Trustee Beverly J. Anderson [letters, July 2] said that the rising costs of medical liability insurance at Fort Washington Hospital and other area hospitals are directly related to increased litigation costs and high damage awards. She warned that higher insurance premiums have in turn driven up health care costs. As a result, she advocated tort reform legislation, including caps on damages awards.

However, malpractice premiums account for less than 1 percent of health care expenditures nationwide. Moreover, a 2002 study by Americans for Insurance Reform found: "[M]edical malpractice premiums charged by insurance companies do not correspond to increases or decreases in payouts, which have been steady for 30 years. Rather, premiums rise and fall in concert with the state of the economy."

Nor has there been any explosion in malpractice litigation. According to data collected by the National Association of Insurance Commissioners, the number of new malpractice claims decreased from 90,212 in 1995 to 86,480 in 2000. The number of malpractice payments for physicians, as reported to the National Practitioner Data Bank, increased from 18,297 in 1997 to only 20,623 in 2001.

A 2003 study by Weiss Ratings Inc., a consumer financial safety organization, found that while caps did reduce the burden on insurers with respect to payouts, most insurers continued to rapidly raise premiums regardless.

GUY CABOT

Fort Washington

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Gov. Robert L. Ehrlich Jr. (R) is pushing for a special legislative session to address the high cost of medical malpractice insurance [Metro, June 26]. He also announced the formation of a task force to examine this issue. He wants, among other things, a reduction in Maryland's cap on damages for pain and suffering from $635,000 to $500,000.

What happened in Texas should serve as a cautionary tale for proponents of tort reform in Maryland. Texans who supported Proposition 12, which amended the state constitution, must feel betrayed by insurers who are ignoring legislators' demands for lower medical malpractice insurance rates while they rake in windfall profits. Instead of decreasing rates, medical liability insurers in Texas are increasing them.

California provides another cautionary tale. In 1975 California enacted the Medical Injury Compensation Reform Act, yet premiums for medical malpractice in California grew more quickly from 1991 to 2000 than in the nation -- 3.5 percent vs. 1.9 percent. Between 1975 and 1993, California's health care costs rose 343 percent.

Only after insurance reform was enacted did malpractice insurance rates drop. Whatever improvements have been made in California regarding malpractice insurance are the result of insurance reform, not tort reform.

Malpractice is at the root of the problem. Insurance companies are the beneficiaries of the problem. The solution is to curb malpractice sig- nificantly and regulate insurance companies.

The threat of a meaningful malpractice award imposed by a jury is the only weapon patients have to prevent the spread of malpractice.

JANE MARSHALL

Clarksville, Tenn.