[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4856 Introduced in House (IH)]

103d CONGRESS
  2d Session
                                H. R. 4856

To improve the Nation's health care by creating a comprehensive medical 
  malpractice prevention program through the creation of independent, 
publicly accountable State medical boards and more stringent licensing 
  and discipline procedures; to empower health consumers by mandating 
 reporting of certain information regarding health care providers and 
  professionals and by enhancing informed individual choice regarding 
health care services by providing certain information to consumers; and 
                          for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 28, 1994

  Mr. Nadler introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
To improve the Nation's health care by creating a comprehensive medical 
  malpractice prevention program through the creation of independent, 
publicly accountable State medical boards and more stringent licensing 
  and discipline procedures; to empower health consumers by mandating 
 reporting of certain information regarding health care providers and 
  professionals and by enhancing informed individual choice regarding 
health care services by providing certain information to consumers; 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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Patient Safety Act 
of 1994''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
                      TITLE I--GENERAL PROVISIONS

Sec. 101. Findings and purpose.
Sec. 102. Preemption.
Sec. 103. Effective date.
Sec. 104. Definitions.
  TITLE II--CREATION OF INDEPENDENT AND EFFECTIVE STATE MEDICAL BOARDS

Sec. 201. Requirements for State medical boards.
Sec. 202. Guidelines for investigations.
Sec. 203. Disciplinary hearings.
Sec. 204. Disciplinary actions.
Sec. 205. Disclosure of disciplinary actions.
Sec. 206. Federal assumption of responsibilities.
  TITLE III--REQUIREMENTS FOR HEALTH CARE PROFESSIONALS AND PROVIDERS

Sec. 301. Renewal of license required every 2 years.
Sec. 302. Reporting requirements.
Sec. 303. Reexamination required after 6 years.
Sec. 304. Audits.
Sec. 305. Mandatory medical malpractice insurance.
Sec. 306. Study of medical negligence.
           TITLE IV--PUBLIC ACCESS TO PRACTITIONER DATA BANK

Sec. 401. Providing public access to the national practitioner data 
                            bank.

                      TITLE I--GENERAL PROVISIONS

SEC. 101. FINDINGS AND PURPOSE.

    (a) Findings.--The Congress finds and declares that--
            (1) there are a large number of avoidable deaths and 
        injuries in the Nation caused by medical negligence and 
        malpractice;
            (2) the identity of health care professionals responsible 
        for medical negligence should be revealed to the public and 
        they should be subject to discipline by the appropriate State 
        medical boards;
            (3) despite the large number of consumers injured by 
        medical malpractice each year, fewer than \1/2\ of 1 percent of 
        the Nation's health care professionals face any serious State 
        sanctions each year;
            (4) the purpose of State medical boards is to protect the 
        public from the unprofessional, improper and incompetent 
        practice of medicine;
            (5) most State medical boards are not adequately 
        disciplining health care professionals and when they do, most 
        of their efforts focus on offenses other than medical 
        negligence, with revocations or suspensions of licenses rarely 
        occurring;
            (6) among the reasons why the State medical boards are 
        unwilling or unable to identify and discipline negligent health 
        care professions are that the boards lack adequate funding, 
        staffing, investigative and disciplinary powers and because the 
        boards are dominated by health care professionals who are 
        reluctant to discipline their colleagues;
            (7) medical malpractice lawsuits are a necessary adjunct to 
        State disciplinary proceedings, but they are not a substitute 
        for them, since it is government, through its licensure of 
        health care professionals, that must ensure that high-quality 
        health care is delivered to the public;
            (8) health care consumers have very little information 
        available to them regarding the quality of their health care 
        providers and professionals;
            (9) in order to make informed choices between health care 
        providers and professionals, consumers need access to more 
        information about their health care providers and 
        professionals, including disciplinary and malpractice records; 
        and
            (10) more and better information to health care consumers 
        about their health care providers and professionals and more 
        and better discipline of incompetent and negligent health care 
        professionals will alleviate the medical malpractice crisis and 
        improve the quality of health care in the Nation by helping 
        consumers to choose between health care providers and 
        professionals and by removing the licenses of those health care 
        professionals who are a danger to the public health and 
        welfare.
    (b) Purpose.--It is the purpose of this Act--
            (1) to create a national program of medical malpractice 
        prevention by requiring State medical boards to be controlled 
        by members of the public and not of the profession being 
        monitored;
            (2) to ensure that State medical boards are more effective 
        in identifying and disciplining incompetent, unethical, and 
        negligent health care professionals by ensuring that such 
        boards are adequately staffed and funded to fulfill their 
        purpose of permitting only qualified and fit individuals to 
        practice medicine;
            (3) to provide ready access to consumers of information 
        regarding their health care providers and professionals; and
            (4) to ensure that all health care professionals remain 
        abreast of new information regarding the efficacy of medical 
        tests and procedures and to assist in the identification of 
        incompetent health care professionals, thereby reducing the 
        incidence of the practice of unnecessary medicine and the 
        incidence of preventable injuries to patients.

