,,ii  #aacth ,,congress  #ast ,session  
,s4 #dd  ,,in ,,the ,,senate ,,of ,,the 
,,united ,,states  ,january #bb         
7legislative day1 ,january #c71 #bjac   
,mr4 ,portman 7for himself and ,mr4     
,inhofe7 introduced the following bill2 
which was read twice and referred to the
 ,committee on ,health1 ,education1     
,labor1 and ,pensions  ,a ,,bill  ,to   
improve patient access to health care   
services and provide improved medical   
care by reducing the excessive burden   
the liability system places on the      
health care delivery system4  #a4 ,short
 title ,this ,act may be cited as the   
,medical ,care ,access ,protection ,act 
of #bjac or the ,,mcap ,act4  #b4       
,findings and purpose  7a7 ,findings    
7#a7 ,effect on health care access and  
costs ,congress finds that our current  
civil justice system is adversely       
affecting patient access to health care 
services1 better patient care1 and      
cost-efficient health care1 in that the 
health care liability system is a costly

 and ineffective mechanism for resolving
 claims of health care liability and    
compensating injured patients1 and is a 
deterrent to the sharing of information 
among health care professionals which   
impedes efforts to improve patient      
safety and quality of care4  7#b7       
,effect on interstate commerce ,congress
 finds that the health care and         
insurance industries are industries     
affecting interstate commerce and the   
health care liability litigation systems
 existing throughout the ,united ,states
 are activities that affect interstate  
commerce by contributing to the high    
costs of health care and premiums for   
health care liability insurance         
purchased by health care system         
providers4  7#c7 ,effect on ,federal    
spending ,congress finds that the health
 care liability litigation systems      
existing throughout the ,united ,states 
have a significant effect on the amount1
 distribution1 and use of ,federal funds
 because of--  7,a7 the large number of 

individuals who receive health care     
benefits under programs operated or     
financed by the ,federal ,government2   
7,b7 the large number of individuals who
 benefit because of the exclusion from  
,federal taxes of the amounts spent to  
provide them with health insurance      
benefits2 and  7,c7 the large number of 
health care providers who provide items 
or services for which the ,federal      
,government makes payments4  7b7        
,purpose ,it is the purpose of this ,act
 to implement reasonable1 comprehensive1
 and effective health care liability    
reforms designed to--  7#a7 improve the 
availability of health care services in 
cases in which health care liability    
actions have been shown to be a factor  
in the decreased availability of        
services2  7#b7 reduce the incidence of 
defensive medicine and lower the cost of
 health care liability insurance1 all of
 which contribute to the escalation of  
health care costs2  7#c7 ensure that    
persons with meritorious health care    

injury claims receive fair and adequate 
compensation1 including reasonable      
noneconomic damages2  7#d7 improve the  
fairness and cost-effectiveness of our  
current health care liability system to 
resolve disputes over1 and provide      
compensation for1 health care liability 
by reducing uncertainty in the amount of
 compensation provided to injured       
individuals2 and  7#e7 provide an       
increased sharing of information in the 
health care system which will reduce    
unintended injury and improve patient   
care4  #c4 ,definitions ,in this ,act3  
7#a7 ,alternative dispute resolution    
system2 ,,adr ,the term alternative     
dispute resolution system or ,,adr means
 a system that provides for the         
resolution of health care lawsuits in a 
manner other than through a civil action
 brought in a ,state or ,federal court4 
7#b7 ,claimant ,the term claimant means 
any person who brings a health care     
lawsuit1 including a person who asserts 
or claims a right to legal or equitable 

contribution1 indemnity or subrogation1 
arising out of a health care liability  
claim or action1 and any person on whose
 behalf such a claim is asserted or such
 an action is brought1 whether deceased1
 incompetent1 or a minor4  7#c7         
,collateral source benefits ,the term   
collateral source benefits means any    
amount paid or reasonably likely to be  
paid in the future to or on behalf of   
the claimant1 or any service1 product or
 other benefit provided or reasonably   
likely to be provided in the future to  
or on behalf of the claimant1 as a      
result of the injury or wrongful death1 
pursuant to--  7,a7 any ,state or       
,federal health1 sickness1              
income-disability1 accident1 or workers'
 compensation law2  7,b7 any health1    
sickness1 income-disability1 or accident
 insurance that provides health benefits
 or income-disability coverage2  7,c7   
any contract or agreement of any group1 
organization1 partnership1 or           
corporation to provide1 pay for1 or     

