COMMITTEE ON HEALTH, HOSPITALS AND HUMAN 
SERVICES 
 
BILL NO. 
36-0048 
 
Thirty-Sixth Legislature of the Virgin Islands 
 
 
 
March 28, 2025 
 
 
 
An Act amending title 22, Virgin Islands Code, chapter 3 relating to annual rate changes for 
medical malpractice liability insurance and amending title 27, Virgin Islands Code, chapter 1 
by increasing the limitation on recovery in medical malpractice actions from $250,000 to 
$400,000; designating the records and testimony gathered by quality improvement committees 
as confidential; and establishing additional requirements for filing medical malpractice claims 
 
 
 
PROPOSED BY: 
 
 
Senator Novelle E. Francis, Jr. 
 
Be it enacted by the Legislature of the Virgin Islands: 
1 
SECTION 1.  Title 22 Virgin Islands Code, chapter 3 is amended by adding the 
2 
following section 53b: 
3 
Ҥ53b.  Annual rate change for medical malpractice liability insurance 
4 
(a) 
The Commissioner shall prescribe, by regulation, a designated range of 
5 
annual rate change for medical malpractice liability insurance, which must be an increase 
6 
or decrease of between not less than 5% and not more than 15%, and within which any 
7 
rate, supplementary rate information, or change or amendment thereof, filed by an 
8 
insurer or rating organization, becomes effective not less than 30 days after the  filing. 
9 
(1) The Commissioner may determine, pursuant to regulation, the 
10 
categories, subcategories, specialties, and subspecialties of the health care 
11 
provider to which the application of the designated range will apply. 
12 
(2) Only one filing by an insurer or rating organization of a proposed 
13 
2 
 
rate change within the designated range may take effect within any 12-month 
1 
period without the express approval of the Commissioner, as set forth in 
2 
subsection (c). 
3 
(b) 
In prescribing the designated range of annual rate change, the 
4 
Commissioner may consider the availability and affordability of medical malpractice 
5 
liability insurance for different categories, subcategories, specialties, and 
6 
subspecialties of the health care provider in relation to the capitalization and reserve 
7 
requirements necessary to ensure the solvency of the insurers.  The Commissioner may 
8 
also consider current data relating to the frequency and severity of medical malpractice 
9 
claims and trends in the cost of investigating, defending and settling claims. 
10 
(c) 
(1) Any filing by an insurer or rating organization proposing a rate change 
11 
that exceeds  the designated range established pursuant to subsection (a) or proposing 
12 
an additional rate change within this range during any 12-month period, is subject to 
13 
approval by the Commissioner. 
14 
(2) 
If the Commissioner determines that there is not sufficient evidence to justify 
15 
a new rate, the Commissioner may disallow the rate increase.  The reason for the rejection 
16 
must be in writing.  An aggrieved carrier may demand a hearing pursuant to chapter 7 of 
17 
this title to reconsider the ruling and may appeal from the Commissioner's order refusing 
18 
a hearing or an order on hearing to the Superior Court of the Virgin Islands.  The appeal 
19 
must be taken within 30 days. 
20 
SECTION 2.  Title 27 Virgin Islands Code, chapter 1 is amended as follows: 
21 
(a) 
Add subchapter IId to read: 
22 
“Subchapter IId. Quality Improvement Committees 
23 
§58.  Policy 
24 
It is the policy of this Territory to encourage the improvement of patient safety, 
25 
3 
 
