HB 0019C 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 Internet website; requiring additional information in
105	such 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 rate base; 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 claimants
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 Department
377	of Health in the development of information to be provided
378	to patients and their families on risks of treatment
379	options to assist in receiving informed consent; creating
380	s. 1005.07, F.S.; requiring patient safety instruction for
381	certain students in nonpublic schools, colleges, and
382	universities; creating s. 1005.075, F.S.; requiring
383	certain nonpublic schools to assist the Department of
384	Health in the development of information to be provided to
385	patients and their families on risks of treatment options
386	to assist in receiving informed consent; directing the
387	Agency for Health Care Administration to conduct or
388	contract for a study to determine what information to
389	provide to the public comparing hospitals, based on
390	inpatient quality indicators developed by the federal
391	Agency for Healthcare Research and Quality; creating a
392	workgroup to study the health care practitioner
393	disciplinary process; providing for workgroup membership;
394	providing that the workgroup deliver its report by January
395	1, 2004; providing severability; providing for
396	construction of the act in pari materia with laws enacted
397	during the 2003 Regular Session, the 2003 Special Session
398	A, or the 2003 Special Session B 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 chair.
672	(e) Board members shall serve without compensation but may
673	be reimbursed for travel expenses pursuant to s. %_%1%_%.
674	(8) The center shall be financed as follows:
675	(a) Notwithstanding any law to the contrary, each health
676	insurer issued a certificate of authority under part VI, part
677	VII, or part VIII of chapter 627 shall, as a condition of
678	maintaining such certificate, make payment to the center on
679	April 1 of each year in the amount of $1 for each individual
680	insured covered by an insurance policy issued by or on behalf of
681	such insurer during the previous calendar year. Accompanying any
682	payment shall be a certification under oath by the chief
683	executive officer that states the number of individuals on which
684	such payment was based. The health insurer may collect this $1
685	from policyholders. The center may direct the insurer to provide
686	an independent audit of the certification that shall be
687	furnished within 90 days. If payment is not received by the
688	center within 30 days after April 1, interest at the annualized
689	rate of 18 percent shall begin to be charged on the amount due.
690	If payment has not been received within 60 days after interest
691	is charged, the center shall notify the Office of Insurance
692	Regulation that payment has not been received pursuant to the
693	requirements of this paragraph. An insurer that refuses to
694	comply with the requirements of this paragraph is subject to the
695	forfeiture of its certificate of authority.
696	(b) Notwithstanding any law to the contrary, each health
697	maintenance organization issued a certificate of authority under
698	part I of chapter 641 and each prepaid clinic issued a
699	certificate of authority under part II of chapter 641 shall, as
700	a condition of maintaining such certificate, make payment to the
701	center on April 1 of each year in the amount of $1 for each
702	individual who is eligible to receive services pursuant to a
703	contract with the health maintenance organization or the prepaid
704	clinic during the previous calendar year. Accompanying any
705	payment shall be a certification under oath by the chief
706	executive officer that states the number of individuals on which
707	such payment was based. The health maintenance organization or
708	prepaid clinic may collect the $1 from individuals eligible to
709	receive services under contract. The center may direct the
710	health maintenance organization or prepaid clinic to provide an
711	independent audit of the certification that shall be furnished
712	within 90 days. If payment is not received by the center within
713	30 days after April 1, interest at the annualized rate of 18
714	percent shall begin to be charged on the amount due. If payment
715	has not been received within 60 days after interest is charged,
716	the center shall notify the Department of Financial Services
717	that payment has not been received pursuant to the requirements
718	of this paragraph. A health maintenance organization or prepaid
719	clinic that refuses to comply with the requirements of this
720	paragraph is subject to the forfeiture of its certificate of
721	authority.
722	(c) Notwithstanding any law to the contrary, each hospital
723	and ambulatory surgical center licensed under chapter 395 shall,
724	as a condition of licensure, make payment to the center on April
725	1 of each year in the amount of $1 for each individual during
726	the previous 12 months who was an inpatient discharged by the
727	hospital or who was a patient in the ambulatory surgical center.
728	Accompanying payment shall be a certification under oath by the
729	chief executive officer that states the number of individuals on
730	which such payment was based. The facility may collect the $1
731	from patients discharged from the facility. The center may
732	direct the facility to provide an independent audit of the
733	certification that shall be furnished within 90 days. If payment
734	is not received by the center within 30 days after April 1,
735	interest at the annualized rate of 18 percent shall begin to be
736	charged on the amount due. If payment has not been received
737	within 60 days after interest is charged, the center shall
738	notify the Agency for Health Care Administration that payment
739	has not been received pursuant to the requirements of this
740	paragraph. An entity that refuses to comply with the
741	requirements of this paragraph is subject to the forfeiture of
742	its license.
743	(d) Notwithstanding any law to the contrary, each nursing
744	home, assisted living facility, home health agency, hospice,
745	prescribed pediatric extended care center, and health care
746	services pool licensed under chapter 400 shall, as a condition
747	of licensure, make payment to the center on April 1 of each year
748	in the amount of $1 for each individual served by each
749	aforementioned entity during the previous 12 months.
750	Accompanying payment shall be a certification under oath by the
751	chief executive officer that states the number of individuals on
752	which such payment was based. The entity may collect the $1 from
753	individuals served by the entity. The center may direct the
754	entity to provide an independent audit of the certification that
755	shall be furnished within 90 days. If payment is not received by
756	the center within 30 days after April 1, interest at the
757	annualized rate of 18 percent shall begin to be charged on the
758	amount due. If payment has not been received within 60 days
759	after interest is charged, the center shall notify the Agency
760	for Health Care Administration that payment has not been
761	received pursuant to the requirements of this paragraph. An
762	entity that refuses to comply with the requirements of this
763	paragraph is subject to the forfeiture of its license.
764	(e) Notwithstanding any law to the contrary, each initial
765	application and renewal fee for each license and each fee for
766	certification or recertification for each person licensed or
767	certified under chapter 401 or chapter 404 and for each person
768	licensed as a health care practitioner shall be increased by the
769	amount of $1 for each year for which the license or
770	certification is issued. The Department of Health shall make
771	payment to the center on April 1 of each year in the amount of
772	the total received pursuant to this paragraph during the
773	preceding 12 months.
774	(f) The center shall develop a business and financing plan
775	to obtain funds through other means if funds beyond those that
776	are provided for in this subsection are needed to accomplish the
777	objectives of the center.
778	(9) The center may enter into affiliations with
779	universities for any purpose.
780	(10) Pursuant to s. 287.057(5)(f)6., state agencies may
781	contract with the center on a sole source basis for projects to
782	improve the quality of program administration, including, but
783	not limited to, the implementation of an electronic medical
784	record for Medicaid program recipients.
785	(11) All travel and per diem paid with center funds shall
786	be in accordance with s. %_%3%_%.
787	(12) The center may use state purchasing and travel
788	contracts and the state communications system in accordance with
789	s. %_%4%_%(3).
790	(13) The center may acquire, enjoy, use, and dispose of
791	patents, copyrights, trademarks, and any licenses, royalties,
792	and other rights or interests thereunder or therein.
793	(14) The center shall submit an annual report to the
794	Governor, the President of the Senate, and the Speaker of the
795	House of Representatives no later than October 1 of each year
796	which includes:
797	(a) The status report on the implementation of a program
798	to analyze data concerning adverse incidents and patient safety
799	events.
800	(b) The status report on the implementation of technology
801	designed to reduce medication error.
802	(c) The status report on the implementation of an
803	electronic medical record.
804	(d) Other pertinent information relating to the efforts of
805	the center to improve health care quality and efficiency.
806	(e) A financial statement and balance sheet. The initial
807	report shall include any recommendations that the center deems
808	appropriate regarding revisions in the definition of adverse
809	incidents in s. 395.0197 and the reporting of such adverse
810	incidents by licensed facilities.
811	(15) The center may establish and manage an operating fund
812	for the purposes of addressing the center's cash flow needs and
813	facilitating the fiscal management of the corporation. Upon
814	dissolution of the corporation, any remaining cash balances of
815	any state funds shall revert to the General Revenue Fund, or
816	such other state funds consistent with appropriated funding, as
817	provided by law.
818	(16) The center may carry over funds from year to year.
819	(17) All books, records, and audits of the center shall be
820	open to the public unless exempted by law.
821	(18) The center shall furnish an annual audited report to
822	the Governor and Legislature by March 1 of each year.
823	(19) In carrying out this section, the center shall
824	consult with and develop partnerships, as appropriate, with all
825	segments of the health care industry, including, but not limited
826	to, health care practitioners, health care facilities, health
827	care consumers, professional organizations, agencies, health
828	care practitioner licensing boards, and educational
829	institutions.
830	Section 5. Subsection (3) is added to section 395.004,
831	Florida Statutes, to read:
832	395.004 Application for license, fees; expenses.--
833	(3) A licensed facility may apply to the agency for
834	certification of a quality improvement program that results in
835	the reduction of adverse incidents at that facility. The agency,
836	in consultation with the Office of Insurance Regulation, shall
837	develop criteria for such certification. Insurers shall file
838	with the Office of Insurance Regulation a discount in the rate
839	or rates applicable for medical liability insurance coverage to
840	reflect the implementation of a certified program. In reviewing
841	insurance company filings with respect to rate discounts
842	authorized under this subsection, the Office of Insurance
843	Regulation shall consider whether, and the extent to which, the
844	program certified under this subsection is otherwise covered
845	under a program of risk management offered by an insurance
846	company or self-insurance plan providing medical liability
847	insurance coverage.
848	Section 6. Section 395.0056, Florida Statutes, is created
849	to read:
850	395.0056 Litigation notice requirement.--Upon receipt of
851	a copy of a complaint filed against a hospital as a defendant in
852	a medical malpractice action as required by s. 766.106(2), the
853	agency shall:
854	(1) Review its adverse incident report files pertaining
855	to the licensed facility that is the subject of the complaint to
856	determine whether the facility timely complied with the
857	requirements of s. 395.0197.
858	(2) Review the incident that is the subject of the
859	complaint and determine whether it involved conduct by a
860	licensee which is potentially subject to disciplinary action.
861	Section 7. Subsection (7) of section 395.0191, Florida
862	Statutes, is amended to read:
863	395.0191 Staff membership and clinical privileges.--
864	(7) There shall be no monetary liability on the part of,
865	and no cause of action for injunctive relief ordamages shall
866	arise against, any licensed facility, its governing board or
867	governing board members, medical staff, or disciplinary board or
868	against its agents, investigators, witnesses, or employees, or
869	against any other person, for any action arising out of or
870	related to carrying out the provisions of this section, absent
871	taken in good faith and without intentional fraud in carrying
872	out the provisions of this section.
873	Section 8. Subsections (3) and (9) of section 395.0193,
874	Florida Statutes, are amended to read:
875	395.0193 Licensed facilities; peer review; disciplinary
876	powers; agency or partnership with physicians.--
877	(3) If reasonable belief exists that conduct by a staff
878	member or physician who delivers health care services at the
879	licensed facility may constitute one or more grounds for
880	discipline as provided in this subsection, a peer review panel
881	shall investigate and determine whether grounds for discipline
882	exist with respect to such staff member or physician. The
883	governing board of any licensed facility, after considering the
884	recommendations of its peer review panel, shall suspend, deny,
885	revoke, or curtail the privileges, or reprimand, counsel, or
886	require education, of any such staff member or physician after a
887	final determination has been made that one or more of the
888	following grounds exist:
889	(a) Incompetence.
890	(b) Being found to be a habitual user of intoxicants or
891	drugs to the extent that he or she is deemed dangerous to
892	himself, herself, or others.
893	(c) Mental or physical impairment which may adversely
894	affect patient care.
895	(d) Mental or physical abuse of a nurse or other staff
896	member.
897	(e)(d)Being found liable by a court of competent
898	jurisdiction for medical negligence or malpractice involving
899	negligent conduct.
900	(f)(e)One or more settlements exceeding $10,000 for
901	medical negligence or malpractice involving negligent conduct by
902	the staff member.
903	(g)(f)Medical negligence other than as specified in
904	paragraph (e)(d) or paragraph (f)(e).
905	(h)(g)Failure to comply with the policies, procedures, or
906	directives of the risk management program or any quality
907	assurance committees of any licensed facility.
908	(9)(a) If the defendant prevails in an action brought by a
909	staff member or physician who delivers health care services at
910	the licensed facility against any person or entity that
911	initiated, participated in, was a witness in, or conducted any
912	review as authorized by this section, the court shall award
913	reasonable attorney's fees and costs to the defendant.
914	(b) As a condition of any staff member or physician
915	bringing any action against any person or entity that initiated,
916	participated in, was a witness in, or conducted any review as
917	authorized by this section and before any responsive pleading is
918	due, the staff member or physician shall post a bond or other
919	security, as set by the court having jurisdiction of the action,
920	in an amount sufficient to pay the costs and attorney's fees. A
921	defendant's monetary liability under this section shall not
922	exceed $250,000.
923	Section 9. Section 395.0194, Florida Statutes, is created
924	to read:
925	395.0194 Licensed facilities; quality assurance
926	responsibilities of governing board.--
927	(1) A governing board's authority for the administration
928	of the hospital is not limited by the authority of its medical
929	staff. Therefore, a governing board may reject or modify a
930	medical staff recommendation or may, if the medical staff has
931	failed to act, take action independent of the medical staff
932	concerning medical staff membership, clinical privileges, peer
933	review, patient safety, and quality assurance.
934	(2) To the extent a governing board seeks to modify a
935	medical staff recommendation, or where a medical staff has
936	failed to act within 75 days after a request from the governing
937	board to take action against, or with regard to, an individual
938	physician concerning medical staff membership, clinical
939	privileges, peer review, or quality assurance, a governing board
940	may take action independent of the actions of the medical staff.
941	If no existing bylaw provision exists and if, after any informal
942	interview, the governing board determines that corrective or
943	disciplinary action is necessary, it shall recommend such action
944	to a six-member joint conference committee composed of three
945	members of the governing board, to be appointed by the chair of
946	the governing board, and three members of the medical staff, to
947	be appointed by the chair or president of the medical staff. The
948	joint conference committee shall, within 15 days after the
949	governing board's decision, conduct a fair hearing in which the
950	physician is entitled to be represented by counsel, to be
951	afforded an opportunity to present oral and written argument in
952	response to the corrective or disciplinary action proposed, and
953	to comment upon and cross-examine witnesses and evidence against
954	such physician and notify the governing board that the joint
955	conference committee accepts, rejects, or cannot reach a
956	majority consensus concerning the governing board's
957	recommendation. If the joint conference committee's
958	recommendation is to accept the governing board's
959	recommendation, the governing board's decision shall be final.
960	If the joint conference committee rejects the governing board's
961	recommendation and suggests an alternative corrective or
962	disciplinary action, or finds that no corrective or disciplinary
963	action is warranted, the governing board shall not unreasonably
964	reject the joint conference committee's recommendation. If the
965	joint conference committee cannot reach a majority consensus to
966	either accept or reject the governing board's action concerning
967	the fair hearing decision, the governing board's action shall be
968	final. The governing board shall give full and complete
969	consideration to the joint conference committee’s
970	recommendations.
971	Section 10. Subsections (12) through (20) of section
972	395.0197, Florida Statutes, are renumbered as subsections (13)
973	through (21), respectively, subsections (1), (3), (7), and (8)
974	of said section are amended, and a new subsection (12) is added
975	to said section, to read:
976	395.0197 Internal risk management program.--
977	(1) Every licensed facility shall, as a part of its
978	administrative functions, establish an internal risk management
979	program that includes all of the following components:
980	(a) The investigation and analysis of the frequency and
981	causes of general categories and specific types of adverse
982	incidents to patients.
983	(b) The development of appropriate measures to minimize
984	the risk of adverse incidents to patients, including, but not
985	limited to:
986	1. Risk management and risk prevention education and
987	training of all nonphysician personnel as follows:
988	a. Such education and training of all nonphysician
989	personnel as part of their initial orientation; and
990	b. At least 1 hour of such education and training annually
991	for all personnel of the licensed facility working in clinical
992	areas and providing patient care, except those persons licensed
993	as health care practitioners who are required to complete
994	continuing education coursework pursuant to chapter 456 or the
995	respective practice act, which education and training shall
996	include components designed to assist physicians and hospital
997	personnel in providing constructive advice to patients when
998	there is an adverse outcome.
999	2. A prohibition, except when emergency circumstances
1000	require otherwise, against a staff member of the licensed
1001	facility attending a patient in the recovery room, unless the
1002	staff member is authorized to attend the patient in the recovery
1003	room and is in the company of at least one other person.
1004	However, a licensed facility is exempt from the two-person
1005	requirement if it has:
1006	a. Live visual observation;
1007	b. Electronic observation; or
1008	c. Any other reasonable measure taken to ensure patient
1009	protection and privacy.
1010	3. A prohibition against an unlicensed person from
1011	assisting or participating in any surgical procedure unless the
1012	facility has authorized the person to do so following a
1013	competency assessment, and such assistance or participation is
1014	done under the direct and immediate supervision of a licensed
1015	physician and is not otherwise an activity that may only be
1016	performed by a licensed health care practitioner.
1017	4. Development, implementation, and ongoing evaluation of
1018	procedures, protocols, and systems to accurately identify
1019	patients, planned procedures, and the correct site of the
1020	planned procedure so as to minimize the performance of a
1021	surgical procedure on the wrong patient, a wrong surgical
1022	procedure, a wrong-site surgical procedure, or a surgical
1023	procedure otherwise unrelated to the patient's diagnosis or
1024	medical condition.
1025	(c) The analysis of patient grievances that relate to
1026	patient care and the quality of medical services.
1027	(d) A system for informing a patient or a proxy authorized
1028	by law to make health care decisions on behalf of a patient that
1029	the patient was the subject of an adverse incident as defined in
1030	subsection (5). Such notice shall be given by the risk manager,
1031	or his or her designee, as soon as practicable to allow the
1032	patient an opportunity to minimize damage or injury.
1033	(e)(d)The development and implementation of an incident
1034	reporting system based upon the affirmative duty of all health
1035	care providers and all agents and employees of the licensed
1036	health care facility to report adverse incidents to the risk
1037	manager, or to his or her designee, within 3 business days after
1038	their occurrence.
1039	(f) The development of a facilitywide plan for reducing
1040	medication errors, which shall include:
1041	1. The development of effective reporting mechanisms to
1042	ensure that medication-related errors are reviewed.
1043	2. The establishment of a baseline assessment and a review
1044	to be conducted at least annually of the effectiveness of the
1045	plan to reduce medication-related errors.
1046	3. The use of technology.
1047
1048	Pertinent literature related to the reduction of medication-
1049	related errors shall be reviewed and utilized in the development
1050	and ongoing review of the plan developed pursuant to this
1051	paragraph.
1052	(3) In addition to the programs mandated by this section,
1053	other innovative approaches intended to reduce the frequency and
1054	severity of medical malpractice and patient injury claims shall
1055	be encouraged and their implementation and operation
1056	facilitated. Such additional approaches may include extending
1057	internal risk management programs to health care providers'
1058	offices and the assuming of provider liability by a licensed
1059	health care facility for acts or omissions occurring within the
1060	licensed facility. Each licensed facility shall annually report
1061	to the agency and the Department of Health the name and
1062	judgments entered against each health care practitioner for
1063	which the facility assumes liability. The agency and the
1064	Department of Health, in their respective annual reports, shall
1065	include statistics that report the number of licensed facilities
1066	that assume such liability and the number of health care
1067	practitioners, by profession, for whom they assume liability.
1068	(7) The licensed facility shall notify the agency no later
1069	than 7 calendar days 1 business dayafter the risk manager or
1070	his or her designee has received a report pursuant to paragraph
1071	(1)(d) and can determine within 7 calendar days 1 business day
1072	that any of the following adverse incidents has occurred,
1073	whether occurring in the licensed facility or arising from
1074	health care prior to admission in the licensed facility:
1075	(a) The death of a patient;
1076	(b) Brain or spinal damage to a patient;
1077	(c) The performance of a surgical procedure on the wrong
1078	patient;
1079	(d) The performance of a wrong-site surgical procedure; or
1080	(e) The performance of a wrong surgical procedure.
1081
1082	The notification must be made in writing and be provided by
1083	facsimile device or overnight mail delivery. The notification
1084	must include information regarding the identity of the affected
1085	patient, the type of adverse incident, the initiation of an
1086	investigation by the facility, and whether the events causing or
1087	resulting in the adverse incident represent a potential risk to
1088	other patients.
1089	(8) Any of the following adverse incidents, whether
1090	occurring in the licensed facility or arising from health care
1091	prior to admission in the licensed facility, shall be reported
1092	by the facility to the agency within 15 calendar days after its
1093	occurrence:
1094	(a) The death of a patient;
1095	(b) Brain or spinal damage to a patient;
1096	(c) The performance of a surgical procedure on the wrong
1097	patient;
1098	(d) The performance of a wrong-site surgical procedure;
1099	(e) The performance of a wrong surgical procedure;
1100	(f) The performance of a surgical procedure that is
1101	medically unnecessary or otherwise unrelated to the patient's
1102	diagnosis or medical condition;
1103	(g) The surgical repair of damage resulting to a patient
1104	from a planned surgical procedure, where the damage is not a
1105	recognized specific risk, as disclosed to the patient and
1106	documented through the informed-consent process; or
1107	(h) The performance of procedures to remove unplanned
1108	foreign objects remaining from a surgical procedure.
