In the Iowa Supreme Court
No. 25–0287
Submitted January 21, 2026—Filed March 6, 2026
Linda Jones,
Appellant,
vs.
Larry Lindell, Broadlawns Medical Center Foundation d/b/a Broadlawns Medical Center, and Does I-V and Roes Corporations VI-X, inclusive,
Appellees.
Appeal from the Iowa District Court for Polk County, Michael D. Huppert,
judge.
The plaintiff appeals from a decision striking her expert as unqualified
under Iowa Code section 147.139 and granting the defendants’ motion for
summary judgment. Affirmed.
McDonald, J., delivered the opinion of the court, in which all justices
joined.
Devin K. Ross (argued) and James R. Jackson of Lowe Law Group, Ogden,
Utah, for appellant.
Joseph F. Moser (argued) and Connie L. Diekema of Finley Law Firm, P.C.,
Des Moines, for appellees. 2
McDonald, Justice.
“If the standard of care given by a health care provider” is at issue in a
case, the plaintiff’s designated expert witness cannot qualify as an expert witness
to testify “on the issue of the appropriate standard of care or breach of the
standard of care” unless, among other things, the plaintiff’s expert is “licensed
to practice in the same or a substantially similar field as the defendant.” Iowa
Code § 147.139(1) (2023). In addition, “[i]f the defendant is board-certified in a
specialty,” the plaintiff’s designated expert witness must be “certified in the same
or a substantially similar specialty.” Id. § 147.139(3). The question presented in
this medical malpractice case is whether the plaintiff’s designated expert
witness, a board-certified urologist, meets these requirements to qualify as an
expert witness in a suit brought against a board-certified ob-gyn.
I.
Linda Jones filed this medical malpractice action against Broadlawns
Medical Center and Dr. Larry Lindell. Jones alleged that she underwent a total
hysterectomy and bilateral salpingo-oophorectomy at Broadlawns. The
procedure involved the removal of her uterus, cervix, ovaries, and fallopian
tubes. Dr. Lindell performed the surgery. Dr. Lindell holds a license to practice
medicine in the State of Iowa, and he holds a board certification in Obstetrics
and Gynecology from the American Board of Obstetrics and Gynecology.
Immediately following the surgery, Jones experienced pain, fever, dysuria, and
other symptoms. Despite these symptoms, she was discharged from the hospital.
Her symptoms persisted after being discharged, and she called 911 later that
same day. Emergency personnel transported Jones to a different medical center,
where surgeons identified and repaired injuries to her right ureter. In her 3
petition, Jones alleged the defendants were negligent in their surgical and
postoperative care.
Jones designated Dr. Robert Wayment as her expert witness to testify
regarding the standard of care and breach of the standard of care. Dr. Wayment
holds licenses to practice medicine in Utah, North Dakota, and Wyoming, and
he holds a board certification in Urology from the American Board of Urology. In
his expert report, Dr. Wayment identified the standard of care and opined that
Dr. Lindell breached the standard of care during and after Jones’s surgery by
damaging the right ureter with a cautery device, failing to perform a cystoscopy
to detect a ureteral injury, discharging Jones instead of ordering appropriate
diagnostic assessments when she reported experiencing certain symptoms after
the procedure, and failing to consult a urologist postoperatively when
complications involving the ureter became apparent.
The defendants deposed Dr. Wayment. He testified that he maintains an
active urological practice that primarily consists of treating prostate and kidney
cancers; treating kidney stones, percutaneous stones, and urinary tract
infections; performing robotic renal and ureteral surgeries; and performing
prostate procedures and vasectomies. Dr. Wayment coauthored a single article
involving a hysterectomy during his residency in 2009, but he testified that his
focus during that research was the “urologic aspect” of the article, while a
coauthor, a gynecologist, “covered the hysterectomy part.” Dr. Wayment further
testified that he has never performed an exploratory laparotomy with total
abdominal hysterectomy and bilateral salpingectomy and has never been trained
in that procedure: 4
Q It is outside the scope of your practice and training to testify as to the standard of care as an OB/GYN; correct?
....
A I have reviewed the literature. I work closely with gynecologists that do many hysterectomies, and I repair the problems that come from them. So in discussing this with other gynecologists, I believe this is the standard of care.
