(2) sets forth a summary of the expert opinion 
of that expert as to— 
(A) the standard of care applicable to that 
practitioner; 
(B) how that practitioner failed to meet 
that standard of care; and 
(C) the causal relationship between that 
failure and the injury or death of the individual. 
(c) MOTION TO ENFORCE.—A party not served as 
required by subsection (a) may move the court to enforce 
that subsection. On such a motion, the court— 
(1) shall dismiss, with prejudice, the pleading 
as it relates to that party; and 
(2) shall award to that party the attorney fees 
reasonably incurred by that party to respond to that 
pleading. 
(d) USE OF EXPERT REPORT.— 
(1) IN
GENERAL.—Except as otherwise pro-
vided in this section, a qualified expert report served 
under subsection (a) may not, in that civil action— 
(A) be offered by any party as evidence; 
(B) be used by any party in discovery or 
any other pretrial proceeding; or 
(C) be referred to by any party at trial. 
(2) VIOLATIONS.— 
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(A) BY OTHER PARTY.—If paragraph (1) 
is violated by a party other than the party who 
served the report, the court shall, on motion of 
any party or on its own motion, take such 
measures as the court considers appropriate, 
which may include the imposition of sanctions. 
(B) BY SERVING PARTY.—If paragraph (1) 
is violated by the party who served the report, 
paragraph (1) shall no longer apply to any 
party. 
SEC. 9. EXPERT OPINIONS RELATING TO PHYSICIANS MAY 
BE PROVIDED ONLY BY ACTIVELY PRAC-
TICING PHYSICIANS. 
(a) IN GENERAL.—A physician-related opinion may 
be provided only by an actively practicing physician who 
is determined by the court to be qualified on the basis 
of training and experience to render that opinion. 
(b) CONSIDERATIONS REQUIRED.—In determining 
whether an actively practicing physician is qualified under 
subsection (a), the court shall, except on good cause 
shown, consider whether that physician is board-certified, 
or has other substantial training, in an area of medical 
practice relevant to the health care to which the opinion 
relates. 
(c) DEFINITIONS.—In this section: 
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(1) The term ‘‘actively practicing physician’’ 
means an individual who— 
(A) is licensed to practice medicine in the 
United States or, if the individual is a defend-
ant providing a physician-related opinion with 
respect to the health care provided by that de-
fendant, is a graduate of a medical school ac-
credited by the Liaison Committee on Medical 
Education or the American Osteopathic Asso-
ciation; 
(B) is practicing medicine when the opin-
ion is rendered, or was practicing medicine 
when the health care was provided; and 
(C) has knowledge of the accepted stand-
ards of care for the health care to which the 
opinion relates. 
(2) The term ‘‘physician-related opinion’’ means 
an expert opinion as to any one or more of the fol-
lowing: 
(A) The standard of care applicable to a 
physician. 
(B) Whether a physician failed to meet 
such a standard of care. 
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(C) Whether there was a causal relation-
ship between such a failure by a physician and 
the injury or death of an individual. 
(3) The term ‘‘practicing medicine’’ includes 
training residents or students at an accredited 
school of medicine or osteopathy, and serving as a 
consulting physician to other physicians who provide 
direct patient care. 
SEC. 10. PAYMENT OF FUTURE DAMAGES ON PERIODIC OR 
ACCRUAL BASIS. 
(a) IN GENERAL.—When future damages are award-
ed against a health care practitioner to a person for the 
injury or death of an individual as a result of health care, 
and the present value of those future damages is $100,000 
or more, that health care practitioner may move that the 
court order payment on a periodic or accrual basis of those 
damages. On such a motion, the court— 
(1) shall order that payment be made on an ac-
crual basis of future damages described in sub-
section (b)(1); and 
(2) may order that payment be made on a peri-
odic or accrual basis of any other future damages 
that the court considers appropriate. 
(b) FUTURE DAMAGES DEFINED.—In this section, 
the term ‘‘future damages’’ means— 
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(1) the future costs of medical, health care, or 
custodial services; 
(2) noneconomic damages, such as pain and 
suffering or loss of consortium; 
(3) loss of future earnings; and 
(4) any other damages incurred after the award 
is made. 
SEC. 11. UNANIMOUS JURY REQUIRED FOR PUNITIVE OR 
EXEMPLARY DAMAGES. 
When an individual is injured or dies as the result 
of health care, a jury may not award punitive or exemplary 
damages against a health care practitioner or health care 
institution unless the jury is unanimous with regard to 
both the liability of that party for such damages and the 
amount of the award of such damages. 
SEC. 12. PROPORTIONATE LIABILITY. 
When an individual is injured or dies as the result 
of health care and a person is entitled to damages for that 
injury or death, each person responsible is liable only for 
a proportionate share of the total damages that directly 
corresponds to that person’s proportionate share of the 
total responsibility. 
