Sunday, April 26, 2026

The TEACH Act Transparent Error Analysis, Candor, and Healthcare Learning Act

Every serious medical error must teach. Candor is protected. Cover-up is punished.

The TEACH Act

Transparent Error Analysis, Candor, and Healthcare Learning Act

A Model State Medical Error Public Reporting and Patient Safety Investigation Act

Section 1. Short Title

This Act shall be known and may be cited as the Transparent Error Analysis, Candor, and Healthcare Learning Act, or the TEACH Act.

Section 2. Legislative Findings and Purpose

2.1 Findings

The Legislature finds that:

(a) Serious medical errors resulting in death or injury requiring medical treatment are matters of public health and public safety.

(b) The purpose of a medical-error investigation is to identify every human, technical, organizational, environmental, staffing, communication, diagnostic, medication, equipment, training, supervision, and policy factor that converged to cause or contribute to patient harm.

(c) A serious medical error is rarely caused by one act or one person. It is commonly the result of multiple converging system conditions.

(d) The existing tort litigation system creates incentives for silence, defensive documentation, delay, incomplete investigation, and concealment of lessons that could prevent future patient harm.

(e) Public safety requires immediate investigation, preservation of evidence, candid participation by health care personnel, disclosure of de-identified lessons, and protection of investigative findings from use in adversarial litigation.

(f) The State has a compelling interest in replacing secrecy after serious medical error with mandatory learning, mandatory reporting, and public dissemination of de-identified safety lessons.

(g) The purpose of this Act is not to conceal ordinary medical records or independently existing facts. The purpose is to protect the special safety investigation so that health care entities and personnel can identify causes candidly and prevent recurrence.

2.2 Purpose

The purposes of this Act are to:

(a) Require immediate reporting of serious medical errors;

(b) Require a complete patient safety investigation of each serious medical error;

(d) Protect patient safety investigation materials and findings from discovery, subpoena, public-records requests, and evidentiary use in civil litigation;

(e) Preserve access to original medical records and independently existing evidence;

(f) Create penalties for failure to report, failure to investigate, false reporting, concealment, retaliation, and cover-up; and

(g) Establish a legal structure in which candor is protected and concealment is punished.

Section 3. Definitions

For purposes of this Act:

3.1 “Adverse medical event”

“Adverse medical event” means an injury, complication, death, or other negative patient outcome that occurs during or after medical care, whether or not the event is ultimately determined to have been preventable.

3.2 “Agency”

“Agency” means the State Department of Health, or such other state agency designated by law to administer this Act.

3.3 “Contributing factor”

“Contributing factor” means any condition, act, omission, decision, process, equipment feature, communication failure, staffing condition, policy, training issue, supervision issue, organizational practice, environmental condition, diagnostic factor, medication factor, handoff failure, documentation failure, technology issue, human-factors issue, financial pressure, production pressure, or other circumstance that caused, increased the risk of, or failed to prevent a serious medical error.

3.4 “Cover-up”

“Cover-up” means any knowing, reckless, or intentional act or omission designed to conceal, distort, delay, falsify, suppress, destroy, alter, mischaracterize, or prevent discovery of a serious medical error or its contributing factors. Cover-up includes, but is not limited to:

(a) Falsifying, altering, backdating, or destroying records;

(b) Directing, pressuring, or inducing any person to provide false or misleading information;

(d) Failing to report a serious medical error as required by this Act;

(e) Knowingly submitting a materially false or misleading report;

(f) Preventing a patient, patient representative, or family member from receiving information required by this Act;

(g) Concealing an ongoing hazard after the health care entity has actual or constructive notice of the hazard; or

(h) Failing to conduct or complete a required patient safety investigation.

3.5 “De-identified”

“De-identified” means that information has been removed, redacted, generalized, coded, aggregated, or otherwise modified so that the identity of a patient, patient representative, family member, individual clinician, individual employee, or other natural person is not reasonably ascertainable.

