.

Estelle Kokales McGrath

Supervisor, Professional Liability - Western Pennsylvania

Chair, Real Estate E&O Liability Practice Group

Portrait of Estelle Kokales McGrath

Estelle is a Shareholder in the firm’s Professional Liability Department and serves as Supervisor of the Professional Liability Practice Group in Western Pennsylvania, where she oversees the operations and strategic direction of the Professional Liability attorneys in the firm’s Pittsburgh, Erie, Cincinnati, and Cleveland offices.  Her practice focuses on various miscellaneous professional liability matters, including errors and omissions, directors and officers liability and management liability.

Insurance Agents & Brokers Liability.  A significant portion of Estelle’s practice is dedicated to defending errors and omissions claims against insurance agents and brokers.  She represents agents and brokers of all sizes in both pre-suit matters and litigation and is skilled at managing the complex relationships among agents, insureds, and insurance carriers.

Real Estate E&O Liability.  As Chair of the firm’s Real Estate Errors and Omissions Liability Practice Group, Estelle represents real estate agents and brokers, appraisers, home inspectors, property management companies, homeowner associations, boards, and individual board members. Her work frequently involves detailed analysis of contracts, association governing documents, and the Uniform Planned Community Act.

Public Entity and Civil Rights.  Estelle also maintains a robust practice in public entity and civil rights defense.  She represents municipalities, school districts, universities, and other public entities, as well as police chiefs, police officers, constables, humane officers, volunteers, security personnel, and educators – including teachers, professors, and coaches– in a wide range of professional liability and civil rights matters.

Employment Law.  In the employment law arena, Estelle counsels employers pre-suit and defends public entities and private companies in claims alleging discrimination and retaliation, in addition to whistleblower claims and allegations of sexual assault.  She frequently appears before the EEOC and PHRC and continues representation through litigation in state and federal courts. She also previously served as a pro bono mediator for the Equal Employment Opportunity Commission.

Estelle also recently served a two-year term on the firm’s Executive Committee Advisory Council, a select group of firm leaders dedicated to strengthening communication between the Executive Committee and associates, special counsel, and junior shareholders.

