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 Material Information
Title: Journal of the Florida House of Representatives
Physical Description: v. : ; 31 cm.
Language: English
Creator: Florida -- Legislature. -- House of Representatives
Publisher: State of Florida
Place of Publication: Tallahassee
Creation Date: February 2, 1988
Frequency: annual
regular
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Genre: government publication (state, provincial, terriorial, dependent)   ( marcgt )
periodical   ( marcgt )
serial   ( sobekcm )
 Notes
General Note: Description from: 1984.
Funding: Digitized for the Florida House of Representatives, the Office of the Clerk.
 Record Information
Source Institution: University of Florida
Holding Location: Florida House of Representatives. African American History Collections at the Office of the Clerk.
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: aleph - 003417946
oclc - 12895215
System ID: UF00027836:00013
 Related Items
Preceded by: Journal of the House of Representatives of the session of ...

Table of Contents
    Title Page
        Page i
    February 1988
        Tuesday, February 2
            Page 1
            Page 2
            Page 3
            Page 4
            Page 5
            Page 6
            Page 7
        Wednesday, February 3
            Page 8
            Page 9
            Page 10
            Page 11
            Page 12
            Page 13
            Page 14
            Page 15
            Page 16
            Page 17
            Page 18
            Page 19
            Page 20
            Page 21
            Page 22
            Page 23
            Page 24
            Page 25
            Page 26
            Page 27
            Page 28
            Page 29
            Page 30
            Page 31
        Thursday, February 4
            Page 32
            Page 33
            Page 34
            Page 35
            Page 36
            Page 37
            Page 38
            Page 39
            Page 40
            Page 41
            Page 42
            Page 43
            Page 44
            Page 45
            Page 46
            Page 47
            Page 48
            Page 49
            Page 50
            Page 51
            Page 52
            Page 53
            Page 54
            Page 55
            Page 56
            Page 57
            Page 58
            Page 59
            Page 60
            Page 61
            Page 62
            Page 63
            Page 64
            Page 65
    Index
        Contents
            Page 66
        Bill Sponsors in "E" Session
            Page 67
        Miscellaneous Subjects
            Page 68
        Subject Index of House and Senate Bills, Resolutions, and Memorials
            Page 69
            Page 70
            Page 71
        Bills, Resolutions and Memorials by Number, Subject, Sponsor and Disposition
            Page 72
Full Text




Journal
of the

Florida



House of Representatives



Special Session "E"
February 2 through February 4, 1988


of the
Seventy-third House



since Statehood in 1845



[Including a record of transmittal of Acts subsequent to sine die adjournment]













y r W6v4jo OF THE


V house of e preseqtatives



FIFTH SPECIAL SESSION-"E" of 1986-1988



Number 1



Tuesday, February 2, 1988



Journal of the House of Representatives for a Special Session of the Seventy-third House since Statehood in 1845,
convened by Proclamation of the President of the Senate and the Speaker of the House of Representatives, and held
at the Capitol in the City of Tallahassee in the State of Florida, on Tuesday, February 2, 1988.



The House was called to order by the Honorable Jon Mills, Speaker,
at 1:00 p.m.
The following proclamation was read:

THE FLORIDA LEGISLATURE
JOINT PROCLAMATION

TO THE HONORABLE MEMBERS OF THE FLORIDA SENATE
AND THE FLORIDA HOUSE OF REPRESENTATIVES:
We, John W. Vogt, President of The Florida Senate, and Jon L.
Mills, Speaker of the Florida House of Representatives, by virtue of the
authority vested in us by Section 3, Article III, Florida Constitution,
and Section 11.011, Florida Statutes, do hereby proclaim:
1. That the Legislature of the State of Florida is convened in Special
Session pursuant to Section 3(c), Article III, Florida Constitution and
Section 11.011, Florida Statutes, at the Capitol in Tallahassee, Florida
at 1:00 p.m., on Tuesday, the 2nd day of February, 1988, for a period of
three days, ending at 5:00 p.m., Thursday, February 4, 1988.
2. That the Legislature is convened for the sole and exclusive
purposes of consideration of the following matters:
1) Medical Liability, Medical Regulatory, ard Medical Insurance
Reform
2) State Group Insurance Programs



JOHN W. VOGT
President,
The Florida Senate
DATE: January 5, 1988



JON L. MILLS
Speaker,
The Florida House of Representatives
DATE: January 4, 1988











Duly filed with and received by
the Florida Department of State
this 5th day of January, 1988
by:
JIM SMITH



Prayer
The following prayer from the book of Psalms was offered by
Representative Fran Carlton:
Our Father, God of the Universe. Be merciful unto us, bless us, and
cause Your face to shine upon us. Lead us, Oh Lord, in Thy
righteousness; make Your way straight before us, for in Thee do we
trust. Oh, send out Your light and Your truth and let them lead us!
Create in us, clean hearts, Oh God, renew a right spirit within us.
Our fathers trusted in Thee; they trusted, and You delivered them.
Incline Thine ear unto us. Keep us under the shadow of Thy wings.
Blessed be the Lord God of Israel from everlasting and to everlasting.
For Thine is the Kingdom, and the Power, and the Glory, forever.
Amen.
The following Members were recorded present:



The Chair
Abrams
Arnold
Ascherl
Bainter
Banjanin
Bankhead
Bass
Bell
Bloom
Bronson
Brown
Burke
Burnsed
Canady
Carlton
Carpenter
Casas
Clark
Clements
Cosgrove
Crady
Crotty
Dantzler
Davis
Deutsch
Diaz-Balart
Drage
Dunbar
Figg



Frankel
Friedman
Frishe
Gaffney
Garcia
Gardner
Glickman
Gonzalez-
Quevedo
Goode
Gordon
Grindle
Guber
Gustafson
Gutman
Hanson
Harden
Hargrett
Harris
Hawkins
Healey
Hill
Hodges
Holland
Ireland
Irvine
Jamerson
Jennings
Johnson, B. L.
Johnson, R. C.



Jones, C. F.
Jones, D. L.
Kelly
King
Langton
Lawson
Lewis
Liberti
Lippman
Locke
Logan
Lombard
Long
Mackenzie
Mackey
Martin
Martinez
McEwan
Meffert
Messersmith
Metcalf
Mitchell
Morse
Mortham
Nergard
Ogden
Ostrau
Patchett
Peeples
Press



Reaves
Reddick
Rehm
Renke
Rochlin
Rudd
Rush
Sample
Sanderson
Sansom
Saunders
Shelley
Silver
Simon
Simone
Smith
Souto
Starks
Stone
Thomas
Titone
Tobiassen
Tobin
Trammell
Troxler
Upchurch
Webster
Wetherell
Woodruff
Young



Excused: Representative Wallace.
A quorum was present.
Under Rule 5.17, Representative Gaffney was reinstated on Decem-
ber 18, 1987 after verdict was vacated.
Pledge
The Members pledged allegiance to the Flag.



1










JOURNAL OF THE HOUSE OF REPRESENTATIVES



House Physician
The Speaker introduced Dr. Tony McDonald of Gainesville, who was
serving in the Clinic today, upon invitation of Representative Martin.

The Journal

The Journal of December 9, 1987, Special Session "D", was approved
as corrected.

Committee Members Announced
On July 9, 1987, the Speaker announced the creation of a sixteen
member ad hoc Committee on Medical Malpractice Insurance. The
group was given the responsibility to report to the House on possible
solutions to the malpractice crisis. The members appointed were: Rep.
Ogden, Chairman, Rep. Upchurch, Vice Chairman, Representatives
Abrams, Bell, Burke, Carpenter, Dunbar, Gardner, Gordon, Gustafson,
Hawkins, Lippman, Patchett, Renke, Simon, and Thomas.
On July 10, 1987, the Speaker announced the House appointees to
the Joint Working Group on Medical Malpractice Insurance, consisting
of twelve members, the Governor, Senate President and Speaker of the
House each appointing four. House members appointed were: Speaker
pro tempore Burke and Representatives Carpenter, Ogden, and
Patchett.

Changes in Committee Assignments
Representatives C. F. Jones and Souto have been removed from the
Committee on Appropriations, effective February 1.

Abolishment of the Select Committee on Special Districts
The Speaker advised the Select Committee on Special Districts had
been abolished, effective February 1. The members serving on this
Select Committee were Representatives C. F. Jones (Chairman),
Gardner (Vice Chairman), Figg, Hanson, Ogden, Peeples, and Troxler.

Change in Majority Leadership
The Speaker advised that Rep. Mackenzie had been appointed
Majority Whip, effective February 1, replacing Rep. Canady.

Introduction and Reference

By Representatives Bell, Patchett, Clements, Lippman, Shelley,
Grindle, Guber, Sanderson, Casas, Sansom, Ireland, Rochlin, Gardner,
Goode, Metcalf, Renke, Simone, Ascherl, Hodges, Martin, Thomas,
Gonzalez-Quevedo, Mortham, Hanson, Stone, Figg, Metcalf, Rehm,
Tobiassen, Long, Smith, Kelly, Hawkins, Carlton, Irvine, Bainter,
Locke, Crotty, Reddick, Hill, Troxler, Garcia, Gutman, Sample,
Bloom-
HB 1-E-A bill to be entitled An act relating to medical incident
recovery; creating a chapter in F.S.; creating the "Florida Medical
Incident Recovery Act of 1988"; providing applicability and scope;
creating a plan for prompt resolution of medical negligence claims;
providing legislative findings and intent; providing definitions; pro-
viding applicability of and procedure for mandatory presuit investiga-
tion and medical expert corroboration of medical negligence claims and
defenses by prospective parties; requiring availability of medical
records for presuit screening of claims and defenses and providing
penalties; providing for presuit discovery of medical negligence claims
and defenses and providing immunity with respect thereto; providing
for presuit investigation of medical negligence claims and defenses by
the court, and providing penalties for lack of reasonable investigation
in filing or in corroborating medical negligence claims or defenses;
providing for voluntary binding arbitration of medical negligence
claims; precluding voluntary binding arbitration with respect to
actions for wrongful death and actions involving defendants who have
sovereign immunity under s. 768.28, F.S.; providing for voluntary
binding arbitration to allocate responsibility among multiple defen-
dants to medical negligence claims; providing disincentives to a party



failing to offer or accept voluntary binding arbitration; providing
misarbitration procedure; providing for payment of arbitration award



and interest; providing for appeal of award; creating the medical care
availability assistance plan; providing legislative findings and intent;
providing definitions; creating the Florida Medical Care Availability
Assistance Trust Fund, to be administered by the Department of
Insurance; providing funding for such fund, including an initial
appropriation from the Insurance Commissioner's Regulatory Trust
Fund, and providing for distributions; providing for physician eligibili-
ty to receive premium assistance from such fund; providing for
designation by the Department of Health and Rehabilitative Services
of medical manpower shortage areas for purposes of physician
availability assistance and providing a penalty for physicians who fail
to cooperate with such department in making such designation;
requiring a report; providing rulemaking authority; providing for
review and repeal; creating the Florida Birth-Related Neurological
Injury Compensation Plan; providing legislative findings and intent;
providing definitions; providing exclusiveness of remedy; providing for
the hearing of claims by deputy commissioners of the Division of
Workers' Compensation of the Department of Labor and Employment
Security; providing procedure for the filing of claims and responses;
providing for medical disciplinary review; providing for tolling of the
statute of limitations; providing for hearings, parties, and discovery;
providing for review by a medical advisory panel; providing for
determination of claims; providing a presumption as to injury;
providing for binding nature of findings; providing for awards for
birth-related neurological injuries, and for notice of such awards;
providing for conclusiveness of determination or award; providing for
appeal; providing for enforcement of awards; providing a limitation on
the bringing of claims; creating the Birth-Related Neurological Injury
Compensation Trust Fund within the Department of Insurance and
providing for administration of the fund by the Florida Birth-Related
Neurological Injury Compensation Association pursuant to a plan of
operation approved by said department; providing for assessments for
participation in the plan; providing for actuarial valuation of the fund
by the department; providing for membership and a board of directors
for the association; providing powers and duties of the association;
providing for notice to obstetrical patients of participation in the plan;
providing for medical emergency care liability reform; providing
legislative findings and intent; providing definitions; providing immu-
nity from civil liability for medical emergency care facilities and
providers; providing rulemaking authority; amending s. 20.30, F.S.;
creating the Division of Medical Quality Assurance within the
Department of Professional Regulation and creating the Bureau of
Medical Regulation within said division; providing duties of the
division and bureau; requiring a report; placing the Board of Medicine
and the Board of Osteopathic Medical Examiners within the division;
amending s. 395.0115, F.S.; providing antitrust immunity through
establishment of a state-mandated peer review process; requiring
licensed facilities to provide for peer review of physicians who provide
health care services at such facilities and providing procedures
therefore; requiring report of final disciplinary actions to the Division of
Medical Quality Assurance for further investigation; providing for peer
review panel immunity and for confidentiality of records; amending
s. 395.509, F.S., relating to review of hospital budgets, to provide for
approval of assessments to fund the birth-related neurological injury
plan; amending s. 395.504, F.S., to correct a cross-reference; amending
s. 455.225, F.S.; providing civil immunity and prohibition from
discharge to persons reporting with respect to incompetence, impair-
ment, or unprofessional conduct of specified health care providers;
providing a penalty; creating s. 455.28, F.S.; requiring reporting of
certain physicians for violation of grounds for disciplinary action;
providing a penalty; requiring establishment of a toll-free telephone
system for receiving grievances and providing information about
physicians; requiring investigation of probable disciplinary violations;
amending ss. 458.331 and 459.015, F.S.; providing additional grounds
for disciplinary action against physicians and osteopathic physicians;
providing penalties and providing priorities for application thereof;
establishing the burden of proof for administrative actions against
physicians; providing for injunctive relief; amending ss. 460.413,
461.013, 464.018, 465.016, and 466.028, F.S.; providing additional
grounds for disciplinary action against chiropractic physicians, podia-
trists, nurses, pharmacists, and dentists; amending s. 768.19, F.S.;



providing for presuit investigation of medical negligence claims in
wrongful death actions; amending s. 768.40, F.S.; providing for



February 2, 1988



2











JOURNAL OF THE HOUSI



professional society review of certain physicians; providing specified
immunity with respect thereto; amending s. 768.57, F.S.; expanding
notice requirements prior to filing a claim for medical malpractice;
stipulating informal discovery provisions with respect to presuit
screening of such claims; creating s. 768.67, F.S.; prohibiting settle-
ment agreements from denying parties thereto the right to discuss
with or report to the Division of Medical Quality Assurance the events
giving rise to the claim; amending s. 240.213, F.S.; providing for
medical malpractice damages which are attributed to the Board of
Regents; providing severability; providing an effective date.
-was read the first time by title and referred to the Committees on
Insurance and Appropriations.

By Representatives Bell, Clements, Souto, Sanderson, Guber, Roch-
lin, Gardner, Goode, Metcalf, Patchett, Ascherl, Hodges, Thomas-
HJR 2-E-A joint resolution proposing an amendment to Section 21
of Article I of the State Constitution relating to medical malpractice.
-was read the first time by title and referred to the Committees on
Judiciary and Appropriations.

By Representative Kelly-
HB 3-E-A bill to be entitled An act relating to regulation of
professions and occupations; amending s. 455.213, F.S., providing for
establishment of initial license fee by rule; providing a period for
issuance; authorizing professional regulatory boards to defer compli-
ance with continuing education requirements; amending s. 455.218,
F.S., modifying eligibility requirements for examination for licensure
of foreign-trained professionals; deleting provisions relating to a
special license for podiatric technicians; amending s. 455.219, F.S.,
providing for establishment of license application and examination fees
by rule; providing for refund of examination fee under certain
circumstances; providing a fee for verifying licensure and disciplinary
status; amending s. 455.232, F.S., prohibiting unlawful conveyance or
misuse of a license; providing penalties; amending s. 455.24, F.S.,
including acupuncturists under provisions regulating advertisement
by health care providers of free or discounted services; amending
s. 455.241, F.S., providing for reports of psychiatric examination and
treatment; authorizing disclosure of confidential patient-psychiatrist
communications under certain circumstances; amending ss. 458.347
and 459.022, F.S., relating to physician's assistants and osteopathic
physician assistants, respectively, to permit applicants who fail the
proficiency examination to apply for a second year of temporary
certification; amending s. 460.408, F.S., providing conditions for
approval of continuing education courses by the Board of Chiropractic;
repealing s. 455.218, F.S., relating to examination and licensure of
foreign-trained professionals; repealing s. 455.2182, F.S., relating to
construction of chapter 86-290, Laws of Florida; providing an effective
date.
Consideration of the bill was temporarily deferred. Subsequently,
Rep. Kelly moved that HB 3-E be admitted for introduction, the
Speaker having ruled the measure was outside the purview of the Call,
which was agreed to by the required Constitutional two-thirds vote
and the bill was read the first time by title and referred to the
Committees on Regulatory Reform and Appropriations.

By Representative Liberti--
HB 4-E-A bill to be entitled An act relating to medical negligence;
providing that, except when the right of subrogation exists, the
amount of damages awarded to a medical malpractice claimant be
reduced by the amount of all collateral source payments; providing for
the court to receive evidence and testimony regarding such claimant's
collateral source benefits; providing definitions; providing for setting
certain legal fees; limiting the right of an insurer or provider of
collateral source benefits to recover certain benefit amounts; amending
s. 768.57, F.S.; requiring an investigation to determine negligent care
or treatment and a written expert opinion finding evidence of medical
negligence prior to filing a notice of intent to initiate medical
malpractice litigation; providing requirements for such notice of
intent; providing that the question of the receipt of such notice of



intent to initiate litigation is a question of fact for the court; requiring
a defendant to obtain a written expert opinion that there appears to be



February 2, 1988



By Representative Bell-
HB 5-E-A bill to be entitled An act relating to notes secured by
mortgages; amending s. 697.06, F.S.; repealing certain restrictions on



OF REPRESENTATIVES 3

no evidence of medical negligence prior to denying a claim for medical
malpractice; deleting provisions providing procedures for the investi-
gation, review, and evaluation by an insurer of malpractice claims;
providing for the investigation of claims by the Medical Negligence
Liability Insurance Trust Fund or its agent; deleting the provision
whereby a settlement offer may be made by the insurer; requiring a
defendant to either reject a claim of medical malpractice or admit
financial responsibility and submit to binding arbitration on the issue
of damages; deleting provisions deeming the failure of a prospective
defendant to reply to a notice of intent to initiate litigation as a
rejection of the claim; clarifying the application of the work product
rule to the presuit screening process; providing for discovery of
documents or things prior to the filing of suit; providing for certain
unsworn statements to be used for presuit screening; providing that a
claimant or his attorney is personally liable for attorney's fees and
costs if a notice of intent to initiate litigation is sent in bad faith;
providing that a defendant or his attorney is personally liable for
attorney's fees and costs if a defendant denies in bad faith a claim for
medical malpractice; requiring each party to a medical malpractice
action to provide, upon motion, a copy of the written report upon which
the claim or denial of a claim is based; authorizing a court to dismiss a
claim or provide certain other relief if a claim or answer is filed
without good cause; providing for a settlement conference conducted by
a court-appointed mediator; providing that an attorney acting in bad
faith in certain medical malpractice matters or filing certain unsuc-
cessful malpractice actions be referred to The Florida Bar for
disciplinary review; repealing s. 768.575, F.S., relating to court-
ordered arbitration of medical malpractice claims; providing amended
procedures for such arbitration in actions filed after a specified date;
providing qualifications for arbitrators; providing for selecting arbi-
tration panels; providing procedures for arbitration hearings; requiring
that an award of damages be made by unanimous decision of the
arbitration panel; providing for the settlement of disputed financial
responsibility by arbitration; providing for the payment of arbitration
panels and attorney's fees; amending s. 768.54, F.S., relating to the
Florida Patient's Compensation Fund; deleting certain documentation
requirements, minimum fund entry level requirements, and member-
ship fee requirements for health care providers that participate in the
fund; prohibiting the fund from providing coverage for any fiscal year
beginning after a specified date; creating the Medical Negligence
Liability Insurance Trust Fund; providing definitions; defining the
coverage afforded by the fund; providing for fund administration,
operation, and powers; providing for appointment of the board of
governors of the fund and for the organization and meetings of the
board; providing for fees and assessments for participants in the fund;
providing for fund accounting, records, and audits; providing a
procedure for claims against participants covered by the fund;
providing for the payment of settlements and judgments; amending
ss. 458.331, 459.015, 627.912, F.S.; revising the grounds for disciplin-

ary action against a physician or osteopathic physician by the
Department of Professional Regulation; prescribing duties of the
Department of Insurance; providing conforming language; amending
ss. 395.017, 455.241, F.S.; providing a penalty for a hospital or health
care practitioner failing to appropriately release certain patient
records; amending s. 395.0115, F.S.; providing a standard for the
burden of proof required in an action seeking reinstatement of staff
privileges at a health care facility; establishing a system of physician's
grievance committees to hear complaints filed with the Board of
Medicine or the Department of Professional Regulation; providing
definitions; providing for committee membership and terms of office;
providing for committee meetings and quorum requirements; providing
for committee investigations and proceedings; requiring the committee
to forward a formal complaint to the board and the department upon a
finding of probable cause to justify disciplinary action; providing
certain limitations on committee membership; providing an effective
date.
-was read the first time by title and referred to the Committees on
Insurance and Appropriations.










4 JOURNAL OF THE HOUSE

assessing certain charges, fees, or penalties for the prepayment of such
a note when the obligee has accelerated the maturity date of such note;
providing an effective date.
Consideration of the bill was temporarily deferred. Subsequently,
Rep. Bell moved that the rules be waived and HB 5-E be admitted for
introduction, the Speaker having ruled the measure was outside the
purview of the Call, which was agreed to by the required Constitu-
tional two-thirds vote and the bill was read the first time by title and
referred to the Committee on Commerce.

By Representative Glickman-
HB 6-E-A bill to be entitled An act relating to medical malpractice;
establishing the Medical Catastrophic Injury Fund within the Depart-
ment of Insurance to ensure the payment of all settlements, verdicts,
and judgments in excess of insurance limits of health care providers
who are in compliance with mandatory medical malpractice basic
insurance coverages; providing administrative and rulemaking author-
ity to the department with respect to such fund; amending s. 20.30,
F.S.; revising the structure of the Department of Professional Regula-
tion; amending ss. 390.026 and 395.041, F.S.; requiring the obtention
and maintenance of basic medical malpractice insurance coverage and
providing immunity for excess awards for complying facilities; amend-
ing s. 395.0115, F.S.; providing for peer review and for reports to and
investigation by the Division of Medical Quality Assurance; amending
s. 455.225, F.S.; providing specified immunity with respect to certain
civil actions; creating s. 455.28, F.S.; providing for reporting of
violations of grounds for disciplinary actions; providing penalties;
providing a toll-free telephone system; amending ss. 458.320 and
459.0085, F.S.; increasing the required amounts of basic medical
malpractice insurance coverage and providing that complying physic-
ians shall not be responsible for settlements, verdicts, or judgments in
excess of such insurance limits; amending ss. 458.331 and 459.015,
F.S.; providing additional grounds against physicians and osteopathic
physicians for disciplinary action; providing sanctions in cases involv-
ing medical malpractice and mandating disciplinary action for in-
stances of serious malpractice; providing for injunction; providing for
department review and investigation of certain claims; amending
ss. 460.413, 461.013, 464.018, 465.016, and 466.028, F.S.; providing
additional grounds for disciplinary action against chiropractic physic-
ians, podiatrists, nurses, pharmacists, and dentists; amending
s. 627.357, F.S.; authorizing self-insurance for hospitals and specified
health care facilities but not for physicians or other health care
practitioners; amending s. 627.351, F.S.; revising the make-up of the
board of governors of the Joint Underwriting Association; creating the
premium stabilization plan; providing coverage requirements and
limits; providing the type of coverage available; providing rate criteria;
providing when a physician may not obtain coverage; providing deficit
criteria; providing activation criteria; providing that certain premiums
collected by the Joint Underwriting Association are exempt from the
premium tax; amending s. 627.6057, F.S.; increasing the required offer
of coverage limits; amending s. 627.912, F.S.; providing for mandatory
reporting by the Department of Insurance of settlements, verdicts, and
judgments against health care providers to the appropriate regulatory
agency for malpractice investigation; creating s. 627.9127, F.S.; pro-
viding expanded authority of the Department of Insurance regarding
medical malpractice actions; amending s. 768.19, F.S.; making presuit
investigation requirements applicable to wrongful death actions;
amending s. 768.28, F.S., to delete a cross-reference; amending
s. 768.40, F.S.; providing specified immunity from liability for mem-
bers of state or local professional medical societies; amending s. 768.54,
F.S.; providing that health care providers in compliance with manda-
tory basic medical malpractice insurance coverages shall not be
responsible for amounts of claims in excess of such basic coverage;
providing that such overage, to the extent it exceeds such basic
coverage and an elected limit of coverage by the Florida Patient's
Compensation Fund, shall be paid by the Medical Catastrophic Injury
Fund; increasing the amounts of coverages required to demonstrate



E



financial responsibility; amending s. 768.57, F.S.; providing for infor-
mal discovery; creating s. 768.597, F.S.; providing for comparative
fault and contribution in tort actions; creating s. 768.67, F.S.; prohibit-
ing restriction of disclosure of settlement agreements; providing a
prompt resolution plan for medical negligence claims; providing



OF REPRESENTATIVES February 2, 1988

findings and intent; providing definitions; providing for presuit
investigation by prospective parties; providing for availability of
medical records; providing penalties; providing for presuit investiga-
tion by court; providing a plan for voluntary binding arbitration of
medical negligence claims; providing for allocation of responsibility
among multiple defendants; providing for effects of failure to offer or
accept arbitration; providing for misarbitration; providing for payment
of award and interest; providing for appeal of arbitration award;
repealing s. 768.31, F.S., relating to contribution among tortfeasors;
repealing s. 768.81, F.S., relating to comparative fault; providing an
effective date.
-was read the first time by title and referred to the Committees on
Insurance and Appropriations.

By Representatives Bell, Ogden, Lippman-
HB 7-E-A bill to be entitled An act relating to medical incident
recovery; creating a chapter in F.S.; creating the "Florida Medical
Incident Recovery Act of 1988"; providing applicability and scope;
creating a plan for prompt resolution of medical negligence claims;
providing legislative findings and intent; providing definitions; pro-
viding applicability of and procedure for mandatory presuit investiga-
tion and medical expert corroboration of medical negligence claims and
defenses by prospective parties; requiring availability of medical
records for presuit screening of claims and defenses and providing
penalties; providing for presuit discovery of medical negligence claims
and defenses and providing immunity with respect thereto; providing
for presuit investigation of medical negligence claims and defenses by
the court, and providing penalties for lack of reasonable investigation
in filing or in corroborating medical negligence claims or defenses;
providing for voluntary binding arbitration of medical negligence
claims; precluding voluntary binding arbitration with respect to
actions for wrongful death and actions involving defendants who have
sovereign immunity under s. 768.28, F.S.; providing for voluntary
binding arbitration to allocate responsibility among multiple defen-
dants to medical negligence claims; providing disincentives to a party
failing to offer or accept voluntary binding arbitration; providing
misarbitration procedure; providing for payment of arbitration award
and interest; providing for appeal of award; creating the medical care
availability assistance plan; providing legislative findings and intent;
providing definitions; creating the Florida Medical Care Availability
Assistance Trust Fund, to be administered by the Department of
Insurance; providing funding for such fund, including an initial
appropriation from the Insurance Commissioner's Regulatory Trust
Fund, and providing for distributions; providing for physician eligibili-
ty to receive premium assistance from such fund; providing for
designation by the Department of Health and Rehabilitative Services
of medical manpower shortage areas for purposes of physician
availability assistance and providing a penalty for physicians who fail
to cooperate with such department in making such designation;
requiring a report; providing rulemaking authority; providing for
review and repeal; creating the Florida Birth-Related Neurological
Injury Compensation Plan; providing legislative findings and intent;
providing definitions; providing exclusiveness of remedy; providing for
the hearing of claims by deputy commissioners of the Division of
Workers' Compensation of the Department of Labor and Employment
Security; providing procedure for the filing of claims and responses;
providing for medical disciplinary review; providing for tolling of the
statute of limitations; providing for hearings, parties, and discovery;
providing for review by a medical advisory panel; providing for
determination of claims; providing a presumption as to injury;
providing for binding nature of findings; providing for awards for
birth-related neurological injuries, and for notice of such awards;
providing for conclusiveness of determination or award; providing for
appeal; providing for enforcement of awards; providing a limitation on
the bringing of claims; creating the Birth-Related Neurological Injury
Compensation Trust Fund within the Department of Insurance and
providing for administration of the fund by the Florida Birth-Related



Neurological Injury Compensation Association pursuant to a plan of
operation approved by said department; providing for assessments for
participation in the plan; providing for actuarial valuation of the fund
by the department; providing for membership and a board of directors
for the association; providing powers and duties of the association;











JOURNAL OF THE HOUSE OF REPRESENTATIVES



providing for notice to obstetrical patients of participation in the plan;
providing for medical emergency care liability reform; providing
legislative findings and intent; providing definitions; providing immu-
nity from civil liability for medical emergency care facilities and
providers; providing rulemaking authority; providing legislative find-
ings and intent regarding regulatory reform; amending s. 20.30, F.S.;
creating the Division of Medical Quality Assurance within the
Department of Professional Regulation and creating the Bureau of
Medical Regulation within said division; providing duties of the
division and bureau; requiring a report; placing the Board of Medicine
and the Board of Osteopathic Medical Examiners within the division;
amending s. 395.0115, F.S.; providing antitrust immunity through
establishment of a state-mandated peer review process; requiring
licensed facilities to provide for peer review of physicians who provide
health care services at such facilities and providing procedures
therefore; requiring report of final disciplinary actions to the Division of
Medical Quality Assurance for further investigation; providing for peer
review panel immunity and for confidentiality of records; amending
s. 395.017, F.S.; providing maximum charge for copying records;
providing access to confidential patient records for certain proceedings
of the Department of Professional Regulation; limiting public access
thereto; amending s. 395.041, F.S.; expanding internal risk manage-
ment education and training requirements; requiring certain incident
reports relating to surgical procedures; requiring report of certain
incidents to the department; limiting public access; providing for
department review and investigation of incidents which may involve
conduct subject to discipline; providing an administrative fine for
violation of reporting requirements; providing for annual review of
risk management programs; protecting risk managers from liability
for implementation of risk management programs; requiring a report
to the Legislature; amending s. 395.504, F.S., to correct a cross-refer-
ence; amending s. 395.509, F.S., relating to review of hospital budgets,
to provide for approval of assessments to fund the birth-related
neurological injury plan; amending s. 455.225, F.S.; providing civil
immunity and prohibition from discharge to persons reporting with
respect to incompetence, impairment, or unprofessional conduct of
specified health care providers; providing penalties; amending
s. 455.241, F.S.; providing for reports of patient records; creating
s. 455.2415, F.S.; providing for disclosure of patient communications
under certain circumstances; amending s. 455.242, F.S.; providing for
disposition of records of physicians who terminate practice or relocate;
amending s. 455.245, F.S.; providing conditions for considering emer-
gency suspension or restriction of a license; creating s. 455.247, F.S.;
requiring physicians, osteopathic physicians, podiatrists, and dentists
to report professional liability claims and actions to the department;
specifying contents; creating s. 455.28, F.S.; requiring reporting of
certain physicians for violation of grounds for disciplinary action;
providing a penalty; requiring establishment of a toll-free telephone
system for receiving grievances and providing information about
physicians; requiring investigation of probable disciplinary violations;
amending s. 458.307, F.S.; modifying membership of the Board of
Medicine; specifying composition of probable cause panels; providing
for a training program; providing for completion of a panel's work;
amending s. 458.311, F.S.; relating to requirements for licensure of
physicians by examination; providing for an investigative process;
providing for restricted licenses; amending s. 458.313, F.S.; providing
for an investigative process for licensure by endorsement; requiring
certain active practice; providing for restricted licenses; amending
s. 458.315, F.S.; prohibiting issuance of temporary certificates for
practice in areas of critical need to certain persons by endorsement;
amending s. 458.3165, F.S.; providing for biennial renewal of public
psychiatry certificates; amending s. 458.319, F.S.; requiring evidence
of active practice for license renewal; providing for supervised practice;
amending ss. 458.320 and 459.0085, F.S.; authorizing physicians and
osteopathic physicians to use risk retention groups to meet financial
responsibility requirements; amending ss. 458.331 and 459.015, F.S.;
providing additional grounds for disciplinary action against physicians
and osteopathic physicians; providing penalties and providing priori-
ties for application thereof; establishing the burden of proof for
administrative actions against physicians; providing for injunctive
relief; providing for department review and investigation of claims;



amending s. 458.337, F.S.; specifying requirements for reports by
medical organizations and hospitals when the physician has resigned;



amending s. 458.345, F.S.; establishing requirements for registration
of resident physicians and interns; providing a fee; restricting renewal
or extension; prohibiting registration of certain persons; increasing a
penalty; amending ss. 458.347 and 459.022, F.S.; allowing extended
temporary certification of physician assistants and osteopathic physic-
ian assistants; amending s. 459.0055, F.S.; providing for an investiga-
tive process for licensure of osteopathic physicians; amending
s. 459.008, F.S.; requiring evidence of active practice for license
renewal; providing for supervised practice; amending ss. 460.413,
461.013, 464.018, 465.016, and 466.028, F.S.; providing additional
grounds for disciplinary action against chiropractic physicians, podia-
trists, nurses, pharmacists, and dentists; amending s. 627.912, F.S.;
requiring insurers to report certain claims against dentists; providing
for department review and investigation; providing for an annual
report; amending s. 641.55, F.S.; providing for department review and
investigation of certain incidents reported by health maintenance
organization internal risk management programs; limiting public
access; requiring report of certain incidents relating to surgical
procedures; amending s. 768.19, F.S.; providing for presuit investiga-
tion of medical negligence claims in wrongful death actions; amending
s. 768.40, F.S.; providing for professional society review of certain
physicians; providing specified immunity with respect thereto; amend-
ing s. 768.57, F.S.; expanding notice requirements prior to filing a
claim for medical malpractice; stipulating informal discovery provi-
sions with respect to presuit screening of such claims; creating
s. 768.67, F.S.; prohibiting settlement agreements from denying par-
ties thereto the right to discuss with or report to the Division of
Medical Quality Assurance the events giving rise to the claim;
amending s. 240.213, F.S.; providing for medical malpractice damages
which are attributed to the Board of Regents; repealing s. 768.66, F.S.,
relating to medical malpractice impact study; providing severability;
providing an effective date.
-was read the first time by title and referred to the Committees on
Insurance and Appropriations. On motion by Rep. Upchurch, Chair-
man, without objection, the bill was referred also to the Committee on
Judiciary.

By Representative Carlton-
HB 8-E-A bill to be entitled An act relating to driving under the
influence; amending s. 316.192, F.S., providing an additional penalty
for reckless driving under certain circumstances; amending s. 316.193,
F.S., providing clarifying language with respect to convictions for
driving under the influence with a certain blood alcohol level;
providing clarifying language with respect to substance abuse educa-
tion, evaluation, and treatment for a violation of law relating to
driving under the influence; amending s. 316.1932, F.S., deleting
reference to a prearrest breath test; authorizing the use of infrared
light measuring devices approved by the Department of Health and
Rehabilitative Services for breath testing of motorists to determine
blood alcohol levels; amending s. 316.1933, F.S., authorizing blood
testing of certain persons under certain circumstances; deleting a
restriction on certified paramedics withdrawing blood for the purpose
of determining alcohol content; amending s. 316.1934, F.S.; authoriz-
ing the use of infrared light measuring devices approved by the
Department of Health and Rehabilitative Services for breath testing of
motorists to determine blood alcohol levels; providing an effective date.
Consideration of the bill was temporarily deferred. Subsequently,
Rep. Carlton moved that HB 8-E be admitted for introduction, the
Speaker having ruled the measure was outside the purview of the Call,
which was agreed to by the required Constitutional two-thirds vote
and the bill was read the first time by title and referred to the
Committees on Criminal Justice and Appropriations.

By Representative Gardner-
HB 9-E-A bill to be entitled An act relating to tax on sales, use,
and other transactions; amending s. 212.08, F.S.; restricting the
application of an exemption for charges for aircraft modification
services; amending section 49 of chapter 87-548, Laws of Florida;
extending the application of provisions which authorize a refund to



certain contractors of additional taxes paid; providing effective and
retroactive effective dates.



February 2, 1988



5











6 JOURNAL OF THE HOUSI

Consideration of the bill was temporarily deferred. Subsequently,
Rep. Gardner moved that HB 9-E be admitted for introduction, the
Speaker having ruled the measure was outside the purview of the Call,
which was agreed to by the required Constitutional two-thirds vote
and the bill was read the first time by title and referred to the
Committees on Finance & Taxation and Appropriations.

By Representatives Lawson, Abrams, Rudd-
HB 10-E-A bill to be entitled An act relating to the State Group
Insurance Program; amending s. 110.123, F.S., providing definitions;
providing legislative intent; repealing authorization for competitive
bidding to contract with health maintenance organizations; authoriz-
ing the Department of Administration to negotiate contracts with
health maintenance organizations to service members of the state
group insurance program; establishing maximum premiums, a mini-
mum benefit package, and criteria to be used in negotiating health
maintenance organization contracts; entitling certain health mainte-
nance organizations to enter into contract with the Department of
Administration; requiring submission of certain data elements by
health maintenance organizations contracting with the state; provid-
ing an effective date.
-was read the first time by title and referred to the Committees on
Health Care and Appropriations.

By Representatives Lippman and D. L. Jones-
HB 11-E-A bill to be entitled An act relating to medical practice;
providing legislative intent; amending s. 20.30, F.S.; creating the
Division of Medical Quality Assurance within the Department of
Professional Regulation and creating the Bureau of Medical Regula-
tion within said division; providing duties of the division and bureau;
requiring a report; placing the Board of Medicine and the Board of
Osteopathic Medical Examiners within the division; amending
s. 395.0115, F.S.; providing antitrust immunity through establishment
of a state-mandated peer review process; requiring licensed facilities to
provide for peer review of physicians who provide health care services
at such facilities and providing procedures therefore; requiring report of
final disciplinary actions to the Division of Medical Quality Assurance
for further investigation; providing for peer review panel immunity
and for confidentiality of records; amending s. 395.017, F.S.; providing
maximum charge for copying records; providing access to confidential
patient records for certain proceedings of the Department of Profes-
sional Regulation; limiting public access thereto; amending s. 395.041,
F.S.; expanding internal risk management education and training
requirements; requiring certain incident reports relating to surgical
procedures; requiring report of certain incidents to the department;
limiting public access; providing for department review and investiga-
tion of incidents which may involve conduct subject to discipline;
providing an administrative fine for violation of reporting require-
ments; providing for annual review of risk management programs;
protecting risk managers from liability for implementation of risk
management programs; requiring a report to the Legislature; amend-
ing s. 455.225, F.S.; providing for proceedings for restriction of a
license; providing civil immunity and prohibition from discharge to
persons reporting with respect to incompetence, impairment, or
unprofessional conduct of specified physicians; providing a penalty;
amending s. 455.241, F.S.; providing for reports in lieu of certain
psychiatric-patient records; providing for transfer of records; providing
for assertion of psychiatrist-patient privilege; limiting public access to
records; providing maximum copying charges; providing for disclosure
of patient communications under certain circumstances; amending
s. 455.242, F.S.; providing for disposition of records of physicians who
terminate practice or relocate; amending s. 455.245, F.S.; providing
conditions for considering emergency suspension or restriction of a
license; creating s. 455.247, F.S.; requiring physicians, osteopathic
physicians, podiatrists, and dentists to report professional liability
claims and actions to the department; specifying contents; creating



s. 455.28, F.S.; requiring reporting of certain physicians for violation of
grounds for disciplinary action; providing a penalty; requiring investi-
gation of probable disciplinary violations; amending s. 458.303, F.S.;
clarifying an exception for federally commissioned medical officers;
amending s. 458.307, F.S.; modifying membership of the Board of



E



have to address this week. The reason we are here is to assure that we
provide adequate access to health care for the public that we represent;
affordable health care; that we protect the rights of individuals in the
judicial system of the State of Florida; and that we protect good
physicians from unnecessary law suits and excess insurance premiums.



SOF REPRESENTATIVES February 2, 1988

Medicine; specifying composition of probable cause panels; providing
for a training program; providing for completion of a panel's work;
amending s. 458.311, F.S.; relating to requirements for licensure of
physicians by examination; providing for an investigative process;
providing for restricted licenses; amending s. 458.313, F.S.; providing
for an investigative process for licensure by endorsement; requiring
certain active practice; providing for restricted licenses; amending
s. 458.315, F.S.; prohibiting issuance of temporary certificates for
practice in areas of critical need to certain persons by endorsement;
amending s. 458.3165, F.S.; providing for biennial renewal of public
psychiatry certificates; amending s. 458.319, F.S.; requiring evidence
of active practice for license renewal; providing for supervised practice;
amending ss. 458.320 and 459.0085, F.S.; authorizing physicians and
osteopathic physicians to obtain professional liability coverage from a
risk retention group; amending s. 458.327, F.S.; providing a penalty for
misrepresenting oneself as a licensed physician; amending ss. 458.331
and 459.015, F.S.; providing additional grounds for disciplinary action
against physicians and osteopathic physicians; providing penalties and
providing priorities for application thereof; establishing the burden of
proof for administrative actions against physicians; providing for
injunctive relief; providing for department review and investigation of
claims; amending ss. 458.3315 and 459.0155, F.S.; providing for
certain release of medical records of an impaired practitioner; amend-
ing s. 458.337, F.S.; specifying requirements for reports by medical
organizations and hospitals when the physician has resigned; amend-
ing s. 458.345, F.S.; establishing requirements for registration of
resident physicians and interns; providing a fee; restricting renewal or
extension; prohibiting registration of certain persons; increasing a
penalty; amending ss. 458.347 and 459.022, F.S.; allowing extended
temporary certification of physician assistants and osteopathic physic-
ian assistants; amending s. 459.0055, F.S.; providing for an investiga-
tive process for licensure of osteopathic physicians; amending
s. 459.008, F.S.; requiring evidence of active practice for license
renewal; providing for supervised practice; amending ss. 460.413,
461.013, 464.018, 465.016, and 466.028, F.S.; providing additional
grounds for disciplinary action against chiropractic physicians, podia-
trists, nurses, pharmacists, and dentists; providing for department
review and investigation of certain claims; amending s. 627.912, F.S.;
requiring insurers to report certain claims against dentists; providing
for department review and investigation; providing for an annual
report; amending s. 641.55, F.S.; providing for department review and
investigation of certain incidents reported by health maintenance
organization internal risk management programs; limiting public

access; requiring report of certain incidents relating to surgical
procedures; amending s. 768.40, F.S.; providing for professional society
review of certain physicians; providing for advisory reports to the
department; providing confidentiality; providing for review and repeal;
providing specified immunity; prohibiting causes of action against
health care providers for furnishing certain information; amending
s. 768.57, F.S.; requiring notice to the department prior to filing
certain malpractice claims; specifying contents; protecting claimants'
legal rights; providing for department review and investigation;
creating s. 768.67, F.S.; prohibiting settlement agreements from
denying parties thereto the right to discuss with or report to the
Division of Medical Quality Assurance the events giving rise to the
claim; providing effective dates.

-was read the first time by title and referred to the Committees on
Regulatory Reform and Appropriations.

Comments by Speaker Mills
The Speaker explained: First of all, I think it's important to make
clear why the Legislature called the session. The issue of medical
malpractice has been in front of this Legislature since last session. In
fact, we recognized the importance of it the last session by creating a
task force.
I think we have some very specific goals to keep in mind that we













Those goals are all laudatory, relatively straightforward and highly
difficult to achieve. So, we together in the next four days, with those
goals in mind, will attempt to improve the overall health care system
of the State.
There are five relatively specific issues, which I won't go into detail
about now, but I will mention to you, that are being considered and
these items are being discussed either with you in committees or
individually.
Overall the issues are: issues relating to non-economic damages and
caps, an attempt there to deal with the long term health care cost and
insurance cost to the medical profession; the arbitration issue. There is
also the premium subsidy issue, a separate issue being considered to
deal with the overall health care cost, or insurance cost to doctors; the
birth-related neurological injury plan, typically called the Virginia
Plan, to deal with a no-fault system for compensating badly-injured
babies, and to deal with the issue of emergency rooms. And that issue
is being dealt with in several different ways and will probably come to
us either as a standard of care issue or as a standard of evidence issue.
In terms of how the bills will be considered, the Insurance
Committee will meet upon adjournment today. Upon adjournment of
the Insurance Committee, the Health Care Committee will meet in 317
C to take up House Bill 10-E, the HMO Bill, and we expect that should
take no more than about an hour. This will allow the staff to sort out
what's happened to the malpractice bill in Insurance and upon
adjournment of Health Care, Judiciary will meet in Morris Hall and
take up the Malpractice Bill this afternoon. And I think at this point,
we decided that also Regulatory Reform would be meeting this
afternoon so it could take up its portion of the Medical Malpractice
Bill. And at eight o'clock in the morning, the Appropriations
Committee will meet. I neglected to mention the other portion of the
Medical Malpractice Bill is a DPR reform dealing with doctor review.
And approximately three hours after the Appropriations Committee
adjourns tomorrow, which we hope will be about 1:00 p.m., we would
intend to go into session.

Notice of Committee Meetings

On motion by Rep. Ogden, without objection, the rules were waived
and the Committee on Insurance was given permission to meet today
immediately upon adjournment in Morris Hall to consider HB 7-E for
two hours.
Rep. Bell announced a meeting of the Committee on Appropriations
at 8:00 a.m. tomorrow in Morris Hall to consider HBs 7-E, 10-E and
11-E.
On motion by Rep. Abrams, Chairman, without objection, the rules
were waived and the Committee on Health Care was given permission
to meet in Room 317 C upon adjournment of the Committee on
Insurance.
On motion by Rep. Upchurch, Chairman, without objection, the rules
were waived and the Committee on Judiciary was given permission to
meet upon adjournment of the Committee on Health Care to consider
HB 7-E.
On motion by Rep. Lippman, Chairman, without objection, the rules
were waived and the Committee on Regulatory Reform was given
permission to meet in Room 417 C, upon adjournment of the
Committee on Health Care to consider HBs 3-E and 11-E.
Rep. Carpenter, Chairman, announced a meeting of the Committee
on Rules & Calendar at 12 noon, tomorrow.

Announcements Relating to Previously Scheduled Committee
Meetings
The following announcements were made relating to committee
meetings as shown in Interim Calendar No. 6:
Rep. Burnsed, Chairman, announced the Subcommittee on Highway



7



Safety & Motor Vehicles of the Committee on Transportation has
changed its meeting scheduled for 1:00 p.m. today to 2:00 p.m.
Rep. Tobin, Chairman, announced the three subcommittees of the
Committee on Health & Rehabilitative Services will meet today at
2:00 p.m. as scheduled.
Rep. Mitchell, Chairman, announced the Committee on Agriculture
will meet today at 2:00 p.m. as scheduled.
Rep. Canady, Chairman, announced that the Subcommittee on
Crimes, Penalties & Prosecutions of the Committee on Criminal
Justice will meet today at 2:00 p.m. as scheduled.
Rep. Rush, Chairman, announced that the Subcommittee on Cultur-
al Affairs of the Committee on Tourism & Cultural Affairs will meet
today at 2:05 p.m. in Room 212 HOB as scheduled.

Announcements
Rep. Ostrau announced the birth of his first grandchild, Heather
Blair Ostrau, stating he was excited to be a grandfather.
Rep. Carpenter moved that the House, after receiving Reports, stand
in recess for the purpose of holding committee meetings, and
conducting other House business to reconvene at 1:00 p.m. tomorrow or
upon call of the Speaker. The motion was agreed to.

Reports of Standing Committees

The Committee on Regulatory Reform recommends the following
pass: HB 11-E
The above bill was referred to the Committee on Appropria-
tions.
The Committee on Health Care recommends a committee substitute
for the following: HB 10-E
The above committee substitute was referred to the Committee
on Appropriations and, under the rule, HB 10-E was laid on the
table.
The Committee on Insurance recommends the following pass:
HB 7-E, with 27 amendments
The above bill was referred to the Committee on Judiciary.

First Reading of Committee Substitute
by Publication

By the Committee on Health Care and Representatives Lawson,
Abrams, Rudd-
CS/HB 10-E-A bill to be entitled An act relating to the State
Group Insurance Program; amending s. 110.123, F.S., providing defini-
tions; providing legislative intent; repealing authorization for competi-
tive bidding to contract with health maintenance organizations;
authorizing the Department of Administration to negotiate contracts
with health maintenance organizations to service members of the state
group insurance program; establishing maximum premiums, a mini-
mum benefit package, and criteria to be used in negotiating health
maintenance organization contracts; entitling certain health mainte-
nance organizations to enter into contract with the Department of
Administration; requiring submission of certain data elements by
health maintenance organizations contracting with the state; provid-
ing an effective date.

Recessed

Pursuant to the motion previously agreed to, the House recessed at
1:44 p.m. to reconvene at 1:00 p.m. tomorrow or upon call of the
Speaker.



February 2, 1988



JOURNAL OF THE HOUSE OF REPRESENTATIVES

















C e JourRal OFTHE


V house of Ie preseqtatives



FIFTH SPECIAL SESSION--E" of 1986-1988



Wednesday, February 3, 1988



The House was called to order by the Speaker at 1:11 p.m.



Prayer



A quorum was present.

Pledge



The following prayer was offered by Representative Grindle:
Father, Creator of all things, we as elected Representatives, men,
women, conservatives, liberals, republicans, democrats, all stand
before You this day believing strongly in our American system of
government.
Let us turn for a moment with introspection, searching our
conscience for affirmation of our personal pledge to serve humanity.
Let us find solutions to our differences and join together to put the
interests of our constituents above all else. Help us reach consensus so
that the members of this great state may all benefit.
Set Your divine hand upon us giving us direction to use our special
gifts which You have provided. Expand our thinking and feed our
spirit with Your energy so that we, as a group, can find the best way of
serving all of the citizens of Florida. Amen.

The following Members were recorded present:



The Chair
Abrams
Arnold
Ascherl
Bainter
Banjanin
Bankhead
Bass
Bell
Bloom
Bronson
Brown
Burke
Burnsed
Canady
Carlton
Carpenter
Casas
Clark
Clements
Cosgrove
Crady
Crotty
Dantzler
Davis
Deutsch
Diaz-Balart
Drage
Dunbar
Figg
Frankel



Friedman
Frishe
Gaffney
Garcia
Gardner
Glickman
Gonzalez-
Quevedo
Goode
Gordon
Grindle
Guber
Gustafson
Gutman
Hanson
Harden
Hargrett
Harris
Hawkins
Healey
Hill
Hodges
Holland
Ireland
Irvine
Jamerson
Jennings
Johnson, B. L.
Johnson, R. C.
Jones, C. F.
Jones, D. L.



Kelly
King
Langton
Lawson
Lewis
Liberti
Lippman
Locke
Logan
Lombard
Long
Mackenzie
Mackey
Martin
Martinez
McEwan
Meffert
Messersmith
Metcalf
Mitchell
Morse
Mortham
Nergard
Ogden
Ostrau
Patchett
Peeples
Press
Reaves
Reddick
Rehm



Renke
Rochlin
Rudd
Rush
Sample
Sanderson
Sansom
Saunders
Shelley
Silver
Simon
Simone
Smith
Souto
Starks
Stone
Thomas
Titone
Tobiassen
Tobin
Trammell
Troxler
Upchurch
Wallace
Webster
Wetherell
Woodruff
Young



The Members pledged allegiance to the Flag.

House Physician
The Speaker introduced Dr. Linda Ann Marraccini of Miami, who
was serving in the Clinic today, upon invitation of Representative
Guber.

The Journal

The Journal of February 2 was approved as corrected.

