II 

Calendar No. 49

108TH CONGRESS 

1ST SESSION H. R. 5

IN THE SENATE OF THE UNITED STATES 

MARCH 13, 2003

Received 

MARCH 20, 2003

Read the first time 

MARCH 21, 2003

Read the second time and placed on the calendar 

AN ACT

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,
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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Help Efficient, Acces3 sible, Low-cost, Timely Healthcare (HEALTH) Act of 

4 2003’’. 

5 SEC. 2. FINDINGS AND PURPOSE. 

6 (a) FINDINGS.—

7 (1) EFFECT ON HEALTH CARE ACCESS AND

8 COSTS.—Congress finds that our current civil justice 

9 system is adversely affecting patient access to health 

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

11 health care, in that the health care liability system 

12 is a costly and ineffective mechanism for resolving 

13 claims of health care liability and compensating in14 jured patients, and is a deterrent to the sharing of 

15 information among health care professionals which 

16 impedes efforts to improve patient safety and quality 

17 of care. 

18 (2) EFFECT ON INTERSTATE COMMERCE.—

19 Congress finds that the health care and insurance 

20 industries are industries affecting interstate com21 merce and the health care liability litigation systems 

22 existing throughout the United States are activities 

23 that affect interstate commerce by contributing to 

24 the high costs of health care and premiums for 

25 health care liability insurance purchased by health 

26 care system providers. 
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1 (3) EFFECT ON FEDERAL SPENDING.—Con2 gress finds that the health care liability litigation 

3 systems existing throughout the United States have 

4 a significant effect on the amount, distribution, and 

5 use of Federal funds because of—

6 (A) the large number of individuals who 

7 receive health care benefits under programs op8 erated or financed by the Federal Government; 

9 (B) the large number of individuals who 

10 benefit because of the exclusion from Federal 

11 taxes of the amounts spent to provide them 

12 with health insurance benefits; and 

13 (C) the large number of health care pro14 viders who provide items or services for which 

15 the Federal Government makes payments. 

16 (b) PURPOSE.—It is the purpose of this Act to imple17 ment reasonable, comprehensive, and effective health care 

18 liability reforms designed to—

19 (1) improve the availability of health care serv20 ices in cases in which health care liability actions 

21 have been shown to be a factor in the decreased 

22 availability of services; 

23 (2) reduce the incidence of ‘‘defensive medi24 cine’’ and lower the cost of health care liability in-
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1 surance, all of which contribute to the escalation of 

2 health care costs; 

3 (3) ensure that persons with meritorious health 

4 care injury claims receive fair and adequate com5 pensation, including reasonable noneconomic dam6 ages; 

7 (4) improve the fairness and cost-effectiveness 

8 of our current health care liability system to resolve 

9 disputes over, and provide compensation for, health 

10 care liability by reducing uncertainty in the amount 

11 of compensation provided to injured individuals; and 

12 (5) provide an increased sharing of information 

13 in the health care system which will reduce unin14 tended injury and improve patient care. 

15 SEC. 3. ENCOURAGING SPEEDY RESOLUTION OF CLAIMS. 

16 The time for the commencement of a health care law17 suit shall be 3 years after the date of manifestation of 

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

19 the use of reasonable diligence should have discovered, the 

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

21 for commencement of a health care lawsuit exceed 3 years 

22 after the date of manifestation of injury unless tolled for 

23 any of the following—

24 (1) upon proof of fraud; 

25 (2) intentional concealment; or 
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1 (3) the presence of a foreign body, which has no 

2 therapeutic or diagnostic purpose or effect, in the 

3 person of the injured person. 

4 Actions by a minor shall be commenced within 3 years 

5 from the date of the alleged manifestation of injury except 

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

7 be commenced within 3 years of manifestation of injury 

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

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

10 minors for any period during which a parent or guardian 

11 and a health care provider or health care organization 

12 have committed fraud or collusion in the failure to bring 

13 an action on behalf of the injured minor. 

