leased by a discharge in bankruptcy under title 
11 of the United States Code only if such dis-
charge is granted after the expiration of the 5- 
year period beginning on the first date that 
payment of such damages is required. 
(b) PERIODIC REASSESSMENT
OF WORKER RA-
TIOS.—The National Health Board shall periodically as-
sess the ratio of the number of health workers employed 
by the Board in each job category (established under sub-
title A) in an area to the number of residents in the area. 
(c) WORKER MATCHES.—The National Health Board 
shall establish a program to match the locational pref-
erences of graduates of schools with the needs and pref-
erences of regions. 
SEC. 313. PAYMENT FOR CERTAIN EDUCATIONAL LOANS. 
(a) LOAN PAYMENT PROGRAM.—In the case of any 
individual who has incurred any educational loan before 
the fourth year after the effective date of health services 
and for the individual’s costs for an educational program 
in health care delivery, health care specialties, or health 
science specialty fields, the National Health Board shall 
make payments, in accordance with subsection (b), for and 
on behalf of that individual, on the principal of and inter-
est on any such loan which is outstanding on the date the 
individual begins to work for the Service.
(b) MAKING OF PAYMENT.—The payments described 
in subsection (a) shall be made by the National Health 
Board as follows: 
(1) Upon completion by the individual for whom 
the payments are to be made of the first year of em-
ployment with the Service, the National Health 
Board shall pay 30 percent of the principal of, and 
the interest on, each loan described in subsection (a) 
which is outstanding on the date he began such em-
ployment. 
(2) Upon completion by that individual of the 
second year of such employment, the National 
Health Board shall pay another 30 percent of the 
principal of, and the interest on, each such loan. 
(3) Upon completion by that individual of a 
third year of such employment, the National Health 
Board shall pay another 25 percent of the principal 
of, and the interest on, each such loan. 
(4) Upon completion by that individual of a 
fourth year of such employment, the National 
Health Board shall pay the remaining 15 percent of 
the principal of, and all remaining interest on, each 
such loan. 
No payment may be made under this subsection with re-
spect to a loan unless the person on whose behalf the pay-
ment is to be made has submitted to the National Health 
Board a certified copy of the agreement under which such 
loan was made. 
(c) PAYMENT
DURING
EMPLOYMENT.—Notwith-
standing the requirement of completion of employment 
specified in subsection (b), the National Health Board 
shall on or before the due date thereof, pay any loan or 
loan installment which may fall due within the period of 
employment for which the borrower may receive payments 
under this section, upon the declaration of such borrower, 
at such times and in such manner as the National Health 
Board may prescribe (and supported by such other evi-
dence as the National Health Board may reasonably re-
quire), that the borrower is then employed as described 
in subsection (b) and that the borrower will continue to 
be so engaged for the period required (in the absence of 
this subsection) to entitle the borrower to have made the 
payments provided by this section for such period, except 
that not more than 85 percent of the principal of any such 
loan shall be paid pursuant to this subsection.
Subtitle 
C—Employment 
and 
Labor-management 
Relations 
Within the Service 
SEC. 321. EMPLOYMENT, TRANSFER, PROMOTION, AND RE-
CEIPT OF FEES. 
(a) SERVICE EMPLOYEES.—The National Health 
Board shall employ, classify, and fix the salaries and bene-
fits of all employees of the Service employed in the Serv-
ice’s facilities. 
(b) POLICIES.—The National Health Board, in estab-
lishing guidelines and standards under this subtitle, shall, 
to the extent feasible and consistent with the provisions 
of this subtitle, provide for— 
(1) employment and promotion in the Service in 
the same manner as is provided for employment and 
promotion under the Federal civil service system; 
(2) meaningful opportunities for career ad-
vancement; 
(3) encouragement of health workers to use up 
to 10 percent of their work time for continuing edu-
cation under subtitle B without loss of pay or other 
job rights; and 
(4) full protection of employees’ rights by pro-
viding an opportunity for a fair hearing on adverse 
actions with representation of their own choosing.
