The state legal systems are quite diverse. Many predate the formation of the United States. The East Coast states derive their law from the English common law, many of the western states were influenced by the Spanish civil law, Louisiana follows the French civil law, and Texas entered the Union as an independent nation with a strong Spanish and Mexican heritage.

Despite the diverse backgrounds, the state court systems tend to follow the three levels of the federal courts. The levels have different names, but the process of starting in a trial court, progressing to an appeals court, and ending up in a state supreme court is common to most of the states. In some cases that involve federal laws or constitutional rights, it is possible to appeal the state supreme court decision directly to the U.S. Supreme Court.

With these exceptions, most litigation is brought directly in the state courts. Even in medical malpractice cases brought in the federal courts, the federal court will apply state law unless the case involves a specific federal statute or a constitutional right. For example, if a Veterans Administration physician working in Maryland is sued for medical malpractice, the case would be brought in federal court because the physician is an employee of the government. The federal court would then apply Maryland’s law to determine if the physician was negligent.

One of the difficulties in this book is that the laws vary greatly among the states. This is most pronounced in laws that govern financial matters and tax, but it extends to some of the laws that affect medical practice. For example, in some states, hypodermic syringes are a prescription item. Possessing them without the requisite prescription violates the state’s drug paraphernalia law. In other states, these same syringes are legal to buy without a prescription and may be possessed without violating the law.