HARRISBURG -- Like a horror movie villain, the undying debate over whether to cap "pain and suffering" damages awarded in medical malpractice lawsuits is set to come alive again today, when the state Senate discusses a tort reform measure that would give lawmakers the authority to limit jury awards in all civil litigation cases.

Proponents of a $250,000 cap, mainly Republicans and doctors groups, say the limits are necessary to weed out frivolous lawsuits, thereby driving down the costs of medical malpractice insurance and making it cheaper for surgeons and specialists to practice in the state.

Opponents, including trial lawyers, consumer advocates and Gov. Ed Rendell, say a limit on pain-and-suffering awards infringes on victims' rights, and suggest that there's no evidence tying award caps to lower insurance rates in the states that already have approved such limits.

By most impartial calculations, the math isn't so simple, and the high rates result from a combination of factors: a limited number of insurers, thinning profits for insurance firms, bad doctors, exploitative lawyers, overly litigious patients and, to an unspecified degree, large jury awards.

Senate leaders are predicting an evening vote on the issue, following emotional protests throughout the day. The amended bill will carry language identical to that in House Bill 1326, which was endorsed by the House in June but has been languishing in the Senate Judiciary Committee since then.

Unable to force the bill out of the judiciary committee's hands, the Senate will instead attach the proposed amendment to a shell bill, then send it back to the House, if it's approved.

State law currently prevents the Legislature from placing limits on "noneconomic" damages awarded in lawsuits, but the constitutional amendment under consideration says lawmakers "may by statute limit the recovery of noneconomic damages for injuries resulting in death or for injuries to persons or property."

The proposed amendment makes no specific reference to medical malpractice, meaning it could theoretically apply to all civil cases, and all future high-profile defendants -- gun makers, the fast-food industry and so on. A few moderate Republicans and most Democrats are cringing at the all-encompassing language, fearing it could lead to universal tort reform years down the road.

But Sens. Jake Corman, R-Centre, and Jeff Piccola, R-Dauphin, said yesterday that they would oppose any language restricting the amendment to only medical malpractice cases, saying the open-ended language would give lawmakers the ability to head off future insurance crises in other industries.

The pair also urged senators who for the moment are sitting squarely on the fence to look beyond today's passionate testimony, which no doubt will include wrenching accounts of botched surgeries and devastating misdiagnoses, as well as protests from groups against the idea of tort reform generally.

"Take the emotion out of this," Corman said.

The proposed amendment, if it's approved by the Senate, then again the House, is just the first step of what would be a years-long legislative process. The amendment language would have to be approved a second time, in the next legislative session, and followed by a voter referendum in May 2005, at the earliest.

The governor has no say in whether a voter referendum to amend the constitution is placed on the ballot, but he would have a say in any legislation arising out of the constitutional change.

If voters approve a referendum, it's back to work for the lawmakers, who would then have to craft a law creating a specific limit -- for a year, they've been citing $250,000 as a target figure -- and specific applications of that limit. Initial law likely would tackle only medical malpractice caps.

Then there's the issue of which type of cap fits best for Pennsylvania: a hard cap, an adjustable cap that moves from year to year based on inflation and other factors, or split-level caps that would allow different limits depending on who's being sued, individual doctors or entire hospital system. Other states allow for higher jury awards if a doctor's mistake leads to a patient's death, or affects a woman's ability to bear a child.

No matter what pain-and-suffering cap might be enacted, it wouldn't affect the money that can be collected for lost wages, short-term medical bills and long-range care costs.

The tort reform drama has been unfolding primarily in Philadelphia, where medical malpractice rates are higher and where lawsuits have been more prevalent than in Pittsburgh.

But the issue resonates in the Pittsburgh area, especially in the more rural surrounding counties, where some hospitals have been forced to cut back on high-risk services and where specialists, like obstetricians and radiologists, have been leaving for states where the malpractice insurance rates are lower.