(REPRINTED WITH ADOPTED AMENDMENTS)

 

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

 

July 30, 2002

________________________

 

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

 

Referred to Committee on Medical Malpractice Issues

 

SUMMARY—Makes various changes related to medical and dental malpractice. (BDR 3‑17)

 

FISCAL NOTE:                     Effect on Local Government: No.

                             Effect on the State: No.

 

~

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

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:

 

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

1-2  new section to read as follows:

1-3    1.  Except as otherwise provided in subsection 2 and NRS 41.505:

1-4    (a) A hospital which has been designated as a center for the treatment

1-5  of trauma by the administrator of the health division of the department of

1-6  human resources pursuant to NRS 450B.237 and which is a nonprofit

1-7  organization;

1-8    (b) A hospital other than a hospital described in paragraph (a);

1-9    (c) An employee of a hospital described in paragraph (a) or (b) who

1-10  renders care or assistance to patients;

1-11  (d) A physician or dentist licensed under the provisions of chapter

1-12  630, 631 or 633 of NRS who renders care or assistance in a hospital

1-13  described in paragraph (a) or (b), whether or not the care or assistance

1-14  was rendered gratuitously or for a fee; and

1-15  (e) A physician or dentist licensed under the provisions of chapter

1-16  630, 631 or 633 of NRS:

1-17      (1) Whose liability is not otherwise limited pursuant to NRS 41.032

1-18  to 41.0337, inclusive; and

1-19      (2) Who renders care or assistance in a hospital of a governmental

1-20  entity that has been designated as a center for the treatment of trauma by

1-21  the administrator of the health division of the department of human

1-22  resources pursuant to NRS 450B.237, whether or not the care or

1-23  assistance was rendered gratuitously or for a fee,

1-24  that in good faith renders care or assistance necessitated by a traumatic

1-25  injury demanding immediate medical attention, for which the patient

1-26  enters the hospital through its emergency room or trauma center, may

1-27  not be held liable for more than $50,000 in civil damages, exclusive of

1-28  interest computed from the date of judgment, to or for the benefit of any

1-29  claimant arising out of any act or omission in rendering that care or

1-30  assistance if the care or assistance is rendered in good faith and in a

1-31  manner not amounting to gross negligence or reckless, willful or wanton

1-32  conduct.

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

1-33  not apply to any act or omission in rendering care or assistance:

1-34  (a) Which occurs after the patient is stabilized and is capable of

1-35  receiving medical treatment as a nonemergency patient, unless surgery is

1-36  required as a result of the emergency within a reasonable time after the

1-37  patient is stabilized, in which case the limitation on liability provided by

1-38  subsection 1 applies to any act or omission in rendering care or

1-39  assistance which occurs before the stabilization of the patient following

1-40  the surgery; or

1-41  (b) Unrelated to the original traumatic injury.

1-42  3.  If:

1-43  (a) A physician or dentist  provides follow-up care to a patient to

1-44  whom he rendered care or assistance pursuant to subsection 1;

1-45  (b) A medical condition arises during the course of the follow-up care

1-46  that is directly related to the original traumatic injury for which care or

1-47  assistance was rendered pursuant to subsection 1; and

1-48  (c) The patient files an action for malpractice based on the medical

1-49  condition that arises during the course of the follow-up care,

1-50  there is a rebuttable presumption that the medical condition was the

1-51  result of the original traumatic injury and that the limitation on liability

1-52  provided by subsection 1 applies with respect to the medical condition

1-53  that arises during the course of the follow-up care.

1-54  4.  For the purposes of this section:

1-55  (a) “Reckless, willful or wanton conduct,” as it applies to a person to

1-56  whom subsection 1 applies, shall be deemed to be that conduct which the

1-57  person knew or should have known at the time he rendered the care or

1-58  assistance would be likely to result in injury so as to affect the life or

1-59  health of another person, taking into consideration to the extent

1-60  applicable:

1-61      (1) The extent or serious nature of the prevailing circumstances;

1-62      (2) The lack of time or ability to obtain appropriate consultation;

1-63      (3) The lack of a prior medical relationship with the patient;

1-64      (4) The inability to obtain an appropriate medical history of the

1-65  patient; and

1-66      (5) The time constraints imposed by coexisting emergencies.

1-67  (b) “Traumatic injury” means any acute injury which, according to

1-68  standardized criteria for triage in the field, involves a significant risk of

1-69  death or the precipitation of complications or disabilities.

1-70  Sec. 1.5.  NRS 41.505 is hereby amended to read as follows:

1-71  41.505  1.  Any physician or registered nurse who in good faith gives

1-72  instruction or provides supervision to an emergency medical attendant or

1-73  registered nurse, at the scene of an emergency or while transporting an ill

1-74  or injured person from the scene of an emergency, is not liable for any civil

1-75  damages as a result of any act or omission, not amounting to gross

1-76  negligence, in giving that instruction or providing that supervision. An

1-77  emergency medical attendant, registered nurse or licensed practical nurse

1-78  who obeys an instruction given by a physician, registered nurse or licensed

1-79  practical nurse and thereby renders emergency care, at the scene of an

1-80  emergency or while transporting an ill or injured person from the scene of

2-1  an emergency, is not liable for any civil damages as a result of any act or

2-2  omission, not amounting to gross negligence, in rendering that emergency

2-3  care.

2-4    2.  Except as otherwise provided in subsection 3, any person licensed

2-5  under the provisions of chapter 630, 632 or 633 of NRS and any person

2-6  who holds an equivalent license issued by another state, who renders

2-7  emergency care or assistance in an emergency, gratuitously and in good

2-8  faith, is not liable for any civil damages as a result of any act or omission,

2-9  not amounting to gross negligence, by him in rendering the emergency care

2-10  or assistance or as a result of any failure to act, not amounting to gross

2-11  negligence, to provide or arrange for further medical treatment for the

2-12  injured or ill person. This section does not excuse a physician or nurse

2-13  from liability for damages resulting from his acts or omissions which occur

2-14  in a licensed medical facility relative to any person with whom there is a

2-15  preexisting relationship as a patient.

2-16  3.  Any person licensed under the provisions of chapter 630, 632 or 633

2-17  of NRS and any person who holds an equivalent license issued by another

2-18  state who renders emergency obstetrical care or assistance to a pregnant

2-19  woman during labor or the delivery of the child is not liable for any civil

2-20  damages as a result of any act or omission by him in rendering that care or

2-21  assistance if:

2-22  (a) The care or assistance is rendered in good faith and in a manner not

2-23  amounting to gross negligence or reckless, willful or wanton conduct;

2-24  (b) The person has not previously provided prenatal or obstetrical care

2-25  to the woman; and

2-26  (c) The damages are reasonably related to or primarily caused by a lack

2-27  of prenatal care received by the woman.

2-28  A licensed medical facility in which such care or assistance is rendered is

2-29  not liable for any civil damages as a result of any act or omission by the

2-30  person in rendering that care or assistance if that person is not liable for

2-31  any civil damages pursuant to this subsection and the actions of the

2-32  medical facility relating to the rendering of that care or assistance do not

2-33  amount to gross negligence or reckless, willful or wanton conduct.

2-34  4.  Any person licensed under the provisions of chapter 630, 632 or 633

2-35  of NRS and any person who holds an equivalent license issued by another

2-36  state who:

2-37  (a) Is retired or otherwise does not practice on a full-time basis; and

2-38  (b) Gratuitously and in good faith, renders medical care within the

2-39  scope of his license to an indigent person,

2-40  is not liable for any civil damages as a result of any act or omission by him,

2-41  not amounting to gross negligence or reckless, willful or wanton conduct,

2-42  in rendering that care.

2-43  5.  Any person licensed to practice medicine under the provisions of

2-44  chapter 630 or 633 of NRS or licensed to practice dentistry under the

2-45  provisions of chapter 631 of NRS who renders care or assistance to a

2-46  patient at a health care facility of a governmental entity or a nonprofit

2-47  organization is not liable for any civil damages as a result of any act or

2-48  omission by him in rendering that care or assistance if the care or

3-1  assistance is rendered gratuitously, in good faith and in a manner not

3-2  amounting to gross negligence or reckless, willful or wanton conduct.

3-3    6.  As used in this section:

3-4    (a) “Emergency medical attendant” means a person licensed as an

3-5  attendant or certified as an emergency medical technician, intermediate

3-6  emergency medical technician or advanced emergency medical technician

3-7  pursuant to chapter 450B of NRS.

3-8    (b) “Gratuitously” has the meaning ascribed to it in NRS 41.500.

3-9    (c) “Health care facility” has the meaning ascribed to it in

3-10  NRS 449.800.

3-11  Sec. 2. Chapter 41A of NRS is hereby amended by adding thereto the

3-12  provisions set forth as sections 3 to 9, inclusive, of this act.

3-13  Sec. 3.  “Economic damages” includes damages for medical

3-14  treatment, care or custody, loss of earnings and loss of earning capacity.

3-15  Sec. 4.  “Noneconomic damages” includes damages to compensate

3-16  for pain, suffering, inconvenience, physical impairment, disfigurement

3-17  and other nonpecuniary damages.