SEC. 102. PREEMPTION.

    The provisions of this Act shall preempt State law only to the 
extent that the Secretary finds that State law does not protect the 
health and safety of patients in the State at least as effectively as 
the provisions of this Act.

SEC. 103. DEFINITIONS.

    As used in this Act:
            (1) 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 the laws or regulations of the State to be 
        licensed or certified by the State to engage in the delivery of 
        such services in the State.
            (2) Health care professional or licensee.--The terms 
        ``health care professional'' and ``licensee'' mean an 
        individual who provides health care services in a State and who 
        is required by the laws or regulations of the State to be 
        licensed or certified by the State to provide such services in 
        the State.
            (3) Injury.--The term ``injury'' means any illness, 
        disease, or other harm that is the subject of a quality of care 
        complaint or a medical malpractice claim.
            (4) Quality of care complaint.--The term ``quality of 
        health care complaint'' means a claim in which the claimant 
        alleges to a State medical board or any entity of the Federal 
        Government which sanctions health care professionals that 
        injury was caused by the provision of (or the failure to 
        provide) health care services.
            (5) Medical malpractice action.--The term ``medical 
        malpractice 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 claim.
            (6) Medical malpractice claim.--The term ``medical 
        malpractice claim'' means a claim in which an individual 
        alleges that injury was caused by the provision of (or the 
        failure to provide) health care services.
            (7) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (8) State.--The term ``State'' means the 50 States, the 
        District of Columbia, Puerto Rico, the Virgin Islands, Guam, 
        American Samoa, and the Northern Mariana Islands.
            (9) State medical board.--The term ``State medical board'' 
        means the entity (as determined by a State) with responsibility 
        for the disciplining or licensing of health care professionals, 
        and includes a subdivision of such an entity.

SEC. 104. EFFECTIVE DATE.

    This Act shall take effect January 1, 1996.

  TITLE II--CREATION OF INDEPENDENT AND EFFECTIVE STATE MEDICAL BOARDS

SEC. 201. REQUIREMENTS FOR STATE MEDICAL BOARDS.