(c) HIRING PREFERENCES.—The National Health 
Board, in hiring for employees to fill vacancies in newly 
created positions, shall give preference to individuals who 
were employed as health workers, or self-employed while 
delivering health services, before the date of enactment of 
this Act. The National Health Board shall ensure, through 
such steps as it deems necessary, that all such individuals 
desiring to be employed within the Service shall find ap-
propriate employment in the Service. 
(d) PROMOTION AND TRANSFER.—Employees of the 
Service shall be eligible for promotion or transfer to any 
position in the Service for which they are qualified. A job 
placement service in each region shall assist health work-
ers in its region in identifying suitable employment oppor-
tunities and in transferring between jobs. The authority 
given by this subsection shall be used to provide a max-
imum degree of career opportunities for employees and to 
ensure continued improvement of health care services. 
(e) NO UNDUE FINANCIAL INCENTIVES.—No health 
worker should benefit financially from the provision or de-
nial of services to individual patients, beyond their regular 
remuneration. 
(f) SOLE EMPLOYER.—An employee of the Service 
may not receive any fee or perquisite on account of duties
performed by virtue of such employment except from the 
Service. 
(g) GRANDFATHER CLAUSE.—The National Health 
Board shall support alternative procedures to assure that 
health care professionals meet required standards, par-
ticularly those currently practicing in health professional 
shortage areas in inner cities and in rural communities. 
(h) TRANSITIONAL EMPLOYMENT.—Up to 1 percent 
of the budget of the United States Health Service for each 
of its first 2 years may be expended for the retraining 
and hiring of sales, administrative, clerical, and service 
employees displaced as a result of this Act, including those 
in the health insurance industry. 
SEC. 322. APPLICABILITY OF LAWS RELATING TO FEDERAL 
EMPLOYEES. 
(a) IN GENERAL.—Chapter 75 of title 5, United 
States Code (relating to adverse actions against employ-
ees), apply to employees of the Service (other than employ-
ees serving on the personal staff of members of health 
boards) except to the extent provided— 
(1) in a collective bargaining agreement nego-
tiated on behalf of and applicable to them; or 
(2) in procedures established by the Service and 
approved by the Office of Personnel Management.
(b) COVERAGE UNDER WORKERS COMPENSATION.— 
Employees of the Service are covered by subchapter I of 
chapter 81 of title 5, United States Code (relating to com-
pensation for work injuries). 
(c) CIVIL SERVICE.— 
(1) APPLICATION
OF
CIVIL
SERVICE
RETIRE-
MENT.—Chapter 83 of title 5, United States Code 
(relating to civil service retirement), applies to em-
ployees of the Service except to the extent provided 
in a collective bargaining agreement negotiated on 
behalf of and applicable to them. 
(2) WITHHOLDING.—The Service shall withhold 
from pay and shall pay into the Civil Service Retire-
ment and Disability Fund the amounts specified in 
chapter 83 of title 5, United States Code, as re-
quired under paragraph (1). The Service, upon re-
quest of the Office of Personnel Management, but 
not less frequently than annually, shall pay to the 
Office the costs reasonably related to the adminis-
tration of Fund activities for employees of the Serv-
ice. 
(d) ACCRUAL OF SICK AND ANNUAL LEAVE.—Sick 
and annual leave and compensatory time of employees of 
the Service, whether accrued prior to or after the com-
mencement of operations of the Service, shall be obliga-
tions of the Service. 
(e) APPLICATION OF CONDITIONS.— 
(1) TERMS OF EMPLOYMENT.—Compensation, 
benefits, and other terms and conditions of employ-
ment in effect on the effective date of health services 
for employees of the Federal Government performing 
functions that are provided under this Act by the 
Service, shall apply to all employees of the Service 
performing similar functions until changed by the 
Service in accordance with this Act. Subject to the 
provisions of this Act, the provisions of subchapter 
I of chapter 85 and chapter 87 of title 5, United 
States Code (relating to unemployment compensa-
tion and life insurance), apply to employees of the 
Service unless varied, added to, or substituted for in 
accordance with paragraph (2). 