1109
1110	The agency may grant extensions to this reporting requirement
1111	for more than 15 days upon justification submitted in writing by
1112	the facility administrator to the agency. The agency may require
1113	an additional, final report. These reports shall not be
1114	available to the public pursuant to s. 119.07(1) or any other
1115	law providing access to public records, nor be discoverable or
1116	admissible in any civil or administrative action, except in
1117	disciplinary proceedings by the agency or the appropriate
1118	regulatory board, nor shall they be available to the public as
1119	part of the record of investigation for and prosecution in
1120	disciplinary proceedings made available to the public by the
1121	agency or the appropriate regulatory board. However, the agency
1122	or the appropriate regulatory board shall make available, upon
1123	written request by a health care professional against whom
1124	probable cause has been found, any such records which form the
1125	basis of the determination of probable cause. The agency may
1126	investigate, as it deems appropriate, any such incident and
1127	prescribe measures that must or may be taken in response to the
1128	incident. The agency shall review each incident and determine
1129	whether it potentially involved conduct by the health care
1130	professional who is subject to disciplinary action, in which
1131	case the provisions of s. 456.073 shall apply. Copies of all
1132	reports of adverse incidents submitted to the agency by
1133	hospitals and ambulatory surgical centers shall be forwarded to
1134	the Florida Center for Excellence in Health Care, as defined in
1135	s. 381.0409, for analysis by experts who may make
1136	recommendations regarding the prevention of such incidents. Such
1137	information shall remain confidential as otherwise provided by
1138	law.
1139	(12) If appropriate, a licensed facility in which sexual
1140	abuse occurs must offer the victim of sexual abuse testing for
1141	sexually transmissible diseases and shall provide all such
1142	testing at no cost to the victim.
1143	Section 11. Section 395.1012, Florida Statutes, is created
1144	to read:
1145	395.1012 Patient safety.--
1146	(1) Each licensed facility shall adopt a patient safety
1147	plan. A plan adopted to implement the requirements of 42 C.F.R.
1148	s. 482.21 shall be deemed to comply with this requirement.
1149	(2) Each licensed facility shall appoint a patient safety
1150	officer and a patient safety committee, which shall include at
1151	least one person who is neither employed by nor practicing in
1152	the facility, for the purpose of promoting the health and safety
1153	of patients, reviewing and evaluating the quality of patient
1154	safety measures used by the facility, and assisting in the
1155	implementation of the facility patient safety plan.
1156	Section 12. Section 395.1051, Florida Statutes, is created
1157	to read:
1158	395.1051 Duty to notify patients.-- Every licensed
1159	facility shall inform each patient, or an individual identified
1160	pursuant to s. 765.401(1), in person about unanticipated
1161	outcomes of care that result in serious harm to the patient.
1162	Notification of outcomes of care that result in harm to the
1163	patient under this section shall not constitute an
1164	acknowledgement or admission of liability, nor can it be
1165	introduced as evidence in any civil lawsuit.
1166	Section 13. Section 456.026, Florida Statutes, is amended
1167	to read:
1168	456.026 Annual report concerning finances, administrative
1169	complaints, disciplinary actions, and recommendations.-- The
1170	department is directed to prepare and submit a report to the
1171	President of the Senate and the Speaker of the House of
1172	Representatives by November 1 of each year. The department shall
1173	publish the report on its Internet website simultaneously with
1174	delivery to the President of the Senate and the Speaker of the
1175	House of Representatives. The report must be directly accessible
1176	on the department's Internet homepage highlighted by easily
1177	identifiable links and buttons.In addition to finances and any
1178	other information the Legislature may require, the report shall
1179	include statistics and relevant information, profession by
1180	profession, detailing:
1181	(1) The number of health care practitioners licensed by
1182	the Division of Medical Quality Assurance or otherwise
1183	authorized to provide services in the state, if known to the
1184	department.
1185	(2)(1)The revenues, expenditures, and cash balances for
1186	the prior year, and a review of the adequacy of existing fees.
1187	(3)(2)The number of complaints received and investigated.
1188	(4)(3)The number of findings of probable cause made.
1189	(5)(4)The number of findings of no probable cause made.
1190	(6)(5)The number of administrative complaints filed.
1191	(7)(6)The disposition of all administrative complaints.
1192	(8)(7)A description of disciplinary actions taken.
1193	(9) For licensees under chapter 458, chapter 459, chapter
1194	461, or chapter 466, the professional liability claims and
1195	actions reported by insurers, as provided in s. 627.912. This
1196	information must be provided in a separate section of the report
1197	restricted to providing professional liability claims and
1198	actions data.
1199	(10)(8)A description of any effort by the department to
1200	reduce or otherwise close any investigation or disciplinary
1201	proceeding not before the Division of Administrative Hearings
1202	under chapter 120 or otherwise not completed within 1 year after
1203	the initial filing of a complaint under this chapter.
1204	(11)(9)The status of the development and implementation
1205	of rules providing for disciplinary guidelines pursuant to s.
1206	456.079.
1207	(12)(10)Such recommendations for administrative and
1208	statutory changes necessary to facilitate efficient and cost-
1209	effective operation of the department and the various boards.
1210	Section 14. Paragraph (a) of subsection (1) of section
1211	456.039, Florida Statutes, is amended to read:
1212	456.039 Designated health care professionals; information
1213	required for licensure.--
1214	(1) Each person who applies for initial licensure as a
1215	physician under chapter 458, chapter 459, chapter 460, or
1216	chapter 461, except a person applying for registration pursuant
1217	to ss. 458.345 and 459.021, must, at the time of application,
1218	and each physician who applies for license renewal under chapter
1219	458, chapter 459, chapter 460, or chapter 461, except a person
1220	registered pursuant to ss. 458.345 and 459.021, must, in
1221	conjunction with the renewal of such license and under
1222	procedures adopted by the Department of Health, and in addition
1223	to any other information that may be required from the
1224	applicant, furnish the following information to the Department
1225	of Health:
1226	(a)1. The name of each medical school that the applicant
1227	has attended, with the dates of attendance and the date of
1228	graduation, and a description of all graduate medical education
1229	completed by the applicant, excluding any coursework taken to
1230	satisfy medical licensure continuing education requirements.
1231	2. The name of each hospital at which the applicant has
1232	privileges.
1233	3. The address at which the applicant will primarily
1234	conduct his or her practice.
1235	4. Any certification that the applicant has received from
1236	a specialty board that is recognized by the board to which the
1237	applicant is applying.
1238	5. The year that the applicant began practicing medicine.
1239	6. Any appointment to the faculty of a medical school
1240	which the applicant currently holds and an indication as to
1241	whether the applicant has had the responsibility for graduate
1242	medical education within the most recent 10 years.
1243	7. A description of any criminal offense of which the
1244	applicant has been found guilty, regardless of whether
1245	adjudication of guilt was withheld, or to which the applicant
1246	has pled guilty or nolo contendere. A criminal offense committed
1247	in another jurisdiction which would have been a felony or
1248	misdemeanor if committed in this state must be reported. If the
1249	applicant indicates that a criminal offense is under appeal and
1250	submits a copy of the notice for appeal of that criminal
1251	offense, the department must state that the criminal offense is
1252	under appeal if the criminal offense is reported in the
1253	applicant's profile. If the applicant indicates to the
1254	department that a criminal offense is under appeal, the
1255	applicant must, upon disposition of the appeal, submit to the
1256	department a copy of the final written order of disposition.
1257	8. A description of any final disciplinary action taken
1258	within the previous 10 years against the applicant by the agency
1259	regulating the profession that the applicant is or has been
1260	licensed to practice, whether in this state or in any other
1261	jurisdiction, by a specialty board that is recognized by the
1262	American Board of Medical Specialties, the American Osteopathic
1263	Association, or a similar national organization, or by a
1264	licensed hospital, health maintenance organization, prepaid
1265	health clinic, ambulatory surgical center, or nursing home.
1266	Disciplinary action includes resignation from or nonrenewal of
1267	medical staff membership or the restriction of privileges at a
1268	licensed hospital, health maintenance organization, prepaid
1269	health clinic, ambulatory surgical center, or nursing home taken
1270	in lieu of or in settlement of a pending disciplinary case
1271	related to competence or character. If the applicant indicates
1272	that the disciplinary action is under appeal and submits a copy
1273	of the document initiating an appeal of the disciplinary action,
1274	the department must state that the disciplinary action is under
1275	appeal if the disciplinary action is reported in the applicant's
1276	profile.
1277	9. Relevant professional qualifications as defined by the
1278	applicable board.
1279	Section 15 Section 456.041, Florida Statutes, is amended
1280	to read:
1281	456.041 Practitioner profile; creation.--
1282	(1)(a)Beginning July 1, 1999, the Department of Health
1283	shall compile the information submitted pursuant to s. 456.039
1284	into a practitioner profile of the applicant submitting the
1285	information, except that the Department of Health may develop a
1286	format to compile uniformly any information submitted under s.
1287	456.039(4)(b). Beginning July 1, 2001, the Department of Health
1288	may, and beginning July 1, 2004, shall,compile the information
1289	submitted pursuant to s. 456.0391 into a practitioner profile of
1290	the applicant submitting the information.
1291	(b) Each practitioner licensed under chapter 458 or
1292	chapter 459 must report to the Department of Health and the
1293	Board of Medicine or the Board of Osteopathic Medicine,
1294	respectively, all final disciplinary actions, sanctions by a
1295	governmental agency or a facility or entity licensed under state
1296	law, and claims or actions, as provided under s. 456.051, to
1297	which he or she is subject no later than 15 calendar days after
1298	such action or sanction is imposed. Failure to submit the
1299	requisite information within 15 calendar days in accordance with
1300	this paragraph shall subject the practitioner to discipline by
1301	the Board of Medicine or the Board of Osteopathic Medicine and a
1302	fine of $100 for each day that the information is not submitted
1303	after the expiration of the 15-day reporting period.
1304	(c) Within 15 days after receiving a report under
1305	paragraph (b), the department shall update the practitioner's
1306	profile in accordance with the requirements of subsection (7).
1307	(2) On the profile published under subsection (1), the
1308	department shall indicate whether ifthe information provided
1309	under s. 456.039(1)(a)7. or s. 456.0391(1)(a)7. is or isnot
1310	corroborated by a criminal history check conducted according to
1311	this subsection. If the information provided under s.
1312	456.039(1)(a)7. or s. 456.0391(1)(a)7. is corroborated by the
1313	criminal history check, the fact that the criminal history check
1314	was performed need not be indicated on the profile.The
1315	department, or the board having regulatory authority over the
1316	practitioner acting on behalf of the department, shall
1317	investigate any information received by the department or the
1318	board when it has reasonable grounds to believe that the
1319	practitioner has violated any law that relates to the
1320	practitioner's practice.
1321	(3) The Department of Health shall mayinclude in each
1322	practitioner's practitioner profile that criminal information
1323	that directly relates to the practitioner's ability to
1324	competently practice his or her profession. The department must
1325	include in each practitioner's practitioner profile the
1326	following statement: "The criminal history information, if any
1327	exists, may be incomplete; federal criminal history information
1328	is not available to the public." The department shall provide in
1329	each practitioner profile, for every final disciplinary action
1330	taken against the practitioner, a narrative description, written
1331	in plain English, that explains the administrative complaint
1332	filed against the practitioner and the final disciplinary action
1333	imposed on the practitioner. The department shall include a
1334	hyperlink to each final order listed on its Internet website
1335	report of dispositions of recent disciplinary actions taken
1336	against practitioners.
1337	(4) The Department of Health shall include, with respect
1338	to a practitioner licensed under chapter 458 or chapter 459, a
1339	statement of how the practitioner has elected to comply with the
1340	financial responsibility requirements of s. 458.320 or s.
1341	459.0085. The department shall include, with respect to
1342	practitioners subject to s. 456.048, a statement of how the
1343	practitioner has elected to comply with the financial
1344	responsibility requirements of that section. The department
1345	shall include, with respect to practitioners licensed under
1346	chapter 458, chapter 459, or chapter 461, information relating
1347	to liability actions which has been reported under s. 456.049 or
1348	s. 627.912 within the previous 10 years for any paid claim of
1349	$50,000 or more that exceeds $5,000. Such claims information
1350	shall be reported in the context of comparing an individual
1351	practitioner's claims to the experience of other practitioners
1352	within the same specialty, or profession if the practitioner is
1353	not a specialist, to the extent such information is available to
1354	the Department of Health. The department shall include a
1355	hyperlink to all such comparison reports in such practitioner's
1356	profile on its Internet website.If information relating to a
1357	liability action is included in a practitioner's practitioner
1358	profile, the profile must also include the following statement:
1359	"Settlement of a claim may occur for a variety of reasons that
1360	do not necessarily reflect negatively on the professional
1361	competence or conduct of the practitioner. A payment in
1362	settlement of a medical malpractice action or claim should not
1363	be construed as creating a presumption that medical malpractice
1364	has occurred."
1365	(5) The Department of Health shall may not include the
1366	date of adisciplinary action taken by a licensed hospital or an
1367	ambulatory surgical center, in accordance with the requirements
1368	of s. 395.0193, in the practitioner profile. Any practitioner
1369	disciplined under paragraph (1)(b) must report to the department
1370	the date the disciplinary action was imposed. The department
1371	shall state whether the action is related to professional
1372	competence and whether it is related to the delivery of services
1373	to a patient.
1374	(6) The Department of Health may include in the
1375	practitioner's practitioner profile any other information that
1376	is a public record of any governmental entity and that relates
1377	to a practitioner's ability to competently practice his or her
1378	profession. However, the department must consult with the board
1379	having regulatory authority over the practitioner before such
1380	information is included in his or her profile.
1381	(7) Upon the completion of a practitioner profile under
1382	this section, the Department of Health shall furnish the
1383	practitioner who is the subject of the profile a copy of it. The
1384	practitioner has a period of 30 days in which to review the
1385	profile and to correct any factual inaccuracies in it. The
1386	Department of Health shall make the profile available to the
1387	public at the end of the 30-day period. The department shall
1388	make the profiles available to the public through the World Wide
1389	Web and other commonly used means of distribution.
1390	(8) The Department of Health shall provide in each profile
1391	an easy-to-read explanation of any disciplinary action taken and
1392	the reason the sanction or sanctions were imposed.
1393	(9)(8)Making a practitioner profile available to the
1394	public under this section does not constitute agency action for
1395	which a hearing under s. 120.57 may be sought.
1396	Section 15. Section 456.042, Florida Statutes, is amended
1397	to read:
1398	456.042 Practitioner profiles; update.--A practitioner
1399	must submit updates of required information within 15 days after
1400	the final activity that renders such information a fact.The
1401	Department of Health shall update each practitioner's
1402	practitioner profile periodically. An updated profile is subject
1403	to the same requirements as an original profile with respect to
1404	the period within which the practitioner may review the profile
1405	for the purpose of correcting factual inaccuracies.
1406	Section 16. Subsection (1) of section 456.049, Florida
1407	Statutes, is amended, and subsection (3) is added to said
1408	section, to read:
1409	456.049 Health care practitioners; reports on professional
1410	liability claims and actions.--
1411	(1) Any practitioner of medicine licensed pursuant to the
1412	provisions of chapter 458, practitioner of osteopathic medicine
1413	licensed pursuant to the provisions of chapter 459, podiatric
1414	physician licensed pursuant to the provisions of chapter 461, or
1415	dentist licensed pursuant to the provisions of chapter 466 shall
1416	report to the department any claim or action for damages for
1417	personal injury alleged to have been caused by error, omission,
1418	or negligence in the performance of such licensee's professional
1419	services or based on a claimed performance of professional
1420	services without consent if the claim was not covered by an
1421	insurer required to report under s. 627.912 andthe claim
1422	resulted in:
1423	(a) A final judgment of $50,000 or more or, with respect
1424	to a dentist licensed pursuant to chapter 466, a final judgment
1425	of $25,000 or more in any amount.
1426	(b) A settlement of $50,000 or more or, with respect to a
1427	dentist licensed pursuant to chapter 466, a settlement of
1428	$25,000 or more in any amount.
1429	(c) A final disposition not resulting in payment on behalf
1430	of the licensee.
1431
1432	Reports shall be filed with the department no later than 60 days
1433	following the occurrence of any event listed in paragraph (a),
1434	paragraph (b), or paragraph (c).
1435	(3) The department shall forward the information collected
1436	under this section to the Office of Insurance Regulation.
1437	Section 17. Section 456.051, Florida Statutes, is amended
1438	to read:
1439	456.051 Reports of professional liability actions;
1440	bankruptcies; Department of Health's responsibility to
1441	provide.--
1442	(1) The report of a claim or action for damages for
1443	personal injury which is required to be provided to the
1444	Department of Health under s. 456.049 or s. 627.912 is public
1445	information except for the name of the claimant or injured
1446	person, which remains confidential as provided in ss.
1447	456.049(2)(d) and 627.912(2)(e). The Department of Health shall,
1448	upon request, make such report available to any person. The
1449	department shall make such report available as a part of the
1450	practitioner's profile within 45 calendar days after receipt.
1451	(2) Any information in the possession of the Department of
1452	Health which relates to a bankruptcy proceeding by a
1453	practitioner of medicine licensed under chapter 458, a
1454	practitioner of osteopathic medicine licensed under chapter 459,
1455	a podiatric physician licensed under chapter 461, or a dentist
1456	licensed under chapter 466 is public information. The Department
1457	of Health shall, upon request, make such information available
1458	to any person. The department shall make such report available
1459	as a part of the practitioner's profile within 45 calendar days
1460	after receipt.
1461	Section 18. Paragraph (a) of subsection (7) of section
1462	456.057, Florida Statutes, is amended to read:
1463	456.057 Ownership and control of patient records; report
1464	or copies of records to be furnished.--
1465	(7)(a)1. The department may obtain patient records
1466	pursuant to a subpoena without written authorization from the
1467	patient if the department and the probable cause panel of the
1468	appropriate board, if any, find reasonable cause to believe that
1469	a health care practitioner has excessively or inappropriately
1470	prescribed any controlled substance specified in chapter 893 in
1471	violation of this chapter or any professional practice act or
1472	that a health care practitioner has practiced his or her
1473	profession below that level of care, skill, and treatment
1474	required as defined by this chapter or any professional practice
1475	act and also find that appropriate, reasonable attempts were
1476	made to obtain a patient release.
1477	2. The department may obtain patient records and insurance
1478	information pursuant to a subpoena without written authorization
1479	from the patient if the department and the probable cause panel
1480	of the appropriate board, if any, find reasonable cause to
1481	believe that a health care practitioner has provided inadequate
1482	medical care based on termination of insurance and also find
1483	that appropriate, reasonable attempts were made to obtain a
1484	patient release.
1485	3. The department may obtain patient records, billing
1486	records, insurance information, provider contracts, and all
1487	attachments thereto pursuant to a subpoena without written
1488	authorization from the patient if the department and probable
1489	cause panel of the appropriate board, if any, find reasonable
1490	cause to believe that a health care practitioner has submitted a
1491	claim, statement, or bill using a billing code that would result
1492	in payment greater in amount than would be paid using a billing
1493	code that accurately describes the services performed, requested
1494	payment for services that were not performed by that health care
1495	practitioner, used information derived from a written report of
1496	an automobile accident generated pursuant to chapter 316 to
1497	solicit or obtain patients personally or through an agent
1498	regardless of whether the information is derived directly from
1499	the report or a summary of that report or from another person,
1500	solicited patients fraudulently, received a kickback as defined
1501	in s. 456.054, violated the patient brokering provisions of s.
1502	817.505, or presented or caused to be presented a false or
1503	fraudulent insurance claim within the meaning of s.
1504	817.234(1)(a), and also find that, within the meaning of s.
1505	817.234(1)(a), patient authorization cannot be obtained because
1506	the patient cannot be located or is deceased, incapacitated, or
1507	suspected of being a participant in the fraud or scheme, and if
1508	the subpoena is issued for specific and relevant records.
1509	4. Notwithstanding subparagraphs 1.-3., when the
1510	department investigates a professional liability claim or
1511	undertakes action pursuant to s. 456.049 or s. 627.912, the
1512	department may obtain patient records pursuant to a subpoena
1513	without written authorization from the patient if the patient
1514	refuses to cooperate or attempts to obtain a patient release and
1515	failure to obtain the patient records would be detrimental to
1516	the investigation.
1517	Section 19. Section 456.0575, Florida Statutes, is created
1518	to read:
1519	456.0575 Duty to notify patients.--Every licensed health
1520	care practitioner shall inform each patient, or an individual
1521	identified pursuant to s. 765.401(1), in person about adverse
1522	incidents that result in serious harm to the patient.
1523	Notification of outcomes of care that result in harm to the
1524	patient under this section shall not constitute an
1525	acknowledgement of admission of liability, nor can such
1526	notifications be introduced as evidence in any civil lawsuit.
1527	Section 20. Patient safety discount.--A health care
1528	facility licensed pursuant to chapter 395, Florida Statutes, may
1529	apply to the Department of Financial Services for certification
1530	of any program that is recommended by the Florida Center for
1531	Excellence in Health Care to reduce adverse incidents, as
1532	defined in s. 395.0197, Florida Statutes, which result in the
1533	reduction of serious events at that facility. The department
1534	shall develop criteria for such certification. Insurers shall
1535	file with the department a discount in the rate or rates
1536	applicable for insurance coverage to reflect the effect of a
1537	certified program. A health care facility shall receive a
1538	discount in the rate or rates applicable for mandated basic
1539	insurance coverage required by law. In reviewing filings under
1540	this section, the department shall consider whether, and the
1541	extent to which, the program certified under this section is
1542	otherwise covered under a program of risk management offered by
1543	an insurance company or exchange or self-insurance plan
1544	providing medical professional liability coverage.
1545	Section 21. Subsection (4) is added to section 456.063,
1546	Florida Statutes, to read:
1547	456.063 Sexual misconduct; disqualification for license,
1548	certificate, or registration.--
1549	(4) Each board, or the department if there is no board,
1550	may adopt rules to implement the requirements for reporting
1551	allegations of sexual misconduct, including rules to determine
1552	the sufficiency of the allegations.
