HB 1621

1	A bill to be entitled
2	An act relating to medical malpractice insurance; creating
3	the Enterprise Act for Patient Protection and Provider
4	Liability; providing legislative findings; amending s.
5	381.0271, F.S.; authorizing the Florida Patient Safety
6	Corporation to intervene as a party in certain actions
7	involving patient safety; amending s. 395.0197, F.S.,
8	relating to internal risk management programs; conforming
9	provisions to changes made by the act; amending s.
10	458.320, F.S.; exempting certain physicians who perform
11	surgery in certain patient safety facilities from the
12	requirement to establish financial responsibility;
13	requiring a licensed physician who is covered for medical
14	negligence claims by a hospital that assumes liability
15	under the act to prominently post notice or provide a
16	written statement to patients; requiring a licensed
17	physician who meets certain requirements for payment or
18	settlement of a medical malpractice claim and who is
19	covered for medical negligence claims by a hospital that
20	assumes liability under the act to prominently post notice
21	or provide a written statement to patients; amending s.
22	459.0085, F.S.; requiring a licensed osteopathic physician
23	who is covered for medical negligence claims by a hospital
24	that assumes liability under the act to prominently post
25	notice or provide a written statement to patients;
26	requiring a licensee of osteopathic medicine who meets
27	certain requirements for payment or settlement of a
28	medical malpractice claim and who is covered for medical
29	negligence claims by a hospital that assumes liability
30	under the act to prominently post notice or provide a
31	written statement to patients; creating s. 627.41485,
32	F.S.; authorizing insurers to offer liability insurance
33	coverage to physicians which has an exclusion for certain
34	acts of medical negligence under certain conditions;
35	authorizing the Department of Health to adopt rules;
36	amending s. 766.316, F.S.; requiring hospitals that assume
37	liability for affected physicians under the act to provide
38	notice to obstetrical patients regarding the limited no-
39	fault alternative to birth-related neurological injuries;
40	amending s. 766.110, F.S.; requiring hospitals that assume
41	liability for acts of medical negligence under the act to
42	carry insurance; requiring the hospital's policy regarding
43	medical liability insurance to satisfy certain statutory
44	financial-responsibility requirements; authorizing an
45	insurer who is authorized to write casualty insurance to
46	write such coverage; authorizing certain hospitals to
47	indemnify certain medical staff for legal liability of
48	loss, damages, or expenses arising from medical
49	malpractice within hospital premises; requiring a hospital
50	to acquire a policy of professional liability insurance or
51	a fund for malpractice coverage; requiring an annual
52	certified financial statement to the Patient Safety
53	Corporation and the Office of Insurance Regulation within
54	the Department of Financial Services; authorizing certain
55	hospitals to charge physicians a fee for malpractice
56	coverage; creating s. 766.401, F.S.; providing
57	definitions; creating s. 766.402, F.S.; authorizing an
58	eligible hospital to petition the Agency for Health Care
59	Administration to enter an order certifying the hospital
60	as a patient safety facility; providing requirements for
61	certification as a patient safety facility; creating s.
62	766.403, F.S.; providing requirements for a hospital to
63	demonstrate that it is engaged in a common enterprise for
64	the care and treatment of patients; specifying required
65	patient safety measures; prohibiting a report or document
66	generated under the act, from being admissible or
67	discoverable as evidence; creating s. 766.404, F.S.;
68	authorizing the agency to enter an order certifying a
69	hospital as a patient safety facility and providing that
70	the hospital bears liability for acts of medical
71	negligence for its health care providers or an agent of
72	the hospital; providing that certain persons or entities
73	are not liable for medically negligent acts occurring in a
74	certified patient safety facility; requiring that an
75	affected practitioner prominently post notice regarding
76	exemption from personal liability; requiring an affected
77	physician who is covered by an enterprise plan in a
78	licensed facility that receives sovereign immunity to
79	prominently post notice regarding exemption from personal
80	liability; providing that an agency order certifying
81	approval of an enterprise plan is evidence of a hospital's
82	compliance with applicable patient safety requirements;
83	providing circumstances in which notice is not required;
84	providing that the order certifying approval of an
85	enterprise plan applies prospectively to causes of action
86	for medical negligence; authorizing the agency to conduct
87	onsite examinations of a licensed facility; providing
88	circumstances under which the agency may revoke its order
89	certifying approval of an enterprise plan; providing that
90	an employee or agent of a certified patient safety
91	facility may not be joined as a defendant in an action for
92	medical negligence; requiring an affected physician to
93	cooperate in good faith in an investigation of a claim for
94	medical malpractice; providing a cause of action for
95	failure of a physician to act in good faith; providing
96	that strict liability or liability without fault is not
97	imposed for medical incidents that occur in the affected
98	facility; providing requirements that a claimant must
99	prove to demonstrate medical negligence by an employee,
100	agent, or medical staff of a licensed facility; providing
101	that the act does not create an independent cause of
102	action or waive sovereign immunity; creating s. 766.405,
103	F.S.; requiring an eligible hospital to execute an
104	enterprise agreement; requiring certain conditions to be
105	contained within an enterprise agreement; creating s.
106	766.406, F.S.; requiring a certified patient safety
107	facility to report medical incidents occurring on its
108	premises and adverse findings of medical negligence to the
109	Department of Health; authorizing an affected facility to
110	require an affected practitioner to undertake additional
111	training, education, or professional counseling under
112	certain conditions; authorizing an affected facility to
113	limit, suspend, or terminate clinical privileges of an
114	affected practitioner under certain circumstances;
115	providing that a licensed facility and its officers,
116	directors, employees, and agents are immune from liability
117	for certain sanctions; providing that deliberations and
118	findings of a peer review committee are not discoverable
119	or admissible as evidence; authorizing the department to
120	adopt rules; creating s. 766.407, F.S.; providing that an
121	enterprise agreement may provide clinical privileges to
122	certain persons; requiring certain organizations to share
123	in the cost of omnibus medical liability insurance
124	premiums subject to certain conditions; authorizing a
125	licensed facility to impose a reasonable assessment
126	against an affected practitioner who commits medical
127	negligence; providing for the revocation of clinical
128	privileges for failure to pay the assessment; exempting
129	certain employees and agents from such assessments;
130	creating s. 766.408, F.S.; requiring a certified patient
131	safety facility to submit an annual report to the agency
132	and the Legislature; providing requirements for the annual
133	report; providing that the annual report may include
134	certain information from the Office of Insurance
135	Regulation within the Department of Financial Services;
136	providing that the annual report is subject to public-
137	records requirements, but is not admissible as evidence in
138	a legal proceeding; creating s. 766.409, F.S.; providing
139	rulemaking authority; creating s. 766.410, F.S.;
140	authorizing certain teaching hospitals and eligible
141	hospitals to petition the agency for certification;
142	providing for limitations on damages for eligible
143	hospitals that are certified for compliance with certain
144	patient safety measures; authorizing the agency to conduct
145	onsite examinations of certified eligible hospitals;
146	authorizing the agency to revoke its order certifying
147	approval of an enterprise plan; providing that an agency
148	order certifying approval of an enterprise plan is
149	evidence of a hospital's compliance with applicable
150	patient safety requirements; providing that evidence of
151	noncompliance is inadmissible in any action for medical
152	malpractice; providing that entry of the agency's order
153	does not impose enterprise liability on the licensed
154	facility for acts or omissions of medical negligence;
155	providing that a hospital may not be approved for
156	certification for both enterprise liability and
157	limitations on damages; amending s. 768.28, F.S.;
158	providing limitations on payment of a claim or judgment
159	for an action for medical negligence within a certified
160	patient safety facility that is covered by sovereign
161	immunity; providing definitions; providing that a
162	certified patient safety facility is an agent of a state
163	university board of trustees to the extent that the
164	licensed facility is solely liable for acts of medical
165	negligence of physicians providing health care services
166	within the licensed facility; providing for severability;
167	providing for broad statutory view of the act; providing
168	for self-execution of the act; providing an effective
169	date.
170
171	Be It Enacted by the Legislature of the State of Florida:
172
173	Section 1.  Popular name.--This act may be cited as the
174	"Enterprise Act for Patient Protection and Provider Liability."
175	Section 2.  Legislative findings.--
176	(1)  The Legislature finds that this state is in the midst
177	of a prolonged medical malpractice insurance crisis that has
178	serious adverse effects on patients, practitioners, licensed
179	healthcare facilities, and all residents of this state.
180	(2)  The Legislature finds that hospitals are central
181	components of the modern health care delivery system.
182	(3)  The Legislature finds that many of the most serious
183	incidents of medical negligence occur in hospitals, where the
184	most seriously ill patients are treated, and where surgical
185	procedures are performed.
186	(4)  The Legislature finds that modern hospitals are
187	complex organizations, that medical care and treatment in
188	hospitals is a complex process, and that, increasingly, medical
189	care and treatment in hospitals is a common enterprise involving
190	an array of responsible employees, agents, and other persons,
191	such as physicians, who are authorized to exercise clinical
192	privileges within the premises.
193	(5)  The Legislature finds that an increasing number of
194	medical incidents in hospitals involve a combination of acts and
195	omissions by employees, agents, and other persons, such as
196	physicians, who are authorized to exercise clinical privileges
197	within the premises.
198	(6)  The Legislature finds that the medical malpractice
199	insurance crisis in this state can be alleviated by the adoption
200	of innovative approaches for patient protection in hospitals
201	which can lead to a reduction in medical errors.
202	(7)  The Legislature finds statutory incentives are
203	necessary to facilitate innovative approaches for patient
204	protection in hospitals.
205	(8)  The Legislature finds that an enterprise approach to
206	patient protection and provider liability in hospitals will lead
207	to a reduction in the frequency and severity of incidents of
208	medical malpractice in hospitals.
209	(9)  The Legislature finds that a reduction in the
210	frequency and severity of incidents of medical malpractice in
211	hospitals will reduce attorney's fees and other expenses
212	inherent in the medical liability system.
213	(10)  The Legislature finds that making high-quality health
214	care available to the residents of this state is an overwhelming
215	public necessity.
216	(11)  The Legislature finds that medical education in this
217	state is an overwhelming public necessity.
218	(12)  The Legislature finds that statutory teaching
219	hospitals and hospitals owned by and operated by universities
220	that maintain accredited medical schools are essential for high-
221	quality medical care and medical education in this state.
