PROTECTING ACCESS TO CARE ACT OF 2017
(House of Representatives - June 28, 2017)

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[Congressional Record Volume 163, Number 111 (Wednesday, June 28, 2017)]
[Pages H5263-H5287]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]





                 PROTECTING ACCESS TO CARE ACT OF 2017


                             General Leave

  Mr. GOODLATTE. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days to revise and extend their remarks and 
include extraneous material on H.R. 1215.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Virginia?
  There was no objection.
  The SPEAKER pro tempore. Pursuant to House Resolution 382 and rule 
XVIII, the Chair declares the House in the Committee of the Whole House 
on the state of the Union for the consideration of the bill, H.R. 1215.
  The Chair appoints the gentleman from Louisiana (Mr. Graves) to 
preside over the Committee of the Whole.

                              {time}  1407


                     In the Committee of the Whole

  Accordingly, the House resolved itself into the Committee of the 
Whole House on the state of the Union for the consideration of the bill 
(H.R. 1215) to improve patient access to health care services and 
provide improved medical care by reducing the excessive burden the 
liability system places on the health care delivery system, with Mr. 
Graves of Louisiana in the chair.
  The Clerk read the title of the bill.
  The CHAIR. Pursuant to the rule, the bill is considered read the 
first time.
  The gentleman from Virginia (Mr. Goodlatte) and the gentleman from 
Michigan (Mr. Conyers) each will control 30 minutes.
  The Chair recognizes the gentleman from Virginia.
  Mr. GOODLATTE. Mr. Chairman, I yield myself such time as I may 
consume.
  Mr. Chairman, the bill before us today is modeled on California's 
highly successful litigation reforms that have lowered healthcare costs 
and made healthcare much more accessible to the people of that State.
  Because the evidence of the effects of those reforms on lowering 
healthcare costs is so overwhelming, the Congressional Budget Office 
has estimated that, if the same reforms were applied at the Federal 
level, they would save over $50 billion over a 10-year period.
  Because the evidence that those reforms increase access to healthcare 
is so overwhelming, they are supported by a huge variety of public 
safety and labor unions, community clinics and health centers, and 
organizations dedicated to disease prevention, all of which have seen 
the beneficial effects of these reforms in California.
  So popular are these reforms among the citizens of California that a 
ballot initiative to raise the damages cap, backed and funded by trial 
lawyers, was defeated by an over 2-to-1 margin in 2014.
  This bill's commonsense reforms include a $250,000 cap on inherently 
unquantifiable noneconomic damages and limits on the contingency fees 
lawyers can charge. They allow courts to require periodic payments for 
future damages instead of lump sum awards so bankruptcies in which 
plaintiffs would receive only pennies on the dollar can be prevented. 
They include provisions creating a ``fair share'' rule by which damages 
are allocated fairly in direct proportion to fault.
  This bill does all this without in any way limiting compensation for 
100 percent of plaintiffs' economic losses, which include anything to 
which a receipt can be attached, including all medical costs, lost 
wages, future lost wages, rehabilitation costs, and any other economic 
out-of-pocket loss suffered as the result of a healthcare injury. Far 
from limiting deserved recoveries in California, these reforms have led 
to medical damage awards in deserving cases in the $80 million and $90 
million range.
  Unlike past iterations, this bill only applies to claims concerning 
the provision of goods or services for which coverage is provided in 
whole or in part via a Federal program, subsidy, or tax benefit, giving 
it a clear Federal nexus. Wherever Federal policy directly affects the 
distribution of healthcare, there is a clear Federal interest in 
reducing the costs of such Federal policies.
  The legislation before us today also protects any State law that 
otherwise caps damages--whether at a higher level or lower than the 
caps in the bill--or provides greater protections that lower healthcare 
costs.
  When President Ronald Reagan established a special task force to 
study the need for Federal tort reform, that task force concluded as 
follows: ``In sum, tort law appears to be a major cause of the 
insurance availability and affordability crisis which the Federal 
Government can and should address in a variety of sensible and 
appropriate ways.''
  Indeed, the Reagan task force specifically recommended ``eliminate 
joint and several liability,'' ``provide for periodic payments of 
future economic damages,'' ``schedule''--that is, limit--``contingency 
fees'' of attorneys, and ``limit noneconomic damages to a fair and 
reasonable amount.'' All of these recommended reforms are part of the 
bill before us today.
  I urge my colleagues to support this legislation that would enact 
much-needed commonsense and cost-saving litigation reforms that would 
increase healthcare accessibility for all.
  Mr. Chairman, I reserve the balance of my time.

                                         House of Representatives,


                             Committee on Energy and Commerce,

                                   Washington, DC, March 21, 2017.
     Hon. Bob Goodlatte,
     Chairman, Committee on the Judiciary,
     Washington, DC.
       Dear Chairman Goodlatte: I write in regard to H.R. 1215, 
     Protecting Access to Care Act of 2017, which was referred in 
     addition to the Committee on Energy and Commerce. I wanted to 
     notify you that the Committee will forgo action on the bill 
     so that it may proceed expeditiously to the House floor for 
     consideration.
       The Committee on Energy and Commerce takes this action with 
     our mutual understanding that by foregoing consideration of 
     H.R. 1215, the Committee does not waive any jurisdiction over 
     the subject matter contained in this or similar legislation 
     and will be appropriately consulted and involved as this or 
     similar legislation moves forward to address any remaining 
     issues within the Committee's jurisdiction. The Committee 
     also reserves the right to seek appointment of an appropriate 
     number of conferees to any House-Senate conference involving 
     this or similar legislation and asks that you support any 
     such request.
       I would appreciate your response confirming this 
     understanding with respect to H.R. 1215 and ask that a copy 
     of our exchange of letters on this matter be included in your 
     committee's report on the legislation or the Congressional 
     Record during its consideration on the House floor.
           Sincerely,
                                                      Greg Walden,
     Chairman.
                                  ____

                                         House of Representatives,


                                   Committee on the Judiciary,

                                   Washington, DC, March 21, 2017.
     Hon. Greg Walden,
     Chairman, Committee on Energy and Commerce,
     Washington, DC.
       Dear Chairman Walden: Thank you for consulting with the 
     Committee on the Judiciary and agreeing to be discharged from 
     further consideration of H.R. 1215, the ``Protecting Access 
     to Care Act,'' so that the bill may proceed expeditiously to 
     the House floor.
       I agree that your foregoing further action on this measure 
     does not in any way diminish or alter the jurisdiction of 
     your committee or prejudice its jurisdictional prerogatives 
     on this bill or similar legislation in the future. I would 
     support your effort to seek appointment of an appropriate 
     number of conferees from your committee to any House-Senate 
     conference on this legislation.
       I will seek to place our letters on H.R. 1215 into the 
     Congressional Record during floor consideration of the bill. 
     I appreciate your cooperation regarding this legislation and 
     look forward to continuing to work together as this measure 
     moves through the legislative process.
           Sincerely,
                                                    Bob Goodlatte,
                                                         Chairman.

  Mr. CONYERS. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, H.R. 1215 will do little to protect Americans' access 
to safe and affordable healthcare. Instead, it will deny victims of 
medical malpractice and defective medical products the opportunity to 
be fully compensated for their injuries and to hold wrongdoers 
accountable.
  This legislation imposes various restrictions on lawsuits against 
healthcare providers concerning the provision of healthcare goods or 
services that would apply regardless of the merits of the case, the 
misconduct at issue, or the severity of the victim's injury.
  There are so many problems with this bill, but to begin with, this 
bill would cause real harm by severely limiting the ability of victims 
to be made whole. For instance, the bill's $250,000 aggregate limit for 
noneconomic damages, an amount established more than

[[Page H5264]]

40 years ago pursuant to a California statute, would have a 
particularly adverse impact on women, children, the poor, and other 
vulnerable members of our society.
  These groups are more likely to receive noneconomic damages in 
healthcare cases because they are less able to establish lost wages and 
other economic losses. Women, for example, are often paid at a lower 
rate than men, even for the same job. Also, they are more likely to 
suffer noneconomic loss, such as disfigurement or loss of fertility. 
Imposing a severe limit on noneconomic damages, therefore, hurts them 
disproportionately.

                              {time}  1415

  Finally, this bill is particularly harmful for veterans, members of 
the military, and their families. Because the bill prevents State tort 
law in any healthcare-related lawsuit that includes any coverage 
provided by a Federal health program, all cases arising from 
substandard care received in a Veterans Administration facility or a 
military hospital would be subject to the bill's restrictions.
  As a diverse coalition of veterans organizations noted in their 
letter of opposition, H.R. 1215 would limit the ability of veterans and 
military families to hold healthcare providers, drug manufacturers, and 
medical products providers accountable for pain and suffering and death 
that result from substandard care, preventable medical errors, and 
defective drugs and devices.
  For these and other reasons, I implore and urge my colleagues to 
oppose H.R. 1215.
  Mr. Chairman, I reserve the balance of my time.
  Mr. GOODLATTE. Mr. Chairman, I yield 2 minutes to the gentleman from 
Florida (Mr. Gaetz), a member of the Judiciary Committee.
  Mr. GAETZ. Mr. Chairman, I thank the gentleman for yielding.
  Today, in the Congress, too many Republicans and Democrats are 
obsessed with health insurance, often at the expense of the reforms 
that could reduce the cost of healthcare. If we cut the cost of 
healthcare, we make solutions far more attainable for affordable 
coverage.
  I support this tort reform legislation because it will make 
healthcare in America more accessible and less expensive.
  Defensive medicine costs Americans over $50 billion. Commonsense 
reform will eliminate these costs, help patients afford healthcare, all 
while reducing the Federal deficit.
  It is no surprise that defensive medicine costs so much. One survey 
recently reported that 93 percent of doctors practice defensive 
medicine due to a broken tort system.
  It is outrageous that we force doctors to subject patients to costly, 
unnecessary, and occasionally harmful tests just to avoid frivolous 
lawsuits.
  Let's go back to performing medical tests when needed for the 
patient, not to simply avoid exposure in litigation for insurance 
companies. This will lower healthcare costs.
  The New England Journal of Medicine found that 1 in every 14 doctors 
gets sued each year. An earlier Harvard study revealed that 40 percent 
of these malpractice suits were groundless, yet over a quarter of these 
frivolous cases are settled, and the average payout was $300,000.
  Groundless cases overburden our legal system, making it harder for 
people with legitimate grievances to have their day in court.
  Frivolous claims drive up the cost of insurance for all healthcare 
providers, driving many physicians away from the healthcare profession. 
We need more doctors and hospitals, not less. Without reform, we get 
higher costs, fewer doctors, a larger Federal deficit, and worse 
healthcare outcomes.
  Let's pass this bill and start delivering on more accessible 
healthcare for the American people.
  Mr. CONYERS. Mr. Chairman, I yield 3 minutes to the distinguished 
gentleman from Tennessee (Mr. Cohen).
  Mr. COHEN. Mr. Chairman, I thank Ranking Member Conyers for yielding 
me time. Mr. Chair, I share your grief over last night's loss. Sorry 
about that.
  Mr. Chairman, this bill is a loss, too. It is a loss to people who 
have been injured by defective drugs, defective medical devices, been 
harmed in nursing homes, or been harmed by medical malpractice because 
it sets a cap on noneconomic damages of $250,000, no matter whom the 
person is, whatever their position was, no matter what damages they 
suffered.
  Trial lawyers aren't the most liked people in America. They are a 
little bit above Congress people, I think, but it is right in there 
with used car salesmen. None of the three of us are doing real good. So 
it is easy to kind of beat us up.
  But people like their doctors. I see Dr. Roe over there. People like 
doctors. Doctors provide healthcare, if they are allowed to by Federal 
law and given the opportunity to get reimbursed and have a system. 
People don't generally like trial lawyers. But the fact is, trial 
lawyers do a public service because they represent people. When they do 
it on contingency fees, they do it for people who wouldn't have the 
money to hire a lawyer, necessarily, but have been harmed. And they go 
in on the idea that sometimes they will get nothing, but if they win, 
they get a contingency fee, and they give representation to people who 
otherwise couldn't afford it.
  When they win, they win because a jury--which is like a little focus 
group of America--says there was a duty that the doctor breached and a 
harm done to the patient and the patient should be compensated.
  My chairman says this is just like California, and there he goes 
again with that Reagan stuff. Reagan was 40 years ago, I think, 35 
years ago. Whatever. Californians thought this isn't California's law. 
This goes further than California on joint liability. The fact is, when 
you eliminate joint and several liability in certain places, a certain 
part of it is California, a certain part of it isn't, it is less likely 
that the injured party is going to be able to collect.
  It goes further in terms of setting a statute of limitations, but the 
big picture is States' rights. Normally, the folks on the other side of 
the aisle are all for States' rights. They are for States' rights when 
it comes to voting rights. They are for States' rights when it comes to 
civil rights. They are for States' rights on all kinds of things that 
generally tend to tamp down the lower economic folk in our country, 
particularly in the South.
  But here on medical malpractice, which has always been a province of 
the States, they want to usurp it and make a Federal standard that 
applies to everybody.
  If a State hasn't set a cap on damages, then the Federal cap of 
$250,000 would go into place. So if you have a State that says it is 
unconstitutional to have a cap because you have got a right to a jury 
trial, then you might not be able to have that cap, and you will have 
this $250,000 cap set.

  There are all kinds of problems with Federalism, all kinds of 
problems with people who have been injured getting compensated, and 
other problems.
  Go Tigers.
  Mr. GOODLATTE. Mr. Chairman, I yield 2 minutes to the gentleman from 
West Virginia (Mr. Jenkins).
  Mr. JENKINS of West Virginia. Mr. Chairman, I thank the gentleman for 
this opportunity. I have been sitting here listening very carefully to 
this debate. It sounds like a partisan fight. Democrats say this is a 
bad bill. Republicans say it is a good bill. If you are watching at 
home, you think: Here we go again. Just gridlock in Washington. Can't 
get something done.
  Well, let me tell you and let me suggest that preserving and 
protecting access to care should not be a partisan issue. Why do I say 
that? I am from West Virginia, and 14 years ago we passed medical 
liability reform very similar to what we are getting ready to pass 
today, including $250,000 caps on noneconomic damages.
  Why do I know it was not a partisan issue back then is because the 
Governor of West Virginia who introduced the bill, House Bill 2122, was 
Congressman Governor Bob Wise. Bob Wise had been a Member of Congress 
for 18 years as a Democrat here in Congress. He introduced the bill 14 
years ago in West Virginia. He signed the bill. It was his bill.
  The West Virginia Legislature, the House of Delegates, was 68 percent 
Democrat. The West Virginia Senate was 70 percent Democrat. A Democrat 
Legislature, a Democrat Governor, and the reform is just like what we 
are getting ready to pass today.

[[Page H5265]]

  Here is what Democrat Governor Bob Wise said about the bill and why 
they did it. What was the goal? ``To work together towards a common 
goal preserving the healthcare system that serves all West 
Virginians.''
  What else did Governor Democrat Bob Wise say? He said, ``This is a 
prime example of how government can work for the people,'' when he 
passed this bill and signed it.
  On the day he signed the bill, this is what Democrat Bob Wise's 
newsletter said: ``My number one commitment is the health and safety of 
the citizens of West Virginia?''
  The CHAIR. The time of the gentleman has expired.
  Mr. GOODLATTE. Mr. Chairman, I yield an additional 1 minute to the 
gentleman.
  Mr. JENKINS of West Virginia. Mr. Chair, this should not be a 
Democrat/Republican issue. This should be an American healthcare issue. 
This should be preserving and protecting access to quality care. Just 
like Democrat Congressman Bob Wise in West Virginia 14 years ago set 
the example, we ought to set the example here of passing this with 
strong bipartisan support. This is quality care for the American 
citizens.
  Mr. CONYERS. Mr. Chairman, I yield 2 minutes to the gentleman from 
New York (Mr. Nadler), a senior member of the House Judiciary 
Committee.
  Mr. NADLER. Mr. Chairman, I thank the gentleman for yielding.
  Yes, the previous speaker is right. This shouldn't be a partisan 
issue, but the Republican Party in both houses has been doing its best 
to destroy healthcare for the American people in the last couple of 
months. This is just a different piece of the same plot. Bob Wise 
didn't always have the best judgment.
  This cruel legislation does exactly the opposite of what its title 
states. It would place an artifical and very low cap on noneconomic 
damages in medical malpractice cases, and it would lock that figure 
into law without adjustment for inflation, which would reduce its value 
almost to zero over time.
  By capping damages, this bill would ensure that many victims of 
medical malpractice will not be fairly compensated for their injuries. 
Many other victims may be unable even to file a case in the first place 
because they will be unable to retain a lawyer. That is because medical 
malpractice cases often require significant upfront costs, as high as 
$100,000 on average, and few attorneys will take a case if the cap on 
damages means that there will be no reasonable likelihood of recouping 
their costs.
  This bill's cap on noneconomic damages is particularly insidious 
because of its discriminatory effect on many women, children, and 
seniors. They often have little or no lost wages to calculate, and, 
therefore, they may recover very little in the form of economic 
damages. But they may still have suffered a real and lasting injury 
that deserves compensation. This includes women who may have chosen to 
stay home and raise a family, children who have yet to begin their 
careers, or seniors who have retired and left the workforce.
  Why should they be punished under this bill and get very little 
compensation for a lost limb or something else?
  The law recognizes that pain and suffering, and other noneconomic 
damages, are worthy of compensation, but supporters of this bill think 
Congress, not juries, should decide what those injuries are worth, and 
it is shamefully little.
  This legislation is based on the California law that includes a cap 
of $250,000 for noneconomic damages, but it was enacted back in 1975. 
Whether or not that was an appropriate figure 40 years ago, in today's 
dollars, it is clearly inadequate.
  After adjusting for inflation, the cap would need to be approximately 
$1.128 million to be the same as the $250,000 cap was when it was 
enacted.
  The CHAIR. The time of the gentleman has expired.
  Mr. CONYERS. Mr. Chairman, I yield the gentleman an additional 30 
seconds.
  Mr. NADLER. Thinking of it another way, that $250,000 cap is now 
worth just over $56,000, nearly a fifth as much.
  Even assuming that $250,000 is the appropriate figure today, fairness 
demands that this cap be indexed for inflation going forward so that we 
do not see a similar erosion of value. But this bill locks in 
an already low cap and lets it dwindle away until it is worth 
essentially zero.

  I offered an amendment to adjust the cap to reflect 40 years of 
inflation, and to index it going forward, but the Rules Committee did 
not make it in order. Instead, we are forced to vote on a bill that, 
over time, will consider pain and suffering to be worth nothing at all.
  This bill would not reduce the cost of malpractice insurance, it 
would not drive bad doctors out of practice, and it would certainly not 
protect patients.
  What it would do is give a free ride to a healthcare provider, or a 
healthcare entity, that seriously harms a patient or a consumer.
  I urge my colleagues to reject this unfair and unnecessary 
legislation.
  Mr. KING of Iowa. Mr. Chairman, I yield 4 minutes to the gentleman 
from Tennessee (Mr. Roe).
  Mr. ROE of Tennessee. Mr. Chairman, I rise today in support of H.R. 
1215, the Protecting Access to Care Act of 2017, a much needed piece of 
legislation aimed at reforming medical malpractice law in order to help 
drive down the cost of providing healthcare and, thereby, making it 
more affordable for all Americans.
  I had the privilege of practicing medicine in the great State of 
Tennessee for 31 years before coming to Congress. The one thing that 
took away some of the joy from that practice was the threat of 
frivolous lawsuits.
  Because of trial attorneys, over the years, the premiums for 
malpractice insurance have ballooned to levels that make it difficult 
for providers to practice and are driving more people out of practice, 
away from small practices, and into large hospital systems just so they 
can survive as a practitioner. Worse still, the jury awards aren't 
going to the victims of actual malpractice.

                              {time}  1430

  In Tennessee, prior to implementing some malpractice reforms, over 
half the premium dollars were paid out to attorneys, and less than 40 
cents of every dollar paid out have gone to people who have actually 
been injured. So we are not compensating the injured party.
  Thankfully, States like my home State of Tennessee are taking action 
and have enacted much-needed reforms in the last decade, and the costs 
associated with providing care have plummeted since then. In 2008, the 
Tennessee Medical Malpractice Act was signed into law and created 
requirements that the plaintiff in a healthcare liability action 
provide the defendant with a pre-suit notice of the claim as well as a 
qualified expert to review the case and certify it has merit.
  Adding onto these reforms, in 2011, the Tennessee Civil Justice Act 
was signed into law, and it included a $750,000 cap for noneconomic 
damages and a cap on punitive damages at the greater of twice the 
compensatory damages or $500,000.
  With these changes, between 2008 and 2014, the number of medical 
malpractice lawsuits in Tennessee decreased by 36 percent, from 584 to 
just 374. And, Mr. Chairman, between 2009 and 2014, the annual medical 
malpractice premium for an OB/GYN doctor like myself decreased from 
$52,000-plus to $33,000-plus, nearly a $20,000 decrease in premiums per 
year.
  Those of us who were here in 2009 when the Affordable Care Act was 
debated remember that President Obama acknowledged that the cost of 
defensive medicine was a bipartisan concern and something that he 
wanted to address. Despite the fact that our legislation is modeled on 
a California law that has stood the test for 40 years through both 
Republican and Democratic Governors, Democrats made no serious attempt 
to address medical malpractice as their healthcare bill was pushed 
through, which is yet another flaw of the ACA.
  Today's bill is common sense. With these reforms, we will ensure 
patients, not trial attorneys, are compensated for legitimate 
malpractice claims--and there are legitimate claims out there. But we 
will also prevent frivolous litigation from moving forward.
  For those concerned about the 10th Amendment, this bill respects 
States' rights and only subjects claims with a Federal nexus to this 
law, while giving a great deal of latitude to States to act in their 
own accord.

[[Page H5266]]

  Mr. Chairman, I loved what I did while I was in practice. I had the 
chance to deliver about 5,000 babies, and it never felt like a job. It 
is just what I did and enjoyed doing. But at a time when healthcare 
costs are spiraling out of control, an easy fix like H.R. 1215 just 
makes sense and is just another piece of the puzzle to help the costs 
of healthcare go down.
  I strongly support the much-needed reforms in this legislation, and I 
urge my colleagues to vote in favor of final passage.
  One final thing, Mr. Chairman. I have a list here of our premiums in 
the State of Tennessee, and under every specialty listed here--and 
there are numerous--there were dramatic decreases in each of these.
  Mr. CONYERS. Mr. Chairman, I yield 2 minutes to the gentlewoman from 
Texas (Ms. Jackson Lee), the most active Member in the 115th Congress.
  Ms. JACKSON LEE. Mr. Chairman, I thank the gentleman for yielding.
  Mr. Chairman, I would say to my colleagues that this is about bad 
medicine, not good medicine, and it is about undermining good 
healthcare, as we have seen in the TrumpCare saga, causing some 49 
million people to lose their insurance. Here we go again.
  I would offer to say that the most difficult, hurtful, and harmful 
aspect of this particular legislation is that it would make it more 
difficult for plaintiffs to seek redress for medical injuries that have 
been proven in court.
  In addition, it proposes to make dangerous and potentially 
unconstitutional changes to our Nation's Federal system, intruding on 
State sovereignty, the very thing that Republicans seem to relish and 
to support, because this bill attempts to preempt the several areas of 
tort law that have been traditionally reserved to the States.
  I would tell my good friends in Tennessee and West Virginia: Deal 
with your States, just as other individuals deal with their own States.
  This bill, as well, has a very difficult impact on medical 
malpractice. Because it was written so vaguely, the broad language 
sweeps into not only doctors and other medical professionals, but 
hospitals and clinics and almost every entity that contributes in any 
way to making any healthcare product or service available. That clearly 
impacts the healthcare of Americans.
  When your child is injured through no fault of their own or your own, 
you need relief for that child. Interestingly enough, the American Bar 
Association that represents all lawyers, trial lawyers, of which there 
is an attempt to impugn their work, contempt for trial lawyers and the 
good work that they do. But the ABA says they are opposed to this bill, 
and they represent lawyers who fight every day to make sure the 
injustices don't happen.
  But here is the real cause of my angst for this particular bill: 
``Medical Error Leaves Family With Unanswered Questions.''
  ``Olivia was a senior in high school in Santa Monica, California, an 
accomplished scholar, actress, and musician who had earned early 
acceptance to Smith College.''
  The CHAIR. The time of the gentlewoman has expired.
  Mr. CONYERS. Mr. Chairman, I yield the gentlewoman an additional 30 
seconds.
  Ms. JACKSON LEE. ``Olivia was born with a congenital heart 
condition.''
  She was going into college, but had a condition that caused her to go 
into the hospital. When she went in, she had a small procedure. Her 
vitals were dropping. Hospital staff waited more than 10 minutes before 
attempting resuscitation, but it was too late. She remained in a coma 
and died.
  Mr. Chairman, I include the article in the Record.