1553	Section 22. Subsection (4) of section 456.072, Florida
1554	Statutes, is amended, and subsection (7) is added to said
1555	section, to read:
1556	456.072 Grounds for discipline; penalties; enforcement.--
1557	(4) In any addition to any other discipline imposed
1558	throughfinal order, or citation, entered on or after July 1,
1559	2001, that imposes a penalty or other form of discipline
1560	pursuant to this section or discipline imposed through final
1561	order, or citation, entered on or after July 1, 2001,for a
1562	violation of any practice act, the board, or the department when
1563	there is no board, shall assess costs related to the
1564	investigation and prosecution of the case, including costs
1565	associated with an attorney's time. The amount of costs to be
1566	assessed shall be determined by the board, or the department
1567	when there is no board, following its consideration of an
1568	affidavit of itemized costs and any written objections thereto.
1569	In any case in which where the board or the department imposesa
1570	fine or assessment of costs imposed by the board or department
1571	and the fine or assessmentis not paid within a reasonable time,
1572	such reasonable time to be prescribed in the rules of the board,
1573	or the department when there is no board, or in the order
1574	assessing such fines or costs, the department or the Department
1575	of Legal Affairs may contract for the collection of, or bring a
1576	civil action to recover, the fine or assessment.
1577	(7) In any formal administrative hearing conducted under
1578	s. 120.57(1), the board or department shall establish grounds
1579	for the discipline of a licensee by the greater weight of the
1580	evidence.
1581	Section 23. Subsections (1) and (5) of section 456.073,
1582	Florida Statutes, are amended to read:
1583	456.073 Disciplinary proceedings.-- Disciplinary
1584	proceedings for each board shall be within the jurisdiction of
1585	the department.
1586	(1) The department, for the boards under its jurisdiction,
1587	shall cause to be investigated any complaint that is filed
1588	before it if the complaint is in writing, signed by the
1589	complainant, and legally sufficient. A complaint is legally
1590	sufficient if it contains ultimate facts that show that a
1591	violation of this chapter, of any of the practice acts relating
1592	to the professions regulated by the department, or of any rule
1593	adopted by the department or a regulatory board in the
1594	department has occurred. In order to determine legal
1595	sufficiency, the department may require supporting information
1596	or documentation. The department may investigate, and the
1597	department or the appropriate board may take appropriate final
1598	action on, a complaint even though the original complainant
1599	withdraws it or otherwise indicates a desire not to cause the
1600	complaint to be investigated or prosecuted to completion. The
1601	department may investigate an anonymous complaint if the
1602	complaint is in writing and is legally sufficient, if the
1603	alleged violation of law or rules is substantial, and if the
1604	department has reason to believe, after preliminary inquiry,
1605	that the violations alleged in the complaint are true. The
1606	department may investigate a complaint made by a confidential
1607	informant if the complaint is legally sufficient, if the alleged
1608	violation of law or rule is substantial, and if the department
1609	has reason to believe, after preliminary inquiry, that the
1610	allegations of the complainant are true. The department may
1611	initiate an investigation if it has reasonable cause to believe
1612	that a licensee or a group of licensees has violated a Florida
1613	statute, a rule of the department, or a rule of a board. The
1614	department may investigate information filed pursuant to s.
1615	456.041(4) relating to liability actions with respect to health
1616	care practitioners licensed under chapter 458 and chapter 459
1617	which have been reported under s. 456.049 or s. 627.912 within
1618	the previous 5 years for any paid claim that exceeds $50,000.
1619	Except as provided in ss. 458.331(9), 459.015(9), 460.413(5),
1620	and 461.013(6), when an investigation of any subject is
1621	undertaken, the department shall promptly furnish to the subject
1622	or the subject's attorney a copy of the complaint or document
1623	that resulted in the initiation of the investigation. The
1624	subject may submit a written response to the information
1625	contained in such complaint or document within 20 days after
1626	service to the subject of the complaint or document. The
1627	subject's written response shall be considered by the probable
1628	cause panel. The right to respond does not prohibit the issuance
1629	of a summary emergency order if necessary to protect the public.
1630	However, if the secretary, or the secretary's designee, and the
1631	chair of the respective board or the chair of its probable cause
1632	panel agree in writing that such notification would be
1633	detrimental to the investigation, the department may withhold
1634	notification. The department may conduct an investigation
1635	without notification to any subject if the act under
1636	investigation is a criminal offense.
1637	(5)(a)A formal hearing before an administrative law judge
1638	from the Division of Administrative Hearings shall be held
1639	pursuant to chapter 120 if there are any disputed issues of
1640	material fact. The administrative law judge shall issue a
1641	recommended order pursuant to chapter 120. If any party raises
1642	an issue of disputed fact during an informal hearing, the
1643	hearing shall be terminated and a formal hearing pursuant to
1644	chapter 120 shall be held.
1645	(b) Notwithstanding s. 120.569(2), the department shall
1646	notify the Division of Administrative Hearings within 45 days
1647	after receipt of a petition or request for a hearing that the
1648	department has determined requires a formal hearing before an
1649	administrative law judge.
1650	Section 24. Subsections (1) and (2) of section 456.077,
1651	Florida Statutes, are amended to read:
1652	456.077 Authority to issue citations.--
1653	(1) Notwithstanding s. 456.073, the board, or the
1654	department if there is no board, shall adopt rules to permit the
1655	issuance of citations. The citation shall be issued to the
1656	subject and shall contain the subject's name and address, the
1657	subject's license number if applicable, a brief factual
1658	statement, the sections of the law allegedly violated, and the
1659	penalty imposed. The citation must clearly state that the
1660	subject may choose, in lieu of accepting the citation, to follow
1661	the procedure under s. 456.073. If the subject disputes the
1662	matter in the citation, the procedures set forth in s. 456.073
1663	must be followed. However, if the subject does not dispute the
1664	matter in the citation with the department within 30 days after
1665	the citation is served, the citation becomes a publicfinal
1666	order and does not constitute constitutes discipline for a first
1667	offense, but does constitute discipline for a second or
1668	subsequent offense. The penalty shall be a fine or other
1669	conditions as established by rule.
1670	(2) The board, or the department if there is no board,
1671	shall adopt rules designating violations for which a citation
1672	may be issued. Such rules shall designate as citation violations
1673	those violations for which there is no substantial threat to the
1674	public health, safety, and welfare or no violation of standard
1675	of care involving injury to a patient. Violations for which a
1676	citation may be issued shall include violations of continuing
1677	education requirements; failure to timely pay required fees and
1678	fines; failure to comply with the requirements of ss. 381.026
1679	and 381.0261 regarding the dissemination of information
1680	regarding patient rights; failure to comply with advertising
1681	requirements; failure to timely update practitioner profile and
1682	credentialing files; failure to display signs, licenses, and
1683	permits; failure to have required reference books available; and
1684	all other violations that do not pose a direct and serious
1685	threat to the health and safety of the patient or involve a
1686	violation of standard of care that has resulted in injury to a
1687	patient.
1688	Section 25. Subsections (1) and (2) of section 456.078,
1689	Florida Statutes, are amended to read:
1690	456.078 Mediation.--
1691	(1) Notwithstanding the provisions of s. 456.073, the
1692	board, or the department when there is no board, shall adopt
1693	rules to designate which violations of the applicable
1694	professional practice act are appropriate for mediation. The
1695	board, or the department when there is no board, shall may
1696	designate as mediation offenses those complaints where harm
1697	caused by the licensee is economic in nature, except any act or
1698	omission involving intentional misconduct, orcan be remedied by
1699	the licensee, is not a standard of care violation involving any
1700	type of injury to a patient, or does not result in an adverse
1701	incident. For the purposes of this section, an "adverse
1702	incident" means an event that results in:
1703	(a) The death of a patient;
1704	(b) Brain or spinal damage to a patient;
1705	(c) The performance of a surgical procedure on the wrong
1706	patient;
1707	(d) The performance of a wrong-site surgical procedure;
1708	(e) The performance of a surgical procedure that is
1709	medically unnecessary or otherwise unrelated to the patient's
1710	diagnosis or medical condition;
1711	(f) The surgical repair of damage to a patient resulting
1712	from a planned surgical procedure, which damage is not a
1713	recognized specific risk as disclosed to the patient and
1714	documented through the informed-consent process;
1715	(g) The performance of a procedure to remove unplanned
1716	foreign objects remaining from a surgical procedure; or
1717	(h) The performance of any other surgical procedure that
1718	breached the standard of care.
1719	(2) After the department determines a complaint is legally
1720	sufficient and the alleged violations are defined as mediation
1721	offenses, the department or any agent of the department may
1722	conduct informal mediation to resolve the complaint. If the
1723	complainant and the subject of the complaint agree to a
1724	resolution of a complaint within 14 days after contact by the
1725	mediator, the mediator shall notify the department of the terms
1726	of the resolution. The department or board shall take no further
1727	action unless the complainant and the subject each fail to
1728	record with the department an acknowledgment of satisfaction of
1729	the terms of mediation within 60 days of the mediator's
1730	notification to the department. A successful mediation which
1731	results in an award of $50,000 or less shall not constitute
1732	discipline.In the event the complainant and subject fail to
1733	reach settlement terms or to record the required acknowledgment,
1734	the department shall process the complaint according to the
1735	provisions of s. 456.073.
1736	Section 26. Civil immunity for members of or consultants
1737	to certain boards, committees, or other entities.--
1738	(1) Each member of, or health care professional consultant
1739	to, any committee, board, group, commission, or other entity
1740	shall be immune from civil liability for any act, decision,
1741	omission, or utterance done or made in performance of his or her
1742	duties while serving as a member of or consultant to such
1743	committee, board, group, commission, or other entity established
1744	and operated for purposes of quality improvement review,
1745	evaluation, and planning in a state-licensed health care
1746	facility. Such entities must function primarily to review,
1747	evaluate, or make recommendations relating to:
1748	(a) The duration of patient stays in health care
1749	facilities;
1750	(b) The professional services furnished with respect to
1751	the medical, dental, psychological, podiatric, chiropractic, or
1752	optometric necessity for such services;
1753	(c) The purpose of promoting the most efficient use of
1754	available health care facilities and services;
1755	(d) The adequacy or quality of professional services;
1756	(e) The competency and qualifications for professional
1757	staff privileges;
1758	(f) The reasonableness or appropriateness of charges made
1759	by or on behalf of health care facilities; or
1760	(g) Patient safety, including entering into contracts with
1761	patient safety organizations.
1762	(2) Such committee, board, group, commission, or other
1763	entity must be established in accordance with state law or in
1764	accordance with requirements of the Joint Commission on
1765	Accreditation of Healthcare Organizations, established and duly
1766	constituted by one or more public or licensed private hospitals
1767	or behavioral health agencies, or established by a governmental
1768	agency. To be protected by this section, the act, decision,
1769	omission, or utterance may not be made or done in bad faith or
1770	with malicious intent.
1771	Section 27. Patient safety data privilege.--
1772	(1) As used in this section, the term:
1773	(a) "Patient safety data" means reports made to patient
1774	safety organizations, including all health care data,
1775	interviews, memoranda, analyses, root cause analyses, products
1776	of quality assurance or quality improvement processes,
1777	corrective action plans, or information collected or created by
1778	a health care facility licensed under chapter 395, Florida
1779	Statutes, or a health care practitioner as defined in s.
1780	456.001(4), Florida Statutes, as a result of an occurrence
1781	related to the provision of health care services which
1782	exacerbates an existing medical condition or could result in
1783	injury, illness, or death.
1784	(b) "Patient safety organization" means any organization,
1785	group, or other entity that collects and analyzes patient safety
1786	data for the purpose of improving patient safety and health care
1787	outcomes and that is independent and not under the control of
1788	the entity that reports patient safety data.
1789	(2) Patient safety data shall not be subject to discovery
1790	or introduction into evidence in any civil or administrative
1791	action.
1792	(3) Unless otherwise provided by law, a patient safety
1793	organization shall promptly remove all patient-identifying
1794	information after receipt of a complete patient safety data
1795	report unless such organization is otherwise permitted by state
1796	or federal law to maintain such information. Patient safety
1797	organizations shall maintain the confidentiality of all patient-
1798	identifying information and may not disseminate such
1799	information, except as permitted by state or federal law.
1800	(4) The exchange of patient safety data among health care
1801	facilities licensed under chapter 395, Florida Statutes, or
1802	health care practitioners as defined in s. 456.001(4), Florida
1803	Statutes, or patient safety organizations which does not
1804	identify any patient shall not constitute a waiver of any
1805	privilege established in this section.
1806	(5) Reporting of patient safety data to patient safety
1807	organizations does not abrogate obligations to make reports to
1808	the Department of Health, the Agency for Health Care
1809	Administration, or other state or federal regulatory agencies.
1810	(6) An employer may not take retaliatory action against an
1811	employee who in good faith makes a report of patient safety data
1812	to a patient safety organization.
1813	Section 28. Each board within the Department of Health
1814	which has jurisdiction over health care practitioners who are
1815	authorized to prescribe drugs may adopt by rule standards of
1816	practice for health care practitioners who are under that
1817	board's jurisdiction for the safe and ethical prescription of
1818	drugs to patients via the Internet or other electronic means.
1819	Section 29. The Office of Program Policy Analysis and
1820	Government Accountability and the Office of the Auditor General
1821	must jointly conduct an audit of the Department of Health's
1822	health care practitioner disciplinary process and closed claims
1823	that are filed with the department under s. 627.912, Florida
1824	Statutes. The Office of Program Policy Analysis and Government
1825	Accountability and the Office of the Auditor General shall
1826	submit a report to the Legislature by January 1, 2004.
1827	Section 30. Subsection (10) is added to section 458.320,
1828	Florida Statutes, subsection (8) of said section is renumbered
1829	as subsection (9), and a new subsection (8) is added to said
1830	section, to read:
1831	458.320 Financial responsibility.--
1832	(8) Notwithstanding any other provision of this section,
1833	the department shall suspend the license of any physician who
1834	does not have insurance as required by this section against whom
1835	has been entered a final judgment, arbitration award, or other
1836	order or who has entered into a settlement agreement to pay
1837	damages arising out of a claim for medical malpractice, if all
1838	appellate remedies have been exhausted and payment up to the
1839	amounts required by this section has not been made within 30
1840	days after the entering of such judgment, award, order, or
1841	agreement, until proof of payment is received by the department
1842	or a payment schedule has been agreed upon by the physician and
1843	the claimant and presented to the department. This subsection
1844	does not apply to a physician who has met the financial
1845	responsibility requirements in paragraphs (1)(b) and (2)(b).
1846	(10) Nothing in this section shall be construed as
1847	creating a civil cause of action against any hospital as a
1848	result of the failure of any physician with staff privileges to
1849	comply with the requirements of this section.
1850	Section 31. Paragraph (t) of subsection (1) and
1851	subsections (3) and (6) of section 458.331, Florida Statutes,
1852	are amended to read:
1853	458.331 Grounds for disciplinary action; action by the
1854	board and department.--
1855	(1) The following acts constitute grounds for denial of a
1856	license or disciplinary action, as specified in s. 456.072(2):
1857	(t) Gross or repeated malpractice or the failure to
1858	practice medicine with that level of care, skill, and treatment
1859	which is recognized by a reasonably prudent similar physician as
1860	being acceptable under similar conditions and circumstances. The
1861	board shall give great weight to the provisions of s. 766.102
1862	when enforcing this paragraph. As used in this paragraph,
1863	"repeated malpractice" includes, but is not limited to, three or
1864	more claims for medical malpractice within the previous 5-year
1865	period resulting in indemnities being paid in excess of $50,000
1866	$25,000each to the claimant in a judgment or settlement and
1867	which incidents involved negligent conduct by the physician. As
1868	used in this paragraph, "gross malpractice" or "the failure to
1869	practice medicine with that level of care, skill, and treatment
1870	which is recognized by a reasonably prudent similar physician as
1871	being acceptable under similar conditions and circumstances,"
1872	shall not be construed so as to require more than one instance,
1873	event, or act. Nothing in this paragraph shall be construed to
1874	require that a physician be incompetent to practice medicine in
1875	order to be disciplined pursuant to this paragraph.
1876	(3) In any administrative action against a physician which
1877	does not involve revocation or suspension of license, the
1878	division shall have the burden, by the greater weight of the
1879	evidence, to establish the existence of grounds for disciplinary
1880	action. The division shall establish grounds for revocation or
1881	suspension of license by clear and convincing evidence.
1882	(6) Upon the department's receipt from an insurer or self-
1883	insurer of a report of a closed claim against a physician
1884	pursuant to s. 627.912 or from a health care practitioner of a
1885	report pursuant to s. 456.049, or upon the receipt from a
1886	claimant of a presuit notice against a physician pursuant to s.
1887	766.106, the department shall review each report and determine
1888	whether it potentially involved conduct by a licensee that is
1889	subject to disciplinary action, in which case the provisions of
1890	s. 456.073 shall apply. However, if it is reported that a
1891	physician has had three or more claims with indemnities
1892	exceeding $50,000 $25,000each within the previous 5-year
1893	period, the department shall investigate the occurrences upon
1894	which the claims were based and determine if action by the
1895	department against the physician is warranted.
1896	Section 32. Section 458.3311, Florida Statutes, is created
1897	to read:
1898	458.3311 Emergency procedures for disciplinary action.--
1899	Notwithstanding any other provision of law to the contrary:
1900	(1) Each physician must report to the Department of Health
1901	any judgment for medical negligence levied against the
1902	physician. The physician must make the report no later than 15
1903	days after the exhaustion of the last opportunity for any party
1904	to appeal the judgment or request a rehearing.
1905	(2) No later than 30 days after a physician has, within a
1906	60-month period, made three reports as required by subsection
1907	(1), the Department of Health shall initiate an emergency
1908	investigation and the Board of Medicine shall conduct an
1909	emergency probable cause hearing to determine whether the
1910	physician should be disciplined for a violation of s.
1911	458.331(1)(t) or any other relevant provision of law.
1912	Section 33. Subsection (11) is added to section 459.0085,
1913	Florida Statutes, subsection (9) of said section is renumbered
1914	as subsection (10), and a new subsection (9) is added to said
1915	section, to read:
1916	459.0085 Financial responsibility.--
1917	(9) Notwithstanding any other provision of this section,
1918	the department shall suspend the license of any osteopathic
1919	physician who does not have insurance as required by this
1920	section against whom has been entered a final judgment,
1921	arbitration award, or other order or who has entered into a
1922	settlement agreement to pay damages arising out of a claim for
1923	medical malpractice, if all appellate remedies have been
1924	exhausted and payment up to the amounts required by this section
1925	has not been made within 30 days after the entering of such
1926	judgment, award, order, or agreement, until proof of payment is
1927	received by the department or a payment schedule has been agreed
1928	upon by the osteopathic physician and the claimant and presented
1929	to the department. This subsection does not apply to an
1930	osteopathic physician who has met the financial responsibility
1931	requirements in paragraphs (1)(b) and (2)(b).
1932	(11) Nothing in this section shall be construed as
1933	creating a civil cause of action against any hospital as a
1934	result of the failure of any physician with staff privileges to
1935	comply with the requirements of this section.
1936	Section 34. Paragraph (x) of subsection (1) and
1937	subsections (3) and (6) of section 459.015, Florida Statutes,
1938	are amended to read:
1939	459.015 Grounds for disciplinary action; action by the
1940	board and department.--
1941	(1) The following acts constitute grounds for denial of a
1942	license or disciplinary action, as specified in s. 456.072(2):
1943	(x) Gross or repeated malpractice or the failure to
1944	practice osteopathic medicine with that level of care, skill,
1945	and treatment which is recognized by a reasonably prudent
1946	similar osteopathic physician as being acceptable under similar
1947	conditions and circumstances. The board shall give great weight
1948	to the provisions of s. 766.102 when enforcing this paragraph.
1949	As used in this paragraph, "repeated malpractice" includes, but
1950	is not limited to, three or more claims for medical malpractice
1951	within the previous 5-year period resulting in indemnities being
1952	paid in excess of $50,000 $25,000each to the claimant in a
1953	judgment or settlement and which incidents involved negligent
1954	conduct by the osteopathic physician. As used in this paragraph,
1955	"gross malpractice" or "the failure to practice osteopathic
1956	medicine with that level of care, skill, and treatment which is
1957	recognized by a reasonably prudent similar osteopathic physician
1958	as being acceptable under similar conditions and circumstances"
1959	shall not be construed so as to require more than one instance,
1960	event, or act. Nothing in this paragraph shall be construed to
1961	require that an osteopathic physician be incompetent to practice
1962	osteopathic medicine in order to be disciplined pursuant to this
1963	paragraph. A recommended order by an administrative law judge or
1964	a final order of the board finding a violation under this
1965	paragraph shall specify whether the licensee was found to have
1966	committed "gross malpractice," "repeated malpractice," or
1967	"failure to practice osteopathic medicine with that level of
1968	care, skill, and treatment which is recognized as being
1969	acceptable under similar conditions and circumstances," or any
1970	combination thereof, and any publication by the board shall so
1971	specify.
1972	(3) In any administrative action against a physician which
1973	does not involve revocation or suspension of license, the
1974	division shall have the burden, by the greater weight of the
1975	evidence, to establish the existence of grounds for disciplinary
1976	action. The division shall establish grounds for revocation or
1977	suspension of license by clear and convincing evidence.
1978	(6) Upon the department's receipt from an insurer or self-
1979	insurer of a report of a closed claim against an osteopathic
1980	physician pursuant to s. 627.912 or from a health care
1981	practitioner of a report pursuant to s. 456.049, or upon the
1982	receipt from a claimant of a presuit notice against an
1983	osteopathic physician pursuant to s. 766.106, the department
1984	shall review each report and determine whether it potentially
1985	involved conduct by a licensee that is subject to disciplinary
1986	action, in which case the provisions of s. 456.073 shall apply.
1987	However, if it is reported that an osteopathic physician has had
1988	three or more claims with indemnities exceeding $50,000 $25,000
1989	each within the previous 5-year period, the department shall
1990	investigate the occurrences upon which the claims were based and
1991	determine if action by the department against the osteopathic
1992	physician is warranted.
