Ellie T. Shimp, Zach Shimp and Kerri Shimp v. Timothy A. Gibbons, M.D., Chad H. Boyer, P.A.-C., Jared A. Knowles, P.A.-C., Mason City Clinic, PC, Mercy Health Services-Iowa Corp. d/b/a MercyOne North Iowa Medical Center and Mercy Medical Center-North Iowa

IN THE COURT OF APPEALS OF IOWA

No. 23-2025
Filed November 13, 2025

ELLIE T. SHIMP, ZACH SHIMP, and KERRI SHIMP,
Plaintiffs-Appellants,

vs.

TIMOTHY A. GIBBONS, MD., CHAD H. BOYER, P.A.-C., JARED A. KNOWLES,
P.A.-C., MASON CITY CLINIC, PC, MERCY HEALTH SERVICES-IOWA, CORP.
d/b/a MERCYONE NORTH IOWA MEDICAL CENTER, and MERCY MEDICAL
CENTER-NORTH IOWA,
Defendants-Appellees.
________________________________________________________________

Appeal from the Iowa District Court for Cerro Gordo County, Gregg R.

Rosenbladt, Judge.

Plaintiffs, an injured jet skier and her parents, challenge a pretrial ruling

confirming that under Iowa Code chapter 668 (2020) any fault of the defendant

medical providers would be compared with the fault of the original tortfeasor, who

settled with the plaintiffs. REVERSED AND REMANDED.

Ryan G. Koopmans (argued) of Koopmans Law Group, LLC, Des Moines,

and H. Daniel Holm Jr. and Eashaan Vajpeyi of Ball, Kirk & Holm, P.C., Waterloo,

for appellants.

Paul J. Esker (argued) and Desirée Kilburg of Bradley & Riley PC, Iowa

City, for appellees Mercy Health Services-Iowa, Corp. d/b/a MercyOne North Iowa

Medical Center and Mercy Medical Center-North Iowa.
2

John A. Maschman (argued) and Frederick T. Harris of Lamson Dugan &

Murray LLP, West Des Moines, for appellees Timothy A. Gibbons, MD., Chad H.

Boyer, P.A.-C., Jared A. Knowles, P.A.-C., and Mason City Clinic, PC.

Heard at oral argument by Tabor, C.J., and Greer, Ahlers, Badding, and

Buller, JJ.
3

TABOR, Chief Judge.

“Earth and sky, woods and fields, lakes and rivers, the mountain and the

sea, are excellent schoolmasters, and teach some of us more than we can ever

learn from books.”1 Here, Clear Lake has taught us to navigate the shoals of

comparative fault principles.

On the lake, in the summer of 2018, Ellie Shimp suffered serious injuries to

her leg in jet ski accident. Ellie and her parents sued and settled with the jet ski

operator and owners. Now the Shimps are suing Ellie’s medical providers, alleging

malpractice in the treatment of her injury. In a pretrial motion, the medical

providers sought to “confirm the applicability of the Comparative Fault Act to the

released persons.” The district court granted the motion, finding that any fault of

the medical providers could be compared with the fault of the released parties

under Iowa Code chapter 668 (2020). In this interlocutory appeal, the Shimps ask

us to reverse that ruling. Because it would be error to instruct the jury to compare

the fault of the released parties with any fault of the medical providers on the

question of their breach of duty to their patient, we reverse and remand.

I. Facts and Prior Proceedings

After a collision of two jet skis on Clear Lake crushed her leg, Ellie arrived

at Mercy Medical Center-North Iowa in Mason City, where she received treatment

for a left tibial plateau fracture. The next day, her medical providers diagnosed her

with a popliteal artery injury and occlusion. They transferred her by helicopter to

1 From The Use of Life (1894) by Sir John Lubbock, First Baron Avebury.
4

the Mayo Clinic. According to a review of Ellie’s medical records by Dr. Matt

Weresh, an orthopedic expert for Mercy, “Once received by the Mayo Clinic, she

was taken to surgery immediately, and a vascular bypass was performed to the

area of damaged arteries in her leg. Ellie reportedly has some muscle loss and

weakness of dorsiflexion, as after effects from her injury. She did not have an

amputation.”

Ellie and her parents first sued the jet skis owners and operator (jet ski

defendants) for negligence. The Shimps settled with the jet ski defendants. The

Shimps then filed a lawsuit for medical malpractice against Dr. Timothy Gibbons,

physician assistants Chad Boyer and Jared Knowles, Mercy Medical Center, and

the Mason City Clinic, PC (medical providers). The Shimps allege that Ellie’s

medical providers failed to timely diagnose and treat the popliteal artery injury,

resulting in severe injury, disfigurement, and disability of her left leg. The medical

providers asserted comparative fault as an affirmative defense in their answers.

