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framework by which hospitals, doctors, and healthcare providers may voluntarily report information to PSOs on a privileged and confidential basis, for the aggregation and analysis of patient safety events.” It also delineates the requirements to be met to become a PSO and how applicants will be reviewed and certified (AHRQ, n.d.). As of early January 2014 there are 79 PSOs in 29 states (a PSO can operate nationwide and not just in its home state); Florida has eight of them (AHRQ, 2014).Florida History, Laws, and Requirements In 2004, largely in response to the 1999 IOM report, the Florida legislature established the Florida Patient Safety Corporation (FPSC), whose purpose was to monitor patient safety throughout the state. An important goal of the FPSC was to establish a voluntary Near Miss Reporting System (NMRS), based on a successful system used in the commercial aviation industry, and the system was intended to provide immunity from legal penalties and sanctions (Florida Senate, 2008, 2009). In 2004 two amendments to the state constitution were passed by Florida voters: the Patients’ Right-to-Know about Adverse Medical Incidents Act (known at the time as Amendment 7 but now Article 10, Section 25 of the Florida Constitution), and the Three Strikes and You Are Out Act (Amendment 8). Writing the following year for “AHRQ: Morbidity and Mortality Rounds on the Web,” Paul Barach noted that Amendment 7 had eliminated confidentiality provisions recommended by the near-miss reporting program and allowed full access to all patient records, including all meetings, morbidity and mortality conferences, root cause analyses, and any other professional exchanges of information related to a patient’s injury or death. Brach noted that risk management professionals said that Amendment 7 had done immense harm to quality assurance and peer-review protections developed over the previous twenty years and caused an immediate decline in the reporting of adverse events throughout the state. Amendment 8 also had an unintended chilling effect on the reporting of near misses and adverse events (Barach, 2005). The two amendments to the state constitution did indeed introduce a great deal of confusion and uncertainty into the Florida medical errors situation and they exacerbated an already recognized issue with under-reporting of adverse events. Approximately three dozen court cases were filed in the four years following the passage of Amendment 7, with lower-court decisions ruling both for and against the release of information. Two cases eventually found their way to the Florida Supreme Court, which rendered its decision in favor of Amendment 7 in both cases in early 2008 (Florida Senate, 2008; Rosenfeld, 2008). The Florida Patient Safety Corporation operated until May 2009, when its enabling statute was repealed at the corporation’s request. Since 2004 the FPSC had followed its legislative mandate to establish itself as a working entity. It had acquired preliminary certification as a PSO from the AHRQ and gotten the Near Miss Reporting System (NMRS) up and running. However, part of its establishing legislation required it to obtain grants and other private funding in order to fully support itself. It was never able to do so; and, in fact, the FPSC believed that some funding should always come from the state as a show of support for its mission. State funding for the FPSC ended after the 2007–2008 fiscal year and the first casualty was the NMRS. Although senate committee recommendations had been to continue the corporation and extend the exceptions allowing confidentiality of reports, it was unclear how the latter would fit with the Florida Supreme Court decisions regarding Amendment 7. On January 29, 2009, the FPSC “Board of Directors voted to seek repeal of the statutes establishing the corporation and this was accomplished in May 2009 (Florida House, 2009; Florida Legislature, 2006; Florida Senate, 2007, 2008, 2009; Florida Statutes, 2009). Reports in the Florida media in 2011 suggested the system remained in a state of paralysis, in part due to conflicts, or perceived conflicts, between state and federal laws and in part because of the apparent refusal of some hospitals to make available reports of adverse