I
103D CONGRESS
2D SESSION
H. R. 4856
To improve the Nation’s health care by creating a comprehensive medical
malpractice prevention program through the creation of independent,
publicly accountable State medical boards and more stringent licensing
and discipline procedures; to empower health consumers by mandating
reporting of certain information regarding health care providers and
professionals and by enhancing informed individual choice regarding
health care services by providing certain information to consumers; and
for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JULY 28, 1994
Mr. NADLER introduced the following bill; which was referred to the
Committee on Energy and Commerce
A BILL
To improve the Nation’s health care by creating a com-
prehensive medical malpractice prevention program
through the creation of independent, publicly accountable
State medical boards and more stringent licensing and
discipline procedures; to empower health consumers by
mandating reporting of certain information regarding
health care providers and professionals and by enhancing
informed individual choice regarding health care services
by providing certain information to consumers; 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; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Patient Safety Act of 1994’’.
(b) TABLE OF CONTENTS.—The table of contents for
this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—GENERAL PROVISIONS
Sec. 101. Findings and purpose.
Sec. 102. Preemption.
Sec. 103. Effective date.
Sec. 104. Definitions.
TITLE II—CREATION OF INDEPENDENT AND EFFECTIVE STATE
MEDICAL BOARDS
Sec. 201. Requirements for State medical boards.
Sec. 202. Guidelines for investigations.
Sec. 203. Disciplinary hearings.
Sec. 204. Disciplinary actions.
Sec. 205. Disclosure of disciplinary actions.
Sec. 206. Federal assumption of responsibilities.
TITLE III—REQUIREMENTS FOR HEALTH CARE PROFESSIONALS
AND PROVIDERS
Sec. 301. Renewal of license required every 2 years.
Sec. 302. Reporting requirements.
Sec. 303. Reexamination required after 6 years.
Sec. 304. Audits.
Sec. 305. Mandatory medical malpractice insurance.
Sec. 306. Study of medical negligence.
TITLE IV—PUBLIC ACCESS TO PRACTITIONER DATA BANK
Sec. 401. Providing public access to the national practitioner data bank.
TITLE I—GENERAL PROVISIONS
SEC. 101. FINDINGS AND PURPOSE.
(a) FINDINGS.—The Congress finds and declares
that—
(1) there are a large number of avoidable
deaths and injuries in the Nation caused by medical
negligence and malpractice;
(2) the identity of health care professionals re-
sponsible for medical negligence should be revealed
to the public and they should be subject to discipline
by the appropriate State medical boards;
(3) despite the large number of consumers in-
jured by medical malpractice each year, fewer than
1⁄2 of 1 percent of the Nation’s health care profes-
sionals face any serious State sanctions each year;
(4) the purpose of State medical boards is to
protect the public from the unprofessional, improper
and incompetent practice of medicine;
(5) most State medical boards are not ade-
quately disciplining health care professionals and
when they do, most of their efforts focus on offenses
other than medical negligence, with revocations or
suspensions of licenses rarely occurring;
(6) among the reasons why the State medical
boards are unwilling or unable to identify and dis-
cipline negligent health care professions are that the
boards lack adequate funding, staffing, investigative
and disciplinary powers and because the boards are
dominated by health care professionals who are re-
luctant to discipline their colleagues;
(7) medical malpractice lawsuits are a nec-
essary adjunct to State disciplinary proceedings, but
they are not a substitute for them, since it is govern-
ment, through its licensure of health care profes-
sionals, that must ensure that high-quality health
care is delivered to the public;
(8) health care consumers have very little infor-
mation available to them regarding the quality of
their health care providers and professionals;
(9) in order to make informed choices between
health care providers and professionals, consumers
need access to more information about their health
care providers and professionals, including discipli-
nary and malpractice records; and
(10) more and better information to health care
consumers about their health care providers and pro-
fessionals and more and better discipline of incom-
petent and negligent health care professionals will
alleviate the medical malpractice crisis and improve
the quality of health care in the Nation by helping
consumers to choose between health care providers
and professionals and by removing the licenses of
those health care professionals who are a danger to
the public health and welfare.
