I 
108TH CONGRESS 
1ST SESSION H. R. 1219
To limit frivolous medical malpractice lawsuits, to reform the medical mal-
practice insurance business in order to reduce the cost of medical mal-
practice insurance, to enhance patient access to medical care, and for 
other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 12, 2003
Mr. CONYERS (for himself and Mr. DINGELL) 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 
A BILL 
To limit frivolous medical malpractice lawsuits, to reform 
the medical malpractice insurance business in order to 
reduce the cost of medical malpractice insurance, to en-
hance patient access to medical care, and for other pur-
poses.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Medical Malpractice and Insurance Reform Act of 
2003’’.
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows:
Sec. 1. Short title; table of contents. 
TITLE I—LIMITING FRIVOLOUS MEDICAL MALPRACTICE 
LAWSUITS 
Sec. 101. Statute of limitations. 
Sec. 102. Health care specialist affidavit. 
Sec. 103. Sanctions for frivolous actions and pleadings. 
Sec. 104. Mandatory mediation. 
Sec. 105. Limitation on punitive damages. 
Sec. 106. Reduction in premiums paid by physicians for medical malpractice in-
surance coverage. 
Sec. 107. Definitions. 
Sec. 108. Applicability. 
TITLE II—MEDICAL MALPRACTICE INSURANCE REFORM 
Sec. 201. Prohibition on anticompetitive activities by medical malpractice insur-
ers. 
Sec. 202. Medical malpractice insurance price comparison. 
TITLE III—ENHANCING PATIENT ACCESS TO CARE THROUGH 
DIRECT ASSISTANCE 
Sec. 301. Grants and contracts regarding health provider shortages. 
Sec. 302. Health professional assignments to trauma centers through national 
health service corps. 
TITLE IV—INDEPENDENT ADVISORY COMMISSION ON MEDICAL 
MALPRACTICE INSURANCE 
Sec. 401. Establishment. 
Sec. 402. Duties. 
Sec. 403. Report. 
Sec. 404. Membership. 
Sec. 405. Director and staff; experts and consultants. 
Sec. 406. Powers. 
Sec. 407. Authorization of appropriations.
TITLE I—LIMITING FRIVOLOUS 
MEDICAL MALPRACTICE LAW-
SUITS 
SEC. 101. STATUTE OF LIMITATIONS. 
(a) IN GENERAL.—A medical malpractice action shall 
be barred unless the complaint is filed within 3 years after 
the right of action accrues. 
(b) ACCRUAL.—A right of action referred to in sub-
section (a) accrues upon the last to occur of the following 
dates: 
(1) The date of the injury. 
(2) The date on which the claimant discovers, 
or through the use of reasonable diligence should 
have discovered, the injury. 
(3) The date on which the claimant becomes 18 
years of age. 
(c) APPLICABILITY.—This section shall apply to any 
injury occurring after the date of the enactment of this 
Act. 
SEC. 102. HEALTH CARE SPECIALIST AFFIDAVIT. 
(a) REQUIRING SUBMISSION WITH COMPLAINT.—No 
medical malpractice action may be brought by any indi-
vidual unless, at the time the individual brings the action 
(except as provided in subsection (b)(1)), it is accom-
panied by the affidavit of a qualified specialist that in-
cludes the specialist’s statement of belief that, based on 
a review of the available medical record and other relevant 
material, there is a reasonable and meritorious cause for 
the filing of the action against the defendant. 
(b) EXTENSION IN CERTAIN INSTANCES.—
(1) IN GENERAL.—Subject to paragraph (2), 
subsection (a) shall not apply with respect to an in-
dividual who brings a medical malpractice action 
without submitting an affidavit described in such 
subsection if, as of the time the individual brings the 
action, the individual has been unable to obtain ade-
quate medical records or other information necessary 
to prepare the affidavit. 
(2) DEADLINE
FOR
SUBMISSION
WHERE
EX-
TENSION APPLIES.—In the case of an individual who 
brings an action for which paragraph (1) applies, 
the action shall be dismissed unless the individual 
(or the individual’s attorney) submits the affidavit 
described in subsection (a) not later than 90 days 
after obtaining the information described in such 
paragraph. 
