractice coverage:

Investigator-initiated trials where you serve as principal investigator without formal sponsor funding. These pilot studies and proof-of-concept trials may lack institutional backing or sponsor-provided coverage.

Off-label treatment using approved medications or devices for non-approved indications. While off-label use is legal and common, it creates increased malpractice exposure when outcomes are poor.

Compassionate use and expanded access programs providing investigational treatments outside formal trials. These programs help desperately ill patients but carry significant liability if treatments cause harm.

Genetic testing and precision medicine where treatment decisions are guided by genomic analysis. Claims arise from:

• Incorrect test interpretation
• Failure to identify actionable mutations
• Treatment selections based on genetic markers
• Counseling about hereditary disease risk

Tissue banking and specimen management where improper handling, labeling errors, or contamination affects multiple patients.

An MD Anderson researcher developed a novel immunotherapy protocol combining checkpoint inhibitors with oncolytic virus therapy. Initial results were promising, and he enrolled 12 patients in an investigator-initiated trial. One patient developed life-threatening cytokine release syndrome. The patient’s family sued for inadequate informed consent and failure to monitor toxicity. The research sponsor’s coverage had $1 million limits, far below the eventual $3.8 million settlement. The researcher needed personal malpractice coverage supplementing research liability.

What happens if a doctor does not have malpractice insurance?

You’re personally liable for all defense costs ($100,000-$500,000+) and settlements. Texas allows wage garnishment and property liens to satisfy judgments. Your personal assets—home, investments, retirement—are exposed.

Do doctors pay for malpractice insurance?

TMC institutions cover employed physicians’ premiums. You pay out-of-pocket for tail coverage when leaving ($35,000-$315,000), supplemental policies for excluded activities, and excess liability beyond institutional limits.

Which doctor gets sued the most?

Neurosurgeons, cardiothoracic surgeons, and OB/GYNs. At TMC, high-acuity specialties see more claims—not from poor care, but from treating catastrophically ill patients. TMC settlements run $100,000-$300,000 higher than community hospitals.

What is the hardest element to prove in a medical malpractice case?

Causation. Plaintiffs must prove your actions caused the injury—not the underlying disease. With TMC’s severely ill patients, distinguishing treatment error from disease progression is extremely difficult, which is why many claims are dismissed.

Who should get malpractice insurance?

Every practicing physician. TMC doctors need supplemental coverage for research, moonlighting, volunteer work, expert testimony, and multi-institutional privileges. You also need tail coverage when leaving TMC employment.

Protect Your Assets Beyond Institutional Coverage

Your TMC institutional policy covers your employment—nothing else. Every moonlighting shift, research protocol, board position, expert testimony, and volunteer activity creates personal liability exposure that threatens your accumulated wealth.

A single uncovered claim can cost $200,000-$500,000 in defense fees alone. Judgments routinely exceed $2 million. Texas law allows plaintiffs to seize your home equity, investment portfolios, and garnish future earnings to satisfy malpractice judgments.

If you’re earning $500,000+ annually and participating in any activities outside your official TMC employment, you’re operating with significant uninsured liability exposure.

We structure comprehensive supplemental coverage for high-income TMC physicians:

• Individual malpractice policies covering moonlighting and locum work
• Expert witness liability coverage for medical-legal consulting
• Research liability for investigator-initiated trials and off-label protocols
• International volunteer coverage for medical missions
• Excess liability protecting personal assets beyond institutional limits

Most TMC physicians don’t discover coverage gaps until receiving lawsuit notices. By then, your assets are already at risk.

Schedule a confidential consultation: (713) 621-6765 or fill out the form below.

We work exclusively with high-net-worth physicians who need liability protection matching their financial complexity.

This article is for informational purposes only and does not constitute legal or insurance advice. Consult with our licensed professionals to evaluate your specific coverage needs.