$250,000 shall be reduced either before the entry of judg-
ment, or by amendment of the judgment after entry of 
judgment, and such reduction shall be made before ac-
counting for any other reduction in damages required by 
law. If separate awards are rendered for past and future 
noneconomic damages and the combined awards exceed 
$250,000, the future noneconomic damages shall be re-
duced first. 
(d) FAIR SHARE RULE.—In any health care lawsuit, 
each party shall be liable for that party’s several share 
of any damages only and not for the share of any other 
person. Each party shall be liable only for the amount of 
damages allocated to such party in direct proportion to 
such party’s percentage of responsibility. Whenever a 
judgment of liability is rendered as to any party, a sepa-
rate judgment shall be rendered against each such party 
for the amount allocated to such party. For purposes of 
this section, the trier of fact shall determine the propor-
tion of responsibility of each party for the claimant’s 
harm. 
SEC. 5. MAXIMIZING PATIENT RECOVERY. 
(a) COURT SUPERVISION OF SHARE OF DAMAGES 
ACTUALLY PAID TO CLAIMANTS.—In any health care law-
suit, the court shall supervise the arrangements for pay-
ment of damages to protect against conflicts of interest 
VerDate Nov 24 2008 
23:18 Jun 20, 2009
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H2975.IH
H2975
pwalker on PROD1PC71 with BILLS
that may have the effect of reducing the amount of dam-
ages awarded that are actually paid to claimants. In par-
ticular, in any health care lawsuit in which the attorney 
for a party claims a financial stake in the outcome by vir-
tue of a contingent fee, the court shall have the power 
to restrict the payment of a claimant’s damage recovery 
to such attorney, and to redirect such damages to the 
claimant based upon the interests of justice and principles 
of equity. In no event shall the total of all contingent fees 
for representing all claimants in a health care lawsuit ex-
ceed the following limits: 
(1) 40 percent of the first $50,000 recovered by 
the claimant(s). 
(2) 331⁄3 percent of the next $50,000 recovered 
by the claimant(s). 
(3) 25 percent of the next $500,000 recovered 
by the claimant(s). 
(4) 15 percent of any amount by which the re-
covery by the claimant(s) is in excess of $600,000. 
(b) APPLICABILITY.—The limitations in this section 
shall apply whether the recovery is by judgment, settle-
ment, mediation, arbitration, or any other form of alter-
native dispute resolution. In a health care lawsuit involv-
ing a minor or incompetent person, a court retains the 
authority to authorize or approve a fee that is less than 
VerDate Nov 24 2008 
23:18 Jun 20, 2009
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H2975.IH
H2975
pwalker on PROD1PC71 with BILLS
the maximum permitted under this section. The require-
ment for court supervision in the first two sentences of 
subsection (a) applies only in civil actions. 
SEC. 6. ADDITIONAL HEALTH BENEFITS. 
In any health care lawsuit involving injury or wrong-
ful death, any party may introduce evidence of collateral 
source benefits. If a party elects to introduce such evi-
dence, any opposing party may introduce evidence of any 
amount paid or contributed or reasonably likely to be paid 
or contributed in the future by or on behalf of the oppos-
ing party to secure the right to such collateral source bene-
fits. No provider of collateral source benefits shall recover 
any amount against the claimant or receive any lien or 
credit against the claimant’s recovery or be equitably or 
legally subrogated to the right of the claimant in a health 
care lawsuit involving injury or wrongful death. This sec-
tion shall apply to any health care lawsuit that is settled 
as well as a health care lawsuit that is resolved by a fact 
finder. This section shall not apply to section 1862(b) (42 
U.S.C. 1395y(b)) or section 1902(a)(25) (42 U.S.C. 
1396a(a)(25)) of the Social Security Act. 
SEC. 7. PUNITIVE DAMAGES. 
