AB1_EN

Assembly Bill No. 1–Assemblymen Perkins, Buckley, Anderson, Hettrick, Cegavske, Angle, Arberry, Bache, Beers, Berman, Brower, Brown, Carpenter, Chowning, Claborn, Collins, de Braga, Dini, Freeman, Gibbons, Giunchigliani, Goldwater, Gustavson, Humke, Koivisto, Lee, Leslie, Manendo, Martin, Marvel, McClain, Mortenson, Neighbors, Nolan, Oceguera, Ohrenschall, Parks, Parnell, Price, Smith, Tiffany and Williams

Joint Sponsors: Senators Raggio, Titus, Amodei, Care, Carlton, Coffin, Jacobsen, Mathews, McGinness, Milburn, Neal, O’Connell, O’Donnell, Paulk, Rawson, Rhoads, Schneider, Shaffer, Townsend, Washington and Wiener

CHAPTER..........

AN ACT relating to malpractice; limiting the liability of certain medical providers for negligent acts under certain circumstances; establishing a limitation on the amount of noneconomic damages that may be awarded in an action for medical malpractice or dental malpractice; providing for several liability of a defendant for noneconomic damages in an action for medical malpractice; making various changes concerning the payment of future economic damages in actions for medical malpractice; providing for the mandatory dismissal of an action for medical malpractice or dental malpractice under certain circumstances; repealing the provisions pertaining to the use of screening panels for an action for medical malpractice or dental malpractice; revising the statute of limitations for filing an action for medical malpractice or dental malpractice; making various other changes concerning actions for medical malpractice or dental malpractice; requiring certain district judges to receive training concerning the complex issues involved in medical malpractice litigation; requiring courts to impose certain sanctions on attorneys in certain circumstances; making various changes relating to the reporting of claims of malpractice or negligence; requiring the commissioner of insurance to report to the legislative commission and the legislature regarding certain premiums for insurance and certain jury verdicts and settlements; and providing other matters properly relating thereto.

Whereas, The State of Nevada is experiencing extreme difficulties attracting and maintaining a sufficient network of physicians to meet the needs of the residents of this state; and

Whereas, The Nevada Legislature has determined that the shortage of physicians and the inability to attract new physicians to this state pose a serious threat to the health, welfare and safety of the residents of the State of Nevada; and

Whereas, It is recognized that patients who have been injured by medical malpractice must be afforded appropriate access to legal remedies for their injuries and that judicial discretion to render decisions in malpractice actions involving exceptional circumstances must be preserved; now, therefore,

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

Section 1. Chapter 41 of NRS is hereby amended by adding thereto a

new section to read as follows:

1. Except as otherwise provided in subsection 2 and NRS 41.505:

(a) A hospital which has been designated as a center for the treatment

of trauma by the administrator of the health division of the department of

human resources pursuant to NRS 450B.237 and which is a nonprofit

organization;

(b) A hospital other than a hospital described in paragraph (a);

renders care or assistance to patients;

(d) A physician or dentist licensed under the provisions of chapter

630, 631 or 633 of NRS who renders care or assistance in a hospital

described in paragraph (a) or (b), whether or not the care or assistance

was rendered gratuitously or for a fee; and

(e) A physician or dentist licensed under the provisions of chapter

630, 631 or 633 of NRS:

(1) Whose liability is not otherwise limited pursuant to NRS 41.032

to 41.0337, inclusive; and

(2) Who renders care or assistance in a hospital of a governmental

entity that has been designated as a center for the treatment of trauma by

the administrator of the health division of the department of human

resources pursuant to NRS 450B.237, whether or not the care or

assistance was rendered gratuitously or for a fee,

that in good faith renders care or assistance necessitated by a traumatic

injury demanding immediate medical attention, for which the patient

enters the hospital through its emergency room or trauma center, may

not be held liable for more than $50,000 in civil damages, exclusive of

interest computed from the date of judgment, to or for the benefit of any

claimant arising out of any act or omission in rendering that care or

assistance if the care or assistance is rendered in good faith and in a

manner not amounting to gross negligence or reckless, willful or wanton

conduct.

2. The limitation on liability provided pursuant to this section does

not apply to any act or omission in rendering care or assistance:

(a) Which occurs after the patient is stabilized and is capable of

receiving medical treatment as a nonemergency patient, unless surgery is

required as a result of the emergency within a reasonable time after the

patient is stabilized, in which case the limitation on liability provided by

subsection 1 applies to any act or omission in rendering care or

assistance which occurs before the stabilization of the patient following

the surgery; or

(b) Unrelated to the original traumatic injury.

3. If:

(a) A physician or dentist provides follow-up care to a patient to

whom he rendered care or assistance pursuant to subsection 1;

(b) A medical condition arises during the course of the follow-up care

that is directly related to the original traumatic injury for which care or

assistance was rendered pursuant to subsection 1; and

condition that arises during the course of the follow-up care,

there is a rebuttable presumption that the medical condition was the

result of the original traumatic injury and that the limitation on liability

provided by subsection 1 applies with respect to the medical condition

that arises during the course of the follow-up care.

4. For the purposes of this section:

(a) “Reckless, willful or wanton conduct,” as it applies to a person to

whom subsection 1 applies, shall be deemed to be that conduct which the

person knew or should have known at the time he rendered the care or

assistance would be likely to result in injury so as to affect the life or

health of another person, taking into consideration to the extent

applicable:

(1) The extent or serious nature of the prevailing circumstances;

(2) The lack of time or ability to obtain appropriate consultation;

(3) The lack of a prior medical relationship with the patient;

(4) The inability to obtain an appropriate medical history of the

patient; and

(5) The time constraints imposed by coexisting emergencies.

(b) “Traumatic injury” means any acute injury which, according to

standardized criteria for triage in the field, involves a significant risk of

death or the precipitation of complications or disabilities.

