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.

September 23, 2026 by matray

A series of recent Iowa Supreme Court decisions reinforced the state’s strict certificate-of-merit requirements while recog-nizing limited exceptions for informed-consent claims and plaintiffs whose older cases were affected by changes in the law.

The rulings also restrict claims against healthcare institutions, clarify when malpractice cases may be refiled and require judges to consider lesser sanctions before excluding an expert witness. Many involve Iowa Code §147.140, which requires a medical malpractice plaintiff to serve a certificate-of-merit affidavit within 60 days after a defendant answers when expert testimony is needed.

The court interpreted the statute to require that the certificate be sworn before someone authorized to administer oaths or signed under penalty of perjury. Calling a document an affidavit or stating that the expert was “duly sworn” is insufficient without evidence that an oath was administered.

In Rarick v. Smidt, the plaintiffs timely served a certificate that contained neither a notarial jurat nor penalty-of-perjury language. They submitted a notarized version after the deadline.

The Supreme Court affirmed dismissal, holding that the original was not a valid affidavit and the corrected filing could not cure the defect. Iowa’s statute does not allow an amended certificate to relate back to the original filing.

The court applied similar reasoning in Bunce v. Hansen. The certificate stated that the expert was “duly sworn on oath” but was not notarized or signed under penalty of perjury.

The court rejected arguments for prospective application and directed dismissal even though the certificate had been submitted before the Supreme Court clarified the requirement in its 2024 Miller v. Catholic Health Initiatives-Iowa Corp. decision.

A divided court reached the same practical result in Willhoite v. Genesis Health System, a wrongful-death action involving an allegedly missed lung cancer diagnosis. The plaintiffs timely submitted certificates signed by their experts, but the documents were neither notarized nor signed under penalty of perjury. The justices divided 3-3 over dismissal. With one justice not participating, the lower court’s dismissal was affirmed by operation of law.

Two other decisions provided relief for plaintiffs whose lawsuits became vulnerable after the court clarified the affidavit requirement.

In Trask v. Ahmed, the plaintiff voluntarily dismissed his original action after the defendants challenged his certificates under Miller. He filed an identical lawsuit within six months under Iowa’s savings statute, which allows certain refiled actions to be treated as continuations of earlier lawsuits.

A district court dismissed the second suit, finding that the plaintiff had voluntarily abandoned the first case. The Supreme Court reversed, concluding that the certificate requirements were unsettled when the original action was filed. The plaintiff was not required to pursue futile arguments before dismissing and refiling.

The court reached the same conclusion in Williams v. Hartman, holding that a plaintiff who voluntarily dismissed her malpractice action after Miller could use the savings statute to preserve an otherwise untimely second lawsuit. Although later precedent indicated that the defendant’s original certificate challenge might have been untimely, that rule had not been established when the plaintiff dismissed her case. The court said lawyers were not required to predict future judicial decisions.

The rulings do not relax certificate requirements for new cases but provide limited relief for plaintiffs who filed defective certificates before the court clarified the statute and then refiled within six months.

The court identified another exception in Lofgren v. Simpson. A mother alleged that she consented to an ear, nose and throat specialist performing surgery on her 2-year-old son but was not told that a fourth-year medical resident would participate in the procedure. The child later died from postoperative bleeding.

The Supreme Court affirmed dismissal of conventional negligence claims because the certificate was defective but reinstated the informed-consent claim, finding that expert testimony was unnecessary to determine whether a reasonable parent would want to know that a resident might participate.

Because a certificate is required only when expert testimony is necessary to establish a prima facie case, the informed-consent claim could proceed without one.

In Baldwin v. Central Iowa Hospital Corp., the court limited claims that may be pursued directly against healthcare institutions.

The estate of a patient who died after a dialysis catheter became unsecured alleged that the hospital was vicariously liable for its nurse and independently liable for negligent hiring, supervision or retention.

The court held that when an employer admits vicarious liability for an employee’s negligence, a plaintiff generally may not pursue duplicative negligent hiring, retention or supervision claims.

