-CITE-

42 USC CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL

REVIEW ACTIVITIES 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

-HEAD-

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

-MISC1-

Sec.

11101. Findings.

SUBCHAPTER I - PROMOTION OF PROFESSIONAL REVIEW ACTIVITIES

11111. Professional review.

(a) In general.

(b) Exception.

(c) Treatment under State laws.

11112. Standards for professional review actions.

(a) In general.

(b) Adequate notice and hearing.

(c) Adequate procedures in investigations or health

emergencies.

11113. Payment of reasonable attorneys' fees and costs in

defense of suit.

11114. Guidelines of Secretary.

11115. Construction.

(a) In general.

(b) Scope of clinical privileges.

(c) Treatment of nurses and other practitioners.

(d) Treatment of patient malpractice claims.

SUBCHAPTER II - REPORTING OF INFORMATION

11131. Requiring reports on medical malpractice payments.

(a) In general.

(b) Information to be reported.

(c) Sanctions for failure to report.

(d) Report on treatment of small payments.

11132. Reporting of sanctions taken by Boards of Medical

Examiners.

(a) In general.

(b) Failure to report.

11133. Reporting of certain professional review actions taken

by health care entities.

(a) Reporting by health care entities.

(b) Reporting by Board of Medical Examiners.

(c) Sanctions.

(d) References to Board of Medical Examiners.

11134. Form of reporting.

(a) Timing and form.

(b) To whom reported.

(c) Reporting to State licensing boards.

11135. Duty of hospitals to obtain information.

(a) In general.

(b) Failure to obtain information.

(c) Reliance on information provided.

11136. Disclosure and correction of information.

11137. Miscellaneous provisions.

(a) Providing licensing boards and other health

care entities with access to information.

(b) Confidentiality of information.

(c) Relief from liability for reporting.

(d) Interpretation of information.

SUBCHAPTER III - DEFINITIONS AND REPORTS

11151. Definitions.

11152. Reports and memoranda of understanding.

(a) Annual reports to Congress.

(b) Memoranda of understanding.

(c) Memorandum of understanding with Drug

Enforcement Administration.

-SECREF-

CHAPTER REFERRED TO IN OTHER SECTIONS

This chapter is referred to in sections 1320a-7e, 1396r-2 of this

title.

-End-

-CITE-

42 USC Sec. 11101 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

-HEAD-

Sec. 11101. Findings

-STATUTE-

The Congress finds the following:

(1) The increasing occurrence of medical malpractice and the

need to improve the quality of medical care have become

nationwide problems that warrant greater efforts than those that

can be undertaken by any individual State.

(2) There is a national need to restrict the ability of

incompetent physicians to move from State to State without

disclosure or discovery of the physician's previous damaging or

incompetent performance.

(3) This nationwide problem can be remedied through effective

professional peer review.

(4) The threat of private money damage liability under Federal

laws, including treble damage liability under Federal antitrust

law, unreasonably discourages physicians from participating in

effective professional peer review.

(5) There is an overriding national need to provide incentive

and protection for physicians engaging in effective professional

peer review.

-SOURCE-

(Pub. L. 99-660, title IV, Sec. 402, Nov. 14, 1986, 100 Stat.

3784.)

-REFTEXT-

REFERENCES IN TEXT

The Federal antitrust laws, referred to in par. (4), are

classified generally to chapter 1 (Sec. 1 et seq.) of Title 15,

Commerce and Trade.

-MISC1-

SHORT TITLE

Section 401 of title IV of Pub. L. 99-660 provided that: "This

title [enacting this chapter and provisions set out as a note under

section 11111 of this title] may be cited as the 'Health Care

Quality Improvement Act of 1986'."

-End-

-CITE-

42 USC SUBCHAPTER I - PROMOTION OF PROFESSIONAL REVIEW

ACTIVITIES 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

SUBCHAPTER I - PROMOTION OF PROFESSIONAL REVIEW ACTIVITIES

-HEAD-

SUBCHAPTER I - PROMOTION OF PROFESSIONAL REVIEW ACTIVITIES

-End-

-CITE-

42 USC Sec. 11111 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

SUBCHAPTER I - PROMOTION OF PROFESSIONAL REVIEW ACTIVITIES

-HEAD-

Sec. 11111. Professional review

-STATUTE-

(a) In general

(1) Limitation on damages for professional review actions

If a professional review action (as defined in section 11151(9)

of this title) of a professional review body meets all the

standards specified in section 11112(a) of this title, except as

provided in subsection (b) of this section -

(A) the professional review body,

(B) any person acting as a member or staff to the body,

(C) any person under a contract or other formal agreement

with the body, and

(D) any person who participates with or assists the body with

respect to the action,

shall not be liable in damages under any law of the United States

or of any State (or political subdivision thereof) with respect

to the action. The preceding sentence shall not apply to damages

under any law of the United States or any State relating to the

civil rights of any person or persons, including the Civil Rights

Act of 1964, 42 U.S.C. 2000e, et seq. and the Civil Rights Acts,

42 U.S.C. 1981, et seq. Nothing in this paragraph shall prevent

the United States or any Attorney General of a State from

bringing an action, including an action under section 15c of

title 15, where such an action is otherwise authorized.

