II 

109TH CONGRESS 

1ST SESSION S. 1784 

To amend the Public Health Service Act to promote a culture of safety 

within the health care system through the establishment of a National 

Medical Error Disclosure and Compensation Program. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 28, 2005 

Mrs. CLINTON (for herself and Mr. OBAMA) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To amend the Public Health Service Act to promote a culture 

of safety within the health care system through the establishment of a National Medical Error Disclosure and 

Compensation Program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘National Medical Error 

5 Disclosure and Compensation Act’’ or the ‘‘National 

6 MEDiC Act’’. 

7 SEC. 2. FINDINGS. 

8 Congress makes the following findings: 
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1 (1) In 1999, the Institute of Medicine released 

2 a report entitled ‘‘To Err is Human’’ that found 

3 medical errors to be the eighth leading cause of 

4 death in the United States, with as many as 98,000 

5 people dying each year as a result of medical errors. 

6 (2) To reduce deaths and injuries due to med7 ical errors, the health care system must identify and 

8 learn how to prevent such errors so that health care 

9 quality can be improved. 

10 (3) The goals of the liability system are to iden11 tify causes of medical error, remediate those causes 

12 to prevent reoccurrence, and to compensate those in13 jured by medical negligence. Studies have shown, 

14 however, that only one medical malpractice claim is 

15 filed for every 8 medical injuries, and the average 

16 duration of malpractice claim resolution is between 

17 4 and 8 years. Thus, the current health care liability 

18 system has been found to be an inefficient and 

19 sometimes ineffective mechanism for initiating or re20 solving claims of medical error, medical negligence, 

21 or malpractice. 

22 (4) The current liability system has also been 

23 shown to be a deterrent to the timely sharing of in24 formation among health care professionals, as well 

25 as between health care professionals and patients, 
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1 which impedes efforts to improve patient safety and 

2 quality of care. 

3 (5) Solutions to the patient safety, litigation, 

4 and medical liability insurance problems have been 

5 elusive. A middle ground solution that meets the 

6 basic needs of all stakeholders including patients, 

7 health care providers, insurers, purchasers, and at8 torneys is desperately needed. 

9 (6) Some hospital systems and private medical 

10 liability insurance companies have adopted a policy 

11 of robust disclosure of medical errors, apologies for 

12 such errors, and early compensation for patient in13 jury. For example, a Department of Veterans Affairs 

14 hospital in Lexington, Kentucky, the University of 

15 Michigan Health System, and the private insurer 

16 Copic Insurance Company in Colorado have adopted 

17 such policies and have reported significantly de18 creased legal expenses and smaller claim payouts. 

19 Overall, these policies have resulted in fewer num20 bers of malpractice suits being filed, more patients 

21 being compensated for injuries, greater patient trust 

22 and satisfaction, and significantly reduced adminis23 trative and legal defense costs for providers, insur24 ers, and hospitals where such policies are in place. 
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1 SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

2 ACT. 

3 (a) IN GENERAL.—Title IX of the Public Health 

4 Service Act (42 U.S.C. 299 et seq.), as amended by the 

5 Patient Safety and Quality Improvement Act of 2005 

6 (Public Law 109–41), is amended— 

7 (1) by redesignating part D as part E; 

8 (2) by redesignating sections 931 through 938 

9 as sections 941 through 948, respectively; 

10 (3) in section 948(1) (as so redesignated), by 

11 striking ‘‘931’’ and inserting ‘‘941’’; and 

12 (4) by inserting after part C the following: 

13 ‘‘PART D—MEDICAL ERROR DISCLOSURE AND 

14 COMPENSATION 

15 ‘‘SEC. 931. DEFINITIONS. 

16 ‘‘In this part: 

17 ‘‘(1) DATABASE.—The term ‘Database’ means 

18 the National Patient Safety Database established 

19 under section 934. 

