[Congressional Record Volume 149, Number 116 (Thursday, July 31, 2003)]
[Senate]
[Pages S10638-S10643]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ENZI:
  S. 1518. A bill to restore reliability to the medical justice system 
by fostering alternatives to current medical tort litigation, and for 
other purposes; to the Committee on Health, Education, Labor, and 
Pensions.
  Mr. ENZI. Mr. President, I rise today to introduce a bill that will 
help bring about a more reliable system of medical justice for all 
Americans.
  Earlier this month, we had a robust debate on a critical issue--
medical liability reform. Though a majority of the Members of this body 
wanted to begin working to pass the bill, we didn't have the 60 
Senators necessary to begin the real work on the legislation.
  I co-sponsored that bill, the Patients First Act, and I still support 
it. Passing the Patients First Act would be an important short-term 
step to controlling the excesses in our legal system that have sent 
medical liability insurance premiums through the roof. Skyrocketing 
premiums are forcing doctors to move their practices to States with 
better legal environments and lower insurance premiums. This is 
endangering the availability of critical healthcare services in many 
areas of Wyoming and other states.
  Throughout our debate, I heard many of my colleagues say that they 
wanted to work on this issue, but that they simply could not support 
the bill as it stood. We heard that the bill approaches the issue from 
too narrow of a perspective. We heard that the bill's caps on non-
economic damages are unfair to patients, despite the fact that the bill 
places no limits whatsoever on a patient's right to recover all 
quantifiable economic damages.
  While I disagree with my colleagues who oppose the Patients First 
Act, I

[[Page S10640]]

respect their opposition. I also trust that they sincerely want to help 
solve our Nation's medical liability and litigation crisis.
  During the debate this month, I noticed something interesting. While 
we argued the ``pros and cons'' of the bill, no one stood up to defend 
our current system of medical litigation. Now, we heard a lot about the 
caps, and the insurance industry, and we heard Senators say that ``Yes, 
there is a problem, but the bill before us won't solve it.''
  One thing we didn't hear was a rousing defense of our medical 
litigation system. Even some of the lawyers in this body agreed that 
frivolous lawsuits are a problem and that our medical litigation system 
needs reform.
  Why didn't we hear anyone defend the merits of our current medical 
litigation system? It's because our system doesn't work. It simply 
doesn't work for patients or for healthcare providers.
  Compensation to patients injured by healthcare errors is neither 
prompt nor fair. The randomness and delay associated with medical 
litigation does not contribute to timely, reasonable compensation for 
most injured patients. Some injured patients get huge jury awards, 
while many others get nothing at all.