    (a) In General.--Each State medical board shall meet the following 
requirements:
            (1) Composition.--Not less than 51 percent of the members 
        of a State medical board shall be public members with no 
        current or previous significant business, professional, or 
        pecuniary connection with a health care professional, medical 
        education facility, or health care provider (other than as a 
        patient or potential patient), in accordance with regulations 
        of the Secretary. The number of members of the board shall be 
        based on the State's physician population (as prescribed by the 
        Secretary), except that in no event may a board have fewer than 
        12 members. The Chairperson and Vice-Chairperson of the board 
        shall be public members.
            (2) Term of service.--Each member of the board shall serve 
        a term of 3 years.
            (3) Consumer assistance unit.--
                    (A) In general.--A special consumer assistance unit 
                shall be created within the board to deal directly with 
                complainants. The staff of the unit shall consist of 
                consumer protection officers with medical or social 
                work background.
                    (B) Toll-free hotline.--The consumer assistance 
                unit shall operate a toll-free phone number through 
                which the unit--
                            (i) shall advise the public of any hearing 
                        pending pursuant to formal charges filed 
                        against a health care professional, any summary 
                        suspension or other disciplinary action taken 
                        by the board against a health care 
                        professional, and the charges (excluding 
                        patient identifying information) against the 
                        professional on which such hearing or action is 
                        based (in a manner that does not disclose the 
                        identity of an individual patient);
                            (ii) accept consumer complaints about 
                        suspected health care professional misconduct 
                        (other than complaints over billing disputes); 
                        and
                            (iii) provide information to consumers on 
                        health care professionals, including the date 
                        the professional was first licensed, the 
                        registration status of the professional, the 
                        professional's hospital affiliations, and the 
                        names of other States in which the professional 
                        holds a license.
                    (C) Posting requirement.--The toll-free phone 
                number described in subparagraph (B) shall be 
                conspicuously posted by all health care providers and 
                professionals in the State and shall be added to any 
                printed materials distributed to the public by the 
                board, together with a clear statement that the number 
                is not to be used for filing complaints over billing 
                disputes.
            (4) Disclosure of information to national practitioner data 
        bank.--Each State medical board shall report the information 
        received under title III to the Secretary in accordance with 
        section 424 of the Health Care Quality Improvement Act of 1986.
    (b) Additional State Requirements.--
            (1) Oversight panel.--As prescribed by the Secretary, each 
        State shall establish an oversight panel to independently 
        assess and audit the State medical board process and hear 
        appeals from complainants whose claims have been dismissed by 
        State medical boards. The panel shall consist of 7 members 
        appointed by the Governor and shall include not more than 2 
        physicians.
            (2) Funding.--Each State shall ensure that the State 
        medical boards are fully supported by the revenues generated 
        from their activities, including fees, charges, and reimbursed 
        costs. The health care professional licensing fees charged in 
        the State may not be less than $500 annually. All revenues 
        generated by this fee shall be used exclusively for State 
        medical board activities.

SEC. 202. GUIDELINES FOR INVESTIGATIONS.