3.6 “Finding”

“Finding” means any conclusion, determination, causal statement, contributing-factor identification, root-cause analysis, safety recommendation, corrective-action recommendation, hazard classification, preventability assessment, risk assessment, timeline interpretation, credibility assessment, deliberation, analysis, judgment, or evaluative statement created, obtained, assembled, or used in a patient safety investigation under this Act.

3.7 “Health care entity”

“Health care entity” means any hospital, health system, clinic, physician practice, ambulatory surgical center, nursing facility, rehabilitation facility, hospice, home health agency, laboratory, imaging center, pharmacy, emergency medical service, behavioral health facility, birthing center, telehealth provider, accountable care organization, managed care entity, or other person or organization licensed, certified, registered, authorized, or paid to provide health care services in this State.

3.8 “Health care personnel”

“Health care personnel” means any physician, nurse, pharmacist, therapist, technician, aide, resident, fellow, student, contractor, employee, agent, administrator, executive, board member, or other person involved in the delivery, supervision, management, financing, documentation, or support of health care services.

3.9 “Medical error”

“Medical error” means an act, omission, failure, delay, system condition, process failure, diagnostic failure, medication failure, device failure, communication failure, staffing failure, supervision failure, or other health care-related event that caused or contributed to patient harm or created an unreasonable risk of patient harm, regardless of whether the error would constitute negligence under tort law.

3.10 “Patient representative”

“Patient representative” means a person authorized by law to act for the patient, including a parent, guardian, health care proxy, personal representative, executor, administrator, next of kin, or other legally authorized representative.

3.11 “Patient safety investigation”

“Patient safety investigation” means the mandatory investigation required by this Act after a reportable serious medical error, including preservation of evidence, interviews, analysis, root-cause or systems analysis, contributing-factor analysis, corrective-action planning, follow-up, and creation of a public learning report.

3.12 “Protected investigation material”

“Protected investigation material” means all materials created, collected, received, maintained, assembled, analyzed, generated, or used primarily for a patient safety investigation under this Act, including:

(a) Interview notes, transcripts, statements, memoranda, and summaries;

(b) Internal communications concerning the investigation;

(c) Root-cause analyses, apparent-cause analyses, failure-mode analyses, timelines, diagrams, causal maps, and contributing-factor analyses;

(d) Findings, recommendations, conclusions, drafts, deliberations, opinions, and evaluative judgments;

(e) Safety committee materials;

(f) Corrective-action deliberations and implementation analyses;

(g) Reports submitted to the Agency under this Act, except as otherwise expressly provided;

(h) Materials prepared for publication in the public medical error learning registry; and

(i) Any metadata, audit notes, or analytical work product created for the investigation.

3.13 “Public learning report”

“Public learning report” means the de-identified report required by this Act for publication in the State Medical Error Learning Registry.

3.14 “Reportable serious medical error”

“Reportable serious medical error” means any medical error, suspected medical error, or adverse medical event occurring in whole or in part in the course of health care that results in:

(a) Death;

(b) Injury requiring medical treatment;

(d) Unplanned transfer to a higher level of care;

(e) Unplanned surgical, procedural, medication, blood-product, device, or other therapeutic intervention;

(f) Prolonged hospitalization;

(g) Emergency department evaluation or treatment caused by the event;

(h) Birth injury requiring medical treatment;

(i) Hospital-acquired infection or complication requiring medical treatment;

(j) Medication, diagnostic, surgical, anesthesia, monitoring, laboratory, imaging, device, transfusion, handoff, or discharge error requiring medical treatment; or

(k) Any other event designated by Agency regulation as reportable because of its severity or preventability.

Section 4. Duty to Report Serious Medical Errors

4.1 Mandatory internal report

A health care entity shall require health care personnel to report any known or reasonably suspected reportable serious medical error to the entity’s patient safety officer or designated reporting system as soon as practicable, and in no event later than twenty-four hours after discovery.

4.2 Mandatory report to Agency

A health care entity shall report any known or reasonably suspected reportable serious medical error to the Agency no later than seventy-two hours after discovery.

