in an amount more than $250,000, adjusted for inflation 
from 1975 as provided in subsection (b). This limitation 
applies separately to each person entitled to recover such 
damages. 
(b) ADJUSTMENT FOR INFLATION FROM 1975.— 
(1) PUBLICATION BY SECRETARY OF LABOR.— 
On or about December 1 of each year, the Secretary 
of Labor shall publish in the Federal Register a dol-
lar amount determined by adjusting the dollar 
amount specified in subsection (a) according to the 
adjustments in the Consumer Price Index of the Bu-
reau of Labor Statistics of the Department of Labor 
for the period beginning on or about October 1, 
1975, and ending on or about October 1 of that 
year. 
(2) APPLICABILITY.—For purposes of sub-
section (a), the dollar amount that applies to a cal-
endar year is the dollar amount published on or 
about December 1 of the preceding year. 
(3) ESTIMATION.—Congress estimates that the 
dollar amount that would apply to calendar year 
2005 would be approximately $878,000, though the 
dollar amount published under paragraph (1), rather 
than the estimation in this paragraph, is to be ap-
plied. 
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(c) APPLICABILITY.— 
(1) IN GENERAL.—Subject to paragraph (2), 
this section applies whenever the amount of a recov-
ery is made final in a calendar year after the date 
of the enactment of this Act. In applying the dollar 
amount to a recovery, all recoveries made final 
(whether before or after the date of the enactment 
of this Act) are included in the aggregate. 
(2) NOT APPLICABLE WHEN STATE BOARD NOT 
IN COMPLIANCE.—During a period in which a State 
medical board is not in compliance with the vol-
untary performance standards developed under sec-
tion 103 or is failing to submit the information de-
scribed in paragraphs (2) and (3)(A) of section 
104(b) (as determined by the Secretary under sec-
tion 103 or 104, respectively), the limitation in sub-
section (a) does not apply to liability arising under 
the law of that State. 
(d) RELATIONSHIP TO STATE LAW.—This section op-
erates on a case-by-case basis to provide a maximum re-
covery and to prevent State law from providing a recovery 
above that maximum. It does not prevent State law from 
providing a recovery below that maximum. 
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SEC. 102. SANCTIONS FOR MERITLESS ACTIONS AND 
PLEADINGS. 
(a) SIGNATURE REQUIRED.—Every pleading, written 
motion, and other paper in any medical malpractice action 
shall be signed by at least 1 attorney of record in the at-
torney’s individual name, or, if the party is not rep-
resented by an attorney, shall be signed by the party. Each 
paper shall state the signer’s address and telephone num-
ber, if any. An unsigned paper shall be stricken unless 
omission of the signature is corrected promptly after being 
called to the attention of the attorney or party. 
(b) CERTIFICATE OF MERIT.— 
(1) IN GENERAL.—A medical malpractice action 
shall be dismissed unless the attorney or unrepre-
sented party presenting the complaint certifies that, 
to the best of the person’s knowledge, information, 
and belief, formed after an inquiry reasonable under 
the circumstances— 
(A) it is not being presented for any im-
proper purpose, such as to harass or to cause 
unnecessary delay or needless increase in the 
cost of litigation; 
(B) the claims and other legal contentions 
therein are warranted by existing law or by a 
nonfrivolous argument for the extension, modi-
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fication, or reversal of existing law or the estab-
lishment of new law; and 
(C) the allegations and other factual con-
tentions have evidentiary support or, if specifi-
cally so identified, are likely to have evidentiary 
support after a reasonable opportunity for fur-
ther investigation and discovery. 
(2) PAPER
CONSIDERED
TO
BE
A
CERTIFI-
CATION.—By presenting to the court (whether by 
signing, filing, submitting, or later advocating) a 
pleading, written motion, or other paper, an attorney 
or unrepresented party is certifying that to the best 
of the person’s knowledge, information and belief, 
formed after an inquiry reasonable under the cir-
cumstances— 
(A) it is not being presented for any im-
proper purpose, such as to harass or to cause 
unnecessary delay or needless increase in the 
cost of litigation; 
(B) the claims, defenses, and other legal 
contentions therein are warranted by existing 
law or by a nonfrivolous argument for the ex-
tension, modification, or reversal of existing law 
or the establishment of new law; and 
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(C) the allegations and other factual con-
tentions have evidentiary support or, if specifi-
cally so identified, are reasonable based on a 
lack of information or belief. 