the quality of patient care and the evaluation of the quality, safety, cost, processes 
1 
and necessity of healthcare services by hospitals, healthcare facilities and 
2 
healthcare providers.  This Territory further recognizes that certain protections 
3 
must be available to these entities to ensure that they are able to effectively pursue 
4 
these measures. 
5 
§59.  Definitions 
6 
As used in this section: 
7 
(a) "Healthcare organization" means any: 
8 
(1) 
Healthcare facility licensed or regulated by the Territory; 
9 
(2) 
Hospital under the Virgin Islands Government Hospitals and Health 
10 
Facilities Corporation or any other hospital regulated by this Territory; 
11 
(3) 
Entity owning, owned by, affiliated with or providing ancillary or 
12 
allied health services to, or on behalf of, a hospital or healthcare facility 
13 
licensed or regulated by this Territory; 
14 
(4) 
Entity that contracts with a healthcare organization to perform any 
15 
of the functions of a quality improvement committee; 
16 
(5) 
Entity that maintains a patient safety evaluation system in 
17 
compliance with the Patient Safety and Quality Improvement Act of 2005, P.L. 
18 
109-41 for reporting to a patient safety organization listed as such by the 
19 
federal  secretary of health and human services pursuant to § 924 of the Patient 
20 
Safety and Quality Improvement Act of 2005; 
21 
(6) 
Professional assistance program providing, or attempting to 
22 
provide, intervention, counseling, referral or other assistance to any 
23 
healthcare provider or family of a healthcare provider directly related to and 
24 
including the alcohol or drug impairment of a healthcare provider; 
25 
4 
 
(7) 
Professional healthcare foundation; 
1 
(8) 
Health maintenance organization, preferred provider organization, 
2 
hospital and medical service corporation, or accountable care organization as 
3 
defined by§ 3022 of the federal Patient Protection and Affordable Care Act, P.L. 
4 
111-148; 
5 
(9) 
Entity that operates or manages hospitals or related facilities in the 
6 
Virgin Islands, including specifically the Virgin Islands Government Hospitals 
7 
and  Health Facilities Corporation; 
8 
(10) Accredited medical programs in the Territory; or 
9 
(11) Community behavioral health center as defined by 19 V.I.C. § 4101. 
10 
(b) "Healthcare provider" means any healthcare professional licensed, 
11 
authorized, certified or regulated under title 27 Virgin Islands Code, including 
12 
medical resident physicians, interns and fellows participating in a training 
13 
program of one of the accredited medical schools or of one of such medical school's 
14 
affiliated teaching hospitals in this Territory, or any other clinical staff of a healthcare 
15 
organization. 
16 
(c) "Quality improvement committee" or "QIC" means a committee formed or 
17 
retained by a healthcare organization, an activity of a healthcare organization, or one or more 
18 
individuals employed by a healthcare organization performing the types of functions listed in 
19 
paragraphs (1)-(16), the purpose of which, or one of the purposes  of which is to evaluate the 
20 
safety, quality, processes, costs, appropriateness or necessity of healthcare services by 
21 
performing functions including: 
22 
(1) 
Evaluation and improvement of the quality of healthcare 
23 
services  rendered; 
24 
(2) 
Determination 
that health services rendered were professionally 
25 
5 
 
indicated or were performed in compliance with the applicable standards of care; 
1 
(3) 
Determination that the cost of health care rendered was reasonable; 
2 
(4) 
Evaluation 
of 
the 
qualifications, credentials, 
competence 
and 
3 
performance of healthcare providers or actions upon matters relating to the 
4 
discipline of any individual healthcare provider; 
5 
(5) 
Reduction of morbidity or mortality; 
6 
(6) 
Establishment and enforcement of guidelines designed to keep the cost of  
7 
health care within reasonable bounds; 
8 
(7) 
Research; 
9 
(8) 
Evaluation of whether healthcare facilities are being properly utilized; 
10 
(9) 
Supervision, education, discipline, admission, and the determination of 
11 
privileges of healthcare providers; 
12 
(10) Review of professional qualifications or activities of healthcare providers; 
13 
(11) Evaluation of the quantity, quality and timeliness of healthcare services  
14 
rendered to patients; 
15 
(12) Evaluation, review or improvement of methods, procedures or 
16 
treatments  being utilized; 
17 
(13) Participation in utilization review activities, including participation in review 
18 
activities within the healthcare facility and activities in conjunction  with an insurer or 
19 
utilization review committee members or related or affiliated personnel; 
20 
(14) The evaluation of reports and any internal reports related thereto or in  the 
21 
course of a healthcare organization's patient safety and risk management activities; 
22 
(15) Activities to determine the healthcare organization's compliance with 
23 
local or federal regulations; 
24 
6 
 
