### IN THE UNI TED STAT ES COURT OF APPEALS

FOR THE FIF TH CIRCU IT

N o

. 0 9

- 3 1 0 5 6

C H O I C E H E A L T H C A R E

, I N C

. ; T O U R O I N F I R M A R Y

, a s P r i n c i p a l o f C h o i c e

H e a l t h c a r e

, I n c

. ,

P l a i n t i f f s

- A p p e l l a n t s

v

.

K A I S E R F O U N D A T I O N H E A L T H P L A N O F C O L O R A D O ; K A I S E R

F O U N D A T I O N H E A L T H P L A N

, I N C

. ; K A I S E R F O U N D A T I O N H E A L T H

P L A N O F G E O R G I A I N C

. ; K A I S E R F O U N D A T I O N H E A L T H P L A N O F

S O U T H E R N C A L I F O R N I A H M O ; K A I S E R F O U N D A T I O N H E A L T H P L A N

O F T H E M I D A T L A N T I C S T A T E S ; K A I S E R P E R M A N E N T E I N S U R A N C E

C O M P A N Y

,

D e f e n d a n t s

- A p p e l l e e s

A p p e a l f

r o m t h e U n i t e d S t a t e s D i s t r i c t C o u r t f o r t h e

E a s t e r n D i s t r i c t o f L o u i s i a n a

B e f o r e D A V I S

, S M I T H

, a n d H A Y N E S

, C i r c u i t J u d g e s

W

. E U G E N E D A V I S

, C i r c u i t J u d g e :

I n t h i s s u i t b e t w e e n a L o u i s i a n a h e a l t h c a r e p r o v i d e r a n d a f o r e i g n h e a l t h

i n s u r e r

, w e c o n s i d e r w h e t h e r t h e d i s t r i c t c o u r t e r r e d i n f i n d i n g t h a t i t l a c k e d

p e r s o n a l j u r i s d i c t i o n o v e r t h e d e f e n d a n t b a s e d o n t h e d e f e n d a n t ’ s p a y m e n t s t o

p l a i n t i f f s f o r t r e a t m e n t o f a s m a l l n u m b e r o f d e f e n d a n t ’ s i n s u r e d s o v e r t h e U n i te d S ta te s C o u rt o f A p p ea l s

F i ft h C i rc u i t



### F I L E D

August 11, 20 10

Lyle W . Cayce

Clerk Case: 09-31056 Document: 00511201250 Page: 1 Date Filed: 08/11/2010N o

. 0 9

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c o u r s e o f t h r e e y e a r s

. F o r t h e f o l l o w i n g r e a s o n s

, w e A F F I R M t h e j u d g m e n t o f

t h e d i s t r i c t c o u r t

.

I

.

P l a i n t i f f s

- a p p e l l a n t s C h o i c e H e a l t h C a r e

, I n c

. a n d T o u r o I n f i r m a r y

( c o l l e c t i v e l y

, “ C h o i c e ” ) a r e m e d i c a l s e r v i c e s p r o v i d e r s w h i c h a d m i t a n d t r e a t

p a t i e n t s i n N e w O r l e a n s

, L o u i s i a n a

. D e f e n d a n t s

- a p p e l l e e s K a i s e r F o u n d a t i o n

H e a l t h P l a n e t a l

. ( “ K a i s e r ” ) a r e h e a l t h m a i n t e n a n c e o r g a n i z a t i o n s ( H M O s )

a n d / o r h e a l t h a n d d i s a b i l i t y i n s u r e r s w h i c h p r o v i d e h e a l t h c a r e s e r v i c e s a n d

c o v e r a g e t o i n d i v i d u a l s

. T h e K a i s e r e n t i t i e s i n t h i s c a s e a c c e p t e n r o l l m e n t o n l y

f r o m i n s u r e d s l i v i n g i n t h e i r s e r v i c e a r e a s

, o f w h i c h L o u i s i a n a i s n o t o n e

. 1

C h o i c e e n t e r e d i n t o a c o n t r a c t w i t h M u l t i p l a n

, I n c

. ( “ M u l t i p l a n ” )

, a p r e f e r r e d

p r o v i d e r o r g a n i z a t i o n ( “ P P O ” )

, i n w h i c h C h o i c e a g r e e d t o c h a r g e a n d a c c e p t

d i s c o u n t e d r a t e s f

r o m M u l t i p l a n c l i e n t s / p a y o r s w h i c h p a r t i c i p a t e d i n t h e

M u l t i p l a n P P O

. K a i s e r e n t e r e d i n t o a s e p a r a t e c o n t r a c t w i t h M u l t i p l a n

,

w h e r e b y K a i s e r b e c a m e a c l i e n t / p a y o r o f M u l t i p l a n a n d

, t h u s

, e n t i t l e d t o t h e

d i s c o u n t e d c h a r g e s a g r e e d t o b y C h o i c e a n d a l l o t h e r p a r t i c i p a t i n g h e a l t h c a r e

p r o v i d e r s w h o h a d c o n t r a c t e d w i t h M u l t i p l a n

. A c c o r d i n g t o i t s w e b s i t e

,

M u l t i p l a n i s c o m p o s e d o f “ m o r e t h a n h a l f a m i l l i o n h e a l t h c a r e p r o v i d e r s u n d e r

c o n t r a c t

, a n e s t i m a t e d 4 0 m i l l i o n c o n s u m e r s a c c e s s i n g o u r n e t w o r k p r o d u c t s

,

a n d s o m e 7 0 m i l l i o n c l a i m s p r o c e s s e d t h r o u g h o u r n e t w o r k e a c h y e a r

. ”

M u l t i p l a n

– A b o u t U s

, h t t p : / / w w w

. m u l t i p l a n

. c o m / a b o u t u s ( l a s t v i s i t e d A u g u s t

9

, 2 0 1 0 )

.

De fen dant s des cri be the mul tip le def enda nts and their rela tio nshi p to the for um as 1

fol low s: “K FHP, KFH P Color ado

, KFH P Ge orgia, and KFH P Mid -At lanti c are HM Os that only

acc ept app lica tio ns for enro llm ent fr om indi vidual s wh o live or wo rk in thei r res pec tive se rvice

area s, and Louis iana is not in any of thei r se rvice area s. KPIC is a hea lth and dis abilit y

ins urer that off

ers its inde mni ty ins uranc e cover age only in conjunc tio n wi t h the HM O

cover age off

ere d by its aff

iliat es KFH P, KFH P Color ado

, KFH P Ge orgia, KFH P Mid -At lanti c,

and KFH P Nor thw es t, none o f w h i c h off er com pr ehens ive HM O cover age in Louis iana. ”

Plaint iff d oes no t dis put e t he above des cri pt ion.