(2) Protection for those providing information to professional

review bodies

Notwithstanding any other provision of law, no person (whether

as a witness or otherwise) providing information to a

professional review body regarding the competence or professional

conduct of a physician shall be held, by reason of having

provided such information, to be liable in damages under any law

of the United States or of any State (or political subdivision

thereof) unless such information is false and the person

providing it knew that such information was false.

(b) Exception

If the Secretary has reason to believe that a health care entity

has failed to report information in accordance with section

11133(a) of this title, the Secretary shall conduct an

investigation. If, after providing notice of noncompliance, an

opportunity to correct the noncompliance, and an opportunity for a

hearing, the Secretary determines that a health care entity has

failed substantially to report information in accordance with

section 11133(a) of this title, the Secretary shall publish the

name of the entity in the Federal Register. The protections of

subsection (a)(1) of this section shall not apply to an entity the

name of which is published in the Federal Register under the

previous sentence with respect to professional review actions of

the entity commenced during the 3-year period beginning 30 days

after the date of publication of the name.

(c) Treatment under State laws

(1) Professional review actions taken on or after October 14,

1989

Except as provided in paragraph (2), subsection (a) of this

section shall apply to State laws in a State only for

professional review actions commenced on or after October 14,

1989.

(2) Exceptions

(A) State early opt-in

Subsection (a) of this section shall apply to State laws in a

State for actions commenced before October 14, 1989, if the

State by legislation elects such treatment.

(B) Effective date of election

An election under State law is not effective, for purposes

of,(!1) for actions commenced before the effective date of the

State law, which may not be earlier than the date of the

enactment of that law.

-SOURCE-

(Pub. L. 99-660, title IV, Sec. 411, Nov. 14, 1986, 100 Stat. 3784;

Pub. L. 100-177, title IV, Sec. 402(c), as added Pub. L. 101-239,

title VI, Sec. 6103(e)(6)(A), Dec. 19, 1989, 103 Stat. 2208.)

-REFTEXT-

REFERENCES IN TEXT

The Civil Rights Act of 1964, referred to in subsec. (a)(1), is

Pub. L. 88-352, July 2, 1964, 78 Stat. 241, as amended, which is

classified principally to subchapters II to IX (Sec. 2000a et seq.)

of chapter 21 of this title. Title VII of this Act relates to equal

employment opportunities, and is classified generally to subchapter

VI (Sec. 2000e et seq.) of chapter 21 of this title. For complete

classification of this Act to the Code, see Short Title note set

out under section 2000a of this title and Tables.

The Civil Rights Acts, referred to in subsec. (a)(1), are

classified generally to chapter 21 (Sec. 1981 et seq.) of this

title.

-MISC1-

AMENDMENTS

1989 - Subsec. (c)(2)(B), (C). Pub. L. 101-239 added Pub. L.

100-177, Sec. 402(c), see 1987 Amendment note below.

1987 - Subsec. (c)(2)(B), (C). Pub. L. 100-177, Sec. 402(c), as

added by Pub. L. 101-239, redesignated subpar. (C) as (B), struck

out "subparagraphs (A) and (B)" after "for purposes of", and struck

out former subpar. (B) which read as follows: "Subsection (a) of

this section shall not apply to State laws in a State for actions

commenced on or after October 14, 1989, if the State by legislation

elects such treatment."

EFFECTIVE DATE OF 1987 AMENDMENT

Amendment by Pub. L. 100-177 effective Nov. 14, 1986, see section

402(d) of Pub. L. 100-177, as renumbered and amended, set out as a

note under section 11137 of this title.

EFFECTIVE DATE

Section 416 of Pub. L. 99-660 provided that: "This part [part A

(Secs. 411-416) of title IV of Pub. L. 99-660, enacting this

subchapter] shall apply to professional review actions commenced on

or after the date of the enactment of this Act [Nov. 14, 1986]."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 11112, 11133 of this

title.

-FOOTNOTE-

(!1) So in original. Probably should be "for purposes of

subparagraph (A),".

-End-

-CITE-

42 USC Sec. 11112 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

SUBCHAPTER I - PROMOTION OF PROFESSIONAL REVIEW ACTIVITIES

-HEAD-

Sec. 11112. Standards for professional review actions

-STATUTE-

(a) In general

For purposes of the protection set forth in section 11111(a) of

this title, a professional review action must be taken -

(1) in the reasonable belief that the action was in the

furtherance of quality health care,

(2) after a reasonable effort to obtain the facts of the

matter,

(3) after adequate notice and hearing procedures are afforded

to the physician involved or after such other procedures as are

fair to the physician under the circumstances, and

(4) in the reasonable belief that the action was warranted by

the facts known after such reasonable effort to obtain facts and

after meeting the requirement of paragraph (3).

