[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5690 Introduced in House (IH)]

111th CONGRESS
  2d Session
                                H. R. 5690

To improve patient access to health care services and provide improved 
  medical care by reducing the excessive burden the liability system 
   places on the health care delivery system, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              July 1, 2010

 Mr. Gingrey of Georgia (for himself, Mr. Fleming, Mr. Smith of Texas, 
 Mr. Kline of Minnesota, Mr. Hall of Texas, Mr. Bilbray, Mr. Marchant, 
Mr. Bishop of Utah, Mr. Franks of Arizona, Mr. Rooney, Mr. Shadegg, Mr. 
  Lee of New York, Mrs. McMorris Rodgers, Mrs. Blackburn, Mr. Roe of 
    Tennessee, Mr. Kingston, Mr. Cole, Mr. Cassidy, Mr. Pitts, Mr. 
  Westmoreland, Mr. Latta, Mr. Bonner, Mr. Linder, Mr. Boustany, Mr. 
 Griffith, Mr. Tim Murphy of Pennsylvania, Mr. Bartlett, and Mr. Dent) 
 introduced the following bill; which was referred to the Committee on 
the Judiciary, and in addition to the Committee on Energy and Commerce, 
for a period to be subsequently determined by the Speaker, in each case 
for consideration of such provisions as fall within the jurisdiction of 
                        the committee concerned

_______________________________________________________________________

                                 A BILL


 
To improve patient access to health care services and provide improved 
  medical care by reducing the excessive burden the liability system 
   places on the health care delivery system, 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 ``Meaningful End to 
Defensive Medicine & Aimless Lawsuits (MedMal) Act of 2010''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings; purpose.
Sec. 3. Health care lawsuit statute of limitations.
Sec. 4. Early offer.
Sec. 5. Collateral source benefits.
Sec. 6. Benevolent gesture or admission of fault by a health care 
                            provider.
Sec. 7. Fair share rule.
Sec. 8. Punitive damages.
Sec. 9. Authorization of payment of future damages to claimants in 
                            health care lawsuits.
Sec. 10. Liability of health care providers for FDA-approved products.
Sec. 11. Expert Witness Standards.
Sec. 12. Protection of States' rights and effect on other laws.
Sec. 13. Definitions.
Sec. 14. Applicability.

SEC. 2. FINDINGS; PURPOSE.

    (a) Findings.--
            (1) Effect on health care access and costs.--Congress finds 
        that the United States civil justice system adversely affects 
        patient access to health care services, the quality of patient 
        care, and the cost-efficiency of health care because the health 
        care liability system is costly, ineffective, and a deterrent 
        to the sharing of information among health care professionals, 
        which impedes efforts to improve patient safety and quality of 
        care.
            (2) Effect on interstate commerce.--Congress finds that--
                    (A) the health care and insurance industries affect 
                interstate commerce; and
                    (B) the health care liability litigation systems 
                throughout the United States affect interstate commerce 
                by contributing to the high cost of health care and 
                premiums for health care liability insurance purchased 
                by health care system providers.
            (3) Effect on federal spending.--Congress finds that the 
        health care liability litigation systems throughout the United 
        States have a significant effect on the amount, distribution, 
        and use of Federal funds because of--
                    (A) the large number of individuals who receive 
                health care benefits under programs operated or 
                financed by the Federal Government;
                    (B) the large number of individuals who benefit 
                because of the exclusion from Federal taxes of the 
                amounts spent to provide them with health insurance 
                benefits; and
                    (C) the large number of health care providers who 
                provide items or services for which the Federal 
                Government makes payments.
    (b) Purpose.--It is the purpose of this Act to implement 
reasonable, comprehensive, and effective health care liability reforms 
designed to--
            (1) improve the availability of health care services in 
        cases in which health care lawsuits have been shown to be a 
        factor in the decreased availability of services;
            (2) reduce the incidence of ``defensive medicine'' and 
        lower the cost of health care liability insurance, all of which 
        contribute to the escalation of health care costs;
            (3) ensure that persons with meritorious health care injury 
        claims receive fair and adequate compensation, including 
        reasonable noneconomic damages;
            (4) improve the fairness and cost-effectiveness of our 
        current health care liability system to resolve disputes over 
        health care liability by reducing uncertainty in the amount of 
        compensation provided to injured individuals; and
            (5) increase the sharing of information in the health care 
        system to reduce unintended injury and improve patient care.

SEC. 3. HEALTH CARE LAWSUIT STATUTE OF LIMITATIONS.