reimburse the cost of medical1 hospital1
 dental1 or income disability benefits2 
and  7,d7 any other publicly or         
privately funded program4  7#d7         
,compensatory damages ,the term         
compensatory damages means objectively  
verifiable monetary losses incurred as a
 result of the provision of1 use of1 or 
payment for 7or failure to provide1 use1
 or pay for7 health care services or    
medical products1 such as past and      
future medical expenses1 loss of past   
and future earnings1 cost of obtaining  
domestic services1 loss of employment1  
and loss of business or employment      
opportunities1 damages for physical and 
emotional pain1 suffering1              
inconvenience1 physical impairment1     
mental anguish1 disfigurement1 loss of  
enjoyment of life1 loss of society and  
companionship1 loss of consortium 7other
 than loss of domestic service71 hedonic
 damages1 injury to reputation1 and all 
other nonpecuniary losses of any kind or
 nature4 ,such term includes economic   

damages and noneconomic damages1 as such
 terms are defined in this section4     
7#e7 ,contingent fee ,the term          
contingent fee includes all compensation
 to any person or persons which is      
payable only if a recovery is effected  
on behalf of one or more claimants4     
7#f7 ,economic damages ,the term        
economic damages means objectively      
verifiable monetary losses incurred as a
 result of the provision of1 use of1 or 
payment for 7or failure to provide1 use1
 or pay for7 health care services or    
medical products1 such as past and      
future medical expenses1 loss of past   
and future earnings1 cost of obtaining  
domestic services1 loss of employment1  
and loss of business or employment      
opportunities4  7#g7 ,health care goods 
or services ,the term health care goods 
or services means any goods or services 
provided by a health care institution1  
provider1 or by any individual working  
under the supervision of a health care  
provider1 that relates to the diagnosis1

 prevention1 care1 or treatment of any  
human disease or impairment1 or the     
assessment of the health of human       
beings4  7#h7 ,health care institution  
,the term health care institution means 
any entity licensed under ,federal or   
,state law to provide health care       
services 7including but not limited to  
ambulatory surgical centers1 assisted   
living facilities1 emergency medical    
services providers1 hospices1 hospitals 
and hospital systems1 nursing homes1 or 
other entities licensed to provide such 
services74  7#i7 ,health care lawsuit   
,the term health care lawsuit means any 
health care liability claim concerning  
the provision of health care goods or   
services affecting interstate commerce1 
or any health care liability action     
concerning the provision of 7or the     
failure to provide7 health care goods or
 services affecting interstate commerce1
 brought in a ,state or ,federal court  
or pursuant to an alternative dispute   
resolution system1 against a health care

 provider or a health care institution  
regardless of the theory of liability on
 which the claim is based1 or the number
 of claimants1 plaintiffs1 defendants1  
or other parties1 or the number of      
claims or causes of action1 in which the
 claimant alleges a health care         
liability claim4  7#aj7 ,health care    
liability action ,the term health care  
liability action means a civil action   
brought in a ,state or ,federal ,court  
or pursuant to an alternative dispute   
resolution system1 against a health care
 provider or a health care institution  
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#aa7     
,health care liability claim ,the term  
health care liability claim means a     
demand by any person1 whether or not    
pursuant to ,,adr1 against a health care
 provider or health care institution1   

including third-party claims1           
cross-claims1 counter-claims1 or        
contribution claims1 which are based    
upon the provision of1 use of1 or       
payment for 7or the failure to provide1 
use1 or pay for7 health care services1  
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     
action4  7#ab7 ,health care provider    
7,a7 ,in general ,the term health care  
provider means any person 7including but
 not limited to a physician 7as defined 
by section #ahfa7r7 of the ,social      
,security ,act 7#db ,u4,s4,c4           
#aciex7r7771 registered nurse1 dentist1 
podiatrist1 pharmacist1 chiropractor1 or
 optometrist7 required by ,state or     
,federal law 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,b7 ,treatment of      