         Medical Error Leaves Family With Unanswered Questions

       Research has found that 440,000 Americans die every year 
     from preventable medical errors each year.
       Olivia was a senior in high school in Santa Monica, 
     California, an accomplished scholar, actress, and musician 
     who had earned early acceptance to Smith College.
       Olivia was born with a congenital heart condition that was 
     monitored throughout her childhood.
       The fall that Olivia was supposed to start college, she 
     underwent a routine procedure to help doctors figure out if 
     she could be considered for a surgery that would improve her 
     condition.
       The procedure was completed without complications, but 
     while Olivia was still under anesthesia, a cardiology fellow-
     in-training pulled the catheter lines, causing Olivia's heart 
     rate, pulse, and blood pressure to drop rapidly. Even though 
     her vitals were dropping, hospital staff waited more than 10 
     minutes before attempting resuscitation. But it was too late.
       Olivia would never regain consciousness and died that 
     winter, never having lived her dream and attending college.
       Her future was stolen from her, and immediately her family 
     tried to understand what had gone wrong. They began to ask 
     questions on how this could have happened, but they were 
     given very few answers from the hospital.
       Finally, the hospital gave her family incomplete medical 
     records to sift through and find answers. They sought the 
     help of an attorney because, despite their best efforts, they 
     still did not fully understand what caused their daughter's 
     death. But due to California's out dated $250,000 cap on 
     medical negligence damages, it was nearly impossible to find 
     one.
       Olivia's life was cut short by a preventable medical error, 
     and unfortunately, she is not alone. In the U.S., preventable 
     medical errors are the third leading cause of death.
       Our focus should be on improving patient safety and 
     preventing medical errors, not limiting the rights of injured 
     patients and their families. Lawmakers who seek to limit the 
     accountability of health care providers are seeking to limit 
     our rights and our avenues to justice.
       Don't our loved ones deserve better?

  Ms. JACKSON LEE. Mr. Chairman, what do you want families to face--no 
relief? Or do you want these constant errors to go unrecognized and 
reconciled? This bill will do that by denying the ability.
  It provides immunity for healthcare providers who dispense defective 
or dangerous products. It makes it harder for victims to attain 
adequate legal representation, and it imposes a risk or loss on victims 
rather than wrongdoers. This bill undermines healthcare and it 
undermines good healthcare.
  Mr. Chair, I include in the Record a letter from the American Bar 
Association opposing this bill.

                                     American Bar Association,

                                Washington, DC, February 27, 2017.
     Re Concerns Regarding H.R. 1215, the ``Protecting Access to 
         Care Act of 2017.''

     Hon. Bob Goodlatte,
     Chairman, Committee on the Judiciary, House of 
         Representatives, Washington, DC.
     Hon. John Conyers, Jr.,
     Ranking Member, Committee on the Judiciary, House of 
         Representatives, Washington, DC.
       Dear Chairman Goodlatte and Ranking Member Conyers: On 
     behalf of the American Bar Association, which is the largest 
     voluntary membership organization of legal professionals in 
     the United States, consisting of more than 400,000 members 
     from all 50 states, the District of Columbia and other 
     jurisdictions, I am writing to express our opposition to H.R. 
     1215, the ``Protecting Access to Care Act of 2017.'' I 
     understand that your committee is scheduled to mark up this 
     bill as early as tomorrow.
       For over 200 years, the authority to determine medical 
     liability law has rested in the states. This system, which 
     grants each state the autonomy to regulate the resolution of 
     medical liability actions within its own borders, is a 
     hallmark of our American justice system. The states also 
     regulate the insurance industry. Because of the roles they 
     have played, the states are the repositories of experience 
     and expertise in these matters. Therefore, the ABA believes 
     that Congress should not substitute its judgment, as is 
     proposed in H.R. 1215, for the systems that have evolved in 
     each state over time.
       Specifically, I would like to share with you the ABA's 
     concerns and other views regarding key provisions in the 
     proposed legislation relating to damages, proportionate 
     liability, and contingent fees.
       Damages. The ABA believes that compensatory damages should 
     not be capped at either the state or federal level, and, as a 
     result, we have serious concerns regarding Section 3(b) of 
     H.R. 1215 that would cap noneconomic damages for a 
     plaintiff's injuries at $250,000 regardless of the number of 
     parties against whom the action is brought or the number of 
     separate claims or actions brought with respect to the same 
     injury. For more than thirty years, the ABA has studied the 
     research on federal and state legislative efforts to impose 
     limits on noneconomic damages, including pain and suffering. 
     Empirical research has shown that caps diminish access to the 
     courts for low wage earners, like the elderly, children, and 
     women; if economic damages are minor and noneconomic damages 
     are capped, victims are less likely to be able to obtain 
     counsel to represent them in seeking redress.
       Those affected by caps on damages are the patients who have 
     been most severely injured by the negligence of others. These 
     patients who reside in communities around the country should 
     not be told that, due to an arbitrary limit set by members of 
     Congress in Washington, DC, they will be deprived of the 
     compensation determined by a fair and impartial jury. The 
     courts already possess

[[Page H5267]]

     and exercise their powers of remittitur to set aside 
     excessive jury verdicts, and that is the appropriate solution 
     rather than an arbitrary cap. For these reasons, the ABA 
     opposes those provisions in H.R. 1215, such as Section 3(b), 
     which would place a dollar limit on recoverable damages and 
     operate to deny full compensation to a patient in a medical 
     liability action.
       Proportionate Liability. Section 3(d) of H.R. 1215 would 
     create a ``fair share rule'' under which each party would be 
     liable only for its share of any damages, and, as a result, 
     the provision would preempt existing state laws that provide 
     for joint and several liability in medical liability cases. 
     The ABA believes that, at the state level, the laws providing 
     for joint and several liability should be modified to 
     recognize that defendants whose responsibility is 
     substantially disproportionate to liability for the entire 
     loss suffered by the plaintiff should be held liable for only 
     their equitable share of the plaintiff's noneconomic loss. 
     Although the ABA supports this principle and encourages other 
     improvements to the tort laws at the state level, it opposes 
     federal preemption of the medical liability laws of the 
     states and territories. Therefore, the ABA opposes Section 
     3(d) to the extent that it would preempt existing state laws 
     and to the extent that it would apply a proportionate 
     liability rule to all damages, not just the plaintiff's non-
     economic damages.
       Contingent Fees. Section 4(a) of H.R. 1215 would empower a 
     court to reduce the contingent fees paid from a plaintiff's 
     damage award to an attorney, redirect damages to the 
     plaintiff, and further reduce contingent fees in cases 
     involving minors and incompetent persons. The ABA opposes 
     sliding scales for contingent fees and other special 
     restrictions on such fees. In 1985, the ABA created a Special 
     Committee on Medical Professional Liability (``Special 
     Committee'') to study the initiatives proposed at that time 
     in an Action Plain of the American Medical Association 
     Special Task Force on Professional Liability and Insurance. 
     Among the initiatives was a recommendation of sliding scales 
     on contingent fees, having effects comparable to the caps 
     proposed here. After review, the Special Committee concluded 
     the following:
       ``A sliding scale for contingency fees in medical 
     malpractice litigation may very well reduce total awards for 
     patient-victims by depriving them of representation by a 
     trial lawyer sufficiently skilled at obtaining the highest 
     appropriate award. Mandatory sliding scale systems could also 
     inhibit claimants' access to the court system by limiting the 
     availability of counsel. And imposing sliding scales only in 
     medical malpractice cases would, in effect, create different 
     level of skills among available counsel for plaintiffs in 
     medical malpractice cases from those available to claimants 
     in other tort cases.''
       As a result of this finding, the ABA adopted a policy in 
     1986 that ``no justification exists for imposing special 
     restrictions on contingent fees in medical malpractice 
     actions.'' Therefore, the ABA opposes the limits on 
     contingent fees contained in Section 4 of H.R. 1215.
       The American Bar Association remains committed to 
     maintaining a fair and efficient justice system where victims 
     of medical malpractice can obtain redress based on state 
     laws, without arbitrary or harmful restrictions. We offer 
     these perspectives for your consideration as you mark up H.R. 
     1215.
           Sincerely,
                                                 Thomas M. Susman,
                            Director, Governmental Affairs Office.
  Mr. CHAIR, as a senior member of the Judiciary Committee, I rise in 
strong opposition to H.R. 1215, the so-called ``Protecting Access to 
Care Act of 2017.''
  I oppose this misguided and ill-considered legislation for several 
reasons.
  Specifically, the bill before us should be rejected because:
  1. H.R. 1215 violates state sovereignty;
  2. H.R. 1215 applies well beyond medical malpractice;
  3. Unjustifiably caps noneconomic damages, which will have a 
disproportionately adverse impact on women, the poor, and other 
vulnerable groups.
  4. Provides unjustifiable immunity for health care providers who 
dispense defective or dangerous pharmaceuticals or medical devices;
  5. Imposes an excessively short statute of limitations period;
  6. Makes it harder for victims to obtain adequate legal 
representation; and
  7. Inequitably imposes the risk of loss on victims rather than 
wrongdoers.
  For over 200 years, the authority to determine medical liability has 
rested in the states.
  This system, which grants each state the autonomy to regulate the 
resolution of medical liability actions within its own borders, is a 
hallmark of our American justice system.
  H.R. 1215 would preempt state law in all 50 states with a rigid, 
uniform set of rules designed to make it more difficult for malpractice 
victims to obtain relief in the courts.
  Victims injured by the negligent conduct of others, who have lost 
limbs, suffered traumatic brain injury, or lost their vision following 
medical procedures should not be subject to additional burdens of a 
possible limited recovery, currently available under state patients' 
bills of rights and other protections under the Affordable Care Act.
  The definitions in H.R. 1215 are written in such vague and broad 
language as to potentially sweep in not only doctors and other medical 
professionals, hospitals and clinics, but also every entity that 
contributes in any way to making any health care product or service 
available, including insurance companies, pharmaceutical manufacturers, 
health product manufacturers, pharmacists, nursing homes, assisted 
living facilities, and mental health treatment centers, and drug and 
alcohol rehabilitation facility, among others.
  H.R. 1215 will do nothing to strengthen protections for patients.
  It goes in the opposite direction, by excusing the health care 
industry from accountability for carelessness, and shifting the burden 
for shouldering the consequences of preventable medical injury to the 
injured patients, their families, their employers, their insurance 
companies, and taxpayers.
  Current provisions of the Affordable Care Act prohibit insurance 
companies from denying coverage for preexisting conditions, mandate 
coverage for young adults and children under the age of 26, and secure 
lifetime coverage caps, ensuring patients receive the care they need.
  Empirical research has shown that caps on damages, such as those 
envisioned by H.R. 1215, diminish access to the courts for the most 
vulnerable, such as low wage earners, like the elderly, children, and 
women.
  The bill arbitrarily caps so-called ``non-economic loss''--which 
sweeps in essentially everything that is not loss of salary or 
additional medical expenses--at $250,000 for the patient's lifetime, 
punishing those patients with the most devastating, life-altering 
injuries.
  The bill forces the injured patient to take the amounts received for 
future expenses resulting from the injury in a ``structured 
settlement,'' which may not match up with the patient's actual needs as 
they arise, and would further reduce the amount the careless health 
care provider actually pays.
  Preventable medical errors are the third-leading cause of death in 
the United States, with an estimated 440,000 deaths each year following 
a medical error or hospital-caused infection during a hospital stay.
  Addressing this problem must be a national priority.
  And although policies to promote and require safer practices are key 
to this effort, that is insufficient.
  We cannot assign a government monitor to every hospital operating 
room and every doctor's office.
  Effective protection should also include enabling patients and their 
families to hold health care providers accountable for errors that 
cause harm.
  H.R. 1215 would unfortunately take several major steps backward from 
this goal.
  The bill twists important protections found in many state laws into 
an additional legal hurdle.
  An extended statute of limitations protection allows patients who do 
not discover their injury until much later, sometimes many years after 
the medical procedure or intervention, to still have a change to seek 
legal help.
  But in the bill, the period in which an injured patient can seek 
legal help is actually shortened to one year.
  The bill cuts off a patient injured as a young child if their family 
fails to bring legal action on their behalf, long before they are old 
enough to legally act on their own behalf.
  This legislation would impose various restrictions on medical 
malpractice lawsuits, causing these restrictions to apply regardless of 
how much merit a case may have, the negligence at issue, or the 
severity of the issue.
  If economic damages are minor and noneconomic damages are capped, 
victims are less likely to be able to obtain counsel to represent them 
in seeking redress in these personal injury malpractice cases that 
often operate under contingency fee.
  Those affected by caps on damages are the patients who have been most 
severely injured by the negligence of others.
  These patients who reside in communities around the country should 
not be told that, due to an arbitrary limit set by members of Congress 
in Washington, DC, they will be deprived of the compensation determined 
by a fair and impartial jury.
  The courts already possess and exercise their powers of remittitur to 
set aside excessive jury verdicts, and that is the appropriate solution 
rather than an arbitrary cap.
  I am concerned that H.R. 1215 would put patient safety at higher 
risk, by significantly undermining the accountability of those who 
provide patients with medical care.
  H.R. 1215 undercuts patients in situations in which carelessness or 
misconduct by several health care providers combines to injure the 
patient.
  It arbitrarily ``divides'' blame among those actors and then if one 
of them evades accountability for any reason, the others who caused the 
injury are excused from having to make up the difference, and the 
injured patient is short-changed.

[[Page H5268]]

  H.R. 1215 shifts accountability away from the careless health care 
providers who caused the injury and onto ``collateral sources,'' such 
as the patient's insurance company or employer, or the government, that 
pay for part of the patient's medical expenses or other expenses 
resulting from the injury.
  In effect, these other sources provide involuntary free insurance to 
careless health care providers.
  The bill excuses doctors and other health care providers from any 
responsibility of looking into the safety and effectiveness of any 
medication or medical product, so long as it has been approved by the 
FDA.
  Accordingly, I strongly oppose H.R. 1215 for these and many more 
reasons and urge my colleagues to reject this bill.
  Mr. KING of Iowa. Mr. Chairman, I yield myself 5 minutes.
  Mr. Chairman, first of all, the statement that this bill caps or 
limits States on economic or noneconomic damages is incorrect. In fact, 
I would point the gentlewoman from Texas to page 6 of the bill, that 
says, under State Flexibility, that specifies a particular monetary 
amount of economic or economic damages, there is no provision in this 
section that shall be construed to preempt State law. We wrote that 
specifically to respect the States' rights.
  I recall a number of these pieces of legislation that have come 
before this Congress. I can remember it back at least until 2007. I was 
uneasy about the constitutionality because it did reach in and preempt 
State law.
  And I am a respecter of States' rights, but we have a Federal 
interest in healthcare. That is the provision that is written into the 
bill. If there are Federal dollars involved, if it is a Federal 
program, then the Federal Government has an interest in limiting these 
damages.
  We capped the damages in this bill, not the economic damages. Those 
real damages that are economic damages are fully compensated, without 
limit, without cap, and without the interference of this law, unless 
States choose to cap economic damages.
  Noneconomic damages, however, are capped at $250,000; and that 
$250,000 cap is something that has existed in California State law for 
more than 40 years, signed into law by the very durable Jerry Brown. 
But if the States want to change that, if they want to raise the cap 
beyond $250,000, that is their right to do so. We specify that in the 
bill.
  I would like to discuss a need for this bill. It is necessary to 
preserve fiscal sanity in Federal healthcare policy. And I would like 
to point out, also, at the outset that this bill only applies to claims 
concerning the provision of goods and services for which coverage is 
provided in whole or in part by a Federal program, a Federal subsidy, 
or a Federal tax benefit. It is a clear, clear, Mr. Chairman, Federal 
nexus. Wherever Federal policy affects the distribution of healthcare, 
there is a clear Federal interest.
  So, the bill's commonsense reforms, which have been the law in 
California for over 40 years and that the CBO has scored a couple of 
times here--the previous score was $54 billion; this score is $50 
billion--is over $50 billion in savings to the people who are paying 
for healthcare in this country, and that includes our taxpayers and the 
healthcare users.
  But the $250,000 cap is reasonable. It has sustained itself over 
those 40 years in California, and it is good enough for other States to 
emulate.
  When I hear some pushback from Texas, I am kind of thinking they want 
to keep the system they have, and they don't want to have to compete 
with the rest of the country. I think we might lose a vote or two to 
from Texas on that alone: We have ours; we don't want America to have 
anything like that because then we have to compete with all of America.
  This bill will allow courts to require periodic payments for future 
damages instead of lump sum awards. That helps limit bankruptcies so 
plaintiffs that might receive only pennies on the dollar can be 
prevented. And it includes provisions creating a ``fair share'' rule by 
which damages are allocated fairly in direct proportion to fault. That 
has got to help a lot when you are thinking about the cost of 
healthcare.
  The bill does all this without in any way limiting compensation for 
100 percent of the plaintiffs' economic losses, which include anything 
to which a receipt can be attached, including all medical costs, lost 
wages, future lost wages, rehabilitation costs, or any other economic 
out-of-pocket loss suffered as a result of a healthcare injury.
  Far from limiting deserved recoveries in California, these reforms 
have led to medical damage awards in deserving cases, Mr. Chairman, in 
the area of the $80 million to $90 million range.
  The Washington Post reported a few months ago: ``U.S. healthcare 
spending . . . is projected to accelerate over the next decade. . . . A 
study by the Centers for Medicare and Medicaid Services projects that 
the average growth in health spending will be even faster in 2016'' on 
up through the decade of 2025. ``The projections are based on an 
assumption that the legislative status quo will prevail.''
  If we don't change the law, we are going to see these costs going up.
  As Nate Silver pointed out in The New York Times, not my favorite 
document: ``All the major categories of Federal Government spending 
have been increasing relative to inflation. But essentially all of the 
increase in spending relative to economic growth and the potential tax 
base has come from entitlement programs, and about half of all of that 
has come from healthcare entitlements specifically.''
  Studies show that as healthcare costs rise, wages fall; and the more 
companies pay in healthcare costs, the less they can pay in wages. So 
when healthcare costs increase and that growth increases, wages 
stagnate; and when healthcare costs growth slows, wages go up.
  Members who want to see wages increase should vote for this bill--it 
is good for the healthcare workers--because one of the drivers of 
higher healthcare spending is so-called defensive medicine.
  The CHAIR. The time of the gentleman has expired.
  Mr. KING of Iowa. Mr. Chairman, I yield myself an additional 2 
minutes.
  That is a very real phenomenon confirmed by countless studies in 
which healthcare workers conduct many additional costly tests and 
procedures with no medical value. That is charged to our Federal 
taxpayers, and it is simply to avoid excessive litigation costs.
  A survey published in the Archives of Internal Medicine found that 91 
percent of the over 1,000 doctors surveyed ``reported believing that 
physicians order more tests and procedures than needed to protect 
themselves from malpractices suits.''

  The study also asked: ``Are protections against unwarranted medical 
malpractice lawsuits needed to decrease the unnecessary use of 
diagnostic tests?'' And the answer, an identical number: 91 percent of 
the doctors surveyed agreed.
  But there is one Newsweek reporter who described the personal 
experience of individual doctors this way: ``Typical was one doctor, 
who had a list as long as my arm of procedures ER docs perform . . . 
for no patient benefit. They include following a bedside sonogram . . . 
with an ``official'' sonogram because it's easier to defend yourself to 
a jury if you've ordered the second one; a CT scan for every child who 
bumped his or her head, to rule out things that can be diagnosed just 
fine by observation; X-rays that do not guide treatment, such as for a 
simple broken arm; CTs for suspected appendicitis that has been 
perfectly well diagnosed without it.
  ``Although doctors may hate practicing defensive medicine, they do it 
so they don't get sued. . . . Nationwide, physicians estimate that 35 
percent of diagnostic tests they ordered were to avoid lawsuits, as 
were 19 percent of hospitalizations, 14 percent of prescriptions, and 8 
percent of surgeries. . . . All told,'' according to the Newsweek 
article, $650 billion in unnecessary care every year was provided by 
these doctors. Another ER doctor said he ordered 52 CT scans in one 12-
hour shift for a total of $104,000 in a single day.
  These are the things we are dealing with, Mr. Chairman.
  The CHAIR. The time of the gentleman has again expired.
  Mr. KING of Iowa. Mr. Chairman, I yield myself an additional 1 
minute.
  One of the most recent studies, published a few months ago in the 
Journal of the American College of Radiology studied the effects of 
tort reform on

[[Page H5269]]

just radiographic tests alone and found that there were ``2.4 million 
to 2.7 million fewer radiographic tests annually attributed to tort 
reforms.''
  Just imagine what savings would occur if such reforms were attached 
to all Federal healthcare programs, as this bill would do.