4.3 Preliminary report

The preliminary report to the Agency shall include, to the extent known:

(a) The date, time, and location of the event;

(b) The type of care involved;

(d) Whether death or injury requiring medical treatment occurred;

(e) Whether an ongoing risk to other patients may exist;

(f) Immediate steps taken to protect the patient and other patients;

(g) Confirmation that a patient safety investigation has begun; and

(h) Such other nonprivileged administrative information as the Agency may require.

4.4 No admission of liability

A report made under this Act shall not constitute an admission of negligence, causation, liability, standard-of-care violation, professional misconduct, or legal fault.

4.5 Continuing duty

A health care entity has a continuing duty to supplement its report when additional material information becomes known.

Section 5. Immediate Preservation of Evidence

5.1 Preservation duty

Upon discovery of a reportable serious medical error, the health care entity shall immediately preserve all relevant original records and physical, electronic, and digital evidence.

5.2 Materials to be preserved

Preserved materials shall include, as applicable:

(a) The medical record;

(b) Orders, notes, medication administration records, flowsheets, operative records, anesthesia records, discharge records, nursing records, pharmacy records, laboratory records, imaging records, and billing records;

(d) Electronic health record audit trails;

(e) Medication dispensing records;

(f) Staffing schedules, assignments, acuity data, and supervision records;

(g) Policies, protocols, guidelines, checklists, and training materials in effect at the time;

(h) Relevant communications, including secure messages, pages, calls, texts, emails, and handoff documents;

(i) Photographs, videos, physical objects, medication containers, devices, implants, instruments, and specimens; and

(j) Any other material reasonably likely to contain relevant information.

5.3 Preservation period

Evidence preserved under this section shall be maintained for the longer of:

(a) Ten years;

(b) The applicable statute of limitations and repose;

(d) The period required by the Agency; or

(e) The period required by court order.

5.4 Original records not privileged merely because preserved

Original records and independently existing evidence do not become privileged merely because they are preserved, reviewed, copied, referenced, or analyzed in a patient safety investigation.

Section 6. Mandatory Patient Safety Investigation

6.1 Commencement

A health care entity shall commence a patient safety investigation immediately upon discovery of a reportable serious medical error.

6.2 Investigation team

The investigation shall be conducted by a qualified patient safety investigation team. The team shall include individuals with appropriate clinical, operational, human-factors, risk-management, quality-improvement, and subject-matter expertise.

6.3 Independence

The investigation team shall have authority to obtain information, interview personnel, review records, inspect equipment, examine policies, and recommend corrective action without interference by any person whose primary interest is litigation defense, financial protection, public relations, or avoidance of regulatory consequences.

6.4 Required scope

The patient safety investigation shall identify all contributing factors, including, where relevant:

(a) Diagnostic factors;

(b) Medication factors;

(d) Communication and handoff factors;

(e) Staffing, workload, fatigue, and supervision factors;

(f) Equipment, device, alarm, interface, maintenance, and design factors;

(g) Electronic health record and health information technology factors;

(h) Training, credentialing, privileging, and competency factors;

(i) Policy, protocol, checklist, and workflow factors;

(j) Environmental and facility factors;

(k) Leadership, governance, production pressure, and financial incentive factors;

(l) Prior similar events or near misses;

(m) Reporting culture and retaliation risk;

(n) Patient-specific factors relevant to prevention, without blaming the patient; and

(o) Any other factor necessary to understand how the harm occurred and how recurrence may be prevented.

6.5 Required investigative questions

The investigation shall answer, to the extent reasonably possible:

(a) What happened?

(b) What harm occurred?

(d) What conditions made the event possible?

(e) What safeguards failed?

(f) What safeguards were missing?

(g) Whether similar hazards exist for other patients;

(h) Whether the event was reasonably preventable;

(i) What corrective actions are required;

(j) Who is responsible for implementing each corrective action;

(k) When each corrective action will be completed; and

(l) How completion and effectiveness will be verified.

