IB 
Union Calendar No. 20
108TH CONGRESS 
1ST SESSION 
H. R. 5
[Report No. 108–32, Parts I and II] 
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 
FEBRUARY 5, 2003
Mr. GREENWOOD (for himself, Mr. MURTHA, Mr. COX, Mr. SENSENBRENNER, 
Mr. TAUZIN, Mr. THOMAS, Mr. GOODE, Mr. FERGUSON, Mr. GERLACH, 
Mrs. CAPITO, Mr. FEENEY, Mr. KIRK, Mrs. BIGGERT, Mr. PLATTS, Mr. 
SHAYS, Mr. FRELINGHUYSEN, Mr. MURPHY, Mr. PETERSON of Min-
nesota, Mr. LUCAS of Kentucky, Mr. STENHOLM, Mr. TAYLOR of Mis-
sissippi, Mr. HOBSON, Ms. GRANGER, Mrs. JOHNSON of Connecticut, Ms. 
DUNN, Mr. ROGERS of Michigan, Ms. GINNY BROWN-WAITE of Florida, 
Mr. HAYES, Mr. LEACH, Mr. OTTER, Mr. GRAVES, Mr. LATOURETTE, 
Mr. FLETCHER, Mr. WELDON of Florida, Mr. TIBERI, Mr. HAYWORTH, 
Mr. CRANE, Mr. PORTMAN, Mr. SULLIVAN, Mr. SOUDER, Mr. CANNON, 
Mr. SHAW, Mr. MCHUGH, Mr. MCKEON, Mr. LEWIS of Kentucky, Mrs. 
NORTHUP, Mr. SESSIONS, Mr. HULSHOF, Mr. PUTNAM, Mr. GILCHREST, 
Mr. KNOLLENBERG, Mr. HOUGHTON, Mr. REGULA, Mr. TOM DAVIS of 
Virginia, Mr. FORBES, Mr. PETERSON of Pennsylvania, Mr. LOBIONDO, 
Mr. BOEHLERT, Mr. NUSSLE, Mr. SHUSTER, Mr. TIAHRT, Mr. STEARNS, 
Mr. GILLMOR, Ms. HART, Mr. WALSH, Mr. CRENSHAW, Mr. BARTON of 
Texas, Mr. KELLER, and Mr. COLLINS) 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 subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
MARCH 11, 2003
Additional sponsors: Mr. GOODLATTE, Mr. BURGESS, Mr. PICKERING, Mrs. 
KELLY, Mr. TOOMEY, Mr. CHABOT, Mr. PENCE, Mrs. EMERSON, Mr. 
ROGERS of Alabama, Mr. SMITH of Texas, Mr. MCINNIS, Mr. BORDALLO, 
Mr. GINGREY, Mr. EVERETT, Mr. MICA, Mrs. JO ANN DAVIS of Virginia,
Mr. CUNNINGHAM, Mr. BURR, Mr. DREIER, Mr. CANTOR, Mr. 
GALLEGLY, Mr. GARY G. MILLER of Californina, Mr. NEY, Mr. RADANO-
VICH, Mr. FOSSELLA, Mr. WAMP, Mr. WELLER, Mr. KINGSTON, Mr. 
WHITFIELD, Mr. THORNBERRY, Mr. WOLF, Mr. PITTS, Mr. KENNEDY of 
Minnesota, Mrs. MYRICK, Mr. COLE, Mr. BEAUPREZ, Mrs. CUBIN, Mrs. 
BONO, Mr. ISSA, Mr. SAXTON, Mr. BRADY of Texas, Mr. BLUNT, Mr. 
ADERHOLT, 
Mrs. 
MUSGRAVE, 
Mr. 
LUCAS
of 
Oklahoma, 
Mr. 
HENSARLING, Mr. KING of Iowa, Mr. BASS, Mr. BARRETT of South 
Carolina, Mr. HASTINGS of Washington, Mr. BOOZMAN, Mr. COMBEST, 
Mr. BROWN of South Carolina, Mr. HOLDEN, Mr. DEMINT, Mr. 
