The Merit of Merit Affidavits in Malpractice Lawsuits

Similar to many other states, Oklahoma has a statute prescribing that suits alleging medical malpractice must be verified by an affidavit from a qualified medical expert. Suits unaccompanied by a proper affidavit must be stricken out. This statute is part of what I call – and commend – as a procedural tort reform: it allows courts to get rid of unmeritorious suits against doctors and hospitals early in the process.

The statute, however, recently became a dead letter after being pronounced unconstitutional by Oklahoma’s Supreme Court for the second time in a row (Wall v. Marouk, — P.3d —-, 2013 WL 2407160 (Okla. 2013)). Evidently, this Court does not view merit affidavits as favorably as I do.  Let’s see why.

The previous version of Oklahoma’s affidavit-of-merit requirement, limited to medical malpractice suits, was found unconstitutional as a “special law” and “monetary barrier to the access to courts” (Zeier v. Zimmer, Inc., 152 P. 3d 861 (Okla. 2006)). The current version extended to all suits asserting professional negligence, which makes it less “special.” This version was nonetheless challenged by a patient whose suit against a physician was not accompanied by a merit affidavit from a qualified expert.

The plaintiff alleged that the physician caused him permanent injury during surgery (loss of feeling in right fingers) by negligently cutting the median nerve in his right arm.  The trial court ruled that the plaintiff must submit the required affidavit within twenty days or face dismissal.

The Oklahoma Supreme Court voided this requirement for being as unconstitutional as the previous one.  The Court ruled that the requirement arbitrarily separates suits that allege professional negligence from other civil actions, in which plaintiffs do not bear the costly burden of obtaining expert review prior to proceeding. This disparate treatment, explained the Court, discriminates against victims of professional misconduct.

The Court also ruled that the merit affidavit requirement creates an unconstitutional burden on access to the courts. The Court estimated that the cost of obtaining an expert opinion to support the required affidavit of merit may range from $500 to $5000, well above the benchmark that it previously found constitutional as a jury fee ($349). This burden, held the Court, is too heavy.

At the beginning of its decision, the Court noted that “The Oklahoma Constitution is a unique document” as “some of its provisions are unlike those in the constitutions of any other state, and some are more detailed and restrictive than those of other states.”  By making this point, the Court indicated that it is well aware of the fact that its decision is a constitutional outlier: as I mentioned at the outset, the prevalent view across the states holds that merit affidavit requirements are constitutional.

The uniqueness of Oklahoma’s Constitution makes it difficult for an outsider law professor to comment on the Court’s decision. With this caveat in mind, I still fail to understand the Court’s economic analysis of the merit affidavit requirement. The statute that the Court pronounced unconstitutional required plaintiffs to procure expert testimony well before trial. This requirement imposes a financial burden on medical-malpractice (and other) plaintiffs. However, when a case goes to trial—which happens whenever the defendant claims that the suit has no merit—the plaintiff must procure expert testimony and pay for it. The condemned statute thus merely required plaintiffs to upfront their expenditure on expert testimony.

I can’t see how this impedes access to the courts. The right comparison here is not between the expert’s $5000 fee and the Court’s constitutionality benchmark for fees, $349.  Rather, the right comparison here is between the $349 benchmark and the interest accruable on $5000 for the period separating the trial from the filing of the plaintiff’s suit. When an individual makes, say, a two-year deposit of $5000 in an interest bearing savings account, she hardly earns $349.  If so, the merit affidavit requirement is not as onerous as estimated by the Court. At the same time, it promotes an important social interest by screening away unmeritorious suits that waste public resources and in more extreme scenarios drive up the cost of medical care.

Furthermore, as noted by Justice Steven Taylor in his dissent, the condemned statute exempted indigent plaintiffs from the duty to submit a merit affidavit. This exemption protected Oklahomans’ access to justice well enough.

Alex Stein is a Professor of Law at Cardozo Law School. His specialty areas are Evidence, Medical Malpractice, Torts and Economic Analysis of Law in general. This blog originally appeared in Harvard Law School Petrie-Flom Center’s blog project, Bill of Health.

7 replies »

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  2. If an affidavit of merit is submitted is there any reason for a trial? Obviously an “expert” has said the plaintiff was harmed – so just work out the settlement and be done with it.

  3. Not sure this is going to work, for the reasons stated above. (The last thing we need around here is more bureaucracies that will inevitably misfunction as participants figure out how to game the system.) Rather, there should be some penalty applied in cases where suits are filed without merit. Although this is tricky. Broadly, the state should monitor the litigation practices of law firms – much as it now proposes to monitor physicians, hospitals – and already does regulate financial markets (however clumsily) and some consumer products (with varying degrees of success). Firms that file more than x suits found to be frivolous, should be penalized. Repeat offenders should lose their license to operate.

  4. Matthew’s idea is spot-on. Experts are needed. It is ABSURD to use a layperson jury who doesnt understand medicine or science to decide these cases.

    The question is then, how do you find an unbiased expert?

    Certainly, the WRONG approach is our current system where experts are hired gun whores who will say anything for any party depending on how much they are being paid.

    The right answer is a rotating pool of doctors who are paid a LOW FLAT FEE UPFRONT before they render a decision. Remove the money bias and you will get honest analysis from experts.

  5. Makes no difference. (As has been said with respect to Grand Juries – “you can get a Grand Jury to indict a ham sandwich”.) You can get a plaintiff’s expert to certify the merits of any case.

    Any lawyer who can’t get an expert to conclude there was a “violation of the standard of care” is probably incompetent.

    The system is a corrupt turd – and as we all know, you can’t shine sh*t.

  6. The state could just hire some experts and process the merits for free or for a low fee. Would probably be better that way since the state experts could be trained both in medicine and in the legal issues, making them better judges and more impartial on the merits of the cases. I fear that ordinary doctors with no legal background would be too likely to sympathize with the medical provider rather than the patient.