certain professional associations ,for  
purposes of this ,act1 a professional   
association that is organized under     
,state law by an individual physician or
 group of physicians1 a partnership or  
limited liability partnership formed by 
a group of physicians1 a nonprofit      
health corporation certified under      
,state law1 or a company formed by a    
group of physicians under ,state law    
shall be treated as a health care       
provider under subparagraph 7,a74  7#ac7
 ,malicious intent to injure ,the term  
malicious intent to injure means        
intentionally causing or attempting to  
cause physical injury other than        
providing health care goods or services4
  7#ad7 ,noneconomic damages ,the term  
noneconomic damages means damages for   
physical and emotional pain1 suffering1 
inconvenience1 physical impairment1     
mental anguish1 disfigurement1 loss of  
enjoyment of life1 loss of society and  
companionship1 loss of consortium 7other
 than loss of domestic service71 hedonic

 damages1 injury to reputation1 and all 
other nonpecuniary losses of any kind or
 nature4  7#ae7 ,punitive damages ,the  
term punitive damages means damages     
awarded1 for the purpose of punishment  
or deterrence1 and not solely for       
compensatory purposes1 against a health 
care provider or health care            
institution4 ,punitive damages are      
neither economic nor noneconomic        
damages4  7#af7 ,recovery ,the term     
recovery means the net sum recovered    
after deducting any disbursements or    
costs incurred in connection with       
prosecution or settlement of the claim1 
including all costs paid or advanced by 
any person4 ,costs of health care       
incurred by the plaintiff and the       
attorneys' office overhead costs or     
charges for legal services are not      
deductible disbursements or costs for   
such purpose4  7#ag7 ,state ,the term   
,state means each of the several        
,states1 the ,district of ,columbia1 the
 ,commonwealth of ,puerto ,rico1 the    

,virgin ,islands1 ,guam1 ,american      
,samoa1 the ,northern ,mariana ,islands1
 the ,trust ,territory of the ,pacific  
,islands1 and any other territory or    
possession of the ,united ,states1 or   
any political subdivision thereof4  #d4 
,encouraging speedy resolution of claims
  7a7 ,in general ,except as otherwise  
provided for in this section1 the time  
for the commencement of a health care   
lawsuit shall be #c years after the date
 of manifestation of injury or #a year  
after the claimant discovers1 or through
 the use of reasonable diligence should 
have discovered1 the injury1 whichever  
occurs first4  7b7 ,general exception   
,the time for the commencement of a     
health care lawsuit shall not exceed #c 
years after the date of manifestation of
 injury unless the tolling of time was  
delayed as a result of--  7#a7 fraud2   
7#b7 intentional concealment2 or  7#c7  
the presence of a foreign body1 which   
has no therapeutic or diagnostic purpose
 or effect1 in the person of the injured

 person4  7c7 ,minors ,an action by a   
minor shall be commenced within #c years
 from the date of the alleged           
manifestation of injury except that if  
such minor is under the full age of #f  
years1 such action shall be commenced   
within #c years of the manifestation of 
injury1 or prior to the eighth birthday 
of the minor1 whichever provides a      
longer period4 ,such time limitation    
shall be tolled for minors for any      
period during which a parent or guardian
 and a health care provider or health   
care institution have committed fraud or
 collusion in the failure to bring an   
action on behalf of the injured minor4  
7d7 ,rule #aa sanctions ,whenever a     
,federal or ,state court determines     
7whether by motion of the parties or    
whether on the motion of the court7 that
 there has been a violation of ,rule #aa
 of the ,federal ,rules of ,civil       
,procedure 7or a similar violation of   
applicable ,state court rules7 in a     
health care liability action to which   

