Kate Thompson was a spirited sophomore at the College of Charleston before her operation.

In 1996, the then-20-year-old cheerleader underwent brain surgery to remove a benign tumor. By all accounts, the procedure went well. But soon after returning to school, she started to suffer severe headaches. Her family was told the pain was part of the recovery process -- nothing to worry about.

When she began experiencing seizures on her way to the emergency room of a Myrtle Beach hospital, it was clear something was terribly wrong.

It turns out that surgical foam and gel used to stem bleeding during her surgery had been left inside her head, causing her brain to hemorrhage and destroying much of her short-term memory. While she can still walk and talk, doctors say she will need constant care for the rest of her life.

Thompson's parents settled a civil lawsuit against Kate's doctor for an undisclosed amount. Fayrell Furr, the Thompson family lawyer, said the money is "vital to her well-being."

A bevy of bills now up for debate in the state Legislature would limit the amount of money future Kate Thompsons could receive.

If the limits pass, critics say, the unintended consequences of these bills would disproportionately punish the unemployed, children, the elderly and the poor.

On Tuesday, a Senate subcommittee is expected to vote to send up to 16 related bills to the Senate floor. Together, these pieces of proposed legislation seek in one way or another to curb the way civil suits are brought and processed in the courts.

Critics are most alarmed by several of the bills that aim to cap jury awards. Other states have enacted similar caps.

To proponents, among them doctors, insurance companies and Gov. Mark Sanford, these bills represent "tort reform."

They say runaway jury verdicts are to blame for today's skyrocketing health care costs. A ceiling preventing someone from suing a doctor for an unlimited amount of money, these advocates maintain, will corral out-of-control medical malpractice insurance premiums that are forcing some physicians out of business and creating a shortage of much-needed doctors in certain fields and in some pockets of the state.

Opponents of caps contend none of that is true.

Plaintiffs' lawyers and consumer advocates say the number of doctors in South Carolina is growing, not shrinking. They also say any links between jury awards and insurance rates are sketchy at best. The real culprits driving up insurance costs, these groups argue, are the insurance companies themselves, as they seek to recoup stock market losses from earlier this decade.

PITFALLS

Both sides of the debate offer reams of data to support their arguments.

State lawmakers, swayed by one side or the other, have been gridlocked on the issue for years. As the fight heats up again, the few ambivalent ones get bombarded with phone calls from lobbyists, while the public is treated to a steady stream of infomercials and media ads replete with images of greedy lawyers or negligent doctors.

Regardless of who's right, the caps imposed in Senate Bill 38 and others like it will take a toll on some more than others.

That's the case for anyone relying on so-called noneconomic damages, or "pain and suffering," for compensation. It's these damages that would be capped.

Jury awards generally fall into three categories of damages: economic, noneconomic and punitive.

Economic damages are awarded based on criteria including how much a person earned and what they would be expected to earn in the future.

This approach poses a problem for juries trying to assess damages for the unemployed and stay-at-home moms, who don't earn paychecks, and young people like Kate Thompson, who hadn't entered the work force. Senior citizens and minimum-wage earners also don't fare well in this category.

Noneconomic damages are supposed to pick up the slack for those people.

Senate Bill 83, however, would limit noneconomic damages to $250,000 for a medical malpractice case unless there was "gross negligence," allowing the plaintiff to sue for punitive damages.

But even when such negligence is proved, Senate Bill 2 would seek to cap punitive damages at $250,000 as well.

"Why is that fair?" asked Furr, a Myrtle Beach-based lawyer. "If that's the most we could have gotten for Kate, how would that make up for what happened and help her folks take care of her for the rest of her life?"

BIGGER THAN S.C.

The debate over the guidelines governing liability law has raged across the nation for years. Roughly 30 states have imposed caps, dating back to 1975 when California became the first.

President Bush has taken up the mantle for change. Aside from caps, his agenda -- similar to many South Carolina Republicans -- includes a host of proposals ranging from reducing the time someone is allowed to sue a company after a problem has been discovered to restricting the venues where lawsuits can be filed.

Still, the issue of caps is the most contentious. Last year, caps proved the sticking point in the state General Assembly. The House of Representatives passed a bill approving caps, but the Senate became deadlocked. Caps turned out to be the deal-breaker.

To avoid a possible repeat performance, the House this year is poised to pass a bill that has removed all talk of dollar limits. The Senate, though, doesn't have such reservations.

Activists backing both sides traveled to Columbia last week to be seen and heard.

The South Carolina Trial Lawyers Association brought out family members of medical malpractice victims who told horror stories of how loved ones were maimed or killed by negligent doctors.