(a) IN GENERAL.—Punitive damages may, if other-
wise permitted by applicable State or Federal law, be 
awarded against any person in a health care lawsuit only 
VerDate Nov 24 2008 
23:18 Jun 20, 2009
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H2975.IH
H2975
pwalker on PROD1PC71 with BILLS
if it is proven by clear and convincing evidence that such 
person acted with malicious intent to injure the claimant, 
or that such person deliberately failed to avoid unneces-
sary injury that such person knew the claimant was sub-
stantially certain to suffer. In any health care lawsuit 
where no judgment for compensatory damages is rendered 
against such person, no punitive damages may be awarded 
with respect to the claim in such lawsuit. No demand for 
punitive damages shall be included in a health care lawsuit 
as initially filed. A court may allow a claimant to file an 
amended pleading for punitive damages only upon a mo-
tion by the claimant and after a finding by the court, upon 
review of supporting and opposing affidavits or after a 
hearing, after weighing the evidence, that the claimant has 
established by a substantial probability that the claimant 
will prevail on the claim for punitive damages. At the re-
quest of any party in a health care lawsuit, the trier of 
fact shall consider in a separate proceeding— 
(1) whether punitive damages are to be award-
ed and the amount of such award; and 
(2) the amount of punitive damages following a 
determination of punitive liability. 
If a separate proceeding is requested, evidence relevant 
only to the claim for punitive damages, as determined by 
applicable State law, shall be inadmissible in any pro-
VerDate Nov 24 2008 
23:18 Jun 20, 2009
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H2975.IH
H2975
pwalker on PROD1PC71 with BILLS
ceeding to determine whether compensatory damages are 
to be awarded. 
(b) DETERMINING AMOUNT
OF PUNITIVE DAM-
AGES.— 
(1) FACTORS
CONSIDERED.—In determining 
the amount of punitive damages, if awarded, in a 
health care lawsuit, the trier of fact shall consider 
only the following— 
(A) the severity of the harm caused by the 
conduct of such party; 
(B) the duration of the conduct or any 
concealment of it by such party; 
(C) the profitability of the conduct to such 
party; 
(D) the number of products sold or med-
ical procedures rendered for compensation, as 
the case may be, by such party, of the kind 
causing the harm complained of by the claim-
ant; 
(E) any criminal penalties imposed on such 
party, as a result of the conduct complained of 
by the claimant; and 
(F) the amount of any civil fines assessed 
against such party as a result of the conduct 
complained of by the claimant. 
VerDate Nov 24 2008 
23:18 Jun 20, 2009
Jkt 079200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H2975.IH
H2975
pwalker on PROD1PC71 with BILLS
SEC. 8. AUTHORIZATION OF PAYMENT OF FUTURE DAM-
AGES TO CLAIMANTS IN HEALTH CARE LAW-
SUITS. 
(a) IN GENERAL.—In any health care lawsuit, if an 
award of future damages, without reduction to present 
value, equaling or exceeding $50,000 is made against a 
party with sufficient insurance or other assets to fund a 
periodic payment of such a judgment, the court shall, at 
the request of any party, enter a judgment ordering that 
the future damages be paid by periodic payments in ac-
cordance with the Uniform Periodic Payment of Judg-
ments Act promulgated by the National Conference of 
Commissioners on Uniform State Laws. 
(b) APPLICABILITY.—This section applies to all ac-
tions which have not been first set for trial or retrial be-
fore the effective date of this Act. 
SEC. 9. DEFINITIONS. 
In this Act: 
(1) ALTERNATIVE DISPUTE RESOLUTION SYS-
TEM; ADR.—The term ‘‘alternative dispute resolution 
system’’ or ‘‘ADR’’ means a system that provides 
for the resolution of health care lawsuits in a man-
ner other than through a civil action brought in a 
State or Federal court. 
(2) CLAIMANT.—The term ‘‘claimant’’ means 
any person who brings a health care lawsuit, includ-
VerDate Nov 24 2008 
23:18 Jun 20, 2009
Jkt 079200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H2975.IH
H2975
pwalker on PROD1PC71 with BILLS
ing a person who asserts or claims a right to legal 
or equitable contribution, indemnity or subrogation, 
arising out of a health care liability claim or action, 
and any person on whose behalf such a claim is as-
serted or such an action is brought, whether de-
ceased, incompetent, or a minor. 
(3) COLLATERAL
SOURCE
BENEFITS.—The 
term ‘‘collateral source benefits’’ means any amount 
paid or reasonably likely to be paid in the future to 
or on behalf of the claimant, or any service, product 
or other benefit provided or reasonably likely to be 
provided in the future to or on behalf of the claim-
ant, as a result of the injury or wrongful death, pur-
suant to— 
(A) any State or Federal health, sickness, 
income-disability, accident, or workers’ com-
pensation law; 
(B) any health, sickness, income-disability, 
or accident insurance that provides health bene-
fits or income-disability coverage; 
(C) any contract or agreement of any 
group, organization, partnership, or corporation 
to provide, pay for, or reimburse the cost of 
medical, hospital, dental, or income disability 
benefits; and 
VerDate Nov 24 2008 
23:18 Jun 20, 2009
Jkt 079200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H2975.IH
H2975
pwalker on PROD1PC71 with BILLS
(D) any other publicly or privately funded 
program. 
