meeting of the committee will come to order we have pending an amendment in the nature of the manager's amendment and the first amendment would come from the republican side dollars of unnecessary tests and procedures season medical profession are retiring early because practice is no longer financially feasible contributing to our nation's doctor shortage this is a growing crisis and it's pushing affordable healthcare beyond the grasp of millions of americans and my mandate is fairly straightforward national across the board just like the medical justice system that we have in texas suits and brought back to earth caps noneconomic damages at two hundred fifty thousand dollars for the doctor two hundred fifty thousand dollars for the hospital two hundred fifty thousand dollars for a second hospital or nursing home is involved for a total aggregate  seven hundred fifty dollars there's a cap on wrongful death awards that one point four million dollars expert opinions related to physicians may only be provided by actively practicing physicians and i cannot overemphasize how important this point is if virtually every meeting town meeting which i have with doctors and i've done many across the country this past year one of the main complaints is that the plaintiff can produce a hired gun from outside of the community who perhaps is no longer even in active practice or the type of practice where the question of the lawsuit has been given and will offer testimony in support of the pla payment of future damages should be on a periodic or accrual basis and limitations on liability for good samaritans providing emergency health care i'll never forget shortly after hurricane katrina many people fled louisiana mississippi gulf coast and came to the dallas fort worth metroplex we had retired doctors who either couldn't come down to the various centers that were set up they either couldn't come down and help for fear that they would expose themselves t doctors to come to our state it has provided the funding mechanism to improve access to care and enhanced patient safety through significant liability savings in two thousand and three when texas passed a sweeping the medical liability reform the results have been better than expected recent results posted by the texas medical association show that charity care rendered by texas hospitals rose twenty four percent in the three years following these reforms texas has licensed nearly fifteen thousand new physicians in the five years since reform thirty six percent increase from pretty reform days thirty three rural counties have seen a net gain in their emergency room doctors including twenty six twenty six counties that previously had no emergency room doctor male have an e r doctor because of this reform after years of decline the ranks of medical specialists are growing again in texas and what's important to me in my field of obstetric we saw a net loss of fourteen obstetricians in the two years preceding reform since in the state of experienced a net gain of almost two hundred twenty six rural counties have added an obstetrician including ten counties that have previously not now a vote against this amendment will indeed fulfill the commitment to the american trial lawyers association that perhaps has contributed to some of our campaigns over the years so instead of making it easier for doctors to practice medicine we're going to make you vote against this amendment will make it easier for for attorneys to file lawsuits a vote for this amendment will tell the american doctors that we're committed to putting in place reforms that will allow them to do their job free of that government or the balance of his time six recognition mr palumbo thank you mr chairman i'm going to insist on my point of order without reference to the you know to how i personally feel about  the amendment the amendment contains provisions obviously on malpractise such as caps on damages and jury instructions and these are not sufficiently tied to health care policy otherwise they fall outside of our jurisdiction to basically within the scope of the dish area committee and therefore outside the scope of the bills or under rule ten i know that i know the gentleman feels very strongly about this and this is certainly something that has been debated in the media and with the to oppose mr the loans interpretation on the point of order and you can correct me mr chairman if i'm wrong but i believe this committee in pass congress's has passed liability reform measures at full committee level that included certainly the subject issues and mr dr burgess's amendment  and in some cases some of the specifics so i don't know why it was in order and pass congress is it wouldn't be in order in this congress there are certainly things in the bill within the jurisdiction of the comm and there are things in the manager's memory in the nature of the substitute that are clearly in the jurisdiction of the ways and means committee but they're in the committee i'm in the nature that we're considering so i would respectfully urge you  regulation interstate commerce is within our jurisdiction i don't think anyone i want to make the argument that two other committees in the past twenty four hours have made similar legislation within their jurisdiction when clearly it falls more into the jurisdiction of this committee than in education work force and ways and means so i'll just make a point that this is germane to our committee this is within our committee's jurisdiction extremely important point again if you feel that you have to vote against the amendment  that's your that's your conscience but i think the striking down on a technicality really it will limit the future ability to discuss things in this committee and even more to the point i think it just sends the wrong message to the people that we're trying to  would i would encourage you that this is a this is a moment in time for us to address the issue the president has embraced the cause of the american people to say that you want to lower quality to lower cost and increase quality that is  leave medical liability reform out of that denominator on our part so i would encourage chairman that this committee has jurisdiction on this issue if other other committees want to work with you once we and this is a moment in time in our country that if we're going to address this on a national basis mr chairman i think it is very appropriate that we allow the gentleman's amendment to be heard and for there to be thorough discussion and i would urge the chairman to make this amendment in order for the the chairs ready to rule but the gentleman from georgia wishes to speak i'd like you to speak on the point of order on the point of order mr chairman and since i don't know what you're about to the same thing i would think that our committee would be looking for every possible way to reap in that growth curve and this would certainly go a long way toward that i yield back and i ism and thank you very  be germane to the pending matter and the parliamentarian has told us that because the amendment legislate in the area that's soley within the jurisdiction of the judicia committee when it refers to jury instructions or defines negligence or deals with the question the damages that the amendment offered by the gentleman from texas is not your main to the bill that perhaps the amendment can be rewritten in a way that it would be germane to the bill but this amendment that has been offered is not you made and therefore the chair has to rule under the rules that it is not in order w further amendments mister mr pallone you have you have an amendment i want to ask you is it an amendment to division and it was the amendments submitted with two hours lead time for committee review and are there copies for distribution of the yes ok let's have the amendment distributed and and the clerk clerk will ominous is the better term but no i think actually you'll like this for the most part this amendment reflects the hard work of many