The South Carolina Medical Association countered by bringing forward physicians who said their insurance was so expensive they could no longer afford to deliver babies or work in trauma centers, two areas with some of the higher insurance premiums.

Sanford joined the ranks of doctors rallying around the Statehouse in their white gowns. Changing the liability laws is one of the governor's top five priorities this year.

Sen. Scott Richardson, R-Hilton Head, has sponsored many of the bills that could make their way to the Senate floor as early as this week and is a big supporter of caps. "Health insurance and access to health care is a social issue, and the public deserves good health," Richardson said. "The trial lawyers will always talk about exceptions (of what will happen if caps are imposed), about awful stories ... but I'm concerned about what will happen if we drive out insurers and doctors.

"I'm not trying to shield bad doctors from responsibility," he added. "I just want to take a good look at what's in the best interest of the public good."

Sen. Robert Ford, D-Charleston, says Richardson has got it all wrong.

"Proponents of these bills are worrying about the doctors. Opponents are worrying about the lawyers. But who is worrying about the citizens of this state?" Ford said. "With these caps, by the time you're done paying the lawyers, there's no money left. And why are you in such a situation? Because someone else, a doctor, screwed up.

"We talk about the fight between the doctors and the lawyers on this one," Ford continued. "The real question is, why isn't anyone taking a look at these insurance companies."

TIT-FOR-TAT

Robert Hunter has looked hard at the insurance companies for years and agrees with Ford.

The director of insurance for the Consumer Federation of America, Hunter says he has seen similar crises with high malpractice premiums in the past. When interest rates are low and the stock market does poorly, insurers typically scale back on writing such policies. And that jacks up the rates on the doctors.

His research -- backed up by other independent studies -- also shows that caps have not had a noticeable impact in the states that have them. "Rates go up just as fast in states with caps as states without them," he said.

Hunter also points to a report from the nonpartisan Congressional Budget Office that found malpractice costs came to less than 2 percent of overall health care costs in the country.

That means, according to the data, that a 30 percent cut in malpractice premiums would shave only 0.5 percent off national health care spending.

Critics of Hunter and studies with similar results attack the methodology of the research. They also come armed with figures to back their own assertions.

"The bottom line is the (insurance) industry has been losing a lot of money because of the rising awards and settlements and other tort-related costs," said Loretta Worters of the Insurance Information Institute, an industry-backed group in New York.

"In 2003, medical malpractice costs, at almost $27 billion, cost each American an average $91 a year," she said. "This compares with $5 a year in 1975."

Worters was referring to a study released this month by insurance industry consulting firm Tillinghast-Towers Perrin, indicating how increases of malpractice costs have outpaced other tort areas. The annual report's methodology and conclusions have been hotly disputed by opponents of liability changes.

Christian Hartley, a product liability lawyer with the Charleston firm Richardson, Patrick, Westbrook & Brickman, said passing the limits would be a big mistake.

"The Legislature is about to make changes with very few facts," Hartley said. "If you scratch the surface, you will see that the ones they have are fake."

Caps, he said, would be a disaster for those who have already been victimized.

"The right to have our day in court and to sue is a check and balance to the system," he said. "The deck is stacked against the little guy, and this is the only thing giving them some recourse."

Hartley also said state figures show the number of physicians practicing in South Carolina grew 9.3 percent between 1999 and 2003. "Doctors aren't going anywhere," he said.

The South Carolina Medical Association counters with figures of its own. Students interested in studying neurosurgery and obstetrics at the Medical University of South Carolina are down, the association says, because they see insurance premiums soar in these fields.

Also, trauma and burn centers across the state, including in Charleston, have been forced to close because of the exorbitant costs of doing business, the SCMA says.

Whichever side ends up victorious, Ann Marie Thompson, Kate's sister, says she cannot imagine what caps would have meant for her family.

"That money is extremely important. My parents would never think of putting Kate in assisted living," said the 23-year-old law school student at the University of South Carolina.

Ann Marie Thompson was among those who testified last week in front of lawmakers.

"Limiting caps will allow them (doctors) to act negligently and not worry about it," she said later. "In life, you have to pay for your mistakes. That is their job and the responsibility they take."

UP FOR DEBATE

Several bills limiting jury awards in medical malpractice cases soon could make their way to the Senate floor.

-- Senate Bill 83 would limit noneconomic damages to $250,000 for such cases unless the defendant or medical provider's conduct was grossly negligent, allowing for punitive damages.

-- Senate Bill 2 would do the same as S83 and limit punitive damages to the "lesser of three times the amount of compensatory damages or $250,000."

-- Senate Bill 36 would limit noneconomic damages to $300,000 with nine exceptions, including requiring mediation or arbitration prior to the trial.

Source: South Carolina Senate Judiciary Committee