1993	Section 35. Section 459.0151, Florida Statutes, is created
1994	to read:
1995	459.0151 Emergency procedures for disciplinary action.--
1996	Notwithstanding any other provision of law to the contrary:
1997	(1) Each osteopathic physician must report to the
1998	Department of Health any judgment for medical negligence levied
1999	against the physician. The osteopathic physician must make the
2000	report no later than 15 days after the exhaustion of the last
2001	opportunity for any party to appeal the judgment or request a
2002	rehearing.
2003	(2) No later than 30 days after an osteopathic physician
2004	has, within a 60-month period, made three reports as required by
2005	subsection (1), the Department of Health shall initiate an
2006	emergency investigation and the Board of Osteopathic Medicine
2007	shall conduct an emergency probable cause hearing to determine
2008	whether the physician should be disciplined for a violation of
2009	s. 459.015(1)(x) or any other relevant provision of law.
2010	Section 36. Paragraph (s) of subsection (1) and paragraph
2011	(a) of subsection (5) of section 461.013, Florida Statutes, are
2012	amended to read:
2013	461.013 Grounds for disciplinary action; action by the
2014	board; investigations by department.--
2015	(1) The following acts constitute grounds for denial of a
2016	license or disciplinary action, as specified in s. 456.072(2):
2017	(s) Gross or repeated malpractice or the failure to
2018	practice podiatric medicine at a level of care, skill, and
2019	treatment which is recognized by a reasonably prudent podiatric
2020	physician as being acceptable under similar conditions and
2021	circumstances. The board shall give great weight to the
2022	standards for malpractice in s. 766.102 in interpreting this
2023	section. As used in this paragraph, "repeated malpractice"
2024	includes, but is not limited to, three or more claims for
2025	medical malpractice within the previous 5-year period resulting
2026	in indemnities being paid in excess of $50,000 $10,000each to
2027	the claimant in a judgment or settlement and which incidents
2028	involved negligent conduct by the podiatric physicians. As used
2029	in this paragraph, "gross malpractice" or "the failure to
2030	practice podiatric medicine with the level of care, skill, and
2031	treatment which is recognized by a reasonably prudent similar
2032	podiatric physician as being acceptable under similar conditions
2033	and circumstances" shall not be construed so as to require more
2034	than one instance, event, or act.
2035	(5)(a) Upon the department's receipt from an insurer or
2036	self-insurer of a report of a closed claim against a podiatric
2037	physician pursuant to s. 627.912, or upon the receipt from a
2038	claimant of a presuit notice against a podiatric physician
2039	pursuant to s. 766.106, the department shall review each report
2040	and determine whether it potentially involved conduct by a
2041	licensee that is subject to disciplinary action, in which case
2042	the provisions of s. 456.073 shall apply. However, if it is
2043	reported that a podiatric physician has had three or more claims
2044	with indemnities exceeding $50,000 $25,000each within the
2045	previous 5-year period, the department shall investigate the
2046	occurrences upon which the claims were based and determine if
2047	action by the department against the podiatric physician is
2048	warranted.
2049	Section 37. Paragraph (x) of subsection (1) of section
2050	466.028, Florida Statutes, is amended to read:
2051	466.028 Grounds for disciplinary action; action by the
2052	board.--
2053	(1) The following acts constitute grounds for denial of a
2054	license or disciplinary action, as specified in s. 456.072(2):
2055	(x) Being guilty of incompetence or negligence by failing
2056	to meet the minimum standards of performance in diagnosis and
2057	treatment when measured against generally prevailing peer
2058	performance, including, but not limited to, the undertaking of
2059	diagnosis and treatment for which the dentist is not qualified
2060	by training or experience or being guilty of dental malpractice.
2061	For purposes of this paragraph, it shall be legally presumed
2062	that a dentist is not guilty of incompetence or negligence by
2063	declining to treat an individual if, in the dentist's
2064	professional judgment, the dentist or a member of her or his
2065	clinical staff is not qualified by training and experience, or
2066	the dentist's treatment facility is not clinically satisfactory
2067	or properly equipped to treat the unique characteristics and
2068	health status of the dental patient, provided the dentist refers
2069	the patient to a qualified dentist or facility for appropriate
2070	treatment. As used in this paragraph, "dental malpractice"
2071	includes, but is not limited to, three or more claims within the
2072	previous 5-year period which resulted in indemnity being paid,
2073	or any single indemnity paid in excess of $25,000 $5,000in a
2074	judgment or settlement, as a result of negligent conduct on the
2075	part of the dentist.
2076	Section 38. Subsection (2) of section 624.462, Florida
2077	Statutes, is amended to read:
2078	624.462 Commercial self-insurance funds.--
2079	(2) As used in ss. 624.460-624.488, "commercial self-
2080	insurance fund" or "fund" means a group of members, operating
2081	individually and collectively through a trust or corporation,
2082	that must be:
2083	(a) Established by:
2084	1. A not-for-profit trade association, industry
2085	association, or professional association of employers or
2086	professionals which has a constitution or bylaws, which is
2087	incorporated under the laws of this state, and which has been
2088	organized for purposes other than that of obtaining or providing
2089	insurance and operated in good faith for a continuous period of
2090	1 year;
2091	2. A self-insurance trust fund organized pursuant to s.
2092	627.357 and maintained in good faith for a continuous period of
2093	1 year for purposes other than that of obtaining or providing
2094	insurance pursuant to this section. Each member of a commercial
2095	self-insurance trust fund established pursuant to this
2096	subsection must maintain membership in the self-insurance trust
2097	fund organized pursuant to s. 627.357; or
2098	3. A group of 10 or more health care providers, as defined
2099	in s. %_%9%_%(4)(h); or
2100	4.3.A not-for-profit group comprised of no less than 10
2101	condominium associations as defined in s. 718.103(2), which is
2102	incorporated under the laws of this state, which restricts its
2103	membership to condominium associations only, and which has been
2104	organized and maintained in good faith for a continuous period
2105	of 1 year for purposes other than that of obtaining or providing
2106	insurance.
2107	(b)1. In the case of funds established pursuant to
2108	subparagraph (a)2. or subparagraph (a)4.3., operated pursuant to
2109	a trust agreement by a board of trustees which shall have
2110	complete fiscal control over the fund and which shall be
2111	responsible for all operations of the fund. The majority of the
2112	trustees shall be owners, partners, officers, directors, or
2113	employees of one or more members of the fund. The trustees shall
2114	have the authority to approve applications of members for
2115	participation in the fund and to contract with an authorized
2116	administrator or servicing company to administer the day-to-day
2117	affairs of the fund.
2118	2. In the case of funds established pursuant to
2119	subparagraph (a)1. or subparagraph (a)3., operated pursuant to a
2120	trust agreement by a board of trustees or as a corporation by a
2121	board of directors which board shall:
2122	a. Be responsible to members of the fund or beneficiaries
2123	of the trust or policyholders of the corporation;
2124	b. Appoint independent certified public accountants, legal
2125	counsel, actuaries, and investment advisers as needed;
2126	c. Approve payment of dividends to members;
2127	d. Approve changes in corporate structure; and
2128	e. Have the authority to contract with an administrator
2129	authorized under s. 626.88 to administer the day-to-day affairs
2130	of the fund including, but not limited to, marketing,
2131	underwriting, billing, collection, claims administration, safety
2132	and loss prevention, reinsurance, policy issuance, accounting,
2133	regulatory reporting, and general administration. The fees or
2134	compensation for services under such contract shall be
2135	comparable to the costs for similar services incurred by
2136	insurers writing the same lines of insurance, or where available
2137	such expenses as filed by boards, bureaus, and associations
2138	designated by insurers to file such data. A majority of the
2139	trustees or directors shall be owners, partners, officers,
2140	directors, or employees of one or more members of the fund.
2141	Section 39. Paragraph (a) of subsection (6) of section
2142	627.062, Florida Statutes, is amended, and subsections (7), (8),
2143	(9), and (10) are added to said section, to read:
2144	627.062 Rate standards.--
2145	(6)(a) After any action with respect to a rate filing that
2146	constitutes agency action for purposes of the Administrative
2147	Procedure Act, except for a rate filing for medical malpractice
2148	insurance,an insurer may, in lieu of demanding a hearing under
2149	s. 120.57, require arbitration of the rate filing. Arbitration
2150	shall be conducted by a board of arbitrators consisting of an
2151	arbitrator selected by the department, an arbitrator selected by
2152	the insurer, and an arbitrator selected jointly by the other two
2153	arbitrators. Each arbitrator must be certified by the American
2154	Arbitration Association. A decision is valid only upon the
2155	affirmative vote of at least two of the arbitrators. No
2156	arbitrator may be an employee of any insurance regulator or
2157	regulatory body or of any insurer, regardless of whether or not
2158	the employing insurer does business in this state. The
2159	department and the insurer must treat the decision of the
2160	arbitrators as the final approval of a rate filing. Costs of
2161	arbitration shall be paid by the insurer.
2162	(7) Notwithstanding any other provision of this section,
2163	in matters relating to professional liability insurance coverage
2164	for medical negligence, any portion of a judgment entered as a
2165	result of a statutory or common-law bad faith action and any
2166	portion of a judgment entered that awards punitive damages
2167	against an insurer may not be included in the insurer's rate
2168	base and may not be used to justify a rate or rate change. In
2169	matters relating to professional liability insurance coverage
2170	for medical negligence, any portion of a settlement entered as a
2171	result of a statutory or common-law bad faith action identified
2172	as such and any portion of a settlement wherein an insurer
2173	agrees to pay specific punitive damages may not be used to
2174	justify a rate or rate change. The portion of the taxable costs
2175	and attorney's fees that is identified as being related to the
2176	bad faith and punitive damages in these judgments and
2177	settlements may not be included in the insurer's rate base and
2178	may not be utilized to justify a rate or rate change.
2179	(8) Each insurer writing professional liability insurance
2180	coverage for medical negligence must make a rate filing under
2181	this section with the Office of Insurance Regulation at least
2182	once each calendar year.
2183	(9) Medical malpractice insurance companies shall submit a
2184	rate filing to the Office of Insurance Regulation no earlier
2185	than 30 days, but no later than 120 days, after the date upon
2186	which this act becomes law.
2187	(10)(a) The provisions of this subsection apply only with
2188	respect to rates for medical malpractice insurance and shall
2189	control to the extent of any conflict with other provisions of
2190	this section.
2191	(b) Any portion of a judgment entered or settlement paid
2192	as a result of a statutory or common-law bad faith action and
2193	any portion of a judgment entered which awards punitive damages
2194	against an insurer may not be included in the insurer's rate
2195	base and shall not be used to justify a rate or rate change. Any
2196	common-law bad faith action identified as such and any portion
2197	of a settlement entered as a result of a statutory or portion of
2198	a settlement wherein an insurer agrees to pay specific punitive
2199	damages may not be used to justify a rate or rate change. The
2200	portion of the taxable costs and attorney's fees which is
2201	identified as being related to the bad faith and punitive
2202	damages in these judgments and settlements may not be included
2203	in the insurer's rate base and may not be utilized to justify a
2204	rate or rate change.
2205	(c) Upon reviewing a rate filing and determining whether
2206	the rate is excessive, inadequate, or unfairly discriminatory,
2207	the Office of Insurance Regulation shall consider, in accordance
2208	with generally accepted and reasonable actuarial techniques,
2209	past and present prospective loss experience, either using loss
2210	experience solely for this state or giving greater credibility
2211	to this state's loss data.
2212	(d) Rates shall be deemed excessive if, among other
2213	standards established by this section, the rate structure
2214	provides for replenishment of reserves or surpluses from
2215	premiums when the replenishment is attributable to investment
2216	losses.
2217	(e) The insurer must apply a discount or surcharge based
2218	on the health care provider's loss experience or shall establish
2219	an alternative method giving due consideration to the provider's
2220	loss experience. The insurer must include in the filing a copy
2221	of the surcharge or discount schedule or a description of the
2222	alternative method used and must provide a copy of such schedule
2223	or description, as approved by the office, to policyholders at
2224	the time of renewal and to prospective policyholders at the time
2225	of application for coverage.
2226	Section 40. Section 627.0662, Florida Statutes, is created
2227	to read:
2228	627.0662 Excessive profits for medical liability insurance
2229	prohibited.--
2230	(1) As used in this section:
2231	(a) “Medical liability insurance” means insurance that is
2232	written on a professional liability insurance policy issued to a
2233	health care practitioner or on a liability insurance policy
2234	covering medical malpractice claims issued to a health care
2235	facility.
2236	(b) “Medical liability insurer” means any insurance
2237	company or group of insurance companies writing medical
2238	liability insurance in this state and does not include any self-
2239	insurance fund or other nonprofit entity writing such insurance.
2240	(2) Each medical liability insurer shall file with the
2241	Office of Insurance Regulation, prior to July 1 of each year on
2242	forms prescribed by the office, the following data for medical
2243	liability insurance business in this state. The data shall
2244	include both voluntary and joint underwriting association
2245	business, as follows:
2246	(a) Calendar-year earned premium.
2247	(b) Accident-year incurred losses and loss adjustment
2248	expenses.
2249	(c) The administrative and selling expenses incurred in
2250	this state or allocated to this state for the calendar year.
2251	(d) Policyholder dividends incurred during the applicable
2252	calendar year.
2253	(3)(a) Excessive profit has been realized if there has
2254	been an underwriting gain for the 3 most recent calendar-
2255	accident years combined which is greater than the anticipated
2256	underwriting profit plus 5 percent of earned premiums for those
2257	calendar-accident years.
2258	(b) As used in this subsection with respect to any 3-year
2259	period, “anticipated underwriting profit” means the sum of the
2260	dollar amounts obtained by multiplying, for each rate filing of
2261	the insurer group in effect during such period, the earned
2262	premiums applicable to such rate filing during such period by
2263	the percentage factor included in such rate filing for profit
2264	and contingencies, such percentage factor having been determined
2265	with due recognition to investment income from funds generated
2266	by business in this state. Separate calculations need not be
2267	made for consecutive rate filings containing the same percentage
2268	factor for profits and contingencies.
2269	(4) Each medical liability insurer shall also file a
2270	schedule of medical liability insurance loss in this state and
2271	loss adjustment experience for each of the 3 most recent
2272	accident years. The incurred losses and loss adjustment expenses
2273	shall be valued as of March 31 of the year following the close
2274	of the accident year, developed to an ultimate basis, and at two
2275	12-month intervals thereafter, each developed to an ultimate
2276	basis, to the extent that a total of three evaluations is
2277	provided for each accident year. The first year to be so
2278	reported shall be accident year 2004, such that the reporting of
2279	3 accident years will not take place until accident years 2005
2280	and 2006 have become available.
2281	(5) Each insurer group's underwriting gain or loss for
2282	each calendar-accident year shall be computed as follows: the
2283	sum of the accident-year incurred losses and loss adjustment
2284	expenses as of March 31 of the following year, developed to an
2285	ultimate basis, plus the administrative and selling expenses
2286	incurred in the calendar year, plus policyholder dividends
2287	applicable to the calendar year, shall be subtracted from the
2288	calendar-year earned premium to determine the underwriting gain
2289	or loss.
2290	(6) For the 3 most recent calendar-accident years, the
2291	underwriting gain or loss shall be compared to the anticipated
2292	underwriting profit.
2293	(7) If the medical liability insurer has realized an
2294	excessive profit, the office shall order a return of the
2295	excessive amounts to policyholders after affording the insurer
2296	an opportunity for hearing and otherwise complying with the
2297	requirements of chapter 120. Such excessive amounts shall be
2298	refunded to policyholders in all instances unless the insurer
2299	affirmatively demonstrates to the office that the refund of the
2300	excessive amounts will render the insurer or a member of the
2301	insurer group financially impaired or will render it insolvent.
2302	(8) The excessive amount shall be refunded to
2303	policyholders on a pro rata basis in relation to the final
2304	compilation year earned premiums to the voluntary medical
2305	liability insurance policyholders of record of the insurer group
2306	on December 31 of the final compilation year.
2307	(9) Any return of excessive profits to policyholders under
2308	this section shall be provided in the form of a cash refund or a
2309	credit towards the future purchase of insurance.
2310	(10)(a) Cash refunds to policyholders may be rounded to
2311	the nearest dollar.
2312	(b) Data in required reports to the office may be rounded
2313	to the nearest dollar.
2314	(c) Rounding, if elected by the insurer group, shall be
2315	applied consistently.
2316	(11)(a) Refunds to policyholders shall be completed as
2317	follows:
2318	1. If the insurer elects to make a cash refund, the refund
2319	shall be completed within 60 days after entry of a final order
2320	determining that excessive profits have been realized; or
2321	2. If the insurer elects to make refunds in the form of a
2322	credit to renewal policies, such credits shall be applied to
2323	policy renewal premium notices which are forwarded to insureds
2324	more than 60 calendar days after entry of a final order
2325	determining that excessive profits have been realized. If an
2326	insurer has made this election but an insured thereafter cancels
2327	his or her policy or otherwise allows the policy to terminate,
2328	the insurer group shall make a cash refund not later than 60
2329	days after termination of such coverage.
2330	(b) Upon completion of the renewal credits or refund
2331	payments, the insurer shall immediately certify to the office
2332	that the refunds have been made.
2333	(12) Any refund or renewal credit made pursuant to this
2334	section shall be treated as a policyholder dividend applicable
2335	to the year in which it is incurred, for purposes of reporting
2336	under this section for subsequent years.
2337	Section 41. Subsection (10) of section 627.357, Florida
2338	Statutes, is amended to read:
2339	627.357 Medical malpractice self-insurance.--
2340	(10)(a) An application to form a self-insurance fund under
2341	this section must be filed with the Office of Insurance
2342	Regulation.
2343	(b) The Office of Insurance Regulation must ensure that
2344	self-insurance funds remain solvent and provide insurance
2345	coverage purchased by participants. The Financial Services
2346	Commission may adopt rules pursuant to ss. 120.536(1) and 120.54
2347	to implement this subsection A self-insurance fund may not be
2348	formed under this section after October 1, 1992.
2349	Section 42. Section 627.3575, Florida Statutes, is created
2350	to read:
2351	627.3575 Health Care Professional Liability Insurance
2352	Facility.--
2353	(1) FACILITY CREATED; PURPOSE; STATUS.--There is created
2354	the Health Care Professional Liability Insurance Facility. The
2355	facility is intended to meet ongoing availability and
2356	affordability problems relating to liability insurance for
2357	health care professionals by providing an affordable, self-
2358	supporting source of excess insurance coverage for those
2359	professionals who are willing and able to self-insure for
2360	smaller losses. The facility shall operate on a not-for-profit
2361	basis. The facility is self-funding and is intended to serve a
2362	public purpose but is not a state agency or program, and no
2363	activity of the facility shall create any state liability.
2364	(2) GOVERNANCE; POWERS.--
2365	(a) The facility shall operate under a seven-member board
2366	of governors consisting of the Secretary of Health, three
2367	members appointed by the Governor, and three members appointed
2368	by the Chief Financial Officer. The board shall be chaired by
2369	the Secretary of Health. The secretary shall serve by virtue of
2370	his or her office, and the other members of the board shall
2371	serve terms concurrent with the term of office of the official
2372	who appointed them. Any vacancy on the board shall be filled in
2373	the same manner as the original appointment. Members serve at
2374	the pleasure of the official who appointed them. Members are not
2375	eligible for compensation for their service on the board, but
2376	the facility may reimburse them for per diem and travel expenses
2377	at the same levels as are provided in s. 112.061 for state
2378	employees.
2379	(b) The facility shall have such powers as are necessary
2380	to operate as an insurer, including the power to:
2381	1. Sue and be sued.
2382	2. Hire such employees and retain such consultants,
2383	attorneys, actuaries, and other professionals as it deems
2384	appropriate.
2385	3. Contract with such service providers as it deems
2386	appropriate.
2387	4. Maintain offices appropriate to the conduct of its
2388	business.
2389	5. Take such other actions as are necessary or appropriate
2390	in fulfillment of its responsibilities under this section.
2391	(3) COVERAGE PROVIDED.-- The facility shall provide
2392	liability insurance coverage for health care professionals. The
2393	facility shall allow policyholders to select from policies with
2394	deductibles of $25,000 per claim, $50,000 per claim, and
2395	$100,000 per claim and with coverage limits of $250,000 per
2396	claim and $750,000 annual aggregate and $1 million per claim and
2397	$3 million annual aggregate. To the greatest extent possible,
2398	the terms and conditions of the policies shall be consistent
2399	with terms and conditions commonly used by professional
2400	liability insurers. The facility shall offer policies to cover
2401	health care professionals who have retired from practice or
2402	maintain a part-time practice as set forth herein. For health
2403	care professionals who meet the following requirements, the
2404	premiums for such policies shall be no more than 50 percent of
2405	the cost of premiums for similar specialties for health care
2406	professionals who meet each of the following requirements:
2407	(a) The health care professional has held an active
2408	license to practice in this state or another state or some
2409	combination thereof for more than 15 years.
2410	(b) The health care professional has either retired from
2411	the practice of medicine or maintains a part-time practice of no
2412	more than 1,000 patient contact hours per year.
2413	(c) The health care professional has had no more than two
2414	claims for medical malpractice resulting in an indemnity
2415	exceeding $50,000 each within the previous 5-year period.
2416	(d) The health care professional has not been convicted
2417	of, or pled guilty or nolo contendere to, any criminal violation
2418	specified in this chapter or the medical practice act of any
2419	other state.
2420	(e) The health care professional has not been subject
2421	within the last 10 years of practice to license revocation or
2422	suspension for any period of time; probation for a period of 3
2423	years or longer; or a fine of $500 or more for a violation of
2424	this chapter or the medical practice act of another
2425	jurisdiction. The regulatory agency's acceptance of a health
2426	care professional's relinquishment of a license, stipulation,
2427	consent order, or other settlement, offered in response to or in
2428	anticipation of the filing of administrative charges against the
2429	health care professional's license, shall be construed as action
2430	against the health care professional's license for the purposes
2431	of this paragraph.
