HB 0065B 2003
1	A bill to be entitled
2	An act relating to medical incidents; providing
3	legislative findings; amending s. 395.0191, F.S.; deleting
4	requirement that persons act in good faith to avoid
5	liability or discipline for their actions regarding the
6	awarding of staff membership or clinical privileges;
7	amending s. 395.1012, F.S.; requiring hospitals,
8	ambulatory surgical centers, and mobile surgical
9	facilities to establish patient safety plans and
10	committees; creating s. 395.1051, F.S.; providing for
11	notification of injuries in a hospital, ambulatory
12	surgical center, or mobile surgical facility; amending s.
13	456.041, F.S.; requiring additional information to be
14	included in health care practitioner profiles; providing
15	for fines; revising requirements for the reporting of paid
16	liability claims; amending s. 456.042, F.S.; requiring
17	health care practitioner profiles to be updated within a
18	specific time period; amending s. 456.049, F.S.; revising
19	requirements for the reporting of paid liability claims;
20	amending s. 456.057, F.S.; authorizing the Department of
21	Health to utilize subpoenas to obtain patient records
22	without patients' consent under certain circumstances;
23	amending s. 456.072, F.S.; authorizing the Department of
24	Health to determine administrative costs in disciplinary
25	actions; amending s. 456.073, F.S.; extending the time for
26	the Department of Health to refer a request for an
27	administrative hearing; amending s. 456.077, F.S.;
28	revising provisions relating to designation of certain
29	citation violations; amending s. 456.078, F.S.; revising
30	provisions relating to designation of certain mediation
31	offenses; creating s. 456.085, F.S.; providing for
32	notification of an injury by a physician; amending s.
33	458.331, F.S.; increasing the amount of paid liability
34	claims requiring investigation by the Department of
35	Health; revising the definition of "repeated malpractice"
36	to conform; creating s. 458.3311, F.S.; establishing
37	emergency procedures for disciplinary actions; amending s.
38	459.015, F.S.; increasing the amount of paid liability
39	claims requiring investigation by the Department of
40	Health; revising the definition of "repeated malpractice"
41	to conform; creating s. 459.0151, F.S.; establishing
42	emergency procedures for disciplinary actions; amending s.
43	461.013, F.S.; increasing the amount of paid liability
44	claims requiring investigation by the Department of
45	Health; revising the definition of "repeated malpractice"
46	to conform; amending s. 627.062, F.S.; prohibiting the
47	inclusion of payments made by insurers for bad faith
48	claims in an insurer's rate base; requiring certain rate
49	filings; creating s. 627.0662, F.S.; providing
50	definitions; requiring each medical liability insurer to
51	report certain information to the Office of Insurance
52	Regulation; providing for determination of whether
53	excessive profit has been realized; requiring return of
54	excessive amounts; amending s. 627.357, F.S.; deleting the
55	prohibition against formation of medical malpractice self-
56	insurance funds; providing requirements to form a self-
57	insurance fund; providing rulemaking authority to the
58	Financial Services Commission; creating s. 627.3575, F.S.;
59	creating the Health Care Professional Liability Insurance
60	Facility; providing purpose; providing for governance and
61	powers; providing eligibility requirements; providing for
62	premiums and assessments; providing for regulation;
63	providing applicability; specifying duties of the
64	Department of Health; providing for debt and regulation
65	thereof; amending s. 627.912, F.S.; requiring certain
66	claims information to be filed with the Office of
67	Insurance Regulation and the Department of Health;
68	providing for rulemaking by the Financial Services
69	Commission; creating s. 627.9121, F.S.; requiring certain
70	information relating to medical malpractice to be reported
71	to the Office of Insurance Regulation; providing for
72	enforcement; amending s. 766.106, F.S.; extending the time
73	period for the presuit screening period; providing
74	conditions for causes of action for bad faith against
75	insurers providing coverage for medical negligence;
76	revising provisions relating to a claimant's period to
77	file suit after rejection of a prospective defendant's
78	offer to admit liability and for arbitration on the issue
79	of damages; specifying consequences of failure to
80	cooperate on the part of any party during the presuit
81	investigation; providing factors to be considered with
82	respect to certain claims against bad faith against an
83	insurer; creating s. 766.1065, F.S.; requiring parties to
84	provide certain information to parties without request;
85	authorizing the issuance of subpoenas without case
86	numbers; requiring that parties and certain experts be
87	made available for deposition; providing for mandatory
88	presuit mediation; creating s. 766.1067, F.S.; providing
89	for mandatory mediation in medical negligence causes of
90	action; creating s. 766.118, F.S.; providing a limitation
91	on noneconomic damages which can be awarded in causes of
92	action involving medical negligence; amending s. 766.202,
93	F.S.; providing requirements for medical experts; amending
94	s. 766.203, F.S.; providing for discovery of opinions and
95	statements tendered during presuit investigation; amending
96	s. 766.207, F.S.; conforming provisions to the extension
97	in the time period for presuit investigation; requiring
98	the Department of Health to study the efficacy and
99	constitutionality of medical review panels; requiring a
100	report; amending s. 768.81, F.S.; providing that a
101	defendant's liability for damages in medical negligence
102	cases is several only; creating s. 1004.08, F.S.;
103	requiring patient safety instruction for certain students
104	in public schools, colleges, and universities; creating s.
105	1005.07, F.S.; requiring patient safety instruction for
106	certain students in nonpublic schools, colleges, and
107	universities; requiring a report by the Agency for Health
108	Care Administration regarding information to be provided
109	to health care consumers; requiring a report by the Agency
110	for Health Care Administration regarding the establishment
111	of a Patient Safety Authority; specifying elements of the
112	report; providing severability; providing for construction
113	of the act in pari materia with laws enacted during the
114	2003 Regular Session or the 2003 Special Session A of the
115	Legislature; providing an effective date.
116
117	Be It Enacted by the Legislature of the State of Florida:
118
119	Section 1. Findings.--
120	(1) The Legislature finds that Florida is in the midst of
121	a medical malpractice insurance crisis of unprecedented
122	magnitude.
123	(2) The Legislature finds that this crisis threatens the
124	quality and availability of health care for all Florida
125	citizens.
126	(3) The Legislature finds that the rapidly growing
127	population and the changing demographics of Florida make it
128	imperative that students continue to choose Florida as the place
129	they will receive their medical educations and practice
130	medicine.
131	(4) The Legislature finds that Florida is among the states
132	with the highest medical malpractice insurance premiums in the
133	nation.
134	(5) The Legislature finds that the cost of medical
135	malpractice insurance has increased dramatically during the past
136	decade and both the increase and the current cost are
137	substantially higher than the national average.
138	(6) The Legislature finds that the increase in medical
139	malpractice liability insurance rates is forcing physicians to
140	practice medicine without professional liability insurance, to
141	leave Florida, to not perform high-risk procedures, or to retire
142	early from the practice of medicine.
143	(7) The Legislature finds that there are certain elements
144	of damage presently recoverable that have no monetary value,
145	except on a purely arbitrary basis, while other elements of
146	damage are either easily measured on a monetary basis or reflect
147	ultimate monetary loss.
148	(8) The Governor created the Governor's Select Task Force
149	on Healthcare Professional Liability Insurance to study and make
150	recommendations to address these problems.
151	(9) The Legislature has reviewed the findings and
152	recommendations of the Governor's Select Task Force on
153	Healthcare Professional Liability Insurance.
154	(10) The Legislature finds that the Governor's Select Task
155	Force on Healthcare Professional Liability Insurance has
156	established that a medical malpractice crisis exists in the
157	State of Florida which can be alleviated by the adoption of
158	comprehensive legislatively enacted reforms.
159	(11) The Legislature finds that making high-quality health
160	care available to the citizens of this state is an overwhelming
161	public necessity.
162	(12) The Legislature finds that ensuring that physicians
163	continue to practice in Florida is an overwhelming public
164	necessity.
165	(13) The Legislature finds that ensuring the availability
166	of affordable professional liability insurance for physicians is
167	an overwhelming public necessity.
168	(14) The Legislature finds, based upon the findings and
169	recommendations of the Governor's Select Task Force on
170	Healthcare Professional Liability Insurance, the findings and
171	recommendations of various study groups throughout the nation,
172	and the experience of other states, that the overwhelming public
173	necessities of making quality health care available to the
174	citizens of this state, of ensuring that physicians continue to
175	practice in Florida, and of ensuring that those physicians have
176	the opportunity to purchase affordable professional liability
177	insurance cannot be met unless a cap on noneconomic damages in
178	an amount no higher than $250,000 is imposed.
179	(15) The Legislature finds that the high cost of medical
180	malpractice claims can be substantially alleviated by imposing a
181	limitation on noneconomic damages in medical malpractice
182	actions.
183	(16) The Legislature further finds that there is no
184	alternative measure of accomplishing such result without
185	imposing even greater limits upon the ability of persons to
186	recover damages for medical malpractice.
187	(17) The Legislature finds that the provisions of this act
188	are naturally and logically connected to each other and to the
189	purpose of making quality health care available to the citizens
190	of Florida.
191	(18) The Legislature finds that each of the provisions of
192	this act is necessary to alleviate the crisis relating to
193	medical malpractice insurance.
194	Section 2. Subsection (7) of section 395.0191, Florida
195	Statutes, is amended to read:
196	395.0191 Staff membership and clinical privileges.--
197	(7) There shall be no monetary liability on the part of,
198	and no cause of action for injunctive relief or damages shall
199	arise against, any licensed facility, its governing board or
200	governing board members, medical staff, or disciplinary board or
201	against its agents, investigators, witnesses, or employees, or
202	against any other person, for any action arising out of or
203	related to carrying out the provisions of this section, absent
204	taken in good faith and without intentional fraud in carrying
205	out the provisions of this section.