A professional review action shall be presumed to have met the

preceding standards necessary for the protection set out in section

11111(a) of this title unless the presumption is rebutted by a

preponderance of the evidence.

(b) Adequate notice and hearing

A health care entity is deemed to have met the adequate notice

and hearing requirement of subsection (a)(3) of this section with

respect to a physician if the following conditions are met (or are

waived voluntarily by the physician):

(1) Notice of proposed action

The physician has been given notice stating -

(A)(i) that a professional review action has been proposed to

be taken against the physician,

(ii) reasons for the proposed action,

(B)(i) that the physician has the right to request a hearing

on the proposed action,

(ii) any time limit (of not less than 30 days) within which

to request such a hearing, and

(C) a summary of the rights in the hearing under paragraph

(3).

(2) Notice of hearing

If a hearing is requested on a timely basis under paragraph

(1)(B), the physician involved must be given notice stating -

(A) the place, time, and date, of the hearing, which date

shall not be less than 30 days after the date of the notice,

and

(B) a list of the witnesses (if any) expected to testify at

the hearing on behalf of the professional review body.

(3) Conduct of hearing and notice

If a hearing is requested on a timely basis under paragraph

(1)(B) -

(A) subject to subparagraph (B), the hearing shall be held

(as determined by the health care entity) -

(i) before an arbitrator mutually acceptable to the

physician and the health care entity,

(ii) before a hearing officer who is appointed by the

entity and who is not in direct economic competition with the

physician involved, or

(iii) before a panel of individuals who are appointed by

the entity and are not in direct economic competition with

the physician involved;

(B) the right to the hearing may be forfeited if the

physician fails, without good cause, to appear;

(C) in the hearing the physician involved has the right -

(i) to representation by an attorney or other person of the

physician's choice,

(ii) to have a record made of the proceedings, copies of

which may be obtained by the physician upon payment of any

reasonable charges associated with the preparation thereof,

(iii) to call, examine, and cross-examine witnesses,

(iv) to present evidence determined to be relevant by the

hearing officer, regardless of its admissibility in a court

of law, and

(v) to submit a written statement at the close of the

hearing; and

(D) upon completion of the hearing, the physician involved

has the right -

(i) to receive the written recommendation of the

arbitrator, officer, or panel, including a statement of the

basis for the recommendations, and

(ii) to receive a written decision of the health care

entity, including a statement of the basis for the decision.

A professional review body's failure to meet the conditions

described in this subsection shall not, in itself, constitute

failure to meet the standards of subsection (a)(3) of this section.

(c) Adequate procedures in investigations or health emergencies

For purposes of section 11111(a) of this title, nothing in this

section shall be construed as -

(1) requiring the procedures referred to in subsection (a)(3)

of this section -

(A) where there is no adverse professional review action

taken, or

(B) in the case of a suspension or restriction of clinical

privileges, for a period of not longer than 14 days, during

which an investigation is being conducted to determine the need

for a professional review action; or

(2) precluding an immediate suspension or restriction of

clinical privileges, subject to subsequent notice and hearing or

other adequate procedures, where the failure to take such an

action may result in an imminent danger to the health of any

individual.

-SOURCE-

(Pub. L. 99-660, title IV, Sec. 412, Nov. 14, 1986, 100 Stat.

3785.)

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 11111, 11113, 11114 of

this title.

-End-

-CITE-

42 USC Sec. 11113 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

SUBCHAPTER I - PROMOTION OF PROFESSIONAL REVIEW ACTIVITIES

-HEAD-

Sec. 11113. Payment of reasonable attorneys' fees and costs in

defense of suit

-STATUTE-

In any suit brought against a defendant, to the extent that a

defendant has met the standards set forth under section 11112(a) of

this title and the defendant substantially prevails, the court

shall, at the conclusion of the action, award to a substantially

prevailing party defending against any such claim the cost of the

suit attributable to such claim, including a reasonable attorney's

fee, if the claim, or the claimant's conduct during the litigation

of the claim, was frivolous, unreasonable, without foundation, or

in bad faith. For the purposes of this section, a defendant shall

not be considered to have substantially prevailed when the

plaintiff obtains an award for damages or permanent injunctive or

declaratory relief.

-SOURCE-

(Pub. L. 99-660, title IV, Sec. 413, Nov. 14, 1986, 100 Stat.

3787.)