(16) Participation in patient safety activities as defined at § 921 of the 
1 
Patient Safety and Quality Improvement Act of 2005. 
2 
(d) "Records" means records of interviews and all reports, incident reports, 
3 
statements, minutes, memoranda, charts, statistics, evaluations, critiques, test results, 
4 
corrective actions, disciplinary actions, and all other documentation generated by  or 
5 
in connection with activities of a QIC and any patient safety work product as defined 
6 
at § 921 of the Patient Safety and Quality Improvement Act of 2005. 
7 
§60.  Records, confidentiality 
8 
(a) Records of a QIC and testimony or statements by a healthcare organization's 
9 
officers, directors, trustees, healthcare providers, administrative staff, employees or 
10 
other committee members or attendees relating to activities of the QIC are confidential 
11 
and privileged and are protected from direct or indirect means of discovery, subpoena 
12 
or admission into evidence in any judicial or administrative proceeding.  Any person 
13 
who supplies information, testifies or makes statements as part of a QIC may not be 
14 
required to provide information as to the information, testimony or statements 
15 
provided to or made before a QIC or opinions formed by such person as a result of 
16 
committee participation. 
17 
(b) Any information, documents or records, which are not produced for use by 
18 
a QIC, or which are not produced by persons acting on behalf of a QIC, and are otherwise 
19 
available from original sources, may not be construed as immune from discovery or 
20 
use in  any judicial or administrative proceeding merely because the information, 
21 
documents or  records were presented during proceedings of the QIC. 
22 
(c) A QIC may share information and documents, including complaints, 
23 
incident reports, and testimony and statements by any person to the QIC, with one or 
24 
more other QICs as defined under this section.  Information and documents disclosed 
25 
7 
 
by one QIC to another QIC, and any information and documents created or maintained 
1 
as a result of the sharing of such information and documents, are confidential, 
2 
privileged and protected from direct or indirect means of discovery, subpoena or 
3 
admission into evidence, to the same extent as provided in subsection (a).  The QIC 
4 
sharing such information with another QIC shall determine the manner and process by 
5 
which it will share such information and documents, which process may include 
6 
requiring a written agreement between QICs regarding the sharing of practitioner 
7 
information.  The QIC and its sponsoring healthcare organization may not be held 
8 
liable and are immune from suit for any disclosure or sharing of information in 
9 
compliance with this section. 
10 
§60a.  Immunity, information provided to QIC 
11 
(a) No healthcare organization or its officers, trustees, directors, healthcare 
12 
providers, administrative staff, employees, other committee members or attendees, or 
13 
any person  providing information to a QIC is liable: 
14 
(1) 
In any action for damages or other relief arising from the provision of 
15 
information to a QIC or in any judicial or administrative proceeding if the 
16 
information is provided to the QIC in good faith and without malice and on 
17 
the  basis of facts reasonably known or reasonably believed to exist; or 
18 
(2) 
For damages resulting from any decisions, opinions, actions, and 
19 
proceedings rendered, entered or acted upon by a QIC undertaken or 
20 
performed within the scope or function of the duties of a QIC or in any judicial 
21 
or administrative proceeding, if made or taken in good faith and without 
22 
malice and on  the basis of facts reasonably known or reasonably believed to 
23 
exist. 
24 
(b) Any person providing information to a QIC is presumed to have acted 
25 
8 
 
in good faith and without malice.  Any person alleging lack of good faith has the 
1 
burden of proving bad-faith and malice. 
2 
(c) All decisions, opinions, actions and proceedings rendered, entered or acted 
3 
upon by a QIC are presumed to have been completed in good faith and without malice. 
4 
Any person alleging lack of good faith has the burden of proving bad faith and malice. 
5 
§60b.  Immunity, reviewers in general 
6 
Any person who serves on any peer review committee or any other committee 
7 
board, commission or other entity constituted by any Virgin Islands medical 
8 
association, local medical society, the Virgin Islands Government Hospitals and Health 
9 
Facilities or governmental or quasi-governmental agency, for the purpose of quality 
10 
improvement, evaluating or making determinations relative to alleged acts or 
11 
omissions of patient care and treatment, is immune from liability with respect to  any 
12 
action taken by that person in good faith and without malice as a member of the 
13 
committee, board, commission or other entity. 
14 
§60c.  Federal laws 
15 
Nothing in this subchapter may conflict with any federal protection of records 
16 
provided under the federal Health Care Quality Improvement Act, compiled in 42 
17 
U.S.C. § 11101 et.  seq., or the federal Patient Safety Act.” 
18 
SECTION 3.  Title 27 Virgin Islands Code, chapter 1, subchapter IX is amended in the 
19 
following instances: 
20 
(a) 
In section 166, subsection (g), strike “$250,000” and insert “$400,000”; 
21 
(b) 
In section 166b: 
22 
(1) 
in subsection (a), strike “two hundred and fifty thousand dollars ($250,000)” 
23 
and insert “$400,000”; 
24 
9 
 
