OLYMPIA — And you probably thought it was going to be a quiet little off-year election.

Trial lawyers, doctors and other combatants in the long-running fight over medical malpractice are gearing up to wage what will be the most expensive — and possibly the most acrimonious — ballot-initiative campaign that Washington voters have ever seen.

All told, the two sides so far have raised nearly $10 million for the lead-up to Nov. 8. Soon they will start bombarding the airwaves with campaign commercials smearing each other and painting differing versions of the truth about medical malpractice.

One indication of the nastiness to come: The doctors recently filed a complaint with the state Public Disclosure Commission accusing the trial lawyers of violating state campaign-finance laws. The agency has launched an investigation.

State Insurance Commissioner Mike Kreidler said he thinks voters will quickly tire of all the finger-pointing, and he worries the initiative battle will do little to resolve the medical-malpractice dispute.

"It's fair to say the arguments that will be presented on either side will not necessarily focus on the real problems," Kreidler said. "There's going to be a lot of confusion when this is done."

The medical-malpractice fight has flared repeatedly over the past several decades. This time around the two sides appear more entrenched than ever.

That's largely why there are two medical-malpractice initiatives on this year's ballot. Unable to find middle ground in the Legislature, the two sides — each backed by big money — decided to go straight to the voters.

Initiative 330 is the medical community's prescription for what it contends is an epidemic of "jackpot" jury verdicts and skyrocketing malpractice-insurance costs.

Among other things, the measure would place a $350,000 cap on what juries could award in noneconomic damages — also known as pain and suffering — to victims of medical negligence. It also would limit attorney fees.

Initiative 336, funded almost exclusively by trial lawyers, would do nothing to limit what injured patients could seek in court and instead would target negligent doctors.

The measure would require the state to track health-care providers' malpractice history and make that information available to the public. Doctors who have three or more malpractice judgments against them in a 10-year period could have their licenses revoked.

The dueling ballot measures have spawned four political-action committees, two backed by the trial lawyers and two backed by doctors, hospitals and others in the medical business.

So far, the doctors and their allies are leading the race for campaign cash by a ratio of nearly 2-1. But neither side is hurting.

The money raised so far around I-330 alone will easily shatter the state record for total spending on a ballot initiative. The previous record was the nearly $7 million spent in 1997 on Paul Allen's successful referendum for a taxpayer-financed stadium for the Seattle Seahawks.

One pro-I-330 political-action committee — Doctors, Nurses and Patients for a Healthy Washington — has raised more than $4 million, according to the latest PDC filings. On top of that, the group spent about $1.1 million on signature gathering and other grass-roots efforts to qualify I-330 for the ballot.

Well over half of the money has come from physicians, clinics and groups that represent them, including the Washington State Medical Association and the American Medical Association.

But the group also has received more than $800,000 from insurance companies and health plans. The prescription-drug industry has pitched in $500,000.

A separate pro-I-330 committee — Hospitals for Health Care Access — has raised $1.8 million, nearly all of it from hospitals and medical centers across the state. Swedish Medical Center in Seattle gave the most so far, $270,000.

On the other side, the No on I-330 committee has raised nearly $2 million. About $600,000 of that came from the Washington State Trial Lawyers Association. The committee also has received more than $1.3 million directly from lawyers and law firms.

More than 40 attorneys have donated at least $10,000 to the cause. Trial lawyers association President Jack Connelly, a Tacoma attorney who has won several multimillion-dollar liability cases against the state, pitched in $51,000.

The No on I-330 campaign got a boost earlier this month from one of the nation's most famous trial lawyers, 2004 vice-presidential candidate John Edwards, who made millions as a malpractice litigator. He appeared at a fund-raiser in Seattle that brought in more than $25,000.

The committee behind I-336 — Citizens for Better, Safer Healthcare — has raised about $1.5 million since launching its initiative drive last year. Almost all of that money has come from the trial lawyers association and individual attorneys.

People on both sides of the fight are using the fund-raising figures to malign each other.

"Personal-injury lawyers are desperate to defeat I-330 because of what it does to their incomes," said Tom Curry, executive director of the Washington State Medical Association.

Opponents, meanwhile, paint I-330 as an attempt by groups such as the insurance and prescription-drug industries to stomp on the rights of injured patients.

Barb Flye, chairwoman of the No on I-330 campaign, pointed out her group is supported by a broad coalition of injured-patient organizations and consumer groups. But she said those types of groups don't have much money, so trial lawyers are stepping in.

"When you think of victims' rights, that's who is your champion," Flye said.

Other states have been through similar battles in recent years.

Last year in Florida, doctors and lawyers spent $37 million on three competing medical-malpractice ballot measures. Though all of the measures passed, the medical-malpractice fight still rages in the Sunshine State.

"It didn't resolve anything," said Florida state Rep. Dan Gelber, a former federal prosecutor. "It really was just a big food fight between powerful special interests."

But Gelber, a Democrat, said the fight left the two sides so battered they might now be more willing to work with the Legislature on a compromise.

"You sort of get the sense down here that the two sides feel a little bit like drunken sailors who went a little too hard on the town last night," Gelber said. "They might think that the legislative process is a better way to go."

Ralph Thomas: 360-943-9882 or rthomas@seattletimes.com