HB 1621

CS

CHAMBER ACTION

1	The Health Care Regulation Committee recommends the following:
2
3	Council/Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to medical malpractice insurance; creating
7	the Enterprise Act for Patient Protection and Provider
8	Liability; providing legislative findings; amending s.
9	395.0197, F.S., relating to internal risk management
10	programs; conforming provisions to changes made by the
11	act; amending s. 458.320, F.S.; exempting certain
12	physicians who perform surgery in certain patient safety
13	facilities from the requirement to establish financial
14	responsibility; requiring a licensed physician who is
15	covered for medical negligence claims by a hospital that
16	assumes liability under the act to prominently post notice
17	or provide a written statement to patients; requiring a
18	licensed physician who meets certain requirements for
19	payment or settlement of a medical malpractice claim and
20	who is covered for medical negligence claims by a hospital
21	that assumes liability under the act to prominently post
22	notice or provide a written statement to patients;
23	amending s. 459.0085, F.S.; exempting certain osteopathic
24	physicians who perform surgery in certain patient safety
25	facilities from the requirement to establish financial
26	responsibility; requiring a licensed osteopathic physician
27	who is covered for medical negligence claims by a hospital
28	that assumes liability under the act to prominently post
29	notice or provide a written statement to patients;
30	requiring a licensee of osteopathic medicine who meets
31	certain requirements for payment or settlement of a
32	medical malpractice claim and who is covered for medical
33	negligence claims by a hospital that assumes liability
34	under the act to prominently post notice or provide a
35	written statement to patients; creating s. 627.41485,
36	F.S.; authorizing insurers to offer liability insurance
37	coverage to physicians which has an exclusion for certain
38	acts of medical negligence under certain conditions;
39	authorizing the Department of Financial Services to adopt
40	rules; amending s. 766.316, F.S.; requiring hospitals that
41	assume liability for affected physicians under the act to
42	provide notice to obstetrical patients regarding the
43	limited no-fault alternative to birth-related neurological
44	injuries; amending s. 766.110, F.S.; requiring hospitals
45	that assume liability for acts of medical negligence under
46	the act to carry insurance; requiring the hospital's
47	policy regarding medical liability insurance to satisfy
48	certain statutory financial responsibility requirements;
49	authorizing an insurer who is authorized to write casualty
50	insurance to write such coverage; authorizing certain
51	hospitals to indemnify certain medical staff for legal
52	liability of loss, damages, or expenses arising from
53	medical negligence within hospital premises; requiring a
54	hospital to acquire a policy of professional liability
55	insurance or a fund for malpractice coverage; requiring an
56	annual certified financial statement to the Agency for
57	Health Care Administration; authorizing certain hospitals
58	to charge physicians a fee for malpractice coverage;
59	preserving a hospital's ability to indemnify certain
60	medical staff members; creating s. 766.401, F.S.;
61	providing definitions; creating s. 766.402, F.S.;
62	authorizing an eligible hospital to petition the Agency
63	for Health Care Administration to enter an order
64	certifying the hospital as a patient safety facility;
65	providing requirements for certification as a patient
66	safety facility; creating s. 766.403, F.S.; providing
67	requirements for a hospital to demonstrate that it is
68	engaged in a common enterprise for the care and treatment
69	of patients; specifying required patient safety measures;
70	prohibiting a report or document generated under the act
71	from being admissible or discoverable as evidence;
72	creating s. 766.404, F.S.; authorizing the agency to enter
73	an order certifying a hospital as a patient safety
74	facility and providing that the hospital bears liability
75	for acts of medical negligence for its health care
76	providers or an agent of the hospital; providing that
77	certain persons or entities are not liable for medically
78	negligent acts occurring in a certified patient safety
79	facility; requiring that an affected practitioner
80	prominently post notice regarding exemption from personal
81	liability; requiring an affected physician who is covered
82	by an enterprise plan in a licensed facility that receives
83	sovereign immunity to prominently post notice regarding
84	exemption from personal liability; providing that an
85	agency order certifying approval of an enterprise plan is
86	evidence of a hospital's compliance with applicable
87	patient safety requirements; providing circumstances in
88	which notice is not required; providing that the order
89	certifying approval of an enterprise plan applies
90	prospectively to causes of action for medical negligence;
91	authorizing the agency to conduct onsite examinations of a
92	licensed facility; providing circumstances under which the
93	agency may revoke its order certifying approval of an
94	enterprise plan; providing that an employee or agent of a
95	certified patient safety facility may not be joined as a
96	defendant in an action for medical negligence; requiring
97	an affected practitioner to cooperate in good faith in an
98	investigation of a claim for medical malpractice;
99	providing a cause of action for failure of a physician to
100	act in good faith; providing that strict liability or
101	liability without fault is not imposed for medical
102	incidents that occur in the affected facility; providing
103	requirements that a claimant must prove to demonstrate
104	medical negligence by an employee, agent, or medical staff
105	of a licensed facility; providing that the act does not
106	create an independent cause of action or waive sovereign
107	immunity; creating s. 766.405, F.S.; requiring an eligible
108	hospital to execute an enterprise plan; requiring certain
109	conditions to be contained within an enterprise plan;
110	creating s. 766.406, F.S.; requiring a certified patient
111	safety facility to report medical incidents occurring on
112	its premises and adverse findings of medical negligence to
113	the Department of Health; requiring certified patient
114	safety facilities to perform certain peer review
115	functions; creating s. 766.407, F.S.; providing that an
116	enterprise plan may provide clinical privileges to certain
117	persons; requiring certain organizations to share in the
118	cost of omnibus medical liability insurance premiums
119	subject to certain conditions; authorizing a licensed
120	facility to impose a reasonable assessment against an
121	affected practitioner who commits medical negligence;
122	providing for the revocation of clinical privileges for
123	failure to pay the assessment; exempting certain employees
124	and agents from such assessments; creating s. 766.408,
125	F.S.; requiring a certified patient safety facility to
126	submit an annual report to the agency and the Legislature;
127	providing requirements for the annual report; providing
128	that the annual report may include certain information
129	from the Office of Insurance Regulation within the
130	Department of Financial Services; providing that the
131	annual report is subject to public records requirements,
132	but is not admissible as evidence in a legal proceeding;
133	creating s. 766.409, F.S.; authorizing certain teaching
134	hospitals and eligible hospitals to petition the agency
135	for certification; providing for limitations on damages
136	for eligible hospitals that are certified for compliance
137	with certain patient safety measures; authorizing the
138	agency to conduct onsite examinations of certified
139	eligible hospitals; authorizing the agency to revoke its
140	order certifying approval of an enterprise plan; providing
141	that an agency order certifying approval of an enterprise
142	plan is evidence of a hospital's compliance with
143	applicable patient safety requirements; providing that
144	evidence of noncompliance is inadmissible in any action
145	for medical malpractice; providing that entry of the
146	agency's order does not impose enterprise liability on the
147	licensed facility for acts or omissions of medical
148	negligence; providing that a hospital may not be approved
149	for certification for both enterprise liability and
150	limitations on damages; creating s. 766.410, F.S.;
151	providing rulemaking authority; amending s. 768.28, F.S.;
152	providing limitations on payment of a claim or judgment
153	for an action for medical negligence within a certified
154	patient safety facility that is covered by sovereign
155	immunity; providing definitions; providing that a
156	certified patient safety facility is an agent of a state
157	university board of trustees to the extent that the
158	licensed facility is solely liable for acts of medical
159	negligence of physicians providing health care services
160	within the licensed facility; specifying that certain
161	certified patient safety facilities are agents of a state
162	university board of trustees under certain circumstances;
163	authorizing licensed facilities to secure limits of
164	liability protection from certain self-insurance programs;
165	providing requirements for commencing an action for
166	certain medical negligence; providing procedures;
167	providing limitations; providing for severability;
168	providing for broad statutory view of the act; providing
169	for self-execution of the act; providing an effective
170	date.
171
172	Be It Enacted by the Legislature of the State of Florida:
173
174	Section 1.  Popular name.--This act may be cited as the
175	"Enterprise Act for Patient Protection and Provider Liability."
176	Section 2.  Legislative findings.--
177	(1)  The Legislature finds that this state is in the midst
178	of a prolonged medical malpractice insurance crisis that has
179	serious adverse effects on patients, practitioners, licensed
180	healthcare facilities, and all residents of this state.
181	(2)  The Legislature finds that hospitals are central
182	components of the modern health care delivery system.
183	(3)  The Legislature finds that many of the most serious
184	incidents of medical negligence occur in hospitals, where the
185	most seriously ill patients are treated, and where surgical
186	procedures are performed.
187	(4)  The Legislature finds that modern hospitals are
188	complex organizations, that medical care and treatment in
189	hospitals is a complex process, and that, increasingly, medical
190	care and treatment in hospitals is a common enterprise involving
191	an array of responsible employees, agents, and other persons,
192	such as physicians, who are authorized to exercise clinical
193	privileges within the premises.
194	(5)  The Legislature finds that an increasing number of
195	medical incidents in hospitals involve a combination of acts and
196	omissions by employees, agents, and other persons, such as
197	physicians, who are authorized to exercise clinical privileges
198	within the premises.
199	(6)  The Legislature finds that the medical malpractice
200	insurance crisis in this state can be alleviated by the adoption
201	of innovative approaches for patient protection in hospitals
202	which can lead to a reduction in medical errors.
203	(7)  The Legislature finds statutory incentives are
204	necessary to facilitate innovative approaches for patient
205	protection in hospitals.
206	(8)  The Legislature finds that an enterprise approach to
207	patient protection and provider liability in hospitals will lead
208	to a reduction in the frequency and severity of incidents of
209	medical malpractice in hospitals.
210	(9)  The Legislature finds that a reduction in the
211	frequency and severity of incidents of medical malpractice in
212	hospitals will reduce attorney's fees and other expenses
213	inherent in the medical liability system.
214	(10)  The Legislature finds that making high-quality health
215	care available to the residents of this state is an overwhelming
216	public necessity.
217	(11)  The Legislature finds that medical education in this
218	state is an overwhelming public necessity.
219	(12)  The Legislature finds that statutory teaching
220	hospitals and hospitals owned by and operated by universities
221	that maintain accredited medical schools are essential for high-
222	quality medical care and medical education in this state.
223	(13)  The Legislature finds that the critical mission of
224	statutory teaching hospitals and hospitals owned and operated by
225	universities that maintain accredited medical schools is
226	severely undermined by the ongoing medical malpractice crisis.
227	(14)  The Legislature finds that statutory teaching
228	hospitals and hospitals owned and operated by universities that
229	maintain accredited medical schools are appropriate health care
230	facilities for the implementation of innovative approaches to
231	patient protection and provider liability.