SWEENEY, Mr. LAHOOD, Mr. BRADLEY of New Hampshire, Mr. MAN-
ZULLO, and Mr. SIMPSON
MARCH 11, 2003
Reported from the Committee on the Judiciary with an amendment 
[Strike out all after the enacting clause and insert the part printed in italic] 
MARCH 11, 2003
Reported from the Committee on Energy and Commerce with an amendment; 
committed to the Committee of the Whole House on the State of the 
Union and ordered to be printed 
[Strike out all after the enacting clause and insert the part printed in boldface roman] 
[For text of introduced bill, see copy of bill as introduced on February 5, 2003] 
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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Help Efficient, Acces-
sible, Low-cost, Timely Healthcare (HEALTH) Act of 
2003’’.
SEC. 2. FINDINGS AND PURPOSE. 
(a) FINDINGS.—
(1) EFFECT
ON
HEALTH
CARE
ACCESS
AND 
COSTS.—Congress finds that our current civil justice 
system is adversely affecting patient access to health 
care services, better patient care, and cost-efficient 
health care, in that the health care liability system is 
a costly and ineffective mechanism for resolving 
claims of health care liability and compensating in-
jured patients, and is a deterrent to the sharing of in-
formation among health care professionals which im-
pedes efforts to improve patient safety and quality of 
care. 
(2) EFFECT ON INTERSTATE COMMERCE.—Con-
gress finds that the health care and insurance indus-
tries are industries affecting interstate commerce and 
the health care liability litigation systems existing 
throughout the United States are activities that affect 
interstate commerce by contributing to the high costs 
of health care and premiums for health care liability 
insurance purchased by health care system providers. 
(3) EFFECT ON FEDERAL SPENDING.—Congress 
finds that the health care liability litigation systems 
existing throughout the United States have a signifi-
cant effect on the amount, distribution, and use of 
Federal funds because of—
(A) the large number of individuals who re-
ceive health care benefits under programs oper-
ated or financed by the Federal Government; 
(B) the large number of individuals who 
benefit because of the exclusion from Federal 
taxes of the amounts spent to provide them with 
health insurance benefits; and 
(C) the large number of health care pro-
viders who provide items or services for which 
the Federal Government makes payments. 
(b) PURPOSE.—It is the purpose of this Act to imple-
ment reasonable, comprehensive, and effective health care 
liability reforms designed to—
(1) improve the availability of health care serv-
ices in cases in which health care liability actions 
have been shown to be a factor in the decreased avail-
ability of services; 
(2) reduce the incidence of ‘‘defensive medicine’’ 
and lower the cost of health care liability insurance, 
all of which contribute to the escalation of health care 
costs; 
(3) ensure that persons with meritorious health 
care injury claims receive fair and adequate com-
pensation, including reasonable noneconomic dam-
ages;
(4) improve the fairness and cost-effectiveness of 
our current health care liability system to resolve dis-
putes over, and provide compensation for, health care 
liability by reducing uncertainty in the amount of 
compensation provided to injured individuals; and 
(5) provide an increased sharing of information 
in the health care system which will reduce unin-
tended injury and improve patient care. 
SEC. 3. ENCOURAGING SPEEDY RESOLUTION OF CLAIMS. 
The time for the commencement of a health care law-
suit shall be 3 years after the date of manifestation of injury 
or 1 year after the claimant discovers, or through the use 
of reasonable diligence should have discovered, the injury, 
whichever occurs first. In no event shall the time for com-
mencement of a health care lawsuit exceed 3 years after the 
date of manifestation of injury unless tolled for any of the 
following: 
(1) Upon proof of fraud; 
(2) Intentional concealment; or 
(3) The presence of a foreign body, which has no 
therapeutic or diagnostic purpose or effect, in the per-
son of the injured person. 
Actions by a minor shall be commenced within 3 years from 
the date of the alleged manifestation of injury except that 
actions by a minor under the full age of 6 years shall be
commenced within 3 years of manifestation of injury or 
prior to the minor’s 8th birthday, whichever provides a 
longer period. Such time limitation shall be tolled for mi-
nors for any period during which a parent or guardian 
and a health care provider or health care organization have 
committed fraud or collusion in the failure to bring an ac-
tion on behalf of the injured minor.
