[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1989 Introduced in House (IH)]

103d CONGRESS
  1st Session
                                H. R. 1989

   To provide for medical injury compensation reform for health care 
services furnished using funds provided under certain Federal programs 
          or under group health plans, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 5, 1993

Mr. McMillan (for himself, Mr. Taylor of North Carolina, Mr. Santorum, 
   Mr. DeLay, Mr. Gingrich, Mr. Hastert, Mr. Hobson, Mr. Kasich, Mr. 
Kolbe, Mr. Paxon, Mrs. Roukema, Mr. Walker, Mr. Ballenger, Mr. Bliley, 
    Mr. Dreier, Mr. Goss, Mr. Grandy, Mr. Solomon, Mr. Castle, Mr. 
Sundquist, and Mr. Sam Johnson of Texas) introduced the following bill; 
which was referred jointly to the Committees on the Judiciary, Ways and 
                     Means, and Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
   To provide for medical injury compensation reform for health care 
services furnished using funds provided under certain Federal programs 
          or under group health plans, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

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

SEC. 2. FINDINGS AND PURPOSE.

    (a) Findings.--Congress finds that--
            (1) health care expenditures are escalating beyond the 
        ability of Americans to afford them, having increased from 5.9 
        percent of gross national product in 1965 to over 12 percent in 
        1990;
            (2) the medical injury compensation system currently in 
        effect in the United States is ineffectual in compensating 
        injured persons, has very high administrative costs, and 
        contributes to the high level of unnecessary spending on health 
        care;
            (3) as many as 15 out of 16 persons injured due to medical 
        negligence never get compensation through the current medical 
        malpractice system;
            (4) malpractice insurance premiums, only 40 percent of 
        which ever reach injured persons as compensation for their 
        injuries, increased at an average rate of 18.3 percent per year 
        from 1982 to 1988;
            (5) unnecessary defensive medical practices, rendered by 
        physicians in anticipation of juries' retrospective application 
        of poorly specified standards of care to their diagnostic and 
        treatment choices, add billions of dollars to the Nation's 
        health care bill;
            (6) the law governing medical malpractice operates to limit 
        access to health care by driving costs to unaffordable levels 
        and by discouraging physicians from treating high-risk patients 
        and from practicing in high-risk areas and specialties; and
            (7) the Federal Government, which directly finances about 
        30 percent of the health care consumed in the United States and 
        subsidizes a substantial portion of private health insurance, 
        has a legitimate financial interest in addressing the problems 
        associated with the current medical malpractice system.
    (b) Purpose.--It is the purpose of this Act to--
            (1) encourage the efficient resolution of medical injury 
        claims, using alternative methods of dispute resolution;
            (2) ensure fairness in the awards granted in medical injury 
        cases;
            (3) reduce inappropriate, unnecessary or defensive medical 
        practices;
            (4) reduce public and private health care costs;
            (5) improve access to health care; and
            (6) facilitate informed, responsible choices in the 
        selection of alternative methods of dispute resolution and in 
        the specification of appropriate standards for medical 
        practice.

SEC. 3. MANDATORY RESOLUTION OF CLAIMS THROUGH CERTIFIED DISPUTE 
              RESOLUTION SYSTEMS.