2 Case: 09-31056 Document: 00511201250 Page: 2 Date Filed: 08/11/2010N o

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D u r i n g t h e t h r e e y e a r p e r i o d f r o m 2 0 0 2 t o 2 0 0 5

, C h o i c e p r o v i d e d m e d i c a l

s e r v i c e s i n N e w O r l e a n s t o a p p r o x i m a t e l y f i f t y o f K a i s e r ’ s i n s u r e d s

. C h o i c e 2

a l l e g e s t h a t t h e s e i n d i v i d u a l s p r e s e n t e d C h o i c e w i t h i n s u r a n c e b e n e f i t c a r d s t h a t

d i d n o t d i s p l a y t h e M u l t i p l a n i d e n t i t y o r l o g o a s r e q u i r e d b y L o u i s i a n a l a w

. A s

a r e s u l t

, C h o i c e c h a r g e d t h e u s u a l

, c u s t o m a r y r a t e s f o r t h e s e r v i c e s i n s t e a d o f

t h e l o w e r r a t e s a s p r o v i d e d b y C h o i c e a n d K a i s e r ’ s s e p a r a t e c o n t r a c t s w i t h

M u l t i p l a n

. W h e n K a i s e r p r o c e s s e d t h e c l a i m s

, h o w e v e r

, i t p a i d C h o i c e t h e

d i s c o u n t e d M u l t i p l a n r a t e s r a t h e r t h a n t h e r a t e s C h o i c e b i l l e d

. C h o i c e b r o u g h t

s u i t a g a i n s t K a i s e r f o r f a i l i n g t o p a y t h e b a l a n c e

, a l l e g i n g t h a t u n d e r L A

. R E V

.

S T A T

. A N N

. 4 0 : 2 2 0 3

. 1 B

, K a i s e r ’ s f a i l u r e t o p r o p e r l y g i v e C h o i c e n o t i c e o f i t s

m e m b e r s h i p i n t h e P P O r e q u i r e d K a i s e r t o p a y t h e c u s t o m a r y r a t e s

. 3

K a i s e r f

i l e d a m o t i o n t o d i s m i s s C h o i c e ’ s s u i t

, a r g u i n g t h a t t h e d i s t r i c t

c o u r t i n L o u i s i a n a l a c k e d p e r s o n a l j u r i s d i c t i o n

. T h e d i s t r i c t c o u r t r e l i e d

p r i m a r i l y o n S t

. L u k e ’ s E p i s c o p a l H o s p

. v

. L a

. H e a l t h S e r v

. a n d I n d e m

. C o

. , N o

.

0 8

- 1 8 7 0

, 2 0 0 9 W L 4 7 1 2 5 ( S

. D

. T e x

. J a n

. 6

, 2 0 0 9 )

, a n d f o u n d t h a t K a i s e r ’ s

p a y m e n t o f f

i f t y

- t h r e e c l a i m s t o C h o i c e i n L o u i s i a n a o v e r a t h r e e

- y e a r p e r i o d w a s

i n s u f f i c i e n t t o p e r m i t C h o i c e t o e s t a b l i s h e i t h e r g e n e r a l o r s p e c i f i c p e r s o n a l

j u r i s d i c t i o n

.

The pr ecis e num ber of both Ka ise r’s ins ured s wh o pr es ente d for tre atm ent at Choice ’s 2

hos pit als and the num ber of paym ents Ka ise r mad e to Choice for its se rvice s is uncle ar. It is

als o unclea r how the Kais er insured s who we re tr eate d by Choice are dis tri bute d amo ng the

six Ka ise r enti tie s wh ich are def enda nts

. In its brie f to this cour t

, C h o i c e s tat ed that fiftythr ee se p a r a t e pat ient acc ount s we re rep ric ed sub ject to the ter ms of the Mul tip lan

agree me nts and that Ka ise r tend ere d paym ent for thes e se rvice s. At oral argum ent, couns el

for Choice st ated that on fo rt y-s even occ asi ons indi vidual s app eare d of wh ich thir ty-t hree we re

paid ou t by K ais er.

L A

. R E V

. S T A T

. A N N

. 40:2 203. 1B r ead s, in p ert inent p art : 3

A pr efe rre d pr ovide r organi zatio n's alte rnat ive rat es of paym ent sha ll not be

enf orc eable or bind ing upon any pr ovide r unles s suc h organi zatio n is clea rly

ide n t i f i e d on the benef

it car d iss ued by the group pur chas er or othe r enti ty

acc es sin g a group pur chas er' s cont rac tual a greem ent or agree me nts and

pr es ente d to the par tic ipat ing p rovid er wh en me dic al car e i s pr ovide d.

. . .

3 Case: 09-31056 Document: 00511201250 Page: 3 Date Filed: 08/11/2010N o

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C h o i c e t i m e l y a p p e a l e d

.

I I

.

A

.

T h i s c o u r t r e v i e w s d e n o v o a d i s t r i c t c o u r t ’ s d i s m i s s a l f o r l a c k o f p e r s o n a l

j u r i s d i c t i o n

. W

a l k H a y d e l & A s s o c s

. , I n c

. v

. C o a s t a l P o w e r P r o d

. C o

. , 5 1 7 F

. 3 d

2 3 5

, 2 4 1 ( 5 t h C i r

. 2 0 0 8 )

. A d i s t r i c t c o u r t s i t t i n g i n d i v e r s i t y m a y e x e r c i s e

p e r s o n a l j u r i s d i c t i o n o v e r a d e f e n d a n t t o t h e e x t e n t p e r m i t t e d b y s t a t e l a w

. I d

.

a t 2 4 2

. T h e L o u i s i a n a l o n g

- a r m s t a t u t e a u t h o r i z e s t h e e x e r c i s e o f p e r s o n a l

j u r i s d i c t i o n t o t h e l i m i t s o f d u e p r o c e s s

. I d

. a t 2 4 2

– 4 4

. T h e e x e r c i s e o f p e r s o n a l

j u r i s d i c t i o n c o m p o r t s w i t h d u e p r o c e s s w h e r e : ( 1 ) t h e d e f e n d a n t h a s p u r p o s e f

u l l y

a v a i l e d i t s e l f o f t h e b e n e f i t s a n d p r o t e c t i o n s o f t h e f o r u m s t a t e b y e s t a b l i s h i n g

“ m i n i m u m c o n t a c t s ” w i t h t h a t s t a t e ; a n d ( 2 ) t h e e x e r c i s e o f p e r s o n a l j u r i s d i c t i o n

d o e s n o t o f

f e n d “ t r a d i t i o n a l n o t i o n s o f f a i r p l a y a n d s u b s t a n t i a l j u s t i c e

. ” M i n k

v

. A A A A D e v

. L

. L

. C

. , 1 9 0 F

. 3 d 3 3 3

, 3 3 6 ( 5 t h C i r

. 1 9 9 9 ) ( c i t a t i o n s o m i t t e d )

.

