,,ii  #aac? ,,congress  #a/ ,session    
,s4 #dd  ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$
 ,,/ates  ,janu>y #bb 7legislative day1 
,janu>y #c71 #bjac ,mr4 ,portman 7=     
himself & ,mr4 ,inh(e7 introduc$ !      
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,heal?1 ,education1  
,labor1 & ,p5sions  ,a ,,bill  ,to      
improve pati5t access to heal? c>e      
s]vices & provide improv$ m$ical c>e by 
r$uc+ ! excessive burd5 ! liability     
sy/em places on ! heal? c>e deliv]y     
sy/em4  #a4 ,%ort title ,?is ,act may be
 cit$ z ! ,m$ical ,c>e ,access          
,protection ,act ( #bjac or ! ,,mcap    
,act4  #b4 ,f9d+s & purpose  7a7 ,f9d+s 
7#a7 ,effect on heal? c>e access & co/s 
,congress f9ds t our curr5t civil ju/ice
 sy/em is adv]sely affect+ pati5t access
 to heal? c>e s]vices1 bett] pati5t c>e1
 & co/-effici5t heal? c>e1 9 t ! heal?  
c>e liability sy/em is a co/ly &        
ineffective me*anism = resolv+ claims ( 
heal? c>e liability & comp5sat+ injur$  
pati5ts1 & is a det]r5t to ! %>+ (      

in=mation among heal? c>e pr(essionals  
:i* imp$es ef=ts to improve pati5t      
safety & quality ( c>e4  7#b7 ,effect on
 int]/ate comm]ce ,congress f9ds t !    
heal? c>e & insurance indu/ries are     
indu/ries affect+ int]/ate comm]ce & !  
heal? c>e liability litigation sy/ems   
exi/+ ?r\gh\t ! ,unit$ ,/ates are       
activities t affect int]/ate comm]ce by 
contribut+ to ! high co/s ( heal? c>e & 
premiums = heal? c>e liability insurance
 pur*as$ by heal? c>e sy/em provid]s4   
7#c7 ,effect on ,f$]al sp5d+ ,congress  
f9ds t ! heal? c>e liability litigation 
sy/ems exi/+ ?r\gh\t ! ,unit$ ,/ates h a
 significant effect on ! am\nt1         
di/ribution1 & use ( ,f$]al funds       
because (--  7,a7 ! l>ge numb] (        
individuals :o receive heal? c>e b5efits
 "u programs op]at$ or f9anc$ by !      
,f$]al ,gov]nm5t2  7,b7 ! l>ge numb] (  
individuals :o b5efit because ( !       
exclusion f ,f$]al taxes ( ! am\nts sp5t
 to provide !m ) heal? insurance        
b5efits2 &  7,c7 ! l>ge numb] ( heal?   

c>e provid]s :o provide items or s]vices
 = :i* ! ,f$]al ,gov]nm5t makes paym5ts4
  7b7 ,purpose ,x is ! purpose ( ?is    
,act to implem5t reasonable1            
compreh5sive1 & effective heal? c>e     
liability re=ms design$ to--  7#a7      
improve ! availability ( heal? c>e      
s]vices 9 cases 9 :i* heal? c>e         
liability actions h be5 %[n to be a     
factor 9 ! decreas$ availability (      
s]vices2  7#b7 r$uce ! incid5ce (       
def5sive m$ic9e & l[] ! co/ ( heal? c>e 
liability insurance1 all ( :i*          
contribute to ! escalation ( heal? c>e  
co/s2  7#c7 ensure t p]sons ) m]itori\s 
heal? c>e injury claims receive fair &  
adequate comp5sation1 includ+ reasonable
 noneconomic damages2  7#d7 improve !   
fairness & co/-effectiv5ess ( our curr5t
 heal? c>e liability sy/em to resolve   
disputes ov]1 & provide comp5sation =1  
heal? c>e liability by r$uc+ unc]ta9ty 9
 ! am\nt ( comp5sation provid$ to injur$
 individuals2 &  7#e7 provide an        
increas$ %>+ ( in=mation 9 ! heal? c>e  

sy/em :i* w r$uce un9t5d$ injury &      
improve pati5t c>e4  #c4 ,def9itions ,9 
?is ,act3  7#a7 ,alt]native dispute     
resolution sy/em2 ,,adr ,! t]m          
alt]native dispute resolution sy/em or  
,,adr means a sy/em t provides = !      
resolution ( heal? c>e lawsuits 9 a     
mann] o!r ?an ?r\gh a civil action      
br\ght 9 a ,/ate or ,f$]al c\rt4  7#b7  
,claimant ,! t]m claimant means any     
p]son :o br+s a heal? c>e lawsuit1      
includ+ a p]son :o ass]ts or claims a "r
 to legal or equitable contribution1    
indemnity or subrogation1 aris+ out ( a 
heal? c>e liability claim or action1 &  
any p]son on ^: behalf su* a claim is   
ass]t$ or su* an action is br\ght1 :e!r 
deceas$1 incompet5t1 or a m9or4  7#c7   
,collat]al s\rce b5efits ,! t]m         
collat]al s\rce b5efits means any am\nt 
paid or reasonably likely to be paid 9 !
 future to or on behalf ( ! claimant1 or
 any s]vice1 product or o!r b5efit      
provid$ or reasonably likely to be      
provid$ 9 ! future to or on behalf ( !  

