Florida Senate - 2011                        COMMITTEE AMENDMENT
       Bill No. SB 1590
       
       
       
       
       
       
                                Barcode 330054                          
       
                              LEGISLATIVE ACTION                        
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       The Committee on Health Regulation (Bennett) recommended the
       following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete lines 198 - 614
    4  and insert:
    5         Section 6. Section 766.102, Florida Statutes, is amended to
    6  read:
    7         766.102 Medical negligence; standards of recovery; expert
    8  witness.—
    9         (1) In any action for recovery of damages based on the
   10  death or personal injury of any person in which it is alleged
   11  that such death or injury resulted from the negligence of a
   12  health care provider as defined in s. 766.202(4), the claimant
   13  shall have the burden of proving by the greater weight of
   14  evidence that the alleged actions of the health care provider
   15  represented a breach of the prevailing professional standard of
   16  care for that health care provider. The prevailing professional
   17  standard of care for a given health care provider shall be that
   18  level of care, skill, and treatment which, in light of all
   19  relevant surrounding circumstances, is recognized as acceptable
   20  and appropriate by reasonably prudent similar health care
   21  providers.
   22         (2)(a) If the injury is claimed to have resulted from the
   23  negligent affirmative medical intervention of the health care
   24  provider, the claimant must, in order to prove a breach of the
   25  prevailing professional standard of care, show that the injury
   26  was not within the necessary or reasonably foreseeable results
   27  of the surgical, medicinal, or diagnostic procedure constituting
   28  the medical intervention, if the intervention from which the
   29  injury is alleged to have resulted was carried out in accordance
   30  with the prevailing professional standard of care by a
   31  reasonably prudent similar health care provider.
   32         (b) The provisions of this subsection shall apply only when
   33  the medical intervention was undertaken with the informed
   34  consent of the patient in compliance with the provisions of s.
   35  766.103.
   36         (3) The existence of a medical injury shall not create any
   37  inference or presumption of negligence against a health care
   38  provider, and the claimant must maintain the burden of proving
   39  that an injury was proximately caused by a breach of the
   40  prevailing professional standard of care by the health care
   41  provider. However, the discovery of the presence of a foreign
   42  body, such as a sponge, clamp, forceps, surgical needle, or
   43  other paraphernalia commonly used in surgical, examination, or
   44  diagnostic procedures, shall be prima facie evidence of
   45  negligence on the part of the health care provider.
   46         (4) The Legislature is cognizant of the changing trends and
   47  techniques for the delivery of health care in this state and the
   48  discretion that is inherent in the diagnosis, care, and
   49  treatment of patients by different health care providers. The
   50  failure of a health care provider to order, perform, or
   51  administer supplemental diagnostic tests shall not be actionable
   52  if the health care provider acted in good faith and with due
   53  regard for the prevailing professional standard of care.
   54         (5) A person may not give expert testimony concerning the
   55  prevailing professional standard of care unless that person is a
   56  licensed health care provider and meets the following criteria:
   57         (a) If the health care provider against whom or on whose
   58  behalf the testimony is offered is a specialist, the expert
   59  witness must:
   60         1. Specialize in the same specialty as the health care
   61  provider against whom or on whose behalf the testimony is
   62  offered; or specialize in a similar specialty that includes the
   63  evaluation, diagnosis, or treatment of the medical condition
   64  that is the subject of the claim and have prior experience
   65  treating similar patients; and
   66         2. Have devoted professional time during the 2 3 years
   67  immediately preceding the date of the occurrence that is the
   68  basis for the action to:
   69         a. The active clinical practice of, or consulting with
   70  respect to, the same or similar specialty that includes the
   71  evaluation, diagnosis, or treatment of the medical condition
   72  that is the subject of the claim and have prior experience
   73  treating similar patients;
   74         b. Instruction of students in an accredited health
   75  professional school or accredited residency or clinical research
   76  program in the same or similar specialty; or
   77         c. A clinical research program that is affiliated with an
   78  accredited health professional school or accredited residency or
   79  clinical research program in the same or similar specialty.
   80         (b) If the health care provider against whom or on whose
   81  behalf the testimony is offered is a general practitioner, the
   82  expert witness must have devoted professional time during the 2
   83  5 years immediately preceding the date of the occurrence that is
   84  the basis for the action to:
   85         1. The active clinical practice or consultation as a
   86  general practitioner;
   87         2. The instruction of students in an accredited health
   88  professional school or accredited residency program in the
   89  general practice of medicine; or
   90         3. A clinical research program that is affiliated with an
   91  accredited medical school or teaching hospital and that is in
   92  the general practice of medicine.
