HB 1621

CS

CHAMBER ACTION

1	The Health & Families Council 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	458.320, F.S.; exempting certain physicians who perform
10	surgery in certain patient safety facilities from the
11	requirement to establish financial responsibility;
12	requiring a licensed physician who is covered for medical
13	negligence claims by a hospital that assumes liability
14	under the act to prominently post notice or provide a
15	written statement to patients; requiring a licensed
16	physician who meets certain requirements for payment or
17	settlement of a medical malpractice claim and who is
18	covered for medical negligence claims by a hospital that
19	assumes liability under the act to prominently post notice
20	or provide a written statement to patients; amending s.
21	459.0085, F.S.; exempting certain osteopathic physicians
22	who perform surgery in certain patient safety facilities
23	from the requirement to establish financial
24	responsibility; requiring a licensed osteopathic physician
25	who is covered for medical negligence claims by a hospital
26	that assumes liability under the act to prominently post
27	notice or provide a written statement to patients;
28	requiring a licensee of osteopathic medicine who meets
29	certain requirements for payment or settlement of a
30	medical malpractice claim and who is covered for medical
31	negligence claims by a hospital that assumes liability
32	under the act to prominently post notice or provide a
33	written statement to patients; creating s. 627.41485,
34	F.S.; authorizing insurers to offer liability insurance
35	coverage to physicians which has an exclusion for certain
36	acts of medical negligence under certain conditions;
37	authorizing the Department of Financial Services to adopt
38	rules; amending s. 766.316, F.S.; requiring hospitals that
39	assume liability for affected physicians under the act to
40	provide notice to obstetrical patients regarding the
41	limited no-fault alternative to birth-related neurological
42	injuries; amending s. 766.110, F.S.; requiring hospitals
43	that assume liability for acts of medical negligence under
44	the act to carry insurance; requiring the hospital's
45	policy regarding medical liability insurance to satisfy
46	certain statutory financial responsibility requirements;
47	authorizing an insurer who is authorized to write casualty
48	insurance to write such coverage; authorizing certain
49	hospitals to indemnify certain medical staff for legal
50	liability of loss, damages, or expenses arising from
51	medical negligence within hospital premises; requiring a
52	hospital to acquire a policy of professional liability
53	insurance or a fund for malpractice coverage; requiring an
54	annual certified financial statement to the Agency for
55	Health Care Administration; authorizing certain hospitals
56	to charge physicians a fee for malpractice coverage;
57	preserving a hospital's ability to indemnify certain
58	medical staff members; amending s. 766.118, F.S.;
59	providing a cap on noneconomic damages for eligible
60	hospitals meeting certain patient safety measures;
61	creating s. 766.401, F.S.; providing definitions; creating
62	s. 766.402, F.S.; authorizing an eligible hospital to
63	petition the Agency for Health Care Administration to
64	enter an order certifying the hospital as a patient safety
65	facility; providing requirements for certification as a
66	patient safety facility; creating s. 766.403, F.S.;
67	providing requirements for a hospital to demonstrate that
68	it is engaged in a common enterprise for the care and
69	treatment of patients; specifying required patient safety
70	measures; prohibiting a report or document generated under
71	the act 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 by certain physicians and
76	practitioners; specifying a licensed facility as bearing
77	sole and exclusive liability for medical negligence by
78	certain physicians and practitioners under certain
79	circumstances in actions for personal injury or wrongful
80	death; providing that certain persons or entities are not
81	liable for medically negligent acts occurring in a
82	certified patient safety facility; requiring that an
83	affected practitioner prominently post notice regarding
84	exemption from personal liability; requiring an affected
85	physician who is covered by an enterprise plan in a
86	licensed facility that receives sovereign immunity to
87	prominently post notice regarding exemption from personal
88	liability; providing that an agency order certifying
89	approval of an enterprise plan is evidence of a hospital's
90	compliance with applicable patient safety requirements;
91	providing circumstances in which notice is not required;
92	providing that the order certifying approval of an
93	enterprise plan applies prospectively to causes of action
94	for medical negligence; authorizing the agency to conduct
95	onsite examinations of a licensed facility; providing
96	circumstances under which the agency may revoke its order
97	certifying approval of an enterprise plan; providing that
98	an employee or agent of a certified patient safety
99	facility may not be joined as a defendant in an action for
100	medical negligence; requiring an affected practitioner to
101	cooperate in good faith in an investigation of a claim for
102	medical malpractice; providing a cause of action for
103	failure of a physician to act in good faith; providing
104	that strict liability or liability without fault is not
105	imposed for medical incidents that occur in the affected
106	facility; providing requirements that a claimant must
107	prove to demonstrate medical negligence by an employee,
108	agent, or medical staff of a licensed facility; providing
109	that the act does not create an independent cause of
110	action or waive sovereign immunity; creating s. 766.405,
111	F.S.; requiring an eligible hospital to execute an
112	enterprise plan; requiring certain conditions to be
113	contained within an enterprise plan; creating s. 766.406,
114	F.S.; requiring a certified patient safety facility to
115	report medical incidents occurring on its premises and
116	adverse findings of medical negligence to the Department
117	of Health; requiring certified patient safety facilities
118	to perform certain peer review functions; creating s.
119	766.407, F.S.; providing that an enterprise plan may
120	provide clinical privileges to certain persons; requiring
121	certain organizations to share in the cost of omnibus
122	medical liability insurance premiums subject to certain
123	conditions; authorizing a licensed facility to impose a
124	reasonable assessment against an affected practitioner who
125	commits medical negligence; providing for the revocation
126	of clinical privileges for failure to pay the assessment;
127	exempting certain employees and agents from such
128	assessments; creating s. 766.408, F.S.; requiring a
129	certified patient safety facility to submit an annual
130	report to the agency and the Legislature; providing
131	requirements for the annual report; providing that the
132	annual report may include certain information from the
133	Office of Insurance Regulation within the Department of
134	Financial Services; providing that the annual report is
135	subject to public records requirements, but is not
136	admissible as evidence in a legal proceeding; creating s.
137	766.409, F.S.; authorizing certain teaching hospitals and
138	eligible hospitals to petition the agency for
139	certification; providing criteria for determining
140	noneconomic, economic, and future economic damages
141	recoverable in actions arising from medical negligence;
142	providing for application of limitations on damages for
143	eligible hospitals that are certified for compliance with
144	certain patient safety measures; authorizing the agency to
145	conduct onsite examinations of certified eligible
146	hospitals; authorizing the agency to revoke its order
147	certifying approval of an enterprise plan; providing that
148	an agency order certifying approval of an enterprise plan
149	is evidence of a hospital's compliance with applicable
150	patient safety requirements; providing that evidence of
151	noncompliance is inadmissible in any action for medical
152	malpractice; providing that entry of the agency's order
153	does not impose enterprise liability on the licensed
154	facility for acts or omissions of medical negligence;
155	providing that a hospital may not be approved for
156	certification for both enterprise liability and
157	limitations on damages; creating s. 766.410, F.S.;
158	providing rulemaking authority; amending s. 768.28, F.S.;
159	providing limitations on payment of a claim or judgment
160	for an action for medical negligence within a certified
161	patient safety facility that is covered by sovereign
162	immunity; providing definitions; providing that a
163	certified patient safety facility is an agent of a state
164	university board of trustees to the extent that the
165	licensed facility is solely liable for acts of medical
166	negligence of physicians providing health care services
167	within the licensed facility; specifying that certain
168	certified patient safety facilities are agents of a state
169	university board of trustees under certain circumstances;
170	authorizing licensed facilities to secure limits of
171	liability protection from certain self-insurance programs;
172	providing requirements for commencing an action for
173	certain medical negligence; providing procedures;
174	providing limitations; providing for severability;
175	providing for broad statutory view of the act; providing
176	for self-execution of the act; providing an effective
177	date.
178
179	Be It Enacted by the Legislature of the State of Florida:
180
181	Section 1.  Popular name.--This act may be cited as the
182	"Enterprise Act for Patient Protection and Provider Liability."
183	Section 2.  Legislative findings.--
184	(1)  The Legislature finds that this state is in the midst
185	of a prolonged medical malpractice insurance crisis that has
186	serious adverse effects on patients, practitioners, licensed
187	healthcare facilities, and all residents of this state.
188	(2)  The Legislature finds that hospitals are central
189	components of the modern health care delivery system.
190	(3)  The Legislature finds that many of the most serious
191	incidents of medical negligence occur in hospitals, where the
192	most seriously ill patients are treated, and where surgical
193	procedures are performed.
194	(4)  The Legislature finds that modern hospitals are
195	complex organizations, that medical care and treatment in
196	hospitals is a complex process, and that, increasingly, medical
197	care and treatment in hospitals is a common enterprise involving
198	an array of responsible employees, agents, and other persons,
199	such as physicians, who are authorized to exercise clinical
200	privileges within the premises.
201	(5)  The Legislature finds that an increasing number of
202	medical incidents in hospitals involve a combination of acts and
203	omissions by employees, agents, and other persons, such as
204	physicians, who are authorized to exercise clinical privileges
205	within the premises.
206	(6)  The Legislature finds that the medical malpractice
207	insurance crisis in this state can be alleviated by the adoption
208	of innovative approaches for patient protection in hospitals
209	which can lead to a reduction in medical errors.
210	(7)  The Legislature finds statutory incentives are
211	necessary to facilitate innovative approaches for patient
212	protection in hospitals.
213	(8)  The Legislature finds that an enterprise approach to
214	patient protection and provider liability in hospitals will lead
215	to a reduction in the frequency and severity of incidents of
216	medical malpractice in hospitals.
217	(9)  The Legislature finds that a reduction in the
218	frequency and severity of incidents of medical malpractice in
219	hospitals will reduce attorney's fees and other expenses
220	inherent in the medical liability system.
221	(10)  The Legislature finds that making high-quality health
222	care available to the residents of this state is an overwhelming
223	public necessity.
