SB 727 - The act revises provisions relating to civil liability. TAX CREDITS - A tax credit is allowed, up to $10,000, for 10% of the amounts paid for medical malpractice insurance premiums in the aggregate in one policy period for any physician who practices in a high risk specialty and who sees patients, at least 20% of whom are on Medicaid. The credit expires on December 31, 2007. INSURANCE REQUIREMENTS FOR HMO'S - The act provides that health services corporations, HMO's and health benefit plan entities cannot require, as a condition of participation in the network, that a physician maintain a medical malpractice insurance policy that is deemed excessive by the director of the department of insurance. MEDICAL MALPRACTICE INSURANCE RATES - Insurance companies are prohibited from increasing or modifying existing premiums or canceling policies until such time as new rate filings are approved by the Department of Insurance. The act requires the director of the Department of Insurance to approve or disapprove rates for medical malpractice insurance. The act sets out factors for the Director to consider including the Missouri loss experience, rather than the loss experience in other states unless the failure to do so would jeopardize the insurer's financial stability. The Director must also ensure that the rates reflect the impact of any state and federal legislation regarding tort reform or medical malpractice insurance. The Director must approve or disapprove rate filings within 60 days unless additional time is needed based on applicant's failure to provide information. If the Director finds a rate to be excessive, the director may order a refund of the excessive portion of the rate to the policyholder. NOTICE OF PREMIUM INCREASES - This act also prohibits insurers who issue medical malpractice policies from increasing premiums without providing 90 days written notice. VENUE IN MEDICAL MALPRACTICE ACTIONS - In any action commenced against a health care provider for improper healthcare, no suit can be commenced in any county other than the county where the cause of action accrued or an adjoining county. STATUTE OF LIMITATIONS - The act modifies the exception to the two year statute of limitations in cases involving minors. Currently, a minor under 18 years of age has until his or her 20th birthday to bring suit. The act provides that a minor less than 12 years of age has until his or her 14th birthday to bring suit. JOINT AND SEVERAL LIABILITY - Only in medical malpractice actions, the act requires the court to enter judgment against each liable party based on their percentage of fault and on the principle of joint and several liability up to certain dollar amounts depending on the fault of the plaintiff and the percentage fault of the defendant. NON-ECONOMIC DAMAGE CAPS - This provision removes the words "per occurrence" to ensure that there is a single cap, and not multiple caps per incidents of medical malpractice as held by the court in Scott v. SSM Healthcare. Provides for a cap on noneconomic damages of $350,000 and that periodic inflationary increases from the cap shall begin on August 28, 2004. A plaintiff may recover up to $700,000 in noneconomic damages where the damages suffered by the plaintiff were for: (1) wrongful death, (2) permanent and substantial physical deformity, loss of use of a limb or loss of a bodily organ system, or (3) permanent physical or mental functional injury that permanently prevents the injured person from being able to independently care for himself or herself and perform life sustaining activities. AFFIDAVIT OF MERIT - The act modifies the requirements of the affidavit. The health care provider offering the opinion must have training and experience in a like area of expertise and must have been actively practicing within 10 years of the date of the affidavit. The affidavit is subject to review by the court, upon motion of a party, to determine compliance with this section. The affidavit must be filed within 90 days of the defendant filing an affidavit indicating that all records pertaining to the patient have been disclosed to the patient. If the plaintiff fails to file such affidavit in time, the action as to that defendant shall be stayed and, upon motion of the defendant, shall be dismissed without prejudice. BENEVOLENT GESTURES - This provision would make statements, writings, or benevolent gestures expressing sympathy or a general sense of benevolence relating to the pain, suffering, or death of a person involved in an accident inadmissible as evidence in a civil action. Statements of fault, however, shall not be inadmissible. EFFECTIVE DATE OF ACT - The provisions of this act concerning tort reform shall only apply to cases filed after August 28, 2004. This act contains an emergency clause. This act is similar to SB 280 (2003), SB 257 (2003) and SB 387 (2003). JIM ERTLE