I 

108TH CONGRESS 

2D SESSION H. R. 4280 

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 system. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 5, 2004 

Mr. GREENWOOD (for himself, Mr. COX, and Mr. BARTON of Texas) introduced the following bill; which was referred to the Committee on the Judiciary, and in addition to the Committee on Energy and Commerce, for 

a period to be subsequently determined by the Speaker, 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 

system. 

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 ‘‘Help Efficient, Acces5 sible, Low-cost, Timely Healthcare (HEALTH) Act of 

6 2004’’. 
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1 SEC. 2. FINDINGS AND PURPOSE. 

2 (a) FINDINGS.— 

3 (1) EFFECT ON HEALTH CARE ACCESS AND

4 COSTS.—Congress finds that our current civil justice 

5 system is adversely affecting patient access to health 

6 care services, better patient care, and cost-efficient 

7 health care, in that the health care liability system 

8 is a costly and ineffective mechanism for resolving 

9 claims of health care liability and compensating in10 jured patients, and is a deterrent to the sharing of 

11 information among health care professionals which 

12 impedes efforts to improve patient safety and quality 

13 of care. 

14 (2) EFFECT ON INTERSTATE COMMERCE.— 

15 Congress finds that the health care and insurance 

16 industries are industries affecting interstate com17 merce and the health care liability litigation systems 

18 existing throughout the United States are activities 

19 that affect interstate commerce by contributing to 

20 the high costs of health care and premiums for 

21 health care liability insurance purchased by health 

22 care system providers. 

23 (3) EFFECT ON FEDERAL SPENDING.—Con24 gress finds that the health care liability litigation 

25 systems existing throughout the United States have 
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1 a significant effect on the amount, distribution, and 

2 use of Federal funds because of— 

3 (A) the large number of individuals who 

4 receive health care benefits under programs op5 erated or financed by the Federal Government; 

6 (B) the large number of individuals who 

7 benefit because of the exclusion from Federal 

8 taxes of the amounts spent to provide them 

9 with health insurance benefits; and 

10 (C) the large number of health care pro11 viders who provide items or services for which 

12 the Federal Government makes payments. 

13 (b) PURPOSE.—It is the purpose of this Act to imple14 ment reasonable, comprehensive, and effective health care 

15 liability reforms designed to— 

16 (1) improve the availability of health care serv17 ices in cases in which health care liability actions 

18 have been shown to be a factor in the decreased 

19 availability of services; 

20 (2) reduce the incidence of ‘‘defensive medi21 cine’’ and lower the cost of health care liability in22 surance, all of which contribute to the escalation of 

23 health care costs; 

24 (3) ensure that persons with meritorious health 

25 care injury claims receive fair and adequate com-
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1 pensation, including reasonable noneconomic dam2 ages; 

3 (4) improve the fairness and cost-effectiveness 

4 of our current health care liability system to resolve 

5 disputes over, and provide compensation for, health 

6 care liability by reducing uncertainty in the amount 

7 of compensation provided to injured individuals; and 

8 (5) provide an increased sharing of information 

9 in the health care system which will reduce unin10 tended injury and improve patient care. 

11 SEC. 3. ENCOURAGING SPEEDY RESOLUTION OF CLAIMS. 

12 The time for the commencement of a health care law13 suit shall be 3 years after the date of manifestation of 

14 injury or 1 year after the claimant discovers, or through 

15 the use of reasonable diligence should have discovered, the 

16 injury, whichever occurs first. In no event shall the time 

17 for commencement of a health care lawsuit exceed 3 years 

18 after the date of manifestation of injury unless tolled for 

19 any of the following— 

20 (1) upon proof of fraud; 

21 (2) intentional concealment; or 

22 (3) the presence of a foreign body, which has no 

23 therapeutic or diagnostic purpose or effect, in the 

24 person of the injured person. 
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1 Actions by a minor shall be commenced within 3 years 

2 from the date of the alleged manifestation of injury except 

3 that actions by a minor under the full age of 6 years shall 

4 be commenced within 3 years of manifestation of injury 

5 or prior to the minor’s 8th birthday, whichever provides 

6 a longer period. Such time limitation shall be tolled for 

7 minors for any period during which a parent or guardian 

8 and a health care provider or health care organization 

9 have committed fraud or collusion in the failure to bring 

10 an action on behalf of the injured minor. 