6.6 Patient and family participation

The health care entity shall offer the patient or patient representative a reasonable opportunity to provide information for the investigation, including observations, questions, concerns, and relevant records.

6.7 Time for completion

The health care entity shall complete the patient safety investigation and submit a final report to the Agency within sixty days after discovery of the reportable serious medical error, unless the Agency grants an extension for good cause.

6.8 Immediate hazard notice

If the investigation identifies an ongoing substantial risk to other patients, the health care entity shall notify the Agency within twenty-four hours and immediately implement interim protective measures.

Section 7. Disclosure to Patient or Patient Representative

7.1 Initial disclosure

Within seven days after discovery of a reportable serious medical error, the health care entity shall disclose to the patient or patient representative:

(a) That a serious adverse event or suspected medical error occurred;

(b) The known general nature of the event;

(d) The care being provided to address the harm;

(e) That a patient safety investigation has begun;

(f) How the patient or patient representative may provide information; and

(g) The expected schedule for further communication.

7.2 Follow-up disclosure

Upon completion of the investigation, the health care entity shall disclose to the patient or patient representative, in plain language:

(a) What is known about what happened;

(b) The general contributing factors identified;

(d) The location of the public learning report when published.

7.3 Apology and expression of sympathy

An apology, expression of sympathy, expression of responsibility, explanation, or disclosure made under this section shall not be admissible to prove negligence, causation, liability, standard of care, professional misconduct, or legal fault.

7.4 No waiver

Disclosure to a patient or patient representative under this section does not waive any privilege, confidentiality, immunity, or protection under this Act.

Section 8. State Medical Error Learning Registry

8.1 Creation

The Agency shall establish and maintain a publicly accessible online registry known as the State Medical Error Learning Registry.

8.2 Purpose

The purpose of the Registry is to allow patients, families, clinicians, health care entities, regulators, researchers, policymakers, and the public to learn from serious medical errors without revealing protected identities or creating litigation evidence.

8.3 Public learning report required

For each reportable serious medical error, the health care entity shall submit a public learning report to the Agency.

8.4 Contents of public learning report

The public learning report shall include, in de-identified form:

(a) The general care setting;

(b) The general type of event;

(d) The relevant clinical process involved;

(e) A plain-language description of what happened;

(f) The contributing factors identified;

(g) The safeguards that failed or were absent;

(h) The corrective actions taken or planned;

(i) The schedule for corrective action;

(j) The method for verifying corrective action;

(k) Any broader safety lesson for other health care entities; and

(l) Such additional de-identified safety information as the Agency may require.

8.5 De-identification

The public learning report shall not identify:

(a) The patient;

(b) A patient representative;

(d) Individual health care personnel;

(e) A witness;

(f) A reporter;

(g) A reviewer; or

(h) Any other natural person whose identity is not necessary for public safety learning.

8.6 Identification of health care entity

The Legislature may choose one of the following alternatives:

Alternative A — Named entity reporting.
The public learning report shall identify the health care entity where the event occurred.

Alternative B — De-identified entity reporting.
The public learning report shall not identify the health care entity, but the Agency shall maintain confidential entity-identifying information for enforcement, trend analysis, and corrective-action monitoring.

Alternative C — Tiered reporting.
The public learning report shall not identify the health care entity for the first event of a substantially similar type, but the Agency shall identify the entity publicly if the entity fails to complete corrective action, repeats a substantially similar preventable event, submits a false report, or engages in cover-up.

8.7 Publication deadline

The Agency shall publish the public learning report within thirty days after receipt of the final investigation report, unless the Agency determines that additional de-identification, clarification, or corrective-action information is required.

8.8 Searchability

The Registry shall be searchable by event type, care setting, specialty, medication, device, diagnosis, procedure, workflow, contributing factor, corrective action, and other patient-safety categories.

8.9 Public report not admissible

A public learning report is created solely for public safety learning and shall not be admissible in any civil action to prove negligence, causation, standard of care, liability, damages, professional misconduct, notice, defect, recklessness, or any other element of a civil claim.