The court also dismissed the patient’s wife’s bystander emotional-distress claim because she did not contemporaneously perceive the event that caused the injury.

Another ruling prevents defendants from repeatedly challenging a certificate after an earlier appeal. In Jorgensen v. Smith, the defendants sought summary judgment by reframing certificate-of-merit arguments following an interlocutory appeal. The Supreme Court held that the law-of-the-case doctrine barred reconsideration because the prior decision had necessarily treated the certificate as sufficient for the claims against the surgeon and determined the statute did not apply to the negligent-retention claim. The court returned the case for trial.

The court separately addressed expert-witness sanctions in Sondag v. Orthopaedic Specialists. It held that a trial court generally must consider the reason for a delayed expert designation, prejudice to the opposing party, disruption of the trial schedule and availability of lesser sanctions before excluding an expert.

Because striking a standard-of-care expert can effectively end a malpractice action, exclusion should not be an automatic consequence of a missed deadline.

Taken together, the Iowa Supreme Court’s 2026 decisions preserve strict enforcement of the state’s certificate-of-merit statute while identifying limited circumstances in which claims may survive without a compliant certificate. They also restrict separate institutional-negligence claims when a healthcare employer accepts vicarious liability.

September 22, 2026 by matray

LAMMICO named Morehouse General Hospital in Bastrop, La., the recipient of its 11th annual Patient Safety Award and Grant for efforts to reduce pressure injuries.

The 2025-26 award program focused on reducing skin and pressure injuries, which can cause pain and other complications for patients and expose healthcare facilities to potential litigation.

Participating organizations completed a skin and pressure injury course through the medical liability insurer’s learning management system. The course addressed risk factors, skin care and measures healthcare providers can take to prevent pressure injuries.

Morehouse General Hospital received the top award after demonstrating the greatest reduction in healthcare facility-acquired pressure injury rates through its prevention and treatment efforts and participation in LAMMICO’s risk management and patient safety education.

The hospital received a $10,000 grant for nursing professional development and a one-year risk manager membership in the American Society for Health Care Risk Management.

Morehouse General implemented a hospital-wide wound care improvement initiative that included standardized pressure injury prevention protocols, structured skin assessments and staff education across patient care areas. According to LAMMICO, the initiative significantly reduced wound care-related injuries and improved patient outcomes.

Winston Medical Center’s Turning Point geriatric and psychiatric unit in Louisville, Miss., was the second-place recipient. The hospital received a $5,000 nursing professional development grant and a one-year risk manager membership in the American Society for Health Care Risk Management.

Turning Point implemented a patient safety initiative focused on skin integrity and wound prevention. LAMMICO said staff engagement, education and ongoing quality improvement efforts contributed to a significant reduction in wound care-related injuries and improved patient outcomes.

September 22, 2026 by matray

AM Best has affirmed the A (Excellent) financial strength rating of Mutual Insurance Company of Arizona and MICA Risk Retention Group Inc., the medical professional liability insurer announced today.

The rating agency also affirmed the companies’ long-term issuer credit ratings of “a+” (Excellent). The outlook for both companies’ ratings is stable.

The affirmation comes as MICA marks its 50th anniversary.

“As MICA celebrates its 50th anniversary, AM Best’s continued recognition affirms the long-term perspective and commitment to our members that have defined MICA since 1976,” said Edward G. Marley, president and CEO of MICA. “For five decades, we have built our success around medical professional liability, earning the trust of physicians and medical practices through deep expertise, exceptional service, and the financial strength to deliver lasting value to our policyholders.”

According to MICA, AM Best’s rating rationale cited the insurer’s risk-adjusted capitalization, as measured by Best’s Capital Adequacy Ratio, as being at the strongest level. The rating agency also cited MICA’s operating performance and history of returning dividends to policyholders.

MICA has paid policyholder dividends for more than 20 consecutive years and has returned more than $760 million to policyholders since its founding in 1976.