Q Well, I’m not here taking the deposition of any gynecologist you’ve discussed this with.
You would agree that you do not perform hysterectomies, and therefore, you do not know the standard of care for performing a hysterectomy?
A Okay. I do not perform hysterectomies. You’re right.
Q And answer the second part of that question. So you do not know the standard of care for performing a hysterectomy?
A Yeah, you can say -- I guess you can say yes.
He testified that he would ordinarily not be in the operating room while an ob-gyn
was performing a hysterectomy. Apart from occasionally making the initial
incision at an ob-gyn’s request, he has not removed any of the female
reproductive organs, does not conduct preoperative risk counseling for
hysterectomy procedures, and does not typically recommend hysterectomies to
patients.
After deposing Dr. Wayment, the defendants filed a combined motion to
strike and exclude Dr. Wayment as unqualified and a motion for summary
judgment. They argued that Dr. Wayment could not be qualified as an expert
witness in this case pursuant to Iowa Code section 147.139 because he was not
licensed to and did not maintain a practice in the same or a substantially similar 5
field as Dr. Lindell and because he was not certified in the same or substantially
similar specialty as Dr. Lindell. Because Dr. Wayment could not be qualified as
an expert witness in this case, Jones had no expert witness to opine on the
standard of care and breach of the standard of care necessary to establish a
prima facie case of negligence. Accordingly, the defendants argued, they were
entitled to judgment as a matter of law.
The district court granted the motion. The district court relied on
dictionary definitions of “substantially” and “similar” and concluded that “an
appropriate definition of the phrase ‘substantially similar’ would be that the field
of the designated expert and the physician who is the subject of the negligence
claim ‘must have considerable characteristics in common with and be, to a large
degree, very much alike in substance and essentials.’ ” (Quoting Ray v. State,
564 S.W.3d 771, 777 (Mo. Ct. App. 2018).) Applying that definition, the court
found that the plaintiff could not meet her burden to establish that urology is
the same or substantially similar specialty as obstetrics and gynecology. Because
Jones failed to establish that the specialties themselves are substantially similar,
the court struck Dr. Wayment’s report and dismissed the case.
II.
The dispute in this case involves whether the district court erred in
concluding that the plaintiff’s designated expert witness was not qualified to
opine on the standard of care and breach of the standard of care. We review
issues of statutory interpretation for correction of errors at law. Cnty. Bank v.
Shalla, 20 N.W.3d 812, 818 (Iowa 2025). 6
A.
Iowa law imposes a heightened standard to qualify an expert witness in
cases where the standard of care given by a health care provider is at issue. The
relevant statute provides:
If the standard of care given by a health care provider, as defined in section 147.136A, is at issue, the court shall only allow a person the plaintiff designates as an expert witness to qualify as an expert witness and to testify on the issue of the appropriate standard of care or breach of the standard of care if all of the following are established by the evidence:
1. The person is licensed to practice in the same or a substantially similar field as the defendant, is in good standing in each state of licensure, and in the five years preceding the act or omission alleged to be negligent, has not had a license in any state revoked or suspended.
2. In the five years preceding the act or omission alleged to be negligent, the person actively practiced in the same or a substantially similar field as the defendant or was a qualified instructor at an accredited university in the same field as the defendant.
3. If the defendant is board-certified in a specialty, the person is certified in the same or a substantially similar specialty by a board recognized by the American board of medical specialties, the American osteopathic association, or the council on podiatric medical education.
Iowa Code § 147.139(1)–(3) (emphasis added). The parties dispute whether
Drs. Wayment and Lindell are licensed to practice and do practice in the same
or substantially similar field and whether Drs. Wayment and Lindell are board-
certified in the same or substantially similar specialty.
B.
The parties first dispute whether Dr. Wayment was licensed to practice
and had actively practiced in the same or substantially similar field as Dr. Lindell
within the meaning of subsections (1) and (2) of the statute. See id. § 147.139(1)– 7
(2). In resolving that dispute, it is important to understand the scope of the entire
statutory scheme. The expert witness qualification statute does not just apply to
suits against physicians; it applies whenever the “standard of care given by a
health care provider, as defined in section 147.136A, is at issue.” Id. § 147.139.
