Opinion ID: 6334092
Heading Depth: 1
Heading Rank: 3

Heading: analysis

Text: Our court has not yet interpreted or applied Iowa Code section 147.140, enacted in 2017. See 2017 Iowa Acts ch. 107, § 4 (codified at Iowa Code § 147.140 (2018)). This statute provides that the plaintiff in a medical malpractice action requiring expert testimony must file a certificate of merit signed by a qualified expert within sixty days of the defendant’s answer. See Iowa Code § 147.140(1).3 “Failure to substantially comply with [the certificate of merit requirement] shall result, upon motion, in dismissal with prejudice of each cause of action as to which expert witness testimony is necessary to establish a prima facie case.” Id. § 147.140(6). It is well settled that expert testimony is required to prove professional negligence claims against healthcare providers. “To establish a prima facie case of medical malpractice, a plaintiff must produce evidence that (1) establishes the applicable standard of care, (2) demonstrates a violation of this standard, and (3) develops a causal relationship between the violation and the injury sustained.” Oswald v. LeGrand, 453 N.W.2d 634, 635 (Iowa 1990). “Ordinarily, evidence of the applicable standard of care—and its breach—must be furnished by an expert.” Id.;4 see also Susie v. Fam. Health Care of Siouxland, P.L.C., 942 3The sixty-day deadline can be extended by agreement of the parties or “for good cause shown and in response to a motion filed” within that deadline. Iowa Code § 147.140(4). 4The Oswald court noted two exceptions to the expert witness requirement: One is where the physician’s lack of care is so obvious as to be within the comprehension of a lay[person] and requires only common knowledge and experience to understand. The other exception is really an example of the first situation. It arises when the physician injures a part of the body not being treated. 9 N.W.2d 333, 337 (Iowa 2020) (“Expert testimony is required to create a jury question on causation when the causal connection ‘is not within the knowledge and experience of an ordinary layperson.’ ” (quoting Doe v. Cent. Iowa Health Sys., 766 N.W.2d 787, 793 (Iowa 2009))). We conclude that the legislature enacted section 147.140 to provide a mechanism for early dismissal with prejudice of professional liability claims against healthcare providers when supporting expert testimony is lacking. As the court of appeals recognized, Struck concedes that the district court correctly ruled that section 147.140 applies to her claims alleging the professional negligence of her healthcare providers. We hold the court of appeals correctly affirmed the district court’s dismissal of Struck’s claims alleging professional negligence and negligent hiring, retention, or supervision of professional staff. The fighting issue is whether that determination ends the entire case. We conclude that it does, and the court of appeals erred in construing Struck’s petition to encompass ordinary negligence claims that survive a motion to dismiss under section 147.140(6). 453 N.W.2d at 636 (quoting Buckroyd v. Bunten, 237 N.W.2d 808, 811–12 (Iowa 1976)). For example, expert testimony would not be required in a malpractice action alleging the surgeon removed the wrong kidney or inadvertently left a clamp inside the patient’s body. See, e.g., Donovan v. State, 445 N.W.2d 763, 766 (Iowa 1989) (“If a doctor operates on the wrong patient or amputates the wrong limb, a plaintiff would not have to introduce expert testimony to establish that the doctor was negligent.”); Whetstine v. Moravec, 291 N.W. 425, 436 (Iowa 1940) (“It has seldom been questioned, that where the act of omission or commission, upon the part of the surgeon, has been plainly negligent, as where a sponge, gauze, an instrument, or needle has been left in the body, the rule of res ipsa loquitur applies, and that it is also unnecessary to show by expert testimony that such an act does not comport with the required standards.”). 10 A. Error Preservation. For the first time on appeal, Struck argued her petition alleged “possible acts of general negligence,” including premises liability and lack of supervision by nonprofessional staff of Mercy that would not require expert testimony and fall outside the scope of section 147.140. Struck did not raise that issue in district court and therefore waived it. “Nothing is more basic in the law of appeal and error than the axiom that a party cannot sing a song to us that was not first sung in trial court.” State v. Rutledge, 600 N.W.2d 324, 325 (Iowa 1999). As Mercy correctly argued in its appellate brief: Plaintiff did not preserve arguments pertaining to negligent supervision, premises liability, and general negligence. Plaintiff did not raise these issues before the district court and the district court did not decide . . . these issues. As such, Plaintiff cannot raise these issues on appeal. We agree. The court of appeals did not address error preservation and decided this unpreserved issue. But because the issue was fully briefed on appeal and decided by the