September 24, 2026 by matray

The Iowa Court of Appeals upheld the dismissal of a medical malpractice action against eight healthcare providers, finding the plaintiffs’ certificates of merit failed to comply with state law because they were neither executed under oath nor signed under penalty of perjury.

Case: Estate of Williamson v. Great River Health System Inc., No. 24-1609, 09/02/2026, published.

Facts and procedural history: The estate of Emily Williamson and her children filed suit against eight of her medical providers, alleging that their malpractice over six months in late 2021 and early 2022 caused Williamson’s death.

In June 2024 — over four months before the dispositive-motion deadline — the medical providers moved to dismiss all the estate’s claims for failing to comply with the statutory certificate-of-merit requirement.

Relying on Miller v. Catholic Health Initiatives-Iowa Corp., which had been decided the month before, Great River Health System argued that the estate’s attempted certificates of merit failed to substantially comply with Iowa Code Section 147.140.

Section 147.140 requires plaintiffs in medical malpractice or personal injury cases against health care providers to serve a certificate of merit affidavit from a qualified expert witness within 60 days of the defendant’s answer.

In Miller, the Iowa Supreme Court clarified the certificate must be signed under oath or penalty of perjury. The district court granted the defendants’ motion. Analysis: The Iowa Court of Appeals noted the certificates submitted by the estate were each captioned as a “Certificate of Merit Affidavit” and included an introductory statement that “[i]n compliance with Iowa Code Section 147.140,” the expert did “hereby affirm and state as follows.”

But the certificates did not have a jurat completed by a notary, or other authorized person, to prove the oath was administered.

“Calling the certificate of merit an affidavit or stating that its contents are affirmed in compliance with Section 147.140 does not make it an affidavit or make its statements to be ones under oath and actually in compliance with the statute,” the court said.

The court explained there are only two ways to substantially comply with the statute as well.

"The plaintiff must either provide (1) an actual affidavit executed by an expert before a separate person who is authorized to administer the oath, or (2) the permissible substitute, namely, a document compliant with Section 622.1, which requires the statement that the person is signing under penalty of perjury.”

Here, the court said, the certificates of merit were not actual affidavits and they did not include any penalty-of-perjury language.

“That is the end of the analysis, notwithstanding the estate’s other arguments to the contrary,” the court said. “The estate’s certificates of merit do not substantially comply with Section 147.140.”

Disposition: Affirmed.

To read the court’s decision, click here.

September 24, 2026 by matray

Federal legislation introduced this month would establish nationwide restrictions on corporate ownership and control of medical practices while limiting the authority of management services organizations and strengthening protections for physicians and other licensed healthcare professionals. 

The Stop Corporate Takeovers of Physicians Act of 2026 would generally prohibit a partnership or corporate entity from owning or controlling a medical practice, employing or contracting for the professional services of a licensed healthcare professional, or practicing medicine unless the entity is majority owned and controlled by licensed professionals. 

The legislation was introduced Sept. 16 in both chambers of Congress. Sens. Elizabeth Warren, Ron Wyden and Jeff Merkley introduced S. 5419, which was referred to the Senate Committee on Commerce, Science & Transportation. Reps. Val Hoyle, Suhas Subramanyam and Alexandria Ocasio-Cortez introduced the House version, H.R. 10444, which was referred to the House Energy & Commerce and Ways & Means committees. 

The bill targets arrangements in which corporations, private equity firms, insurers and other organizations exercise control over physician practices through management services organizations, or MSOs, even when physicians technically retain ownership. 

Under the legislation, an MSO generally could not own shares in a medical practice, finance the acquisition of ownership interests or exercise control over the transfer or disposition of those interests. The legislation also would restrict MSOs from controlling practice operations through management agreements or other arrangements. 

Among the decisions that would remain under the control of the medical practice are hiring and firing, compensation, work schedules, staffing levels, the amount of time clinicians spend with patients, disbursement of practice revenue, revenue targets, billing and coding practices, prices and payer contracting. 

Physician owners also would have to be licensed and present in a state where the practice provides medical care and be substantially engaged in delivering medical care. The provision addresses arrangements described by the bill's sponsors as the “friendly physician” model, in which a physician holds formal ownership while an outside organization exercises significant control over the practice. The sponsors say the legislation is intended to close that loophole. 