  Let's look at the facts. In 1991, a group of researchers published a 
study in the New England Journal of Medicine. The study, known as the 
Harvard Medical Practice Study, was the basis for the Institute of 
Medicine's estimate that nearly 100,000 people die every year from 
healthcare errors.
  As part of their study, the researchers reviewed the medical records 
of a random sample of more than 31,000 patients in New York State. They 
matched those records with statewide data on medical malpractice 
claims. The researchers found that nearly 30 percent of injuries caused 
by medical negligence resulted in temporary disability, permanent 
disability or death. However, less than 2 percent of those who were 
injured by medical negligence filed a claim. These figures suggest that 
most people who suffer negligent injuries don't receive any 
compensation.
  When a patient does decide to litigate, only a few recover anything. 
Only one of every ten medical malpractice cases actually goes to trial, 
and of those cases, plaintiffs win less than one of every five. In 
addition, patients who file suit and are ultimately successful must 
wait a long time for their compensation--the average length of a 
medical malpractice action filed in state court is about 30 months.
  While the vast majority of malpractice cases that go to trial are 
settled before the court hands down a verdict, the settlements even 
then don't guarantee that patients are compensated fairly, particularly 
after legal fees are subtracted. Research shows that for every dollar 
paid in malpractice insurance premiums, about 40 cents in compensation 
is actually paid to the plaintiff--the rest goes for legal fees, court 
costs, and other administrative expenditures.
  To sum up: most patients injured by negligence don't file claims or 
receive compensation. Few of those that do file claims and go to court 
recover anything, and those who are successful wait a long time for 
their compensation. And those who settle out of court end up receiving 
only 40 cents for every dollar that healthcare providers pay in 
liability insurance premiums.
  It's hard to say that our medical litigation system does right by 
patients in light of those facts. Unfortunately, our system doesn't 
work for healthcare providers either.
  Earlier, I spoke about those Harvard researchers who found that fewer 
than 2 percent of those who were injured by medical negligence even 
filed a claim. As they reviewed the medical records for their study, 
the researchers also found another interesting fact--most of the 
providers against whom claims were eventually filed were not negligent 
at all.
  That's right--most providers who were sued had not committed a 
negligent act.
  In matching the records they reviewed to data on malpractice claims, 
the Harvard researchers found 47 actual malpractice claims. In only 8 
of the 47 claims did they find evidence that medical malpractice had 
caused an injury. Even more amazingly, the physician reviewers found no 
evidence of any medical injury, negligent or not, in 26 of the 47 
claims. However, 40 percent of these cases where they found no evidence 
of negligence nonetheless resulted in a payment by the provider. 
Basically, the researchers found no positive relationship between 
medical negligence and compensation.
  That study was based on 1984 data. The same group of researchers 
conducted another study in Colorado and Utah in 1992, and they found 
the same thing. As in the 1984 study, they found that only 3 percent of 
patients who suffered an injury as a result of negligence actually 
sued. And again, physician reviewers could not find negligence in most 
of the cases in which lawsuits were filed.
  Now, I assume that the patients who sued had either an adverse 
medical outcome, or at least an outcome that was less satisfactory than 
the patient expected. But our medical litigation system is not supposed 
to compensate patients for adverse outcomes or dissatisfaction--it's 
supposed to compensate patients who are victims of negligent behavior. 
It's supposed to be a deterrent to substandard medical care.
  It's not fair to doctors and hospitals that they must pay to defend 
against meritless lawsuits. Nor is it fair that they must face a choice 
between settling for a small sum, even if they aren't at fault, so that 
they avoid getting sucked into a whirlpool of our medical litigation 
system.
  It's not hard to understand why physicians and hospitals and their 
insurers want to stay out of court. When they lose, the decisions are 
increasingly resulting in mega-awards based on subjective ``non-
economic'' damages. The number of awards exceeding $1 million grew by 
50 percent between the periods of 1994-1996 and 1999-2000. Today, more 
than half of all jury awards exceed $1 million.
  As a result, when a patient suffers a bad outcome and sues, providers 
have an incentive to settle the case out of court, even if the provider 
isn't at fault. But is this how our medical litigation system is 
supposed to work--as a tool for shaking down our healthcare providers?
  Let's face it--our medical litigation system is broken. It doesn't 
work for patients or providers. Even worse, it replaces the trust in 
the provider-patient relationship with distrust.
  Then, when courts and juries render verdicts with huge awards that 
bear no relation to the conduct of the defendants, this destabilizes 
the insurance markets and sends premiums skyrocketing. This forces many 
physicians to curtail, move or drop their practices, leaving patients 
without access to necessary medical care. This is a particular problem 
in states like Wyoming, where we traditionally struggle with recruiting 
doctors and other healthcare providers.
  Perhaps we could live with this flawed system if litigation served to 
improve quality or safety, but it doesn't. Litigation discourages the 
exchange of critical information that could be used to improve the 
quality and safety of patient care. The constant threat of litigation 
also drives the inefficient, costly and even dangerous practice of 
``defensive medicine.''
  Yes, indeed, defensive medicine is dangerous. A recent study found 
that one of every 1200 children who receive a CAT scan may die later in 
life from radiation-induced cancer. Knowing this puts a physician faced 
with anxious parents in a difficult situation. Does the doctor use his 
or her professional judgment and tell the parents of a sick child not 
to worry, or does the doctor order the CAT scan and subject the child 
to radiation that is probably unnecessary, just to provide some 
protection against a possible lawsuit?
  We have a medical litigation system in which many patients who are 
hurt by negligent actions receive no compensation for their loss. Those 
who do receive compensation end up with about 40 cents of every premium 
dollar after legal fees and other costs are subtracted. And the 
likelihood and the outcomes of lawsuits and settlements bear little 
relation to whether or not a healthcare provider was at fault.
  We like to say that justice is blind. With respect to our medical 
litigation system, I would say that justice is absent and nowhere to be 
found.

