According to never-ending reports about the medical malpractice crisis, it would appear that the main victims are doctors and insurance companies, and the main benefactors, lawyers. To fix this, according to the American Medical Associations's new proposed solution to the crisis, doctors would become key players in deciding whether patients get compensated and, if so, how much money they get. Part of the idea is that this would reduce the victimization of doctors, which occurs when a jury of the patient's peers passes judgment.

In many doctors' diatribes about the crisis, patients are occasionally mentioned, but only as potential victims if insurance companies carry out their threat to cut off malpractice insurance or raise premiums sky-high, forcing doctors to stop practicing.

But patients are the real victims, and the extent of their victimization would increase enormously if the AMA's scheme were enacted into law. By one reliable estimate, 200,000 hospitalized patients are injured or killed a year in the United States as a result of negligence by doctors or other hospital staff.

What this means, contrary to the contention of the AMA, is that the root cause of the medical malpractice crisis is, in fact, medical malpractice -- the injury or death of patients because of negligence by doctors.

Although most doctors practice good medicine and the majority of doctors in the United States have never been sued for malpractice (one exception is obstetrics-gynecology, in which over 50 percent of doctors have been sued), in every state where it has been studied, a tiny fraction of doctors account for a disproportionate share of the malpractice payouts for the injuries or deaths of patients: In Pennsylvania, 1 percent of the doctors accounted for 25 percent of the malpractice payouts. In Florida, 3 percent of the doctors accounted for 48 percent of the payouts. In Maryland, 1 percent of the doctors accounted for 54 percent of the payouts.

These findings belie the AMA's contention that there is no connection between the medical malpractice crisis and the inadequacy of doctor discipline. This small proportion of doctors, who are proven multiple malpractice offenders, are on the loose, injuring and killing patients because they have not lost their licenses or otherwise been disciplined by their state licensing board.

The AMA's "solution" to the malpractice crisis would "totally replace the existing court or jury system" with an expanded-duty state medical licensing board, which includes doctors among its members. This would be a threat to patients and shows profound ignorance and disregard for the current problems of existing state licensing boards.

In many states, it is already "too much" to expect doctors on state boards to discipline seriously their fellow doctors by revocation or suspension of license. Although the situation is improving, in 1985, the last year for which data are available, there were only 1,132 serious disciplinary actions by state licensing boards out of well over 400,000 physicians in the United States.

The size of awards has a direct effect on malpractice insurance rates. To ask state licensing boards, and their doctor members, to frequently pass judgments on the merits of malpractice suits and the level of awards is, on the face of it, absurd. The reason doctors are usually, if not always, excluded from the jury of peers that hears malpractice cases is because of this very conflict of interest.

Abolishing the system of jury by peers for malpractice suits is tantamount to closing the door for most patients on their right to adequate recovery for the damage they have suffered.

In an April 1987 report on medical malpractice, the General Accounting Office found that "median payments for patients with economic losses of $100,000 or more were less than the {actual} economic losses." With doctors in the driver's seat, these already inadequate payouts are likely to decrease, not increase.

The threat to patients is further worsened by the AMA's proposal to put a cap on the amount recoverable for pain and suffering.

If the AMA really wants to help solve, by prevention, the malpractice problem in this country, it will lobby much more vigorously along with state medical associations for greatly strengthened doctor disciplinary boards to do much more of what some states, such as Massachusetts, Iowa, New York, Oregon and others, are beginning to do.

At the very time when, unquestionably driven by the malpractice crisis, more and more states are beginning to do a better job of protecting patients from those doctors who are not able to practice medicine in a competent manner, the last thing that is needed is to divert attention away from the growth of this lifesaving work.

The AMA calls its plan "patient-oriented." The plan, to empower doctors to "solve" the malpractice crisis by positioning them to interfere with the right of patients to a just amount of recovery when they have been damaged as a result of doctor negligence, may be good for insurance companies and doctors but would be a disaster for patients.

Sidney M. Wolfe, MD, is director of Public Citizen Health Research Group.