Pennsylvania Supreme Court Takes Medical Malpractice Case With Potential Impact on Venue Fight

October 1, 2026 by matray

The Pennsylvania Supreme Court agreed this week to hear a medical malpractice case that could clarify how readily healthcare defendants can use forum non conveniens to move litigation out of Pennsylvania, adding a new chapter to the state’s long-running fight over where medical liability lawsuits may be tried.

The court on Sept. 29 granted review in Duxbury v. Reconstructive Orthopedic Associates II, P.C., a case involving New Jersey residents who filed a medical malpractice lawsuit in Philadelphia County over treatment that occurred in New Jersey.

The case arrives nearly four years after Pennsylvania eliminated a special venue rule that generally required medical professional liability lawsuits to be filed in the county where the alleged malpractice occurred.

Effective Jan. 1, 2023, the Supreme Court rescinded Pennsylvania Rule of Civil Procedure 1006(a.1), returning medical liability cases to the same general venue rules that apply to other civil actions. The change made it possible for some medical malpractice plaintiffs to file lawsuits in counties other than where the care occurred, including Philadelphia, depending on factors such as where defendants regularly conduct business.

The change was strongly opposed by healthcare providers, medical liability insurers and defense organizations, which warned it would encourage plaintiffs to move cases into jurisdictions perceived as more favorable to plaintiffs. Supporters of the change argued that medical malpractice plaintiffs should be governed by the same venue rules as other litigants.

The Supreme Court’s decision in Duxbury will not directly determine whether the 2023 rule change should remain in effect. Instead, it could help define the strength of one of the mechanisms available to defendants seeking relief when a plaintiff selects Pennsylvania as the forum: the doctrine of forum non conveniens.

The dispute began after Elizabeth Duxbury, a New Jersey resident, received treatment for lower-back problems at Rothman Urgent Care in Marlton, New Jersey. She and her husband, Brian Duxbury, subsequently filed a medical malpractice action in Philadelphia County against Reconstructive Orthopedic Associates II, P.C., doing business as The Rothman Institute of New Jersey; Atlanticare Surgery Care; and physician Alyson Axelrod, D.O.

Although the Duxburys live in New Jersey and the medical treatment at issue occurred there, the plaintiffs alleged significant connections between the defendants and Pennsylvania. Reconstructive Orthopedic Associates had its principal place of business in Philadelphia, and the plaintiffs alleged additional corporate and professional ties to Pennsylvania.

The defendants asked the Philadelphia County Court of Common Pleas to dismiss the lawsuit under Pennsylvania’s forum non conveniens statute and permit it to be refiled in New Jersey.

The trial court agreed.

It found that the treatment giving rise to the lawsuit occurred in New Jersey, the Duxburys lived there, relevant medical providers and potential witnesses were located there and medical records relating to the procedure were maintained there.

The Pennsylvania Superior Court reversed in March.

In a published opinion, a three-judge panel said the trial court had incorrectly focused on reasons New Jersey would be a more convenient forum rather than determining whether the defendants had demonstrated sufficiently weighty reasons for overriding the plaintiffs’ selection of Pennsylvania.

The Superior Court emphasized that a forum non conveniens analysis requires consideration of the connections to Pennsylvania as well as those favoring another jurisdiction.

The panel noted that witnesses were located in both states, evidence could be obtained in either jurisdiction and the defendants had significant corporate connections to Pennsylvania.

The Superior Court also found that the trial court failed to adequately consider public-interest factors, including Pennsylvania’s interest in litigation involving businesses headquartered in the state and healthcare professionals licensed to practice there.

The parties agreed that New Jersey substantive law would govern the malpractice claims, but the Superior Court said the defendants had not demonstrated that applying New Jersey law would impose a significant burden on a Pennsylvania trial court.

The panel concluded that the defendants had not established sufficiently weighty reasons to disturb the plaintiffs’ forum selection and remanded the case for further proceedings in Philadelphia County.

The defendants sought review by the Pennsylvania Supreme Court.

