October 28, 2026 by matray

The Iowa Supreme Court reversed the dismissal of a medical malpractice lawsuit against a physician assistant, ruling that physicians and physician assistants practice in substantially similar fields under the state's certificate of merit requirements. The court held that an expert's qualifications depend on the field covered by their professional license, rather than their particular area of medical practice. The decision allows a surgeon's certificate of merit affidavit to support a malpractice claim against a physician assistant practicing in primary care.

Case: Davenport v. Fuller, No. 25–1183, 10/16/2026, published.

Facts: In March 2023, Joshua Davenport saw his primary care provider, physician assistant Nathaneal Fuller, twice in three days, complaining of abdominal pain and trouble urinating.

Fuller diagnosed Davenport with urinary retention secondary to a probable enlarged prostate and sent him home with medication.

A few days later, Davenport’s symptoms worsened, and he sought emergency care. Davenport was then diagnosed with acute diverticulitis. He suffered a perforated bowel, feculent peritonitis, and septic shock, requiring him to be hospitalized for several weeks.

Procedural history: Davenport filed a medical malpractice action against Fuller. He timely served Fuller with a certificate of merit affidavit signed by Dr. Cass Franklin.

After Davenport’s deadline to designate additional experts expired, Fuller moved to dismiss the lawsuit for failure to comply with Iowa’s certificate of merit affidavit requirements. Fuller argued that Franklin, as a surgeon, was not qualified to opine on the standard of care for a physician assistant practicing as a family medicine or primary care provider.

A trial judge agreed and granted the motion to dismiss.

Analysis: The Iowa Supreme Court explained that a medical malpractice expert must be “licensed to practice in the same or a substantially similar field as the defendant,” and have “actively practiced in the same or a substantially similar field” for the past five years.

The court said it has interpreted the term “field” as categorically distinguishing one type of healthcare provider from another, and that it has rejected the argument that “field” means a specific practice area.

An expert and defendant are therefore “licensed in and practice in the same field if they hold the same license and practice under the same license,” the court said.

Here, the court noted, the judge found Fuller practiced “mainly as a primary care provider in the practice of family medicine” and Franklin practiced “in the fields of general surgery, vascular access surgery, and transplant surgery” while working as a trauma surgeon in the emergency department.

The court said that “a healthcare provider’s field is coterminous with his license, not a specific area of practice within that license,” and so the judge erred in focusing on Fuller and Franklin’s respective areas of practice within their licenses to conclude they did not practice in the same or substantially similar fields.

While Fuller’s license as a physician assistant is not “the same” as Franklin’s license as a physician, the court said they are licensed and practice in substantially similar fields.

“Fields are substantially similar when they share a high degree of likeness in their core characteristics, although not identical, such that a practitioner licensed in one field would, by virtue of that license alone, possess the foundational knowledge and competence to evaluate and opine on the standard of care applicable to the other field,” the court said.

The court said it has identified seven nonexclusive factors relevant to assessing whether specialties are substantially similar: (1) the formal definitions of the specialties, (2) the certifying board structures, (3) the required education and training, (4) the scope of practice, (5) overlap in core and procedural competencies, (6) professional association overlap, and (7) hospital credentialing patterns.

The court determined “the respective definitions, scopes of practice, certifying board structures, and education and training requirements for physicians and physician assistants demonstrate that the two fields are substantially similar.”

Iowa defines both physician assistants and physicians based on a shared “practice of medicine, the court said. The specific medical services physician assistants can provide also indicates that their scope of practice is substantially similar to physicians, the court said, and there is licensure oversight by the board of medicine and mandatory physician participation on the board of physician assistants.

“The requirement for physician oversight before a physician assistant can practice medicine independently further supports a determination that the fields are substantially similar,” the court added.

In light of these considerations, the court concluded physicians and physician assistants are licensed to practice in substantially similar fields.

Disposition: Reversed and remanded.

To read the court’s decision, click here.