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Q: SECTION 1. SHORT TITLE.

This Act may be cited as the ''Medical Injury Compensation Reform
Act of 1993''.

SEC. 2. GENERAL PROVISIONS.

(a) Congressional Findings.--
(1) Effect on interstate commerce.--The Congress finds that
the health care and insurance industries are industries
affecting interstate commerce and the medical malpractice
litigation systems existing throughout the United States affect
interstate commerce by contributing to the high cost of health
care and premiums for malpractice insurance purchased by health
care providers.
(2) Effect on federal spending.--The Congress finds that
the medical malpractice litigation systems existing throughout
the United States have a significant effect on the amount,
distribution, and use of Federal funds because of--
(A) the large number of individuals who receive
health care benefits under programs operated or
financed by the Federal Government;
(B) the large number of individuals who benefit
because of the exclusion from Federal taxes of the
amounts spent by their employers to provide them with
health insurance benefits;
(C) the large number of health care providers and
health care professionals who provide items or services
for which the Federal Government makes payments; and
(D) the large number of such providers and
professionals who have received direct or indirect
financial assistance from the Federal Government
because of their status as such professionals or
providers.
(b) Applicability.--This Act shall apply with respect to any
medical malpractice liability claim and to any medical malpractice
liability action brought in any State or Federal court, except that
this Act shall not apply to--
(1) a claim or action for damages arising from a vaccine-
related injury or death to the extent that title XXI of the
Public Health Service Act applies to the claim or action; or
(2) a claim or action in which the claimant's sole
allegation is an allegation of an injury arising from the use
of a medical product.
(c) Preemption of State Law.--Subject to section 10, this Act
supersedes State law only to the extent that State law differs from any
provision of law established by or under this Act. Any issue that is
not governed by any provision of law established by or under this Act
shall be governed by otherwise applicable State or Federal law.
(d) Federal Court Jurisdiction Not Established on Federal Question
Grounds.--Nothing in this Act shall be construed to establish any
jurisdiction in the district courts of the United States over medical
malpractice liability actions on the basis of section 1331 or 1337 of
title 28, United States Code.

SEC. 3. DEFINITIONS.

As used in this Act:
(1) Claimant.--The term ''claimant'' means any person who
alleges a medical malpractice liability claim or, in the case
of an individual who is deceased, incompetent, or a minor, the
person on whose behalf such a claim is alleged.
(2) Economic damages.--The term ''economic damages'' means
damages paid to compensate an individual for losses for
hospital and other medical expenses, lost wages, lost
employment, and other pecuniary losses.
(3) Health care professional.--The term ''health care
professional'' means any individual who provides health care
services in a State and who is required by State law or
regulation to be licensed or certified by the State to provide
such services in the State.
(4) 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 State law or regulation to be licensed or
certified by the State to engage in the delivery of such
services in the State.
(5) Injury.--The term ''injury'' means any illness,
disease, or other harm that is the subject of a medical
malpractice liability action or claim.
(6) Medical malpractice liability action.--The term
''medical malpractice liability action'' means a civil action
(other than an action in which the claimant's sole allegation
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 claimant alleges a medical
malpractice liability claim.
(7) Medical malpractice liability claim.--The term
''medical malpractice liability claim'' means a claim in which
the claimant alleges that injury was caused by the provision of
(or the failure to provide) health care services.
(8) Medical product.--The term ''medical product'' means a
device (as defined in section 201(h) of the Federal Food, Drug,
and Cosmetic Act) or a drug (as defined in section 201(g)(1) of
the Federal Food, Drug, and Cosmetic Act).
(9) Noneconomic damages.--The term ''noneconomic damages''
means damages paid to compensate an individual for losses for
physical and emotional pain, suffering, inconvenience, physical
impairment, mental anguish, disfigurement, loss of enjoyment of
life, loss of consortium, and other nonpecuniary losses, but
does not include punitive damages.
(10) Secretary.--The term ''Secretary'' means the Secretary
of Health and Human Services.
(11) State.--The term ''State'' means each of the several
States, the District of Columbia, the Commonwealth of Puerto
Rico, and any other territory or possession of the United
States.

SEC. 4. EFFECTIVE DATE.