September 11, 2026 by matray

A Philadelphia judge has urged the Pennsylvania Superior Court to uphold a $124.2 million medical malpractice judgment arising from a birth injury, rejecting challenges to the jury’s causation finding, its $106.1 million future-care award and its decision to hold a hospital vicariously liable even though two individually named obstetricians were cleared of negligence.

The latter issue could prove particularly significant because the trial court relied heavily on Hagans v. Hospital of the University of Pennsylvania, a decision the Pennsylvania Supreme Court recently agreed to review (see MLM, September 2026).

In a 71-page opinion, Philadelphia County Court of Common Pleas Judge Caroline Turner defended the judgment entered in favor of Jasmine Pagan, Jose Finley and their minor son, identified as K.F., against Albert Einstein Medical Center, Einstein Pediatrics at Holland and pediatrician Dr. Kavita Gupta-Shah.

The defendants are appealing under Superior Court Nos. 1935 EDA 2026 and 1938 EDA 2026.

The lawsuit arose from K.F.’s December 2018 birth at Albert Einstein Medical Center. According to Turner’s opinion, plaintiffs’ obstetrical expert Dr. Howard Mandel testified that K.F. suffered head trauma during the birth process and that a decision to proceed with a cesarean section at approximately 8 a.m. more likely than not would have avoided the trauma.

Months later, imaging revealed bilateral subdural hemorrhages with mass effect, and K.F. underwent emergency neurosurgical treatment.

Following a March trial, the jury returned a $108.6 million verdict, including $106.1 million in future medical expenses. Turner subsequently added approximately $15.6 million in delay damages, producing a molded verdict of $124,187,697.35.

Vicarious Liability Question Echoes Hagans

Among the defendants’ principal appellate arguments is that the evidence was insufficient to impose vicarious liability on Albert Einstein Medical Center because the jury found two individually named obstetricians, Drs. Cheryl Yondorf and Aishat Olatunde, not negligent.

Turner rejected that argument, relying significantly on the Superior Court’s decision in Hagans.

She said the relevant question was whether the plaintiffs presented sufficient evidence that an Einstein employee or agent was negligent while acting within the scope of employment, not whether the jury returned an adverse verdict against a particular employee.

The plaintiffs’ case extended beyond Yondorf and Olatunde to resident physicians and labor-and-delivery nurses. The alleged conduct included labor management, administration and readministration of Pitocin, fetal monitoring and the failure to move to cesarean delivery at approximately 8 to 8:30 a.m.

Turner concluded the evidence permitted jurors to find negligence by Einstein personnel while finding Yondorf and Olatunde individually not negligent. The verdict sheet broadly asked whether Einstein, acting through its obstetric physicians, residents and nurses, had fallen below the applicable standard of care.

That reasoning closely tracks Hagans, where the Superior Court held that a jury need not make an express negligence finding against each individual provider before imposing vicarious liability on a hospital when the evidence establishes negligent conduct by hospital agents.

That precedent, however, is now before the Pennsylvania Supreme Court.

As MLM reported last month, the Supreme Court agreed July 29 to review a record $207.6 million judgment against the Hospital of the University of Pennsylvania in Hagans. One question is whether a hospital may be held vicariously liable when providers whose conduct allegedly caused the injuries were named as defendants but the jury was not required to determine whether any particular provider was negligent.

Turner said Hagans “directly addresses” Einstein’s vicarious-liability argument, meaning the Supreme Court's eventual ruling could have implications for the legal theory supporting the Einstein judgment.

Judge Rejects Causation Challenge

Einstein also argued the plaintiffs failed to establish the cause of K.F.’s injury to the required degree of medical certainty because Mandel identified three possible mechanisms for the birth trauma but could not identify which actually occurred.

Turner disagreed.

Mandel testified that the injury could have resulted from forceps used for delivery, forceps used to rotate or position K.F., or pressure from a physician’s hand. Turner distinguished uncertainty over the precise physical mechanism from uncertainty over whether traumatic injury occurred.

She said Mandel tied the injury to the traumatic vaginal birth process and testified that an appropriately timed cesarean section would have avoided it, providing sufficient evidence for the jury to resolve causation.

