I 
108TH CONGRESS 
1ST SESSION H. R. 1124
To reduce the cost of medical malpractice insurance, to enhance patient 
access to medical care, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 6, 2003
Mr. DINGELL (for himself, Mr. BROWN of Ohio, Mr. TOWNS, Mr. PALLONE, 
Mr. DEUTSCH, Mr. RUSH, Ms. ESHOO, Mr. ENGEL, Mr. GREEN of 
Texas, Ms. MCCARTHY of Missouri, Ms. DEGETTE, Mrs. CAPPS, Ms. 
SOLIS, Mr. ANDREWS, and Mr. DEFAZIO) 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 reduce the cost of medical malpractice insurance, to en-
hance patient access to medical care, and for other pur-
poses.
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 ‘‘Medical Malpractice 
Reform Act of 2003’’.
TITLE 
I—HEALTH 
PROVIDER 
SHORTAGES 
RESULTING 
FROM 
COSTS 
OF 
MEDICAL 
MALPRACTICE INSURANCE 
SEC. 101. GRANTS AND CONTRACTS REGARDING HEALTH 
PROVIDER SHORTAGES. 
Subpart I of part D of title III of the Public Health 
Service Act (42 U.S.C. 254b et seq.) is amended by adding 
at the end the following section. 
‘‘SEC. 330L. HEALTH PROVIDER SHORTAGES RESULTING 
FROM COSTS OF MEDICAL MALPRACTICE IN-
SURANCE. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration, may make awards of grants or contracts 
in accordance with this section for geographic areas that, 
as determined by the Secretary, have a shortage of one 
or more types of health providers as a result of the pro-
viders making the decision to cease or curtail providing 
health services in the geographic areas because of the costs 
of maintaining malpractice insurance. 
‘‘(b) RECIPIENTS OF AWARDS; EXPENDITURE.—In 
accordance with such criteria as the Secretary may estab-
lish:
‘‘(1) Awards under subsection (a) may be made 
to health providers who agree to provide health serv-
ices (or to continue providing health services, as the 
case may be) in geographic areas described in such 
subsection for the period during which payments 
under the awards are made to the health providers. 
‘‘(2) Health providers who receive such awards 
may expend the awards to assist the providers with 
the costs of maintaining medical malpractice insur-
ance for providing health services in the geographic 
area for which the award is made. 
‘‘(c) DEFINITION.—For purposes of this section, the 
term ‘health providers’ means physicians and other health 
professionals, and organizations that provide health serv-
ices (including hospitals, clinics, and group practices), that 
meet applicable legal requirements to provide the health 
services involved.’’. 
SEC. 102. HEALTH PROFESSIONAL ASSIGNMENTS TO TRAU-
MA CENTERS THROUGH NATIONAL HEALTH 
SERVICE CORPS. 
Section 338H of the Public Health Service Act (42 
U.S.C. 254q) is amended by adding at the end the fol-
lowing subsection:
‘‘(d) TRAUMA CENTERS; SEPARATE AUTHORIZATION 
REGARDING SHORTAGES RESULTING FROM COSTS OF 
MEDICAL MALPRACTICE INSURANCE.—
‘‘(1) IN GENERAL.—For the purpose of assign-
ing Corps surgeons, obstetricians/gynecologists, and 
other health professionals to trauma centers in 
health professional shortage areas described in para-
graph (2), there are authorized to be appropriated 
such sums as may be necessary for each of the fiscal 
years 2003 through 2006. Such authorization is in 
addition to any other authorization of appropriations 
that is available for such purpose. 
‘‘(2) DESCRIPTION OF AREAS.—A health pro-
fessional shortage area referred to in paragraph (1) 
is such an area in which, as determined by the Sec-
retary, a medical facility in the area has lost its des-
ignation as a trauma center or as a particular level 
of trauma center, or is at significant risk of losing 
such a designation, as a result of one or more sur-
geons, obstetricians/gynecologists, or other health 
professionals making the decision to cease or curtail 
practicing at the facility because of the costs of 
maintaining malpractice insurance. For purposes of 
paragraph (1), (A) the term ‘trauma center’ includes 
such a medical facility; and (B) the Secretary may
adjust the criteria for designation as a health profes-
sional shortage area to the extent necessary to make 
funds appropriated under paragraph (1) available 
with respect to any medical facility to ensure that 
the facility does not lose any such designation as a 
result of such decisions by health professionals.’’. 