   93         (c) If the health care provider against whom or on whose
   94  behalf the testimony is offered is a health care provider other
   95  than a specialist or a general practitioner, the expert witness
   96  must have devoted professional time during the 2 3 years
   97  immediately preceding the date of the occurrence that is the
   98  basis for the action to:
   99         1. The active clinical practice of, or consulting with
  100  respect to, the same or similar health profession as the health
  101  care provider against whom or on whose behalf the testimony is
  102  offered;
  103         2. The instruction of students in an accredited health
  104  professional school or accredited residency program in the same
  105  or similar health profession in which the health care provider
  106  against whom or on whose behalf the testimony is offered; or
  107         3. A clinical research program that is affiliated with an
  108  accredited medical school or teaching hospital and that is in
  109  the same or similar health profession as the health care
  110  provider against whom or on whose behalf the testimony is
  111  offered.
  112         (6) A physician licensed under chapter 458 or chapter 459
  113  who qualifies as an expert witness under subsection (5) and who,
  114  by reason of active clinical practice or instruction of
  115  students, has knowledge of the applicable standard of care for
  116  nurses, nurse practitioners, certified registered nurse
  117  anesthetists, certified registered nurse midwives, physician
  118  assistants, or other medical support staff may give expert
  119  testimony in a medical negligence action with respect to the
  120  standard of care of such medical support staff.
  121         (7) Notwithstanding subsection (5), in a medical negligence
  122  action against a hospital, a health care facility, or medical
  123  facility, a person may give expert testimony on the appropriate
  124  standard of care as to administrative and other nonclinical
  125  issues if the person has substantial knowledge, by virtue of his
  126  or her training and experience, concerning the standard of care
  127  among hospitals, health care facilities, or medical facilities
  128  of the same type as the hospital, health care facility, or
  129  medical facility whose acts or omissions are the subject of the
  130  testimony and which are located in the same or similar
  131  communities at the time of the alleged act giving rise to the
  132  cause of action.
  133         (8) If a health care provider described in subsection (5),
  134  subsection (6), or subsection (7) is providing evaluation,
  135  treatment, or diagnosis for a condition that is not within his
  136  or her specialty, a specialist trained in the evaluation,
  137  treatment, or diagnosis for that condition may give expert
  138  testimony concerning the prevailing professional standard of
  139  care shall be considered a similar health care provider.
  140         (9)(a) In any action for damages involving a claim of
  141  negligence against a physician licensed under chapter 458,
  142  osteopathic physician licensed under chapter 459, podiatric
  143  physician licensed under chapter 461, or chiropractic physician
  144  licensed under chapter 460 providing emergency medical services
  145  in a hospital emergency department, the court shall admit expert
  146  medical testimony only from physicians, osteopathic physicians,
  147  podiatric physicians, and chiropractic physicians who have had
  148  substantial professional experience within the preceding 2 5
  149  years while assigned to provide emergency medical services in a
  150  hospital emergency department.
  151         (b) For the purposes of this subsection:
  152         1. The term “emergency medical services” means those
  153  medical services required for the immediate diagnosis and
  154  treatment of medical conditions which, if not immediately
  155  diagnosed and treated, could lead to serious physical or mental
  156  disability or death.
  157         2. “Substantial professional experience” shall be
  158  determined by the custom and practice of the manner in which
  159  emergency medical coverage is provided in hospital emergency
  160  departments in the same or similar localities where the alleged
  161  negligence occurred.
  162         (10) In any action alleging medical negligence, an expert
  163  witness may not testify on a contingency fee basis.
  164         (11) Any attorney who proffers a person as an expert
  165  witness pursuant to this section must certify that such person
  166  has not been found guilty of fraud or perjury in any
  167  jurisdiction.
  168         (12) If the party against whom or on whose behalf the
  169  expert testimony concerning the prevailing professional standard
  170  of care is offered is a physician licensed under chapter 458 or
  171  chapter 459, the expert witness must be licensed in this state
  172  under chapter 458 or chapter 459 or possess an expert witness
  173  certificate as provided in s. 458.3175 or s. 459.0066. Expert
  174  testimony is not admissible unless the expert providing such
  175  testimony is licensed by this state or possesses an expert
  176  witness certificate as provided in s. 458.3175 or s. 459.0066.
  177         (13)(12) This section does not limit the power of the trial
  178  court to disqualify or qualify an expert witness on grounds
  179  other than the qualifications in this section.
