To amend sections 3929.482, 3929.85, 3931.01, 3955.05, 3960.06, and 4731.143, to enact sections 2323.45, 2323.451, 2323.452, 2323,453, 2323.454, 2323.455, 2323.456, 2323.457, 2323.458, 2323.459, 2323.4510, 2323.4511, 2323.4512, 2323.4513, 2323.4514, 2323.4515, 2323.4516, 2323.4517, 2323.4518, 2323.4519, and 2323.4520, and to repeal sections 3929.71, 3929.72, 3929.721, 3929.73, 3929.75, 3929.76, 3929.77, 3929.78, 3929.79, 3929.80, 3929.81, 3929.82, 3929.83, and 3929.84 of the Revised Code to require medical claims against healthcare providers to be reviewed by a medical review panel prior to the claim proceeding in court.

Section 1. That sections 3929.482, 3929.85, 3931.01, 3955.05, 3960.06, and 4731.143 be amended, and sections 2323.45, 2323.451, 2323.452, 2323,453, 2323.454, 2323.455, 2323.456, 2323.457, 2323.458, 2323.459, 2323.4510, 2323.4511, 2323.4512, 2323.4513, 2323.4514, 2323.4515, 2323.4516, 2323.4517, 2323.4518, 2323.4519, and 2323.4520 of the Revised Code be enacted to read as follows:

Sec. 2323.45.  (A) As used in sections 2323.45 and 2323.451 to 2323.4520 of the Revised Code:

(1) "Medical claim" means any claim that is asserted in any civil actions against a physician, podiatrist, hospital, home, or residential facility, against any employee or agent of a physician, podiatrist, hospital, home, or residential facility, or against a licensed practical nurse, registered nurse, advanced practice nurse, physical therapist, physician assistant, emergency medical technician-basic, emergency medical technician-intermediate, or emergency medical technician-paramedic, and that arises out of the medical diagnosis, care, or treatment of any person. "Medical claim" includes the following:

(a) A derivative claim for relief that arises out of the medical diagnosis, care, or treatment of an individual;

(b) A claim that arises out of the medical diagnosis, care, or treatment of an individual, resulting from acts or omissions in providing medical care or the hiring, training, supervision, retention, or termination of caregivers providing medical diagnosis, care, or treatment.

(2) "Provider" means a physician, podiatrist, hospital, home, or residential facility, an employee or agent of a physician, podiatrist, hospital, home, or residential facility, a licensed practical nurse, registered nurse, advanced practice nurse, physical therapist, physician assistant, emergency medical technician-basic, emergency medical technician-intermediate, or emergency medical technician-paramedic.

(B) Sections 2323.45 and 2323.451 to 2323.4520 of the Revised Code apply when a medical claim is asserted against a provider, unless the plaintiff and provider have entered into a valid and enforceable contract under section 2711.22 of the Revised Code requiring binding arbitration of medical claims or have agreed to submit to nonbinding arbitration under section 2711.21 of the Revised Code.

(C) A medical review panel shall review medical claims against providers pursuant to sections 2323.45 and 2323.451 to 2323.4520 of the Revised Code. A provider shall notify the superintendent of insurance when a civil action asserting a medical claim against the provider is commenced. The medical review panel shall review the claim and render its expert opinion prior to the civil action proceeding on the claim.

(D) Section 2305.113 of the Revised Code governs the time limits for commencing the medical claim with the common pleas court.

Sec. 2323.451.  Not earlier than twenty days after a provider notifies the department of insurance of the commencement of a medical claim against the provider either party to the claim may request the formation of a medical review panel by serving notice by certified mail upon all parties and the superintendent of insurance.

Sec. 2323.452.  (A) A medical review panel shall consist of one attorney and three providers.

(B) The attorney member of the medical review panel shall act as chairperson of the panel and in an advisory capacity, but shall not vote.

(C) The chairperson of a medical review panel shall expedite the selection of the other panel members, convene the panel, and expedite the panel's review of the medical claim. The chairperson shall establish a reasonable schedule for submission of evidence to the medical review panel, allowing sufficient time for the parties to make full and adequate presentation of facts and authorities related to the claim.