The justices granted the petition and rephrased the question they will decide as whether the Superior Court “misapplied its standard of review or otherwise erred” when it reversed the trial court’s decision granting dismissal under the state’s forum non conveniens statute.

That focus could make the eventual decision important beyond the particular interstate dispute.

At issue is not simply whether New Jersey or Pennsylvania is the more logical location for the Duxbury litigation. The Supreme Court will also consider the extent to which an appellate court may second-guess a trial judge who has weighed competing connections and concluded that litigation belongs elsewhere.

The question has particular significance in Pennsylvania’s post-2023 medical malpractice venue environment.

When the Supreme Court eliminated the special medical liability venue restriction, the Civil Procedural Rules Committee specifically noted that defendants remained able to use procedural mechanisms available in other civil cases to seek a change of venue.

Forum non conveniens is one of those mechanisms.

The doctrine allows courts to look beyond whether venue and jurisdiction technically exist and consider whether another forum would better serve the interests of justice.

A decision emphasizing trial courts’ discretion to grant forum non conveniens motions could strengthen healthcare defendants’ ability to challenge medical liability cases brought in Pennsylvania despite substantial connections to another jurisdiction. A decision endorsing the Superior Court’s analysis could reinforce the burden defendants face when attempting to override a plaintiff’s otherwise permissible choice of forum.

The case also follows another significant Supreme Court decision addressing forum non conveniens.

In Tranter v. Z&D Tour Inc. in 2025, the court rejected what it considered an excessively demanding evidentiary requirement imposed on defendants seeking an intrastate venue transfer and emphasized the discretion afforded trial judges in weighing forum non conveniens claims.

Although Tranter concerned transferring cases between Pennsylvania counties while Duxbury concerns dismissing a Pennsylvania action in favor of another state, the Superior Court itself acknowledged Tranter while deciding the Duxbury appeal.

The broader medical malpractice venue rules, meanwhile, remain in place.

When the Supreme Court adopted the 2023 changes, it directed its Civil Procedural Rules Committee to reexamine them two years after they took effect. In February 2026, the court removed those expired reexamination provisions from the rules, noting that representatives of medical professionals had argued more time was needed to determine the effect of the changes and develop sufficient data.

The court said future proposals concerning venue could proceed through its normal rulemaking process.

That leaves forum non conveniens as an increasingly important part of the practical boundary surrounding Pennsylvania’s broader medical liability venue rules.

The Supreme Court’s eventual ruling in Duxbury therefore will not restore or eliminate the pre-2023 medical malpractice venue restriction. But it could help determine how much discretion trial judges have to prevent cases with limited Pennsylvania connections from remaining in the state — and how difficult it will be for plaintiffs to overturn those decisions on appeal.

Illinois Appeals Court Revives Malpractice Case Despite Expert Testimony Bar

October 1, 2026 by matray

A divided Illinois Appellate Court upheld a ruling barring a medical malpractice plaintiff’s sole expert from testifying about causation and damages because he had offered opinions only on the standard of care. But the court reversed the dismissal of the lawsuit, finding that the evidentiary ruling alone did not establish that the plaintiff could not present other competent evidence of causation.

Case: Spies v. Amine, No. 1-25-1630, 09/18/2026, published.

Facts: Kathleen Spies suffered from chronic back pain. In 2015, after a work-related injury, Dr. Abdul Amine implanted an intrathecal morphine pump to help manage her pain.

In May 2017, Spies went to Advocate Christ Medical Center with symptoms attributed to opiate withdrawal. After it was determined that her morphine pump was malfunctioning, Amine performed surgery to remove the old pump, implant a new one and insert a new catheter.

Amine’s operative report initially stated that the old tubing was attached to the new pump but was later edited to indicate that new tubing had been attached. The discrepancy between the two versions of the operative report eventually became a point of contention during expert discovery.

Amine maintained that the original reference to “old tubing” was a typographical error and that the new catheter had been connected to the new pump. Spies alleged that Amine left the old catheter tubing in place, leaving a segment through which cerebrospinal fluid could escape.

After the May 2017 surgery, Spies experienced a cerebrospinal fluid leak from her intrathecal catheter, leading to a second surgery by Amine to locate and repair the leak.

