The $68 million represents the accumulated excess of premiums collected minus payouts for claims for settlements and jury verdicts and an undisclosed amount retained by Med Mutual for future losses over the last three years.

As expected, many lawmakers recently said the dividend shows no reform in Maryland’s tort system was needed in 2004 — and now. At the time, they said the legislation was just a means to ride out another “insurance cycle.”

The Maryland State Medical Society (MedChi), the Maryland Chapter of the American College of Surgeons and many other medical and hospital organizations reluctantly endorsed HB 2.

Their position was, and remains, that a subsidy for malpractice premiums should be only a temporary measure. It would buy time that must be used to rectify the problems that plague our system of adjudicating medical errors.

But nothing has changed. The system still does not work to discover and compensate patients harmed by truly preventable medical errors.

And it does not return to the injured patients and their families the proportion of the award that they deserve. The capricious and unpredictable nature of the system, which resulted in this dividend, is further evidence of its continued dysfunction.

A recently released study — “Jackpot Justice: The True Cost of America’s Tort System” — by the nonprofit Pacific Research Institute has calculated that the practice of “defensive medicine” by physicians in America increases health care costs by more than $124 billion per year.

To the taxpayers of Maryland this means hundreds of millions of dollars wasted on unnecessary tests, more consultations, unjust litigation and higher health care insurance premiums.

Our liability climate, combined with the non-competitive, reimbursement structure in Maryland, makes it virtually impossible to attract new practitioners into our communities. More established, experienced physicians have stopped accepting new patients and many have limited, or quietly left, practice.

To determine precisely the number of physicians remaining to care for patients in Maryland, the governor’s office and the Maryland Hospital Association in conjunction with MedChi are currently conducting studies of these issues.

When released later this fall, they will provide the data to document these critical problems increasingly threatening access to affordable health care in Maryland.

The myriad tort reform measures available to legislators are well-known. The most long-term, far-reaching reform would be the institution of the “health care court” concept, where the adjudication of deviation of the standard of care would be decided by a special administrative panel, probably composed of specially trained judges with neutral experts hired by the court.

Though the $68 million held in limbo by Insurance Commissioner Tyler is certainly just a drop in the budget deficit bucket, lawmakers likely will not want to give it up.

However, if they do not work this session to address the real problems of health care delivery in Maryland, patients and all citizens of Maryland will lose quality doctors, access to care and see health insurance premiums continue to spike.

Dr. Scott E. Maizel is president of the Maryland State Surgical Association.