HB 1621

1	A bill to be entitled
2	An act relating to medical malpractice insurance; creating
3	the Enterprise Act for Patient Protection and Provider
4	Liability; providing legislative findings; amending s.
5	458.320, F.S.; requiring a licensed physician who is
6	covered for medical negligence claims by a hospital that
7	assumes liability under the act to prominently post notice
8	or provide a written statement to patients; requiring a
9	licensed physician who meets certain requirements for
10	payment or settlement of a medical malpractice claim and
11	who is covered for medical negligence claims by a hospital
12	that assumes liability under the act to prominently post
13	notice or provide a written statement to patients;
14	amending s. 459.0085, F.S.; requiring a licensed
15	osteopathic physician who is covered for medical
16	negligence claims by a hospital that assumes liability
17	under the act to prominently post notice or provide a
18	written statement to patients; requiring a licensee of
19	osteopathic medicine who meets certain requirements for
20	payment or settlement of a medical malpractice claim and
21	who is covered for medical negligence claims by a hospital
22	that assumes liability under the act to prominently post
23	notice or provide a written statement to patients;
24	creating s. 627.41485, F.S.; authorizing insurers to offer
25	liability insurance coverage to physicians which has an
26	exclusion for certain acts of medical negligence under
27	certain conditions; authorizing the Department of
28	Financial Services to adopt rules; amending s. 766.316,
29	F.S.; requiring hospitals that assume liability for
30	affected physicians under the act to provide notice to
31	obstetrical patients regarding the limited no-fault
32	alternative to birth-related neurological injuries;
33	amending s. 766.110, F.S.; requiring hospitals that assume
34	liability for acts of medical negligence under the act to
35	carry insurance; requiring the hospital's policy regarding
36	medical liability insurance to satisfy certain statutory
37	financial responsibility requirements; authorizing an
38	insurer who is authorized to write casualty insurance to
39	write such coverage; authorizing certain hospitals to
40	indemnify certain medical staff for legal liability of
41	loss, damages, or expenses arising from medical negligence
42	within hospital premises; requiring a hospital to acquire
43	a policy of professional liability insurance or a fund for
44	malpractice coverage; requiring an annual certified
45	financial statement to the Agency for Health Care
46	Administration; authorizing certain hospitals to charge
47	physicians a fee for malpractice coverage; preserving a
48	hospital's ability to indemnify certain medical staff
49	members; amending s. 766.118, F.S.; providing a cap on
50	noneconomic damages for eligible hospitals meeting certain
51	patient safety measures; creating s. 766.401, F.S.;
52	providing definitions; creating s. 766.402, F.S.;
53	authorizing an eligible hospital to petition the Agency
54	for Health Care Administration to enter an order
55	certifying the hospital as a patient safety facility;
56	providing requirements for certification as a patient
57	safety facility; creating s. 766.403, F.S.; providing
58	requirements for a hospital to demonstrate that it is
59	engaged in a common enterprise for the care and treatment
60	of patients; specifying required patient safety measures;
61	prohibiting a report or document generated under the act
62	from being admissible or discoverable as evidence;
63	creating s. 766.404, F.S.; authorizing the agency to enter
64	an order certifying a hospital as a patient safety
65	facility and providing that the hospital bears liability
66	for acts of medical negligence by certain physicians and
67	practitioners; specifying a licensed facility as bearing
68	sole and exclusive liability for medical negligence by
69	certain physicians and practitioners under certain
70	circumstances in actions for personal injury or wrongful
71	death; providing that certain persons or entities are not
72	liable for medically negligent acts occurring in a
73	certified patient safety facility; requiring that an
74	affected practitioner prominently post notice regarding
75	exemption from personal liability; requiring an affected
76	physician who is covered by an enterprise plan in a
77	licensed facility that receives sovereign immunity to
78	prominently post notice regarding exemption from personal
79	liability; providing that an agency order certifying
80	approval of an enterprise plan is evidence of a hospital's
81	compliance with applicable patient safety requirements;
82	providing circumstances in which notice is not required;
83	providing that the order certifying approval of an
84	enterprise plan applies prospectively to causes of action
85	for medical negligence; authorizing the agency to conduct
86	onsite examinations of a licensed facility; providing
87	circumstances under which the agency may revoke its order
88	certifying approval of an enterprise plan; providing that
89	an employee or agent of a certified patient safety
90	facility may not be joined as a defendant in an action for
91	medical negligence; requiring an affected practitioner to
92	cooperate in good faith in an investigation of a claim for
93	medical malpractice; providing a cause of action for
94	failure of a physician to act in good faith; providing
95	that strict liability or liability without fault is not
96	imposed for medical incidents that occur in the affected
97	facility; providing requirements that a claimant must
98	prove to demonstrate medical negligence by an employee,
99	agent, or medical staff of a licensed facility; providing
100	that the act does not create an independent cause of
101	action or waive sovereign immunity; creating s. 766.405,
102	F.S.; requiring an eligible hospital to execute an
103	enterprise plan; requiring certain conditions to be
104	contained within an enterprise plan; creating s. 766.406,
105	F.S.; requiring a certified patient safety facility to
106	report medical incidents occurring on its premises and
107	adverse findings of medical negligence to the Department
108	of Health; requiring certified patient safety facilities
109	to perform certain peer review functions; creating s.
110	766.407, F.S.; providing that an enterprise plan may
111	provide clinical privileges to certain persons; requiring
112	certain organizations to share in the cost of omnibus
113	medical liability insurance premiums subject to certain
114	conditions; authorizing a licensed facility to impose a
115	reasonable assessment against an affected practitioner who
116	commits medical negligence; providing for the revocation
117	of clinical privileges for failure to pay the assessment;
118	exempting certain employees and agents from such
119	assessments; creating s. 766.408, F.S.; requiring a
120	certified patient safety facility to submit an annual
121	report to the agency and the Legislature; providing
122	requirements for the annual report; providing that the
123	annual report may include certain information from the
124	Office of Insurance Regulation within the Department of
125	Financial Services; providing that the annual report is
126	subject to public records requirements, but is not
127	admissible as evidence in a legal proceeding; creating s.
128	766.409, F.S.; authorizing certain teaching hospitals and
129	eligible hospitals to petition the agency for
130	certification; providing criteria for determining
131	noneconomic, economic, and future economic damages
132	recoverable in actions arising from medical negligence;
133	providing for application of limitations on damages for
134	eligible hospitals that are certified for compliance with
135	certain patient safety measures; authorizing the agency to
136	conduct onsite examinations of certified eligible
137	hospitals; authorizing the agency to revoke its order
138	certifying approval of an enterprise plan; providing that
139	an agency order certifying approval of an enterprise plan
140	is evidence of a hospital's compliance with applicable
141	patient safety requirements; providing that evidence of
142	noncompliance is inadmissible in any action for medical
143	malpractice; providing that entry of the agency's order
144	does not impose enterprise liability on the licensed
145	facility for acts or omissions of medical negligence;
146	providing that a hospital may not be approved for
147	certification for both enterprise liability and
148	limitations on damages; creating s. 766.410, F.S.;
149	providing rulemaking authority; amending s. 768.28, F.S.;
150	providing limitations on payment of a claim or judgment
151	for an action for medical negligence within a certified
152	patient safety facility that is covered by sovereign
153	immunity; providing definitions; providing that a
154	certified patient safety facility is an agent of a state
155	university board of trustees to the extent that the
156	licensed facility is solely liable for acts of medical
157	negligence of physicians providing health care services
158	within the licensed facility; specifying that certain
159	certified patient safety facilities are agents of a state
160	university board of trustees under certain circumstances;
161	authorizing licensed facilities to secure limits of
162	liability protection from certain self-insurance programs;
163	providing requirements for commencing an action for
164	certain medical negligence; providing procedures;
165	providing limitations; providing for severability;
166	providing for broad statutory view of the act; providing
167	for self-execution of the act; providing an effective
168	date.
169
170	Be It Enacted by the Legislature of the State of Florida:
171
172	Section 1.  Popular name.--This act may be cited as the
173	"Enterprise Act for Patient Protection and Provider Liability."
174	Section 2.  Legislative findings.--
175	(1)  The Legislature finds that this state is in the midst
176	of a prolonged medical malpractice insurance crisis that has
177	serious adverse effects on patients, practitioners, licensed
178	healthcare facilities, and all residents of this state.
179	(2)  The Legislature finds that hospitals are central
180	components of the modern health care delivery system.
181	(3)  The Legislature finds that many of the most serious
182	incidents of medical negligence occur in hospitals, where the
183	most seriously ill patients are treated, and where surgical
184	procedures are performed.
185	(4)  The Legislature finds that modern hospitals are
186	complex organizations, that medical care and treatment in
187	hospitals is a complex process, and that, increasingly, medical
188	care and treatment in hospitals is a common enterprise involving
189	an array of responsible employees, agents, and other persons,
190	such as physicians, who are authorized to exercise clinical
191	privileges within the premises.
192	(5)  The Legislature finds that an increasing number of
193	medical incidents in hospitals involve a combination of acts and
194	omissions by employees, agents, and other persons, such as
195	physicians, who are authorized to exercise clinical privileges
196	within the premises.
197	(6)  The Legislature finds that the medical malpractice
198	insurance crisis in this state can be alleviated by the adoption
199	of innovative approaches for patient protection in hospitals
200	which can lead to a reduction in medical errors.
201	(7)  The Legislature finds statutory incentives are
202	necessary to facilitate innovative approaches for patient
203	protection in hospitals.
204	(8)  The Legislature finds that an enterprise approach to
205	patient protection and provider liability in hospitals will lead
206	to a reduction in the frequency and severity of incidents of
207	medical malpractice in hospitals.
208	(9)  The Legislature finds that a reduction in the
209	frequency and severity of incidents of medical malpractice in
210	hospitals will reduce attorney's fees and other expenses
211	inherent in the medical liability system.
212	(10)  The Legislature finds that making high-quality health
213	care available to the residents of this state is an overwhelming
214	public necessity.