(b) PURPOSE.—It is the purpose of this Act—
(1) to create a national program of medical
malpractice prevention by requiring State medical
boards to be controlled by members of the public
and not of the profession being monitored;
(2) to ensure that State medical boards are
more effective in identifying and disciplining incom-
petent, unethical, and negligent health care profes-
sionals by ensuring that such boards are adequately
staffed and funded to fulfill their purpose of permit-
ting only qualified and fit individuals to practice
medicine;
(3) to provide ready access to consumers of in-
formation regarding their health care providers and
professionals; and
(4) to ensure that all health care professionals
remain abreast of new information regarding the ef-
ficacy of medical tests and procedures and to assist
in the identification of incompetent health care pro-
fessionals, thereby reducing the incidence of the
practice of unnecessary medicine and the incidence
of preventable injuries to patients.
SEC. 102. PREEMPTION.
The provisions of this Act shall preempt State law
only to the extent that the Secretary finds that State law
does not protect the health and safety of patients in the
State at least as effectively as the provisions of this Act.
SEC. 103. DEFINITIONS.
As used in this Act:
(1) 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.
(2) HEALTH
CARE
PROFESSIONAL
OR
LI-
CENSEE.—The terms ‘‘health care professional’’ and
‘‘licensee’’ mean an 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 cer-
tified by the State to provide such services in the
State.
(3) INJURY.—The term ‘‘injury’’ means any ill-
ness, disease, or other harm that is the subject of
a quality of care complaint or a medical malpractice
claim.
(4) QUALITY OF CARE COMPLAINT.—The term
‘‘quality of health care complaint’’ means a claim in
which the claimant alleges to a State medical board
or any entity of the Federal Government which sanc-
tions health care professionals that injury was
caused by the provision of (or the failure to provide)
health care services.
(5) MEDICAL MALPRACTICE ACTION.—The term
‘‘medical malpractice action’’ means a civil action
(other than an action in which the plaintiff’s sole al-
legation is an allegation of an intentional tort)
brought in a State or Federal court against a health
care provider or health care professional (regardless
of the theory of liability on which the action is
based) in which the plaintiff alleges a medical mal-
practice claim.
(6) MEDICAL MALPRACTICE CLAIM.—The term
‘‘medical malpractice claim’’ means a claim in which
an individual alleges that injury was caused by the
provision of (or the failure to provide) health care
services.
(7) SECRETARY.—The term ‘‘Secretary’’ means
the Secretary of Health and Human Services.
(8) STATE.—The term ‘‘State’’ means the 50
States, the District of Columbia, Puerto Rico, the
Virgin Islands, Guam, American Samoa, and the
Northern Mariana Islands.
(9) STATE MEDICAL BOARD.—The term ‘‘State
medical board’’ means the entity (as determined by
a State) with responsibility for the disciplining or li-
censing of health care professionals, and includes a
subdivision of such an entity.
SEC. 104. EFFECTIVE DATE.
This Act shall take effect January 1, 1996.
TITLE II—CREATION OF INDE-
PENDENT 
AND 
EFFECTIVE
STATE MEDICAL BOARDS
SEC. 201. REQUIREMENTS FOR STATE MEDICAL BOARDS.
(a) IN GENERAL.—Each State medical board shall
meet the following requirements:
(1) COMPOSITION.—Not less than 51 percent of
the members of a State medical board shall be pub-
lic members with no current or previous significant
business, professional, or pecuniary connection with
a health care professional, medical education facility,
or health care provider (other than as a patient or
potential patient), in accordance with regulations of
the Secretary. The number of members of the board
shall be based on the State’s physician population
(as prescribed by the Secretary), except that in no
event may a board have fewer than 12 members.