                              {time}  1445

  It causes me to think of an orthopedic surgeon who told me that he 
can diagnose an ACL almost every time, yet he is compelled by his 
liability insurance to do additional tests, 97 percent of which are 
unnecessary.
  That is the kind of thing we are dealing with, Mr. Chairman, and it 
is time for us to bring sanity to this litigation that we have in this 
country.
  I reserve the balance of my time.
  Mr. CONYERS. Mr. Chairman, I yield 30 seconds to the gentlewoman from 
Texas (Ms. Jackson Lee).
  Ms. JACKSON LEE. Mr. Chair, I thank the gentleman very much. I think 
the question to the gentleman from Michigan, and the gentleman's 
comments from Iowa, is the question of good medicine, and additional 
tests may, frankly, just be good medicine.
  Maybe, Mr. Chair, Mr. Conyers would agree that we should gather about 
insurance reform and capping premiums so that we can help our doctors. 
And I would assure you that they would be very happy on that.
  But to the gentleman's point, I'm sorry to say he was incorrect, 
because we note that there are almost 20 States that have a variety of 
noncaps on certain aspects, and now the Federal intrusion will come in 
and now tell them where they do not have caps, that they have to have 
caps.
  In fact, he is incorrect, and this bill does skew the medical service 
or medical treatment in our States.
  Mr. CONYERS. Mr. Chair, I yield 2 minutes to the gentleman from Rhode 
Island (Mr. Cicilline), a distinguished member of the House Judiciary 
Committee.
  Mr. CICILLINE. Mr. Chair, I thank the gentleman for yielding.
  I rise in strong opposition to H.R. 1215, which should be more 
accurately called the taking away access to care and justice act. This 
bill will do nothing to strengthen patient protections and will make 
careless healthcare providers less accountable.
  It will severely limit when an injured person is allowed to bring a 
healthcare lawsuit by shortening the time that injured people have to 
seek relief. It will also impose a one-size-fits-all cap on how much 
compensation victims of medical malpractice can receive for pain and 
suffering, regardless of the severity of a person's injury--in order to 
benefit insurance companies and wrongdoers.
  This cap even applies to intentional acts of misconduct. This bill 
would unfairly limit a patient suing a healthcare provider for sexual 
assault, as well as a veteran who has received substandard medical 
care. The bill is written so broadly, it shields both negligent doctors 
and manufacturers of dangerous drugs and medical devices from 
liability.
  H.R. 1215 is before us at a time when Republicans in the Senate are 
working hard to pass a bill that eliminates health coverage for 22 
million people in order to give the wealthiest Americans and insurance 
companies a huge tax cut. The American people deserve better than this.
  Our legal and healthcare system should work for the benefit of 
hardworking Americans, the people we represent, not for the powerful 
special interests. Republicans are chomping at the bit for the 
opportunity to eliminate health coverage for honest, hardworking 
Americans and are making deep cuts to Medicaid just so they can give 
the richest people in this country a $600 billion tax cut.
  And now, they want to prevent injured people from getting justice 
when they are hurt. Middle class families need to see that we are on 
their side. They don't need bills like H.R. 1215, which will rig the 
healthcare and justice systems against them.
  I strongly urge my colleagues to vote ``no'' on H.R. 1215.
  Mr. KING of Iowa. Mr. Chairman, I yield myself 1 minute.
  Mr. Chairman, it is just interesting to me to hear this discussion 
about the Senate addressing the healthcare situation in America. I 
stood on this floor time, after time, after time, and in 2010, March 23 
of 2010, the final passage of ObamaCare was sent out of the Congress to 
the President of the United States, who signed it immediately before 
the sun could come up in the morning.
  And I was sick at heart at what happened to our Constitution, our 
rule of law, our individual rights. And now we have a mess of a 
healthcare system in America. This is a component of the fix. We don't 
have a single Democrat in the House or Senate that is willing to even 
commit to work with us to put up a single vote to try to improve the 
healthcare system in America.
  They made a mistake, and they passed ObamaCare. They served it over 
to us and said: Now you fix it. Well, we are going to declare it a mess 
no matter what you do. We are going to fix it. It is going to take some 
time.
  I reserve the balance of my time.
  Mr. CONYERS. Mr. Chairman, I am pleased to yield 2 minutes to the 
gentleman from Florida (Mr. Deutch), a distinguished member of the 
Judiciary Committee.
  Mr. DEUTCH. Mr. Chair, I thank my friend, the ranking member from 
Michigan.
  Mr. Chairman, I am thrilled to hear my colleague talk about the 
Constitution. I am sorry that the Constitution that he is talking about 
doesn't include the right to a jury trial because that is the 
Constitution that I read.
  And this piece of legislation, H.R. 1215, will threaten that 
constitutional right. We have been told there is nothing to worry about 
in this bill because it will cover 100 percent of economic costs--
anything that comes with a receipt, we were told.
  I am going to tell you what is wrong with this bill and the stories 
of four people: a young child who goes in for a simple procedure and 
leaves the hospital paralyzed; a young adult who requires the 
amputation of his left leg, but the doctor amputates the right leg and 
he leaves the hospital with neither; the woman whose physician used his 
power to sexually assault her while she is sedated; and the rape of a 
nursing home patient by a trusted healthcare provider.

  Mr. Chairman, there will be no receipts that will cover the costs 
that those four individuals would suffer for the rest of their lives 
that could be turned in, compensated, and subject to this artificial 
cap.
  Why is it that my colleagues believe that they are in a better 
position to determine how those wronged individuals should be 
compensated for the atrocities that happened to them instead of 
allowing a jury of their peers do the same?
  This bill is not meant to help reduce costs. This is an assault on 
injured people. This is an assault on those who value access to the 
courtroom in order to see justice.
  I urge my colleagues, in the strongest possible terms, to reject this 
anticonsumer, this terrible piece of legislation.
  Mr. KING of Iowa. Mr. Chairman, I yield myself 1 minute.
  Mr. Chairman, as you listen to the stories that are here that have 
been delivered by the gentleman from Florida, I am wondering why we 
haven't heard these stories come out of California. Because this 
legislation essentially mirrors California legislation. That was the 
model that we followed. And they have had over 40 years to repeal or 
amendment it, and it has been sustainable.
  There is a right to a jury trial under this. It is just that there 
are caps that are set, that are reasonable caps, and the States are 
free to change those caps up or down.
  So I don't quite follow this, but I would say someone who is raped in 
a nursing home is not covered under this. This legislation doesn't 
affect it at all. It has to have an affect by a diagnosis, a 
prevention, or a treatment of a disease impairment; and a rape is not 
that. So it would not be covered under this legislation.
  Mr. Chairman, I know that my opposition would like to have this 
legislation killed. I would just point out something that I heard on 
the floor of the House here about 10 years ago, and it was this: We can 
pass this legislation, but the Senate may not pass it. And I would urge 
them to take it up. There is a special interest, and it is the Trial 
Lawyers Association. They are the ones who will not come out of this 
very well.

[[Page H5270]]

  Mr. Chair, I reserve the balance of my time.
  Mr. CONYERS. Mr. Chairman, I yield 1 minute to the gentleman from 
Tennessee (Mr. Duncan).
  Mr. DUNCAN of Tennessee. Mr. Chairman, I rise in opposition to this 
bill. As the House Liberty Caucus wrote, this bill violates the 10th 
Amendment that conservatives have always supported.
  More troubling is the way this bill is worded. It could lead to what 
the Liberty Caucus describes as a ``massive expansion of Federal 
authority'' because it could make almost every medical malpractice case 
a Federal case. Every case should not be a Federal case.
  The States have already put pretty severe limits on medical 
malpractice cases. I have two other problems with this bill. I am in my 
29th year in Congress. The doctors were asking for this $250,000 limit 
then, too. $250,000 29 years ago is certainly not $250,000 today.
  Finally, this bill, in the end, is saying there are really no limits 
on suits against 99.8 percent of the people I represent, but we are 
going to have special protection for this one very respected group of 
people. Conservatives have traditionally had more faith in people than 
in government.
  I was a judge for 7.5 years before coming to Congress. Conservatives 
used to believe strongly in the jury system, and still should believe 
in that today.
  Mr. KING of Iowa. Mr. Chairman, I yield myself 1 minute.
  Mr. Chairman, I point out also that this bill keeps these cases in 
State court. It doesn't move them to Federal court. Previous 
legislation that has been brought to this floor, a decade or so ago, 
did move a lot of these cases to Federal court. But it is carefully 
drafted to keep this with the maximum amount of respect for States' 
rights that can be held and still have a Federal interest.
  There has to be a Federal interest in every dollar involved in this. 
In every single case, there has to be Federal dollars involved in it, 
or this bill wouldn't affect it at all. And so I am one who is also a 
great respecter of States' rights. And in this legislation, as drafted, 
there are provisions in there over and over again that protect as many 
of the States' rights as can be. And if you take the other side of this 
argument, then it is far stronger that the right of the Federal 
Government would be usurped by the States if we don't have this 
legislation.
  That is what is taking place now--States that choose not to make a 
decision, not to set caps, and we are seeing huge settlements going on 
around the country. This is what we want to end, so that we can save 
the $50 to $54 billion for the taxpayers. But the thing that is even 
worth more than this is, how much of that $650 billion in defensive 
medicine will no longer be used in this country, and how much safer and 
less expensive will our healthcare be in America?
  I reserve the balance of my time.
  Mr. CONYERS. Mr. Chairman, I yield myself such time as I may consume.
  I just have to add here that H.R. 1215 deeply intrudes on States' 
sovereignty. In particular, H.R. 1215 preempts State law governing 
joint and several liability, the availability of damages, the ability 
to introduce evidence of collateral source benefits, attorneys' fees, 
and periodic payments of future damages.
  Members should not be fooled by assertions that the bill preserves 
State law. In fact, the rule of construction contained in the bill 
expressly states that it preempts State law, except in very limited 
circumstances where State law is more favorable to defendants.
  Mr. Chair, I yield 2 minutes to the gentlewoman from Washington (Ms. 
Jayapal).
  Ms. JAYAPAL. Mr. Chair, I thank the gentleman for yielding.

  Mr. Chair, I rise today to express my strong opposition to H.R. 1215. 
First of all, my home State of Washington is one of those States where 
our Supreme Court has ruled and said that caps are not constitutional. 
So this bill is an intrusion of our States' rights.
  This bill also clearly puts the interests of big corporations over 
everyday people and sends a signal to medical and health providers that 
they can act irresponsibly, perhaps to make more money, and get away 
with it.
  Let me give you a very real example of what happens when hospitals 
put profit over people. The neurology program at Swedish Medical 
Center-Cherry Hill in Seattle is under investigation for negligent care 
arising out of a program designed to incentivize neuroscience doctors 
to take on heavy caseloads of complicated cases that lead to serious 
errors and even death.
  One of the patients was Talia Goldenberg, a talented and vibrant 
young woman. Talia went in for a cervical spinal fusion with a 
neurosurgeon who had been embroiled in numerous investigations. And as 
a result of gross medical malpractice, Talia died.
  According to a Seattle Times investigation, numerous problems 
surfaced around her care--or lack thereof--and attention to the surgery 
and medical complications that arose from it.
  When Talia went in for her surgery, she was filled with hope. In 
thinking about the life that she might have after surgery, she wrote 
this: So who am I? I am an artist, a dreamer. I am a stationary biker. 
I am a woman, a girl, a person. I am a skier. I am an aspiring pole 
vaulter. I am a reluctant, yet faithful, believer of the power of lucky 
underwear. I am someone with a voice.
  Talia died. She is one of the many tragic instances of people losing 
their lives to medical malpractice, and, even in my own office, two of 
my staffers have lost three of their grandparents due to medical 
malpractice. We have to make sure that we have consequences when we 
entrust our healthcare to someone, and there are grave errors.
  For the sake of Talia and so many others like her who have dreams 
that are violated by preventable errors, we must defeat this bill.
  A ``no'' vote is a vote for the American people.

                              {time}  1500

  Mr. KING of Iowa. Mr. Chairman, I yield myself 1 minute.
  Mr. Chairman, I was a little surprised to hear that a judge in the 
State of Washington had ruled that caps are unconstitutional. In fact, 
it is kind of curious to hear the same arguments--or conflicting 
arguments coming out of the other side. One of them says it is the 
States' rights to be able to set the caps. The other one says it is 
unconstitutional to set the caps. So I think that conflict, it would be 
good if that were resolved.
  I think, in either case, that I disagree with both of those 
positions, Mr. Chairman.
  If a Washington State judge says caps are unconstitutional, on what 
basis?
  That would say, then, that a State legislature couldn't cap them; 
Congress can't cap them; that this is essentially, then, a function of 
the courts.
  I remember a decision that came out of the State of Washington. It 
was a Federal judge that essentially ruled that the President's 
executive order on, let's say, migrants coming into the United States 
was unconstitutional, even though Congress specifically granted the 
authority to their President. So I am not going to defer to a single 
judge's opinion in that fashion.
  I would point out, too, that we do protect States' rights. There is 
provision in this bill after provision, and it is titled State 
Flexibility. Look through their and find all the provisions of State 
Flexibility where we respect States' rights. And it is written as 
carefully as it can be to respect the maximum amount of States' rights.
  Mr. Chairman, I reserve the balance of my time.
  Mr. CONYERS. Mr. Chairman, I yield 2 minutes to the gentleman from 
New York (Mr. Jeffries).
  Mr. JEFFRIES. Mr. Chairman, let's be clear: this bill has nothing to 
do with litigation reform. It has nothing to do with a good faith 
attempt to improve our healthcare system.
  In fact, this bill was described as phase 3 of an effort to improve 
our healthcare by the majority leader on the other side of the aisle. I 
put out a search committee. I still can't find phase 1 or phase 2. It 
has nothing to do with reforming our healthcare system.
  This bill is an unprecedented attack on States' rights. It is a wolf 
in sheep's clothing. It is a solution in search of a problem. It is 
nothing more than a reckless legislative joyride guaranteed to crash 
and burn on the American people.

[[Page H5271]]

  This bill, if enacted, will hurt working families, middle class 
people, senior citizens, the poor, the sick, the afflicted, veterans, 
and nursing home residents.
  The American people deserve a litigation system that works for 
everyone, not simply the wealthy and the well-off. The American people 
deserve a litigation system that puts the public's interest ahead of 
special interests. The American people deserve a litigation system that 
promotes public health, not just excessive wealth.
  This bill fails on all of those counts. It is mean-spirited, it is 
cruel, it is heartless. Mr. Chairman, that is why it must be defeated.
  Mr. KING of Iowa. Mr. Chairman, I yield myself 15 seconds.
  I would just point out to the body that I didn't hear a single fact 
in the previous 2 minutes. It is all opinion and hurled accusations. 
But I think it is important for this body to deliberate over the facts 
themselves, and I have delivered a lot of that data.
  Mr. Chairman, I reserve the balance of my time.
  Mr. CONYERS. Mr. Chairman, I yield 2 minutes to the gentleman from 
Maryland (Mr. Raskin), a distinguished member of the House Judiciary 
Committee.
  Mr. RASKIN. Mr. Chairman, the floor leader has invited us to stick to 
the facts, so I want to stick to the facts in order to clear up some of 
the propaganda I have heard today for this terrible bill.
  First of all, it has nothing to do with ``groundless cases or 
frivolous claims,'' because the draconian new limits proposed in their 
legislation applied only to valid claims in serious cases. It has 
nothing to do with groundless cases and frivolous claims. That is an 
irrelevant distraction from their own legislation, which is an attempt 
to reduce what you can recover with a perfectly valid claim when a jury 
has awarded you damages.
  Number two, the floor leader says that it would not apply in the case 
of someone being raped in a nursing home. Perhaps he thinks it wouldn't 
apply to my constituent, a 15-year-old girl who got raped by her 
dentist.
  But as I read the bill, it says, ``healthcare lawsuit means any 
action against a healthcare provider,'' and that includes anyone who is 
providing healthcare. So if a nursing home is providing healthcare or a 
dentist is providing healthcare, they would be covered by the law.
  But I would invite the floor leader to clear this up, because if he 
is representing now that rapes of patients in a nursing home or in a 
dentist's office don't count, that should be definitive legislative 
history that we establish today because we tried to amend the bill to 
that effect in committee and the majority voted it down. But he has 
just represented that a rape would not count, and I want him to 
definitively commit whether or not a rape by a healthcare provider 
would count.
  Finally, the gentleman from Iowa says it won't preempt the States, it 
will not impose Federal laws because it is still in the State courts. 
It is still in the State courts, but Federal law now applies.
  There are 28 States which have said that you cannot limit people's 
access to noneconomic damages when a jury wants to award them those 
damages for pain and suffering. They have either said in their 
Constitution there can be no limits at all, or the legislatures have 
said it, or the State supreme courts have struck it down. And their 
legislation is a bulldozer that will run over the laws of 28 States.
  And they claim, Mr. Chairman, that somehow they are acting in the 
guise of federalism. They are destroying federalism. That is why I was 
so happy that Mr. Duncan, a former State Judge from Tennessee, and a 
member of the GOP majority, got up to say this is antithetical to 
everything they stand for.

  Mr. KING of Iowa. Mr. Chairman, I yield myself 1 minute.
  Mr. Chairman, I would point out, first of all, the gentleman from 
Maryland must know that this isn't a criminal statute. This is civil 
law. It doesn't have anything to do with crime or criminal law, so 
let's keep our discussion to the civil actions that we are discussing 
here.
  It is not propaganda. It is facts that we have delivered on this 
side. So I want to put this into the Record verbatim, Mr. Chairman. 
Regarding cases of rape or physical abuse, H.R. 1215 does not cover 
such cases at all. That is because the bill only applies to medical 
malpractice claims based on the provision or use of healthcare 
services; and healthcare services are defined in the bill as things 
related to the diagnosis, prevention, or treatment of any human disease 
or impairment.
  Clearly, rape or any other physical abuse, and the neglect of basic 
sanitary conditions, is not related to the diagnosis, prevention, or 
treatment of any human disease or impairment. So in cases involving 
rape or physical abuse by anyone, or neglect of basic needs, the bill 
simply does not apply.
  But it does respect States' rights. It is carefully written to 
protect States' rights. It is a significant and huge improvement upon 
some efforts we have seen in the past, and one of those reasons is 
because many of us care about States' rights, and we pay attention to 
the Constitution. There is a Federal nexus in everything that goes on 
here, and States are not limited from raising caps on economic or 
noneconomic damages or lowering those caps. We respect the States in 
every way possible, and still get a positive result out of H.R. 1215.
  Mr. Chairman, I reserve the balance of my time.
  Mr. CONYERS. Mr. Chairman, I yield 30 seconds to the gentleman from 
Maryland (Mr. Raskin).
  Mr. RASKIN. Mr. Chairman, first of all, there are only three States 
in the Union that set the limit where they want Congress to set it for 
every State, which is $250,000. They are overriding the laws of 28 
States which allow for unlimited damages.
  Number two, the gentleman from Iowa says: Well, a rape is criminal, 
so it is not related.
  But you can bring civil actions against the same conduct that 
constitutes a crime. So if you look at your own bill, it says any 
theory of liability, so that would include intentional acts.
  Now, again, Mr. Chairman, is the majority representing that this will 
not apply to intentional torts?
  Because they were very definitive in committee that it would apply to 
intentional torts, including rapes and assaults. So I would like to 
know: Does it apply or does it not?
  Because this is a critical matter, because people have been--we are 
not talking about the good doctors. Everybody loves the good doctors. 
We are talking about doctors or nursing home providers or dentists who 
rape their patients and assault their patients.
  They would be limited--juries could try to give millions of dollars, 
but their legislation would limit you to $250,000 in noneconomic 
damages. We have got to clear this up, Mr. Chairman.
  Mr. KING of Iowa. Mr. Chairman, I reserve the balance of my time.
  Mr. CONYERS. Mr. Chairman, I yield 1 minute to the gentlewoman from 
Oregon (Ms. Bonamici).
  Ms. BONAMICI. Mr. Chairman, I rise today in strong opposition to H.R. 
1215, a misguided and misnamed bill that will limit access to justice, 
especially for women.
  The bill caps the amount of compensation a jury can award to a victim 
who suffers medical injuries, even catastrophic injuries, because it 
creates a lifetime cap of $250,000 for noneconomic damages.
  This means that women, or men, for that matter, who are at home 
raising their families, or children who are victims of devastating 
medical malpractice are told that the value of their injuries and their 
lives is less than that of their wage-earning counterparts. That is 
patently unfair. It disproportionately penalizes people who are family 
caregivers--a very important job, but one that does not involve wages.
  Furthermore, many women across the country have been victims of 
medical malpractice that has left them unable to bear children.
  How can we say to these women that the loss they have suffered, the 
loss of an opportunity to be a mother is without value?
  That is unacceptable, and it is cruel.
  Many medical errors are preventable. We should be focusing on 
improving patient safety, not taking away rights from victims.
  I oppose this bill, and I will continue to fight back against 
attempts to limit access to justice for those who need it most. Please 
join me in voting ``no.''

[[Page H5272]]

  

  Mr. KING of Iowa. Mr. Chairman, I yield myself 30 seconds.
  Mr. Chairman, I have heard the gentleman from Maryland say that this 
legislation would override the laws of 28 States. That was a surprise 
to me to hear that when I heard the number before Rules Committee, 
which I think I actually recall it was 27. But 28, 27, it doesn't 
override laws. It is the absence of laws.
  There are States that don't have caps. That is what we are talking 
about here. So it is not overriding State laws in States where there 
are no laws. It simply is setting a Federal foundation and a guideline 
for them.
  And if I am in a State legislature, I know I have the authority to 
raise or lower the cap on economic and on noneconomic damages, and that 
my laws are not being overridden, but they are being provided by the 
wisdom of the American people, then I am going to be thankful I have 
that to work with until I can amend it.
  Mr. Chairman, I reserve the balance of my time.
  Mr. CONYERS. Mr. Chairman, I refer my colleague, the floor leader on 
the other side to section 9 of the bill. We have just looked at it.
  Mr. Chairman, I yield 1 minute to the gentlewoman from California 
(Ms. Barragan).
  Ms. BARRAGAN. Mr. Chairman, I rise today in opposition to H.R. 1215 
and to express my extreme concerns with this bill.
  I am from California, and I am an attorney, and I can tell you that 
this bill goes beyond medical malpractice. It goes way beyond that. It 
includes cases involving unsafe drugs and nursing home abuse and 
neglect. That is not happening in California.
  If passed, it would prevent cases where seniors have endured tragic 
deaths and injuries, like an 88-year-old California woman who was 
sexually assaulted by her nursing assistant after she suffered a 
stroke, resulting in lifelong mental and physical pain.
  Over 80 senior and healthcare groups, including the American 
Association for Justice and the California Advocates for Nursing Home 
Reform, have come out against this bill. They recognize that we need to 
protect our vulnerable seniors.
  Mr. Chairman, I urge my colleagues to oppose this bill.
  Mr. KING of Iowa. Mr. Chairman, I reserve the balance of my time.
  Mr. CONYERS. Mr. Chairman, I yield 1 minute to the gentleman from 
Pennsylvania (Mr. Cartwright).
  Mr. CARTWRIGHT. Mr. Chairman, here we are dealing with some amount of 
irony with H.R. 1215. The year 1215 was the year the Magna Carta was 
signed, something that created the seeds of the American right to jury 
trial, for Heaven's sake.
  You know, we were pleased to hear Representative Duncan from 
Tennessee say: ``Conservatives believe strongly in the jury system.'' 
And I do, too, and Americans do, too. Our Founding Fathers believed in 
it.
  Here in America, where we trust juries to decide life and death for 
criminal defendants, why wouldn't we trust them to set a proper and 
fair dollar amount on a malpractice case?
  By definition, these are meritorious cases, cases where there was 
actual negligence, actual recklessness, actual intentional harm by 
healthcare providers or nursing homes.