215	(11)  The Legislature finds that medical education in this
216	state is an overwhelming public necessity.
217	(12)  The Legislature finds that statutory teaching
218	hospitals and hospitals owned by and operated by universities
219	that maintain accredited medical schools are essential for high-
220	quality medical care and medical education in this state.
221	(13)  The Legislature finds that the critical mission of
222	statutory teaching hospitals and hospitals owned and operated by
223	universities that maintain accredited medical schools is
224	severely undermined by the ongoing medical malpractice crisis.
225	(14)  The Legislature finds that statutory teaching
226	hospitals and hospitals owned and operated by universities that
227	maintain accredited medical schools are appropriate health care
228	facilities for the implementation of innovative approaches to
229	patient protection and provider liability.
230	(15)  The Legislature finds an overwhelming public
231	necessity to impose reasonable limitations on actions for
232	medical malpractice against statutory teaching hospitals and
233	hospitals that are owned and operated by universities that
234	maintain accredited medical schools, in furtherance of the
235	critical public interest in promoting access to high-quality
236	medical care, medical education, and innovative approaches to
237	patient protection.
238	(16)  The Legislature finds an overwhelming public
239	necessity for statutory teaching hospitals and hospitals owned
240	and operated by universities that maintain accredited medical
241	schools to implement innovative measures for patient protection
242	and provider liability in order to generate empirical data for
243	state policymakers on the effectiveness of these measures. Such
244	data may lead to broader application of these measures in a
245	wider array of hospitals after a reasonable period of evaluation
246	and review.
247	(17)  The Legislature finds an overwhelming public
248	necessity to promote the academic mission of statutory teaching
249	hospitals and hospitals owned and operated by universities that
250	maintain accredited medical schools. Furthermore, the
251	Legislature finds that the academic mission of these medical
252	facilities is materially enhanced by statutory authority for the
253	implementation of innovative approaches to patient protection
254	and provider liability. Such approaches can be carefully studied
255	and learned by medical students, medical school faculty, and
256	affiliated physicians in appropriate clinical settings, thereby
257	enlarging the body of knowledge concerning patient protection
258	and provider liability which is essential for advancement of
259	patient safety, reduction of expenses inherent in the medical
260	liability system, and curtailment of the medical malpractice
261	insurance crisis in this state.
262	Section 3.  Paragraphs (f) and (g) of subsection (5) of
263	section 458.320, Florida Statutes, are amended to read:
264	458.320  Financial responsibility.--
265	(5)  The requirements of subsections (1), (2), and (3) do
266	not apply to:
267	(f)  Any person holding an active license under this
268	chapter who meets all of the following criteria:
269	1.  The licensee has held an active license to practice in
270	this state or another state or some combination thereof for more
271	than 15 years.
272	2.  The licensee has either retired from the practice of
273	medicine or maintains a part-time practice of no more than 1,000
274	patient contact hours per year.
275	3.  The licensee has had no more than two claims for
276	medical malpractice resulting in an indemnity exceeding $25,000
277	within the previous 5-year period.
278	4.  The licensee has not been convicted of, or pled guilty
279	or nolo contendere to, any criminal violation specified in this
280	chapter or the medical practice act of any other state.
281	5.  The licensee has not been subject within the last 10
282	years of practice to license revocation or suspension for any
283	period of time; probation for a period of 3 years or longer; or
284	a fine of $500 or more for a violation of this chapter or the
285	medical practice act of another jurisdiction. The regulatory
286	agency's acceptance of a physician's relinquishment of a
287	license, stipulation, consent order, or other settlement,
288	offered in response to or in anticipation of the filing of
289	administrative charges against the physician's license,
290	constitutes action against the physician's license for the
291	purposes of this paragraph.
292	6.  The licensee has submitted a form supplying necessary
293	information as required by the department and an affidavit
294	affirming compliance with this paragraph.
295	7.  The licensee must submit biennially to the department
296	certification stating compliance with the provisions of this
297	paragraph. The licensee must, upon request, demonstrate to the
298	department information verifying compliance with this paragraph.
299
300	A licensee who meets the requirements of this paragraph must
301	post notice in the form of a sign prominently displayed in the
302	reception area and clearly noticeable by all patients or provide
303	a written statement to any person to whom medical services are
304	being provided. The sign or statement must read as follows:
305	"Under Florida law, physicians are generally required to carry
306	medical malpractice insurance or otherwise demonstrate financial
307	responsibility to cover potential claims for medical
308	malpractice. However, certain part-time physicians who meet
309	state requirements are exempt from the financial responsibility
310	law. YOUR DOCTOR MEETS THESE REQUIREMENTS AND HAS DECIDED NOT TO
311	CARRY MEDICAL MALPRACTICE INSURANCE. This notice is provided
312	pursuant to Florida law." In addition, a licensee who is covered
313	for claims of medical negligence arising from care and treatment
314	of patients in a hospital that assumes sole and exclusive
315	liability for all such claims pursuant to the Enterprise Act for
316	Patient Protection and Provider Liability, inclusive of ss.
317	766.401-766.409, shall post notice in the form of a sign
318	prominently displayed in the reception area and clearly
319	noticeable by all patients or provide a written statement to any
320	person for whom the physician may provide medical care and
321	treatment in any such hospital in accordance with the
322	requirements of s. 766.404.
323	(g)  Any person holding an active license under this
324	chapter who agrees to meet all of the following criteria:
325	1.  Upon the entry of an adverse final judgment arising
326	from a medical malpractice arbitration award, from a claim of
327	medical malpractice either in contract or tort, or from
328	noncompliance with the terms of a settlement agreement arising
329	from a claim of medical malpractice either in contract or tort,
330	the licensee shall pay the judgment creditor the lesser of the
331	entire amount of the judgment with all accrued interest or
332	either $100,000, if the physician is licensed pursuant to this
333	chapter but does not maintain hospital staff privileges, or
334	$250,000, if the physician is licensed pursuant to this chapter
335	and maintains hospital staff privileges, within 60 days after
336	the date such judgment became final and subject to execution,
337	unless otherwise mutually agreed to in writing by the parties.
338	Such adverse final judgment shall include any cross-claim,
339	counterclaim, or claim for indemnity or contribution arising
340	from the claim of medical malpractice. Upon notification of the
341	existence of an unsatisfied judgment or payment pursuant to this
342	subparagraph, the department shall notify the licensee by
343	certified mail that he or she shall be subject to disciplinary
344	action unless, within 30 days from the date of mailing, he or
345	she either:
346	a.  Shows proof that the unsatisfied judgment has been paid
347	in the amount specified in this subparagraph; or
348	b.  Furnishes the department with a copy of a timely filed
349	notice of appeal and either:
350	(I)  A copy of a supersedeas bond properly posted in the
351	amount required by law; or
352	(II)  An order from a court of competent jurisdiction
353	staying execution on the final judgment pending disposition of
354	the appeal.
355	2.  The Department of Health shall issue an emergency order
356	suspending the license of any licensee who, after 30 days
357	following receipt of a notice from the Department of Health, has
358	failed to: satisfy a medical malpractice claim against him or
359	her; furnish the Department of Health a copy of a timely filed
360	notice of appeal; furnish the Department of Health a copy of a
361	supersedeas bond properly posted in the amount required by law;
362	or furnish the Department of Health an order from a court of
363	competent jurisdiction staying execution on the final judgment
364	pending disposition of the appeal.
365	3.  Upon the next meeting of the probable cause panel of
366	the board following 30 days after the date of mailing the notice
367	of disciplinary action to the licensee, the panel shall make a
368	determination of whether probable cause exists to take
369	disciplinary action against the licensee pursuant to
370	subparagraph 1.
371	4.  If the board determines that the factual requirements
372	of subparagraph 1. are met, it shall take disciplinary action as
373	it deems appropriate against the licensee. Such disciplinary
374	action shall include, at a minimum, probation of the license
375	with the restriction that the licensee must make payments to the
376	judgment creditor on a schedule determined by the board to be
377	reasonable and within the financial capability of the physician.
378	Notwithstanding any other disciplinary penalty imposed, the
379	disciplinary penalty may include suspension of the license for a
380	period not to exceed 5 years. In the event that an agreement to
381	satisfy a judgment has been met, the board shall remove any
382	restriction on the license.
383	5.  The licensee has completed a form supplying necessary
384	information as required by the department.
385
386	A licensee who meets the requirements of this paragraph shall be
387	required either to post notice in the form of a sign prominently
388	displayed in the reception area and clearly noticeable by all
389	patients or to provide a written statement to any person to whom
390	medical services are being provided. Such sign or statement
391	shall state: "Under Florida law, physicians are generally
392	required to carry medical malpractice insurance or otherwise
393	demonstrate financial responsibility to cover potential claims
394	for medical malpractice. YOUR DOCTOR HAS DECIDED NOT TO CARRY
395	MEDICAL MALPRACTICE INSURANCE. This is permitted under Florida
396	law subject to certain conditions. Florida law imposes penalties
397	against noninsured physicians who fail to satisfy adverse
398	judgments arising from claims of medical malpractice. This
399	notice is provided pursuant to Florida law." In addition, a
400	licensee who meets the requirements of this paragraph and who is
401	covered for claims of medical negligence arising from care and
402	treatment of patients in a hospital that assumes sole and
403	exclusive liability for all such claims pursuant to the
404	Enterprise Act for Patient Protection and Provider Liability,
405	inclusive of ss. 766.401-766.409, shall post notice in the form
406	of a sign prominently displayed in the reception area and
407	clearly noticeable by all patients or provide a written
408	statement to any person for whom the physician may provide
409	medical care and treatment in any such hospital. The sign or
410	statement must adhere to the requirements of s. 766.404.
411	Section 4.  Paragraphs (f) and (g) of subsection (5) of
412	section 459.0085, Florida Statutes, are amended to read:
413	459.0085  Financial responsibility.--
414	(5)  The requirements of subsections (1), (2), and (3) do
415	not apply to:
416	(f)  Any person holding an active license under this
417	chapter who meets all of the following criteria:
418	1.  The licensee has held an active license to practice in
419	this state or another state or some combination thereof for more
420	than 15 years.