The Chairperson and Vice-Chairperson of the board
shall be public members.
(2) TERM OF SERVICE.—Each member of the
board shall serve a term of 3 years.
(3) CONSUMER ASSISTANCE UNIT.—
(A) IN GENERAL.—A special consumer as-
sistance unit shall be created within the board
to deal directly with complainants. The staff of
the unit shall consist of consumer protection of-
ficers with medical or social work background.
(B) TOLL-FREE HOTLINE.—The consumer
assistance unit shall operate a toll-free phone
number through which the unit—
(i) shall advise the public of any hear-
ing pending pursuant to formal charges
filed against a health care professional,
any summary suspension or other discipli-
nary action taken by the board against a
health care professional, and the charges
(excluding patient identifying information)
against the professional on which such
hearing or action is based (in a manner
that does not disclose the identity of an in-
dividual patient);
(ii) accept consumer complaints about
suspected health care professional mis-
conduct (other than complaints over billing
disputes); and
(iii) provide information to consumers
on health care professionals, including the
date the professional was first licensed, the
registration status of the professional, the
professional’s hospital affiliations, and the
names of other States in which the profes-
sional holds a license.
(C) POSTING
REQUIREMENT.—The toll-
free phone number described in subparagraph
(B) shall be conspicuously posted by all health
care providers and professionals in the State
and shall be added to any printed materials dis-
tributed to the public by the board, together
with a clear statement that the number is not
to be used for filing complaints over billing dis-
putes.
(4) DISCLOSURE
OF
INFORMATION
TO
NA-
TIONAL
PRACTITIONER
DATA
BANK.—Each State
medical board shall report the information received
under title III to the Secretary in accordance with
section 424 of the Health Care Quality Improvement
Act of 1986.
(b) ADDITIONAL STATE REQUIREMENTS.—
(1) OVERSIGHT PANEL.—As prescribed by the
Secretary, each State shall establish an oversight
panel to independently assess and audit the State
medical board process and hear appeals from com-
plainants whose claims have been dismissed by State
medical boards. The panel shall consist of 7 mem-
bers appointed by the Governor and shall include not
more than 2 physicians.
(2) FUNDING.—Each State shall ensure that
the State medical boards are fully supported by the
revenues generated from their activities, including
fees, charges, and reimbursed costs. The health care
professional licensing fees charged in the State may
not be less than $500 annually. All revenues gen-
erated by this fee shall be used exclusively for State
medical board activities.
SEC. 202. GUIDELINES FOR INVESTIGATIONS.
(a) MANDATORY INVESTIGATION OF CERTAIN RE-
PORTS AND NATIONAL PRACTITIONER DATA BANK IN-
FORMATION.—
(1) IN GENERAL.—Upon receipt of reports pur-
suant to section 302 of the Health Care Quality Im-
provement Act, and upon querying the National
Practitioner Data Bank while performing its reg-
istration or reregistration functions, the State medi-
cal board shall investigate any evidence which ap-
pears to show that a health care professional is or
may be medically incompetent, has engaged in un-
professional conduct, or is mentally or physically un-
able to engage safely in the performance of health
care services.
(2) 
SPECIFIC
GROUNDS
FOR
INVESTIGA-
TIONS.—In addition to other information the report-
ing of which may constitute grounds for an inves-
tigation, receipt of reports disclosing the following
information may be grounds for instituting an inves-
tigation with respect to a health care professional:
(A) Quality of care complaints or medical
malpractice actions brought against the health
care professional.
(B) Payments in settlement (or partial set-
tlement) of, or in satisfaction of a judgment or
arbitration award in, a medical malpractice ac-
tion or claim.
(C) Professional liability insurance can-
cellations for reasons related to liability claims
or actions brought against the health care pro-
fessional.
(D) Sanctions or disciplinary actions taken
against the health care professional by another
State or jurisdiction, a peer review body, a
health care provider, or a medical or profes-
sional association or society.