    (a) Application to Claims Arising From Services Financed Through 
Certain Federal Programs.--
            (1) In general.--Each individual or entity providing or 
        receiving health care services for which payment may be made in 
        whole or in part with funds provided under a Federal program 
        described in paragraph (2) shall be deemed to have entered into 
        an agreement--
                    (A) to resolve any medical malpractice liability 
                claim arising from the provision of (or failure to 
                provide) such services through a State dispute 
                resolution system that is certified by the Secretary 
                under section 4(b) (or the alternative Federal ADR 
                system applicable under section 4(c)); and
                    (B) to bring any medical malpractice liability 
                action that arises from a claim resolved through such a 
                system only in accordance with the procedures described 
                in section 5.
            (2) Federal programs described.--The Federal programs 
        described in this paragraph are as follows:
                    (A) The health insurance program under title XVIII 
                of the Social Security Act.
                    (B) A State plan for medical assistance under title 
                XIX of the Social Security Act.
                    (C) The health benefit program for Federal 
                employees under chapter 89 of title 5, United States 
                Code.
                    (D) Any program for the provision of hospital care 
                and medical services by the Department of Veterans 
                Affairs under chapter 17 of title 38, United States 
                Code.
                    (E) A program for the provision of services at 
                facilities of the Indian Health Service or at other 
                facilities under the Indian Health Care Improvement 
                Act.
                    (F) The program authorized under sections 1079 and 
                1086 of title 10, United States Code.
                    (G) The program for providing medical care at 
                facilities of the uniformed services under title 10, 
                United States Code.
    (b) Application to Services Furnished Under Employer-Sponsored 
Health Plans.--
            (1) Restriction on deductibility of business expenses.--
        Section 162 of the Internal Revenue Code of 1986 is amended--
                    (A) by redesignating subsection (m) as subsection 
                (n); and
                    (B) by inserting after subsection (l) the following 
                new subsection:
    ``(m) Conditioning Deductibility of Health Insurance Expenses on 
Application of Alternative Dispute Resolution Procedures.--
Notwithstanding any other provision of this Code, no deduction may be 
taken under this section (including a deduction taken under subsection 
(l)) for expenses paid for insurance which constitutes medical care 
unless there is in effect an agreement described in section 3(a) of the 
Medical Injury Compensation Fairness Act of 1993 with respect to the 
resolution of medical malpractice claims arising from the provision of 
(or failure to provide) such medical care.''.
            (2) Requirement for exemption from excise tax for 
        nonconforming plans of tax-exempt organizations.--Section 
        5000(c) of the Internal Revenue Code of 1986 is amended by 
        striking the period at the end and inserting the following: ``, 
        or (in the case of an employee or an employer organization 
        exempt from taxation under subtitle A) does not have in effect 
        an agreement described in section 3(a) of the Medical Injury 
        Compensation Fairness Act of 1993 with respect to the 
        resolution of medical malpractice claims arising from the 
        provision of (or failure to provide) items and services for 
        which payment may be made under the plan.''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply to taxable years beginning after December 1994.
    (c) Waiver of Agreements not Permitted.--An individual or entity 
may not waive an agreement referred to in subsection (a) and may seek 
the enforcement of the agreement in any court of competent 
jurisdiction.

SEC. 4. REQUIREMENTS FOR DISPUTE RESOLUTION PROGRAMS.

    (a) In General.--A State's alternative dispute resolution system 
meets the requirements of this section if the system--
