A desire to protect themselves from medical liability lawsuits may be as much of a motivator as patients’ best interests in spurring emergency room (ER) physicians to order tests, reveals a new survey from the American College of Emergency Physicians (ACEP). Of roughly 1,800 ER practitioners queried in the survey, more than 50% deemed fear of being sued their primary rationale for ordering the number of tests they do. Moreover, the survey indicates, over-testing is likely to continue to generate sizeable expenditures for patients, as well as for the overall health care industry, until such fear is alleviated. Almost 49% of survey participants said diagnostic testing accounts for the biggest expense on patients’ ER bills. In fact, such defensive medicine can cost anywhere from $60 billion to $151 billion a year, according to ACEP President Sandra Schneider. This figure “dwarfs total expenditures on emergency care, which at $47.3 billion in 2008 represented just 2% of all health care spending," Schneider notes. If the survey results are any indication, hospitals must address medical liability issues if they are to trim expenses: A whopping 44% of ER doctors surveyed claim they consider fear of lawsuits the biggest challenge to cutting ER costs. But just as defensive test-ordering continues to boost health care expenditures, it also endangers patients' health. According to the ACEP, recent studies have shown that the use of CT exams in emergency departments has significantly increased, along with exposure to high-dose ionizing radiation. ACEP counsels hospitals to look to tort reform enacted in Texas, which by capping non-economic damages achieved a decrease in health care costs and an improvement in patient safety.