SB1636 94TH GENERAL ASSEMBLY

LRB094 09981 DRJ 40239 b

94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006
SB1636

Introduced 2/23/2005, by Sen. Bill Brady

SYNOPSIS AS INTRODUCED:

New Act
225 ILCS 60/29	from Ch. 111, par. 4400-29

Creates the Affordable Health Care Act and amends the Medical Practice Act of 1987. Provides that the Affordable Health Care Act applies to and governs all health care agreements between a patient and a health care provider that (A) voluntarily limit economic damages or non-economic damages arising out of (i) injuries alleged to have been received by a person as the result of medical negligence, or (ii) the death of a person, due to alleged medical negligence of a health care provider or (B) contractually obligate the plaintiff in a medical negligence lawsuit to pay the defendants' reasonable legal fees, including costs and expenses, if the lawsuit fails to establish liability on the part of the defendants. Sets forth conditions to which health care agreements are subject, and requires that such agreements contain a notice to patients. Provides for the termination of health care agreements. Provides that no patient with an emergency medical condition shall be asked to enter into a health care agreement until after stabilization of the patient's condition. Prohibits certain types of threats to health care providers, and makes a violation of those provisions a Class A misdemeanor. Provides that a health care agreement that complies with the Affordable Health Care Act does not violate the provisions of the Medical Practice Act of 1987 concerning certain prohibited contracts or agreements and is not void or against the public policy of the State of Illinois.

CORRECTIONAL BUDGET AND IMPACT NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning health.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be cited as the Affordable Health Care Act.

Section 5. Findings and purpose.

(a) The General Assembly recognizes that many consumers of health care services experience difficulty in trying to find and obtain affordable health care services. The General Assembly finds that many consumers of health care services experience high out-of-pocket costs when receiving those services. The General Assembly also finds that consumers should have the right to voluntarily contract with and negotiate with their health care providers in ways to decrease their out-of-pocket costs for health care services.

The General Assembly acknowledges that jury awards in Illinois have increased substantially, far in excess of the rate of inflation or the consumer price index. Medical malpractice liability insurance costs have increased dramatically, causing physicians to leave the State, retire early, and discontinue providing certain medical services. The fear of jury awards in excess of a physician's professional medical malpractice insurance policy limits is dramatically and negatively affecting access to health care in the State. Threats of a potential jury award above a physician's policy limits are often used to coerce physicians into out-of-court settlements. These fears are placing physicians in an adversarial relationship with their patients. The General Assembly finds this is contrary to the best interest of the citizens of the State of Illinois.

Furthermore, the General Assembly acknowledges that many health care providers order expensive diagnostic medical tests and procedures on consumers based on the assumption that these tests and procedures will decrease potential liability in the event a claim is filed against them based upon allegations of medical negligence. This unnecessarily increases the overall costs for health care services. Health care providers are experiencing difficulty in finding affordable medical liability insurance because many insurance companies have discontinued selling medical liability insurance in this State. Many geographic areas of the State are unable to attract health care providers, resulting in limited access to heath care services, due to the lack of affordable medical liability insurance.

Allegations of medical negligence often include requests for economic damages and non-economic damages such as pain and suffering. The possibility of awards for economic damages and non-economic damages have resulted in many insurance companies discontinuing business operations in the State. This has limited access to affordable medical liability insurance and resulted in higher costs for liability insurance, which are ultimately passed on to the consumers of health care services. Inability to obtain affordable medical malpractice liability insurance has resulted in many health care providers discontinuing the provision of high risk medical services, leaving the State, and discontinuing the provision of medical services altogether.

(b) This Act is intended to:

(1) Specifically authorize the right of consumers to voluntarily contract with health care providers in an attempt to lower their costs for health care services by entering into agreements that voluntarily limit the amount of economic or non-economic damages, or both, that may be recovered in a medical negligence lawsuit, or that contractually obligate the plaintiff in a medical negligence lawsuit to pay the defendants' reasonable legal fees, including costs and expenses, if the lawsuit fails to establish liability on the part of the defendants.

(2) Improve the overall quality of care delivered to the public by health care providers throughout the State.