members on this committee and i'd like to thank you all for your dedication to these very important issues first the m m and includes the class act a bill that i originally introduced with my colleague chairman emeritus dingle these provisions establish a national voluntary insurance program that will among other things allow individuals with functional limitations to maintain their personal and financial independence and it will alleviate burdens on family caregivers now members have asked us to include provisions on long term care in the bill and i believe that these provisions will get at the heart of some of the challenges the challenges that we face in the long term care sector next referencing health centers liability coverage we have included language that mr green and mr murphy have been working on to extend federal tort claims act coverage to medically licensed volunteers who practice at federally funded health centers this is something that we talked about at some of the hearing community health centers are vitally important in providing care in under served areas physicians however are often dissuaded from volunteer in their services at these health centers due to the cost of medical liability insurance by extending the f t c a coverage to volunteer positions practicing at federally qualified health centers we can increase the number of physicians serving in under served communities and us refers to nurse managed health centers to further increase access to health care in under served communities we've included language proposed by ms taps that would establish a nurse managed health center program within the health resources and services administration similar to community health centers this program would provide grants to entities to plan develop and operate nurse managed health centers in communities where there is a lack of access to medical care next we address federally qualified behavioral health centers in the on the bus we have included a new definition of federally qualified behavioral health centers put forth by mismatch julie and mr angle that will allow the centers to provide a basic set of mental and behavioral health services to under served communities and will help ensure adequate capacity to serve patients with mental health needs next is the reauthorization of tele health and telemedicine the omnibus includes language spearheaded by mr butterfield and mr space to reauthorize the tele health network and telehealth resource center grant programs these programs are aimed at reaching under served in remote areas by establishing linkages between hospitals providers and patients in rural areas next is with regard to trauma care we included ms castor mr townsend mr rush's language to provide grants to trauma centers that will prevent further trauma center closures and downgrades by assisting the centers with uncompensated care costs who are mission services emergency needs and information technology we've also included some language that mr rush recommended to eight areas where trauma centers have already closed next with regard to emergency care the on and this includes a provision recommended by mr gordon to authorize the emergency care coordination center at h h s this center will strengthen our efforts to promote federal state tribal local and private sector collaboration and support to enhance our nation's system of emergency medical care delivery we've also included language authored by chairman waxman to create a demonstration program to strengthen our capacity and then we have dental emergency responder provisions there are provisions in this amendment that miss just two pac has been working on to strengthen our emergency response system by including dentists in the federal definitions of public health worker and emergency response provider  dentist have gone through training in emergency care they're really integrated into an emergency response plan and this language will help remedy that situation next is with regard to pain care we've included provisions from ms capps bill on pain care research and awareness pain is the most common reason americans access to health care system and as the leading cause of disability it's also a major contributor to health care costs the provisions in this amendment would address this public health problem by advancing research into the causes and treatments of pain and expanding outreach and education of health professionals next with regard to postpartum depression we've included language championed by mr rush to encourage continued research in educational activities  postpartum conditions postpartum depression occurs after ten to fifteen percent of all deliveries and the majority of patients suffer from this illness for more than six months in this most severe form postpartum psychosis women may actually suffer from hallucinations and delusions that can put them and their babies at risk next is no child left on immunized against influenza beyond this includes language spearheaded by mr green and mr murphy there's a gentleman wish an additional measures as time has expired it's almost done live here without objection the gentleman will be given additional minutes this on the bus includes language spearheaded by mr graham mr murphy that would create a multi state demonstration program designed to test the feasibility of using the nation's elementary and secondary schools as seasonal and pandemic vaccination center's children are a particularly high risk of complications from flu and in fact influenza is the leading cause of vaccine preventable deaths among children in the u s having immunization clinics and schools could help increase immunization rates among children for us thus protecting them from this disease to more menu labeling we've included language that ms de lauro and mr matheson have matheson have been working on that will require restaurants to label the total calories of their items directly on menus and menu board and to provide more detailed nutritional information to customers upon request now we know why mr matheson and ms de lauro so thin this will help consumers make more informed decisions on what they are eating and help reduce obesity helps prevent heart disease and stroke by providing screenings and counseling for low income women just two days ago secretary sebelius heralded this program as a great example of a community based prevention program the wise woman program has improved because the fact  not a speed reader but i can read and i have tried to scan every page of this seventy some odd page from him and seventy five pages there are some good things in here there are also some things that in and of themselves would be entire bills the very first one this section thirty two and one the community living that appears to be a brand new long term health care program is not paid for for restaurant peers i have to say i'm not saying that it is a given the fact the majority is had all year to put their bill together and r on a on a case by case basis with the gentleman yield sure i just want to point out with regard to the class act as you mentioned about the pay for it says that the statute or that class act would not go into effect until a voluntary payroll deduction under the i r s code is authorized so it's totally paid for with a voluntary payroll deduction that the secretary would have to put forward otherwise it wouldn't put it into effect i this amendment available to your staff last night i understand your concern this is a legislative this is a piece of legislation that's moving forward and some of these things i believe have been non controversial and people who want to do it i won't disagree that there are things in some things in here that are not we've got a vote pending on the house floor so let's break for a vote and come back immediately afterwards and we'll talk further if members desire to proceed to further consideration of this pending about so we stand in recess until the last vote of the series that's pending on the house floor