Craig Backer of Caliente, near Bakersfield, suffered headaches for five years and eventually lost hearing in his left ear. Although the former Marine visited a Veterans Affairs hospital half a dozen times, doctors told him his condition was temporary and never performed advanced screening tests, according to his family.
Last spring, Backer began having problems with his vision and returned for a battery of exams. Doctors discovered that he had a large brain tumor and scheduled surgery days later. It was successful, but Backer remains in the hospital and can't talk. He is also learning how to swallow again, and the left side of his face droops. Doctors say they don't know if he will improve.
His wife, Jeriah, wants to sue but the case is subject to California's malpractice cap. Six lawyers have turned her down. One told her that because her husband didn't earn a large income as a mechanic, the case wasn't feasible. "We're living a nightmare," she said.
Linda Fermoyle Rice, one of the state's best-known malpractice lawyers, says the law often leads to difficult trade-offs.
"It has had the effect of making an infant who is severely injured more valuable than those who don't make it, since families of children who die are limited to the cap," said Rice, who is based in Woodland Hills. "It's sad to say, but most attorneys I know won't take a dead-baby case."
A 2003 Rand Corp. report found that the law has reduced jury awards by 30%, and that the savings have come largely at the expense of severely injured or impaired patients.
On average, California juries (which are rarely informed of the cap during trials) awarded $800,000 in malpractice death cases from 1995 to 1999, but the amounts were later reduced to $250,000 under the law. This suggests that medical malpractice victims and their families could be reaping much larger payouts than the law allows. But proponents of MICRA say raising the cap could harm patients.
"Raising the MICRA cap would significantly increase healthcare costs, limiting patient access to doctors, hospitals and clinics throughout California," said Lisa Maas, executive director of Californians Allied for Patient Protection, a trade group. "MICRA protects patient access to healthcare."
San Diego obstetrician Philip Diamond is skeptical that the law is keeping patients from obtaining malpractice lawyers. But he acknowledged that limits on payouts do lead to trade-offs.
"If we raise the cap, where does that money come from?" he asked. "Any increase means a drop in access."
The link between malpractice payouts and increases in doctors' insurance premiums, though, remains unclear.
One of the largest studies done on the topic -- by Dartmouth College researchers in 2003 -- concluded that malpractice payments had risen in line with medical care costs, whereas doctors' insurance premiums grew far faster -- by double-digit percentages annually for some specialties.
To some, that suggests that recent malpractice premium increases may have had more to do with insurers' business models and financial investments -- including documented losses in their investment portfolios in recent years -- than with their core businesses.
Nationally, the rise in malpractice premiums has slowed in recent years.
"Just 16.2% of insurers raised their malpractice premiums in 2007 compared to 77.3% in 2003," said the Medical Liability Monitor, a newsletter based in Chicago.
Douglas Heller, executive director of the Santa Monica-based Foundation for Taxpayer and Consumer Rights, says the 1975 liability caps aren't the reason that doctors' insurance premiums have been relatively low in California. He says the reason is that, unlike other states, insurance is tightly regulated here. In a 1988 statewide vote, Proposition 103 rolled back all casualty insurance rates by 20% and required the approval of the state insurance commissioner for any rate increase.
Malpractice rates rose sixfold between 1975 and 1988 despite the state's awards cap, Heller said, but have held roughly steady since Proposition 103's passage.
Stewart, of San Diego, said he had long been a MICRA advocate, believing it was in the best interest of doctors and patients. Not anymore.
After he and his family got over the initial shock of losing their mother, they wanted justice. Most attorneys turned them down over the phone, although three agreed to meet in person. Last summer, the entire family and their 80-year-old father made the trip to San Francisco and Oakland for meetings.
One lawyer said he would take the case only if the family paid the expected $50,000 in trial costs upfront.
San Francisco lawyer Brad Corsiglia at first seemed interested but later sent a letter dated July 11, 2007, that read: "As you can understand, with a cap of $250,000, we are limited in the type of case we can take on a contingency fee basis to only those cases that involve catastrophic economic losses."