HONOLULU - A cap on how much patients can sue doctors for was resurrected during a stormy committee hearing Wednesday, but it still has a long way to go.

The House Health Committee voted 7-3 to amend a Senate bill about mental health to include the language of a House bill that died when it failed to meet a crucial deadline last week. But two of the yes votes came with reservations, meaning the committee is almost evenly split on the issue.

"I think we have a good opportunity to work together to create a piece of legislation that will help us through the health care crisis," said Chairman Josh Green, D-North Kona, Keauhou, Kailua-Kona.

The new SB 2160, applying only to counties of 500,000 or less, limits noneconomic damages -- such as emotional distress and loss of companionship -- to $250,000 for most specialties and $500,000 for high-risk specialties, unless a judge determines the case is "catastrophic," raising the limit to $3 million.

Proponents say medical malpractice insurance reform is needed to keep doctors from leaving the state, especially on the neighbor islands and other rural areas. But opponents note that Hawaii has more doctors now than ever before and say there's no proof that limiting damages leads to more doctors in rural areas.

"I think they're barking up the wrong tree," said Rep. Karl Rhoads, D-Kakaako, Iwilei, who voted against the bill.

The Hawaii Medical Association left the hearing optimistic that the bill would proceed through the House Judiciary Committee this time.

"We certainly are grateful to Rep. Green for resurrecting the medical liability reform issue," said HMA President Cynthia Goto. "We feel that this is an important issue that needs to be addressed by the Legislature."

But a move by House leadership later in the day, adding another committee that must hear the measure, could send it back to the grave as the 60-day session heads past its midpoint. A so-called triple referral is seen as the kiss of death for a bill this late in the session.

And it remains unlikely that Judiciary Chairman Tommy Waters, who facetiously asked for a moment of silence on the floor for the death of tort reform last week, will add the controversial measure to his agenda. Waters, D-Lanikai, Waimanalo, did not return phone calls Wednesday.

State Insurance Commissioner J.P. Schmidt predicted doctors' medical malpractice insurance premiums would decrease by 12 percent to 18 percent based on a recent actuarial report.

"The facts are clear," Schmidt said. "Some of the legislators who oppose it say they're tired of hearing about it, but they're going to hear about it until there's a solution."

House Majority Leader Kirk Caldwell, D-Manoa, said the Legislature last year passed other measures to help keep doctors in rural areas, but Republican Gov. Linda Lingle hasn't released the money. He said other measures moving this year -- including some that are part of the majority package -- will give doctors incentives to practice in rural areas through enterprise zones, tax credits and loan programs.

Caldwell said he felt "a certain amount of discomfort" about the tenor of the committee hearing. But he said it's understandable that passions sometimes rise on contentious issues and there was no disrespect.

"If the temperature goes up a bit, I don't think that's a bad thing," Caldwell said. "I don't think they crossed that line."