Federal Rule of Evidence 601 Mandates Application of State Expert-Competency Rules in Federal Medical-Malpractice Actions: A Commentary on Manuel Moreno v. Carol Bosholm (4th Cir. 2025)

1. Introduction

In Moreno v. Bosholm, the United States Court of Appeals for the Fourth Circuit confronted a deceptively simple question: when a state-law medical-malpractice claim is litigated in federal court, which evidentiary rule governs the competency of the plaintiff’s medical-standard-of-care expert—the Federal Rules of Evidence or the state’s own, more restrictive statute?

The answer, the court held, is found in the overlooked second sentence of Federal Rule of Evidence 601. Rule 601 directs federal courts in civil cases to apply state law governing a witness’s “competency” whenever that state’s substantive law supplies the rule of decision. Consequently, North Carolina Rule of Evidence 702(b)—which strictly limits who may testify about the standard of care in a medical-malpractice action—controlled, and the district court properly excluded the plaintiff’s expert. That exclusion proved fatal to Manuel Moreno’s malpractice, gross-negligence, and deliberate-indifference claims against prison physician Dr. Carol Bosholm.

Beyond its immediate effect on the parties, the published decision aligns the Fourth Circuit with the Fifth, Sixth, Ninth, and Eleventh Circuits and cements a new, bright-line precedent: in this circuit, Rule 601 trumps Rule 702 when it comes to expert competency on state-law claims. Litigants can no longer assume federal Daubert gate-keeping will rescue an expert who fails to satisfy state practice-or-teaching requirements.

2. Summary of the Judgment

• The Fourth Circuit affirmed the district court’s judgment as a matter of law (JMOL) for Dr. Bosholm on all claims.
• It upheld the pre-trial order excluding testimony from the plaintiff’s expert, Dr. Robert Bilbro, about the applicable medical standard of care and breach, because he did not satisfy N.C. R. Evid. 702(b)’s “majority active-practice/teaching” requirement.
• The appellate court ruled that Rule 601 incorporated the state expert-competency statute, rejecting the plaintiff’s argument that Federal Rule 702 alone governs in federal court.
• Absent competent expert testimony, the plaintiff could not establish the standard of care, breach, or causation—essential elements of malpractice, gross negligence, and deliberate indifference—so JMOL was proper.
• The court also rejected remaining arguments regarding gross negligence, deliberate indifference, punitive damages, and a last-minute motion to disqualify appellate counsel.

3. Analysis

3.1 Precedents Cited and Their Influence

• Federal Rule of Evidence 601 – “State law governs the witness’s competency regarding a claim … for which state law supplies the rule of decision.” This was the linchpin.
• Federal Rule of Evidence 702 & Daubert – Sets reliability standards but, the court held, does not override Rule 601’s specific state-competency mandate.
• Coleman v. United States, 912 F.3d 824 (5th Cir. 2019); Legg v. Chopra, 286 F.3d 286 (6th Cir. 2002); Liebsack v. United States, 731 F.3d 850 (9th Cir. 2013); McDowell v. Brown, 392 F.3d 1283 (11th Cir. 2004)
• Each applied state expert-qualification rules in federal medical-malpractice or FTCA cases; the Fourth Circuit joins their ranks.
• Shady Grove Orthopedic Assocs. v. Allstate, 559 U.S. 393 (2010)
• Re-affirmed that a valid, directly-on-point federal rule controls over state procedure—unless another federal rule incorporates state law, as Rule 601 does here.
• Estelle v. Gamble, 429 U.S. 97 (1976) – Distinguished medical negligence from constitutional deliberate indifference.
• Farmer v. Brennan, 511 U.S. 825 (1994) – Defined the subjective “actual knowledge” prong of deliberate indifference.
• North Carolina cases Atkins v. Mortenson, Weatherford v. Glassman, etc. – Confirm expert testimony is generally indispensable to establish the medical standard of care.

3.2 The Court’s Legal Reasoning

1. Rule 601 Analysis
   
   • The phrase “state law governs the witness’s competency” is plain and unconditional.
   • North Carolina 702(b) is a competency rule because it specifies who may testify on the standard of care, not what they may say.
   • Therefore, before the court ever reaches Rule 702’s reliability inquiry, it must ask whether the proffered expert meets the state’s competency threshold.
2. No Conflict with Rule 702
   Rule 601 and Rule 702 operate “in tandem.” If the expert is competent under state law (per Rule 601), the court then assesses reliability (Rule 702). If not competent, the testimony never reaches the Rule 702 gate.
3. Application to Dr. Bilbro
   Deposition showed he had not devoted a majority of his professional time to active clinical practice or teaching in the relevant specialty during the year preceding the incident. He therefore failed North Carolina 702(b).
4. Consequences for the Claims
   Without standard-of-care evidence, the plaintiff lacked proof of breach and causation for malpractice and, by extension, for gross negligence and §1983 deliberate indifference. The district judge properly granted JMOL.

3.3 Impact of the Decision

Doctrinal Impact

• Creates binding Fourth-Circuit precedent aligning with a growing inter-circuit consensus.
• Shifts litigation strategy: plaintiffs must now secure experts who satisfy both state competency rules and federal Daubert standards.
• Clarifies that Rule 601 may trump the Erie “substantive versus procedural” debate because it is itself a federal rule that incorporates state law.

Practical Impact

• More summary judgments/JMOLs are likely where experts fail the state test.
• Federal-court malpractice or FTCA plaintiffs must vet expert credentials earlier and often.
• Defense counsel gain a potent, threshold exclusion tool; motions in limine will increasingly target 702(b)-type requirements.
• District judges in the Fourth Circuit now have a clear roadmap and no longer confront conflicting authority.

4. Complex Concepts Simplified

Rule 601 vs. Rule 702

Rule 601 asks “Is this person legally allowed to testify on this topic?” (competency).
Rule 702 asks “Is this testimony reliable, relevant, based on sufficient data and a sound methodology?” (admissibility). Competency comes first.

JMOL – Judgment as a Matter of Law

A trial judge’s ruling that no reasonable jury could find for the non-moving party on one or more essential elements of a claim, even viewing evidence in that party’s favor.

Gross Negligence (NC)

Conduct showing conscious or reckless disregard for others’ safety—higher than ordinary negligence but short of intent. Usually still requires proof of standard of care unless the misconduct is egregiously obvious.

Deliberate Indifference (§1983)

Constitutional tort requiring (1) a serious medical need and (2) prison official’s actual knowledge of and disregard for an excessive risk to inmate health—mere malpractice is not enough.

5. Conclusion

Moreno v. Bosholm stands for a straightforward yet far-reaching principle: under Federal Rule of Evidence 601, federal courts must honor state statutes that define who is competent to testify about the medical standard of care in state-law malpractice claims. This ruling brings the Fourth Circuit into harmony with four sister circuits and provides much-needed predictability to litigants.

Practitioners must now treat state expert-competency rules as obligatory—fail them, and the case may collapse before a jury ever hears it. Conversely, satisfying the state rule does not guarantee admission; Daubert screens reliability next. The decision also illustrates the enduring power of JMOL when essential expert testimony is absent. Finally, the court’s thoughtful handling of late-raised ethics issues underscores a balanced approach to attorney conduct without sacrificing litigant rights.

Prepared by: [Your Name], appellate commentator.