222	(13)  The Legislature finds that the critical mission of
223	statutory teaching hospitals and hospitals owned and operated by
224	universities that maintain accredited medical schools is
225	severely undermined by the ongoing medical malpractice crisis.
226	(14)  The Legislature finds that statutory teaching
227	hospitals and hospitals owned and operated by universities that
228	maintain accredited medical schools are appropriate health care
229	facilities for the implementation of innovative approaches to
230	patient protection and provider liability.
231	(15)  The Legislature finds an overwhelming public
232	necessity to impose reasonable limitations on actions for
233	medical malpractice against statutory teaching hospitals and
234	hospitals that are owned and operated by universities that
235	maintain accredited medical schools, in furtherance of the
236	critical public interest in promoting access to high-quality
237	medical care, medical education, and innovative approaches to
238	patient protection.
239	(16)  The Legislature finds an overwhelming public
240	necessity for statutory teaching hospitals and hospitals owned
241	and operated by universities that maintain accredited medical
242	schools to implement innovative measures for patient protection
243	and provider liability in order to generate empirical data for
244	state policymakers on the effectiveness of these measures. Such
245	data may lead to broader application of these measures in a
246	wider array of hospitals after a reasonable period of evaluation
247	and review.
248	(17)  The Legislature finds an overwhelming public
249	necessity to promote the academic mission of statutory teaching
250	hospitals and hospitals owned and operated by universities that
251	maintain accredited medical schools. Furthermore, the
252	Legislature finds that the academic mission of these medical
253	facilities is materially enhanced by statutory authority for the
254	implementation of innovative approaches to patient protection
255	and provider liability. Such approaches can be carefully studied
256	and learned by medical students, medical school faculty, and
257	affiliated physicians in appropriate clinical settings, thereby
258	enlarging the body of knowledge concerning patient protection
259	and provider liability which is essential for advancement of
260	patient safety, reduction of expenses inherent in the medical
261	liability system, and curtailment of the medical malpractice
262	insurance crisis in this state.
263	Section 3.  Paragraph (b) of subsection (7) of section
264	381.0271, Florida Statutes, is amended to read:
265	381.0271  Florida Patient Safety Corporation.--
266	(7)  POWERS AND DUTIES.--
267	(b)  In carrying out its powers and duties, the corporation
268	may also:
269	1.  Assess the patient safety culture at volunteering
270	hospitals and recommend methods to improve the working
271	environment related to patient safety at these hospitals.
272	2.  Inventory the information technology capabilities
273	related to patient safety of health care facilities and health
274	care practitioners and recommend a plan for expediting the
275	implementation of patient safety technologies statewide.
276	3.  Recommend continuing medical education regarding
277	patient safety to practicing health care practitioners.
278	4.  Study and facilitate the testing of alternative systems
279	of compensating injured patients as a means of reducing and
280	preventing medical errors and promoting patient safety.
281	5.  Intervene as a party, as defined by s. 120.52, in any
282	administrative action related to patient safety in hospitals or
283	other licensed health care facilities.
284	6.5.  Conduct other activities identified by the board of
285	directors to promote patient safety in this state.
286	Section 4.  Subsection (3) of section 395.0197, Florida
287	Statutes, is amended to read:
288	395.0197  Internal risk management program.--
289	(3)  In addition to the programs mandated by this section,
290	other innovative approaches intended to reduce the frequency and
291	severity of medical malpractice and patient injury claims shall
292	be encouraged and their implementation and operation
293	facilitated. Such additional approaches may include extending
294	internal risk management programs to health care providers'
295	offices and the assuming of provider liability by a licensed
296	health care facility for acts or omissions occurring within the
297	licensed facility pursuant to the Enterprise Act for Patient
298	Protection and Provider Liability, inclusive of ss. 766.401-
299	766.409. Each licensed facility shall annually report to the
300	agency and the Department of Health the name and judgments
301	entered against each health care practitioner for which it
302	assumes liability. The agency and Department of Health, in their
303	respective annual reports, shall include statistics that report
304	the number of licensed facilities that assume such liability and
305	the number of health care practitioners, by profession, for whom
306	they assume liability.
307	Section 5.  Subsection (2) and paragraphs (f) and (g) of
308	subsection (5) of section 458.320, Florida Statutes, are amended
309	to read:
310	458.320  Financial responsibility.--
311	(2)  Physicians who perform surgery in an ambulatory
312	surgical center licensed under chapter 395 and, as a continuing
313	condition of hospital staff privileges, physicians who have
314	staff privileges must also establish financial responsibility by
315	one of the following methods:
316	(a)  Establishing and maintaining an escrow account
317	consisting of cash or assets eligible for deposit in accordance
318	with s. 625.52 in the per claim amounts specified in paragraph
319	(b). The required escrow amount set forth in this paragraph may
320	not be used for litigation costs or attorney's fees for the
321	defense of any medical malpractice claim.
322	(b)  Obtaining and maintaining professional liability
323	coverage in an amount not less than $250,000 per claim, with a
324	minimum annual aggregate of not less than $750,000 from an
325	authorized insurer as defined under s. 624.09, from a surplus
326	lines insurer as defined under s. 626.914(2), from a risk
327	retention group as defined under s. 627.942, from the Joint
328	Underwriting Association established under s. 627.351(4),
329	through a plan of self-insurance as provided in s. 627.357, or
330	through a plan of self-insurance which meets the conditions
331	specified for satisfying financial responsibility in s. 766.110.
332	The required coverage amount set forth in this paragraph may not
333	be used for litigation costs or attorney's fees for the defense
334	of any medical malpractice claim.
335	(c)  Obtaining and maintaining an unexpired irrevocable
336	letter of credit, established pursuant to chapter 675, in an
337	amount not less than $250,000 per claim, with a minimum
338	aggregate availability of credit of not less than $750,000. The
339	letter of credit must be payable to the physician as beneficiary
340	upon presentment of a final judgment indicating liability and
341	awarding damages to be paid by the physician or upon presentment
342	of a settlement agreement signed by all parties to such
343	agreement when such final judgment or settlement is a result of
344	a claim arising out of the rendering of, or the failure to
345	render, medical care and services. The letter of credit may not
346	be used for litigation costs or attorney's fees for the defense
347	of any medical malpractice claim. The letter of credit must be
348	nonassignable and nontransferable. The letter of credit must be
349	issued by any bank or savings association organized and existing
350	under the laws of this state or any bank or savings association
351	organized under the laws of the United States which has its
352	principal place of business in this state or has a branch office
353	that is authorized under the laws of this state or of the United
354	States to receive deposits in this state.
355
356	This subsection shall be inclusive of the coverage in subsection
357	(1). A physician who only performs surgery or who has only
358	clinical privileges or admitting privileges in one or more
359	certified patient safety facilities, which health care facility
360	or facilities are legally liable for medical negligence of
361	affected practitioners, pursuant to the Enterprise Act for
362	Patient Protection and Provider Liability, inclusive of ss.
363	766.401-766.409, is exempt from the requirements of this
364	subsection.
365	(5)  The requirements of subsections (1), (2), and (3) do
366	not apply to:
367	(f)  Any person holding an active license under this
368	chapter who meets all of the following criteria:
369	1.  The licensee has held an active license to practice in
370	this state or another state or some combination thereof for more
371	than 15 years.
372	2.  The licensee has either retired from the practice of
373	medicine or maintains a part-time practice of no more than 1,000
374	patient contact hours per year.
375	3.  The licensee has had no more than two claims for
376	medical malpractice resulting in an indemnity exceeding $25,000
377	within the previous 5-year period.
378	4.  The licensee has not been convicted of, or pled guilty
379	or nolo contendere to, any criminal violation specified in this
380	chapter or the medical practice act of any other state.
381	5.  The licensee has not been subject within the last 10
382	years of practice to license revocation or suspension for any
383	period of time; probation for a period of 3 years or longer; or
384	a fine of $500 or more for a violation of this chapter or the
385	medical practice act of another jurisdiction. The regulatory
386	agency's acceptance of a physician's relinquishment of a
387	license, stipulation, consent order, or other settlement,
388	offered in response to or in anticipation of the filing of
389	administrative charges against the physician's license,
390	constitutes action against the physician's license for the
391	purposes of this paragraph.
392	6.  The licensee has submitted a form supplying necessary
393	information as required by the department and an affidavit
394	affirming compliance with this paragraph.
395	7.  The licensee must submit biennially to the department
396	certification stating compliance with the provisions of this
397	paragraph. The licensee must, upon request, demonstrate to the
398	department information verifying compliance with this paragraph.
399
400	A licensee who meets the requirements of this paragraph must
401	post notice in the form of a sign prominently displayed in the
402	reception area and clearly noticeable by all patients or provide
403	a written statement to any person to whom medical services are
404	being provided. The sign or statement must read as follows:
405	"Under Florida law, physicians are generally required to carry
406	medical malpractice insurance or otherwise demonstrate financial
407	responsibility to cover potential claims for medical
408	malpractice. However, certain part-time physicians who meet
409	state requirements are exempt from the financial responsibility
410	law. YOUR DOCTOR MEETS THESE REQUIREMENTS AND HAS DECIDED NOT TO
411	CARRY MEDICAL MALPRACTICE INSURANCE.  This notice is provided
412	pursuant to Florida law." In addition, a licensee who is covered
413	for claims of medical negligence arising from care and treatment
414	of patients in a hospital that assumes sole and exclusive
415	liability for all such claims pursuant to the Enterprise Act for
416	Patient Protection and Provider Liability, inclusive of ss.
417	766.401-766.409, shall post notice in the form of a sign
418	prominently displayed in the reception area and clearly
419	noticeable by all patients or provide a written statement to any
420	person for whom the physician may provide medical care and
421	treatment in any such hospital in accordance with the
422	requirements of s. 766.404.
