Holli K. Archer

Pennsylvania’s medical malpractice landscape has undergone significant changes. In the last two years, courts, litigants, insurers, and health care providers have faced a dramatic rise in nuclear verdicts, evolving juror attitudes, aggressive plaintiff advertising, third-party litigation funding, and increasingly complex procedural challenges. These developments have not only reshaped medical malpractice litigation, but have also intensified concerns about health care access, insurance costs, and Pennsylvania’s legal climate. The Expansion of Liability and the Rise of Nuclear Verdicts One of the most significant trends in medical malpractice litigation is the expansion of liability and the rise of so-called “nuclear verdicts” (generally speaking, personal injury verdicts in excess of $10 million). Nationally, 2025 set the all-time record with 140 nuclear verdicts, including 30 thermonuclear verdicts (above $100 million) and five verdicts exceeding $1 billion. This continued a steady upward trend from 108 nuclear verdicts in 2024 and 91 in 2023. Pennsylvania has exceeded the national trend. From June 2021 to May 2026, the Commonwealth had 42 nuclear verdicts, with 29 occurring in Philadelphia alone. Medical malpractice cases account for 17 of those 42 verdicts. Philadelphia remains the epicenter of large medical malpractice awards, producing 11 of the state’s 17 medical malpractice nuclear verdictss. Other excessive malpractice verdicts have occurred in York, Beaver, Chester, Delaware, and Luzerne counties. Although appellate courts have occasionally reduced excessive awards, the overall trend is concerning. Only five of Pennsylvania’s 42 nuclear verdicts have been reversed or reduced. In medical malpractice cases, notable examples include: Newlin v. Vita Healthcare Group – $19 million verdict overturned. Dawson v. Bayada Home Health Care – $14 million verdict remitted to $8 million. What Is Driving Large Verdicts? Legal analysts increasingly point to the COVID-19 pandemic as a catalyst for changing juror perspectives and expanded liability. The pandemic created what many describe as twin sensitivities: a heightened concern for safety and risk prevention, and increased skepticism toward corporations and institutions. These attitudes align closely with the plaintiff-oriented “reptile” litigation strategy, which aims to generate juror anger by framing a corporate defendant’s alleged actions as a threat to community safety. Another factor frequently cited in discussions about large verdicts is a growing skepticism toward institutions and large organizations. In many cases, jurors may view corporations, hospitals, insurers, and other well-resourced entities as being in a better position to prevent harm and protect the public. As a result, they may hold these organizations to particularly high (and in many cases unrealistic) standards of conduct and accountability. The Impact of Changing Jury Demographics Demographic changes are also influencing litigation outcomes. Millennials represent the largest cohort and may comprise up to 40% of many jury pools. Studies suggest they are the most likely to award large verdicts as they are highly safety-conscious due to experiences such as 9/11, school shootings, and COVID-19, and generally less trusting of large institutions, corporations, and established systems. Equally important is the emergence of what jury consultants describe as “vulnerable jurors” – individuals who have recently experienced significant financial, medical, or personal hardship. The economic and health-related disruptions of the pandemic have expanded this segment of the population. Notably, political affiliation has become a less reliable predictor of defense-oriented verdicts. Jurors at both political extremes may be receptive to plaintiffs’ arguments, particularly when they perceive corporate defendants as part of a powerful establishment. Lawyer Advertising and the Litigation Economy Philadelphia has become one of the most heavily advertised legal markets in the country. According to the 2025-2026 Judicial Hellholes report, plaintiffs’ firms reportedly spent $76.6 million on more than 634,000 advertisements in the region. Billboard, television, radio, and digital marketing campaigns have become nearly unavoidable throughout the metropolitan area. Critics argue that extensive advertising creates a self-reinforcing cycle by: Encouraging potential plaintiffs to pursue claims. Increasing settlement demands. Raising expectations regarding verdict values. Expanding public awareness of litigation opportunities. Consequences for Insurance and Health Care The rise in nuclear verdicts has had substantial financial consequences. As verdict severity rises, liability insurance becomes both more expensive and more difficult to obtain. Insurers increasingly report reduced capacity, higher premiums, and more restrictive underwriting practices. For health care providers already facing workforce shortages, reimbursement pressures and rising operational costs, increased malpractice exposure creates additional strain. The result may ultimately affect patient access to care, particularly in underserved or rural communities. The Legal Marketplace: Workforce Challenges Although the number of lawyers increased dramatically throughout the 20th century, growth has slowed considerably since 2000. Am Law 200 firms have experienced a net loss of litigators in recent years, and trends suggest that demand for experienced trial attorneys may increasingly outpace supply, particularly in high-exposure litigation areas such as medical malpractice defense. Looking Ahead Pennsylvania’s medical malpractice environment is undergoing a profound transformation. Rising nuclear verdicts, evolving juror attitudes, aggressive advertising, and procedural complexities are reshaping the risk landscape for health care providers, insurers, and defense counsel. As courts, legislators, and industry stakeholders consider potential reforms, medical malpractice practitioners must remain vigilant. Success increasingly depends not only on the merits of a case, but also on understanding changing jury behavior, preserving appellate issues, and navigating a legal environment that continues to expand the boundaries of liability.