    (a) Statute of Limitations for Health Care Lawsuit.--Except as 
provided under subsection (b), a health care lawsuit is barred unless 
it is commenced before the earlier of--
            (1) the expiration of the 3-year period beginning on the 
        date of manifestation of injury; or
            (2) the expiration of the 1-year period beginning on the 
        date on which the claimant discovers, or through the use of 
        reasonable diligence should have discovered, the injury.
    (b) Tolling of Statute of Limitations.--The statute of limitations 
under subsection (a) may be tolled for any of the following:
            (1) Proof of fraud.
            (2) Intentional concealment of information necessary for a 
        claimant to file a health care lawsuit.
            (3) The presence of a foreign body, which has no 
        therapeutic or diagnostic purpose or effect, in the person of 
        the injured person that is related to the health care liability 
        claim.
    (c) Applicability.--This section shall not apply to any health care 
lawsuit arising from an injury occurring before the date of the 
enactment of this Act.

SEC. 4. EARLY OFFER.

    (a) In General.--If a claimant rejects a qualified early offer from 
a defendant in a health care lawsuit, the amount of noneconomic damages 
that may be awarded against that defendant in the lawsuit may not 
exceed $350,000.
    (b) Qualified Early Offer.--In this section, the term ``qualified 
early offer'' means, with respect to a health care lawsuit, a 
reasonable offer that--
            (1) is made by a defendant to a claimant in order to settle 
        the health care liability claim which is the subject of the 
        lawsuit;
            (2) provides for the periodic payment to the claimant of 
        net economic damages as such damages accrue, for which the 
        defendant is responsible, to the claimant, to the extent that 
        such damages are not already covered by a collateral source;
            (3) provides for payment of the reasonable attorney's fees 
        of the claimant;
            (4) is made to the claimant not later than 180 days after 
        the date such lawsuit is commenced; and
            (5) allows the claimant to accept or reject such offer 
        within 30 days after the date on which such offer is made.
    (c) Calculation of Award.--If a claimant rejects a qualified early 
offer from a defendant in a health care lawsuit--
            (1) an award for noneconomic damages in excess of $350,000 
        shall be reduced to such amount either before the entry of 
        judgment, or by amendment of the judgment after entry of 
        judgment, and such reduction shall be made before accounting 
        for any other reduction in damages required by law; and
            (2) in a case in which separate awards are rendered for 
        past and future noneconomic damages, the future noneconomic 
        damages shall be reduced first.
    (d) Attorney's Fees.--If a qualified early offer is rejected and a 
judgment is subsequently entered against the offeree in that health 
care lawsuit, the offeree shall be liable for the attorney's fees of 
the offeror.
    (e) No Jury Notification.--If a claimant rejects a qualified early 
offer, the jury shall not be informed about the maximum award for 
noneconomic damages.
    (f) Early Offer Evidence Inadmissible.--In any health care lawsuit, 
a qualified early offer shall be inadmissible as evidence of admission 
of liability or as evidence of an admission against interest.

SEC. 5. COLLATERAL SOURCE BENEFITS.

    (a) Evidence of Collateral Source Benefits Admissible.--In any 
health care lawsuit involving injury or wrongful death, a party may 
introduce evidence of collateral source benefits.
    (b) Collateral Source Benefits Introduced.--If a party elects to 
introduce evidence of collateral source benefits, an opposing party may 
introduce evidence of an amount paid or contributed or reasonably 
likely to be paid or contributed in the future by or on behalf of the 
opposing party in order to secure such collateral source benefits.
    (c) Providers of Collateral Source Benefits Barred From Recovery.--
In any health care lawsuit involving injury or wrongful death, a 
provider of collateral source benefits may not--
            (1) recover an amount against the claimant;
            (2) receive a lien or credit against the claimant's 
        recovery; or
            (3) be equitably or legally subrogated to the rights of the 
        claimant.
    (d) Recovery Defined.--In this section, the term ``recovery'' 
means, with respect to a health care liability claim, the net sum 
recovered by a claimant after deducting any disbursements or costs 
incurred in connection with prosecution or settlement of the claim, 
including all costs paid or advanced by any person, but does not 
include costs of health care incurred by the claimant or the charges 
for legal services of the claimant's attorney.
    (e) Applicability.--Subsection (c) shall not apply in the case of a 
collateral source benefit for which the Secretary of Health and Human 
Services or a State or local agency administering a State Medicaid plan 
may recover (or expect to recover) any payment made for such benefit 
pursuant to section 1862(b) (42 U.S.C. 1395y(b)) or section 1902(a)(25) 
(42 U.S.C. 1396a(a)(25)) of the Social Security Act.