claimant1 z a result ( ! injury or      
wrongful dea?1 pursuant to--  7,a7 any  
,/ate or ,f$]al heal?1 sickness1        
income-disability1 accid5t1 or work]s'  
comp5sation law2  7,b7 any heal?1       
sickness1 income-disability1 or accid5t 
insurance t provides heal? b5efits or   
income-disability cov]age2  7,c7 any    
contract or agreem5t ( any gr\p1        
organization1 p>tn]%ip1 or corporation  
to provide1 pay =1 or reimburse ! co/ ( 
m$ical1 hospital1 d5tal1 or income      
disability b5efits2 &  7,d7 any o!r     
publicly or privately fund$ program4    
7#d7 ,comp5satory damages ,! t]m        
comp5satory damages means objectively   
v]ifiable monet>y losses incurr$ z a    
result ( ! provision (1 use (1 or paym5t
 = 7or failure to provide1 use1 or pay  
=7 heal? c>e s]vices or m$ical products1
 su* z pa/ & future m$ical exp5ses1 loss
 ( pa/ & future e>n+s1 co/ ( obta9+     
dome/ic s]vices1 loss ( employm5t1 &    
loss ( bus9ess or employm5t             
opportunities1 damages = physical &     

emotional pa91 suff]+1 inconv5i5ce1     
physical impairm5t1 m5tal angui%1       
disfigurem5t1 loss ( enjoym5t ( life1   
loss ( society & companion%ip1 loss (   
consortium 7o!r ?an loss ( dome/ic      
s]vice71 h$onic damages1 injury to      
reputation1 & all o!r nonpecuni>y losses
 ( any k9d or nature4 ,su* t]m includes 
economic damages & noneconomic damages1 
z su* t]ms are def9$ 9 ?is section4     
7#e7 ,cont+5t fee ,! t]m cont+5t fee    
includes all comp5sation to any p]son or
 p]sons :i* is payable only if a recov]y
 is effect$ on behalf ( "o or m         
claimants4  7#f7 ,economic damages ,!   
t]m economic damages means objectively  
v]ifiable monet>y losses incurr$ z a    
result ( ! provision (1 use (1 or paym5t
 = 7or failure to provide1 use1 or pay  
=7 heal? c>e s]vices or m$ical products1
 su* z pa/ & future m$ical exp5ses1 loss
 ( pa/ & future e>n+s1 co/ ( obta9+     
dome/ic s]vices1 loss ( employm5t1 &    
loss ( bus9ess or employm5t             
opportunities4  7#g7 ,heal? c>e goods or

 s]vices ,! t]m heal? c>e goods or      
s]vices means any goods or s]vices      
provid$ by a heal? c>e in/itution1      
provid]1 or by any individual work+ "u !
 sup]vision ( a heal? c>e provid]1 t    
relates to ! diagnosis1 prev5tion1 c>e1 
or treatm5t ( any human disease or      
impairm5t1 or ! assessm5t ( ! heal? (   
human be+s4  7#h7 ,heal? c>e in/itution 
,! t]m heal? c>e in/itution means any   
entity lic5s$ "u ,f$]al or ,/ate law to 
provide heal? c>e s]vices 7includ+ b n  
limit$ to ambulatory surgical c5t]s1    
assi/$ liv+ facilities1 em]g5cy m$ical  
s]vices provid]s1 hospices1 hospitals & 
hospital sy/ems1 nurs+ homes1 or o!r    
entities lic5s$ to provide su* s]vices74
  7#i7 ,heal? c>e lawsuit ,! t]m heal?  
c>e lawsuit means any heal? c>e         
liability claim conc]n+ ! provision (   
heal? c>e goods or s]vices affect+      
int]/ate comm]ce1 or any heal? c>e      
liability action conc]n+ ! provision (  
7or ! failure to provide7 heal? c>e     
goods or s]vices affect+ int]/ate       

