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action may not exceed $250,000, regardless of the number
of parties against whom the action is brought or the num-
ber of actions brought with respect to the injury.
(b) JOINT AND SEVERAL LIABILITY.—In any District
of Columbia health care liability action, a defendant shall
be liable only for the amount of noneconomic damages at-
tributable to such defendant in direct proportion to such
defendant’s share of fault or responsibility for the claim-
ant’s actual damages, as determined by the trier of fact.
In all such cases, the liability of a defendant for non-
economic damages shall be several and not joint.
SEC. 204. CRITERIA FOR AWARDING OF PUNITIVE DAM-
AGES; LIMITATION ON AMOUNT AWARDED.
(a) IN GENERAL.—Punitive damages may, to the ex-
tent permitted by applicable District of Columbia law, be
awarded in any District of Columbia health care liability
action if the claimant establishes by clear and convincing
evidence that the harm suffered was the result of—
(1) conduct specifically intended to cause harm,
or
(2) conduct manifesting a conscious, flagrant
indifference to the rights or safety of others.
(b) PROPORTIONAL AWARDS.—The amount of puni-
tive damages that may be awarded in any District of Co-
lumbia health care liability action may not exceed 3 times
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the amount of damages awarded to the claimant for eco-
nomic loss, or $250,000, whichever is greater. This sub-
section shall be applied by the court and shall not be dis-
closed to the jury.
(c) APPLICABILITY.—This subsection shall apply to
any District of Columbia health care liability action
brought on any theory under which punitive damages are
sought. This subsection does not create a cause of action
for punitive damages. This subsection does not preempt
or supersede any law to the extent that such law would
further limit the award of punitive damages.
(d) BIFURCATION.—At the request of any party, the
trier of fact shall consider in a separate proceeding wheth-
er punitive damages are to be awarded and the amount
of such award. If a separate proceeding is requested, evi-
dence relevant only to the claim of punitive damages, as
determined by applicable District of Columbia law, shall
be inadmissible in any proceeding to determine whether
actual damages are to be awarded.
SEC. 205. TREATMENT OF PUNITIVE DAMAGES IN ACTIONS
RELATING TO DRUGS OR MEDICAL DEVICES.
(a) PROHIBITING AWARD OF PUNITIVE DAMAGES
WITH RESPECT TO CERTAIN APPROVED DRUGS AND DE-
VICES.—
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(1) IN GENERAL.—In any District of Columbia
health care liability action, punitive damages may
not be awarded against a manufacturer or product
seller of a drug or medical device which caused the
claimant’s harm if—
(A) such drug or device was subject to pre-
market approval by the Food and Drug Admin-
istration with respect to the safety of the for-
mulation or performance of the aspect of such
drug or device which caused the claimant’s
harm, or the adequacy of the packaging or la-
beling of such drug or device which caused the
harm, and such drug, device, packaging, or la-
beling was approved by the Food and Drug Ad-
ministration; or
(B) the drug is generally recognized as
safe and effective pursuant to conditions estab-
lished by the Food and Drug Administration
and applicable regulations, including packaging
and labeling regulations.
(2) EXCEPTION.—Paragraph (1) shall not
apply in any case in which the defendant, before or
after premarket approval of a drug or device—
(A) intentionally and wrongfully withheld
from or misrepresented to the Food and Drug
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Administration information concerning such
drug or device 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) that is ma-
terial and relevant to the harm suffered by the
claimant, or
(C) made an illegal payment to an official
or employee of the Food and Drug Administra-
tion for the purpose of securing or maintaining
approval of such drug or device.
(b) SPECIAL RULE REGARDING CLAIMS RELATING
TO PACKAGING.—In a District of Columbia health care
liability action relating 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 (including labeling regula-
tions related to such packaging), the manufacturer or
product seller of the drug shall not be held liable for puni-
tive damages unless such packaging or labeling is found
by the court by clear and convincing evidence to be sub-
stantially out of compliance with such regulations.
(c) DEFINITIONS.—In this section, the following defi-
nitions apply:
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(1) DRUG.—The term ‘‘drug’’ has the meaning
given such term in section 201(g)(1) of the Federal
Food, 
Drug, 
and 
Cosmetic 
Act 
(21 
U.S.C.