11 SEC. 4. COMPENSATING PATIENT INJURY. 

12 (a) UNLIMITED AMOUNT OF DAMAGES FOR ACTUAL

13 ECONOMIC LOSSES IN HEALTH CARE LAWSUITS.—In any 

14 health care lawsuit, nothing in this Act shall limit a claim15 ant’s recovery of the full amount of the available economic 

16 damages, notwithstanding the limitation in subsection (b). 

17 (b) ADDITIONAL NONECONOMIC DAMAGES.—In any 

18 health care lawsuit, the amount of noneconomic damages, 

19 if available, may be as much as $250,000, regardless of 

20 the number of parties against whom the action is brought 

21 or the number of separate claims or actions brought with 

22 respect to the same injury. 

23 (c) NO DISCOUNT OF AWARD FOR NONECONOMIC

24 DAMAGES.—For purposes of applying the limitation in 

25 subsection (b), future noneconomic damages shall not be 
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1 discounted to present value. The jury shall not be in2 formed about the maximum award for noneconomic dam3 ages. An award for noneconomic damages in excess of 

4 $250,000 shall be reduced either before the entry of judg5 ment, or by amendment of the judgment after entry of 

6 judgment, and such reduction shall be made before ac7 counting for any other reduction in damages required by 

8 law. If separate awards are rendered for past and future 

9 noneconomic damages and the combined awards exceed 

10 $250,000, the future noneconomic damages shall be re11 duced first. 

12 (d) FAIR SHARE RULE.—In any health care lawsuit, 

13 each party shall be liable for that party’s several share 

14 of any damages only and not for the share of any other 

15 person. Each party shall be liable only for the amount of 

16 damages allocated to such party in direct proportion to 

17 such party’s percentage of responsibility. Whenever a 

18 judgment of liability is rendered as to any party, a sepa19 rate judgment shall be rendered against each such party 

20 for the amount allocated to such party. For purposes of 

21 this section, the trier of fact shall determine the propor22 tion of responsibility of each party for the claimant’s 

23 harm. 
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1 SEC. 5. MAXIMIZING PATIENT RECOVERY. 

2 (a) COURT SUPERVISION OF SHARE OF DAMAGES

3 ACTUALLY PAID TO CLAIMANTS.—In any health care law4 suit, the court shall supervise the arrangements for pay5 ment of damages to protect against conflicts of interest 

6 that may have the effect of reducing the amount of dam7 ages awarded that are actually paid to claimants. In par8 ticular, in any health care lawsuit in which the attorney 

9 for a party claims a financial stake in the outcome by vir10 tue of a contingent fee, the court shall have the power 

11 to restrict the payment of a claimant’s damage recovery 

12 to such attorney, and to redirect such damages to the 

13 claimant based upon the interests of justice and principles 

14 of equity. In no event shall the total of all contingent fees 

15 for representing all claimants in a health care lawsuit ex16 ceed the following limits: 

17 (1) 40 percent of the first $50,000 recovered by 

18 the claimant(s). 

(2) 331 19 ⁄3 percent of the next $50,000 recovered 

20 by the claimant(s). 

21 (3) 25 percent of the next $500,000 recovered 

22 by the claimant(s). 

23 (4) 15 percent of any amount by which the re24 covery by the claimant(s) is in excess of $600,000. 

25 (b) APPLICABILITY.—The limitations in this section 

26 shall apply whether the recovery is by judgment, settle-
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1 ment, mediation, arbitration, or any other form of alter2 native dispute resolution. In a health care lawsuit involv3 ing a minor or incompetent person, a court retains the 

4 authority to authorize or approve a fee that is less than 

5 the maximum permitted under this section. The require6 ment for court supervision in the first two sentences of 

7 subsection (a) applies only in civil actions. 

