P.R. Laws tit. 26, § 4105
Every health service professional and healthcare institution shall annually file proof of his/her or its financial liability in the amount of one hundred thousand dollars ($100,000) per incident or up to an aggregate of three hundred thousand dollars ($300,000) per year. The Commissioner may require limits for a maximum of five hundred thousand dollars ($500,000) per medical incident and an aggregate of one million dollars ($1,000,000) per year in the case of healthcare institutions and of those rate classifications of healthcare service professionals engaged in the practice of high risk specialties, upon the holding of public hearings where such professionals or institutions or any other interested party shall have the opportunity of appearing and expressing their points of view on the matter in question and of furnishing any information, documents, or studies to support their position. Those health service professionals who do not practice their profession privately and who work exclusively as employees of private healthcare institutions shall be exempt from this requirement; provided, that they are covered by the proof of financial liability of the latter. Those health service professionals who render services exclusively as employees, officials, agents, consultants or contractors of the Government of Puerto Rico, its agencies, instrumentalities and municipalities shall also be exempt from this requirement, provided that they do not practice their profession privately. Healthcare institutions belonging to and operated or administered by the Commonwealth of Puerto Rico, its agencies, instrumentalities and municipalities shall also be exempt.
The proof of financial responsibility demanded in the first paragraph of this Section shall be presented at the corresponding Board of Examiners or at the Department of Health, as the case may be, no later than the 30th of June of each year and it shall cover the financial responsibility of the health service professional or of the healthcare institution, as the case may be for the following year.
No healthcare professional (employee or contractor) may be included as defendant in a civil action for damages because of culpability or negligence arising from malpractice committed in the practice of his/her profession while said healthcare professional acts in compliance with his/her duties and functions, including teaching duties; in the neonatal or pediatric intensive care units, operating or emergency rooms, and trauma centers of the San Antonio Hospital in Mayagüez, the Mayagüez Medical Center-Dr. Ramón Emeterio-Betances Hospital-its Trauma Center and its offices; to health professionals rendering such services to patients referred by the State Insurance Fund Corporation (SIFC), as well as those Trauma and Stabilization Centers designated as such under Act No. 544-2004. The same limits shall apply to students and residents using the neonatal or pediatric intensive care units, operating or emergency rooms, and trauma centers of the San Antonio Hospital in Mayagüez and the Mayagüez Medical Center-Dr. Ramón Emeterio-Betances Hospital-as a teaching and university research facility. In these cases, the pediatric and neonatal intensive care specialists and pediatricians, as well as the obstetricians/gynecologists and surgeons of the San Antonio Hospital, the Mayagüez Medical Center-Dr. Ramón Emeterio-Betances Hospital-and the corresponding Trauma Center shall be subject to the liability limits set forth in §§ 3077 et seq. of Title 32, for the Commonwealth under similar circumstances.
The liability limits established in this chapter shall be extensive to every healthcare professional intervening in the diagnosis and treatment of Trauma and Stabilization Center patients, from the time of their admission to their discharge, in a duly designated Trauma and Stabilization Center as provided in the regulations adopted in accordance with Act No. 544-2004, regardless of whether such entity is administered or operated by a private entity.
In any civil action in which damages are claimed against the University of Puerto Rico or the Cardiovascular Center of Puerto Rico and the Caribbean; in any case in which a judgment is pronounced for acts which constitute hospital-medical malpractice committed by the employees, faculty members, residents or students of the Medical Sciences Campus of the University of Puerto Rico or physicians rendering services under contract to the University of Puerto Rico in the performance of its institutional duties; in any case in which a judgment is pronounced for acts or omissions which constitute medico-hospital malpractice incurred by the employees of the Cardiovascular Center of Puerto Rico and the Caribbean, any student or resident of the University of Puerto Rico working therein or any government employee assigned to, and performing duties in said Center; or when a judgment is pronounced for acts or omissions which constitute a fault or negligence directly related to the operation of a health care institution by the University of Puerto Rico, the latter or the Cardiovascular Center of Puerto Rico and the Caribbean shall be subject to the liability limits and conditions which §§ 3077 et seq. of Title 32 imposes to demand that the Commonwealth of Puerto Rico be made liable in similar circumstances.
Every health services professional and health care institution must show its financial solvency for the fiscal year in which it shall exercise its function in one of the following manners:
(1) Establish a guarantee fund whose minimum amount in the case of a health services professional shall be, at all times, the amount of the aggregate limit established as provided in this section and in the case of health care institutions for the amount of one million dollars ($1,000,000). In no case may it be drawn against those amounts without the prior authorization of the Commissioner.