(c) QUALIFIED
SPECIALIST
DEFINED.—In sub-
section (a), a ‘‘qualified specialist’’ means, with respect 
to a medical malpractice action, a health care professional
who is reasonably believed by the individual bringing the 
action (or the individual’s attorney)—
(1) to be knowledgeable in the relevant issues 
involved in the action; 
(2) to practice (or to have practiced) or to teach 
(or to have taught) in the same area of health care 
or medicine that is at issue in the action; and 
(3) in the case of an action against a physician, 
to be board certified in a specialty relating to that 
area of medicine. 
(d) CONFIDENTIALITY
OF
SPECIALIST.—Upon a 
showing of good cause by a defendant, the court may as-
certain the identity of a specialist referred to in subsection 
(a) while preserving confidentiality. 
SEC. 103. SANCTIONS FOR FRIVOLOUS 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) A medical mal-
practice action shall be dismissed unless the attorney or 
unrepresented 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 improper 
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 non-
frivolous argument for the extension, modification, 
or reversal of existing law or the establishment of 
new law; and 
(C) the allegations and other factual conten-
tions have evidentiary support or, if specifically so 
identified, are likely to have evidentiary support 
after a reasonable opportunity for further investiga-
tion and discovery. 
(2) 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 knowl-
edge, information and belief, formed after an inquiry rea-
sonable under the circumstances—
(A) it is not being presented for any improper 
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 con-
tentions therein are warranted by existing law or by 
a nonfrivolous argument for the extension, modifica-
tion, or reversal of existing law or the establishment 
of new law; and 
(C) the allegations and other factual conten-
tions have evidentiary support or, if specifically so 
identified, are reasonable based on a lack of infor-
mation 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-
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 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 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 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). 
SEC. 104. MANDATORY MEDIATION. 
(a) IN GENERAL.—In any medical malpractice ac-
tion, before such action comes to trial, mediation shall be 
required. Such mediation shall be conducted by one or 
more mediators who are selected by agreement of the par-
ties or, if the parties do not agree, who are qualified under 
applicable State law and selected by the court. 
(b) REQUIREMENTS.—Mediation under subsection 
(a) shall be made available by a State subject to the fol-
lowing requirements: 
(1) Participation in such mediation shall be in 
lieu of any alternative dispute resolution method re-
quired by any other law or by any contractual ar-
rangement made by or on behalf of the parties be-
fore the commencement of the action. 
(2) Each State shall disclose to residents of the 
State the availability and procedures for resolution 
of consumer grievances regarding the provision of 
(or failure to provide) health care services, including 
such mediation. 
(3) Each State shall provide that such medi-
ation may begin before or after, at the option of the 
claimant, the commencement of a medical mal-
practice action. 
(4) The Attorney General, in consultation with 
the Secretary of Health and Human Services, shall, 
by regulation, develop requirements with respect to 
such mediation to ensure that it is carried out in a 
manner that—
(A) is affordable for the parties involved; 
(B) encourages timely resolution of claims; 
(C) encourages the consistent and fair res-
olution of claims; and 
(D) provides for reasonably convenient ac-
cess to dispute resolution. 
(c) FURTHER REDRESS AND ADMISSIBILITY.—Any 
party dissatisfied with a determination reached with re-
spect to a medical malpractice claim as a result of an al-
ternative dispute resolution method applied under this sec-
tion shall not be bound by such determination. The results 
of any alternative dispute resolution method applied under 
this section, and all statements, offers, and communica-
tions made during the application of such method, shall 
be inadmissible for purposes of adjudicating the claim. 
SEC. 105. LIMITATION ON PUNITIVE DAMAGES. 
(a) IN GENERAL.—Punitive damages may not be 
awarded in a medical malpractice action, except upon 
proof of—
(1) gross negligence; 
(2) reckless indifference to life; or 
(3) an intentional act, such as voluntary intoxi-
cation or impairment by a physician, sexual abuse or 
misconduct, assault and battery, or falsification of 
records. 