8 SEC. 6. ADDITIONAL HEALTH BENEFITS. 

9 In any health care lawsuit involving injury or wrong10 ful death, any party may introduce evidence of collateral 

11 source benefits. If a party elects to introduce such evi12 dence, any opposing party may introduce evidence of any 

13 amount paid or contributed or reasonably likely to be paid 

14 or contributed in the future by or on behalf of the oppos15 ing party to secure the right to such collateral source bene16 fits. No provider of collateral source benefits shall recover 

17 any amount against the claimant or receive any lien or 

18 credit against the claimant’s recovery or be equitably or 

19 legally subrogated to the right of the claimant in a health 

20 care lawsuit involving injury or wrongful death. This sec21 tion shall apply to any health care lawsuit that is settled 

22 as well as a health care lawsuit that is resolved by a fact 

23 finder. This section shall not apply to section 1862(b) (42 

24 U.S.C. 1395y(b)) or section 1902(a)(25) (42 U.S.C. 

25 1396a(a)(25)) of the Social Security Act. 
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1 SEC. 7. PUNITIVE DAMAGES. 

2 (a) IN GENERAL.—Punitive damages may, if other3 wise permitted by applicable State or Federal law, be 

4 awarded against any person in a health care lawsuit only 

5 if it is proven by clear and convincing evidence that such 

6 person acted with malicious intent to injure the claimant, 

7 or that such person deliberately failed to avoid unneces8 sary injury that such person knew the claimant was sub9 stantially certain to suffer. In any health care lawsuit 

10 where no judgment for compensatory damages is rendered 

11 against such person, no punitive damages may be awarded 

12 with respect to the claim in such lawsuit. No demand for 

13 punitive damages shall be included in a health care lawsuit 

14 as initially filed. A court may allow a claimant to file an 

15 amended pleading for punitive damages only upon a mo16 tion by the claimant and after a finding by the court, upon 

17 review of supporting and opposing affidavits or after a 

18 hearing, after weighing the evidence, that the claimant has 

19 established by a substantial probability that the claimant 

20 will prevail on the claim for punitive damages. At the re21 quest of any party in a health care lawsuit, the trier of 

22 fact shall consider in a separate proceeding— 

23 (1) whether punitive damages are to be award24 ed and the amount of such award; and 

25 (2) the amount of punitive damages following a 

26 determination of punitive liability. 
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1 If a separate proceeding is requested, evidence relevant 

2 only to the claim for punitive damages, as determined by 

3 applicable State law, shall be inadmissible in any pro4 ceeding to determine whether compensatory damages are 

5 to be awarded. 

6 (b) DETERMINING AMOUNT OF PUNITIVE DAM7 AGES.— 

8 (1) FACTORS CONSIDERED.—In determining 

9 the amount of punitive damages, if awarded, in a 

10 health care lawsuit, the trier of fact shall consider 

11 only the following— 

12 (A) the severity of the harm caused by the 

13 conduct of such party; 

14 (B) the duration of the conduct or any 

15 concealment of it by such party; 

16 (C) the profitability of the conduct to such 

17 party; 

18 (D) the number of products sold or med19 ical procedures rendered for compensation, as 

20 the case may be, by such party, of the kind 

21 causing the harm complained of by the claim22 ant; 

23 (E) any criminal penalties imposed on such 

24 party, as a result of the conduct complained of 

25 by the claimant; and 
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1 (F) the amount of any civil fines assessed 

2 against such party as a result of the conduct 

3 complained of by the claimant. 

4 (2) MAXIMUM AWARD.—The amount of punitive 

5 damages, if awarded, in a health care lawsuit may 

6 be as much as $250,000 or as much as two times 

7 the amount of economic damages awarded, which8 ever is greater. The jury shall not be informed of 

9 this limitation. 