    • Widener University Delaware Law School (J.D., 2001)
    • Juniata College (B.A., 1998)
    • Pennsylvania, 2001
    • West Virginia, 2011
    • U.S. District Court Southern District of West Virginia, 2011
    • U.S. District Court Western District of Pennsylvania, 2011
    • U.S. District Court Northern District of West Virginia, 2017
    • Pennsylvania Super Lawyer Rising Star (2008, 2012-2016)
    • Allegheny County Bar Association
    • Council on Litigation Management
    • FETA 2013-present
    • Pennsylvania Bar Association
    • Professional Liability Underwriting Society (PLUS) 2013-present
    • West Virginia Bar Association
    • Anti-Harassment, Anti-Discrimination and Anti-Bullying /Workplace Conduct, Client Seminar, August 2025
    • Prohibition Against Discrimination and Harassment, Client Seminars, June 2025
    • Insurance Agent and Broker Webinar, Philadelphia Insurance Company, April 1, 2025
    • Risk Management for Insurance Agents & Brokers, Pittsburgh I-Day, October 8, 2024
    • How to Avoid Mistakes with Mismanagement of Life & Health Claims, Joint Webinar with National Association of Professional Agents, May 2023
    • Pandemic Coverage Litigation Update / Insurance Broker Best Practices, Client Webinar, September 2022
    • The Aftermath of the Pandemic For Carriers and Agents, Client Webinar, July 2021
    • Civil Litigation Updates in COVID-19 Litigation – Where Do We Stand One Year Later? Marshall Dennehey Webinar, May 2021
    • Supervisor Training on Discrimination, Client Seminar, June 2021
    • Impact of COVID-19 on Insurance Agents, Client Webinar, May 2021
    • Pandemic Coverage Litigation Update: Agent E & O Wars to Come, Client Webinar, March 2021
    • Pregnancy Discrimination, Client Seminar, March 2020
    • Promoting Diversity & Inclusion, Client Seminar, November 2019
    • Police:  Handling Critical Incidents, Client Seminar, May 2018
    • "Lessons From Accountant's Age Discrimination Suit," Pennsylvania CPA Journal, Spring 2024
    • "EEOC Mediation: Five Things to Consider Before Participating,"The Legal Intelligencer, Employment Law Supplement, October 2023
    • "Top 10 Ways an Insurance Broker Can Avoid Liability," National Association of Professional Agents, March 1, 2023
    • "Top Ten Ways an Insurance Broker Can Avoid Liability,"Legal Update for Insurance Agents & Brokers, December 21, 2022
    • “HOA Living. It Is Not For Everyone,” Defense Digest, June 2021, Vol. 27, No. 3
    • "Ten Ways An Employer Can Reduce Their Chances of Being Sued for Discrimination,"PLUS Blog, May 10, 2021
    • “HOA Living. It Is Not For Everyone.,” Defense Digest, March 2021, Vol. 27, No. 2
    • "House Bill No. 88 to be Signed by Governor Rendell," What's Hot in Workers' Comp, Volume 7, No. 12, December 2003
    • "Supreme Court Reverses Caso Decision," What's Hot in Workers' Comp, Volume 7, No. 12, December 2003
    • "Course of Employment Argument Saves Employer," Defense Digest, Volume 9, No. 2, June 2003
    • "Board's Decision Reversed Where Claimant Failed to Present Evidence," Lawyers Journal, The Journal of the Allegheny County Bar Association, June 27, 2003
    • "Borough of Lewistown v. Pennsylvania Labor Relations Board: The Supreme Court of Pennsylvania Holds Arbitration Award Final and Binding When Participating Joint Employer Failed to Appeal the Award," 9 WIDENER J. PUB. L 615 (2001).
    • Summary Judgment For Child Care Center In Employment Case, November 19, 2025
    • We obtained summary judgment on behalf of a child care center in an employment discrimination action brought by two former employees. Plaintiffs alleged multiple claims arising from their termination, including age and race discrimination and unlawful interference with leave, in violation of the Age Discrimination in Employment Act (ADEA), the Pennsylvania Human Relations Act (PHRA), Title VII, Section 1981, and the Family and Medical Leave Act (FMLA).  The Court agreed that Plaintiffs failed to establish a prima facie case of age discrimination, as they could not show they were replaced by sufficiently younger employees to support an inference of discriminatory animus.  Plaintiffs likewise failed to meet their burden on their race discrimination claims, as they did not demonstrate that the employer retained similarly situated employees who were not within the protected class.  Finally, the Court rejected Plaintiff’s FMLA interference claim, finding that the employee voluntarily ended her leave and that the employer would have continued to honor her FMLA rights had she not done so.  Accordingly, the Court held that Plaintiffs failed to present evidence to support their prima facie claims and granted summary judgment in favor of the employer.  