3-18  Sec. 5.  1.  Except as otherwise provided in subsection 2 and except

3-19  as further limited in subsection 3, in an action for damages for medical

3-20  malpractice or dental malpractice, the noneconomic damages awarded to

3-21  each plaintiff from each defendant must not exceed $350,000.

3-22  2.  In an action for damages for medical malpractice or dental

3-23  malpractice, the limitation on noneconomic damages set forth in

3-24  subsection 1 does not apply in the following circumstances and types of

3-25  cases:

3-26  (a) A case in which the conduct of the defendant is determined to

3-27  constitute gross malpractice; or

3-28  (b) A case in which, following return of a verdict by the jury or a

3-29  finding of damages in a bench trial, the court determines, by clear and

3-30  convincing evidence admitted at trial, that an award in excess of

3-31  $350,000 for noneconomic damages is justified because of exceptional

3-32  circumstances.

3-33  3.  Except as otherwise provided in subsection 4, in an action for

3-34  damages for medical malpractice or dental malpractice, in the

3-35  circumstances and types of cases described in subsections 1 and 2, the

3-36  noneconomic damages awarded to each plaintiff from each defendant

3-37  must not exceed the amount of money remaining under the professional

3-38  liability insurance policy limit covering the defendant after subtracting

3-39  the economic damages awarded to that plaintiff. Irrespective of the

3-40  number of plaintiffs in the action, in no event may any single defendant

3-41  be liable to the plaintiffs in the aggregate in excess of the professional

3-42  liability insurance policy limit covering that defendant.

3-43  4.  The limitation set forth in subsection 3 does not apply in an action

3-44  for damages for medical malpractice or dental malpractice unless the

3-45  defendant was covered by professional liability insurance at the time of

3-46  the occurrence of the alleged malpractice and on the date on which the

3-47  insurer receives notice of the claim, in an amount of:

3-48  (a) Not less than $1,000,000 per occurrence; and

3-49  (b) Not less than $3,000,000 in the aggregate.

4-1    5.  This section is not intended to limit the responsibility of any

4-2  defendant for the total economic damages awarded.

4-3    6.  For the purposes of this section, “gross malpractice” means

4-4  failure to exercise the required degree of care, skill or knowledge that

4-5  amounts to:

4-6    (a) A conscious indifference to the consequences which may result

4-7  from the gross malpractice; and

4-8    (b) A disregard for and indifference to the safety and welfare of the

4-9  patient.

4-10  Sec. 6.  1.  In an action for damages for medical malpractice, each

4-11  defendant is liable for noneconomic damages severally only, and not

4-12  jointly, to the plaintiff only for that portion of the judgment which

4-13  represents the percentage of negligence attributable to the defendant.

4-14  2.  As used in this section, “medical malpractice” means the failure

4-15  of a physician, hospital, employee of a hospital, certified nurse midwife

4-16  or certified registered nurse anesthetist in rendering services to use the

4-17  reasonable care, skill or knowledge ordinarily used under similar

4-18  circumstances.

4-19  Sec. 7.  1.  Upon the motion of any party or upon its own motion,

4-20  unless good cause is shown for the delay, the court shall, after due notice

4-21  to the parties, dismiss an action involving medical malpractice or dental

4-22  malpractice if the action is not brought to trial within:

4-23  (a) Three years after the date on which the action is filed, if the action

4-24  is filed on or after October 1, 2002, but before October 1, 2005.

4-25  (b) Two years after the date on which the action is filed, if the action

4-26  is filed on or after October 1, 2005.

4-27  2.  Dismissal of an action pursuant to subsection 1 is a bar to the

4-28  filing of another action upon the same claim for relief against the same

4-29  defendants.

4-30  3.  Each district court shall adopt court rules to expedite the

4-31  resolution of an action involving medical malpractice or dental

4-32  malpractice.

4-33  Sec. 8.  If an action for medical malpractice or dental malpractice is

4-34  filed in the district court, the district court shall dismiss the action,

4-35  without prejudice, if the action is filed without an affidavit, supporting

4-36  the allegations contained in the action, submitted by a medical expert

4-37  who practices or has practiced in an area that is substantially similar to

4-38  the type of practice engaged in at the time of the alleged malpractice.

4-39  Sec. 9.  1.  In an action for medical malpractice or dental

4-40  malpractice, all the parties to the action, the insurers of the respective

4-41  parties and the attorneys of the respective parties shall attend and

4-42  participate in a settlement conference before a district judge, other than

4-43  the judge assigned to the action, to ascertain whether the action may be

4-44  settled by the parties before trial.

4-45  2.  The judge before whom the settlement conference is held:

4-46  (a) May, for good cause shown, waive the attendance of any party.

4-47  (b) Shall decide what information the parties may submit at the

4-48  settlement conference.

5-1    3.  The judge shall notify the parties of the time and place of the

5-2  settlement conference.

5-3    4.  The failure of any party, his insurer or his attorney to participate

5-4  in good faith in the settlement conference is grounds for sanctions

5-5  against the party or his attorney, or both.

5-6    Sec. 10.  NRS 41A.003 is hereby amended to read as follows:

5-7    41A.003  As used in this chapter, unless the context otherwise requires,

5-8  the words and terms defined in NRS 41A.004 [to 41A.013, inclusive,] ,

5-9  41A.009 and 41A.013 and sections 3 and 4 of this act have the meanings

5-10  ascribed to them in those sections.

5-11  Sec. 11.  NRS 41A.097 is hereby amended to read as follows:

5-12  41A.097  1.  Except as otherwise provided in subsection [2,] 3, an

5-13  action for injury or death against a provider of health care may not be

5-14  commenced more than 4 years after the date of injury or 2 years after the

5-15  plaintiff discovers or through the use of reasonable diligence should have

5-16  discovered the injury, whichever occurs first, for:

5-17  (a) Injury to or the wrongful death of a person[,] occurring before

5-18  October 1, 2002, based upon alleged professional negligence of the

5-19  provider of health care;

5-20  (b) Injury to or the wrongful death of a person occurring before

5-21  October 1, 2002, from professional services rendered without consent; or

5-22  (c) Injury to or the wrongful death of a person occurring before

5-23  October 1, 2002, from error or omission in practice by the provider of

5-24  health care.

5-25  2.  Except as otherwise provided in subsection 3, an action for injury

5-26  or death against a provider of health care may not be commenced more

5-27  than 3 years after the date of injury or 2 years after the plaintiff discovers

5-28  or through the use of reasonable diligence should have discovered the

5-29  injury, whichever occurs first, for:

5-30  (a) Injury to or the wrongful death of a person occurring on or after

5-31  October 1, 2002, based upon alleged professional negligence of the

5-32  provider of health care;

5-33  (b) Injury to or the wrongful death of a person occurring on or after

5-34  October 1, 2002, from professional services rendered without consent; or

5-35  (c) Injury to or the wrongful death of a person occurring on or after

5-36  October 1, 2002, from error or omission in practice by the provider of

5-37  health care.

5-38  3.  This time limitation is tolled[:

5-39  (a) For] for any period during which the provider of health care has

5-40  concealed any act, error or omission upon which the action is based and

5-41  which is known or through the use of reasonable diligence should have

5-42  been known to him.

5-43  [(b) In any action governed by the provisions of NRS 41A.003 to

5-44  41A.069, inclusive, from the date a claimant files a complaint for review

5-45  by a screening panel until 30 days after the date the panel notifies the

5-46  claimant, in writing, of its findings. The provisions of this paragraph apply

5-47  to an action against the provider of health care and to an action against any

5-48  person, government or political subdivision of a government who is alleged

5-49  by the claimant to be liable vicariously for the medical or dental

6-1  malpractice of the provider of health care, if the provider, person,

6-2  government or political subdivision has received notice of the filing of a

6-3  complaint for review by a screening panel within the limitation of time

6-4  provided in subsection 1.

6-5    3.] 4.  For the purposes of this section, the parent, guardian or legal

6-6  custodian of any minor child is responsible for exercising reasonable

6-7  judgment in determining whether to prosecute any cause of action limited

6-8  by subsection 1[.] or 2. If the parent, guardian or custodian fails to

6-9  commence an action on behalf of that child within the prescribed period of

6-10  limitations, the child may not bring an action based on the same alleged

6-11  injury against any provider of health care upon the removal of his

6-12  disability, except that in the case of:

6-13  (a) Brain damage or birth defect, the period of limitation is extended

6-14  until the child attains 10 years of age.

6-15  (b) Sterility, the period of limitation is extended until 2 years after the

6-16  child discovers the injury.

6-17  [4.] 5.  As used in this section, “provider of health care” means a

6-18  physician licensed under chapter 630 or 633 of NRS, dentist, registered

6-19  nurse, dispensing optician, optometrist, registered physical therapist,

6-20  podiatric physician, licensed psychologist, chiropractor, doctor of Oriental

6-21  medicine, medical laboratory director or technician, or a licensed hospital

6-22  as the employer of any such person.