Introduction and Reference

By Representatives Silver and Gordon-
HB 12-E-A bill to be entitled An act relating to weapons and
firearms; amending ss. 119.07 and 790.06, F.S.; authorizing the
Department of State to exempt certain persons from the residency
requirements for carrying a concealed weapon or firearm; exempting
information with respect to such persons from the public records law;
authorizing the Department of State to promulgate certain rules;
providing an effective date.
Rep. Silver moved that HB 12-E be admitted for introduction, the
Speaker having ruled the measure was outside the purview of the Call,
which was not agreed to. The vote was:
Yeas-31



Abrams
Bloom
Brown
Burke
Carlton
Cosgrove
Dantzler
Davis
Nays-80
Arnold
Ascherl
Bainter
Banjanin
Bankhead
Bass
Bronson
Burnsed
Canady
Carpenter
Casas
Clark
Clements
8



Deutsch
Figg
Friedman
Goode
Gordon
Guber
Healey
Lawson


Crady
Crotty
Diaz-Balart
Drage
Dunbar
Frishe
Gaffney
Garcia
Gardner
Glickman
Gonzalez-
Quevedo
Grindle



Liberti
Lipplman
Mackenzie
Metcalf
Ostrau
Press
Reddick
Rochlin


Gustafson
Gutman
Hanson
Harden
Hargrett
Harris
Hawkins
Hill
Holland
Ireland
Irvine
Jamerson
Jennings



Rush
Saunders
Silver
Simon
Tobin
Wallace
Young



Johnson, B. L.
Johnson, R. C.
Jones, C. F.
Jones, D. L.
Kelly
Lewis
Locke
Lombard
Long
Mackey
Martin
Martinez
McEwan



A digest of today's Chamber action appears on last page



Number 2











JOURNAL OF THE HOUSE OF REPRESENTATIVES



Meffert
Messersmith
Mitchell
Morse
Mortham
Nergard
Ogden
Patchett



Peeples
Renke
Rudd
Sample
Sanderson
Sansom
Shelley
Simone



Smith
Souto
Starks
Stone
Thomas
Titone
Tobiassen
Trammell



Troxler
Upchurch
Webster
Wetherell
Woodruff



Votes after roll call:

Yeas-Logan
Yeas to Nays-Tobin
By Representative Burnsed-

HB 13-E-A bill to be entitled An act relating to state uniform
traffic control; amending s. 316.302, F.S.; revising language with
respect to operation of a commercial motor vehicle; limiting periods of
time where a driver may be on duty; providing that certain commercial
vehicle operators are exempt from described rules; providing an
effective date.

Rep. Burnsed moved that HB 13-E be admitted for introduction, the
Speaker having ruled the measure was outside the purview of the Call,
which was agreed to by the required Constitutional two-thirds vote
and the bill was read the first time by title and placed on the Calendar.

Messages from the Senate

The Honorable Jon Mills, Speaker

I am directed to inform the House of Representatives that the Senate
has admitted for introduction and consideration by the required
Constitutional two-thirds vote and passed SB 7-E and requests the
concurrence of the House.

Joe Brown, Secretary



Report of the Committee on Rules & Calendar
The Honorable Jon Mills
Speaker, House of Representatives



February 3, 1988



Sir:
Your Committee on Rules & Calendar herewith submits as the
Special and Continuing Order Calendar under Rule 8.16 beginning
Wednesday, February 3, 1988, consideration of the following bills:
CS/HB 7-E-Florida Medical Incident Recovery Act
CS/HB 10-E-State Group Insurance Program
HB 13-E-State Uniform Traffic Control
HB 8-E-Driving Under Influence
HB 3-E-Professions & Occupations/Regulation
HB 9-E-Sales Tax/Aircraft Modification
A quorum of the Committee was present in person, and a majority of
those present agreed to the above Report.
Respectfully submitted,
Carl Carpenter, Jr., Chairman

Statement of Intent
On motion by Rep. D. L. Jones, the rules were waived and the
following statement of intent on HBs 1292 and 649, which passed the
House on June 3 and May 29, 1987 respectively, was spread upon the
Journal:
I was prime sponsor of Section 31 of HB 1292 which became Section
31 of Ch. 87-226, Laws of Florida and Section 1 of HB 649, which
became Section 1 of Ch. 87-282, Laws of Florida, which was identical
language and is now contained in Section 627.736(7)(a), F.S., 1987.
As prime sponsor, it was the legislative intent they were placed in
(7)(a) of 627.736 as the last sentence, rather than in a separate
subsection, because it was to be read in the context of Section 7(a)
requiring an actual mental or physical examination and should not be
taken out of context of 7(a).



Representative T. M. Woodruff
By Senators Meek and Gordon- District 58



SB 7-E-A bill to be entitled An act relating to the Legislature;
amending s. 11.12, F.S.; providing for legislators to designate employ-
ees who are to attend sessions and receive subsistence and travel
expenses in connection therewith; providing an effective date.

Rep. Burke moved that SB 7-E be admitted for introduction, the
Speaker having ruled the measure was outside the purview of the Call,
which was agreed to by the required Constitutional two-thirds vote
and the bill was read the first time by title and referred to the
Committee on House Administration.

Reports of Standing Committees

The Committee on Regulatory Reform recommends the following
pass: HB 3-E, with 8 amendments

The above bill was referred to the Committee on Appropria-
tions.

The Committee on Judiciary recommends a committee substitute for
the following: HB 7-E

The above committee substitute was referred to the Committee
on Appropriations and, under the rule, HB 7-E was laid on the
table.

The Committee on Appropriations recommends the following pass:
CS/HB 10-E, with 1 amendment (fiscal note attached)
CS/HB 7-E, with 25 amendments (fiscal note attached)

The above bills were placed in the Committee on Rules &
Calendar.



Motions Relating to Committee References

On motion by Rep. R. C. Johnson, Chairman, without objection, HB
5-E was withdrawn from the Committee on Commerce and placed on
the Calendar.
On motion by Rep. Gustafson, Chairman, without objection, HB 8-E
was withdrawn from the Committee on Criminal Justice and remains
referred to the Committee on Appropriations.
On point of order by Rep. Bell, Chairman, that they do not affect
appropriations, the following bills were withdrawn from the Commit-
tee on Appropriations: HBs 8-E, 9-E and 3-E. HBs 8-E and 3-E were
placed in the Committee on Rules & Calendar. HB 9-E remains
referred to the Committee on Finance & Taxation.
On motion by Rep. Kelly, without objection, HB 3-E was withdrawn
from further consideration of the House.

Announcements Relating to Previously Scheduled
Committee Meetings

Rep. Kelly, Chairman, announced that the meeting scheduled for
today of the Subcommittee on Prisons & Jails of the Committee on
Corrections, Probation & Parole has been cancelled, and that the
meeting of the Subcommittee on Correctional Programs & Operations
of the Committee on Corrections, Probation & Parole, jointly with
Subcommittee I of the Committee on Appropriations has been
rescheduled for tomorrow afternoon from 1:00 p.m. to 5:00 p.m. in 214
C.
Rep. Hodges, Chairman, announced that the meeting of the Sub-
committee on Executive Organization of the Committee on Govern-
mental Operations has been rescheduled for tomorrow at 9:00 a.m. and
that the meeting of the full Committee on Governmental Operations



February 3, 1988



9











JOURNAL OF THE HOUSE OF REPRESENTATIVES



will follow at 9:30 a.m. in 413 C to consider Open Government Sunset
Reviews.

Amendment Filing Deadline
The House agreed to a cut-off time of 2:45 p.m. for filing
amendments to CS/HB 7-E, that being one hour after the beginning of
consideration of the bill.

Special and Continuing Orders

Consideration of CS/HB 7-E and CS/HB 10-E was temporarily
deferred.
HB 13-E-A bill to be entitled An act relating to state uniform
traffic control; amending s. 316.302, F.S.; revising language with
respect to operation of a commercial motor vehicle; limiting periods of
time where a driver may be on duty; providing that certain commercial
vehicle operators are exempt from described rules; providing an
effective date.
-was taken up. On motions by Rep. Burnsed, the rules were waived
by two-thirds vote and HB 13-E was read the second time by title and
the third time by title. On passage, the vote was:
Yeas-113



The Chair
Abrams
Arnold
Ascherl
Bainter
Banjanin
Bankhead
Bass
Bell
Bloom
Bronson
Brown
Burnsed
Canady
Carlton
Carpenter
Casas
Clark
Clements
Cosgrove
Crady
Crotty
Dantzler
Davis
Deutsch
Diaz-Balart
Drage
Dunbar
Figg
Nays-None



Frankel
Friedman
Frishe
Gaffney
Garcia
Gardner
Glickman
Gonzalez-
Quevedo
Goode
Gordon
Grindle
Guber
Gustafson
Gutman
Hanson
Hargrett
Harris
Hawkins
Healey
Hill
Hodges
Holland
Ireland
Irvine
Jamerson
Jennings
Johnson, B. L.
Johnson, R. C.



Jones, C. F.
Jones, D. L.
Kelly
King
Langton
Lawson
Lewis
Liberti
Lippman
Locke
Logan
Lombard
Long
Mackenzie
Mackey
Martin
McEwan
Meffert
Messersmith
Metcalf
Mitchell
Morse
Mortham
Nergard
Ogden
Ostrau
Patchett
Peeples
Press



Reddick
Renke
Rochlin
Rudd
Rush
Sample
Sanderson
Sansom
Saunders
Shelley
Simon
Simone
Smith
Souto
Starks
Stone
Thomas
Titone
Tobiassen
Tobin
Trammell
Troxler
Wallace
Webster
Wetherell
Woodruff
Young



Votes after roll call:
Yeas-Harden, Rehm
So the bill passed and was immediately certified to the Senate.

HB 8-E-A bill to be entitled An act relating to driving under the
influence; amending s. 316.192, F.S., providing an additional penalty
for reckless driving under certain circumstances; amending s. 316.193,
F.S., providing clarifying language with respect to convictions for
driving under the influence with a certain blood alcohol level;
providing clarifying language with respect to substance abuse educa-
tion, evaluation, and treatment for a violation of law relating to
driving under the influence; amending s. 316.1932, F.S., deleting
reference to a prearrest breath test; authorizing the use of infrared
light measuring devices approved by the Department of Health and
Rehabilitative Services for breath testing of motorists to determine
blood alcohol levels; amending s. 316.1933, F.S., authorizing blood
testing of certain persons under certain circumstances; deleting a



February 3, 1988



restriction on certified paramedics withdrawing blood for the purpose
of determining alcohol content; amending s. 316.1934, F.S.; authoriz-
ing the use of infrared light measuring devices approved by the
Department of Health and Rehabilitative Services for breath testing of
motorists to determine blood alcohol levels; providing an effective date.
-was read the second time by title.
Representative Carlton offered the following amendment:

Amendment 1-On page 14, line 4, strike "January" and insert: July
Rep. Carlton moved the adoption of the amendment, which was
adopted without objection.
On motion by Rep. Carlton, the rules were waived by two-thirds vote
and HB 8-E, as amended, was read the third time by title. On passage,
the vote was:



Yeas-112
The Chair
Abrams
Arnold
Bainter
Banjanin
Bankhead
Bass
Bell
Bloom
Bronson
Brown
Burke
Burnsed
Canady
Carlton
Carpenter
Casas
Clark
Clements
Cosgrove
Crady
Crotty
Dantzler
Davis
Deutsch
Diaz-Balart
Drage
Dunbar
Figg
Nays-None



Friedman
Frishe
Gaffney
Garcia
Gardner
Glickman
Gonzalez-
Quevedo
Gordon
Grindle
Guber
Gustafson
Gutman
Hanson
Harden
Hargrett
Harris
Hawkins
Healey
Hill
Hodges
Holland
Ireland
Irvine
Jamerson
Jennings
Johnson, B. L.
Johnson, R. C.
Jones, D. L.



Kelly
King
Langton
Lawson
Lewis
Liberti
Lippman
Locke
Logan
Lombard
Mackenzie
Mackey
Martin
Martinez
McEwan
Messersmith
Metcalf
Mitchell
Mortham
Nergard
Ogden
Ostrau
Patchett
Peeples
Press
Reaves
Reddick
Renke
Rochlin



Rudd
Rush
Sample
Sanderson
Sansom
Saunders
Shelley
Silver
Simon
Simone
Smith
Souto
Starks
Stone
Thomas
Titone
Tobiassen
Tobin
Trammell
Troxler
Upchurch
Wallace
Webster
Wetherell
Woodruff
Young



Votes after roll call:
Yeas-Ascherl, Goode, C. F. Jones, Rehm
So the bill passed, as amended, and was immediately certified to the
Senate after engrossment.

Consideration of HB 9-E was temporarily deferred.

By the Committee on Judiciary and Representatives Bell, Ogden,
Lippman-
CS/HB 7-E-A bill to be entitled An act relating to medical incident
recovery; creating a chapter in F.S.; creating the "Florida Medical
Incident Recovery Act of 1988"; providing applicability and scope;
creating a plan for prompt resolution of medical negligence claims;
providing legislative findings and intent; providing definitions; pro-
viding applicability of and procedure for mandatory presuit investiga-
tion and medical expert corroboration of medical negligence claims and
defenses by prospective parties; requiring availability of medical
records for presuit screening of claims and defenses and providing
penalties; providing for presuit discovery of medical negligence claims
and defenses and providing immunity with respect thereto; providing
for presuit investigation of medical negligence claims and defenses by
the court, and providing penalties for lack of reasonable investigation
in filing or in corroborating medical negligence claims or defenses;



10













providing for nonbinding arbitration of civil cases involving claims for
medical negligence; providing for selection of arbitration panels;
providing for referral of cases to arbitration and procedures for
referral; providing procedures for hearings; providing for arbitration
awards and judgments; providing for trial de novo; providing for
assessment of attorney's fees and costs in certain circumstances;
providing for appeal of award; creating the medical malpractice
premium assistance plan; providing legislative findings and intent;
providing definitions; creating a trust fund, to be administered by the
Department of Insurance; providing funding for such fund; providing
for physician eligibility to receive premium assistance from such fund;
providing rulemaking authority; creating the Florida Birth-Related
Neurological Injury Compensation Plan; providing legislative findings
and intent; providing definitions; providing exclusiveness of remedy;
providing for the hearing of claims by deputy commissioners of the
Division of Workers' Compensation of the Department of Labor and
Employment Security; providing procedure for the filing of claims and
responses; providing for medical disciplinary review; providing for
tolling of the statute of limitations; providing for hearings, parties, and
discovery; providing for review by a medical advisory panel; providing
for determination of claims; providing a presumption as to injury;
providing for binding nature of findings; providing for awards for
birth-related neurological injuries, and for notice of such awards;
providing for conclusiveness of determination or award; providing for
appeal; providing for enforcement of awards; providing a limitation on
the bringing of claims; creating the Birth-Related Neurological Injury
Compensation Trust Fund within the Department of Insurance and
providing for administration of the fund by the Florida Birth-Related
Neurological Injury Compensation Association pursuant to a plan of
operation approved by said department; providing for assessments for
participation in the plan; providing for actuarial valuation of the fund
by the department; providing for membership and a board of directors
for the association; providing powers and duties of the association;
providing for notice to obstetrical patients of participation in the plan;
providing for trauma center liability reform; providing legislative
findings and intent; providing definitions; providing immunity from
civil liability for trauma centers and teams; providing rulemaking
authority; providing legislative findings and intent regarding regulato-
ry reform; amending s. 20.30, F.S.; creating the Division of Medical
Quality Assurance within the Department of Professional Regulation
and creating the Bureau of Medical Regulation within said division;
providing duties of the division and bureau; requiring a report; placing
the Board of Medicine and the Board of Osteopathic Medical Examin-
ers within the division; amending s. 395.0115, F.S.; providing antitrust
immunity through establishment of a state-mandated peer review
process; requiring licensed facilities to provide for peer review of
physicians who provide health care services at such facilities and
providing procedures therefore; requiring report of final disciplinary
actions to the Division of Medical Quality Assurance for further
investigation; providing for peer review panel immunity and for
confidentiality of records; creating s. 395.0116, F.S., providing that it
is unlawful for certain persons to threaten, coerce, intimidate, or
discipline any licensed physician or nurse under certain circumstances;
providing a penalty; providing for civil actions; amending s. 395.017,
F.S.; providing maximum charge for copying records; providing access
to confidential patient records for certain proceedings of the Depart-
ment of Professional Regulation; limiting public access thereto;
amending s. 395.041, F.S.; expanding internal risk management
education and training requirements; requiring certain incident
reports relating to surgical procedures; requiring report of certain
incidents to the department; limiting public access; providing for
department review and investigation of incidents which may involve
conduct subject to discipline; providing an administrative fine for
violation of reporting requirements; providing for annual review of
risk management programs; protecting risk managers from liability
for implementation of risk management programs; requiring a report
to the Legislature; amending s. 395.504, F.S., to correct a cross-refer-
ence; amending s. 395.509, F.S., relating to review of hospital budgets,
to provide for approval of assessments to fund the birth-related
neurological injury plan; amending s. 455.225, F.S.; providing civil
immunity and prohibition from discharge to persons reporting with



respect to incompetence, impairment, or unprofessional conduct of
specified physicians; providing penalties; amending s. 455.241, F.S.;



11



providing for reports of patient records; creating s. 455.2415, F.S.;
providing for disclosure of patient communications under certain
circumstances; amending s. 455.242, F.S.; providing for disposition of
records of physicians who terminate practice or relocate; amending
s. 455.245, F.S.; providing conditions for considering emergency sus-
pension or restriction of a license; creating s. 455.247, F.S.; requiring
physicians, osteopathic physicians, podiatrists, and dentists to report
professional liability claims and actions to the department; specifying
contents; creating s. 455.28, F.S.; requiring reporting of certain
physicians for violation of grounds for disciplinary action; providing a
penalty; requiring investigation of probable disciplinary violations;
amending s. 458.303, F.S.; clarifying an exception for federally com-
missioned medical officers; amending s. 458.307, F.S.; modifying
membership of the Board of Medicine; specifying composition of
probable cause panels; providing for a training program; providing for
completion of a panel's work; amending s. 458.311, F.S.; relating to
requirements for licensure of physicians by examination; providing for
an investigative process; providing for restricted licenses; amending
s. 458.313, F.S.; providing for an investigative process for licensure by
endorsement; requiring certain active practice; providing for restricted
licenses; amending s. 458.315, F.S.; prohibiting issuance of temporary
certificates for practice in areas of critical need to certain persons by
endorsement; amending s. 458.3165, F.S.; providing for biennial
renewal of public psychiatry certificates; amending s. 458.319, F.S.;
requiring evidence of active practice for license renewal; providing for
supervised practice; amending ss. 458.320 and 459.0085, F.S.; auth-
orizing physicians and osteopathic physicians to use risk retention
groups to meet financial responsibility requirements; amending
s. 458.327, F.S.; providing a penalty for misrepresenting oneself as a
licensed physician; amending ss. 458.331 and 459.015, F.S.; providing
additional grounds for disciplinary action against physicians and
osteopathic physicians; providing penalties and providing priorities for
application thereof; establishing the burden of proof for administrative
actions against physicians; providing for injunctive relief; providing for
department review and investigation of claims; amending ss. 458.3315
and 459.0155, F.S.; providing for certain release of medical records of
an impaired practitioner; amending s. 458.337, F.S.; specifying re-
quirements for reports by medical organizations and hospitals when
the physician has resigned; amending s. 458.345, F.S.; establishing
requirements for registration of resident physicians and interns;
providing a fee; restricting renewal or extension; prohibiting registra-
tion of certain persons; increasing a penalty; amending ss. 458.347 and
459.022, F.S.; allowing extended temporary certification of physician
assistants and osteopathic physician assistants; amending s. 459.0055,
F.S.; providing for an investigative process for licensure of osteopathic
physicians; amending s. 459.008, F.S.; requiring evidence of active
practice for license renewal; providing for supervised practice; amend-
ing ss. 460.413, 461.013, 464.018, 465.016, and 466.028, F.S.; providing
additional grounds for disciplinary action against chiropractic physic-
ians, podiatrists, nurses, pharmacists, and dentists; amending
s. 627.912, F.S.; requiring insurers to report certain claims against
dentists; providing for department review and investigation; providing
for an annual report; amending s. 641.55, F.S.; providing for depart-
ment review and investigation of certain incidents reported by health
maintenance organization internal risk management programs; limit-
ing public access; requiring report of certain incidents relating to
surgical procedures; amending s. 768.19, F.S.; providing for presuit
investigation of medical negligence claims in wrongful death actions;
amending s. 768.40, F.S.; providing for professional society review of
certain physicians; providing for advisory reports to the department;
providing confidentiality; providing for review and repeal; providing
specified immunity with respect thereto; amending s. 768.57, F.S.;
expanding notice requirements prior to filing a claim for medical
malpractice; stipulating informal discovery provisions with respect to
presuit screening of such claims; amending s. 627.351, F.S., relating to
required coverage with respect to medical malpractice risk apportion-
ment; creating s. 768.67, F.S.; prohibiting settlement agreements from
denying parties thereto the right to discuss with or report to the
Division of Medical Quality Assurance the events giving rise to the
claim; amending s. 240.213, F.S.; providing for medical malpractice
damages which are attributed to the Board of Regents; amending



s. 95.11, F.S., relating to the statute of limitations; requesting the
Supreme Court to adopt a standard jury instruction; repealing



February 3, 1988



JOURNAL OF THE HOUSE OF REPRESENTATIVES











12 JOURNAL OF THE HOUSE]

s. 768.66, F.S., relating to medical malpractice impact study; providing
severability; providing an effective date.
-was read the first time by title. On motion by Rep. Bell, the rules
were waived by two-thirds vote and the bill was read the second time
by title.
The Committee on Appropriations offered the following amendment:
Amendment 1 profilee 1)-On page 19, line 16, through page 26,
line 13, strike all of said lines and insert:
B. ARBITRATION
Section 10. Voluntary binding arbitration of medical negligence
claims.-
(1) Voluntary binding arbitration pursuant to sections 10-15 shall not
apply to:
(a) Rights of action under s. 768.19, Florida Statutes.
(b) Rights of action involving the state or its agencies or subdivisions,
or the officers, employees, or agents thereof, pursuant to s. 76828,
Florida Statutes.
(2) Upon the completion of presuit investigation with preliminary
"reasonable grounds for a medical negligence claim intact, the parties
may elect to have damages determined by an arbitration panel. Such
election may be initiated by either party by serving a request for
voluntary binding arbitration of damages pursuant to this part within
90 days of service of the claimant's notice of intent to initiate litigation
upon the defendant. The evidentiary standards for voluntary binding
arbitration of medical negligence claims shall be as provided in
s. 120.58(1)(a), Florida Statutes. To the extent not inconsistent with this
part, voluntary binding arbitration of medical negligence claims shall
utilize the procedures in s. 44.304, Florida Statutes.
(3) Upon receipt of a party's request for such arbitration, the opposing
party may accept the offer of voluntary binding arbitration within 30
days. However, in no event shall the defendant be required to respond to
the request for arbitration sooner than 90 days after service of the notice
of intent ,to initiate litigation under s. 768.57, Florida Statutes. Such
acceptance within the time period provided by this subsection shall be a
binding commitment to comply with the decision of the arbitration
panel, subject to any applicable insurance policy limits.
(4) The arbitration panel shall be composed of three arbitrators, one
selected by the claimant, one selected by the defendant, and one an
administrative hearing officer furnished by the Division of Adminis-
trative Hearings who shall serve as the chief arbitrator with the
authority granted a chief arbitrator under s. 44.304, Florida Statutes.
In the event of multiple plaintiffs or multiple defendants, the arbitrator
selected by the side with multiple parties shall be the choice of those
parties. If the multiple parties cannot reach agreement as to their
arbitrator, each of the multiple parties shall submit a nominee, and the
director of the Division of Administrative Hearings shall appoint the
arbitrator from among such nominees.
(5) The arbitrators shall be independent of all parties, witnesses, and
legal counsel, and no officer, director, affiliate, subsidiary, or employee
of a party, witness, or legal counsel may serve as an arbitrator in the
proceeding.
(6) The rate of compensation for medical negligence claims arbitrators
other than the administrative hearing officer shall be set by the chief
judge of the appropriate circuit court by schedule providing for
compensation of not less than $250 per day nor more than $750 per day
or as agreed by the parties. In setting the schedule, the chief judge shall
consider the prevailing rates charged for the delivery of professional
services in the community.
(7) Arbitration pursuant to this section shall preclude recourse to any
other remedy by the claimant against any participating defendant, and
shall be undertaken with the understanding that:
(a) Net economic damages shall be awardable, including, but not



limited to, past and future medical expenses and 80 percent of wage loss
and loss of earning capacity, offset by any collateral source payments.
(b) Noneconomic damages shall be limited to a maximum of $250,000
per incident, and shall be calculated on a percentage basis with respect



- -- ----



separate binding arbitration proceeding. Such proceeding shall be with
a panel of three arbitrators, which panel shall consist of the adminis-
trative hearing officer who presided in the first arbitration proceeding,
who shall serve as the chief arbitrator with the authority granted a chief
arbitrator under s. 44.304, Florida Statutes, and two medical practi-



E



OF REPRESENTATIVES February 3, 1988

to capacity to enjoy life, so that a finding that the claimant's injuries
resulted in a 50-percent reduction in his capacity to enjoy life would
warrant an award of not more than $125,000 noneconomic damages.
(c) Damages for future economic losses shall be awarded to be paid by
periodic payments pursuant to section 5(8), and shall be offset by future
collateral source payments.
(d) Punitive damages shall not be awarded.
(e) The defendant shall be responsible for the payment of interest on
all accrued damages with respect to which interest would be awarded at
trial.
(f) The defendant shall pay the claimant's reasonable attorney's fees
and costs, as determined by the arbitration panel, but in no event more
than 15 percent of the award, reduced to present value.
(g) The defendant shall pay all the costs of the arbitration proceeding
and the fees of all the arbitrators other than the administrative hearing
officer.
(h) Each defendant who submits to arbitration under this section
shall be jointly and severally liable for all damages assessed pursuant to
this section.
(i) The defendant's obligation to pay the claimant's damages shall be
for the purpose of arbitration under this section only. A defendant's or
claimant's offer to arbitrate shall not be used in evidence or in argument
during any subsequent litigation of the claim following the rejection
thereof.
(j) The fact of making or accepting an offer to arbitrate shall not be
admissible as evidence of liability in any collateral or subsequent
proceeding on the claim.
(k) Any offer by a claimant to arbitrate must be made to each
defendant against whom the claimant has made a claim. Any offer by a
defendant to arbitrate must be made to each claimant who has joined in
the notice of intent to initiate litigation, as provided in s. 768.57, Florida
Statutes. A defendant who rejects a claimant's offer to arbitrate shall be
subject to the provisions of section 12(3). A claimant who rejects a
defendant's offer to arbitrate shall be subject to the provisions of section
12(4). If there are multiple claimants, rejection of a defendant's offer to
arbitrate by any such claimant shall be treated as a rejection of the offer
to arbitrate by all such claimants.
(1) The hearing shall be conducted by all of the arbitrators, but a
majority may determine any fact question and render a final decision.
The chief arbitrator shall decide all evidentiary matters.
The provisions of this subsection shall not preclude settlement at any
time by mutual agreement of the parties.
(8) Any issue between the defendant and the defendant's insurer or
self-insurer as to who shall control the defense of the claim and any
responsibility for payment of an arbitration award, shall be determined
under existing principles of law; provided that the insurer or self-insur-
er shall not offer to arbitrate or accept a claimant's offer to arbitrate
without the written consent of the defendant.
(9) The Division of Administrative Hearings is authorized to
promulgate rules to effect the orderly and efficient processing of the
arbitration procedures of this part.
Section 11. Arbitration to allocate responsibility among multiple
defendants.-
(1) The provisions of this section shall apply when more than one
defendant has participated in voluntary binding arbitration pursuant to
section 10.
(2) Within 20 days of the determination of damages by the arbitration
panel in the first arbitration proceeding, those defendants who have
agreed to voluntary binding arbitration shall submit any dispute among
them regarding the apportionment of financial responsibility to a











JOURNAL OF THE HOUSE



tioners appointed by the defendants, except that if a hospital licensed
pursuant to chapter 395, Florida Statutes, is involved in the arbitration
proceeding, one arbitrator appointed by the defendants shall be a
certified hospital risk manager. In the event the defendants cannot agree
on their selection of arbitrators within 20 days of the determination of
damages by the arbitration panel in the first arbitration proceeding, a
list of not more than five nominees shall be submitted by each defendant
to the director of the Division of Administrative Hearings, who shall
select the other arbitrators but shall not select more than one from the
list of nominees of any defendant.
(3) The administrative hearing officer appointed to serve as the chief
arbitrator shall convene the arbitrators for the purpose of determining
allocation of responsibility among multiple defendants within 65 days of
the determination of damages by the arbitration panel in the first
arbitration proceeding.
(4) The arbitration panel shall allocate financial responsibility among
all defendants named in the notice of intent to initiate litigation,
regardless of whether the defendant has submitted to arbitration. The
defendants in the arbitration proceeding shall pay their proportionate
share of the economic and noneconomic damages awarded by the
arbitration panel. All defendants in the arbitration proceeding shall be
jointly and severally liable for their proportionate share of any damages
assessed in arbitration. The determination of the percentage of fault of
any defendant not in the arbitration case shall not be binding against
that defendant, nor shall it be admissible in any subsequent legal
proceeding.
(5) Payment by the defendants of the damages awarded by the
arbitration panel in the first arbitration proceeding shall extinguish
those defendants' liability to the claimant and shall also extinguish
those defendants' liability for contribution to any defendants who did
not participate in arbitration.
(6) Any defendant paying damages assessed pursuant to this section
or section 10 shall have an action for contribution against any
nonarbitrating person whose negligence contributed to the injury.
Section 12. Effects of failure to offer or accept voluntary binding
arbitration.-
(1) A proceeding for voluntary binding arbitration is an alternative to
jury trial and shall not supersede the right of any party to a jury trial.
(2) If neither party requests or agrees to voluntary binding arbitra-
tion, the claim shall proceed to trial or to any available legal alternative
such as offer of and demand for judgment under s. 768.79, Florida
Statutes, or offer of settlement under s. 45.061, Florida Statutes.
(3) If the defendant refuses a claimant's offer of voluntary binding
arbitration:
(a) The claim shall proceed to trial without limitation on damages,
and the claimant, upon proving medical negligence, shall be entitled to
recover prejudgment interest, and reasonable attorney's fees up to 25
percent of the award reduced to present value.
(b) The claimant's award at trial shall be reduced by any damages
recovered by the claimant from arbitrating codefendants following
arbitration.

(4) If the claimant rejects a defendant's offer to enter voluntary
binding arbitration:
(a) The damages awardable at trial shall be limited to net economic
damages, plus noneconomic damages not to exceed $300,000 per
incident. The Legislature expressly finds that such conditional limit on
noneconomic damages is warranted by the claimant's refusal to accept
arbitration under this part, and represents an appropriate balance
between the interests of all patients who ultimately pay for medical
negligence losses and the interests of those patients who are injured as a
result of medical negligence.
(b) Net economic damages reduced to present value shall be
awardable, including, but not limited to, past and future medical



expenses and 80 percent of wage loss and loss of earning capacity, offset
by any collateral source payments.



February 3, 1988



Ascherl
Bainter
Bass
Bell
Bronson
Burnsed



Carlton
Casas
Clements
Davis
Dunbar
Garcia



Gonzalez-
Quevedo
Goode
Grindle
Guber
Gutman



Hanson
Harris
Hawkins
Hill
Hodges
Holland



OF REPRESENTATIVES 13

(c) Damages for future economic losses shall be awarded to be paid by
periodic payments pursuant to section 5(8), and shall be offset by future
collateral source payments.
(5) Jury trial shall proceed in accordance with existing principles of
law.
Section 13. Misarbitration.-
(1) At any time during the course of voluntary binding arbitration of
a medical negligence claim pursuant to section 10 or section 11, the
administrative hearing officer serving as chief arbitrator on the
arbitration panel, if he determines that agreement cannot be reached,
shall be authorized to dissolve the arbitration panel and request the
director of the Division of Administrative Hearings to appoint two new
arbitrators from new lists of five names provided by each party to the
arbitration. Not more than one arbitrator shall be appointed from the
list provided by any party.
(2) Upon appointment of the new arbitrators, arbitration shall proceed
at the direction of the chief arbitrator in accordance with the provisions
of this part.
Section 14. Payment of arbitration award; interest.-
(1) Within 20 days of the determination of damages by the arbitration
panel pursuant to section 10, the defendant shall:
(a) Pay the arbitration award, including interest at the legal rate, to
the claimant; or
(b) Submit any dispute among multiple defendants to arbitration
pursuant to section 11.
(2) Commencing 90 days after the award rendered in the arbitration
procedure pursuant to section 10, such award shall begin to accrue
interest at the rate of 18 percent per year.
Section 15. Appeal of arbitration award.-An arbitration award is a
final agency action for purposes of ss. 120.68 and 120.69, Florida
Statutes. Any appeal of an award shall be taken to the district court of
appeal and shall be limited to review on the record, and not de novo.
Rep. Bell moved the adoption of the amendment.

Recessed
The House stood in informal recess at 2:48 p.m. to reconvene at 3:00
p.m. or upon the call of the Speaker.

Reconvened
The House was called to order by the Speaker at 3:12 p.m. A quorum
was present.
The House returned to consideration of Amendment 1 to CS/HB 7-E.
Representative Hill offered the following amendment to the amend-
ment:
Amendment 1 to Amendment 1-On page 3, line 20, strike
"$250,000" and insert: $100,000; and on page 8, line 10, strike
"$300,000" and insert: $200,000
Rep. Hill moved the adoption of the amendment to the amendment,
which failed of adoption.
Representative Bell offered the following amendment to the amend-
ment:
Amendment 2 to Amendment 1-On page 3, line 20, strike
"$250,000" and insert: $200,000
Rep. Bell moved the adoption of the amendment to the amendment,
which failed of adoption. The vote was:
Yeas-53











JOURNAL OF THE HOUSE OF REPRESENTATIVES



Ireland
Irvine
Johnson, B. L.
Johnson, R. C.
Kelly
Lippman
Locke
Lombard

Nays-53

The Chair
Abrams
Arnold
Banjanin
Bankhead
Canady
Carpenter
Clark
Cosgrove
Crotty
Dantzler
Deutsch
Diaz-Balart
Drage



Long
Martin
Mitchell
Mortham
Nergard
Peeples
Rehm
Renke



Frankel
Friedman
Gardner
Glickman
Gordon
Gustafson
Harden
Hargrett
Healey
Jamerson
Jones, C. F.
Jones, D. L.
Lawson
Lewis



Rochlin
Rudd
Sanderson
Sansom
Shelley
Simone
Smith
Starks



Liberti
Logan
Mackenzie
Mackey
Martinez
McEwan
Meffert
Metcalf
Ogden
Ostrau
Patchett
Press
Reaves
Reddick



Stone
Thomas
Tobiassen
Troxler
Webster
Wetherell



Rush
Silver
Simon
Souto
Titone
Tobin
Trammell
Upchurch
Wallace
Woodruff
Young



Votes after roll call:

Yeas-Bloom
Nays-Figg, Sample, Langton
Nays to Yeas-Souto

Rep. Lewis moved to reconsider the vote by which Amendment 2 to
Amendment 1 failed of adoption. Rep. Carpenter moved to lay the
motion to reconsider on the table, which was not agreed to. The vote
was:



Yeas-53

The Chair
Abrams
Arnold
Banjanin
Brown
Burke
Canady
Carpenter
Clark
Cosgrove
Crotty
Dantzler
Deutsch
Diaz-Balart

Nays-61

Ascherl
Bainter
Bankhead
Bass
Bell
Bloom
Bronson
Burnsed
Carlton
Casas
Clements
Crady
Davis
Dunbar
Frishe
Garcia



Drage
Figg
Frankel
Friedman
Gardner
Glickman
Gordon
Guber
Gustafson
Harden
Hargrett
Healey
Jamerson
Jones, C. F.



Gonzalez-
Quevedo
Goode
Grindle
Gutman
Hanson
Harris
Hawkins
Hill
Hodges
Holland
Ireland
Irvine
Jennings
Johnson, B. L.
Johnson, R. C.



Jones, D. L.
Lawson
Liberti
Logan
Mackey
Martinez
McEwan
Meffert
Metcalf
Ogden
Ostrau
Patchett
Press
Reaves



Kelly
King
Lewis
Lippman
Locke
Lombard
Long
Martin
Mitchell
Mortham
Nergard
Peeples
Reddick
Rehm
Rochlin
Rudd



Renke
Rush
Saunders
Silver
Simon
Titone
Tobin
Trammell
Upchurch
Wallace
Woodruff






Sample
Sanderson
Sansom
Shelley
Simone
Smith
Souto
Starks
Stone
Thomas
Tobiassen
Troxler
Webster
Wetherell



"The question recurred on the motion to reconsider, which was agreed
to. The vote was:



Yeas-63



Ascherl
Bainter
Bankhead
Bass
Bell
Bloom
Bronson
Burnsed
Carlton
Casas
Clements
Crady
Davis
Dunbar
Garcia
Gonzalez-
Quevedo

Nays-53

The Chair
Abrams
Arnold
Banjanin
Brown
Burke
Canady
Carpenter
Clark
Cosgrove
Crotty
Dantzler
Deutsch
Diaz-Balart



Goode
Grindle
Guber
Gutman
Hanson
Harris
Hawkins
Hill
Hodges
Holland
Ireland
Irvine
Jennings
Johnson, B. L.
Johnson, R. C.
Kelly
King



Drage
Figg
Frankel
Friedman
Frishe
Gardner
Glickman
Gordon
Gustafson
Harden
Hargrett
Healey
Jamerson
Jones, C. F.



Lewis
Lippman
Locke
Lombard
Long
Martin
Mitchell
Mortham
Nergard
Peeples
Reddick
Rehm
Renke
Rochlin
Rudd
Sample
Sanderson


Jones, D. L.
Lawson
Liberti
Logan
Mackey
Martinez
McEwan
Meffert
Messersmith
Metcalf
Ogden
Ostrau
Patchett
Press



Sansom
Saunders
Shelley
Simone
Smith
Souto
Starks
Stone
Thomas
Tobiassen
Troxler
Webster
Wetherell



Reaves
Rush
Silver
Simon
Titone
Tobin
Trammell
Upchurch
Wallace
Woodruff
Young



The question then recurred on the adoption of Amendment 2 to
Amendment 1, which was adopted. The vote was:

Yeas-62



Ascherl
Bainter
Bass
Bell
Bloom
Bronson
Burnsed
Carlton
Casas
Clements
Crady
Davis
Dunbar
Garcia
Gardner
Gonzalez-
Quevedo

Nays-55

The Chair
Abrams
Arnold
Banjanin
Bankhead
Brown
Burke
Canady
Carpenter
Clark
Cosgrove
Crotty
Dantzler
Deutsch



Goode
Grindle
Guber
Gutman
Hanson
Harris
Hawkins
Hill
Hodges
Holland
Ireland
Irvine
Jennings
Johnson, B. L.
Johnson, R. C.
Kelly
King


Diaz-Balart
Drage
Figg
Frankel
Friedman
Frishe
Glickman
Gordon
Gustafson
Harden
Hargrett
Healey
Jamerson
Jones, C. F.



Lewis
Lippman
Locke
Lombard
Long
Martin
Mitchell
Mortham
Nergard
Peeples
Reddick
Rehm
Renke
Rochlin
Rudd
Sample
Sanderson


Jones, D. L.
Lawson
Liberti
Logan
Mackenzie
Mackey
Martinez
McEwan
Meffert
Messersmith
Metcalf
Ogden
Ostrau
Patchett



Saunders
Shelley
Simone
Smith
Souto
Starks
Stone
Thomas
Tobiassen
Troxler
Webster
Wetherell



Press
Reaves
Rush
Sansom
Silver
Simon
Titone
Tobin
Trammell
Upchurch
Wallace
Woodruff
Young



14



February 3, 1988











JOURNAL OF THE HOUSE OF REPRESENTATIVES



Votes after roll call:
Nays-Langton, Gaffney
Representative Drage offered the following amendment to the
amendment:
Amendment 3 to Amendment 1-On page 3, lines 20-24, strike all
of said lines and insert: of $250,000 per incident.
Representative Drage moved the adoption of the amendment to the
amendment, which failed of adoption. The vote was:
Yeas-54



Abrams
Arnold
Banjanin
Bankhead
Canady
Casas
Clark
Cosgrove
Crotty
Dantzler
Deutsch
Diaz-Balart
Drage
Frankel
Nays-54
The Chair
Ascherl
Bass
Bell
Bloom
Bronson
Burke
Burnsed
Carpenter
Clements
Crady
Davis
Figg
Gardner



Friedman
Garcia
Glickman
Hanson
Harden
Hargrett
Healey
Hill
Irvine
Jamerson
Jones, D. L.
King
Langton
Lawson


Gonzalez-
Quevedo
Goode
Gordon
Grindle
Guber
Gutman
Harris
Hawkins
Hodges
Holland
Ireland
Jennings
Johnson, B. L.



Votes after roll call:
Yeas-Dunbar, Gaffney
Nays-Reddick
Yeas to Nays-Casas, Souto
Representative Ogden offered
amendment:



Liberti
Logan
Mackey
Martinez
McEwan
Meffert
Messersmith
Nergard
Ostrau
Patchett
Press
Reaves
Renke
Rush


Johnson, R. C.
Kelly
Lewis
Lippman
Locke
Lombard
Long
Mackenzie
Metcalf
Mitchell
Mortham
Peeples
Rehm
Rochlin



Sample
Sansom
Simon
Souto
Starks
Stone
Titone
Trammell
Troxler
Upchurch
Wallace
Woodruff



Rudd
Sanderson
Saunders
Shelley
Silver
Simone
Smith
Thomas
Tobiassen
Tobin
Webster
Wetherell
Young



the following amendment to the



Amendment 4 to Amendment 1-On page 8, line 10, strike
"$250,000" and insert: $350,000
Rep. Ogden moved the adoption of the amendment. Pending
consideration thereof, without objection, further consideration of the
amendment to the amendment was temporarily deferred. Subsequent-
ly, the amendment to the amendment was abandoned.
Representatives Glickman and Rush offered the following amend-
ment to the amendment:
Amendment 5 to Amendment 1-On page 8, line 10, strike the
period and insert: unless the claimant demonstrates to the court by
clear and convincing evidence that a greater amount is needed to
adequately compensate the injured person in light of the facts and
circumstances presented to the court.
Rep. Glickman moved the adoption of the amendment to the
amendment. Pending consideration thereof, further consideration of
the amendment to the amendment was temporarily deferred.
Subsequently, the question recurred on the adoption of Amendment
5 to Amendment 1, which failed of adoption.
Representatives Glickman and Rush offered the following amend-
ment to the amendment:



15



Amendment 6 to Amendment 1-On page 3, line 20, and on page
8, line 23, strike "80" and insert: 85
Rep. Rush moved the adoption of the amendment to the amendment,
which failed of adoption.

Rep. Ogden, citing the authority of Precedent 11(o), offered the
following amendment, which had been prefiled by Rep. Drage and
withdrawn:

Amendment 7 to Amendment 1-On page 8, line 10, strike
"$300,00" and insert: $350,000
Rep. Ogden moved the adoption of the amendment to the amend-
ment.

Rep. Thomas asked the Chair to reiterate the authority of Precedent
11(o). The Chair responded, "If you have profiled an amendment prior
to a deadline, another Member is able to use that amendment as an
amendment, even if the sponsor withdrew it. The Clerk advises that is
the way we have treated it before. In other words, the only reason
someone couldn't introduce that amendment is that it was not
introduced prior to the deadline. The fact that an amendment of a
certain substance was introduced prior to the deadline entitles another
Member to re-offer the amendment if it had been withdrawn. The
reason being that another Member could have relied on the fact that
the amendment would be available for them to vote on."

The question recurred on the adoption of Amendment 7 to Amend-
ment 1, which was adopted. The vote was:
Yeas-64



The Chair
Abrams
Arnold
Banjanin
Bankhead
Brown
Canady
Carlton
Carpenter
Clark
Cosgrove
Crady
Crotty
Dantzler
Deutsch
Diaz-Balart
Drage
Nays-46
Ascherl
Bainter
Bass
Bell
Bloom
Bronson
Casas
Clements
Garcia
Goode
Grindle
Guber



Dunbar
Figg
Frankel
Friedman
Frishe
Gardner
Glickman
Gonzalez-
Quevedo
Gordon
Gustafson
Harden
Healey
Hodges
Jamerson
Johnson, R. C.
Jones, C. F.


Gutman
Hanson
Harris
Hawkins
Hill
Holland
Ireland
Irvine
Jennings
Johnson, B. L.
Kelly
Lewis



Jones, D. L.
King
Langton
Lawson
Lippman
Logan
Mackey
Martin
Martinez
McEwan
Meffert
Messersmith
Nergard
Ogden
Ostrau
Patchett
Press


Locke
Lombard
Mackenzie
Metcalf
Mitchell
Mortham
Reddick
Rehm
Rudd
Sample
Sanderson
Saunders



Reaves
Renke
Rush
Sansom
Silver
Simon
Stone
Titone
Trammell
Troxler
Upchurch
Wallace
Webster
Woodruff



Shelley
Simone
Smith
Souto
Starks
Thomas
Tobiassen
Tobih
Wetherell
Young



Votes after roll call:

Yeas-Hargrett, Gaffney, Liberti
Yeas to Nays-Gonzalez-Quevedo

REPRESENTATIVE CARPENTER IN THE CHAIR

Representatives Glickman and Rush offered the following amend-
ment to the amendment:
Amendment 8 to Amendment 1-On page 3, line 17, and on page
8, line 23 strike "80" and insert: 85



February 3, 1988











JOURNAL OF THE HOUSE OF REPRESENTATIVES



Rep. Rush moved the adoption of the amendment to the amendment,
which failed of adoption.
Representative Ogden offered the following amendment to the
amendment:
Amendment 9 to Amendment 1-On page 3, line 20, strike
"$200,000" and insert: $250,000
Rep. Ogden moved the adoption of the amendment to the amend-
ment, which was adopted. The vote was:
Yeas-63



Dunbar
Frankel
Friedman
Frishe
Gardner
Glickman
Gordon
Gustafson
Harden
Hargrett
Healey
Hodges
Jamerson
Johnson, R. C.
Jones, C. F.
Jones, D. L.


Goode
Grindle
Guber
Gutman
Hanson
Harris
Hawkins
Hill
Holland
Ireland
Irvine
Jennings
Johnson, B. L.
Kelly



King
Langton
Lawson
Lippman
Logan
Mackenzie
Mackey
Martin
Martinez
McEwan
Meffert
Messersmith
Nergard
Ogden
Ostrau
Patchett


Lewis
Locke
Lombard
Long
Metcalf
Mitchell
Mortham
Peeples
Reddick
Rehm
Rochlin
Rudd
Sample
Sanderson



Votes after roll call:
Yeas-Gaffney, Liberti
Representative Upchurch offered the following
amendment:



Press
Reaves
Renke
Rush
Silver
Simon
Stone
Titone
Tobin
Trammell
Upchurch
Wallace
Webster
Woodruff
Young



Saunders
Shelley
Simone
Smith
Souto
Starks
Thomas
Tobiassen
Troxler
Wetherell



amendment to the



Amendment 10 to Amendment 1-On page 5, line 22, insert:
(10) Rules promulgated by the Division of Administrative Hearings
pursuant to this section, s. 120.53 or s. 120.65, may authorize any
reasonable sanctions except contempt for violation of the rules of the
Division or failure to comply with a reasonable order issued by a
Hearing Officer, which is not under judicial review.
Rep. Upchurch moved the adoption of the amendment to the
amendment, which was adopted.
Representative Woodruff offered the following amendment to the
amendment:
Amendment 11 to Amendment 1-On page 4, lines 4-7, strike all
of said lines and insert: (f) The defendant shall pay the claimant's
reasonable attorney's fees and costs, as determined by the arbitration
panel, but in no event shall the attorney's fees exceed 25 percent of the
award, reduced to present value, or the amount of such fees paid to the
defense, whichever amount is larger.
Rep. Woodruff moved the adoption of the amendment to the
amendment, which failed of adoption.

THE SPEAKER IN THE CHAIR

Representative Simon offered the following amendment to the
amendment:



Abrams
Arnold
Banjanin
Bankhead
Brown
Burke
Canady
Carlton
Clark
Cosgrove
Crotty
Dantzler
Davis
Deutsch
Diaz-Balart
Drage
Nays-51
Ascherl
Bainter
Bass
Bell
Bloom
Bronson
Burnsed
Casas
Clements
Crady
Figg
Garcia
Gonzalez-
Quevedo



Arnold
Ascherl
Bainter
Bass
Bell
Bloom
Bronson
Brown



Burnsed
Carlton
Casas
Crady
Crotty
Dantzler
Davis
Dunbar



Figg
Frishe
Garcia
Gonzalez-
Quevedo
Goode
Gordon
Grindle



Guber
Gutman
Hanson
Harden
Harris
Hawkins
Hill
Hodges



Amendment 12 to Amendment 1-On page 3, line 24, after the
period insert: Noneconomic damages for loss of consortium shall be
limited to a maximum of $200,000 per incident, and shall be calculated
on a percentage basis with respect to the estimated lifelong capacity to
enjoy consortium, so that a finding that the claimant's injuries resulted
in a 50-percent reduction in his lifelong capacity to enjoy consorting
would warrant an award of not more than $100,000 noneconomic
damages. When determining damages for loss of consortium the
arbitrators shall consider the quantity and quality of claimant's
consortium before and after the incident, and the estimated remaining
sexual life expectancy of the claimant. In any derivative action for
medical malpractice wherein the claimant seeks damages for loss of
consortium, the arbitrators shall reduce the damage award by the value
attributable to collateral sources.
Rep. Simon moved the adoption of the amendment to the amend-
ment, which failed of adoption.
Representative Simon offered the following amendment to the
amendment:
Amendment 13 to Amendment 1-On page 3, lines 19-24, strike
all of said lines and insert: (b) Noneconomic damages shall be limited
to the amount of such damages offered by the defendant.
Rep. Simon moved the adoption of the amendment to the amend-
ment, which failed of adoption.

THE SPEAKER PRO TEMPORE IN THE CHAIR

Representative Simon offered the following amendment to the
amendment:
Amendment 14 to Amendment 1-On page 4, line 31 through
page 5, line 3, strike all of said lines and insert: the provisions of
section 12(4).
Rep. Simon moved the adoption of the amendment to the amend-
ment, which was adopted.
Representative Simon offered the following amendment to the
amendment:
Amendment 15 to Amendment 1-On page 1, line 13, through
page 9, line 25 strike all of said lines and insert: Section 10.
Determination of noneconomic damages.-In any action for damages
arising out of medical malpractice, whether in tort or in contract,
damages for noneconomic losses to compensate for pain and suffering,
inconvenience, physical impairment, mental anguish, disfigurement,
loss of capacity for enjoyment of life, and other nonpecuniary damages
may be awarded in any amount not to exceed $250,000 per incident.
Rep. Simon moved the adoption of the amendment to the amend-
ment, which failed of adoption.
Representative Simon offered the following amendment to the
amendment:
Amendment 16 to Amendment 1-On page 6, lines 25-31, and
page 7, lines 1-6, strike all of said lines and insert: (4) The arbitration
panel shall allocate financial responsibility among all defendants that
have submitted to arbitration. All defendants in the arbitration
proceeding shall be jointly and severally liable for the entire arbitration
award.
Rep. Simon moved the adoption of the amendment to the amend-
ment, which failed of adoption.
The question recurred on the adoption of Amendment 1 as amended
which was adopted. The vote was:
Yeas-80



16



February 3, 1988














Holland
Ireland
Irvine
Jennings
Johnson, B. L.
Johnson, R. C.
Jones, C. F.
Jones, D. L.
Kelly
King
Lewis
Liberti
Lippman
Nays-32
The Chair
Abrams
Banjanin
Bankhead
Canady
Clark
Cosgrove
Deutsch



Locke
Lombard
Mackenzie
Martin
McEwan
Messersmith
Metcalf
Mitchell
Mortham
Nergard
Ogden
Ostrau
Patchett


Diaz-Balart
Frankel
Friedman
Gaffney
Gardner
Glickman
Gustafson
Hargrett



Souto
Starks
Stone
Thomas
Tobiassen
Troxler
Wallace
Webster
Wetherell
Young



Peeples
Reddick
Rehm
Renke
Rochlin
Rudd
Sample
Sanderson
Sansom
Shelley
Silver
Simone
Smith


Healey
Jamerson
Langton
Logan
Mackey
Martinez
Press
Reaves



Votes after roll call:
Yeas-Clements, Carpenter
Yeas to Nays-Brown
Nays to Yeas-Bankhead
The Committee on Appropriations offered the following amendment:
Amendment 2 (prefile 2)-On page 26, line 14, through page 32,
line 12, strike all of said lines and insert:
PART III
FLORIDA MEDICAL CARE AVAILABILITY
ASSISTANCE PLAN
Section 16. Legislative findings and intent.-
(1) The Legislature makes the following findings:
(a) In order to ensure continued delivery of needed medical services in
the state and to encourage physicians to continue practice in Florida, a
temporary physician availability assistance plan is necessary to provide
rapid medical care availability to areas of the state which are
experiencing a genuine medical care availability crisis.
(b) A medical care availability assistance plan should provide a
cost-effective, short-term solution to the medical care availability crisis
without substantially damaging the private market for medical mal-
practice liability insurance in the state.
(2) It is the intent of the Legislature to provide a plan of medical care
availability assistance, in accordance with the following goals:
(a) Administrative costs, both public and private, should be mini-
mized.
(b) Medical manpower shortage areas should be identified by the
Department of Health and Rehabilitative Services.
(c) Medical care availability assistance should be targeted to those
areas identified to be in need of such assistance.
Section 17. Definitions.-As used in this part:
(1) "Department" means the Department of Insurance.
(2) "Division" means the Division of Medical Quality Assurance of the
Department of Professional Regulation.
(3) "Eligible physician" means any physician licensed under chapter
458 or chapter 459, Florida Statutes, who meets the requirements set
forth in section 19.
(4) "Fund" means the Florida Medical Care Availability Assistance
Trust Fund.
(5) "Geographical area" includes, but is not limited to, any health care
facility, prison, county, group of counties, or census track within a
county.



