Illinois courts have put a hot political issue back in play with a decision striking down limits on pain-and-suffering awards.

It's back to square one on the medical malpractice issue following a decision last week by the Illinois Supreme Court striking down a 2005 law that limited the size of jury awards for pain-and-suffering claims.

The high court – voting 4-2 with Justice Robert Thomas not participating – found that the law limiting pain-and-suffering damages to $500,000 for doctors and $1 million for hospitals violates the inherent authority of the judiciary to handle damage issues on a case-by-case basis.

Plaintiffs' lawyers, naturally, were jubilant with the victory while doctors and insurance companies were distraught.

Now the issue will inevitably go back to the Illinois General Assembly for further skirmishing on an issue that has dogged legislators for nearly 40 years. The Legislature has passed bills putting limits on damage claims three times over past decades, and the Illinois Supreme Court has struck them down three times on the grounds that, basically, the size of damage awards is really none of the Legislature's business.

As is the case with virtually every public issue in Illinois, the dispute over medical malpractice damages has as much to do with politics as it does law.

Trial lawyers, who are major contributors to the majority Democrats, thought they had made the issue politically off limits.

But a voter revolt in the Metro East area over concerns from doctors about skyrocketing insurance rates and from patients about doctors leaving the state for safer legal climes so terrified Democrats that they worked with Republicans to pass the 2005 law solely addressing medical malpractice issues.

Many Democrats who supported the legislation, no doubt, were hoping that the high court would bail them out of an action they felt forced to take, and the justices complied with a lengthy decision striking down the law on Thursday.

Beyond the usual legalese, the decision contained a sharp exchange between the majority – Justices Thomas Fitzgerald, Anne Burke, Charles Freeman and Thomas Kilbride, each elected as Democrats – and dissenting Justices Lloyd Karmeier and Rita Garman, elected as Republicans. Karmeier contended in his dissent that "it is critical. ... that the courts not stand as an obstacle to the legitimate efforts by the Legislature" to address issues surrounding the debate about skyrocketing medical costs. Karmeier asserted that when courts "exceed their constitutional role" they "put at risk the welfare of the people the government was created to serve."

An angry Fitzgerald responded that the court should focus only on legal issues and that the "emotional and political rhetoric that peppers the dissent is ill-suited to this purpose."

The specific case giving rise to the high court decision involves a horribly disabled 4-year-old girl born with cerebral palsy, leading to a lawsuit against the doctor, nurse and hospital involved in the delivery.

Cases like this lead to huge awards for actual damages, not capped under the 2005 law, and often even-larger awards for pain and suffering.

But it's not just extreme cases involving disabled children that drive up costs. Fearful of being sued if something goes wrong, doctors routinely engage in defensive medicine, the ordering of unnecessary tests that can fend off litigation but drive patient medical costs sky high. The circumstances create a double whammy – insurance companies raise patient premiums to cover the costs of skyrocketing medical bills caused by doctors' fear of lawsuits and insurance companies boost medical malpractice premiums to cover the cost of huge jury awards for malpractice.

Further, there is the cost of defending lawsuits. Even when doctors and hospitals successfully defend themselves, they are stuck with large legal costs. To forestall paying excessive legal fees, doctors and hospitals sometimes settle a claim for less than they would pay their lawyers, but that simply creates more incentives to file lawsuits.

It's a complicated issue on which the opposing sides vehemently disagree. Lawyers complain that insurance companies grossly overcharge patients and doctors for insurance coverage and that the costs of malpractice litigation have little to do with premiums. Doctors claim that the high costs have caused many of them, particularly specialists, to practice elsewhere, leaving areas of the state without access to physicians. So alienated are the opposing sides that they rarely agree on anything and routinely demonize each other as motivated solely by greed.

It's the kind of dispute that calls for a negotiated settlement providing each side a system it can live with. But that's not what the courts do. They declare winners and losers. Last week, the lawyers won big and the doctors lost. As for the public, it's difficult say. But until the matter is resolved, if that's even possible, the public will pick up the costs for both sides.