6-23  Sec. 12.  NRS 41A.100 is hereby amended to read as follows:

6-24  41A.100  1.  Liability for personal injury or death is not imposed upon

6-25  any provider of medical care based on alleged negligence in the

6-26  performance of that care unless evidence consisting of expert medical

6-27  testimony, material from recognized medical texts or treatises or the

6-28  regulations of the licensed medical facility wherein the alleged negligence

6-29  occurred is presented to demonstrate the alleged deviation from the

6-30  accepted standard of care in the specific circumstances of the case and to

6-31  prove causation of the alleged personal injury or death, except that such

6-32  evidence is not required and a rebuttable presumption that the personal

6-33  injury or death was caused by negligence arises where evidence is

6-34  presented that the personal injury or death occurred in any one or more of

6-35  the following circumstances:

6-36  (a) A foreign substance other than medication or a prosthetic device was

6-37  unintentionally left within the body of a patient following surgery;

6-38  (b) An explosion or fire originating in a substance used in treatment

6-39  occurred in the course of treatment;

6-40  (c) An unintended burn caused by heat, radiation or chemicals was

6-41  suffered in the course of medical care;

6-42  (d) An injury was suffered during the course of treatment to a part of the

6-43  body not directly involved in the treatment or proximate thereto; or

6-44  (e) A surgical procedure was performed on the wrong patient or the

6-45  wrong organ, limb or part of a patient’s body.

6-46  2.  Expert medical testimony provided pursuant to subsection 1 may

6-47  only be given by a provider of medical care who practices or has

6-48  practiced in an area that is substantially similar to the type of practice

6-49  engaged in at the time of the alleged negligence.

7-1    3. As used in this section, “provider of medical care” means a

7-2  physician, dentist, registered nurse or a licensed hospital as the employer of

7-3  any such person.

7-4    Sec. 13. NRS 42.020 is hereby amended to read as follows:

7-5    42.020  1.  Except as otherwise provided in subsection 2, in any action

7-6  for damages for medical malpractice, the amount of damages, if any,

7-7  awarded in the action must be reduced by the amount of any prior payment

7-8  made by or on behalf of the provider of health care against whom the

7-9  action is brought to the injured person or to the claimant to meet reasonable

7-10  expenses of medical care, other essential goods or services or reasonable

7-11  living expenses.

7-12  2.  In any action described in subsection 1 in which liability for medical

7-13  malpractice is established or admitted, the court shall, before the entry of

7-14  judgment, hold a separate hearing to determine if any expenses incurred by

7-15  the claimant for medical care, loss of income or other financial loss have

7-16  been paid or reimbursed as a benefit from a collateral source. If the court

7-17  determines that a claimant has received such a benefit, the court shall

7-18  reduce the amount of damages, if any, awarded in the action by the amount

7-19  of the benefit. The amount so reduced must not include any amount for

7-20  which there is a right of subrogation to the rights of the claimant if the right

7-21  of subrogation is exercised by serving a notice of lien on the claimant

7-22  before the settlement of or the entry of judgment in the action. Notice of

7-23  the action must be provided by the claimant to any statutory holder of a

7-24  lien.

7-25  3.  If future economic damages are awarded in an action for medical

7-26  malpractice, the [award must be paid, at the election of the claimant:] court

7-27  may, at the request of the claimant, order the award to be paid:

7-28  (a) In a lump sum which has been reduced to its present value as

7-29  determined by the trier of fact and approved by the court; or

7-30  (b) Subject to the provisions of [subsection 5,] subsections 5 and 6 and

7-31  the discretion of the court, in periodic payments either by an annuity

7-32  purchased to provide periodic payments[.] or by other means if the

7-33  defendant posts an adequate bond or other security to ensure full

7-34  payment by periodic payments of the damages awarded by the

7-35  judgment.

7-36  As used in this subsection, “future economic damages” includes damages

7-37  for future medical treatment, care or custody, and loss of future earnings.

7-38  4.  If the claimant [elects to receive] receives periodic payments

7-39  pursuant to paragraph (b) of subsection 3, the award must not be reduced to

7-40  its present value. The amount of the periodic payments must be equal to the

7-41  total amount of all future damages awarded by the trier of fact and

7-42  approved by the court. The period for which the periodic payments must be

7-43  made must be determined by the trier of fact and approved by the court.

7-44  Before the entry of judgment, each party shall submit to the court a plan

7-45  specifying the recipient of the payments, the amount of the payments and a

7-46  schedule of periodic payments for the award. Upon receipt and review of

7-47  the plans, the court shall specify in its judgment rendered in the action the

7-48  recipient of the payments, the amount of the payments and a schedule of

7-49  payments for the award.

8-1    5.  If an annuity is purchased pursuant to paragraph (b) of subsection 3,

8-2  the claimant shall select the provider of the annuity. Upon purchase of the

8-3  annuity, the claimant shall:

8-4    (a) Execute a satisfaction of judgment or a stipulation for dismissal of

8-5  the claim with prejudice; and

8-6    (b) Release forever the defendant and his insurer, if any, from any

8-7  obligation to make periodic payments pursuant to the award.

8-8    6.  If the defendant posts a bond or other security pursuant to

8-9  paragraph (b) of subsection 3, upon termination of the payment of

8-10  periodic payments of damages, the court shall order the return of the

8-11  bond or other security, or as much as remains, to the defendant.

8-12  7.  As used in this section:

8-13  (a) “Benefit from a collateral source” means any money, service or

8-14  other benefit which is paid or provided or is reasonably likely to be paid or

8-15  provided to a claimant for personal injury or wrongful death pursuant to:

8-16      (1) A state or federal act which provides benefits for sickness,

8-17  disability, accidents, loss of income or workers’ compensation;

8-18      (2) A policy of insurance which provides health benefits or coverage

8-19  for loss of income;

8-20      (3) A contract of any group, organization, partnership or corporation

8-21  which provides, pays or reimburses the cost of medical, hospital or dental

8-22  benefits or benefits for loss of income; or

8-23      (4) Any other publicly or privately funded program which provides

8-24  such benefits.

8-25  (b) “Medical malpractice” has the meaning ascribed to it in

8-26  NRS 41A.009.

8-27  Sec. 14.  NRS 1.360 is hereby amended to read as follows:

8-28  1.360  Under the direction of the supreme court, the court administrator

8-29  shall:

8-30  1.  Examine the administrative procedures employed in the offices of

8-31  the judges, clerks, court reporters and employees of all courts of this state

8-32  and make recommendations, through the chief justice, for the improvement

8-33  of those procedures;

8-34  2.  Examine the condition of the dockets of the courts and determine

8-35  the need for assistance by any court;

8-36  3.  Make recommendations to and carry out the directions of the chief

8-37  justice relating to the assignment of district judges where district courts are

8-38  in need of assistance;

8-39  4.  Develop a uniform system for collecting and compiling statistics

8-40  and other data regarding the operation of the state court system and

8-41  transmit that information to the supreme court so that proper action may be

8-42  taken in respect thereto;

8-43  5.  Prepare and submit a budget of state appropriations necessary for

8-44  the maintenance and operation of the state court system and make

8-45  recommendations in respect thereto;

8-46  6.  Develop procedures for accounting, internal auditing, procurement

8-47  and disbursement for the state court system;

9-1    7.  Collect statistical and other data and make reports relating to the

9-2  expenditure of all public money for the maintenance and operation of the

9-3  state court system and the offices connected therewith;

9-4    8.  Compile statistics from the information required to be maintained

9-5  by the clerks of the district courts pursuant to NRS 3.275 and make reports

9-6  as to the cases filed in the district courts;

9-7    9.  Formulate and submit to the supreme court recommendations of

9-8  policies or proposed legislation for the improvement of the state court

9-9  system;

9-10  10.  On or before January 1 of each year, submit to the director of the

9-11  legislative counsel bureau a written report compiling the information

9-12  submitted to the court administrator pursuant to NRS 3.243, 4.175 and

9-13  5.045 during the immediately preceding fiscal year; [and]

9-14  11.  On or before February 15 of each odd-numbered year, submit to

9-15  the governor and to the director of the legislative counsel bureau for

9-16  transmittal to the next regular session of the legislature a written report

9-17  compiling the information submitted by clerks of courts to the court

9-18  administrator pursuant to NRS 630.307 and section 64 of this act which

9-19  includes only aggregate information for statistical purposes and excludes

9-20  any identifying information related to a particular person; and

9-21  12.  Attend to such other matters as may be assigned by the supreme

9-22  court or prescribed by law.

9-23  Sec. 15.  Chapter 3 of NRS is hereby amended by adding thereto a new

9-24  section to read as follows:

9-25  The supreme court shall provide by court rule for mandatory

9-26  appropriate training concerning the complex issues of medical

9-27  malpractice litigation for each district judge to whom actions involving

9-28  medical malpractice are assigned.

9-29  Sec. 16.  NRS 7.085 is hereby amended to read as follows:

9-30  7.085  If a court finds that an attorney has:

9-31  1.  Filed, maintained or defended a civil action or proceeding in any

9-32  court in this state and such action or defense is not well-grounded in fact or

9-33  is not warranted by existing law or by an argument for changing the

9-34  existing law that is made in good faith; or

9-35  2.  Unreasonably and vexatiously extended a civil action or proceeding

9-36  before any court in this state,

9-37  the court [may] shall require the attorney personally to pay the additional

9-38  costs, expenses and attorney’s fees reasonably incurred because of such

9-39  conduct.

