HB 0665

CS

CHAMBER ACTION

1	The Health Care Regulation Committee recommends the following:
2
3	Council/Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to the regulation of physicians,
7	osteopathic physicians, and physician assistants; amending
8	ss. 458.320 and 459.0085, F.S.; revising the methods and
9	monetary amounts by which certain physician or osteopathic
10	physician licensure applicants must demonstrate financial
11	responsibility; providing additional escrow account
12	requirements; removing provisions exempting physicians or
13	osteopathic physicians from financial responsibility
14	requirements; amending ss. 458.331 and 459.015, F.S.;
15	requiring the inclusion of a licensed physician assistant
16	on certain probable cause panels; providing an effective
17	date.
18
19	Be It Enacted by the Legislature of the State of Florida:
20
21	Section 1.  Section 458.320, Florida Statutes, is amended
22	to read:
23	458.320  Financial responsibility.--
24	(1)  As a condition of licensing and maintaining an active
25	license, and prior to the issuance or renewal of an active
26	license or reactivation of an inactive license for the practice
27	of medicine, an applicant must by one of the following methods
28	demonstrate to the satisfaction of the board and the department
29	financial responsibility to pay claims and costs ancillary
30	thereto arising out of the rendering of, or the failure to
31	render, medical care or services:
32	(a)  Establishing and maintaining an escrow account
33	consisting of cash or assets eligible for deposit in accordance
34	with s. 625.52 in an amount sufficient to meet the minimum
35	annual aggregate claim amount the per claim amounts specified in
36	paragraph (b). The escrow account must be payable to the
37	physician as beneficiary upon presentation of a final judgment
38	indicating liability and awarding damages to be paid by the
39	physician or upon presentation of a settlement agreement signed
40	by all parties to such agreement when such final judgment or
41	settlement is a result of a claim arising out of the rendering
42	of, or the failure to render, medical care and services. The
43	required escrow amount set forth in this paragraph may not be
44	used for litigation costs or attorney's fees for the defense of
45	any medical malpractice claim. The escrow account must be
46	nonassignable and nontransferable. Such escrow account must be
47	made with and held by the trust department of the bank or saving
48	association organized and existing under the laws of the United
49	States which has its principal place of business in this state
50	or has a branch office that is authorized under the laws of this
51	state or of the United States to receive deposits in this state.
52	(b)  Obtaining and maintaining professional liability
53	coverage in an amount not less than $100,000 per claim, with a
54	minimum annual aggregate of not less than $300,000, from an
55	authorized insurer as defined under s. 624.09, from a surplus
56	lines insurer as defined under s. 626.914(2), from a risk
57	retention group as defined under s. 627.942, from the Joint
58	Underwriting Association established under s. 627.351(4), or
59	through a plan of self-insurance as provided in s. 627.357. The
60	required coverage amount set forth in this paragraph may not be
61	used for litigation costs or attorney's fees for the defense of
62	any medical malpractice claim.
63	(c)  Obtaining and maintaining an unexpired, irrevocable
64	letter of credit, established pursuant to chapter 675, in an
65	amount sufficient to meet the minimum annual aggregate claim
66	amount specified in paragraph (b) not less than $100,000 per
67	claim, with a minimum aggregate availability of credit of not
68	less than $300,000. The letter of credit must be payable to the
69	physician as beneficiary upon presentment of a final judgment
70	indicating liability and awarding damages to be paid by the
71	physician or upon presentment of a settlement agreement signed
72	by all parties to such agreement when such final judgment or
73	settlement is a result of a claim arising out of the rendering
74	of, or the failure to render, medical care and services. The
75	letter of credit may not be used for litigation costs or
76	attorney's fees for the defense of any medical malpractice
77	claim. The letter of credit must be nonassignable and
78	nontransferable. Such letter of credit must be issued by any
79	bank or savings association organized and existing under the
80	laws of this state or any bank or savings association organized
81	under the laws of the United States which has its principal
82	place of business in this state or has a branch office that is
83	authorized under the laws of this state or of the United States
84	to receive deposits in this state.
85	(2)  Physicians who perform surgery in an ambulatory
86	surgical center licensed under chapter 395 and, as a continuing
87	condition of hospital staff privileges, physicians who have
88	staff privileges must also establish financial responsibility by
89	one of the following methods:
90	(a)  Establishing and maintaining an escrow account
91	consisting of cash or assets eligible for deposit in accordance
92	with s. 625.52 in the per claim amounts specified in paragraph
93	(b). The escrow account must be payable to the physician as
94	beneficiary upon presentation of a final judgment indicating
95	liability and awarding damages to be paid by the physician or
96	upon presentation of a settlement agreement signed by all
97	parties to such agreement when such final judgment or settlement
98	is a result of a claim arising out of the rendering of, or the
99	failure to render, medical care and services. The required
100	escrow amount set forth in this paragraph may not be used for
101	litigation costs or attorney's fees for the defense of any
102	medical malpractice claim. The escrow account must be
103	nonassignable and nontransferable. Such escrow account must be
104	made with and held by the trust department of a bank or savings
105	association organized and existing under the laws of the United
106	States which has its principal place of business in this state
107	or has a branch office that is authorized under the laws of this
108	state or of the United States to receive deposits in this state.