17



(6) "Premiums" means consideration paid to one of the types of
insurers or trusts specified in s. 458.320(1)(b), Florida Statutes, or
s. 459.0085(1)(b), Florida Statutes, for the issuance and delivery of any
binder or policy of medical malpractice insurance, but does not include
any assessment or charge which is paid after the expiration of the policy
or contract.
Section 18. Florida Medical Care Availability Assistance Trust
Fund.-
(1) There is created the Florida Medical Care Availability Assistance
Trust Fund to be administered by the Department of Insurance for the
purposes set forth in this part.
(2) There is hereby appropriated to the fund from the Insurance
Commissioner's Regulatory Trust Fund an amount determined by the
department to be necessary for funding, such amount not to exceed $40
million.
(3) Distributions shall be made from the fund on an annual basis
beginning July 1, 1988, as follows:
(a) The department shall, by July 1 of each year, distribute from the
fund to each applying eligible physician an amount equal to the amount
by which the physician's premium payments for the preceding calendar
year exceeded 15 percent of the physician's annual gross revenue derived
from the physician's delivery of medical services for the preceding
calendar year. The physician shall have the burden of establishing to
the department's satisfaction the gross revenue derived from the delivery
of medical services, the amount of premiums paid for medical
malpractice liability coverage, the medical specialty practiced by the
physician during the previous year, and the physician's eligibility under
section 19 to participate in the premium assistance plan.
(b) In the event the fund does not contain sufficient funds in any one
year to make full distribution to every eligible physician, the department
shall make distributions on a pro rata basis, based on the amount due to
each eligible physician and the amount due to all eligible physicians. In
the event that the amounts appropriated to the fund have been
exhausted, no physician shall be entitled to premium assistance
payments.
(4) The amount of premium payments considered under this section
shall not exceed the premium amount necessary to obtain liability
coverage not to exceed $1 million per claim, $3 million annual
aggregate. In cases where the eligible physician pays premiums for
coverage in excess of $1 million per claim, $3 million annual aggregate,
the department shall determine the premium amount which would be
paid if coverage were limited to $1 million per claim, $3 million annual
aggregate. Where more than one policy is in effect during the applicable
calendar year, the premium paid under each policy shall be prorated by
the number of months the policy is in effect during the applicable
calendar year, and the amount so determined for each shall be added to
all other such amounts and shall constitute the premium paid for the
calendar year. In cases where a single policy covers more than one
physician, the department shall determine the amount of the premium
which relates to coverage for the eligible physician.
(5) Every eligible physician entitled to a distribution under this part
shall file an application with the department by May 1 of each year. The
department shall provide the application form. Failure to file an
application by May 1 of any year shall constitute a waiver of any
distribution to which a physician may be entitled.
(6) Prior to making a distribution to an eligible physician, the
department shall obtain an assignment of any right the physician may
have to a dividend, refund, or reimbursement of premium under the
terms of his medical malpractice liability insurance policy, contract, or
agreement. The department's rights under an assignment shall not
exceed the amount distributed to the physician under this section.
Section 19. Physician eligibility.-
(1) To be eligible to receive a distribution under this part, an applying
physician shall meet the following requirements:
(a) The physician was engaged in the active practice of medicine in



Florida during the entire preceding calendar year, and such practice
was in a geographical area determined by the Department of Health and



February 3, 1988



JOURNAL OF THE HOUSE OF REPRESENTATIVES



Rush
Saunders
Simon
Titone
Tobin
Trammell
Upchurch
Woodruff











JOURNAL OF THE HOUSE OF REPRESENTATIVES



Rehabilitative Services pursuant to section 20 to be a medical manpower
shortage area for the medical specialty practiced by the physician.
(b) The physician was covered by medical malpractice liability
insurance during the entire preceding calendar year, and the insurance
was obtained from one of the types of insurers or trusts specified in
s. 458.320(1)(b), Florida Statutes, or s. 459.0085(1)(b), Florida Stat-
utes.
(c) The physician had staff privileges during the entire preceding
calendar year at a hospital or hospitals licensed under chapter 395,
Florida Statutes, which had an emergency room and which required
physicians with staff privileges to provide, when needed, medical care to
unassigned patients entering the hospital through the emergency room.
The physician must show that he was available to provide medical care
to unassigned patients and that, when needed, did provide medical care
to unassigned patients entering the hospital through the emergency
room.
(d) The physician has not incurred two or more claims resulting in
indemnities exceeding $125,000 each in the preceding 5 years. Payment
of a claim or judgment by an uninsured physician shall be considered a
claim resulting in indemnity under this paragraph.
(e) The physician does not have an unsatisfied medical malpractice
judgment which was entered within the preceding 5 years, or, if there is
such an unsatisfied judgment, the physician can show that at least
$250,000 of the judgment has been satisfied.
(f) The physician did not obtain medical malpractice liability
insurance coverage for the preceding calendar year from the Joint
Underwriting Association established under s. 627.351(4), Florida
Statutes.
(g) The physician has met the threshold criteria as provided in section
18 to qualify for a premium assistance distribution from the fund.
(h) The physician's medical malpractice liability insurance premium
for the preceding calendar year did not include any surcharge for claims
experience or past disciplinary actions or proceedings.
(2) The burden shall be upon an applying physician to establish
eligibility under all criteria by clear and convincing evidence.
Section 20. Medical manpower shortage areas.-
(1) The Department of Health and Rehabilitative Services shall
designate, and shall report, by April 1, 1988, to the Governor, the
President of the Senate, and the Speaker of the House of Representa-
tives, state medical manpower shortage areas and the methodology used
by the department to designate such areas, which shall be based on the
availability of physicians by geographical area and medical specialty.
Such availability shall be determined by the number of physicians who
are actually providing services to patients within their particular
specialty in a geographical area.
(2) Such designated medical manpower shortage areas shall be based
on the supply of and demand for medical services and facilities; the
health status data of the population, including mortality, morbidity,
and births; and any other indications of the need for medical services
and facilities. The department shall also survey physicians regarding
the gross revenue derived from the provision of medical services and
shall include the results of such survey in its report of April 1, 1988.
(3) The Division of Medical Quality Assurance shall require that all
physicians report to the Department of Health and Rehabilitative
Services such information as such department deems necessary in order
to designate medical manpower shortage areas. Noncompliance by any
physician shall be grounds for an appropriate disciplinary sanction by
the division.
(4) The Department of Health and Rehabilitative Services shall adopt
all rules necessary to carry out the provisions of this section.
Section 21. Except as provided in section 20, the Department of
Insurance shall adopt all rules necessary to carry out the provisions of
this part.



Section 22. This part is repealed on July 1, 1994, and shall be
reviewed by the Legislature prior to said date.



Rep. Ogden moved the adoption of the amendment.

THE SPEAKER IN THE CHAIR

Representatives Abrams and Gordon offered the following amend-
ment to the amendment:
Amendment 1 to Amendment 2-On page 6, line 16 after the
period, insert:
(i) The physician has been certified by the Department of Health and
Rehabilitative Services as a meaningful participant in a public program
providing health care to individuals of low income. To qualify as a
meaningful participant the physician shall have provided in the
preceding calendar year the equivalent of at least $2,500 in patient care
to clients of at least one of the following programs:
1. Medicaid.
2. Improved Pregnancy Outcome Program.
3. State or federal primary care programs.
4. Children's Medical Services.
5. Any other public programs as determined by the department which
provides health care to individuals of low income.
(j) The physician is enrolled as a participating physician in the
Medicare assignment program.
Rep. Abrams moved the adoption of the amendment to the amend-
ment, which failed of adoption. The vote was:
Yeas-37



Abrams
Arnold
Banjanin
Bloom
Brown
Burke
Canady
Clark
Cosgrove
Dantzler
Nays-69
The Chair
Ascherl
Bainter
Bankhead
Bass
Bell
Bronson
Burnsed
Carpenter
Casas
Clements
Crady
Crotty
Deutsch
Dunbar
Frishe
Garcia
Gardner



Diaz-Balart
Figg
Frankel
Friedman
Gaffney
Glickman
Gonzalez-
Quevedo
Gordon
Gustafson


Goode
Grindle
Guber
Hanson
Harden
Harris
Hawkins
Hill
Holland
Ireland
Irvine
Jennings
Johnson, B. L.
Johnson, R. C.
Jones, D. L.
Kelly
King
Lewis



Gutman
Healey
Jamerson
Jones, C. F.
Langton
Liberti
Logan
Martinez
Peeples
Press


Lippman
Lombard
Long
Mackenzie
Mackey
Martin
McEwan
Messersmith
Metcalf
Mitchell
Mortham
Ogden
Ostrau
Patchett
Rehm
Renke
Rochlin
Rudd



Votes after roll call:
Yeas to Nays-Gonzalez-Quevedo
Representative Logan offered the following
amendment:



Reaves
Reddick
Sample
Silver
Simon
Titone
Upchurch
Wallace




Sanderson
Saunders
Shelley
Simone
Smith
Souto
Starks
Stone
Thomas
Tobiassen
Tobin
Troxler
Webster
Woodruff
Young



amendment to the



Amendment 2 to Amendment 2-On page 5, line 4, after the colon,
insert: (a) The physician's net income from the provision of medical
services did not exceed $75,000 for the previous calendar year.
(renumber subsequent paragraphs)
Rep. Logan moved the adoption of the amendment to the amend-
ment, which failed of adoption.



February 3, 1988



18














Representative Logan offered the following amendment to the
amendment:
Amendment 3 to Amendment 2-On page 5, line 25, insert: (d)
The physician submits an affidavit to the department stating that the
physician has received $1,000 in medicaid reimbursement, and is
currently registered with the Department of Health and Rehabilitative
Services as a participating physician in the Medicaid program. The
department has the discretion to waive this requirement if the physician
is a member of a physician's group which has been actively billing for
medicaid reimbursement during the previous calendar year, and is
currently registered with the Department of Health and Rehabilitative
Services as a participating physician's group in the medicaid program.
The physician must also submit an affidavit stating that the physician
participates in the medicare assignment program. (renumber subse-
quent paragraphs)
Rep. Logan moved the adoption of the amendment to the amend-
ment, which failed of adoption.
Representative Simon offered the following amendment to the
amendment:
Amendment 4 to Amendment 2-On page 6, between lines 19 and
20, insert:
Section 20. Distributions.-
(1) As used in this section:
(a) "Class 1" means physicians who practice a medical specialty not
included in Classes 2, 3, or 4.
(b) "Class 2" means physicians who practice the following medical
specialties: urological surgery, major ophthalmological surgery, family
physicians and general practitioners who perform obstetrical proce-
dures, and major invasive procedures.
(c) "Class 3" means physicians who practice the following medical
specialties: plastic surgery, major gynecological surgery, hand surgery,
head and neck surgery, major laryngological surgery, major general
surgery, emergency medicine, major otological surgery, major otorhino-
laringological surgery, major rhinological surgery, abdominal surgery,
anesthesiology, bronco-esophagology, major endocrinological surgery,
major gastroenterological surgery, major geriatric surgery, major
neoplastic surgery, major nephrological surgery, colon and rectal
surgery, and general practice with major surgery.
(d) "Class 4" means physicians who practice the following medical
specialties in performing major surgery: neurological surgery, obstetri-
cal surgery, thoracic surgery, vascular surgery, cardiovascular surgery,
orthopedic surgery, traumatic surgery, and cardiac surgery.
(2)(a) No more than 25 percent of the premium assistance payments
shall be made to eligible physicians based upon the location of their
practice in a medical manpower shortage area. All remaining payments
shall be made to otherwise eligible physicians, regardless of whether the
physician practiced in a medical manpower shortage area in accordance
with paragraph (b)
(b) In the event the trust fund does not contain sufficient funds in any
one year to make full distributions to every eligible physician, full
distributions shall first be made to those physicians in Class 4, then to
those physicians in Class 3, then to those physicians in Class 2, and
then to those physicians in Class 1. In the event sufficient funds are not
available to make full distributions to all physicians in a particular
class, distributions shall be made on a pro rata basis based on the
amount due to each physician in the class and the amount due to all
physicians in the class. (renumber subsequent sections)
Rep. Simon moved the adoption of the amendment to the amend-
ment, which failed of adoption. The vote was:
Yeas-29



Abrams
Arnold
Bloom
Cosgrove
Davis



Diaz-Balart
Frankel
Friedman
Gaffney
Glickman



Gonzalez-
Quevedo
Guber
Gustafson
Healey



Langton
Lawson
Logan
Martinez
Metcalf



Ostrau
Press
Reaves
Nays-82
The Chair
Ascherl
Bainter
Banjanin
Bankhead
Bass
Bell
Bronson
Brown
Burke
Burnsed
Canady
Carlton
Carpenter
Crady
Crotty
Dantzler
Deutsch
Dunbar
Figg
Frishe



Rochlin
Sample
Simon



Garcia
Gardner
Goode
Gordon
Grindle
Gutman
Hanson
Harden
Hargrett
Harris
Hawkins
Hill
Hodges
Holland
Ireland
Jamerson
Jennings
Johnson, B. L.
Johnson, R. C.
Jones, C. F.
Jones, D. L.



19



Souto
Titone
Upchurch



Kelly
King
Lewis
Liberti
Lippman
Locke
Lombard
Long
Mackenzie
Mackey
McEwan
Meffert
Messersmith
Mitchell
Mortham
Nergard
Ogden
Patchett
Peeples
Reddick
Rehm



Woodruff



Renke
Rudd
Sanderson
Sansom
Saunders
Shelley
Silver
Simone
Smith
Starks
Thomas
Tobiassen
Tobin
Trammell
Troxler
Wallace
Webster
Wetherell
Young



The question recurred on the adoption of Amendment 2, which was
adopted.
The Committee on Appropriations offered the following amendment:
Amendment 3 profilee 3)-On page 44, line 24, strike "obstetricians"
and insert: physicians who wish to participate in the Florida Birth-Re-
lated Neurological Injury Compensation Plan and who otherwise
qualify as participating physicians under this part
Rep. Bell moved the adoption of the amendment, which was adopted.
The Committee on Appropriations offered the following amendment:
Amendment 4 profilee 4)-On page 40, line 2, and on page 40, line
12, strike "an obstetrician" and insert "a participating physician"; and
on page 44, line 31, and on page 46, line 24, strike "obstetricians" and
insert "participating physicians"; and on page 48, line 28, strike
"obstetrician" and insert: participating physician
Rep. Bell moved the adoption of the amendment, which was adopted
without objection.
The Committee on Appropriations offered the following amendment:
Amendment 5 profilee 5)-On page 40, line 5, strike "An obstetric-
ian" and insert: By becoming a participating physician, a physician
Rep. Bell moved the adoption of the amendment, which was adopted
without objection.
The Committee on Appropriations offered the following amendment:
Amendment 6 profilee 6)-On page 45, line 24, strike "obstetricians
and other" and insert: participating and non-participating
Rep. Bell moved the adoption of the amendment, which was adopted
without objection.
The Committee on Appropriations offered the following amendment:
Amendment 7 profilee 7)-On page 45, lines 8-16, strike all of said
lines and renumber remaining subsections
Rep. Bell moved the adoption of the amendment, which was adopted.
The Committee on Appropriations offered the following amendment:
Amendment 8 profilee 8)-On page 48, line 27, through page 49,
line 2, strike all of said lines and insert:
Section 38. Notice to obstetrical patients of participation in plan.-
Each hospital and each participating physician under the Florida
Birth-Related Neurological Injury Compensation Plan shall provide
notice to the obstetrical patients thereof as to participation in the limited
no-fault alternative for birth-related neurological injuries. Such notice



February 3, 1988



JOURNAL OF THE HOUSE OF REPRESENTATIVES











20



shall be provided on forms furnished by the association and shall
include a clear and concise explanation of a patient's rights and
limitations under the plan.
Rep. Bell moved the adoption of the amendment, which was adopted
without objection.
The Committee on Appropriations offered the following amendment:
Amendment 9 profilee 9)-On page 45, line 17, through page 46,
line 5, strike all of said lines and insert:
(5)(a) Beginning January 1, 1990, the persons and entities listed in
subsection (4), as of the date determined in accordance with the plan of
operation, shall pay an annual assessment in the amount equal to their
initial assessments, in the manner required by the plan of operation.
(b)l. Taking into account the assessments collected pursuant to
subsection (4), if required to maintain the fund on an actuarially sound
basis, the Department of Insurance shall require all entities licensed to
issue casualty insurance as defined in s. 624.605(1)(b), (k), and (q),
Florida Statutes, and self-insurers authorized to issue medical mal-
practice insurance under s. 627.357, Florida Statutes, to pay into the
fund an annual assessment, in an amount determined by the depart-
ment pursuant to paragraph (7)(a), in the manner required by the plan
of operation.
2. All annual assessments shall be made on the basis of net direct
premiums written for the business activity which forms the basis for
each such entity's inclusion as a funding source for the plan in the state
during the prior year ending December 31, as reported to the
Department of Insurance, and shall be in the proportion that the net
direct premiums written by each carrier on account of the business
activity forming the basis for its inclusion in the plan bears to the
aggregate net direct premiums for all such business activity written in
this state by all such entities.
3. No entity listed in this paragraph shall be individually liable for an
annual assessment in excess of 0.25 percent of that entity's net direct
premiums written.
4. Casualty insurance carriers shall be entitled to recover their initial
and annual assessments through a surcharge on future policies, a rate
increase applicable prospectively, or a combination of the two.
(6)(a) The Department of Professional Regulation shall collect and
enforce collection of all assessments required to be paid by participating
and non-participating physicians pursuant to this part. Failure of a
physician to pay an assessment required by this part shall be grounds
for disciplinary action pursuant to chapter 458 or chapter 459, Florida
Statutes.
(b) The Department of Health and Rehabilitative Services shall collect
and enforce collection of all assessments required to be paid by hospitals
pursuant to this part. Failure of a hospital to pay an assessment
required by this part shall be grounds for disciplinary action pursuant
to s. 395.018, Florida Statutes.
(c) Assessments collected pursuant to this subsection shall be
transferred to the Department of Insurance for deposit in the fund.
(7)(a) The Department of Insurance shall undertake an actuarial
investigation of the requirements of the fund based on the fund's
experience in the first year of operation, including without limitation the
assets and liabilities of the fund. Pursuant to such investigation, the
Department of Insurance shall establish the rate of contribution of the
entities listed in paragraph (5)(b) for the tax year beginning January 1,
1990. Following the initial valuation, the Department of Insurance shall
cause an actuarial valuation to be made of the assets and liabilities of
the fund no less frequently than biennially. Pursuant to the results of
such valuations, the Department of Insurance shall prepare a statement
as to the contribution rate applicable to the entities listed in paragraph
(5)(b). However, at no time shall the rate be greater than 0.25 percent of
net direct premiums written.
(b) If the Department of Insurance finds that the fund cannot be
maintained on an actuarially sound basis based on the assessments
listed in subsections (4) and (5), the Department of Insurance shall



promptly notify the President of the Senate, the Speaker of the House of
Representatives, and the division.



February 3, 1988



Rep. Bell moved the adoption of the amendment.
Representative Simon offered the following amendment to the
amendment:
Amendment 1 to Amendment 9-On page 1, lines 24-26, strike all
of said lines and insert: Florida Statutes, to pay into the fund an annual
assessment in an
Rep. Simon moved the adoption of the amendment to the amendment
which was adopted.
The question recurred on the adoption of Amendment 9, as amended,
which was adopted.
The Committee on Appropriations offered the following amendment:
Amendment 10 profilee 11)--On page 44, line 29, after the period
insert: All hospitals owned or operated by the state, any county, any
special taxing district or any other political subdivision of the state shall
not be required to pay the initial assessment or any assessment required
by subsection (5) of this section.
Rep. Bell moved the adoption of the amendment.
Representatives Bankhead, Crady, Martin, King, Brown, Gaffney,
and Troxler offered the following amendment to the amendment:
Amendment 1 to Amendment 10-On page 1, line 16 insert the
following after the period: The term "infant delivered during the prior
calendar year" shall not include infants delivered by a physician
employed by the State or any political subdivision thereof.
Rep. Bankhead moved the adoption of the amendment to the
amendment, which was adopted without objection.
The question recurred on the adoption of Amendment 10, as
amended, which was adopted.
The Committee on Appropriations offered the following amendment:
Amendment 11 profilee 12)-On page 129, line 14, insert: Section
54 Appropriations:
There is hereby appropriated to the Department of Insurance
$2,300,000 from the General Revenue Fund for transfer to the
Birth-Related Neurological Injury Compensation Trust Fund for the
1988-89 fiscal year. (renumber subsequent sections)
Rep. Bell moved the adoption of the amendment.
Representatives Bankhead, Crady, Martin, King, Brown, Gaffney
and Troxler offered the following amendment to the amendment:
Amendment 1 to Amendment 11-On page 129, line 14, strike
"$2,300,000" and insert: $2,650,000
Rep. Bankhead moved the adoption of the amendment to the
amendment, which was adopted without objection.
The question recurred on the adoption of Amendment 11, as
amended, which was adopted.

The Committee on Appropriations offered the following amendment:
Amendment 12 (prefile 13)-On page 45, lines 3-7, strike all of said
lines



Rep. Gordon moved the
adopted. The vote was:
Yeas-62



The Chair
Abrams
Ascherl
Bass
Bell
Bloom
Brown
Burke
Burnsed
Clark
Dantzler
Davis



Deutsch
Figg
Frankel
Friedman
Gaffney
Gardner
Glickman
Goode
Gordon
Guber
Gustafson
Gutman



adoption of the amendment, which was



Hanson
Hargrett
Hawkins
Hodges
Holland
Ireland
Jennings
Johnson, B. L.
King
Lawson
Lewis
Liberti



Lippman
Locke
Logan
Long
Mackenzie
Meffert
Metcalf
Mitchell
Ostrau
Peeples
Press
Reaves



JOURNAL OF THE HOUSE OF REPRESENTATIVES











February 3, 1988



Reddick
Rehm
Rochlin
Rudd
Nays-51



Sanderson
Silver
Simon
Simone



Arnold Frishe
Banjanin Garcia
Bankhead Gonzalez-
Bronson Quevedo
Canady Grindle
Carlton Harden
Casas Harris
Clements Healey
Cosgrove Hill
Crady Irvine
Crotty Johnson, R. C.
Diaz-Balart Jones, C. F.
Dunbar Jones, D. L.
Votes after roll call:
Yeas-Wallace



Smith
Stone
Tobin
Trammell



Kelly
Langton
Lombard
Mackey
Martinez
McEwan
Messersmith
Morse
Mortham
Nergard
Patchett
Renke
Rush



Wetherell
Young



Sample
Sansom
Saunders
Shelley
Souto
Starks
Thomas
Titone
Tobiassen
Troxler
Upchurch
Webster
Woodruff



Yeas to Nays-Meffert, Trammell
Nays to Yeas-Saunders
The Committee on Appropriations offered the following amendment:
Amendment 13 profilee 14)-On page 49, line 3, through page 53,
line 11, strike all of said lines and insert:
PART V
FLORIDA MEDICAL EMERGENCY CARE
LIABILITY REFORM
Section 39. Legislative findings and intent.-
(1) The Legislature makes the following findings:
(a) A system for the adequate delivery of medical emergency care
services located appropriately throughout the state, which system
provides the care needed by medical emergency care patients, is a
priority health care need and can have a dramatic impact in reducing
civil lawsuits which ultimately result in high medical malpractice
insurance premiums. Therefore, the establishment of such a system
represents an essential public service.
(b) Development of such a system has been impeded by the fact that
medical emergency care patients may be unable to pay for their medical
emergency care. Medical emergency care providers are often faced with
civil lawsuits brought on behalf of medical emergency care patients,
many of which may not be the direct result of substandard care, but
rather may be prompted by recovery of such patient to less than full
mental and physical health due to the severe nature of the medical
emergency.
(c) Civil lawsuits brought on behalf of medical emergency care
patients are often the result of factors beyond the control of the medical
emergency care facility or the provider rendering such care, including,
but not limited to:
1. The severe nature of many such emergencies; and
2. The fact that the emergency patient may not have had a previously
established medical relationship with the defendant, may have been
unknown to the defendant, and may have been unconscious or unable to
provide essential information, such as medical history, allergies to
drugs, and other relevant facts.
(2) It is the intent of the Legislature to promote the establishment of a
statewide system of medical emergency care which shall assure the care
needed by medical emergency care patients by reducing civil lawsuits
against medical emergency care facilities and the medical emergency
care providers who render care therein. Therefore, it is the intent of the
Legislature that medical emergency care facilities and the medical
emergency care providers rendering care therein to medical emergency
patients shall be immune from civil liability with respect thereto unless
such medical emergency care constitutes medical emergency negligence
as defined in section 40. The Legislature provides this limitation on civil
liability to medical emergency care facilities and providers in exchange



21



for the requirement that all such facilities and providers provide
medical emergency care to medical emergency care patients regardless
of ability to pay. This provision of care requirement shall include the
acceptance of medical emergency care patients from hospitals which are
unable to provide the level of care required by such patients.
Section 40. Definitions.-As used in this part:
(1) "Medical emergency negligence" means the failure to provide
medical emergency care, under circumstances demonstrating reckless
disregard for consequences so as to affect the life or health of another.
(2) "Department" means the Department of Health and Rehabilitative
Services.
(3) "Medical emergency care" means care or treatment necessitated by
a sudden, unexpected situation or occurrence resulting in a serious
medical condition demanding immediate medical attention for which
the patient enters the hospital through its emergency room or trauma
center. This subsection shall not apply to any act or omission of medical
care provided after the patient has been stabilized, except that if surgery
is required by such an emergency, this subsection shall apply to any act
or omission of medical care provided prior to post-surgical stabilization.
Further, this subsection shall not apply to any act or omission of
medical care provided by a physician to a patient with whom the
physician has had a pre-existing doctor-patient relationship within the
previous two years. Medical emergency care shall include emergency
psychiatric care performed a medical emergency care facility or at any
community mental health center or crisis stabilization unit.
(4) "Medical emergency care facility" means the trauma center or
full-time emergency room of a hospital.
(5) "Medical emergency care patient" means a person who has
incurred a sudden and serious injury or illness necessitating medical
emergency care as defined in subsection (3).
(6) "Medical emergency care provider" means any physician, dentist,
or staff or personnel of a hospital trauma center or emergency room
selected by such hospital as having the degree of skill and training
necessary to provide the requisite medical emergency care for that
professional. Such term shall apply to the acts or omissions of a medical
emergency care provider licensed under chapter 458, chapter 459, or
chapter 466, Florida Statutes, only if such medical emergency care
provider:
(a) Is certified as a specialist for the medical or dental procedures
performed, either by one of the appropriate American specialty boards
accredited by the Council on Medical Education of the American
Medical Association or by one of the appropriate specialty boards of the
American Osteopathic Association or the American Dental Association;
(b) Possesses the education, training, and experience required as a
prerequisite for examination by one of such specialty boards; or
(c) Is certified by the credentialing committee or equivalent hospital
committee as having a level of skill, training, and experience which is
equivalent to certification by one of such boards.
Section 41. Immunity from civil liability for rendering medical
emergency care.-
(1) No medical emergency care facility or provider rendering medical
emergency care to a medical emergency care patient in response to a
medical emergency without the objection of the patient shall be held
liable for damages in any civil action as a result of rendering such
medical emergency care or as a result of any act or failure to act in
rendering or arranging further medical emergency care, unless the
claimant proves by clear and convincing evidence that medical emergen-
cy care or act or failure to act constitutes medical emergency negligence
as defined in section 40. The immunity provided to a medical emergency
care facility pursuant to this section shall extend to the officers,
directors, trustees, employees, and agents thereof.
(2) The immunity from civil liability granted pursuant to subsection
(1) shall be in effect only for the period during which such patient is
being treated for such emergency which, if left untreated, would likely
result in a significantly worsened medical condition and shall not apply



to any act or omission of medical care provided after the patient has
been stabilized, except that if surgery is required, this subsection shall



JOURNAL OF THE HOUSE OF REPRESENTATIVES













apply to any act or omission of medical care provided prior to
post-surgical stabilization.
(3) The immunity from civil liability granted pursuant to subsection
(1) shall also apply when any such medical emergency care facility or
provider accepts and treats a medical emergency care patient as a
transfer patient from another medical emergency care facility or other
health care provider.
(4) Every medical emergency care facility shall accept and treat all
medical emergency care patients within the operational capacity of such
facility without regard to ability to pay, including patients transferred
from another medical emergency care facility or other health care
provider pursuant to Pub. L. No. 99-272, s. 9121. Failure of a medical
emergency care facility to comply with the provisions of this subsection
shall constitute grounds for the department to initiate disciplinary
action against the facility pursuant to chapter 395, Florida Statutes.
Section 42. Department to adopt rules.-The department shall adopt
rules necessary for the implementation of this part.
Rep. Bell moved the adoption of the amendment.
On motion by Rep. Dunbar, the rules were waived and debate on the
amendments to Amendment 13 was limited to three minutes per side.
Representative Upchurch offered the following amendment to the
amendment:
Amendment 1 to Amendment 13-On page 2, lines 23-26, strike
all of said lines and insert:
medical emergency patients shall not be subject to civil liability with
respect thereto unless such care was rendered in bad faith and in breach
of the prevailing professional standard of care. The Legislature provides
this limitation on civil



Rep. Upchurch moved the adoption of the
amendment, which was adopted. The vote was:
Yeas-58



Diaz-Balart
Drage
Dunbar
Figg
Frankel
Friedman
Frishe
Gaffney
Gardner
Glickman
Gonzalez-
Quevedo
Gordon
Guber
Gustafson


Harden
Hawkins
Hill
Hodges
Holland
Ireland
Irvine
Jennings
Johnson, B. L.
Johnson, R. C.
Jones, D. L.
Kelly



Hargrett
Harris
Healey
Jamerson
King
Langton
Liberti
Logan
Mackenzie
Mackey
Martinez
McEwan
Ostrau
Peeples
Press


Lewis
Lombard
Long
Martin
Messersmith
Metcalf
Mitchell
Nergard
Ogden
Patchett
Rehm
Renke



amendment to the



Reaves
Reddick
Rush
Sample
Saunders
Silver
Simon
Titone
Tobin
Trammell
Upchurch
Wallace
Woodruff
Young



Rochlin
Rudd
Sanderson
Sansom
Smith
Souto
Starks
Stone
Thomas
Tobiassen
Troxler



Votes after roll call:
Yeas-Carpenter
Nays-Arnold, Simone
Yeas to Nays-Bloom, Guber, King
Representative Upchurch offered the following amendment to the
amendment:



February 3, 1988



Amendment 2 to Amendment 13-On page 3, lines 6 and 7, strike
all of said lines and insert: demonstrating breach of the prevailing
professional standard of care.
Rep. Upchurch moved the adoption of the amendment to the
amendment, which was adopted without objection.
Representative Upchurch offered the following amendment to the
amendment:
Amendment 3 to Amendment 13-On page 5, lines 4 and 5, strike
all of said lines and insert: the alleged action of the facility or provider
represented a breach of the prevailing professional standard of care. It
shall be a defense to an asserted breach of the prevailing professional
standard of care that the defendant acted in good faith. The defendant
must prove the existence of good faith by clear and convincing evidence.
The
Rep. Upchurch moved the adoption of the amendment to the
amendment, which was adopted without objection.
Representatives Glickman and Rush offered the following amend-
ment to the amendment:
Amendment 4 to Amendment 13-On page 2, lines 20-26, strike
all of said lines and insert: render care therein. The Legislature
provides limitations on civil
Rep. Glickman moved the adoption of the amendment to the
amendment. During consideration thereof, further consideration was
temporarily deferred. Subsequently, the amendment to the amendment
was withdrawn.
Representative Logan offered the following amendment to the
amendment:
Amendment 5 to Amendment 13-On page 3, lines 10-26, strike
all said lines and insert:
(3) "Medical Emergency Care" means care or treatment necessitated
by a single or multi system life-threatening injury due to blunt or
penetrating means, burns or oxygen deprivation. Medical emergency
care also means care provided to a mother or child who is injured due to
an accident or illness resulting from or related to childbirth. This
subsection shall not apply to any act or omission of medical care
provided after the patient has been stabilized, except that if surgery is
required by such an emergency, this subsection shall apply to any act or
omission of medical care provided prior to post-surgical stabilization.
With regard to an injury resulting from or related to childbirth, the
immunity granted pursuant to subsection (1) shall not apply beyond 24
hours after delivery. Further, this subsection shall not apply to any act
or omission of medical care provided by a physician to a patient with
whom the physician has had a pre-existing doctor-patient relationship
within the previous two years.
Rep. Logan moved the adoption of the amendment, which failed of
adoption.
Representative Woodruff offered the following amendment to the
amendment:
Amendment 6 to Amendment 13-On page 4, line 29, after
"emergency" insert: provided at a medical emergency care facility or at
any community mental health center or crisis stabilization unit.
Rep. Woodruff moved the adoption of the amendment to the
amendment, which was adopted without objection.
Representative Woodruff offered the following amendment to the
amendment:
Amendment 7 to Amendment 13-On page 5, line 8, after the
period, insert: It does not apply to the transportation to and from
facilities.
Rep. Woodruff moved the adoption of the amendment to the
amendment, which was adopted without objection.
Representative Frankel offered the following amendment to the
amendment:



Amendment 8 to Amendment 13-On page 3, lines 5-7, strike all
of said lines and insert: to provide medical emergency care as a



22



JOURNAL OF THE HOUSE OF REPRESENTATIVES



The Chair
Abrams
Bainter
Banjanin
Bloom
Brown
Burke
Canady
Carlton
Clark
Cosgrove
Crady
Dantzler
Davis
Deutsch
Nays-47
Ascherl
Bankhead
Bass
Bell
Bronson
Burnsed
Casas
Clements
Garcia
Goode
Grindle
Gutman










JOURNAL OF THE HOUSE



reasonably prudent health care provider would have provided such care
under the same or similar circumstances.
Rep. Frankel moved the adoption of the amendment to the
amendment, which failed of adoption.
Representatives Glickman and Rush offered the following amend-
ment to the amendment:
Amendment 9 to Amendment 13-On page 5, lines 15-17, strike
all of said lines and insert: patient has been stabilized.
Rep. Glickman moved the adoption of the amendment to the
amendment, which failed of adoption.
Representative Simon offered the following amendment to the
amendment:
Amendment 10 to Amendment 13-On page 6, line 3, insert: (5)
Every hospital licensed under chapter 395 which has an emergency
room shall require, as a condition of staff membership or professional
clinical privileges, that a health care practitioner perform medical
emergency care in the emergency room. The governing body of the
hospital shall set standards and procedures to be applied to this
requirement and shall exempt therefrom any practitioner whose practice
is not applicable to the performance of medical emergency care.
Rep. Simon moved the adoption of the amendment to the amend-
ment, which failed of adoption.
The question recurred on the adoption of Amendment 13, as
amended, which was adopted.
On motion by Rep. Dunbar, without objection, the rules were waived
and debate was limited to one minute per side.
The Committee on Appropriations offered the following amendment:
Amendment 14 profilee 15)-On page 127, line 24, through page
128, line 26, strike all of said lines. (renumber subsequent sections)
Rep. Bell moved the adoption of the amendment. Pending considera-
tion thereof--
Rep. Martinez offered the following substitute amendment:
Substitute Amendment 14-On page 128, lines 21-26, strike all of
said lines and insert: If an action for medical malpractice has been
commenced within the time period required by this paragraph, joinder
of any other party defendant to which this paragraph applies shall be
allowed for 1 year from the date of commencement of such action.
Rep. Martinez moved the adoption of the substitute amendment,
which was adopted.
The Committee on Appropriations offered the following amendment:
Amendment 15 profilee 16)-On page 124, line 30, through page
126, line 30, strike all of said lines (renumber subsequent sections)
Rep. Bell moved the adoption of the amendment, which was adopted
without objection.
The Committee on Appropriations offered the following amendment:
Amendment 16 (prefile 17)-On page 129, line 5, insert: Section
54-Appropriations.-
(1) There is hereby appropriated to the Department of Professional
Regulation 89 positions and $1,547,751 from the Professional Regula-
tion Trust Fund for the 1987-88 fiscal year to implement the provisions
of this act.
(2) There is hereby appropriated to the Department of Administration,
Division of Administrative Hearings 5 positions and $207,168 from the
General Revenue Fund and 5 positions and $66,000 from the Adminis-
trative Trust Fund for the 1987-88 fiscal year to implement the
provisions of this act. Additional salary rate of $380,425 is provided to
the Division.
(3) There is hereby appropriated to the Department of Insurance 9
positions and $149,616 from the Insurance Commissioner's Regulatory



Trust Fund for the 1987-88 fiscal year to implement the provisions of
this act. In addition, for the 1987-88 fiscal year there is hereby
appropriated to the Department of Insurance $40,000 from the Insur-



February 3, 1988



Rep. Lippman moved the adoption of the substitute amendment,
which was adopted.
Representatives Lippman and Gordon offered the following title
amendment:



OF REPRESENTATIVES 23

ance Commissioner's Regulatory Trust Fund for transfer to the Florida
Medical Care Availability Assistance Trust Fund. (renumber subse-
quent sections.)
Rep. Bell moved the adoption of the amendment, which was adopted
without objection.
The Committee on Appropriations offered the following title amend-
ment:
Amendment 17 profilee 18)-On page 9, line 5, insert after
"severability;": providing appropriations
Rep. Bell moved the adoption of the amendment, which was adopted
without objection.
The Committee on Appropriations offered the following amendment:
Amendment 18 (prefile 21)-On page 101, line 21, insert: Section
34. Subsection (2) of section 459.0092, Florida Statutes, is amended to
read:
459.0092 Fees.-The board shall set fees according to the following
schedule:
(2) The fee for biennial renewal of licensure or certification shall not
exceed $200 450 (renumber subsequent sections)
Rep. Bell moved the adoption of the amendment, which was adopted
without objection.
The Committee on Appropriations offered the following amendment:
Amendment 19 profilee 22)-On page 87, line 24, strike "$250" and
insert: $350
Rep. Bell moved the adoption of the amendment, which was adopted
without objection.
The Committee on Appropriations offered the following amendment:
Amendment 20-On page 127, line 24, insert: Section 50. Subsec-
tions (6)-(16) of section 768.28, Florida Statutes are renumbered as
subsections (7)-(17) and a new subsection (6) is added to said section to
read:
(6) In an action for damages for personal injury or wrongful death
arising out of medical malpractice, whether in contract or tort, when an
apportionment of damages pursuant to s. 768.81 is attributed to a
medical teaching hospital as defined by s. 395.002(6) or the Hospital
Cost Containment Board, the court shall enter judgment against each
party liable on the basis of such party's percentage of fault and not on
the basis of the doctrine of joint and several liability. The sole remedy
available to a claimant to collect damages, subject to the provisions of
this subsection, against a medical teaching hospital as defined by
s. 395.002(6) or the Hospital Cost Containment Board shall be pursuant
to s. 768.28. (renumber subsequent sections)
Rep. Bell moved the adoption of the amendment. Pending considera-
tion thereof-
Representatives Lippman and Gordon offered the following substi-
tute amendment:
Substitute Amendment 20-On page 127, line 24, insert:
Section 50. Subsection (6) of section 768.81, Florida Statutes is
created to read:
(6) Notwithstanding anything in law to the contrary, in an action for
damages for personal injury or wrongful death arising out of medical
malpractice, whether in contract or tort, when an apportionment of
damages pursuant to this section is attributed to a teaching hospital as
defined in section 395.502(22), the court shall enter judgment against
each party liable on the basis of such party's percentage of fault and not
on the basis of the doctrine of joint and several liability. (renumber
subsequent subsections)











24



Amendment 21-On page 8, line 31 after "regents:" insert:
amending section 768.81, Florida Statutes, providing for medical
malpractice damages which are attributed to a medical teaching
hospital as defined by section 395.502(22).
Rep. Lippman moved the adoption of the amendment, which was
adopted without objection.
The Committee on Appropriations offered the following amendment:
Amendment 22 profilee 25)-On page 73, line 14, insert:
Section 10. Subsection (2) of section 455.203, Florida Statutes, is
amended to read:
455.203 Department of Professional Regulation; powers and
duties.-The Department of Professional Regulation shall:
(2) Appoint the executive director of each board within the
department, who shall be exempt from the career service system, subject
to the approval of the board. (renumber subsequent sections)
Rep. Bell moved the adoption of the amendment, which was adopted
without objection.
The Committee on Appropriations offered the following title amend-
ment:
Amendment 23 (prefile 26)-On page 5, line 6, insert after the
semicolon: amending s. 455.203, F.S., exempting executive directors of
professional regulation boards from the career service system;
Rep. Bell moved the adoption of the amendment, which was adopted
without objection.
The Committee on Appropriations offered the following amendment:
Amendment 24 profilee 27)-On page 87, line 23, and page 99, line
24, insert after the word "medicine": or has been on the active teaching
faculty of an accredited medical school
Rep. Bell moved the adoption of the amendment, which was adopted
without objection.
Representative Locke offered the following amendment:
Amendment 25-On page 129, line 13 after the period insert:
Section 54. Any other provision to the :contrary notwithstanding, no
member of the Florida Bar shall advertise his legal services in any
media. and renumber the subsequent section
Rep. Locke moved.the adoption of the amendment. During considera-
tion thereof, without objection, the amendment was withdrawn.
Representatives Silver, Ogden, Lippman, Dunbar, Carlton, and
Mackenzie offered the following amendment:
Amendment 26-On page 129, line 8, after the period insert:
Section 44.(1) The legislature finds that the provisions of this act will
substantially reduce medical malpractice costs. It is the legislative intent
that these reductions be reflected in a reduction in medical malpractice
premiums within the next two years.
(2) Notwithstanding any law to the contrary, on or before January 1,
1990, all approved medical malpractice insurance rates for each
geographic area and classification shall be at least 15 percent less than
the approved medical malpractice insurance rates in effect for each
geographic area and classification on the effective date of this act, as
adjusted prior to January 1, 1990, by the Medical Price Index issued by
the United States Department of Labor.
(3) On or before March 1, 1990, the Insurance Commissioner shall
certify to the legislature compliance with subsection (2).
(4) For purposes of this section, the term "insurer" includes an
authorized insurer as defined under s. 624.09, a surplus lines insurer as
defined under s. 626.914(2), a risk retention group as defined under
s. 627.942, the Joint Underwriting Association established under
s. 627.351(4).
(5) This act shall be repealed on July 1, 1990, and shall be reviewed
by the legislature in advance of said date. It is the intent of the
legislature that the legislature shall not reenact the provisions of this act



unless insurers comply with the provisions of subsection (2). (renumber
subsequent sections)



February 3, 1988



Rep. Silver moved the adoption of the amendment, which was
adopted without objection.
Representative Simon offered the following amendment:
Amendment 27-On page 34, line 16, after the period insert:
Such term shall not apply to:
(a) Any physician who practices medicine as an officer, employee, or
agent of the Federal Government or of the state or its agencies or its
subdivisions. For the purposes of this subsection, an agent of the state,
its agencies or subdivisions is a person who is eligible for coverage
under any self-insurance or insurance program authorized by the
provisions of s. 76828(13).
(b) Any physician who practices obstetrics in conjunction with his
teaching duties at an accredited medical school or in its main teaching
hospitals.
Rep. Simon moved the adoption of the amendment, which was
adopted without objection.

THE SPEAKER PRO TEMPORE IN THE CHAIR

Representative King offered the following amendment:
Amendment 28-On page 50, between lines 27 & 28, insert the
following:
(3) Any doctor who has active staff privileges at a hospital must
participate in the call schedule for emergency patients within the
framework of the specialties provided by that hospital, with the
exception of the following justifiable exceptions:
1. Tenure
2. Age
3. Physical Impairment
The level and limits of the exemptions are to be determined and
uniformly applied by the medical staff of that hospital.
Rep. King moved the adoption of the amendment, which failed of
adoption.
Representatives Glickman and Rush offered the following amend-
ment:
Amendment 29-On page 127, lines 9-23, strike lines 9-23, all of
section 49 (renumber subsequent section)
Rep. Glickman moved the adoption of the amendment, which failed
of adoption.
Representative Woodruff offered the following amendment:
Amendment 30-On page 129, between lines 7 & 8, insert: Section
53. This act does not apply to causes of action arising prior to the
effective date of this act. (renumber subsequent sections)
Rep. Woodruff moved the adoption of the amendment, which was
adopted without objection.
Representative Woodruff offered the following title amendment:
Amendment 31-On page 9, line 4, insert after the semicolon:
providing certain legal actions exempted;
Rep. Woodruff moved the adoption of the amendment, which was
adopted without objection.
Representative Abrams offered the following amendment:
Amendment 32-On page 34, line 23, strike all of said line and
insert: births occurring on or after September 1, 1988, and shall be
Rep. Abrams moved the adoption of the amendment, which was
adopted without objection.
Representative Logan offered the following amendment:
Amendment 33-On page 129, line 15, after the word "law" insert:,
except that the arbitration provisions as set forth in sections 10, 11, 12,



13, 14, 15, 16, and 17 of this act shall take effect if a constitutional
amendment which authorizes the legislature to limit noneconomic



JOURNAL OF THE HOUSE OF REPRESENTATIVES













damages in civil actions based on a claim of medical malpractice is
adopted by the electors at the general election in November, 1988
Rep. Logan moved the adoption of the amendment, which failed of
adoption.

THE SPEAKER IN THE CHAIR

Representative Logan offered the following amendment:
Amendment 34-On page 129, line 4, after the period insert:
Section 42. Paragraphs (c), (d), and (e) of subsection (4) of section
627.351, Florida Statutes, are amended, and paragraph (k) is added to
said subsection, to read:
627.351 Insurance risk apportionment plans.-
(4) MEDICAL MALPRACTICE RISK APPORTIONMENT.-
(c) The Joint Underwriting Association shall operate subject to the
supervision and approval of a board of governors consisting of
representatives of five of the insurers participating in the Joint
Underwriting Association, an attorney to be named by The Florida
Bar, a physician to be named by the Florida Medical Association, and a
hospital representative to be named by the Florida Hospital Associa-
tion. The board of governors shall choose, during the first meeting of
the board after June 30 of each year, one of its members to serve as
chairman of the board and another member to serve as vice chairman
of the board. There shall be no liability on the part of, and no cause of
action of any nature shall arise against, any member insurer,
self-insurer, or its agents or employees, the Joint Underwriting
Association or its agents or employees, members of the board of
governors, or the department or its representatives for any action
taken by them in the performance of their powers and duties under
this subsection. In the event that the premium stabilization plan is
activated pursuant to subparagraph (d)6., three additional members of
the board of governors shall be appointed by the Insurance Commission-
er, two of whom shall be physicians and one of whom shall be a
representative of the general public.
(d) The plan shall provide coverage for claims arising out of the
rendering of, or failure to render, medical care or services and, in the
case of health care facilities, coverage for bodily injury or property
damage to the person or property of any patient arising out of the
insured's activities, in appropriate policy forms for all health care
providers as defined in paragraph (h). The plan shall include, but shall
not be limited to:
1. Classifications of risks and rates which reflect past and prospec-
tive loss and expense experience in different areas of practice and in
different geographical areas. To assure that plan rates are adequate to
pay claims and expenses, the Joint Underwriting Association shall
develop a means of obtaining loss and expense experience; and the plan
shall file such experience, when available, with the department in
sufficient detail to make a determination of rate adequacy. Within 60
days after a rate filing, the department shall approve such rates or rate
revisions as are fully supported by the filing. In addition to provisions
for claims and expenses, the ratemaking formula may include a factor
for projected claims trending and a margin for contingencies. The use
of trend factors shall not be found to be inappropriate.
2. A rating plan which reasonably recognizes the prior claims
experience of insureds.
3. Provisions as to rates for:
a. Insureds who are retired or semiretired.
b. The estates of deceased insureds.
c. Part-time professionals.

