RALEIGH, N.C. -- Doctors whose negligence causes patient death or disfigurement wouldn't be protected from the same liability limits placed on other malpractice lawsuits, the state House decided Wednesday.

The House voted 91-27 to approve a package aimed at limiting what doctors who harm patients must pay. The bill now returns to the Senate, where it could get final approval or wind up in a committee to negotiate changes.

The measure passed easily after bipartisan pressure led to removing liability limits in cases that cause serious and tangible harm to a patient, such as loss of limbs or vision or death, that can't be measured by lost income or cost of future care. Pain and suffering and other kinds of non-economic harm would see jury awards capped at $500,000.

Proving medical malpractice in a hospital emergency room would be held to a higher standard than other kinds of tort lawsuits, which determine responsibility for harm and decide whether compensation is deserved.

Supporters said limits on medical malpractice lawsuits are needed to reduce spending on tests and procedures that doctors perform to decrease the chances they'll be sued. Opponents said the limits harm patient's ability to hold doctors responsible for their actions.

Malpractice lawsuits cannot be filed unless a plaintiff finds a doctor in the same field to review medical records and determine that negligence caused a person's injuries.

A study of 10 North Carolina hospitals published last fall in the New England Journal of Medicine concluded that "harm to patients resulting from medical care was common" over a six-year period ending in 2007, and amounted to several thousand cases of medical mistakes.

The number of malpractice cases filed in state courts has averaged nearly 480 a year over the past five years, with an average of 64 cases getting to trial before a jury or judge, according to the Administrative Office of the Courts.