224	(11)  The Legislature finds that medical education in this
225	state is an overwhelming public necessity.
226	(12)  The Legislature finds that statutory teaching
227	hospitals and hospitals owned by and operated by universities
228	that maintain accredited medical schools are essential for high-
229	quality medical care and medical education in this state.
230	(13)  The Legislature finds that the critical mission of
231	statutory teaching hospitals and hospitals owned and operated by
232	universities that maintain accredited medical schools is
233	severely undermined by the ongoing medical malpractice crisis.
234	(14)  The Legislature finds that statutory teaching
235	hospitals and hospitals owned and operated by universities that
236	maintain accredited medical schools are appropriate health care
237	facilities for the implementation of innovative approaches to
238	patient protection and provider liability.
239	(15)  The Legislature finds an overwhelming public
240	necessity to impose reasonable limitations on actions for
241	medical malpractice against statutory teaching hospitals and
242	hospitals that are owned and operated by universities that
243	maintain accredited medical schools, in furtherance of the
244	critical public interest in promoting access to high-quality
245	medical care, medical education, and innovative approaches to
246	patient protection.
247	(16)  The Legislature finds an overwhelming public
248	necessity for statutory teaching hospitals and hospitals owned
249	and operated by universities that maintain accredited medical
250	schools to implement innovative measures for patient protection
251	and provider liability in order to generate empirical data for
252	state policymakers on the effectiveness of these measures. Such
253	data may lead to broader application of these measures in a
254	wider array of hospitals after a reasonable period of evaluation
255	and review.
256	(17)  The Legislature finds an overwhelming public
257	necessity to promote the academic mission of statutory teaching
258	hospitals and hospitals owned and operated by universities that
259	maintain accredited medical schools. Furthermore, the
260	Legislature finds that the academic mission of these medical
261	facilities is materially enhanced by statutory authority for the
262	implementation of innovative approaches to patient protection
263	and provider liability. Such approaches can be carefully studied
264	and learned by medical students, medical school faculty, and
265	affiliated physicians in appropriate clinical settings, thereby
266	enlarging the body of knowledge concerning patient protection
267	and provider liability which is essential for advancement of
268	patient safety, reduction of expenses inherent in the medical
269	liability system, and curtailment of the medical malpractice
270	insurance crisis in this state.
271	Section 3.  Subsection (2) and paragraphs (f) and (g) of
272	subsection (5) of section 458.320, Florida Statutes, are amended
273	to read:
274	458.320  Financial responsibility.--
275	(2)  Physicians who perform surgery in an ambulatory
276	surgical center licensed under chapter 395 and, as a continuing
277	condition of hospital staff privileges, physicians who have
278	staff privileges must also establish financial responsibility by
279	one of the following methods:
280	(a)  Establishing and maintaining an escrow account
281	consisting of cash or assets eligible for deposit in accordance
282	with s. 625.52 in the per claim amounts specified in paragraph
283	(b). The required escrow amount set forth in this paragraph may
284	not be used for litigation costs or attorney's fees for the
285	defense of any medical malpractice claim.
286	(b)  Obtaining and maintaining professional liability
287	coverage in an amount not less than $250,000 per claim, with a
288	minimum annual aggregate of not less than $750,000 from an
289	authorized insurer as defined under s. 624.09, from a surplus
290	lines insurer as defined under s. 626.914(2), from a risk
291	retention group as defined under s. 627.942, from the Joint
292	Underwriting Association established under s. 627.351(4),
293	through a plan of self-insurance as provided in s. 627.357, or
294	through a plan of self-insurance which meets the conditions
295	specified for satisfying financial responsibility in s. 766.110.
296	The required coverage amount set forth in this paragraph may not
297	be used for litigation costs or attorney's fees for the defense
298	of any medical malpractice claim.
299	(c)  Obtaining and maintaining an unexpired irrevocable
300	letter of credit, established pursuant to chapter 675, in an
301	amount not less than $250,000 per claim, with a minimum
302	aggregate availability of credit of not less than $750,000. The
303	letter of credit must be payable to the physician as beneficiary
304	upon presentment of a final judgment indicating liability and
305	awarding damages to be paid by the physician or upon presentment
306	of a settlement agreement signed by all parties to such
307	agreement when such final judgment or settlement is a result of
308	a claim arising out of the rendering of, or the failure to
309	render, medical care and services. The letter of credit may not
310	be used for litigation costs or attorney's fees for the defense
311	of any medical malpractice claim. The letter of credit must be
312	nonassignable and nontransferable. The letter of credit must be
313	issued by any bank or savings association organized and existing
314	under the laws of this state or any bank or savings association
315	organized under the laws of the United States which has its
316	principal place of business in this state or has a branch office
317	that is authorized under the laws of this state or of the United
318	States to receive deposits in this state.
319
320	This subsection shall be inclusive of the coverage in subsection
321	(1). A physician who only performs surgery or who has only
322	clinical privileges or admitting privileges in one or more
323	certified patient safety facilities, which health care facility
324	or facilities are legally liable for medical negligence of
325	affected practitioners, pursuant to the Enterprise Act for
326	Patient Protection and Provider Liability, inclusive of ss.
327	766.401-766.409, is exempt from the requirements of this
328	subsection.
329	(5)  The requirements of subsections (1), (2), and (3) do
330	not apply to:
331	(f)  Any person holding an active license under this
332	chapter who meets all of the following criteria:
333	1.  The licensee has held an active license to practice in
334	this state or another state or some combination thereof for more
335	than 15 years.
336	2.  The licensee has either retired from the practice of
337	medicine or maintains a part-time practice of no more than 1,000
338	patient contact hours per year.
339	3.  The licensee has had no more than two claims for
340	medical malpractice resulting in an indemnity exceeding $25,000
341	within the previous 5-year period.
342	4.  The licensee has not been convicted of, or pled guilty
343	or nolo contendere to, any criminal violation specified in this
344	chapter or the medical practice act of any other state.
345	5.  The licensee has not been subject within the last 10
346	years of practice to license revocation or suspension for any
347	period of time; probation for a period of 3 years or longer; or
348	a fine of $500 or more for a violation of this chapter or the
349	medical practice act of another jurisdiction. The regulatory
350	agency's acceptance of a physician's relinquishment of a
351	license, stipulation, consent order, or other settlement,
352	offered in response to or in anticipation of the filing of
353	administrative charges against the physician's license,
354	constitutes action against the physician's license for the
355	purposes of this paragraph.
356	6.  The licensee has submitted a form supplying necessary
357	information as required by the department and an affidavit
358	affirming compliance with this paragraph.
359	7.  The licensee must submit biennially to the department
360	certification stating compliance with the provisions of this
361	paragraph. The licensee must, upon request, demonstrate to the
362	department information verifying compliance with this paragraph.
363
364	A licensee who meets the requirements of this paragraph must
365	post notice in the form of a sign prominently displayed in the
366	reception area and clearly noticeable by all patients or provide
367	a written statement to any person to whom medical services are
368	being provided. The sign or statement must read as follows:
369	"Under Florida law, physicians are generally required to carry
370	medical malpractice insurance or otherwise demonstrate financial
371	responsibility to cover potential claims for medical
372	malpractice. However, certain part-time physicians who meet
373	state requirements are exempt from the financial responsibility
374	law. YOUR DOCTOR MEETS THESE REQUIREMENTS AND HAS DECIDED NOT TO
375	CARRY MEDICAL MALPRACTICE INSURANCE. This notice is provided
376	pursuant to Florida law." In addition, a licensee who is covered
377	for claims of medical negligence arising from care and treatment
378	of patients in a hospital that assumes sole and exclusive
379	liability for all such claims pursuant to the Enterprise Act for
380	Patient Protection and Provider Liability, inclusive of ss.
381	766.401-766.409, shall post notice in the form of a sign
382	prominently displayed in the reception area and clearly
383	noticeable by all patients or provide a written statement to any
384	person for whom the physician may provide medical care and
385	treatment in any such hospital in accordance with the
386	requirements of s. 766.404.
387	(g)  Any person holding an active license under this
388	chapter who agrees to meet all of the following criteria:
389	1.  Upon the entry of an adverse final judgment arising
390	from a medical malpractice arbitration award, from a claim of
391	medical malpractice either in contract or tort, or from
392	noncompliance with the terms of a settlement agreement arising
393	from a claim of medical malpractice either in contract or tort,
394	the licensee shall pay the judgment creditor the lesser of the
395	entire amount of the judgment with all accrued interest or
396	either $100,000, if the physician is licensed pursuant to this
397	chapter but does not maintain hospital staff privileges, or
398	$250,000, if the physician is licensed pursuant to this chapter
399	and maintains hospital staff privileges, within 60 days after
400	the date such judgment became final and subject to execution,
401	unless otherwise mutually agreed to in writing by the parties.
402	Such adverse final judgment shall include any cross-claim,
403	counterclaim, or claim for indemnity or contribution arising
404	from the claim of medical malpractice. Upon notification of the
405	existence of an unsatisfied judgment or payment pursuant to this
406	subparagraph, the department shall notify the licensee by
407	certified mail that he or she shall be subject to disciplinary
408	action unless, within 30 days from the date of mailing, he or
409	she either:
410	a.  Shows proof that the unsatisfied judgment has been paid
411	in the amount specified in this subparagraph; or
412	b.  Furnishes the department with a copy of a timely filed
413	notice of appeal and either:
414	(I)  A copy of a supersedeas bond properly posted in the
415	amount required by law; or
416	(II)  An order from a court of competent jurisdiction
417	staying execution on the final judgment pending disposition of
418	the appeal.
419	2.  The Department of Health shall issue an emergency order
420	suspending the license of any licensee who, after 30 days
421	following receipt of a notice from the Department of Health, has
422	failed to: satisfy a medical malpractice claim against him or
423	her; furnish the Department of Health a copy of a timely filed
424	notice of appeal; furnish the Department of Health a copy of a
425	supersedeas bond properly posted in the amount required by law;
426	or furnish the Department of Health an order from a court of
427	competent jurisdiction staying execution on the final judgment
428	pending disposition of the appeal.
