,i  #aafth ,,congress  #ast ,session    
,h4 ,r4 #cfef  ,,in ,,the ,,house ,,of  
,,representatives  ,july #i1 #bjai,mr4  
,hudson 7for himself1 ,mr4 ,marshall1   
and ,mr4 ,bucshon7 introduced the       
following bill2 which was referred to   
the ,committee on the ,judiciary1 and in
 addition to the ,committee on ,energy  
and ,commerce1 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 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 title2 table of     
contents  7a7 ,short title ,this ,act   
may be cited as the ,accessible ,care by
 ,curbing ,excessive law,suit,s ,act of 
#bjai or the ,,access ,act of #bjai4    
7b7 ,table of contents ,the table of    
contents of this ,act is as follows3    

,sec4 #a4 ,short title2 table of        
contents4 ,sec4 #b4 ,findings and       
purpose4 ,sec4 #c4 ,encouraging speedy  
resolution of claims4 ,sec4 #d4         
,compensating patient injury4 ,sec4 #e4 
,maximizing patient recovery4 ,sec4 #f4 
,additional health benefits4 ,sec4 #g4  
,authorization of payment of future     
damages to claimants in health care     
lawsuits4 ,sec4 #h4 ,product liability  
for health care providers4 ,sec4 #i4    
,communications following unanticipated 
outcome4 ,sec4 #aj4 ,notice of intent to
 commence lawsuit4 ,sec4 #aa4 ,affidavit
 of merit4 ,sec4 #ab4 ,expert witness   
qualifications4 ,sec4 #ac4 ,definitions4
 ,sec4 #ad4 ,effect on other laws4 ,sec4
 #ae4 ,rules of construction4 ,sec4 #af4
 ,effective date4  #b4 ,findings and    
purpose  7a7 ,findings  7#a7 ,effect on 
health care access and costs ,congress  
finds that the 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 without reform is a costly and   
inefficient 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 ,federal spending  7,a7      
,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--  7i7 the large number of   
individuals who receive health care     
benefits under programs operated or     
financed by the ,federal ,government2   
7ii7 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  7iii7 the large number of
 health care providers who provide items

 or services for which the ,federal     
,government makes payments4  7,b7       
,congress finds that the ,federal       
deficit would be reduced by #fb billion 
over the next decade if ,federal health 
care liability reforms were enacted1 as 
verified by the ,congressional ,budget  
,office4  7#c7 ,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  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 ,encouraging speedy          
resolution of claims  7a7 ,statute of   
limitations ,the time for the           
commencement of a health care lawsuit   

shall be #c years after the date of     
injury or #a year after the claimant    
discovers1 or through the use of        
reasonable diligence should have        
discovered1 the injury1 whichever occurs
 first4 ,in no event shall the time for 
commencement of a health care lawsuit   
exceed #c years after the date of injury
 unless tolled for any of the           
following--  7#a7 upon proof of 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  ,actions by a minor shall be  
commenced within #c years from the date 
of the injury except that actions by a  
minor under the full age of #f years    
shall be commenced within #c years of   
injury1 or #a year after the injury is  
discovered1 or through the use of       
reasonable diligence should have been   
discovered1 or prior to the minor's #hth
 birthday1 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 have committed fraud or   
collusion in the failure to bring an    
action on behalf of the injured minor4  
7b7 ,state flexibility ,no provision of 
,subsection 7a7 shall be construed to   
preempt any state law 7whether effective
 before1 on1 or after the date of the   
enactment of this ,act7 that--  7#a7    
specifies a time period of less than #c 
years after the date of injury or less  
than #a year after the claimant         
discovers1 or through the use of        
reasonable diligence should have        
discovered1 the injury1 for the filing  
of a health care lawsuit2  7#b7 that    
specifies a different time period for   
the filing of lawsuits by a minor2  7#c7
 that triggers the time period based on 
the date of the alleged negligence2 or  
7#d7 establishes a statute of repose for
 the filing of health care lawsuit4  #d4
 ,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 a claimant's      
recovery of the full amount of the      
available economic damages1             
notwithstanding the limitation in       
subsection 7b74  7b7 ,additional        
noneconomic damages ,in any health care 
lawsuit1 the amount of noneconomic      
damages1 if available1 shall not exceed 
#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 injury4  7c7 ,no discount of award 
for noneconomic damages ,for purposes of
 applying the limitation in subsection  
7b71 future noneconomic damages shall   
not be discounted to present value4 ,the
 jury shall not be informed about the   
maximum award for noneconomic damages4  
,an award for noneconomic damages in    
excess of #bej1jjj 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 law4   
,if separate awards are rendered for    
past and future noneconomic damages and 
the combined awards exceed #bej1jjj1 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   
,whenever a judgment of liability is    
rendered as to any party1 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  7e7 ,state flexibility