(3) Improve access to health care services by allowing consumers and health care providers to voluntarily enter into agreements, thereby encouraging health care providers to continue to offer services in this State.

(4) Lower the overall cost of health care services by reducing the number and amount of unnecessary diagnostic tests and procedures that are performed on patients based on the theory of "defensive medicine".

(5) Encourage health care providers to offer and provide services in geographic areas of the State that have traditionally been underserved or experienced shortages in qualified health care providers.

Section 10. Definitions. In this Act:

"Consumer" means any person, individual, corporation, association, partnership, limited liability company, sole proprietorship, or other legal entity.

"Economic damages" means objectively verifiable monetary losses incurred as a result of the provision of, use of, or payment for health care services or medical products, such as past and future medical expenses, loss of past and future earnings, cost of obtaining domestic services, loss of employment, and loss of business or employment opportunities.

"Effective date" means the date on which a health care agreement becomes effective and binds the parties to the terms of the agreement.

"Emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity (including, but not limited to, severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:

(1) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;

(2) serious impairment to bodily functions; or

(3) serious dysfunction of any bodily organ or part.

"Emergency services" means medical services furnished by a health care provider that are needed to evaluate or stabilize an emergency medical condition. "Emergency services" does not refer to post-stabilization medical services.

"Group of health care providers" means any group, association, partnership, corporation, limited liability company, limited liability partnership, organization, or collection of health care providers that provide health care services to the general public or perform business operations under a common business name.

"Health care agreement" means a written agreement entered into between a patient and a health care provider that (A) prohibits or limits economic damages or non-economic damages arising out of (i) injuries alleged to have been received by a patient as the result of medical negligence or (ii) the death of a patient, due to alleged medical negligence services provided by a health care provider or (B) contractually obligates the plaintiff in a medical negligence lawsuit to pay the defendants' reasonable legal fees, including costs and expenses, if the lawsuit fails to establish liability on the part of the defendants.

"Health care provider" means any physician, nurse, licensed advanced practice nurse, licensed physician assistant, chiropractor, licensed hospital facility, licensed ambulatory surgery center, or other person that is licensed or otherwise authorized to provide or deliver health care services.

"Health care service" means any service provided to a person by a health care provider that relates to, or is for the purpose of, preventing, alleviating, curing, or healing human illness or injury.

"Non-economic damages" means damages for physical and emotional pain, suffering, inconvenience, physical impairment, mental anguish, disfigurement, loss of enjoyment of life, loss of society and companionship, loss of consortium, hedonic damages, injury to reputation, and all other non-pecuniary losses of any kind or nature.

"Nurse" means a person licensed under the Nursing and Advanced Practice Nursing Act.

"Party" means any person who is a plaintiff or a defendant in a medical negligence lawsuit.

"Patient" means any person who receives health care services from a health care provider.

"Person" means any individual, corporation, association, partnership, limited liability company, sole proprietorship, or any other legal entity.

"Physician" means a person licensed under the Medical Practice Act of 1987 to practice medicine in all of its branches or a chiropractic physician licensed to treat human ailments without the use of drugs and without operative surgery.

"Post-stabilization medical services" means health care services furnished by a health care provider to a patient after stabilization of an emergency medical condition.

"Stabilization" means, with respect to an emergency medical condition, to provide such medical treatment of the condition as may be necessary to ensure, within reasonable medical probability, that no material deterioration of the condition is likely to result.

"Termination date" means the date after which a health care agreement becomes terminated and no longer binds the parties to the agreement.

Section 15. Applicability. This Act shall apply to and shall govern all health care agreements between a patient and a health care provider that (A) voluntarily limit economic damages or non-economic damages arising out of (i) injuries alleged to have been received by a person as the result of medical negligence, or (ii) the death of a person, due to alleged medical negligence of a health care provider or (B) contractually obligate the plaintiff in a medical negligence lawsuit to pay the defendants' reasonable legal fees, including costs and expenses, if the lawsuit fails to establish liability on the part of the defendants.