    (a) Mandatory Investigation of Certain Reports and National 
Practitioner Data Bank Information.--
            (1) In general.--Upon receipt of reports pursuant to 
        section 302 of the Health Care Quality Improvement Act, and 
        upon querying the National Practitioner Data Bank while 
        performing its registration or reregistration functions, the 
        State medical board shall investigate any evidence which 
        appears to show that a health care professional is or may be 
        medically incompetent, has engaged in unprofessional conduct, 
        or is mentally or physically unable to engage safely in the 
        performance of health care services.
            (2) Specific grounds for investigations.--In addition to 
        other information the reporting of which may constitute grounds 
        for an investigation, receipt of reports disclosing the 
        following information may be grounds for instituting an 
        investigation with respect to a health care professional:
                    (A) Quality of care complaints or medical 
                malpractice actions brought against the health care 
                professional.
                    (B) Payments in settlement (or partial settlement) 
                of, or in satisfaction of a judgment or arbitration 
                award in, a medical malpractice action or claim.
                    (C) Professional liability insurance cancellations 
                for reasons related to liability claims or actions 
                brought against the health care professional.
                    (D) Sanctions or disciplinary actions taken against 
                the health care professional by another State or 
                jurisdiction, a peer review body, a health care 
                provider, or a medical or professional association or 
                society.
                    (E) The failure of the professional to meet the 
                requirements of section 302(b) (relating to annual 
                reports to health care consumers).
                    (F) The filing of a report by a medical examiner 
                under section 302(c) indicating that a death may have 
                been the result of the professional's negligence or 
                incompetence.
                    (G) The failure of the professional to meet the 
                requirements of section 401(b) (relating to providing 
                information to patients on rights established under 
                title IV).
    (b) Investigatory Powers and Procedures.--
            (1) In general.--The State shall ensure that the State 
        medical boards are given sufficient powers and follow certain 
        procedural guidelines sufficient to ensure efficient and 
        effective performance of their investigatory duties.
            (2) Staffing.--The Secretary shall establish guidelines for 
        the duties of and qualifications for staff positions of State 
        medical boards, addressing the appropriate separation of 
        investigatory and adjudicatory functions. The Board's staff may 
        include, but need not be limited to--
                    (A) an executive director,
                    (B) 1 or more hearing officers trained to conduct 
                hearings (whose decision shall be reviewed, approved, 
                modified, or disapproved by the Board), and
                    (C) 1 or more investigators trained in the 
                investigation of medical and related health care 
                practice.
            (3) Investigative powers.--The State shall ensure that the 
        State medical boards have at least the following investigative 
        powers:
                    (A) The power to subpoena documents and individuals 
                possessing information relevant to investigations:
                    (B) The power to swear in witnesses.
                    (C) The power to require professional competency 
                examinations upon reasonable suspicion of incompetence. 
                For purposes of this clause, a single act of alleged 
                negligence may serve as a reasonable suspicion of 
                incompetence.
                    (D) To the extent necessary to complete an 
                investigation, the power to conduct an unannounced on-
                site review of the licensee's entire practice, 
                including but not limited to a comprehensive review of 
                patient records of the licensee and such office records 
                of the licensee as are relevant to the investigation, 
                and a review of procedures and safeguards in the 
                offices.
                    (E) The power to obtain the involuntary, temporary, 
                and summary suspension of a licensee from practice who 
                poses an imminent threat to patient health.
                    (F) The power to order immediate supervision of 
                certain procedures by another licensee.
                    (G) The power to require the licensee to submit to 
                1 or more physical or mental examinations.
                    (H) The power to order drug testing of the 
                licensee.
            (4) Procedural guidelines.--The State shall ensure that 
        State medical boards adhere to the following procedures:
                    (A) All investigations of cases alleging patient 
                harm and conducted pursuant to this section shall be 
                completed within 90 days of the receipt of the report 
                initiating the investigation, except that such deadline 
                may be extended for reasonable cause.
                    (B) In conducting an investigation of a licensee, 
                the State medical board shall, at no cost, query the 
                National Practitioner Data Bank for all available 
                information relating to the professional competence and 
                conduct of the licensee.

SEC. 203. DISCIPLINARY HEARINGS.

    (a) Grounds for Hearing.--If following an investigation, the State 
medical board finds there is probable cause to believe that a health 
care professional has provided substandard treatment, has engaged in 
unprofessional conduct, is medically incompetent or is mentally or 
physically unable to engage safely in the performance of health care 
services, a disciplinary hearing shall be conducted in accordance with 
procedures established by State law (consistent with the requirements 
of subsection (b)).
    (b) Requirements for Hearing.--
            (1) Timing.--A disciplinary hearing with respect to a 
        health care professional shall be held promptly after the 
        conclusion of the State medical board's investigation of the 
        health care professional, and a decision shall be rendered not 
        later than 60 days following completion of the hearing (except 
        that such deadline may be extended for reasonable cause).
            (2) Powers of board.--In conducting a disciplinary hearing 
        with respect to a health care professional, the State medical 
        board may subpoena documents and individuals possessing 
        relevant information and may swear in witnesses.
            (3) Evidentiary standard.--The decision under a 
        disciplinary hearing shall be based on the preponderance of the 
        evidence.
            (4) Dissemination of information.--The State medical board 
        shall make summaries of ongoing disciplinary proceedings 
        available to the public, except that such summaries shall not 
        include any information that may disclose the identity of, or 
        identifying information on, an individual patient.

SEC. 204. DISCIPLINARY ACTIONS.