  180         Section 7.  Paragraph (a) of subsection (2), subsection
  181  (5), and paragraph (b) of subsection (6) of section 766.106,
  182  Florida Statutes, are amended to read:
  183         766.106 Notice before filing action for medical negligence;
  184  presuit screening period; offers for admission of liability and
  185  for arbitration; informal discovery; review.—
  186         (2) PRESUIT NOTICE.—
  187         (a) After completion of presuit investigation pursuant to
  188  s. 766.203(2) and prior to filing a complaint for medical
  189  negligence, a claimant shall notify each prospective defendant
  190  by certified mail, return receipt requested, of intent to
  191  initiate litigation for medical negligence. Notice to each
  192  prospective defendant must include, if available, a list of all
  193  known health care providers seen by the claimant for the
  194  injuries complained of subsequent to the alleged act of
  195  negligence, all known health care providers during the 2-year
  196  period prior to the alleged act of negligence who treated or
  197  evaluated the claimant, and copies of all of the medical records
  198  relied upon by the expert in signing the affidavit, and the
  199  executed authorization form provided in s. 766.1065. The
  200  requirement of providing the list of known health care providers
  201  may not serve as grounds for imposing sanctions for failure to
  202  provide presuit discovery.
  203         (5) DISCOVERY AND ADMISSIBILITY.—A No statement,
  204  discussion, written document, report, or other work product
  205  generated by the presuit screening process is not discoverable
  206  or admissible in any civil action for any purpose by the
  207  opposing party. All participants, including, but not limited to,
  208  physicians, investigators, witnesses, and employees or
  209  associates of the defendant, are immune from civil liability
  210  arising from participation in the presuit screening process.
  211  This subsection does not prevent a physician licensed under
  212  chapter 458 or chapter 459 who submits a verified written expert
  213  medical opinion from being subject to denial of a license or
  214  disciplinary action under s. 458.331(1)(oo) or s.
  215  459.015(1)(qq).
  216         (6) INFORMAL DISCOVERY.—
  217         (b) Informal discovery may be used by a party to obtain
  218  unsworn statements, the production of documents or things, and
  219  physical and mental examinations, as follows:
  220         1. Unsworn statements.—Any party may require other parties
  221  to appear for the taking of an unsworn statement. Such
  222  statements may be used only for the purpose of presuit screening
  223  and are not discoverable or admissible in any civil action for
  224  any purpose by any party. A party desiring to take the unsworn
  225  statement of any party must give reasonable notice in writing to
  226  all parties. The notice must state the time and place for taking
  227  the statement and the name and address of the party to be
  228  examined. Unless otherwise impractical, the examination of any
  229  party must be done at the same time by all other parties. Any
  230  party may be represented by counsel at the taking of an unsworn
  231  statement. An unsworn statement may be recorded electronically,
  232  stenographically, or on videotape. The taking of unsworn
  233  statements is subject to the provisions of the Florida Rules of
  234  Civil Procedure and may be terminated for abuses.
  235         2. Documents or things.—Any party may request discovery of
  236  documents or things. The documents or things must be produced,
  237  at the expense of the requesting party, within 20 days after the
  238  date of receipt of the request. A party is required to produce
  239  discoverable documents or things within that party’s possession
  240  or control. Medical records shall be produced as provided in s.
  241  766.204.
  242         3. Physical and mental examinations.—A prospective
  243  defendant may require an injured claimant to appear for
  244  examination by an appropriate health care provider. The
  245  prospective defendant shall give reasonable notice in writing to
  246  all parties as to the time and place for examination. Unless
  247  otherwise impractical, a claimant is required to submit to only
  248  one examination on behalf of all potential defendants. The
  249  practicality of a single examination must be determined by the
  250  nature of the claimant’s condition, as it relates to the
  251  liability of each prospective defendant. Such examination report
  252  is available to the parties and their attorneys upon payment of
  253  the reasonable cost of reproduction and may be used only for the
  254  purpose of presuit screening. Otherwise, such examination report
  255  is confidential and exempt from the provisions of s. 119.07(1)
  256  and s. 24(a), Art. I of the State Constitution.
  257         4. Written questions.—Any party may request answers to
  258  written questions, the number of which may not exceed 30,
  259  including subparts. A response must be made within 20 days after
  260  receipt of the questions.
  261         5. Ex parte interviews of treating health care providers.—A
  262  prospective defendant or his or her legal representative shall
  263  have access to interview the claimant’s treating health care
  264  providers without notice to or the presence of the claimant or
  265  the claimant’s legal representative.
  266         6.5.Unsworn statements of treating health care providers
  267  Medical information release.—The claimant must execute a medical
  268  information release that allows A prospective defendant or his
  269  or her legal representative may to take unsworn statements of
  270  the claimant’s treating health care providers physicians. The
  271  statements must be limited to those areas that are potentially
  272  relevant to the claim of personal injury or wrongful death.
  273  Subject to the procedural requirements of subparagraph 1., a
  274  prospective defendant may take unsworn statements from a
  275  claimant’s treating physicians. Reasonable notice and
  276  opportunity to be heard must be given to the claimant or the
  277  claimant’s legal representative before taking unsworn
  278  statements. The claimant or claimant’s legal representative has
  279  the right to attend the taking of such unsworn statements.