[[Page S10641]]

  During our debate on the Patients First Act, I said that the current 
medical liability crisis and the shortcomings of our medical litigation 
system make it clear that it is time for a major change. I also said 
that regardless of how we voted, we all should work toward replacing 
the current medical tort liability scheme with a more reliable and 
predictable system of medical justice.
  Today, I am introducing a bill that would help achieve that goal.
  Most of us are familiar with the report on medical errors from the 
Institute of Medicine, also known as the IOM. Many of us may be less 
familiar with another report that the IOM published earlier this year. 
That report is called ``Fostering Rapid Advances in Healthcare: 
Learning from System Demonstrations.''
  Our Secretary of Health and Human Services, Tommy Thompson, 
challenged the IOM to identify bold ideas that would challenge 
conventional thinking about some of the most vexing problems facing our 
healthcare system. In response, an IOM committee developed this report, 
which identified a set of demonstration projects that committee members 
felt would break new ground and yield a very high return-on-investment 
in terms of dollars and health.
  Medical liability was one of the areas upon which the IOM committee 
focused. The IOM suggested that the federal government should support 
demonstration projects in the states. These demonstrations should be 
based on ``replacing tort liability with a system of patient-centered 
and safety-focused non-judicial compensation.''
  The bill I am introducing today is in the spirit of this IOM report. 
This bill, the Reliable Medical Justice Act, would authorize funding 
for States to create demonstration programs to test alternatives to 
current medical tort litigation.
  The funding to States under this bill would cover planning grants for 
developing proposals based on the models or other innovative ideas. 
Funding to States would also include the initial costs of getting the 
alternatives up and running.
  The Reliable Medical Justice Act would require participating states 
and the Federal Government to collaborate in continuous evaluations of 
the results of the alternatives as compared to traditional tort 
litigation. This way, all States and the federal government can learn 
from new approaches.
  By funding demonstration projects, I believe Congress could enable 
States to experiment with and learn from ideas that could provide long-
term solutions to the current medical liability and litigation crisis.
  In introducing this bill, I wanted to provide some alternative ideas 
that would contribute to the debate. As a result, the bill describes 
three models to which states could look in designing their 
alternatives.
  For instance, a State could provide healthcare providers and 
organizations with immunity from lawsuits if they make a timely offer 
to compensate an injured patient for his or her actual net economic 
loss, plus a payment for pain and suffering if experts deem such a 
payment to be appropriate. This could give a healthcare provider who 
makes an honest mistake the chance to make amends financially with a 
patient, without the provider fearing that their honesty would land 
them in a lawsuit.
  Another idea would be for a state to set up classes of avoidable 
injuries and a schedule of compensation for them, and then establish an 
administrative board to resolve claims related to those injuries. A 
scientifically rigorous process of identifying preventable injuries and 
setting appropriate compensation would be preferable to the randomness 
of the current system.