T h e “ m i n i m u m c o n t a c t s ” p r o n g o f t h e t w o

- p a r t t e s t m a y b e f u r t h e r

s u b d i v i d e d i n t o c o n t a c t s t h a t g i v e r i s e t o “ g e n e r a l ” p e r s o n a l j u r i s d i c t i o n a n d

“ s p e c i f i c ” p e r s o n a l j u r i s d i c t i o n

. W h e r e a d e f e n d a n t h a s “ c o n t i n u o u s a n d

s y s t e m a t i c g e n e r a l b u s i n e s s c o n t a c t s ” w i t h t h e f o r u m s t a t e

, t h e c o u r t m a y

e x e r c i s e “ g e n e r a l ” j u r i s d i c t i o n o v e r a n y a c t i o n b r o u g h t a g a i n s t t h a t d e f e n d a n t

.

L u v N ’ C a r e L t d

. v

. I n s t a

- M i x

, I

n c

. , 4 3 8 F

. 3 d 4 6 5

, 4 6 9 ( 5 t h C i r

. 2 0 0 6 ) ( c i t i n g

H e l i c o p t e r o s N a c i o n a l e s d e C o l o m b i a

, S

. A

. v

. H a l l

, 4 6 6 U

. S

. 4 0 8

, 4 1 4 ( 1 9 8 4 ) )

.

W h e n t h e c o n t a c t s a r e l e s s e x t e n s i v e

, t h e c o u r t m a y s t i l l e x e r c i s e “ s p e c i f i c ”

j u r i s d i c t i o n w h e r e a “ n o n r e s i d e n t d e f e n d a n t h a s p u r p o s e f u l l y d i r e c t e d i t s

a c t i v i t i e s a t t h e f

o r u m s t a t e a n d t h e l i t i g a t i o n r e s u l t s f r o m a l l e g e d i n j u r i e s t h a t

a r i s e o u t o f o r r e l a t e t o t h o s e a c t i v i t i e s

. ” W a l k H a y d e l

, 5 1 7 F

. 3 d a t 2 4 3 ( i n t e r n a l

q u o t a t i o n s o m i t t e d )

. T h e p l a i n t i f f b e a r s t h e b u r d e n o f e s t a b l i s h i n g a d i s t r i c t

c o u r t ’ s j u r i s d i c t i o n o v e r a n o n r e s i d e n t ; t h a t b u r d e n i s m e t b y a p r i m a f a c i e

4 Case: 09-31056 Document: 00511201250 Page: 4 Date Filed: 08/11/2010N o

. 0 9

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s h o w i n g

. Jo h n s t o n v

. M u l t i d a t a S y s

. I n t ’ l C o r p

. , 5 2 3 F

. 3 d 6 0 2

, 6 0 9 ( 5 t h C i r

.

2 0 0 8 ) ( c i t a t i o n s o m i t t e d )

.

B

.

T o s h o w t h e t y p e o f “ c o n t i n u o u s a n d s y s t e m a t i c ” c o n t a c t r e q u i r e d f o r

g e n e r a l j u r i s d i c t i o n

, a p l a i n t i f f m u s t d e m o n s t r a t e c o n t a c t s o f a m o r e e x t e n s i v e

q u a l i t y a n d n a t u r e b e t w e e n t h e f o r u m s t a t e a n d t h e d e f e n d a n t t h a n t h o s e

n e e d e d f

o r s p e c i f

i c j u r i s d i c t i o n

. I

d

. a t 6 0 9

– 1 0

. T o f

i n d g e n e r a l j u r i s d i c t i o n o v e r

t h e d e f e n d a n t

, a d e f e n d a n t ’ s c o n t a c t s w i t h t h e f o r u m m u s t b e s u b s t a n t i a l ;

r a n d o m

, f

o r t u i t o u s

, o r a t t e n u a t e d c o n t a c t s a r e n o t s u f f i c i e n t

. I

d

. a t 6 1 0

.

P l a i n t i f f d o e s n o t c h a l l e n g e t h e f a c t t h a t K a i s e r h a s n o o f f i c e s a n d o w n s n o

p r o p e r t y i n L o u i s i a n a

. K a i s e r m a i n t a i n s n o a c c o u n t s a n d p a y s n o t a x e s i n t h e

s t a t e

. F u r t h e r

, K a i s e r i s n o t l i c e n s e d t o d o b u s i n e s s i n L o u i s i a n a a n d n e i t h e r

c o n d u c t s n o r s o l i c i t s b u s i n e s s i n t h e s t a t e

. C h o i c e a r g u e s t h a t K a i s e r ’ s f i f t y

t h r e e p a y m e n t s o v e r t h e c o u r s e o f m o r e t h a n t h r e e y e a r s c o n s t i t u t e d “ c o n t i n u o u s

a n d s y s t e m a t i c ” c o n t a c t w i t h t h e f o r u m

. T h i s a r g u m e n t i s u n a v a i l i n g a s t h i s

c i r c u i t h a s f

o u n d g e n e r a l j u r i s d i c t i o n l a c k i n g i n i n s t a n c e s w h e r e a d e f e n d a n t ’ s

f o r u m c o n t a c t s w e r e s i g n i f i c a n t l y m o r e s u b s t a n t i a l t h a n K a i s e r ’ s

. B e c a u s e o f 4

For ins tanc e, in Cent. Frei ght Line s, Inc. v. APA Tra nsp

. Corp

. , 322 F.3d 376 (5t h Cir. 4

2003)

, the def

enda nt wa s a t r a n sp ort com pany wh ich rout inely arr anged and rec eived

shi pm ents to and fr om Texas. In addit ion to its mul tip le shi pm ents in and out of the fo rum

, the def enda nt als o se nt sal es me n to t h e s t a t e o n a regula r bas is to deve lop bus ines se s,

negot iate cont rac ts

, and se rvice natio nal acc ount s. De sp ite thes e exten sive tra nsa cti ons

, this

cour t fou nd that gene ral juris dic tio n w as lack ing:

In this cas e, altho ugh [d efe ndant ] has fed eral ope rat ing autho ri t y in Texas

, [d efe ndant ]

. . . has never mai ntain ed any ki nd of busine ss off

ice or rec ord s in

th e s t ate, and has never paid fr anchi se taxes in the st ate.

. . . Even if

[d efe ndant ’s ] cont act s wi th the st ate of Texas have been, in so me se nse

, “co ntinu ous and sys tem atic ,” [d efe nda n t ’ s ] a cti vitie s, in toto, are clea rly not

sub st antia l enough t o j ust ify sub ject ing [d efe ndant ] to sui t in the Wes ter n

Di st ric t of Texas bas ed on a t heor y of gene ral per so nal juris dic tio n.