this ,act applies1 the court shall      
impose upon the attorneys1 law firms1 or
 pro se litigants that have violated    
,rule #aa or are responsible for the    
violation1 an appropriate sanction1     
which shall include an order to pay the 
other party or parties for the          
reasonable expenses incurred as a direct
 result of the filing of the pleading1  
motion1 or other paper that is the      
subject of the violation1 including a   
reasonable attorneys' fee4 ,such        
sanction shall be sufficient to deter   
repetition of such conduct or comparable
 conduct by others similarly situated1  
and to compensate the party or parties  
injured by such conduct4  #e4           
,compensating patient injury  7a7       
,unlimited amount of damages for actual 
economic losses in health care lawsuits 
,in any health care lawsuit1 nothing in 
this ,act shall limit the recovery by a 
claimant of the full amount of the      
available economic damages1             
notwithstanding the limitation contained

 in subsection 7b74  7b7 ,additional    
noneconomic damages  7#a7 ,health care  
providers ,in any health care lawsuit   
where final judgment is rendered against
 a health care provider1 the amount of  
noneconomic damages recovered from the  
provider1 if otherwise available under  
applicable ,federal or ,state law1 may  
be as much as #bej1jjj1 regardless of   
the number of parties other than a      
health care institution against whom the
 action is brought or the number of     
separate claims or actions brought with 
respect to the same occurrence4  7#b7   
,health care institutions  7,a7 ,single 
institution ,in any health care lawsuit 
where final judgment is rendered against
 a single health care institution1 the  
amount of noneconomic damages recovered 
from the institution1 if otherwise      
available under applicable ,federal or  
,state law1 may be as much as #bej1jjj1 
regardless of the number of parties     
against whom the action is brought or   
the number of separate claims or actions

 brought with respect to the same       
occurrence4  7,b7 ,multiple institutions
 ,in any health care lawsuit where final
 judgment is rendered against more than 
one health care institution1 the amount 
of noneconomic damages recovered from   
each institution1 if otherwise available
 under applicable ,federal or ,state    
law1 may be as much as #bej1jjj1        
regardless of the number of parties     
against whom the action is brought or   
the number of separate claims or actions
 brought with respect to the same       
occurrence1 except that the total amount
 recovered from all such institutions in
 such lawsuit shall not exceed #ejj1jjj4
  7c7 ,no discount of award for         
noneconomic damages ,in any health care 
lawsuit--  7#a7 an award for future     
noneconomic damages shall not be        
discounted to present value2  7#b7 the  
jury shall not be informed about the    
maximum award for noneconomic damages   
under subsection 7b72  7#c7 an award for
 noneconomic damages in excess of the   

limitations provided for in subsection  
7b7 shall be reduced either before the  
entry of judgment1 or by amendment of   
the judgment after entry of judgment1   
and such reduction shall be made before 
accounting for any other reduction in   
damages required by law2 and  7#d7 if   
separate awards are rendered for past   
and future noneconomic damages and the  
combined awards exceed the limitations  
described in subsection 7b71 the future 
noneconomic damages shall be reduced    
first4  7d7 ,fair share rule ,in any    
health care lawsuit1 each party shall be
 liable for that party's several share  
of any damages only and not for the     
share of any other person4 ,each party  
shall be liable only for the amount of  
damages allocated to such party in      
direct proportion to such party's       
percentage of responsibility4 ,a        
separate judgment shall be rendered     
against each such party for the amount  
allocated to such party4 ,for purposes  
of this section1 the trier of fact shall

 determine the proportion of            
responsibility of each party for the    
claimant's harm4  #f4 ,maximizing       
patient recovery  7a7 ,court supervision
 of share of damages actually paid to   
claimants  7#a7 ,in general ,in any     
health care lawsuit1 the court shall    
supervise the arrangements for payment  
of damages to protect against conflicts 
of interest that may have the effect of 
reducing the amount of damages awarded  
that are actually paid to claimants4    
7#b7 ,contingency fees  7,a7 ,in general
 ,in any health care lawsuit in which   
the attorney for a party claims a       
financial stake in the outcome by virtue
 of a contingent fee1 the court shall   
have the power to restrict the payment  
of a claimant's damage recovery to such 
attorney1 and to redirect such damages  
to the claimant based upon the interests
 of justice and principles of equity4   
7,b7 ,limitation ,the total of all      
contingent fees for representing all    
claimants in a health care lawsuit shall