They moved to confirm that chapter 668 applies to compare their fault with the jet

ski defendants. See Iowa Code § 668(7). After hearing arguments, the district

court confirmed the applicability of the comparative fault chapter.

The Shimps sought interlocutory appeal. Our supreme court granted review

and transferred the case to us.

II. Scope and Standard of Review

Whether Iowa Code chapter 668 applies to these proceedings is a matter

of statutory interpretation, so we review for the correction of errors at law. Mulhern

v. Cath. Health Initiatives, 799 N.W.2d 104, 113 (Iowa 2011).
5

III. Analysis

This interlocutory medical-malpractice appeal raises a single question:

should a jury be instructed to compare the fault of the medical providers who

allegedly misdiagnosed Ellie’s arterial injury with the fault of the jet ski operator

and owners who settled with the Shimps in their original negligence suit?

To answer this question, we start with the comparative fault principles

codified in Iowa Code chapter 668. The chapter describes how to determine

liability: “In the trial of a claim involving the fault of more than one party to the claim,

. . . the court . . . shall instruct the jury to answer special interrogatories” in which

the jury must indicate “[t]he percentage of total fault allocated to each claimant,

defendant, third-party defendant, person who has been released from liability

under section 668.7,” and the injured party.2 Iowa Code § 668.3(2).

From that provision, we focus on two key terms: fault and claim. One is

defined, but the other is not. The chapter defines “fault” broadly as “acts or

omissions that are in any measure negligent or reckless . . . or that subject a

person to strict liability.” Id. § 668.1(1). But “claim” is undefined.

To avoid comparing fault, the Shimps assert that their claim against the

medical providers is not the same claim as the claim they settled against the jet ski

defendants. They argue the word claim cannot mean “any wrong ever done to the

same party, lest the word lose all meaning.” To support that argument, the Shimps

cite DeMoss v. Hamilton, where our supreme court found that a patient’s fault for

2 The Shimps and the medical providers agree that the jet ski defendants are

released parties under Iowa Code section 668.2(3).
6

his poor health cannot be compared with the medical negligence alleged in the

patient’s cause of action.3 644 N.W.2d 302, 307 (Iowa 2002). DeMoss embraced

Fritts v. McKinne, which stated that a physician “may not avoid liability for negligent

treatment by asserting that the patient’s injuries were originally caused by the

patient’s own negligence.” 934 P.2d 371, 374 (Okla. Civ. App. 1996)). The core

concept is that “even a patient who suffers a self-inflicted injury is entitled to non-

negligent medical treatment.”4 DeMoss, 644 N.W.2d at 305. The Shimps believe

that DeMoss also prohibits the medical providers from avoiding liability for

negligent treatment by asserting that the patient’s injuries were caused by a third

party’s negligence.

The medical defendants disagree that DeMoss applies.5 They contend “the

law does not afford the same protection to someone other than the patient when

that other person caused or contributed to the injury necessitating the medical

treatment.” They rely on Jahn v. Hyundai Motor Co., where our supreme court

held that the fault of a negligent driver could be compared by the jury when

evaluating Jahn’s products liability claim against Hyundai. 773 N.W.2d 550, 552

3 Brian DeMoss sought medical care for chest pains. Id. at 304. After testing, his
doctor prescribed him antibiotics and discharged him. Id. He died of a heart attack
the next morning, and his wife sued his doctor for medical malpractice. Id. At trial,
the judge permitted the jury to assign a percentage of fault to Brian for his failure
to follow recommendations by previous physicians. Id. at 305. His wife appealed.
Id. The supreme court concluded it was error “to permit the jury to compare Brian’s
fault with Hamilton’s.” Id. at 307.
4 Iowa courts do recognize “a comparative fault defense to a medical malpractice

action when the plaintiff fails to follow the doctor’s instructions as to follow-up care.”
Mulhern, 799 N.W.2d at 120 (citing DeMoss, 644 N.W.2d at 306).
5 The medical providers filed separate appellees’ briefs: one by the Mercy

defendants and one on behalf of Gibbons, Boyer, Knowles, and the Mason City
Clinic. Because they take consistent positions, we address them together.
7

(Iowa 2009). Jahn explained: “Under an enhanced injury theory, the product defect

is not the cause of the initial accident. As a result, the manufacturer cannot be

held liable for injuries arising out of the initial collision. The manufacturer, however,

is liable for enhanced injuries over and above the injuries caused by the initial

collision.” Id. at 553. Analogizing to Jahn, the medical providers contend that the

alleged misdiagnosis of Ellie’s popliteal artery occlusion was an “enhanced injury”

for which the jury should be instructed to compare the fault of the original

tortfeasors and the medical providers. To counter, the Shimps maintain that Jahn

does not apply to cases of professional negligence, “which is to say that it did not

involve a contractual (or quasi-contractual) arrangement in which the defendant

agreed to remedy an already-existing problem.”