  Still another option would be for a state to establish a special 
healthcare court for adjudicating medical malpractice cases. For this 
idea to work, the State would need to ensure that the presiding judges 
have expertise in and an understanding of healthcare, and allow them to 
make binding rulings on issues like causation compensation, and 
standards of care.
  We already have specialized courts for complicated issues like taxes 
and highly charged issues like substance abuse and domestic violence. 
With all the flaws in our current medical litigation system, perhaps we 
should consider special courts for the complex and emotional issue of 
medical malpractice.
  I believe one thing in our medical liability debate is absolutely 
clear--people are demanding change. Ten States have passed some 
liability reform in the past year, and another 17 have debated it. 
States are heeding this call for change, and Congress should support 
those efforts.
  My own State, Wyoming, had a lively legislative debate on medical 
liability reform this year, but we have a constitutional amendment that 
prohibits limits on the amounts that can be recovered through lawsuits. 
The Wyoming Senate considered a bill to amend our State's constitution 
to create a commission on healthcare errors. That commission would have 
had the power to review claims, decide if healthcare negligence had 
occurred, and determine the compensation for the death or injury 
according to a schedule or formula provided by law. However, the bill 
died in a tie vote on the Wyoming Senate floor.
  According to one of the sponsors of the bill, Senator Charlie Scott, 
one of the biggest obstacles to passage was the uncertainty surrounding 
this new idea. No one had any basis for knowing what a proper schedule 
or formula for compensation would be. No one knew how much the system 
might cost, or how much injured patients would recover compared to what 
they recover now.
  Senator Scott wrote me to say that federal support for finding 
answers to these questions might help the bill's sponsors sufficiently 
respond to the legitimate concerns of their fellow Wyoming legislators. 
We should be helping state legislators like Senator Scott develop 
thoughtful and innovative ideas such as the one he has proposed. That's 
one of the reasons I am offering this bill.
  Clearly, the American people and their elected representatives have 
identified the need to reform our current medical litigation system. 
The United States Senate did not vote to proceed to the Patients First 
Act this month, but no member of this body denied that there is a 
medical liability crisis, or that Congress needs to act sooner rather 
than later.
  While we continue that debate, we ought to lend a hand to States that 
are working to change their current medical litigation systems and to 
develop creative alternatives that could work much better for patients 
and providers. The States have been policy pioneers in many areas--
workers' compensation, welfare reform, and electricity de-regulation, 
to name three. Medical litigation should be the next item on the agenda 
of the laboratories of democracy that are our 50 States.
  No one questions the need to restore reliability to our medical 
justice system. But how do we begin the process? One way is to foster 
innovation by encouraging States to develop more rational and 
predictable methods for resolving healthcare injury claims. And that is 
what the Reliable Medical Justice Act aims to do.
  In the long run, we would all be better off with a more reliable 
system of medical justice than we have today. I know that my fellow 
Senators recognize this, so I hope my colleagues on both sides of the 
aisle will work with me on this legislation.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1518

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Reliable Medical Justice 
     Act''.

     SEC. 2. PURPOSES.

       The purposes of this Act are--
       (1) to restore reliability to the medical justice system by 
     fostering alternatives to current medical tort litigation 
     that promote early disclosure of health care errors and 
     provide prompt, fair, and reasonable compensation to patients 
     who are injured by health care errors; and
       (2) to support and assist States in developing such 
     alternatives.

     SEC. 3. STATE DEMONSTRATION PROGRAMS TO EVALUATE ALTERNATIVES 
                   TO CURRENT MEDICAL TORT LITIGATION.

       Part P of title III of the Public Health Service Act (42 
     U.S.C. 280g et seq.) is amended by adding at the end the 
     following:

[[Page S10642]]

     ``SEC. 3990. STATE DEMONSTRATION PROGRAM TO EVALUATE 
                   ALTERNATIVES TO CURRENT MEDICAL TORT 
                   LITIGATION.