            (1) provides that the standards described in section 6 
        shall apply to all claims resolved under the system;
            (2) requires that a written opinion resolving the dispute 
        be issued not later than 6 months after the date by which each 
        party against whom the claim is filed has received notice of 
        the claim (other than in exceptional cases for which a longer 
        period is required for the issuance of such an opinion), and 
        that the opinion contain--
                    (A) findings of fact relating to the dispute, and
                    (B) a description of the costs incurred in 
                resolving the dispute under the system (including any 
                fees paid to the individuals hearing and resolving the 
                claim), together with an appropriate assessment of the 
                costs against any of the parties;
            (3) requires individuals who hear and resolve claims under 
        the system to meet such qualifications as the State may require 
        (in accordance with regulations of the Secretary);
            (4) is approved by the State or by local governments in the 
        State;
            (5) with respect to a State system that consists of 
        multiple dispute resolution procedures--
                    (A) permits the parties to a dispute to select the 
                procedure to be used for the resolution of the dispute 
                under the system, and
                    (B) if the parties do not agree on the procedure to 
                be used for the resolution of the dispute, assigns a 
                particular procedure to the parties;
            (6) provides for the transmittal to the State agency 
        responsible for monitoring or disciplining health care 
        professionals and health care providers of any findings made 
        under the system that such a professional or provider committed 
        malpractice, unless, during the 90-day period beginning on the 
        date the system resolves the claim against the professional or 
        provider, the professional or provider brings a medical 
        malpractice liability action contesting the decision made under 
        the system; and
            (7) provides for the regular transmittal to the 
        Administrator for Health Care Policy and Research of 
        information on disputes resolved under the system, in a manner 
        that assures that the identity of the parties to a dispute 
        shall not be revealed.
    (b) Certification of State Systems.--
            (1) In general.--Not later than October 1 of each year 
        (beginning with 1994), the Secretary, in consultation with the 
        Attorney General, shall determine whether a State's alternative 
        dispute resolution system meets the requirements of subsection 
        (a) for the following calendar year.
            (2) Basis for certification.--The Secretary shall certify a 
        State's alternative dispute resolution system under this 
        subsection for a calendar year if the Secretary determines 
        under paragraph (1) that the system meets the requirements of 
        subsection (a).
    (c) Applicability of Alternative Federal System.--
            (1) Establishment and applicability.--Not later than 
        October 1, 1994, the Secretary, in consultation with the 
        Attorney General, shall establish by rule an alternative 
        Federal ADR system for the resolution of medical malpractice 
        liability claims during a calendar year in States that do not 
        have in effect an alternative dispute resolution system 
        certified under subsection (b) for the year.
            (2) Requirements for system.--Under the alternative Federal 
        ADR system established under paragraph (1)--
                    (A) paragraphs (2), (6), and (7) of subsection (a) 
                shall apply to claims brought under the system;
                    (B) claims brought under the system shall be heard 
                and resolved by arbitrators appointed by the Secretary 
                in consultation with the Attorney General; and
                    (C) with respect to a State in which the system is 
                in effect, the Secretary may (at the State's request) 
                modify the system to take into account the existence of 
                dispute resolution procedures in the State that affect 
                the resolution of medical malpractice liability claims.

