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(I) Death.
(3) FACTORS CONSIDERED.—In developing lim-
its under paragraph (1) for each of the categories
described in paragraph (2), the Commission shall—
(A) examine the most recent available data
on the amount of damages awarded with re-
spect to such claims; and
(B) set specific limits that reasonably com-
pensate most injured parties at the level of
compensation currently provided, excluding
those levels of compensation that the Commis-
sion finds unreasonably large.
(4) 
CONSULTATION.—In 
developing 
limits
under this subsection, the Commission shall consult
with representatives of each of the following:
(A) Attorneys who represent plaintiffs in
medical malpractice liability actions.
(B) Attorneys who represent health care
professionals and health care providers in medi-
cal malpractice liability actions.
(C) Physicians and other health care pro-
fessionals and providers.
(D) Individuals who have suffered injury
as a result of medical malpractice.
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(E) Judges who preside over medical mal-
practice liability actions.
(F) Medical ethicists.
(G) Health care economists.
(H) Liability insurers.
(5) 
GUIDANCE
TO
ENTITIES
RESOLVING
CLAIMS.—If Congress enacts legislation that imposes
the limits developed by the Commission under this
subsection on the amount of noneconomic damages
that may be awarded with respect to medical mal-
practice liability claims, the Commission shall pre-
pare and disseminate guidelines to assist courts and
other entities resolving such claims in the determina-
tion of the particular category of injury specified in
paragraph (2) to which a claimant’s injury shall be
assigned for purposes of applying the appropriate
limit on such damages.
SEC. 5105. PERIODIC PAYMENTS FOR FUTURE LOSSES.
(a) IN GENERAL.—In any medical malpractice liabil-
ity action in which the damages awarded for future eco-
nomic loss exceeds $100,000, a defendant may not be re-
quired to pay such damages in a single, lump-sum pay-
ment, but may be permitted to make such payments on
a periodic basis. The periods for such payments shall be
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determined by the court, based upon projections of when
such expenses are likely to be incurred.
(b) WAIVER.—A court may waive the application of
subsection (a) with respect to a defendant if the court de-
termines that it is not in the best interests of the plaintiff
to receive payments for damages on such a periodic basis.
SEC. 5106. TREATMENT OF ATTORNEY’S FEES AND OTHER
COSTS.
(a) LIMITATION
ON AMOUNT
OF CONTINGENCY
FEES.—
(1) IN GENERAL.—An attorney who represents,
on a contingency fee basis, a claimant in a medical
malpractice liability claim may not charge, demand,
receive, or collect for services rendered in connection
with such claim in excess of the following amount re-
covered by judgment or settlement under such claim:
(A) 25 percent of the first $150,000 (or
portion thereof) recovered, plus
(B) 10 percent of any amount in excess of
$150,000 recovered.
(2) CALCULATION OF PERIODIC PAYMENTS.—In
the event that a judgment or settlement includes
periodic or future payments of damages, the amount
recovered for purposes of computing the limitation
on the contingency fee under paragraph (1) shall be
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based on the cost of the annuity or trust established
to make the payments. In any case in which an an-
nuity or trust is not established to make such pay-
ments, such amount shall be based on the present
value of the payments.
(b) REQUIRING PARTY CONTESTING ADR RULING
TO PAY ATTORNEY’S FEES AND OTHER COSTS.—
(1) IN GENERAL.—The court in a medical mal-
practice liability action shall require the party that
(pursuant to section 5102(c)(1)) contested the ruling
of the alternative dispute resolution system with re-
spect to the medical malpractice liability claim that
is the subject of the action to pay to the opposing
party the costs incurred by the opposing party under
the action, including attorney’s fees, fees paid to ex-
pert witnesses, and other litigation expenses (but not
including court costs, filing fees, or other expenses
paid directly by the party to the court, or any fees
or costs associated with the resolution of the claim
under the alternative dispute resolution system), but
only if—
(A) in the case of an action in which the
party that contested the ruling is the claimant,
the amount of damages awarded to the party
under the action is not greater than the amount
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of damages awarded to the party under the
ADR system; and
(B) in the case of an action in which the
party that contested the ruling is the defendant,
the amount of damages assessed against the
party under the action is not less than the
amount of damages assessed under the ADR
system.
