,i  #aacth ,,congress  #b;d ,session    
,h4 ,r4 #dajf  ,,in ,,the ,,house ,,of  
,,representatives  ,february #bg1 #bjad 
,mr4 ,barr 7for himself and ,mr4 ,bera  
of ,california7 introduced the following
 bill2 which was referred to the        
,committee on ,energy and ,commerce1 and
 in addition to the ,committee on the   
,judiciary1 for a period to be          
subsequently determined by the ,speaker1
 in each case for consideration of such 
provisions as fall within the           
jurisdiction of the committee concerned 
,a ,,bill  ,to provide for the          
development and dissemination of        
clinical practice guidelines and the    
establishment of a right of removal to  
,federal courts for defendants in       
medical malpractice actions involving a 
,federal payor1 and for other purposes4 
#a4 ,short title ,this ,act may be cited
 as the ,saving ,lives1 ,saving ,costs  
,act4  #b4 ,purposes  ,the purposes of  
this ,act are3  7#a7 ,to offer          
physicians who document adherence to    

certain evidence-based clinical-practice
 guidelines1 and1 when applicable1      
appropriate use criteria1 a safe harbor 
from medical-malpractice litigation4    
7#b7 ,to reduce the practice of         
defensive medicine and resulting health 
care costs4  7#c7 ,to increase adherence
 to evidence-based clinical practice    
guidelines to reduce clinical variation 
in health care practice4  7#d7 ,to      
improve quality of care and patient     
safety4  7#e7 ,to permit organizations  
with relevant expertise to participate  
in the selection of clinical practice   
guidelines4  7#f7 ,to permit            
professionals with relevant expertise to
 participate and benefit from liability 
reform4  #c4 ,requirements for selection
 of clinical practice guidelines  7a7   
,selection ,not later than #f months    
after the date of enactment of this     
,act1 eligible professional             
organizations that have established1    
published1 maintained and updated on a  
regular basis1 clinical practice        

guidelines1 including when applicable1  
appropriate use criteria1 that          
incorporate best practices1 shall submit
 to the ,secretary those guidelines4    
,not later than #f months after that    
submission date1 the ,secretary shall   
select and designate one or more of     
those eligible professional             
organizations to provide and maintain   
such clinical practice guidelines on    
behalf of the ,secretary4 ,to this end1 
not more than #f months after           
designating each such eligible          
professional organization1 the          
,secretary shall enter into an agreement
 with each such eligible professional   
organization for maintenance and        
updating of such clinical practice      
guidelines4  7b7 ,maintenance  7#a7     
,periodic review ,not later than #e     
years after publication of guidelines1  
and every five years thereafter1 the    
,secretary shall review the clinical    
practice guidelines and shall1 as       
necessary1 enter into agreements with   

eligible professional organizations4    
7#b7 ,update by eligible professional   
organization ,an eligible professional  
organization that collaborated in the   
establishment of a clinical practice    
guideline may submit amendments to that 
clinical practice guideline at any time 
to the ,secretary1 who shall review the 
amendments4  7#c7 ,notification required
 for certain updates ,in the case of an 
amendment under paragraph 7#b7 that     
adds1 materially changes1 or removes a  
guideline from a set of guidelines1 such
 update shall not apply under this      
subsection unless notification of such  
update is made available to applicable  
eligible professionals4  #d4            
,development  7a7 ,guideline standards  
,to the extent possible1 the development
 of clinical practice guidelines should 
be guided by the ,institute of          
,medicine's ,standards for ,developing  
,trustworthy ,guidelines and should--   
7#a7 be developed through a transparent 
process that minimizes conflicts of     

interest2  7#b7 be developed by a       
knowledgeable1 multidisciplinary panel  
of experts and representatives from key 
affected groups2  7#c7 take into        
consideration important patient         
subgroups and patient preferences as    
appropriate2  7#d7 be based on a        
systematic review of the existing       
evidence2  7#e7 provide a clear         
explanation of the relationship between 
care options and health outcomes2  7#f7 
provide ratings of both the quality of  
evidence and strength of recommendation2
  7#g7 be reconsidered and revised when 
new evidence emerges2 and  7#h7 clearly 
identify any exceptions to the          
application of the clinical practice    
guideline4  7b7 ,required disclosures   
from eligible professional organizations
 ,any person who is affiliated with an  
eligible professional organization and  
who directly participated in the        
creation of a clinical practice         
guideline shall disclose any conflicts  
of interest pertaining to the           