TITLE 
II—TORT 
REFORM 
RE-
GARDING 
MEDICAL 
MAL-
PRACTICE 
Subtitle A—Medical Malpractice 
Litigation Reform 
SEC. 201. STATUTE OF LIMITATIONS. 
(a) IN GENERAL.—In any State or Federal court, a 
medical malpractice action shall be barred unless the com-
plaint is filed within 3 years after the right of action ac-
crues. 
(b) ACCRUAL.—A right of action referred to in sub-
section (a) accrues upon the last to occur of the following 
dates: 
(1) The date of the injury. 
(2) The date on which the claimant discovers, 
or through the use of reasonable diligence should 
have discovered, the injury. 
(3) The date on which the claimant became 18 
years of age.
(c) APPLICABILITY.—This section shall apply to any 
injury occurring after the date of the enactment of this 
Act. 
SEC. 202. ATTORNEY CERTIFICATE OF MERIT. 
(a) IN GENERAL.—In any State or Federal court, a 
medical malpractice action shall be dismissed unless the 
attorney or unrepresented party presenting the complaint 
certifies that, to the best of the person’s knowledge, infor-
mation, and belief, formed after an inquiry reasonable 
under the circumstances,—
(1) it is not being presented for any improper 
purpose, such as to harass or to cause unnecessary 
delay or needless increase in the cost of litigation; 
(2) the claims and other legal contentions 
therein are warranted by existing law or by a non-
frivolous argument for the extension, modification, 
or reversal of existing law or the establishment of 
new law; and 
(3) the allegations and other factual contentions 
have evidentiary support or, if specifically so identi-
fied, are likely to have evidentiary support after a 
reasonable opportunity for further investigation and 
discovery. 
(b) SANCTIONS.—If, after notice and a reasonable op-
portunity to respond, the court determines that a person,
in certifying under subsection (a), has violated that sub-
section, the court shall impose an appropriate sanction 
upon the attorneys, law firms, or parties that have violated 
that subsection or are responsible for the violation. Any 
sanction or relief available under Rule 11 of the Federal 
Rules of Civil Procedure shall be available under this sec-
tion. 
(c) COORDINATION WITH OTHER SANCTIONS.—A 
sanction imposed under this section shall be in addition 
to any other sanction available under any other law. 
(d) APPLICABILITY.—This section shall apply to any 
complaint filed after the date of the enactment of this Act. 
SEC. 203. LIMITATION ON PUNITIVE DAMAGES. 
(a) IN GENERAL.—In any State or Federal court, pu-
nitive damages may not be awarded on a medical mal-
practice action, except upon proof of—
(1) gross negligence; 
(2) reckless indifference to life; or 
(3) an intentional act, such as voluntary intoxi-
cation or impairment by a physician, sexual abuse or 
misconduct, assault and battery, or falsification of 
records. 
(b) ALLOCATION.—In such a case, the award of puni-
tive damages shall be allocated 50 percent to the claimant 
and 50 percent to a trustee appointed by the court, to
be used by such trustee in the manner specified in subtitle 
B. The court shall appoint the Secretary of Health and 
Human Services as such trustee. 
(c) EXCEPTION.—This subsection shall not apply 
with respect to an action if the applicable State law pro-
vides (or has been construed to provide) for damages in 
such an action that are only punitive or exemplary in na-
ture. 
SEC. 204. REDUCTION IN PREMIUMS PAID BY PHYSICIANS 
FOR 
MEDICAL 
MALPRACTICE 
INSURANCE 
COVERAGE. 