14 SEC. 4. COMPENSATING PATIENT INJURY. 

15 (a) UNLIMITED AMOUNT OF DAMAGES FOR ACTUAL

16 ECONOMIC LOSSES IN HEALTH CARE LAWSUITS.—In any 

17 health care lawsuit, nothing in this Act shall limit a claim18 ant’s recovery of the full amount of the available economic 

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

20 (b) ADDITIONAL NONECONOMIC DAMAGES.—In any 

21 health care lawsuit, the amount of noneconomic damages, 

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

23 the number of parties against whom the action is brought 

24 or the number of separate claims or actions brought with 

25 respect to the same injury. 
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1 (c) NO DISCOUNT OF AWARD FOR NONECONOMIC

2 DAMAGES.—For purposes of applying the limitation in 

3 subsection (b), future noneconomic damages shall not be 

4 discounted to present value. The jury shall not be in5 formed about the maximum award for noneconomic dam6 ages. An award for noneconomic damages in excess of 

7 $250,000 shall be reduced either before the entry of judg8 ment, or by amendment of the judgment after entry of 

9 judgment, and such reduction shall be made before ac10 counting for any other reduction in damages required by 

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

12 noneconomic damages and the combined awards exceed 

13 $250,000, the future noneconomic damages shall be re14 duced first. 

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

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

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

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

19 damages allocated to such party in direct proportion to 

20 such party’s percentage of responsibility. Whenever a 

21 judgment of liability is rendered as to any party, a sepa22 rate judgment shall be rendered against each such party 

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

24 this section, the trier of fact shall determine the propor-
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1 tion of responsibility of each party for the claimant’s 

2 harm. 

3 SEC. 5. MAXIMIZING PATIENT RECOVERY. 

4 (a) COURT SUPERVISION OF SHARE OF DAMAGES

5 ACTUALLY PAID TO CLAIMANTS.—In any health care law6 suit, the court shall supervise the arrangements for pay7 ment of damages to protect against conflicts of interest 

8 that may have the effect of reducing the amount of dam9 ages awarded that are actually paid to claimants. In par10 ticular, in any health care lawsuit in which the attorney 

11 for a party claims a financial stake in the outcome by vir12 tue of a contingent fee, the court shall have the power 

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

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

15 claimant based upon the interests of justice and principles 

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

17 for representing all claimants in a health care lawsuit ex18 ceed the following limits: 

19 (1) 40 percent of the first $50,000 recovered by 

20 the claimant(s). 

(2) 331 21 ⁄3 percent of the next $50,000 recovered 

22 by the claimant(s). 

23 (3) 25 percent of the next $500,000 recovered 

24 by the claimant(s). 
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1 (4) 15 percent of any amount by which the re2 covery by the claimant(s) is in excess of $600,000. 

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

4 shall apply whether the recovery is by judgment, settle5 ment, mediation, arbitration, or any other form of alter6 native dispute resolution. In a health care lawsuit involv7 ing a minor or incompetent person, a court retains the 

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

9 the maximum permitted under this section. The require10 ment for court supervision in the first two sentences of 

11 subsection (a) applies only in civil actions. 

12 SEC. 6. ADDITIONAL HEALTH BENEFITS. 

13 In any health care lawsuit involving injury or wrong14 ful death, any party may introduce evidence of collateral 

15 source benefits. If a party elects to introduce such evi16 dence, any opposing party may introduce evidence of any 

17 amount paid or contributed or reasonably likely to be paid 

18 or contributed in the future by or on behalf of the oppos19 ing party to secure the right to such collateral source bene20 fits. No provider of collateral source benefits shall recover 

21 any amount against the claimant or receive any lien or 

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

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

24 care lawsuit involving injury or wrongful death. This sec25 tion shall apply to any health care lawsuit that is settled 
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1 as well as a health care lawsuit that is resolved by a fact 

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

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

4 1396a(a)(25)) of the Social Security Act. 

