SB413 By Senators Pittman, Melson and Scofield RFD Health and Human Services Rd 1 13-APR-16

SYNOPSIS: Under existing law, if a physician or other health care practitioner injures a patient because he or she has failed to follow the governing standard of care in the applicable area of medicine, the patient can bring an action against the physician or health care practitioner for medical malpractice.

This bill would establish a Patient Compensation System to be administered by the Alabama Department of Public Health to provide for a mandatory alternative administrative procedure to address medical malpractice claims by a panel of physicians and medical experts to determine the payment of damages related to medical injuries.

This bill would establish a Patient Compensation Board to govern the system and to approve a schedule of compensation for confirmed medical injuries.

On or after January 1, 2017, this bill would require a person to submit an application with the Patient Compensation System in order to obtain compensation for a medical injury.

This bill would provide that, upon a finding by the Office of Medical Review within the system of prima facie evidence that an application establishes a medical injury, a health care practitioner is afforded the opportunity to support or oppose the application, and contested applications are referred to an Independent Medical Review Panel for a determination of whether a medical injury exists. If it is determined that a medical injury occurred, the applicant shall be compensated according to the adopted schedule of compensation for medical injuries.

This bill would require health care practitioners to pay an annual contribution amount based upon the practitioner's type of practice, from which compensation for medical injuries would be paid by the Office of Compensation, created within the system.

This bill would also provide for the appeal of final determinations made in the system to the circuit court.

A BILL TO BE ENTITLED AN ACT

Relating to health; to create a Patient Compensation System to be administered by the Alabama Department of Public Health for the recovery of damages related to medical injuries; to define terms; to create the Patient Compensation Board; to provide for membership and duties of the board; to create the Office of Medical Review, the Office of Compensation, and the Office of Quality Improvement within the system; to provide for committees within the system; to provide procedures for the application for compensation for a medical injury; to provide for an evaluation by an independent medical review panel; to require recusal upon a conflict of interest; to provide procedures for the review of applications, a final determination, and payment of compensation to applicants; to provide for the appeal of final determinations in the system; to require the board to assess a contribution amount to be paid by health care practitioners from which compensation awards would be paid; to create the Patient Compensation Fund; and to require certain reports to the Governor and the Legislature.

BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:

Section 1. This act shall be known and may be cited as the Alabama Patient Compensation and Insurance Reduction Act of 2016.

Section 2. This act shall apply to any person seeking recovery of a medical injury, as defined in Section 3, where a health care practitioner licensed to practice in this state performed medical treatment on a person; provided, however, if the proximate cause of the medical injury is in dispute, all proceedings under this act shall be exhausted prior to the commencement of any health care liability action against a health care practitioner.

Section 3. For the purposes of this act, the following terms shall have the following meanings:

(1) APPLICANT. A person who files an application under this act requesting the investigation of an alleged occurrence of a medical injury.

(2) APPLICATION. A request for investigation by the Patient Compensation System of an alleged occurrence of a medical injury. The term does not constitute a demand for payment under any applicable state or federal law.

(3) BOARD. The Patient Compensation Board created in Section 4.

(4) COLLATERAL SOURCE. Any payments made to the applicant, or made on the applicant's behalf, by or pursuant to any of the following:

a. The federal Social Security Act, 42 U.S.C. § 301 et seq., any federal, state, or local income disability act, or any other public programs providing medical expenses, disability payments, or other similar benefits, except as prohibited by federal law.

b. Any health, sickness, or income disability insurance, automobile accident insurance that provides health benefits or income disability coverage, or any other similar insurance benefits, except life insurance benefits available to the applicant, whether purchased by the applicant or provided by others.

c. Any contract or agreement of any group, organization, partnership, or corporation to provide, pay for, or reimburse the costs of hospital, medical, dental, or other health care services.

d. Any contractual or voluntary wage continuation plan provided by employers or by any other system intended to provide wages during a period of disability.

(5) COMPENSATION SCHEDULE. A schedule of damages for medical injuries.

(6) DEPARTMENT. The Alabama Department of Public Health.