(a) IN GENERAL.—Not later than 180 days after the 
date of the enactment of this Act, each medical mal-
practice liability insurance company shall—
(1) develop a reasonable estimate of the annual 
amount of financial savings that will be achieved by 
the company as a result of this subtitle; 
(2) develop and implement a plan to annually 
dedicate at least 50 percent of such annual savings 
to reduce the amount of premiums that the company 
charges physicians for medical malpractice liability 
coverage; and 
(3) submit to the Secretary of Health and 
Human Services (referred to in this section as the
‘‘Secretary’’) a written certification that the com-
pany has complied with paragraphs (1) and (2). 
(b) REPORTS.—Not later than one year after the date 
of the enactment of this Act and annually thereafter, each 
medical malpractice liability insurance company shall sub-
mit to the Secretary a report that identifies the percentage 
by which the company has reduced medical malpractice 
coverage premiums relative to the date of the enactment 
of this Act. 
(c) ENFORCEMENT.—A medical malpractice liability 
insurance company that violates a provision of this section 
is liable to the United States for a civil penalty in an 
amount assessed by the Secretary, not to exceed $11,000 
for each such violation. The provisions of paragraphs (3) 
through (5) of section 303(g) of the Federal Food, Drug, 
and Cosmetic Act apply to such a civil penalty to the same 
extent and in the same manner as such paragraphs apply 
to a civil penalty under such section. 
(d) DEFINITION.—For purposes of this section, the 
term ‘‘medical malpractice liability insurance company’’ 
means an entity in the business of providing an insurance 
policy under which the entity makes payment in settlement 
(or partial settlement) of, or in satisfaction of a judgment 
in, a medical malpractice action or claim.
SEC. 205. DEFINITIONS. 
In this subtitle: 
(1) The term ‘‘State’’ means each of the several 
States, the District of Columbia, the Commonwealth 
of Puerto Rico, American Samoa, Guam, the Com-
monwealth of the Northern Mariana Islands, the 
Virgin Islands, and any other territory or possession 
of the United States. 
(2) The term ‘‘medical malpractice action’’ 
means an action against a physician, or other health 
professional, who is licensed in accordance with the 
requirements of the State involved that—
(A) arises under the law of the State in-
volved; 
(B) alleges the failure of such physician or 
other health professional to adhere to the rel-
evant professional standard of care for the serv-
ice and specialty involved; 
(C) alleges death or injury proximately 
caused by such failure; and 
(D) seeks monetary damages, whether 
compensatory or punitive, as relief for such 
death or injury.
Subtitle B—Use of Amounts Recov-
ered as Punitive Damages in 
Medical Malpractice Actions 
SEC. 221. AMOUNTS COVERED. 
(a) IN GENERAL.—This subtitle applies to amounts 
allocated to the Secretary of Health and Human Services 
as trustee under section 203. 
(b) AVAILABILITY.—Such amounts shall be available 
for use by the Secretary of Health and Human Services 
under section 222 and shall remain so available until ex-
pended. 
SEC. 222. USE OF AMOUNTS. 
(a) IN GENERAL.—Subject to subsection (b), the Sec-
retary of Health and Human Services, acting through the 
Director of the Agency for Healthcare Research and Qual-
ity, shall use the amounts to which this subtitle applies 
for activities to reduce medical errors and improve patient 
safety. 
(b) NO FUNDS FOR MANDATORY REPORTING SYS-
TEM.—The Secretary of Health and Human Services may 
not use any part of such amounts to establish or maintain 
any system that requires mandatory reporting of medical 
errors.
(1) The sudden rise in medical malpractice pre-
miums in regions of the United States can threaten 
patient access to doctors and other health providers. 
(2) Improving patient access to doctors and 
other health providers is a national priority. 
(b) ESTABLISHMENT.—There is established a na-
tional commission to be known as the ‘‘Independent Advi-
sory Commission on Medical Malpractice Insurance’’ (in 
this title referred to as the ‘‘Commission’’). 
SEC. 302. DUTIES. 