321(g)(1)).
(2) MEDICAL DEVICE.—The term ‘‘medical de-
vice’’ has the meaning given such term in section
201(h) of the Federal Food, Drug, and Cosmetic
Act (21 U.S.C. 321(h)).
(3) PRODUCT SELLER.—
(A) IN
GENERAL.—Subject to subpara-
graph (B), the term ‘‘product seller’’ means a
person who, in the course of a business con-
ducted for that purpose—
(i) sells, distributes, rents, leases, pre-
pares, blends, packages, labels, or is other-
wise involved in placing, a product in the
stream of commerce, or
(ii) installs, repairs, or maintains the
harm-causing aspect of a product.
(B) EXCLUSION.—Such term does not in-
clude—
(i) a seller or lessor of real property;
(ii) a provider of professional services
in any case in which the sale or use of a
product is incidental to the transaction and
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the essence of the transaction is the fur-
nishing of judgment, skill, or services; or
(iii) any person who—
(I) acts in only a financial capac-
ity with respect to the sale of a prod-
uct; or
(II) leases a product under a
lease arrangement in which the selec-
tion, possession, maintenance, and op-
eration of the product are controlled
by a person other than the lessor.
SEC. 206. PERIODIC PAYMENTS FOR FUTURE LOSSES.
(a) IN GENERAL.—In any District of Columbia
health care liability action in which the damages awarded
for future economic and noneconomic loss exceeds
$50,000, a person shall not be required to pay such dam-
ages in a single, lump-sum payment, but shall be per-
mitted to make such payments periodically based on when
the damages are found likely to occur, as such payments
are determined by the court.
(b) FINALITY OF JUDGMENT.—The judgment of the
court awarding periodic payments under this section may
not, in the absence of fraud, be reopened at any time to
contest, amend, or modify the schedule or amount of the
payments.
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(c) LUMP-SUM SETTLEMENTS.—This section may
not be construed to preclude a settlement providing for
a single, lump-sum payment.
SEC. 207. TREATMENT OF COLLATERAL SOURCE PAY-
MENTS.
(a) INTRODUCTION INTO EVIDENCE.—In any Dis-
trict of Columbia health care liability action, any defend-
ant may introduce evidence of collateral source payments.
If any defendant elects to introduce such evidence, the
claimant 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 claimant to secure
the right to such collateral source payments.
(b) NO SUBROGATION.—No provider of collateral
source payments may recover any amount against the
claimant or receive any lien or credit against the claim-
ant’s recovery or be equitably or legally subrogated the
right of the claimant in a District of Columbia health care
liability action.
(c) APPLICATION TO SETTLEMENTS.—This section
shall apply to an action that is settled as well as an action
that is resolved by a fact finder.
(d) COLLATERAL SOURCE PAYMENTS DEFINED.—In
this section, the term ‘‘collateral source payments’’ means
any amount paid or reasonably likely to be paid in the
118
future to or on behalf of a claimant, or any service, prod-
uct, or other benefit provided or reasonably likely to be
provided in the future to or on behalf of a claimant, as
a result of an injury or wrongful death, pursuant to—
(1) any State or Federal health, sickness, in-
come-disability, accident or workers’ compensation
Act;
(2) any health, sickness, income-disability, or
accident insurance that provides health benefits or
income-disability coverage;
(3) any contract or agreement of any group, or-
ganization, partnership, or corporation to provide,
pay for, or reimburse the cost of medical, hospital,
dental, or income disability benefits; and
(4) any other publicly or privately funded pro-
gram.
SEC. 208. APPLICATION OF STANDARDS TO CLAIMS RE-
SOLVED THROUGH ALTERNATIVE DISPUTE
RESOLUTION.
(a) IN GENERAL.—Any alternative dispute resolution
system used to resolve a District of Columbia health care
liability action or claim shall contain provisions relating
to statute of limitations, non-economic damages, joint and
several liability, punitive damages, collateral source rule,
119
and periodic payments which are identical to the provi-
sions relating to such matters in this title.
