Expert-Testimony Gatekeeping for Negligence/IIED Claims Challenging Mandated Child-Abuse Reporting; Evidence of Actual Service Denial Required for Section 504

1. Introduction

J.S.H. v. Newton arises from a medically complex and emotionally fraught setting: prolonged pediatric care for a child, G.H., with severe, multi-system symptoms and no confirmed unifying diagnosis. In 2018, Dr. Alice Newton—then Medical Director of the Child Protection Program at Massachusetts General Hospital (MGH) and a Massachusetts “mandated reporter”—documented concerns of suspected medical child abuse (also described as “Munchausen syndrome by proxy”) and filed a report with the Massachusetts Department of Children and Families (DCF) under Mass. Gen. Laws ch. 119, § 51A(a).

DCF ultimately deemed the 2018 report unsubstantiated (as it had an earlier 2011 report). Several years later, J.S.H. sued Dr. Newton and MGH, asserting (among other counts) Massachusetts emotional distress claims and a federal disability discrimination claim under Section 504 of the Rehabilitation Act, 29 U.S.C. § 794(a). The district court granted summary judgment for both defendants; the First Circuit affirmed.

The appeal presented four key issues: (i) whether J.S.H. could reach trial on negligent infliction of emotional distress (NIED) against Dr. Newton; (ii) whether J.S.H. could reach trial on intentional infliction of emotional distress (IIED) against Dr. Newton; (iii) whether G.H. could reach trial on IIED against Dr. Newton; and (iv) whether G.H. could reach trial on a Section 504 claim against MGH based on alleged loss of medical services following the abuse report and related chart note.

2. Summary of the Opinion

The First Circuit affirmed summary judgment on all claims at issue.

• NIED (J.S.H. v. Dr. Newton): Affirmed on an alternative ground: regardless of emotional distress and physical manifestation evidence, J.S.H. failed to produce required expert testimony to establish that Dr. Newton breached a relevant professional standard of care in making a mandated-reporting/child-protection medical judgment.
• IIED (J.S.H. v. Dr. Newton): Affirmed because J.S.H. failed to create a triable issue that Dr. Newton’s conduct was “extreme and outrageous.” The court reasoned that, in this context, whether conduct crosses that line depends on whether the underlying medical judgment was reasonable—again requiring expert testimony that was not provided.
• IIED (G.H. v. Dr. Newton): Affirmed on lack of causation evidence: no record basis that G.H. knew of the chart note/report or that it caused him severe distress.
• Section 504 (G.H. v. MGH): Affirmed because the record did not show MGH denied or limited services (or otherwise caused meaningful loss of access) to G.H. due to disability. Testimony suggesting care disruption was largely hearsay or showed family-initiated discontinuation rather than institutional denial by MGH.

3. Analysis

3.1 Precedents Cited

A. Summary judgment framework (federal)

The court anchored its de novo review in established First Circuit summary-judgment doctrine:

• Appleton v. Nat'l Union Fire Ins. Co. of Pittsburgh (citing Sutherland v. Peterson's Oil Serv., Inc.): used for the proposition that the record is viewed in the light most favorable to the nonmovant.
• Cruz-Cedeño v. Vega-Moral (quoting Klunder v. Brown Univ.): reiterated the standard and the “no genuine issue of material fact” test.
• Burt v. Bd. of Trs. of Univ. of R.I. (quoting Garside v. Osco Drug, Inc.): emphasized summary judgment’s purpose to “pierce the pleadings” and require proof once the movant properly supports its motion.
• Rodrique v. Hearst Commc'ns, Inc.: supported affirmance on any alternative ground apparent from the record (crucial to the NIED disposition).

These authorities did not decide the merits directly; they disciplined the evidentiary lens. The court’s repeated emphasis on what the record did (and did not) contain foreshadowed the outcome across all claims.

B. Massachusetts NIED elements and the expert-testimony requirement

For NIED, the court relied on:

• Lanier v. President & Fellows of Harvard Coll. (quoting Payton v. Abbott Labs.): supplied the five NIED elements, including negligence and objective physical symptomatology.
• LeBlanc v. Logan Hilton Joint Venture (quoting Haggerty v. McCarthy): for the general rule that expert testimony is required when issues are beyond lay experience; also notable for its articulation that expert testimony is “generally needed” to establish a professional standard of care, even in duties running to “third parties.”
• Silva v. Norfolk & Dedham Mut. Fire Ins. Co. (quoting Herbert A. Sullivan, Inc. v. Utica Mut. Ins. Co.): reinforced the functional test—expert testimony is proper when it assists the jury beyond common experience.
• Klein v. Catalano: invoked through LeBlanc to frame the “similarly situated” professional standard.
• Earley v. Slavin (citing Palandjian v. Foster): linked the requirement of expert proof to claims arising from “exercise of medical judgment.”
• Zaleskas v. Brigham & Women's Hosp. (quoting Palandjian v. Foster): reiterated medical standard-of-care concepts and that expert testimony is generally required.
• Bellmar v. Moore: used to illustrate how expert testimony can create a genuine dispute of material fact on deviation from the standard of care.