(a) IN GENERAL.—The Commission shall evaluate 
the causes and scope of the recent and dramatic increases 
in medical malpractice insurance premiums and formulate 
additional proposals to reduce such medical malpractice 
premiums and make recommendations to avoid any dra-
matic increases in medical malpractice premiums in the 
future, in light of proposals for tort reform regarding med-
ical malpractice. 
(b) CONSIDERATIONS.—In formulating proposals 
under this section, the Commission shall, at a minimum, 
consider the following: 
(1) Alternatives to the current medical mal-
practice tort system that would ensure adequate 
compensation for patients, preserve access to pro-
viders, and improve health care safety and quality.
(2) The effect of Federal laws on the pricing of 
medical malpractice insurance. 
(3) Modifications of, and alternatives to, the ex-
isting State and Federal regulations and oversight 
that affect, or could affect, medical malpractice lines 
of insurance. 
(4) State and Federal reforms that would dis-
tribute the risk of medical malpractice more equi-
tably among health care providers. 
(5) State and Federal reforms that would more 
evenly distribute the risk of medical malpractice 
across various categories of providers. 
(6) The effect of a Federal medical malpractice 
reinsurance program administered by the Depart-
ment of Health and Human Services. 
(7) Programs that would reduce medical errors 
and increase patient safety, including new innova-
tions in technology and management. 
SEC. 303. REPORT. 
(a) IN GENERAL.—The Commission shall transmit to 
Congress—
(1) an initial report not later than 180 days 
after the date of the initial meeting of the Commis-
sion; and
(2) a report not less than each year thereafter 
until the Commission terminates. 
(b) CONTENTS.—Each report transmitted under this 
section shall contain a detailed statement of the findings 
and conclusions of the Commission, including proposals 
for addressing the current dramatic increases in medical 
malpractice insurance rates and recommendations for 
avoiding any such dramatic increases in the future. 
(c) VOTING AND REPORTING REQUIREMENTS.—With 
respect to each proposal or recommendation contained in 
the report submitted under subsection (a), each member 
of the Commission shall vote on the proposal or rec-
ommendation, and the Commission shall include, by mem-
ber, the results of that vote in the report. 
SEC. 304. MEMBERSHIP. 
(a) NUMBER AND APPOINTMENT.—The Commission 
shall be composed of 15 members appointed by the Comp-
troller General of the United States. 
(b) MEMBERSHIP.—
(1) IN
GENERAL.—The membership of the 
Commission shall include individuals with national 
recognition for their expertise in health finance and 
economics, actuarial science, medical malpractice in-
surance, insurance regulation, health care law, 
health care policy, health care access, allopathic and
osteopathic physicians, other providers of health care 
services, patient advocacy, and other related fields, 
who provide a mix of different professionals, broad 
geographic representations, and a balance between 
urban and rural representatives. 
(2) INCLUSION.—The membership of the Com-
mission shall include the following: 
(A) Two individuals with expertise in 
health finance and economics, including one 
with expertise in consumer protections in the 
area of health finance and economics. 
(B) Two individuals with expertise in med-
ical malpractice insurance, representing both 
commercial insurance carriers and physician-
sponsored insurance carriers. 
(C) An individual with expertise in State 
insurance regulation and State insurance mar-
kets. 
(D) An individual representing physicians. 
(E) An individual with expertise in issues 
affecting hospitals, nursing homes, nurses, and 
other providers. 
(F) Two individuals representing patient 
interests.
(G) Two individuals with expertise in 
health care law or health care policy. 
(H) An individual with expertise in rep-
resenting patients in malpractice lawsuits. 
(3) MAJORITY.—The total number of individ-
uals who are directly involved with the provision or 
management of malpractice insurance, representing 
physicians or other providers, or representing physi-
cians or other providers in malpractice lawsuits, 
shall not constitute a majority of the membership of 
the Commission. 
(4) ETHICAL
DISCLOSURE.—The Comptroller 
General of the United States shall establish a system 
for public disclosure by members of the Commission 
of financial or other potential conflicts of interest re-
lating to such members. 
(c) TERMS.—
(1) IN GENERAL.—The terms of the members 
of the Commission shall be for 3 years except that 
the Comptroller General of the United States shall 
designate staggered terms for the members first ap-
pointed. 