SEC. 4. COMPENSATING PATIENT INJURY. 
(a) UNLIMITED AMOUNT OF DAMAGES FOR ACTUAL 
ECONOMIC LOSSES IN HEALTH CARE LAWSUITS.—In any 
health care lawsuit, the full amount of a claimant’s eco-
nomic loss may be fully recovered without limitation. 
(b) ADDITIONAL NONECONOMIC DAMAGES.—In any 
health care lawsuit, the amount of noneconomic damages 
recovered may be as much as $250,000, regardless of the 
number of parties against whom the action is brought or 
the number of separate claims or actions brought with re-
spect to the same occurrence. 
(c) NO DISCOUNT OF AWARD FOR NONECONOMIC DAM-
AGES.—In any health care lawsuit, an award for future 
noneconomic damages shall not be discounted to present 
value. The jury shall not be informed about the maximum 
award for noneconomic damages. An award for non-
economic damages in excess of $250,000 shall be reduced 
either before the entry of judgment, or by amendment of
the judgment after entry of judgment, and such reduction 
shall be made before accounting 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 reduced 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. A separate 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 proportion of responsibility of each 
party for the claimant’s harm. 
SEC. 5. MAXIMIZING PATIENT RECOVERY. 
(a) COURT SUPERVISION OF SHARE OF DAMAGES AC-
TUALLY PAID TO CLAIMANTS.—In any health care lawsuit, 
the court shall supervise the arrangements for payment of 
damages to protect against conflicts of interest that may 
have the effect of reducing the amount of damages awarded 
that are actually paid to claimants. In particular, in any 
health care lawsuit in which the attorney for a party claims 
a financial stake in the outcome by virtue 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 inter-
ests 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 exceed 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, settlement, 
mediation, arbitration, or any other form of alternative dis-
pute resolution. In a health care lawsuit involving a minor 
or incompetent person, a court retains the authority to au-
thorize or approve a fee that is less than the maximum per-
mitted under this section. 
SEC. 6. ADDITIONAL HEALTH BENEFITS. 
In any health care lawsuit, any party may introduce 
evidence of collateral source benefits. If a party elects to in-
troduce such evidence, 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 opposing party to secure the right to such collateral 
source benefits. 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 eq-
uitably or legally subrogated to the right of the claimant 
in a health care lawsuit. This section 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 Secu-
rity 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 
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 unnecessary 
injury that such person knew the claimant was substan-
tially 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 puni-
tive 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 awarded 
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 appli-
cable State law, shall be inadmissible in any proceeding 
to determine whether compensatory damages are to be 
awarded. 
(b) DETERMINING AMOUNT OF PUNITIVE DAMAGES.—
(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 con-
cealment of it by such party; 
(C) the profitability of the conduct to such 
party; 
(D) the number of products sold or medical 
procedures rendered for compensation, as the
case may be, by such party, of the kind causing 
the harm complained of by the claimant; 
(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. 
(2) MAXIMUM AWARD.—The amount of punitive 
damages, if awarded, in a health care lawsuit may be 
as much as $250,000 or as much as two times the 
amount of economic damages awarded, whichever is 
greater. The jury shall not be informed of this limita-
tion. 
(c) NO PUNITIVE DAMAGES
FOR PRODUCTS THAT 
COMPLY WITH FDA STANDARDS.—
(1) IN GENERAL.—No punitive damages may be 
awarded against the manufacturer or distributor of a 
medical product based on a claim that such product 
caused the claimant’s harm where—
(A)(i) such medical product was subject to 
premarket approval or clearance by the Food 
and Drug Administration with respect to the 
safety of the formulation or performance of the 
aspect of such medical product which caused the 
claimant’s harm or the adequacy of the pack-
aging or labeling of such medical product; and 
(ii) such medical product was so approved 
or cleared; or 
(B) such medical product is generally recog-
nized among qualified experts as safe and effec-
tive pursuant to conditions established by the 
Food and Drug Administration and applicable 
Food and Drug Administration regulations, in-
cluding without limitation those related to pack-
aging and labeling, unless the Food and Drug 
Administration has determined that such med-
ical product was not manufactured or distrib-
uted in substantial compliance with applicable 
Food and Drug Administration statutes and reg-
ulations.
