On December 22, 2015, in Pacific Radiation Oncology, LLC, et al v. The Queen's Medical Center, et al, the US Court of Appeals for the Ninth Circuit held that, in order to succeed on a motion for a preliminary injunction or temporary restraining order, a movant must establish a relationship between the injury claimed in the motion and the conduct asserted in the complaint. In so holding, the Ninth Circuit explicitly adopted the rule established by the US Court of Appeals for the Eighth Circuit as well as several other federal circuits (No. 14-17050, (9th Cir. Dec. 22, 2015)).

The plaintiff, Pacific Radiation Oncology (PRO), is a group of physicians specializing in radiation oncology that provided medical services to patients at the defendant hospital, The Queen's Medical Center (QMC), as well as one of the defendant's competitors, The Cancer Center of Hawaii (TCCH). The plaintiff and defendant had a long-standing business relationship in which PRO physicians were permitted to treat patients at QMC if their patients so preferred.

The relationship terminated in 2011 when QMC moved to a 'closed-facility model' that denied hospital privileges to doctors unless they were exclusively employed at QMC. In January 2012, PRO sued QMC alleging numerous claims, including tortious interference with contract, illegal trade practices, and breach of fiduciary duty. After the court granted PRO's motion for preliminary injunction, allowing it to continue treating patients at QMC, QMC brought a counterclaim, alleging PRO physicians unlawfully transferred patients from QMC to its competitor, TCCH.

As part of its counterclaim, QMC subpoenaed TCCH seeking information on a subset of patients who had initial consultations with PRO physicians at QMC but did not return for therapy. However, when filing the certificate of service, QMC accidentally publicly filed the subpoena, including complete lists of patient names and treating physicians. Even though QMC quickly discovered the error and sealed the document, PRO moved for a preliminary injunction seeking to prevent QMC from reviewing the medical records it sought in the subpoena. PRO alleged that QMC's conduct violated the Hawai'i Constitution and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) (42 U.S.C. § 1320d).

The district court denied PRO's motion because the allegations in the motion of improper use of confidential patient information bore no relation to the injuries alleged in the complaint, which revolved around illegal business practices. The district court construed the motion as a discovery dispute, sanctioned QMC with attorneys' fees and costs, and instructed the parties to meet and discuss how QMC could access the medical records it sought, in compliance with HIPAA and the Hawai'i Constitution. PRO appealed the decision.

The Ninth Circuit upheld the district court's denial and agreed with its reasoning.

The Ninth Circuit explicitly adopted the rule that a party moving for a preliminary injunction must establish a relationship between the injury claimed in the motion for injunctive relief and the conduct alleged in the underlying complaint. The panel noted that this approach was in line with Supreme Court precedent (De Beers Consol. Mines v. United States, 325 U.S. 212, 220 (1945) (a preliminary injunction is appropriate when it grants relief of the same nature as that to be finally granted), as well as several circuits, including the Second (Stewart v. U.S. I.N.S., 762 F.2d 193, 198–99 (2nd Cir. 1985)), Fourth (Omega World Travel, Inc. v. Trans World Airlines, 111 F.3d 14, 16 (4th Cir. 1997)), Sixth (Colvin v. Caruso, 605 F.3d 282, 299-300 (6th Cir. 2010)), Eighth (Devose v. Herrington, 42 F.3d 470, 471 (8th Cir. 1994)) and Tenth (Little v. Jones, 607 F.3d 1245, 1251 (10th Cir. 2010)). The panel was especially influenced by the Eight Circuit's Devose decision, noting that district courts in the Ninth Circuit have already abided the rule of Devose.

Applying the rule in the present action, the court found that PRO's motion for injunctive relief based on QMC's alleged HIPAA violations bore no nexus to the unfair competition and due process claims alleged in the complaint. PRO was unable to articulate a nexus between the two sets of claims or point to any conduct described in the complaint that implicated patient privacy.

Practitioners in the Ninth Circuit should be aware that in order to successfully obtain injunctive relief, the movant has the burden of showing that the injury claimed in the motion is related to the conduct alleged in the underlying complaint. Without this nexus, a district court lacks jurisdiction to grant injunctive relief.