421	2.  The licensee has either retired from the practice of
422	osteopathic medicine or maintains a part-time practice of
423	osteopathic medicine of no more than 1,000 patient contact hours
424	per year.
425	3.  The licensee has had no more than two claims for
426	medical malpractice resulting in an indemnity exceeding $25,000
427	within the previous 5-year period.
428	4.  The licensee has not been convicted of, or pled guilty
429	or nolo contendere to, any criminal violation specified in this
430	chapter or the practice act of any other state.
431	5.  The licensee has not been subject within the last 10
432	years of practice to license revocation or suspension for any
433	period of time, probation for a period of 3 years or longer, or
434	a fine of $500 or more for a violation of this chapter or the
435	medical practice act of another jurisdiction. The regulatory
436	agency's acceptance of an osteopathic physician's relinquishment
437	of a license, stipulation, consent order, or other settlement,
438	offered in response to or in anticipation of the filing of
439	administrative charges against the osteopathic physician's
440	license, constitutes action against the physician's license for
441	the purposes of this paragraph.
442	6.  The licensee has submitted a form supplying necessary
443	information as required by the department and an affidavit
444	affirming compliance with this paragraph.
445	7.  The licensee must submit biennially to the department a
446	certification stating compliance with this paragraph. The
447	licensee must, upon request, demonstrate to the department
448	information verifying compliance with this paragraph.
449
450	A licensee who meets the requirements of this paragraph must
451	post notice in the form of a sign prominently displayed in the
452	reception area and clearly noticeable by all patients or provide
453	a written statement to any person to whom medical services are
454	being provided. The sign or statement must read as follows:
455	"Under Florida law, osteopathic physicians are generally
456	required to carry medical malpractice insurance or otherwise
457	demonstrate financial responsibility to cover potential claims
458	for medical malpractice. However, certain part-time osteopathic
459	physicians who meet state requirements are exempt from the
460	financial responsibility law. YOUR OSTEOPATHIC PHYSICIAN MEETS
461	THESE REQUIREMENTS AND HAS DECIDED NOT TO CARRY MEDICAL
462	MALPRACTICE INSURANCE. This notice is provided pursuant to
463	Florida law." In addition, a licensee who is covered for claims
464	of medical negligence arising from care and treatment of
465	patients in a hospital that assumes sole and exclusive liability
466	for all such claims pursuant to the Enterprise Act for Patient
467	Protection and Provider Liability, inclusive of ss. 766.401-
468	766.409, shall post notice in the form of a sign prominently
469	displayed in the reception area and clearly noticeable by all
470	patients or provide a written statement to any person for whom
471	the osteopathic physician may provide medical care and treatment
472	in any such hospital in accordance with the requirements of s.
473	766.404.
474	(g)  Any person holding an active license under this
475	chapter who agrees to meet all of the following criteria.
476	1.  Upon the entry of an adverse final judgment arising
477	from a medical malpractice arbitration award, from a claim of
478	medical malpractice either in contract or tort, or from
479	noncompliance with the terms of a settlement agreement arising
480	from a claim of medical malpractice either in contract or tort,
481	the licensee shall pay the judgment creditor the lesser of the
482	entire amount of the judgment with all accrued interest or
483	either $100,000, if the osteopathic physician is licensed
484	pursuant to this chapter but does not maintain hospital staff
485	privileges, or $250,000, if the osteopathic physician is
486	licensed pursuant to this chapter and maintains hospital staff
487	privileges, within 60 days after the date such judgment became
488	final and subject to execution, unless otherwise mutually agreed
489	to in writing by the parties. Such adverse final judgment shall
490	include any cross-claim, counterclaim, or claim for indemnity or
491	contribution arising from the claim of medical malpractice. Upon
492	notification of the existence of an unsatisfied judgment or
493	payment pursuant to this subparagraph, the department shall
494	notify the licensee by certified mail that he or she shall be
495	subject to disciplinary action unless, within 30 days from the
496	date of mailing, the licensee either:
497	a.  Shows proof that the unsatisfied judgment has been paid
498	in the amount specified in this subparagraph; or
499	b.  Furnishes the department with a copy of a timely filed
500	notice of appeal and either:
501	(I)  A copy of a supersedeas bond properly posted in the
502	amount required by law; or
503	(II)  An order from a court of competent jurisdiction
504	staying execution on the final judgment, pending disposition of
505	the appeal.
506	2.  The Department of Health shall issue an emergency order
507	suspending the license of any licensee who, after 30 days
508	following receipt of a notice from the Department of Health, has
509	failed to: satisfy a medical malpractice claim against him or
510	her; furnish the Department of Health a copy of a timely filed
511	notice of appeal; furnish the Department of Health a copy of a
512	supersedeas bond properly posted in the amount required by law;
513	or furnish the Department of Health an order from a court of
514	competent jurisdiction staying execution on the final judgment
515	pending disposition of the appeal.
516	3.  Upon the next meeting of the probable cause panel of
517	the board following 30 days after the date of mailing the notice
518	of disciplinary action to the licensee, the panel shall make a
519	determination of whether probable cause exists to take
520	disciplinary action against the licensee pursuant to
521	subparagraph 1.
522	4.  If the board determines that the factual requirements
523	of subparagraph 1. are met, it shall take disciplinary action as
524	it deems appropriate against the licensee. Such disciplinary
525	action shall include, at a minimum, probation of the license
526	with the restriction that the licensee must make payments to the
527	judgment creditor on a schedule determined by the board to be
528	reasonable and within the financial capability of the
529	osteopathic physician. Notwithstanding any other disciplinary
530	penalty imposed, the disciplinary penalty may include suspension
531	of the license for a period not to exceed 5 years. In the event
532	that an agreement to satisfy a judgment has been met, the board
533	shall remove any restriction on the license.
534	5.  The licensee has completed a form supplying necessary
535	information as required by the department.
536
537	A licensee who meets the requirements of this paragraph shall be
538	required either to post notice in the form of a sign prominently
539	displayed in the reception area and clearly noticeable by all
540	patients or to provide a written statement to any person to whom
541	medical services are being provided. Such sign or statement
542	shall state: "Under Florida law, osteopathic physicians are
543	generally required to carry medical malpractice insurance or
544	otherwise demonstrate financial responsibility to cover
545	potential claims for medical malpractice. YOUR OSTEOPATHIC
546	PHYSICIAN HAS DECIDED NOT TO CARRY MEDICAL MALPRACTICE
547	INSURANCE. This is permitted under Florida law subject to
548	certain conditions. Florida law imposes strict penalties against
549	noninsured osteopathic physicians who fail to satisfy adverse
550	judgments arising from claims of medical malpractice. This
551	notice is provided pursuant to Florida law." In addition, a
552	licensee who meets the requirements of this paragraph and who is
553	covered for claims of medical negligence arising from care and
554	treatment of patients in a hospital that assumes sole and
555	exclusive liability for all such claims pursuant to an
556	enterprise plan for patient protection and provider liability
557	under ss. 766.401-766.409, shall post notice in the form of a
558	sign prominently displayed in the reception area and clearly
559	noticeable by all patients or provide a written statement to any
560	person for whom the osteopathic physician may provide medical
561	care and treatment in any such hospital. The sign or statement
562	must adhere to the requirements of s. 766.404.
563	Section 5.  Section 627.41485, Florida Statutes, is created
564	to read:
565	627.41485  Medical malpractice insurers; optional coverage
566	exclusion for insureds who are covered by an enterprise plan for
567	patient protection and provider liability.--
568	(1)  An insurer issuing policies of professional liability
569	coverage for claims arising out of the rendering of, or the
570	failure to render, medical care or services may make available
571	to physicians licensed under chapter 458 and to osteopathic
572	physicians licensed under chapter 459 coverage having an
573	appropriate exclusion for acts of medical negligence occurring
574	within:
575	(a)  A certified patient safety facility that bears sole
576	and exclusive liability for acts of medical negligence pursuant
577	to the Enterprise Act for Patient Protection and Provider
578	Liability, inclusive of ss. 766.401-766.409, subject to the
579	usual underwriting standards; or
580	(b)  A statutory teaching hospital that has agreed to
581	indemnify the physician or osteopathic physician for legal
582	liability pursuant to s. 766.110(2)(c), subject to the usual
583	underwriting standards.
584	(2)  The Department of Financial Services may adopt rules
585	to administer this section.
586	Section 6.  Section 766.316, Florida Statutes, is amended
587	to read:
588	766.316  Notice to obstetrical patients of participation in
589	the plan.--Each hospital with a participating physician on its
590	staff, each hospital that assumes liability for affected
591	physicians pursuant to the Enterprise Act for Patient Protection
592	and Provider Liability, inclusive of ss. 766.401-766.409, and
593	each participating physician, other than residents, assistant
594	residents, and interns deemed to be participating physicians
595	under s. 766.314(4)(c), under the Florida Birth-Related
596	Neurological Injury Compensation Plan shall provide notice to
597	the obstetrical patients as to the limited no-fault alternative
598	for birth-related neurological injuries. Such notice shall be
599	provided on forms furnished by the association and shall include
600	a clear and concise explanation of a patient's rights and
601	limitations under the plan. The hospital or the participating
602	physician may elect to have the patient sign a form
603	acknowledging receipt of the notice form. Signature of the
604	patient acknowledging receipt of the notice form raises a
605	rebuttable presumption that the notice requirements of this
606	section have been met. Notice need not be given to a patient
607	when the patient has an emergency medical condition as defined
608	in s. 395.002(9)(b) or when notice is not practicable.
609	Section 7.  Subsection (2) of section 766.110, Florida
610	Statutes, is amended to read:
611	766.110  Liability of health care facilities.--
612	(2)(a)  Every hospital licensed under chapter 395 may carry
613	liability insurance or adequately insure itself in an amount of
614	not less than $1.5 million per claim, $5 million annual
615	aggregate to cover all medical injuries to patients resulting
616	from negligent acts or omissions on the part of those members of
617	its medical staff who are covered thereby in furtherance of the
618	requirements of ss. 458.320 and 459.0085. Self-insurance
619	coverage extended hereunder to a member of a hospital's medical
620	staff meets the financial responsibility requirements of ss.