    • Preliminary Objections Sustained in Employment Suit for Public Entity, October 5, 2023 Obtained dismissal of employment case for public entity.  Plaintiff alleged a whistleblower claim and multiple wrongful discharge claims after being terminated.  The Judge sustained the employer’s preliminary objections, as the Court agreed that plaintiff failed to set forth any legally viable claims against her supervisor or prior employer.
    • Dismissal of Employment Discrimination Charge Before the Pennsylvania Human Relations Commission, August 24, 2023 A terminated employee filed a Charge of Discrimination with the Pennsylvania Human Relations Commission against her non-profit employer alleging age, sex and disability discrimination.  We were able to prove through the investigation process that there was no discrimination.  The Charge was accordingly dismissed.
    • Dismissal of Employment Discrimination Charge Before Pittsburgh Commission on Human Relations, August 14, 2023 A terminated employee filed a charge of discrimination with the Pittsburgh Commission on Human Relations against his non-profit employer alleging age and disability discrimination.  We were able to prove through the investigation process that there was no age or disability discrimination.  The Charge was accordingly dismissed.
    • Secured Voluntary Dismissal of Employment Suit for Public Entity, May 24, 2023 A terminated employee filed suit in the United States District Court for The Western District alleging violation of his First Amendment Rights as a result of retaliation based on political opposition and protected speech.  The employee also alleged a violation of the Equal Protection clause of the Fourteenth Amendment.  After filing a Motion for Sanctions, the employee voluntarily dismissed the entire federal lawsuit. 
    • Secured Voluntary Dismissal of Homeowners Association in Unjust Enrichment Suit, January 13, 2023 A contractor sued a homeowner's association for unjust enrichment because the builder failed to pay it for its services.  After discussions with counsel, the contractor agreed to voluntarily withdraw said suit against the homeowner's association.
    • Motion to Dismiss Granted in Employment Suit for Public Entity, December 19, 2022 Secured dismissal of First Amendment count in the United States District Court for The Western District on behalf of public entity alleged to have retaliated against plaintiff for exercising her First Amendment rights to freedom of speech and to petition the government for redress of grievances. The public entity employer was entitled to dismissal of the First Amendment Count because plaintiff’s complaints were only intended to protect her interests, not that of the public.  The court declined to exercise supplemental jurisdiction over the remaining state law claims.
    • Summary Judgment Granted for Vocational School, May 10, 2021
    • Obtained summary judgment in state court on behalf of a vocational school alleged to have violated the plaintiff’s procedural due process rights to continued enrollment.  The plaintiff alleged sexual assault by an instructor and asserted that she was dismissed from the school after reporting the alleged assault.  The school was entitled to judgment as a matter of law as the plaintiff was unable to prove that she had a recognized property right in continued enrollment in a commercial driver’s license program.
    • Complaint Dismissed Against Homeowners' Association and Property Management Company, January 28, 2020 A homeowner, Plaintiff, filed suit in Butler County Court of Common Pleas.  Plaintiff sued the Homeowners' Association, the Property Management Company, the Property Managers and individual board members alleging breach of contract, breach of fiduciary duty, gross negligence, intentional misrepresentation and negligent misrepresentation. After arguing preliminary objections to the 490-paragraph complaint, the Judge sustained the objections and dismissed the entire lawsuit with prejudice.  The Judge also granted the Defendants' Motion for Sanctions against Plaintiff for failing to voluntarily dismiss the individual defendants from the suit.