Sec. 2323.453.  A medical review panel shall be selected in the following manner:

(A) Within fifteen days after the filing of a request for the formation of a medical review panel under section 2323.45 of the Revised Code, the parties shall select a chairperson by agreement.

(B)(1) If an agreement on a chairperson cannot be reached, either party may request the clerk of the Ohio supreme court to draw at random a list of the names of five attorneys who are qualified to practice in Ohio and who maintain offices in the county of venue designated in the medical claim or in a contiguous county.

(2) The clerk may charge a reasonable fee for drawing the list of qualified attorneys.

(3) The clerk shall notify the parties when a list of attorneys' names has been drawn, and the parties shall then strike names alternately, with the plaintiff striking first. The clerk shall notify a party after the opposing party has stricken a name. The remaining attorney shall be the chairperson of the medical review panel. The clerk shall notify the attorney and all other parties of the identity of the chairperson within five days after the selection.

(4) If a party does not strike a name within five days after receiving notice from the clerk, the opposing party shall, in writing, direct the clerk to strike an attorney's name. The remaining attorney shall be the chairperson of the medical review panel. The clerk shall notify the attorney and all other parties of the identity of the chairperson within five days after the selection.

(C) Within fifteen days after receiving notice of being selected as chairperson, the chairperson either shall:

(1) Send a written acknowledgment of appointment to the clerk;

(2) Show good cause for relief from the appointment under section 2323.458 of the Revised Code.

Sec. 2323.454.  (A) Within fifteen days after being notified of the selection of a chairperson, each party before a medical review panel shall select a provider to serve as a member of the panel. Except for individuals who are serving as an administrator of a hospital, home, or residential facility, all individual providers shall be available for selection as a member of a medical review panel. Each party shall identify the provider selected, in writing, to the other party and the chairperson, within this fifteen-day period. If a party fails to make a selection and provide notice within the time provided, the chairperson shall make the selection and identify the provider selected, in writing, to all parties.

(B) Within fifteen days after being selected, the two providers selected under division (A) of this section shall select a third provider and notify the chairperson and all parties in writing. If the providers fail to make a selection, the chairperson shall select the third provider and notify all parties.

Sec. 2323.455.  (A) If there are multiple plaintiffs or defendants before a medical review panel, only one provider shall be selected per side to serve as a member of the panel. The plaintiff, whether single or multiple, has the right to select one provider and the defendant, whether single or multiple, has the right to select one provider.

(B) If there is only one defendant, and that defendant is an individual, two of the panel members selected shall be providers in the same health care profession as the defendant. If the defendant specializes in a limited field, two of the panel members selected shall be providers who specialize in the same field as the defendant.

Sec. 2323.456.  (A) Within ten days after a party is notified of the opposing party's selection of a provider to serve as a member of the medical review panel, the opposing party may challenge the selection without cause and submit the challenge to the chairperson in writing. Upon a challenge, the party whose selection is challenged shall select another provider.

(B) If either party challenges the selection made by the two providers chosen by the parties, the providers shall make a new selection. If two challenges without cause are submitted to the chairperson, the chairperson shall nominate three qualified providers within ten days after receiving the second challenge without cause. Each party shall eliminate one of the nominated providers within ten days, and the remaining provider shall serve as the third member of the panel.

Sec. 2323.457.  Within five days after all members of a medical review panel are selected, the chairperson shall send a notice by certified mail to the superintendent of insurance and all parties before the panel, notifying them of the following:

(A) The names and addresses of the panel members;

(B) The date on which the last panel member was selected.

Sec. 2323.458.  (A) An individual selected to serve as a member of a medical review panel under section 2323.453, 2323.454, or 2323.456 of the Revised Code shall serve unless:

(1) The parties excuse the individual by mutual agreement;

(2) The individual is excused for good cause shown under division (B) or (C) of this section.

(B) To show good cause for relief from serving on a medical review panel, the attorney selected as chairperson of a medical review panel shall serve an affidavit upon the clerk of the Ohio supreme court, setting out facts showing that service would constitute an unreasonable burden or undue hardship. The clerk may excuse the attorney from serving on the panel and shall notify all parties. The parties shall select a new chairperson pursuant to section 2323.453 of the Revised Code.