(2) LIMITATION ON VARIATION.—No variation, 
addition, or substitution with respect to fringe bene-
fits shall result in a program of fringe benefits which 
on the whole is less favorable to employees of the 
Service than fringe benefits in effect for employees 
of the Federal Government on the effective date of 
health services. No variation, addition, or substi-
tution with respect to fringe benefits of employees
for whom there is a collective bargaining representa-
tive shall be made except by agreement between such 
representative and the Service. 
SEC. 323. APPLICABILITY OF FEDERAL LABOR-MANAGE-
MENT RELATIONS LAWS. 
(a) APPLICATION OF NLRA.— 
(1) IN GENERAL.—The provisions of the Na-
tional Labor Relations Act (42 U.S.C. 141 et seq.) 
shall apply to the Service and its employees to the 
extent, not inconsistent with subsection (b), to which 
such provisions apply to employers (as defined in 
section 2(2) of such Act), except that— 
(A) the phrase ‘‘or any individual employed 
as a supervisor’’ in section 2(3) of such Act 
shall not apply (thereby making such Act apply, 
for these purposes, to such individuals); 
(B) section 9(b)(1) of such Act (providing 
for separate treatment for professional and 
nonprofessional employees) shall not apply; 
(C) sections 206 through 210 of such Act 
(relating to national emergencies) shall, for pur-
poses of this Act, have the phrases ‘‘the Presi-
dent of the United States’’ and ‘‘the Presi-
dent’’, wherever they appear, replaced by the 
phrase ‘‘the National Health Board (or a com-
mittee thereof to which it has delegated such 
authority)’’ and the phrase ‘‘national health or 
safety’’ replaced by the phrase ‘‘health or safety 
of the residents of any region’’; and 
(D) section 213 (providing for intervention 
in a strike or lockout by the Director of the 
Federal Mediation and Conciliation Service) 
shall not apply. 
(2) STRIKES PERMITTED.—Paragraphs (3) and 
(4) of section 7311 of title 5, United States Code 
(prohibiting participation in a strike or an organiza-
tion asserting the right to strike), shall not apply to 
employees of the Service. 
(b) NEUTRALITY
IN UNION MATTERS.—The Na-
tional Health Board shall adopt as a matter of general 
policy that governing boards at each level of the Service, 
and employers acting as agents of these boards, agree to 
determine employee preference on the subject of labor 
union representation, and to determine which one if union 
representation is preferred, by a card check procedure con-
ducted by a neutral third party in lieu of a formal election. 
(c) COLLECTIVE BARGAINING.— 
(1) IN GENERAL.—Collective bargaining agree-
ments between the National Health Board and duly 
recognized bargaining representatives of employees
of the Service may include procedures for resolution 
by the parties of grievances and adverse actions aris-
ing under the agreement, including procedures cul-
minating in binding third party arbitration. 
(2) ALTERNATIVE PROCEDURES.—The National 
Health Board and duly recognized bargaining rep-
resentatives of employees of the Service may by mu-
tual agreement adopt procedures for the resolution 
by the parties— 
(A) of grievances and adverse actions aris-
ing under collective bargaining agreements, and 
(B) of disputes or impasses arising in the 
negotiation of such agreements. 
(d) CONFORMING AMENDMENT.—Section 3(e) of the 
Labor-Management Reporting and Disclosure Act of 1959 
(42 U.S.C. 402(e)) is amended by inserting ‘‘the United 
States Health Service and’’ after ‘‘and includes’’. 
SEC. 324. DEFENSE OF CERTAIN MALPRACTICE AND NEG-
LIGENCE SUITS. 