After weighing both positions, we find DeMoss provides better guidance

than Jahn in analyzing this issue. True, DeMoss does not explicitly hold that a

subsequent medical malpractice action is a separate claim. But its approach to

comparative fault suggests that view. The court states, “our threshold question

must be what is the conduct at issue?” DeMoss, 644 N.W.2d at 307. The court

found the patient’s conduct contributing to his heart attack before seeking

treatment was “simply irrelevant to the question of medical negligence.” Id. Only

if the jury found the doctor at fault for misdiagnosing or mistreating the patient

would the patient’s state of health “become potentially relevant to the remaining

questions of proximate cause, lost chance of survival and life expectancy. And on

those questions, whether his state of health resulted from poor lifestyle choices or

bad genes would make no difference.” Id. Applying that reasoning here, only if
8

the medical providers were at fault for misdiagnosing Ellie’s artery occlusion, would

the extent of her leg injuries become potentially relevant to causation or scope of

liability questions. And on those questions, whether her injuries resulted from her

own negligence or the negligence of the jet ski defendants would make no

difference. See id.

What’s more, chapter 668 treats claimants, released parties, and

defendants all the same when allocating fault. Iowa Code § 668.3(2). So no

statutory basis exists for limiting DeMoss to situations invoking the plaintiff’s own

negligence. Thus, we conclude that DeMoss applies to these facts, and the jury

should not be instructed to compare the medical provider’s fault with the fault of

the released third-party jet ski defendants.6

On a practical level, we share the Shimps’ concern that it would be

unworkable to ask a jury to compare fault in a case where the suit against the

original tortfeasor had not been settled. Under that scenario, the original

tortfeasors could raise Ellie’s contributory negligence as a defense, but the medical

providers could not. No clear path emerges for the district court to draft those

special interrogatories. As the Shimps argue: “That is the very definition of

separate claims.”

6 The medical providers insist that they are not asking to overrule DeMoss. But
the Mercy defendants do venture that if we find DeMoss “establishes that the
original tortfeasor’s fault cannot be compared against the medical providers in a
subsequent medical malpractice case, the Court should overrule that portion of the
opinion.” Of course, our court cannot overrule supreme court precedent. State v.
Beck, 854 N.W.2d 56, 64 (Iowa Ct. App. 2014).
9

Beyond disputing the expansion of DeMoss, the medical providers describe

Ellie’s damages as “indivisible” and contend that the popliteal injury was caused

by the original tortfeasor, not their alleged malpractice.7 They point to the

“causation opinions” of their expert, Dr. Weresh, who believed that “the fate and

ultimate function of Ellie‘s left leg was determined at the time” of the jet ski impact.

But as the Shimps note, “that is not a comparative fault argument; it is a

causation argument, and one that defendants are free to make to the jury.”

Causation is an element in the prima facie negligence case, and it remains there.8

At trial, if the Shimps fail to prove the causation element of their case, then the

medical defendants will not need the court to instruct the jury under chapter 668.

Chapter 668 applies when fault is established and when there are multiple parties

to the same claim. Iowa Code § 668.3(2); Schwennen v. Abell, 430

N.W.2d 98, 102 (Iowa 1988). That is not the case here.

The Mercy defendants also claim their position is supported by section 35

of the Restatement (Third) of Torts: Liability for Physical or Emotional Harm, which

they acknowledge reiterates the original tortfeasor rule:

An actor whose tortious conduct is a factual cause of harm to another
is subject to liability for any enhanced harm the other suffers due to
the efforts of third persons to render aid reasonably required by the
other’s injury, so long as the enhanced harm arises from a risk that
inheres in the effort to render aid.

7 The Shimps reply that Ellie’s injuries are divisible because the medical providers

are liable for less than the entire amount of damages that she suffered.
8 “To establish a prima facie case of medical malpractice, a plaintiff must produce

evidence that (1) establishes the applicable standard of care, (2) demonstrates a
violation of this standard, and (3) develops a causal relationship between the
violation and the injury sustained.” Struck v. Mercy Health Servs.-Iowa Corp., 973
N.W.2d 533, 539 (Iowa 2022) (quoting Oswald v. LeGrand, 453 N.W.2d 634, 635
(Iowa 1990)).
10

But the parties disagree on how the original tortfeasor rule impacts the

question on appeal. For sure, Iowa courts have long recognized that “tortfeasors

are responsible for the natural and foreseeable consequences of their acts.” Jahn,

773 N.W.2d at 559–60. This rule applies to the medical context, so “assuming

there was no negligence in selecting the doctor . . . the general rule is that a

tortfeasor is responsible for the negligence of an attending physician in treating the

injured party.” Casey v. Koos, 323 N.W.2d 193, 197 (Iowa 1982). By operation of

this rule, the original tortfeasor is responsible for the entire injury resulting from

medical malpractice.

