Corporate Healthcare Decisions as Professional Negligence: Expert-Affidavit Requirement under NRS 41A.071

1. Introduction

This commentary examines the Supreme Court of Nevada’s decision in Warren v. Reno Orthopaedic Clinic, Ltd., 141 Nev. ___ (Apr. 1, 2025), which clarifies the boundary between professional and ordinary negligence in the context of healthcare corporate decisions. Melissa Warren, a former patient, sued Reno Orthopaedic Clinic, Ltd. (“ROC”) after a post-operative lapse in supervision led to an infection and emergency surgery. Warren alleged that ROC’s administrative decisions—locking out her surgeon and failing to supervise its physician assistant—constituted ordinary negligence. ROC moved to dismiss on the ground that Warren’s claim sounded in professional negligence and lacked the mandatory medical-expert affidavit required by Nevada law (NRS 41A.071). The district court ultimately dismissed her complaint, and the Supreme Court of Nevada affirmed.

2. Summary of the Judgment

The Nevada Supreme Court held, by a unanimous vote, that Warren’s negligence and negligence per se claims against ROC were “inextricably linked” to questions of medical judgment and patient care. Because Warren was in a professional relationship with ROC at the time of her injury, and her allegations centered on decisions affecting diagnosis, supervision, and treatment, her claims sounded in professional negligence as defined by NRS 41A.015. Under NRS 41A.071, any professional-negligence complaint filed without a supporting affidavit of merit from a qualified medical expert is void ab initio. Warren’s failure to attach such an affidavit required dismissal of her complaint. The Supreme Court affirmed the district court’s order of dismissal and declined to reach collateral discovery issues as moot.

3. Analysis

3.1 Precedents Cited

The court’s reasoning rested on a line of Nevada authorities interpreting professional negligence and the affidavit requirement:

NRS 41A.015: Defines professional negligence as the failure of a healthcare provider to use reasonable care, skill or knowledge ordinarily used under similar circumstances.
NRS 41A.071: Requires that any complaint alleging professional negligence be accompanied by an affidavit from a qualified medical expert stating that the defendant breached the applicable standard of care.
Borger v. Eighth Judicial District Court (2004): Declared that a professional negligence complaint filed without the required affidavit is void ab initio.
Gallen v. Eighth Judicial District Court (1996): Held that conversion to summary-judgment standard is necessary only when a court “actually considers materials outside the pleadings.”
Washoe Medical Center v. Second Judicial District Court (2006): Reaffirmed that a void complaint cannot be amended once dismissed for lack of an affidavit.
Szymborski v. Spring Mountain Treatment Center (2017): Distinguished ordinary negligence (e.g., property damage; decisions not requiring medical judgment) from professional negligence.
DeBoer v. Senior Bridges (2012): Applied ordinary negligence standards where the claim concerned non-medical misconduct.
Yafchak v. Southern Las Vegas Medical Investments (2022): Confirmed de novo review of dismissals for failure to comply with NRS 41A.071.
Limprasert v. PAM Specialty Hospital of Las Vegas (2024): Clarified that the focus is on “the nature of the conduct” and whether it involves medical services.
Estate of Curtis v. Southern Las Vegas Medical Investments (2020): Held that claims “inextricably linked” to underlying professional negligence require expert-affidavit support even when brought against non-provider corporate entities.

3.2 Legal Reasoning

The court applied a two-step analysis:

Determine the nature of the claim. Warren alleged that ROC’s corporate decision to bar Dr. Halki from its offices—and thus deprive her of his expert supervision—constituted independent administrative negligence. The court held that these decisions were “rooted in providing care to patients” and therefore implicated medical judgment and standard-of-care considerations. They did not concern wholly non-medical business operations.
Apply the affidavit requirement. Because the gravamen of Warren’s claim was professional negligence, NRS 41A.071 mandated a supporting expert affidavit. Warren did not file such an affidavit; her complaint was therefore void from the outset and not subject to amendment.

On procedural posture, the court confirmed that it properly treated ROC’s supplemental trial statement as a motion to dismiss. Under NRCP 12, dismissal based on a threshold statutory pleading defect is appropriately decided without converting to summary judgment when no materials outside the pleadings are relied upon.

3.3 Impact

This decision reinforces three critical principles:

Any claim against a healthcare provider or corporate healthcare entity that hinges on medical judgment, treatment decisions, or diagnosis will be classified as professional negligence.
Such claims cannot proceed without an expert affidavit attesting to the breach of the applicable standard of care (NRS 41A.071).
Corporate or administrative decisions that affect patient care (e.g., staffing, supervision, termination of key medical personnel) will be subject to the same rigorous affidavit requirement as direct claims of surgeon or physician assistant negligence.

Going forward, plaintiffs must assess early whether their claims implicate professional standards of care and secure expert affidavits when suing healthcare entities for corporate decisions impacting treatment. Defense counsel may confidently move to dismiss complaints lacking this threshold affidavit, even when the plaintiff characterizes the claim as “ordinary negligence.”

4. Complex Concepts Simplified

Professional Negligence: Failure of a healthcare provider or system to use reasonable care and skill in diagnosis, treatment, or supervision—measured against peers in the same field.
Ordinary Negligence: General duty to avoid foreseeable harm in non-medical contexts, e.g., slip-and-fall, property damage, or corporate mishaps unrelated to medical judgment.
NRS 41A.071 (Affidavit of Merit): Statutory requirement that any medical-negligence complaint must be accompanied by an expert affidavit affirming that the defendant breached the standard of care.
Void ab initio: Treated as invalid from inception—once a professional negligence complaint lacks the statutory affidavit, it has no legal effect and cannot be amended.
“Inextricably Linked”: When a subsidiary claim (e.g., negligent hiring or supervision) depends on the same medical-judgment facts as the primary malpractice allegation.

5. Conclusion

The Supreme Court of Nevada’s decision in Warren v. Reno Orthopaedic Clinic clarifies that corporate or administrative decisions in a healthcare setting—when they affect diagnosis, treatment, or supervision—are professional negligence claims subject to the affidavit-of-merit requirement under NRS 41A.071. Plaintiffs must secure and file expert affidavits when bringing any claim tied to medical judgment, and courts should dismiss without prejudice any complaint that fails this threshold obligation. This ruling strengthens procedural safeguards against unfounded medical-negligence suits and underscores the importance of expert validation in complex healthcare litigation.