(a) EXCLUSIVE REMEDY.—The remedy against the 
United States provided by sections 1346(b) and 2672 of 
title 28, United States Code, or by alternative benefits 
provided by the United States where the availability of 
such benefits precludes a remedy under section 1346(b) 
of such title, for damage for personal injury, including
death, resulting from the performance of medical, surgical, 
dental, or related functions, including the conduct of clin-
ical studies or investigations, by any employee of the Serv-
ice while acting within the scope of the employee’s employ-
ment, shall be exclusive of any other civil action or pro-
ceeding by reason of the same subject matter against the 
employee (or the employee’s estate) whose act or omission 
gave rise to the claim. 
(b) DEFENSE.—The Attorney General shall defend 
any civil action or proceeding brought in any court against 
any person referred to in subsection (a) (or the person’s 
estate) for any such damage or injury. Any such person 
against whom such civil action or proceeding is brought 
shall deliver within such time after date of service or 
knowledge of service as determined by the Attorney Gen-
eral, all process served upon the person or an attested true 
copy thereof to the person’s immediate superior or to 
whomever was designated by the appropriate National 
Health Board to receive such papers and such person shall 
promptly furnish copies of the pleading and process there-
in to the United States attorney for the district embracing 
the place wherein the proceeding is brought, to the Attor-
ney General, and to the National Health Board. 
(c) PROCEDURE.—
(1) REMOVAL FROM STATE COURTS.—Upon a 
certification by the Attorney General that the de-
fendant was acting in the scope of employment at 
the time of the incident out of which the suit arose, 
any such civil action or proceeding commenced in a 
State court shall be removed without bond at any 
time before trial by the Attorney General to the dis-
trict court of the United States of the district and 
division embracing the place wherein it is pending 
and the proceeding deemed a tort action brought 
against the United States under the provision of 
title 28, United States Code, and all references 
thereto. 
(2) MOTIONS TO REMAND.—If a United States 
district court determines on a hearing on a motion 
to remand held before a trial on the merits that the 
case so removed is one in which a remedy by suit 
within the meaning of subsection (a) is not available 
against the United States, the case shall be re-
manded to the State court. 
(3) EFFECT
OF
ALTERNATIVE
REMEDIES.— 
Where a remedy by suit within the meaning of sub-
section (a) is not available because of the availability 
of a remedy through proceedings for compensation 
or other benefits from the United States as provided
by any other law, the case shall be dismissed, but in 
the event the running of any limitation of time for 
commencing, or filing an application or claim in, 
such proceedings for compensation or other benefits 
shall be deemed to have been suspended during the 
pendency of the civil action or proceeding under this 
section. 
(d) SETTLEMENT.—The Attorney General may com-
promise or settle any claim asserted in such civil action 
or proceeding in the manner provided in section 2677 of 
title 28, United States Code, and with the same effect. 
(e) LIMITATION.—For purposes of this section, the 
provisions of section 2680(h) of title 28, United States 
Code, shall not apply to assault or battery arising out of 
negligence in the performance of medical, surgical, dental, 
or related functions, including the conduct of clinical stud-
ies or investigations. 
(f) LIABILITY INSURANCE.—The appropriate Na-
tional Health Board may, to the extent it deems appro-
priate, hold harmless or provide liability insurance for any 
employee of the Service for damage for personal injury, 
including death, negligently caused by such employee while 
acting within the scope of employment and as a result of 
the performance of medical, surgical, dental, or related 
functions, including the conduct of clinical studies or in-
vestigations, if the employee is assigned to a foreign coun-
try or detailed to a State or political subdivision thereof 
or to a nonprofit institution, and if the circumstances are 
such as are likely to preclude the remedies of third persons 
against the United States described in section 2679(b) of 
title 28, United States Code, for such damage or injury. 
TITLE IV—OTHER FUNCTIONS 
OF HEALTH BOARDS 
Subtitle A—Advocacy, Grievance 
Procedures, and Trusteeships 
SEC. 401. ADVOCACY AND LEGAL SERVICES PROGRAM. 