(a) In General.--Except as provided in subsection (b) and section
11, this Act shall apply with respect to claims accruing or actions
brought on or after the expiration of the 3-year period that begins on
the date of the enactment of this Act.
(b) Exception for States Requesting Earlier Implementation of
Reforms.--
(1) Application.--A State may submit an application to the
Secretary requesting the early implementation of this Act with
respect to claims or actions brought in the State.
(2) Decision by secretary.--The Secretary shall issue a
response to a State's application under paragraph (1) not later
than 90 days after receiving the application. If the Secretary
determines that the State meets the requirements of this Act at
the time of submitting its application, the Secretary shall
approve the State's application, and this Act shall apply with
respect to actions brought in the State on or after the
expiration of the 90-day period that begins on the date the
Secretary issues the response. If the Secretary denies the
State's application, the Secretary shall provide the State with
a written explanation of the grounds for the decision.

SEC. 5. STATUTE OF LIMITATIONS.

(a) In General.--No medical malpractice liability claim may be
brought after the expiration of the 2-year period that begins on the
date the alleged injury that is the subject of the action should
reasonably have been discovered, but in no event after the expiration
of the 4-year period that begins on the date the alleged injury
occurred.
(b) Exception for Minors.--In the case of an alleged injury
suffered by a minor who has not attained 6 years of age, no medical
malpractice liability claim may be brought after the expiration of the
2-year period that begins on the date the alleged injury that is the
subject of the action should reasonably have been discovered, but in no
event after the date on which the minor attains 10 years of age.

SEC. 6. ATTORNEYS' FEES.

(a) Limitation on Contingency Fees.--An attorney shall not contract
for or collect a contingency fee for representing a claimant in a
medical malpractice liability action in excess of the following:
(1) 40 percent of the first $50,000 (or portion thereof) of
the amount recovered by the claimant.
(2) 33/3\ percent of the next $50,000 (or portion
thereof) of the amount recovered by the claimant.
(3) 25 percent of the next $500,000 (or portion thereof) of
the amount recovered by the claimant.
(4) 15 percent of any amounts recovered by the claimant in
excess of $600,000.
This subsection applies whether the recovery is by settlement,
arbitration, or judgment.
(b) Calculation of Periodic Payments.--If periodic payments are
awarded to the claimant pursuant to section 7(b), the court shall place
a total value on these payments based upon the projected life
expectancy of the claimant and include this amount in computing the
total award from which attorneys' fees are calculated under subsection
(a).
(c) Effect of Failure To Comply.--Failure to comply with this
section by an attorney at law shall be grounds for professional
discipline by the appropriate State agency responsible for the conduct
of disciplinary actions against attorneys-at-law.
(d) Definitions.--For purposes of this section--
(1) the term ''contingency fee'' means any fee for
professional legal services which is in whole or in part
contingent upon the recovery of any amount of damages, whether
through judgment or settlement; and
(2) the term ''recovered'' means the net sum recovered
after deducting any disbursements or costs incurred in
connection with prosecution or settlement of the claim, except
that costs of medical care incurred by the claimant and the
attorney's office overhead costs or charges shall not be
deductible disbursements under this paragraph.

SEC. 7. CALCULATION AND PAYMENT OF DAMAGES.

(a) Limitation on Noneconomic Damages.--The total amount of
noneconomic damages that may be awarded to a claimant for losses
resulting from the injury which is the subject of a medical malpractice
liability action may not exceed $250,000, regardless of the number of
parties against whom the action is brought or the number of actions
brought with respect to the injury.
(b) Periodic Payments for Future Losses.--If more than $50,000 in
damages for expenses to be incurred in the future is awarded to the
claimant in a medical malpractice liability action, the court shall, at
the request of either party, enter a judgment ordering such damages to
be paid on a periodic basis determined appropriate by the court (based
upon projections of when such expenses are likely to be incurred).
(c) Mandatory Offsets for Damages Paid by a Collateral Source.--The
total amount of damages received by a claimant in a medical malpractice
liability action shall be reduced by any other payment that has been or
will be made to the individual to compensate the claimant for the
injury that was the subject of the action, including payment under--
(1) Federal or State disability or sickness programs;
(2) Federal, State, or private health insurance programs;
(3) private disability insurance programs;
(4) employer wage continuation programs; and
(5) any other source of payment intended to compensate the
claimant for such injury.

SEC. 8. NOTICE OF ACTION.

