Margaret Lofgren, both individually and as administrator of the Estate of Louden P. Lofgren v. Thomas Simpson, M.D., and ENT Medical Services, P.C.

── Margaret Lofgren, both individually and as administrator of the Estate of Louden P. Lofgren v. Thomas Simpson, M.D., and ENT Medical Services, P.C. ── Court: Supreme Court of Iowa Date: May 29, 2026 Category: General In the Iowa Supreme Court No. 24–1972 Submitted January 21, 2026—Filed May 29, 2026 Margaret Lofgren, both individually and as administrator of the Estate of Louden P. Lofgren, Appellant, vs. Thomas Simpson, M.D. and ENT Medical Services, P.C., Appellees. Appeal from the Iowa District Court for Johnson County, Andrew Chappell, judge. The plaintiffs appeal the district court ruling dismissing this medical malpractice action with prejudice under Iowa Code section 147.140. Affirmed in Part, Reversed in Part, and Case Remanded. Waterman, J., delivered the opinion of the court, in which Christensen, C.J., and McDonald and May, JJ., joined. Mansfield, J., filed an opinion concurring in part and dissenting in part. McDermott, J., filed an opinion concurring in part and dissenting in part, in which Oxley, J., joined. Brian Patrick Galligan (argued) of Galligan Law, P.C., Clive, for appellant. Graham R. Carl (argued), Jennifer Rinden, and Vincent S. Geis of Shuttleworth & Ingersoll, Cedar Rapids, for appellees. Erik P. Bergeland and Jeffrey R. Kappelman of Finley Law Firm, P.C., Des Moines, for amicus curiae American Hospital Association.  2 Waterman, Justice. In this appeal, we must decide whether Iowa Code section 147.140 (2022) requires a plaintiff to file a certificate of merit (COM) for a claim that the defendants failed to obtain informed consent. This medical malpractice case arose from a child’s death following routine surgery. The plaintiffs allege medical negligence in postoperative care and lack of informed consent because the mother was not told that a medical resident would assist in performing the surgery. After our decision in Miller v. Catholic Health Initiatives–Iowa, Corp., 7 N.W.3d 367, 374–75 (Iowa 2024), the defendants moved to dismiss, arguing that the plaintiff’s COM did not substantially comply with section 147.140 because it was not signed under oath or penalty of perjury. The district court agreed and dismissed the action with prejudice. The plaintiffs appealed, and we retained the case. We conclude that a COM was not required for the informed-consent claim, but that the district court correctly dismissed the other negligence claims. I. Background Facts and Proceedings. L.L., age two, underwent surgery at the Iowa City Ambulatory Surgery Center to have ear tubes implanted and his adenoids removed. Margaret Lofgren, the patient’s mother, consented in advance to have Dr. Thomas Simpson, an otolaryngologist (ENT), perform the surgery. Margaret claims that she was not informed that a fourth-year medical resident would assist with or perform the procedure. During the operation, the child began bleeding from his upper throat. Initially, the doctors stanched the bleeding, and they discharged the child. Within a day, the child presented at the University of Iowa Hospitals & Clinics (UIHC). He was pale and listless and his stool was black—symptoms of  3 internal bleeding. UIHC doctors performed a blood transfusion, which stabilized the child’s vitals. Soon after, they discharged him. Five days later, as he was eating dinner, the child began to hemorrhage. Despite the efforts of physicians at Trinity Hospital in Muscatine and the UIHC, L.L. died from blood loss. Later investigation revealed that the fatal bleed stemmed from the site of the adenoid surgery. Margaret Lofgren sued Dr. Simpson and his employer, ENT Medical Services, P.C., alleging that Simpson’s negligent care caused L.L.’s death and that the defendants failed to secure Margaret’s informed consent. She sued individually and as administrator for the estate of h