5 SEC. 7. PUNITIVE DAMAGES. 

6 (a) IN GENERAL.—Punitive damages may, if other7 wise permitted by applicable State or Federal law, be 

8 awarded against any person in a health care lawsuit only 

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

10 person acted with malicious intent to injure the claimant, 

11 or that such person deliberately failed to avoid unneces12 sary injury that such person knew the claimant was sub13 stantially certain to suffer. In any health care lawsuit 

14 where no judgment for compensatory damages is rendered 

15 against such person, no punitive damages may be awarded 

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

17 punitive damages shall be included in a health care lawsuit 

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

19 amended pleading for punitive damages only upon a mo20 tion by the claimant and after a finding by the court, upon 

21 review of supporting and opposing affidavits or after a 

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

23 established by a substantial probability that the claimant 

24 will prevail on the claim for punitive damages. At the re-
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1 quest of any party in a health care lawsuit, the trier of 

2 fact shall consider in a separate proceeding—

3 (1) whether punitive damages are to be award4 ed and the amount of such award; and 

5 (2) the amount of punitive damages following a 

6 determination of punitive liability. 

7 If a separate proceeding is requested, evidence relevant 

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

9 applicable State law, shall be inadmissible in any pro10 ceeding to determine whether compensatory damages are 

11 to be awarded. 

12 (b) DETERMINING AMOUNT OF PUNITIVE DAM13 AGES.—

14 (1) FACTORS CONSIDERED.—In determining 

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

16 health care lawsuit, the trier of fact shall consider 

17 only the following—

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

19 conduct of such party; 

20 (B) the duration of the conduct or any 

21 concealment of it by such party; 

22 (C) the profitability of the conduct to such 

23 party; 

24 (D) the number of products sold or med25 ical procedures rendered for compensation, as 
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1 the case may be, by such party, of the kind 

2 causing the harm complained of by the claim3 ant; 

4 (E) any criminal penalties imposed on such 

5 party, as a result of the conduct complained of 

6 by the claimant; and 

7 (F) the amount of any civil fines assessed 

8 against such party as a result of the conduct 

9 complained of by the claimant. 

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

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

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

13 the amount of economic damages awarded, which14 ever is greater. The jury shall not be informed of 

15 this limitation. 

16 (c) NO PUNITIVE DAMAGES FOR PRODUCTS THAT

17 COMPLY WITH FDA STANDARDS.—

18 (1) IN GENERAL.—

19 (A) No punitive damages may be awarded 

20 against the manufacturer or distributor of a 

21 medical product, or a supplier of any compo22 nent or raw material of such medical product, 

23 based on a claim that such product caused the 

24 claimant’s harm where—
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1 (i)(I) such medical product was sub2 ject to premarket approval, clearance, or li3 censure by the Food and Drug Administra4 tion with respect to the safety of the for5 mulation or performance of the aspect of 

6 such medical product which caused the 

7 claimant’s harm or the adequacy of the 

8 packaging or labeling of such medical 

9 product; and 

10 (II) such medical product was so ap11 proved, cleared, or licensed; or 

12 (ii) such medical product is generally 

13 recognized among qualified experts as safe 

14 and effective pursuant to conditions estab15 lished by the Food and Drug Administra16 tion and applicable Food and Drug Admin17 istration regulations, including without 

18 limitation those related to packaging and 

19 labeling, unless the Food and Drug Admin20 istration has determined that such medical 

21 product was not manufactured or distrib22 uted in substantial compliance with appli23 cable Food and Drug Administration stat24 utes and regulations. 
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1 (B) RULE OF CONSTRUCTION.—Subpara2 graph (A) may not be construed as establishing 

3 the obligation of the Food and Drug Adminis4 tration to demonstrate affirmatively that a 

5 manufacturer, distributor, or supplier referred 

6 to in such subparagraph meets any of the con7 ditions described in such subparagraph. 

8 (2) LIABILITY OF HEALTH CARE PROVIDERS.—

9 A health care provider who prescribes, or who dis10 penses pursuant to a prescription, a medical product 

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

12 Administration shall not be named as a party to a 

13 product liability lawsuit involving such product and 

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

15 lawsuit against the manufacturer, distributor, or 

16 seller of such product. Nothing in this paragraph 

17 prevents a court from consolidating cases involving 

18 health care providers and cases involving products li19 ability claims against the manufacturer, distributor, 

20 or product seller of such medical product. 

