HB 0055B 2003
1	A bill to be entitled
2	An act relating to medical malpractice insurance,
3	liability, and litigation reform; providing a popular
4	name; providing findings; amending s. 120.65, F.S.;
5	requiring the Division of Administrative Hearings to
6	designate administrative law judges to preside over
7	actions involving a health care practitioner; providing
8	qualifications for such administrative law judges;
9	creating s. 381.0409, F.S.; creating the Florida Center
10	for Excellence in Health Care as a not-for-profit
11	corporation; providing goals; providing definitions;
12	providing limitations on the center's liability for any
13	lawful actions taken; requiring the center to issue
14	patient safety recommendations; requiring the development
15	of a statewide electronic infrastructure to improve
16	patient care and the delivery and quality of health care
17	services; providing requirements for development of a core
18	electronic medical record; authorizing access to the
19	electronic medical records and other data maintained by
20	the center; providing for the use of computerized
21	physician medication ordering systems; providing for the
22	establishment of a simulation center for high technology
23	intervention surgery and intensive care; providing for the
24	immunity of specified information in adverse incident
25	reports from discovery or admissibility in civil or
26	administrative actions; providing limitations on liability
27	of specified health care practitioners and facilities
28	under specified conditions; providing an exception to
29	confidentiality requirements; providing for a board of
30	directors to be appointed by the Governor; providing for
31	the assessment, payment, and collection of fees on certain
32	health insurance policies; providing that health
33	maintenance organizations and prepaid clinics and patients
34	served by certain health care facilities are a funding
35	source for the center; providing penalties for late
36	payments of assessed fees; requiring the Florida Center
37	for Excellence in Health Care to develop a business and
38	financing plan; authorizing state agencies to contract
39	with the center for specified projects; authorizing the
40	use of center funds and the use of state purchasing and
41	travel contracts for the center; requiring annual reports
42	to the Legislature and the Governor; providing for the
43	transfer of assets upon the dissolution of the center;
44	amending s. 395.004, F.S., relating to licensure of
45	certain health care facilities; providing for discounted
46	medical liability insurance based on certification of
47	programs that reduce adverse incidents; requiring the
48	Office of Insurance Regulation to consider certain
49	information in reviewing discounted rates; creating s.
50	395.0056, F.S.; requiring the Agency for Health Care
51	Administration to review complaints submitted if the
52	defendant is a hospital; amending s. 395.0191, F.S.;
53	providing certain immunity from suit, including actions
54	for injunctive relief, for actions relating to staff
55	membership and clinical privileges; deleting requirement
56	that persons act in good faith to avoid liability or
57	discipline for their actions regarding the awarding of
58	staff membership or clinical privileges; amending s.
59	395.0193, F.S., relating to peer review and disciplinary
60	actions; providing for discipline of a physician for
61	mental or physical abuse of staff; limiting liability of
62	certain participants in certain disciplinary actions at a
63	licensed facility; providing that a defendant's monetary
64	liability shall not exceed $250,000 on any action brought
65	under this section; creating s. 395.0194, F.S.;
66	authorizing the governing boards of hospitals to reject or
67	modify medical staff recommendations or to take action
68	where the medical staff has failed to act under certain
69	circumstances; providing procedures for corrective or
70	disciplinary actions, including referral of such matters
71	to a joint committee appointed by the governing board and
72	the medical staff; providing for review and consideration
73	of the recommendations of the joint committee by the
74	governing board; amending s. 395.0197, F.S., relating to
75	internal risk management programs; requiring certain
76	training components in internal risk management programs;
77	requiring a system for notifying patients that they are
78	victims of an adverse incident; requiring risk managers or
79	their designees to give notice; requiring internal risk
80	management programs to address methods for reducing
81	medication errors; requiring licensed facilities to
82	annually report certain information about health care
83	practitioners for whom they assume liability; requiring
84	the Agency for Health Care Administration and the
85	Department of Health to annually publish statistics about
86	licensed facilities that assume liability for health care
87	practitioners; providing for analysis of reports of
88	adverse incidents; providing for confidentiality;
89	requiring a licensed facility at which sexual abuse occurs
90	to offer testing for sexually transmitted disease at no
91	cost to the victim; creating s. 395.1012, F.S.; requiring
92	hospitals, ambulatory surgical centers, and mobile
93	surgical facilities to establish patient safety plans and
94	committees; providing for discount on medical malpractice
95	insurance premiums for certain health care facilities that
96	implement certain programs recommended by the Florida
97	Center for Excellence in Health Care; creating s.
98	395.1051, F.S.; requiring certain facilities to notify
99	patients about adverse incidents under specified
100	conditions; amending s. 456.026, F.S.; requiring the
101	Department of Health to publish its annual report to the
102	Legislature concerning finances, administrative
103	complaints, disciplinary actions, and recommendations on
104	its website; requiring additional information in such
105	report including the number of licensed health care
106	practitioners and the claims reported against certain
107	health care practitioners; amending s. 456.039, F.S.;
108	amending the information required to be furnished to the
109	Department of Health for licensure purposes; amending s.
110	456.041, F.S.; requiring additional information to be
111	included in health care practitioner profiles; providing
112	for fines; revising requirements for the reporting of paid
113	liability claims; amending s. 456.042, F.S.; requiring
114	health care practitioner profiles to be updated within a
115	specific time period; amending s. 456.049, F.S.; revising
116	requirements for the reporting of paid liability claims;
117	amending s. 456.051, F.S.; requiring the Department of
118	Health to provide reports of professional liability
119	actions and bankruptcies in a practitioner's profile
120	within a specified period; amending s. 456.057, F.S.;
121	authorizing the Department of Health to utilize subpoenas
122	to obtain patient records without patients' consent under
123	certain circumstances; creating s. 456.0575, F.S.;
124	requiring licensed health care practitioners to notify
125	patients about adverse incidents under certain conditions;
126	amending s. 456.063, F.S.; providing for adopting rules to
127	implement requirements for reporting allegations of sexual
128	misconduct; amending s. 456.072, F.S.; authorizing the
129	Department of Health to determine and assess
130	administrative costs, including attorney's fees in
131	disciplinary actions; changing the burden of proof in
132	certain administrative hearings; amending s. 456.073,
133	F.S.; authorizing the Department of Health to investigate
134	certain paid claims made on behalf of health care
135	practitioners licensed under ch. 458 or ch. 459, F.S.;
136	providing a deadline relating to notice of receipt of a
137	request for a formal hearing; amending s. 456.077, F.S.;
138	revising provisions relating to designation of certain
139	citation violations; amending s. 456.078, F.S.; revising
140	provisions relating to designation of certain mediation
141	offenses; providing civil immunity for certain
142	participants in quality improvement processes; providing a
143	patient safety data privilege; defining the terms "patient
144	safety data" and "patient safety organization"; providing
145	for use of patient safety data by patient safety
146	organizations; providing limitations on use of patient
147	safety data; providing for protection of patient-
148	identifying information; providing for determination of
149	whether privilege applies as asserted; providing that an
150	employer may not take retaliatory action against an
151	employee who makes a good faith report concerning patient
152	safety data; providing that certain regulatory boards may
153	adopt rules governing the safe and ethical prescription of
154	drugs to patients via the Internet or other electronic
155	means; requiring the Office of Program Policy Analysis and
156	Government Accountability and the Office of the Auditor
157	General to jointly conduct an audit of the Department of
158	Health's health care practitioner disciplinary process and
159	closed claims, requiring a report; amending s. 458.320,
160	F.S., relating to financial responsibility requirements
161	for medical physicians; requiring the department to
162	suspend the license of a medical physician who has not
163	paid, up to the amounts required by any applicable
164	financial responsibility provision, any outstanding
165	judgment, arbitration award, other order, or settlement;
166	amending s. 458.331, F.S., relating to grounds for
167	disciplinary action of a physician; redefining the term
168	"repeated malpractice"; revising the standards for the
169	burden of proof in an administrative action against a
170	physician; revising the minimum amount of a claim against
171	a licensee which will trigger a departmental
172	investigation; creating s. 458.3311, F.S.; establishing
173	emergency procedures for disciplinary actions; amending s.
174	459.0085, F.S., relating to financial responsibility
175	requirements for osteopathic physicians; requiring that
176	the department suspend the license of an osteopathic
177	physician who has not paid, up to the amounts required by
178	any applicable financial responsibility provision, any
179	outstanding judgment, arbitration award, other order, or
180	settlement; amending s. 459.015, F.S., relating to grounds
181	for disciplinary action against an osteopathic physician;
182	redefining the term "repeated malpractice"; revising the
183	standards for the burden of proof in an administrative
184	action against an osteopathic physician; amending
185	conditions that necessitate a departmental investigation
186	of an osteopathic physician; revising the minimum amount
187	of a claim against a licensee which will trigger a
188	departmental investigation; creating s. 459.0151, F.S.;
189	establishing emergency procedures for disciplinary
190	actions; amending s. 461.013, F.S.; increasing the amount
191	of paid liability claims requiring investigation by the
192	Department of Health; revising the definition of "repeated
193	malpractice" to conform; amending s. 466.028, F.S.;
194	redefining "dental malpractice"; amending s. 624.462,
195	F.S.; authorizing health care providers to form a
196	commercial self-insurance fund; amending s. 627.062, F.S.;
197	providing additional requirements for medical malpractice
198	insurance rate filings; providing that portions of
199	judgments and settlements entered against a medical
200	malpractice insurer for bad faith actions or for punitive
201	damages against the insurer, as well as related taxable
202	costs and attorney's fees, may not be included in an
203	insurer's base rate; providing for review of rate filings
204	by the Office of Insurance Regulation for excessive,
205	inadequate, or unfairly discriminatory rates; requiring
206	insurers to apply a discount based on the health care
207	provider's loss experience; creating s. 627.0662, F.S.;
208	providing definitions; requiring each medical liability
209	insurer to report certain information to the Office of
210	Insurance Regulation; providing for determination of
211	whether excessive profit has been realized; requiring
212	return of excessive amounts; amending s. 627.357, F.S.;
213	deleting the prohibition against formation of medical
214	malpractice self-insurance funds; providing requirements
215	to form a self-insurance fund; providing rulemaking
216	authority to the Financial Services Commission; creating
217	s. 627.3575, F.S.; creating the Health Care Professional
218	Liability Insurance Facility; providing purpose; providing
219	for governance and powers; providing for eligibility and
220	termination; providing for premiums and assessments;
221	providing for regulation; providing applicability;
222	specifying duties of the Department of Health; providing
223	for debt and regulation thereof; creating s. 627.358,
224	F.S.; authorizing the issuance of reduced premium medical
225	malpractice insurance policies to certain part-time or
226	retired health care professionals; providing eligibility
227	requirements; creating s. 627.359, F.S.; providing for
228	discounts on medical malpractice premiums for health care
229	professionals who enter medication orders electronically
230	using certain approved computer software; amending s.
231	627.4147, F.S.; revising certain notification criteria for
232	medical and osteopathic physicians; requiring prior
233	notification of a rate increase; creating s. 627.41491,
234	F.S.; requiring the Office of Insurance Regulation to
235	require health care providers to annually publish certain
236	rate comparison information; creating s. 627.41492, F.S.;
237	requiring the Office of Insurance Regulation to prepare
238	and publish an annual comparison of rates for malpractice
239	insurance; creating s. 627.41493, F.S.; requiring a
240	medical malpractice insurance rate rollback; providing for
241	subsequent increases under certain circumstances;
242	providing authority for the Insurance Regulatory
243	Commission to adopt rules relating to discounts authorized
244	by this act; requiring the Office of Program Policy
245	Analysis and Government Accountability to study and report
246	to the Legislature on requirements for coverage by the
247	Florida Birth-Related Neurological Injury Compensation
248	Association; amending s. 627.912, F.S.; requiring certain
249	claims information to be filed with the Office of
250	Insurance Regulation and the Department of Health;
251	providing for rulemaking by the Financial Services
252	Commission; increasing the limit on and making mandatory a
253	fine against insurers for certain actions; creating s.
254	627.9121, F.S.; requiring certain information relating to
255	medical malpractice to be reported to the Office of
256	Insurance Regulation; providing for enforcement; amending
257	s. 766.102, F.S; revising requirements for health care
258	providers providing expert testimony in medical negligence
259	actions; prohibiting contingency fees for an expert
260	witness; requiring attorneys proffering expert witness
261	testimony from a medical expert to certify that the
262	witness has not been found guilty of fraud or perjury in
263	any jurisdiction; providing an hourly cap on certain
264	expert witness fees; amending s. 766.106, F.S.; requiring
265	additional information to be provided in presuit notices;
266	requiring that certain complaints alleging medical
267	malpractice be provided by the claimant to the Agency for
268	Health Care Administration; increasing certain timeframes
269	for the conduct of presuit investigations; establishing
270	the date from which the time for filing certain actions is
271	measured; revising standards for determination of bad
272	faith by an insurer to timely pay its policy limits;
273	providing that failure to cooperate during a presuit
274	investigation is grounds to strike claims or defenses;
275	revising the standards for determining when an insurer has
276	acted in bad faith; creating s. 766.1065, F.S.; providing
277	for presuit discovery in medical malpractice actions;
278	requiring mandatory mediation of medical malpractice
279	claims; creating s. 766.1066, F.S.; creating the Office of
280	Presuit Screening Administration; requiring the office to
281	maintain a database of physicians, attorneys, and
282	consumers willing to serve on presuit screening panels;
283	providing for the assessment of certain fees to fund the
284	office; providing requirements for eligibility to serve on
285	presuit screening panels; providing powers and duties of
286	the panels; providing for the makeup and appointment of
287	such panels; requiring panelist to disclose conflicts of
288	interest and providing for challenge of such panelists;
289	providing for impact of decisions of panels; creating s.
290	766.1067, F.S.; providing for structured judgments in
291	medical malpractice actions; creating s. 766.1068, F.S.;
292	providing that offers of settlement may be made at any
293	time following the filing of suit; creating s. 766.110,
294	F.S.; providing limitations on liability for certain
295	medical staff, public family practice teaching hospitals,
296	or medical school faculty members for the performance of
297	emergency services prior to the patient being sufficiently
298	stable; providing limitations on liability for certain
299	medical facility staff when providing services following a
300	subsequent injury in the facility prior to the patient
301	again becoming sufficiently stable; amending s. 766.112,
302	F.S.; eliminating the application of the doctrine of joint
303	and several liability to medical malpractice actions;
304	estopping plaintiffs from denying that a defendant or
305	prospective defendant with whom the plaintiff settled
306	contributed to the injury alleged; creating s. 766.118,
307	F.S.; revising the method for determining and reviewing
308	awards of noneconomic damages; authorizing judges to alter
309	certain awards; providing an exception; providing the
310	right to appeal such awards and establishing the standard
311	for review; defining the term "sufficiently stable";
312	creating s. 766.185, F.S.; requiring joinder of certain
313	parties; prohibiting the assignment of fault to such
314	parties if not joined; amending s. 766.202, F.S.; revising
315	the definition of "medical expert"; amending s. 766.203,
316	F.S.; providing that presuit expert opinions in medical
317	malpractice actions are subject to discovery; amending s.
318	766.206, F.S.; providing for dismissal of a claim or the
319	striking of a defense under certain circumstances;
320	requiring the court to make certain reports concerning a
321	medical expert who fails to meet qualifications; requiring
322	the court to refuse to consider testimony from certain
323	expert witnesses; amending s. 766.207, F.S.; providing
324	that voluntary binding arbitration shall be authorized
325	only after the hearing of a presuit screening panel;
326	providing a limitation on damages, including certain
327	economic and noneconomic damages under certain
328	circumstances; deleting an exception to the time
329	limitation for agreeing to arbitration; providing that the
330	Florida Rules of Civil Procedure shall govern discovery;
331	providing exceptions; providing that discovery disputes
332	shall be resolved by an administrative law judge; revising
333	the makeup of arbitration panels; revising the
334	compensation of the arbitrators; providing limitations on
335	damages which may be awarded under certain circumstances;
336	deleting the provision that defendants who agree to
337	arbitration are jointly and severally liable for all
338	damages awarded in arbitration; providing that claimant's
339	may recover additional damages and costs at trial if a
340	defendant refuses an offer of voluntary binding
341	arbitration; providing a limitation on certain damages
342	which may be awarded at trial if a plaintiff refuses an
343	offer of voluntary binding arbitration; providing for an
344	award and allocation of damages in arbitration; providing
345	for periodic payment of certain damages; providing for
346	extinguishing liability to claimants and for contribution;
347	providing for a right of contribution against defendants
348	not in arbitration; providing that physicians not carrying
349	medical malpractice insurance require no relief provided
350	by this act; creating s. 766.25, F.S.; prescribing a
351	method for itemization of specific categories of damages
352	awarded in medical malpractice actions; creating s.
353	766.26, F.S.; requiring the Agency for Health Care
354	Administration to maintain a jury verdict database
355	regarding malpractice actions; requiring the Clerks of the
356	Court to report all such future verdicts to the agency;
357	creating s. 766.27, F.S.; providing sanctions against
358	certain attorneys who file frivolous medical malpractice
359	lawsuits; requiring the Office of Insurance Regulation to
360	compile annual statistical reports of closed claims on
361	files relating to health care providers; requiring
362	physicians to report certain claims or actions for medical
363	malpractice against the physician to the Office of
364	Insurance Regulation and the Department of Health;
365	providing requirements for such reports; amending s.
366	768.21, F.S.; providing that certain adult beneficiaries
367	of estates are entitled to damages in wrongful death
368	actions; amending s. 768.81, F.S.; eliminating the
369	application of the doctrine of joint and several liability
370	to medical malpractice actions; estopping plaintiffs from
371	denying that a defendant or prospective defendant with
372	whom the plaintiff settled contributed to the injury
373	alleged; creating s. 1004.08, F.S.; requiring patient
374	safety instruction for certain students in public schools,
375	colleges, and universities; creating s. 1004.085, F.S.;
376	requiring certain public schools to assist the Agency for
377	Health Care Administration in the development of
378	information to be provided to patients and their families
379	on risks of treatment options to assist in receiving
380	informed consent; creating s. 1005.07, F.S.; requiring
381	patient safety instruction for certain students in
382	nonpublic schools, colleges, and universities; creating s.
383	1005.075, F.S.; requiring certain nonpublic schools to
384	assist the Agency for Health Care Administration in the
385	development of information to be provided to patients and
386	their families on risks of treatment options to assist in
387	receiving informed consent; directing the Agency for
388	Health Care Administration to conduct or contract for a
389	study to determine what information to provide to the
390	public comparing hospitals, based on inpatient quality
391	indicators developed by the federal Agency for Healthcare
392	Research and Quality; creating a workgroup to study the
393	health care practitioner disciplinary process; providing
394	for workgroup membership; providing that the workgroup
395	deliver its report by January 1, 2004; providing
396	severability; providing for construction of the act in
397	pari materia with laws enacted during the 2003 Regular
398	Session or the 2003 Special Session A of the Legislature;
399	providing for future repeal of the act; providing for
400	applicability; providing an effective date.
401
402	Be It Enacted by the Legislature of the State of Florida:
403
404	Section 1. Popular name.-- This act may be cited as the
405	"Malpractice Insurance, Liability, and Litigation Reform Act"
406	(MILLRA).
407	Section 2. Findings.--
408	(1) The Legislature finds that Florida is in the midst of
409	a medical malpractice insurance crisis of unprecedented
410	magnitude.
411	(2) The Legislature finds that this crisis threatens the
412	quality and availability of health care for all Florida
413	citizens.
414	(3) The Legislature finds that the rapidly growing
415	population and the changing demographics of Florida make it
416	imperative that students continue to choose Florida as the place
417	they will receive their medical educations and practice
418	medicine.
419	(4) The Legislature finds that Florida is among the states
420	with the highest medical malpractice insurance premiums in the
421	nation.
422	(5) The Legislature finds that the cost of medical
423	malpractice insurance has increased dramatically during the past
424	decade and both the increase and the current cost are
425	substantially higher than the national average.
426	(6) The Legislature finds that the increase in medical
427	malpractice liability insurance rates is forcing physicians to
428	practice medicine without professional liability insurance, to
429	leave Florida, to not perform high-risk procedures, and to
430	retire early from the practice of medicine.
431	(7) The Legislature finds that there are certain elements
432	of damage presently recoverable that have no monetary value,
433	except on a purely arbitrary basis, while other elements of
434	damage are either easily measured on a monetary basis or reflect
435	ultimate monetary loss.
436	(8) The Governor created the Governor's Select Task Force
437	on Healthcare Professional Liability Insurance to study and make
438	recommendations to address these problems.
439	(9) The Legislature has reviewed the findings and
440	recommendations of the Governor's Select Task Force on
441	Healthcare Professional Liability Insurance.
442	(10) The Legislature finds that the Governor's Select Task
443	Force on Healthcare Professional Liability Insurance has
444	established that a medical malpractice crisis exists in the
445	state which can be alleviated by the adoption of comprehensive
446	legislatively enacted reforms.
447	(11) The Legislature finds that making high-quality health
448	care available to the citizens of the state is an overwhelming
449	public necessity.
450	(12) The Legislature finds that ensuring that physicians
451	continue to practice in Florida is an overwhelming public
452	necessity.
453	(13) The Legislature finds that ensuring the availability
454	of affordable professional liability insurance for physicians
455	and healthcare facilities is an overwhelming public necessity.
456	(14) The Legislature finds, based upon the findings and
457	recommendations of the Governor's Select Task Force on
458	Healthcare Professional Liability Insurance, the findings and
459	recommendations of various study groups throughout the nation,
460	and the experience of other states, that the overwhelming public
461	necessities of making quality health care available to the
462	citizens of this state, of ensuring that physicians continue to
463	practice in Florida, and of ensuring that those physicians have
464	the opportunity to purchase affordable professional liability
465	insurance cannot be met unless a cap on noneconomic damages is
466	imposed under certain circumstances.
467	(15) The Legislature finds that the high cost of medical
468	malpractice claims can be substantially alleviated, in the short
469	term, by imposing a limitation on noneconomic damages in medical
470	malpractice actions under certain circumstances.
471	(16) The Legislature further finds that there is no
472	alternative measure of accomplishing such result without
473	imposing even greater limits upon the ability of persons to
474	recover damages for medical malpractice.
475	(17) The Legislature finds that the provisions of this act
476	are naturally and logically connected to each other and to the
477	purpose of making quality health care available to the citizens
478	of Florida.
479	(18) The Legislature finds that each of the provisions of
480	this act is necessary to alleviate the crisis relating to
481	medical malpractice insurance.
482	Section 3. A new subsection (11) is added to section
483	120.65, Florida Statutes, to read:
484	120.65 Administrative law judges.--
485	(11) The Division of Administrative Hearings shall
486	designate at least two administrative law judges who will
487	specifically preside over actions involving a health care
488	practitioner as defined in s. 456.001(4). Each designated
489	administrative law judge shall be a member of The Florida Bar in
490	good standing and shall be a health care practitioner or have
491	experience in health care. The Division of Administrative
492	Hearings and the Department of Health shall work cooperatively
493	to enhance the effectiveness of disciplinary actions involving a
494	health care practitioner as defined in s. 456.001(4).
495	Section 4. Section 381.0409, Florida Statutes, is created
496	to read:
497	381.0409 Florida Center for Excellence in Health Care.--
498	There is created the Florida Center for Excellence in Health
499	Care, which shall be responsible for performing activities and
500	functions that are designed to improve the quality of health
501	care delivered by health care facilities and health care
502	practitioners. The principal goals of the center are to improve
503	health care quality and patient safety. The long-term goal of
504	the center is to improve diagnostic and treatment decisions,
505	thus further improving quality.
506	(1) As used in this section, the term:
507	(a) "Center" means the Florida Center for Excellence in
508	Health Care.
509	(b) "Health care facility" means any facility licensed
510	under chapter 395.
511	(c) "Health care practitioner" means any health care
512	practitioner as defined in s. 456.001(4).
513	(d) "Health research entity" means any university or
514	academic health center engaged in research designed to improve,
515	prevent, diagnose, or treat diseases or medical conditions or an
516	entity that receives state or federal funds for such research.
517	(e) “Medication error” is any preventable event that may
518	cause or lead to inappropriate medication use or patient harm
519	while the medication is in the control of the health care
520	professional, patient, or consumer. Such events may be related
521	to professional practice, health care products, health care
522	procedures, and health care systems, each of which may include
523	the prescribing of medications and order communications; product
524	labeling; product packaging; the nomenclature, compounding,
525	dispensing, distribution, administration, and use of
526	medications; and education and monitoring related thereto.
527	(f) "Patient safety data" means any data, reports,
528	records, memoranda, or analyses of patient safety events and
529	adverse incidents reported by a licensed facility pursuant to s.
530	395.0197 which are submitted to the Florida Center for Excellence
531	in Health Care or the corrective actions taken in response to
532	such patient safety events or adverse incidents.
533	(g) "Patient safety event" means an event over which
534	health care personnel could exercise control and which is
535	associated in whole or in part with medical intervention, rather
536	than the condition for which such intervention occurred, and
537	which could have resulted, but did not result, in serious
538	patient injury or death.
539	(2) The center shall, either directly or by contract:
540	(a) Analyze patient safety data for the purpose of
541	recommending changes in practices and procedures which may be
542	implemented by health care practitioners and health care
543	facilities to prevent future adverse incidents.
