There’s a new Pennsylvania lottery game and it’s not Power Ball. In fact, the game is not new. And, unlike the other lottery games, you don’t even have to purchase a ticket. All you have to do is to call one of the many “1-800-Sue-The-Heck-Out-Of-Someone” law firms and sign up for your multi-million dollar chance to sue your doctor. Better hurry, though, there’s not much time left. Soon, there won’t be many doctors left to sue in Pennsylvania.

Last year, I predicted in an Another View column in The Morning Call that the medical malpractice situation in Pennsylvania was rising to the level of a crisis. No one heeded the warnings and now many doctors are scrambling to find malpractice coverage. Hundreds of doctors have been unable to renew their insurance policies even if they have no malpractice claims against them. Those who still are insured are seeing premiums that have increased 300-400 percent.

Many specialists are facing insurance premiums over $100,000 per year. Several neurosurgeons in Philadelphia have been quoted premiums over $200,000. The orthopedic surgeon for the 76ers and the Philadelphia Ballet has stopped operating because he cannot get insurance. Trauma centers and emergency rooms are threatening to close. Many obstetricians have stopped delivering babies.

Overreacting? I don’t think so. My wife is pregnant with our second child. Her obstetrician sat down with us last week to inform us that his malpractice insurance runs out in July, but we should be all right because my wife is due in May! He is considering not accepting patients who are expecting to deliver after June. Dr. John Angstadt, a vascular surgeon and chief of the renal transplant service at Lankenau and Bryn Mawr hospitals discussed in The Philadelphia Inquirer how his malpractice premium rose in one year from $20,000 to $190,000. He has since moved his practice and his family to Georgia, where his premium will be only $9,000 per year.

Gov. Mark Schweiker has promised to intervene. He has asked the Legislature to take up the malpractice insurance problem in January. I hope the Governor will have an impact, but unfortunately, the trial lawyers lobby is very powerful and has thwarted efforts at tort reform in the past. Simply put, lawyers make the laws, and on an individual basis, lawyers are much more politically savvy than your average physician.

Indeed, no two words, upset a lawyer more than “tort reform.” Just the same, if changes are not made in our legal system, your doctor’s practice and the future of health care in Pennsylvania will be at risk. Therefore, I wish to prescribe the following three-step cure to the state’s malpractice malady:

1. Establish county and state arbitration panels. I believe that every citizen should have to right to raise a concern that an injury or death has occurred due to negligence. However, why not have each inquiry be addressed first by an unbiased panel consisting of both doctors and lawyers? Every doctor and lawyer would have to serve on a panel in order to keep his or her license. If the panel believes the case should be closed, no lawsuit would occur. If the panel feels there was indeed possible negligence, the suit would be allowed to proceed. This would save millions of dollars and thousands of hours. This would also engage lawyers and doctors to sit down together and discuss medical legal issues and probably, bring these two professions closer.

2. Cap Settlements. In Philadelphia, one patient was awarded $10 million because she claimed that a CT scan of her head resulted in her inability to read the future. More serious suits that involved real injuries or even deaths resulted in settlements of up to $100 million. I know it’s not easy to determine what an injury or life is worth. Still, there has to be some limit to the amount that is awarded in most cases, even those where settlements are completely deserved. Jurors should not be able to hand out overzealous gifts in the hopes that someday, a jury will do the same for them.

3. You lose, you pay. In England, if you sue someone and you lose, you must pay at least part of the cost of the trial. In the United States, the lawyers work on a percentage, typically 33 percent of the settlement. Lawyers say that the “You pay, you lose” principle is not fair to poor people. I disagree. The medical profession provides free care for millions of poor people without health insurance and has always done so. If a plaintiff can’t pay for the cost of a trial that he lost, the law firm who took on the losing case should foot the bill. What a concept! This one change would immediately eliminate thousands of frivolous medical malpractice cases.

No doubt, doctors and hospitals need to continue to police themselves with very active quality assurance programs. Moreover, doctors need to communicate clearly, thoroughly and often to patients and their families. However, patients need to understand that not every bad outcome implies negligence. Indeed, all operations and procedures have risk. Your doctor needs to spend as much time as possible explaining your diagnosis, treatment, and possible complications.

Without quick and decisive action by legislators, your doctor may be forced to stop practicing in Pennsylvania. The malpractice crisis is real and your health care is at risk. Let your voices be heard.

(Raymond L. Singer, M.D., is the treasurer for The Pennsylvania Association for Thoracic Surgery and is in private practice in Allentown.)