423	(g)  Any person holding an active license under this
424	chapter who agrees to meet all of the following criteria:
425	1.  Upon the entry of an adverse final judgment arising
426	from a medical malpractice arbitration award, from a claim of
427	medical malpractice either in contract or tort, or from
428	noncompliance with the terms of a settlement agreement arising
429	from a claim of medical malpractice either in contract or tort,
430	the licensee shall pay the judgment creditor the lesser of the
431	entire amount of the judgment with all accrued interest or
432	either $100,000, if the physician is licensed pursuant to this
433	chapter but does not maintain hospital staff privileges, or
434	$250,000, if the physician is licensed pursuant to this chapter
435	and maintains hospital staff privileges, within 60 days after
436	the date such judgment became final and subject to execution,
437	unless otherwise mutually agreed to in writing by the parties.
438	Such adverse final judgment shall include any cross-claim,
439	counterclaim, or claim for indemnity or contribution arising
440	from the claim of medical malpractice. Upon notification of the
441	existence of an unsatisfied judgment or payment pursuant to this
442	subparagraph, the department shall notify the licensee by
443	certified mail that he or she shall be subject to disciplinary
444	action unless, within 30 days from the date of mailing, he or
445	she either:
446	a.  Shows proof that the unsatisfied judgment has been paid
447	in the amount specified in this subparagraph; or
448	b.  Furnishes the department with a copy of a timely filed
449	notice of appeal and either:
450	(I)  A copy of a supersedeas bond properly posted in the
451	amount required by law; or
452	(II)  An order from a court of competent jurisdiction
453	staying execution on the final judgment pending disposition of
454	the appeal.
455	2.  The Department of Health shall issue an emergency order
456	suspending the license of any licensee who, after 30 days
457	following receipt of a notice from the Department of Health, has
458	failed to: satisfy a medical malpractice claim against him or
459	her; furnish the Department of Health a copy of a timely filed
460	notice of appeal; furnish the Department of Health a copy of a
461	supersedeas bond properly posted in the amount required by law;
462	or furnish the Department of Health an order from a court of
463	competent jurisdiction staying execution on the final judgment
464	pending disposition of the appeal.
465	3.  Upon the next meeting of the probable cause panel of
466	the board following 30 days after the date of mailing the notice
467	of disciplinary action to the licensee, the panel shall make a
468	determination of whether probable cause exists to take
469	disciplinary action against the licensee pursuant to
470	subparagraph 1.
471	4.  If the board determines that the factual requirements
472	of subparagraph 1. are met, it shall take disciplinary action as
473	it deems appropriate against the licensee. Such disciplinary
474	action shall include, at a minimum, probation of the license
475	with the restriction that the licensee must make payments to the
476	judgment creditor on a schedule determined by the board to be
477	reasonable and within the financial capability of the physician.
478	Notwithstanding any other disciplinary penalty imposed, the
479	disciplinary penalty may include suspension of the license for a
480	period not to exceed 5 years. In the event that an agreement to
481	satisfy a judgment has been met, the board shall remove any
482	restriction on the license.
483	5.  The licensee has completed a form supplying necessary
484	information as required by the department.
485
486	A licensee who meets the requirements of this paragraph shall be
487	required either to post notice in the form of a sign prominently
488	displayed in the reception area and clearly noticeable by all
489	patients or to provide a written statement to any person to whom
490	medical services are being provided.  Such sign or statement
491	shall state: "Under Florida law, physicians are generally
492	required to carry medical malpractice insurance or otherwise
493	demonstrate financial responsibility to cover potential claims
494	for medical malpractice. YOUR DOCTOR HAS DECIDED NOT TO CARRY
495	MEDICAL MALPRACTICE INSURANCE. This is permitted under Florida
496	law subject to certain conditions. Florida law imposes penalties
497	against noninsured physicians who fail to satisfy adverse
498	judgments arising from claims of medical malpractice.  This
499	notice is provided pursuant to Florida law." In addition, a
500	licensee who meets the requirements of this paragraph and who is
501	covered for claims of medical negligence arising from care and
502	treatment of patients in a hospital that assumes sole and
503	exclusive liability for all such claims pursuant to the
504	Enterprise Act for Patient Protection and Provider Liability,
505	inclusive of ss. 766.401-766.409, shall post notice in the form
506	of a sign prominently displayed in the reception area and
507	clearly noticeable by all patients or provide a written
508	statement to any person for whom the physician may provide
509	medical care and treatment in any such hospital. The sign or
510	statement must adhere to the requirements of s. 766.404.
511	Section 6.  Paragraphs (f) and (g) of subsection (5) of
512	section 459.0085, Florida Statutes, are amended to read:
513	459.0085  Financial responsibility.--
514	(5)  The requirements of subsections (1), (2), and (3) do
515	not apply to:
516	(f)  Any person holding an active license under this
517	chapter who meets all of the following criteria:
518	1.  The licensee has held an active license to practice in
519	this state or another state or some combination thereof for more
520	than 15 years.
521	2.  The licensee has either retired from the practice of
522	osteopathic medicine or maintains a part-time practice of
523	osteopathic medicine of no more than 1,000 patient contact hours
524	per year.
525	3.  The licensee has had no more than two claims for
526	medical malpractice resulting in an indemnity exceeding $25,000
527	within the previous 5-year period.
528	4.  The licensee has not been convicted of, or pled guilty
529	or nolo contendere to, any criminal violation specified in this
530	chapter or the practice act of any other state.
531	5.  The licensee has not been subject within the last 10
532	years of practice to license revocation or suspension for any
533	period of time, probation for a period of 3 years or longer, or
534	a fine of $500 or more for a violation of this chapter or the
535	medical practice act of another jurisdiction.  The regulatory
536	agency's acceptance of an osteopathic physician's relinquishment
537	of a license, stipulation, consent order, or other settlement,
538	offered in response to or in anticipation of the filing of
539	administrative charges against the osteopathic physician's
540	license, constitutes action against the physician's license for
541	the purposes of this paragraph.
542	6.  The licensee has submitted a form supplying necessary
543	information as required by the department and an affidavit
544	affirming compliance with this paragraph.
545	7.  The licensee must submit biennially to the department a
546	certification stating compliance with this paragraph. The
547	licensee must, upon request, demonstrate to the department
548	information verifying compliance with this paragraph.
549
550	A licensee who meets the requirements of this paragraph must
551	post notice in the form of a sign prominently displayed in the
552	reception area and clearly noticeable by all patients or provide
553	a written statement to any person to whom medical services are
554	being provided. The sign or statement must read as follows:
555	"Under Florida law, osteopathic physicians are generally
556	required to carry medical malpractice insurance or otherwise
557	demonstrate financial responsibility to cover potential claims
558	for medical malpractice. However, certain part-time osteopathic
559	physicians who meet state requirements are exempt from the
560	financial responsibility law. YOUR OSTEOPATHIC PHYSICIAN MEETS
561	THESE REQUIREMENTS AND HAS DECIDED NOT TO CARRY MEDICAL
562	MALPRACTICE INSURANCE. This notice is provided pursuant to
563	Florida law." In addition, a licensee who is covered for claims
564	of medical negligence arising from care and treatment of
565	patients in a hospital that assumes sole and exclusive liability
566	for all such claims pursuant to the Enterprise Act for Patient
567	Protection and Provider Liability, inclusive of ss. 766.401-
568	766.409, shall post notice in the form of a sign prominently
569	displayed in the reception area and clearly noticeable by all
570	patients or provide a written statement to any person for whom
571	the osteopathic physician may provide medical care and treatment
572	in any such hospital in accordance with the requirements of s.
573	766.404.
574	(g)  Any person holding an active license under this
575	chapter who agrees to meet all of the following criteria.
576	1.  Upon the entry of an adverse final judgment arising
577	from a medical malpractice arbitration award, from a claim of
578	medical malpractice either in contract or tort, or from
579	noncompliance with the terms of a settlement agreement arising
580	from a claim of medical malpractice either in contract or tort,
581	the licensee shall pay the judgment creditor the lesser of the
582	entire amount of the judgment with all accrued interest or
583	either $100,000, if the osteopathic physician is licensed
584	pursuant to this chapter but does not maintain hospital staff
585	privileges, or $250,000, if the osteopathic physician is
586	licensed pursuant to this chapter and maintains hospital staff
587	privileges, within 60 days after the date such judgment became
588	final and subject to execution, unless otherwise mutually agreed
589	to in writing by the parties. Such adverse final judgment shall
590	include any cross-claim, counterclaim, or claim for indemnity or
591	contribution arising from the claim of medical malpractice. Upon
592	notification of the existence of an unsatisfied judgment or
593	payment pursuant to this subparagraph, the department shall
594	notify the licensee by certified mail that he or she shall be
595	subject to disciplinary action unless, within 30 days from the
596	date of mailing, the licensee either:
597	a.  Shows proof that the unsatisfied judgment has been paid
598	in the amount specified in this subparagraph; or
599	b.  Furnishes the department with a copy of a timely filed
600	notice of appeal and either:
601	(I)  A copy of a supersedeas bond properly posted in the
602	amount required by law; or
603	(II)  An order from a court of competent jurisdiction
604	staying execution on the final judgment, pending disposition of
605	the appeal.
606	2.  The Department of Health shall issue an emergency order
607	suspending the license of any licensee who, after 30 days
608	following receipt of a notice from the Department of Health, has
609	failed to: satisfy a medical malpractice claim against him or
610	her; furnish the Department of Health a copy of a timely filed
611	notice of appeal; furnish the Department of Health a copy of a
612	supersedeas bond properly posted in the amount required by law;
613	or furnish the Department of Health an order from a court of
614	competent jurisdiction staying execution on the final judgment
615	pending disposition of the appeal.
616	3.  Upon the next meeting of the probable cause panel of
617	the board following 30 days after the date of mailing the notice
618	of disciplinary action to the licensee, the panel shall make a
619	determination of whether probable cause exists to take
620	disciplinary action against the licensee pursuant to
621	subparagraph 1.
622	4.  If the board determines that the factual requirements
623	of subparagraph 1. are met, it shall take disciplinary action as
624	it deems appropriate against the licensee. Such disciplinary
625	action shall include, at a minimum, probation of the license
626	with the restriction that the licensee must make payments to the
627	judgment creditor on a schedule determined by the board to be
628	reasonable and within the financial capability of the
629	osteopathic physician. Notwithstanding any other disciplinary
630	penalty imposed, the disciplinary penalty may include suspension
631	of the license for a period not to exceed 5 years.  In the event
632	that an agreement to satisfy a judgment has been met, the board
633	shall remove any restriction on the license.
634	5.  The licensee has completed a form supplying necessary
635	information as required by the department.