232	(15)  The Legislature finds an overwhelming public
233	necessity to impose reasonable limitations on actions for
234	medical malpractice against statutory teaching hospitals and
235	hospitals that are owned and operated by universities that
236	maintain accredited medical schools, in furtherance of the
237	critical public interest in promoting access to high-quality
238	medical care, medical education, and innovative approaches to
239	patient protection.
240	(16)  The Legislature finds an overwhelming public
241	necessity for statutory teaching hospitals and hospitals owned
242	and operated by universities that maintain accredited medical
243	schools to implement innovative measures for patient protection
244	and provider liability in order to generate empirical data for
245	state policymakers on the effectiveness of these measures. Such
246	data may lead to broader application of these measures in a
247	wider array of hospitals after a reasonable period of evaluation
248	and review.
249	(17)  The Legislature finds an overwhelming public
250	necessity to promote the academic mission of statutory teaching
251	hospitals and hospitals owned and operated by universities that
252	maintain accredited medical schools. Furthermore, the
253	Legislature finds that the academic mission of these medical
254	facilities is materially enhanced by statutory authority for the
255	implementation of innovative approaches to patient protection
256	and provider liability. Such approaches can be carefully studied
257	and learned by medical students, medical school faculty, and
258	affiliated physicians in appropriate clinical settings, thereby
259	enlarging the body of knowledge concerning patient protection
260	and provider liability which is essential for advancement of
261	patient safety, reduction of expenses inherent in the medical
262	liability system, and curtailment of the medical malpractice
263	insurance crisis in this state.
264	Section 3.  Subsection (3) of section 395.0197, Florida
265	Statutes, is amended to read:
266	395.0197  Internal risk management program.--
267	(3)  In addition to the programs mandated by this section,
268	other innovative approaches intended to reduce the frequency and
269	severity of medical malpractice and patient injury claims shall
270	be encouraged and their implementation and operation
271	facilitated. Such additional approaches may include extending
272	internal risk management programs to health care providers'
273	offices and the assuming of provider liability by a licensed
274	health care facility for acts or omissions occurring within the
275	licensed facility pursuant to the Enterprise Act for Patient
276	Protection and Provider Liability, inclusive of ss. 766.401-
277	766.409. Each licensed facility shall annually report to the
278	agency and the Department of Health the name and judgments
279	entered against each health care practitioner for which it
280	assumes liability. The agency and Department of Health, in their
281	respective annual reports, shall include statistics that report
282	the number of licensed facilities that assume such liability and
283	the number of health care practitioners, by profession, for whom
284	they assume liability.
285	Section 4.  Subsection (2) and paragraphs (f) and (g) of
286	subsection (5) of section 458.320, Florida Statutes, are amended
287	to read:
288	458.320  Financial responsibility.--
289	(2)  Physicians who perform surgery in an ambulatory
290	surgical center licensed under chapter 395 and, as a continuing
291	condition of hospital staff privileges, physicians who have
292	staff privileges must also establish financial responsibility by
293	one of the following methods:
294	(a)  Establishing and maintaining an escrow account
295	consisting of cash or assets eligible for deposit in accordance
296	with s. 625.52 in the per claim amounts specified in paragraph
297	(b). The required escrow amount set forth in this paragraph may
298	not be used for litigation costs or attorney's fees for the
299	defense of any medical malpractice claim.
300	(b)  Obtaining and maintaining professional liability
301	coverage in an amount not less than $250,000 per claim, with a
302	minimum annual aggregate of not less than $750,000 from an
303	authorized insurer as defined under s. 624.09, from a surplus
304	lines insurer as defined under s. 626.914(2), from a risk
305	retention group as defined under s. 627.942, from the Joint
306	Underwriting Association established under s. 627.351(4),
307	through a plan of self-insurance as provided in s. 627.357, or
308	through a plan of self-insurance which meets the conditions
309	specified for satisfying financial responsibility in s. 766.110.
310	The required coverage amount set forth in this paragraph may not
311	be used for litigation costs or attorney's fees for the defense
312	of any medical malpractice claim.
313	(c)  Obtaining and maintaining an unexpired irrevocable
314	letter of credit, established pursuant to chapter 675, in an
315	amount not less than $250,000 per claim, with a minimum
316	aggregate availability of credit of not less than $750,000. The
317	letter of credit must be payable to the physician as beneficiary
318	upon presentment of a final judgment indicating liability and
319	awarding damages to be paid by the physician or upon presentment
320	of a settlement agreement signed by all parties to such
321	agreement when such final judgment or settlement is a result of
322	a claim arising out of the rendering of, or the failure to
323	render, medical care and services. The letter of credit may not
324	be used for litigation costs or attorney's fees for the defense
325	of any medical malpractice claim. The letter of credit must be
326	nonassignable and nontransferable. The letter of credit must be
327	issued by any bank or savings association organized and existing
328	under the laws of this state or any bank or savings association
329	organized under the laws of the United States which has its
330	principal place of business in this state or has a branch office
331	that is authorized under the laws of this state or of the United
332	States to receive deposits in this state.
333
334	This subsection shall be inclusive of the coverage in subsection
335	(1). A physician who only performs surgery or who has only
336	clinical privileges or admitting privileges in one or more
337	certified patient safety facilities, which health care facility
338	or facilities are legally liable for medical negligence of
339	affected practitioners, pursuant to the Enterprise Act for
340	Patient Protection and Provider Liability, inclusive of ss.
341	766.401-766.409, is exempt from the requirements of this
342	subsection.
343	(5)  The requirements of subsections (1), (2), and (3) do
344	not apply to:
345	(f)  Any person holding an active license under this
346	chapter who meets all of the following criteria:
347	1.  The licensee has held an active license to practice in
348	this state or another state or some combination thereof for more
349	than 15 years.
350	2.  The licensee has either retired from the practice of
351	medicine or maintains a part-time practice of no more than 1,000
352	patient contact hours per year.
353	3.  The licensee has had no more than two claims for
354	medical malpractice resulting in an indemnity exceeding $25,000
355	within the previous 5-year period.
356	4.  The licensee has not been convicted of, or pled guilty
357	or nolo contendere to, any criminal violation specified in this
358	chapter or the medical practice act of any other state.
359	5.  The licensee has not been subject within the last 10
360	years of practice to license revocation or suspension for any
361	period of time; probation for a period of 3 years or longer; or
362	a fine of $500 or more for a violation of this chapter or the
363	medical practice act of another jurisdiction. The regulatory
364	agency's acceptance of a physician's relinquishment of a
365	license, stipulation, consent order, or other settlement,
366	offered in response to or in anticipation of the filing of
367	administrative charges against the physician's license,
368	constitutes action against the physician's license for the
369	purposes of this paragraph.
370	6.  The licensee has submitted a form supplying necessary
371	information as required by the department and an affidavit
372	affirming compliance with this paragraph.
373	7.  The licensee must submit biennially to the department
374	certification stating compliance with the provisions of this
375	paragraph. The licensee must, upon request, demonstrate to the
376	department information verifying compliance with this paragraph.
377
378	A licensee who meets the requirements of this paragraph must
379	post notice in the form of a sign prominently displayed in the
380	reception area and clearly noticeable by all patients or provide
381	a written statement to any person to whom medical services are
382	being provided. The sign or statement must read as follows:
383	"Under Florida law, physicians are generally required to carry
384	medical malpractice insurance or otherwise demonstrate financial
385	responsibility to cover potential claims for medical
386	malpractice. However, certain part-time physicians who meet
387	state requirements are exempt from the financial responsibility
388	law. YOUR DOCTOR MEETS THESE REQUIREMENTS AND HAS DECIDED NOT TO
389	CARRY MEDICAL MALPRACTICE INSURANCE. This notice is provided
390	pursuant to Florida law." In addition, a licensee who is covered
391	for claims of medical negligence arising from care and treatment
392	of patients in a hospital that assumes sole and exclusive
393	liability for all such claims pursuant to the Enterprise Act for
394	Patient Protection and Provider Liability, inclusive of ss.
395	766.401-766.409, shall post notice in the form of a sign
396	prominently displayed in the reception area and clearly
397	noticeable by all patients or provide a written statement to any
398	person for whom the physician may provide medical care and
399	treatment in any such hospital in accordance with the
400	requirements of s. 766.404.
401	(g)  Any person holding an active license under this
402	chapter who agrees to meet all of the following criteria:
403	1.  Upon the entry of an adverse final judgment arising
404	from a medical malpractice arbitration award, from a claim of
405	medical malpractice either in contract or tort, or from
406	noncompliance with the terms of a settlement agreement arising
407	from a claim of medical malpractice either in contract or tort,
408	the licensee shall pay the judgment creditor the lesser of the
409	entire amount of the judgment with all accrued interest or
410	either $100,000, if the physician is licensed pursuant to this
411	chapter but does not maintain hospital staff privileges, or
412	$250,000, if the physician is licensed pursuant to this chapter
413	and maintains hospital staff privileges, within 60 days after
414	the date such judgment became final and subject to execution,
415	unless otherwise mutually agreed to in writing by the parties.
416	Such adverse final judgment shall include any cross-claim,
417	counterclaim, or claim for indemnity or contribution arising
418	from the claim of medical malpractice. Upon notification of the
419	existence of an unsatisfied judgment or payment pursuant to this
420	subparagraph, the department shall notify the licensee by
421	certified mail that he or she shall be subject to disciplinary
422	action unless, within 30 days from the date of mailing, he or
423	she either:
424	a.  Shows proof that the unsatisfied judgment has been paid
425	in the amount specified in this subparagraph; or
426	b.  Furnishes the department with a copy of a timely filed
427	notice of appeal and either:
428	(I)  A copy of a supersedeas bond properly posted in the
429	amount required by law; or
430	(II)  An order from a court of competent jurisdiction
431	staying execution on the final judgment pending disposition of
432	the appeal.
433	2.  The Department of Health shall issue an emergency order
434	suspending the license of any licensee who, after 30 days
435	following receipt of a notice from the Department of Health, has
436	failed to: satisfy a medical malpractice claim against him or
437	her; furnish the Department of Health a copy of a timely filed
438	notice of appeal; furnish the Department of Health a copy of a
439	supersedeas bond properly posted in the amount required by law;
440	or furnish the Department of Health an order from a court of
441	competent jurisdiction staying execution on the final judgment
442	pending disposition of the appeal.
443	3.  Upon the next meeting of the probable cause panel of
444	the board following 30 days after the date of mailing the notice
445	of disciplinary action to the licensee, the panel shall make a
446	determination of whether probable cause exists to take
447	disciplinary action against the licensee pursuant to
448	subparagraph 1.
449	4.  If the board determines that the factual requirements
450	of subparagraph 1. are met, it shall take disciplinary action as
451	it deems appropriate against the licensee. Such disciplinary
452	action shall include, at a minimum, probation of the license
453	with the restriction that the licensee must make payments to the
454	judgment creditor on a schedule determined by the board to be
455	reasonable and within the financial capability of the physician.