(2) LIABILITY OF HEALTH CARE PROVIDERS.—A 
health care provider who prescribes, or who dispenses 
pursuant to a prescription, a drug or device (includ-
ing blood products) approved by the Food and Drug 
Administration shall not be named as a party to a 
product liability lawsuit involving such drug or de-
vice and shall not be liable to a claimant in a class 
action lawsuit against the manufacturer, distributor, 
or product seller of such drug or device. 
(3) PACKAGING.—In a health care lawsuit for 
harm which is alleged to relate to the adequacy of the 
packaging or labeling of a drug which is required to 
have tamper-resistant packaging under regulations of 
the Secretary of Health and Human Services (includ-
ing labeling regulations related to such packaging), 
the manufacturer or product seller of the drug shall 
not be held liable for punitive damages unless such 
packaging or labeling is found by the trier of fact by 
clear and convincing evidence to be substantially out 
of compliance with such regulations. 
(4) EXCEPTION.—Paragraph (1) shall not apply 
in any health care lawsuit in which—
(A) a person, before or after premarket ap-
proval or clearance of such medical product, 
knowingly misrepresented to or withheld from
the Food and Drug Administration information 
that is required to be submitted under the Fed-
eral Food, Drug, and Cosmetic Act (21 U.S.C. 
301 et seq.) or section 351 of the Public Health 
Service Act (42 U.S.C. 262) that is material and 
is causally related to the harm which the claim-
ant allegedly suffered; or 
(B) a person made an illegal payment to an 
official of the Food and Drug Administration for 
the purpose of either securing or maintaining 
approval or clearance of such medical product. 
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 accord-
ance with the Uniform Periodic Payment of Judgments 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 before 
the effective date of this Act. 
SEC. 9. DEFINITIONS. 
In this Act: 
(1) ALTERNATIVE DISPUTE RESOLUTION SYSTEM; 
ADR.—The term ‘‘alternative dispute resolution sys-
tem’’ or ‘‘ADR’’ means a system that provides for the 
resolution of health care lawsuits in a manner other 
than through a civil action brought in a State or Fed-
eral court. 
(2) CLAIMANT.—The term ‘‘claimant’’ means 
any person who brings a health care lawsuit, includ-
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 deceased, 
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 pro-
vided in the future to or on behalf of the claimant,
as a result of the injury or wrongful death, pursuant 
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 med-
ical, hospital, dental, or income disability bene-
fits; and 
(D) any other publicly or privately funded 
program. 
(4) COMPENSATORY DAMAGES.—The term ‘‘com-
pensatory damages’’ means objectively verifiable mon-
etary 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, damages for physical and emo-
tional pain, suffering, inconvenience, physical im-
pairment, mental anguish, disfigurement, loss of en-
joyment of life, loss of society and companionship, 
loss of consortium (other than loss of domestic serv-
ice), hedonic damages, injury to reputation, and all 
other nonpecuniary losses of any kind or nature. The 
term ‘‘compensatory damages’’ includes economic 
damages and noneconomic damages, 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. 
(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 employment op-
portunities. 
(7) HEALTH CARE LAWSUIT.—The term ‘‘health 
care lawsuit’’ means any health care liability claim 
concerning the provision of health care goods or serv-
ices, or any medical product, affecting interstate com-
merce, 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 pursuant to 
an alternative dispute resolution system, against a 
health care provider, a health care organization, or 
the manufacturer, distributor, supplier, marketer, 
promoter, or seller of a medical product, regardless of 
the theory of liability on which the claim is based, or 
the number of claimants, plaintiffs, defendants, or 
other parties, or the number of claims or causes of ac-
tion, in which the claimant alleges a health care li-
ability claim. 
(8) HEALTH CARE LIABILITY ACTION.—The term 
‘‘health care liability action’’ means a civil action 
brought in a State or Federal Court or pursuant to 
an alternative dispute resolution system, against a 
health care provider, a health care organization, or 
the manufacturer, distributor, supplier, marketer, 
promoter, or seller of a medical product, regardless 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, in which the claim-
ant alleges a health care liability claim.
