I 
113TH CONGRESS 
2D SESSION 
H. R. 4106 
To provide for the development and dissemination of clinical practice guide-
lines and the establishment of a right of removal to Federal courts 
for defendants in medical malpractice actions involving a Federal payor, 
and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 27, 2014 
Mr. BARR (for himself and Mr. BERA of California) introduced the following 
bill; which was referred to the Committee on Energy and Commerce, and 
in addition to the Committee on the Judiciary, 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 provide for the development and dissemination of clinical 
practice guidelines and the establishment of a right of 
removal to Federal courts for defendants in medical mal-
practice actions involving a Federal payor, and for other 
purposes. 
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 ‘‘Saving Lives, Saving 
Costs Act’’. 
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SEC. 2. PURPOSES. 
The purposes of this Act are: 
(1) To offer physicians who document adher-
ence to certain evidence-based clinical-practice guide-
lines, and, when applicable, appropriate use criteria, 
a safe harbor from medical-malpractice litigation. 
(2) To reduce the practice of defensive medicine 
and resulting health care costs. 
(3) To increase adherence to evidence-based 
clinical practice guidelines to reduce clinical vari-
ation in health care practice. 
(4) To improve quality of care and patient safe-
ty. 
(5) To permit organizations with relevant ex-
pertise to participate in the selection of clinical prac-
tice guidelines. 
(6) To permit professionals with relevant exper-
tise to participate and benefit from liability reform. 
SEC. 3. REQUIREMENTS FOR SELECTION OF CLINICAL 
PRACTICE GUIDELINES. 
(a) SELECTION.—Not later than 6 months after the 
date of enactment of this Act, eligible professional organi-
zations that have established, published, maintained and 
updated on a regular basis, clinical practice guidelines, in-
cluding when applicable, appropriate use criteria, that in-
corporate best practices, shall submit to the Secretary 
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shall not apply under this subsection unless notifica-
tion of such update is made available to applicable 
eligible professionals. 
SEC. 4. DEVELOPMENT. 
(a) GUIDELINE STANDARDS.—To the extent possible, 
the development of clinical practice guidelines should be 
guided by the Institute of Medicine’s Standards for Devel-
oping Trustworthy Guidelines and should— 
(1) be developed through a transparent process 
that minimizes conflicts of interest; 
(2) be developed by a knowledgeable, multidisci-
plinary panel of experts and representatives from 
key affected groups; 
(3) take into consideration important patient 
subgroups and patient preferences as appropriate; 
(4) be based on a systematic review of the exist-
ing evidence; 
(5) provide a clear explanation of the relation-
ship between care options and health outcomes; 
(6) provide ratings of both the quality of evi-
dence and strength of recommendation; 
(7) be reconsidered and revised when new evi-
dence emerges; and 
(8) clearly identify any exceptions to the appli-
cation of the clinical practice guideline. 
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(b) REQUIRED DISCLOSURES FROM ELIGIBLE PRO-
FESSIONAL ORGANIZATIONS.—Any person who is affili-
ated with an eligible professional organization and who di-
rectly participated in the creation of a clinical practice 
guideline shall disclose any conflicts of interest pertaining 
to the development of the clinical practice guideline, in-
cluding any conflict of interest pertaining to any instru-
ment, medicine, drug, or any other substance, device, or 
means included in the clinical practice guideline. Disclo-
sures by eligible professional organizations shall be made 
promptly, upon submission of the guidelines, and during 
every review of the guidelines, to the Secretary. Disclo-
sures shall additionally include the following: 
(1) Scientific methodology and evidence that 
supports clinical practice guidelines. 
(2) Outside collaborators. 
(3) Endorsements. 
SEC. 5. INTERNET PUBLICATION OF GUIDELINES. 
The Secretary of Health and Human Services shall 
publish all clinical practice guidelines on the Internet 
through the National Guideline Clearinghouse or other ap-
propriate sites or sources, including all data and method-
ology used in the development and selection of the guide-
lines in compliance with data disclosure standards in the 
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Health Insurance Portability and Accountability Act of 
1996. 
SEC. 6. STATE FLEXIBILITY AND PROTECTION OF STATES’ 
RIGHTS. 
(a) LIMITATION.—This Act shall not preempt or su-
persede any State or Federal law that imposes greater 
procedural or substantive protections for health care pro-
viders and health care organizations from liability, loss, 
or damages than those provided by this title or create a 
cause of action. 
(b) STATE FLEXIBILITY.—No provision of this Act 
shall be construed to preempt any defense available to a 
party in a health care liability action under any other pro-
vision of State or Federal law. 
SEC. 7. RIGHT OF REMOVAL. 
Section 1441 of title 28, United States Code, is 
amended by adding at the end the following: 
‘‘(g) CERTAIN ACTIONS AGAINST MEDICAL PROFES-
SIONALS.—(1) Any health care liability action brought in 
a State court against an applicable eligible professional or 
health care provider may be removed by any defendant 
or the defendants to the district court of the United States 
for the district and division embracing the place where 
such action is pending. 
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‘‘(2) For purposes of this subsection the terms ‘appli-
cable eligible professional’, ‘health care provider’, ‘health 
care liability action’, and ‘health care liability claim’ have 
the meaning given such term in section 10 of the Saving 
Lives, Saving Costs Act of 2014.’’. 
SEC. 8. MANDATORY REVIEW BY INDEPENDENT MEDICAL 
REVIEW PANEL. 
(a) IN GENERAL.—If, in any health care liability ac-
tion against an applicable eligible professional, the appli-
cable eligible professional alleges, in any response to the 
claimant’s filing, that the applicable eligible professional 
adhered to an applicable clinical practice guideline in the 
provision of health care goods or services to the claimant, 
then the court shall suspend further proceedings on the 
health care liability action prior to discovery proceedings, 
until the completion of a review of the action by an inde-
pendent medical review panel. 
(b) INDEPENDENT MEDICAL REVIEW PANEL.— 
(1) COMPOSITION.—An independent medical re-
view panel under this section shall be composed of 
3 members who are experts in the relevant field of 
clinical practice. 
(2) 
REQUIREMENTS
FOR
MEMBER
ELIGI-
BILITY.—To be eligible to serve on an independent 
medical review panel, a member shall— 
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(A) be an experienced physician certified 
by a board recognized by the American Board 
of Medical Specialties; 
(B) not earlier than 2 years prior to the 
date of selection to the board, have been in ac-
tive medical practice or devoted a substantial 
portion of his or her time to teaching at an ac-
credited medical school, or have been engaged 
in university-based research in relation to the 
medical care and type of treatment at issue; 
and 
(C) be approved by his or her specialty so-
ciety. 
When possible, members should be from the region 
where the case in question originates to account for 
geographical practice variation. 
(3) NO CIVIL LIABILITY FOR MEMBERS.—No 
civil action shall be brought in any court against any 
member for any act done, failure to act, or state-
ment or opinion made, within the scope of his or her 
duties as a member of the independent medical re-
view panel. 
(4) CONSIDERATIONS IN MAKING DETERMINA-
TIONS.—The members of the independent medical 
review panel shall acknowledge the ability of physi-
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