    • Motion to Dismiss Granted for Housing Authority Alleged to Have Violated Civil Rights of Tenant and Guest, January 13, 2020 Plaintiffs filed a lawsuit in the United States District Court for the Southern District of West Virginia alleging that the housing authority and their employee violated state and federal laws.  After filing a motion to dismiss all claims against the housing authority and their employee, the Judge granted the motion in its entirety dismissing three counts alleging violations of federal laws and four counts alleging violations of state laws.
    • Defeated Class Action Certification Against Property Management Company, November 20, 2019 Eight homeowners filed a class-action complaint in Washington County Court of Common Pleas avering claims of conversion and conspiracy against a property manager of their homeowners' association. The homeowners sought to certify a class-action lawsuit for all of the unit owners in the planned community.  They accused the property manager of wrongfully converting unit owner association fees and conspiring to delay the "turn over" of their homeowners' association. After a lengthy and contentious discovery process, the Judge denied the class certification against the property management company. 
    • Dismissal of Employee's Claims of Employee Status, August 2018 Claimant filed a claim petition alleging he was an employee of a newspaper. The case was bifurcated to determine whether the claimant was an employee versus an independent contractor. The Judge dismissed the claim petition finding that claimant was an independent contractor. The Judge’s decision was upheld by the Workers’ Compensation Appeal Board and the Commonwealth Court. 
    • Voluntary Dismissal of Real Estate Agent from Lawsuit, November 16, 2017 A buyer sued multiple defendants, in Westmoreland County Court of Common Pleas, including the seller's real estate agent alleging claims of misrepresentation and unfair trade practices in Pennsylvania state court.  During the discovery process, counsel was able to prove that the real estate agent was not liable. Thus, Plaintiff voluntarily agreed to discontinue the lawsuit as to the real estate agent.   
    • Voluntary Dismissal of Borough and Chief of Police, March 17, 2017 A prior employee (plaintiff) filed a complaint in the United States District Court For The Western District of Pennsylvania alleging that the borough, the mayor and chief of police unlawfully discriminated against him, which forced him to resign. The employee set forth various federal and state claims including a violation of his substantive due process rights and intentional infliction of emotional distress. After deposing the plaintiff, he voluntarily agreed to dismiss the complaint with prejudice. 
    • Employee Injuries Denied and Determined Fully Recovered, May 2016 A union president filed multiple petitions against the employer for accepted and unaccepted injuries. During a six-year battle, the employer was successful in its defenses before the workers' compensation judge, the workers' compensation appeal board, the Commonwealth Court and the Pennsylvania Supreme Court. 
    • Employee's Claims for Wage Loss Denied, March 17, 2015 An employee, truck driver, filed a claim in West Virginia for injuries he suffered in the course of his employment. The Employer was successful in proving that claimant's disc injury was preexisting in nature, which was affirmed by the Supreme Court of Appeals.
    • Preliminary Injunction Denied, November 24, 2014 Plaintiff, a manufacturer and seller of refractory products, filed a Motion for Injunctive Relief to prohibit their prior employees from working with a new company, which also manufactured and sold refractory products. The Judge denied Plaintiff's Motion for Preliminary Injunctive Relief after a contentious, speedy discovery stage of depositions and other motions. The trial team was successful in protecting the defendants' new business from being shut down. 