9-40  Sec. 17.  NRS 49.245 is hereby amended to read as follows:

9-41  49.245  There is no privilege under NRS 49.225 or 49.235:

9-42  1.  For communications relevant to an issue in proceedings to

9-43  hospitalize the patient for mental illness, if the doctor in the course of

9-44  diagnosis or treatment has determined that the patient is in need of

9-45  hospitalization.

9-46  2.  As to communications made in the course of a court-ordered

9-47  examination of the condition of a patient with respect to the particular

9-48  purpose of the examination unless the court orders otherwise.

10-1  3.  As to written medical or hospital records relevant to an issue of the

10-2  condition of the patient in any proceeding in which the condition is an

10-3  element of a claim or defense.

10-4  4.  In a prosecution or mandamus proceeding under chapter 441A of

10-5  NRS.

10-6  5.  As to any information communicated to a physician in an effort

10-7  unlawfully to procure a dangerous drug or controlled substance, or

10-8  unlawfully to procure the administration of any such drug or substance.

10-9  6.  As to any written medical or hospital records which are furnished in

10-10  accordance with the provisions of NRS 629.061.

10-11  7.  As to records that are required by chapter 453 of NRS to be

10-12  maintained.

10-13  8.  [In a review before a screening panel pursuant to NRS 41A.003 to

10-14  41A.069, inclusive.

10-15  9.] If the services of the physician are sought or obtained to enable or

10-16  aid a person to commit or plan to commit fraud or any other unlawful act in

10-17  violation of any provision of chapter 616A, 616B, 616C, 616D or 617 of

10-18  NRS which the person knows or reasonably should know is fraudulent or

10-19  otherwise unlawful.

10-20  Sec. 18. Chapter 439 of NRS is hereby amended by adding thereto the

10-21  provisions set forth as sections 19 to 39, inclusive, of this act.

10-22  Sec. 19.  As used in sections 19 to 39, inclusive, of this act, unless the

10-23  context otherwise requires, the words and terms defined in sections 20 to

10-24  25, inclusive, of this act have the meanings ascribed to them in those

10-25  sections.

10-26  Sec. 20.  “Medical facility” means:

10-27  1.  A hospital, as that term is defined in NRS 449.012 and 449.0151;

10-28  2.  An obstetric center, as that term is defined in NRS 449.0151 and

10-29  449.0155;

10-30  3.  A surgical center for ambulatory patients, as that term is defined

10-31  in NRS 449.0151 and 449.019; and

10-32  4.  An independent center for emergency medical care, as that term is

10-33  defined NRS 449.013 and 449.0151.

10-34  Sec. 21.  “Patient” means a person who:

10-35  1.  Is admitted to a medical facility for the purpose of receiving

10-36  treatment;

10-37  2.  Resides in a medical facility; or

10-38  3.  Receives treatment from a provider of health care.

10-39  Sec. 22.  “Patient safety officer” means a person who is designated

10-40  as such by a medical facility pursuant to section 35 of this act.

10-41  Sec. 23.  “Provider of health care” means a person who is licensed,

10-42  certified or otherwise authorized by the law of this state to administer

10-43  health care in the ordinary course of the business or practice of a

10-44  profession.

10-45  Sec. 24.  “Repository” means the repository for health care quality

10-46  assurance created by section 31 of this act.

10-47  Sec. 25.  “Sentinel event” means an unexpected occurrence

10-48  involving death or serious physical or psychological injury or the risk

10-49  thereof, including, without limitation, any process variation for which a

11-1  recurrence would carry a significant chance of a serious adverse

11-2  outcome. The term includes loss of limb or function.

11-3  Secs. 26 and 27.  (Deleted by amendment.)

11-4  Sec. 28.  1.  Except as otherwise provided in subsection 2:

11-5  (a) A person who is employed by a medical facility shall, within 24

11-6  hours after becoming aware of a sentinel event that occurred at the

11-7  medical facility, notify the patient safety officer of the facility of the

11-8  sentinel event; and

11-9  (b) The patient safety officer shall, within 13 days after receiving

11-10  notification pursuant to paragraph (a), report the date, the time and a

11-11  brief description of the sentinel event to:

11-12     (1) The health division; and

11-13     (2) The representative designated pursuant to section 32 of this act,

11-14  if that person is different from the patient safety officer.

11-15  2.  If the patient safety officer of a medical facility personally

11-16  discovers or becomes aware, in the absence of notification by another

11-17  employee, of a sentinel event that occurred at the medical facility, the

11-18  patient safety officer shall, within 14 days after discovering or becoming

11-19  aware of the sentinel event, report  the date, time and brief description of

11-20  the sentinel event to:

11-21  (a) The health division; and

11-22  (b) The representative designated pursuant to section 32 of this act, if

11-23  that person is different from the patient safety officer.

11-24  3.  The administrator shall prescribe the manner in which reports of

11-25  sentinel events must be made pursuant to this section.

11-26  Sec. 29.  1.  The health division shall, to the extent of legislative

11-27  appropriation and authorization:

11-28  (a) Collect and maintain reports received pursuant to section 28 of

11-29  this act; and

11-30  (b) Ensure that such reports, and any additional documents created

11-31  from such reports, are protected adequately from fire, theft, loss,

11-32  destruction and other hazards and from unauthorized access.

11-33  2.  Reports received pursuant to section 28 of this act are

11-34  confidential, not subject to subpoena or discovery and not subject to

11-35  inspection by the general public.

11-36  Sec. 30.  1.  The health division shall, to the extent of legislative

11-37  appropriation and authorization, contract with a quality improvement

11-38  organization, as defined in 42 C.F.R. § 400.200, to analyze and report

11-39  trends regarding sentinel events.

11-40  2.  When the health division receives notice from a medical facility

11-41  that the medical facility has taken corrective action to remedy the causes

11-42  or contributing factors, or both, of a sentinel event, the health division

11-43  shall:

11-44  (a) Make a record of the information;

11-45  (b) Ensure that the information is aggregated so as not to reveal the

11-46  identity of a specific person or medical facility; and

11-47  (c) Transmit the information to a quality improvement organization.

11-48  3.  A quality improvement organization to whom information is

11-49  transmitted pursuant to subsection 2 shall, at least quarterly, report its

12-1  findings regarding the analysis of aggregated trends of sentinel events to

12-2  the repository for health care quality assurance.

12-3  Sec. 31.  1.  The repository for health care quality assurance is

12-4  hereby created within the health division.

12-5  2.  The repository shall, to the extent of legislative appropriation and

12-6  authorization, function as a clearinghouse of information relating to

12-7  aggregated trends of sentinel events.

12-8  Sec. 32.  1.  Each medical facility that is located within this state

12-9  shall designate a representative for the notification of patients who have

12-10  been involved in sentinel events at that medical facility.

12-11  2.  A representative designated pursuant to subsection 1 shall, not

12-12  later than 7 days after discovering or becoming aware of a sentinel event

12-13  that occurred at the medical facility, provide notice of that fact to each

12-14  patient who was involved in that sentinel event.

12-15  3.  The provision of notice to a patient pursuant to subsection 2 must

12-16  not, in any action or proceeding, be considered an acknowledgment or

12-17  admission of liability.

12-18  4.  A representative designated pursuant to subsection 1 may or may

12-19  not be the same person who serves as the facility’s patient safety officer.

12-20  Sec. 33.  Any report, document and any other information compiled

12-21  or disseminated pursuant to the provisions of sections 19 to 39, inclusive,

12-22  of this act is not admissible in evidence in any administrative or legal

12-23  proceeding conducted in this state.

12-24  Sec. 34.  1.  Each medical facility that is located within this state

12-25  shall develop, in consultation with the providers of health care who

12-26  provide treatment to patients at the medical facility, an internal patient

12-27  safety plan to improve the health and safety of patients who are treated at

12-28  that medical facility.

12-29  2.  A medical facility shall submit its patient safety plan to the

12-30  governing board of the medical facility for approval in accordance with

12-31  the requirements of this section.

12-32  3.  After a medical facility’s patient safety plan is approved, the

12-33  medical facility shall notify all providers of health care who provide

12-34  treatment to patients at the medical facility of the existence of the plan

12-35  and of the requirements of the plan. A medical facility shall require

12-36  compliance with its patient safety plan.

12-37  Sec. 35.  1.  A medical facility shall designate an officer or

12-38  employee of the facility to serve as the patient safety officer of the

12-39  medical facility.

12-40  2.  The person who is designated as the patient safety officer of a

12-41  medical facility shall:

12-42  (a) Serve on the patient safety committee.

12-43  (b) Supervise the reporting of all sentinel events alleged to have

12-44  occurred at the medical facility, including, without limitation, performing

12-45  the duties required pursuant to section 28 of this act.

12-46  (c) Take such action as he determines to be necessary to ensure the

12-47  safety of patients as a result of an investigation of any sentinel event

12-48  alleged to have occurred at the medical facility.