-End-

-CITE-

42 USC Sec. 11114 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

SUBCHAPTER I - PROMOTION OF PROFESSIONAL REVIEW ACTIVITIES

-HEAD-

Sec. 11114. Guidelines of Secretary

-STATUTE-

The Secretary may establish, after notice and opportunity for

comment, such voluntary guidelines as may assist the professional

review bodies in meeting the standards described in section

11112(a) of this title.

-SOURCE-

(Pub. L. 99-660, title IV, Sec. 414, Nov. 14, 1986, 100 Stat.

3787.)

-End-

-CITE-

42 USC Sec. 11115 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

SUBCHAPTER I - PROMOTION OF PROFESSIONAL REVIEW ACTIVITIES

-HEAD-

Sec. 11115. Construction

-STATUTE-

(a) In general

Except as specifically provided in this subchapter, nothing in

this subchapter shall be construed as changing the liabilities or

immunities under law or as preempting or overriding any State law

which provides incentives, immunities, or protection for those

engaged in a professional review action that is in addition to or

greater than that provided by this subchapter.

(b) Scope of clinical privileges

Nothing in this subchapter shall be construed as requiring health

care entities to provide clinical privileges to any or all classes

or types of physicians or other licensed health care practitioners.

(c) Treatment of nurses and other practitioners

Nothing in this subchapter shall be construed as affecting, or

modifying any provision of Federal or State law, with respect to

activities of professional review bodies regarding nurses, other

licensed health care practitioners, or other health professionals

who are not physicians.

(d) Treatment of patient malpractice claims

Nothing in this chapter shall be construed as affecting in any

manner the rights and remedies afforded patients under any

provision of Federal or State law to seek redress for any harm or

injury suffered as a result of negligent treatment or care by any

physician, health care practitioner, or health care entity, or as

limiting any defenses or immunities available to any physician,

health care practitioner, or health care entity.

-SOURCE-

(Pub. L. 99-660, title IV, Sec. 415, Nov. 14, 1986, 100 Stat. 3787;

Pub. L. 100-177, title IV, Sec. 402(c), as added Pub. L. 101-239,

title VI, Sec. 6103(e)(6)(A), Dec. 19, 1989, 103 Stat. 2208.)

-MISC1-

AMENDMENTS

1989 - Subsec. (a). Pub. L. 101-239 added Pub. L. 100-177, Sec.

402(c), see 1987 Amendment note below.

1987 - Subsec. (a). Pub. L. 100-177, Sec. 402(c), as added by

Pub. L. 101-239, inserted before period at end "or as preempting or

overriding any State law which provides incentives, immunities, or

protection for those engaged in a professional review action that

is in addition to or greater than that provided by this

subchapter".

EFFECTIVE DATE OF 1987 AMENDMENT

Amendment by Pub. L. 100-177 effective Nov. 14, 1986, see section

402(d) of Pub. L. 100-177, as renumbered and amended, set out as a

note under section 11137 of this title.

-End-

-CITE-

42 USC SUBCHAPTER II - REPORTING OF INFORMATION 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

SUBCHAPTER II - REPORTING OF INFORMATION

-HEAD-

SUBCHAPTER II - REPORTING OF INFORMATION

-SECREF-

SUBCHAPTER REFERRED TO IN OTHER SECTIONS

This subchapter is referred to in section 11152 of this title.

-End-

-CITE-

42 USC Sec. 11131 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

SUBCHAPTER II - REPORTING OF INFORMATION

-HEAD-

Sec. 11131. Requiring reports on medical malpractice payments

-STATUTE-

(a) In general

Each entity (including an insurance company) which makes payment

under a policy of insurance, self-insurance, or otherwise in

settlement (or partial settlement) of, or in satisfaction of a

judgment in, a medical malpractice action or claim shall report, in

accordance with section 11134 of this title, information respecting

the payment and circumstances thereof.

(b) Information to be reported

The information to be reported under subsection (a) of this

section includes -

(1) the name of any physician or licensed health care

practitioner for whose benefit the payment is made,

(2) the amount of the payment,

(3) the name (if known) of any hospital with which the

physician or practitioner is affiliated or associated,

(4) a description of the acts or omissions and injuries or

illnesses upon which the action or claim was based, and

(5) such other information as the Secretary determines is

required for appropriate interpretation of information reported

under this section.

(c) Sanctions for failure to report

Any entity that fails to report information on a payment required

to be reported under this section shall be subject to a civil money

penalty of not more than $10,000 for each such payment involved.

Such penalty shall be imposed and collected in the same manner as

civil money penalties under subsection (a) of section 1320a-7a of

this title are imposed and collected under that section.

(d) Report on treatment of small payments

The Secretary shall study and report to Congress, not later than

two years after November 14, 1986, on whether information

respecting small payments should continue to be required to be

reported under subsection (a) of this section and whether

information respecting all claims made concerning a medical

malpractice action should be required to be reported under such

subsection.