Sec. 1.5. NRS 41.505 is hereby amended to read as follows:

41.505 1. Any physician or registered nurse who in good faith gives

instruction or provides supervision to an emergency medical attendant or

registered nurse, at the scene of an emergency or while transporting an ill

or injured person from the scene of an emergency, is not liable for any civil

damages as a result of any act or omission, not amounting to gross

negligence, in giving that instruction or providing that supervision. An

emergency medical attendant, registered nurse or licensed practical nurse

who obeys an instruction given by a physician, registered nurse or licensed

practical nurse and thereby renders emergency care, at the scene of an

emergency or while transporting an ill or injured person from the scene of

an emergency, is not liable for any civil damages as a result of any act or

omission, not amounting to gross negligence, in rendering that emergency

care.

2. Except as otherwise provided in subsection 3, any person licensed

under the provisions of chapter 630, 632 or 633 of NRS and any person

who holds an equivalent license issued by another state, who renders

emergency care or assistance in an emergency, gratuitously and in good

faith, is not liable for any civil damages as a result of any act or omission,

not amounting to gross negligence, by him in rendering the emergency care

or assistance or as a result of any failure to act, not amounting to gross

negligence, to provide or arrange for further medical treatment for the

injured or ill person. This section does not excuse a physician or nurse

from liability for damages resulting from his acts or omissions which occur

in a licensed medical facility relative to any person with whom there is a

preexisting relationship as a patient.

3. Any person licensed under the provisions of chapter 630, 632 or 633

of NRS and any person who holds an equivalent license issued by another

state who renders emergency obstetrical care or assistance to a pregnant

woman during labor or the delivery of the child is not liable for any civil

damages as a result of any act or omission by him in rendering that care or

assistance if:

(a) The care or assistance is rendered in good faith and in a manner not

amounting to gross negligence or reckless, willful or wanton conduct;

(b) The person has not previously provided prenatal or obstetrical care

to the woman; and

of prenatal care received by the woman.

A licensed medical facility in which such care or assistance is rendered is

not liable for any civil damages as a result of any act or omission by the

person in rendering that care or assistance if that person is not liable for

any civil damages pursuant to this subsection and the actions of the

medical facility relating to the rendering of that care or assistance do not

amount to gross negligence or reckless, willful or wanton conduct.

4. Any person licensed under the provisions of chapter 630, 632 or 633

of NRS and any person who holds an equivalent license issued by another

state who:

(a) Is retired or otherwise does not practice on a full-time basis; and

(b) Gratuitously and in good faith, renders medical care within the

scope of his license to an indigent person,

is not liable for any civil damages as a result of any act or omission by him,

not amounting to gross negligence or reckless, willful or wanton conduct,

in rendering that care.

5. Any person licensed to practice medicine under the provisions of

chapter 630 or 633 of NRS or licensed to practice dentistry under the

provisions of chapter 631 of NRS who renders care or assistance to a

patient at a health care facility of a governmental entity or a nonprofit

organization is not liable for any civil damages as a result of any act or

omission by him in rendering that care or assistance if the care or

assistance is rendered gratuitously, in good faith and in a manner not

amounting to gross negligence or reckless, willful or wanton conduct.

6. As used in this section:

(a) “Emergency medical attendant” means a person licensed as an

attendant or certified as an emergency medical technician, intermediate

emergency medical technician or advanced emergency medical technician

pursuant to chapter 450B of NRS.

(b) “Gratuitously” has the meaning ascribed to it in NRS 41.500.

NRS 449.800.

Sec. 2. Chapter 41A of NRS is hereby amended by adding thereto the

provisions set forth as sections 3 to 9, inclusive, of this act.

Sec. 3. “Economic damages” includes damages for medical

treatment, care or custody, loss of earnings and loss of earning capacity.

Sec. 4. “Noneconomic damages” includes damages to compensate

for pain, suffering, inconvenience, physical impairment, disfigurement

and other nonpecuniary damages.

Sec. 5. 1. Except as otherwise provided in subsection 2 and except

as further limited in subsection 3, in an action for damages for medical

malpractice or dental malpractice, the noneconomic damages awarded to

each plaintiff from each defendant must not exceed $350,000.

2. In an action for damages for medical malpractice or dental

malpractice, the limitation on noneconomic damages set forth in

subsection 1 does not apply in the following circumstances and types of

cases:

(a) A case in which the conduct of the defendant is determined to

constitute gross malpractice; or

(b) A case in which, following return of a verdict by the jury or a

finding of damages in a bench trial, the court determines, by clear and

convincing evidence admitted at trial, that an award in excess of

$350,000 for noneconomic damages is justified because of exceptional

circumstances.

3. Except as otherwise provided in subsection 4, in an action for

damages for medical malpractice or dental malpractice, in the

circumstances and types of cases described in subsections 1 and 2, the

noneconomic damages awarded to each plaintiff from each defendant

must not exceed the amount of money remaining under the professional

liability insurance policy limit covering the defendant after subtracting

the economic damages awarded to that plaintiff. Irrespective of the

number of plaintiffs in the action, in no event may any single defendant

be liable to the plaintiffs in the aggregate in excess of the professional

liability insurance policy limit covering that defendant.

4. The limitation set forth in subsection 3 does not apply in an action

for damages for medical malpractice or dental malpractice unless the

defendant was covered by professional liability insurance at the time of

the occurrence of the alleged malpractice and on the date on which the

insurer receives notice of the claim, in an amount of:

(a) Not less than $1,000,000 per occurrence; and

(b) Not less than $3,000,000 in the aggregate.

5. This section is not intended to limit the responsibility of any

defendant for the total economic damages awarded.

6. For the purposes of this section, “gross malpractice” means

failure to exercise the required degree of care, skill or knowledge that

amounts to:

(a) A conscious indifference to the consequences which may result

from the gross malpractice; and

(b) A disregard for and indifference to the safety and welfare of the

patient.

Sec. 6. 1. In an action for damages for medical malpractice, each

defendant is liable for noneconomic damages severally only, and not

jointly, to the plaintiff only for that portion of the judgment which

represents the percentage of negligence attributable to the defendant.

2. As used in this section, “medical malpractice” means the failure

of a physician, hospital, employee of a hospital, certified nurse midwife

or certified registered nurse anesthetist in rendering services to use the

reasonable care, skill or knowledge ordinarily used under similar

circumstances.