20 ‘‘(2) HEALTH CARE PROVIDER.—The term 

21 ‘health care provider’ means a person or entity li22 censed or otherwise authorized under State law to 

23 provide health care services, including— 

24 ‘‘(A) a hospital, health plan, community 

25 clinic, nursing facility, comprehensive rehabili26 tation facility, home health agency, hospice pro-
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1 gram, renal dialysis facility, ambulatory sur2 gical center, pharmacy, doctor’s or health care 

3 practitioner’s office, long-term care facility, be4 havior health residential treatment facility, clin5 ical laboratory, or health center; 

6 ‘‘(B) a doctor, nurse, physician assistant, 

7 nurse practitioner, clinical nurse specialist, cer8 tified nurse anesthetist, certified nurse midwife, 

9 psychologist, certified social worker, registered 

10 dietitian or nutrition professional, physical or 

11 occupational therapist, pharmacist, or other in12 dividual health care practitioner; and 

13 ‘‘(C) any other health care professional 

14 specified in regulations promulgated by the Sec15 retary. 

16 ‘‘(3) IDENTIFIABLE PATIENT SAFETY WORK

17 PRODUCT.—The term ‘identifiable patient safety 

18 work product’ means patient safety work product 

19 that— 

20 ‘‘(A) is presented in a form and manner 

21 that allows the identification of any provider 

22 that is a subject of the work product, or any 

23 providers that participate in activities that are 

24 a subject of the work product; 
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1 ‘‘(B) constitutes individually identifiable 

2 health information as that term is defined in 

3 the regulations promulgated under section 

4 264(c) of the Health Insurance Portability and 

5 Accountability Act of 1996; or 

6 ‘‘(C) is presented in a form and manner 

7 that allows the identification of an individual 

8 who reported information in the manner speci9 fied in section 922(e) or 935. 

10 ‘‘(4) MEDICAL ERROR.—The term ‘medical 

11 error’ means an unexpected occurrence involving 

12 death or serious physical or psychological injury, or 

13 the risk of such injury, including any process vari14 ation of which recurrence may carry significant 

15 chance of a serious adverse outcome. 

16 ‘‘(5) NONIDENTIFIABLE PATIENT SAFETY WORK

17 PRODUCT.—The term ‘nonidentifiable patient safety 

18 work product’ has the meaning given such term in 

19 section 921. 

20 ‘‘(6) OFFICE.—The term ‘Office’ means the Of21 fice of Patient Safety and Health Care Quality es22 tablished under section 933, which shall be a cer23 tified patient safety organization as defined under 

24 part C. 
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1 ‘‘(7) PATIENT SAFETY DATA.—The term ‘pa2 tient safety data’ means information requested by 

3 the Director of the Office to be submitted by the pa4 tient safety officer of a Program participant as de5 scribed in section 935(e). 

6 ‘‘(8) PATIENT SAFETY EVENT.—The term ‘pa7 tient safety event’ means an occurrence, incident, or 

8 process that either contributes to, or has the poten9 tial to contribute to, a patient injury or degrades the 

10 ability of health care providers to provide the appro11 priate standard of care. 

12 ‘‘(9) PATIENT SAFETY OFFICER.—The term 

13 ‘patient safety officer’ means the individual des14 ignated by a Program participant as being respon15 sible for ensuring that the conditions for participa16 tion in the Program are met. 

17 ‘‘(10) PATIENT SAFETY ORGANIZATION.—The 

18 term ‘patient safety organization’ has the meaning 

19 given such term in section 921. 

20 ‘‘(11) PATIENT SAFETY WORK PRODUCT.—The 

21 term ‘patient safety work product’ has the meaning 

22 given such term in section 921. 

23 ‘‘(12) PROGRAM.—The term ‘Program’ means 

24 the National Medical Error Disclosure and Com-
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1 pensation (MEDiC) Program, established under sec2 tion 935. 

3 ‘‘(13) PROGRAM PARTICIPANT.—The term ‘Pro4 gram participant’ means a participant that meets 

5 the requirements of section 935(b). 

6 ‘‘(14) ROOT CAUSE ANALYSIS.—The term ‘root 

7 cause analysis’ means an examination or investiga8 tion of an occurrence, event, or incident to determine 

9 if a preventable medical error took place or the 

10 standard of care was not followed and to identify the 

11 causal factors that led to such occurrence, event, or 

12 incident. 

13 ‘‘SEC. 932. PURPOSE AND GOALS. 

