1. Introduction HELMS & GREENE, LLC When it’s all on the line HOUSE BILL 4 Kirk Willis MEMBER kwillis@helmsgreene.com

2. Good bye Article 4590i, Hello Chapter 74 of the Civil Practice & Remedies Code.

3. New major changes in 6 areas of the law New definitions with an expanded scope of Health Care Institutions and Health Care Providers New Damage Caps for Non-economic Damages New Provisions Re: Emergency Care New Procedures for Notice, Expert Reports (No More Cost Bonds) and Discovery New Statutes of Repose New periodic payment provisions for future

4. Lets start with the new definitions 1.“ Claimant” 2.“Affiliate” 3.“Control” 4.“Court” 5.“Disclosure panel” 6.“Economic damages” 7.“Emergency medical care” 8.“Emergency medical services provider” 9.“Gross negligence” 10.“Health care”

5. New Definitions “Claimant” means a person, including a decedent’s estate, seeking or who has sought recovery of damages in a health care liability claim. All persons claiming to have sustained damages as the result of the bodily injury or death of a single person are considered a single claimant. “Claimant” means a person, including a decedent’s estate, seeking or who has sought recovery of damages in a health care liability claim. All persons claiming to have sustained damages as the result of the bodily injury or death of a single person are considered a single claimant.

6. Bad Death Case- The Utts Exception Utts v. Short which came out of the Texas Supreme Court about a year ago. In Utts, there were several plaintiffs in a lawsuit and one of the defendants settled out.

7. New Definitions “Emergency medical care” “Emergency medical care” I. Bona fide emergency services provided II. Sudden onset of a medical trauma or condition III. Acute symptoms of sufficient severity IV. Lack of medical attention could result in compromise of health.

8. Patient is Stabilized I would like to point out that the term does not cover medical care after the patient is stabilized. There are special protections in the new statute for those who render emergency care.

9. Jury Consideration in Emergency Cases Whether the person providing care did or did not have the patients medical history The presence or lack of a preexisting physician- patient relationship The circumstances constituting the emergency The circumstances surrounding the delivery of the emergency medical care

10. “Health Care Institution” includes: 1.a n ambulatory surgical center 2.a n assisted living facility licensed under Chapter 247, Health and Safety Code 3.a n emergency medical services provider 4.a health services district created under Chapter 287, Health and Safety Code 5.a home and community support services agency 6.a hospice 7.a hospital 8.a hospital system

11. Chiropractors are now covered under the statute

12. Optometrist are now covered under the statute

13. New Definitions “Health care provider” “Health care provider” (B) The term includes: (i) an officer, director, shareholder, owner, or affiliate of a health care member, partner, manager provider or physician; and (ii) an employee, independent contractor, or agent of a health care provider or physician acting in the course and scope of the employment or contractual relationship. (ii) an employee, independent contractor, or agent of a health care provider or physician acting in the course and scope of the employment or contractual relationship.

14. Professional Association Partnership of Limited Liability Partnership formed by physicians Nonprofit health corporation Company formed under the Texas Limited Liability Company Act The Court has also now expanded the definition of Physician

15. It’s All About The Money! Care Maintenance Support Service Advice Counsel

16. Jury Consideration Relationship between parties Living arrangement Any absence for long period of time Harmony of family unit Common interests and activities Letters Photos Videotapes Audiotapes Movies

17. No Mix of Business with Medical

18. Lets now move to Notice and Pleadings Plaintiffs must now give 60 days written notice before filing a med mal suit. This notice must be accompanied by a medical authorization which form is set out in Section 74.052. If notice is given it tolls the statute of limitations for 75 days against all parties to whom it is given and all potential parties. So we really have a statute of limitations in Texas of 2 years and 75 days.

19. Medical Authorizations Defendants can now go and talk to plaintiff’s treating physicians after they receive the medical authorization.

20. Kirk Willis – Mr. Texas

21. Patient Authorization The plaintiffs have the option under of listing health care providers who they have seen in the last 5 years which they contend are not related to the issues in the current lawsuit.

22. Cornerstone of Tort Reform 1 physician, 6 physicians or 10 physicians, the most the plaintiff can recover in all of those situations for their non- economic damages is $250,000.00

23. Economic Damages No Cap Lost wages and Medical Expenses unlimited Apartments Stocks Profit Sharing

24. Cornerstone of Tort Reform The most the plaintiff can recover for their non- economic damages in a suit against a single health care entity is $250,000.00.

25. Absolute CAP The most a plaintiff can recover for their non-economic damages if they get a negligence finding against one physician and two health care institutions is $750,000.00.

26. Stowers Doctrine Basically there is no more Stowers doctrine in Texas for med mal cases as the liability of any insurer shall not exceed the liability of the insured.

27. Experts Plaintiff’s must still provide expert reports. Now it must be done with 120 days after the claim was filed. The date can be extended by agreement of the parties. If you are to object to the report you must do it now within 21 days after you get it or you have waived you objections

28. Experts Set forth the standard of care How the standard was breached How the negligent act or omission proximately cause injury

29. Objection to Experts Objection to the qualifications an expert witness must be filed on the 21st day after you get the expert’s resume or 21 days after his deposition, whichever is later

30. Causation Causation

31. Pecuniary Loss Care Maintenance Support Service Advice Counsel

32. Loss Earning Over $100,000 You can move the court to pay these future damages in periodic payments The court shall order these periodic payments Courts discretion to determine the amount of the payments, to whom they will be made Future damages by periodic payments constitutes a release of the health care liability claim

33. Kirk Willis MEMBER Thank You kwillis@helmsgreene.com HELMS GREENE, LLC When it’s all on the line