Gov. Robert L. Ehrlich Jr. said yesterday that he will convene a special session of the General Assembly in 10 days in hopes of passing legislation to ease rising malpractice insurance costs for doctors, an unexpected announcement that caps months of studies, posturing and unsuccessful negotiations.
"We're going to get the people's business done," Ehrlich said last night. "This is the most important issue facing the state of Maryland."
Ehrlich said he wants legislative committees to meet on Dec. 27 and the full Assembly to pass a comprehensive reform bill on Dec. 28 that is expected to include mandatory mediation in some medical legal cases, and higher Medicaid reimbursement rates for obstetricians and other doctors.
The development offers the hope of some relief for doctors facing rising insurance costs, but it comes late: Payment to Maryland's largest provider of malpractice coverage was due Dec. 1, and policies will be canceled on Jan. 1 if bills are not paid. They were on average 33 percent higher than a year ago, an increase that has led some doctors to say they will leave their practices.
Special sessions of the Maryland legislature are relatively rare - the last one took place in 1992 - and are typically called only when agreement exists between the governor and legislative leaders on pressing issues.
But in this case, the Assembly will be summoned without consensus on how to cover the malpractice proposal's estimated $60 million annual cost.
The money would, in part, pay for a fund that would allow the state to freeze insurance rates at last year's level. The fund would be tapped if claims exceed the insurance companies' ability to pay.
Busch and Miller both favor removing a 2 percent tax exemption for health maintenance organizations. They argue that all other insurers pay the tax, and that it would be logical to use the money for health care purposes.
Ehrlich opposes the HMO tax and has suggested using general fund money to pay for the insurance fund, an option that legislative leaders have rejected.
Without an agreement on financing, lawmakers could pass a bill that Ehrlich would ultimately choose to veto.
Still, Busch and Miller said yesterday that other than a funding source, they and the governor have agreed on most elements that the malpractice reform bill will contain. A draft of the legislation was not available yesterday, and unforeseen problems could arise when interest groups study the bill.
"If the governor didn't think there was enough good will to come to an agreement, he wouldn't have called a special session," Bush said.
Miller said he suggested tackling the funding mechanism in a separate bill that could be considered when the assembly meets for its regular 90-day session beginning Jan. 12.
If the governor vetoes an HMO tax, "all this work would have been in vain," Miller said.
"I personally feel that if we don't have an agreement, we should wait only three weeks, for the regular session," Miller said.
According to documents used by participants in the afternoon meeting, Miller, Busch and Ehrlich have agreed to a provision that allows doctors to apologize to the families of harmed patients without their explanation being used in legal cases against them, as well as an increase in the number of jurors in civil cases.
They have also agreed to increase Medicaid reimbursements by $10 million for obstetricians, neurosurgeons, orthopedists and emergency room physicians.
The three have also rejected some tort-reform concepts backed by Ehrlich in previous versions of bills he supported: a limit on noneconomic damages would not be lowered from its $650,000 ceiling, plaintiff's attorney fees would not be limited, and so-called good-Samaritan immunity would not be provided for emergency departments and physicians.
The call for a special session comes after months of visits by the governor to hospitals across the state designed to raise the visibility of what Ehrlich says is an arriving insurance-cost crisis.
The state's largest provider of malpractice insurance, the Medical Mutual Liability Insurance Society of Maryland, sent out bills this month with an average 33 percent premium increase, which comes after a 28 percent increase a year ago.
"I'm really happy that [the governor] called it," said Dr. Carol Ritter, a gynecologist in private practice in Towson. "It's kind of late in the game, obviously, because doctors are all waiting. Jan. 1 is D-Day."
Ritter dropped the obstetrics portion of her practice a year ago - she was caring for 100 pregnant patients at the time - because she couldn't afford the premium increase.
T. Michael Preston, executive director of MedChi, the state medical society, called the announcement "great news, particularly if there's an agreement to do this."
"That would suggest that the leaders see enough momentum to go forward and accomplish something rather than to go forward and have a train wreck," Preston said.
Wayne M. Willoughby, legislative chairman of the Maryland Trial Lawyers Association, said he wanted to see significant patient safety measures in the bill.
"That is the root cause of the whole problem," Willoughby said. "If you eliminate the malpractice, then you eliminate the lawsuits."
Nancy Fiedler, senior vice president for communications at the Maryland Hospital Association, said she hoped the session would resolve a doctors' crisis.
"It very much is encouraging that we may address it before we lose more physicians, before we have more physicians scaling back their practices," Fiedler said.
A special session carries political intrigue. By law, the assembly must take up overrides of bills from this year's session that the governor vetoed last spring, if they hope to reverse the vetoes.
Democratic lawmakers and interest groups have been preparing for several overrides, including on legislation establishing a living wage for state government contractors; taxing corporations more to pay for higher education; and providing better community-based care for lower-income senior citizens.
The governor is expected to lobby against overrides, adding more tension to a one-day session and possibly prolonging debate.
Sun staff writer Erika Niedowski and the Associated Press contributed to this article.