The medical providers argue that because an original tortfeasor is

responsible for subsequent medical negligence, the two actions are a part of the

same claim, and the original tortfeasor’s fault should be compared with the medical

providers’ fault.9 But that argument overstates the rule. The original tortfeasor rule

extends the scope of the original tortfeasor’s liability by operation of law, making

the original tortfeasor vicariously responsible for the entirety of the subsequent

harm. See State ex rel. Miller v. Philip Morris Inc., 577 N.W.2d 401, 406 (Iowa

1998) (treating a case involving an original tortfeasor and later medical malpractice

as a “classic case[] involving vicarious liability”). Thus, both the original tortfeasor

and subsequent medical provider are fully responsible for the injuries caused by

9
The Mercy defendants also point to comment (d) of section 35, the Restatement
(Third) of Torts: Liability for Physical and Emotional Harm, which discusses the
interplay of the original tortfeasor rule with comparative fault statutes. But no Iowa
case law suggests that our supreme court has adopted that comment, so we do
not address it here.
11

medical negligence; there is no fault to be compared.10 Because we are dealing

with a matter of vicarious liability, chapter 668 does not apply.

This analysis fits with our concepts of indemnity. In Hunt, the original

tortfeasor could seek indemnity from the hospital because the original tortfeasor

was responsible for the later medical malpractice by operation of law. Philip Morris

Inc., 577 N.W.2d at 406 (citing Hunt, 252 N.W.2d at 447–48). If, in this case, we

allowed the jury to compare fault between the original tortfeasor and the medical

providers, we would be stepping on Hunt’s toes by making neither party fully

responsible for the later medical harm and eliminating the need for indemnity. But

our case law treats both parties as fully responsible through principles of vicarious

liability and allows indemnity.

For these reasons, we hold that chapter 668 does not apply to compare the

fault of the allegedly negligent medical providers with the fault of the released third-

party jet ski defendants. We reverse the district court’s order confirming the

applicability of the comparative fault act to these facts and remand for further

proceedings.

REVERSED AND REMANDED.

Ahlers and Badding, JJ., concur; Buller, J., specially concurs; and Greer, J.,

dissents.

10 In Philip Morris Inc., the court analyzed Hunt v. Ernzen, 252 N.W.2d 445 (Iowa

1977). There, the court held a tortfeasor liable for injuries inflicted by the treating
hospital. Id. at 447.
12

BULLER, Judge (specially concurring).

I concur in the judgment for two reasons.

First, although DeMoss v. Hamilton, 644 N.W.2d 302 (Iowa 2002), is not an

airtight fit for the facts here, I believe it strongly nudges us toward reversing unless

or until it is overruled. In my view, the district court’s pretrial ruling cannot be

reconciled with DeMoss’s general rule that a factfinder cannot consider the original

tortfeasor’s negligence when evaluating the medical negligence of subsequent

treatment providers. See id. at 307. And as an intermediate appellate court, I am

bound to follow supreme court precedent even when I question whether it has

overstayed its welcome.

Second, although the dissent may be correct that Iowa ends up following

comment (d) to section 35 of the Restatement (Third) of Torts, the supreme court

has not gone there yet and I am skeptical our court can adopt it with DeMoss

looming overheard. This case highlights my frustration with the ad-hoc and partial

adoption of the restatement. It leaves our intermediate appellate court, the district

courts, and practitioners wondering which if any of these “evolving legal concepts”

(as the dissent calls them) govern today’s litigation. And it undermines the stability

and predictability of the law.

Last, I join in Judge Greer’s observation that—as one of the parties

requested in the briefing—this might have been a case better suited for supreme

court retention than disposition by our court. But, since the case is here, I concur

in the judgment to reverse based on existing precedent.
13

GREER, Judge (dissenting).

In what feels like a yoga exercise, each of the parties to this medical

malpractice matter asks us to stretch the holdings of cases decided by our

supreme court. The plaintiffs (the “Shimps”) ask us to expand the holding of

DeMoss v. Hamilton, 644 N.W.2d 302 (Iowa 2002), to prohibit the factfinder from

comparing a third party’s fault (the “jet ski defendants”) in the malpractice case.

DeMoss held that generally a plaintiff’s fault cannot be considered when

determining whether a medical provider negligently breached the standard of care.

Id. at 307. On the other side, the defendants (the “medical providers”) 11 ask us to

expand the enhanced injury reasoning of Jahn v. Hyundai Motor Co., 773 N.W.2d

550 (Iowa 2009), to the question this medical malpractice case raises. They argue

that Jahn opens the door to allowing the medical providers to compare the fault of

the jet ski defendants for any enhanced injury that the Shimps claim was caused

by the negligent care of the medical providers. Both parties contest the legal

arguments of the other, and so, we are left to make sense of how they should

proceed at trial.12 From my review, I am not on board with extending the holding

of DeMoss or prohibiting the application of the comparative fault act under these

facts, but instead would find that the enhanced injury analysis developed through

the extension of Jahn and the application of section 35 of the Restatement (Third)

of Torts should be employed.

