Malpractice law may deny justice

"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."