Hammons v. University of Maryland Medical System Corporation, 551 F.Supp.3d 567

Background

University of Maryland Medical System (UMMS) purchased University of Maryland St. Joseph Medical Center (UMSJ), which operates under Catholic Ethical and Religious Directives that prohibit direct sterilization except to cure/alleviate a present serious pathology when no simpler treatment exists.
Jesse Hammons, a transgender man, was diagnosed with gender dysphoria, met WPATH criteria, and scheduled a medically recommended hysterectomy at UMSJ; the Hospital’s Chief Medical Officer cancelled the operation days before it was to occur, citing the Directives.
Hammons subsequently obtained the hysterectomy elsewhere about six months later and sued UMMS and the Hospital LLCs alleging Establishment Clause and Equal Protection violations under 42 U.S.C. § 1983 (Counts I–II) and a § 1557 ACA sex-discrimination claim (Count III).
Defendants moved to dismiss, arguing lack of standing, that they are private actors (or immune state actors), sovereign immunity bars the § 1983 claims, and that the ACA claim fails as a matter of law.
The court found Hammons had Article III standing, dismissed Counts I and II because UMMS is an arm of the State entitled to sovereign immunity, and denied dismissal of Count III (§ 1557 sex-discrimination claim).

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Standing	Hammons suffered concrete injury when Hospital cancelled his medically indicated surgery; cancellation is traceable to Hospital and damages would redress him.	The surgeon’s decision to schedule at UMSJ (knowing the Directives) was the but-for and intervening cause; Hospital not the traceable actor.	Standing satisfied: CMO’s cancellation was at least a partial cause; damages/redress adequate (nominal/compensatory).
State-action for § 1983	UMMS is an instrumentality of Maryland under Lebron (created by statute for governmental purposes; Governor appoints board).	UMMS/Hospital are private nonprofit entities; Moore/close-nexus test shows no state action.	Court applies Lebron and treats UMMS as a governmental entity for constitutional claims.
Sovereign immunity / § 1983 personhood	UMMS is not immune or the statute waives immunity; if not an arm, it is a ‘‘person’’ under § 1983.	If UMMS is part of the State, it is an arm entitled to Eleventh Amendment immunity and is not a "person" under § 1983; Counts I–II barred.	Court holds UMMS is an arm of the State for Eleventh Amendment purposes and dismisses Counts I and II on sovereign-immunity/jurisdictional grounds.
ACA §1557 sex-discrimination	Hospital cancelled a medically necessary, gender-affirming hysterectomy because Hammons is transgender; under Bostock/Grimm this is sex-based discrimination.	Policy is facially neutral (religious/directive-based); recent HHS guidance not controlling here.	§1557 claim survives: court denies dismissal of Count III, concluding Hammons plausibly alleges sex-based discrimination.

Key Cases Cited

Lebron v. Nat'l R.R. Passenger Corp., 513 U.S. 374 (1995) (treats a statutory corporation as a government entity where created by special law for governmental purposes and government control exists)
Bostock v. Clayton Cty., 140 S. Ct. 1731 (2020) (discrimination against transgender persons is discrimination "because of sex")
Ram Ditta v. Md. Nat. Cap. Park & Planning Comm'n, 822 F.2d 456 (4th Cir. 1987) (multi-factor arm-of-the-state test for Eleventh Amendment immunity)
Will v. Michigan Dep't of State Police, 491 U.S. 58 (1989) (States and arms of the State are not "persons" under § 1983)
Uzuegbunam v. Preczewski, 141 S. Ct. 792 (2021) (nominal damages satisfy redressability element for standing as to past injuries)
Napata v. Univ. of Md. Med. Sys. Corp., 417 Md. 724 (Md. 2011) (Maryland court finding UMMS an instrumentality of the State for Maryland law purposes)
Moore v. Williamsburg Reg'l Hosp., 560 F.3d 166 (4th Cir. 2009) ("close nexus" state-action discussion for private entities)
Pennhurst State Sch. & Hosp. v. Halderman, 465 U.S. 89 (1984) (Eleventh Amendment bars suits against unconsenting states and their agencies)