2432	(f) The health care professional has submitted a form
2433	supplying necessary information as required by the department
2434	and an affidavit affirming compliance with the provisions of
2435	this subsection.
2436	(g) The health care professional submits biennially to the
2437	facility certification stating compliance with the provisions of
2438	this subsection. The health care professional shall, upon
2439	request, demonstrate to the facility information verifying
2440	compliance with this subsection.
2441	(4) ELIGIBILITY; TERMINATION.--
2442	(a) Any health care professional is eligible for coverage
2443	provided by the facility if the professional at all times
2444	maintains either:
2445	1. An escrow account consisting of cash or assets eligible
2446	for deposit under s. 625.52 in an amount equal to the deductible
2447	amount of the policy; or
2448	2. An unexpired, irrevocable letter of credit, established
2449	pursuant to chapter 675, in an amount not less than the
2450	deductible amount of the policy. The letter of credit shall be
2451	payable to the health care professional as beneficiary upon
2452	presentment of a final judgment indicating liability and
2453	awarding damages to be paid by the health care professional or
2454	upon presentment of a settlement agreement signed by all parties
2455	to such agreement when such final judgment or settlement is a
2456	result of a claim arising out of the rendering of, or the
2457	failure to render, medical care and services. Such letter of
2458	credit shall be nonassignable and nontransferable. Such letter
2459	of credit shall be issued by any bank or savings association
2460	organized and existing under the laws of this state or any bank
2461	or savings association organized under the laws of the United
2462	States that has its principal place of business in this state or
2463	has a branch office which is authorized under the laws of this
2464	state or of the United States to receive deposits in this state.
2465	(b) The eligibility of a health care professional for
2466	coverage terminates upon:
2467	1. The failure of the professional to comply with
2468	paragraph (a);
2469	2. The failure of the professional to timely pay premiums
2470	or assessments; or
2471	3. The commission of any act of fraud in connection with
2472	the policy, as determined by the board of governors.
2473	(c) The board of governors, in its discretion, may
2474	reinstate the eligibility of a health care professional whose
2475	eligibility has terminated pursuant to paragraph (b) upon
2476	determining that the professional has subsequently complied with
2477	paragraph (a) or has paid the overdue premiums or assessments.
2478	Eligibility may be reinstated in the case of fraud only if the
2479	board determines that its initial determination of fraud was in
2480	error.
2481	(5) PREMIUMS; ASSESSMENTS.--
2482	(a) The facility shall charge the actuarially indicated
2483	premium for the coverage provided and shall retain the services
2484	of consulting actuaries to prepare its rate filings. The
2485	facility shall not provide dividends to policyholders, and, to
2486	the extent that premiums are more than the amount required to
2487	cover claims and expenses, such excess shall be retained by the
2488	facility for payment of future claims. In the event of
2489	dissolution of the facility, any amounts not required as a
2490	reserve for outstanding claims shall be transferred to the
2491	policyholders of record as of the last day of operation.
2492	(b) To ensure that the facility has the funds to pay
2493	claims, the facility shall receive:
2494	1. From each judgment awarded and settlement agreed to
2495	from which a claim will be paid in whole or in part by the
2496	facility, the facility shall retain 1 percent of its portion of
2497	the award or settlement for deposit into a separate account for
2498	guaranteeing payment of claims.
2499	2. A surcharge of $100 on each medical malpractice policy
2500	issued or renewed after July 1, 2003.
2501	(6) REGULATION; APPLICABILITY OF OTHER STATUTES.--
2502	(a) The facility shall operate pursuant to a plan of
2503	operation approved by order of the Office of Insurance
2504	Regulation of the Financial Services Commission. The board of
2505	governors may at any time adopt amendments to the plan of
2506	operation and submit the amendments to the Office of Insurance
2507	Regulation for approval.
2508	(b) The facility is subject to regulation by the Office of
2509	Insurance Regulation of the Financial Services Commission in the
2510	same manner as other insurers, except that, in recognition of
2511	the fact that its ability to levy assessments against its own
2512	policyholders is a substitute for the protections ordinarily
2513	afforded by such statutory requirements, the facility is exempt
2514	from statutory requirements relating to surplus as to
2515	policyholders.
2516	(c) The facility is not subject to part II of chapter 631,
2517	relating to the Florida Insurance Guaranty Association.
2518	(7) STARTUP PROVISIONS.--
2519	(a) It is the intent of the Legislature that the facility
2520	begin providing coverage no later than January 1, 2004.
2521	(b) The Governor and the Chief Financial Officer shall
2522	make their appointments to the board of governors of the
2523	facility no later than August 1, 2003. Until the board is
2524	appointed, the Secretary of Health may perform ministerial acts
2525	on behalf of the facility as chair of the board of governors.
2526	(c) Until the facility is able to hire permanent staff and
2527	enter into contracts for professional services, the office of
2528	the Secretary of Health shall provide support services to the
2529	facility.
2530	(d) In order to provide startup funds for the facility,
2531	the board of governors may incur debt or enter into agreements
2532	for lines of credit, provided that the sole source of funds for
2533	repayment of any debt is future premium revenues of the
2534	facility. The amount of such debt or lines of credit may not
2535	exceed $10 million.
2536	Section 43. Section 627.358, Florida Statutes, is created
2537	to read:
2538	627.358 Medical malpractice insurance; part-time
2539	coverage.--Insurance carriers shall be permitted to offer
2540	policies to cover health care professionals who have retired
2541	from practice or maintain a part-time practice as set forth
2542	herein. For health care professionals who meet each of the
2543	following requirements, the premiums for such policies shall be
2544	no more than 50 percent of the cost of premiums for similar
2545	specialties for health care professionals who meet each of the
2546	following requirements:
2547	(1) The health care professional has held an active
2548	license to practice in this state or another state or some
2549	combination thereof for more than 15 years.
2550	(2) The health care professional has either retired from
2551	the practice of medicine or maintains a part-time practice of no
2552	more than 1,000 patient contact hours per year.
2553	(3) The health care professional has had no more than two
2554	claims for medical malpractice resulting in an indemnity
2555	exceeding $50,000 each within the previous 5-year period.
2556	(4) The health care professional has not been convicted
2557	of, or pled guilty or nolo contendere to, any criminal violation
2558	specified in this chapter or the medical practice act of any
2559	other state.
2560	(5) The health care professional has not been subject
2561	within the last 10 years of practice to license revocation or
2562	suspension for any period of time; probation for a period of 3
2563	years or longer; or a fine of $500 or more for a violation of
2564	this chapter or the medical practice act of another
2565	jurisdiction. The regulatory agency's acceptance of a health
2566	care professional's relinquishment of a license, stipulation,
2567	consent order, or other settlement, offered in response to or in
2568	anticipation of the filing of administrative charges against the
2569	health care professional's license, shall be construed as action
2570	against the health care professional's license for the purposes
2571	of this subsection.
2572	(6) The health care professional has submitted a form
2573	supplying necessary information as required by the department
2574	and an affidavit affirming compliance with the provisions of
2575	this section.
2576	(7) The health care professional submits biennially to his
2577	or her insurance provider certification stating compliance with
2578	the provisions of this section. The health care professional
2579	shall, upon request, demonstrate to the Office of Insurance
2580	Regulation information verifying compliance with this section.
2581	Section 44. Section 627.359, Florida Statutes, is created
2582	to read:
2583	627.359 Discounts on medical malpractice liability
2584	insurance.--
2585	(1)(a) Medical malpractice insurance providers, including
2586	the Health Care Professional Liability Insurance Facility, shall
2587	provide a 20-percent discount on premiums for health care
2588	professionals who implement a system wherein the professional
2589	enters medication orders using a computer linked to prescribing
2590	error prevention software.
2591	(b) The Office of Insurance Regulation shall designate
2592	software vendors who meet the requirements of paragraph (a).
2593	(2)(a) Medical malpractice insurance providers, including
2594	the Health Care Professional Liability Insurance Facility, shall
2595	provide a 10-percent discount on premiums for health care
2596	professionals who implement a system wherein patients are only
2597	referred to a hospital based on scientifically valid criteria.
2598	(b) The Agency for Health Care Administration shall
2599	develop criteria that meet the requirements of paragraph (a).
2600	Section 45. Paragraph (c) of subsection (1) and subsection
2601	(3) of section 627.4147, Florida Statutes, are amended, and
2602	paragraph (d) is added to subsection (1) of said section, to
2603	read:
2604	627.4147 Medical malpractice insurance contracts.--
2605	(1) In addition to any other requirements imposed by law,
2606	each self-insurance policy as authorized under s. 627.357 or
2607	insurance policy providing coverage for claims arising out of
2608	the rendering of, or the failure to render, medical care or
2609	services, including those of the Florida Medical Malpractice
2610	Joint Underwriting Association, shall include:
2611	(c) A clause requiring the insurer or self-insurer to
2612	notify the insured no less than 90 60days prior to the
2613	effective date of cancellation of the policy or contract and, in
2614	the event of a determination by the insurer or self-insurer not
2615	to renew the policy or contract, to notify the insured no less
2616	than 90 60days prior to the end of the policy or contract
2617	period. If cancellation or nonrenewal is due to nonpayment or
2618	loss of license, 10 days' notice is required.
2619	(d) A clause requiring the insurer or self-insurer to
2620	notify the insured no less than 60 days prior to the effective
2621	date of a rate increase. The provisions of s. 627.4133 shall
2622	apply to such notice and to the failure of the insurer to
2623	provide such notice to the extent not in conflict with this
2624	section.
2625	(3) This section shall apply to all policies issued or
2626	renewed after October 1, 2003 1985.
2627	Section 46. Section 627.41491, Florida Statutes, is
2628	created to read:
2629	627.41491 Medical malpractice rate comparison.--The
2630	Office of Insurance Regulation shall annually publish a
2631	comparison of the rate in effect for each medical malpractice
2632	insurer and self-insurer and the Florida Medical Malpractice
2633	Joint Underwriting Association. Such rate comparison shall be
2634	made available to the public through the Internet and other
2635	commonly used means of distribution no later than July 1 of each
2636	year.
2637	Section 47. Section 627.41492, Florida Statutes, is
2638	created to read:
2639	627.41492 Annual medical malpractice report.--The Office
2640	of Insurance Regulation shall prepare an annual report by
2641	October 1 of each year, which shall be available to the public
2642	and posted on the Internet, which includes the following
2643	information:
2644	(1) A summary and analysis of the closed claim information
2645	required to be reported pursuant to s. %_%10%_%.
2646	(2) A summary and analysis of the annual and quarterly
2647	financial reports filed by each insurer writing medical
2648	malpractice insurance in the state.
2649	Section 48. Section 627.41493, Florida Statutes, is
2650	created to read:
2651	627.41493 Insurance rate rollback.--
2652	(1) For medical malpractice insurance policies issued or
2653	renewed on or after July 1, 2003, and before July 1, 2004, every
2654	insurer, including the Florida Medical Malpractice Joint
2655	Underwriting Association, shall reduce its rates and premiums by
2656	25 percent. The lower rates must be in effect for at least 12
2657	months and may not be raised by more than 15 percent after the
2658	expiration of those 12 months. Thereafter, there will be
2659	consideration for a physician, hospital, other health care
2660	professional, or other health care facility to receive a credit
2661	against the rate or rates applicable to its medical malpractice
2662	insurance, consistent with the level of such discount set in
2663	rule by the Financial Services Commission. In developing such
2664	rules, the commission may consider whether, and the extent to
2665	which, the types of programs approved under this act are
2666	otherwise covered under a program of risk management offered by
2667	the insurer.
2668	(2) The Financial Services Commission may adopt rules to
2669	implement the provisions of this section.
2670	Section 49. The Office of Program Policy Analysis and
2671	Government Accountability shall complete a study of the
2672	eligibility requirements for a birth to be covered under the
2673	Florida Birth-Related Neurological Injury Compensation
2674	Association and submit a report to the Legislature by January 1,
2675	2004, recommending whether the statutory criteria for a claim to
2676	qualify for referral to the Florida Birth-Related Neurological
2677	Injury Compensation Association under s. 766.302, Florida
2678	Statutes, should be modified.
2679	Section 50. Subsections (1) and (4) and paragraph (n) of
2680	subsection (2) of section 627.912, Florida Statutes, are amended
2681	to read:
2682	627.912 Professional liability claims and actions; reports
2683	by insurers.--
2684	(1)(a)Each self-insurer authorized under s. 627.357 and
2685	each insurer or joint underwriting association providing
2686	professional liability insurance to a practitioner of medicine
2687	licensed under chapter 458, to a practitioner of osteopathic
2688	medicine licensed under chapter 459, to a podiatric physician
2689	licensed under chapter 461, to a dentist licensed under chapter
2690	466, to a hospital licensed under chapter 395, to a crisis
2691	stabilization unit licensed under part IV of chapter 394, to a
2692	health maintenance organization certificated under part I of
2693	chapter 641, to clinics included in chapter 390, to an
2694	ambulatory surgical center as defined in s. 395.002, or to a
2695	member of The Florida Bar shall report in duplicate to the
2696	Department of Insurance any claim or action for damages for
2697	personal injuries claimed to have been caused by error,
2698	omission, or negligence in the performance of such insured's
2699	professional services or based on a claimed performance of
2700	professional services without consent, if the claim resulted in:
2701	1.(a)A final judgment in any amount.
2702	2.(b)A settlement in any amount.
2703
2704	Reports shall be filed with the department.
2705	(b) In addition to the requirements of paragraph (a), if
2706	the insured party is licensed under chapter 395, chapter 458,
2707	chapter 459, chapter 461, or chapter 466, the insurer shall
2708	report in duplicate to the Office of Insurance Regulation any
2709	other disposition of the claim, including, but not limited to, a
2710	dismissal. If the insured is licensed under chapter 458, chapter
2711	459, or chapter 461, any claim that resulted in a final judgment
2712	or settlement in the amount of $50,000 or more shall be reported
2713	to the Department of Health no later than 30 days following the
2714	occurrence of that event. If the insured is licensed under
2715	chapter 466, any claim that resulted in a final judgment or
2716	settlement in the amount of $25,000 or more shall be reported to
2717	the Department of Health no later than 30 days following the
2718	occurrence of that event and, if the insured party is licensed
2719	under chapter 458, chapter 459, chapter 461, or chapter 466,
2720	with the Department of Health, no later than 30 days following
2721	the occurrence of any event listed in paragraph (a) or paragraph
2722	(b). The Department of Health shall review each report and
2723	determine whether any of the incidents that resulted in the
2724	claim potentially involved conduct by the licensee that is
2725	subject to disciplinary action, in which case the provisions of
2726	s. 456.073 shall apply. The Department of Health, as part of the
2727	annual report required by s. 456.026, shall publish annual
2728	statistics, without identifying licensees, on the reports it
2729	receives, including final action taken on such reports by the
2730	Department of Health or the appropriate regulatory board.
2731	(2) The reports required by subsection (1) shall contain:
2732	(n) Any other information required by the department to
2733	analyze and evaluate the nature, causes, location, cost, and
2734	damages involved in professional liability cases. The Financial
2735	Services Commission shall adopt by rule requirements for
2736	additional information to assist the Office of Insurance
2737	Regulation in its analysis and evaluation of the nature, causes,
2738	location, cost, and damages involved in professional liability
2739	cases reported by insurers under this section.
2740	(4) There shall be no liability on the part of, and no
2741	cause of action of any nature shall arise against, any insurer
2742	reporting hereunder or its agents or employees or the department
2743	or its employees for any action taken by them under this
2744	section. The department shall mayimpose a fine of $250 per day
2745	per case, but not to exceed a total of $10,000 $1,000per case,
2746	against an insurer that violates the requirements of this
2747	section. This subsection applies to claims accruing on or after
2748	October 1, 1997.
2749	Section 51. Section 627.9121, Florida Statutes, is created
2750	to read:
2751	627.9121 Required reporting of claims; penalties.--Each
2752	entity that makes payment under a policy of insurance, self-
2753	insurance, or otherwise in settlement, partial settlement, or
2754	satisfaction of a judgment in a medical malpractice action or
2755	claim that is required to report information to the National
2756	Practitioner Data Bank under 42 U.S.C. s. 11131 must also report
2757	the same information to the Office of Insurance Regulation. The
2758	office shall include such information in the data that it
2759	compiles under s. 627.912. The office must compile and review
2760	the data collected pursuant to this section and must assess an
2761	administrative fine on any entity that fails to fully comply
2762	with such reporting requirements.
2763	Section 52. Section 766.102, Florida Statutes, is amended
2764	to read:
2765	766.102 Medical negligence; standards of recovery.--
2766	(1) In any action for recovery of damages based on the
2767	death or personal injury of any person in which it is alleged
2768	that such death or injury resulted from the negligence of a
2769	health care provider as defined in s. 766.101(1)(b)
2770	768.50(2)(b), the claimant shall have the burden of proving by
2771	the greater weight of evidence that the alleged actions of the
2772	health care provider represented a breach of the prevailing
2773	professional standard of care for that health care provider. The
2774	prevailing professional standard of care for a given health care
2775	provider shall be that level of care, skill, and treatment
2776	which, in light of all relevant surrounding circumstances, is
2777	recognized as acceptable and appropriate by reasonably prudent
2778	similar health care providers.
2779	(2)(a) If the health care provider whose negligence is
2780	claimed to have created the cause of action is not certified by
2781	the appropriate American board as being a specialist, is not
2782	trained and experienced in a medical specialty, or does not hold
2783	himself or herself out as a specialist, a "similar health care
2784	provider" is one who:
2785	1. Is licensed by the appropriate regulatory agency of
2786	this state;
2787	2. Is trained and experienced in the same discipline or
2788	school of practice; and
2789	3. Practices in the same or similar medical community.
2790	(b) If the health care provider whose negligence is
2791	claimed to have created the cause of action is certified by the
2792	appropriate American board as a specialist, is trained and
2793	experienced in a medical specialty, or holds himself or herself
2794	out as a specialist, a "similar health care provider" is one
2795	who:
2796	1. Is trained and experienced in the same specialty; and
2797	2. Is certified by the appropriate American board in the
2798	same specialty.
2799
2800	However, if any health care provider described in this paragraph
2801	is providing treatment or diagnosis for a condition which is not
2802	within his or her specialty, a specialist trained in the
2803	treatment or diagnosis for that condition shall be considered a
2804	"similar health care provider."
2805	(c) The purpose of this subsection is to establish a
2806	relative standard of care for various categories and
2807	classifications of health care providers. Any health care
2808	provider may testify as an expert in any action if he or she:
2809	1. Is a similar health care provider pursuant to paragraph
2810	(a) or paragraph (b); or
2811	2. Is not a similar health care provider pursuant to
2812	paragraph (a) or paragraph (b) but, to the satisfaction of the
2813	court, possesses sufficient training, experience, and knowledge
2814	as a result of practice or teaching in the specialty of the
2815	defendant or practice or teaching in a related field of
2816	medicine, so as to be able to provide such expert testimony as
2817	to the prevailing professional standard of care in a given field
2818	of medicine. Such training, experience, or knowledge must be as
2819	a result of the active involvement in the practice or teaching
2820	of medicine within the 5-year period before the incident giving
2821	rise to the claim.
2822	(2)(3)(a) If the injury is claimed to have resulted from
2823	the negligent affirmative medical intervention of the health
2824	care provider, the claimant must, in order to prove a breach of
2825	the prevailing professional standard of care, show that the
2826	injury was not within the necessary or reasonably foreseeable
2827	results of the surgical, medicinal, or diagnostic procedure
2828	constituting the medical intervention, if the intervention from
2829	which the injury is alleged to have resulted was carried out in
2830	accordance with the prevailing professional standard of care by
2831	a reasonably prudent similar health care provider.
2832	(b) The provisions of this subsection shall apply only
2833	when the medical intervention was undertaken with the informed
2834	consent of the patient in compliance with the provisions of s.
2835	766.103.
2836	(3)(4)The existence of a medical injury shall not create
2837	any inference or presumption of negligence against a health care
2838	provider, and the claimant must maintain the burden of proving
2839	that an injury was proximately caused by a breach of the
2840	prevailing professional standard of care by the health care
2841	provider. However, the discovery of the presence of a foreign
2842	body, such as a sponge, clamp, forceps, surgical needle, or
2843	other paraphernalia commonly used in surgical, examination, or
2844	diagnostic procedures, shall be prima facie evidence of
2845	negligence on the part of the health care provider.
2846	(4)(5)The Legislature is cognizant of the changing trends
2847	and techniques for the delivery of health care in this state and
2848	the discretion that is inherent in the diagnosis, care, and
2849	treatment of patients by different health care providers. The
2850	failure of a health care provider to order, perform, or
2851	administer supplemental diagnostic tests shall not be actionable
2852	if the health care provider acted in good faith and with due
2853	regard for the prevailing professional standard of care.
2854	(5) A person may not give expert testimony concerning the
2855	prevailing professional standard of care unless that person is a
2856	licensed health care provider and meets the following criteria:
2857	(a) If the party against whom or on whose behalf the
2858	testimony is offered is a specialist, the expert witness must:
2859	1. Specialize in the same specialty as the party against
2860	whom or on whose behalf the testimony is offered; or
2861	2. Specialize in a similar specialty that includes the
2862	evaluation, diagnosis, or treatment of the medical condition
2863	that is the subject of the claim and have prior experience
2864	treating similar patients.