544	(b) Collect, analyze, and evaluate patient safety data
545	submitted voluntarily by a health care practitioner or health
546	care facility. The center shall establish a series of baseline
547	assessments in order to, at a minimum annual frequency, review
548	the effectiveness of patient safety initiatives and enacted
549	recommendations. The center shall recommend to health care
550	practitioners and health care facilities changes in practices
551	and procedures that may be implemented for the purpose of
552	improving patient safety and preventing patient safety events.
553	(c) Foster the development of a statewide electronic
554	infrastructure, which may be implemented in phases over a
555	multiyear period, that is designed to improve patient care and
556	the delivery and quality of health care services by health care
557	facilities and practitioners. The electronic infrastructure
558	shall be a secure platform for communication and the sharing of
559	clinical and other data, including, but not limited to, business
560	data, among providers and between patients and providers. The
561	electronic infrastructure shall include a core electronic
562	medical record. Health care practitioners and health care
563	facilities shall have access to individual electronic medical
564	records subject to the consent of the individual. Health
565	insurers licensed under chapter 627 or chapter 641 shall have
566	access to the electronic medical records of their policyholders
567	and to other data if such access is for the sole purpose of
568	conducting research to identify diagnostic tests and treatments
569	that are medically effective. Health research entities shall
570	have access to the electronic medical records of individuals
571	subject to the consent of the individual and to other data if
572	such access is for the sole purpose of conducting research to
573	identify diagnostic tests and treatments that are medically
574	effective.
575	(d) Inventory hospitals to determine the current status of
576	implementation of computerized physician medication ordering
577	systems, barcode point of care systems, or other technological
578	patient safety implementation, and recommend a plan for
579	expediting implementation statewide or, in hospitals where the
580	center determines that implementation of such systems is not
581	practicable, alternative methods to reduce medication errors.
582	The center shall identify in its plan any barriers to statewide
583	implementation and shall include recommendations to the
584	Legislature of statutory changes that may be necessary to
585	eliminate those barriers. The center will review newly developed
586	plans for compliance with statewide initiatives and to determine
587	both the commitment of the health care facility staff and the
588	capability of the facility to successfully coordinate and
589	implement these plans, especially from a technological
590	perspective.
591	(e) Establish a simulation center for high technology
592	intervention surgery and intensive care for use by all
593	hospitals.
594	(f) Establish a pilot review program in Dade,
595	Hillsborough, and Clay Counties to evaluate the effectiveness of
596	technological implementations of Computerized Physician Order
597	Entry (CPOE) and Barcode Point of Care (BPOC) as they relate to
598	the patient safety initiatives outlined in the Malpractice
599	Insurance, Liability, and Litigation Reform Act. After a 6-month
600	evaluation, a series of recommendations will be produced,
601	including considerations regarding appropriate financial terms
602	to allow health care practitioners and health care facilities to
603	absorb the costs associated with these technological solutions.
604	Incorporated in this evaluation will be a recommendation for two
605	commercial patient safety technology solutions. These
606	recommendations are designed to assist health care practitioners
607	and health care facilities in their individual patient safety
608	plan development.
609	(g) Identify best practices and share this information
610	with health care providers. Nothing in this section shall serve
611	to limit the scope of services provided by the center with
612	regard to engaging in other activities that improve health care
613	quality, improve the diagnosis and treatment of diseases and
614	medical conditions, increase the efficiency of the delivery of
615	health care services, increase administrative efficiency, or
616	increase access to quality health care services.
617	(3) The center may release deidentified information
618	contained in patient safety data to any health care practitioner
619	or health care facility when recommending changes in practices
620	and procedures which may be implemented by such practitioner or
621	facility to prevent patient safety events or adverse incidents.
622	(4) All information related to adverse incident reports
623	and all patient safety data submitted to or received by the
624	center shall not be subject to discovery or introduction into
625	evidence in any civil or administrative action. Individuals in
626	attendance at meetings held for the purpose of discussing
627	information related to adverse incidents and patient safety data
628	and meetings held to formulate recommendations to prevent future
629	adverse incidents or patient safety events may not be permitted
630	or required to testify in any civil or administrative action
631	related to such events. There shall be no liability on the part
632	of, and no cause of action of any nature shall arise against,
633	any employee or agent of the center for any lawful action taken
634	by such individual in advising health care practitioners or
635	health care facilities with regard to carrying out their duties
636	under this section. There shall be no liability on the part of,
637	and no cause of action of any nature shall arise against, a
638	health care practitioner or health care facility or its agents
639	or employees when it acts in reliance on any advice or
640	information provided by the center.
641	(5) The center shall be a nonprofit corporation
642	registered, incorporated, organized, and operated in compliance
643	with chapter 617, and shall have all powers necessary to carry
644	out the purposes of this section, including, but not limited to,
645	the power to receive and accept from any source contributions of
646	money, property, labor, or any other thing of value, to be held,
647	used, and applied for the purpose of this section.
648	(6) The center shall:
649	(a) Be designed and operated by an individual or entity
650	with demonstrated expertise in health care quality data and
651	systems analysis, health information management, systems
652	thinking and analysis, human factors analysis, and
653	identification of latent and active errors.
654	(b) Include procedures for ensuring the confidentiality of
655	data which are consistent with state and federal law.
656	(7) The center shall be governed by a 10-member board of
657	directors appointed by the Governor.
658	(a) The Governor shall appoint two members representing
659	hospitals, one member representing physicians, one member
660	representing nurses, one member representing health insurance
661	indemnity plans, one member representing health maintenance
662	organizations, one member representing business, and one member
663	representing consumers. The Governor shall appoint members for
664	2-year terms. Such members shall serve until their successors
665	are appointed. Members are eligible to be reappointed for
666	additional terms.
667	(b) The Secretary of Health or his or her designee shall
668	be a member of the board.
669	(c) The Secretary of Health Care Administration or his or
670	her designee shall be a member of the board.
671	(d) The members shall elect from the membership a
672	chairperson.
673	(e) Board members shall serve without compensation but may
674	be reimbursed for travel expenses pursuant to s. %_%1%_%.
675	(8) The center shall be financed as follows:
676	(a) Notwithstanding any law to the contrary, each health
677	insurer issued a certificate of authority under part VI, part
678	VII, or part VIII of chapter 627 shall, as a condition of
679	maintaining such certificate, make payment to the center on
680	April 1 of each year, in the amount of $1 for each individual
681	insured covered by an insurance policy issued by or on behalf of
682	such insurer during the previous calendar year. Accompanying any
683	payment shall be a certification under oath by the chief
684	executive officer that states the number of individuals on which
685	such payment was based. The health insurer may collect this $1
686	from policyholders. The center may direct the insurer to provide
687	an independent audit of the certification that shall be
688	furnished within 90 days. If payment is not received by the
689	center within 30 days after April 1, interest at the annualized
690	rate of 18 percent shall begin to be charged on the amount due.
691	If payment has not been received within 60 days after interest
692	is charged, the center shall notify the Office of Insurance
693	Regulation that payment has not been received pursuant to the
694	requirements of this paragraph. An insurer that refuses to
695	comply with the requirements of this paragraph is subject to the
696	forfeiture of its certificate of authority.
697	(b) Notwithstanding any law to the contrary, each health
698	maintenance organization issued a certificate of authority under
699	part I of chapter 641 and each prepaid clinic issued a
700	certificate of authority under part II of chapter 641 shall, as
701	a condition of maintaining such certificate, make payment to the
702	center on April 1 of each year, in the amount of $1 for each
703	individual who is eligible to receive services pursuant to a
704	contract with the health maintenance organization or the prepaid
705	clinic during the previous calendar year. Accompanying any
706	payment shall be a certification under oath by the chief
707	executive officer that states the number of individuals on which
708	such payment was based. The health maintenance organization or
709	prepaid clinic may collect the $1 from individuals eligible to
710	receive services under contract. The center may direct the
711	health maintenance organization or prepaid clinic to provide an
712	independent audit of the certification that shall be furnished
713	within 90 days. If payment is not received by the center within
714	30 days after April 1, interest at the annualized rate of 18
715	percent shall begin to be charged on the amount due. If payment
716	has not been received within 60 days after interest is charged,
717	the center shall notify the Department of Financial Services
718	that payment has not been received pursuant to the requirements
719	of this paragraph. A health maintenance organization or prepaid
720	clinic that refuses to comply with the requirements of this
721	paragraph is subject to the forfeiture of its certificate of
722	authority.
723	(c) Notwithstanding any law to the contrary, each hospital
724	and ambulatory surgical center licensed under chapter 395 shall,
725	as a condition of licensure, make payment to the center on April
726	1 of each year, in the amount of $1 for each individual during
727	the previous 12 months who was an inpatient discharged by the
728	hospital or who was a patient in the ambulatory surgical center.
729	Accompanying payment shall be a certification under oath by the
730	chief executive officer that states the number of individuals on
731	which such payment was based. The facility may collect the $1
732	from patients discharged from the facility. The center may
733	direct the facility to provide an independent audit of the
734	certification that shall be furnished within 90 days. If payment
735	is not received by the center within 30 days after April 1,
736	interest at the annualized rate of 18 percent shall begin to be
737	charged on the amount due. If payment has not been received
738	within 60 days after interest is charged, the center shall
739	notify the Agency for Health Care Administration that payment
740	has not been received pursuant to the requirements of this
741	paragraph. An entity that refuses to comply with the
742	requirements of this paragraph is subject to the forfeiture of
743	its license.
744	(d) Notwithstanding any law to the contrary, each nursing
745	home, assisted living facility, home health agency, hospice,
746	prescribed pediatric extended care center, and health care
747	services pool licensed under chapter 400 shall, as a condition
748	of licensure, make payment to the center on April 1 of each
749	year, in the amount of $1 for each individual served by each
750	aforementioned entity during the previous 12 months.
751	Accompanying payment shall be a certification under oath by the
752	chief executive officer that states the number of individuals on
753	which such payment was based. The entity may collect the $1 from
754	individuals served by the entity. The center may direct the
755	entity to provide an independent audit of the certification that
756	shall be furnished within 90 days. If payment is not received by
757	the center within 30 days after April 1, interest at the
758	annualized rate of 18 percent shall begin to be charged on the
759	amount due. If payment has not been received within 60 days
760	after interest is charged, the center shall notify the Agency
761	for Health Care Administration that payment has not been
762	received pursuant to the requirements of this paragraph. An
763	entity that refuses to comply with the requirements of this
764	paragraph is subject to the forfeiture of its license.
765	(e) Notwithstanding any law to the contrary, each initial
766	application and renewal fee for each license and each fee for
767	certification or recertification for each person licensed or
768	certified under chapter 401 or chapter 404 and for each person
769	licensed as a health care practitioner shall be increased by the
770	amount of $1 for each year for which the license or
771	certification is issued. The Department of Health shall make
772	payment to the center on April 1 of each year in the amount of
773	the total received pursuant to this paragraph during the
774	preceding 12 months.
775	(f) The center shall develop a business and financing plan
776	to obtain funds through other means if funds beyond those that
777	are provided for in this subsection are needed to accomplish the
778	objectives of the center.
779	(9) The center may enter into affiliations with
780	universities for any purpose.
781	(10) Pursuant to s. 287.057(5)(f)6., state agencies may
782	contract with the center on a sole source basis for projects to
783	improve the quality of program administration, including, but
784	not limited to, the implementation of an electronic medical
785	record for Medicaid program recipients.
786	(11) All travel and per diem paid with center funds shall
787	be in accordance with s. %_%3%_%.
788	(12) The center may use state purchasing and travel
789	contracts and the state communications system in accordance with
790	s. %_%4%_%(3).
791	(13) The center may acquire, enjoy, use, and dispose of
792	patents, copyrights, trademarks, and any licenses, royalties,
793	and other rights or interests thereunder or therein.
794	(14) The center shall submit an annual report to the
795	Governor, the President of the Senate, and the Speaker of the
796	House of Representatives no later than October 1 of each year
797	which includes:
798	(a) The status report on the implementation of a program
799	to analyze data concerning adverse incidents and patient safety
800	events.
801	(b) The status report on the implementation of technology
802	designed to reduce medication error.
803	(c) The status report on the implementation of an
804	electronic medical record.
805	(d) Other pertinent information relating to the efforts of
806	the center to improve health care quality and efficiency.
807	(e) A financial statement and balance sheet. The initial
808	report shall include any recommendations that the center deems
809	appropriate regarding revisions in the definition of adverse
810	incidents in s. 395.0197 and the reporting of such adverse
811	incidents by licensed facilities.
812	(15) The center may establish and manage an operating fund
813	for the purposes of addressing the center's cash flow needs and
814	facilitating the fiscal management of the corporation. Upon
815	dissolution of the corporation, any remaining cash balances of
816	any state funds shall revert to the General Revenue Fund, or
817	such other state funds consistent with appropriated funding, as
818	provided by law.
819	(16) The center may carry over funds from year to year.
820	(17) All books, records, and audits of the center shall be
821	open to the public unless exempted by law.
822	(18) The center shall furnish an annual audited report to
823	the Governor and Legislature by March 1 of each year.
824	(19) In carrying out this section, the center shall
825	consult with and develop partnerships, as appropriate, with all
826	segments of the health care industry, including, but not limited
827	to, health care practitioners, health care facilities, health
828	care consumers, professional organizations, agencies, health
829	care practitioner licensing boards, and educational
830	institutions.
831	Section 5. Subsection (3) is added to section 395.004,
832	Florida Statutes, to read:
833	395.004 Application for license, fees; expenses.--
834	(3) A licensed facility may apply to the agency for
835	certification of a quality improvement program that results in
836	the reduction of adverse incidents at that facility. The agency,
837	in consultation with the Office of Insurance Regulation, shall
838	develop criteria for such certification. Insurers shall file
839	with the Office of Insurance Regulation a discount in the rate
840	or rates applicable for medical liability insurance coverage to
841	reflect the implementation of a certified program. In reviewing
842	insurance company filings with respect to rate discounts
843	authorized under this subsection, the Office of Insurance
844	Regulation shall consider whether, and the extent to which, the
845	program certified under this subsection is otherwise covered
846	under a program of risk management offered by an insurance
847	company or self-insurance plan providing medical liability
848	insurance coverage.
849	Section 6. Section 395.0056, Florida Statutes, is created
850	to read:
851	395.0056 Litigation notice requirement.-- Upon receipt of
852	a copy of a complaint filed against a hospital as a defendant in
853	a medical malpractice action as required by s. 766.106(2), the
854	agency shall:
855	(1) Review its adverse incident report files pertaining
856	to the licensed facility that is the subject of the complaint to
857	determine whether the facility timely complied with the
858	requirements of s. 395.0197.
859	(2) Review the incident that is the subject of the
860	complaint and determine whether it involved conduct by a
861	licensee which is potentially subject to disciplinary action.
862	Section 7. Subsection (7) of section 395.0191, Florida
863	Statutes, is amended to read:
864	395.0191 Staff membership and clinical privileges.--
865	(7) There shall be no monetary liability on the part of,
866	and no cause of action for injunctive relief ordamages shall
867	arise against, any licensed facility, its governing board or
868	governing board members, medical staff, or disciplinary board or
869	against its agents, investigators, witnesses, or employees, or
870	against any other person, for any action arising out of or
871	related to carrying out the provisions of this section, absent
872	taken in good faith and without intentional fraud in carrying
873	out the provisions of this section.
874	Section 8. Subsections (3) and (9) of section 395.0193,
875	Florida Statutes, are amended to read:
876	395.0193 Licensed facilities; peer review; disciplinary
877	powers; agency or partnership with physicians.--
878	(3) If reasonable belief exists that conduct by a staff
879	member or physician who delivers health care services at the
880	licensed facility may constitute one or more grounds for
881	discipline as provided in this subsection, a peer review panel
882	shall investigate and determine whether grounds for discipline
883	exist with respect to such staff member or physician. The
884	governing board of any licensed facility, after considering the
885	recommendations of its peer review panel, shall suspend, deny,
886	revoke, or curtail the privileges, or reprimand, counsel, or
887	require education, of any such staff member or physician after a
888	final determination has been made that one or more of the
889	following grounds exist:
890	(a) Incompetence.
891	(b) Being found to be a habitual user of intoxicants or
892	drugs to the extent that he or she is deemed dangerous to
893	himself, herself, or others.
894	(c) Mental or physical impairment which may adversely
895	affect patient care.
896	(d) Mental or physical abuse of a nurse or other staff
897	member.
898	(e)(d)Being found liable by a court of competent
899	jurisdiction for medical negligence or malpractice involving
900	negligent conduct.
901	(f)(e)One or more settlements exceeding $10,000 for
902	medical negligence or malpractice involving negligent conduct by
903	the staff member.
904	(g)(f)Medical negligence other than as specified in
905	paragraph (d) or paragraph (e).
906	(h)(g)Failure to comply with the policies, procedures, or
907	directives of the risk management program or any quality
908	assurance committees of any licensed facility.
909	(9)(a) If the defendant prevails in an action brought by a
910	staff member or physician who delivers health care services at
911	the licensed facility against any person or entity that
912	initiated, participated in, was a witness in, or conducted any
913	review as authorized by this section, the court shall award
914	reasonable attorney's fees and costs to the defendant.
915	(b) As a condition of any staff member or physician
916	bringing any action against any person or entity that initiated,
917	participated in, was a witness in, or conducted any review as
918	authorized by this section and before any responsive pleading is
919	due, the staff member or physician shall post a bond or other
920	security, as set by the court having jurisdiction of the action,
921	in an amount sufficient to pay the costs and attorney's fees. A
922	defendant's monetary liability under this section shall not
923	exceed $250,000.
924	Section 9. Section 395.0194, Florida Statutes, is created
925	to read:
926	395.0194 Licensed facilities; quality assurance
927	responsibilities of governing board.--
928	(1) A governing board's authority for the administration
929	of the hospital is not limited by the authority of its medical
930	staff. Therefore, a governing board may reject or modify a
931	medical staff recommendation or may, if the medical staff has
932	failed to act, take action independent of the medical staff
933	concerning medical staff membership, clinical privileges, peer
934	review, patient safety, and quality assurance.
935	(2) To the extent a governing board seeks to modify a
936	medical staff recommendation, or where a medical staff has
937	failed to act within 75 days after a request from the governing
938	board to take action against, or with regard to, an individual
939	physician concerning medical staff membership, clinical
940	privileges, peer review, or quality assurance, a governing board
941	may take action independent of the actions of the medical staff.
942	If no existing bylaw provision exists and if, after any informal
943	interview, the governing board determines that corrective or
944	disciplinary action is necessary, it shall recommend such action
945	to a six-member joint conference committee composed of three
946	members of the governing board, to be appointed by the chair of
947	the governing board, and three members of the medical staff, to
948	be appointed by the chair or president of the medical staff. The
949	joint conference committee shall, within 15 days after the
950	governing board's decision, conduct a fair hearing in which the
951	physician is entitled to be represented by counsel, to be
952	afforded an opportunity to present oral and written argument in
953	response to the corrective or disciplinary action proposed, and
954	to comment upon and cross-examine witnesses and evidence against
955	such physician and notify the governing board that the joint
956	conference committee accepts, rejects, or cannot reach a
957	majority consensus concerning the governing board's
958	recommendation. If the joint conference committee's
959	recommendation is to accept the governing board's
960	recommendation, the governing board's decision shall be final.
961	If the joint conference committee rejects the governing board's
962	recommendation and suggests an alternative corrective or
963	disciplinary action, or finds that no corrective or disciplinary
964	action is warranted, the governing board shall not unreasonably
965	reject the joint conference committee's recommendation. If the
966	joint conference committee cannot reach a majority consensus to
967	either accept or reject the governing board's action concerning
968	the fair hearing decision, the governing board's action shall be
969	final. The governing board shall give full and complete
970	consideration to the joint conference committee’s
971	recommendations.
972	Section 10. Subsections (12) through (20) of section
973	395.0197, Florida Statutes, are renumbered as subsections (13)
974	through (21), respectively, subsections (1), (3), (7), and (8)
975	of said section are amended, and a new subsection (12) is added
976	to said section, to read:
977	395.0197 Internal risk management program.--
978	(1) Every licensed facility shall, as a part of its
979	administrative functions, establish an internal risk management
980	program that includes all of the following components:
981	(a) The investigation and analysis of the frequency and
982	causes of general categories and specific types of adverse
983	incidents to patients.
984	(b) The development of appropriate measures to minimize
985	the risk of adverse incidents to patients, including, but not
986	limited to:
987	1. Risk management and risk prevention education and
988	training of all nonphysician personnel as follows:
989	a. Such education and training of all nonphysician
990	personnel as part of their initial orientation; and
991	b. At least 1 hour of such education and training annually
992	for all personnel of the licensed facility working in clinical
993	areas and providing patient care, except those persons licensed
994	as health care practitioners who are required to complete
995	continuing education coursework pursuant to chapter 456 or the
996	respective practice act, which education and training shall
997	include components designed to assisting physicians and hospital
998	personnel in providing constructive advice to patients when
999	there is an adverse outcome.
1000	2. A prohibition, except when emergency circumstances
1001	require otherwise, against a staff member of the licensed
1002	facility attending a patient in the recovery room, unless the
1003	staff member is authorized to attend the patient in the recovery
1004	room and is in the company of at least one other person.
1005	However, a licensed facility is exempt from the two-person
1006	requirement if it has:
1007	a. Live visual observation;
1008	b. Electronic observation; or
1009	c. Any other reasonable measure taken to ensure patient
1010	protection and privacy.
1011	3. A prohibition against an unlicensed person from
1012	assisting or participating in any surgical procedure unless the
1013	facility has authorized the person to do so following a
1014	competency assessment, and such assistance or participation is
1015	done under the direct and immediate supervision of a licensed
1016	physician and is not otherwise an activity that may only be
1017	performed by a licensed health care practitioner.
1018	4. Development, implementation, and ongoing evaluation of
1019	procedures, protocols, and systems to accurately identify
1020	patients, planned procedures, and the correct site of the
1021	planned procedure so as to minimize the performance of a
1022	surgical procedure on the wrong patient, a wrong surgical
1023	procedure, a wrong-site surgical procedure, or a surgical
1024	procedure otherwise unrelated to the patient's diagnosis or
1025	medical condition.
1026	(c) The analysis of patient grievances that relate to
1027	patient care and the quality of medical services.
1028	(d) A system for informing a patient or a proxy authorized
1029	by law to make health care decisions on behalf of a patient that
1030	the patient was the subject of an adverse incident as defined in
1031	subsection (5). Such notice shall be given by the risk manager,
1032	or his or her designee, as soon as practicable to allow the
1033	patient an opportunity to minimize damage or injury.
1034	(e)(d)The development and implementation of an incident
1035	reporting system based upon the affirmative duty of all health
1036	care providers and all agents and employees of the licensed
1037	health care facility to report adverse incidents to the risk
1038	manager, or to his or her designee, within 3 business days after
1039	their occurrence.
1040	(f) The development of a facilitywide plan for reducing
1041	medication errors, which shall include:
1042	1. The development of effective reporting mechanisms to
1043	ensure that medication-related errors are reviewed.
1044	2. The establishment of a baseline assessment and a review
1045	to be conducted at least annually of the effectiveness of the
1046	plan to reduce medication-related errors.
1047	3. The use of technology.
1048
1049	Pertinent literature related to the reduction of medication-
1050	related errors shall be reviewed and utilized in the development
1051	and ongoing review of the plan developed pursuant to this
1052	paragraph.
1053	(3) In addition to the programs mandated by this section,
1054	other innovative approaches intended to reduce the frequency and
1055	severity of medical malpractice and patient injury claims shall
1056	be encouraged and their implementation and operation
1057	facilitated. Such additional approaches may include extending
1058	internal risk management programs to health care providers'
1059	offices and the assuming of provider liability by a licensed
1060	health care facility for acts or omissions occurring within the
1061	licensed facility. Each licensed facility shall annually report
1062	to the agency and the Department of Health the name and
1063	judgments entered against each health care practitioner for
1064	which the facility assumes liability. The agency and the
1065	Department of Health, in their respective annual reports, shall
1066	include statistics that report the number of licensed facilities
1067	that assume such liability and the number of health care
1068	practitioners, by profession, for whom they assume liability.
1069	(7) The licensed facility shall notify the agency no later
1070	than 7 calendar days1 business dayafter the risk manager or
1071	his or her designee has received a report pursuant to paragraph
1072	(1)(d) and can determine within 7 calendar days1 business day
1073	that any of the following adverse incidents has occurred,
1074	whether occurring in the licensed facility or arising from
1075	health care prior to admission in the licensed facility:
1076	(a) The death of a patient;
1077	(b) Brain or spinal damage to a patient;
1078	(c) The performance of a surgical procedure on the wrong
1079	patient;
1080	(d) The performance of a wrong-site surgical procedure; or
1081	(e) The performance of a wrong surgical procedure.
1082
1083	The notification must be made in writing and be provided by
1084	facsimile device or overnight mail delivery. The notification
1085	must include information regarding the identity of the affected
1086	patient, the type of adverse incident, the initiation of an
1087	investigation by the facility, and whether the events causing or
1088	resulting in the adverse incident represent a potential risk to
1089	other patients.