109	(b)  Obtaining and maintaining professional liability
110	coverage in an amount not less than $250,000 per claim, with a
111	minimum annual aggregate of not less than $750,000 from an
112	authorized insurer as defined under s. 624.09, from a surplus
113	lines insurer as defined under s. 626.914(2), from a risk
114	retention group as defined under s. 627.942, from the Joint
115	Underwriting Association established under s. 627.351(4),
116	through a plan of self-insurance as provided in s. 627.357, or
117	through a plan of self-insurance which meets the conditions
118	specified for satisfying financial responsibility in s. 766.110.
119	The required coverage amount set forth in this paragraph may not
120	be used for litigation costs or attorney's fees for the defense
121	of any medical malpractice claim.
122	(c)  Obtaining and maintaining an unexpired irrevocable
123	letter of credit, established pursuant to chapter 675, in an
124	amount sufficient to meet the minimum annual aggregate claim
125	amount specified in paragraph (b) not less than $250,000 per
126	claim, with a minimum aggregate availability of credit of not
127	less than $750,000. The letter of credit must be payable to the
128	physician as beneficiary upon presentment of a final judgment
129	indicating liability and awarding damages to be paid by the
130	physician or upon presentment of a settlement agreement signed
131	by all parties to such agreement when such final judgment or
132	settlement is a result of a claim arising out of the rendering
133	of, or the failure to render, medical care and services. The
134	letter of credit may not be used for litigation costs or
135	attorney's fees for the defense of any medical malpractice
136	claim. The letter of credit must be nonassignable and
137	nontransferable. The letter of credit must be issued by any bank
138	or savings association organized and existing under the laws of
139	this state or any bank or savings association organized under
140	the laws of the United States which has its principal place of
141	business in this state or has a branch office that is authorized
142	under the laws of this state or of the United States to receive
143	deposits in this state.
144
145	This subsection shall be inclusive of the coverage in subsection
146	(1).
147	(3)(a)  Meeting the financial responsibility requirements
148	of this section or the criteria for any exemption from such
149	requirements must be established at the time of issuance or
150	renewal of a license.
151	(b)  Any person may, at any time, submit to the department
152	a request for an advisory opinion regarding such person's
153	qualifications for exemption.
154	(4)(a)  Each insurer, self-insurer, risk retention group,
155	or Joint Underwriting Association must promptly notify the
156	department of cancellation or nonrenewal of insurance required
157	by this section. Unless the physician demonstrates that he or
158	she is otherwise in compliance with the requirements of this
159	section, the department shall suspend the license of the
160	physician pursuant to ss. 120.569 and 120.57 and notify all
161	health care facilities licensed under chapter 395 of such
162	action. Any suspension under this subsection remains in effect
163	until the physician demonstrates compliance with the
164	requirements of this section. If any judgments or settlements
165	are pending at the time of suspension, those judgments or
166	settlements must be paid in accordance with this section unless
167	otherwise mutually agreed to in writing by the parties. This
168	paragraph does not abrogate a judgment debtor's obligation to
169	satisfy the entire amount of any judgment.
170	(b)  If financial responsibility requirements are met by
171	maintaining an escrow account or letter of credit as provided in
172	this section, upon the entry of an adverse final judgment
173	arising from a medical malpractice arbitration award, from a
174	claim of medical malpractice either in contract or tort, or from
175	noncompliance with the terms of a settlement agreement arising
176	from a claim of medical malpractice either in contract or tort,
177	the licensee shall pay the entire amount of the judgment
178	together with all accrued interest, or the amount maintained in
179	the escrow account or provided in the letter of credit as
180	required by this section, whichever is less, within 60 days
181	after the date such judgment became final and subject to
182	execution, unless otherwise mutually agreed to in writing by the
183	parties. If timely payment is not made by the physician, the
184	department shall suspend the license of the physician pursuant
185	to the following procedures: set forth in subparagraphs
186	(5)(g)3., 4., and 5.
187	1.  The Department of Health shall issue an emergency order
188	suspending the license of any licensee who, after 30 days
189	following receipt of a notice from the Department of Health, has
190	failed to: satisfy a medical malpractice claim against him or
191	her; furnish the Department of Health a copy of a timely filed
192	notice of appeal; furnish the Department of Health a copy of a
193	supersedeas bond properly posted in the amount required by law;
194	or furnish the Department of Health an order from a court of
195	competent jurisdiction staying execution on the final judgment
196	pending disposition of the appeal.
197	2.  Upon the next meeting of the probable cause panel of
198	the board following 30 days after the date of mailing the notice
199	of disciplinary action to the licensee, the panel shall make a
200	determination of whether probable cause exists to take
201	disciplinary action against the licensee pursuant to
202	subparagraph 1.
203	3.  If the board determines that the factual requirements
204	of subparagraph 1. are met, it shall take disciplinary action as
205	it deems appropriate against the licensee. Such disciplinary
206	action shall include, at a minimum, probation of the license
207	with the restriction that the licensee must make payments to the
208	judgment creditor on a schedule determined by the board to be
209	reasonable and within the financial capability of the physician.
210	Notwithstanding any other disciplinary penalty imposed, the
211	disciplinary penalty may include suspension of the license for a
212	period not to exceed 5 years. In the event that an agreement to
213	satisfy a judgment has been met, the board shall remove any
214	restriction on the license.