comm]ce1 br\ght 9 a ,/ate or ,f$]al c\rt
 or pursuant to an alt]native dispute   
resolution sy/em1 aga9/ a heal? c>e     
provid] or a heal? c>e in/itution       
reg>dless ( ! !ory ( liability on :i* ! 
claim is bas$1 or ! numb] ( claimants1  
pla9tiffs1 def5dants1 or o!r p>ties1 or 
! numb] ( claims or causes ( action1 9  
:i* ! claimant alleges a heal? c>e      
liability claim4  7#aj7 ,heal? c>e      
liability action ,! t]m heal? c>e       
liability action means a civil action   
br\ght 9 a ,/ate or ,f$]al ,c\rt or     
pursuant to an alt]native dispute       
resolution sy/em1 aga9/ a heal? c>e     
provid] or a heal? c>e in/itution       
reg>dless ( ! !ory ( liability on :i* ! 
claim is bas$1 or ! numb] ( pla9tiffs1  
def5dants1 or o!r p>ties1 or ! numb] (  
causes ( action1 9 :i* ! claimant       
alleges a heal? c>e liability claim4    
7#aa7 ,heal? c>e liability claim ,! t]m 
heal? c>e liability claim means a dem&  
by any p]son1 :e!r or n pursuant to     
,,adr1 aga9/ a heal? c>e provid] or     

heal? c>e in/itution1 includ+ ?ird-p>ty 
claims1 cross-claims1 c\nt]-claims1 or  
contribution claims1 :i* are bas$ ^u !  
provision (1 use (1 or paym5t = 7or !   
failure to provide1 use1 or pay =7 heal?
 c>e s]vices1 reg>dless ( ! !ory (      
liability on :i* ! claim is bas$1 or !  
numb] ( pla9tiffs1 def5dants1 or o!r    
p>ties1 or ! numb] ( causes ( action4   
7#ab7 ,heal? c>e provid]  7,a7 ,9 g5]al 
,! t]m heal? c>e provid] means any p]son
 7includ+ b n limit$ to a physician 7z  
def9$ by section #ahfa7r7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#aciex7r7771 regi/]$ nurse1 d5ti/1      
podiatri/1 ph>maci/1 *iropractor1 or    
optometri/7 requir$ by ,/ate or ,f$]al  
law to be lic5s$1 regi/]$1 or c]tifi$ to
 provide heal? c>e s]vices1 & be+ ei!r s
 lic5s$1 regi/]$1 or c]tifi$1 or exempt$
 f su* requirem5t by o!r /atute or      
regulation4  7,b7 ,treatm5t ( c]ta9     
pr(essional associations ,= purposes (  
?is ,act1 a pr(essional association t is
 organiz$ "u ,/ate law by an individual 

physician or gr\p ( physicians1 a       
p>tn]%ip or limit$ liability p>tn]%ip   
=m$ by a gr\p ( physicians1 a nonpr(it  
heal? corporation c]tifi$ "u ,/ate law1 
or a company =m$ by a gr\p ( physicians 
"u ,/ate law %all be treat$ z a heal?   
c>e provid] "u subp>agraph 7,a74  7#ac7 
,malici\s int5t to injure ,! t]m        
malici\s int5t to injure means          
int5tionally caus+ or attempt+ to cause 
physical injury o!r ?an provid+ heal?   
c>e goods or s]vices4  7#ad7            
,noneconomic damages ,! t]m noneconomic 
damages means damages = physical &      
emotional pa91 suff]+1 inconv5i5ce1     
physical impairm5t1 m5tal angui%1       
disfigurem5t1 loss ( enjoym5t ( life1   
loss ( society & companion%ip1 loss (   
consortium 7o!r ?an loss ( dome/ic      
s]vice71 h$onic damages1 injury to      
reputation1 & all o!r nonpecuni>y losses
 ( any k9d or nature4  7#ae7 ,punitive  
damages ,! t]m punitive damages means   
damages aw>d$1 = ! purpose ( puni%m5t or
 det]r5ce1 & n solely = comp5satory     

purposes1 aga9/ a heal? c>e provid] or  
heal? c>e in/itution4 ,punitive damages 
are nei!r economic nor noneconomic      
damages4  7#af7 ,recov]y ,! t]m recov]y 
means ! net sum recov]$ aft] d$uct+ any 
disbursem5ts or co/s incurr$ 9          
connection ) prosecution or settlem5t ( 
! claim1 includ+ all co/s paid or       
advanc$ by any p]son4 ,co/s ( heal? c>e 
incurr$ by ! pla9tiff & ! attorneys'    
(fice ov]head co/s or *>ges = legal     
s]vices are n d$uctible disbursem5ts or 
co/s = su* purpose4  7#ag7 ,/ate ,! t]m 
,/ate means ea* ( ! sev]al ,/ates1 !    
,di/rict ( ,columbia1 ! ,commonweal? (  
,pu]to ,rico1 ! ,virg9 ,isl&s1 ,guam1   
,am]ican ,samoa1 ! ,nor!rn ,m>iana      
,isl&s1 ! ,tru/ ,t]ritory ( ! ,pacific  
,isl&s1 & any o!r t]ritory or possession
 ( ! ,unit$ ,/ates1 or any political    
subdivision !re(4  #d4 ,enc\rag+ spe$y  
resolution ( claims  7a7 ,9 g5]al       
,except z o!rwise provid$ = 9 ?is       
section1 ! "t = ! comm5cem5t ( a heal?  
c>e lawsuit %all be #c ye>s aft] ! date 