 ,no provision of this section 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 economic or noneconomic       
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 section4
  #e4 ,maximizing patient recovery  7a7 
,court supervision of share of damages  
actually paid to claimants ,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 ,in
 particular1 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 ,in no event shall the total of 
all contingent fees for representing all
 claimants in a health care lawsuit     
exceed the following limits3  7#a7      
,forty percent of the first #ej1jjj     
recovered by the claimant7s74  7#b7     
,thirty-three and one-third percent of  
the next #ej1jjj recovered by the       
claimant7s74  7#c7 ,twenty-five percent 
of the next #ejj1jjj recovered by the   
claimant7s74  7#d7 ,fifteen percent of  
any amount by which the recovery by the 
claimant7s7 is in excess of #fjj1jjj4   
7b7 ,applicability ,the limitations in  
this section shall apply whether the    
recovery is by judgment1 settlement1    
mediation1 arbitration1 or any other    
form of alternative dispute resolution4 
,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   
,the requirement for court supervision  
in the first two sentences of subsection
 7a7 applies only in civil actions4  7c7
 ,state flexibility ,no provision of    
this section 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 lesser percentage or lesser 
total value of damages which may be     
claimed by an attorney representing a   
claimant in a health care lawsuit4  #f4 
,additional health benefits  7a7        
,collateral source benefits ,in any     
health care lawsuit involving injury or 
wrongful death1 any party may introduce 
evidence of collateral source benefits4 
,if a party elects to introduce such    
evidence1 any opposing party may        
introduce evidence of any amount paid or
 contributed or reasonably likely to be 
paid or contributed in the future by or 
on behalf of the opposing party to      

secure the right to such collateral     
source benefits4  7b7 ,subrogation ,no  
provider of collateral source benefits  
shall recover any amount against the    
claimant or receive any lien or credit  
against the claimant's recovery or be   
equitably or legally subrogated to the  
right of the claimant in a health care  
lawsuit involving injury or wrongful    
death4  7c7 ,applicability ,this section
 shall apply to any health care lawsuit 
that is settled as well as a health care
 lawsuit that is resolved by a fact     
finder4 ,this section shall not apply to
 section #ahfb7;b7 7#db ,u4,s4,c4       
#aciey7b77 or section #aijb7;a77#be7    
7#db ,u4,s4,c4 #acif;a7a77#be77 of the  
,social ,security ,act4  7d7 ,state     
flexibility ,no provision of subsection 
7a7 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 mandatory
 offset of collateral source benefits   
against an award in a health care       

liability lawsuit4  #g4 ,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 payments1 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  7c7 ,state
 ,flexibility ,no provision of this     
section shall be construed to preempt   
any ,state law 7whether effective       
before1 on1 or after the date of the    

enactment of this ,act7 that specifies  
periodic payments for future damages at 
any amount other than #ej1jjj or that   
mandates such payments absent the       
request of either party4  #h4 ,product  
liability for health care providers ,a  
health care provider who prescribes1 or 
who dispenses pursuant to a             
prescription1 a medical product         
approved1 licensed1 or cleared by the   
,food and ,drug ,administration shall   
not be named as a party to a product    
liability lawsuit involving such product
 and shall not be liable to a claimant  
in a class action lawsuit against the   
manufacturer1 distributor1 or seller of 
such product4  #i4 ,communications      
following unanticipated outcome  7a7    
,provider communications ,in any health 
care liability action1 any and all      
statements1 affirmations1 gestures1 or  
conduct expressing apology1 fault1      
sympathy1 commiseration1 condolence1    
compassion1 or a general sense of       
benevolence which are made by a health  

care provider or an employee of a health
 care provider to the patient1 a        
relative of the patient1 or a           
representative of the patient and which 
relate to the discomfort1 pain1         
suffering1 injury1 or death of the      
patient as the result of the            
unanticipated outcome of medical care   
shall be inadmissible for any purpose as
 evidence of an admission of liability  
or as evidence of an admission against  
interest4  7b7 ,state ,flexibility ,no  
provision of this section shall be      
construed to preempt any ,state law     
7whether effective before1 on1 or after 
the date of the enactment of this ,act7 
that makes additional communications    
inadmissible as evidence of an admission
 of liability or as evidence of an      
admission against interest4  #aj4       
,notice of intent to commence lawsuit   
7a7 ,advance notice ,a person shall not 
commence an action against a health care
 provider unless the person has given   
the health care provider #ij days       