(C) To show good cause for relief from serving on a medical review panel, a provider shall serve an affidavit upon the panel chairperson. The affidavit shall set out facts showing that service would constitute an unreasonable burden or undue hardship. The chairperson may excuse the provider from serving on the panel, and shall notify all parties. The remaining members of the panel shall select a new provider within fifteen days.

Sec. 2323.459.  (A) A medical review panel shall give its expert opinion within one hundred eighty days after the selection of the last member of the panel. However, if more than ninety days after the last member of the panel is selected the panel's chairperson is removed under division (C) of this section, the chairperson removes a panel member under division (D) of this section, or any member of the panel is removed by a court order, the panel has ninety days after the selection of a new panel member to give its expert opinion.

(B) If the medical review panel does not give an opinion within the time allowed under division (A) of this section, the panel shall submit a report to the superintendent of insurance stating the reason for the delay.

(C) The superintendent of insurance may remove the chairperson of a medical review panel if the superintendent determines that the chairperson is not fulfilling the duties imposed upon the chairperson by sections 2323.45 and 2323.451 to 2323.4520 of the Revised Code. If the chairperson is removed under this division, the parties shall select a new chairperson pursuant to section 2323.453 of the Revised Code.

(D) The chairperson may remove a member of the medical review panel if the chairperson determines that the member is not fulfilling the duties imposed upon panel members by sections 2323.45 and 2323.451 to 2323.4520 of the Revised Code. If a member is removed under this division, the remaining members of the panel shall select a new member within fifteen days.

Sec. 2323.4510.  (A) Parties wanting written evidence to be considered by the medical review panel shall submit the evidence promptly. The evidence may consist of medical charts, x-rays, lab tests, excerpts of treatises, depositions of witnesses including parties, and any other form of evidence allowable by the medical review panel.

(B) Parties and witnesses may be deposed before the convening of the medical review panel.

(C) The chairperson shall ensure that before the medical review panel gives its expert opinion under section 2323.4515 of the Revised Code, each panel member has the opportunity to review every item of evidence submitted by the parties.

(D) Before considering any evidence or deliberating with other panel members, each member of the medical review panel shall take an oath in writing on a form provided by the panel chairperson, which shall read as follows:

"I (swear) (affirm) under penalties of perjury that I will well and truly consider the evidence submitted by the parties; that I will render my opinion without bias, based upon the evidence submitted by the parties, and that I have not and will not communicate with any party or representative of a party before rendering my opinion, except as authorized by law."

Sec. 2323.4511.  The parties before a medical review panel, agents and attorneys of the parties, and the defendant's medical malpractice insurer, shall not communicate with any member of the panel before the panel gives its expert opinion under section 2323.4515 of the Revised Code.

Sec. 2323.4512.  The chairperson of the medical review panel shall advise the panel relative to any legal question involved in the review proceeding and shall prepare the opinion of the panel given under section 2323.4515 of the Revised Code.

Sec. 2323.4513.  (A) A medical review panel may request all information necessary to reach its expert opinion and may consult with medical authorities. The panel may examine relevant provider medical reports.

(B) All parties shall have full access to any material received by the medical review panel.

Sec. 2323.4514.  (A) After all evidence is submitted to the medical review panel, either party may convene the panel at a time and place agreeable to the members of the panel. After an agreement is reached on the time and place, the chairperson of the panel shall give ten days notice to the other party. Either party may question the panel concerning any matter pertaining to the panel's review.

(B) The chairperson of the medical review panel shall preside at all meetings. Meetings shall be informal.

Sec. 2323.4515.  (A) The sole duty of the medical review panel is to express the panel's expert opinion as to whether or not the evidence supports a conclusion that the defendant or defendants failed to act within the appropriate standards of medical care as claimed by the plaintiff. The opinion is not a ruling of law. The opinion may be a consideration to parties negotiating a settlement.

(B) Within thirty days after all evidence is submitted by the parties, the panel shall review the evidence and give one or more of the following expert opinions, in writing and signed by the panel members:

(1) The evidence supports the conclusion that the defendant or defendants failed to comply with the appropriate standard of care as claimed by the plaintiff.