1090	(8) Any of the following adverse incidents, whether
1091	occurring in the licensed facility or arising from health care
1092	prior to admission in the licensed facility, shall be reported
1093	by the facility to the agency within 15 calendar days after its
1094	occurrence:
1095	(a) The death of a patient;
1096	(b) Brain or spinal damage to a patient;
1097	(c) The performance of a surgical procedure on the wrong
1098	patient;
1099	(d) The performance of a wrong-site surgical procedure;
1100	(e) The performance of a wrong surgical procedure;
1101	(f) The performance of a surgical procedure that is
1102	medically unnecessary or otherwise unrelated to the patient's
1103	diagnosis or medical condition;
1104	(g) The surgical repair of damage resulting to a patient
1105	from a planned surgical procedure, where the damage is not a
1106	recognized specific risk, as disclosed to the patient and
1107	documented through the informed-consent process; or
1108	(h) The performance of procedures to remove unplanned
1109	foreign objects remaining from a surgical procedure.
1110
1111	The agency may grant extensions to this reporting requirement
1112	for more than 15 days upon justification submitted in writing by
1113	the facility administrator to the agency. The agency may require
1114	an additional, final report. These reports shall not be
1115	available to the public pursuant to s. 119.07(1) or any other
1116	law providing access to public records, nor be discoverable or
1117	admissible in any civil or administrative action, except in
1118	disciplinary proceedings by the agency or the appropriate
1119	regulatory board, nor shall they be available to the public as
1120	part of the record of investigation for and prosecution in
1121	disciplinary proceedings made available to the public by the
1122	agency or the appropriate regulatory board. However, the agency
1123	or the appropriate regulatory board shall make available, upon
1124	written request by a health care professional against whom
1125	probable cause has been found, any such records which form the
1126	basis of the determination of probable cause. The agency may
1127	investigate, as it deems appropriate, any such incident and
1128	prescribe measures that must or may be taken in response to the
1129	incident. The agency shall review each incident and determine
1130	whether it potentially involved conduct by the health care
1131	professional who is subject to disciplinary action, in which
1132	case the provisions of s. 456.073 shall apply. Copies of all
1133	reports of adverse incidents submitted to the agency by
1134	hospitals and ambulatory surgical centers shall be forwarded to
1135	the Florida Center for Excellence in Health Care, as defined in
1136	s. 381.0409, for analysis by experts who may make
1137	recommendations regarding the prevention of such incidents. Such
1138	information shall remain confidential as otherwise provided by
1139	law.
1140	(12) If appropriate, a licensed facility in which sexual
1141	abuse occurs must offer the victim of sexual abuse testing for
1142	sexually transmissible diseases and shall provide all such
1143	testing at no cost to the victim.
1144	Section 11. Section 395.1012, Florida Statutes, is created
1145	to read:
1146	395.1012 Patient safety.--
1147	(1) Each licensed facility shall adopt a patient safety
1148	plan. A plan adopted to implement the requirements of 42 C.F.R.
1149	s. 482.21 shall be deemed to comply with this requirement.
1150	(2) Each licensed facility shall appoint a patient safety
1151	officer and a patient safety committee, which shall include at
1152	least one person who is neither employed by nor practicing in
1153	the facility, for the purpose of promoting the health and safety
1154	of patients, reviewing and evaluating the quality of patient
1155	safety measures used by the facility, and assisting in the
1156	implementation of the facility patient safety plan.
1157	Section 12. Section 395.1051, Florida Statutes, is created
1158	to read:
1159	395.1051 Duty to notify patients.-- Every licensed
1160	facility shall inform each patient, or an individual identified
1161	pursuant to s. 765.401(1), in person about unanticipated
1162	outcomes of care that result in serious harm to the patient.
1163	Notification of outcomes of care that result in harm to the
1164	patient under this section shall not constitute an
1165	acknowledgement or admission of liability, nor can it be
1166	introduced as evidence in any civil lawsuit.
1167	Section 13. Section 456.026, Florida Statutes, is amended
1168	to read:
1169	456.026 Annual report concerning finances, administrative
1170	complaints, disciplinary actions, and recommendations.-- The
1171	department is directed to prepare and submit a report to the
1172	President of the Senate and the Speaker of the House of
1173	Representatives by November 1 of each year. The department shall
1174	publish the report on its website simultaneously with delivery
1175	to the President of the Senate and the Speaker of the House of
1176	Representatives. The report must be directly accessible on the
1177	department's Internet homepage highlighted by easily
1178	identifiable links and buttons.In addition to finances and any
1179	other information the Legislature may require, the report shall
1180	include statistics and relevant information, profession by
1181	profession, detailing:
1182	(1) The number of health care practitioners licensed by
1183	the Division of Medical Quality Assurance or otherwise
1184	authorized to provide services in the state, if known to the
1185	department.
1186	(2)(1)The revenues, expenditures, and cash balances for
1187	the prior year, and a review of the adequacy of existing fees.
1188	(3)(2)The number of complaints received and investigated.
1189	(4)(3)The number of findings of probable cause made.
1190	(5)(4)The number of findings of no probable cause made.
1191	(6)(5)The number of administrative complaints filed.
1192	(7)(6)The disposition of all administrative complaints.
1193	(8)(7)A description of disciplinary actions taken.
1194	(9) For licensees under chapter 458, chapter 459, chapter
1195	461, or chapter 466, the professional liability claims and
1196	actions reported by insurers, as provided in s. 627.912. This
1197	information must be provided in a separate section of the report
1198	restricted to providing professional liability claims and
1199	actions data.
1200	(10)(8)A description of any effort by the department to
1201	reduce or otherwise close any investigation or disciplinary
1202	proceeding not before the Division of Administrative Hearings
1203	under chapter 120 or otherwise not completed within 1 year after
1204	the initial filing of a complaint under this chapter.
1205	(11)(9)The status of the development and implementation
1206	of rules providing for disciplinary guidelines pursuant to s.
1207	456.079.
1208	(12)(10)Such recommendations for administrative and
1209	statutory changes necessary to facilitate efficient and cost-
1210	effective operation of the department and the various boards.
1211	Section 14. Paragraph (a) of subsection (1) of section
1212	456.039, Florida Statutes, is amended to read:
1213	456.039 Designated health care professionals; information
1214	required for licensure.--
1215	(1) Each person who applies for initial licensure as a
1216	physician under chapter 458, chapter 459, chapter 460, or
1217	chapter 461, except a person applying for registration pursuant
1218	to ss. 458.345 and 459.021, must, at the time of application,
1219	and each physician who applies for license renewal under chapter
1220	458, chapter 459, chapter 460, or chapter 461, except a person
1221	registered pursuant to ss. 458.345 and 459.021, must, in
1222	conjunction with the renewal of such license and under
1223	procedures adopted by the Department of Health, and in addition
1224	to any other information that may be required from the
1225	applicant, furnish the following information to the Department
1226	of Health:
1227	(a)1. The name of each medical school that the applicant
1228	has attended, with the dates of attendance and the date of
1229	graduation, and a description of all graduate medical education
1230	completed by the applicant, excluding any coursework taken to
1231	satisfy medical licensure continuing education requirements.
1232	2. The name of each hospital at which the applicant has
1233	privileges.
1234	3. The address at which the applicant will primarily
1235	conduct his or her practice.
1236	4. Any certification that the applicant has received from
1237	a specialty board that is recognized by the board to which the
1238	applicant is applying.
1239	5. The year that the applicant began practicing medicine.
1240	6. Any appointment to the faculty of a medical school
1241	which the applicant currently holds and an indication as to
1242	whether the applicant has had the responsibility for graduate
1243	medical education within the most recent 10 years.
1244	7. A description of any criminal offense of which the
1245	applicant has been found guilty, regardless of whether
1246	adjudication of guilt was withheld, or to which the applicant
1247	has pled guilty or nolo contendere. A criminal offense committed
1248	in another jurisdiction which would have been a felony or
1249	misdemeanor if committed in this state must be reported. If the
1250	applicant indicates that a criminal offense is under appeal and
1251	submits a copy of the notice for appeal of that criminal
1252	offense, the department must state that the criminal offense is
1253	under appeal if the criminal offense is reported in the
1254	applicant's profile. If the applicant indicates to the
1255	department that a criminal offense is under appeal, the
1256	applicant must, upon disposition of the appeal, submit to the
1257	department a copy of the final written order of disposition.
1258	8. A description of any final disciplinary action taken
1259	within the previous 10 years against the applicant by the agency
1260	regulating the profession that the applicant is or has been
1261	licensed to practice, whether in this state or in any other
1262	jurisdiction, by a specialty board that is recognized by the
1263	American Board of Medical Specialties, the American Osteopathic
1264	Association, or a similar national organization, or by a
1265	licensed hospital, health maintenance organization, prepaid
1266	health clinic, ambulatory surgical center, or nursing home.
1267	Disciplinary action includes resignation from or nonrenewal of
1268	medical staff membership or the restriction of privileges at a
1269	licensed hospital, health maintenance organization, prepaid
1270	health clinic, ambulatory surgical center, or nursing home taken
1271	in lieu of or in settlement of a pending disciplinary case
1272	related to competence or character. If the applicant indicates
1273	that the disciplinary action is under appeal and submits a copy
1274	of the document initiating an appeal of the disciplinary action,
1275	the department must state that the disciplinary action is under
1276	appeal if the disciplinary action is reported in the applicant's
1277	profile.
1278	9. Relevant professional qualifications as defined by the
1279	applicable board.
1280	Section 15 Section 456.041, Florida Statutes, is amended
1281	to read:
1282	456.041 Practitioner profile; creation.--
1283	(1)(a)Beginning July 1, 1999, the Department of Health
1284	shall compile the information submitted pursuant to s. 456.039
1285	into a practitioner profile of the applicant submitting the
1286	information, except that the Department of Health may develop a
1287	format to compile uniformly any information submitted under s.
1288	456.039(4)(b). Beginning July 1, 2001, the Department of Health
1289	may, and beginning July 1, 2004, shall,compile the information
1290	submitted pursuant to s. 456.0391 into a practitioner profile of
1291	the applicant submitting the information.
1292	(b) Each practitioner licensed under chapter 458 or
1293	chapter 459 must report to the Department of Health and the
1294	Board of Medicine or the Board of Osteopathic Medicine,
1295	respectively, all final disciplinary actions, sanctions by a
1296	governmental agency or a facility or entity licensed under state
1297	law, and claims or actions, as provided under s. 456.051, to
1298	which he or she is subject no later than 15 calendar days after
1299	such action or sanction is imposed. Failure to submit the
1300	requisite information within 15 calendar days in accordance with
1301	this paragraph shall subject the practitioner to discipline by
1302	the Board of Medicine or the Board of Osteopathic Medicine and a
1303	fine of $100 for each day that the information is not submitted
1304	after the expiration of the 15-day reporting period.
1305	(c) Within 15 days after receiving a report under
1306	paragraph (b), the department shall update the practitioner's
1307	profile in accordance with the requirements of subsection (7).
1308	(2) On the profile published under subsection (1), the
1309	department shall indicate whetherifthe information provided
1310	under s. 456.039(1)(a)7. or s. 456.0391(1)(a)7. is or isnot
1311	corroborated by a criminal history check conducted according to
1312	this subsection. If the information provided under s.
1313	456.039(1)(a)7. or s. 456.0391(1)(a)7. is corroborated by the
1314	criminal history check, the fact that the criminal history check
1315	was performed need not be indicated on the profile.The
1316	department, or the board having regulatory authority over the
1317	practitioner acting on behalf of the department, shall
1318	investigate any information received by the department or the
1319	board when it has reasonable grounds to believe that the
1320	practitioner has violated any law that relates to the
1321	practitioner's practice.
1322	(3) The Department of Health shallmayinclude in each
1323	practitioner's practitioner profile that criminal information
1324	that directly relates to the practitioner's ability to
1325	competently practice his or her profession. The department must
1326	include in each practitioner's practitioner profile the
1327	following statement: "The criminal history information, if any
1328	exists, may be incomplete; federal criminal history information
1329	is not available to the public." The department shall provide in
1330	each practitioner profile, for every final disciplinary action
1331	taken against the practitioner, a narrative description, written
1332	in plain English, that explains the administrative complaint
1333	filed against the practitioner and the final disciplinary action
1334	imposed on the practitioner. The department shall include a
1335	hyperlink to each final order listed on its Internet website
1336	report of dispositions of recent disciplinary actions taken
1337	against practitioners.
1338	(4) The Department of Health shall include, with respect
1339	to a practitioner licensed under chapter 458 or chapter 459, a
1340	statement of how the practitioner has elected to comply with the
1341	financial responsibility requirements of s. 458.320 or s.
1342	459.0085. The department shall include, with respect to
1343	practitioners subject to s. 456.048, a statement of how the
1344	practitioner has elected to comply with the financial
1345	responsibility requirements of that section. The department
1346	shall include, with respect to practitioners licensed under
1347	chapter 458, chapter 459, or chapter 461, information relating
1348	to liability actions which has been reported under s. 456.049 or
1349	s. 627.912 within the previous 10 years for any paid claim of
1350	$50,000 or morethat exceeds $5,000. Such claims information
1351	shall be reported in the context of comparing an individual
1352	practitioner's claims to the experience of other practitioners
1353	within the same specialty, or profession if the practitioner is
1354	not a specialist, to the extent such information is available to
1355	the Department of Health. The department shall include a
1356	hyperlink to all such comparison reports in such practitioner's
1357	profile on its Internet website.If information relating to a
1358	liability action is included in a practitioner's practitioner
1359	profile, the profile must also include the following statement:
1360	"Settlement of a claim may occur for a variety of reasons that
1361	do not necessarily reflect negatively on the professional
1362	competence or conduct of the practitioner. A payment in
1363	settlement of a medical malpractice action or claim should not
1364	be construed as creating a presumption that medical malpractice
1365	has occurred."
1366	(5) The Department of Health shallmay not include the
1367	date of adisciplinary action taken by a licensed hospital or an
1368	ambulatory surgical center, in accordance with the requirements
1369	of s. 395.0193, in the practitioner profile. Any practitioner
1370	disciplined under paragraph (1)(b) must report to the department
1371	the date the disciplinary action was imposed. The department
1372	shall state whether the action is related to professional
1373	competence and whether it is related to the delivery of services
1374	to a patient.
1375	(6) The Department of Health may include in the
1376	practitioner's practitioner profile any other information that
1377	is a public record of any governmental entity and that relates
1378	to a practitioner's ability to competently practice his or her
1379	profession. However, the department must consult with the board
1380	having regulatory authority over the practitioner before such
1381	information is included in his or her profile.
1382	(7) Upon the completion of a practitioner profile under
1383	this section, the Department of Health shall furnish the
1384	practitioner who is the subject of the profile a copy of it. The
1385	practitioner has a period of 30 days in which to review the
1386	profile and to correct any factual inaccuracies in it. The
1387	Department of Health shall make the profile available to the
1388	public at the end of the 30-day period. The department shall
1389	make the profiles available to the public through the World Wide
1390	Web and other commonly used means of distribution.
1391	(8) The Department of Health shall provide in each profile
1392	an easy-to-read explanation of any disciplinary action taken and
1393	the reason the sanction or sanctions were imposed.
1394	(9)(8)Making a practitioner profile available to the
1395	public under this section does not constitute agency action for
1396	which a hearing under s. 120.57 may be sought.
1397	Section 15. Section 456.042, Florida Statutes, is amended
1398	to read:
1399	456.042 Practitioner profiles; update.-- A practitioner
1400	must submit updates of required information within 15 days after
1401	the final activity that renders such information a fact.The
1402	Department of Health shall update each practitioner's
1403	practitioner profile periodically. An updated profile is subject
1404	to the same requirements as an original profile with respect to
1405	the period within which the practitioner may review the profile
1406	for the purpose of correcting factual inaccuracies.
1407	Section 16. Subsection (1) of section 456.049, Florida
1408	Statutes, is amended, and subsection (3) is added to said
1409	section, to read:
1410	456.049 Health care practitioners; reports on professional
1411	liability claims and actions.--
1412	(1) Any practitioner of medicine licensed pursuant to the
1413	provisions of chapter 458, practitioner of osteopathic medicine
1414	licensed pursuant to the provisions of chapter 459, podiatric
1415	physician licensed pursuant to the provisions of chapter 461, or
1416	dentist licensed pursuant to the provisions of chapter 466 shall
1417	report to the department any claim or action for damages for
1418	personal injury alleged to have been caused by error, omission,
1419	or negligence in the performance of such licensee's professional
1420	services or based on a claimed performance of professional
1421	services without consent if the claim was not covered by an
1422	insurer required to report under s. 627.912 andthe claim
1423	resulted in:
1424	(a) A final judgment of $50,000 or more or, with respect
1425	to a dentist licensed pursuant to chapter 466, a final judgment
1426	of $25,000 or morein any amount.
1427	(b) A settlement of $50,000 or more or, with respect to a
1428	dentist licensed pursuant to chapter 466, a settlement of
1429	$25,000 or morein any amount.
1430	(c) A final disposition not resulting in payment on behalf
1431	of the licensee.
1432
1433	Reports shall be filed with the department no later than 60 days
1434	following the occurrence of any event listed in paragraph (a),
1435	paragraph (b), or paragraph (c).
1436	(3) The department shall forward the information collected
1437	under this section to the Office of Insurance Regulation.
1438	Section 17. Section 456.051, Florida Statutes, is amended
1439	to read:
1440	456.051 Reports of professional liability actions;
1441	bankruptcies; Department of Health's responsibility to
1442	provide.--
1443	(1) The report of a claim or action for damages for
1444	personal injury which is required to be provided to the
1445	Department of Health under s. 456.049 or s. 627.912 is public
1446	information except for the name of the claimant or injured
1447	person, which remains confidential as provided in ss.
1448	456.049(2)(d) and 627.912(2)(e). The Department of Health shall,
1449	upon request, make such report available to any person. The
1450	department shall make such report available as a part of the
1451	practitioner's profile within 45 calendar days after receipt.
1452	(2) Any information in the possession of the Department of
1453	Health which relates to a bankruptcy proceeding by a
1454	practitioner of medicine licensed under chapter 458, a
1455	practitioner of osteopathic medicine licensed under chapter 459,
1456	a podiatric physician licensed under chapter 461, or a dentist
1457	licensed under chapter 466 is public information. The Department
1458	of Health shall, upon request, make such information available
1459	to any person. The department shall make such report available
1460	as a part of the practitioner's profile within 45 calendar days
1461	after receipt.
1462	Section 18. Paragraph (a) of subsection (7) of section
1463	456.057, Florida Statutes, is amended to read:
1464	456.057 Ownership and control of patient records; report
1465	or copies of records to be furnished.--
1466	(7)(a)1. The department may obtain patient records
1467	pursuant to a subpoena without written authorization from the
1468	patient if the department and the probable cause panel of the
1469	appropriate board, if any, find reasonable cause to believe that
1470	a health care practitioner has excessively or inappropriately
1471	prescribed any controlled substance specified in chapter 893 in
1472	violation of this chapter or any professional practice act or
1473	that a health care practitioner has practiced his or her
1474	profession below that level of care, skill, and treatment
1475	required as defined by this chapter or any professional practice
1476	act and also find that appropriate, reasonable attempts were
1477	made to obtain a patient release.
1478	2. The department may obtain patient records and insurance
1479	information pursuant to a subpoena without written authorization
1480	from the patient if the department and the probable cause panel
1481	of the appropriate board, if any, find reasonable cause to
1482	believe that a health care practitioner has provided inadequate
1483	medical care based on termination of insurance and also find
1484	that appropriate, reasonable attempts were made to obtain a
1485	patient release.
1486	3. The department may obtain patient records, billing
1487	records, insurance information, provider contracts, and all
1488	attachments thereto pursuant to a subpoena without written
1489	authorization from the patient if the department and probable
1490	cause panel of the appropriate board, if any, find reasonable
1491	cause to believe that a health care practitioner has submitted a
1492	claim, statement, or bill using a billing code that would result
1493	in payment greater in amount than would be paid using a billing
1494	code that accurately describes the services performed, requested
1495	payment for services that were not performed by that health care
1496	practitioner, used information derived from a written report of
1497	an automobile accident generated pursuant to chapter 316 to
1498	solicit or obtain patients personally or through an agent
1499	regardless of whether the information is derived directly from
1500	the report or a summary of that report or from another person,
1501	solicited patients fraudulently, received a kickback as defined
1502	in s. 456.054, violated the patient brokering provisions of s.
1503	817.505, or presented or caused to be presented a false or
1504	fraudulent insurance claim within the meaning of s.
1505	817.234(1)(a), and also find that, within the meaning of s.
1506	817.234(1)(a), patient authorization cannot be obtained because
1507	the patient cannot be located or is deceased, incapacitated, or
1508	suspected of being a participant in the fraud or scheme, and if
1509	the subpoena is issued for specific and relevant records.
1510	4. Notwithstanding subparagraphs 1.-3., when the
1511	department investigates a professional liability claim or
1512	undertakes action pursuant to s. 456.049 or s. 627.912, the
1513	department may obtain patient records pursuant to a subpoena
1514	without written authorization from the patient if the patient
1515	refuses to cooperate or attempts to obtain a patient release and
1516	failure to obtain the patient records would be detrimental to
1517	the investigation.
1518	Section 19. Section 456.0575, Florida Statutes, is created
1519	to read:
1520	456.0575 Duty to notify patients.-- Every licensed health
1521	care practitioner shall inform each patient, or an individual
1522	identified pursuant to s. 765.401(1), in person about adverse
1523	incidents that result in serious harm to the patient.
1524	Notification of outcomes of care that result in harm to the
1525	patient under this section shall not constitute an
1526	acknowledgement of admission of liability, nor can such
1527	notifications be introduced as evidence in any civil lawsuit.
1528	Section 20. Patient safety discount.-- A health care
1529	facility licensed pursuant to chapter 395, Florida Statutes, may
1530	apply to the Department of Financial Services for certification
1531	of any program that is recommended by the Florida Center for
1532	Excellence in Health Care to reduce adverse incidents, as
1533	defined in s. 395.0197, Florida Statutes, which result in the
1534	reduction of serious events at that facility. The department
1535	shall develop criteria for such certification. Insurers shall
1536	file with the department a discount in the rate or rates
1537	applicable for insurance coverage to reflect the effect of a
1538	certified program. A health care facility shall receive a
1539	discount in the rate or rates applicable for mandated basic
1540	insurance coverage required by law. In reviewing filings under
1541	this section, the department shall consider whether, and the
1542	extent to which, the program certified under this section is
1543	otherwise covered under a program of risk management offered by
1544	an insurance company or exchange or self-insurance plan
1545	providing medical professional liability coverage.
1546	Section 21. Subsection (4) is added to section 456.063,
1547	Florida Statutes, to read:
1548	456.063 Sexual misconduct; disqualification for license,
1549	certificate, or registration.--
1550	(4) Each board, or the department if there is no board,
1551	may adopt rules to implement the requirements for reporting
1552	allegations of sexual misconduct, including rules to determine
1553	the sufficiency of the allegations.
1554	Section 22. Subsection (4) of section 456.072, Florida
1555	Statutes, is amended, and subsection (7) is added to said
1556	section, to read:
1557	456.072 Grounds for discipline; penalties; enforcement.--
1558	(4) In anyaddition to any other discipline imposed
1559	throughfinal order, or citation, entered on or after July 1,
1560	2001, that imposes a penalty or other form of discipline
1561	pursuant to this section or discipline imposed through final
1562	order, or citation, entered on or after July 1, 2001,for a
1563	violation of any practice act, the board, or the department when
1564	there is no board, shall assess costs related to the
1565	investigation and prosecution of the case, including costs
1566	associated with an attorney's time. The amount of costs to be
1567	assessed shall be determined by the board, or the department
1568	when there is no board, following its consideration of an
1569	affidavit of itemized costs and any written objections thereto.
1570	In any case in whichwhere the board or the department imposesa
1571	fine or assessment of costs imposed by the board or department
1572	and the fine or assessmentis not paid within a reasonable time,
1573	such reasonable time to be prescribed in the rules of the board,
1574	or the department when there is no board, or in the order
1575	assessing such fines or costs, the department or the Department
1576	of Legal Affairs may contract for the collection of, or bring a
1577	civil action to recover, the fine or assessment.
1578	(7) In any formal administrative hearing conducted under
1579	s. 120.57(1), the board or department shall establish grounds
1580	for the discipline of a licensee by the greater weight of the
1581	evidence.
1582	Section 23. Subsections (1) and (5) of section 456.073,
1583	Florida Statutes, are amended to read:
1584	456.073 Disciplinary proceedings.-- Disciplinary
1585	proceedings for each board shall be within the jurisdiction of
1586	the department.
1587	(1) The department, for the boards under its jurisdiction,
1588	shall cause to be investigated any complaint that is filed
1589	before it if the complaint is in writing, signed by the
1590	complainant, and legally sufficient. A complaint is legally
1591	sufficient if it contains ultimate facts that show that a
1592	violation of this chapter, of any of the practice acts relating
1593	to the professions regulated by the department, or of any rule
1594	adopted by the department or a regulatory board in the
1595	department has occurred. In order to determine legal
1596	sufficiency, the department may require supporting information
1597	or documentation. The department may investigate, and the
1598	department or the appropriate board may take appropriate final
1599	action on, a complaint even though the original complainant
1600	withdraws it or otherwise indicates a desire not to cause the
1601	complaint to be investigated or prosecuted to completion. The
1602	department may investigate an anonymous complaint if the
1603	complaint is in writing and is legally sufficient, if the
1604	alleged violation of law or rules is substantial, and if the
1605	department has reason to believe, after preliminary inquiry,
1606	that the violations alleged in the complaint are true. The
1607	department may investigate a complaint made by a confidential
1608	informant if the complaint is legally sufficient, if the alleged
1609	violation of law or rule is substantial, and if the department
1610	has reason to believe, after preliminary inquiry, that the
1611	allegations of the complainant are true. The department may
1612	initiate an investigation if it has reasonable cause to believe
1613	that a licensee or a group of licensees has violated a Florida
1614	statute, a rule of the department, or a rule of a board. The
1615	department may investigate information filed pursuant to s.
