Maryland's top political leaders want to convene a special session of the General Assembly in the coming weeks to address escalating medical malpractice insurance rates, but they remain divided over how much to try to accomplish.

Senate President Thomas V. Mike Miller Jr. (D-Calvert) is drafting legislation that would create a temporary state fund to effectively block the 33 percent rate increase most doctors are facing in the coming year.

"If the goal is no increases for doctors, we can do that right now," Miller said in an interview. "We should have done it in July. . . . If the goal is to push right-wing party politics, nothing is going to happen."

Longer-range reforms, he said, can be debated when the legislature returns for its regular session in January.

Miller's stance puts him at odds with Gov. Robert L. Ehrlich Jr. (R) and House Speaker Michael E. Busch (D-Anne Arundel). Both of them advocate linking passage of a state fund to more substantive changes in how injured patients are compensated in malpractice cases, as well as measures that might curb insurance costs for years to come.

A task force appointed by Ehrlich is expected to issue proposals in early November, while Busch's staff is researching reforms that have been enacted in other states, many of which experienced similar spikes in insurance premiums.

"If there's going to be some kind of fund, it's got to be coupled with significant reforms," Busch said in an interview. "I think it can be done if people of goodwill want to get it done."

Busch argued that if the legislature simply creates a fund to freeze rates, the interest groups fighting over the issue -- doctors, trial lawyers and insurance companies -- will have little incentive to craft longer-range solutions.

Miller, however, suggested that the parties are so "dug in" that compromise over most issues could be difficult. Ehrlich's task force, for example, is using as its starting point for reform a bill that the Senate killed during the last legislative session. The legislation included several new limits on payouts to patients.

"A special session needs to be limited to what can pass now," Miller said.

Medical Mutual Liability Insurance Society of Maryland, which provides coverage to more than three-quarters of the state's physicians in private practice, is raising rates by 33 percent next year, following a 28 percent increase this year. Obstetricians and others in higher-risk specialties have felt the brunt; their premiums have gone up more sharply than other physicians.

That was underscored during a meeting of Montgomery County legislators and health care providers last week.

Among those who spoke was Amy Ampey. The young physician delivers babies and cares for women's health. She would like to continue doing both but with her bill for malpractice insurance climbing to $112,000 in 2005, she worries what the future holds. Three years ago, her malpractice premium was $45,000.

On Wednesday, a partner in her Olney practice saw her last obstetrics patient after concluding that the cost equation was too risky. The decision reverberated immediately, forcing the dismissal of a nurse practitioner.

"I feel demoralized and devalued," Ampey said.

Though nearly everyone in the audience at Washington Adventist Hospital wore suits, not white coats or scrubs, most were doctors, from a variety of specialties, and they listened knowingly as Ampey and others detailed the steps they've taken to cover the steep insurance increases.

Legislation being drafted by Miller is intended to address the squeeze in the short term. A fund created by the state would cover a portion of insurance companies' malpractice payouts in exchange for their agreement to freeze doctors' premium costs.

Miller said that there are several ways to pay for such a fund but that his preference is ending the state's exemption of HMOs from a 2 percent premium tax imposed on for-profit insurance carriers.

Legislation to end the exemption has passed both the House and Senate in recent years but was vetoed by Ehrlich in 2003, as part of a package of corporate taxes. State fiscal analysts determined that such a bill would generate close to $50 million in its first year and increasingly more in subsequent years.

Donald J. Hogan Jr., a policy aide to Ehrlich, said the governor remains cool to the idea of an HMO tax but would reserve judgment until he sees Miller's proposal.

But Hogan said Ehrlich remains opposed to a special session merely to create such a fund. "Without a long-term solution, just creating a fund is a non-starter," Hogan said. "That's just feeding the beast."

In an interview, Busch ticked off a wide range of long-term proposals he is exploring to contain insurance costs. Some were included in a bill that passed the House last session but died in the Senate. Others are far more ambitious.

Those include the possibility of moving some medical malpractice cases out of the tort liability system and into a system similar to the one for workers' compensation, where payouts are made according to a schedule.

Busch said he also plans to closely examine the way malpractice insurance is sold in the state and explore several measures to protect patients' safety.

Within a month, "I think we'll have a pretty good package," he said.

Many who attended Wednesday's meeting in Montgomery County said such solutions are overdue. "Ultimately, if there's not an answer, doctors will end up leaving Maryland," warned George Schweitzer, an emergency physician at Montgomery General Hospital for 30 years.

Norton Elsen, an internist and pulmonologist at Washington Adventist, said he is about to pack up his office. His partner has taken a position with the federal government. "The legislators in Annapolis are going to have to face the reality on the ground," Elsen said.