Results

Putative Class Action Lawsuit Dismissed

In a case where we represented a child care center, a federal district judge from the Western District of Pennsylvania granted our motion to dismiss with prejudice. The plaintiffs were nine minority employees who were involuntarily furloughed in the fall of 2020. They filed suit, alleging their employment was terminated in violation of Title VII of the Civil Rights Act, the Age Discrimination in Employment Act, the Family Medical Leave Act, the Pennsylvania Human Relations Act, the Wage Payment and Collection Law, and Section 1981 of the Civil Rights Act. The court agreed with the arguments made by the center, finding that the plaintiffs’ class claims were not timely exhausted. The court disagreed with the plaintiffs’ arguments that their charges gave notice of their putative class claims because each charge only focused on the individual complainant’s alleged personal disparate treatment. The court also found that the plaintiffs were not entitled to equitable tolling as they did not exercise reasonable diligence in obtaining essential information bearing on their claim. Accordingly, the court dismissed the entire complaint with prejudice, finding no need to address the other bases for dismissal or the center’s request to strike the class action allegations. 

Lawsuit Against Insurance Broker Dismissed

In a case where we represented an insurance broker, a Federal District Judge from the Southern District of West Virginia granted our motion to dismiss and dismissed the suit in its entirety. The plaintiff was a women’s fashion and accessory boutique. The suit arose from a dispute over the plaintiff’s insurance coverage for damages it sustained while being ordered to close by West Virginia’s COVID-19-related orders. The insurance carrier filed a motion to dismiss, and, thereafter, the plaintiff voluntarily dismissed the carrier. The broker filed a motion to dismiss all of the claims plead against it, including bad faith, West Virginia’s Unfair Trade Practices Act, estoppel and breach of fiduciary duty. The court dismissed the counts of bad faith and Unfair Trade Practices Act, finding that the plaintiff failed to provide sufficient allegations to support such claims. The court further explained that the plaintiff alleged very few facts specific to the broker and that the allegations plead did not support any unreasonable conduct by the broker, which is required to establish bad faith or deception. For similar reasons, the court held that the plaintiff’s estoppel claim failed. The plaintiff alleged the broker advised that they would have coverage as a result of the COVID-19 orders. The court found that the plaintiff failed to allege how it relied on those representations or how that reliance was detrimental. The alleged representations occurred months after the plaintiff accepted the policy and did not appear to have any impact on the plaintiff’s request for payments from its insurance carrier. Finally, the court explained that the plaintiff failed to identify any West Virginia authority to establish a breach of fiduciary duty against the broker. Regardless, the court found that the plaintiff failed to allege that it requested specific coverage before the broker procured the policy.

