The Nevada Legislature opened its special session on medical malpractice in confusion Monday with lobbyists for the lawyers, doctors and insurance companies moving between closed-door meetings to try finalize a compromise.
But the start of session was apparently the boot they needed and, shortly after noon, Gov. Kenny Guinn announced a deal had been reached.
He described it as "a comprehensive bill that hopefully will set the tone for tort reform."
Minority Leader Sen. Dina Titus, D-Las Vegas, asked that lawmakers also consider adding a requirement that the high rates now charged for malpractice insurance be rolled back 20 percent.
But Majority Leader Bill Raggio, R-Reno, said the governor's proclamation calling the special session was so tightly worded that amendment falls outside the scope of what they are allowed to do.
Speaker Richard Perkins, D-Henderson, told an Assembly panel reviewing the plan that he too believes insurance reform "simply must be part of the solution."
But other lawmakers generally agreed they expected the details of that deal to be passed into law. And the plan doesn't impose any such requirements on the insurance industry.
Sen. Randolph Townsend, R-Reno, said too much work went into the negotiations for lawmakers to make major changes that would cause one or more of the parties to withdraw support.
The special session was forced after the biggest insurer in Southern Nevada pulled out of the market and other insurers demanded increases from doctors of more than 100 percent in some cases.
The plan introduced as Senate Bill 2 sets a cap on non-economic damages for pain and suffering at $350,000 per defendant, or whatever amount is left under the doctor's malpractice insurance policy after paying economic damages such as medical costs and loss of earnings.
But it exempts cases where the doctor is guilty of "gross malpractice" or where there is catastrophic damage to the patient resulting in such things as serious brain damage, total blindness, loss of a limb or paralysis.
And it eliminates Nevada's medical screening panel, which physicians say hasn't prevented cases from getting to court, in favor of mandatory settlement conferences before a district judge to see if the case can be resolved without a trial.
Dean Hardy of the Trial Lawyers Association said there was no intent to limit provable economic damages. He said the caps apply only to "non-economic" damages such as pain and suffering.
The bill also limits non-economic damages each defendant must pay to that defendant's percentage of negligence. Existing law requires that, if one defendant can't pay his share, the other defendants in a case are responsible for the entire judgment. That has resulted in cases where a doctor judged only 10 percent or less at fault in a case was forced to pay the lion's share of a judgment because he was the only one with insurance.
For the first time, the plan would require doctors to have at least $1 million per person and $3 million per occurrence in liability insurance or lose their license to practice in Nevada.
It would require the Board of Medical Examiners to collect and report disciplinary actions against doctors to the governor and Legislature. Similar reporting requirements would be imposed on hospitals and on insurance companies that provide medical malpractice insurance. Those who fail to file the reports would face stiff fines.
Perkins said among changes he would like to see in the legislation is stronger reporting of "incidents" rather than just disciplinary actions. He said the idea would be to use the information to find and fix problems rather than to punish anyone.
Lawmakers appropriated $160,000 to run the special session. That is enough to cover start-up costs and operate for three days. It is the second special session since the end of the 2001 Legislature. The first was a two-day session for reapportionment called immediately after that regular session ended.