Section 9. Privilege, Confidentiality, and Immunity from Discovery

9.1 General privilege

Protected investigation material is privileged and confidential.

9.2 Immunity from discovery and subpoena

Protected investigation material shall not be:

(a) Subject to subpoena;

(b) Subject to discovery;

(d) Subject to a public-records or freedom-of-information request;

(e) Subject to compulsory disclosure in any civil, administrative, arbitration, licensing, credentialing, employment, or professional disciplinary proceeding;

(f) Admitted into evidence;

(g) Used for impeachment;

(h) Used to establish negligence, causation, liability, standard of care, damages, notice, foreseeability, recklessness, or professional misconduct; or

(i) Used as the basis for expert opinion testimony in any civil action.

9.3 Protection of findings

All findings of a patient safety investigation are absolutely privileged and immune from discovery and evidentiary use, except as expressly provided in this Act.

9.4 Protection of interviews and statements

Statements made by health care personnel, patients, patient representatives, family members, witnesses, reviewers, or investigators for purposes of a patient safety investigation are privileged and immune from discovery and evidentiary use.

9.5 Protection of drafts and deliberations

Drafts, comments, notes, deliberations, mental impressions, disagreements, recommendations, rejected recommendations, and internal communications created for a patient safety investigation are privileged and immune from discovery and evidentiary use.

9.6 Protection of corrective-action analysis

Corrective-action deliberations, risk-ranking, preventability assessments, implementation analysis, and effectiveness analysis are privileged and immune from discovery and evidentiary use.

9.7 No waiver

Privilege and confidentiality under this Act are not waived by:

(a) Reporting to the Agency;

(b) Submitting material to a patient safety organization;

(d) Publication of a de-identified public learning report;

(e) Disclosure to a regulator under confidentiality protection;

(f) Disclosure to a contractor, consultant, expert, insurer, reinsurer, attorney, auditor, accrediting organization, or quality-improvement organization for patient safety purposes;

(g) Use in internal education, quality improvement, credentialing, or peer review; or

(h) Any other disclosure made for patient safety, compliance, or corrective-action purposes under this Act.

9.8 Construction with federal law

This Act shall be construed to supplement, and not reduce, any privilege, confidentiality, or protection available under the Patient Safety and Quality Improvement Act, 42 U.S.C. §§ 299b-21 through 299b-26, 42 C.F.R. Part 3, or any other federal or state law.

Section 10. Materials Not Protected

10.1 Original records

The following are not protected investigation material merely because they are reviewed, copied, preserved, referenced, or analyzed in a patient safety investigation:

(a) Medical records;

(b) Billing records;

(d) Consent forms;

(e) Orders;

(f) Medication administration records;

(g) Laboratory records;

(h) Imaging records;

(i) Device logs existing before the investigation;

(j) Electronic health record audit trails existing before the investigation;

(k) Policies and procedures existing before the investigation;

(l) Staffing records existing before the investigation;

(m) Communications existing before the investigation;

(n) Physical evidence; and

(o) Any other original patient or provider information that exists independently of the patient safety investigation.

10.2 Independent facts

A fact does not become privileged merely because it is learned, discussed, analyzed, or included in protected investigation material.

10.3 Independent testimony

A person with independent knowledge of facts may be required to testify to those facts, but may not be required to disclose:

(a) Statements made for purposes of the patient safety investigation;

(b) Questions asked during the patient safety investigation;

(d) Findings of the investigation;

(e) Deliberations of the investigation team; or

(f) The contents of protected investigation material.

10.4 Required records

A health care entity may not shield records required to be maintained or reported by state or federal law by placing them in a patient safety investigation file.

Section 11. Cover-Up Exception and Forfeiture

11.1 No protection for cover-up

This Act does not protect cover-up.

11.2 Loss of protection

A health care entity that engages in cover-up forfeits the protections of this Act with respect to materials directly relevant to proving the cover-up, subject to the procedures in this section.