(9) 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, health care organization, or the 
manufacturer, distributor, supplier, marketer, pro-
moter, or seller of a medical product, 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, regardless of the theory 
of liability on which the claim is based, or the num-
ber of plaintiffs, defendants, or other parties, or the 
number of causes of action. 
(10) HEALTH CARE ORGANIZATION.—The term 
‘‘health care organization’’ means any person or enti-
ty which is obligated to provide or pay for health ben-
efits under any health plan, including any person or 
entity acting under a contract or arrangement with 
a health care organization to provide or administer 
any health benefit. 
(11) 
HEALTH
CARE
PROVIDER.—The 
term 
‘‘health care provider’’ means any person or entity re-
quired by State or Federal laws or regulations to be 
licensed, registered, or certified to provide health care
services, and being either so licensed, registered, or 
certified, or exempted from such requirement by other 
statute or regulation. 
(12) HEALTH CARE GOODS OR SERVICES.—The 
term ‘‘health care goods or services’’ means any goods 
or services provided by a health care organization, 
provider, or by any individual working under the su-
pervision of a health care provider, that relate to the 
diagnosis, prevention, or treatment of any human dis-
ease or impairment, or the assessment of the health of 
human beings. 
(13) MALICIOUS INTENT TO INJURE.—The term 
‘‘malicious intent to injure’’ means intentionally 
causing or attempting to cause physical injury other 
than providing health care goods or services. 
(14) MEDICAL
PRODUCT.—The term ‘‘medical 
product’’ means a drug or device intended for hu-
mans, and the terms ‘‘drug’’ and ‘‘device’’ have the 
meanings given such terms in sections 201(g)(1) and 
201(h) of the Federal Food, Drug and Cosmetic Act 
(21 U.S.C. 321), respectively, including any compo-
nent or raw material used therein, but excluding 
health care services. 
(15) NONECONOMIC DAMAGES.—The term ‘‘non-
economic damages’’ means damages for physical and
emotional pain, suffering, inconvenience, physical im-
pairment, mental anguish, disfigurement, loss of en-
joyment of life, loss of society and companionship, 
loss of consortium (other than loss of domestic serv-
ice), hedonic damages, injury to reputation, 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 compen-
satory purposes, against a health care provider, 
health care organization, or a manufacturer, dis-
tributor, or supplier of a medical product. Punitive 
damages are neither economic nor noneconomic dam-
ages. 
(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 
incurred by the plaintiff and the attorneys’ office 
overhead costs or charges for legal services are not de-
ductible disbursements or costs for such purpose. 
(18) STATE.—The term ‘‘State’’ means each of 
the several States, the District of Columbia, the Com-
monwealth of Puerto Rico, the Virgin Islands, Guam,
American Samoa, the Northern Mariana Islands, 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 Fed-
eral rule of law under title XXI of the Public Health 
Service Act does not apply, then this Act or otherwise 
applicable law (as determined under this Act) will 
apply to such aspect of such action. 
(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 gov-
erning health care lawsuits set forth in this Act supersede 
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 applica-
bility or scope of periodic payment of future damages, 
than provided in this Act; or 
(2) prohibits the introduction of evidence regard-
ing collateral source benefits, or mandates or permits 
subrogation or a lien on collateral source benefits. 
(b) PROTECTION OF STATES’ RIGHTS.—Any issue that 
is not governed by any provision of law established by or 
under this Act (including State standards of negligence) 
shall be governed by otherwise applicable State or Federal 
law. This Act does not preempt or supersede any law that 
imposes greater protections (such as a shorter statute of lim-
itations) for health care providers and health care organiza-
tions from liability, loss, or damages than those provided 
by this Act. 