456	Notwithstanding any other disciplinary penalty imposed, the
457	disciplinary penalty may include suspension of the license for a
458	period not to exceed 5 years. In the event that an agreement to
459	satisfy a judgment has been met, the board shall remove any
460	restriction on the license.
461	5.  The licensee has completed a form supplying necessary
462	information as required by the department.
463
464	A licensee who meets the requirements of this paragraph shall be
465	required either to post notice in the form of a sign prominently
466	displayed in the reception area and clearly noticeable by all
467	patients or to provide a written statement to any person to whom
468	medical services are being provided. Such sign or statement
469	shall state: "Under Florida law, physicians are generally
470	required to carry medical malpractice insurance or otherwise
471	demonstrate financial responsibility to cover potential claims
472	for medical malpractice. YOUR DOCTOR HAS DECIDED NOT TO CARRY
473	MEDICAL MALPRACTICE INSURANCE. This is permitted under Florida
474	law subject to certain conditions. Florida law imposes penalties
475	against noninsured physicians who fail to satisfy adverse
476	judgments arising from claims of medical malpractice. This
477	notice is provided pursuant to Florida law." In addition, a
478	licensee who meets the requirements of this paragraph and who is
479	covered for claims of medical negligence arising from care and
480	treatment of patients in a hospital that assumes sole and
481	exclusive liability for all such claims pursuant to the
482	Enterprise Act for Patient Protection and Provider Liability,
483	inclusive of ss. 766.401-766.409, shall post notice in the form
484	of a sign prominently displayed in the reception area and
485	clearly noticeable by all patients or provide a written
486	statement to any person for whom the physician may provide
487	medical care and treatment in any such hospital. The sign or
488	statement must adhere to the requirements of s. 766.404.
489	Section 5.  Subsection (2) and paragraphs (f) and (g) of
490	subsection (5) of section 459.0085, Florida Statutes, are
491	amended to read:
492	459.0085  Financial responsibility.--
493	(2)  Osteopathic physicians who perform surgery in an
494	ambulatory surgical center licensed under chapter 395 and, as a
495	continuing condition of hospital staff privileges, osteopathic
496	physicians who have staff privileges must also establish
497	financial responsibility by one of the following methods:
498	(a)  Establishing and maintaining an escrow account
499	consisting of cash or assets eligible for deposit in accordance
500	with s. 625.52 in the per-claim amounts specified in paragraph
501	(b). The required escrow amount set forth in this paragraph may
502	not be used for litigation costs or attorney's fees for the
503	defense of any medical malpractice claim.
504	(b)  Obtaining and maintaining professional liability
505	coverage in an amount not less than $250,000 per claim, with a
506	minimum annual aggregate of not less than $750,000 from an
507	authorized insurer as defined under s. 624.09, from a surplus
508	lines insurer as defined under s. 626.914(2), from a risk
509	retention group as defined under s. 627.942, from the Joint
510	Underwriting Association established under s. 627.351(4),
511	through a plan of self-insurance as provided in s. 627.357, or
512	through a plan of self-insurance that meets the conditions
513	specified for satisfying financial responsibility in s. 766.110.
514	The required coverage amount set forth in this paragraph may not
515	be used for litigation costs or attorney's fees for the defense
516	of any medical malpractice claim.
517	(c)  Obtaining and maintaining an unexpired, irrevocable
518	letter of credit, established pursuant to chapter 675, in an
519	amount not less than $250,000 per claim, with a minimum
520	aggregate availability of credit of not less than $750,000. The
521	letter of credit must be payable to the osteopathic physician as
522	beneficiary upon presentment of a final judgment indicating
523	liability and awarding damages to be paid by the osteopathic
524	physician or upon presentment of a settlement agreement signed
525	by all parties to such agreement when such final judgment or
526	settlement is a result of a claim arising out of the rendering
527	of, or the failure to render, medical care and services. The
528	letter of credit may not be used for litigation costs or
529	attorney's fees for the defense of any medical malpractice
530	claim. The letter of credit must be nonassignable and
531	nontransferable. The letter of credit must be issued by any bank
532	or savings association organized and existing under the laws of
533	this state or any bank or savings association organized under
534	the laws of the United States which has its principal place of
535	business in this state or has a branch office that is authorized
536	under the laws of this state or of the United States to receive
537	deposits in this state.
538
539	This subsection shall be inclusive of the coverage in subsection
540	(1). An osteopathic physician who only performs surgery or who
541	has only clinical privileges or admitting privileges in one or
542	more certified patient safety facilities, which health care
543	facility or facilities are legally liable for medical negligence
544	of affected practitioners, pursuant to the Enterprise Act for
545	Patient Protection and Provider Liability, inclusive of ss.
546	766.401-766.409, is exempt from the requirements of this
547	subsection.
548	(5)  The requirements of subsections (1), (2), and (3) do
549	not apply to:
550	(f)  Any person holding an active license under this
551	chapter who meets all of the following criteria:
552	1.  The licensee has held an active license to practice in
553	this state or another state or some combination thereof for more
554	than 15 years.
555	2.  The licensee has either retired from the practice of
556	osteopathic medicine or maintains a part-time practice of
557	osteopathic medicine of no more than 1,000 patient contact hours
558	per year.
559	3.  The licensee has had no more than two claims for
560	medical malpractice resulting in an indemnity exceeding $25,000
561	within the previous 5-year period.
562	4.  The licensee has not been convicted of, or pled guilty
563	or nolo contendere to, any criminal violation specified in this
564	chapter or the practice act of any other state.
565	5.  The licensee has not been subject within the last 10
566	years of practice to license revocation or suspension for any
567	period of time, probation for a period of 3 years or longer, or
568	a fine of $500 or more for a violation of this chapter or the
569	medical practice act of another jurisdiction. The regulatory
570	agency's acceptance of an osteopathic physician's relinquishment
571	of a license, stipulation, consent order, or other settlement,
572	offered in response to or in anticipation of the filing of
573	administrative charges against the osteopathic physician's
574	license, constitutes action against the physician's license for
575	the purposes of this paragraph.
576	6.  The licensee has submitted a form supplying necessary
577	information as required by the department and an affidavit
578	affirming compliance with this paragraph.
579	7.  The licensee must submit biennially to the department a
580	certification stating compliance with this paragraph. The
581	licensee must, upon request, demonstrate to the department
582	information verifying compliance with this paragraph.
583
584	A licensee who meets the requirements of this paragraph must
585	post notice in the form of a sign prominently displayed in the
586	reception area and clearly noticeable by all patients or provide
587	a written statement to any person to whom medical services are
588	being provided. The sign or statement must read as follows:
589	"Under Florida law, osteopathic physicians are generally
590	required to carry medical malpractice insurance or otherwise
591	demonstrate financial responsibility to cover potential claims
592	for medical malpractice. However, certain part-time osteopathic
593	physicians who meet state requirements are exempt from the
594	financial responsibility law. YOUR OSTEOPATHIC PHYSICIAN MEETS
595	THESE REQUIREMENTS AND HAS DECIDED NOT TO CARRY MEDICAL
596	MALPRACTICE INSURANCE. This notice is provided pursuant to
597	Florida law." In addition, a licensee who is covered for claims
598	of medical negligence arising from care and treatment of
599	patients in a hospital that assumes sole and exclusive liability
600	for all such claims pursuant to the Enterprise Act for Patient
601	Protection and Provider Liability, inclusive of ss. 766.401-
602	766.409, shall post notice in the form of a sign prominently
603	displayed in the reception area and clearly noticeable by all
604	patients or provide a written statement to any person for whom
605	the osteopathic physician may provide medical care and treatment
606	in any such hospital in accordance with the requirements of s.
607	766.404.
608	(g)  Any person holding an active license under this
609	chapter who agrees to meet all of the following criteria.
610	1.  Upon the entry of an adverse final judgment arising
611	from a medical malpractice arbitration award, from a claim of
612	medical malpractice either in contract or tort, or from
613	noncompliance with the terms of a settlement agreement arising
614	from a claim of medical malpractice either in contract or tort,
615	the licensee shall pay the judgment creditor the lesser of the
616	entire amount of the judgment with all accrued interest or
617	either $100,000, if the osteopathic physician is licensed
618	pursuant to this chapter but does not maintain hospital staff
619	privileges, or $250,000, if the osteopathic physician is
620	licensed pursuant to this chapter and maintains hospital staff
621	privileges, within 60 days after the date such judgment became
622	final and subject to execution, unless otherwise mutually agreed
623	to in writing by the parties. Such adverse final judgment shall
624	include any cross-claim, counterclaim, or claim for indemnity or
625	contribution arising from the claim of medical malpractice. Upon
626	notification of the existence of an unsatisfied judgment or
627	payment pursuant to this subparagraph, the department shall
628	notify the licensee by certified mail that he or she shall be
629	subject to disciplinary action unless, within 30 days from the
630	date of mailing, the licensee either:
631	a.  Shows proof that the unsatisfied judgment has been paid
632	in the amount specified in this subparagraph; or
633	b.  Furnishes the department with a copy of a timely filed
634	notice of appeal and either:
635	(I)  A copy of a supersedeas bond properly posted in the
636	amount required by law; or
637	(II)  An order from a court of competent jurisdiction
638	staying execution on the final judgment, pending disposition of
639	the appeal.
640	2.  The Department of Health shall issue an emergency order
641	suspending the license of any licensee who, after 30 days
642	following receipt of a notice from the Department of Health, has
643	failed to: satisfy a medical malpractice claim against him or
644	her; furnish the Department of Health a copy of a timely filed
645	notice of appeal; furnish the Department of Health a copy of a
646	supersedeas bond properly posted in the amount required by law;
647	or furnish the Department of Health an order from a court of
648	competent jurisdiction staying execution on the final judgment
649	pending disposition of the appeal.
650	3.  Upon the next meeting of the probable cause panel of
651	the board following 30 days after the date of mailing the notice
652	of disciplinary action to the licensee, the panel shall make a
653	determination of whether probable cause exists to take
654	disciplinary action against the licensee pursuant to
655	subparagraph 1.
656	4.  If the board determines that the factual requirements
657	of subparagraph 1. are met, it shall take disciplinary action as
658	it deems appropriate against the licensee. Such disciplinary
659	action shall include, at a minimum, probation of the license
660	with the restriction that the licensee must make payments to the
661	judgment creditor on a schedule determined by the board to be
662	reasonable and within the financial capability of the
663	osteopathic physician. Notwithstanding any other disciplinary
664	penalty imposed, the disciplinary penalty may include suspension
665	of the license for a period not to exceed 5 years. In the event
666	that an agreement to satisfy a judgment has been met, the board
667	shall remove any restriction on the license.
668	5.  The licensee has completed a form supplying necessary
669	information as required by the department.