636
637	A licensee who meets the requirements of this paragraph shall be
638	required either to post notice in the form of a sign prominently
639	displayed in the reception area and clearly noticeable by all
640	patients or to provide a written statement to any person to whom
641	medical services are being provided.  Such sign or statement
642	shall state: "Under Florida law, osteopathic physicians are
643	generally required to carry medical malpractice insurance or
644	otherwise demonstrate financial responsibility to cover
645	potential claims for medical malpractice. YOUR OSTEOPATHIC
646	PHYSICIAN HAS DECIDED NOT TO CARRY MEDICAL MALPRACTICE
647	INSURANCE. This is permitted under Florida law subject to
648	certain conditions.  Florida law imposes strict penalties
649	against noninsured osteopathic physicians who fail to satisfy
650	adverse judgments arising from claims of medical malpractice.
651	This notice is provided pursuant to Florida law." In addition, a
652	licensee who meets the requirements of this paragraph and who is
653	covered for claims of medical negligence arising from care and
654	treatment of patients in a hospital that assumes sole and
655	exclusive liability for all such claims pursuant to an
656	enterprise plan for patient protection and provider liability
657	under ss. 766.401-766.409, shall post notice in the form of a
658	sign prominently displayed in the reception area and clearly
659	noticeable by all patients or provide a written statement to any
660	person for whom the osteopathic physician may provide medical
661	care and treatment in any such hospital. The sign or statement
662	must adhere to the requirements of s. 766.404.
663	Section 7.  Section 627.41485, Florida Statutes, is created
664	to read:
665	627.41485  Medical malpractice insurers; optional coverage
666	exclusion for insureds who are covered by an enterprise plan for
667	patient protection and provider liability.--
668	(1)  An insurer issuing policies of professional liability
669	coverage for claims arising out of the rendering of, or the
670	failure to render, medical care or services may make available
671	to physicians licensed under chapter 458 and to osteopathic
672	physicians licensed under chapter 459 coverage having an
673	appropriate exclusion for acts of medical negligence occurring
674	within a certified patient safety facility that bears sole and
675	exclusive liability for acts of medical negligence pursuant to
676	the Enterprise Act for Patient Protection and Provider
677	Liability, inclusive of ss. 766.401-766.409, subject to the
678	usual underwriting standards.
679	(2)  The Department of Health may adopt rules to administer
680	this section.
681	Section 8.  Section 766.316, Florida Statutes, is amended
682	to read:
683	766.316  Notice to obstetrical patients of participation in
684	the plan.--Each hospital with a participating physician on its
685	staff, each hospital that assumes liability for affected
686	physicians pursuant to the Enterprise Act for Patient Protection
687	and Provider Liability, inclusive of ss. 766.401-766.409, and
688	each participating physician, other than residents, assistant
689	residents, and interns deemed to be participating physicians
690	under s. 766.314(4)(c), under the Florida Birth-Related
691	Neurological Injury Compensation Plan shall provide notice to
692	the obstetrical patients as to the limited no-fault alternative
693	for birth-related neurological injuries. Such notice shall be
694	provided on forms furnished by the association and shall include
695	a clear and concise explanation of a patient's rights and
696	limitations under the plan. The hospital or the participating
697	physician may elect to have the patient sign a form
698	acknowledging receipt of the notice form. Signature of the
699	patient acknowledging receipt of the notice form raises a
700	rebuttable presumption that the notice requirements of this
701	section have been met. Notice need not be given to a patient
702	when the patient has an emergency medical condition as defined
703	in s. 395.002(9)(b) or when notice is not practicable.
704	Section 9.  Subsection (2) of section 766.110, Florida
705	Statutes, is amended to read:
706	766.110  Liability of health care facilities.--
707	(2)(a)  Every hospital licensed under chapter 395 may carry
708	liability insurance or adequately insure itself in an amount of
709	not less than $1.5 million per claim, $5 million annual
710	aggregate to cover all medical injuries to patients resulting
711	from negligent acts or omissions on the part of those members of
712	its medical staff who are covered thereby in furtherance of the
713	requirements of ss. 458.320 and 459.0085.  Self-insurance
714	coverage extended hereunder to a member of a hospital's medical
715	staff meets the financial responsibility requirements of ss.
716	458.320 and 459.0085 if the physician's coverage limits are not
717	less than the minimum limits established in ss. 458.320 and
718	459.0085 and the hospital is a verified trauma center that has
719	extended self-insurance coverage continuously to members of its
720	medical staff for activities both inside and outside of the
721	hospital. Any insurer authorized to write casualty insurance may
722	make available, but is shall not be required to write, such
723	coverage.  The hospital may assess on an equitable and pro rata
724	basis the following professional health care providers for a
725	portion of the total hospital insurance cost for this coverage:
726	physicians licensed under chapter 458, osteopathic physicians
727	licensed under chapter 459, podiatric physicians licensed under
728	chapter 461, dentists licensed under chapter 466, and nurses
729	licensed under part I of chapter 464. The hospital may provide
730	for a deductible amount to be applied against any individual
731	health care provider found liable in a law suit in tort or for
732	breach of contract.  The legislative intent in providing for the
733	deductible to be applied to individual health care providers
734	found negligent or in breach of contract is to instill in each
735	individual health care provider the incentive to avoid the risk
736	of injury to the fullest extent and ensure that the citizens of
737	this state receive the highest quality health care obtainable.
738	(b)  Except with regard to hospitals that receive sovereign
739	immunity under s. 768.28, each hospital licensed under chapter
740	395 which assumes sole and exclusive liability for acts of
741	medical negligence by affected providers pursuant to the
742	Enterprise Act for Patient Protection and Provider Liability,
743	inclusive in ss. 766.401-766.409, shall carry liability
744	insurance or adequately insure itself in an amount of not less
745	than $2.5 million per claim, $7.5 million annual aggregate to
746	cover all medical injuries to patients resulting from negligent
747	acts or omissions on the part of affected members of its medical
748	staff and others who are covered by an enterprise plan for
749	patient protection and provider liability. The hospital's policy
750	of medical liability insurance or self-insurance must satisfy
751	the financial-responsibility requirements of ss. 458.320(2) and
752	459.0085(2) for affected providers. Any insurer authorized to
753	write casualty insurance may make available, but is not required
754	to write, such coverage.
755	(c)  Notwithstanding any provision in the Insurance Code to
756	the contrary, a statutory teaching hospital, as defined in s.
757	408.07, other than a hospital that receives sovereign immunity
758	under s. 768.28, which complies with the patient safety measures
759	specified in s. 766.403 and all other requirements of s.
760	766.410, including approval by the Agency for Health Care
761	Administration, may agree to indemnify some or all members of
762	its medical staff, including, but not limited to, physicians
763	having clinical privileges who are not employees or agents of
764	the hospital and any organization, association, or group of
765	persons liable for the negligent acts of such physicians,
766	whether incorporated or unincorporated, and some or all medical,
767	nursing, or allied health students affiliated with the hospital,
768	collectively covered persons, other than persons exempt from
769	liability due to sovereign immunity under s. 768.28, for legal
770	liability of such covered persons for loss, damages, or expense
771	arising out of medical malpractice or professional error or
772	mistake within the hospital premises, as defined in s. 766.401,
773	thereby providing limited malpractice coverage for such covered
774	persons. Any hospital that agrees to provide malpractice
775	coverage for covered persons pursuant to this section shall
776	acquire an appropriate policy of professional liability
777	insurance or establish and maintain a fund from which such
778	malpractice coverage is provided, in accordance with usual
779	underwriting standards. Such insurance or self-insurance may be
780	separate and apart from any insurance or self-insurance
781	maintained by or on behalf of the hospital or combined in a
782	single policy of insurance or a single self-insurance fund
783	maintained by or on behalf of the hospital. Any hospital that
784	provides malpractice coverage to covered persons through a self-
785	insurance fund, or a self-insurance fund providing any such
786	malpractice coverage, shall annually provide a certified
787	financial statement containing actuarial projections as to the
788	soundness of reserves to the Patient Safety Corporation and the
789	Office of Insurance Regulation within the Department of
790	Financial Services. The indemnity agreements or malpractice
791	coverage provided by this section shall be in amounts that, at a
792	minimum, meet the financial responsibility requirements of ss.
793	458.320 and 459.0085 for affected physicians. Any such indemnity
794	agreement or malpractice coverage in such amounts satisfies the
795	financial responsibility requirements of ss. 458.320 and
796	459.0085 for affected physicians. Any statutory teaching
797	hospital that agrees to indemnify physicians or other covered
798	persons for medical negligence on the premises pursuant to this
799	section may charge such physicians or other covered persons a
800	reasonable fee for malpractice coverage, notwithstanding any
801	provision in the Insurance Code to the contrary. Such fee shall
802	be based on appropriate actuarial criteria. This paragraph does
803	not constitute a waiver of sovereign immunity under s. 768.28.
804	Section 10.  Section 766.401, Florida Statutes, is created
805	to read:
806	766.401  Definitions.--As used in this section and ss.
807	766.402-766.410, the term:
808	(1)  "Affected facility" means a certified patient safety
809	facility.
810	(2)  "Affected patient" means a patient of a certified
811	patient safety facility.
812	(3)  "Affected practitioner" and "affected physician" means
813	a medical staff member who is covered by an enterprise plan for
814	patient protection and provider liability in a certified patient
815	safety facility.
816	(4)  "Agency" means the Agency for Health Care
817	Administration.
818	(5)  "Certified patient safety facility" means any eligible
819	hospital that is solely and exclusively liable for acts or
820	omissions of medical negligence within the licensed facility in
821	accordance with an agency order approving an enterprise plan for
822	patient protection and provider liability.
823	(6)  "Clinical privileges" means the privileges granted to
824	a physician or other licensed health care practitioner to render
825	patient care services in a hospital.
826	(7)  "Eligible hospital" or "licensed facility" means:
827	(a)  A statutory teaching hospital as defined by s. 408.07;
828	or
829	(b)  A hospital licensed in accordance with chapter 395
830	which is wholly owned by a university based in this state which
831	maintains an accredited medical school.
