OLYMPIA — That old sticks-and-stones saying might have applied on the playground but not in the politics of medical malpractice, where name-calling clearly has become the weapon of choice.

In the fast-escalating fight over a pair of initiatives on the Nov. 8 ballot, doctors and their allies are running TV commercials lampooning personal-injury trial lawyers as cigar-puffing money-grubbers. "Lawyers are greedy, desperate and they're lying," one recent ad proclaims.

Lawyers, meanwhile, are painting doctors as pawns in a sinister plot by the Bush White House and "fat-cat" insurance executives to jack up profits by robbing injured patients of their right to jury trials.

"In a campaign like this, given how complicated the arguments are, you really have to resort to stereotypes to get people's attention," said Randy Pepple, a Seattle public-relations executive and Republican political consultant.

Washington is the latest front in a medical-malpractice war that has erupted in several states during the past few years. The attacks here are nearly identical to what doctors and lawyers unleashed against each other in recent initiative battles in Florida, Nevada and Oregon.

Nationwide, medical malpractice has become the focus of a broader debate over liability laws — and key fodder in the struggle between Republicans and Democrats.

At issue here are dueling ballot measures — Initiative 330 and Initiative 336 — that offer radically different solutions to rising malpractice-insurance costs.

But it's clear that both sides are focused mostly on I-330. Backed by doctors, hospitals, insurance companies and others, the measure would limit attorney fees in malpractice cases and place a $350,000 cap on noneconomic — also known as pain and suffering — jury awards.

For the I-330 fight alone, the two sides have amassed more than $10 million — a record for an initiative campaign and more than triple the combined total raised for the other four initiatives on this year's ballot.

Doctors and trial lawyers are mounting aggressive grass-roots campaigns, but both sides know this fight won't be won with mailers, yard signs and stump speeches. Both are pouring the bulk of their money into TV airtime and have hired national media consultants capable of crafting new ads in a matter of hours.

Thirty-second TV spots will likely provide the only information many people have to go on in deciding how to vote.

It's no way to resolve disputes over issues as complex as medical malpractice, said Michael McCann, a political-science professor at the University of Washington.

"We keep getting further and further away from having a meaningful conversation about how to really address this issue," said McCann, co-author of a recent book titled "Distorting the Law: Politics, Media and the Litigation Crisis."

Lawyers under attack

The key to the doctors' strategy is obvious: prey on the unpopularity of trial lawyers.

They put up a campaign Web site called "theirlipsaremoving.com" — the punch line to the joke "How can you tell when a lawyer is lying?"

Their TV ads are filled with demeaning images of lawyers: giving each other high fives while throwing darts at a picture of a doctor and stuffing fat wads of cash in their pockets (presumably their take from another medical-malpractice "jackpot").

One ad features a split-screen image — on one side a doctor gives a child a checkup; on the other a lawyer wags a big cigar. "When your health matters," the announcer asks, "do you believe your doctor or [in a sneering voice] lawyers?"

When Seattle pollster Stuart Elway asked almost that very question in a statewide survey earlier this year, 66 percent sided with doctors, compared to 6 percent for trial lawyers.

As Frank Luntz, a Washington, D.C.-based Republican pollster, once noted, "It's almost impossible to go too far when it comes to demonizing lawyers."

But I-330 opponents say the relentless attack against lawyers is proof that the doctors can't win on the merits.

"What they have to resort to in order to win is to convince everyone that it's greedy trial lawyers who are causing the problems in our state," said Barb Flye, chairwoman of the No-on-330 campaign.

But don't expect the trial lawyers to fight back by attacking doctors. "That would just be throwing money away," Elway said.

Instead, the trial lawyers are doing everything they can to convince voters that insurance companies — not doctors — are the real driving force behind I-330.

They also will rely heavily on heart-wrenching stories and images of patients injured by negligent doctors.

That's what worked last year in Oregon, where trial lawyers persuaded voters to narrowly defeat Measure 35, a doctor-backed initiative similar to I-330.

"In the end, people realized this could happen to them," said Beth Bernard, executive director of the Oregon Trial Lawyers Association. "They realized what it would be like to be up against a huge insurance company."

Jason Sykes, spokesman for the I-330 campaign, points out that insurance companies have put up only a fraction of the money for the campaign — less than 15 percent at last tally. Still, he said, the trial lawyers' tactic is no surprise.

"If you had to pick one group in our little corner that was almost as unpopular as the trial lawyers, that would be insurance companies," Sykes said.

But Sykes said his side also learned an important lesson from last year's medical-malpractice tussle in Oregon: Don't hold back on attacking lawyers.

When the Measure 35 foes started tying it to the insurance industry, political advisers urged the doctors to retaliate by smearing trial lawyers. But the doctors were not comfortable with that, said Jim Kronenberg, spokesman for the Oregon Medical Association.

"In retrospect, I think there's a very good chance that if we had made the trial lawyers the issue, we might have prevailed," Kronenberg said.

A partisan feud

Business leaders for decades have pushed for limits in what juries can award for liability claims against negligence and faulty products. Historically, however, medical malpractice was never the centerpiece of the broader "tort reform" fight, said McCann, the UW professor.

But McCann said a recent shift in emphasis to medical malpractice has given the whole tort-reform movement new legs.

McCann said the "old tort reform," which pitted trial lawyers against big corporations, didn't play well with many consumers.

That's changed, he said, largely because it's easier for people to relate to the doctors' assertion that medical-malpractice insurance costs are to blame for our soaring health-care costs.

"That is a wound everybody feels," McCann said.

On the campaign trail last year and during his State of the Union speech earlier this year, President Bush talked repeatedly about medical-malpractice concerns and the need to stamp out what he called "junk lawsuits."

But critics say the president and his Republican allies have ulterior motives. They see medical-malpractice changes as a way to boost corporate profits while at the same time cutting into the livelihood of trial lawyers, who traditionally steer the bulk of their campaign donations to Democrats.

"Initiative 330 is part of a national campaign orchestrated by Karl Rove, George Bush's political guru," Flye and Democratic state Sen. Margarita Prentice said earlier this year in a fund-raising letter for the No on I-330 campaign.

Their assertion drew a chuckle from Dr. James Blue, a neurosurgeon in Everett.

"We talk about this issue quite a bit," Blue said. "I haven't talked to any doctors who see this as part of some Republican conspiracy. Not even my more liberal Democratic colleagues."

Sykes warned that if Democrats insist on turning I-330 into a partisan issue, "it's going to turn a lot of physicians into Republicans."

There are indications aplenty, however, that this is very much a partisan feud.

As of last month, for instance, the trial lawyers had paid more than $83,000 to Murphy Putnam Shorr, a national Democratic consulting firm. And the No on I-330 campaign is backed by the state Democratic Party and numerous labor unions.

The doctors, meanwhile, had paid more than $250,000 to Dresner, Wickers and Associates, a national consulting firm that works almost exclusively for Republicans, including California Gov. Arnold Schwarzenegger.

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