 not exceed the following limits3  7i7  
,forty percent of the first #ej1jjj     
recovered by the claimant7s74  7ii7     
,thirty-three and one-third percent of  
the next #ej1jjj recovered by the       
claimant7s74  7iii7 ,twenty-five percent
 of the next #ejj1jjj recovered by the  
claimant7s74  7iv7 ,fifteen percent of  
any amount by which the recovery by the 
claimant7s7 is in excess of #fjj1jjj4   
7b7 ,applicability  7#a7 ,in general    
,the limitations in subsection 7a7 shall
 apply whether the recovery is by       
judgment1 settlement1 mediation1        
arbitration1 or any other form of       
alternative dispute resolution4  7#b7   
,minors ,in a health care lawsuit       
involving a minor or incompetent person1
 a court retains the authority to       
authorize or approve a fee that is less 
than the maximum permitted under this   
section4  7c7 ,expert witnesses  7#a7   
,requirement ,no individual shall be    
qualified to testify as an expert       
witness concerning issues of negligence 

in any health care lawsuit against a    
defendant unless such individual--  7,a7
 except as required under paragraph     
7#b71 is a health care professional     
who--  7i7 is appropriately credentialed
 or licensed in #a or more ,states to   
deliver health care services2 and  7ii7 
typically treats the diagnosis or       
condition or provides the type of       
treatment under review2 and  7,b7 can   
demonstrate by competent evidence that1 
as a result of training1 education1     
knowledge1 and experience in the        
evaluation1 diagnosis1 and treatment of 
the disease or injury which is the      
subject matter of the lawsuit against   
the defendant1 the individual was       
substantially familiar with applicable  
standards of care and practice as they  
relate to the act or omission which is  
the subject of the lawsuit on the date  
of the incident4  7#b7 ,physician review
 ,in a health care lawsuit1 if the claim
 of the plaintiff involved treatment    
that is recommended or provided by a    

physician 7allopathic or osteopathic71  
an individual shall not be qualified to 
be an expert witness under this         
subsection with respect to issues of    
negligence concerning such treatment    
unless such individual is a physician4  
7#c7 ,specialties and subspecialties    
,with respect to a lawsuit described in 
paragraph 7#a71 a court shall not permit
 an expert in one medical specialty or  
subspecialty to testify against a       
defendant in another medical specialty  
or subspecialty unless1 in addition to a
 showing of substantial familiarity in  
accordance with paragraph 7#a77;,b71    
there is a showing that the standards of
 care and practice in the two specialty 
or subspecialty fields are similar4     
7#d7 ,limitation ,the limitations in    
this subsection shall not apply to      
expert witnesses testifying as to the   
degree or permanency of medical or      
physical impairment4  #g4 ,additional   
health benefits  7a7 ,in general ,the   
amount of any damages received by a     

claimant in any health care lawsuit     
shall be reduced by the court by the    
amount of any collateral source benefits
 to which the claimant is entitled1 less
 any insurance premiums or other        
payments made by the claimant 7or by the
 spouse1 parent1 child1 or legal        
guardian of the claimant7 to obtain or  
secure such benefits4  7b7 ,preservation
 of current law ,where a payor of       
collateral source benefits has a right  
of recovery by reimbursement or         
subrogation and such right is permitted 
under ,federal or ,state law1 subsection
 7a7 shall not apply4  7c7 ,application 
of provision ,this section shall apply  
to any health care lawsuit that is      
settled or resolved by a fact finder4   
#h4 ,punitive damages  7a7 ,punitive    
damages permitted  7#a7 ,in general     
,punitive damages may1 if otherwise     
available under applicable ,state or    
,federal law1 be awarded against any    
person in a health care lawsuit only if 
it is proven by clear and convincing    

evidence that such person acted with    
malicious intent to injure the claimant1
 or that such person deliberately failed
 to avoid unnecessary injury that such  
person knew the claimant was            
substantially certain to suffer4  7#b7  
,filing of lawsuit ,no demand for       
punitive damages shall be included in a 
health care lawsuit as initially filed4 
,a court may allow a claimant to file an
 amended pleading for punitive damages  
only upon a motion by the claimant and  
after a finding by the court1 upon      
review of supporting and opposing       
affidavits or after a hearing1 after    
weighing the evidence1 that the claimant
 has established by a substantial       
probability that the claimant will      
prevail on the claim for punitive       
damages4  7#c7 ,separate proceeding ,at 
the request of any party in a health    
care lawsuit1 the trier of fact shall   
consider in a separate proceeding--     
7,a7 whether punitive damages are to be 
awarded and the amount of such award2   