621	458.320 and 459.0085 if the physician's coverage limits are not
622	less than the minimum limits established in ss. 458.320 and
623	459.0085 and the hospital is a verified trauma center that has
624	extended self-insurance coverage continuously to members of its
625	medical staff for activities both inside and outside of the
626	hospital. Any insurer authorized to write casualty insurance may
627	make available, but is shall not be required to write, such
628	coverage. The hospital may assess on an equitable and pro rata
629	basis the following professional health care providers for a
630	portion of the total hospital insurance cost for this coverage:
631	physicians licensed under chapter 458, osteopathic physicians
632	licensed under chapter 459, podiatric physicians licensed under
633	chapter 461, dentists licensed under chapter 466, and nurses
634	licensed under part I of chapter 464. The hospital may provide
635	for a deductible amount to be applied against any individual
636	health care provider found liable in a law suit in tort or for
637	breach of contract. The legislative intent in providing for the
638	deductible to be applied to individual health care providers
639	found negligent or in breach of contract is to instill in each
640	individual health care provider the incentive to avoid the risk
641	of injury to the fullest extent and ensure that the citizens of
642	this state receive the highest quality health care obtainable.
643	(b)  Except with regard to hospitals that receive sovereign
644	immunity under s. 768.28, each hospital licensed under chapter
645	395 which assumes sole and exclusive liability for acts of
646	medical negligence by affected providers pursuant to the
647	Enterprise Act for Patient Protection and Provider Liability,
648	inclusive of ss. 766.401-766.409, shall carry liability
649	insurance or adequately insure itself in an amount not less than
650	$2.5 million per claim, $7.5 million annual aggregate to cover
651	all medical injuries to patients resulting from negligent acts
652	or omissions on the part of affected physicians and
653	practitioners who are covered by an enterprise plan for patient
654	protection and provider liability. The hospital's policy of
655	medical liability insurance or self-insurance must satisfy the
656	financial responsibility requirements of ss. 458.320(2) and
657	459.0085(2) for affected providers. Any authorized insurer as
658	defined in s. 626.914(2), risk retention group as defined in s.
659	627.942, or joint underwriting association established under s.
660	627.351(4) that has authority to write casualty insurance may
661	make available, but is not required to write, such coverage.
662	(c)  Notwithstanding any provision in the Insurance Code to
663	the contrary, a statutory teaching hospital, as defined in s.
664	408.07, other than a hospital that receives sovereign immunity
665	under s. 768.28, which complies with the patient safety measures
666	specified in s. 766.403 and all other requirements of s.
667	766.409, including approval by the Agency for Health Care
668	Administration, may agree to indemnify some or all members of
669	its medical staff, including, but not limited to, physicians
670	having clinical privileges who are not employees or agents of
671	the hospital and any organization, association, or group of
672	persons liable for the negligent acts of such physicians,
673	whether incorporated or unincorporated, and some or all medical,
674	nursing, or allied health students affiliated with the hospital,
675	collectively known as covered persons, other than persons exempt
676	from liability due to sovereign immunity under s. 768.28, for
677	legal liability of such covered persons for loss, damages, or
678	expense arising out of medical negligence within the hospital
679	premises, as defined in s. 766.401, thereby providing limited
680	malpractice coverage for such covered persons. Any hospital that
681	agrees to provide malpractice coverage for covered persons under
682	this section shall acquire an appropriate policy of professional
683	liability insurance or establish and maintain a fund from which
684	such malpractice coverage is provided, in accordance with usual
685	underwriting standards. Such insurance or fund may be separate
686	and apart from any insurance or fund maintained by or on behalf
687	of the hospital or combined in a single policy of insurance or a
688	fund maintained by or on behalf of the hospital. Any hospital
689	that provides malpractice coverage to covered persons as defined
690	in this paragraph through a fund providing any such malpractice
691	coverage, shall annually provide a certified financial statement
692	containing actuarial projections as to the soundness of reserves
693	to the Agency for Health Care Administration. The indemnity
694	agreements or malpractice coverage provided by this section
695	shall be in amounts that, at a minimum, meet the financial
696	responsibility requirements of ss. 458.320 and 459.0085 for
697	affected providers. Any such indemnity agreement or malpractice
698	coverage in such amounts satisfies the financial responsibility
699	requirements of ss. 458.320 and 459.0085 for affected providers.
700	Any statutory teaching hospital that agrees to indemnify
701	physicians or other covered persons for medical negligence on
702	the premises pursuant to this section may charge such physicians
703	or other covered persons a reasonable fee for malpractice
704	coverage, notwithstanding any provision in the Insurance Code to
705	the contrary. Such fee shall be based on appropriate actuarial
706	criteria. This paragraph does not constitute a waiver of
707	sovereign immunity under s. 768.28. Nothing in this subsection
708	impairs a hospital's ability to indemnify member of its medical
709	staff to the extent such indemnification is allowed by law.
710	Section 8.  Subsections (6) and (7) of section 766.118,
711	Florida Statutes, are renumbered as subsections (7) and (8),
712	respectively, and new subsection (6) is added to said section,
713	to read:
714	766.118  Determination of noneconomic damages.--
715	(6)  LIMITATION ON NONECONOMIC DAMAGES FOR NEGLIGENCE OF
716	CERTAIN HOSPITALS.--A hospital that has received an order from
717	the Agency for Health Care Administration pursuant to s. 766.409
718	certifying that the facility complies with patient safety
719	measures specified in s. 766.403 shall be liable for no more
720	than $500,000 in noneconomic damages, regardless of the number
721	of claimants or theory of liability, including vicarious
722	liability, and notwithstanding any other provisions of this
723	section.
724	Section 9.  Section 766.401, Florida Statutes, is created
725	to read:
726	766.401  Definitions.--As used in this section and ss.
727	766.402-766.409, the term:
728	(1)  "Affected facility" means a certified patient safety
729	facility.
730	(2)  "Affected patient" means a patient of a certified
731	patient safety facility.
732	(3)  "Affected physician" means a medical staff member who
733	is covered by an enterprise plan for patient protection and
734	provider liability in a certified patient safety facility.
735	(4)  "Affected practitioner" means any person, including a
736	physician, who is credentialed by the eligible hospital to
737	provide health care services who is covered by an enterprise
738	plan for patient protection and provider liability in a
739	certified patient safety facility.
740	(5)  "Agency" means the Agency for Health Care
741	Administration.
742	(6)  "Certified patient safety facility" means any eligible
743	hospital that, in accordance with agency order, is solely and
744	exclusively liable for the medical negligence within the
745	licensed facility by affected physicians and practitioners who
746	are employees or agents of an accredited medical school or who
747	are employees or agents of the hospital.
748	(7)  "Clinical privileges" means the privileges granted to
749	a physician or other licensed health care practitioner to render
750	patient care services in a hospital.
751	(8)  "Eligible hospital" or "licensed facility" means:
752	(a)  A statutory teaching hospital as defined by s. 408.07,
753	which maintains at least seven different accredited graduate
754	medical education programs and has 100 or more full-time
755	equivalent resident physicians; or
756	(b)  A hospital licensed in accordance with chapter 395
757	which is wholly owned by a university based in this state which
758	maintains an accredited medical school.
759	(9)  "Employee or agent of an accredited medical school"
760	means any physician or practitioner who is a full-time employee
761	or agent of the accredited medical school or who devotes his or
762	her entire paid professional effort to the accredited medical
763	school.
764	(10)  "Enterprise plan" means a document adopted by the
765	governing board of an eligible hospital and the executive
766	committee of the medical staff of the eligible hospital, however
767	defined, or the board of trustees of a state university,
768	manifesting concurrence and setting forth certain rights,
769	duties, privileges, obligations, and responsibilities of the
770	health care facility and its medical staff, or its affiliated
771	medical school, in furtherance of seeking and maintaining status
772	as a certified patient safety facility.
773	(11)  "Health care provider" or "provider" means:
774	(a)  An eligible hospital.
775	(b)  A physician or physician assistant licensed under
776	chapter 458.
777	(c)  An osteopathic physician or osteopathic physician
778	assistant licensed under chapter 459.
779	(d)  A registered nurse, nurse midwife, licensed practical
780	nurse, or advanced registered nurse practitioner licensed or
781	registered under part I of chapter 464 or any facility that
782	employs nurses licensed or registered under part I of chapter
783	464 to supply all or part of the care delivered by that
784	facility.
785	(e)  A health care professional association and its
786	employees or a corporate medical group and its employees.
787	(f)  Any other medical facility the primary purpose of
788	which is to deliver human medical diagnostic services or which
789	delivers nonsurgical human medical treatment, including an
790	office maintained by a provider.
791	(g)  A free clinic that delivers only medical diagnostic
792	services or nonsurgical medical treatment free of charge to all
793	low-income recipients.
794	(h)  Any other health care professional, practitioner, or
795	provider, including a student enrolled in an accredited program
796	that prepares the student for licensure as any one of the
797	professionals listed in this subsection.
798
799	The term includes any person, organization, or entity that is
800	vicariously liable under the theory of respondent superior or
801	any other theory of legal liability for medical negligence
802	committed by any licensed professional listed in this
803	subsection. The term also includes any nonprofit corporation
804	qualified as exempt from federal income taxation under s. 501(a)
805	of the Internal Revenue Code, and described in s. 501(c) of the
806	Internal Revenue Code, including any university or medical
807	school that employs licensed professionals listed in this
808	subsection or that delivers health care services provided by
809	licensed professionals listed in this subsection, any federally
810	funded community health center, and any volunteer corporation or
811	volunteer health care provider that delivers health care
812	services.
813	(12)  "Health care practitioner" or "practitioner" means
814	any person, entity, or organization identified in subsection
815	(9), except for a hospital.