Sec. 7. 1. Upon the motion of any party or upon its own motion,

unless good cause is shown for the delay, the court shall, after due notice

to the parties, dismiss an action involving medical malpractice or dental

malpractice if the action is not brought to trial within:

(a) Three years after the date on which the action is filed, if the action

is filed on or after October 1, 2002, but before October 1, 2005.

(b) Two years after the date on which the action is filed, if the action

is filed on or after October 1, 2005.

2. Dismissal of an action pursuant to subsection 1 is a bar to the

filing of another action upon the same claim for relief against the same

defendants.

3. Each district court shall adopt court rules to expedite the

resolution of an action involving medical malpractice or dental

malpractice.

Sec. 8. If an action for medical malpractice or dental malpractice is

filed in the district court, the district court shall dismiss the action,

without prejudice, if the action is filed without an affidavit, supporting

the allegations contained in the action, submitted by a medical expert

who practices or has practiced in an area that is substantially similar to

the type of practice engaged in at the time of the alleged malpractice.

Sec. 9. 1. In an action for medical malpractice or dental

malpractice, all the parties to the action, the insurers of the respective

parties and the attorneys of the respective parties shall attend and

participate in a settlement conference before a district judge, other than

the judge assigned to the action, to ascertain whether the action may be

settled by the parties before trial.

2. The judge before whom the settlement conference is held:

(a) May, for good cause shown, waive the attendance of any party.

(b) Shall decide what information the parties may submit at the

settlement conference.

3. The judge shall notify the parties of the time and place of the

settlement conference.

4. The failure of any party, his insurer or his attorney to participate

in good faith in the settlement conference is grounds for sanctions

against the party or his attorney, or both.

Sec. 10. NRS 41A.003 is hereby amended to read as follows:

41A.003 As used in this chapter, unless the context otherwise requires,

the words and terms defined in NRS 41A.004 [to 41A.013, inclusive,] ,

41A.009 and 41A.013 and sections 3 and 4 of this act have the meanings

ascribed to them in those sections.

Sec. 11. NRS 41A.097 is hereby amended to read as follows:

41A.097 1. Except as otherwise provided in subsection [2,] 3, an

action for injury or death against a provider of health care may not be

commenced more than 4 years after the date of injury or 2 years after the

plaintiff discovers or through the use of reasonable diligence should have

discovered the injury, whichever occurs first, for:

(a) Injury to or the wrongful death of a person[,] occurring before

October 1, 2002, based upon alleged professional negligence of the

provider of health care;

(b) Injury to or the wrongful death of a person occurring before

October 1, 2002, from professional services rendered without consent; or

October 1, 2002, from error or omission in practice by the provider of

health care.

2. Except as otherwise provided in subsection 3, an action for injury

or death against a provider of health care may not be commenced more

than 3 years after the date of injury or 2 years after the plaintiff discovers

or through the use of reasonable diligence should have discovered the

injury, whichever occurs first, for:

(a) Injury to or the wrongful death of a person occurring on or after

October 1, 2002, based upon alleged professional negligence of the

provider of health care;

(b) Injury to or the wrongful death of a person occurring on or after

October 1, 2002, from professional services rendered without consent; or

October 1, 2002, from error or omission in practice by the provider of

health care.

3. This time limitation is tolled[:

(a) For] for any period during which the provider of health care has

concealed any act, error or omission upon which the action is based and

which is known or through the use of reasonable diligence should have

been known to him.

[(b) In any action governed by the provisions of NRS 41A.003 to

41A.069, inclusive, from the date a claimant files a complaint for review

by a screening panel until 30 days after the date the panel notifies the

claimant, in writing, of its findings. The provisions of this paragraph apply

to an action against the provider of health care and to an action against any

person, government or political subdivision of a government who is alleged

by the claimant to be liable vicariously for the medical or dental

malpractice of the provider of health care, if the provider, person,

government or political subdivision has received notice of the filing of a

complaint for review by a screening panel within the limitation of time

provided in subsection 1.

3.] 4. For the purposes of this section, the parent, guardian or legal

custodian of any minor child is responsible for exercising reasonable

judgment in determining whether to prosecute any cause of action limited

by subsection 1[.] or 2. If the parent, guardian or custodian fails to

commence an action on behalf of that child within the prescribed period of

limitations, the child may not bring an action based on the same alleged

injury against any provider of health care upon the removal of his

disability, except that in the case of:

(a) Brain damage or birth defect, the period of limitation is extended

until the child attains 10 years of age.

(b) Sterility, the period of limitation is extended until 2 years after the

child discovers the injury.

[4.] 5. As used in this section, “provider of health care” means a

physician licensed under chapter 630 or 633 of NRS, dentist, registered

nurse, dispensing optician, optometrist, registered physical therapist,

podiatric physician, licensed psychologist, chiropractor, doctor of Oriental

medicine, medical laboratory director or technician, or a licensed hospital

as the employer of any such person.

Sec. 12. NRS 41A.100 is hereby amended to read as follows:

41A.100 1. Liability for personal injury or death is not imposed upon

any provider of medical care based on alleged negligence in the

performance of that care unless evidence consisting of expert medical

testimony, material from recognized medical texts or treatises or the

regulations of the licensed medical facility wherein the alleged negligence

occurred is presented to demonstrate the alleged deviation from the

accepted standard of care in the specific circumstances of the case and to

prove causation of the alleged personal injury or death, except that such

evidence is not required and a rebuttable presumption that the personal

injury or death was caused by negligence arises where evidence is

presented that the personal injury or death occurred in any one or more of

the following circumstances:

(a) A foreign substance other than medication or a prosthetic device was

unintentionally left within the body of a patient following surgery;

(b) An explosion or fire originating in a substance used in treatment

occurred in the course of treatment;

suffered in the course of medical care;

(d) An injury was suffered during the course of treatment to a part of the

body not directly involved in the treatment or proximate thereto; or

(e) A surgical procedure was performed on the wrong patient or the

wrong organ, limb or part of a patient’s body.

2. Expert medical testimony provided pursuant to subsection 1 may

only be given by a provider of medical care who practices or has

practiced in an area that is substantially similar to the type of practice

engaged in at the time of the alleged negligence.

3. As used in this section, “provider of medical care” means a

physician, dentist, registered nurse or a licensed hospital as the employer of

any such person.

