Civil Litigation FLASHPOINTS November 2022

Casey McClaren, Katten Muchin Rosenman LLP, Chicago
312-902-5200 | E-mail Casey McClaren

Allen v. Missouri Baptist Medical Center: Fifth District Appellate Court Clarifies Standard for Exercising Specific Personal Jurisdiction Over Nonresident Healthcare Provider

In Allen v. Missouri Baptist Medical Center, 2022 IL App (5th) 210263, the Fifth District Appellate Court clarified the standard for exercising specific personal jurisdiction over a nonresident defendant. Specifically, it held that a plaintiff’s unilateral activity in reaching out to an out-of-state healthcare provider, without more evidence, is not sufficient to allow Illinois courts to exercise specific personal jurisdiction over the out-of-state provider.

Facts of the Case and Procedural Background

On September 4, 2018, Richard Wikiera, D.O., performed a gallbladder surgery on Barbara Sisson at Anderson Hospital, which is located in Madison County, Illinois. On September 5, 2018, Barbara developed a subsequent complication. To address the issue, Dr. Wikiera contacted a physician who specializes in gastroenterology and internal medicine and has privileges at Missouri Baptist Medical Center. Barbara was subsequently transferred to Missouri Baptist, where she underwent another surgery and received additional care. Barbara continued to decline, however, and on September 26, 2018, she died. Both the decedent and her husband were residents of Illinois at all times relevant to the lawsuit.

Richard Allen served as the personal representative and executor of Barbara’s estate. On September 4, 2020, he filed a complaint against several physicians, healthcare groups, and hospitals, including Missouri Baptist, alleging medical negligence and wrongful death. Missouri Baptist filed a motion to dismiss for lack of personal jurisdiction. However, the circuit court denied the motion to dismiss because it found that “sufficient minimum contacts occurred with the State of Illinois [to] make[ ] specific jurisdiction over this matter appropriate.” 2022 IL App (5th) 210263 at ¶10. A timely appeal followed.

Because neither party asserted that the Illinois courts have general personal jurisdiction over Missouri Baptist, the court limited its analysis to whether specific personal jurisdiction existed over this matter. The court first discussed the Illinois long-arm statute that could provide a basis for specific personal jurisdiction. It then went on to determine whether the facts of this case met the statutory due-process standard. Although the court concluded that the due-process standard was not met, it also noted in the alternative that the nonresident defendant’s activities that the plaintiff deemed relevant to personal jurisdiction were not the proximate cause of the plaintiff’s injuries. Finally, the court’s analysis concluded by providing an example of a case in which it appropriately exercised personal jurisdiction over a nonresident healthcare provider.

Analysis of Illinois Long-Arm Statute

The court’s analysis began with a discussion of subsection (c) of the Illinois long-arm statute, 735 ILCS 5/2-209(c), which both parties agree determines whether the court may exercise personal jurisdiction over Missouri Baptist in this matter. The “catch-all” provision in subsection (c) allows Illinois courts to “exercise jurisdiction on any other basis now or hereafter permitted by the Illinois Constitution and the Constitution of the United States.” 2022 IL App (5th) 210263 at ¶15. As a result, the court then turned to an analysis of whether Missouri Baptist’s conduct, as the nonresident defendant, was “sufficient to satisfy federal and Illinois due process.” Id., quoting Russell v. SNFA, 2013 IL 113909, ¶30, 987 N.E.2d 778, 370 Ill.Dec. 12.

Analysis of Due-Process Standard

To determine whether exercising specific personal jurisdiction satisfies federal and state due-process standards, the burden is on the plaintiff to establish a prima facie basis for personal jurisdiction. 2022 IL App (5th) 210263 at ¶15. To do so, a plaintiff must demonstrate that the nonresident defendant “purposefully directed its activities at the forum state and the cause of action arose out of or relates to the [nonresident] defendant’s contacts with the forum state.” Id., quoting Linder v. A.W. Chesterton Co., 2020 IL App (5th) 200101, ¶11, 171 N.E.3d 930, 446 Ill.Dec. 825. In this case, the plaintiff alleged in his complaint that Missouri Baptist purposely directed its activities to Illinois facilities and patients when “it agreed to a request by the Illinois defendants to accept [Barbara] as a patient.” 2022 IL App (5th) 210263 at ¶16. Moreover, the plaintiff alleged that Missouri Baptist was “engaged in the business of providing medical care and accepting referrals of patients in Madison County, Illinois, by and through its officers, agents, employees, and representatives.” Id. The plaintiff did not allege any other contacts with Illinois, proffer any affidavits or related supplemental evidence, nor request to conduct limited discovery on the jurisdictional issue. Id.