The legislation also would prohibit healthcare providers from interfering with the professional judgment of employed or contracted clinicians through retaliation, adverse employment actions, coercion or other means. 

It specifically addresses interference involving decisions such as the amount of time spent with patients, admission or observation status, timing of treatment, referrals and diagnoses. 

The bill also would generally prohibit noncompete agreements involving licensed healthcare professionals, along with nondisclosure and nondisparagement agreements restricting them from disclosing information about their employment or working conditions. The legislation provides an exception to the noncompete prohibition for a licensee who owns at least 25% of a medical practice. 

“Patients want to know that decisions about their health are being made by their doctors, not by Wall Street investors,” Warren said. “If we’re going to lower costs and un-rig the health care system, we need to stop the corporate takeover of medicine.” 

The legislation includes exceptions to its corporate-practice prohibition for certain organizations, including nonprofit and public healthcare providers, hospitals and hospital-affiliated clinics, critical access hospitals and rural emergency hospitals. 

The bill also would preserve state laws that impose equal or more stringent requirements on medical-practice ownership and control, provide equal or greater protections to licensed healthcare professionals or impose equal or more stringent restrictions on MSOs. 

The proposal includes several enforcement mechanisms. Violations could be enforced by the Federal Trade Commission, state attorneys general or individuals harmed by violations. Private plaintiffs could seek damages, including treble damages, as well as attorneys' fees. 

Courts finding violations would be required to order violators to cease the prohibited conduct and, when applicable, require divestment and disgorgement of revenue received during the period of the violation. Either party could request a jury trial. Entities violating the legislation's requirements also could face exclusion from federal healthcare programs. 

The bill would take effect one year after enactment. 

Supporters say the legislation responds to the growing employment of physicians by corporate organizations. The sponsors cited research indicating that more than 80% of U.S. physicians are employed by corporate entities, including private equity firms and insurers, compared with 62% in 2019. They also contend that MSO arrangements have allowed corporate organizations to circumvent corporate-practice-of-medicine restrictions already in effect in many states. 

“Across the country, private equity firms and corporate conglomerates are buying up American physician offices. To increase shareholder profits, these entities often cut corners, leading to patients paying more for significantly worse care,” Ocasio-Cortez said. “I’m proud to co-lead the Stop Corporate Takeovers of Physicians Act to get Wall Street out of Americans’ doctors’ offices and ban predatory noncompete agreements for healthcare workers.” 

The legislation is modeled on an Oregon law restricting the corporate practice of medicine. 

The legislation has been endorsed by organizations including the American Academy of Emergency Medicine, American Economic Liberties Project, Coalition for Patient-Centered Care, Association for Independent Medicine, Alliance of Independent Dentists and Private Equity Stakeholder Project. 

September 24, 2026 by matray

Medical Mutual Insurance Company of Maine is warning its insured physicians and healthcare organizations that three nuclear verdicts in Maine during a nine-month period may signal that social inflation is taking hold in a region historically known for a relatively stable medical liability environment. 

In an article published in its Fall 2026 Rounds newsletter for insureds, the medical professional liability insurer pointed to three Maine verdicts — $25 million last October, $23.1 million in June and $17 million in July — as evidence that the litigation environment may be changing. 

“One outsized verdict is an anomaly,” Medical Mutual wrote. “Three in a single state, in nine months, is a trend line.” 

The insurer characterized the development as part of a broader national rise in nuclear verdicts, generally defined as awards of $10 million or more, and cautioned that neighboring New England states should not assume they are insulated from the trend. 

Medical Mutual provides medical professional liability coverage to physicians, practices, hospitals and health systems in Maine, New Hampshire, Vermont and Massachusetts. 

Its insureds in New Hampshire, Vermont and Massachusetts have not experienced verdicts of the magnitude recently seen in Maine, according to the insurer. But Medical Mutual argued that some of the forces it believes are driving larger awards — including litigation funding, national plaintiffs' firms and evolving trial strategies — don’t stop at state borders. 

“The prudent assumption is not that our other states are immune, but that they are earlier in the same curve,” the insurer wrote. 