11.3 Motion and showing

A party seeking disclosure under this section must file a motion supported by specific facts establishing a substantial basis to believe that cover-up occurred.

11.4 In camera review

Before ordering disclosure, the court shall conduct an in camera review of the disputed materials.

11.5 Standard

The court may order disclosure only upon finding by clear and convincing evidence that:

(a) Cover-up occurred;

(b) The requested material is directly relevant to proving the cover-up or its consequences;

(d) Disclosure is narrowly tailored to the demonstrated need.

11.6 Protective order

Any disclosure ordered under this section shall be subject to a protective order limiting use, reproduction, dissemination, and public filing.

11.7 Punitive consequence

A health care entity that engages in cover-up shall be subject to:

(a) Civil penalties under this Act;

(b) Loss of statutory privilege to the extent provided in this section;

(d) Enhanced administrative sanctions;

(e) Ineligibility for safe-harbor protections under this Act; and

(f) Any other remedy authorized by law.

Section 12. Protection Against Retaliation

12.1 Prohibited retaliation

A health care entity shall not discharge, demote, suspend, threaten, harass, discipline, discriminate against, report in bad faith, reduce privileges, reduce compensation, or otherwise retaliate against any person because the person:

(a) Reports a serious medical error;

(b) Participates in a patient safety investigation;

(d) Refuses to participate in cover-up;

(e) Discloses an ongoing substantial risk to patient safety; or

(f) Assists a patient, patient representative, or family member in providing information.

12.2 Remedies

A person subjected to retaliation may bring a civil action for:

(a) Reinstatement;

(b) Restoration of privileges;

(d) Front pay;

(e) Compensatory damages;

(f) Reasonable attorney fees and costs;

(g) Injunctive relief; and

(h) Any other relief necessary to make the person whole.

12.3 Burden of proof

If protected activity was a contributing factor in the adverse action, the burden shifts to the health care entity to prove by clear and convincing evidence that it would have taken the same action absent the protected activity.

Section 13. Agency Oversight and Enforcement

13.1 Agency authority

The Agency shall administer and enforce this Act.

13.2 Powers

The Agency may:

(a) Receive reports;

(b) Require supplemental information;

(d) Require corrective action;

(e) Monitor implementation;

(f) Publish public learning reports;

(g) Issue regulations;

(h) Impose civil penalties;

(i) Refer matters to licensing boards, accrediting bodies, payors, or law enforcement; and

(j) Take any action reasonably necessary to carry out this Act.

13.3 Confidential Agency file

The Agency shall maintain confidential files sufficient to identify health care entities, monitor recurring hazards, enforce corrective action, and detect failure to report.

13.4 Trend reports

The Agency shall publish at least annually an aggregate statewide patient-safety report identifying:

(a) Number and type of serious medical errors reported;

(b) Care settings involved;

(d) Recurrent hazards;

(e) Corrective-action categories;

(f) Compliance trends;

(g) Enforcement actions;

(h) Recommendations for statewide safety improvement; and

(i) Legislative or regulatory recommendations.

13.5 Agency use of protected material

The Agency may use protected investigation material for oversight, enforcement, public health, and patient safety purposes, but shall not disclose protected investigation material except as expressly authorized by this Act.

Section 14. Civil Penalties

14.1 Failure to report

A health care entity that fails to report a reportable serious medical error as required by this Act shall be subject to a civil penalty of not less than $25,000 and not more than $250,000 per event.

14.2 Failure to investigate

A health care entity that fails to conduct or complete a patient safety investigation as required by this Act shall be subject to a civil penalty of not less than $50,000 and not more than $500,000 per event.

14.3 Failure to publish or submit public learning report

A health care entity that fails to submit a public learning report as required by this Act shall be subject to a civil penalty of not less than $25,000 and not more than $250,000 per event.

14.4 False or misleading report

A health care entity that knowingly submits a materially false or misleading report shall be subject to a civil penalty of not less than $100,000 and not more than $1,000,000 per event.