Id. at 381. See al so B e a r r y v. Beec h Ai rcr af

t Corp

. , 818 F.2d 370, 373–76 (5t h Cir. 1987)

(ho ldi ng that the sal e of over $250 mi llion of pr oduc ts to se v e n t e e n T e x a s cus tom ers over a

5 Case: 09-31056 Document: 00511201250 Page: 5 Date Filed: 08/11/2010N o

. 0 9

- 3 1 0 5 6

t h e s e l i m i t e d c o n t a c t s

, K a i s e r ’ s i n t e r m i t t e n t p a y m e n t s t o L o u i s i a n a o v e r t h e

c o u r s e o f t h r e e y e a r s a r e i n s u f f i c i e n t t o e s t a b l i s h t h a t K a i s e r m a i n t a i n e d

“ c o n t i n u o u s a n d s y s t e m a t i c ” c o n t a c t w i t h L o u i s i a n a

.

C

.

A c o u r t m a y e x e r c i s e s p e c i f i c j u r i s d i c t i o n w h e n : ( 1 ) t h e n o n r e s i d e n t

d e f e n d a n t p u r p o s e f

u l l y a v a i l s i t s e l f o f t h e p r i v i l e g e s o f c o n d u c t i n g a c t i v i t i e s i n

t h e f o r u m s t a t e ; a n d ( 2 ) t h e c o n t r o v e r s y a r i s e s o u t o f o r i s r e l a t e d t o t h e

d e f e n d a n t ’ s c o n t a c t s w i t h t h e f o r u m s t a t e

. F r e u d e n s p r u n g v

. O f

f s h o r e T e c h

.

S e r v s

. , I n c

. , 3 7 9 F

. 3 d 3 2 7

, 3 4 3 ( 5 t h C i r

. 2 0 0 4 ) ( c i t a t i o n o m i t t e d )

. T h e “ p u r p o s e f u l

a v a i l m e n t ” e l e m e n t e n s u r e s t h a t a d e f e n d a n t w i l l n o t b e h a l e d i n t o c o u r t i n a

j u r i s d i c t i o n s o l e l y a s a r e s u l t o f r a n d o m

, f o r t u i t o u s

, o r a t t e n u a t e d c o n t a c t s o r t h e

u n i l a t e r a l a c t i v i t y o f a n o t h e r p e r s o n o r t h i r d p a r t y

. B u r g e r K i n g C o r p

. v

.

R u d z e w i c z

, 4 7 1 U

. S

. 4 6 2

, 4 7 5 ( 1 9 8 5 )

.

T h e c a u s e o f

a c t i o n i n t h i s c a s e a r i s e s f r o m K a i s e r ’ s f a i l u r e t o p a y C h o i c e

t h e f u l l a m o u n t C h o i c e c h a r g e d f o l l o w i n g i t s t r e a t m e n t o f K a i s e r ’ s i n s u r e d s

.

T h o u g h t h e r e c o r d i s u n c l e a r a s t o h o w m a n y p a y m e n t s K a i s e r s e n t t o C h o i c e

,

t h e r e i s n o d i s p u t e t h a t K a i s e r d i d t e n d e r s o m e p a y m e n t s t o C h o i c e i n

a c c o r d a n c e w i t h t h e f e e s c h e d u l e c o n t a i n e d i n t h e M u l t i p l a n a g r e e m e n t t o w h i c h

b o t h p a r t i e s h a d i n d e p e n d e n t l y j o i n e d

. T h u s t h e f o r u m c o n t a c t s r e l e v a n t t o o u r

i n q u i r y a r e ( 1 ) t h e p a y m e n t s K a i s e r m a d e t o C h o i c e o v e r t h e c o u r s e o f t h r e e

y e a r s

, a n d ( 2 ) K a i s e r ’ s c o n t r a c t w i t h M u l t i p l a n w h i c h a l l o w e d K a i s e r t o r e c e i v e

d i s c o u n t e d c o v e r a g e f r o m p a r t i c i p a t i n g h e a l t h c a r e p r o v i d e r s

.

I n f i n d i n g t h a t i t l a c k e d p e r s o n a l j u r i s d i c t i o n o v e r K a i s e r

, t h e d i s t r i c t

c o u r t r e l i e d o n t h e r e a s o n i n g i n S t

. L u k e ’ s

. I n t h a t c a s e

, a T e x a s h o s p i t a l s u e d

B l u e C r o s s B l u e S h i e l d L o u i s i a n a ( B C B S L a ) o v e r i t s f a i l u r e t o p a y a n e n t i r e

five -year per iod did not cons tit ute sys tem atic and cont inuous cont act s wi th Texas beca use

del ivery wa s acc ept ed in Ka nsa s)

.

6 Case: 09-31056 Document: 00511201250 Page: 6 Date Filed: 08/11/2010N o

. 0 9

- 3 1 0 5 6

h o s p i t a l b i l l

. 2 0 0 9 W L 4 7 1 2 5

, a t * 1

. T h e b i l l a r o s e f r o m s e r v i c e s t h e h o s p i t a l

p r o v i d e d t o o n e o f

B C B S L a ’ s i n s u r e d s w h o h a d s o u g h t t r e a t m e n t i n T e x a s

. I d

.

P r i o r t o t h e h o s p i t a l ’ s t r e a t m e n t o f B C B S L a ’ s i n s u r e d

, t h e h o s p i t a l s o u g h t

– a n d

B C B S L a g a v e

– a u t h o r i z a t i o n f o r t r e a t m e n t

. I

d

. A m o n t h a f

t e r b e i n g

d i s c h a r g e d

, t h e i n s u r e d a g a i n s o u g h t t r e a t m e n t a t t h e T e x a s h o s p i t a l a n d

B C B S L a a g a i n g a v e i t s a u t h o r i z a t i o n

. I d

. a t * 2

. B C B S L a t e n d e r e d p a r t i a l

p a y m e n t f

o r t h e h o s p i t a l ’ s s e r v i c e s b u t d i s p u t e d s o m e o f t h e c o s t s c h a r g e d

. I d

.

T h e h o s p i t a l b r o u g h t s u i t a g a i n s t B C B S L a i n T e x a s f o r t h e u n p a i d b a l a n c e

. I d

.

B e f o r e t h e d i s t r i c t c o u r t

, B C B S L a m o v e d t o d i s m i s s f o r l a c k o f p e r s o n a l

j u r i s d i c t i o n

. I

d

. B C B S L a w a s i n t h e b u s i n e s s o f o f f e r i n g h e a l t h c a r e i n s u r a n c e

t o L o u i s i a n a r e s i d e n t s a n d i s s u e d n o p o l i c i e s o u t s i d e o f L o u i s i a n a

. I d

. B C B S L a

,

h o w e v e r

, p a r t i c i p a t e d i n a “ B l u e C a r d P r o g r a m ” w h i c h a l l o w e d B C B S L a t o

r e c e i v e w h a t e v e r d i s c o u n t e d r a t e s i n

- s t a t e h o s p i t a l s o f f e r e d t o i n

- s t a t e B l u e

C r o s s B l u e S h i e l d i n s u r e r s

. I d

. T h e h o s p i t a l a r g u e d t h a t B C B S L a ’ s

p a r t i c i p a t i o n i n t h e B l u e C a r d P r o g r a m

, w h e n c o n s i d e r e d i n c o n j u n c t i o n w i t h i t s

a u t h o r i z a t i o n o f t r e a t m e n t a n d i t s p a r t i a l p a y m e n t o f t h e T e x a s

- i s s u e d b i l l s f o r

t h e i n s u r e d ’ s t r e a t m e n t i n T e x a s

, p r o v i d e d a s u f f i c i e n t b a s i s f

o r s p e c i f

i c p e r s o n a l

j u r i s d i c t i o n

. I

d

. a t * 7

.