(b) ALLOCATION.—In such a case, the award of puni-
tive damages shall be allocated 50 percent to the claimant 
and 50 percent to a trustee appointed by the court, to 
be used by such trustee in the manner specified in sub-
section (d). The court shall appoint the Secretary of 
Health and Human Services as such trustee. 
(c) EXCEPTION.—This section shall not apply with 
respect to an action if the applicable State law provides
(or has been construed to provide) for damages in such 
an action that are only punitive or exemplary in nature. 
(d) TRUST FUND.—
(1) IN GENERAL.—This subsection applies to 
amounts allocated to the Secretary of Health and 
Human Services as trustee under subsection (b). 
(2) AVAILABILITY.—Such amounts shall be 
available for use by the Secretary of Health and 
Human Services under paragraph (3) and shall re-
main so available until expended. 
(3) USE.—
(A) Subject to subparagraph (B), the Sec-
retary of Health and Human Services, acting 
through the Director of the Agency for 
Healthcare Research and Quality, shall use the 
amounts to which this subsection applies for ac-
tivities to reduce medical errors and improve 
patient safety. 
(B) The Secretary of Health and Human 
Services may not use any part of such amounts 
to establish or maintain any system that re-
quires mandatory reporting of medical errors. 
(C) The Secretary of Health and Human 
Services shall promulgate regulations to estab-
lish programs and procedures for carrying out 
this paragraph. 
(4) INVESTMENT.—
(A) The Secretary of Health and Human 
Services shall invest the amounts to which this 
subsection applies in such amounts as such Sec-
retary determines are not required to meet cur-
rent withdrawals. Such investments may be 
made only in interest-bearing obligations of the 
United States. For such purpose, such obliga-
tions may be acquired on original issue at the 
issue price, or by purchase of outstanding obli-
gations at the market price. 
(B) Any obligation acquired by the Sec-
retary in such Secretary’s capacity as trustee of 
such amounts may be sold by the Secretary at 
the market price. 
SEC. 106. REDUCTION IN PREMIUMS PAID BY PHYSICIANS 
FOR 
MEDICAL 
MALPRACTICE 
INSURANCE 
COVERAGE. 
(a) IN GENERAL.—Not later than 180 days after the 
date of the enactment of this Act, each medical mal-
practice liability insurance company shall—
(1) develop a reasonable estimate of the annual 
amount of financial savings that will be achieved by 
the company as a result of this title; 
(2) develop and implement a plan to annually 
dedicate at least 50 percent of such annual savings 
to reduce the amount of premiums that the company 
charges physicians for medical malpractice liability 
coverage; and 
(3) submit to the Secretary of Health and 
Human Services (hereinafter referred to in this sec-
tion as the ‘‘Secretary’’) a written certification that 
the company has complied with paragraphs (1) and 
(2). 
(b) REPORTS.—Not later than one year after the date 
of the enactment of this Act and annually thereafter, each 
medical malpractice liability insurance company shall sub-
mit to the Secretary a report that identifies the percentage 
by which the company has reduced medical malpractice 
coverage premiums relative to the date of the enactment 
of this Act. 
(c) ENFORCEMENT.—A medical malpractice liability 
insurance company that violates a provision of this section 
is liable to the United States for a civil penalty in an 
amount assessed by the Secretary, not to exceed $11,000 
for each such violation. The provisions of paragraphs (3)
through (5) of section 303(g) of the Federal Food, Drug, 
and Cosmetic Act apply to such a civil penalty to the same 
extent and in the same manner as such paragraphs apply 
to a civil penalty under such section. 
(d) DEFINITION.—For purposes of this section, the 
term ‘‘medical malpractice liability insurance company’’ 
means an entity in the business of providing an insurance 
policy under which the entity makes payment in settlement 
(or partial settlement) of, or in satisfaction of a judgment 
in, a medical malpractice action or claim. 
SEC. 107. DEFINITIONS. 