    (a) Penalties Described.--The penalties that may be imposed on a 
health care professional by a State medical board are as follows:
            (1) Revocation or suspension of a license.
            (2) Restriction or limitation of the extent, scope, or type 
        of practice, if such limitation is conducted under the presence 
        and guidance of a supervising licensee.
            (3) Imposition of an administrative fine of at least $1,000 
        for each count or separate offense.
            (4) Issuance of a warning or reprimand.
            (5) Probation with or without conditions (such as 
        submission to treatment, attendance at continuing education 
        courses, reexamination, or practice only under the presence and 
        guidance of a supervising licensee).
            (6) Assessment of the reasonable costs of investigation, 
        hearing, and review, and the costs of probation supervision.
    (b) Summary License Suspension.--
            (1) In general.--The State medical board may suspend the 
        license of a health care professional without the opportunity 
        for a prior hearing if the board finds that at least one of the 
        following conditions exists:
                    (A) The individual's continued practice creates a 
                clear and present danger to public health.
                    (B) The individual has been found or has pleaded 
                guilty to a felony charge within the State or in 
                another jurisdiction relating to the individual's 
                professional activities.
                    (C) The individual's license has been suspended or 
                revoked in another jurisdiction, without regard to 
                whether such suspension or revocation has occurred or 
                is pending.
            (2) Timing for formal hearing.--After the summary 
        suspension of a license pursuant to paragraph (1), the State 
        medical board shall hold a formal hearing as soon as 
        practicable following the summary suspension (but in no event 
        later than 90 days after such summary suspension).
    (c) Notification of Patients.--Any health care professional subject 
to probation or a restriction or limitation on the scope of practice 
shall notify patients of such probation, restriction, or limitation.
    (d) Termination of Sanction.--
            (1) No stay of suspension or revocation during appeal.--
        Under no circumstances may a board stay the suspension or 
        revocation of a license pending an appeal, and the licensee may 
        not resume practice unless and until the penalty is overturned 
        upon such appeal.
            (2) Minimum period of revocation.--After revocation of a 
        license by a State medical board, a health care professional 
        may not petition for reinstatement for at least a 3-year 
        period.
            (3) Imposition of conditions.--The State medical board may 
        condition the restoration of a suspended or revoked license or 
        the removal of limitations on a license upon the health care 
        professional obtaining minimum results on one or more physical, 
        mental, or professional competency examinations.

SEC. 205. DISCLOSURE OF DISCIPLINARY ACTIONS.

    (a) In General.--
            (1) Publication of newsletter.--State medical boards shall 
        report regularly (but not less often than monthly) in a 
        published newsletter all final disciplinary actions taken and 
        formal charges filed after State medical board investigation of 
        a complaint, including the names of the professionals involved, 
        a description of the acts or omissions subject to discipline or 
        listed as the formal charge and the nature of the actions 
        taken.
            (2) Annual reports.--State medical boards shall publish 
        annual reports compiling statistics on disciplinary actions 
        taken during a year (in accordance with criteria established by 
        the Secretary).
    (b) Dissemination of Disciplinary Action Reports.--The reports 
published under subsection (a) shall be widely disseminated to the 
public (free of charge) by advertising their availability through the 
news media, and shall be forwarded to--
            (1) health care providers in the State;
            (2) the Secretary;
            (3) the Medicare peer review organization serving 
        geographic areas in the State under title XVIII of the Social 
        Security Act;
            (4) entities offering medical malpractice insurance within 
        the State; and
            (5) Federal depository libraries.

SEC. 206. FEDERAL ASSUMPTION OF RESPONSIBILITIES.

    (a) Determination of State Compliance.--Not later than October 1 of 
each year (beginning with 1995), the Secretary shall determine whether 
a State's medical board meets the requirements of this title and title 
III for the following calendar year.
    (b) Federal Assumption of Responsibility.--If the Secretary 
determines that a State medical board does not meet the requirements of 
this title and title III for a year--
            (1) the Secretary shall carry out all functions of the 
        board in the State during the year; and
            (2) the State shall reimburse the Secretary (at such time 
        and in such manner as the Secretary may require) for the costs 
        incurred by the Secretary during the year as a result of the 
        application of paragraph (1).