2865	(b) Have devoted professional time during the 3 years
2866	immediately preceding the date of the occurrence that is the
2867	basis for the action to:
2868	1. The active clinical practice of, or consulting with
2869	respect to, the same or similar health profession as the health
2870	care provider against whom or on whose behalf the testimony is
2871	offered and, if that health care provider is a specialist, the
2872	active clinical practice of, or consulting with respect to, the
2873	same or similar specialty that includes the evaluation,
2874	diagnosis, or treatment of the medical condition that is the
2875	subject of the claim and have prior experience treating similar
2876	patients;
2877	2. The instruction of students in an accredited health
2878	professional school or accredited residency program in the same
2879	or similar health profession in which the health care provider
2880	against whom or on whose behalf the testimony is offered and, if
2881	that health care provider is a specialist, an accredited health
2882	professional school or accredited residency or clinical research
2883	program in the same or similar specialty; or
2884	3. A clinical research program that is affiliated with an
2885	accredited medical school or teaching hospital and that is in
2886	the same or similar health profession as the health care
2887	provider against whom or on whose behalf the testimony is
2888	offered and, if that health care provider is a specialist, a
2889	clinical research program that is affiliated with an accredited
2890	health professional school or accredited residency or clinical
2891	research program in the same or similar specialty.
2892	(c) If the party against whom or on whose behalf the
2893	testimony is offered is a general practitioner, the expert
2894	witness must have devoted professional time during the 5 years
2895	immediately preceding the date of the occurrence that is the
2896	basis for the action to:
2897	1. Active clinical practice or consultation as a general
2898	practitioner;
2899	2. Instruction of students in an accredited health
2900	professional school or accredited residency program in the
2901	general practice of medicine; or
2902	3. A clinical research program that is affiliated with an
2903	accredited medical school or teaching hospital and that is in
2904	the general practice of medicine.
2905	(6) A physician licensed under chapter 458 or chapter 459
2906	who qualifies as an expert witness under subsection (5) and who,
2907	by reason of active clinical practice or instruction of
2908	students, has knowledge of the applicable standard of care for
2909	nurses, nurse practitioners, certified registered nurse
2910	anesthetists, certified registered nurse midwives, physician
2911	assistants, or other medical support staff may give expert
2912	testimony in a medical malpractice action with respect to the
2913	standard of care of such medical support staff.
2914	(7) Notwithstanding subsection (5), in a medical
2915	malpractice action against a hospital, health care facility, or
2916	medical facility, a person may give expert testimony on the
2917	appropriate standard of care as to administrative and other
2918	nonclinical issues if the person has substantial knowledge, by
2919	virtue of his or her training and experience, concerning the
2920	standard of care among hospitals, health care facilities, or
2921	medical facilities of the same type as the hospital, health care
2922	facility, or medical facility whose acts or omissions are the
2923	subject of the testimony and which are located in the same or
2924	similar communities at the time of the alleged act giving rise
2925	to the cause of action.
2926	(8) If a health care provider described in subsection (5),
2927	subsection (6), or subsection (7) is providing evaluation,
2928	treatment, or diagnosis for a condition that is not within his
2929	or her specialty, a specialist trained in the evaluation,
2930	treatment, or diagnosis for that condition shall be considered a
2931	similar health care provider.
2932	(9)(6)(a) In any action for damages involving a claim of
2933	negligence against a physician licensed under chapter 458,
2934	osteopathic physician licensed under chapter 459, podiatric
2935	physician licensed under chapter 461, or chiropractic physician
2936	licensed under chapter 460 providing emergency medical services
2937	in a hospital emergency department, the court shall admit expert
2938	medical testimony only from physicians, osteopathic physicians,
2939	podiatric physicians, and chiropractic physicians who have had
2940	substantial professional experience within the preceding 5 years
2941	while assigned to provide emergency medical services in a
2942	hospital emergency department.
2943	(b) For the purposes of this subsection:
2944	1. The term "emergency medical services" means those
2945	medical services required for the immediate diagnosis and
2946	treatment of medical conditions which, if not immediately
2947	diagnosed and treated, could lead to serious physical or mental
2948	disability or death.
2949	2. "Substantial professional experience" shall be
2950	determined by the custom and practice of the manner in which
2951	emergency medical coverage is provided in hospital emergency
2952	departments in the same or similar localities where the alleged
2953	negligence occurred.
2954	(10) In any action alleging medical malpractice, an expert
2955	witness may not testify on a contingency fee basis.
2956	(11) Any attorney who proffers a person as an expert
2957	witness pursuant to this section must certify that such person
2958	has not been found guilty of fraud or perjury in any
2959	jurisdiction.
2960	(12) Any person who serves as an expert witness under
2961	subsection (5) may not receive remuneration in excess of $300
2962	per hour.
2963	(13) This section does not limit the power of the trial
2964	court to disqualify or qualify an expert witness on grounds
2965	other than the qualifications in this section.
2966	Section 53. Subsections (2), (3), and (4) and paragraph
2967	(a) of subsection (10) of section 766.106, Florida Statutes, are
2968	amended, and subsections (13), (14), and (15) are added to said
2969	section, to read:
2970	766.106 Notice before filing action for medical
2971	malpractice; presuit screening period; offers for admission of
2972	liability and for arbitration; informal discovery; review.--
2973	(2)(a)After completion of presuit investigation pursuant
2974	to s. 766.203 and prior to filing a claim for medical
2975	malpractice, a claimant shall notify each prospective defendant
2976	by certified mail, return receipt requested, of intent to
2977	initiate litigation for medical malpractice. Notice to each
2978	prospective defendant must include, if available, a list of all
2979	known health care providers seen by the claimant for the
2980	injuries complained of subsequent to the alleged act of
2981	malpractice, a list of all known health care providers during
2982	the 2-year period prior to the alleged act of malpractice who
2983	treated or evaluated the claimant, and copies of all of the
2984	medical records relied upon by the expert in signing the
2985	affidavit. The requirement of providing the list of known health
2986	care providers may not serve as grounds for imposing sanctions
2987	for failure to provide presuit discovery.
2988	(b)Following the initiation of a suit alleging medical
2989	malpractice with a court of competent jurisdiction, and service
2990	of the complaint upon a defendant, the claimant shall provide a
2991	copy of the complaint to the Department of Health and, if the
2992	complaint involves a facility licensed under chapter 395, the
2993	Agency for Health Care Administration. The requirement of
2994	providing the complaint to the Department of Health or the
2995	Agency for Health Care Administrationdoes not impair the
2996	claimant's legal rights or ability to seek relief for his or her
2997	claim. The Department of Health or the Agency for Health Care
2998	Administration shall review each incident that is the subject of
2999	the complaintand determine whether it involved conduct by a
3000	licensee which is potentially subject to disciplinary action, in
3001	which case the provisions of s. 456.073 or s. 395.1046apply.
3002	(3)(a) No suit may be filed for a period of 150 90days
3003	after notice is mailed to any prospective defendant. During the
3004	150-day 90-dayperiod, the prospective defendant's insurer or
3005	self-insurer shall conduct a review to determine the liability
3006	of the defendant. Each insurer or self-insurer shall have a
3007	procedure for the prompt investigation, review, and evaluation
3008	of claims during the 150-day 90-dayperiod. This procedure shall
3009	include one or more of the following:
3010	1. Internal review by a duly qualified claims adjuster;
3011	2. Creation of a panel comprised of an attorney
3012	knowledgeable in the prosecution or defense of medical
3013	malpractice actions, a health care provider trained in the same
3014	or similar medical specialty as the prospective defendant, and a
3015	duly qualified claims adjuster;
3016	3. A contractual agreement with a state or local
3017	professional society of health care providers, which maintains a
3018	medical review committee;
3019	4. Any other similar procedure which fairly and promptly
3020	evaluates the pending claim.
3021
3022	Each insurer or self-insurer shall investigate the claim in good
3023	faith, and both the claimant and prospective defendant shall
3024	cooperate with the insurer in good faith. If the insurer
3025	requires, a claimant shall appear before a pretrial screening
3026	panel or before a medical review committee and shall submit to a
3027	physical examination, if required. Unreasonable failure of any
3028	party to comply with this section justifies dismissal of claims
3029	or defenses. There shall be no civil liability for participation
3030	in a pretrial screening procedure if done without intentional
3031	fraud.
3032	(b) At or before the end of the 150 90days, the insurer
3033	or self-insurer shall provide the claimant with a response:
3034	1. Rejecting the claim;
3035	2. Making a settlement offer; or
3036	3. Making an offer to arbitrate, in which case liability
3037	is deemed admitted and arbitration will be held only of
3038	admission of liability and for arbitrationon the issue of
3039	damages. This offer may be made contingent upon a limit of
3040	general damages.
3041	(c) The response shall be delivered to the claimant if not
3042	represented by counsel or to the claimant's attorney, by
3043	certified mail, return receipt requested. Failure of the
3044	prospective defendant or insurer or self-insurer to reply to the
3045	notice within 150 90days after receipt shall be deemed a final
3046	rejection of the claim for purposes of this section.
3047	(d) Within 30 days after ofreceipt of a response by a
3048	prospective defendant, insurer, or self-insurer to a claimant
3049	represented by an attorney, the attorney shall advise the
3050	claimant in writing of the response, including:
3051	1. The exact nature of the response under paragraph (b).
3052	2. The exact terms of any settlement offer, or admission
3053	of liability and offer of arbitration on damages.
3054	3. The legal and financial consequences of acceptance or
3055	rejection of any settlement offer, or admission of liability,
3056	including the provisions of this section.
3057	4. An evaluation of the time and likelihood of ultimate
3058	success at trial on the merits of the claimant's action.
3059	5. An estimation of the costs and attorney's fees of
3060	proceeding through trial.
3061	(4) The notice of intent to initiate litigation shall be
3062	served within the time limits set forth in s. 95.11. However,
3063	during the 150-day 90-dayperiod, the statute of limitations is
3064	tolled as to all potential defendants. Upon stipulation by the
3065	parties, the 150-day 90-dayperiod may be extended and the
3066	statute of limitations is tolled during any such extension. Upon
3067	receiving notice of termination of negotiations in an extended
3068	period, the claimant shall have 60 days or the remainder of the
3069	period of the statute of limitations, whichever is greater,
3070	within which to file suit.
3071	(10) If a prospective defendant makes an offer to admit
3072	liability and for arbitration on the issue of damages, the
3073	claimant has 50 days from the date of receipt of the offer to
3074	accept or reject it. The claimant shall respond in writing to
3075	the insurer or self-insurer by certified mail, return receipt
3076	requested. If the claimant rejects the offer, he or she may then
3077	file suit. Acceptance of the offer of admission of liability and
3078	for arbitration waives recourse to any other remedy by the
3079	parties, and the claimant's written acceptance of the offer
3080	shall so state.
3081	(a) If rejected, the offer to admit liability and for
3082	arbitration on damages is not admissible in any subsequent
3083	litigation. Upon rejection of the offer to admit liability and
3084	for arbitration, the claimant has 60 days from receipt of the
3085	rejection of the offer to admit liability and for arbitration,
3086	60 days from the date of the declaration of impasse during
3087	presuit mediation conducted pursuant to s. 766.1065,or the
3088	remainder of the period of the statute of limitations, whichever
3089	period is greater, in which to file suit.
3090	(13) In matters relating to professional liability
3091	insurance coverage for medical negligence, an insurer shall not
3092	be held in bad faith for failure to timely pay its policy limits
3093	if it tenders its policy limits and meets all other conditions
3094	of settlement prior to the conclusion of the presuit screening
3095	period.
3096	(14) Failure to cooperate on the part of any party during
3097	the presuit investigation may be grounds to strike any claim
3098	made, or defense raised, by such party in suit.
3099	(15) In all matters relating to professional liability
3100	insurance coverage for medical negligence, and in determining
3101	whether the insurer has acted in good faith, the following
3102	factors may be considered, along with all of the other
3103	circumstances of the case:
3104	(a) Whether the damages recoverable against the insured
3105	are large or small.
3106	(b) Whether the liability against the insured is
3107	relatively clear.
3108	(c) Whether the insurance companies or its agents were
3109	negligent in handling the claim.
3110	(d) Whether the carrier acted as a reasonable person would
3111	who was facing the prospect of paying the entire loss.
3112	(e) Whether the insurance company made a fair offer as
3113	soon as a reasonable investigation would reveal that liability
3114	was reasonably clear and that the damages were greater than the
3115	policy limits.
3116	(f) Whether the insurer violated the unfair claims
3117	practice standards.
3118	(g) Whether the insurer’s communications with its insureds
3119	were actually honest, candid, and complete.
3120	(h) Whether the insurer violated the adjuster’s code of
3121	ethics in handling the claim.
3122	(i) Whether the insurer fully documented its claims-
3123	handling activities and the reasons for its decisions.
3124	(j) Whether the insurer or its agents properly trained its
3125	adjusters and provided adequate written standards for the
3126	adjustment of claims.
3127	(k) Whether the insurer used the policy benefits available
3128	to the insurer to extinguish as much of the insured’s liability
3129	as possible.
3130	(l) Whether the attorney appointed by the insurer to
3131	defend the insured was competent, independent, and faithfully
3132	representing the interests of the insured.
3133	Section 54. Section 766.1065, Florida Statutes, is created
3134	to read:
3135	766.1065 Mandatory staging of presuit investigation;
3136	mandatory mediation.--
3137	(1) Within 30 days after service of the presuit notice of
3138	intent to initiate medical malpractice litigation, each party
3139	shall voluntarily produce to all other parties, without being
3140	requested, any and all medical, hospital, health care, and
3141	employment records concerning the claimant in the disclosing
3142	party’s possession, custody, or control, and the disclosing
3143	party shall affirmatively certify in writing that the records
3144	produced include all records in that party’s possession,
3145	custody, or control or that the disclosing party has no medical,
3146	hospital, health care, or employment records concerning the
3147	claimant.
3148	(a) Subpoenas may be issued according to the Florida Rules
3149	of Civil Procedure as though suit had been filed for the limited
3150	purpose of obtaining copies of medical, hospital, health care,
3151	and employment records of the claimant. The party shall indicate
3152	on the subpoena that it is being issued in accordance with the
3153	presuit procedures of this section and shall not be required to
3154	include a case number.
3155	(b) Nothing in this section shall limit the ability of any
3156	party to use any other available form of presuit discovery
3157	available under this chapter or the Florida Rules of Civil
3158	Procedure.
3159	(2) Within 60 days after service of the presuit notice of
3160	intent to initiate medical malpractice litigation, all parties
3161	must be made available for a sworn deposition. Such deposition
3162	may not be used in a civil suit for medical negligence.
3163	(3) Within 120 days after service of the presuit notice of
3164	intent to initiate medical malpractice litigation, each party’s
3165	corroborating expert, who will otherwise be tendered as the
3166	expert complying with the affidavit provisions set forth in s.
3167	766.203, must be made available for a sworn deposition.
3168	(a) The expenses associated with the expert’s time and
3169	travel in preparing for and attending such deposition shall be
3170	the responsibility of the party retaining such expert.
3171	(b) An expert shall be deemed available for deposition if
3172	suitable accommodations can be made for appearance of said
3173	expert via real-time video technology.
3174	(4) Within 150 days after service of the presuit notice of
3175	intent to initiate medical malpractice litigation, all parties
3176	shall attend in-person mandatory mediation in accordance with s.
3177	44.102 if binding arbitration under s. 766.106 or s. 766.207 has
3178	not been agreed to by the parties. The Florida Rules of Civil
3179	Procedure shall apply to mediation held pursuant to this
3180	section.
3181	(5) If the parties declare an impasse during the mandatory
3182	mediation required in subsection (4), the plaintiff shall
3183	request, via certified mail, a hearing of a presuit screening
3184	panel which shall be convened pursuant to s. 766.1066.
3185	Section 55. Section 766.1066, Florida Statutes, is created
3186	to read:
3187	766.1066 Office of Presuit Screening Administration;
3188	presuit screening panels.-—
3189	(1)(a) There is created within the Department of Health
3190	the Office of Presuit Screening Administration, which shall be
3191	responsible for administering the presuit screening program.
3192	(b) The Office of Presuit Screening Administration shall
3193	develop and maintain a database of physicians, attorneys, and
3194	consumers to serve as members of presuit screening panels as
3195	described in this section.
3196	(c) The Office of Presuit Screening Administration shall
3197	develop an application by September 1, 2003, that can be
3198	submitted in writing and via the Internet for physicians,
3199	attorneys, and consumers to volunteer for the panels.
3200	(d) Funding for the Office of Presuit Screening
3201	Administration shall come from:
3202	1. A fee equal to 0.5 percent of, and assessed against,
3203	all judgments and settlements in medical malpractice liability
3204	cases. The defendant shall remit such fee to the Office of
3205	Presuit Administration.
3206	2. An annual fee of $1 on all medical malpractice
3207	liability insurance policies issued to physicians licensed by
3208	the Department of Health, which shall be collected by the
3209	insurer and submitted by the insurer to the Office of Presuit
3210	Administration.
3211	(e)1. Physicians, attorneys, and consumers who volunteer
3212	for the panels shall be obligated to serve on a panel for no
3213	longer than 2 calendar days per selection.
3214	2. Every person applying to serve on a panel shall
3215	designate in advance any time period during which he or she will
3216	not be available to serve on a panel.
3217	3. When a plaintiff requests a hearing of a presuit
3218	screening panel, the Office of Presuit Screening Administration
3219	shall randomly select members for a panel as provided in
3220	subsection (2) from among the available persons in the
3221	appropriate categories who have not served on a panel in the
3222	past 12 months. If there are no other potential panelists
3223	available, a panelist may be asked to serve on another panel
3224	within 12 months.
3225	(f) If a physician, attorney, or consumer is selected to
3226	serve on a panel, he or she shall not be obligated to serve for
3227	a period exceeding 2 days.
3228	(g) All persons serving on a panel shall receive
3229	reimbursement for their travel expenses.
3230	(h) Physicians who are selected to serve on a panel:
3231	1. Shall receive credit for 20 hours of continuing medical
3232	education for his or her service.
3233	2. Must reside and practice at least 50 miles from the
3234	location of the injury alleged by the plaintiff.
3235	3. Must have had no more than three judgments for medical
3236	malpractice liability against him or her within the preceding 5
3237	years and no more than 10 claims of medical malpractice filed
3238	against him or her within the preceding 3 years.
3239	4. Must have an active license with the Department of
3240	Health and be in good standing.
3241	(i) Attorneys who are selected to serve on a panel:
3242	1. Shall receive credit for 20 hours of continuing legal
3243	education and credit towards pro bono requirements for his or
3244	her service.
3245	2. Must reside and practice at least 50 miles from the
3246	location of the injury alleged by the plaintiff.
3247	3. Must have had no judgments of filing a frivolous
3248	lawsuit within the preceding 5 years.
3249	4. Must have an active license with The Florida Bar and be
3250	in good standing.
3251	(2)(a) A presuit screening panel shall be composed of five
3252	persons, consisting of:
3253	1. One physician board certified in the same specialty as
3254	the defendant physician.
3255	2. One physician who is a general practitioner, family
3256	practitioner, or an internist or one physician who serves as a
3257	full-time member in the faculty of an accredited public or
3258	private medical school in the state.
3259	3. One attorney who has served as a plaintiff’s attorney,
3260	with 5 years' experience in medical malpractice liability cases
3261	including at least one jury trial.
3262	4. One attorney who has served as a defendant’s attorney,
3263	with 5 years' experience in medical malpractice liability cases
3264	including at least one jury trial.
3265	5. One consumer who shall not have a professional or
3266	financial relationship with either a health care provider or an
3267	attorney.
3268	(b) In cases with more than one physician defendant, the
3269	plaintiff shall designate the subject areas in which both
3270	physician members of the panel shall be board certified.
3271	(c) Any panelist who knowingly has a conflict of interest
3272	or potential conflict of interest must disclose such conflict of
3273	interest prior to the hearing.
3274	(d) A plaintiff or a defendant may challenge any panel
3275	member for a conflict of interest and ask that the panelist be
3276	replaced by the Office of Presuit Screening Administration.
3277	(3) The Office of Presuit Screening Administration shall
3278	provide an administrator for the panel.
3279	(4) The plaintiff shall be allowed 8 hours to present his
3280	or her case. The defendants shall be allowed a total of 8 hours
3281	to present their case. No hearing shall exceed a total of 16
3282	hours; however, the panel may hear the case over the course of 2
3283	calendar days.
3284	(5) A presuit screening panel shall, by a majority vote
3285	for each defendant, make its findings in regards to reasonable
3286	grounds for liability of the defendant based on the
3287	preponderance of the evidence.
3288	(a) If a panel finds that there are no reasonable grounds
3289	for liability on the part of a defendant for the injury alleged,
3290	the defendant may, within 10 days, request voluntary binding
3291	arbitration pursuant to s. 766.207.
3292	(b) If a panel finds that there are reasonable grounds for
3293	liability on the part of a defendant for the injury alleged, the
3294	parties may elect to have damages determined by voluntary
3295	binding arbitration pursuant to s. 766.207.
3296	(c) If a panel finds that there are no reasonable grounds
3297	for liability on the part of a defendant for the injury alleged
3298	and the defendant does not request arbitration, or if a panel
3299	finds that there are reasonable grounds for liability on the
3300	part of a defendant for the injury alleged and either a
3301	defendant or the plaintiff do not agree to voluntary binding
3302	arbitration pursuant to s. 766.207, the claim shall proceed to
3303	trial or to any available legal alternative such as offer of
3304	judgment and demand for judgment under s. 768.79 or offer of
3305	settlement under s. 45.061. The damages that may be awarded
3306	during such trial are subject to the limitations included in s.
3307	766.118.
3308	Section 56. Section 766.1067, Florida Statutes, is created
3309	to read:
3310	766.1067 Structured judgments.--For cases that are decided
3311	in a trial, the judgment may be structured as follows:
3312	(1) If the noneconomic damages awarded to the plaintiff
3313	are equal to or greater than $500,000 and the jury finds the
3314	life expectancy of the plaintiff to be 20 years or greater, the
3315	defendant may compel a structured judgment for 50 percent of the
3316	noneconomic damages to be paid over the remaining life of the
3317	plaintiff. Such payments shall terminate upon the plaintiff’s
3318	death.