(2) EXCEPTIONS.—Paragraph (1) shall not
apply if—
(A) the party contesting the ruling made
under the previous alternative dispute resolu-
tion system shows that—
(i) the ruling was procured by corrup-
tion, fraud, or undue means,
(ii) there was partiality or corruption
under the system,
(iii) there was other misconduct under
the system that materially prejudiced the
party’s rights, or
(iv) the ruling was based on an error
of law;
(B) the party contesting the ruling made
under the alternative dispute resolution system
presents new evidence before the trier of fact
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that was not available for presentation under
the ADR system;
(C) the medical malpractice liability action
raised a novel issue of law; or
(D) the court finds that the application of
such paragraph to a party would constitute an
undue hardship, and issues an order waiving or
modifying the application of such paragraph
that specifies the grounds for the court’s deci-
sion.
(3) LIMIT ON ATTORNEY’S FEES PAID.—Attor-
neys’ fees that are required to be paid under para-
graph (1) by the contesting party shall not exceed
the amount of the attorneys’ fees incurred by the
contesting party in the action. If the attorneys’ fees
of the contesting party are based on a contingency
fee agreement, the amount of attorneys’ fees for
purposes of the preceding sentence shall not exceed
the reasonable value of those services.
(4) RECORDS.—In order to receive attorneys’
fees under paragraph (1), counsel of record in the
medical malpractice liability action involved shall
maintain accurate, complete records of hours worked
on the action, regardless of the fee arrangement
with the client involved.
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(c) CONTINGENCY FEE DEFINED.—As used in this
section, the term ‘‘contingency fee’’ means any fee for pro-
fessional legal services which is, in whole or in part, con-
tingent upon the recovery of any amount of damages,
whether through judgment or settlement.
SEC. 5107. UNIFORM STATUTE OF LIMITATIONS.
(a) IN GENERAL.—No medical malpractice claim
may be initiated after the expiration of the 2-year period
that begins on the date on which the alleged injury that
is the subject of such claim was discovered or the date
on which such injury should reasonably have been discov-
ered, whichever is earlier.
(b) EXCEPTION FOR MINORS.—In the case of an al-
leged injury suffered by a minor who has not attained 6
years of age, a medical malpractice claim may be initiated
after the expiration of the period described in subsection
(a) if the claim is initiated before the minor attains 8
years of age.
SEC. 5108. SPECIAL PROVISION FOR CERTAIN OBSTETRIC
SERVICES.
(a) IN GENERAL.—In the case of a medical mal-
practice claim relating to services provided during labor
or the delivery of a baby, if the health care professional
or health care provider against whom the claim is brought
did not previously treat the claimant for the pregnancy,
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the trier of fact may not find that such professional or
provider committed malpractice and may not assess dam-
ages against such professional or provider unless the mal-
practice is proven by clear and convincing evidence.
(b) APPLICABILITY
TO
GROUP
PRACTICES
OR
AGREEMENTS AMONG PROVIDERS.—For purposes of sub-
section (a), a health care professional shall be considered
to have previously treated an individual for a pregnancy
if the professional is a member of a group practice whose
members previously treated the individual for the preg-
nancy or is providing services to the individual during
labor or the delivery of a baby pursuant to an agreement
with another professional.
SEC. 5109. UNIFORM STANDARD FOR DETERMINING LIABIL-
ITY IN ACTIONS BASED ON NEGLIGENCE.
(a) STANDARD
OF REASONABLENESS.—Except as
provided in subsection (b), a defendant in a medical mal-
practice liability action may not be found to have commit-
ted malpractice unless the defendant’s conduct at the time
of providing the health care services that are the subject
of the action was not reasonable.