1616	456.041(4) relating to liability actions with respect to health
1617	care practitioners licensed under chapter 458 and chapter 459
1618	which have been reported under s. 456.049 or s. 627.912 within
1619	the previous 5 years for any paid claim that exceeds $50,000.
1620	Except as provided in ss. 458.331(9), 459.015(9), 460.413(5),
1621	and 461.013(6), when an investigation of any subject is
1622	undertaken, the department shall promptly furnish to the subject
1623	or the subject's attorney a copy of the complaint or document
1624	that resulted in the initiation of the investigation. The
1625	subject may submit a written response to the information
1626	contained in such complaint or document within 20 days after
1627	service to the subject of the complaint or document. The
1628	subject's written response shall be considered by the probable
1629	cause panel. The right to respond does not prohibit the issuance
1630	of a summary emergency order if necessary to protect the public.
1631	However, if the secretary, or the secretary's designee, and the
1632	chair of the respective board or the chair of its probable cause
1633	panel agree in writing that such notification would be
1634	detrimental to the investigation, the department may withhold
1635	notification. The department may conduct an investigation
1636	without notification to any subject if the act under
1637	investigation is a criminal offense.
1638	(5)(a)A formal hearing before an administrative law judge
1639	from the Division of Administrative Hearings shall be held
1640	pursuant to chapter 120 if there are any disputed issues of
1641	material fact. The administrative law judge shall issue a
1642	recommended order pursuant to chapter 120. If any party raises
1643	an issue of disputed fact during an informal hearing, the
1644	hearing shall be terminated and a formal hearing pursuant to
1645	chapter 120 shall be held.
1646	(b) Notwithstanding s. 120.569(2), the department shall
1647	notify the Division of Administrative Hearings within 45 days
1648	after receipt of a petition or request for a hearing that the
1649	department has determined requires a formal hearing before an
1650	administrative law judge.
1651	Section 24. Subsections (1) and (2) of section 456.077,
1652	Florida Statutes, are amended to read:
1653	456.077 Authority to issue citations.--
1654	(1) Notwithstanding s. 456.073, the board, or the
1655	department if there is no board, shall adopt rules to permit the
1656	issuance of citations. The citation shall be issued to the
1657	subject and shall contain the subject's name and address, the
1658	subject's license number if applicable, a brief factual
1659	statement, the sections of the law allegedly violated, and the
1660	penalty imposed. The citation must clearly state that the
1661	subject may choose, in lieu of accepting the citation, to follow
1662	the procedure under s. 456.073. If the subject disputes the
1663	matter in the citation, the procedures set forth in s. 456.073
1664	must be followed. However, if the subject does not dispute the
1665	matter in the citation with the department within 30 days after
1666	the citation is served, the citation becomes a publicfinal
1667	order and does not constituteconstitutes discipline for a first
1668	offense, but does constitute discipline for a second or
1669	subsequent offense. The penalty shall be a fine or other
1670	conditions as established by rule.
1671	(2) The board, or the department if there is no board,
1672	shall adopt rules designating violations for which a citation
1673	may be issued. Such rules shall designate as citation violations
1674	those violations for which there is no substantial threat to the
1675	public health, safety, and welfare or no violation of standard
1676	of care involving injury to a patient. Violations for which a
1677	citation may be issued shall include violations of continuing
1678	education requirements; failure to timely pay required fees and
1679	fines; failure to comply with the requirements of ss. 381.026
1680	and 381.0261 regarding the dissemination of information
1681	regarding patient rights; failure to comply with advertising
1682	requirements; failure to timely update practitioner profile and
1683	credentialing files; failure to display signs, licenses, and
1684	permits; failure to have required reference books available; and
1685	all other violations that do not pose a direct and serious
1686	threat to the health and safety of the patient or involve a
1687	violation of standard of care that has resulted in injury to a
1688	patient.
1689	Section 25. Subsections (1) and (2) of section 456.078,
1690	Florida Statutes, are amended to read:
1691	456.078 Mediation.--
1692	(1) Notwithstanding the provisions of s. 456.073, the
1693	board, or the department when there is no board, shall adopt
1694	rules to designate which violations of the applicable
1695	professional practice act are appropriate for mediation. The
1696	board, or the department when there is no board, shallmay
1697	designate as mediation offenses those complaints where harm
1698	caused by the licensee is economic in nature, except any act or
1699	omission involving intentional misconduct,orcan be remedied by
1700	the licensee, is not a standard of care violation involving any
1701	type of injury to a patient, or does not result in an adverse
1702	incident. For the purposes of this section, an "adverse
1703	incident" means an event that results in:
1704	(a) The death of a patient;
1705	(b) Brain or spinal damage to a patient;
1706	(c) The performance of a surgical procedure on the wrong
1707	patient;
1708	(d) The performance of a wrong-site surgical procedure;
1709	(e) The performance of a surgical procedure that is
1710	medically unnecessary or otherwise unrelated to the patient's
1711	diagnosis or medical condition;
1712	(f) The surgical repair of damage to a patient resulting
1713	from a planned surgical procedure, which damage is not a
1714	recognized specific risk as disclosed to the patient and
1715	documented through the informed-consent process;
1716	(g) The performance of a procedure to remove unplanned
1717	foreign objects remaining from a surgical procedure; or
1718	(h) The performance of any other surgical procedure that
1719	breached the standard of care.
1720	(2) After the department determines a complaint is legally
1721	sufficient and the alleged violations are defined as mediation
1722	offenses, the department or any agent of the department may
1723	conduct informal mediation to resolve the complaint. If the
1724	complainant and the subject of the complaint agree to a
1725	resolution of a complaint within 14 days after contact by the
1726	mediator, the mediator shall notify the department of the terms
1727	of the resolution. The department or board shall take no further
1728	action unless the complainant and the subject each fail to
1729	record with the department an acknowledgment of satisfaction of
1730	the terms of mediation within 60 days of the mediator's
1731	notification to the department. A successful mediation which
1732	results in an award of $50,000 or less shall not constitute
1733	discipline.In the event the complainant and subject fail to
1734	reach settlement terms or to record the required acknowledgment,
1735	the department shall process the complaint according to the
1736	provisions of s. 456.073.
1737	Section 26. Civil immunity for members of or consultants
1738	to certain boards, committees, or other entities.--
1739	(1) Each member of, or health care professional consultant
1740	to, any committee, board, group, commission, or other entity
1741	shall be immune from civil liability for any act, decision,
1742	omission, or utterance done or made in performance of his or her
1743	duties while serving as a member of or consultant to such
1744	committee, board, group, commission, or other entity established
1745	and operated for purposes of quality improvement review,
1746	evaluation, and planning in a state-licensed health care
1747	facility. Such entities must function primarily to review,
1748	evaluate, or make recommendations relating to:
1749	(a) The duration of patient stays in health care
1750	facilities;
1751	(b) The professional services furnished with respect to
1752	the medical, dental, psychological, podiatric, chiropractic, or
1753	optometric necessity for such services;
1754	(c) The purpose of promoting the most efficient use of
1755	available health care facilities and services;
1756	(d) The adequacy or quality of professional services;
1757	(e) The competency and qualifications for professional
1758	staff privileges;
1759	(f) The reasonableness or appropriateness of charges made
1760	by or on behalf of health care facilities; or
1761	(g) Patient safety, including entering into contracts with
1762	patient safety organizations.
1763	(2) Such committee, board, group, commission, or other
1764	entity must be established in accordance with state law or in
1765	accordance with requirements of the Joint Commission on
1766	Accreditation of Healthcare Organizations, established and duly
1767	constituted by one or more public or licensed private hospitals
1768	or behavioral health agencies, or established by a governmental
1769	agency. To be protected by this section, the act, decision,
1770	omission, or utterance may not be made or done in bad faith or
1771	with malicious intent.
1772	Section 27. Patient safety data privilege.--
1773	(1) As used in this section, the term:
1774	(a) "Patient safety data" means reports made to patient
1775	safety organizations, including all health care data,
1776	interviews, memoranda, analyses, root cause analyses, products
1777	of quality assurance or quality improvement processes,
1778	corrective action plans, or information collected or created by
1779	a health care facility licensed under chapter 395, Florida
1780	Statutes, or a health care practitioner as defined in s.
1781	456.001(4), Florida Statutes, as a result of an occurrence
1782	related to the provision of health care services which
1783	exacerbates an existing medical condition or could result in
1784	injury, illness, or death.
1785	(b) "Patient safety organization" means any organization,
1786	group, or other entity that collects and analyzes patient safety
1787	data for the purpose of improving patient safety and health care
1788	outcomes and that is independent and not under the control of
1789	the entity that reports patient safety data.
1790	(2) Patient safety data shall not be subject to discovery
1791	or introduction into evidence in any civil or administrative
1792	action.
1793	(3) Unless otherwise provided by law, a patient safety
1794	organization shall promptly remove all patient-identifying
1795	information after receipt of a complete patient safety data
1796	report unless such organization is otherwise permitted by state
1797	or federal law to maintain such information. Patient safety
1798	organizations shall maintain the confidentiality of all patient-
1799	identifying information and may not disseminate such
1800	information, except as permitted by state or federal law.
1801	(4) The exchange of patient safety data among health care
1802	facilities licensed under chapter 395, Florida Statutes, or
1803	health care practitioners as defined in s. 456.001 (4), Florida
1804	Statutes, or patient safety organizations which does not
1805	identify any patient shall not constitute a waiver of any
1806	privilege established in this section.
1807	(5) Reporting of patient safety data to patient safety
1808	organizations does not abrogate obligations to make reports to
1809	the Department of Health, the Agency for Health Care
1810	Administration, or other state or federal regulatory agencies.
1811	(6) An employer may not take retaliatory action against an
1812	employee who in good faith makes a report of patient safety data
1813	to a patient safety organization.
1814	Section 28. Each board within the Department of Health
1815	which has jurisdiction over health care practitioners who are
1816	authorized to prescribe drugs may adopt by rule standards of
1817	practice for health care practitioners who are under that
1818	board's jurisdiction for the safe and ethical prescription of
1819	drugs to patients via the Internet or other electronic means.
1820	Section 29. The Office of Program Policy Analysis and
1821	Government Accountability and the Office of the Auditor General
1822	must jointly conduct an audit of the Department of Health's
1823	health care practitioner disciplinary process and closed claims
1824	that are filed with the department under s. 627.912, Florida
1825	Statutes. The Office of Program Policy Analysis and Government
1826	Accountability and the Office of the Auditor General shall
1827	submit a report to the Legislature by January 1, 2004.
1828	Section 30. Subsection (10) is added to section 458.320,
1829	Florida Statutes, subsection (8) of said section is renumbered
1830	as subsection (9), and a new subsection (8) is added to said
1831	section, to read:
1832	458.320 Financial responsibility.--
1833	(8) Notwithstanding any other provision of this section,
1834	the department shall suspend the license of any physician who
1835	does not have insurance as required by this section against whom
1836	has been entered a final judgment, arbitration award, or other
1837	order or who has entered into a settlement agreement to pay
1838	damages arising out of a claim for medical malpractice, if all
1839	appellate remedies have been exhausted and payment up to the
1840	amounts required by this section has not been made within 30
1841	days after the entering of such judgment, award, order, or
1842	agreement, until proof of payment is received by the department
1843	or a payment schedule has been agreed upon by the physician and
1844	the claimant and presented to the department. This subsection
1845	does not apply to a physician who has met the financial
1846	responsibility requirements in paragraphs (1)(b) and (2)(b).
1847	(10) Nothing in this section shall be construed as
1848	creating a civil cause of action against any hospital as a
1849	result of the failure of any physician with staff privileges to
1850	comply with the requirements of this section.
1851	Section 31. Paragraph (t) of subsection (1) and
1852	subsections (3) and (6) of section 458.331, Florida Statutes,
1853	are amended to read:
1854	458.331 Grounds for disciplinary action; action by the
1855	board and department.--
1856	(1) The following acts constitute grounds for denial of a
1857	license or disciplinary action, as specified in s. 456.072(2):
1858	(t) Gross or repeated malpractice or the failure to
1859	practice medicine with that level of care, skill, and treatment
1860	which is recognized by a reasonably prudent similar physician as
1861	being acceptable under similar conditions and circumstances. The
1862	board shall give great weight to the provisions of s. 766.102
1863	when enforcing this paragraph. As used in this paragraph,
1864	"repeated malpractice" includes, but is not limited to, three or
1865	more claims for medical malpractice within the previous 5-year
1866	period resulting in indemnities being paid in excess of $50,000
1867	$25,000each to the claimant in a judgment or settlement and
1868	which incidents involved negligent conduct by the physician. As
1869	used in this paragraph, "gross malpractice" or "the failure to
1870	practice medicine with that level of care, skill, and treatment
1871	which is recognized by a reasonably prudent similar physician as
1872	being acceptable under similar conditions and circumstances,"
1873	shall not be construed so as to require more than one instance,
1874	event, or act. Nothing in this paragraph shall be construed to
1875	require that a physician be incompetent to practice medicine in
1876	order to be disciplined pursuant to this paragraph.
1877	(3) In any administrative action against a physician which
1878	does not involve revocation or suspension of license, the
1879	division shall have the burden, by the greater weight of the
1880	evidence, to establish the existence of grounds for disciplinary
1881	action. The division shall establish grounds for revocation or
1882	suspension of license by clear and convincing evidence.
1883	(6) Upon the department's receipt from an insurer or self-
1884	insurer of a report of a closed claim against a physician
1885	pursuant to s. 627.912 or from a health care practitioner of a
1886	report pursuant to s. 456.049, or upon the receipt from a
1887	claimant of a presuit notice against a physician pursuant to s.
1888	766.106, the department shall review each report and determine
1889	whether it potentially involved conduct by a licensee that is
1890	subject to disciplinary action, in which case the provisions of
1891	s. 456.073 shall apply. However, if it is reported that a
1892	physician has had three or more claims with indemnities
1893	exceeding $50,000$25,000each within the previous 5-year
1894	period, the department shall investigate the occurrences upon
1895	which the claims were based and determine if action by the
1896	department against the physician is warranted.
1897	Section 32. Section 458.3311, Florida Statutes, is created
1898	to read:
1899	458.3311 Emergency procedures for disciplinary action.--
1900	Notwithstanding any other provision of law to the contrary:
1901	(1) Each physician must report to the Department of Health
1902	any judgment for medical negligence levied against the
1903	physician. The physician must make the report no later than 15
1904	days after the exhaustion of the last opportunity for any party
1905	to appeal the judgment or request a rehearing.
1906	(2) No later than 30 days after a physician has, within a
1907	60-month period, made three reports as required by subsection
1908	(1), the Department of Health shall initiate an emergency
1909	investigation and the Board of Medicine shall conduct an
1910	emergency probable cause hearing to determine whether the
1911	physician should be disciplined for a violation of s.
1912	458.331(1)(t) or any other relevant provision of law.
1913	Section 33. Subsection (11) is added to section 459.0085,
1914	Florida Statutes, subsection (9) of said section is renumbered
1915	as subsection (10), and a new subsection (9) is added to said
1916	section, to read:
1917	459.0085 Financial responsibility.--
1918	(9) Notwithstanding any other provision of this section,
1919	the department shall suspend the license of any osteopathic
1920	physician who does not have insurance as required by this
1921	section against whom has been entered a final judgment,
1922	arbitration award, or other order or who has entered into a
1923	settlement agreement to pay damages arising out of a claim for
1924	medical malpractice, if all appellate remedies have been
1925	exhausted and payment up to the amounts required by this section
1926	has not been made within 30 days after the entering of such
1927	judgment, award, order, or agreement, until proof of payment is
1928	received by the department or a payment schedule has been agreed
1929	upon by the osteopathic physician and the claimant and presented
1930	to the department. This subsection does not apply to an
1931	osteopathic physician who has met the financial responsibility
1932	requirements in paragraphs (1)(b) and (2)(b).
1933	(11) Nothing in this section shall be construed as
1934	creating a civil cause of action against any hospital as a
1935	result of the failure of any physician with staff privileges to
1936	comply with the requirements of this section.
1937	Section 34. Paragraph (x) of subsection (1) and
1938	subsections (3) and (6) of section 459.015, Florida Statutes,
1939	are amended to read:
1940	459.015 Grounds for disciplinary action; action by the
1941	board and department.--
1942	(1) The following acts constitute grounds for denial of a
1943	license or disciplinary action, as specified in s. 456.072(2):
1944	(x) Gross or repeated malpractice or the failure to
1945	practice osteopathic medicine with that level of care, skill,
1946	and treatment which is recognized by a reasonably prudent
1947	similar osteopathic physician as being acceptable under similar
1948	conditions and circumstances. The board shall give great weight
1949	to the provisions of s. 766.102 when enforcing this paragraph.
1950	As used in this paragraph, "repeated malpractice" includes, but
1951	is not limited to, three or more claims for medical malpractice
1952	within the previous 5-year period resulting in indemnities being
1953	paid in excess of $50,000$25,000each to the claimant in a
1954	judgment or settlement and which incidents involved negligent
1955	conduct by the osteopathic physician. As used in this paragraph,
1956	"gross malpractice" or "the failure to practice osteopathic
1957	medicine with that level of care, skill, and treatment which is
1958	recognized by a reasonably prudent similar osteopathic physician
1959	as being acceptable under similar conditions and circumstances"
1960	shall not be construed so as to require more than one instance,
1961	event, or act. Nothing in this paragraph shall be construed to
1962	require that an osteopathic physician be incompetent to practice
1963	osteopathic medicine in order to be disciplined pursuant to this
1964	paragraph. A recommended order by an administrative law judge or
1965	a final order of the board finding a violation under this
1966	paragraph shall specify whether the licensee was found to have
1967	committed "gross malpractice," "repeated malpractice," or
1968	"failure to practice osteopathic medicine with that level of
1969	care, skill, and treatment which is recognized as being
1970	acceptable under similar conditions and circumstances," or any
1971	combination thereof, and any publication by the board shall so
1972	specify.
1973	(3) In any administrative action against a physician which
1974	does not involve revocation or suspension of license, the
1975	division shall have the burden, by the greater weight of the
1976	evidence, to establish the existence of grounds for disciplinary
1977	action. The division shall establish grounds for revocation or
1978	suspension of license by clear and convincing evidence.
1979	(6) Upon the department's receipt from an insurer or self-
1980	insurer of a report of a closed claim against an osteopathic
1981	physician pursuant to s. 627.912 or from a health care
1982	practitioner of a report pursuant to s. 456.049, or upon the
1983	receipt from a claimant of a presuit notice against an
1984	osteopathic physician pursuant to s. 766.106, the department
1985	shall review each report and determine whether it potentially
1986	involved conduct by a licensee that is subject to disciplinary
1987	action, in which case the provisions of s. 456.073 shall apply.
1988	However, if it is reported that an osteopathic physician has had
1989	three or more claims with indemnities exceeding $50,000$25,000
1990	each within the previous 5-year period, the department shall
1991	investigate the occurrences upon which the claims were based and
1992	determine if action by the department against the osteopathic
1993	physician is warranted.
1994	Section 35. Section 459.0151, Florida Statutes, is created
1995	to read:
1996	459.0151 Emergency procedures for disciplinary action.--
1997	Notwithstanding any other provision of law to the contrary:
1998	(1) Each osteopathic physician must report to the
1999	Department of Health any judgment for medical negligence levied
2000	against the physician. The osteopathic physician must make the
2001	report no later than 15 days after the exhaustion of the last
2002	opportunity for any party to appeal the judgment or request a
2003	rehearing.
2004	(2) No later than 30 days after an osteopathic physician
2005	has, within a 60-month period, made three reports as required by
2006	subsection (1), the Department of Health shall initiate an
2007	emergency investigation and the Board of Osteopathic Medicine
2008	shall conduct an emergency probable cause hearing to determine
2009	whether the physician should be disciplined for a violation of
2010	s. 459.015(1)(x) or any other relevant provision of law.
2011	Section 36. Paragraph (s) of subsection (1) and paragraph
2012	(a) of subsection (5) of section 461.013, Florida Statutes, are
2013	amended to read:
2014	461.013 Grounds for disciplinary action; action by the
2015	board; investigations by department.--
2016	(1) The following acts constitute grounds for denial of a
2017	license or disciplinary action, as specified in s. 456.072(2):
2018	(s) Gross or repeated malpractice or the failure to
2019	practice podiatric medicine at a level of care, skill, and
2020	treatment which is recognized by a reasonably prudent podiatric
2021	physician as being acceptable under similar conditions and
2022	circumstances. The board shall give great weight to the
2023	standards for malpractice in s. 766.102 in interpreting this
2024	section. As used in this paragraph, "repeated malpractice"
2025	includes, but is not limited to, three or more claims for
2026	medical malpractice within the previous 5-year period resulting
2027	in indemnities being paid in excess of $50,000$10,000each to
2028	the claimant in a judgment or settlement and which incidents
2029	involved negligent conduct by the podiatric physicians. As used
2030	in this paragraph, "gross malpractice" or "the failure to
2031	practice podiatric medicine with the level of care, skill, and
2032	treatment which is recognized by a reasonably prudent similar
2033	podiatric physician as being acceptable under similar conditions
2034	and circumstances" shall not be construed so as to require more
2035	than one instance, event, or act.
2036	(5)(a) Upon the department's receipt from an insurer or
2037	self-insurer of a report of a closed claim against a podiatric
2038	physician pursuant to s. 627.912, or upon the receipt from a
2039	claimant of a presuit notice against a podiatric physician
2040	pursuant to s. 766.106, the department shall review each report
2041	and determine whether it potentially involved conduct by a
2042	licensee that is subject to disciplinary action, in which case
2043	the provisions of s. 456.073 shall apply. However, if it is
2044	reported that a podiatric physician has had three or more claims
2045	with indemnities exceeding $50,000$25,000each within the
2046	previous 5-year period, the department shall investigate the
2047	occurrences upon which the claims were based and determine if
2048	action by the department against the podiatric physician is
2049	warranted.
2050	Section 37. Paragraph (x) of subsection (1) of section
2051	466.028, Florida Statutes, is amended to read:
2052	466.028 Grounds for disciplinary action; action by the
2053	board.--
2054	(1) The following acts constitute grounds for denial of a
2055	license or disciplinary action, as specified in s. 456.072(2):
2056	(x) Being guilty of incompetence or negligence by failing
2057	to meet the minimum standards of performance in diagnosis and
2058	treatment when measured against generally prevailing peer
2059	performance, including, but not limited to, the undertaking of
2060	diagnosis and treatment for which the dentist is not qualified
2061	by training or experience or being guilty of dental malpractice.
2062	For purposes of this paragraph, it shall be legally presumed
2063	that a dentist is not guilty of incompetence or negligence by
2064	declining to treat an individual if, in the dentist's
2065	professional judgment, the dentist or a member of her or his
2066	clinical staff is not qualified by training and experience, or
2067	the dentist's treatment facility is not clinically satisfactory
2068	or properly equipped to treat the unique characteristics and
2069	health status of the dental patient, provided the dentist refers
2070	the patient to a qualified dentist or facility for appropriate
2071	treatment. As used in this paragraph, "dental malpractice"
2072	includes, but is not limited to, three or more claims within the
2073	previous 5-year period which resulted in indemnity being paid,
2074	or any single indemnity paid in excess of $25,000$5,000in a
2075	judgment or settlement, as a result of negligent conduct on the
2076	part of the dentist.
2077	Section 38. Subsection (2) of section 624.462, Florida
2078	Statutes, is amended to read:
2079	624.462 Commercial self-insurance funds.--
2080	(2) As used in ss. 624.460-624.488, "commercial self-
2081	insurance fund" or "fund" means a group of members, operating
2082	individually and collectively through a trust or corporation,
2083	that must be:
2084	(a) Established by:
2085	1. A not-for-profit trade association, industry
2086	association, or professional association of employers or
2087	professionals which has a constitution or bylaws, which is
2088	incorporated under the laws of this state, and which has been
2089	organized for purposes other than that of obtaining or providing
2090	insurance and operated in good faith for a continuous period of
2091	1 year;
2092	2. A self-insurance trust fund organized pursuant to s.
2093	627.357 and maintained in good faith for a continuous period of
2094	1 year for purposes other than that of obtaining or providing
2095	insurance pursuant to this section. Each member of a commercial
2096	self-insurance trust fund established pursuant to this
2097	subsection must maintain membership in the self-insurance trust
2098	fund organized pursuant to s. 627.357; or
2099	3. A group of 10 or more health care providers, as defined
2100	in s. %_%9%_%(4)(h); or
2101	4.3. A not-for-profit group comprised of no less than 10
2102	condominium associations as defined in s. 718.103(2), which is
2103	incorporated under the laws of this state, which restricts its
2104	membership to condominium associations only, and which has been
2105	organized and maintained in good faith for a continuous period
2106	of 1 year for purposes other than that of obtaining or providing
2107	insurance.
