WASHINGTON With the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS; Rosemont, Illinois) held in the nation's capital this year, a little political talk was probably both inevitable and unavoidable.

The topic: medical liability reform.

Stuart Weinstein, MD, charged that the continuing rise of medical insurance premiums is an "enormous concern" for the medical community. From 1994 to 2000, the median jury award for a medical liability case rose by 176%, according to Weinstein, the newly elected president of AAOS and chairman of a group called Doctors for Medical Liability Reform (Washington).

"Americans can't afford to lose any more doctors," Weinstein said in his presentation at AAOS, arguing that some doctors stop practicing due to the high cost of insurance premiums.

Physicians have already been faced with judgments that have led to an increase in the average jury award to $3.5 million, he said. And he contended that the high cost to defend against lawsuits and the associated, escalating jury awards have driven big increases in medial liability insurance premiums.

"Many states are struggling to find the balance between protecting their citizens from potential medical error and providing means for proper access to care," Weinstein said. "There will be no reform unless it comes from the federal government."

President George Bush made federal tort reform one of his priorities for his re-election and in his second term. In a recent speech on the subject in Collinsville, Illinois, he charged that "junk lawsuits" drive up costs for all doctors, even for those who never have been sued.

"When insurance premiums rise, doctors have no choice but to pass some of the costs on to their patients," Bush said. The president and the many supporters of this policy say that passing a nationwide limit on frivolous malpractice lawsuits would reverse some of the escalating healthcare costs.

On the other hand, critics of this type of reform argue that caps on malpractice claims serve only to shield doctors and companies that provide substandard healthcare or products. The real problem, according to lawyers who represent malpractice victims, is insurers who look to raise premiums, which affects the healthcare spending for individuals and companies.

Currently, California, Colorado, Indiana, Louisiana, New Mexico and Wisconsin are the only states that have instituted some sort of medical liability caps. A bill to adopt liability reform measures is currently being debated by Georgia's House of Representatives. Maryland also is working on legislation to limit payouts in malpractice cases.

Though Weinstein acknowledged that enacting medical liability caps would not be a cure-all for the U.S. healthcare system, he called it "a solid step in the right direction."

Christopher Delporte, Washington Editor