Dr. James Baben is a retired surgeon; his insurance company paid more than $125,000 to defend a case three years ago that ended without any money being awarded to the plaintiff. (Tony Jones/The Enquirer)

THE SERIES

Day 2 • Doctors pay more • All sides offer reform ideas Day 1 • Region gains doctors • Rising rates: Consumers pay

As doctors, hospitals, insurers and lawyers argue over Ohio's yet-to-be-tested cap on malpractice damage awards, some of those involved in the debate say they'd like to see even more changes to the legal system.

• Several doctors told the Enquirer there should be a state-sponsored insurance program or a shared risk pool to help pay for large malpractice damage awards. A patient compensation fund is being considered this year by state lawmakers. Such programs could help reduce coverage fees by spreading the risk among larger groups of physicians or by having taxpayers pick up part of the bill.

• Bigger organizations, be they hospital systems or government programs, ought to cover the liability risks for doctors considered vital to public health - such as those providing emergency services, said Dr. Lori Shutter, a Cincinnati-area neuro-intensivist. Shutter says it's a shame that doctors involved in trauma care face some of the industry's highest malpractice insurance rates. "These are the people saving lives in our country." About 85 percent of hospitals nationwide offer no liability coverage for on-call doctors who take on emergency cases, according to a report issued in September by the American College of Emergency Physicians.

•  It would be "wonderful" if the plaintiffs' lawyers - not necessarily the plaintiffs themselves - had to pay all legal fees if they lost a malpractice case, said Dr. Thomas Leyrer, a Greater Cincinnati pulmonary medicine specialist who retired in November at age 62 after 30 years in practice.

• Reforming how statutes of limitations work could help some doctors, says Frederick Gittes, president of the Ohio Academy of Trial Lawyers. Once a malpractice case is filed, Gittes says there should be a "hold" on the statute of limitations for that case to allow an initial stage of discovery. In many cases, lawyers sue almost everybody who had the slightest contact with a patient because current deadlines do not allow enough time to sort out who really should be held responsible for a patient's harm.

• Ohio doesn't have enough competition in the malpractice insurance field, says Dr. James Baden, a retired Butler County surgeon. The state needs to encourage more insurers to do business here so that doctors can have at least some choice among rate quotes. Even though five insurers cover nearly all doctors in the state, only one or two companies are willing to cover doctors in some high-risk specialties. In other cases, some insurers do not have bond ratings high enough to satisfy hospital requirements for granting access privileges to doctors.

Tim Bonfield