development of the clinical practice    
guideline1 including any conflict of    
interest pertaining to any instrument1  
medicine1 drug1 or any other substance1 
device1 or means included in the        
clinical practice guideline4            
,disclosures by eligible professional   
organizations shall be made promptly1   
upon submission of the guidelines1 and  
during every review of the guidelines1  
to the ,secretary4 ,disclosures shall   
additionally include the following3     
7#a7 ,scientific methodology and        
evidence that supports clinical practice
 guidelines4  7#b7 ,outside             
collaborators4  7#c7 ,endorsements4  #e4
 ,internet publication of guidelines    
,the ,secretary of ,health and ,human   
,services shall publish all clinical    
practice guidelines on the ,internet    
through the ,national ,guideline        
,clearinghouse or other appropriate     
sites or sources1 including all data and
 methodology used in the development and
 selection of the guidelines in         

compliance with data disclosure         
standards in the ,health ,insurance     
,portability and ,accountability ,act of
 #aiif4  #f4 ,state flexibility and     
protection of ,states' rights  7a7      
,limitation ,this ,act shall not preempt
 or supersede any ,state or ,federal law
 that imposes greater procedural or     
substantive protections for health care 
providers and health care organizations 
from liability1 loss1 or damages than   
those provided by this title or create a
 cause of action4  7b7 ,state           
,flexibility ,no provision of this ,act 
shall be construed to preempt any       
defense available to a party in a health
 care liability action under any other  
provision of ,state or ,federal law4    
#g4 ,right of removal ,section #adda of 
title #bh1 ,united ,states ,code1 is    
amended by adding at the end the        
following3  7g7 ,certain actions against
 medical professionals  7#a7 ,any health
 care liability action brought in a     
,state court against an applicable      

eligible professional or health care    
provider may be removed by any defendant
 or the defendants to the district court
 of the ,united ,states for the district
 and division embracing the place where 
such action is pending4  7#b7 ,for      
purposes of this subsection the terms   
applicable eligible professional1 health
 care provider1 health care liability   
action1 and health care liability claim 
have the meaning given such term in     
section #aj of the ,saving ,lives1      
,saving ,costs ,act of #bjad4  4  #h4   
,mandatory review by independent medical
 review panel  7a7 ,in general ,if1 in  
any health care liability action against
 an applicable eligible professional1   
the applicable eligible professional    
alleges1 in any response to the         
claimant's filing1 that the applicable  
eligible professional adhered to an     
applicable clinical practice guideline  
in the provision of health care goods or
 services to the claimant1 then the     
court shall suspend further proceedings 

on the health care liability action     
prior to discovery proceedings1 until   
the completion of a review of the action
 by an independent medical review panel4
  7b7 ,independent medical review panel 
7#a7 ,composition ,an independent       
medical review panel under this section 
shall be composed of #c members who are 
experts in the relevant field of        
clinical practice4  7#b7 ,requirements  
for member eligibility ,to be eligible  
to serve on an independent medical      
review panel1 a member shall--  7,a7 be 
an experienced physician certified by a 
board recognized by the ,american ,board
 of ,medical ,specialties2  7,b7 not    
earlier than #b years prior to the date 
of selection to the board1 have been in 
active medical practice or devoted a    
substantial portion of his or her time  
to teaching at an accredited medical    
school1 or have been engaged in         
university-based research in relation to
 the medical care and type of treatment 
at issue2 and  7,c7 be approved by his  