429	3.  Upon the next meeting of the probable cause panel of
430	the board following 30 days after the date of mailing the notice
431	of disciplinary action to the licensee, the panel shall make a
432	determination of whether probable cause exists to take
433	disciplinary action against the licensee pursuant to
434	subparagraph 1.
435	4.  If the board determines that the factual requirements
436	of subparagraph 1. are met, it shall take disciplinary action as
437	it deems appropriate against the licensee. Such disciplinary
438	action shall include, at a minimum, probation of the license
439	with the restriction that the licensee must make payments to the
440	judgment creditor on a schedule determined by the board to be
441	reasonable and within the financial capability of the physician.
442	Notwithstanding any other disciplinary penalty imposed, the
443	disciplinary penalty may include suspension of the license for a
444	period not to exceed 5 years. In the event that an agreement to
445	satisfy a judgment has been met, the board shall remove any
446	restriction on the license.
447	5.  The licensee has completed a form supplying necessary
448	information as required by the department.
449
450	A licensee who meets the requirements of this paragraph shall be
451	required either to post notice in the form of a sign prominently
452	displayed in the reception area and clearly noticeable by all
453	patients or to provide a written statement to any person to whom
454	medical services are being provided. Such sign or statement
455	shall state: "Under Florida law, physicians are generally
456	required to carry medical malpractice insurance or otherwise
457	demonstrate financial responsibility to cover potential claims
458	for medical malpractice. YOUR DOCTOR HAS DECIDED NOT TO CARRY
459	MEDICAL MALPRACTICE INSURANCE. This is permitted under Florida
460	law subject to certain conditions. Florida law imposes penalties
461	against noninsured physicians who fail to satisfy adverse
462	judgments arising from claims of medical malpractice. This
463	notice is provided pursuant to Florida law." In addition, a
464	licensee who meets the requirements of this paragraph and who is
465	covered for claims of medical negligence arising from care and
466	treatment of patients in a hospital that assumes sole and
467	exclusive liability for all such claims pursuant to the
468	Enterprise Act for Patient Protection and Provider Liability,
469	inclusive of ss. 766.401-766.409, shall post notice in the form
470	of a sign prominently displayed in the reception area and
471	clearly noticeable by all patients or provide a written
472	statement to any person for whom the physician may provide
473	medical care and treatment in any such hospital. The sign or
474	statement must adhere to the requirements of s. 766.404.
475	Section 4.  Subsection (2) and paragraphs (f) and (g) of
476	subsection (5) of section 459.0085, Florida Statutes, are
477	amended to read:
478	459.0085  Financial responsibility.--
479	(2)  Osteopathic physicians who perform surgery in an
480	ambulatory surgical center licensed under chapter 395 and, as a
481	continuing condition of hospital staff privileges, osteopathic
482	physicians who have staff privileges must also establish
483	financial responsibility by one of the following methods:
484	(a)  Establishing and maintaining an escrow account
485	consisting of cash or assets eligible for deposit in accordance
486	with s. 625.52 in the per-claim amounts specified in paragraph
487	(b). The required escrow amount set forth in this paragraph may
488	not be used for litigation costs or attorney's fees for the
489	defense of any medical malpractice claim.
490	(b)  Obtaining and maintaining professional liability
491	coverage in an amount not less than $250,000 per claim, with a
492	minimum annual aggregate of not less than $750,000 from an
493	authorized insurer as defined under s. 624.09, from a surplus
494	lines insurer as defined under s. 626.914(2), from a risk
495	retention group as defined under s. 627.942, from the Joint
496	Underwriting Association established under s. 627.351(4),
497	through a plan of self-insurance as provided in s. 627.357, or
498	through a plan of self-insurance that meets the conditions
499	specified for satisfying financial responsibility in s. 766.110.
500	The required coverage amount set forth in this paragraph may not
501	be used for litigation costs or attorney's fees for the defense
502	of any medical malpractice claim.
503	(c)  Obtaining and maintaining an unexpired, irrevocable
504	letter of credit, established pursuant to chapter 675, in an
505	amount not less than $250,000 per claim, with a minimum
506	aggregate availability of credit of not less than $750,000. The
507	letter of credit must be payable to the osteopathic physician as
508	beneficiary upon presentment of a final judgment indicating
509	liability and awarding damages to be paid by the osteopathic
510	physician or upon presentment of a settlement agreement signed
511	by all parties to such agreement when such final judgment or
512	settlement is a result of a claim arising out of the rendering
513	of, or the failure to render, medical care and services. The
514	letter of credit may not be used for litigation costs or
515	attorney's fees for the defense of any medical malpractice
516	claim. The letter of credit must be nonassignable and
517	nontransferable. The letter of credit must be issued by any bank
518	or savings association organized and existing under the laws of
519	this state or any bank or savings association organized under
520	the laws of the United States which has its principal place of
521	business in this state or has a branch office that is authorized
522	under the laws of this state or of the United States to receive
523	deposits in this state.
524
525	This subsection shall be inclusive of the coverage in subsection
526	(1). An osteopathic physician who only performs surgery or who
527	has only clinical privileges or admitting privileges in one or
528	more certified patient safety facilities, which health care
529	facility or facilities are legally liable for medical negligence
530	of affected practitioners, pursuant to the Enterprise Act for
531	Patient Protection and Provider Liability, inclusive of ss.
532	766.401-766.409, is exempt from the requirements of this
533	subsection.
534	(5)  The requirements of subsections (1), (2), and (3) do
535	not apply to:
536	(f)  Any person holding an active license under this
537	chapter who meets all of the following criteria:
538	1.  The licensee has held an active license to practice in
539	this state or another state or some combination thereof for more
540	than 15 years.
541	2.  The licensee has either retired from the practice of
542	osteopathic medicine or maintains a part-time practice of
543	osteopathic medicine of no more than 1,000 patient contact hours
544	per year.
545	3.  The licensee has had no more than two claims for
546	medical malpractice resulting in an indemnity exceeding $25,000
547	within the previous 5-year period.
548	4.  The licensee has not been convicted of, or pled guilty
549	or nolo contendere to, any criminal violation specified in this
550	chapter or the practice act of any other state.
551	5.  The licensee has not been subject within the last 10
552	years of practice to license revocation or suspension for any
553	period of time, probation for a period of 3 years or longer, or
554	a fine of $500 or more for a violation of this chapter or the
555	medical practice act of another jurisdiction. The regulatory
556	agency's acceptance of an osteopathic physician's relinquishment
557	of a license, stipulation, consent order, or other settlement,
558	offered in response to or in anticipation of the filing of
559	administrative charges against the osteopathic physician's
560	license, constitutes action against the physician's license for
561	the purposes of this paragraph.
562	6.  The licensee has submitted a form supplying necessary
563	information as required by the department and an affidavit
564	affirming compliance with this paragraph.
565	7.  The licensee must submit biennially to the department a
566	certification stating compliance with this paragraph. The
567	licensee must, upon request, demonstrate to the department
568	information verifying compliance with this paragraph.
569
570	A licensee who meets the requirements of this paragraph must
571	post notice in the form of a sign prominently displayed in the
572	reception area and clearly noticeable by all patients or provide
573	a written statement to any person to whom medical services are
574	being provided. The sign or statement must read as follows:
575	"Under Florida law, osteopathic physicians are generally
576	required to carry medical malpractice insurance or otherwise
577	demonstrate financial responsibility to cover potential claims
578	for medical malpractice. However, certain part-time osteopathic
579	physicians who meet state requirements are exempt from the
580	financial responsibility law. YOUR OSTEOPATHIC PHYSICIAN MEETS
581	THESE REQUIREMENTS AND HAS DECIDED NOT TO CARRY MEDICAL
582	MALPRACTICE INSURANCE. This notice is provided pursuant to
583	Florida law." In addition, a licensee who is covered for claims
584	of medical negligence arising from care and treatment of
585	patients in a hospital that assumes sole and exclusive liability
586	for all such claims pursuant to the Enterprise Act for Patient
587	Protection and Provider Liability, inclusive of ss. 766.401-
588	766.409, shall post notice in the form of a sign prominently
589	displayed in the reception area and clearly noticeable by all
590	patients or provide a written statement to any person for whom
591	the osteopathic physician may provide medical care and treatment
592	in any such hospital in accordance with the requirements of s.
593	766.404.
594	(g)  Any person holding an active license under this
595	chapter who agrees to meet all of the following criteria.
596	1.  Upon the entry of an adverse final judgment arising
597	from a medical malpractice arbitration award, from a claim of
598	medical malpractice either in contract or tort, or from
599	noncompliance with the terms of a settlement agreement arising
600	from a claim of medical malpractice either in contract or tort,
601	the licensee shall pay the judgment creditor the lesser of the
602	entire amount of the judgment with all accrued interest or
603	either $100,000, if the osteopathic physician is licensed
604	pursuant to this chapter but does not maintain hospital staff
605	privileges, or $250,000, if the osteopathic physician is
606	licensed pursuant to this chapter and maintains hospital staff
607	privileges, within 60 days after the date such judgment became
608	final and subject to execution, unless otherwise mutually agreed
609	to in writing by the parties. Such adverse final judgment shall
610	include any cross-claim, counterclaim, or claim for indemnity or
611	contribution arising from the claim of medical malpractice. Upon
612	notification of the existence of an unsatisfied judgment or
613	payment pursuant to this subparagraph, the department shall
614	notify the licensee by certified mail that he or she shall be
615	subject to disciplinary action unless, within 30 days from the
616	date of mailing, the licensee either:
617	a.  Shows proof that the unsatisfied judgment has been paid
618	in the amount specified in this subparagraph; or
619	b.  Furnishes the department with a copy of a timely filed
620	notice of appeal and either:
621	(I)  A copy of a supersedeas bond properly posted in the
622	amount required by law; or
623	(II)  An order from a court of competent jurisdiction
624	staying execution on the final judgment, pending disposition of
625	the appeal.