A “health care provider” refers to a wide variety of health care professionals each
subject to their own licensure scheme, including:
a physician or an osteopathic physician licensed under chapter 148, a physician assistant licensed and practicing under a supervising physician under chapter 148C, a podiatrist licensed under chapter 149, a chiropractor licensed under chapter 151, a licensed practical nurse, a registered nurse, or an advanced registered nurse practitioner licensed under chapter 152 or 152E, a dentist licensed under chapter 153, an optometrist licensed under chapter 154, a pharmacist licensed under chapter 155A, a professional corporation under chapter 496C that is owned by persons licensed to practice a profession listed in this paragraph, or any other person or entity who is licensed, certified, or otherwise authorized or permitted by the law of this state to administer health care in the ordinary course of business or in the practice of a profession.
Id. § 147.136A(1)(a).
Because the statute applies to different categories of health care providers,
the most logical interpretation of the qualification provision in section 147.139
is that the term “field” categorically distinguishes one type of health care provider
“licensed, certified, or otherwise authorized” to administer health care in this
state from another. Id.; see also Field, Webster’s Third New International
Dictionary 845 (unabr. ed. 2002) [hereinafter Webster’s] (defining “field” as a
“category, or division wherein a particular activity or pursuit is carried out”). A
designated expert and a health care provider defendant are thus licensed in and
practice in the same field if they hold the same license and practice under the
same license. 8
The defendants contend that this is too low of a bar and that the statute
must demand something more than holding the same license and practicing
under the same license. The defendants argue that field must refer to some
subset of practice within the license, for example, the health care provider’s
specific area of practice. Dr. Wayment practices in the area of urology, but
Dr. Lindell practices in the area of obstetrics and gynecology. Therefore, the
defendants argue, Dr. Wayment and Dr. Lindell are not in the same field.
The defendants’ argument is not consistent with the text of the statute.
The statute first requires that the qualifying expert be “licensed to practice in the
same or a substantially similar field” as the defendant health care provider. Iowa
Code § 147.139(1) (emphasis added). The defendants concede that Dr. Lindell
does not hold a license in obstetrics and gynecology, however, because there is
no separate license for obstetrics and gynecology. We thus cannot interpret field
to mean the defendant health care provider’s limited area of practice within a
license without reading the word license out of the statute, and this we decline
to do. See State v. Boone, 989 N.W.2d 645, 650 (Iowa 2023) (“We presume
statutes or rules do not contain superfluous words.” (quoting State v. Iowa Dist.
Ct., 889 N.W.2d 467, 474 (Iowa 2017))).
With that understanding, it is clear that subsections (1) and (2) of the
statute are satisfied here. Dr. Lindell and Dr. Wayment are both licensed
physicians, and they both practice medicine. They are thus licensed to practice
and do in fact practice in the same field within the meaning of the statute.
Because Drs. Lindell and Wayment are both licensed to practice and do in fact
practice in the same field, we need not consider the issue of what constitutes a
substantially similar field within the meaning of the statute. 9
C.
The parties next dispute whether Dr. Wayment was board-certified in the
same or a substantially similar specialty as Dr. Lindell within the meaning of
subsection (3) of the statute. See Iowa Code § 147.139(3). Dr. Wayment is board-
certified in Urology by the American Board of Urology. Dr. Lindell is board-
certified in Obstetrics and Gynecology by the American Board of Obstetrics and
Gynecology. The parties agree that these are not the same specialties, but they
dispute whether these specialties are substantially similar.
The statutory history and the text of the statute make clear that courts are
to take a categorical approach in determining whether one specialty is
substantially similar to another. In the prior version of this statute, a person
could be qualified as an expert witness “if the person’s medical or dental
qualifications relate directly to the medical problem or problems at issue and the
type of treatment administered in the case.” Iowa Code § 147.139 (2016). This
required courts to make a case-by-case determination focused on the proposed
expert’s qualifications as they related to the specific problems and treatments at
issue in the case. The legislature replaced that case-by-case-problem approach
in 2017 when it adopted the current version of the statute. 2017 Iowa Acts
ch. 107, § 3 (codified at Iowa Code § 147.139 (2018)). The statute now requires
courts to make a categorical determination of whether the proposed expert and
the defendant health care provider are board-certified in the same or
substantially similar specialty without any consideration of the actual problems
or treatments at issue in the case.