SEC. 5. STANDARDS FOR MEDICAL MALPRACTICE LIABILITY ACTIONS BROUGHT 
              AFTER RESOLUTION UNDER ADR SYSTEM.

    (a) No Action Permitted Until Resolution of Claim Under ADR 
System.--
            (1) In general.--If a medical malpractice liability claim 
        is subject to an agreement under section 3(a), no medical 
        malpractice liability action that is based on the claim may be 
        brought in any court until the claim is initially resolved 
        under an alternative dispute resolution system in accordance 
        with this Act.
            (2) Initial resolution of claims under adr.--For purposes 
        of paragraph (1), an action is ``initially resolved'' under an 
        alternative dispute resolution system if--
                    (A) the ADR reaches a decision on whether the 
                defendant is liable to the plaintiff for damages; and
                    (B) if the ADR determines that the defendant is 
                liable, the ADR reaches a decision on the amount of 
                damages assessed against the defendant.
    (b) Procedures for Filing Actions.--
            (1) Notice of intent to contest decision.--Not later than 
        60 days after a decision is issued with respect to a claim 
        under an alternative dispute resolution system described in 
        section 4, each party affected by the decision shall submit a 
        sealed statement to a court of competent jurisdiction 
        indicating whether or not the party intends to contest the 
        decision.
            (2) Deadline for filing action.--No civil action arising 
        from a claim that is subject to alternative dispute resolution 
        under this Act may be brought unless the action is filed in a 
        court of competent jurisdiction not later than 90 days after 
        the decision resolving the medical malpractice liability claim 
        that is the subject of the action is issued under the 
        applicable alternative dispute resolution system.
            (3) Mandatory pre-trial settlement conference.--
                    (A) In general.--Before the beginning of the trial 
                phase of any medical malpractice liability action 
                arising from a claim that is subject to alternative 
                dispute resolution under this Act, the parties shall 
                attend a conference called by the court for purposes of 
                determining whether grounds exist upon which the 
                parties may negotiate a settlement for the action.
                    (B) Requiring parties to submit settlement 
                offers.--At the conference called pursuant to 
                subparagraph (A), each party to a medical malpractice 
                liability action shall present an offer of settlement 
                for the action.
            (4) Court of competent jurisdiction.--For purposes of this 
        subsection, the term ``court of competent jurisdiction'' 
        means--
                    (A) with respect to actions filed in a State court, 
                the appropriate State trial court; and
                    (B) with respect to actions filed in a Federal 
                court, the appropriate United States district court.
    (c) Effect of ADR Decision on Burden of Proof in Subsequent 
Action.--In any action arising from a claim that is subject to an 
agreement under section 3(a), the trier of fact shall uphold the 
decision made under the previous alternative dispute resolution system 
with respect to the claim unless the party contesting the decision 
proves by a preponderance of the evidence that the decision was 
incorrect.
    (d) Requiring Party Contesting ADR Ruling To Pay Attorney's Fees 
and Other Costs.--
            (1) In general.--The court in a medical malpractice 
        liability action shall require the party that (pursuant to 
        subsection (b)(1)) contested the ruling of the alternative 
        dispute resolution system with respect to the medical 
        malpractice liability claim that is the subject of the action 
        to pay to the opposing party the costs incurred by the opposing 
        party under the action, including attorney's fees, fees paid to 
        expert witnesses, and other litigation expenses (but not 
        including court costs, filing fees, or other expenses paid 
        directly by the party to the court, or any fees or costs 
        associated with the resolution of the claim under the 
        alternative dispute resolution system), but only if--
                    (A) in the case of an action in which the party 
                that contested the ruling is the plaintiff, the amount 
                of damages awarded to the party under the action does 
                not exceed the amount of damages awarded to the party 
                under the ADR system by at least 10 percent; and
                    (B) in the case of an action in which the party 
                that contested the ruling is the defendant, the amount 
                of damages assessed against the party under the action 
                is not at least 10 percent less than the amount of 
                damages assessed under the ADR system.
            (2) Exceptions.--Paragraph (1) shall not apply if--
                    (A) the party contesting the ruling made under the 
                previous alternative dispute resolution system shows 
                that--
                            (i) the ruling was procured by corruption, 
                        fraud, or undue means,
                            (ii) there was partiality or corruption 
                        under the system,
                            (iii) there was other misconduct under the 
                        system that materially prejudiced the party's 
                        rights, or
                            (iv) the ruling was based on an error of 
                        law;
                    (B) the party contesting the ruling made under the 
                previous alternative dispute resolution system presents 
                new evidence before the trier of fact that was not 
                available for presentation under the ADR system;
                    (C) the medical malpractice liability action raised 
                a novel issue of law; or
                    (D) the court finds that the application of such 
                paragraph to a party would constitute an undue 
                hardship, and issues an order waiving or modifying the 
                application of such paragraph that specifies the 
                grounds for the court's decision.
    (e) Legal Effect of Uncontested ADR Decision.--The decision reached 
under an alternative dispute resolution system shall, for purposes of 
enforcement by a court of competent jurisdiction, have the same status 
in the court as the verdict of an action adjudicated in a State or 
Federal trial court. The previous sentence shall not apply to a 
decision that is contested by a party affected by the decision pursuant 
to subsection (b)(1).
    (f) Applicability of Standards.--The standards described in section 
5 shall apply to any action arising from a claim that is subject to an 
agreement under section 3(a) in the same manner as such standards apply 
to the resolution of such claims.