215
216	Nothing in this paragraph shall abrogate a judgment debtor's
217	obligation to satisfy the entire amount of any judgment.
218	(5)  The requirements of subsections (1), (2), and (3) do
219	not apply to:
220	(a)  Any person licensed under this chapter who practices
221	medicine exclusively as an officer, employee, or agent of the
222	Federal Government or of the state or its agencies or its
223	subdivisions. For the purposes of this subsection, an agent of
224	the state, its agencies, or its subdivisions is a person who is
225	eligible for coverage under any self-insurance or insurance
226	program authorized by the provisions of s. 768.28(16).
227	(b)  Any person whose license has become inactive under
228	this chapter and who is not practicing medicine in this state.
229	Any person applying for reactivation of a license must show
230	either that such licensee maintained tail insurance coverage
231	which provided liability coverage for incidents that occurred on
232	or after January 1, 1987, or the initial date of licensure in
233	this state, whichever is later, and incidents that occurred
234	before the date on which the license became inactive; or such
235	licensee must submit an affidavit stating that such licensee has
236	no unsatisfied medical malpractice judgments or settlements at
237	the time of application for reactivation.
238	(c)  Any person holding a limited license pursuant to s.
239	458.317 and practicing under the scope of such limited license.
240	(d)  Any person licensed or certified under this chapter
241	who practices only in conjunction with his or her teaching
242	duties at an accredited medical school or in its main teaching
243	hospitals. Such person may engage in the practice of medicine to
244	the extent that such practice is incidental to and a necessary
245	part of duties in connection with the teaching position in the
246	medical school.
247	(e)  Any person holding an active license under this
248	chapter who is not practicing medicine in this state. If such
249	person initiates or resumes any practice of medicine in this
250	state, he or she must notify the department of such activity and
251	fulfill the financial responsibility requirements of this
252	section before resuming the practice of medicine in this state.
253	(f)  Any person holding an active license under this
254	chapter who meets all of the following criteria:
255	1.  The licensee has held an active license to practice in
256	this state or another state or some combination thereof for more
257	than 15 years.
258	2.  The licensee has either retired from the practice of
259	medicine or maintains a part-time practice of no more than 1,000
260	patient contact hours per year.
261	3.  The licensee has had no more than two claims for
262	medical malpractice resulting in an indemnity exceeding $25,000
263	within the previous 5-year period.
264	4.  The licensee has not been convicted of, or pled guilty
265	or nolo contendere to, any criminal violation specified in this
266	chapter or the medical practice act of any other state.
267	5.  The licensee has not been subject within the last 10
268	years of practice to license revocation or suspension for any
269	period of time; probation for a period of 3 years or longer; or
270	a fine of $500 or more for a violation of this chapter or the
271	medical practice act of another jurisdiction. The regulatory
272	agency's acceptance of a physician's relinquishment of a
273	license, stipulation, consent order, or other settlement,
274	offered in response to or in anticipation of the filing of
275	administrative charges against the physician's license,
276	constitutes action against the physician's license for the
277	purposes of this paragraph.
278	6.  The licensee has submitted a form supplying necessary
279	information as required by the department and an affidavit
280	affirming compliance with this paragraph.
281	7.  The licensee must submit biennially to the department
282	certification stating compliance with the provisions of this
283	paragraph. The licensee must, upon request, demonstrate to the
284	department information verifying compliance with this paragraph.
285
286	A licensee who meets the requirements of this paragraph must
287	post notice in the form of a sign prominently displayed in the
288	reception area and clearly noticeable by all patients or provide
289	a written statement to any person to whom medical services are
290	being provided. The sign or statement must read as follows:
291	"Under Florida law, physicians are generally required to carry
292	medical malpractice insurance or otherwise demonstrate financial
293	responsibility to cover potential claims for medical
294	malpractice. However, certain part-time physicians who meet
295	state requirements are exempt from the financial responsibility
296	law. YOUR DOCTOR MEETS THESE REQUIREMENTS AND HAS DECIDED NOT TO
297	CARRY MEDICAL MALPRACTICE INSURANCE. This notice is provided
298	pursuant to Florida law."
299	(g)  Any person holding an active license under this
300	chapter who agrees to meet all of the following criteria:
301	1.  Upon the entry of an adverse final judgment arising
302	from a medical malpractice arbitration award, from a claim of
303	medical malpractice either in contract or tort, or from
304	noncompliance with the terms of a settlement agreement arising
305	from a claim of medical malpractice either in contract or tort,
306	the licensee shall pay the judgment creditor the lesser of the
307	entire amount of the judgment with all accrued interest or
308	either $100,000, if the physician is licensed pursuant to this
309	chapter but does not maintain hospital staff privileges, or
310	$250,000, if the physician is licensed pursuant to this chapter
311	and maintains hospital staff privileges, within 60 days after
312	the date such judgment became final and subject to execution,
313	unless otherwise mutually agreed to in writing by the parties.
