Top officials from Maryland's insurance industry have quietly been working with advocates for trial lawyers and doctors to draw up a plan that would rein in the skyrocketing cost of medical malpractice insurance.

The industry leaders presented their plan last week to Maryland House Speaker Michael E. Busch (D-Anne Arundel) and will bring it to Gov. Robert L. Ehrlich Jr. (R) on Thursday. Busch described the proposal as "a stopgap measure" that would call on the state to assume the costs if malpractice judgments get so high that insurers cannot afford to keep rates steady.

Busch and Ehrlich said yesterday that they were encouraged that the groups are actively seeking a solution, because insurance costs are driving some doctors out of business and leaving some Maryland residents without access to health care.

Ehrlich said he is "willing to look at any idea that leads to a bottom-line result."

The development comes as members of a state Senate commission meet in Annapolis today to start discussing how best to resolve the issue, which heated up last fall when the state's largest malpractice insurer, Medical Mutual Liability Insurance Society of Maryland, raised premiums 28 percent.

Addressing the issue was Ehrlich's top priority during this year's legislative session, but his approach -- limiting court awards to malpractice victims -- was rejected by the Senate.

Busch said the plan relies at least in part on the creation of a special fund, administered by the state's insurance commissioner, that would become available to pay malpractice claims if rates hit a certain threshold. One possible funding source would be a tax on HMOs, though Ehrlich has not supported that approach.

Such an arrangement, in theory, would enable insurance carriers to keep rates stable enough to satisfy doctors, without restricting the ability of victims and their lawyers to be compensated when they win a malpractice suit.

Busch said that if there is a real threat that malpractice insurance rates will rise again, it might create enough of a crisis to make such a proposal necessary. But he said it avoids addressing the underlying problems associated with rising malpractice premiums.

"The problem I have with it," Busch said, "is really what you're doing is asked the state to underwrite both the doctors and the trial bar."

Ehrlich said yesterday that he will wait to hear the details but that he is still committed to a solution that includes some level of tort reform.

The chances that there will be an easy or quick solution to the issue remain slim.

Medical malpractice ranks among the most contentious issues before state lawmakers across the nation, pitting doctors against trial lawyers. In Maryland, it also pits Ehrlich against Senate President Thomas V. Mike Miller Jr. (D-Calvert) and Senate Judicial Proceedings Committee Chairman Brian E. Frosh (D-Montgomery), two trial lawyers who argue that lawmakers should study the complex circumstances driving up insurance rates before moving to limit claims.

For years, the state's insurance rates had been relatively stable. But in the past two years, claims paid by Medical Mutual jumped from $49.5 million for all of 2001 to more than $73 million in the first 10 months of last year, according to David L. Murray, Medical Mutual's president.