The decisive move was synthesizing these cases to treat the challenged conduct—deciding whether circumstances reasonably triggered a statutory reporting duty—as a professional, medically inflected judgment outside ordinary juror competence. That synthesis underwrote summary judgment: without an expert, there was no triable negligence breach.

C. Massachusetts IIED doctrine and its application in professional contexts

For IIED, the court relied on:

• Roman v. Trs. of Tufts Coll. (quoting Sena v. Commonwealth): provided the four IIED elements and the “extreme and outrageous” test.
• Polay v. McMahon (quoting Doyle v. Hasbro, Inc.): emphasized the “very high” threshold to sustain IIED.
• Foley v. Polaroid Corp.: supplied classic language describing conduct that is “atrocious” and “utterly intolerable.”
• Agis v. Howard Johnson Co.: cited (via the district court opinion) for “utterly intolerable” framing.
• Kelly v. Brigham & Women's Hosp.: used as an analog in a medical setting, rejecting IIED absent record support for reckless misleading or actual knowledge of intrusiveness.
• Howell v. Enter. Publ'g Co.: cited for the causation requirement in IIED.

The opinion’s notable doctrinal step is functional: in a child-protection/mandated-reporting setting, “extreme and outrageous” turns on whether the clinician’s professional judgment was reasonable in context. That mapping effectively imports an expert-testimony gate into IIED where the alleged outrageousness is inseparable from specialized medical decision-making.

D. Section 504 standards

• Thiersaint v. Dep't of Homeland Sec. (quoting Lesley v. Hee Man Chie): supplied the four Section 504 elements and, in particular, the requirement that denial be “solely by reason of” disability.

Importantly, the court assumed—without deciding—the plaintiff-favorable legal proposition that “loss of meaningful access” (not only outright denial) could satisfy the “denied services” component, but it nevertheless found the evidentiary showing lacking.

E. Medical child abuse definitional support

• In re Adoption of Willamina and N.J. Dep't of Child. & Fams. v. L.O.: cited to define “medical child abuse” and describe its harms.

3.2 Legal Reasoning

A. NIED: breach of duty required expert testimony because the negligence theory attacked a specialized mandated-reporting medical judgment

J.S.H.’s NIED claim required proof of negligence under Lanier v. President & Fellows of Harvard Coll.. The First Circuit did not resolve whether Dr. Newton owed a duty to J.S.H. as a non-patient; it instead focused on breach. The court treated the core disputed question as: what is the standard of reasonable care for a physician specializing in child protection when evaluating whether circumstances amount to “reasonable cause to believe” abuse occurred under Mass. Gen. Laws ch. 119, § 51A(a)?

That inquiry, the court held, is beyond lay competence and requires expert testimony under the principles in LeBlanc v. Logan Hilton Joint Venture, Haggerty v. McCarthy, and related cases. The court expressly rejected the idea that absence of a doctor-patient relationship eliminates the need for expert proof; rather, where the alleged wrong turns on a professional standard of conduct and medically inflected judgment, expert evidence is typically necessary even when the claimant is a third party.

While J.S.H. offered testimony from treating providers who saw no abuse concerns and criticized Dr. Newton’s conduct as “unwarranted,” the court found those statements did not establish the applicable standard of care for a specialist mandated reporter, nor did they show a deviation from such a standard. Without an expert to articulate what “reasonable” reporting practice entails for suspected medical child abuse in these circumstances, the record could not support a finding of negligence breach.

Doctrinally, the court used its authority under Rodrique v. Hearst Commc'ns, Inc. to affirm on an alternative ground (expert-proof failure) rather than the district court’s focus on distress/physical manifestations and the affidavit’s timeliness.

B. IIED (J.S.H.): “Extreme and outrageous” could not be assessed without expert evidence separating reasonable reporting from intolerable conduct

Under Roman v. Trs. of Tufts Coll., IIED demands conduct “so outrageous” and “so extreme” that it is “utterly intolerable.” The court reasoned that, in a mandated-reporting child-protection context, making a reasonable report—even if ultimately unsubstantiated—is not “utterly intolerable.” Therefore, the “extreme and outrageous” element could only be satisfied if a jury could find that Dr. Newton’s reporting and related chart note were professionally unreasonable in the relevant sense.

Because that reasonableness question is anchored in specialized medical judgment (again invoking Earley v. Slavin and LeBlanc v. Logan Hilton Joint Venture), the absence of expert testimony left the jury without a principled basis to label the conduct as “extreme and outrageous” rather than (at worst) a contested professional call. The court reinforced that IIED is a high bar (Polay v. McMahon; Doyle v. Hasbro, Inc.), and analogized to Kelly v. Brigham & Women's Hosp., where IIED failed absent proof of reckless misleading or knowing intrusiveness.

C. IIED (G.H.): failure of causation as a matter of evidence

Even if one assumes arguendo that Dr. Newton’s conduct was actionable, G.H.’s IIED claim failed on causation (Howell v. Enter. Publ'g Co.). The record did not show G.H. knew about the note/report or that it caused him severe distress. The court treated this as a straightforward evidentiary gap: no knowledge, no causal chain to emotional injury.