11 The Shimps brought a lawsuit against Timothy Gibbons, MD, Chad Boyer, PA-

C, Jared Knowles, PA-C, Mercy Health Services–Iowa, Corp., and the Mason City
Clinic, PC.
12 As the majority notes, this case comes to us before trial, on interlocutory appeal

from the district court’s ruling allowing the medical providers to compare the jet ski
defendants’ fault in the medical malpractice trial.
14

I write because I do not feel the majority opinion correctly tackled the task

and there may be confusion about how courts and litigants address these concerns

in the future based upon some of the conclusions made. Injured citizens are

entitled to full and fair compensation for their injuries, but, in line with that goal, “[a]

successful plaintiff is entitled to one, but only one, full recovery, no matter how

many theories support entitlement.” Revere Transducers, Inc. v. Deere & Co., 595

N.W.2d 751, 770 (Iowa 1999) (quotation marks and citation omitted). I think our

role is to look at how the process here assures that goal through the application of

our existing law. Of course, as the Shimps suggest in their appellate briefing, “a

new precedential opinion from the supreme court may give lower courts and the

bar needed and valuable guidance in this area.” Seems like a good idea to me.

So, I start with how the parties handled the appellate briefing to answer the

question posed. In a medical malpractice trial, should a jury be instructed to

compare the fault of the medical providers with the fault of a third-party tortfeasor,

the released jet ski defendants, with respect to the injuries Ellie Shimp sustained?

And specific to this case, as the Shimps framed the question, “is the negligent jet

ski driver who hit Ellie (and entered into a settlement agreement) ‘liable upon the

same claim’ as the medical providers who violated the standard of care in their

treatment of Ellie’s injuries?” (Emphasis in original.) I start with the procedural

background.

The Shimps initially sued the jet ski operator and owners who they assert

caused the injury; that claim settled. Then, arguing her medical providers

negligently delayed diagnosing arterial damage caused by the accident, the
15

Shimps brought a separate lawsuit against the medical providers involved in the

aftercare. Those medical providers successfully argued to the district court that

the fault of the jet ski defendants should be compared to any fault of the medical

providers. Before trial and in this interlocutory review, we must decide if a

comparative fault exercise is warranted under these facts. Making our task more

complicated, each party raises several alternative paths to get to the answer they

advocate.

I. DeMoss and Its Application.

The Shimps approach this issue from several angles. I start with the

Shimps’ focus on DeMoss to support their challenge to the district court’s pre-trial

order. In DeMoss, our supreme court said that “[a]ny ‘fault’ on [the decedent's] part

for conduct contributing to his heart attack is simply irrelevant to the question of

medical negligence underlying DeMoss’s cause of action.” 644 N.W.2d at 307.

From that holding, the Shimps contend if Iowa’s comparative fault statute does not

apply to compare fault between a plaintiff and a medical provider in a malpractice

action, then it follows the comparative fault statute cannot apply to compare the

fault of a released third party. The medical providers counter that DeMoss is

distinguishable from the present action, but if we decide differently, we should

overrule the portion of the opinion that prohibits the extension that the Shimps

advocate. Still, the overall premise in DeMoss was not that a patient’s negligent

conduct may never be considered by a jury in a medical malpractice case, but that

it might in “limited circumstances.” Id. at 305–06. So, in cases where the patient’s
16

fault can be properly considered, how does that fact change the Shimps’ argument

to extend DeMoss?

To the extent, as the majority frames it, that the medical providers are

looking to avoid liability for negligent treatment by asserting the patient’s injuries

were caused by a third party, the majority ignores reality. The medical providers’

interest is in only paying for the damages they caused in this claim. There is no

reciprocal rule that just because the tortfeasor has responsibility for the fault of a

medical provider for its negligent medical treatment following the accident that the

medical providers have responsibility for a tortfeasor’s fault in causing damages to

the patient. Thus, while a medical provider may not be able to compare the fault

of the patient, nothing in our caselaw or statutes prohibits the allocation of

responsibility for a claim of damage between the original tortfeasor and the medical

providers. Even the Shimps agree that the medical providers and the jet ski

defendants should not be responsible for the same damages.