( manife/ation ( injury or #a ye> aft] !
 claimant discov]s1 or ?r\gh ! use (    
reasonable dilig5ce %\ld h discov]$1 !  
injury1 :i*ev] occurs fir/4  7b7 ,g5]al 
exception ,! "t = ! comm5cem5t ( a heal?
 c>e lawsuit %all n exce$ #c ye>s aft] !
 date ( manife/ation ( injury unless !  
toll+ ( "t 0 delay$ z a result (--  7#a7
 fraud2  7#b7 int5tional concealm5t2 or 
7#c7 ! pres5ce ( a =eign body1 :i* has  
no !rapeutic or diagno/ic purpose or    
effect1 9 ! p]son ( ! injur$ p]son4  7c7
 ,m9ors ,an action by a m9or %all be    
comm5c$ )9 #c ye>s f ! date ( ! alleg$  
manife/ation ( injury except t if su*   
m9or is "u ! full age ( #f ye>s1 su*    
action %all be comm5c$ )9 #c ye>s ( !   
manife/ation ( injury1 or prior to !    
eigh? bir?day ( ! m9or1 :i*ev] provides 
a long] p]iod4 ,su* "t limitation %all  
be toll$ = m9ors = any p]iod dur+ :i* a 
p>5t or gu>dian & a heal? c>e provid] or
 heal? c>e in/itution h committ$ fraud  
or collusion 9 ! failure to br+ an      
action on behalf ( ! injur$ m9or4  7d7  

,rule #aa sanctions ,:5ev] a ,f$]al or  
,/ate c\rt det]m9es 7:e!r by motion ( ! 
p>ties or :e!r on ! motion ( ! c\rt7 t  
!re has be5 a violation ( ,rule #aa ( ! 
,f$]al ,rules ( ,civil ,proc$ure 7or a  
simil> violation ( applicable ,/ate c\rt
 rules7 9 a heal? c>e liability action  
to :i* ?is ,act applies1 ! c\rt %all    
impose ^u ! attorneys1 law firms1 or pro
 se litigants t h violat$ ,rule #aa or  
are responsible = ! violation1 an       
appropriate sanction1 :i* %all include  
an ord] to pay ! o!r p>ty or p>ties = ! 
reasonable exp5ses incurr$ z a direct   
result ( ! fil+ ( ! plead+1 motion1 or  
o!r pap] t is ! subject ( ! violation1  
includ+ a reasonable attorneys' fee4    
,su* sanction %all be suffici5t to det] 
repetition ( su* conduct or comp>able   
conduct by o!rs simil>ly situat$1 & to  
comp5sate ! p>ty or p>ties injur$ by su*
 conduct4  #e4 ,comp5sat+ pati5t injury 
7a7 ,unlimit$ am\nt ( damages = actual  
economic losses 9 heal? c>e lawsuits ,9 
any heal? c>e lawsuit1 no?+ 9 ?is ,act  

%all limit ! recov]y by a claimant ( !  
full am\nt ( ! available economic       
damages1 not)/&+ ! limitation conta9$ 9 
subsection 7b74  7b7 ,additional        
noneconomic damages  7#a7 ,heal? c>e    
provid]s ,9 any heal? c>e lawsuit :]e   
f9al judgm5t is r5d]$ aga9/ a heal? c>e 
provid]1 ! am\nt ( noneconomic damages  
recov]$ f ! provid]1 if o!rwise         
available "u applicable ,f$]al or ,/ate 
law1 may be z mu* z #bej1jjj1 reg>dless 
( ! numb] ( p>ties o!r ?an a heal? c>e  
in/itution aga9/ :om ! action is br\ght 
or ! numb] ( sep>ate claims or actions  
br\ght ) respect to ! same occurr5ce4   
7#b7 ,heal? c>e in/itutions  7,a7 ,s+le 
in/itution ,9 any heal? c>e lawsuit :]e 
f9al judgm5t is r5d]$ aga9/ a s+le heal?
 c>e in/itution1 ! am\nt ( noneconomic  
damages recov]$ f ! in/itution1 if      
o!rwise available "u applicable ,f$]al  
or ,/ate law1 may be z mu* z #bej1jjj1  
reg>dless ( ! numb] ( p>ties aga9/ :om !
 action is br\ght or ! numb] ( sep>ate  
claims or actions br\ght ) respect to ! 

