HOUSE AMENDMENT Bill No. HB 63B
1	CHAMBER ACTION
2	Senate House
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12	Representative Murman offered the following:
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14	Substitute Amendment for Amendment (224015) (with title
15	amendment)
16	Between line(s) 2510 and 2511, insert:
17	Section 55. (1) The Legislature finds and declares it to
18	be of vital importance that emergency services and care be
19	provided by hospitals, physicians, and emergency medical
20	services providers to every person in need of such care. The
21	Legislature finds that providers of emergency medical services
22	and care are critical elements in responding to disaster and
23	emergency situations that might affect our local communities,
24	state, and country. The Legislature recognizes the importance of
25	maintaining a viable system of providing for the emergency
26	medical needs of residents of this state and visitors to this
27	state. The Legislature and the Federal Government have required
28	such providers of emergency medical services and care to provide
29	emergency services and care to all persons who present
30	themselves to hospitals seeking such care. The Legislature has
31	further mandated that prehospital emergency medical treatment or
32	transport may not be denied by emergency medical services
33	providers to persons who have or are likely to have an emergency
34	medical condition. Such governmental requirements have imposed a
35	unilateral obligation for providers of emergency medical
36	services and care to provide services to all persons seeking
37	emergency care without ensuring payment or other consideration
38	for provision of such care. The Legislature also recognizes that
39	providers of emergency medical services and care provide a
40	significant amount of uncompensated emergency medical care in
41	furtherance of such governmental interest. A significant
42	proportion of the residents of this state who are uninsured or
43	are Medicaid or Medicare recipients are unable to access needed
44	health care because health care providers fear the increased
45	risk of medical malpractice liability. Such patients, in order
46	to obtain medical care, are frequently forced to seek care
47	through providers of emergency medical services and care.
48	Providers of emergency medical services and care in this state
49	have reported significant problems with both the availability
50	and affordability of professional liability coverage. Medical
51	malpractice liability insurance premiums have increased
52	dramatically and a number of insurers have ceased providing
53	medical malpractice coverage for emergency medical services and
54	care in this state. This results in a functional unavailability
55	of malpractice coverage for some providers of emergency medical
56	services and care. The Legislature further finds that certain
57	specialist physicians have resigned from serving on hospital
58	staffs or have otherwise declined to provide on-call coverage to
59	hospital emergency departments due to increased medical
60	malpractice liability exposure created by treating such
61	emergency department patients. It is the intent of the
62	Legislature that hospitals, emergency medical services
63	providers, and physicians be able to ensure that patients who
64	might need emergency medical services treatment or
65	transportation or who present themselves to hospitals for
66	emergency medical services and care have access to such needed
67	services.
68	(2) The Legislature finds that access to quality,
69	affordable health care for all Floridians is a necessary goal
70	for this state and that public teaching hospitals play an
71	essential role in providing access to comprehensive health care
72	services. The Legislature finds that access to quality health
73	care at public teaching hospitals is enhanced when public
74	teaching hospitals affiliate and coordinate their common
75	endeavors with medical schools. These affiliations have proved
76	to be an integral part of the delivery of more efficient and
77	economical health care services to patients of teaching
78	hospitals by offering quality graduate medical education
79	programs to resident physicians who provide patient services at
80	public teaching hospitals and clinics owned by such hospitals.
81	These affiliations ensure continued access to quality
82	comprehensive health care services for Floridians and,
83	therefore, should be encouraged in order to maintain and expand
84	such services. The Legislature finds that when teaching
85	hospitals affiliate or enter into contracts with medical schools
86	to provide comprehensive health care services to patients of
87	teaching hospitals, public teaching hospitals greatly increase
88	their exposure to claims arising out of alleged medical
89	malpractice and other allegedly negligent acts because some
90	public teaching hospital employees and agents do not have the
91	same level of protection against liability claims as colleges
92	and universities with medical schools and their employees
93	providing the same patient services to the same public teaching
94	hospital patients. The Legislature finds that the high cost of
95	litigation, unequal liability exposure, and increased medical
96	malpractice insurance premiums have adversely impacted the
97	ability of some public teaching hospitals to permit their
98	employees to provide patient services to patients of public
99	teaching hospitals. This finding is consistent with the report
100	issued in April 2002 by the American Medical Association
101	declaring Florida to be one of 12 states in the midst of a
102	medical liability insurance crisis. The crisis in the
103	availability and affordability of medical malpractice insurance
104	is a contributing factor in the reduction of access to quality
105	health care in this state and has declined significantly. If no
106	corrective action is taken, this health care crisis will lead to
107	a continued reduction of patient services in public teaching
108	hospitals. The Legislature finds that the state's 6 public
109	teaching hospitals provide 70 percent of the state's graduate
110	medical education as reported in the 2001-2002 Report on
111	Graduate Medical Education in Florida: Findings and
112	Recommendations and that the public teaching hospitals ensure
113	the state's future medical manpower. The Legislature finds that
114	the public is better served and will benefit from corrective
115	action to address the foregoing concerns. It is imperative that
116	the legislature further the public benefit by conferring
117	sovereign immunity upon public teaching hospitals and their
118	employees and agents when public teaching hospitals elect to be
119	agents of the Department of Health as providers of the state's
120	graduate medical education. It is also the intent of the
121	Legislature that employees of public teaching hospitals
122	providing patient services to patients of a public teaching
123	hospital be immune from lawsuits in the same manner and to the
124	same extent as employees and agents of the state, its agencies
125	and political subdivisions, and further, that they shall not be
126	held personally liable in tort or named as a party defendant in
127	an action while performing patient services except as provided
128	in s. 768.28(9)(a).
129	Section 56. Paragraph (b) of subsection (9) of section
130	768.28, Florida Statutes, is amended to read:
131	768.28 Waiver of sovereign immunity in tort actions;
132	recovery limits; limitation on attorney fees; statute of
133	limitations; exclusions; indemnification; risk management
134	programs.--
135	(9)
136	(b) As used in this subsection, the term:
137	1. "Employee" includes any volunteer firefighter.
138	2. "Officer, employee, or agent" includes, but is not
139	limited to:,
140	a. Any receiving facility designated under chapter 394 and
141	any persons operating as employees or agents of the receiving
142	facility when providing emergency treatment to a person who
143	presented himself or herself for examination and treatment in
144	accordance with chapter 394.
145	b.Any health care provider when providing services
146	pursuant to s. 766.1115, any member of the Florida Health
147	Services Corps, as defined in s. 381.0302, who provides
148	uncompensated care to medically indigent persons referred by the
149	Department of Health, and any public defender or her or his
150	employee or agent, including, among others, an assistant public
151	defender and an investigator.
152	c. Any provider of emergency medical services and care
153	acting pursuant to obligations imposed by s. 395.1041, s.
154	395.401, or s. 401.45. Except for persons or entities that are
155	otherwise covered under this section, providers of emergency
156	medical services and care shall be considered agents of the
157	Department of Health and shall indemnify the state for the
158	reasonable costs of defense and indemnity payments, if any, up
159	to the liability limits set forth in this chapter. For purposes
160	of this sub-subparagraph:
161	(I) The term "provider of emergency medical services and
162	care" means all persons and entities covered under or providing
163	services pursuant to obligations imposed by s. 395.1041, s.
164	395.401, or s. 401.45, including, but not limited to:
165	(A) An emergency medical services provider licensed under
166	part III of chapter 401 and persons operating as employees or
167	agents of such provider or an emergency medical technician or
168	paramedic certified under part III of chapter 401.
169	(B) A hospital licensed under chapter 395 and persons
170	operating as employees or agents of such hospital.
171	(C) A physician licensed under chapter 458, chapter 459,
172	chapter 460, or chapter 461 or a dentist licensed under chapter
173	466.
174	(D) A physician assistant licensed under chapter 458 or
175	chapter 459.
176	(E) A registered nurse, nurse midwife, licensed practical
177	nurse, or advanced registered nurse practitioner licensed or
178	registered under part I of chapter 464.
179	(F) A midwife licensed under chapter 467.
180	(G) A health care professional association and employees
181	or agents of the association or a corporate medical group and
182	employees or agents of such group.
183	(H) Any student or medical resident who is enrolled in an
184	accredited program or licensed program that prepares the student
185	for licensure or certification in any one of the professions
186	listed in sub-sub-sub-subparagraphs (C)-(G), the program that
187	prepares the student for licensure or certification, and the
188	entity responsible for the training of the student or medical
189	resident.
190	(I) Any other person or entity that provides services
191	pursuant to obligations imposed by s. 395.1041, s. 395.401, or
192	s. 401.45.
193	(II) The term "emergency medical services" means ambulance
194	assessment, treatment, or transport services provided pursuant
195	to obligations imposed by s. 395.1041 or s. 401.45; all
196	screening, examination, and evaluation performed by a physician,
197	hospital, or other person or entity acting pursuant to
198	obligations imposed by s. 395.1041 or s. 395.401; and any care,
199	treatment, surgery, or other medical services provided, as
200	outpatient or inpatient, to relieve or eliminate an emergency
201	medical condition, including all medical services to eliminate
202	the likelihood that the emergency medical condition will
203	deteriorate or recur without further medical attention within a
204	reasonable period of time.
205	d. Any public teaching hospital, as defined in s. 408.07,
206	and any employee or agent of a public teaching hospital who
207	provides patient services to patients at such facility or at a
208	clinic or other facility owned and operated by the public
209	teaching hospital, that elects to be considered as an agent of
210	the Department of Health and indemnifies the state for the
211	reasonable costs of defense and indemnity payments, if any, up
212	to the liability limits set forth in this chapter.
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214	================= T I T L E A M E N D M E N T =================
215	Remove line 215, and insert:
216	1, 2004; providing legislative findings and intent; amending s.
217	768.28, F.S.; revising the definition of the term "officer,
218	employee, or agent" to include certain receiving facilities and
219	employees or agents of such facilities, providers of emergency
220	medical services and care, and certain public teaching hospitals
221	for purposes of limitation of liability in tort under certain
222	circumstances; providing that providers of emergency medical
223	services and care are deemed agents of the Department of Health
224	for certain purposes; requiring such providers to indemnify the
225	state for certain reasonable defense and indemnity costs within
226	certain limitations; specifying certain persons as providers of
227	emergency medical services and care; defining emergency medical
228	services; providing severability; providing for