The doctors came to Springfield this spring. The Medical Practice Act that governs physicians was set to expire on December 31. Doctors wanted limits to malpractice awards. They opposed a requirement that physicians accept Medicare allowances as full payment. The conflict led to an impasse between doctors and their Republican allies on one side and consumer groups and their Democratic supporters on the other. To free the Medical Practice Act of 1987, negotiators hammered out a compromise that postponed the malpractice and Medicare issues until 1989. That done, the new act sailed through the legislature and was signed into law.

Gov. James R. Thompson's signature enacting Public Act 85-0004 followed closed-door negotiations between his staff, led by Deputy Gov. James Reilly, and the legislative leadership, represented by Sen. Emil Jones Jr. (D-17, Chicago), Sen. Jack Schaffer (R-32, Cary), Rep. Alan J. Greiman (D-l, Skokie) and House Minority Leader Lee A. Daniels (R-46, Elmhurst).

The new act, effective with Thompson's May 22 signing, incorporates recommendations from the Governor's Task Force on Medical Discipline: giving more authority to the Illinois Department of Registration and Education to discipline doctors and providing it $2.6 million in funds via an increase in medical license fees. Dr. Alfred Clementi, chairman of the task force, represented the Illinois State Medical Society in the negotiations.

As for the postponed issues, the Medical Society had lobbied for a $250,000 cap on noneconomic damage awards ("pain and suffering" to opponents) in medical malpractice suits. The society backed Republican-sponsored bills to set the cap. In addition the doctors and Republicans pushed for legislation to shorten the statute of limitations for malpractice suits filed on behalf of minors. Illinois law has allowed a doctor to be sued for an injury to a minor up to 22 years after the injury occurred; the society wanted a limit of five years.

Statehouse Democrats, backed by the Illinois Trial Lawyers Association, opposed both the cap on damages and the reduction in the statute of limitations. Greiman, the House assistant majority leader, criticized any type of cap on damages: "I'm not willing to say a kid crippled for 60 years should get $4,000 a year for the rest of his life."

Greiman engaged the doctor lobby on another front by sponsoring a bill requiring all Illinois doctors who treat beneficiaries of the federal Medicare program (mostly senior citizens) to accept Medicare's assigned rates as full payment and not bill for the difference. Greiman's bill drew support from the Illinois Public Action Council and other consumer lobbies. Jan Schakowsky, executive director of the Illinois State Council of Senior Citizens' Organizations, says that only 21.8 percent of the state's doctors who treat Medicare patients accept Medicare's assigned rates all the time. As a result, according to the Public Action Council, doctors in Illinois overcharge Medicare patients by $150 million per year. The Medical Society replies that Medicare's assigned rates have failed to keep up with inflation and maintains that the requirement would force many doctors to refuse those patients.

The disagreements over the medical malpractice issues and the Medicare payment issue caused an impasse over the Medical Practice Act until Reilly and company helped hammer out a compromise. The lawmakers agreed to a moratorium until 1989: Republicans will withhold any bills to cap noneconomic awards and Democrats will not pursue mandatory Medicare assignment. The deal got the Medical Practice Act through the House and Senate on unanimous votes.

The compromise also cleared the way for a reduction in the statute of limitations on malpractice suits: The Democrats agreed to an eight-year limit. Rep. John O'Connell (D-47, Western Springs) attached the compromise limit to a civil procedure bill, which passed both houses on May 22. The governor signed it July 20 (P.A. 85-0018). It became effective immediately and applies to all cases filed after January 1, 1988.

The legislators had aimed to complete action so that the new Medical Practice Act could take effect before the end of May, according to Sen Jones. That's when the Department of Registration and Education had to start sending out license renewal notices to the 25,450 in-state and 9,836 out-of-state physicians whose Illinois licenses expired July 31.

The revised act raises license fees from $35 to $100 per year for Illinois-based physicians, and to $200 per year for out-of-state physicians. It also raises fees for new applicants and temporary licenses. The increases will give the department $2.6 million in new money this year and allow it to carry out the act's tougher disciplinary procedures that include:

• providing state investigators greater access to patient medical records (patient confidentiality would be protected);

• granting the department's Medical Disciplinary Board the authority to order inspection of a physician's office;

• increasing the number of department medical inspectors and the number of doctors available for review committees;

• improving coordination with other state and national agencies on reporting disciplinary actions.

A Medical Society spokesperson says the lobby's 17,000 member physicians are pleased with the deal, although the Democrats' refusal to cap malpractice awards disappointed many. But the society plans to obey the moratorium and postpone its push for a cap until 1989.

On the other side, Robert Creamer, executive director of the Public Action Council, also says he's "generally pleased with the revised version of the act and the deal involving its passage. But a council spokesman, John Cameron, says it will ignore the moratorium since the negotiations excluded the council. He says the council plans to approach legislators, probably those outside either party's leadership, to sponsor mandatory Medicare assignment bills either in this year's veto session or next year. 

Chris Gaudet