written notice before the action is     
commenced4  7b7 ,exceptions ,a lawsuit  
against a health care provider filed    
within #f months of the statute of      
limitations expiring as to any claimant1
 or within #a year of the statute of    
repose expiring as to any claimant1     
shall be exempt from compliance with    
this section4  7c7 ,state ,flexibility  
,no provision of this section shall be  
construed to preempt any ,state law     
7whether effective before1 on1 or after 
the date of the enactment of this ,act7 
that establishes a different time period
 for the filing of written notice4  #aa4
 ,affidavit of merit  7a7 ,required     
filing ,subject to subsection 7b71 the  
plaintiff in an action alleging medical 
negligence or1 if the plaintiff is      
represented by an attorney1 the         
plaintiff's attorney shall file         
simultaneously with the health care     
lawsuit an affidavit of merit signed by 
a health professional who meets the     
requirements for an expert witness under

 ,sec4 #ab of this ,act4 ,the affidavit 
of merit shall certify that the health  
professional has reviewed the notice and
 all medical records supplied to him or 
her by the plaintiff's attorney         
concerning the allegations contained in 
the notice and shall contain a statement
 of each of the following3  7#a7 ,the   
applicable standard of practice or care4
  7#b7 ,the health professional's       
opinion that the applicable standard of 
practice or care was breached by the    
health professional or health facility  
receiving the notice4  7#c7 ,the actions
 that should have been taken or omitted 
by the health professional or health    
facility in order to have complied with 
the applicable standard of practice or  
care4  7#d7 ,the manner in which the    
breach of the standard of practice or   
care was the proximate cause of the     
injury alleged in the notice4  7#e7 ,a  
listing of the medical records reviewed4
  7b7 ,filing extension ,upon motion of 
a party for good cause shown1 the court 

in which the complaint is filed may     
grant the plaintiff or1 if the plaintiff
 is represented by an attorney1 the     
plaintiff's attorney an additional #bh  
days in which to file the affidavit     
required under subsection 7#a74  7c7    
,state ,flexibility ,no provision of    
this section shall be construed to      
preempt any ,state law 7whether         
effective before1 on1 or after the date 
of the enactment of this ,act7 that     
establishes additional requirements for 
the filing of an affidavit of merit or  
similar pre-litigation documentation4   
#ab4 ,expert witness qualifications  7a7
 ,in general ,in any health care        
lawsuit1 an individual shall not give   
expert testimony on the appropriate     
standard of practice or care involved   
unless the individual is licensed as a  
health professional in #a or more       
,states and the individual meets the    
following criteria3  7#a7 ,if the party 
against whom or on whose behalf the     
testimony is to be offered is or claims 

to be a specialist1 the expert witness  
shall specialize at the time of the     
occurrence that is the basis for the    
lawsuit in the same specialty or claimed
 specialty as the party against whom or 
on whose behalf the testimony is to be  
offered4 ,if the party against whom or  
on whose behalf the testimony is to be  
offered is or claims to be a specialist 
who is board certified1 the expert      
witness shall be a specialist who is    
board certified in that specialty or    
claimed specialty4  7#b7 ,during the    
#a-year period immediately preceding the
 occurrence of the action that gave rise
 to the lawsuit1 the expert witness     
shall have devoted a majority of the    
individual's professional time to one or
 more of the following3  7,a7 ,the      
active clinical practice of the same    
health profession as the defendant and1 
if the defendant is or claims to be a   
specialist1 in the same specialty or    
claimed specialty4  7,b7 ,the           
instruction of students in an accredited

 health professional school or          
accredited residency or clinical        
research program in the same health     
profession as the defendant and1 if the 
defendant is or claims to be a          
specialist1 in an accredited health     
professional school or accredited       
residency or clinical research program  
in the same specialty or claimed        
specialty4  7#c7 ,if the defendant is a 
general practitioner1 the expert witness
 shall have devoted a majority of the   
witness's professional time in the      
#a-year period preceding the occurrence 
of the action giving rise to the lawsuit
 to one or more of the following3  7,a7 
,active clinical practice as a general  
practitioner4  7,b7 ,instruction of     
students in an accredited health        
professional school or accredited       
residency or clinical research program  
in the same health profession as the    
defendant4  7b7 ,lawsuits against       
entities ,if the defendant in a health  
care lawsuit is an entity that employs a