3319	(2) If the economic damages awarded to the plaintiff are
3320	equal to or greater than $250,000 and the jury finds the
3321	plaintiff would otherwise have been able to work for 20 years or
3322	more, the defendant may compel a structured judgment for 75
3323	percent of the future economic damages to be paid over the years
3324	in which the jury finds the plaintiff would otherwise have been
3325	able to work. Any unpaid portion of a structured judgment made
3326	under this subsection which is attributable to medical expenses
3327	that have not yet been incurred shall terminate upon the death
3328	of the plaintiff. Any outstanding medical expenses incurred
3329	prior to the death of the plaintiff shall be paid from that
3330	portion of the structured judgment attributable to medical
3331	expenses.
3332	Section 57. Section 766.1068, Florida Statutes, is created
3333	to read:
3334	766.1068 Proposal for settlement; timing.--Notwithstanding
3335	any other provision of law, any party may serve another party in
3336	a medical malpractice suit with a proposal for settlement at any
3337	time after the filing of the complaint. If a claimant rejects
3338	the proposal for settlement, then either loses at trial or
3339	prevails at trial while receiving an award for damages less than
3340	the most recent proposal for settlement, the court may require
3341	the claimant to pay the attorney's fees and costs of the
3342	defendant from whom the claimant will receive the award. If a
3343	defendant rejects the proposal for settlement, then loses at
3344	trial while receiving a judgment greater than the most resent
3345	proposal for settlement, the court may require the defendant to
3346	pay the attorney's fees and costs of the claimant to whom the
3347	judgment is awarded.
3348	Section 58. Subsections (3), (4), (5), and (6) are added
3349	to section 766.110, Florida Statutes, to read:
3350	766.110 Liability of health care facilities.--
3351	(3)(a) Members of the medical staff of a hospital licensed
3352	under chapter 395 and any professional group comprised of such
3353	persons shall be immune from liability for noneconomic damages
3354	in excess of $250,000 per emergency room admission arising from
3355	medical injuries to a patient resulting from negligent acts or
3356	omissions of such medical staff members in the performance of
3357	emergency medical services as defined in s. 768.13(2) prior to
3358	the patient’s condition being sufficiently stable, and no member
3359	of the medical staff of a hospital and no professional group
3360	comprised of such persons shall be liable to pay noneconomic
3361	damages in excess of $250,000 to any person or persons for any
3362	single incident of medical negligence that causes injuries to a
3363	patient or patients in the performance of emergency medical
3364	services.
3365	(b) For the purposes of paragraph (a), a patient’s
3366	condition shall be deemed to be sufficiently stable when that
3367	patient could reasonably be transferred to another health care
3368	facility without causing further injury, whether or not the
3369	patient is in fact transferred.
3370	(4)(a) No person or persons may recover damages from a
3371	public family practice teaching hospital licensed under chapter
3372	395 and designated under s. 398.806, or its insurer, or any
3373	health care professional who is a full-time member of the
3374	faculty of an accredited public medical school, or his or her
3375	insurer, in excess of $250,000 per emergency room admission
3376	arising from medical injuries to a patient or patients caused by
3377	negligent acts or omissions on the part of the hospital or
3378	members of the hospital's medical staff in the performance of
3379	emergency medical services as defined in s. 768.13(2) prior to
3380	the patient’s condition being sufficiently stable.
3381	(b) For the purposes of paragraph (a), a patient’s
3382	condition shall be deemed to be sufficiently stable when that
3383	patient could reasonably be transferred to another health care
3384	facility without causing further injury, whether or not the
3385	patient is in fact transferred.
3386	(5)(a) Other than as provided in paragraph (c), when a
3387	subsequent injury occurs after a patient’s condition is
3388	sufficiently stable, no person or persons may recover
3389	noneconomic damages from any health care professional who is a
3390	member of the medical staff of such facility, or his or her
3391	insurer, in excess of $250,000 per injury arising from medical
3392	injury to a patient caused by negligent acts or omissions on the
3393	part of the hospital or members of the hospital's medical staff
3394	in the performance of emergency medical services as defined in
3395	s. 768.13(2) until the patient’s condition returns to
3396	sufficiently stable.
3397	(b) For the purposes of paragraph (a), a patient’s
3398	condition shall be deemed to be sufficiently stable when that
3399	patient could reasonably be transferred to another health care
3400	facility without causing further injury, whether or not the
3401	patient is in fact transferred.
3402	(c) A person or persons may recover damages from the
3403	health care professional who caused the subsequent injury in
3404	paragraph (a) and the hospital licensed under chapter 395, or
3405	its insurer, where the injury occurred.
3406	(6) The limits established in this section shall be
3407	adjusted annually in accordance with the changes in the Consumer
3408	Price Index as issued by the United States Department of Labor
3409	Bureau of Labor Statistics. The Florida Supreme Court shall
3410	determine and publish the new limits on July 1 of each year.
3411	Section 59. Section 766.118, Florida Statutes, is created
3412	to read:
3413	766.118 Determination of noneconomic damages.--With
3414	respect to a cause of action for personal injury or wrongful
3415	death resulting from an occurrence of medical negligence,
3416	including actions pursuant to s. 766.209, damages recoverable
3417	for noneconomic losses to compensate for pain and suffering,
3418	inconvenience, physical impairment, mental anguish,
3419	disfigurement, loss of capacity for enjoyment of life, and all
3420	other noneconomic damages shall be determined as follows:
3421	(1) The award for noneconomic damages from the jury shall
3422	be reviewed by the judge to determine the appropriateness of the
3423	award.
3424	(2) In reviewing the award, the judge shall utilize the
3425	Florida Jury Verdict Database as provided in s. 766.26.
3426	(3)(a) The judge shall examine all cases where the
3427	injuries alleged and the economic damages awarded are
3428	substantially similar.
3429	(b) The judge shall adopt a presumptively reasonable range
3430	of similar awards that shall be one standard deviation above and
3431	below the mean award for similar cases. The judge shall then
3432	subtract the economic damages awarded by the jury from the valid
3433	range to find the valid range for noneconomic damages.
3434	(c) If the award for noneconomic damages is outside of the
3435	presumptively reasonable range for noneconomic damages based on
3436	similar cases, the judge may elect to change the award so that
3437	it falls within said range, which is subject to appeal based on
3438	abuse of discretion standards, or the judge may elect to leave
3439	the amount as awarded by providing findings of fact on the
3440	record, which shall be subject to appeal based on clear and
3441	convincing evidence standards.
3442	(4) If a health care professional does not meet his or her
3443	financial responsibility requirements as provided in s.
3444	458.320(1)(b) or s. 459.0085(1)(b), as applicable, by July 1,
3445	2004, the limits on damages established in this section shall
3446	not apply and awards for economic and noneconomic damages shall
3447	not be limited during arbitration or at trial.
3448	Section 60. Section 766.185, Florida Statutes, is created
3449	to read:
3450	766.185 Apportionment of fault in medical negligence
3451	actions.--
3452	(1) In an action for damages for personal injury or
3453	wrongful death arising out of medical negligence, whether in
3454	contract or tort, when a defendant asserts an affirmative
3455	defense that one or more nonparties is liable, in whole or in
3456	part, for damages arising out of medical negligence, such
3457	defendant must join the nonparties into the action by means of a
3458	third-party complaint asserting a cause of action for
3459	comparative fault in medical negligence against the nonparties,
3460	except with respect to a nonparty who meets one of the following
3461	criteria:
3462	(a) The nonparty has entered into a settlement with each
3463	of the plaintiffs;
3464	(b) The nonparty has complete immunity from suit;
3465	(c) The statute of limitations involving the nonparty
3466	expired prior to filing of the presuit notice of intent to
3467	initiate medical malpractice litigation; or
3468	(d) The nonparty cannot be otherwise legally joined to the
3469	suit.
3470	(2) If the defendant has reasonable grounds to believe
3471	during the presuit investigation that one or more nonparties are
3472	liable, in whole or in part, for damages arising out of medical
3473	negligence and that such nonparties would be joinable into the
3474	action under this section, the defendant must notify the
3475	claimant in writing of the identity and reasonable grounds for
3476	inclusions of such nonparty in the action within 10 days after
3477	obtaining such information.
3478	(3) If the defendant fails to comply with the provisions
3479	set forth in this section, then the defendant shall be estopped
3480	from asserting the negligence of the nonparty who should have
3481	otherwise been joined into the action.
3482	(4) Any third party joined into the action under the
3483	provisions of this section shall be liable to the plaintiff for
3484	any damages adjudicated by the trier of fact subject to the
3485	provisions of this chapter.
3486	Section 61. Subsection (5) of section 766.202, Florida
3487	Statutes, is amended to read:
3488	766.202 Definitions; ss. 766.201-766.212.-- As used in ss.
3489	766.201-766.212, the term:
3490	(5) "Medical expert" means a person duly and regularly
3491	engaged in the practice of his or her profession who holds a
3492	health care professional degree from a university or college and
3493	who meets the requirements of an expert witness as set forth in
3494	s. 766.102 has had special professional training and experience
3495	or one possessed of special health care knowledge or skill about
3496	the subject upon which he or she is called to testify or provide
3497	an opinion.
3498	Section 62. Subsections (2) and (3) of section 766.203,
3499	Florida Statutes, are amended to read:
3500	766.203 Presuit investigation of medical negligence claims
3501	and defenses by prospective parties.--
3502	(2) Prior to issuing notification of intent to initiate
3503	medical malpractice litigation pursuant to s. 766.106, the
3504	claimant shall conduct an investigation to ascertain that there
3505	are reasonable grounds to believe that:
3506	(a) Any named defendant in the litigation was negligent in
3507	the care or treatment of the claimant; and
3508	(b) Such negligence resulted in injury to the claimant.
3509
3510	Corroboration of reasonable grounds to initiate medical
3511	negligence litigation shall be provided by the claimant's
3512	submission of a verified written medical expert opinion from a
3513	medical expert as defined in s. 766.202(5), at the time the
3514	notice of intent to initiate litigation is mailed, which
3515	statement shall corroborate reasonable grounds to support the
3516	claim of medical negligence. This opinion and statement are
3517	subject to discovery.
3518	(3) Prior to issuing its response to the claimant's notice
3519	of intent to initiate litigation, during the time period for
3520	response authorized pursuant to s. 766.106, the defendant or the
3521	defendant's insurer or self-insurer shall conduct an
3522	investigation to ascertain whether there are reasonable grounds
3523	to believe that:
3524	(a) The defendant was negligent in the care or treatment
3525	of the claimant; and
3526	(b) Such negligence resulted in injury to the claimant.
3527
3528	Corroboration of lack of reasonable grounds for medical
3529	negligence litigation shall be provided with any response
3530	rejecting the claim by the defendant's submission of a verified
3531	written medical expert opinion from a medical expert as defined
3532	in s. 766.202(5), at the time the response rejecting the claim
3533	is mailed, which statement shall corroborate reasonable grounds
3534	for lack of negligent injury sufficient to support the response
3535	denying negligent injury. This opinion and statement are subject
3536	to discovery.
3537	Section 63. Subsections (2), (3), and (5) of section
3538	766.206, Florida Statutes, are amended to read:
3539	766.206 Presuit investigation of medical negligence claims
3540	and defenses by court.--
3541	(2) If the court finds that the notice of intent to
3542	initiate litigation mailed by the claimant is not in compliance
3543	with the reasonable investigation requirements of ss. 766.201-
3544	766.212, including a review of the claim and a verified written
3545	medical expert opinion by an expert witness as defined in s.
3546	766.202,the court shall dismiss the claim, and the person who
3547	mailed such notice of intent, whether the claimant or the
3548	claimant's attorney, shall be personally liable for all
3549	attorney's fees and costs incurred during the investigation and
3550	evaluation of the claim, including the reasonable attorney's
3551	fees and costs of the defendant or the defendant's insurer.
3552	(3) If the court finds that the response mailed by a
3553	defendant rejecting the claim is not in compliance with the
3554	reasonable investigation requirements of ss. 766.201-766.212,
3555	including a review of the claim and a verified written medical
3556	expert opinion by an expert witness as defined in s. 766.202,
3557	the court shall strike the defendant's pleading. response, and
3558	The person who mailed such response, whether the defendant, the
3559	defendant's insurer, or the defendant's attorney, shall be
3560	personally liable for all attorney's fees and costs incurred
3561	during the investigation and evaluation of the claim, including
3562	the reasonable attorney's fees and costs of the claimant.
3563	(5)(a) If the court finds that the corroborating written
3564	medical expert opinion attached to any notice of claim or intent
3565	or to any response rejecting a claim lacked reasonable
3566	investigation, or that the medical expert submitting the opinion
3567	did not meet the expert witness qualifications as set forth in
3568	s. 766.202(5),the court shall report the medical expert issuing
3569	such corroborating opinion to the Division of Medical Quality
3570	Assurance or its designee. If such medical expert is not a
3571	resident of the state, the division shall forward such report to
3572	the disciplining authority of that medical expert.
3573	(b) The court shall may refuse to consider the testimony
3574	or opinion attached to any notice of intent or to any response
3575	rejecting a claim of suchan expert who has been disqualified
3576	three times pursuant to this section.
3577	Section 64. Section 766.207, Florida Statutes, is amended
3578	to read:
3579	766.207 Voluntary binding arbitration of medical
3580	negligence claims.--
3581	(1) Voluntary binding arbitration pursuant to this section
3582	and ss. 766.208-766.212 shall not apply to rights of action
3583	involving the state or its agencies or subdivisions, or the
3584	officers, employees, or agents thereof, pursuant to s. 768.28.
3585	(2)(a) Upon the completion of the hearing of a presuit
3586	screening panel pursuant to s. 706.1066 investigation with
3587	preliminary reasonable grounds for a medical negligence claim
3588	intact, the parties may elect to have damages determined by an
3589	arbitration panel. Such election may be initiated by either
3590	party by serving a request for voluntary binding arbitration of
3591	damages within 10 90 days after the hearing of a presuit
3592	screening panel service of the claimant's notice of intent to
3593	initiate litigation upon the defendant. The evidentiary
3594	standards for voluntary binding arbitration of medical
3595	negligence claims shall be as provided in ss. 120.569(2)(g) and
3596	120.57(1)(c).
3597	(b) If the presuit screening panel pursuant to s. 766.1066
3598	found that the defendant was not liable by unanimous vote and
3599	the plaintiff refuses arbitration, damages that can be awarded
3600	during a trial shall not exceed a total of $350,000, as adjusted
3601	herein, per defendant for both future economic and all
3602	noneconomic damages. If the presuit screening panel pursuant to
3603	s. 766.1066 found that the defendant was not liable by majority
3604	vote and the plaintiff refuses arbitration, damages that can be
3605	awarded during a trial for all noneconomic damages shall not
3606	exceed a total of $350,000, as adjusted herein, per defendant.
3607	(3) Upon receipt of a party's request for such
3608	arbitration, the opposing party may accept the offer of
3609	voluntary binding arbitration within 30 days, and such
3610	arbitration shall be held within 120 days after acceptance of
3611	the offer of voluntary binding arbitration. However, in no event
3612	shall the defendant be required to respond to the request for
3613	arbitration sooner than 90 days after service of the notice of
3614	intent to initiate litigation under s. 766.106.Such acceptance
3615	within the time period provided by this subsection shall be a
3616	binding commitment to comply with the decision of the
3617	arbitration panel. The liability of any insurer shall be subject
3618	to any applicable insurance policy limits.
3619	(4) The arbitration panel shall be a presuit screening
3620	panel selected by the Office of Presuit Screening Administration
3621	as provided in s. 766.1066. The Florida Rules of Civil Procedure
3622	shall apply to discovery, except as follows:
3623	(a) Any 30-day deadline provided in such rules shall be
3624	shortened to 10 business days.
3625	(b) Depositions of expert witnesses shall be permitted for
3626	no more than five experts per side.
3627
3628	Discovery disputes shall be resolved by an administrative law
3629	judge assigned by the Division of Administrative Hearings until
3630	arbitration is completed composed of three arbitrators, one
3631	selected by the claimant, one selected by the defendant, and one
3632	an administrative law judge furnished by the Division of
3633	Administrative Hearings who shall serve as the chief arbitrator.
3634	In the event of multiple plaintiffs or multiple defendants, the
3635	arbitrator selected by the side with multiple parties shall be
3636	the choice of those parties. If the multiple parties cannot
3637	reach agreement as to their arbitrator, each of the multiple
3638	parties shall submit a nominee, and the director of the Division
3639	of Administrative Hearings shall appoint the arbitrator from
3640	among such nominees.
3641	(5) The panel arbitratorsshall be independent of all
3642	parties, witnesses, and legal counsel, and no officer, director,
3643	affiliate, subsidiary, or employee of a party, witness, or legal
3644	counsel may serve as a panelist an arbitratorin the proceeding.
3645	(6) The rate of compensation for arbitration panelists
3646	shall be the same as for members of a presuit screening panel as
3647	outlined in s. 766.1066 medical negligence claims arbitrators
3648	other than the administrative law judge shall be set by the
3649	chief judge of the appropriate circuit court by schedule
3650	providing for compensation of not less than $250 per day nor
3651	more than $750 per day or as agreed by the parties. In setting
3652	the schedule, the chief judge shall consider the prevailing
3653	rates charged for the delivery of professional services in the
3654	community.
3655	(7) Arbitration pursuant to this section shall preclude
3656	recourse to any other remedy by the claimant against any
3657	participating defendant, and shall be undertaken with the
3658	understanding that:
3659	(a) If the presuit screening panel established pursuant to
3660	s. 766.1066 found that the defendant was not liable by unanimous
3661	vote, the damages that can be awarded during arbitration shall
3662	not exceed a total of $250,000, as adjusted herein, per
3663	defendant for both future economic and all noneconomic damages.
3664	If the presuit screening panel established pursuant to s.
3665	766.1066 found that the defendant was not liable by majority
3666	vote, the damages that can be awarded during arbitration for all
3667	noneconomic damages shall not exceed a total of $250,000, as
3668	adjusted herein, per defendant.
3669	(b) If the presuit screening panel established pursuant to
3670	s. 766.1066 found that the defendant was liable, the following
3671	conditions shall apply:
3672	1.(a)Net economic damages shall be awardable, including,
3673	but not limited to, past and future medical expenses and 80
3674	percent of wage loss and loss of earning capacity, offset by any
3675	collateral source payments, beginning at the time the injury
3676	occurred and extended to a work-life expectancy as determined by
3677	the jury. Net economic damages shall also include interest on
3678	all economic damages occurring prior to trial.
3679	2.(b)Noneconomic damages shall be limited to a maximum of
3680	$250,000, as adjusted herein,per incident, and shall be
3681	calculated on a percentage basis with respect to capacity to
3682	enjoy life, so that a finding that the claimant's injuries
3683	resulted in a 50-percent reduction in his or her capacity to
3684	enjoy life would warrant an award of not more than $125,000
3685	noneconomic damages. The limits on damages established in this
3686	subparagraph shall be adjusted annually in accordance with the
3687	changes in the Consumer Price Index as issued by the United
3688	States Department of Labor Bureau of Labor Statistics. The
3689	Florida Supreme Court shall determine and publish the new limits
3690	on July 1 of each year.
3691	3.(c)Damages for future economic losses shall be awarded
3692	to be paid by periodic payments pursuant to s. 766.1067(2)
3693	766.202(8)and shall be offset by future collateral source
3694	payments.
3695	4.(d)Punitive damages shall not be awarded.
3696	5.(e)The defendant shall be responsible for the payment
3697	of interest on all accrued damages with respect to which
3698	interest would be awarded at trial.
3699	6.(f)The defendant shall pay the claimant's reasonable
3700	attorney's fees and costs, as determined by the arbitration
3701	panel, but in no event more than 15 percent of the award,
3702	reduced to present value.
3703	(g) The defendant shall pay all the costs of the
3704	arbitration proceeding and the fees of all the arbitrators other
3705	than the administrative law judge.
3706	(h) Each defendant who submits to arbitration under this
3707	section shall be jointly and severally liable for all damages
3708	assessed pursuant to this section.
3709	7.(i)The defendant's obligation to pay the claimant's
3710	damages shall be for the purpose of arbitration under this
3711	section only. A defendant's or claimant's offer to arbitrate
3712	shall not be used in evidence or in argument during any
3713	subsequent litigation of the claim following the rejection
3714	thereof.
3715	8.(j)The fact of making or accepting an offer to
3716	arbitrate shall not be admissible as evidence of liability in
3717	any collateral or subsequent proceeding on the claim.
3718	9.(k)Any offer by a claimant to arbitrate must be made to
3719	each defendant against whom the claimant has made a claim. Any
3720	offer by a defendant to arbitrate must be made to each claimant
3721	who has joined in the notice of intent to initiate litigation,
3722	as provided in s. 766.106. A defendant who rejects a claimant's
3723	offer to arbitrate shall be subject to the provisions of
3724	subsection (11) s. 766.209(3). A claimant who rejects a
3725	defendant's offer to arbitrate shall be subject to the
3726	provisions of subsection (12) s. 766.209(4).
3727	10.(l) The hearing shall be conducted by the panel all of
3728	the arbitrators, but a majority may determine any question of
3729	fact and render a final decision. The chief arbitrator shall
3730	decide all evidentiary matters.
3731
3732	The provisions of this subsection shall not preclude settlement
3733	at any time by mutual agreement of the parties.
3734	(8) Any issue between the defendant and the defendant's
3735	insurer or self-insurer as to who shall control the defense of
3736	the claim and any responsibility for payment of an arbitration
3737	award, shall be determined under existing principles of law;
3738	provided that the insurer or self-insurer shall not offer to
3739	arbitrate or accept a claimant's offer to arbitrate without the
3740	written consent of the defendant.
3741	(9) The Division of Administrative Hearings is authorized
3742	to promulgate rules to effect the orderly and efficient
3743	processing of the arbitration procedures of ss. 766.201-766.212.