Section 20. Minor parties. A minor child shall be bound by a health care agreement executed on his or her behalf by any parent or legal guardian of the minor child. A minor child shall be bound by such an agreement irrespective of whether that parent is also a minor. A minor child shall be bound by a health care agreement executed on his or her behalf irrespective of whether the agreement was entered into before the birth of the minor child. An agreement so executed shall not be voidable because of the minority of the parent, and for such purposes a minor who is a parent shall be deemed to have the full legal capacity as if that parent were above the age of majority.

Section 25. Conditions. Every health care agreement shall be subject to all of the following conditions:

(1) The agreement shall be voluntarily executed by the patient receiving health care services or the patient's legal parent or guardian prior to, during, or after the term of provision of services by a health care provider.

(2) The agreement must be a separate instrument complete in itself and not a part of any other contract or instrument.

(3) The agreement may not limit, impair, or waive any substantive rights or defenses of any patient, other than the right of a patient to (A) allege damages and receive an award for economic damages or non-economic damages in a medical negligence lawsuit or (B) contractually obligate the plaintiff in a medical negligence lawsuit to pay the defendants' reasonable legal fees, including costs and expenses, if the lawsuit fails to establish liability on the part of the defendants.

(4) The agreement may not limit, impair, or waive the procedural rights to be heard, to present material evidence, to cross-examine witnesses, and to be represented by an attorney, or other procedural rights of due process of any party.

(5) The original agreement may be in written or electronic format, and any patient executing such an agreement shall be given a copy of the signed agreement immediately after executing the agreement or at any time when requested by the patient.

(6) The agreement shall remain in effect and shall apply to all health care services provided to the patient on or after the effective date by the health care provider or providers who is, or are, a party to the agreement.

(7) The agreement shall include an effective date clearly indicating the date the agreement is to become effective; the effective date may be a date prior to the date the agreement is executed.

(8) The agreement may be amended to include additional health care providers with the written consent of the patient, by including a written amendment with the names of the additional health care providers and the effective date or dates of the amendment.

(9) The agreement may be terminated by the patient at any time by notifying the health care provider in writing via certified mail, return receipt requested, at the address listed on the original agreement, and the termination shall become effective on the date the termination letter is postmarked by the United States Postal Service.

(10) Notwithstanding any other provision in this Act, an agreement under this Act may limit economic damages only to the extent those damages exceed $500,000.

Section 30. Termination of a health care agreement. Any health care agreement subject to this Act may be terminated at any time by the patient by notifying the health care provider in writing via certified mail, return receipt requested, at the address listed on the original agreement, and the termination shall become effective on the date the termination letter is postmarked by the United States Postal Service. After the termination date of a health care agreement, a patient shall not be subject to any limitations on economic damages or non-economic damages for claims based on medical negligence for health care services provided after the termination date. Health care services provided to a patient by a health care provider prior to the termination date of a health care agreement shall be subject to the limitations regarding economic damages or non-economic damages contained in the agreement, and the plaintiff in a medical negligence lawsuit shall be contractually obligated to pay the defendants' reasonable legal fees, including costs and expenses, if the lawsuit fails to establish liability on the part of the defendants in the agreement.

Section 35. Emergencies. No patient with an emergency medical condition shall be asked to enter into a health care agreement until after stabilization of the patient's condition. Nothing contained in this Act shall prohibit a health care provider from entering into a health care agreement with a patient after stabilization of the emergency medical condition or while providing post-stabilization medical services.

Section 40. Groups of health care providers. Any patient may enter into a health care agreement with a group of health care providers by including the name of the group on the agreement. The terms of the agreement shall apply to the patient and all members of the group, irrespective of whether the individual members of the group of health providers sign the agreement. A health care agreement signed by a patient and any authorized representative of a group of health care providers shall apply to each and every member of the group, thereby restricting or limiting a patient's right to economic damages or non-economic damages that may result from negligence caused by any member of the group.

Section 45. Hospitalization. A patient may sign a health care agreement with a hospital that limits or restricts a patient's right to economic damages or non-economic damages or that contractually obligates the plaintiff in a medical negligence lawsuit to pay the defendants' reasonable legal fees, including costs and expenses, and the agreement may include language that applies to all health care providers who provide health care services to the patient during hospitalizations up to and through discharge from the hospital, irrespective of whether those health care providers are employees, agents, or representatives of the hospital.