626	2.  The Department of Health shall issue an emergency order
627	suspending the license of any licensee who, after 30 days
628	following receipt of a notice from the Department of Health, has
629	failed to: satisfy a medical malpractice claim against him or
630	her; furnish the Department of Health a copy of a timely filed
631	notice of appeal; furnish the Department of Health a copy of a
632	supersedeas bond properly posted in the amount required by law;
633	or furnish the Department of Health an order from a court of
634	competent jurisdiction staying execution on the final judgment
635	pending disposition of the appeal.
636	3.  Upon the next meeting of the probable cause panel of
637	the board following 30 days after the date of mailing the notice
638	of disciplinary action to the licensee, the panel shall make a
639	determination of whether probable cause exists to take
640	disciplinary action against the licensee pursuant to
641	subparagraph 1.
642	4.  If the board determines that the factual requirements
643	of subparagraph 1. are met, it shall take disciplinary action as
644	it deems appropriate against the licensee. Such disciplinary
645	action shall include, at a minimum, probation of the license
646	with the restriction that the licensee must make payments to the
647	judgment creditor on a schedule determined by the board to be
648	reasonable and within the financial capability of the
649	osteopathic physician. Notwithstanding any other disciplinary
650	penalty imposed, the disciplinary penalty may include suspension
651	of the license for a period not to exceed 5 years. In the event
652	that an agreement to satisfy a judgment has been met, the board
653	shall remove any restriction on the license.
654	5.  The licensee has completed a form supplying necessary
655	information as required by the department.
656
657	A licensee who meets the requirements of this paragraph shall be
658	required either to post notice in the form of a sign prominently
659	displayed in the reception area and clearly noticeable by all
660	patients or to provide a written statement to any person to whom
661	medical services are being provided. Such sign or statement
662	shall state: "Under Florida law, osteopathic physicians are
663	generally required to carry medical malpractice insurance or
664	otherwise demonstrate financial responsibility to cover
665	potential claims for medical malpractice. YOUR OSTEOPATHIC
666	PHYSICIAN HAS DECIDED NOT TO CARRY MEDICAL MALPRACTICE
667	INSURANCE. This is permitted under Florida law subject to
668	certain conditions. Florida law imposes strict penalties against
669	noninsured osteopathic physicians who fail to satisfy adverse
670	judgments arising from claims of medical malpractice. This
671	notice is provided pursuant to Florida law." In addition, a
672	licensee who meets the requirements of this paragraph and who is
673	covered for claims of medical negligence arising from care and
674	treatment of patients in a hospital that assumes sole and
675	exclusive liability for all such claims pursuant to an
676	enterprise plan for patient protection and provider liability
677	under ss. 766.401-766.409, shall post notice in the form of a
678	sign prominently displayed in the reception area and clearly
679	noticeable by all patients or provide a written statement to any
680	person for whom the osteopathic physician may provide medical
681	care and treatment in any such hospital. The sign or statement
682	must adhere to the requirements of s. 766.404.
683	Section 5.  Section 627.41485, Florida Statutes, is created
684	to read:
685	627.41485  Medical malpractice insurers; optional coverage
686	exclusion for insureds who are covered by an enterprise plan for
687	patient protection and provider liability.--
688	(1)  An insurer issuing policies of professional liability
689	coverage for claims arising out of the rendering of, or the
690	failure to render, medical care or services may make available
691	to physicians licensed under chapter 458 and to osteopathic
692	physicians licensed under chapter 459 coverage having an
693	appropriate exclusion for acts of medical negligence occurring
694	within:
695	(a)  A certified patient safety facility that bears sole
696	and exclusive liability for acts of medical negligence pursuant
697	to the Enterprise Act for Patient Protection and Provider
698	Liability, inclusive of ss. 766.401-766.409, subject to the
699	usual underwriting standards; or
700	(b)  A statutory teaching hospital that has agreed to
701	indemnify the physician or osteopathic physician for legal
702	liability pursuant to s. 766.110(2)(c), subject to the usual
703	underwriting standards.
704	(2)  The Department of Financial Services may adopt rules
705	to administer this section.
706	Section 6.  Section 766.316, Florida Statutes, is amended
707	to read:
708	766.316  Notice to obstetrical patients of participation in
709	the plan.--Each hospital with a participating physician on its
710	staff, each hospital that assumes liability for affected
711	physicians pursuant to the Enterprise Act for Patient Protection
712	and Provider Liability, inclusive of ss. 766.401-766.409, and
713	each participating physician, other than residents, assistant
714	residents, and interns deemed to be participating physicians
715	under s. 766.314(4)(c), under the Florida Birth-Related
716	Neurological Injury Compensation Plan shall provide notice to
717	the obstetrical patients as to the limited no-fault alternative
718	for birth-related neurological injuries. Such notice shall be
719	provided on forms furnished by the association and shall include
720	a clear and concise explanation of a patient's rights and
721	limitations under the plan. The hospital or the participating
722	physician may elect to have the patient sign a form
723	acknowledging receipt of the notice form. Signature of the
724	patient acknowledging receipt of the notice form raises a
725	rebuttable presumption that the notice requirements of this
726	section have been met. Notice need not be given to a patient
727	when the patient has an emergency medical condition as defined
728	in s. 395.002(9)(b) or when notice is not practicable.
729	Section 7.  Subsection (2) of section 766.110, Florida
730	Statutes, is amended to read:
731	766.110  Liability of health care facilities.--
732	(2)(a)  Every hospital licensed under chapter 395 may carry
733	liability insurance or adequately insure itself in an amount of
734	not less than $1.5 million per claim, $5 million annual
735	aggregate to cover all medical injuries to patients resulting
736	from negligent acts or omissions on the part of those members of
737	its medical staff who are covered thereby in furtherance of the
738	requirements of ss. 458.320 and 459.0085. Self-insurance
739	coverage extended hereunder to a member of a hospital's medical
740	staff meets the financial responsibility requirements of ss.
741	458.320 and 459.0085 if the physician's coverage limits are not
742	less than the minimum limits established in ss. 458.320 and
743	459.0085 and the hospital is a verified trauma center that has
744	extended self-insurance coverage continuously to members of its
745	medical staff for activities both inside and outside of the
746	hospital. Any insurer authorized to write casualty insurance may
747	make available, but is shall not be required to write, such
748	coverage. The hospital may assess on an equitable and pro rata
749	basis the following professional health care providers for a
750	portion of the total hospital insurance cost for this coverage:
751	physicians licensed under chapter 458, osteopathic physicians
752	licensed under chapter 459, podiatric physicians licensed under
753	chapter 461, dentists licensed under chapter 466, and nurses
754	licensed under part I of chapter 464. The hospital may provide
755	for a deductible amount to be applied against any individual
756	health care provider found liable in a law suit in tort or for
757	breach of contract. The legislative intent in providing for the
758	deductible to be applied to individual health care providers
759	found negligent or in breach of contract is to instill in each
760	individual health care provider the incentive to avoid the risk
761	of injury to the fullest extent and ensure that the citizens of
762	this state receive the highest quality health care obtainable.
763	(b)  Except with regard to hospitals that receive sovereign
764	immunity under s. 768.28, each hospital licensed under chapter
765	395 which assumes sole and exclusive liability for acts of
766	medical negligence by affected providers pursuant to the
767	Enterprise Act for Patient Protection and Provider Liability,
768	inclusive of ss. 766.401-766.409, shall carry liability
769	insurance or adequately insure itself in an amount not less than
770	$2.5 million per claim, $7.5 million annual aggregate to cover
771	all medical injuries to patients resulting from negligent acts
772	or omissions on the part of affected physicians and
773	practitioners who are covered by an enterprise plan for patient
774	protection and provider liability. The hospital's policy of
775	medical liability insurance or self-insurance must satisfy the
776	financial responsibility requirements of ss. 458.320(2) and
777	459.0085(2) for affected providers. Any authorized insurer as
778	defined in s. 626.914(2), risk retention group as defined in s.
779	627.942, or joint underwriting association established under s.
780	627.351(4) that has authority to write casualty insurance may
781	make available, but is not required to write, such coverage.
782	(c)  Notwithstanding any provision in the Insurance Code to
783	the contrary, a statutory teaching hospital, as defined in s.
784	408.07, other than a hospital that receives sovereign immunity
785	under s. 768.28, which complies with the patient safety measures
786	specified in s. 766.403 and all other requirements of s.
787	766.409, including approval by the Agency for Health Care
788	Administration, may agree to indemnify some or all members of
789	its medical staff, including, but not limited to, physicians
790	having clinical privileges who are not employees or agents of
791	the hospital and any organization, association, or group of
792	persons liable for the negligent acts of such physicians,
793	whether incorporated or unincorporated, and some or all medical,
794	nursing, or allied health students affiliated with the hospital,
795	collectively known as covered persons, other than persons exempt
796	from liability due to sovereign immunity under s. 768.28, for
797	legal liability of such covered persons for loss, damages, or
798	expense arising out of medical negligence within the hospital
799	premises, as defined in s. 766.401, thereby providing limited
800	malpractice coverage for such covered persons. Any hospital that
801	agrees to provide malpractice coverage for covered persons under
802	this section shall acquire an appropriate policy of professional
803	liability insurance or establish and maintain a fund from which
804	such malpractice coverage is provided, in accordance with usual
805	underwriting standards. Such insurance or fund may be separate
806	and apart from any insurance or fund maintained by or on behalf
807	of the hospital or combined in a single policy of insurance or a
808	fund maintained by or on behalf of the hospital. Any hospital
809	that provides malpractice coverage to covered persons as defined
810	in this paragraph through a fund providing any such malpractice
811	coverage, shall annually provide a certified financial statement
812	containing actuarial projections as to the soundness of reserves
813	to the Agency for Health Care Administration. The indemnity
814	agreements or malpractice coverage provided by this section
815	shall be in amounts that, at a minimum, meet the financial
816	responsibility requirements of ss. 458.320 and 459.0085 for
817	affected providers. Any such indemnity agreement or malpractice
818	coverage in such amounts satisfies the financial responsibility
819	requirements of ss. 458.320 and 459.0085 for affected providers.
