Pacific Radiation Oncology v. the Queen's Medical Center, 2015 U.S. App. LEXIS 22309

Background

Pacific Radiation Oncology (PRO), a group of radiation oncologists, sued The Queen’s Medical Center (QMC) after QMC ended a nearly 40-year privileges arrangement by adopting a closed-facility model that excluded PRO physicians unless they became QMC employees and divested outside interests.
PRO’s 2012 complaint asserted ten claims (due process, various torts, multiple Chapter 480 unfair competition claims, breach of fiduciary duty) and sought injunctive relief and damages relating to termination of hospital privileges.
QMC counterclaimed alleging PRO physicians improperly encouraged patient transfers to a competing clinic (TCCH) and failed to disclose financial interests.
During discovery QMC accidentally filed an unredacted subpoena listing ~132 patients on the public docket; QMC quickly moved to seal and the court restricted access; PRO then sought a TRO/preliminary injunction to enjoin QMC’s review/use of patient records, alleging HIPAA and Hawaii Constitutional violations.
The district court denied injunctive relief because PRO’s complaint did not plead privacy/HIPAA claims, treated the matter largely as a discovery dispute, sanctioned QMC for the public filing, and directed parties to resolve access under the protective order and pending certified questions to the Hawaii Supreme Court.
On appeal, the Ninth Circuit affirmed, adopting the Devose rule requiring a nexus between the injury alleged in a motion for interim equitable relief and the conduct pleaded in the underlying complaint.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether plaintiff can obtain injunctive relief (TRO/PI) to stop QMC’s review/use of patient records though complaint contains no privacy claim	PRO argued injunctive relief was warranted because QMC’s use and public filing of patient-identifying records violated HIPAA and the Hawaii Constitution and threatened irreparable harm	QMC argued the privacy claims were not pleaded in PRO’s complaint; the motion raised new, separate allegations better addressed via discovery or a separate suit	Held: Denied. Court adopted Devose rule — an injunction must relate to claims pleaded; no sufficient nexus here, so district court didn’t abuse discretion
Whether the district court erred by treating the motion as a discovery issue and sanctioning QMC	PRO contended emergency equitable relief was appropriate given disclosure and ongoing misuse of records	QMC maintained the filing was inadvertent, the protective order and discovery process were the proper mechanisms, and sanctions limited to sanctionable filing conduct	Held: No error. Court affirmed the district court’s sanctions for the public filing and its instruction to resolve access/production under discovery/protective order
Whether PRO’s Chapter 480 and other pleaded claims encompass alleged privacy violations such that injunctive relief is available	PRO argued privacy violations were relevant or incorporated into its unfair-competition and related claims, making injunction appropriate	QMC argued the complaint’s allegations concern privileges and competition, not privacy law violations; evidence of privacy violations might be relevant but does not convert the pleading into a privacy claim	Held: Court held relevance alone does not make a motion for equitable relief permissible; privacy allegations were distinct and not pleaded, so injunction unavailable
Whether PRO could have sought amendment or separate suit instead of injunctive relief	PRO suggested the urgency required interim relief in the current action	QMC noted the proper course was to amend or file a distinct claim or let patients assert their rights; discovery motions are the appropriate forum for limiting access	Held: Court observed PRO could have amended or filed separately; denial of TRO/PI appropriate because relief sought was not relief of the same character as that sought in the complaint

Key Cases Cited

De Beers Consol. Mines v. United States, 325 U.S. 212 (1945) (preliminary injunction must grant relief of same character as may be granted finally)
Devose v. Herrington, 42 F.3d 470 (8th Cir. 1994) (motion for injunctive relief must relate to conduct asserted in underlying complaint)
Pimentel v. Dreyfus, 670 F.3d 1096 (9th Cir. 2012) (standard of review for preliminary injunction: abuse of discretion; two-part test)
Omega World Travel, Inc. v. Trans World Airlines, 111 F.3d 14 (4th Cir. 1997) (applying nexus requirement between injunction and pleaded claims)
Colvin v. Caruso, 605 F.3d 282 (6th Cir. 2010) (endorsing rule that injunctive relief must relate to complaint)
Little v. Jones, 607 F.3d 1245 (10th Cir. 2010) (same)
Kaimowitz v. Orlando, 122 F.3d 41 (11th Cir. 1997) (same)
Stewart v. U.S. I.N.S., 762 F.2d 193 (2d Cir. 1985) (same)