(2) 
in subsection (c), strike “seventy-five thousand dollars ($75,000)” and insert 
1 
“$120,000”; and  
2 
(3) 
add subsections (g) and (h) to read: 
3 
“(g) (1) Beginning July 1, 2026, and each July 1 thereafter until July 1, 
4 
2031, the Director of the Office of Management and Budget (“OMB”), with the 
5 
assistance of the V.I. Bureau of Economic Research (“VIBER”) shall adjust the 
6 
limit for damages under subsection (a) for inflation. 
7 
(2) 
The amount in paragraph (1) must: 
8 
(A) be rounded to the nearest $10,000; and 
9 
(B) apply to a cause of action arising on or after the date the 
10 
annual adjustment is made. 
11 
(3) 
By July 15 of each year until July 1, 2031, the Director of OMB, 
12 
with the assistance of the VIBER, shall: 
13 
(A) certify the inflation-adjusted limit calculated under this 
14 
subsection; and 
15 
(B) inform the Commissioner of Health and the Superior Court 
16 
of the Virgin Islands of the certified limit. 
17 
(h) 
The term “inflation” as used in subsection (g) means the seasonally 
18 
adjusted consumer price index for all urban consumers as published by the Bureau 
19 
of Labor Statistics of the United States Department of Labor.” 
20 
(c) 
In section 166e: 
21 
(1) 
in subsection (b), strike “$250,000” and insert “$400,000”; 
22 
(2) 
in subsection (e)(3), strike “$250,000” and insert “$400,000”; and 
23 
(3) 
add subsection (j) to read: 
24 
10 
 
“(j) The liability amounts in subsection (b) and subsection (e)(3) must be 
1 
adjusted to conform with the provisions of 27 V.I.C. §166b(g).” 
2 
(d) 
In section 166i: 
3 
(1) 
in subsection (b), insert “if the complaint is accompanied by an Affidavit of 
4 
Merit consistent with section 166n” after “provider in court”. 
5 
(2) 
in subsection (d), add paragraph (5) to read: 
6 
“(5) In an action subsequently brought by a claimant in court after a finding 
7 
by the expert under subsection (d)(1) that the health care provider acted within the 
8 
appropriate standards of medical care as charged in the proposed complaint, the 
9 
claimant shall file an Affidavit of Merit, consistent with section 166n, and post a 
10 
bond, consistent with section 166o, with the filing of the complaint.” 
11 
(e) 
add sections 166n through 166q to read: 
12 
Ҥ166n.  Affidavit of Merit  
13 
(a) 
Except as provided in subsection (f), the claimant shall file the Affidavit of Merit 
14 
required to be filed under section 166i subsections (b) and (d)(5) as to each named defendant 
15 
signed by an expert witness, as defined in section 166p(b)(1), and accompanied by a current 
16 
curriculum vitae of the expert witness, stating that: 
17 
(1) 
the expert is competent under section 166p (b) to express an opinion or 
18 
opinions in the case; and 
19 
(2) 
there are reasonable grounds and a good faith basis to maintain an  action 
20 
consistent with the requirements of section166p(a) as to each named defendant. 
21 
(b) 
The Affidavit of Merit and curriculum vitae must be filed with the court in a 
22 
sealed  envelope which must  state on its face: 
23 
11 
 