14.5 Cover-up

A health care entity that engages in cover-up shall be subject to a civil penalty of not less than $250,000 and not more than $5,000,000 per event.

14.6 Retaliation

A health care entity that retaliates against a person protected by this Act shall be subject to a civil penalty of not less than $50,000 and not more than $500,000 per violation.

14.7 Factors

In setting penalties, the Agency shall consider:

(a) Severity of harm;

(b) Duration of noncompliance;

(d) Prior violations;

(e) Size and resources of the health care entity;

(f) Cooperation with the Agency;

(g) Corrective action taken;

(h) Whether patients remained at risk; and

(i) Whether cover-up or retaliation occurred.

Section 15. Safe Harbor for Full Compliance

15.1 Safe harbor

A health care entity that timely reports, fully investigates, preserves evidence, discloses to the patient or patient representative, submits a public learning report, implements corrective action, and does not engage in cover-up shall receive the protections of this Act.

15.2 No punitive damages based on protected investigation

No punitive, exemplary, or enhanced damages may be based on protected investigation material, findings, public learning reports, disclosures required by this Act, or corrective actions taken under this Act.

15.3 Corrective action not admission

Corrective action taken after a reportable serious medical error shall not be admissible to prove negligence, culpability, standard of care, defect, causation, liability, or damages.

Section 16. Interaction with Civil Litigation

16.1 No discovery of protected material

In any civil action, arbitration, or administrative proceeding, no party may obtain protected investigation material.

16.2 No adverse inference

No adverse inference may be drawn from a health care entity’s assertion of privilege under this Act.

16.3 Discovery of original evidence preserved

Nothing in this Act prevents discovery of original records, independently existing evidence, or testimony based on independent personal knowledge, subject to otherwise applicable law.

16.4 Expert testimony

An expert witness may not rely on protected investigation material, findings, or public learning reports as a basis for an opinion in civil litigation.

16.5 Public learning report

A public learning report may be used for public health, research, policy, education, and safety improvement, but shall not be admissible in civil litigation.

Section 17. Criminal Conduct

17.1 Criminal conduct not protected

This Act does not immunize criminal conduct.

17.2 Referral

If a patient safety investigation identifies evidence of intentional falsification, intentional destruction of evidence, intentional patient harm, criminal neglect, fraud, or other criminal conduct, the health care entity shall report the matter to the appropriate law enforcement authority and the Agency.

17.3 Limited disclosure

Protected investigation material may be disclosed to law enforcement only as expressly required by court order after in camera review and only to the extent necessary to investigate or prosecute criminal conduct.

Section 18. Regulatory and Licensing Proceedings

18.1 General protection

Protected investigation material shall not be used in professional licensing, credentialing, privileging, employment, or disciplinary proceedings except as expressly authorized in this Act.

18.2 Original evidence available

Licensing boards and regulators may obtain original records and independently existing evidence.

18.3 Cover-up and intentional misconduct

Upon a finding after in camera review that cover-up or intentional misconduct occurred, the court may authorize limited disclosure of protected investigation material directly relevant to such cover-up or intentional misconduct.

Section 19. Data Use, Research, and Public Health

19.1 De-identified use

The Agency may use de-identified information from reports and public learning reports for research, public health, education, and patient-safety improvement.

19.2 Research access

The Agency may permit qualified researchers to access de-identified or limited data sets under data-use agreements that protect confidentiality and prohibit re-identification.

19.3 Prohibition on re-identification

No person may attempt to re-identify any patient, clinician, reporter, reviewer, witness, family member, or health care personnel from information published under this Act.

19.4 Penalty for re-identification

A person who knowingly re-identifies or attempts to re-identify protected information shall be subject to civil penalties and injunctive relief.