       ``(a) In General.--The Secretary is authorized to award 
     demonstration grants to States for the development, 
     implementation, and evaluation of alternatives to current 
     tort litigation for resolving disputes over injuries 
     allegedly caused by health care providers or health care 
     organizations.
       ``(b) Duration.--The Secretary may award up to 7 grants 
     under subsection (a) and each grant awarded under such 
     subsection may not exceed a period of 10 years.
       ``(c) Conditions for Demonstration Grants.--
       ``(1) Requirements.--Each State desiring a grant under 
     subsection (a) shall--
       ``(A) develop an alternative to current tort litigation for 
     resolving disputes over injuries allegedly caused by health 
     care providers or health care organizations that may be 1 of 
     the models described in subsection (d); and
       ``(B) establish procedures to allow for patient safety data 
     related to disputes resolved under subparagraph (A) to be 
     collected and analyzed by organizations that engage in 
     voluntary efforts to improve patient safety and the quality 
     of health care delivery, in accordance with guidelines 
     established by the Secretary.
       ``(2) Alternative to current tort litigation.--Each State 
     desiring a grant under subsection (a) shall demonstrate how 
     the proposed alternative described in paragraph (1)(A)--
       ``(A) makes the medical liability system more reliable;
       ``(B) enhances patient safety; and
       ``(C) maintains access to liability insurance.
       ``(3) Sources of compensation.--Each State desiring a grant 
     under subsection (a) shall identify the sources from and 
     methods by which compensation would be paid for claims 
     resolved under the proposed alternative to current tort 
     litigation, which may include public or private funding 
     sources, or a combination of such sources. Funding methods 
     may provide financial incentives for activities that improve 
     patient safety.
       ``(4) Scope.--Each State desiring a grant under subsection 
     (a) may establish a scope of jurisdiction (such as a 
     designated geographic region or a designated area of health 
     care practice) for the proposed alternative to current tort 
     litigation that is sufficient to evaluate the effects of the 
     alternative.
       ``(d) Models.--
       ``(1) In general.--Any State desiring a grant under 
     subsection (a) that proposes an alternative described in 
     paragraph (2), (3), or (4) shall be deemed to meet the 
     criteria under subsection (c)(2).
       ``(2) Early disclosure and compensation model.--In the 
     early disclosure and compensation model, the State shall--
       ``(A) provide immunity from tort liability (except in cases 
     of fraud, or in cases of criminal or intentional harm) to any 
     health care provider or health care organization that enters 
     into an agreement to pay compensation to a patient for an 
     injury;
       ``(B) set a limited time period during which a health care 
     provider or health care organization may make an offer of 
     compensation benefits under subparagraph (A), with 
     consideration for instances where prompt recognition of an 
     injury is unlikely or impossible;
       ``(C) require that the compensation provided under 
     subparagraph (A) include--
       ``(i) payment for the net economic loss of the patient, on 
     a periodic basis, reduced by any payments received by the 
     patient under--

       ``(I) any health or accident insurance;
       ``(II) any wage or salary continuation plan; or
       ``(III) any disability income insurance;

       ``(ii) payment for the patient's pain and suffering, if 
     appropriate for the injury, based on a capped payment 
     schedule developed by the State in consultation with relevant 
     experts; and
       ``(iii) reasonable attorney's fees;
       ``(D) not abridge the right of an injured patient to seek 
     redress through the State tort system if a health care 
     provider does not enter into a compensation agreement with 
     the patient in accordance with subparagraph (A);
       ``(E) prohibit a patient who accepts compensation benefits 
     in accordance with subparagraph (A) from filing a health care 
     lawsuit against other health care providers or health care 
     organizations for the same injury; and
       ``(F) permit a health care provider or health care 
     organization that enters into an agreement to pay 
     compensation benefits to an individual under subparagraph (A) 
     to join in the payment of the compensation benefits of any 
     health care provider or health care organization that is 
     potentially liable, in whole or in part, for the injury.
       ``(3) Administrative determination of compensation model.--
       ``(A) In general.--In the administrative determination of 
     compensation model--
       ``(i) the State shall--