10 (c) NO PUNITIVE DAMAGES FOR PRODUCTS THAT

11 COMPLY WITH FDA STANDARDS.— 

12 (1) IN GENERAL.— 

13 (A) No punitive damages may be awarded 

14 against the manufacturer or distributor of a 

15 medical product, or a supplier of any compo16 nent or raw material of such medical product, 

17 based on a claim that such product caused the 

18 claimant’s harm where— 

19 (i)(I) such medical product was sub20 ject to premarket approval, clearance, or li21 censure by the Food and Drug Administra22 tion with respect to the safety of the for23 mulation or performance of the aspect of 

24 such medical product which caused the 

25 claimant’s harm or the adequacy of the 
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1 packaging or labeling of such medical 

2 product; and 

3 (II) such medical product was so ap4 proved, cleared, or licensed; or 

5 (ii) such medical product is generally 

6 recognized among qualified experts as safe 

7 and effective pursuant to conditions estab8 lished by the Food and Drug Administra9 tion and applicable Food and Drug Admin10 istration regulations, including without 

11 limitation those related to packaging and 

12 labeling, unless the Food and Drug Admin13 istration has determined that such medical 

14 product was not manufactured or distrib15 uted in substantial compliance with appli16 cable Food and Drug Administration stat17 utes and regulations. 

18 (B) RULE OF CONSTRUCTION.—Subpara19 graph (A) may not be construed as establishing 

20 the obligation of the Food and Drug Adminis21 tration to demonstrate affirmatively that a 

22 manufacturer, distributor, or supplier referred 

23 to in such subparagraph meets any of the con24 ditions described in such subparagraph. 
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1 (2) LIABILITY OF HEALTH CARE PROVIDERS.— 

2 A health care provider who prescribes, or who dis3 penses pursuant to a prescription, a medical product 

4 approved, licensed, or cleared by the Food and Drug 

5 Administration shall not be named as a party to a 

6 product liability lawsuit involving such product and 

7 shall not be liable to a claimant in a class action 

8 lawsuit against the manufacturer, distributor, or 

9 seller of such product. Nothing in this paragraph 

10 prevents a court from consolidating cases involving 

11 health care providers and cases involving products li12 ability claims against the manufacturer, distributor, 

13 or product seller of such medical product. 

14 (3) PACKAGING.—In a health care lawsuit for 

15 harm which is alleged to relate to the adequacy of 

16 the packaging or labeling of a drug which is required 

17 to have tamper-resistant packaging under regula18 tions of the Secretary of Health and Human Serv19 ices (including labeling regulations related to such 

20 packaging), the manufacturer or product seller of 

21 the drug shall not be held liable for punitive dam22 ages unless such packaging or labeling is found by 

23 the trier of fact by clear and convincing evidence to 

24 be substantially out of compliance with such regula25 tions. 
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1 (4) EXCEPTION.—Paragraph (1) shall not 

2 apply in any health care lawsuit in which— 

3 (A) a person, before or after premarket ap4 proval, clearance, or licensure of such medical 

5 product, knowingly misrepresented to or with6 held from the Food and Drug Administration 

7 information that is required to be submitted 

8 under the Federal Food, Drug, and Cosmetic 

9 Act (21 U.S.C. 301 et seq.) or section 351 of 

10 the Public Health Service Act (42 U.S.C. 262) 

11 that is material and is causally related to the 

12 harm which the claimant allegedly suffered; or 

13 (B) a person made an illegal payment to 

14 an official of the Food and Drug Administra15 tion for the purpose of either securing or main16 taining approval, clearance, or licensure of such 

17 medical product. 

18 SEC. 8. AUTHORIZATION OF PAYMENT OF FUTURE DAM19 AGES TO CLAIMANTS IN HEALTH CARE LAW20 SUITS. 

21 (a) IN GENERAL.—In any health care lawsuit, if an 

22 award of future damages, without reduction to present 

23 value, equaling or exceeding $50,000 is made against a 

24 party with sufficient insurance or other assets to fund a 

25 periodic payment of such a judgment, the court shall, at 
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1 the request of any party, enter a judgment ordering that 

2 the future damages be paid by periodic payments. In any 

3 health care lawsuit, the court may be guided by the Uni4 form Periodic Payment of Judgments Act promulgated by 

5 the National Conference of Commissioners on Uniform 

6 State Laws. 

7 (b) APPLICABILITY.—This section applies to all ac8 tions that have not been first set for trial or retrial before 

9 the effective date of this Act. 