The court noted that in Burger King Corp. v. Rudzewicz, 471 U.S. 462, 85 L.Ed.2d 528, 105 S.Ct. 2174 (1985), the United States Supreme Court stated that a “potential nonresident defendant should be able to ‘reasonably anticipate’ being drawn into litigation in the foreign forum” (Russell, supra, 2013 IL 113909 at ¶42) and that “[t]he unilateral activity of those who claim some relationship with a nonresident defendant cannot satisfy the requirement of contact with the forum State” (Burger King, supra, 105 S.Ct. at 2183). 2022 IL App (5th) 210263 at ¶17. Additionally, a showing that the nonresident defendant “purposefully avail[ed] itself of the privilege of conducting activities within the forum State, thus invoking the benefits and protections of its laws,” is required to prevent a nonresident defendant from being “haled into a jurisdiction based on random or attenuated contacts” with the forum state. Id.

Thus, the court examined Illinois precedent to determine whether Missouri Baptist’s alleged acts — routinely accepting patients from Illinois and accepting Barbara’s transfer — constituted minimum contacts with Illinois that could give rise to specific personal jurisdiction. The court found that the plaintiff failed to meet his required prima facie showing. In general, the court found that the cases summarized below lead to a holding that “where a patient initiates contact with an out-of-state facility, which does not have offices or conduct services within Illinois, personal jurisdiction generally will not exist without further contacts or activities by the out-of-state defendant with Illinois.” 2022 IL App (5th) 210263 at ¶22.

First, in Muffo v. Forsyth, 37 Ill.App.3d 6, 345 N.E.2d 149, 152 (5th Dist. 1976), the court established that when an Illinois resident “seeks out treatment from a nonresident provider,” the fact that the Illinois resident “ ‘would likely fill’ the provider’s prescription in Illinois” did not give rise to personal jurisdiction over the nonresident. 2022 IL App (5th) 210263 at ¶18. In that case, the court reasoned that the Illinois resident was “the motivating force for the relationship” and should accordingly be required to “return to Missouri to prosecute any actions arising out of that treatment” given that he sought treatment in Missouri. 2022 IL App (5th) 210263 at ¶18, quoting Muffo, supra, 345 N.E.2d at 152.

Second, Ballard v. Fred E. Rawlins, M.D. Inc., 101 Ill.App.3d 601, 428 N.E.2d 532, 535, 56 Ill.Dec. 940 (5th Dist. 1981), and Veeninga v. Alt, 111 Ill.App.3d 775, 444 N.E.2d 780, 782, 67 Ill.Dec. 544 (1st Dist. 1982), each built on the reasoning in Muffo. Involving similar facts, both cases held that exercising personal jurisdiction is not appropriate when a nonresident provider asked an Illinois resident for the name of a pharmacy near where the Illinois resident lived and called in a prescription to that pharmacy. The “unilateral activity” of the Illinois resident “ ‘seeking and obtaining medical services outside of Illinois’ led to the alleged damages” and so “the nonresident provider ‘was not amenable to the jurisdiction of Illinois courts.’ ” Allen, supra, 2022 IL App (5th) 210263 at ¶18, quoting Veeninga, supra, 444 N.E.2d at 782.

Third, in Unterreiner v. Pernikoff, 2011 IL App (5th) 110006, 961 N.E.2d 1, 356 Ill.Dec. 167, the plaintiff traveled to Missouri for medical appointments. 2022 IL App (5th) 210263 at ¶20. The provider subsequently phoned the plaintiff at her home in Illinois to follow up regarding the results of her bloodwork. Id. The court found that personal jurisdiction “could not rest on a phone conversation” when the plaintiff “unilaterally sought out the defendants and traveled to Missouri to receive treatment.” Id.

Fourth, in Sabados v. Planned Parenthood of Greater Indiana, 378 Ill.App.3d 243, 882 N.E.2d 121, 128, 317 Ill.Dec. 547 (1st Dist. 2007), the healthcare provider’s telephone book advertisements in Illinois were “mere solicitation” and did not constitute minimum contacts required for personal jurisdiction. 2022 IL App (5th) 210263 at ¶21.

In this case, the court found that Barbara’s transfer to Missouri Baptist constituted unilateral activity that was analogous to the cited precedent. It determined that her physician-initiated “transfer” was legally indistinguishable from a patient traveling on her own to an out-of-state healthcare provider, given that in each case, the patient (whether on her own or via her physician acting on her behalf) “reached out into the out-of-state forum for treatment.” 2022 IL App (5th) 210263 at ¶23. The court also noted that Missouri Baptist did not come into Illinois but rather required that Barbara come to Missouri for treatment. Id.

