Iowa Supreme Court Further Clarifies Certificate of Merit Requirements

Posted on: April 3rd, 2023

Roberta Butterfield’s estate brought suit against her nursing home, Chautauqua Guest Home, Inc., after her death in 2019. Butterfield’s estate alleged various omissions on the part of the nursing home throughout her residency. Chautauqua timely answered and a discovery plan was subsequently agreed to. Plaintiffs then failed to serve a certificate of merit affidavit and Chautauqua filed a motion to dismiss with prejudice pursuant to Iowa Code 147.140. The district court dismissed all of the estate’s claims. The court of appeals confirmed.

On appeal, the Estate argued that the certificate of merit was unnecessary because that requirement does not apply to plaintiffs who need experts solely for causation (as opposed to the standard of care of breach). Chautauqua argued that all elements of the Estate’s claims were dependent on medical judgment and therefore required experts.

The Supreme Court determined that Section 147.140(1) is ambiguous as to when a certificate of merit is required. The statute says it applies to any cause of action in which an expert is needed, but then it only requires the expert to address the standard of care and breach elements in the certificate of merit affidavit. The statute does not explain whether a certificate of merit affidavit is required in cases where expert testimony is necessary only to establish other elements of a prima facie case, such as causation or damages. The Supreme Court relied on the legislative history of the statute to clarify the ambiguity. The Court analyzed the text of three draft bills that contained the certificate of merit requirements. The draft bills required a certificate of merit to attest to standard of care, breach, or causation. However, the enacted language removed the word ‘causation’, which the Supreme Court inferred to be an intentional exclusion. Ultimately, the Supreme Court ruled that Section 147.140(1)(a) does not require plaintiffs to submit certificates of merit attesting to causation even though expert testimony about causation is necessary for the plaintiff to state a prima facie case. Ultimately, when a cause of action does not require an expert for standard of care or breach, no certificate of merit is required.

Iowa law is well settled that professional negligence claims against healthcare providers require expert testimony. Struck v. Mercy Health Services-Iowa Corp, 973 N.W.2d 533, 539 (Iowa 2022). However, our Supreme Court has recognized some professional breaches to be so blatant that no expert testimony is required as to standard of care. Id. at 539. For example, breaches in which “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.” Id. The Supreme Court has now clarified that a certificate of merit affidavit is not required in those very limited circumstances in which an expert will only testify as to causation. This ruling does not alter the requirement to provide a certificate of merit affidavit when an expert will testify as to standard of care and breach, and confirms that a dismissal with prejudice is the consequence of a failure to do so.

Estate of Roberta Ann Butterfield by Bradley Dean Butterfield and Deanne Marie Rogers, Co-Administrators  v. Chautauqua Guest Home, Inc. d/b/a Chautauqua Guest Home #3 and Chautauqua Guest Homes, No. 22-0101 (Iowa March 17, 2023).

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