(c) STATE FLEXIBILITY.—No provision of this Act 
shall be construed to preempt—
(1) any State law (whether effective before, on, or 
after the date of the enactment of this Act) that speci-
fies a particular monetary amount of compensatory 
or punitive damages (or the total amount of damages) 
that may be awarded in a health care lawsuit, re-
gardless of whether such monetary amount is greater 
or lesser than is provided for under this Act, notwith-
standing section 4(a); or 
(2) any defense available to a party in a health 
care lawsuit under any other provision of State or 
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.
SEC. 13. SENSE OF CONGRESS. 
It is the sense of Congress that a health insurer should 
be liable for damages for harm caused when it makes a deci-
sion as to what care is medically necessary and appro-
priate.
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Help Effi-
cient, Accessible, Low-cost, Timely Healthcare 
(HEALTH) Act of 2003’’. 
SEC. 2. FINDINGS AND PURPOSE. 
(a) FINDINGS.—
(1) EFFECT
ON
HEALTH
CARE
ACCESS 
AND COSTS.—Congress finds that our cur-
rent civil justice system is adversely af-
fecting patient access to health care serv-
ices, better patient care, and cost-effi-
cient health care, in that the health care 
liability system is a costly and ineffective 
mechanism for resolving claims of health 
care liability and compensating injured 
patients, and is a deterrent to the sharing 
of information among health care profes-
sionals which impedes efforts to improve 
patient safety and quality of care. 
(2) 
EFFECT
ON
INTERSTATE
COM-
MERCE.—Congress finds that the health
care and insurance industries are indus-
tries affecting interstate commerce and 
the health care liability litigation systems 
existing throughout the United States are 
activities that affect interstate commerce 
by contributing to the high costs of 
health care and premiums for health care 
liability insurance purchased by health 
care system providers. 
(3) EFFECT
ON
FEDERAL
SPENDING.—
Congress finds that the health care liabil-
ity litigation systems existing throughout 
the United States have a significant effect 
on the amount, distribution, and use of 
Federal funds because of—
(A) the large number of individ-
uals who receive health care benefits 
under programs operated or financed 
by the Federal Government; 
(B) the large number of individ-
uals who benefit because of the exclu-
sion 
from 
Federal 
taxes 
of 
the 
amounts spent to provide them with 
health insurance benefits; and
(C) the large number of health 
care providers who provide items or 
services for which the Federal Gov-
ernment makes payments. 
(b) PURPOSE.—It is the purpose of this Act 
to implement reasonable, comprehensive, and 
effective health care liability reforms de-
signed to—
(1) improve the availability of health 
care services in cases in which health 
care liability actions have been shown to 
be a factor in the decreased availability 
of services; 
(2) reduce the incidence of ‘‘defensive 
medicine’’ and lower the cost of health 
care liability insurance, all of which con-
tribute to the escalation of health care 
costs; 
(3) ensure that persons with meri-
torious health care injury claims receive 
fair and adequate compensation, includ-
ing reasonable noneconomic damages; 
(4) improve the fairness and cost-ef-
fectiveness of our current health care li-
ability system to resolve disputes over,
and provide compensation for, health 
care liability by reducing uncertainty in 
the amount of compensation provided to 
injured individuals; and 
(5) provide an increased sharing of 
information in the health care system 
which will reduce unintended injury and 
improve patient care. 
SEC. 3. ENCOURAGING SPEEDY RESOLUTION OF CLAIMS. 
The time for the commencement of a 
health care lawsuit shall be 3 years after the 
date of manifestation of injury or 1 year after 
the claimant discovers, or through the use of 
reasonable diligence should have discovered, 
the injury, whichever occurs first. In no event 
shall the time for commencement of a health 
care lawsuit exceed 3 years after the date of 
manifestation of injury unless tolled for any 
of the following: 
(1) Upon proof of fraud; 
(2) Intentional concealment; or 
(3) The presence of a foreign body, 
which has no therapeutic or diagnostic 
purpose or effect, in the person of the in-
jured person.
Actions by a minor shall be commenced with-
in 3 years from the date of the alleged mani-
festation of injury except that actions by a 
minor under the full age of 6 years shall be 
commenced within 3 years of manifestation of 
injury or prior to the minor’s 8th birthday, 
whichever provides a longer period. Such 
time limitation shall be tolled for minors for 
any period during which a parent or guardian 
and a health care provider or health care or-
ganization have committed fraud or collusion 
in the failure to bring an action on behalf of 
the injured minor. 