                              {time}  1515

  But maybe most importantly, none of us, nary a soul in this House 
would deny that standing up for veterans and our military families is a 
core value for all of us. This is a bill that prevents accountability 
for harm done to military and veterans of the VA system.
  Mr. KING of Iowa. Mr. Chairman, I reserve the balance of my time.
  Mr. CONYERS. Mr. Chairman, I yield 1 minute to the gentleman from 
Maryland (Mr. Raskin).
  Mr. RASKIN. Mr. Chairman, I thank Mr. Conyers very much for yielding.
  The good gentleman from Iowa invites us to believe that the laws of 
the States are not being overridden because some of these States don't 
have laws. That's right, because their State supreme courts have said 
that their constitutions forbid the imposition of a cap on what juries 
would award people who are injured in medical cases.
  So, in Arizona, Arkansas, Kentucky, Pennsylvania, and Wyoming, there 
are State constitutional prohibitions explicitly on damage caps. In New 
York and Oklahoma, there are explicit caps on damages in wrongful death 
cases. And in 11 States, State supreme courts have struck down 
statutorily enacted medical malpractice damage caps: Alabama, Florida, 
Georgia, Illinois, Missouri, New Hampshire, North Dakota, South Dakota, 
Utah, Washington, and Wisconsin.
  Now, what is interesting in my State, the 15-year-old girl who was 
raped by her dentist could recover up to $785,000 because we had a 
whole special session of our general assembly to arrive at that figure. 
But there are other States where they said you can't have any limits at 
all, and those are the States that are being attacked by this 
legislation because now they are reducing them from potentially $20 
million or $10 million to $200,000, an outrageous invasion in states' 
rights and the rights of juries to decide how people need to be 
compensated.
  Mr. CONYERS. Mr. Chairman, I yield myself the balance of my time to 
close.
  Numerous consumer, labor, veterans, and legal groups all oppose H.R. 
1215, including the AFL-CIO, the American College of Physicians, the 
Consumers Union, Public Citizen, Vietnam Veterans of America, 12 other 
national veterans organizations, and the Liberty Caucus.
  H.R. 1215 is an extremely flawed bill that will deny access to 
justice for victims of medical malpractice and especially those who are 
the most vulnerable among us. It would deny full compensation for 
injuries suffered by veterans and military families, children, the 
elderly, and the poor.
  I hope my colleagues will join us in opposing this very unnecessary, 
mean-spirited bill.
  Mr. Chairman, I yield back the balance of my time.
  Mr. KING of Iowa. Mr. Chairman, I inquire as to the amount of time I 
have remaining.
  The CHAIR. The gentleman from Iowa has 4\1/2\ minutes remaining.
  Mr. KING of Iowa. Mr. Chair, I yield myself the balance of my time.
  First, I say in response to the gentleman from Maryland's discussion 
about the States courts that have prohibited caps. That is one of the 
reasons that we need this legislation, is that you have out-of-control 
liberal judges that have decided that even their State legislatures 
can't pass the laws. They want to come in and preempt the states' 
rights of we, the people, of the individual States who elect their 
general assemblies to make their decisions.
  Often, the judges are set in lifetime appointments where they are not 
held accountable, so it would be interesting to look back into each of 
these States that the gentleman from Maryland has mentioned and address 
this thing from ``we, the people'' because we, the people, are the 
power in this country. Our rights come from God, and they are vested in 
we, the people.
  I thought the gentleman from Pennsylvania's look at H.R. 1215 was a 
really deft way to focus on this and speak about the Magna Carta, but 
there wasn't anybody back in old England in that time that had any shot 
at filing a liability claim, let alone receiving a frivolous claim that 
would make one individual vastly wealthy at the expense of a lot of 
other folks. So this is something that has accumulated over the last 
502 years since the Magna Carta was signed.
  So I would say this: healthcare costs are out of control due in large 
part to unlimited lawsuits and other problems ObamaCare failed to solve 
or else ObamaCare made worse. H.R. 1215 is commonsense litigation 
reform legislation that will rein in overly aggressive and healthcare 
lawsuits while preserving the ability of plaintiffs to recover 
unlimited economic damages.
  The bill applies only to claims concerning the provision of 
healthcare goods or services for which coverage is provided in whole or 
in part by a Federal program, a Federal subsidy, or a Federal tax 
benefit giving it a clear Federal nexus.
  This isn't criminal legislation. It doesn't address the cases of 
rape. We should arrest those people and lock them up in prison and 
punish them to the max, but it is not the subject of this legislation.
  So wherever the Federal policy directly affects the distribution of

[[Page H5273]]

healthcare, there is a clear Federal interest in reducing the cost of 
such Federal policy. This bill's commonsense reforms, which have been 
the law in California for over 40 years, are conservatively estimated 
by CBO to save at least $50 billion. The previous estimate was $54 
billion in Federal healthcare dollars. At the same time, this bill 
doesn't in any way limit compensation for 100 percent of plaintiffs' 
losses.
  As reported in The Washington Post last month, the U.S. healthcare 
spending is projected to accelerate over the next day. A study by the 
Centers for Medicare and Medicaid Services project that the average 
growth in healthcare spending will be even faster between 2016 and 
2025. The projections are based on an assumption that the legislative 
status quo will prevail. Studies show that, as healthcare costs rise, 
wages fall. H.R. 1215 will save billions of dollars in healthcare costs 
and will, thereby, increase wages for workers nationwide.

  Mr. Chairman, as I look at the picture of how I watched this 
defensive medicine grow over the years and over the decades, $650 
billion potentially, reported by a Newsweek article, in unnecessary 
defensive medicine tests that are done. A doctor that ordered CT scans 
in massive numbers in a single day, when I see 97 percent of the MRIs 
just to be sure that the diagnosis of an ACL knee injury is protected 
in the case of liability insurance, we are not going to see just $50 
billion in savings here. We are going to see hundreds of billions of 
dollars in savings.
  And as an anesthesiologist told me that--he was practicing in Texas--
when Texas passed the law that is roughly a mirror of California law, 
that his premium as an anesthesiologist was $26,000 a year; and after 
the law passed in Texas, it dropped to $6,500, exactly one-fourth. A 75 
percent reduction in that particular case. He is now practicing in 
Iowa. Iowa passed mirror legislation as well.
  Mr. Chairman, I urge all of my colleagues to join me in supporting 
this vital legislation, and I yield back the balance of my time.
  The CHAIR. All time for general debate has expired.
  Pursuant to the rule, the bill shall be considered for amendment 
under the 5-minute rule.
  In lieu of the amendment in the nature of a substitute recommended by 
the Committee on the Judiciary, printed in the bill, it shall be in 
order to consider as an original bill for the purpose of amendment 
under the 5-minute rule an amendment in the nature of a substitute 
consisting of the text of Rules Committee Print 115-10. That amendment 
in the nature of a substitute shall be considered as read.
  The text of the amendment in the nature of a substitute is as 
follows:

                               H.R. 1215

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Protecting 
     Access to Care Act of 2017''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

       Sec. 1. Short title; table of contents.
       Sec. 2. Encouraging speedy resolution of claims.
       Sec. 3. Compensating patient injury.
       Sec. 4. Maximizing patient recovery.
       Sec. 5. Authorization of payment of future damages to 
           claimants in health care lawsuits.
       Sec. 6. Product liability for health care providers.
       Sec. 7. Definitions.
       Sec. 8. Effect on other laws.
       Sec. 9. Rules of construction.
       Sec. 10. Effective date.

     SEC. 2. ENCOURAGING SPEEDY RESOLUTION OF CLAIMS.

       (a) Statute of Limitations.--The time for the commencement 
     of a health care lawsuit shall be 3 years after the date of 
     injury or 1 year after the claimant discovers, or through the 
     use of reasonable diligence should have discovered, the 
     injury, whichever occurs first. In no event shall the time 
     for commencement of a health care lawsuit exceed 3 years 
     after the date of injury unless tolled for any of the 
     following--
       (1) upon proof of fraud;
       (2) intentional concealment; or
       (3) the presence of a foreign body, which has no 
     therapeutic or diagnostic purpose or effect, in the person of 
     the injured person.
     Actions by a minor shall be commenced within 3 years from the 
     date of the injury except that actions by a minor under the 
     full age of 6 years shall be commenced within 3 years of 
     injury, or 1 year after the injury is discovered, or through 
     the use of reasonable diligence should have been discovered, 
     or prior to the minor's 8th birthday, whichever provides a 
     longer period. Such time limitation shall be tolled for 
     minors for any period during which a parent or guardian and a 
     health care provider have committed fraud or collusion in the 
     failure to bring an action on behalf of the injured minor.
       (b) State Flexibility.--No provision of subsection (a) 
     shall be construed to preempt any state law (whether 
     effective before, on, or after the date of the enactment of 
     this Act) that--
       (1) specifies a time period of less than 3 years after the 
     date of injury or less than 1 year after the claimant 
     discovers, or through the use of reasonable diligence should 
     have discovered, the injury, for the filing of a health care 
     lawsuit;
       (2) that specifies a different time period for the filing 
     of lawsuits by a minor;
       (3) that triggers the time period based on the date of the 
     alleged negligence; or
       (4) establishes a statute of repose for the filing of 
     health care lawsuit.

     SEC. 3. COMPENSATING PATIENT INJURY.

       (a) Unlimited Amount of Damages for Actual Economic Losses 
     in Health Care Lawsuits.--In any health care lawsuit, nothing 
     in this Act shall limit a claimant's recovery of the full 
     amount of the available economic damages, notwithstanding the 
     limitation in subsection (b).
       (b) Additional Noneconomic Damages.--In any health care 
     lawsuit, the amount of noneconomic damages, if available, 
     shall not exceed $250,000, regardless of the number of 
     parties against whom the action is brought or the number of 
     separate claims or actions brought with respect to the same 
     injury.
       (c) No Discount of Award for Noneconomic Damages.--For 
     purposes of applying the limitation in subsection (b), future 
     noneconomic damages shall not be discounted to present value. 
     The jury shall not be informed about the maximum award for 
     noneconomic damages. An award for noneconomic damages in 
     excess of $250,000 shall be reduced either before the entry 
     of judgment, or by amendment of the judgment after entry of 
     judgment, and such reduction shall be made before accounting 
     for any other reduction in damages required by law. If 
     separate awards are rendered for past and future noneconomic 
     damages and the combined awards exceed $250,000, the future 
     noneconomic damages shall be reduced first.
       (d) Fair Share Rule.--In any health care lawsuit, each 
     party shall be liable for that party's several share of any 
     damages only and not for the share of any other person. Each 
     party shall be liable only for the amount of damages 
     allocated to such party in direct proportion to such party's 
     percentage of responsibility. Whenever a judgment of 
     liability is rendered as to any party, a separate judgment 
     shall be rendered against each such party for the amount 
     allocated to such party. For purposes of this section, the 
     trier of fact shall determine the proportion of 
     responsibility of each party for the claimant's harm.
       (e) State Flexibility.--No provision of this section shall 
     be construed to preempt any State law (whether effective 
     before, on, or after the date of the enactment of this Act) 
     that specifies a particular monetary amount of economic or 
     noneconomic damages (or the total amount of damages) that may 
     be awarded in a health care lawsuit, regardless of whether 
     such monetary amount is greater or lesser than is provided 
     for under this section.

     SEC. 4. MAXIMIZING PATIENT RECOVERY.

       (a) Court Supervision of Share of Damages Actually Paid to 
     Claimants.--In any health care lawsuit, the court shall 
     supervise the arrangements for payment of damages to protect 
     against conflicts of interest that may have the effect of 
     reducing the amount of damages awarded that are actually paid 
     to claimants. In particular, in any health care lawsuit in 
     which the attorney for a party claims a financial stake in 
     the outcome by virtue of a contingent fee, the court shall 
     have the power to restrict the payment of a claimant's damage 
     recovery to such attorney, and to redirect such damages to 
     the claimant based upon the interests of justice and 
     principles of equity. In no event shall the total of all 
     contingent fees for representing all claimants in a health 
     care lawsuit exceed the following limits:
       (1) Forty percent of the first $50,000 recovered by the 
     claimant(s).
       (2) Thirty-three and one-third percent of the next $50,000 
     recovered by the claimant(s).
       (3) Twenty-five percent of the next $500,000 recovered by 
     the claimant(s).
       (4) Fifteen percent of any amount by which the recovery by 
     the claimant(s) is in excess of $600,000.
       (b) Applicability.--The limitations in this section shall 
     apply whether the recovery is by judgment, settlement, 
     mediation, arbitration, or any other form of alternative 
     dispute resolution. In a health care lawsuit involving a 
     minor or incompetent person, a court retains the authority to 
     authorize or approve a fee that is less than the maximum 
     permitted under this section. The requirement for court 
     supervision in the first two sentences of subsection (a) 
     applies only in civil actions.
       (c) State Flexibility.--No provision of this section shall 
     be construed to preempt any State law (whether effective 
     before, on, or after the date of the enactment of this Act) 
     that specifies a lesser percentage or lesser total value of 
     damages which may be claimed by an attorney representing a 
     claimant in a health care lawsuit.

[[Page H5274]]

  


     SEC. 5. AUTHORIZATION OF PAYMENT OF FUTURE DAMAGES TO 
                   CLAIMANTS IN HEALTH CARE LAWSUITS.

       (a) In General.--In any health care lawsuit, if an award of 
     future damages, without reduction to present value, equaling 
     or exceeding $50,000 is made against a party with sufficient 
     insurance or other assets to fund a periodic payment of such 
     a judgment, the court shall, at the request of any party, 
     enter a judgment ordering that the future damages be paid by 
     periodic payments, in accordance with the Uniform Periodic 
     Payment of Judgments Act promulgated by the National 
     Conference of Commissioners on Uniform State Laws.
       (b) Applicability.--This section applies to all actions 
     which have not been first set for trial or retrial before the 
     effective date of this Act.
       (c) State Flexibility.--No provision of this section shall 
     be construed to preempt any State law (whether effective 
     before, on, or after the date of the enactment of this Act) 
     that specifies periodic payments for future damages at any 
     amount other than $50,000 or that mandates such payments 
     absent the request of either party.

     SEC. 6. PRODUCT LIABILITY FOR HEALTH CARE PROVIDERS.

       A health care provider who prescribes, or who dispenses 
     pursuant to a prescription, a medical product approved, 
     licensed, or cleared by the Food and Drug Administration 
     shall not be named as a party to a product liability lawsuit 
     involving such product and shall not be liable to a claimant 
     in a class action lawsuit against the manufacturer, 
     distributor, or seller of such product.

     SEC. 7. DEFINITIONS.

       In this Act:
       (1) Alternative dispute resolution system; adr.--The term 
     ``alternative dispute resolution system'' or ``ADR'' means a 
     system that provides for the resolution of health care 
     lawsuits in a manner other than through a civil action 
     brought in a State or Federal court.
       (2) Claimant.--The term ``claimant'' means any person who 
     brings a health care lawsuit, including a person who asserts 
     or claims a right to legal or equitable contribution, 
     indemnity, or subrogation, arising out of a health care 
     liability claim or action, and any person on whose behalf 
     such a claim is asserted or such an action is brought, 
     whether deceased, incompetent, or a minor.
       (3) Collateral source benefits.--The term ``collateral 
     source benefits'' means any amount paid or reasonably likely 
     to be paid in the future to or on behalf of the claimant, or 
     any service, product, or other benefit provided or reasonably 
     likely to be provided in the future to or on behalf of the 
     claimant, as a result of the injury or wrongful death, 
     pursuant to--
       (A) any State or Federal health, sickness, income-
     disability, accident, or workers' compensation law;
       (B) any health, sickness, income-disability, or accident 
     insurance that provides health benefits or income-disability 
     coverage;
       (C) any contract or agreement of any group, organization, 
     partnership, or corporation to provide, pay for, or reimburse 
     the cost of medical, hospital, dental, or income-disability 
     benefits; and
       (D) any other publicly or privately funded program.
       (4) Contingent fee.--The term ``contingent fee'' includes 
     all compensation to any person or persons which is payable 
     only if a recovery is effected on behalf of one or more 
     claimants.
       (5) Economic damages.--The term ``economic damages'' means 
     objectively verifiable monetary losses incurred as a result 
     of the provision or use of (or failure to provide or use) 
     health care services or medical products, such as past and 
     future medical expenses, loss of past and future earnings, 
     cost of obtaining domestic services, loss of employment, and 
     loss of business or employment opportunities, unless 
     otherwise defined under applicable state law. In no 
     circumstances shall damages for health care services or 
     medical products exceed the amount actually paid or incurred 
     by or on behalf of the claimant.
       (6) Future damages.--The term ``future damages'' means any 
     damages that are incurred after the date of judgment, 
     settlement, or other resolution (including mediation, or any 
     other form of alternative dispute resolution).
       (7) Health care lawsuit.--The term ``health care lawsuit'' 
     means any health care liability claim concerning the 
     provision of goods or services for which coverage was 
     provided in whole or in part via a Federal program, subsidy 
     or tax benefit, or any health care liability action 
     concerning the provision of goods or services for which 
     coverage was provided in whole or in part via a Federal 
     program, subsidy or tax benefit, brought in a State or 
     Federal court or pursuant to an alternative dispute 
     resolution system, against a health care provider regardless 
     of the theory of liability on which the claim is based, or 
     the number of claimants, plaintiffs, defendants, or other 
     parties, or the number of claims or causes of action, in 
     which the claimant alleges a health care liability claim. 
     Such term does not include a claim or action which is based 
     on criminal liability; which seeks civil fines or penalties 
     paid to Federal, State, or local government; or which is 
     grounded in antitrust.
       (8) Health care liability action.--The term ``health care 
     liability action'' means a civil action brought in a State or 
     Federal court or pursuant to an alternative dispute 
     resolution system, against a health care provider regardless 
     of the theory of liability on which the claim is based, or 
     the number of plaintiffs, defendants, or other parties, or 
     the number of causes of action, in which the claimant alleges 
     a health care liability claim.
       (9) Health care liability claim.--The term ``health care 
     liability claim'' means a demand by any person, whether or 
     not pursuant to ADR, against a health care provider, 
     including, but not limited to, third-party claims, cross-
     claims, counter-claims, or contribution claims, which are 
     based upon the provision or use of (or the failure to provide 
     or use) health care services or medical products, regardless 
     of the theory of liability on which the claim is based, or 
     the number of plaintiffs, defendants, or other parties, or 
     the number of causes of action.
       (10) Health care provider.--The term ``health care 
     provider'' means any person or entity required by State or 
     Federal laws or regulations to be licensed, registered, or 
     certified to provide health care services, and being either 
     so licensed, registered, or certified, or exempted from such 
     requirement by other statute or regulation, as well as any 
     other individual or entity defined as a health care provider, 
     health care professional, or health care institution under 
     state law.
       (11) Health care services.--The term ``health care 
     services'' means the provision of any goods or services by a 
     health care provider, or by any individual working under the 
     supervision of a health care provider, that relates to the 
     diagnosis, prevention, or treatment of any human disease or 
     impairment, or the assessment or care of the health of human 
     beings.
       (12) Medical product.--The term ``medical product'' means a 
     drug, device, or biological product intended for humans, and 
     the terms ``drug'', ``device'', and ``biological product'' 
     have the meanings given such terms in sections 201(g)(1) and 
     201(h) of the Federal Food, Drug and Cosmetic Act (21 U.S.C. 
     321(g)(1) and (h)) and section 351(a) of the Public Health 
     Service Act (42 U.S.C. 262(a)), respectively, including any 
     component or raw material used therein, but excluding health 
     care services.
       (13) Noneconomic damages.--The term ``noneconomic damages'' 
     means damages for physical and emotional pain, suffering, 
     inconvenience, physical impairment, mental anguish, 
     disfigurement, loss of enjoyment of life, loss of society and 
     companionship, loss of consortium (other than loss of 
     domestic service), hedonic damages, injury to reputation, and 
     all other nonpecuniary losses of any kind or nature incurred 
     as a result of the provision or use of (or failure to provide 
     or use) health care services or medical products, unless 
     otherwise defined under applicable state law.
       (14) Recovery.--The term ``recovery'' means the net sum 
     recovered after deducting any disbursements or costs incurred 
     in connection with prosecution or settlement of the claim, 
     including all costs paid or advanced by any person. Costs of 
     health care incurred by the plaintiff and the attorneys' 
     office overhead costs or charges for legal services are not 
     deductible disbursements or costs for such purpose.
       (15) Representative.--The term ``representative'' means a 
     legal guardian, attorney, person designated to make decisions 
     on behalf of a patient under a medical power of attorney, or 
     any person recognized in law or custom as a patient's agent.
       (16) State.--The term ``State'' means each of the several 
     States, the District of Columbia, the Commonwealth of Puerto 
     Rico, the Virgin Islands, Guam, American Samoa, the Northern 
     Mariana Islands, the Trust Territory of the Pacific Islands, 
     and any other territory or possession of the United States, 
     or any political subdivision thereof.

     SEC. 8. EFFECT ON OTHER LAWS.

       (a) Vaccine Injury.--
       (1) To the extent that title XXI of the Public Health 
     Service Act establishes a Federal rule of law applicable to a 
     civil action brought for a vaccine-related injury or death--
       (A) this Act does not affect the application of the rule of 
     law to such an action; and
       (B) any rule of law prescribed by this Act in conflict with 
     a rule of law of such title XXI shall not apply to such 
     action.
       (2) If there is an aspect of a civil action brought for a 
     vaccine-related injury or death to which a Federal rule of 
     law under title XXI of the Public Health Service Act does not 
     apply, then this Act or otherwise applicable law (as 
     determined under this Act) will apply to such aspect of such 
     action.
       (b) Other Federal Law.--Except as provided in this section, 
     nothing in this Act shall be deemed to affect any defense 
     available to a defendant in a health care lawsuit or action 
     under any other provision of Federal law.

     SEC. 9. RULES OF CONSTRUCTION.

       (a) Health Care Lawsuits.--Unless otherwise specified in 
     this Act, the provisions governing health care lawsuits set 
     forth in this Act preempt, subject to subsections (b) and 
     (c), State law to the extent that State law prevents the 
     application of any provisions of law established by or under 
     this Act. The provisions governing health care lawsuits set 
     forth in this Act supersede chapter 171 of title 28, United 
     States Code, to the extent that such chapter--
       (1) provides for a greater amount of damages or contingent 
     fees, a longer period in which a health care lawsuit may be 
     commenced, or a reduced applicability or scope

[[Page H5275]]

     of periodic payment of future damages, than provided in this 
     Act; or
       (2) prohibits the introduction of evidence regarding 
     collateral source benefits, or mandates or permits 
     subrogation or a lien on collateral source benefits.
       (b) Protection of States' Rights and Other Laws.--Any issue 
     that is not governed by any provision of law established by 
     or under this Act (including State standards of negligence) 
     shall be governed by otherwise applicable State or Federal 
     law
       (c) State Flexibility.--No provision of this Act shall be 
     construed to preempt any defense available to a party in a 
     health care lawsuit under any other provision of State or 
     Federal law.

     SEC. 10. EFFECTIVE DATE.

       This Act shall apply to any health care lawsuit brought in 
     a Federal or State court, or subject to an alternative 
     dispute resolution system, that is initiated on or after the 
     date of the enactment of this Act, except that any health 
     care lawsuit arising from an injury occurring prior to the 
     date of the enactment of this Act shall be governed by the 
     applicable statute of limitations provisions in effect at the 
     time the cause of action accrued.

  The CHAIR. No amendment to that amendment in the nature of a 
substitute shall be in order except those printed in House Report 115-
179. Each such amendment may be offered only in the order printed in 
the report, by a Member designated in the report, shall be considered 
as read, shall be debatable for the time specified in the report 
equally divided and controlled by the proponent and an opponent, shall 
not be subject to amendment, and shall not be subject to a demand for 
division of the question.


                Amendment No. 1 Offered by Mr. Sessions

  The CHAIR. It is now in order to consider amendment No. 1 printed in 
House Report 115-179.
  Mr. SESSIONS. Mr. Chairman, I have an amendment at the desk.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 1, strike line 7 and all that follows through page 2, 
     line 18 and insert the following:
       (a) Statute of Limitations.--
       (1) In general.--Except as provided in paragraph (2), the 
     time for the commencement of a health care lawsuit shall be, 
     whichever occurs first of the following:
       (A) 3 years after the date of the occurrence of the breach 
     or tort;
       (B) 3 years after the date the medical or health care 
     treatment that is the subject of the claim is completed; or
       (C) 1 year after the claimant discovers, or through the use 
     of reasonable diligence should have discovered, the injury.
       (2) Tolling.--In no event shall the time for commencement 
     of a health care lawsuit exceed 3 years after the date of the 
     occurrence of the breach or tort or 3 years after the date 
     the medical or health care treatment that is the subject of 
     the claim is completed (whichever occurs first) unless tolled 
     for any of the following--
       (A) upon proof of fraud;
       (B) intentional concealment; or
       (C) the presence of a foreign body, which has no 
     therapeutic or diagnostic purpose or effect, in the person of 
     the injured person.
       (3) Actions by a minor.--Actions by a minor shall be 
     commenced within 3 years after the date of the occurrence of 
     the breach or tort or 3 years after the date of the medical 
     or health care treatment that is the subject of the claim is 
     completed (whichever occurs first) except that actions by a 
     minor under the full age of 6 years shall be commenced within 
     3 years after the date of the occurrence of the breach or 
     tort, 3 years after the date of the medical or health care 
     treatment that is the subject of the claim is completed, or 1 
     year after the injury is discovered, or through the use of 
     reasonable diligence should have been discovered, or prior to 
     the minor's 8th birthday, whichever provides a longer period. 
     Such time limitation shall be tolled for minors for any 
     period during which a parent or guardian and a health care 
     provider have committed fraud or collusion in the failure to 
     bring an action on behalf of the injured minor.