670
671	A licensee who meets the requirements of this paragraph shall be
672	required either to post notice in the form of a sign prominently
673	displayed in the reception area and clearly noticeable by all
674	patients or to provide a written statement to any person to whom
675	medical services are being provided. Such sign or statement
676	shall state: "Under Florida law, osteopathic physicians are
677	generally required to carry medical malpractice insurance or
678	otherwise demonstrate financial responsibility to cover
679	potential claims for medical malpractice. YOUR OSTEOPATHIC
680	PHYSICIAN HAS DECIDED NOT TO CARRY MEDICAL MALPRACTICE
681	INSURANCE. This is permitted under Florida law subject to
682	certain conditions. Florida law imposes strict penalties against
683	noninsured osteopathic physicians who fail to satisfy adverse
684	judgments arising from claims of medical malpractice. This
685	notice is provided pursuant to Florida law." In addition, a
686	licensee who meets the requirements of this paragraph and who is
687	covered for claims of medical negligence arising from care and
688	treatment of patients in a hospital that assumes sole and
689	exclusive liability for all such claims pursuant to an
690	enterprise plan for patient protection and provider liability
691	under ss. 766.401-766.409, shall post notice in the form of a
692	sign prominently displayed in the reception area and clearly
693	noticeable by all patients or provide a written statement to any
694	person for whom the osteopathic physician may provide medical
695	care and treatment in any such hospital. The sign or statement
696	must adhere to the requirements of s. 766.404.
697	Section 6.  Section 627.41485, Florida Statutes, is created
698	to read:
699	627.41485  Medical malpractice insurers; optional coverage
700	exclusion for insureds who are covered by an enterprise plan for
701	patient protection and provider liability.--
702	(1)  An insurer issuing policies of professional liability
703	coverage for claims arising out of the rendering of, or the
704	failure to render, medical care or services may make available
705	to physicians licensed under chapter 458 and to osteopathic
706	physicians licensed under chapter 459 coverage having an
707	appropriate exclusion for acts of medical negligence occurring
708	within:
709	(a)  A certified patient safety facility that bears sole
710	and exclusive liability for acts of medical negligence pursuant
711	to the Enterprise Act for Patient Protection and Provider
712	Liability, inclusive of ss. 766.401-766.409, subject to the
713	usual underwriting standards; or
714	(b)  A statutory teaching hospital that has agreed to
715	indemnify the physician or osteopathic physician for legal
716	liability pursuant to s. 766.110(2)(c), subject to the usual
717	underwriting standards.
718	(2)  The Department of Financial Services may adopt rules
719	to administer this section.
720	Section 7.  Section 766.316, Florida Statutes, is amended
721	to read:
722	766.316  Notice to obstetrical patients of participation in
723	the plan.--Each hospital with a participating physician on its
724	staff, each hospital that assumes liability for affected
725	physicians pursuant to the Enterprise Act for Patient Protection
726	and Provider Liability, inclusive of ss. 766.401-766.409, and
727	each participating physician, other than residents, assistant
728	residents, and interns deemed to be participating physicians
729	under s. 766.314(4)(c), under the Florida Birth-Related
730	Neurological Injury Compensation Plan shall provide notice to
731	the obstetrical patients as to the limited no-fault alternative
732	for birth-related neurological injuries. Such notice shall be
733	provided on forms furnished by the association and shall include
734	a clear and concise explanation of a patient's rights and
735	limitations under the plan. The hospital or the participating
736	physician may elect to have the patient sign a form
737	acknowledging receipt of the notice form. Signature of the
738	patient acknowledging receipt of the notice form raises a
739	rebuttable presumption that the notice requirements of this
740	section have been met. Notice need not be given to a patient
741	when the patient has an emergency medical condition as defined
742	in s. 395.002(9)(b) or when notice is not practicable.
743	Section 8.  Subsection (2) of section 766.110, Florida
744	Statutes, is amended to read:
745	766.110  Liability of health care facilities.--
746	(2)(a)  Every hospital licensed under chapter 395 may carry
747	liability insurance or adequately insure itself in an amount of
748	not less than $1.5 million per claim, $5 million annual
749	aggregate to cover all medical injuries to patients resulting
750	from negligent acts or omissions on the part of those members of
751	its medical staff who are covered thereby in furtherance of the
752	requirements of ss. 458.320 and 459.0085. Self-insurance
753	coverage extended hereunder to a member of a hospital's medical
754	staff meets the financial responsibility requirements of ss.
755	458.320 and 459.0085 if the physician's coverage limits are not
756	less than the minimum limits established in ss. 458.320 and
757	459.0085 and the hospital is a verified trauma center that has
758	extended self-insurance coverage continuously to members of its
759	medical staff for activities both inside and outside of the
760	hospital. Any insurer authorized to write casualty insurance may
761	make available, but is shall not be required to write, such
762	coverage. The hospital may assess on an equitable and pro rata
763	basis the following professional health care providers for a
764	portion of the total hospital insurance cost for this coverage:
765	physicians licensed under chapter 458, osteopathic physicians
766	licensed under chapter 459, podiatric physicians licensed under
767	chapter 461, dentists licensed under chapter 466, and nurses
768	licensed under part I of chapter 464. The hospital may provide
769	for a deductible amount to be applied against any individual
770	health care provider found liable in a law suit in tort or for
771	breach of contract. The legislative intent in providing for the
772	deductible to be applied to individual health care providers
773	found negligent or in breach of contract is to instill in each
774	individual health care provider the incentive to avoid the risk
775	of injury to the fullest extent and ensure that the citizens of
776	this state receive the highest quality health care obtainable.
777	(b)  Except with regard to hospitals that receive sovereign
778	immunity under s. 768.28, each hospital licensed under chapter
779	395 which assumes sole and exclusive liability for acts of
780	medical negligence by affected providers pursuant to the
781	Enterprise Act for Patient Protection and Provider Liability,
782	inclusive of ss. 766.401-766.409, shall carry liability
783	insurance or adequately insure itself in an amount not less than
784	$2.5 million per claim, $7.5 million annual aggregate to cover
785	all medical injuries to patients resulting from negligent acts
786	or omissions on the part of affected physicians and
787	practitioners who are covered by an enterprise plan for patient
788	protection and provider liability. The hospital's policy of
789	medical liability insurance or self-insurance must satisfy the
790	financial responsibility requirements of ss. 458.320(2) and
791	459.0085(2) for affected providers. Any authorized insurer as
792	defined in s. 626.914(2), risk retention group as defined in s.
793	627.942, or joint underwriting association established under s.
794	627.351(4) that has authority to write casualty insurance may
795	make available, but is not required to write, such coverage.
796	(c)  Notwithstanding any provision in the Insurance Code to
797	the contrary, a statutory teaching hospital, as defined in s.
798	408.07, other than a hospital that receives sovereign immunity
799	under s. 768.28, which complies with the patient safety measures
800	specified in s. 766.403 and all other requirements of s.
801	766.409, including approval by the Agency for Health Care
802	Administration, may agree to indemnify some or all members of
803	its medical staff, including, but not limited to, physicians
804	having clinical privileges who are not employees or agents of
805	the hospital and any organization, association, or group of
806	persons liable for the negligent acts of such physicians,
807	whether incorporated or unincorporated, and some or all medical,
808	nursing, or allied health students affiliated with the hospital,
809	collectively known as covered persons, other than persons exempt
810	from liability due to sovereign immunity under s. 768.28, for
811	legal liability of such covered persons for loss, damages, or
812	expense arising out of medical negligence within the hospital
813	premises, as defined in s. 766.401, thereby providing limited
814	malpractice coverage for such covered persons. Any hospital that
815	agrees to provide malpractice coverage for covered persons under
816	this section shall acquire an appropriate policy of professional
817	liability insurance or establish and maintain a fund from which
818	such malpractice coverage is provided, in accordance with usual
819	underwriting standards. Such insurance or fund may be separate
820	and apart from any insurance or fund maintained by or on behalf
821	of the hospital or combined in a single policy of insurance or a
822	fund maintained by or on behalf of the hospital. Any hospital
823	that provides malpractice coverage to covered persons as defined
824	in this paragraph through a fund providing any such malpractice
825	coverage, shall annually provide a certified financial statement
826	containing actuarial projections as to the soundness of reserves
827	to the Agency for Health Care Administration. The indemnity
828	agreements or malpractice coverage provided by this section
829	shall be in amounts that, at a minimum, meet the financial
830	responsibility requirements of ss. 458.320 and 459.0085 for
831	affected providers. Any such indemnity agreement or malpractice
832	coverage in such amounts satisfies the financial responsibility
833	requirements of ss. 458.320 and 459.0085 for affected providers.
834	Any statutory teaching hospital that agrees to indemnify
835	physicians or other covered persons for medical negligence on
836	the premises pursuant to this section may charge such physicians
837	or other covered persons a reasonable fee for malpractice
838	coverage, notwithstanding any provision in the Insurance Code to
839	the contrary. Such fee shall be based on appropriate actuarial
840	criteria. This paragraph does not constitute a waiver of
841	sovereign immunity under s. 768.28. Nothing in this subsection
842	impairs a hospital's ability to indemnify member of its medical
843	staff to the extent such indemnification is allowed by law.
844	Section 9.  Section 766.401, Florida Statutes, is created
845	to read:
846	766.401  Definitions.--As used in this section and ss.
847	766.402-766.409, the term:
848	(1)  "Affected facility" means a certified patient safety
849	facility.
850	(2)  "Affected patient" means a patient of a certified
851	patient safety facility.
852	(3)  "Affected physician" means a medical staff member who
853	is covered by an enterprise plan for patient protection and
854	provider liability in a certified patient safety facility.
855	(4)  "Affected practitioner" means any person, including a
856	physician, who is credentialed by the eligible hospital to
857	provide health care services who is covered by an enterprise
858	plan for patient protection and provider liability in a
859	certified patient safety facility.
860	(5)  "Agency" means the Agency for Health Care
861	Administration.
862	(6)  "Certified patient safety facility" means any eligible
863	hospital that is solely and exclusively liable for the medical
864	negligence within the licensed facility in accordance with an
865	agency order approving an enterprise plan for patient protection
866	and provider liability, except that for an eligible hospital
867	meeting the requirements of s. 768.28(12)(c)3., such hospital
868	shall be solely and exclusively liable for the medical
869	negligence of affected practitioners who are employees and
870	agents of a state university and the employees and agents of the
871	hospital.
872	(7)  "Clinical privileges" means the privileges granted to
873	a physician or other licensed health care practitioner to render
874	patient care services in a hospital.
875	(8)  "Eligible hospital" or "licensed facility" means:
876	(a)  A statutory teaching hospital as defined by s. 408.07;
877	or
878	(b)  A hospital licensed in accordance with chapter 395
879	which is wholly owned by a university based in this state which
880	maintains an accredited medical school.