1

.

S t

. L u k e ’

s c o n s i d e r e d a n u m b e r o f t h e i s s u e s p r e s e n t e d i n t h i s c a s e

. T h e

c o u r t i n S t

. L u k e ’

s f i r s t c o n s i d e r e d a n d r e j e c t e d p l a i n t i f f ’ s a r g u m e n t t h a t

j u r i s d i c t i o n w a s p r o p e r b e c a u s e d e f e n d a n t a u t h o r i z e d t h e h e a l t h c a r e p r o v i d e r

t o t r e a t i t s i n s u r e d a n d p a r t i a l l y p a i d i t s b i l l

. I d

. W e a g r e e w i t h t h i s a n a l y s i s

.

I n t h e i n s t a n t c a s e

, n o e v i d e n c e w a s p r e s e n t e d t h a t C h o i c e o b t a i n e d a d v a n c e

a p p r o v a l f

r o m K a i s e r p r i o r t o t r e a t m e n t

. W e a r e s a t i s f i e d

, h o w e v e r

, t h a t

K a i s e r ’ s p a y m e n t o f a l i m i t e d n u m b e r o f c l a i m s f o r t r e a t m e n t o f K a i s e r ’ s

i n s u r e d s

, b a s e d o n t h e u n i l a t e r a l d e c i s i o n s o f t h o s e i n s u r e d s w h o s o u g h t

t r e a t m e n t i n L o u i s i a n a

, d o e s n o t e s t a b l i s h p u r p o s e f u l c o n t a c t b e t w e e n t h e

7 Case: 09-31056 Document: 00511201250 Page: 7 Date Filed: 08/11/2010N o

. 0 9

- 3 1 0 5 6

i n d i v i d u a l K a i s e r d e f e n d a n t s a n d t h e S t a t e o f L o u i s i a n a

. T h e i n d i v i d u a l K a i s e r

d e f e n d a n t s c o v e r e d t h e i r r e s p e c t i v e i n s u r e d s f o r t r e a t m e n t i n H M O s i n t h e a r e a

w h e r e t h e i n s u r e d s l i v e d a n d w o r k e d

. T h i s i s w h e r e K a i s e r d i r e c t e d t h e i r

i n s u r e d s f

o r t r e a t m e n t

. K a i s e r o n l y p r o v i d e d o u t

- o f

- a r e a c o v e r a g e f o r l i m i t e d

t r e a t m e n t t o i n s u r e d s b a s e d o n e m e r g e n c y c a r e o r o t h e r u r g e n t h e a l t h c a r e

n e e d s

. V i e w e d i n t h i s l i g h t

, K a i s e r ’ s p a y m e n t t o C h o i c e f o r u r g e n t o r e m e r g e n c y

t r e a t m e n t o f i t s i n s u r e d s w h o v i s i t e d L o u i s i a n a a n d f o r t u i t o u s l y r e q u i r e d s u c h

t r e a t m e n t c a n n o t q u a l i f y a s c o m m e r c i a l a c t i v i t y p u r p o s e f u l l y d i r e c t e d t o w a r d

L o u i s i a n a

. I n m a k i n g t h e s e p a y m e n t s

, K a i s e r w a s n o t a t t e m p t i n g t o e x p a n d

s a l e s t o L o u i s i a n a o r o t h e r w i s e d e v e l o p c o m m e r c i a l a c t i v i t y i n L o u i s i a n a

. K a i s e r

m a d e t h e p a y m e n t s b e c a u s e i t s i n s u r e d s i n d e p e n d e n t l y a n d w i t h o u t

e n c o u r a g e m e n t f

r o m K a i s e r p r e s e n t e d t o a L o u i s i a n a h o s p i t a l f o r u r g e n t c a r e

w h i l e v i s i t i n g L o u i s i a n a

.

T h i s a n a l y s i s i s c o n s i s t e n t w i t h a n u m b e r o f o t h e r c a s e s

. I n H u n t v

. E r i e

I n s

. G r o u

p

, 7 2 8 F

. 2 d 1 2 4 4 ( 9 t h C i r

. 1 9 8 4 )

, f o r i n s t a n c e

, a n E a s t C o a s t i n s u r e r

p r o v i d e d a u t o m o b i l e i n s u r a n c e p a y m e n t s t o p l a i n t i f f

, a r e s i d e n t o f P e n n s y l v a n i a

i n v o l v e d i n a c a r a c c i d e n t i n C o l o r a d o

. I d

. a t 1 2 4 5

. A f

t e r i n i t i a l l y b e i n g t r e a t e d

i n C o l o r a d o

, p l a i n t i f f s o u g h t m e d i c a l t r e a t m e n t f r o m a s p e c i a l i s t i n C a l i f o r n i a

a n d m a d e a c l a i m f

o r c o v e r a g e u n d e r t h e p o l i c y

. I d

. W h e n t h e i n s u r e r p a i d o u t

s o m e b u t n o t a l l o f p l a i n t i f f ’ s c l a i m s

, p l a i n t i f

f f i l e d s u i t i n C a l i f

o r n i a

. I d

. a t 1 2 4 6

.