(4) 
COMPENSATORY
DAMAGES.—The 
term 
‘‘compensatory damages’’ means objectively verifi-
able monetary losses incurred as a result of the pro-
vision of, use of, or payment for (or failure to pro-
vide, use, or pay for) health care services or medical 
products, such as past and future medical expenses, 
loss of past and future earnings, cost of obtaining 
domestic services, loss of employment, and loss of 
business or employment opportunities, damages for 
physical and emotional pain, suffering, inconven-
ience, physical impairment, mental anguish, dis-
figurement, loss of enjoyment of life, loss of society 
and companionship, loss of consortium (other than 
loss of domestic service), hedonic damages, injury to 
reputation, and all other nonpecuniary losses of any 
kind or nature. The term ‘‘compensatory damages’’ 
includes economic damages and noneconomic dam-
ages, as such terms are defined in this section. 
(5) CONTINGENT FEE.—The term ‘‘contingent 
fee’’ includes all compensation to any person or per-
sons which is payable only if a recovery is effected 
on behalf of one or more claimants. 
VerDate Nov 24 2008 
23:18 Jun 20, 2009
Jkt 079200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H2975.IH
H2975
pwalker on PROD1PC71 with BILLS
(6) ECONOMIC DAMAGES.—The term ‘‘economic 
damages’’ means objectively verifiable monetary 
losses incurred as a result of the provision of, use 
of, or payment for (or failure to provide, use, or pay 
for) health care services or medical products, such as 
past and future medical expenses, loss of past and 
future earnings, cost of obtaining domestic services, 
loss of employment, and loss of business or employ-
ment opportunities. 
(7) HEALTH
CARE
INSTITUTION.—The term 
‘‘health care institution’’ means any entity licensed 
under Federal or State law to provide health care 
services (including but not limited to ambulatory 
surgical centers, assisted living facilities, emergency 
medical services providers, hospices, hospitals and 
hospital systems, nursing homes, or other entities li-
censed to provide such services). 
(8) 
HEALTH
CARE
LAWSUIT.—The 
term 
‘‘health care lawsuit’’ means any health care liability 
claim concerning the provision of health care goods 
or services or any medical product affecting inter-
state commerce, or any health care liability action 
concerning the provision of health care goods or 
services or any medical product affecting interstate 
commerce, brought in a State or Federal court or 
VerDate Nov 24 2008 
23:18 Jun 20, 2009
Jkt 079200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H2975.IH
H2975
pwalker on PROD1PC71 with BILLS
pursuant to an alternative dispute resolution system, 
against a health care provider or a health care insti-
tution, regardless of the theory of liability on which 
the claim is based, or the number of claimants, 
plaintiffs, defendants, or other parties, or the num-
ber of claims or causes of action, in which the claim-
ant alleges a health care liability claim. Such term 
does not include a claim or action which is based on 
criminal liability; which seeks civil fines or penalties 
paid to Federal, State, or local government; or which 
is grounded in antitrust. 
(9) HEALTH
CARE
LIABILITY
ACTION.—The 
term ‘‘health care liability action’’ means a civil ac-
tion brought in a State or Federal Court or pursu-
ant to an alternative dispute resolution system, 
against a health care provider or a health care insti-
tution, regardless of the theory of liability on which 
the claim is based, or the number of plaintiffs, de-
fendants, or other parties, or the number of causes 
of action, in which the claimant alleges a health care 
liability claim. 
(10) HEALTH
CARE
LIABILITY
CLAIM.—The 
term ‘‘health care liability claim’’ means a demand 
by any person, whether or not pursuant to ADR, 
against a health care provider or health care institu-
VerDate Nov 24 2008 
23:18 Jun 20, 2009
Jkt 079200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H2975.IH
H2975
pwalker on PROD1PC71 with BILLS
tion, including, but not limited to, third-party 
claims, cross-claims, counter-claims, or contribution 
claims, which are based upon the provision of, use 
of, or payment for (or the failure to provide, use, or 
pay for) health care services or medical products, re-
gardless of the theory of liability on which the claim 
is based, or the number of plaintiffs, defendants, or 
other parties, or the number of causes of action. 