(7) HEALTH CARE PRACTITIONER or PRACTITIONER. A medical practitioner licensed to practice medicine or osteopathy in this state, a dentist, or physician.

(8) INDEPENDENT MEDICAL REVIEW PANEL or PANEL. A panel of qualified physicians or other medical experts convened to review each application.

(9) MEDICAL INJURY. A personal injury or wrongful death due to medical treatment, including a missed diagnosis, where all of the following exist:

a. The health care practitioner performed a medical treatment on the applicant.

b. The applicant suffered a medical injury with damages.

c. The medical treatment was the proximate cause of the damages.

d. Based on the facts at the time of medical treatment, either of the following occurred:

1. An accepted method of medical services was not used for treatment.

2. An accepted method of medical services was used for treatment, but executed in a substandard fashion.

The term does not include an injury or wrongful death caused by a product defect in a drug or a device used during the medical treatment.

(10) PATIENT COMPENSATION SYSTEM or SYSTEM. The system created pursuant to Section 4.

Section 4. (a) The Patient Compensation System is created to be administered by the Alabama Department of Public Health. The department may contract with designated agents to provide for the administration of this act.

(b)(1) The Patient Compensation Board is established to govern the Patient Compensation System.

(2) The board shall be composed of the following 11 members who shall represent the medical, legal, patient, and business communities from diverse geographic areas throughout this state:

a. Five members appointed by the Governor as follows:

1. One member who is a physician licensed to practice medicine in this state and who actively practices in this state.

2. One member who is an executive in the business community in this state.

3. One member who is a hospital administrator in this state.

4. One member who is a certified public accountant who actively practices in this state.

5. One member who is an attorney licensed to practice in any jurisdiction in this state.

b. Three members appointed by the President Pro Tempore of the Senate as follows:

1. One member who is a physician licensed to practice medicine in this state and who actively practices in this state.

2. One member who is a patient advocate.

3. One member who is a resident of this state.

c. Three members appointed by the Speaker of the House of Representatives as follows:

1. One member who is a physician licensed to practice medicine in this state and who actively practices in this state.

2. One member who is a patient advocate.

3. One member who is a resident of this state.

(3) The appointing authorities shall coordinate their appointments to assure that the membership of the board is inclusive and reflects the racial, gender, geographic, urban, rural, and economic diversity of the state.

(4) Each member shall be appointed for a four-year term. For the purpose of providing staggered terms of the initial appointments, the five members appointed by the Governor shall be appointed to two-year terms and the remaining six members shall be appointed to three-year terms. If a vacancy occurs on the board before the expiration of a term, the original appointing authority shall appoint a successor to serve the unexpired portion of the term.

(5) The board shall annually elect from its membership one member to serve as chair of the board and one member to serve as vice chair.

(6) The first meeting of the board shall be held no later than January 1, 2017. Thereafter, the board shall meet at least quarterly upon the call of the chair. A majority of the board members constitutes a quorum. Meetings may be held by teleconference, web conference, or other electronic means.

(7) The members of the board shall serve without compensation, but they may be reimbursed for actual expenses incurred in the performance of their duties.

(8) The board shall have all of the following powers and duties:

a. Ensuring the operation of the Patient Compensation System in accordance with applicable federal and state laws, rules, and regulations.

b. Entering into contracts as necessary to administer this act.

c. Employing an executive director and other staff as are necessary to perform the functions of the Patient Compensation System, except that the Governor shall appoint the initial executive director.

d. Approving the hiring of a chief compensation officer and chief medical officer, both as recommended by the executive director.

e. Approving a schedule of compensation for medical injuries, as recommended by the Compensation Committee.

f. Approving medical review panelists, as recommended by the Medical Review Committee.

g. Approving an annual budget.

h. Annually approving health care practitioner contribution amounts.

(9) The executive director shall oversee the operation of the Patient Compensation System in accordance with this act.

(10) The following staff shall be hired by the executive director and report directly to and serve at the pleasure of the executive director:

a. The advocacy director, who shall do all of the following:

1. Ensure that each applicant is provided high quality individual assistance throughout the process, from initial filing to disposition of the application.

