The number of medical malpractice lawsuits filed in Tennessee has dropped 36% since the state implemented several reforms from 2008 to 2011 after concerns the state was losing doctors.

The reforms included $750,000 cap on noneconomic damages, which is on the high side of most state caps on damages, and a process requiring attorneys to certify a medical expert had evaluated the claim and found it had merit.

The state medical association asserts the decrease in claims is evidence that a change was needed and the financial benefits of the system will help patients get access to medical care. But plaintiffs’ attorneys are not happy, and claim that the reforms favor doctors at the expense of injured patients.

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“What people in Tennessee don’t understand is there has been an effort to take away their rights to access the courthouse,” Bryan Smith, president of the Tennessee Action for Justice, a lawyers group, said in a statement

They contend that the complex certifying process required to file a malpractice suit is causing attorneys to avoid malpractice cases altogether. Plaintiffs’ attorneys also complain that the costs associated with trial preparation and hiring experts is prohibitive with the cap on awards in place.

For physicians, the reforms have had positive effects – for every medical specialty in the state, insurance premiums have dropped since 2009.