Thought Leadership

Legal Updates for Real Estate E&O Liability

Protecting Real Estate Professionals with Renewed Strength and Expanded Reach

November 1, 2025

We are excited to announce the reinvigoration of our Real Estate Professional Liability defense team, servicing clients in eight states including Delaware, Florida, Maryland, New Jersey, New York, Ohio, Pennsylvania and West Virginia. Our Real Estate E&O Liability Practice Group represents real estate professionals and related service providers in high-stakes civil litigation across a wide range of claims. We have extensive experience defending real estate brokers, agents, and REALTORS® against malpractice and breach of duty allegations stemming from residential and commercial transactions, as well as those who play critical roles in facilitating these transactions, including title agents, abstractors, surveyors, mortgage brokers, appraisers, home inspectors and title insurance companies.  Our attorneys understand the complexities of real estate law and the nuances of professional standards in each of the jurisdictions in which we practice, allowing us to craft targeted defenses that protect our clients’ reputations and livelihoods. We are creative, proactive and strategic, working closely with our clients and their insurers to craft a formidable defense, often helping to resolve matters through negotiation or early motion practice pre-suit. When litigation is unavoidable, we bring deep courtroom experience and an unwavering commitment to defending our clients through trial and appeal, if necessary. We know that for professionals involved in real estate, litigation can be both financially and professionally disruptive. That’s why we prioritize efficient case management, cost-effective strategies and clear communication throughout the life of a case. Our goal is always to protect our clients’ interests while minimizing the impact on their business operations and professional standing. With a team that blends deep legal knowledge and real-world insight into the real estate industry, we are trusted counsel to professionals facing complex and often emotionally-charged disputes. Whether the matter involves a multimillion-dollar commercial deal or a single-family home transaction, our attorneys bring the same level of dedication and attention to detail. We are proud to be a reliable defense partner for real estate professionals and the businesses that support them. When your work is under scrutiny, you need a legal team that understands the stakes—and how to win.  Legal Update for Real Estate E&O – November 2025, is prepared by Marshall Dennehey to provide information on recent legal developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. We would be pleased to provide such legal assistance as you require on these and other subjects when called upon. ATTORNEY ADVERTISING pursuant to New York RPC 7.1 Copyright © 2025 Marshall Dennehey, all rights reserved. No part of this publication may be reprinted without the express written permission of our firm. For reprints or inquiries, or if you wish to be removed from this mailing list, contact tamontemuro@mdwcg.com.

Lessons from Accountant's Age Discrimination Suit

March 1, 2024

A recent employment law case in Pennsylvania reinforces the necessity for employers to base all employment decisions on legitimate, non-discriminatory business reasons. Further, the employer's decision-makers should be able to clearly articulate the rationale supporting such decisions. In a perfect world, contemporaneous documentation would be available to assist the defense. In Rodrock v. Public Utility Commission, an accountant's claims of age discrimination failed because there was no evidence to support that his employer's decision not to promote him was based on his age.

