Section 3333.2 of California's civil code offers a level of specificity not seen in many parts of the state's laws, a fact that's been debated for months behind closed doors in the Capitol... and now poised to spark an expensive political war in 2014.

The law in question, the Medical Injury Compensation Reform Act of 1975 (MICRA), limits malpractice lawsuit awards for pain and suffering to $250,000.

"That $250,000 is a joke," says Rob Downey, a Rancho Cordova quadruple amputee who lost all four limbs after a monthlong coma caused by MRSA bacteria in 2011.

Downey, 49, has amalpractice lawsuit now pending and has been left largely unable to care for himself since the infection that took his hands and legs.

"How am I going to make up for what I've lost, what my kids have lost, what my wife has lost?" he says. "It would make a difference."

The MICRA cap does not cover malpractice awards for medical costs or possible punitive damages. In current dollars, the 1975 limit would be worth more than $1 million.

But that's about the extent of what's not in dispute. The 38 year old law's relevance and impact, among other items, have been the subject of intense political negotiations that seem to all but officially be over.

"There is no middle ground," says Dr. Paul Phinney, president of the California Medical Association. The doctors organization has been one of the strongest defenders in a coalition that warns a lifting of the MICRA cap will only raise costs and fuel the paydays of attorneys.

"Where does that money come from?" says Phinney. "It comes from the patients, what patients pay physicians to provide care. Or what systems, or insurance companies pay physicians to provide care."

Doctors also point out the influx of new patients under the federal health care law will further exacerbate the high costs of malpractice policies should the cap be removed or tied to the cost of inflation.

Critics of the insurance industry and trial attorneys, though, insist the MICRA limit counter by sayingit's insurance companies that gain the most by keeping the 1975 cap in place. They also argue that the $250,000 capdisproportionately hurts the poor, the elderly and disabled, and children who are injured in a medical mishap -- none of whom have much, if anything, to gain in uncapped trial awards for things like lost wages.

Last month, an outspoken Bay Area father -- whose children were killed in 2003 by a driver under the influence of alcohol and prescription drugs -- filed a ballot initiative (PDF) to lift the MICRA cap. The measure also would enact a series of drug testing requirements on doctors.

The initiative, which some observers saw as a plan B for backers of lifting the cap should legislative efforts come up short, may have itself squelched any chance of Capitol compromise.

And if the political campaign moves to the electorate, it's going to be an epic battle.

"This is easily a $100 million dollar campaign," says Democratic strategist Steve Maviglio, who is not involved with either side's efforts.

It's also a campaign, if it happens, that could leave Democrats -- the long time beneficiaries of political cash given by both attorneys and the medical community -- in a quandary.

"Money is going to be diverted from helping elect Democrats" in 2014, says Maviglio. "And these are the two biggest givers to Democrats."

Back in his suburban Sacramento are home, Rob Downey doesn't have much use for talk of the politics of the medical malpractice fight. He sees the issue as one of fairness.

"What good is it to have a jury?" says Downey about a malpractice award that's set by law, not by the facts in a case. "What's the point?"

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