Sec. 13. NRS 42.020 is hereby amended to read as follows:

42.020 1. Except as otherwise provided in subsection 2, in any action

for damages for medical malpractice, the amount of damages, if any,

awarded in the action must be reduced by the amount of any prior payment

made by or on behalf of the provider of health care against whom the

action is brought to the injured person or to the claimant to meet reasonable

expenses of medical care, other essential goods or services or reasonable

living expenses.

2. In any action described in subsection 1 in which liability for medical

malpractice is established or admitted, the court shall, before the entry of

judgment, hold a separate hearing to determine if any expenses incurred by

the claimant for medical care, loss of income or other financial loss have

been paid or reimbursed as a benefit from a collateral source. If the court

determines that a claimant has received such a benefit, the court shall

reduce the amount of damages, if any, awarded in the action by the amount

of the benefit. The amount so reduced must not include any amount for

which there is a right of subrogation to the rights of the claimant if the right

of subrogation is exercised by serving a notice of lien on the claimant

before the settlement of or the entry of judgment in the action. Notice of

the action must be provided by the claimant to any statutory holder of a

lien.

3. If future economic damages are awarded in an action for medical

malpractice, the [award must be paid, at the election of the claimant:] court

may, at the request of the claimant, order the award to be paid:

(a) In a lump sum which has been reduced to its present value as

determined by the trier of fact and approved by the court; or

(b) Subject to the provisions of [subsection 5,] subsections 5 and 6 and

the discretion of the court, in periodic payments either by an annuity

purchased to provide periodic payments[.] or by other means if the

defendant posts an adequate bond or other security to ensure full

payment by periodic payments of the damages awarded by the

judgment.

As used in this subsection, “future economic damages” includes damages

for future medical treatment, care or custody, and loss of future earnings.

4. If the claimant [elects to receive] receives periodic payments

pursuant to paragraph (b) of subsection 3, the award must not be reduced to

its present value. The amount of the periodic payments must be equal to the

total amount of all future damages awarded by the trier of fact and

approved by the court. The period for which the periodic payments must be

made must be determined by the trier of fact and approved by the court.

Before the entry of judgment, each party shall submit to the court a plan

specifying the recipient of the payments, the amount of the payments and a

schedule of periodic payments for the award. Upon receipt and review of

the plans, the court shall specify in its judgment rendered in the action the

recipient of the payments, the amount of the payments and a schedule of

payments for the award.

5. If an annuity is purchased pursuant to paragraph (b) of subsection 3,

the claimant shall select the provider of the annuity. Upon purchase of the

annuity, the claimant shall:

(a) Execute a satisfaction of judgment or a stipulation for dismissal of

the claim with prejudice; and

(b) Release forever the defendant and his insurer, if any, from any

obligation to make periodic payments pursuant to the award.

6. If the defendant posts a bond or other security pursuant to

paragraph (b) of subsection 3, upon termination of the payment of

periodic payments of damages, the court shall order the return of the

bond or other security, or as much as remains, to the defendant.

7. As used in this section:

(a) “Benefit from a collateral source” means any money, service or

other benefit which is paid or provided or is reasonably likely to be paid or

provided to a claimant for personal injury or wrongful death pursuant to:

(1) A state or federal act which provides benefits for sickness,

disability, accidents, loss of income or workers’ compensation;

(2) A policy of insurance which provides health benefits or coverage

for loss of income;

(3) A contract of any group, organization, partnership or corporation

which provides, pays or reimburses the cost of medical, hospital or dental

benefits or benefits for loss of income; or

(4) Any other publicly or privately funded program which provides

such benefits.

(b) “Medical malpractice” has the meaning ascribed to it in

NRS 41A.009.

Sec. 14. NRS 1.360 is hereby amended to read as follows:

1.360 Under the direction of the supreme court, the court administrator

shall:

1. Examine the administrative procedures employed in the offices of

the judges, clerks, court reporters and employees of all courts of this state

and make recommendations, through the chief justice, for the improvement

of those procedures;

2. Examine the condition of the dockets of the courts and determine

the need for assistance by any court;

3. Make recommendations to and carry out the directions of the chief

justice relating to the assignment of district judges where district courts are

in need of assistance;

4. Develop a uniform system for collecting and compiling statistics

and other data regarding the operation of the state court system and

transmit that information to the supreme court so that proper action may be

taken in respect thereto;

5. Prepare and submit a budget of state appropriations necessary for

the maintenance and operation of the state court system and make

recommendations in respect thereto;

6. Develop procedures for accounting, internal auditing, procurement

and disbursement for the state court system;

7. Collect statistical and other data and make reports relating to the

expenditure of all public money for the maintenance and operation of the

state court system and the offices connected therewith;

8. Compile statistics from the information required to be maintained

by the clerks of the district courts pursuant to NRS 3.275 and make reports

as to the cases filed in the district courts;

9. Formulate and submit to the supreme court recommendations of

policies or proposed legislation for the improvement of the state court

system;

10. On or before January 1 of each year, submit to the director of the

legislative counsel bureau a written report compiling the information

submitted to the court administrator pursuant to NRS 3.243, 4.175 and

5.045 during the immediately preceding fiscal year; [and]

11. On or before February 15 of each odd-numbered year, submit to

the governor and to the director of the legislative counsel bureau for

transmittal to the next regular session of the legislature a written report

compiling the information submitted by clerks of courts to the court

administrator pursuant to NRS 630.307 and section 64 of this act which

includes only aggregate information for statistical purposes and excludes

any identifying information related to a particular person; and

12. Attend to such other matters as may be assigned by the supreme

court or prescribed by law.

Sec. 15. Chapter 3 of NRS is hereby amended by adding thereto a new

section to read as follows:

The supreme court shall provide by court rule for mandatory

appropriate training concerning the complex issues of medical

malpractice litigation for each district judge to whom actions involving

medical malpractice are assigned.