  280         Section 8. Section 766.1065, Florida Statutes, is created
  281  to read:
  282         766.1065Authorization form for release of protected health
  283  information.—
  284         (1) Presuit notice of intent to initiate litigation for
  285  medical negligence under s. 766.106(2) must be accompanied by an
  286  authorization for release of protected health information in the
  287  form specified by this section, authorizing the disclosure of
  288  protected health information that is potentially relevant to the
  289  claim of personal injury or wrongful death. The presuit notice
  290  is void if this authorization does not accompany the presuit
  291  notice and other materials required by s. 766.106(2).
  292         (2) If the authorization required by this section is
  293  revoked, the presuit notice under s. 766.106(2) shall be deemed
  294  retroactively void from the date of issuance, and any tolling
  295  effect that the presuit notice may have had on any applicable
  296  statute-of-limitations period is retroactively rendered void.
  297         (3) The authorization required by this section shall be in
  298  the following form and shall be construed in accordance with the
  299  “Standards for Privacy of Individually Identifiable Health
  300  Information” in 45 C.F.R. parts 160 and 164:
  301  
  302         AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION
  303  
  304         A. I,_(...Name of patient or authorized
  305         representative...) [hereinafter “Patient”], authorize
  306         that (...Name of health care provider to whom the
  307         presuit notice is directed...) and his/her/its
  308         insurer(s), self-insurer(s), and attorney(s) may
  309         obtain and disclose (within the parameters set out
  310         below) the protected health information described
  311         below for the following specific purposes:
  312         1. Facilitating the investigation and evaluation
  313         of the medical negligence claim described in the
  314         accompanying presuit notice; or
  315         2. Defending against any litigation arising out
  316         of the medical negligence claim made on the basis of
  317         the accompanying presuit notice.
  318         B. The health information obtained, used, or
  319         disclosed extends to, and includes, oral as well as
  320         the written information, and is described as follows:
  321         1. The health information in the custody of the
  322         following health care providers who have examined,
  323         evaluated, or treated the Patient in connection with
  324         injuries complained of after the alleged act of
  325         negligence: (List the name and current address of all
  326         health care providers). This authorization extends to
  327         any additional health care providers that may in the
  328         future evaluate, examine, or treat the Patient for the
  329         injuries complained of.
  330         2. The health information in the custody of the
  331         following health care providers who have examined,
  332         evaluated, or treated the Patient during a period
  333         commencing 2 years before the incident that is the
  334         basis of the accompanying presuit notice.
  335  
  336         (List the name and current address of such health care
  337         providers, if applicable.)
  338  
  339         C. This authorization does not apply to the
  340         following list of health care providers possessing
  341         health care information about the Patient because the
  342         Patient certifies that such health care information is
  343         not potentially relevant to the claim of personal
  344         injury or wrongful death which is the basis of the
  345         accompanying presuit notice.
  346  
  347         (List the name of each health care provider to whom
  348         this authorization does not apply and the inclusive
  349         dates of examination, evaluation, or treatment to be
  350         withheld from disclosure. If none, specify “none.”)
  351  
  352         D. The persons or class of persons to whom the
  353         Patient authorizes such health information to be
  354         disclosed, or by whom such health information is to be
  355         used, includes:
  356         1. Any health care provider providing care or
  357         treatment for the Patient.
  358         2. Any liability insurer or self-insurer
  359         providing liability insurance coverage, self
  360         insurance, or defense to any health care provider to
  361         whom presuit notice is given regarding the care and
  362         treatment of the Patient.
  363         3. Any consulting or testifying expert employed
  364         by or on behalf of (name of health care provider to
  365         whom presuit notice was given) or his/her/its
  366         insurer(s), self-insurer(s), or attorney(s) regarding
  367         the matter of the presuit notice accompanying this
  368         authorization.
  369         4. Any attorney (including secretarial, clerical,
  370         or paralegal staff) employed by or on behalf of (name
  371         of health care provider to whom presuit notice was
  372         given) regarding the matter of the presuit notice
  373         accompanying this authorization.
  374         5. Any trier of the law or facts relating to any
  375         suit filed seeking damages arising out of the medical
  376         care or treatment of the Patient.
  377         E. This authorization expires upon resolution of
  378         the claim or at the conclusion of any litigation
  379         instituted in connection with the matter of the
  380         presuit notice accompanying this authorization,
  381         whichever occurs first.
  382         F. The Patient understands that, without
  383         exception, the Patient has the right to revoke this
  384         authorization in writing. The Patient further
  385         understands that the consequence of any such
  386         revocation is that the presuit notice under s.
  387         766.106(2), Florida Statutes, is deemed retroactively
  388         void from the date of issuance, and any tolling effect
  389         that the presuit notice may have had on any applicable
  390         statute-of-limitations period is retroactively
  391         rendered void.