(a) ESTABLISHMENT OF PROGRAM.—The National 
Health Board shall establish a program of health advocacy 
to ensure the full realization of the patient rights enumer-
ated in subtitle A of title II. Such a program shall in-
clude— 
(1) the employment of individuals having basic 
legal knowledge and skills as health advocates; 
(2) the presence of health advocates— 
(A) in inpatient health care facilities at all 
times; and 
(B) in other health care facilities during 
the provision of health care services; 
(3) provision for health advocates to (A) in-
form, on an ongoing basis, users and health workers
of such patient rights and (B) report to the National 
Health Board any infraction of such rights which is 
not promptly corrected; 
(4) provision for regular meetings between 
health workers and health advocates, users, and any 
user representatives to discuss ways of ensuring the 
fulfillment of such rights through affirmative action 
of such workers and the National Health Board; and 
(5) appropriate action by the National Health 
Board to ensure that infractions of such rights are 
promptly and sufficiently corrected. 
(b) HEALTH RIGHTS LEGAL SERVICES.— 
(1) ESTABLISHMENT OF PROGRAM.—The Na-
tional Health Board shall establish a health rights 
legal services program and shall provide such pro-
gram with sufficient legal and administrative per-
sonnel, funding, and facilities (A) to ensure that 
users and health workers receive, free of charge, 
high quality legal services (including representation 
in grievance proceedings commenced under section 
402) for legal problems related to health rights and 
health care services, and (B) to improve, through 
litigation and other activities, the health care system 
and expand the rights of users and health workers.
(2) SERVICES.—The health rights legal services 
program shall provide directly, by contract with the 
Legal Services Corporation, or by contract with 
members of the private bar, for— 
(A) establishment of a legal services office 
in each region to provide representation (other 
than representation provided under subpara-
graph (B)) of users, health workers, and vol-
untary associations having a demonstrated in-
terest in health care in proceedings and hear-
ings under sections 324 and 402; and 
(B) establishment of legal services offices 
in such communities and districts as are deter-
mined, in accordance with guidelines established 
by the National Health Board, to have inad-
equate legal services to provide the legal serv-
ices described in paragraph (1)(A). 
(3) USE OF CONTRACTS.—The National Health 
Board may carry out the functions described in 
paragraph (1)(B) directly, by contract, or otherwise. 
SEC. 402. GRIEVANCE PROCEDURES. 
(a) GRIEVANCE PROCEEDINGS.— 
(1) IN GENERAL.—The National Health Board 
shall provide, in accordance with this section, that 
any user, health worker, or any user association hav-
ing a demonstrated interest in health care may com-
mence a grievance proceeding before the Board (or 
a person or committee designated by such Board) 
with respect to an alleged violation of this Act. The 
National Health Board may commence a grievance 
proceeding before itself (or a person or committee 
designated by such Board) with respect to an alleged 
violation of this Act. 
(2) GRIEVANCES AGAINST NATIONAL HEALTH 
BOARD.—Grievances against the National Health 
Board may be presented to and adjudicated by the 
Inspector General for Health Services or the Inspec-
tor’s General local designees. Grievants shall also 
have access to review in the courts. 
(b) REVIEW.— 
(1) BY NATIONAL HEALTH BOARD.—The Na-
tional Health Board shall provide, subject to para-
graphs (2) and (3), for its review (or a review by a 
person or committee designated by the Board), by 
appeal to the Board by any party to a proceeding 
described in subsection (a)(1) or on its own initia-
tive, of an adverse decision. 
(2) LIMITATION ONCE SUIT COMMENCED.—On 
and after the date a suit with respect to an adverse 
determination in a grievance proceeding or review
proceeding is filed under subsection (e), no review 
proceeding respecting such proceeding may be com-
menced by appeal to the Board under paragraph (1), 
and any such review proceeding which was com-
menced by appeal to the Board under such para-
graph before the date of filing of such suit and is 
pending on such date shall promptly be discon-
tinued. 
(3) TIME LIMIT.—No review of an adverse ad-
ministrative decision may be made by appeal or by 
initiative under this subsection unless the appeal is 
filed or notice of the initiative is published (as the 
case may be) not later than 30 days after the publi-
cation of the decision. 