SEC. 6. BENEVOLENT GESTURE OR ADMISSION OF FAULT BY A HEALTH CARE 
              PROVIDER.

    (a) Evidence Inadmissible.--In any health care lawsuit, a 
benevolent gesture or admission of fault that is made by a health care 
provider, or an employee of a health care provider, to the claimant, a 
relative of the claimant, or a representative of the claimant shall be 
inadmissible as evidence of admission of liability or as evidence of an 
admission against interest.
    (b) Application of Rule.--The rule established under subsection (a) 
applies to a benevolent gesture or admission of fault by a health care 
provider to a claimant or the claimant's relative or representative 
(including any such gesture or admission made before the commencement 
of the health care lawsuit) regarding the claimant's discomfort, pain, 
suffering, injury, or death, regardless of the cause, including the 
unanticipated outcome of any treatment, consultation, care, or service 
provided by such provider (or by the employees, agents, or contractors 
of such provider) or the omission of such treatment, consultation, 
care, or service.
    (c) Applicability.--This section shall apply in all judicial 
proceedings commenced after the date of the enactment of this Act and, 
insofar as is just and practicable, in all judicial proceedings pending 
on such date of enactment.
    (d) Definitions.--In this section:
            (1) Benevolent gesture.--The term ``benevolent gesture'' 
        means any statement, affirmation, gesture, or conduct, 
        including subsequent remedial or preventative measures, 
        expressing apology, sympathy, commiseration, condolence, 
        compassion, or a general sense of benevolence that relates 
        solely to discomfort, pain, suffering, injury, or death as the 
        result of the unanticipated outcome of medical care.
            (2) Relative.--The term ``relative'' means, with respect to 
        a claimant, the claimant's spouse, parent, stepparent, 
        grandparent, child, stepchild, grandchild, brother, sister, 
        half-brother, half-sister, spouse's parents, or any other 
        person who has a family-type relationship with the claimant.
            (3) Representative.--The term ``representative'' means a 
        legal guardian, attorney, or an agent designated to make 
        medical decisions under a power of attorney over health care 
        matters, a health care representative who is authorized to make 
        health care decisions for a principal under applicable law, a 
        surrogate designated in an advance directive for health care, 
        or any person recognized in law or custom as an agent.
            (4) Unanticipated outcome.--The term ``unanticipated 
        outcome'' means an outcome of a medical treatment or procedure, 
        care, or service that differs from the expected or anticipated 
        result.

SEC. 7. FAIR SHARE RULE.

    (a) Liability.--In any health care lawsuit, each party shall be 
liable for that party's several share of any damages only and not for 
the share of any other person.
    (b) Allocation of Damages.--Each party shall be liable only for the 
amount of damages allocated to such party in direct proportion to such 
party's percentage of responsibility.
    (c) Determination of Responsibility.--For purposes of this section, 
the trier of fact shall determine the proportion of responsibility of 
each party for the claimant's harm.

SEC. 8. PUNITIVE DAMAGES.