       ``(I) designate an administrative entity (in this paragraph 
     referred to as the `Board') that shall include 
     representatives of--

       ``(aa) relevant State licensing boards;
       ``(bb) patient advocacy groups;
       ``(cc) health care providers and health care organizations; 
     and
       ``(dd) attorneys in relevant practice areas;

       ``(II) set up classes of avoidable injuries that will be 
     used by the Board to determine compensation under clause 
     (ii)(II) and, in setting such classes, may consider 1 or more 
     factors, including--

       ``(aa) the severity of the disability arising from the 
     injury;
       ``(bb) the cause of injury;
       ``(cc) the length of time the patient will be affected by 
     the injury;
       ``(dd) the degree of fault of the health care provider or 
     health care organization; and
       ``(ee) standards of care that the State may adopt and their 
     breach;

       ``(III) modify tort liability, through statute or contract, 
     to bar negligence claims in court against health care 
     providers and health care organizations for the classes of 
     injuries established under subclause (II), except in cases of 
     fraud, or in cases of criminal or intentional harm;
       ``(IV) outline a procedure for informing patients about the 
     modified liability system described in this paragraph and, in 
     systems where participation by the health care provider, 
     health care organization, or patient is voluntary, allow for 
     the decision by the provider, organization, or patient of 
     whether to participate to be made prior to the provision of, 
     use of, or payment for the health care service;
       ``(V) provide for an appeals process to allow for a review 
     of decisions; and
       ``(VI) establish procedures to coordinate settlement 
     payments with other sources of payment;

       ``(ii) the Board shall--

       ``(I) resolve health care liability claims for certain 
     classes of avoidable injuries as determined by the State and 
     determine compensation for such claims; and
       ``(II) develop a schedule of compensation to be used in 
     making such determinations that includes--

       ``(aa) payment for the net economic loss of the patient, on 
     a periodic basis, reduced by any payments received by the 
     patient under any health or accident insurance, any wage or 
     salary continuation plan, or any disability income insurance;
       ``(bb) payment for the patient's pain and suffering, if 
     appropriate for the injury, based on a capped payment 
     schedule developed by the State in consultation with relevant 
     experts; and
       ``(cc) reasonable attorney's fees; and
       ``(iii) the Board may--

       ``(I) develop guidelines relating to--

       ``(aa) the standard of care; and
       ``(bb) the credentialing and disciplining of doctors; and

       ``(II) develop a plan for updating the schedule under 
     clause (ii)(II) on a regular basis.

       ``(B) Appeals.--The State, in establishing the appeals 
     process described in subparagraph (A)(i)(V), may choose 
     whether to allow for de novo review, review with deference, 
     or some opportunity for parties to reject determinations by 
     the Board and elect to file a civil action after such 
     rejection. Any State desiring to adopt the model described in 
     this paragraph shall indicate how such review method meets 
     the criteria under subsection (c)(2).
       ``(C) Timeliness.--Any claim handled under the system 
     described in this paragraph shall provide for adjudication 
     that is more timely and expedited than adjudication in a 
     traditional tort system.
       ``(4) Special health care court model.--In the special 
     health care court model, the State shall--
       ``(A) establish a special court for adjudication of 
     disputes over injuries allegedly caused by health care 
     providers or health care organizations;
       ``(B) ensure that such court is presided over by judges 
     with expertise in and an understanding of health care;
       ``(C) provide authority to such judges to make binding 
     rulings on causation, compensation, standards of care, and 
     related issues;
       ``(D) provide for an appeals process to allow for a review 
     of decisions; and
       ``(E) at its option, establish an administrative entity 
     similar to the entity described in paragraph (3)(a)(i)(I) to 
     provide advice and guidance to the special court.
       ``(e) Application.--Each State desiring a grant under 
     subsection (a) shall submit to the Secretary an application, 
     at such time, in such manner, and containing such information 
     as the Secretary may require.
       ``(f) Report.--Each State receiving a grant under 
     subsection (a) shall submit to the Secretary a report 
     evaluating the effectiveness of activities funded with grants 
     awarded under such subsection at such time and in such manner 
     as the Secretary may require.
       ``(g) Technical Assistance.--The Secretary shall provide 
     technical assistance to the States awarded grants under 
     subsection (a). Such technical assistance shall include the 
     development, in consultation with States, of common 
     definitions, formats, and data collection infrastructure for 
     States receiving grants under this section to use in 
     reporting to facilitate aggregation and analysis of data both 
     within and between States. States not receiving grants under 
     this section may also use such common definitions, formats, 
     and data collection infrastructure.
       ``(h) Evaluation.--
       ``(1) In general.--The Secretary shall enter into a 
     contract with an appropriate research organization to conduct 
     an overall evaluation of the effectiveness of grants awarded 
     under subsection (a) and to annually prepare and submit a 
     report to the appropriate committees of Congress. Such an 
     evaluation shall begin not later than 18

