Officially, the Washington State Supreme Court got rid of the locality rule many years ago, but practically, it still exists. The locality rule was a rule that determined that the standard of care would be different for small, rural medical facilities than it would be for bigger, urban facilities with more information and resources. In other words, a doctor or nurse working in Seattle, Washington (population over 700,000) would be held to a higher degree of skill and learning than an equivalent doctor or nurse in Pomeroy, Washington (population less than 2,000).

In 1967, the Washington State Supreme Court abolished the locality rule. By that time JAMA and other medical journals were regularly mailed to rural areas and televised and tape recorded medical presentations were widely available. There was no reason a doctor in a remote area would be less informed than an urban doctor. Of course, with the invention of the internet this is even more the case, with every major medical journal now being published online.

But even though the locality rule was abolished, there’s still an understanding that rural hospitals might have to make different decisions than hospitals with a larger population. When a hospital is caring for a smaller population, they need less specialty equipment for rare scenarios. They might not even have a surgeon on staff. It will often be more economical for a small hospital to triage and transfer patients with serious or unusual conditions. 

Because of this difference in access, a jury will still consider the environment of the doctor in their decision-making process, even though the locality rule was abolished and doctors are expected to be equally proficient state-wide. A jury in a small county might also be more likely to feel a personal connection to a healthcare facility that committed malpractice in their county, which could lead to the jury being more lenient on that facility. 

So although the locality rule was abolished, it still needs to be considered.

If you want to learn more about the locality rule you can read our attorney Carl-Erich Kruse’s article on the subject, as it was published in the May 2023 edition of the Washington State Association for Justice’s Trial News.