Doctors in West Virginia are on strike, but doctors across the country are feeling the pressure of malpractice insurance premiums that they say are driving them out of business.

"The cost of liability insurance, when it's available, is prohibitive," said Dr. Peter Carmel of the American Medical Association.

Premiums can run as high as $200,000 a year for a neurosurgeon or obstetrician, and high rates have forced some doctors to hold back on doing high-risk procedures, making medical care less available, sometimes when it is most frequently needed.

As a result of the surgeons' strike in West Virginia, four hospitals have had to cut back staff hours and send patients across the state line to Ohio to receive medical care they need.

In Cleveland, Miss., there are no obstetricians left to deliver babies. A Philadelphia doctor travels 900 miles to Illinois to save on insurance costs.

And some surgeons are reportedly considering the idea of flying their patients to a Caribbean island for a liability-free surgery.

The AMA said there is currently a medical malpractice crisis in 12 states.

"The solution has to be legislative, either states or the Congress have to give doctors protection by making the liability market stable and affordable," Carmel said.

West Virginia Gov. Bob Wise promised the surgeons he will unveil malpractice legislation next week that has been months in the making, Health and Human Resources Secretary Paul Nusbaum said Thursday.

"Six days before our announcement is not the time to go and [walk out]," Nusbaum said. "I urge the physicians to give us time to fix this."

Several of the surgeons returned to work when life-threatening cases presented themselves, but one spokesman-surgeon said the walkout will continue.

States will be hard-pressed to find solutions. High insurance costs are partly the result of skyrocketing jury awards that sometimes reach millions of dollars in some case, say critics.

"The average award for pain and suffering is about $3.5 million and in some specialties like obstetrics, gynecology and so on it's even higher than that," said Stuart Butler of the Heritage Foundation.

Twenty-six states have passed some kind of cap on awards. Carmel said California caps on pain and suffering awards have stemmed the runaway insurance rates and "contributed to enormous stability in the California malpractice liability insurance market."

In the last session, the House of Representatives passed a $250,000 limit on punitive damages. President Bush has urged the Senate to do the same.

"There are a lot of good doctors who aren't going to be doctors anymore, and people suffer, and that's not right. And so it's time to act on this," Bush said at the Health Care Security Session of the President's Economic Forum in Waco, Texas, over the summer.

Some critics say trial lawyers are to blame, and claim they encourage patients to sue their doctors for outrageous sums, even when there's an honest mistake or an unavoidable injury or death.

Butler said the trial lawyers are the ones preventing any kind of reform.

"Trial lawyers are very well represented in the Congress, they're disproportionately represented and they've generally been able to block sweeping malpractice reform," he said.

But trial lawyers blame the insurance companies for the way they invest the insurance premiums they collect.

"Twenty-five percent of their investments are in stocks, so when the stock market goes down and they lose a quarter of their profits then they turn around and put it onto doctors and therefore patients," said Mary Alexander, president of the Association of Trial Lawyers of America.

The insurance industry says it only invests 13 percent of its premiums in stocks, the rest in bonds. But they admit they have been forced to raise rates because of declining interest rates on bonds.

Supporters of malpractice reform are hopeful things will change now that a practicing physician — Bill Frist — is taking over as Senate majority leader, but they are not overly optimistic.

Fox News' Steve Centanni contributed to this report.