In this title, the following definitions apply: 
(1) ALTERNATIVE DISPUTE RESOLUTION METH-
OD.—The term ‘‘alternative dispute resolution meth-
od’’ means a method that provides for the resolution 
of medical malpractice claims in a manner other 
than through medical malpractice actions. 
(2) CLAIMANT.—The term ‘‘claimant’’ means 
any person who alleges a medical malpractice claim, 
and any person on whose behalf such a claim is al-
leged, including the decedent in the case of an action 
brought through or on behalf of an estate. 
(3) HEALTH CARE PROFESSIONAL.—The term 
‘‘health care professional’’ means any individual who 
provides health care services in a State and who is
required by the laws or regulations of the State to 
be licensed or certified by the State to provide such 
services in the State. 
(4) HEALTH
CARE
PROVIDER.—The term 
‘‘health care provider’’ means any organization or 
institution that is engaged in the delivery of health 
care services in a State and that is required by the 
laws or regulations of the State to be licensed or cer-
tified by the State to engage in the delivery of such 
services in the State. 
(5) INJURY.—The term ‘‘injury’’ means any ill-
ness, disease, or other harm that is the subject of 
a medical malpractice action or a medical mal-
practice claim. 
(6) 
MANDATORY.—The 
term 
‘‘mandatory’’ 
means required to be used by the parties to attempt 
to resolve a medical malpractice claim notwith-
standing any other provision of an agreement, State 
law, or Federal law. 
(7) MEDIATION.—The term ‘‘mediation’’ means 
a settlement process coordinated by a neutral third 
party and without the ultimate rendering of a formal 
opinion as to factual or legal findings. 
(8) MEDICAL MALPRACTICE ACTION.—The term 
‘‘medical malpractice action’’ means an action in any
State or Federal court against a physician, or other 
health professional, who is licensed in accordance 
with the requirements of the State involved that—
(A) arises under the law of the State in-
volved; 
(B) alleges the failure of such physician or 
other health professional to adhere to the rel-
evant professional standard of care for the serv-
ice and specialty involved; 
(C) alleges death or injury proximately 
caused by such failure; and 
(D) seeks monetary damages, whether 
compensatory or punitive, as relief for such 
death or injury. 
(9) MEDICAL MALPRACTICE CLAIM.—The term 
‘‘medical malpractice claim’’ means a claim forming 
the basis of a medical malpractice action. 
(10) STATE.—The term ‘‘State’’ means each of 
the several States, the District of Columbia, the 
Commonwealth of Puerto Rico, American Samoa, 
Guam, the Commonwealth of the Northern Mariana 
Islands, the Virgin Islands, and any other territory 
or possession of the United States.
SEC. 108. APPLICABILITY. 
(a) IN GENERAL.—Except as provided in section 104, 
this title shall apply with respect to any medical mal-
practice action brought on or after the date of the enact-
ment of this Act. 
(b) FEDERAL COURT JURISDICTION NOT ESTAB-
LISHED ON FEDERAL QUESTION GROUNDS.—Nothing in 
this title shall be construed to establish any jurisdiction 
in the district courts of the United States over medical 
malpractice actions on the basis of section 1331 or 1337 
of title 28, United States Code. 
TITLE 
II—MEDICAL 
MAL-
PRACTICE 
INSURANCE 
RE-
FORM 
SEC. 201. PROHIBITION ON ANTICOMPETITIVE ACTIVITIES 
BY MEDICAL MALPRACTICE INSURERS. 
Notwithstanding any other provision of law, nothing 
in the Act of March 9, 1945 (15 U.S.C. 1011 et seq., com-
monly known as the ‘‘McCarran-Ferguson Act’’) shall be 
construed to permit commercial insurers to engage in any 
form of price fixing, bid rigging, or market allocations in 
connection with the conduct of the business of providing 
medical malpractice insurance. This section does not apply 
to the information-gathering and rate-setting activities of 
any State commissions of insurance, or any other State 
regulatory body with authority to set insurance rates.
SEC. 202. MEDICAL MALPRACTICE INSURANCE PRICE COM-
PARISON. 