$106.1M Future-Care Award Defended

The defendants also challenged the $106.1 million future-medical award as speculative, inadequately supported and excessive given K.F.’s present functioning.

Turner again sided with the plaintiffs.

Pediatric neurologist Dr. Daniel Adler testified that K.F.’s neurological and developmental impairments were permanent and endorsed the life-care plan as fair, reasonable and necessary. Neuropsychologist Dr. Susannah Hughes also reviewed the plan and agreed with its future-care recommendations. Certified life-care planner Alex Karras organized and priced the recommended care.

The defense emphasized evidence that K.F. currently walks, talks, attends school, feeds himself, takes no medication and receives limited supplemental instruction.

Turner said those facts did not undermine expert testimony concerning his lifetime needs. Evidence showed language deficits, poor coordination, permanent brain injury, low intellectual functioning and an inability to make independent decisions involving safety and activities of daily living.

Economist Dr. Thomas Borzilleri projected approximately $14.25 million for a nonresidential care plan and $106.84 million for residential care. The jury’s $106,144,132 award closely tracked the residential-care projection, which Turner said provided a rational evidentiary basis for the verdict.

She also rejected remittitur, again citing Hagans, where the Superior Court upheld a future-medical award exceeding $101 million and emphasized that an award’s size alone does not establish excessiveness.

Other Challenges Rejected

Turner also defended several evidentiary rulings, including excluding a Social Security disability evaluation that produced a higher IQ score for K.F. and evidence concerning an allegation that he suffered nonaccidental head trauma years after his birth injury. She found the latter allegation unsubstantiated and unsupported by expert testimony connecting it to the permanent brain injury at issue.

The judge also rejected the defendants’ challenge to delay damages on the future-medical award. She concluded Pennsylvania precedent permits Rule 238 delay damages on future medical expenses and that the MCARE Act’s present-value requirement applies to calculating attorney fees and costs, not Rule 238 damages.

The appeals now place the $124.2 million judgment before the Superior Court.

September 11, 2026 by matray

Physicians’ concerns about malpractice lawsuits contribute to unnecessary testing, higher healthcare spending and potential harm to patients, according to a new Milliman Inc. report examining the forces driving the U.S. healthcare system.

The August report, The Complex Mechanisms Underlying U.S. Healthcare: Dynamics That Drive Our System, estimates that defensive medicine accounts for roughly 2% to 3% of total U.S. healthcare expenditures. One analysis cited by Milliman found that 2.9% of hospital spending was clearly defensive and another 10% potentially fell into that category.

In the section titled “Malpractice & Defensive Medicine: How Liability Concerns Drive Healthcare Costs in the United States,” Brad Schliesmann, ASA, MAAA, JD, a senior actuarial manager at Milliman, wrote that U.S. physicians face a combination of legal, financial, reputational and cultural incentives to practice medicine from a “just in case” perspective.

The civil liability system makes large jury awards possible, while the fee-for-service payment model allows insurers and other payers to absorb the cost of additional testing rather than physicians, the report said. Public rating systems can heighten physicians’ concerns about reputational damage, and medical training may reinforce the belief that ordering too many tests is safer than ordering too few.

Those pressures can lead physicians to test for rare conditions or unusual presentations that fall outside established standards of care. Although such exceptions can be medically significant, routinely searching for them can generate substantial costs.

Malpractice insurance premiums add to the economic burden. The report noted that neurosurgeons in some states face annual premiums exceeding $400,000. A study cited by Milliman estimated that defensive medicine and malpractice insurance premiums together accounted for 2.4% of national health spending, or about $56 billion annually, as of 2010.

The consequences extend beyond spending, according to the report. Unnecessary imaging can expose patients to radiation, false-positive results and anxiety, while unneeded procedures carry the risk of complications without corresponding clinical benefits. Liability concerns also may cause physicians to avoid high-risk patients, potentially delaying needed treatment and worsening geographic disparities in access to care.