832	(8)  "Enterprise agreement" means a document executed by
833	the governing board of an eligible hospital and the governing
834	board of the medical staff of the eligible hospital, however
835	defined, manifesting concurrence and setting forth certain
836	rights, duties, privileges, obligations, and responsibilities of
837	the health care facility and its medical staff in furtherance of
838	an enterprise plan for patient protection and provider liability
839	in a certified patient safety facility.
840	(9)  "Health care provider" or "provider" means:
841	(a)  An eligible hospital.
842	(b)  A physician or physician assistant licensed under
843	chapter 458.
844	(c)  An osteopathic physician or osteopathic physician
845	assistant licensed under chapter 459.
846	(d)  A registered nurse, nurse midwife, licensed practical
847	nurse, or advanced registered nurse practitioner licensed or
848	registered under part I of chapter 464 or any facility that
849	employs nurses licensed or registered under part I of chapter
850	464 to supply all or part of the care delivered by that
851	facility.
852	(e)  A health care professional association and its
853	employees or a corporate medical group and its employees.
854	(f)  Any other medical facility the primary purpose of
855	which is to deliver human medical diagnostic services or which
856	delivers nonsurgical human medical treatment, including an
857	office maintained by a provider.
858	(g)  A free clinic that delivers only medical diagnostic
859	services or nonsurgical medical treatment free of charge to all
860	low-income recipients.
861	(h)  Any other health care professional, practitioner, or
862	provider, including a student enrolled in an accredited program
863	that prepares the student for licensure as any one of the
864	professionals listed in this subsection.
865
866	The term includes any person, organization, or entity that is
867	vicariously liable under the theory of respondent superior or
868	any other theory of legal liability for medical negligence
869	committed by any licensed professional listed in this
870	subsection. The term also includes any nonprofit corporation
871	qualified as exempt from federal income taxation under s. 501(a)
872	of the Internal Revenue Code, and described in s. 501(c) of the
873	Internal Revenue Code, including any university or medical
874	school that employs licensed professionals listed in this
875	subsection or that delivers health care services provided by
876	licensed professionals listed in this subsection, any federally
877	funded community health center, and any volunteer corporation or
878	volunteer health care provider that delivers health care
879	services.
880	(10)  "Health care practitioner" or "practitioner" means
881	any person, entity, or organization identified in subsection
882	(9), except for a hospital.
883	(11)  "Medical incident" or "adverse incident" has the same
884	meaning as provided in ss. 381.0271, 395.0197, 458.351, and
885	459.026.
886	(12)  "Medical negligence" means medical malpractice,
887	whether grounded in tort or in contract.  The term does not
888	include intentional acts.
889	(13)  "Medical staff" means a physician licensed under
890	chapter 458 or chapter 459 having privileges in a licensed
891	facility, as well as any other licensed health care practitioner
892	having clinical privileges as approved by a licensed facility's
893	governing board. The term includes any affected physician,
894	regardless of his or her status as an employee, agent, or
895	independent contractor with regard to the licensed facility.
896	(14)  "Person" means any individual, partnership,
897	corporation, association, or governmental unit.
898	(15)  "Premises" means those buildings, beds, and equipment
899	located at the address of the licensed facility and all other
900	buildings, beds, and equipment for the provision of hospital,
901	ambulatory surgical, mobile surgical care, primary care, or
902	comprehensive health care under the dominion and control of the
903	licensee, or located in such reasonable proximity to the address
904	of the licensed facility as to appear to the public to be under
905	the dominion and control of the licensee, including offices and
906	locations where the licensed facility provides medical care and
907	treatment to affected patients.
908	(16)  "Statutory teaching hospital" or "teaching hospital"
909	has the same meaning as provided in s. 408.07.
910	(17)  "Within the licensed facility" or "within the
911	premises" means anywhere on the premises of the licensed
912	facility or the premises of any office, clinic, or ancillary
913	facility that is owned, operated, leased, or controlled by the
914	licensed facility.
915	Section 11.  Section 766.402, Florida Statutes, is created
916	to read:
917	766.402  Agency approval of enterprise plans for patient
918	protection and provider liability.--
919	(1)  An eligible hospital in conjunction with its medical
920	staff, or vice versa, may petition the Agency for Health Care
921	Administration to enter an order certifying approval of the
922	hospital as a certified patient safety facility.
923	(2)  In accordance with chapter 120, the agency shall enter
924	an order certifying approval of the certified patient safety
925	facility upon a showing that, in furtherance of an enterprise
926	approach to patient protection and provider liability:
927	(a)  The petitioners are engaged in a common enterprise for
928	the care and treatment of hospital patients;
929	(b)  The petitioners satisfy requirements for patient
930	protection measures, as specified in s. 766.403;
931	(c)  The petitioners acknowledge and agree to hospital-
932	centered enterprise liability for medical negligence within the
933	premises, as specified in s. 766.404;
934	(d)  The petitioners have executed an enterprise agreement,
935	as specified in s. 766.405;
936	(e)  The petitioners satisfy requirements for professional
937	accountability of affected practitioners, as specified in s.
938	766.406;
939	(f)  The petitioners satisfy requirements for financial
940	accountability of affected practitioners, as specified in s.
941	766.407;
942	(g)  The petitioners satisfy all other requirements of ss.
943	766.401-766.410; and
944	(h)  The public interest in assuring access to quality
945	health care services and the promotion of patient safety in
946	licensed health care facilities is served by entry of the order.
947	(3)  The Florida Patient Safety Corporation may intervene
948	and participate as a party, as defined in s. 120.52, or
949	otherwise present relevant testimony in any administrative
950	hearing conducted pursuant to this section.
951	Section 12.  Section 766.403, Florida Statutes, is created
952	to read:
953	766.403  Enterprise-wide patient safety measures.--
954	(1)  In order to satisfy the requirements of s.
955	766.402(2)(a) or s. 766.410, the licensed facility shall:
956	(a)  Have in place a process, either through the facility's
957	patient safety committee or a similar body, for coordinating the
958	quality control, risk management, and patient relations
959	functions of the facility and for reporting to the facility's
960	governing board at least quarterly regarding such efforts.
961	(b)  Establish within the facility a system for reporting
962	near misses and agree to submit any information collected to the
963	Florida Patient Safety Corporation. Such information must be
964	submitted by the facility and made available by the Patient
965	Safety Corporation in accordance with s. 381.0271(7).
966	(c)  Design and make available to facility staff, including
967	medical staff, a patient safety curriculum that provides lecture
968	and web-based training on recognized patient safety principles,
969	which may include communication skills training, team
970	performance assessment and training, risk prevention strategies,
971	and best practices and evidence based medicine. The licensed
972	facility shall report annually to the agency the programs
973	presented.
974	(d)  Implement a program to identify health care providers
975	on the facility's staff who may be eligible for an early-
976	intervention program providing additional skills assessment and
977	training and offer such training to the staff on a voluntary and
978	confidential basis with established mechanisms to assess program
979	performance and results.
980	(e)  Implement a simulation-based program for skills
981	assessment, training, and retraining of a facility's staff in
982	those tasks and activities that the agency identifies by rule.
983	(f)  Designate a patient advocate that reports to the
984	facility's risk manager who coordinates with members of the
985	medical staff and the facility's chief medical officer regarding
986	disclosure of medical incidents to patients. In addition, the
987	patient advocate shall establish an advisory panel, consisting
988	of providers, patients or their families, and other health care
989	consumer or consumer groups to review general patient safety
990	concerns and other issues related to relations among and between
991	patients and providers and to identify areas where additional
992	education and program development may be appropriate.
993	(g)  Establish a procedure for a semiannual review of the
994	facility's patient safety program and its compliance with the
995	requirements of this section. Such review shall be conducted by
996	an independent patient safety organization as defined in s.
997	766.1016(1) or other professional organization approved by the
998	agency. The organization performing the review shall prepare a
999	written report with detailed findings and recommendations. The
1000	report shall be forwarded to the facility's risk manager or
1001	patient safety officer, who may make written comments in
1002	response thereto. The report and any written comments shall be
1003	presented to the governing board of the licensed facility. A
1004	copy of the report and any of the facilities' responses to the
1005	findings and recommendations shall be provided to the agency
1006	within 60 days after the date that the governing board reviewed
1007	the report. The report is confidential and exempt from
1008	production or discovery in any civil action. Likewise, the
1009	report, and the information contained therein, is not admissible
1010	as evidence for any purpose in any action for medical
1011	malpractice.
1012	(h)  Establish a system for the trending and tracking of
1013	quality and patient safety indicators that the agency may
1014	identify by rule, and a method for review of the data at least
1015	semiannually by the facility's patient safety committee.
1016	(i)  Provide assistance to affected physicians, upon
1017	request, in their establishment, implementation, and evaluation
1018	of individual risk-management, patient-safety, and incident-
1019	reporting systems in clinical settings outside the premises of
1020	the licensed facility.
1021	(2)  This section does not constitute an applicable
1022	standard of care in any action for medical negligence or
1023	otherwise create a private right of action, and evidence of
1024	noncompliance with this section is not admissible for any
1025	purpose in any action for medical negligence against an affected
1026	facility or any other health care provider.
1027	(3)  This section does not prohibit the licensed  facility
1028	from implementing other measures for promoting patient safety
1029	within the premises. This section does not relieve the licensed
1030	facility from the duty to implement any other patient safety
1031	measure that is required by state law. The Legislature intends
1032	that the patient safety measures specified in this section are
1033	in addition to all other patient safety measures required by
1034	state law, federal law, and applicable accreditation standards
1035	for licensed facilities.
1036	(4)  A review, report, or other document created, produced,
1037	delivered, or discussed pursuant to this section is not
1038	discoverable or admissible as evidence in any legal action.
1039	Section 13.  Section 766.404, Florida Statutes, is created
1040	to read:
1041	766.404  Enterprise liability in certain health care
1042	facilities.--
1043	(1)  Subject to the requirements of ss. 766.401-766.410,
1044	the Agency for Health Care Administration may enter an order
1045	certifying the petitioner-hospital as a certified patient safety
1046	facility and providing that the hospital bears sole and
1047	exclusive liability for any and all acts of medical negligence
1048	within the licensed facility when such acts of medical
1049	negligence within the premises cause damage to affected
1050	patients, including, but not limited to, acts of medical
1051	negligence by physicians or other licensed health care providers
1052	who exercise clinical privileges in a licensed hospital, whether
1053	or not the active tortfeasor is an employee or agent of the
1054	health care facility when the incident of medical negligence
1055	occurred.
