The political battle in Maryland to limit medical malpractice lawsuits is also underway in Virginia and the District, where doctors and hospitals are pressing for greater restrictions on who can sue for a medical mistake and how much can be collected.
In the District, medical practitioners have the support of Mayor Anthony A. Williams (D), who this year proposed a law that would cap damages for pain and suffering at $250,000 and, the mayor hopes, bring down malpractice premiums.
A senior aide to Williams said the mayor intends to push forward with similar legislation to curb insurance premiums next year. Gregory M. McCarthy, the mayor's top legislative aide, said the mayor is "not interested in waiting for it to become an acute crisis. He's going to act before then."
Virginia law caps medical malpractice awards at about $1.75 million, and the legislature has enacted other changes aimed at making it tougher to sue doctors. The result, many say, is that malpractice insurance has been available and relatively affordable in Virginia.
But doctors and hospital groups say they will press for more limits, including a stricter cap on damages for pain and suffering. They have the support of some Republican lawmakers, who have made such changes a priority for the legislative session.
House of Delegates Speaker William J. Howell (R-Stafford) said in a statement: "Although Virginia laws in this public policy area already are stronger than a number of other states, we can and must do better so frivolous, but expensive lawsuits won't threaten the well-being of small business owners and manufacturers, cost jobs, and keep driving up health care costs."
Opponents of stricter caps on damage awards in Virginia and the District say such legislation will do little to bring down the soaring costs of malpractice insurance for doctors. They say limiting the damages is an affront to people who are seriously injured at the hands of negligent doctors.
"If you make it hard enough for an injured victim to bring a suit, you become bulletproof from even the worst negligence," said Chuck Zauzig, a malpractice lawyer in Northern Virginia.
Zauzig said Virginia law already protects health professionals against frivolous lawsuits, and he said the state's trial lawyers association is preparing for a fight when the General Assembly convenes in January.
"We have all sorts of safeguards, if you want to call it that, in place," said Zauzig, the association's vice president for government affairs. "We don't have runaway verdicts. We don't have a problem with excessive verdicts. We have plenty of tort reform."
But physicians, who are sometimes the defendants in lengthy, costly lawsuits, beg to differ.
Doctors say that with no cap on damages, the District is an even riskier place to practice than Maryland. Insurance premiums in the city, particularly for specialists such as neurosurgeons and obstetricians, are set far higher than in Maryland and Virginia, according to the D.C. Medical Society and its Web site.
"If we fail to control the problem . . . we will drive physician practices out of D.C.," Victor G. Freeman, president of the society, said in an interview.
Scott Johnson, general counsel for the Medical Society of Virginia, said some doctors are barely able to stay in business because of the high cost of insurance. He said that fact argues for new laws.
"The proof is in the pudding when you look at what physicians are having to pay in malpractice premiums," Johnson said. "We are trying to look at everything we can do to stay in business, take care of the patients and make premiums affordable."
Advocates of new restrictions in Virginia and the District say the rising cost of practicing medicine has recently led obstetricians in both jurisdictions to abandon their practices. This year, Virginia Gov. Mark R. Warner (D) ordered higher Medicaid payments to baby doctors to help stem the outflow in some rural areas.
But trial lawyers and patient groups say capping damages won't solve the problem.
"It's not going to do it," Zauzig said. "It's just going to limit the rights of these individual people to have the doctors be accountable."