4. Protection in an amount not to exceed $250,000 per claim,
$750,000 annual aggregate for health-care providers other than
hospitals and in an amount not to exceed $1.5 million per claim, $5
million annual aggregate for hospitals. Such coverage for health care
providers other than hospitals shall be available as primary coverage



and as excess coverage for the layer of coverage between the primary
coverage and the total limits of $250,000 per claim, $750,000 annual
aggregate. The plan shall also provide tail coverage in these amounts



25



to insureds whose claims-made coverage with another insurer or trust
has or will be terminated. Such tail coverage shall provide coverage for
incidents that occurred during the claims-made policy period for which
a claim is made after the policy period.
5. A risk management program for insureds of the association. This
program shall include, but not be limited to: investigation and analysis
of frequency, severity, and causes of adverse or untoward medical
injuries; development of measures to control these injuries; systematic
reporting of medical incidents; investigation and analysis of patient
complaints; and auditing of association members to assure implemen-
tation of this program. The plan may refuse to insure any insured who
refuses or fails to comply with the risk management program
implemented by the association. Prior to cancellation or refusal to
renew an insured, the association shall provide the insured 60 days'
notice of intent to cancel or non-renew and shall further notify the
insured of any action which must be taken to be in compliance with the
risk management program.
6. A premium stabilization plan, which shall provide coverage to
physicians as provided herein, subject to a determination by the
Department made pursuant to sub-subparagraph (d)6.k.
a. Physicians with hospital staff privileges shall obtain coverage
under the premium stabilization plan in an amount equal to at least
$250,000 per claim and $750,000 annual aggregate. All other physic-
ians shall obtain coverage under the premium stabilization plan in an
amount equal to at least $100,000 per claim and $300,000 annual
aggregate. The requirements of subparagraph 6. shall not apply to:
(I) Any physician who elects to meet the financial responsibility
requirements of s. 458.320 or s. 459.0085 by any authorized method
other than obtaining professional liability coverage from the types of
insurers specified in s. 458.310(1)(b) or s. 458.0085(1)(b).
(II) Any physician who is exempt from the financial responsibility
requirements of s. 458.320 or s. 459.0085 and who chooses not to obtain
professional liability coverage from any type of insurance or self-insur-
ance organization.
(III) Any physician who meets the financial responsibility require-
ments of s. 458.320 or s. 459.0085 by being provided professional
liability coverage by a hospital or hospitals at which the physician has
staff privileges. However, any physician electing to purchase profes-
sional liability insurance shall purchase the amounts required by this
sub-subparagraph from the premium stabilization plan.
b. The requirements of this subparagraph shall apply to physicians
obtaining professional liability coverage on or after the plan activation
date except that for any physician who is covered under a professional
liability insurance policy in effect on the activation date, which meets
the financial responsibility requirements of s. 458.320 or s. 459.0085,
the requirements of this subparagraph shall apply to such physician
upon the termination date of the policy. For this purpose, "termination
date" means the last day of the policy period, the date of renewal, or
such earlier date that the policy is canceled by the insurer or insured.
c. The premium stabilization plan shall make coverage available to
physicians in amounts up to $1 million per claim with a $3 million
annual aggregate limit. Such amounts of coverage shall be inclusive of
any amounts of coverage required to be obtained pursuant to sub-sub-
paragraph 6.a.
d. The premium stabilization plan shall provide coverage on a
claims-made basis. In order to eliminate gaps in coverage, the initial
policies issued by the premium stabilization plan to physicians who
make timely application therefore shall include a retroactive date for
covering prior acts, which date coincides with the coverage of any
professional liability policy issued by an authorized insurer or author-
ized self-insurance trust fund covering the physician immediately prior
to obtaining coverage through the premium stabilization plan. Coverage
under the premium stabilization plan shall also include tail coverage
without an additional premium for retirement, death, and disability, if
a physician is covered by the premium stabilization plan immediately
prior to retirement, death, or disability and subject to such other
reasonable conditions as provided in the plan of operation.



e. The initial rates to be charged by the association for coverage
provided under the premium stabilization plan shall be established by



February 3, 1988



JOURNAL OF THE HOUSE OF REPRESENTATIVES











26 JOURNAL OF THE HOUSE

the department based on the considerations set forth in subparagraphs
1., 2., and 3., and taking into account the rates charged for similar
coverage by the five largest medical malpractice insurers operating in
the state on the plan activation date. Such rates shall be effective for one
year, after which the association may establish new rates for the
premium stabilization plan in the manner provided in subparagraph 1.
f Rates for any class of physician within a rating territory shall not
exceed five times the rates for any other class of physician in the same
rating territory, provided that total premiums projected under the plan
shall be sufficient to maintain actuarial soundness. The provisions of
this sub-subparagraph shall apply only to the minimum levels of
coverage required under sub-subparagraph 6.a.
g. Notwithstanding any other provisions of this subparagraph, any
physician who has incurred two or more claims resulting in indemnities
exceeding $125,000 each in the preceding five years or who has incurred
three or more claims resulting in indemnities exceeding $10,000 each in
the preceding five years shall not obtain coverage under the premium
stabilization plan. Payment of a claim or judgment by an uninsured
physician shall be considered a claim resulting in indemnity. A
three-member risk underwriting committee appointed by the board may
determine that a physician otherwise ineligible for coverage under the
premium stabilization plan due to this limitation may be deemed
eligible for coverage under the plan if the committee determines that the
previous indemnity payments are not an indication that the physician is
an unacceptable or poor risk compared to other physicians in the same
class. Any physician who cannot obtain coverage under the premium
stabilization plan may obtain coverage from the Joint Underwriting
Association or from any other authorized insurer or self-insurance trust.
h. In the event an underwriting deficit exists for any policy year the
premium stabilization plan is in effect, any surplus which has accrued
from previous years and is not projected within reasonable actuarial
certainty to be needed for payment of claims in the year the surplus
arose shall be used to offset the deficit to the extent available. If there is
any remaining deficit under the premium stabilization plan, such deficit
shall be recovered from the companies participating in the joint
underwriting plan in the proportion that the net direct premiums of
each such member written during the calendar year immediately
preceding the end of the policy year for which there is a deficit
assessment bears to the aggregate net direct premiums written in this
state by all members of the association. The term "premiums" as used
herein means premiums for the lines of insurance defined in
s. 624.605(1)(b), (k), and (q), including premiums for such coverage
issued under package policies.
i. The association shall market the policies issued under the premium
stabilization plan directly to physicians and is hereby prohibited from
paying sales commissions. However, the association may contract for the
servicing of the insurance contracts issued by the association, in
exchange for a reasonable fee.
j. The requirements of this subparagraph shall be continuous
conditions of a physician's licensure under chapter 458 and 459. Prior
to the issuance or renewal of an active license or reactivation of an
inactive license for the practice of medicine under either of such
chapters, the applicant shall demonstrate to the Department of Profes-
sional Regulation and the appropriate regulatory board that the
requirements of this subparagraph have been met. If any physician fails
to comply with the requirements of this subparagraph, the agency
issuing the license to practice for such physician shall immediately
suspend the license of such physician. The suspension shall remain in
effect until such time as the physician complies with the provisions of
this subparagraph.
k. Upon determination by the Department of Insurance on or after
March 1, 1988, that medical malpractice insurance is not adequately
available to Florida physicians the Department shall activate the
premium stabilization plan as provided herein. The Department shall
determine that medical malpractice insurance is not adequately avail-



E



able to Florida physicians in the voluntary market only if 25 percent of
the physicians previously obtaining medical malpractice insurance from
authorized medical malpractice insurers and self-insurance trusts, have
obtained insurance from the Florida Medical Malpractice Joint Under-
writing Association at rates which are significantly higher than rates



OF REPRESENTATIVES February 3, 1988

which the physicians were paying for the comparable types of coverage
and limits contained in the policies purchased by the physicians from
authorized insurers for the 12-month period immediately preceding the
physicians' application to the association. There shall be prima facie
evidence that association rates are significantly higher than rates
charged by authorized insurers if the mean association rate is at least 10
percent higher than the aggregate mean rate collectively charged by all
authorized insurers.
1. As used in this act, "activation date" means the date, provided in
the Department's determination that medical malpractice insurance is
not adequately available, for the activation of the premium stabilization
plan.
m. As used in this subparagraph, "physician" means any physician
licensed under chapter 458 and any osteopathic physician licensed
under chapter 459.
n. It shall be a violation of the Florida Insurance Code for an insurer
or self-insurance trust fund to provide professional liability coverage to
a physician when the insurer or trust knew or should have known that
the physician was required by this subparagraph to obtain such
coverage from the premium stabilization plan.
(e) In the event an underwriting deficit exists for any policy year the
plan is in effect, any surplus wihch has accrued from previous years
and is not projected within reasonable actuarial certainty to be needed
for payment of claims in the year the surplus arose shall be used to
offset the deficit to the extent available.
1. As to remaining deficit, except those relating to deficit assessment
coverage, each policyholder shall pay to the association a premium
contingency assessment not to exceed one-third of the premium
payment paid by such policyholder to the association for that policy
year. The association shall pay no further claims on any policy for the
policyholder who fails to pay the premium contingency assessment.
2. If there is any remaining deficit under the plan after maximum
collection of the premium contingency assessment, such deficit shall be
recovered from the companies participating in the plan in the
proportion that the net direct premiums of each such member written
during the calendar year immediately preceding the end of the policy
year for which there is a deficit assessment bears to the aggregate net
direct premiums written in this state by all members of the
association. The term "premiums" as used herein means premiums for
the lines of insurance defined in s. 624.605(1)(b), (k), and (q), including
premiums for such coverage issued under package policies.
3. This paragraph shall not apply to the premium stabilization plan
described in subparagraph (d)6.
(k) The premiums collected by the Joint Underwriting Association
under this subsection are exempt from the premium tax imposed under
s. 624.509. (renumber subsequent sections)
Rep. Logan moved the adoption of the amendment, which failed of
adoption.
Representative Irvine offered the following amendment:
Amendment 35-On page 27, line 9, insert a new section 19:
Section 19. Contract providers seeing local public Health Care unit
patients will be extended sovereign immunity for those specific patients,
for those specific problems. (renumber subsequent sections)
Rep. Irvine moved the adoption of the amendment, which failed of
adoption.
Representative Rudd offered the following amendment:
Amendment 36-On page 44, line 29, after the period, insert:
However, hospitals which have contracts with health maintenance
organizations or other medical facilities for fixed-price deliveries shall
be authorized to withhold paying such assessment for a period of up to 1



year until a new contract for such fixed-price deliveries is negotiated.
Rep. Rudd moved the adoption of the amendment, which failed of
adoption.
Representative Sanderson offered the following amendment:











February 3, 1988



JOURNAL OF THE HOUSE OF REPRESENTATIVES



Amendment 37-On page 13, lines 4-7, strike all of said lines and
insert: had special professional training and experience in the same
specialty or field of practice as the defendant and has significant patient
care responsibilities within the preceding three years. In the case of
multiple defendants, such expert witness should be in the same specialty
or field of practice as each and every defendant and has significant
patient responsibilities within the preceding three years.
Rep. Sanderson moved the adoption of the amendment, which failed
of adoption.
Representative Healey offered the following amendment:
Amendment 38-On page 92, line 3, after "investigation" insert:
(11) Conspiring with any person to withhold medical services for
treatment in a hospital by a boycott or walk-out for the purpose of
obtaining personal gain.
Rep. Healey moved the adoption of the amendment, which failed of
adoption.
Rep. Sanderson moved to reconsider the vote by which Amendment
13 was adopted. On motion by Rep. Carpenter, the motion to reconsider
was laid on the table. The vote was:
Yeas-71



Gaffney
Gardner
Glickman
Goode
Gordon
Grindle
Guber
Gustafson
Gutman
Hanson
Hargrett
Harris
Hawkins
Healey
Hodges
Holland
Jamerson
Jennings


Dunbar
Frishe
Garcia
Gonzalez-
Quevedo
Harden
Hill
Ireland
Irvine
Johnson, R. C.
Jones, C. F.
Jones, D. L.



Johnson, B. L.
King
Lawson
Liberti
Lippman
Locke
Logan
Long
Mackenzie
Martin
Meffert
Metcalf
Mitchell
Ogden
Ostrau
Peeples
Press
Reaves


Kelly
Lewis
Lombard
Mackey
Martinez
McEwan
Messersmith
Morse
Mortham
Nergard
Patchett
Renke



On motion by Rep. Bell, the rules were waived
and CS/HB 7-E, as amended, was read the third
passage, the vote was:
Yeas-89



Goode
Gordon
Grindle
Guber
Hanson
Harden
Harris
Hawkins
Hill
Hodges
Holland
Ireland



Reddick
Rehm
Rochlin
Rudd
Saunders
Silver
Simon
Simone
Smith
Titone
Tobiassen
Tobin
Trammell
Upchurch
Wallace
Wetherell
Young



Rush
Sample
Sanderson
Sansom
Shelley
Souto
Starks
Stone
Thomas
Troxler
Webster
Woodruff
by two-thirds vote
time by title. On



Irvine
Jennings
Johnson, B. L.
Johnson, R. C.
Jones, C. F.
Jones, D. L.
Kelly
King
Lewis
Liberti
Lippman
Locke



Lombard
Long
Mackenzie
Mackey
Martin
McEwan
Meffert
Messersmith
Metcalf
Mitchell
Mortham
Nays-30
Abrams
Canady
Casas
Clark
Cosgrove
Crady
Deutsch
Diaz-Balart



Nergard
Ogden
Ostrau
Patchett
Peeples
Reddick
Rehm
Renke
Rochlin
Rudd
Sample



Frankel
Friedman
Garcia
Glickman
Gonzalez-
Quevedo
Gustafson
Gutman



Votes after roll call:
Yeas to Nays-Gaffney
So the bill passed, as amended,
Senate, after engrossment.



Sanderson
Sansom
Saunders
Shelley
Silver
Simone
Smith
Starks
Stone
Thomas
Tobiassen


Hargrett
Healey
Jamerson
Langton
Lawson
Logan
Martinez
Morse



Tobin
Trammell
Troxler
Upchurch
Wallace
Webster
Wetherell
Young



Press
Reaves
Rush
Simon
Souto
Titone
Woodruff



and was immediately certified to the



Messages from the Senate

The Honorable Jon Mills, Speaker
I am directed to inform the House of Representatives that the Senate
has passed CS for SB 6-E and requests the concurrence of the House.

Joe Brown, Secretary

By the Committees on Appropriations and Commerce-
CS for SB 6-E-A bill to be entitled An act relating to medical
incidents; providing legislative findings and intent regarding regulato-
ry reform; amending s. 20.30, F.S.; creating the Division of Medical
Quality Assurance within the Department of Professional Regulation
and creating the Bureau of Medical Regulation within said division;
providing duties of the division and bureau; requiring a report; placing
the licensing boards for various health care professions within the
division; amending s. 395.0115, F.S.; providing antitrust immunity
through establishment of a state-mandated peer review process;
requiring licensed facilities to provide for peer review of physicians
who provide health care services at such facilities and providing
procedures therefore; requiring report of final disciplinary actions to the
Division of Medical Quality Assurance for further investigation;
providing for peer review panel immunity and for confidentiality of
records; amending s. 395.017, F.S.; providing maximum charge for
copying records; providing access to confidential patient records for
certain proceedings of the Department of Professional Regulation;
limiting public access thereto; amending s. 395.041, F.S.; expanding
internal risk management education and training requirements;
requiring certain incident reports relating to surgical procedures;
requiring report of certain incidents to the department; limiting public
access; providing for department review and investigation of incidents
which may involve conduct subject to discipline; providing adminis-
trative fines for violation of reporting requirements; providing for
annual review of risk management programs; protecting risk manag-
ers from liability for implementation of risk management programs;
requiring a report to the Legislature; amending s. 395.504, F.S., to
correct a cross-reference; amending s. 455.225, F.S.; providing civil
immunity and prohibition from discharge to persons reporting with
respect to incompetence, impairment, or unprofessional conduct of
specified health care providers; providing penalties; amending
s. 455.241, F.S.; providing fir reports of patient records; creating
s. 455.2415, F.S.; providing for disclosure of patient communications
under certain circumstances; amending s. 455.242, F.S.; providing for
disposition of records of physicians who terminate practice or relocate;
amending s. 455.245, F.S.; providing conditions for considering emer-



27



The Chair
Abrams
Ascherl
Bass
Bell
Bloom
Brown
Burke
Burnsed
Clark
Clements
Crady
Dantzler
Davis
Deutsch
Figg
Frankel
Friedman
Nays-47
Arnold
Bainter
Banjanin
Bankhead
Bronson
Canady
Carlton
Casas
Cosgrove
Crotty
Diaz-Balart
Drage



The Chair
Arnold
Ascherl
Bainter
Banjanin
Bankhead
Bass
Bell
Bloom
Bronson
Brown
Burnsed



Carlton
Carpenter
Clements
Crotty
Dantzler
Davis
Drage
Dunbar
Figg
Frishe
Gaffney
Gardner











28 JOURNAL OF THE HOUSE

agency suspension or restriction of a license; creating s. 455.247, F.S.;
requiring physicians, osteopathic physicians, podiatrists, and dentists
to report professional liability claims and actions to the department;
specifying contents; creating s. 455.28, F.S.; requiring reporting of
certain physicians for violation of grounds for disciplinary action;
providing a penalty; requiring investigation of probable disciplinary
violations; amending s. 458.303, F.S.; revising exemption of certain
commissioned medical officers from specified medical practice provi-
sions; amending s. 458.307, F.S.; modifying membership of the Board
of Medicine; specifying composition of probable cause panels; providing
for a training program; providing for completion of a panel's work;
amending s. 458.311, F.S.; relating to requirements for licensure of
physicians by examination; providing for an investigative process;
providing for restricted licenses; amending s. 458.313, F.S.; providing
for an investigative process for licensure by endorsement; requiring
certain active practice; providing for restricted licenses; amending
s. 458.315, F.S.; prohibiting issuance of temporary certificates for
practice in areas of critical need to certain persons by endorsement;
amending s. 458.3165, F.S.; providing for biennial renewal of public
psychiatry certificates; amending s. 458.319, F.S.; increasing the
maximum fee for renewal of a license to practice medicine; requiring
evidence of active practice for license renewal; providing for supervised
practice; amending ss. 458.320 and 459.0085, F.S.; authorizing physic-
ians and osteopathic physicians to use risk retention groups to meet
financial responsibility requirements; amending s. 458.327, F.S.; pro-
viding a penalty for leading the public to believe that one is licensed as
a medical doctor, or is engaged in the licensed practice of medicine,
without a license; amending ss. 458.331 and 459.015, F.S.; providing
additional grounds for disciplinary action against physicians and
osteopathic physicians; providing penalties and providing priorities for
application thereof; establishing the burden of proof for administrative
actions against physicians; providing for injunctive relief; providing for
department review and investigation of claims; amending ss. 458.3315,
459.0155, F.S.; providing that a physician or osteopathic physician who
is believed to be impaired must execute a release of his medical records
to a consultant retained by the Department of Professional Regulation
and limiting the use which the consultant may make of such records;
amending s. 458.337, F.S.; specifying requirements for reports by
medical organizations and hospitals when the physician has resigned;
amending s. 458.345, F.S.; establishing requirements for registration
of resident physicians and interns; providing a fee; restricting renewal
or extension; prohibiting registration of certain persons; increasing a
penalty; amending ss. 458.347 and 459.022, F.S.; allowing extended
temporary certification of physician assistants and osteopathic physic-
ian assistants; amending s. 459.0055, F.S.; providing for an investiga-
tive process for licensure of osteopathic physicians; amending
s. 459.008, F.S.; requiring evidence of active practice for license
renewal; providing for supervised practice; amending s. 459.0092, F.S.;
increasing the maximum fee for renewal of a license to practice
osteopathic medicine; amending ss. 460.413, 461.013, 464.018, 465.016,
and 466.028, F.S.; providing additional grounds for disciplinary action
against chiropractic physicians, podiatrists, nurses, pharmacists, and
dentists; amending s. 627.912, F.S.; requiring insurers to report
certain claims against dentists; providing for department review and
investigation; providing for an annual report; amending s. 641.55, F.S.;
providing for department review and investigation of certain incidents
reported by health maintenance organization internal risk manage-
ment programs; limiting public access; requiring report of certain
incidents relating to surgical procedures; amending s. 768.13, F.S.;
providing immunity from civil liability to physicians, hospitals, and
certain hospital employees rendering medical care or treatment in
response to an emergency within a hospital or trauma center;
providing exceptions to such immunity; amending s. 768.45, F.S.;
prescribing matters to be considered by the trier of fact in a claim of
negligence for services provided in a hospital emergency room; limiting
who may give expert medical testimony; amending s. 768.40, F.S.;
providing for professional society review of certain physicians; provid-
ing specified immunity with respect thereto; amending s. 768.57, F.S.;
expanding notice requirements prior to filing a claim for medical



malpractice; stipulating informal discovery provisions with respect to
presuit screening of such claims; prescribing conditions under which
attorney's fees and costs may be awarded; providing for motions with
respect to claims and denials; providing for notice to The Florida Bar



E



providing powers and duties of the association; providing for notice to
obstetrical patients of participation in the plan; providing for trauma
center liability reform; providing legislative findings and intent;
providing definitions; providing immunity from civil liability for



_ ___ _ ___ __ __I_



OF REPRESENTATIVES February 3, 1988

and the Division of Medical Quality Assurance in certain circum-
stances; providing for award and payment of damages; prescribing a
limit on noneconomic damages; creating s. 768.67, F.S.; prohibiting
settlement agreements from denying parties thereto the right to
discuss with or report to the Division of Medical Quality Assurance the
events giving rise to the claim; providing positions for and an
appropriation to the Department of Professional Regulation; authoriz-
ing the Board of Medicine and Board of Osteopathic Medical Examin-
ers to make a fee assessment; requiring medical malpractice insurers
to reflect certain savings in rate filings and schedules; providing an
effective date.
-was read the first time by title. On motion by Rep. Bell, the rules
were waived by two-thirds vote and CS/SB 6-E was read the second
time by title.
Representative Bell offered Amendment 1, striking everything after
the enacting clause and inserting the text of engrossed CS/HB 7-E and
moved its adoption, which was adopted.
On motion by Rep. Carpenter, the rules were waived and the
amendment was not printed in the Journal because of its length.
Representative Bell offered the following title amendment:
Amendment 2-Strike the title and insert: A bill to be entitled An
act relating to medical incident recovery; creating a chapter in F.S.;
creating the "Florida Medical Incident Recovery Act of 1988"; provid-
ing applicability and scope; creating a plan for prompt resolution of
medical negligence claims; providing legislative findings and intent;
providing definitions; providing applicability of and procedure for
mandatory presuit investigation and medical expert corroboration of
medical negligence claims and defenses by prospective parties; requir-
ing availability of medical records for presuit screening of claims and
defenses and providing penalties; providing for presuit discovery of
medical negligence claims and defenses and providing immunity with
respect thereto; providing for presuit investigation of medical negli-
gence claims and defenses by the court, and providing penalties for
lack of reasonable investigation in filing or in corroborating medical
negligence claims or defenses; providing for nonbinding arbitration of
civil cases involving claims for medical negligence; providing for
selection of arbitration panels; providing for referral of cases to
arbitration and procedures for referral; providing procedures for
hearings; providing for arbitration awards and judgments; providing
for trial de novo; providing for assessment of attorney's fees and costs
in certain circumstances; providing for appeal of award; creating the
medical malpractice premium assistance plan; providing legislative
findings and intent; providing definitions; creating a trust fund, to be
administered by the Department of Insurance; providing funding for
such fund; providing for physician eligibility to receive premium
assistance from such fund; providing rulemaking authority; creating
the Florida Birth-Related Neurological Injury Compensation Plan;
providing legislative findings and intent; providing definitions; pro-
viding exclusiveness of remedy; providing for the hearing of claims by
deputy commissioners of the Division of Workers' Compensation of the
Department of Labor and Employment Security; providing procedure
for the filing of claims and responses; providing for medical disciplin-
ary review; providing for tolling of the statute of limitations; providing
for hearings, parties, and discovery; providing for review by a medical
advisory panel; providing for determination of claims; providing a
presumption as to injury; providing for binding nature of findings;
providing for awards for birth-related neurological injuries, and for
notice of such awards; providing for conclusiveness of determination or
award; providing for appeal; providing for enforcement of awards;
providing a limitation on the bringing of claims; creating the
Birth-Related Neurological Injury Compensation Trust Fund within
the Department of Insurance and providing for administration of the
fund by the Florida Birth-Related Neurological Injury Compensation
Association pursuant to a plan of operation approved by said
department; providing for assessments for participation in the plan;
providing for actuarial valuation of the fund by the department;
providing for membership and a board of directors for the association;











JOURNAL OF THE HOUSE OF REPRESENTATIVES



trauma centers and teams; providing rulemaking authority; providing
legislative findings and intent regarding regulatory reform; amending
s. 20.30, F.S.; creating the Division of Medical Quality Assurance
within the Department of Professional Regulation and creating the
Bureau of Medical Regulation within said division; providing duties of
the division and bureau; requiring a report; placing the Board of
Medicine and the Board of Osteopathic Medical Examiners within the
division; amending s. 395.0115, F.S.; providing antitrust immunity
through establishment of a state-mandated peer review process;
requiring licensed facilities to provide for peer review of physicians
who provide health care services at such facilities and providing
procedures therefore; requiring report of final disciplinary actions to the
Division of Medical Quality Assurance for further investigation;
providing for peer review panel immunity and for confidentiality of
records; creating s. 395.0116, F.S., providing that it is unlawful for
certain persons to threaten, coerce, intimidate, or discipline any
licensed physician or nurse under certain circumstances; providing a
penalty; providing for civil actions; amending s. 395.017, F.S.; provid-
ing maximum charge for copying records; providing access to confi-
dential patient records for certain proceedings of the Department of
Professional Regulation; limiting public access thereto; amending
s. 395.041, F.S.; expanding internal risk management education and
training requirements; requiring certain incident reports relating to
surgical procedures; requiring report of certain incidents to the
department; limiting public access; providing for department review
and investigation of incidents which may involve conduct subject to
discipline; providing an administrative fine for violation of reporting
requirements; providing for annual review of risk management
programs; protecting risk managers from liability for implementation
of risk management programs; requiring a report to the Legislature;
amending s. 395.504, F.S., to correct a cross-reference; amending
s. 395.509, F.S., relating to review of hospital budgets, to provide for
approval of assessments to fund the birth-related neurological injury
plan; amending s. 455.203, F.S., exempting executive directors of
professional regulation boards from the career service system; amend-
ing s. 455.225, F.S.; providing civil immunity and prohibition from
discharge to persons reporting with respect to incompetence, impair-
ment, or unprofessional conduct of specified physicians; providing
penalties; amending s. 455.241, F.S.; providing for reports of patient
records; creating s. 455.2415, F.S.; providing for disclosure of patient
communications under certain circumstances; amending s. 455.242,
F.S.; providing for disposition of records of physicians who terminate
practice or relocate; amending s. 455.245, F.S.; providing conditions for
considering emergency suspension or restriction of a license; creating
s. 455.247, F.S.; requiring physicians, osteopathic physicians, podia-
trists, and dentists to report professional liability claims and actions to
the department; specifying contents; creating s. 455.28, F.S.; requiring
reporting of certain physicians for violation of grounds for disciplinary
action; providing a penalty; requiring investigation of probable
disciplinary violations; amending s. 458.303, F.S.; clarifying an excep-
tion for federally commissioned medical officers; amending s. 458.307,
F.S.; modifying membership of the Board of Medicine; specifying
composition of probable cause panels; providing for a training program;
providing for completion of a panel's work; amending s. 458.311, F.S.;
relating to requirements for licensure of physicians by examination;
providing for an investigative process; providing for restricted licenses;
amending s. 458.313, F.S.; providing for an investigative process for
licensure by endorsement; requiring certain active practice; providing
for restricted licenses; amending s. 458.315, F.S.; prohibiting issuance
of temporary certificates for practice in areas of critical need to certain
persons by endorsement; amending s. 458.3165, F.S.; providing for
biennial renewal of public psychiatry certificates; amending s. 458.319,
F.S.; requiring evidence of active practice for license renewal; provid-
ing for supervised practice; amending ss. 458.320 and 459.0085, F.S.;
authorizing physicians and osteopathic physicians to use risk retention
groups to meet financial responsibility requirements; amending
s. 458.327, F.S.; providing a penalty for misrepresenting oneself as a
licensed physician; amending ss. 458.331 and 459.015, F.S.; providing
additional grounds for disciplinary action against physicians and
osteopathic physicians; providing penalties and providing priorities for
application thereof; establishing the burden of proof for administrative



actions against physicians; providing for injunctive relief; providing for
department review and investigation of claims; amending ss. 458.3315



and 459.0155, F.S.; providing for certain release of medical records of
an impaired practitioner; amending s. 458.337, F.S.; specifying re-
quirements for reports by medical organizations and hospitals when
the physician has resigned; amending s. 458.345, F.S.; establishing
requirements for registration of resident physicians and interns;
providing a fee; restricting renewal or extension; prohibiting registra-
tion of certain persons; increasing a penalty; amending ss. 458.347 and
459.022, F.S.; allowing extended temporary certification of physician
assistants and osteopathic physician assistants; amending s. 459.0055,
F.S.; providing for an investigative process for licensure of osteopathic
physicians; amending s. 459.008, F.S.; requiring evidence of active
practice for license renewal; providing for supervised practice; amend-
ing ss. 460.413, 461.013, 464.018, 465.016, and 466.028, F.S.; providing
additional grounds for disciplinary action against chiropractic physic-
ians, podiatrists, nurses, pharmacists, and dentists; amending
s. 627.912, F.S.; requiring insurers to report certain claims against
dentists; providing for department review and investigation; providing
for an annual report; amending s. 641.55, F.S.; providing for depart-
ment review and investigation of certain incidents reported by health
maintenance organization internal risk management programs; limit-
ing public access; requiring report of certain incidents relating to
surgical procedures; amending s. 768.19, F.S.; providing for presuit
investigation of medical negligence claims in wrongful death actions;
amending s. 768.40, F.S.; providing for professional society review of
certain physicians; providing for advisory reports to the department;
providing confidentiality; providing for review and repeal; providing
specified immunity with respect thereto; amending s. 768.57, F.S.;
expanding notice requirements prior to filing a claim for medical
malpractice; stipulating informal discovery provisions with respect to
presuit screening of such claims; amending s. 627.351, F.S., relating to
required coverage with respect to medical malpractice risk apportion-
ment; creating s. 768.67, F.S.; prohibiting settlement agreements from
denying parties thereto the right to discuss with or report to the
Division of Medical Quality Assurance the events giving rise to the
claim; amending s. 240.213, F.S.; providing for medical malpractice
damages which are attributed to the Board of Regents; amending
s. 768.81, F.S., providing for medical malpractice damages which are
attributed to a medical teaching hospital as defined by s. 395.502(22);
amending s. 95.11, F.S., relating to the statute of limitations; request-
ing the Supreme Court to adopt a standard jury instruction; repealing
s. 768.66, F.S., relating to medical malpractice impact study; providing
certain legal actions exempted; providing severability; providing
appropriations; providing an effective date.
Rep. Bell moved the adoption of the amendment, which was adopted
without objection.
On motion by Rep. Bell, the rules were waived by two-thirds vote
and CS/SB 6-E, as amended, was read the third time by title. On
passage, the vote was:
Yeas-100



The Chair
Abrams
Arnold
Ascherl
Bainter
Banjanin
Bankhead
Bass
Bell
Bloom
Bronson
Brown
Burnsed
Carlton
Carpenter
Clements
Cosgrove
Crotty
Dantzler
Davis
Drage
Dunbar



Figg
Friedman
Frishe
Garcia
Gardner
Glickman
Gonzalez-
Quevedo
Goode
Gordon
Grindle
Guber
Hanson
Harden
Hargrett
Harris
Hawkins
Hill
Hodges
Holland
Ireland
Irvine



Jamerson
Jennings
Johnson, B. L.
Johnson, R. C.
Jones, C. F.
Jones, D. L.
Kelly
King
Lawson
Lewis
Liberti
Lippman
Locke
Logan
Lombard
Long
Mackenzie
Mackey
Martin
McEwan
Messersmith
Metcalf



Mitchell
Mortham
Nergard
Ogden
Ostrau
Patchett
Peeples
Reaves
Reddick
Rehm
Renke
Rochlin
Rudd
Rush
Sample
Sanderson
Sansom
Saunders
Shelley
Silver
Simon
Simone



February 3, 1988



29











30



JOURNAL OF THE HOUSE



Smith
Starks
Stone
Thomas
Nays-18
Burke
Canady
Casas
Clark
Crady



Tobiassen
Tobin
Trammell
Troxler


Deutsch
Frankel
Gaffney
Gustafson
Gutman



Upchurch
Wallace
Webster
Wetherell


Healey
Langton
Martinez
Morse
Press



Young



Souto
Titone
Woodruff



Votes after roll call:
Nays-Diaz-Balart
Yeas to Nays-Jamerson, Hargrett, Gonzalez-Quevedo
So the bill passed as amended. On motion by Rep. Bell, the House
requested the Senate to concur in House Amendments 1 and 2 to
CS/SB 6-E and, in the event the Senate refuses to concur, asked for a
Conference Committee. The action, together with the bill and amend-
ments thereto, was immediately certified to the Senate after engross-
ment.

Continuation of Special and Continuing Orders

On motion by Rep. Gardner, without objection, HB 9-E was
withdrawn from the Committee on Finance & Taxation and-
HB 9-E-A bill to be entitled An act relating to tax on sales, use,
and other transactions; amending s. 212.08, F.S.; restricting the
application of an exemption for charges for aircraft modification
services; amending section 49 of chapter 87-548, Laws of Florida;
extending the application of provisions which authorize a refund to
certain contractors of additional taxes paid; providing effective and
retroactive effective dates.
-was read the second time by title.
Representative Gardner offered the following amendment:
Amendment 1-On page 1, line 12, strike everything after the
enacting clause and insert: Section 1. Subsection (1) of section
212.0598, Florida Statutes, as amended by chapter 87-548, Laws of
Florida, is amended, subsection (2) is added to said section and current
subsections (2) through (4) are renumbered as subsections (3) through
(5), to read:
212.0598 Special provisions; air carriers.-
(1) Notwithstanding other provisions of this part to the contrary, any
air carrier utilizing mileage apportionment for corporate income tax
purposes in this state pursuant to chapter 214 may elect, upon the
conditions prescribed in subsection (4) (3), to be subject to the tax
imposed by this part on tangible personal property according to the
provisions of this section.
(2) The basis of the tax shall be the ratio of Florida mileage to total
mileage as determined pursuant to part IV of chapter 214. The ratio
shall be determined at the close of the carrier's preceding fiscal year.
The ratio shall be applied each month to the carrier's total systemwide
gross purchases of tangible personal property and services otherwise
taxable in Florida.
Section 2. (1) Section 212.065, Florida Statutes, as created by section
22 of chapter 87-548, Laws of Florida, and amended by section 23 of
said chapter is hereby repealed.
(2) The provisions of s. 212.065, Florida Statutes, shall not apply to
contracts entered into on or after January 1, 1988, and before the
effective date of this act but not completed on the effective date of this
act, if the prime contractor can show to the satisfaction of the
Department of Revenue that all taxes pursuant to part I of chapter 212,
Florida Statutes, have been paid on materials purchased or manufac-
tured pursuant to such contract by the prime contractor or his
subcontractors. If the prime contractor cannot show that such taxes have
been paid, the provisions of section 212.065, Florida Statutes, shall
remain in effect for the life of the contract.



OF REPRESENTATIVES February 3, 1988

Section 3. Effective upon this act becoming a law and operating
retroactively to February 1, 1988, section 49 of chapter 87-548, Laws of
Florida, is amended to read:
Section 49. (1) In the case of any qualified written contract, as
defined in subsection (2), signed prior to May 4- 4987, or any offer
submitted prior to suh date which was binding on the offeror and was
aeeepted, or any eontraet funded by government bonds sold before May
4- 1987, or efontrated prior to such date to be ofe l for eonstrueting
improvements to real property, the prime contractor; as defined in
s1; -594 Florida Stattes-, as created by chapter 87-, 7 Laws of
Florida, responsible for performing the contract shall pay the sales or
use tax on materials necessary to complete the contract at the rate
provided in this act. Such contractor, within 3 years after the effective
date of this section, may apply for one refund of the additional sales or
use tax paid on materials necessary to complete the contract.
Application for such refund shall be pursuant to Department of
Revenue rule. The application shall contain a sworn statement, signed
by the applicant or its representative, attesting to the validity of the
application. The Department of Revenue shall, within 30 days after
approval of a complete application, certify to the Comptroller informa-
tion necessary for issuance of a refund to the applicant of said
additional sales or use taxes. Alternatively, for up to a 3-year period
after the effective date of this section, pursuant to Department of
Revenue rule, such a contractor may apply quarterly for a refund of
taxes paid pursuant to the contract during the previous quarter. Any
person who fraudulently obtains or attempts to obtain a refund
pursuant to this section, in addition to being liable for repayment of
any refund fraudulently obtained plus a penalty of 100 percent of the
refund, is guilty of a misdemeanor of the second degree, punishable as
provided in s. 775.082, s. 775.083, or s. 775.084, Florida Statutes. This
section shall take effect February 1, 1988.
(2) As used in this section, a "qualified contract" means:

(a) A contract signed prior to December 11, 1987, or any offer
submitted prior to such date which was binding on the offeror and was
accepted, for constructing improvements to real property, entered into by
a subcontractor, as defined in s. 212.0594, Florida Statutes, as created
by chapter 87-101, Laws of Florida, a road contractor constructing or
repairing a road for a governmental entity described in s. 212.08(6),
Florida Statutes, or a prime contractor, as defined in s. 212.0594,
Florida Statutes, as created by chapter 87-101, Laws of Florida,
constructing or repairing property used primarily for public worship; or

(b) A contract signed prior to May 1, 1987, or any offer submitted
prior to such date which was binding on the offeror and was accepted,
or any contract funded by government bonds sold before May 1, 1987, or
contracted prior to such date to be sold, for constructing improvements
to real property, entered into by a prime contractor, as defined in
s. 212.0594, Florida Statutes, as created by chapter 87-101, Laws of
Florida.
Section 4. Except as otherwise provided herein, this act shall take
effect upon becoming a law.
Rep. Gardner moved the adoption of the amendment, which was
adopted without objection.

Representative Gardner offered the following title amendment:
Amendment 2-On page 1, strike the entire title and insert:
An act relating to tax on sales, use, and other transactions; amending
s. 212.0598, F.S.; providing basis for calculating tax for certain air
carriers; repealing s. 212.065, F.S., which provides application of tax to
certain road construction; providing for applicability of existing
contracts; amending section 49 of chapter 87-548, Laws of Florida;
extending the application of provisions which authorize a refund to
certain contractors of additional taxes paid; providing effective and
retroactive effective dates.
Rep. Gardner moved the adoption of the amendment, which was



adopted without objection.
On motion by Rep. Gardner, the rules were waived by two-thirds
vote and HB 9-E, as amended, was read the third time by title. On
passage, the vote was:











JOURNAL OF THE HOUSE OF REPRESENTATIVES



Notice of Committee Meetings



Yeas-114
The Chair
Abrams
Arnold
Ascherl
Bainter
Banjanin
Bankhead
Bass
Bell
Bloom
Bronson
Brown
Burnsed
Canady
Carlton
Carpenter
Casas
Clark
Clements
Cosgrove
Crady
Crotty
Dantzler
Davis
Deutsch
Diaz-Balart
Drage
Dunbar
Figg



Frankel
Friedman
Frishe
Gaffney
Garcia
Gardner
Glickman
Gonzalez-
Quevedo
Goode
Gordon
Grindle
Guber
Gutman
Hanson
Harden
Hargrett
Harris
Hawkins
Healey
Hill
Hodges
Holland
Ireland
Irvine
Jamerson
Jennings
Johnson, B. L.
Johnson, R. C.



Jones, C. F.
Jones, D. L.
Kelly
King
Langton
Lawson
Lewis
Liberti
Lippman
Locke
Logan
Lombard
Long
Mackenzie
Mackey
McEwan
Meffert
Messersmith
Metcalf
Mitchell
Morse
Mortham
Nergard
Ogden
Ostrau
Patchett
Peeples
Press
Reaves



Nays-None
Votes after roll call:
Yeas-Martin
So the bill passed, as amended, and was immediately certified to the
Senate after engrossment.



On motion by Rep. B. L. Johnson, without objection, the rules were
waived and the following Subcommittees of the Committee on
Education, K-12 were given permission to meet: Administration &
Finance-8:30 a.m. in Room 214 C; Programs-8:30 a.m.; Oversight-9
a.m.

Introduction of Guest
Representative Messersmith introduced his daughter Kym, visiting
from Washington, D.C., who was seated in the gallery.

Notice of Withdrawal as Prime Sponsor
HB 1-E-Gonzalez-Quevedo

Recessed

On motion by Rep. Carpenter, the House recessed at 8:05 p.m. for the
purpose of holding committee meetings and conducting other House
business, to reconvene at 11:00 a.m. tomorrow.



Reddick
Rehm
Renke
Rochlin
Rudd
Sample
Sanderson
Sansom
Saunders
Shelley
Silver
Simon
Simone
Smith
Souto
Starks
Stone
Thomas
Titone
Tobiassen
Tobin
Trammell
Troxler
Upchurch
Wallace
Wetherell
Woodruff
Young



CHAMBER ACTION ON BILLS
WEDNESDAY, FEBRUARY 3, 1988
HB 3-E-Withdrawn from further consideration
HB 7-E-CS passed as amended 89-30
HB 8-E-Passed as amended 112-0
HB 9-E-Passed as amended 114-0
HB 12-E-Failed vote for introduction
HB 13-E-Passed 113-0
SB 6-E-CS passed as amended 100-18 Requested Senate to
concur
SB 7-E-Introduction allowed
[Source: Legislative Information Division]



February 3, 1988



31
















cljte Joujal OFTHE


Iouse of e preseQttatives



FIFTH SPECIAL SESSION-"E" of 1986-1988



The House was called to order by the Speaker at 11:17 a.m.



Prayer



The following prayer was offered by Representative Lippman:
From Job 34:2. Hear My words, you wise people; listen to Me, you of
learning. For the ear tests words as the tongue tests food. Let us
discern for ourselves what is right; let us learn together what is good.
Blessed art Thou O Lord our God, King of the Universe. Bless our
members, bless our leaders. In Your name, Amen.
The following Members were recorded present:



The Chair
Abrams
Arnold
Ascherl
Bainter
Banjanin
Bankhead
Bass
Bell
Bloom
Brown
Burke
Burnsed
Canady
Carlton
Carpenter
Casas
Clark
Clements
Cosgrove
Crady
Crotty
Dantzler
Davis
Deutsch
Diaz-Balart
Drage
Dunbar
Figg
Frankel



Friedman
Frishe
Gaffney
Garcia
Gardner
Glickman
Gonzalez-
Quevedo
Goode
Gordon
Grindle
Guber
Gutman
Hanson
Harden
Hargrett
Harris
Hawkins
Healey
Hill
Hodges
Holland
Ireland
Irvine
Jamerson
Jennings
Johnson, B. L.
Johnson, R. C.
Jones, C. F.
Jones, D. L.



Kelly
King
Langton
Lawson
Lewis
Liberti
Lippman
Locke
Logan
Lombard
Long
Mackenzie
Mackey
Martin
Martinez
McEwan
Meffert
Messersmith
Metcalf
Mitchell
Morse
Mortham
Nergard
Ogden
Ostrau
Patchett
Peeples
Press
Reaves
Reddick



Rehm
Renke
Rochlin
Rudd
Rush
Sample
Sanderson
Sansom
Saunders
Shelley
Silver
Simon
Simone
Smith
Souto
Starks
Stone
Thomas
Titone
Tobiassen
Tobin
Trammell
Troxler
Upchurch
Wallace
Webster
Wetherell
Woodruff
Young



Excused: Representative Bronson, due to illness; Representative
Gustafson, due to prior commitments in his district; Representative
Smith, for the afternoon, due to illness.

Conference Committee Managers Excused
Representatives Ogden, Bell, Upchurch, Lippman, Patchett, Burke,
Thomas, D. L. Jones and Simon, members of the Conference Commit-
tee on medical malpractice, were excused from time to time for the
purpose of meeting.
A quorum was present.



Pledge

The Members pledged allegiance to the Flag.



House Physician
The Speaker introduced Dr. Donald G. Nikolaus, of Dunedin, who
was serving in the Clinic today, upon invitation of Representative
Dunbar.

The Journal

The Journal of February 3 was approved as corrected.

Messages from the Senate

The Honorable Jon Mills, Speaker
I am directed to inform the House of Representatives that the Senate
has admitted for introduction and consideration by the required
Constitutional two-thirds vote and passed SB 10-E and requests the
concurrence of the House.
Joe Brown, Secretary

By Senator McPherson-
SB 10-E-A bill to be entitled An act relating to notes secured by
mortgages; amending s. 697.06, F.S.; repealing certain restrictions on
assessing certain charges, fees, or penalties for the prepayment of such
a note when the obligee has accelerated the maturity date of such note;
providing an effective date.
Rep. Burnsed moved that SB 10-E be admitted for introduction, the
Speaker having ruled the measure was outside the purview of the Call,
which was agreed to by the required Constitutional two-thirds vote
and the bill was read the first time by title. Without objection, further
consideration of the bill was temporarily deferred.
Subsequently, on motions by Rep. Burnsed, the rules were waived by
two-thirds vote and the bill was read the second time by title and the
third time by title. On passage, the vote was:
Yeas-109



The Chair
Abrams
Arnold
Ascherl
Bainter
Banjanin
Bankhead
Bass
Bell
Bloom
Brown
Burke
Burnsed



Canady
Carlton
Carpenter
Casas
Clark
Cosgrove
Crady
Crotty
Dantzler
Davis
Deutsch
Diaz-Balart
Drage



Dunbar
Figg
Frankel
Friedman
Frishe
Gaffney
Garcia
Gardner
Glickman
Gonzalez-
Quevedo
Goode
Gordon



Grindle
Guber
Gutman
Hanson
Harden
Hargrett
Harris
Hawkins
Healey

Hill
Hodges
Holland
Ireland



32

A digest of today's Chamber action appears on last page



Number 3



Thursday, February 4, 1988










JOURNAL OF THE HOUSE OF REPRESENTATIVES



Irvine
Jamerson
Jennings
Johnson, B. L.
Johnson, R. C.
Jones, D. L.
Kelly
King
Langton
Lawson
Lewis
Lippman
Locke
Logan
Lombard



Long
Mackenzie
Mackey
Martin
McEwan
Meffert
Messersmith
Metcalf
Mitchell
Morse
Mortham
Nergard
Ogden
Ostrau
Peeples



Press
Reaves
Reddick
Rehm
Renke
Rochlin
Rudd
Rush
Sample
Sanderson
Sansom
Saunders
Shelley
Simone
Smith



Souto
Starks
Stone
Thomas
Titone
Tobiassen
Tobin
Trammell
Troxler
Webster
Wetherell
Woodruff
Young



Nays-None
Votes after roll call:
Yeas-C. F. Jones, Clements
So the bill passed and was immediately certified to the Senate.

The Honorable Jon Mills, Speaker
I am directed to inform the House of Representatives that the Senate
has admitted for introduction and consideration by the required
Constitutional two-thirds vote and passed SB 11-E and requests the
concurrence of the House.
Joe Brown, Secretary

By Senator Beard-
SB 11-E-A bill to be entitled An act relating to operation of
commercial motor vehicles; amending s. 316.302,.F.S.; revising provi-
sions with respect to operation of a commercial motor vehicle solely
within this state; limiting periods of time when a driver may be on
duty; providing that certain commercial vehicle operators are exempt
from described rules; providing that the amendments to s. 316.302,
F.S., shall be invalid under certain circumstances; providing for
severability of the provisions of the act; providing an effective date.
Rep. Burnsed moved that SB 11-E be admitted for introduction, the
Speaker having ruled the measure was outside the purview of the Call,
which was agreed to by the required Constitutional two-thirds vote
and the bill was read the first time by title. On motions by Rep.
Burnsed, the rules were waived by two-thirds vote and SB 11-E was
read the second time by title and the third time by title. On passage,
the vote was:
Yeas-107



The Chair
Abrams
Arnold
Bainter
Banjanin
Bankhead
Bass
Bell
Bloom
Brown
Burke
Burnsed
Canady
Carlton
Carpenter
Casas
Clark
Cosgrove
Crady
Crotty
Dantzler
Davis
Deutsch
Diaz-Balart



Drage
Dunbar
Figg
Frankel
Frishe
Gaffney
Garcia
Glickman
Gonzalez-
Quevedo
Goode
Gordon
Grindle
Guber
Gutman
Hanson
Harden
Hargrett
Harris
Hawkins
Healey
Hill
Hodges
Holland



Ireland
Irvine
Jamerson
Jennings
Johnson, B. L.
Johnson, R. C.
Jones, C. F.
Jones, D. L.
Kelly
King
Langton
Lawson
Lewis
Lippman
Locke
Logan
Lombard
Long
Mackenzie
Mackey
Martin
Martinez
McEwan
Meffert



Messersmith
Metcalf
Mitchell
Morse
Mortham
Nergard
Ogden
Ostrau
Peeples
Press
Reaves
Reddick
Renke
Rochlin
Rudd
Rush
Sample
Sanderson
Sansom
Saunders
Shelley
Simone
Smith
Souto



Starks
Stone
Thomas



Titone
Tobiassen
Tobin



Trammell
Troxler
Webster



Wetherell
Woodruff
Young



Nays-None
Votes after roll call:
Yeas-Ascherl, Rehm, Clements
So the bill passed and was immediately certified to the Senate.

On motion by Rep. Clements, without objection, SB 7-E was
withdrawn from the Committee on House Administration and-

SB 7-E-A bill to be entitled An act relating to the Legislature;
amending s. 11.12, F.S.; providing for legislators to designate employ-
ees who are to attend sessions and receive subsistence and travel
expenses in connection therewith; providing an effective date.
-was taken up and read the second time by title. On motion by Rep.
Burke, the rules were waived by two-thirds vote and the bill was read
the third time by title. On passage, the vote was:
Yeas-104



The Chair
Arnold
Bainter
Banjanin
Bankhead
Bass
Bell
Bloom
Brown
Burke
Burnsed
Canady
Carlton
Carpenter
Casas
Clark
Cosgrove
Crady
Crotty
Dantzler
Davis
Deutsch
Diaz-Balart
Drage
Dunbar
Figg
Frankel



Frishe
Gaffney
Garcia
Glickman
Gonzalez-
Quevedo
Goode
Gordon
Grindle
Guber
Hanson
Harden
Hargrett
Harris
Hawkins
Healey
Hill
Hodges
Holland
Ireland
Irvine
Jamerson
Jennings
Johnson, B. L.
Johnson, R. C.
Jones, C. F.
Jones, D. L.



Kelly
King
Langton
Lawson
Lewis
Lippman
Locke
Logan
Lombard
Long
Mackenzie
Mackey
Martin
Martinez
McEwan
Meffert
Messersmith
Metcalf
Mitchell
Morse
Mortham
Nergard
Ostrau
Peeples
Press
Reaves
Reddick



Renke
Rochlin
Rush
Sample
Sanderson
Sansom
Saunders
Shelley
Simon
Simone
Smith
Souto
Starks
Stone
Thomas
Titone
Tobiassen
Tobin
Trammell
Troxler
Webster
Wetherell
Woodruff
Young



Nays-None
Votes after roll call:
Yeas-Gutman, Ascherl, Rehm, Clements
So the bill passed and was immediately certified to the Senate.

The Honorable Jon Mills, Speaker
I am directed to inform the House of Representatives that the Senate
has refused to concur in House amendments to CS for SB 6-E and
requests the House to recede and, in the event the House refuses to
recede, the Senate has acceded to the request of the House for
appointment of a conference committee.
The President has appointed Senators Jennings, Barron, Hair,
Kirkpatrick, and Myers; and alternates, Senators Deratany, Kiser,
Thomas and D. Childers; as conferees on the part of the Senate.
Joe Brown, Secretary
(House amendments attached to original bill)

On motion by Rep. Bell, the House refused to recede from House
Amendments 1 and 2 to CS/SB 6-E. The Speaker appointed Represen-



February 4, 1988



33










34 JOURNAL OF THE HOUSE

tatives Ogden, Bell, Upchurch, Lippman and Patchett, with Burke,
Thomas, D. L. Jones and Simon, alternates, as Managers on the part of
the House. The action, together with the bill and amendments
attached thereto, was immediately certified to the Senate.
The Honorable Jon Mills, Speaker
I am directed to inform the House of Representatives that the Senate
has admitted for introduction and consideration by the required
Constitutional two-thirds vote and passed SB 12-E and requests the
concurrence of the House.
Joe Brown, Secretary

By Senator Deratany-
SB 12-E-A bill to be entitled An act relating to sales tax; repealing
s. 212.065, F.S., relating to taxability of road construction; providing
an exception; providing for application of such provisions under certain
circumstances; providing an effective date.
Rep. Gardner moved that SB 12-E be admitted for introduction, the
Speaker having ruled the measure was outside the purview of the Call,
which was agreed to by the required Constitutional two-thirds vote
and the bill was read the first time by title. On motion by Rep.
Gardner, the rules were waived by two-thirds vote and SB 12-E was
read the second time by title.
Representative Gardner offered the following amendment:
Amendment 1-On page 1, lines 23 and 24, strike all of said lines
and insert: Section 2. Subsection (1) of section 212.0598, Florida
Statutes, as amended by chapter 87-548, Laws of Florida, is amended,
subsection (2) is added to said section and current subsections (2)
through (4) are renumbered as subsections (3) through (5), to read:
212.0598 Special provisions; air carriers.-

(1) Notwithstanding other provisions of this part to the contrary, any
air carrier utilizing mileage apportionment for corporate income tax
purposes in this state pursuant to chapter 214 may elect, upon the
conditions prescribed in subsection (4) (3), to be subject to the tax
imposed by this part on tangible personal property according to the
provisions of this section.

(2) The basis of the tax shall be the ratio of Florida mileage to total
mileage as determined pursuant to part IV of chapter 214. The ratio
shall be determined at the close of the carrier's preceding fiscal year.
The ratio shall be applied each month to the carrier's total systemwide
gross purchases of tangible personal property and services otherwise
taxable in Florida.
Section 3. Effective upon this act becoming a law and operating
retroactively to February 1, 1988, section 49 of chapter 87-548, Laws of
Florida, is amended to read:

Section 49. (1) In the case of any qualified written contract, as
defined in subsection (2), signed prior to May 4; 1987, er any effer
submitted prier to sueh date which was binding on the efferer and was
aeeepted, or any eontraet funded by government bonds sold before May
, 1987 or contracted prior to seh date to be eeld for eenstrueting
improvements to real property, the prime contractor; as defined in
- 2140 Q 94 Florida Statutet as erected by chapter 87-4144w 1TwT of
Florida, responsible for performing the contract shall pay the sales or
use tax on materials necessary to complete the contract at the rate
provided in this act. Such contractor, within 3 years after the effective
date of this section, may apply for one refund of the additional sales or
use tax paid on materials necessary to complete the contract.
Application for such refund shall be pursuant to Department of
Revenue rule. The application shall contain a sworn statement, signed
by the applicant or its representative, attesting to the validity of the
application. The Department of Revenue shall, within 30 days after
approval of a complete application, certify to the Comptroller informa-



tion necessary for issuance of a refund to the applicant of said
additional sales or use taxes. Alternatively, for up to a 3-year period
after the effective date of this section, pursuant to Department of
Revenue rule, such a contractor may apply quarterly for a refund of
taxes paid pursuant to the contract during the previous quarter. Any



E



OF REPRESENTATIVES February 4, 1988

person who fraudulently obtains or attempts to obtain a refund
pursuant to this section, in addition to being liable for repayment of
any refund fraudulently obtained plus a penalty of 100 percent of the
refund, is guilty of a misdemeanor of the second degree, punishable as
provided in s. 775.082, s. 775.083, or s. 775.084, Florida Statutes. This
section shall take effect February 1, 1988.
(2) As used in this section, a "qualified contract" means:
(a) A contract signed prior to December 11, 1987, or any offer
submitted prior to such date which was binding on the offeror and was
accepted, for constructing improvements to real property, entered into by
a subcontractor, as defined in s. 212.0594, Florida Statutes, as created
by chapter 87-101, Laws of Florida, a road contractor constructing or
repairing a road for a governmental entity described in s. 212.08(6),
Florida Statutes, or a prime contractor, as defined in s. 212.0594,
Florida Statutes, as created by chapter 87-101, Laws of Florida,
constructing or repairing property used primarily for public worship; or
(b) A contract signed prior to May 1, 1987, or any offer submitted
prior to such date which was binding on the offeror and was accepted,
or any contract funded by government bonds sold before May 1, 1987, or
contracted prior to such date to be sold, for constructing improvements
to real property, entered into by a prime contractor, as defined in
s. 212.0594, Florida Statutes, as created by chapter 87-101, Laws of
Florida.
Section 4. Except as otherwise provided herein, this act shall take
effect upon becoming a law.
Rep. Gardner moved the adoption of the amendment, which was
adopted.
Representative Gardner offered the following title amendment:
Amendment 2-On page 1, strike the entire title and insert: An act
relating to tax on sales, use, and other transactions; amending
s. 212.0598, F.S.; providing basis for calculating tax for certain air
carriers; repealing s. 212.065, F.S., which provides application of tax to
certain road construction; providing for applicability of existing
contracts; amending section 49 of chapter 87-548, Laws of Florida;
extending the application of provisions which authorize a refund to
certain contractors of additional taxes paid; providing effective and
retroactive effective dates.
Rep. Gardner moved the adoption of the amendment, which was
adopted without objection.
On motion by Rep. Gardner, the rules were waived by two-thirds
vote and SB 12-E, as amended, was read the third time by title. On
passage, the vote was:
Yeas-109



The Chair
Arnold
Ascherl
Bainter
Banjanin
Bankhead
Bass
Bell
Bloom
Brown
Burnsed
Canady
Carlton
Carpenter
Casas
Clark
Cosgrove
Crady
Crotty
Dantzler
Davis
Deutsch
Diaz-Balart
Drage
Dunbar



Figg
Frankel
Frishe
Gaffney
Garcia
Gardner
Glickman
Gonzalez-
Quevedo
Goode
Gordon
Grindle
Guber
Gutman
Hanson
Harden
Hargrett
Harris
Hawkins
Healey
Hill
Hodges
Holland
Ireland
Irvine



Jamerson
Jennings
Johnson, B. L.
Johnson, R. C.
Jones, C. F.
Kelly
King
Langton
Lawson
Lewis
Liberti
Lippman
Locke
Logan
Lombard
Long
Mackenzie
Mackey
Martin
Martinez
McEwan
Meffert
Messersmith
Metcalf
Mitchell



Morse
Mortham
Nergard
Ogden
Ostrau
Peeples
Press
Reaves
Reddick
Rehm
Renke
Rochlin
Rudd
Rush
Sample
Sanderson
Sansom
Saunders
Shelley
Silver
Simone
Smith
Souto
Starks
Stone










February 4, 1988



JOURNAL OF THE HOUSE OF REPRESENTATIVES



Thomas
Titone
Tobiassen



Tobin
Trammell
Troxler



Webster
Wetherell
Woodruff



Young



Nays-None
Votes after roll call:
Yeas-Clements
So the bill passed, as amended, and was immediately certified to the
Senate after engrossment.