  The CHAIR. Pursuant to House Resolution 382, the gentleman from Texas 
(Mr. Session) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from Texas.
  Mr. SESSIONS. Mr. Chairman, I am pleased to offer this amendment with 
Dr. Michael Burgess, also a member of the House Rules Committee, and 
also a gentleman from my home State of Texas.
  The goal of our amendment is to strengthen the underlying legislation 
by clarifying the point at which the statute of limitations begins to 
run.
  In Texas, the statute of limitations begins to run from the date the 
alleged negligence occurs or date of last treatment. This is a certain 
date that does not leave room for controversy. I believe aligning the 
underlying text with this approach will benefit both physicians and 
patients to clarify exactly where harm might occur.
  My amendment clarifies that when the date of the breach or tort is 
known, the statute runs from that date. When the date of the breach or 
tort is not known, the statute runs from the last date of treatment. By 
this method, certainty is provided to defendant, plaintiff, and the 
court. Easy understanding. For example, if there is a surgical mishap, 
the statute would run from that date. On the other hand, if the injury 
is from the prescription medication over a long period of time, it 
would run from the date of last treatment.
  I am pleased that the Texas Medical Association, the Texas Alliance 
for Patient Access, the Health Coalition of Liability and Access, as 
well as the National Physicians' Council for Healthcare Policy support 
this process and this amendment. I hope my colleagues on both sides of 
the aisle will support this commonsense, reasonable reform that comes 
to us today in an amendment.
  I thank Chairman Bob Goodlatte from Virginia and his awesome staff 
for their work to make sure this amendment and the underlying 
legislation conform with their ideas consistent with the legislation.
  Mr. Chairman, I reserve the balance of my time.
  Mr. COHEN. Mr. Chairman, I rise in opposition to the amendment.
  The CHAIR. The gentleman from Tennessee is recognized for 5 minutes.
  Mr. COHEN. Mr. Chairman, the amendment does even more damage than the 
bill does because it makes it possible that there will be even less 
time for a plaintiff, once they are aware of their injury, to bring 
action.
  This is something that lessens the statute of limitations. That is 
what the bill is trying to do, is to see that less people get their 
opportunity to get to court, which is what statute of limitations are 
intended to do. That is the purpose.
  When somebody has been injured from a medical malpractice case or 
negligence from a nursing home, we should encourage people to get 
relief and let a jury decide.
  These bills--and I suspect these amendments because they are aimed at 
the same thing--are opposed by the AFL-CIO; the American Federation of 
State, County, and Municipal Employees; the American Bar Association--
not exactly a liberal lion--the Center for Justice and Democracy; and 
the National Conference of State Legislatures. Also, because this is a 
foray into federalism--unheard of before, making this a Federal issue, 
not a State issue--the Consumer Federation of America, the Consumers 
Unions, Public Citizen, and Vietnam Veterans of America. There are many 
other groups as well.
  This amendment does more to see that folks don't get access to a 
jury. And the irony of it is that the national Republican effort seems 
to be to talk badly about Washington and Congress and drain the swamp 
and believe in the individuals back home and folks at home.
  Well, the most pure form of justice comes from a jury where you have 
a jury of your peers in your own community who are chosen to determine 
what happened, to determine the facts, and to determine the damages. 
Instead, they are proposing that the Republicans in Congress know 
better what to do to put limits on what a jury can award their fellow 
citizens.
  And they are also putting limitations on the statute of limitations 
and lessening that, and on joint and several liability, which go toward 
helping people who have gotten judgments be able to collect on 
judgments, which is so important. A judgment is no good unless you can 
collect on it. It is just counter to what the Republican Party 
philosophy generally is and has been, that I have kind of perceived 
recently, about being against Washington and laws coming on down high 
from Washington, D.C.

                              {time}  1530

  Much of what we heard at our discussion from a gentleman from West 
Virginia was about a West Virginia law. That is what you are supposed 
to have is a West Virginia law. Then somebody else talked about a Texas 
law, and they are holding up a California law.
  Each State is supposed to make its own laws. We have got 50 States. 
They

[[Page H5276]]

talk a lot about the 50 States and the electoral college, and the 
States have an important function in our system of government. They are 
supposed to be areas where they have provinces and act. Juries, jury 
trials, and trial courts, that is all State law, and that should be 
determined by West Virginia, Texas, California, and Florida, not up 
here.
  This bill, when it went through committee, passed by one vote because 
a couple of folks--I think it was Judge Poe and Judge Gohmert; I am 
pretty sure it was the two of them--two judges from the State of Texas 
felt it went too far in encroaching on the States' province dealing 
with tort law. This amendment just goes the same direction.
  This is just unfortunate that what we are trying to do is help, 
really, insurance companies; it is not so much doctors. Doctors might 
benefit some, but it is the insurance companies that would benefit the 
most, and that is who this is about.
  So we oppose the amendment and we oppose the bill. We support the 
American people and the right of the people and the juries to dispense 
justice that the facts dictate and that justice demands.
  Mr. Chairman, I reserve the balance of my time.
  Mr. SESSIONS. Mr. Chairman, perhaps the debate that the gentleman 
from Iowa (Mr. King) had was completely clear, which I would disagree 
with that statement. The gentleman from Iowa stated very clearly that 
there are surgeries, there are procedures, and there are processes that 
cost the Federal Government hundreds of millions, and the gentleman 
even went into the billions of dollars, which are parts of practices of 
medicine that doctors do as a defensive part of medicine to avoid 
exactly what we are talking about: getting sued. It is costing the 
Federal Government an enormous amount of money.
  The gentleman did refer to two Members of Congress from Texas. We 
will see how they vote.
  But the clarifying amendments that we are offering now, amendment No. 
1 and amendment No. 2, come directly from negotiations with and 
understanding with the Texas Medical Association and the National 
Physicians' Policy Council to ensure that, in fact, the compliance is 
made that people not only in Texas, but also in other States, would 
have that would offer a physician the ability for them to use their 
knowledge, their training, and their expertise as opposed to practicing 
defensive medicine that harms every single taxpayer. That is why we are 
offering this today.
  I am delighted. I believe what we have done is right.
  Mr. Chairman, I yield such time as he may consume to the gentleman 
from Iowa (Mr. King).
  Mr. KING of Iowa. Mr. Chairman, I thank the gentleman from Texas for 
yielding.
  I want to express, Mr. Chairman, how much I appreciate the work that 
has been done by so many people and their part in this bill.
  I rise in support of this improving amendment--it comes out of the 
minds of Texas, I might add--which would clarify the timing of the 
statute of limitations in the provision base of the bill.
  Mr. Chairman, I urge the adoption of the Sessions amendment.
  Mr. SESSIONS. Mr. Chairman, I reserve the balance of my time.
  Mr. COHEN. Mr. Chairman, this is an amendment--a bad amendment--that 
makes a bad bill worse. All those folks from Texas ought to be going to 
Austin. Where this belongs is in Austin, not in Washington. These are 
State issues.
  We had an amendment that said that these defensive measures that you 
say that they are taking that waste all this money and time, we had an 
amendment that said these caps wouldn't apply if you cut off the wrong 
arm, and you all wouldn't take it. So I don't know how many defensive 
measures they have got.
  This is the right arm; this is the left arm. When you go in to do 
surgery and you have to amputate an arm, take off the right arm or the 
left arm, but not the wrong arm. If you take off the wrong arm--damages 
big time. You all didn't accept that amendment.
  This is shutting the courthouse door, closing down juries, and not 
having faith in the American people to be able to ascertain facts and 
damages as they have throughout time immemorial. It is a power grab 
from Washington. It is the swamp draining over to flood the State 
houses of all 50 of our States.
  Mr. Chairman, I yield back the balance of my time.
  Mr. SESSIONS. Mr. Chairman, I believe the gentleman, Mr. King, has 
argued the point very successfully, and that is we believe it is in the 
best interests of not only the taxpayers, but physicians, physicians 
who have used their training, their expertise, and their knowledge to 
perform the necessary missions that are necessary. When those 
physicians do make mistakes--and mistakes will happen--then we believe 
that the rights of those that are reported in California and Texas 
would be consistent with those that would be great for the country. We 
are willing to share, and we appreciate the opportunity to present 
this.
  Mr. Chairman, I would ask my colleagues to support this amendment 
that I have presented today, and I yield back the balance of my time.
  The CHAIR. The question is on the amendment offered by the gentleman 
from Texas (Mr. Sessions).
  The amendment was agreed to.


                Amendment No. 2 Offered by Mr. Sessions

  The CHAIR. It is now in order to consider amendment No. 2 printed in 
House Report 115-179.
  Mr. SESSIONS. Mr. Chairman, I have an amendment at the desk as the 
designee of the gentleman from Texas (Mr. Burgess).
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 12, line 13, insert after ``goods or services'' the 
     following: ``(including safety, professional, or 
     administrative services directly related to health care)''.

  The CHAIR. Pursuant to House Resolution 382, the gentleman from Texas 
(Mr. Sessions) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from Texas.
  Mr. SESSIONS. Mr. Chairman, I offer my thanks not only to Chairman 
Bob Goodlatte, but also the distinguished gentleman from Iowa (Mr. 
King) for his work on behalf of all Members on the floor today, for his 
work not only for the Judiciary Committee, but people of faith and 
confidence that this country can address the issues and needs.
  Mr. Chairman, I offer this amendment with Dr. Michael Burgess, who is 
also from my home State of Texas as well as a member of the Rules 
Committee.
  The goal of our amendment is to clarify that healthcare liability 
claims covered by the legislation include safety, professional, and 
administrative services directly related to healthcare. In other words, 
we are bringing in the entire scope, not just necessarily the medical 
procedure.
  I was glad to see that H.R. 1215 adopts many of the reforms that 
States across this country have thoroughly tested in their efforts to 
improve medical liability law, including my home State of Texas.
  Not all claims asserted against healthcare providers arise from the 
direct provision of medical care. My amendment addresses the full 
spectrum of healthcare claims by following the model that Texas has 
successfully implemented.
  Common examples of administrative claims related to healthcare are 
cases for negligence involving credentialing fraud against hospitals 
and those serving on their professional committees. In these cases, the 
plaintiff typically is not a patient of the physician serving on the 
committee; however, there is significant exposure to liability for the 
physician.
  Safety claims are another necessary component in the scope of this 
bill. In these cases, a patient's injury does not arise out of the 
rendition of healthcare, but pertains to the safety of the patient.
  The Texas Medical Association, the Texas Alliance for Patient Access, 
and the National Physicians' Policy Council are among those 
organizations who not only support this narrowly tailored amendment, 
but also their support of the entire bill and the inclusions of this 
amendment.
  Mr. Chairman, I reserve the balance of my time.
  Mr. COHEN. Mr. Chairman, I claim the time in opposition.

[[Page H5277]]

  The CHAIR. The gentleman from Tennessee is recognized for 5 minutes.
  Mr. COHEN. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, this is called the Protecting Access to Care Act, but 
that is really a misnomer because the purpose of these amendments in 
the bill takes as a given that there are going to be allegations that 
doctors, medical device companies--not exactly limited financial 
resources or in potential for harm--and nursing homes are going to be 
alleged to have committed torts against individuals and that when that 
happens, if this becomes law, there will be less opportunity for 
individuals to get their day in court.
  Because most people in the United States are not wealthy, most of the 
people that get injured not being wealthy are going to bear the brunt 
of this when they don't get to court within the statute of limitations 
or they don't collect because of the joint and several liability 
changes in the law or they get less with noneconomic damages because of 
the $250,000 cap.
  Who is going to benefit from this? Who is going to benefit? It is 
going to be the person who a jury has found to have been negligent and 
violated their duty of care: a nursing home, a medical device company, 
or a physician. They are going to have less damages, less judgments 
against them, and less costs. Insurance companies can then make more 
money, and doctors will have lesser premiums.
  Who loses? People who have been injured by medical device defective 
merchandise, nursing home negligence, or medical malpractice.
  We are not talking about limiting damages and the ability to recover 
by having a lesser joint and several liability law. We are not talking 
about people who have not gotten a judgment. We are talking about 
people who have gotten a judgment for negligence.
  Just like the Republican healthcare bill, this gives billions of 
dollars to the richest people in America with tax cuts at the expense 
of poor people who get Medicaid, people with disabilities, pregnant 
women, poor people, and seniors in nursing homes. They suffer.
  This is a microcosm of the healthcare proposals that the Senate can't 
get 50 votes for--and they didn't even try for 60, which they normally 
do, because they knew it was not going to be that sufficient, but now 
they can't even get 50 under reconciliation--and it is a microcosm of 
hurting the poor and enriching the rich.
  These are cases where there will be judgments--juries finding 
negligence, harm, and damages--if you get to the courthouse on time, 
and then you won't be able to collect as much.
  So who wins? The rich, the medical device companies, the nursing 
homes, and the physicians. Who loses? Those who have suffered, those 
whom juries have found to be victims, and victims who should be able to 
collect but we are limiting how much they can collect and we are making 
it more difficult for them to collect.
  That is not what this Congress should be doing is enriching the 
wealthy and hurting those who have been harmed by negligence. If it is 
going to happen, it ought to happen in the States. So it is an attack 
on the 10th Amendment.
  Mr. Duncan from Tennessee came here and gave beautiful testimony 
about a consistent life protecting the 10th Amendment, and that is what 
Mr. Gohmert and Judge Poe also did about what is left to the States. 
That is why this amendment and the bill are both bad.
  Mr. Chairman, I reserve the balance of my time.
  Mr. SESSIONS. Mr. Chairman, I yield myself such time as I may 
consume.
  Mr. Chairman, the gentleman I respect very much, not only the 
perspective that the gentleman holds, but perhaps some of his argument 
could be true.
  Mr. Chairman, what we are trying to do is to balance out the 
opportunity for the American people to have access to healthcare where, 
many items, they are denied.
  I was reminded by the gentleman, the young chairman of the Veterans' 
Affairs Committee, Dr. Phil Roe, who served his great State of 
Tennessee and the American people as an obstetrician and gynecologist, 
I was reminded of the facts of the case, as it were, where, when Texas 
passed this, counties all along our Texas borders received, instead of 
midwives and others who might perform these important services to 
deliver babies, all of a sudden medical professionals, doctors, came 
into play who had been shut out because of the fear of malpractice 
lawsuits against them. Texas added, in the first year, some 4,500 
doctors who came to Texas knowing that it was a level playing field.
  In this case, Mr. Chairman, we are arguing that the United States of 
America and the citizens would not have to pay outrageous amounts of 
money for defensive medicine, whereby physicians, in order to protect 
themselves and to protect themselves in a difficult circumstance, might 
order, as a defensive mechanism, excessive amounts of either X-rays or 
other procedures that really cost the government money instead of 
providing better healthcare.

                              {time}  1545

  This has been an advantage in the State of California, and in the 
State of Texas, where physicians use not only their training and their 
professional conduct, but they use what is in the best interest of the 
patient. That is why we are here today.
  Mr. Chair, I yield such time as he may consume to the gentleman from 
Iowa (Mr. King).
  Mr. KING of Iowa. Mr. Chair, I thank the gentleman from Texas for his 
leadership on the Rules Committee and in many other ways; and I also 
thank Dr. Burgess, another gentleman from Texas on the Rules Committee 
whose amendment is being offered by Mr. Sessions.
  As I listen to this dialogue, Mr. Chairman, I am just thinking that 
States do have rights. They have the right to control any of the 
healthcare services that are funded by individuals or States. This only 
affects that because it has Federal dollars in it. We drive at a 55-
mile-an-hour speed limit because the Federal Government sets that.
  So I rise in support of this amendment, but the States are not 
funding Medicare, Medicaid, or ObamaCare.
  Mr. COHEN. Mr. Chairman, how much time do I have remaining?
  The CHAIR. The gentleman from Tennessee has 1 minute remaining.
  Mr. COHEN. Mr. Chair, I yield 1 minute to the gentleman from Iowa 
(Mr. King), because I think it helps my case.
  Mr. KING of Iowa. Mr. Chair, I am happy to accept the time from the 
gentleman from Tennessee and make the point that hasn't been made very 
well here today that--apparently, not well enough or the gentleman 
wouldn't have yielded the time to me, I don't believe--where there are 
Federal dollars involved, there have been Federal regulations that have 
matched along with that.
  We have written all kinds of legislation in this Congress, a lot of 
which I disagreed with. But there was a Federal nexus, and it hasn't 
been litigated successfully time after time after time.
  We saw ObamaCare itself was litigated over and over again and the 
Supreme Court came down with rulings that let that legislation stand. 
That is one of the reasons why we have the angst that we have today.
  But the case that this usurps States' rights is thin. It is not 
without some consequence, but it is very thin. We have gone way over to 
the other side, and we have written everything that we can possibly 
write into this bill that respects the rights of States. There is 
always a Federal nexus--we can count on that--and it is so small in 
comparison to so many other Federal things. Some of the things in our 
Federal Government are overreach. This is not. This is a minimal, de 
minimis reach in order to regulate over-the-top trial lawyers, who are 
the ones who are the only losers today, Mr. Chairman.
  Mr. SESSIONS. Mr. Chair, I yield back the balance of my time.
  Mr. COHEN. Mr. Chair, I yield back the balance of my time.
  The CHAIR. The question is on the amendment offered by the gentleman 
from Texas (Mr. Sessions).
  The amendment was agreed to.


            Amendment No. 3 Offered by Mr. Roe of Tennessee

  The CHAIR. It is now in order to consider amendment No. 3 printed in 
House Report 115-179.

[[Page H5278]]

  

  Mr. ROE of Tennessee. Mr. Chairman, I have an amendment at the desk.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Add, at the end of the bill, the following (and amend the 
     table of contents accordingly):

     SEC. 11. LIMITATION ON EXPERT WITNESS TESTIMONY.

       (a) In General.--No person in a health care profession 
     requiring licensure under the laws of a State shall be 
     competent to testify in any court of law to establish the 
     following facts--
       (1) the recognized standard of acceptable professional 
     practice and the specialty thereof, if any, that the 
     defendant practices, which shall be the type of acceptable 
     professional practice recognized in the defendant's community 
     or in a community similar to the defendant's community that 
     was in place at the time the alleged injury or wrongful 
     action occurred,
       (2) that the defendant acted with less than or failed to 
     act with ordinary and reasonable care in accordance with the 
     recognized standard, and
       (3) that as a proximate result of the defendant's negligent 
     act or omission, the claimant suffered injuries which would 
     not otherwise have occurred,
     unless the person was licensed to practice, in the State or a 
     contiguous bordering State, a profession or specialty which 
     would make the person's expert testimony relevant to the 
     issues in the case and had practiced this profession or 
     specialty in one of these States during the year preceding 
     the date that the alleged injury or wrongful act occurred.
       (b) Applicability.--The requirements set forth in 
     subsection (a) shall also apply to expert witnesses 
     testifying for the defendant as rebuttal witnesses.
       (c) Waiver Authority.--The court may waive the requirements 
     in this subsection if it determines that the appropriate 
     witnesses otherwise would not be available.

  The CHAIR. Pursuant to House Resolution 382, the gentleman from 
Tennessee (Mr. Roe) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from Tennessee.
  Mr. ROE of Tennessee. Mr. Chairman, I yield myself such time as I may 
consume.
  Mr. Chairman, medical malpractice lawsuits in this country have 
gotten out of hand, which is hurting both providers and patients. 
Something must be done.
  I have spent 31 years practicing medicine in Tennessee before coming 
to Congress. In that time, I saw my medical malpractice insurance 
premiums increase from $4,000 a year to over $50,000 a year, by the 
time I left practice.
  Why were the premiums so expensive? My practice group took everyone: 
private insurance, Medicare, Medicaid, TRICARE, and the uninsured. Some 
practices limit their patient populations, but when you are in rural 
Appalachia, you take all comers.
  The reality is, when you are taking care of patients with elevated 
risk, you get more frequent negative outcomes, increasing your risk for 
lawsuits, and this creates an issue for patient access to care.
  Finally, right when I was leaving practice in 2008, Governor Haslam 
signed into law some of the best reforms we have in Tennessee, in the 
Tennessee Medical Malpractice Act, which created a 60-day notice 
statute and a certificate of good faith certifying a case has merit 
before it can be filed.
  In 2011, Governor Haslam then signed the Tennessee Civil Justice Act 
into law, which contained a restriction on who could testify as an 
expert witness in medical malpractice litigation.
  Too often, physicians practicing medicine are pitted in litigation 
against a professional witness who has gone to medical school but 
specialized in a different field and wasn't even licensed to practice 
in their State or a contiguous State. Mr. Chairman, that is absolutely 
wrong.
  The fact is, these changes work. In Tennessee, we saw medical 
malpractice premiums reduced from 2009 to 2014 by between 25 and 40 
percent, depending on the specialty. OBs saw average premiums reduced 
from over $52,000 to just over $33,000; neurosurgeons saw average 
premiums reduced from $49,000 to $35,000; cardiovascular surgeons saw 
their premiums go down from $44,000 to $31,000. There were other 
changes that were put into place that helped, including caps, but the 
fact was, this change had a major impact.
  My amendment follows Tennessee's law and strengthens the changes 
contained in the underlying text of the bill, H.R. 1215, by adding 
further restrictions to those individuals who would qualify as an 
expert witness for medical malpractice litigation. My amendment limits 
who can be called as an expert witness, not only by the individual's 
professional accreditation, but also by his or her geographic location.
  The fact is, as Tennessee's law proved, we needed medical 
professionals from the area where the incident in question occurred to 
testify as an expert, not a foreign jurisdiction hundreds of thousands 
of miles away. If that proves to be impossible, the court can waive 
this requirement if a witness that fits these criteria is otherwise 
unavailable.
  Mr. Chairman, no one knows the people or healthcare providers in an 
area better than the people and healthcare providers in that area. 
Whether testifying for the plaintiff or defendant, it is important that 
those individuals called as experts really know the people in the area 
and aren't simply flown in from a faraway place just to get a paycheck.
  We all want improved quality and lower costs of care. Reforming the 
litigation process is a step in the right direction.
  Mr. Chairman, I encourage Members to support my amendment, and I 
reserve the balance of my time.
  Mr. COHEN. Mr. Chairman, I claim the time in opposition.
  The CHAIR. The gentleman from Tennessee is recognized for 5 minutes.
  Mr. COHEN. Mr. Chair, this is the Tennessee law. I remember it. It is 
probably not such a wonderful law, even in Tennessee, even though some 
of us didn't care because Tennessee is an unusual State.
  You see it when you go to Rock City. From Rock City, you see seven, 
eight, or nine States. That is pretty good, even without the help of 
the Southern College of Optometry.
  If you are in Memphis, the bill would say that you could have an 
expert from Arlington, Virginia, come to Memphis. That is a long way, 
yet we are so much closer to Springfield, Illinois, or even to Dallas, 
Texas, or we are much closer to Baton Rouge, where they have got a lot 
of great doctors. Those doctors from Baton Rouge could come to Memphis. 
They would be closer to Memphis than somebody from Arlington, Virginia.
  The fact is, the State should decide this. Tennessee made this 
contiguous State or your own State law. For Alaska, that means you have 
got Alaska. For Hawaii, it means you have got Hawaii. The States should 
decide who is an expert and who isn't.
  It also says you have got to be in practice for the previous year. If 
somebody is not in practice and they are a professor at a medical 
school and maybe the outstanding expert on cardiovascular diseases, and 
they happen to be someplace like Harvard, they wouldn't be able to go 
to a State that is not contiguous to Massachusetts. If they weren't 
practicing, they wouldn't be able to be an expert at all.
  These arbitrary time limits, arbitrary requirements, and arbitrary 
demographic limitations are not aimed at justice or saving costs. They 
are aimed at reducing the number of experts who might be available.
  In a State, it is more difficult to get an expert to come testify 
because you may get ostracized by your fellow professionals. It might 
be easier for a plaintiff to find an expert from a State that is a 
little bit of a distance.
  I am not that familiar with Maine. Does it touch maybe Vermont and 
New Hampshire? It kind of limits itself, too. In Tennessee, you would 
have 9 or 10 States; in Alaska, none; Hawaii, none; Maine, two. 
Minnesota has got to be limited because we wouldn't go to Canada 
because that is not part of our system.

  Of course, this isn't really part of our system either because our 
system is a Federal system, where we give States the right to make 
these decisions and not make them up in Washington with a one-size-
fits-all way to stop people who have been damaged by medical 
malpractice, medical device defects, or nursing home negligence from 
getting whole compensation.
  We put a limit from Washington on the old person who is being taken 
advantage of by some individual in a nursing home or some individual 
who has been given a defective valve in their heart because of a 
medical device problem.