(2) The evidence does not support the conclusion that the defendant or defendants failed to meet the applicable standard of care as claimed by the plaintiff.

(3) There is a material question of fact bearing on the defendant's or defendants' liability.

(4) The conduct complained of was or was not a factor in the resultant damages. If the panel concludes the conduct was a factor, the panel shall state whether the plaintiff suffered any disability and the extent and duration of the disability, or suffered any permanent impairment and the percentage of the impairment.

(C) Upon issuing its opinion, the panel shall cease to exist.

Sec. 2323.4516.  The expert opinion reached by the medical review panel is admissible as evidence in any civil action brought by the plaintiff. The expert opinion is not conclusive. Either party to the civil action, at the party's cost, may call any member of the medical review panel as a witness. If called, the member shall appear and testify.

Sec. 2323.4517.  The chairperson of a medical review panel shall send a copy of the panel's report, by certified mail, to the superintendent of insurance and all parties within five days after the panel gives its expert opinion.

Sec. 2323.4518.  Members of a medical review panel have absolute immunity from civil liability for all communications, findings, opinions, and conclusions made in the course and scope of the duties assigned to them under sections 2323.45 and 2323.451 to 2323.4520 of the Revised Code.

Sec. 2323.4519. (A) Each provider member of a medical review panel shall receive both of the following:

(1) Three hundred fifty dollars for all work performed as a member of the panel. If the member is called to testify as a witness in court, the member's time in court is not work as a member of the panel.

(2) Reasonable travel expenses.

(B) The chairperson of a medical review panel shall receive both of the following:

(1) Pay of two hundred fifty dollars per day, not to exceed two thousand dollars;

(2) Reasonable travel expenses.

(C) The chairperson shall keep an accurate record of the time and expenses of each member of the panel. The record shall be submitted to the parties for payment with the panel's report.

(D) The prevailing party shall pay the panel's expenses, including travel expenses and other expenses of the review. If there is no majority opinion, each side shall pay fifty per cent of the panel's expenses.

Sec. 2323.4520.  If all parties to a medical claim agree to submit the claim to nonbinding arbitration, the medical review panel shall end its review of the medical claim and the claim shall proceed to nonbinding arbitration under section 2711.21 of the Revised Code. Sections 2323.45 and 2323.451 to 2323.4517 of the Revised Code shall not apply to a medical claim after the parties have agreed to submit the claim to nonbinding arbitration.

Sec. 3929.482.  (A) The Ohio fair plan underwriting association by action of its board of governors, with the approval of the superintendent of insurance, is authorized to enter into a contract with any association formed under a medical professional liability insurance plan created by authority of section 3929.72 of the Revised Code, whereby Ohio fair plan underwriting association will perform administrative services necessary or incidental to the operation of the medical professional liability insurance plan. Such contract shall provide that the Ohio fair plan underwriting association will be reimbursed for its actual expenses incurred in performing such services. Common expenses applicable both to the Ohio fair plan and to the medical professional liability insurance plan shall be allocated between them on an equitable basis approved by the superintendent of insurance.

(B) The Ohio fair plan underwriting association by action of its board of governors, with the approval of the superintendent of insurance, is authorized to enter into a contract with the Ohio mine subsidence insurance underwriting association to provide administrative and claims adjusting services required by it. Such contract shall provide indemnification by the Ohio mine subsidence insurance underwriting association to the Ohio fair plan underwriting association, its members, members of its board of governors, officers, employees, and agents against all liability, loss, and expense resulting from acts done or omitted in good faith in performing such contract. Such contract shall also provide that the Ohio fair plan underwriting association will be reimbursed for its actual expenses incurred in performing such services. Common expenses applicable both to the Ohio fair plan and to the mine subsidence insurance underwriting association shall be allocated between them on an equitable basis approved by the superintendent of insurance.