same occurr5ce4  7,b7 ,multiple         
in/itutions ,9 any heal? c>e lawsuit :]e
 f9al judgm5t is r5d]$ aga9/ m ?an "o   
heal? c>e in/itution1 ! am\nt (         
noneconomic damages recov]$ f ea*       
in/itution1 if o!rwise available "u     
applicable ,f$]al or ,/ate law1 may be z
 mu* z #bej1jjj1 reg>dless ( ! numb] (  
p>ties aga9/ :om ! action is br\ght or !
 numb] ( sep>ate claims or actions      
br\ght ) respect to ! same occurr5ce1   
except t ! total am\nt recov]$ f all su*
 in/itutions 9 su* lawsuit %all n exce$ 
#ejj1jjj4  7c7 ,no disc\nt ( aw>d =     
noneconomic damages ,9 any heal? c>e    
lawsuit--  7#a7 an aw>d = future        
noneconomic damages %all n be disc\nt$  
to pres5t value2  7#b7 ! jury %all n be 
in=m$ ab\t ! maximum aw>d = noneconomic 
damages "u subsection 7b72  7#c7 an aw>d
 = noneconomic damages 9 excess ( !     
limitations provid$ = 9 subsection 7b7  
%all be r$uc$ ei!r be=e ! entry (       
judgm5t1 or by am5dm5t ( ! judgm5t aft] 
entry ( judgm5t1 & su* r$uction %all be 

made be=e acc\nt+ = any o!r r$uction 9  
damages requir$ by law2 &  7#d7 if      
sep>ate aw>ds are r5d]$ = pa/ & future  
noneconomic damages & ! comb9$ aw>ds    
exce$ ! limitations describ$ 9          
subsection 7b71 ! future noneconomic    
damages %all be r$uc$ fir/4  7d7 ,fair  
%>e rule ,9 any heal? c>e lawsuit1 ea*  
p>ty %all be liable = t p>ty's sev]al   
%>e ( any damages only & n = ! %>e ( any
 o!r p]son4 ,ea* p>ty %all be liable    
only = ! am\nt ( damages allocat$ to su*
 p>ty 9 direct proportion to su* p>ty's 
p]c5tage ( responsibility4 ,a sep>ate   
judgm5t %all be r5d]$ aga9/ ea* su* p>ty
 = ! am\nt allocat$ to su* p>ty4 ,=     
purposes ( ?is section1 ! tri] ( fact   
%all det]m9e ! proportion (             
responsibility ( ea* p>ty = ! claimant's
 h>m4  #f4 ,maximiz+ pati5t recov]y  7a7
 ,c\rt sup]vision ( %>e ( damages       
actually paid to claimants  7#a7 ,9     
g5]al ,9 any heal? c>e lawsuit1 ! c\rt  
%all sup]vise ! arrangem5ts = paym5t (  
damages to protect aga9/ conflicts (    

int]e/ t may h ! effect ( r$uc+ ! am\nt 
( damages aw>d$ t are actually paid to  
claimants4  7#b7 ,cont+5cy fees  7,a7 ,9
 g5]al ,9 any heal? c>e lawsuit 9 :i* ! 
attorney = a p>ty claims a f9ancial /ake
 9 ! outcome by virtue ( a cont+5t fee1 
! c\rt %all h ! p[] to re/rict ! paym5t 
( a claimant's damage recov]y to su*    
attorney1 & to r$irect su* damages to ! 
claimant bas$ ^u ! int]e/s ( ju/ice &   
pr9ciples ( equity4  7,b7 ,limitation ,!
 total ( all cont+5t fees = repres5t+   
all claimants 9 a heal? c>e lawsuit %all
 n exce$ ! foll[+ limits3  7i7 ,=ty     
p]c5t ( ! fir/ #ej1jjj recov]$ by !     
claimant7s74  7ii7 ,?irty-?ree & "o-?ird
 p]c5t ( ! next #ej1jjj recov]$ by !    
claimant7s74  7iii7 ,tw5ty-five p]c5t ( 
! next #ejj1jjj recov]$ by !            
claimant7s74  7iv7 ,fifte5 p]c5t ( any  
am\nt by :i* ! recov]y by ! claimant7s7 
is 9 excess ( #fjj1jjj4  7b7            
,applicability  7#a7 ,9 g5]al ,!        
limitations 9 subsection 7a7 %all apply 
:e!r ! recov]y is by judgm5t1 settlem5t1

 m$iation1 arbitration1 or any o!r =m ( 
alt]native dispute resolution4  7#b7    
,m9ors ,9 a heal? c>e lawsuit involv+ a 
m9or or incompet5t p]son1 a c\rt reta9s 
! au?ority to au?orize or approve a fee 
t is less ?an ! maximum p]mitt$ "u ?is  
section4  7c7 ,exp]t witnesses  7#a7    
,requirem5t ,no individual %all be      
qualifi$ to te/ify z an exp]t witness   
conc]n+ issues ( neglig5ce 9 any heal?  
c>e lawsuit aga9/ a def5dant unless su* 
individual--  7,a7 except z requir$ "u  
p>agraph 7#b71 is a heal? c>e           
pr(essional :o--  7i7 is appropriately  
cr$5tial$ or lic5s$ 9 #a or m ,/ates to 
deliv] heal? c>e s]vices2 &  7ii7       
typically treats ! diagnosis or         
condition or provides ! type ( treatm5t 
"u review2 &  7,b7 c demon/rate by      
compet5t evid5ce t1 z a result ( tra9+1 
education1 k1 & exp]i5ce 9 ! evaluation1
 diagnosis1 & treatm5t ( ! disease or   
injury :i* is ! subject matt] ( !       
lawsuit aga9/ ! def5dant1 ! individual 0
 sub/antially famili> ) applicable /&>ds