(b) ALTERNATIVE DISPUTE RESOLUTION SYSTEM
DEFINED.—In this title, the term ‘‘alternative dispute res-
olution system’’ means a system that provides for the reso-
lution of District of Columbia health care liability claims
in a manner other than through District of Columbia
health care liability actions.
Subtitle B—General Provisions
SEC. 211. GENERAL DEFINITIONS.
(a) DISTRICT OF COLUMBIA HEALTH CARE LIABIL-
ITY ACTION.—
(1) IN GENERAL.—In this title, the term ‘‘Dis-
trict of Columbia health care liability action’’ means
a civil action brought against a health care provider,
an entity which is obligated to provide or pay for
health benefits under any health benefit plan (in-
cluding any person or entity acting under a contract
or arrangement to provide or administer any health
benefit), or the manufacturer, distributor, supplier,
marketer, promoter, or seller of a medical product,
in which the claimant alleges a claim (including
third party claims, cross claims, counter claims, or
distribution claims) based upon the provision of (or
the failure to provide or pay for) health care services
120
or the use of a medical product within the District
of Columbia, regardless of the theory of liability on
which the claim is based or the number of plaintiffs,
defendants, or causes of action.
(2) 
HEALTH
BENEFIT
PLAN.—The 
term
‘‘health benefit plan’’ means—
(A) a hospital or medical expense incurred
policy or certificate,
(B) a hospital or medical service plan con-
tract,
(C) a health maintenance subscriber con-
tract, or
(D) a Medicare+Choice plan (as described
in section 1859(b)(1) of the Social Security
Act),
that provides benefits with respect to health care
services.
(3) HEALTH
CARE
PROVIDER.—The term
‘‘health care provider’’ means any person that is en-
gaged in the delivery of health care services in the
District of Columbia and that is required by the
laws or regulations of the District of Columbia to be
licensed or certified to engage in the delivery of such
services in the District of Columbia, and includes an
employee of the government of the District of Co-
121
lumbia (including an independent agency of the Dis-
trict of Columbia).
(b) DISTRICT OF COLUMBIA HEALTH CARE LIABIL-
ITY CLAIM.—The term ‘‘District of Columbia health care
liability claim’’ means a claim in which the claimant al-
leges that injury was caused by the provision of (or the
failure to provide) health care services within the District
of Columbia.
(c) OTHER DEFINITIONS.—As used in this title:
(1) ACTUAL DAMAGES.—The term ‘‘actual dam-
ages’’ means damages awarded to pay for economic
loss.
(2) CLAIMANT.—The term ‘‘claimant’’ means
any person who brings a District of Columbia health
care liability action and any person on whose behalf
such an action is brought. If such action is brought
through or on behalf of an estate, the term includes
the claimant’s decedent. If such action is brought
through or on behalf of a minor or incompetent, the
term includes the claimant’s legal guardian.
(3) CLEAR AND CONVINCING EVIDENCE.—The
term ‘‘clear and convincing evidence’’ is that meas-
ure or degree of proof that will produce in the mind
of the trier of fact a firm belief or conviction as to
the truth of the allegations sought to be established.
122
Such measure or degree of proof is more than that
required under preponderance of the evidence but
less than that required for proof beyond a reason-
able doubt.
(4) ECONOMIC
LOSS.—The term ‘‘economic
loss’’ means any pecuniary loss resulting from injury
(including the loss of earnings or other benefits re-
lated to employment, medical expense loss, replace-
ment services loss, loss due to death, burial costs,
and loss of business or employment opportunities),
to the extent recovery for such loss is allowed under
applicable District of Columbia law.
(5) HARM.—The term ‘‘harm’’ means any le-
gally cognizable wrong or injury for which punitive
damages may be imposed.
(6) HEALTH CARE SERVICE.—The term ‘‘health
care service’’ means any service for which payment
may be made under a health benefit plan including
services related to the delivery or administration of
such service.
(7) NONECONOMIC DAMAGES.—The term ‘‘non-
economic damages’’ means damages paid to an indi-
vidual for pain and suffering, inconvenience, emo-
tional distress, mental anguish, loss of consortium,