Firm Highlights

Result

No-Cause Jury Verdict Secured in Wrongful Death Trial

We successfully obtained a no-cause jury verdict in a 13-day wrongful death trial. The decedent, a 59-year-old man, was admitted to the emergency room on February 15, 2019, with complaints of abdominal pain, decreased appetite, and constipation, despite the use of laxatives. The patient did not complain of any nausea, vomiting, or diarrhea. He had a significant medical history including diabetes, hypertension, prior coronary artery stenting, morbid obesity (with past gastric bypass surgery), longstanding ventral hernia, and back pain. A CT scan revealed multiple hernias and a potential closed-loop bowel obstruction, leading to a surgery consultation. Our client, an emergency general surgeon, interpreted that the patient did not have a closed loop or any significant obstruction and recommended non-surgical management. The patient was approved to have clear liquids, and had a vomiting incident shortly after, but our client was not notified. The patient was returned to NPO status, and after improving overnight, he was returned to “clears” and additional medical and renal consults were ordered. Our client did not receive any communications from the residents/nurses of any changes in the patient’s condition. On February 18, 2019, two rapid responses were called due to increased heart rate and vomiting. It is believed that the vomiting resulted in aspiration, causing sepsis, ultimately leading to the patient’s death. During the trial, the plaintiff’s sole medical expert highlighted imaging on the wrong hernia, which called into question all of his opinions in the case. We made key objections related to the expert testimony, limiting what the allegations were, and preventing new allegations from being made. After approximately two and a half hours of deliberating, the jury returned a no-cause verdict. 

Thought Leadership

SIDEBAR: News and Happenings

We are pleased to share that attorneys from our health care team have been selected to the 2026  New Jersey and Pennsylvania Super Lawyers and Rising Stars lists. Their dedication to clients and commitment to high-quality work continues to strengthen our firm! Please join us in congratulating: NJ Super Lawyers: Robert T. Evers and Justin F. Johnson NJ Super Lawyer Rising Stars: Nataliana A. Guida  2026 Pennsylvania Super Lawyers: Alyson J. Kirleis and Gary M. Samms 2026 Pennsylvania Rising Stars: Holli K. Archer and Daniel Dolente Victoria Scanlon (Scranton) was a faculty presenter at the 2026 American Roentgen Ray Society (ARRS) Annual Meeting in Pittsburgh. She participated in the “Resident Symposium: Producing Quality Reports,” focusing her presentation on “How to Write a Great Report: Malpractice Lawyer’s Perspective.” Vicky, the only attorney presenter for this two-hour segment, was joined by several health care professionals including diagnostic radiologists, an interventional radiologist, an internal medicine physician, and a radiologist turned AI entrepreneur expert.  Matthew Keris (Scranton), President of the Pennsylvania Association for Health Care Risk Management (PAHCRM) and shareholder in our Scranton Health Care Department, presented an important and timely session titled “Keynote Address: A Conversation with RaDonda Vaught on Criminalizing Errors” at PAHCRM’s Annual Meeting in April. RaDonda is a former Tennessee nurse widely known for being criminally convicted in 2022 of negligent homicide and gross neglect after a 2017 fatal medication error at Vanderbilt University Medical Center. Her case gained national attention because she was criminally prosecuted rather than just facing licensing board action, sparking debate over blaming individual nurses for systemic healthcare failures. Matt and RaDonda’s conversation explored one of the most consequential issues in health care risk management today—how systems respond to human error, and what it means for patient safety, accountability, and the professionals who serve on the front lines. Gary Samms was a panelist for a podcast hosted by the Medical Liability Monitor, “From Outliers to Pattern: The Increasing Predictability of Megaverdicts in the Med-Mal Industry – and How to Reduce the Likelihood of Getting Hit with One.” Gary discussed the changing megaverdict landscape and why “outlier” verdicts are becoming structural, in addition to how plaintiffs turn weaknesses into megaverdicts (including building emotional narrative and jury psychology). Thank you to our clients who joined us for our Trends in Health Care & Health Law seminar on May 14. Led by our Health Care Department Director and Assistant Director, Robin Snyder and Donna Modestine, the session explored key issues that are currently shaping outcomes in health care litigation. We owe a debt of gratitude to our esteemed guest speaker, Mary Ellen Nepps, Esq., Senior Counsel, University of Pennsylvania, who presented “Medical Malpractice Litigation: Driving Another Health Care Crisis in Pennsylvania.” And special thanks to our attorneys who presented and shared their insights, including John J. Hare and Holli Archer who discussed “Highlights in PA Medical Malpractice Law;” David Drake for his presentation, “From Claims to Courtroom: Key Trends in NJ Medical Malpractice Litigation;” and Matthew Keris with an “Update on Health Care Tech Discovery.” Thank you to all of our clients for entrusting us with your health care litigation. We are proud to partner with you as we defend your interests and navigate legal landscapes together.

