On Dec. 30, however, Gov.-elect Ed Rendell and Gov. Mark Schweiker said that with their support remedial legislation would be introduced to create a short-term fix.

The proposals would include two main points. One would eliminate or reduce payments for Medical Care Availability and Reduction of Error fund assessment. Mcare provides a catastrophic layer of malpractice coverage.

Also proposed is a surcharge on insurance companies to help pay for part of Mcare, according to Roger Baumgartan, a spokesperson for the Hospital & Health System Association of Pennsylvania, a trade group representing institutions throughout the state.

"Medical malpractice insurance cost is an issue that's been brewing for more than two years. I think no community in Pennsylvania has been untouched by this. We have heard stories throughout the past year about doctors from every part of the state who have moved out of Pennsylvania," Mr. Baumgartan said.

Mr. Baumgartan said state officials' proposals appear to be the main reason that the protest has been averted.

"That certainly seems to be what tipped it. But what Governor-Elect Rendell proposed is not a done deal--it still requires legislative action. The media says this is a wonderful short-term remedy, and clearly there is still more to do, but it's important to point out that there were also some long-term fixes that were made last year," he said.

None of the Pennsylvania hospitals that had expected a work stoppage has seen their doctors go ahead with their plan, Mr. Baumgartan said, with the sole exception of Abington Memorial in suburban Philadelphia. Doctors there saw the institution close its trauma center on Dec. 20, 2002.

Patricia Usner, a spokesperson for Delaware Valley Health Care Council, a trade association that includes hospitals and healthcare organizations in Pennsylvania, also applauded state officials' latest proposals.

"Our reaction is that they do provide a short-term relief and they helped forestall immediate problems on Jan. 1. As many as 21 hospitals around Philadelphia, and possibly hundreds of hospitals around the state, had concerns that they would have to stop some elective surgeries," Ms. Usner said.

The governor-elect provided a short-term relief until longer-term solutions are passed, she noted. There is also the state's medical liability taskforce that is looking into possible solutions and will provide the governor-elect with a set of recommendations by April 1.

"Some hospitals had been notified that some surgeons would not be doing elective surgeries as of Jan. 1. Other doctors were planning for leaves of absence or to inactivate their licenses. But it looks like the problem is averted now," she said.

Although the immediate crisis has been averted in Pennsylvania, more than two dozen surgeons in the neighboring West Virginia have gone ahead with a similar walkout plan to protest their state's high med mal insurance cost.

"On Jan. 1, 18 surgeons began their 30-day leaves of absence and stopped working, affecting three Northern Panhandle hospitals in West Virginia: Wheeling Hospital, Ohio Valley Medical Center and Reynolds Memorial Hospital. Another 11 surgeons are taking a leave from Weirton Medical Center in Weirton," Tony Gregory, director of communications at the West Virginia Hospital Association, told National Underwriter.

Mr. Gregory added that the governor's office and the state administrators are continuing to work with hospitals in those areas to address access to patient care.

"There is also willingness by the governor and the legislature to reform the state's medical liability insurance. The legislative session starts Jan. 8," he said.

Many surgeons in West Virginia who are participating in the walkout are insured by the West Virginia Board of Risk and Insurance Management, which was mandated by the state legislature last year to cover premiums of doctors who are not state employees.

But those who signed up for leaves of absence argue more legislative actions are needed, including making filing malpractice lawsuits more difficult and capping damage awards.

"They are concerned and frustrated with the medical liability climate in West Virginia. However, the governor and the legislature are making efforts to bring the matter to a solution," Dr. Donald Hofreuter, chief executive officer of Wheeling Hospital at Wheeling, W.Va., told National Underwriter.

"I understand the concerns and frustrations of the surgeons--I am also a physician. Our medical liability costs are higher than those in states like California where there is a $250,000 cap on non-economic damages, whereas in West Virginia, it's one million dollars. California has made significant medical liability reforms," Dr. Hofreuter said.

Howard Gamble, a spokesperson for Ohio Valley Medical Center in Wheeling, W. Va., which has also been affected by surgeons' protest, said the hospital remains supportive of its physicians.

"What they are doing is trying to make the public aware of the difficulties of practicing medicine in West Virginia due to an increase in medical liability insurance costs," Mr. Gamble said.

"We understand physicians. At the hospital, we experience the same situation--we pay over $10,000 a day for medical liability insurance. We understand why they are doing it and we support them. We have a sister facility, East Ohio Regional Hospital, which is five miles away, that could pick up some of the surgical procedures, and we have seen an increase in scheduling at East Ohio," he said.

Such walkouts, although rare, have occurred elsewhere in the U.S., according to Chicago-based American Medical Association, the country's largest physicians group.

In Las Vegas, for example, some 150 doctors at University Medical Center resigned last July to protest high insurance premiums, prompting the hospital to shut down its trauma center for more than a week.

The action prompted a special session of the state legislature, which enacted a law capping damages in trauma center malpractice cases at $50,000, except in cases of gross negligence.