    (a) Punitive Damages Award.--Punitive damages may be awarded 
against a defendant in a health care lawsuit for a health care 
liability claim only if--
            (1) otherwise permitted by applicable State or Federal law;
            (2) it is proven by clear and convincing evidence that such 
        defendant acted with malicious intent to injure the claimant, 
        or that such defendant deliberately failed to avoid unnecessary 
        injury that such defendant knew the claimant was substantially 
        certain to suffer; and
            (3) compensatory damages are awarded for such claim.
    (b) Demand for Punitive Damages.--
            (1) Complaint.--A claimant may not file a demand for 
        punitive damages in the original complaint for a health care 
        lawsuit.
            (2) Amended complaint.--A claimant may file an amended 
        complaint for punitive damages if the court finds, after 
        reviewing supporting and opposing affidavits or after a 
        hearing, that the claimant has established by a substantial 
        probability that the claimant will prevail on the claim for 
        punitive damages.
            (3) Hearing.--
                    (A) Request for punitive damages hearing.--At the 
                request of any party in a health care lawsuit, the 
                trier of fact shall consider in a separate hearing 
                whether punitive damages are to be awarded and the 
                amount of such award, using the factors listed under 
                subsection (c).
                    (B) Evidence inadmissible.--If a separate punitive 
                damages hearing is requested, any evidence introduced 
                at such hearing that is relevant only to the claim for 
                punitive damages, as determined by applicable State 
                law, shall be inadmissible in any proceeding to 
                determine whether compensatory damages are to be 
                awarded.
    (c) Amount of Punitive Damages.--
            (1) Factors considered.--In determining the amount of 
        punitive damages against a party in a health care lawsuit, the 
        trier of fact shall consider, where applicable, only the 
        following:
                    (A) The severity of the harm caused by the conduct 
                of such party.
                    (B) The duration of the conduct or any concealment 
                of conduct by such party.
                    (C) The profitability of the conduct to such party.
                    (D) The number of products sold or medical 
                procedures rendered for compensation by such party that 
                caused the harm complained of by the claimant.
                    (E) Any criminal penalties imposed on such party, 
                as a result of the conduct complained of by the 
                claimant.
                    (F) The amount of any civil fines assessed against 
                such party as a result of the conduct complained of by 
                the claimant.
            (2) Maximum award.--The maximum amount of punitive damages 
        that may be awarded in a health care lawsuit is $350,000 or two 
        times the amount of economic damages awarded, whichever is 
        greater.
            (3) No jury notification.--The jury shall not be informed 
        about the maximum award for punitive damages under paragraph 
        (2).
    (d) Malicious Intent To Injure.--In this section, the term 
``malicious intent to injure'' means intentionally causing or 
attempting to cause physical injury other than providing health care 
goods or services.

SEC. 9. AUTHORIZATION OF PAYMENT OF FUTURE DAMAGES TO CLAIMANTS IN 
              HEALTH CARE LAWSUITS.

    (a) In General.--In any health care lawsuit, if an award of future 
damages, without reduction to present value, equaling or exceeding 
$50,000 is made against a party with sufficient insurance or other 
assets to fund a periodic payment of such a judgment, the court shall, 
at the request of any party, enter a judgment ordering that the future 
damages be paid by periodic payments.
    (b) Court Guidance.--In any health care lawsuit, the court may be 
guided by the Uniform Periodic Payment of Judgments Act promulgated by 
the National Conference of Commissioners on Uniform State Laws.
    (c) Applicability.--This section applies to all actions that have 
not been first set for trial or retrial before the effective date of 
this Act.

SEC. 10. LIABILITY OF HEALTH CARE PROVIDERS FOR FDA-APPROVED PRODUCTS.

    (a) In General.--Except as provided in subsection (b), a health 
care provider who prescribes, or who dispenses pursuant to a 
prescription, a medical product approved, licensed, or cleared by the 
Food and Drug Administration may not be named as a party to a product 
liability lawsuit involving such product and shall not be liable to a 
claimant in a class action involving such product that is brought 
against the manufacturer, distributor, or seller of such product.
    (b) Consolidation of Cases.--Nothing in subsection (a) prevents a 
court from consolidating cases involving health care providers and 
cases involving product liability claims against the manufacturer, 
distributor, or seller of a medical product.

SEC. 11. EXPERT WITNESS STANDARDS.

    (a) Requirements.--No individual shall be qualified to testify as 
an expert witness concerning issues of negligence in any health care 
lawsuit against a defendant unless such individual--
            (1) except as required under subsection (b), is a health 
        care professional who--
                    (A) is appropriately credentialed or licensed in 1 
                or more States to deliver health care services; and
                    (B) typically treats the diagnosis or condition or 
                provides the type of treatment under review; and
            (2) can demonstrate by competent evidence that, as a result 
        of training, education, knowledge, and experience in the 
        evaluation, diagnosis, and treatment of the disease or injury 
        which is the subject matter of the lawsuit against the 
        defendant, the individual was substantially familiar with 
        applicable standards of care and practice as they relate to the 
        act or omission which is the subject of the lawsuit on the date 
        of the incident.
    (b) Physician Review.--In a health care lawsuit, if the claim of 
the plaintiff involved treatment that is recommended or provided by a 
physician (allopathic or osteopathic), an individual shall not be 
qualified to be an expert witness under this subsection with respect to 
issues of negligence concerning such treatment unless such individual 
is a physician.
    (c) Specialties and Subspecialties.--With respect to a lawsuit 
described in subsection (a), a court shall not permit an expert in one 
medical specialty or subspecialty to testify against a defendant in 
another medical specialty or subspecialty unless, in addition to a 
showing of substantial familiarity in accordance with subsection 
(a)(2), there is a showing that the standards of care and practice in 
the two specialty or subspecialty fields are similar.
    (d) Limitation.--The limitations in this subsection shall not apply 
to expert witnesses testifying as to the degree or permanency of 
medical or physical impairment.