(c) INVESTIGATION.—Whenever a grievance pro-
ceeding is commenced under subsection (a), the entity be-
fore which the proceeding is held shall investigate the 
grievance. 
(d) RIGHT TO SUE.—Any party to a grievance pro-
ceeding or review proceeding commenced under this sec-
tion may bring suit in the United States district court for 
the judicial district in which such proceeding, or review 
proceeding, was brought, for the review of an adverse de-
termination in such proceeding or review proceeding. Such 
court shall affirm such determination unless it finds that
such determination is not supported by substantial evi-
dence or is arbitrary and capricious. 
Subtitle B—Occupational Safety 
and Health Programs 
SEC. 411. FUNCTIONS OF THE NATIONAL HEALTH BOARD. 
(a) OVERSIGHT AUTHORITY.—On and after the effec-
tive date of health services, the National Health Board 
shall oversee occupational safety and health programs con-
ducted at the regional level, and shall participate in the 
establishment and administration of occupational safety 
and health standards under the Occupational Safety and 
Health Act of 1970. 
(b) CONFORMING AMENDMENTS.— 
(1) IN GENERAL.—To provide for participation 
of the National Health Board in the establishment 
and administration of occupational safety and health 
standards, the Occupational Safety and Health Act 
of 1970 (29 U.S.C. 651 et seq.) is amended— 
(A) in section 3, by adding at the end the 
following new paragraph: 
‘‘(15) The term ‘National Health Board’ means 
the National Health Board of the United States 
Health Services.’’; 
(B) by striking ‘‘Secretary of Health and 
Human Services’’ each place it appears (other
than in section 22(b)) and inserting ‘‘National 
Health Board’’; 
(C) in the first sentence of section 6(b)(1), 
by inserting ‘‘shall request the National Health 
Board and’’ before ‘‘may request’’; 
(D) in the second sentence of section 
6(b)(1), by inserting ‘‘the Board and’’ after 
‘‘The Secretary shall provide’’; 
(E) in the third sentence of section 
6(b)(1), by striking ‘‘An’’ and inserting ‘‘The 
Board and an’’; 
(F) in the third sentence of section 
6(b)(1), by striking ‘‘its’’ each place it appears 
and inserting ‘‘their’’; 
(G) in the fourth sentence of section 
6(b)(6)(A), by inserting ‘‘after consultation 
with the National Health Board and’’ after 
‘‘may be granted only’’; 
(H) in the third sentence of section 6(d), 
by inserting ‘‘after consultation with the Na-
tional Health Board and’’ before ‘‘after oppor-
tunity for’’; 
(I) in section 8(g)(2), by striking ‘‘The 
Secretary’’ and all that follows through ‘‘shall 
each’’ and inserting ‘‘The Secretary shall’’;
(J) in section 8(g)(2), by striking ‘‘their’’ 
and inserting ‘‘his’’; 
(K) in section 16, by inserting ‘‘after con-
sultation with the National Health Board and’’ 
before ‘‘after notice and opportunity’’; 
(L) in section 18(c), by inserting ‘‘(after 
consultation with the National Health Board)’’ 
after ‘‘in his judgment’’; 
(M) in section 19(d), by inserting ‘‘and the 
National Health Board’’ after ‘‘Secretary’’ each 
place it appears; and 
(N) in section 20(a), by striking the first 
sentence of paragraph (5). 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall take effect on the effective 
date of health services. 
(f) GUIDELINES.—The National Health Board shall 
establish guidelines— 
(1) for its participation in the establishment 
and administration of occupational safety and health 
standards under the Occupational Safety and Health 
Act of 1970; and 
(2) for the establishment and operation of 
workplace health facilities under section 413.
SEC. 
412. 
COMMUNITY 
OCCUPATIONAL 
SAFETY 
AND 
HEALTH ACTIVITIES. 