  TITLE III--REQUIREMENTS FOR HEALTH CARE PROFESSIONALS AND PROVIDERS

SEC. 301. RENEWAL OF LICENSE REQUIRED EVERY 2 YEARS.

    (a) In General.--Every 2 years, each health care professional and 
health care provider shall demonstrate to the satisfaction of the State 
medical board the professional's continuing qualification for medical 
licensing.
    (b) Signature Required.--An application for reregistration of a 
license submitted under this section shall be signed by the applicant 
and notarized, and shall contain a statement of the applicant affirming 
(under penalty of perjury) that the information provided is true to the 
best of the applicant's knowledge.

SEC. 302. REPORTING REQUIREMENTS.

    (a) Renewal of License.--
            (1) In general.--As a condition of the renewal of a license 
        under section 301, at the time of reregistration a health care 
        professional or health care provider shall report (on a form 
        prescribed and promulgated by the Secretary) the following 
        information:
                    (A) Any pending investigation or preliminary or 
                final action taken against the licensee by--
                            (i) any jurisdiction or authority (whether 
                        in the United States or a foreign nation) which 
                        licenses or authorizes the practice of 
                        medicine;
                            (ii) any peer review body;
                            (iii) any health care provider;
                            (iv) any professional medical society or 
                        association;
                            (v) any law enforcement agency;
                            (vi) any court; or
                            (vii) any governmental agency,
                for acts or conduct which may constitute grounds for 
                disciplinary action described in section 204.
                    (B) Any pending medical malpractice claim which has 
                been filed against the licensee.
                    (C) Any adverse judgment, settlement, or award 
                against the licensee arising from a medical malpractice 
                claim.
                    (D) The licensee's voluntary surrender of a license 
                or authorization to practice medicine in any 
                jurisdiction (including military, public health, and 
                foreign) or voluntary limitation on the scope of 
                services which the licensee would otherwise be 
                authorized to provide under the license.
                    (E) Any denial to the licensee of a license or 
                authorization to practice medicine by any jurisdiction 
                (including military, public health, and foreign).
                    (F) The licensee's removal from the medical staff 
                of any health care provider or limitation of staff 
                privileges at such a provider (whether voluntary or 
                involuntary), if such removal or limitation occurred 
                while the licensee was under formal or informal 
                investigation by the provider or a committee thereof 
                for any reason related to possible medical 
                incompetence, unprofessional conduct, or mental or 
                physical inability to safely perform health care 
                services.
                    (G) The licensee's resignation or withdrawal from a 
                national, State, or county medical society, 
                association, or organization (whether voluntary or 
                involuntary) if that action occurred while the licensee 
                was under formal or informal investigation or review by 
                that body for any reason related to possible medical 
                incompetence, unprofessional conduct, or mental or 
                physical inability to safely perform health care 
                services.
                    (H) Whether the licensee has been treated for an 
                alcohol or chemical substance problem during the 5-year 
                period preceding the submission of the report.
                    (I) Any denial or restriction of the licensee's 
                privileges to prescribe controlled substances.
                    (J) Whether the licensee has had any physical 
                injury or disease or mental disability within the 
                reregistration period which could reasonably be 
                expected to affect the licensee's ability to safely 
                perform health care services.
                    (K) The licensee's completion of continuing medical 
                education or other forms of professional maintenance or 
                evaluation, including specialty board certification or 
                recertification, within the reregistration period, 
                including participation in malpractice prevention 
                programs required by a State medical board.
                    (L) Any loss or restriction of medical malpractice 
                insurance coverage in any jurisdiction (including 
                military, public health and foreign).
                    (M) Any name change or change of home or 
                professional address.
                    (N) In the case of a health care professional, the 
                information contained in the professional's annual 
                report made available to consumers under subsection 
                (b)(2).
            (2) Review of reports submitted.--
                    (A) In general.--The State medical board shall 
                review the information reported by a licensee under 
                paragraph (1) to determine whether reregistration of a 
                medical license to the licensee is appropriate and 
                whether an investigation or disciplinary action should 
