California voters nixed efforts Tuesday by a consumer group and trial attorneys to lift the cap on pain-and-suffering damages in medical malpractice lawsuits — but proponents say they will keep on fighting.

Proposition 46 was defeated by a margin of 67.1 percent to 32.9 percent. The actual vote count was 3,415,996 "No" votes to 1,671,163 "Yes" votes, according to figures from the California Secretary of State.

The defeat follows a confusing campaign that touted other provisions of the measure, including drug testing for doctors and a requirement that doctors consult a state database before prescribing powerful pain medications. The central thrust of Proposition 46 was to link the damages cap in the Medical Injury and Compensation Reform Act — better known as MICRA — to inflation. This year, that means $1.1 million.

"California voters spoke loudly and definitively: In this health-care environment, undermining California's long-standing malpractice cap is a political poison pill and a policy 'third rail,'" Dustin Corcoran, CEO of the California Medical Association and chair of the opposition campaign, said in a news release.

Voters rejected the measure because higher payouts in medical lawsuits would have increased health-care costs and reduced access to needed medical care, Corcoran said. And voters "declared a political 'no-fly' zone around making it easier and more profitable for trial lawyers to file more lawsuits."

The cap has been in place since 1975, the product of concern about rising medical malpractice rates. Attempts to increase the amount have been rejected 10 times in court, five times in the state Legislature and, now, by voters.

Jamie Court, president of Consumer Watchdog, the group that put Proposition 46 on the ballot blamed "big corporate money" and low voter turnout for the loss and said threats to patient safety addressed by the measure will not go away.

One reason for the initiative is the damages cap is so low that the payoff on labor-intensive medical malpractice lawsuits is not enough to convince trial attorneys to take these cases.

"The families of innocent victims of negligence deserve access to justice," Court said. "The fight for patient and consumer protections is just beginning. We will continue that battle."

Kathy Robertson covers health care, law and lobbying, labor, workplace issues and immigration for the Sacramento Business Journal.