14 ‘‘It is the purpose of this part to promote a culture 

15 of safety within hospitals, health systems, clinics, and 

16 other sites of health care, through the establishment of 

17 a National Medical Error Disclosure and Compensation 

18 (MEDiC) Program (referred to in this part as the ‘Pro19 gram’). It shall be a goal of the Program to— 

20 ‘‘(1) improve the quality of health care by en21 couraging open communication between patients and 

22 health care providers about medical errors and other 

23 patient safety events; 

24 ‘‘(2) reduce rates of preventable medical errors; 
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1 ‘‘(3) ensure patients have access to fair com2 pensation for medical injury due to medical error, 

3 negligence, or malpractice; and 

4 ‘‘(4) reduce the cost of medical liability insur5 ance for doctors, hospitals, health systems, and 

6 other health care providers. 

7 ‘‘SEC. 933. OFFICE OF PATIENT SAFETY AND HEALTH CARE 

8 QUALITY. 

9 ‘‘(a) IN GENERAL.—The Secretary shall establish 

10 within the Office of the Secretary, an Office of Patient 

11 Safety and Health Care Quality to collaborate with the 

12 Director of the Agency for Health Care Research and 

13 Quality to improve patient safety and reduce medical error 

14 across the health care system. The Office shall be headed 

15 by a Director to be appointed by the Secretary. 

16 ‘‘(b) ACTIVITIES.—The activities of the Office shall 

17 be deemed patient safety activities, as defined in section 

18 921. 

19 ‘‘(c) DUTIES.—The Director of the Office shall— 

20 ‘‘(1) establish and administer the Program; 

21 ‘‘(2) determine who is eligible for participation 

22 in the Program in accordance with section 935; 

23 ‘‘(3) develop a standardized application to be 

24 submitted by interested parties for entry into the 

25 Program; 
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1 ‘‘(4) oversee the application process for entry 

2 into the Program under section 935 and provide 

3 technical assistance to Program applicants and Pro4 gram participants; 

5 ‘‘(5) contract with an independent entity for the 

6 purpose of evaluating the Program at least once 

7 every two years, with the results of such evaluations 

8 being disseminated to Program participants, Con9 gress, and the public; 

10 ‘‘(6) establish and maintain, in consultation 

11 with patient safety organizations, health care quality 

12 organizations, health care providers, and the health 

13 information technology industry, a National Patient 

14 Safety Database as provided for in section 934 to 

15 receive nonidentifiable patient safety work product 

16 as described in the reporting requirements for Pro17 gram participants under section 935(c)(10); 

18 ‘‘(7) determine and adopt a standardized pa19 tient safety taxonomy, necessary elements, common 

20 and consistent definitions, and standardized formats 

21 for the electronic reporting of patient safety data to 

22 the Database as described in section 934(e); 

23 ‘‘(8) survey Federal, State, and local require24 ments for the reporting of patient safety data and 
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1 work to streamline and reduce duplication of such 

2 requirements; 

3 ‘‘(9) grant patient safety organizations, re4 searchers, and other qualified individuals and insti5 tutions access to the Database as determined appro6 priate through the evaluation of completed applica7 tions submitted to the Office for such purpose; 

8 ‘‘(10) analyze, directly or through a contract 

9 with a patient safety organization, all data entered 

10 into the Database and provide Program participants, 

11 Congress, and the public with medical error trend 

12 reports and other analyses as determined appro13 priate by the Director on a quarterly basis; 

14 ‘‘(11) develop, directly or through a contract 

15 with a patient safety organization, safety and train16 ing recommendations for health care providers that 

17 focus on the reduction of medical errors, improved 

18 patient safety, and increased quality of care on at 

19 least a yearly basis; 

20 ‘‘(12) maintain a publicly accessible Internet 

21 website to provide patients and health care providers 

22 with information concerning the Program and the 

23 Database; 

24 ‘‘(13) conduct, directly or through a contract, 

25 the National MEDiC Accountability Study, as de-
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1 scribed in section 937, the Medical Liability Insur2 ance Study, as described in section 938, and a study 

3 to reduce the incidence of lawsuits not related to 

4 medical error, as described in section 939; and 

5 ‘‘(14) perform any other duties for the adminis6 tration of the Program as determined necessary by 

7 the Secretary. 

8 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

9 are authorized to be appropriated, such sums as may be 

10 necessary for each fiscal year to carry out the activities 

11 of the Office. 

