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It's been a little more than a year since the state cap on malpractice pay-outs took effect, but both supporters and opponents say it will be years before its impact is felt -- if ever.

Taylor Lincoln of the national consumer group Public Citizen said that historically premiums have gone up independent of malpractice pay-outs.

"One of the things we noticed in their advocacy for these laws," he said, "was that insurance companies when asked wouldn't pledge to lower their rates."

A Public Citizen analysis found that the number of malpractice pay-outs dropped 9 percent between 1991 and 2004 -- 16 percent between 2001 and 2004 alone -- and that the number of multi-million dollar pay-outs, which represent just 1 percent of all awards, declined 56 percent during that time, a time when premiums increased most.

Noting that double-digit premium increases have been seen in other areas as well, the group says what's needed is reform of insurance industry business practices.

Patient safety advocate Helen Haskell of Columbia, who settled a malpractice suit for $950,000 after her 15-year-old son died as a result of surgery in 2000, suspects there's been little impact from the cap so far.

But she points to government reports of the thousands of Americans who die from medical errors every year, along with untold numbers of medical injuries, whose families are often left with staggering hospital and doctor bills and disability in addition to their grief. And she says that "penalizing" injured patients through caps is not the way to go.

"I find it interesting that they're talking about all these frivolous lawsuits and yet admitting all these medical errors," she says.