(E) The failure of the professional to meet
the requirements of section 302(b) (relating to
annual reports to health care consumers).
(F) The filing of a report by a medical ex-
aminer under section 302(c) indicating that a
death may have been the result of the profes-
sional’s negligence or incompetence.
(G) The failure of the professional to meet
the requirements of section 401(b) (relating to
providing information to patients on rights es-
tablished under title IV).
(b) INVESTIGATORY POWERS AND PROCEDURES.—
(1) IN GENERAL.—The State shall ensure that
the State medical boards are given sufficient powers
and follow certain procedural guidelines sufficient to
ensure efficient and effective performance of their
investigatory duties.
(2) STAFFING.—The Secretary shall establish
guidelines for the duties of and qualifications for
staff positions of State medical boards, addressing
the appropriate separation of investigatory and adju-
dicatory functions. The Board’s staff may include,
but need not be limited to—
(A) an executive director,
(B) 1 or more hearing officers trained to
conduct hearings (whose decision shall be re-
viewed, approved, modified, or disapproved by
the Board), and
(C) 1 or more investigators trained in the
investigation of medical and related health care
practice.
(3) INVESTIGATIVE POWERS.—The State shall
ensure that the State medical boards have at least
the following investigative powers:
(A) The power to subpoena documents and
individuals possessing information relevant to
investigations:
(B) The power to swear in witnesses.
(C) The power to require professional com-
petency examinations upon reasonable suspicion
of incompetence. For purposes of this clause, a
single act of alleged negligence may serve as a
reasonable suspicion of incompetence.
(D) To the extent necessary to complete an
investigation, the power to conduct an unan-
nounced on-site review of the licensee’s entire
practice, including but not limited to a com-
prehensive review of patient records of the li-
censee and such office records of the licensee as
are relevant to the investigation, and a review
of procedures and safeguards in the offices.
(E) The power to obtain the involuntary,
temporary, and summary suspension of a li-
censee from practice who poses an imminent
threat to patient health.
(F) The power to order immediate super-
vision of certain procedures by another licensee.
(G) The power to require the licensee to
submit to 1 or more physical or mental exami-
nations.
(H) The power to order drug testing of the
licensee.
(4) PROCEDURAL
GUIDELINES.—The State
shall ensure that State medical boards adhere to the
following procedures:
(A) All investigations of cases alleging pa-
tient harm and conducted pursuant to this sec-
tion shall be completed within 90 days of the
receipt of the report initiating the investigation,
except that such deadline may be extended for
reasonable cause.
(B) In conducting an investigation of a li-
censee, the State medical board shall, at no
cost, query the National Practitioner Data
Bank for all available information relating to
the professional competence and conduct of the
licensee.
SEC. 203. DISCIPLINARY HEARINGS.
(a) GROUNDS FOR HEARING.—If following an inves-
tigation, the State medical board finds there is probable
cause to believe that a health care professional has pro-
vided substandard treatment, has engaged in unpro-
fessional conduct, is medically incompetent or is mentally
or physically unable to engage safely in the performance
of health care services, a disciplinary hearing shall be con-
ducted in accordance with procedures established by State
law (consistent with the requirements of subsection (b)).
(b) REQUIREMENTS FOR HEARING.—
(1) TIMING.—A disciplinary hearing with re-
spect to a health care professional shall be held
promptly after the conclusion of the State medical
board’s investigation of the health care professional,
and a decision shall be rendered not later than 60
days following completion of the hearing (except that
such deadline may be extended for reasonable
cause).
(2) POWERS OF BOARD.—In conducting a dis-
ciplinary hearing with respect to a health care pro-
fessional, the State medical board may subpoena
documents and individuals possessing relevant infor-
mation and may swear in witnesses.
(3) EVIDENTIARY
STANDARD.—The decision
under a disciplinary hearing shall be based on the
preponderance of the evidence.
