Fred Pakron, who has been a pulmonologist in Gulfport and Biloxi for almost 20 years, said the Tobacco Trust Fund money would allow the Medical Assurance Co. of Mississippi to cover more doctors. MACM, an insurance cooperative owned by Mississippi physicians, was established by the state medical association in 1976.

The trust fund was established with the settlement money paid by tobacco companies to end the state's lawsuit to recoup health costs related to smoking.

The tobacco companies pay Mississippi about $200 million a year. Some legislators have resisted tapping into the trust fund to support Medicaid and other programs, instead wanting the fund to build up to more than $1 billion, so that the state can use the interest and dividends to support health-care programs in perpetuity.

Pakron said he may have to close his medical practice on Aug. 2, when his malpractice insurance expires. MACM said it wouldn't cover him, so Pakron is approaching smaller insurance companies.

"Unless something happens, I'm going to have to close down," he said.

Insurance Commissioner George Dale, who spoke at a Gulfport Business Club meeting Tuesday, said while he's not a fan of a state-run insurance pool, it may be the only solution to the medical insurance crisis.

"If the private sector is not meeting the needs of the public, then the state may have to step in," Dale said. "That's what we may be facing here. "

Dale said he's heard Gov. Ronnie Musgrove is considering a state-supported insurance pool, and may call a special session to deal with the availability of insurance for health-care providers.

The plan would be similar to a program instituted by the state of West Virginia, Dale said.

During his 26 years as insurance commissioner, Dale said the state has been through three medical malpractice insurance crises.

"This is a cyclical business that goes through soft and hard markets," he said. "We're now in one of those tough, hard markets. "

There are four factors that cause insurance rates to go up: policy-writing, the investment market, the price insurance companies pay to larger insurers to cover major losses, and the legal climate. Doctors and businesses claim the large jury verdicts and liberal civil court rules make them more appetizing targets for lawsuits.

"The legal climate is the only one of the four that the Mississippi Legislature can do anything about," Dale said.

One move that may help, Dale said, is setting a cap on the amount of noneconomic damages a plaintiff can receive. The state of California set similar caps in 1975.

"Now California has more medical malpractice insurers than any state we've found," Dale said. "Would tort reform be helpful over the long haul? I think it will. "