WASHINGTON — The House passed legislation Thursday imposing a $250,000 limit on jury awards for pain and suffering in medical malpractice cases, arguing that frivolous lawsuits are driving medical liability premiums out of control and forcing doctors to quit.
The vote of 229-196 with one member voting present, was an important victory for President Bush, who has made overhauling the nation's medical liability laws a centerpiece of his domestic agenda.
"Today's House vote," Bush said, "is an important step toward creating a liability system that fairly compensates those who are truly harmed, punishes egregious misconduct without driving good doctors out of medicine and improves access to quality affordable health care by reducing health care costs."
The vote was also a crucial victory for doctors, insurance companies, the pharmaceutical industry and business groups, which had lobbied heavily for it. By Thursday, those groups were so confident the measure would pass that the American Insurance Association, an industry trade group, put out a press release lauding the vote hours before it was taken.
Now the measure moves to the Senate, where it faces an uncertain future. Sen. Bill Frist, the majority leader, has vowed to take up medical malpractice legislation this month, and at least one influential Democratic senator, Dianne Feinstein of California, strongly supports revamping the liability laws.
But several prominent Senate Republicans have said that any malpractice legislation would have to include an exception for egregious cases, like the one involving Jesica Santillan, the 17-year-old who died after transplant surgeons gave her a heart and lungs of the wrong blood type.
And backers of the House bill are acutely aware that Republicans hold only 51 votes in the Senate, nine short of the number needed to break a filibuster.
"We're going to have to find nine Democrats," said Rep. James C. Greenwood, R-Pa., who is the chief sponsor of the House bill. But, he added, "I think we have the best chance we've ever had, and we have a president who is very keen to get this done."
So keen, in fact, that on Wednesday Bush invited about a dozen undecided lawmakers to the White House to urge them to support the bill.
At the time, Republican leaders counted 220 votes in their camp. Rep. Billy Tauzin, R-La., who shepherded the measure on the House floor, said Thursday that Bush was instrumental in bringing up the total to 229. Sixteen Democrats voted with 213 Republicans to ensure the measure's passage, while nine Republicans voted against the bill.
"The president was very persuasive," Tauzin said. "He basically made the case for it and urged them to consider the importance of for the nation's good. This was a national thing that he was very invested in personally."
Changing medical malpractice law has long been high on the Republican agenda. But the issue has gained national attention this year, in part because President Bush has taken a strong stand, and in part because doctors around the country have engaged in highly publicized walkouts and rallies to protest high insurance costs.
The bill the House passed Thursday does not limit jury awards for medical and funeral expenses. But the caps it imposes on pain and suffering damages apply not only to lawsuits filed against doctors, but also to those filed against insurers, pharmaceutical companies and makers of medical devices — a provision that Rep. Henry A. Waxman, D-Calif., called "another reward that Republicans are giving to the pharmaceutical industry."
Democrats, adopting the argument of trial lawyers and consumer groups, say the House bill will unfairly prevent innocent victims of medical malpractice from seeking legal recourse. They also argue there is no evidence the bill will actually bring down liability premiums.
"We're voting on a bill that overrides state law and undercuts compensation for victims of medical malpractice, yet we don't know whether medical malpractice premiums will come down," said Rep. Sherrod Brown, D--Ohio.
Brown said: "We're supposed to take it on faith, trust the insurance companies that they will pass along the savings. We can't trust patients, we can't trust juries, we can't trust lawyers, but we can trust the insurance companies?"
At times, Thursday's debate seemed like a face-off between victims. Democrats showed pictures of victims of medical malpractice, while Republicans talked about what Tauzin calls "the hidden victims" and cast the debate as one over access to medical care.
"What we don't often hear about are the victims of a medical malpractice system gone awry," Tauzin said. "They are the victims who get hurt, who get injured, who get denied access to health care at critical moments, because some doctor couldn't get his insurance renewed because the premiums are too high."
Thursday's vote came after hours of contentious debate in which Democrats complained bitterly that Republicans were preventing an alternative measure from getting a fair hearing. In a series of party-line votes late Wednesday, Republicans on the House Rules Committee voted to block any amendments from being introduced — an action that enraged Rep. John D. Dingell, D-Mich., and chief sponsor of the alternative, which would not have imposed caps on jury awards.
"It is shameful and it is totally inconsistent with the practices, rules and traditions of the House of Representatives," Dingell said, calling the move "a bite on the throat of the right to free debate."