court of appeals, we exercise our discretion to clarify the scope of the new statute. B. Section 147.140 Required Dismissal of Struck’s Claims Against Mercy. In our view, the district court correctly ruled that Iowa Code section 147.140 required dismissal of Struck’s professional negligence and negligent hiring, retention, or supervision of professional staff claims against Mercy upon her failure to file a certificate of merit. We begin with the text of the statute. Iowa Code section 147.140(1)(a) provides: In any action for personal injury or wrongful death against a health care provider based upon the alleged negligence in the practice of that profession or occupation or in patient care, which includes a cause of action for which expert testimony is necessary to establish 11 a prima facie case, the plaintiff shall, prior to the commencement of discovery in the case and within sixty days of the defendant’s answer, serve upon the defendant a certificate of merit affidavit signed by an expert witness with respect to the issue of standard of care and an alleged breach of the standard of care. The expert witness must meet the qualifying standards of section 147.139. Section 147.140(1)(a) establishes that a certificate of merit is required when a plaintiff pleads (1) an “action for personal injury or wrongful death,” (2) “against a health care provider,” (3) which is “based upon the alleged negligence in the practice of that profession or occupation or in patient care,” and (4) “includes a cause of action for which expert testimony is necessary to establish a prima facie case.” The first two requirements are clearly met. Struck brought this action for her personal injury, and Mercy is a healthcare provider. Section 147.140(7) provides that “[f]or purposes of this section, ‘health care provider’ means the same as defined in section 147.136A,” which in turn defines “health care provider” as including “a hospital as defined in section 135B.1.”5 Struck concedes the third and fourth requirements are met as to her “professional negligence” claims against Mercy.6 As noted, those claims require expert testimony. 5Section 135B.1(3) defines “hospital” as a place which is devoted primarily to the maintenance and operation of facilities for the diagnosis, treatment or care over a period exceeding twenty-four hours of two or more nonrelated individuals suffering from illness, injury, or deformity, or a place which is devoted primarily to the rendering over a period exceeding twentyfour hours of obstetrical or other medical or nursing care for two or more nonrelated individuals . . . . 6Section 147.140 does not use the term “professional negligence” but talks in terms of “alleged negligence in the practice of that profession or occupation or in patient care”—a broader concept. Iowa Code § 147.140(1). So any claim for negligence in patient care requires the certificate of merit, as long as expert testimony is required to prove up the claim. 12 The court of appeals, however, viewed Struck’s petition as “broad enough to encompass ordinary negligence claims against Mercy” such as “premises liability and negligent hiring, retention, and supervision of non-professional staff,” which do not necessarily require expert testimony. But in our view, Struck pleaded no claim outside the scope of section 147.140. Struck is bound by the allegations actually pleaded within the four corners of her petition. By alleging only “professional negligence” claims and not filing a certificate of merit, she effectively pleaded herself out of court. See Benskin, 952 N.W.2d at 299, 306. If Struck really had ordinary negligence claims that don’t require expert testimony, she should have alleged them in her petition or moved for leave to amend to add them, neither of which she did. A contrary holding would undermine the legislative goal to enable healthcare providers to quickly dismiss professional negligence claims that are not supported by the requisite expert testimony. Section 147.140(3) incorporates by reference, and works in tandem with, the expert disclosure requirements in Iowa Code section 668.11 (requiring disclosure of expert witnesses in professional liability cases “within one hundred eighty days of the defendant’s answer”).7 We have observed that “[s]ection 668.11 is designed to require a 7Iowa Code section 668.11 provides in part: 1. A party in a professional liability case brought against a licensed professional pursuant to this chapter who intends to call an expert witness of their own selection, shall certify to the court and all other parties the expert’s name, qualifications and the purpose for calling the expert within the following time period: a. The plaintiff within one hundred eighty days of the defendant’s answer unless the court for good cause not ex parte extends the time of disclosure. 