Imagine enjoying your day on a Big Island golf course when you notice pain in your knee that had a knee replacement two years earlier, followed by fever and chills. Someone drives you to the nearest emergency room. There, a physician drains your knee of pus and starts antibiotics. You need surgery immediately, The Queen's Medical Center on O'ahu is full and your emergency-room physician cannot find a surgeon anywhere in the state to take your case. You wait, and worry about losing your leg, or even the possibility of death.

This is what happened last week to the father of a college friend of mine. She called me from Washington, begging me to take care of her father, which I did despite four days on call and not seeing my kids for two days.

Physicians are leaving Hawai'i, resulting in situations such as my friend's father. I will agree that low reimbursements are a major factor, but the increase in malpractice premiums is also a major issue. Malpractice premiums increased up to 90 percent between 2001 and 2006 for neurosurgeons, obstetrician/gynecologists, general surgeons and orthopedic surgeons. Our Legislature can address this urgent issue this year through medical tort reform.

Practicing medicine in a healthcare system under stress is a factor as well. The worry of being sued has physicians practicing defensive medicine. Ordering tests to protect against lawsuits drives up the cost of healthcare, but does not benefit our patients. We often lose sleep worrying that the natural course of a patient's illness will be blamed on us. We are expected to be perfect, but as humans we are not. Medical students see this and make career choices to avoid it.

The number of Hawai'i doctors who practice in high-risk environments is steadily declining. The emergency room is an especially litigious environment. There used to be 38 orthopedic surgeons covering emergency room calls at Queen's, and now there are only two. This threatens your health if you have a broken hip or spine and need immediate attention. Hawai'i's pregnant mothers are also at risk, as it is becoming too hard to find a physician to deliver their babies. Malpractice premiums are $69,000 for an obstetrician/gynecologist who delivers babies, and $25,000 for those who do not.

In his Island Voices column on March 12, attorney Rick Fried compared Hawai'i to California, which is a very litigious state. According to The Doctor's Company, a malpractice insurance company that insures doctors in all 50 states, the number of suits in Southern California is 250 percent of the national average. California's medical malpractice reform has stabilized rates, despite the litigious climate. If you compare California to other large metropolitan areas, California's rates are far less.

Caps on non-economic damages will help to stabilize the most unpredictable aspect of medical malpractice cases. Caps do not limit the ability for plaintiffs to receive awards for medical expenses, lost wages and future lost wages, or punitive damages. These awards can be millions of dollars.

The plaintiff cases heard at the House Judiciary Committee hearing are a cry for medical tort reform. Without good doctors and access to care, there will be more malpractice cases in Hawai'i. Maybe that is what the trial attorneys want.

Who will speak up for the families of people who have died or suffered permanent injury as a result of lack of access to care? The physicians have to be their voice because the personal injury lawyers certainly are not.

Tort reform works. Texas passed tort reform legislation in 2003. Since then, Texas has gained 152 orthopedic surgeons, 153 OB/GYN physicians and 33 neurosurgeons — 4,500 physicians overall. Physicians are flocking to Texas — there is a huge backlog for medical licenses.

One of my partners is leaving in May for Texas. We have been unable to find a replacement. Prospective candidates won't even interview for the job after finding out there is no medical tort reform in Hawai'i. Without medical malpractice insurance, a physician cannot practice or admit patients to hospitals.

In Texas it took a serious head injury to a legislator's family member who was thrown from a vehicle and had no access to a neurosurgeon before they passed medical malpractice reform. Do we have to wait for a legislator's family to be harmed before they will act to protect the rest of us?

Dr. Linda Rasmussen is president of the Hawaii Medical Association and is an orthopedic surgeon in Kailua. She wrote this commentary for The Advertiser.