Section 20. Rulemaking

The Agency shall promulgate regulations to implement this Act, including rules governing:

(a) Report forms;

(b) Reporting deadlines;

(d) De-identification standards;

(e) Investigation standards;

(f) Corrective-action tracking;

(g) Registry design;

(h) Agency audits;

(i) Enforcement procedures;

(j) Civil penalties;

(k) Patient and family disclosure;

(l) Protection of confidential information; and

(m) Coordination with federal patient safety organizations and federal reporting systems.

Section 21. Annual Legislative Review

The Agency shall submit an annual report to the Governor and Legislature containing:

(a) Aggregate serious medical error data;

(b) Trends in death and serious injury;

(d) Corrective actions taken statewide;

(e) Rates of reporting by health care entity type;

(f) Enforcement actions;

(g) Barriers to reporting and investigation;

(h) Recommendations for statutory or regulatory amendment; and

(i) Assessment of whether the Act is improving patient safety.

Section 22. Private Right of Action for Retaliation and Cover-Up

22.1 Retaliation

A person injured by retaliation prohibited by this Act may bring a civil action as provided in Section 12.

22.2 Cover-up injury

A patient or patient representative injured by cover-up may bring a civil action for damages caused by the cover-up.

22.3 Remedies

In an action for cover-up, the court may award:

(a) Actual damages caused by the cover-up;

(b) Reasonable attorney fees and costs;

(d) Punitive damages where authorized by law;

(e) Civil penalties payable to the State; and

(f) Any other appropriate relief.

22.4 Protected investigation material

Discovery in an action for cover-up shall be governed by Section 11.

Section 23. Severability

If any provision of this Act or its application to any person or circumstance is held invalid, the invalidity shall not affect other provisions or applications of the Act that can be given effect without the invalid provision or application. The provisions of this Act are severable.

Section 24. Effective Date

This Act shall take effect one year after enactment.

Section 25. Transition

25.1 Agency preparation

Within six months after enactment, the Agency shall establish reporting forms, de-identification standards, investigation standards, and the initial design of the State Medical Error Learning Registry.

25.2 Health care entity preparation

Within nine months after enactment, each health care entity shall:

(a) Designate a patient safety officer;

(b) Establish a reporting process;

(d) Adopt evidence-preservation procedures;

(e) Adopt investigation procedures;

(f) Adopt patient and family disclosure procedures;

(g) Adopt anti-retaliation procedures; and

(h) Certify readiness to the Agency.

25.3 Initial implementation

For the first year after the effective date, the Agency may reduce civil penalties for good-faith first violations that do not involve death, intentional misconduct, retaliation, false reporting, or cover-up.

Optional Stronger Version: Tort-Limiting Addendum

The following optional section would go beyond reporting and privilege. It would move the statute closer to the position that ordinary medical error should be handled through mandatory investigation and public learning, while litigation should be reserved for cover-up, intentional misconduct, reckless disregard, or refusal to comply.

Optional Section 26. Limitation on Civil Actions Where Full Compliance Occurs

26.1 Administrative remedy

Where a health care entity fully complies with this Act and does not engage in cover-up, intentional misconduct, reckless disregard, or knowing repetition of a previously identified hazard, the patient’s remedy for ordinary medical error shall be limited to an administrative compensation process established by separate statute.

26.2 Preservation of action for cover-up and intentional misconduct

Nothing in this section bars a civil action for:

(a) Cover-up;

(b) Intentional harm;

(d) Falsification or destruction of records;

(e) Retaliation;

(f) Knowing failure to correct a previously identified serious hazard;

(g) Reckless disregard of a known and substantial risk; or

(h) Failure to comply materially with this Act.

26.3 No use of protected findings

Even where a civil action is permitted under this section, protected investigation material and findings remain privileged except as provided in the cover-up exception.

Optional Constitutional Guardrail

Optional Section 27. Preservation of Due Process

This Act shall not be construed to deny any person access to original medical records, independently existing evidence, eyewitness testimony based on independent knowledge, or any remedy required by the State Constitution or the Constitution of the United States. The privilege created by this Act applies only to protected investigation material created or assembled for patient safety investigation, learning, reporting, corrective action, and prevention.