Section 50. Required language. Every health care agreement shall contain, immediately above the signature lines, in upper-case type in printed letters of at least 3/16-inch height, captions and a paragraph as follows:

AGREEMENT LIMITING DAMAGES IN NEGLIGENCE CLAIMS AND BINDING THE

PLAINTIFF TO PAY THE DEFENDANTS' LEGAL FEES IN THE EVENT OF A

TRIAL

NOTICE TO PATIENT

BY SIGNING THIS AGREEMENT, YOU ARE LIMITING YOUR RIGHT TO DAMAGES THAT MAY RESULT FROM NEGLIGENCE DURING YOUR TREATMENT OR CARE BY THE HEALTH CARE PROVIDER OR GROUP OF HEALTH CARE PROVIDERS LISTED BELOW. YOU ARE ALSO ENTERING INTO AN AGREEMENT THAT WILL OBLIGATE THE PLAINTIFF TO PAY THE DEFENDANTS' REASONABLE LEGAL FEES, INCLUDING COSTS AND EXPENSES, IN THE EVENT OF A TRIAL, IF AT TRIAL THE JURY FAILS TO ESTABLISH LIABILITY ON THE PART OF THE DEFENDANTS. THIS AGREEMENT MAY BE TERMINATED BY YOU AT ANY TIME BY SENDING A WRITTEN NOTICE VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED, TO YOUR HEALTH CARE PROVIDER AT THE ADDRESS LISTED BELOW. HEALTH CARE SERVICES PROVIDED TO YOU AFTER TERMINATION OF THIS AGREEMENT SHALL NOT BE SUBJECT TO DAMAGE LIMITATIONS FOR CLAIMS BASED ON ALLEGATIONS OF NEGLIGENCE. ALL HEALTH CARE SERVICES PROVIDED TO YOU AFTER SIGNING THIS DOCUMENT SHALL BE SUBJECT TO THE LIMITATIONS FOR DAMAGES CONTAINED IN THIS AGREEMENT AND SHALL OBLIGATE YOU TO PAY THE DEFENDANTS' LEGAL COSTS AND EXPENSES IF YOU FAIL TO ESTABLISH DEFENDANTS' LIABILITY AT TRIAL. IF YOU HAVE QUESTIONS ABOUT THIS AGREEMENT, YOU SHOULD CONTACT AN ATTORNEY TO DISCUSS THE LEGAL CONSEQUENCES OF SIGNING THIS DOCUMENT.

Section 55. Admissibility as evidence. A health care agreement subject to this Act shall be admissible as evidence in any court, mediation panel, or arbitration hearing or before any tribunal, board, agency, or person. Any person challenging the validity of a health care agreement shall have the burden of proving that the agreement was not voluntarily entered into or that consent to the agreement was based on willful and wanton fraud or deceit.

Section 60. Threats to health care providers. No person, attorney, agent, or representative shall orally, or in writing, attempt to coerce, threaten, intimidate, or extort another person to induce settlement of a medical negligence lawsuit by referring to, implying, or stating the plaintiff will seek damages in excess of a health care provider's medical malpractice liability insurance policy limits. No person, attorney, agent, or representative shall orally, or in writing, attempt to coerce, threaten, intimidate, or extort another person to induce settlement of a medical negligence lawsuit by referring to, implying, or stating the plaintiff will seek the health care provider's personal assets to satisfy any judgment rendered in a medical negligence lawsuit. Any person convicted of violating any of the provisions of this Section 60 is guilty of a Class A misdemeanor.

Section 90. The Medical Practice Act of 1987 is amended by changing Section 29 as follows:

(225 ILCS 60/29) (from Ch. 111, par. 4400-29)

(Section scheduled to be repealed on January 1, 2007)

Sec. 29. Except as otherwise provided in this Section, any contract or agreement signed by any person prior to, or as a condition of, such person receiving medical treatment in any form, which releases from liability any physician, hospital or other health care provider for any malfeasance, misfeasance or nonfeasance in the course of administering any medical treatment or service is void and against the public policy of the State of Illinois. A health care agreement that complies with the Affordable Health Care Act does not violate this Section and is not void or against the public policy of the State of Illinois.

(Source: P.A. 85-4.)