Sec. 16. NRS 7.085 is hereby amended to read as follows:

7.085 If a court finds that an attorney has:

1. Filed, maintained or defended a civil action or proceeding in any

court in this state and such action or defense is not well-grounded in fact or

is not warranted by existing law or by an argument for changing the

existing law that is made in good faith; or

2. Unreasonably and vexatiously extended a civil action or proceeding

before any court in this state,

the court [may] shall require the attorney personally to pay the additional

costs, expenses and attorney’s fees reasonably incurred because of such

conduct.

Sec. 17. NRS 49.245 is hereby amended to read as follows:

49.245 There is no privilege under NRS 49.225 or 49.235:

1. For communications relevant to an issue in proceedings to

hospitalize the patient for mental illness, if the doctor in the course of

diagnosis or treatment has determined that the patient is in need of

hospitalization.

2. As to communications made in the course of a court-ordered

examination of the condition of a patient with respect to the particular

purpose of the examination unless the court orders otherwise.

3. As to written medical or hospital records relevant to an issue of the

condition of the patient in any proceeding in which the condition is an

element of a claim or defense.

4. In a prosecution or mandamus proceeding under chapter 441A of

NRS.

5. As to any information communicated to a physician in an effort

unlawfully to procure a dangerous drug or controlled substance, or

unlawfully to procure the administration of any such drug or substance.

6. As to any written medical or hospital records which are furnished in

accordance with the provisions of NRS 629.061.

7. As to records that are required by chapter 453 of NRS to be

maintained.

8. [In a review before a screening panel pursuant to NRS 41A.003 to

41A.069, inclusive.

9.] If the services of the physician are sought or obtained to enable or

aid a person to commit or plan to commit fraud or any other unlawful act in

violation of any provision of chapter 616A, 616B, 616C, 616D or 617 of

NRS which the person knows or reasonably should know is fraudulent or

otherwise unlawful.

Sec. 18. Chapter 439 of NRS is hereby amended by adding thereto the

provisions set forth as sections 19 to 39, inclusive, of this act.

Sec. 19. As used in sections 19 to 39, inclusive, of this act, unless the

context otherwise requires, the words and terms defined in sections 20 to

25, inclusive, of this act have the meanings ascribed to them in those

sections.

Sec. 20. “Medical facility” means:

1. A hospital, as that term is defined in NRS 449.012 and 449.0151;

2. An obstetric center, as that term is defined in NRS 449.0151 and

449.0155;

3. A surgical center for ambulatory patients, as that term is defined

in NRS 449.0151 and 449.019; and

4. An independent center for emergency medical care, as that term is

defined NRS 449.013 and 449.0151.

Sec. 21. “Patient” means a person who:

1. Is admitted to a medical facility for the purpose of receiving

treatment;

2. Resides in a medical facility; or

3. Receives treatment from a provider of health care.

Sec. 22. “Patient safety officer” means a person who is designated

as such by a medical facility pursuant to section 35 of this act.

Sec. 23. “Provider of health care” means a person who is licensed,

certified or otherwise authorized by the law of this state to administer

health care in the ordinary course of the business or practice of a

profession.

Sec. 24. “Repository” means the repository for health care quality

assurance created by section 31 of this act.

Sec. 25. “Sentinel event” means an unexpected occurrence

involving death or serious physical or psychological injury or the risk

thereof, including, without limitation, any process variation for which a

recurrence would carry a significant chance of a serious adverse

outcome. The term includes loss of limb or function.

Secs. 26 and 27. (Deleted by amendment.)

Sec. 28. 1. Except as otherwise provided in subsection 2:

(a) A person who is employed by a medical facility shall, within 24

hours after becoming aware of a sentinel event that occurred at the

medical facility, notify the patient safety officer of the facility of the

sentinel event; and

(b) The patient safety officer shall, within 13 days after receiving

notification pursuant to paragraph (a), report the date, the time and a

brief description of the sentinel event to:

(1) The health division; and

(2) The representative designated pursuant to section 32 of this act,

if that person is different from the patient safety officer.

2. If the patient safety officer of a medical facility personally

discovers or becomes aware, in the absence of notification by another

employee, of a sentinel event that occurred at the medical facility, the

patient safety officer shall, within 14 days after discovering or becoming

aware of the sentinel event, report the date, time and brief description of

the sentinel event to:

(a) The health division; and

(b) The representative designated pursuant to section 32 of this act, if

that person is different from the patient safety officer.

3. The administrator shall prescribe the manner in which reports of

sentinel events must be made pursuant to this section.

Sec. 29. 1. The health division shall, to the extent of legislative

appropriation and authorization:

(a) Collect and maintain reports received pursuant to section 28 of

this act; and

(b) Ensure that such reports, and any additional documents created

from such reports, are protected adequately from fire, theft, loss,

destruction and other hazards and from unauthorized access.

2. Reports received pursuant to section 28 of this act are

confidential, not subject to subpoena or discovery and not subject to

inspection by the general public.

Sec. 30. 1. The health division shall, to the extent of legislative

appropriation and authorization, contract with a quality improvement

organization, as defined in 42 C.F.R. § 400.200, to analyze and report

trends regarding sentinel events.

2. When the health division receives notice from a medical facility

that the medical facility has taken corrective action to remedy the causes

or contributing factors, or both, of a sentinel event, the health division

shall:

(a) Make a record of the information;

(b) Ensure that the information is aggregated so as not to reveal the

identity of a specific person or medical facility; and

(c) Transmit the information to a quality improvement organization.

3. A quality improvement organization to whom information is

transmitted pursuant to subsection 2 shall, at least quarterly, report its

findings regarding the analysis of aggregated trends of sentinel events to

the repository for health care quality assurance.

Sec. 31. 1. The repository for health care quality assurance is

hereby created within the health division.

2. The repository shall, to the extent of legislative appropriation and

authorization, function as a clearinghouse of information relating to

aggregated trends of sentinel events.

Sec. 32. 1. Each medical facility that is located within this state

shall designate a representative for the notification of patients who have

been involved in sentinel events at that medical facility.

2. A representative designated pursuant to subsection 1 shall, not

later than 7 days after discovering or becoming aware of a sentinel event

that occurred at the medical facility, provide notice of that fact to each

patient who was involved in that sentinel event.

3. The provision of notice to a patient pursuant to subsection 2 must

not, in any action or proceeding, be considered an acknowledgment or

admission of liability.