(a) Notice Requirement.--
(1) In general.--No medical malpractice liability action
may be commenced unless the defendant has been given at least
90 days notice of the intention to commence the action.
(2) Contents of notice.--The notice under paragraph (1)
shall include the legal basis of the medical malpractice
liability claim on which the action is based and the type of
loss sustained, including the specific nature of the injuries
suffered.
(b) Effect on Statute of Limitations.--If the notice under
paragraph (1) is served within 90 days before the expiration of the
statute of limitations for filing the medical malpractice liability
action, the time for commencing the action shall extend for 90 days
after the notice under paragraph (1) is served.
(c) Effect of Failure to Comply.--Failure to comply with this
section shall not invalidate any court proceedings in the medical
malpractice liability action involved, and shall not affect the
jurisdiction of the court to render a judgment in the action, but a
failure to comply with this section by an attorney at law shall be
grounds for professional discipline by the appropriate State agency
responsible for the conduct of disciplinary actions against attorneys-
at-law.

SEC. 9. INJUNCTIVE RELIEF.

Whenever any person has engaged or is about to engage in any
conduct in violation of this Act, the appropriate court may, upon
application of an interested party, issue an injunction or other
appropriate order restraining such conduct.

SEC. 10. PREEMPTION.

(a) In General.--The preceding provisions of this Act supersede any
State law only to the extent that State law--
(1) permits the recovery of a greater amount of damages by
claimant;
(2) permits the collection of a greater amount of
attorneys' fees by a claimant's attorney; or
(3) establishes a longer period during which a medical
malpractice liability claim may be initiated.
(b) Effect on Sovereign Immunity and Choice of Law or Venue.--
Nothing in subsection (a) shall be construed to--
(1) waive or affect any defense of sovereign immunity
asserted by any State under any provision of law;
(2) waive or affect any defense of sovereign immunity
asserted by the United States;
(3) affect the applicability of any provision of the
Foreign Sovereign Immunities Act of 1976;
(4) preempt State choice-of-law rules with respect to
claims brought by a foreign country or a citizen of a foreign
country; or
(5) affect the right of any court to transfer venue or to
apply the law of a foreign country or to dismiss a claim of a
foreign country or of a citizen of a foreign nation on the
ground of inconvenient forum.

SEC. 11. PERMITTING STATE PROFESSIONAL SOCIETIES TO PARTICIPATE IN
DISCIPLINARY ACTIVITIES.

(a) Role of Professional Societies.--Notwithstanding any other
provision of State or Federal law, a State agency responsible for the
conduct of disciplinary actions for a type of health care practitioner
may enter into agreements with State or county professional societies
of such type of health care practitioner to permit such societies to
participate in the licensing of such health care practitioner, and to
review any health care malpractice action, health care malpractice
claim or allegation, or other information concerning the practice
patterns of any such health care practitioner. Any such agreement shall
comply with subsection (b).
(b) Requirements of Agreements.--Any agreement entered into under
subsection (a) for licensing activities or the review of any health
care malpractice action, health care malpractice claim or allegation,
or other information concerning the practice patterns of a health care
practitioner shall provide that--
(1) the health care professional society conducts such
activities or review as expeditiously as possible;
(2) after the completion of such review, such society shall
report its findings to the State agency with which it entered
into such agreement;
(3) the conduct of such activities or review and the
reporting of such findings be conducted in a manner which
assures the preservation of confidentiality of health care
information and of the review process; and
(4) no individual affiliated with such society is liable
for any damages or injury directly caused by the individual's
actions in conducting such activities or review.
(c) Agreements Not Mandatory.--Nothing in this section may be
construed to require a State to enter into agreements with societies
described in subsection (a) to conduct the activities described in such
subsection.
(d) Effective Date.--This section shall take effect 2 years after
the date of the enactment of this Act.
A:
Medical Injury Compensation Reform Act of 1993 - Makes this Act applicable, with exceptions, to: (1) any medical malpractice liability claim and action brought in State or Federal court; and (2) claims accruing or actions brought after three years after enactment of this Act. Specifies that nothing in this Act shall be construed to establish jurisdiction in U.S. district courts over medical malpractice liability actions on Federal question grounds.
Prohibits a medical malpractice liability claim from being brought more than two years after the date the alleged injury should reasonably have been discovered, but in no event after four years after the alleged injury occurred, with an exception for minors.
Sets forth provisions regarding: (1) attorney's fees (including limitations on contingency fees); (2) calculation and payment of damages (including limitations on noneconomic damages, periodic payments for future losses, and mandatory offsets for damages paid by a collateral source); (3) notice requirements; (4) injunctive relief; and (5) preemption.
Permits State professional societies to participate in disciplinary activities.