820	Any statutory teaching hospital that agrees to indemnify
821	physicians or other covered persons for medical negligence on
822	the premises pursuant to this section may charge such physicians
823	or other covered persons a reasonable fee for malpractice
824	coverage, notwithstanding any provision in the Insurance Code to
825	the contrary. Such fee shall be based on appropriate actuarial
826	criteria. This paragraph does not constitute a waiver of
827	sovereign immunity under s. 768.28. Nothing in this subsection
828	impairs a hospital's ability to indemnify member of its medical
829	staff to the extent such indemnification is allowed by law.
830	Section 8.  Subsections (6) and (7) of section 766.118,
831	Florida Statutes, are renumbered as subsections (7) and (8),
832	respectively, and new subsection (6) is added to said section,
833	to read:
834	766.118  Determination of noneconomic damages.--
835	(6)  LIMITATION ON NONECONOMIC DAMAGES FOR NEGLIGENCE OF
836	CERTAIN HOSPITALS.--A hospital that has received an order from
837	the Agency for Health Care Administration pursuant to s. 766.410
838	certifying that the facility complies with patient safety
839	measures specified in s. 766.403 shall be liable for no more
840	than $500,000 in noneconomic damages, regardless of the number
841	of claimants or theory of liability, including vicarious
842	liability, and notwithstanding any other provisions of this
843	section.
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, in accordance with agency order, is solely and
864	exclusively liable for the medical negligence within the
865	licensed facility by affected physicians and practitioners who
866	are employees or agents of an accredited medical school or who
867	are employees or agents of the hospital.
868	(7)  "Clinical privileges" means the privileges granted to
869	a physician or other licensed health care practitioner to render
870	patient care services in a hospital.
871	(8)  "Eligible hospital" or "licensed facility" means:
872	(a)  A statutory teaching hospital as defined by s. 408.07,
873	which maintains at least seven different accredited graduate
874	medical education programs and has 100 or more full-time
875	equivalent resident physicians; or
876	(b)  A hospital licensed in accordance with chapter 395
877	which is wholly owned by a university based in this state which
878	maintains an accredited medical school.
879	(9)  "Employee or agent of an accredited medical school"
880	means any physician or practitioner who is a full-time employee
881	or agent of the accredited medical school or who devotes his or
882	her entire paid professional effort to the accredited medical
883	school.
884	(10)  "Enterprise plan" means a document adopted by the
885	governing board of an eligible hospital and the executive
886	committee of the medical staff of the eligible hospital, however
887	defined, or the board of trustees of a state university,
888	manifesting concurrence and setting forth certain rights,
889	duties, privileges, obligations, and responsibilities of the
890	health care facility and its medical staff, or its affiliated
891	medical school, in furtherance of seeking and maintaining status
892	as a certified patient safety facility.
893	(11)  "Health care provider" or "provider" means:
894	(a)  An eligible hospital.
895	(b)  A physician or physician assistant licensed under
896	chapter 458.
897	(c)  An osteopathic physician or osteopathic physician
898	assistant licensed under chapter 459.
899	(d)  A registered nurse, nurse midwife, licensed practical
900	nurse, or advanced registered nurse practitioner licensed or
901	registered under part I of chapter 464 or any facility that
902	employs nurses licensed or registered under part I of chapter
903	464 to supply all or part of the care delivered by that
904	facility.
905	(e)  A health care professional association and its
906	employees or a corporate medical group and its employees.
907	(f)  Any other medical facility the primary purpose of
908	which is to deliver human medical diagnostic services or which
909	delivers nonsurgical human medical treatment, including an
910	office maintained by a provider.
911	(g)  A free clinic that delivers only medical diagnostic
912	services or nonsurgical medical treatment free of charge to all
913	low-income recipients.
914	(h)  Any other health care professional, practitioner, or
915	provider, including a student enrolled in an accredited program
916	that prepares the student for licensure as any one of the
917	professionals listed in this subsection.
918
919	The term includes any person, organization, or entity that is
920	vicariously liable under the theory of respondent superior or
921	any other theory of legal liability for medical negligence
922	committed by any licensed professional listed in this
923	subsection. The term also includes any nonprofit corporation
924	qualified as exempt from federal income taxation under s. 501(a)
925	of the Internal Revenue Code, and described in s. 501(c) of the
926	Internal Revenue Code, including any university or medical
927	school that employs licensed professionals listed in this
928	subsection or that delivers health care services provided by
929	licensed professionals listed in this subsection, any federally
930	funded community health center, and any volunteer corporation or
931	volunteer health care provider that delivers health care
932	services.
933	(12)  "Health care practitioner" or "practitioner" means
934	any person, entity, or organization identified in subsection
935	(9), except for a hospital.
936	(13)  "Medical incident" or "adverse incident" has the same
937	meaning as provided in ss. 381.0271, 395.0197, 458.351, and
938	459.026.
939	(14)  "Medical negligence" means medical malpractice,
940	whether grounded in tort or in contract, arising out of the
941	rendering of or failure to render medical care or services.
942	(15)  "Medical staff" means a physician licensed under
943	chapter 458 or chapter 459 having clinical privileges and active
944	status in a licensed facility. The term includes any affected
945	physician.
946	(16)  "Person" means any individual, partnership,
947	corporation, association, or governmental unit.
948	(17)  "Premises" means those buildings, beds, and equipment
949	located at the address of the licensed facility and all other
950	buildings, beds, and equipment for the provision of hospital,
951	ambulatory surgical, mobile surgical care, primary care, or
952	comprehensive health care under the dominion and control of the
953	licensee, including offices and locations where the licensed
954	facility provides medical care and treatment to affected
955	patients.
956	(18)  "Statutory teaching hospital" or "teaching hospital"
957	has the same meaning as provided in s. 408.07.
958	(19)  "Within the licensed facility" or "within the
959	premise" means anywhere on the premises of the licensed facility
960	or the premises of any office, clinic, or ancillary facility
961	that is owned or leased or controlled by the licensed 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 by affected
1092	physicians and affected practitioners who are employees or
1093	agents of the accredited medical school or employees or agents
1094	of the hospital when such medical negligence causes damage to
1095	affected patients.
1096	(2)  In any action for personal injury or wrongful death,
1097	whether in contract or tort or predicated upon a statutory cause
1098	of action, arising out of medical negligence within the premises
1099	resulting in damages to a patient of a certified patient safety
1100	facility, the licensed facility bears sole and exclusive
1101	liability for medical negligence by affected physicians and
1102	affected practitioners who, when the act of medical negligence
1103	occurred, were employees or agents of the accredited medical
1104	school or employees or agents of the hospital. Any such affected
1105	physician or affected practitioner may not be named as defendant
1106	in any such action. This subsection does not impose liability or
1107	confer immunity on any other provider, person, organization, or
1108	entity for acts of medical malpractice committed on any person
1109	in clinical settings other than the premises of the affected
1110	facility.
1111	(3)  An affected practitioner shall post an applicable
1112	notice or provide an appropriate written statement as follows:
1113	(a)  An affected practitioner shall post notice in the form
1114	of a sign prominently displayed in the reception area and
1115	clearly noticeable by all patients or provide a written
1116	statement to any person to whom medical services are being
1117	provided. The sign or statement must read as follows: "In
1118	general, physicians in the State of Florida are personally
1119	liable for acts of medical negligence, subject to certain
1120	limitations. However, physicians who perform medical services
1121	within a certified patient safety facility are exempt from
1122	personal liability because the licensed hospital bears sole and
1123	exclusive liability for acts of medical negligence within the
1124	health care facility pursuant to an administrative order of the
1125	Agency for Health Care Administration entered in accordance with
1126	the Enterprise Act for Patient Protection and Provider
1127	Liability. YOUR DOCTOR HOLDS CLINICAL STAFF PRIVILEGES IN A
1128	CERTIFIED PATIENT SAFETY FACILITY. UNDER FLORIDA LAW, ANY CLAIM
1129	FOR MEDICAL NEGLIGENCE WITHIN THE HEALTH CARE FACILITY MUST BE
1130	INITIATED AGAINST THE HOSPITAL AND NOT AGAINST YOUR DOCTOR,
1131	BECAUSE THE HOSPITAL IS SOLELY RESPONSIBLE FOR ALL ACTS OF
1132	PROFESSIONAL NEGLIGENCE WITHIN THE PREMISES. THIS PROVISION DOES
1133	NOT AFFECT YOUR PHYSICIAN'S LIABILITY FOR ACTS OF MEDICAL
1134	NEGLIGENCE IN OTHER CLINICAL SETTINGS. IF YOU DO NOT UNDERSTAND,
1135	PLEASE DISCUSS WITH YOUR DOCTOR BEFORE YOUR CONSULTATION. This
1136	notice is provided pursuant to Florida law."