SEC. 4. COMPENSATING PATIENT INJURY. 
(a) UNLIMITED AMOUNT
OF DAMAGES
FOR 
ACTUAL ECONOMIC LOSSES
IN HEALTH CARE 
LAWSUITS.—In any health care lawsuit, noth-
ing in this Act shall limit a claimant’s recov-
ery of the full amount of the available eco-
nomic damages, notwithstanding the limita-
tion in subsection (b). 
(b) ADDITIONAL NONECONOMIC DAMAGES.—
In any health care lawsuit, the amount of non-
economic damages, if available, may be as 
much as $250,000, regardless of the number of
parties against whom the action is brought or 
the number of separate claims or actions 
brought with respect to the same injury. 
(c) NO
DISCOUNT
OF
AWARD
FOR
NON-
ECONOMIC DAMAGES.—For purposes of apply-
ing the limitation in subsection (b), future 
noneconomic damages shall not be discounted 
to present value. The jury shall not be in-
formed about the maximum award for non-
economic 
damages. 
An 
award 
for 
non-
economic damages in excess of $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 accounting for any other re-
duction in damages required by law. If sepa-
rate awards are rendered for past and future 
noneconomic damages and the combined 
awards exceed $250,000, the future non-
economic damages shall be reduced first.
(d) FAIR SHARE RULE.—In any health care 
lawsuit, each party shall be liable for that par-
ty’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 separate 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 deter-
mine the proportion of responsibility of each 
party for the claimant’s harm. 
SEC. 5. MAXIMIZING PATIENT RECOVERY. 
(a) COURT SUPERVISION OF SHARE OF DAM-
AGES ACTUALLY PAID
TO CLAIMANTS.—In any 
health care lawsuit, the court shall supervise 
the arrangements for payment of damages to 
protect against conflicts of interest that may 
have the effect of reducing the amount of 
damages awarded that are actually paid to 
claimants. In particular, 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 claim-
ant’s damage recovery to such attorney, and 
to redirect such damages to the claimant 
based upon the interests of justice and prin-
SEC. 6. ADDITIONAL HEALTH BENEFITS. 
In any health care lawsuit involving in-
jury or wrongful death, any party may intro-
duce evidence of collateral source benefits. If 
a party elects to introduce such evidence, 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 opposing party to se-
cure the right to such collateral source bene-
fits. No provider of collateral source benefits 
shall recover any amount against the claim-
ant 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 wrong-
ful death. This section 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 So-
cial Security Act. 
SEC. 7. PUNITIVE DAMAGES. 
(a) IN GENERAL.—Punitive damages may, if 
otherwise permitted by applicable State or
Federal law, be awarded against any person 
in a health care lawsuit only if it is proven by 
clear and convincing evidence that such per-
son acted with malicious intent to injure the 
claimant, or that such person deliberately 
failed to avoid unnecessary injury that such 
person knew the claimant was substantially 
certain to suffer. In any health care lawsuit 
where no judgment for compensatory dam-
ages is rendered against such person, no puni-
tive damages may be awarded with respect to 
the claim in such lawsuit. No demand for pu-
nitive 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 motion by 
the claimant and after a finding by the court, 
upon review of supporting and opposing affi-
davits 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 dam-
ages. At the request 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 awarded and the amount of such 
award; and 
(2) the amount of punitive damages 
following a determination of punitive li-
ability. 
If a separate proceeding is requested, evi-
dence relevant only to the claim for punitive 
damages, as determined by applicable State 
law, shall be inadmissible in any proceeding 
to determine whether compensatory damages 
are to be awarded. 
(b) DETERMINING
AMOUNT
OF
PUNITIVE 
DAMAGES.—
(1) FACTORS
CONSIDERED.—In deter-
mining the amount of punitive damages, 
if awarded, in a health care lawsuit, the 
trier of fact shall consider only the fol-
lowing: 
(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 con-
duct to such party;
(D) the number of products sold 
or medical procedures rendered for 
compensation, as the case may be, by 
such party, of the kind causing the 
harm complained of by the claimant; 
(E) any criminal penalties im-
posed on such party, as a result of the 
conduct complained of by the claim-
ant; and 
(F) the amount of any civil fines 
assessed against such party as a re-
sult of the conduct complained of by 
the claimant. 