1056	(2)  In any action for personal injury or wrongful death,
1057	whether in contract or tort, arising out of medical negligence
1058	resulting in damages to a patient of a certified patient safety
1059	facility, the licensed facility bears sole and exclusive
1060	liability for medical negligence, whether or not the
1061	practitioner was an employee or agent of the facility when the
1062	incident of medical negligence occurred. Any other provider,
1063	person, organization, or entity that commits medical negligence
1064	within the premises, and any other provider, person,
1065	organization, or entity that is vicariously liable for medical
1066	negligence within the premises of an affected practitioner under
1067	the theory of respondent superior or otherwise, may not be named
1068	as a defendant in any such action and any such provider, person,
1069	organization, or entity is not liable for the medical negligence
1070	of a covered practitioner. This subsection does not impose
1071	liability or confer immunity on any other provider, person,
1072	organization, or entity for acts of medical malpractice
1073	committed on any person before admission as a patient of a
1074	certified patient safety facility, or on any person after being
1075	discharged from the affected facility, or on affected patients
1076	in clinical settings other than the premises of the affected
1077	facility.
1078	(3)  An affected practitioner shall post an applicable
1079	notice or provide an appropriate written statement as follows:
1080	(a)  An affected practitioner shall post notice in the form
1081	of a sign prominently displayed in the reception area and
1082	clearly noticeable by all patients or provide a written
1083	statement to any person to whom medical services are being
1084	provided. The sign or statement must read as follows: "In
1085	general, physicians in the State of Florida are personally
1086	liable for acts of medical negligence, subject to certain
1087	limitations. However, physicians who perform medical services
1088	within a certified patient safety facility are exempt from
1089	personal liability because the licensed hospital bears sole and
1090	exclusive liability for acts of medical negligence within the
1091	health care facility pursuant to an administrative order of the
1092	Agency for Health Care Administration entered in accordance with
1093	the Enterprise Act for Patient Protection and Provider
1094	Liability. YOUR DOCTOR HOLDS CLINICAL STAFF PRIVILEGES IN A
1095	CERTIFIED PATIENT SAFETY FACILITY. UNDER FLORIDA LAW, ANY CLAIM
1096	FOR MEDICAL NEGLIGENCE WITHIN THE HEALTH CARE FACILITY MUST BE
1097	INITIATED AGAINST THE HOSPITAL AND NOT AGAINST YOUR DOCTOR,
1098	BECAUSE THE HOSPITAL IS SOLELY RESPONSIBLE FOR ALL ACTS OF
1099	PROFESSIONAL NEGLIGENCE WITHIN THE PREMISES. THIS PROVISION DOES
1100	NOT AFFECT YOUR PHYSICIAN'S LIABILITY FOR ACTS OF MEDICAL
1101	NEGLIGENCE IN OTHER CLINICAL SETTINGS. IF YOU DO NOT UNDERSTAND,
1102	PLEASE DISCUSS WITH YOUR DOCTOR BEFORE YOUR CONSULTATION. This
1103	notice is provided pursuant to Florida law."
1104	(b)  If an affected practitioner is covered by an
1105	enterprise plan for patient protection and provider liability in
1106	one or more licensed facilities that receive sovereign immunity,
1107	and one or more other licensed facilities, the affected
1108	practitioner shall post notice in the form of a sign prominently
1109	displayed in the reception area and clearly noticeable by all
1110	patients or provide a written statement to any person to whom
1111	medical services are being provided. The sign or statement must
1112	read as follows: "In general, physicians in the state of Florida
1113	are personally liable for acts of medical negligence, subject to
1114	certain limitations such as sovereign immunity. However,
1115	physicians who perform medical services within a certified
1116	patient safety facility are exempt from personal liability
1117	because the licensed hospital bears sole and exclusive liability
1118	for acts of medical negligence within the affected facility
1119	pursuant to an administrative order of the Agency for Health
1120	Care Administration entered in accordance with the Enterprise
1121	Act for Patient Protection and Provider Liability. YOUR DOCTOR
1122	HOLDS CLINICAL STAFF PRIVILEGES IN ONE OR MORE CERTIFIED PATIENT
1123	SAFETY FACILITIES. AT LEAST ONE OF THESE HOSPITALS IS SUBJECT TO
1124	SOVEREIGN IMMUNITY. UNDER FLORIDA LAW, ANY CLAIM FOR MEDICAL
1125	NEGLIGENCE WITHIN THE HEALTH CARE FACILITY MUST BE INITIATED
1126	AGAINST THE HOSPITAL AND NOT AGAINST YOUR DOCTOR, BECAUSE THE
1127	HOSPITAL IS SOLELY RESPONSIBLE FOR ALL ACTS OF PROFESSIONAL
1128	NEGLIGENCE WITHIN THE PREMISES. MOREOVER, RECOVERY AGAINST THE
1129	HOSPITAL MAY BE LIMITED, DUE TO FLORIDA'S SOVEREIGN IMMUNITY
1130	LAW. THESE PROVISIONS DO NOT AFFECT YOUR PHYSICIAN'S LIABILITY
1131	FOR ACTS OF MEDICAL NEGLIGENCE IN OTHER CLINICAL SETTINGS. IF
1132	YOU DO NOT UNDERSTAND, PLEASE DISCUSS WITH YOUR DOCTOR BEFORE
1133	YOUR CONSULTATION. This notice is provided pursuant to Florida
1134	law."
1135	(c)  Notice need not be given to a patient when:
1136	1.  The patient has an emergency medical condition as
1137	defined in s. 395.002;
1138	2.  The practitioner is an employee or agent of a
1139	governmental entity and is immune from liability and suit under
1140	s. 768.28; or
1141	3.  Notice is not practicable.
1142	(d)  This subsection is directory in nature. An agency
1143	order certifying approval of an enterprise plan for patient
1144	protection and provider liability shall, as a matter of law,
1145	constitute conclusive evidence that the hospital complies with
1146	all applicable patient safety requirements of s. 766.403 and all
1147	other requirements of ss. 766.401-766.410. Evidence of
1148	noncompliance with s. 766.403 or any other provision of ss.
1149	766.401-766.410 may not be admissible for any purpose in any
1150	action for medical malpractice. Failure to comply with the
1151	requirements of this subsection does not affect the liabilities
1152	or immunities conferred by ss. 766.401-766.410. This subsection
1153	does not give rise to an independent cause of action for
1154	damages.
1155	(4)  The agency order certifying approval of an enterprise
1156	plan for patient protection and provider liability applies
1157	prospectively to causes of action for medical negligence that
1158	arise on or after the effective date of the order.
1159	(5)  Upon entry of an order approving the petition, the
1160	agency may conduct onsite examinations of the licensed facility
1161	to assure continued compliance with the terms and conditions of
1162	the order.
1163	(6)  The agency order certifying approval of an enterprise
1164	plan for patient protection remains in effect until revoked. The
1165	agency shall revoke the order upon the unilateral request of the
1166	licensed facility or the affected medical staff. The agency may
1167	revoke the order upon reasonable notice to the affected facility
1168	that it fails to comply with material requirements of ss.
1169	766.401-766.410 or material conditions of the order certifying
1170	approval of the enterprise plan and further upon a determination
1171	that the licensed facility has failed to cure stated
1172	deficiencies upon reasonable notice. An administrative order
1173	revoking approval of an enterprise plan for patient protection
1174	and provider liability terminates the plan on January 1 of the
1175	year following entry of the order or 6 months after entry of the
1176	order, whichever is longer. Revocation of an agency order
1177	certifying approval of an enterprise plan for patient protection
1178	and provider liability applies prospectively to causes of action
1179	for medical negligence which arise on or after the effective
1180	date of the order of revocation.
1181	(7)  This section do not exempt a licensed facility from
1182	liability for acts of medical negligence committed by employees
1183	and agents thereof; although employees and agents of a certified
1184	patient safety facility may not be joined as defendants in any
1185	action for medical negligence because the licensed facility
1186	bears sole and exclusive liability for acts of medical
1187	negligence within the premises of the licensed facility,
1188	including acts of medical negligence by such employees and
1189	agents.
1190	(8)  Affected physicians shall cooperate in good faith with
1191	an affected facility in the investigation and defense of any
1192	claim for medical malpractice. Failure to cooperate in good
1193	faith is grounds for disciplinary action against an affected
1194	physician by the affected facility and the Department of Health.
1195	An affected facility shall have a cause of action for damages
1196	against an affected physician for bad faith refusal to cooperate
1197	in the investigation and defense of any claim of medical
1198	malpractice against the licensed facility.
1199	(9)  Sections 766.401-766.410 does not impose strict
1200	liability or liability without fault for medical incidents that
1201	occur within an affected facility. To maintain a cause of action
1202	against an affected facility pursuant to ss. 766.401-766.410,
1203	the claimant must allege and prove that an employee or agent of
1204	the licensed facility, or an affected member of the medical
1205	staff who is covered by an approved enterprise plan for patient
1206	protection and provider liability, committed an act or omission
1207	within the licensed facility which constitutes medical
1208	negligence under state law, even though an active tortfeasor is
1209	not named or joined as a party defendant in the lawsuit.
1210	(10)  Sections 766.401-766.410 do not create an independent
1211	cause of action against any health care provider, do not impose
1212	enterprise liability on any health care provider, except as
1213	expressly provided, and may not be construed to support any
1214	cause of action other than an action for medical malpractice as
1215	expressly provided against any person, organization, or entity.
1216	(11)  Sections 766.401-766.410 do not waive sovereign
1217	immunity, except as expressly provided in s. 768.28.
1218	Section 14.  Section 766.405, Florida Statutes, is created
1219	to read:
1220	766.405  Enterprise agreements.--
1221	(1)  It is the intent of the Legislature that enterprise
1222	plans for patient protection are elective and not mandatory for
1223	eligible hospitals. It is further the intent of the Legislature
1224	that the medical staff of an eligible hospital must concur with
1225	the development and implementation of an enterprise plan for
1226	patient protection and provider liability. It is further the
1227	intent of the Legislature that the licensed facility and medical
1228	staff be accorded wide latitude in formulating enterprise
1229	agreements, consistent with the underlying purpose of ss.