Milliman highlighted several approaches for reducing those costs and risks.

New Zealand replaced tort-based malpractice litigation with a publicly funded, no-fault compensation system under its 1972 Accident Compensation Act. The system sharply reduced legal expenses and largely eliminated incentives for routine defensive testing while maintaining relatively high patient satisfaction with compensation, the report said.

Communication-and-resolution programs may provide another path. Such programs encourage early disclosure, apologies and negotiated compensation after adverse events. The University of Michigan Health System reduced liability costs by 41% and new claims by 65% within four years of implementing one, according to research cited in the report.

Johns Hopkins similarly found that training physicians in risk communication, shared decision-making and disclosure reduced defensive ordering and malpractice claims among participating clinicians over five years.

Milliman said no single reform is likely to eliminate defensive medicine. It suggested combining legal safe harbors and other tort reforms with apology programs, alternative dispute resolution and clinician training intended to address risk aversion.

Such an approach could help physicians focus more closely on patients’ needs and less on protecting themselves from litigation, the report concluded.

September 11, 2026 by matray

The 2nd U.S. Circuit Court of Appeals ruled that the PREP Act shielded a physician from malpractice claims arising from his prescription of prednisone to treat a COVID-19 patient who later died from complications of a perforated ulcer. The court found the drug was a covered countermeasure with a sufficient causal connection to the patient’s death to trigger federal immunity. It also upheld dismissal of a Connecticut Unfair Trade Practices Act claim, finding the allegations amounted to medical malpractice rather than an actionable business or entrepreneurial practice.

Case: Kory v. Waters, No. 25-76(L), 08/26/2026, published.

Facts: Edward James Waters contracted COVID-19 in November 2021. He sought treatment from Dr. Pierre Kory in December 2021.

Kory allegedly held himself out as a counter-culture expert regarding COVID-19 treatment and had a tele-health practice for treating patients remotely.

At around the same time that he contracted COVID-19, Waters experienced a flare-up of gout and was treated with a drug called prednisone, which is a corticosteroid. Kory was aware that Waters had recently taken prednisone. Nevertheless, Kory prescribed Waters additional prednisone to treat his COVID-19 infection, along with ivermectin, spironolactone and dutasteride.

Despite Kory’s treatments, Waters’ condition worsened and he was admitted to the hospital a week later. Waters was hospitalized for four days and was treated with additional corticosteroids.

He was also given a proton pump inhibitor, which is used to counteract the risk of developing peptic ulcer disease through a protracted course of high dose corticosteroids.

After he was released from the hospital, Waters’ condition improved. Kory then prescribed another round of prednisone, which Waters was instructed to take after the initial prescription from the hospital ran its course.

Kory did not personally review the details of Waters’ hospitalization and treatment before issuing the prescription. He also did not prescribe a treatment, such as a proton pump inhibitor, to mitigate the harmful side effects of the prednisone.

In late December, Waters returned to the hospital with abdominal pain and abdominal distension. Doctors suspected a perforated ulcer and confirmed their suspicions through an emergency exploratory laparotomy.

Waters later died as a result of multiple organ failure.

Procedural history: The administrator of Waters’ estate sued Kory for negligence, a lack of informed consent in Waters’ treatment, and violations of the Connecticut Unfair Trade Practices Act.

The estate filed suit in a Connecticut state court, and Kory removed the case to the District of Connecticut based on diversity. Kory then moved to dismiss the claims based on the immunity provided in the Public Readiness and Emergency Preparedness Act as well as on a theory that the complaint failed to state a viable CUTPA claim.

The trial court judge dismissed the CUTPA claim but concluded that PREP Act immunity did not apply and denied the motion to dismiss as to the remaining claims.

Waters appealed the dismissal of the CUPTA claim.

Analysis: The U.S. 2nd Circuit Court of Appeals ruled that the denial of a motion to dismiss on PREP Act immunity grounds is an immediately appealable collateral order.