"CONFIDENTIAL SUBJECT TO  27 V.I.C. §166n. THE CONTENTS OF 
1 
THIS ENVELOPE MAY ONLY BE VIEWED BY A JUDGE OF THE SUPERIOR 
2 
COURT." 
3 
(c) 
Notwithstanding 3 V.I.C. §881 or any law to the contrary, the Affidavit of Merit 
4 
must be and must remain sealed and confidential, except as provided in subsection (g). 
5 
(d) 
If the Affidavit of Merit is not filed with the complaint, the court shall dismiss 
6 
as provided in subsection (e) absent a showing that the failure was due to demonstrated 
7 
extraordinary cause. 
8 
(e) 
The failure of a claimant to file an Affidavit of Merit in compliance with this 
9 
section, upon motion, makes the action subject to dismissal with prejudice.  The court 
10 
may, upon timely motion of the claimant and for extraordinary cause shown, grant a single 
11 
60-day extension to file the Affidavit of Merit.  Extraordinary cause includes the inability 
12 
to obtain, despite reasonable efforts, relevant medical records for expert review.  A motion 
13 
to extend the time for filing an Affidavit of Merit is timely only if it is filed on or before 
14 
the filing date of the complaint.  The filing of a motion to extend the time for filing an 
15 
Affidavit of Merit tolls the time period within which the affidavit must be filed until the 
16 
court rules on the motion.  In cases where a motion to extend the time for filing an Affidavit 
17 
of Merit is filed, the defendant is not required to take any action with respect to the 
18 
complaint until 20 days after the court rules on the motion and the claimant has filed the 
19 
Affidavit of Merit. 
20 
(f) 
An Affidavit of Merit is not required if the complaint alleges a rebuttable 
21 
inference of medical negligence, the grounds of which are set forth in subsection (h). 
22 
(g) 
Upon motion by the defendant, the court shall determine in camera if the 
23 
Affidavit of Merit complies with subsection (a).  The Affidavit of Merit  is not discoverable 
24 
in any malpractice action.  The Affidavit of Merit itself, and the fact that an expert has 
25 
12 
 
signed the Affidavit of Merit, are not discoverable or admissible, nor may the expert be 
1 
questioned in any respect about the existence of the Affidavit of Merit in the underlying 
2 
malpractice action or any subsequent unrelated malpractice action in which that expert serves 
3 
as a witness. 
4 
(h) 
(1) A rebuttable inference that personal injury or death was caused by medical 
5 
negligence arises where evidence is presented that the personal injury or death occurred in any 
6 
one or more of the following circumstances: 
7 
(A) A foreign object was unintentionally left within the body of the 
8 
patient following surgery; 
9 
(B) An explosion or fire originating in a substance used in treatment 
10 
occurred in the course of treatment; or 
11 
(C) A surgical procedure was performed on the wrong patient or the wrong 
12 
organ, limb or part of the patient's body. 
13 
(2) 
Except as otherwise provided in paragraph (1), there may be no inference or 
14 
presumption of negligence on the part of a health care provider. 
15 
§166o.  Requirement of a Bond 
16 
(a) 
The bond required to be filed under section 166i(d)(5) must be in the amount 
17 
$6,000.00 in the aggregate, secured by cash or its equivalent, and filed with the clerk of the 
18 
Superior Court of the Virgin Islands, payable to the defendant in the case for costs assessed, 
19 
including witness and experts fees and attorney's fees if the claimant does not prevail in the 
20 
final judgment. If the bond is not posted when the complaint is filed, the action shall be 
21 
dismissed. 
22 
(b) 
Upon motion filed by the claimant, and a determination by the court that the 
23 
claimant is indigent, the judge may reduce the amount of the bond but may not eliminate the 
24 
requirement of a bond. 
25 
13 
 