The Occupational Safety and Health Administration, 
under the direction of the National Health Board, shall 
develop and provide staff support for local and regional 
occupational safety and health programs, to include com-
munity-based occupational safety and health councils that 
represent community workers and residents. Such pro-
grams shall— 
(1) promote and assist in the establishment of 
workplace occupational safety and health committees 
in workplaces in the community, and advise and fa-
cilitate such committees’ actions relating to safety 
and health hazards in workplaces in the community; 
(2) assist employees in determining methods of, 
and requirements for, inspections of workplaces in 
the community for safety and health hazards; 
(3) implement training programs to enhance 
the ability of employees in the region to monitor 
safety and health conditions in their workplaces and 
to assist safety and health inspectors in the conduct 
of workplace inspections; 
(4) facilitate communication among workers 
employed in similar industries in the region and the 
Nation with respect to occupational health and safe-
ty hazards they face in common;
(5) conduct baseline and periodic biologic 
screening of employees in the region; 
(6) develop and maintain environmental moni-
toring programs to identify and isolate hazardous 
workplaces and work areas in the region; and 
(7) analyze employment-related injuries and ill-
nesses occurring in the region. 
SEC. 413. WORKPLACE HEALTH FACILITIES. 
(a) ESTABLISHMENT.—The Occupational Safety and 
Health Administration, under the direction of the Na-
tional Health Board, shall develop a program to establish 
worksite health facilities, distributed to make available oc-
cupational and emergency health care services to individ-
uals employed in the workplace in accordance with this 
section and guidelines and standards for such facilities es-
tablished by the National Health Board. Such facilities 
may be maintained by each employer where the facility 
is located, or by the group of employers covered by a facil-
ity. 
(b) APPLICATION OF GUIDELINES.—Each workplace 
health facility established pursuant to subsection (a) shall, 
taking into account guidelines established by the National 
Health Board— 
(1) be organized in a manner so as to provide 
an appropriate number of appropriately skilled
health workers to meet occupational and emergency 
health care needs of employees in the workplace; and 
(2) be operated by the community for the com-
munity in which the workplace is predominantly lo-
cated, or, where the National Health Board or its 
local authority deems appropriate, by the employer, 
with the cost in either case borne by the employer 
in each workplace. 
SEC. 414. EMPLOYEE RIGHTS RELATING TO OCCUPATIONAL 
SAFETY AND HEALTH. 
(a) WORKPLACE COMMITTEES.— 
(1) 
ESTABLISHMENT.—Employees 
in 
each 
workplace having 25 or more employees shall have 
the right to establish workplace occupational safety 
and health committees (each in this subsection re-
ferred to as a ‘‘committee’’) with members of their 
choosing. 
(2) MEMBERSHIP.—Members of committees 
(composed of the greater of 3 members or one mem-
ber for each 100 employees in the workplace) shall, 
without any loss of pay or other job rights— 
(A) be permitted to spend eight hours of 
each month inspecting their workplace and con-
ducting such other functions relating to occupa-
tional safety and health as are determined by 
the employees in the workplace; and 
(B) be permitted to accompany any safety 
and health inspectors during inspections of the 
workplace. 
(b) SAFETY-RELATED RIGHTS.—Employees in each 
workplace shall have the right, without any loss of pay 
or other job rights— 
(1) to monitor safety and health conditions in 
their workplace whenever they reasonably deem it 
necessary and with whatever reasonable scientific in-
struments and expert assistance they choose; and 
(2) to remove themselves from the site of any 
hazard to their safety or health until an authorized 
inspector has certified that the hazard has been 
eliminated. 
(c) SAFE WORKPLACES.—Employers shall adopt all 
feasible engineering measures that will minimize occupa-
tional safety and health hazards in the workplace. Where 
such measures are not adequate to protect employees from 
such hazards, employers shall furnish their employees 
with, or reimburse their employees for the reasonable cost 
of, equipment and clothing needed to protect an employee 
from any residual occupational safety and health hazards 
in the workplace.
(d) RIGHT TO INSPECT MEDICAL RECORDS.—Em-
ployees or their duly chosen representatives shall have the 
right to inspect all medical records maintained by their 
employers on the condition of their health, and shall have 
the right to be assisted during such inspections by persons 
of their choosing. 