  392         G. The Patient understands that signing this
  393         authorization is not a condition for continued
  394         treatment, payment, enrollment, or eligibility for
  395         health plan benefits.
  396         H. The Patient understands that information used
  397         or disclosed under this authorization may be subject
  398         to additional disclosure by the recipient and may not
  399         be protected by federal HIPAA privacy regulations.
  400  
  401         Signature of Patient/Representative: ....
  402         Date: ....
  403         Name of Patient/Representative: ....
  404         Description of Representative’s Authority: ....
  405         Section 9. Subsection (2) of section 766.206, Florida
  406  Statutes, is amended to read:
  407         766.206 Presuit investigation of medical negligence claims
  408  and defenses by court.—
  409         (2) If the court finds that the notice of intent to
  410  initiate litigation mailed by the claimant does is not comply in
  411  compliance with the reasonable investigation requirements of ss.
  412  766.201-766.212, including a review of the claim and a verified
  413  written medical expert opinion by an expert witness as defined
  414  in s. 766.202, or that the authorization form accompanying the
  415  notice of intent provided for in s. 766.1065 was not completed
  416  in good faith by the claimant, the court shall dismiss the
  417  claim, and the person who mailed such notice of intent, whether
  418  the claimant or the claimant’s attorney, shall be personally
  419  liable for all attorney’s fees and costs incurred during the
  420  investigation and evaluation of the claim, including the
  421  reasonable attorney’s fees and costs of the defendant or the
  422  defendant’s insurer.
  423         Section 10. Subsections (3), (4), and (5) of section
  424  463.002, Florida Statutes, are amended to read:
  425         463.002 Definitions.—As used in this chapter, the term:
  426         (3)(a) “Licensed practitioner” means a person who is a
  427  primary health care provider licensed to engage in the practice
  428  of optometry under the authority of this chapter.
  429         (b) A licensed practitioner who is not a certified
  430  optometrist shall be required to display at her or his place of
  431  practice a sign which states, “I am a Licensed Practitioner, not
  432  a Certified Optometrist, and I am not able to prescribe topical
  433  ocular pharmaceutical agents.”
  434         (c) All practitioners initially licensed after July 1,
  435  1993, must be certified optometrists.
  436         (4) “Certified optometrist” means a licensed practitioner
  437  authorized by the board to administer and prescribe topical
  438  ocular pharmaceutical agents.
  439         (5) “Optometry” means the diagnosis of conditions of the
  440  human eye and its appendages; the employment of any objective or
  441  subjective means or methods, including the administration of
  442  topical ocular pharmaceutical agents, for the purpose of
  443  determining the refractive powers of the human eyes, or any
  444  visual, muscular, neurological, or anatomic anomalies of the
  445  human eyes and their appendages; and the prescribing and
  446  employment of lenses, prisms, frames, mountings, contact lenses,
  447  orthoptic exercises, light frequencies, and any other means or
  448  methods, including topical ocular pharmaceutical agents, for the
  449  correction, remedy, or relief of any insufficiencies or abnormal
  450  conditions of the human eyes and their appendages.
  451         Section 11. Paragraph (g) of subsection (1) of section
  452  463.005, Florida Statutes, is amended to read:
  453         463.005 Authority of the board.—
  454         (1) The Board of Optometry has authority to adopt rules
  455  pursuant to ss. 120.536(1) and 120.54 to implement the
  456  provisions of this chapter conferring duties upon it. Such rules
  457  shall include, but not be limited to, rules relating to:
  458         (g) Administration and prescription of topical ocular
  459  pharmaceutical agents.
  460         Section 12. Section 463.0055, Florida Statutes, is amended
  461  to read:
  462         463.0055 Administration and prescription of topical ocular
  463  pharmaceutical agents; committee.—
  464         (1) Certified optometrists may administer and prescribe
  465  topical ocular pharmaceutical agents as provided in this section
  466  for the diagnosis and treatment of ocular conditions of the
  467  human eye and its appendages without the use of surgery or other
  468  invasive techniques. However, a licensed practitioner who is not
  469  certified may use topically applied anesthetics solely for the
  470  purpose of glaucoma examinations, but is otherwise prohibited
  471  from administering or prescribing topical ocular pharmaceutical
  472  agents.
  473         (2)(a) There is hereby created a committee composed of two
  474  optometrists licensed pursuant to this chapter, appointed by the
  475  Board of Optometry, two board-certified ophthalmologists
  476  licensed pursuant to chapter 458 or chapter 459, appointed by
  477  the Board of Medicine, and one additional person with a
  478  doctorate degree in pharmacology who is not licensed pursuant to
  479  chapter 458, chapter 459, or this chapter, appointed by the
  480  State Surgeon General. The committee shall review requests for
  481  additions to, deletions from, or modifications of a formulary of
  482  topical ocular pharmaceutical agents for administration and
  483  prescription by certified optometrists and shall provide to the
  484  board advisory opinions and recommendations on such requests.
