I 
108TH CONGRESS 
2D SESSION 
H. R. 4211 
To amend the Health Care Quality Improvement Act of 1986 to expand 
the National Practitioner Data Bank. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 22, 2004 
Mr. PALLONE introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
A BILL 
To amend the Health Care Quality Improvement Act of 
1986 to expand the National Practitioner Data Bank. 
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 ‘‘Safe Health Care Re-
porting Act of 2004’’. 
SEC. 2. REPORTING OF SANCTIONS. 
Section 422 of the Health Care Quality Improvement 
Act of 1986 (42 U.S.C. 11132) is amended—
(1) in the section heading by striking ‘‘Boards 
of medical examiners’’ and inserting ‘‘State licensing 
boards’’; 
(2) in paragraphs (1) and (2) of subsection 
(a)— 
(A) by striking ‘‘physician’s’’ each place it 
appears and inserting ‘‘physician’s or other 
health care practitioner’s’’; and 
(B) by striking ‘‘physician’’ each place it 
appears and inserting ‘‘physician or other 
health care practitioner’’; and 
(3) in subsections (a) and (b), by striking 
‘‘Board of Medical Examiners’’ each place it appears 
and inserting ‘‘State licensing board’’. 
SEC. 3. REPORTING OF CERTAIN PROFESSIONAL REVIEW 
ACTIONS. 
Section 423 of the Health Care Quality Improvement 
Act of 1986 (42 U.S.C. 11133) is amended— 
(1) by striking ‘‘Board of Medical Examiners’’ 
each place it appears and inserting ‘‘State licensing 
board’’; 
(2) in subsection (a)— 
(A) by striking paragraph (2) and insert-
ing the following:
‘‘(2) MANDATORY
REPORTING
ON
OTHER
LI-
CENSED HEALTH CARE PRACTITIONERS.—A health 
care entity shall report to the appropriate State li-
censing boards and to the agency designated under 
section 424(b), the information described in para-
graph (3) in the case of a licensed health care prac-
titioner who is not a physician, if the entity would 
be required to report such information under para-
graph (1) with respect to the practitioner if the 
practitioner were a physician.’’; 
(B) by redesignating paragraph (3)(C) as 
paragraph (3)(D); and 
(C) by striking paragraph (3)(B) and in-
serting the following: 
‘‘(B) a description of any adverse action, 
including dismissal and review action, taken by 
a hospital or other health care entity against a 
health care practitioner who is employed by, has 
privileges at, is under contract with, or other-
wise works at the health care entity for conduct 
that may be construed to violate any Federal or 
State law, including laws governing licensed 
health care professional practice standards, 
‘‘(C) information on a health care practi-
tioner who voluntarily resigns during, or as a
result of, a pending dismissal or review action, 
and’’; 
(3) by redesignating subsections (b), (c), and 
(d) as subsections (c), (d), and (e), respectively; 
(4) by inserting after subsection (a), the fol-
lowing: 
‘‘(b) STANDARD FOR REPORTING OF ADVERSE AC-
TIONS.—Adverse actions reported under subsection (a)(2) 
shall be made in accordance with the rights and proce-
dures afforded to physicians under section 412.’’; 
(5) in subsection (c) (as so redesignated), in the 
subsection heading, by striking ‘‘Board of Medical 
Examiners’’ and inserting ‘‘State licensing board’’; 
(6) in subsection (d)(1) (as so redesignated), by 
striking ‘‘subsection (a)(1)’’ and inserting ‘‘para-
graphs (1) and (2) of subsection (a) and subsection 
(b)’’; 
(7) in subsection (d)(2) (as so redesignated), in 
the paragraph heading, by striking ‘‘Board of Med-
ical Examiners’’ and inserting ‘‘State licensing 
board’’; 
(8) in subsection (e) (as so redesignated), in the 
subsection heading, by striking ‘‘Board of Medical 
Examiners’’ and inserting ‘‘State licensing board’’; 
and
(9) by adding at the end the following: 
‘‘(f) CIVIL PENALTIES.— 
‘‘(1) IN GENERAL.—The Secretary shall provide 
for the imposition of no more than $50,000 per vio-
lation for health care entities that fail to comply 
with this section. 