(e) COPIES OF REPORTS.—Employers shall provide 
their employees with copies of all reports, studies, and 
data concerning conditions affecting the health and safety 
of employees within their workplaces, with annual reports 
on the morbidity and mortality experience of present and 
former employees, and with timely notification of the pres-
ence within the workplace of any materials, agents, or con-
ditions which may have a deleterious effect on the safety 
and health of their employees, along with relevant infor-
mation on hazards and precautions, symptoms, remedies, 
and antidotes. 
(f) RIGHT TO NEGOTIATE STANDARDS.—Employees 
shall have the right to seek, through collective bargaining, 
occupational safety and health standards, including stand-
ards relating to physical and mental stress and speed of 
work, more restrictive than such standards established 
under the Occupational Safety and Health Act of 1970.
SEC. 415. DEFINITIONS. 
(a) WORKPLACE.—For purposes of this subtitle, the 
term ‘‘workplace’’ means the regular location where work 
is performed by one or more employees of an employer. 
(b) EMPLOYER; EMPLOYEE.—For the purposes of 
sections 413 and 414, the terms ‘‘employer’’ and ‘‘em-
ployee’’ have the same meanings those terms have in sec-
tion 3 of the Occupational Safety and Health Act of 1970 
(42 U.S.C. 653). 
Subtitle 
C—Health 
and 
Health 
Care Delivery Research, Quality 
Assurance, and Health Equity 
SEC. 421. PRINCIPLES AND GUIDELINES FOR RESEARCH. 
(a) CONDUCT.—On and after the effective date of 
health services, the Service shall conduct a program of re-
search concerning health and health care delivery. On and 
after 2 years after such date, such research program shall 
conform to the following principles: 
(1) The research shall, to the maximum extent 
possible, be performed under the direction of, and in 
association with, agencies representative of the popu-
lation. 
(2) No research shall be conducted within, or 
using the resources of, an area health facility until 
it has been reviewed and approved by the National
Health Board, or a designated local authority re-
sponsible for such facility. 
(3) Priority shall be given in health research to 
the prevention and correction of the leading causes 
of illness and death, particularly environmental, oc-
cupational, nutritional, social, and economic causes. 
(4) Priority shall be given in health care deliv-
ery research to improvement of the effectiveness and 
efficiency of ambulatory and primary health care de-
livery, including research on alternative systems of 
health care delivery and alternative conceptions of 
health and health care. 
(5) The National Health Board shall encourage 
and support the conduct of clinical trials that may 
improve the health of the public. Any clinical trial 
conducted with the intention of evaluating new pre-
ventive, diagnostic, or therapeutic methods or agents 
shall be conducted only in accordance with estab-
lished ethical procedures that protect subjects from 
undue harm. If benefit becomes apparent, by sci-
entific consensus, before the scheduled conclusion of 
any clinical trial, such trial shall nevertheless be ter-
minated, and the benefit made available to trial par-
ticipants and the public at large.
(6) No research shall be conducted on a human 
subject without the subject’s informed written con-
sent. 
(7) No research shall be conducted on a human 
subject while the subject is involuntarily confined to 
an institution. 
(8) The planning and conduct of research under 
the program, shall take place in cooperation with ap-
propriate officials conducting related research in the 
Federal Government and agencies and departments 
of State, territorial, and local governments. 
(9) The results of research shall be dissemi-
nated to the public and to National Health Board in 
a manner that will most readily permit the use of 
such results to improve the health of users and the 
delivery of health care services. 
(b) GUIDELINES.—The National Health Board shall 
establish guidelines for the conduct of research in con-
formance with the principles described in subsection (a). 
SEC. 422. ESTABLISHMENT OF INSTITUTES. 
(a) IN GENERAL.—On the effective date of health 
services, the agencies of the Department of Health and 
Human Services that conduct research on health and 
health care are transferred to the National Health Board. 
These include the Agency for Healthcare Research and