Medical Mutual said the increase in large verdicts raises questions about whether jury awards remain closely connected to compensating patients for their injuries or are increasingly influenced by trial strategies intended to generate larger noneconomic damage awards. 

The insurer also pointed to the difficulty juries face when evaluating complex medical decisions after an adverse outcome has occurred. Jurors may be asked to assess split-second clinical judgments, differential diagnoses and rare complications months or years later, Medical Mutual said, creating the potential for hindsight to affect how those decisions are viewed. 

Medical Mutual said similar patterns have emerged in states including Florida and Georgia and in parts of the West and Midwest. The insurer argued that once nuclear verdicts become common, the trend is unlikely to correct itself without legal or legislative intervention. 

The company said it is responding through aggressive claims defense, disciplined reserving, risk management and education, and advocacy with hospital associations and state medical societies throughout its four-state territory. 

Medical Mutual also placed the recent verdicts in the context of earlier medical liability crises. 

The insurer noted that New England experienced periods of liability instability in the 1970s and early 2000s that contributed to physician departures and difficulties obtaining coverage. It said the medical community ultimately responded collectively to those earlier challenges. 

“That is the work in front of us again,” Medical Mutual wrote, “and our members can count on Medical Mutual to be at the center of it.” 

September 24, 2026 by matray

California legislation that would establish new liability rules for artificial intelligence used in patient care is awaiting action by Gov. Gavin Newsom, who has until Sept. 30 to sign or veto the measure.

Assembly Bill 2575, which cleared the Legislature Aug. 31, and was presented to Newsom Sept. 15, would prevent AI developers and deployers from escaping liability by arguing that a healthcare professional should have overridden an AI-generated recommendation.

The legislation would establish protections for healthcare workers using clinical decision-support systems while addressing how responsibility may be allocated when an AI system contributes to patient harm.

Under the bill, a defendant that developed, modified, selected or deployed a clinical decision-support system could not argue that a healthcare professional's failure to override the system's output was a superseding cause that severed the defendant's liability for the alleged harm.

The provision could have significant implications for medical professional liability claims involving AI.

For example, if an AI system recommends against additional testing and a physician follows that recommendation, the developer or organization responsible for deploying the system could not avoid liability simply by arguing that the physician should have recognized the erroneous recommendation and overridden it.

The legislation would not, however, immunize physicians or other healthcare professionals from malpractice liability. Clinicians would remain responsible for meeting applicable professional standards of care, and defendants could still present evidence concerning the fault of other parties, causation and foreseeability.

The result could be claims in which responsibility for an adverse outcome is divided among physicians, healthcare organizations and AI developers or vendors rather than placed solely on the clinician who made the ultimate treatment decision.

AB 2575 also seeks to preserve clinicians' independent professional judgment when using AI. It declares it California public policy that workers providing direct patient care remain free to exercise professional judgment when making patient-care decisions.

Employers generally would be prohibited from retaliating or discriminating against healthcare workers based solely on their decision to override or rely upon the output of a clinical decision-support system. Those protections would not determine whether the clinician satisfied the standard of care in a professional negligence or malpractice action.

The legislation also would impose transparency requirements on healthcare organizations using clinical decision-support systems. Healthcare facilities, clinics, physician offices and group practices would be required to make information about the systems available to healthcare professionals and other workers who use or review their outputs.

The measure comes as hospitals and medical practices increasingly incorporate AI into clinical decision-making, raising questions for liability insurers about how responsibility should be allocated when technology influences a diagnosis, treatment recommendation or other clinical decision.

An Assembly analysis of AB 2575 noted that an estimated 65% of U.S. hospitals already use AI tools, including systems used for clinical decision support, patient monitoring, electronic health records, staffing and predicting patient outcomes.

The legislation has also generated opposition from healthcare organizations. The California Hospital Association and other healthcare stakeholders have argued that the proposal could create problematic liability incentives, interfere with quality oversight and discourage adoption of beneficial AI technology. The association continues to list its position as opposed to AB 2575 while noting that the bill is pending action by the governor.

Supporters, including the California Nurses Association, argue that the measure would protect healthcare workers' ability to exercise independent professional judgment and prevent AI developers and deployers from shifting responsibility for harmful AI outputs onto clinicians.