Still, the Shimps contend that DeMoss can be extended to support the

argument that chapter 668 only applies to “claims” that allow a jury to assign a

“percentage of the total fault allocated to each claimant, defendant, third-party

defendant” and “person[s] who [have] been released.” See Iowa Code

§ 668.3(2)(b) (2020)13 (emphasis added). The Shimps point out that these are the

“parties” under the chapter, so that

13 Iowa Code section 668.3(1)(a) provides:

Contributory fault shall not bar recovery in an action by a claimant to
recover damages for fault resulting in death or in injury to person or
property unless the claimant bears a greater percentage of fault than
the combined percentage of fault attributed to the defendants, third-
17

under Chapter 668, if a party’s fault is not part of the same claim as
the defendant’s fault, then the jury cannot assign any percentage of
fault to that party, regardless of whether they are a “claimant,”
another “person named as defendant,[”] a “person who has been
released pursuant to section 668.7,” or a “third-party defendant.”
[Iowa] Code §§ 668.3, 668.7.

From a practical perspective, I cannot follow that reasoning. There are many

factual situations that invoke the application of chapter 668 where a claimant’s fault

is not at issue, but still require the comparison of fault among tortfeasors. The fact

that our caselaw supports a policy decision to limit, not to fully exclude, proof of a

patient’s fault does not take me to the conclusion that the Shimps and the majority

advance—that “no statutory basis exists for limiting DeMoss to situations invoking

the plaintiff’s own negligence.” If part of the rationale is that crafting jury

instructions would be hard, there are ways to bifurcate the trial to address separate

issues. In any event, here, these parties would not have difficulty with the

instructions because the patient’s fault is not at issue.

In sum, I cannot follow the majority’s conclusion related to an extension of

the holding in DeMoss.

II. Separate Claims.

Next, the Shimps contend that the malpractice action is a “successive,

divisible claim” separate from “the original tort claim.” They argue that these

different claims cannot be appropriately compared for fault purposes. The majority

falls into this theory, pointing out that chapter 668 does not define “claim” and

party defendants and persons who have been released pursuant to
section 668.7, but any damages allowed shall be diminished in
proportion to the amount of fault attributable to the claimant.
18

agreeing that the medical malpractice action is a separate claim from the

underlying tort case claim because we should compare the “conduct at issue.”

While I cannot agree with that conclusion, I also do not believe it has much to do

with how we should arrive at the answer to the core question.

On their end, the medical providers argue that because the damages arise

from the jet ski accident, the successive malpractice claim overlaps with the initial

jet ski tort—so the different-claim theory does not apply here. They contend that

chapter 668 applies to medical malpractice claims and they can determine the

“percentages of fault” by having the trier of fact consider “both the nature of the

conduct of each party and the extent of the causal relation between the conduct

and the damages claimed.” Id. § 668.3(3) (emphasis added). From a reading of

this statutory section, I would assert that comparing the conduct at issue is exactly

what is required in examining who is at fault for the damages assessed in this one

claim.

My position is that we should look at a “claim” as one for damages involving

differing theories of recovery. And while chapter 668 does not define the word

“claim,” when it does make reference to the term, it pertains to a claim to recover

damages (section 668.3(2)(b)). There is some help in other similar sections of the

Iowa Code. Referencing the recovery for damages, a “claim” has been defined in

our Iowa Tort Claims Act as:

a. Any claim against the state of Iowa for money only, on
account of damage to or loss of property or on account of personal
injury or death, caused by the negligent or wrongful act or omission
of any employee of the state while acting within the scope of the
employee's office or employment, under circumstances where the
19

state, if a private person, would be liable to the claimant for such
damage, loss, injury, or death.

b. Any claim against an employee of the state for money only,
on account of damage to or loss of property or on account of personal
injury or death, caused by the negligent or wrongful act or omission
of any employee of the state while acting within the scope of the
employee's office or employment.

Id. § 669.2(3) (emphasis added). So, I agree with the medical providers that the

claim for damages arising from the jet ski incident makes this one claim. 14 Plus,

the Shimps argue that a later credit could apply if there are duplicate damages,

suggesting that the claim does overlap as one. This conclusion is further

supported by the original tortfeasor doctrine because the damages related to any

negligent medical care following the incident are part of the total damages

allocated to the plaintiff in the claim made against the tortfeasor. Our rule is that

we favor granting a plaintiff only one “full recovery, no matter how many theories

support entitlement.” See Revere Transducers, Inc., 595 N.W.2d at 770 (citation

omitted). So, along with the judicial economy of deciding a claim in one lawsuit, I

would find that there are not separate claims involved here in deciding what

recovery the Shimps are entitled to and who should have to pay.

Thus, I reject the same claim arguments. To me, the solution to the parties’

concerns here is answered through Jahn and section 35 of the Restatement

(Third) of Torts—Enhanced Harm Due to Efforts to Render Medical or Other Aid.

So, we turn to the medical providers’ argument.

14 The medical providers point out that the demand for damages made in each

case are similar—asking both the jet ski defendants and the medical providers to
pay all medical expenses, pain and suffering, loss of function, etc.
20

III. Enhanced Injury under Jahn and Section 35 of the Restatement

(Third).