1137	(b)  If an affected practitioner is covered by an
1138	enterprise plan for patient protection and provider liability in
1139	one or more licensed facilities that receive sovereign immunity,
1140	and one or more other licensed facilities, the affected
1141	practitioner shall post notice in the form of a sign prominently
1142	displayed in the reception area and clearly noticeable by all
1143	patients or provide a written statement to any person to whom
1144	medical services are being provided. The sign or statement must
1145	read as follows: "In general, physicians in the state of Florida
1146	are personally liable for acts of medical negligence, subject to
1147	certain limitations such as sovereign immunity. However,
1148	physicians who perform medical services within a certified
1149	patient safety facility are exempt from personal liability
1150	because the licensed hospital bears sole and exclusive liability
1151	for acts of medical negligence within the affected facility
1152	pursuant to an administrative order of the Agency for Health
1153	Care Administration entered in accordance with the Enterprise
1154	Act for Patient Protection and Provider Liability. YOUR DOCTOR
1155	HOLDS CLINICAL STAFF PRIVILEGES IN ONE OR MORE CERTIFIED PATIENT
1156	SAFETY FACILITIES. AT LEAST ONE OF THESE HOSPITALS IS SUBJECT TO
1157	SOVEREIGN IMMUNITY. UNDER FLORIDA LAW, ANY CLAIM FOR MEDICAL
1158	NEGLIGENCE WITHIN THE HEALTH CARE FACILITY MUST BE INITIATED
1159	AGAINST THE HOSPITAL AND NOT AGAINST YOUR DOCTOR, BECAUSE THE
1160	HOSPITAL IS SOLELY RESPONSIBLE FOR ALL ACTS OF PROFESSIONAL
1161	NEGLIGENCE WITHIN THE PREMISES. MOREOVER, RECOVERY AGAINST THE
1162	HOSPITAL MAY BE LIMITED, DUE TO FLORIDA'S SOVEREIGN IMMUNITY
1163	LAW. THESE PROVISIONS DO NOT AFFECT YOUR PHYSICIAN'S LIABILITY
1164	FOR ACTS OF MEDICAL NEGLIGENCE IN OTHER CLINICAL SETTINGS. IF
1165	YOU DO NOT UNDERSTAND, PLEASE DISCUSS WITH YOUR DOCTOR BEFORE
1166	YOUR CONSULTATION. This notice is provided pursuant to Florida
1167	law."
1168	(c)  Notice need not be given to a patient when:
1169	1.  The patient has an emergency medical condition as
1170	defined in s. 395.002;
1171	2.  The practitioner is an employee or agent of a
1172	governmental entity and is immune from liability and suit under
1173	s. 768.28; or
1174	3.  Notice is not practicable.
1175	(d)  This subsection is directory in nature. An agency
1176	order certifying approval of an enterprise plan for patient
1177	protection and provider liability shall, as a matter of law,
1178	constitute conclusive evidence that the hospital complies with
1179	all applicable patient safety requirements of s. 766.403 and all
1180	other requirements of ss. 766.401-766.409. Evidence of
1181	noncompliance with s. 766.403 or any other provision of ss.
1182	766.401-766.409 may not be admissible for any purpose in any
1183	action for medical malpractice. Failure to comply with the
1184	requirements of this subsection does not affect the liabilities
1185	or immunities conferred by ss. 766.401-766.409. This subsection
1186	does not give rise to an independent cause of action for
1187	damages.
1188	(4)  The agency order certifying approval of an enterprise
1189	plan for patient protection and provider liability applies
1190	prospectively to causes of action for medical negligence that
1191	arise on or after the effective date of the order.
1192	(5)  Upon entry of an order approving the petition, the
1193	agency may conduct onsite examinations of the licensed facility
1194	to assure continued compliance with the terms and conditions of
1195	the order.
1196	(6)  The agency order certifying approval of an enterprise
1197	plan for patient protection remains in effect until revoked. The
1198	agency shall revoke the order upon the unilateral request of the
1199	licensed facility, the executive committee of the medical staff,
1200	or the affiliated medical school, whichever is applicable. The
1201	agency may revoke the order upon reasonable notice to the
1202	affected facility that it fails to comply with material
1203	requirements of ss. 766.401-766.409 or material conditions of
1204	the order certifying approval of the enterprise plan and further
1205	upon a determination that the licensed facility has failed to
1206	cure stated deficiencies upon reasonable notice. An
1207	administrative order revoking approval of an enterprise plan for
1208	patient protection and provider liability terminates the plan on
1209	January 1 of the year following entry of the order or 6 months
1210	after entry of the order, whichever is longer. Revocation of an
1211	agency order certifying approval of an enterprise plan for
1212	patient protection and provider liability applies prospectively
1213	to causes of action for medical negligence which arise on or
1214	after the effective date of the termination.
1215	(7)  This section does not exempt a licensed facility from
1216	liability for acts of medical negligence committed by employees
1217	and agents thereof; although employees and agents of a certified
1218	patient safety facility may not be joined as defendants in any
1219	action for medical negligence because the licensed facility
1220	bears sole and exclusive liability for acts of medical
1221	negligence within the premises of the licensed facility,
1222	including acts of medical negligence by such employees and
1223	agents.
1224	(8)  Affected practitioners shall cooperate in good faith
1225	with an affected facility in the investigation and defense of
1226	any claim for medical negligence. An affected facility shall
1227	have a cause of action for damages against an affected
1228	practitioner for bad faith refusal to cooperate in the
1229	investigation and defense of any claim of medical malpractice
1230	against the licensed facility.
1231	(9)  Sections 766.401-766.409 do not impose strict
1232	liability or liability without fault for medical incidents that
1233	occur within an affected facility. To maintain a cause of action
1234	against an affected facility pursuant to ss. 766.401-766.409,
1235	the claimant must allege and prove that an employee or agent of
1236	the licensed facility, or an affected practitioner who is
1237	covered by an approved enterprise plan for patient protection
1238	and provider liability, committed medical negligence within the
1239	premises of the licensed facility which constitutes medical
1240	negligence under state law, even though an active tortfeasor is
1241	not named or joined as a party defendant in the lawsuit.
1242	(10)  Sections 766.401-766.409 do not create an independent
1243	cause of action against any health care provider and do not
1244	impose enterprise liability on any health care provider, except
1245	as expressly provided, and may not be construed to support any
1246	cause of action other than an action for medical negligence as
1247	expressly provided against any person, organization, or entity.
1248	(11)  Sections 766.401-766.409 do not waive sovereign
1249	immunity, except as expressly provided in s. 768.28.
1250	Section 13.  Section 766.405, Florida Statutes, is created
1251	to read:
1252	766.405  Enterprise plans.--
1253	(1)  It is the intent of the Legislature that enterprise
1254	plans for patient protection are elective and not mandatory for
1255	eligible hospitals. It is further the intent of the Legislature
1256	that the medical staff or affiliated medical school of an
1257	eligible hospital must concur with the development and
1258	implementation of an enterprise plan for patient protection and
1259	provider liability. It is further the intent of the Legislature
1260	that the licensed facility and medical staff or affiliated
1261	medical school be accorded wide latitude in formulating
1262	enterprise plans consistent with the underlying purpose of ss.
1263	766.401-766.409 to encourage innovative, systemic measures for
1264	patient protection and quality assurance in licensed facilities,
1265	especially in clinical settings where surgery is performed.
1266	Adoption of an enterprise plan is a necessary condition for
1267	agency approval of an enterprise plan for a certified patient
1268	safety facility.
1269	(2)  An eligible hospital and the executive committee of
1270	its medical staff of the board of trustees of a state
1271	university, if applicable, shall adopt an enterprise plan as a
1272	necessary condition to agency approval of a certified patient
1273	safety facility. An affirmative vote of approval by the
1274	regularly constituted executive committee of the medical staff,
1275	however named or constituted, is sufficient to manifest approval
1276	by the medical staff of the enterprise plan. Once approved,
1277	affected practitioners are subject to the enterprise plan. The
1278	plan may be conditioned on agency approval of an enterprise plan
1279	for patient protection and provider liability for the affected
1280	facility. The enterprise plan shall be limited to affected
1281	physicians and affected practitioners who are employees or
1282	agents of an accredited medical school or who are employees or
1283	agents of the hospital. At a minimum, the enterprise plan must
1284	contain provisions covering:
1285	(a)  Compliance with a patient protection plan.
1286	(b)  Internal review of medical incidents.
1287	(c)  Timely reporting of medical incidents to state
1288	agencies.
1289	(d)  Professional accountability of affected practitioners.
1290	(e)  Financial accountability of affected practitioners.
1291	(3)  This section does not prohibit a patient safety
1292	facility from including other provisions in the enterprise plan,
1293	in a separate agreement, as a condition of staff privileges, or
1294	by way of contract with an organization providing medical staff
1295	for the licensed facility.
1296	(4)  This section does not limit the power of any licensed
1297	facility to enter into other agreements with members of its
1298	medical staff or otherwise to impose restrictions, requirements,
1299	or conditions on clinical privileges, as authorized by law.
1300	(5)  If multiple campuses of a licensed facility share a
1301	license, the enterprise plan may be limited to the primary
1302	campus or the campus with the largest number of beds and, if
1303	applicable, associated outpatient ancillary facilities. If the
1304	enterprise plan is so limited, the plan must specify the campus
1305	and, if applicable, the ancillary facilities that will
1306	constitute the enterprise.
1307	Section 14.  Section 766.406, Florida Statutes, is created
1308	to read:
1309	766.406  Professional accountability of affected
1310	practitioners.--
1311	(1)  A certified patient safety facility shall report
1312	medical incidents occurring in the affected facility to the
1313	Department of Health, in accordance with s. 395.0197.
1314	(2)  A certified patient safety facility shall report
1315	adverse findings of medical negligence or failure to adhere to
1316	applicable standards of professional responsibility by affected
1317	practitioners to the Department of Health.
1318	(3)  A certified patient safety facility shall continue to
1319	perform all peer review functions pursuant to s. 395.0193.
1320	Section 15.  Section 766.407, Florida Statutes, is created
1321	to read:
1322	766.407  Financial accountability of affected
1323	practitioners.--
1324	(1)  An enterprise plan may provide that any affected
1325	member of the medical staff or any affected practitioner having
1326	clinical privileges, other than an employee of the licensed
1327	facility, and any organization that contracts with the licensed
1328	facility to provide practitioners to treat patients within the
1329	licensed facility, shall share equitably in the cost of omnibus
1330	medical liability insurance premiums covering the certified
1331	patient safety facility, similar self-insurance expense, or
1332	other expenses reasonably related to risk management and
1333	adjustment of claims of medical negligence. This subsection does
1334	not permit a licensed facility and any affected practitioner to
1335	agree on charges for an equitable share of medical liability
1336	expense based on the number of patients admitted to the hospital
1337	by individual practitioners, patient revenue for the licensed
1338	facility generated by individual practitioners, or overall
1339	profit or loss sustained by the certified patient safety
1340	facility in a given fiscal period.
