The Maryland General Assembly soon may hold a special session to address the state's medical malpractice insurance crisis. "Special" is the acceptable shorthand for an off-season convening of the legislature, but the Maryland Constitution regards such gatherings as "extraordinary" and that is a more accurate description of the opportunity that will present itself to Gov. Robert L. Ehrlich Jr. (R) and legislative leaders.

Maryland has a once-in-a-generation opportunity to fix an escalating problem that touches the lives of every resident of the state. Medical malpractice insurance rates for doctors, hospitals and other health care providers are soaring. This is more than just a financial issue for the physicians and hospitals that foot the insurance bills; for the insurers responsible for paying massive malpractice judgments and settlements; and for the patients and families who receive a measure of compensation through the existing system. At stake is Maryland's ability to ensure that its residents have access to emergency, obstetric, surgical and other specialized medical services.

It is too late to avoid a crisis -- the crisis is here. Physicians providing critical medical services are getting harder to find in portions of the state as doctors retire or move to avoid paying malpractice insurance premiums that can hit six figures annually. The potential liability and limited earning potential associated with high-risk medical specialties, such as obstetrics, are discouraging aspiring professionals from entering those fields.

Medical malpractice reform must be considered within a framework that addresses all elements of the system, including the prevention of medical errors. The tort system and medical liability practices must be reformed while alternatives to litigation should be encouraged. The medical malpractice insurance system also must be improved. Anything short of this will be the equivalent of putting a plastic bandage on a gaping wound.

Addressing these issues comprehensively will require a demonstration of political will in Annapolis and a heretofore unseen willingness to compromise by the many interested parties.

For example, a lawyer in Maryland now can make as much as $800,000 plus fees and expenses on a settlement of $2 million. Limiting attorney's fees would put more of the settlement dollars where they belong -- in plaintiffs' pockets.

Less controversial measures that have proved effective elsewhere in reining in medical malpractice costs also should be implemented in Maryland. Under Maryland's system, for instance, defendants must pay damages in lump sums. Allowing defendants to spread out settlement payments of more than $50,000 would reduce the effect of large damage awards while ensuring that plaintiffs have the necessary funds to pay for medical costs.

Other remedies exist that, when combined, would produce a lasting solution to the seemingly intractable issues plaguing the medical malpractice system. They include a more effective process to screen out non-meritorious suits and to reduce the number of defendants named in a suit as well as a mandated mediation to foster an early, less-expensive resolution of claims.

With a sense of urgency finally felt in the halls of the statehouse in Annapolis, now is the time to tackle the problem. This is an extraordinary opportunity. For the sake of Maryland's health care system, it must be met with an extraordinary response.

-- John P. McDaniel

is chief executive officer

of MedStar Health,

a nonprofit health care

organization serving

the Baltimore-

Washington region.