The court noted the PREP Act bestows complete immunity from suit, Kory’s PREP Act immunity defense is completely separate from the merits of the estate’s claims, and the entitlement it bestows is “effectively lost” if the defendant is made to face the burdens of litigation making the denial of a motion to dismiss “effectively unreviewable on appeal from a final judgment.”

The court said the dismissal of the estate’s CUTPA claim is also reviewable since it is distinct from the estate’s remaining claims, the trial judge made a substantive determination that the estate’s allegations are not cognizable under CUTPA, and reviewing the claim along with the collateral appeal of the PREP Act immunity issue allows for the entirety of the judge’s order to be reviewed at once.

The PREP Act provides broad immunity from liability for a “covered person” from all claims for loss caused by, arising out of, relating to, or resulting from the administration to or the use by an individual of a covered countermeasure during a public-health emergency, the court said.

A “covered person” is “a person or entity that is . . . a qualified person who prescribed, administered, or dispensed [a covered] countermeasure,” the court said. A “qualified person” includes “a licensed health professional or other individual who is authorized to prescribe, administer, or dispense [covered] countermeasures under the law of the state in which the countermeasure was prescribed, administered, or dispensed.”

A “covered countermeasure” is any antiviral, drug, biologic, diagnostic, device, or vaccine used to treat, diagnose, cure, prevent, or mitigate COVID-19.

The court said Kory was a covered person because he is a licensed health professional authorized to prescribe, administer, or dispense covered countermeasures in Connecticut since he held a current license in good standing in New York and Wisconsin.

Kory also used a covered countermeasure to treat Waters, the court said, as the estate conceded prednisone is a covered countermeasure under the PREP Act.

The court said the covered countermeasure had a sufficient causal relationship with Waters’ death to trigger immunity as well, as the estate alleged Kory “prescribed an unreasonably high dose of prednisone and did so without proper consideration for gastrointestinal protection.”

The PREP Act does not require that a covered countermeasure be the sole cause of an alleged loss, the court said, as nothing in the act’s text indicates that Congress contemplated such a narrow causal tie between the use or administration of the covered countermeasure and the loss alleged.

Instead, the court said, the PREP Act’s text “makes clear that a wide range of claims based on the use or administration of covered countermeasures are barred.” The court said there just needs to be “some factual causal connection to the ultimate loss.”

Here, as alleged, the prednisone directly and foreseeably caused the ulcers that perforated and led to Waters’ death, the court said. Thus, the prednisone was allegedly both a factual and proximate cause of Waters’ death.

“We have no trouble concluding that such allegations more than trigger the PREP Act’s immunity provision, and therefore, Kory is entitled to immunity,” the court said.

The court further said the judge properly dismissed the estate’s CUTPA claim on the merits.

CUTPA provides that “[n]o person shall engage in unfair methods of competition and unfair or deceptive acts or practices in the conduct of any trade or commerce,” the court said.

“Medical malpractice claims recast as CUTPA claims cannot form the basis for a CUTPA violation,” the court explained. “[T]he touchstone for a legally sufficient CUTPA claim against a healthcare provider is an allegation that an entrepreneurial or business aspect of the provision of services aside from medical competence is implicated, aside from medical malpractice based on the adequacy of staffing, training, equipment or support personnel.”

Here, the CUTPA claim was premised entirely on Kory’s medical treatment of Waters, the court said. The sole allegations relating to the entrepreneurial or business aspect of Kory’s medical practice explain that Kory was overly focused on growing his brand and business, and that “he could not devote adequate time to providing patients such as the plaintiff with proper medical care.”

The court said such an allegation was “nothing like the cases in which Connecticut courts have recognized viable CUTPA claims against medical professionals.” Where claims are premised on the notion that a component of the defendant’s business or entrepreneurial efforts weighed on the care that defendant was able to provide to the plaintiff, Connecticut courts have generally concluded that such claims are barred as recast medical malpractice claims, the federal appellate court said. The court therefore said the dismissal of the estate’s CUPTA claim was appropriate.

Disposition: Reversed in part and remanded. To read the court’s decision, click here.