Recessed
On motion by Rep. Carpenter, the House recessed at 11:41 a.m. to
reconvene at 3:00 p.m. today or upon call of the Speaker.

Reconvened
The House was called to order by the Speaker at 3:16 p.m. A quorum
was present.

Special and Continuing Orders

CS/HB 10-E-A bill to be entitled An act relating to the State
Group Insurance Program; amending s. 110.123, F.S., providing defini-
tions; providing legislative intent; repealing authorization for competi-
tive bidding to contract with health maintenance organizations;
authorizing the Department of Administration to negotiate contracts
with health maintenance organizations to service members of the state
group insurance program; establishing maximum premiums, a mini-
mum benefit package, and criteria to be used in negotiating health
maintenance organization contracts; entitling certain health mainte-
nance organizations to enter into contract with the Department of
Administration; requiring submission of certain data elements by
health maintenance organizations contracting with the state; provid-
ing an effective date.
-was read the second time by title.
The Committee on Appropriations offered the following amendment:
Amendment 1-On page 9, line 10, after the word "physicians"
insert: "and other health care providers"
Rep. Abrams moved the adoption of the amendment, which was
adopted without objection.
Representative Abrams offered the following amendment:
Amendment 2-On pages 1-10, strike everything after the enacting
clause and insert: Section 1. Paragraph (d) of subsection (3) of section
110.123, Florida Statutes, is amended to read:
110.123 State group insurance program.-
(3) STATE GROUP INSURANCE PROGRAM.-
(d)l. A person eligible to participate in the state group health
insurance plan may be authorized by rules adopted by the Department
of Administration, in lieu of participating in the state group health
insurance plan, to exercise an option to elect membership in a health
maintenance organization which is qualified in accordance with
criteria established by said rules. The offer of optional membership in
a health maintenance organization permitted by this paragraph may
be limited or conditioned by rule as may be necessary to meet the
requirements of federal law.
2. Effective July 1 January 1-, 1988, the Department of Administra-
tion shall, by rule, contract with health maintenance organizations to
participate in the state group health insurance plan through the
competitive bid process based on cost, service area, plan benefits, and
accessibility. Effective January 1, 1988, all employees participating in
the state group health insurance plan, irrespective of whether or not
the member participates in a health maintenance organization, shall
be subject to the same total premium, regardless of the state or
employee share.
Section 2. Except in those areas of the State where contracts have been
executed pursuant to chapter 87-156, Laws of Florida, and final agency
action has occurred prior to the effective date of this act, the Department



35



of Administration shall continue to contract with health maintenance
organizations to serve members of the state group insurance program in
the manner it contracted for such services prior to January 1, 1988. This
section shall stand repealed effective July 1, 1988.
Section 3. This act shall take effect upon becoming a law.
Rep. Abrams moved the adoption of the amendment, which was
adopted without objection.
Representative Abrams offered the following title amendment:
Amendment 3-On page 1, lines 1-19, strike the entire title and
insert: A bill to be entitled An act relating to the State Group
Insurance Program Law; amending s. 110.123, F.S.; delaying the
requirement that the Department of Administration contract with
health maintenance organizations on a competitive bid basis; provid-
ing for continued HMO services under certain circumstances; provid-
ing an effective date.
Rep. Abrams moved the adoption of the amendment, which was
adopted without objection.
Representative Messersmith offered the following amendment:
Amendment 4-On page 1, line 21, strike everything after the
enacting clause and insert: Section 1. Subparagraphs 3, 4, 5 and 6 are
added to paragraph (d) of subsection (3) of section 110.123, Florida
Statutes, to read:
3. a. Notwithstanding the HMOs selected in subparagraph 2., the
Department of Administration is authorized to contract with an
additional HMO to participate in the state group health insurance
program in each service area.
b. Any HMO who was ranked third by the department in the
competitive bid process described in subparagraph 2. and who agrees to
comply with all terms and conditions required by the department in the
competitive bid process may be selected by the department for participa-
tion in the state group health insurance program.
c. The department will negotiate a rate with the selected HMO which
will not exceed the rate of the lowest successful bidder for the HMO's
service area including rate increases for subsequent years of the
negotiated contract.
d. All HMOs under contract shall, at least quarterly, furnish a list of
all employees under the program by social security number, the amount
of all administration fees and such other information as the department
shall require by rule.
e. The Department of Administration shall analyze and include a
summary of the data contained in the HMO reports, described in d., in a
comprehensive report to the Governor and Legislature by February 1,
1989. Such report shall also include an evaluation of the appropriate-
ness of the competitive bid and the negotiated selection processes.
4. a. It shall be the policy of the state that equal contractual
consideration shall be given to all board-certified and Florida licensed
physicians on an equitable nondiscriminatory basis which allows full
utilization of women and minorities. Any HMO whose premiums are
paid in whole or part with public funds shall, as a condition of enrolling
state employees, provide equal contractual consideration.
b. Any individual claiming to be aggrieved by any discriminatory
practice may file a complaint with the Department of Administration
which names the HMO responsible for the violation and describes the
violation.
c. In the event the department is unable to reach conciliation with the
aggrieved person and the HMO, it shall conduct a hearing pursuant to
s. 120.57.
d. If the department determines that an HMO is guilty of a
discriminatory practice, a copy of the final order shall be filed with the
Department of Insurance for revocation of the HMO's Certificate of
Authority as provided in s. 641.23.



e. The department may adopt any rule necessary to carry out the
purpose of this section.











JOURNAL OF THE HOUSE OF REPRESENTATIVES



5. Nothing contained herein shall be construed as interfering with the
bid selection process described in subparagraph 2. or any bid protest
filed as part of that process pursuant to the authority of s. 120.53(5).
6. Section 1. of this act and Chapter 87-156, Laws of Florida, shall
stand repealed effective July 1, 1989.
Section 2. This act shall take effect upon becoming law.
Rep. Messersmith moved the adoption of the amendment. On motion
by Rep. Hodges, the amendment was laid on the table. The vote was:
Yeas-64



Deutsch
Figg
Frankel
Friedman
Gaffney
Gardner
Glickman
Goode
Gordon
Guber
Hargrett
Harris
Healey
Hodges
Jamerson
Johnson, B. L.


Grindle
Gutman
Hanson
Harden
Hawkins
Holland
Ireland
Irvine
Jennings
Jones, D. L.
King
Lewis



Johnson, R. C.
Langton
Lawson
Liberti
Lippman
Logan
Long
Mackenzie
Mackey
Martin
Martinez
Meffert
Metcalf
Mitchell
Ostrau
Peeples


Lombard
Messersmith
Morse
Mortham
Nergard
Patchett
Renke
Sample
Sanderson
Sansom
Shelley
Simone



Press
Reaves
Reddick
Rehm
Rochlin
Rudd
Rush
Saunders
Silver
Simon
Titone
Tobiassen
Tobin
Trammell
Wallace
Young


Souto
Starks
Stone
Thomas
Troxler
Webster
Woodruff



Pair Vote
I am paired with Representative Bronson on the motion to lay
Amendment 4 to CS/HB 10-E on the table. If he were present, he would
vote "Yea" and I would vote "Nay".
Representative Bruce McEwan
District 38
Amendment 5 by Representative Ogden was withdrawn.
On motion by Rep. Abrams, the rules were waived by two-thirds vote
and CS/HB 10-E, as amended, was read the third time by title.
Pending roll call, further consideration of the bill was temporarily
deferred.
On motion by Rep. Abrams, the rules were waived and the House
reverted to the order of-

Messages from the Senate

The Honorable Jon Mills, Speaker
I am directed to inform the House of Representatives that the Senate
has passed, as amended, SB 4-E and requests the concurrence of the
House.
Joe Brown, Secretary
By Senators Thomas and Hollingsworth-
SB 4-E-A bill to be entitled An act relating to the State Group
Insurance Program Law; amending s. 110.123, F.S.; delaying the
requirement that the Department of Administration contract with
health maintenance organizations on a competitive bid basis; prohibit-
ing impairment of obligations of contract; providing an effective date.



-was read the first time by title. On motion by Rep. Abrams, the
rules were waived by two-thirds vote and the bill was read the second
time by title.
Representatives Abrams, Lawson and Rudd offered the following
amendment:
Amendment 1-On pages 1 & 2 strike everything after the enacting
clause and insert: Section 1. Paragraph (d) of subsection (3) of section
110.123, Florida Statutes, is amended to read:
110.123 State group insurance program.-
(3) STATE GROUP INSURANCE PROGRAM.-
(d)l. A person eligible to participate in the state group health
insurance plan may be authorized by rules adopted by the Department
of Administration, in lieu of participating in the state group health
insurance plan, to exercise an option to elect membership in a health
maintenance organization which is qualified in accordance with
criteria established by said rules. The offer of optional membership in
a health maintenance organization permitted by this paragraph may
be limited or conditioned by rule as may be necessary to meet the
requirements of federal law.
2. Effective July 1 Ja&nuary -, 1988, the Department of Administra-
tion shall, by rule, contract with health maintenance organizations to
participate in the state group health insurance plan through the
competitive bid process based on cost, service area, plan benefits, and
accessibility. Effective January 1, 1988, all employees participating in
the state group health insurance plan, irrespective of whether or not
the member participates in a health maintenance organization, shall
be subject to the same total premium, regardless of the state or
employee share.
Section 2. Except in those areas of the State where contracts have been
executed pursuant to chapter 87-156, Laws of Florida, and final agency
action has occurred prior to the effective date of this act, the Department
of Administration shall continue to contract with health maintenance
organizations to serve members of the state group insurance program in
the manner it contracted for such services prior to January 1, 1988. This
section shall stand repealed effective July 1, 1988.
Section 3. This act shall take effect upon becoming a law.
Rep. Abrams moved the adoption of the amendment, which was
adopted. The vote was:
Yeas-64



The Chair
Abrams
Arnold
Ascherl
Bass
Bell
Bloom
Brown
Burke
Canady
Carpenter
Clark
Clements
Cosgrove
Crady
Davis
Nays-45
Bainter
Banjanin
Bankhead
Burnsed
Casas
Crotty
Diaz-Balart
Drage
Dunbar
Frishe
Garcia
Gonzalez-
Quevedo



Deutsch
Figg
Frankel
Friedman
Gaffney
Gardner
Glickman
Goode
Gordon
Guber
Hargrett
Harris
Healey
Jamerson
Johnson, B. L.
Johnson, R. C.


Grindle
Gutman
Hanson
Harden
Hawkins
Hill
Holland
Ireland
Irvine
Jennings
Jones, D. L.
Kelly
King



Jones, C. F.
Langton
Lawson
Liberti
Lippman
Logan
Long
Mackenzie
Mackey
Martin
Martinez
Meffert
Metcalf
Mitchell
Ogden
Ostrau


Lewis
Lombard
Messersmith
Morse
Mortham
Nergard
Patchett
Rehm
Renke
Sample
Sanderson
Sansom
Shelley



Peeples
Press
Reaves
Reddick
Rochlin
Rudd
Rush
Saunders
Silver
Titone
Tobiassen
Tobin
Trammell
Wallace
Wetherell
Young


Simone
Souto
Starks
Stone
Troxler
Webster
Woodruff



The Chair
Abrams
Arnold
Ascherl
Bass
Bloom
Brown
Burke
Canady
Carlton
Carpenter
Clark
Clements
Cosgrove
Crady
Davis
Nays-42
Bainter
Banjanin
Bankhead
Casas
Crotty
Diaz-Balart
Drage
Dunbar
Frishe
Garcia
Gonzalez-
Quevedo



February 4, 1988.



36











JOURNAL OF THE HOUSE OF REPRESENTATIVES



Pair Vote
I am paired with Rep. Bronson on the adoption of Amendment 1 to
SB 4-E. If he were present, he would vote "Yea" and I would vote
"Nay".
Representative Bruce McEwan
District 38
Representatives Abrams, Lawson and Rudd offered the following
title amendment:
Amendment 2-On page 1, lines 7 and 8 strike all of said lines and
insert: providing for continued contracting with respect to Health
Maintenance Organizations under certain circumstances; providing an
effective date.
Rep. Abrams moved the adoption of the amendment, which was
adopted without objection.
On motion by Rep. Abrams, the rules were waived by two-thirds vote
and SB 4-E, as amended, was read the third time by title. On passage,
the vote was:
Yeas-67



authority vested in us by Section 3, Article III, Florida Constitution,
and Section 11.011, Florida Statutes, do hereby proclaim:
1. That Paragraph 1. of our Joint Proclamation filed January 5,
1988, is hereby amended to read:
That the Legislature of the State of Florida is convened in Special
Session pursuant to Section 3(c), Article III, Florida Constitution and
Section 11.011, Florida Statutes, at the Capitol in Tallahassee, Florida,
at 1:00 p.m., on Tuesday, the 2nd day of February, 1988, for a period of
three days, ending at 9:00 p.m., on Thursday, February 4th, 1988.
2. Except as amended by this Proclamation, the Joint Proclamation
filed January 5, 1988, is ratified and confirmed.



JOHN W. VOGT
President,
The Florida Senate

DATE: February 4, 1988



JON L. MILLS
Speaker,
The Florida House of Representa-
tives

DATE: February 4, 1988



The Chair
Abrams
Arnold
Ascherl
Bass
Bell
Bloom
Brown
Burke
Canady
Carlton
Carpenter
Clark
Clements
Cosgrove
Crady
Davis
Nays-45
Bainter
Banjanin
Bankhead
Burnsed
Casas
Crotty
Diaz-Balart
Drage
Dunbar
Frishe
Garcia
Gonzalez-
Quevedo

Pair Vote



Deutsch
Figg
Frankel
Friedman
Gaffney
Gardner
Glickman
Goode
Gordon
Guber
Hargrett
Harris
Healey
Hodges
Jamerson
Johnson, B. L.
Johnson, R. C.


Grindle
Gutman
Hanson
Harden
Hawkins
Hill
Holland
Ireland
Irvine
Jennings
Jones, D. L.
Kelly
King



Jones, C. F.
Langton
Lawson
Liberti
Lippman
Locke
Logan
Long
Mackenzie
Mackey
Martin
Martinez
Meffert
Metcalf
Mitchell
Ostrau
Peeples


Lewis
Lombard
Messersmith
Morse
Mortham
Nergard
Patchett
Renke
Sample
Sanderson
Sansom
Shelley
Simone



Press
Reaves
Reddick
Rehm
Rochlin
Rudd
Rush
Saunders
Silver
Titone
Tobiassen
Tobin
Trammell
Wallace
Wetherell
Young



Souto
Starks
Stone
Thomas
Troxler
Webster
Woodruff



I am paired with Rep. Bronson on the passage of SB 4-E. If he were
present, he would vote "Yea" and I would vote "Nay".
Representative Bruce McEwan
District 38
So the bill passed, as amended, and was immediately certified to the
Senate after engrossment.

The following amended proclamation was read:

THE FLORIDA LEGISLATURE
AMENDED JOINT PROCLAMATION
TO THE HONORABLE MEMBERS OF THE FLORIDA SENATE
AND THE FLORIDA HOUSE OF REPRESENTATIVES:
We, John W. Vogt, President of The Florida Senate, and Jon L.
Mills, Speaker of the Florida House of Representatives, by virtue of the



( - Duly filed with and received by the
Florida Department of State this
4th day of February, 1988 by:

JIM SMITH
Secretary of State



The Honorable Jon Mills, Speaker
I am directed to inform the House of Representatives that the Senate
has refused to concur in House amendments to SB 12-E and requests
the House to recede.
Joe Brown, Secretary
(House amendments attached to original bill)

On motion by Rep. Gardner, the House refused to recede from the
House amendments to SB 12-E and again requested the Senate to
concur therein. The action, together with the bill and amendments
thereto, was immediately certified to the Senate.


Recessed
On motion by Rep. Crady, the House recessed at 4:35 p.m. to
reconvene at 6:30 p.m. or upon call of the Speaker.
The House reconvened at 6:38 p.m.
Rep. Locke was excused after 4:35 p.m.
After a brief report by the Speaker on the state of the Conference
Committee on CS/SB 6-E, the House again recessed at 6:41 p.m. to
reconvene at 8:15 p.m. or upon call of the Speaker.
The following amended Proclamation was received:



THE FLORIDA LEGISLATURE
SECOND AMENDED JOINT PROCLAMATION

TO THE HONORABLE MEMBERS OF THE FLORIDA SENATE
AND THE FLORIDA HOUSE OF REPRESENTATIVES:
We, John W. Vogt, President of the Florida Senate, and Jon L. Mills,
Speaker of the Florida House of Representatives, by virtue of the
authority vested in us by Section 3, Article III, Florida Constitution,
and Section 11.011, Florida Statutes, do hereby proclaim:
1. That Paragraph 1. of our Joint Proclamation filed January 5,
1988, and first amended on February 4, 1988, is hereby further
amended to read:



February 4, 1988



37











JOURNAL OF THE HOUSE OF REPRESENTATIVES



That the Legislature of the State of Florida is convened in Special
Session pursuant to Section 3(c), Article III, Florida Constitution and
Section 11.011, Florida Statutes, at the Capitol in Tallahassee, Florida,
at 1:00 p.m., on Tuesday, the 2nd day of February, 1988, for a period of
three days, ending at 11:59 p.m., Thursday, February 4th, 1988.
2. Except as amended by this Proclamation, our Joint Proclamation
filed January 5, 1988, and our Amended Proclamation filed February
4, 1988, are ratified and confirmed.



JOHN W. VOGT
President,
The Florida Senate


DATE: February 4, 1988



JON L. MILLS
Speaker,
The Florida House of Representa-
tives
DATE: February 4, 1988



IEDuly filed with and received by the
Florida Department of State this
4th day of February, 1988 by:
JIM SMITH
Secretary of State





Reconvened
The House was called to order by the Speaker at 10:31 p.m. A
quorum was present.

Messages from the Senate

The Honorable Jon Mills, Speaker
I am directed to inform the House of Representatives that the Senate
has admitted for introduction and consideration by the required
Constitutional two-thirds vote and passed SB 13-E, as amended, and
requests the concurrence of the House.

Joe Brown, Secretary

By Senator Margolis-
SB 13-E-A bill to be entitled An act relating to educational
facilities; amending s. 235.056, F.S.; providing for separately advertis-
ing for and receiving certain bids and proposals on the financing and
construction of facilities; providing for public disclosure of information
related to lease-purchase agreements; providing an effective date.
Rep. Patchett moved that SB 13-E be admitted for introduction, the
Speaker having ruled the measure was outside the purview of the Call,
which was agreed to by the required Constitutional two-thirds vote
and the bill was read the first time by title. On motion by Rep. B. L.
Johnson, the rules were waived by two-thirds vote and the bill was
read the second time by title.
Representatives Wetherell and B. L. Johnson offered the following
amendment:
Amendment 1-On page 1, line 30, after "organization" insert: or a
consortium of district school boards
Rep. Johnson moved the adoption of the amendment, which was
adopted without objection.
Representatives Wetherell and B. L. Johnson offered the following
amendment:
Amendment 2-On page 2, line 5, before the period insert: and the
pledged revenues are limited to those authorized in s. 23625(2)(e)
Rep. Johnson moved the adoption of the amendment, which was
adopted without objection.
On motion by Rep. B. L. Johnson, the rules were waived by
two-thirds vote and SB 13-E, as amended, was read the third time by
title. On passage, the vote was:



Yeas-60
The Chair
Abrams
Bass
Bell
Bloom
Burke
Carlton
Carpenter
Casas
Clark
Cosgrove
Crady
Dantzler
Davis
Diaz-Balart
Friedman
Nays-40
Bainter
Banjanin
Bankhead
Clements
Crotty
Drage
Dunbar
Figg
Frishe
Gaffney



Garcia
Gardner
Gonzalez-
Quevedo
Goode
Gordon
Guber
Gutman
Harris
Hodges
Irvine
Johnson, B. L.
Johnson, R. C.
Jones, C. F.
Kelly
Lawson



Glickman
Grindle
Hanson
Harden
Hawkins
Healey
Hill
Holland
Ireland
Jennings



Lippman
Logan
Long
Mackenzie
Mackey
Martin
Martinez
Metcalf
Mitchell
Morse
Nergard
Press
Reaves
Reddick
Rochlin
Rudd


Jones, D. L.
King
Langton
Lewis
Liberti
McEwan
Messersmith
Mortham
Patchett
Peeples



Sanderson
Sansom
Saunders
Silver
Simon
Souto
Starks
Tobiassen
Tobin
Trammell
Troxler
Wetherell
Young





Rehm
Renke
Rush
Sample
Shelley
Simone
Stone
Thomas
Webster
Woodruff



So the bill passed, as amended, and was immediately certified to the
Senate after engrossment.
On motion by Rep. Ogden, the House took up the following Report of
the Conference Committee on CS/SB 6-E:
The Honorable Jon Mills, Speaker
I am directed to inform the House of Representatives that the Senate
has accepted the Conference Committee Report as an entirety and
passed CS/SB 6-E, as amended by the Conference Committee Report.
Joe Brown, Secretary

Conference Committee Report on CS/SB 6-E



February 4, 1988



The Honorable John W. Vogt
President of the Senate



The Honorable Jon Mills
Speaker, House of Representatives
Dear Sirs:
Your Conference Committee on the disagreeing votes of the two
Houses on Committee Substitute Senate Bill 6E, same being:
An act relating to medical incidents; providing legislative findings
and intent regarding regulatory reform
having met, and after full and free conference, do recommend to their
respective Houses, as follows:
1. That the House and Senate adopt the Conference Committee
Amendments 1 and 2, attached hereto, and by reference made a
part of this report.
2. That the Senate and House pass the Committee Substitute for
Senate Bill 6E as amended by said Conference Committee
amendments.
Toni Jennings, Chairman Carl Ogden, Co-Chairman
Dempsey Barron Samuel Bell
Mattox Hair Fred Lippman
George Kirkpatrick Dale Patchett
William Myers Hamilton Upchurch
Managers on the part of the Managers on the part of the House
Senate of Representatives
Summary of Conference Committee Action:
1. Statement of legislative findings and purpose.



February 4, 1988



38














2. Provides for increased efficiency to the disciplinary process for
physicians by the following changes:
a) Creates a new division of Medical Quality Assurance within
the Department of Professional Regulation to focus on the
regulation of physicians and appropriates $1.4 million to
provide staffing for same.
b) Provides mandatory standards and immunity for the hospital
peer review process.
c) Provides for the cooperation of professional medical societies in
the disciplinary process.
d) Provides that the Department of Professional Regulation will
get more information on activity that may violate disciplinary
standards. That information will come from:
-HRS concerning untoward incidents in hospitals and HMOs,
-Hospitals and HMOs concerning risk management program
data on physicians,
-Hospital and HMOs records subpoenaed by DPR,
-Insurers who report claims against physicians, and unin-
sured physicians who report claims against themselves, and
-Patients who file medical malpractice suits.
e) Provides that a doctor, dentist, pharmacist, or nurse is immune
from civil suit by another health care practitioner for reporting
or providing information to a hospital committee, to an
internal risk management program, to DPR, or to the appropri-
ate regulatory board about patient care at a hospital where
both of them practice. Internal risk managers are also immune
from suit for investigating such reports.
f) Expands the membership of the Board of Medicine, which
makes disciplinary decisions, to include a hospital risk manag-
er and two physicians who are on the faculty of a medical
school or the staff of a teaching hospital in Florida.
g) Problems with the speed of the disciplinary process and with
board quorums are reduced by allowing the board to use two
probable cause panels, each of which may have one past
physician member of the board and by requiring each panel to
complete work on cases it begins. Board members will also be
required to go through a training program on discipline of
physicians in Florida.
3. Creates new law on presuit investigation and voluntary, binding
arbitration.
4. Provides that claimant or attorney must conduct reasonable
investigation to determine negligence prior to submitting notice
of intent to initiate litigation and must include written opinion
of medical expert corroborating claim.
5. Provides that within 90 days of receipt of notice, defendant must
conduct a reasonable investigation to determine defendant's
liability. If a claim is denied, it must be accompanied by a
written opinion of medical expert.
6. Provides for access to medical records prior to mailing notice of
intent. Provides for informal discovery by the parties after
claimant has filed notice of intent to initiate litigation. Non-
compliance is grounds for dismissal of claim or defense.
7. Allows a court to dismiss a claim or defense for lack of
reasonable investigation.
8. Requires attorneys and physicians.to be reported to Florida Bar
or DPR if they fail to comply with reasonable investigation
requirements.
9. Allows either party to request arbitration of damages within 90
days of service of notice of intent to initiate litigation. The
arbitration panel will be composed of one arbitrator selected by
claimant, one selected by defendant, and one DOAH hearing
officer.



10. Damages awarded in arbitration will consist of net economic



39



damages including 80% of wage loss, offset by collateral sources,
costs and reasonable attorneys fees up to 15% of the award
reduced to present value, and noneconomic damages to a
maximum of $250,000 per incident. Punitive damages may not
be awarded. The liability of any insurer shall be subject to any
applicable insurance policy limits.
11. Provides for a separate binding arbitration panel to determine
disputes among defendants regarding apportionment of financial
responsibility.
12. If plaintiff refuses to arbitrate, his noneconomic damages at trial
are limited to $350,000 per incident. If defendant refuses, he
must pay a successful plaintiffs reasonable attorney's fees up to
25% of the award reduced to present value and prejudgment
interest.
13. Provides legislative findings and intent regarding the Florida
Birth-Related Neurological Injury Compensation Plan.
14. Provides definitions for terms, including birth-related neurologi-
cal injury.
15. Creates the Florida Birth-Related Neurological Injury Compen-
sation Plan, which will provide compensation for birth-related
neurological injury claims. The plan will apply to births
occurring on or after January 1, 1989, and will be administered
by the Florida Birth-Related Neurological Injury Compensation
Association.
16. Provides that a deputy commissioner from the Division of
Workers Compensation will hear and determine all birth-related
neurological injury claims.
17. Requires the claimant seeking compensation to file a petition
with the division. The division must serve the association and
mail copies to other parties including the Division of Medical
Quality Assurance and the Department of Health and Rehabili-
tative Services.
18. Provides that the filing of a claim with the division on behalf of
an injured infant tolls the statute of limitations for a civil action.
19. Requires the deputy commissioner to set a hearing date within a
specified time period after the filing of a petition by the
claimant. The parties to the hearing will include the claimant
and the association.
20. Requires every claim that is filed to be reviewed by a medical
advisory panel of three physicians. The panel must file its
recommendation as to whether the injury is a birth-related
neurological injury with the division before the hearing.
21. Authorizes the deputy commissioner to determine whether a
birth-related neurological injury occurred. The deputy commis-
sioner will also determine whether obstetrical services were
delivered by a participating physician at birth and how much
compensation is awardable.
22. Authorizes the deputy commissioner to make an award for a
birth-related neurological injury. The award can include com-
pensation for reasonable medical care. Attorney's fees are
payable subject to the approval of the deputy commissioner.
23. Provides that an award by a deputy commissioner may be
appealed to the district court of appeal.
24. Authorizes a party to petition the circuit court for enforcement of
a final award by the deputy commissioner.
25. Provides a statute of limitation of 7 years for the filing of a claim
for a birth-related neurological injury.
26. Creates the Birth-Related Neurological Injury Compensation
Trust Fund within the Department of Insurance. The fund will
be administered by the Florida Birth-Related Neurological
Injury Compensation Association. On March 1, 1988 initial
assessments will be made from each participating physician,



from all hospitals and from all other practicing physicians.
Beginning January 1, 1990 annual assessment will be made to



February 4, 1988



JOURNAL OF THE HOUSE OF REPRESENTATIVES











40 JOURNAL OF THE HOUSE

the same parties in the same amounts. Additionally, $20 million
will be appropriated on March 1, 1988 from the Insurance
Commissioner's Regulatory Trust Fund to the fund. Deficits in
the fund will be offset first by an annual assessment against
specified insurers and then, if needed, from an additional
appropriation from the Insurance Commissioner's Regulatory
Trust Fund.

27. Provides that the Florida Birth-Related Neurological Injury
Compensation Plan will be governed by a board of directors. The
directors will be appointed for three-year terms by the Insurance
Commissioner.

28. Requires each hospital and each participating physician under
the plan to provide notice to their obstetrical patients as to their
participation in the plan.

29. Provides a separate standard of care for emergency health care
services provided in a hospital emergency room or trauma
center. To recover damages for a medical injury, the plaintiff
must prove that the health care provider acted with reckless
disregard for the life or health of the patient. Reckless disregard
for the purposes of medical malpractice is defined as that
conduct which the health care provider knew or should have
known to be likely to result in injury so as to affect the life or
health of another, taking into account the following to the extent
they may be present:

a) The extent or serious nature of the circumstances prevailing;

b) The lack of time or ability to obtain appropriate consultation;

c) The lack of a prior patient-physician relationship;

d) The inability to obtain an appropriate medical history of the
patient; and

e) The time constraints imposed by coexisting emergencies.

30. Provides that a teaching hospital will not be jointly and
severally liable for damages assessed against the Board of
Regents.

31. Provides that damages assessed against a teaching hospital will
be several rather than joint and several.

32. Provides that insurers reflect any savings in their rate filings.

33. Provides an effective date.

Conference Committee Amendment 1-Strike everything after the
enacting clause and insert:

Section 1. Legislative findings and intent.-The Legislature finds
that the costs, both in terms of real dollars and access, to the public for
quality health care are so high that not all Floridians can be
guaranteed an acceptable level of care. The Legislature further finds
that the strict regulation of health care practitioners is imperative to
maintaining the quality of health care delivered in the state. It is,
therefore, the intent of the Legislature to encourage health care
practitioners to report possible instances of malpractice by offering
them protection from civil, suit. It is, further, the intent of the
Legislature to facilitate the maintenance of medical practice in Florida
by promptly and fairly disciplining health care practitioners whose
performance is outside acceptable limits.

Section 2. Section 20.30, Florida Statutes, is amended to read:
20.30 Department of Professional Regulation.-There is created a
Department of Professional Regulation.



EI



(1) The head of the Department of Professional Regulation is the
Secretary of Professional Regulation. The secretary shall be appointed
by the Governor subject to confirmation by the Senate. The secretary
shall serve at the pleasure of the Governor.

(2) The following divisions of the Department of Professional
Regulation are established:



OF REPRESENTATIVES February 4, 1988

(a) Division of Examination and Licensure.
(b) Division of Professions.
(c) Division of Medical Quality Assurance.
1. The director of the division shall be a deputy assistant secretary of
professional regulation and shall be appointed by the Secretary of the
Department of Professional Regulation.
2. The division shall concentrate sufficient resources and efforts on
the investigation and discipline of physicians in violation of the
unprofessional conduct provisions of the applicable practice acts as are
necessary to meet the challenge of identifying those physicians who are
not providing adequate medical care in order to take forceful corrective
measures to assure quality medical care throughout the state.
3. The division shall coordinate closely with the Office of Health
Planning and Regulation in the Department of Health and Rehabilita-
tive Services to ensure that the state's regulation of health care facilities
and the physicians who practice therein is consistent and offers
adequate protection to the public.
4. The division shall establish and maintain a disciplinary training
program for division staff and board members designed to ensure the
proper and appropriate administration of medical quality assurance.
The program shall provide for initial and periodic training in the
grounds for disciplinary action, the actions which may be taken,
changes in any relevant law, sanctions which are most appropriate for
specified types of unprofessional conduct, guidelines for the conduct of
hearings, and any other matters which the division shall determine may
be necessary or useful.
(d)(e4 Division of Real Estate.
1. The director of the division shall be appointed by the Secretary of
Professional Regulation, subject to approval by a majority of the
Florida Real Estate Commission.
2. The offices of the Division of Real Estate shall be located in
Orlando.
(e)(d Division of Regulation.
(3) There shall be a director of the Division of Examination and
Licensure, a director of the Division of Professions, a deputy assistant
secretary of the Division of Medical Quality Assurance, a director of the
Division of Regulation, and a director of the Division of Real Estate.
Each division director shall directly administer his division and shall
be responsible to the secretary of the department.
(4) The following boards are established within the Department of
Professional Regulation, Division of Professions:
(a) Board of Accountancy, created under chapter 473.
(h) Beard of Aeupuneture, created under chapter 457.
(b)(e Board of Architecture, created under part I of chapter 481.
(c)(W Board of Auctioneers, created under part VI of chapter 468.
(d)(-e Barbers' Board, created under chapter 476.
() Board of Chiroeprae.tie created under chapter 460w
(e)(g4 Construction Industry Licensing Board, created under part I of
chapter 489.
(f)(h) Board of Cosmetology, created under chapter 477.
i) Beard of Dentistry efeated ifider ehapter 466w
(g)^fi Electrical Contractors' Licensing Board, created under part II
of chapter 489.
(h)(k) Board of Professional Engineers, created under chapter 471.
(i)(4 Board of Funeral Directors and Embalmers, created under
chapter 470.



(j)(-) Board of Professional Land Surveyors, created under chapter
472.
(k)(n4 Board of Landscape Architecture, created under part II of
chapter 481.











JOURNAL OF THE HOUSI



(l)(e) Board of Massage, created under chapter 480.
(p) Board of Medical Examiners, created under chapter 458.
Sq4 Board of Naturopathic Examiners, created under chapter 462
(r4 Board of Nursing, created under chapter 464o
(m)(s) Board of Nursing Home Administrators, created under part III
of chapter 468.
(n)(4 Board of Opticianry, created under chapter 484.
fut) Beard of Optomot created under chapter 46%-
(v) Board of Osteopathie Medial Examiners, created uder chapter
459.
(w) Board of Pharmaey,- created under hapter465
(o)x) Board of Pilot Commissioners, created under chapter 310.
(y) Board of Podiatry, created under chapter 461-
(sz Board of Veterinary Medieinie, created under chapter 474.
(5) The following boards are established within the Department of
Professional Regulation, Division of Medical Quality Assurance:
(a) Board of Medicine, created under chapter 458.
(b) Board of Osteopathic Medical Examiners, created under chapter
459.
(c) Board of Acupuncture, created under chapter 457.
(d) Board of Chiropractic, created under chapter 460.
(e) Board of Dentistry, created under chapter 466.
(f) Board of Naturopathic Examiners, created under chapter 462.
(g) Board of Nursing, created under chapter 464.
(h) Board of Optometry, created under chapter 463.
(i) Board of Pharmacy, created under chapter 465.
(j) Board of Podiatry, created under chapter 461.
(k) Board of Veterinary Medicine, created under chapter 474.
(6)(6 The members of each board shall be appointed by the
Governor, subject to confirmation by the Senate. Lay members on the
board shall be appointed pursuant to subsection (7) (6). Members shall
be appointed for 4-year terms. A vacancy on the board shall be filled
for the unexpired portion of the term in the same manner as the
original appointment. No member shall serve more than two consecu-
tive terms on the board.
(7)(6) Each board with five or more members shall have at least two
lay members who are not, and have never been, members or
practitioners of the profession regulated by such board or of any closely
related profession. Each board with fewer than five members shall
have at least one lay member who is not, and has never been, a
member or practitioner of the profession regulated by such board or of
any closely related profession.
(8)(7W No board, with the exception of joint coordinatorships, shall be
transferred from its location on July 1, 1979, without legislative
authorization.
(9)(8) Chapter 79-36, Laws of Florida, shall not be construed to
supersede the abolition of any board within the Department of
Professional Regulation, pursuant to the Regulatory Reform Act of
1976, as amended by chapter 77-457, Laws of Florida, or as subse-
quently amended.
Section 3. Section 395.0115, Florida Statutes, is amended to read:
395.0115 Licensed facilities; peer review; disciplinary powers.--
(1) It is the intent of the Legislature that good-faith participants in the
process of investigating and disciplining physicians pursuant to the
state-mandated peer review process shall, in addition to receiving



immunity from retaliatory tort suits pursuant to s. 455.225(11), be
protected from federal antitrust suits filed under the Sherman Act, 15



February 4, 1988



(4) All final disciplinary actions taken under subsection (3) shall be
reported within 10 working days to the Division of Medical Quality
Assurance in writing and shall specify the disciplinary action taken and
the specific grounds therefore. The division shall treat each report and



SOF REPRESENTATIVES 41

U.S.C.A., s. 1 et seq. Such intent is within the public policy of the state
to secure the provision of quality medical services to its citizens.
(2) Each licensed facility, as a condition of licensure, shall provide for
peer review of physicians who deliver health care services at the facility.
Each facility shall develop written, binding procedures by which such
peer review shall be conducted. Such procedures shall include:
(a) Mechanism for choosing the membership of the body or bodies that
conduct peer review.
(b) Adoption of rules of order for the peer review process.
(c) Fair review of the case with the physician involved.
(d) Mechanism to identify and avoid conflict of interest on the part of
the peer review panel members.
(e) Recording of agendas and minutes which do not contain
confidential material, for review by the Division of Medical Quality
Assurance of the Department of Professional Regulation.

(f) Mechanism for advising the Division of Medical Quality Assurance
in writing of all new procedures for and changes to existing peer review
procedures.
(g) Process for amending peer review procedures when the Division of
Medical Quality Assurance advises the facility in writing that the
procedures do not meet the requirements of the law.
(h) Review, at least annually, of the peer review procedures by the
governing board of the facility.
(i) Focus of the peer review process on review of professional practices
at the facility to reduce morbidity and mortality and to improve patient
care.
(3)f4 If the governing board of any licensed facility has reasonable
belief exists that conduct by a staff member or physician who delivers
health care services at the facility may constitute one or more grounds
for discipline as provided in this subsection, a peer review panel the
board shall investigate and determine whether grounds for discipline
exist with respect to such the staff member or physician. The
governing board of any licensed facility, after considering the recom-
mendations of its peer review panel medial staff, shall suspend, deny,
revoke, or curtail the staff privileges, or reprimand, counsel, or require
education, of any such staff member or physician after a final
determination has been made that one or more of the following
grounds exist:
(a) Incompetence.
(b) Being found to be a habitual user of intoxicants or drugs to the
extent that he is deemed dangerous to himself or others.
(c) Mental or physical impairment which may adversely affect
patient care.
(d) Being found liable by a court of competent jurisdiction for
medical negligence or malpractice involving negligent conduct.
(e) One or more settlements exceeding $10,000 for medical negli-
gence or malpractice involving negligent conduct by the staff member.
(f) Medical negligence other than as specified in paragraphs (d) or
(e).
(g) Failure to comply with the policies, procedures, or directives of
the risk management program or any quality assurance committees of
any licensed facility.
However, the procedures for such actions shall comply with the
standards outlined by the Joint Commission on Accreditation of
Hospitals, the American Osteopathic Association, the Accreditation
Association for Ambulatory Health Care, and the "Medicare/Medicaid
Conditions of Participation," as such procedures existed on January 1,
1985. The procedures shall be adopted pursuant to hospital bylaws.











42 JOURNAL OF THE HOUSE

determine whether it potentially involved conduct by the licensee that is
subject to disciplinary action, in which case the provisions of s. 455.255
shall apply. However, the report shall not be subject to inspection under
the provisions of chapter 119 even if the division's investigation results
in a finding of probable cause.

(5)(2- There shall be no monetary liability on the part of, and no
cause of action for damages shall arise against, any licensed facility,
its governing body and governing body members, peer review panel,
medical staff, or disciplinary body, or its agents, investigators,
witnesses, employees, or any other person for any action taken without
intentional fraud in carrying out the provisions of this section.
(6)34) The proceedings and records of peer review panels, committees,
and governing bodies which relate solely to actions taken in carrying
out the provisions of this section shall not under any circumstances be
subject to inspection under the provisions of chapter 119; nor shall
meetings held pursuant to achieving the objectives of such panels,
committees, and governing bodies be open to the public under the
provisions of chapter 286.
(7)(44 The investigations, proceedings, and records of the board as
described in this section shall not be subject to discovery or introduc-
tion into evidence in any civil action against a provider of professional
health services arising out of the matters which are the subject of
evaluation and review by such board, and no person who was in
attendance at a meeting of such board shall be permitted or required to
testify in any such civil action as to any evidence or other matters
produced or presented during the proceedings of such board or as to
any findings, recommendations, evaluations, opinions, or other actions
of such board or any members thereof. However, information, docu-
ments, or records otherwise available from original sources are not to
be construed as immune from discovery or use in any such civil action
merely because they were presented during proceedings of such board;
nor should any person who testifies before such board or who is a
member of such board be prevented from testifying as to matters
within his knowledge, but such witness cannot be asked about his
testimony before such a board or opinions formed by him as a result of
such board hearings.
(8)(5)(a) In the event that the defendant prevails in an action
brought by a staff member or physician who delivers health care
services at the facility against any person or entity that initiated,
participated in, was a witness in, or conducted any review as
authorized by this section, the court shall award reasonable attorney's
fees and costs to the defendant.
(b) As a condition of any staff member or physician bringing any
action against any person or entity that initiated, participated in, was
a witness in, or conducted any review as authorized by this section and
before any responsive pleading is due, the staff member or physician
shall post a bond or other security, as set by the court having
jurisdiction of the action, in an amount sufficient to pay the costs and
attorney's fees.
Section 4. Section 395.0146, Florida Statutes, is created to read:
395.0146 Certificate of need for termination or reduction of emergen-
cy or trauma services.-Notwithstanding any provision of chapter 381,
a hospital licensed under this chapter which operates an emergency
room or trauma center may not terminate or substantially reduce the
availability of emergency or trauma service without first obtaining
from the Department of Health and Rehabilitative Services a certifi-
cate of need for such termination or reduction in service. An
application for such a certificate of need may not be approved by the
department unless the applicant shows that no need exists in the
applicable service area for continuing such service.
Section 5. Subsection (1) and paragraph (e) of subsection (3) of
section 395.017, Florida Statutes, are amended to read:
395.017 Patient records; copies; examination.-



(1) Any licensed facility shall, upon request, and only after discharge
of the patient, furnish to any person admitted therein for care and
treatment or treated threat, or to any such person's guardian, curator,
or personal representative, or to anyone designated by such person in



E



OF REPRESENTATIVES February 4, 1988

writing, a true and correct copy of all patient records, including X rays,
concerning such person, which records are in the possession of the
licensed facility, except progress notes and consultation report sections
of a psychiatric nature concerning the care and treatment performed
by the licensed facility, provided the person requesting such records
agrees to pay a charge not to exceed the actual cost of copying the
records, including reasonable staff time reasonable charge fr eepying
the reeerds. The licensed facility shall further allow any such person to
examine the original records in its possession, or microfilms or other
suitable reproductions of the records, upon such reasonable terms as
shall be imposed to assure that the records will not be damaged,
destroyed, or altered.
(3) Patient records shall have a privileged and confidential status
and shall not be disclosed without the consent of the person to whom
they pertain, but appropriate disclosure may be made without such
consent to:
(e) The Department of Professional Regulation upon subpoena issued
pursuant to s. 455.223, but the records obtained thereby shall be used
solely for the purpose of the Department of Professional Regulation
and the appropriate professional board in its investigation, prosecution,
and appeal of disciplinary proceedings. If the Department of Profes-
sional Regulation requests copies of such records, the facility shall
charge no more than its actual copying costs, including reasonable staff
time. The records shall otherwise be sealed and shall not be available
to the public pursuant to s. 119.07 or any other statute providing
access to records, nor shall they be available to the public as part of the
record of investigation for and prosecution in disciplinary proceedings
made available to the public by the Department of Professional
Regulation or the appropriate regulatory board. However, the Depart-
ment of Professional Regulation shall make available, upon written
request by a practitioner against whom probable cause has been found,
any such records which form the basis of the determination of probable
cause; or
Section 6. The introductory paragraph and paragraph (b) of subsec-
tion (1) and subsections (5) and (6) of section 395.041, Florida Statutes,
are amended, present subsection (7) is renumbered and amended,
subsections (8), (9), and (10) are renumbered as subsections (12), (13),
and (14), respectively, and new subsections (7), (9), (10), and (11) are
added to said section, to read:
395.041 Internal risk management program.-
(1) Every facility licensed under this chapter ehapter 89, or chapter
390 shall, as a part of its administrative functions, establish an
internal risk management program which shall include the following
components:
(b) The development of appropriate measures to minimize the risk of
injuries and adverse incidents to patients, including at least annual
risk management and risk prevention education and training of all
nonphysician personnel as follows:,
1. Such education and training of all nonphysician personnel as part
of their initial orientation; and
2. At least 1 hour of such education and training annually for all
nonphysician personnel of the facility working in clinical areas and
providing patient care;
(5)(a) Each licensed facility subject to this section shall submit an
annual report to the department summarizing the incident reports that
have been filed in the facility for that year. The report shall be on a
form prescribed by rule of the department and shall include:
1. The total number of adverse incidents causing injury to patients.
2. A listing, by category, of the types of operations, diagnostic or
treatment procedures, or other actions causing the injuries, and the
number of incidents occurring within each category.



3. A listing, by category, of the types of injuries caused and the
number of incidents occurring within each category.
4. A code number utilizing the health care professionals licensure
number and a separate code number identifying all other individuals











JOURNAL OF THE HOUSE



directly involved in adverse incidents causing injury to patients, the
relationship of the individual to the facility, and the number of
incidents in which each individual has been directly involved. Each
facility shall maintain names of the health care professionals and
individuals identified by code numbers for purposes of this section aet.
5. A description of all malpractice claims filed against the facility,
including the total number of pending and closed claims and the
nature of the incident which led to, the persons involved in, and the
status and disposition of each claim. Each report shall update status
and disposition for all prior reports.
6. A report of all disciplinary actions pertaining to patient care
taken against any medical staff member, including the nature and
cause of the action.
(b) The information reported to the department pursuant to para-
graph (a) which relates to persons licensed under chapter 458, chapter
459, chapter 461, or chapter 466 shall also be reported to the
Department of Professional Regulation on a quarterly basis. The
Department of Professional Regulation shall review the information and
determine whether any of the incidents potentially involved conduct by a
licensee that is subject to disciplinary action, in which case the
provisions of s. 455225 shall apply.
(c)(b) The annual report shall also contain the name of the risk
manager of the facility, a copy of its policy and procedures which
govern the measures taken by the facility and its risk manager to
reduce the risk of injuries and adverse or untoward incidents, and the
results of such measures. This report shall be held confidential and
shall not be available to the public pursuant to s. 119.07 or any other
law providing access to public records, nor be discoverable or
admissible in any civil or administrative action, except in disciplinary
proceedings by the department, the Department of Professional Regula-
tion, and the appropriate regulatory board. This report shall not be
available to the public as part of the record of investigation for and
prosecution in disciplinary proceedings made available to the public by
the department, the Department of Professional Regulation, or the
appropriate regulatory board. However, the Department of Professional
Regulation shall make available, upon written request by a practitioner
against whom probable cause has been found, any such records which
form the basis of the determination of probable cause.
(6) If an adverse or untoward incident, whether occurring in the
facility or arising from health care prior to admission in the facility,
results in:
(a) The death of a patient; er in
(b) Severe brain or spinal damage to a patient;,
(c) A surgical procedure being performed on the wrong patient; or
(d) A surgical procedure unrelated to the patient's diagnosis or
medical needs being performed on any patient, the facility shall report
this incident to the department within 3 working days of its
occurrence. A more detailed follow-up report shall be submitted to the
department within 10 days after the first report. The department may
require an additional, final report. Reports under this subsection shall
be sent immediately by the department to the Department of Professional
Regulation whenever they involve a health care provider licensed under
chapter 458, chapter 459, chapter 461, or chapter 466. These reports
shall not be available to the public pursuant to s. 119.07 or any other
law providing access to public records, nor be discoverable or
admissible in any civil or administrative action, except in disciplinary
proceedings by the department, the Department of Professional Regula-
tion, and the appropriate regulatory board7, nor shall they be available
to the public as part of the record of investigation for and prosecution in
disciplinary proceedings made available to the public by the Department
of Professional Regulation or the appropriate regulatory board. Howev-
er, the Department of Professional Regulation shall make available,
upon written request by a practitioner against whom probable cause has
been found, any such records which form the basis of the determination
of probable cause. The department may investigate, as it deems
appropriate, any such incident and prescribe measures that must or



may be taken in response to the incident. The Department of
"Professional Regulation shall review each incident and determine



February 4, 1988



(11)(a) No person who reports in any capacity, whether or not
required by law, information to the Division of Medical Quality
Assurance with regard to the incompetence, impairment, or unprofes-
sional conduct of any health care provider licensed under chapter 458,



SOF REPRESENTATIVES 43

whether it potentially involved conduct by the licensee that is subject to
disciplinary action, in which case the provisions of s. 455.225 shall
apply. This subseetion shall take effect January 4 1986.
(7) In addition to any penalty imposed pursuant to s. 395.018, the
department may impose an administrative fine, not to exceed $5,000, for
any violation of the reporting requirements of subsection (5) or
subsection (6). This subsection shall take effect July 1, 1989.
(8)(74 The department and, upon subpoena issued pursuant to
s. 455.223, the Department of Professional Regulation shall have access
to all facility records necessary to carry out the provisions of this
section. The records obtained are not available to public access, nor
shall they be discoverable or admissible in any civil or administrative
action, except in disciplinary proceedings by the department, the
Department of Professional Regulation, and the appropriate regulatory
board-, nor shall records obtained pursuant to s. 455.223 be available to
the public as part of the record of investigation for and prosecution in
disciplinary proceedings made available to the public by the Department
of Professional Regulation or the appropriate regulatory board. Howev-
er, the Department of Professional Regulation shall make available,
upon written request by a practitioner against whom probable cause has
been found, any such records which form the basis of the determination
of probable cause, except that, with respect to medical review committee
records, the provisions of s. 768.40 shall control.
(9) The department shall review, no less than annually, the risk
management program at each facility regulated by this section to
determine whether the program meets standards established in statutes
and rules, whether the program is being conducted in a manner
designed to reduce adverse incidents, and whether the program is
appropriately reporting incidents under subsections (5) and (6).
(10) There shall be no monetary liability on the part of, and no cause
of action for damages shall arise against, any risk manager, certified
under part IX of chapter 626, for the implementation and oversight of
the risk management program in a facility licensed under this chapter
or chapter 390 as required by this section, for any act or proceeding
undertaken or performed within the scope of the functions of such risk
management program if the risk manager acts without intentional
fraud.
(11) By December 1, 1988, the Department of Professional Regulation,
in coordination with representatives of the Florida Society of Health
Care Risk Managers, shall report to the Legislature on classifications of
adverse or untoward incidents, which involve results similar in nature
to those in subsection (6) and potentially involve conduct by licensees
that is subject to disciplinary action, and on time frames for reporting
such incidents. Such additional incidents shall be related directly to the
department's duties to investigate and reduce incidents of medical
malpractice. The department shall propose a level of incident reporting
with benefits from reduced malpractice that outweigh the costs of its
implementation. The report to the Legislature shall include proposals
for the content of the incident reports, the uses of the incident reports,
the availability of the reports to the Department of Health and
Rehabilitative Services, and the appropriate level of confidentiality of
the reports.
Section 7. Subsection (8) of section 395.504, Florida Statutes, is
amended to read:
395.504 Powers and duties of board.-To properly carry out its
authority, the board:
(8) Shall designate executive staff members to issue preliminary
findings pursuant to s. 395.509(9)(8).
Section 8. Subsection (7) of section 455.225, Florida Statutes, is
amended, and subsection (11) is added to said section, to read:
455.225 Disciplinary proceedings.-
(7) Any proceeding for the purpose of summary suspension or
restriction of a license pursuant to s. 120.60(8) shall be conducted by
the secretary or his designee, who shall issue the final summary order.











JOURNAL OF THE HOUSE OF REPRESENTATIVES



chapter 459, chapter 460, chapter 461, chapter 462, chapter 463, chapter
464, chapter 465, or chapter 466 shall be held liable in any civil action
for reporting against such health care provider if such person acts
without intentional fraud or malice.

(b) No facility licensed under chapter 395, health maintenance
organization certificated under part II of chapter 641, physician licensed
under chapter 458, or osteopathic physician licensed under chapter 459
shall discharge, threaten to discharge, intimidate, or coerce any
employee or staff member by reason of such employee's or staff member's
report to the division about a physician licensed under chapter 458,
chapter 459, chapter 460, chapter 461, or chapter 466 who may be guilty
of incompetence, impairment, or unprofessional conduct so long as such
report is given without intentional fraud or malice.