2. Assist each applicant in determining whether to retain an attorney, which assistance shall include an explanation of possible fee arrangements and the benefits and disadvantages of retaining an attorney.

3. If the applicant seeks to file an application without an attorney, assist the applicant in filing the application.

4. Regularly provide status reports to the applicant or applicant's attorney regarding the applicant's application.

b. The chief compensation officer, who shall manage the Office of Compensation, created in subsection (c). The Chief Compensation Officer shall recommend to the Compensation Committee, created in subsection (d), a compensation schedule for each type of injury. The compensation schedule may include provisions for the consideration of specific economic damages associated with the medical injury. The chief compensation officer shall not be a licensed physician or an attorney.

c. The chief financial officer, who shall oversee the financial operations of the system, including the annual development of a budget.

d. The chief legal officer, who shall represent the system in all contested applications, oversee the operation of the Patient Compensation System to ensure compliance with established procedures, and ensure adherence to all applicable federal and state laws, rules, and regulations.

e. The chief medical officer, who shall be a physician licensed to practice medicine in this state and shall recommend to the medical review committee a qualified list of panelists for independent medical review panels. The chief medical officer shall convene independent medical review panels as necessary to review applications and shall manage the Office of Medical Review, created in subsection (c).

f. The chief quality officer, who shall manage the Office of Quality Improvement, created in subsection (c).

(11) Board members shall be indemnified by the state for any liability they might incur while acting in the capacity of a board member.

(c) The following offices are established within the Patient Compensation System:

(1) The Office of Medical Review, which shall evaluate and, as necessary, investigate all applications in accordance with this act. For the purpose of an investigation of an application, the office shall have the power to administer oaths, take depositions, issue subpoenas, compel the attendance of witnesses and the production of papers, documents, and other evidence, and obtain patient records pursuant to the applicant's release of protected health information.

(2) The Office of Compensation, which shall allocate compensation for each application in accordance with the compensation schedule.

(3) The Office of Quality Improvement, which shall regularly review application data to conduct root cause analyses in order to develop and disseminate best practices based on the reviews. In addition, the office shall capture and record safety-related data obtained during an investigation conducted by the Office of Medical Review, including the cause of the medical injury, the contributing factors, and any interventions that may have prevented the injury.

(d)(1) The board shall create a Medical Review Committee and a Compensation Committee. The board may create additional committees as necessary to assist in the performance of its duties and responsibilities.

(2)a. Each committee shall be composed of three board members chosen by a majority vote of the board.

b. The Medical Review Committee shall be composed of two physicians, each licensed to practice medicine in this state and a board member who is not an attorney. The board shall designate one of the physician committee members as chair of the committee.

c. The Compensation Committee shall be composed of a certified public accountant and two board members who are not physicians or attorneys. The certified public accountant shall serve as chair of the committee.

(3) Members of each committee shall serve two-year terms within their respective terms as board members. If a vacancy occurs on a committee, the board shall appoint a successor to serve the unexpired portion of the term. A committee member who is removed or resigns from the board shall be removed from the committee.

(4) The board shall annually designate a chair of each committee in accordance with this subsection.

(5) Each committee shall meet at least quarterly or at the specific direction of the board. Meetings may be held by teleconference, web conference, or other electronic means.

(6)a. The Medical Review Committee shall recommend to the board a comprehensive, multidisciplinary list of qualified physicians who shall serve on the independent medical review panels convened pursuant to subsection (e), as needed.

b. The Compensation Committee, in consultation with the chief compensation officer, shall annually review the compensation schedule set out in subsection (b) of Section 8, for purposes of making recommendations for revisions to the Legislature; provided, however, that the total compensation paid to injured patients shall not exceed the funds generated by the contribution amounts from physicians as determined pursuant to Section 8.

(e) The chief medical officer shall convene an independent medical review panel to evaluate whether an application constitutes a medical injury. Each panel shall be composed of an odd number of at least three panelists chosen from a list of panelists representing a like or similar specialty or practice as any practitioner named in the application, and shall be convened upon the call of the chief medical officer. Each panelist shall be paid a stipend as determined by the board for the panelist's service on the panel. In order to expedite the review of applications, the chief medical officer, whenever practicable, may group related applications together for consideration by a single panel.