4. A representative designated pursuant to subsection 1 may or may

not be the same person who serves as the facility’s patient safety officer.

Sec. 33. Any report, document and any other information compiled

or disseminated pursuant to the provisions of sections 19 to 39, inclusive,

of this act is not admissible in evidence in any administrative or legal

proceeding conducted in this state.

Sec. 34. 1. Each medical facility that is located within this state

shall develop, in consultation with the providers of health care who

provide treatment to patients at the medical facility, an internal patient

safety plan to improve the health and safety of patients who are treated at

that medical facility.

2. A medical facility shall submit its patient safety plan to the

governing board of the medical facility for approval in accordance with

the requirements of this section.

3. After a medical facility’s patient safety plan is approved, the

medical facility shall notify all providers of health care who provide

treatment to patients at the medical facility of the existence of the plan

and of the requirements of the plan. A medical facility shall require

compliance with its patient safety plan.

Sec. 35. 1. A medical facility shall designate an officer or

employee of the facility to serve as the patient safety officer of the

medical facility.

2. The person who is designated as the patient safety officer of a

medical facility shall:

(a) Serve on the patient safety committee.

(b) Supervise the reporting of all sentinel events alleged to have

occurred at the medical facility, including, without limitation, performing

the duties required pursuant to section 28 of this act.

safety of patients as a result of an investigation of any sentinel event

alleged to have occurred at the medical facility.

(d) Report to the patient safety committee regarding any action taken

in accordance with paragraph (c).

Sec. 36. 1. A medical facility shall establish a patient safety

committee.

2. Except as otherwise provided in subsection 3:

(a) A patient safety committee established pursuant to subsection 1

must be composed of:

(1) The patient safety officer of the medical facility.

(2) At least three providers of health care who treat patients at the

medical facility, including, without limitation, at least one member of the

medical, nursing and pharmaceutical staff of the medical facility.

(3) One member of the executive or governing body of the medical

facility.

(b) A patient safety committee shall meet at least once each month.

3. The administrator shall adopt regulations prescribing the

composition and frequency of meetings of patient safety committees at

medical facilities having fewer than 25 employees and contractors.

4. A patient safety committee shall:

(a) Receive reports from the patient safety officer pursuant to section

35 of this act.

(b) Evaluate actions of the patient safety officer in connection with all

reports of sentinel events alleged to have occurred at the medical facility.

medical facility to improve the safety of patients who receive treatment at

the medical facility.

(d) Make recommendations to the executive or governing body of the

medical facility to reduce the number and severity of sentinel events that

occur at the medical facility.

(e) At least once each calendar quarter, report to the executive or

governing body of the medical facility regarding:

(1) The number of sentinel events that occurred at the medical

facility during the preceding calendar quarter; and

(2) Any recommendations to reduce the number and severity of

sentinel events that occur at the medical facility.

5. The proceedings and records of a patient safety committee are

subject to the same privilege and protection from discovery as the

proceedings and records described in NRS 49.265.

Sec. 37. No person is subject to any criminal penalty or civil liability

for libel, slander or any similar cause of action in tort if he, without

malice:

1. Reports a sentinel event to a governmental entity with jurisdiction

or another appropriate authority;

2. Notifies a governmental entity with jurisdiction or another

appropriate authority of a sentinel event;

3. Transmits information regarding a sentinel event to a

governmental entity with jurisdiction or another appropriate authority;

4. Compiles, prepares or disseminates information regarding a

sentinel event to a governmental entity with jurisdiction or another

appropriate authority; or

5. Performs any other act authorized pursuant to sections 19 to 39,

inclusive, of this act.

Sec. 38. If a medical facility:

1. Commits a violation of any provision of sections 19 to 39,

inclusive, of this act or for any violation for which an administrative

sanction pursuant to NRS 449.163 would otherwise be applicable; and

2. Of its own volition, reports the violation to the

administrator,

such a violation must not be used as the basis for imposing an

administrative sanction pursuant to NRS 449.163.

Sec. 39. The administrator shall adopt such regulations as the

administrator determines to be necessary or advisable to carry out the

provisions of sections 19 to 39, inclusive, of this act.

Secs. 40-43. (Deleted by amendment.)

Sec. 44. Chapter 449 of NRS is hereby amended by adding thereto the

provisions set forth as sections 45 and 46 of this act.

Sec. 45. 1. A medical facility or any agent or employee thereof

shall not retaliate or discriminate unfairly against an employee of the

medical facility or a person acting on behalf of the employee who in good

faith:

(a) Reports to the board of medical examiners or the state board of

osteopathic medicine, as applicable, information relating to the conduct

of a physician which may constitute grounds for initiating disciplinary

action against the physician or which otherwise raises a reasonable

question regarding the competence of the physician to practice medicine

with reasonable skill and safety to patients;

(b) Reports a sentinel event to the health division pursuant to section

28 of this act; or

proceeding conducted by the board of medical examiners, the state board

of osteopathic medicine or another governmental entity relating to

conduct described in paragraph (a) or (b).

2. A medical facility or any agent or employee thereof shall not

retaliate or discriminate unfairly against an employee of the

medical facility because the employee has taken an action described in

subsection 1.

3. A medical facility or any agent or employee thereof shall not

prohibit, restrict or attempt to prohibit or restrict by contract, policy,

procedure or any other manner the right of an employee of the medical

facility to take an action described in subsection 1.

4. As used in this section:

(a) “Physician” means a person licensed to practice medicine

pursuant to chapter 630 or 633 of NRS.

(b) “Retaliate or discriminate”:

(1) Includes, without limitation, the following action if such action

is taken solely because the employee took an action described in

subsection 1:

(I) Frequent or undesirable changes in the location where the

employee works;

(II) Frequent or undesirable transfers or reassignments;

(III) The issuance of letters of reprimand, letters of admonition

or evaluations of poor performance;

(IV) A demotion;

(V) A reduction in pay;

(VI) The denial of a promotion;

(VII) A suspension;

(VIII) A dismissal;

(IX) A transfer; or

(X) Frequent changes in working hours or workdays.