13-1  (d) Report to the patient safety committee regarding any action taken

13-2  in accordance with paragraph (c).

13-3  Sec. 36.  1.  A medical facility shall establish a patient safety

13-4  committee.

13-5  2.  Except as otherwise provided in subsection 3:

13-6  (a) A patient safety committee established pursuant to subsection 1

13-7  must be composed of:

13-8      (1) The patient safety officer of the medical facility.

13-9      (2) At least three providers of health care who treat patients at the

13-10  medical facility, including, without limitation, at least one member of the

13-11  medical, nursing and pharmaceutical staff of the medical facility.

13-12     (3) One member of the executive or governing body of the medical

13-13  facility.

13-14  (b) A patient safety committee shall meet at least once each month.

13-15  3.  The administrator shall adopt regulations prescribing the

13-16  composition and frequency of meetings of patient safety committees at

13-17  medical facilities having fewer than 25 employees and contractors.

13-18  4.  A patient safety committee shall:

13-19  (a) Receive reports from the patient safety officer pursuant to section

13-20  35 of this act.

13-21  (b) Evaluate actions of the patient safety officer in connection with all

13-22  reports of sentinel events alleged to have occurred at the medical facility.

13-23  (c) Review and evaluate the quality of measures carried out by the

13-24  medical facility to improve the safety of patients who receive treatment at

13-25  the medical facility.

13-26  (d) Make recommendations to the executive or governing body of the

13-27  medical facility to reduce the number and severity of sentinel events that

13-28  occur at the medical facility.

13-29  (e) At least once each calendar quarter, report to the executive or

13-30  governing body of the medical facility regarding:

13-31     (1) The number of sentinel events that occurred at the medical

13-32  facility during the preceding calendar quarter; and

13-33     (2) Any recommendations to reduce the number and severity of

13-34  sentinel events that occur at the medical facility.

13-35  5.  The proceedings and records of a patient safety committee are

13-36  subject to the same privilege and protection from discovery as the

13-37  proceedings and records described in NRS 49.265.

13-38  Sec. 37.  No person is subject to any criminal penalty or civil liability

13-39  for libel, slander or any similar cause of action in tort if he, without

13-40  malice:

13-41  1.  Reports a sentinel event to a governmental entity with jurisdiction

13-42  or another appropriate authority;

13-43  2.  Notifies a governmental entity with jurisdiction or another

13-44  appropriate authority of a sentinel event;

13-45  3.  Transmits information regarding a sentinel event to a

13-46  governmental entity with jurisdiction or another appropriate authority;

13-47  4.  Compiles, prepares or disseminates information regarding a

13-48  sentinel event to a governmental entity with jurisdiction or another

13-49  appropriate authority; or

14-1  5.  Performs any other act authorized pursuant to sections 19 to 39,

14-2  inclusive, of this act.

14-3  Sec. 38.  If a medical facility:

14-4  1.  Commits a violation of any provision of sections 19 to 39,

14-5  inclusive, of this act or for any violation for which an administrative

14-6  sanction pursuant to NRS 449.163 would otherwise be applicable; and

14-7  2.  Of its own volition, reports the violation to the

14-8  administrator,

14-9  such a violation must not be used as the basis for imposing an

14-10  administrative sanction pursuant to NRS 449.163.

14-11  Sec. 39.  The administrator shall adopt such regulations as the

14-12  administrator determines to be necessary or advisable to carry out the

14-13  provisions of sections 19 to 39, inclusive, of this act.

14-14  Secs. 40-43.  (Deleted by amendment.)

14-15  Sec. 44.  Chapter 449 of NRS is hereby amended by adding thereto the

14-16  provisions set forth as sections 45 and 46 of this act.

14-17  Sec. 45.  1.  A medical facility or any agent or employee thereof

14-18  shall not retaliate or discriminate unfairly against an employee of the

14-19  medical facility or a person acting on behalf of the employee who in good

14-20  faith:

14-21  (a) Reports to the board of medical examiners or the state board of

14-22  osteopathic medicine, as applicable, information relating to the conduct

14-23  of a physician which may constitute grounds for initiating disciplinary

14-24  action against the physician or which otherwise raises a reasonable

14-25  question regarding the competence of the physician to practice medicine

14-26  with reasonable skill and safety to patients;

14-27  (b) Reports a sentinel event to the health division pursuant to section

14-28  28 of this act; or

14-29  (c) Cooperates or otherwise participates in an investigation or

14-30  proceeding conducted by the board of medical examiners, the state board

14-31  of osteopathic medicine or another governmental entity relating to

14-32  conduct described in paragraph (a) or (b).

14-33  2.  A medical facility or any agent or employee thereof shall not

14-34  retaliate or discriminate unfairly against an employee of the

14-35  medical facility because the employee has taken an action described in

14-36  subsection 1.

14-37  3.  A medical facility or any agent or employee thereof shall not

14-38  prohibit, restrict or attempt to prohibit or restrict by contract, policy,

14-39  procedure or any other manner the right of an employee of the medical

14-40  facility to take an action described in subsection 1.

14-41  4.  As used in this section:

14-42  (a) “Physician” means a person licensed to practice medicine

14-43  pursuant to chapter 630 or 633 of NRS.

14-44  (b) “Retaliate or discriminate”:

14-45     (1) Includes, without limitation, the following action if such action

14-46  is taken solely because the employee took an action described in

14-47  subsection 1:

15-1         (I) Frequent or undesirable changes in the location where the

15-2  employee works;

15-3         (II) Frequent or undesirable transfers or reassignments;

15-4         (III) The issuance of letters of reprimand, letters of admonition

15-5  or evaluations of poor performance;

15-6         (IV) A demotion;

15-7         (V) A reduction in pay;

15-8         (VI) The denial of a promotion;

15-9         (VII) A suspension;

15-10        (VIII) A dismissal;

15-11        (IX) A transfer; or

15-12        (X) Frequent changes in working hours or workdays.

15-13     (2) Does not include action described in subparagraphs (I) to (X),

15-14  inclusive, of paragraph (1) if the action is taken in the normal course of

15-15  employment or as a form of discipline.

15-16  Sec. 46.  An employee of a medical facility who believes that he has

15-17  been retaliated or discriminated against in violation of section 45 of this

15-18  act may file an action in a court of competent jurisdiction for such relief

15-19  as may be appropriate under the law.

15-20  Sec. 47.  Chapter 630 of NRS is hereby amended by adding thereto the

15-21  provisions set forth as sections 48 and 49 of this act.

15-22  Sec. 48.  1.  A physician or any agent or employee thereof shall not

15-23  retaliate or discriminate unfairly against an employee of the physician or

15-24  a person acting on behalf of the employee who in good faith:

15-25  (a) Reports to the board information relating to the conduct of the

15-26  physician which may constitute grounds for initiating disciplinary action

15-27  against the physician or which otherwise raises a reasonable question

15-28  regarding the competence of the physician to practice medicine with

15-29  reasonable skill and safety to patients;

15-30  (b) Reports a sentinel event to the health division pursuant to section

15-31  28 of this act; or

15-32  (c) Cooperates or otherwise participates in an investigation or

15-33  proceeding conducted by the board or another governmental entity

15-34  relating to conduct described in paragraph (a) or (b).

15-35  2.  A physician or any agent or employee thereof shall not retaliate or

15-36  discriminate unfairly against an employee of the physician because the

15-37  employee has taken an action described in subsection 1.

15-38  3.  A physician or any agent or employee thereof shall not prohibit,

15-39  restrict or attempt to prohibit or restrict by contract, policy, procedure or

15-40  any other manner the right of an employee of the physician to take an

15-41  action described in subsection 1.

15-42  4.  As used in this section, “retaliate or discriminate”:

15-43  (a) Includes, without limitation, the following action if such

15-44  action is taken solely because the employee took an action described in

15-45  subsection 1:

15-46     (1) Frequent or undesirable changes in the location where the

15-47  employee works;

15-48     (2) Frequent or undesirable transfers or reassignments;

16-1      (3) The issuance of letters of reprimand, letters of admonition or

16-2  evaluations of poor performance;

16-3      (4) A demotion;

16-4     (5) A reduction in pay;

16-5      (6) The denial of a promotion;

16-6      (7) A suspension;

16-7      (8) A dismissal;

16-8      (9) A transfer; or

16-9      (10) Frequent changes in working hours or workdays.

16-10  (b) Does not include action described in paragraphs (1) to (10),

16-11  inclusive, of paragraph (a) if the action is taken in the normal course of

16-12  employment or as a form of discipline.

16-13  Sec. 49.  An employee of a physician who believes that he has been

16-14  retaliated or discriminated against in violation of section 48 of this act

16-15  may file an action in a court of competent jurisdiction for such relief as

16-16  may be appropriate.

16-17  Sec. 50. (Deleted by amendment.)