(c) MANDATORY SANCTIONS.— 
(1) FIRST VIOLATION.—If, after notice and a 
reasonable opportunity to respond, a court, upon 
motion or upon its own initiative, determines that 
subsection (b) has been violated, the court shall find 
each attorney or party in violation in contempt of 
court and shall require the payment of costs and at-
torneys fees. The court may also impose additional 
appropriate sanctions, such as striking the plead-
ings, dismissing the suit, and sanctions plus interest, 
upon the person in violation, or upon both such per-
son and such person’s attorney or client (as the case 
may be). 
(2) SECOND VIOLATION.—If, after notice and a 
reasonable opportunity to respond, a court, upon 
motion or upon its own initiative, determines that 
subsection (b) has been violated and that the attor-
ney or party with respect to which the determination 
was made has committed one previous violation of 
subsection (b) before this or any other court, the 
court shall find each such attorney or party in con-
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tempt of court and shall require the payment of 
costs and attorneys fees, and require such person in 
violation (or both such person and such person’s at-
torney or client (as the case may be)) to pay a mon-
etary fine. The court may also impose additional ap-
propriate sanctions, such as striking the pleadings, 
dismissing the suit and sanctions plus interest, upon 
such person in violation, or upon both such person 
and such person’s attorney or client (as the case 
may be). 
(3) THIRD AND SUBSEQUENT VIOLATIONS.—If, 
after notice and a reasonable opportunity to re-
spond, a court, upon motion or upon its own initia-
tive, determines that subsection (b) has been vio-
lated and that the attorney or party with respect to 
which the determination was made has committed 
more than one previous violation of subsection (b) 
before this or any other court, the court shall find 
each such attorney or party in contempt of court, 
refer each such attorney to one or more appropriate 
State bar associations for disciplinary proceedings, 
require the payment of costs and attorneys fees, and 
require such person in violation (or both such person 
and such person’s attorney or client (as the case 
may be)) to pay a monetary fine. The court may 
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also impose additional appropriate sanctions, such as 
striking the pleadings, dismissing the suit, and sanc-
tions plus interest, upon such person in violation, or 
upon both such person and such person’s attorney or 
client (as the case may be). 
(d) CENTRAL TRACKING DATABASE.—The Attorney 
General shall establish and maintain a central tracking 
database reporting system to which courts are to report 
violations of subsection (b). The database shall include all 
identifying information with respect to the attorney or the 
party (if not represented by an attorney). The Attorney 
General shall permit courts to consult the database to de-
termine the extent to which an attorney or party has vio-
lated subsection (b) previously. 
SEC. 103. PERFORMANCE STANDARDS APPLICABLE TO 
STATE MEDICAL BOARDS. 
(a) DEVELOPMENT.—Not later than 1 year after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services, in consultation with the Federation 
of State Medical Boards, shall develop and make publicly 
available voluntary performance standards applicable to 
State medical boards. 
(b) CONTENTS.—In developing performance stand-
ards under this section, the Secretary shall include stand-
ards to require the following: 
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(1) Processing patient complaints within a spec-
ified limited period of time. 
(2) Maintaining a website or toll-free telephone 
number to enable a patient submitting a complaint 
to track the status of the complaint. 
(3) Maintaining an adequate level of staff for 
the activities of the State medical board. 
(4) Ensuring that staff are qualified. 
(5) Making the following information available 
to the public for physicians: 
(A) Each physician’s education and train-
ing. 
(B) Each physician’s medical specialties. 
(C) For each physician a description of 
medical malpractice claims paid, hospital dis-
ciplinary actions taken, criminal convictions oc-
curring, and disciplinary actions taken by the 
State medical board, within the previous 10 
years. 
(D) At the option of a State medical 
board, each physician’s professional demo-
graphics (such as business address, insurance 
plan and hospital affiliations, and available 
translation services), professional or community 
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awards received, and research or other profes-
sional publications. 
(6) Issuing an annual report that includes ag-
gregate disciplinary statistics, including— 
(A) statistics on the number and type of 
complaints received; and 
(B) with respect to physicians, statistics on 
the number and type of complaints received, 
disaggregated by the medical school and grad-
uate medical education program completed by 
the physicians involved. 
(7) Such other issues as the Secretary deter-
mines appropriate. 
(c) DETERMINATION REQUIRED.—For the period be-
ginning 3 years after the date of the enactment of this 
Act, the Secretary shall determine whether the State med-
ical board of each State is in compliance with the vol-
untary performance standards developed under subsection 
(a). 