(c) In any civil suit brought outside the protections of paragraphs (a)
and (b), where intentional fraud or malice is alleged, the person
alleging intentional fraud or malice shall be liable for all court costs
and for the other party's reasonable attorney's fees if intentional fraud or
malice is not proved.

Section 9. Section 455.241, Florida Statutes, is amended to read:

455.241 Patient records; report or copies of records to be furnished.-

(1) Any health care practitioner licensed pursuant to chapter 458,
chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
chapter 464, chapter 466, or chapter 474 who makes a physical or
mental examination of, or administers treatment to, any person shall,
upon request of such person or his legal representative, furnish copies
of all reports or records made of such examination or treatment,
including X rays-; except that when a patient's psychiatric records are
requested by him or his legal representative, the practitioner may
provide a report of examination and treatment in lieu of copies of
records. However, upon a patient's written request, complete copies of the
patient's psychiatric records shall be provided directly to a subsequent
treating psychiatrist. The furnishing of such report or copies shall not
be conditioned upon payment of a disputed fee for services rendered.

(2) Such records shall not be furnished to any person other than the
patient or his legal representative, except upon written authorization
of the patient. However, such records may be furnished without
written authorization to any person, firm, or corporation which has
procured or furnished such examination or treatment with the
patient's consent or when compulsory physical examination is made
pursuant to Rule 1.360, Florida Rules of Civil Procedure, in which case
copies of the medical record shall be furnished to both the defendant
and the plaintiff. Such records may be furnished in any civil or
criminal action, unless otherwise prohibited by law, upon the issuance
of a subpoena from a court of competent jurisdiction and proper notice
to the patient or his legal representative by the party seeking such
records. The Department of Professional Regulation may obtain
patient records pursuant to a subpoena without written authorization
from the patient if the department and the probable cause panel of the
appropriate board, if any, find reasonable cause to believe that a
practitioner has excessively or inappropriately prescribed any con-
trolled substance specified in chapter 893 in violation of
s. 458.331(1)(q), s. 459.015(1)(q), s. 461.013(1)(p), s. 462.14(1),
s. 466.028(1)(q), or s. 474.214(1)(x) or (y) or that a practitioner has
practiced his profession below that level of care, skill, and treatment
required as defined by s. 458.331(1)(t), s. 459.015(1)(t), s. 460.413(1)(s),
s. 461.013(1)(t), s. 462.14(1)(t), s. 463.016(1)(g), s. 464.018(1)(f),
s. 466.028(1)(y), or s. 474.214(1)(g); but the patient record obtained by
the department pursuant to this subsection shall be used solely for the
purpose of the department and board in disciplinary proceedings. The
record shall otherwise be sealed and shall not be available to the public
pursuant to the provisions of s. 119.07 or any other statute providing
access to public records. Nothing in this section shall be construed to
limit the assertion of the psychotherapist-patient privilege under
s. 90.503 in regard to records of treatment for mental or nervous
disorders by of a medical practitioner licensed pursuant to chapter 458
or chapter 459 who has primarily diagnosed and treated mental and



nervous disorders for a period of not less than 3 years, inclusive of
psychiatric residency. However, the practitioner shall release records of



treatment for medical conditions even if the practitioner has also treated
the patient for mental or nervous disorders. If the department has found
reasonable cause under this section and the psychotherapist-patient
privilege is asserted, the department may petition the circuit court for an
in camera review of the records by expert medical practitioners
appointed by the court to determine if the records or any part thereof are
protected under the psychotherapist-patient privilege.
(3) All patient records obtained by the Department of Professional
Regulation and any other documents identifying the patient by name
shall be used solely for the purpose of the Department of Professional
Regulation and the appropriate regulatory board in its investigation,
prosecution, and appeal of disciplinary proceedings. The records shall
be sealed and shall not be available to the public as part of the record of
investigation for and prosecution in disciplinary proceedings made
available to the public by the Department of Professional Regulation or
the appropriate regulatory board.
(4) A health care practitioner furnishing copies of reports or records
pursuant to this section shall charge no more than the actual cost of
copying, including reasonable staff time, or the amount specified in
administrative rule by the appropriate regulatory board.
Section 10. Section 455.2415, Florida Statutes, is created to read:
455.2415 Communications confidential; exceptions.-Communica-
tions between a patient and a psychiatrist, as defined in
s. 394.455(2)(e), shall be held confidential and shall not be disclosed
except upon the request of the patient or his legal representative.
Provision of psychiatric records and reports shall be governed by
s. 455.241. Notwithstanding any other provisions of this section or
s. 90.503, where:
(1) A patient is engaged in a treatment relationship with a
psychiatrist;
(2) Such patient has made an actual threat to physically harm an
identifiable victim or victims; and
(3) The treating psychiatrist makes a clinical judgment that the
patient has the apparent capability to commit such an act and that it is
more likely than not that in the near future the patient will carry out
that threat,
the psychiatrist may disclose patient communications to the extent
necessary to warn any potential victim or to communicate the threat to
a law enforcement agency. No civil or criminal action shall be
instituted and there shall be no liability on account of disclosure of
otherwise confidential communications by a psychiatrist in disclosing a
threat pursuant to this section.
Section 11. Section 455.242, Florida Statutes, is amended to read:
455.242 Disposition of records of deceased practitioners or practition-
ers relocating or terminating practice.-Each board created under the
provisions of chapter 458, chapter 459, chapter 460, chapter 461,
chapter 462, chapter 463, chapter 464, chapter 466, or chapter 474
shall provide by rule for the disposition, under said chapter, of the
medical records of practitioners which are in existence at the time of
the death of the practitioner dies, terminates his practice, or relocates
and is no longer available to his patients and which pertain to the
practitioner's patients. The rules shall provide fer disposition of sekh
records by the estate of the practitioner and shall provide that the
records shall be retained for at least 1 year after the practitioner's
death., termination of practice, or relocation. In the case of the death of
the practitioner, the rules shall provide for the disposition of such
records by the estate of the practitioner.
Section 12. Subsection (3) is added to section 455.245, Florida
Statutes, to read:
455.245 Health care practitioners; immediate suspension of license
for certain convictions.-
(3) If the board has previously found any physician or osteopathic
physician in violation of the provisions of s. 458.331(1)(t) or
s. 459.015(1)(y), in regard to his treatment of three or more patients,



and the probable cause panel of the board finds probable cause of an
additional violation of that section, then the secretary shall review the



44



February 4, 1988











JOURNAL OF THE HOUSE



matter to determine if an emergency suspension or restriction order is
warranted. Nothing in this section shall be construed so as to limit the
secretary's authority to issue an emergency order.
Section 13. Section 455.247, Florida Statutes, is created to read:
455.247 Health care practitioners; reports on professional liability
claims and actions.-
(1) Any practitioner of medicine licensed pursuant to the provisions
of chapter 458, practitioner of osteopathic medicine licensed pursuant
to the provisions of chapter 459, podiatrist licensed pursuant to the
provisions of chapter 461, or dentist licensed pursuant to the provisions
of chapter 466 shall report to the department any claim or action for
damages for personal injury claimed to have been caused by error,
omission, or negligence in the performance of such licensee's profes-
sional services or based on a claimed performance of professional
services without consent if the claim was not covered by an insurer
required to report under s. 627.912 and the claim resulted in:
(a) A final judgment in any amount.
(b) A settlement in any amount.
(c) A final disposition not resulting in payment on behalf of the
licensee.
Reports shall be filed with the department no later than 60 days
following the occurrence of any event listed in paragraph (a),
paragraph (b), or paragraph (c).
(2) Reports shall contain:
(a) The name and address of the licensee.
(b) The date of the occurrence which created the claim.
(c) The date the claim was reported to the licensee.
(d) The name and address of the injured person. This information
shall be privileged and confidential and shall not be disclosed by the
department without the injured person's consent. This information
may be used by the department for purposes of identifying multiple or
duplicate claims arising out of the same occurrence.
(e) The date of suit, if filed.
(f) The injured person's age and sex.
(g) The total number and names of all defendants involved in the
claim.
(h) The date and amount of judgment or settlement, if any,
including the itemization of the verdict, together with a copy of the
settlement or judgment.
(i) In the case of a settlement, such information as the department
may require with regard to the injured person's incurred and
anticipated medical expense, wage loss, and other expenses.
(j) The loss adjustment expense paid to defense counsel, and all
other allocated loss adjustment expense paid.
(k) The date and reason for final disposition, if no judgment or
settlement.
(1) A summary of the occurrence which created the claim, which
shall include:
1. The name of the institution, if any, and the location within such
institution, at which the injury occurred.
2. The final diagnosis for which treatment was sought or rendered,
including the patient's actual condition.
3. A description of the misdiagnosis made, if any, of the patient's
actual condition.
4. The operation or the diagnostic or treatment procedure causing
the injury.
5. A description of the principal injury giving rise to the claim.
6. The safety management steps that have been taken by the



licensee to make similar occurrences or injuries less likely in the
future.



February 4, 1988



them. In the event that consideration of a case is begun but not
completed during the term of those members on the panel, they may
reconvene as a probable cause panel, in addition to the panels
established under paragraph (2)(b), for the purpose of completing their
deliberations on that case.



OF REPRESENTATIVES 45

(m) Any other information required by the department to analyze
and evaluate the nature, causes, location, cost, and damages involved
in professional liability cases.
Section 14. Section 455.28, Florida Statutes, is created to read:
455.28 Reporting of violations of grounds for disciplinary action;
penalty.-
(1) Any person licensed under chapter 458 (physicians), 459 (osteo-
pathic physicians), 460 (chiropractic physicians), 461 (podiatrists), 464
(nurses), 465 (pharmacists), or 466 (dentists), shall report to the
Division of Medical Quality Assurance any physician who the licensee
knows has violated the grounds for disciplinary action set out in the
law under which that physician is licensed and who provides health
care services in a facility licensed under chapter 395 in which the
licensee also provides such services. Any licensee who fails to report a
physician as required by this subsection shall be subject to the
appropriate penalty under that licensee's licensing provisions.
(2) Complaints alleging probable disciplinary violations shall be
investigated by the division.
Section 15. Paragraph (c) of subsection (1) of section 458.303, Florida
Statutes, is amended to read:
458.303 Provisions not applicable to other practitioners; exceptions,
etc.-
(1) The provisions of ss. 458.301, 458.303, 458.305, 458.307, 458.309,
458.311, 458.313, 458.315, 458.317, 458.319, 458.321, 458.327,
458.329, 458.331, 458.337, 458.339, 458.341, 458.343, 458.345, and
458.347 shall have no application to:
(c) Commissioned medical officers of the Armed Forces of the United
States and of the Public Health Service of the United States while on
active duty and while acting within the scope of their military or public
health responsibilities.
Section 16. Subsection (2) of section 458.307, Florida Statutes, is
amended, subsection (4) is renumbered as subsection (6), and new
subsections (4) and (5) are added to said section, to read:
458.307 Board of Medicine.-
(2)(a) Ten members of the board must be licensed physicians in good
standing in this state who are residents of the state and who have been
engaged in the practice or teaching of medicine for at least 4 years
immediately prior to their appointment. Two of the physicians must be
on the faculty of a medical school in this state or on the full-time staff of
a teaching hospital in this state. At least one 41 of the 10 physicians
must be a graduate of a foreign medical school. The remaining three
members must be residents of the state who are not, and have never
been, licensed health care practitioners. One member must be a
hospital risk manager certified under part IX of chapter 626. At least
one member of the board must be 60 years of age or older.
(b) The board shall establish at least one, but not more than two,
probable cause panels to meet the responsibilities set out in
s. 455.225(3). Each probable cause panel shall be composed of three

may, if provided for in administrative rule, be a past board member who
is not currently appointed to the board.
(4) The board, in conjunction with the department, shall establish a
disciplinary training program for board members. The program shall
provide for initial and periodic training in the grounds for disciplinary
action, the actions which may be taken by the board and the department,
changes in relevant statutes and rules, and any relevant judicial and
administrative decisions. After January 1, 1989, no member of the
board shall participate on probable cause panels or in disciplinary
decisions of the board unless he has completed the disciplinary training
program.
(5) During the time members are appointed to a probable cause panel,
they shall attempt to complete their work on every case presented to











46 JOURNAL OF THE HOUSE

Section 17. Subsection (5) of section 458.311, Florida Statutes, is
renumbered and amended, subsections (4) and (6) are renumbered as
subsections (5) and (9), respectively, and new subsections (4), (7), and
(8) are added to said section, to read:
458.311 Licensure by examination; requirements; fees.-
(4) The department and the board shall assure that applicants for
licensure meet the criteria in subsection (1) through an investigative
process. When the investigative process is not completed within the time
set out in s. 120.60(2), and the department or board has reason to
believe that the applicant does not meet the criteria, the secretary or his
designee may issue a 90-day licensure delay which shall be in writing
and sufficient to notify the applicant of the reason for the delay. The
provisions of this subsection shall control over any conflicting provisions
of s. 120.60(2).
(6)A5 The board may not certify to the department for licensure Each
applicant who passes the examination and meets the requirements of
this chapter shall be licensed as a physician- with rights as defined by
law. The department may et issue a license to any applicant who is
under investigation in another jurisdiction for an offense which would
constitute a violation of this chapter until such investigation is
completed. Upon completion of the investigation, the provisions of
s. 458.331 shall apply.
(7) Each applicant who passes the examination and meets the
requirements of this chapter shall be licensed as a physician, with rights
as defined by law.
(8) Upon certification by the board, the department shall impose
conditions, limitations, or restrictions on a license by examination if the
applicant is on probation in another jurisdiction for an act which would
constitute a violation of this chapter.
Section 18. Paragraph (a) of subsection (1) of section 458.313, Florida
Statutes, is amended, subsections (3), (4), and (5) are renumbered as
subsections (5), (6), and (8), respectively, and new subsections (3), (4),
and (7) are added to said section, to read:
458.313 Licensure by endorsement; requirements; fees.-
(1) The department shall issue a license by endorsement to any
applicant who, upon applying to the department and remitting a fee
not to exceed $400 set by the board, demonstrates to the board that he
has met the qualifications for licensure in s. 458.311(1)(b)-(f) and:
(a) Has obtained a passing score, as established by rule of the board,
on the licensure examination of the Federation of State Medical Boards
of the United States, Inc. (FLEX) or on the examination of the
National Board of Medical Examiners, provided that said examination
required shall have been so taken within the 10 years immediately
preceding the filing of his application for licensure under this section,
and shows evidence of the active practice of medicine within the previous
4 years; or
(3) The department and the board shall assure that applicants for
licensure by endorsement meet applicable criteria in this chapter
through an investigative process. When the investigative process is not
completed within the time set out in s. 120.60(2), and the department or
board has reason to believe that the applicant does not meet the criteria,
the secretary or his designee may issue a 90-day licensure delay which
shall be in writing and sufficient to notify the applicant of the reason for
the delay. The provisions of this subsection shall control over any
conflicting provisions of s. 120.60(2).
(4) If the applicant has not actively practiced medicine within the
previous 4 years, the board shall certify the applicant to the department
for licensure by endorsement subject to the condition that the applicant
work under the supervision of another physician for a period, not to
exceed 1 year, as determined by the board based on its determination of
the licensee's ability to practice medicine. The supervising physician
shall have had no probable cause findings against him within the
previous 3 years.



E



(7) Upon certification by the board, the department shall impose
conditions, limitations, or restrictions on a license by endorsement if the
applicant is on probation in another jurisdiction for an act which would
constitute a violation of this chapter.



SOF REPRESENTATIVES February 4, 1988

Section 19. The introductory paragraph of section 458.315, Florida
Statutes, is amended, and subsection (4) is added to said section, to
read:
458.315 Temporary certificate for practice in areas of critical
need.-Any physician who is licensed to practice in any other state,
whose license is currently valid, and who pays a fee of $100 may be
issued a temporary certificate to practice in communities of Florida
where there is a critical need for physicians and the population is less
than 7,500. The Board of Medicine Medical Examiners may issue this
temporary certificate with the following restrictions:
(4) The board shall not certify to the department for licensure by
endorsement any physician who is under investigation in another state
for an act which would constitute a violation of this chapter until such
time as the investigation is complete, at which time the provisions of
s. 458.331 shall apply.
Section 20. Paragraph (b) of subsection (1) of section 458.3165,
Florida Statutes, is amended to read:
458.3165 Public psychiatry certificate.-The board shall issue a
public psychiatry certificate to an individual who remits an application
fee not to exceed $100, as set by the board, who is a board certified
psychiatrist, who is licensed to practice medicine without restriction in
another state, and who meets the requirements in s. 458.311(1)(a)-(f)
and (6)(5.
(1) Such certificate shall:
(b) Be issued and renewable biennially annually if the secretary of
the Department of Health and Rehabilitative Services and the
chairman of the department of psychiatry at one of the public medical
schools or the chairman of the department of psychiatry at the
accredited medical school at the University of Miami recommend in
writing that the certificate be issued or renewed.
Section 21. Subsection (1) of section 458.319, Florida Statutes, is
amended to read:
458.319 Renewal of license.
(1) The department shall renew a license upon receipt of the renewal
application, evidence that the applicant has actively practiced medicine,
or has been on the active teaching faculty of an accredited medical
school, within the previous 4 years, and fee not to exceed $500 $250. If
the licensee has not actively practiced medicine within the previous 4
years, the board shall certify the licensee to the department for renewal
of the license subject to the condition that the licensee work under the
supervision of another physician for a period, not to exceed 1 year, as
determined by the board based on its determination of the licensee's
ability to practice medicine. The supervising physician shall have had
no probable cause findings against him within the previous 3 years.
Section 22. Paragraph (b) of subsection (1), paragraph (b) of
subsection (2), and paragraph (a) of subsection (4) of section 458.320,
Florida Statutes, are amended to read:
458.320 Financial responsibility.-
(1) As a condition of licensing and prior to the issuance or renewal of
an active license or reactivation of an inactive license for the practice
of medicine, an applicant shall by one of the following methods
demonstrate to the satisfaction of the board and the department
financial responsibility to pay claims and costs ancillary thereto
arising out of the rendering of, or the failure to render, medical care or
services:
(b) Obtaining and maintaining professional liability coverage in an
amount not less than $100,000 per claim, with a minimum annual
aggregate of not less than $300,000, from an authorized insurer as
defined under s. 624.09, from a surplus lines insurer as defined under
s. 626.914(2), from a risk retention group as defined under s. 627.942,
from the Joint Underwriting Association established under
s. 627.351(4), or through a plan of self-insurance as provided in



s. 627.357.
(2) As a continuing condition of hospital staff privileges, physicians
with staff privileges shall also be required to establish financial
responsibility by one of the following methods:










JOURNAL OF THE HOUSE OF REPRESENTATIVES



(b) Obtaining and maintaining professional liability coverage in an
amount not less than $250,000 per claim, with a minimum annual
aggregate of not less than $750,000 from an authorized insurer as
defined under s. 624.09, from a surplus lines insurer as defined under
s. 626.914(2), from a risk retention group as defined under s. 627.942,
from the Joint Underwriting Association established under
s. 627.351(4), or through a plan of self-insurance as provided in
s. 627.357.

(4)(a) Each insurer, self-insurer, risk retention group, or Joint
Underwriting Association shall promptly notify the Department of
Professional Regulation of cancellation or nonrenewal of insurance
required by this section. Unless the physician demonstrates that he is
otherwise in compliance with the requirements of this section, the
Department of Professional Regulation shall suspend the license of the
physician pursuant to s. 120.57 and notify all health care facilities
licensed under chapter 395 of such action. Any suspension under this
subsection shall remain in effect until the physician demonstrates
compliance with the requirements of this section, except that a license
suspended under paragraph (5)(g) shall not be reinstated until the
physician demonstrates compliance with the requirements of that
provision.

Section 23. Paragraph (d) is added to subsection (2) of section
458.327, Florida Statutes, to read:

458.327 Penalty for violations.-

(2) Each of the following acts constitutes a misdemeanor of the first
degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084:
(d) Leading the public to believe that one is licensed as a medical
doctor, or is engaged in the licensed practice of medicine, without
holding a valid, active license.

Section 24. Section 458.3295, Florida Statutes, is created to read:

458.3295 Concerted effort to refuse emergency room treatment to
patients; penalties.-
(1) A physician licensed pursuant to this chapter may not instigate
or engage in a concerted effort to refuse to render services to a patient
in a hospital emergency room either through such physicians' failing to
report for duty, such physicians' absenting themselves from their
positions, such physicians' submitting their resignations, such physic-
ians' abstaining from the full and faithful performance of their medical
duties, or such physicians' otherwise causing conduct that adversely
affects the services of the hospital. For the purposes of this subsection,
the term "concerted" means contrived or arranged by agreement,
planned or devised together, or done or performed together in
cooperation.

(2) If a physician or group of physicians engages in conduct in
violation of subsection (1), either the department or the hospital where
the conduct occurs may file suit in circuit court to enjoin such conduct.

(a) Upon such suit being filed, the court shall conduct a hearing,
with notice to the department, the board, and all interested parties, at
the earliest practicable time. If the plaintiff makes a showing that a
violation of subsection (1) is in progress or that there is a clear, real,
and present danger that such a violation is about to commence, the
court shall issue a temporary injunction enjoining such violation. Upon
final hearing, the court shall either make the injunction permanent or
dissolve it.

(b) A physician found to be in contempt of court for violating such an
injunction shall be fined an amount considered appropriate by the
court, but not less than $5,000. In determining the appropriate fine,
the court shall objectively consider the extent of services lost to the
hospital and its patients.

(3) A violation by a physician of subsection (1) constitutes ground for
disciplinary action against him by the board, including the suspension
or revocation of his license, and subjects him to liability for any



damages that the hospital or any patient therein sustains as a result of

the violation.



Section 25. Paragraphs (b), (m), and (t) of subsection (1) and
subsections (2) and (5) of section 458.331, Florida Statutes, are
amended, paragraphs (hh), (ii), (jj), and (kk) are added to subsection
(1), subsections (3) through (6) are renumbered as subsections (4)
through (7), respectively, and new subsections (3) and (8) are added to
said section, to read:
458.331 Grounds for disciplinary action; action by the board and
department.-
(1) The following acts shall constitute grounds for which the
disciplinary actions specified in subsection (2) may be taken:
(b) Having a license or the authority to practice medicine revoked,
suspended, or otherwise acted against, including the denial of licen-
sure, by the licensing authority of any jurisdiction, including its
agencies or subdivisions state, territory, or eeuntry. The licensing
authority's acceptance of a physician's relinquishment of a license,
stipulation, consent order, or other settlement, offered in response to or
in anticipation of the filing of administrative charges against the
physician's license, shall be construed as action against the physician's
license.
(m) Failing to keep written medical records justifying the course of
treatment of the patient, including, but not limited to, patient
histories, examination results, anA test results, records of drugs
prescribed, dispensed, or administered, and reports of consultations and
hospitalizations.
(t) Gross or repeated malpractice or the failure to practice medicine
with that level of care, skill, and treatment which is recognized by a
reasonably prudent similar physician as being acceptable under
similar conditions and circumstances. The board shall give great
weight to the provisions of s. 768.45 when enforcing this paragraph. As
used in this paragraph, "repeated malpractice" includes, but is not
limited to, three or more claims for medical malpractice within the
previous 5-year period resulting in indemnities being paid in excess of
$10,000 each to the claimant in a judgment or settlement and which
incidents involved negligent conduct by the physician. As used in this
paragraph, "gross malpractice" or "the failure to practice medicine
with that level of care, skill, and treatment which is recognized by a
reasonably prudent similar physician as being acceptable under
similar conditions and circumstances," shall not be construed so as to
require more than one instance, event, or act. Nothing in this
paragraph shall be construed to require that a physician be incompetent
to practice medicine in order to be disciplined pursuant to this
paragraph.
(hh) Misrepresenting or concealing a material fact at any time during
any phase of a licensing or disciplinary process or procedure.
(ii) Improperly interfering with an investigation or with any disci-
plinary proceeding.
(jj) Failing to report to the Division of Medical Quality Assurance, as
required by s. 45528, any physician licensed under chapter 458 or
osteopathic physician licensed under chapter 459 who the physician
knows has violated the grounds for disciplinary action set out in the law
under which that physician or osteopathic physician is licensed and who
provides health care services in a facility licensed under chapter 395, or
a health maintenance organization certificated under part II of chapter
641, in which the physician also provides services.
(kk) Being found by any court in this state to have provided
corroborating written medical expert opinion attached to any statutorily
required notice of claim or intent or to any statutorily required response
rejecting a claim, without reasonable investigation.
(2) When the board finds any person guilty of any of the grounds set
forth in subsection (1), it may enter an order imposing one or more of
the following penalties:
(a) Refusal to certify, or certification with restrictions, to the
department an application for licensure, certification, or registration.
(b) Revocation or suspension of a license.
(c) Restriction of practice.



(d) Imposition of an administrative fine not to exceed $5,000 for each
count or separate offense.



February 4, 1988



47










48 JOURNAL OF THE HOUSE]

(e) Issuance of a reprimand.
(f) Placement of the physician on probation for a period of time and
subject to such conditions as the board may specify, including, but not
limited to, requiring the physician to submit to treatment, to attend
continuing education courses, to submit to reexamination, or to work
under the supervision of another physician.
(g) Issuance of a letter of concern.
(h) Corrective action.
(i) Refund of fees billed to and collected from the patient.
In determining what action is appropriate, the board must first
consider what sanctions are necessary to protect the public or to
compensate the patient. Only after those sanctions have been imposed
may the disciplining authority consider and include in the order
requirements designed to rehabilitate the physician. All costs associated
with compliance with orders issued under this subsection are the
obligation of the physician.
(3) In any administrative action against a physician which does not
involve revocation or suspension of license, the division shall have the
burden, by the greater weight of the evidence, to establish the existence
of grounds for disciplinary action. The division shall establish grounds
for revocation or suspension of license by clear and convincing evidence.
(6)(4) Upon the department's receipt from an insurer or self-insurer
of a report of a closed claim against a physician pursuant to s. 627.912
or from a health care practitioner of a report pursuant to s. 455247, or
upon the receipt from a claimant of a presuit notice against a physician
pursuant to s. 768.57, the department shall review each report and
determine whether it potentially involved conduct by a licensee that is
subject to disciplinary action, in which case the provisions of s. 455225
shall apply. However, if it is reported that a physician has had the
Department of Insuranee of the name of a physician having three or
more claims with indemnities exceeding $10,000 each within the
previous 5-year period, including reports for the 3 year period
preceding the effective date of this aet the department shall investi-
gate the occurrences upon which the claims were based and determine
if action by the department against the physician is warranted.
(8) If any physician regulated by the Division of Medical Quality
Assurance is guilty of such unprofessional conduct, negligence, or
mental or physical incapacity or impairment that the division deter-
mines that the physician is unable to practice with reasonable skill and
safety and presents a danger to patients, the division shall be authorized
to maintain an action in circuit court enjoining such physician from
providing medical services to the public until the physician demon-
strates the ability to practice with reasonable skill and safety and
without danger to patients.
Section 26. Paragraph (a) of subsection (4) of section 458.3315,
Florida Statutes, is amended to read:
458.3315 Treatment programs for impaired practitioners.-
(4)(a) Whenever the consultant is notified that there is reason to
believe that a practitioner licensed under this chapter is impaired as a
result of the misuse or abuse of alcohol or drugs, or both, or due to a
mental condition, which could affect the practitioner's ability to
practice his profession, and no complaint against the practitioner other
than impairment exists, the reporting of such information shall not
constitute a complaint within the meaning of s. 455.255 if the probable
cause panel of the board under which the practitioner is licensed finds
that:
1. The practitioner has acknowledged his impairment problem;
2. The practitioner has voluntarily enrolled in an appropriate,
approved treatment program; and
3. The practitioner has voluntarily withdrawn from his practice or
limited the scope of his practice as determined by the panel in each



case, until such time as the panel is satisfied that he has successfully
completed an approved treatment program; and-
4. The practitioner has executed releases for medical records,
authorizing the release of all records of evaluations, diagnoses, and



- --- - -- -- ----



intern shall, on January 1 and July 1 of each year, furnish the
department with a list of its employees and such other information as
the board may direct. Unless pre iously authorized by the board, No
person registered under this section may be employed as a house
physician or act as a resident physician, an assistant resident



E



OF REPRESENTATIVES February 4, 1988

treatment of the practitioner, including records of treatment for
emotional or mental conditions, to the consultant. The consultant shall
make no copies or reports of records that do not regard the issue of the
practitioner's impairment and his participation in a treatment program.
Section 27. Paragraph (a) of subsection (1) of section 458.337, Florida
Statutes, is amended to read:
458.337 Reports of disciplinary actions by medical organizations and
hospitals.-
(1)(a) The department shall be notified when any physician:
1. Has been removed or suspended or has had any other disciplinary
action taken by his peers within any professional medical association,
society, body, or professional standards review organization estab-
lished pursuant to s. 249F of Pub. L. No. 92-603 or similarly
constituted professional organization, whether or not such association,
society, body, or organization is local, regional, state, national, or
international in scope; or
2. Has been disciplined which includes allowing the physician to
resign by a licensed hospital, health maintenance organization,
prepaid health clinic, ambulatory surgical center, or nursing home or
the medical staff of such a hospital, health maintenance organization,
prepaid health clinic, ambulatory surgical center, or nursing home,
including allowing the physician to resign, for any act that constitutes
a violation of this chapter. If a physician resigns or withdraws from
privileges when such facility notifies the physician that it is conducting
an investigation or inquiry regarding an act which is potentially a
violation of this chapter, the facility shall complete its investigation or
inquiry and shall notify the department of the physician's resignation or
withdrawal from privileges if the completed investigation or inquiry
results in a finding that such act constitutes a violation of this chapter
for which the facility would have disciplined the physician or allowed
him to resign or withdraw from privileges.
Section 28. Section 458.345, Florida Statutes, is amended to read:
458.345 Registration of resident physicians and interns; list of
hospital employees; penalty.-
(1) Any person desiring to practice as a resident physician, assistant
resident physician, house physician, or intern in this state who does not
hold a valid, active license issued under this chapter shall apply to the
department to be registered and shall remit a fee not to exceed $100 as
set by the board. The department shall register any applicant the board
certifies has met the following requirements:
(a) Is at least 21 years of age.
(b) Has not committed any act or offense within or without the state
which would constitute the basis for refusal to certify an application for
licensure pursuant to s. 458.331.
(c) Is a graduate of a medical school or college as specified in
s. 458.311(1)(f).
(2) Registration under this section shall automatically expire after 2
years and shall neither be renewed nor extended, unless the registrant is
in an approved postgraduate training program, as defined by the board
by rule.
(3) The board shall not certify to the department for registration any
applicant who is under investigation in any state or jurisdiction for an
act which would constitute the basis for imposing a disciplinary penalty
specified in s. 458.331(2)(b) until such time as the investigation is
completed, at which time the provisions of s. 458.331 shall apply.
(4) Every person praetieing as a resident physician, assistant
resident physic-an, house physician, or intern in this state shall
register with the department, showing the date upon which he started
to praetiee as aforesaid within this state. Every hospital employing a
resident physician, assistant resident physician, house physician, or











JOURNAL OF THE HOUSE



physician, or an intern in a hospital of this state for more than 2 years
without a valid, active license, except that resident physicians,
assistant resident physicians, and interns in approved training
programs listed by the board in rule shall be exempt from this
limitation. Any person willfully violating this section shall be guilty of
a misdemeanor of the first seeend degree, punishable as provided in
s. 775.082, s. 775.083, or s. 775.084.
(5) Persons required to reregister under this section on the effective
date of this act shall complete that registration within 1 year.
Section 29. Paragraphs (a) and (e) of subsection (7) of section
458.347, Florida Statutes, are amended to read:
458.347 Physician's assistants.-
(7) PHYSICIAN'S ASSISTANT CERTIFICATION.-
(a) Any person desiring to be certified as a physician's assistant must
apply to the department. The department shall issue a certificate to any
person who the board certifies has met the following requirements
certify each applicant who:
1. Is at least 18 years of age.
2. Has satisfactorily passed a proficiency examination by an
acceptable score established by the National Commission on Certifica-
tion of Physician's Assistants.
3. Has completed the application form and remitted an application
fee not to exceed $100 as set by the board. An application for
certification made by a physician's assistant shall include all of the
following:
a. A certificate of completion of an approved physician's assistant
training program.
b. A sworn statement of any prior felony convictions.
c. A sworn statement of any previous revocation or denial of
licensure or certification in any state.
d. Two letters of recommendation.
e. The full name, Florida medical license number, and address of the
supervising physician.
f. The specialty of the supervising physician.
(e) Notwithstanding the provisions of paragraph (a)2., the board may
grant temporary certification to a recent graduate of an approved
program to expire upon receipt of scores of the proficiency examination
administered by the National Commission on Certification of Physic-
ian's Assistants. An applicant who has passed the proficiency examina-
tion may be granted permanent certification. An applicant failing the
proficiency examination is no longer temporarily certified, but may
reapply for a 1-year extension of temporary certification. If an applicant
fails the examination two times, he is no longer eligible for certifica-
tion.
Section 30. Subsection (4) is added to section 459.0055, Florida
Statutes, to read:
459.0055 General licensure requirements.-
(4) The department and the board shall assure that applicants for
licensure meet applicable criteria in this chapter through an investiga-
tive process. When the investigative process is not completed within the
time set out in s. 120.60(2), and the department or board has reason to
believe that the applicant does not meet the criteria, the secretary or his
designee may issue a 90-day licensure delay which shall be in writing
and sufficient to notify the applicant of the reason for the delay. The
provisions of this subsection shall control over any conflicting provisions
of s. 120.60(2).
Section 31. Subsection (1) of section 459.008, Florida Statutes, is
amended to read:
459.008 Renewal of licenses and certificates.-
(1) The department shall renew a license or certificate upon receipt



of the renewal application, evidence that the applicant has actively
practiced osteopathic medicine, or has been on the active



February 4, 1988



(1) A physician licensed pursuant to this chapter may not instigate
or engage in a concerted effort to refuse to render services to a patient
in a hospital emergency room either through such physicians' failing to
report for duty, such physicians' absenting themselves from their



SOF REPRESENTATIVES 49

teaching faculty of an accredited osteopathic medical school, within the
previous 4 years, and fee. If the licensee has not actively practiced
osteopathic medicine within the previous 4 years, the board shall certify
the licensee to the department for renewal of the license subject to the
condition that the licensee work under the supervision of another
osteopathic physician for a period, not to exceed 1 year, as determined by
the board based on its determination of the licensee's ability to practice
osteopathic medicine. The supervising physician shall have had no
probable cause findings against him within the previous 3 years.
Section 32. Paragraph (b) of subsection (1), paragraph (b) of
subsection (2), and paragraph (a) of subsection (4) of section 459.0085,
Florida Statutes, are amended to read:
459.0085 Financial responsibility.-
(1) As a condition of licensing and prior to the issuance or renewal of
an active license or reactivation of an inactive license for the practice
of osteopathic medicine, an applicant shall by one of the following
methods demonstrate to the satisfaction of the board and the
department financial responsibility to pay claims and costs ancillary
thereto arising out of the rendering of, or the failure to render, medical
care or services:
(b) Obtaining and maintaining professional liability coverage in an
amount not less than $100,000 per claim, with a minimum annual
aggregate of not less than $300,000, from an "authorized insurer" as
defined under s. 624.09, from a surplus lines insurer as defined under
s. 626.914(2), from a risk retention group as defined under s. 627.942,
from the Joint Underwriting Association established under
s. 627.351(4), or through a plan of self-insurance as provided in
s. 627.357.
(2) As a continuing condition of hospital staff privileges, osteopathic
physicians with staff privileges shall also be required to establish
financial responsibility by one of the following methods:
(b) Obtaining and maintaining professional liability coverage in an
amount not less than $250,000 per claim, with a minimum annual
aggregate of not less than $750,000 from an authorized insurer as
defined under s. 624.09, from a surplus lines insurer as defined under
s. 626.914(2), from a risk retention group as defined under s. 627.942,
from the Joint Underwriting Association established under
s. 627.351(4), or through a plan of self-insurance as provided in
s. 627.357.

(4)(a) Each insurer, self-insurer, risk retention group, or Joint
Underwriting Association shall promptly notify the Department of
Professional Regulation of cancellation or nonrenewal of insurance
required by this section. Unless the osteopathic physician demon-
strates that he is otherwise in compliance with the requirements of
this section, the Department of Professional Regulation shall suspend
the license of the osteopathic physician pursuant to s. 120.57 and
notify all health-care facilities licensed under chapter 395 of such
action. Any suspension under this subsection shall remain in effect
until the osteopathic physician demonstrates compliance with the
requirements of this section, except that a license suspended under
paragraph (5)(g) shall not be reinstated until the osteopathic physician
demonstrates compliance with the requirements of that provision.
Section 33. Subsection (2) of section 459.0092, Florida Statutes, is
amended to read:
459.0092 Fees.-The board shall set fees according to the following
schedule:
(2) The fee for biennial renewal of licensure or certification shall not
exceed $300 $10.
Section 34. Section 459.0145, Florida Statutes, is created to read:
459.0145 Concerted effort to refuse emergency room treatment to
patients; penalties.-











50



positions, such physicians' submitting their resignations, such physic-
ians' abstaining from the full and faithful performance of their medical
duties, or such physicians' otherwise causing conduct that adversely
affects the services of the hospital. For the purposes of this subsection,
the term "concerted" means contrived or arranged by agreement,
planned or devised together, or done or performed together in
cooperation.
(2) If a physician or group of physicians engages in conduct in
violation of subsection (1), either the department or the hospital where
the conduct occurs may file suit in circuit court to enjoin such conduct.

(a) Upon such suit being filed, the court shall conduct a hearing,
with notice to the department, the board, and all interested parties, at
the earliest practicable time. If the plaintiff makes a showing that a
violation of subsection (1) is in progress or that there is a clear, real,
and present danger that such a violation is about to commence, the
court shall issue a temporary injunction enjoining such violation. Upon
final hearing, the court shall either make the injunction permanent or
dissolve it.
(b) A physician found to be in contempt of court for violating such an
injunction shall be fined an amount considered appropriate by the
court, but not less than $5,000. In determining the appropriate fine,
the court shall objectively consider the extent of services lost to the
hospital and its patients.
(3) A violation by a physician of subsection (1) constitutes ground for
disciplinary action against him by the board, including the suspension
or revocation of his license, and subjects him to liability for any
damages that the hospital or any patient therein sustains as a result of
the violation.
Section 35. Paragraphs (b), (p), and (y) of subsection (1) and
subsections (2) and (5) of section 459.015, Florida Statutes, are
amended, paragraphs (kk), (11), (mm), and (nn) are added to subsection
(1), subsections (3) through (6) are renumbered as subsections (4)
through (7), respectively, and new subsections (3) and (8) are added to
said section, to read:
459.015 Grounds for disciplinary action by the board.-
(1) The following acts shall constitute grounds for which the
disciplinary actions specified in subsection (2) may be taken:
(b) Having a license or the authority to practice osteopathic medicine
revoked, suspended, or otherwise acted against, including the denial of
licensure, by the licensing authority of any jurisdiction, including its
agencies or subdivisions state, territory, eO country. The licensing
authority's acceptance of a physician's relinquishment of license,
stipulation, consent order, or other settlement, offered in response to or
in anticipation of the filing of administrative charges against the
physician, shall be construed as action against the physician's license.
(p) Failing to keep written medical records justifying the course of
treatment of the patient, including, but not limited to, patient
histories, examination results, and test results, records of drugs
prescribed, dispensed, or administered, and reports of consultations and
hospitalizations.
(y) Gross or repeated malpractice or the failure to practice osteo-
pathic medicine with that level of care, skill, and treatment which is
recognized by a reasonably prudent similar osteopathic physician as
being acceptable under similar conditions and circumstances. The
board shall give great weight to the provisions of s. 768.45 when
enforcing this paragraph. As used in this paragraph, "repeated
malpractice" includes, but is not limited to, three or more claims for
medical malpractice within the previous 5-year period resulting in
indemnities being paid in excess of $10,000 each to the claimant in a
judgment or settlement and which incidents involved negligent
conduct by the osteopathic physician. As used in this paragraph, "gross
malpractice" or "the failure to practice osteopathic medicine with that
level of care, skill, and treatment which is recognized by a reasonably
prudent similar osteopathic physician as being acceptable under
similar conditions and circumstances" shall not be construed so as to



require more than one instance, event, or act. Nothing in this
paragraph shall be construed to require that an osteopathic physician be



February 4, 1988



incompetent to practice osteopathic medicine in order to be disciplined
pursuant to this paragraph.
(kk) Misrepresenting or concealing a material fact at any time during
any phase of a licensing or disciplinary process or procedure.
(11) Improperly interfering with an investigation or with any disci-
plinary proceeding.
(mm) Failing to report to the Division of Medical Quality Assurance,
as required by s. 45528, any physician licensed under chapter 458 or
osteopathic physician licensed under chapter 459 who the osteopathic
physician knows has violated the grounds for disciplinary action set out
in the law under which that physician or osteopathic physician is
licensed and who provides health care services in a facility licensed
under chapter 395, or a health maintenance organization certificated
under part II of chapter 641, in which the osteopathic physician also
provides services.
(nn) Being found by any court in this state to have provided
corroborating written medical expert opinion attached to any statutorily
required notice of claim or intent or to any statutorily required response
rejecting a claim, without reasonable investigation.
(2) When the board finds any person guilty of any of the grounds set
forth in subsection (1), it may enter an order imposing one or more of
the following penalties:
(a) Refusal to certify, or certify with restrictions, to the department
an application for certification, licensure, renewal, or reactivation.
(b) Revocation or suspension of a license or certificate.
(c) Restriction of practice.
(d) Imposition of an administrative fine not to exceed $5,000 for each
count or separate offense.
(e) Issuance of a reprimand.
(f) Issuance of a letter of concern.
(g) Placement of the osteopathic physician on probation for a period
of time and subject to such conditions as the board may specify,
including, but not limited to, requiring the osteopathic physician to
submit to treatment, attend continuing education courses, submit to
reexamination, or work under the supervision of another osteopathic
physician.
(h) Corrective action.
(i) Refund of fees billed to and collected from the patient.
In determining what action is appropriate, the board must first consider
what sanctions are necessary to protect the public or to compensate the
patient. Only after those sanctions have been imposed may the
disciplining authority consider and include in the order requirements
designed to rehabilitate the physician. All costs associated with
compliance with orders issued under this subsection are the obligation
of the physician.
(3) In any administrative action against a physician which does not
involve revocation or suspension of license, the division shall have the
burden, by the greater weight of the evidence, to establish the existence
of grounds for disciplinary action. The division shall establish grounds
for revocation or suspension of license by clear and convincing evidence.
(6)(-) Upon the department's receipt from an insurer or self-insurer
of a report of a closed claim against an osteopathic physician pursuant
to s. 627.912, or upon the receipt from a claimant of a presuit notice
against an osteopathic physician pursuant to s. 768.57, the department
shall review each report and determine whether it potentially involved
conduct by a licensee that is subject to disciplinary action, in which case
the provisions of s. 455225 shall apply. However, if it is reported that
an osteopathic physician has had the Department of Insuranee of the
name of an esteepathie physician having three or more claims with
indemnities exceeding $10,000 each within the previous 5-year period,
including reports for the 8 year period preceding Oeteber 4 -198- 5 the



department shall investigate the occurrences upon which the claims
were based and determine if action by the department against the
osteopathic physician is warranted.



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(8) If any osteopathic physician regulated by the Division of Medical
Quality Assurance is guilty of such unprofessional conduct, negligence,
or mental or physical incapacity or impairment that the division
determines that the osteopathic physician is unable to practice with
reasonable skill and safety and presents a danger to patients, the
division shall be authorized to maintain an action in circuit court
enjoining such osteopathic physician from providing medical services to
the public until the osteopathic physician demonstrates the ability to
practice with reasonable skill and safety and without danger to patients.

Section 36. Paragraph (a) of subsection (4) of section 459.0155,
Florida Statutes, is amended to read:
459.0155 Treatment programs for impaired practitioners.-

(4)(a) Whenever the consultant is notified and there is reason to
believe that a practitioner licensed by the state under this chapter is
impaired as a result of the misuse or abuse of alcohol or drugs, or both,
or due to a mental condition, which could affect the practitioner's
ability to practice his profession, and no complaint against the
practitioner other than impairment exists, the reporting of such
information shall not constitute a complaint within the meaning of
s. 455.225 if the probable cause panel of the board under which the
practitioner is licensed finds that:
1. The practitioner has acknowledged his impairment problem;
2. The practitioner has voluntarily enrolled in an appropriate,
approved treatment program; and
3. The practitioner has voluntarily withdrawn from his practice or
limited the scope of his practice, as determined by the panel in each
case, until such time as the panel is satisfied that he has successfully
completed an approved treatment program; and-
4. The practitioner has executed releases for medical records,
authorizing the release of all records of evaluations, diagnoses, and
treatment of the practitioner, including records of treatment for
emotional or mental conditions, to the consultant. The consultant shall
make no copies or reports of records that do not regard the issue of the
practitioner's impairment and his participation in a treatment program.

Section 37. Paragraph (a) of subsection (7) of section 459.022, Florida
Statutes, is amended, and paragraph (f) is added to said subsection, to
read:
459.022 Osteopathic physician assistants.-
(7) OSTEOPATHIC PHYSICIAN ASSISTANT CERTIFICATION.--

(a) Any person desiring to be certified in this state as an osteopathic
physician assistant shall apply to the department. The department
shall issue a certificate to any person who the board certifies has met the
following requirements certify eaeh applicant whe:
1. Is at least 18 years of age.
2. Has satisfactorily passed a proficiency examination by an
acceptable score established by the National Commission on Certifica-
tion of Physician Assistants.
3. Has completed the application form and remitted an application
fee not to exceed $100 as set by the board. An application for
certification made by an osteopathic physician assistant shall include
all of the following:
a. A certificate of completion of an approved physician assistant
training program.
b. A sworn statement of any prior felony convictions.
c. A sworn statement of any previous revocation or denial of
licensure or certification in any state.
d. Two letters of recommendation.
e. The full name, Florida osteopathic medical license number, and



address of the supervising physician.
f. The specialty of the supervising osteopathic physician.



February 4, 1988



has violated the grounds for disciplinary action set out in the law under
which that physician or osteopathic physician is licensed and who
provides health care services in a facility licensed under chapter 395, or
a health maintenance organization certificated under part II of chapter
641, in which the nurse also provides services.



OF REPRESENTATIVES 51

(f) Notwithstanding the provisions of subparagraph (a)2., the board
may grant temporary certification to a recent graduate of an approved
program to expire upon receipt of scores of the proficiency examination
administered by the National Commission on Certification of Physic-
ian's Assistants. An applicant who has passed the proficiency examina-
tion may be granted permanent certification. An applicant failing the
proficiency examination is no longer temporarily certified, but may
reapply for a 1-year extension of temporary certification. If an applicant
fails the examination two times, he is no longer eligible for certification.

Section 38. Paragraph (hh) is added to subsection (1) of section
460.413, Florida Statutes, to read:

460.413 Grounds for disciplinary action; action by the board.-

(1) The following acts shall constitute grounds for which the
disciplinary actions specified in subsection (2) may be taken:

(hh) Failing to report to the Division of Medical Quality Assurance, as
required by s. 455.28, any physician licensed under chapter 458 or
osteopathic physician licensed under chapter 459 who the chiropractic
physician knows has violated the grounds for disciplinary action set out
in the law under which that physician or osteopathic physician is
licensed and who provides health care services in a facility licensed
under chapter 395, or a health maintenance organization certificated
under part II of chapter 641, in which the chiropractic physician also
provides services.

Section 39. Paragraph (bb) is added to subsection (1) of section
461.013, Florida Statutes, and paragraph (a) of subsection (5) of said
section is amended, to read:

461.013 Grounds for disciplinary action; action by the board;
investigations by department.-

(1) The following acts shall constitute grounds for which the
disciplinary actions specified in subsection (2) may be taken:

(bb) Failing to report to the Division of Medical Quality Assurance, as
required by s. 455.28, any physician licensed under chapter 458 or
osteopathic physician licensed under chapter 459 who the podiatrist
knows has violated the grounds for disciplinary action set out in the law
under which that physician or osteopathic physician is licensed and who
provides health care services in a facility licensed under chapter 395, or
a health maintenance organization certificated under part II of chapter
641, in which the podiatrist also provides services.

(5)(a) Upon the department's receipt from an insurer or self-insurer
of a report of a closed claim against a podiatrist pursuant to s. 627.912,
or upon the receipt from a claimant of a presuit notice against a
podiatrist pursuant to s. 768.57, the department shall review each report
and determine whether it potentially involved conduct by a licensee that
is subject to disciplinary action, in which case the provisions of
s. 455.225 shall apply. However, if it is reported that a podiatrist has
had the Department of Insuranee of the name of a podiatrist having
three or more claims with indemnities exceeding $10,000 each within
the previous 5-year period, including reports for the 3-year period
preeedinig Oeteber ^- 4-986 the department shall investigate the
occurrences upon which the claims were based and determine if action
by the department against the podiatrist is warranted.

Section 40. Paragraph (k) is added to subsection (1) of section
464.018, Florida Statutes, to read:

464.018 Disciplinary actions.-

(1) The following acts shall be grounds for disciplinary action set
forth in this section:

(k) Failing to report to the Division of Medical Quality Assurance, as
required by s. 45528, any physician licensed under chapter 458 or
osteopathic physician licensed under chapter 459 who the nurse knows











52



Section 41. Paragraph (o) is added to subsection (1) of section
465.016, Florida Statutes, to read:

465.016 Disciplinary actions.-

(1) The following acts shall be grounds for disciplinary action set
forth in this section:

(o) Failing to report to the Division of Medical Quality Assurance, as
required by s. 455.28, any physician licensed under chapter 458 or
osteopathic physician licensed under chapter 459 who the pharmacist
knows has violated the grounds for disciplinary action set out in the law
under which that physician or osteopathic physician is licensed and who
provides health care services in a facility licensed under chapter 395, or
a health maintenance organization certificated under part II of chapter
641, in which the pharmacist also provides services.

Section 42. Paragraph (ii) is added to subsection (1) of section
466.028, Florida Statutes, and subsection (6) of said section is
amended, to read:

466.028 Grounds for disciplinary action; action by the board.-

(1) The following acts shall constitute grounds for which the
disciplinary actions specified in subsection (2) may be taken:

(ii) Failing to report to the Division of Medical Quality Assurance, as
required by s. 455.28, any physician licensed under chapter 458 or
osteopathic physician licensed under chapter 459 who the dentist knows
has violated the grounds for disciplinary action set out in the law under
which that physician or osteopathic physician is licensed and who
provides health care services in a facility licensed under chapter 395, or
a health maintenance organization certificated under part II of chapter
641, in which the dentist also provides services.

(6) Upon the department's receipt from an insurer or self-insurer of a
report of a closed claim against a dentist pursuant to s. 627.912, or upon
the receipt from a claimant of a presuit notice against a dentist pursuant
to s. 768.57, the department shall review each report and determine
whether it potentially involved conduct by a licensee that is subject to
disciplinary action, in which case the provisions of s. 455225 shall
apply. However, if it is reported that a dentist has had the Department
of Insurance of the name of a dentist with any indemnity paid in excess
of $5,000 in a judgment or settlement or has had any dentist having
three or more claims for dental malpractice within the previous 5-year
period which resulted in indemnity being paid, the department shall
investigate the occurrence upon which the claims were based and
determine if action by the department against the dentist is warrant-
ed.

Section 43. Subsections (1) and (3) and paragraph (e) of subsection
(2) of section 627.912, Florida Statutes, are amended to read:

627.912 Professional liability claims and actions; reports by insur-
ers.-

(1) Each self-insurer authorized under s. 627.356 or s. 627.357 and
each insurer or joint underwriting association providing professional
liability insurance to a practitioner of medicine licensed pursuant to
the provisions of chapter 458, to a practitioner of osteopathic medicine
licensed pursuant to the provisions of chapter 459, to a podiatrist
licensed pursuant to the provisions of chapter 461, to a dentist licensed
pursuant to the provisions of chapter 466, to a hospital licensed
pursuant to the provisions of chapter 395, to clinics included in chapter
389 and chapter 390, to an ambulatory surgical center as defined in
s. 395.002(2), or to a member of The Florida Bar shall report in
duplicate to the Department of Insurance any claim or action for
damages for personal injuries claimed to have been caused by error,
omission, or negligence in the performance of such insured's profes-
sional services or based on a claimed performance of professional
services without consent, if the claim resulted in:

(a) A final judgment in any amount.



(b) A settlement in any amount.



February 4, 1988



(c) A final disposition not resulting in payment on behalf of the
insured.

Reports shall be filed with the department and, if the insured party
is licensed pursuant to chapter 458, chapter 459, chapter 461, or chapter
466, with the Department of Professional Regulation, no later than 60
days following the occurrence of any event listed in paragraph (a),
paragraph (b), or paragraph (c). The Department of Professional
Regulation shall review each report and determine whether any of the
incidents that resulted in the claim potentially involved conduct by the
licensee that is subject to disciplinary action, in which case the
provisions of s. 455225 shall apply. The Department of Professional
Regulation, as part of the annual report required by s. 4552285, shall
publish annual statistics, without identifying licensees, on the reports it
receives, including final action taken on such reports by the Department
of Professional Regulation or the appropriate regulatory board.