1341	(2)  Pursuant to an enterprise plan for patient protection
1342	and provider liability, a licensed facility may impose a
1343	reasonable assessment against an affected practitioner that
1344	commits medical negligence resulting in injury and damages to an
1345	affected patient of the health care facility, upon a
1346	determination of failure to adhere to acceptable standards of
1347	professional responsibility by an internal peer review
1348	committee. A schedule of assessments, criteria for the levying
1349	of assessments, procedures for levying assessments, and due
1350	process rights of an affected practitioner must be agreed to by
1351	the executive committee of the medical staff or affiliated
1352	medical school, as applicable, and the licensed facility. The
1353	legislative intent in providing for assessments against an
1354	affected physician is to instill in each individual health care
1355	practitioner the incentive to avoid the risk of injury to the
1356	fullest extent and ensure that the residents of this state
1357	receive the highest quality health care obtainable. Failure to
1358	pay an assessment constitutes grounds for suspension of clinical
1359	privileges by the licensed facility. Assessments may be enforced
1360	as bona fide debts in a court of law. The licensed facility may
1361	exempt its employees and agents from all such assessments.
1362	Employees and agents of the state, its agencies, and
1363	subdivisions, as defined by s. 768.28, are exempt from all such
1364	assessments.
1365	(3)  An assessment levied pursuant to this section is not
1366	discoverable or admissible as evidence in any legal action.
1367	Section 16.  Section 766.408, Florida Statutes, is created
1368	to read:
1369	766.408  Data collection and reports.--
1370	(1)  Each certified patient safety facility shall submit an
1371	annual report to the agency containing information and data
1372	reasonably required by the agency to evaluate performance and
1373	effectiveness of the facility's enterprise plan for patient
1374	protection and provider liability. However, information may not
1375	be submitted or disclosed in violation of any patient's right to
1376	privacy under state or federal law.
1377	(2)  The agency shall aggregate information and data
1378	submitted by all affected facilities and each year, on or before
1379	March 1, the agency shall submit a report to the Legislature
1380	that evaluates the performance and effectiveness of the
1381	enterprise approach to patient safety and provider liability in
1382	certified patient safety facilities, which reports must include,
1383	but are not limited to, pertinent data on:
1384	(a)  The number and names of affected facilities;
1385	(b)  The number and types of patient protection measures
1386	currently in effect in these facilities;
1387	(c)  The number of affected practitioners;
1388	(d)  The number of affected patients;
1389	(e)  The number of surgical procedures by affected
1390	practitioners on affected patients;
1391	(f)  The number of medical incidents, claims of medical
1392	malpractice, and claims resulting in indemnity;
1393	(g)  The average time for resolution of contested and
1394	uncontested claims of medical malpractice;
1395	(h)  The percentage of claims that result in civil trials;
1396	(i)  The percentage of civil trials resulting in adverse
1397	judgments against affected facilities;
1398	(j)  The number and average size of an indemnity paid to
1399	claimants;
1400	(k)  The number and average size of assessments imposed on
1401	affected practitioners;
1402	(l)  The estimated liability expense, inclusive of medical
1403	liability insurance premiums; and
1404	(m)  The percentage of medical liability expense, inclusive
1405	of medical liability insurance premiums, which is borne by
1406	affected practitioners in affected health care facilities.
1407
1408	Such reports to the Legislature may also include other
1409	information and data that the agency deems appropriate to gauge
1410	the cost and benefit of enterprise plans for patient protection
1411	and provider liability.
1412	(3)  The agency's annual report to the Legislature may
1413	include relevant information and data obtained from the Office
1414	of Insurance Regulation within the Department of Financial
1415	Services on the availability and affordability of enterprise-
1416	wide medical liability insurance coverage for affected
1417	facilities and the availability and affordability of insurance
1418	policies for individual practitioners which contain coverage
1419	exclusions for acts of medical negligence in certified patient
1420	safety facilities. The Office of Insurance Regulation within the
1421	Department of Financial Services shall cooperate with the agency
1422	in the reporting of information and data specified in this
1423	subsection.
1424	(4)  Reports submitted to the agency by affected facilities
1425	pursuant to this section are public records under chapter 199.
1426	However, these reports, and the information contained therein,
1427	are not admissible as evidence in a court of law in any action.
1428	Section 17.  Section 766.409, Florida Statutes, is created
1429	to read:
1430	766.409  Damages in malpractice actions against certain
1431	hospitals that meet patient safety requirements; agency approval
1432	of patient safety measures.--
1433	(1)  In recognition of their essential role in training
1434	future health care providers and in providing innovative medical
1435	care for this state's residents, in recognition of their
1436	commitment to treating indigent patients, and further in
1437	recognition that all teaching hospitals, as defined in s.
1438	408.07, both public and private, and hospitals licensed under
1439	chapter 395 which are owned and operated by a university that
1440	maintains an accredited medical school, collectively defined as
1441	eligible hospitals in s. 766.401(8), provide benefits to the
1442	residents of this state through their roles in improving the
1443	quality of medical care, training health care providers, and
1444	caring for indigent patients, the limits of liability for
1445	medical malpractice arising out of the rendering of, or the
1446	failure to render, medical care by all such hospitals, shall be
1447	determined in accordance with the requirements of this section.
1448	(2)  Except as otherwise provided in subsections (9) and
1449	(10), any eligible hospital may petition the agency to enter an
1450	order certifying that the licensed facility complies with
1451	patient safety measures specified in s. 766.403.
1452	(3)  In accordance with chapter 120, the agency shall enter
1453	an order approving the petition upon a showing that the eligible
1454	hospital complies with the patient safety measures specified in
1455	s. 766.403. Upon entry of an order, and for the entire period of
1456	time that the order remains in effect, the damages recoverable
1457	from the eligible hospital covered by the order and its
1458	employees and agents in actions arising from medical negligence
1459	shall be determined in accordance with the following provisions:
1460	(a)  Noneconomic damages shall be limited to a maximum of
1461	$500,000, regardless of the number of claimants or the theory of
1462	liability, in accordance with s. 766.118(6).
1463	(b)  Awards of economic damages shall be offset by payments
1464	from collateral sources, as defined by s. 766.202(2), and any
1465	set-offs available under ss. 46.015 and 768.041. Awards for
1466	future economic losses shall be offset by future collateral
1467	source payments.
1468	(c)  Awards of future economic damages, after being offset
1469	by collateral sources, shall, at the option of the eligible
1470	hospital, be reduced by the court to present value or paid by
1471	means of periodic payments in the form of annuities or
1472	reversionary trusts. Payment for damages awarded to compensate a
1473	claimant for future medical and rehabilitation expenses or loss
1474	of future earning capacity when the claimant does not have a
1475	spouse, lineal descendants, or a surviving parent, shall be paid
1476	for the life of the claimant or for so long as the condition for
1477	which the award was made persists, whichever is shorter, without
1478	regard to the number of years awarded by the trier of fact, at
1479	which time the obligation to make such payments terminates. An
1480	eligible hospital seeking to cause future payments to be
1481	terminated pursuant to this provision shall be liable for the
1482	reasonable attorney's fees incurred by a claimant or the
1483	claimant's representative in responding to a petition seeking
1484	such relief. A company that underwrites an annuity to pay future
1485	economic damages shall have rating of "A" or higher by A.M. Best
1486	Company. The terms of the reversionary instrument used to
1487	periodically pay future economic damages must be approved by the
1488	court; such approval may not be unreasonably withheld.
1489	(4)  The limitations on damages in subsection (3) apply
1490	prospectively to causes of action for medical negligence that
1491	arise on or after the effective date of the order.
1492	(5)  Upon entry of an order approving the petition, the
1493	agency may conduct onsite examinations of the licensed facility
1494	to assure continued compliance with terms and conditions of the
1495	order.
1496	(6)  The agency order certifying approval of a petition
1497	under this section remains in effect until revoked. The agency
1498	may revoke the order upon reasonable notice to the affected
1499	hospital that it fails to comply with material requirements of
1500	ss. 766.401-766.409 or material conditions of the order
1501	certifying compliance with required patient safety measures and
1502	that the hospital has failed to cure stated deficiencies upon
1503	reasonable notice. Revocation of an agency order certifying
1504	approval of an enterprise plan for patient protection and
1505	provider liability applies prospectively to causes of action for
1506	medical negligence that arise on or after the effective date of
1507	the order of revocation.
1508	(7)  An agency order certifying approval of a petition
1509	under this section shall, as a matter of law, constitute
1510	conclusive evidence that the hospital complies with all
1511	applicable patient safety requirements of s. 766.403. A
1512	hospital's noncompliance with the requirements of s. 766.403 may
1513	not affect the limitations on damages conferred by this section.
1514	Evidence of noncompliance with s. 766.403 may not be admissible
1515	for any purpose in any action for medical malpractice. This
1516	section, or any portion thereof, may not give rise to an
1517	independent cause of action for damages against any hospital.
1518	(8)  The entry of an agency order pursuant to this section
1519	does not impose enterprise liability, or sole and exclusive
1520	liability, on the licensed facility for acts or omissions of
1521	medical negligence within the premises.
1522	(9)  An eligible hospital may petition the agency for an
1523	order pursuant to this section or an order pursuant to s.
1524	766.404. However, a hospital may not be approved for both
1525	enterprise liability under s. 766.404 and the limitations on
1526	damages under this section.
1527	(10)  This section may not apply to hospitals that are
1528	subject to sovereign immunity under s. 768.28.
1529	Section 18.  Section 766.410, Florida Statutes, is created
1530	to read:
1531	766.410  Rulemaking authority.--The agency may adopt rules
1532	to administer ss. 766.401-766.409.