(d) DETERMINATION OF NONCOMPLIANCE.—Before 
making a determination under subsection (c) that a State 
medical board is not in compliance with the voluntary per-
formance standards developed under subsection (a), the 
Secretary shall— 
(1) propose a determination of noncompliance; 
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(2) identify the reasons for such noncompliance; 
and 
(3) give the State medical board an opportunity 
to correct such noncompliance. 
(e) REVISION OF DETERMINATIONS.—The Secretary 
shall periodically review and, as necessary, revise deter-
minations of compliance and noncompliance under sub-
section (c). 
(f) REPORT BY SECRETARY.—Not later than 5 years 
after the date of the enactment of this Act, and annually 
thereafter, the Secretary shall submit a report to the Con-
gress on the activities of the Secretary under this section, 
including a listing of the State medical boards determined 
by the Secretary to be in compliance or not in compliance 
with the voluntary standards developed under subsection 
(a). 
SEC. 104. INTERSTATE PATIENT REPORTING AND PHYSI-
CIAN TRACKING DATABASE. 
(a) ESTABLISHMENT.—The Secretary of Health and 
Human Services shall establish and maintain an interstate 
patient reporting and physician tracking database (in this 
section referred to as the ‘‘database’’) . 
(b) DATABASE CONTENTS.— 
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(1) IN GENERAL.—The database shall consist of 
information about physicians voluntarily submitted 
to the database by— 
(A) State medical boards; and 
(B) patients. 
(2) 
SUBMISSIONS
BY
STATE
MEDICAL 
BOARDS.—The database shall encourage the State 
medical board of each State to submit, with respect 
to each physician licensed by the State, the fol-
lowing: 
(A) The physician’s identity. 
(B) The physician’s education and train-
ing. 
(C) The physician’s medical specialties. 
(D) A description of medical malpractice 
claims paid, hospital disciplinary actions taken, 
criminal convictions occurring, and disciplinary 
actions taken by the State medical board, with-
in the previous 10 years. 
(3) 
PATIENT
COMPLAINTS.—The 
database 
shall— 
(A) encourage the State medical board of 
each State to submit, with respect to each phy-
sician licensed by the State, a description of 
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pending patient complaints about the physician; 
and 
(B) allow patients to submit complaints 
about physicians directly to the database. 
(c) AVAILABILITY OF INFORMATION.— 
(1) IN GENERAL.—The information submitted 
to the database pursuant to subsection (b)(2) shall 
be available to the public, including by means of the 
Internet and a toll-free telephone number. 
(2) PATIENT COMPLAINTS.— 
(A) CONFIDENTIALITY.—Any patient com-
plaint about a physician submitted to the data-
base shall be kept confidential and shall not be 
subject to disclosure under section 552 of title 
5, United States Code. Except as provided in 
subparagraph (B), the database may disclose 
information derived from such a patient com-
plaint only if the information is not individually 
identifiable. 
(B) TRACKING
PATIENT
COMPLAINTS.— 
The database shall— 
(i) assign a tracking number to each 
patient complaint submitted to the data-
base pursuant to subsection (b)(3); 
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(ii) provide notice and a description of 
each patient complaint submitted pursuant 
to subsection (b)(3)(B) to the applicable 
State medical board; and 
(iii) allow the patient making any 
complaint submitted to the database pur-
suant to subsection (b)(3) to track the sta-
tus of the complaint, including by means of 
the Internet and a toll-free telephone num-
ber. 
(C) ANALYSIS.—Subject to subparagraph 
(A), the Secretary of Health and Human Serv-
ices shall conduct analysis of patient complaints 
submitted to the database, including complaints 
that do not result in disciplinary action, and 
use the data and conclusions derived from such 
analysis to provide timely public health safety 
information to health care consumers and prac-
titioners. 
(d) TECHNICAL
ASSISTANCE.—The Secretary of 
Health and Human Services shall provide technical assist-
ance to States to facilitate the exchange of information 
between State medical boards and the database. 
(e) DETERMINATION REQUIRED.—For the period be-
ginning 3 years after the date of the enactment of this 
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Act, the Secretary shall determine whether the State med-
ical board of each State is failing to submit the informa-
tion described in subsections (b)(2) and (b)(3)(A). 
