Federal rules trump state malpractice barriers

Overview

Updated May 22

For decades, more than half of U.S. states required injured patients to obtain expert affidavits before filing medical malpractice lawsuits—a screening mechanism designed to filter frivolous claims. On January 20, 2026, the Supreme Court ruled unanimously that these state requirements don't apply when patients sue in federal court.

The decision in Berk v. Choy resolves a long-standing circuit split and reaffirms a principle dating to 1938: when federal procedural rules are on point, they control. The ruling affects how approximately 29 states' malpractice screening laws interact with federal courts.

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Key Indicators

States with affidavit requirements

States requiring certificates or affidavits of merit for malpractice claims, now unenforceable in federal court

9-0

Supreme Court vote

Unanimous decision with Justice Barrett writing for the Court

6-2

Circuit split resolved

Six circuits had already rejected state affidavit laws; Third and Tenth circuits had enforced them

Years since Erie

The 1938 Erie doctrine remains the framework for determining when federal courts apply state law

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People Involved

Harold R. Berk

Petitioner

Case remanded for further proceedings

Wilson C. Choy, MD

Respondent

Case remanded for further proceedings

Amy Coney Barrett

Associate Justice, U.S. Supreme Court

Authored majority opinion

Ketanji Brown Jackson

Associate Justice, U.S. Supreme Court

Filed concurrence in judgment

Robert Peck

Attorney, Center for Constitutional Litigation

Represented amici supporting petitioner

Brandon Vaughn

Attorney, Robins Kaplan LLP

Plaintiffs' counsel analyzing decision

Hillary A. Taylor

Managing Shareholder, Keating Jones Hughes

Healthcare defense counsel analyzing decision

Organizations Involved

American Medical Association

Medical Association

Filed amicus brief supporting respondent

The largest association of physicians in the United States, advocating for healthcare policy including medical liability reform.

American Association for Justice

Legal Advocacy Organization

Filed amicus brief supporting petitioner

Formerly the Association of Trial Lawyers of America, representing plaintiffs' attorneys and advocating for civil justice system access.

Public Justice

Legal Advocacy Organization

Filed amicus brief supporting petitioner

A nonprofit legal advocacy organization pursuing high-impact lawsuits to advance civil rights and access to justice.

Center for Constitutional Litigation

Legal Advocacy Organization

Supported petitioner through amici representation

Legal organization that represented parties supporting Harold Berk's position in the Supreme Court case.

Robins Kaplan LLP

Law Firm

Plaintiffs' firm analyzing decision impact

National plaintiffs' law firm with attorneys practicing medical malpractice litigation.

Keating Jones Hughes

Law Firm

Healthcare defense firm warning of forum shopping

Healthcare defense law firm representing medical providers in malpractice litigation.

Timeline

April 1938 January 2026

13 events Latest: January 20th, 2026 · 8 months ago Showing 8 of 13

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January 2026
Supreme Court Rules for Berk Unanimously
Latest Court Ruling

In a 9-0 decision, the Court holds that Delaware's affidavit requirement does not apply in federal court because it conflicts with the Federal Rules.
January 20th, 2026
October 2025
Supreme Court Hears Oral Argument
Court Proceeding

Justices hear arguments on whether Delaware's affidavit requirement conflicts with Federal Rules of Civil Procedure.
October 6th, 2025
March 2025
Supreme Court Grants Certiorari
Court Action

Supreme Court agrees to hear the case, recognizing the circuit split between the Third and Tenth Circuits and six other circuits.
March 10th, 2025
October 2024
Berk Petitions Supreme Court
Legal Filing

Berk files petition for certiorari asking the Supreme Court to resolve the circuit split on whether state affidavit requirements apply in federal court.
October 16th, 2024
July 2024
Third Circuit Affirms Dismissal
Court Ruling

U.S. Court of Appeals for the Third Circuit affirms, holding Delaware's statute is substantive and promotes Erie's twin aims of preventing forum shopping.
July 25th, 2024
April 2023
District Court Dismisses Berk's Lawsuit
Court Ruling

Federal district court dismisses the case for failure to comply with Delaware's affidavit-of-merit requirement.
April 4th, 2023
November 2022
Berk Files Federal Lawsuit Without Affidavit
Legal Filing

Berk sues Dr. Wilson Choy and Beebe Medical Center in federal court for medical malpractice without including Delaware's required affidavit of merit.
November 18th, 2022
August 2020
Harold Berk Injured at Delaware Home
Incident

Berk falls out of bed, fractures his ankle, and receives treatment at Beebe Medical Center that allegedly worsens his injury.
August 1st, 2020
March 2010
Shady Grove v. Allstate Expands Federal Rule Supremacy
Legal Precedent

Supreme Court holds that Federal Rule 23 allows class actions in federal court even when state law prohibits them, strengthening federal procedural rule supremacy.
March 31st, 2010
January 2004
Delaware Strengthens Affidavit Requirements
Legislation

Delaware amends Section 6853 to require expert affidavits accompany medical malpractice complaints, with the complaint refused if the affidavit is missing.
January 1st, 2004
January 1975
California Enacts MICRA
Legislation