314	Such adverse final judgment shall include any cross-claim,
315	counterclaim, or claim for indemnity or contribution arising
316	from the claim of medical malpractice. Upon notification of the
317	existence of an unsatisfied judgment or payment pursuant to this
318	subparagraph, the department shall notify the licensee by
319	certified mail that he or she shall be subject to disciplinary
320	action unless, within 30 days from the date of mailing, he or
321	she either:
322	a.  Shows proof that the unsatisfied judgment has been paid
323	in the amount specified in this subparagraph; or
324	b.  Furnishes the department with a copy of a timely filed
325	notice of appeal and either:
326	(I)  A copy of a supersedeas bond properly posted in the
327	amount required by law; or
328	(II)  An order from a court of competent jurisdiction
329	staying execution on the final judgment pending disposition of
330	the appeal.
331	2.  The Department of Health shall issue an emergency order
332	suspending the license of any licensee who, after 30 days
333	following receipt of a notice from the Department of Health, has
334	failed to: satisfy a medical malpractice claim against him or
335	her; furnish the Department of Health a copy of a timely filed
336	notice of appeal; furnish the Department of Health a copy of a
337	supersedeas bond properly posted in the amount required by law;
338	or furnish the Department of Health an order from a court of
339	competent jurisdiction staying execution on the final judgment
340	pending disposition of the appeal.
341	3.  Upon the next meeting of the probable cause panel of
342	the board following 30 days after the date of mailing the notice
343	of disciplinary action to the licensee, the panel shall make a
344	determination of whether probable cause exists to take
345	disciplinary action against the licensee pursuant to
346	subparagraph 1.
347	4.  If the board determines that the factual requirements
348	of subparagraph 1. are met, it shall take disciplinary action as
349	it deems appropriate against the licensee. Such disciplinary
350	action shall include, at a minimum, probation of the license
351	with the restriction that the licensee must make payments to the
352	judgment creditor on a schedule determined by the board to be
353	reasonable and within the financial capability of the physician.
354	Notwithstanding any other disciplinary penalty imposed, the
355	disciplinary penalty may include suspension of the license for a
356	period not to exceed 5 years. In the event that an agreement to
357	satisfy a judgment has been met, the board shall remove any
358	restriction on the license.
359	5.  The licensee has completed a form supplying necessary
360	information as required by the department.
361
362	A licensee who meets the requirements of this paragraph shall be
363	required either to post notice in the form of a sign prominently
364	displayed in the reception area and clearly noticeable by all
365	patients or to provide a written statement to any person to whom
366	medical services are being provided. Such sign or statement
367	shall state: "Under Florida law, physicians are generally
368	required to carry medical malpractice insurance or otherwise
369	demonstrate financial responsibility to cover potential claims
370	for medical malpractice. YOUR DOCTOR HAS DECIDED NOT TO CARRY
371	MEDICAL MALPRACTICE INSURANCE. This is permitted under Florida
372	law subject to certain conditions. Florida law imposes penalties
373	against noninsured physicians who fail to satisfy adverse
374	judgments arising from claims of medical malpractice. This
375	notice is provided pursuant to Florida law."
376	(6)  Any deceptive, untrue, or fraudulent representation by
377	the licensee with respect to any provision of this section shall
378	result in permanent disqualification from any exemption to
379	mandated financial responsibility as provided in this section
380	and shall constitute grounds for disciplinary action under s.
381	458.331.
382	(7)  Any licensee who relies on any exemption from the
383	financial responsibility requirement shall notify the
384	department, in writing, of any change of circumstance regarding
385	his or her qualifications for such exemption and shall
386	demonstrate that he or she is in compliance with the
387	requirements of this section.
388	(8)  Notwithstanding any other provision of this section,
389	the department shall suspend the license of any physician
390	against whom has been entered a final judgment, arbitration
391	award, or other order or who has entered into a settlement
392	agreement to pay damages arising out of a claim for medical
393	malpractice, if all appellate remedies have been exhausted and
394	payment up to the amounts required by this section has not been
395	made within 30 days after the entering of such judgment, award,
396	or order or agreement, until proof of payment is received by the
397	department or a payment schedule has been agreed upon by the
398	physician and the claimant and presented to the department. This
399	subsection does not apply to a physician who has met the
400	financial responsibility requirements in paragraphs (1)(b) and
401	(2)(b).
402	(9)  The board shall adopt rules to implement the
403	provisions of this section.
404	Section 2.  Subsection (2) of section 458.331, Florida
405	Statutes, is amended to read:
406	458.331  Grounds for disciplinary action; action by the
407	board and department.--
408	(2)  The board may enter an order denying licensure or
409	imposing any of the penalties in s. 456.072(2) against any
410	applicant for licensure or licensee who is found guilty of
411	violating any provision of subsection (1) of this section or who
412	is found guilty of violating any provision of s. 456.072(1). A
413	probable cause panel considering disciplinary action against a
414	physician assistant pursuant to s. 456.073 shall include a
415	licensed physician assistant designated by the Council on
416	Physician Assistants. In determining what action is appropriate,
417	the board must first consider what sanctions are necessary to
418	protect the public or to compensate the patient. Only after
419	those sanctions have been imposed may the disciplining authority
420	consider and include in the order requirements designed to
421	rehabilitate the physician. All costs associated with compliance
422	with orders issued under this subsection are the obligation of
423	the physician.