 ( c>e & practice z !y relate to ! act  
or omission :i* is ! subject ( ! lawsuit
 on ! date ( ! incid5t4  7#b7 ,physician
 review ,9 a heal? c>e lawsuit1 if !    
claim ( ! pla9tiff involv$ treatm5t t is
 recomm5d$ or provid$ by a physician    
7allopa?ic or o/eopa?ic71 an individual 
%all n be qualifi$ to be an exp]t       
witness "u ?is subsection ) respect to  
issues ( neglig5ce conc]n+ su* treatm5t 
unless su* individual is a physician4   
7#c7 ,specialties & subspecialties ,)   
respect to a lawsuit describ$ 9 p>agraph
 7#a71 a c\rt %all n p]mit an exp]t 9 "o
 m$ical specialty or subspecialty to    
te/ify aga9/ a def5dant 9 ano!r m$ical  
specialty or subspecialty unless1 9     
addition to a %[+ ( sub/antial          
famili>ity 9 accordance ) p>agraph      
7#a77;,b71 !re is a %[+ t ! /&>ds ( c>e 
& practice 9 ! two specialty or         
subspecialty fields are simil>4  7#d7   
,limitation ,! limitations 9 ?is        
subsection %all n apply to exp]t        
witnesses te/ify+ z to ! degree or      

p]man5cy ( m$ical or physical impairm5t4
  #g4 ,additional heal? b5efits  7a7 ,9 
g5]al ,! am\nt ( any damages receiv$ by 
a claimant 9 any heal? c>e lawsuit %all 
be r$uc$ by ! c\rt by ! am\nt ( any     
collat]al s\rce b5efits to :i* !        
claimant is entitl$1 less any insurance 
premiums or o!r paym5ts made by !       
claimant 7or by ! sp\se1 p>5t1 *ild1 or 
legal gu>dian ( ! claimant7 to obta9 or 
secure su* b5efits4  7b7 ,pres]vation ( 
curr5t law ,:]e a payor ( collat]al     
s\rce b5efits has a "r ( recov]y by     
reimbursem5t or subrogation & su* "r is 
p]mitt$ "u ,f$]al or ,/ate law1         
subsection 7a7 %all n apply4  7c7       
,application ( provision ,?is section   
%all apply to any heal? c>e lawsuit t is
 settl$ or resolv$ by a fact f9d]4  #h4 
,punitive damages  7a7 ,punitive damages
 p]mitt$  7#a7 ,9 g5]al ,punitive       
damages may1 if o!rwise available "u    
applicable ,/ate or ,f$]al law1 be aw>d$
 aga9/ any p]son 9 a heal? c>e lawsuit  
only if x is prov5 by cle> & conv9c+    

evid5ce t su* p]son act$ ) malici\s     
int5t to injure ! claimant1 or t su*    
p]son delib]ately fail$ to avoid        
unnecess>y injury t su* p]son knew !    
claimant 0 sub/antially c]ta9 to suff]4 
7#b7 ,fil+ ( lawsuit ,no dem& = punitive
 damages %all be includ$ 9 a heal? c>e  
lawsuit z initially fil$4 ,a c\rt may   
all[ a claimant to file an am5d$ plead+ 
= punitive damages only ^u a motion by !
 claimant & aft] a f9d+ by ! c\rt1 ^u   
review ( support+ & oppos+ affidavits or
 aft] a he>+1 aft] weigh+ ! evid5ce1 t !
 claimant has e/abli%$ by a sub/antial  
probability t ! claimant w prevail on ! 
claim = punitive damages4  7#c7 ,sep>ate
 proce$+ ,at ! reque/ ( any p>ty 9 a    
heal? c>e lawsuit1 ! tri] ( fact %all   
consid] 9 a sep>ate proce$+--  7,a7 :e!r
 punitive damages are to be aw>d$ & !   
am\nt ( su* aw>d2 &  7,b7 ! am\nt (     
punitive damages foll[+ a det]m9ation ( 
punitive liability4  ,if a sep>ate      
proce$+ is reque/$1 evid5ce relevant    
only to ! claim = punitive damages1 z   