(2) The reports required by subsection (1) shall contain:

(e) The name and address of the injured person. This information
shall be privileged and confidential and shall not be disclosed by the
department without the injured person's consent. This information
may be used by the department for purposes of identifying multiple or
duplicate claims arising out of the same occurrence.

(3) The department shall screen the reports and send to the
Department of Pfofessional Regulation asd the appropriate regulatory
board eepies of the reports of any physicians eosteopaths having three
o more claims with indemnities c feeding $144000 eaeh within the
previous 5 year period, including se.reening r reports fo the 3 year
period preceding Oeteber4 1985. With respect to any such report, the
Department of Professional Regulation shall be authorized to obtain
the name of the patient to whom the report applies directly from the
insurer or self-insurer filing the report, and the insurer or self-insurer
shall promptly furnish the name of the patient to the department when
requested. For purposes of safety management, the department shall
annually provide the Department of Health and Rehabilitative
Services with copies of the reports in cases resulting in an indemnity
being paid to the claimants.

Section 44. Subsections (5) and (6) of section 641.55, Florida
Statutes, as renumbered from section 641.395 by chapter 87-236, Laws
of Florida, are amended to read:

641.55 Internal risk management program.-

(5)(a) Each health maintenance organization subject to this section
shall submit an annual report to the Department of Health and
Rehabilitative Services summarizing the incident reports that have
been filed in the health maintenance organization for that year
pertaining to services rendered on the premises of the health
maintenance organization. The report shall be on a form prescribed by
rule of the Department of Health and Rehabilitative Services and shall
include with respect to medical services rendered on the premises of
the health maintenance organization:

1. The total number of adverse incidents causing injury to patients.

2. A listing, by category, of the types of operations, diagnostic or
treatment procedures, or other actions causing the injuries and the
number of incidents occurring within each category.

3. A listing, by category, of the types of injuries caused and the
number of incidents occurring within each category.

4. The name of each individual or provider responsible for adverse
incidents causing injury to patients, the relationship of the individual
or provider to the health maintenance organization, and the number of



incidents in which each individual or provider has been directly
involved.



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5. A description of all medical malpractice claims filed against the
health maintenance organization or its providers, including the total
number pending and closed, the nature of the incident which led to the
claims, the persons involved in the claim, and the status and
disposition of each claim. Each report shall update status and
disposition for all prior reports.

6. A report of all disciplinary actions taken against any provider or
any medical staff member of the health maintenance organization,
including the nature and cause of the action.

(b) The information reported to the department pursuant to subpara-
graphs (a)4., 5., and 6. which relates to persons licensed under chapter
458, chapter 459, chapter 461, or chapter 466 shall also be reported to
the Department of Professional Regulation. The Department of Profes-
sional Regulation shall review the information and determine whether
any of the incidents potentially involved conduct by a licensee that is
subject to disciplinary action, in which case the provisions of s. 455.225
shall apply.

(c)(b) The annual report shall also contain the name of the risk
manager of the health maintenance organization, a copy of its policy
and procedures which govern the measures taken by the organization
and its risk manager to reduce the risk of injuries and adverse or
untoward incidents, and the results of these measures. This report
shall be held confidential and shall not be available to the public
pursuant to s. 119.07 or any other law providing access to public
records, nor shall the report be discoverable or admissible in any civil
or administrative action, except in disciplinary proceedings by the
Department of Professional Regulation and the appropriate regulatory
board. This report shall not be available to the public as part of the
record of investigation for and prosecution in disciplinary proceedings
made available to the public by the Department of Professional
Regulation or the appropriate regulatory board. However, the Depart-
ment of Professional Regulation shall make available, upon written
request by a practitioner against whom probable cause has been found,
any such records which form the basis of the determination of probable
cause.

(6) If an adverse or untoward incident, whether occurring in the
facilities of the health maintenance organization or arising from
health care prior to admission to the facilities of the organization or in
the facility of one of its providers, results in:

(a) The death of a patient; or

(b) Severe brain or spinal damage to a patient;,

(c) A surgical procedure being performed on the wrong patient; or

(d) A surgical procedure unrelated to the patient's diagnosis or
medical needs being performed on any patient,

the organization shall report this incident to the Department of Health
and Rehabilitative Services within 3 working days of its occurrence. A
more detailed follow-up report shall be submitted to the Department of
Health and Rehabilitative Services within 10 days after the first
report. The department may require an additional, final report.
Reports under this subsection shall be sent immediately by the
department to the Department of Professional Regulation whenever they
involve a health care provider licensed under chapter 458, chapter 459,
chapter 461, or chapter 466. These reports shall not be available to the
public pursuant to s. 119.07 or any other law providing access to public
records-, nor be discoverable or admissible in any civil or administrative
action, except in disciplinary proceedings by the Department of Profes-
sional Regulation and the appropriate regulatory board, nor shall they
be available to the public as part of the record of investigation for and
prosecution in disciplinary proceedings made available to the public by
the Department of Professional Regulation or the appropriate regulatory
board. However, the Department of Professional Regulation shall make
available, upon written request by a practitioner against whom probable
cause has been found, any such records which form the basis of the



determination of probable cause. The Department of Health and
Rehabilitative Services may investigate, as it deems appropriate, any



February 4, 1988



treatment necessitated by a sudden, unexpected situation or occurrence
resulting in a serious medical condition demanding immediate medical
attention, for which the patient enters the hospital through its
emergency room i- response to a "eede blue" emergency within a
hospital or trauma center, shall not be held liable for any civil
damages as a result of such medical care or treatment, unless such



OF REPRESENTATIVES 53

such incident and prescribe measures that must or may be taken by
the health maintenance organization in response to the incident. The
Department of Professional Regulation shall review each incident and
determine whether it potentially involved conduct by the licensee that is
subject to disciplinary action, in which case the provisions of s. 455.225
shall apply. The requirements of this subseetion shall take effect
January 14986. The gross data compiled pursuant to this section or
s. 395.041 shall be furnished by the Department of Health and
Rehabilitative Services upon request to health maintenance organiza-
tions to be utilized for risk management purposes. The department
may promulgate rules necessary to carry out the provisions of this
section.

Section 45. Legislative findings and intent.-

(1) The Legislature makes the following findings:

(a) The adequate delivery of medical emergency care services is a
priority health care need and can have a dramatic impact in reducing
civil lawsuits which ultimately result in high medical malpractice
insurance premiums. Therefore, the delivery of emergency medical
care represents an essential public service.

(b) Medical emergency care providers are often faced with civil
lawsuits brought on behalf of medical emergency care patients, many
of which may not be the direct result of substandard care, but rather
may be prompted by recovery of such patient to less than full mental
and physical health due to the severe nature of the medical emergency.

(c) Civil lawsuits brought on behalf of medical emergency care
patients are often the result of factors beyond the control of the
medical emergency care facility or the provider rendering such care,
including, but not limited to:

1. The severe nature of many such emergencies; and

2. The fact that the emergency patient may not have had a
previously established medical relationship with the defendant, may
have been unknown to the defendant, and may have been unconscious
or unable to provide essential information, such as medical history,
allergies to drugs, and other relevant facts.

(2) It is the intent of the Legislature to promote the availability of
emergency medical care by providing immunity from civil liability to
hospitals and trauma centers and the medical emergency care
providers rendering care therein to medical emergency patients, unless
such care is rendered with reckless disregard for the life or health of
the patient.

Section 46. Section 768.13, Florida Statutes, is amended to read:

768.13 Good Samaritan Act; immunity from civil liability.-

(1) This act shall be known and cited as the "Good Samaritan Act."

(2)(a) Any person, including those licensed to practice medicine, who
gratuitously and in good faith renders emergency care or treatment at
the scene of an emergency outside of a hospital, doctor's office, or other
place having proper medical equipment, without objection of the
injured victim or victims thereof, shall not be held liable for any civil
damages as a result of such care or treatment or as a result of any act
or failure to act in providing or arranging further medical treatment
where the person acts as an ordinary reasonably prudent man would
have acted under the same or similar circumstances.

(b)1. Any hospital licensed under chapter 395, any employee of such
hospital working in a clinical area within the facility and providing
patient care, and any person licensed to practice medicine who
gratuitoisly aad in good faith renders medical emergency care or










JOURNAL OF THE HOUSE OF REPRESENTATIVES



damages result from providing, or failing to provide, medical care or
treatment under circumstances demonstrating a reckless disregard for
the consequences so as to affect the life or health of another.
2. The immunity provided by this paragraph does not apply to
damages as a result of any act or omission of providing medical care or
treatment:
a. Which occurs after the patient is stabilized and is capable of
receiving medical treatment as a nonemergency patient, unless surgery
is required as a result of the emergency within a reasonable time after
the patient is stabilized, in which case the immunity provided by this
"paragraph applies to any act or omission of providing medical care or
treatment which occurs prior to the stabilization of the patient following
the surgery;
b. Unrelated to the original medical emergency; or as a result of any
aet or failure to aet in providing or arranging further medical
treatment where the person aets as a reasonably prudent person
licensed to praetiee medicine who would have acted under the same or
similar eireumstanees.
3. For purposes of this paragraph, "reckless disregard" as it applies to
a given health care provider rendering emergency medical services shall
be such conduct which a health care provider knows or should know
would be likely to result in injury so as to affect the life or health of
another, taking into account the following to the extent they may be
present;
a. The extent or serious nature of the circumstances prevailing.
b. The lack of time or ability to obtain appropriate consultation.
c. The lack of a prior patient-physician relationship.
d. The inability to obtain an appropriate medical history of the
patient.
e. The time constraints imposed by coexisting emergencies.
(3) Any person, including those licensed to practice veterinary
medicine, who gratuitously and in good faith renders emergency care
or treatment to an injured animal at the scene of an emergency on or
adjacent to a roadway shall not be held liable for any civil damages as
a result of such care or treatment or as a result of any act or failure to
act in providing or arranging further medical treatment where the
person acts as an ordinary reasonably prudent man would have acted
under the same or similar circumstances.
Section 47. Section 768.78, Florida Statutes, is amended to read:
768.78 Alternative methods of payment of damage awards.-
(1)(a) In any action to which this part applies in which the trier of
fact makes an award to compensate the claimant for future economic
losses which exceed $250,000, payment of amounts intended to
compensate the claimant for these losses shall be made by one of the
following means, unless an alternative method of payment of damages
is provided in this section:
1.(-a) The defendant may make a lump-sum payment for all damages
so assessed, with future economic losses and expenses reduced to
present value; or
2.(h) Subject to the provisions of this subsection section, the court
shall, at the request of either party, unless the court determines that
manifest injustice would result to any party, enter a judgment ordering
future economic damages, as itemized pursuant to s. 768.77(1)(a), in
excess of $250,000 to be paid in whole or in part by periodic payments
rather than by a lump-sum payment.
(b)W-) In entering a judgment ordering the payment of such future
damages by periodic payments, the court shall make a specific finding
of the dollar amount of periodic payments which will compensate the
judgment creditor for these future damages after offset for collateral
sources. The total dollar amount of the periodic payments shall equal
the dollar amount of all such future damages before any reduction to
present value, less any attorney's fees payable from future damages in



accordance with paragraph (f) subsection (6). The period of time over
which the periodic payments shall be made is the period of years



determined by the trier of fact in arriving at its itemized verdict and
shall not be extended if the plaintiff lives beyond the determined
period. If the claimant has been awarded damages to be discharged by
periodic payments and the claimant dies prior to the termination of the
period of years during which periodic payments are to be made, the
remaining liability of the defendant, reduced to present value, shall be
paid into the estate of the claimant in a lump sum. The court may
order that the payments be equal or vary in amount, depending upon
the need of the claimant.

(c)3) As a condition to authorizing periodic payments of future
damages, the court shall require the defendant to post a bond or
security or otherwise to assure full payment of these damages awarded
by the judgment. A bond is not adequate unless it is written by a
company authorized to do business in this state and is rated A+ by
Best's. If the defendant is unable to adequately assure full payment of
the damages, the court shall order that all damages be paid to the
claimant in a lump sum pursuant to the verdict. No bond may be
canceled or be subject to cancellation unless at least 60 days' advance
written notice is filed with the court and the judgment creditor. Upon
termination of periodic payments, the court shall order the return of
the security, or so much as remains, to the judgment debtor.
(d)l.4)(a) In the event that the court finds that the judgment debtor
has exhibited a continuing pattern of failing to timely make the
required periodic payments, the court shall:
a.4-l Order that all remaining amounts of the award be paid by lump
sum within 30 days after entry of the order;
b.2- Order that, in addition to the required periodic payments, the
judgment debtor pay the claimant all damages caused by the failure to
timely make periodic payments, including court costs and attorney's
fees; or
c.g. Enter other orders or sanctions as appropriate to protect the
judgment creditor.
2.(h) If it appears that the judgment debtor may be insolvent or that
there is a substantial risk that the judgment debtor may not have the
financial responsibility to pay all amounts due and owing the
judgment creditor, the court may:
a.- Order additional security;
b.2- Order that the balance of payments due be placed in trust for the
benefit of the claimant;
c.x- Order that all remaining amounts of the award be paid by lump
sum within 30 days after entry of the order; or
d.4- Order such other protection as may be necessary to assure the
payment of the remaining balance of the judgment.
(e)6) The judgment providing for payment of future damages by
periodic payments shall specify the recipient or recipients of the
payments, the dollar amounts of the payments, the interval between
payments, and the number of payments or the period of time over
which payments shall be made. Periodic payments shall be subject to
modification only as specified in this subsection section.

(f)(6) Claimant's attorney's fee, if payable from the judgment, shall
be based upon the total judgment, adding all amounts awarded for past
and future damages. The attorney's fee shall be paid from past and
future damages in the same proportion. If a claimant has agreed to pay
his attorney's fees on a contingency fee basis, the claimant shall be
responsible for paying the agreed percentage calculated solely on the
basis of that portion of the award not subject to periodic payments. The
remaining unpaid portion of the attorney's fees shall be paid in a lump
sum by the defendant, who shall receive credit against future
payments for this amount. However, the credit against each future
payment is limited to an amount equal to the contingency fee
percentage of each periodic payment. Any provision of this paragraph
subsection may be modified by the agreement of all interested parties.



(g)(7) Nothing in this subsection section shall preclude any other
method of payment of awards, if such method is consented to by the
parties.



54



February 4, 1988











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(2)(a) In any action for damages based on personal injury or wrongful
death arising out of medical malpractice, whether in tort or contract, in
which the trier of fact makes an award to compensate the claimant for
future economic losses, payment of amounts intended to compensate the
claimant for these losses shall be made by one of the following means:
1. The defendant may make a lump-sum payment for all damages so
assessed, with future economic losses and expenses reduced to present
value; or
2. The court shall, at the request of either party, enter a judgment
ordering future economic damages, as itemized pursuant to s. 768.68, to
be paid by periodic payments rather than lump sum.
(b) For purposes of this subsection "periodic payment" means
provision for the spreading of future economic damage payments, in
whole or in part, over a period of time, as follows:
1. A specific finding of the dollar amount of periodic payments which
will compensate for these future damages after offset for collateral
sources shall be made. The total dollar amount of the periodic payments
shall equal the dollar amount of all such future damages before any
reduction to present value.
2. The defendant shall be required to post a bond or security or
otherwise to assure full payment of these damages awarded. A bond is
not adequate unless it is written by a company authorized to do business
in this state and is rated A + by Best's. If the defendant is unable to
adequately assure full payment of the damages, all damages, reduced to
present value, shall be paid to the claimant in a lump sum. No bond
may be canceled or be subject to cancellation unless at least 60 days'
advance written notice is filed with the court and the claimant. Upon
termination of periodic payments, the security, or so much as remains,
shall be returned to the defendant.
3. The provision for payment of future damages by periodic payments
shall specify the recipient or recipients of the payments, the dollar
amounts of the payments, the interval between payments, and the
number of payments or the period of time over which payments shall be
made.
Section 48. Legislative findings and intent.-
(1) The Legislature makes the following findings:
(a) Medical malpractice liability insurance premiums have increased
dramatically in recent years, resulting in increased medical care costs
for most patients and functional unavailability of malpractice insur-
ance for some physicians.
(b) The primary cause of increased medical malpractice liability
insurance premiums has been the substantial increase in loss pay-
ments to claimants caused by tremendous increases in the amounts of
paid claims.
(c) The average cost of defending a medical malpractice claim has
escalated in the past decade to the point where it has become
imperative to control such cost in the interests of the public need for
quality medical services.
(d) The high cost of medical malpractice claims in the state can be
substantially alleviated by requiring early determination of the merit
of claims, by providing for early arbitration of claims, thereby reducing
delay and attorney's fees, and by imposing reasonable limitations on
damages, while preserving the right of either party to have its case
heard by a jury.
(e) The recovery of 100 percent of economic losses constitutes
overcompensation because such recovery fails to recognize that such
awards are not subject to taxes on economic damages.
(2) It is the intent of the Legislature to provide a plan for prompt
resolution of medical negligence claims. Such plan shall consist of two
separate components, presuit investigation and arbitration. Presuit
investigation shall be mandatory and shall apply to all medical
negligence claims and defenses. Arbitration shall be voluntary, and



shall be available except as specified.
(a) Presuit investigation shall include:



February 4, 1988



(a) A specific finding of the dollar amount of periodic payments
which will compensate for these future damages after offset for
collateral sources shall be made. The total dollar amount of the
periodic payments shall equal the dollar amount of all such future
damages before any reduction to present value.



OF REPRESENTATIVES 55

1. Verifiable requirements that reasonable investigation precede
both malpractice claims and defenses in order to eliminate frivolous
claims and defenses.
2. Medical corroboration procedures.
(b) Arbitration shall provide:
1. Substantial incentives for both claimants and defendants to
submit their cases to binding arbitration, thus reducing attorney's fees,
litigation costs, and delay.
2. A conditional limitation on noneconomic damages where the
defendant concedes willingness to pay economic damages and reason-
able attorney's fees.
3. Limitations on the noneconomic damages components of large
awards to provide increased predictability of outcome of the claims
resolution process for insurer anticipated losses planning, and to
facilitate early resolution of medical negligence claims.
Section 49. Definitions.-As used in sections 48-59, the term:
(1) "Claimant" means any person who has a cause of action arising
from medical negligence.
(2) "Collateral sources" means any payments made to the claimant,
or made on his behalf, by or pursuant to:
(a) The United States Social Security Act; any federal, state, or local
income disability act; or any other public programs providing medical
expenses, disability payments, or other similar benefits, except as
prohibited by federal law.
(b) Any health, sickness, or income disability insurance; automobile
accident insurance that provides health benefits or income disability
coverage; and any other similar insurance benefits, except life
insurance benefits available to the claimant, whether purchased by
him or provided by others.
(c) Any contract or agreement of any group, organization, partner-
ship, or corporation to provide, pay for, or reimburse the costs of
hospital, medical, dental, or other health care services.
(d) Any contractual or voluntary wage continuation plan provided by
employers or by any other system intended to provide wages during a
period of disability.
(3) "Economic damages" means financial losses which would not
have occurred but for the injury giving rise to the cause of action,
including, but not limited to, past and future medical expenses and 80
percent of wage loss and loss of earning capacity.
(4) "Investigation" means that an attorney has reviewed the case
against each and every potential defendant and has consulted with a
medical expert and has obtained a written opinion from said expert.
(5) "Medical expert" means a person duly and regularly engaged in
the practice of his profession who holds a health care professional
degree from a university or college and has had special professional
training and experience or one possessed of special health care
knowledge or skill about the subject upon which he is called to testify
or provide an opinion.
(6) "Medical negligence" means medical malpractice, whether
grounded in tort or in contract.
(7) "Noneconomic damages" means nonfinancial losses which would
not have occurred but for the injury giving rise to the cause of action,
including pain and suffering, inconvenience, physical impairment,
mental anguish, disfigurement, loss of capacity for enjoyment of life,
and other nonfinancial losses.
(8) "Periodic payment" means provision for the structuring of future
economic damages payments, in whole or in part, over a period of time,
as follows:










56 JOURNAL OF THE HOUSE

(b) The defendant shall be required to post a bond or security or
otherwise to assure full payment of these damages awarded. A bond is
not adequate unless it is written by a company authorized to do
business in this state and is rated A + by Best's. If the defendant is
unable to adequately assure full payment of the damages, all damages,
reduced to present value, shall be paid to the claimant in a lump sum.
No bond may be canceled or be subject to cancellation unless at least
60 days' advance written notice is filed with the court and the
claimant. Upon termination of periodic payments, the security, or so
much as remains, shall be returned to the defendant.
(c) The provision for payment of future damages by periodic
payments shall specify the recipient or recipients of the payments, the
dollar amounts of the payments, the interval between payments, and
the number of payments or the period of time over which payments
shall be made.
Section 50. Presuit investigation of medical negligence claims and
defenses by prospective parties.-
(1) Presuit investigation of medical negligence claims and defenses
pursuant to sections 50-53 shall apply to all medical negligence,
including dental negligence, claims and defenses. This shall include:
(a) Rights of action under s. 768.19, Florida Statutes, and defenses
thereto.
(b) Rights of action involving the state or its agencies or subdivi-
sions, or the officers, employees, or agents thereof, pursuant to
s. 768.28, Florida Statutes, and defenses thereto.
(2) Prior to issuing notification of intent to initiate medical
malpractice litigation pursuant to s. 768.57, Florida Statutes, the
claimant shall conduct an investigation to ascertain that there are
reasonable grounds to believe that:
(a) Any named defendant in the litigation was negligent in the care
or treatment of the claimant; and
(b) Such negligence resulted in injury to the claimant.
Corroboration of reasonable grounds to initiate medical negligence
litigation shall be provided by the claimant's submission of a verified
written medical expert opinion from a medical expert as defined in
section 49(5), at the time the notice of intent to initiate litigation is
filed, which statement shall corroborate reasonable grounds to support
the claim of medical negligence.
(3) Prior to issuing its response to the claimant's notice of intent to
initiate litigation, during the time period for response authorized
pursuant to s. 768.57, Florida Statutes, the defendant or the defen-
dant's insurer or self-insurer shall conduct an investigation to
ascertain whether there are reasonable grounds to believe that:
(a) The defendant was negligent in the care or treatment of the
claimant; and
(b) Such negligence resulted in injury to the claimant.
Corroboration of lack of reasonable grounds for medical negligence
litigation shall be provided with any response rejecting the claim by
the defendant's submission of a verified written medical expert opinion
from a medical expert as defined in section 49(5), at the time the
response rejecting the claim is filed, which statement shall corroborate
reasonable grounds for lack of negligent injury sufficient to support the
response denying negligent injury.
(4) The medical expert opinions required by this section shall specify
whether any previous opinion by the same medical expert has been
disqualified and if so the name of the court and the case number in
which the ruling was issued.
Section 51. Availability of medical records for presuit screening of
medical negligence claims and defenses; penalty.-
(1) Copies of any medical record relevant to any litigation of a



medical negligence claim or defense shall be provided to a claimant or
a defendant, or to the attorney thereof, at a reasonable charge within
10 business days of a request for copies. It shall not be grounds to
refuse copies of such medical records that they are not yet completed or
that a medical bill is still owing.



E



OF REPRESENTATIVES February 4, 1988

(2) Failure to provide copies of such medical records, or failure to
make the charge for copies a reasonable charge, shall constitute
evidence of failure of that party to comply with good-faith discovery
requirements and shall waive the requirement of written medical
corroboration by the requesting party.
(3) A hospital shall not be held liable for any civil damages as a
result of complying with this section.
Section 52. Presuit discovery of medical negligence claims and
defenses.-
(1) Upon the completion of presuit investigation pursuant to section
50, which investigation has resulted in the filing of a notice of intent to
initiate litigation in accordance with s. 768.57, Florida Statutes,
corroborated by medical expert opinion that there exist reasonable
grounds for a claim of negligent injury, each party shall provide to the
other party reasonable access to information within its possession or
control, in order to facilitate evaluation of the claim.
(2) Such access shall be provided without formal discovery, pursuant
to s. 768.57, Florida Statutes, and failure to so provide shall be
grounds for dismissal of any applicable claim or defense ultimately
asserted.
(3) Failure of any party to comply with this section shall constitute
evidence of failure of that party to comply with good-faith discovery
requirements and shall waive the requirement of written medical
corroboration by the party seeking production.
(4) No statement, discussion, written document, report, or other
work product generated solely by the presuit screening process is
discoverable or admissible in any civil action for any purpose by the
opposing party. All participants, including, but not limited to,
hospitals and other medical facilities, and the officers, directors,
trustees, employees, and agents thereof, physicians, investigators,
witnesses, and employees or associates of the defendant, are immune
from civil liability arising from participation in the presuit screening
process. Such immunity from civil liability includes immunity for any
acts by a medical facility in connection with providing medical records
pursuant to section 51(1) regardless of whether the medical facility is
or is not a defendant.
Section 53. Presuit investigation of medical negligence claims and
defenses by court.-
(1) After the completion of presuit investigation by the parties
pursuant to section 50 and any informal discovery pursuant to
s. 768.57, Florida Statutes, any party may file a motion in the circuit
court requesting the court to determine whether the opposing party's
claim or denial rests on a reasonable basis.
(2) If the court finds that the notice of intent to initiate litigation
filed by the claimant is not in compliance with the reasonable
investigation requirements of sections 48-59, the court shall dismiss
the claim, and the person who filed such notice of intent, whether the
claimant or the claimant's attorney, shall be personally liable for all
attorney's fees and costs incurred during the investigation and
evaluation of the claim, including the reasonable attorney's fees and
costs of the defendant or the defendant's insurer.
(3) If the court finds that the response filed by a defendant rejecting
the claim is not in compliance with the reasonable investigation
requirements, the court shall strike the defendant's response, and the
person who filed such response, whether the defendant, the defendant's
insurer, or the defendant's attorney, shall be personally liable for all
attorney's fees and costs incurred during the investigation and
evaluation of the claim, including the reasonable attorney's fees and
costs of the claimant.
(4) If the court finds that an attorney for the claimant filed notice of
intent to initiate litigation without reasonable investigation, or filed a
medical negligence claim without first filing such notice of intent



which complies with the reasonable investigation requirements, or if
the court finds that an attorney for a defendant filed a response
rejecting the claim without reasonable investigation, the court shall
submit its finding in the matter to The Florida Bar for disciplinary
review of the attorney. Any attorney so reported three or more times











JOURNAL OF THE HOUSE OF REPRESENTATIVES



within a 5-year period shall be reported to a circuit grievance
committee acting under the jurisdiction of the Supreme Court. If such
committee finds probable cause to believe that an attorney has violated
this section, such committee shall forward to the Supreme Court a copy
of its finding.
(5)(a) If the court finds that the corroborating written medical expert
opinion attached to any notice of claim or intent or to any response
rejecting a claim lacked reasonable investigation, the court shall
report the medical expert issuing such corroborating opinion to the
Division of Medical Quality Assurance or its designee. If such medical
expert is not a resident of the state, the division shall forward such
report to the disciplining authority of that medical expert.
(b) The court may refuse to consider the testimony of such an expert
who has been disqualified three times pursuant to this section.
Section 54. Voluntary binding arbitration of medical negligence
claims.-
(1) Voluntary binding arbitration pursuant to sections 54-59 shall
not apply to rights of action involving the state or its agencies or
subdivisions, or the officers, employees, or agents thereof, pursuant to
s. 768.28, Florida Statutes.
(2) Upon the completion of presuit investigation with preliminary
reasonable grounds for a medical negligence claim intact, the parties
may elect to have damages determined by an arbitration panel. Such
election may be initiated by either party by serving a request for
voluntary binding arbitration of damages within 90 days of service of
the claimant's notice of intent to initiate litigation upon the defendant.
The evidentiary standards for voluntary binding arbitration of medical
"negligence claims shall be as provided in s. 120.58(1)(a), Florida
Statutes. To the extent not inconsistent with sections 48-59, voluntary
binding arbitration of medical negligence claims shall utilize the
procedures in s. 44.304, Florida Statutes.
(3) Upon receipt of a party's request for such arbitration, the
opposing party may accept the offer of voluntary binding arbitration
within 30 days. However, in no event shall the defendant be required
to respond to the request for arbitration sooner than 90 days after
service of the notice of intent to initiate litigation under s. 768.57,
Florida Statutes. Such acceptance within the time period provided by
this subsection shall be a binding commitment to comply with the
decision of the arbitration panel. The liability of any insurer shall be
subject to any applicable insurance policy limits.
(4) The arbitration panel shall be composed of three arbitrators, one
selected by the claimant, one selected by the defendant, and one an
administrative hearing officer furnished by the Division of Adminis-
trative Hearings who shall serve as the chief arbitrator with the
authority granted a chief arbitrator under s. 44.304, Florida Statutes.
In the event of multiple plaintiffs or multiple defendants, the
arbitrator selected by the side with multiple parties shall be the choice
of those parties. If the multiple parties cannot reach agreement as to
their arbitrator, each of the multiple parties shall submit a nominee,
and the director of the Division of Administrative Hearings shall
appoint the arbitrator from among such nominees.
(5) The arbitrators shall be independent of all parties, witnesses, and
legal counsel, and no officer, director, affiliate, subsidiary, or employee
of a party, witness, or legal counsel may serve as an arbitrator in the
proceeding.
(6) The rate of compensation for medical negligence claims arbitra-
tors other than the administrative hearing officer shall be set by the
chief judge of the appropriate circuit court by schedule providing for
compensation of not less than $250 per day nor more than $750 per day
or as agreed by the parties. In setting the schedule, the chief judge
shall consider the prevailing rates charged for the delivery of
professional services in the community.
(7) Arbitration pursuant to this section shall preclude recourse to
any other remedy by the claimant against any participating defendant,
and shall be undertaken with the understanding that:



(a) Net economic damages shall be awardable, including, but not
limited to, past and future medical expenses and 80 percent of wage



loss and loss of earning capacity, offset by any collateral source
payments.
(b) Noneconomic damages shall be limited to a maximum of
$250,000 per incident, and shall be calculated on a percentage basis
with respect to capacity to enjoy life, so that a finding that the
claimant's injuries resulted in a 50-percent reduction in his capacity to
enjoy life would warrant an award of not more than $125,000
noneconomic damages.
(c) Damages for future economic losses shall be awarded to be paid
by periodic payments pursuant to section 49(8), and shall be offset by
future collateral source payments.
(d) Punitive damages shall not be awarded.
(e) The defendant shall be responsible for the payment of interest on
all accrued damages with respect to which interest would be awarded
at trial.
(f) The defendant shall pay the claimant's reasonable attorney's fees
and costs, as determined by the arbitration panel, but in no event more
than 15 percent of the award, reduced to present value.
(g) The defendant shall pay all the costs of the arbitration proceeding
and the fees of all the arbitrators other than the administrative
hearing officer.
(h) Each defendant who submits to arbitration under this section
shall be jointly and severally liable for all damages assessed pursuant
to this section.
(i) The defendant's obligation to pay the claimant's damages shall be
for the purpose of arbitration under this section only. A defendant's or
claimant's offer to arbitrate shall not be used in evidence or in
argument during any subsequent litigation of the claim following the
rejection thereof.
(j) The fact of making or accepting an offer to arbitrate shall not be
admissible as evidence of liability in any collateral or subsequent
proceeding on the claim.
(k) Any offer by a claimant to arbitrate must be made to each
defendant against whom the claimant has made a claim. Any offer by a
defendant to arbitrate must be made to each claimant who has joined
in the notice of intent to initiate litigation, as provided in s. 768.57,
Florida Statutes. A defendant who rejects a claimant's offer to
arbitrate shall be subject to the provisions of section 56(3). A claimant
who rejects a defendant's offer to arbitrate shall be subject to the
provisions of section 56(4).
(1) The hearing shall be conducted by all of the arbitrators, but a
majority may determine any fact question and render a final decision.
The chief arbitrator shall decide all evidentiary matters.
The provisions of this subsection shall not preclude settlement at any
time by mutual agreement of the parties.
(8) Any issue between the defendant and the defendant's insurer or
self-insurer as to who shall control the defense of the claim and any
responsibility for payment of an arbitration award, shall be deter-
mined under existing principles of law; provided that the insurer or
self-insurer shall not offer to arbitrate or accept a claimant's offer to
arbitrate without the written consent of the defendant.
(9) The Division of Administrative Hearings is authorized to
promulgate rules to effect the orderly and efficient processing of the
arbitration procedures of sections 48-59.
(10) Rules promulgated by the Division of Administrative Hearings
pursuant to this section, s. 120.53 or s. 120.65, may authorize any
reasonable sanctions except contempt for violation of the rules of the
Division or failure to comply with a reasonable order issued by a
Hearing Officer, which is not under judicial review.
Section 55. Arbitration to allocate responsibility among multiple
defendants.-
(1) The provisions of this section shall apply when more than one



defendant has participated in voluntary binding arbitration pursuant
to section 54.



February 4, 1988



57











58 JOURNAL OF THE HOUSE:

(2) Within 20 days after the determination of damages by the
arbitration panel in the first arbitration proceeding, those defendants
who have agreed to voluntary binding arbitration shall submit any
dispute among them regarding the apportionment of financial respon-
sibility to a separate binding arbitration proceeding. Such proceeding
shall be with a panel of three arbitrators, which panel shall consist of
the administrative hearing officer who presided in the first arbitration
proceeding, who shall serve as the chief arbitrator with the authority
granted a chief arbitrator under s. 44.304, Florida Statutes, and two
medical practitioners appointed by the defendants, except that if a
hospital licensed pursuant to chapter 395, Florida Statutes, is involved
in the arbitration proceeding, one arbitrator appointed by the defen-
dants shall be a certified hospital risk manager. In the event the
defendants cannot agree on their selection of arbitrators within 20
days after the determination of damages by the arbitration panel in
the first arbitration proceeding, a list of not more than five nominees
shall be submitted by each defendant to the director of the Division of
Administrative Hearings, who shall select the other arbitrators but
shall not select more than one from the list of nominees of any
defendant.

(3) The administrative hearing officer appointed to serve as the chief
arbitrator shall convene the arbitrators for the purpose of determining
allocation of responsibility among multiple defendants within 65 days
after the determination of damages by the arbitration panel in the first
arbitration proceeding.

(4) The arbitration panel shall allocate finanical responsibility
among all defendants named in the notice of intent to initiate
litigation, regardless of whether the defendant has submitted to
arbitration. The defendants in the arbitration proceeding shall pay
their proportionate share of the economic and noneconomic damages
awarded by the arbitration panel. All defendants in the arbitration
proceeding shall be jointly and severally liable for their proportionate
share of any damages assessed in arbitration. The determination of the
percentage of fault of any defendant not in the arbitration case shall
not be binding against that defendant, nor shall it be admissible in any
subsequent legal proceeding.

(5) Payment by the defendants of the damages awarded by the
arbitration panel in the first arbitration proceeding shall extinguish
those defendants' liability to the claimant and shall also extinguish
those defendants' liability for contribution to any defendants who did
not participate in arbitration.

(6) Any defendant paying damages assessed pursuant to this section
or section 54 shall have an action for contribution against any
nonarbitrating person whose negligence contributed to the injury.

Section 56. Effects of failure to offer or accept voluntary binding
arbitration.-

(1) A proceeding for voluntary binding arbitration is an alternative
to jury trial and shall not supersede the right of any party to a jury
trial.

(2) If neither party requests or agrees to voluntary binding
arbitration, the claim shall proceed to trial or to any available legal
alternative such as offer of and demand for judgment under s. 768.79,
Florida Statutes, or offer of settlement under s. 45.061, Florida
Statutes.

(3) If the defendant refuses a claimant's offer of voluntary binding
arbitration:

(a) The claim shall proceed to trial without limitation on damages,
and the claimant, upon proving medical negligence, shall be entitled to
recover prejudgment interest, and reasonable attorney's fees up to 25
percent of the award reduced to present value.
(b) The claimant's award at trial shall be reduced by any damages



recovered by the claimant from arbitrating codefendants following
arbitration.

(4) If the claimant rejects a defendant's offer to enter voluntary
binding arbitration:



E



OF REPRESENTATIVES February 4, 1988

(a) The damages awardable at trial shall be limited to net economic
damages, plus noneconomic damages not to exceed $350,000 per
incident. The Legislature expressly finds that such conditional limit on
noneconomic damages is warranted by the claimant's refusal to accept
arbitration, and represents an appropriate balance between the
interests of all patients who ultimately pay for medical negligence
losses and the interests of those patients who are injured as a result of
medical negligence.
(b) Net economic damages reduced to present value shall be
awardable, including, but not limited to, past and future medical
expenses and 80 percent of wage loss and loss of earning capacity,
offset by any collateral source payments.
(c) Damages for future economic losses shall be awarded to be paid
by periodic payments pursuant to section 49(9), and shall be offset by
future collateral source payments.
(5) Jury trial shall proceed in accordance with existing principles of
law.
Section 57. Misarbitration.-
(1) At any time during the course of voluntary binding arbitration of
a medical negligence claim pursuant to section 54 or section 55, the
administrative hearing officer serving as chief arbitrator on the
arbitration panel, if he determines that agreement cannot be reached,
shall be authorized to dissolve the arbitration panel and request the
director of the Division of Administrative Hearings to appoint two new
arbitrators from new lists of five names provided by each party to the
arbitration. Not more than one arbitrator shall be appointed from the
list provided by any party.
(2) Upon appointment of the new arbitrators, arbitration shall
proceed at the direction of the chief arbitrator in accordance with the
provisions of sections 48-59.
Section 58. Payment of arbitration award; interest.-
(1) Within 20 days after the determination of damages by the
arbitration panel pursuant to section 54, the defendant shall:
(a) Pay the arbitration award, including interest at the legal rate, to
the claimant; or
(b) Submit any dispute among multiple defendants to arbitration
pursuant to section 55.
(2) Commencing 90 days after the award rendered in the arbitration
procedure pursuant to section 10, such award shall begin to accrue
interest at the rate of 18 percent per year.
Section 59. Appeal of arbitration award.-An arbitration award is a
final agency action for purposes of ss. 120.68 and 120.69, Florida
Statutes. Any appeal of an award shall be taken to the district court of
appeal and shall be limited to review on the record, and not de novo.
Section 60. Legislative findings and intent.-
(1) The Legislature makes the following findings:
(a) Physicians practicing obstetrics are high-risk medical specialists
for whom malpractice insurance premiums are very costly, and recent
increases in such premiums have been greater for such physicians than
for other physicians.
(b) Any birth other than a normal birth frequently leads to a claim
against the attending physician; consequently, such physicians are
among the physicians most severely affected by current medical
malpractice problems.
(c) Because obstetric services are essential, it is incumbent upon the
Legislature to provide a plan designed to result in the stabilization and
reduction of malpractice insurance premiums for providers of such
services in Florida.
(d) The costs of birth-related neurological injury claims are particu-



larly high and warrant the establishment of a limited system of
compensation irrespective of fault.
(2) It is the intent of the Legislature to provide compensation, on a
no-fault basis, for a limited class of catastrophic injuries that result in











JOURNAL OF THE HOUSE OF REPRESENTATIVES



unusually high costs for custodial care and rehabilitation. This plan
shall apply only to birth-related neurological injuries.
Section 61. Definitions.-As used in sections 60-75, the term:
(1) "Association" means the Florida Birth-Related Neurological
Injury Compensation Association established in section 74 to adminis-
ter the Florida Birth-Related Neurological Injury Compensation Plan
and the Birth-Related Neurological Injury Compensation Trust Fund
established in section 73.
(2) "Birth-related neurological injury" means injury to the brain or
spinal cord of an infant of term gestation caused by oxygen deprivation
or mechanical injury occurring in the course of labor, delivery, or
resuscitation in the immediate post-delivery period in a hospital,
which renders the infant permanently and substantially mentally and
physically impaired. This definition shall apply to live births only and
shall not include disability or death caused by genetic or congenital
abnormality.
(3) "Claimant" means any person who files a claim pursuant to
section 64 for compensation for a birth-related neurological injury to
an infant. Such a claim may be filed by any legal representative on
behalf of an injured infant; and, in the case of a deceased infant, the
claim may be filed by an administrator, personal representative, or
other legal representative thereof.
(4) "Deputy commissioner" means a deputy commissioner of the
Division of Workers' Compensation of the Department of Labor and
Employment Security.
(5) "Division" means the Division of Workers' Compensation of the
Department of Labor and Employment Security.
(6) "Hospital" means any hospital licensed in Florida.
(7) "Participating physician" means a physician licensed in Florida
to practice medicine who practices obstetrics or performs obstetrical
services either full time or part time and who had paid at the time of
the injury the assessment required for participation in the birth-relat-
ed neurological injury compensation plan for the year in which the
injury occurred. Such term shall not apply to:
(a) Any physician who practices medicine as an officer, employee, or
agent of the Federal Government or of the state or its agencies or its
subdivisions. For the purposes of this subsection, an agent of the state,
its agencies or subdivisions is a person who is eligible for coverage
under any self-insurance or insurance program authorized by the
provisions of s. 768.28(13).
(b) Any physician who practices obstetrics in conjunction with his
teaching duties at an accredited medical school or in its main teaching
hospitals.
Section 62. Florida Birth-Related Neurological Injury Compensation
Plan; exclusiveness of remedy.-
(1) There is established the Florida Birth-Related Neurological
Injury Compensation Plan for the purpose of providing compensation,
irrespective of fault, for birth-related neurological injury claims. Such
plan shall apply to births occurring on or after January 1, 1989, and

Compensation Association.
(2) The rights and remedies granted by this plan on account of a


dents, and next of kin, at common law or otherwise, arising out of or
related to a medical malpractice claim with respect to such injury;
except that a civil action shall not be foreclosed where there is clear
and convincing evidence of bad faith or malicious purpose or willful
and wanton disregard of human rights, safety, or property, provided
that such suit is filed prior to and in lieu of payment of an award under
sections 60-75. Such suit shall be filed before the award of the division
becomes conclusive and binding as provided for in section 70.
(3) Sovereign immunity is hereby waived on behalf of the Birth-Re-
lated Neurological Injury Compensation Association solely to the



extent necessary to assure payment of compensation as provided in
section 69.



Section 63. Deputy commissioner of Division of Workers' Compensa-
tion to determine claims.-The deputy commissioner shall hear and
determine all claims filed pursuant to sections 60-75 and shall exercise
the full power and authority granted to him with respect to workers'
compensation claims, as necessary, to carry out the purposes of such
sections.
Section 64. Filing of claims and responses; medical disciplinary
review.-
(1) All claims filed for compensation under the plan shall commence
by the claimant filing with the division a petition seeking compensa-
tion. Such petition shall include the following information:
(a) The name and address of the legal representative and the basis
for his representation of the injured infant.
(b) The name and address of the injured infant.
(c) The name and address of any physician providing obstetrical
services who was present at the birth and the name and address of the
hospital at which the birth occurred.
(d) A description of the disability for which the claim is made.
(e) The time and place the injury occurred.
(f) A brief statement of the facts and circumstances surrounding the
injury and giving rise to the claim.
(g) All available relevant medical records relating to the birth-re-
lated neurological injury, and an identification of any unavailable
records known to the claimant and the reasons for their unavailability.
(h) Appropriate assessments, evaluations, and prognoses, and such
other records and documents as are reasonably necessary for the
determination of the amount of compensation to be paid to, or on
behalf of, the injured infant on account of the birth-related neurologi-
cal injury.
(i) Documentation of expenses and services incurred to date, which
indicates any payment made for such expenses and services, and by
whom.
(j) Documentation of any applicable private or governmental source
of services or reimbursement relative to the impairments.
(2) The claimant shall furnish the division with as many copies of
the petition as required for service upon the association, any physician
and hospital named in the petition, and the Division of Medical
Quality Assurance, along with a $15 filing fee for deposit in the
Workers' Compensation Administration Trust Fund. Upon receipt of
the petition, the division shall immediately serve the association, by
service upon the agent designated to accept service on behalf of the
association, by registered or certified mail, and shall mail copies of the
petition to any physician and hospital named in the petition, the
Division of Medical Quality Assurance, the Department of Health and
Rehabilitative Services, and the medical advisory review panel
provided for in section 67.
(3) The association shall have 45 days from the date of service in
which to file a response to the petition and to submit relevant written
information relating to the issue of whether the injury alleged is a
birth-related neurological injury.
(4) Upon receipt of such petition, the Division of Medical Quality
Assurance shall review the information therein and determine wheth-
er it involved conduct by a physician licensed under chapter 458,
Florida Statutes, or an osteopathic physician licensed under chapter
459, Florida Statutes, that is subject to disciplinary action, in which
case the provisions of s. 455.225, Florida Statutes, shall apply.
(5) Upon receipt of such petition, the Department of Health and
Rehabilitative Services shall investigate the claim, and if it deter-
mines that the injury resulted from, or was aggravated by, a breach of
duty on the part of a hospital in violation of chapter 395, Florida
Statutes, it shall take any su'h action consistent with its disciplinary
authority as may be appropriate.
Section 65. Tolling of statute of limitations.-The statute of



limitations with respect to any civil action that may be brought by, or
on behalf of, an injured infant allegedly arising out of, or related to, a



February 4, 1988



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birth-related neurological injury shall be tolled by the filing of a claim
in accordance with sections 60-75, and the time such claim is pending
or is on appeal shall not be computed as part of the period within
which such civil action may be brought.
Section 66. Hearing; parties; discovery.-
(1) The deputy commissioner shall set the date for a hearing no
sooner than 60 days and no later than 120 days after the filing by a
claimant of a petition in compliance with section 64. The deputy
commissioner shall immediately notify the parties of the time and
place of such hearing, which shall be held in the county where the
injury occurred unless otherwise agreed to by the parties and
authorized by the division.
(2) The parties to the hearing shall include the claimant and the
association.
(3) Any party to a proceeding under sections 60-75 may, upon
application to the deputy commissioner setting forth the materiality of
the evidence to be given, serve interrogatories or cause the depositions
of witnesses residing within or without the state to be taken, the costs
thereof to be taxed as expenses incurred in connection with the filing of
a claim. Such depositions shall be taken after giving notice and in the
manner prescribed for the taking of depositions in actions at law,
except that they shall be directed to the deputy commissioner before
whom the proceedings may be pending.
Section 67. Medical advisory panel review and recommendations;
procedure.-
(1) Each claim filed with the division under sections 60-75 shall be
reviewed by a medical advisory panel of three qualified physicians of
whom one shall be a neurosurgeon, one shall be an obstetrician, and
one shall be a pediatrician. The panel shall file its report, with its
recommendation as to whether the injury for which the claim is filed is
a birth-related neurological injury, with the division at least 10 days
prior to the date set for the hearing. At the request of the division, at
least one member of the panel shall be available to testify at the
hearing. The deputy commissioner shall consider, but not be bound by,
the recommendation of the panel.
(2) The division shall develop a plan which provides the method and
procedure for such medical advisory panel review and shall develop
such plan in coordination with the Division of Medical Quality
Assurance of the Department of Professional Regulation and the
Children's Medical Services Program Office of the Department of
Health and Rehabilitative Services.
Section 68. Determination of claims; presumption; findings of deputy
commissioner binding on participants.-
(1) Upon completion of the hearing, the deputy commissioner shall
make the following determinations based upon all available evidence;
(a) Whether the injury claimed is a birth-related neurological injury.
1. A rebuttable presumption shall arise that the injury alleged is a
birth-related neurological injury where it has been demonstrated, to
the satisfaction of the deputy commissioner, that the infant has
sustained a brain or spinal cord injury caused by oxygen deprivation or
mechanical injury and that the infant was thereby rendered perman-
ently and substantially mentally and physically impaired.
2. If either party disagrees with such presumption, that party shall
have the burden of proving that the injury alleged is not a
birth-related neurological injury.
(b) Whether obstetrical services were delivered by a participating
physician at the birth.
(c) How much compensation, if any, is awardable pursuant to section
69.
(2) If the deputy commissioner determines that the injury alleged is
not a birth-related neurological injury or that obstetrical services were
not delivered by a participating physician at the birth, he shall enter



an order and shall cause a copy of such order to be sent immediately to
the parties by registered or certified mail.



(3) By becoming a participating physician, a physician shall be
bound for all purposes by the finding of the deputy commissioner or
any appeal therefrom with respect to whether such injury is a
birth-related neurological injury.

Section 69. Deputy commissioner awards for birth-related neurologi-
cal injuries; notice of award.-

(1) Upon determining that an infant has sustained a birth-related
neurological injury and that obstetrical services were delivered by a
participating physician at the birth, the deputy commissioner shall
make an award providing compensation for the following items
relative to such injury:

(a) Actual expenses for medically necessary and reasonable medical
and hospital, rehabilitative, residential, and custodial care and service,
for medically necessary drugs, special equipment, and facilities, and
for related travel; or in lieu of compensation for such items, custodial
care in a state-designated facility, if custodial care in a state-desig-
nated facility is available. However, such expenses shall not include:

1. Expenses for items or services that the infant has received, or is
entitled to receive, under the laws of any state or the Federal
Government, except to the extent such exclusion may be prohibited by
federal law.

2. Expenses for items or services that the infant has received, or is
contractually entitled to receive, from any prepaid health plan, health
maintenance organization, or other private insuring entity.

3. Expenses for which the infant has received reimbursement, or for
which the infant is entitled to receive reimbursement, under the laws
of any state or the Federal Government, except to the extent such
exclusion may be prohibited by federal law.

4. Expenses for which the infant has received reimbursement, or for
which the infant is contractually entitled to receive reimbursement,
pursuant to the provisions of any health or sickness insurance policy or
other private insurance program.

Expenses included under this paragraph shall be limited to reasonable
charges prevailing in the same community for similar treatment of
injured persons when such treatment is paid for by the injured person.

(b) Periodic payments of an award to the parent or legal guardian of
the infant found to have sustained a birth-related neurological injury,
which award shall not exceed $100,000. However, at the discretion of
the deputy commissioner, such award may be made in a lump sum.

(c) Reasonable expenses incurred in connection with the filing of a
claim under sections 60-75, including reasonable attorney's fees, which
shall be subject to the approval and award of the deputy commissioner.

(2) The award shall require the immediate payment of expenses
previously incurred and shall require that future expenses be paid as
incurred.

(3) A copy of the award shall be sent immediately by registered or
certified mail to each person served with a copy of the petition under
section 64(2).
Section 70. Conclusiveness of determination or award; appeal.-

(1) A determination of the deputy commissioner as to qualification of
the claim for purposes of compensability under section 68 or an award
by the deputy commissioner pursuant to section 69 shall be conclusive
and binding as to all questions of fact. Review of an order of a deputy
commissioner shall be by appeal to the District Court of Appeal.
Appeals shall be filed in accordance with rules of procedure prescribed
by the Supreme Court for review of such orders.

(2) In case of an appeal from an award of the deputy commissioner,
the appeal shall operate as a suspension of the award, and the
association shall not be required to make payment of the award
involved in the appeal until the questions at issue therein shall have
been fully determined.



Section 71. Enforcement of awards.-



February 4, 1988



60











JOURNAL OF THE HOUSE



(1) The deputy commissioner shall have full authority to enforce his
awards and to protect himself from any deception or lack of cooperation
in reaching his determination as to any award. Such authority shall
include the power to petition the circuit court for an order of contempt.
(2) A party may, if the circumstances so warrant, petition the circuit
court for enforcement of a final award by the deputy commissioner.
Section 72. Limitation on claim.-Any claim for compensation under
sections 55-70 that is filed more than 7 years after the birth of an
infant alleged to have a birth-related neurological injury shall be
barred.
Section 73. Birth-Related Neurological Injury Compensation Trust
Fund.-
(1) There is hereby created within the Department of Insurance the
Birth-Related Neurological Injury Compensation Trust Fund to fi-
nance the Florida Birth-Related Neurological Injury Compensation
Plan.
(2) Such fund shall be administered by the Florida Birth-Related
Neurological Injury Compensation Association established in section
74, in accordance with the following requirements:
(a) On or before July 1, 1988, the directors of the association shall
submit to the Department of Insurance for review a plan of operation
which shall provide for the efficient administration of the fund and for
prompt processing of claims against and awards made from the fund.
The plan of operation shall include provision for:
1. Establishment of necessary facilities;
2. Management of the fund;
3. Processing of claims against the fund;
4. Initial and annual assessment of the persons and entities listed in
subsection (4) to pay awards and expenses, which assessments shall be
on an actuarially sound basis subject to the limits set forth in
subsection (4); and
(5) Any other matters necessary for the efficient operation of the
birth-related neurological injury compensation plan.
(b) The plan of operation shall be subject to approval by the
Department of Insurance after consultation with representatives of
interested individuals and organizations. If the Department of Insur-
ance disapproves all or any part of the plan of operation, the directors
shall within 30 days submit for review an appropriate revised plan of
operation. If the directors fail to do so, the Department of Insurance
shall promulgate a plan of operation. The plan of operation approved or
promulgated by the Department of Insurance shall become effective
and operational upon order of the Department of Insurance.
(c) Amendments to the plan of operation may be made by the
directors of the plan, subject to the approval of the Department of
Insurance.
(3) All assessments paid pursuant to the plan of operation shall be
deposited in the Birth-Related Neurological Injury Compensation
Trust Fund. The fund and any income therefrom shall be disbursed
only for the payment of awards under sections 60-75 and for the
payment of the reasonable expenses of administering the fund.
(4) On or before March 1, 1988, the following persons and entities
shall pay into the fund an initial assessment in accordance with the
plan of operation:
(a) Each physician who wishes to participate in the Florida
Birth-Related Neurological Injury Compensation Plan and who other-
wise qualifies as a participating physician under sections 60-75 shall
pay an initial assessment of $5,000.
(b) Each hospital licensed under chapter 395, Florida Statutes, shall
pay an initial assessment of $50 per infant delivered during the prior
calendar year, as reported in the most recent annual licensure survey
of hospitals. Each hospital owned or operated by the state or a county,



special taxing district, or other political subdivision of the state shall
not be required to pay the initial assessment or any assessment



February 4, 1988



the entities listed in paragraph (5)(c) for the tax year beginning
January 1, 1990. Following the initial valuation, the Department of
Insurance shall cause an actuarial valuation to be made of the assets
and liabilities of the fund no less frequently than biennially. Pursuant
to the results of such valuations, the Department of Insurance shall
prepare a statement as to the contribution rate applicable to the



SOF REPRESENTATIVES 61

required by subsection (5). The term "infant delivered during the prior
calendar year" shall not include infants delivered by a physician
employed by the State or any political subdivision thereof.