Amine’s operative report from the second surgery stated that he observed cerebrospinal fluid leaking from the “old tubing,” which he knotted, ligated and buried.

Spies last saw Amine in June 2017 for suture removal. Over the next three years, she experienced severe headaches and recurrent blackouts.

In November 2017, Dr. Brendan Gaynor performed surgery to remove the pain pump. His operative note stated that the pump was removed because Spies was not tolerating the therapy due to medication side effects and discomfort from the pump beneath her skin. Gaynor also reported observing no cerebrospinal fluid leak from the tubing. The remaining intrathecal catheters were not removed.

Spies’ headaches worsened after the pump was removed. In April 2020, she saw Dr. Ryan Trombly, who determined that she had severe stenosis at L4-L5 and L5-S1 and required treatment for spinal headaches and lumbar decompression.

In May 2020, Trombly removed Spies’ spinal cord stimulators and retained intrathecal pain-pump catheters. His operative report stated that cerebrospinal fluid leaked after a catheter was removed but did not identify the location of the leak.

Procedural history: Spies sued Amine, alleging that he deviated from the standard of care during and after the May 2017 surgery to replace the first pump.

She also filed a certificate of merit and reviewing health professional’s report from Dr. Ryan Zengou, a board-certified neurosurgeon practicing in Tulsa, Oklahoma.

Zengou opined that Amine’s failure to investigate and correct a potential cerebrospinal fluid leak between May 2017 and May 2020 “was outside the standard of care.” But he said his “whole basis” for that criticism was Amine’s original operative note indicating that the old catheter had been connected to the new pump. If new tubing had been attached, as the edited report stated, Zengou said the procedure complied with the standard of care.

Zengou also repeatedly testified that he was not offering opinions on the sequelae or injuries Spies allegedly sustained.

The trial judge granted Amine’s motion to bar Zengou from offering causation and damages testimony, then dismissed Spies’ claim because she lacked expert testimony linking the alleged breach of the standard of care to her claimed injuries.

Analysis: The Illinois Appellate Court said the trial judge did not abuse his discretion in barring Zengou’s causation and damages testimony.

Zengou identified alleged deviations from the standard of care during the first surgery, but he did not offer an opinion that those deviations proximately caused Spies’ injuries, the court said.

Although Zengou testified that headaches can be a symptom of an ongoing cerebrospinal fluid leak and that Spies experienced headaches, the court said those statements established only a general medical association. They did not amount to an opinion that Spies’ headaches were proximately caused by a leak attributable to Amine’s alleged negligence.

Zengou also repeatedly and affirmatively declined to offer an opinion on the sequelae of the alleged cerebrospinal fluid leak.

The court therefore concluded that Zengou was prepared to testify about Amine’s alleged deviation from the standard of care, but not whether that deviation caused Spies’ injuries. Because Zengou had declined to offer a causation opinion, the trial judge properly barred him from doing so.

The court also rejected Spies’ argument that a causation opinion was a natural and logical corollary to Zengou’s disclosed opinions.

“The logical-corollary doctrine permits an expert to elaborate upon a disclosed opinion; it does not permit a party to supply, for the first time at trial, an opinion that was never disclosed at all,” the court said.

The court added that a causation opinion “that the expert expressly declined to offer, cannot be the logical corollary of a disclosed causation opinion because no such opinion existed to elaborate upon.”

In a medical malpractice action, the court said, a plaintiff must establish the applicable standard of care, a negligent deviation from that standard and an injury proximately caused by the deviation.

“[D]eviation from the standard of care, standing alone, does not establish proximate cause,” the court said.

But while the trial judge properly barred Zengou from offering causation and damages testimony, the appellate court said that evidentiary ruling did not provide a proper procedural basis for terminating Spies’ entire action before trial.

Pretrial motions addressing evidentiary issues are not a substitute for the procedures governing dispositive motions, the court said.

The court acknowledged that the lack of those procedural protections may be harmless when the record establishes that a plaintiff lacks the evidence necessary to sustain a claim. But it found that the record in this case did not establish that Spies could not present competent evidence of causation without Zengou’s testimony.