-SOURCE-

(Pub. L. 99-660, title IV, Sec. 421, Nov. 14, 1986, 100 Stat.

3788.)

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 11134 of this title.

-End-

-CITE-

42 USC Sec. 11132 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

SUBCHAPTER II - REPORTING OF INFORMATION

-HEAD-

Sec. 11132. Reporting of sanctions taken by Boards of Medical

Examiners

-STATUTE-

(a) In general

(1) Actions subject to reporting

Each Board of Medical Examiners -

(A) which revokes or suspends (or otherwise restricts) a

physician's license or censures, reprimands, or places on

probation a physician, for reasons relating to the physician's

professional competence or professional conduct, or

(B) to which a physician's license is surrendered,

shall report, in accordance with section 11134 of this title, the

information described in paragraph (2).

(2) Information to be reported

The information to be reported under paragraph (1) is -

(A) the name of the physician involved,

(B) a description of the acts or omissions or other reasons

(if known) for the revocation, suspension, or surrender of

license, and

(C) such other information respecting the circumstances of

the action or surrender as the Secretary deems appropriate.

(b) Failure to report

If, after notice of noncompliance and providing opportunity to

correct noncompliance, the Secretary determines that a Board of

Medical Examiners has failed to report information in accordance

with subsection (a) of this section, the Secretary shall designate

another qualified entity for the reporting of information under

section 11133 of this title.

-SOURCE-

(Pub. L. 99-660, title IV, Sec. 422, Nov. 14, 1986, 100 Stat.

3789.)

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1396r-2, 11133, 11134 of

this title.

-End-

-CITE-

42 USC Sec. 11133 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

SUBCHAPTER II - REPORTING OF INFORMATION

-HEAD-

Sec. 11133. Reporting of certain professional review actions taken

by health care entities

-STATUTE-

(a) Reporting by health care entities

(1) On physicians

Each health care entity which -

(A) takes a professional review action that adversely affects

the clinical privileges of a physician for a period longer than

30 days;

(B) accepts the surrender of clinical privileges of a

physician -

(i) while the physician is under an investigation by the

entity relating to possible incompetence or improper

professional conduct, or

(ii) in return for not conducting such an investigation or

proceeding; or

(C) in the case of such an entity which is a professional

society, takes a professional review action which adversely

affects the membership of a physician in the society,

shall report to the Board of Medical Examiners, in accordance

with section 11134(a) of this title, the information described in

paragraph (3).

(2) Permissive reporting on other licensed health care

practitioners

A health care entity may report to the Board of Medical

Examiners, in accordance with section 11134(a) of this title, the

information described in paragraph (3) in the case of a licensed

health care practitioner who is not a physician, if the entity

would be required to report such information under paragraph (1)

with respect to the practitioner if the practitioner were a

physician.

(3) Information to be reported

The information to be reported under this subsection is -

(A) the name of the physician or practitioner involved,

(B) a description of the acts or omissions or other reasons

for the action or, if known, for the surrender, and

(C) such other information respecting the circumstances of

the action or surrender as the Secretary deems appropriate.

(b) Reporting by Board of Medical Examiners

Each Board of Medical Examiners shall report, in accordance with

section 11134 of this title, the information reported to it under

subsection (a) of this section and known instances of a health care

entity's failure to report information under subsection (a)(1) of

this section.

(c) Sanctions

(1) Health care entities

A health care entity that fails substantially to meet the

requirement of subsection (a)(1) of this section shall lose the

protections of section 11111(a)(1) of this title if the Secretary

publishes the name of the entity under section 11111(b) of this

title.

(2) Board of Medical Examiners

If, after notice of noncompliance and providing an opportunity

to correct noncompliance, the Secretary determines that a Board

of Medical Examiners has failed to report information in

accordance with subsection (b) of this section, the Secretary

shall designate another qualified entity for the reporting of

information under subsection (b) of this section.

(d) References to Board of Medical Examiners

Any reference in this subchapter to a Board of Medical Examiners

includes, in the case of a Board in a State that fails to meet the

reporting requirements of section 11132(a) of this title or

subsection (b) of this section, a reference to such other qualified

entity as the Secretary designates.

-SOURCE-

(Pub. L. 99-660, title IV, Sec. 423, Nov. 14, 1986, 100 Stat.

3789.)

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 11111, 11132, 11134 of

this title.

-End-

-CITE-

42 USC Sec. 11134 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

SUBCHAPTER II - REPORTING OF INFORMATION

-HEAD-

Sec. 11134. Form of reporting

-STATUTE-

(a) Timing and form

The information required to be reported under sections 11131,

11132(a), and 11133 of this title shall be reported regularly (but

not less often than monthly) and in such form and manner as the

Secretary prescribes. Such information shall first be required to

be reported on a date (not later than one year after November 14,

1986) specified by the Secretary.

