Just under six years have passed since Iowa enacted its medical malpractice certificate of merit requirement, codified at Iowa Code § 147.140.  Iowa practitioners have paid close attention during these years as the Iowa Supreme Court and Iowa Court of Appeals have explored the requirement’s contours.  And just this month, the Iowa Supreme Court outlined another layer of considerations Iowa practitioners must keep in mind while litigating medical malpractice claims.

Estate of Butterfield v. Chautaqua Guest Home, Inc. was an appeal to the Iowa Supreme Court that involved a medical malpractice claim by a decedent’s estate and next-of-kin against a nursing home.  Under § 147.140, “in any action for personal injury or wrongful death against a health care provider based upon . . . alleged negligence . . . for which expert testimony is necessary to establish a prima facie case” the plaintiff must serve on the defendant an “affidavit signed by an expert witness with respect to the issue of standard of care and an alleged breach of the standard of care” within 60 days of the action’s filing.

But as the Iowa Supreme Court noted, though one part of § 147.140 requires a certificate of merit be submitted in medical malpractice cases where an expert’s testimony is required to establish a prima facie case, the statute only requires that the certificate contain information regarding the relevant standard of care and alleged breach—a requirement that omits a prima facie element: causation.  Therefore, the Court asked: “is a certificate of merit required in any medical malpractice action where expert testimony is necessary to establish any part of the prima facie case or only when an expert is needed to establish either the standard of care or breach?” As the Court noted, “The first part of section 147.140(1)(a) implies the former, whereas the second part implies the latter. . .”

To resolve this question, the Iowa Supreme Court turned to the statute’s legislative history.  There, the Court found the bill that contained the certificate of merit requirement had undergone multiple revisions before it was passed.  And where an earlier version of the bill required that the certificate contain an expert’s opinion regarding causation, the version that passed omitted that requirement.

Finding this history “particularly helpful,” the Court inferred the legislature’s intent was that certificates of merit need not contain causation opinions.  Moreover, for cases involving “blatant” professional breaches a lay juror can understand without expert testimony, the Court concluded “there is no need for a certificate of merit about the standard of care and breach when an expert is needed for neither of those elements.”

So what does Estate of Butterfield mean for Iowa’s medical malpractice litigators?  First, with no requirement that certificates of merit contain causation opinions, the statute now imposes a lesser burden on plaintiffs.  Second, where it was previously debatable whether certificates of merit were necessary in cases that involved “blatant” allegedly negligent acts, the Iowa Supreme Court has concluded they are not necessary.  And third, state legislators—from and elsewhere—may look at the ambiguity left in the text of § 147.140 and adapt their practices in future legislative sessions.