(C)(B) The Ohio fair plan underwriting association by action of its board of governors, with the approval of the superintendent of insurance, is authorized to enter into a contract with the Ohio commercial joint underwriting association to provide administrative and claims adjusting services required by it. Such contract shall provide indemnification by the Ohio commercial joint underwriting association to the Ohio fair plan underwriting association, its members, members of its board of governors, officers, employees, and agents against all liability, loss, and expenses resulting from acts done or omitted in good faith in performing such contract. Such contract shall also provide that the Ohio fair plan underwriting association will be reimbursed for its actual expenses incurred in performing such services. Common expenses applicable both to the Ohio fair plan and to the Ohio commercial joint underwriting association shall be allocated between them on an equitable basis approved by the superintendent of insurance.

Sec. 3929.85.  No insurer licensed to carry on the business of insurance in this state that is required by law to contribute to, participate in, or which can be assessed by the Ohio insurance guaranty association pursuant to sections 3955.01 to 3955.19 of the Revised Code, or by the plan for apportionment of applicants for motor vehicle insurance pursuant to section 4509.70 of the Revised Code, or by the Ohio fair plan underwriting association pursuant to sections 3929.43 to 3929.61 of the Revised Code, or by the joint underwriting association pursuant to sections 3929.71 to 3929.85 of the Revised Code, or by the Ohio commercial insurance joint underwriting association pursuant to sections 3930.03 to 3930.18 of the Revised Code shall in any calendar year be required to contribute to, participate in, or be assessed by any one or more of the aforementioned plans or associations in an amount or amounts totaling in excess of two and one-half per cent of its net direct Ohio premium volume for the year next preceding the year in which the assessment or assessments are made or the contributions or participations are required.

Sec. 3931.01.  Individuals, partnerships, and corporations of this state, designated in sections 3931.01 to 3931.12 of the Revised Code, as "subscribers," may exchange reciprocal or interinsurance contracts with each other, and with individuals, partnerships, and corporations of other states, districts, provinces, and countries, providing indemnity among themselves from any loss which may be legally insured against by any fire or casualty insurance company or association provided that contracts of indemnity against property damage and bodily injury arising out of the ownership, maintenance or use of a singly owned private passenger automobile principally used for nonbusiness purposes may not be exchanged through a reciprocal insurer which maintains a surplus over all liabilities of less than two and one-half million dollars and provided that this exception shall not prohibit the exchanging of contracts of indemnity against any form of liability otherwise authorized and arising out of any business or commercial enterprise. Such contracts and the exchange thereof and such subscribers, their attorneys, and representatives shall be regulated by such sections, and no law enacted after July 4, 1917, shall apply to them, unless they are expressly designated therein.

Such a contract may be executed by an attorney or other representative designated "attorney," in sections 3931.01 to 3931.12 of the Revised Code, authorized by and acting for such subscribers under powers of attorney. Such attorney may be a corporation. The principal office of such attorney shall be maintained at the place designated by the subscribers in the powers of attorney.

Except for such limitations on assessability as are approved by the superintendent of insurance, every reciprocal or interinsurance contract written pursuant to this chapter for medical malpractice insurance as defined in division (A) of section 3929.71 of the Revised Code shall be fully assessable and shall contain a statement, in boldface capital letters and in type more prominent than that of the balance of the contract, setting forth such terms of accessability assessability.

Sec. 3955.05.  Sections 3955.01 to 3955.19 of the Revised Code apply to all kinds of direct insurance, except:

(A) Title insurance;

(B) Fidelity or surety bonds, or any other bonding obligations;

(C) Credit insurance, vendors' single interest insurance, collateral protection insurance, or any similar insurance protecting the interests of a creditor arising out of a creditor-debtor transaction;

(D) Mortgage guaranty, financial guaranty, residual value, or other forms of insurance offering protection against investment risks;

(E) Ocean marine insurance;

(F) Any insurance provided by or guaranteed by government including, but not limited to, any department, board, office, commission, agency, institution, or other instrumentality or entity of any branch of state government, any political subdivision of this state, the United States or any agency of the United States, or any separate or joint governmental self-insurance or risk-pooling program, plan, or pool;

(G) Contracts of any corporation by which health services are to be provided to its subscribers;

(H) Life, annuity, health, or disability insurance, including sickness and accident insurance written pursuant to Chapter 3923. of the Revised Code;

(I) Fraternal benefit insurance;

