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Effective Jan. 1, 2023, the Supreme Court rescinded Pennsylvania Rule of Civil Procedure 1006(a.1), returning medical liability cases to the same general venue rules that apply to other civil actions.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

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.

Philadelphia Judge Defends $124.2M Birth-Injury Judgment

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.

They also put another large Philadelphia birth-injury judgment into an appellate landscape that could soon be reshaped by the Supreme Court’s decision in Hagans. If the justices alter the rules governing hospital vicarious liability, their decision could affect not only the record judgment in Hagans, but the reasoning Turner is asking the Superior Court to apply in upholding the Einstein verdict.