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Federal Rules Trump State Malpractice Barriers

Federal Rules Trump State Malpractice Barriers

Supreme Court unanimously rules state affidavit requirements don't apply in federal court

Overview

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, creating a procedural pathway that bypasses state tort reform measures.

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, potentially reshaping where plaintiffs choose to file and how healthcare providers defend against claims.

Key Indicators

29
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
88
Years since Erie
The 1938 Erie doctrine remains the framework for determining when federal courts apply state law

People Involved

Harold R. Berk
Harold R. Berk
Petitioner (Case remanded for further proceedings)
WM
Wilson C. Choy, MD
Respondent (Case remanded for further proceedings)
Amy Coney Barrett
Amy Coney Barrett
Associate Justice, U.S. Supreme Court (Authored majority opinion)
Ketanji Brown Jackson
Ketanji Brown Jackson
Associate Justice, U.S. Supreme Court (Filed concurrence in judgment)

Organizations Involved

American Medical Association
American Medical Association
Professional Association
Status: Filed amicus brief supporting respondent

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

AM
American Association for Justice
Legal Advocacy Organization
Status: Filed amicus brief supporting petitioner

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

PU
Public Justice
Legal Advocacy Organization
Status: Filed amicus brief supporting petitioner

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

Timeline

  1. Supreme Court Rules for Berk Unanimously

    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.

  2. Supreme Court Hears Oral Argument

    Court Proceeding

    Justices hear arguments on whether Delaware's affidavit requirement conflicts with Federal Rules of Civil Procedure.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.'

Scenarios

1

States Adapt: New Substantive Malpractice Hurdles Emerge

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.

2

Forum Shopping Increases: Federal Courts See Malpractice Surge

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.

3

Federal Rules Committee Acts: Uniform Malpractice Screening Adopted

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.

4

Impact Remains Limited: Few Cases Shift Jurisdiction

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

Erie Railroad v. Tompkins (1938)

April 1938

What Happened

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.

Outcome

Short Term

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

Long Term

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 It's Relevant Today

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.

Shady Grove v. Allstate (2010)

March 2010

What Happened

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.

Outcome

Short Term

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

Long Term

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 It's Relevant Today

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.

Medical Malpractice Insurance Crisis (1975)

1974-1976

What Happened

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.

Outcome

Short Term

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

Long Term

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 It's Relevant Today

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.

12 Sources:
+6
Justia U.S. Supreme Court Center Legal Information Institute SCOTUSblog Duane Morris LLP White and Williams LLP American Medical Association Legalytics Expert Institute Justia AMA Journal of Ethics Justia U.S. Supreme Court Center Legal Information Institute