Generally speaking, “substantially similar” means that one thing has a
high degree of likeness to another but may be less than identical. See, e.g., Ray,
564 S.W.3d at 777 (stating that to be substantially similar, elements “must have 10
considerable characteristics in common with and be, to a large degree, very much
alike in substance and essentials”); Fisk v. State, 574 S.W.3d 917, 920 (Tex.
Crim. App. 2019) (stating that substantially similar elements “must display a
high degree of likeness, but may be less than identical” (quoting Prudholm v.
State, 333 S.W.3d 590, 594 (Tex. Crim. App. 2011), overruled in part on other
grounds by, Fisk, 574 S.W.3d 917)); Johnson v. Commonwealth, 674 S.E.2d 541,
543 (Va. Ct. App. 2009) (“[T]wo things are ‘substantially similar’ if they have
common core characteristics or are largely alike in substance or essentials.”). A
specialty is “something in which one specializes or of which one has special
knowledge.” Specialty, Webster’s 2186–87. As used here, then, substantially
similar board-certified medical specialties are those specialties that have a high
degree of likeness but are not identical.
We conclude that two board-certified medical specialties are substantially
similar when they share a high degree of likeness in their core characteristics
such that a practitioner certified in one specialty would, by virtue of that
certification alone, possess the foundational knowledge and competence to
evaluate and opine on the standard of care applicable to the other specialty. The
inquiry is categorical, not case specific. Courts must assess whether the
specialties themselves are substantially similar without regard to whether the
particular expert has individual training or experience relevant to the specific
medical problems or treatments at issue in the case. It requires more than
incidental overlap or occasional clinical collaboration. Relevant factors might
include, but are not limited to, the following: the formal definitions of the
specialties, the certifying board structures, similarities in education and
training, similarities in the scope of practice, overlap in core and procedural 11
competencies, professional association overlap, and hospital credentialing
patterns.
It is the plaintiff’s burden to establish the designated expert witness meets
this standard and is thereby statutorily qualified to testify against a health care
provider. See Ranes v. Adams Lab’ys, Inc., 778 N.W.2d 677, 686 (Iowa 2010) (“In
all circumstances involving expert testimony, the proponent of the evidence has
the burden of demonstrating to the court as a preliminary question of law the
witness’s qualifications and the reliability of the witness’s opinion.”). Where the
issue is contested, “the court shall only allow a person . . . to qualify as an expert
witness and to testify on the issue of the appropriate standard of care or breach
of the standard of care if” the standard is “established by the evidence.” Iowa
Code § 147.139 (2023).
We cannot conclude the district court erred in concluding that Jones failed
to meet her burden in this case. The formal definitions of urology, obstetrics, and
gynecology do not support the conclusion that these specialties are substantially
similar. A medical dictionary defines “urology” as “the medical specialty
concerned with the study, diagnosis, and treatment of diseases of the
genitourinary tract.” Urology, Stedman’s Medical Dictionary for the Health
Professions and Nursing 1755 (7th ed. 2012). “Obstetrics” is “[t]he specialty of
medicine concerned with the care of women during pregnancy, parturition, and
the puerperium.” Obstetrics, id. at 1180. The same medical dictionary defines
“gynecology” as “[t]he medical specialty concerned with diseases of the female
genital tract, as well as endocrinology and reproductive physiology of the female.”
Gynecology, id. at 730. A leading treatise indicates that urology is the “treatment
of diseases and disorders of the urinary systems of both men and women, and
the reproductive system and organs of the male.” 103 Am. Jur. Trials 237, § 1, 12
at 259 (2007); see also 4 Stuart M. Speiser, Charles F. Krause & Alfred W. Gans,
The American Law of Torts § 15:34, at 729 (2009) (“Urology is the scientific study
of the urine and is that branch of medical science embracing the study and
treatment of the diseases and the abnormalities of the urogenital tract in the
human male and the urinary tract in the female. A urologist is one skilled in
urology—a specialist in the diagnosis and treatment of the disorders of the
urogenital tract in the male and of the urinary tract in the female.”). We can infer
from the fact that urology is a specialization in the study of the male reproductive
system that it does not include, generally, specialization in the female
reproductive system, which appears to be a primary area of focus of obstetrics
and gynecology.