881	(9)  "Enterprise plan" means a document adopted by the
882	governing board of an eligible hospital and the executive
883	committee of the medical staff of the eligible hospital, however
884	defined, or the board of trustees of a state university,
885	manifesting concurrence and setting forth certain rights,
886	duties, privileges, obligations, and responsibilities of the
887	health care facility and its medical staff, or its affiliated
888	medical school, in furtherance of seeking and maintaining status
889	as a certified patient safety facility.
890	(10)  "Health care provider" or "provider" means:
891	(a)  An eligible hospital.
892	(b)  A physician or physician assistant licensed under
893	chapter 458.
894	(c)  An osteopathic physician or osteopathic physician
895	assistant licensed under chapter 459.
896	(d)  A registered nurse, nurse midwife, licensed practical
897	nurse, or advanced registered nurse practitioner licensed or
898	registered under part I of chapter 464 or any facility that
899	employs nurses licensed or registered under part I of chapter
900	464 to supply all or part of the care delivered by that
901	facility.
902	(e)  A health care professional association and its
903	employees or a corporate medical group and its employees.
904	(f)  Any other medical facility the primary purpose of
905	which is to deliver human medical diagnostic services or which
906	delivers nonsurgical human medical treatment, including an
907	office maintained by a provider.
908	(g)  A free clinic that delivers only medical diagnostic
909	services or nonsurgical medical treatment free of charge to all
910	low-income recipients.
911	(h)  Any other health care professional, practitioner, or
912	provider, including a student enrolled in an accredited program
913	that prepares the student for licensure as any one of the
914	professionals listed in this subsection.
915
916	The term includes any person, organization, or entity that is
917	vicariously liable under the theory of respondent superior or
918	any other theory of legal liability for medical negligence
919	committed by any licensed professional listed in this
920	subsection. The term also includes any nonprofit corporation
921	qualified as exempt from federal income taxation under s. 501(a)
922	of the Internal Revenue Code, and described in s. 501(c) of the
923	Internal Revenue Code, including any university or medical
924	school that employs licensed professionals listed in this
925	subsection or that delivers health care services provided by
926	licensed professionals listed in this subsection, any federally
927	funded community health center, and any volunteer corporation or
928	volunteer health care provider that delivers health care
929	services.
930	(11)  "Health care practitioner" or "practitioner" means
931	any person, entity, or organization identified in subsection
932	(9), except for a hospital.
933	(12)  "Medical incident" or "adverse incident" has the same
934	meaning as provided in ss. 381.0271, 395.0197, 458.351, and
935	459.026.
936	(13)  "Medical negligence" means medical malpractice,
937	whether grounded in tort or in contract, including statutory
938	claims arising out of any act or omission relating to the
939	rendering or failure to render medical or nursing care. The term
940	does not include intentional acts.
941	(14)  "Medical staff" means a physician licensed under
942	chapter 458 or chapter 459 having clinical privileges and active
943	status in a licensed facility. The term includes any affected
944	physician.
945	(15)  "Person" means any individual, partnership,
946	corporation, association, or governmental unit.
947	(16)  "Premises" means those buildings, beds, and equipment
948	located at the address of the licensed facility and all other
949	buildings, beds, and equipment for the provision of hospital,
950	ambulatory surgical, mobile surgical care, primary care, or
951	comprehensive health care under the dominion and control of the
952	licensee, including offices and locations where the licensed
953	facility provides medical care and treatment to affected
954	patients.
955	(17)  "Statutory teaching hospital" or "teaching hospital"
956	has the same meaning as provided in s. 408.07.
957	(18)  "Within the licensed facility" or "within the
958	premises" means anywhere on the premises of the licensed
959	facility or the premises of any office, clinic, or ancillary
960	facility that is owned or leased or controlled by the licensed
961	facility.
962	Section 10.  Section 766.402, Florida Statutes, is created
963	to read:
964	766.402  Agency approval of enterprise plans for patient
965	protection and provider liability.--
966	(1)  An eligible hospital in conjunction with the executive
967	committee of its medical staff or the board of trustees of a
968	state university, if applicable, that has adopted an enterprise
969	plan may petition the agency to enter an order certifying
970	approval of the hospital as a certified patient safety facility.
971	(2)  In accordance with chapter 120, the agency shall enter
972	an order certifying approval of the certified patient safety
973	facility upon a showing that, in furtherance of an enterprise
974	approach to patient protection and provider liability:
975	(a)  The petitioners have established enterprise-wide
976	safety measures for the care and treatment of patients.
977	(b)  The petitioners satisfy requirements for patient
978	protection measures, as specified in s. 766.403.
979	(c)  The petitioners acknowledge and agree to enterprise
980	liability for medical negligence within the premises, as
981	specified in s. 766.404.
982	(d)  The petitioners have adopted an enterprise plan, as
983	specified in s. 766.405.
984	(e)  The petitioners satisfy requirements for professional
985	accountability of affected practitioners, as specified in s.
986	766.406.
987	(f)  The petitioners satisfy requirements for financial
988	accountability of affected practitioners, as specified in s.
989	766.407.
990	(g)  The petitioners satisfy all other requirements of ss.
991	766.401-766.409.
992	Section 11.  Section 766.403, Florida Statutes, is created
993	to read:
994	766.403  Enterprise-wide patient safety measures.--
995	(1)  In order to satisfy the requirements of s.
996	766.402(2)(a) or s. 766.409, the licensed facility shall:
997	(a)  Have in place a process, either through the facility's
998	patient safety committee or a similar body, for coordinating the
999	quality control, risk management, and patient relations
1000	functions of the facility and for reporting to the facility's
1001	governing board at least quarterly regarding such efforts.
1002	(b)  Establish within the facility a system for reporting
1003	near misses and agree to submit any information collected to the
1004	Florida Patient Safety Corporation. Such information must be
1005	submitted by the facility and made available by the Patient
1006	Safety Corporation in accordance with s. 381.0271(7).
1007	(c)  Design and make available to facility staff, including
1008	medical staff, a patient safety curriculum that provides lecture
1009	and web-based training on recognized patient safety principles,
1010	which may include communication skills training, team
1011	performance assessment and training, risk prevention strategies,
1012	and best practices and evidence based medicine. The licensed
1013	facility shall report annually to the agency the programs
1014	presented.
1015	(d)  Implement a program to identify health care providers
1016	on the facility's staff who may be eligible for an early-
1017	intervention program providing additional skills assessment and
1018	training and offer such training to the staff on a voluntary and
1019	confidential basis with established mechanisms to assess program
1020	performance and results.
1021	(e)  Implement a simulation-based program for skills
1022	assessment, training, and retraining of a facility's staff in
1023	those tasks and activities that the agency identifies by rule.
1024	(f)  Designate a patient advocate who coordinates with
1025	members of the medical staff and the facility's chief medical
1026	officer regarding disclosure of medical incidents to patients.
1027	In addition, the patient advocate shall establish an advisory
1028	panel, consisting of providers, patients or their families, and
1029	other health care consumer or consumer groups to review general
1030	patient safety concerns and other issues related to relations
1031	among and between patients and providers and to identify areas
1032	where additional education and program development may be
1033	appropriate.
1034	(g)  Establish a procedure to biennially review the
1035	facility's patient safety program and its compliance with the
1036	requirements of this section. Such review shall be conducted by
1037	an independent patient safety organization as defined in s.
1038	766.1016(1) or other professional organization approved by the
1039	agency. The organization performing the review shall prepare a
1040	written report with detailed findings and recommendations. The
1041	report shall be forwarded to the facility's risk manager or
1042	patient safety officer, who may make written comments in
1043	response thereto. The report and any written comments shall be
1044	presented to the governing board of the licensed facility. A
1045	copy of the report and any of the facilities' responses to the
1046	findings and recommendations shall be provided to the agency
1047	within 60 days after the date that the governing board reviewed
1048	the report. The report is confidential and exempt from
1049	production or discovery in any civil action. Likewise, the
1050	report, and the information contained therein, is not admissible
1051	as evidence for any purpose in any action for medical
1052	negligence.
1053	(h)  Establish a system for the trending and tracking of
1054	quality and patient safety indicators that the agency may
1055	identify by rule, and a method for review of the data at least
1056	semiannually by the facility's patient safety committee.
1057	(i)  Provide assistance to affected physicians, upon
1058	request, regarding implementation and evaluation of individual
1059	risk-management, patient-safety, and incident-reporting systems
1060	in clinical settings outside the premises of the licensed
1061	facility. Provision of such assistance may not be the basis for
1062	finding or imposing any liability on the licensed facility for
1063	acts or omissions of the affected physicians in clinical
1064	settings outside the premises of the licensed facility.
1065	(2)  This section does not constitute an applicable
1066	standard of care in any action for medical negligence or
1067	otherwise create a private right of action, and evidence of
1068	noncompliance with this section is not admissible for any
1069	purpose in any action for medical negligence against an affected
1070	facility or any other health care provider.
1071	(3)  This section does not prohibit the licensed facility
1072	from implementing other measures for promoting patient safety
1073	within the premises. This section does not relieve the licensed
1074	facility from the duty to implement any other patient safety
1075	measure that is required by state law. The Legislature intends
1076	that the patient safety measures specified in this section are
1077	in addition to all other patient safety measures required by
1078	state law, federal law, and applicable accreditation standards
1079	for licensed facilities.
1080	(4)  A review, report, or other document created, produced,
1081	delivered, or discussed pursuant to this section is not
1082	discoverable or admissible as evidence in any legal action.
1083	Section 12.  Section 766.404, Florida Statutes, is created
1084	to read:
1085	766.404  Enterprise liability in certain health care
1086	facilities.--
1087	(1)  Subject to the requirements of ss. 766.401-766.409,
1088	the agency may enter an order certifying the petitioner-hospital
1089	as a certified patient safety facility and providing that the
1090	hospital bears sole and exclusive liability for any and all acts
1091	of medical negligence within the licensed facility when such
1092	acts of medical negligence within the premises cause damage to
1093	affected patients, including, but not limited to, acts of
1094	medical negligence by physicians or other licensed health care
1095	providers who exercise clinical privileges in a licensed
1096	hospital, whether or not the active tortfeasor is an employee or
1097	agent of the health care facility when the incident of medical
1098	negligence occurred, except that for petitioner hospitals
1099	meeting the requirements of s. 768.28(12)(c)3., enterprise
1100	liability shall be limited to apply to affected practitioners
1101	who are employees or agents of a state university and the
1102	employees and agents of the hospital.
1103	(2)  In any action for personal injury or wrongful death,
1104	whether in contract or tort or predicated upon a statutory cause
1105	of action, arising out of medical negligence within the premises
1106	resulting in damages to a patient of a certified patient safety
1107	facility, the licensed facility bears sole and exclusive
1108	liability for medical negligence, whether or not the
1109	practitioner was an employee or agent of the facility when the
1110	incident of medical negligence occurred, except that for
1111	petitioner hospitals meeting the requirements of s.