(f)(1) A board member, panelist, or employee of the Patient Compensation System may not engage in any conduct that constitutes a conflict of interest. A board member, panelist, or employee shall immediately disclose in writing the presence of a conflict of interest when the board member, panelist, or employee knows or should have known that the factual circumstances surrounding a particular application constitutes or constituted a conflict of interest. A board member, panelist, or employee who violates this subsection is subject to disciplinary action as determined by the board.

(2) For the purposes of this subsection, a conflict of interest means a situation in which the private interest of a board member, panelist, or employee could influence the board member, panelist, or employee's judgment in the performance of the board member, panelist, or employee's duties under this practitioner. A conflict of interest includes, but is not limited to, the following:

a. Any conduct that would lead a reasonable person having knowledge of all of the circumstances to conclude that a board member, panelist, or employee is biased against or in favor of an applicant.

b. Participation in any application in which the board member, panelist, or employee, or the parent, spouse, or child of a board member, panelist, or employee, has a financial interest.

(g)(1) The board shall adopt rules to administer this act, which shall include rules addressing all of the following:

a. The application process, including forms necessary to collect relevant information from applicants.

b. Disciplinary procedures for a board member, panelist, or employee who violates the conflict of interest provisions set out in subsection (f).

c. Stipends paid to panelists for their service on an independent medical review panel. The stipends may be scaled in accordance with the relative scarcity of the practitioner's specialty, if applicable.

d. Payment of compensation awards through periodic payments and the apportionment of compensation among multiple practitioners, as recommended by the Compensation Committee.

(2) All rules adopted pursuant to this subsection shall be adopted in accordance with the Alabama Administrative Procedure Act.

Section 5. (a) On or after January 1, 2017, in order to obtain compensation for a medical injury, a person, or the person's legal representative, shall verbally submit an application with the Patient Compensation System through a toll free telephone number established by the system. The application shall include all of the following:

(1) The full name and address of the applicant, or the applicant's representative and the basis of the representation.

(2) The full name and address of any practitioner who provided medical treatment allegedly resulting in the medical injury.

(3) A brief statement of the facts and circumstances surrounding the medical injury that gave rise to the application.

(4) An authorization for release to the Office of Medical Review of all protected health information that is potentially relevant to the application.

(5) Any other information that the applicant believes will be beneficial to the investigatory process, including the names of potential witnesses.

(6) Documentation of any applicable private or governmental source of services or reimbursement relative to the medical injury.

(b) If an application is not complete, the Patient Compensation System, within 30 days after receipt of the initial application, shall notify the applicant in writing of any errors or omissions. An applicant shall have 30 days after receipt of the notification in which to correct the errors or omissions in the initial application.

(c) An application shall be filed within two years after the date on which a medical injury occurred. In no event shall an application be filed more than five years after the date on which the medical treatment occurred.

(d) After the filing of an application, the applicant may supplement the initial application with additional information that the applicant believes may be beneficial in the resolution of the application.

(e) Nothing in this act shall prohibit an applicant or practitioner from retaining an attorney for the purpose of representing the applicant or practitioner in the review and resolution of an application.

Section 6. (a)(1) Individuals with relevant clinical expertise in the Office of Medical Review, within 10 days of the receipt of a completed application, shall determine whether there is prima facie evidence in the application that establishes a medical injury.

(2) If the Office of Medical Review determines that there is prima facie evidence in the application that establishes a medical injury, the office, by registered or certified mail, shall notify each practitioner named in the application within five days from the determination. The notification shall inform the practitioner that the practitioner may support the application to expedite the processing of the application. A practitioner shall have 15 days from receipt of notification of an application to support the application. If the practitioner supports the application, the Office of Medical Review shall review the application in accordance with subsection (b). A finding that there is prima facie evidence in the application that establishes a medical injury shall not be considered a final determination for purposes of appeal pursuant to Section 7.

(3) If the Office of Medical Review determines that the application does not provide prima facie evidence to establish a medical injury, the office shall send a rejection letter to the applicant by registered or certified mail, which shall inform the applicant of the applicant's right to appeal. A finding that there is not prima facie evidence in the application that establishes a medical injury shall be considered a final determination for purposes of appeal pursuant to Section 7.