T h e i n s u r e r m o v e d t o d i s m i s s f o r l a c k o f

p e r s o n a l j u r i s d i c t i o n

. I d

. T h e i n s u r e r

a r g u e d t h a t w h i l e i t c o v e r e d r e s i d e n t s i n a h a n d f u l o f s t a t e s

, i t w a s n o t

r e g i s t e r e d t o d o b u s i n e s s i n C a l i f o r n i a a n d c o n d u c t e d n o b u s i n e s s w i t h a n y

C a l i f o r n i a r e s i d e n t s

. I

d

. D e s p i t e t h e s e s c a n t c o n t a c t s

, p l a i n t i f f a r g u e d t h a t

j u r i s d i c t i o n o v e r t h e i n s u r e r w a s a p p r o p r i a t e b e c a u s e t h e i n s u r e r p u r p o s e f u l l y

a v a i l e d i t s e l f o f C a l i f o r n i a b y m a i l i n g p a y m e n t s t o C a l i f o r n i a a n d b y c o m m i t t i n g

a t o r t i n C a l i f

o r n i a i n f a i l i n g t o p a y p l a i n t i f f ’ s c l a i m s i n f

u l l

. I d

. T h e N i n t h

C i r c u i t r e j e c t e d t h i s a r g u m e n t

, s t a t i n g :

8 Case: 09-31056 Document: 00511201250 Page: 8 Date Filed: 08/11/2010N o

. 0 9

- 3 1 0 5 6

T h e m e r e f a c t t h a t [ t h e i n s u r e r ] c o m m u n i c a t e d w i t h [ p l a i n t i f f ] i n

t h e s t a t e

, a n d m a y h a v e c o m m i t t e d a t o r t i n t h e e x c h a n g e o f

c o r r e s p o n d e n c e

, d o e s n o t s h o w t h a t [ t h e i n s u r e r ] p u r p o s e f u l l y

a v a i l e d i t s e l f o f t h e p r i v i l e g e o f c o n d u c t i n g b u s i n e s s i n C a l i f o r n i a

. [ P l a i n t i f

f ’ s ] m o v e t o C a l i f

o r n i a f o r c e d [ t h e i n s u r e r ] t o s e n d m a i l t o

t h a t S t a t e c o n c e r n i n g h e r c l a i m

.

I d

. a t 1 2 4 8

. 5

T h i s c o u r t h a s a l s o r e f u s e d t o a s s e r t p e r s o n a l j u r i s d i c t i o n o v e r a n o n

r e s i d e n t i n s u r e r e v e n t h o u g h t h e i n s u r e r i s a w a r e t h a t i t s i n s u r e d s w e r e s e e k i n g

t r e a t m e n t i n t h e f

o r u m s t a t e

. I n P e r e z v

. P a n A m

. L i f e I n s

. C o

. , N o

. 9 6

- 2 0 2 4 1

,

1 9 9 6 W L 5 1 1 7 4 8 ( 5 t h C i r

. A u g u s t 2 0

, 1 9 9 6 ) ( u n p u b l i s h e d )

, a G u a t e m a l a n

i n s u r a n c e c o m p a n y p u r p o r t e d t o p r o v i d e w o r l d w i d e c o v e r a g e t o i t s i n s u r e d s

, a

c o u p l e a n d t h e i r s o n

. B e f o r e i t s i n s u r e d s e n t e r e d t h e f o r u m

, d e f e n d a n t

i n s u r a n c e c o m p a n y a p p r o v e d t h e i n s u r e d s ’ a p p l i c a t i o n t o g o t o H o u s t o n

, T e x a s

f o r m e d i c a l s e r v i c e s

. I d

. a t * 1

. A f

t e r t r e a t m e n t

, t h e d e f e n d a n t i n s u r a n c e

c o m p a n y r e f

u s e d t o p a y t h e c l a i m

. I d

. T h e i n s u r e d s f

i l e d s u i t i n T e x a s a g a i n s t

t h e i n s u r e r t o r e c o v e r b e n e f i t s u n d e r t h e i r p o l i c y

. I d

. I n s u p p o r t o f j u r i s d i c t i o n

,

t h e i n s u r e d s a r g u e d t h a t t h e i n s u r e r h a d p u r p o s e f u l l y a v a i l e d i t s e l f o f t h e

b e n e f i t s a n d p r o t e c t i o n s o f t h e f o r u m s t a t e w h e n t h e i n s u r e r e x p r e s s l y

a u t h o r i z e d t h e i r m e d i c a l a p p l i c a t i o n t o s e e k m e d i c a l s e r v i c e s i n T e x a s

. I d

.

Sever al dis tri ct court s have fou nd that an ins urer ’s par tial paym ent of hos pit al bills 5

wa s ins uff

icie nt to conf

er sp ecif ic per so nal juris dic tio n over the def enda nt. See, e. g., Baya da

Nur ses

, Inc. v. Blue Cros s and Blue Shie ld of Mi ch.

, Civ. No. 08-1 241, 2008 WL 2945388 (E. D.

Pa. July 30, 2008) (w here a Mic higan ins urer had paid a Penns yl v a n i a n u rs ing-s ervic es

pr ovide r for near ly thr ee years for tre ating a ret ired benef icia ry wh o lived in Nor th Carol ina,

the dis tri ct cour t fou nd that the ins urer wa s not sub ject to sp ecif ic per so nal juris d i c t i o n in

Penns ylvania, r eas oning that t he insu rer ’s payme nts to Pennsyl vania we re the res ult of the

benef icia ry’s se lect ion of the nurs ing pr ovide r, not the ins urer ’s “ch oice to do bus ines s wi th [t he

pr ovide r] in Penns ylvania. ”) ; Berg v. Blue Cros s and Blue Shie ld of Utic a- Wate rtow n, Inc.

, No.

C-93- 2752- DLJ

, 1993 WL 467859 (N .D

. Cal. Nov. 2, 1993) (d es pit e mul tip le paym ents by the

ins urer to the for um, the dis tri ct cour t fou nd it lack ed per so nal juris dic tio n; in so hold ing, the

dis tri ct cour t em phas i z e d t h a t t he pr ope r inquir y for per so nal juris dic tio n wa s wh ethe r the

ins urer had tak en aff irm ative st eps to avai l i t s e l f of benef its fr om act ivitie s rela ted to that

Sta te or wh ethe r the ins urer w as me rely res pond ing t o a cti ons t ak en by t he ins ured ).

9 Case: 09-31056 Document: 00511201250 Page: 9 Date Filed: 08/11/2010N o

. 0 9

- 3 1 0 5 6

D e s p i t e t h e i n s u r e r ’ s a c t i o n s

, w e h e l d t h a t n o j u r i s d i c t i o n e x i s t e d b e c a u s e

n e i t h e r t h e b r o a d c o v e r a g e l a n g u a g e i n t h e p o l i c y n o r t h e m e r e a p p r o v a l o f

t r e a t m e n t i n T e x a s c o n s t i t u t e d “ c o n t a c t ” w i t h T e x a s

. I d

. a t * 2

.

2

.

W e n e x t c o n s i d e r a n o t h e r a r g u m e n t m a d e b y C h o i c e w h i c h t h e c o u r t i n S t

.

L u k e ’ s c o n s i d e r e d

. C h o i c e a r g u e s t h a t K a i s e r ’ s a g r e e m e n t t o p a r t i c i p a t e i n t h e

M u l t i p l a n P P O t h r o u g h w h i c h i t w o u l d r e c e i v e d i s c o u n t e d r a t e s f o r s e r v i c e s

r e n d e r e d b y C h o i c e i n L o u i s i a n a a m o u n t s t o p u r p o s e f u l a v a i l m e n t i n t h e f

o r u m

.

