Daniel Altstatt had been in Brownwood, Texas, just two weeks when 71-year-old Ruby Collier came to his office with urinary problems.

Nurses had diagnosed her with a bladder infection. But the problem wasn't that simple.

"He said, 'Ma'am, you don't have a bladder infection, you have kidney cancer,' " Ms. Collier recalled.

Now, nine months after Dr. Altstatt removed her cancerous kidney, Ms. Collier is fine. "He's a marvelous doctor," she said.

He's also a doctor who wouldn't have been there to treat her if not for the state's 2003 cap on malpractice damages.

"I wouldn't be in Texas if it weren't for tort reform," Dr. Altstatt said.

Before Dr. Altstatt came to Brownwood, the town had no urologist; the nearest was 67 miles away, in Abilene.

Dr. Altstatt – who's 38, a native of Tennessee, a graduate of Pennsylvania State University and a father of two – considered job offers from Pennsylvania to Mississippi after finishing his residency.

The fact that Brownwood, population 19,000, is small was a plus, he said. The doctor grew up in a town of 500.

But as a businessman, he also didn't ignore the bottom line.

For one thing, the Brownwood job offered a salary 13 percent higher than the one in Mississippi.

Second, Dr. Altstatt said, he would have paid $60,000 in yearly malpractice insurance in Mississippi, which has a $500,000 cap on noneconomic damages. In Texas, he expects to pay less than $2,000 this year.

Folks in Brownwood feel lucky he's there.

"Recruiting specialists in a rural community is difficult – always has been difficult," said Matt Maxfield, chief executive of Brownwood Regional Medical Center. He's still searching for an orthopedist, obstetrician and radiologist.

Only five of every 100 orthopedists, for example, will move to a community of fewer than 50,000 people, Mr. Maxfield said.

Brownwood is short on incentives to lure big-city talent – there is no symphony or five-star restaurant – but malpractice limits help, he said.

In wooing Dr. Altstatt, the hospital administrator offered a set salary until he could build a patient roster large enough to cover the overhead.

But at the end of the day, "someone has to want the quality of life offered in a small community," Mr. Maxfield said.

Luckily for Ms. Collier, Dr. Altstatt did.

She was in intensive care for three days after the doctor removed her kidney. Now she sings Dr. Altstatt's praises.

"She thinks I walk on water," he said. "But honestly, it's nothing any other urologist wouldn't do."

If you can find one.

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THE GRATEFUL PATIENT:
His spinal infection needed treatment from a specialist – and fortunately, hospital had just hired one

By JASON ROBERSON / The Dallas Morning News
jroberson@dallasnews.com

George Rodriguez heard something pop in his back while cleaning out the dugouts after a minor league baseball game in August 2004. Only slightly alarmed, he called it a night and went home to rest.

When the 43-year-old Robstown man woke up later that night, he couldn't feel his legs. A spinal infection was paralyzing his lower body.

Paramedics rushed him into an operating room at nearby Corpus Christi Medical Center at 2 a.m.

Dr. Mathew Alexander – at the time, a 33-year-old in his first assignment as Corpus Christi's newest surgeon – decided that if Mr. Rodriguez didn't have surgery within the hour, he could be paralyzed forever.

A year earlier, a neurosurgeon might not have been available.

For four years, Corpus Christi medical officials had tried unsuccessfully to recruit such a specialist. Dr. Alexander was their first hire after malpractice caps went into effect, according to the Christus Spohn Health System, which owns the hospital in Corpus Christi.

Dr. Alexander, 35, had a stack of job offers when he finished his residency at a Wisconsin hospital. He said he chose Corpus Christi because his brother, Thomas, is a cardiologist there – and because of Texas' lawsuit limits.

The new doctor spent much of the next three days trying to mend Mr. Rodriguez. The first night, Dr. Alexander treated the spinal infection and worked to relieve pressure on nerves in his lower body.

Two days later, Dr. Alexander again went into Mr. Rodriguez's back to stabilize his spine with rods and screws, administering a series of shots to his legs at the same time.

Today, Mr. Rodriguez walks with a cane and considers himself blessed.

"I'm a fighter," the former amateur boxer explained.

He talked recently of his record from his younger days – 30 wins and 10 losses.

"I was never knocked out," Mr. Rodriguez was quick to point out. "They were all by decision."

He playfully reminds his sons, 16 and 14, that Dad is still stronger and quicker than they are, even in his condition.

Mr. Rodriguez is one of the state's 5.5 million uninsured residents. He receives no company benefits in his job as a maintenance man. But he said he got the best care money could buy on that August night, from one of Texas' newest doctors.