1112	768.28(12)(c)3., enterprise liability shall be limited to apply
1113	to affected practitioners who are employees or agents of a state
1114	university and the employees and agents of the hospital. Any
1115	other provider, person, organization, or entity that commits
1116	medical negligence within the premises resulting in damages to a
1117	patient, and any other provider, person, organization, or entity
1118	that is vicariously liable for medical negligence within the
1119	premises of an affected practitioner under the theory of
1120	respondent superior or otherwise, may not be named as a
1121	defendant in any such action and any such provider, person,
1122	organization, or entity is not liable for the medical negligence
1123	of an affected practitioner. This subsection does not impose
1124	liability or confer immunity on any other provider, person,
1125	organization, or entity for acts of medical malpractice
1126	committed on any person in clinical settings other than the
1127	premises of the affected facility.
1128	(3)  An affected practitioner shall post an applicable
1129	notice or provide an appropriate written statement as follows:
1130	(a)  An affected practitioner shall post notice in the form
1131	of a sign prominently displayed in the reception area and
1132	clearly noticeable by all patients or provide a written
1133	statement to any person to whom medical services are being
1134	provided. The sign or statement must read as follows: "In
1135	general, physicians in the State of Florida are personally
1136	liable for acts of medical negligence, subject to certain
1137	limitations. However, physicians who perform medical services
1138	within a certified patient safety facility are exempt from
1139	personal liability because the licensed hospital bears sole and
1140	exclusive liability for acts of medical negligence within the
1141	health care facility pursuant to an administrative order of the
1142	Agency for Health Care Administration entered in accordance with
1143	the Enterprise Act for Patient Protection and Provider
1144	Liability. YOUR DOCTOR HOLDS CLINICAL STAFF PRIVILEGES IN A
1145	CERTIFIED PATIENT SAFETY FACILITY. UNDER FLORIDA LAW, ANY CLAIM
1146	FOR MEDICAL NEGLIGENCE WITHIN THE HEALTH CARE FACILITY MUST BE
1147	INITIATED AGAINST THE HOSPITAL AND NOT AGAINST YOUR DOCTOR,
1148	BECAUSE THE HOSPITAL IS SOLELY RESPONSIBLE FOR ALL ACTS OF
1149	PROFESSIONAL NEGLIGENCE WITHIN THE PREMISES. THIS PROVISION DOES
1150	NOT AFFECT YOUR PHYSICIAN'S LIABILITY FOR ACTS OF MEDICAL
1151	NEGLIGENCE IN OTHER CLINICAL SETTINGS. IF YOU DO NOT UNDERSTAND,
1152	PLEASE DISCUSS WITH YOUR DOCTOR BEFORE YOUR CONSULTATION. This
1153	notice is provided pursuant to Florida law."
1154	(b)  If an affected practitioner is covered by an
1155	enterprise plan for patient protection and provider liability in
1156	one or more licensed facilities that receive sovereign immunity,
1157	and one or more other licensed facilities, the affected
1158	practitioner shall post notice in the form of a sign prominently
1159	displayed in the reception area and clearly noticeable by all
1160	patients or provide a written statement to any person to whom
1161	medical services are being provided. The sign or statement must
1162	read as follows: "In general, physicians in the state of Florida
1163	are personally liable for acts of medical negligence, subject to
1164	certain limitations such as sovereign immunity. However,
1165	physicians who perform medical services within a certified
1166	patient safety facility are exempt from personal liability
1167	because the licensed hospital bears sole and exclusive liability
1168	for acts of medical negligence within the affected facility
1169	pursuant to an administrative order of the Agency for Health
1170	Care Administration entered in accordance with the Enterprise
1171	Act for Patient Protection and Provider Liability. YOUR DOCTOR
1172	HOLDS CLINICAL STAFF PRIVILEGES IN ONE OR MORE CERTIFIED PATIENT
1173	SAFETY FACILITIES. AT LEAST ONE OF THESE HOSPITALS IS SUBJECT TO
1174	SOVEREIGN IMMUNITY. UNDER FLORIDA LAW, ANY CLAIM FOR MEDICAL
1175	NEGLIGENCE WITHIN THE HEALTH CARE FACILITY MUST BE INITIATED
1176	AGAINST THE HOSPITAL AND NOT AGAINST YOUR DOCTOR, BECAUSE THE
1177	HOSPITAL IS SOLELY RESPONSIBLE FOR ALL ACTS OF PROFESSIONAL
1178	NEGLIGENCE WITHIN THE PREMISES. MOREOVER, RECOVERY AGAINST THE
1179	HOSPITAL MAY BE LIMITED, DUE TO FLORIDA'S SOVEREIGN IMMUNITY
1180	LAW. THESE PROVISIONS DO NOT AFFECT YOUR PHYSICIAN'S LIABILITY
1181	FOR ACTS OF MEDICAL NEGLIGENCE IN OTHER CLINICAL SETTINGS. IF
1182	YOU DO NOT UNDERSTAND, PLEASE DISCUSS WITH YOUR DOCTOR BEFORE
1183	YOUR CONSULTATION. This notice is provided pursuant to Florida
1184	law."
1185	(c)  Notice need not be given to a patient when:
1186	1.  The patient has an emergency medical condition as
1187	defined in s. 395.002;
1188	2.  The practitioner is an employee or agent of a
1189	governmental entity and is immune from liability and suit under
1190	s. 768.28; or
1191	3.  Notice is not practicable.
1192	(d)  This subsection is directory in nature. An agency
1193	order certifying approval of an enterprise plan for patient
1194	protection and provider liability shall, as a matter of law,
1195	constitute conclusive evidence that the hospital complies with
1196	all applicable patient safety requirements of s. 766.403 and all
1197	other requirements of ss. 766.401-766.409. Evidence of
1198	noncompliance with s. 766.403 or any other provision of ss.
1199	766.401-766.409 may not be admissible for any purpose in any
1200	action for medical malpractice. Failure to comply with the
1201	requirements of this subsection does not affect the liabilities
1202	or immunities conferred by ss. 766.401-766.409. This subsection
1203	does not give rise to an independent cause of action for
1204	damages.
1205	(4)  The agency order certifying approval of an enterprise
1206	plan for patient protection and provider liability applies
1207	prospectively to causes of action for medical negligence that
1208	arise on or after the effective date of the order.
1209	(5)  Upon entry of an order approving the petition, the
1210	agency may conduct onsite examinations of the licensed facility
1211	to assure continued compliance with the terms and conditions of
1212	the order.
1213	(6)  The agency order certifying approval of an enterprise
1214	plan for patient protection remains in effect until revoked. The
1215	agency shall revoke the order upon the unilateral request of the
1216	licensed facility, the executive committee of the medical staff,
1217	or the affiliated medical school, whichever is applicable. The
1218	agency may revoke the order upon reasonable notice to the
1219	affected facility that it fails to comply with material
1220	requirements of ss. 766.401-766.409 or material conditions of
1221	the order certifying approval of the enterprise plan and further
1222	upon a determination that the licensed facility has failed to
1223	cure stated deficiencies upon reasonable notice. An
1224	administrative order revoking approval of an enterprise plan for
1225	patient protection and provider liability terminates the plan on
1226	January 1 of the year following entry of the order or 6 months
1227	after entry of the order, whichever is longer. Revocation of an
1228	agency order certifying approval of an enterprise plan for
1229	patient protection and provider liability applies prospectively
1230	to causes of action for medical negligence which arise on or
1231	after the effective date of the termination.
1232	(7)  This section does not exempt a licensed facility from
1233	liability for acts of medical negligence committed by employees
1234	and agents thereof; although employees and agents of a certified
1235	patient safety facility may not be joined as defendants in any
1236	action for medical negligence because the licensed facility
1237	bears sole and exclusive liability for acts of medical
1238	negligence within the premises of the licensed facility,
1239	including acts of medical negligence by such employees and
1240	agents.
1241	(8)  Affected practitioners shall cooperate in good faith
1242	with an affected facility in the investigation and defense of
1243	any claim for medical negligence. An affected facility shall
1244	have a cause of action for damages against an affected
1245	practitioner for bad faith refusal to cooperate in the
1246	investigation and defense of any claim of medical malpractice
1247	against the licensed facility.
1248	(9)  Sections 766.401-766.409 do not impose strict
1249	liability or liability without fault for medical incidents that
1250	occur within an affected facility. To maintain a cause of action
1251	against an affected facility pursuant to ss. 766.401-766.409,
1252	the claimant must allege and prove that an employee or agent of
1253	the licensed facility, or an affected practitioner who is
1254	covered by an approved enterprise plan for patient protection
1255	and provider liability, committed medical negligence within the
1256	premises of the licensed facility which constitutes medical
1257	negligence under state law, even though an active tortfeasor is
1258	not named or joined as a party defendant in the lawsuit.
1259	(10)  Sections 766.401-766.409 do not create an independent
1260	cause of action against any health care provider and do not
1261	impose enterprise liability on any health care provider, except
1262	as expressly provided, and may not be construed to support any
1263	cause of action other than an action for medical negligence as
1264	expressly provided against any person, organization, or entity.
1265	(11)  Sections 766.401-766.409 do not waive sovereign
1266	immunity, except as expressly provided in s. 768.28.
1267	Section 13.  Section 766.405, Florida Statutes, is created
1268	to read:
1269	766.405  Enterprise plans.--
1270	(1)  It is the intent of the Legislature that enterprise
1271	plans for patient protection are elective and not mandatory for
1272	eligible hospitals. It is further the intent of the Legislature
1273	that the medical staff or affiliated medical school of an
1274	eligible hospital must concur with the development and
1275	implementation of an enterprise plan for patient protection and
1276	provider liability. It is further the intent of the Legislature
1277	that the licensed facility and medical staff or affiliated
1278	medical school be accorded wide latitude in formulating
1279	enterprise plans consistent with the underlying purpose of ss.
1280	766.401-766.409 to encourage innovative, systemic measures for
1281	patient protection and quality assurance in licensed facilities,
1282	especially in clinical settings where surgery is performed.
1283	Adoption of an enterprise plan is a necessary condition for
1284	agency approval of an enterprise plan for a certified patient
1285	safety facility.
1286	(2)  An eligible hospital and the executive committee of
1287	its medical staff of the board of trustees of a state
1288	university, if applicable, shall adopt an enterprise plan as a
1289	necessary condition to agency approval of a certified patient
1290	safety facility. An affirmative vote of approval by the
1291	regularly constituted executive committee of the medical staff,
1292	however named or constituted, is sufficient to manifest approval
1293	by the medical staff of the enterprise plan. Once approved,
1294	affected practitioners are subject to the enterprise plan. The
1295	plan may be conditioned on agency approval of an enterprise plan
1296	for patient protection and provider liability for the affected
1297	facility. For eligible hospitals meeting the requirements of s.
1298	768.28(12)(c)3., the enterprise plan shall be limited to
1299	affective practitioners who are also employees or agents of a
1300	state university and employees and agents of the hospital. At a
1301	minimum, the enterprise plan must contain provisions covering:
1302	(a)  Compliance with a patient protection plan.