16-18  Sec. 51.  NRS 630.130 is hereby amended to read as follows:

16-19  630.130  1.  In addition to the other powers and duties provided in this

16-20  chapter, the board shall:

16-21  (a) Enforce the provisions of this chapter;

16-22  (b) Establish by regulation standards for licensure under this chapter;

16-23  (c) Conduct examinations for licensure and establish a system of

16-24  scoring for those examinations;

16-25  (d) Investigate the character of each applicant for a license and issue

16-26  licenses to those applicants who meet the qualifications set by this chapter

16-27  and the board; and

16-28  (e) Institute a proceeding in any court to enforce its orders or the

16-29  provisions of this chapter.

16-30  2.  On or before February 15 of each odd-numbered year, the board

16-31  shall submit to the governor and to the director of the legislative counsel

16-32  bureau for transmittal to the next regular session of the legislature a

16-33  written report compiling:

16-34  (a) Disciplinary action taken by the board during the previous

16-35  biennium against physicians for malpractice or negligence; and

16-36  (b) Information reported to the board during the previous biennium

16-37  pursuant to NRS 630.3067, subsections 2 and 3 of NRS 630.307 and

16-38  NRS 690B.045.

16-39  The report must include only aggregate information for statistical

16-40  purposes and exclude any identifying information related to a particular

16-41  person.

16-42  3.  The board may adopt such regulations as are necessary or desirable

16-43  to enable it to carry out the provisions of this chapter.

16-44  Sec. 52.  NRS 630.267 is hereby amended to read as follows:

16-45  630.267  1.  Each holder of a license to practice medicine must, on or

16-46  before July 1 of each alternate year:

16-47  (a) Submit the statement required pursuant to NRS 630.197; [and]

17-1  (b) Submit a list of all actions filed or claims submitted to arbitration

17-2  or mediation for malpractice or negligence against him during the

17-3  previous 2 years; and

17-4  (c) Pay to the secretary-treasurer of the board the applicable fee for

17-5  biennial registration. This fee must be collected for the period for which a

17-6  physician is licensed.

17-7  2.  When a holder of a license fails to pay the fee for biennial

17-8  registration and submit the statement required pursuant to NRS 630.197

17-9  after they become due, his license to practice medicine in this state is

17-10  automatically suspended. The holder may, within 2 years after the date his

17-11  license is suspended, upon payment of twice the amount of the current fee

17-12  for biennial registration to the secretary-treasurer and submission of the

17-13  statement required pursuant to NRS 630.197 and after he is found to be in

17-14  good standing and qualified under the provisions of this chapter, be

17-15  reinstated to practice.

17-16  3.  The board shall make such reasonable attempts as are practicable to

17-17  notify a licensee:

17-18  (a) At least once that his fee for biennial registration and the statement

17-19  required pursuant to NRS 630.197 are due; and

17-20  (b) That his license is suspended.

17-21  A copy of this notice must be sent to the Drug Enforcement Administration

17-22  of the United States Department of Justice or its successor agency.

17-23  Sec. 53.  NRS 630.3062 is hereby amended to read as follows:

17-24  630.3062  The following acts, among others, constitute grounds for

17-25  initiating disciplinary action or denying licensure:

17-26  1.  Failure to maintain timely, legible, accurate and complete medical

17-27  records relating to the diagnosis, treatment and care of a patient.

17-28  2.  Altering medical records of a patient.

17-29  3.  Making or filing a report which the licensee knows to be false,

17-30  failing to file a record or report as required by law or willfully obstructing

17-31  or inducing another to obstruct such filing.

17-32  4.  Failure to make the medical records of a patient available for

17-33  inspection and copying as provided in NRS 629.061.

17-34  5.  Failure to [report any claim for malpractice or negligence filed

17-35  against the licensee and the subsequent disposition thereof within 90 days

17-36  after the:

17-37  (a) Claim is filed; and

17-38  (b) Disposition of the claim.] comply with the requirements of

17-39  NRS 630.3067.

17-40  6.  Failure to report any person the licensee knows, or has reason to

17-41  know, is in violation of the provisions of this chapter or the regulations of

17-42  the board.

17-43  Sec. 54.  NRS 630.3067 is hereby amended to read as follows:

17-44  630.3067  [Under the provisions of NRS 690B.045, the]

17-45  1.  The insurer of a physician licensed under this chapter and the

17-46  physician must report to the board any action filed or claim submitted to

17-47  arbitration or mediation for malpractice or negligence against the

17-48  physician and the settlement, award, judgment or other disposition

17-49  [thereof.] of the action or claim within 30 days after:

18-1  (a) The action was filed or the claim was submitted to arbitration or

18-2  mediation; and

18-3  (b) The disposition of the action or claim.

18-4  2.  The board shall report any failure to comply with subsection 1 by

18-5  an insurer licensed in this state to the division of insurance of the

18-6  department of business and industry. If, after a hearing, the division of

18-7  insurance determines that any such insurer failed to comply with the

18-8  requirements of subsection 1, the division may impose an administrative

18-9  fine of not more than $10,000 against the insurer for each such failure to

18-10  report. If the administrative fine is not paid when due, the fine must be

18-11  recovered in a civil action brought by the attorney general on behalf of

18-12  the division.

18-13  Sec. 55.  NRS 630.307 is hereby amended to read as follows:

18-14  630.307  1.  Any person, medical school or medical facility that

18-15  becomes aware that a person practicing medicine or respiratory care in this

18-16  state has, is or is about to become engaged in conduct which constitutes

18-17  grounds for initiating disciplinary action shall [forthwith] file a written

18-18  complaint with the board[.] within 30 days after becoming aware of the

18-19  conduct.

18-20  2.  Any hospital, clinic or other medical facility licensed in this state, or

18-21  medical society, shall [forthwith] report to the board any change in a

18-22  physician’s privileges to practice medicine while the physician is under

18-23  investigation and the outcome of any disciplinary action taken by that

18-24  facility or society against the physician concerning the care of a patient or

18-25  the competency of the physician[.] within 30 days after the change in

18-26  privileges is made or disciplinary action is taken. The board shall report

18-27  any failure to comply with this subsection by a hospital, clinic or other

18-28  medical facility licensed in this state to the health division of the

18-29  department of human resources. If, after a hearing, the health division

18-30  determines that any such facility or society failed to comply with the

18-31  requirements of this subsection, the division may impose an

18-32  administrative fine of not more than $10,000 against the facility or

18-33  society for each such failure to report. If the administrative fine is not

18-34  paid when due, the fine must be recovered in a civil action brought by the

18-35  attorney general on behalf of the division.

18-36  3.  The clerk of every court shall [forthwith] report to the board any

18-37  finding, judgment or other determination of the court that a physician,

18-38  physician assistant or practitioner of respiratory care:

18-39  (a) Is mentally ill;

18-40  (b) Is mentally incompetent;

18-41  (c) Has been convicted of a felony or any law governing controlled

18-42  substances or dangerous drugs;

18-43  (d) Is guilty of abuse or fraud under any state or federal program

18-44  providing medical assistance; or

18-45  (e) Is liable for damages for malpractice or negligence[.] ,

18-46  within 45 days after such a finding, judgment or determination is made.

18-47  4.  On or before January 15 of each year, the clerk of each court

18-48  shall submit to the office of court administrator created pursuant to NRS

18-49  1.320 a written report compiling the information that the clerk reported

19-1  during the previous year to the board regarding physicians pursuant to

19-2  paragraph (e) of subsection 3.

19-3  Sec. 56.  NRS 630.364 is hereby amended to read as follows:

19-4  630.364  1.  Any person or organization who furnishes information

19-5  concerning an applicant for a license or a licensee in good faith and

19-6  without malicious intent in accordance with the provisions of this chapter

19-7  is immune from any civil action for furnishing that information.

19-8  2.  The board and any of its members and its staff, counsel,

19-9  investigators, experts, committees, panels, hearing officers and consultants

19-10  are immune from any civil liability for:

19-11  (a) Any decision or action taken in good faith and without malicious

19-12  intent in response to information acquired by the board.

19-13  (b) Disseminating information concerning an applicant for a license or a

19-14  licensee to other boards or agencies of the state, the attorney general, any

19-15  hospitals, medical societies, insurers, employers, patients and their families

19-16  or any law enforcement agency.

19-17  [3.  A screening panel or any of its members, acting pursuant to NRS

19-18  41A.003 to 41A.069, inclusive, that initiates or assists in any proceeding

19-19  concerning a claim of malpractice against a physician is immune from any

19-20  civil action for that initiation or assistance or any consequential damages, if

19-21  the panel or members acted without malicious intent.]

19-22  Sec. 57.  (Deleted by amendment.)

19-23  Sec. 58.  Chapter 633 of NRS is hereby amended by adding thereto the

19-24  provisions set forth as sections 62, 63 and 64 of this act.

19-25  Sec. 59.  1.  An osteopathic physician or any agent or employee

19-26  thereof shall not retaliate or discriminate unfairly against an employee of

19-27  the osteopathic physician or a person acting on behalf of the employee

19-28  who in good faith:

19-29  (a) Reports to the board information relating to the conduct of the

19-30  osteopathic physician which may constitute grounds for initiating

19-31  disciplinary action against the osteopathic physician or which otherwise

19-32  raises a reasonable question regarding the competence of the osteopathic

19-33  physician to practice medicine with reasonable skill and safety to

19-34  patients;

19-35  (b) Reports a sentinel event to the health division pursuant to section

19-36  28 of this act; or

19-37  (c) Cooperates or otherwise participates in an investigation or

19-38  proceeding conducted by the board or another governmental entity

19-39  relating to conduct described in paragraph (a) or (b).

