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Effective Jan. 1, 2023, the Supreme Court rescinded Pennsylvania Rule of Civil Procedure 1006(a.1), returning medical liability cases to the same general venue rules that apply to other civil actions.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