det]m9$ by applicable ,/ate law1 %all be
 inadmissible 9 any proce$+ to det]m9e  
:e!r comp5satory damages are to be      
aw>d$4  7#d7 ,limitation :]e no         
comp5satory damages are aw>d$ ,9 any    
heal? c>e lawsuit :]e no judgm5t =      
comp5satory damages is r5d]$ aga9/ a    
p]son1 no punitive damages may be aw>d$ 
) respect to ! claim 9 su* lawsuit aga9/
 su* p]son4  7b7 ,det]m9+ am\nt (       
punitive damages  7#a7 ,factors consid]$
 ,9 det]m9+ ! am\nt ( punitive damages  
"u ?is section1 ! tri] ( fact %all      
consid] only ! foll[+3  7,a7 ! sev]ity (
 ! h>m caus$ by ! conduct ( su* p>ty2   
7,b7 ! duration ( ! conduct or any      
concealm5t ( x by su* p>ty2  7,c7 !     
pr(itability ( ! conduct to su* p>ty2   
7,d7 ! numb] ( products sold or m$ical  
proc$ures r5d]$ = comp5sation1 z ! case 
may be1 by su* p>ty1 ( ! k9d caus+ ! h>m
 compla9$ ( by ! claimant2  7,e7 any    
crim9al p5alties impos$ on su* p>ty1 z a
 result ( ! conduct compla9$ ( by !     
claimant2 &  7,f7 ! am\nt ( any civil   

f9es assess$ aga9/ su* p>ty z a result (
 ! conduct compla9$ ( by ! claimant4    
7#b7 ,maximum aw>d ,! am\nt ( punitive  
damages aw>d$ 9 a heal? c>e lawsuit may 
n exce$ an am\nt equal to two times !   
am\nt ( economic damages aw>d$ 9 !      
lawsuit or #bej1jjj1 :i*ev] is great]4  
,! jury %all n be in=m$ ( ! limitation  
"u ! prec$+ s5t5ce4  7c7 ,liability (   
heal? c>e provid]s  7#a7 ,9 g5]al ,a    
heal? c>e provid] :o prescribes1 or :o  
disp5ses pursuant to a prescription1 a  
drug1 biological product1 or m$ical     
device approv$ by ! ,food & ,drug       
,adm9i/ration1 = an approv$ indication (
 ! drug1 biological product1 or m$ical  
device1 %all n be nam$ z a p>ty to a    
product liability lawsuit invok+ su*    
drug1 biological product1 or m$ical     
device & %all n be liable to a claimant 
9 a class action lawsuit aga9/ !        
manufactur]1 di/ributor1 or product     
sell] ( su* drug1 biological product1 or
 m$ical device4  7#b7 ,m$ical product ,!
 t]m m$ical product means a drug or     

device int5d$ = humans4 ,! t]ms drug &  
device h ! mean+s giv5 su* t]ms 9       
sections #bja7;g77#a7 & #bja7;h7 ( !    
,f$]al ,food1 ,drug & ,cosmetic ,act    
7#ba ,u4,s4,c4 #cba71 respectively1     
includ+ any compon5t or raw mat]ial us$ 
!re91 b exclud+ heal? c>e s]vices4  #i4 
,au?orization ( paym5t ( future damages 
to claimants 9 heal? c>e lawsuits  7a7  
,9 g5]al ,9 any heal? c>e lawsuit1 if an
 aw>d ( future damages1 )\t r$uction to 
pres5t value1 equal+ or exce$+ #ej1jjj  
is made aga9/ a p>ty ) suffici5t        
insurance or o!r assets to fund a       
p]iodic paym5t ( su* a judgm5t1 ! c\rt  
%all1 at ! reque/ ( any p>ty1 ent] a    
judgm5t ord]+ t ! future damages be paid
 by p]iodic paym5ts 9 accordance ) !    
,uni=m ,p]iodic ,paym5t ( ,judgm5ts ,act
 promulgat$ by ! ,national ,conf]5ce (  
,commission]s on ,uni=m ,/ate ,laws4    
7b7 ,applicability ,?is section applies 
to all actions :i* h n be5 fir/ set =   
trial or retrial be=e ! effective date (
 ?is ,act4  #aj4 ,effect on o!r laws    

7a7 ,g5]al vacc9e injury  7#a7 ,9 g5]al 
,to ! ext5t t title ,,xxi ( ! ,public   
,heal? ,s]vice ,act e/abli%es a ,f$]al  
rule ( law applicable to a civil action 
br\ght = a vacc9e-relat$ injury or      
dea?--  7,a7 ?is ,act %all n affect !   
application ( ! rule ( law to su* an    
action2 &  7,b7 any rule ( law prescrib$
 by ?is ,act 9 conflict ) a rule ( law (
 su* title ,,xxi %all n apply to su*    
action4  7#b7 ,exception ,if !re is an  
aspect ( a civil action br\ght = a      
vacc9e-relat$ injury or dea? to :i* a   
,f$]al rule ( law "u title ,,xxi ( !    
,public ,heal? ,s]vice ,act does n      
apply1 !n ?is ,act or o!rwise applicable
 law 7z det]m9$ "u ?is ,act7 w apply to 
su* aspect ( su* action4  7b7 ,smallpox 
vacc9e injury  7#a7 ,9 g5]al ,to ! ext5t
 t "p ,c ( title ,,ii ( ! ,public ,heal?
 ,s]vice ,act e/abli%es a ,f$]al rule ( 
law applicable to a civil action br\ght 
= a smallpox vacc9e-relat$ injury or    
dea?--  7,a7 ?is ,act %all n affect !   
application ( ! rule ( law to su* an    