                be initiated against the licensee.
                    (B) False or incomplete reporting.--A licensee who 
                knowingly and willfully submits false or incomplete 
                information on an application for license 
                reregistration shall be subject to disciplinary action, 
                including civil money penalties.
    (b) Annual Reports to Consumers.--
            (1) Health care providers.--
                    (A) In general.--Each health care provider shall 
                make an annual report (in such form and manner as the 
                Secretary prescribes) available free of charge to all 
                health care consumers in the provider's service area.
                    (B) Contents of report.--The annual report referred 
                to in subparagraph (A) shall include--
                            (i) a list of all health services which the 
                        provider is licensed to offer;
                            (ii) a list of all routine preoperative and 
                        other medical tests frequently performed by the 
                        provider, together with the cost of such tests;
                            (iii) the number and types of quality of 
                        care complaints and medical malpractice actions 
                        claims decided or settled against the provider 
                        for the year, including the identity of all 
                        health care professionals named in the 
                        complaints and claims;
                            (iv) a list of the names and addresses of 
                        the members of the provider's board of trustees 
                        (if any), the provider's chief administrator, 
                        chief medical officer, and chief nursing 
                        administrator;
                            (v) the provider's accreditation status and 
                        any contingencies on accreditation, Medicare 
                        certification, or licensure and a description 
                        of all plans and current efforts to correct 
                        deficiencies resulting in any such 
                        contingencies; and
                            (vi) such other information as the 
                        Secretary may require.
            (2) Health care professionals.--
                    (A) In general.--Each health care professional 
                shall make an annual report (in such form and manner as 
                the Secretary prescribes) available free of charge to 
                all members of the public health care consumers in the 
                professional's service area.
                    (B) Contents of report.--The report referred to in 
                subparagraph (A) shall include--
                            (i) information regarding the 
                        professional's education, experience, 
                        qualifications, certification by a board 
                        recognized by the Board of American Medical 
                        Specialties, and license to provide health care 
                        services, including a list of the States in 
                        which such professional is licensed and any 
                        limitations on such professional's licenses;
                            (ii) any disciplinary actions relating to 
                        the scope of the professional's practice taken 
                        against the professional by any health care 
                        provider, State medical board, the Federal 
                        Government, or medical accreditation or 
                        certification organization;
                            (iii) any quality of care complaints or 
                        medical malpractice claims decided or settled 
                        against the professional;
                            (iv) a disclosure of any ownership interest 
                        the professional may have in any health care 
                        provider, laboratory, or supplier of health 
                        care items; and
                            (v) such other information as the Secretary 
                        may require.
            (3) Retroactive reporting.--The initial annual report made 
        under this subsection by a health care professional or provider 
        shall include information for the 3 years prior to date the 
        report is made.
    (c) Special Requirements for Medical Examiners.--
            (1) Initial report on deaths resulting from provider 
        negligence.--Each medical examiner shall file a report with the 
        State medical board upon receiving information (based on 
        findings that were reached by or documented and approved by a 
        board-certified or board-eligible pathologist) indicating that 
        a death may be the result of a health care professional's or 
        provider's negligence or incompetence, and shall include in the 
        report the name of the decedent, date and place of death, 
        attending physician, and all other relevant information 
        available.
            (2) Autopsy.--Not later than 90 days after filing the 
        report described in paragraph (1), a medical examiner shall 
        file with the State medical board copies of the medical 
        examiner's report, autopsy protocol, and all other relevant 
        information available.
    (d) Sanctions for Failure to Report.--Any health care provider or 
professional who knowingly and willfully fails to comply with the 
reporting requirements of this section shall be subject, in addition to 
other penalties that may be prescribed by law, to a civil monetary 
penalty of not more than $10,000 for each such failure.