  485  The formulary shall consist of those topical ocular
  486  pharmaceutical agents which the certified optometrist is
  487  qualified to use in the practice of optometry. The board shall
  488  establish, add to, delete from, or modify the formulary by rule.
  489  Notwithstanding any provision of chapter 120 to the contrary,
  490  the formulary rule shall become effective 60 days from the date
  491  it is filed with the Secretary of State.
  492         (b) The formulary may be added to, deleted from, or
  493  modified according to the procedure described in paragraph (a).
  494  Any person who requests an addition, deletion, or modification
  495  of an authorized topical ocular pharmaceutical agent shall have
  496  the burden of proof to show cause why such addition, deletion,
  497  or modification should be made.
  498         (c) The State Surgeon General shall have standing to
  499  challenge any rule or proposed rule of the board pursuant to s.
  500  120.56. In addition to challenges for any invalid exercise of
  501  delegated legislative authority, the administrative law judge,
  502  upon such a challenge by the State Surgeon General, may declare
  503  all or part of a rule or proposed rule invalid if it:
  504         1. Does not protect the public from any significant and
  505  discernible harm or damages;
  506         2. Unreasonably restricts competition or the availability
  507  of professional services in the state or in a significant part
  508  of the state; or
  509         3. Unnecessarily increases the cost of professional
  510  services without a corresponding or equivalent public benefit.
  511  
  512  However, there shall not be created a presumption of the
  513  existence of any of the conditions cited in this subsection in
  514  the event that the rule or proposed rule is challenged.
  515         (d) Upon adoption of the formulary required by this
  516  section, and upon each addition, deletion, or modification to
  517  the formulary, the board shall mail a copy of the amended
  518  formulary to each certified optometrist and to each pharmacy
  519  licensed by the state.
  520         (3) A certified optometrist shall be issued a prescriber
  521  number by the board. Any prescription written by a certified
  522  optometrist for a topical ocular pharmaceutical agent pursuant
  523  to this section shall have the prescriber number printed
  524  thereon.
  525         Section 13. Subsection (3) of section 463.0057, Florida
  526  Statutes, is amended to read:
  527         463.0057 Optometric faculty certificate.—
  528         (3) The holder of a faculty certificate may engage in the
  529  practice of optometry as permitted by this section, but may not
  530  administer or prescribe topical ocular pharmaceutical agents
  531  unless the certificateholder has satisfied the requirements of
  532  s. 463.006(1)(b)4. and 5.
  533         Section 14. Subsections (2) and (3) of section 463.006,
  534  Florida Statutes, are amended to read:
  535         463.006 Licensure and certification by examination.—
  536         (2) The examination shall consist of the appropriate
  537  subjects, including applicable state laws and rules and general
  538  and ocular pharmacology with emphasis on the topical application
  539  and side effects of ocular pharmaceutical agents. The board may
  540  by rule substitute a national examination as part or all of the
  541  examination and may by rule offer a practical examination in
  542  addition to the written examination.
  543         (3) Each applicant who successfully passes the examination
  544  and otherwise meets the requirements of this chapter is entitled
  545  to be licensed as a practitioner and to be certified to
  546  administer and prescribe topical ocular pharmaceutical agents in
  547  the diagnosis and treatment of ocular conditions.
  548         Section 15. Subsection (3) and paragraph (a) of subsection
  549  (4) of section 464.012, Florida Statutes, are amended to read:
  550         464.012 Certification of advanced registered nurse
  551  practitioners; fees.—
  552         (3) An advanced registered nurse practitioner shall perform
  553  those functions authorized in this section within the framework
  554  of an established protocol that is filed with the board upon
  555  biennial license renewal and within 30 days after entering into
  556  a supervisory relationship with a physician or changes to the
  557  protocol. The board shall review the protocol to ensure
  558  compliance with applicable regulatory standards for protocols.
  559  The board shall refer to the department licensees submitting
  560  protocols that are not compliant with the regulatory standards
  561  for protocols. A practitioner currently licensed under chapter
  562  458, chapter 459, or chapter 466 shall maintain supervision for
  563  directing the specific course of medical treatment. Within the
  564  established framework, an advanced registered nurse practitioner
  565  may:
  566         (a) Monitor, prescribe, and alter drug therapies, including
  567  controlled substances in Schedule II through Schedule IV under
  568  chapter 893.
  569         (b) Initiate appropriate therapies for certain conditions.
  570         (c) Perform additional functions as may be determined by
  571  rule in accordance with s. 464.003(2).