SEC. 12. PROTECTION OF STATES' RIGHTS AND EFFECT ON OTHER LAWS.

    (a) Preemption of State Law.--The provisions governing health care 
lawsuits set forth in this Act preempt, subject to subsections (c) and 
(d), State law to the extent that State law prevents the application of 
any provisions of law established by this Act.
    (b) Preemption of Federal Law.--The provisions governing health 
care lawsuits set forth in this Act supersede chapters 161 and 171 of 
title 28, United States Code, to the extent that such chapters--
            (1) provide for a greater amount of damages, a longer 
        period in which a health care lawsuit may be commenced, or a 
        reduced applicability or scope of periodic payment of future 
        damages, than provided in this Act; or
            (2) prohibit the introduction of evidence regarding 
        collateral source benefits, or mandate or permit subrogation or 
        a lien on collateral source benefits.
    (c) Protection of States' Rights and Other Laws.--
            (1) In general.--This Act shall not preempt or supersede 
        any State or Federal law that imposes greater procedural or 
        substantive protections (including any statute of limitations 
        that expires sooner than statutes of limitations imposed in 
        this Act) for health care providers and health care 
        organizations from liability, loss, or damages than those 
        provided by this Act, except as provided for under subsection 
        (d)(1).
            (2) Applicable law.--Any issue that is not governed by any 
        provision of law established by this Act shall be governed by 
        otherwise applicable State or Federal law.
    (d) State Flexibility and Federal Law.--The provisions of this Act 
shall not be construed to preempt--
            (1) any State law (whether effective before, on, or after 
        the date of the enactment of this Act) that specifies a 
        particular monetary amount of compensatory or punitive damages 
        (or the total amount of damages) that may be awarded in a 
        health care lawsuit, regardless of whether such monetary amount 
        is greater or lesser than is provided for by this Act;
            (2) any defense available to a party in a health care 
        lawsuit under any other provision of State or Federal law; or
            (3) any State law that provides for an alternative dispute 
        resolution system.
    (e) Vaccine Injury.--
            (1) In general.--To the extent that title XXI of the Public 
        Health Service Act establishes a Federal rule of law applicable 
        to a civil action brought for a vaccine-related injury or 
        death--
                    (A) this Act does not affect the application of the 
                rule of law to such an action; and
                    (B) any rule of law prescribed by this Act that is 
                in conflict with a rule of law of such title XXI shall 
                not apply to such action.
            (2) Applicable provisions.--If there is an aspect of a 
        civil action brought for a vaccine-related injury or death to 
        which a Federal rule of law under title XXI of the Public 
        Health Service Act does not apply, then this Act shall apply to 
        such aspect of such action.

SEC. 13. DEFINITIONS.