(2) VACANCIES.—Any member appointed to fill 
a vacancy occurring before the expiration of the 
term for which the member’s predecessor was ap-
pointed shall be appointed only for the remainder of 
that term. A member may serve after the expiration 
of that member’s term until a successor has taken 
office. A vacancy in the Commission shall be filled 
in the manner in which the original appointment was 
made. 
(3) COMPENSATION.—Members of the Commis-
sion shall be compensated in accordance with section 
1805(c)(4) of the Social Security Act. 
(4) CHAIRMAN; VICE CHAIRMAN.—The Comp-
troller General of the United States shall designate 
at the time of appointment a member of the Com-
mission as Chairman and a member as Vice Chair-
man. In the case of vacancy of the Chairmanship or 
Vice Chairmanship, the Comptroller General may 
designate another member for the remainder of that 
member’s term. 
(5) MEETINGS.—
(A) IN GENERAL.—The Commission shall 
meet at the call of the Chairman. 
(B) INITIAL MEETING.—The Commission 
shall hold an initial meeting not later than the 
date that is 1 year after the date of the enact-
ment of this title, or the date that is 3 months
after the appointment of all the members of the 
Commission, whichever occurs earlier. 
SEC. 305. DIRECTOR AND STAFF; EXPERTS AND CONSULT-
ANTS. 
Subject to such review as the Comptroller General of 
the United States deems necessary to assure the efficient 
administration of the Commission, the Commission may—
(1) employ and fix the compensation of an Ex-
ecutive Director (subject to the approval of the 
Comptroller General) and such other personnel as 
may be necessary to carry out its duties (without re-
gard to the provisions of title 5, United States Code, 
governing appointments in the competitive service); 
(2) seek such assistance and support as may be 
required in the performance of its duties from ap-
propriate Federal departments and agencies; 
(3) enter into contracts or make other arrange-
ments, as may be necessary for the conduct of the 
work of the Commission (without regard to section 
3709 of the Revised Statutes (41 U.S.C. 5)); 
(4) make advance, progress, and other pay-
ments which relate to the work of the Commission; 
(5) provide transportation and subsistence for 
persons serving without compensation; and
(6) prescribe such rules and regulations as it 
deems necessary with respect to the internal organi-
zation and operation of the Commission. 
SEC. 306. POWERS. 
(a) OBTAINING OFFICIAL DATA.—The Commission 
may secure directly from any department or agency of the 
United States information necessary to enable it to carry 
out this section. Upon request of the Chairman, the head 
of that department or agency shall furnish that informa-
tion to the Commission on an agreed upon schedule. 
(b) DATA COLLECTION.—In order to carry out its 
functions, the Commission shall—
(1) utilize existing information, both published 
and unpublished, where possible, collected and as-
sessed either by its own staff or under other ar-
rangements made in accordance with this section; 
(2) carry out, or award grants or contracts for, 
original research and experimentation, where exist-
ing information is inadequate; and 
(3) adopt procedures allowing any interested 
party to submit information for the Commission’s 
use in making reports and recommendations. 
(c) ACCESS OF GENERAL ACCOUNTING OFFICE TO 
INFORMATION.—The Comptroller General of the United 
States shall have unrestricted access to all deliberations,
records, and nonproprietary data of the Commission, im-
mediately upon request. 
(d) PERIODIC AUDIT.—The Commission shall be sub-
ject to periodic audit by the Comptroller General of the 
United States. 
SEC. 307. AUTHORIZATION OF APPROPRIATIONS. 
(a) IN GENERAL.—There are authorized to be appro-
priated such sums as may be necessary to carry out this 
title for each of fiscal years 2004 through 2008. 
(b) REQUESTS FOR APPROPRIATIONS.—The Commis-
sion shall submit requests for appropriations in the same 
manner as the Comptroller General of the United States 
submits requests for appropriations, but amounts appro-
priated for the Commission shall be separate from 
amounts appropriated for the Comptroller General.
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