(b) ACTIONS BROUGHT UNDER STRICT LIABILITY.—
Subsection (a) shall not apply with respect to a medical
malpractice action if (in accordance with applicable State
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law) the theory of liability upon which the action is based
is a theory of strict liability.
SEC. 5110. JURISDICTION OF FEDERAL COURTS.
Nothing in this subtitle shall be construed to estab-
lish jurisdiction over any medical malpractice liability ac-
tion in the district courts of the United States on the basis
of sections 1331 or 1337 of title 28, United States Code.
SEC. 5111. PREEMPTION.
(a) IN GENERAL.—This subtitle supersedes any State
law only to the extent that the State law permits the recov-
ery by a claimant or the assessment against a defendant
of a greater amount of damages or establishes a less strict
standard of proof for determining whether a defendant has
committed malpractice, than the provisions of this sub-
title.
(b) EFFECT ON SOVEREIGN IMMUNITY AND CHOICE
OF LAW OR VENUE.—Nothing in this subtitle shall be con-
strued to—
(1) waive or affect any defense of sovereign im-
munity asserted by any State under any provision of
law;
(2) waive or affect any defense of sovereign im-
munity asserted by the United States;
(3) affect the applicability of any provision of
the Foreign Sovereign Immunities Act of 1976;
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(4) preempt State choice-of-law rules with re-
spect to claims brought by a foreign nation or a citi-
zen of a foreign nation; or
(5) affect the right of any court to transfer
venue or to apply the law of a foreign nation or to
dismiss a claim of a foreign nation or of a citizen
of a foreign nation on the ground in inconvenient
forum.
Subtitle C—Requirements for State
Alternative Dispute Resolution
Systems (ADR)
SEC. 5201. BASIC REQUIREMENTS.
(a) IN GENERAL.—A State’s alternative dispute reso-
lution system meets the requirements of this section if the
system—
(1) applies to all medical malpractice liability
claims under the jurisdiction of the courts of that
State;
(2) requires that a written opinion resolving the
dispute be issued not later than 6 months after the
date by which each party against whom the claim is
filed has received notice of the claim (other than in
exceptional cases for which a longer period is re-
quired for the issuance of such an opinion), and that
the opinion contain—
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(A) findings of fact relating to the dispute,
and
(B) a description of the costs incurred in
resolving the dispute under the system (includ-
ing any fees paid to the individuals hearing and
resolving the claim), together with an appro-
priate assessment of the costs against any of
the parties;
(3) requires individuals who hear and resolve
claims under the system to meet such qualifications
as the State may require (in accordance with regula-
tions of the Secretary);
(4) is approved by the State or by local govern-
ments in the State;
(5) with respect to a State system that consists
of multiple dispute resolution procedures—
(A) permits the parties to a dispute to se-
lect the procedure to be used for the resolution
of the dispute under the system, and
(B) if the parties do not agree on the pro-
cedure to be used for the resolution of the dis-
pute, assigns a particular procedure to the par-
ties;
(6) provides for the transmittal to the State
agency responsible for monitoring or disciplining
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health care professionals and health care providers
of any findings made under the system that such a
professional or provider committed malpractice, un-
less, during the 90-day period beginning on the date
the system resolves the claim against the profes-
sional or provider, the professional or provider
brings an action contesting the decision made under
the system; and
(7) provides for the regular transmittal to the
Administrator for Health Care Policy and Research
of information on disputes resolved under the sys-
tem, in a manner that assures that the identity of
the parties to a dispute shall not be revealed.
(b) APPLICATION
OF
MALPRACTICE
LIABILITY
STANDARDS TO ALTERNATIVE DISPUTE RESOLUTION.—
The provisions of subtitle B (other than sections 5102 and
5103) shall apply with respect to claims brought under
a State alternative dispute resolution system or the alter-
native Federal system in the same manner as such provi-
sions apply with respect to medical malpractice liability
actions brought in the State.
SEC. 5202. CERTIFICATION OF STATE SYSTEMS; APPLICA-
BILITY OF ALTERNATIVE FEDERAL SYSTEM.
(a) CERTIFICATION.—