2108	(b)1. In the case of funds established pursuant to
2109	subparagraph (a)2. or subparagraph (a)4.3., operated pursuant to
2110	a trust agreement by a board of trustees which shall have
2111	complete fiscal control over the fund and which shall be
2112	responsible for all operations of the fund. The majority of the
2113	trustees shall be owners, partners, officers, directors, or
2114	employees of one or more members of the fund. The trustees shall
2115	have the authority to approve applications of members for
2116	participation in the fund and to contract with an authorized
2117	administrator or servicing company to administer the day-to-day
2118	affairs of the fund.
2119	2. In the case of funds established pursuant to
2120	subparagraph (a)1. or subparagraph (a)3., operated pursuant to a
2121	trust agreement by a board of trustees or as a corporation by a
2122	board of directors which board shall:
2123	a. Be responsible to members of the fund or beneficiaries
2124	of the trust or policyholders of the corporation;
2125	b. Appoint independent certified public accountants, legal
2126	counsel, actuaries, and investment advisers as needed;
2127	c. Approve payment of dividends to members;
2128	d. Approve changes in corporate structure; and
2129	e. Have the authority to contract with an administrator
2130	authorized under s. 626.88 to administer the day-to-day affairs
2131	of the fund including, but not limited to, marketing,
2132	underwriting, billing, collection, claims administration, safety
2133	and loss prevention, reinsurance, policy issuance, accounting,
2134	regulatory reporting, and general administration. The fees or
2135	compensation for services under such contract shall be
2136	comparable to the costs for similar services incurred by
2137	insurers writing the same lines of insurance, or where available
2138	such expenses as filed by boards, bureaus, and associations
2139	designated by insurers to file such data. A majority of the
2140	trustees or directors shall be owners, partners, officers,
2141	directors, or employees of one or more members of the fund.
2142	Section 39. Paragraph (a) of subsection (6) of section
2143	627.062, Florida Statutes, is amended and subsections (7), (8),
2144	(9), and (10) are added to said section, to read:
2145	627.062 Rate standards.--
2146	(6)(a) After any action with respect to a rate filing that
2147	constitutes agency action for purposes of the Administrative
2148	Procedure Act, except for a rate filing for medical malpractice
2149	insurance,an insurer may, in lieu of demanding a hearing under
2150	s. 120.57, require arbitration of the rate filing. Arbitration
2151	shall be conducted by a board of arbitrators consisting of an
2152	arbitrator selected by the department, an arbitrator selected by
2153	the insurer, and an arbitrator selected jointly by the other two
2154	arbitrators. Each arbitrator must be certified by the American
2155	Arbitration Association. A decision is valid only upon the
2156	affirmative vote of at least two of the arbitrators. No
2157	arbitrator may be an employee of any insurance regulator or
2158	regulatory body or of any insurer, regardless of whether or not
2159	the employing insurer does business in this state. The
2160	department and the insurer must treat the decision of the
2161	arbitrators as the final approval of a rate filing. Costs of
2162	arbitration shall be paid by the insurer.
2163	(7) Notwithstanding any other provision of this section,
2164	in matters relating to professional liability insurance coverage
2165	for medical negligence, any portion of a judgment entered as a
2166	result of a statutory or common-law bad faith action and any
2167	portion of a judgment entered that awards punitive damages
2168	against an insurer may not be included in the insurer's rate
2169	base and may not be used to justify a rate or rate change. In
2170	matters relating to professional liability insurance coverage
2171	for medical negligence, any portion of a settlement entered as a
2172	result of a statutory or common-law bad faith action identified
2173	as such and any portion of a settlement wherein an insurer
2174	agrees to pay specific punitive damages may not be used to
2175	justify a rate or rate change. The portion of the taxable costs
2176	and attorney's fees that is identified as being related to the
2177	bad faith and punitive damages in these judgments and
2178	settlements may not be included in the insurer's rate base and
2179	may not be utilized to justify a rate or rate change.
2180	(8) Each insurer writing professional liability insurance
2181	coverage for medical negligence must make a rate filing under
2182	this section with the Office of Insurance Regulation at least
2183	once each calendar year.
2184	(9) Medical malpractice insurance companies shall submit a
2185	rate filing to the Office of Insurance Regulation no earlier
2186	than 30 days, but no later than 120 days, after the date upon
2187	which this act becomes law.
2188	(10)(a) The provisions of this subsection apply only with
2189	respect to rates for medical malpractice insurance and shall
2190	control to the extent of any conflict with other provisions of
2191	this section.
2192	(b) Any portion of a judgment entered or settlement paid
2193	as a result of a statutory or common-law bad faith action and
2194	any portion of a judgment entered which awards punitive damages
2195	against an insurer may not be included in the insurer's rate
2196	base and shall not be used to justify a rate or rate change. Any
2197	common-law bad faith action identified as such and any portion
2198	of a settlement entered as a result of a statutory or portion of
2199	a settlement wherein an insurer agrees to pay specific punitive
2200	damages may not be used to justify a rate or rate change. The
2201	portion of the taxable costs and attorney's fees which is
2202	identified as being related to the bad faith and punitive
2203	damages in these judgments and settlements may not be included
2204	in the insurer's rate base and may not be utilized to justify a
2205	rate or rate change.
2206	(c) Upon reviewing a rate filing and determining whether
2207	the rate is excessive, inadequate, or unfairly discriminatory,
2208	the Office of Insurance Regulation shall consider, in accordance
2209	with generally accepted and reasonable actuarial techniques,
2210	past and present prospective loss experience, either using loss
2211	experience solely for this state or giving greater credibility
2212	to this state's loss data.
2213	(d) Rates shall be deemed excessive if, among other
2214	standards established by this section, the rate structure
2215	provides for replenishment of reserves or surpluses from
2216	premiums when the replenishment is attributable to investment
2217	losses.
2218	(e) The insurer must apply a discount or surcharge based
2219	on the health care provider's loss experience or shall establish
2220	an alternative method giving due consideration to the provider's
2221	loss experience. The insurer must include in the filing a copy
2222	of the surcharge or discount schedule or a description of the
2223	alternative method used and must provide a copy of such schedule
2224	or description, as approved by the office, to policyholders at
2225	the time of renewal and to prospective policyholders at the time
2226	of application for coverage.
2227	Section 40. Section 627.0662, Florida Statutes, is created
2228	to read:
2229	627.0662 Excessive profits for medical liability insurance
2230	prohibited.--
2231	(1) As used in this section:
2232	(a) “Medical liability insurance” means insurance that is
2233	written on a professional liability insurance policy issued to a
2234	health care practitioner or on a liability insurance policy
2235	covering medical malpractice claims issued to a health care
2236	facility.
2237	(b) “Medical liability insurer” means any insurance
2238	company or group of insurance companies writing medical
2239	liability insurance in this state and does not include any self-
2240	insurance fund or other nonprofit entity writing such insurance.
2241	(2) Each medical liability insurer shall file with the
2242	Office of Insurance Regulation, prior to July 1 of each year on
2243	forms prescribed by the office, the following data for medical
2244	liability insurance business in this state. The data shall
2245	include both voluntary and joint underwriting association
2246	business, as follows:
2247	(a) Calendar-year earned premium.
2248	(b) Accident-year incurred losses and loss adjustment
2249	expenses.
2250	(c) The administrative and selling expenses incurred in
2251	this state or allocated to this state for the calendar year.
2252	(d) Policyholder dividends incurred during the applicable
2253	calendar year.
2254	(3)(a) Excessive profit has been realized if there has
2255	been an underwriting gain for the 3 most recent calendar-
2256	accident years combined which is greater than the anticipated
2257	underwriting profit plus 5 percent of earned premiums for those
2258	calendar-accident years.
2259	(b) As used in this subsection with respect to any 3-year
2260	period, “anticipated underwriting profit” means the sum of the
2261	dollar amounts obtained by multiplying, for each rate filing of
2262	the insurer group in effect during such period, the earned
2263	premiums applicable to such rate filing during such period by
2264	the percentage factor included in such rate filing for profit
2265	and contingencies, such percentage factor having been determined
2266	with due recognition to investment income from funds generated
2267	by business in this state. Separate calculations need not be
2268	made for consecutive rate filings containing the same percentage
2269	factor for profits and contingencies.
2270	(4) Each medical liability insurer shall also file a
2271	schedule of medical liability insurance loss in this state and
2272	loss adjustment experience for each of the 3 most recent
2273	accident years. The incurred losses and loss adjustment expenses
2274	shall be valued as of March 31 of the year following the close
2275	of the accident year, developed to an ultimate basis, and at two
2276	12-month intervals thereafter, each developed to an ultimate
2277	basis, to the extent that a total of three evaluations is
2278	provided for each accident year. The first year to be so
2279	reported shall be accident year 2004, such that the reporting of
2280	3 accident years will not take place until accident years 2005
2281	and 2006 have become available.
2282	(5) Each insurer group's underwriting gain or loss for
2283	each calendar-accident year shall be computed as follows: the
2284	sum of the accident-year incurred losses and loss adjustment
2285	expenses as of March 31 of the following year, developed to an
2286	ultimate basis, plus the administrative and selling expenses
2287	incurred in the calendar year, plus policyholder dividends
2288	applicable to the calendar year, shall be subtracted from the
2289	calendar-year earned premium to determine the underwriting gain
2290	or loss.
2291	(6) For the 3 most recent calendar-accident years, the
2292	underwriting gain or loss shall be compared to the anticipated
2293	underwriting profit.
2294	(7) If the medical liability insurer has realized an
2295	excessive profit, the office shall order a return of the
2296	excessive amounts to policyholders after affording the insurer
2297	an opportunity for hearing and otherwise complying with the
2298	requirements of chapter 120. Such excessive amounts shall be
2299	refunded to policyholders in all instances unless the insurer
2300	affirmatively demonstrates to the office that the refund of the
2301	excessive amounts will render the insurer or a member of the
2302	insurer group financially impaired or will render it insolvent.
2303	(8) The excessive amount shall be refunded to
2304	policyholders on a pro rata basis in relation to the final
2305	compilation year earned premiums to the voluntary medical
2306	liability insurance policyholders of record of the insurer group
2307	on December 31 of the final compilation year.
2308	(9) Any return of excessive profits to policyholders under
2309	this section shall be provided in the form of a cash refund or a
2310	credit towards the future purchase of insurance.
2311	(10)(a) Cash refunds to policyholders may be rounded to
2312	the nearest dollar.
2313	(b) Data in required reports to the office may be rounded
2314	to the nearest dollar.
2315	(c) Rounding, if elected by the insurer group, shall be
2316	applied consistently.
2317	(11)(a) Refunds to policyholders shall be completed as
2318	follows:
2319	1. If the insurer elects to make a cash refund, the refund
2320	shall be completed within 60 days after entry of a final order
2321	determining that excessive profits have been realized; or
2322	2. If the insurer elects to make refunds in the form of a
2323	credit to renewal policies, such credits shall be applied to
2324	policy renewal premium notices which are forwarded to insureds
2325	more than 60 calendar days after entry of a final order
2326	determining that excessive profits have been realized. If an
2327	insurer has made this election but an insured thereafter cancels
2328	his or her policy or otherwise allows the policy to terminate,
2329	the insurer group shall make a cash refund not later than 60
2330	days after termination of such coverage.
2331	(b) Upon completion of the renewal credits or refund
2332	payments, the insurer shall immediately certify to the office
2333	that the refunds have been made.
2334	(12) Any refund or renewal credit made pursuant to this
2335	section shall be treated as a policyholder dividend applicable
2336	to the year in which it is incurred, for purposes of reporting
2337	under this section for subsequent years.
2338	Section 41. Subsection (10) of section 627.357, Florida
2339	Statutes, is amended to read:
2340	627.357 Medical malpractice self-insurance.--
2341	(10)(a) An application to form a self-insurance fund under
2342	this section must be filed with the Office of Insurance
2343	Regulation.
2344	(b) The Office of Insurance Regulation must ensure that
2345	self-insurance funds remain solvent and provide insurance
2346	coverage purchased by participants. The Financial Services
2347	Commission may adopt rules pursuant to ss. 120.536(1) and 120.54
2348	to implement this subsectionA self-insurance fund may not be
2349	formed under this section after October 1, 1992.
2350	Section 42. Section 627.3575, Florida Statutes, is created
2351	to read:
2352	627.3575 Health Care Professional Liability Insurance
2353	Facility.--
2354	(1) FACILITY CREATED; PURPOSE; STATUS.-- There is created
2355	the Health Care Professional Liability Insurance Facility. The
2356	facility is intended to meet ongoing availability and
2357	affordability problems relating to liability insurance for
2358	health care professionals by providing an affordable, self-
2359	supporting source of excess insurance coverage for those
2360	professionals who are willing and able to self-insure for
2361	smaller losses. The facility shall operate on a not-for-profit
2362	basis. The facility is self-funding and is intended to serve a
2363	public purpose but is not a state agency or program, and no
2364	activity of the facility shall create any state liability.
2365	(2) GOVERNANCE; POWERS.--
2366	(a) The facility shall operate under a seven-member board
2367	of governors consisting of the Secretary of Health, three
2368	members appointed by the Governor, and three members appointed
2369	by the Chief Financial Officer. The board shall be chaired by
2370	the Secretary of Health. The secretary shall serve by virtue of
2371	his or her office, and the other members of the board shall
2372	serve terms concurrent with the term of office of the official
2373	who appointed them. Any vacancy on the board shall be filled in
2374	the same manner as the original appointment. Members serve at
2375	the pleasure of the official who appointed them. Members are not
2376	eligible for compensation for their service on the board, but
2377	the facility may reimburse them for per diem and travel expenses
2378	at the same levels as are provided in s. 112.061 for state
2379	employees.
2380	(b) The facility shall have such powers as are necessary
2381	to operate as an insurer, including the power to:
2382	1. Sue and be sued.
2383	2. Hire such employees and retain such consultants,
2384	attorneys, actuaries, and other professionals as it deems
2385	appropriate.
2386	3. Contract with such service providers as it deems
2387	appropriate.
2388	4. Maintain offices appropriate to the conduct of its
2389	business.
2390	5. Take such other actions as are necessary or appropriate
2391	in fulfillment of its responsibilities under this section.
2392	(3) COVERAGE PROVIDED.-- The facility shall provide
2393	liability insurance coverage for health care professionals. The
2394	facility shall allow policyholders to select from policies with
2395	deductibles of $25,000 per claim, $50,000 per claim, and
2396	$100,000 per claim and with coverage limits of $250,000 per
2397	claim and $750,000 annual aggregate and $1 million per claim and
2398	$3 million annual aggregate. To the greatest extent possible,
2399	the terms and conditions of the policies shall be consistent
2400	with terms and conditions commonly used by professional
2401	liability insurers. The facility shall offer policies to cover
2402	health care professionals who have retired from practice or
2403	maintain a part-time practice as set forth herein. For health
2404	care professionals who meet the following requirements, the
2405	premiums for such policies shall be no more than 50% of the cost
2406	of premiums for similar specialties for health care
2407	professionals who meet each of the following requirements:
2408	(a) The health care professional has held an active
2409	license to practice in this state or another state or some
2410	combination thereof for more than 15 years.
2411	(b) The health care professional has either retired from
2412	the practice of medicine or maintains a part-time practice of no
2413	more than 1,000 patient contact hours per year.
2414	(c) The health care professional has had no more than two
2415	claims for medical malpractice resulting in an indemnity
2416	exceeding $50,000 each within the previous 5-year period.
2417	(d) The health care professional has not been convicted
2418	of, or pled guilty or nolo contendere to, any criminal violation
2419	specified in this chapter or the medical practice act of any
2420	other state.
2421	(e) The health care professional has not been subject
2422	within the last 10 years of practice to license revocation or
2423	suspension for any period of time; probation for a period of 3
2424	years or longer; or a fine of $500 or more for a violation of
2425	this chapter or the medical practice act of another
2426	jurisdiction. The regulatory agency's acceptance of a health
2427	care professional's relinquishment of a license, stipulation,
2428	consent order, or other settlement, offered in response to or in
2429	anticipation of the filing of administrative charges against the
2430	health care professional's license, shall be construed as action
2431	against the health care professional's license for the purposes
2432	of this paragraph.
2433	(f) The health care professional has submitted a form
2434	supplying necessary information as required by the department
2435	and an affidavit affirming compliance with the provisions of
2436	this subsection.
2437	(g) The health care professional submits biennially to the
2438	facility certification stating compliance with the provisions of
2439	this subsection. The health care professional shall, upon
2440	request, demonstrate to the facility information verifying
2441	compliance with this subsection.
2442	(4) ELIGIBILITY; TERMINATION.--
2443	(a) Any health care professional is eligible for coverage
2444	provided by the facility if the professional at all times
2445	maintains either:
2446	1. An escrow account consisting of cash or assets eligible
2447	for deposit under s. 625.52 in an amount equal to the deductible
2448	amount of the policy; or
2449	2. An unexpired, irrevocable letter of credit, established
2450	pursuant to chapter 675, in an amount not less than the
2451	deductible amount of the policy. The letter of credit shall be
2452	payable to the health care professional as beneficiary upon
2453	presentment of a final judgment indicating liability and
2454	awarding damages to be paid by the health care professional or
2455	upon presentment of a settlement agreement signed by all parties
2456	to such agreement when such final judgment or settlement is a
2457	result of a claim arising out of the rendering of, or the
2458	failure to render, medical care and services. Such letter of
2459	credit shall be nonassignable and nontransferable. Such letter
2460	of credit shall be issued by any bank or savings association
2461	organized and existing under the laws of this state or any bank
2462	or savings association organized under the laws of the United
2463	States that has its principal place of business in this state or
2464	has a branch office which is authorized under the laws of this
2465	state or of the United States to receive deposits in this state.
2466	(b) The eligibility of a health care professional for
2467	coverage terminates upon:
2468	1. The failure of the professional to comply with
2469	paragraph (a);
2470	2. The failure of the professional to timely pay premiums
2471	or assessments; or
2472	3. The commission of any act of fraud in connection with
2473	the policy, as determined by the board of governors.
2474	(c) The board of governors, in its discretion, may
2475	reinstate the eligibility of a health care professional whose
2476	eligibility has terminated pursuant to paragraph (b) upon
2477	determining that the professional has subsequently complied with
2478	paragraph (a) or has paid the overdue premiums or assessments.
2479	Eligibility may be reinstated in the case of fraud only if the
2480	board determines that its initial determination of fraud was in
2481	error.
2482	(5) PREMIUMS; ASSESSMENTS.--
2483	(a) The facility shall charge the actuarially indicated
2484	premium for the coverage provided and shall retain the services
2485	of consulting actuaries to prepare its rate filings. The
2486	facility shall not provide dividends to policyholders, and, to
2487	the extent that premiums are more than the amount required to
2488	cover claims and expenses, such excess shall be retained by the
2489	facility for payment of future claims. In the event of
2490	dissolution of the facility, any amounts not required as a
2491	reserve for outstanding claims shall be transferred to the
2492	policyholders of record as of the last day of operation.
2493	(b) To ensure that the facility has the funds to pay
2494	claims, the facility shall receive:
2495	1. From each judgment awarded and settlement agreed to
2496	from which a claim will be paid in whole or in part by the
2497	facility, the facility shall retain one percent of its portion
2498	of the award or settlement for deposit into a separate account
2499	for guaranteeing payment of claims.
2500	2. A surcharge of $100 on each medical malpractice policy
2501	issued or renewed after July 1, 2003.
2502	(6) REGULATION; APPLICABILITY OF OTHER STATUTES.--
2503	(a) The facility shall operate pursuant to a plan of
2504	operation approved by order of the Office of Insurance
2505	Regulation of the Financial Services Commission. The board of
2506	governors may at any time adopt amendments to the plan of
2507	operation and submit the amendments to the Office of Insurance
2508	Regulation for approval.
2509	(b) The facility is subject to regulation by the Office of
2510	Insurance Regulation of the Financial Services Commission in the
2511	same manner as other insurers, except that, in recognition of
2512	the fact that its ability to levy assessments against its own
2513	policyholders is a substitute for the protections ordinarily
2514	afforded by such statutory requirements, the facility is exempt
2515	from statutory requirements relating to surplus as to
2516	policyholders.
2517	(c) The facility is not subject to part II of chapter 631,
2518	relating to the Florida Insurance Guaranty Association.
2519	(7) STARTUP PROVISIONS.--
2520	(a) It is the intent of the Legislature that the facility
2521	begin providing coverage no later than January 1, 2004.
2522	(b) The Governor and the Chief Financial Officer shall
2523	make their appointments to the board of governors of the
2524	facility no later than August 1, 2003. Until the board is
2525	appointed, the Secretary of Health may perform ministerial acts
2526	on behalf of the facility as chair of the board of governors.
2527	(c) Until the facility is able to hire permanent staff and
2528	enter into contracts for professional services, the office of
2529	the Secretary of Health shall provide support services to the
2530	facility.
2531	(d) In order to provide startup funds for the facility,
2532	the board of governors may incur debt or enter into agreements
2533	for lines of credit, provided that the sole source of funds for
2534	repayment of any debt is future premium revenues of the
2535	facility. The amount of such debt or lines of credit may not
2536	exceed $10 million.
2537	Section 43. Section 627.358, Florida Statutes, is created
2538	to read:
2539	627.358 Medical malpractice insurance; part-time
2540	coverage.-- Insurance carriers shall be permitted to offer
2541	policies to cover health care professionals who have retired
2542	from practice or maintain a part-time practice as set forth
2543	herein. For health care professionals who meet each of the
2544	following requirements, the premiums for such policies shall be
2545	no more than 50 percent of the cost of premiums for similar
2546	specialties for health care professionals who do meet each of
2547	the following requirements:
2548	(1) The health care professional has held an active
2549	license to practice in this state or another state or some
2550	combination thereof for more than 15 years.
2551	(2) The health care professional has either retired from
2552	the practice of medicine or maintains a part-time practice of no
2553	more than 1,000 patient contact hours per year.
2554	(3) The health care professional has had no more than two
2555	claims for medical malpractice resulting in an indemnity
2556	exceeding $50,000 each within the previous 5-year period.
2557	(4) The health care professional has not been convicted
2558	of, or pled guilty or nolo contendere to, any criminal violation
2559	specified in this chapter or the medical practice act of any
2560	other state.
2561	(5) The health care professional has not been subject
2562	within the last 10 years of practice to license revocation or
2563	suspension for any period of time; probation for a period of 3
2564	years or longer; or a fine of $500 or more for a violation of
2565	this chapter or the medical practice act of another
2566	jurisdiction. The regulatory agency's acceptance of a health
2567	care professional's relinquishment of a license, stipulation,
2568	consent order, or other settlement, offered in response to or in
2569	anticipation of the filing of administrative charges against the
2570	health care professional's license, shall be construed as action
2571	against the health care professional's license for the purposes
2572	of this subsection.
2573	(6) The health care professional has submitted a form
2574	supplying necessary information as required by the department
2575	and an affidavit affirming compliance with the provisions of
2576	this section.
2577	(7) The health care professional submits biennially to his
2578	or her insurance provider certification stating compliance with
2579	the provisions of this section. The health care professional
2580	shall, upon request, demonstrate to the Office of Insurance
2581	Regulation information verifying compliance with this section.
2582	Section 44. Section 627.359, Florida Statutes, is created
2583	to read:
2584	627.359 Discounts on medical malpractice liability
2585	insurance.--
2586	(1)(a) Medical malpractice insurance providers, including
2587	the Health Care Professional Liability Insurance Facility, shall
2588	provide a 20 percent discount on premiums for health care
2589	professionals who implement a system wherein the professional
2590	enters medication orders using a computer linked to prescribing
2591	error prevention software.
2592	(b) The Office of Insurance Regulation shall designate
2593	software vendors who meet the requirements of paragraph (a).
2594	(2)(a) Medical malpractice insurance providers, including
2595	the Health Care Professional Liability Insurance Facility, shall
2596	provide a 10 percent discount on premiums for health care
2597	professionals who implement a system wherein patients are only
2598	referred to a hospital based on scientifically valid criteria.
2599	(b) The Agency for Health Care Administration shall
2600	develop criteria that meet the requirements of paragraph (a).
2601	Section 45. Paragraph (c) of subsection (1) and subsection
2602	(3) of section 627.4147, Florida Statutes, are amended, and
2603	paragraph (d) is added to subsection (1) of said section, to
2604	read:
2605	627.4147 Medical malpractice insurance contracts.--
2606	(1) In addition to any other requirements imposed by law,
2607	each self-insurance policy as authorized under s. 627.357 or
2608	insurance policy providing coverage for claims arising out of
2609	the rendering of, or the failure to render, medical care or
2610	services, including those of the Florida Medical Malpractice
2611	Joint Underwriting Association, shall include:
2612	(c) A clause requiring the insurer or self-insurer to
2613	notify the insured no less than 9060days prior to the
2614	effective date of cancellation of the policy or contract and, in
2615	the event of a determination by the insurer or self-insurer not
2616	to renew the policy or contract, to notify the insured no less
2617	than 9060days prior to the end of the policy or contract
2618	period. If cancellation or nonrenewal is due to nonpayment or
2619	loss of license, 10 days' notice is required.
2620	(d) A clause requiring the insurer or self-insurer to
2621	notify the insured no less than 60 days prior to the effective
2622	date of a rate increase. The provisions of s. 627.4133 shall
2623	apply to such notice and to the failure of the insurer to
2624	provide such notice to the extent not in conflict with this
2625	section.
2626	(3) This section shall apply to all policies issued or
2627	renewed after October 1, 20031985.