12 ‘‘SEC. 934. NATIONAL PATIENT SAFETY DATABASE. 

13 ‘‘(a) IN GENERAL.—The Director of the Office shall, 

14 in accordance with section 933(c)(6), establish a National 

15 Patient Safety Database that shall— 

16 ‘‘(1) adopt standardized patient safety tax17 onomy in consultation with the Joint Commission on 

18 Accreditation of the Healthcare Organizations and 

19 other entities with relevant expertise; 

20 ‘‘(2) include necessary elements, common and 

21 consistent definitions, and a standardized electronic 

22 interface for the entry and processing of the data by 

23 Program participants, as developed by the Director 

24 in consultation with patient safety organizations, 
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1 health care providers, and the health information 

2 technology industry; 

3 ‘‘(3) allow for the comprehensive collection and 

4 analysis of the patient safety data required to be 

5 submitted by all Program participants as described 

6 in section 935(e); and 

7 ‘‘(4) include patient safety data required to be 

8 submitted by Program participants as described in 

9 section 935(e) as nonidentifiable patient safety work 

10 product and privileged and confidential in accord11 ance with section 922. 

12 ‘‘(b) LIMITATION.—Information submitted to the 

13 Database shall be confidential and protected from disclo14 sure in accordance with the regulations promulgated 

15 under section 264(c) of the Health Insurance Portability 

16 and Accountability Act of 1996 (42 U.S.C. 1320d–2 note). 

17 ‘‘(c) ACCESS.—Access to the patient safety data con18 tained within the Database shall only be provided through 

19 application to and approval by the Director. 

20 ‘‘SEC. 935. NATIONAL MEDICAL ERROR DISCLOSURE AND 

21 COMPENSATION (MEDIC) PROGRAM. 

22 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

23 through the Director of the Office, shall establish a Na24 tional Medical Error Disclosure and Compensation 

25 (MEDiC) Program to provide for the confidential disclo-
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1 sure of medical errors and patient safety events in order 

2 to improve patient safety and health care quality, reduce 

3 rates of preventable medical errors, ensure patient access 

4 to fair compensation for medical injury due to medical 

5 error, negligence, or malpractice, and reduce the cost of 

6 medical liability for doctors, hospitals, health systems, and 

7 other health care providers. 

8 ‘‘(b) ELIGIBLE PARTICIPANTS.—To be eligible to 

9 participate in the Program an entity shall— 

10 ‘‘(1)(A) be a health care provider as defined in 

11 section 931(2)(A); 

12 ‘‘(B)(i) provide, in whole or part, medical mal13 practice insurance for doctors and other designated 

14 health care providers, including— 

15 ‘‘(I) mutual insurance companies; 

16 ‘‘(II) privately held or publically traded li17 ability insurance companies; 

18 ‘‘(III) self-insured hospitals; 

19 ‘‘(IV) captive insurance companies or pro20 viders covered by captive insurance companies; 

21 and 

22 ‘‘(V) risk-retention groups and any other 

23 alternative malpractice insurance mechanisms; 

24 or 
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1 ‘‘(ii) in the case of a Program participant that 

2 is a medical liability insurer, provide to all, or a sub3 set of, the insured of such insurer, an opportunity 

4 to participate in the Program; or 

5 ‘‘(C) be any other entity determined to be eligi6 ble by the Director; 

7 ‘‘(2) designate a patient safety officer to ensure 

8 that the conditions of participation described in sub9 section (c) are met; 

10 ‘‘(3) submit a completed application to the Of11 fice at such time, in such manner, and containing 

12 such information as the Director may require; and 

13 ‘‘(4) agree to comply with the conditions of par14 ticipation under subsection (c). 