(4) DISSEMINATION
OF
INFORMATION.—The
State medical board shall make summaries of ongo-
ing disciplinary proceedings available to the public,
except that such summaries shall not include any in-
formation that may disclose the identity of, or iden-
tifying information on, an individual patient.
SEC. 204. DISCIPLINARY ACTIONS.
(a) PENALTIES DESCRIBED.—The penalties that may
be imposed on a health care professional by a State medi-
cal board are as follows:
(1) Revocation or suspension of a license.
(2) Restriction or limitation of the extent,
scope, or type of practice, if such limitation is con-
ducted under the presence and guidance of a super-
vising licensee.
(3) Imposition of an administrative fine of at
least $1,000 for each count or separate offense.
(4) Issuance of a warning or reprimand.
(5) Probation with or without conditions (such
as submission to treatment, attendance at continu-
ing education courses, reexamination, or practice
only under the presence and guidance of a super-
vising licensee).
(6) Assessment of the reasonable costs of inves-
tigation, hearing, and review, and the costs of proba-
tion supervision.
(b) SUMMARY LICENSE SUSPENSION.—
(1) IN
GENERAL.—The State medical board
may suspend the license of a health care professional
without the opportunity for a prior hearing if the
board finds that at least one of the following condi-
tions exists:
(A) The individual’s continued practice
creates a clear and present danger to public
health.
(B) The individual has been found or has
pleaded guilty to a felony charge within the
State or in another jurisdiction relating to the
individual’s professional activities.
(C) The individual’s license has been sus-
pended or revoked in another jurisdiction, with-
out regard to whether such suspension or rev-
ocation has occurred or is pending.
(2) TIMING FOR FORMAL HEARING.—After the
summary suspension of a license pursuant to para-
graph (1), the State medical board shall hold a for-
mal hearing as soon as practicable following the
summary suspension (but in no event later than 90
days after such summary suspension).
(c) NOTIFICATION OF PATIENTS.—Any health care
professional subject to probation or a restriction or limita-
tion on the scope of practice shall notify patients of such
probation, restriction, or limitation.
(d) TERMINATION OF SANCTION.—
(1) NO STAY OF SUSPENSION OR REVOCATION
DURING APPEAL.—Under no circumstances may a
board stay the suspension or revocation of a license
pending an appeal, and the licensee may not resume
practice unless and until the penalty is overturned
upon such appeal.
(2) MINIMUM PERIOD OF REVOCATION.—After
revocation of a license by a State medical board, a
health care professional may not petition for rein-
statement for at least a 3-year period.
(3) IMPOSITION
OF
CONDITIONS.—The State
medical board may condition the restoration of a
suspended or revoked license or the removal of limi-
tations on a license upon the health care professional
obtaining minimum results on one or more physical,
mental, or professional competency examinations.
SEC. 205. DISCLOSURE OF DISCIPLINARY ACTIONS.
(a) IN GENERAL.—
(1) PUBLICATION
OF
NEWSLETTER.—State
medical boards shall report regularly (but not less
often than monthly) in a published newsletter all
final disciplinary actions taken and formal charges
filed after State medical board investigation of a
complaint, including the names of the professionals
involved, a description of the acts or omissions sub-
ject to discipline or listed as the formal charge and
the nature of the actions taken.
(2) ANNUAL REPORTS.—State medical boards
shall publish annual reports compiling statistics on
disciplinary actions taken during a year (in accord-
ance with criteria established by the Secretary).
(b) DISSEMINATION OF DISCIPLINARY ACTION RE-
PORTS.—The reports published under subsection (a) shall
be widely disseminated to the public (free of charge) by
advertising their availability through the news media, and
shall be forwarded to—
(1) health care providers in the State;
(2) the Secretary;
(3) the Medicare peer review organization serv-
ing geographic areas in the State under title XVIII
of the Social Security Act;
(4) entities offering medical malpractice insur-
ance within the State; and
(5) Federal depository libraries.