19-40  2.  An osteopathic physician or any agent or employee thereof shall

19-41  not retaliate or discriminate unfairly against an employee of the

19-42  osteopathic physician because the employee has taken  an action

19-43  described in subsection 1.

19-44  3.  An osteopathic physician or any agent or employee thereof shall

19-45  not prohibit, restrict or attempt to prohibit or restrict by contract, policy,

19-46  procedure or any other manner the right of an employee of the

19-47  osteopathic physician to take an action described in subsection 1.

19-48  4.  As used in this section, “retaliate or discriminate”:

20-1  (a) Includes, without limitation, the following action if such

20-2  action is taken solely because the employee took an action described in

20-3  subsection 1:

20-4      (1) Frequent or undesirable changes in the location where the

20-5  employee works;

20-6      (2) Frequent or undesirable transfers or reassignments;

20-7      (3) The issuance of letters of reprimand, letters of admonition or

20-8  evaluations of poor performance;

20-9      (4) A demotion;

20-10     (5) A reduction in pay;

20-11     (6) The denial of a promotion;

20-12     (7) A suspension;

20-13     (8) A dismissal;

20-14     (9) A transfer; or

20-15     (10) Frequent changes in working hours or workdays.

20-16  (b) Does not include action described in paragraphs (1) to (10),

20-17  inclusive, of paragraph (a) if the action is taken in the normal course of

20-18  employment or as a form of discipline.

20-19  Sec. 60. An employee of an osteopathic physician who believes that

20-20  he has been retaliated or discriminated against in violation of section 59

20-21  of this act may file an action in a court of competent jurisdiction for such

20-22  relief as may be appropriate under the law.

20-23  Sec. 61. (Deleted by amendment.)

20-24  Sec. 62.  1.  On or before February 15 of each odd-numbered year,

20-25  the board shall submit to the governor and to the director of the

20-26  legislative counsel bureau for transmittal to the next regular session of

20-27  the legislature a written report compiling:

20-28  (a) Disciplinary action taken by the board during the previous

20-29  biennium against osteopathic physicians for malpractice or negligence;

20-30  and

20-31  (b) Information reported to the board during the previous biennium

20-32  pursuant to NRS 690B.045, section 63 of this act and subsections 2 and 3

20-33  of section 64 of this act.

20-34  2.  The report must include only aggregate information for statistical

20-35  purposes and exclude any identifying information related to a particular

20-36  person.

20-37  Sec. 63. 1.  The insurer of an osteopathic physician licensed under

20-38  this chapter and the osteopathic physician must report to the board any

20-39  action filed or claim submitted to arbitration or mediation for

20-40  malpractice or negligence against the osteopathic physician and the

20-41  settlement, award, judgment or other disposition of the action or claim

20-42  within 30 days after:

20-43  (a) The action was filed or the claim was submitted to arbitration or

20-44  mediation; and

20-45  (b) The disposition of the action or claim.

20-46  2.  The board shall report any failure to comply with subsection 1 by

20-47  an insurer licensed in this state to the division of insurance of the

20-48  department of business and industry. If, after a hearing, the division of

20-49  insurance determines that any such insurer failed to comply with the

21-1  requirements of subsection 1, the division may impose an administrative

21-2  fine of not more than $10,000 against the insurer for each such failure to

21-3  report. If the administrative fine is not paid when due, the fine must be

21-4  recovered in a civil action brought by the attorney general on behalf of

21-5  the division.

21-6  Sec. 64.  1.  Any person, medical school or medical facility that

21-7  becomes aware that a person practicing osteopathic medicine in this state

21-8  has, is or is about to become engaged in conduct which constitutes

21-9  grounds for initiating disciplinary action shall file a written complaint

21-10  with the board within 30 days after becoming aware of the conduct.

21-11  2.  Any hospital, clinic or other medical facility licensed in this state,

21-12  or medical society, shall report to the board any change in an osteopathic

21-13  physician’s privileges to practice osteopathic medicine while the

21-14  osteopathic physician is under investigation and the outcome of any

21-15  disciplinary action taken by that facility or society against the osteopathic

21-16  physician concerning the care of a patient or the competency of the

21-17  osteopathic physician within 30 days after the change in privileges is

21-18  made or disciplinary action is taken. The board shall report any failure to

21-19  comply with this subsection by a hospital, clinic or other medical facility

21-20  licensed in this state to the health division of the department of human

21-21  resources. If, after a hearing, the health division determines that any

21-22  such facility or society failed to comply with the requirements of this

21-23  subsection, the division may impose an administrative fine of not more

21-24  than $10,000 against the facility or society for each such failure to

21-25  report. If the administrative fine is not paid when due, the fine must be

21-26  recovered in a civil action brought by the attorney general on behalf of

21-27  the division.

21-28  3.  The clerk of every court shall report to the board any finding,

21-29  judgment or other determination of the court that an osteopathic

21-30  physician or osteopathic physician’s assistant:

21-31  (a) Is mentally ill;

21-32  (b) Is mentally incompetent;

21-33  (c) Has been convicted of a felony or any law governing controlled

21-34  substances or dangerous drugs;

21-35  (d) Is guilty of abuse or fraud under any state or federal program

21-36  providing medical assistance; or

21-37  (e) Is liable for damages for malpractice or negligence,

21-38  within 45 days after such a finding, judgment or determination is made.

21-39  4.  On or before January 15 of each year, the clerk of every court

21-40  shall submit to the office of court administrator created pursuant to NRS

21-41  1.320 a written report compiling the information that the clerk reported

21-42  during the previous year to the board regarding osteopathic physicians

21-43  pursuant to paragraph (e) of subsection 3.

21-44  Sec. 65.  NRS 633.471 is hereby amended to read as follows:

21-45  633.471  1.  Except as otherwise provided in subsection 3 and in

21-46  NRS 633.491, every holder of a license issued under this chapter, except

21-47  a temporary or a special license, may renew his license on or before

21-48  January 1 of each calendar year after its issuance by:

21-49  (a) Applying for renewal on forms provided by the board;

22-1  (b) Submitting the statement required pursuant to NRS 633.326;

22-2  (c) Paying the annual license renewal fee specified in this chapter; [and]

22-3  (d) Submitting a list of all actions filed or claims submitted to

22-4  arbitration or mediation for malpractice or negligence against him

22-5  during the previous year; and

22-6  (e) Submitting verified evidence satisfactory to the board that in the

22-7  year preceding the application for renewal he has attended courses or

22-8  programs of continuing education approved by the board totaling a number

22-9  of hours established by the board which must not be less than 35 hours nor

22-10  more than that set in the requirements for continuing medical education of

22-11  the American Osteopathic Association.

22-12  2.  The secretary of the board shall notify each licensee of the

22-13  requirements for renewal not less than 30 days before the date of renewal.

22-14  3.  Members of the Armed Forces of the United States and the United

22-15  States Public Health Service are exempt from payment of the annual

22-16  license renewal fee during their active duty status.

22-17  Sec. 66.  NRS 633.511 is hereby amended to read as follows:

22-18  633.511  The grounds for initiating disciplinary action pursuant to this

22-19  chapter are:

22-20  1.  Unprofessional conduct.

22-21  2.  Conviction of:

22-22  (a) A violation of any federal or state law regulating the possession,

22-23  distribution or use of any controlled substance or any dangerous drug as

22-24  defined in chapter 454 of NRS;

22-25  (b) A felony;

22-26  (c) A violation of any of the provisions of NRS 616D.200, 616D.220,

22-27  616D.240 or 616D.300 to 616D.440, inclusive; or

22-28  (d) Any offense involving moral turpitude.

22-29  3.  The suspension of the license to practice osteopathic medicine by

22-30  any other jurisdiction.

22-31  4.  Gross or repeated malpractice, which may be evidenced by claims

22-32  of malpractice settled against a practitioner.

22-33  5.  Professional incompetence.

22-34  6.  Failure to comply with the requirements of section 63 of this act.

22-35  Sec. 67.  NRS 690B.045 is hereby amended to read as follows:

22-36     690B.045  Except as more is required in NRS 630.3067[:] and section

22-37  63 of this act:

22-38  1.  Each insurer which issues a policy of insurance covering the

22-39  liability of a practitioner licensed pursuant to chapters 630 to 640,

22-40  inclusive, of NRS for a breach of his professional duty toward a patient

22-41  shall report to the board which licensed the practitioner within 30 days

22-42  each settlement or award made or judgment rendered by reason of a claim,

22-43  if the settlement, award or judgment is for more than $5,000, giving the

22-44  name and address of the claimant and the practitioner and the

22-45  circumstances of the case.

22-46  2.  A practitioner licensed pursuant to chapters 630 to 640, inclusive, of

22-47  NRS who does not have insurance covering liability for a breach of his

22-48  professional duty toward a patient shall report to the board which issued his

22-49  license within 30 days of each settlement or award made or judgment

23-1  rendered by reason of a claim, if the settlement, award or judgment is for

23-2  more than $5,000, giving his name and address, the name and address of

23-3  the claimant and the circumstances of the case.