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

22 harm which is alleged to relate to the adequacy of 

23 the packaging or labeling of a drug which is required 

24 to have tamper-resistant packaging under regula25 tions of the Secretary of Health and Human Serv-
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1 ices (including labeling regulations related to such 

2 packaging), the manufacturer or product seller of 

3 the drug shall not be held liable for punitive dam4 ages unless such packaging or labeling is found by 

5 the trier of fact by clear and convincing evidence to 

6 be substantially out of compliance with such regula7 tions. 

8 (4) EXCEPTION.—Paragraph (1) shall not 

9 apply in any health care lawsuit in which—

10 (A) a person, before or after premarket ap11 proval, clearance, or licensure of such medical 

12 product, knowingly misrepresented to or with13 held from the Food and Drug Administration 

14 information that is required to be submitted 

15 under the Federal Food, Drug, and Cosmetic 

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

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

18 that is material and is causally related to the 

19 harm which the claimant allegedly suffered; or 

20 (B) a person made an illegal payment to 

21 an official of the Food and Drug Administra22 tion for the purpose of either securing or main23 taining approval, clearance, or licensure of such 

24 medical product. 
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1 SEC. 8. AUTHORIZATION OF PAYMENT OF FUTURE DAM2 AGES TO CLAIMANTS IN HEALTH CARE LAW3 SUITS. 

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

5 award of future damages, without reduction to present 

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

7 party with sufficient insurance or other assets to fund a 

8 periodic payment of such a judgment, the court shall, at 

9 the request of any party, enter a judgment ordering that 

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

11 health care lawsuit, the court may be guided by the Uni12 form Periodic Payment of Judgments Act promulgated by 

13 the National Conference of Commissioners on Uniform 

14 State Laws. 

15 (b) APPLICABILITY.—This section applies to all ac16 tions which have not been first set for trial or retrial be17 fore the effective date of this Act. 

18 SEC. 9. DEFINITIONS. 

19 In this Act: 

20 (1) ALTERNATIVE DISPUTE RESOLUTION SYS21 TEM; ADR.—The term ‘‘alternative dispute resolution 

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

23 for the resolution of health care lawsuits in a man24 ner other than through a civil action brought in a 

25 State or Federal court. 
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1 (2) CLAIMANT.—The term ‘‘claimant’’ means 

2 any person who brings a health care lawsuit, includ3 ing a person who asserts or claims a right to legal 

4 or equitable contribution, indemnity or subrogation, 

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

6 and any person on whose behalf such a claim is as7 serted or such an action is brought, whether de8 ceased, incompetent, or a minor. 

9 (3) COLLATERAL SOURCE BENEFITS.—The 

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

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

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

13 or other benefit provided or reasonably likely to be 

14 provided in the future to or on behalf of the claim15 ant, as a result of the injury or wrongful death, pur16 suant to—

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

18 income-disability, accident, or workers’ com19 pensation law; 

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

21 or accident insurance that provides health bene22 fits or income-disability coverage; 

23 (C) any contract or agreement of any 

24 group, organization, partnership, or corporation 

25 to provide, pay for, or reimburse the cost of 
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1 medical, hospital, dental, or income disability 

2 benefits; and 

3 (D) any other publicly or privately funded 

4 program. 

5 (4) COMPENSATORY DAMAGES.—The term 

6 ‘‘compensatory damages’’ means objectively 

7 verifiable monetary losses incurred as a result of the 

8 provision of, use of, or payment for (or failure to 

9 provide, use, or pay for) health care services or med10 ical products, such as past and future medical ex11 penses, loss of past and future earnings, cost of ob12 taining domestic services, loss of employment, and 

13 loss of business or employment opportunities, dam14 ages for physical and emotional pain, suffering, in15 convenience, physical impairment, mental anguish, 

16 disfigurement, loss of enjoyment of life, loss of soci17 ety and companionship, loss of consortium (other 

18 than loss of domestic service), hedonic damages, in19 jury to reputation, and all other nonpecuniary losses 

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

21 damages’’ includes economic damages and non22 economic damages, as such terms are defined in this 

23 section. 

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

25 fee’’ includes all compensation to any person or per-
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1 sons which is payable only if a recovery is effected 

2 on behalf of one or more claimants. 