SEC. 13. DEFENSE-INITIATED SETTLEMENT PROCESS. 
(a) IN GENERAL.—In a civil action, to the extent the 
civil action seeks damages for the injury or death of an 
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individual as the result of health care, a health care practi-
tioner or health care institution against which such dam-
ages are sought may serve one or more qualified settle-
ment offers under this section to a person seeking such 
damages. If the person seeking such damages does not ac-
cept such an offer, that person may thereafter serve one 
or more qualified settlement offers under this section to 
the party whose offer was not accepted. 
(b) QUALIFIED SETTLEMENT OFFER.—A qualified 
settlement offer under this section is an offer, in writing, 
to settle the matter as between the offeror and the offeree, 
which— 
(1) specifies that it is made under this section; 
(2) states the terms of settlement; and 
(3) states the deadline within which the offer 
must be accepted. 
(c) EFFECT OF OFFER.—If the offeree of a qualified 
settlement offer does not accept that offer, and thereafter 
receives a judgment at trial that, as between the offeror 
and the offeree, is significantly less favorable than the 
terms of settlement in that offer, that offeree is respon-
sible for those litigation costs reasonably incurred, after 
the deadline stated in the offer, by the offeror to respond 
to the claims of the offeree. 
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(d) LITIGATION COSTS DEFINED.—In this section, 
the term ‘‘litigation costs’’ include court costs, filing fees, 
expert witness fees, attorney fees, and any other costs di-
rectly related to carrying out the litigation. 
(e) SIGNIFICANTLY LESS FAVORABLE DEFINED.— 
For purposes of this section, a judgment is significantly 
less favorable than the terms of settlement if— 
(1) in the case of an offeree seeking damages, 
the offeree’s award at trial is less than 80 percent 
of the value of the terms of settlement; and 
(2) in the case of an offeree against whom dam-
ages are sought, the offeror’s award at trial is more 
than 120 percent of the value of the terms of settle-
ment. 
SEC. 14. STATUTE OF LIMITATIONS; STATUTE OF REPOSE. 
(a) STATUTE OF LIMITATIONS.—When an individual 
is injured or dies as the result of health care, the statute 
of limitations shall be as follows: 
(1) INDIVIDUALS OF AGE 12 AND OVER.—If the 
individual has attained the age of 12 years, the 
claim must be brought either— 
(A) within 2 years after the negligence oc-
curred; or 
(B) within 2 years after the health care on 
which the claim is based is completed. 
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(2) INDIVIDUALS UNDER AGE 12.—If the indi-
vidual has not attained the age of 12 years, the 
claim must be brought before the individual attains 
the age of 14 years. 
(b) STATUTE OF REPOSE.—When an individual is in-
jured or dies as the result of health care, the statute of 
repose shall be as follows: The claim must be brought 
within 10 years after the act or omission on which the 
claim is based is completed. 
(c) TOLLING.— 
(1) STATUTE OF LIMITATIONS.—The statute of 
limitations required by subsection (a) may be tolled 
if applicable law so provides, except that it may not 
be tolled on the basis of minority. 
(2) STATUTE
OF
REPOSE.—The statute of 
repose required by subsection (b) may not be tolled 
for any reason. 
SEC. 15. LIMITATION ON LIABILITY FOR GOOD SAMARI-
TANS 
PROVIDING 
EMERGENCY 
HEALTH 
CARE. 
(a) WILLFUL
OR
WANTON
NEGLIGENCE
RE-
QUIRED.—A health care practitioner or health care insti-
tution that provides emergency health care on a Good Sa-
maritan basis is not liable for damages caused by that care 
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except for willful or wanton negligence or more culpable 
misconduct. 
(b) GOOD SAMARITAN BASIS.—For purposes of this 
section, care is provided on a Good Samaritan basis if it 
is not provided for or in expectation of remuneration. 
Being entitled to remuneration is relevant to, but is not 
determinative of, whether it is provided for or in expecta-
tion of remuneration. 
SEC. 16. DEFINITIONS. 
In this Act: 
(1) HEALTH
CARE
INSTITUTION.—The term 
‘‘health care institution’’ includes institutions such 
as— 
(A) an ambulatory surgical center; 
(B) an assisted living facility; 
(C) an emergency medical services pro-
vider; 
(D) a home health agency; 
(E) a hospice; 
(F) a hospital; 
(G) a hospital system; 
(H) an intermediate care facility for the 
mentally retarded; 
(I) a nursing home; and 
(J) an end stage renal disease facility. 
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(2) HEALTH CARE PRACTITIONER.—The term 
‘‘health care practitioner’’ includes a physician and 
a physician entity. 
(3) PHYSICIAN ENTITY.—The term ‘‘physician 
entity’’ includes— 
(A) a partnership or limited liability part-
nership created by a group of physicians; 
(B) a company created by physicians; and 
(C) a nonprofit health corporation whose 
board is composed of physicians. 
Æ 
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