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When Dr. Albert Saloom, of Mt. Pleasant, began practicing medicine in 1961, he could purchase $100,000 in malpractice insurance for $30 a year.

"In the '60s, we delivered babies and did surgery for $30," Saloom said.

When the rate eventually increased to $104 a year, Saloom said he wrote a "tough letter" to the insurance company demanding to know why.

The 74-year-old family doctor now pays more than $7,000 a year. That's still a trifle compared to some of Saloom's colleagues who practice high-risk specialties such as neurosurgery and can pay between $100,000 and $200,000 a year in malpractice premiums.

Doctors representing nine county medical societies Monday canceled their appointments and non-emergency surgeries to meet at Westmoreland Regional Hospital in Greensburg to discuss the malpractice insurance crisis, which they say eventually could cripple health care in the state and make it harder for patients to obtain medical care.

Physicians across Pennsylvania have been staging a work protest since April 30 to draw attention to their financial plight. The campaign culminates today in Harrisburg as physicians descend on the capitol to lobby lawmakers about reform, which they hope would include a $250,000 cap on damages for pain and suffering, and limits on the fees paid to trial attorneys who win malpractice cases.

Physicians worry there will be a "meltdown" of the state's health care system by the time the Legislature acts.

Dr. Jitendra Desai, a Pittsburgh urologist and president-elect of the Pennsylvania Medical Society, told colleagues the crisis is "for real," and they need to become more politically active if reform is ever to be achieved.

"Unless you and your patients get involved, you won't get anywhere," said Desai, who once practiced at Westmoreland. "Physicians are between a rock and a hard place."

He said some doctors have curtailed certain procedures for fear of getting sued or practice defensive medicine by ordering unnecessary tests to protect themselves against malpractice lawsuits. But those extra tests, Desai noted, also are increasing the cost of health care. Other physicians are retiring early, and many young residents are leaving the state rather than starting their practices here.

"Doctors don't have political clout with politicians," Desai said. "They don't want to play the game. They need to get involved in the political process. We don't have political capital. We don't have as much political influence as we think we have. The legal liability system is destroying medicine.

"I want you to talk to your patients," he urged. "Do something. Just don't go out and play golf. As a last resort, we may even have to consider civil disobedience to achieve our goals."

To underscore the lack of physician activism, Dr. Donald Brown, president of the Westmoreland County Medical Society, noted the low turnout yesterday even though there are 700 physicians in Westmoreland County, 350 of whom are society members.

"I can't say there's an overwhelming number here today," added Brown. "Much of our problem lies in the political arena and in the political power of the trial lawyers and their allies."

In addition to limits on damages for pain and suffering, doctors want lawsuits reviewed by an impartial panel of doctors, lawyers and judges to reduce the number of frivolous lawsuits that are filed each year. They want a statewide peer review system that would investigate errors but also would provide immunity for physicians as a result of the investigations. Desai said arbitration or alternative dispute resolution also would help bring about reform.

"Give us immunity and we'll take care of bad doctors," he said. "We'd love to do that."

Dr. Donald Fetteroff, chief medical officer of Highmark Inc., said studies have shown that malpractice litigation is directly responsible for about $5 billion in increased health care costs. The average rate hike in the state in 2000-01 was 15 percent, he said. The median jury award reached $1 million.

Fetteroff attracted the ire of his colleagues when he supported a position of the trial lawyers who have claimed physicians are not leaving the state in large numbers as the Pennsylvania Medical Society has claimed. In reality, he said, the number of physicians grew by several hundred between 2001 and last year.

"Are physicians leaving by the thousands in Pennsylvania? We're not seeing that," Fetteroff said.

Dr. Brian Boyle, of Greensburg, challenged Fetteroff's statistics, arguing that there were decreases in the number of certain specialties.

Desai also was critical. "Listening to Don Fetteroff, I thought he was a front for the insurance industry."

The battle for reform both in Congress and the General Assembly hasn't been easy, said U.S. Rep. Pat Toomey, a Republican from Allentown, Lehigh County, who also attended the daylong event.

"It's going to be very hard to get caps in Harrisburg," Toomey said. "It's going to be a real challenge. I think you need to keep the heat on ... you need to keep the pressure on in Harrisburg."

Boyle, who ran unsuccessfully for the state House last year against state Rep. Tom Tangretti of Hempfield Township, said reform won't be achieved until patients begin to feel the impact and politicians start losing elections.

"It is starting to happen on a personal level," Boyle said. "Until a patient hurts personally, they won't care about the crisis. Legislators are only worried about being re-elected, not malpractice.

"They're still thinking about the same thing they thought about before. Only thing that will change their mind is if you get somebody who will get more votes than them and they sit at home."

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