California passes the Medical Injury Compensation Reform Act, launching the modern era of state tort reform including affidavit-of-merit requirements.
January 1st, 1975
April 1965
Hanna v. Plumer Refines Erie Framework
Legal Precedent

Supreme Court holds that when a Federal Rule of Civil Procedure directly addresses an issue, it controls over conflicting state law in federal court.
April 5th, 1965
April 1938
Erie Railroad v. Tompkins Establishes Doctrine
Legal Precedent

Supreme Court holds that federal courts sitting in diversity must apply state substantive law, ending nearly a century of federal courts applying 'general common law.'
April 25th, 1938

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Scenarios

States Adapt: New Substantive Malpractice Hurdles Emerge

Likely

Discussed by: Legal scholars at Duke Law Journal, healthcare policy analysts at the American Medical Association

States redesign their malpractice screening laws to be clearly substantive rather than procedural—for example, making expert review a condition precedent to the cause of action itself, not just a pleading requirement. This would survive Berk under Erie's substance-procedure distinction. Some states may also impose shorter statutes of limitations or stricter expert qualification standards that federal courts must apply.

Forum Shopping Increases: Federal Courts See Malpractice Surge

Possible

Discussed by: American Association for Justice, healthcare defense attorneys writing in Bloomberg Law

Plaintiffs with diversity jurisdiction increasingly file in federal court to avoid state affidavit requirements, particularly in states with strict screening laws like Pennsylvania, New Jersey, and Texas. Defense attorneys respond by removing cases to federal court in states without such requirements, or by seeking state-level legislative responses. The distribution of malpractice litigation shifts measurably between state and federal courts.

Federal Rules Committee Acts: Uniform Malpractice Screening Adopted

Unlikely

Discussed by: Civil procedure scholars, the Judicial Conference Advisory Committee on Civil Rules

The Advisory Committee on Civil Rules proposes amendments to the Federal Rules establishing uniform expert screening requirements for professional malpractice cases in federal court. This would create a single federal standard, eliminating forum shopping incentives while preserving some filtering mechanism. Such amendments would require multi-year rulemaking and congressional approval.

Impact Remains Limited: Few Cases Shift Jurisdiction

Possible

Discussed by: Federal Judicial Center researchers, empirical legal scholars

Because most malpractice cases lack diversity jurisdiction (patients typically sue local doctors), the practical impact proves modest. The overwhelming majority of malpractice litigation continues in state court under state rules. Federal court malpractice filings increase marginally but do not fundamentally alter the litigation landscape.

Historical Context

3 moments from history that rhyme with this story — and how they unfolded.

April 1938

Erie Railroad v. Tompkins (1938)

Harry Tompkins was struck by an object protruding from a passing Erie Railroad train while walking along tracks in Pennsylvania. He sued in federal court in New York, seeking to apply 'general federal common law' rather than Pennsylvania's contributory negligence standard. Justice Brandeis wrote for a 6-2 majority that federal courts sitting in diversity must apply state substantive law.

Then

Tompkins' case was remanded for retrial under Pennsylvania law, which offered him less favorable treatment as a trespasser.

Now

Created the fundamental framework governing when federal courts apply state versus federal law—a framework Berk v. Choy continues to interpret 88 years later.

Why this matters now

Erie established that preventing forum shopping and ensuring equal administration of the laws requires federal courts to apply state substantive rules. Berk v. Choy tests whether state procedural barriers to malpractice suits qualify as 'substantive' under this framework.

1974-1976

Medical Malpractice Insurance Crisis (1975)

Two major malpractice insurers notified over 6,000 California physicians that their coverage would either not be renewed or would increase by up to 380%. Similar crises affected multiple states. California responded with MICRA, the Medical Injury Compensation Reform Act, which capped noneconomic damages at $250,000 and imposed procedural screening requirements.

Then

California stabilized its malpractice insurance market. Other states followed with their own tort reform packages.

Now

By 2025, approximately 29 states had adopted affidavit-of-merit requirements as part of broader tort reform efforts. These reforms became targets of litigation over federal-state procedural conflicts.

Why this matters now

The 1970s crisis created the tort reform measures now at issue. States enacted affidavit requirements specifically to reduce frivolous suits and insurance costs—policy goals the Supreme Court acknowledges but holds cannot override federal procedural rules in federal court.

March 2010

Shady Grove v. Allstate (2010)

New York law prohibited class actions seeking statutory damages, but Federal Rule 23 allows class certification if prerequisites are met. Shady Grove Orthopedic Associates sought class certification in federal court for a dispute with Allstate over unpaid interest. The Court, in a fractured 5-4 decision with Justice Scalia writing the plurality, held that Rule 23 controls.

Then

Class actions prohibited under state law could proceed in federal court if they met Federal Rule 23's requirements.

Now

Established that federal procedural rules trump conflicting state procedures even when the state rule serves substantive policy goals, strengthening the Hanna v. Plumer framework.

Why this matters now

Shady Grove is the direct precedent for Berk v. Choy—both involve state procedural requirements that serve substantive tort policy goals being displaced by federal rules. The Court's unanimous decision in Berk extends Shady Grove's logic to malpractice screening requirements.