(c) All physicians licensed by the state as of March 1, 1988, other
than participating physicians, shall pay into the fund an initial
assessment of $250, in the manner required by the plan of operation.

(5)(a) Beginning January 1, 1990, the persons and entities listed in
subsection (4), as of the date determined in accordance with the plan of
operation, shall pay an annual assessment in the amount equal to
their initial assessments, in the manner required by the plan of
operation.
(b) If the assessments collected pursuant to subsection (4) and the
appropriation of funds provided by section 76 of this act to the fund
from the Insurance Commissioner's Regulatory Trust Fund are
insufficient to maintain the fund on an actuarially sound basis, there
is hereby appropriated for transfer to the fund from the Insurance
Commissioner's Regulatory Trust Fund an additional amount of up to
$20 million.
(c)1. Taking into account the assessments collected pursuant to
subsection (4) and appropriations from the Insurance Commissioner's
Regulatory Trust Fund, if required to maintain the fund on an
actuarially sound basis, the Department of Insurance shall require
each entity licensed to issue casualty insurance as defined in
s. 624.605(1)(b), (k), and (q), Florida Statutes, to pay into the fund an
annual assessment in an amount determined by the department
pursuant to paragraph (7)(a), in the manner required by the plan of
operation.
2. All annual assessments shall be made on the basis of net direct
premiums written for the business activity which forms the basis for
each such entity's inclusion as a funding source for the plan in the
state during the prior year ending December 31, as reported to the
Department of Insurance, and shall be in the proportion that the net
direct premiums written by each carrier on account of the business
activity forming the basis for its inclusion in the plan bears to the
aggregate net direct premiums for all such business activity written in
this state by all such entities.
3. No entity listed in this paragraph shall be individually liable for
an annual assessment in excess of 0.25 percent of that entity's net
direct premiums written.
4. Casualty insurance carriers shall be entitled to recover their
initial and annual assessments through a surcharge on future policies,
a rate increase applicable prospectively, or a combination of the two.
(6)(a) The Department of Professional Regulation shall collect and
enforce collection of all assessments required to be paid by participat-
ing and nonparticipating physicians pursuant to sections 60-75.
Failure of a physician to pay such assessment is grounds for
disciplinary action pursuant to chapter 458 or chapter 459, Florida
Statutes.
(b) The Department of Health and Rehabilitative Services shall
collect and enforce collection of all assessments required to be paid by
hospitals pursuant to sections 60-75. Failure of a hospital to pay such
assessment is grounds for disciplinary action pursuant to s. 395.018,
Florida Statutes.
(c) Assessments collected pursuant to this subsection shall be
transferred to the Department of Insurance for deposit in the fund.

(7)(a) The Department of Insurance shall undertake an actuarial
investigation of the requirements of the fund based on the fund's
experience in the first year of operation, including without limitation
the assets and liabilities of the fund. Pursuant to such investigation,
the Department of Insurance shall establish the rate of contribution of











62 JOURNAL OF THE HOUSE

entities listed in paragraph (5)(c). However, at no time shall the rate
be greater than 0.25 percent of net direct premiums written.
(b) If the Department of Insurance finds that the fund cannot be
maintained on an actuarially sound basis based on the assessments
and appropriations listed in subsections (4) and (5), the department
shall increase the assessments specified in subsection (4) on a
proportional basis as needed.
Section 74. Florida Birth-Related Neurological Injury Compensation
Association; board of directors.-
(1)(a) The Florida Birth-Related Neurological Injury Compensation
Plan shall be governed by a board of five directors which shall be
known as the Florida Birth-Related Neurological Injury Compensation
Association.
(b) The directors shall be appointed for staggered terms of 3 years or
until their successors are appointed and have qualified.
(c) The directors shall be appointed by the Insurance Commissioner
as follows:
1. One citizen representative.
2. One representative of participating physicians.
3. One representative of hospitals.
4. One representative of casualty insurers.
5. One representative of physicians other than participating physic-
ians.
(2)(a) The Insurance Commissioner may select the representative of
the participating physicians from a list of at least three names to be
recommended by the Florida Obstetric and Gynecologic Society; the
representative of hospitals from a list of at least three names to be
recommended by the Florida Hospital Association; the representative
of casualty insurers from a list of at least three names, one of which is
recommended by the American Insurance Association, one by the
Alliance of American Insurers, and one by the National Association of
Independent Insurers; and the representative of physicians other than
participating physicians from a list of three names to be recommended
by the Florida Medical Association and a list of three names to be
recommended by the Florida Osteopathic Medical Association. In no
case shall the Insurance Commissioner be bound to make any
appointment from among the nominees of such respective associations.
(b) The Insurance Commissioner shall promptly notify the appropri-
ate medical association upon the occurrence of any vacancy, and like
nominations may be made for the filling of the vacancy.
(3) The directors shall act by majority vote with five directors
constituting a quorum for the transaction of any business or the
exercise of any power of the plan. The directors shall serve without
salary, but each director shall be reimbursed for actual and necessary
expenses incurred in the performance of his official duties as a director
of the plan, in accordance with s. 112.061, Florida Statutes. The
directors shall not be subject to any liability with respect to the
administration of the plan.
(4) The board of directors shall have the power to:
(a) Administer the plan.
(b) Administer the Birth-Related Neurological Injury Compensation
Trust Fund.
(c) Administer the payment of claims on behalf of the plan.
(d) Direct the investment and reinvestment of any surplus in the
fund over losses and expenses, provided that any investment income
generated thereby remains in the fund.
(e) Reinsure the risks of the fund in whole or in part.



E



(f) Sue and be sued, and appear and defend, in all actions and
proceedings in its name to the same extent as a natural person.
(g) Have and exercise all powers necessary or convenient to effect
any or all of the purposes for which the plan is created.



---



1. The term "emergency medical services" means those medical
services required for the immediate diagnosis and treatment of medical
conditions which, if not immediately diagnosed and treated, could lead
to serious physical or mental disability or death.



OF REPRESENTATIVES February 4, 1988

(h) Enter into such contracts as are necessary or proper to
administer the plan.
(i) Employ or retain such persons as are necessary to perform the
administrative and financial transactions and responsibilities of the
plan and to perform other necessary and proper functions not
prohibited by law.
(j) Take such legal action as may be necessary to avoid payment of
improper claims.
(k) Indemnify any employee, agent, member of the board of directors
or alternate thereof, or person acting on behalf of the plan in an official
capacity, for expenses, including attorney's fees, judgments, fines, and
amounts paid in settlement actually and reasonably incurred in
connection with any action, suit, or proceeding, including any appeal
thereof, arising out of such person's capacity acting on behalf of the
plan; provided that such person acted in good faith and in a manner he
reasonably believed to be in, or not opposed to, the best interests of the
plan and provided that, with respect to any criminal action or
proceeding, he had reasonable cause to believe his conduct was lawful.
Section 75. Notice to obstetrical patients of participation in the
plan.-Each hospital and each participating physician under the
Florida Birth-Related Neurological Injury Compensation Plan shall
provide notice to the obstetrical patients thereof as to participation in
the limited no-fault alternative for birth-related neurological injuries.
Such notice shall be provided on forms furnished by the association
and shall include a clear and concise explanation of a patient's rights
and limitations under the plan.
Section 76. Appropriations.-
(1) There is hereby appropriated to the Department of Professional
Regulation 89 positions and $1.4 million from the Professional
Regulation Trust Fund for fiscal year 1987-1988 to carry out the
purposes of this act.
(2) There is hereby appropriated to the Department of Administra-
tion, Division of Administrative Hearings 5 positions and $207,168
from the General Revenue Fund and 5 positions and $66,000 from the
Administrative Trust Fund for the 1987-1988 fiscal year to implement
the provisions of this act. Additional salary rate of $380,425 is
provided to the Division.
(3) There is hereby appropriated to the Department of Insurance 9
positions and $149,616 from the Insurance Commissioner's Regulatory
Trust Fund for the 1987-1988 fiscal year to implement the provisions
of this act.
(4) Effective January 1, 1990, there is hereby appropriated for
transfer the sum of $20 million from the Insurance Commissioner's
Regulatory Trust Fund to the Birth-Related Neurological Injury Trust
Fund.
Section 77. Notwithstanding any other provision of law, the Board of
Medicine and the Board of Osteopathic Medical Examiners are hereby
authorized to make a one-time fee assessment and renewal within the
fee limitations of this act.
Section 78. Subsection (6) is added to section 768.45, Florida
Statutes, to read:
768.45 Medical negligence; standards of recovery.-
(6)(a) In any action for damages involving a claim of negligence
against a physician licensed under chapter 458, osteopathic physician
licensed under chapter 459, podiatrist licensed under chapter 461, or
chiropractor licensed under chapter 460 providing emergency medical
services in a hospital emergency department, the court shall admit
expert medical testimony only from physicians, osteopathic physicians,
podiatrists, and chiropractors who have had substantial professional
experience within the preceding 5 years while assigned to provide
emergency medical services in a hospital emergency department.
(b) For the purposes of this subsection:











JOURNAL OF THE HOUSE



2. "Substantial professional experience" shall be determined by the
custom and practice of the manner in which emergency medical
coverage is provided in hospital emergency departments in the same or
similar localities where the alleged negligence occurred.

Section 79. Subsection (6) is added to section 768.81, Florida
Statutes, to read:

768.81 Comparative fault.-

(6) Notwithstanding anything in law to the contrary, in an action for
damages for personal injury or wrongful death arising out of medical
malpractice, whether in contract or tort, when an apportionment of
damages pursuant to this section is attributed to a teaching hospital as
defined in s. 395.502(22), the court shall enter judgment against each
party liable on the basis of such party's percentage of fault and not on
the basis of the doctrine of joint and several liability.

Section 80. In an action for damages for personal injury or wrongful
death arising out of medical malpractice, whether in contract or tort,
when an apportionment of damages pursuant to s. 768.81, Florida
Statutes, is attributed to the Board of Regents, the court shall enter
judgment against each party liable on the basis of such party's
percentage of fault and not on the basis of the doctrine of joint and
several liability. The sole remedy available to a claimant to collect
damages, subject to the provisions of this section, against the Board of
Regents shall be pursuant to s. 768.28, Florida Statutes.
Section 81. Notwithstanding the provisions of s. 627.0625, Florida
Statutes, insurers issuing insurance in this state shall reflect in their
filings for rates, rating schedules, or rating manuals for medical
malpractice insurance any savings or other effects realized by the
insurer as a result of this act.
Section 82. If any provision of this act or the application thereof to
any person or circumstance is held invalid, the invalidity shall not
affect other provisions or applications of the act which can be given
effect without the invalid provision or application, and to this end the
provisions of this act are declared severable.
Section 83. The Supreme Court of the State of Florida is requested to
adopt a standard jury instruction for use in medical negligence cases
involving alleged negligence occurring in hospital emergency rooms. It
is requested that such jury instruction carry out the legislative intent
as provided in section 45 with respect to the standard of care and the
exigencies of medical treatment in hospital emergency rooms.
Section 84. Section 768.66, Florida Statutes, is hereby repealed.
Section 85. In the event that this act does not result in savings in
medical malpractice premiums beyond those which would be otherwise
realized, it is the desire of the Legislature that the provisions of this
act be readdressed by the Legislature.
Section 86. This act does not apply to causes of action arising prior to
the effective date of this act.

Section 87. This act shall take effect upon becoming a law.
Conference Committee Amendment 2-Strike the title and
insert: A bill to be entitled An act relating to medical incidents;
providing legislative findings and intent regarding regulatory reform;
amending s. 20.30, F.S.; creating the Division of Medical Quality
Assurance within the Department of Professional Regulation; provid-
ing duties of the division and bureau; requiring a report; placing the
licensing boards for various health care professions within the division;
amending s. 395.0115, F.S.; providing antitrust immunity through
establishment of a state-mandated peer review process; requiring
licensed facilities to provide for peer review of physicians who provide
health care services at such facilities and providing procedures
therefore; requiring report of final disciplinary actions to the Division of
Medical Quality Assurance for further investigation; providing for peer
review panel immunity and for confidentiality of records; creating
s. 395.0146, F.S.; requiring a certificate of need from the Department
of Health and Rehabilitative Services for termination or reduction of



emergency or trauma services; amending s. 395.017, F.S.; providing
maximum charge for copying records; providing access to confidential



February 4, 1988



amending s. 459.0055, F.S.; providing for an investigative process for
licensure of osteopathic physicians; amending s. 459.008, F.S.; requir-
ing evidence of active practice for license renewal; providing for
supervised practice; amending s. 459.0092, F.S.; increasing the maxi-
mum fee for renewal of a license to practice osteopathic medicine;



SOF REPRESENTATIVES 63

patient records for certain proceedings of the Department of Profes-
sional Regulation; limiting public access thereto; amending s. 395.041,
F.S.; expanding internal risk management education and training
requirements; requiring certain incident reports relating to surgical
procedures; requiring report of certain incidents to the department;
limiting public access; providing for department review and investiga-
tion of incidents which may involve conduct subject to discipline;
providing administrative fines for violation of reporting requirements;
providing for annual review of risk management programs; protecting
risk managers from liability for implementation of risk management
programs; requiring a report to the Legislature; amending s. 395.504,
F.S.; to correct a cross-reference; amending s. 455.225, F.S.; providing
civil immunity and prohibition from discharge to persons reporting
with respect to incompetence, impairment, or unprofessional conduct of
specified health care providers; providing penalties; amending
s. 455.241, F.S.; providing for reports of patient records; creating
s. 455.2415, F.S.; providing for disclosure of patient communications
under certain circumstances; amending s. 455.242, F.S.; providing for
disposition of records of physicians who terminate practice or relocate;
amending s. 455.245, F.S.; providing conditions for considering emer-
gency suspension or restriction of a license; creating s. 455.247, F.S.;
requiring physicians, osteopathic physicians, podiatrists, and dentists
to report professional liability claims and actions to the department;
specifying contents; creating s. 455.28, F.S.; requiring reporting of
certain physicians for violation of grounds for disciplinary action;
providing a penalty; requiring investigation of probable disciplinary
violations; amending s. 458.303, F.S.; revising exemption of certain
commissioned medical officers from specified medical practice provi-
sions; amending s. 458.307, F.S.; modifying membership of the Board
of Medicine; specifying composition of probable cause panels; providing
for a training program; providing for completion of a panel's work;
amending s. 458.311, F.S., relating to requirements for licensure of
physicians by examination; providing for an investigative process;
providing for restricted licenses; amending s. 458.313, F.S.; providing
for an investigative process for licensure by endorsement; requiring
certain active practice; providing for restricted licenses; amending
s. 458.315, F.S.; prohibiting issuance of temporary certificates for
practice in areas of critical need to certain persons by endorsement;
amending s. 458.3165, F.S.; providing for biennial renewal of public
psychiatry certificates; amending s. 458.319, F.S.; increasing the
maximum fee for renewal of a license to practice medicine; requiring
evidence of active practice for license renewal; providing for supervised
practice; amending ss. 458.320 and 459.0085, F.S.; authorizing physic-
ians and osteopathic physicians to use risk retention groups to meet
financial responsibility requirements; amending s. 458.327, F.S.; pro-
viding a penalty for leading the public to believe that one is licensed as
a medical doctor, or is engaged in the licensed practice of medicine,
without a license; creating ss. 458.3295, 459.0145, F.S.; prohibiting a
concerted effort by a physician or osteopathic physician to refuse
emergency room treatment to patients; authorizing a circuit court to
enjoin such conduct; providing a penalty; amending ss. 458.331 and
459.015, F.S.; providing additional grounds for disciplinary action
against physicians and osteopathic physicians; providing penalties and
providing priorities for application thereof; establishing the burden of
proof for administrative actions against physicians; providing for
injunctive relief; providing for department review and investigation of
claims; amending ss. 458.3315, 459.0155, F.S.; providing that a
physician or osteopathic physician who is believed to be impaired must
execute a release of his medical records to a consultant retained by the
Department of Professional Regulation and limiting the use which the
consultant may make of such records; amending s. 458.337, F.S.;
specifying requirements for reports by medical organizations and
hospitals when the physician has resigned; amending s. 458.345, F.S.;
establishing requirements for registration of resident physicians and
interns; providing a fee; restricting renewal or extension; prohibiting
registration of certain persons; increasing a penalty; amending
ss. 458.347 and 459.022, F.S.; allowing extended temporary certifica-
tion of physician assistants and osteopathic physician assistants;











JOURNAL OF THE HOUSE OF REPRESENTATIVES



amending ss. 460.413, 461.013, 464.018, 465.016, and 466.028, F.S.;
providing additional grounds for disciplinary action against chiroprac-
tic physicians, podiatrists, nurses, pharmacists, and dentists; amend-
ing s. 627.912, F.S.; requiring insurers to report certain claims against
dentists; providing for department review and investigation; providing
for an annual report; amending s. 641.55, F.S.; providing for depart-
ment review and investigation of certain incidents reported by health
maintenance organization internal risk management programs; limit-
ing public access; requiring report of certain incidents relating to
surgical procedures; amending s. 768.13, F.S.; providing immunity
from civil liability to physicians, hospitals, and certain hospital
employees rendering medical care or treatment in response to an
emergency within a hospital or trauma center; providing exceptions to
such immunity; amending s. 768.45, F.S.; prescribing matters to be
considered by the trier of fact in a claim of negligence for services
provided in a hospital emergency room; limiting who may give expert
medical testimony; amending s. 768.78, F.S.; providing additional
methods of payments of damage awards; providing legislative findings
and intent; providing definitions; providing applicability of and
procedure for mandatory presuit investigation and medical expert
corroboration of medical negligence claims and defenses by prospective
parties; requiring availability of medical records for presuit screening
of claims and defenses and providing penalties; providing for presuit
discovery of medical negligence claims and defenses and providing
immunity with respect thereto; providing for presuit investigation of
medical negligence claims and defenses by the court, and providing
penalties for lack of reasonable investigation in filing or in corro-
borating medical negligence claims or defenses; providing for non-
binding arbitration of civil cases involving claims for medical negli-
gence; providing for selection of arbitration panels; providing for
referral of cases to arbitration and procedures for referral; providing
procedures for hearings; providing for arbitration awards and judg-
ments; providing for trial de novo; providing for assessment of
attorney's fees and costs in certain circumstances; providing for appeal
of award; creating the Florida Birth-Related Neurological Injury
Compensation Plan; providing legislative findings and intent; provid-
ing definitions; providing exclusiveness of remedy; providing for the
hearing of claims by deputy commissioners of the Division of Workers'
Compensation of the Department of Labor and Employment Security;
providing procedure for the filing of claims and responses; providing
for medical disciplinary review; providing for tolling of the statute of
limitations; providing for hearings, parties, and discovery; providing
for review by a medical advisory panel; providing for determination of
claims; providing a presumption as to injury; providing for binding
nature of findings; providing for awards for birth-related neurological
injuries, and for notice of such awards; providing for conclusiveness of
determination or award; providing for appeal; providing for enforce-
ment of awards; providing a limitation on the bringing of claims;
creating the Birth-Related Neurological Injury Compensation Trust
Fund within the Department of Insurance and providing for adminis-
tration of the fund by the Florida Birth-Related Neurological Injury
Compensation Association pursuant to a plan of operation approved by
said department; providing for assessments for participation in the
plan; providing for actuarial valuation of the fund by the department;
providing for membership and a board of directors for the association;
providing powers and duties of the association; providing for notice to
obstetrical patients of participation in the plan; providing for certain
appropriations; providing for assessment by certain boards; amending
s. 768.81, F.S.; providing for an apportionment of damages based on a
party's percentage of fault and not on the basis of the doctrine of joint
and several liability; requiring medical malpractice insurers to reflect
certain savings in rate filings and schedules; providing an effective
date.


WHEREAS, the Legislature finds that there is in Florida a financial
crisis in the medical liability insurance industry, and


WHEREAS, it is the sense of the Legislature that if the present
crisis is not abated, many persons who are subject to civil actions will
be unable to purchase liability insurance, and many injured persons



will therefore be unable to recover damages for either their economic
losses or their noneconomic losses, and



WHEREAS, the people of Florida are concerned with the increased
cost of litigation and the need for a review of the tort and insurance
laws, and
WHEREAS, the Legislature believes that, in general, the cost of
medical liability insurance is excessive and injurious to the people of
Florida and must be reduced, and
WHEREAS, the Legislature finds that there are certain elements of
damage presently recoverable that have no monetary value, except on
a purely arbitrary basis, while other elements of damage are either
easily measured on a monetary basis or reflect ultimate monetary loss,
and
WHEREAS, the Legislature desires to provide a rational basis for
determining damages for noneconomic losses which may be awarded in
certain civil actions, recognizing that such noneconomic losses should
be fairly compensated and that the interests of the injured party
should be balanced against the interests of society as a whole, in that
the burden of compensating for such losses is ultimately borne by all
persons, rather than by the tortfeasor alone, and
WHEREAS, the Legislature created the Academic Task Force for
Review of the Insurance and Tort Systems which has studied the
medical malpractice problems currently existing in the State of
Florida, and
WHEREAS, the Legislature has reviewed the findings and recom-
mendations of the Academic Task Force relating to medical malprac-
tice, and
WHEREAS, the Legislature finds that the Academic Task Force has
established that a medical malpractice crisis exists in the State of
Florida which can be alleviated by the adoption of comprehensive
legislatively enacted reforms, and
WHEREAS, the magnitude of this compelling social problem
demands immediate and dramatic legislative action, NOW, THERE-
FORE,
On motion by Rep. Ogden, the Report of the Conference Committee
on CS/SB 6-E was accepted in its entirety.
Rep. Carpenter moved that debate be limited to 20 minutes per side.
Rep. Patchett offered a substitute motion that the rules be waived and
debate be limited to 10 minutes per side, which was agreed to.
The question recurred on the passage of CS/SB 6-E. The vote was:
Yeas-79



The Chair
Arnold
Ascherl
Bainter
Banjanin
Bankhead
Bell
Bloom
Burnsed
Canady
Carlton
Carpenter
Clements
Crady
Crotty
Dantzler
Davis
Drage
Dunbar
Figg
Nays-28
Abrams
Bass
Brown
Casas
Clark
Deutsch
Diaz-Balart
Frankel



Frishe
Garcia
Gardner
Goode
Gordon
Grindle
Guber
Hanson
Harden
Harris
Hawkins
Hill
Hodges
Holland
Ireland
Irvine
Jennings
Johnson, B. L.
Johnson, R. C.
Jones, C. F.


Friedman
Gaffney
Glickman
Gonzalez-
Quevedo
Gutman
Hargrett
Jamerson



Jones, D. L.
King
Lewis
Lippman
Long
Mackey
Martin
McEwan
Meffert
Messersmith
Metcalf
Mitchell
Mortham
Nergard
Ogden
Patchett
Peeples
Reddick
Rehm
Renke


Langton
Lawson
Liberti
Logan
Mackenzie
Martinez
Morse
Press



Rochlin
Rudd
Sample
Sanderson
Sansom
Saunders
Shelley
Silver
Simon
Simone
Starks
Stone
Thomas
Tobiassen
Trammell
Troxler
Wallace
Webster
Wetherell



Reaves
Rush
Souto
Tobin
Upchurch



February 4, 1988



64










JOURNAL OF THE HOUSE OF REPRESENTATIVES



Pair Votes



I am paired with Rep. Kelly on the passage of CS/SB 6-E. If he were
present, he would vote "Yea" and I would vote "Nay".

Representative Norman Ostrau
District 96
I am paired with Rep. Young on the passage of CS/SB 6-E. If he were
present, he would vote "Yea" and I would vote "Nay".

Representative Edward J. Healey
District 84
I am paired with Rep. Lombard on the passage of CS/SB 6-E. If he
were present, he would vote "Yea" and I would vote "Nay".

Representative Thomas M. Woodruff
District 58
I am paired with Rep. Bronson on the passage of CS/SB 6-E. If he
were present, he would vote "Yea" and I would vote "Nay".

Representative John Cosgrove
District 119
Rep. Titone was paired to vote "Nay" on the passage of CS/SB 6-E.
Votes after roll call:
Yeas to Nays-Silver

So the bill passed, as amended by the Conference Committee Report.
The action, together with CS/SB 6-E and Conference Committee
Report thereon, was immediately certified to the Senate.

Messages from the Senate

The Honorable Jon Mills, Speaker
I am directed to inform the House of Representatives that the Senate
has admitted for introduction and consideration by the required
Constitutional two-thirds vote and passed CS/HB 8-E.
Joe Brown, Secretary
The above bill was ordered enrolled.

The Honorable Jon Mills, Speaker
I am directed to inform the House of Representatives that the Senate
has concurred in House Amendments 1 and 2 and passed SB 4-E, as
amended; has concurred in House Amendments 1 and 2 and passed SB
12-E, as amended; and has concurred in House Amendments 1 and 2
and passed SB 13-E, as amended.
Joe Brown, Secretary



Remarks of Appreciation
Rep. Bell thanked the staff of the House for their hard work, and
especially the staff of the Committees on Judiciary, Health Care,
Regulatory Reform and Appropriations. He gave a special thanks to
the staff of the Academic Task Force for their efforts.
Speaker Mills thanked the members of the Conference Committee
for ". doing what is a difficult job; perhaps close to thankless."

Recorded Votes
Representative Langton:
Yea-Motion to lay on the table the motion to reconsider the vote by
which Amendment 2 to Amendment 1 to CS/HB 7-E failed of adoption
Nay-Motion to admit HB 12-E for introduction; motion to reconsid-
er the vote by which Amendment 2 to Amendment 1 to CS/HB 7-E
failed of adpotion; motion to lay on the table the motion to reconsider
the vote by which Amendment 13 to CS/HB 7-E was adopted
Representative Rush:
Nay-Amendment 1 to Amendment 2 to CS/HB 7-E; Amendment 4
to Amendment 2 to CS/HB 7-E

Co-sponsors
HB 7-E-Bloom

Adjournment
On motion by Rep. Carpenter, the House adjourned at 11:38 p.m.
sine die.

Enrolling Reports
HB 8-E has been enrolled, signed by the required Constitutional
Officers and presented to the Governor on February 5, 1988.
John B. Phelps, Clerk


CHAMBER ACTION ON BILLS
THURSDAY, February 4, 1988
HB 10-E-Read third time
SB 4-E-Passed as amended 67-45
SB 6-E-Passed as amended by Conference Committee Report
79-28
SB 7-E-Passed 104-0
SB 10-E-Passed 109-0
SB 11-E-Passed 107-0
SB 12-E-Passed as amended 109-0 Refused to recede
SB 13-E-Passed as amended 60-40
[Source: Legislative Information Division]



CERTIFICATE
THIS IS TO CERTIFY that the foregoing pages numbered 1 through
65, inclusive, are and constitute a complete, true and correct journal
and record of the proceedings of the House of Representatives of the
State of Florida at a Special Session of the Seventy-third House since
Statehood in 1845, convened under the Constitution, held from
February 2, 1988 through February 4, 1988. Additionally, there has
been included a record of the transmittal of Acts subsequent to the sine
die adjournment of the Special Session.




Tallahassee, Florida
February 5, 1988 Clerk of the House



65



February 4, 1988














INDEX



to the

JOURNAL OF THE HOUSE OF REPRESENTATIVES

Special Session "E"
February 2 through February 4, 1988












CONTENTS

Pages
Bill Sponsors in "E" Session................................................................................................. ........................................ .................67
M miscellaneous Subjects...................................................................................................................................................................68
Subject Index of House and Senate Bills, Resolutions, and Memorials .............................................................. ..............69
Bills, Resolutions and Memorial by Number, Subject, Sponsor, and Disposition ..................................... ................. 70



66











JOURNAL OF HOUSE OF REPRESENTATIVES


Bill Sponsors in "E" Session

[Source: Information Division, Joint Legislative Management Committee]



ABRAMS, MICHAEL I.-101st District
Sponsored: 10-E
ASCHERL, JACK-30th District
Sponsored: 1-E
Co-sponsored: 2-E
BAINTER, STANLEY-27th District
Sponsored: 1-E
BELL, SAMUEL P., III-28th District
Sponsored: 1-E, 2-E, 5-E, 7-E
BLOOM, ELAINE-104th District
Co-sponsored: 1-E, 7-E
BURNSED, BEVERLY B.-45th District
Sponsored: 13-E
CARLTON, FRAN-39th District
Sponsored: 1-E, 8-E
CASAS, ROBERTO-111th District
Sponsored: 1-E
CLEMENTS, S. L., JR.-62nd District
Sponsored: 1-E, 2-E
CROTTY, RICHARD T.-37th District
Sponsored: 1-E
FIGG, MARY-60th District
Sponsored: 1-E
GARCIA, RODOLFO, JR.-109th District
Sponsored: 1-E
GARDNER, WINSTON W., JR.-31st District
Sponsored: 1-E, 9-E
Co-sponsored: 2-E
GLICKMAN, RONALD CARL-66th District
Sponsored: 6-E
GOODE, HARRY C., JR.-33rd District
Sponsored: 1-E
Co-sponsored: 2-E
GORDON, ELAINE-102nd District
Co-sponsored: 12-E
GRINDLE, ARTHUR E.-35th District
Sponsored: 1-E
GUBER, SUSAN-117th District
Sponsored: 1-E, 2-E
GUTMAN, ALBERTO-105th District
Sponsored: 1-E
HANSON, CAROL G.-87th District
Sponsored: 1-E
HAWKINS, MARY ELLEN-75th District
Sponsored: 1-E
HILL, JAMES C., JR.-80th District
Sponsored: 1-E
HODGES, GENE-11th District
Sponsored: 1-E
Co-sponsored: 2-E
IRELAND, TIMOTHY F.-74th District
Sponsored: 1-E
IRVINE, FRANCES L.-21st District
Sponsored: 1-E
JONES, DENNIS L.-53rd District
Sponsored: 11-E



KELLY, EVERETT A.-46th District
Sponsored: 1-E, 3-E
LAWSON, ALFRED J.,JR.-9th District
Sponsored: 10-E
LIBERTI, RAY-82nd District
Sponsored: 4-E
LIPPMAN, FREDERICK-97th District
Sponsored: 1-E, 7-E, 11-E
LOCKE, DICK-26th District
Sponsored: 1-E
LONG, JOHN-48th District
Sponsored: 1-E
MARTIN, SIDNEY-23rd District
Sponsored: 1-E
METCALF, ELIZABETH-114th District
Sponsored: 1-E
Co-sponsored: 2-E
MORTHAM, SANDRA BARRINGER-52nd District
Sponsored: 1-E
OGDEN, CARL-14th District
Sponsored: 7-E
PATCHETT, R. DALE-78th District
Sponsored: 1-E
Co-sponsored: 2-E
REDDICK, ALZO J.-40th District
Sponsored: 1-E
REHM, GERALD S.-51st District
Sponsored: 1-E
RENKE, JOHN K., II-49th District
Sponsored: 1-E
ROCHLIN, IRMA S.-98th District
Sponsored: 1-E
Co-sponsored: 2-E
RUDD, HURLEY W.-lOth District
Sponsored: 10-E
SAMPLE, DOROTHY EATON-54th District
Co-sponsored: 1-E
SANDERSON, DEBORAH P.-93rd District
Sponsored: 1-E, 2-E
SANSOM, DIXIE N.-32nd District
Sponsored: 1-E
SHELLEY, ROBERT J.-92nd District
Sponsored: 1-E
SILVER, RONALD A.-100th District
Sponsored: 12-E
SIMONE, PEGGY-68th District
Sponsored: 1-E
SMITH, CHARLES R.-47th District
Sponsored: 1-E
SOUTO, JAVIER D.-115th District
Sponsored: 2-E
STONE, FRANK-34th District
Sponsored: 1-E
THOMAS, DAVID L.-71st District
Sponsored: 1-E
Co-sponsored: 2-E



67



INDEX











JOURNAL OF HOUSE OF REPRESENTATIVES



TOBIASSEN, THOMAS J.-lst District
Sponsored: 1-E



TROXLER, DAVID W.-20th District
Sponsored: 1-E



HEALTH CARE
Committee Substitutes 10-E

JUDICIARY

Committee Substitutes 7-E



Miscellaneous Subjects



Subject



Pages Subject



BILLS
Medical Incident Recovery (CS/HB 7-E)
Amendment filing deadline....................
Medical Incidents (SB 6-E)
Conference Committee
Appointment................. ......................
RT? r t --



MEMBERS
Bell, remarks of appreciation ..................................................................65
.10 Excused absences .................................... ............................... 1, 32, 37
Ostrau, Norman; birth of granddaughter ................................................

PRAYERS ......................................................................... ..................... 1, 8, 32



.33-34
Q.Q _A



COMMITTEES
Ad hoc
Medical Malpractice Insurance ...................................... ..............
Conference See: Specific Bill under BILLS
Joint Working Group; Medical Malpractice Insurance.......................2
Select
Special Districts, abolishment ........................................ ..............
Standing, Membership Change ........................................ ............... 2

DEMOCRATIC LEADERSHIP, CHANGE................................................2



GUEST



PRECEDENT 11(o), reiterated
PR OCL. A M ATTONS



.1



37-38



RULES
Waiver of Rule 6 for committee meetings........................................ 7, 31
SPEAKER
Comments........................................................................................... 6-7
Remarks, thanking Conference Committee members.......... ...........65

STATEMENT OF INTENT
HB 1292 and HB 649, 1987 ..................................................................9...

VOTES
Pairs...................................... ...................................................... 36, 65



Pages



INDEX



If ...so. .0........................too..



I................. 0 ................. oo



................................................................... lU



............................... ... ........................ ,



................................................................ ..... ............... 00........................



68



--











JOURNAL OF THE HOUSE OF REPRESENTATIVES



Subject Index of House and Senate

Bills, Resolutions, and Memorials

[Source: Information Division, Joint Legislative Management Committee]

This index embraces all measures introduced in both the House and Senate. The house of origin is identified by
the letter preceding each bill: H-House, S-Senate. Senate bills shown in this index include those never received by
the House, and their inclusion here is only for the convenience of the user interested in all the legislation introduced
in the Legislature on a particular subject.

(Boldfaced bill numbers passed both houses.)



-A-

ACUPUNCTURE
Advertisement of free or discounted services; authorized, S9-E, H3-E

APPROPRIATIONS
Medical Care Availability Assistance Trust Fund, S2-E, H1-E, H7-E
Professional Regulation Department
Medical Quality Assurance Division, staffing, CS/S6-E

ARBITRATION
Medical malpractice actions, CS/S6-E

-C-

CERTIFICATE OF NEED
Emergency or trauma service; availability, reduction; certificate of
need determining factor, CS/S6-E

CHIROPRACTIC
Chiropractic Board, approval of continuing education courses restrict-
ed, S9-E, H3-E

CIVIL PROCEDURE
Health screening, medical practitioners gratuitously performing; civil
liability exemption, CS/S6-E
Joint and several liability, elimination in negligence actions, CS/S6-E
Medical malpractice actions; claims not disposed of in 90 days
deemed final denial, CS/S6-E
Medical malpractice trial de novo; written notification of demand
served by moving party; placement on calendar of court, S5-E
Physicians testifying or who plan to testify in malpractice cases;
threats or intimidation by hospital personnel prohibited, CS/S6-E
Punitive damages, alternative method of payment of awards, noneco-
nomic damages determination, comparative fault; readopted,
CS/S6-E

CONSTITUTIONAL AMENDMENTS
Medical malpractice; arbitration of claims in lieu of courts; $200,000
per incident cap, H2-E

COURTS
Medical malpractice trial de novo; written notification of demand
served by moving party; placement on calendar of court, S5-E

-D-

DAMAGES
Punitive Damages
Alternative method of payment of awards, noneconomic damages
determination, comparative fault; readopted, CS/S6-E

DENTISTS
Financial responsibility condition of licensing, S3-E

DISCLOSURE
Educational facilities, lease-purchase agreements, S13-E

DISCRIMINATION
Emergency services; liability of facility or health care personnel; dis-
crimination prohibited, CS/S6-E

DRIVING UNDER INFLUENCE
Blood alcohol level, language re convictions clarified, HS-E



DRIVING UNDER INFLUENCE (Cont.)
Infrared light measuring devices for breath testing of motorists and
boat operators, H8-E
Substance abuse education, evaluation and treatment; language clari-
fied, H8-E

-E-

EDUCATION
Educational facilities, financing and construction; bid advertisement;
lease-purchase agreements, public disclosure, S13-E

-F-

FOREIGN
Foreign-trained professionals, licensure; eligibility requirement for ex-
amination modified, S9-E, H3-E

-G-

GOOD SAMARITAN LAW
Emergency medical care services, persons and facilities; civil liability
immunity, S2-E, S3-E, CS/S6-E, H1-E, H7-E

GOVERNMENTAL REORGANIZATION
Medical Quality Assurance Division created Professional Regulation
Department, S2-E, CS/S6-E
Professional Regulation Department structure reorganized, H6-E

-H-

HOSPITALS
Crisis stabilization units, mental health services, psychiatric atten-
tion, immunity, CS/S6-E
Emergency services; discrimination; liability of facility or health care
personnel, CS/S6-E
Incident reports, submission to Professional Regulation Department
on quarterly basis, CS/S6-E
Internal risk management education and training requirements,
CS/S6-E, H11-E
Internal risk management program; reporting requirements, CS/S6-E
Medical malpractice testimony by physicians; threats, coercion or dis-
cipline by governing board member or administrator prohibited,
CS/S6-E
Patients Records
Confidential; accessible to Professional Regulation Department for
certain proceedings; public access limited, CS/S6-E, H11-E
Copying; maximum charge, CS/S6-E, H11-E
Surgical procedures, incident reports; certain reported to Professional
Regulation Department; review and investigation, S3-E, CS/S6-E,
H11-E

-I-

IMMUNITY
Crisis stabilization units, mental health services, psychiatric atten-
tion; Good Samaritan Act exemption, CS/S6-E
Medical review committees, malpractice investigations, CS/S6-E

INSURANCE
Medical Care Availability Assistance Trust Fund; administration by
Department, S2-E, H1-E, H7-E



69



INDEX











JOURNAL OF THE HOUSE OF REPRESENTATIVES



INSURANCE (Cont.)
Medical Catastrophic Injury Fund established in Department; use re
payment of settlements and judgments in excess of insurance,
H6-E
State Group Insurance Program
Competitive bidding authorization with health maintenance organi-
zations; repealed, S4-E, H10-E
Health maintenance organizations; Administration Department
contract date delayed to 7/1/88, S4-E, CS/H10-E
Health maintenance organizations, competitive bidding repealed;
contract negotiations; maximum premiums; benefit package,
S4-E, H10-E
Health maintenance organizations, contracts continued certain ar-
eas of state, S4-E, CS/H10-E
Outpatient deductible under self-insured health insurance plan
waived certain state employees, S8-E
Trauma centers, team physicians and consultants, emergency room
physicians; malpractice insurance, S3-E

-L-

LEGISLATURE
Employees, session attendance; limitation of two; subsistence and
travel expenses, payment, S7-E
Joint Legislative Management Committee
Legislative employees, session attendance; limitation of two;
subsistence and travel expenses, payment, S7-E
Outpatient deductible under self-insured health insurance plan
waived certain state employees, S8-E
Members
Legislative employees, session attendance; limitation of two;
subsistence and travel expenses, payment, S7-E
Reports
Professional Regulation Department
Medical incidents, adverse or untoward incidents; confidentiality
level, CS/S6-E, H11-E
State Courts Administrator
Mediation system and status of Medical Malpractice Mediation
Fund, S3-E

LIMITATIONS OF ACTIONS
Birth-related neurological injury, claims for compensation barred af-
ter seven-year period, CS/S6-E

_-M-

MALPRACTICE
Adverse incident reports, submission to Professional Regulation De-
partment, CS/S6-E
Birth-related neurological injuries; no-fault compensation, S2-E,
S3-E, H1-E, H7-E
Medical Malpractice
Arbitration of claims in lieu of courts; $200,000 per incident cap,
S2-E, H1-E, H2-E, H7-E
Arbitration of claims in lieu of courts; $250,000 per incident cap,
CS/S6-E
Arbitration panels, court-appointed; system established to deter-
mine damage amount and apportionment of financial responsi-
bility, S1-E, S5-E, H4-E
Birth-Related Neurological Injury Compensation Plan, establish-
ment, CS/S6-E
Civil actions; presuit screening period, CS/S6-E
Claims litigations, certain malpractice awards reduced by amount
paid claimant from collateral source, S1-E, H4-E
Claims litigations; investigations, written expert opinions; bad faith
claims or denials; attorney fees and cost liability, S1-E, H4-E
Claims not disposed of in 90 days deemed final denial, CS/S6-E
Collateral sources of indemnity; amount determination, S1-E, S2-E,
H1-E, H4-E, H7-E
Countywide grievance committees, each county of state; member-
ship composition, S3-E
Incident reports, submission to Professional Regulation Depart-
ment on quarterly basis, CS/S6-E
Joint and several liability, elimination in negligence actions,
CS/S6-E



Mediation system, panel and mediation period; general procedures
for resolving complaints, S3-E



MALPRACTICE (Cont.)
Medical Malpractice (Cont.)
Medical Catastrophic Injury Fund established; use re payment of
settlements and judgments in excess of insurance limits, H6-E
Medical incident recovery; voluntary binding arbitration medical
negligence claims; multiple defendants, responsibility allocation,
S2-E, H1-E, H7-E
Medical Negligence Liability Insurance Trust Fund established;
primary and excess insurance coverage member health care pro-
viders, Sl-E, H4-E
Patient's Compensation Fund peer review council; appointment,
duties, compensation; civil liability immunity, S3-E
Physician's grievance committees established; review complaints
against physicians filed with Professional Regulation Depart-
ment, Sl-E, H4-E
Physicians, osteopaths, podiatrists, or dentists; two medical mal-
practice occurrences; report review and investigations, S3-E
Physicians testifying or who plan to testify in malpractice cases;
threats or intimidation by hospital personnel prohibited,
CS/S6-E
Punitive damages, alternative method of payment of awards, non-
economic damages determination, comparative fault; readopted,
CS/S6-E
Trauma centers, team physicians and consultants, emergency room
physicians; malpractice insurance, S3-E
Trial de novo, demand; written notification of demand served by
moving party; placement on calendar of court, S5-E

MEDICAL PRACTICE
Health screening, medical practitioners gratuitously performing; civil
liability exemption, CS/S6-E
Impaired Practitioners Committee; treatment programs; approval
based on policies and guidelines, CS/S6-E
Internal risk management education and training requirements,
CS/S6-E, H11-E
Patients Records
Confidential; accessible to Professional Regulation Department for
certain proceedings; public access limited, CS/S6-E, H11-E
Copying; maximum charge, CS/S6-E, Hll-E
Surgical procedures, incident reports; certain reported to Professional
Regulation Department; review and investigation, S3-E, CS/S6-E,
H11-E

MEDICINE, BOARD OF
Membership modified; probable cause panels, establishment of two,
CS/S6-E
Physicians, osteopaths, podiatrists, or dentists; two medical malprac-
tice occurrences; report review and investigations, S3-E, CS/S6-E
Teaching physicians and physicians in private practice, inclusion in
membership, S3-E, CS/S6-E

MORTGAGES AND MORTGAGORS
Secured notes; restriction on assessing certain charges, fees or penal-
ties for prepayment; law repealed, S10-E, H5-E

MOTOR CARRIERS
Commercial truck operators; on-duty period of operation restricted,
Sl1-E, H13-E
Operators, on-duty time; hour time, day time and week time allow-
ances, S11-E

-N-

NEGLIGENCE
Health screening, medical practitioners gratuitously performing; civil
liability exemption, CS/S6-E
Joint and several liability, elimination in negligence actions, CS/S6-E

-0-

OSTEOPATHY
Osteopathic physician assistants failing proficiency examination; sec-



ond-year temporary certification, application authorized, S9-E,
H3-E



70



INDEX











JOURNAL OF THE HOUSE OF REPRESENTATIVES



PER DIEM AND TRAVEL EXPENSES
Legislative employees, members of Legislature; limitation of two;
subsistence and travel expenses, payment, S7-E

PHYSICIANS AND SURGEONS
Birth-Related Neurological Injury Compensation Plan, participants;
$5,000 initial assessment, CS/S6-E
Health screening, medical practitioners gratuitously performing; civil
liability exemption, CS/S6-E
Impaired Practitioners Committee; treatment programs; approval
based on policies and guidelines, CS/S6-E
Medical malpractice testimony by physicians; threats, coercion or dis-
cipline by governing board member or administrator prohibited,
CS/S6-E
Patients Records
Confidential; accessible to Professional Regulation Department for
certain proceedings; public access limited, CS/S6-E, H11-E
Copying; maximum charge, CS/S6-E, H11-E
Surgical procedures, incident reports; certain reported to Professional
Regulation Department; review and investigation, S3-E, CS/S6-E,
H11-E

PODIATRY
Podiatric practitioners, financial responsibility condition of licensing,
S3-E
Podiatric technicians, special license; provision deleted, S9-E, H3-E

POPULAR NAMES
Driving Under Influence Infrared Light Testing, H8-E
Good Samaritan Act (Health Screening), CS/S6-E
Medical Catastrophic Injury Fund, H6-E
Medical Incident Recovery Act of 1988, S2-E, H1-E, H7-E
Medical Malpractice Bills, Sl-E, S2-E, S3-E, H1-E, H2-E, H4-E,
H6-E, H7-E
Medical Malpractice Revision Bill, S6-E
Medical Negligence Liability Insurance Trust Fund, S1-E, H4-E
MIRA Bill (Medical Incident Recovery), S2-E, Hi-E, H2-E, H7-E

PROFESSIONAL REGULATION, DEPARTMENT OF
Acupuncture, advertisement of free or discounted services; author-
ized, S9-E, H3-E
Chiropractic
Board, approval of continuing education courses restricted, S9-E,
H3-E
Foreign-trained professionals, licensure; eligibility requirement for ex-
amination modified, S9-E, H3-E
Impaired Practitioners Committee; treatment programs; approval
based on policies and guidelines, CS/S6-E
Medical Quality Assurance Division, created; physician regulation
and discipline, duties, S2-E, CS/S6-E, H1-E, H7-E
Medicine Board, membership increased to include teaching physi-
cians, S3-E
Osteopathic physician assistants failing proficiency examination; sec-
ond-year temporary certification, application authorized, S9-E,
H3-E
Patient-psychiatrist communications, disclosure when necessary to
warn of patient threats, CS/S6-E, S9-E, H3-E
Patient records, confidential; accessible to Department for certain
proceedings; public access limited, S3-E, CS/S6-E, H11-E
Podiatric technicians, special license; provision deleted, S9-E, H3-E
Professions and occupations; initial license fees and renewal cycle;
continuing education requirement, compliance deferred, S9-E,
H3-E
Psychiatric examination and treatment reports, furnishing authorized
in lieu of copies of patient records, CS/S6-E, S9-E, H3-E
Surgical procedures, incident reports; certain reported to Depart-
ment; review and investigation, S3-E, CS/S6-E, Hll-E

PSYCHIATRISTS AND PSYCHOLOGISTS
Patient-psychiatrist communications, disclosure when necessary to
warn of patient threats, CS/S6-E, S9-E, H3-E



PSYCHIATRISTS AND PSYCHOLOGISTS (Cont.)
Psychiatric examination and treatment reports, furnishing authorized
in lieu of copies of patient records, CS/S6-E, S9-E, H3-E


-R-

REGENTS, BOARD OF
Medical malpractice, wrongful death or personal injury actions for
damages; percentage of fault considered by court, S2-E, H1-E,
H7-E


-S-

SALES TAX
Exemptions
Air carriers, calculation tax; basis provided, S12-E, H9-E
Aircraft modification services, charges; application restricted, H9-E
Road construction, application of tax to certain; law repealed, S12-E,
H9-E
Subcontractors and certain road contractors, refunds; provisions re-
vised re sales tax increase, S12-E, H9-E

SCHOOLS
Educational Facilities
Financing and construction; bid advertisement; lease-purchase
agreements, public disclosure, S13-E

SUNSET BILLS
Foreign-trained professionals, examination and licensure, S9-E, H3-E


-T-

TORTS
Joint and several liability, elimination in negligence actions, CS/SS-E
Punitive damages, alternative method of payment of awards, noneco-
nomic damages determination, comparative fault; readopted,
CS/S6-E

TRAFFIC CONTROL
Commercial truck operators; on-duty period of operation restricted,
S11-E, H13-E
Reckless driving; additional penalty, H8-E

TRAUMA CENTERS
Malpractice insurance; rates, S3-E

TRUCKS AND TRAILERS
Operators, on-duty time; hour time, day time and week time allow-
ances, S11-E

TRUST FUNDS
Birth-Related Neurological Injury Compensation, S6-E
Medical Negligence Liability Insurance, Sl-E, H4-E


-W-

WEAPONS AND FIREARMS
Consular employees, active or former officials; judicial officeholders,
sworn; concealed weapons law exemption re residency, H12-E
Residency requirements, concealed weapon or firearm carrying; cer-
tain persons exempt; public records law exemption; rules, H12-E

WRONGFUL DEATH
Collateral sources of indemnity; amount determination, S1-E, S2-E,
H1-E, H4-E, H7-E
Medical negligence claims, presuit investigation requirements; appli-
cability, S1-E, S2-E, CS/S6-E, H1-E, H4-E, H7-E



71



INDEX










JOURNAL OF THE HOUSE OF REPRESENTATIVES



Bills, Resolutions and Memorials
by Number, Subject, Sponsor and Disposition

To obtain the number of a bill, see the subject matter index preceding this index.

Page numbers in boldfaced print indicate location of roll call votes on disposition.



Abbreviations:
CH-Chapter number, as passed
CSP-Companion or similar bill passed
DCH-Died on House Calendar
DHC-Died in House committee (no action by committee)
DM-Died in Messages



HB
1-E Fla. Medical Incident Recovery Act (Bell) 2-3, 31
DHC/CSP
HJR
2-E Malpractice/Arbitration of Claims (Bell) 3 DHC
HB



3-E

4-E
5-E
6-E



4-E

6-E

7-E



FVI-Failed vote for introduction
HB-House Bill
HJR-House Joint Resolution
SB-Senate Bill
WH-Withdrawn from House



HB



Professions & Occupations/Regulation (Kelly) 3, 7, 9-10
WH/CSP
Medical Negligence (Liberti) 3 DHC/CSP
Mortgage Notes/Prepayment (Bell) 3-4, 9 DCH/CSP
Medical Catastrophic Injury Fund (Glickman) 4
DHC/CSP



Health Maintenance Organizations (Thomas) 36, 37 Ve-
toed
Medical Practice (Commerce) 27-28, 29-30, 33-34, 37-63,
64-65 CH 88-1
Legis. Employees/Per Diem & Travel (Meek) 9, 33
CH 88-6



SB



7-E

8-E
9-E

10-E

11-E
12-E
13-E



Fla. Medical Incident Recovery Act (Bell) 4-5, 7, 9-26, 27,
28, 65 DM/CSP
Driving Under Influence (Carlton) 5, 9, 10 CH 88-5
Sales Tax/Air Carriers (Gardner) 5-6, 9-10, 30, 31
DM/CSP
Health Maintenance Organizations (Lawson) 6-7, 9-10,
35-36 DCH/CSP
Medical Practice (Lippman) 6-7 DHC/CSP
Concealed Weapons & Firearms (Silver) 8-10 FVI
Commercial Motor Vehicle/Operation (Burnsed) 9, 10
DM/CSP



10-E Mortgage Notes/Prepayment (McPherson) 32-33 CH 88-7
11-E Commercial Motor Vehicle/Operation (Beard) 33 CH 88-2
12-E Sales Tax/Air Carriers (Deratany) 34-35, 37 CH 88-3
13-E Educational Facilities (Margolis) 38 CH 88-4



SB



72



INDEX