Maine shields physicians from malpractice charges.

Physicians and state legislators worked side by side in Maine last session to pass the first measure in the nation that helps shield doctors from malpractice lawsuits if they follow a set of state-approved guidelines.

Far from grumbling about state control, 93 percent of the state's emergency physicians, 96 percent of the obstetricians, 90 percent of the anesthesiologists and more than 97 percent of eligible radiologists are now enrolled in the program.

The success of the "medical liability demonstration project" will be determined when malpractice lawsuits are filed. To date, no participating doctors have been sued.

Administered by the state board of registration and medicine and the board of osteopathic examination and registration, the Maine project sets explicit treatment guidelines for specific conditions, such as Caesarean delivery of babies or procedures for anesthesia.

Physicians agree to follow risk management procedures developed by state-appointed committees of doctors and insurance, hospital and consumer representatives. By enrolling in the project and practicing the state-approved protocols, doctors are protected in any malpractice or pretrial proceedings.

The medical project sets aside a portion of the savings from malpractice insurers to help rural doctors pay their malpractice premiums.

Although malpractice premiums run as high as $100,000 a year for some specialists, the larger culprit in rising costs is the exorbitant price of "defensive medicine" practiced by doctors in order to avoid lawsuits--estimated to be $27 billion annually nationwide.

Because Maine's protocols provide a shield for participating physicians, doctors can cut down on the extra tests and other superfluous procedures taken to avoid lawsuits.

As Maine makes strides in its efforts to cap health care costs, other states have devised programs to attain the same goal. Many states have passed laws to cap damage awards, limit attorneys' fees and shorten the time during which a plaintiff can file a medical lawsuit.

Arizona, Hawaii, Louisiana, Nevada, North Carolina, Texas and Washington offer state subsidies for obstetric liability premiums.

Virginia and Florida have medical malpractice "no-fault" programs that create compensation funds for participating obstetricians sued for severe brain and spinal cord injuries.

Florida has developed a law that directs the state health agency to develop and adopt practice parameters in cooperation with medical, chiropractic and other health organizations. The project, similar to Maine's, would allow participating doctors to use the parameters as a defense in liability actions.

In Minnesota, the state health commissioner has been charged with developing and approving outcome-based practice parameters for all medical procedures. Legislators in Vermont will vote in 1994 on practice guidelines that are part of two proposals to provide for universal access.