§166p.  Claimant’s burden in medical malpractice action, expert testimony, jury 
1 
instructions 
2 
(a) 
In a malpractice action, the claimant has the burden of proving by expert testimony, 
3 
the qualifications of which are described in subsection (b), the following: 
4 
(1) 
The recognized standard of acceptable professional practice in the profession 
5 
and the specialty thereof, if any, that the defendant practices in the community in which 
6 
the defendant practices or in a similar community at the time the alleged injury or 
7 
wrongful action occurred; 
8 
(2) 
That the defendant acted with less than or failed to act with ordinary and 
9 
reasonable care in accordance with the standard in paragraph (1); and 
10 
(3) 
As a proximate result of the defendant's negligent act or omission, the 
11 
claimant suffered injuries which would not otherwise have occurred. 
12 
(b) 
(1) No person in a health care profession requiring licensure under the laws of this 
13 
Territory is competent to testify in any court of law to establish the facts required to be 
14 
established by subsection (a), unless the person was licensed to practice in any U.S. state or 
15 
territory, a profession or specialty which would make the person's expert testimony relevant to 
16 
the issues in the case, and has practiced this profession or specialty and has been engaged in 
17 
the treatment of patients in a relevant field of medicine to the issues in the  case in a U.S. state 
18 
or territory during the year immediately preceding the date that the alleged injury or wrongful 
19 
act occurred.  
20 
(2) The requirements of paragraph (1) also apply to expert witnesses testifying 
21 
for the defendant as rebuttal witnesses. 
22 
(c) 
(1) In a malpractice action, the court shall instruct the jury that the claimant has the 
23 
burden of proving, by a preponderance of the evidence, the negligence of the defendant and, 
24 
that as a proximate result of the defendant's negligent act or omission, the claimant suffered an 
25 
14 
 
injury or injuries which would not otherwise have occurred.  The court shall further instruct the 
1 
jury that injury alone does not raise a presumption of a defendant's negligence. 
2 
(2) 
The instructions required to be given in paragraph (1) must also be applied 
3 
in the case of a bench trial. 
4 
§166q.  Claimant’s burden in action for failure to obtain informed consent  
5 
In a malpractice action based upon the lack of informed consent, the claimant shall prove 
6 
by expert testimony, the qualifications of which are described in section 166p (b), that the 
7 
defendant did not supply appropriate information to the claimant  in obtaining informed consent 
8 
as to the procedure out of which claimant's claim allegedly arose, in accordance with the 
9 
recognized standards of acceptable professional practice in the profession and in the specialty, 
10 
if any, that the defendant practices in the community in which the defendant practices and in 
11 
similar communities.” 
12 
BILL SUMMARY 
13 
The bill amends title 22 Virgin Islands Code, chapter 3 by adding section 53b requiring 
14 
the Commissioner of the Division of Banking and Insurance to prescribe, by regulation, a 
15 
designated range of annual rate change for medical malpractice liability insurance and 
16 
restricting insurers offering malpractice insurance to one proposed rate change filing every 12 
17 
months.  The bill also amends title 27 Virgin Islands Code, chapter 1 by: designating the records 
18 
and testimony of healthcare quality improvement committees to be confidential and privileged 
19 
and offering immunity to persons offering this information who act in good faith and without 
20 
malice and offering immunity protection to persons serving on committees, commissions, or 
21 
boards involving patient care and treatment who act in good faith and without malice; 
22 
increasing the limitation on recovery in malpractice actions and increasing the amount required 
23 
for malpractice liability insurance coverage, from $250,0000 to $400,000; requiring the 
24 
Director of the Office of Management and Budget, with the assistance of the VI Bureau of 
25 
Economic Research, to adjust for inflation, the recovery limitation amount for malpractice suits 
26 
15 
 
over the next five years; requiring a claimant to file an Affidavit of Merit in cases where the 
1 
Medical Malpractice Action Review Committee (“Committee”) fails to receive an expert 
2 
opinion within 90 days from the filing date of the complaint and requiring a patient to file an 
3 
Affidavit of Merit and a bond in the amount of $6,000 in cases where the expert selected by 
4 
the Committee renders an opinion that a health care provider acted within the appropriate 
5 
standards of medical care and the patient proceeds to file a malpractice suit in court; 
6 
establishing the requirements for an Affidavit of Merit and requiring the affidavit to be signed 
7 
by an expert witness and accompanied by a current curriculum vitae of the expert witness; 
8 
allowing a judge to reduce the amount of the $6,000 bond upon filing of a motion by the 
9 
claimant and a determination by the court that the claimant is indigent; establishing the factors 
10 
to be proven to establish a rebuttable inference that personal injury or death was caused by 
11 
medical negligence and providing that an Affidavit of Merit is not required in cases where this 
12 
inference exists; and establishing a claimant’s burden in a malpractice action and the jury 
13 
instructions to be given by the court in a jury or bench trial. 
14 
BR25-0189/March 25, 2025/GC 
15