(11) HEALTH CARE PROVIDER.— 
(A) IN GENERAL.—The term ‘‘health care 
provider’’ means any person (including but not 
limited to a physician (as defined by section 
1861(r) of the Social Security Act (42 U.S.C. 
1395x(r)), registered nurse, dentist, podiatrist, 
pharmacist, chiropractor, or optometrist) re-
quired by State or Federal law to be licensed, 
registered, or certified to provide health care 
services, and being either so licensed, reg-
istered, or certified, or exempted from such re-
quirement by other statute or regulation. 
(B) TREATMENT
OF
CERTAIN
PROFES-
SIONAL
ASSOCIATIONS.—For purposes of this 
Act, a professional association that is organized 
under State law by an individual physician or 
group of physicians, a partnership or limited li-
VerDate Nov 24 2008 
23:18 Jun 20, 2009
Jkt 079200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H2975.IH
H2975
pwalker on PROD1PC71 with BILLS
ability partnership formed by a group of physi-
cians, a nonprofit health corporation certified 
under State law, or a company formed by a 
group of physicians under State law shall be 
treated as a health care provider under sub-
paragraph (A). 
(12) HEALTH CARE GOODS OR SERVICES.—The 
term ‘‘health care goods or services’’ means any 
goods or services provided by a health care institu-
tion, a health care provider, or by any individual 
working under the supervision of a health care pro-
vider, that relates to the diagnosis, prevention, or 
treatment of any human disease or impairment, or 
the assessment or care of the health of human 
beings. 
(13) MALICIOUS
INTENT
TO
INJURE.—The 
term ‘‘malicious intent to injure’’ means inten-
tionally causing or attempting to cause physical in-
jury other than providing health care goods or serv-
ices. 
(14) MEDICAL PRODUCT.—The term ‘‘medical 
product’’ means a drug, device, or biological product 
intended for humans, and the terms ‘‘drug’’, ‘‘de-
vice’’, and ‘‘biological product’’ have the meanings 
given such terms in sections 201(g)(1) and 201(h) 
VerDate Nov 24 2008 
23:18 Jun 20, 2009
Jkt 079200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H2975.IH
H2975
pwalker on PROD1PC71 with BILLS
of the Federal Food, Drug and Cosmetic Act (21 
U.S.C. 321) and section 351(a) of the Public Health 
Service Act (42 U.S.C. 262(a)), respectively, includ-
ing any component or raw material used therein, but 
excluding health care services. 
(15) 
NONECONOMIC
DAMAGES.—The 
term 
‘‘noneconomic damages’’ means damages for phys-
ical and emotional pain, suffering, inconvenience, 
physical impairment, mental anguish, disfigurement, 
loss of enjoyment of life, loss of society and compan-
ionship, loss of consortium (other than loss of do-
mestic service), hedonic damages, injury to reputa-
tion, and all other nonpecuniary losses of any kind 
or nature. 
(16) PUNITIVE DAMAGES.—The term ‘‘punitive 
damages’’ means damages awarded, for the purpose 
of punishment or deterrence, and not solely for com-
pensatory purposes, against a health care provider 
or health care institution. Punitive damages are nei-
ther economic nor noneconomic damages. 
(17) RECOVERY.—The term ‘‘recovery’’ means 
the net sum recovered after deducting any disburse-
ments or costs incurred in connection with prosecu-
tion or settlement of the claim, including all costs 
paid or advanced by any person. Costs of health care 
VerDate Nov 24 2008 
23:18 Jun 20, 2009
Jkt 079200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H2975.IH
H2975
pwalker on PROD1PC71 with BILLS
incurred by the plaintiff and the attorney’s office 
overhead costs or charges for legal services are not 
deductible disbursements or costs for such purpose. 
(18) STATE.—The term ‘‘State’’ means each of 
the several States, the District of Columbia, the 
Commonwealth of Puerto Rico, the Virgin Islands, 
Guam, American Samoa, the Northern Mariana Is-
lands, the Trust Territory of the Pacific Islands, and 
any other territory or possession of the United 
States, or any political subdivision thereof. 
