Along with his neighbors, Ed Shanbacker, executive vice president of the DC Medical Society, petitioned the DC Council about a dangerous intersection near their homes. After repeated pleas, they got the council's attention--but not until a four-year-old had been hit by a speeding car.

Shanbacker thinks it will take a similar tragedy for local officials to address DC's medical-malpractice crisis. "At some point, we are going to wake up and see that our hospital infrastructure has completely deteriorated," Shanbacker says.

Medical professionals worry that high DC malpractice-insurance rates will drive more doctors to the Maryland and Virginia suburbs and lead to more hospital closures. Columbia Hospital for Women and DC General already have shut down.

The issue of medical malpractice and liability is complicated, particularly in the Washington area. The District is one of only two jurisdictions in the country--Delaware is the other--that has not enacted medical-liability tort reform that places some brakes on lawsuits. Unlike doctors in many other places, DC physicians can easily move their practices, or part of their practices, to another jurisdiction--to Maryland or Virginia--to reduce liability premiums without uprooting their lives and families.

This exodus of doctors, including some who have chosen to retire early because of escalating malpractice premiums, affects hospital closures and medical access for DC residents. Over the past two decades, hospitals have seen a decline in the average number of days patients spend in hospitals. As more physicians leave the District in search of lower insurance premiums, more hospital admissions leave with them.

Patients who cannot follow their doctor to the suburbs, such as many elderly and those without a car, end up losing their doctor.

Several solutions have been offered. DC mayor Anthony Williams, who like a number of doctors blames lawsuits and excessive jury awards for the problem, has proposed legislation that would limit lawsuits, reduce attorneys' fees, and cap court-awarded damages.

Others officials, including DC Council chair Linda Cropp, point the finger at the insurance industry, saying it is unnecessarily driving up prices on premiums. Cropp has proposed a bill, which many trial lawyers support, that focuses on insurance regulations rather than on lawsuits and jury awards.

DC doctors pay among the highest malpractice premiums in the nation. Malpractice awards in the District average $584,338 per payment, the highest in the nation. The US average is $264,552; Maryland ranks 16th at $282,403; and Virginia ranks 33rd at $227,289.

Premium rates for certain specialties, like neurosurgery, orthopedic surgery, and obstetrics and gynecology, have been particularly affected by rising malpractice premiums. Here is a comparison of the average malpractice-insurance premiums paid annually by doctors in DC, Maryland, and Virginia: