Full Opinion

IN THE COURT OF APPEALS OF IOWA _______________ No. 25-0865 Filed October 7, 2026 _______________ Miranda Anderson and Landen Anderson, Plaintiffs–Appellants, v. Richard Posthuma, M.D., Pella Regional Health Center, and Catholic Health Initiatives-Iowa, Corp. d/b/a MercyOne Des Moines Medical Center, Defendants–Appellees. _______________ Appeal from the Iowa District Court for Polk County, The Honorable Scott J. Beattie, Judge. _______________ REVERSED AND REMANDED _______________ Ryan G. Koopmans (argued) of Koopmans Law Group, LLC, Des Moines, and Thomas P. Slater and Reagan H. Slater of Slater Law, LLC, West Des Moines, attorneys for appellants. Chelsea E. Gavin (argued), Frederick T. Harris, and Michael L. Storey of Lamson Dugan & Murray LLP, West Des Moines, attorneys for appellees. J. Russell Hixson of Hixson & Brown, P.C., West Des Moines, attorney for amici curiae Ivonne Espinoza and Jose Castro. 1 John C. Gray, Jeff W. Wright, and Zack A. Martin of Heidman Law Firm, P.L.L.C., Sioux City, attorneys for amici curiae Leah Johnson, M.D., Alayna Ryan, D.O., and Siouxland Medical Education Foundation, Inc. _______________ Heard at oral argument by Badding, P.J., and Chicchelly and Langholz, JJ. Opinion by Chicchelly, J. 2 CHICCHELLY, Judge. The plaintiffs, Miranda and Landen Anderson, on interlocutory appeal, appeal from the district court’s partial grant of summary judgment capping the amount of noneconomic damages they can recover in their medical malpractice action against the defendants. 1 They allege that the district court erred by finding that none of the exceptions to the statutory cap in Iowa Code section 147.136A(2) (2022) apply to their claims. Upon our review, we hold that the district court erred in ruling that as a matter of law none of the exceptions apply. BACKGROUND FACTS AND PROCEEDINGS Miranda was thirty-four weeks pregnant on April 13, 2021, when she first showed troubling symptoms with her pregnancy. Miranda visited Dr. Posthuma at PRHC; he diagnosed her with preeclampsia. Over the next several days, Miranda was in and out of the hospital as she continued to be affected by the symptoms from the preeclampsia. On April 21, Miranda returned to PRHC where an ultrasound revealed her baby no longer had a heartbeat. Miranda subsequently underwent emergency cesarean surgery to deliver her stillborn child. Miranda and her husband, Landen, brought this action against Posthuma and PRHC in June 2022 alleging medical malpractice for the “in- utero demise of [their] baby”2 and the harm suffered by Miranda. Among other damages, the Andersons sought noneconomic damages for past and 1 Defendants Dr. Richard Posthuma and Pella Regional Health Center (PRHC) are the only defendants participating in this interlocutory appeal. 2 We use this phrasing here and throughout the opinion because it is the phrasing the Andersons used in their petition. 3 future physical and mental pain and suffering, past and future loss of full mind and body, and loss of consortium. Prior to trial, Posthuma and PRHC filed a joint motion for partial summary judgment arguing that section 147.136A(2) caps noneconomic damages at $250,000. The district court granted the motion, holding that the damages cap applies to the Andersons’ claims and none of the statute’s exceptions apply. The Andersons applied for interlocutory appeal, which our supreme court granted and then transferred the case to our court. STANDARD OF REVIEW “We review summary judgment motions for correction of errors at law.” Kirlin v. Monaster, 984 N.W.2d 412, 415 (Iowa 2023). Likewise, our review of a district court’s interpretation of statutes is for correction of errors at law. Breeden v. Iowa Dep’t of Corr., 887 N.W.2d 602, 607 (Iowa 2016). DISCUSSION In 2017, the legislature passed legislation to cap the amount of noneconomic damages a plaintiff could recover in a medical malpractice action. See 2017 Iowa Acts ch. 107, § 2. The legislation stated in part: The total amount recoverable in any civil action for noneconomic damages for personal injury or death, whether in tort, contract, or otherwise, against a health care provider shall be limited to two hundred fifty thousand dollars for any occurrence resulting in injury or death of a patient regardless of the number of plaintiffs, derivative claims, theories of liability, or defendants in the civil action, unless the jury determines that there is a substantial or permanent loss or impairment of a bodily function, substantial disfigurement, or death, which warrants a finding that imposition of such a limitation would deprive the plaintiff of just compensation for the injuries sustained. Iowa Code § 147.136A(2) (2017) (emphasis added). 4 The legislature defined noneconomic damages as “damages arising from pain, suffering, inconvenience, physical impairment, mental anguish, emotional pain and suffering, loss of chance, loss of consortium, or any other nonpecuniary damages.” Id. § 147.136A(1)(b). Thus, unless one of the three exceptions in the statute applied, a plaintiff’s noneconomic damages were capped at $250,000.3 The Andersons argue that all three exceptions to the damages cap apply to this action and that the district court erred in finding that none of them applied. We cover each exception in turn. I. 2023 Amendment Before addressing each of the exceptions, we first address the impact of a 2023 statutory amendment to the current proceeding. In 2023, the legislature amended section 147.136A(2) to add “loss of pregnancy” as an exception to the general cap on noneconomic damages. See 2023 Iowa Acts ch. 4, § 2. The legislature made clear that the amendment applied prospectively—only to causes of action that accrued on or after the law went into effect. Id. § 6. The district court relied on this amendment in its ruling by finding, “The fact that the legislature specifically added ‘loss of pregnancy’ as an exception in the 2023 amendment strongly indicates that this exception was not encompassed within the 2017 version of the statute.” The district court further stated, “To hold otherwise would render the 2023 amendment redundant and superfluous, violating established principles of statutory construction.” 3 Apart from a 2018 amendment to another section of the statute not relevant on appeal, this is how the statute read in 2022 when the Andersons filed their petition. See 2018 Iowa Acts ch. 1041, § 46 (codified at Iowa Code § 147.136A (2022)). 5 The parties dispute the effect this amendment has on the current proceeding. The Andersons argue that the added language clarified what the law already was and did not alter the section. See State ex rel. Schuder v. Schuder, 578 N.W.2d 685, 687 (Iowa 1998) (per curiam) (“An amendment may be enacted so a statute corresponds ‘to what had previously been supposed was the law rather than to effect a change therein.’” (quoting Hansen v. Iowa Emp. Sec. Comm’n, 34 N.W.2d 203, 205 (Iowa 1948))). On the other hand, Posthuma and PRHC argue that the amendment altered the statute to add loss of a pregnancy under the exceptions to the statute. See Davis v. State, 682 N.W.2d 58, 61 (Iowa 2004) (“When an amendment to a statute adds or deletes words, a change in the law will be presumed unless the remaining language amounts to the same thing.”). They contend that the amendment would not have been necessary if loss of pregnancy was already covered by an exception. See id. (“When interpreting amendments, we will assume that the amendment sought to accomplish some purpose and was not a futile exercise.”). We note that the general rule is that amending a statute does not affect how the prior version of the statute operated. Iowa Code § 4.13(1)(a). But as the parties dispute, whether an amendment clarifies or changes the statute can be a central issue when determining the effect of the amendment on the prior statute. See Bd. of Trs. of Mun. Fire & Police Ret. Sys. of Iowa v. City of W. Des Moines., 587 N.W.2d 227, 230 (Iowa 1998). The key here is that the legislature provided the amendment only applied prospectively. See 2023 Iowa Acts ch. 4, § 6. Because the legislature made clear that the amendment applied prospectivity, it only impacts the law going forward. 4 This 4 Had the legislature wanted the amendment to apply retroactively, it could have included express language to do so. See Hedlund v. State, 991 N.W.2d 752, 758 (Iowa 6 prospective amendment does not clarify or change the prior version of the statute. Therefore, we consider whether the exceptions apply under section 147.136A as it read in 2022, without considering the later 2023 amendment. II. Death Exception The Andersons first argue that the in-utero demise of their baby falls under the statute’s death exception. They argue that the alleged medical malpractice that caused the in-utero demise of their baby was a death under the statute. We begin by noting that for the purposes of Iowa’s survival statute, section 611.20, a survival action for wrongful death cannot be brought on behalf of an unborn child because the statute applies “only [to] those born alive.” McKillip v. Zimmerman, 191 N.W.2d 706, 709 (Iowa 1971); see also Weitl v. Moes, 311 N.W.2d 259, 272 (Iowa 1981) (en banc) (extending the McKillip holding to viable fetuses), overruled on other grounds by Audubon- Exira Ready Mix, Inc. v. Ill. Cent. Gulf R.R. Co., 335 N.W.2d 148 (Iowa 1983) (en banc). The district court relied on McKillip in holding that the death exception is not applicable. However, in Dunn v. Rose Way, Inc., our supreme court held that a parent can bring a loss of consortium claim for an unborn child. See 333 N.W.2d 830, 833 (Iowa 1983) (en banc); see also Craig v. IMT Ins. Co., 407 N.W.2d 584, 586 (Iowa 1987) (en banc) (“[O]ur past majority holdings bar a wrongful death claim on behalf of an unborn child while at the same time 2023). And while the rule under Iowa Code section 4.5 is that a statute is presumed to be prospective unless expressly made retrospective, the legislature nonetheless chose to explicitly provide that the amendment applied prospectively. 7 allowing the parents of an unborn child to recover for loss of consortium . . . .”). This distinction was reaffirmed by our supreme court a decade ago. See Est. of Gray ex rel. Gray v. Baldi, 880 N.W.2d 451, 458 (Iowa 2016) (“We conclude the distinction between Dunn and McKillip is a sound one.”). With this in mind, we analyze the death exception under Dunn.5 In Dunn, the court addressed whether a claim could be brought for the death of a viable unborn child under Iowa Rule of Civil Procedure 8.6 See 333 N.W.2d at 831–33. Under the rule, “A parent, or the parents, may sue for the expense and actual loss of services, companionship and society resulting from injury to or death of a minor child.” Iowa R. Civ. P. 1.206; see also Iowa Code § 613.15A. In concluding that such a claim could be brought, the court stated, “A minor person is simply one who has not yet reached majority, a category which certainly includes unborn persons.” Dunn, 333 N.W.2d at 833. The court took great care in making clear that under rule 1.206, the claim belongs to the parent and not the minor child. See, e.g., id. at 832 (“Actions brought under rule [1.206] are not for the injury to the child but for the injury to the [parent] as a consequence of the injury to the child.” (quoting Wardlow v. City of Keokuk, 190 N.W.2d 439, 443 (Iowa 1971))). Thus, the in-utero demise of the Andersons’ baby falls under Dunn. 5 We acknowledge that our supreme court has stated that when considering the legal status of a fetus under a statute, “rather than relying on our prior cases involving different statutes, we center our attention on the legislative intent with respect to the statute at issue.” In re Marriage of Witten, 672 N.W.2d 768, 775 (Iowa 2003). However, because the Andersons’ claim falls under Iowa Rule of Civil Procedure 1.206, we find Dunn dispositive. 6 Iowa Rule of Civil Procedure 8 was later renumbered to rule 1.206. Despite the renumbering, the rule still reads as it did in Dunn. For ease of reference, we refer to the rule as rule 1.206. 8 The text of section 147.136A(2) provides that whether one of the three exceptions applies is for the jury to decide. Under Dunn, a reasonable jury could find that the death exception applies in this case. Therefore, we hold that the district court erred in ruling that the death exception under section 147.136A(2) does not apply as a matter of law. In so holding, “[w]e express no opinion as to the existence of the fetus as a person in either the philosophical or actual sense.” McKillip, 191 N.W.2d at 709; see also Dunn, 333 N.W.2d at 833 (“In interpreting rule [1.206] we can and do set completely aside all the philosophical arguments about the status of the unborn. Those arguments are not at issue here. What is involved here is a right of recovery given to a parent. The parent’s loss does not depend on the legal status of the child; indeed the absence of the child is the crux of the suit.”). III. Substantial or Permanent Loss or Impairment of Bodily Function Exception The Andersons next contend that the in-utero demise of their baby was a substantial or permanent loss or impairment of a bodily function. They assert that this exception applies for two reasons. First, the Andersons argue that this exception applies because the in- utero demise of their baby involved the impairment of Miranda’s bodily function. The Andersons allege that the in-utero demise of their baby involved the impairment of Miranda’s bodily function because the defendants’ failure to treat her preeclampsia impaired her reproductive system. They argue when the fetus’s heart stopped, Miranda’s ongoing reproductive bodily function ended. The Andersons concede that any impairment here was temporary but argue the jury should be allowed to decide whether the impairment was substantial. 9 Our courts have given guidance on what constitutes the loss of a bodily function. Brant v. Bockholt, 532 N.W.2d 801, 804–05 (Iowa 1995) (“The element of loss of function of the body is broadly inclusive of various physical injuries. . . . [T]his element of damage relates to functional impairment as opposed to structural impairment of the body. It is the inability of a particular body part to function in a normal manner.”). Our court has also previously defined function as “the special, normal, or proper action of any part or organ.” Elick v. Garrett, No. 13-0285, 2013 WL 5962960, at *4 (Iowa Ct. App. Nov. 6, 2013) (citation omitted). And “[a]n impairment, according to common usage, includes any deviation from normal health.” State v. McKee, 312 N.W.2d 907, 913 (Iowa 1981). With that law in mind, along with the language in the statute leaving the question of whether the exception applied to the jury, we find that a reasonable jury could find that this exception applies to the in-utero demise of the Andersons’ baby. The district court placed weight on its finding that no Iowa case law defined loss of pregnancy as a loss or impairment of a bodily function. But this was not a reason for the district court to hold that as a matter of law the exception does not apply. And nonetheless, a jury’s finding that the exception applies would have support in the law. See id. (“[A]n impairment of the menstrual function would be an impairment of the function of an organ.”); Witcraft v. Sundstrand Health & Disability Grp. Benefit Plan, 420 N.W.2d 785, 788 (Iowa 1988) (adopting the district court’s finding that “the natural function of the reproductive organs is to procreate”); Iowa Code § 146B.1(5) (including reproductive functions in the definition of major bodily function). As for the Andersons’ second argument, they assert that Miranda’s inability to give birth naturally and only through a cesarean section is an 10 impairment of a bodily function, and that the district court erred as a matter of law in ruling that no reasonable juror could find the impairment permanent or substantial. According to the Andersons, the defendants’ negligence made a cesarean section unavoidable, and Miranda can now only give birth through a cesarean section. The record shows Miranda has given birth to two children by cesarean section since the defendants’ alleged negligence. The district court, while acknowledging that Miranda would likely only be able to deliver future children by cesarean section, ruled that such a limitation does not constitute a substantial or permanent loss or impairment of a bodily function under Iowa law. Relying on the fact that Miranda has since successfully given birth by cesarean section, the district court ruled that such a limitation does not prevent Miranda from giving birth, but rather “represents a different mode of childbirth.” Posthuma and PRHC argue there is no expert testimony that Miranda’s reproductive functions no longer function in a normal manner due to their actions nor was there expert evidence that Miranda’s initial cesarean section was caused by their actions. Posthuma and PRHC are correct that the Andersons must provide expert testimony to support their claims. Struck v. Mercy Health Servs.