The House, in surprisingly swift fashion, passed the bill with few changes from a version passed by the Senate last month. The controversial legislation wasn't scheduled for debate until next week, but Speaker David Wilkins, R-Greenville, put it on the floor and it passed on second reading with no discussion.

The bill must go back across the hall, where key senators said only minor tweaks are necessary before a final version is ready for Gov. Mark Sanford's signature.

"I think the two big changes are not hurdles," said Sen. Brad Hutto, the Orangeburg Democrat pushing the measure in the Senate. "(President Pro Tem Glenn) McConnell and myself were both briefed on the bill ... and I think there is common ground here."

Sanford has said previously that he supports the Senate bill, calling it "absolutely vital legislation" to keep businesses in South Carolina competitive with those in neighboring states. Still, Sanford spokesman Will Folks said the governor "will ultimately have to see what makes its way through the legislative process."

The House version changes the Senate bill by requiring mediation before a malpractice lawsuit is filed, instead of before the case goes to court. It also builds in some liability protections for certain trauma center and emergency-room doctors.

"What we are trying to do is eliminate some frivolous cases early in the process," said House Judiciary Committee Chairman Jim Harrison, R-Columbia.

But the heart of the bill remains unaltered, including an exception that allows people winning lawsuits to collect damages of $1.05 million from a combination of up to three defendants.

Harrison and other supporters say the cost of malpractice insurance is driving doctors out of the state, especially in fields such as obstetrics and neurosurgery.

Those against caps argue that doctors and health care providers should be held accountable for their mistakes. They also say caps unfairly limit damages in extreme cases.

The vote was welcome news to the South Carolina Medical Association, which had mounted a lengthy public campaign advocating limits on jury awards.

"We're very pleased," said Dr. John Evans, president of the association's Board of Trustees. "This is going to go a long way toward stabilizing medical liability premiums."

The South Carolina Trial Lawyers Association has fought the bill the whole way. The organization is tolerating the mediation change, but plans to lobby the Senate about an exemption for doctors in emergency situations.

"We know what they are trying to do, but we think they went too far," said Fayrell Furr, a Myrtle Beach lawyer and past association president. "Some changes are needed to make it livable."

Though the Senate is likely to approve the House's amended version, senators don't plan to address the bill for at least a week so they can continue debate on legislation limiting lawsuits over non-medical issues. Filibusters went on all week as leaders huddled in back rooms negotiating a compromise.