816	(13)  "Medical incident" or "adverse incident" has the same
817	meaning as provided in ss. 381.0271, 395.0197, 458.351, and
818	459.026.
819	(14)  "Medical negligence" means medical malpractice,
820	whether grounded in tort or in contract, arising out of the
821	rendering of or failure to render medical care or services.
822	(15)  "Medical staff" means a physician licensed under
823	chapter 458 or chapter 459 having clinical privileges and active
824	status in a licensed facility. The term includes any affected
825	physician.
826	(16)  "Person" means any individual, partnership,
827	corporation, association, or governmental unit.
828	(17)  "Premises" means those buildings, beds, and equipment
829	located at the address of the licensed facility and all other
830	buildings, beds, and equipment for the provision of hospital,
831	ambulatory surgical, mobile surgical care, primary care, or
832	comprehensive health care under the dominion and control of the
833	licensee, including offices and locations where the licensed
834	facility provides medical care and treatment to affected
835	patients.
836	(18)  "Statutory teaching hospital" or "teaching hospital"
837	has the same meaning as provided in s. 408.07.
838	(19)  "Within the licensed facility" or "within the
839	premise" means anywhere on the premises of the licensed facility
840	or the premises of any office, clinic, or ancillary facility
841	that is owned or leased or controlled by the licensed facility.
842	Section 10.  Section 766.402, Florida Statutes, is created
843	to read:
844	766.402  Agency approval of enterprise plans for patient
845	protection and provider liability.--
846	(1)  An eligible hospital in conjunction with the executive
847	committee of its medical staff or the board of trustees of a
848	state university, if applicable, that has adopted an enterprise
849	plan may petition the agency to enter an order certifying
850	approval of the hospital as a certified patient safety facility.
851	(2)  In accordance with chapter 120, the agency shall enter
852	an order certifying approval of the certified patient safety
853	facility upon a showing that, in furtherance of an enterprise
854	approach to patient protection and provider liability:
855	(a)  The petitioners have established enterprise-wide
856	safety measures for the care and treatment of patients.
857	(b)  The petitioners satisfy requirements for patient
858	protection measures, as specified in s. 766.403.
859	(c)  The petitioners acknowledge and agree to enterprise
860	liability for medical negligence within the premises, as
861	specified in s. 766.404.
862	(d)  The petitioners have adopted an enterprise plan, as
863	specified in s. 766.405.
864	(e)  The petitioners satisfy requirements for professional
865	accountability of affected practitioners, as specified in s.
866	766.406.
867	(f)  The petitioners satisfy requirements for financial
868	accountability of affected practitioners, as specified in s.
869	766.407.
870	(g)  The petitioners satisfy all other requirements of ss.
871	766.401-766.409.
872	Section 11.  Section 766.403, Florida Statutes, is created
873	to read:
874	766.403  Enterprise-wide patient safety measures.--
875	(1)  In order to satisfy the requirements of s.
876	766.402(2)(a) or s. 766.409, the licensed facility shall:
877	(a)  Have in place a process, either through the facility's
878	patient safety committee or a similar body, for coordinating the
879	quality control, risk management, and patient relations
880	functions of the facility and for reporting to the facility's
881	governing board at least quarterly regarding such efforts.
882	(b)  Establish within the facility a system for reporting
883	near misses and agree to submit any information collected to the
884	Florida Patient Safety Corporation. Such information must be
885	submitted by the facility and made available by the Patient
886	Safety Corporation in accordance with s. 381.0271(7).
887	(c)  Design and make available to facility staff, including
888	medical staff, a patient safety curriculum that provides lecture
889	and web-based training on recognized patient safety principles,
890	which may include communication skills training, team
891	performance assessment and training, risk prevention strategies,
892	and best practices and evidence based medicine. The licensed
893	facility shall report annually to the agency the programs
894	presented.
895	(d)  Implement a program to identify health care providers
896	on the facility's staff who may be eligible for an early-
897	intervention program providing additional skills assessment and
898	training and offer such training to the staff on a voluntary and
899	confidential basis with established mechanisms to assess program
900	performance and results.
901	(e)  Implement a simulation-based program for skills
902	assessment, training, and retraining of a facility's staff in
903	those tasks and activities that the agency identifies by rule.
904	(f)  Designate a patient advocate who coordinates with
905	members of the medical staff and the facility's chief medical
906	officer regarding disclosure of medical incidents to patients.
907	In addition, the patient advocate shall establish an advisory
908	panel, consisting of providers, patients or their families, and
909	other health care consumer or consumer groups to review general
910	patient safety concerns and other issues related to relations
911	among and between patients and providers and to identify areas
912	where additional education and program development may be
913	appropriate.
914	(g)  Establish a procedure to biennially review the
915	facility's patient safety program and its compliance with the
916	requirements of this section. Such review shall be conducted by
917	an independent patient safety organization as defined in s.
918	766.1016(1) or other professional organization approved by the
919	agency. The organization performing the review shall prepare a
920	written report with detailed findings and recommendations. The
921	report shall be forwarded to the facility's risk manager or
922	patient safety officer, who may make written comments in
923	response thereto. The report and any written comments shall be
924	presented to the governing board of the licensed facility. A
925	copy of the report and any of the facilities' responses to the
926	findings and recommendations shall be provided to the agency
927	within 60 days after the date that the governing board reviewed
928	the report. The report is confidential and exempt from
929	production or discovery in any civil action. Likewise, the
930	report, and the information contained therein, is not admissible
931	as evidence for any purpose in any action for medical
932	negligence.
933	(h)  Establish a system for the trending and tracking of
934	quality and patient safety indicators that the agency may
935	identify by rule, and a method for review of the data at least
936	semiannually by the facility's patient safety committee.
937	(i)  Provide assistance to affected physicians, upon
938	request, regarding implementation and evaluation of individual
939	risk-management, patient-safety, and incident-reporting systems
940	in clinical settings outside the premises of the licensed
941	facility. Provision of such assistance may not be the basis for
942	finding or imposing any liability on the licensed facility for
943	acts or omissions of the affected physicians in clinical
944	settings outside the premises of the licensed facility.
945	(2)  This section does not constitute an applicable
946	standard of care in any action for medical negligence or
947	otherwise create a private right of action, and evidence of
948	noncompliance with this section is not admissible for any
949	purpose in any action for medical negligence against an affected
950	facility or any other health care provider.
951	(3)  This section does not prohibit the licensed facility
952	from implementing other measures for promoting patient safety
953	within the premises. This section does not relieve the licensed
954	facility from the duty to implement any other patient safety
955	measure that is required by state law. The Legislature intends
956	that the patient safety measures specified in this section are
957	in addition to all other patient safety measures required by
958	state law, federal law, and applicable accreditation standards
959	for licensed facilities.
960	(4)  A review, report, or other document created, produced,
961	delivered, or discussed pursuant to this section is not
962	discoverable or admissible as evidence in any legal action.
963	Section 12.  Section 766.404, Florida Statutes, is created
964	to read:
965	766.404  Enterprise liability in certain health care
966	facilities.--
967	(1)  Subject to the requirements of ss. 766.401-766.409,
968	the agency may enter an order certifying the petitioner-hospital
969	as a certified patient safety facility and providing that the
970	hospital bears sole and exclusive liability for any and all acts
971	of medical negligence within the licensed facility by affected
972	physicians and affected practitioners who are employees or
973	agents of the accredited medical school or employees or agents
974	of the hospital when such medical negligence causes damage to
975	affected patients.
976	(2)  In any action for personal injury or wrongful death,
977	whether in contract or tort or predicated upon a statutory cause
978	of action, arising out of medical negligence within the premises
979	resulting in damages to a patient of a certified patient safety
980	facility, the licensed facility bears sole and exclusive
981	liability for medical negligence by affected physicians and
982	affected practitioners who, when the act of medical negligence
983	occurred, were employees or agents of the accredited medical
984	school or employees or agents of the hospital. Any such affected
985	physician or affected practitioner may not be named as defendant
986	in any such action. This subsection does not impose liability or
987	confer immunity on any other provider, person, organization, or
988	entity for acts of medical malpractice committed on any person
989	in clinical settings other than the premises of the affected
990	facility.
991	(3)  An affected practitioner shall post an applicable
992	notice or provide an appropriate written statement as follows:
993	(a)  An affected practitioner shall post notice in the form
994	of a sign prominently displayed in the reception area and
995	clearly noticeable by all patients or provide a written
996	statement to any person to whom medical services are being
997	provided. The sign or statement must read as follows: "In
998	general, physicians in the State of Florida are personally
999	liable for acts of medical negligence, subject to certain
1000	limitations. However, physicians who perform medical services
1001	within a certified patient safety facility are exempt from
1002	personal liability because the licensed hospital bears sole and
1003	exclusive liability for acts of medical negligence within the
1004	health care facility pursuant to an administrative order of the
1005	Agency for Health Care Administration entered in accordance with
1006	the Enterprise Act for Patient Protection and Provider
1007	Liability. YOUR DOCTOR HOLDS CLINICAL STAFF PRIVILEGES IN A
1008	CERTIFIED PATIENT SAFETY FACILITY. UNDER FLORIDA LAW, ANY CLAIM
1009	FOR MEDICAL NEGLIGENCE WITHIN THE HEALTH CARE FACILITY MUST BE
1010	INITIATED AGAINST THE HOSPITAL AND NOT AGAINST YOUR DOCTOR,
1011	BECAUSE THE HOSPITAL IS SOLELY RESPONSIBLE FOR ALL ACTS OF
1012	PROFESSIONAL NEGLIGENCE WITHIN THE PREMISES. THIS PROVISION DOES
1013	NOT AFFECT YOUR PHYSICIAN'S LIABILITY FOR ACTS OF MEDICAL
1014	NEGLIGENCE IN OTHER CLINICAL SETTINGS. IF YOU DO NOT UNDERSTAND,
1015	PLEASE DISCUSS WITH YOUR DOCTOR BEFORE YOUR CONSULTATION. This
1016	notice is provided pursuant to Florida law."