3744	(10) Rules promulgated by the Division of Administrative
3745	Hearings pursuant to this section, s. 120.54, or s. 120.65 may
3746	authorize any reasonable sanctions except contempt for violation
3747	of the rules of the division or failure to comply with a
3748	reasonable order issued by an administrative law judge, which is
3749	not under judicial review.
3750	(11) If the defendant refuses a claimant's offer of
3751	voluntary binding arbitration:
3752	(a) The claim shall proceed to trial without limitation on
3753	damages and the claimant, upon proving medical negligence, shall
3754	be entitled to recover prejudgment interest and reasonable
3755	attorney's fees up to 25 percent of the award reduced to present
3756	value.
3757	(b) The claimant's award at trial shall be reduced by any
3758	damages recovered by the claimant from arbitrating codefendants
3759	following arbitration.
3760	(c) The claimant shall be entitled to recover prejudgement
3761	interest on economic damages incurred prior to trial.
3762	(12) If the claimant rejects a defendant's offer to enter
3763	voluntary binding arbitration:
3764	(a) The damages awardable at trial shall be limited to net
3765	economic damages, plus noneconomic damages not to exceed
3766	$350,000, as adjusted herein, per incident. The Legislature
3767	expressly finds that such conditional limit on noneconomic
3768	damages is warranted by the claimant's refusal to accept
3769	arbitration, and represents an appropriate balance between the
3770	interests of all patients who ultimately pay for medical
3771	negligence losses and the interests of those patients who are
3772	injured as a result of medical negligence. The limits on damages
3773	established in this paragraph shall be adjusted annually in
3774	accordance with the changes in the Consumer Price Index as
3775	issued by the United States Department of Labor Bureau of Labor
3776	Statistics. The Florida Supreme Court shall determine and
3777	publish the new limits on July 1 of each year. Net economic
3778	damages shall also include interest on all economic damages
3779	occurring prior to trial.
3780	(b) Net economic damages reduced to present value shall be
3781	awardable, including, but not limited to, past and future
3782	medical expenses and 80 percent of wage loss and loss of earning
3783	capacity, offset by any collateral source payments.
3784	(c) Damages for future economic losses shall be awarded to
3785	be paid by periodic payments pursuant to s. 766.202(8) and shall
3786	be offset by future collateral source payments.
3787	(13) The arbitration panel shall allocate financial
3788	responsibility among all defendants named in the notice of
3789	intent to initiate litigation, regardless of whether the
3790	defendant has submitted to arbitration. The defendants in the
3791	arbitration proceeding shall pay their proportionate share of
3792	the economic and noneconomic damages awarded by the arbitration
3793	panel. All defendants in the arbitration proceeding shall be
3794	jointly and severally liable for any damages assessed in
3795	arbitration. The determination of the percentage of fault of any
3796	defendant not in the arbitration case shall neither be binding
3797	against that defendant, nor shall it be admissible in any
3798	subsequent legal proceeding.
3799	(14) Payment by the defendants of the damages awarded by
3800	the arbitration panel shall extinguish those defendants'
3801	liability to the claimant and shall also extinguish those
3802	defendants' liability for contribution to any defendants who did
3803	not participate in arbitration.
3804	(15) Any defendant paying damages assessed pursuant to
3805	this section shall have an action for contribution against any
3806	nonarbitrating person whose negligence contributed to the
3807	injury.
3808	(16)(a) If a health care professional does not meet his or
3809	her financial responsibility requirements as provided in s.
3810	458.320(1)(b) or s. 459.0085(1)(b), as applicable, by July 1,
3811	2004, the limits on damages established in this section shall
3812	not apply and awards for economic and noneconomic damages shall
3813	not be limited during arbitration or at trial.
3814	(b) It is the intent of the Legislature to provide relief
3815	from rising medical malpractice insurance premiums to those
3816	physicians who pay premiums on medical malpractice liability
3817	insurance. Physicians who do not carry medical malpractice
3818	liability insurance and hence do not pay premiums require no
3819	relief from the crisis referred to in the findings provided in
3820	this act.
3821	(17) Jury trials shall proceed in accordance with existing
3822	principles of law.
3823	Section 65. Sections 766.208 and 766.209, Florida
3824	Statutes, are repealed.
3825	Section 66. Section 766.112, Florida Statutes, is amended
3826	to read:
3827	766.112 Comparative fault.--
3828	(1) Notwithstanding any provision of law to the contrary,
3829	in an action for damages for personal injury or wrongful death
3830	arising out of medical malpractice, whether in contract or tort,
3831	the court shall enter judgment on the basis of each party's
3832	percentage of fault and not on the basis of the doctrine of
3833	joint and several liability.
3834	(2)(1) Notwithstanding any provision of anything inlaw to
3835	the contrary, in an action for damages for personal injury or
3836	wrongful death arising out of medical malpractice, whether in
3837	contract or tort, when an apportionment of damages pursuant to
3838	this section is attributed to a teaching hospital as defined in
3839	s. 408.07, the court shall enter judgment against the teaching
3840	hospital on the basis of such party's percentage of fault and
3841	not on the basis of the doctrine of joint and several liability.
3842	(3)(2)In an action for damages for personal injury or
3843	wrongful death arising out of medical malpractice, whether in
3844	contract or tort, when an apportionment of damages pursuant to
3845	s. 768.81 is attributed to a board of trustees of a state
3846	university, the court shall enter judgment against the board of
3847	trustees on the basis of the board's percentage of fault and not
3848	on the basis of the doctrine of joint and several liability. The
3849	sole remedy available to a claimant to collect a judgment or
3850	settlement against a board of trustees, subject to the
3851	provisions of this subsection, shall be pursuant to s. 768.28.
3852	(4) In the trial of any action for medical malpractice
3853	which follows a settlement between the plaintiff and one or more
3854	defendants or potential defendants for the same injury, the
3855	plaintiff shall be estopped from denying that the fault on the
3856	part of any such settled defendant or prospective defendant
3857	contributed to causing the plaintiff’s injuries with respect to
3858	any such settled defendant or prospective defendant who has been
3859	identified by way of affirmative defense or joined by a
3860	nonsettling defendant as a party who is liable, in whole or in
3861	part, for the plaintiff's damages.
3862	Section 67. Section 766.25, Florida Statutes, is created
3863	to read:
3864	766.25 Itemized verdict.--
3865	(1) In any action for damages based on personal injury or
3866	wrongful death arising out of medical malpractice, whether in
3867	tort or contract, to which this part applies in which the trier
3868	of fact determines that liability exists on the part of the
3869	defendant, the trier of fact shall, as a part of the verdict,
3870	itemize the amounts to be awarded to the claimant into the
3871	following categories of damages:
3872	(a) Amounts intended to compensate the claimant for:
3873	1. Past economic losses; and
3874	2. Future economic losses, not reduced to present value,
3875	and the number of years or part thereof which the award is
3876	intended to cover;
3877	(b) Amounts intended to compensate the claimant for:
3878	1. Past noneconomic losses;
3879	2. Future noneconomic losses and the number of years or
3880	part thereof which the award is intended to cover; and
3881	(c) Amounts awarded to the claimant for punitive damages,
3882	if applicable.
3883	Section 68. Section 766.26, Florida Statutes, is created
3884	to read:
3885	766.26 Florida Jury Verdict Database.--
3886	(1) The Agency for Health Care Administration shall
3887	maintain the Florida Jury Verdict Database. For the initial
3888	database, the department shall utilize information and
3889	categories provided by a nationwide jury verdict research
3890	database of plaintiff and defense verdicts and settlements
3891	resulting from medical malpractice claims. The data to be used
3892	must be reported, tabulated, and analyzed to determine values,
3893	trends, and deviations for injuries and liabilities including
3894	medical malpractice.
3895	(2) Beginning September 1, 2003, all awards under
3896	subsection (1) shall be reported by the Clerk of the Court in
3897	the circuit in which the judgment was entered to the agency
3898	within 3 business days for compilation into the Florida Jury
3899	Verdict Database. The agency, in conjunction with the Clerks of
3900	the Court, shall develop a format for the clerks to use in
3901	reporting the information required for the categories utilized
3902	by the database in subsection (1).
3903	(3) Beginning July 1, 2007, the department shall only
3904	utilize reports concerning cases within the state in the Florida
3905	Jury Verdict Database.
3906	(4) The awards reported by the Clerks of the Court shall
3907	be adjusted annually in accordance with the changes in the
3908	Consumer Price Index as issued by the United States Department
3909	of Labor Bureau of Labor Statistics. The Agency for Health Care
3910	Administration shall adjust all previously reported awards in
3911	the Florida Jury Verdict Database as provided herein prior to
3912	July 1 of each year. Only those awards reported from courts in
3913	this state after September 1, 2003, shall be adjusted.
3914	Section 69. Section 766.27, Florida Statutes, is created
3915	to read:
3916	766.27 Sanctions for frivolous medical malpractice
3917	lawsuits.--Any attorney who receives three judgments of filing a
3918	frivolous medical malpractice lawsuit in any 5-year period shall
3919	be precluded from filing a medical malpractice lawsuit for 3
3920	years. Such preclusion shall prohibit him or her from serving as
3921	co-counsel on any medical malpractice lawsuit.
3922	Section 70. Office of Insurance Regulation; closed claim
3923	forms; report required.--The Office of Insurance Regulation
3924	shall revise its closed claim form for readability at the ninth-
3925	grade level. The office shall compile annual statistical reports
3926	that provide data summaries of all closed claims, including, but
3927	not limited to, the number of closed claims on file pertaining
3928	to the referent health care professional or health care entity,
3929	the nature of the errant conduct, the size of payments, and the
3930	frequency and size of noneconomic damage awards. The office
3931	shall develop annualized historical statistical summaries
3932	beginning with the 1976 state fiscal year and publish these
3933	reports on its Internet website no later than the 2005 state
3934	fiscal year. The form must accommodate the following minimum
3935	requirements:
3936	(1) A practitioner of medicine licensed pursuant to
3937	chapter 458, Florida Statutes, or a practitioner of osteopathic
3938	medicine licensed pursuant to chapter 459, Florida Statutes,
3939	shall report to the Office of Insurance Regulation and the
3940	Department of Health any claim or action for damages for
3941	personal injury alleged to have been caused by error, omission,
3942	or negligence in the performance of such licensee's professional
3943	services or based on a claimed performance of professional
3944	services without consent if the claim was not covered by an
3945	insurer required to report under s. 627.912, Florida Statutes,
3946	is not a claim for medical malpractice that is subject to the
3947	provisions of s. 766.106, Florida Statutes, and the claim
3948	resulted in:
3949	(a) A final judgment in any amount.
3950	(b) A settlement in any amount.
3951	(c) A final disposition not resulting in payment on behalf
3952	of the licensee. Reports shall be filed with the Office of
3953	Insurance Regulation no later than 60 days following the
3954	occurrence of any event listed in this subsection.
3955	(2) Health professional reports must contain:
3956	(a) The name and address of the licensee.
3957	(b) The alleged occurrence.
3958	(c) The date of the alleged occurrence.
3959	(d) The date the claim or action was reported to the
3960	licensee.
3961	(e) The name and address of the opposing party.
3962	(f) The date of suit, if filed.
3963	(g) The injured person's age and sex.
3964	(h) The total number and names of all defendants involved
3965	in the claim.
3966	(i) The date and amount of judgment or settlement, if any,
3967	including the itemization of the verdict, together with a copy
3968	of the settlement or judgment.
3969	(j) In the case of a settlement, any information required
3970	by the Office of Insurance Regulation concerning the injured
3971	person's incurred and anticipated medical expense, wage loss,
3972	and other expenses.
3973	(k) The loss adjustment expense paid to defense counsel
3974	and all other allocated loss adjustment expenses paid.
3975	(l) The date and reason for final disposition, if there
3976	was no judgment or settlement.
3977	(m) A summary of the occurrence that created the claim,
3978	which must include:
3979	1. The name of the institution, if any, and the location
3980	within such institution at which the injury occurred.
3981	2. The final diagnosis for which treatment was sought or
3982	rendered, including the patient's actual condition.
3983	3. A description of the misdiagnosis made, if any, of the
3984	patient's actual condition.
3985	4. The operation or the diagnostic or treatment procedure
3986	causing the injury.
3987	5. A description of the principal injury giving rise to
3988	the claim.
3989	6. The safety management steps that have been taken by the
3990	licensee to make similar occurrences or injuries less likely in
3991	the future.
3992	(n) Any other information required by the Office of
3993	Insurance Regulation to analyze and evaluate the nature, causes,
3994	location, cost, and damages involved in professional liability
3995	cases.
3996	Section 71. Subsection (8) of section 768.21, Florida
3997	Statutes, is amended to read:
3998	768.21 Damages.-- All potential beneficiaries of a
3999	recovery for wrongful death, including the decedent's estate,
4000	shall be identified in the complaint, and their relationships to
4001	the decedent shall be alleged. Damages may be awarded as
4002	follows:
4003	(8) Notwithstanding any other provision of law to the
4004	contrary, for purposes of a wrongful death action arising out of
4005	medical negligence, adult individuals named as beneficiaries
4006	under a testamentary estate may recover noneconomic damages as
4007	though they were within that class of survivors identified in
4008	this section when a health care practitioner commits an
4009	intentional tort or is convicted of a crime which resulted in
4010	the death of the benefactor. The personal representative of the
4011	estate shall be entitled to assert a cause of action on behalf
4012	of the class of beneficiaries for the noneconomic damages of
4013	such beneficiaries which shall be in addition to any other
4014	damages that the estate would otherwise be entitled to assert.
4015	However, in no event shall the total amount of noneconomic
4016	damages for the entire class of beneficiaries exceed any
4017	limitation on noneconomic damages imposed under s. 766.118 The
4018	damages specified in subsection (3) shall not be recoverable by
4019	adult children and the damages specified in subsection (4) shall
4020	not be recoverable by parents of an adult child with respect to
4021	claims for medical malpractice as defined by s. 766.106(1).
4022	Section 72. Subsection (5) of section 768.81, Florida
4023	Statutes, is amended to read:
4024	768.81 Comparative fault.--
4025	(5)(a) Notwithstanding any provision of law to the
4026	contrary, in an action for damages for personal injury or
4027	wrongful death arising out of medical malpractice, whether in
4028	contract or tort, the court shall enter judgment on the basis of
4029	each party's percentage of fault and not on the basis of the
4030	doctrine of joint and several liability.
4031	(b) Notwithstanding any provision of anything inlaw to
4032	the contrary, in an action for damages for personal injury or
4033	wrongful death arising out of medical malpractice, whether in
4034	contract or tort, when an apportionment of damages pursuant to
4035	this section is attributed to a teaching hospital as defined in
4036	s. 408.07, the court shall enter judgment against the teaching
4037	hospital on the basis of such party's percentage of fault and
4038	not on the basis of the doctrine of joint and several liability.
4039	(c) In the trial of any action for medical malpractice
4040	which follows a settlement between the plaintiff and one or more
4041	defendants or potential defendants for the same injury, the
4042	plaintiff shall be estopped from denying that the fault on the
4043	part of any such settled defendant or prospective defendant
4044	contributed to causing the plaintiff’s injuries with respect to
4045	any such settled defendant or prospective defendant who has been
4046	identified by way of affirmative defense or joined by a
4047	nonsettling defendant as a party who is liable, in whole or in
4048	part, for the plaintiff's damages.
4049	Section 73. Section 1004.08, Florida Statutes, is created
4050	to read:
4051	1004.08 Patient safety instructional requirements.--Every
4052	public school, college, and university that offers degrees in
4053	medicine, nursing, and allied health shall include in the
4054	curricula applicable to such degrees material on patient safety,
4055	including patient safety improvement. Materials shall include,
4056	but need not be limited to, effective communication and
4057	teamwork; epidemiology of patient injuries and medical errors;
4058	vigilance, attention, and fatigue; checklists and inspections;
4059	automation and technological and computer support; psychological
4060	factors in human error; and reporting systems.
4061	Section 74. Section 1004.085, Florida Statutes, is created
4062	to read:
4063	1004.085 Informed consent standardization project.--Every
4064	public school, college, and university that offers degrees in
4065	medicine, nursing, and allied health shall work with the
4066	Department of Health to develop bilingual, multimedia methods
4067	for communicating the risks of treatment options for the 100
4068	medical procedures from which arise the most claims of medical
4069	malpractice. Such materials shall be provided to patients and
4070	their families in an effort to educate them and to obtain the
4071	informed consent to prescribe a treatment procedure. The agency
4072	shall develop a list of treatment procedures based on
4073	significance of risk and frequency of performance.
4074	Section 75. Section 1005.07, Florida Statutes, is created
4075	to read:
4076	1005.07 Patient safety instructional requirements.--Every
4077	nonpublic school, college, and university that offers degrees in
4078	medicine, nursing, and allied health shall include in the
4079	curricula applicable to such degrees material on patient safety,
4080	including patient safety improvement. Materials shall include,
4081	but need not be limited to, effective communication and
4082	teamwork; epidemiology of patient injuries and medical errors;
4083	vigilance, attention, and fatigue; checklists and inspections;
4084	automation and technological and computer support; psychological
4085	factors in human error; and reporting systems.
4086	Section 76. Section 1005.075, Florida Statutes, is created
4087	to read:
4088	1005.075 Informed consent standardization project.--Every
4089	nonpublic school, college, and university that offers degrees in
4090	medicine, nursing, and allied health shall work with the
4091	Department of Health to develop bilingual, multimedia methods
4092	for communicating the risks of treatment options for the 100
4093	medical procedures from which arise the most claims of medical
4094	malpractice. Such materials shall be provided to patients and
4095	their families in an effort to educate them and to obtain the
4096	informed consent to prescribe a treatment procedure. The agency
4097	shall develop a list of treatment procedures based on
4098	significance of risk and frequency of performance.
4099	Section 77. (1) The Agency for Health Care Administration
4100	shall conduct or contract for a study to determine what
4101	information is most feasible to provide to the public comparing
4102	state-licensed hospitals on certain inpatient quality indicators
4103	developed by the federal Agency for Healthcare Research and
4104	Quality. Such indicators shall be designed to identify
4105	information about specific procedures performed in hospitals for
4106	which there is strong evidence of a link to quality of care. The
4107	Agency for Health Care Administration or the study contractor
4108	shall refer to the hospital quality reports published in New
4109	York and Texas as guides during the evaluation.
4110	(2) The following concepts shall be specifically addressed
4111	in the study report:
4112	(a) Whether hospital discharge data about services can be
4113	translated into understandable and meaningful information for
4114	the public.
4115	(b) Whether the following measures are useful consumer
4116	guides relating to care provided in state-licensed hospitals:
4117	1. Inpatient mortality for medical conditions.
4118	2. Inpatient mortality for procedures.
4119	3. Utilization of procedures for which there are questions
4120	of overuse, underuse, or misuse.
4121	4. Volume of procedures for which there is evidence that a
4122	higher volume of procedures is associated with lower mortality.
4123	(c) Whether there are quality indicators that are
4124	particularly useful relative to the state's unique demographics.
4125	(d) Whether all hospitals should be included in the
4126	comparison.
4127	(e) The criteria for comparison.
4128	(f) Whether comparisons are best within metropolitan
4129	statistical areas or some other geographic configuration.
4130	(g) Identification of several Internet websites on which
4131	such a report should be published to achieve the broadest
4132	dissemination of the information.
4133	(3) The Agency for Health Care Administration shall
4134	consider the input of all interested parties, including
4135	hospitals, physicians, consumer organizations, and patients, and
4136	submit the final report to the Governor and the presiding
4137	officers of the Legislature by January 1, 2004.
4138	Section 78. No later than September 1, 2003, the
4139	Department of Health shall convene a workgroup to study the
4140	current health care practitioner disciplinary process. The
4141	workgroup shall include a representative of the Administrative
4142	Law section of The Florida Bar, a representative of the Health
4143	Law section of The Florida Bar, a representative of the Florida
4144	Medical Association, a representative of the Florida Osteopathic
4145	Medical Association, a representative of the Florida Dental
4146	Association, a member of the Florida Board of Medicine who has
4147	served on the probable cause panel, a member of the Board of
4148	Osteopathic Medicine who has served on the probable cause panel,
4149	and a member of the Board of Dentistry who has served on the
4150	probable cause panel. The workgroup shall also include one
4151	consumer member of the Board of Medicine. The Department of
4152	Health shall present the findings and recommendations to the
4153	Governor, the President of the Senate, and the Speaker of the
4154	House of Representatives no later than January 1, 2004. The
4155	sponsoring organizations shall assume the costs of their
4156	representatives.
4157	Section 79. The sum of $687,786 is appropriated from the
4158	Medical Quality Assurance Trust Fund to the Department of
4159	Health, and seven positions are authorized for the purpose of
4160	implementing this act during the 2003-2004 fiscal year. The sum
4161	of $452,122 is appropriated from the General Revenue Fund to the
4162	Agency for Health Care Administration, and five positions are
4163	authorized for the purpose of implementing this act during the
4164	2003-2004 fiscal year.
4165	Section 80. If any provision of this act or the
4166	application thereof to any person or circumstance is held
4167	invalid, the invalidity does not affect other provisions or
4168	applications of the act which can be given effect without the
4169	invalid provision or application, and to this end the provisions
4170	of this act are declared severable.
4171	Section 81. All provisions of this act shall be repealed
4172	on July 1, 2007, unless the Legislature otherwise directs.
4173	Section 82. If any law amended by this act was also
4174	amended by a law enacted at the 2003 Regular Session, the 2003
4175	Special Session A, or the 2003 Special Session B of the
4176	Legislature, such laws shall be construed as if they had been
4177	enacted at the same session of the Legislature, and full effect
4178	shall be given to each if possible.
4179	Section 83. This act shall take effect upon becoming a law
4180	and shall apply to any cause of action accruing under chapter
4181	766, Florida Statutes, after that date, unless otherwise
4182	provided herein.