or her specialty society4  ,when        
possible1 members should be from the    
region where the case in question       
originates to account for geographical  
practice variation4  7#c7 ,no civil     
liability for members ,no civil action  
shall be brought in any court against   
any member for any act done1 failure to 
act1 or statement or opinion made1      
within the scope of his or her duties as
 a member of the independent medical    
review panel4  7#d7 ,considerations in  
making determinations ,the members of   
the independent medical review panel    
shall acknowledge the ability of        
physicians to depart from the           
recommendations in clinical practice    
guidelines1 when appropriate1 in the    
care of individual patients4  7#e7      
,selection of members ,each member of   
the panel shall be jointly selected by  
the parties4 ,a member whose selection  
one party does not concur in may not    
serve on the panel1 except that1 if1 not
 later than #cj days after a response to

 the health care liability action is    
filed1 #c members have not been selected
 by the parties1 the court shall appoint
 any remaining members4  7#f7           
,compensation of members ,the costs of  
compensation to the members of the panel
 shall be split between the parties     
equally1 unless otherwise agreed to by  
the parties4  7c7 ,terms of review ,a   
review by an independent medical review 
panel under this section shall comply   
with the following3  7#a7 ,standard of  
conduct ,the mandatory independent      
medical review panel that is charged    
with the responsibility of making a     
preliminary finding as to liability of  
the defendant applicable eligible       
professional shall deem the prescribed  
clinical practice guidelines as the     
standard of conduct1 care1 and skill    
expected of members of the medical      
profession engaged in the defendant's   
field of practice under the same or     
similar circumstances4  7#b7 ,record for
 review ,the review panel shall make a  

preliminary finding based solely upon   
the pre-discovery evidence submitted to 
it pursuant to ,rule #bf of the ,federal
 ,rules of ,civil ,procedure and the    
applicable prescribed clinical practice 
guidelines4  7#c7 ,limitation ,the      
review panel shall not make a finding of
 negligence from the mere fact that a   
treatment or procedure was unsuccessful1
 failed to bring the best result or that
 the patient died4  7#d7 ,use at trial  
of work product of review panel ,no     
preliminary finding by the review panel 
that the defendant applicable eligible  
professional breached the standard of   
care as set forth under the prescribed  
clinical practice guidelines shall      
constitute negligence per se or         
conclusive evidence of liability4       
,however1 said findings1 opinions and   
conclusions of the review panel shall be
 admissible as evidence in any and all  
subsequent proceedings before the court1
 including for purposes of motions for  
summary judgment and at trial4  7d7     

,results of review  7#a7 ,in general    
,not later than #fj days after all      
members of the panel have been selected1
 the panel shall complete a review of   
the record of the liability action and  
shall make a finding under this         
subsection4  7#b7 ,finding described ,a 
finding under this subsection shall     
include the following3  7,a7 ,a         
determination of whether or not there   
are any applicable clinical practice    
guidelines to the health care liability 
action that substantively pertains to   
the injury suffered by the claimant4    
7,b7 ,if the applicable eligible        
professional has alleged adherence to   
any such guideline4  7,c7 ,if the       
applicable eligible professional did    
adhere to any such guideline4  7,d7     
,whether there is a reasonable          
probability that--  7i7 the applicable  
eligible professional violated the      
applicable standard of care2  7ii7 that 
violation proximately caused the        
claimant's alleged injury2 and  7iii7   

the claimant suffered damages as a      
result of the injury4  7#c7 ,use at     
trial ,the finding under this subsection
 may be received into evidence by the   
court4 ,if the panel made any finding   
under paragraph 7#b77;,d7 that there was
 no reasonable probability1 the court   
may issue a summary judgment in favor of
 the applicable eligible professional   
unless the claimant is able to show     
otherwise by clear and convincing       
evidence4 ,if the panel made a finding  
under subparagraphs 7,a7 through 7,c7   
that there was an applicable clinical   
practice guideline that the defendant   
adhered to1 the court shall issue       
summary judgment in favor of the        
applicable eligible professional unless 
the claimant is able to show otherwise  
by clear and convincing evidence4 ,any  
preliminary finding that the defendant  
applicable eligible professional did not
 breach the standard of care as set     
forth under the prescribed medical      
practice guidelines or that the         