(a) INTERNET SITE.—Not later than 90 days after 
the date of the enactment of this Act, and after consulta-
tion with the medical malpractice insurance industry, the 
Secretary of Health and Human Services shall establish 
an interactive internet site which shall enable any health 
care provider licensed in the United States to obtain a 
quote from each medical malpractice insurer licensed to 
write the type of coverage sought by the provider. 
(b) ONLINE FORMS.—
(1) IN GENERAL.—The internet site shall en-
able health care providers to complete an online 
form that shall capture a comprehensive set of infor-
mation sufficient to generate a quote for each in-
surer. The Secretary shall develop transmission soft-
ware components which allow such information to be 
formatted for delivery to each medical malpractice 
insurer based on the requirements of the computer 
system of the insurer. 
(2) PROTECTION OF CONFIDENTIALITY OF IN-
FORMATION
DISCLOSED.—All information provided 
by a health care provider for purposes of generating 
a quote through the internet site shall be used only 
for that purpose.
(c) INTEGRATION OF RATING CRITERIA.—The Sec-
retary shall integrate the rating criteria of each insurer 
into its online form after consultation with each insurer. 
The Secretary shall integrate such criteria using one of 
the following methods: 
(1) Developing a customized interface with the 
insurer’s own rating engine. 
(2) Accessing a third-party rating engine of the 
insurer’s choice. 
(3) Loading the carrier’s rating information 
into a rating engine operated by the Secretary. 
(4) Any other method agreed on between the 
Secretary and the insurer. 
(d) PRESENTATION OF QUOTES.—After a health care 
provider has answered all the questions appearing on the 
online form, such provider will be presented with quotes 
from each medical malpractice insurer licensed to write 
the coverage requested by the provider. 
(e) ACCURACY OF QUOTES.—Quotes provided at the 
internet site shall at all times be accurate. Whenever any 
insurer changes its rates, such rate changes shall be imple-
mented at the internet site by the Secretary, in consulta-
tion with the insurer, as soon as practicable, but in no 
event later than 10 days after such changes take effect. 
During any period during which an insurer has changed
its rates but the Secretary has not yet implemented such 
changed rates on the internet site, quotes for that insurer 
shall not be obtainable at the internet site. 
(f) USER-FRIENDLY
FEATURES.—The Secretary 
shall design the internet site to incorporate user-friendly 
formats and self-help guidance materials, and shall de-
velop a user-friendly internet user-interface. 
(g) CONTACT INFORMATION.—The internet site shall 
also provide contact information, including address and 
telephone number, for each medical malpractice insurer 
for which a provider obtains a quote at the site. 
(h) REPORT.—Not later than December 31, 2004, 
the Secretary shall submit a report to the Congress on 
the development, implementation and effects of the inter-
net site. Such report shall be based on—
(1) the Secretary’s consultation with health 
care providers, medical malpractice insurers, State 
insurance commissioners, and other interested par-
ties; and 
(2) the Secretary’s analysis of other informa-
tion available to the Secretary. 
The report shall describe the Secretary’s views concerning 
the extent to which this section has contributed to increas-
ing the availability of medical malpractice insurance, and
the effect this section has had on the cost of medical mal-
practice insurance. 
TITLE III—ENHANCING PATIENT 
ACCESS TO CARE THROUGH 
DIRECT ASSISTANCE 
SEC. 301. GRANTS AND CONTRACTS REGARDING HEALTH 
PROVIDER SHORTAGES. 
Subpart I of part D of title III of the Public Health 
Service Act (42 U.S.C. 254b et seq.) is amended by adding 
at the end the following section. 
‘‘SEC. 330L. HEALTH PROVIDER SHORTAGES RESULTING 
FROM COSTS OF MEDICAL MALPRACTICE IN-
SURANCE. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration, may make awards of grants or contracts 
in accordance with this section for geographic areas that, 
as determined by the Secretary, have a shortage of one 
or more types of health providers as a result of the pro-
viders making the decision to cease or curtail providing 
health services in the geographic areas because of the costs 
of maintaining malpractice insurance. 