SEC. 303. REEXAMINATION REQUIRED AFTER 6 YEARS.

    (a) In General.--Each State medical board shall require a health 
care professional licensed by the board to be reexamined every 6 years 
as a condition of licensure.
    (b) Clinical Performance Evaluations for Certain Licensees.--A 
State medical board may require a licensee to undergo a clinical 
performance evaluation as part of the licensee's reexamination under 
this section if--
            (1) the licensee practices exclusively in a private office 
        setting; or
            (2) a medical malpractice claim has been filed against the 
        licensee since the licensee's most recent reexamination.
    (c) Review of Patient Medical Records.--In the case of a licensee 
described in subsection (b)(1), the State medical board may conduct a 
review of the medical records of the licensee's patients as part of the 
reexamination under this section.

SEC. 304. AUDITS.

    (a) Performance Audits.--On a regular basis, a State medical board 
shall conduct audits of the office-based practices of licensees to 
assess performance and improve practices. In furtherance of this audit 
function, State medical boards shall be granted the authority to 
subpoena office-based and provider-based patient records.
    (b) Pharmacy Audits.--On an annual basis, State medical boards 
shall conduct audits of a randomly selected sample of pharmacy records 
to detect illegal drug diversion and other misuse or overprescribing of 
controlled substances.

SEC. 305. MANDATORY MEDICAL MALPRACTICE INSURANCE.

    A State medical board may not issue or renew the license of a 
health care professional or provider unless the professional or 
provider certifies that the professional or provider is covered under 
malpractice insurance in an amount determined by the Secretary.

SEC. 306. STUDY OF MEDICAL NEGLIGENCE.

    (a) Study.--The Secretary shall conduct (either directly or through 
contract) a national interdisciplinary study modeled on the Harvard 
Medical Practice Study to evaluate--
            (1) the incidence of injuries regulating from medical 
        interventions and the percentage of such injuries that resulted 
        from the negligence or fault of a health care professional or 
        health care provider;
            (2) appropriate measures of the costs of medical expenses, 
        lost wages, and lost household production to individuals who 
        suffer medical injuries and their families, and the 
        compensation provided for such losses under the current medical 
        injury compensation system; and
            (3) appropriate methods to prevent the occurrence of 
        medical negligence.
    (b) Access to Records.--The Secretary shall have the power to 
examine the medical records of patients of a health care provider or 
health care professional (in a manner that does not disclose the 
identity of, or identifying information on, any individual patient) to 
the extent necessary to conduct the study under subsection (a).
    (c) Report.--Not later than 3 years after the date of the enactment 
of this Act, the Secretary shall submit a report to Congress on the 
study conducted under subsection (a).

           TITLE IV--PUBLIC ACCESS TO PRACTITIONER DATA BANK

SEC. 401. PROVIDING PUBLIC ACCESS TO THE NATIONAL PRACTITIONER DATA 
              BANK.

    Section 427(a) of the Health Care Quality Improvement Act of 1986 
(42 U.S.C. 11137(a)) is amended--
            (1) by redesignating subsections (b), (c), and (d) as 
        subsections (c), (d), and (e); and
            (2) by inserting after subsection (a) the following new 
        subsection:
    ``(b) Availability of Information to the Public.--
            ``(1) In general.--Not later than 30 days after the date of 
        the enactment of this subsection and every 6 months thereafter, 
        the Secretary shall publish and make available to the public 
        the following information reported under this part:
                    ``(A) Information reported under section 421, 
                except the following:
                            ``(i) The social security number of the 
                        physician or practitioner.
                            ``(ii) Information disclosing the identity 
                        of the patient involved in such incident.
                    ``(B) Information reported under section 422(a).
                    ``(C) Information reported under section 423 (a) 
                and (b).
            ``(2) Dissemination.--The Secretary shall--
                    ``(A) disseminate the information described in 
                paragraph (1) to public libraries without charge; and
                    ``(B) establish a 24-hour toll-free hotline through 
                which individuals may obtain such information.''.
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