The Locality Rule and the Physician's Dilemma

The applicable standard of care in medical malpractice lawsuits varies among jurisdictions in the United States. Currently 21 states maintain a version of the locality rule, in which a physician is judged by the standard of care in his particular locality. This commentary examines the origins of the locality rule, how courts apply it, the implications of its use for physicians, and ethical implications of this standard. The authors contend that the locality rule is difficult to justify, as medical education has become more standardized and modern technology provides rural physicians with the same access to information for patient care as urban ones. Moreover, the locality rule imposes additional duties and legal risk on physicians, because they need to be aware of and adhere to local standards even where they may be substandard at the national level. When medical advances have not been adopted in their community, physicians may face the choice between doing either what they believe is best for their patients or abiding by the local standard of care to minimize legal risk. It is furthermore troubling that the outcome of a malpractice suit could depend on the ability of the physician to find an expert witness willing to testify to the standard of care in his locality.

In conclusion, the authors note that patients should be able to expect a certain level of competency and skill from their physicians and advocate adopting a nationwide standard of care in all jurisdictions.