The certifying board structure also supports the conclusion that these are
not substantially similar specialties. The record establishes that urology and
obstetrics and gynecology are certified by separate member boards of the
American Board of Medical Specialties. Urologists are certified by the American
Board of Urology. Obstetricians and gynecologists are certified by the American
Board of Obstetrics and Gynecology. The existence of separate certifying boards
indicates that the medical profession has determined that the two specialties
require distinct training, examination, and credentialing processes. Compare
that to the American Board of Radiology, which offers certificates in Diagnostic
Radiology, Interventional Radiology and Diagnostic Radiology, Medical Physics,
and Radiation Oncology, or the American Board of Surgery, which offers
certificates in General Surgery and Vascular Surgery. The fact that a designated
expert witness and defendant health care provider hold certifications from the
same boards may evidence substantial similarity between the specialties. As
noted, however, the specialties in this case are certified by different boards. 13
The fact that the American Board of Obstetrics and Gynecology and the
American Board of Urology each recognize urogynecology as a subspecialty does
not change our analysis. The subspecialty covers only the discrete area of female
pelvic medicine and reconstructive surgery. The existence of a subspecialty for a
discrete area of shared interest does not necessarily establish that the primary
specialties are substantially similar in their entirety. Indeed, the very existence
of a distinct subspecialty undercuts rather than supports Jones’s argument: the
creation of a separate certification suggests that the core specialties are
sufficiently different that a bridge between them was required. Moreover, even if
Jones was correct that a board-certified urogynecologist would be substantially
similar to an ob-gyn, that is not this case. Dr. Wayment is board-certified only
in urology and not the subspecialty of urogynecology.
Jones argues that the two specialties overlap in education, training,
experience, and scope of practice, but these arguments are more assertions
rather than facts proved by competent evidence. For example, there is no
evidence of specific curricular overlap. There is no evidence of specific similarities
in training. There is no evidence of the core competencies of board-certified
specialists in these specialties. There is no evidence of the core procedural
competencies of these specialties. There is no evidence of professional
association overlap. There is no evidence of hospital credentialing permissions
and patterns related to these specialties. To the extent there is any specific
evidence related to these issues, it relates to Dr. Wayment personally. And that
evidence, to the extent it is representative of board-certified urologists, generally,
shows dissimilarity. The record shows that Dr. Wayment has never been trained
to perform surgeries on the female reproductive organs. Dr. Wayment explicitly 14
testified that he would not be familiar with the standard of care imposed on an
ob-gyn.
Finally, Jones argues that “all of Dr. Wayment’s opinions relate to
Dr. Lindell’s post-operative conduct.” The premise is incorrect, as Dr. Wayment’s
written opinion clearly identifies an alleged breach of the standard of care when
Dr. Lindell “caused right ureter damage with the cauterizing tool during surgery.”
(Emphasis added.) Regardless, this argument is irrelevant to our analysis
because it attempts to tie Dr. Wayment’s qualifications to the malpractice alleged
in this case. Under the statute’s categorical approach, the fact that Dr. Wayment
has treated and continues to treat postoperative “ureteral injuries like the one
Ms. Jones experienced in this case” cannot establish that urology and obstetrics
and gynecology are substantially similar.
We find no error in the district court’s conclusion that the plaintiff failed
to prove Dr. Wayment was qualified under the statute to provide expert
testimony in this case. Here, the plaintiff failed to produce sufficient evidence to
establish that board certification in urology is substantially similar to board
certification in obstetrics and gynecology.
III.
Because Jones failed to establish the requisite similarity between the
specialties, the district court did not err in striking Dr. Wayment as an expert.
Without a qualified expert remaining to testify on her behalf, Jones’s medical
malpractice claim cannot proceed. Accordingly, the district court properly
granted the defendants’ motion for summary judgment.
Affirmed.