-Iowa Corp., 973 N.W.2d 533, 539 (Iowa 2022) (“It is well settled that expert testimony is required to prove professional negligence claims against healthcare providers.”). And we have previously found no loss of body function in cases where plaintiffs failed to present evidence of functional impairment. See, e.g., Prouty v. Martin, No. 03-0677, 2004 WL 239998, at *2 (Iowa Ct. App. Feb. 11, 2004); Brundage v. McElderry, No. 00-0811, 2001 WL 725688, at *3 (Iowa Ct. App. June 29, 2001). But despite the defendants’ arguments, we note that the Andersons did provide expert testimony to support their claims. Their expert opined 11 that “[b]ut for the failure to meet the standard of care . . . [Miranda] would have vaginally delivered a viable infant and would have avoided an unnecessary cesarean section. . . . Should [Miranda] elect to become pregnant in the future, delivery would necessarily be by cesarean section.” This evidence was sufficient at the summary judgment stage to allow a reasonable jury to find that Miranda’s ability to give birth only through cesarean section because of the defendants’ alleged negligence was a substantial or permanent loss or impairment of bodily function. See Brant, 532 N.W.2d at 804–05; McKee, 312 N.W.2d at 913 (“[A] harm which makes the function of an organ intensely painful or irregular is an impairment.” (emphasis added)). Therefore, under section 147.136A(2), because the question of whether there was a substantial or permanent loss or impairment of bodily function is a question for the jury, we find the district court erred by finding the exception does not apply as a matter of law. IV. Substantial Disfigurement Exception Lastly, the Andersons assert that the district court erred by finding that the substantial disfigurement exception did not apply because the defendants’ negligence left Miranda with a cesarean section scar that will have to be reopened every time she delivers another child. According to the Andersons, the scar is plainly a disfigurement. The district court ruled as a matter of law that the scar left from the cesarean section is not a substantial disfigurement. The district court reasoned that no Iowa court had ever held that such a scar is a substantial disfigurement under section 147.136A, the Andersons failed to plead substantial disfigurement, and the Andersons failed to provide expert testimony showing the scar is a substantial disfigurement. 12 Returning to the language of the statute, we note that the determination of whether the scar is a substantial disfigurement is a question for the jury. That an Iowa court had never held that a scar from a cesarean section is a substantial disfigurement under section 147.136A is immaterial. Additionally, section 147.136A does not have a heightened pleading standard. Rather, under our notice pleading standard, The petition need not allege ultimate facts that support each element of the cause of action. And the petition need not identify a specific legal theory. Instead, the petition need only contain factual allegations that give the defendant “fair notice” of the claim asserted so the defendant can adequately respond to the petition. A petition complies with the ‘fair notice’ requirement if it informs the defendant of the incident giving rise to the claim and of the claim’s general nature. Mormann v. City of Manchester, 27 N.W.3d 820, 834 (Iowa 2025) (quoting Terrace Hill Soc’y Found. v. Terrace Hill Comm’n, 6 N.W.3d 290, 296 (Iowa 2024)). The Andersons’ petition alleging the defendants’ negligence caused Miranda to suffer past and future physical and mental pain and suffering satisfied the notice pleading requirement here. As noted above, the Andersons provided expert testimony to support their claim. But even if they had not, this would not have defeated their claim under this exception, as expert testimony is not needed for a jury to decide whether a scar is a substantial disfigurement. See, e.g., State v. Awino, No. 23- 0928, 2024 WL 4220580, at *2 (Iowa Ct. App. Sep. 18, 2024) (“Reasonable jurors could conclude the scars reached the level of serious permanent disfigurement.”). While a scar is not substantial disfigurement per se, it can rise to such a level and is for the jury to decide. See State v. Hanes, 790 N.W.2d 545, 554 (Iowa 2010). The text of the statute itself makes clear that whether something is a substantial disfigurement is a question for the jury. 13 Therefore, the district court erred by finding that as a matter of law, Miranda’s scar is not a substantial impairment and that the exception does not apply. CONCLUSION We hold that the district court erred by holding that as a matter of law none of the three exceptions under Iowa Code section 147.136A(2) apply to the Andersons’ action. We therefore reverse the district court’s partial grant of summary judgment and remand for further proceedings consistent with this opinion. REVERSED AND REMANDED. 14