10 SEC. 9. DEFINITIONS. 

11 In this Act: 

12 (1) ALTERNATIVE DISPUTE RESOLUTION SYS13 TEM; ADR.—The term ‘‘alternative dispute resolution 

14 system’’ or ‘‘ADR’’ means a system that provides 

15 for the resolution of health care lawsuits in a man16 ner other than through a civil action brought in a 

17 State or Federal court. 

18 (2) CLAIMANT.—The term ‘‘claimant’’ means 

19 any person who brings a health care lawsuit, includ20 ing a person who asserts or claims a right to legal 

21 or equitable contribution, indemnity or subrogation, 

22 arising out of a health care liability claim or action, 

23 and any person on whose behalf such a claim is as24 serted or such an action is brought, whether de25 ceased, incompetent, or a minor. 
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1 (3) COLLATERAL SOURCE BENEFITS.—The 

2 term ‘‘collateral source benefits’’ means any amount 

3 paid or reasonably likely to be paid in the future to 

4 or on behalf of the claimant, or any service, product 

5 or other benefit provided or reasonably likely to be 

6 provided in the future to or on behalf of the claim7 ant, as a result of the injury or wrongful death, pur8 suant to— 

9 (A) any State or Federal health, sickness, 

10 income-disability, accident, or workers’ com11 pensation law; 

12 (B) any health, sickness, income-disability, 

13 or accident insurance that provides health bene14 fits or income-disability coverage; 

15 (C) any contract or agreement of any 

16 group, organization, partnership, or corporation 

17 to provide, pay for, or reimburse the cost of 

18 medical, hospital, dental, or income disability 

19 benefits; and 

20 (D) any other publicly or privately funded 

21 program. 

22 (4) COMPENSATORY DAMAGES.—The term 

23 ‘‘compensatory damages’’ means objectively 

24 verifiable monetary losses incurred as a result of the 

25 provision of, use of, or payment for (or failure to 
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1 provide, use, or pay for) health care services or med2 ical products, such as past and future medical ex3 penses, loss of past and future earnings, cost of ob4 taining domestic services, loss of employment, and 

5 loss of business or employment opportunities, dam6 ages for physical and emotional pain, suffering, in7 convenience, physical impairment, mental anguish, 

8 disfigurement, loss of enjoyment of life, loss of soci9 ety and companionship, loss of consortium (other 

10 than loss of domestic service), hedonic damages, in11 jury to reputation, and all other nonpecuniary losses 

12 of any kind or nature. The term ‘‘compensatory 

13 damages’’ includes economic damages and non14 economic damages, as such terms are defined in this 

15 section. 

16 (5) CONTINGENT FEE.—The term ‘‘contingent 

17 fee’’ includes all compensation to any person or per18 sons which is payable only if a recovery is effected 

19 on behalf of one or more claimants. 

20 (6) ECONOMIC DAMAGES.—The term ‘‘economic 

21 damages’’ means objectively verifiable monetary 

22 losses incurred as a result of the provision of, use 

23 of, or payment for (or failure to provide, use, or pay 

24 for) health care services or medical products, such as 

25 past and future medical expenses, loss of past and 
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1 future earnings, cost of obtaining domestic services, 

2 loss of employment, and loss of business or employ3 ment opportunities. 

4 (7) HEALTH CARE LAWSUIT.—The term 

5 ‘‘health care lawsuit’’ means any health care liability 

6 claim concerning the provision of health care goods 

7 or services or any medical product affecting inter8 state commerce, or any health care liability action 

9 concerning the provision of health care goods or 

10 services or any medical product affecting interstate 

11 commerce, brought in a State or Federal court or 

12 pursuant to an alternative dispute resolution system, 

13 against a health care provider, a health care organi14 zation, or the manufacturer, distributor, supplier, 

15 marketer, promoter, or seller of a medical product, 

16 regardless of the theory of liability on which the 

17 claim is based, or the number of claimants, plain18 tiffs, defendants, or other parties, or the number of 

19 claims or causes of action, in which the claimant al20 leges a health care liability claim. Such term does 

21 not include a claim or action which is based on 

22 criminal liability; which seeks civil fines or penalties 

23 paid to Federal, State, or local government; or which 

24 is grounded in antitrust. 
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1 (8) HEALTH CARE LIABILITY ACTION.—The 

2 term ‘‘health care liability action’’ means a civil ac3 tion brought in a State or Federal Court or pursu4 ant to an alternative dispute resolution system, 

5 against a health care provider, a health care organi6 zation, or the manufacturer, distributor, supplier, 

7 marketer, promoter, or seller of a medical product, 

8 regardless of the theory of liability on which the 

9 claim is based, or the number of plaintiffs, defend10 ants, or other parties, or the number of causes of ac11 tion, in which the claimant alleges a health care li12 ability claim. 

