954 F.3d 328
1st Cir.2020Background
- eClinicalWorks (ECW) provides electronic-health-record (EHR) software used by many providers; plaintiffs are the estates of two patients (Tot and Monachelli) whose ECW records allegedly contained errors.
- Monachelli’s treating physician ordered an MRA that did not appear on the relevant ECW screen; she never received the test, her aneurysm went undiagnosed, and she later died. Tot discovered inaccuracies before his death.
- The estates allege ECW’s system had pervasive bugs, that ECW hid those defects from regulators to obtain certification, and that accurate disclosure would have reduced adoption; they assert state common-law claims and seek class relief for millions of affected patients.
- The district court dismissed the amended complaint for lack of Article III standing under Fed. R. Civ. P. 12(b)(1); the First Circuit reviewed that dismissal de novo.
- The estates principally claimed two injuries: (1) a risk of misdiagnosis/mistreatment from faulty records and (2) future out-of-pocket costs to find/fix errors; they also argued an "informational injury" from being denied accurate records, but did not invoke any statute that creates a private right to accurate EHRs.
- The First Circuit held the estates lacked a cognizable Article III injury: the alleged risks were not "imminent" for the deceased patients, and the plaintiffs identified no statutory or traditional common-law informational right that would make inaccurate records alone a concrete injury.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Article III standing: injury-in-fact | Estates: inaccurate EHRs caused an informational injury and posed an imminent risk of misdiagnosis; mitigation costs to fix records are concrete injuries | ECW: plaintiffs (estates of deceased patients) faced no imminent risk; alleged costs are manufactured and non-imminent; no statutory right to accurate EHRs | Court: No standing — injuries were not imminent for the decedents and plaintiffs identified no statutory/common-law right making mere inaccuracy a concrete injury. |
| Informational injury doctrine (Akins/Public Citizen line) | Estates: denial of accurate information is a recognized injury analogous to cases where statutes required disclosure | ECW: those precedents rest on statutory disclosure rights or Congress elevating intangible harms; here no such statute grants a private right | Court: The informational-injury precedents require a statutory or established common-law right; estates point to none, so informational theory fails. |
| Reliance on Spokeo/related decisions to identify intangible harms | Estates: analogous cases (data-breach and false-reporting cases) show intangible risks can suffice where statute protects the interest | ECW: those cases rely on statutory schemes that create or identify the concrete interest; here plaintiffs admit no statutory claim | Court: Spokeo permits statutory creation of intangible injuries; absent such a statute or a long-recognized common-law right, plaintiffs’ asserted intangible harms are insufficient. |
| Common-law torts/fiduciary theory as basis for standing | Estates: assert traditional common-law claims (e.g., breach of fiduciary duty) arising from compromised records | ECW: common-law claims still require actual harm causally linked to defendant; mere inaccurate records without real-world harm is insufficient | Court: Common-law claims may furnish standing only when they seek redress for harms traditionally cognizable; plaintiffs did not allege the requisite real-world harm, so standing fails. |
Key Cases Cited
- Steel Co. v. Citizens for a Better Env't, 523 U.S. 83 (1998) (Article III requires a concrete case or controversy)
- Spokeo, Inc. v. Robins, 136 S. Ct. 1540 (2016) (concrete injury requirement; statutes can elevate intangible harms)
- Lujan v. Defenders of Wildlife, 504 U.S. 555 (1992) (standing requires injury, causation, redressability)
- Fed. Election Comm'n v. Akins, 524 U.S. 11 (1998) (failure to obtain statutorily required information can constitute injury)
- Clapper v. Amnesty Int'l USA, 568 U.S. 398 (2013) (threatened injury must be certainly impending or imminent)
- Katz v. Pershing, LLC, 672 F.3d 64 (1st Cir. 2012) (standing doctrine and informational injuries under common law)
- Robins v. Spokeo, Inc., 867 F.3d 1108 (9th Cir. 2017) (FCRA and dissemination of false consumer-report information can be a concrete injury)
- In re Horizon Healthcare Servs. Inc. Data Breach Litig., 846 F.3d 625 (3d Cir. 2017) (unauthorized disclosure of private data can constitute cognizable injury)