(2) MAXIMUM AWARD.—The amount of 
punitive damages, if awarded, in a health 
care lawsuit may be as much as $250,000 
or as much as two times the amount of 
economic damages awarded, whichever is 
greater. The jury shall not be informed of 
this limitation. 
(c) NO PUNITIVE DAMAGES FOR PRODUCTS IN 
COMPLIANCE WITH FDA STANDARDS.—
(1) PUNITIVE DAMAGES.—
(A) IN
GENERAL.—In addition to 
the requirements of subsections (a)
and (b), punitive damages may not be 
awarded against the manufacturer or 
distributor of a medical product, or a 
supplier of any component or raw 
material of such medical product, on 
the basis that the harm to the claim-
ant was caused by the lack of safety 
or effectiveness of the particular 
medical product involved, unless, the 
claimant demonstrates by clear and 
convincing evidence that—
(i) the manufacturer or dis-
tributor of the particular medical 
product, or supplier of any com-
ponent or raw material of such 
medical product, failed to comply 
with a specific requirement of the 
Federal Food, Drug, and Cosmetic 
Act, section 351 of the Public 
Health Service Act, or the regula-
tions 
promulgated 
thereunder; 
and 
(ii) the harm attributed to the 
particular medical product re-
sulted from such failure to com-
ply with such specific statutory 
requirement or regulation. 
(B) RULE OF CONSTRUCTION.—Sub-
paragraph (A) may not be construed 
as establishing the obligation of the 
Food and Drug Administration to 
demonstrate 
affirmatively 
that 
a 
manufacturer, distributor, or supplier 
referred to in such subparagraph 
meets any of the conditions described 
in such subparagraph. 
(2) LIABILITY
OF
HEALTH
CARE
PRO-
VIDERS.—A health care provider who pre-
scribes, or who dispenses pursuant to a 
prescription, 
a 
medical 
product 
ap-
proved, licensed, or cleared by the Food 
and Drug Administration shall not be 
named as a party to a product liability 
lawsuit involving such product and shall 
not be liable to a claimant in a class ac-
tion lawsuit against the manufacturer, 
distributor, or seller of such product. 
Nothing in this paragraph prevents a 
court from consolidating cases involving 
health care providers and cases involving
products liability claims against the man-
ufacturer, distributor, or product seller 
of such medical product. 
(3) EXCEPTION.—Paragraph (1) shall 
not apply in any health care lawsuit in 
which—
(A) a person knowingly misrepre-
sented to the Food and Drug Adminis-
tration information which is required 
to be submitted under the Federal 
Food, Drug, and Cosmetic Act (21 
U.S.C. 301 et seq.) or section 351 of 
the Public Health Service Act (42 
U.S.C. 262); or 
(B) a person made an illegal pay-
ment to a governmental official for 
the purpose of either (i) securing or 
maintaining approval, clearance, or 
licensure of such medical product or 
(ii) preventing an enforcement action. 
SEC. 8. AUTHORIZATION OF PAYMENT OF FUTURE DAM-
AGES TO CLAIMANTS IN HEALTH CARE LAW-
SUITS. 
(a) IN GENERAL.—In any health care law-
suit, if an award of future damages, without
reduction to present value, equaling or ex-
ceeding $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. 
(b) APPLICABILITY.—This section applies to 
all actions which have not been first set for 
trial or retrial before the effective date of this 
Act. 
SEC. 9. DEFINITIONS. 
In this Act: 
(1) ALTERNATIVE
DISPUTE
RESOLUTION 
SYSTEM; ADR.—The term ‘‘alternative dis-
pute resolution system’’ or ‘‘ADR’’ means 
a system that provides for the resolution 
of health care lawsuits in a manner 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, including a person who as-
serts or claims a right to legal or equi-
table contribution, indemnity or subroga-