defendant applicable eligible           
professional's failure to conform to the
 required standard was neither the cause
 in fact nor the proximate cause of the 
plaintiff's injury or that the plaintiff
 did not incur any damages as a result  
shall be given deference by the court   
and shall entitle the defendant         
applicable eligible professional to     
summary judgment unless the plaintiff is
 able to show by clear and convincing   
evidence that the independent medical   
review panel was in error and that there
 is a genuine issue as to a material    
fact in the case4  #i4 ,recovery of     
,costs ,if the defendant applicable     
eligible professional prevails          
subsequent to a preliminary finding in  
his or her favor by the independent     
medical review panel1 the defendant may 
recover costs and attorneys' fees from  
the plaintiff4  #aj4 ,definitions ,in   
this ,act3  7#a7 applicable eligible    
professional ,the term applicable       
eligible professional means physicians  

practicing within clinical practice     
guidelines submitted by an eligible     
professional organization and includes  
employees and agents of a physician4    
7#b7 appropriate use criteria ,the term 
appropriate use criteria means          
established evidence-based guidelines   
developed or endorsed by an eligible    
professional organization that specify  
when the health benefits of a procedure 
or service exceed the expected health   
risks by a significantly wide margin4   
7#c7 clinical practice guideline ,the   
term clinical practice guideline means  
systematically developed statements     
based on the review of clinical evidence
 for assisting a health care provider to
 determine the appropriate health care  
in specific clinical circumstances4     
7#d7 eligible professional organization 
,the term eligible professional         
organization means a national or ,state 
medical society or medical specialty    
society4  7#e7 ,federal payor ,the term 
,federal payor includes reimbursements  

made under the ,medicare program under  
title ,,xviii of the ,social ,security  
,act or the ,medicaid program under     
title ,,xix of the ,social ,security    
,act1 premium tax credits under section 
#cf;,b of the ,internal ,revenue ,code  
of #aihf or cost-sharing reductions     
under section #adjb of the ,patient     
,protection and ,affordable ,care ,act1 
or medical screenings1 treatments1 or   
transfer services provided pursuant to  
section #ahfg of the ,social ,security  
,act is not made by the individual or   
any non-,federal third party on behalf  
of the individual4  7#f7 ,health care   
goods or services ,the term health care 
goods or services means any goods or    
services provided by a health care      
organization1 provider1 or by any       
individual working under the supervision
 of a health care provider1 that relates
 to the diagnosis1 prevention1 or       
treatment of any human disease or       
impairment1 or the assessment or care of
 the health of human beings4  7#g7      

,health care liability action ,the term 
health care liability action means a    
civil action against a health care      
provider or a health care organization1 
regardless of the theory of liability on
 which the claim is based1 or the number
 of plaintiffs1 defendants1 or other    
parties1 or the number of causes of     
action1 in which the claimant alleges a 
health care liability claim4  7#h7      
,health care liability claim ,the term  
health care liability claim means a     
claim by any person against a health    
care provider or a health care          
organization which is based upon the    
provision of1 use of1 or payment for 7or
 the failure to provide1 use1 or pay    
for7 health care goods services for     
which at least partial payment was made 
by a ,federal payor or which was        
mandated by ,federal law1 regardless of 
the theory of liability on which the    
claim is based4  7#i7 ,health care      
organization ,the term health care      
organization means any person or entity 

which is obligated to provide or pay for
 health benefits under any health plan1 
including any person or entity acting   
under a contract or arrangement with a  
health care organization to provide or  
administer any health benefit4  7#aj7   
,health care provider ,the term health  
care provider means any person or entity
 required by ,state or ,federal laws or 
regulations to be licensed1 registered1 
or certified to provide health care     
services1 and being either so licensed1 
registered1 or certified1 or exempted   
from such requirement by other statute  
or regulation4  7#aa7 performance period
 ,the term performance period means the 
period of time during which the final   
rule establishing a clinical practice   
guideline is in effect4  7#ab7          
,secretary ,the term ,secretary means   
the ,secretary of ,health and ,human    
,services4