‘‘(b) RECIPIENTS OF AWARDS; EXPENDITURE.—In 
accordance with such criteria as the Secretary may estab-
lish:
‘‘(1) Awards under subsection (a) may be made 
to health providers who agree to provide health serv-
ices (or to continue providing health services, as the 
case may be) in geographic areas described in such 
subsection for the period during which payments 
under the awards are made to the health providers. 
‘‘(2) Health providers who receive such awards 
may expend the awards to assist the providers with 
the costs of maintaining medical malpractice insur-
ance for providing health services in the geographic 
area for which the award is made. 
‘‘(c) DEFINITION.—For purposes of this section, the 
term ‘health providers’ means physicians and other health 
professionals, and organizations that provide health serv-
ices (including hospitals, clinics, and group practices), that 
meet applicable legal requirements to provide the health 
services involved.’’. 
SEC. 302. HEALTH PROFESSIONAL ASSIGNMENTS TO TRAU-
MA CENTERS THROUGH NATIONAL HEALTH 
SERVICE CORPS. 
Section 338H of the Public Health Service Act (42 
U.S.C. 254q) is amended by adding at the end the fol-
lowing subsection:
‘‘(d) TRAUMA CENTERS; SEPARATE AUTHORIZATION 
REGARDING SHORTAGES RESULTING FROM COSTS OF 
MEDICAL MALPRACTICE INSURANCE.—
‘‘(1) IN GENERAL.—For the purpose of assign-
ing Corps surgeons, obstetricians/gynecologists, and 
other health professionals to trauma centers in 
health professional shortage areas described in para-
graph (2), there are authorized to be appropriated 
such sums as may be necessary for each of the fiscal 
years 2003 through 2006. Such authorization is in 
addition to any other authorization of appropriations 
that is available for such purpose. 
‘‘(2) DESCRIPTION OF AREAS.—A health pro-
fessional shortage area referred to in paragraph (1) 
is such an area in which, as determined by the Sec-
retary, a medical facility in the area has lost its des-
ignation as a trauma center or as a particular level 
of trauma center, or is at significant risk of losing 
such a designation, as a result of one or more sur-
geons, obstetricians/gynecologists, or other health 
professionals making the decision to cease or curtail 
practicing at the facility because of the costs of 
maintaining malpractice insurance. For purposes of 
paragraph (1), (A) the term ‘trauma center’ includes 
such a medical facility; and (B) the Secretary may
adjust the criteria for designation as a health profes-
sional shortage area to the extent necessary to make 
funds appropriated under paragraph (1) available 
with respect to any medical facility to ensure that 
the facility does not lose any such designation as a 
result of such decisions by health professionals.’’. 
TITLE IV—INDEPENDENT ADVI-
SORY COMMISSION ON MED-
ICAL 
MALPRACTICE 
INSUR-
ANCE 
SEC. 401. ESTABLISHMENT. 
(a) FINDINGS.—The Congress finds as follows: 
(1) The sudden rise in medical malpractice pre-
miums in regions of the United States can threaten 
patient access to doctors and other health providers. 
(2) Improving patient access to doctors and 
other health providers is a national priority. 
(b) ESTABLISHMENT.—There is established a na-
tional commission to be known as the ‘‘Independent Advi-
sory Commission on Medical Malpractice Insurance’’ (in 
this title referred to as the ‘‘Commission’’). 
SEC. 402. DUTIES. 
(a) IN GENERAL.—The Commission shall evaluate 
the causes and scope of the recent and dramatic increases 
in medical malpractice insurance premiums and formulate
additional proposals to reduce such medical malpractice 
premiums and make recommendations to avoid any dra-
matic increases in medical malpractice premiums in the 
future, in light of proposals for tort reform regarding med-
ical malpractice. 
(b) CONSIDERATIONS.—In formulating proposals 
under this section, the Commission shall, at a minimum, 
consider the following: 
(1) Alternatives to the current medical mal-
practice tort system that would ensure adequate 
compensation for patients, preserve access to pro-
viders, and improve health care safety and quality. 
