From the blog of medical expert witness Dr. Barry E. Gustin, MD, MPH, FAAEP:
Locality Rules and Qualifying Medical Experts
Where do these rules come from and why are they important? Many years ago, there truly was a disparity between the levels of medical care rendered in rural areas versus urban areas. Full-service hospitals were always located in large cities. Physicians and clinics in rural areas had limited facilities, and house calls were common. Standards of medical practice were different for each circumstance. The basic idea was that it would not be proper to hold a rural physician to the same standard as an urban physician. Medical organizations were concerned that if a rural practitioner were held to a higher standard in an environment that could not support those higher standards, physicians would avoid practicing medicine in rural areas. Also, in those days, there was no uniformity in training and there were no standardized board exams. For certain, urban physicians had better training and support than rural physicians.
Consequently, the legal standard, known as the “locality rule” came into being which stated that the degree of skill and knowledge of physicians varied widely by geography and demographics. The earliest application of the locality rule came in the late 19th century when a court ruled that the standard of care for a physician ought to be measured against others in the area where the physician practiced.