T h i s p r e c i s e a r g u m e n t w a s a d d r e s s e d b y t h e c o u r t i n S t

. L u k e ’ s

. A s e x p l a i n e d

a b o v e

, t h e n o n

- r e s i d e n t i n s u r e r B C B S L a i n S t

. L u k e ’ s b e l o n g e d t o t h e B l u e C a r d

P r o g r a m

, a n a t i o n a l m e m b e r s h i p w h e r e b y i t r e c e i v e d t h e i n

- s t a t e h e a l t h c a r e

p r o v i d e r ’ s r a t e s o f

f e r e d t o f e l l o w B l u e C a r d P r o g r a m m e m b e r s

. T h e d i s t r i c t

c o u r t i n S t

. L u k e ’

s r e a s o n e d t h a t :

B C B S L a h a s n o t c o n t r a c t e d d i r e c t l y w i t h a T e x a s e n t i t y b u t i n s t e a d

h a s j o i n e d a n a t i o n a l o r g a n i z a t i o n t h a t a l l o w s i t t o o b t a i n c o v e r a g e

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, b u t

1 0 Case: 09-31056 Document: 00511201250 Page: 10 Date Filed: 08/11/2010N o

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t h e M i c h i g a n b a n k r e f u s e d t o p a y t h e e l e c t r o n i c d e b i t

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d i s a g r e e d w i t h p l a i n t i f f b e c a u s e :

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e n t i t y

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d o e s n o t e s t a b l i s h a C a l i f o r n i a c o n t r a c t

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1 1 Case: 09-31056 Document: 00511201250 Page: 11 Date Filed: 08/11/2010N o

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O k l a h o m a i n a c a r t h e y p u r c h a s e d i n N e w Y o r k

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d e f e n d a n t s h a d t h e n e c e s s a r y p u r p o s e f u l c o n t a c t w i t h O k l a h o m a t o b e s u e d i n

t h a t s t a t e e v e n t h o u g h i t w a s f o r e s e e a b l e t h a t t h e c a r c o u l d c a u s e i n j u r y i n

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j u r i s d i c t i o n :

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. . . i s n o t

s i m p l y a n i s o l a t e d o c c u r r e n c e

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f o r t s o f t h e

m a n u f a c t u r e r o r d i s t r i b u t o r t o s e r v e d i r e c t l y o r i n d i r e c t l y

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m e r c h a n d i s e h a s t h e r e b e e n t h e s o u r c e o f i n j u r y t o i t s o w n e r o r t o

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t h a t d e l i v e r s i t s p r o d u c t s i n t o t h e s t r e a m o f c o m m e r c e w i t h t h e

e x p e c t a t i o n t h a t t h e y w i l l b e p u r c h a s e d b y c o n s u m e r s i n t h e f o r u m

S t a t e

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. a t 2 9 7

– 9 8 ( c i t a t i o n o m i t t e d )

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r e g u l a r l y s o l d c a r s t o O k l a h o m a c u s t o m e r s

, e i t h e r d i r e c t l y o r t h r o u g h o t h e r s

,

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o f a n a u t o m o b i l e i n N e w Y o r k h a p p e n e d t o s u f f e r a n a c c i d e n t w h i l e p a s s i n g

t h r o u g h O k l a h o m a

. I d

. a t 2 9 8

. T h e C o u r t a c k n o w l e d g e d t h a t i t m a y b e

f o r e s e e a b l e t h a t a n a u t o m o b i l e

, b y i t s v e r y d e s i g n a n d p u r p o s e

, c o u l d c a u s e

i n j u r y i n O k l a h o m a

. I d

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. T h e C o u r t c o n c l u d e d

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j u r i s d i c t i o n u n d e r t h e D u e P r o c e s s C l a u s e

. I d

.

1 2 Case: 09-31056 Document: 00511201250 Page: 12 Date Filed: 08/11/2010N o

. 0 9

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T h e S u p r e m e C o u r t a g a i n a d d r e s s e d t h e s t r e a m o f c o m m e r c e t h e o r y i n

A s a h i M e t a l I

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. C o

. v

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p e r i o r C o u r t o f C a l

. , 4 8 0 U

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. 1 0 2 ( 1 9 8 7 )

. T h e

q u e s t i o n p r e s e n t e d i n t h a t c a s e w a s w h e t h e r a J a p a n e s e m a n u f a c t u r e r o f a v a l v e

a s s e m b l y f o r a m o t o r c y c l e t i r e w a s s u b j e c t t o j u r i s d i c t i o n i n C a l i f o r n i a a r i s i n g

o u t o f a n a c c i d e n t i n t h a t s t a t e

. I d

. a t 1 0 5

. T h e m o t o r c y c l e t i r e i n w h i c h t h e

d e f e n d a n t ’s v a l v e w a s i n c o r p o r a t e d w a s m a n u f a c t u r e d a n d a s s e m b l e d i n T a i w a n

.

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. T h e t i r e w a s i n c o r p o r a t e d i n t o a H o n d a m o t o r c y c l e t h a t w a s s o l d i n

C a l i f o r n i a

. I

d

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- 4

- 1 v o t e o n t h e q u e s t i o n o f w h e t h e r

f o r s e e a b i l i t y a l o n e w a s e n o u g h t o s u b j e c t t h e d e f e n d a n t m a n u f a c t u r e r t o

j u r i s d i c t i o n i n C a l i f o r n i a b a s e d o n t h e s t r e a m o f c o m m e r c e t h e o r y

. J u s t i c e

O ’ C o n n o r d e t e r m i n e d t h a t f o r s e e a b i l i t y a l o n e w a s i n s u f f i c i e n t

. I

d

. a t 1 1 2

– 1 3

( p l u r a l i t y o p i n i o n )

. J u s t i c e B r e n n a n c o n c l u d e d t h a t t h e d e f e n d a n t ’ s k n o w l e d g e

t h a t t h e p r o d u c t

, o n c e i n t r o d u c e d i n t o t h e m a r k e t

, w o u l d l i k e l y e n t e r t h e f o r u m

s t a t e w a s s u f

f i c i e n t t o m e e t t h e p u r p o s e f u l a v a i l m e n t r e q u i r e m e n t

. I d

. a t

1 1 6

– 1 7 ( B r e n n a n

, J

. , c o n c u r r i n g )

.