1303	(b)  Internal review of medical incidents.
1304	(c)  Timely reporting of medical incidents to state
1305	agencies.
1306	(d)  Professional accountability of affected practitioners.
1307	(e)  Financial accountability of affected practitioners.
1308	(3)  This section does not prohibit a patient safety
1309	facility from including other provisions in the enterprise plan,
1310	in a separate agreement, as a condition of staff privileges, or
1311	by way of contract with an organization providing medical staff
1312	for the licensed facility.
1313	(4)  This section does not limit the power of any licensed
1314	facility to enter into other agreements with members of its
1315	medical staff or otherwise to impose restrictions, requirements,
1316	or conditions on clinical privileges, as authorized by law.
1317	(5)  If multiple campuses of a licensed facility share a
1318	license, the enterprise plan may be limited to the primary
1319	campus or the campus with the largest number of beds and, if
1320	applicable, associated outpatient ancillary facilities. If the
1321	enterprise plan is so limited, the plan must specify the campus
1322	and, if applicable, the ancillary facilities that will
1323	constitute the enterprise.
1324	Section 14.  Section 766.406, Florida Statutes, is created
1325	to read:
1326	766.406  Professional accountability of affected
1327	practitioners.--
1328	(1)  A certified patient safety facility shall report
1329	medical incidents occurring in the affected facility to the
1330	Department of Health, in accordance with s. 395.0197.
1331	(2)  A certified patient safety facility shall report
1332	adverse findings of medical negligence or failure to adhere to
1333	applicable standards of professional responsibility by affected
1334	practitioners to the Department of Health.
1335	(3)  A certified patient safety facility shall continue to
1336	perform all peer review functions pursuant to s. 395.0193.
1337	Section 15.  Section 766.407, Florida Statutes, is created
1338	to read:
1339	766.407  Financial accountability of affected
1340	practitioners.--
1341	(1)  An enterprise plan may provide that any affected
1342	member of the medical staff or any affected practitioner having
1343	clinical privileges, other than an employee of the licensed
1344	facility, and any organization that contracts with the licensed
1345	facility to provide practitioners to treat patients within the
1346	licensed facility, shall share equitably in the cost of omnibus
1347	medical liability insurance premiums covering the certified
1348	patient safety facility, similar self-insurance expense, or
1349	other expenses reasonably related to risk management and
1350	adjustment of claims of medical negligence. This subsection does
1351	not permit a licensed facility and any affected practitioner to
1352	agree on charges for an equitable share of medical liability
1353	expense based on the number of patients admitted to the hospital
1354	by individual practitioners, patient revenue for the licensed
1355	facility generated by individual practitioners, or overall
1356	profit or loss sustained by the certified patient safety
1357	facility in a given fiscal period.
1358	(2)  Pursuant to an enterprise plan for patient protection
1359	and provider liability, a licensed facility may impose a
1360	reasonable assessment against an affected practitioner that
1361	commits medical negligence resulting in injury and damages to an
1362	affected patient of the health care facility, upon a
1363	determination of failure to adhere to acceptable standards of
1364	professional responsibility by an internal peer review
1365	committee. A schedule of assessments, criteria for the levying
1366	of assessments, procedures for levying assessments, and due
1367	process rights of an affected practitioner must be agreed to by
1368	the executive committee of the medical staff or affiliated
1369	medical school, as applicable, and the licensed facility. The
1370	legislative intent in providing for assessments against an
1371	affected physician is to instill in each individual health care
1372	practitioner the incentive to avoid the risk of injury to the
1373	fullest extent and ensure that the residents of this state
1374	receive the highest quality health care obtainable. Failure to
1375	pay an assessment constitutes grounds for suspension of clinical
1376	privileges by the licensed facility. Assessments may be enforced
1377	as bona fide debts in a court of law. The licensed facility may
1378	exempt its employees and agents from all such assessments.
1379	Employees and agents of the state, its agencies, and
1380	subdivisions, as defined by s. 768.28, are exempt from all such
1381	assessments.
1382	(3)  An assessment levied pursuant to this section is not
1383	discoverable or admissible as evidence in any legal action.
1384	Section 16.  Section 766.408, Florida Statutes, is created
1385	to read:
1386	766.408  Data collection and reports.--
1387	(1)  Each certified patient safety facility shall submit an
1388	annual report to the agency containing information and data
1389	reasonably required by the agency to evaluate performance and
1390	effectiveness of the facility's enterprise plan for patient
1391	protection and provider liability. However, information may not
1392	be submitted or disclosed in violation of any patient's right to
1393	privacy under state or federal law.
1394	(2)  The agency shall aggregate information and data
1395	submitted by all affected facilities and each year, on or before
1396	March 1, the agency shall submit a report to the Legislature
1397	that evaluates the performance and effectiveness of the
1398	enterprise approach to patient safety and provider liability in
1399	certified patient safety facilities, which reports must include,
1400	but are not limited to, pertinent data on:
1401	(a)  The number and names of affected facilities;
1402	(b)  The number and types of patient protection measures
1403	currently in effect in these facilities;
1404	(c)  The number of affected practitioners;
1405	(d)  The number of affected patients;
1406	(e)  The number of surgical procedures by affected
1407	practitioners on affected patients;
1408	(f)  The number of medical incidents, claims of medical
1409	malpractice, and claims resulting in indemnity;
1410	(g)  The average time for resolution of contested and
1411	uncontested claims of medical malpractice;
1412	(h)  The percentage of claims that result in civil trials;
1413	(i)  The percentage of civil trials resulting in adverse
1414	judgments against affected facilities;
1415	(j)  The number and average size of an indemnity paid to
1416	claimants;
1417	(k)  The number and average size of assessments imposed on
1418	affected practitioners;
1419	(l)  The estimated liability expense, inclusive of medical
1420	liability insurance premiums; and
1421	(m)  The percentage of medical liability expense, inclusive
1422	of medical liability insurance premiums, which is borne by
1423	affected practitioners in affected health care facilities.
1424
1425	Such reports to the Legislature may also include other
1426	information and data that the agency deems appropriate to gauge
1427	the cost and benefit of enterprise plans for patient protection
1428	and provider liability.
1429	(3)  The agency's annual report to the Legislature may
1430	include relevant information and data obtained from the Office
1431	of Insurance Regulation within the Department of Financial
1432	Services on the availability and affordability of enterprise-
1433	wide medical liability insurance coverage for affected
1434	facilities and the availability and affordability of insurance
1435	policies for individual practitioners which contain coverage
1436	exclusions for acts of medical negligence in certified patient
1437	safety facilities. The Office of Insurance Regulation within the
1438	Department of Financial Services shall cooperate with the agency
1439	in the reporting of information and data specified in this
1440	subsection.
1441	(4)  Reports submitted to the agency by affected facilities
1442	pursuant to this section are public records under chapter 199.
1443	However, these reports, and the information contained therein,
1444	are not admissible as evidence in a court of law in any action.
1445	Section 17.  Section 766.409, Florida Statutes, is created
1446	to read:
1447	766.409  Damages in malpractice actions against certain
1448	hospitals that meet patient safety requirements; agency approval
1449	of patient safety measures.--
1450	(1)  In recognition of their essential role in training
1451	future health care providers and in providing innovative medical
1452	care for this state's residents, in recognition of their
1453	commitment to treating indigent patients, and further in
1454	recognition that all teaching hospitals, as defined in s.
1455	408.07, both public and private, and hospitals licensed under
1456	chapter 395 which are owned and operated by a university that
1457	maintains an accredited medical school, collectively defined as
1458	eligible hospitals in s. 766.401(8), provide benefits to the
1459	residents of this state through their roles in improving the
1460	quality of medical care, training health care providers, and
1461	caring for indigent patients, the limits of liability for
1462	medical malpractice arising out of the rendering of, or the
1463	failure to render, medical care by all such hospitals, shall be
1464	determined in accordance with the requirements of this section,
1465	notwithstanding any other provision of state law.
1466	(2)  Except as otherwise provided in subsections (9) and
1467	(10), any eligible hospital may petition the agency to enter an
1468	order certifying that the licensed facility complies with
1469	patient safety measures specified in s. 766.403.
1470	(3)  In accordance with chapter 120, the agency shall enter
1471	an order approving the petition upon a showing that the eligible
1472	hospital complies with the patient safety measures specified in
1473	s. 766.403. Upon entry of the agency order, and for the entire
1474	period of time that the order remains in effect, the limits of
1475	liability for medical malpractice arising out of the rendering
1476	of, or the failure to render, medical care by the hospital
1477	covered by the order and its employees and agents shall be up to
1478	$500,000 in the aggregate for all related claims or judgments
1479	for noneconomic damages arising out of the same incident or
1480	occurrence. Claims or judgments for noneconomic damages and
1481	awards of past economic damages shall be offset by collateral
1482	sources, and paid in full at the time of final settlement.
1483	Awards of future economic damages, after being offset by
1484	collateral sources, shall be reduced, at the option of the
1485	teaching hospital, by the court to present value and paid in
1486	full or paid by means of periodic payments in the form of
1487	annuities or reversionary trusts, such payments to be paid for
1488	the life of the claimant or for so long as the condition for
1489	which the award was made persists, whichever is shorter, without
1490	regard to the number of years awarded by the trier of fact, at
1491	which time the obligation to make such payments terminates. A
1492	company that underwrites an annuity to pay future economic
1493	damages shall have a Best Company rating of not less than A. The
1494	terms of a reversionary instrument used to periodically pay
1495	future economic damages must be approved by the court, such
1496	approval may not be unreasonably withheld.
1497	(4)  The limitations on damages in subsection (3) apply
1498	prospectively to causes of action for medical negligence that
1499	arise on or after the effective date of the order.
1500	(5)  Upon entry of an order approving the petition, the
1501	agency may conduct onsite examinations of the licensed facility
1502	to assure continued compliance with terms and conditions of the
1503	order.
1504	(6)  The agency order certifying approval of a petition
1505	under this section remains in effect until revoked. The agency
1506	may revoke the order upon reasonable notice to the affected
1507	hospital that it fails to comply with material requirements of
1508	ss. 766.401-766.409 or material conditions of the order
1509	certifying compliance with required patient safety measures and
1510	that the hospital has failed to cure stated deficiencies upon
1511	reasonable notice. Revocation of an agency order certifying
1512	approval of an enterprise plan for patient protection and
1513	provider liability applies prospectively to causes of action for
1514	medical negligence that arise on or after the effective date of
1515	the order of revocation.
1516	(7)  An agency order certifying approval of a petition
1517	under this section shall, as a matter of law, constitute
1518	conclusive evidence that the hospital complies with all
1519	applicable patient safety requirements of s. 766.403. A
1520	hospital's noncompliance with the requirements of s. 766.403 may
1521	not affect the limitations on damages conferred by this section.