424	Section 3.  Section 459.0085, Florida Statutes, is amended
425	to read:
426	459.0085  Financial responsibility.--
427	(1)  As a condition of licensing and maintaining an active
428	license, and prior to the issuance or renewal of an active
429	license or reactivation of an inactive license for the practice
430	of osteopathic medicine, an applicant must by one of the
431	following methods demonstrate to the satisfaction of the board
432	and the department financial responsibility to pay claims and
433	costs ancillary thereto arising out of the rendering of, or the
434	failure to render, medical care or services:
435	(a)  Establishing and maintaining an escrow account
436	consisting of cash or assets eligible for deposit in accordance
437	with s. 625.52 in an amount sufficient to meet the minimum
438	annual aggregate claim amount the per-claim amounts specified in
439	paragraph (b). The escrow account must be payable to the
440	osteopathic physician as beneficiary upon presentation of a
441	final judgment indicating liability and awarding damages to be
442	paid by the osteopathic physician or upon presentation of a
443	settlement agreement signed by all parties to such agreement
444	when such final judgment or settlement is a result of a claim
445	arising out of the rendering of, or the failure to render,
446	medical care and services. The required escrow amount set forth
447	in this paragraph may not be used for litigation costs or
448	attorney's fees for the defense of any medical malpractice
449	claim. The escrow account must be nonassignable and
450	nontransferable. Such escrow account must be made with and held
451	by the trust department of a bank or savings association
452	organized and existing under the laws of this state or any bank
453	or savings association organized under the laws of the United
454	States which has its principal place of business in this state
455	or has a branch office that is authorized under the laws of this
456	state or of the United States to receive deposits in this state.
457	(b)  Obtaining and maintaining professional liability
458	coverage in an amount not less than $100,000 per claim, with a
459	minimum annual aggregate of not less than $300,000, from an
460	authorized insurer as defined under s. 624.09, from a surplus
461	lines insurer as defined under s. 626.914(2), from a risk
462	retention group as defined under s. 627.942, from the Joint
463	Underwriting Association established under s. 627.351(4), or
464	through a plan of self-insurance as provided in s. 627.357. The
465	required coverage amount set forth in this paragraph may not be
466	used for litigation costs or attorney's fees for the defense of
467	any medical malpractice claim.
468	(c)  Obtaining and maintaining an unexpired, irrevocable
469	letter of credit, established pursuant to chapter 675, in an
470	amount sufficient to meet the minimum annual aggregate claim
471	amount specified in paragraph (b) not less than $100,000 per
472	claim, with a minimum aggregate availability of credit of not
473	less than $300,000. The letter of credit must be payable to the
474	osteopathic physician as beneficiary upon presentment of a final
475	judgment indicating liability and awarding damages to be paid by
476	the osteopathic physician or upon presentment of a settlement
477	agreement signed by all parties to such agreement when such
478	final judgment or settlement is a result of a claim arising out
479	of the rendering of, or the failure to render, medical care and
480	services. The letter of credit may not be used for litigation
481	costs or attorney's fees for the defense of any medical
482	malpractice claim. The letter of credit must be nonassignable
483	and nontransferable. Such letter of credit must be issued by any
484	bank or savings association organized and existing under the
485	laws of this state or any bank or savings association organized
486	under the laws of the United States which has its principal
487	place of business in this state or has a branch office that is
488	authorized under the laws of this state or of the United States
489	to receive deposits in this state.
490	(2)  Osteopathic physicians who perform surgery in an
491	ambulatory surgical center licensed under chapter 395 and, as a
492	continuing condition of hospital staff privileges, osteopathic
493	physicians who have staff privileges must also establish
494	financial responsibility by one of the following methods:
495	(a)  Establishing and maintaining an escrow account
496	consisting of cash or assets eligible for deposit in accordance
497	with s. 625.52 in an amount sufficient to meet the minimum
498	annual aggregate claim amount the per-claim amounts specified in
499	paragraph (b). The escrow account must be payable to the
500	osteopathic physician as beneficiary upon presentation of a
501	final judgment indicating liability and awarding damages to be
502	paid by the osteopathic physician or upon presentation of a
503	settlement agreement signed by all parties to such agreement
504	when such final judgment or settlement is a result of a claim
505	render of, or failure to render, medical care and services. The
506	required escrow amount set forth in this paragraph may not be
507	used for litigation costs or attorney's fees for the defense of
508	any medical malpractice claim. The escrow account must be
509	nonassignable and nontransferable. Such escrow account must be
510	made with and held by the trust department of a bank or savings
511	association organized and existing under the laws of the state
512	or any bank or savings association organized under the laws of
513	the United States which has its principal place of business in
514	this state or has a branch office that is under the laws of the
515	United States to receive deposits in this state.
516	(b)  Obtaining and maintaining professional liability
517	coverage in an amount not less than $250,000 per claim, with a
518	minimum annual aggregate of not less than $750,000 from an
519	authorized insurer as defined under s. 624.09, from a surplus
520	lines insurer as defined under s. 626.914(2), from a risk
521	retention group as defined under s. 627.942, from the Joint
522	Underwriting Association established under s. 627.351(4),
523	through a plan of self-insurance as provided in s. 627.357, or
524	through a plan of self-insurance that meets the conditions
525	specified for satisfying financial responsibility in s. 766.110.
526	The required coverage amount set forth in this paragraph may not
527	be used for litigation costs or attorney's fees for the defense
528	of any medical malpractice claim.