(2) Modifications of, and alternatives to, the ex-
isting State and Federal regulations and oversight 
that affect, or could affect, medical malpractice lines 
of insurance. 
(3) State and Federal reforms that would dis-
tribute the risk of medical malpractice more equi-
tably among health care providers. 
(4) State and Federal reforms that would more 
evenly distribute the risk of medical malpractice 
across various categories of providers. 
(5) The effect of a Federal medical malpractice 
reinsurance program administered by the Depart-
ment of Health and Human Services.
(6) The effect of a Federal medical malpractice 
insurance program, administered by the Department 
of Health and Human Services, to provide medical 
malpractice insurance based on customary coverage 
terms and liability amounts in States where such in-
surance is unavailable or is unavailable at reasonable 
and customary terms. 
(7) Programs that would reduce medical errors 
and increase patient safety, including new innova-
tions in technology and management. 
(8) The effect of State policies under which—
(A) any health care professional licensed 
by the State has standing in any State adminis-
trative proceeding to challenge a proposed rate 
increase in medical malpractice insurance; and 
(B) a provider of medical malpractice in-
surance in the State may not implement a rate 
increase in such insurance unless the provider, 
at minimum, first submits to the appropriate 
State agency a description of the rate increase 
and a substantial justification for the rate in-
crease. 
SEC. 403. REPORT. 
(a) IN GENERAL.—The Commission shall transmit to 
Congress—
(1) an initial report not later than 180 days 
after the date of the initial meeting of the Commis-
sion; and 
(2) a report not less than each year thereafter 
until the Commission terminates. 
(b) CONTENTS.—Each report transmitted under this 
section shall contain a detailed statement of the findings 
and conclusions of the Commission, including proposals 
for addressing the current dramatic increases in medical 
malpractice insurance rates and recommendations for 
avoiding any such dramatic increases in the future. 
(c) VOTING AND REPORTING REQUIREMENTS.—With 
respect to each proposal or recommendation contained in 
the report submitted under subsection (a), each member 
of the Commission shall vote on the proposal or rec-
ommendation, and the Commission shall include, by mem-
ber, the results of that vote in the report. 
SEC. 404. MEMBERSHIP. 
(a) NUMBER AND APPOINTMENT.—The Commission 
shall be composed of 15 members appointed by the Comp-
troller General of the United States. 
(b) MEMBERSHIP.—
(1) IN
GENERAL.—The membership of the 
Commission shall include individuals with national 
recognition for their expertise in health finance and
economics, actuarial science, medical malpractice in-
surance, insurance regulation, health care law, 
health care policy, health care access, allopathic and 
osteopathic physicians, other providers of health care 
services, patient advocacy, and other related fields, 
who provide a mix of different professionals, broad 
geographic representations, and a balance between 
urban and rural representatives. 
(2) INCLUSION.—The membership of the Com-
mission shall include the following: 
(A) Two individuals with expertise in 
health finance and economics, including one 
with expertise in consumer protections in the 
area of health finance and economics. 
(B) Two individuals with expertise in med-
ical malpractice insurance, representing both 
commercial insurance carriers and physician-
sponsored insurance carriers. 
(C) An individual with expertise in State 
insurance regulation and State insurance mar-
kets. 
(D) An individual representing physicians. 
(E) An individual with expertise in issues 
affecting hospitals, nursing homes, nurses, and 
other providers.
(F) Two individuals representing patient 
interests. 
(G) Two individuals with expertise in 
health care law or health care policy. 
(H) An individual with expertise in rep-
resenting patients in malpractice lawsuits. 
(3) MAJORITY.—The total number of individ-
uals who are directly involved with the provision or 
management of malpractice insurance, representing 
physicians or other providers, or representing physi-
cians or other providers in malpractice lawsuits, 
shall not constitute a majority of the membership of 
the Commission. 
(4) ETHICAL
DISCLOSURE.—The Comptroller 
General of the United States shall establish a system 
for public disclosure by members of the Commission 
of financial or other potential conflicts of interest re-
lating to such members. 