13 plaintiff to have his or her proof prepared at an early stage in the litigation in order that the professional does not have to spend time, effort and expense in defending a frivolous action.” Hantsbarger v. Coffin, 501 N.W.2d 501, 504 (Iowa 1993) (en banc). “Early disposition of potential nuisance[] cases, and those which must ultimately be dismissed for lack of expert testimony, would presumably have a positive impact on the cost and availability of medical services.” Id. (quoting Thomas v. Fellows, 456 N.W.2d 170, 173 (Iowa 1990)). Those goals are further served by section 147.140, which requires an expert’s certification sixty days from the defendant’s answer, even earlier than the one-hundred-eighty-day deadline in section 668.11. And while section 668.11 allows the exclusion of untimely expert testimony, section 147.140 provides an earlier and more complete remedy when the plaintiff lacks an expert: dismissal with prejudice. We agree with the court of appeals’ observation that “[s]ection 147.140 gives the defending health professional a chance to arrest a baseless action early in the process if a qualified expert does not certify that the defendant breached the standard of care.” McHugh v. Smith, 966 N.W.2d 285, 289–90 (Iowa Ct. App. 2021). b. The defendant within ninety days of plaintiff’s certification. 2. If a party fails to disclose an expert pursuant to subsection 1 or does not make the expert available for discovery, the expert shall be prohibited from testifying in the action unless leave for the expert’s testimony is given by the court for good cause shown. 14 At least twenty-eight other states have enacted certificate or affidavit of merit statutes. John D. North, Tort reform-Certificate of Merit, 9 Bus. & Com. Litig. Fed. Cts. § 103:31 (5th ed. 2021). While the specific requirements vary, [t]he common denominator is that all of the statutes, to one degree or another, require the plaintiff’s attorney to do what good practice and economics dictate: perform the due diligence necessary to determine the claim is meritorious before instituting litigation. Unless a case has merit and a deviation from standards of care can be proven through a competent expert, it is senseless to commence a medical malpractice action. Id. As the Pennsylvania Supreme Court recognized, the certificate of merit requirement serves to “identify and weed non-meritorious malpractice claims from the judicial system efficiently and promptly.” Womer v. Hilliker, 908 A.2d 269, 275 (Pa. 2006); see also Rabinovich v. Maimonides Med. Ctr., 179 A.D.3d 88, 91 (N.Y. App. Div. 2019) (noting the purpose of New York’s certificate of merit statute “is to deter the commencement of frivolous actions by counsel on behalf of their clients, and to thereby reduce the cost of medical malpractice litigation and medical malpractice insurance premiums”). The Iowa legislature enacted a comparable certificate of merit statute presumably to further the same goals. The court of appeals determined that Struck’s “surviving” negligence claims should be “fleshed out” in further proceedings on remand to determine whether expert testimony is required. That approach violates the command of section 147.140(6), which mandates the dismissal of pleadings filed without the requisite certificate of merit. The statute is meant to end cases early (sixty days after the answer) when expert testimony is required. We decline to allow plaintiffs to evade the statutory requirement on appeal by relabeling a professional 15 negligence claim as one of ordinary negligence. Struck failed to comply with the certificate of merit requirement in Iowa Code section 147.140, and the district court correctly granted the defendants’ motions to dismiss under section 147.140(6). Our liberal pleading rules do not require a different result. The court of appeals relied on precedent allowing some slip-and-fall claims to proceed against a hospital without expert testimony when routine care is at issue. See, e.g., Kastler v. Iowa Methodist Hosp., 193 N.W.2d 98, 102 (Iowa 1971). “The character of a particular activity of a hospital—whether professional, on the one hand, or nonmedical, administrative, ministerial, or routine care, on the other—is determined by the nature of the activity itself, not by its purpose.” Id. In Kastler v. Iowa Methodist Hospital, the plaintiff “from childhood . . . suffered from spells of headaches, rapid heartbeat, difficult breathing, and dizziness, followed by fainting.” Id. at 99. “The spells grew worse after she became an adult,” and she would become depressed when she regained consciousness. Id. Her doctor eventually referred her to a psychiatrist, “who had her admitted to the psychiatric ward of defendant . . . [h]ospital.” Id. During her stay, the nurse aide sent the plaintiff into the shower room alone, where she lost consciousness and fell. Id. at 100. Plaintiff brought a negligence action against the hospital for her injuries. Id. The Kastler majority held the plaintiff was not required to introduce expert testimony on the standard of care because the activity at issue—“showers of patients—was routine care.” Id. at 102 (reasoning that “the jury could use its own knowledge and good sense with respect to the hospital’s conduct in question”). The plaintiff did not claim improper medication caused her to fall. 16