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

4 damages’’ means objectively verifiable monetary 

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

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

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

8 past and future medical expenses, loss of past and 

9 future earnings, cost of obtaining domestic services, 

10 loss of employment, and loss of business or employ11 ment opportunities. 

12 (7) HEALTH CARE LAWSUIT.—The term 

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

14 claim concerning the provision of health care goods 

15 or services or any medical product affecting inter16 state commerce, or any health care liability action 

17 concerning the provision of health care goods or 

18 services or any medical product affecting interstate 

19 commerce, brought in a State or Federal court or 

20 pursuant to an alternative dispute resolution system, 

21 against a health care provider, a health care organi22 zation, or the manufacturer, distributor, supplier, 

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

24 regardless of the theory of liability on which the 

25 claim is based, or the number of claimants, plain-
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1 tiffs, defendants, or other parties, or the number of 

2 claims or causes of action, in which the claimant al3 leges a health care liability claim. Such term does 

4 not include a claim or action which is based on 

5 criminal liability; which seeks civil fines or penalties 

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

7 is grounded in antitrust. 

8 (8) HEALTH CARE LIABILITY ACTION.—The 

9 term ‘‘health care liability action’’ means a civil ac10 tion brought in a State or Federal Court or pursu11 ant to an alternative dispute resolution system, 

12 against a health care provider, a health care organi13 zation, or the manufacturer, distributor, supplier, 

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

15 regardless of the theory of liability on which the 

16 claim is based, or the number of plaintiffs, defend17 ants, or other parties, or the number of causes of ac18 tion, in which the claimant alleges a health care li19 ability claim. 

20 (9) HEALTH CARE LIABILITY CLAIM.—The 

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

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

23 against a health care provider, health care organiza24 tion, or the manufacturer, distributor, supplier, mar25 keter, promoter, or seller of a medical product, in-
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1 cluding, but not limited to, third-party claims, cross2 claims, counter-claims, or contribution claims, which 

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

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

5 care services or medical products, regardless of the 

6 theory of liability on which the claim is based, or the 

7 number of plaintiffs, defendants, or other parties, or 

8 the number of causes of action. 

9 (10) HEALTH CARE ORGANIZATION.—The term 

10 ‘‘health care organization’’ means any person or en11 tity which is obligated to provide or pay for health 

12 benefits under any health plan, including any person 

13 or entity acting under a contract or arrangement 

14 with a health care organization to provide or admin15 ister any health benefit. 

16 (11) HEALTH CARE PROVIDER.—The term 

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

18 required by State or Federal laws or regulations to 

19 be licensed, registered, or certified to provide health 

20 care services, and being either so licensed, reg21 istered, or certified, or exempted from such require22 ment by other statute or regulation. 

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

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

25 goods or services provided by a health care organiza-
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1 tion, provider, or by any individual working under 

2 the supervision of a health care provider, that relates 

3 to the diagnosis, prevention, or treatment of any 

4 human disease or impairment, or the assessment or 

5 care of the health of human beings. 

6 (13) MALICIOUS INTENT TO INJURE.—The 

7 term ‘‘malicious intent to injure’’ means inten8 tionally causing or attempting to cause physical in9 jury other than providing health care goods or serv10 ices. 

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

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

13 intended for humans, and the terms ‘‘drug’’, ‘‘de14 vice’’, and ‘‘biological product’’ have the meanings 

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

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

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

18 Service Act (42 U.S.C. 262(a)), respectively, includ19 ing any component or raw material used therein, but 

20 excluding health care services. 

21 (15) NONECONOMIC DAMAGES.—The term 

22 ‘‘noneconomic damages’’ means damages for phys23 ical and emotional pain, suffering, inconvenience, 

24 physical impairment, mental anguish, disfigurement, 

25 loss of enjoyment of life, loss of society and compan-
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1 ionship, loss of consortium (other than loss of do2 mestic service), hedonic damages, injury to reputa3 tion, and all other nonpecuniary losses of any kind 

4 or nature. 

