New Iowa Certificate of Merit Appellate Opinion

The Iowa Supreme Court issued an interesting opinion Estate of Butterfield v. Chautauqua Guest Home, Inc. addresses Iowa’s five-year-old certificate of merit requirement in medical malpractice lawsuits.

Background Facts and Proceedings

This is a medical malpractice bed sore case alleging wrongful death. The case revolves around injuries Ms. Butterfield allegedly suffered while caring for Chautauqua Guest Home, Inc., a skilled nursing facility. About a year before her ultimate death, her leg was injured while she was being moved from the bathroom to a wheelchair by the Chautauqua caretakers. She was taken to the hospital six days later, where she was diagnosed with a left hip fracture, which required surgery.

Butterfield returned to Chautauqua a few days later. At that point, she had no pressure injuries or skin problems. Over the next few months, she spent a lot of time in bed. She developed a blister on her left buttock, which grew significantly and eventually became infected, emitting a foul odor as bed sores do. The bed sores eventually caused her death.

A year later, Butterfield’s estate filed the medical malpractice lawsuit currently in question. Discovery ensued. After the statute of limitations passed, Chautauqua moved to dismiss the case with prejudice according to Iowa Code section 147.140. Following a hearing, the trial court dismissed the bed sore lawsuits. Iowa’s intermediate court affirmed and the case went to the state’s Supreme Court.

Iowa Code Section 147.140

This case hinges on the applicability of Iowa Code section 147.140. This Iowa law, passed in 2017, sets rules for personal injury and wrongful death lawsuits against medical professionals. The gist of the law is that it requires plaintiffs’ medical malpractice lawyers in Iowa to submit a statement from a qualified expert indicating that the lawsuit has merit. This requirement is intended to discourage filing lawsuits that are unlikely to succeed because they cannot meet the burden of proof. These are the key points:

When you file a lawsuit that claims a medical professional did something wrong and it caused harm or death, you often need an expert to testify about what the medical professional should have done and how they failed to do it
If your lawsuit is the type that needs an expert to establish these things, you have to serve the person you’re suing with a particular document called a ‘certificate of merit.’ Most states have a similar requirement. An expert witness must sign this document, and it has to state the appropriate standard of care and how it was allegedly breached. So it is a doctor backing up your claim with legal language in writing.
You have to serve this certificate of merit within 60 days after the person you’re suing gives their formal response to your lawsuit (known as an ‘answer’). The best Iowa malpractice lawyers make life easier for themselves by just filing the certificate of merit with the lawsuit.
If you don’t follow these rules, the person you’re suing can ask the court to dismiss your lawsuit ‘with prejudice,’ which means you can’t bring the same lawsuit again. This facet of the § 147.140 looms large in Estate of Butterfield v. Chautauqua Guest Home, Inc.
The goal of this law is to quickly get rid of lawsuits that aren’t backed by expert opinion, to save time and resources, and to deter people from bringing frivolous lawsuits.

Iowa Supreme Court’s Holding

The Estate argues that the requirement does not apply as expert evidence is not necessary to establish the elements of its case. Chautauqua, however, claims that the entire case hinges on medical judgment and therefore requires expert testimony, triggering the need for a Certificate of Merit. Chautauqua argues that the statute requires a Certificate of Merit regarding the standard of care and breach, even if the plaintiff only needs an expert for causation.

Iowa Supreme Court

The Iowa Supreme Court looked at the statute’s legislative history to find clues. The original drafts of the bill required the Certificate of Merit to cover the standard of care, breach, and causation. However, the enacted statute removed the word “causation,” possibly indicating that the legislature did not intend to require plaintiffs to certify causation issues so early in litigation. So the court included ambiguity in section 147.140 regarding when there is a necessity for a certificate of merit, at least with respect to causation.

So the court sent the case back to the trial court to dismiss any counts in the complaint allegations requiring expert opinion on the standard of care and breach and maintain any counts that do not require an expert opinion.

Practically, there do not seem to be counts where a breach of the standard of care is not required, so this ruling likely just prolongs the death of this lawsuit. One issue the court did not raise – likely because the parties did not raise – is if there are waiver issues when a party engages in discovery without objecting to defects in the complaint.