‘‘(2) REPEATED
VIOLATIONS.—The Secretary 
shall provide for civil penalties in addition to the 
amount listed in paragraph (1) for health care enti-
ties that establish patterns of repeated violations of 
this section.’’. 
SEC. 4. CIVIL PENALTIES. 
Section 425 of the Health Care Quality Improvement 
Act of 1986 (42 U.S.C. 11135) is amended— 
(1) in paragraphs (1) and (2) of subsection (a), 
and subsections (b) and (c), by striking ‘‘hospital’’ 
each place it appears and inserting ‘‘health care en-
tity or agency employing a physician or other li-
censed health care practitioner’’; 
(2) in subsection (a)— 
(A) in the matter preceding paragraph 
(1)— 
(i) by striking ‘‘each hospital’’ and in-
serting ‘‘each health care entity and agen-
cy employing a physician or other licensed 
health care practitioner’’; and 
(ii) by inserting ‘‘and from the appro-
priate State licensing board,’’ after ‘‘(or 
the 
agency 
designated 
under 
section 
424(b)),’’; 
(B) in paragraph (1), by inserting ‘‘or em-
ployment’’ after ‘‘clinical privileges’’; and 
(C) in paragraph (2), by inserting ‘‘or em-
ployed’’ after ‘‘clinical privileges’’; 
(3) in subsection (c), by striking ‘‘hospital’s’’ 
and inserting ‘‘the health care entity’s or agency’s’’ 
and 
(4) by adding at the end the following: 
‘‘(d) CIVIL PENALTIES.— 
‘‘(1) IN GENERAL.—The Secretary shall provide 
for the imposition of no more than $50,000 per vio-
lation for a health care entity or agency employing 
a physician or other licensed health care practitioner 
that fails to comply with this section. 
‘‘(2) REPEATED
VIOLATIONS.—The Secretary 
shall provide for civil penalties in addition to the 
amount listed in paragraph (1) for a health care en-
tity or agency employing a physician or other li-
censed health care practitioner that establishes pat-
terns of repeated violations of this section.’’. 
SEC. 5. PROFESSIONAL REVIEW. 
Section 411 of the Health Care Quality Improvement 
Act of 1986 (42 U.S.C. 11111) is amended by adding at 
the end the following: 
‘‘(d) CIVIL LIABILITY IMMUNITY FOR HEALTH CARE 
ENTITIES.— 
‘‘(1) IN GENERAL.—A health care entity that 
discloses information about a former or current em-
ployee pursuant to section 423 is immune from civil 
liability for such disclosure and its consequences un-
less it is demonstrated that the employer— 
‘‘(A) knowingly disclosed false information; 
or 
‘‘(B) violated any right of the former or 
current employee that is protected under Fed-
eral or State laws. 
‘‘(2) APPLICATION.—This subsection applies to 
any employee, agent, or other representative of the 
current or former employer who is authorized to pro-
vide and who provides information in accordance 
with section 423. 
‘‘(e) PROTECTION
OF
HEALTH
CARE
PRACTI-
TIONERS.—A health care entity shall not penalize, dis-
criminate, or retaliate in any manner with respect to em-
ployment, including discharge, promotion, compensation, 
or terms, conditions, or privileges of employment, against 
an employee who, in good faith, reports conduct that may 
be construed to violate a Federal or State law, including 
laws governing licensed health care professional practice 
standards, to a State authority, licensing authority, peer 
review organization, or employer.’’. 
SEC. 6. HEALTH CARE ENTITY; SKILLED NURSING FACIL-
ITY. 
Section 431 of the Health Care Quality Improvement 
Act of 1986 (42 U.S.C. 11151) is amended— 
(1) in paragraph (4)(i), by inserting ‘‘or skilled 
nursing facility’’ after ‘‘hospital’’; 
(2) by redesignating paragraphs (13) and (14) 
as paragraphs (14) and (15), respectively; and 
(3) by inserting after paragraph (12) the fol-
lowing: 
‘‘(13) The term ‘skilled nursing facility’ means 
an entity described in section 1819(a) of the Social 
Security Act (42 U.S.C. 1395i-3(a)).’’.