and  7,b7 the amount of punitive damages
 following a determination of punitive  
liability4  ,if a separate proceeding is
 requested1 evidence relevant only to   
the claim for punitive damages1 as      
determined by applicable ,state law1    
shall be inadmissible in any proceeding 
to determine whether compensatory       
damages are to be awarded4  7#d7        
,limitation where no compensatory       
damages are awarded ,in any health care 
lawsuit where no judgment for           
compensatory damages is rendered against
 a person1 no punitive damages may be   
awarded with respect to the claim in    
such lawsuit against such person4  7b7  
,determining amount of punitive damages 
7#a7 ,factors considered ,in determining
 the amount of punitive damages under   
this section1 the trier of fact shall   
consider only the following3  7,a7 the  
severity of the harm caused by the      
conduct of such party2  7,b7 the        
duration of the conduct or any          
concealment of it by such party2  7,c7  

the profitability of the conduct to such
 party2  7,d7 the number of products    
sold or medical procedures rendered for 
compensation1 as the case may be1 by    
such party1 of the kind causing the harm
 complained of by the claimant2  7,e7   
any criminal penalties imposed on such  
party1 as a result of the conduct       
complained of by the claimant2 and  7,f7
 the amount of any civil fines assessed 
against such party as a result of the   
conduct complained of by the claimant4  
7#b7 ,maximum award ,the amount of      
punitive damages awarded in a health    
care lawsuit may not exceed an amount   
equal to two times the amount of        
economic damages awarded in the lawsuit 
or #bej1jjj1 whichever is greater4 ,the 
jury shall not be informed of the       
limitation under the preceding sentence4
  7c7 ,liability of health care         
providers  7#a7 ,in general ,a health   
care provider who prescribes1 or who    
dispenses pursuant to a prescription1 a 
drug1 biological product1 or medical    

device approved by the ,food and ,drug  
,administration1 for an approved        
indication of the drug1 biological      
product1 or medical device1 shall not be
 named as a party to a product liability
 lawsuit invoking such drug1 biological 
product1 or medical device and shall not
 be liable to a claimant in a class     
action lawsuit against the manufacturer1
 distributor1 or product seller of such 
drug1 biological product1 or medical    
device4  7#b7 ,medical product ,the term
 medical product means a drug or device 
intended for humans4 ,the terms drug and
 device have the meanings given such    
terms in sections #bja7;g77#a7 and      
#bja7;h7 of the ,federal ,food1 ,drug   
and ,cosmetic ,act 7#ba ,u4,s4,c4 #cba71
 respectively1 including any component  
or raw material used therein1 but       
excluding health care services4  #i4    
,authorization of payment of future     
damages to claimants in health care     
lawsuits  7a7 ,in general ,in any health
 care lawsuit1 if an award of future    

damages1 without reduction to present   
value1 equaling or exceeding #ej1jjj is 
made against a party with sufficient    
insurance or other assets to fund a     
periodic payment of such a judgment1 the
 court shall1 at the request of any     
party1 enter a judgment ordering that   
the future damages be paid by periodic  
payments in accordance with the ,uniform
 ,periodic ,payment of ,judgments ,act  
promulgated by the ,national ,conference
 of ,commissioners on ,uniform ,state   
,laws4  7b7 ,applicability ,this section
 applies to all actions which have not  
been first set for trial or retrial     
before the effective date of this ,act4 
#aj4 ,effect on other laws  7a7 ,general
 vaccine injury  7#a7 ,in general ,to   
the extent that title ,,xxi of the      
,public ,health ,service ,act           
establishes a ,federal rule of law      
applicable to a civil action brought for
 a vaccine-related injury or death--    
7,a7 this ,act shall not affect the     
application of the rule of law to such  

