Capping damages for pain and suffering and other noneconomic losses in a medical-malpractice lawsuit is "unfair" to injured patients, a study due out today says.

The report will come just three days after the Pennsylvania House of Representatives passed a bill to amend the state constitution to allow such limits on malpractice and other liability suits.

The legislation does not specify a dollar amount at which noneconomic damages would be capped, nor does the report say at what level such caps would be unfair to patients. California, for example, caps pain-and-suffering damages at $250,000.

Written by Max Mehlman, director of the Law-Medicine Center at Case Western Reserve University in Cleveland and a professor of both law and biomedical ethics, the 100-page report seems to undermine a key change - noneconomic damage caps - promoted by the medical and business communities in their two-year lobbying campaign.

Mehlman's analysis is part of the two-year, $3.2 million Project on Medical Liability in Pennsylvania funded by the Pew Charitable Trusts.

"Flat caps on noneconomic damages, which arbitrarily deny compensation to the most seriously injured patients" are unfair, Mehlman's report says.

However, the report recognizes that rising malpractice premiums could create a shortage of doctors and hospital services.

"At some point, even severely injured patients would lose more by being denied access to health care than by being unfairly compensated for their injuries," the report says.

Chuck Moran, a spokesman for the Pennsylvania Medical Society, said: "That is why we believe a reasonable limit on noneconomic damages in malpractice suits is necessary."

David Lutz, president of the Pennsylvania Trial Lawyers Association, said yesterday that Mehlman's report confirmed the argument his group has made.

"Here we have an objective source confirming that the most seriously injured people would suffer unfairly if damage caps were imposed," Lutz said. "We would hope that the General Assembly would take note of this Pew report and give it weight."

Other malpractice changes Mehlman classifies as unfair include: shortening the statute of limitations and "expert screening of claims, because decision-makers are unlikely to be neutral and impartial."

Mehlman finds that some widely debated changes to the malpractice system are fair, including: limits on lawyers' contingency fees, the payment of damages over time, stronger regulation of insurers, and measures to deter frivolous suits.

"Fair compensation and fewer medical errors are not the only objectives of the malpractice system," the report concludes. "It is also vital to maintain patient access to health care, an economically viable health-care sector, and a sustainable malpractice financing system."

Last week, another Pew-funded study found that Pennsylvania is among the states hardest hit by rising malpractice insurance premiums.

Andrew Wigglesworth of the Delaware Valley Healthcare Council, which represents area hospitals, said caps on noneconomic damages had merit today.

"People absolutely need to be fairly compensated if they are injured as a result of medical negligence," Wigglesworth said.

"I would argue, however, that it is unfair to the rest of the community, which is seeing hospital maternity units close and trauma centers shut down, not to rein in this out-of-control malpractice system. Caps on noneconomic damages are a reasonable compromise given the extraordinary cost of the current system."

Some experts argue that the malpractice system in Pennsylvania and elsewhere is fundamentally unfair because it compensates too few injured patients and provides some of those with excessively large awards, the study notes.

Those experts argue that a no-fault system "would make the system less expensive, prevent patient injury, and compensate more injured patients."

But in Harrisburg, reducing premiums for doctors and hospitals, not completely reinventing the malpractice system, is the focus of policymakers.

Gov. Rendell released his malpractice package on Monday. It included using $600 million in state money to help doctors pay for malpractice coverage.

And with the House passage Tuesday of a bill to amend the state constitution to allow damage caps, that legislation moves on to the Senate, which is unlikely to vote on it until after the summer recess.

A constitutional amendment must pass the General Assembly twice - once in each of two consecutive two-year legislative sessions - and then pass a voter referendum. That process could be completed in the spring of 2005 at the earliest.

Susan Liss, executive director of the Pew-funded project, said "a solution in Pennsylvania cannot be achieved without finding new ways of looking at the issues. Focusing on patient fairness might help break the gridlock."