(c) TERMS.—
(1) IN GENERAL.—The terms of the members 
of the Commission shall be for 3 years except that 
the Comptroller General of the United States shall 
designate staggered terms for the members first ap-
pointed.
(2) VACANCIES.—Any member appointed to fill 
a vacancy occurring before the expiration of the 
term for which the member’s predecessor was ap-
pointed shall be appointed only for the remainder of 
that term. A member may serve after the expiration 
of that member’s term until a successor has taken 
office. A vacancy in the Commission shall be filled 
in the manner in which the original appointment was 
made. 
(3) COMPENSATION.—Members of the Commis-
sion shall be compensated in accordance with section 
1805(c)(4) of the Social Security Act. 
(4) CHAIRMAN; VICE CHAIRMAN.—The Comp-
troller General of the United States shall designate 
at the time of appointment a member of the Com-
mission as Chairman and a member as Vice Chair-
man. In the case of vacancy of the Chairmanship or 
Vice Chairmanship, the Comptroller General may 
designate another member for the remainder of that 
member’s term. 
(5) MEETINGS.—
(A) IN GENERAL.—The Commission shall 
meet at the call of the Chairman. 
(B) INITIAL MEETING.—The Commission 
shall hold an initial meeting not later than the
date that is 1 year after the date of the enact-
ment of this title, or the date that is 3 months 
after the appointment of all the members of the 
Commission, whichever occurs earlier. 
SEC. 405. DIRECTOR AND STAFF; EXPERTS AND CONSULT-
ANTS. 
Subject to such review as the Comptroller General of 
the United States deems necessary to assure the efficient 
administration of the Commission, the Commission may—
(1) employ and fix the compensation of an Ex-
ecutive Director (subject to the approval of the 
Comptroller General) and such other personnel as 
may be necessary to carry out its duties (without re-
gard to the provisions of title 5, United States Code, 
governing appointments in the competitive service); 
(2) seek such assistance and support as may be 
required in the performance of its duties from ap-
propriate Federal departments and agencies; 
(3) enter into contracts or make other arrange-
ments, as may be necessary for the conduct of the 
work of the Commission (without regard to section 
3709 of the Revised Statutes (41 U.S.C. 5)); 
(4) make advance, progress, and other pay-
ments which relate to the work of the Commission;
(5) provide transportation and subsistence for 
persons serving without compensation; and 
(6) prescribe such rules and regulations as it 
deems necessary with respect to the internal organi-
zation and operation of the Commission. 
SEC. 406. POWERS. 
(a) OBTAINING OFFICIAL DATA.—The Commission 
may secure directly from any department or agency of the 
United States information necessary to enable it to carry 
out this section. Upon request of the Chairman, the head 
of that department or agency shall furnish that informa-
tion to the Commission on an agreed upon schedule. 
(b) DATA COLLECTION.—In order to carry out its 
functions, the Commission shall—
(1) utilize existing information, both published 
and unpublished, where possible, collected and as-
sessed either by its own staff or under other ar-
rangements made in accordance with this section; 
(2) carry out, or award grants or contracts for, 
original research and experimentation, where exist-
ing information is inadequate; and 
(3) adopt procedures allowing any interested 
party to submit information for the Commission’s 
use in making reports and recommendations.
(c) ACCESS OF GENERAL ACCOUNTING OFFICE TO 
INFORMATION.—The Comptroller General of the United 
States shall have unrestricted access to all deliberations, 
records, and nonproprietary data of the Commission, im-
mediately upon request. 
(d) PERIODIC AUDIT.—The Commission shall be sub-
ject to periodic audit by the Comptroller General of the 
United States. 
SEC. 407. AUTHORIZATION OF APPROPRIATIONS. 
(a) IN GENERAL.—There are authorized to be appro-
priated such sums as may be necessary to carry out this 
title for each of fiscal years 2004 through 2008. 
(b) REQUESTS FOR APPROPRIATIONS.—The Commis-
sion shall submit requests for appropriations in the same 
manner as the Comptroller General of the United States 
submits requests for appropriations, but amounts appro-
priated for the Commission shall be separate from 
amounts appropriated for the Comptroller General.
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