D. Section 504: the court assumed a broad “meaningful access” theory but required non-hearsay, defendant-specific evidence of actual service denial/limitation

The court framed the fourth element under Thiersaint v. Dep't of Homeland Sec. and Lesley v. Hee Man Chie as requiring proof that the plaintiff was denied services “solely by reason of” disability. While the parties disputed whether an outright refusal is required, the court assumed that “loss of meaningful access” could suffice—then found the record still failed.

The opinion is evidence-centered: Dr. Newton’s chart note and the DCF report showed her suspicions, but they did not show MGH altered, limited, or denied care. The father’s testimony about providers not wanting to treat was deemed largely hearsay and, critically, did not establish MGH action. For the one MGH-affiliated provider identified, the evidence suggested the family chose to discontinue care due to perceived risk (Dr. Newton’s access), not that MGH denied services. For UMass providers, the link to MGH—and to disability-based reasons—was undeveloped, and the father conceded he did not know how much was related.

The result is a practical evidentiary rule: even under an expansive “meaningful access” conception, Section 504 liability requires record evidence of defendant-entity conduct that actually denies/limits access, not speculation, hearsay, or family-initiated withdrawal.

3.3 Impact

A. Litigation against mandated reporters: expert testimony becomes a central gatekeeping requirement

The most consequential doctrinal effect is the court’s insistence that when plaintiffs challenge a clinician’s mandated-reporting decision as negligent or as “outrageous,” and that challenge depends on evaluating specialized medical judgment, expert testimony is ordinarily necessary. This is not limited to classic medical malpractice with a doctor-patient relationship; the decision expressly frames the inquiry as one beyond lay competence and tied to a professional standard of care applicable even to third parties.

Practically, future plaintiffs bringing tort claims arising out of child-protection reporting will need early expert development: defining the standard of care for suspicion thresholds, chart documentation practices, consultation norms, and reporting timing—particularly in complex-diagnosis pediatrics where symptom interpretation is contested.

B. IIED claims in professional-reporting settings face an added “reasonableness” filter

By linking “extreme and outrageous” to the reasonableness of professional judgment, the court narrows the path for IIED in mandated-reporting contexts. Plaintiffs will need to show not merely harm and offensiveness, but professionally unjustifiable action—typically via expert evidence—before a jury can even reach the moral/legal condemnation embedded in the IIED standard.

C. Section 504 healthcare claims: entity-specific proof of denial/limitation is essential

The Section 504 portion underscores evidentiary rigor in discrimination claims against healthcare institutions. Documentation of stigma (e.g., abuse suspicion in a chart) is not enough without proof that the institution actually denied/curtailed benefits. The decision also highlights a recurring causation pitfall: when a family withdraws from care, plaintiffs must still prove the provider’s denial/limitation (and that it was solely due to disability), rather than a precautionary choice by the family.

4. Complex Concepts Simplified

• “Mandated reporter” / “51A report” (Mass. Gen. Laws ch. 119, § 51A(a)): Certain professionals must report to DCF when they have “reasonable cause to believe” a child is suffering injury from abuse creating harm or substantial risk. The duty is triggered by reasonable suspicion, not proof.
• Medical child abuse (“Munchausen syndrome by proxy”): As described with reference to In re Adoption of Willamina and N.J. Dep't of Child. & Fams. v. L.O., it involves a caregiver fabricating or exaggerating a child’s illness, which can lead to unnecessary tests and interventions and complicate diagnosis and care.
• Why expert testimony matters here: A jury can decide ordinary negligence using common experience (e.g., a driver running a red light). But deciding whether a child-protection physician acted reasonably in suspecting medical child abuse—based on complex medical records and professional reporting norms—requires specialized knowledge. Courts therefore often require an expert to explain what competent professionals would do.
• IIED “extreme and outrageous”: Not all harmful or unfair conduct qualifies. Massachusetts sets a very high bar: conduct must be beyond all bounds of decency. In this case, the court said you cannot decide whether reporting was “outrageous” without knowing whether it was medically/professionally reasonable.
• Section 504 “denied benefits” / “meaningful access”: Section 504 forbids disability-based exclusion or denial of benefits by federally funded programs. Even if “meaningful access” (not only explicit refusal) can qualify, plaintiffs must still prove the defendant entity actually limited or denied services because of disability—not merely that a report existed or that someone feared consequences.

5. Conclusion

J.S.H. v. Newton affirms summary judgment across state tort and federal disability claims arising from suspected medical child abuse reporting. Its central contribution is a clear evidentiary and doctrinal gate: when liability turns on evaluating a mandated reporter’s specialized medical judgment—whether framed as negligence (NIED) or as “extreme and outrageous” conduct (IIED)—Massachusetts law, as applied by the First Circuit, ordinarily requires expert testimony to establish the applicable professional standard of care and deviation from it. Separately, the decision reinforces that Section 504 claims against a healthcare institution demand concrete, defendant-specific evidence that services were actually denied or meaningfully curtailed because of disability, not inference, hearsay, or voluntary discontinuation of care.