1017	(b)  If an affected practitioner is covered by an
1018	enterprise plan for patient protection and provider liability in
1019	one or more licensed facilities that receive sovereign immunity,
1020	and one or more other licensed facilities, the affected
1021	practitioner shall post notice in the form of a sign prominently
1022	displayed in the reception area and clearly noticeable by all
1023	patients or provide a written statement to any person to whom
1024	medical services are being provided. The sign or statement must
1025	read as follows: "In general, physicians in the state of Florida
1026	are personally liable for acts of medical negligence, subject to
1027	certain limitations such as sovereign immunity. However,
1028	physicians who perform medical services within a certified
1029	patient safety facility are exempt from personal liability
1030	because the licensed hospital bears sole and exclusive liability
1031	for acts of medical negligence within the affected facility
1032	pursuant to an administrative order of the Agency for Health
1033	Care Administration entered in accordance with the Enterprise
1034	Act for Patient Protection and Provider Liability. YOUR DOCTOR
1035	HOLDS CLINICAL STAFF PRIVILEGES IN ONE OR MORE CERTIFIED PATIENT
1036	SAFETY FACILITIES. AT LEAST ONE OF THESE HOSPITALS IS SUBJECT TO
1037	SOVEREIGN IMMUNITY. UNDER FLORIDA LAW, ANY CLAIM FOR MEDICAL
1038	NEGLIGENCE WITHIN THE HEALTH CARE FACILITY MUST BE INITIATED
1039	AGAINST THE HOSPITAL AND NOT AGAINST YOUR DOCTOR, BECAUSE THE
1040	HOSPITAL IS SOLELY RESPONSIBLE FOR ALL ACTS OF PROFESSIONAL
1041	NEGLIGENCE WITHIN THE PREMISES. MOREOVER, RECOVERY AGAINST THE
1042	HOSPITAL MAY BE LIMITED, DUE TO FLORIDA'S SOVEREIGN IMMUNITY
1043	LAW. THESE PROVISIONS DO NOT AFFECT YOUR PHYSICIAN'S LIABILITY
1044	FOR ACTS OF MEDICAL NEGLIGENCE IN OTHER CLINICAL SETTINGS. IF
1045	YOU DO NOT UNDERSTAND, PLEASE DISCUSS WITH YOUR DOCTOR BEFORE
1046	YOUR CONSULTATION. This notice is provided pursuant to Florida
1047	law."
1048	(c)  Notice need not be given to a patient when:
1049	1.  The patient has an emergency medical condition as
1050	defined in s. 395.002;
1051	2.  The practitioner is an employee or agent of a
1052	governmental entity and is immune from liability and suit under
1053	s. 768.28; or
1054	3.  Notice is not practicable.
1055	(d)  This subsection is directory in nature. An agency
1056	order certifying approval of an enterprise plan for patient
1057	protection and provider liability shall, as a matter of law,
1058	constitute conclusive evidence that the hospital complies with
1059	all applicable patient safety requirements of s. 766.403 and all
1060	other requirements of ss. 766.401-766.409. Evidence of
1061	noncompliance with s. 766.403 or any other provision of ss.
1062	766.401-766.409 may not be admissible for any purpose in any
1063	action for medical malpractice. Failure to comply with the
1064	requirements of this subsection does not affect the liabilities
1065	or immunities conferred by ss. 766.401-766.409. This subsection
1066	does not give rise to an independent cause of action for
1067	damages.
1068	(4)  The agency order certifying approval of an enterprise
1069	plan for patient protection and provider liability applies
1070	prospectively to causes of action for medical negligence that
1071	arise on or after the effective date of the order.
1072	(5)  Upon entry of an order approving the petition, the
1073	agency may conduct onsite examinations of the licensed facility
1074	to assure continued compliance with the terms and conditions of
1075	the order.
1076	(6)  The agency order certifying approval of an enterprise
1077	plan for patient protection remains in effect until revoked. The
1078	agency shall revoke the order upon the unilateral request of the
1079	licensed facility, the executive committee of the medical staff,
1080	or the affiliated medical school, whichever is applicable. The
1081	agency may revoke the order upon reasonable notice to the
1082	affected facility that it fails to comply with material
1083	requirements of ss. 766.401-766.409 or material conditions of
1084	the order certifying approval of the enterprise plan and further
1085	upon a determination that the licensed facility has failed to
1086	cure stated deficiencies upon reasonable notice. An
1087	administrative order revoking approval of an enterprise plan for
1088	patient protection and provider liability terminates the plan on
1089	January 1 of the year following entry of the order or 6 months
1090	after entry of the order, whichever is longer. Revocation of an
1091	agency order certifying approval of an enterprise plan for
1092	patient protection and provider liability applies prospectively
1093	to causes of action for medical negligence which arise on or
1094	after the effective date of the termination.
1095	(7)  This section does not exempt a licensed facility from
1096	liability for acts of medical negligence committed by employees
1097	and agents thereof; although employees and agents of a certified
1098	patient safety facility may not be joined as defendants in any
1099	action for medical negligence because the licensed facility
1100	bears sole and exclusive liability for acts of medical
1101	negligence within the premises of the licensed facility,
1102	including acts of medical negligence by such employees and
1103	agents.
1104	(8)  Affected practitioners shall cooperate in good faith
1105	with an affected facility in the investigation and defense of
1106	any claim for medical negligence. An affected facility shall
1107	have a cause of action for damages against an affected
1108	practitioner for bad faith refusal to cooperate in the
1109	investigation and defense of any claim of medical malpractice
1110	against the licensed facility.
1111	(9)  Sections 766.401-766.409 do not impose strict
1112	liability or liability without fault for medical incidents that
1113	occur within an affected facility. To maintain a cause of action
1114	against an affected facility pursuant to ss. 766.401-766.409,
1115	the claimant must allege and prove that an employee or agent of
1116	the licensed facility, or an affected practitioner who is
1117	covered by an approved enterprise plan for patient protection
1118	and provider liability, committed medical negligence within the
1119	premises of the licensed facility which constitutes medical
1120	negligence under state law, even though an active tortfeasor is
1121	not named or joined as a party defendant in the lawsuit.
1122	(10)  Sections 766.401-766.409 do not create an independent
1123	cause of action against any health care provider and do not
1124	impose enterprise liability on any health care provider, except
1125	as expressly provided, and may not be construed to support any
1126	cause of action other than an action for medical negligence as
1127	expressly provided against any person, organization, or entity.
1128	(11)  Sections 766.401-766.409 do not waive sovereign
1129	immunity, except as expressly provided in s. 768.28.
1130	Section 13.  Section 766.405, Florida Statutes, is created
1131	to read:
1132	766.405  Enterprise plans.--
1133	(1)  It is the intent of the Legislature that enterprise
1134	plans for patient protection are elective and not mandatory for
1135	eligible hospitals. It is further the intent of the Legislature
1136	that the medical staff or affiliated medical school of an
1137	eligible hospital must concur with the development and
1138	implementation of an enterprise plan for patient protection and
1139	provider liability. It is further the intent of the Legislature
1140	that the licensed facility and medical staff or affiliated
1141	medical school be accorded wide latitude in formulating
1142	enterprise plans consistent with the underlying purpose of ss.
1143	766.401-766.409 to encourage innovative, systemic measures for
1144	patient protection and quality assurance in licensed facilities,
1145	especially in clinical settings where surgery is performed.
1146	Adoption of an enterprise plan is a necessary condition for
1147	agency approval of an enterprise plan for a certified patient
1148	safety facility.
1149	(2)  An eligible hospital and the executive committee of
1150	its medical staff of the board of trustees of a state
1151	university, if applicable, shall adopt an enterprise plan as a
1152	necessary condition to agency approval of a certified patient
1153	safety facility. An affirmative vote of approval by the
1154	regularly constituted executive committee of the medical staff,
1155	however named or constituted, is sufficient to manifest approval
1156	by the medical staff of the enterprise plan. Once approved,
1157	affected practitioners are subject to the enterprise plan. The
1158	plan may be conditioned on agency approval of an enterprise plan
1159	for patient protection and provider liability for the affected
1160	facility. The enterprise plan shall be limited to affected
1161	physicians and affected practitioners who are employees or
1162	agents of an accredited medical school or who are employees or
1163	agents of the hospital. At a minimum, the enterprise plan must
1164	contain provisions covering:
1165	(a)  Compliance with a patient protection plan.
1166	(b)  Internal review of medical incidents.
1167	(c)  Timely reporting of medical incidents to state
1168	agencies.
1169	(d)  Professional accountability of affected practitioners.
1170	(e)  Financial accountability of affected practitioners.
1171	(3)  This section does not prohibit a patient safety
1172	facility from including other provisions in the enterprise plan,
1173	in a separate agreement, as a condition of staff privileges, or
1174	by way of contract with an organization providing medical staff
1175	for the licensed facility.
1176	(4)  This section does not limit the power of any licensed
1177	facility to enter into other agreements with members of its
1178	medical staff or otherwise to impose restrictions, requirements,
1179	or conditions on clinical privileges, as authorized by law.
1180	(5)  If multiple campuses of a licensed facility share a
1181	license, the enterprise plan may be limited to the primary
1182	campus or the campus with the largest number of beds and, if
1183	applicable, associated outpatient ancillary facilities. If the
1184	enterprise plan is so limited, the plan must specify the campus
1185	and, if applicable, the ancillary facilities that will
1186	constitute the enterprise.
1187	Section 14.  Section 766.406, Florida Statutes, is created
1188	to read:
1189	766.406  Professional accountability of affected
1190	practitioners.--
1191	(1)  A certified patient safety facility shall report
1192	medical incidents occurring in the affected facility to the
1193	Department of Health, in accordance with s. 395.0197.
1194	(2)  A certified patient safety facility shall report
1195	adverse findings of medical negligence or failure to adhere to
1196	applicable standards of professional responsibility by affected
1197	practitioners to the Department of Health.
