The Pennsylvania Superior Court, in a 2006 ruling, held that a nurse was qualified to offer expert testimony in Freed v. Geisinger Medical Ctr, 607 Pa. 225, 5 A.3d 212 (2010).

The Pennsylvania Supreme Court considered Freed in June of 2009 and the question of whether a nurse may provide expert testimony on the issue of medical causation. The Superior Court in its opinion took great care to distinguish the facts of Freed from Flanagan v. Labe, 690 A.2d 183 (Pa. 1997), which held that nurses are prohibited from making medical diagnoses on the basis of the Professional Nursing Law, after consideration of the merits of stare decisis, the Supreme Court went right at Flanagan and overturned its prior ruling.

In September of 2010, The Pennsylvania Supreme Court reaffirmed its earlier ruling which overruled Flanagan. The Court determined that the issue of whether Flanagan should be overruled had not been waived by the plaintiff when a chief issue before the Superior Court was whether Flanagan could be distinguished from the instant case. Furthermore, the Supreme Court is not prevented from sua sponte overruling an incorrect decision.

On the question of whether it was proper to overrule Flanagan, the Court held that the defendant had presented no new arguments. Accordingly, the Court reaffirmed its prior decision.