THERMOPOLIS, Wyo. (AP) - Wyoming lost nearly 10 percent of its practicing physicians in 18 months. The state's largest medical malpractice insurance carrier announced it would not renew its policies beginning Oct. 1, 2004.

In response to a perceived growing medical emergency across the state, the legislative leadership convened a special session of the state legislature, and Gov. Dave Freudenthal pushed lawmakers to give Wyoming voters an opportunity to modify the state's constitution.

The resulting proposed constitutional amendment authorizes the legislature to put a cap on non-economic damages. Twelve-year state representative Mike Baker, R-Thermopolis, predicts the proposal will lead to a great debate across the entire state.

Wyoming's Territorial Constitution put a limit or "cap" on damages and awards for injury or death, Baker explained after the July special session. He said that the state constitution reversed the territorial constitution by barring caps on damages.

He speculated that the change was in direct response to potential abuses by major employers at the time. Article 10, Section 4 of the Wyoming Constitution states no law may be enacted limiting the amount of damages to be recovered for causing the injury or death of any person.

Baker said during July's special session the legislature authorized putting a constitutional amendment before Wyoming's voters "to allow the legislature to limit the amount to be recovered from a health care provider for non-economic loss resulting from death or injury."

The proposed amendment does not allow the legislature to limit economic, exemplary or punitive damages, according to Baker. The legislation placing the constitutional amendment on the General Election Ballot also directs Secretary of State Cynthia Lummis to provide examples of non-economic and economic damages. The legislature also passed what has been termed the "I'm sorry" bill.

The bill makes a doctor's expression of sympathy or sorrow to a patient "inadmissible as evidence in a civil action brought against the provider for an unanticipated outcome of medical care."

The legislature also appropriated more money to expand the WWAMI medical education program that is designed to ultimately increase the number of doctors in Wyoming, according to Baker.

"We addressed a portion, a small part of the medical coverage needs," Baker said. "From the physician's point of viewpoint, I think we addressed the most important portion of the problem, which is the risk of devastating lawsuits. Those lawsuits are potentially, financially career-ending to the physicians," the lawmaker said.

And, he said, medical professionals claim that insurance premiums are cost prohibitive based on the patient volume, especially in the specialty fields of obstetrics and gynecology and neurosurgery. Baker cited data provided by the state that 59 doctors ended their practices in Wyoming between January 2003 and June 2004.

"Insurance premiums," he said, "played a significant role in their decisions, according to the information I've seen."

Baker said there are about 750 licensed physicians in Wyoming, with about 640 classified as "actively practicing." Insurance premiums have been increasing at a rate of about 30 percent per year to the doctors, according to Baker.

And despite the national increases, insurance reserve funds continue to justify rate increases, he said. "It's not that their reserve funds always decrease, it's that their claims exposure continues to grow," Baker explained.

The lawmaker said that insurance companies "perceive that Wyoming is a large enough risk that they potentially could lose money" by writing medical malpractice policies in Wyoming. Baker warns, though, that just looking at an insurance company's bottom line is not sufficient to see how its insurance reserves are holding or performing.

"Compensation to CEOs, board member salaries and other packages have to be reviewed before agreeing that insurance rates need to be increased."

"I'm interested to see how the debate proceeds. I'm convinced that some of the messages put out by differing viewpoints will be over-the-top and without a doubt, emotional.

"I also have confidence in the Wyoming electorate to see through the propaganda and scare tactics and make the right collective decision."

AP-WS-08-26-04 2035EDT