(b) To whom reported

The information required to be reported under sections 11131,

11132(a), and 11133(b) of this title shall be reported to the

Secretary, or, in the Secretary's discretion, to an appropriate

private or public agency which has made suitable arrangements with

the Secretary with respect to receipt, storage, protection of

confidentiality, and dissemination of the information under this

subchapter.

(c) Reporting to State licensing boards

(1) Malpractice payments

Information required to be reported under section 11131 of this

title shall also be reported to the appropriate State licensing

board (or boards) in the State in which the medical malpractice

claim arose.

(2) Reporting to other licensing boards

Information required to be reported under section 11133(b) of

this title shall also be reported to the appropriate State

licensing board in the State in which the health care entity is

located if it is not otherwise reported to such board under

subsection (b) of this section.

-SOURCE-

(Pub. L. 99-660, title IV, Sec. 424, Nov. 14, 1986, 100 Stat.

3790.)

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 11131, 11132, 11133,

11135, 11136, 11137 of this title.

-End-

-CITE-

42 USC Sec. 11135 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

SUBCHAPTER II - REPORTING OF INFORMATION

-HEAD-

Sec. 11135. Duty of hospitals to obtain information

-STATUTE-

(a) In general

It is the duty of each hospital to request from the Secretary (or

the agency designated under section 11134(b) of this title), on and

after the date information is first required to be reported under

section 11134(a) of this title) - (!1)

(1) at the time a physician or licensed health care

practitioner applies to be on the medical staff (courtesy or

otherwise) of, or for clinical privileges at, the hospital,

information reported under this subchapter concerning the

physician or practitioner, and

(2) once every 2 years information reported under this

subchapter concerning any physician or such practitioner who is

on the medical staff (courtesy or otherwise) of, or has been

granted clinical privileges at, the hospital.

A hospital may request such information at other times.

(b) Failure to obtain information

With respect to a medical malpractice action, a hospital which

does not request information respecting a physician or practitioner

as required under subsection (a) of this section is presumed to

have knowledge of any information reported under this subchapter to

the Secretary with respect to the physician or practitioner.

(c) Reliance on information provided

Each hospital may rely upon information provided to the hospital

under this chapter and shall not be held liable for such reliance

in the absence of the hospital's knowledge that the information

provided was false.

-SOURCE-

(Pub. L. 99-660, title IV, Sec. 425, Nov. 14, 1986, 100 Stat.

3790.)

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 11137 of this title.

-FOOTNOTE-

(!1) So in original. The closing parenthesis probably should not

appear.

-End-

-CITE-

42 USC Sec. 11136 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

SUBCHAPTER II - REPORTING OF INFORMATION

-HEAD-

Sec. 11136. Disclosure and correction of information

-STATUTE-

With respect to the information reported to the Secretary (or the

agency designated under section 11134(b) of this title) under this

subchapter respecting a physician or other licensed health care

practitioner, the Secretary shall, by regulation, provide for -

(1) disclosure of the information, upon request, to the

physician or practitioner, and

(2) procedures in the case of disputed accuracy of the

information.

-SOURCE-

(Pub. L. 99-660, title IV, Sec. 426, Nov. 14, 1986, 100 Stat.

3791.)

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 11137 of this title.

-End-

-CITE-

42 USC Sec. 11137 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

SUBCHAPTER II - REPORTING OF INFORMATION

-HEAD-

Sec. 11137. Miscellaneous provisions

-STATUTE-

(a) Providing licensing boards and other health care entities with

access to information

The Secretary (or the agency designated under section 11134(b) of

this title) shall, upon request, provide information reported under

this subchapter with respect to a physician or other licensed

health care practitioner to State licensing boards, to hospitals,

and to other health care entities (including health maintenance

organizations) that have entered (or may be entering) into an

employment or affiliation relationship with the physician or

practitioner or to which the physician or practitioner has applied

for clinical privileges or appointment to the medical staff.

(b) Confidentiality of information

(1) In general

Information reported under this subchapter is considered

confidential and shall not be disclosed (other than to the

physician or practitioner involved) except with respect to

professional review activity, as necessary to carry out

subsections (b) and (c) of section 11135 of this title (as

specified in regulations by the Secretary), or in accordance with

regulations of the Secretary promulgated pursuant to subsection

(a) of this section. Nothing in this subsection shall prevent the

disclosure of such information by a party which is otherwise

authorized, under applicable State law, to make such disclosure.

Information reported under this subchapter that is in a form that

does not permit the identification of any particular health care

entity, physician, other health care practitioner, or patient

shall not be considered confidential. The Secretary (or the

agency designated under section 11134(b) of this title), on

application by any person, shall prepare such information in such

form and shall disclose such information in such form.