SEC. 206. FEDERAL ASSUMPTION OF RESPONSIBILITIES.
(a) DETERMINATION OF STATE COMPLIANCE.—Not
later than October 1 of each year (beginning with 1995),
the Secretary shall determine whether a State’s medical
board meets the requirements of this title and title III for
the following calendar year.
(b) FEDERAL ASSUMPTION OF RESPONSIBILITY.—If
the Secretary determines that a State medical board does
not meet the requirements of this title and title III for
a year—
(1) the Secretary shall carry out all functions of
the board in the State during the year; and
(2) the State shall reimburse the Secretary (at
such time and in such manner as the Secretary may
require) for the costs incurred by the Secretary dur-
ing the year as a result of the application of para-
graph (1).
TITLE III—REQUIREMENTS FOR
HEALTH 
CARE 
PROFES-
SIONALS AND PROVIDERS
SEC. 301. RENEWAL OF LICENSE REQUIRED EVERY 2
YEARS.
(a) IN GENERAL.—Every 2 years, each health care
professional and health care provider shall demonstrate to
the satisfaction of the State medical board the profes-
sional’s continuing qualification for medical licensing.
(b) SIGNATURE REQUIRED.—An application for re-
registration of a license submitted under this section shall
be signed by the applicant and notarized, and shall contain
a statement of the applicant affirming (under penalty of
perjury) that the information provided is true to the best
of the applicant’s knowledge.
SEC. 302. REPORTING REQUIREMENTS.
(a) RENEWAL OF LICENSE.—
(1) IN GENERAL.—As a condition of the re-
newal of a license under section 301, at the time of
reregistration a health care professional or health
care provider shall report (on a form prescribed and
promulgated by the Secretary) the following infor-
mation:
(A) Any pending investigation or prelimi-
nary or final action taken against the licensee
by—
(i) 
any 
jurisdiction 
or 
authority
(whether in the United States or a foreign
nation) which licenses or authorizes the
practice of medicine;
(ii) any peer review body;
(iii) any health care provider;
(iv) any professional medical society
or association;
(v) any law enforcement agency;
(vi) any court; or
(vii) any governmental agency,
for acts or conduct which may constitute
grounds for disciplinary action described in sec-
tion 204.
(B) Any pending medical malpractice claim
which has been filed against the licensee.
(C) Any adverse judgment, settlement, or
award against the licensee arising from a medi-
cal malpractice claim.
curred while the licensee was under formal or
informal investigation or review by that body
for any reason related to possible medical in-
competence, unprofessional conduct, or mental
or physical inability to safely perform health
care services.
(H) Whether the licensee has been treated
for an alcohol or chemical substance problem
during the 5-year period preceding the submis-
sion of the report.
(I) Any denial or restriction of the licens-
ee’s privileges to prescribe controlled sub-
stances.
(J) Whether the licensee has had any
physical injury or disease or mental disability
within the reregistration period which could
reasonably be expected to affect the licensee’s
ability to safely perform health care services.
(K) The licensee’s completion of continuing
medical education or other forms of professional
maintenance or evaluation, including specialty
board certification or recertification, within the
reregistration period, including participation in
malpractice prevention programs required by a
State medical board.
(L) Any loss or restriction of medical mal-
practice insurance coverage in any jurisdiction
(including military, public health and foreign).
(M) Any name change or change of home
or professional address.
(N) In the case of a health care profes-
sional, the information contained in the profes-
sional’s annual report made available to con-
sumers under subsection (b)(2).
(2) REVIEW OF REPORTS SUBMITTED.—
(A) IN
GENERAL.—The State medical
board shall review the information reported by
a licensee under paragraph (1) to determine
whether reregistration of a medical license to
the licensee is appropriate and whether an in-
vestigation or disciplinary action should be initi-
ated against the licensee.
(B) FALSE OR INCOMPLETE REPORTING.—
A licensee who knowingly and willfully submits
false or incomplete information on an applica-
tion for license reregistration shall be subject to
disciplinary action, including civil money pen-
alties.