5 (16) PUNITIVE DAMAGES.—The term ‘‘punitive 

6 damages’’ means damages awarded, for the purpose 

7 of punishment or deterrence, and not solely for com8 pensatory purposes, against a health care provider, 

9 health care organization, or a manufacturer, dis10 tributor, or supplier of a medical product. Punitive 

11 damages are neither economic nor noneconomic 

12 damages. 

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

14 the net sum recovered after deducting any disburse15 ments or costs incurred in connection with prosecu16 tion or settlement of the claim, including all costs 

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

18 incurred by the plaintiff and the attorneys’ office 

19 overhead costs or charges for legal services are not 

20 deductible disbursements or costs for such purpose. 

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

22 the several States, the District of Columbia, the 

23 Commonwealth of Puerto Rico, the Virgin Islands, 

24 Guam, American Samoa, the Northern Mariana Is25 lands, the Trust Territory of the Pacific Islands, and 
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1 any other territory or possession of the United 

2 States, or any political subdivision thereof. 

3 SEC. 10. EFFECT ON OTHER LAWS. 

4 (a) VACCINE INJURY.—

5 (1) To the extent that title XXI of the Public 

6 Health Service Act establishes a Federal rule of law 

7 applicable to a civil action brought for a vaccine-re8 lated injury or death—

9 (A) this Act does not affect the application 

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

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

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

13 shall not apply to such action. 

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

15 brought for a vaccine-related injury or death to 

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

17 Public Health Service Act does not apply, then this 

18 Act or otherwise applicable law (as determined 

19 under this Act) will apply to such aspect of such ac20 tion. 

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

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

23 any defense available to a defendant in a health care law24 suit or action under any other provision of Federal law. 
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1 SEC. 11. STATE FLEXIBILITY AND PROTECTION OF STATES’ 

2 RIGHTS. 

3 (a) HEALTH CARE LAWSUITS.—The provisions gov4 erning health care lawsuits set forth in this Act preempt, 

5 subject to subsections (b) and (c), State law to the extent 

6 that State law prevents the application of any provisions 

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

8 governing health care lawsuits set forth in this Act super9 sede chapter 171 of title 28, United States Code, to the 

10 extent that such chapter—

11 (1) provides for a greater amount of damages 

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

13 care lawsuit may be commenced, or a reduced appli14 cability or scope of periodic payment of future dam15 ages, than provided in this Act; or 

16 (2) prohibits the introduction of evidence re17 garding collateral source benefits, or mandates or 

18 permits subrogation or a lien on collateral source 

19 benefits. 

20 (b) PROTECTION OF STATES’ RIGHTS AND OTHER

21 LAWS.—(1) Any issue that is not governed by any provi22 sion of law established by or under this Act (including 

23 State standards of negligence) shall be governed by other24 wise applicable State or Federal law. 

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

26 or Federal law that imposes greater procedural or sub-
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1 stantive protections for health care providers and health 

2 care organizations from liability, loss, or damages than 

3 those provided by this Act or create a cause of action. 

4 (c) STATE FLEXIBILITY.—No provision of this Act 

5 shall be construed to preempt—

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

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

8 specifies a particular monetary amount of compen9 satory or punitive damages (or the total amount of 

10 damages) that may be awarded in a health care law11 suit, regardless of whether such monetary amount is 

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

13 notwithstanding section 4(a); or 

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

15 care lawsuit under any other provision of State or 

16 Federal law. 

17 SEC. 12. APPLICABILITY; EFFECTIVE DATE. 

18 This Act shall apply to any health care lawsuit 

19 brought in a Federal or State court, or subject to an alter20 native dispute resolution system, that is initiated on or 

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

22 any health care lawsuit arising from an injury occurring 

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

24 governed by the applicable statute of limitations provisions 

25 in effect at the time the injury occurred. 
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1 SEC. 13. SENSE OF CONGRESS. 

2 It is the sense of Congress that a health insurer 

3 should be liable for damages for harm caused when it 

4 makes a decision as to what care is medically necessary 

5 and appropriate.

Passed the House of Representatives March 13, 

2003. 

Attest: JEFF TRANDAHL, 

Clerk. 

Calendar No. 49

108TH CONGRESS 

1ST SESSION H. R. 5

AN ACT

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. 

MARCH 21, 2003

Read the second time and placed on the calendar