Michelle Bunce, by and through Thomas C. Bunce as guardian, conservator and individually, and Victoria Bunce v. Calvin Hansen, M.D., Pradeep Panuganti, M.D., Seenaiah Byreddy, M.D., Mohammad Alsharabati, M.D., Iowa Physicians Clinic Medical Foundation d/b/a UnityPoint Clinic and Methodist Plaza Specialty, Central Iowa Hospital Corporation d/b/a

── Michelle Bunce, by and through Thomas C. Bunce as guardian, conservator and individually, and Victoria Bunce v. Calvin Hansen, M.D., Pradeep Panuganti, M.D., Seenaiah Byreddy, M.D., Mohammad Alsharabati, M.D., Iowa Physicians Clinic Medical Foundation d/b/a UnityPoint Clinic and Methodist Plaza Specialty, Central Iowa Hospital Corporation d/b/a ── Court: Supreme Court of Iowa Date: May 29, 2026 Category: General In the Iowa Supreme Court No. 24–2034 Submitted January 20, 2026—Filed May 29, 2026 Michelle Bunce, by and through Thomas C. Bunce as guardian, conservator, and individually, and Victoria Bunce, Appellees, vs. Calvin Hansen, Pradeep Panuganti, Seenaiah Byreddy, Mohammad Alsharabati, Iowa Physicians Clinic Medical Foundation d/b/a UnityPoint Clinic and Methodist Plaza Specialty, Central Iowa Hospital Corporation d/b/a Iowa Methodist Medical Center; Iowa Health System d/b/a Iowa Methodist Medical Center, Appellants. Appeal from the Iowa District Court for Polk County, Paul D. Scott, judge. The defendants in a medical malpractice action were granted interlocutory appeal of a ruling that denied their motion for dismissal with prejudice under Iowa Code section 147.140(6). Reversed. Waterman, J., delivered the opinion of the court, in which Christensen, C.J., and May, J., joined. Mansfield, J., filed an opinion concurring in the judgement. McDermott, J., filed an opinion concurring in the judgement, in which Oxley, J., joined. McDonald, J., took no part in the consideration or decision of the case. Jack Hilmes, Erik P. Bergeland, Joseph F. Moser, Jeffrey R. Kappelman, and Jacob T. Wassenaar of Finley Law Firm, P.C., Des Moines, for appellants. Scott M. Wadding and Matthew G. Sease of Sease & Wadding, Des Moines, for appellees.  2 Waterman, Justice. We granted an interlocutory appeal in this medical malpractice action after the district court denied the defendants’ motion to dismiss under Iowa Code section 147.140 (2021). We held in Miller v. Catholic Health Initiatives–Iowa, Corp. that section 147.140 unambiguously requires a plaintiff’s certificate of merit (COM) to be signed by the expert under oath or penalty of perjury. 7 N.W.3d 367, 375 (Iowa 2024). The defendants, relying on Miller, challenged the plaintiffs’ original COM, which lacked a jurat or statement that it was signed under penalty of perjury. The district court denied the defendants’ motion on three grounds urged by the plaintiffs: (1) that Miller applied only prospectively and not to their previously filed COM; (2) that the defendants waived their challenge to the COM by waiting three years to file their motion to dismiss; and (3) that the plaintiffs substantially complied with section 147.140 based in part on a subsequent affidavit filed by their expert, in which he explained that when he signed the original COM he “knew he was under oath and subjecting himself to the penalty of perjury.” On our review, we reverse the district court’s ruling on the first ground for the reasons explained below, and applying Rarick v. Smidt, ___ N.W.3d ___, ___, 2026 WL 1441855, at *5–7 (Iowa May 22, 2026), we reverse on the second and third grounds. We remand the case for entry of an order dismissing this action with prejudice under section 147.140(6). I. Background Facts and Proceedings. The following facts are alleged in the plaintiffs’ petition. On January 27, 2019, Michelle Bunce visited the emergency room at Iowa Lutheran Hospital in Polk County, complaining of severe headaches and vomiting. She was given antimigraine medications and sent home. On February 1, she was seen for the  3 same symptoms at Mercy Hospital and again was given antimigraine medications and sent home. The next day, Michelle went to the emergency room at Iowa Methodist Medical Center after experiencing an altered mental state and suffering a seizure at her home. Because her condition was deteriorating, she was admitted to that hospital. Despite numerous tests, the physici