The majority gave little consideration to the medical providers’ enhanced

injury argument. First, the majority distinguished Jahn, which involved a products

liability case, as different from a “professional negligence” case with a “contractual

(or quasi-contractual) arrangement” such as we have here. But, our supreme court

has made it clear that although labeled “medical malpractice,” a claim that the

medical provider has breached the standard of care is “essentially a negligence

cause of action.” Asher v. OB-Gyn Specialists, P.C., 846 N.W.2d 492, 498 (Iowa

2014) (discussing the applicability of the Restatement (Third) of Torts in medical

negligence cases), overruled, in part, on other grounds by Alcala v. Marriott Int’l,

Inc., 880 N.W.2d 699 (Iowa 2016). And chapter 668 applies to negligence cases.

See Mulhern v. Cath. Health Initiatives, 799 N.W.2d 104, 117 (Iowa 2011) (noting

chapter 668 “expressly states that the fault of other parties is to be compared in

cases of negligence, recklessness, and strict liability” (quoting Jahn, 773 N.W.2d

at 560)). So, that distinction between a product liability case and general

negligence case is not supported under our current case law. Looking beyond just

products liability cases, in the analysis found in Jahn, the supreme court

referenced ordinary negligence cases as examples to support its holding. 773

N.W.2d at 559 (citing Treanor v. B.P.E. Leasing, Inc., 158 N.W.2d 4, 5–7 (Iowa

1968) and Meek v. Long, 142 N.W.2d 385, 388–89 (Iowa 1966)).

I also think it is instructive that, in Jahn, our supreme court referenced a

medical negligence case to support similar treatment between these two types of
21

causes of action related to the allocation of fault. Id. at 560 (“We have repeatedly

held that the tortious conduct of others can be natural and foreseeable in the

context of medical negligence which results after a plaintiff is injured. It is hard to

see how a different approach should apply to a case involving a product defect in

an automobile.” (internal citations to medical malpractice cases omitted)).

Although in Jahn, the Restatement (Third) of Torts: Products Liability sections 16

and 17 apply only to product liability cases—different than the application of what

has been advocated in this case under Restatement (Third) of Torts: Liability for

Physical and Emotional Harm section 35—the supreme court affirmed the

application of the Restatement (Third) treatment of enhanced injuries even though

there was a similar public policy concern as the one involved here. That public

policy concern applied to product liability cases was as follows:

We recognize policy arguments exist for creating an exception to the
comparative fault approach when the defendant owed the plaintiff a
duty to protect the plaintiff from harm. We declined to recognize an
exception in Jahn, even though a similar policy argument supported
denying the motor vehicle manufacturer in a crashworthiness case a
comparative fault defense based on the driver's negligence. A
reasonable legislator could conclude that vehicle manufacturers
must foresee and protect against collisions and that their incentive to
build in safety should not be diluted by allowing jurors to compare the
fault of careless drivers. Similarly, a reasonable legislator could
conclude that mental health practitioners with a duty to prevent
suicide should be denied a comparative fault defense when the
patient kills herself. The legislature, however, created no such
exceptions in the Iowa Comparative Fault Act, and it is not our
prerogative to rewrite the statute to do so.

Mulhern, 799 N.W.2d at 117. So, I think the enhanced-injury discussion deserves

more consideration than the majority gave it.
22

On top of distinguishing Jahn as not helpful, the majority also discounted

the medical providers’ assertion that section 35 of the Restatement (Third) should

answer the question presented. Section 35 provides:

An actor whose tortious conduct is a factual cause of harm to another
is subject to liability for any enhanced harm the other suffers due to
the efforts of third persons to render aid reasonably required by the
other's injury, so long as the enhanced harm arises from a risk that
inheres in the effort to render aid.

Restatement (Third) of Torts: Liab. for Phys. & Emot. Harm § 35 (Am. Law Inst.

2010). “Negligence in medical treatment of a tortiously caused injury is the most

common invocation of the rule in this section.” Id. at cmt. (a). The majority briefly

mentions this section but then contends that no Iowa cases have adopted

comment (d) to that section, so they refuse to consider it. Comment (d) states, in

part:

The rule in this Section does not narrow the scope of liability of a
tortfeasor; indeed it does quite the opposite, by declaring that
subsequent negligence of one rendering assistance to an injured
person is not a superseding cause of any enhanced harm, thereby
including such harm within the initial tortfeasor's scope of liability.
Indeed, the advent of comparative contribution, a derivative of
comparative responsibility, permits a more refined apportionment of
liability between the initial tortfeasor and a subsequent tortious actor
who is a cause of enhanced harm.

Id.