“We therefore reverse the judgment entered for defendants and remand for further proceedings consistent with this order,” the court said.

Dissent: Judge Raymond Mitchell disagreed with the majority’s decision to permit the case to continue “despite the absence of expert testimony on an indispensable element of plaintiffs’ claim.”

Mitchell said a jury may draw reasonable inferences from the evidence, but “it may not supply evidence that a plaintiff’s own expert has affirmatively declined to provide.”

With no admissible expert testimony establishing the necessary link between the alleged breach and Spies’ injuries, Mitchell said he believed entry of judgment for Amine was appropriate.

Disposition: Reversed in part and remanded.

To read the court’s decision, click here.

Tokio Marine HCC Promotes Jonathan Holmes to SVP of Professional Lines

October 1, 2026 by matray

Tokio Marine HCC’s Cyber & Professional Lines Group promoted Jonathan Holmes to senior vice president of professional lines, expanding his responsibilities to include several specialty liability businesses, including healthcare professional liability.

In the expanded role, Holmes will oversee healthcare professional liability as well as employment practices liability, architects and engineers, contractors professional, accountants and miscellaneous professional liability.

The company said the new structure brings the businesses under unified professional lines leadership while retaining specialized underwriting expertise within each product area.

“Jonathan has demonstrated an ability to understand the unique dynamics of specialty products while also recognizing the broader opportunities across our Professional Lines portfolio,” said Michael Palotay, chief executive officer of Tokio Marine HCC’s Cyber & Professional Lines Group.

Holmes has held increasingly senior positions within the Cyber & Professional Lines Group, with responsibilities spanning underwriting, distribution and portfolio development.

“Professional Lines is built on specialized underwriting expertise, and that remains at the center of our business,” Holmes said. “This expanded role gives us an opportunity to preserve that specialization while becoming more connected in how we work across the portfolio and with our broker partners.”

The company said the leadership change is also intended to more closely align underwriting and distribution as it expands access to its professional lines products through traditional and digital distribution channels.

Tokio Marine HCC’s Cyber & Professional Lines Group does business as NAS Insurance Services and is headquartered in Encino, Calif. It is part of Houston-based Tokio Marine HCC, a specialty insurance group operating in the United States, Mexico, United Kingdom and Continental Europe.

Physician Groups Warn Against AI Supplanting Physician Judgment

October 1, 2026 by matray

Six major U.S. physician organizations are warning against treating artificial intelligence as a substitute for physician expertise, emphasizing that doctors must retain professional judgment and responsibility for patient care as AI becomes more widely incorporated into clinical practice.

The American Medical Association, American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians and American College of Surgeons issued a joint statement Sept. 30 addressing the role of AI in healthcare.

The organizations pushed back against suggestions that AI is inherently better informed than physicians or that doctors should be expected to consult the technology before making clinical decisions.

“Statements suggesting AI is inherently better informed than physicians, or that physicians cannot be trusted to make clinical decisions without first consulting this technology, diminish physician expertise and risk undermining patients’ trust,” the groups said.

The statement comes as the growing use of AI in clinical decision-making raises questions about the respective roles and responsibilities of physicians, healthcare organizations and technology developers when the technology influences patient care.

The physician groups emphasized that clinical decision-making involves more than evaluating information generated by a technological system. Physicians consider patients in context, ask questions, assess individual circumstances and draw on their training and experience, they said.

Physicians also “exercise professional judgment and take responsibility for the care they provide,” according to the statement.

The organizations said physicians have long embraced technologies that improve care and acknowledged that AI has significant potential to provide new tools and insights. However, they said patient safety, physician expertise and the human elements of clinical practice should guide the development and use of those tools.

“Pitting physicians against technology or suggesting AI should replace physician expertise does not advance this important work,” the groups said. “We need to move carefully, and we need to get this right.”

The organizations also called for physicians to have a central role in determining how AI is developed and incorporated into medical practice.

“As medical societies representing physicians across the country, we are committed to ensuring physicians help lead the responsible development and use of AI in medicine,” they said.