U.S. Supreme Court Limits Application of Healthcare Affidavit of Merit Requirements in Federal Court

On January 20, 2026, the United States Supreme Court issued a significant decision affecting healthcare litigation nationwide. In Berk v. Choy, the Court held Delaware’s statutory requirement that plaintiffs file an expert affidavit of merit does not apply in federal court because it conflicts with the Federal Rules of Civil Procedure. Though the decision restricted the use of a state affidavit statute in a federal case, the Court expressly recognized the legitimate policy concerns underlying those laws raised by healthcare providers and insurers.

Delaware’s affidavit of merit statute requires a plaintiff alleging medical negligence to file an affidavit with the petition from a qualified medical professional attesting that reasonable grounds exist to believe negligence occurred. Like Missouri’s affidavit of merit statute, the law was enacted in response to rising malpractice costs and was intended to serve as an early screening mechanism to weed out meritless claims.

Berk, who is from Florida, alleged the defendants negligently treated him for ankle fracture while on vacation in Delaware. Berk filed his medical malpractice action in federal court based on diversity jurisdiction. Though the cause of action arose under Delaware law, federal jurisdiction was proper under 28 U.S.C. § 1332.

Berk did not file the required affidavit of merit because, even after obtaining a statutory extension of time to file, he was unable to obtain expert support despite his efforts. Instead, Berk submitted copies of medical records under seal, prompting defendants to seek dismissal based on Delaware’s affidavit statute, and the District Court granted the motion. On appeal, the Third Circuit affirmed, holding the affidavit requirement applies in federal court.

Berk then appealed to the U.S. Supreme Court, arguing Delaware’s affidavit of merit statute could not be enforced in federal court because it conflicts with the Federal Rules of Civil Procedure, which require only a short and plain statement of the claim and do not permit dismissal based on the absence of expert evidence at the pleadings stage. The defendant healthcare providers argued this screening function is both necessary and sensible. They emphasized that affidavit requirements protect healthcare providers from being subjected to costly discovery and litigation based solely on conclusory allegations, particularly in technically complex medical cases where expert support is essential. Without an early expert review requirement, defendants are forced to incur substantial litigation expenses before a plaintiff is ever required to demonstrate the claim has medical support.

Despite acknowledging the purpose behind healthcare affidavit of merit statutes, the Supreme Court unanimously concluded Delaware’s affidavit law could not be enforced in federal court. The Court explained that when a state law claim is litigated in federal court, the Federal Rules of Civil Procedure govern procedural matters. Federal Rule of Civil Procedure 8 requires only a “short and plain statement” showing entitlement to relief and does not permit courts to demand evidentiary proof, such as an expert affidavit, at the pleadings stage. Because the Delaware statute imposed an additional requirement beyond what the Federal Rules require, the Court held it conflicted with valid federal rules and therefore could not be applied in federal court, even though the statute remains enforceable in state court.

Importantly, the Court did not question the wisdom or legitimacy of the policy goals behind affidavit statutes. Rather, it concluded only that those policy objectives cannot override the uniform procedural framework established by the Federal Rules.

Implications for Missouri Healthcare Claims

Missouri’s affidavit of merit statute, Section 538.225, RSMo, remains fully enforceable in Missouri state courts. Plaintiffs must still timely file an affidavit of merit, and failure to do so continues to provide grounds for dismissal under Missouri law. However, after Berk v. Choy, Missouri’s affidavit requirement cannot be applied in federal court if it conflicts with the Federal Rules of Civil Procedure. Plaintiffs pursuing Missouri healthcare claims in federal court therefore might not be subject to the affidavit of merit requirement. Instead, federal courts must evaluate pleadings under federal standards, with challenges to the merits occurring through motions to dismiss, expert disclosures, summary judgment, and Daubert proceedings.

The decision creates a clear procedural divide between state and federal healthcare litigation. While affidavit statutes remain a powerful tool for early claim screening in state court, the federal rules do not currently provide such a mechanism. As a result, jurisdictional strategy will continue to play an important role. When federal jurisdiction exists, early case evaluation, focused discovery planning, and aggressive expert practice become even more critical in addressing meritless claims at the earliest practicable stage.