    In this Act:
            (1) Alternative dispute resolution system.--The term 
        ``alternative dispute resolution system'' means a system that 
        provides for the resolution of health care lawsuits in a manner 
        other than through a civil action brought in a State or Federal 
        court.
            (2) Claimant.--The term ``claimant'' means any person who 
        brings a health care lawsuit, including a person who asserts or 
        claims a right to legal or equitable contribution, indemnity, 
        or subrogation, arising out of a health care liability claim, 
        and any person on whose behalf such a claim is asserted, 
        whether such person is deceased, incompetent, or a minor.
            (3) Collateral source benefits.--The term ``collateral 
        source benefits'' means any amount paid or reasonably likely to 
        be paid in the future to or on behalf of a claimant, or any 
        service, product, or other benefit provided or reasonably 
        likely to be provided in the future to or on behalf of a 
        claimant, as a result of the injury or wrongful death, pursuant 
        to--
                    (A) any State or Federal health, sickness, income-
                disability, accident, or workers' compensation law;
                    (B) any health, sickness, income-disability, or 
                accident insurance that provides health benefits or 
                income-disability coverage;
                    (C) any contract or agreement of any group, 
                organization, partnership, or corporation to provide, 
                pay for, or reimburse the cost of medical, hospital, 
                dental, or income-disability benefits; or
                    (D) any other publicly or privately funded program.
            (4) Compensatory damages.--The term ``compensatory 
        damages'' means economic damages and noneconomic damages.
            (5) Economic damages.--The term ``economic damages'' means 
        objectively verifiable monetary losses incurred as a result of 
        the provision of, use of, or payment for (or failure to 
        provide, use, or pay for) health care services or medical 
        products, such as past and future medical expenses, loss of 
        past and future earnings, cost of obtaining domestic services, 
        loss of employment, and loss of business or employment 
        opportunities.
            (6) Health care goods or services.--The term ``health care 
        goods or services'' means any goods or services provided by a 
        health care organization, a health care provider, or an 
        individual working under the supervision of a health care 
        provider, that relate to the diagnosis, prevention, or 
        treatment of any human disease or impairment, or the assessment 
        or care of the health of human beings.
            (7) Health care lawsuit.--The term ``health care 
        lawsuit''--
                    (A) means any health care liability claim affecting 
                interstate commerce that is brought in a State or 
                Federal court or pursuant to an alternative dispute 
                resolution system; and
                    (B) does not include a claim or action that is 
                based on criminal liability, that seeks civil fines or 
                penalties paid to Federal, State, or local government, 
                or that is grounded in antitrust.
            (8) Health care liability claim.--The term ``health care 
        liability claim'' means a demand by any person, whether or not 
        pursuant to an alternative dispute resolution system, against a 
        health care provider, health care organization, or the 
        manufacturer, distributor, supplier, marketer, promoter, or 
        seller of a medical product, including third-party claims, 
        cross-claims, counterclaims, or contribution claims, that is 
        based upon the provision of, use of, or payment for (or the 
        failure to provide, use, or pay for) health care goods or 
        services or any medical product, for injury or wrongful death, 
        regardless of the number of plaintiffs, defendants, or other 
        parties, or the number of causes of action.
            (9) Health care organization.--The term ``health care 
        organization''--
                    (A) means any person or entity that is obligated to 
                provide or pay for health care goods or services under 
                any health insurance plan; and
                    (B) includes any person or entity acting under a 
                contract or arrangement with a health care organization 
                to provide or administer any healthcare goods or 
                services.
            (10) Health care provider.--The term ``health care 
        provider'' means any person or entity required by State or 
        Federal laws or regulations to be licensed, registered, or 
        certified to provide health care services, or exempted from 
        such requirement by other law or regulation.
            (11) Medical product.--
                    (A) In general.--The term ``medical product'' means 
                a drug, device, or biological product intended for 
                humans.
                    (B) Additional definitions.--For purposes of 
                subparagraph (A):
                            (i) Drug.--The term ``drug'' has the 
                        meaning given such term in section 201(g)(1) of 
                        the Federal Food, Drug, and Cosmetic Act (21 
                        U.S.C. 321(g)(1)).
                            (ii) Device.--The term ``device'' has the 
                        meaning given such term in section 201(h) of 
                        the Federal Food, Drug, and Cosmetic Act (21 
                        U.S.C. 321(h)).
                            (iii) Biological product.--The term 
                        ``biological product'' has the meaning given 
                        such term in section 351(i) of the Public 
                        Health Service Act (42 U.S.C. 262(i)).
            (12) Minor.--The term ``minor'' means an individual who is 
        less than 18 years of age.
            (13) Noneconomic damages.--The term ``noneconomic damages'' 
        means damages for physical and emotional pain, suffering, 
        inconvenience, physical impairment, mental anguish, 
        disfigurement, loss of enjoyment of life, loss of society and 
        companionship, loss of consortium (other than loss of domestic 
        service), hedonic damages, injury to reputation, and all other 
        nonpecuniary losses of any kind or nature.
            (14) Punitive damages.--The term ``punitive damages''--
                    (A) means damages awarded, for the purpose of 
                punishment or deterrence, and not solely for 
                compensatory purposes, against a health care provider, 
                health care organization, or a manufacturer, 
                distributor, or supplier of a medical product; and
                    (B) does not include economic damages or 
                noneconomic damages.
            (15) State.--The term ``State'' means each of the several 
        States, the District of Columbia, the Commonwealth of Puerto 
        Rico, the United States Virgin Islands, Guam, American Samoa, 
        the Commonwealth of the Northern Mariana Islands, the Trust 
        Territory of the Pacific Islands, and any other territory or 
        possession of the United States, or any political subdivision 
        thereof.

SEC. 14. APPLICABILITY.

    Except as otherwise provided, this Act shall apply to any health 
care lawsuit brought in a Federal or State court, or subject to an 
alternative dispute resolution system, that is initiated on or after 
the date of the enactment of this Act.
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