H.F. _____ Section 1. Section 147.139, Code 2011, is amended to read 1 as follows: 2 147.139 Expert witness standards. 3 If the standard of care given by a physician and surgeon 4 or an osteopathic physician and surgeon licensed pursuant 5 to chapter 148 , or a dentist licensed pursuant to chapter 6 153 , is at issue, the court shall only allow a person to 7 qualify as an expert witness and to testify on the issue of 8 the appropriate standard of care if the person’s medical or 9 dental qualifications relate directly to the medical problem or 10 problems at issue and the type of treatment administered in the 11 case. , breach of the standard of care, or proximate cause if 12 all of the following qualifications are established: 13 1. The expert is licensed to practice medicine, osteopathic 14 medicine, or dentistry and in the three years preceding the 15 allegedly negligent act, was engaged in the active practice 16 of medicine, osteopathic medicine, or dentistry, or was a 17 qualified instructor at an accredited university of medicine 18 and surgery, osteopathic medicine and surgery, or dentistry. 19 2. The expert practices or provides university instruction 20 in the same or substantially similar specialty as the 21 defendant. 22 3. If the defendant is board-certified in a specialty, 23 the expert is also certified in that specialty by a board 24 recognized by the American board of medical specialties and is 25 licensed and in good standing in each state of licensure, and 26 has not had the expert’s license revoked or suspended in the 27 past five years. 28 Sec. 2. Section 668A.1, Code 2011, is amended by adding the 29 following new subsection: 30 NEW SUBSECTION . 4. a. In any action for damages for injury 31 or death against any health care provider, whether based in 32 tort, contract, or otherwise, arising out of an act or omission 33 in connection with the provision of health care services, 34 punitive or exemplary damages may be awarded only if the jury 35 -1- LSB 2388YC (5) 84 rh/rj 1/ 4

H.F. _____ is unanimous in regard to finding liability and the amount of 1 exemplary or punitive damages. 2 b. Notwithstanding section 668.4, in any action brought 3 under subsection 1 in which there are two or more defendants, 4 an award of punitive or exemplary damages shall be specific 5 as to a defendant, and each defendant is liable only for the 6 amount of the award made against that defendant. 7 c. For purposes of this subsection, “health care provider” 8 means a physician as defined in section 135.1, an advanced 9 registered nurse practitioner licensed pursuant to chapter 152, 10 a hospital as defined in section 135B.1, and a health care 11 facility as defined in section 135C.1. 12 Sec. 3. NEW SECTION . 668B.1 Title. 13 This chapter may be cited as the “Noneconomic Damage Awards 14 Against Health Care Providers Act” . 15 Sec. 4. NEW SECTION . 668B.2 Definitions. 16 As used in this chapter, unless the context otherwise 17 requires: 18 1. “Health care provider” means a physician as defined 19 in section 135.1, an advanced registered nurse practitioner 20 licensed pursuant to chapter 152, a hospital as defined in 21 section 135B.1, and a health care facility as defined in 22 section 135C.1. 23 2. “Health care services” means services that involve 24 diagnosis, treatment, medical evaluation, advice, or such acts 25 as may be permissible under the health care licensing statutes 26 of this state. 27 3. “Noneconomic damages” means damages arising from 28 pain, suffering, inconvenience, physical impairment, mental 29 anguish, emotional pain and suffering, loss of chance, loss of 30 consortium, and any other nonpecuniary damages. 31 Sec. 5. NEW SECTION . 668B.3 Damage awards. 32 3. In any action for damages for injury or death against 33 any health care provider, whether based in tort, contract, or 34 otherwise, arising out of an act or omission in connection with 35 -2- LSB 2388YC (5) 84 rh/rj 2/ 4

H.F. _____ the provision of health care services, the injured plaintiff 1 shall be entitled to recover noneconomic damages, but such 2 damages shall not exceed the following amounts, except upon a 3 finding of actual malice on the part of the defendant: 4 a. In any action against a single health care provider, two 5 hundred fifty thousand dollars. 6 b. In any action a against certified class of health care 7 providers, five hundred thousand dollars. 8 EXPLANATION 9 This bill relates to expert witness standards, damage 10 awards, and proportionate liability in medical malpractice 11 actions. 12 The bill provides that if the standard of care given by a 13 physician or surgeon, or an osteopathic physician or surgeon 14 licensed pursuant to Code chapter 148, or a dentist licensed 15 pursuant to Code chapter 153, is at issue in a medical 16 malpractice case, the court shall only allow a licensed health 17 care provider to qualify as an expert witness and to testify 18 on the issue of the appropriate standard of care, breach of 19 that standard, or proximate cause if the health care provider 20 meets certain professional practice and educational criteria. 21 Current law relating to expert witness standards in a medical 22 malpractice action allows a person to testify as an expert 23 witness and to testify on the appropriate standard of care if 24 the person’s medical or dental qualifications relate directly 25 to the medical problem at issue and the type of treatment 26 involved. 27 The bill provides that in any action for damages for injury 28 or death against any health care provider, whether based in 29 tort, contract, or otherwise, arising out of an act or omission 30 in connection with the provision of health care services, 31 punitive or exemplary damages may be awarded only if the jury 32 is unanimous in regard to finding liability and the amount of 33 exemplary or punitive damages. Notwithstanding Iowa’s rule 34 of joint and several liability in Code section 668.4, in any 35 -3- LSB 2388YC (5) 84 rh/rj 3/ 4

H.F. _____ medical malpractice action in which there are two or more 1 defendants, an award of punitive or exemplary damages shall be 2 specific as to a defendant, and each defendant is liable only 3 for the amount of the award made against that defendant. 4 The bill provides that in any action for noneconomic damages 5 for injury or death against any health care provider whether 6 based in tort, contract, or otherwise, arising out of an act 7 or omission in connection with the provision of health care 8 services, the injured plaintiff shall be entitled to recover 9 noneconomic damages not to exceed $250,000 from a single 10 defendant or $500,000 from a certified class of defendants, 11 except upon a finding of actual malice on the part of the 12 defendant. 13 “Noneconomic damages” is defined as damages arising from 14 pain, suffering, inconvenience, physical impairment, mental 15 anguish, emotional pain and suffering, loss of chance, loss of 16 consortium, and any other nonpecuniary damages. 17 For purposes of the damage award provisions in the bill that 18 are to be codified in Code chapters 668A and 668B, “health 19 care provider” means a physician defined as a person licensed 20 to practice medicine and surgery, osteopathic medicine and 21 surgery, osteopathy, chiropractic, podiatry, or optometry 22 under the laws of this state pursuant to Code section 135.1, 23 an advanced registered nurse practitioner licensed pursuant 24 to Code chapter 152, a hospital defined as a place which 25 is devoted primarily to the maintenance and operation of 26 facilities for the medical diagnosis, treatment, or care over a 27 period exceeding 24 hours of two or more nonrelated individuals 28 pursuant to Code section 135B.1, and a health care facility 29 defined as a residential care facility, a nursing facility, an 30 intermediate care facility for persons with mental illness, 31 or an intermediate care facility for persons with mental 32 retardation pursuant to Code section 135C.1. 33 -4- LSB 2388YC (5) 84 rh/rj 4/ 4