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Effective Jan. 1, 2023, the Supreme Court rescinded Pennsylvania Rule of Civil Procedure 1006(a.1), returning medical liability cases to the same general venue rules that apply to other civil actions.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.

Indigo Surpasses $20M in Medical Malpractice Insurance Premiums

September 29, 2026 by matray

The vertically integrated, artificial intelligence-driven medical professional liability insurance platform Indigo surpassed $20 million in premiums, doubling its premium volume since announcing a $50 million Series B financing round in January.

The company said growth has been driven by increased business from larger physician groups, expansion of its broker network and greater use of automated underwriting.

Indigo said about 40% of submissions now receive an automated underwriting decision, more than twice the rate a year ago. The company reported a median quote turnaround time of less than one business day and said it is on pace to process more than 10,000 submissions this year with five underwriters.

“Our credibility in the market is compounding as Indigo grows and this milestone is an encouraging proof point for our strategy and underwriting model,” said Jared Kaplan, CEO of Indigo. “Indigo is extremely deliberate in its approach. Automating underwriting in medical malpractice requires deep expertise and an understanding of the nuances that contribute to individual physician or practice risk. With claim severity trending upward, precision in how we assess risk is more important than ever, and it’s clearly an approach that’s resonating with healthcare providers.”

Indigo uses AI technology to assess medical professional liability risk at the individual physician level rather than relying solely on group-level pricing. The company said the approach allows lower-risk physicians within a practice to be priced according to their individual risk profiles.

The company said its growth comes amid increasing medical malpractice claim severity and large jury verdicts, as well as rising insurance costs for physicians and medical groups.

Indigo also was named to CB Insights’ 2026 Insurtech 50, an annual list of insurance technology companies.

“We’re proving that you can build a technology-driven insurance platform without compromising on the fundamentals of underwriting,” added Kaplan. “As we look ahead, our focus is on continuing to scale thoughtfully, continuing to earn the trust of brokers and physicians, and expanding where our technology can create real value.”

Indigo said it plans to continue expanding its technology and product offerings as it grows.

Iowa Appeals Court Affirms Dismissal Over Defective Certificate of Merit

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.

Federal Bill Would Restrict Corporate Ownership, Control of Medical Practices 

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. 

Three Maine Nuclear Verdicts in Nine Months Prompt Social Inflation Warning

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.” 

California Bill Would Reshape Liability for Clinical AI Systems

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.

If signed by Newsom, the liability provisions would effectively prevent an AI developer or deployer from using the clinician as an automatic liability firewall when an AI-assisted clinical decision results in patient harm.

Iowa High Court Reinforces Strict Certificate Requirements

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.