BERLIN, GERMANY - SEPTEMBER 05: A doctor holds a stethoscope on September 5, 2012 in Berlin, Germany. Doctors in the country are demanding higher payments from health insurance companies (Krankenkassen). Over 20 doctors' associations are expected to hold a vote this week over possible strikes and temporary closings of their practices if assurances that a requested additional annual increase of 3.5 billion euros (4,390,475,550 USD) in payments are not provided. The Kassenaerztlichen Bundesvereinigung (KBV), the National Association of Statutory Health Insurance Physicians, unexpectedly broke off talks with the health insurance companies on Monday. (Photo by Adam Berry/Getty Images)

SAN FRANCISCO (CBS/AP) — Voters on Tuesday soundly defeated a proposal to lift a decades-old cap on courtroom damages for medical negligence, after a multimillion-dollar political duel pitting trial lawyers against doctors and insurers.

The defeat of Proposition 46 came after a cascade of negative advertising financed by insurance and physician groups. They warned the change would send medical costs soaring and drive doctors from the state.

“In this health care environment, undermining California’s long-standing malpractice cap is a political poison pill,” Dustin Corcoran, chief executive of the California Medical Association and chairman of the No on 46 campaign, said in a statement. “Increasing payouts in medical lawsuits would have increased health care costs.”

The fight over the proposal created the most expensive campaign in the state this year. The initiative attracted national attention, in part because it called for making California the first state to impose random drug and alcohol tests on doctors.

But the reason the contest lured more than $60 million in donations was its proposal to lift the cap on damages for pain and suffering caused by doctor negligence to $1.1 million, up from $250,000.

Consumer advocates and lawyers who backed the proposal said it was about safety and point to cases in which drug- or alcohol-addicted doctors have harmed patients. In one ad, Democratic Sen. Barbara Boxer says, “Make sure impaired doctors don’t treat someone you love.”

A third provision called for requiring doctors to check a statewide database before prescribing painkillers and other powerful drugs in an attempt to curb pill-shopping and other abuses.

Bob Pack, whose 10-year-old son and 7-year-old daughter were run over and killed by a drug-abusing nanny in 2003, was pushing the proposal in hopes of stopping doctors who recklessly prescribe painkillers.

“We’ve opened the eyes of all Californians about patient safety,” he said in a statement.

In this election, he added, “insurance industry profits trumped patient safety.”

Insurance companies, hospitals and physician groups depicted the proposal as a sugar-coated pill that’s really about fattening attorneys’ wallets.

California’s 1975 medical malpractice law was the first in the nation to impose caps and paved the way for roughly 30 states to adopt some limits on payouts. It also was used as a template for national proposals.

It made California rates among the lowest in the nation. According to the California Medical Association, the average doctor in the state paid $26,511 last year in premiums compared with $99,290 in Connecticut and $137,412 in New York, two states without caps.

The nonpartisan Legislative Analyst’s Office concluded that raising the cap on medical malpractice damages will increase government health care costs “from the tens of millions of dollars to several hundred million dollars annually.” The higher costs could be offset to some extent by uncertain, but potentially significant, savings from prescription drug monitoring and doctor testing, the analyst found.

Research has indicated the rates of drug and alcohol abuse for health care professionals are similar to those in the general public, if not higher because of access to prescription narcotics.

According to the proposal, doctors with hospital privileges would be tested randomly or when a physician is suspected of abusing alcohol or drugs or when a mistake occurs in treatment, such as surgery.

COMPLETE CAMPAIGN 2014 RESULTS

TM and © Copyright 2014 CBS Radio Inc. and its relevant subsidiaries. CBS RADIO and EYE Logo TM and Copyright 2014 CBS Broadcasting Inc. Used under license. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. The Associated Press contributed to this report