  572         (d) Order diagnostic tests and physical and occupational
  573  therapy.
  574         (4) In addition to the general functions specified in
  575  subsection (3), an advanced registered nurse practitioner may
  576  perform the following acts within his or her specialty:
  577         (a) The certified registered nurse anesthetist may, to the
  578  extent authorized by established protocol approved by the
  579  medical staff of the facility in which the anesthetic service is
  580  performed, perform any or all of the following:
  581         1. Determine the health status of the patient as it relates
  582  to the risk factors and to the anesthetic management of the
  583  patient through the performance of the general functions.
  584         2. Based on history, physical assessment, and supplemental
  585  laboratory results, determine, with the consent of the
  586  responsible physician, the appropriate type of anesthesia within
  587  the framework of the protocol.
  588         3. Order under the protocol preanesthetic medication.
  589         4. Perform under the protocol procedures commonly used to
  590  render the patient insensible to pain during the performance of
  591  surgical, obstetrical, therapeutic, or diagnostic clinical
  592  procedures. These procedures include ordering and administering
  593  regional, spinal, and general anesthesia; inhalation agents and
  594  techniques; intravenous agents and techniques; and techniques of
  595  hypnosis.
  596         5. Order or perform monitoring procedures indicated as
  597  pertinent to the anesthetic health care management of the
  598  patient.
  599         6. Support life functions during anesthesia health care,
  600  including induction and intubation procedures, the use of
  601  appropriate mechanical supportive devices, and the management of
  602  fluid, electrolyte, and blood component balances.
  603         7. Recognize and take appropriate corrective action for
  604  abnormal patient responses to anesthesia, adjunctive medication,
  605  or other forms of therapy.
  606         8. Recognize and treat a cardiac arrhythmia while the
  607  patient is under anesthetic care.
  608         9. Participate in management of the patient while in the
  609  postanesthesia recovery area, including ordering the
  610  administration of fluids and drugs, which include drugs that are
  611  commonly used to alleviate pain.
  612         10. Place special peripheral and central venous and
  613  arterial lines for blood sampling and monitoring as appropriate.
  614         Section 16. Section 768.135, Florida Statutes, is amended
  615  to read:
  616         768.135 Volunteer team physicians; immunity.—Any person
  617  licensed to practice medicine pursuant to chapter 458, chapter
  618  459, chapter 460, chapter 461, or chapter 466:
  619         (1) Who is acting in the capacity of a volunteer team
  620  physician in attendance at an athletic event sponsored by a
  621  public or private elementary or secondary school; and
  622         (2) Who gratuitously and in good faith prior to the
  623  athletic event agrees to render emergency care or treatment to
  624  any participant in such event in connection with an emergency
  625  arising during or as the result of such event, without objection
  626  of such participant,
  627  
  628  shall not be held liable for any civil damages as a result of
  629  such care or treatment or as a result of any act or failure to
  630  act in providing or arranging further medical treatment unless
  631  when such care or treatment was rendered in a wrongful manner as
  632  a reasonably prudent person similarly licensed to practice
  633  medicine would have acted under the same or similar
  634  circumstances.
  635         (3) As used in this section, the term “wrongful manner”
  636  means bad faith or with malicious purposes or in a manner
  637  exhibiting wanton and willful disregard of human rights, safety,
  638  or property, and shall be construed in conformity with the
  639  standard set forth in s. 768.28(9)(a).
  640         Section 17. Subsection (20) of section 893.02, Florida
  641  Statutes, is amended to read:
  642         893.02 Definitions.—The following words and phrases as used
  643  in this chapter shall have the following meanings, unless the
  644  context otherwise requires:
  645         (20) “Practitioner” means a physician licensed pursuant to
  646  chapter 458, a dentist licensed pursuant to chapter 466, a
  647  veterinarian licensed pursuant to chapter 474, an osteopathic
  648  physician licensed pursuant to chapter 459, a naturopath
  649  licensed pursuant to chapter 462, a certified optometrist
  650  licensed pursuant to chapter 463, an advanced registered nurse
  651  practitioner licensed pursuant to chapter 464, or a podiatric
  652  physician licensed pursuant to chapter 461, if provided such
  653  practitioner holds a valid federal controlled substance registry
  654  number.