206	Section 3. Section 395.1012, Florida Statutes, is created
207	to read:
208	395.1012 Patient safety.--
209	(1) Each licensed facility shall adopt a patient safety
210	plan. A plan adopted to implement the requirements of 42 C.F.R.
211	s. 482.21 shall be deemed to comply with this requirement.
212	(2) Each licensed facility shall appoint a patient safety
213	officer and a patient safety committee, which shall include at
214	least one person who is neither employed by nor practicing in
215	the facility, for the purpose of promoting the health and safety
216	of patients, reviewing and evaluating the quality of patient
217	safety measures used by the facility, and assisting in the
218	implementation of the facility patient safety plan.
219	Section 4. Section 395.1051, Florida Statutes, is created
220	to read:
221	395.1051 Duty to notify patients.--Every licensed facility
222	shall inform each patient, or an individual identified pursuant
223	to s. 765.401(1), in person about unanticipated outcomes of care
224	that result in serious harm to the patient. Notification of
225	outcomes of care that result in harm to the patient under this
226	section shall not constitute an acknowledgement or admission of
227	liability, nor can it be introduced as evidence in any civil
228	lawsuit.
229	Section 5. Section 456.041, Florida Statutes, is amended
230	to read:
231	456.041 Practitioner profile; creation.--
232	(1)(a)Beginning July 1, 1999, the Department of Health
233	shall compile the information submitted pursuant to s. 456.039
234	into a practitioner profile of the applicant submitting the
235	information, except that the Department of Health may develop a
236	format to compile uniformly any information submitted under s.
237	456.039(4)(b). Beginning July 1, 2001, the Department of Health
238	may, and beginning July 1, 2004, shall,compile the information
239	submitted pursuant to s. 456.0391 into a practitioner profile of
240	the applicant submitting the information.
241	(b) Each practitioner licensed under chapter 458 or
242	chapter 459 must report to the Department of Health and the
243	Board of Medicine or the Board of Osteopathic Medicine,
244	respectively, all final disciplinary actions, sanctions by a
245	governmental agency or a facility or entity licensed under state
246	law, and claims or actions, as provided under s. 456.051, to
247	which he or she is subjected no later than 15 calendar days
248	after such action or sanction is imposed. Failure to submit the
249	requisite information within 15 calendar days in accordance with
250	this paragraph shall subject the practitioner to discipline by
251	the Board of Medicine or the Board of Osteopathic Medicine and a
252	fine of $100 for each day that the information is not submitted
253	after the expiration of the 15-day reporting period.
254	(c) Within 15 days after receiving a report under
255	paragraph (b), the department shall update the practitioner's
256	profile in accordance with the requirements of subsection (7).
257	(2) On the profile published under subsection (1), the
258	department shall indicate whetherifthe information provided
259	under s. 456.039(1)(a)7. or s. 456.0391(1)(a)7. is or isnot
260	corroborated by a criminal history check conducted according to
261	this subsection. If the information provided under s.
262	456.039(1)(a)7. or s. 456.0391(1)(a)7. is corroborated by the
263	criminal history check, the fact that the criminal history check
264	was performed need not be indicated on the profile.The
265	department, or the board having regulatory authority over the
266	practitioner acting on behalf of the department, shall
267	investigate any information received by the department or the
268	board when it has reasonable grounds to believe that the
269	practitioner has violated any law that relates to the
270	practitioner's practice.
271	(3) The Department of Health shallmayinclude in each
272	practitioner's practitioner profile that criminal information
273	that directly relates to the practitioner's ability to
274	competently practice his or her profession. The department must
275	include in each practitioner's practitioner profile the
276	following statement: "The criminal history information, if any
277	exists, may be incomplete; federal criminal history information
278	is not available to the public." The department shall provide in
279	each practitioner profile, for every final disciplinary action
280	taken against the practitioner, a narrative description, written
281	in plain English, that explains the administrative complaint
282	filed against the practitioner and the final disciplinary action
283	imposed on the practitioner. The department shall include a
284	hyperlink to each final order listed on its Internet website
285	report of dispositions of recent disciplinary actions taken
286	against practitioners.
287	(4) The Department of Health shall include, with respect
288	to a practitioner licensed under chapter 458 or chapter 459, a
289	statement of how the practitioner has elected to comply with the
290	financial responsibility requirements of s. 458.320 or s.
291	459.0085. The department shall include, with respect to
292	practitioners subject to s. 456.048, a statement of how the
293	practitioner has elected to comply with the financial
294	responsibility requirements of that section. The department
295	shall include, with respect to practitioners licensed under
296	chapter 458, chapter 459, or chapter 461, information relating
297	to liability actions which has been reported under s. 456.049 or
298	s. 627.912 within the previous 10 years for any paid claim of
299	$50,000 or morethat exceeds $5,000. Such claims information
300	shall be reported in the context of comparing an individual
301	practitioner's claims to the experience of other practitioners
302	within the same specialty, or profession if the practitioner is
303	not a specialist, to the extent such information is available to
304	the Department of Health. The department shall include a
305	hyperlink to all such comparison reports in such practitioner's
306	profile on its Internet website.If information relating to a
307	liability action is included in a practitioner's practitioner
308	profile, the profile must also include the following statement:
309	"Settlement of a claim may occur for a variety of reasons that
310	do not necessarily reflect negatively on the professional
311	competence or conduct of the practitioner. A payment in
312	settlement of a medical malpractice action or claim should not
313	be construed as creating a presumption that medical malpractice
314	has occurred."
315	(5) The Department of Health shallmay not include the
316	date of adisciplinary action taken by a licensed hospital or an
317	ambulatory surgical center, in accordance with the requirements
318	of s. 395.0193, in the practitioner profile. Any practitioner
319	disciplined under paragraph (1)(b) must report to the department
320	the date the disciplinary action was imposed. The department
321	shall state whether the action is related to professional
322	competence and whether it is related to the delivery of services
323	to a patient.
324	(6) The Department of Health may include in the
325	practitioner's practitioner profile any other information that
326	is a public record of any governmental entity and that relates
327	to a practitioner's ability to competently practice his or her
328	profession. However, the department must consult with the board
329	having regulatory authority over the practitioner before such
330	information is included in his or her profile.
331	(7) Upon the completion of a practitioner profile under
332	this section, the Department of Health shall furnish the
333	practitioner who is the subject of the profile a copy of it. The
334	practitioner has a period of 30 days in which to review the
335	profile and to correct any factual inaccuracies in it. The
336	Department of Health shall make the profile available to the
337	public at the end of the 30-day period. The department shall
338	make the profiles available to the public through the World Wide
339	Web and other commonly used means of distribution.
340	(8) The Department of Health shall provide in each profile
341	an easy-to-read explanation of any disciplinary action taken and
342	the reason the sanction or sanctions were imposed.
343	(9)(8)Making a practitioner profile available to the
344	public under this section does not constitute agency action for
345	which a hearing under s. 120.57 may be sought.
346	Section 6. Section 456.042, Florida Statutes, is amended
347	to read:
348	456.042 Practitioner profiles; update.--A practitioner
349	must submit updates of required information within 15 days after
350	the final activity that renders such information a fact.The
351	Department of Health shall update each practitioner's
352	practitioner profile periodically. An updated profile is subject
353	to the same requirements as an original profile with respect to
354	the period within which the practitioner may review the profile
355	for the purpose of correcting factual inaccuracies.
356	Section 7. Subsection (1) of section 456.049, Florida
357	Statutes, is amended, and subsection (3) is added to said
358	section, to read:
359	456.049 Health care practitioners; reports on professional
360	liability claims and actions.--
361	(1) Any practitioner of medicine licensed pursuant to the
362	provisions of chapter 458, practitioner of osteopathic medicine
363	licensed pursuant to the provisions of chapter 459, podiatric
364	physician licensed pursuant to the provisions of chapter 461, or
365	dentist licensed pursuant to the provisions of chapter 466 shall
366	report to the department any claim or action for damages for
367	personal injury alleged to have been caused by error, omission,
368	or negligence in the performance of such licensee's professional
369	services or based on a claimed performance of professional
370	services without consent if the claim was not covered by an
371	insurer required to report under s. 627.912 andthe claim
372	resulted in:
373	(a) A final judgment of $50,000 or more or, with respect
374	to a dentist licensed pursuant to chapter 466, a final judgment
375	of $25,000 or morein any amount.
376	(b) A settlement of $50,000 or more or, with respect to a
377	dentist licensed pursuant to chapter 466, a settlement of
378	$25,000 or morein any amount.
379	(c) A final disposition not resulting in payment on behalf
380	of the licensee.
381
382	Reports shall be filed with the department no later than 60 days
383	following the occurrence of any event listed in paragraph (a),
384	paragraph (b), or paragraph (c).
385	(3) The department shall forward the information collected
386	under this section to the Office of Insurance Regulation.
387	Section 8. Paragraph (a) of subsection (7) of section
388	456.057, Florida Statutes, is amended to read:
389	456.057 Ownership and control of patient records; report
390	or copies of records to be furnished.--
391	(7)(a)1. The department may obtain patient records
392	pursuant to a subpoena without written authorization from the
393	patient if the department and the probable cause panel of the
394	appropriate board, if any, find reasonable cause to believe that
395	a health care practitioner has excessively or inappropriately
396	prescribed any controlled substance specified in chapter 893 in
397	violation of this chapter or any professional practice act or
398	that a health care practitioner has practiced his or her
399	profession below that level of care, skill, and treatment
400	required as defined by this chapter or any professional practice
401	act and also find that appropriate, reasonable attempts were
402	made to obtain a patient release.