529	(c)  Obtaining and maintaining an unexpired, irrevocable
530	letter of credit, established pursuant to chapter 675, in an
531	amount sufficient to meet the minimum annual aggregate claim
532	amount specified in paragraph (b) not less than $250,000 per
533	claim, with a minimum aggregate availability of credit of not
534	less than $750,000. The letter of credit must be payable to the
535	osteopathic physician as beneficiary upon presentment of a final
536	judgment indicating liability and awarding damages to be paid by
537	the osteopathic physician or upon presentment of a settlement
538	agreement signed by all parties to such agreement when such
539	final judgment or settlement is a result of a claim arising out
540	of the rendering of, or the failure to render, medical care and
541	services. The letter of credit may not be used for litigation
542	costs or attorney's fees for the defense of any medical
543	malpractice claim. The letter of credit must be nonassignable
544	and nontransferable. The letter of credit must be issued by any
545	bank or savings association organized and existing under the
546	laws of this state or any bank or savings association organized
547	under the laws of the United States which has its principal
548	place of business in this state or has a branch office that is
549	authorized under the laws of this state or of the United States
550	to receive deposits in this state.
551
552	This subsection shall be inclusive of the coverage in subsection
553	(1).
554	(3)(a)  Meeting the financial responsibility requirements
555	of this section or the criteria for any exemption from such
556	requirements must be established at the time of issuance or
557	renewal of a license.
558	(b)  Any person may, at any time, submit to the department
559	a request for an advisory opinion regarding such person's
560	qualifications for exemption.
561	(4)(a)  Each insurer, self-insurer, risk retention group,
562	or joint underwriting association must promptly notify the
563	department of cancellation or nonrenewal of insurance required
564	by this section. Unless the osteopathic physician demonstrates
565	that he or she is otherwise in compliance with the requirements
566	of this section, the department shall suspend the license of the
567	osteopathic physician pursuant to ss. 120.569 and 120.57 and
568	notify all health care facilities licensed under chapter 395,
569	part IV of chapter 394, or part I of chapter 641 of such action.
570	Any suspension under this subsection remains in effect until the
571	osteopathic physician demonstrates compliance with the
572	requirements of this section. If any judgments or settlements
573	are pending at the time of suspension, those judgments or
574	settlements must be paid in accordance with this section unless
575	otherwise mutually agreed to in writing by the parties. This
576	paragraph does not abrogate a judgment debtor's obligation to
577	satisfy the entire amount of any judgment.
578	(b)  If financial responsibility requirements are met by
579	maintaining an escrow account or letter of credit as provided in
580	this section, upon the entry of an adverse final judgment
581	arising from a medical malpractice arbitration award, from a
582	claim of medical malpractice either in contract or tort, or from
583	noncompliance with the terms of a settlement agreement arising
584	from a claim of medical malpractice either in contract or tort,
585	the licensee shall pay the entire amount of the judgment
586	together with all accrued interest or the amount maintained in
587	the escrow account or provided in the letter of credit as
588	required by this section, whichever is less, within 60 days
589	after the date such judgment became final and subject to
590	execution, unless otherwise mutually agreed to in writing by the
591	parties. If timely payment is not made by the osteopathic
592	physician, the department shall suspend the license of the
593	osteopathic physician pursuant to the following procedures: set
594	forth in subparagraphs (5)(g)3., 4., and 5.
595	1.  The Department of Health shall issue an emergency order
596	suspending the license of any licensee who, after 30 days
597	following receipt of a notice from the Department of Health, has
598	failed to: satisfy a medical malpractice claim against him or
599	her; furnish the Department of Health a copy of a timely filed
600	notice of appeal; furnish the Department of Health a copy of a
601	supersedeas bond properly posted in the amount required by law;
602	or furnish the Department of Health an order from a court of
603	competent jurisdiction staying execution on the final judgment
604	pending disposition of the appeal.
605	2.  Upon the next meeting of the probable cause panel of
606	the board following 30 days after the date of mailing the notice
607	of disciplinary action to the licensee, the panel shall make a
608	determination of whether probable cause exists to take
609	disciplinary action against the licensee pursuant to
610	subparagraph 1.
611	3.  If the board determines that the factual requirements
612	of subparagraph 1. are met, it shall take disciplinary action as
613	it deems appropriate against the licensee. Such disciplinary
614	action shall include, at a minimum, probation of the license
615	with the restriction that the licensee must make payments to the
616	judgment creditor on a schedule determined by the board to be
617	reasonable and within the financial capability of the
618	osteopathic physician. Notwithstanding any other disciplinary
619	penalty imposed, the disciplinary penalty may include suspension
620	of the license for a period not to exceed 5 years. In the event
621	that an agreement to satisfy a judgment has been met, the board
622	shall remove any restriction on the license.
623
624	Nothing in this paragraph shall abrogate a judgment debtor's
625	obligation to satisfy the entire amount of any judgment.
626	(5)  The requirements of subsections (1), (2), and (3) do
627	not apply to:
628	(a)  Any person licensed under this chapter who practices
629	medicine exclusively as an officer, employee, or agent of the
630	Federal Government or of the state or its agencies or its
631	subdivisions. For the purposes of this subsection, an agent of
632	the state, its agencies, or its subdivisions is a person who is
633	eligible for coverage under any self-insurance or insurance
634	program authorized by the provisions of s. 768.28(16).