(J) Mutual protective insurance of persons or property;

(K) Reciprocal or interinsurance contracts written pursuant to Chapter 3931. of the Revised Code for medical malpractice insurance as defined in division (A) of section 3929.71 of the Revised Code;

(L) Any political subdivision self-insurance program or joint political subdivision self-insurance pool established under Chapter 2744. of the Revised Code;

(M) Warranty or service contracts, or the insurance of such contracts;

(N) Any state university or college self-insurance program established under section 3345.202 of the Revised Code;

(O) Any transaction, or combination of transactions, between a person, including affiliates of such person, and an insurer, including affiliates of such insurer, that involves the transfer of investment or credit risk unaccompanied by a transfer of insurance risk;

(P) Credit union share guaranty insurance issued pursuant to Chapter 1761. of the Revised Code;

(Q) Insurance issued by risk retention groups as defined in Chapter 3960. of the Revised Code;

(R) Workers' compensation insurance, including any contract indemnifying an employer who pays compensation directly to employees.

Sec. 3960.06.  (A) A purchasing group and its insurer or insurers are subject to all applicable laws of this state, except that a purchasing group and its insurer or insurers, in regard to liability insurance for the purchasing group, are exempt from any law that does any of the following:

(1) Prohibits the establishment of a purchasing group;

(2) Makes it unlawful for an insurer to provide or offer to provide insurance on a basis providing, to a purchasing group or its members, advantages based on their loss and expense experience not afforded to other persons with respect to rates, policy forms, coverages, or other matters;

(3) Prohibits a purchasing group or its members from purchasing insurance on a group basis described in division (A)(2) of this section;

(4) Prohibits a purchasing group from obtaining insurance on a group basis because the group has not been in existence for a minimum period of time or because any member has not belonged to the group for a minimum period of time;

(5) Requires that a purchasing group have a minimum number of members, common ownership or affiliation, or a certain legal form;

(6) Requires that a certain percentage of a purchasing group obtain insurance on a group basis;

(7) Otherwise discriminates against a purchasing group or any of its members;

(8) Requires that any insurance policy issued to a purchasing group or any of its members be countersigned by an insurance agent or broker residing in this state.

(B) The superintendent of insurance may require or exempt a risk retention group from participation in any joint underwriting association established under section 3929.72 or 3930.03 or in the plan established under section 4509.70 of the Revised Code. Any risk retention group that is required to participate under this division shall submit sufficient information to the superintendent to enable him the superintendent to apportion on a nondiscriminatory basis the risk retention group's proportionate share of losses and expenses.

Sec. 4731.143.  (A) Each person holding a valid certificate under this chapter authorizing the certificate holder to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery, who is not covered by medical malpractice insurance as defined in section 3929.71 of the Revised Code, shall provide a patient with written notice of the certificate holder's lack of such insurance coverage prior to providing nonemergency professional services to the patient. The notice shall be provided alone on its own page. The notice shall provide space for the patient to acknowledge receipt of the notice, and shall be in the following form:

"N O T I C E:

Dr. ............... (here state the full name of the certificate holder) is not covered by medical malpractice insurance.

The undersigned acknowledges the receipt of this notice.

The certificate holder shall obtain the patient's signature, acknowledging the patient's receipt of the notice, prior to providing nonemergency professional services to the patient. The certificate holder shall maintain the signed notice in the patient's file.

(B) This section does not apply to any officer or employee of the state, as those terms are defined in section 9.85 of the Revised Code, who is immune from civil liability under section 9.86 of the Revised Code or is entitled to indemnification pursuant to section 9.87 of the Revised Code, to the extent that the person is acting within the scope of the person's employment or official responsibilities.

This section does not apply to a person who complies with division (B)(2) of section 2305.234 of the Revised Code.

Section 2. That existing sections 3929.482, 3929.85, 3931.01, 3955.05, 3960.06, and 4731.143 and sections 3929.71, 3929.72, 3929.721, 3929.73, 3929.75, 3929.76, 3929.77, 3929.78, 3929.79, 3929.80, 3929.81, 3929.82, 3929.83, and 3929.84 of the Revised Code are hereby repealed.