(b)(1) An application that is supported by a practitioner in accordance with subsection (a) shall be reviewed by individuals with relevant clinical expertise in the Office of Medical Review within 30 days of the notification of the practitioner's support of the application to validate the application.

(2) If the Office of Medical Review finds that the application is valid, the Office of Compensation shall determine an award of compensation in accordance with this subsection. A finding that the application is valid and a subsequent award of compensation shall be considered a final determination for purposes of appeal pursuant to Section 7.

(3) If the Office of Medical Review finds that the application is not valid, the office shall immediately notify the applicant of the rejection of the application within five business days from such finding, and, in the case of fraud, the Office of Medical Review shall immediately notify relevant law enforcement authorities. A finding that the application is not valid shall be considered a final determination for purposes of appeal pursuant to Section 7.

(c)(1) If the Office of Medical Review determines that the application provides prima facie evidence establishing a medical injury, and the practitioner does not elect to support the application, the office shall complete a thorough investigation of the application within 60 days after the determination by the office.

(2) The investigation shall be conducted by a multidisciplinary team with relevant clinical expertise and shall include a thorough investigation of all available documentation, witnesses, and other information, including national practice standards for the care and treatment of patients, as determined to exist and be relevant by the chief medical officer.

(3) Within 15 days after the completion of the investigation, the chief medical officer shall allow the applicant and the practitioner to access records, statements, and other information obtained in the course of the investigation in accordance with relevant state and federal laws.

(4) Within 30 days after the completion of the investigation, the chief medical officer shall convene an independent medical review panel to determine whether the application constitutes a medical injury.

(5) The independent medical review panel shall have access to all redacted information obtained by the office in the course of its investigation of the application, including national practice standards for the care and treatment of patients as determined to exist and be relevant by the chief medical officer or the panel. If the panel determines that the medical treatment conformed to national practice standards for the care and treatment of patients, then the application shall be dismissed and the practitioner shall not be held responsible for the applicant's injury. The panel shall make a written determination within 10 days after the convening of the panel, and the panel shall notify the applicant and the practitioner within five business days from the determination.

(6)a. If the panel determines that none of the factors set out in paragraph b. apply, the application shall be dismissed, and the practitioner may not be held responsible for the applicant's medical injury.

b. If the panel, by a preponderance of the evidence, determines that the following factors exist, the panel shall report that the application constitutes a medical injury:

1. The practitioner performed a medical treatment on the applicant.

2. The applicant suffered a medical injury with damages.

3. The medical treatment was the proximate cause of the damages.

4. Based on the facts at the time of medical treatment, either of the following occurred:

(i) An accepted method of medical services was not used for treatment.

(ii) An accepted method of medical services was used for treatment, but executed in a substandard fashion.

c. A determination pursuant to paragraph a. or paragraph b. shall be considered a final determination for purposes of appeal pursuant to Section 7.

(d) Upon any final determination made pursuant to this section, the Office of Medical Review shall notify the practitioner by registered or certified mail of the right to appeal the determination within five days from the final determination. A practitioner shall have 15 days from the receipt of the letter in which to appeal the determination pursuant to Section 7.

(e)(1) If an independent medical review panel finds that an application constitutes a medical injury pursuant to subsection (c), and all appeals of that finding have been exhausted pursuant to Section 7, the Office of Compensation, within 30 days after either the finding of the panel or the exhaustion of all appeals of that finding, whichever occurs later, shall make a written determination of an award of compensation in accordance with the compensation schedule and the findings of the panel.

(2) The determination of an award of compensation shall be considered a final determination for purposes of appeal pursuant to Section 7. The office shall notify the applicant and the practitioner by registered or certified mail of the amount of compensation and shall explain the process to appeal the determination of the office. Either applicant shall have 15 days from receipt of the letter to appeal the determination of the office pursuant to Section 7.

(f) Compensation for each application shall be offset by any past and future collateral source payments. In addition, compensation may be paid by periodic payments as determined by the Office of Compensation in accordance with the rules adopted by the board.