Thought Leadership

Casual Care, Serious Consequences: How Informal Prescribing Can Trigger Medical Board Scrutiny

The lesson for health care practitioners is that regular review of the regulatory requirements can ensure compliance and that casual prescribing may be in violation of state regulations if the necessary components are not met. Consider the following scenario: in December 2025, a medical provider renewed a prescription for a long-standing telemedicine patient receiving a Schedule II controlled dangerous substance. This was not a violation of the New Jersey Administrative Code. Another provider doing the same action for an equally situated patient in March 2026 would be in violation. The casual prescriber who is not aware of newer regulatory requirements may have a more difficult time responding to a medical board complaint. Medicine is a highly-regulated helping profession. Without addressing the merits of this regulatory burden, the practice of medicine continues to see drastic changes impacting the everyday life of patient and provider. Telemedicine, COVID-19, and other advances and roadblocks, present a challenge to those saving lives while attempting to comply with the rules of practice. Physicians often discover—through real cases and the lens of regulatory expectations—that even well-intentioned informal help can be reinterpreted as stepping outside mandated professional boundaries, and seemingly harmless actions can be construed as deviations from required practice standards specifically outlined in Title 13, Chapter 35, Subchapters 7.1A of the New Jersey Administrative Code. Title 45, "Professions and Occupations," of the New Jersey code governs the practice of medicine, nursing, optometry, pharmacy, and many other professional occupations. Section 9 specifically addresses the state board of medical examiners and allows for the creation of rules and regulations in Section 45:9-5.3. These regulations can be found in the New Jersey Administrative Code Title 13, Chapter 35. While broad in scope, Chapter 35 contains a subchapter dedicated to the administration and dispensing of prescription drugs. Such knowledge will arm physicians with the tools they need to prevent a negative outcome if a medical board complaint is filed. Likewise, attorneys must be familiar with these regulatory requirements when advising and defending providers. In New Jersey, N.J.A.C. Section 13:35-7.1A(a) requires that a practitioner conduct an examination and appropriately document the same within the medical record before dispensing drugs or issuing prescriptions. The examination must include an "appropriate history and physical examination," a diagnosis based upon the examination and any testing consistent with good medical care, the formulation of a therapeutic plan discussed with the patient, and the availability of appropriate follow-up care. There are only six exceptions to this requirement: In admission orders for a newly hospitalized patient For a patient of another physician for whom the practitioner is taking calls For continuation medications on a short-term basis for a new patient prior to the patient's first appointment For an established patient who, based on sound medical practice, the physician believes does not require a new examination before issuing a new prescription For a patient examined by a healthcare professional who is in collaborative practice with the practitioner When treatment is provided by a practitioner for an emergency medical condition Emergencies are also limited to situations where someone's health is in serious jeopardy, there is serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. During the COVID-19 pandemic, then New Jersey Governor Phil Murphy issued an executive order declaring a public health emergency and a state of emergency that allowed authorized prescribers to prescribe Schedule II controlled dangerous substances via telemedicine. The order was terminated when he left office earlier this year and the state reverted to the requirement of an initial in-person examination and quarterly in-person visits. With this return to prior regulatory requirements, practitioners subject to the jurisdiction of the board of medical examiners may benefit from a refresher on the regulatory limitations on their practice now that the pandemic-era flexibilities have ended. This new requirement may create confusion for prescribers and lead to casual prescribing of medication in violation of the regulations, even in the setting of recurrent telemedicine appointments as noted in the example above. Casual prescribing can take many forms: filling a prescription request from a friend or family member without an examination or contemporary medical record; using telemedicine to expand your practice without proper in-person appointments or documentation in the medical record; failing to ensure appropriate follow-up care for a "one time" prescription; etc. Although not all board complaints end in a publicly available opinion, serious deviations from regulatory requirements can shine a light on practices that will require action by the board if a complaint is received. Consider the following cases: In October 2025, the board issued a final consent order in an administrative action where a doctor provided opioids without examination and his license was permanently revoked. In re Robert Dela Gente, D.O., N.J. State Bd. of Med. Exam'rs Oct. 21, 2025. Criminal charges were filed (though that is not always the case). In a September 2025 consent order, a physician was reprimanded for "prescribing opioids several months in advance without the proper patient follow-up..." and explained that they did so for "patients who can not pay for multiple visits to refill medications." In re A/an E. Schultz, M.D., N.J. State Bd. of Med. Exam'rs Sept. 25, 2025. Another physician was suspended and placed on probation in a consent order for prescribing three patients the weight-loss medication "Ozempic" via text messages through a website called "Push Health" and without any further communication with the patients or taking a medical history. In re Laura E. Purdy, M.D., N.J. State Bd. of Med. Exam'rs Aug. 29, 2025. A June 2025 interim consent order required a "full evaluation and assessment of [a physician's] general knowledge and skill, with specific emphasis on his knowledge of and ability to safely prescribe [controlled dangerous substances]" due to his failure to review a patient's prior medical history and medical record, assess and review the prescription monitoring program before prescribing CDS, and conduct random urine screens on a patient that tested positive for CDS upon admission to his practice because "he trusted the patient." In re Donald Oh, M.D., N.J. State Bd. of Med. Exam'rs June 2, 2025. Each of these examples demonstrate a failure to follow strict procedure regardless of the intention. Failing to follow procedure secondary to good intentions, such as considering a patient's financial constraints, trust in the patient, or utilizing a new telemedicine service platform, will not be a defense to a board complaint. Especially when practicing via telemedicine, practitioners must ensure they are adhering to the appropriate regulatory standard. A provider who calls in a prescription for a traveling friend or family member or agrees to prescribe medication for individuals using the newest phone app will have a hard time meeting the requirements of N.J.A.C. Section 13:35-7.1A. Even if a history was taken, a "therapeutic plan" was created, and "follow up care" was provided, the prescriber would still not be in compliance with the regulation without an in-person examination. In our opening hypothetical, the prescriber's behavior did not change between December and March; however, the legal shift in the regulatory landscape made once acceptable behavior a violation as a required examination did not occur. When complaints are made with regard to informal prescribing, the board has discretion to employ measures to encourage compliance in lieu of formal proceedings such as a private, written warning; suspending fines subject to continuing compliance; medical or professional treatment as may be necessary; medical or diagnostic testing and monitoring; skills assessment; corrective training; participation in outreach programming; or contribution to the consumer fraud protection fund. The lesson for health care practitioners is that regular review of the regulatory requirements can ensure compliance and that casual prescribing may be in violation of state regulations if the necessary components are not met. Even compliant providers who had not conducted an in-person examination for telemedicine patients during the COVID-19 emergency would be in violation of the regulations as of January 2026 for the same practice. Practitioners should be diligent in adhering to the prescribing rules to avoid sanctions related to casual care. Likewise, attorneys advising or defending practitioners before the board must be aware of the in-person examination requirements for prescribing in New Jersey whether the care in question took place in-person or in a telemedicine setting. Reprinted with permission from the April 22, 2026 issue of the New Jersey Law Journal. ©2026 ALM Media Properties, LLC. Further duplication without permission is prohibited. All rights reserved.