2628	Section 46. Section 627.41491, Florida Statutes, is
2629	created to read:
2630	627.41491 Medical malpractice rate comparison.-- The
2631	Office of Insurance Regulation shall annually publish a
2632	comparison of the rate in effect for each medical malpractice
2633	insurer and self-insurer and the Florida Medical Malpractice
2634	Joint Underwriting Association. Such rate comparison shall be
2635	made available to the public through the Internet and other
2636	commonly used means of distribution no later than July 1 of each
2637	year.
2638	Section 47. Section 627.41492, Florida Statutes, is
2639	created to read:
2640	627.41492 Annual medical malpractice report.-- The Office
2641	of Insurance Regulation shall prepare an annual report by
2642	October 1 of each year, which shall be available to the public
2643	and posted on the Internet, which includes the following
2644	information:
2645	(1) A summary and analysis of the closed claim information
2646	required to be reported pursuant to s. %_%10%_%.
2647	(2) A summary and analysis of the annual and quarterly
2648	financial reports filed by each insurer writing medical
2649	malpractice insurance in the state.
2650	Section 48. Section 627.41493, Florida Statutes, is
2651	created to read:
2652	627.41493 Insurance rate rollback.--
2653	(1) For medical malpractice insurance policies issued or
2654	renewed on or after July 1, 2003, and before July 1, 2004, every
2655	insurer, including the Florida Medical Malpractice Joint
2656	Underwriting Association, shall reduce its rates and premiums by
2657	25 percent. The lower rates must be in effect for at least 12
2658	months and may not be raised by more than 15 percent after the
2659	expiration of those 12 months. Thereafter, there will be
2660	consideration for a physician, hospital, other health care
2661	professional, or other health care facility to receive a credit
2662	against the rate or rates applicable to their medical
2663	malpractice insurance, consistent with the level of such
2664	discount set in rule by the Financial Services Commission. In
2665	developing such rules, the commission may consider whether, and
2666	the extent to which, the types of programs approved under this
2667	act are otherwise covered under a program of risk management
2668	offered by the insurer.
2669	(2) The Financial Services Commission may adopt rules to
2670	implement the provisions of this section.
2671	Section 49. The Office of Program Policy Analysis and
2672	Government Accountability shall complete a study of the
2673	eligibility requirements for a birth to be covered under the
2674	Florida Birth-Related Neurological Injury Compensation
2675	Association and submit a report to the Legislature by January 1,
2676	2004, recommending whether the statutory criteria for a claim to
2677	qualify for referral to the Florida Birth-Related Neurological
2678	Injury Compensation Association under s. 766.302, Florida
2679	Statutes, should be modified.
2680	Section 50. Subsections (1) and (4) and paragraph (n) of
2681	subsection (2) of section 627.912, Florida Statutes, are amended
2682	to read:
2683	627.912 Professional liability claims and actions; reports
2684	by insurers.--
2685	(1)(a)Each self-insurer authorized under s. 627.357 and
2686	each insurer or joint underwriting association providing
2687	professional liability insurance to a practitioner of medicine
2688	licensed under chapter 458, to a practitioner of osteopathic
2689	medicine licensed under chapter 459, to a podiatric physician
2690	licensed under chapter 461, to a dentist licensed under chapter
2691	466, to a hospital licensed under chapter 395, to a crisis
2692	stabilization unit licensed under part IV of chapter 394, to a
2693	health maintenance organization certificated under part I of
2694	chapter 641, to clinics included in chapter 390, to an
2695	ambulatory surgical center as defined in s. 395.002, or to a
2696	member of The Florida Bar shall report in duplicate to the
2697	Department of Insurance any claim or action for damages for
2698	personal injuries claimed to have been caused by error,
2699	omission, or negligence in the performance of such insured's
2700	professional services or based on a claimed performance of
2701	professional services without consent, if the claim resulted in:
2702	1.(a)A final judgment in any amount.
2703	2.(b)A settlement in any amount.
2704
2705	Reports shall be filed with the department.
2706	(b) In addition to the requirements of paragraph (a), if
2707	the insured party is licensed under chapter 395, chapter 458,
2708	chapter 459, chapter 461, or chapter 466, the insurer shall
2709	report in duplicate to the Office of Insurance Regulation any
2710	other disposition of the claim, including, but not limited to, a
2711	dismissal. If the insured is licensed under chapter 458, chapter
2712	459, or chapter 461, any claim that resulted in a final judgment
2713	or settlement in the amount of $50,000 or more shall be reported
2714	to the Department of Health no later than 30 days following the
2715	occurrence of that event. If the insured is licensed under
2716	chapter 466, any claim that resulted in a final judgment or
2717	settlement in the amount of $25,000 or more shall be reported to
2718	the Department of Health no later than 30 days following the
2719	occurrence of that eventand, if the insured party is licensed
2720	under chapter 458, chapter 459, chapter 461, or chapter 466,
2721	with the Department of Health, no later than 30 days following
2722	the occurrence of any event listed in paragraph (a) or paragraph
2723	(b). The Department of Health shall review each report and
2724	determine whether any of the incidents that resulted in the
2725	claim potentially involved conduct by the licensee that is
2726	subject to disciplinary action, in which case the provisions of
2727	s. 456.073 shall apply. The Department of Health, as part of the
2728	annual report required by s. 456.026, shall publish annual
2729	statistics, without identifying licensees, on the reports it
2730	receives, including final action taken on such reports by the
2731	Department of Health or the appropriate regulatory board.
2732	(2) The reports required by subsection (1) shall contain:
2733	(n) Any other information required by the department to
2734	analyze and evaluate the nature, causes, location, cost, and
2735	damages involved in professional liability cases. The Financial
2736	Services Commission shall adopt by rule requirements for
2737	additional information to assist the Office of Insurance
2738	Regulation in its analysis and evaluation of the nature, causes,
2739	location, cost, and damages involved in professional liability
2740	cases reported by insurers under this section.
2741	(4) There shall be no liability on the part of, and no
2742	cause of action of any nature shall arise against, any insurer
2743	reporting hereunder or its agents or employees or the department
2744	or its employees for any action taken by them under this
2745	section. The department shallmayimpose a fine of $250 per day
2746	per case, but not to exceed a total of $10,000$1,000per case,
2747	against an insurer that violates the requirements of this
2748	section. This subsection applies to claims accruing on or after
2749	October 1, 1997.
2750	Section 51. Section 627.9121, Florida Statutes, is created
2751	to read:
2752	627.9121 Required reporting of claims; penalties.-- Each
2753	entity that makes payment under a policy of insurance, self-
2754	insurance, or otherwise in settlement, partial settlement, or
2755	satisfaction of a judgment in a medical malpractice action or
2756	claim that is required to report information to the National
2757	Practitioner Data Bank under 42 U.S.C. s. 11131 must also report
2758	the same information to the Office of Insurance Regulation. The
2759	office shall include such information in the data that it
2760	compiles under s. 627.912. The office must compile and review
2761	the data collected pursuant to this section and must assess an
2762	administrative fine on any entity that fails to fully comply
2763	with such reporting requirements.
2764	Section 52. Section 766.102, Florida Statutes, is amended
2765	to read:
2766	766.102 Medical negligence; standards of recovery.--
2767	(1) In any action for recovery of damages based on the
2768	death or personal injury of any person in which it is alleged
2769	that such death or injury resulted from the negligence of a
2770	health care provider as defined in s. 766.101(1)(b)s.
2771	768.50(2)(b), the claimant shall have the burden of proving by
2772	the greater weight of evidence that the alleged actions of the
2773	health care provider represented a breach of the prevailing
2774	professional standard of care for that health care provider. The
2775	prevailing professional standard of care for a given health care
2776	provider shall be that level of care, skill, and treatment
2777	which, in light of all relevant surrounding circumstances, is
2778	recognized as acceptable and appropriate by reasonably prudent
2779	similar health care providers.
2780	(2)(a) If the health care provider whose negligence is
2781	claimed to have created the cause of action is not certified by
2782	the appropriate American board as being a specialist, is not
2783	trained and experienced in a medical specialty, or does not hold
2784	himself or herself out as a specialist, a "similar health care
2785	provider" is one who:
2786	1. Is licensed by the appropriate regulatory agency of
2787	this state;
2788	2. Is trained and experienced in the same discipline or
2789	school of practice; and
2790	3. Practices in the same or similar medical community.
2791	(b) If the health care provider whose negligence is
2792	claimed to have created the cause of action is certified by the
2793	appropriate American board as a specialist, is trained and
2794	experienced in a medical specialty, or holds himself or herself
2795	out as a specialist, a "similar health care provider" is one
2796	who:
2797	1. Is trained and experienced in the same specialty; and
2798	2. Is certified by the appropriate American board in the
2799	same specialty.
2800
2801	However, if any health care provider described in this paragraph
2802	is providing treatment or diagnosis for a condition which is not
2803	within his or her specialty, a specialist trained in the
2804	treatment or diagnosis for that condition shall be considered a
2805	"similar health care provider."
2806	(c) The purpose of this subsection is to establish a
2807	relative standard of care for various categories and
2808	classifications of health care providers. Any health care
2809	provider may testify as an expert in any action if he or she:
2810	1. Is a similar health care provider pursuant to paragraph
2811	(a) or paragraph (b); or
2812	2. Is not a similar health care provider pursuant to
2813	paragraph (a) or paragraph (b) but, to the satisfaction of the
2814	court, possesses sufficient training, experience, and knowledge
2815	as a result of practice or teaching in the specialty of the
2816	defendant or practice or teaching in a related field of
2817	medicine, so as to be able to provide such expert testimony as
2818	to the prevailing professional standard of care in a given field
2819	of medicine. Such training, experience, or knowledge must be as
2820	a result of the active involvement in the practice or teaching
2821	of medicine within the 5-year period before the incident giving
2822	rise to the claim.
2823	(2)(3)(a) If the injury is claimed to have resulted from
2824	the negligent affirmative medical intervention of the health
2825	care provider, the claimant must, in order to prove a breach of
2826	the prevailing professional standard of care, show that the
2827	injury was not within the necessary or reasonably foreseeable
2828	results of the surgical, medicinal, or diagnostic procedure
2829	constituting the medical intervention, if the intervention from
2830	which the injury is alleged to have resulted was carried out in
2831	accordance with the prevailing professional standard of care by
2832	a reasonably prudent similar health care provider.
2833	(b) The provisions of this subsection shall apply only
2834	when the medical intervention was undertaken with the informed
2835	consent of the patient in compliance with the provisions of s.
2836	766.103.
2837	(3)(4)The existence of a medical injury shall not create
2838	any inference or presumption of negligence against a health care
2839	provider, and the claimant must maintain the burden of proving
2840	that an injury was proximately caused by a breach of the
2841	prevailing professional standard of care by the health care
2842	provider. However, the discovery of the presence of a foreign
2843	body, such as a sponge, clamp, forceps, surgical needle, or
2844	other paraphernalia commonly used in surgical, examination, or
2845	diagnostic procedures, shall be prima facie evidence of
2846	negligence on the part of the health care provider.
2847	(4)(5)The Legislature is cognizant of the changing trends
2848	and techniques for the delivery of health care in this state and
2849	the discretion that is inherent in the diagnosis, care, and
2850	treatment of patients by different health care providers. The
2851	failure of a health care provider to order, perform, or
2852	administer supplemental diagnostic tests shall not be actionable
2853	if the health care provider acted in good faith and with due
2854	regard for the prevailing professional standard of care.
2855	(5) A person may not give expert testimony concerning the
2856	prevailing professional standard of care unless that person is a
2857	licensed health care provider and meets the following criteria:
2858	(a) If the party against whom or on whose behalf the
2859	testimony is offered is a specialist, the expert witness must:
2860	1. Specialize in the same specialty as the party against
2861	whom or on whose behalf the testimony is offered; or
2862	2. Specialize in a similar specialty that includes the
2863	evaluation, diagnosis, or treatment of the medical condition
2864	that is the subject of the claim and have prior experience
2865	treating similar patients.
2866	(b) Have devoted professional time during the 3 years
2867	immediately preceding the date of the occurrence that is the
2868	basis for the action to:
2869	1. The active clinical practice of, or consulting with
2870	respect to, the same or similar health profession as the health
2871	care provider against whom or on whose behalf the testimony is
2872	offered and, if that health care provider is a specialist, the
2873	active clinical practice of, or consulting with respect to, the
2874	same or similar specialty that includes the evaluation,
2875	diagnosis, or treatment of the medical condition that is the
2876	subject of the claim and have prior experience treating similar
2877	patients;
2878	2. The instruction of students in an accredited health
2879	professional school or accredited residency program in the same
2880	or similar health profession in which the health care provider
2881	against whom or on whose behalf the testimony is offered and, if
2882	that health care provider is a specialist, an accredited health
2883	professional school or accredited residency or clinical research
2884	program in the same or similar specialty; or
2885	3. A clinical research program that is affiliated with an
2886	accredited medical school or teaching hospital and that is in
2887	the same or similar health profession as the health care
2888	provider against whom or on whose behalf the testimony is
2889	offered and, if that health care provider is a specialist, a
2890	clinical research program that is affiliated with an accredited
2891	health professional school or accredited residency or clinical
2892	research program in the same or similar specialty.
2893	(c) If the party against whom or on whose behalf the
2894	testimony is offered is a general practitioner, the expert
2895	witness must have devoted professional time during the 5 years
2896	immediately preceding the date of the occurrence that is the
2897	basis for the action to:
2898	1. Active clinical practice or consultation as a general
2899	practitioner;
2900	2. Instruction of students in an accredited health
2901	professional school or accredited residency program in the
2902	general practice of medicine; or
2903	3. A clinical research program that is affiliated with an
2904	accredited medical school or teaching hospital and that is in
2905	the general practice of medicine.
2906	(6) A physician licensed under chapter 458 or chapter 459
2907	who qualifies as an expert witness under subsection (5) and who,
2908	by reason of active clinical practice or instruction of
2909	students, has knowledge of the applicable standard of care for
2910	nurses, nurse practitioners, certified registered nurse
2911	anesthetists, certified registered nurse midwives, physician
2912	assistants, or other medical support staff may give expert
2913	testimony in a medical malpractice action with respect to the
2914	standard of care of such medical support staff.
2915	(7) Notwithstanding subsection (5), in a medical
2916	malpractice action against a hospital, a health care facility,
2917	or medical facility, a person may give expert testimony on the
2918	appropriate standard of care as to administrative and other
2919	nonclinical issues if the person has substantial knowledge, by
2920	virtue of his or her training and experience, concerning the
2921	standard of care among hospitals, health care facilities, or
2922	medical facilities of the same type as the hospital, health care
2923	facility, or medical facility whose acts or omissions are the
2924	subject of the testimony and which are located in the same or
2925	similar communities at the time of the alleged act giving rise
2926	to the cause of action.
2927	(8) If a health care provider described in subsection (5),
2928	subsection (6), or subsection (7) is providing evaluation,
2929	treatment, or diagnosis for a condition that is not within his
2930	or her specialty, a specialist trained in the evaluation,
2931	treatment, or diagnosis for that condition shall be considered a
2932	similar health care provider.
2933	(9)(6)(a) In any action for damages involving a claim of
2934	negligence against a physician licensed under chapter 458,
2935	osteopathic physician licensed under chapter 459, podiatric
2936	physician licensed under chapter 461, or chiropractic physician
2937	licensed under chapter 460 providing emergency medical services
2938	in a hospital emergency department, the court shall admit expert
2939	medical testimony only from physicians, osteopathic physicians,
2940	podiatric physicians, and chiropractic physicians who have had
2941	substantial professional experience within the preceding 5 years
2942	while assigned to provide emergency medical services in a
2943	hospital emergency department.
2944	(b) For the purposes of this subsection:
2945	1. The term "emergency medical services" means those
2946	medical services required for the immediate diagnosis and
2947	treatment of medical conditions which, if not immediately
2948	diagnosed and treated, could lead to serious physical or mental
2949	disability or death.
2950	2. "Substantial professional experience" shall be
2951	determined by the custom and practice of the manner in which
2952	emergency medical coverage is provided in hospital emergency
2953	departments in the same or similar localities where the alleged
2954	negligence occurred.
2955	(10) In any action alleging medical malpractice, an expert
2956	witness may not testify on a contingency fee basis.
2957	(11) Any attorney who proffers a person as an expert
2958	witness pursuant to this section must certify that such person
2959	has not been found guilty of fraud or perjury in any
2960	jurisdiction.
2961	(12) Any person who serves as an expert witness under
2962	subsection (5) may not receive remuneration in excess of $300
2963	per hour.
2964	(13) This section does not limit the power of the trial
2965	court to disqualify or qualify an expert witness on grounds
2966	other than the qualifications in this section.
2967	Section 53. Subsections (2), (3), and (4) and paragraph
2968	(a) of subsection (10) of section 766.106, Florida Statutes, are
2969	amended, and subsections (13), (14), and (15) are added to said
2970	section, to read:
2971	766.106 Notice before filing action for medical
2972	malpractice; presuit screening period; offers for admission of
2973	liability and for arbitration; informal discovery; review.--
2974	(2)(a)After completion of presuit investigation pursuant
2975	to s. 766.203 and prior to filing a claim for medical
2976	malpractice, a claimant shall notify each prospective defendant
2977	by certified mail, return receipt requested, of intent to
2978	initiate litigation for medical malpractice. Notice to each
2979	prospective defendant must include, if available, a list of all
2980	known health care providers seen by the claimant for the
2981	injuries complained of subsequent to the alleged act of
2982	malpractice, a list of all known health care providers during
2983	the 2-year period prior to the alleged act of malpractice who
2984	treated or evaluated the claimant, and copies of all of the
2985	medical records relied upon by the expert in signing the
2986	affidavit. The requirement of providing the list of known health
2987	care providers may not serve as grounds for imposing sanctions
2988	for failure to provide presuit discovery.
2989	(b)Following the initiation of a suit alleging medical
2990	malpractice with a court of competent jurisdiction, and service
2991	of the complaint upon a defendant, the claimant shall provide a
2992	copy of the complaint to the Department of Health and, if the
2993	complaint involves a facility licensed under chapter 395, the
2994	Agency for Health Care Administration. The requirement of
2995	providing the complaint to the Department of Health or the
2996	Agency for Health Care Administrationdoes not impair the
2997	claimant's legal rights or ability to seek relief for his or her
2998	claim. The Department of Health or the Agency for Health Care
2999	Administration shall review each incident that is the subject of
3000	the complaintand determine whether it involved conduct by a
3001	licensee which is potentially subject to disciplinary action, in
3002	which case the provisions of s. 456.073 or s. 395.1046apply.
3003	(3)(a) No suit may be filed for a period of 15090days
3004	after notice is mailed to any prospective defendant. During the
3005	150-day90-dayperiod, the prospective defendant's insurer or
3006	self-insurer shall conduct a review to determine the liability
3007	of the defendant. Each insurer or self-insurer shall have a
3008	procedure for the prompt investigation, review, and evaluation
3009	of claims during the 150-day90-dayperiod. This procedure shall
3010	include one or more of the following:
3011	1. Internal review by a duly qualified claims adjuster;
3012	2. Creation of a panel comprised of an attorney
3013	knowledgeable in the prosecution or defense of medical
3014	malpractice actions, a health care provider trained in the same
3015	or similar medical specialty as the prospective defendant, and a
3016	duly qualified claims adjuster;
3017	3. A contractual agreement with a state or local
3018	professional society of health care providers, which maintains a
3019	medical review committee;
3020	4. Any other similar procedure which fairly and promptly
3021	evaluates the pending claim.
3022
3023	Each insurer or self-insurer shall investigate the claim in good
3024	faith, and both the claimant and prospective defendant shall
3025	cooperate with the insurer in good faith. If the insurer
3026	requires, a claimant shall appear before a pretrial screening
3027	panel or before a medical review committee and shall submit to a
3028	physical examination, if required. Unreasonable failure of any
3029	party to comply with this section justifies dismissal of claims
3030	or defenses. There shall be no civil liability for participation
3031	in a pretrial screening procedure if done without intentional
3032	fraud.
3033	(b) At or before the end of the 15090days, the insurer
3034	or self-insurer shall provide the claimant with a response:
3035	1. Rejecting the claim;
3036	2. Making a settlement offer; or
3037	3. Making an offer to arbitrate, in which case liability
3038	is deemed admitted and arbitration will be held onlyof
3039	admission of liability and for arbitrationon the issue of
3040	damages. This offer may be made contingent upon a limit of
3041	general damages.
3042	(c) The response shall be delivered to the claimant if not
3043	represented by counsel or to the claimant's attorney, by
3044	certified mail, return receipt requested. Failure of the
3045	prospective defendant or insurer or self-insurer to reply to the
3046	notice within 15090days after receipt shall be deemed a final
3047	rejection of the claim for purposes of this section.
3048	(d) Within 30 days afterofreceipt of a response by a
3049	prospective defendant, insurer, or self-insurer to a claimant
3050	represented by an attorney, the attorney shall advise the
3051	claimant in writing of the response, including:
3052	1. The exact nature of the response under paragraph (b).
3053	2. The exact terms of any settlement offer, or admission
3054	of liability and offer of arbitration on damages.
3055	3. The legal and financial consequences of acceptance or
3056	rejection of any settlement offer, or admission of liability,
3057	including the provisions of this section.
3058	4. An evaluation of the time and likelihood of ultimate
3059	success at trial on the merits of the claimant's action.
3060	5. An estimation of the costs and attorney's fees of
3061	proceeding through trial.
3062	(4) The notice of intent to initiate litigation shall be
3063	served within the time limits set forth in s. 95.11. However,
3064	during the 150-day90-dayperiod, the statute of limitations is
3065	tolled as to all potential defendants. Upon stipulation by the
3066	parties, the 150-day90-dayperiod may be extended and the
3067	statute of limitations is tolled during any such extension. Upon
3068	receiving notice of termination of negotiations in an extended
3069	period, the claimant shall have 60 days or the remainder of the
3070	period of the statute of limitations, whichever is greater,
3071	within which to file suit.
3072	(10) If a prospective defendant makes an offer to admit
3073	liability and for arbitration on the issue of damages, the
3074	claimant has 50 days from the date of receipt of the offer to
3075	accept or reject it. The claimant shall respond in writing to
3076	the insurer or self-insurer by certified mail, return receipt
3077	requested. If the claimant rejects the offer, he or she may then
3078	file suit. Acceptance of the offer of admission of liability and
3079	for arbitration waives recourse to any other remedy by the
3080	parties, and the claimant's written acceptance of the offer
3081	shall so state.
3082	(a) If rejected, the offer to admit liability and for
3083	arbitration on damages is not admissible in any subsequent
3084	litigation. Upon rejection of the offer to admit liability and
3085	for arbitration, the claimant has 60 days from receipt of the
3086	rejection of the offer to admit liability and for arbitration,
3087	60 days from the date of the declaration of impasse during
3088	presuit mediation conducted pursuant to s. 766.1065,or the
3089	remainder of the period of the statute of limitations, whichever
3090	period is greater, in which to file suit.
3091	(13) In matters relating to professional liability
3092	insurance coverage for medical negligence, an insurer shall not
3093	be held in bad faith for failure to timely pay its policy limits
3094	if it tenders its policy limits and meets all other conditions
3095	of settlement prior to the conclusion of the presuit screening
3096	period.
3097	(14) Failure to cooperate on the part of any party during
3098	the presuit investigation may be grounds to strike any claim
3099	made, or defense raised, by such party in suit.
3100	(15) In all matters relating to professional liability
3101	insurance coverage for medical negligence, and in determining
3102	whether the insurer has acted in good faith, the following
3103	factors may be considered, along with all of the other
3104	circumstances of the case:
3105	(a) Whether the damages recoverable against the insured
3106	are large or small.
3107	(b) Whether the liability against the insured is
3108	relatively clear.
3109	(c) Whether the insurance companies or its agents were
3110	negligent in handling the claim.
3111	(d) Whether the carrier acted as a reasonable person would
3112	who was facing the prospect of paying the entire loss.
3113	(e) Whether the insurance company made a fair offer as
3114	soon as a reasonable investigation would reveal that liability
3115	was reasonably clear and that the damages were greater than the
3116	policy limits.
3117	(f) Whether the insurer violated the unfair claims
3118	practice standards.
3119	(g) Whether the insurer’s communications with its insureds
3120	were actually honest, candid, and complete.
3121	(h) Whether the insurer violated the adjuster’s code of
3122	ethics in handling the claim.
3123	(i) Whether the insurer fully documented its claims
3124	handling activities and the reasons for its decisions.
3125	(j) Whether the insurer or its agents properly trained its
3126	adjusters and provided adequate written standards for the
3127	adjustment of claims.
3128	(k) Whether the insurer used the policy benefits available
3129	to the insurer to extinguish as much of the insured’s liability
3130	as possible.
3131	(l) Whether the attorney appointed by the insurer to
3132	defend the insured was competent, independent, and faithfully
3133	representing the interests of the insured.
3134	Section 54. Section 766.1065, Florida Statutes, is created
3135	to read:
3136	766.1065 Mandatory staging of presuit investigation;
3137	mandatory mediation.--
3138	(1) Within 30 days after service of the presuit notice of
3139	intent to initiate medical malpractice litigation, each party
3140	shall voluntarily produce to all other parties, without being
3141	requested, any and all medical, hospital, health care, and
3142	employment records concerning the claimant in the disclosing
3143	party’s possession, custody, or control, and the disclosing
3144	party shall affirmatively certify in writing that the records
3145	produced include all records in that party’s possession,
3146	custody, or control or that the disclosing party has no medical,
3147	hospital, health care, or employment records concerning the
3148	claimant.