(g) Within 15 days after either the acceptance of compensation by the applicant or the conclusion of all appeals pursuant to Section 7, whichever occurs later, the board shall provide compensation to the applicant in accordance with the final compensation award.

(h) The filing of an application involving a health care practitioner shall not be reportable to any applicable licensing entity, unless there is a separate determination by the board or the independent medical review panel that the practitioner represents an imminent risk of harm to the public.

(i) If a practitioner represents an imminent risk of harm to the public as determined by the independent medical review panel, the Patient Compensation System shall provide the department and the appropriate state licensing entity of the practitioner, against whom a medical injury was determined to exist, with electronic access to applications. The department and the appropriate state licensing entity shall review the applications to determine whether any of the incidents that resulted in the application potentially involved conduct by the licensee that is subject to disciplinary action.

Section 7. An applicant, an applicant's legal representative, or a practitioner may appeal any final determination made in the Patient Compensation System as provided in this section.

(1) The only issues for consideration by the circuit court shall be whether the final determination was any of the following:

a. In violation of constitutional or statutory provisions.

b. In excess of the statutory authority of the system.

c. Made upon unlawful procedure.

d. Arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion.

e. Unsupported by evidence that is both substantial and material in the light of the entire record.

(2) The circuit court shall not modify any final determination but may reverse a determination for the reasons set out in subdivision (1) and remand the case back to the Patient Compensation System for further action.

Section 8. (a) The board shall annually determine and assess a contribution amount that shall be paid by each health care practitioner for the payment of damages for medical injuries and for the administration of this act. The contribution amount shall be determined by January 1 of each year, and shall be based on the anticipated payment of damages and expenses of the administration of this act for the next fiscal year.

(b) The contribution amount assessed pursuant to subsection (a) may not exceed the amounts set out in the following compensation rating model:

COMPENSATION RATING MODEL Abdominal Surgery $12,100 Addictionology $3,200 Aeropspace Medicine $3,200 Allergy $2,400 Anesthesia-Pain Mngt Inc Local Reg and Epid $8,000 Anesthesiology $4,400 Cardiac Surgery $14,600 Cardiovascular Disease-minor surgery $8,000 Cardiovascular Disease-no surgery $3,700 Colon and/or Rectal Surgery $7,400 Dermatology-Including Minor Surgery $2,400 Dermatology-Surgery, Includes Liposuction $5,400 Diabetes-Including Minor Surgery $4,400 Emergency Medicine-No Major Surgery $8,000 Endocrinology, Reproductive $8,000 Endocrinology-Including Minor Surgery $8,000 Forensic Medicine $2,400 FP/GP-Minor Surgery (No C-Sections) $9,600 FP/GP-No Surgery $4,400 Gastroenterology-Including Minor Surgery $7,400 General Preventive Medicine-No Surgery $4,400 General Surgery N.O.C. $9,600 Geriatric-Including Minor Surgery $3,200 Geriatric-Surgery $11,300 Gynecology-Including Minor Surgery $4,400 Hand and Foot Surgery $12,400 Hematology-Including Minor Surgery $8,000 Hospitalist-No Surgery $5,400 Infectious Disease-Including Minor Surgery $8,000 Intensive Care Medicine $4,400 Internal Medicine-Minor Surgery $6,800 Internal Medicine-No Surgery $5,400 Legal Medicine $2,400 Medical Director Only-Managed Care Organization $2,400 Miscellaneous-Physicians Lower rated Specialty $6,800 Miscellaneous-Physicians Lower rated Specialty $8,000 Neonatology-Minor Surgery $6,400 Neoplastic Diseases/Oncology-Including Minor Surgery $12,400 Neoplastic Diseases-Surgery $8,700 Nephrology-Including Minor Surgery $4,400 Nephrology-Surgery $4,400 Neurological Surgery-Including Child $23,600 Neurological Surgery-Limited To The Back $9,600 Neurology-(Including Child)-Including Minor Surgery $12,100 Nuclear Medicine $3,200 Nutrition $3,200 Obstetrics and Gynecology Surgery $19,700 Occupational Medicine $3,200 Opthalmology-No Surgery $2,400 Opthalmology-Occular Plastic $10,200 Oral/Maxillofacial Surgery Includes DMD and DDS $12,400 Orthopedics Surgery $12,100 Orthopedics-Surgery-No Spinal $4,400 Otorhinolaryngology-Minor Surgery $4,400 Otorhinolaryngology-No Surgery $3,200 Otorhinolaryngology-Surgery, Cosmetic $11,300 Pathology-Including Minor Surgery $3,500 Pediatric-Including Minor Surgery $4,400 Pharmacology-Clinical $2,400 Physical Medicine and Rehabilitation $2,800 Plastic Surgery N.O.C. $9,600 Psychiatry (Including Child) $3,200 Public Health $3,200 Pulmonary Diseases-No Surgery $8,000 Radiation-Therapy $4,400 Radiology-Diagnostic-Minor Surgery $6,800 Radiology-Diagnostic-No Surgery $4,400 Radiology-Major Invasive $10,200 Rheumatology-No Surgery $3,500 Thoracic Surgery $14,600 Traumatic Surgery $22,200 Urology-Surgery $8,000 Vascular Surgery $22,200 Weight Reduction Surgery $14,600