13 (9) HEALTH CARE LIABILITY CLAIM.—The 

14 term ‘‘health care liability claim’’ means a demand 

15 by any person, whether or not pursuant to ADR, 

16 against a health care provider, health care organiza17 tion, or the manufacturer, distributor, supplier, mar18 keter, promoter, or seller of a medical product, in19 cluding, but not limited to, third-party claims, cross20 claims, counter-claims, or contribution claims, which 

21 are based upon the provision of, use of, or payment 

22 for (or the failure to provide, use, or pay for) health 

23 care services or medical products, regardless of the 

24 theory of liability on which the claim is based, or the 
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1 number of plaintiffs, defendants, or other parties, or 

2 the number of causes of action. 

3 (10) HEALTH CARE ORGANIZATION.—The term 

4 ‘‘health care organization’’ means any person or en5 tity which is obligated to provide or pay for health 

6 benefits under any health plan, including any person 

7 or entity acting under a contract or arrangement 

8 with a health care organization to provide or admin9 ister any health benefit. 

10 (11) HEALTH CARE PROVIDER.—The term 

11 ‘‘health care provider’’ means any person or entity 

12 required by State or Federal laws or regulations to 

13 be licensed, registered, or certified to provide health 

14 care services, and being either so licensed, reg15 istered, or certified, or exempted from such require16 ment by other statute or regulation. 

17 (12) HEALTH CARE GOODS OR SERVICES.—The 

18 term ‘‘health care goods or services’’ means any 

19 goods or services provided by a health care organiza20 tion, provider, or by any individual working under 

21 the supervision of a health care provider, that relates 

22 to the diagnosis, prevention, or treatment of any 

23 human disease or impairment, or the assessment or 

24 care of the health of human beings. 
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1 (13) MALICIOUS INTENT TO INJURE.—The 

2 term ‘‘malicious intent to injure’’ means inten3 tionally causing or attempting to cause physical in4 jury other than providing health care goods or serv5 ices. 

6 (14) MEDICAL PRODUCT.—The term ‘‘medical 

7 product’’ means a drug, device, or biological product 

8 intended for humans, and the terms ‘‘drug’’, ‘‘de9 vice’’, and ‘‘biological product’’ have the meanings 

10 given such terms in sections 201(g)(1) and 201(h) 

11 of the Federal Food, Drug and Cosmetic Act (21 

12 U.S.C. 321) and section 351(a) of the Public Health 

13 Service Act (42 U.S.C. 262(a)), respectively, includ14 ing any component or raw material used therein, but 

15 excluding health care services. 

16 (15) NONECONOMIC DAMAGES.—The term 

17 ‘‘noneconomic damages’’ means damages for phys18 ical and emotional pain, suffering, inconvenience, 

19 physical impairment, mental anguish, disfigurement, 

20 loss of enjoyment of life, loss of society and compan21 ionship, loss of consortium (other than loss of do22 mestic service), hedonic damages, injury to reputa23 tion, and all other nonpecuniary losses of any kind 

24 or nature. 
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1 (16) PUNITIVE DAMAGES.—The term ‘‘punitive 

2 damages’’ means damages awarded, for the purpose 

3 of punishment or deterrence, and not solely for com4 pensatory purposes, against a health care provider, 

5 health care organization, or a manufacturer, dis6 tributor, or supplier of a medical product. Punitive 

7 damages are neither economic nor noneconomic 

8 damages. 

9 (17) RECOVERY.—The term ‘‘recovery’’ means 

10 the net sum recovered after deducting any disburse11 ments or costs incurred in connection with prosecu12 tion or settlement of the claim, including all costs 

13 paid or advanced by any person. Costs of health care 

14 incurred by the plaintiff and the attorneys’ office 

15 overhead costs or charges for legal services are not 

16 deductible disbursements or costs for such purpose. 