635	(b)  Any person whose license has become inactive under
636	this chapter and who is not practicing medicine in this state.
637	Any person applying for reactivation of a license must show
638	either that such licensee maintained tail insurance coverage
639	that provided liability coverage for incidents that occurred on
640	or after January 1, 1987, or the initial date of licensure in
641	this state, whichever is later, and incidents that occurred
642	before the date on which the license became inactive; or such
643	licensee must submit an affidavit stating that such licensee has
644	no unsatisfied medical malpractice judgments or settlements at
645	the time of application for reactivation.
646	(c)  Any person holding a limited license pursuant to s.
647	459.0075 and practicing under the scope of such limited license.
648	(d)  Any person licensed or certified under this chapter
649	who practices only in conjunction with his or her teaching
650	duties at a college of osteopathic medicine. Such person may
651	engage in the practice of osteopathic medicine to the extent
652	that such practice is incidental to and a necessary part of
653	duties in connection with the teaching position in the college
654	of osteopathic medicine.
655	(e)  Any person holding an active license under this
656	chapter who is not practicing osteopathic medicine in this
657	state. If such person initiates or resumes any practice of
658	osteopathic medicine in this state, he or she must notify the
659	department of such activity and fulfill the financial
660	responsibility requirements of this section before resuming the
661	practice of osteopathic medicine in this state.
662	(f)  Any person holding an active license under this
663	chapter who meets all of the following criteria:
664	1.  The licensee has held an active license to practice in
665	this state or another state or some combination thereof for more
666	than 15 years.
667	2.  The licensee has either retired from the practice of
668	osteopathic medicine or maintains a part-time practice of
669	osteopathic medicine of no more than 1,000 patient contact hours
670	per year.
671	3.  The licensee has had no more than two claims for
672	medical malpractice resulting in an indemnity exceeding $25,000
673	within the previous 5-year period.
674	4.  The licensee has not been convicted of, or pled guilty
675	or nolo contendere to, any criminal violation specified in this
676	chapter or the practice act of any other state.
677	5.  The licensee has not been subject within the last 10
678	years of practice to license revocation or suspension for any
679	period of time, probation for a period of 3 years or longer, or
680	a fine of $500 or more for a violation of this chapter or the
681	medical practice act of another jurisdiction. The regulatory
682	agency's acceptance of an osteopathic physician's relinquishment
683	of a license, stipulation, consent order, or other settlement,
684	offered in response to or in anticipation of the filing of
685	administrative charges against the osteopathic physician's
686	license, constitutes action against the physician's license for
687	the purposes of this paragraph.
688	6.  The licensee has submitted a form supplying necessary
689	information as required by the department and an affidavit
690	affirming compliance with this paragraph.
691	7.  The licensee must submit biennially to the department a
692	certification stating compliance with this paragraph. The
693	licensee must, upon request, demonstrate to the department
694	information verifying compliance with this paragraph.
695
696	A licensee who meets the requirements of this paragraph must
697	post notice in the form of a sign prominently displayed in the
698	reception area and clearly noticeable by all patients or provide
699	a written statement to any person to whom medical services are
700	being provided. The sign or statement must read as follows:
701	"Under Florida law, osteopathic physicians are generally
702	required to carry medical malpractice insurance or otherwise
703	demonstrate financial responsibility to cover potential claims
704	for medical malpractice. However, certain part-time osteopathic
705	physicians who meet state requirements are exempt from the
706	financial responsibility law. YOUR OSTEOPATHIC PHYSICIAN MEETS
707	THESE REQUIREMENTS AND HAS DECIDED NOT TO CARRY MEDICAL
708	MALPRACTICE INSURANCE. This notice is provided pursuant to
709	Florida law."
710	(g)  Any person holding an active license under this
711	chapter who agrees to meet all of the following criteria.
712	1.  Upon the entry of an adverse final judgment arising
713	from a medical malpractice arbitration award, from a claim of
714	medical malpractice either in contract or tort, or from
715	noncompliance with the terms of a settlement agreement arising
716	from a claim of medical malpractice either in contract or tort,
717	the licensee shall pay the judgment creditor the lesser of the
718	entire amount of the judgment with all accrued interest or
719	either $100,000, if the osteopathic physician is licensed
720	pursuant to this chapter but does not maintain hospital staff
721	privileges, or $250,000, if the osteopathic physician is
722	licensed pursuant to this chapter and maintains hospital staff
723	privileges, within 60 days after the date such judgment became
724	final and subject to execution, unless otherwise mutually agreed
725	to in writing by the parties. Such adverse final judgment shall
726	include any cross-claim, counterclaim, or claim for indemnity or
727	contribution arising from the claim of medical malpractice. Upon
728	notification of the existence of an unsatisfied judgment or
729	payment pursuant to this subparagraph, the department shall
730	notify the licensee by certified mail that he or she shall be
731	subject to disciplinary action unless, within 30 days from the
732	date of mailing, the licensee either:
733	a.  Shows proof that the unsatisfied judgment has been paid
734	in the amount specified in this subparagraph; or
735	b.  Furnishes the department with a copy of a timely filed
736	notice of appeal and either:
737	(I)  A copy of a supersedeas bond properly posted in the
738	amount required by law; or
739	(II)  An order from a court of competent jurisdiction
740	staying execution on the final judgment, pending disposition of
741	the appeal.
