[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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