A week after proponents of medical-lawsuit reform launched a shark-themed advertising campaign, the Association of Trial Lawyers of America has snapped back with a predatory mascot of its own: the alligator.

Starting today, ATLA will begin airing television and print ads that compare insurance companies and health maintenance organizations to the reptiles.

“Big Insurance and HMOs have a big appetite … But it’s getting even bigger,” the advertisements say. “The next time you see one of their ads attacking lawyers, ask yourself: Who is gouging consumers?”

The earlier shark ads, sponsored by America’s Health Insurance Plans, continue to run on TV and in Washington, D.C.’s Metrorail system. They call trial lawyers sharks who are hungry for money.

ATLA spokesman Carlton Carl said that his group wanted “to make sure the public and policy makers recognize that the real culprit in our health care problems are the HMOs and the insurance industry. They don’t want to talk about the real issues, so they’re running these far-fetched ads that blame lawyers for everything. When in fact, lawyers don’t commit medical malpractice. Our ads tell the truth.”

Carl added that the insurance companies are “gouging doctors and patients.”

Many insiders on both sides of the issue have said that legislation over medical liability reform — which would include caps on non-economic damages for plaintiffs — doesn’t have a shot at passage.

But the issue remains a top priority for doctors, insurance and pro-business groups, and they aren’t giving up yet.

ATLA’s Carl said that medical liability reforms won’t come to fruition this year because Republicans in the Senate do not have enough votes.

ATLA still plans to spend $100,000 on this portion of the advertising campaign, which includes ads in Roll Call and on the Sunday political talk shows. ATLA also plans to launch “comparable advertising in targeted states,” Carl said.

Carl said the gator campaign isn’t a direct response to the shark ads, and added that ATLA had considered the alligator attack for a while.

He added, though, that “it certainly answers the charge that the insurance industry has targeted lawyers as a surrogate for their real target, which is the American people who are hurt as a result of medical malpractice.”

Kate Sullivan Hare, executive director of health care policy at the U.S. Chamber of Commerce, said ATLA has to be more concerned about the prospect of medical malpractice reforms than the group lets on. “You only spend money when you have a reason to do it,” she said.

A spokesman for AHIP said its shark ads deal with specific issues, including the idea that the medical liability system costs each U.S. household up to $1,200 a year.

“We really believe that the crisis in the medical liability system speaks for itself,” said AHIP’s Mohit Ghose. “We tried to put the numbers in perspective by pointing out that a system that costs up to four times more than what the federal government spends on homeland security … with no clear benefit to the American public needs to be reformed.”

Ghose added that his group — whose allies on this issue include the American Medical Association, which represents doctors — continues “to have hope that we will advance this issue this year.”

And AHIP and the AMA aren’t the only groups that are stepping up their lobbying efforts for medical liability reform.

The Coalition for Accessible Physicians’ Ruth Schulze, an obstetrician-gynecologist in private practice in New Jersey, is helping organize more than 4,000 doctors and other health care workers for an April 20 rally on the Capitol’s West Lawn.

“We expect to be coming down via bus caravan with 80 busloads and then some local people from the [D.C.] area,” said Schulze.

Carl, whose group is allied with consumer groups, said doctors have been duped by insurers.

“They’ve been deceived by the insurance industry that somehow their insurance rates will go down” if caps are imposed on non-economic damages, he said.

Carl added that caps would further harm patients already hurt by doctors.

“This big-government, one-size-fits-all cap in every case, regardless of how serious the injury or how egregious the malpractice, will hurt the most seriously injured the most,” Carl said.

Schulze said her group is intent on coming to Washington because doctors, especially those in high-risk specialties, are “in desperate trouble” and need a legislative fix.

“It’s a system problem, not a physician problem,” she said.

Schulze said doctors spend an estimated $100,000 to litigate a malpractice case, and 75 percent to 80 percent of medical malpractice cases that do make it to a courtroom are ruled in favor of the doctor.

“Ultimately maybe the system prevails, but it costs you a lot of money to go there,” she said. “For our legal friends to take us to court only to be wrong 80 percent of the time, there’s something wrong here. They’re wasting the time of the court, and the money of having to defend all of this and escalating the concept that you need to practice ‘defensive medicine.’”