 person against whom or on whose behalf 
the testimony is offered1 the provisions
 of paragraph 7#a7 apply as if the      
person were the party or defendant      
against whom or on whose behalf the     
testimony is offered4  7c7 ,power of    
court ,nothing in this subsection shall 
limit the power of the trial court in a 
health care lawsuit to disqualify an    
expert witness on grounds other than the
 qualifications set forth under this    
subsection4  7d7 ,limitation ,an expert 
witness in a health care lawsuit shall  
not be permitted to testify if the fee  
of the witness is in any way contingent 
on the outcome of the lawsuit4  7e7     
,state flexibility ,no provision of this
 section shall be construed to preempt  
any ,state law 7whether effective       
before1 on1 or after the date of the    
enactment of this ,act7 that places     
additional qualification requirements   
upon any individual testifying as an    
expert witness4  #ac4 ,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 indemnity1 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
 product1 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         
,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#e7 ,economic damages
 ,the term economic damages means       
objectively verifiable monetary losses  
incurred as a result of the provision or
 use of 7or failure to provide or use7  
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 unless otherwise defined 
under applicable state law4 ,in no      
circumstances shall damages for health  
care services or medical products exceed
 the amount actually paid or incurred by
 or on behalf of the claimant4  7#f7    
,future damages ,the term future damages
 means any damages that are incurred    
after the date of judgment1 settlement1 
or other resolution 7including          
mediation1 or any other form of         
alternative dispute resolution74  7#g7  
,health care lawsuit ,the term health   
care lawsuit means any health care      
liability claim concerning the provision
 of goods or services for which coverage
 was provided in whole or in part via a 
,federal program1 subsidy or tax        
benefit1 or any health care liability   
action concerning the provision of goods
 or services for which coverage was     

provided in whole or in part via a      
,federal program1 subsidy or tax        
benefit1 brought in a ,state or ,federal
 court or pursuant to an alternative    
dispute resolution system1 against a    
health care provider 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  
,such term does not include a claim or  
action which is based on criminal       
liability2 which seeks civil fines or   
penalties paid to ,federal1 ,state1 or  
local government2 or which is grounded  
in antitrust4  7#h7 ,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 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#i7 ,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
 provider1 including1 but not limited   
to1 third-party claims1 cross-claims1   
counter-claims1 or contribution claims1 
which are based upon the provision or   
use of 7or the failure to provide or    
use7 health care services or medical    
products1 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#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         
regulation1 as well as any other        
individual or entity defined as a health
 care provider1 health care             
professional1 or health care institution
 under state law4  7#aa7 ,health care   
services ,the term health care services 
means the provision of any goods or     
services by a health care 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#ab7 ,medical product ,the term medical
 product means a drug1 device1 or       
biological product intended for humans1 
and the terms drug1 device1 and         
biological product 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 #cba7;g77#a7 and 7h77   

and section #cea7;a7 of the ,public     
,health ,service ,act 7#db ,u4,s4,c4    
#bfb7;a771 respectively1 including any  
component or raw material used therein1 
but excluding health care services4     
7#ac7 ,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
 nature incurred as a result of the     
provision or use of 7or failure to      
provide or use7 health care services or 
medical products1 unless otherwise      
defined under applicable state law4     
7#ad7 ,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#ae7 ,relative ,the term relative    
means a victim's spouse1 parent1        
grandparent1 stepfather1 stepmother1    
child1 grandchild1 brother1 sister1 half
 brother1 half sister1 or spouse's      
parents4 ,the term includes said        
relationships that are created as a     
result of adoption4  7#af7              
,representative ,the term representative
 means a legal guardian1 attorney1      
person designated to make decisions on  
behalf of a patient under a medical     
power of attorney1 or any person        
recognized in law or custom as a        
patient's agent4  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      
7#ah7 ,unanticipated outcome ,the term  
unanticipated outcome means the outcome 
of a medical treatment or procedure that
 differs from an expected result4  #ad4 
,effect on other laws  7a7 ,vaccine     
injury  7#a7 ,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 does 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 ,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     
,other ,federal law ,except as provided 
in this section1 nothing in this ,act   
shall be deemed to affect any defense   
available to a defendant in a health    
care lawsuit or action under any other  
provision of ,federal law4  #ae4 ,rules 
of construction  7a7 ,health care       
lawsuits ,unless otherwise specified in 
this ,act1 the provisions governing     
health care lawsuits set forth in this  
,act 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    
benefits1 or mandates or permits        
subrogation or a lien on collateral     
source benefits4  7b7 ,protection of    
,states' rights and other laws ,any     
issue that is not governed by any       
provision of law established by or under
 this ,act 7including ,state standards  
of negligence7 shall be governed by     
otherwise applicable ,state or ,federal 
law4  7c7 ,state ,flexibility ,no       
provision of this ,act shall be         
construed to preempt any defense        
available to a party in a health care   
lawsuit under any other provision of    
,state or ,federal law4  #af4 ,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 the enactment of this    
,act shall be governed by the applicable
 statute of limitations provisions in   
effect at the time the cause of action  
accrued4