Less than 12 hours after the Maryland General Assembly passed legislation to keep malpractice insurance costs for doctors in check, Gov. Robert L. Ehrlich Jr. said yesterday that he is preparing his veto message and will hold a ceremony next week to nix the outcome of a special session he called specifically to deal with what he called a crisis.
"It gets easier and easier [to veto] as we look at what survived," he said. "What survived was almost nothing in the way of tort reform."
When legislators passed the bills after 3 a.m. yesterday, both the House and Senate chambers did so with enough votes to override the promised veto.
While the House majority leader was confident enough to describe an override as "done," the Senate president was cagey yesterday as to whether he would pursue the maneuver. Other Democratic senators were more definitive: A good compromise was reached, they said, and it should become law.
"We're hoping that the governor exercises sound judgment, talks to his advisers and recognizes that it is a good bill," said Senate President Thomas V. Mike Miller. "It provides for quality health care.
"The physicians are happy, the hospitals are happy. ... We hope he can declare victory, rather than exacerbate the problem by forcing the Democrats to do the heavy lifting."
Legislative negotiators struck a deal Wednesday that would limit doctors' insurance increases to 5 percent in the coming year, instead of the 33 percent increase that they face tomorrow. Other agreed-to changes are intended to make patients safer, discipline negligent doctors and alter the way courts award damages for injuries and improper care.
The biggest stumbling block for Ehrlich was what money to use to help doctors defray their soaring costs. The bill passed by both Democrat-controlled chambers would remove a decades-old tax exemption applied to health maintenance organizations, making them subject to the same 2 percent premium tax paid by other insurers.
But the Republican governor has repeatedly called such a tax "regressive" and won't support it. Instead, he wants to use a corporate tax windfall to create a stopgap fund for doctors who say the increases in insurance premiums are forcing them to curtail care and even quit.
Ehrlich said his staff will be looking to quantify the financial savings of the bill, which he predicted would be small.
He also criticized the final legislative product for not including enough of the lawsuit reform that he says is necessary to produce long-term savings. He promised to introduce a bill during the regular General Assembly session that begins in two weeks, with much stricter limits on lawsuits - a bill with dubious chances since the governor's version of a bill this week was quickly rejected.
"If they override it, they will have passed another tax," he said. "If they override it, they will have passed a regressive tax. If they override it, they will have passed a tax that did not need to be passed."
The special session was called in advance of a deadline tomorrow, the latest date medical malpractice insurance bills can be paid. Most doctors have renewed for this coming year, though Ehrlich and others say many are close to quitting their practice or, in the case of doctors who practice obstetrics and gynecology, some have dropped the riskier and more expensive business of delivering babies.
Should the bill become law, doctors would be eligible for rebates on the insurance premiums they have already paid.
"January 1st is going to come and everyone's going to realize the first attempt at comprehensive reform failed," Ehrlich said.
Officials with both the state medical society and the Maryland Hospital Association, two organizations that pushed for insurance rate relief, said yesterday that they are analyzing what was passed and intend to make statements Tuesday.
Dr. Karl P. Riggle, a Hagerstown surgeon who co-founded the Save Our Doctors Protect Our Patients Coalition that lobbied hard for changes to the malpractice system, said what he has seen of the compromise is "a good start."
He said he had to balance his desire to hold out for everything with his pragmatic side, which realizes the legislative appetite is unlikely there for more legal reforms.
"I think there's some meaningful elements to this," said Riggle, adding that he hoped for some of the stronger legal reforms advocated by the governor.
Ehrlich called for the rare special session two weeks ago. Typically governors have called such sessions only when passage of legislation is a sure thing.
Ehrlich has said he thought he had an agreement with Miller and House Speaker Michael E. Busch, but the accord quickly unraveled. The governor accused Miller of reneging on a deal - though the leaders had never settled on an acceptable funding source for the package.
Miller and Busch both pushed to eliminate the HMO tax exemption, putting them at odds with the governor.
In less than 48 hours, the two chambers quickly went through a process that can take 90 days. Some legislators were surprised that any bills were passed and even more so when both chambers struck a compromise.
House Majority Leader Kumar P. Barve, a Montgomery County Democrat, said he couldn't believe so many delegates voted for the bill.
"When I saw 85 [votes] up there, I had to rub my eyes," he said.
Sen. Brian E. Frosh, chairman of the Judicial Proceedings Committee and the author of the Senate version of the bill, said overriding the veto is the responsible thing for the legislature to do. Such a vote would come Jan. 11, the day before the formal start of the 90-day session, when lawmakers plan to reconsider several other vetoed bills.
"It was the governor who yanked everyone back from their vacations for an emergency," he said. "I don't think we need to wrestle with it for 90 days. ... We came up with a good product. I'm sure there are flaws in it."
Still, other Democrats were questioning the wisdom of a veto override, worried that they might be giving the governor an unearned victory.
"Some say why override the governor's veto because he gets the political benefit out of fighting the tax, not getting the full tort reform he wants, and we override the veto and he gets the money," said Sen. Thomas M. Middleton, a Charles County Democrat and chairman of the Finance Committee.
Frosh was upset that the governor was threatening a veto before the final bill was even written and that his aides were nowhere to be found during negotiations. The only way legislators knew what he was thinking, Frosh said, was by watching television.
"The skeptical person would wonder if it isn't all for show," Frosh said. "He called us into session. We came. We did our job and he just had press conferences. ... I don't think the governor is acting as he should. We have to be grown-ups in any case."
Ehrlich said if there is any victory in the special session, it is in sparking a conversation about the plight of Maryland doctors and the crisis that could be driving them away.
During the 2004 regular session, no one listened, he said, when the doctors rallied and worried about their colleagues who were dropping Medicaid patients or retiring early or those who stopped delivering babies.
"Now," Ehrlich said, "everyone's talking about this issue."
Sun staff writer David Nitkin contributed to this article.