Saying the federal government must take a stand against "junk lawsuits," Mr. Cheney told the crowd of about 300 gathered at the Dana Conference Center on the campus of the Medical College of Ohio that it is time for a "reasonable federal cap" of $250,000 on noneconomic damages in medical liability court cases.

"This problem doesn't start in the waiting room. It doesn't start in the operating room. This problem starts in the courtroom," he said.

"Many lawsuits filed against doctors have no merit. Even though they are baseless, these junk lawsuits are expensive to fight, and many doctors, encouraged by their insurance companies, settle out of court," Mr. Cheney said.

"The picture has become clear across the country: Huge payoffs for personal injury trial lawyers, smaller shares of compensation for those who have been wronged, and massive increases in medical liability insurance premiums for doctors across the country," the vice president said.

"Our medical liability litigation system is broken," Mr. Cheney said.

"This problem has been building for years, but now is at a crisis level."

Mr. Cheney also called for Congress to change the way liability in medical malpractice lawsuits is spread between several doctors who collaborate on medical cases that end up in court.

During his appearance in Toledo - an important city in what both major presidential campaigns have said is the most important state in the election this fall - Mr. Cheney included a veiled jab at Democratic vice presidential candidate John Edwards, a U.S. senator from North Carolina who made a fortune as a lawyer trying medical liability cases.

While the Bush/Cheney team has offered a package of reforms of the nation's medical system that leaves the private health-care system mostly intact, Democratic presidential candidate John Kerry has proposed a more aggressive role for the federal government in health care.

Mr. Cheney's visit to Toledo was the first since the closing weeks of the 2000 presidential campaign, during which he talked with locals who gathered at the Maumee Senior Center on Detroit Avenue.

He has been more active on the campaign trail lately, campaigning across northeast Ohio during the July 4 holiday weekend, just before Mr. Kerry announced the addition of Mr. Edwards to the ticket.

Yesterday, Mr. Cheney campaigned in Missouri - another toss-up state that Mr. Bush narrowly won four years ago - before traveling to Toledo for the late afternoon event at MCO. While the format in Columbia, Mo., differed from the Toledo stop in that Mr. Cheney took questions from supporters, the topic was the same in both places.

It was largely preaching to the choir.

But Dr. Kris Brickman, director of the emergency department at MCO, said if anything, Mr. Cheney's remarks about a medical liability "crisis" weren't dire enough.

"It's out of control," he said of rising premiums. "Two years ago in my practice, it cost us $2 per patient to cover our medical malpractice premiums. Today, it's $12.42. We've gone from $7,000 to $9,000 per doctor to $60,000 to $80,000. It's changed the way we practice medicine. We now order every test in the world to avoid getting sued."

Referred to as "defensive medicine," the practice is not only inefficient medicine, but drives up overall health-care costs too, he said.

Dr. Brickman's concerns were repeated in large part by physician after physician who spoke after hearing Mr. Cheney's remarks.

"We're getting pulled both ways. Our liability is going up and reimbursements are going down," said Dr. Steven Combs, a Cleveland-area physician and president of the Ohio State Medical Association.

Dr. Patrick McCormick, a Toledo neurosurgeon, said his annual premiums have gone from $40,000 a year in 2000 to $120,000 today, making premiums his second-largest item of business expense after staff costs. At some point, he said, it makes sense to stop practicing medicine and pursue other options.

In fact, he's already completed a master's of business administration degree and said a career in a nonmedical business is looking more appealing.

Dr. William Sternfeld, a Toledo general surgeon and past president of the association, said doctors need to do a better job educating the public about the problem.

"I don't think the public is fully aware of the crisis we're in," he said, noting that Ohio is one of the 20 "crisis" states labeled by the American Medical Association as having high malpractice premiums.

Democrats and many trial lawyers say there is no solid proof that rising malpractice premiums are caused by frivolous lawsuits, as Mr. Cheney alleges.

They also say there is no reliable evidence overall that doctors in Ohio, for example, are leaving the state or retiring early, as Dr. Sternfeld and his colleagues allege.

A review by The Blade in April found the number of Ohio physicians with active medical licenses increased 5 percent from 1998 through last year, from 36,464 to 38,332.

Physicians say that does not prove doctors are not affected because most physicians keep their licenses after they retire, and it doesn't show how many doctors have stopped doing high-risk procedures.