(c) The contribution assessed pursuant to this section shall be payable by each health care practitioner on July 1 of each year beginning on January 1, 2017. Each health care practitioner shall pay the contribution amount within 30 days from the date that notice is delivered to the health care practitioner. If any health care practitioner fails to pay the contribution determined under this section within 30 days, the board shall notify the practitioner by certified or registered mail that the practitioner's license shall be subject to revocation if the contribution is not paid within 60 days from the date of the original notice.

(d) A health care practitioner who fails to pay the contribution amount assessed pursuant to this section within 60 days from the date of the receipt of the original notice shall be subject to a licensure revocation action by the appropriate licensing entity.

(e) The total compensation paid to injured patients shall not exceed the funds generated pursuant to this section.

(f) There is created the Patient Compensation Fund within the State Treasury to be administered by the Alabama Department of Public Health. All amounts collected under this section shall be paid to the Patient Compensation Fund and may be expended for purposes authorized by this act. Any amounts deposited in this fund shall remain in the fund until expended for purposes authorized by this act and shall not revert to the General Fund.

Section 9. No later than January 1, 2018, and annually thereafter, the board shall submit a report that describes the filing and disposition of applications from the prior fiscal year. The report shall include, in the aggregate, the number of applications, the disposition of such applications, and the compensation awarded. The report shall also provide recommendations, if any, regarding legislative changes that would improve the efficiency of the functions of the Patient Compensation System. The report shall be provided to the Governor, the President Pro Tempore of the Senate, and the Speaker of the House of Representatives.

Section 10. (a) This act applies exclusively to applications submitted under this act. An applicant whose injury is excluded from coverage under this act may file a claim for recovery of damages in accordance with other provisions of law.

(b) An individual who accepts a settlement offer related to a medical injury may not file an application under this act for the same medical injury. In addition, if an application has been filed prior to settlement of the claim for the medical injury in the application, and the applicant subsequently settles the claim with the health care practitioner, the applicant's application shall be withdrawn.

Section 11. Any constitutional provision or law granting immunity for the rendering of medical services to a patient by a health care practitioner shall remain in effect. Nothing in this act shall be construed to abrogate such immunity or provide relief under this act.

Section 12. (a) This act applies to medical injuries resulting from medical treatment provided on or after January 1, 2017, and abrogates and supersedes any common law or statutory cause of action claiming liability for a medical injury resulting from medical treatment provided on or after January 1, 2017, against a health care practitioner.

(b) Medical malpractice actions claiming liability for a medical injury against a health care practitioner resulting from medical treatment provided prior to January 1, 2017, shall be governed by Article 29 of Chapter 5, of Title 6, Code of Alabama 1975, and the common law, as both existed prior to January 1, 2017.

Section 13. This act shall become effective immediately following its passage and approval by the Governor, or its otherwise becoming law.

Health

Medical Malpractice

Physicians

Civil Procedure

Public Health Department

Health Care Providers