S.K., a legally incapacitated Minor by and through his Conservator, Thomas T. Tarbox v. Obstetric & Gynecologic Associates of Iowa City and Coralville, P.C., and Mercy Hospital Iowa City and Jill Christine Goodman, 13 N.W.3d 546

S.K., a minor, suffered severe brain injuries at birth, allegedly due to Dr. Goodman’s negligent use of forceps and a Mityvac vacuum during delivery at Mercy Hospital.
S.K.'s conservator filed a medical malpractice suit against Dr. Goodman, the clinic (Obstetric & Gynecologic Associates of Iowa City and Coralville, P.C.), and Mercy Hospital.
Prior to trial, claims against Dr. Goodman and S.K.'s parents were dismissed, leaving the conservator’s claims against Mercy and the clinic (vicariously liable for Dr. Goodman).
At trial, expert testimony heavily disputed causes of injury and standard of care; the jury awarded over $97 million in damages against the defendants.
The clinic appealed, primarily challenging the admissibility of the Mityvac vacuum’s package insert as hearsay and prejudicial, as well as raising procedural and excessive damages issues.
The Supreme Court's core ruling: the package insert was inadmissible hearsay, not covered by any exception, requiring reversal and a new trial.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Admission of Mityvac package insert as evidence	Insert showed negligent use per standard of care; admissible	Hearsay not covered by exception; unfairly prejudicial	Insert is inadmissible hearsay; reversal
Residual exception to hearsay (Iowa R. Evid. 5.807)	Insert trustworthy, necessary, and probative for the jury	Not necessary/superior to expert testimony or other sources	Exception not met—necessity not shown
Market reports exception to hearsay (Iowa R. Evid. 5.803(17))	Insert is a reliable, occupational standard reference	Insert contains warnings/opinions, not factual compilations	Exception not applicable to warnings
Prejudice from admitting insert	Any error harmless; cumulative or irrelevant evidence	Admission was central, persuasive, and highly prejudicial	Prejudice presumed; not rebutted
Motion to reverse for lack of valid certificate of merit	Issue not preserved (not raised below); no grounds for reversal	Waiver: defendant failed to timely challenge during litigation	Not preserved; challenge waived

Miller v. Catholic Health Initiatives-Iowa, Corp., 7 N.W.3d 367 (Iowa 2024) (certificate of merit affidavit must be signed under oath; dispositive motions for noncompliance must be timely raised)
Hawkins v. Grinnell Reg’l Med. Ctr., 929 N.W.2d 261 (Iowa 2019) (erroneous admission of hearsay presumed prejudicial unless affirmatively rebutted)
Veverka, 938 N.W.2d 197 (Iowa 2020) (residual hearsay exception extremely limited and rarely applies)
Skahill, 966 N.W.2d 1 (Iowa 2021) (all residual exception criteria must be satisfied; necessity requires best available evidence)
Heuser, 661 N.W.2d 157 (Iowa 2003) (market reports exception limited to objective factual compilations)