provider, or by any individual working 
under the supervision of a health care 
provider, 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 intentionally causing or attempt-
ing to cause physical injury other than 
providing health care goods or services. 
(14) 
MEDICAL
PRODUCT.—The 
term 
‘‘medical product’’ means a drug, device, 
or biological product intended for hu-
mans, and the terms ‘‘drug’’, ‘‘device’’, and 
‘‘biological product’’ have the meanings 
given such terms in sections 201(g)(1) and 
201(h) of the Federal Food, Drug and Cos-
metic Act (21 U.S.C. 321) and section 
351(a) of the Public Health Service Act 
(42 U.S.C. 262(a)), respectively, including 
any component or raw material used 
therein, but excluding health care serv-
ices.
(15) 
NONECONOMIC
DAMAGES.—The 
term 
‘‘noneconomic 
damages’’ 
means 
damages for physical and emotional pain, 
suffering, inconvenience, physical impair-
ment, mental anguish, disfigurement, 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. 
(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, distributor, 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 de-
ducting any disbursements or costs in-
curred in connection with prosecution 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 over-
head 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 Islands, 
the Trust Territory of the Pacific Islands, 
and any other territory or possession of 
the United States, or any political sub-
division 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-related in-
jury or death—
(A) this Act does not affect the ap-
plication 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 ac-
tion brought for a vaccine-related injury 
or death to which a Federal rule of law 
under title XXI of the Public Health Serv-
ice 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 pro-
vided in this section, nothing in this Act shall 
be deemed to affect any defense available to 
a defendant in a health care lawsuit or action 
under any other provision of Federal law. 
SEC. 11. STATE FLEXIBILITY AND PROTECTION OF STATES’ 
RIGHTS. 
(a) HEALTH CARE LAWSUITS.—The provi-
sions governing 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 pro-
visions governing 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 pe-
riod in which a health care lawsuit may 
be commenced, or a reduced applicability 
or scope of periodic payment of future 
damages, than provided in this Act; or 
(2) prohibits the introduction of evi-
dence regarding collateral source bene-
fits, or mandates or permits subrogation 
or a lien on collateral source benefits. 
(b) PROTECTION
OF STATES’ RIGHTS
AND 
OTHER LAWS.—(1) Any issue that is not gov-
erned 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. 
(2) This Act shall not preempt or super-
sede any State or Federal law that imposes
greater procedural or substantive protections 
for health care providers and health care or-
ganizations from liability, loss, or damages 
than those provided by this Act or create a 
cause of action. 
(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 enact-
ment of this Act) that specifies a par-
ticular monetary amount of compen-
satory or punitive damages (or the total 
amount of damages) that may be awarded 
in a health care lawsuit, regardless of 
whether such monetary amount is great-
er or lesser than is provided for under 
this Act, notwithstanding 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 alternative 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 oc-
curring 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 decision as to what 
care is medically necessary and appropriate.
Union Calendar No. 20
108TH CONGRESS 
1ST SESSION 
H. R. 5
[Report No. 108–32, Parts I and II] 
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. 
MARCH 11, 2003
Reported from the Committee on the Judiciary with an 
amendment 
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 or-
dered to be printed