House File 487 H-1222 Amend House File 487 as follows: 1 1. By striking everything after the enacting clause and 2 inserting: 3 < Section 1. Section 135P.1, subsections 1 and 2, Code 2017, 4 are amended to read as follows: 5 1. “Adverse health care incident” means an objective and 6 definable outcome arising from or related to patient care that 7 results in the death or serious physical injury of a patient. 8 2. “Health care provider” means a physician or osteopathic 9 physician licensed under chapter 148 , a physician assistant 10 licensed under and practicing under a supervising physician 11 pursuant to chapter 148C , a podiatrist licensed under chapter 12 149 , or a chiropractor licensed under chapter 151, a licensed 13 practical nurse, a registered nurse, or an advanced registered 14 nurse practitioner licensed pursuant to under chapter 152 or 15 152E , a dentist licensed under chapter 153, an optometrist 16 licensed under chapter 154, a pharmacist licensed under chapter 17 155A, or any other person who is licensed, certified, or 18 otherwise authorized or permitted by the law of this state to 19 administer health care in the ordinary course of business or in 20 the practice of a profession . 21 Sec. 2. NEW SECTION . 147.136A Noneconomic damage awards 22 against health care providers. 23 1. For purposes of this section: 24 a. “Health care provider” means a physician or an 25 osteopathic physician licensed under chapter 148, a 26 chiropractor licensed under chapter 151, a podiatrist 27 licensed under chapter 149, a physician assistant licensed and 28 practicing under a supervising physician under chapter 148C, a 29 licensed practical nurse, a registered nurse, or an advanced 30 registered nurse practitioner licensed under chapter 152 or 31 152E, a dentist licensed under chapter 153, an optometrist 32 licensed under chapter 154, a pharmacist licensed under chapter 33 155A, a hospital as defined in section 135B.1, a health care 34 facility as defined in section 135C.1, a health facility as 35 -1- HF487.1625 (3) 87 (amending this HF 487 to CONFORM to SF 465) jh/nh 1/ 5 #1.

defined in section 135P.1, a professional corporation under 1 chapter 496C that is owned by persons licensed to practice a 2 profession listed in this paragraph, or any other person or 3 entity who is licensed, certified, or otherwise authorized or 4 permitted by the law of this state to administer health care 5 in the ordinary course of business or in the practice of a 6 profession. 7 b. “Health care services” means medical diagnosis, 8 treatment, evaluation, advice, or acts that are permitted under 9 chapter 148, 148C, 149, 152, 152E, 153, 154, or 155A, or any 10 other health care licensing statutes of this state. 11 c. “Noneconomic damages” means damages arising from 12 pain, suffering, inconvenience, physical impairment, mental 13 anguish, emotional pain and suffering, loss of chance, loss of 14 consortium, or any other nonpecuniary damages. 15 d. “Occurrence” means the event, incident, or happening, 16 and the acts or omissions incident thereto, which proximately 17 caused injuries or damages for which recovery is claimed by the 18 patient or the patient’s representative. 19 2. The total amount recoverable in any civil action for 20 noneconomic damages for personal injury or death, whether in 21 tort, contract, or otherwise, against a health care provider 22 shall be limited to two hundred fifty thousand dollars for any 23 occurrence resulting in injury or death of a patient regardless 24 of the number of plaintiffs, derivative claims, theories of 25 liability, or defendants in the civil action. 26 3. The limitation on damages contained in this section 27 shall not apply as to a defendant if that defendant’s actions 28 constituted actual malice. 29 Sec. 3. Section 147.139, Code 2017, is amended to read as 30 follows: 31 147.139 Expert witness standards. 32 If the standard of care given by a physician and surgeon 33 or an osteopathic physician and surgeon licensed pursuant 34 to chapter 148 , or a dentist licensed pursuant to chapter 35 -2- HF487.1625 (3) 87 (amending this HF 487 to CONFORM to SF 465) jh/nh 2/ 5