15 ‘‘(c) CONDITIONS OF PARTICIPATION.—A Program 

16 participant shall, directly or indirectly— 

17 ‘‘(1) submit a comprehensive plan, as part of 

18 the application for participation in the Program, to 

19 reduce the incidence of medical errors and improve 

20 patient safety; 

21 ‘‘(2) submit cost analysis statements, in such 

22 manner as determined by the Director, for the 2 fis23 cal years prior to the year of expected entry into the 

24 Program at the time of application and at the end 

25 of every year of participation in the Program, that 
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1 outline all real and projected costs and savings re2 lated to the liability coverage and legal defense costs 

3 of doctors and other health care providers; 

4 ‘‘(3) allocate an amount equal to not less than 

5 50 percent of the projected annual savings for the 

6 first year of participation in the Program, not less 

7 than 40 percent of the actual savings reported for 

8 the second year, and not less than 30 percent of the 

9 actual savings reported for the third and each subse10 quent year of participation to— 

11 ‘‘(A) in the case of a Program participant 

12 that is a medical liability insurer, the reduction 

13 of medical liability premiums for doctors or 

14 other designated health care providers as de15 fined in section 931; or 

16 ‘‘(B) in the case of a Program participant 

17 that is a health care provider as defined in sec18 tion 931(2)(A), activities that result in the re19 duction of medical errors or that otherwise im20 prove patient safety; 

21 ‘‘(4) require health care providers included in 

22 the Program by the Program participant and as out23 lined in the Program participant application, to sub24 mit to the patient safety officer a report of— 
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1 ‘‘(A) any incident or occurrence involving a 

2 patient that is thought to either be a medical 

3 error or patient safety event; and 

4 ‘‘(B) any legal action related to the med5 ical liability of a health care provider; 

6 ‘‘(5) ensure that the reports filed under para7 graph (4) are submitted to the Database in a stand8 ardized format as designated by the Director; 

9 ‘‘(6) where appropriate, ensure that a root 

10 cause analysis of any report submitted to the patient 

11 safety officer as described in paragraph (4) is per12 formed within 90 days of the filing of a report under 

13 such paragraph; 

14 ‘‘(7) ensure that if a patient was harmed or in15 jured as the result of a medical error, or as a result 

16 of the relevant standard of care not being followed, 

17 an account of the incident or occurrence, as de18 scribed in paragraph (4)(A) shall be disclosed to the 

19 patient not later than 5 business days after the com20 pletion of root cause analysis; 

21 ‘‘(8) disclose information contained in any re22 port submitted to the patient safety officer as de23 scribed in paragraph (4)(A) upon the request of the 

24 patient with respect to whom the report has been 

25 filed; 
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1 ‘‘(9) offer, at the time of disclosure of an inci2 dent or occurrence in which it was determined that 

3 a patient was harmed or injured as a result of med4 ical error or as a result of the relevant standard of 

5 care not being followed, to— 

6 ‘‘(A) negotiate compensation with the pa7 tient involved in accordance with subsection (d); 

8 ‘‘(B) provide, at the discretion of the 

9 health care provider involved, an apology or ex10 pression of remorse; and 

11 ‘‘(C) share, where practicable, any efforts 

12 the health care provider will undertake to pre13 vent reoccurrence; and 

14 ‘‘(10) prepare and submit entries to the Data15 base as required by the Director of the Office and 

16 in accordance with subsection (e). 

17 ‘‘(d) NEGOTIATIONS.— 

18 ‘‘(1) TERMS.—If at the time of the disclosure 

19 of an incident or occurrence in which it was deter20 mined that a patient was harmed or injured as a re21 sult of medical error or as a result of the relevant 

22 standard of care not being followed, a patient elects 

23 to enter into an agreement for negotiations with a 

24 Program participant as provided for in subsection 
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1 (c)(9), such negotiations shall, at a minimum, pro2 vide for the following: 

3 ‘‘(A) The confidentiality of the pro4 ceedings. 

5 ‘‘(B) An agreement that any apology or ex6 pression of remorse by a doctor or other des7 ignated health care provider at any time during 

8 the negotiations shall be kept confidential and 

9 shall not be used in any subsequent legal pro10 ceedings as an admission of guilt if such nego11 tiations end without an offer of compensation 

12 that is acceptable to both parties. 

13 ‘‘(C) Written notification of a patient’s 

14 right to legal counsel, which shall include an af15 firmative declaration that no coercive or other16 wise inappropriate action was taken to dissuade 

17 a patient from utilizing counsel for the negotia18 tions. 

19 ‘‘(2) NEUTRAL THIRD PARTY MEDIATOR.—Both 

20 parties may agree to the use of a neutral third party 

21 mediator to facilitate the negotiation of the terms of 

22 the settlement. 