1198	(3)  A certified patient safety facility shall continue to
1199	perform all peer review functions pursuant to s. 395.0193.
1200	Section 15.  Section 766.407, Florida Statutes, is created
1201	to read:
1202	766.407  Financial accountability of affected
1203	practitioners.--
1204	(1)  An enterprise plan may provide that any affected
1205	member of the medical staff or any affected practitioner having
1206	clinical privileges, other than an employee of the licensed
1207	facility, and any organization that contracts with the licensed
1208	facility to provide practitioners to treat patients within the
1209	licensed facility, shall share equitably in the cost of omnibus
1210	medical liability insurance premiums covering the certified
1211	patient safety facility, similar self-insurance expense, or
1212	other expenses reasonably related to risk management and
1213	adjustment of claims of medical negligence. This subsection does
1214	not permit a licensed facility and any affected practitioner to
1215	agree on charges for an equitable share of medical liability
1216	expense based on the number of patients admitted to the hospital
1217	by individual practitioners, patient revenue for the licensed
1218	facility generated by individual practitioners, or overall
1219	profit or loss sustained by the certified patient safety
1220	facility in a given fiscal period.
1221	(2)  Pursuant to an enterprise plan for patient protection
1222	and provider liability, a licensed facility may impose a
1223	reasonable assessment against an affected practitioner that
1224	commits medical negligence resulting in injury and damages to an
1225	affected patient of the health care facility, upon a
1226	determination of failure to adhere to acceptable standards of
1227	professional responsibility by an internal peer review
1228	committee. A schedule of assessments, criteria for the levying
1229	of assessments, procedures for levying assessments, and due
1230	process rights of an affected practitioner must be agreed to by
1231	the executive committee of the medical staff or affiliated
1232	medical school, as applicable, and the licensed facility. The
1233	legislative intent in providing for assessments against an
1234	affected physician is to instill in each individual health care
1235	practitioner the incentive to avoid the risk of injury to the
1236	fullest extent and ensure that the residents of this state
1237	receive the highest quality health care obtainable. Failure to
1238	pay an assessment constitutes grounds for suspension of clinical
1239	privileges by the licensed facility. Assessments may be enforced
1240	as bona fide debts in a court of law. The licensed facility may
1241	exempt its employees and agents from all such assessments.
1242	Employees and agents of the state, its agencies, and
1243	subdivisions, as defined by s. 768.28, are exempt from all such
1244	assessments.
1245	(3)  An assessment levied pursuant to this section is not
1246	discoverable or admissible as evidence in any legal action.
1247	Section 16.  Section 766.408, Florida Statutes, is created
1248	to read:
1249	766.408  Data collection and reports.--
1250	(1)  Each certified patient safety facility shall submit an
1251	annual report to the agency containing information and data
1252	reasonably required by the agency to evaluate performance and
1253	effectiveness of the facility's enterprise plan for patient
1254	protection and provider liability. However, information may not
1255	be submitted or disclosed in violation of any patient's right to
1256	privacy under state or federal law.
1257	(2)  The agency shall aggregate information and data
1258	submitted by all affected facilities and each year, on or before
1259	March 1, the agency shall submit a report to the Legislature
1260	that evaluates the performance and effectiveness of the
1261	enterprise approach to patient safety and provider liability in
1262	certified patient safety facilities, which reports must include,
1263	but are not limited to, pertinent data on:
1264	(a)  The number and names of affected facilities;
1265	(b)  The number and types of patient protection measures
1266	currently in effect in these facilities;
1267	(c)  The number of affected practitioners;
1268	(d)  The number of affected patients;
1269	(e)  The number of surgical procedures by affected
1270	practitioners on affected patients;
1271	(f)  The number of medical incidents, claims of medical
1272	malpractice, and claims resulting in indemnity;
1273	(g)  The average time for resolution of contested and
1274	uncontested claims of medical malpractice;
1275	(h)  The percentage of claims that result in civil trials;
1276	(i)  The percentage of civil trials resulting in adverse
1277	judgments against affected facilities;
1278	(j)  The number and average size of an indemnity paid to
1279	claimants;
1280	(k)  The number and average size of assessments imposed on
1281	affected practitioners;
1282	(l)  The estimated liability expense, inclusive of medical
1283	liability insurance premiums; and
1284	(m)  The percentage of medical liability expense, inclusive
1285	of medical liability insurance premiums, which is borne by
1286	affected practitioners in affected health care facilities.
1287
1288	Such reports to the Legislature may also include other
1289	information and data that the agency deems appropriate to gauge
1290	the cost and benefit of enterprise plans for patient protection
1291	and provider liability.
1292	(3)  The agency's annual report to the Legislature may
1293	include relevant information and data obtained from the Office
1294	of Insurance Regulation within the Department of Financial
1295	Services on the availability and affordability of enterprise-
1296	wide medical liability insurance coverage for affected
1297	facilities and the availability and affordability of insurance
1298	policies for individual practitioners which contain coverage
1299	exclusions for acts of medical negligence in certified patient
1300	safety facilities. The Office of Insurance Regulation within the
1301	Department of Financial Services shall cooperate with the agency
1302	in the reporting of information and data specified in this
1303	subsection.
1304	(4)  Reports submitted to the agency by affected facilities
1305	pursuant to this section are public records under chapter 199.
1306	However, these reports, and the information contained therein,
1307	are not admissible as evidence in a court of law in any action.
1308	Section 17.  Section 766.409, Florida Statutes, is created
1309	to read:
1310	766.409  Damages in malpractice actions against certain
1311	hospitals that meet patient safety requirements; agency approval
1312	of patient safety measures.--
1313	(1)  In recognition of their essential role in training
1314	future health care providers and in providing innovative medical
1315	care for this state's residents, in recognition of their
1316	commitment to treating indigent patients, and further in
1317	recognition that all teaching hospitals, as defined in s.
1318	408.07, both public and private, and hospitals licensed under
1319	chapter 395 which are owned and operated by a university that
1320	maintains an accredited medical school, collectively defined as
1321	eligible hospitals in s. 766.401(8), provide benefits to the
1322	residents of this state through their roles in improving the
1323	quality of medical care, training health care providers, and
1324	caring for indigent patients, the limits of liability for
1325	medical malpractice arising out of the rendering of, or the
1326	failure to render, medical care by all such hospitals, shall be
1327	determined in accordance with the requirements of this section.
1328	(2)  Except as otherwise provided in subsections (9) and
1329	(10), any eligible hospital may petition the agency to enter an
1330	order certifying that the licensed facility complies with
1331	patient safety measures specified in s. 766.403.
1332	(3)  In accordance with chapter 120, the agency shall enter
1333	an order approving the petition upon a showing that the eligible
1334	hospital complies with the patient safety measures specified in
1335	s. 766.403. Upon entry of an order, and for the entire period of
1336	time that the order remains in effect, the damages recoverable
1337	from the eligible hospital covered by the order and its
1338	employees and agents in actions arising from medical negligence
1339	shall be determined in accordance with the following provisions:
1340	(a)  Noneconomic damages shall be limited to a maximum of
1341	$500,000, regardless of the number of claimants or the theory of
1342	liability, in accordance with s. 766.118(6).
1343	(b)  Awards of economic damages shall be offset by payments
1344	from collateral sources, as defined by s. 766.202(2), and any
1345	set-offs available under ss. 46.015 and 768.041. Awards for
1346	future economic losses shall be offset by future collateral
1347	source payments.
1348	(c)  Awards of future economic damages, after being offset
1349	by collateral sources, shall, at the option of the eligible
1350	hospital, be reduced by the court to present value or paid by
1351	means of periodic payments in the form of annuities or
1352	reversionary trusts. A company that underwrites an annuity to
1353	pay future economic damages shall have rating of "A" or higher
1354	by A.M. Best Company. The terms of the reversionary instrument
1355	used to periodically pay future economic damages must be
1356	approved by the court; such approval may not be unreasonably
1357	withheld.
1358	(4)  The limitations on damages in subsection (3) apply
1359	prospectively to causes of action for medical negligence that
1360	arise on or after the effective date of the order.
1361	(5)  Upon entry of an order approving the petition, the
1362	agency may conduct onsite examinations of the licensed facility
1363	to assure continued compliance with terms and conditions of the
1364	order.
1365	(6)  The agency order certifying approval of a petition
1366	under this section remains in effect until revoked. The agency
1367	may revoke the order upon reasonable notice to the affected
1368	hospital that it fails to comply with material requirements of
1369	ss. 766.401-766.409 or material conditions of the order
1370	certifying compliance with required patient safety measures and
1371	that the hospital has failed to cure stated deficiencies upon
1372	reasonable notice. Revocation of an agency order certifying
1373	approval of an enterprise plan for patient protection and
1374	provider liability applies prospectively to causes of action for
1375	medical negligence that arise on or after the effective date of
1376	the order of revocation.
1377	(7)  An agency order certifying approval of a petition
1378	under this section shall, as a matter of law, constitute
1379	conclusive evidence that the hospital complies with all
1380	applicable patient safety requirements of s. 766.403. A
1381	hospital's noncompliance with the requirements of s. 766.403 may
1382	not affect the limitations on damages conferred by this section.
1383	Evidence of noncompliance with s. 766.403 may not be admissible
1384	for any purpose in any action for medical malpractice. This
1385	section, or any portion thereof, may not give rise to an
1386	independent cause of action for damages against any hospital.
1387	(8)  The entry of an agency order pursuant to this section
1388	does not impose enterprise liability, or sole and exclusive
1389	liability, on the licensed facility for acts or omissions of
1390	medical negligence within the premises.
1391	(9)  An eligible hospital may petition the agency for an
1392	order pursuant to this section or an order pursuant to s.
1393	766.404. However, a hospital may not be approved for both
1394	enterprise liability under s. 766.404 and the limitations on
1395	damages under this section.
1396	(10)  This section may not apply to hospitals that are
1397	subject to sovereign immunity under s. 768.28.
1398	Section 18.  Section 766.410, Florida Statutes, is created
1399	to read:
1400	766.410  Rulemaking authority.--The agency may adopt rules
1401	to administer ss. 766.401-766.409.