153 health care provider, as defined in section 147.136A , is 1 at issue, the court shall only allow a person the plaintiff 2 designates as an expert witness to qualify as an expert witness 3 and to testify on the issue of the appropriate standard of 4 care if the person’s medical or dental qualifications relate 5 directly to the medical problem or problems at issue and the 6 type of treatment administered in the case. or breach of the 7 standard of care if all of the following are established by the 8 evidence: 9 1. The person is licensed to practice in the same or a 10 substantially similar field as the defendant, is in good 11 standing in each state of licensure, and in the five years 12 preceding the act or omission alleged to be negligent, has not 13 had a license in any state revoked or suspended. 14 2. In the five years preceding the act or omission alleged 15 to be negligent, the person actively practiced in the same or a 16 substantially similar field as the defendant or was a qualified 17 instructor at an accredited university in the same field as the 18 defendant. 19 3. If the defendant is board-certified in a specialty, the 20 person is certified in the same or a substantially similar 21 specialty by a board recognized by the American board of 22 medical specialties or the American osteopathic association. 23 4. If the defendant is a licensed physician or osteopathic 24 physician under chapter 148, the person is a physician or 25 osteopathic physician licensed in this state or another state. 26 Sec. 4. NEW SECTION . 147.140 Expert witness —— certificate 27 of merit affidavit. 28 1. a. In any action for personal injury or wrongful 29 death against a health care provider based upon the alleged 30 negligence in the practice of that profession or occupation or 31 in patient care, which includes a cause of action for which 32 expert testimony is necessary to establish a prima facie case, 33 the plaintiff shall, prior to the commencement of discovery in 34 the case and within sixty days of the defendant’s answer, serve 35 -3- HF487.1625 (3) 87 (amending this HF 487 to CONFORM to SF 465) jh/nh 3/ 5

upon the defendant a certificate of merit affidavit signed by 1 an expert witness with respect to the issue of standard of care 2 and an alleged breach of the standard of care. The expert 3 witness must meet the qualifying standards of section 147.139. 4 b. A certificate of merit affidavit must be signed by the 5 expert witness and certify the purpose for calling the expert 6 witness by providing under the oath of the expert witness all 7 of the following: 8 (1) The expert witness’s statement of familiarity with the 9 applicable standard of care. 10 (2) The expert witness’s statement that the standard of care 11 was breached by the health care provider named in the petition. 12 c. A plaintiff shall serve a separate certificate of merit 13 affidavit on each defendant named in the petition. 14 2. An expert witness’s certificate of merit affidavit does 15 not preclude additional discovery and supplementation of the 16 expert witness’s opinions in accordance with the rules of civil 17 procedure. 18 3. The parties shall comply with the requirements of section 19 668.11 and all other applicable law governing certification and 20 disclosure of expert witnesses. 21 4. The parties by agreement or the court for good cause 22 shown and in response to a motion filed prior to the expiration 23 of the time limits specified in subsection 1 may provide for 24 extensions of the time limits. Good cause shall include 25 but not be limited to the inability to timely obtain the 26 plaintiff’s medical records from health care providers when 27 requested prior to filing the petition. 28 5. If the plaintiff is acting pro se, the plaintiff shall 29 have the expert witness sign the certificate of merit affidavit 30 or answers to interrogatories referred to in this section 31 and the plaintiff shall be bound by those provisions as if 32 represented by an attorney. 33 6. Failure to substantially comply with subsection 1 shall 34 result, upon motion, in dismissal with prejudice of each cause 35 -4- HF487.1625 (3) 87 (amending this HF 487 to CONFORM to SF 465) jh/nh 4/ 5

of action as to which expert witness testimony is necessary to 1 establish a prima facie case. 2 7. For purposes of this section, “health care provider” 3 means the same as defined in section 147.136A. > 4 2. Title page, lines 1 and 2, by striking < expert witnesses 5 and defenses > and inserting < noneconomic damage awards and 6 expert witnesses > 7 ______________________________ HINSON of Linn -5- HF487.1625 (3) 87 (amending this HF 487 to CONFORM to SF 465) jh/nh 5/ 5 #2.