(b) ANNUAL REPORTS TO CONSUMERS.—
(1) HEALTH CARE PROVIDERS.—
(A) IN GENERAL.—Each health care pro-
vider shall make an annual report (in such form
and manner as the Secretary prescribes) avail-
able free of charge to all health care consumers
in the provider’s service area.
(B) CONTENTS OF REPORT.—The annual
report referred to in subparagraph (A) shall in-
clude—
(i) a list of all health services which
the provider is licensed to offer;
(ii) a list of all routine preoperative
and other medical tests frequently per-
formed by the provider, together with the
cost of such tests;
(iii) the number and types of quality
of care complaints and medical malpractice
actions claims decided or settled against
the provider for the year, including the
identity of all health care professionals
named in the complaints and claims;
(iv) a list of the names and addresses
of the members of the provider’s board of
trustees (if any), the provider’s chief ad-
ministrator, chief medical officer, and chief
nursing administrator;
(v) the provider’s accreditation status
and any contingencies on accreditation,
Medicare certification, or licensure and a
description of all plans and current efforts
to correct deficiencies resulting in any such
contingencies; and
(vi) such other information as the
Secretary may require.
(2) HEALTH CARE PROFESSIONALS.—
(A) IN GENERAL.—Each health care pro-
fessional shall make an annual report (in such
form and manner as the Secretary prescribes)
available free of charge to all members of the
public health care consumers in the profes-
sional’s service area.
(B) CONTENTS OF REPORT.—The report
referred to in subparagraph (A) shall include—
(i) information regarding the profes-
sional’s education, experience, qualifica-
tions, certification by a board recognized
by the Board of American Medical Special-
ties, and license to provide health care
services, including a list of the States in
which such professional is licensed and any
limitations on such professional’s licenses;
(ii) any disciplinary actions relating to
the scope of the professional’s practice
taken against the professional by any
health care provider, State medical board,
the Federal Government, or medical ac-
creditation or certification organization;
(iii) any quality of care complaints or
medical malpractice claims decided or set-
tled against the professional;
(iv) a disclosure of any ownership in-
terest the professional may have in any
health care provider, laboratory, or sup-
plier of health care items; and
(v) such other information as the Sec-
retary may require.
(3) RETROACTIVE REPORTING.—The initial an-
nual report made under this subsection by a health
care professional or provider shall include informa-
tion for the 3 years prior to date the report is made.
(c) SPECIAL REQUIREMENTS FOR MEDICAL EXAMIN-
ERS.—
(1) INITIAL
REPORT
ON
DEATHS
RESULTING
FROM
PROVIDER
NEGLIGENCE.—Each medical ex-
aminer shall file a report with the State medical
board upon receiving information (based on findings
that were reached by or documented and approved
by a board-certified or board-eligible pathologist) in-
dicating that a death may be the result of a health
care professional’s or provider’s negligence or incom-
petence, and shall include in the report the name of
the decedent, date and place of death, attending
physician, and all other relevant information avail-
able.
(2) AUTOPSY.—Not later than 90 days after fil-
ing the report described in paragraph (1), a medical
examiner shall file with the State medical board cop-
ies of the medical examiner’s report, autopsy proto-
col, and all other relevant information available.
(d) SANCTIONS
FOR FAILURE
TO REPORT.—Any
health care provider or professional who knowingly and
willfully fails to comply with the reporting requirements
of this section shall be subject, in addition to other pen-
alties that may be prescribed by law, to a civil monetary
penalty of not more than $10,000 for each such failure.
SEC. 303. REEXAMINATION REQUIRED AFTER 6 YEARS.
(a) IN GENERAL.—Each State medical board shall
require a health care professional licensed by the board
to be reexamined every 6 years as a condition of licensure.