True, it is not entirely clear if our supreme court has adopted section 35

comment (d). But our supreme court has said that “[w]e often look to the

Restatements for guidance.” Barker v. Capotosto, 875 N.W.2d 157, 166 (Iowa

2016). And in my review of section 35, in two of the comments, the authors
23

reference several Iowa cases that reinforce the section’s analysis. 15 Plus I find it

significant that in Asher, when the supreme court emphasized that the factual

causation and scope of liability provisions of the Restatement (Third) specifically

apply to a claim of medical negligence, it gave other examples, noting:

“Restatement (Third) section 35, comment a uses an example of a negligent

medical professional in discussing the medical professional's scope of liability. Id.

§ 35 cmt. a, illus. 1, at 592–93.” Asher, 846 N.W.2d at 498. Thus, by implication,

I would assert our supreme court considered section 35 a proper treatment of

enhanced injuries. And in Jahn, our supreme court noted that in the midst of the

“clash of court cases and academic antlers” it considered the Restatement (Third)

sections [16 and 17] on enhanced injury claims in products liability to be the

“proper approach.” 773 N.W.2d at 555. Thus, it is less of a stretch of our existing

law to extend that proper approach here under the direction of another section of

the Restatement.

So, I would apply the teachings of Jahn and section 35 of the Restatement

(Third) and find that the fault of the released party, whose negligence is a cause of

the underlying accident and of Ellie’s injuries, should be compared by the jury on

the Shimps’ enhanced injury claim against the medical providers. See Jahn, 773

N.W.2d at 551, 560–61; see also Restatement (Third) § 35, cmt (b) (noting the

reasons associated with this rule “are various and may apply differentially,

15
Asher, 846 N.W.2d at 498 appears in support of reporters’ note to comment (a);
along with Casey v. Koos, 323 N.W.2d 193, 197 (Iowa 1982). Weems v. Hy–Vee
Food Stores, Inc., 526 N.W.2d 571, 573 (Iowa Ct. App. 1994) is cited in reporters’
notes to comment (c).
24

depending on the circumstances of the case.”). And as the governing law imposes

several liability, “each of the defendants is held liable for the amount of damages

reflecting the enhanced harm discounted by the comparative share of

responsibility assigned by the fact finder to that defendant.” Id. at cmt (d). In Jahn,

comparative fault and joint and several liability provisions of chapter 668 apply to

parties liable for divisible and indivisible injuries. 773 N.W.2d at 560. And in Lee

v. Small, 829 F. Supp. 2d 728, 750, n.8 (N.D. Iowa 2011), in a discussion over

Jahn, the United States District Court for the Northern District of Iowa opined that

“it appears likely that the comparative fault concepts of [chapter 668] would also

apply to the issue of whether or not a physician's or hospital's malpractice or

negligence increased a plaintiff's injuries from conduct of an original tortfeasor.” I

would follow the suggestions of this authority and affirm the district court’s order

and remand for further proceedings.

In conclusion: (1) I do not think DeMoss prohibits what the medical

providers seek to accomplish, thus we need not extend or overrule its holding or

even engage in that exercise. (2) The majority finding that this malpractice action

is a separate “claim” is misplaced and again does not provide any path to

answering the question of whether chapter 668 applies here. (3) Because Jahn

and section 35 of the Restatement (Third) provide a judicially efficient path to avoid

double recovery, yet fully compensate the Shimps, I would apply those evolving
25

legal concepts so that the appropriate defendant, including the released party, is

responsible for its share of the enhanced injury.16

16 The majority also touches on the application of the pro tanto rule and concerns

over authorities related to indemnity, but here where the fault allocation is required
under Iowa Code section 668.7 (“[T]he claim of the releasing person against other
persons is reduced by the amount of the released person's equitable share of the
obligation”), that “equitable share of the obligation” will be assigned to the settling
defendant by the trier of fact. Thomas v. Solberg, 442 N.W.2d 73, 76 (Iowa 1989).
And under Thomas, our supreme court opined that “Iowa Code chapter 668 was
intended to eliminate the pro tanto credit rule for tort actions tried after July 1,
1984.” Thomas, 442 N.W.2d at 77. And as for the indemnity question, the medical
providers are not vicariously liable to the tortfeasor for all damages, but they do
potentially share liability for some of the damages between the two defendants.
“Since the adoption of Iowa Code Chapter 668, Iowa courts have distributed
responsibility for liabilities between negligent parties who share a common liability
based on their respective fault. A negligent party may seek contribution from
another negligent party and a court will distribute responsibility for the common
liability according to the fault of each party.” Jeffrey A. Stone, The Law of
Contribution and Tort-Based Indemnity in Iowa, 55 Drake L. Rev. 113, 164 (2006).
As the author notes “[a] party may seek contribution from another party only if they
share common liability” which means that the injured plaintiff can enforce liability
against each party individually. Id. at 131–32.