742	2.  The Department of Health shall issue an emergency order
743	suspending the license of any licensee who, after 30 days
744	following receipt of a notice from the Department of Health, has
745	failed to: satisfy a medical malpractice claim against him or
746	her; furnish the Department of Health a copy of a timely filed
747	notice of appeal; furnish the Department of Health a copy of a
748	supersedeas bond properly posted in the amount required by law;
749	or furnish the Department of Health an order from a court of
750	competent jurisdiction staying execution on the final judgment
751	pending disposition of the appeal.
752	3.  Upon the next meeting of the probable cause panel of
753	the board following 30 days after the date of mailing the notice
754	of disciplinary action to the licensee, the panel shall make a
755	determination of whether probable cause exists to take
756	disciplinary action against the licensee pursuant to
757	subparagraph 1.
758	4.  If the board determines that the factual requirements
759	of subparagraph 1. are met, it shall take disciplinary action as
760	it deems appropriate against the licensee. Such disciplinary
761	action shall include, at a minimum, probation of the license
762	with the restriction that the licensee must make payments to the
763	judgment creditor on a schedule determined by the board to be
764	reasonable and within the financial capability of the
765	osteopathic physician. Notwithstanding any other disciplinary
766	penalty imposed, the disciplinary penalty may include suspension
767	of the license for a period not to exceed 5 years. In the event
768	that an agreement to satisfy a judgment has been met, the board
769	shall remove any restriction on the license.
770	5.  The licensee has completed a form supplying necessary
771	information as required by the department.
772
773	A licensee who meets the requirements of this paragraph shall be
774	required either to post notice in the form of a sign prominently
775	displayed in the reception area and clearly noticeable by all
776	patients or to provide a written statement to any person to whom
777	medical services are being provided. Such sign or statement
778	shall state: "Under Florida law, osteopathic physicians are
779	generally required to carry medical malpractice insurance or
780	otherwise demonstrate financial responsibility to cover
781	potential claims for medical malpractice. YOUR OSTEOPATHIC
782	PHYSICIAN HAS DECIDED NOT TO CARRY MEDICAL MALPRACTICE
783	INSURANCE. This is permitted under Florida law subject to
784	certain conditions. Florida law imposes strict penalties against
785	noninsured osteopathic physicians who fail to satisfy adverse
786	judgments arising from claims of medical malpractice. This
787	notice is provided pursuant to Florida law."
788	(6)  Any deceptive, untrue, or fraudulent representation by
789	the licensee with respect to any provision of this section shall
790	result in permanent disqualification from any exemption to
791	mandated financial responsibility as provided in this section
792	and shall constitute grounds for disciplinary action under s.
793	459.015.
794	(7)  Any licensee who relies on any exemption from the
795	financial responsibility requirement shall notify the department
796	in writing of any change of circumstance regarding his or her
797	qualifications for such exemption and shall demonstrate that he
798	or she is in compliance with the requirements of this section.
799	(8)  If a physician is either a resident physician,
800	assistant resident physician, or intern in an approved
801	postgraduate training program, as defined by the board's rules,
802	and is supervised by a physician who is participating in the
803	Florida Birth-Related Neurological Injury Compensation Plan,
804	such resident physician, assistant resident physician, or intern
805	is deemed to be a participating physician without the payment of
806	the assessment set forth in s. 766.314(4).
807	(9)  Notwithstanding any other provision of this section,
808	the department shall suspend the license of any osteopathic
809	physician against whom has been entered a final judgment,
810	arbitration award, or other order or who has entered into a
811	settlement agreement to pay damages arising out of a claim for
812	medical malpractice, if all appellate remedies have been
813	exhausted and payment up to the amounts required by this section
814	has not been made within 30 days after the entering of such
815	judgment, award, or order or agreement, until proof of payment
816	is received by the department or a payment schedule has been
817	agreed upon by the osteopathic physician and the claimant and
818	presented to the department. This subsection does not apply to
819	an osteopathic physician who has met the financial
820	responsibility requirements in paragraphs (1)(b) and (2)(b).
821	(10)  The board shall adopt rules to implement the
822	provisions of this section.
823	Section 4.  Subsection (2) of section 459.015, Florida
824	Statutes, is amended to read:
825	459.015  Grounds for disciplinary action; action by the
826	board and department.--
827	(2)  The board may enter an order denying licensure or
828	imposing any of the penalties in s. 456.072(2) against any
829	applicant for licensure or licensee who is found guilty of
830	violating any provision of subsection (1) of this section or who
831	is found guilty of violating any provision of s. 456.072(1). A
832	probable cause panel considering disciplinary action against a
833	physician assistant pursuant to s. 456.073 shall include a
834	licensed physician assistant designated by the Council on
835	Physician Assistants. In determining what action is appropriate,
836	the board must first consider what sanctions are necessary to
837	protect the public or to compensate the patient. Only after
838	those sanctions have been imposed may the disciplining authority
839	consider and include in the order requirements designed to
840	rehabilitate the physician. All costs associated with compliance
841	with orders issued under this subsection are the obligation of
842	the physician.
843	Section 5.  This act shall take effect upon becoming a law.

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