HOUSE AMENDMENT Bill No. HB 63B
1	CHAMBER ACTION
2	Senate House
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12	Representative Murman offered the following:
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14	Substitute Amendment for Amendment (224015) (with directory
15	and title amendments)
16	Between line(s) 2510 and 2511, insert:
17	Section 55. (1) The Legislature finds and declares it to
18	be of vital importance that emergency services and care be
19	provided by hospitals, physicians, and emergency medical
20	services providers to every person in need of such care. The
21	Legislature finds that providers of emergency medical services
22	and care are critical elements in responding to disaster and
23	emergency situations that might affect our local communities,
24	state, and country. The Legislature recognizes the importance of
25	maintaining a viable system of providing for the emergency
26	medical needs of residents of this state and visitors to this
27	state. The Legislature and the Federal Government have required
28	such providers of emergency medical services and care to provide
29	emergency services and care to all persons who present
30	themselves to hospitals seeking such care. The Legislature has
31	further mandated that prehospital emergency medical treatment or
32	transport may not be denied by emergency medical services
33	providers to persons who have or are likely to have an emergency
34	medical condition. Such governmental requirements have imposed a
35	unilateral obligation for providers of emergency medical
36	services and care to provide services to all persons seeking
37	emergency care without ensuring payment or other consideration
38	for provision of such care. The Legislature also recognizes that
39	providers of emergency medical services and care provide a
40	significant amount of uncompensated emergency medical care in
41	furtherance of such governmental interest. A significant
42	proportion of the residents of this state who are uninsured or
43	are Medicaid or Medicare recipients are unable to access needed
44	health care because health care providers fear the increased
45	risk of medical malpractice liability. Such patients, in order
46	to obtain medical care, are frequently forced to seek care
47	through providers of emergency medical services and care.
48	Providers of emergency medical services and care in this state
49	have reported significant problems with both the availability
50	and affordability of professional liability coverage. Medical
51	malpractice liability insurance premiums have increased
52	dramatically and a number of insurers have ceased providing
53	medical malpractice coverage for emergency medical services and
54	care in this state. This results in a functional unavailability
55	of malpractice coverage for some providers of emergency medical
56	services and care. The Legislature further finds that certain
57	specialist physicians have resigned from serving on hospital
58	staffs or have otherwise declined to provide on-call coverage to
59	hospital emergency departments due to increased medical
60	malpractice liability exposure created by treating such
61	emergency department patients. It is the intent of the
62	Legislature that hospitals, emergency medical services
63	providers, and physicians be able to ensure that patients who
64	might need emergency medical services treatment or
65	transportation or who present themselves to hospitals for
66	emergency medical services and care have access to such needed
67	services.
68	(2) The Legislature finds that access to quality,
69	affordable health care for all Floridians is a necessary goal
70	for this state and that teaching hospitals play an essential
71	role in providing access to comprehensive health care services.
72	The Legislature finds that access to quality health care at
73	teaching hospitals is enhanced when teaching hospitals affiliate
74	and coordinate their common endeavors with medical schools.
75	These affiliations have proved to be an integral part of the
76	delivery of more efficient and economical health care services
77	to patients of teaching hospitals by offering quality graduate
78	medical education programs to resident physicians who provide
79	patient services at teaching hospitals and clinics owned by such
80	hospitals. These affiliations ensure continued access to quality
81	comprehensive health care services for Floridians and,
82	therefore, should be encouraged in order to maintain and expand
83	such services. The Legislature finds that when teaching
84	hospitals affiliate or enter into contracts with medical schools
85	to provide comprehensive health care services to patients of
86	teaching hospitals, teaching hospitals greatly increase their
87	exposure to claims arising out of alleged medical malpractice
88	and other allegedly negligent acts because some teaching
89	hospital employees and agents do not have the same level of
90	protection against liability claims as colleges and universities
91	with medical schools and their employees providing the same
92	patient services to the same teaching hospital patients. The
93	Legislature finds that the high cost of litigation, unequal
94	liability exposure, and increased medical malpractice insurance
95	premiums have adversely impacted the ability of some teaching
96	hospitals to permit their employees to provide patient services
97	to patients of teaching hospitals. This finding is consistent
98	with the report issued in April 2002 by the American Medical
99	Association declaring Florida to be one of 12 states in the
100	midst of a medical liability insurance crisis. The crisis in the
101	availability and affordability of medical malpractice insurance
102	is a contributing factor in the reduction of access to quality
103	health care in this state and has declined significantly. If no
104	corrective action is taken, this health care crisis will lead to
105	a continued reduction of patient services in teaching hospitals.
106	The Legislature finds that the state's 6 teaching hospitals
107	provide 70 percent of the state's graduate medical education as
108	reported in the 2001-2002 Report on Graduate Medical Education
109	in Florida: Findings and Recommendations and that the teaching
110	hospitals ensure the state's future medical manpower. The
111	Legislature finds that the public is better served and will
112	benefit from corrective action to address the foregoing
113	concerns. It is imperative that the legislature further the
114	public benefit by conferring sovereign immunity upon teaching
115	hospitals and their employees and agents when teaching hospitals
116	elect to be agents of the Department of Health as providers of
117	the state's graduate medical education. It is also the intent of
118	the Legislature that employees of teaching hospitals providing
119	patient services to patients of a teaching hospital be immune
120	from lawsuits in the same manner and to the same extent as
121	employees and agents of the state, its agencies and political
122	subdivisions, and further, that they shall not be held
123	personally liable in tort or named as a party defendant in an
124	action while performing patient services except as provided in
125	s. 768.28(9)(a).