Analysis of Causation Standard for Specific Personal Jurisdiction

Even though the court found that Missouri Baptist had not established minimum contacts with Illinois such that it could be subjected to personal jurisdiction in the Illinois courts, the court went on to reiterate that even when a nonresident defendant establishes minimum contacts with the forum state, “specific jurisdiction can be exercised with due process only where the defendant’s activities in the state ‘give rise to the liabilities sued on.’ ” 2022 IL App (5th) 210263 at ¶24. The plaintiff submitted a “but-for” theory of causation, arguing that but for Missouri Baptist’s acceptance of Barbara’s transfer to their facility, the harm never would have occurred. The court, though, explained that but-for causation is insufficient to meet due-process requirements and that instead “due process demands something like a ‘proximate cause’ nexus.” 2022 IL App (5th) 210263 at ¶25, citing Harlow v. Children’s Hospital, 432 F.3d 50, 61 (1st Cir. 2005). As a result, the “subsequent alleged medical negligence of a heath care provider, without more, does not ‘arise out of’ the acceptance or transfer of a patient.” 2022 IL App (5th) 210263 at ¶26. Although a patient’s transfer might meet the but-for causation standard, it alone cannot be the proximate cause of medical negligence.

The court also specifically noted that the plaintiff and circuit court improperly used the allegation that Missouri Baptist routinely accepted Illinois patients as a basis for specific jurisdiction. Although the “number of patients a health care facility sees could be evidence of business activity within a state” to the extent that a plaintiff might argue that the facility is “ ‘at home’ for purposes of general jurisdiction,” such activity is not relevant to an inquiry into specific jurisdiction unless “it demonstrates activity that would be directed at Illinois residents or the injured party or that the defendant is availing itself of Illinois laws or protections.” 2022 IL App (5th) 210263 at ¶27.

Analysis of Kostal v. Pinkus Dermatopathology Laboratory, P.C.

The court concluded its legal analysis by providing an example of a case in which it exercised specific personal jurisdiction over a nonresident healthcare provider defendant. In Kostal v. Pinkus Dermatopathology Laboratory, P.C., 357 Ill.App.3d 381, 827 N.E.2d 1031, 293 Ill.Dec. 150 (1st Dist. 2005), the defendant was a “national diagnostic lab company based in Michigan, whose physicians provided diagnostic services in Michigan through the mail to Illinois patients.” 2022 IL App (5th) 210263 at ¶28. In Kostal, the provided services were “fundamentally interstate in nature from the inception of the relationship.” Id.

Special Concurrence

Judge Cates wrote a special concurrence, agreeing with the majority that the plaintiff failed to meet its burden of making a prima facie showing of a basis for specific personal jurisdiction but disagreeing with some of the majority’s reasoning. She first observed that the facts went underdeveloped in this case and that additional investigation into Missouri Baptist’s contacts with Illinois might have established more precise facts that would have allowed the court to exercise personal jurisdiction. Because of the lack of jurisdictional facts, Judge Cates disagreed with the majority that the court could draw comparisons between the cited precedent and the case at bar. Judge Cates stated that “[i]t is like trying to compare an open box, with its contents displayed, and a closed container, sealed with conclusory allegations,” which is a meaningful distinction given the fact-specific nature of the personal jurisdiction inquiry. 2022 IL App (5th) 210263 at ¶45.

Implications of the Decision

This decision has important implications for future cases involving out-of-state healthcare providers, which are likely to continue to come before Illinois courts. Both the majority opinion and the special concurrence note the rapid change in the delivery of healthcare services in the past several years, as more and more virtual healthcare services are being offered via telemedicine and the web. 2022 IL App (5th) 210263 at ¶¶30, 48. Furthermore, healthcare providers are consolidating and becoming larger and more regional. 2022 IL App (5th) 210263 at ¶30. The majority opinion reiterates that “each case where the issue of personal jurisdiction arises, especially in the context of medical services, must be decided upon its own facts.” Id. However, there are some lessons in this opinion that for future cases.

Parties in cases involving out-of-state providers should take notice of the court’s emphasis on the need for specific facts to show a prima facie case of specific personal jurisdiction and the apparent need to investigate or conduct limited discovery on the jurisdictional issue. Plaintiffs cannot rely on conclusory allegations regarding the nonresident defendant’s conduct. Parties should also note the need to connect the defendant’s alleged actions to the harm the plaintiff suffered to establish proximate causation and thereby meet the due-process standard for finding personal jurisdiction. Finally, parties should take note of the court’s focus in Kostal on specific and systemic ways that the nonresident defendant affirmatively reached into the forum state to establish personal jurisdiction and demonstrate that the due-process standard was met.

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