In 1975 California became the first state to enact caps on noneconomic damages in medical malpractice cases. Although the idea was progressive and became a template for other states, the law has faced increasing scrutiny over the last few years.

California’s cap was set at $250,000, which in 1975 was worth a lot more than it is today — the amount is equivalent to about $58,000 in 2013 dollars. A new ballot initiative, slated for 2014, aims to raise the cap to $1.1 million to account for inflation, and is already causing a commotion. The California Medical Association alone has spent $5 million to defeat the measure so far, and more than $31 million has been raised in total to oppose the measure.

Increasing the malpractice cap is only one part of the ballot initiative. The measure also aims at reducing harm caused by clinicians under the influence of drugs or alcohol, and requires random drug and alcohol testing for clinicians, as well as mandatory testing after an unexpected death or injury to a patient.

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The ballot measure, called the Troy and Alana Pack Patient Safety Act of 2014, was authored by Bob Pack. Pack’s 7-year-old daughter, Alana, and 10-year-old son, Troy, were killed in an accident, in which a drugged driver fell asleep at the wheel and ran the children over. The driver turned out to be a doctor-shopping prescription drug addict, whose medications were not being monitored by his various physicians.

One of the measures in the ballot initiative calls for mandatory use of the electronic CURES database, which tracks prescriptions dispensed in the state to help identify drug-seekers.

The initiative needs about 750,000 valid signatures to make it onto next year’s ballot.