(f) DETERMINATION OF NONCOMPLIANCE.—Before 
making a determination under subsection (e) that a State 
medical board is failing to submit such information, the 
Secretary shall— 
(1) propose a determination of noncompliance; 
(2) identify the reasons for such noncompliance; 
and 
(3) give the State medical board an opportunity 
to correct such noncompliance. 
(g) REVISION OF DETERMINATIONS.—The Secretary 
shall periodically review and, as necessary, revise deter-
minations of compliance and noncompliance under sub-
section (e). 
(h) ASSESSMENT.—Not later than 3 years after the 
date of the enactment of this Act, the Secretary shall— 
(1) conduct an assessment of the database, in-
cluding an assessment of the value of the database 
to patients and the effect of the database on physi-
cians; and 
(2) submit a report to the Congress on the re-
sults of the assessment, including any recommenda-
tions for improvement of the database. 
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SEC. 105. DEFINITIONS. 
In this title: 
(1) The term ‘‘State medical board’’ means a 
State entity responsible for licensing physicians or a 
subdivision of such an entity. 
(2) The term ‘‘health care malpractice’’ means 
the negligence or other fault of a health care pro-
vider. 
(3) The term ‘‘health care provider’’ means— 
(A) any individual who is engaged in the 
delivery of health care services in a State and 
who is required by State law or regulation to be 
licensed or certified by the State to engage in 
the delivery of such services in the State; and 
(B) any entity that is engaged in the deliv-
ery of health care services in a State and that, 
if it is required by State law or regulation to be 
licensed or certified by the State to engage in 
the delivery of such services in the State, is so 
licensed. 
(4) The term ‘‘State’’ includes the District of 
Columbia, the Commonwealth of Puerto Rico, and 
other territories and possessions of the United 
States. 
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TITLE II—HEALTH CARE MAL-
PRACTICE 
LIABILITY 
MEDI-
ATION PROGRAMS 
SEC. 201. GRANTS TO STATES AND HEALTH CARE ENTITIES 
FOR MEDIATION PROGRAMS. 
(a) GRANTS AUTHORIZED.—From amounts made 
available to carry out this section, the Attorney General 
shall carry out a program under which the Attorney Gen-
eral makes grants to States and health care entities to 
carry out mediation programs described in subsection (b). 
(b) MEDIATION PROGRAMS.—A mediation program 
referred to in subsection (a) is a program, based on the 
Rush model, under which an allegation that an individual 
has been injured or has died as the result of health care 
malpractice is mediated by those parties consenting to do 
so in an effort to resolve the matter without litigation. 
(c) RUSH MODEL.—For purposes of this section, a 
program is based on the Rush model if the program satis-
fies each of the following: 
(1) Participation by the parties in the medi-
ation is voluntary. 
(2) The mediator is neutral, having no interest 
in or power to determine the outcome of the pro-
ceedings. 
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(3) The site of the mediation conference is held 
in a neutral setting, one that the parties mutually 
agree upon. 
(4) At the commencement of a mediation, the 
parties enter into a mediation agreement that— 
(A) states that the parties— 
(i) will not request or subpoena the 
mediator to testify or produce any docu-
ments or other information in any pro-
ceeding related to the mediation; and 
(ii) will defend and indemnify the me-
diator in connection with any summons or 
subpoena arising out of the mediation pro-
ceeding; 
(B) provides for confidentiality of the me-
diation proceedings; and 
(C) states that any apology or expression 
of remorse by a health care provider or other 
entity at any time during the mediation pro-
ceedings will be kept confidential and will not 
be used in any subsequent legal proceeding. 
(5) The program is similar to the mediation 
program carried out as of January 1, 2005, at 
Rush-Presbyterian-St. Luke’s Medical Center in Chi-
cago, Illinois. 
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(d) DEFINITIONS.—In this section: 
(1) The term ‘‘health care entity’’ means an en-
tity covered by section 105(3)(B). 
(2) The term ‘‘health care malpractice’’ has the 
meaning given such term in section 105. 
(3) The term ‘‘State’’ has the meaning given 
such term in section 105. 
SEC. 202. TRAINING AND ASSISTANCE FOR MEDIATION 
PROGRAMS. 
From amounts made available to carry out this sec-
tion, the Attorney General shall carry out a program 
under which the Attorney General provides training and 
assistance to recipients of grant amounts under section 
201 to carry out mediation programs under that section. 
SEC. 203. AUTHORIZATION OF APPROPRIATIONS. 
There are authorized to be appropriated to the Attor-
ney General such sums as may be necessary to carry out 
sections 201 and 202. 
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