1533	Section 19.  Subsections (5) and (12) of section 768.28,
1534	Florida Statutes, are amended to read:
1535	768.28  Waiver of sovereign immunity in tort actions;
1536	recovery limits; limitation on attorney fees; statute of
1537	limitations; exclusions; indemnification; risk management
1538	programs.--
1539	(5)(a)  The state and its agencies and subdivisions shall
1540	be liable for tort claims in the same manner and to the same
1541	extent as a private individual under like circumstances, but
1542	liability does shall not include punitive damages or interest
1543	for the period before judgment.
1544	(b)  Except as provided in paragraph (c), neither the state
1545	or nor its agencies or subdivisions are shall be liable to pay a
1546	claim or a judgment by any one person which exceeds the sum of
1547	$100,000 or any claim or judgment, or portions thereof, which,
1548	when totaled with all other claims or judgments paid by the
1549	state or its agencies or subdivisions arising out of the same
1550	incident or occurrence, exceeds the sum of $200,000. However, a
1551	judgment or judgments may be claimed and rendered in excess of
1552	these amounts and may be settled and paid pursuant to this act
1553	up to $100,000 or $200,000, as the case may be; and that portion
1554	of the judgment that exceeds these amounts may be reported to
1555	the Legislature, but may be paid in part or in whole only by
1556	further act of the Legislature. Notwithstanding the limited
1557	waiver of sovereign immunity provided herein, the state or an
1558	agency or subdivision thereof may agree, within the limits of
1559	insurance coverage provided, to settle a claim made or a
1560	judgment rendered against it without further action by the
1561	Legislature, but the state or agency or subdivision thereof
1562	shall not be deemed to have waived any defense of sovereign
1563	immunity or to have increased the limits of its liability as a
1564	result of its obtaining insurance coverage for tortious acts in
1565	excess of the $100,000 or $200,000 waiver provided above. The
1566	limitations of liability set forth in this subsection shall
1567	apply to the state and its agencies and subdivisions whether or
1568	not the state or its agencies or subdivisions possessed
1569	sovereign immunity before July 1, 1974.
1570	(c)  In any action for medical negligence within a
1571	certified patient safety facility that is covered by sovereign
1572	immunity, given that the licensed health care facility bears
1573	sole and exclusive liability for acts of medical negligence
1574	pursuant to the Enterprise Act for Patient Protection and
1575	Provider Liability, inclusive of ss. 766.401-766.409, neither
1576	the state or its agencies or subdivisions are liable to pay a
1577	claim or a judgment by any one person which exceeds the sum of
1578	$150,000 or any claim or judgment, or portions thereof, which,
1579	when totaled with all other claims or judgments paid by the
1580	state or its agencies or subdivisions arising out of the same
1581	incident or occurrence, exceeds the sum of $300,000. However, a
1582	judgment may be claimed and rendered in excess of these amounts
1583	and may be settled and paid up to $150,000 or $300,000, as the
1584	case may be. That portion of the judgment which exceeds these
1585	amounts may be reported to the Legislature, but may be paid in
1586	part or in whole only by further act of the Legislature.
1587	Notwithstanding the limited waiver of sovereign immunity
1588	provided in this paragraph, the state or an agency or
1589	subdivision thereof may agree, within the limits of insurance or
1590	self-insurance coverage provided, to settle a claim made or a
1591	judgment rendered against it without further action by the
1592	Legislature, but the state or agency or subdivision thereof does
1593	not waive any defense of sovereign immunity or increase limits
1594	of its liability as a result of its obtaining insurance coverage
1595	or providing for self-insurance to cover claims for medical
1596	negligence in excess of the $150,000 waiver or the $300,000
1597	waiver provided in this paragraph. The limitations of liability
1598	set forth in this paragraph apply to the state and its agencies
1599	and subdivisions whether or not the state or its agencies or
1600	subdivisions possessed sovereign immunity before July 1, 1974.
1601	(12)(a)  A health care practitioner, as defined in s.
1602	456.001(4), who has contractually agreed to act as an agent of a
1603	state university board of trustees to provide medical services
1604	to a student athlete for participation in or as a result of
1605	intercollegiate athletics, to include team practices, training,
1606	and competitions, is shall be considered an agent of the
1607	respective state university board of trustees, for the purposes
1608	of this section, while acting within the scope of and pursuant
1609	to guidelines established in that contract. The contracts shall
1610	provide for the indemnification of the state by the agent for
1611	any liabilities incurred up to the limits set out in this
1612	chapter.
1613	(b)  This subsection shall not be construed as designating
1614	persons providing contracted health care services to athletes as
1615	employees or agents of a state university board of trustees for
1616	the purposes of chapter 440.
1617	(c)1.  For purposes of this subsection, the terms
1618	"certified patient safety facility," "medical staff," and
1619	"medical negligence" have the same meanings as provided in s.
1620	766.401.
1621	2.  A certified patient safety facility, wherein a minimum
1622	of 90 percent of the members of the medical staff consist of
1623	physicians are employees or agents of a state university, is an
1624	agent of the respective state university board of trustees for
1625	purposes of this section to the extent that the licensed
1626	facility, in accordance with an enterprise plan for patient
1627	protection and provider liability, inclusive of ss. 766.401-
1628	766.409, approved by the Agency for Health Care Administration,
1629	is solely and exclusively liable for acts of medical negligence
1630	of physicians providing health care services within the licensed
1631	facility.
1632	3.  A certified patient safety facility that has been found
1633	to be an agent of the state for other purposes and has adopted
1634	an enterprise plan for patient protection and provider liability
1635	for the sole and exclusive liability for acts of medical
1636	negligence of affected practitioners who are employees and
1637	agents of the affiliated state university board of trustees and
1638	its own hospital employees and agents, inclusive of ss. 766.401-
1639	766.409, approved by the Agency for Health Care Administration,
1640	is an agent of the respective state university board of trustees
1641	for purposes of this subsection only.
1642	4.  Subject to the acceptance of the Board of Governors and
1643	a state university board of trustees, a licensed facility as
1644	described by this subsection may secure the limits of liability
1645	protection described in paragraph (c) from a self insurance
1646	program created pursuant to s. 1004.24.
1647	5.  A notice of intent to commence an action for medical
1648	negligence arising from the care or treatment of a patient in a
1649	certified patient safety facility subject to the provisions of
1650	this subsection shall be sent to the licensed facility as the
1651	statutory agent created pursuant to an enterprise plan of the
1652	related board of trustees of a state university for the limited
1653	purposes of administering an enterprise plan for patient
1654	protection and provider liability. A complaint alleging medical
1655	negligence resulting in damages to a patient in a certified
1656	patient safety facility subject to the provisions of this
1657	paragraph shall be commenced against the applicable board of
1658	trustees of a state university on the relation of the licensed
1659	facility, and the doctrines of res judicata and collateral
1660	estoppel shall apply. The complaint shall be served on the
1661	licensed facility. Any notice of intent mailed to the licensed
1662	facility, any legal process served on the licensed facility, and
1663	any other notice, paper, or pleading that is served, sent, or
1664	delivered to the licensed facility pertaining to a claim of
1665	medical negligence shall have the same legal force and effect as
1666	mailing, service, or delivery to a duly authorized agent of the
1667	board of trustees of the respective state university,
1668	notwithstanding any provision of the laws of this state to the
1669	contrary. Upon receipt of any such notice of intent, complaint
1670	for damages, or other notice, paper, or pleading pertaining to a
1671	claim of medical negligence, a licensed facility subject to the
1672	provisions of this paragraph shall give timely notice to the
1673	related board of trustees of the state university, although
1674	failure to give timely notice does not affect the legal
1675	sufficiency of the notice of intent, service of process, or
1676	other notice, paper, or pleading. A final judgment or binding
1677	arbitration award against the board of trustees of a state
1678	university on the relation of a licensed facility, arising from
1679	a claim of medical negligence resulting in damages to a patient
1680	in a certified patient safety facility subject to the provisions
1681	of this paragraph, may be enforced in the same manner, and is
1682	subject to the same limitations on enforcement or recovery, as
1683	any final judgment for damages or binding arbitration award
1684	against the board of trustees of a state university,
1685	notwithstanding any provision of the laws of this state to the
1686	contrary. Any settlement agreement executed by the board of
1687	trustees of a state university on the relation of a licensed
1688	facility, arising from a claim of medical negligence resulting
1689	in damages to a patient in a certified patient safety facility
1690	subject to the provisions of this paragraph, may be enforced in
1691	the same manner and is subject to the same limitations as a
1692	settlement agreement executed by an authorized agent of the
1693	board of trustees. The board of trustees of a state university
1694	may make payment to a claimant in whole or in part of any
1695	portion of a final judgment or binding arbitration award against
1696	the board of trustees of a state university on the relation of a
1697	licensed facility, and any portion of a settlement of a claim
1698	for medical negligence arising from a certified patient safety
1699	facility subject to the provisions of this paragraph, which
1700	exceeds the amounts of the limited waiver of sovereign immunity
1701	specified in paragraph (5)(c), only as provided in that
1702	paragraph.
1703	Section 20.  If any provision of this act or its
1704	application to any person or circumstance is held invalid, the
1705	invalidity does not affect other provisions or applications of
1706	the act which can be given effect without the invalid provision
1707	or application, and to this end, the provisions of this act are
1708	severable.
1709	Section 21.  If a conflict between any provision of this
1710	act and s. 456.052, s. 456.053, s. 456.054, s. 458.331, s.
1711	459.015, or s. 817.505, Florida Statutes, the provisions of this
1712	act shall govern. The provisions of this act should be broadly
1713	construed in furtherance of the overriding legislative intent to
1714	facilitate innovative approaches for patient protection and
1715	provider liability in eligible hospitals.
1716	Section 22.  It is the intention of the Legislature that
1717	the provisions of this act are self-executing.
1718	Section 23.  This act shall take effect upon becoming a
1719	law.

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