[[Page H5279]]

  We in Washington, under this bill, think we know more than what a 
jury should know about the effects and the damages when that person 
testifies in that courtroom in front of that jury and before that judge 
and have their damages proven. You can see that individual and know the 
harm they have been caused, but their damages are going to be limited 
because of something that goes on here in Washington, D.C.
  That is something the other side argues against constantly. They say 
things should be decided back home in the States--things like voting 
rights and trying to limit the opportunity for people in the Justice 
Department to see to it that people get a chance to vote. They say that 
States' rights are primary when it suits their purposes.
  In Tennessee, the doctors own the medical malpractice insurance 
company. I think it has the word ``Volunteer'' in it. It is the doctors 
who own it. So they will be direct beneficiaries.
  Mr. Chairman, I reserve the balance of my time.
  Mr. ROE of Tennessee. Mr. Chairman, where the subsidies were going in 
our State were to the lawyers, since they got over 60 percent of any 
medical malpractice settlement. The poor patients got less than forty 
cents on the dollar.
  Mr. Chairman, I yield 1 minute to the gentleman from Iowa (Mr. King).
  Mr. KING of Iowa. Mr. Chairman, I thank Dr. Roe, the gentleman from 
Tennessee, for bringing this amendment.
  Looking at the language here, it is interesting that the concern was 
that the witnesses may not be available within a large State. I notice, 
as I read the language, that unless the person was licensed for 
practice in the State or a contiguous border State--that is pretty 
good. If you are Hawaii, maybe not so good. But Dr. Roe, typical to his 
style, anticipated these things by putting the waiver authority in the 
last provision in the amendment, which says: ``The court may waive the 
requirements in this subsection if it determines that the appropriate 
witnesses otherwise would not be available.''
  So this is a sound, well thought-out directive that ensures that we 
have a high level of professionalism.
  When the gentleman earlier talked about a jury of your peers, what 
about having professionals who are highly credentialed that do 
understand the locality and the normal practices within the region?
  So not only do I support this amendment, but I encourage its 
adoption. It requires expert witnesses to have knowledge of the 
standard of care in their local communities. It is a commonsense 
amendment, and I urge its adoption.
  Mr. COHEN. Mr. Chair, I yield myself such time as I may consume.
  Mr. Chair, I was going to try to find that language.
  Years ago, a trial lawyer named J.D. Lee told me when I was just a 
28-year-old constitutional convention delegate: Don't go down rabbit 
trails. The gentleman from Iowa is throwing rabbit trails out there, 
and I am not going to go down one.
  The fact is, this is a State issue that should be determined by the 
States and should be determined by judges and jurors in their 
jurisdiction who see the defendant and see the plaintiff with their own 
eyes and determine the facts as the facts dictate and justice demands, 
is what we hear and what we live by in jury cases. That is what we 
should live by in Washington in determining what damages are, and not 
making the decisions up here in Washington, D.C.
  This is a bad amendment. It is a bad bill. It is contrary to the 
mantra that you normally hear from the other side.
  Mr. Chairman, I yield back the balance of my time.
  Mr. ROE of Tennessee. Mr. Chairman, I wish the damages did go to 
patients in Tennessee. They don't. The majority goes to lawyers.
  Mr. Chairman, I yield the balance of my time to the gentleman from 
Kansas (Mr. Marshall), my good friend and a fellow OB/GYN.

                              {time}  1600

  Mr. MARSHALL. Mr. Chairman, I rise in support of this amendment 
offered by gentleman from Tennessee. Like Dr. Roe, I, too, have been an 
OB-GYN.
  The standard of care is defined by local physicians. Let me say that 
again. The standard of care should be defined by local physicians, and 
how medicine is practiced may vary from location to location. No matter 
what, all physicians, especially in rural settings, don't have access 
to all the luxuries in tertiary centers. Demanding that experts 
representing either side of a dispute practice medicine in the State of 
jurisdiction is just common sense.
  Mr. ROE of Tennessee. Mr. Chair, I yield back the balance of my time.
  Mr. BUCSHON. Mr. Chair, as a physician I have seen firsthand how 
frivolous lawsuits against experienced physicians have hindered the 
health care system and increased costs to all patients.
  It is imperative we address this through common sense legislation.
  This amendment would require expert witnesses in medical malpractice 
negligence cases to have practiced in the same specialty and 
geographical area as the physician defendant.
  This limitation ensures that the expert witness has the qualified 
experience with and knowledge of the standard of care recognized in 
their local communities. I was a heart surgeon. I was not qualified to 
testify in a dermatology case.
  I ask my colleagues to join me in voting yes on Dr. Roe's amendment 
and the Protecting Access to Care Act.
  The CHAIR. The question is on the amendment offered by the gentleman 
from Tennessee (Mr. Roe).
  The amendment was agreed to.


                 Amendment No. 4 Offered by Mr. Hudson

  The CHAIR. It is now in order to consider amendment No. 4 printed in 
House Report 115-179.
  Mr. HUDSON. Mr. Chair, I have an amendment that the desk.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Add, at the end of the bill, the following:

     SEC. 11. COMMUNICATIONS FOLLOWING UNANTICIPATED OUTCOME.

       (a) Provider Communications.--In any health care liability 
     action, any and all statements, affirmations, gestures, or 
     conduct expressing apology, fault, sympathy, commiseration, 
     condolence, compassion, or a general sense of benevolence 
     which are made by a health care provider or an employee of a 
     health care provider to the patient, a relative of the 
     patient, or a representative of the patient and which relate 
     to the discomfort, pain, suffering, injury, or death of the 
     patient as the result of the unanticipated outcome of medical 
     care shall be inadmissible for any purpose as evidence of an 
     admission of liability or as evidence of an admission against 
     interest.
       (b) State Flexibility.--No provision of this section shall 
     be construed to preempt any State law (whether effective 
     before, on, or after the date of the enactment of this Act) 
     that makes additional communications inadmissible as evidence 
     of an admission of liability or as evidence of an admission 
     against interest.

     SEC. 12. EXPERT WITNESS QUALIFICATIONS.

       (a) In General.--In any health care lawsuit, an individual 
     shall not give expert testimony on the appropriate standard 
     of practice or care involved unless the individual is 
     licensed as a health professional in one or more States and 
     the individual meets the following criteria:
       (1) If the party against whom or on whose behalf the 
     testimony is to be offered is or claims to be a specialist, 
     the expert witness shall specialize at the time of the 
     occurrence that is the basis for the lawsuit in the same 
     specialty or claimed specialty as the party against whom or 
     on whose behalf the testimony is to be offered. If the party 
     against whom or on whose behalf the testimony is to be 
     offered is or claims to be a specialist who is board 
     certified, the expert witness shall be a specialist who is 
     board certified in that specialty or claimed specialty.
       (2) During the 1-year period immediately preceding the 
     occurrence of the action that gave rise to the lawsuit, the 
     expert witness shall have devoted a majority of the 
     individual's professional time to one or more of the 
     following:
       (A) The active clinical practice of the same health 
     profession as the defendant and, if the defendant is or 
     claims to be a specialist, in the same specialty or claimed 
     specialty.
       (B) The instruction of students in an accredited health 
     professional school or accredited residency or clinical 
     research program in the same health profession as the 
     defendant and, if the defendant is or claims to be a 
     specialist, in an accredited health professional school or 
     accredited residency or clinical research program in the same 
     specialty or claimed specialty.
       (3) If the defendant is a general practitioner, the expert 
     witness shall have devoted a majority of the witness's 
     professional time in the 1-year period preceding the 
     occurrence of the action giving rise to the lawsuit to one or 
     more of the following:
       (A) Active clinical practice as a general practitioner.

[[Page H5280]]

       (B) Instruction of students in an accredited health 
     professional school or accredited residency or clinical 
     research program in the same health profession as the 
     defendant.
       (b) Lawsuits Against Entities.--If the defendant in a 
     health care lawsuit is an entity that employs a person 
     against whom or on whose behalf the testimony is offered, the 
     provisions of subsection (a) apply as if the person were the 
     party or defendant against whom or on whose behalf the 
     testimony is offered.
       (c) Power of Court.--Nothing in this subsection shall limit 
     the power of the trial court in a health care lawsuit to 
     disqualify an expert witness on grounds other than the 
     qualifications set forth under this subsection.
       (d) Limitation.--An expert witness in a health care lawsuit 
     shall not be permitted to testify if the fee of the witness 
     is in any way contingent on the outcome of the lawsuit.
       (e) State Flexibility.--No provision of this section shall 
     be construed to preempt any State law (whether effective 
     before, on, or after the date of the enactment of this Act) 
     that places additional qualification requirements upon any 
     individual testifying as an expert witness.

     SEC. 13. AFFIDAVIT OF MERIT.

       (a) Required Filing.--Subject to subsection (b), the 
     plaintiff in a health care lawsuit alleging negligence or, if 
     the plaintiff is represented by an attorney, the plaintiff's 
     attorney shall file simultaneously with the health care 
     lawsuit an affidavit of merit signed by a health professional 
     who meets the requirements for an expert witness under 
     section 14 of this Act. The affidavit of merit shall certify 
     that the health professional has reviewed the notice and all 
     medical records supplied to him or her by the plaintiff's 
     attorney concerning the allegations contained in the notice 
     and shall contain a statement of each of the following:
       (1) The applicable standard of practice or care.
       (2) The health professional's opinion that the applicable 
     standard of practice or care was breached by the health 
     professional or health facility receiving the notice.
       (3) The actions that should have been taken or omitted by 
     the health professional or health facility in order to have 
     complied with the applicable standard of practice or care.
       (4) The manner in which the breach of the standard of 
     practice or care was the proximate cause of the injury 
     alleged in the notice.
       (5) A listing of the medical records reviewed.
       (b) Filing Extension.--Upon motion of a party for good 
     cause shown, the court in which the complaint is filed may 
     grant the plaintiff or, if the plaintiff is represented by an 
     attorney, the plaintiff's attorney an additional 28 days in 
     which to file the affidavit required under subsection (a).
       (c) State Flexibility.--No provision of this section shall 
     be construed to preempt any State law (whether effective 
     before, on, or after the date of the enactment of this Act) 
     that establishes additional requirements for the filing of an 
     affidavit of merit or similar pre-litigation documentation.

     SEC. 14. NOTICE OF INTENT TO COMMENCE LAWSUIT.

       (a) Advance Notice.--A person shall not commence a health 
     care lawsuit against a health care provider unless the person 
     has given the health care provider 90 days written notice 
     before the action is commenced.
       (b) Exceptions.--A health care lawsuit against a health 
     care provider filed within 6 months of the statute of 
     limitations expiring as to any claimant, or within 1 year of 
     the statute of repose expiring as to any claimant, shall be 
     exempt from compliance with this section.
       (c) State Flexibility.--No provision of this section shall 
     be construed to preempt any State law (whether effective 
     before, on, or after the date of the enactment of this Act) 
     that establishes a different time period for the filing of 
     written notice.

  The CHAIR. Pursuant to House Resolution 382, the gentleman from North 
Carolina (Mr. Hudson) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from North Carolina.
  Mr. HUDSON. Mr. Chairman, access to a fair and just court system is a 
vital part of the makeup of the United States. It is important that 
courts are used to seek justice, not for the financial benefit of 
lawyers looking to take advantage of patients. Basic protections these 
amendments provide from frivolous lawsuits will provide peace of mind 
for the vast majority of physicians who work so hard to protect and 
heal their patients.
  Patients in States that have enacted comprehensive medical liability 
reform have seen their healthcare costs decrease and their access to 
quality medical care increase. Enacting these reforms at the Federal 
level will benefit patients nationwide.
  All provisions within this amendment defer to State laws and directly 
address the issues covered.
  The first provision is called the Sorry Provision. This provision 
would allow a physician to apologize to a patient for an unintended 
outcome without having that apology count against them in a court of 
law. Thirty-two States plus the District of Columbia have an apology 
provision in place.
  The second issue in this amendment is Notice of Intent. This 
provision would require a plaintiff to provide a notice of intent to 
the physician 90 days before a lawsuit is filed. Cases are often 
settled before reaching a verdict, and this provision would encourage 
settlement before court proceedings begin.
  The third provision is Affidavits of Merit. This provision would 
require a plaintiff to have a physician in the same specialty as the 
defendant physician to sign an affidavit certifying the merits of the 
case before the lawsuit could be brought to court. Twenty-seven States 
have some form of affidavits of merit, though the standards vary from 
State to State.
  The final provision in the amendment is Expert Witness 
Qualifications. This provision would require that any expert witness 
called to testify during a trial would need to meet the same licensing 
requirements as the defendant physician. Forty-eight States plus the 
District of Columbia have some form of expert witness qualification, 
though the standards vary from State to State.
  So you see, these are very commonsense provisions. They are 
provisions that many States already have, and they will lead to lower 
costs and better care for patients, which ought to be our goal in the 
end.
  Mr. Chairman, I reserve the balance of my time.
  Mr. COHEN. Mr. Chairman, I rise in opposition to my friend's 
amendment.
  The CHAIR. The gentleman from Tennessee is recognized for 5 minutes.
  Mr. COHEN. Mr. Chairman, this amendment prohibits the introduction of 
apologies as evidence of liability, imposes on States the 
qualifications for expert witnesses in a healthcare lawsuit, requires 
plaintiffs to obtain a certificate of merit from a healthcare 
professional in order to pursue a healthcare lawsuit, and has a 90-day 
pre-suit notification requirement.
  This amendment is very, very difficult in that it says that, if you 
apologize, a doctor apologizes, the hope is that the doctor can 
apologize and the patient may think: Oh, he apologized. That is nice. I 
won't sue him. But then if you decide to sue him or her, you can't put 
that apology in evidence against him. So it is kind of maybe crocodile 
tears, a crocodile apology.
  But it also requires a plaintiff to get a certificate of merit from a 
healthcare professional to pursue a healthcare lawsuit--not from a 
lawyer, but from a healthcare professional. You have got to go to the 
fraternity to sue a fellow fraternity brother. That is a strange one.
  This amendment would add numerous problematic provisions that 
significantly expand this bill beyond what was even discussed in the 
Judiciary Committee and in Rules, and it violates State sovereignty, 
all without any proper legislative vetting before coming to the floor. 
This is the first I have seen it or I think anybody has seen this 
proposal--not necessarily regular order.
  Its apology provision is overly broad and undermines the legal right 
of patients. This provision states any apology by a healthcare provider 
given to a patient or their family is inadmissible for any purpose as 
evidence of liability or an admission against interest. If it is a true 
apology, it should be admitted, but it won't be.
  The purpose of so-called apology laws that occur sometimes at the 
State level, which is where they should be, is to encourage a doctor to 
apologize to the patient for any harm while preserving that patient's 
ability to offer evidence of wrongdoing. Yet this amendment upends this 
balance by prohibiting the admission of all expressions of empathy or 
apology for any purpose of evidence or admission of liability.
  This overbroad language undermines the patient's ability to offer 
evidence that he or she was harmed by wrongdoing. By making 
inadmissible admissions of fault by the provider, the amendment goes 
further than many State laws that do not prohibit admissions of fault 
and would still allow apology evidence to be used for purposes other 
than proving liability, such as impeaching a witness.

[[Page H5281]]

  Second, the amendment imposes highly restrictive expert witness 
qualifications on State courts, which we just discussed with Mr. Roe's 
amendment. This amendment requires the expert witness to be an exact 
carbon copy of the defendant. The expert must teach or practice in the 
same specialty and must have been doing so at the time of the 
occurrence that forms the basis of the lawsuit and for 1 year preceding 
the occurrence.
  Under this provision, someone with 30 years of professional 
experience may not qualify; whereas, a person with 1 year of experience 
could qualify as an expert. Indeed, this rule excludes retired 
professionals, many academics, and researchers from testifying as 
experts. It should be up to a judge in the courtroom or to a State that 
has province over this jurisdiction, not the Federal Government.

  Third, this amendment imposes further burdens on injured plaintiffs 
beyond the already onerous requirements of the underlying bill before 
they can even file a lawsuit. The amendment requires an injured patient 
to obtain a certificate from a healthcare professional attesting to the 
legal merit of the case. This requires injured plaintiffs to find a 
healthcare professional, not a lawyer, to evaluate the legal merits of 
the case at the time of filing--closed frat house.
  Certificates of merit are a costly, unnecessary obstacle and only 
serve to block injured plaintiffs access to the courts. There is little 
proof that such requirements reduce frivolous litigation or costs to 
medical providers, and certainly they don't help people who have been 
harmed by negligent treatment.
  This requirement overrides State supreme court decisions in Arizona, 
Arkansas, Ohio, Oklahoma, and Washington, which held that similar 
lawsuit certification laws violated their State constitutions.
  The amendment also requires an injured plaintiff to provide a 
healthcare provider 90 days' written notice before commencing the 
lawsuit. This notice requirement is another unnecessary hurdle intended 
to increase the cost of litigation for injured plaintiffs and dissuade 
them from filing suit. There is scant evidence that such notice reduces 
frivolous litigation or facilitates the compensation of the injured 
party.
  Finally, the amendment represents the extreme intrusion on States' 
rights, which this whole bill does, and is such a flip from the normal 
Republican thought processes.
  Each previously described provision includes the so-called State 
flexibility provisions in an attempt to brush off federalism concerns 
that these provisions are mostly one-way preemptive. They only preserve 
State laws that mirror the amendments' requirements and State laws 
which include requirements in addition to those imposed by the 
amendment. While it preserves State notice requirements, it overrides 
State laws that do not have such.
  The States, not Congress, should determine the qualifications for 
appearing as an expert witness in State court proceedings, determine 
the appropriate uses of apology evidence, and decide whether 
certificates are proper or not.
  For these reasons, I, unfortunately, have to oppose the amendment by 
my good friend Mr. Hudson, who is a great Tar Heel.
  I yield back the balance of my time.
  Mr. HUDSON. Mr. Chairman, may I ask how much how time I have 
remaining.
  The CHAIR. The gentleman from North Carolina has 3 minutes remaining.
  Mr. HUDSON. Mr. Chairman, I yield 1 minute to the gentleman from Iowa 
(Mr. King).
  Mr. KING of Iowa. Mr. Chairman, I thank the gentleman for yielding 
time to me.
  Mr. Chairman, I rise in support of this improving amendment which 
would save even more Federal taxpayer dollars by requiring the filing 
of affidavits of merit from an appropriately qualified specialist, 
requiring that expert witnesses have speciality backgrounds relevant to 
the case, allowing doctors to apologize without fear of penalty, and 
requiring a 90-day cooling-off period before lawsuits can be filed to 
facilitate voluntary settlements.
  I urge its adoption by the House, and I would point out that, as the 
gentleman from Tennessee referred to a fraternity of healthcare 
professionals as if somehow they couldn't come to an objective decision 
on their own profession, there has to be a fraternity of lawyers that 
are making these decisions for all of America right now. What we are 
seeking to do today is to bring this back to common sense, bring it 
back to we the people, keep it within the bounds of the Constitution, 
and reduce the cost of healthcare across America $54 billion, and we 
are looking at a potential for $650 billion a year.
  Mr. Chairman, I urge its adoption.
  Mr. HUDSON. Mr. Chairman, I thank the gentleman for his leadership on 
this issue, and I also would like to express my appreciation to my 
colleague from Tennessee.
  We all care about patients and we all care about patients seeking 
justice, but I just think maybe we disagree how to get there at this 
point.
  The one point he raised about the crocodile tears, the way he 
describes the Sorry Provision, look, doctors are human beings and 
sometimes things happen. It should be appropriate for a physician to be 
able to express those feelings that they are sorry that that happened 
without that being seen as some sign that there is guilt involved. So I 
think the Sorry Provision is important because the doctor-patient 
relationship is very important, and these are human beings.
  The other argument that was raised, that it is an undue burden to 
have to have an expert witness, listen. A lot of these cases are very 
detailed and very specific. If you are talking about a cardiothoracic 
event, you need a cardiothoracic surgeon to discuss that. A lot of 
these speciality fields, it is important that you have someone from 
that field as an expert.
  Frankly, there are folks out there who have the profession of being 
professional witnesses. They travel around the country and testify on 
behalf of the plaintiff bar. Frankly, I think we need to have experts 
testifying that are qualified to talk about those very specific cases 
that they are testifying against.
  The other thing that was raised is that the 90-day notice is an 
unfair burden on a patient. Frankly, I believe that having a little bit 
of time where individuals can talk could actually help that patient get 
to a settlement, get some redress earlier.
  I don't think you are delaying any kind of justice for individuals, 
but I think it is important that there is notification time, there is 
time for both parties to communicate. I think, in the end, you might 
end up having justice delivered much quicker than going through a 
lengthy trial that could have been avoided if you had a notice in the 
beginning.
  This amendment simply is seeking to provide justice for those who 
deserve it much more quickly with much less expense, but also to 
preserve our healthcare system.
  Mr. Chairman, I urge my colleagues to support this amendment, and I 
yield back the balance of my time.
  The CHAIR. The question is on the amendment offered by the gentleman 
from North Carolina (Mr. Hudson).
  The question was taken; and the Chair announced that the ayes 
appeared to have it.
  Mr. COHEN. Mr. Chairman, I demand a recorded vote.
  The CHAIR. Pursuant to clause 6 of rule XVIII, further proceedings on 
the amendment offered by the gentleman from North Carolina will be 
postponed.


                  Amendment No. 5 Offered by Mr. Barr

  The CHAIR. It is now in order to consider amendment No. 5 printed in 
House Report 115-179.
  Mr. BARR. Mr. Chair, I have an amendment at the desk.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Add, at the end of the bill, the following (and amend the 
     table of contents accordingly):

     SEC. 11. AFFIRMATIVE DEFENSE.

       (a) In General.--In the case of a health care lawsuit, it 
     shall be an affirmative defense to any health care liability 
     claim alleged therein that the defendant complied with a 
     clinical practice guideline that was established, published, 
     maintained, and updated on a regular basis by an eligible 
     professional organization and that is applicable to the 
     provision or use of health care services or medical products 
     for which the health care liability claim is brought.
       (b) Definitions.--For purposes of this section:

[[Page H5282]]

       (1) Clinical practice guideline.--The term ``clinical 
     practice guideline'' means systematically developed 
     statements based on the review of clinical evidence for 
     assisting a health care provider to determine the appropriate 
     health care in specific clinical circumstances.
       (2) Eligible professional organization.--The term 
     ``eligible professional organization'' means a national or 
     State medical society or medical specialty society.

  The CHAIR. Pursuant to House Resolution 382, the gentleman from 
Kentucky (Mr. Barr) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from Kentucky.
  Mr. BARR. Mr. Chairman, I first want to commend Chairman Goodlatte 
and Congressman King and others who worked on H.R. 1215, the Protecting 
Access to Care Act, which aims to address the real problem of junk 
lawsuits in the context of medical care.
  Seventy-five percent of the doctors will face a malpractice lawsuit 
over the course of their careers, and many of these claims are 
frivolous, which drives up the cost of healthcare, encourages defensive 
medicine, and contributes to the Nation's severe shortage of doctors 
and nurses, especially in high-risk areas such as obstetrics, 
neurosurgery, and emergency medicine.
  We need to enact sensible medical malpractice reform, and given the 
clear Federal interest in reducing taxpayer costs wherever Federal 
policy affects the distribution of healthcare, I support H.R. 1215.
  However, H.R. 1215 does not go far enough to discourage the practice 
of defensive medicine, the provision of health services, tests, and 
procedures designed to shield the provider from legal liability but 
which may not be medically necessary or in the best interests of the 
patient.
  Defensive medicine is a major driver of healthcare costs and also 
reduces the quality of patient care.