(b) CLINICAL PERFORMANCE EVALUATIONS
FOR
CERTAIN LICENSEES.—A State medical board may re-
quire a licensee to undergo a clinical performance evalua-
tion as part of the licensee’s reexamination under this sec-
tion if—
(1) the licensee practices exclusively in a private
office setting; or
(2) a medical malpractice claim has been filed
against the licensee since the licensee’s most recent
reexamination.
(c) REVIEW OF PATIENT MEDICAL RECORDS.—In
the case of a licensee described in subsection (b)(1), the
State medical board may conduct a review of the medical
records of the licensee’s patients as part of the reexamina-
tion under this section.
SEC. 304. AUDITS.
(a) PERFORMANCE AUDITS.—On a regular basis, a
State medical board shall conduct audits of the office-
based practices of licensees to assess performance and im-
prove practices. In furtherance of this audit function,
State medical boards shall be granted the authority to
subpoena office-based and provider-based patient records.
(b) PHARMACY AUDITS.—On an annual basis, State
medical boards shall conduct audits of a randomly selected
sample of pharmacy records to detect illegal drug diversion
and other misuse or overprescribing of controlled sub-
stances.
SEC. 305. MANDATORY MEDICAL MALPRACTICE INSUR-
ANCE.
A State medical board may not issue or renew the
license of a health care professional or provider unless the
professional or provider certifies that the professional or
provider is covered under malpractice insurance in an
amount determined by the Secretary.
SEC. 306. STUDY OF MEDICAL NEGLIGENCE.
(a) STUDY.—The Secretary shall conduct (either di-
rectly or through contract) a national interdisciplinary
study modeled on the Harvard Medical Practice Study to
evaluate—
(1) the incidence of injuries regulating from
medical interventions and the percentage of such in-
juries that resulted from the negligence or fault of
a health care professional or health care provider;
(2) appropriate measures of the costs of medi-
cal expenses, lost wages, and lost household produc-
tion to individuals who suffer medical injuries and
their families, and the compensation provided for
such losses under the current medical injury com-
pensation system; and
(3) appropriate methods to prevent the occur-
rence of medical negligence.
(b) ACCESS TO RECORDS.—The Secretary shall have
the power to examine the medical records of patients of
a health care provider or health care professional (in a
manner that does not disclose the identity of, or identify-
ing information on, any individual patient) to the extent
necessary to conduct the study under subsection (a).
(c) REPORT.—Not later than 3 years after the date
of the enactment of this Act, the Secretary shall submit
a report to Congress on the study conducted under sub-
section (a).
TITLE IV—PUBLIC ACCESS TO
PRACTITIONER DATA BANK
SEC. 401. PROVIDING PUBLIC ACCESS TO THE NATIONAL
PRACTITIONER DATA BANK.
Section 427(a) of the Health Care Quality Improve-
ment Act of 1986 (42 U.S.C. 11137(a)) is amended—
(1) by redesignating subsections (b), (c), and
(d) as subsections (c), (d), and (e); and
(2) by inserting after subsection (a) the follow-
ing new subsection:
‘‘(b) AVAILABILITY OF INFORMATION TO THE PUB-
LIC.—
‘‘(1) IN
GENERAL.—Not later than 30 days
after the date of the enactment of this subsection
and every 6 months thereafter, the Secretary shall
publish and make available to the public the follow-
ing information reported under this part:
‘‘(A) Information reported under section
421, except the following:
‘‘(i) The social security number of the
physician or practitioner.
‘‘(ii) Information disclosing the iden-
tity of the patient involved in such inci-
dent.
‘‘(B) Information reported under section
422(a).
‘‘(C) Information reported under section
423 (a) and (b).
‘‘(2) DISSEMINATION.—The Secretary shall—
‘‘(A) disseminate the information described
in paragraph (1) to public libraries without
charge; and
‘‘(B) establish a 24-hour toll-free hotline
through which individuals may obtain such in-
formation.’’.
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HR 4856 IH——2
HR 4856 IH——3