[[Page S10643]]

     months following the date of implementation of the first 
     program funded by a grant under subsection (a).
       ``(2) Contents.--The evaluation under paragraph (1) shall 
     include--
       ``(A) an analysis of the effect of the grants awarded under 
     subsection (a) on the number, nature, and costs of health 
     care liability claims;
       ``(B) a comparison of the claim and cost information of 
     each State receiving a grant under subsection (a); and
       ``(C) a comparison between States receiving a grant under 
     this section and States that did not receive such a grant, 
     matched to ensure similar legal and health care environments, 
     and to determine the effects of the grants and subsequent 
     reforms on--
       ``(i) the liability environment;
       ``(ii) health care quality; and
       ``(iii) patient safety.
       ``(i) Option To Provide for Initial Planning Grants.--Of 
     the funds appropriated pursuant to subsection (k), the 
     Secretary may use a portion not to exceed $500,000 per State 
     to provide planning grants to such States for the development 
     of demonstration proposals meeting the criteria described in 
     subsection (c). In selecting States to receive such planning 
     grants, the Secretary shall give preference to those States 
     in which current law would not prohibit the adoption of an 
     alternative to current tort litigation.
       ``(j) Definitions.--In this section:
       ``(1) Health care services.--The term `health care 
     services' means any services provided by a health care 
     provider, or by any individual working under the supervision 
     of a health care provider, that relate to--
       ``(A) the diagnosis, prevention, or treatment of any human 
     disease or impairment; or
       ``(B) the assessment of the health of human beings.
       ``(2) Health care organization.--The term `health care 
     organization' means any individual or entity which is 
     obligated to provide, pay for, or administer health benefits 
     under any health plan.
       ``(3) Health care provider.--The term `health care 
     provider' means any individual or entity--
       ``(A) licensed, registered, or certified under Federal or 
     State laws or regulations to provide health care services; or
       ``(B) required to be so licensed, registered, or certified 
     but that is exempted by other statute or regulation.
       ``(4) Net economic loss.--The term `net economic loss' 
     means--
       ``(A) reasonable expenses incurred for products, services, 
     and accommodations needed for health care, training, and 
     other remedial treatment and care of an injured individual;
       ``(B) reasonable and appropriate expenses for 
     rehabilitation treatment and occupational training;
       ``(C) 100 percent of the loss of income from work that an 
     injured individual would have performed if not injured, 
     reduced by any income from substitute work actually 
     performed; and
       ``(D) reasonable expenses incurred in obtaining ordinary 
     and necessary services to replace services an injured 
     individual would have performed for the benefit of the 
     individual or the family of such individual if the individual 
     had not been injured.
       ``(k) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section such 
     sums as may be necessary. Amounts appropriated pursuant to 
     this subsection shall remain available until expended.''.
                                 ______