Those health care institutions that avail themselves of this option must also comply with the conditions established below and with those others the Commissioner may authorize so that two (2) or more health care institutions may establish guarantee funds in common, provided they also meet the following requirements:
(a) That the guarantee fund be deposited in a trust created according to the laws of the Commonwealth of Puerto Rico.
(b) That the trust invest said funds in securities authorized by this title for the insurers of the country.
(c) That the trust accredits to the guarantee fund the income accrued as a result of its investments.
(d) That any sum needed to ensure that the guarantee fund maintains the minimum level required be replaced, in case disbursements are made to pay claims.
(e) That the trust use the guarantee fund solely and exclusively for paying claims for medical-hospital professional liability and for paying expenses inherent to said claims.
(f) That a risk management plan be established, with emphasis on matters pertaining to the prevention of losses approved by the Commissioner who may authorize that two or more institutions establish guarantee funds in common, provided they meet all requirements herein established.
(2) To have obtained from an insurer active in the free trade market, or from the Syndicate, a professional liability medical-hospital insurance policy for the limits established as provided in this section. Said insurance contract shall contain a provision stating that the insurer or the Syndicate shall previously notify the corresponding Board of Examiners or the Secretary of Health, as the case may be, about the cancellation or termination of the insurance.
(3) Any combination of a professional liability medical-hospital insurance policy and a guarantee fund that meets all minimum requirements herein established.
(4) Should a health services professional or a health care institution fail to comply with the provisions on financial solvency established in this section, the corresponding Board of Examiners or the Secretary of Health, as the case may be, shall suspend the license or the certificate of authority issued in favor of the aforementioned health services professional or the health care institution, to practice the profession or trade.
(5) In those situations in which the health services professional or the health care institution have incurred by error, omission, fault or negligence in acts of professional malpractice or manifest negligence in the practice of their profession or trade, the Board of Examiners corresponding or the Secretary of Health, as the case may be, shall take the disciplinary actions specifically provided by the law, suspend or revoke the license or certificate of authority issued in favor of the health services professional or the health care institution.
(1) To the University of Puerto Rico, the Puerto Rico and the Caribbean Cardiovascular Center, the Center for Diabetes Research, Education, and Medical Services, and the Industrial Hospital of Puerto Rico in any civil action in which damages are claimed;
(2) to the Medical Sciences Campus of the University of Puerto Rico, in any case in which a judgment is pronounced for medical and hospital malpractice committed by its employees, faculty members, residents, students, or physicians rendering services under contract;
(3) to the Industrial Hospital and healthcare professionals working in said institution in any case in which a judgment is pronounced for actions that constitute medical and hospital malpractice committed by its employees or healthcare professionals who are employees or render services under contract;
(4) to the State Insurance Fund Corporation (SIFC) and the healthcare professionals rendering services to the patients of said public corporation for actions that constitute medical and hospital malpractice committed by said professionals while rendering services to patients referred by the SIFC;
(5) to the Puerto Rico and the Caribbean Cardiovascular Center and the health professionals working in said institution in any case in which a judgment is pronounced for actions that constitute medical and hospital malpractice committed by its employees or healthcare professionals providing services therein while carrying out their teaching duties or offering emergency services;
(6) to the Center for Diabetes Research, Education, and Medical Services, the students working therein, and the health professionals rendering services in said institution while carrying out their teaching or other duties for said Center as its employees or contractors;
(7) to the Regional Academic Medical Centers of Puerto Rico, its students, and faculty members in any case in which a judgment is pronounced for actions that constitute medical and hospital malpractice committed by its students or faculty members while carrying out their teaching duties;
(8) to any student or resident of the Medical Sciences Campus of the University of Puerto Rico or any other duly accredited university or any other government employee assigned to and carrying out functions in the Centers mentioned in subsections (2), (3), (4), (5), and (6), and
(9) to the University of Puerto Rico in any case in which a judgment is pronounced for culpable or negligent actions or omissions directly related to the operation of a healthcare institution.
The responsibility limits imposed by §§ 3077 et seq. of Title 32, on the Commonwealth of Puerto Rico under similar circumstances shall apply in the following cases:
History —Ins. Code, added as § 41.050 on Dec. 30, 1986, No. 4, p. 869, § 1; Aug. 24, 1994, No. 98, § 1; Sept. 19, 1996, No. 242, § 2; Aug. 15, 1999, No. 247, § 2; Dec. 19, 2002, No. 284, § 7; Aug. 24, 2004, No. 228, § 1; Aug. 26, 2004, No. 230, § 16; Aug. 23, 2005, No. 62, § 1; Dec. 5, 2006, No. 260, § 1; June 27, 2011, No. 103, § 1; June 27, 2011, No. 104, § 1; Sept. 29, 2012, No. 278, § 1.