23 ‘‘(3) TIMEFRAME FOR NEGOTIATIONS.—With 

24 respect to negotiations under paragraph (1), the 

25 parties shall agree that if an agreement on the terms 
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1 of compensation is not reached within 6 months 

2 from the date of the disclosure required under sub3 section (c)(7) to the patient— 

4 ‘‘(A) the patient may proceed directly to 

5 the judicial system for a resolution of the issues 

6 involved; or 

7 ‘‘(B) the parties may sign an extension of 

8 the agreement to provide an additional 3-month 

9 negotiation period. 

10 ‘‘(4) PAYMENT.—Upon reaching an agreement 

11 under this subsection, the Program participant shall 

12 provide the negotiated compensation to the patient 

13 within an agreed upon timeframe. 

14 ‘‘(5) FINALITY.—Upon receipt of the final pay15 ment of the accepted settlement as negotiated under 

16 this subsection, the patient shall agree to the final 

17 settlement of the incident described in the report 

18 and findings of the root cause analysis under sub19 section (c)(7), and further litigation with respect to 

20 such matter shall be prohibited in Federal or State 

21 court. 

22 ‘‘(e) SUBMISSION OF PATIENT SAFETY DATA.— 

23 ‘‘(1) IN GENERAL.—All entries into the Data24 base shall— 
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1 ‘‘(A) contain only non-identifiable patient 

2 safety work product; 

3 ‘‘(B) be in a standardized electronic format 

4 to be determined by the Director; and 

5 ‘‘(C) if related to a single occurrence or in6 cident, be given a common identifier to link en7 tries of related data. 

8 ‘‘(2) REPORTING REQUIREMENTS.—The patient 

9 safety officer of a Program participant shall be re10 quired to prepare and enter into the Database— 

11 ‘‘(A) reports, containing only nonidentifi12 able patient safety work product, filed by a 

13 health care provider under subsection (c)(4) 

14 and a summary of the findings of the root 

15 cause analysis with respect to such report with16 in 5 business days of the completion of the root 

17 cause analysis; 

18 ‘‘(B) the terms of any agreement reached 

19 through negotiations under subsection (d); 

20 ‘‘(C) any awards given by a Program par21 ticipant to a patient as compensation for harm 

22 or injury whether obtained through negotiations 

23 under subsection (d) or by other means; 

24 ‘‘(D) any disciplinary actions taken against 

25 a health care provider as a result of involve-
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1 ment in any incident or occurrence involving a 

2 patient that is thought to be a medical error or 

3 patient safety event, or legal action for which a 

4 report under subsection (c)(4) was filed; or 

5 ‘‘(E) other data as determined appropriate 

6 by the Director. 

7 ‘‘(3) PRIVILEGE AND CONFIDENTIALITY.—The 

8 provisions of section 922 shall apply to patient safe9 ty data submitted under this subsection. 

10 ‘‘SEC. 936. NATIONAL MEDIC GRANT PROGRAM. 

11 ‘‘(a) IN GENERAL.—The Director of the Office shall 

12 award grants— 

13 ‘‘(1) to Program participants, to enable such 

14 participants to— 

15 ‘‘(A) develop and implement communica16 tion programs to help health care providers dis17 close medical errors and other patient safety 

18 events to patients; and 

19 ‘‘(B) procure information technology prod20 ucts, including hardware, software, and support 

21 services, to facilitate the reporting, collection, 

22 and analysis of patient safety data as required 

23 under this part; and 

24 ‘‘(2) to patient safety organizations and quali25 fied institutions or individuals, to enable the— 
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1 ‘‘(A) tracking and analysis of local and re2 gional patient safety trends; and 

3 ‘‘(B) development and dissemination of 

4 training guidelines and other recommendations 

5 for doctors and other designated health care 

6 providers that focus on methods to reduce med7 ical errors and improve patient safety and qual8 ity of care. 

9 ‘‘(b) APPLICATION.—To be eligible to receive a grant 

10 under this section, a Program participant, patient safety 

11 organization, or qualified institution or individuals shall 

12 submit to the Director of the Office an application at such 

13 time, in such manner, and containing such information as 

14 the Director may require. 

15 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.— 

16 ‘‘(1) IN GENERAL.—There are authorized to be 

17 appropriated, such sums as may be necessary to 

18 carry out this section. 