SEC. 6. STANDARDS FOR THE RESOLUTION OF CLAIMS AND ACTIONS.

    (a) Applicability.--This section shall apply with respect to 
medical malpractice liability claims for which an agreement described 
in section 3(a) is in effect.
    (b) Statute of Limitations.--
            (1) In general.--No 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 claim 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.
            (2) Exception for minors.--In the case of an alleged injury 
        suffered by a minor who has not attained 6 years of age, no 
        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.
    (c) Calculation and Payment of Damages.--
            (1) Limitation on noneconomic damages.--The total amount of 
        noneconomic damages that may be awarded to a claimant and the 
        members of the claimant's family for losses resulting from the 
        injury which is the subject of a claim may not exceed $250,000, 
        regardless of the number of parties against whom the claim is 
        brought or the number of claims brought with respect to the 
        injury.
            (2) Treatment of punitive damages.--
                    (A) Limitation on amount.--The total amount of 
                punitive damages that may be imposed under a claim may 
                not exceed twice the total of the damages awarded to 
                the claimant and the members of the claimant's family.
                    (B) Payments to state for medical quality assurance 
                activities.--
                            (i) In general.--Any punitive damages 
                        imposed under a claim shall be paid to the 
                        State in which the claim is brought.
                            (ii) Activities described.--A State shall 
                        use amount paid pursuant to clause (i) to carry 
                        out activities to assure the safety and quality 
                        of health care services provided in the State, 
                        including (but not limited to)--
                                    (I) licensing or certifying health 
                                care professionals and health care 
                                providers in the State;
                                    (II) operating alternative dispute 
                                resolution systems;
                                    (III) carrying out public education 
                                programs relating to medical 
                                malpractice and the availability of 
                                alternative dispute resolution systems 
                                in the State; and
                                    (IV) carrying out programs to 
                                reduce malpractice-related costs for 
                                retired providers or other providers 
                                volunteering to provide services in 
                                medically underserved areas.
                            (iii) Maintenance of effort.--A State shall 
                        use any amounts paid pursuant to clause (i) to 
                        supplement and not to replace amounts spent by 
                        the State for the activities described in 
                        clause (ii).
            (3) Periodic payments for future losses.--If more than 
        $100,000 in damages for expenses to be incurred in the future 
        is awarded to the claimant, the party against whom the damages 
        are awarded shall provide for payment for such damages on a 
        periodic basis determined appropriate by the alternative 
        dispute resolution system (based upon projections of when such 
        expenses are likely to be incurred), unless it is determined 
        that it is not in the claimant's best interests to receive 
        payments for such damages on such a periodic basis.
            (4) Mandatory offsets for damages paid by a collateral 
        source.--
                    (A) In general.--The total amount of damages 
                received by a claimant shall be reduced (in accordance 
                with subparagraph (B)) by any other payment that has 
                been or will be made to compensate the claimant for the 
                injury that was the subject of the claim, including 
                payment under--
                            (i) Federal or State disability or sickness 
                        programs;
                            (ii) Federal, State, or private health 
                        insurance programs;
                            (iii) private disability insurance 
                        programs;
                            (iv) employer wage continuation programs; 
                        and
                            (v) any other source of payment intended to 
                        compensate the claim for such injury.
                    (B) Amount of reduction.--The amount by which an 
                award of damages to a claimant shall be reduced under 
                subparagraph (A) shall be--
                            (i) the total amount of any payments (other 
                        than such award) that have been made or that 
                        will be made to the claimant to compensate the 
                        claimant for the injury that was the subject of 
                        the claim; minus
                            (ii) the amount paid by the claimant (or by 
                        the spouse, parent, or legal guardian of the 
                        claimant) to secure the payments described in 
                        clause (i).
    (d) Limitation on Attorney's Fees.--If the claimant has entered 
into an agreement with the claimant's attorney to pay the attorney's 
fees on a contingency basis, the attorney's fees for the claim may not 
exceed--
            (1) 25 percent of the first $150,000 of any award or 
        settlement paid to the claimant; or
            (2) 15 percent of any additional amounts paid to the 
        claimant.
    (e) Joint and Several Liability.--The liability of each party 
against whom a claim is filed shall be several only and shall not be 
joint, and each party shall be liable only for the amount of damages 
allocated to the party in direct proportion to the party's percentage 
of responsibility (as determined by the trier of fact).
    (f) Uniform Standard for Determining Negligence.--A party against 
whom a claim is filed may not be found to have acted negligently unless 
the party's conduct at the time of providing the health care services 
that are the subject of the claim was not reasonable.
    (g) Application of Medical Practice Guidelines.--
            (1) Use of guidelines as affirmative defense.--In the 
        resolution of any claim, it shall be a complete defense to any 
        allegation that a party against whom the claim is filed was 
        negligent that, in the provision of (or the failure to provide) 
        the services that are the subject of the claim, the party 
        followed the appropriate practice guideline.
            (2) Restriction on guidelines considered appropriate.--