126	Section 56. Paragraph (b) of subsection (9) of section
127	768.28, Florida Statutes, is amended to read:
128	768.28 Waiver of sovereign immunity in tort actions;
129	recovery limits; limitation on attorney fees; statute of
130	limitations; exclusions; indemnification; risk management
131	programs.--
132	(9)
133	(b) As used in this subsection, the term:
134	1. "Employee" includes any volunteer firefighter.
135	2. "Officer, employee, or agent" includes, but is not
136	limited to:,
137	a. Any receiving facility designated under chapter 394 and
138	any persons operating as employees or agents of the receiving
139	facility when providing emergency treatment to a person who
140	presented himself or herself for examination and treatment in
141	accordance with chapter 394.
142	b.Any health care provider when providing services
143	pursuant to s. 766.1115, any member of the Florida Health
144	Services Corps, as defined in s. 381.0302, who provides
145	uncompensated care to medically indigent persons referred by the
146	Department of Health, and any public defender or her or his
147	employee or agent, including, among others, an assistant public
148	defender and an investigator.
149	c. Any provider of emergency medical services and care
150	acting pursuant to obligations imposed by s. 395.1041, s.
151	395.401, or s. 401.45. Except for persons or entities that are
152	otherwise covered under this section, providers of emergency
153	medical services and care shall be considered agents of the
154	Department of Health and shall indemnify the state for the
155	reasonable costs of defense and indemnity payments, if any, up
156	to the liability limits set forth in this chapter. For purposes
157	of this sub-subparagraph:
158	(I) The term "provider of emergency medical services and
159	care" means all persons and entities covered under or providing
160	services pursuant to obligations imposed by s. 395.1041, s.
161	395.401, or s. 401.45, including, but not limited to:
162	(A) An emergency medical services provider licensed under
163	part III of chapter 401 and persons operating as employees or
164	agents of such provider or an emergency medical technician or
165	paramedic certified under part III of chapter 401.
166	(B) A hospital licensed under chapter 395 and persons
167	operating as employees or agents of such hospital.
168	(C) A physician licensed under chapter 458, chapter 459,
169	chapter 460, or chapter 461 or a dentist licensed under chapter
170	466.
171	(D) A physician assistant licensed under chapter 458 or
172	chapter 459.
173	(E) A registered nurse, nurse midwife, licensed practical
174	nurse, or advanced registered nurse practitioner licensed or
175	registered under part I of chapter 464.
176	(F) A midwife licensed under chapter 467.
177	(G) A health care professional association and employees
178	or agents of the association or a corporate medical group and
179	employees or agents of such group.
180	(H) Any student or medical resident who is enrolled in an
181	accredited program or licensed program that prepares the student
182	for licensure or certification in any one of the professions
183	listed in sub-sub-sub-subparagraphs (C)-(G), the program that
184	prepares the student for licensure or certification, and the
185	entity responsible for the training of the student or medical
186	resident.
187	(I) Any other person or entity that provides services
188	pursuant to obligations imposed by s. 395.1041, s. 395.401, or
189	s. 401.45.
190	(II) The term "emergency medical services" means ambulance
191	assessment, treatment, or transport services provided pursuant
192	to obligations imposed by s. 395.1041 or s. 401.45; all
193	screening, examination, and evaluation performed by a physician,
194	hospital, or other person or entity acting pursuant to
195	obligations imposed by s. 395.1041 or s. 395.401; and any care,
196	treatment, surgery, or other medical services provided, as
197	outpatient or inpatient, to relieve or eliminate an emergency
198	medical condition, including all medical services to eliminate
199	the likelihood that the emergency medical condition will
200	deteriorate or recur without further medical attention within a
201	reasonable period of time.
202	d. Any hospital which is either:
203	(I) A teaching hospital, as defined in s. 408.07;
204	(II) A hospital participating under the provisions of s.
205	381.0403; or
206	(III) A hospital designated as a family practice teaching
207	hospital under the provisions of s. 395.806:
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209	and any employee or agent of such hospital who provides patient
210	services to patients at the hospital facility or at a clinic or
211	other facility owned and operated by the hospital, which
212	hospital elects to be considered as an agent of the Department
213	of Health and indemnifies the state for the reasonable costs of
214	defense and indemnity payments, if any, up to the liability
215	limits set forth in this chapter.
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217	================= T I T L E A M E N D M E N T =================
218	Remove line 215, and insert:
219	1, 2004; providing legislative findings and intent; amending s.
220	768.28, F.S.; revising the definition of the term "officer,
221	employee, or agent" to include certain receiving facilities and
222	employees or agents of such facilities, providers of emergency
223	medical services and care, and certain hospitals for purposes of
224	limitation of liability in tort under certain circumstances;
225	providing that providers of emergency medical services and care
226	are deemed agents of the Department of Health for certain
227	purposes; requiring such providers to indemnify the state for
228	certain reasonable defense and indemnity costs within certain
229	limitations; specifying certain persons as providers of
230	emergency medical services and care; defining emergency medical
231	services; providing severability; providing for
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