1402	Section 19.  Subsections (5) and (12) of section 768.28,
1403	Florida Statutes, are amended to read:
1404	768.28  Waiver of sovereign immunity in tort actions;
1405	recovery limits; limitation on attorney fees; statute of
1406	limitations; exclusions; indemnification; risk management
1407	programs.--
1408	(5)(a)  The state and its agencies and subdivisions shall
1409	be liable for tort claims in the same manner and to the same
1410	extent as a private individual under like circumstances, but
1411	liability does shall not include punitive damages or interest
1412	for the period before judgment.
1413	(b)  Except as provided in paragraph (c), neither the state
1414	or nor its agencies or subdivisions are shall be liable to pay a
1415	claim or a judgment by any one person which exceeds the sum of
1416	$100,000 or any claim or judgment, or portions thereof, which,
1417	when totaled with all other claims or judgments paid by the
1418	state or its agencies or subdivisions arising out of the same
1419	incident or occurrence, exceeds the sum of $200,000. However, a
1420	judgment or judgments may be claimed and rendered in excess of
1421	these amounts and may be settled and paid pursuant to this act
1422	up to $100,000 or $200,000, as the case may be; and that portion
1423	of the judgment that exceeds these amounts may be reported to
1424	the Legislature, but may be paid in part or in whole only by
1425	further act of the Legislature. Notwithstanding the limited
1426	waiver of sovereign immunity provided herein, the state or an
1427	agency or subdivision thereof may agree, within the limits of
1428	insurance coverage provided, to settle a claim made or a
1429	judgment rendered against it without further action by the
1430	Legislature, but the state or agency or subdivision thereof
1431	shall not be deemed to have waived any defense of sovereign
1432	immunity or to have increased the limits of its liability as a
1433	result of its obtaining insurance coverage for tortious acts in
1434	excess of the $100,000 or $200,000 waiver provided above. The
1435	limitations of liability set forth in this subsection shall
1436	apply to the state and its agencies and subdivisions whether or
1437	not the state or its agencies or subdivisions possessed
1438	sovereign immunity before July 1, 1974.
1439	(c)  In any action for medical negligence within a
1440	certified patient safety facility that is covered by sovereign
1441	immunity, given that the licensed health care facility bears
1442	sole and exclusive liability for acts of medical negligence
1443	pursuant to the Enterprise Act for Patient Protection and
1444	Provider Liability, inclusive of ss. 766.401-766.409, neither
1445	the state or its agencies or subdivisions are liable to pay a
1446	claim or a judgment by any one person which exceeds the sum of
1447	$150,000 or any claim or judgment, or portions thereof, which,
1448	when totaled with all other claims or judgments paid by the
1449	state or its agencies or subdivisions arising out of the same
1450	incident or occurrence, exceeds the sum of $300,000. However, a
1451	judgment may be claimed and rendered in excess of these amounts
1452	and may be settled and paid up to $150,000 or $300,000, as the
1453	case may be. That portion of the judgment which exceeds these
1454	amounts may be reported to the Legislature, but may be paid in
1455	part or in whole only by further act of the Legislature.
1456	Notwithstanding the limited waiver of sovereign immunity
1457	provided in this paragraph, the state or an agency or
1458	subdivision thereof may agree, within the limits of insurance or
1459	self-insurance coverage provided, to settle a claim made or a
1460	judgment rendered against it without further action by the
1461	Legislature, but the state or agency or subdivision thereof does
1462	not waive any defense of sovereign immunity or increase limits
1463	of its liability as a result of its obtaining insurance coverage
1464	or providing for self-insurance to cover claims for medical
1465	negligence in excess of the $150,000 waiver or the $300,000
1466	waiver provided in this paragraph. The limitations of liability
1467	set forth in this paragraph apply to the state and its agencies
1468	and subdivisions whether or not the state or its agencies or
1469	subdivisions possessed sovereign immunity before July 1, 1974.
1470	(12)(a)  A health care practitioner, as defined in s.
1471	456.001(4), who has contractually agreed to act as an agent of a
1472	state university board of trustees to provide medical services
1473	to a student athlete for participation in or as a result of
1474	intercollegiate athletics, to include team practices, training,
1475	and competitions, is shall be considered an agent of the
1476	respective state university board of trustees, for the purposes
1477	of this section, while acting within the scope of and pursuant
1478	to guidelines established in that contract. The contracts shall
1479	provide for the indemnification of the state by the agent for
1480	any liabilities incurred up to the limits set out in this
1481	chapter.
1482	(b)  This subsection shall not be construed as designating
1483	persons providing contracted health care services to athletes as
1484	employees or agents of a state university board of trustees for
1485	the purposes of chapter 440.
1486	(c)1.  For purposes of this subsection, the terms
1487	"certified patient safety facility," "medical staff," and
1488	"medical negligence" have the same meanings as provided in s.
1489	766.401.
1490	2.  A certified patient safety facility, wherein a minimum
1491	of 90 percent of the members of the medical staff consist of
1492	physicians are employees or agents of a state university, is an
1493	agent of the respective state university board of trustees for
1494	purposes of this section to the extent that the licensed
1495	facility, in accordance with an enterprise plan for patient
1496	protection and provider liability, inclusive of ss. 766.401-
1497	766.409, approved by the Agency for Health Care Administration,
1498	is solely and exclusively liable for acts of medical negligence
1499	of physicians providing health care services within the licensed
1500	facility.
1501	3.  A certified patient safety facility that has been found
1502	to be an agent of the state for other purposes and has adopted
1503	an enterprise plan for patient protection and provider liability
1504	for the sole and exclusive liability for acts of medical
1505	negligence of affected practitioners who are employees and
1506	agents of the affiliated state university board of trustees and
1507	its own hospital employees and agents, inclusive of ss. 766.401-
1508	766.409, approved by the Agency for Health Care Administration,
1509	is an agent of the respective state university board of trustees
1510	for purposes of this subsection only.
1511	4.  Subject to the acceptance of the Board of Governors and
1512	a state university board of trustees, a licensed facility as
1513	described by this subsection may secure the limits of liability
1514	protection described in paragraph (c) from a self insurance
1515	program created pursuant to s. 1004.24.
1516	5.  A notice of intent to commence an action for medical
1517	negligence arising from the care or treatment of a patient in a
1518	certified patient safety facility subject to the provisions of
1519	this subsection shall be sent to the licensed facility as the
1520	statutory agent created pursuant to an enterprise plan of the
1521	related board of trustees of a state university for the limited
1522	purposes of administering an enterprise plan for patient
1523	protection and provider liability. A complaint alleging medical
1524	negligence resulting in damages to a patient in a certified
1525	patient safety facility subject to the provisions of this
1526	paragraph shall be commenced against the applicable board of
1527	trustees of a state university on the relation of the licensed
1528	facility, and the doctrines of res judicata and collateral
1529	estoppel shall apply. The complaint shall be served on the
1530	licensed facility. Any notice of intent mailed to the licensed
1531	facility, any legal process served on the licensed facility, and
1532	any other notice, paper, or pleading that is served, sent, or
1533	delivered to the licensed facility pertaining to a claim of
1534	medical negligence shall have the same legal force and effect as
1535	mailing, service, or delivery to a duly authorized agent of the
1536	board of trustees of the respective state university,
1537	notwithstanding any provision of the laws of this state to the
1538	contrary. Upon receipt of any such notice of intent, complaint
1539	for damages, or other notice, paper, or pleading pertaining to a
1540	claim of medical negligence, a licensed facility subject to the
1541	provisions of this paragraph shall give timely notice to the
1542	related board of trustees of the state university, although
1543	failure to give timely notice does not affect the legal
1544	sufficiency of the notice of intent, service of process, or
1545	other notice, paper, or pleading. A final judgment or binding
1546	arbitration award against the board of trustees of a state
1547	university on the relation of a licensed facility, arising from
1548	a claim of medical negligence resulting in damages to a patient
1549	in a certified patient safety facility subject to the provisions
1550	of this paragraph, may be enforced in the same manner, and is
1551	subject to the same limitations on enforcement or recovery, as
1552	any final judgment for damages or binding arbitration award
1553	against the board of trustees of a state university,
1554	notwithstanding any provision of the laws of this state to the
1555	contrary. Any settlement agreement executed by the board of
1556	trustees of a state university on the relation of a licensed
1557	facility, arising from a claim of medical negligence resulting
1558	in damages to a patient in a certified patient safety facility
1559	subject to the provisions of this paragraph, may be enforced in
1560	the same manner and is subject to the same limitations as a
1561	settlement agreement executed by an authorized agent of the
1562	board of trustees. The board of trustees of a state university
1563	may make payment to a claimant in whole or in part of any
1564	portion of a final judgment or binding arbitration award against
1565	the board of trustees of a state university on the relation of a
1566	licensed facility, and any portion of a settlement of a claim
1567	for medical negligence arising from a certified patient safety
1568	facility subject to the provisions of this paragraph, which
1569	exceeds the amounts of the limited waiver of sovereign immunity
1570	specified in paragraph (5)(c), only as provided in that
1571	paragraph.
1572	Section 20.  If any provision of this act or its
1573	application to any person or circumstance is held invalid, the
1574	invalidity does not affect other provisions or applications of
1575	the act which can be given effect without the invalid provision
1576	or application, and to this end, the provisions of this act are
1577	severable.
1578	Section 21.  If a conflict between any provision of this
1579	act and s. 456.052, s. 456.053, s. 456.054, s. 458.331, s.
1580	459.015, or s. 817.505, Florida Statutes, the provisions of this
1581	act shall govern. The provisions of this act should be broadly
1582	construed in furtherance of the overriding legislative intent to
1583	facilitate innovative approaches for patient protection and
1584	provider liability in eligible hospitals.
1585	Section 22.  It is the intention of the Legislature that
1586	the provisions of this act are self-executing.
1587	Section 23.  This act shall take effect upon becoming a
1588	law.

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