                    (A) Guidelines sanctioned by secretary.--For 
                purposes of paragraph (1), a practice guideline may not 
                be considered appropriate with respect to claims during 
                a year unless the Secretary has sanctioned the use of 
                the guideline for purposes of an affirmative defense to 
                claims brought during the year in accordance with 
                subparagraph (B) or (C).
                    (B) Process for sanctioning guidelines.--Not less 
                frequently than October 1 of each year (beginning with 
                1994), the Secretary, shall review the practice 
                guidelines and standards developed by the Administrator 
                for Health Care Policy and Research pursuant to section 
                1142 of the Social Security Act, and shall sanction 
                those guidelines which the Secretary considers 
                appropriate for purposes of an affirmative defense to 
                claims brought during the next calendar year as 
                appropriate practice guidelines for purposes of 
                paragraph (1).
                    (C) Use of state guidelines.--Upon the application 
                of a State, the Secretary may sanction practice 
                guidelines selected by the State for purposes of an 
                affirmative defense to claims brought in the State as 
                appropriate practice guidelines for purposes of 
                paragraph (1) if the guidelines meet such requirements 
                as the Secretary may impose.
            (3) Prohibiting application of failure to follow guidelines 
        as prima facie evidence of negligence.--No claimant may be 
        deemed to have presented prima facie evidence that a party 
        against whom the claim is filed was negligent solely by showing 
        that the party failed to follow the appropriate practice 
        guideline.
    (h) Special Provision for Certain Obstetric Services.--
            (1) Imposition of higher standard of proof.--
                    (A) In general.--In the case of a claim relating to 
                services provided during labor or the delivery of a 
                baby, if the party against whom the claim is filed did 
                not previously treat the claimant for the pregnancy, 
                the trier of fact may not find that the party committed 
                malpractice and may not assess damages against the 
                party unless the malpractice is proven by clear and 
                convincing evidence.
                    (B) Applicability to group practices or agreements 
                among providers.--For purposes of subparagraph (A), a 
                party shall be considered to have previously treated an 
                individual for a pregnancy if the party is a member of 
                a group practice whose members previously treated the 
                claimant for the pregnancy or is providing services to 
                the claimant during labor or the delivery of a baby 
                pursuant to an agreement with another party.
            (2) Clear and convincing evidence defined.--In paragraph 
        (1), the term ``clear and convincing evidence'' is that measure 
        or degree of proof that will produce in the mind of the trier 
        of fact a firm belief or conviction as to the truth of the 
        allegations sought to be established, except that such measure 
        or degree of proof is more than that required under 
        preponderance of the evidence, but less than that required for 
        proof beyond a reasonable doubt.
    (i) Preemption.--
            (1) In general.--This section supersedes any State law only 
        to the extent that State law--
                    (A) permits the recovery of a greater amount of 
                damages by a plaintiff;
                    (B) permits the collection of a greater amount of 
                attorneys' fees by a plaintiff's attorney;
                    (C) establishes a longer period during which a 
                medical malpractice liability claim may be initiated; 
                or
                    (D) establishes a stricter standard for determining 
                whether a defendant was negligent or for determining 
                the liability of defendants described in subsection (h) 
                in actions described in such subsection.
            (2) Effect on sovereign immunity and choice of law or 
        venue.--Nothing in paragraph (1) shall be construed to--
                    (A) waive or affect any defense of sovereign 
                immunity asserted by any State under any provision of 
                law;
                    (B) waive or affect any defense of sovereign 
                immunity asserted by the United States;
                    (C) affect the applicability of any provision of 
                the Foreign Sovereign Immunities Act of 1976;
                    (D) preempt State choice-of-law rules with respect 
                to claims brought by a foreign nation or a citizen of a 
                foreign nation; or
                    (E) affect the right of any court to transfer venue 
                or to apply the law of a foreign nation or to dismiss a 
                claim of a foreign nation or of a citizen of a foreign 
                nation on the ground of inconvenient forum.

SEC. 7. DEFINITIONS.

    As used in this Act:
            (1) Alternative dispute resolution system; adr.--The term 
        ``alternative dispute resolution system'' or ``ADR'' means a 
        system established by a State that provides for the resolution 
        of medical malpractice liability claims in a manner other than 
        through medical malpractice liability actions.
            (2) 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.
            (3) 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.
            (4) 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.
            (5) 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.
            (6) Injury.--The term ``injury'' means any illness, 
        disease, or other harm that is the subject of a medical 
        malpractice liability action or claim.
            (7) Medical malpractice liability action.--The term 
        ``medical malpractice liability action'' means a civil action 
        (other than an action in which the plaintiff'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 plaintiff alleges a medical 
        malpractice liability claim.
            (8) 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.
            (9) 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).
            (10) 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.
            (11) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (12) State.--The term ``State'' means each of the several 
        States, the District of Columbia, the Commonwealth of Puerto 
        Rico, the Virgin Islands, Guam, and American Samoa.

SEC. 8. EFFECTIVE DATE.

    This Act shall apply to claims accruing on or after January 1, 
1994.

                                 <all>

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