23-4  3.  These reports are public records and must be made available for

23-5  public inspection within a reasonable time after they are received by the

23-6  licensing board.

23-7  Sec. 68.  NRS 690B.050 is hereby amended to read as follows:

23-8     690B.050  1.  Each insurer which issues a policy of insurance

23-9  covering the liability of a physician licensed under chapter 630 of NRS or

23-10  an osteopathic physician licensed under chapter 633 of NRS for a breach

23-11  of his professional duty toward a patient shall report to the commissioner

23-12  within 30 days each settlement or award made or judgment rendered by

23-13  reason of a claim, giving the name and address of the claimant and

23-14  physician and the circumstances of the case.

23-15  2.  The commissioner shall report to the board of medical examiners[,]

23-16  or the state board of osteopathic medicine, as applicable, within 30 days

23-17  after receiving the report of the insurer, each claim made and each

23-18  settlement, award or judgment.

23-19  Sec. 69.  NRS 41A.0043, 41A.005, 41A.008, 41A.016, 41A.019,

23-20  41A.023, 41A.024, 41A.026, 41A.029, 41A.033, 41A.036, 41A.039,

23-21  41A.043, 41A.046, 41A.049, 41A.051, 41A.053, 41A.056, 41A.059,

23-22  41A.069 and 631.377 are hereby repealed.

23-23  Sec. 70. The amendatory provisions of sections 1 to 6, inclusive, and

23-24  11 of this act apply only to a cause of action that accrues on or after

23-25  October 1, 2002.

23-26  Sec. 71.  The amendatory provisions of sections 7, 8, 12 and 17 apply

23-27  only to an action filed on or after October 1, 2002.

23-28  Sec. 72.  1.  Notwithstanding the repeal of NRS 41A.0043, 41A.005,

23-29  41A.008 and 41A.016 to 41A.069, inclusive, if a claimant has filed a

23-30  complaint with the division of insurance of the department of business and

23-31  industry pursuant to NRS 41A.039 before October 1, 2002, and a

23-32  determination has not been made by the screening panel as provided in

23-33  NRS 41A.003 to 41A.069, inclusive, before October 1, 2002, the claimant

23-34  may elect:

23-35  (a) To have a determination made by the screening panel as provided in

23-36  NRS 41A.003 to 41A.069, inclusive. If the claimant elects to have a

23-37  determination made by the screening panel, the provisions of NRS

23-38  41A.003 to 41A.069, inclusive, shall be deemed to continue to apply to the

23-39  claim and to any subsequent action filed in the district court. If the claimant

23-40  wishes to elect to have a determination made by the screening panel, the

23-41  claimant must, before December 1, 2002, file written notice of that fact

23-42  with the division. If the claimant fails to provide such written notice, the

23-43  claimant shall be deemed to have elected to have no further action taken by

23-44  the screening panel concerning the complaint.

23-45  (b) To have no further action taken by the screening panel concerning

23-46  the complaint. If the claimant elects to have no further action taken by the

23-47  screening panel concerning the complaint, the division and the screening

23-48  panel shall not take any further action with respect to the complaint, and

23-49  the claimant may file an action in the district court.

24-1  2.  Notwithstanding the repeal of NRS 41A.0043, 41A.005, 41A.008

24-2  and 41A.016 to 41A.069, inclusive, and the amendment of paragraph (b) of

24-3  subsection 2 of NRS 41A.097, if a claimant elects:

24-4  (a) To have a determination made by the screening panel, the tolling of

24-5  the time limitation provided for review of the complaint by the screening

24-6  panel pursuant to NRS 41A.097 shall be deemed to continue to apply until

24-7  30 days after the date on which the screening panel notifies the claimant, in

24-8  writing, of its findings.

24-9  (b) To have no further action taken by the screening panel concerning

24-10  the complaint, the tolling of the time limitation provided for review of the

24-11  complaint by the screening panel pursuant to NRS 41A.097 ceases on

24-12  December 1, 2002.

24-13  3.  If a claimant:

24-14  (a) Elects to have no further action taken by the screening panel

24-15  concerning the complaint;

24-16  (b) Files an action in the district court; and

24-17  (c) Prevails at the trial of the action,

24-18  the claimant is entitled to tax, as costs, the fee paid to the division pursuant

24-19  to NRS 41A.039 for filing the complaint.

24-20  Sec. 72.5. 1.  For the period beginning on October 1, 2002, and

24-21  ending on October 1, 2005, the division shall monitor and maintain records

24-22  of all:

24-23  (a) Premiums charged for policies of insurance covering the liability of

24-24  a practitioner licensed to practice medicine, dentistry or osteopathic

24-25  medicine pursuant to chapter 630, 631 or 633 of NRS for a breach of his

24-26  professional duty toward a patient; and

24-27  (b) Jury verdicts and settlements of cases and claims relating to the

24-28  liability of a practitioner licensed to practice medicine, dentistry or

24-29  osteopathic medicine pursuant to chapter 630, 631 or 633 of NRS for a

24-30  breach of his professional duty toward a patient, including, without

24-31  limitation:

24-32     (1) The amount of each jury verdict or settlement;

24-33     (2) For each case or claim, whether any limitation on the amount of

24-34  any damages applied; and

24-35     (3) For each case or claim, the effect of any applicable limitation on

24-36  the amount of any damages.

24-37  2.  Not later than November 1, 2005, the division shall deliver to the

24-38  commissioner for review a report that must include, without limitation:

24-39  (a) A summary of the information obtained pursuant to subsection 1;

24-40  and

24-41  (b) Analyses of any changes or trends in the amounts of or volumes of

24-42  premiums or jury verdicts and settlements as evidenced by the information

24-43  obtained pursuant to subsection 1.

24-44  3.  Not later than December 1, 2005, the commissioner shall submit to

24-45  the director of the legislative counsel bureau for transmission to the

24-46  legislative commission and the legislature a report that must include,

24-47  without limitation:

25-1  (a) The findings of the division delivered to the commissioner pursuant

25-2  to this section; and

25-3  (b) Any recommendations of the commissioner for legislation based

25-4  upon the findings of the division, including, without limitation, any

25-5  recommendations for annual adjustments for inflation for any limitations

25-6  on damages applicable to cases and claims relating to the liability of a

25-7  practitioner licensed to practice medicine, dentistry or osteopathic

25-8  medicine pursuant to chapter 630, 631 or 633 of NRS for a breach of his

25-9  professional duty toward a patient.

25-10  4.  As used in this section:

25-11  (a) “Commissioner” has the meaning ascribed to it in NRS 679A.060.

25-12  (b) “Division” has the meaning ascribed to it in NRS 679A.085.

25-13  Sec. 73.  On or before March 1, 2003, pursuant to subsection 3 of

25-14  section 7 of this act, each district court in this state shall adopt court rules

25-15  to expedite the resolution of an action involving medical malpractice or

25-16  dental malpractice.

25-17  Sec. 74.  (Deleted by amendment.)

25-18  Sec. 75.  1.  This section and sections 1 to 17, inclusive, 51 to 58,

25-19  inclusive, and 62 to 73, inclusive, of this act become effective on

25-20  October 1, 2002.

25-21  2.  Sections 18 to 39, inclusive, 44 to 49, inclusive, 59 and 60 of this

25-22  act become effective on July 1, 2003.

 

25-23  LEADLINES OF REPEALED SECTIONS

 

25-24     41A.0043  “Dentist” defined.

25-25  41A.005  “Division” defined.

25-26  41A.008  “Health care records” defined.

25-27  41A.016  Submission of case to screening panel required before suit

25-28  may be filed; admissibility in court of findings of screening panel.

25-29  41A.019  Creation of tentative screening panels.

25-30  41A.023  Designation of members.

25-31  41A.024  Courses of instruction for members.

25-32  41A.026  Election of chairmen; applicability of rules.

25-33  41A.029  Requirements regarding open meetings do not apply to

25-34  meetings of screening panels.

25-35  41A.033  Administrative duties and powers of division.

25-36  41A.036  Deposit of money received by division with state

25-37  treasurer; payment of administrative costs of screening panel.

25-38  41A.039  Submission of claim to screening panel: Complaint;

25-39  answer; response to answer; service of pleadings; fees.

25-40  41A.043  Selection of members for particular screening panel.

25-41  41A.046  Subpoenas: Powers and duties of division; enforcement.

25-42  41A.049  Hearing by screening panel: Time for holding; materials

25-43  for consideration; findings.

26-1    41A.051  Hearing by screening panel: Preferential scheduling for

26-2  certain elderly claimants and claimants who suffer from terminal

26-3  illness or condition.

26-4    41A.053  Early disclosure of medical or dental records prohibited;

26-5  penalty.

26-6    41A.056  Effect of decision of screening panel.

26-7    41A.059  Conference for settlement of claim: Attendance; powers

26-8  and duties of judge; effect of failure to settle.

26-9    41A.069  Instructions to jury.

26-10  631.377  Screening panel immune from civil action.

 

26-11  H