403	2. The department may obtain patient records and insurance
404	information pursuant to a subpoena without written authorization
405	from the patient if the department and the probable cause panel
406	of the appropriate board, if any, find reasonable cause to
407	believe that a health care practitioner has provided inadequate
408	medical care based on termination of insurance and also find
409	that appropriate, reasonable attempts were made to obtain a
410	patient release.
411	3. The department may obtain patient records, billing
412	records, insurance information, provider contracts, and all
413	attachments thereto pursuant to a subpoena without written
414	authorization from the patient if the department and probable
415	cause panel of the appropriate board, if any, find reasonable
416	cause to believe that a health care practitioner has submitted a
417	claim, statement, or bill using a billing code that would result
418	in payment greater in amount than would be paid using a billing
419	code that accurately describes the services performed, requested
420	payment for services that were not performed by that health care
421	practitioner, used information derived from a written report of
422	an automobile accident generated pursuant to chapter 316 to
423	solicit or obtain patients personally or through an agent
424	regardless of whether the information is derived directly from
425	the report or a summary of that report or from another person,
426	solicited patients fraudulently, received a kickback as defined
427	in s. 456.054, violated the patient brokering provisions of s.
428	817.505, or presented or caused to be presented a false or
429	fraudulent insurance claim within the meaning of s.
430	817.234(1)(a), and also find that, within the meaning of s.
431	817.234(1)(a), patient authorization cannot be obtained because
432	the patient cannot be located or is deceased, incapacitated, or
433	suspected of being a participant in the fraud or scheme, and if
434	the subpoena is issued for specific and relevant records.
435	4. Notwithstanding subparagraphs 1.-3., when the
436	department investigates a professional liability claim or
437	undertakes action pursuant to s. 456.049 or s. 627.912, the
438	department may obtain patient records pursuant to a subpoena
439	without written authorization from the patient if the patient
440	refuses to cooperate or attempts to obtain a patient release and
441	failure to obtain the patient records would be detrimental to
442	the investigation.
443	Section 9. Subsection (4) of section 456.072, Florida
444	Statutes, is amended to read:
445	456.072 Grounds for discipline; penalties; enforcement.--
446	(4) In anyaddition to any other discipline imposed
447	throughfinal order, or citation, entered on or after July 1,
448	2001, that imposes a penalty or other form of discipline
449	pursuant to this section or discipline imposed through final
450	order, or citation, entered on or after July 1, 2001,for a
451	violation of any practice act, the board, or the department when
452	there is no board, shall assess costs related to the
453	investigation and prosecution of the case, including costs
454	associated with an attorney's time. The amount of costs to be
455	assessed shall be determined by the board, or the department
456	when there is no board, following its consideration of an
457	affidavit of itemized costs and any written objections thereto.
458	In any case in whichwhere the board or the department imposesa
459	fine or assessment of costs imposed by the board or department
460	and the fine or assessmentis not paid within a reasonable time,
461	such reasonable time to be prescribed in the rules of the board,
462	or the department when there is no board, or in the order
463	assessing such fines or costs, the department or the Department
464	of Legal Affairs may contract for the collection of, or bring a
465	civil action to recover, the fine or assessment.
466	Section 10. Subsection (5) of section 456.073, Florida
467	Statutes, is amended to read:
468	456.073 Disciplinary proceedings.--Disciplinary
469	proceedings for each board shall be within the jurisdiction of
470	the department.
471	(5)(a)A formal hearing before an administrative law judge
472	from the Division of Administrative Hearings shall be held
473	pursuant to chapter 120 if there are any disputed issues of
474	material fact. The administrative law judge shall issue a
475	recommended order pursuant to chapter 120. If any party raises
476	an issue of disputed fact during an informal hearing, the
477	hearing shall be terminated and a formal hearing pursuant to
478	chapter 120 shall be held.
479	(b) Notwithstanding s. 120.569(2), the department shall
480	notify the Division of Administrative Hearings within 45 days
481	after receipt of a petition or request for a hearing that the
482	department has determined requires a formal hearing before an
483	administrative law judge.
484	Section 11. Subsections (1) and (2) of section 456.077,
485	Florida Statutes, are amended to read:
486	456.077 Authority to issue citations.--
487	(1) Notwithstanding s. 456.073, the board, or the
488	department if there is no board, shall adopt rules to permit the
489	issuance of citations. The citation shall be issued to the
490	subject and shall contain the subject's name and address, the
491	subject's license number if applicable, a brief factual
492	statement, the sections of the law allegedly violated, and the
493	penalty imposed. The citation must clearly state that the
494	subject may choose, in lieu of accepting the citation, to follow
495	the procedure under s. 456.073. If the subject disputes the
496	matter in the citation, the procedures set forth in s. 456.073
497	must be followed. However, if the subject does not dispute the
498	matter in the citation with the department within 30 days after
499	the citation is served, the citation becomes a publicfinal
500	order and does not constituteconstitutes discipline for a first
501	offense, but does constitute discipline for a second or
502	subsequent offense. The penalty shall be a fine or other
503	conditions as established by rule.
504	(2) The board, or the department if there is no board,
505	shall adopt rules designating violations for which a citation
506	may be issued. Such rules shall designate as citation violations
507	those violations for which there is no substantial threat to the
508	public health, safety, and welfare or no violation of standard
509	of care involving injury to a patient. Violations for which a
510	citation may be issued shall include violations of continuing
511	education requirements; failure to timely pay required fees and
512	fines; failure to comply with the requirements of ss. 381.026
513	and 381.0261 regarding the dissemination of information
514	regarding patient rights; failure to comply with advertising
515	requirements; failure to timely update practitioner profile and
516	credentialing files; failure to display signs, licenses, and
517	permits; failure to have required reference books available; and
518	all other violations that do not pose a direct and serious
519	threat to the health and safety of the patient or involve a
520	violation of standard of care that has resulted in injury to a
521	patient.
522	Section 12. Subsections (1) and (2) of section 456.078,
523	Florida Statutes, are amended to read:
524	456.078 Mediation.--
525	(1) Notwithstanding the provisions of s. 456.073, the
526	board, or the department when there is no board, shall adopt
527	rules to designate which violations of the applicable
528	professional practice act are appropriate for mediation. The
529	board, or the department when there is no board, shallmay
530	designate as mediation offenses those complaints where harm
531	caused by the licensee is economic in nature, except any act or
532	omission involving intentional misconduct,orcan be remedied by
533	the licensee, is not a standard of care violation involving any
534	type of injury to a patient, or does not result in an adverse
535	incident. For the purposes of this section, an "adverse
536	incident" means an event that results in:
537	(a) The death of a patient;
538	(b) Brain or spinal damage to a patient;
539	(c) The performance of a surgical procedure on the wrong
540	patient;
541	(d) The performance of a wrong-site surgical procedure;
542	(e) The performance of a surgical procedure that is
543	medically unnecessary or otherwise unrelated to the patient's
544	diagnosis or medical condition;
545	(f) The surgical repair of damage to a patient resulting
546	from a planned surgical procedure, which damage is not a
547	recognized specific risk as disclosed to the patient and
548	documented through the informed-consent process;
549	(g) The performance of a procedure to remove unplanned
550	foreign objects remaining from a surgical procedure; or
551	(h) The performance of any other surgical procedure that
552	breached the standard of care.
553	(2) After the department determines a complaint is legally
554	sufficient and the alleged violations are defined as mediation
555	offenses, the department or any agent of the department may
556	conduct informal mediation to resolve the complaint. If the
557	complainant and the subject of the complaint agree to a
558	resolution of a complaint within 14 days after contact by the
559	mediator, the mediator shall notify the department of the terms
560	of the resolution. The department or board shall take no further
561	action unless the complainant and the subject each fail to
562	record with the department an acknowledgment of satisfaction of
563	the terms of mediation within 60 days of the mediator's
564	notification to the department. A successful mediation shall not
565	constitute discipline.In the event the complainant and subject
566	fail to reach settlement terms or to record the required
567	acknowledgment, the department shall process the complaint
568	according to the provisions of s. 456.073.
569	Section 13. Section 456.085, Florida Statutes, is created
570	to read:
571	456.085 Duty to notify patients.--Every physician licensed
572	under chapter 458 or chapter 459 shall inform each patient, or
573	an individual identified pursuant to s. 765.401(1), in person
574	about unanticipated outcomes of care that result in serious harm
575	to the patient. Notification of outcomes of care that result in
576	harm to the patient under this section shall not constitute an
577	acknowledgement or admission of liability, nor can it be
578	introduced as evidence in any civil lawsuit.
579	Section 14. Paragraph (t) of subsection (1) and subsection
580	(6) of section 458.331, Florida Statutes, are amended to read:
581	458.331 Grounds for disciplinary action; action by the
582	board and department.--
583	(1) The following acts constitute grounds for denial of a
584	license or disciplinary action, as specified in s. 456.072(2):
585	(t) Gross or repeated malpractice or the failure to
586	practice medicine with that level of care, skill, and treatment
587	which is recognized by a reasonably prudent similar physician as
588	being acceptable under similar conditions and circumstances. The
589	board shall give great weight to the provisions of s. 766.102
590	when enforcing this paragraph. As used in this paragraph,
591	"repeated malpractice" includes, but is not limited to, three or
592	more claims for medical malpractice within the previous 5-year
593	period resulting in indemnities being paid in excess of $50,000
594	$25,000each to the claimant in a judgment or settlement and
595	which incidents involved negligent conduct by the physician. As
596	used in this paragraph, "gross malpractice" or "the failure to
597	practice medicine with that level of care, skill, and treatment
598	which is recognized by a reasonably prudent similar physician as
599	being acceptable under similar conditions and circumstances,"
600	shall not be construed so as to require more than one instance,
601	event, or act. Nothing in this paragraph shall be construed to
602	require that a physician be incompetent to practice medicine in
603	order to be disciplined pursuant to this paragraph.
604	(6) Upon the department's receipt from an insurer or self-
605	insurer of a report of a closed claim against a physician
606	pursuant to s. 627.912 or from a health care practitioner of a
607	report pursuant to s. 456.049, or upon the receipt from a
608	claimant of a presuit notice against a physician pursuant to s.
609	766.106, the department shall review each report and determine
610	whether it potentially involved conduct by a licensee that is
611	subject to disciplinary action, in which case the provisions of
612	s. 456.073 shall apply. However, if it is reported that a
613	physician has had three or more claims with indemnities
614	exceeding $50,000$25,000each within the previous 5-year
615	period, the department shall investigate the occurrences upon
616	which the claims were based and determine if action by the
617	department against the physician is warranted.
618	Section 15. Section 458.3311, Florida Statutes, is created
619	to read:
620	458.3311 Emergency procedures for disciplinary
621	action.--Notwithstanding any other provision of law to the
622	contrary:
623	(1) Each physician must report to the Department of Health
624	any judgment for medical negligence levied against the
625	physician. The physician must make the report no later than 15
626	days after the exhaustion of the last opportunity for any party
627	to appeal the judgment or request a rehearing.
628	(2) No later than 30 days after a physician has, within a
629	60-month period, made three reports as required by subsection
630	(1), the Department of Health shall initiate an emergency
631	investigation and the Board of Medicine shall conduct an
632	emergency probable cause hearing to determine whether the
633	physician should be disciplined for a violation of s.
634	458.331(1)(t) or any other relevant provision of law.
635	Section 16. Paragraph (x) of subsection (1) and subsection
636	(6) of section 459.015, Florida Statutes, are amended to read:
637	459.015 Grounds for disciplinary action; action by the
638	board and department.--
639	(1) The following acts constitute grounds for denial of a
640	license or disciplinary action, as specified in s. 456.072(2):
641	(x) Gross or repeated malpractice or the failure to
642	practice osteopathic medicine with that level of care, skill,
643	and treatment which is recognized by a reasonably prudent
644	similar osteopathic physician as being acceptable under similar
645	conditions and circumstances. The board shall give great weight
646	to the provisions of s. 766.102 when enforcing this paragraph.
647	As used in this paragraph, "repeated malpractice" includes, but
648	is not limited to, three or more claims for medical malpractice
649	within the previous 5-year period resulting in indemnities being
650	paid in excess of $50,000$25,000each to the claimant in a
651	judgment or settlement and which incidents involved negligent
652	conduct by the osteopathic physician. As used in this paragraph,
653	"gross malpractice" or "the failure to practice osteopathic
654	medicine with that level of care, skill, and treatment which is
655	recognized by a reasonably prudent similar osteopathic physician
656	as being acceptable under similar conditions and circumstances"
657	shall not be construed so as to require more than one instance,
658	event, or act. Nothing in this paragraph shall be construed to
659	require that an osteopathic physician be incompetent to practice
660	osteopathic medicine in order to be disciplined pursuant to this
661	paragraph. A recommended order by an administrative law judge or
662	a final order of the board finding a violation under this
663	paragraph shall specify whether the licensee was found to have
664	committed "gross malpractice," "repeated malpractice," or
665	"failure to practice osteopathic medicine with that level of
666	care, skill, and treatment which is recognized as being
667	acceptable under similar conditions and circumstances," or any
668	combination thereof, and any publication by the board shall so
669	specify.
670	(6) Upon the department's receipt from an insurer or self-
671	insurer of a report of a closed claim against an osteopathic
672	physician pursuant to s. 627.912 or from a health care
673	practitioner of a report pursuant to s. 456.049, or upon the
674	receipt from a claimant of a presuit notice against an
675	osteopathic physician pursuant to s. 766.106, the department
676	shall review each report and determine whether it potentially
677	involved conduct by a licensee that is subject to disciplinary
678	action, in which case the provisions of s. 456.073 shall apply.
679	However, if it is reported that an osteopathic physician has had
680	three or more claims with indemnities exceeding $50,000$25,000
681	each within the previous 5-year period, the department shall
682	investigate the occurrences upon which the claims were based and
683	determine if action by the department against the osteopathic
684	physician is warranted.
685	Section 17. Section 459.0151, Florida Statutes, is created
686	to read:
687	459.0151 Emergency procedures for disciplinary
688	action.--Notwithstanding any other provision of law to the
689	contrary:
690	(1) Each osteopathic physician must report to the
691	Department of Health any judgment for medical negligence levied
692	against the physician. The osteopathic physician must make the
693	report no later than 15 days after the exhaustion of the last
694	opportunity for any party to appeal the judgment or request a
695	rehearing.
696	(2) No later than 30 days after an osteopathic physician
697	has, within a 60-month period, made three reports as required by
698	subsection (1), the Department of Health shall initiate an
699	emergency investigation and the Board of Osteopathic Medicine
700	shall conduct an emergency probable cause hearing to determine
701	whether the physician should be disciplined for a violation of
702	s. 459.015(1)(x) or any other relevant provision of law.
703	Section 18. Paragraph (s) of subsection (1) and paragraph
704	(a) of subsection (5) of section 461.013, Florida Statutes, are
705	amended to read:
706	461.013 Grounds for disciplinary action; action by the
707	board; investigations by department.--
708	(1) The following acts constitute grounds for denial of a
709	license or disciplinary action, as specified in s. 456.072(2):
710	(s) Gross or repeated malpractice or the failure to
711	practice podiatric medicine at a level of care, skill, and
712	treatment which is recognized by a reasonably prudent podiatric
713	physician as being acceptable under similar conditions and
714	circumstances. The board shall give great weight to the
715	standards for malpractice in s. 766.102 in interpreting this
716	section. As used in this paragraph, "repeated malpractice"
717	includes, but is not limited to, three or more claims for
718	medical malpractice within the previous 5-year period resulting
719	in indemnities being paid in excess of $50,000$10,000each to
720	the claimant in a judgment or settlement and which incidents
721	involved negligent conduct by the podiatric physicians. As used
722	in this paragraph, "gross malpractice" or "the failure to
723	practice podiatric medicine with the level of care, skill, and
724	treatment which is recognized by a reasonably prudent similar
725	podiatric physician as being acceptable under similar conditions
726	and circumstances" shall not be construed so as to require more
727	than one instance, event, or act.
728	(5)(a) Upon the department's receipt from an insurer or
729	self-insurer of a report of a closed claim against a podiatric
730	physician pursuant to s. 627.912, or upon the receipt from a
731	claimant of a presuit notice against a podiatric physician
732	pursuant to s. 766.106, the department shall review each report
733	and determine whether it potentially involved conduct by a
734	licensee that is subject to disciplinary action, in which case
735	the provisions of s. 456.073 shall apply. However, if it is
736	reported that a podiatric physician has had three or more claims
737	with indemnities exceeding $50,000$25,000each within the
738	previous 5-year period, the department shall investigate the
739	occurrences upon which the claims were based and determine if
740	action by the department against the podiatric physician is
741	warranted.
742	Section 19. Subsections (7), (8), and (9) are added to
743	section 627.062, Florida Statutes, to read:
744	627.062 Rate standards.--
745	(7) Notwithstanding any other provision of this section,
746	in matters relating to professional liability insurance coverage
747	for medical negligence, any portion of a judgment entered as a
748	result of a statutory or common-law bad faith action and any
749	portion of a judgment entered that awards punitive damages
750	against an insurer may not be included in the insurer's rate
751	base and may not be used to justify a rate or rate change. In
752	matters relating to professional liability insurance coverage
753	for medical negligence, any portion of a settlement entered as a
754	result of a statutory or common-law bad faith action identified
755	as such and any portion of a settlement wherein an insurer
756	agrees to pay specific punitive damages may not be used to
757	justify a rate or rate change. The portion of the taxable costs
758	and attorney's fees that is identified as being related to the
759	bad faith and punitive damages in these judgments and
760	settlements may not be included in the insurer's rate base and
761	may not be utilized to justify a rate or rate change.
762	(8) Each insurer writing professional liability insurance
763	coverage for medical negligence must make a rate filing under
764	this section with the Office of Insurance Regulation at least
765	once each calendar year.
766	(9) Medical malpractice insurance companies shall submit a
767	rate filing to the Office of Insurance Regulation no earlier
768	than 30 days, but no later than 120 days, after the date upon
769	which this act becomes law.
770	Section 20. Section 627.0662, Florida Statutes, is created
771	to read:
772	627.0662 Excessive profits for medical liability insurance
773	prohibited.--
774	(1) As used in this section:
775	(a) “Medical liability insurance” means insurance that is
776	written on a professional liability insurance policy issued to a
777	health care practitioner or on a liability insurance policy
778	covering medical malpractice claims issued to a health care
779	facility.
780	(b) “Medical liability insurer” means any insurance
781	company or group of insurance companies writing medical
782	liability insurance in this state and does not include any self-
783	insurance fund or other nonprofit entity writing such insurance.
784	(2) Each medical liability insurer shall file with the
785	Office of Insurance Regulation, prior to July 1 of each year on
786	forms prescribed by the office, the following data for medical
787	liability insurance business in this state. The data shall
788	include both voluntary and joint underwriting association
789	business, as follows:
790	(a) Calendar-year earned premium.
791	(b) Accident-year incurred losses and loss adjustment
792	expenses.
793	(c) The administrative and selling expenses incurred in
794	this state or allocated to this state for the calendar year.
795	(d) Policyholder dividends incurred during the applicable
796	calendar year.
797	(3)(a) Excessive profit has been realized if there has
798	been an underwriting gain for the 3 most recent calendar-
799	accident years combined which is greater than the anticipated
800	underwriting profit plus 5 percent of earned premiums for those
801	calendar-accident years.
802	(b) As used in this subsection with respect to any 3-year
803	period, “anticipated underwriting profit” means the sum of the
804	dollar amounts obtained by multiplying, for each rate filing of
805	the insurer group in effect during such period, the earned
806	premiums applicable to such rate filing during such period by
807	the percentage factor included in such rate filing for profit
808	and contingencies, such percentage factor having been determined
809	with due recognition to investment income from funds generated
810	by business in this state. Separate calculations need not be
811	made for consecutive rate filings containing the same percentage
812	factor for profits and contingencies.
813	(4) Each medical liability insurer shall also file a
814	schedule of medical liability insurance loss in this state and
815	loss adjustment experience for each of the 3 most recent
816	accident years. The incurred losses and loss adjustment expenses
817	shall be valued as of March 31 of the year following the close
818	of the accident year, developed to an ultimate basis, and at two
819	12-month intervals thereafter, each developed to an ultimate
820	basis, to the extent that a total of three evaluations is
821	provided for each accident year. The first year to be so
822	reported shall be accident year 2004, such that the reporting of
823	3 accident years will not take place until accident years 2005
824	and 2006 have become available.
825	(5) Each insurer group's underwriting gain or loss for
826	each calendar-accident year shall be computed as follows: the
827	sum of the accident-year incurred losses and loss adjustment
828	expenses as of March 31 of the following year, developed to an
829	ultimate basis, plus the administrative and selling expenses
830	incurred in the calendar year, plus policyholder dividends
831	applicable to the calendar year, shall be subtracted from the
832	calendar-year earned premium to determine the underwriting gain
833	or loss.
834	(6) For the 3 most recent calendar-accident years, the
835	underwriting gain or loss shall be compared to the anticipated
836	underwriting profit.
837	(7) If the medical liability insurer has realized an
838	excessive profit, the office shall order a return of the
839	excessive amounts to policyholders after affording the insurer
840	an opportunity for hearing and otherwise complying with the
841	requirements of chapter 120. Such excessive amounts shall be
842	refunded to policyholders in all instances unless the insurer
843	affirmatively demonstrates to the office that the refund of the
844	excessive amounts will render the insurer or a member of the
845	insurer group financially impaired or will render it insolvent.
846	(8) The excessive amount shall be refunded to
847	policyholders on a pro rata basis in relation to the final
848	compilation year earned premiums to the voluntary medical
849	liability insurance policyholders of record of the insurer group
850	on December 31 of the final compilation year.
851	(9) Any return of excessive profits to policyholders under
852	this section shall be provided in the form of a cash refund or a
853	credit towards the future purchase of insurance.
854	(10)(a) Cash refunds to policyholders may be rounded to
855	the nearest dollar.
856	(b) Data in required reports to the office may be rounded
857	to the nearest dollar.
858	(c) Rounding, if elected by the insurer group, shall be
859	applied consistently.
860	(11)(a) Refunds to policyholders shall be completed as
861	follows:
862	1. If the insurer elects to make a cash refund, the refund
863	shall be completed within 60 days after entry of a final order
864	determining that excessive profits have been realized; or
865	2. If the insurer elects to make refunds in the form of a
866	credit to renewal policies, such credits shall be applied to
867	policy renewal premium notices which are forwarded to insureds
868	more than 60 calendar days after entry of a final order
869	determining that excessive profits have been realized. If an
870	insurer has made this election but an insured thereafter cancels
871	his or her policy or otherwise allows the policy to terminate,
872	the insurer group shall make a cash refund not later than 60
873	days after termination of such coverage.
874	(b) Upon completion of the renewal credits or refund
875	payments, the insurer shall immediately certify to the office
876	that the refunds have been made.
877	(12) Any refund or renewal credit made pursuant to this
878	section shall be treated as a policyholder dividend applicable
879	to the year in which it is incurred, for purposes of reporting
880	under this section for subsequent years.
881	Section 21. Subsection (10) of section 627.357, Florida
882	Statutes, is amended to read:
883	627.357 Medical malpractice self-insurance.--
884	(10)(a) An application to form a self-insurance fund under
885	this section must be filed with the Office of Insurance
886	Regulation.
887	(b) The Office of Insurance Regulation must ensure that
888	self-insurance funds remain solvent and provide insurance
889	coverage purchased by participants. The Financial Services
890	Commission may adopt rules pursuant to ss. 120.536(1) and 120.54
891	to implement this subsectionA self-insurance fund may not be
892	formed under this section after October 1, 1992.
893	Section 22. Section 627.3575, Florida Statutes, is created
894	to read:
895	627.3575 Health Care Professional Liability Insurance
896	Facility.--
897	(1) FACILITY CREATED; PURPOSE; STATUS.--There is created
898	the Health Care Professional Liability Insurance Facility. The
899	facility is intended to meet ongoing availability and
900	affordability problems relating to liability insurance for
901	health care professionals by providing an affordable, self-
902	supporting source of excess insurance coverage for those
903	professionals who are willing and able to self-insure for
904	smaller losses. The facility shall operate on a not-for-profit
905	basis. The facility is self-funding and is intended to serve a
906	public purpose but is not a state agency or program, and no
907	activity of the facility shall create any state liability.
908	(2) GOVERNANCE; POWERS.--
909	(a) The facility shall operate under a seven-member board
910	of governors consisting of the Secretary of Health, three
911	members appointed by the Governor, and three members appointed
912	by the Chief Financial Officer. The board shall be chaired by
913	the Secretary of Health. The secretary shall serve by virtue of
914	his or her office, and the other members of the board shall
915	serve terms concurrent with the term of office of the official
916	who appointed them. Any vacancy on the board shall be filled in
917	the same manner as the original appointment. Members serve at
918	the pleasure of the official who appointed them. Members are not
919	eligible for compensation for their service on the board, but
920	the facility may reimburse them for per diem and travel expenses
921	at the same levels as are provided in s. 112.061 for state
922	employees.
923	(b) The facility shall have such powers as are necessary
924	to operate as an insurer, including the power to:
925	1. Sue and be sued.
926	2. Hire such employees and retain such consultants,
927	attorneys, actuaries, and other professionals as it deems
928	appropriate.
929	3. Contract with such service providers as it deems
930	appropriate.
931	4. Maintain offices appropriate to the conduct of its
932	business.
933	5. Take such other actions as are necessary or appropriate
934	in fulfillment of its responsibilities under this section.
935	(3) COVERAGE PROVIDED.--The facility shall provide
936	liability insurance coverage for health care professionals. The
937	facility shall allow policyholders to select from policies with
938	deductibles of $25,000 per claim, $50,000 per claim, and
939	$100,000 per claim and with coverage limits of $250,000 per
940	claim and $750,000 annual aggregate and $1 million per claim and
941	$3 million annual aggregate. To the greatest extent possible,
942	the terms and conditions of the policies shall be consistent
943	with terms and conditions commonly used by professional
944	liability insurers.
945	(4) ELIGIBILITY; TERMINATION.--
946	(a) Any health care professional is eligible for coverage
947	provided by the facility if the professional at all times
948	maintains either:
949	1. An escrow account consisting of cash or assets eligible
950	for deposit under s. 625.52 in an amount equal to the deductible
951	amount of the policy; or
952	2. An unexpired, irrevocable letter of credit, established
953	pursuant to chapter 675, in an amount not less than the
954	deductible amount of the policy. The letter of credit shall be
955	payable to the health care professional as beneficiary upon
956	presentment of a final judgment indicating liability and
957	awarding damages to be paid by the physician or upon presentment
958	of a settlement agreement signed by all parties to such
959	agreement when such final judgment or settlement is a result of
960	a claim arising out of the rendering of, or the failure to
961	render, medical care and services. Such letter of credit shall
962	be nonassignable and nontransferable. Such letter of credit
963	shall be issued by any bank or savings association organized and
964	existing under the laws of this state or any bank or savings
965	association organized under the laws of the United States that
966	has its principal place of business in this state or has a
967	branch office which is authorized under the laws of this state
968	or of the United States to receive deposits in this state.
969	(b) The eligibility of a health care professional for
970	coverage terminates upon:
971	1. The failure of the professional to comply with
972	paragraph (a);
973	2. The failure of the professional to timely pay premiums
974	or assessments; or
975	3. The commission of any act of fraud in connection with
976	the policy, as determined by the board of governors.
977	(c) The board of governors, in its discretion, may
978	reinstate the eligibility of a health care professional whose
979	eligibility has terminated pursuant to paragraph (b) upon
980	determining that the professional has come back into compliance
981	with paragraph (a) or has paid the overdue premiums or
982	assessments. Eligibility may be reinstated in the case of fraud
983	only if the board determines that its initial determination of
984	fraud was in error.
985	(5) PREMIUMS; ASSESSMENTS.--
986	(a) The facility shall charge the actuarially indicated
987	premium for the coverage provided and shall retain the services
988	of consulting actuaries to prepare its rate filings. The
989	facility shall not provide dividends to policyholders, and, to
990	the extent that premiums are more than the amount required to
991	cover claims and expenses, such excess shall be retained by the
992	facility for payment of future claims. In the event of
993	dissolution of the facility, any amounts not required as a
994	reserve for outstanding claims shall be transferred to the
995	policyholders of record as of the last day of operation.
996	(b) In the event that the premiums for a particular year,
997	together with any investment income or reinsurance recoveries
998	attributable to that year, are insufficient to pay claims
999	arising out of claims accruing in that year, the facility shall
1000	levy assessments against all of its policyholders in a uniform
1001	percentage of premium. Each policyholder's assessment shall be
1002	such percentage of the premium that policyholder paid for
1003	coverage for the year to which the insufficiency is
1004	attributable.
1005	(c) The policyholder is personally liable for any
1006	assessment. The failure to timely pay an assessment is grounds
1007	for suspension or revocation of the policyholder's professional
1008	license by the appropriate licensing entity.
1009	(6) REGULATION; APPLICABILITY OF OTHER STATUTES.--
1010	(a) The facility shall operate pursuant to a plan of
1011	operation approved by order of the Office of Insurance
1012	Regulation of the Financial Services Commission. The board of
1013	governors may at any time adopt amendments to the plan of
1014	operation and submit the amendments to the Office of Insurance
1015	Regulation for approval.
1016	(b) The facility is subject to regulation by the Office of
1017	Insurance Regulation of the Financial Services Commission in the
1018	same manner as other insurers, except that, in recognition of
1019	the fact that its ability to levy assessments against its own
1020	policyholders is a substitute for the protections ordinarily
1021	afforded by such statutory requirements, the facility is exempt
1022	from statutory requirements relating to surplus as to
1023	policyholders.
1024	(c) The facility is not subject to part II of chapter 631,
1025	relating to the Florida Insurance Guaranty Association.
1026	(7) STARTUP PROVISIONS.--
1027	(a) It is the intent of the Legislature that the facility
1028	begin providing coverage no later than January 1, 2004.
1029	(b) The Governor and the Chief Financial Officer shall
1030	make their appointments to the board of governors of the
1031	facility no later than August 1, 2003. Until the board is
1032	appointed, the Secretary of Health may perform ministerial acts
1033	on behalf of the facility as chair of the board of governors.
1034	(c) Until the facility is able to hire permanent staff and
1035	enter into contracts for professional services, the office of
1036	the Secretary of Health shall provide support services to the
1037	facility.
1038	(d) In order to provide startup funds for the facility,
1039	the board of governors may incur debt or enter into agreements
1040	for lines of credit, provided that the sole source of funds for
1041	repayment of any debt is future premium revenues of the
1042	facility. The amount of such debt or lines of credit may not
1043	exceed $10 million.
1044	Section 23. Subsection (1) and paragraph (n) of subsection
1045	(2) of section 627.912, Florida Statutes, are amended to read:
1046	627.912 Professional liability claims and actions; reports
1047	by insurers.--
1048	(1)(a)Each self-insurer authorized under s. 627.357 and
1049	each insurer or joint underwriting association providing
1050	professional liability insurance to a practitioner of medicine
1051	licensed under chapter 458, to a practitioner of osteopathic
1052	medicine licensed under chapter 459, to a podiatric physician
1053	licensed under chapter 461, to a dentist licensed under chapter
1054	466, to a hospital licensed under chapter 395, to a crisis
1055	stabilization unit licensed under part IV of chapter 394, to a
1056	health maintenance organization certificated under part I of
1057	chapter 641, to clinics included in chapter 390, to an
1058	ambulatory surgical center as defined in s. 395.002, or to a
1059	member of The Florida Bar shall report in duplicate to the
1060	Department of Insurance any claim or action for damages for
1061	personal injuries claimed to have been caused by error,
1062	omission, or negligence in the performance of such insured's
1063	professional services or based on a claimed performance of
1064	professional services without consent, if the claim resulted in:
1065	1.(a)A final judgment in any amount.
1066	2.(b)A settlement in any amount.
1067
1068	Reports shall be filed with the department.
1069	(b) In addition to the requirements of paragraph (a), if
1070	the insured party is licensed under chapter 395, chapter 458,
1071	chapter 459, chapter 461, or chapter 466, the insurer shall
1072	report in duplicate to the Office of Insurance Regulation any
1073	other disposition of the claim, including, but not limited to, a
1074	dismissal. If the insured is licensed under chapter 458, chapter
1075	459, or chapter 461, any claim that resulted in a final judgment
1076	or settlement in the amount of $50,000 or more shall be reported
1077	to the Department of Health no later than 30 days following the
1078	occurrence of that event. If the insured is licensed under
1079	chapter 466, any claim that resulted in a final judgment or
1080	settlement in the amount of $25,000 or more shall be reported to
1081	the Department of Health no later than 30 days following the
1082	occurrence of that eventand, if the insured party is licensed
1083	under chapter 458, chapter 459, chapter 461, or chapter 466,
1084	with the Department of Health, no later than 30 days following
1085	the occurrence of any event listed in paragraph (a) or paragraph
1086	(b). The Department of Health shall review each report and
1087	determine whether any of the incidents that resulted in the
1088	claim potentially involved conduct by the licensee that is
1089	subject to disciplinary action, in which case the provisions of
1090	s. 456.073 shall apply. The Department of Health, as part of the
1091	annual report required by s. 456.026, shall publish annual
1092	statistics, without identifying licensees, on the reports it
1093	receives, including final action taken on such reports by the
1094	Department of Health or the appropriate regulatory board.
1095	(2) The reports required by subsection (1) shall contain:
1096	(n) Any other information required by the department to
1097	analyze and evaluate the nature, causes, location, cost, and
1098	damages involved in professional liability cases. The Financial
1099	Services Commission shall adopt by rule requirements for
1100	additional information to assist the Office of Insurance
1101	Regulation in its analysis and evaluation of the nature, causes,
1102	location, cost, and damages involved in professional liability
1103	cases reported by insurers under this section.
1104	Section 24. Section 627.9121, Florida Statutes, is created
1105	to read:
1106	627.9121 Required reporting of claims; penalties.--Each
1107	entity that makes payment under a policy of insurance, self-
1108	insurance, or otherwise in settlement, partial settlement, or
1109	satisfaction of a judgment in a medical malpractice action or
1110	claim that is required to report information to the National
1111	Practitioner Data Bank under 42 U.S.C. s. 11131 must also report
1112	the same information to the Office of Insurance Regulation. The
1113	office shall include such information in the data that it
1114	compiles under s. 627.912. The office must compile and review
1115	the data collected pursuant to this section and must assess an
1116	administrative fine on any entity that fails to fully comply
1117	with such reporting requirements.
1118	Section 25. Subsections (3) and (4) and paragraph (a) of
1119	subsection (10) of section 766.106, Florida Statutes, are
1120	amended, and subsections (13), (14), and (15) are added to said
1121	section, to read:
1122	766.106 Notice before filing action for medical
1123	malpractice; presuit screening period; offers for admission of
1124	liability and for arbitration; informal discovery; review.--
1125	(3)(a) No suit may be filed for a period of 18090days
1126	after notice is mailed to any prospective defendant. During the
1127	180-day90-dayperiod, the prospective defendant's insurer or
1128	self-insurer shall conduct a review to determine the liability
1129	of the defendant. Each insurer or self-insurer shall have a
1130	procedure for the prompt investigation, review, and evaluation
1131	of claims during the 180-day90-dayperiod. This procedure shall
1132	include one or more of the following:
1133	1. Internal review by a duly qualified claims adjuster;
1134	2. Creation of a panel comprised of an attorney
1135	knowledgeable in the prosecution or defense of medical
1136	malpractice actions, a health care provider trained in the same
1137	or similar medical specialty as the prospective defendant, and a
1138	duly qualified claims adjuster;
1139	3. A contractual agreement with a state or local
1140	professional society of health care providers, which maintains a
1141	medical review committee;
1142	4. Any other similar procedure which fairly and promptly
1143	evaluates the pending claim.
1144
1145	Each insurer or self-insurer shall investigate the claim in good
1146	faith, and both the claimant and prospective defendant shall
1147	cooperate with the insurer in good faith. If the insurer
1148	requires, a claimant shall appear before a pretrial screening
1149	panel or before a medical review committee and shall submit to a
1150	physical examination, if required. Unreasonable failure of any
1151	party to comply with this section justifies dismissal of claims
1152	or defenses. There shall be no civil liability for participation
1153	in a pretrial screening procedure if done without intentional
1154	fraud.
1155	(b) At or before the end of the 18090days, the insurer
1156	or self-insurer shall provide the claimant with a response:
1157	1. Rejecting the claim;
1158	2. Making a settlement offer; or
1159	3. Making an offer of admission of liability and for
1160	arbitration on the issue of damages. This offer may be made
1161	contingent upon a limit of general damages.
1162	(c) The response shall be delivered to the claimant if not
1163	represented by counsel or to the claimant's attorney, by
1164	certified mail, return receipt requested. Failure of the
1165	prospective defendant or insurer or self-insurer to reply to the
1166	notice within 18090days after receipt shall be deemed a final
1167	rejection of the claim for purposes of this section.
1168	(d) Within 30 days afterofreceipt of a response by a
1169	prospective defendant, insurer, or self-insurer to a claimant
1170	represented by an attorney, the attorney shall advise the
1171	claimant in writing of the response, including:
1172	1. The exact nature of the response under paragraph (b).
1173	2. The exact terms of any settlement offer, or admission
1174	of liability and offer of arbitration on damages.
1175	3. The legal and financial consequences of acceptance or
1176	rejection of any settlement offer, or admission of liability,
1177	including the provisions of this section.
1178	4. An evaluation of the time and likelihood of ultimate
1179	success at trial on the merits of the claimant's action.
1180	5. An estimation of the costs and attorney's fees of
1181	proceeding through trial.
1182	(4) The notice of intent to initiate litigation shall be
1183	served within the time limits set forth in s. 95.11. However,
1184	during the 180-day90-dayperiod, the statute of limitations is
1185	tolled as to all potential defendants. Upon stipulation by the
1186	parties, the 180-day90-dayperiod may be extended and the
1187	statute of limitations is tolled during any such extension. Upon
1188	receiving notice of termination of negotiations in an extended
1189	period, the claimant shall have 60 days or the remainder of the
1190	period of the statute of limitations, whichever is greater,
1191	within which to file suit.
1192	(10) If a prospective defendant makes an offer to admit
1193	liability and for arbitration on the issue of damages, the
1194	claimant has 50 days from the date of receipt of the offer to
1195	accept or reject it. The claimant shall respond in writing to
1196	the insurer or self-insurer by certified mail, return receipt
1197	requested. If the claimant rejects the offer, he or she may then
1198	file suit. Acceptance of the offer of admission of liability and
1199	for arbitration waives recourse to any other remedy by the
1200	parties, and the claimant's written acceptance of the offer
1201	shall so state.
1202	(a) If rejected, the offer to admit liability and for
1203	arbitration on damages is not admissible in any subsequent
1204	litigation. Upon rejection of the offer to admit liability and
1205	for arbitration, the claimant has 60 days from receipt of the
1206	rejection of the offer to admit liability and for arbitration,
1207	60 days from the date of the declaration of impasse during
1208	presuit mediation conducted pursuant to s. 766.1065,or the
1209	remainder of the period of the statute of limitations, whichever
1210	period is greater, in which to file suit.
1211	(13) In matters relating to professional liability
1212	insurance coverage for medical negligence, an insurer shall not
1213	be held in bad faith for failure to timely pay its policy limits
1214	if it tenders its policy limits and meets all other conditions
1215	of settlement prior to the conclusion of the presuit screening
1216	period provided for in this section.
1217	(14) Failure to cooperate on the part of any party during
1218	the presuit investigation may be grounds to strike any claim
1219	made, or defense raised, by such party in suit.
1220	(15) In all matters relating to professional liability
1221	insurance coverage for medical negligence, and in determining
1222	whether the insurer acted fairly and honestly towards its
1223	insured with due regard for her or his interest during the
1224	presuit process or after a complaint has been filed, the
1225	following factors shall be considered:
1226	(a) The insurer’s willingness to negotiate with the
1227	claimant;
1228	(b) The insurer’s consideration of the advice of its
1229	defense counsel;
1230	(c) The insurer’s proper investigation of the claim;
1231	(d) Whether the insurer informed the insured of the offer
1232	to settle within the limits of coverage, the right to retain
1233	personal counsel, and risk of litigation;
1234	(e) Whether the insured denied liability or requested that
1235	the case be defended; and
1236	(f) Whether the claimant imposed any condition, other than
1237	the tender of the policy limits, on the settlement of the claim.
1238	Section 26. Section 766.1065, Florida Statutes, is created
1239	to read:
1240	766.1065 Mandatory staging of presuit investigation and
1241	mandatory mediation.--
1242	(1) Within 30 days after service of the presuit notice of
1243	intent to initiate medical malpractice litigation, each party
1244	shall voluntarily produce to all other parties, without being
1245	requested, any and all medical, hospital, health care, and
1246	employment records concerning the claimant in the disclosing
1247	party’s possession, custody, or control, and the disclosing
1248	party shall affirmatively certify in writing that the records
1249	produced include all records in that party’s possession,
1250	custody, or control or that the disclosing party has no medical,
1251	hospital, health care, or employment records concerning the
1252	claimant.
1253	(a) Subpoenas may be issued according to the Florida Rules
1254	of Civil Procedure as though suit had been filed for the limited
1255	purpose of obtaining copies of medical, hospital, health care,
1256	and employment records of the claimant. The party shall indicate
1257	on the subpoena that it is being issued in accordance with the
1258	presuit procedures of this section and shall not be required to
1259	include a case number.
1260	(b) Nothing in this section shall limit the ability of any
1261	party to use any other available form of presuit discovery
1262	available under this chapter or the Florida Rules of Civil
1263	Procedure.
1264	(2) Within 60 days after service of the presuit notice of
1265	intent to initiate medical malpractice litigation, all parties
1266	must be made available for a sworn deposition. Such deposition
1267	may not be used in a civil suit for medical negligence.
1268	(3) Within 120 days after service of the presuit notice of
1269	intent to initiate medical malpractice litigation, each party’s
1270	corroborating expert, who will otherwise be tendered as the
1271	expert complying with the affidavit provisions set forth in s.
1272	766.203, must be made available for a sworn deposition.
1273	(a) The expenses associated with the expert’s time and
1274	travel in preparing for and attending such deposition shall be
1275	the responsibility of the party retaining such expert.
1276	(b) An expert shall be deemed available for deposition if
1277	suitable accommodations can be made for appearance of said
1278	expert via real-time video technology.
1279	(4) Within 180 days after service of the presuit notice of
1280	intent to initiate medical malpractice litigation, all parties
1281	shall attend in-person mandatory mediation in accordance with s.
1282	44.102 if binding arbitration under s. 766.106 or s. 766.207 has
1283	not been agreed to by the parties. The Florida Rules of Civil
1284	Procedure shall apply to mediation held pursuant to this
1285	section.
1286	Section 27. Section 766.1067, Florida Statutes, is created
1287	to read:
1288	766.1067 Mandatory mediation after suit is filed.--Within
1289	120 days after suit being filed, unless such period is extended
1290	by mutual agreement of all parties, all parties shall attend in-
1291	person mandatory mediation in accordance with s. 44.102 if
1292	binding arbitration under s. 766.106 or s. 766.207 has not been
1293	agreed to by the parties. The Florida Rules of Civil Procedure
1294	shall apply to mediation held pursuant to this section.
1295	Section 28. Section 766.118, Florida Statutes, is created
1296	to read:
1297	766.118 Determination of noneconomic damages.--With
1298	respect to a cause of action for personal injury or wrongful
1299	death resulting from an occurrence of medical negligence,
1300	including actions pursuant to s. 766.209, damages recoverable
1301	for noneconomic losses to compensate for pain and suffering,
1302	inconvenience, physical impairment, mental anguish,
1303	disfigurement, loss of capacity for enjoyment of life, and all
1304	other noneconomic damages shall not exceed $250,000, regardless
1305	of the number of claimants or defendants involved in the action.
1306	Section 29. Subsection (5) of section 766.202, Florida
1307	Statutes, is amended to read:
1308	766.202 Definitions; ss. 766.201-766.212.--As used in ss.
1309	766.201-766.212, the term:
1310	(5) "Medical expert" means a person familiar with the
1311	evaluation, diagnosis, or treatment of the medical condition at
1312	issue who:
1313	(a) Isduly and regularly engaged in the practice of his
1314	or her profession,whoholds a health care professional degree
1315	from a university or college,and has had special professional
1316	training and experience;or
1317	(b) Hasone possessed ofspecial health care knowledge or
1318	skill about the subject upon which he or she is called to
1319	testify or provide an opinion.
1320
1321	Such expert shall certify that he or she has similar credentials
1322	and expertise in the area of the defendant's particular practice
1323	or specialty, if the defendant is a specialist.
1324	Section 30. Subsections (2) and (3) of section 766.203,
1325	Florida Statutes, are amended to read:
1326	766.203 Presuit investigation of medical negligence claims
1327	and defenses by prospective parties.--
1328	(2) Prior to issuing notification of intent to initiate
1329	medical malpractice litigation pursuant to s. 766.106, the
1330	claimant shall conduct an investigation to ascertain that there
1331	are reasonable grounds to believe that:
1332	(a) Any named defendant in the litigation was negligent in
1333	the care or treatment of the claimant; and
1334	(b) Such negligence resulted in injury to the claimant.
1335
1336	Corroboration of reasonable grounds to initiate medical
1337	negligence litigation shall be provided by the claimant's
1338	submission of a verified written medical expert opinion from a
1339	medical expert as defined in s. 766.202(5), at the time the
1340	notice of intent to initiate litigation is mailed, which
1341	statement shall corroborate reasonable grounds to support the
1342	claim of medical negligence. This opinion and statement are
1343	subject to discovery.
1344	(3) Prior to issuing its response to the claimant's notice
1345	of intent to initiate litigation, during the time period for
1346	response authorized pursuant to s. 766.106, the defendant or the
1347	defendant's insurer or self-insurer shall conduct an
1348	investigation to ascertain whether there are reasonable grounds
1349	to believe that:
1350	(a) The defendant was negligent in the care or treatment
1351	of the claimant; and
1352	(b) Such negligence resulted in injury to the claimant.
1353
1354	Corroboration of lack of reasonable grounds for medical
1355	negligence litigation shall be provided with any response
1356	rejecting the claim by the defendant's submission of a verified
1357	written medical expert opinion from a medical expert as defined
1358	in s. 766.202(5), at the time the response rejecting the claim
1359	is mailed, which statement shall corroborate reasonable grounds
1360	for lack of negligent injury sufficient to support the response
1361	denying negligent injury. This opinion and statement are subject
1362	to discovery.
1363	Section 31. Subsections (2) and (3) of section 766.207,
1364	Florida Statutes, are amended to read:
1365	766.207 Voluntary binding arbitration of medical
1366	negligence claims.--
1367	(2) Upon the completion of presuit investigation with
1368	preliminary reasonable grounds for a medical negligence claim
1369	intact, the parties may elect to have damages determined by an
1370	arbitration panel. Such election may be initiated by either
1371	party by serving a request for voluntary binding arbitration of
1372	damages within 18090days after service of the claimant's
1373	notice of intent to initiate litigation upon the defendant. The
1374	evidentiary standards for voluntary binding arbitration of
1375	medical negligence claims shall be as provided in ss.
1376	120.569(2)(g) and 120.57(1)(c).
1377	(3) Upon receipt of a party's request for such
1378	arbitration, the opposing party may accept the offer of
1379	voluntary binding arbitration within 30 days. However, in no
1380	event shall the defendant be required to respond to the request
1381	for arbitration sooner than 18090days after service of the
1382	notice of intent to initiate litigation under s. 766.106. Such
1383	acceptance within the time period provided by this subsection
1384	shall be a binding commitment to comply with the decision of the
1385	arbitration panel. The liability of any insurer shall be subject
1386	to any applicable insurance policy limits.
1387	Section 32. (1) The Department of Health shall study and
1388	report to the Legislature as to whether medical review panels
1389	should be included as part of the presuit process in medical
1390	malpractice litigation. Medical review panels review a medical
1391	malpractice case during the presuit process and make judgments
1392	on the merits of the case based on established standards of care
1393	with the intent of reducing the number of frivolous claims. The
1394	panel's report could be used as admissible evidence at trial or
1395	for other purposes. The department's report should address:
1396	(a) Historical use of medical review panels and similar
1397	pretrial programs in this state, including the mediation panels
1398	created by chapter 75-9, Laws of Florida.
1399	(b) Constitutional issues relating to the use of medical
1400	review panels.
1401	(c) The use of medical review panels or similar programs
1402	in other states.
1403	(d) Whether medical review panels or similar panels should
1404	be created for use during the presuit process.
1405	(e) Other recommendations and information that the
1406	department deems appropriate.
1407	(f) In submitting its report with respect to (a)-(c), the
1408	Department should identify at a minimum:
1409	1. The percentage of medical malpractice claims submitted
1410	to the panels during the time period the panels were in
1411	existence.
1412	2. The percentage of claims that were settled while the
1413	panels were in existence and the percentage of claims that were
1414	settled in the 3 years prior to the establishment of such panels
1415	or, for each panel which no longer exists, 3 years after the
1416	dissolution of such panels.
1417	3. In those state where panels have been discontinued,
1418	whether additional safeguards have been implemented to avoid the
1419	filing of frivolous lawsuits and what those additional
1420	safeguards are.
1421	4. How the rates for medical malpractice insurance in
1422	states utilizing such panels compares with the rates in states
1423	not utilizing such panels.
1424	5. Whether, and to what extent, a finding by a panel is
1425	subject to review and the burden of proof required to overcome a
1426	finding by the panel.
1427	(2) If the department finds that medical review panels or
1428	a similar structure should be created in this state, it shall
1429	include draft legislation to implement its recommendations in
1430	its report.
1431	(3) The department shall submit its report to the Speaker
1432	of the House of Representatives and the President of the Senate
1433	no later than December 31, 2003.
1434	Section 33. Subsection (5) of section 768.81, Florida
1435	Statutes, is amended to read:
1436	768.81 Comparative fault.--
1437	(5) Notwithstanding anything in law to the contrary, in an
1438	action for damages for personal injury or wrongful death arising
1439	out of medical malpractice, whether in contract or tort, when an
1440	apportionment of damages pursuant to this section is attributed
1441	to a teaching hospital as defined in s. 408.07,the court shall
1442	enter judgment against the teaching hospital on the basis of
1443	eachsuchparty's percentage of fault and not on the basis of
1444	the doctrine of joint and several liability.
1445	Section 34. Section 1004.08, Florida Statutes, is created
1446	to read:
1447	1004.08 Patient safety instructional requirements.--Every
1448	public school, college, and university that offers degrees in
1449	medicine, nursing, and allied health shall include in the
1450	curricula applicable to such degrees material on patient safety,
1451	including patient safety improvement. Materials shall include,
1452	but need not be limited to, effective communication and
1453	teamwork; epidemiology of patient injuries and medical errors;
1454	vigilance, attention, and fatigue; checklists and inspections;
1455	automation and technological and computer support; psychological
1456	factors in human error; and reporting systems.
1457	Section 35. Section 1005.07, Florida Statutes, is created
1458	to read:
1459	1005.07 Patient safety instructional requirements.--Every
1460	nonpublic school, college, and university that offers degrees in
1461	medicine, nursing, and allied health shall include in the
1462	curricula applicable to such degrees material on patient safety,
1463	including patient safety improvement. Materials shall include,
1464	but need not be limited to, effective communication and
1465	teamwork; epidemiology of patient injuries and medical errors;
1466	vigilance, attention, and fatigue; checklists and inspections;
1467	automation and technological and computer support; psychological
1468	factors in human error; and reporting systems.
1469	Section 36. The Agency for Health Care Administration is
1470	directed to study the types of information the public would find
1471	relevant in the selection of hospitals. The agency shall review
1472	and recommend appropriate methods of collection, analysis, and
1473	dissemination of that information. The agency shall complete its
1474	study and report its findings and recommendations to the
1475	Legislature by January 15, 2004.
1476	Section 37. Comprehensive study and report on the creation
1477	of a Patient Safety Authority.--
1478	(1) The Agency for Health Care Administration, in
1479	consultation with the Department of Health, is directed to study
1480	the need for, and the implementation requirements of,
1481	establishing a Patient Safety Authority. The authority would be
1482	responsible for performing activities and functions designed to
1483	improve patient safety and the quality of care delivered by
1484	health care facilities and health care practitioners.
1485	(2) In undertaking its study, the agency shall examine and
1486	evaluate a Patient Safety Authority that would, either directly
1487	or by contract:
1488	(a) Analyze information concerning adverse incidents
1489	reported to the Agency for Health Care Administration pursuant
1490	to s. 395.0197, Florida Statutes, for the purpose of
1491	recommending changes in practices and procedures that may be
1492	implemented by health care practitioners and health care
1493	facilities to prevent future adverse incidents.
1494	(b) Collect, analyze, and evaluate patient safety data
1495	submitted voluntarily by a health care practitioner or health
1496	care facility. The authority would communicate to health care
1497	practitioners and health care facilities changes in practices
1498	and procedures that may be implemented for the purpose of
1499	improving patient safety and preventing future patient safety
1500	events from resulting in serious injury or death. At a minimum,
1501	the authority would:
1502	1. Be designed and operated by an individual or entity
1503	with demonstrated expertise in health care quality data and
1504	systems analysis, health information management, systems
1505	thinking and analysis, human factors analysis, and
1506	identification of latent and active errors.
1507	2. Include procedures for ensuring its confidentiality,
1508	timeliness, and independence.
1509	(c) Foster the development of a statewide electronic
1510	infrastructure, which would be implemented in phases over a
1511	multiyear period, that is designed to improve patient care and
1512	the delivery and quality of health care services by health care
1513	facilities and practitioners. The electronic infrastructure
1514	would be a secure platform for communication and the sharing of
1515	clinical and other data, such as business data, among providers
1516	and between patients and providers. The electronic
1517	infrastructure would include a core electronic medical record.
1518	Health care providers would have access to individual electronic
1519	medical records, subject to the consent of the individual. The
1520	right, if any, of other entities, including health insurers and
1521	researchers, to access the records would need further
1522	examination and evaluation by the agency.
1523	(d) Foster the use of computerized physician medication
1524	ordering systems by hospitals that do not have such systems and
1525	develop protocols for these systems.
1526	(e) Implement paragraphs (c) and (d) as a demonstration
1527	project for Medicaid recipients.
1528	(f) Identify best practices and share this information
1529	with health care providers.
1530	(g) Engage in other activities that improve health care
1531	quality, improve the diagnosis and treatment of diseases and
1532	medical conditions, increase the efficiency of the delivery of
1533	health care services, increase administrative efficiency, and
1534	increase access to quality health care services.
1535	(3) The agency shall also consider ways in which a Patient
1536	Safety Authority would be able to facilitate the development of
1537	no-fault demonstration projects as means to reduce and prevent
1538	medical errors and promote patient safety.
1539	(4) The agency shall seek information and advice from and
1540	consult with hospitals, physicians, other health care providers,
1541	attorneys, consumers, and individuals involved with and
1542	knowledgeable about patient safety and quality-of-care
1543	initiatives.
1544	(5) In evaluating the need for, and the operation of, a
1545	Patient Safety Authority, the agency shall determine the costs
1546	of implementing and administering an authority and suggest
1547	funding sources and mechanisms.
1548	(6) The agency shall complete its study and issue a report
1549	to the Legislature by February 1, 2004. In its report, the
1550	agency shall include specific findings, recommendations, and
1551	proposed legislation.
1552	Section 38. If any provision of this act or the
1553	application thereof to any person or circumstance is held
1554	invalid, the invalidity does not affect other provisions or
1555	applications of the act which can be given effect without the
1556	invalid provision or application, and to this end the provisions
1557	of this act are declared severable.
1558	Section 39. If any law amended by this act was also
1559	amended by a law enacted at the 2003 Regular Session of the
1560	Legislature or at the 2003 Special Session A of the Legislature,
1561	such laws shall be construed as if they had been enacted at the
1562	same session of the Legislature, and full effect shall be given
1563	to each if possible.
1564	Section 40. This act shall take effect upon becoming a law
1565	and shall apply to all actions filed after the effective date of
1566	the act.