                              {time}  1615

  In that spirit, I offer this amendment, which would expand upon the 
reforms in H.R. 1215, to protect physicians from frivolous lawsuits, 
while promoting the practice of evidence-based medicine to lower costs 
and improve healthcare quality.
  My amendment offers a legal safe harbor in the form of an affirmative 
defense for defendants who can show that they adhered to clinical 
practice guidelines in their area of medical practice. Rather than 
Washington-based care, the guidelines would be developed by the 
physician community-based on the best available scientific evidence. 
This allows doctors to focus on practicing medicine and improves 
healthcare quality by encouraging the practice of evidence-based, not 
defensive medicine.
  A New England Journal of Medicine study on clinical practice 
guidelines and tort reform stated that ``Safe harbor rules hold promise 
for realigning legal incentives with good medical practice and 
promoting fast uptake of proven modes of care.'' By promoting adherence 
to clinical practice guidelines that are already maintained by medical 
specialty groups, this amendment would encourage physicians to provide 
higher quality care, while reducing medical errors and waste.
  Several States have already adopted safe harbor legislation and have 
significantly lowered the length and costs associated with medical 
malpractice cases. My amendment would build on the success of State 
safe harbor laws by expanding it to a national level, while not 
infringing on States' ability to implement additional tort reform.
  Americans deserve healthcare reform that will help lower the cost of 
care and protect the sacred doctor-patient relationship. The current 
reforms within H.R. 1215 are an important first step to reducing the 
high costs of medical malpractice claims. My amendment will further 
strengthen this legislation to promote affordable evidence-based 
patient care, reduce defensive medicine, and allow health professionals 
to focus on patients' actual needs.
  Mr. Chairman, I reserve the balance of my time.
  Mr. COHEN. Mr. Chairman, I claim the time in opposition to my 
friend's misguided amendment.
  The Acting CHAIR (Mr. Collins of Georgia). The gentleman from 
Tennessee is recognized for 5 minutes.
  Mr. COHEN. Mr. Chairman, this is incongruous with the rest of the 
discussion we have had. It is consistent in that it is an attempt to 
say that people who have been harmed won't be able to recover, and it 
makes it harder to recover; and it protects the physicians--and the 
people--who basically are determined to have been negligent.
  But, it says that, it is an affirmative defense to any healthcare 
liability claim--that is not just to a doctor. A healthcare liability 
claim could be to a nursing home or a medical device company--where the 
defendant complied with a clinical practice guideline developed by a 
national or State medical society or medical specialty society that is 
applicable.
  They have just argued that for the plaintiff to have an expert 
witness, that expert witness has to come from the State where the 
action is brought, or a contiguous State. But, for the defendant, you 
can have a national practice guideline as an affirmative defense. So 
when you are in Memphis, you can't get an expert witness from Harvard 
or the University of Michigan or the University of Southern California 
because those States aren't contiguous, but the physician could get a 
medical society's or a national society's perspective and have it be an 
affirmative offense.
  It is inconsistent. The whole purpose of this law is inconsistency, 
to give an advantage to those who have much and who do harm at the 
expense of those who have been harmed and have less. We see this 
continual attack on the poor and the injured.
  In the healthcare bill, we talk about less opportunity because of 
diminution in Medicaid for the poor, disabled, seniors, and pregnant 
women to get healthcare. Here, we are talking about people who have 
been injured--actually, in fact, injured. And we are saying that a 
medical society's rule should be an affirmative defense, no matter 
where they are. We limit the experts you can have, and we limit the 
damages you can collect.
  And this isn't to some specious group. This is to people who have 
actually been injured, and the juries in their home districts have 
found them to be plaintiffs who proved by a preponderance of the 
evidence that the defendant tort fees, or doctor, nursing home, or 
medical device company, breached the standard of care to which they 
were held to. It is giving them protections of the law given by 
Washington, almighty Washington.
  Once again, I submit to you that the swamp is not being drained but 
is overflowing to flood the courthouses and not allow justice to come 
to those who have been harmed by negligence. For time and memorial, it 
has been the province of the States, the Tenth Amendment. Tort 
liability and court systems should be determined by legislators and bar 
associations, maybe medical societies, but back home, not national 
medical specialty societies or national medical societies as defenses, 
which is what this particular amendment brings forth.
  I heard my friend from Tennessee say that in Tennessee, 60 percent of 
the verdicts go to lawyers. That is not true. He first talked about a 
law passed in 2008, that limits attorneys' fees. So since then, it 
certainly has not been 60 percent, and even before then it wasn't 60 
percent. The typical contingency fee is a third, and nothing if you 
don't win, and there are great expenses incurred.
  This is closing the courthouse door to injured parties who juries 
have found to be injured and limiting their access to recovery. This 
allows a national medical society to be a part of a fraternity to give 
an affirmative defense to another frat brother.
  I oppose the amendment, I oppose the bill, and I am in favor of an 
open and free court system that punishes malfeasance and rewards those 
who have been injured by people who do not practice up to the standard 
of care that is dictated for them in their own State.

  Mr. Chairman, I reserve the balance of my time.
  Mr. BARR. Mr. Chairman, in brief response to my friend from 
Tennessee, the safe harbor legislation would not supplant the standard 
of care, but it would allow for evidence-based medicine to improve 
healthcare quality. Those standards would be developed by local doctors 
participating in their medical societies.
  Mr. Chairman, I yield to the gentleman from Iowa (Mr. King), my 
friend.
  Mr. KING of Iowa. Mr. Chairman, I thank the gentleman for yielding.

[[Page H5283]]

  Mr. Chairman, I have a statement before me from Chairman Goodlatte, 
the chairman of the full Judiciary Committee. I am going to represent 
this as his statement, but the chairman thanks the gentleman from 
Kentucky for his clarification while he remains opposed to the 
amendment because it provides an overly broad definition of the 
eligible professional organizations authorized to issue the guidelines 
that would be used as an affirmative defense, and because it is not 
supported by the wider coalition of medical groups supporting the base 
bill. He looks forward to working with the gentleman to further refine 
and improve his legislative proposal.
  That concludes Chairman Goodlatte's statement that he would like read 
into this Record.
  And I would say on my own behalf, Mr. Chairman, that I very much 
appreciate the work that Mr. Barr has brought to this. The language 
that he presented originally, that had to be amended in order to 
conform with the parliamentarian, I believe, does define this with 
clarity. So I am inclined to support the gentleman from Kentucky. We 
will see what happens if there is a recorded vote.
  Mr. BARR. Mr. Chairman, I thank the gentleman for those comments.
  Mr. Chairman, the clinical practice guideline safe harbor policies 
have been supported by the American for Tax Reform, American College of 
Radiology, Healthcare Leadership Council, American Academy of 
Orthopedic Surgeons, American Society of Anesthesiologists, American 
Academy of Neurology, American Urological Association, American College 
of Surgeons, American Health Care Association, American College of 
Obstetricians and Gynecologists, American Association of Neurological 
Surgeons, Alliance of Specialty Medicine, Third Way, American College 
of Physicians, American College of Emergency Physicians, American 
Osteopathic Association, American College of Cardiologists, and the 
American Academy of Ophthalmology.
  As originally drafted, the amendment set forth the procedure in 
detail.
  Nevertheless, the process by which clinical practice guidelines are 
proved and published is well established and well known. The text of 
the amendment clearly references that existing and well-defined process 
that provides for guidelines to be proposed, submitted, approved, and 
published through the National Guideline Clearinghouse under the Agency 
for Healthcare Research and Quality. This is a process that ensures the 
integrity and quality of the applicable guidelines.
  Mr. Chairman, I yield back the balance of my time.
  Mr. COHEN. Mr. Chairman, I thank Mr. Goodlatte for his honest 
testimony and submitting it. For that reason, among others, I will be 
voting ``no'' on this amendment, and I hope that it will be found to be 
``no'' by the Chair. Because when the chairman of the Judiciary 
Committee, a fine Republican lawyer, says that the amendment is beyond 
what they intended, it shouldn't really be part of the bill.
  Mr. Chairman, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from Kentucky (Mr. Barr).
  The question was taken; and the Acting Chair announced that the noes 
appeared to have it.
  Mr. BARR. Mr. Chairman, I demand a recorded vote.
  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further 
proceedings on the amendment offered by the gentleman from Kentucky 
will be postponed.


                    Announcement by the Acting Chair

  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, proceedings 
will now resume on those amendments printed in House Report 115-179 on 
which further proceedings were postponed, in the following order:
  Amendment No. 4 by Mr. Hudson of North Carolina.
  Amendment No. 5 by Mr. Barr of Kentucky.
  The Chair will reduce to 2 minutes the minimum time for any 
electronic vote after the first vote in this series.


                 Amendment No. 4 Offered by Mr. Hudson

  The Acting CHAIR. The unfinished business is the demand for a 
recorded vote on the amendment offered by the gentleman from North 
Carolina (Mr. Hudson) on which further proceedings were postponed and 
on which the ayes prevailed by voice vote.
  The Clerk will redesignate the amendment.
  The Clerk redesignated the amendment.


                             Recorded Vote

  The Acting CHAIR. A recorded vote has been demanded.
  A recorded vote was ordered.
  The vote was taken by electronic device, and there were--ayes 222, 
noes 197, not voting 14, as follows:

                             [Roll No. 334]

                               AYES--222

     Abraham
     Aderholt
     Allen
     Arrington
     Babin
     Bacon
     Banks (IN)
     Barletta
     Barr
     Barton
     Bera
     Bergman
     Biggs
     Bilirakis
     Bishop (MI)
     Bishop (UT)
     Blackburn
     Blum
     Bost
     Brady (TX)
     Brat
     Bridenstine
     Brooks (AL)
     Brooks (IN)
     Buchanan
     Buck
     Bucshon
     Budd
     Burgess
     Byrne
     Calvert
     Carter (GA)
     Carter (TX)
     Chabot
     Chaffetz
     Cheney
     Coffman
     Cole
     Collins (GA)
     Collins (NY)
     Comer
     Comstock
     Conaway
     Cook
     Correa
     Costello (PA)
     Cramer
     Crawford
     Cuellar
     Culberson
     Davis, Rodney
     Denham
     Dent
     DeSantis
     DesJarlais
     Donovan
     Duffy
     Duncan (SC)
     Dunn
     Emmer
     Estes (KS)
     Farenthold
     Faso
     Ferguson
     Fitzpatrick
     Fleischmann
     Flores
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gaetz
     Gallagher
     Gianforte
     Gibbs
     Gohmert
     Goodlatte
     Gosar
     Gowdy
     Granger
     Graves (GA)
     Graves (LA)
     Graves (MO)
     Grothman
     Guthrie
     Handel
     Harper
     Harris
     Hartzler
     Hensarling
     Herrera Beutler
     Hice, Jody B.
     Higgins (LA)
     Hill
     Holding
     Hollingsworth
     Hudson
     Huizenga
     Hultgren
     Hunter
     Hurd
     Issa
     Jenkins (KS)
     Jenkins (WV)
     Johnson (LA)
     Johnson (OH)
     Johnson, Sam
     Jordan
     Joyce (OH)
     Katko
     Kelly (MS)
     Kelly (PA)
     King (IA)
     King (NY)
     Kinzinger
     Knight
     Kustoff (TN)
     Labrador
     LaHood
     LaMalfa
     Lamborn
     Lance
     Latta
     Lewis (MN)
     Loudermilk
     Love
     Lucas
     Luetkemeyer
     MacArthur
     Marchant
     Marino
     Marshall
     Mast
     McCarthy
     McCaul
     McClintock
     McHenry
     McKinley
     McMorris Rodgers
     McSally
     Meadows
     Meehan
     Messer
     Mitchell
     Moolenaar
     Mooney (WV)
     Mullin
     Murphy (PA)
     Newhouse
     Noem
     Norman
     Nunes
     Olson
     Palazzo
     Palmer
     Paulsen
     Pearce
     Peters
     Peterson
     Pittenger
     Poliquin
     Ratcliffe
     Reed
     Reichert
     Rice (SC)
     Roby
     Roe (TN)
     Rogers (KY)
     Rohrabacher
     Rokita
     Rooney, Francis
     Rooney, Thomas J.
     Rosen
     Roskam
     Ross
     Rothfus
     Rouzer
     Royce (CA)
     Ruiz
     Rutherford
     Schweikert
     Scott, Austin
     Sensenbrenner
     Sessions
     Shimkus
     Shuster
     Simpson
     Smith (MO)
     Smith (NE)
     Smith (TX)
     Smucker
     Stefanik
     Stewart
     Taylor
     Tenney
     Thompson (PA)
     Thornberry
     Tiberi
     Tipton
     Trott
     Upton
     Valadao
     Wagner
     Walberg
     Walden
     Walker
     Walorski
     Walters, Mimi
     Weber (TX)
     Webster (FL)
     Wenstrup
     Westerman
     Williams
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Yoder
     Yoho
     Young (AK)
     Young (IA)
     Zeldin

                               NOES--197

     Adams
     Aguilar
     Amash
     Barragan
     Bass
     Beatty
     Beyer
     Bishop (GA)
     Blumenauer
     Blunt Rochester
     Bonamici
     Boyle, Brendan F.
     Brady (PA)
     Brown (MD)
     Brownley (CA)
     Bustos
     Butterfield
     Capuano
     Carbajal
     Cardenas
     Carson (IN)
     Cartwright
     Castor (FL)
     Castro (TX)
     Chu, Judy
     Cicilline
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly
     Conyers
     Cooper
     Costa
     Courtney
     Crist
     Crowley
     Curbelo (FL)
     Davidson
     Davis (CA)
     Davis, Danny
     DeFazio
     DeGette
     Delaney
     DeLauro
     DelBene
     Demings
     DeSaulnier
     Deutch
     Diaz-Balart
     Dingell
     Doggett
     Doyle, Michael F.
     Duncan (TN)
     Ellison
     Engel
     Eshoo
     Espaillat
     Esty (CT)
     Evans
     Foster
     Frankel (FL)
     Fudge
     Gabbard
     Gallego
     Garamendi
     Garrett
     Gonzalez (TX)
     Gottheimer
     Green, Al
     Green, Gene
     Griffith
     Grijalva
     Gutierrez
     Hanabusa
     Hastings
     Heck
     Higgins (NY)
     Himes
     Hoyer
     Huffman
     Jackson Lee
     Jayapal
     Jeffries
     Johnson (GA)
     Kaptur
     Keating
     Kelly (IL)
     Kennedy
     Khanna
     Kihuen
     Kildee
     Kilmer
     Kind
     Krishnamoorthi
     Kuster (NH)
     Larsen (WA)
     Larson (CT)
     Lawrence
     Lawson (FL)
     Lee
     Levin
     Lewis (GA)
     Lieu, Ted
     Lipinski
     LoBiondo
     Loebsack
     Lofgren
     Lowenthal
     Lowey
     Lujan Grisham, M.
     Lujan, Ben Ray
     Lynch
     Maloney, Carolyn B.
     Maloney, Sean
     Massie
     Matsui
     McCollum
     McEachin
     McGovern
     Meng
     Moore
     Moulton
     Murphy (FL)
     Nadler
     Neal
     Nolan
     Norcross
     O'Halleran
     O'Rourke
     Pallone
     Panetta
     Pascrell
     Payne
     Pelosi
     Perlmutter
     Perry
     Pingree

[[Page H5284]]


     Pocan
     Poe (TX)
     Polis
     Posey
     Price (NC)
     Quigley
     Raskin
     Rice (NY)
     Richmond
     Ros-Lehtinen
     Roybal-Allard
     Ruppersberger
     Rush
     Russell
     Ryan (OH)
     Sanchez
     Sanford
     Sarbanes
     Schakowsky
     Schiff
     Schneider
     Schrader
     Scott (VA)
     Scott, David
     Serrano
     Sewell (AL)
     Shea-Porter
     Sherman
     Sinema
     Sires
     Slaughter
     Smith (NJ)
     Smith (WA)
     Soto
     Speier
     Suozzi
     Swalwell (CA)
     Takano
     Thompson (CA)
     Thompson (MS)
     Titus
     Tonko
     Torres
     Tsongas
     Turner
     Vargas
     Veasey
     Vela
     Velazquez
     Visclosky
     Walz
     Wasserman Schultz
     Waters, Maxine
     Watson Coleman
     Welch
     Wilson (FL)
     Yarmuth

                             NOT VOTING--14

     Amodei
     Black
     Cummings
     Johnson, E. B.
     Jones
     Langevin
     Long
     McNerney
     Meeks
     Napolitano
     Renacci
     Rogers (AL)
     Scalise
     Stivers

                              {time}  1646

  Ms. TSONGAS changed her vote from ``aye'' to ``no.''
  So the amendment was agreed to.
  The result of the vote was announced as above recorded.
  Stated against:
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Chair, I was unavoidably 
detained. Had I been present, I would have voted ``nay'' on rollcall 
No. 334.


                  Amendment No. 5 Offered by Mr. Barr

  The Acting CHAIR. The unfinished business is the demand for a 
recorded vote on the amendment offered by the gentleman from Kentucky 
(Mr. Barr) on which further proceedings were postponed and on which the 
noes prevailed by voice vote.
  The Clerk will redesignate the amendment.
  The Clerk redesignated the amendment.


                             Recorded Vote

  The Acting CHAIR. A recorded vote has been demanded.
  A recorded vote was ordered.
  The Acting CHAIR. This is a 2-minute vote.
  The vote was taken by electronic device, and there were--ayes 116, 
noes 310, not voting 7, as follows:

                             [Roll No. 335]

                               AYES--116

     Abraham
     Aderholt
     Allen
     Amodei
     Barletta
     Barr
     Bera
     Bergman
     Bilirakis
     Bishop (UT)
     Brooks (AL)
     Bucshon
     Budd
     Carter (GA)
     Cheney
     Cole
     Comstock
     Correa
     Costello (PA)
     Cuellar
     Davidson
     Davis, Rodney
     Dent
     DeSantis
     DesJarlais
     Duffy
     Duncan (SC)
     Dunn
     Farenthold
     Ferguson
     Fitzpatrick
     Fleischmann
     Fortenberry
     Foxx
     Franks (AZ)
     Gaetz
     Gallagher
     Gianforte
     Gosar
     Graves (GA)
     Graves (LA)
     Graves (MO)
     Guthrie
     Harris
     Hice, Jody B.
     Holding
     Hollingsworth
     Hudson
     Huizenga
     Hunter
     Jenkins (KS)
     Jenkins (WV)
     Johnson (LA)
     Joyce (OH)
     Kaptur
     Kelly (PA)
     King (IA)
     Kustoff (TN)
     Labrador
     LaMalfa
     Lamborn
     Loudermilk
     MacArthur
     Marchant
     Marino
     Marshall
     Mast
     McCaul
     McMorris Rodgers
     Meadows
     Meehan
     Mooney (WV)
     Mullin
     Norman
     Nunes
     Palmer
     Pearce
     Peters
     Rice (SC)
     Roe (TN)
     Rogers (KY)
     Rohrabacher
     Rokita
     Rooney, Thomas J.
     Rosen
     Roskam
     Ross
     Rothfus
     Rouzer
     Ruiz
     Schrader
     Schweikert
     Scott, Austin
     Sessions
     Simpson
     Sinema
     Smith (MO)
     Smith (NE)
     Smucker
     Stewart
     Tenney
     Thompson (PA)
     Tiberi
     Valadao
     Wagner
     Walberg
     Walker
     Webster (FL)
     Wenstrup
     Westerman
     Williams
     Wilson (SC)
     Woodall
     Yoder
     Young (AK)
     Young (IA)

                               NOES--310

     Adams
     Aguilar
     Amash
     Arrington
     Babin
     Bacon
     Banks (IN)
     Barragan
     Barton
     Bass
     Beatty
     Beyer
     Biggs
     Bishop (GA)
     Bishop (MI)
     Black
     Blackburn
     Blum
     Blumenauer
     Blunt Rochester
     Bonamici
     Bost
     Boyle, Brendan F.
     Brady (PA)
     Brady (TX)
     Brat
     Bridenstine
     Brooks (IN)
     Brown (MD)
     Brownley (CA)
     Buchanan
     Buck
     Burgess
     Bustos
     Butterfield
     Byrne
     Calvert
     Capuano
     Carbajal
     Cardenas
     Carson (IN)
     Carter (TX)
     Cartwright
     Castor (FL)
     Castro (TX)
     Chabot
     Chaffetz
     Chu, Judy
     Cicilline
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Coffman
     Cohen
     Collins (GA)
     Collins (NY)
     Comer
     Conaway
     Connolly
     Conyers
     Cook
     Cooper
     Costa
     Courtney
     Cramer
     Crawford
     Crist
     Crowley
     Culberson
     Curbelo (FL)
     Davis (CA)
     Davis, Danny
     DeFazio
     DeGette
     Delaney
     DeLauro
     DelBene
     Demings
     Denham
     DeSaulnier
     Deutch
     Diaz-Balart
     Dingell
     Doggett
     Donovan
     Doyle, Michael F.
     Duncan (TN)
     Ellison
     Emmer
     Engel
     Eshoo
     Espaillat
     Estes (KS)
     Esty (CT)
     Evans
     Faso
     Flores
     Foster
     Frankel (FL)
     Frelinghuysen
     Fudge
     Gabbard
     Gallego
     Garrett
     Gibbs
     Gohmert
     Gonzalez (TX)
     Goodlatte
     Gottheimer
     Gowdy
     Granger
     Green, Al
     Green, Gene
     Griffith
     Grijalva
     Grothman
     Gutierrez
     Hanabusa
     Handel
     Harper
     Hartzler
     Hastings
     Heck
     Hensarling
     Herrera Beutler
     Higgins (LA)
     Higgins (NY)
     Hill
     Himes
     Hoyer
     Huffman
     Hultgren
     Hurd
     Issa
     Jackson Lee
     Jayapal
     Jeffries
     Johnson (GA)
     Johnson (OH)
     Johnson, E. B.
     Johnson, Sam
     Jones
     Jordan
     Katko
     Keating
     Kelly (IL)
     Kelly (MS)
     Kennedy
     Khanna
     Kihuen
     Kildee
     Kilmer
     Kind
     King (NY)
     Kinzinger
     Knight
     Krishnamoorthi
     Kuster (NH)
     LaHood
     Lance
     Langevin
     Larsen (WA)
     Larson (CT)
     Latta
     Lawrence
     Lawson (FL)
     Lee
     Levin
     Lewis (GA)
     Lewis (MN)
     Lieu, Ted
     Lipinski
     LoBiondo
     Loebsack
     Lofgren
     Love
     Lowenthal
     Lowey
     Lucas
     Luetkemeyer
     Lujan Grisham, M.
     Lujan, Ben Ray
     Lynch
     Maloney, Carolyn B.
     Maloney, Sean
     Massie
     Matsui
     McCarthy
     McClintock
     McCollum
     McEachin
     McGovern
     McHenry
     McKinley
     McNerney
     McSally
     Meeks
     Meng
     Messer
     Mitchell
     Moolenaar
     Moore
     Moulton
     Murphy (FL)
     Murphy (PA)
     Nadler
     Neal
     Newhouse
     Noem
     Nolan
     Norcross
     O'Halleran
     O'Rourke
     Olson
     Palazzo
     Pallone
     Panetta
     Pascrell
     Paulsen
     Payne
     Pelosi
     Perlmutter
     Perry
     Peterson
     Pingree
     Pittenger
     Pocan
     Poe (TX)
     Poliquin
     Polis
     Posey
     Price (NC)
     Quigley
     Raskin
     Ratcliffe
     Reed
     Reichert
     Rice (NY)
     Richmond
     Roby
     Rogers (AL)
     Rooney, Francis
     Ros-Lehtinen
     Roybal-Allard
     Royce (CA)
     Ruppersberger
     Rush
     Russell
     Rutherford
     Ryan (OH)
     Sanchez
     Sanford
     Sarbanes
     Schakowsky
     Schiff
     Schneider
     Scott (VA)
     Scott, David
     Sensenbrenner
     Serrano
     Sewell (AL)
     Shea-Porter
     Sherman
     Shimkus
     Shuster
     Sires
     Slaughter
     Smith (NJ)
     Smith (TX)
     Smith (WA)
     Soto
     Speier
     Stefanik
     Suozzi
     Swalwell (CA)
     Takano
     Taylor
     Thompson (CA)
     Thompson (MS)
     Thornberry
     Tipton
     Titus
     Tonko
     Torres
     Trott
     Tsongas
     Turner
     Upton
     Vargas
     Veasey
     Vela
     Velazquez
     Visclosky
     Walden
     Walorski
     Walters, Mimi
     Walz
     Wasserman Schultz
     Waters, Maxine
     Watson Coleman
     Weber (TX)
     Welch
     Wilson (FL)
     Wittman
     Womack
     Yarmuth
     Yoho
     Zeldin

                             NOT VOTING--7

     Cummings
     Garamendi
     Long
     Napolitano
     Renacci
     Scalise
     Stivers


                    Announcement by the Acting Chair

  The Acting CHAIR (during the vote). There is 1 minute remaining.