(2) Penalty for violations

Any person who violates paragraph (1) shall be subject to a

civil money penalty of not more than $10,000 for each such

violation involved. Such penalty shall be imposed and collected

in the same manner as civil money penalties under subsection (a)

of section 1320a-7a of this title are imposed and collected under

that section.

(3) Use of information

Subject to paragraph (1), information provided under section

11135 of this title and subsection (a) of this section is

intended to be used solely with respect to activities in the

furtherance of the quality of health care.

(4) Fees

The Secretary may establish or approve reasonable fees for the

disclosure of information under this section or section 11136 of

this title. The amount of such a fee may not exceed the costs of

processing the requests for disclosure and of providing such

information. Such fees shall be available to the Secretary (or,

in the Secretary's discretion, to the agency designated under

section 11134(b) of this title) to cover such costs.

(c) Relief from liability for reporting

No person or entity (including the agency designated under

section 11134(b) of this title) shall be held liable in any civil

action with respect to any report made under this subchapter

(including information provided under subsection (a) of this

section (!1) without knowledge of the falsity of the information

contained in the report.

(d) Interpretation of information

In interpreting information reported under this subchapter, a

payment in settlement of a medical malpractice action or claim

shall not be construed as creating a presumption that medical

malpractice has occurred.

-SOURCE-

(Pub. L. 99-660, title IV, Sec. 427, Nov. 14, 1986, 100 Stat. 3791;

Pub. L. 100-177, title IV, Sec. 402(a), (b), Dec. 1, 1987, 101

Stat. 1007.)

-MISC1-

AMENDMENTS

1987 - Subsec. (b)(1). Pub. L. 100-177, Sec. 402(a)(1),

substituted "as necessary to carry out subsections (b) and (c) of

section 11135 of this title (as specified in regulations by the

Secretary)" for "with respect to medical malpractice actions" and

inserted at end "Information reported under this subchapter that is

in a form that does not permit the identification of any particular

health care entity, physician, other health care practitioner, or

patient shall not be considered confidential. The Secretary (or the

agency designated under section 11134(b) of this title), on

application by any person, shall prepare such information in such

form and shall disclose such information in such form."

Subsec. (b)(4). Pub. L. 100-177, Sec. 402(b), added par. (4).

Subsec. (c). Pub. L. 100-177, Sec. 402(a)(2), inserted

"(including the agency designated under section 11134(b) of this

title)" after "entity" and "(including information provided under

subsection (a) of this section" after "subchapter".

EFFECTIVE DATE OF 1987 AMENDMENT

Section 402(d), formerly section 402(c), of Pub. L. 100-177, as

renumbered and amended by Pub. L. 101-239, title VI, Sec.

6103(e)(6), Dec. 19, 1989, 103 Stat. 2208, provided that:

"(1) In general. - The amendments made by subsections (a) and (c)

[amending this section and sections 1111 and 1115 of this title]

shall become effective on November 14, 1986.

"(2) Fees. - The amendment made by subsection (b) [amending this

section] shall become effective on the date of enactment of this

Act [Dec. 1, 1987]."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 1396r-2 of this title.

-FOOTNOTE-

(!1) So in original. Probably should be followed by a closing

parenthesis.

-End-

-CITE-

42 USC SUBCHAPTER III - DEFINITIONS AND REPORTS 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

SUBCHAPTER III - DEFINITIONS AND REPORTS

-HEAD-

SUBCHAPTER III - DEFINITIONS AND REPORTS

-End-

-CITE-

42 USC Sec. 11151 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

SUBCHAPTER III - DEFINITIONS AND REPORTS

-HEAD-

Sec. 11151. Definitions

-STATUTE-

In this chapter:

(1) The term "adversely affecting" includes reducing,

restricting, suspending, revoking, denying, or failing to renew

clinical privileges or membership in a health care entity.

(2) The term "Board of Medical Examiners" includes a body

comparable to such a Board (as determined by the State) with

responsibility for the licensing of physicians and also includes

a subdivision of such a Board or body.

(3) The term "clinical privileges" includes privileges,

membership on the medical staff, and the other circumstances

pertaining to the furnishing of medical care under which a

physician or other licensed health care practitioner is permitted

to furnish such care by a health care entity.

(4)(A) The term "health care entity" means -

(i) a hospital that is licensed to provide health care

services by the State in which it is located,

(ii) an entity (including a health maintenance organization

or group medical practice) that provides health care services

and that follows a formal peer review process for the purpose

of furthering quality health care (as determined under

regulations of the Secretary), and

(iii) subject to subparagraph (B), a professional society (or

committee thereof) of physicians or other licensed health care

practitioners that follows a formal peer review process for the

purpose of furthering quality health care (as determined under

regulations of the Secretary).

(B) The term "health care entity" does not include a

professional society (or committee thereof) if, within the

previous 5 years, the society has been found by the Federal Trade

Commission or any court to have engaged in any anti-competitive

practice which had the effect of restricting the practice of

licensed health care practitioners.