3149	(a) Subpoenas may be issued according to the Florida Rules
3150	of Civil Procedure as though suit had been filed for the limited
3151	purpose of obtaining copies of medical, hospital, health care,
3152	and employment records of the claimant. The party shall indicate
3153	on the subpoena that it is being issued in accordance with the
3154	presuit procedures of this section and shall not be required to
3155	include a case number.
3156	(b) Nothing in this section shall limit the ability of any
3157	party to use any other available form of presuit discovery
3158	available under this chapter or the Florida Rules of Civil
3159	Procedure.
3160	(2) Within 60 days after service of the presuit notice of
3161	intent to initiate medical malpractice litigation, all parties
3162	must be made available for a sworn deposition. Such deposition
3163	may not be used in a civil suit for medical negligence.
3164	(3) Within 120 days after service of the presuit notice of
3165	intent to initiate medical malpractice litigation, each party’s
3166	corroborating expert, who will otherwise be tendered as the
3167	expert complying with the affidavit provisions set forth in s.
3168	766.203, must be made available for a sworn deposition.
3169	(a) The expenses associated with the expert’s time and
3170	travel in preparing for and attending such deposition shall be
3171	the responsibility of the party retaining such expert.
3172	(b) An expert shall be deemed available for deposition if
3173	suitable accommodations can be made for appearance of said
3174	expert via real-time video technology.
3175	(4) Within 150 days after service of the presuit notice of
3176	intent to initiate medical malpractice litigation, all parties
3177	shall attend in-person mandatory mediation in accordance with s.
3178	44.102 if binding arbitration under s. 766.106 or s. 766.207 has
3179	not been agreed to by the parties. The Florida Rules of Civil
3180	Procedure shall apply to mediation held pursuant to this
3181	section.
3182	(5) If the parties declare an impasse during the mandatory
3183	mediation required in subsection (4), the plaintiff shall
3184	request, via certified mail, a hearing of a presuit screening
3185	panel which shall be convened pursuant to s. 766.1066.
3186	Section 55. Section 766.1066, Florida Statutes, is created
3187	to read:
3188	766.1066 Office of Presuit Screening Administration;
3189	presuit screening panels.—
3190	(1)(a) There is created within the Department of Health
3191	the Office of Presuit Screening Administration, which shall be
3192	responsible for administering the presuit screening program.
3193	(b) The Office of Presuit Screening Administration shall
3194	develop and maintain a database of physicians, attorneys, and
3195	consumers to serve as members of presuit screening panels as
3196	described in this section.
3197	(c) The Office of Presuit Screening Administration shall
3198	develop an application by September 1, 2003, that can be
3199	submitted in writing and via the Internet for physicians,
3200	attorneys, and consumers to volunteer for the panels.
3201	(d) Funding for the Office of Presuit Screening
3202	Administration shall come from:
3203	1. A fee equal to 0.5 percent of, and assessed against,
3204	all judgments and settlements in medical malpractice liability
3205	cases. The defendant shall remit such fee to the Office of
3206	Presuit Administration.
3207	2. An annual fee of $1 on all medical malpractice
3208	liability insurance policies issued to physicians licensed by
3209	the Department of Health, which shall be collected by the
3210	insurer and submitted by the insurer to the Office of Presuit
3211	Administration.
3212	(e)1. Physicians, attorneys, and consumers who volunteer
3213	for the panels shall be obligated to serve on a panel for no
3214	longer than 2 calendar days per selection.
3215	2. Every person applying to serve on a panel shall
3216	designate in advance any time period during which he or she will
3217	not be available to serve on a panel.
3218	3. When a plaintiff requests a hearing of a presuit
3219	screening panel, the Office of Presuit Screening Administration
3220	shall randomly select members for a panel as provided in
3221	subsection (2) from among the available persons in the
3222	appropriate categories who have not served on a panel in the
3223	past 12 months. If there are no other potential panelists
3224	available, a panelist may be asked to serve on another panel
3225	within 12 months.
3226	(f) If a physician, attorney, or consumer is selected to
3227	serve on a panel, he or she shall not be obligated to serve for
3228	a period exceeding 2 days.
3229	(g) All persons serving on a panel shall receive
3230	reimbursement for their travel expenses.
3231	(h) Physicians who are selected to serve on a panel:
3232	1. Shall receive credit for 20 hours of continuing medical
3233	education for his or her service.
3234	2. Must reside and practice at least 50 miles from the
3235	location of the injury alleged by the plaintiff.
3236	3. Must have had no more than three judgments for medical
3237	malpractice liability against him or her within the preceding 5
3238	years and no more than 10 claims of medical malpractice filed
3239	against him or her within the preceding 3 years.
3240	4. Must have an active license with the Department of
3241	Health and be in good standing.
3242	(i) Attorneys who are selected to serve on a panel:
3243	1. Shall receive credit for 20 hours of continuing legal
3244	education and credit towards pro bono requirements for his or
3245	her service.
3246	2. Must reside and practice at least 50 miles from the
3247	location of the injury alleged by the plaintiff.
3248	3. Must have had no judgments of filing a frivolous
3249	lawsuit within the preceding 5 years.
3250	4. Must have an active license with The Florida Bar and be
3251	in good standing.
3252	(2)(a) A presuit screening panel shall be composed of five
3253	persons, consisting of:
3254	1. One physician board certified in the same specialty as
3255	the defendant physician.
3256	2. One physician who is a general practitioner, family
3257	practitioner, or an internist or one physician who serves as a
3258	full-time member in the faculty of an accredited public or
3259	private medical school in the state.
3260	3. One attorney who has served as a plaintiff’s attorney,
3261	with 5 years' experience in medical malpractice liability cases
3262	including at least one jury trial.
3263	4. One attorney who has served as a defendant’s attorney,
3264	with 5 years' experience in medical malpractice liability cases
3265	including at least one jury trial.
3266	5. One consumer who shall not have a professional or
3267	financial relationship with either a health care provider or an
3268	attorney.
3269	(b) In cases with more than one physician defendant, the
3270	plaintiff shall designate the subject areas in which both
3271	physician members of the panel shall be board certified.
3272	(c) Any panelist who knowingly has a conflict of interest
3273	or potential conflict of interest must disclose such conflict of
3274	interest prior to the hearing.
3275	(d) A plaintiff or a defendant may challenge any panel
3276	member for a conflict of interest and ask that the panelist be
3277	replaced by the Office of Presuit Screening Administration.
3278	(3) The Office of Presuit Screening Administration shall
3279	provide an administrator for the panel.
3280	(4) The plaintiff shall be allowed 8 hours to present his
3281	or her case. The defendants shall be allowed a total of 8 hours
3282	to present their case. No hearing shall exceed a total of 16
3283	hours; however, the panel may hear the case over the course of 2
3284	calendar days.
3285	(5) A presuit screening panel shall, by a majority vote
3286	for each defendant, make its findings in regards to reasonable
3287	grounds for liability of the defendant based on the
3288	preponderance of the evidence.
3289	(a) If a panel finds that there are no reasonable grounds
3290	for liability on the part of a defendant for the injury alleged,
3291	the defendant may, within 10 days, request voluntary binding
3292	arbitration pursuant to s. 766.207.
3293	(b) If a panel finds that there are reasonable grounds for
3294	liability on the part of a defendant for the injury alleged, the
3295	parties may elect to have damages determined by voluntary
3296	binding arbitration pursuant to s. 766.207.
3297	(c) If a panel finds that there are no reasonable grounds
3298	for liability on the part of a defendant for the injury alleged
3299	and the defendant does not request arbitration, or if a panel
3300	finds that there are reasonable grounds for liability on the
3301	part of a defendant for the injury alleged and either a
3302	defendant or the plaintiff do not agree to voluntary binding
3303	arbitration pursuant to s. 766.207, the claim shall proceed to
3304	trial or to any available legal alternative such as offer of
3305	judgment and demand for judgment under s. 768.79 or offer of
3306	settlement under s. 45.061. The damages that may be awarded
3307	during such trial are subject to the limitations included in s.
3308	766.118.
3309	Section 56. Section 766.1067, Florida Statutes, is created
3310	to read:
3311	766.1067 Structured judgments.-- For cases that are
3312	decided in a trial, the judgment may be structured as follows:
3313	(1) If the noneconomic damages awarded to the plaintiff
3314	are equal to or greater than $500,000 and the jury finds the
3315	life expectancy of the plaintiff to be 20 years or greater, the
3316	defendant may compel a structured judgment for 50 percent of the
3317	noneconomic damages to be paid over the remaining life of the
3318	plaintiff. Such payments shall terminate upon the plaintiff’s
3319	death.
3320	(2) If the economic damages awarded to the plaintiff are
3321	equal to or greater than $250,000 and the jury finds the
3322	plaintiff would otherwise have been able to work for 20 years or
3323	more, the defendant may compel a structured judgment for 75
3324	percent of the future economic damages to be paid over the years
3325	in which the jury finds the plaintiff would otherwise have been
3326	able to work. Any unpaid portion of a structured judgment made
3327	under this subsection which is attributable to medical expenses
3328	that have not yet been incurred shall terminate upon the death
3329	of the plaintiff. Any outstanding medical expenses incurred
3330	prior to the death of the plaintiff shall be paid from that
3331	portion of the structured judgment attributable to medical
3332	expenses.
3333	Section 57. Section 766.1068, Florida Statutes, is created
3334	to read:
3335	766.1068 Proposal for settlement; timing.--
3336	Notwithstanding any other provision of law, any party may serve
3337	another party in a medical malpractice suit with a proposal for
3338	settlement at any time after the filing of the complaint. If a
3339	claimant rejects the proposal for settlement, then either loses
3340	at trial or prevails at trial while receiving an award for
3341	damages less than the most recent proposal for settlement, the
3342	court may require the claimant to pay the attorney's fees and
3343	costs of the defendant from whom the claimant will receive the
3344	award. If a defendant rejects the proposal for settlement, then
3345	loses at trial while receiving a judgment greater than the most
3346	resent proposal for settlement, the court may require the
3347	defendant to pay the attorney's fees and costs of the claimant
3348	to whom the judgment is awarded.
3349	Section 58. Subsections (3), (4), (5), and (6) are added
3350	to section 766.110, Florida Statutes, to read:
3351	766.110 Liability of health care facilities.--
3352	(3)(a) Members of the medical staff of a hospital licensed
3353	under chapter 395 and any professional group comprised of such
3354	persons shall be immune from liability for noneconomic damages
3355	in excess of $250,000 per emergency room admission arising from
3356	medical injuries to a patient resulting from negligent acts or
3357	omissions of such medical staff members in the performance of
3358	emergency medical services as defined in s. 768.13(2) prior to
3359	the patient’s condition being sufficiently stable, and no member
3360	of the medical staff of a hospital and no professional group
3361	comprised of such persons shall be liable to pay noneconomic
3362	damages in excess of $250,000 to any person or persons for any
3363	single incident of medical negligence that causes injuries to a
3364	patient or patients in the performance of emergency medical
3365	services.
3366	(b) For the purposes of paragraph (a), a patient’s
3367	condition shall be deemed to be sufficiently stable when that
3368	patient could reasonably be transferred to another health care
3369	facility without causing further injury, whether or not the
3370	patient is in fact transferred.
3371	(4)(a) No person or persons may recover damages from a
3372	public family practice teaching hospital licensed under chapter
3373	395 and designated under s. 398.806, or its insurer, or any
3374	health care professional who is a full-time member of the
3375	faculty of an accredited public medical school, or his or her
3376	insurer, in excess of $250,000 per emergency room admission
3377	arising from medical injuries to a patient or patients caused by
3378	negligent acts or omissions on the part of the hospital or
3379	members of the hospital's medical staff in the performance of
3380	emergency medical services as defined in s. 768.13(2) prior to
3381	the patient’s condition being sufficiently stable.
3382	(b) For the purposes of paragraph (a), a patient’s
3383	condition shall be deemed to be sufficiently stable when that
3384	patient could reasonably be transferred to another health care
3385	facility without causing further injury, whether or not the
3386	patient is in fact transferred.
3387	(5)(a) Other than as provided in paragraph (c), when a
3388	subsequent injury occurs after a patient’s condition is
3389	sufficiently stable, no person or persons may recover
3390	noneconomic damages from any health care professional who is a
3391	member of the medical staff of such facility, or his or her
3392	insurer, in excess of $250,000 per injury arising from medical
3393	injury to a patient caused by negligent acts or omissions on the
3394	part of the hospital or members of the hospital's medical staff
3395	in the performance of emergency medical services as defined in
3396	s. 768.13(2) until the patient’s condition returns to
3397	sufficiently stable.
3398	(b) For the purposes of paragraph (a), a patient’s
3399	condition shall be deemed to be sufficiently stable when that
3400	patient could reasonably be transferred to another health care
3401	facility without causing further injury, whether or not the
3402	patient is in fact transferred.
3403	(c) A person or persons may recover damages from the
3404	health care professional who caused the subsequent injury in
3405	paragraph (a) and the hospital licensed under chapter 395, or
3406	its insurer, where the injury occurred.
3407	(6) The limits established in this section shall be
3408	adjusted annually in accordance with the changes in the Consumer
3409	Price Index as issued by the United States Department of Labor
3410	Bureau of Labor Statistics. The Agency for Health Care
3411	Administration shall establish by rule the new limits on July 1
3412	of each year.
3413	Section 59. Section 766.118, Florida Statutes, is created
3414	to read:
3415	766.118 Determination of noneconomic damages.-- With
3416	respect to a cause of action for personal injury or wrongful
3417	death resulting from an occurrence of medical negligence,
3418	including actions pursuant to s. 766.209, damages recoverable
3419	for noneconomic losses to compensate for pain and suffering,
3420	inconvenience, physical impairment, mental anguish,
3421	disfigurement, loss of capacity for enjoyment of life, and all
3422	other noneconomic damages shall be determined as follows:
3423	(1) The award for noneconomic damages from the jury shall
3424	be reviewed by the judge to determine the appropriateness of the
3425	award.
3426	(2) In reviewing the award, the judge shall utilize the
3427	Florida Jury Verdict Database as provided in s. 766.26.
3428	(3)(a) The judge shall examine all cases where the
3429	injuries alleged and the economic damages awarded are
3430	substantially similar.
3431	(b) The judge shall adopt a presumptively reasonable range
3432	of similar awards that shall be one standard deviation above and
3433	below the mean award for similar cases. The judge shall then
3434	subtract the economic damages awarded by the jury from the valid
3435	range to find the valid range for noneconomic damages.
3436	(c) If the award for noneconomic damages is outside of the
3437	presumptively reasonable range for noneconomic damages based on
3438	similar cases, the judge may elect to change the award so that
3439	it falls within said range, which is subject to appeal based on
3440	abuse of discretion standards, or the judge may elect to leave
3441	the amount as awarded by providing findings of fact on the
3442	record, which shall be subject to appeal based on clear and
3443	convincing evidence standards.
3444	(4) If a health care professional does not meet his or her
3445	financial responsibility requirements as provided in s. 458.320
3446	or 459.0085, as applicable, by July 1, 2004, the limits
3447	established in this section shall not apply and awards for
3448	economic and noneconomic damages shall not be limited.
3449	Section 60. Section 766.185, Florida Statutes, is created
3450	to read:
3451	766.185 Apportionment of fault in medical negligence
3452	actions.--
3453	(1) In an action for damages for personal injury or
3454	wrongful death arising out of medical negligence, whether in
3455	contract or tort, when a defendant asserts an affirmative
3456	defense that one or more nonparties is liable, in whole or in
3457	part, for damages arising out of medical negligence, such
3458	defendant must join the nonparties into the action by means of a
3459	third-party complaint asserting a cause of action for
3460	comparative fault in medical negligence against the nonparties,
3461	except with respect to a nonparty who meets one of the following
3462	criteria:
3463	(a) The nonparty has entered into a settlement with each
3464	of the plaintiffs;
3465	(b) The nonparty has complete immunity from suit;
3466	(c) The statute of limitations involving the nonparty
3467	expired prior to filing of the presuit notice of intent to
3468	initiate medical malpractice litigation; or
3469	(d) The nonparty cannot be otherwise legally joined to the
3470	suit.
3471	(2) If the defendant has reasonable grounds to believe
3472	during the presuit investigation that one or more nonparties are
3473	liable, in whole or in part, for damages arising out of medical
3474	negligence and that such nonparties would be joinable into the
3475	action under this section, the defendant must notify the
3476	claimant in writing of the identity and reasonable grounds for
3477	inclusions of such nonparty in the action within 10 days after
3478	obtaining such information.
3479	(3) If the defendant fails to comply with the provisions
3480	set forth in this section, then the defendant shall be estopped
3481	from asserting the negligence of the nonparty who should have
3482	otherwise been joined into the action.
3483	(4) Any third party joined into the action under the
3484	provisions of this section shall be liable to the plaintiff for
3485	any damages adjudicated by the trier of fact subject to the
3486	provisions of this chapter.
3487	Section 61. Subsection (5) of section 766.202, Florida
3488	Statutes, is amended to read:
3489	766.202 Definitions; ss. 766.201-766.212.-- As used in ss.
3490	766.201-766.212, the term:
3491	(5) "Medical expert" means a person duly and regularly
3492	engaged in the practice of his or her profession who holds a
3493	health care professional degree from a university or college and
3494	who meets the requirements of an expert witness as set forth in
3495	s. 766.102has had special professional training and experience
3496	or one possessed of special health care knowledge or skill about
3497	the subject upon which he or she is called to testify or provide
3498	an opinion.
3499	Section 62. Subsections (2) and (3) of section 766.203,
3500	Florida Statutes, are amended to read:
3501	766.203 Presuit investigation of medical negligence claims
3502	and defenses by prospective parties.--
3503	(2) Prior to issuing notification of intent to initiate
3504	medical malpractice litigation pursuant to s. 766.106, the
3505	claimant shall conduct an investigation to ascertain that there
3506	are reasonable grounds to believe that:
3507	(a) Any named defendant in the litigation was negligent in
3508	the care or treatment of the claimant; and
3509	(b) Such negligence resulted in injury to the claimant.
3510
3511	Corroboration of reasonable grounds to initiate medical
3512	negligence litigation shall be provided by the claimant's
3513	submission of a verified written medical expert opinion from a
3514	medical expert as defined in s. 766.202(5), at the time the
3515	notice of intent to initiate litigation is mailed, which
3516	statement shall corroborate reasonable grounds to support the
3517	claim of medical negligence. This opinion and statement are
3518	subject to discovery.
3519	(3) Prior to issuing its response to the claimant's notice
3520	of intent to initiate litigation, during the time period for
3521	response authorized pursuant to s. 766.106, the defendant or the
3522	defendant's insurer or self-insurer shall conduct an
3523	investigation to ascertain whether there are reasonable grounds
3524	to believe that:
3525	(a) The defendant was negligent in the care or treatment
3526	of the claimant; and
3527	(b) Such negligence resulted in injury to the claimant.
3528
3529	Corroboration of lack of reasonable grounds for medical
3530	negligence litigation shall be provided with any response
3531	rejecting the claim by the defendant's submission of a verified
3532	written medical expert opinion from a medical expert as defined
3533	in s. 766.202(5), at the time the response rejecting the claim
3534	is mailed, which statement shall corroborate reasonable grounds
3535	for lack of negligent injury sufficient to support the response
3536	denying negligent injury. This opinion and statement are subject
3537	to discovery.
3538	Section 63. Subsections (2), (3), and (5) of section
3539	766.206, Florida Statutes, are amended to read:
3540	766.206 Presuit investigation of medical negligence claims
3541	and defenses by court.--
3542	(2) If the court finds that the notice of intent to
3543	initiate litigation mailed by the claimant is not in compliance
3544	with the reasonable investigation requirements of ss. 766.201-
3545	766.212, including a review of the claim and a verified written
3546	medical expert opinion by an expert witness as defined in s.
3547	766.202,the court shall dismiss the claim, and the person who
3548	mailed such notice of intent, whether the claimant or the
3549	claimant's attorney, shall be personally liable for all
3550	attorney's fees and costs incurred during the investigation and
3551	evaluation of the claim, including the reasonable attorney's
3552	fees and costs of the defendant or the defendant's insurer.
3553	(3) If the court finds that the response mailed by a
3554	defendant rejecting the claim is not in compliance with the
3555	reasonable investigation requirements of ss. 766.201-766.212,
3556	including a review of the claim and a verified written medical
3557	expert opinion by an expert witness as defined in s. 766.202,
3558	the court shall strike the defendant's pleading.response, and
3559	The person who mailed such response, whether the defendant, the
3560	defendant's insurer, or the defendant's attorney, shall be
3561	personally liable for all attorney's fees and costs incurred
3562	during the investigation and evaluation of the claim, including
3563	the reasonable attorney's fees and costs of the claimant.
3564	(5)(a) If the court finds that the corroborating written
3565	medical expert opinion attached to any notice of claim or intent
3566	or to any response rejecting a claim lacked reasonable
3567	investigation, or that the medical expert submitting the opinion
3568	did not meet the expert witness qualifications as set forth in
3569	s. 766.202(5),the court shall report the medical expert issuing
3570	such corroborating opinion to the Division of Medical Quality
3571	Assurance or its designee. If such medical expert is not a
3572	resident of the state, the division shall forward such report to
3573	the disciplining authority of that medical expert.
3574	(b) The court shallmay refuse to consider the testimony
3575	or opinion attached to any notice of intent or to any response
3576	rejecting a claim of suchan expert who has been disqualified
3577	three times pursuant to this section.
3578	Section 64. Section 766.207, Florida Statutes, is amended
3579	to read:
3580	766.207 Voluntary binding arbitration of medical
3581	negligence claims.--
3582	(1) Voluntary binding arbitration pursuant to this section
3583	and ss. 766.208-766.212 shall not apply to rights of action
3584	involving the state or its agencies or subdivisions, or the
3585	officers, employees, or agents thereof, pursuant to s. 768.28.
3586	(2)(a) Upon the completion of the hearing of a presuit
3587	screening panel pursuant to s. 706.1066investigation with
3588	preliminary reasonable grounds for a medical negligence claim
3589	intact, the parties may elect to have damages determined by an
3590	arbitration panel. Such election may be initiated by either
3591	party by serving a request for voluntary binding arbitration of
3592	damages within 1090 days after the hearing of a presuit
3593	screening panelservice of the claimant's notice of intent to
3594	initiate litigation upon the defendant. The evidentiary
3595	standards for voluntary binding arbitration of medical
3596	negligence claims shall be as provided in ss. 120.569(2)(g) and
3597	120.57(1)(c).
3598	(b) If the presuit screening panel pursuant to s. 766.1066
3599	found that the defendant was not liable by unanimous vote and
3600	the plaintiff refuses arbitration, damages that can be awarded
3601	during a trial shall not exceed a total of $350,000, as adjusted
3602	herein, per defendant for both future economic and all
3603	noneconomic damages. If the presuit screening panel pursuant to
3604	s. 766.1066 found that the defendant was not liable by majority
3605	vote and the plaintiff refuses arbitration, damages that can be
3606	awarded during a trial for all noneconomic damages shall not
3607	exceed a total of $350,000, as adjusted herein, per defendant.
3608	(3) Upon receipt of a party's request for such
3609	arbitration, the opposing party may accept the offer of
3610	voluntary binding arbitration within 30 days, and such
3611	arbitration shall be held within 120 days of acceptance of the
3612	offer of voluntary binding arbitration. However, in no event
3613	shall the defendant be required to respond to the request for
3614	arbitration sooner than 90 days after service of the notice of
3615	intent to initiate litigation under s. 766.106.Such acceptance
3616	within the time period provided by this subsection shall be a
3617	binding commitment to comply with the decision of the
3618	arbitration panel. The liability of any insurer shall be subject
3619	to any applicable insurance policy limits.
3620	(4) The arbitration panel shall be a presuit screening
3621	panel selected by the Office of Presuit Screening as provided in
3622	s. 766.1066. The Florida Rules of Civil Procedure shall apply to
3623	discovery, except as follows:
3624	(a) Any 30-day deadline provided in such rules shall be
3625	shortened to 10 business days.
3626	(b) Depositions of expert witnesses shall be permitted for
3627	no more than five experts per side.
3628
3629	Discovery disputes shall be resolved by an administrative law
3630	judge assigned by the Division of Administrative Hearings until
3631	arbitration is completedcomposed of three arbitrators, one
3632	selected by the claimant, one selected by the defendant, and one
3633	an administrative law judge furnished by the Division of
3634	Administrative Hearings who shall serve as the chief arbitrator.
3635	In the event of multiple plaintiffs or multiple defendants, the
3636	arbitrator selected by the side with multiple parties shall be
3637	the choice of those parties. If the multiple parties cannot
3638	reach agreement as to their arbitrator, each of the multiple
3639	parties shall submit a nominee, and the director of the Division
3640	of Administrative Hearings shall appoint the arbitrator from
3641	among such nominees.
3642	(5) The panelarbitratorsshall be independent of all
3643	parties, witnesses, and legal counsel, and no officer, director,
3644	affiliate, subsidiary, or employee of a party, witness, or legal
3645	counsel may serve as a panelistan arbitratorin the proceeding.
3646	(6) The rate of compensation for arbitration panelists
3647	shall be the same as for members of a presuit screening panel as
3648	outlined in s. 766.1066medical negligence claims arbitrators
3649	other than the administrative law judge shall be set by the
3650	chief judge of the appropriate circuit court by schedule
3651	providing for compensation of not less than $250 per day nor
3652	more than $750 per day or as agreed by the parties. In setting
3653	the schedule, the chief judge shall consider the prevailing
3654	rates charged for the delivery of professional services in the
3655	community.