an action2 and  7,b7 any rule of law    
prescribed by this ,act in conflict with
 a rule of law of such title ,,xxi shall
 not apply to such action4  7#b7        
,exception ,if there is an aspect of a  
civil action brought for a              
vaccine-related injury or death to which
 a ,federal rule of law under title     
,,xxi of the ,public ,health ,service   
,act does not apply1 then this ,act or  
otherwise applicable law 7as determined 
under this ,act7 will apply to such     
aspect of such action4  7b7 ,smallpox   
vaccine injury  7#a7 ,in general ,to the
 extent that part ,c of title ,,ii of   
the ,public ,health ,service ,act       
establishes a ,federal rule of law      
applicable to a civil action brought for
 a smallpox vaccine-related injury or   
death--  7,a7 this ,act shall not affect
 the application of the rule of law to  
such an action2 and  7,b7 any rule of   
law prescribed by this ,act in conflict 
with a rule of law of such part ,c shall
 not apply to such action4  7#b7        

,exception ,if there is an aspect of a  
civil action brought for a smallpox     
vaccine-related injury or death to which
 a ,federal rule of law under part ,c of
 title ,,ii of the ,public ,health      
,service ,act does not apply1 then this 
,act or otherwise applicable law 7as    
determined under this ,act7 will apply  
to such aspect of such action4  7c7     
,other ,federal law ,except as provided 
in this section1 nothing in this ,act   
shall be deemed to affect any defense   
available1 or any limitation on         
liability that applies to1 a defendant  
in a health care lawsuit or action under
 any other provision of ,federal law4   
#aa4 ,state flexibility and protection  
of states' rights  7a7 ,health care     
lawsuits ,the provisions governing      
health care lawsuits set forth in this  
,act shall preempt1 subject to          
subsections 7b7 and 7c71 ,state law to  
the extent that ,state law prevents the 
application of any provisions of law    
established by or under this ,act4 ,the 

provisions governing health care        
lawsuits set forth in this ,act         
supersede chapter #aga of title #bh1    
,united ,states ,code1 to the extent    
that such chapter--  7#a7 provides for a
 greater amount of damages or contingent
 fees1 a longer period in which a health
 care lawsuit may be commenced1 or a    
reduced applicability or scope of       
periodic payment of future damages1 than
 provided in this ,act2 or  7#b7        
prohibits the introduction of evidence  
regarding collateral source benefits4   
7b7 ,preemption of certain ,state laws  
,no provision of this ,act shall be     
construed to preempt any ,state law     
7whether effective before1 on1 or after 
the date of the enactment of this ,act7 
that specifies a particular monetary    
amount of compensatory or punitive      
damages 7or the total amount of damages7
 that may be awarded in a health care   
lawsuit1 regardless of whether such     
monetary amount is greater or lesser    
than is provided for under this ,act1   

notwithstanding section #e7;a74  7c7    
,protection of state's rights and other 
laws  7#a7 ,in general ,any issue that  
is not governed by a provision of law   
established by or under this ,act       
7including the ,state standards of      
negligence7 shall be governed by        
otherwise applicable ,federal or ,state 
law4  7#b7 ,rule of construction        
,nothing in this ,act shall be construed
 to--  7,a7 preempt or supersede any    
,federal or ,state law that imposes     
greater procedural or substantive       
protections 7such as a shorter statute  
of limitations7 for a health care       
provider or health care institution from
 liability1 loss1 or damages than those 
provided by this ,act2  7,b7 preempt or 
supercede any ,state law that permits   
and provides for the enforcement of any 
arbitration agreement related to a      
health care liability claim whether     
enacted prior to or after the date of   
enactment of this ,act2  7,c7 create a  
cause of action that is not otherwise   

available under ,federal or ,state law2 
or  7,d7 affect the scope of preemption 
of any other ,federal law4  #ab4        
,applicability2 effective date ,this    
,act shall apply to any health care     
lawsuit brought in a ,federal or ,state 
court1 or subject to an alternative     
dispute resolution system1 that is      
initiated on or after the date of the   
enactment of this ,act1 except that any 
health care lawsuit arising from an     
injury occurring prior to the date of   
enactment of this ,act shall be governed
 by the applicable statute of           
limitations provisions in effect at the 
time the injury occurred4