19 ‘‘(2) RESERVES.—The Secretary shall reserve 

20 20 percent of the funds appropriated under para21 graph (1) to provide funding to Program partici22 pants if the Secretary determines that the total costs 

23 of the cases handled under the Program for the year 

24 exceed the total costs that would have been incurred 
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1 if such cases had not been handled under the Pro2 gram. 

3 ‘‘SEC. 937. THE NATIONAL MEDIC ACCOUNTABILITY STUDY. 

4 ‘‘(a) IN GENERAL.—The Director of the Office shall 

5 conduct, directly or through a contract with patient safety 

6 organizations or qualified individuals or institutions, an 

7 analysis of the patient safety data in the Database and 

8 other available data to determine performance and sys9 tems standards, tools, and best practices (including peer10 review) for doctors and other health care providers nec11 essary to prevent medical errors, improve patient safety, 

12 and increase accountability within the health care system. 

13 Such analysis shall also consider the value of increasing 

14 the transparency of the patient safety data to include the 

15 identity of health care providers and provide recommenda16 tions for improvements to the peer review process. 

17 ‘‘(b) REPORT AND RECOMMENDATIONS.—Not later 

18 than 2 years after the date of enactment of the National 

19 MEDiC Act, the Director of the Office shall submit to 

20 Congress and make available to States, State medical 

21 boards, and the public a report that describes the results 

22 of the study carried out under subsection (a) and contains 

23 recommendations for Congress based on the findings of 

24 the report. 
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1 ‘‘SEC. 938. MEDICAL LIABILITY INSURANCE STUDY. 

2 ‘‘(a) IN GENERAL.—The Director of the Office shall 

3 conduct, directly or through contract with patient safety 

4 organizations or qualified individuals or institutions, an 

5 analysis of the medical liability insurance market that dis6 tinguishes between types of carriers to determine historic 

7 and current legal costs related to medical liability, factors 

8 leading to increased legal costs related to medical liability, 

9 and which, if any, State medical liability insurance re10 forms have led to stabilization or reduction in medical li11 ability premiums. 

12 ‘‘(b) REPORT AND RECOMMENDATIONS.—Not later 

13 than 2 years after the date of enactment of the National 

14 MEDiC Act, the Director of the Office shall submit to 

15 Congress and make available to the States, State insur16 ance regulators, and the public a report that describes the 

17 results of the study carried out under subsection (a) and 

18 contains recommendations for Congress based on the find19 ings of the report. 

20 ‘‘SEC. 939. STUDY TO REDUCE THE INCIDENCE OF LAW21 SUITS NOT RELATED TO MEDICAL ERROR. 

22 ‘‘(a) IN GENERAL.—The Director of the Office shall 

23 conduct, directly or through a contract with patient safety 

24 organizations or qualified individuals and institutions, an 

25 analysis of the patient safety data in the Database to ex26 amine cases that were not successfully negotiated through 
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1 the Program, or of which the parties (including providers 

2 and patients) chose not to participate in the Program and 

3 to determine the reasons, trends, and impact on the Pro4 gram participants and patients. 

5 ‘‘(b) REPORT AND RECOMMENDATIONS.— 

6 ‘‘(1) IN GENERAL.—Not later than 5 years 

7 after the date of enactment of the National MEDiC 

8 Act, the Director of the Office shall submit to Con9 gress and make available to the States, and the pub10 lic a report that describes the results of the study 

11 carried out under subsection (a) and contains rec12 ommendations for Congress based on the findings of 

13 the report. 

14 ‘‘(2) INTERIM REPORTS.—The Director of the 

15 Office shall submit periodic interim reports to Con16 gress (and make such reports available to the States 

17 and the public) before the submission on the report 

18 under paragraph (1) that describes the progress and 

19 findings made in carrying out the study under sub20 section (a). 

21 ‘‘SEC. 940. AUTHORIZATION OF APPROPRIATIONS. 

22 ‘‘There are authorized to be appropriated, such sums 

23 as may be necessary to carry out this part.’’. 

24 (b) CONFORMING AMENDMENT.—Section 

25 921(7)(A)(i)(II) is amended by inserting ‘‘, including ac-
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1 tivities under section 935(e)’’ after ‘‘patient safety activi2 ties’’. 

Æ