(5) The term "hospital" means an entity described in paragraphs

(1) and (7) of section 1395x(e) of this title.

(6) The terms "licensed health care practitioner" and

"practitioner" mean, with respect to a State, an individual

(other than a physician) who is licensed or otherwise authorized

by the State to provide health care services.

(7) The term "medical malpractice action or claim" means a

written claim or demand for payment based on a health care

provider's furnishing (or failure to furnish) health care

services, and includes the filing of a cause of action, based on

the law of tort, brought in any court of any State or the United

States seeking monetary damages.

(8) The term "physician" means a doctor of medicine or

osteopathy or a doctor of dental surgery or medical dentistry

legally authorized to practice medicine and surgery or dentistry

by a State (or any individual who, without authority holds

himself or herself out to be so authorized).

(9) The term "professional review action" means an action or

recommendation of a professional review body which is taken or

made in the conduct of professional review activity, which is

based on the competence or professional conduct of an individual

physician (which conduct affects or could affect adversely the

health or welfare of a patient or patients), and which affects

(or may affect) adversely the clinical privileges, or membership

in a professional society, of the physician. Such term includes a

formal decision of a professional review body not to take an

action or make a recommendation described in the previous

sentence and also includes professional review activities

relating to a professional review action. In this chapter, an

action is not considered to be based on the competence or

professional conduct of a physician if the action is primarily

based on -

(A) the physician's association, or lack of association, with

a professional society or association,

(B) the physician's fees or the physician's advertising or

engaging in other competitive acts intended to solicit or

retain business,

(C) the physician's participation in prepaid group health

plans, salaried employment, or any other manner of delivering

health services whether on a fee-for-service or other basis,

(D) a physician's association with, supervision of,

delegation of authority to, support for, training of, or

participation in a private group practice with, a member or

members of a particular class of health care practitioner or

professional, or

(E) any other matter that does not relate to the competence

or professional conduct of a physician.

(10) The term "professional review activity" means an activity

of a health care entity with respect to an individual physician -

(A) to determine whether the physician may have clinical

privileges with respect to, or membership in, the entity,

(B) to determine the scope or conditions of such privileges

or membership, or

(C) to change or modify such privileges or membership.

(11) The term "professional review body" means a health care

entity and the governing body or any committee of a health care

entity which conducts professional review activity, and includes

any committee of the medical staff of such an entity when

assisting the governing body in a professional review activity.

(12) The term "Secretary" means the Secretary of Health and

Human Services.

(13) The term "State" means the 50 States, the District of

Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa,

and the Northern Mariana Islands.

(14) The term "State licensing board" means, with respect to a

physician or health care provider in a State, the agency of the

State which is primarily responsible for the licensing of the

physician or provider to furnish health care services.

-SOURCE-

(Pub. L. 99-660, title IV, Sec. 431, Nov. 14, 1986, 100 Stat.

3792.)

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1396r-2, 11111 of this

title.

-End-

-CITE-

42 USC Sec. 11152 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 117 - ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES

SUBCHAPTER III - DEFINITIONS AND REPORTS

-HEAD-

Sec. 11152. Reports and memoranda of understanding

-STATUTE-

(a) Annual reports to Congress

The Secretary shall report to Congress, annually during the three

years after November 14, 1986, on the implementation of this

chapter.

(b) Memoranda of understanding

The Secretary of Health and Human Services shall seek to enter

into memoranda of understanding with the Secretary of Defense and

the Administrator of Veterans' Affairs to apply the provisions of

subchapter II of this chapter to hospitals and other facilities and

health care providers under the jurisdiction of the Secretary or

Administrator, respectively. The Secretary shall report to

Congress, not later than two years after November 14, 1986, on any

such memoranda and on the cooperation among such officials in

establishing such memoranda.

(c) Memorandum of understanding with Drug Enforcement

Administration

The Secretary of Health and Human Services shall seek to enter

into a memorandum of understanding with the Administrator of Drug

Enforcement relating to providing for the reporting by the

Administrator to the Secretary of information respecting physicians

and other practitioners whose registration to dispense controlled

substances has been suspended or revoked under section 824 of title

21. The Secretary shall report to Congress, not later than two

years after November 14, 1986, on any such memorandum and on the

cooperation between the Secretary and the Administrator in

establishing such a memorandum.

-SOURCE-

(Pub. L. 99-660, title IV, Sec. 432, Nov. 14, 1986, 100 Stat.

3794.)

-CHANGE-

CHANGE OF NAME

Reference to Administrator of Veterans' Affairs deemed to refer

to Secretary of Veterans Affairs pursuant to section 10 of Pub. L.

100-527, set out as a Department of Veterans Affairs Act note under

section 301 of Title 38, Veterans' Benefits.

-End-