                              {time}  1653

  Mr. MICHAEL F. DOYLE of Pennsylvania changed his vote from ``aye'' to 
``no.''
  Messrs. RICE of South Carolina and DENT changed their vote from 
``no'' to ``aye.''
  So the amendment was rejected.
  The result of the vote was announced as above recorded.
  Stated against:
  Mr. LANGEVIN. Mr. Chair, on rollcall vote 335, I was unavoidably 
detained. Had I been present, I would have voted ``no.''
  The Acting CHAIR (Mr. Yoder). The question is on the amendment in the 
nature of a substitute, as amended.
  The amendment was agreed to.
  The Acting CHAIR. Under the rule, the Committee rises.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Collins of Georgia) having assumed the chair, Mr. Yoder, Acting Chair 
of the Committee of the Whole House on the state of the Union, reported 
that that Committee, having had under consideration the bill (H.R. 
1215) to improve patient access to health care services and provide 
improved medical care by reducing the excessive burden the liability 
system places on the health care delivery system, and, pursuant to 
House Resolution 382, he reported the bill back to the House with an 
amendment adopted in the Committee of the Whole.
  The SPEAKER pro tempore. Under the rule, the previous question is 
ordered.
  Is a separate vote demanded on any amendment to the amendment 
reported from the Committee of the Whole?
  If not, the question is on the amendment in the nature of a 
substitute, as amended.
  The amendment was agreed to.
  The SPEAKER pro tempore. The question is on the engrossment and third 
reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.

[[Page H5285]]

  



                           Motion to Recommit

  Ms. KUSTER of New Hampshire. Mr. Speaker, I have a motion to recommit 
at the desk.
  The SPEAKER pro tempore. Is the gentlewoman opposed to the bill?
  Ms. KUSTER of New Hampshire. I am opposed to the bill in its current 
form.
  The SPEAKER pro tempore. The Clerk will report the motion to 
recommit.
  The Clerk read as follows:

       Ms. KUSTER of New Hampshire moves to recommit the bill H.R. 
     1215 to the Committee on the Judiciary with instructions to 
     report the same back to the House forthwith with the 
     following amendment:

       Add, at the end of the bill, the following (and conform the 
     table of contents accordingly):

     SEC. 11. COMBATTING THE OPIOIDS EPIDEMIC.

       For purposes of this Act, the term ``health care lawsuit'', 
     as defined in section 7, does not include a claim or action 
     which pertains to the grossly negligent prescription of 
     opioids.

  Mr. GAETZ (during the reading). Mr. Speaker, I ask unanimous consent 
to dispense with the reading.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Florida?
  There was no objection.
  The SPEAKER pro tempore. The gentlewoman is recognized for 5 minutes.
  Ms. KUSTER of New Hampshire. Mr. Speaker, this is the final amendment 
to the bill, which will not kill the bill or send it back to committee. 
If adopted, the bill will immediately proceed to final passage as 
amended.
  Like so many communities and States across this country, New 
Hampshire has been devastated by the heroin and opioid epidemic. Last 
year alone, my State lost 500 people to substance use disorder.
  Helping families, first responders, treatment providers, law 
enforcement officials, and family advocates in the Granite State 
confront this crisis has been my number one priority in Congress.
  In 2015, Mr. Guinta and I founded the Bipartisan Congressional Heroin 
Task Force to raise awareness of this crisis and to advocate in a 
collaborative way for solutions at the Federal level. I am proud to 
report that our bipartisan task force is now 90 members strong, and we 
have made important progress in passing legislation and securing 
critical funding.
  But the causes of this crisis are complex, requiring a multifaceted 
approach addressing every angle of the epidemic, from treatment to 
recovery, from education and prevention to law enforcement and 
interdiction.
  A primary cause of opioid misuse resulting in heroin dependence is 
the overprescribing of opioid pain medication.
  The data is astonishing. A December 2016 study found that opioids 
were prescribed to 91 percent of patients after they had experienced an 
overdose, and, in fact, 63 percent of patients on high-dose opioids 
were still prescribed high-dose opioids after overdosing.
  We have all heard the stories: teens who had their wisdom teeth 
removed receiving 30-day supplies of opioids, or a person with back 
pain receiving prescriptions for extended release opioids even though 
Tylenol would keep them comfortable.
  America consumes 80 percent of the global supply of opioid 
medication, and 650,000 opioid prescriptions are written every single 
day.
  Earlier this year, a study by the Centers for Disease Control and 
Prevention found the following extraordinary fact: if 100 people take 
opioid medication for 1 day, 6 percent will still be using 30 days 
later; and if 100 people take opioid medication for 30 days, 35 percent 
of those patients will still be using opioids a year later.
  Our task force is working closely with the medical community to 
strengthen prescribing practices so that patients can manage their pain 
in an effective and responsible way.
  Through my role on the Veterans' Affairs Committee, I am working with 
my colleagues to improve pain management practices at the VA and to 
better understand alternative methods for pain management.
  The White River Junction VA facility in Vermont serving New Hampshire 
veterans is a great example where they have cut opioid prescriptions 
nearly in half by incorporating alternative treatments.
  While there is much work that we can do to understand this issue, 
there remain bad actors across this country who are exploiting those 
who suffer from substance use disorder for their own financial gain.
  In rural communities and elsewhere, pill mills churn out opioid 
prescriptions with no regard for the well-being of their patients. And 
just last month, a doctor in New England pled guilty to healthcare 
fraud for overprescribing opioids, including writing more than 1,100 
Oxycodone prescriptions in a single month.
  Victims of exploitative prescribing practices must have the 
unencumbered capacity of our legal system to recoup their damages and 
to deter negative industry practices.
  I am concerned that arbitrary limitations in this legislation on 
legal damages could limit their ability to effectively respond to the 
opioid epidemic, and that is why my amendment would simply exempt from 
the legislation any claim or action that pertains to grossly negligent 
prescription of opioids. Should this bill become law, this provision 
will help protect those who have been exploited by predatory physicians 
operating pill mills.
  There is so much we should do to roll back this crisis, and I look 
forward to our continued bipartisan work. But today I urge my 
colleagues to approve this motion.
  Mr. Speaker, I yield back the balance of my time.
  Mr. GAETZ. Mr. Speaker, I rise to oppose the motion to recommit.
  The SPEAKER pro tempore. The gentleman from Florida is recognized for 
5 minutes.
  Mr. GAETZ. Mr. Speaker, the motion to recommit is ambiguous, as there 
is no legal standard currently for that which constitutes gross 
negligence in the area of prescriptions.
  Already this legislation does not apply to circumstances in which 
there is criminal conduct. That means that bad doctors with bad intent 
will be prosecuted, and in every State in America, there are legal 
standards by which those very doctors would lose their license were 
they to engage in the conduct that the gentlewoman highlighted.
  Mr. Speaker, healthcare costs are rising at alarming rates due to the 
failures of ObamaCare. This bill will reduce healthcare costs. It will 
improve the quality of care received.
  Mr. Speaker, through this underlying legislation, we will enhance the 
relationship between patients and doctors. We will reduce frivolous 
litigation. And by ultimately addressing the challenges that arise with 
increasing healthcare costs, we will make it more easy to get to the 
affordability challenges with healthcare coverage.
  This will ultimately increase wages for the American worker because, 
due to the failures of ObamaCare, more businesses are having to put 
money into healthcare premiums and not into wages, not into job 
creation, and not into the success of the American people.
  Mr. Speaker, if what we really aspire to are better healthcare 
outcomes and more doctors able to treat people who are dealing with the 
challenges of opioid addiction, I would ask my colleagues to oppose 
this motion to recommit, support this bill, and get better healthcare 
outcomes for the American people.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. Without objection, the previous question is 
ordered on the motion to recommit.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to recommit.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.


                             Recorded Vote

  Ms. KUSTER of New Hampshire. Mr. Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 and clause 9 of rule 
XX, this 5-minute vote on the motion to recommit will be followed by 5-
minute votes on:
  Passage of the bill, if ordered; and
  The motion to suspend the rules and pass H.R. 1500.
  The vote was taken by electronic device, and there were--ayes 191, 
noes 235, not voting 7, as follows:

[[Page H5286]]

  


                             [Roll No. 336]

                               AYES--191

     Adams
     Aguilar
     Barragan
     Bass
     Beatty
     Bera
     Beyer
     Bishop (GA)
     Blumenauer
     Blunt Rochester
     Bonamici
     Boyle, Brendan F.
     Brady (PA)
     Brown (MD)
     Brownley (CA)
     Bustos
     Butterfield
     Capuano
     Carbajal
     Cardenas
     Carson (IN)
     Cartwright
     Castor (FL)
     Castro (TX)
     Chu, Judy
     Cicilline
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly
     Conyers
     Cooper
     Correa
     Costa
     Courtney
     Crist
     Crowley
     Cuellar
     Davis (CA)
     Davis, Danny
     DeFazio
     DeGette
     Delaney
     DeLauro
     DelBene
     Demings
     DeSaulnier
     Deutch
     Dingell
     Doggett
     Doyle, Michael F.
     Ellison
     Engel
     Eshoo
     Espaillat
     Esty (CT)
     Evans
     Foster
     Frankel (FL)
     Fudge
     Gabbard
     Gallego
     Garamendi
     Gonzalez (TX)
     Gottheimer
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hanabusa
     Hastings
     Heck
     Higgins (NY)
     Himes
     Hoyer
     Huffman
     Jackson Lee
     Jayapal
     Jeffries
     Johnson (GA)
     Johnson, E. B.
     Kaptur
     Keating
     Kelly (IL)
     Kennedy
     Khanna
     Kihuen
     Kildee
     Kilmer
     Kind
     Krishnamoorthi
     Kuster (NH)
     Langevin
     Larsen (WA)
     Larson (CT)
     Lawrence
     Lawson (FL)
     Lee
     Levin
     Lewis (GA)
     Lieu, Ted
     Lipinski
     Loebsack
     Lofgren
     Lowenthal
     Lowey
     Lujan Grisham, M.
     Lujan, Ben Ray
     Lynch
     Maloney, Carolyn B.
     Maloney, Sean
     Matsui
     McCollum
     McEachin
     McGovern
     McNerney
     Meeks
     Meng
     Moore
     Moulton
     Murphy (FL)
     Nadler
     Neal
     Nolan
     Norcross
     O'Halleran
     O'Rourke
     Pallone
     Panetta
     Pascrell
     Payne
     Pelosi
     Perlmutter
     Peters
     Peterson
     Pingree
     Pocan
     Polis
     Price (NC)
     Quigley
     Raskin
     Rice (NY)
     Richmond
     Rosen
     Roybal-Allard
     Ruiz
     Ruppersberger
     Rush
     Ryan (OH)
     Sanchez
     Sarbanes
     Schakowsky
     Schiff
     Schneider
     Schrader
     Scott (VA)
     Scott, David
     Serrano
     Sewell (AL)
     Shea-Porter
     Sherman
     Sinema
     Sires
     Slaughter
     Smith (WA)
     Soto
     Speier
     Suozzi
     Swalwell (CA)
     Takano
     Thompson (CA)
     Thompson (MS)
     Titus
     Tonko
     Torres
     Tsongas
     Vargas
     Veasey
     Vela
     Velazquez
     Visclosky
     Walz
     Wasserman Schultz
     Waters, Maxine
     Watson Coleman
     Welch
     Wilson (FL)
     Yarmuth

                               NOES--235

     Abraham
     Aderholt
     Allen
     Amash
     Amodei
     Arrington
     Babin
     Bacon
     Banks (IN)
     Barletta
     Barr
     Barton
     Bergman
     Biggs
     Bilirakis
     Bishop (MI)
     Bishop (UT)
     Black
     Blackburn
     Blum
     Bost
     Brat
     Bridenstine
     Brooks (AL)
     Brooks (IN)
     Buchanan
     Buck
     Bucshon
     Budd
     Burgess
     Byrne
     Calvert
     Carter (GA)
     Carter (TX)
     Chabot
     Chaffetz
     Cheney
     Coffman
     Cole
     Collins (GA)
     Collins (NY)
     Comer
     Comstock
     Conaway
     Cook
     Costello (PA)
     Cramer
     Crawford
     Culberson
     Curbelo (FL)
     Davidson
     Davis, Rodney
     Denham
     Dent
     DeSantis
     DesJarlais
     Diaz-Balart
     Donovan
     Duffy
     Duncan (SC)
     Duncan (TN)
     Dunn
     Emmer
     Estes (KS)
     Farenthold
     Faso
     Ferguson
     Fitzpatrick
     Fleischmann
     Flores
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gaetz
     Gallagher
     Garrett
     Gianforte
     Gibbs
     Gohmert
     Goodlatte
     Gosar
     Gowdy
     Granger
     Graves (GA)
     Graves (LA)
     Graves (MO)
     Griffith
     Grothman
     Guthrie
     Handel
     Harper
     Harris
     Hartzler
     Hensarling
     Herrera Beutler
     Hice, Jody B.
     Higgins (LA)
     Hill
     Holding
     Hollingsworth
     Hudson
     Huizenga
     Hultgren
     Hunter
     Hurd
     Issa
     Jenkins (KS)
     Jenkins (WV)
     Johnson (LA)
     Johnson (OH)
     Johnson, Sam
     Jones
     Jordan
     Joyce (OH)
     Katko
     Kelly (MS)
     Kelly (PA)
     King (IA)
     King (NY)
     Kinzinger
     Knight
     Kustoff (TN)
     Labrador
     LaHood
     LaMalfa
     Lamborn
     Lance
     Latta
     Lewis (MN)
     LoBiondo
     Loudermilk
     Love
     Lucas
     Luetkemeyer
     MacArthur
     Marchant
     Marino
     Marshall
     Massie
     Mast
     McCarthy
     McCaul
     McClintock
     McHenry
     McKinley
     McMorris Rodgers
     McSally
     Meadows
     Meehan
     Messer
     Mitchell
     Moolenaar
     Mooney (WV)
     Mullin
     Murphy (PA)
     Newhouse
     Noem
     Norman
     Nunes
     Olson
     Palazzo
     Palmer
     Paulsen
     Pearce
     Perry
     Pittenger
     Poe (TX)
     Poliquin
     Posey
     Ratcliffe
     Reed
     Reichert
     Rice (SC)
     Roby
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rohrabacher
     Rokita
     Rooney, Francis
     Rooney, Thomas J.
     Ros-Lehtinen
     Roskam
     Ross
     Rothfus
     Rouzer
     Royce (CA)
     Russell
     Rutherford
     Sanford
     Schweikert
     Scott, Austin
     Sensenbrenner
     Sessions
     Shimkus
     Shuster
     Simpson
     Smith (MO)
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Smucker
     Stefanik
     Stewart
     Taylor
     Tenney
     Thompson (PA)
     Thornberry
     Tiberi
     Tipton
     Trott
     Turner
     Upton
     Valadao
     Wagner
     Walberg
     Walden
     Walker
     Walorski
     Walters, Mimi
     Weber (TX)
     Webster (FL)
     Wenstrup
     Westerman
     Williams
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Yoder
     Yoho
     Young (AK)
     Young (IA)
     Zeldin

                             NOT VOTING--7

     Brady (TX)
     Cummings
     Long
     Napolitano
     Renacci
     Scalise
     Stivers


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore (during the vote). There are 2 minutes 
remaining.

                              {time}  1712

  So the motion to recommit was rejected.
  The result of the vote was announced as above recorded.
  Stated against:
  Mr. BRADY of Texas. Mr. Speaker, on rollcall no. 336, I was 
unavoidably detained to cast my vote in time. Had I been present, I 
would have voted ``no.''
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.


                             Recorded Vote

  Mr. CONYERS. Mr. Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The SPEAKER pro tempore. This is a 5-minute vote.
  The vote was taken by electronic device, and there were--ayes 218, 
noes 210, not voting 6, as follows:

                             [Roll No. 337]

                               AYES--218

     Abraham
     Aderholt
     Allen
     Amodei
     Arrington
     Babin
     Bacon
     Banks (IN)
     Barletta
     Barr
     Barton
     Bergman
     Biggs
     Bilirakis
     Bishop (MI)
     Bishop (UT)
     Black
     Blackburn
     Blum
     Bost
     Brady (TX)
     Brat
     Bridenstine
     Brooks (AL)
     Brooks (IN)
     Buchanan
     Buck
     Bucshon
     Budd
     Burgess
     Byrne
     Calvert
     Carter (GA)
     Carter (TX)
     Chabot
     Chaffetz
     Cheney
     Coffman
     Cole
     Collins (GA)
     Collins (NY)
     Comer
     Comstock
     Conaway
     Cook
     Cramer
     Crawford
     Culberson
     Davidson
     Davis, Rodney
     Denham
     Dent
     DeSantis
     DesJarlais
     Diaz-Balart
     Donovan
     Duffy
     Duncan (SC)
     Dunn
     Estes (KS)
     Farenthold
     Faso
     Ferguson
     Fitzpatrick
     Fleischmann
     Flores
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gaetz
     Gallagher
     Gianforte
     Gibbs
     Goodlatte
     Gosar
     Gowdy
     Granger
     Graves (GA)
     Graves (LA)
     Graves (MO)
     Grothman
     Guthrie
     Handel
     Harper
     Harris
     Hartzler
     Hensarling
     Herrera Beutler
     Hice, Jody B.
     Higgins (LA)
     Hill
     Holding
     Hollingsworth
     Hudson
     Huizenga
     Hultgren
     Hunter
     Hurd
     Issa
     Jenkins (KS)
     Jenkins (WV)
     Johnson (LA)
     Johnson (OH)
     Johnson, Sam
     Jordan
     Joyce (OH)
     Katko
     Kelly (MS)
     Kelly (PA)
     King (IA)
     King (NY)
     Kinzinger
     Knight
     Labrador
     LaHood
     LaMalfa
     Lamborn
     Lance
     Latta
     Lewis (MN)
     LoBiondo
     Loudermilk
     Love
     Lucas
     Luetkemeyer
     MacArthur
     Marchant
     Marshall
     Mast
     McCarthy
     McCaul
     McClintock
     McHenry
     McKinley
     McMorris Rodgers
     Meadows
     Messer
     Mitchell
     Moolenaar
     Mooney (WV)
     Mullin
     Murphy (PA)
     Newhouse
     Noem
     Norman
     Nunes
     Olson
     Palazzo
     Palmer
     Paulsen
     Pearce
     Perry
     Pittenger
     Poliquin
     Ratcliffe
     Reed
     Reichert
     Rice (SC)
     Roby
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rohrabacher
     Rokita
     Rooney, Francis
     Rooney, Thomas J.
     Roskam
     Ross
     Rothfus
     Rouzer
     Royce (CA)
     Rutherford
     Ryan (WI)
     Sanford
     Schweikert
     Scott, Austin
     Sensenbrenner
     Sessions
     Shimkus
     Shuster
     Simpson
     Smith (MO)
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Smucker
     Stefanik
     Stewart
     Taylor
     Tenney
     Thompson (PA)
     Thornberry
     Tiberi
     Tipton
     Trott
     Turner
     Upton
     Valadao
     Wagner
     Walberg
     Walden
     Walker
     Walorski
     Walters, Mimi
     Weber (TX)
     Wenstrup
     Westerman
     Williams
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Yoder
     Yoho
     Young (AK)
     Young (IA)
     Zeldin

                               NOES--210

     Adams
     Aguilar
     Amash
     Barragan
     Bass
     Beatty
     Bera
     Beyer
     Bishop (GA)
     Blumenauer
     Blunt Rochester
     Bonamici
     Boyle, Brendan F.
     Brady (PA)
     Brown (MD)
     Brownley (CA)
     Bustos
     Butterfield
     Capuano
     Carbajal
     Cardenas
     Carson (IN)
     Cartwright
     Castor (FL)
     Castro (TX)
     Chu, Judy
     Cicilline
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly
     Conyers
     Cooper
     Correa
     Costa
     Costello (PA)
     Courtney
     Crist
     Crowley
     Cuellar
     Curbelo (FL)
     Davis (CA)
     Davis, Danny
     DeFazio
     DeGette
     Delaney
     DeLauro
     DelBene
     Demings
     DeSaulnier
     Deutch
     Dingell
     Doggett
     Doyle, Michael F.
     Duncan (TN)
     Ellison
     Emmer
     Engel
     Eshoo
     Espaillat
     Esty (CT)
     Evans
     Foster
     Frankel (FL)
     Fudge
     Gabbard
     Gallego
     Garamendi
     Garrett
     Gohmert

[[Page H5287]]


     Gonzalez (TX)
     Gottheimer
     Green, Al
     Green, Gene
     Griffith
     Grijalva
     Gutierrez
     Hanabusa
     Hastings
     Heck
     Higgins (NY)
     Himes
     Hoyer
     Huffman
     Jackson Lee
     Jayapal
     Jeffries
     Johnson (GA)
     Johnson, E. B.
     Jones
     Kaptur
     Keating
     Kelly (IL)
     Kennedy
     Khanna
     Kihuen
     Kildee
     Kilmer
     Kind
     Krishnamoorthi
     Kuster (NH)
     Kustoff (TN)
     Langevin
     Larsen (WA)
     Larson (CT)
     Lawrence
     Lawson (FL)
     Lee
     Levin
     Lewis (GA)
     Lieu, Ted
     Lipinski
     Loebsack
     Lofgren
     Lowenthal
     Lowey
     Lujan Grisham, M.
     Lujan, Ben Ray
     Lynch
     Maloney, Carolyn B.
     Maloney, Sean
     Marino
     Massie
     Matsui
     McCollum
     McEachin
     McGovern
     McNerney
     McSally
     Meehan
     Meeks
     Meng
     Moore
     Moulton
     Murphy (FL)
     Nadler
     Neal
     Nolan
     Norcross
     O'Halleran
     O'Rourke
     Pallone
     Panetta
     Pascrell
     Payne
     Pelosi
     Perlmutter
     Peters
     Peterson
     Pingree
     Pocan
     Poe (TX)
     Polis
     Posey
     Price (NC)
     Quigley
     Raskin
     Rice (NY)
     Richmond
     Ros-Lehtinen
     Rosen
     Roybal-Allard
     Ruiz
     Ruppersberger
     Rush
     Russell
     Ryan (OH)
     Sanchez
     Sarbanes
     Schakowsky
     Schiff
     Schneider
     Schrader
     Scott (VA)
     Scott, David
     Serrano
     Sewell (AL)
     Shea-Porter
     Sherman
     Sinema
     Sires
     Slaughter
     Smith (WA)
     Soto
     Speier
     Suozzi
     Swalwell (CA)
     Takano
     Thompson (CA)
     Thompson (MS)
     Titus
     Tonko
     Torres
     Tsongas
     Vargas
     Veasey
     Vela
     Velazquez
     Visclosky
     Walz
     Wasserman Schultz
     Waters, Maxine
     Watson Coleman
     Webster (FL)
     Welch
     Wilson (FL)
     Yarmuth

                             NOT VOTING--6

     Cummings
     Long
     Napolitano
     Renacci
     Scalise
     Stivers


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore (during the vote). There are 2 minutes 
remaining.

                              {time}  1719

  So the bill was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.

                          ____________________