action2 &  7,b7 any rule ( law prescrib$
 by ?is ,act 9 conflict ) a rule ( law (
 su* "p ,c %all n apply to su* action4  
7#b7 ,exception ,if !re is an aspect ( a
 civil action br\ght = a smallpox       
vacc9e-relat$ injury or dea? to :i* a   
,f$]al rule ( law "u "p ,c ( title ,,ii 
( ! ,public ,heal? ,s]vice ,act does n  
apply1 !n ?is ,act or o!rwise applicable
 law 7z det]m9$ "u ?is ,act7 w apply to 
su* aspect ( su* action4  7c7 ,o!r      
,f$]al law ,except z provid$ 9 ?is      
section1 no?+ 9 ?is ,act %all be deem$  
to affect any def5se available1 or any  
limitation on liability t applies to1 a 
def5dant 9 a heal? c>e lawsuit or action
 "u any o!r provision ( ,f$]al law4     
#aa4 ,/ate flexibility & protection (   
/ates' rights  7a7 ,heal? c>e lawsuits  
,! provisions gov]n+ heal? c>e lawsuits 
set =? 9 ?is ,act %all preempt1 subject 
to subsections 7b7 & 7c71 ,/ate law to !
 ext5t t ,/ate law prev5ts ! application
 ( any provisions ( law e/abli%$ by or  
"u ?is ,act4 ,! provisions gov]n+ heal? 

c>e lawsuits set =? 9 ?is ,act sup]s$e  
*apt] #aga ( title #bh1 ,unit$ ,/ates   
,code1 to ! ext5t t su* *apt]--  7#a7   
provides = a great] am\nt ( damages or  
cont+5t fees1 a long] p]iod 9 :i* a     
heal? c>e lawsuit may be comm5c$1 or a  
r$uc$ applicability or scope ( p]iodic  
paym5t ( future damages1 ?an provid$ 9  
?is ,act2 or  7#b7 prohibits !          
introduction ( evid5ce reg>d+ collat]al 
s\rce b5efits4  7b7 ,preemption ( c]ta9 
,/ate laws ,no provision ( ?is ,act %all
 be con/ru$ to preempt any ,/ate law    
7:e!r effective be=e1 on1 or aft] ! date
 ( ! enactm5t ( ?is ,act7 t specifies a 
p>ticul> monet>y am\nt ( comp5satory or 
punitive damages 7or ! total am\nt (    
damages7 t may be aw>d$ 9 a heal? c>e   
lawsuit1 reg>dless ( :e!r su* monet>y   
am\nt is great] or less] ?an is provid$ 
= "u ?is ,act1 not)/&+ section #e7;a74  
7c7 ,protection ( /ate's rights & o!r   
laws  7#a7 ,9 g5]al ,any issue t is n   
gov]n$ by a provision ( law e/abli%$ by 
or "u ?is ,act 7includ+ ! ,/ate /&>ds ( 

neglig5ce7 %all be gov]n$ by o!rwise    
applicable ,f$]al or ,/ate law4  7#b7   
,rule ( con/ruction ,no?+ 9 ?is ,act    
%all be con/ru$ to--  7,a7 preempt or   
sup]s$e any ,f$]al or ,/ate law t       
imposes great] proc$ural or sub/antive  
protections 7su* z a %ort] /atute (     
limitations7 = a heal? c>e provid] or   
heal? c>e in/itution f liability1 loss1 
or damages ?an ^? provid$ by ?is ,act2  
7,b7 preempt or sup]c$e any ,/ate law t 
p]mits & provides = ! en=cem5t ( any    
arbitration agreem5t relat$ to a heal?  
c>e liability claim :e!r enact$ prior to
 or aft] ! date ( enactm5t ( ?is ,act2  
7,c7 create a cause ( action t is n     
o!rwise available "u ,f$]al or ,/ate    
law2 or  7,d7 affect ! scope (          
preemption ( any o!r ,f$]al law4  #ab4  
,applicability2 effective date ,?is ,act
 %all apply to any heal? c>e lawsuit    
br\ght 9 a ,f$]al or ,/ate c\rt1 or     
subject to an alt]native dispute        
resolution sy/em1 t is initiat$ on or   
aft] ! date ( ! enactm5t ( ?is ,act1    

except t any heal? c>e lawsuit aris+ f  
an injury occurr+ prior to ! date (     
enactm5t ( ?is ,act %all be gov]n$ by ! 
applicable /atute ( limitations         
provisions 9 effect at ! "t ! injury    
occurr$4