(2) Does not include action described in subparagraphs (I) to (X),

inclusive, of paragraph (1) if the action is taken in the normal course of

employment or as a form of discipline.

Sec. 46. An employee of a medical facility who believes that he has

been retaliated or discriminated against in violation of section 45 of this

act may file an action in a court of competent jurisdiction for such relief

as may be appropriate under the law.

Sec. 47. Chapter 630 of NRS is hereby amended by adding thereto the

provisions set forth as sections 48 and 49 of this act.

Sec. 48. 1. A physician or any agent or employee thereof shall not

retaliate or discriminate unfairly against an employee of the physician or

a person acting on behalf of the employee who in good faith:

(a) Reports to the board information relating to the conduct of the

physician which may constitute grounds for initiating disciplinary action

against the physician or which otherwise raises a reasonable question

regarding the competence of the physician to practice medicine with

reasonable skill and safety to patients;

(b) Reports a sentinel event to the health division pursuant to section

28 of this act; or

proceeding conducted by the board or another governmental entity

relating to conduct described in paragraph (a) or (b).

2. A physician or any agent or employee thereof shall not retaliate or

discriminate unfairly against an employee of the physician because the

employee has taken an action described in subsection 1.

3. A physician or any agent or employee thereof shall not prohibit,

restrict or attempt to prohibit or restrict by contract, policy, procedure or

any other manner the right of an employee of the physician to take an

action described in subsection 1.

4. As used in this section, “retaliate or discriminate”:

(a) Includes, without limitation, the following action if such

action is taken solely because the employee took an action described in

subsection 1:

(1) Frequent or undesirable changes in the location where the

employee works;

(2) Frequent or undesirable transfers or reassignments;

(3) The issuance of letters of reprimand, letters of admonition or

evaluations of poor performance;

(4) A demotion;

(5) A reduction in pay;

(6) The denial of a promotion;

(7) A suspension;

(8) A dismissal;

(9) A transfer; or

(10) Frequent changes in working hours or workdays.

(b) Does not include action described in paragraphs (1) to (10),

inclusive, of paragraph (a) if the action is taken in the normal course of

employment or as a form of discipline.

Sec. 49. An employee of a physician who believes that he has been

retaliated or discriminated against in violation of section 48 of this act

may file an action in a court of competent jurisdiction for such relief as

may be appropriate.

Sec. 50. (Deleted by amendment.)

Sec. 51. NRS 630.130 is hereby amended to read as follows:

630.130 1. In addition to the other powers and duties provided in this

chapter, the board shall:

(a) Enforce the provisions of this chapter;

(b) Establish by regulation standards for licensure under this chapter;

scoring for those examinations;

(d) Investigate the character of each applicant for a license and issue

licenses to those applicants who meet the qualifications set by this chapter

and the board; and

(e) Institute a proceeding in any court to enforce its orders or the

provisions of this chapter.

2. On or before February 15 of each odd-numbered year, the board

shall submit to the governor and to the director of the legislative counsel

bureau for transmittal to the next regular session of the legislature a

written report compiling:

(a) Disciplinary action taken by the board during the previous

biennium against physicians for malpractice or negligence; and

(b) Information reported to the board during the previous biennium

pursuant to NRS 630.3067, subsections 2 and 3 of NRS 630.307 and

NRS 690B.045.

The report must include only aggregate information for statistical

purposes and exclude any identifying information related to a particular

person.

3. The board may adopt such regulations as are necessary or desirable

to enable it to carry out the provisions of this chapter.

Sec. 52. NRS 630.267 is hereby amended to read as follows:

630.267 1. Each holder of a license to practice medicine must, on or

before July 1 of each alternate year:

(a) Submit the statement required pursuant to NRS 630.197; [and]

(b) Submit a list of all actions filed or claims submitted to arbitration

or mediation for malpractice or negligence against him during the

previous 2 years; and

biennial registration. This fee must be collected for the period for which a

physician is licensed.

2. When a holder of a license fails to pay the fee for biennial

registration and submit the statement required pursuant to NRS 630.197

after they become due, his license to practice medicine in this state is

automatically suspended. The holder may, within 2 years after the date his

license is suspended, upon payment of twice the amount of the current fee

for biennial registration to the secretary-treasurer and submission of the

statement required pursuant to NRS 630.197 and after he is found to be in

good standing and qualified under the provisions of this chapter, be

reinstated to practice.

3. The board shall make such reasonable attempts as are practicable to

notify a licensee:

(a) At least once that his fee for biennial registration and the statement

required pursuant to NRS 630.197 are due; and

(b) That his license is suspended.

A copy of this notice must be sent to the Drug Enforcement Administration

of the United States Department of Justice or its successor agency.

Sec. 53. NRS 630.3062 is hereby amended to read as follows:

630.3062 The following acts, among others, constitute grounds for

initiating disciplinary action or denying licensure:

1. Failure to maintain timely, legible, accurate and complete medical

records relating to the diagnosis, treatment and care of a patient.

2. Altering medical records of a patient.

3. Making or filing a report which the licensee knows to be false,

failing to file a record or report as required by law or willfully obstructing

or inducing another to obstruct such filing.

4. Failure to make the medical records of a patient available for

inspection and copying as provided in NRS 629.061.

5. Failure to [report any claim for malpractice or negligence filed

against the licensee and the subsequent disposition thereof within 90 days

after the:

(a) Claim is filed; and

(b) Disposition of the claim.] comply with the requirements of

NRS 630.3067.

6. Failure to report any person the licensee knows, or has reason to

know, is in violation of the provisions of this chapter or the regulations of

the board.

Sec. 54. NRS 630.3067 is hereby amended to read as follows:

630.3067 [Under the provisions of NRS 690B.045, the]

1. The insurer of a physician licensed under this chapter and the

physician must report to the board any action filed or claim submitted to

arbitration or mediation for malpractice or negligence against the

physician and the settlement, award, judgment or other disposition

[thereof.] of the action or claim within 30 days after:

(a) The action was filed or the claim was submitted to arbitration or

mediation; and

(b) The disposition of the action or claim.