1230	766.401-766.410 to encourage innovative, systemic measures for
1231	patient protection and quality assurance in licensed facilities,
1232	especially in clinical settings where surgery is performed. This
1233	section does not require an eligible hospital to commence
1234	negotiations or enter into an enterprise agreement with its
1235	medical staff. However, execution of an enterprise agreement is
1236	a necessary condition for agency approval of an enterprise plan
1237	for patient protection and provider liability.
1238	(2)  An eligible hospital and its medical staff shall
1239	execute an enterprise agreement as a necessary condition to
1240	agency approval of a certified patient safety facility. An
1241	affirmative vote of approval by the regularly constituted board
1242	of directors of the medical staff, however named or constituted,
1243	is sufficient to manifest approval by the medical staff of the
1244	enterprise agreement. Once approved, affected members of the
1245	medical staff are subject to the enterprise agreement. The
1246	agreement may be conditioned on agency approval of an enterprise
1247	plan for patient protection and provider liability for the
1248	affected facility. At a minimum, the enterprise agreement must
1249	contain provisions covering:
1250	(a)  Compliance with a patient protection plan;
1251	(b)  Internal review of medical incidents;
1252	(c)  Timely reporting of medical incidents to state
1253	agencies;
1254	(d)  Professional accountability of affected practitioners;
1255	and
1256	(e)  Financial accountability of affected practitioners.
1257	(3)  This section does not prohibit a patient safety
1258	facility from including other provisions of interest to the
1259	affected parties in the enterprise agreement, in a separate
1260	agreement, as a condition of staff privileges, or by way of
1261	contract with an organization providing medical staff for the
1262	licensed facility.
1263	(4)  This section does not limit the power of any licensed
1264	facility to enter into other agreements with its medical staff,
1265	or members thereof, or otherwise to impose restrictions,
1266	requirements, or conditions on clinical privileges, as
1267	authorized by law.
1268	Section 15.  Section 766.406, Florida Statutes, is created
1269	to read:
1270	766.406  Professional accountability of affected
1271	practitioners.--
1272	(1)  A certified patient safety facility shall report
1273	medical incidents occurring in the affected facility to the
1274	Department of Health, in accordance with ss. 458.351 and
1275	459.026.
1276	(2)  A certified patient safety facility shall report
1277	adverse findings of medical negligence or failure to adhere to
1278	applicable standards of professional responsibility by affected
1279	practitioners to the Department of Health.
1280	(3)  Upon a determination by a peer review committee that a
1281	practitioner committed an act or omission or a pattern of acts
1282	or omissions which adversely affected the safety of any patient
1283	in the licensed facility, or which unduly exposed any patient to
1284	a risk of injury, the affected facility may require that the
1285	affected practitioner undertake additional training, education,
1286	or professional counseling as a condition of maintaining
1287	clinical privileges, in addition to any other sanction or
1288	penalty authorized by law.
1289	(4)  Upon a determination by a peer review committee that a
1290	practitioner committed an act or omission or a pattern of acts
1291	or omissions which caused injury or damages to any patient or
1292	patients in an affected facility, the facility may limit,
1293	suspend, or terminate clinical privileges of the practitioner,
1294	in addition to any other sanction or penalty authorized by law.
1295	This section does not prohibit an affected facility from taking
1296	emergency action to temporarily limit or suspend clinical
1297	privileges of an affected practitioner pending a hearing and
1298	recommendation by the peer review committee and final action by
1299	the governing board of the licensed facility.
1300	(5)  The licensed facility and its officers, directors,
1301	employees, and agents are immune from liability for any
1302	sanctions imposed against individual practitioners pursuant to
1303	this section.
1304	(6)  Members of a peer review committee are immune from
1305	liability for any acts performed pursuant to this section.
1306	(7)  Deliberations and findings of a peer review committee
1307	are not discoverable or admissible in any legal action.
1308	(8)  The Department of Health may adopt rules to implement
1309	this section.
1310	Section 16.  Section 766.407, Florida Statutes, is created
1311	to read:
1312	766.407  Financial accountability of affected
1313	practitioners.--
1314	(1)  An enterprise agreement may provide that any affected
1315	member of the medical staff or any affected practitioner having
1316	clinical privileges, other than an employee of the licensed
1317	facility, and any organization that contracts with the licensed
1318	facility to provide practitioners to treat patients within the
1319	licensed facility, shall share equitably in the cost of omnibus
1320	medical liability insurance premiums covering the facility-based
1321	medical enterprise, similar self-insurance expense, or other
1322	expenses reasonably related to risk management and adjustment of
1323	claims of medical negligence, subject to the following
1324	conditions:
1325	(a)  This subsection does not permit a licensed facility
1326	and any affected practitioner to agree on charges for an
1327	equitable share of medical liability expense based on the number
1328	of patients admitted to the hospital by individual
1329	practitioners, patient revenue for the licensed facility
1330	generated by individual practitioners, or overall profit or loss
1331	sustained by the certified patient safety facility or certified
1332	patient safety department of a licensed facility in a given
1333	fiscal period.
1334	(b)  Any agreement described in paragraph (a) must be
1335	reviewed and approved by the agency.
1336	(2)  Pursuant to an enterprise plan for patient protection
1337	and provider liability, a licensed facility may impose a
1338	reasonable assessment against an affected practitioner that
1339	commits medical negligence resulting in injury and damages to an
1340	affected patient of the health care facility, upon a
1341	determination of professional responsibility by an internal peer
1342	review committee. A schedule of assessments, criteria for the
1343	levying of assessments, procedures for levying assessments, and
1344	due process rights of an affected practitioner must be agreed to
1345	by the medical staff. The legislative intent in providing for
1346	assessments against an affected physician is to instill in each
1347	individual health care practitioner the incentive to avoid the
1348	risk of injury to the fullest extent and ensure that the
1349	residents of this state receive the highest quality health care
1350	obtainable. Failure to pay an assessment constitutes grounds for
1351	suspension of clinical privileges by the licensed facility.
1352	Assessment may be enforced as bona fide debts in a court of law.
1353	The licensed facility may exempt its employees, agents, and
1354	other persons for whom it bears vicarious responsibility for
1355	acts of medical negligence from all such assessments. Employees
1356	and agents of the state, its agencies, and subdivisions, as
1357	defined by s. 768.28, are exempt from all such assessments.
1358	Section 17.  Section 766.408, Florida Statutes, is created
1359	to read:
1360	766.408  Data collection and reports.--
1361	(1)  Each certified patient safety facility shall submit an
1362	annual report to the agency containing information and data
1363	reasonably required by the agency to evaluate performance and
1364	effectiveness of the facility's enterprise plan for patient
1365	protection and provider liability. However, information may not
1366	be submitted or disclosed in violation of any patient's right to
1367	privacy under state or federal law.
1368	(2)  The agency shall aggregate information and data
1369	submitted by all affected facilities and each year, on or before
1370	March 1, the agency shall submit a report to the Legislature
1371	which evaluates the performance and effectiveness of the
1372	enterprise approach to patient safety and provider liability in
1373	certified health care facilities, which reports must include,
1374	but are not limited to, pertinent data on:
1375	(a)  The number and names of affected facilities;
1376	(b)  The number and types of patient protection measures
1377	currently in effect in these facilities;
1378	(c)  The number of affected practitioners;
1379	(d)  The number of affected patients;
1380	(e)  The number of surgical procedures by affected
1381	practitioners on affected patients;
1382	(f)  The number of medical incidents, claims of medical
1383	malpractice, and claims resulting in indemnity;
1384	(g)  The average time for resolution of contested and
1385	uncontested claims of medical malpractice;
1386	(h)  The percentage of claims that result in civil trials;
1387	(i)  The percentage of civil trials resulting in adverse
1388	judgments against affected facilities;
1389	(j)  The number and average size of an indemnity paid to
1390	claimants;
1391	(k)  The number and average size of assessments imposed on
1392	affected practitioners;
1393	(l)  The estimated liability expense, inclusive of medical
1394	liability insurance premiums; and
1395	(m)  The percentage of medical liability expense, inclusive
1396	of medical liability insurance premiums, which is borne by
1397	affected practitioners in affected health care facilities.
1398
1399	Such reports to the Legislature may also include other
1400	information and data that the agency deems appropriate to gauge
1401	the cost and benefit of enterprise plans for patient protection
1402	and provider liability.
1403	(3)  The agency's annual report to the Legislature may
1404	include relevant information and data obtained from the Office
1405	of Insurance Regulation within the Department of Financial
1406	Services on the availability and affordability of enterprise-
1407	wide medical liability insurance coverage for affected
1408	facilities and the availability and affordability of insurance
1409	policies for individual practitioners which contain coverage
1410	exclusions for acts of medical negligence in certified patient
1411	safety facilities and certified patient safety departments of
1412	licensed facilities. The Office of Insurance Regulation within
1413	the Department of Financial Services shall cooperate with the
1414	agency in the reporting of information and data specified in
1415	this subsection.
1416	(4)  Reports submitted to the agency by affected facilities
1417	pursuant to this section are public records under chapter 112.
1418	However, these reports, and the information contained therein,
1419	are not admissible as evidence in a court of law in any action.
1420	Section 18.  Section 766.409, Florida Statutes, is created
1421	to read:
1422	766.409  Rulemaking authority.--The agency may adopt rules
1423	to administer ss. 766.401-766.410.
1424	Section 19.  Section 766.410, Florida Statutes, is created
1425	to read:
1426	766.410  Damages in malpractice actions against certain
1427	hospitals that meet patient safety requirements; agency approval
1428	of patient safety measures.--
1429	(1)  In recognition of their essential role in training
1430	future health care providers and in providing innovative medical
1431	care for this state's residents, in recognition of their
1432	commitment to treating indigent patients, and further in
1433	recognition that all teaching hospitals, as defined in s.
1434	408.07, both public and private, and hospitals licensed under
1435	chapter 395 which are owned and operated by a university that
1436	maintains an accredited medical school, collectively defined as
1437	eligible hospitals in s. 766.401(7), provide benefits to the
1438	residents of this state through their roles in improving the
1439	quality of medical care, training health care providers, and
1440	caring for indigent patients, the limits of liability for
1441	medical malpractice arising out of the rendering of, or the
1442	failure to render, medical care by all such hospitals, shall be
1443	determined in accordance with the requirements of this section,
1444	notwithstanding any other provision of state law.
1445	(2)  Except as otherwise provided in subsections (9) and
1446	(10), any eligible hospital may petition the Agency for Health
1447	Care Administration to enter an order certifying that the
1448	licensed facility complies with patient safety measures
1449	specified in s. 766.403.
1450	(3)  In accordance with chapter 120, the agency shall enter
1451	an order approving the petition upon a showing that the eligible
1452	hospital complies with the patient safety measures specified in
1453	s. 766.403. Upon entry of the agency order, and for the entire
1454	period of time that the order remains in effect, the limits of
1455	liability for medical malpractice arising out of the rendering
1456	of, or the failure to render, medical care by the hospital
1457	covered by the order and its employees and agents shall be up to
1458	$500,000 in the aggregate for claims or judgments for
1459	noneconomic damages arising out of the same incident or
1460	occurrence. Claims or judgments for noneconomic damages and
1461	awards of past economic damages shall be offset by collateral
1462	sources and paid in full at the time of final settlement. Awards
1463	of future economic damages, after being offset by collateral
1464	sources at the option of the teaching hospital, shall be reduced
1465	by the court to present value and paid in full or paid by means
1466	of periodic payments in the form of annuities or reversionary
1467	trusts, such payments to be paid for the life of the claimant or
1468	for so long as the condition for which the award was made
1469	persists, whichever is shorter, without regard to the number of
1470	years awarded by the trier of fact, at which time the obligation
1471	to make such payments terminates. A company that underwrites an
1472	annuity to pay future economic damages shall have a Best Company
1473	rating of not less than A. The terms of a reversionary
1474	instrument used to periodically pay future economic damages must
1475	be approved by the court, such approval may not be unreasonably
1476	withheld.
1477	(4)  The limitations on damages in subsection (3) apply
1478	prospectively to causes of action for medical negligence that
1479	arise on or after the effective date of the order.
1480	(5)  Upon entry of an order approving the petition, the
1481	agency may conduct onsite examinations of the licensed facility
1482	to assure continued compliance with terms and conditions of the
1483	order.
1484	(6)  The agency order certifying approval of an enterprise
1485	plan for patient protection under this section remains in effect
1486	until revoked. The agency may revoke the order upon reasonable
1487	notice to the affected hospital that it fails to comply with
1488	material requirements of ss. 766.401-766.410 or material
1489	conditions of the order certifying compliance with required
1490	patient safety measures and that the hospital has failed to cure
1491	stated deficiencies upon reasonable notice. Revocation of an
1492	agency order certifying approval of an enterprise plan for
1493	patient protection and provider liability applies prospectively
1494	to causes of action for medical negligence that arise on or
1495	after the effective date of the order of revocation.
1496	(7)  An agency order certifying approval of an enterprise
1497	plan for patient protection under this section shall, as a
1498	matter of law, constitute conclusive evidence that the hospital
1499	complies with all applicable patient safety requirements of s.
1500	766.403. A hospital's noncompliance with the requirements of s.
1501	766.403 may not affect the limitations on damages conferred by
1502	this section. Evidence of noncompliance with s. 766.403 may not
1503	be admissible for any purpose in any action for medical
1504	malpractice. This section, or any portion thereof, may not give
1505	rise to an independent cause of action for damages against any
1506	hospital.
1507	(8)  The entry of an agency order pursuant to this section
1508	does not impose enterprise liability, or sole and exclusive
1509	liability, on the licensed facility for acts or omissions of
1510	medical negligence within the premises.
1511	(9)  An eligible hospital may petition the agency for an
1512	order pursuant to this section or an order pursuant to s.
1513	766.404. However, a hospital may not be approved for both
1514	enterprise liability under s. 766.404 and the limitations on
1515	damages under this section.
1516	(10)  This section may not apply to hospitals that are
1517	subject to sovereign immunity under s. 768.28.
1518	Section 20.  Subsections (5) and (12) of section 768.28,
1519	Florida Statutes, are amended to read:
1520	768.28  Waiver of sovereign immunity in tort actions;
1521	recovery limits; limitation on attorney fees; statute of
1522	limitations; exclusions; indemnification; risk management
1523	programs.--
1524	(5)(a)  The state and its agencies and subdivisions shall
1525	be liable for tort claims in the same manner and to the same
1526	extent as a private individual under like circumstances, but
1527	liability does shall not include punitive damages or interest
1528	for the period before judgment.
1529	(b)  Except as provided in paragraph (c), neither the state
1530	or nor its agencies or subdivisions are shall be liable to pay a
1531	claim or a judgment by any one person which exceeds the sum of
1532	$100,000 or any claim or judgment, or portions thereof, which,
1533	when totaled with all other claims or judgments paid by the
1534	state or its agencies or subdivisions arising out of the same
1535	incident or occurrence, exceeds the sum of $200,000.  However, a
1536	judgment or judgments may be claimed and rendered in excess of
1537	these amounts and may be settled and paid pursuant to this act
1538	up to $100,000 or $200,000, as the case may be; and that portion
1539	of the judgment that exceeds these amounts may be reported to
1540	the Legislature, but may be paid in part or in whole only by
1541	further act of the Legislature. Notwithstanding the limited
1542	waiver of sovereign immunity provided herein, the state or an
1543	agency or subdivision thereof may agree, within the limits of
1544	insurance coverage provided, to settle a claim made or a
1545	judgment rendered against it without further action by the
1546	Legislature, but the state or agency or subdivision thereof
1547	shall not be deemed to have waived any defense of sovereign
1548	immunity or to have increased the limits of its liability as a
1549	result of its obtaining insurance coverage for tortious acts in
1550	excess of the $100,000 or $200,000 waiver provided above.  The
1551	limitations of liability set forth in this subsection shall
1552	apply to the state and its agencies and subdivisions whether or
1553	not the state or its agencies or subdivisions possessed
1554	sovereign immunity before July 1, 1974.
1555	(c)  In any action for medical negligence within a
1556	certified patient safety facility that is covered by sovereign
1557	immunity, given that the licensed health care facility bears
1558	sole and exclusive liability for acts of medical negligence
1559	pursuant to the Enterprise Act for Patient Protection and
1560	Provider Liability, inclusive of ss. 766.401-766.409, neither
1561	the state or its agencies or subdivisions are liable to pay a
1562	claim or a judgment by any one person which exceeds the sum of
1563	$150,000 or any claim or judgment, or portions thereof, which,
1564	when totaled with all other claims or judgments paid by the
1565	state or its agencies or subdivisions arising out of the same
1566	incident or occurrence, exceeds the sum of $300,000. However, a
1567	judgment may be claimed and rendered in excess of these amounts
1568	and may be settled and paid up to $150,000 or $300,000, as the
1569	case may be. That portion of the judgment which exceeds these
1570	amounts may be reported to the Legislature, but may be paid in
1571	part or in whole only by further act of the Legislature.
1572	Notwithstanding the limited waiver of sovereign immunity
1573	provided in this paragraph, the state or an agency or
1574	subdivision thereof may agree, within the limits of insurance
1575	coverage provided, to settle a claim made or a judgment rendered
1576	against it without further action by the Legislature, but the
1577	state or agency or subdivision thereof does not waive any
1578	defense of sovereign immunity or increase limits of its
1579	liability as a result of its obtaining insurance coverage for
1580	tortious acts in excess of the $150,000 waiver or the $300,000
1581	waiver provided in this paragraph. The limitations of liability
1582	set forth in this paragraph apply to the state and its agencies
1583	and subdivisions whether or not the state or its agencies or
1584	subdivisions possessed sovereign immunity before July 1, 1974.
1585	(12)(a)  A health care practitioner, as defined in s.
1586	456.001(4), who has contractually agreed to act as an agent of a
1587	state university board of trustees to provide medical services
1588	to a student athlete for participation in or as a result of
1589	intercollegiate athletics, to include team practices, training,
1590	and competitions, is shall be considered an agent of the
1591	respective state university board of trustees, for the purposes
1592	of this section, while acting within the scope of and pursuant
1593	to guidelines established in that contract. The contracts shall
1594	provide for the indemnification of the state by the agent for
1595	any liabilities incurred up to the limits set out in this
1596	chapter.
1597	(b)  This subsection shall not be construed as designating
1598	persons providing contracted health care services to athletes as
1599	employees or agents of a state university board of trustees for
1600	the purposes of chapter 440.
1601	(c)1.  For purposes of this subsection only, the terms
1602	"certified patient safety facility," "medical staff," and
1603	"medical negligence" have the same meanings as provided in s.
1604	766.401.
1605	2.  A certified patient safety facility, wherein a minimum
1606	of 50 percent of the members of the medical staff consist of
1607	physicians are employees or agents of a state university, is an
1608	agent of the respective state university board of trustees for
1609	purposes of this section to the extent that the licensed
1610	facility, in accordance with an enterprise plan for patient
1611	protection and provider liability, inclusive of ss. 766.401-
1612	766.409, approved by the Agency for Health Care Administration,
1613	is solely and exclusively liable for acts of medical negligence
1614	of physicians providing health care services within the licensed
1615	facility. Subject to the acceptance of the Florida Board of
1616	Governors and a state university board of trustees, a licensed
1617	facility as herein described may secure the limits of liability
1618	protection described in paragraph (c) from a self insurance
1619	program created pursuant to s. 1004.24.
1620	Section 21.  If any provision of this act or its
1621	application to any person or circumstance is held invalid, the
1622	invalidity does not affect other provisions or applications of
1623	the act which can be given effect without the invalid provision
1624	or application, and to this end, the provisions of this act are
1625	severable.
1626	Section 22.  If a conflict between any provision of this
1627	act and s. 17.505, s. 456.052, s. 456.053, s. 456.054, s.
1628	458.331, or s. 459.015, the provisions of this act shall govern.
1629	The provisions of this act should be broadly construed in
1630	furtherance of the overriding legislative intent to facilitate
1631	innovative approaches for patient protection and provider
1632	liability in eligible hospitals.
1633	Section 23.  It is the intention of the Legislature that
1634	the provisions of this act are self-executing.
1635	Section 24.  This act shall take effect upon becoming a
1636	law.

CODING: Words stricken are deletions; words underlined are additions.