SEC. 10. EFFECT ON OTHER LAWS. 
(a) VACCINE INJURY.— 
(1) To the extent that title XXI of the Public 
Health Service Act establishes a Federal rule of law 
applicable to a civil action brought for a vaccine-re-
lated injury or death— 
(A) this Act does not affect the application 
of the rule of law to such an action; and 
(B) any rule of law prescribed by this Act 
in conflict with a rule of law of such title XXI 
shall not apply to such action. 
(2) If there is an aspect of a civil action 
brought for a vaccine-related injury or death to 
which a Federal rule of law under title XXI of the 
Public Health Service Act does not apply, then this 
VerDate Nov 24 2008 
23:18 Jun 20, 2009
Jkt 079200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H2975.IH
H2975
pwalker on PROD1PC71 with BILLS
Act or otherwise applicable law (as determined 
under this Act) will apply to such aspect of such ac-
tion. 
(b) OTHER FEDERAL LAW.—Except as provided in 
this section, nothing in this Act shall be deemed to affect 
any defense available to a defendant in a health care law-
suit or action under any other provision of Federal law. 
SEC. 11. STATE FLEXIBILITY AND PROTECTION OF STATES’ 
RIGHTS. 
(a) HEALTH CARE LAWSUITS.—The provisions gov-
erning health care lawsuits set forth in this Act preempt, 
subject to subsections (b) and (c), State law to the extent 
that State law prevents the application of any provisions 
of law established by or under this Act. The provisions 
governing health care lawsuits set forth in this Act super-
sede chapter 171 of title 28, United States Code, to the 
extent that such chapter— 
(1) provides for a greater amount of damages 
or contingent fees, a longer period in which a health 
care lawsuit may be commenced, or a reduced appli-
cability or scope of periodic payment of future dam-
ages, than provided in this Act; or 
(2) prohibits the introduction of evidence re-
garding collateral source benefits, or mandates or 
VerDate Nov 24 2008 
23:18 Jun 20, 2009
Jkt 079200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6201
E:\BILLS\H2975.IH
H2975
pwalker on PROD1PC71 with BILLS
permits subrogation or a lien on collateral source 
benefits. 
(b) PREEMPTION OF CERTAIN STATE LAWS.—The 
provisions of this Act shall preempt any constitutional pro-
vision, statute, or rule of State law, whether enacted prior 
to, on, or after the date of enactment of this Act, that— 
(1) prohibits the application of any limitation 
on the amount of compensatory, punitive, or total 
damages in a health care lawsuit; or 
(2) provides for a greater amount of compen-
satory, punitive, or total damages in a health care 
lawsuit than those provided for under this Act. 
(c) PROTECTION OF STATE’S RIGHTS AND OTHER 
LAWS.— 
(1) IN GENERAL.—Any issue that is not gov-
erned by a provision of law established by or under 
this Act (including the State standards of neg-
ligence) shall be governed by otherwise applicable 
Federal or State law. 
(2) RULE OF CONSTRUCTION.—Nothing in this 
Act shall be construed to— 
(A) preempt or supersede any Federal or 
State law that imposes greater procedural or 
substantive protections (such as a shorter stat-
ute of limitations) for a health care provider or 
VerDate Nov 24 2008 
23:18 Jun 20, 2009
Jkt 079200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6201
E:\BILLS\H2975.IH
H2975
pwalker on PROD1PC71 with BILLS
health care institution from liability, loss, or 
damages than those provided by this Act; 
(B) create a cause of action that is not 
otherwise available under Federal or State law; 
or 
(C) affect the scope of preemption of any 
other Federal law. 
SEC. 12. APPLICABILITY; EFFECTIVE DATE. 
This Act shall apply to any health care lawsuit 
brought in a Federal or State court, or subject to an alter-
native dispute resolution system, that is initiated on or 
after the date of the enactment of this Act, except that 
any health care lawsuit arising from an injury occurring 
prior to the date of the enactment of this Act shall be 
governed by the applicable statute of limitations provisions 
in effect at the time the injury occurred. 
Æ 
VerDate Nov 24 2008 
23:18 Jun 20, 2009
Jkt 079200
PO 00000
Frm 00022
Fmt 6652
Sfmt 6301
E:\BILLS\H2975.IH
H2975
pwalker on PROD1PC71 with BILLS