[Congressional Record Volume 156, Number 47 (Wednesday, March 24, 2010)]
[Extensions of Remarks]
[Pages E472-E473]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                       RECONCILIATION ACT OF 2010

                                 ______
                                 

                               speech of

                         HON. DENNIS A. CARDOZA

                             of california

                    in the house of representatives

                         Sunday, March 21, 2010

  Mr. CARDOZA. Mr. Speaker, I would like to submit for the record a 
letter sent to me by the Physician Insurers Association (PIAA) 
expressing their concerns that multiple provisions of H.R. 3590 could 
potentially create new causes of action for medical liability claims 
despite the assurances I received from the committees and others that 
there would be no impact.
  Mr. Speaker, the House-passed H.R. 3962 prevented these causes of 
action from being created by adding Section 261. Section 261 stated 
that the development, recognition, or implementation of any guideline 
or other standard shall not be construed to establish the standard of 
care or the duty of care owed by healthcare providers to their patients 
in any malpractice action or claim.
  Mr. Speaker, for the record, it was the legislative intent of 
Congress to insert Section 261 or similar language in any Conference 
Committee bill to prevent new causes of action. It was not and never 
has been the intent of this legislation to create any new causes of 
action or claims premised on the development of guidelines or other 
standards.

                                                Physician Insurers


                                       Association of America,

                                     Rockville, MD, March 9, 2010.
     Hon. Dennis Cardoza,
     Longworth Building,
     Washington, DC.
       Dear Congressman Cardoza: On behalf of the 60 domestic 
     primary medical professional liability insurance company 
     members of the Physician Insurers Association of America 
     (PIAA), I am writing regarding the healthcare reform 
     legislation passed by the Senate. Specifically, I would like 
     to share our concerns about the legislation creating new 
     causes of action for medical liability claims.
       The PIAA is the only trade association in the nation 
     dedicated solely to the medical professional liability 
     insurance industry. Our members are physician and other 
     healthcare provider owned or operated professional liability 
     insurers which provide indemnification for over 60% of 
     America's doctors, as well as dentists, hospitals and other 
     healthcare providers. Our member insurance companies were 
     formed by state medical, dental and hospital associations 
     over the past 30 years, to include 4 which are domiciled in 
     California. They were formed with the specific goals of 
     lowering insurance costs for providers and helping patients 
     through sound underwriting and patient safety practices. In 
     this regard, we are uniquely qualified to offer our 
     perspective on medical liability issues.
       As approved by the Senate, H.R. 3590 contains at least 14 
     provisions which could create new causes of action for 
     medical liability claims. These include:
       Section 2701 (adult health quality measures).
       Section 2702 (payment adjustments for health care acquired 
     conditions).
       Section 3001 (Hospital Value-Based Purchase Program).
       Section 3002 (improvements to the Physician Quality 
     Reporting Initiative).
       Section 3003 (improvements to the Physician Feedback 
     Program).
       Section 3007 (value based payment modifier under physician 
     fee schedule).
       Section 3008 (payment adjustment for conditions acquired in 
     hospitals).
       Section 3013 (quality measure development).
       Section 3014 (quality measurement).
       Section 3021 (Establishment of Center for Medicare and 
     Medicaid Innovation).
       Section 3025 (hospital readmission reduction program).
       Section 3501 (health care delivery system research, quality 
     improvement).
       Section 4003 (Task Force on Clinical and Preventive 
     Services).
       Section 4301 (research to optimize deliver of public health 
     services).
       Sufficient questions were raised about these sections of 
     H.R. 3590 that a provision was added to the bill 
     commissioning a Government Accountability Office (GAO) study 
     to see if these sections did indeed result in new avenues for 
     medical liability claims to be filed. Quite simply, such a 
     study is unnecessary and possibly harmful. If Congress 
     intends to create multiple new avenues for the filing of 
     medical liability claims, it does not need to commission the 
     study. If, as we have been told, it does not intend to 
     substantially increase medical liability litigation, a study 
     will only needlessly create an opening for such cases to be 
     filed until Congress finds the opportunity to correct the 
     issue.
       Congress should not wait for a study to be conducted--it 
     should clearly state its intent in the legislation to not 
     create new medical liability causes of action which could 
     dramatically increase medical liability insurance premiums 
     and potentially decrease access to healthcare providers in 
     the process. The PIAA recommends the following legislation 
     language to address this issue:
       Sec. XXXX--Construction Regarding Standard of Care
       The development, recognition, or implementation of any 
     guideline or other standard under any provision of this Act 
     shall not be construed to establish the standard of care or 
     duty of care owed by healthcare providers to their patients 
     in any medical malpractice action or claim (as defined in 
     section 431(7) of the Health Care Quality Improvement Act of 
     1986 (42 U.S.C.10 11151(7)).
       From the very beginning of the healthcare reform debate, 
     there has been broad consensus that medical liability reform 
     was a necessary component in making our healthcare system 
     more efficient and effective. While the exact nature of that 
     reform has been the source of some disagreement, no one has 
     been suggesting that our medical system will be improved by 
     having new opportunities for even more medical liability 
     claims to be filed. Congress should ensure such opportunities 
     are not created by healthcare reform legislation.
       Thank you for your time and consideration of this 
     critically important issue. Should you have any questions 
     about these proposals, or need additional information, please 
     do not hesitate to contact me. We look forward to working 
     with you on this most important issue.
           Sincerely,
                                                Lawrence E. Smarr,
                                                        President.

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