17 (18) STATE.—The term ‘‘State’’ means each of 

18 the several States, the District of Columbia, the 

19 Commonwealth of Puerto Rico, the Virgin Islands, 

20 Guam, American Samoa, the Northern Mariana Is21 lands, the Trust Territory of the Pacific Islands, and 

22 any other territory or possession of the United 

23 States, or any political subdivision thereof. 

24 SEC. 10. EFFECT ON OTHER LAWS. 

25 (a) VACCINE INJURY.— 
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1 (1) To the extent that title XXI of the Public 

2 Health Service Act establishes a Federal rule of law 

3 applicable to a civil action brought for a vaccine-re4 lated injury or death— 

5 (A) this Act does not affect the application 

6 of the rule of law to such an action; and 

7 (B) any rule of law prescribed by this Act 

8 in conflict with a rule of law of such title XXI 

9 shall not apply to such action. 

10 (2) If there is an aspect of a civil action 

11 brought for a vaccine-related injury or death to 

12 which a Federal rule of law under title XXI of the 

13 Public Health Service Act does not apply, then this 

14 Act or otherwise applicable law (as determined 

15 under this Act) will apply to such aspect of such ac16 tion. 

17 (b) OTHER FEDERAL LAW.—Except as provided in 

18 this section, nothing in this Act shall be deemed to affect 

19 any defense available to a defendant in a health care law20 suit or action under any other provision of Federal law. 

21 SEC. 11. STATE FLEXIBILITY AND PROTECTION OF STATES’ 

22 RIGHTS. 

23 (a) HEALTH CARE LAWSUITS.—The provisions gov24 erning health care lawsuits set forth in this Act preempt, 

25 subject to subsections (b) and (c), State law to the extent 
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1 that State law prevents the application of any provisions 

2 of law established by or under this Act. The provisions 

3 governing health care lawsuits set forth in this Act super4 sede chapter 171 of title 28, United States Code, to the 

5 extent that such chapter— 

6 (1) provides for a greater amount of damages 

7 or contingent fees, a longer period in which a health 

8 care lawsuit may be commenced, or a reduced appli9 cability or scope of periodic payment of future dam10 ages, than provided in this Act; or 

11 (2) prohibits the introduction of evidence re12 garding collateral source benefits, or mandates or 

13 permits subrogation or a lien on collateral source 

14 benefits. 

15 (b) PROTECTION OF STATES’ RIGHTS AND OTHER

16 LAWS.—(1) Any issue that is not governed by any provi17 sion of law established by or under this Act (including 

18 State standards of negligence) shall be governed by other19 wise applicable State or Federal law. 

20 (2) This Act shall not preempt or supersede any State 

21 or Federal law that imposes greater procedural or sub22 stantive protections for health care providers and health 

23 care organizations from liability, loss, or damages than 

24 those provided by this Act or create a cause of action. 
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1 (c) STATE FLEXIBILITY.—No provision of this Act 

2 shall be construed to preempt— 

3 (1) any State law (whether effective before, on, 

4 or after the date of the enactment of this Act) that 

5 specifies a particular monetary amount of compen6 satory or punitive damages (or the total amount of 

7 damages) that may be awarded in a health care law8 suit, regardless of whether such monetary amount is 

9 greater or lesser than is provided for under this Act, 

10 notwithstanding section 4(a); or 

11 (2) any defense available to a party in a health 

12 care lawsuit under any other provision of State or 

13 Federal law. 

14 SEC. 12. APPLICABILITY; EFFECTIVE DATE. 

15 This Act shall apply to any health care lawsuit 

16 brought in a Federal or State court, or subject to an alter17 native dispute resolution system, that is initiated on or 

18 after the date of the enactment of this Act, except that 

19 any health care lawsuit arising from an injury occurring 

20 prior to the date of the enactment of this Act shall be 

21 governed by the applicable statute of limitations provisions 

22 in effect at the time the injury occurred. 

23 SEC. 13. SENSE OF CONGRESS. 

24 It is the sense of Congress that a health insurer 

25 should be liable for damages for harm caused when it 
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1 makes a decision as to what care is medically necessary 

2 and appropriate. 

Æ