  655         Section 18. Subsection (1) of section 893.05, Florida
  656  Statutes, is amended to read:
  657         893.05 Practitioners and persons administering controlled
  658  substances in their absence.—
  659         (1) A practitioner, in good faith and in the course of his
  660  or her professional practice only, may prescribe, administer,
  661  dispense, mix, or otherwise prepare a controlled substance, or
  662  the practitioner may cause the same to be administered by a
  663  licensed nurse or an intern practitioner under his or her
  664  direction and supervision only. A veterinarian may so prescribe,
  665  administer, dispense, mix, or prepare a controlled substance for
  666  use on animals only, and may cause it to be administered by an
  667  assistant or orderly under the veterinarian’s direction and
  668  supervision only. A certified optometrist licensed under chapter
  669  463 may not administer or prescribe ocular pharmaceutical agents
  670  listed under Schedule I or Schedule II of the Florida
  671  Comprehensive Drug Abuse Prevention and Control Act.
  672  
  673  ================= T I T L E  A M E N D M E N T ================
  674         And the title is amended as follows:
  675         Delete lines 2 - 50
  676  and insert:
  677         An act relating to health care; creating ss. 458.3175
  678         and 459.0066, F.S.; requiring the Board of Medicine
  679         and the Board of Osteopathic Medicine to issue expert
  680         witness certificates to physicians licensed outside
  681         the state; providing application and certification
  682         requirements; establishing application fees; providing
  683         for validity and use of the certification; exempting a
  684         physician issued a certificate from certain licensure
  685         and fee requirements; requiring the boards to adopt
  686         rules; amending ss. 458.331 and 459.015, F.S.;
  687         providing additional acts that constitute grounds for
  688         denial of a license or disciplinary action to which
  689         penalties apply; amending s. 627.4147, F.S.; deleting
  690         a requirement that medical malpractice insurance
  691         contracts contain a clause authorizing the insurer to
  692         make and conclude certain offers within policy limits
  693         over the insured’s veto; amending s. 766.102, F.S.;
  694         revising the criteria required in order for a health
  695         care provider to give expert testimony concerning the
  696         prevailing professional standard of care; authorizing
  697         certain specialists, rather than certain health care
  698         providers, to give expert testimony concerning the
  699         prevailing professional standard of care under certain
  700         circumstances; requiring an expert witness in certain
  701         medical negligence actions to be licensed under ch.
  702         458 or ch. 459, F.S., or possess an expert witness
  703         certificate under certain conditions; providing that
  704         certain medical expert testimony is not admissible
  705         unless the expert witness meets certain requirements;
  706         amending s. 766.106, F.S.; requiring claimants for
  707         medical malpractice to execute an authorization form;
  708         deleting a provision prohibiting failure to provide
  709         certain presuit notice from serving as grounds for
  710         imposing sanctions; providing that certain immunity
  711         arising from participation in the presuit screening
  712         process does not prohibit certain physicians from
  713         being subject to certain penalties; allowing
  714         prospective medical malpractice defendants to
  715         interview a claimant’s treating health care providers
  716         without notice to or the presence of the claimant or
  717         the claimant’s legal representative; authorizing
  718         prospective defendants to take unsworn statements of a
  719         claimant’s health care providers; creating s.
  720         766.1065, F.S.; requiring that presuit notice for
  721         medical negligence claims be accompanied by an
  722         authorization for release of protected health
  723         information; providing requirements for the form of
  724         such authorization; amending s. 766.206, F.S.;
  725         requiring dismissal of a medical malpractice claim and
  726         payment of certain costs if such authorization form is
  727         not completed in good faith; amending s. 463.002,
  728         F.S.; redefining the terms “licensed practitioner,”
  729         “certified optometrist,” and “optometry” within the
  730         practice of optometry; amending s. 463.005, F.S.;
  731         authorizing the Board of Optometry to adopt rules
  732         pertaining to the administration and prescription of
  733         all ocular pharmaceutical agents; amending s.
  734         463.0055, F.S.; expanding the type of ocular
  735         pharmaceuticals that are prescribed and administered;
  736         amending ss. 463.0057 and 463.006, F.S.; specifying
  737         certain persons who may or may not prescribe or
  738         administer any ocular pharmaceutical agents; amending
  739         s. 464.012, F.S.; expanding the scope of practice to
  740         authorize an advanced registered nurse practitioner to
  741         order, administer, monitor, and alter any drug or drug
  742         therapies; expanding the scope of practice to
  743         authorize a certified registered nurse anesthetist to
  744         participate in management of a patient while in the
  745         postanesthesia recovery area, including ordering the
  746         administration of fluids and drugs that are commonly
  747         used to alleviate pain; amending s. 768.135, F.S.;
  748         providing the circumstance in which a volunteer team
  749         physician or person is liable for civil damages as a
  750         result of care or treatment or as a result of any act
  751         or failure to act in providing or arranging further
  752         medical treatment; defining the term “wrongful manner”
  753         as it relates to the immunity for volunteer team
  754         physicians; amending s. 893.02, F.S.; redefining the
  755         term “practitioner” as it relates to the Florida
  756         Comprehensive Drug Abuse Prevention and Control Act;
  757         amending s. 893.05, F.S.; prohibiting a certified
  758         optometrist from administering or prescribing certain
  759         ocular pharmaceutical agents;