2. The board shall report any failure to comply with subsection 1 by

an insurer licensed in this state to the division of insurance of the

department of business and industry. If, after a hearing, the division of

insurance determines that any such insurer failed to comply with the

requirements of subsection 1, the division may impose an administrative

fine of not more than $10,000 against the insurer for each such failure to

report. If the administrative fine is not paid when due, the fine must be

recovered in a civil action brought by the attorney general on behalf of

the division.

Sec. 55. NRS 630.307 is hereby amended to read as follows:

630.307 1. Any person, medical school or medical facility that

becomes aware that a person practicing medicine or respiratory care in this

state has, is or is about to become engaged in conduct which constitutes

grounds for initiating disciplinary action shall [forthwith] file a written

complaint with the board[.] within 30 days after becoming aware of the

conduct.

2. Any hospital, clinic or other medical facility licensed in this state, or

medical society, shall [forthwith] report to the board any change in a

physician’s privileges to practice medicine while the physician is under

investigation and the outcome of any disciplinary action taken by that

facility or society against the physician concerning the care of a patient or

the competency of the physician[.] within 30 days after the change in

privileges is made or disciplinary action is taken. The board shall report

any failure to comply with this subsection by a hospital, clinic or other

medical facility licensed in this state to the health division of the

department of human resources. If, after a hearing, the health division

determines that any such facility or society failed to comply with the

requirements of this subsection, the division may impose an

administrative fine of not more than $10,000 against the facility or

society for each such failure to report. If the administrative fine is not

paid when due, the fine must be recovered in a civil action brought by the

attorney general on behalf of the division.

3. The clerk of every court shall [forthwith] report to the board any

finding, judgment or other determination of the court that a physician,

physician assistant or practitioner of respiratory care:

(a) Is mentally ill;

(b) Is mentally incompetent;

substances or dangerous drugs;

(d) Is guilty of abuse or fraud under any state or federal program

providing medical assistance; or

(e) Is liable for damages for malpractice or negligence[.] ,

within 45 days after such a finding, judgment or determination is made.

4. On or before January 15 of each year, the clerk of each court

shall submit to the office of court administrator created pursuant to NRS

1.320 a written report compiling the information that the clerk reported

during the previous year to the board regarding physicians pursuant to

paragraph (e) of subsection 3.

Sec. 56. NRS 630.364 is hereby amended to read as follows:

630.364 1. Any person or organization who furnishes information

concerning an applicant for a license or a licensee in good faith and

without malicious intent in accordance with the provisions of this chapter

is immune from any civil action for furnishing that information.

2. The board and any of its members and its staff, counsel,

investigators, experts, committees, panels, hearing officers and consultants

are immune from any civil liability for:

(a) Any decision or action taken in good faith and without malicious

intent in response to information acquired by the board.

(b) Disseminating information concerning an applicant for a license or a

licensee to other boards or agencies of the state, the attorney general, any

hospitals, medical societies, insurers, employers, patients and their families

or any law enforcement agency.

[3. A screening panel or any of its members, acting pursuant to NRS

41A.003 to 41A.069, inclusive, that initiates or assists in any proceeding

concerning a claim of malpractice against a physician is immune from any

civil action for that initiation or assistance or any consequential damages, if

the panel or members acted without malicious intent.]

Sec. 57. (Deleted by amendment.)

Sec. 58. Chapter 633 of NRS is hereby amended by adding thereto the

provisions set forth as sections 62, 63 and 64 of this act.

Sec. 59. 1. An osteopathic physician or any agent or employee

thereof shall not retaliate or discriminate unfairly against an employee of

the osteopathic physician or a person acting on behalf of the employee

who in good faith:

(a) Reports to the board information relating to the conduct of the

osteopathic physician which may constitute grounds for initiating

disciplinary action against the osteopathic physician or which otherwise

raises a reasonable question regarding the competence of the osteopathic

physician to practice medicine with reasonable skill and safety to

patients;

(b) Reports a sentinel event to the health division pursuant to section

28 of this act; or

proceeding conducted by the board or another governmental entity

relating to conduct described in paragraph (a) or (b).

2. An osteopathic physician or any agent or employee thereof shall

not retaliate or discriminate unfairly against an employee of the

osteopathic physician because the employee has taken an action

described in subsection 1.

3. An osteopathic physician or any agent or employee thereof shall

not prohibit, restrict or attempt to prohibit or restrict by contract, policy,

procedure or any other manner the right of an employee of the

osteopathic physician to take an action described in subsection 1.

4. As used in this section, “retaliate or discriminate”:

(a) Includes, without limitation, the following action if such

action is taken solely because the employee took an action described in

subsection 1:

(1) Frequent or undesirable changes in the location where the

employee works;

(2) Frequent or undesirable transfers or reassignments;

(3) The issuance of letters of reprimand, letters of admonition or

evaluations of poor performance;

(4) A demotion;

(5) A reduction in pay;

(6) The denial of a promotion;

(7) A suspension;

(8) A dismissal;

(9) A transfer; or

(10) Frequent changes in working hours or workdays.

(b) Does not include action described in paragraphs (1) to (10),

inclusive, of paragraph (a) if the action is taken in the normal course of

employment or as a form of discipline.

Sec. 60. An employee of an osteopathic physician who believes that

he has been retaliated or discriminated against in violation of section 59

of this act may file an action in a court of competent jurisdiction for such

relief as may be appropriate under the law.

Sec. 61. (Deleted by amendment.)

Sec. 62. 1. On or before February 15 of each odd-numbered year,

the board shall submit to the governor and to the director of the

legislative counsel bureau for transmittal to the next regular session of

the legislature a written report compiling:

(a) Disciplinary action taken by the board during the previous

biennium against osteopathic physicians for malpractice or negligence;

and

(b) Information reported to the board during the previous biennium

pursuant to NRS 690B.045, section 63 of this act and subsections 2 and 3

of section 64 of this act.

2. The report must include only aggregate information for statistical

purposes and exclude any identifying information related to a particular

person.

Sec. 63. 1. The insurer of an osteopathic physician licensed under

this chapter and the osteopathic physician must report to the board any

action filed or claim submitted to arbitration or mediation for

malpractice or negligence against the osteopathic physician and the

settlement, award, judgment or other disposition of the action or claim

within 30 days after: