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Medical Malpractice Litigation Ilona Kickbusch such as the ability toOver the past 50 years, the United States experienced three major medical malpractice (med mal) crises, each marked by dramatic increases in the cost of malpractice liability insurance. These crises fostered a vigorous politicized debate about the causes of the premium spikes, and the impact on access to care and defensive medicine. State legislatures responded to the premium spikes by enacting damages caps on non economic, punitive, or total damages