3656	(7) Arbitration pursuant to this section shall preclude
3657	recourse to any other remedy by the claimant against any
3658	participating defendant, and shall be undertaken with the
3659	understanding that:
3660	(a) If the presuit screening panel pursuant to s. 766.1066
3661	found that the defendant was not liable by unanimous vote, the
3662	damages that can be awarded during arbitration shall not exceed
3663	a total of $250,000, as adjusted herein, per defendant for both
3664	future economic and all noneconomic damages. If the presuit
3665	screening panel established pursuant to s. 766.1066 found that
3666	the defendant was not liable by majority vote, the damages that
3667	can be awarded during arbitration for all noneconomic damages
3668	shall not exceed a total of $250,000, as adjusted herein, per
3669	defendant.
3670	(b) If the presuit screening panel established pursuant to
3671	s. 766.1066 found that the defendant was liable, the following
3672	conditions shall apply:
3673	1.(a)Net economic damages shall be awardable, including,
3674	but not limited to, past and future medical expenses and 80
3675	percent of wage loss and loss of earning capacity, offset by any
3676	collateral source payments, beginning at the time the injury
3677	occurred and extended to a work-life expectancy as determined by
3678	the jury. Net economic damages shall also include interest on
3679	all economic damages occurring prior to trial.
3680	2.(b)Noneconomic damages shall be limited to a maximum of
3681	$250,000, as adjusted herein,per incident, and shall be
3682	calculated on a percentage basis with respect to capacity to
3683	enjoy life, so that a finding that the claimant's injuries
3684	resulted in a 50-percent reduction in his or her capacity to
3685	enjoy life would warrant an award of not more than $125,000
3686	noneconomic damages. The limits on damages established in this
3687	paragraph shall be adjusted annually in accordance with the
3688	changes in the Consumer Price Index as issued by the United
3689	States Department of Labor Bureau of Labor Statistics. The
3690	Agency for Health Care Administration shall establish by rule
3691	the new limits on July 1 of each year.
3692	3.(c)Damages for future economic losses shall be awarded
3693	to be paid by periodic payments pursuant to s. 766.1067(2)s.
3694	766.202(8)and shall be offset by future collateral source
3695	payments.
3696	4.(d)Punitive damages shall not be awarded.
3697	5.(e)The defendant shall be responsible for the payment
3698	of interest on all accrued damages with respect to which
3699	interest would be awarded at trial.
3700	6.(f)The defendant shall pay the claimant's reasonable
3701	attorney's fees and costs, as determined by the arbitration
3702	panel, but in no event more than 15 percent of the award,
3703	reduced to present value.
3704	(g) The defendant shall pay all the costs of the
3705	arbitration proceeding and the fees of all the arbitrators other
3706	than the administrative law judge.
3707	(h) Each defendant who submits to arbitration under this
3708	section shall be jointly and severally liable for all damages
3709	assessed pursuant to this section.
3710	7.(i)The defendant's obligation to pay the claimant's
3711	damages shall be for the purpose of arbitration under this
3712	section only. A defendant's or claimant's offer to arbitrate
3713	shall not be used in evidence or in argument during any
3714	subsequent litigation of the claim following the rejection
3715	thereof.
3716	8.(j)The fact of making or accepting an offer to
3717	arbitrate shall not be admissible as evidence of liability in
3718	any collateral or subsequent proceeding on the claim.
3719	9.(k)Any offer by a claimant to arbitrate must be made to
3720	each defendant against whom the claimant has made a claim. Any
3721	offer by a defendant to arbitrate must be made to each claimant
3722	who has joined in the notice of intent to initiate litigation,
3723	as provided in s. 766.106. A defendant who rejects a claimant's
3724	offer to arbitrate shall be subject to the provisions of
3725	subsection (11)s. 766.209(3). A claimant who rejects a
3726	defendant's offer to arbitrate shall be subject to the
3727	provisions of subsection (12)s. 766.209(4).
3728	10.(l) The hearing shall be conducted by the panelall of
3729	the arbitrators, but a majority may determine any question of
3730	fact and render a final decision. The chief arbitrator shall
3731	decide all evidentiary matters.
3732
3733	The provisions of this subsection shall not preclude settlement
3734	at any time by mutual agreement of the parties.
3735	(8) Any issue between the defendant and the defendant's
3736	insurer or self-insurer as to who shall control the defense of
3737	the claim and any responsibility for payment of an arbitration
3738	award, shall be determined under existing principles of law;
3739	provided that the insurer or self-insurer shall not offer to
3740	arbitrate or accept a claimant's offer to arbitrate without the
3741	written consent of the defendant.
3742	(9) The Division of Administrative Hearings is authorized
3743	to promulgate rules to effect the orderly and efficient
3744	processing of the arbitration procedures of ss. 766.201-766.212.
3745	(10) Rules promulgated by the Division of Administrative
3746	Hearings pursuant to this section, s. 120.54, or s. 120.65 may
3747	authorize any reasonable sanctions except contempt for violation
3748	of the rules of the division or failure to comply with a
3749	reasonable order issued by an administrative law judge, which is
3750	not under judicial review.
3751	(11) If the defendant refuses a claimant's offer of
3752	voluntary binding arbitration:
3753	(a) The claim shall proceed to trial without limitation on
3754	damages and the claimant, upon proving medical negligence, shall
3755	be entitled to recover prejudgment interest and reasonable
3756	attorney's fees up to 25 percent of the award reduced to present
3757	value.
3758	(b) The claimant's award at trial shall be reduced by any
3759	damages recovered by the claimant from arbitrating codefendants
3760	following arbitration.
3761	(c) The claimant shall be entitled to recover prejudgement
3762	interest on economic damages incurred prior to trial.
3763	(12) If the claimant rejects a defendant's offer to enter
3764	voluntary binding arbitration:
3765	(a) The damages awardable at trial shall be limited to net
3766	economic damages, plus noneconomic damages not to exceed
3767	$350,000, as adjusted herein, per incident. The Legislature
3768	expressly finds that such conditional limit on noneconomic
3769	damages is warranted by the claimant's refusal to accept
3770	arbitration, and represents an appropriate balance between the
3771	interests of all patients who ultimately pay for medical
3772	negligence losses and the interests of those patients who are
3773	injured as a result of medical negligence. The limits on damages
3774	established in this paragraph shall be adjusted annually in
3775	accordance with the changes in the Consumer Price Index as
3776	issued by the United States Department of Labor Bureau of Labor
3777	Statistics. The Agency for Health Care Administration shall
3778	establish by rule the new limits on July 1 of each year. Net
3779	economic damages shall also include interest on all economic
3780	damages occurring prior to trial.
3781	(b) Net economic damages reduced to present value shall be
3782	awardable, including, but not limited to, past and future
3783	medical expenses and 80 percent of wage loss and loss of earning
3784	capacity, offset by any collateral source payments.
3785	(c) Damages for future economic losses shall be awarded to
3786	be paid by periodic payments pursuant to s. 766.202(8), and
3787	shall be offset by future collateral source payments.
3788	(13) The arbitration panel shall allocate financial
3789	responsibility among all defendants named in the notice of
3790	intent to initiate litigation, regardless of whether the
3791	defendant has submitted to arbitration. The defendants in the
3792	arbitration proceeding shall pay their proportionate share of
3793	the economic and noneconomic damages awarded by the arbitration
3794	panel. All defendants in the arbitration proceeding shall be
3795	jointly and severally liable for any damages assessed in
3796	arbitration. The determination of the percentage of fault of any
3797	defendant not in the arbitration case shall neither be binding
3798	against that defendant, nor shall it be admissible in any
3799	subsequent legal proceeding.
3800	(14) Payment by the defendants of the damages awarded by
3801	the arbitration panel shall extinguish those defendants'
3802	liability to the claimant and shall also extinguish those
3803	defendants' liability for contribution to any defendants who did
3804	not participate in arbitration.
3805	(15) Any defendant paying damages assessed pursuant to
3806	this section shall have an action for contribution against any
3807	nonarbitrating person whose negligence contributed to the
3808	injury.
3809	(16)(a) If a health care professional does not meet his or
3810	her financial responsibility requirements as provided in s.
3811	458.320(1)(b) or s. 459.0085(1)(b), as applicable, by July 1,
3812	2004, the limits on damages established in this section shall
3813	not apply and awards for economic and noneconomic damages shall
3814	not be limited during arbitration or jury trial.
3815	(b) It is the intent of the Legislature to provide relief
3816	from rising medical malpractice insurance premiums to those
3817	physicians who pay premiums on medical malpractice liability
3818	insurance. Physicians who do not carry medical malpractice
3819	liability insurance and hence do not pay premiums require no
3820	relief from the crisis referred to in the findings provided in
3821	this act.
3822	(17) Jury trials shall proceed in accordance with existing
3823	principles of law.
3824	Section 65. Sections 766.208 and 766.209, Florida
3825	Statutes, are repealed.
3826	Section 66. Subsection (1) of section 766.112, Florida
3827	Statutes, is amended to read:
3828	766.112 Comparative fault.--
3829	(1) Notwithstanding any provision ofanything inlaw to
3830	the contrary, in an action for damages for personal injury or
3831	wrongful death arising out of medical malpractice, whether in
3832	contract or tort, when an apportionment of damages pursuant to
3833	this section is attributed to a teaching hospital as defined in
3834	s. 408.07, the court shall enter judgment against the teaching
3835	hospital on the basis of suchparty's percentage of fault and
3836	not on the basis of the doctrine of joint and several liability.
3837	In the trial of any action for medical malpractice which follows
3838	a settlement between the plaintiff and one or more defendants or
3839	potential defendants for the same injury, the plaintiff shall be
3840	estopped from denying that the fault on the part of any such
3841	settled defendant or prospective defendant contributed to
3842	causing the plaintiff’s injuries with respect to any such
3843	settled defendant or prospective defendant who has been
3844	identified by way of affirmative defense or joined by a
3845	nonsettling defendant as a party who is liable, in whole or in
3846	part, for the plaintiff's damages.
3847	Section 67. Section 766.25, Florida Statutes, is created
3848	to read:
3849	766.25 Itemized verdict.--
3850	(1) In any action for damages based on personal injury or
3851	wrongful death arising out of medical malpractice, whether in
3852	tort or contract, to which this part applies in which the trier
3853	of fact determines that liability exists on the part of the
3854	defendant, the trier of fact shall, as a part of the verdict,
3855	itemize the amounts to be awarded to the claimant into the
3856	following categories of damages:
3857	(a) Amounts intended to compensate the claimant for:
3858	1. Past economic losses; and
3859	2. Future economic losses, not reduced to present value,
3860	and the number of years or part thereof which the award is
3861	intended to cover;
3862	(b) Amounts intended to compensate the claimant for:
3863	1. Past noneconomic losses;
3864	2. Future noneconomic losses and the number of years or
3865	part thereof which the award is intended to cover; and
3866	(c) Amounts awarded to the claimant for punitive damages,
3867	if applicable.
3868	Section 68. Section 766.26, Florida Statutes, is created
3869	to read:
3870	766.26 Florida Jury Verdict Database.--
3871	(1) The Agency for Health Care Administration shall
3872	maintain the Florida Jury Verdict Database. For the initial
3873	database, the department shall utilize information and
3874	categories provided by a nationwide jury verdict research
3875	database of plaintiff and defense verdicts and settlements
3876	resulting from medical malpractice claims. The data to be used
3877	must be reported, tabulated, and analyzed to determine values,
3878	trends, and deviations for injuries and liabilities including
3879	medical malpractice.
3880	(2) Beginning September 1, 2003, all awards under
3881	subsection (1) shall be reported by the Clerk of the Court in
3882	the circuit in which the judgment was entered to the agency
3883	within 3 business days for compilation into the Florida Jury
3884	Verdict Data Base. The agency, in conjunction with the Clerks of
3885	the Court, shall develop a format for the clerks to use in
3886	reporting the information required for the categories utilized
3887	by the database in subsection (1).
3888	(3) Beginning July 1, 2007, the department shall only
3889	utilize reports concerning cases within the state in the Florida
3890	Jury Verdict Database.
3891	(4) The awards reported by the Clerks of the Court shall
3892	be adjusted annually in accordance with the changes in the
3893	Consumer Price Index as issued by the United States Department
3894	of Labor Bureau of Labor Statistics. The Agency for Health Care
3895	Administration shall adjust all previously reported awards in
3896	the Florida Jury Verdict Database as provided herein prior to
3897	July 1 of each year. Only those awards reported from courts in
3898	this state after September 1, 2003, shall be adjusted.
3899	Section 69. Section 766.27, Florida Statutes, is created
3900	to read:
3901	766.27 Sanctions for frivolous medical malpractice
3902	lawsuits.-- Any attorney who receives three judgments of filing
3903	a frivolous medical malpractice lawsuit in any 5-year period
3904	shall be precluded from filing a medical malpractice lawsuit for
3905	3 years. Such preclusion shall prohibit him or her from serving
3906	as co-counsel on any medical malpractice lawsuit.
3907	Section 70. Office of Insurance Regulation; closed claim
3908	forms; report required.-- The Office of Insurance Regulation
3909	shall revise its closed claim form for readability at the ninth-
3910	grade level. The office shall compile annual statistical reports
3911	that provide data summaries of all closed claims, including, but
3912	not limited to, the number of closed claims on file pertaining
3913	to the referent health care professional or health care entity,
3914	the nature of the errant conduct, the size of payments, and the
3915	frequency and size of noneconomic damage awards. The office
3916	shall develop annualized historical statistical summaries
3917	beginning with the 1976 state fiscal year and publish these
3918	reports on its website no later than the 2005 state fiscal year.
3919	The form must accommodate the following minimum requirements:
3920	(1) A practitioner of medicine licensed pursuant to
3921	chapter 458, Florida Statutes, or a practitioner of osteopathic
3922	medicine licensed pursuant to chapter 459, Florida Statutes,
3923	shall report to the Office of Insurance Regulation and the
3924	Department of Health any claim or action for damages for
3925	personal injury alleged to have been caused by error, omission,
3926	or negligence in the performance of such licensee's professional
3927	services or based on a claimed performance of professional
3928	services without consent if the claim was not covered by an
3929	insurer required to report under s. 627.912, Florida Statutes,
3930	is not a claim for medical malpractice that is subject to the
3931	provisions of s. 766.106, Florida Statutes, and the claim
3932	resulted in:
3933	(a) A final judgment in any amount.
3934	(b) A settlement in any amount.
3935	(c) A final disposition not resulting in payment on behalf
3936	of the licensee. Reports shall be filed with the Office of
3937	Insurance Regulation no later than 60 days following the
3938	occurrence of any event listed in this subsection.
3939	(2) Health professional reports must contain:
3940	(a) The name and address of the licensee.
3941	(b) The alleged occurrence.
3942	(c) The date of the alleged occurrence.
3943	(d) The date the claim or action was reported to the
3944	licensee.
3945	(e) The name and address of the opposing party.
3946	(f) The date of suit, if filed.
3947	(g) The injured person's age and sex.
3948	(h) The total number and names of all defendants involved
3949	in the claim.
3950	(i) The date and amount of judgment or settlement, if any,
3951	including the itemization of the verdict, together with a copy
3952	of the settlement or judgment.
3953	(j) In the case of a settlement, any information required
3954	by the Office of Insurance Regulation concerning the injured
3955	person's incurred and anticipated medical expense, wage loss,
3956	and other expenses.
3957	(k) The loss adjustment expense paid to defense counsel,
3958	and all other allocated loss adjustment expenses paid.
3959	(l) The date and reason for final disposition, if there
3960	was no judgment or settlement.
3961	(m) A summary of the occurrence that created the claim,
3962	which must include:
3963	1. The name of the institution, if any, and the location
3964	within such institution at which the injury occurred.
3965	2. The final diagnosis for which treatment was sought or
3966	rendered, including the patient's actual condition.
3967	3. A description of the misdiagnosis made, if any, of the
3968	patient's actual condition.
3969	4. The operation or the diagnostic or treatment procedure
3970	causing the injury.
3971	5. A description of the principal injury giving rise to
3972	the claim.
3973	6. The safety management steps that have been taken by the
3974	licensee to make similar occurrences or injuries less likely in
3975	the future.
3976	(n) Any other information required by the Office of
3977	Insurance Regulation to analyze and evaluate the nature, causes,
3978	location, cost, and damages involved in professional liability
3979	cases.
3980	Section 71. Subsection (8) of section 768.21, Florida
3981	Statutes, is amended to read:
3982	768.21 Damages.-- All potential beneficiaries of a
3983	recovery for wrongful death, including the decedent's estate,
3984	shall be identified in the complaint, and their relationships to
3985	the decedent shall be alleged. Damages may be awarded as
3986	follows:
3987	(8) Notwithstanding any other provision of law to the
3988	contrary, for purposes of a wrongful death action arising out of
3989	medical negligence, adult individuals named as beneficiaries
3990	under a testamentary estate may recover noneconomic damages as
3991	though they were within that class of survivors identified in
3992	this section when a health care practitioner commits an
3993	intentional tort or is convicted of a crime which resulted in
3994	the death of the benefactor. The personal representative of the
3995	estate shall be entitled to assert a cause of action on behalf
3996	of the class of beneficiaries for the noneconomic damages of
3997	such beneficiaries which shall be in addition to any other
3998	damages that the estate would otherwise be entitled to assert.
3999	However, in no event shall the total amount of noneconomic
4000	damages for the entire class of beneficiaries exceed any
4001	limitation on noneconomic damages imposed under s. 766.118The
4002	damages specified in subsection (3) shall not be recoverable by
4003	adult children and the damages specified in subsection (4) shall
4004	not be recoverable by parents of an adult child with respect to
4005	claims for medical malpractice as defined by s. 766.106(1).
4006	Section 72. Subsection (5) of section 768.81, Florida
4007	Statutes, is amended to read:
4008	768.81 Comparative fault.--
4009	(5) Notwithstanding any provision ofanything inlaw to
4010	the contrary, in an action for damages for personal injury or
4011	wrongful death arising out of medical malpractice, whether in
4012	contract or tort, when an apportionment of damages pursuant to
4013	this section is attributed to a teaching hospital as defined in
4014	s. 408.07, the court shall enter judgment against the teaching
4015	hospital on the basis of eachsuchparty's percentage of fault
4016	and not on the basis of the doctrine of joint and several
4017	liability. In the trial of any action for medical malpractice
4018	which follows a settlement between the plaintiff and one or more
4019	defendants or potential defendants for the same injury, the
4020	plaintiff shall be estopped from denying that the fault on the
4021	part of any such settled defendant or prospective defendant
4022	contributed to causing the plaintiff’s injuries with respect to
4023	any such settled defendant or prospective defendant who has been
4024	identified by way of affirmative defense or joined by a
4025	nonsettling defendant as a party who is liable, in whole or in
4026	part, for the plaintiff's damages.
4027	Section 73. Section 1004.08, Florida Statutes, is created
4028	to read:
4029	1004.08 Patient safety instructional requirements.-- Every
4030	public school, college, and university that offers degrees in
4031	medicine, nursing, and allied health shall include in the
4032	curricula applicable to such degrees material on patient safety,
4033	including patient safety improvement. Materials shall include,
4034	but need not be limited to, effective communication and
4035	teamwork; epidemiology of patient injuries and medical errors;
4036	vigilance, attention, and fatigue; checklists and inspections;
4037	automation and technological and computer support; psychological
4038	factors in human error; and reporting systems.
4039	Section 74. Section 1004.085, Florida Statutes, is created
4040	to read:
4041	1004.085 Informed consent standardization project.-- Every
4042	public school, college, and university that offers degrees in
4043	medicine, nursing, and allied health shall work with the Agency
4044	for Health Care Administration to develop bilingual, multimedia
4045	methods for communicating the risks of treatment options for
4046	medical procedures. Such materials shall be provided to patients
4047	and their families in an effort to educate them and to obtain
4048	the informed consent to prescribe a treatment procedure. The
4049	agency shall develop a list of treatment procedures based on
4050	significance of risk and frequency of performance.
4051	Section 75. Section 1005.07, Florida Statutes, is created
4052	to read:
4053	1005.07 Patient safety instructional requirements.-- Every
4054	nonpublic school, college, and university that offers degrees in
4055	medicine, nursing, and allied health shall include in the
4056	curricula applicable to such degrees material on patient safety,
4057	including patient safety improvement. Materials shall include,
4058	but need not be limited to, effective communication and
4059	teamwork; epidemiology of patient injuries and medical errors;
4060	vigilance, attention, and fatigue; checklists and inspections;
4061	automation and technological and computer support; psychological
4062	factors in human error; and reporting systems.
4063	Section 76. Section 1005.075, Florida Statutes, is created
4064	to read:
4065	1005.075 Informed consent standardization project.-- Every
4066	nonpublic school, college, and university that offers degrees in
4067	medicine, nursing, and allied health shall work with the Agency
4068	for Health Care Administration to develop bilingual, multimedia
4069	methods for communicating the risks of treatment options for
4070	medical procedures. Such materials shall be provided to patients
4071	and their families in an effort to educate them and to obtain
4072	the informed consent to prescribe a treatment procedure. The
4073	agency shall develop a list of treatment procedures based on
4074	significance of risk and frequency of performance.
4075	Section 77. (1) The Agency for Health Care Administration
4076	shall conduct or contract for a study to determine what
4077	information is most feasible to provide to the public comparing
4078	state-licensed hospitals on certain inpatient quality indicators
4079	developed by the federal Agency for Healthcare Research and
4080	Quality. Such indicators shall be designed to identify
4081	information about specific procedures performed in hospitals for
4082	which there is strong evidence of a link to quality of care. The
4083	Agency for Health Care Administration or the study contractor
4084	shall refer to the hospital quality reports published in New
4085	York and Texas as guides during the evaluation.
4086	(2) The following concepts shall be specifically addressed
4087	in the study report:
4088	(a) Whether hospital discharge data about services can be
4089	translated into understandable and meaningful information for
4090	the public.
4091	(b) Whether the following measures are useful consumer
4092	guides relating to care provided in state-licensed hospitals:
4093	1. Inpatient mortality for medical conditions.
4094	2. Inpatient mortality for procedures.
4095	3. Utilization of procedures for which there are questions
4096	of overuse, underuse, or misuse.
4097	4. Volume of procedures for which there is evidence that a
4098	higher volume of procedures is associated with lower mortality.
4099	(c) Whether there are quality indicators that are
4100	particularly useful relative to the state's unique demographics.
4101	(d) Whether all hospitals should be included in the
4102	comparison.
4103	(e) The criteria for comparison.
4104	(f) Whether comparisons are best within metropolitan
4105	statistical areas or some other geographic configuration.
4106	(g) Identification of several Internet websites on which
4107	such a report should be published to achieve the broadest
4108	dissemination of the information.
4109	(3) The Agency for Health Care Administration shall
4110	consider the input of all interested parties, including
4111	hospitals, physicians, consumer organizations, and patients, and
4112	submit the final report to the Governor and the presiding
4113	officers of the Legislature by January 1, 2004.
4114	Section 78. No later than September 1, 2003, the
4115	Department of Health shall convene a workgroup to study the
4116	current healthcare practitioner disciplinary process. The
4117	workgroup shall include a representative of the Administrative
4118	Law section of The Florida Bar, a representative of the Health
4119	Law section of The Florida Bar, a representative of the Florida
4120	Medical Association, a representative of the Florida Osteopathic
4121	Medical Association, a representative of the Florida Dental
4122	Association, a member of the Florida Board of Medicine who has
4123	served on the probable cause panel, a member of the Board of
4124	Osteopathic Medicine who has served on the probable cause panel,
4125	and a member of the Board of Dentistry who has served on the
4126	probable cause panel. The workgroup shall also include one
4127	consumer member of the Board of Medicine. The Department of
4128	Health shall present the findings and recommendations to the
4129	Governor, the President of the Senate, and the Speaker of the
4130	House of Representatives no later than January 1, 2004. The
4131	sponsoring organizations shall assume the costs of their
4132	representative.
4133	Section 79. The sum of $687,786 is appropriated from the
4134	Medical Quality Assurance Trust Fund to the Department of
4135	Health, and seven positions are authorized for the purpose of
4136	implementing this act during the 2003-2004 fiscal year. The sum
4137	of $452,122 is appropriated from the General Revenue Fund to the
4138	Agency for Health Care Administration, and five positions are
4139	authorized for the purpose of implementing this act during the
4140	2003-2004 fiscal year.
4141	Section 80. If any provision of this act or the
4142	application thereof to any person or circumstance is held
4143	invalid, the invalidity does not affect other provisions or
4144	applications of the act which can be given effect without the
4145	invalid provision or application, and to this end the provisions
4146	of this act are declared severable.
4147	Section 81. All provisions of this act shall be repealed
4148	on July 1, 2007, unless the Legislature otherwise directs.
4149	Section 82. If any law amended by this act was also
4150	amended by a law enacted at the 2003 Regular Session of the
4151	Legislature or at the 2003 Special Session A of the Legislature,
4152	such laws shall be construed as if they had been enacted at the
4153	same session of the Legislature, and full effect shall be given
4154	to each if possible.
4155	Section 83. This act shall take effect upon becoming a law
4156	and shall apply to all actions filed after the effective date of
4157	the act.