The first tentative steps toward dealing with the medical malpractice crisis in Pennsylvania were taken in Harrisburg this week when the state Senate began debate on capping so-called pain and suffering awards.

The "cap" path, which has been pursued by 26 states, is the high-profile solution backed by the medical community. But a multi-faceted solution is more likely to produce the best remedy to skyrocketing medical malpractice insurance premiums that have been placing great financial burdens on many doctors in this state.

A cap on non-economic damages or pain-and-suffering awards is credited with restraining the cost of medical malpractice in other states, notably California where a $250,000 cap was establishe more than 20 years ago.

The caps being discussed in Harrisburg, like those already in place in other states, only limit pain-and-suffering awards. They do not limit awards for economic damages such as lost wages, or the costs of caring for an injured person.

The legal community is fighting caps, saying it will limit a victim of medical malpractice from adequately punishing a bad doctor. The medical community, on the other hand suggests fee-driven lawyers and outrageous jury awards, particularly from cases in the Philadelphia area, have caused insurance premiums for doctors to reach the point where many have decided to retire early, or leave the state and establish a practice where caps are in place.

Unfortunately, the malpractice debate too often looks like nothing more than doctors blaming lawyers and lawyers blaming doctors. A fair and workable solution has to get beyond this simplistic, two-sided feud.

While a cap on pain-and-suffering awards is part of the solution, it alone is not enough.

Effort should be directed at reducing the number of medical malpractice reaching the courts. Also, clearly frivolous lawsuits should be screened out and kept from entering the courts at all.

Some sort of a review board to pre-screen medical malpractice lawsuits, already established in several other states, could include legal and medical experts as well as average citizens. Its purpose would be to stop the most baseless malpractice lawsuits from proceeding. Without such a control, the current system encourages insurance settlement prior to a case reaching the courts, based simply on the cost of defending a lawsuit. Innocent doctors should not be encouraged to settle (and pay to end baseless lawsuits) by insurance companies worried about the cost of a legal defense - even if eventual victory is likely.

Something close to this approach will soon be tried at Drexel University College of Medicine in Philadelphia where mediation will be used to attempt to settle legitimate malpractice claims before the courts become involved.

All of these reforms should help reduce financial pressures now facing doctors, especially those in higher risk specialties such as OB/GYN and surgery. For their part, doctors and the state's medical association should be open to dealing with what lawyers' groups suggest are really at the root of the problem - bad doctors.

Accepting that there are some bad doctors practicing medicine, just as there are bad lawyers, or bad truck drivers or bad accountants, the medical community should resist shielding and protecting negligent doctors. Those doctors who are found to be responsible for multiple incidents of malpractice should be identified and prevented from practicing, at least in ways in which people could be physically harmed.

Finally, the insurance industry should not be spared scrutiny when it comes to the malpractice crisis. If caps are approved and other measures taken to reduce medical malpractice awards, there is a clear expectation that doctors' insurance premiums would drop significantly. Any other result would suggest profiteering by the insurance industry.

Lawmakers should proceed with passing a limit on pain-and-suffering awards, but should not stop there, thinking they have solved the state's medical malpractice crisis. Additional reforms should focus on review boards, mediation and more transparency - and consequences - where doctors have a record of malpractice.

Such a multi-track approach offers the best solution to truly solving the medical malpractice crisis in Pennsylvania.

- J.L.W.III