1522	Evidence of noncompliance with s. 766.403 may not be admissible
1523	for any purpose in any action for medical malpractice. This
1524	section, or any portion thereof, may not give rise to an
1525	independent cause of action for damages against any hospital.
1526	(8)  The entry of an agency order pursuant to this section
1527	does not impose enterprise liability, or sole and exclusive
1528	liability, on the licensed facility for acts or omissions of
1529	medical negligence within the premises.
1530	(9)  An eligible hospital may petition the agency for an
1531	order pursuant to this section or an order pursuant to s.
1532	766.404. However, a hospital may not be approved for both
1533	enterprise liability under s. 766.404 and the limitations on
1534	damages under this section.
1535	(10)  This section may not apply to hospitals that are
1536	subject to sovereign immunity under s. 768.28.
1537	Section 18.  Section 766.410, Florida Statutes, is created
1538	to read:
1539	766.410  Rulemaking authority.--The agency may adopt rules
1540	to administer ss. 766.401-766.409.
1541	Section 19.  Subsections (5) and (12) of section 768.28,
1542	Florida Statutes, are amended to read:
1543	768.28  Waiver of sovereign immunity in tort actions;
1544	recovery limits; limitation on attorney fees; statute of
1545	limitations; exclusions; indemnification; risk management
1546	programs.--
1547	(5)(a)  The state and its agencies and subdivisions shall
1548	be liable for tort claims in the same manner and to the same
1549	extent as a private individual under like circumstances, but
1550	liability does shall not include punitive damages or interest
1551	for the period before judgment.
1552	(b)  Except as provided in paragraph (c), neither the state
1553	or nor its agencies or subdivisions are shall be liable to pay a
1554	claim or a judgment by any one person which exceeds the sum of
1555	$100,000 or any claim or judgment, or portions thereof, which,
1556	when totaled with all other claims or judgments paid by the
1557	state or its agencies or subdivisions arising out of the same
1558	incident or occurrence, exceeds the sum of $200,000. However, a
1559	judgment or judgments may be claimed and rendered in excess of
1560	these amounts and may be settled and paid pursuant to this act
1561	up to $100,000 or $200,000, as the case may be; and that portion
1562	of the judgment that exceeds these amounts may be reported to
1563	the Legislature, but may be paid in part or in whole only by
1564	further act of the Legislature. Notwithstanding the limited
1565	waiver of sovereign immunity provided herein, the state or an
1566	agency or subdivision thereof may agree, within the limits of
1567	insurance coverage provided, to settle a claim made or a
1568	judgment rendered against it without further action by the
1569	Legislature, but the state or agency or subdivision thereof
1570	shall not be deemed to have waived any defense of sovereign
1571	immunity or to have increased the limits of its liability as a
1572	result of its obtaining insurance coverage for tortious acts in
1573	excess of the $100,000 or $200,000 waiver provided above. The
1574	limitations of liability set forth in this subsection shall
1575	apply to the state and its agencies and subdivisions whether or
1576	not the state or its agencies or subdivisions possessed
1577	sovereign immunity before July 1, 1974.
1578	(c)  In any action for medical negligence within a
1579	certified patient safety facility that is covered by sovereign
1580	immunity, given that the licensed health care facility bears
1581	sole and exclusive liability for acts of medical negligence
1582	pursuant to the Enterprise Act for Patient Protection and
1583	Provider Liability, inclusive of ss. 766.401-766.409, neither
1584	the state or its agencies or subdivisions are liable to pay a
1585	claim or a judgment by any one person which exceeds the sum of
1586	$150,000 or any claim or judgment, or portions thereof, which,
1587	when totaled with all other claims or judgments paid by the
1588	state or its agencies or subdivisions arising out of the same
1589	incident or occurrence, exceeds the sum of $300,000. However, a
1590	judgment may be claimed and rendered in excess of these amounts
1591	and may be settled and paid up to $150,000 or $300,000, as the
1592	case may be. That portion of the judgment which exceeds these
1593	amounts may be reported to the Legislature, but may be paid in
1594	part or in whole only by further act of the Legislature.
1595	Notwithstanding the limited waiver of sovereign immunity
1596	provided in this paragraph, the state or an agency or
1597	subdivision thereof may agree, within the limits of insurance
1598	coverage provided, to settle a claim made or a judgment rendered
1599	against it without further action by the Legislature, but the
1600	state or agency or subdivision thereof does not waive any
1601	defense of sovereign immunity or increase limits of its
1602	liability as a result of its obtaining insurance coverage for
1603	tortious acts in excess of the $150,000 waiver or the $300,000
1604	waiver provided in this paragraph. The limitations of liability
1605	set forth in this paragraph apply to the state and its agencies
1606	and subdivisions whether or not the state or its agencies or
1607	subdivisions possessed sovereign immunity before July 1, 1974.
1608	(12)(a)  A health care practitioner, as defined in s.
1609	456.001(4), who has contractually agreed to act as an agent of a
1610	state university board of trustees to provide medical services
1611	to a student athlete for participation in or as a result of
1612	intercollegiate athletics, to include team practices, training,
1613	and competitions, is shall be considered an agent of the
1614	respective state university board of trustees, for the purposes
1615	of this section, while acting within the scope of and pursuant
1616	to guidelines established in that contract. The contracts shall
1617	provide for the indemnification of the state by the agent for
1618	any liabilities incurred up to the limits set out in this
1619	chapter.
1620	(b)  This subsection shall not be construed as designating
1621	persons providing contracted health care services to athletes as
1622	employees or agents of a state university board of trustees for
1623	the purposes of chapter 440.
1624	(c)1.  For purposes of this subsection, the terms
1625	"certified patient safety facility," "medical staff," and
1626	"medical negligence" have the same meanings as provided in s.
1627	766.401.
1628	2.  A certified patient safety facility, wherein a minimum
1629	of 90 percent of the members of the medical staff consist of
1630	physicians are employees or agents of a state university, is an
1631	agent of the respective state university board of trustees for
1632	purposes of this section to the extent that the licensed
1633	facility, in accordance with an enterprise plan for patient
1634	protection and provider liability, inclusive of ss. 766.401-
1635	766.409, approved by the Agency for Health Care Administration,
1636	is solely and exclusively liable for acts of medical negligence
1637	of physicians providing health care services within the licensed
1638	facility.
1639	3.  A certified patient safety facility that has been found
1640	to be an agent of the state for other purposes and has adopted
1641	an enterprise plan for patient protection and provider liability
1642	for the sole and exclusive liability for acts of medical
1643	negligence of affected practitioners who are employees and
1644	agents of the affiliated state university board of trustees and
1645	its own hospital employees and agents, inclusive of ss. 766.401-
1646	766.409, approved by the Agency for Health Care Administration,
1647	is an agent of the respective state university board of trustees
1648	for purposes of this subsection only.
1649	4.  Subject to the acceptance of the Board of Governors and
1650	a state university board of trustees, a licensed facility as
1651	described by this subsection may secure the limits of liability
1652	protection described in paragraph (c) from a self insurance
1653	program created pursuant to s. 1004.24.
1654	5.  A notice of intent to commence an action for medical
1655	negligence arising from the care or treatment of a patient in a
1656	certified patient safety facility subject to the provisions of
1657	this subsection shall be sent to the licensed facility as the
1658	statutory agent created pursuant to an enterprise plan of the
1659	related board of trustees of a state university for the limited
1660	purposes of administering an enterprise plan for patient
1661	protection and provider liability. A complaint alleging medical
1662	negligence resulting in damages to a patient in a certified
1663	patient safety facility subject to the provisions of this
1664	paragraph shall be commenced against the applicable board of
1665	trustees of a state university on the relation of the licensed
1666	facility, and the doctrines of res judicata and collateral
1667	estoppel shall apply. The complaint shall be served on the
1668	licensed facility. Any notice of intent mailed to the licensed
1669	facility, any legal process served on the licensed facility, and
1670	any other notice, paper, or pleading that is served, sent, or
1671	delivered to the licensed facility pertaining to a claim of
1672	medical negligence shall have the same legal force and effect as
1673	mailing, service, or delivery to a duly authorized agent of the
1674	board of trustees of the respective state university,
1675	notwithstanding any provision of the laws of this state to the
1676	contrary. Upon receipt of any such notice of intent, complaint
1677	for damages, or other notice, paper, or pleading pertaining to a
1678	claim of medical negligence, a licensed facility subject to the
1679	provisions of this paragraph shall give timely notice to the
1680	related board of trustees of the state university, although
1681	failure to give timely notice does not affect the legal
1682	sufficiency of the notice of intent, service of process, or
1683	other notice, paper, or pleading. A final judgment or binding
1684	arbitration award against the board of trustees of a state
1685	university on the relation of a licensed facility, arising from
1686	a claim of medical negligence resulting in damages to a patient
1687	in a certified patient safety facility subject to the provisions
1688	of this paragraph, may be enforced in the same manner, and is
1689	subject to the same limitations on enforcement or recovery, as
1690	any final judgment for damages or binding arbitration award
1691	against the board of trustees of a state university,
1692	notwithstanding any provision of the laws of this state to the
1693	contrary. Any settlement agreement executed by the board of
1694	trustees of a state university on the relation of a licensed
1695	facility, arising from a claim of medical negligence resulting
1696	in damages to a patient in a certified patient safety facility
1697	subject to the provisions of this paragraph, may be enforced in
1698	the same manner and is subject to the same limitations as a
1699	settlement agreement executed by an authorized agent of the
1700	board of trustees. The board of trustees of a state university
1701	may make payment to a claimant in whole or in part of any
1702	portion of a final judgment or binding arbitration award against
1703	the board of trustees of a state university on the relation of a
1704	licensed facility, and any portion of a settlement of a claim
1705	for medical negligence arising from a certified patient safety
1706	facility subject to the provisions of this paragraph, which
1707	exceeds the amounts of the limited waiver of sovereign immunity
1708	specified in paragraph (5)(c), only as provided in that
1709	paragraph.
1710	Section 20.  If any provision of this act or its
1711	application to any person or circumstance is held invalid, the
1712	invalidity does not affect other provisions or applications of
1713	the act which can be given effect without the invalid provision
1714	or application, and to this end, the provisions of this act are
1715	severable.
1716	Section 21.  If a conflict between any provision of this
1717	act and s. 456.052, s. 456.053, s. 456.054, s. 458.331, s.
1718	459.015, or s. 817.505, Florida Statutes, the provisions of this
1719	act shall govern. The provisions of this act should be broadly
1720	construed in furtherance of the overriding legislative intent to
1721	facilitate innovative approaches for patient protection and
1722	provider liability in eligible hospitals.
1723	Section 22.  It is the intention of the Legislature that
1724	the provisions of this act are self-executing.
1725	Section 23.  This act shall take effect upon becoming a
1726	law.

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