S o m e c i r c u i t s f

o l l o w J u s t i c e O ’ C o n n o r ’ s a n a l y s i s w h i l e o t h e r c i r c u i t s f o l l o w

J u s t i c e B r e n n a n ’ s a n a l y s i s

. T h i s c i r c u i t h a s a d o p t e d J u s t i c e B r e n n a n ’ s

a n a l y s i s

. F o r p r e s e n t p u r p o s e s

, t h e i m p o r t a n t f e a t u r e o f J u s t i c e B r e n n a n ’ s 7

c o n c u r r e n c e i s t h e n a t u r e o f t h e c a s e t o w h i c h t h e s t r e a m o f c o m m e r c e t h e o r y

a p p l i e s t o p e r m i t a p l a i n t i f f t o o b t a i n p e r s o n a l j u r i s d i c t i o n o v e r a f o r e i g n

r e s i d e n t

. I n d i s c u s s i n g t h e j u s t i f i c a t i o n f

o r s u b j e c t i n g a d e f e n d a n t t o p e r s o n a l

j u r i s d i c t i o n u n d e r t h i s t h e o r y

, J u s t i c e B r e n n a n s t a t e d :

T h e s t r e a m o f c o m m e r c e r e f e r s n o t t o u n p r e d i c t a b l e c u r r e n t s o r

e d d i e s

, b u t t o t h e r e g u l a r a n d a n t i c i p a t e d f l o w o f p r o d u c t s f

r o m

m a n u f a c t u r e r t o d i s t r i b u t i o n t o r e t a i l s a l e

. A s l o n g a s a p a r t i c i p a n t

See Ruston Ga s Turb ine s, Inc. v. Do nal dson Co.

, 9 F.3d 415, 420 (5t h Cir. 1993) (“ In 7

the years aft er As ahi

, the Fift h Circ uit has cont inued t o fol low the origi nal ‘s tre am- ofcom me rce ’ theo ry es tabl ish ed in the m a j orit y opi nion of Wor ld- Wid e Vo lks wa gen

, and has

rejec ted t he ‘s tre am- of- com me rce -p lus ’ theo ry a dvoc ated by the As ahi plur alit y.” )

.

1 3 Case: 09-31056 Document: 00511201250 Page: 13 Date Filed: 08/11/2010N o

. 0 9

- 3 1 0 5 6

i n t h i s p r o c e s s i s a w a r e t h a t t h e f i n a l p r o d u c t i s b e i n g m a r k e t e d i n

t h e f o r u m S t a t e

, t h e p o s s i b i l i t y o f a l a w s u i t t h e r e c a n n o t c o m e a s a

s u r p r i s e

. N o r w o u l d t h e l i t i g a t i o n p r e s e n t a b u r d e n f o r w h i c h t h e r e

i s n o t c o r r e s p o n d i n g b e n e f i t

. A d e f e n d a n t w h o h a s p l a c e d g o o d s i n

t h e s t r e a m o f c o m m e r c e b e n e f i t s e c o n o m i c a l l y f

r o m t h e r e t a i l s a l e

o f t h e f i n a l p r o d u c t i n t h e f

o r u m S t a t e

, a n d i n d i r e c t l y b e n e f i t s f r o m

t h e S t a t e ’ s l a w s t h a t r e g u l a t e a n d f a c i l i t a t e c o m m e r c i a l a c t i v i t y

. T h e s e b e n e f

i t s a c c r u e r e g a r d l e s s o f w h e t h e r t h a t p a r t i c i p a n t d i r e c t l y

c o n d u c t s b u s i n e s s i n t h e f o r u m S t a t e o r e n g a g e s i n a d d i t i o n a l

c o n d u c t d i r e c t e d t o w a r d t h a t S t a t e

.

I d

. a t 1 1 7 ( B r e n n a n

, J

. , c o n c u r r i n g )

.

T h e f a c t s o f t h i s c a s e s i m p l y d o n o t f i t t h e s t r e a m o f c o m m e r c e m o d e l

d e s c r i b e d b y J u s t i c e B r e n n a n

. U n l i k e t h e c a s e s w h e r e t h e s t r e a m o f c o m m e r c e

t h e o r y h a s b e e n a p p l i e d

, t h i s i s n o t a p r o d u c t s l i a b i l i t y c a s e o r s i m i l a r c a s e

w h e r e a d e f e n d a n t p l a c e s a p r o d u c t i n t h e s t r e a m o f c o m m e r c e a s p a r t o f a s a l e s

o r d i s t r i b u t i o n n e t w o r k d e s i g n e d t o m a r k e t i t s p r o d u c t s n a t i o n w i d e ( o r a t l e a s t

o u t s i d e o f i t s h o m e s t a t e ) w h e r e i t w o u l d d e r i v e f i n a n c i a l b e n e f

i t f r o m s a l e s i n

t h e f o r u m

. S e e

, e

. g

. , J o h n s t o n

, 5 2 3 F

. 3 d 6 0 2 ( 5 t h C i r

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.

H e l i c o p t e r o s A t u n e r o s

, I

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. B r u s h

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. 3 d 8 0 9 ( 5 t h C i r

. 2 0 0 6 )

. D e r i v i n g r e v e n u e f r o m

s u c h c o m m e r c i a l a c t i v i t y i s t h e q u i d p r o q u o f o r r e q u i r i n g t h e d e f e n d a n t t o

s u f f e r a s u i t i n t h e f

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. T h u s t h e d o c t r i n a l u n d e r p i n n i n g j u s t i f y i n g

t h e u s e o f t h e s t r e a m o f c o m m e r c e t h e o r y t o s u p p o r t p e r s o n a l j u r i s d i c t i o n d o e s

n o t a p p l y

. A d d i t i o n a l l y

, t h e i n d e p e n d e n t a c t i o n o f t h e i n s u r e d s i n t r a v e l i n g t o

t h e f o r u m s t a t e t o s e e k t r e a t m e n t o u t s i d e o f t h e i r c o v e r a g e a r e a i s a r g u a b l y

a n a l o g o u s t o t h e d r i v e r o f t h e a u t o m o b i l e i n W o r l d

- W i d e V

o l k s w a g e n

. T h i s

8

As add res se d above in Hu nt

, the ins urer paid for me dic al tre atm ent in Calif orni a aft er 8

the plai ntif

f mo ved fr om Penns ylvania to Calif orni a. In find ing no per so nal juris dic tio n over

the ins urer

, the Nint h Cir cuit s tat ed:

In our view, [p laint iff

]’ s decis ion to move to C alif orni a canno t be att ribut ed to

[t he ins urer ]. We sym pat hize wi th [p laint iff ]’ s cont enti on that she had to com e

1 4 Case: 09-31056 Document: 00511201250 Page: 14 Date Filed: 08/11/2010N o

. 0 9

- 3 1 0 5 6

i n d e p e n d e n t a c t i o n b y t h e i n s u r e d t o o b t a i n e m e r g e n c y c a r e i n L o u i s i a n a

,

u n r e l a t e d t o a n y m a r k e t i n g s c h e m e b y K a i s e r

, i s i n c o n s i s t e n t w i t h t h e n o t i o n

t h a t K a i s e r m a d e p u r p o s e f u l c o m m e r c i a l c o n t a c t w i t h L o u i s i a n a f o r t h e p u r p o s e

o f i n c r e a s i n g i t s r e v e n u e

. 9

W e t h e r e f

o r e c o n c l u d e t h a t t h e s t r e a m o f c o m m e r c e t h e o r y d o e s n o t a p p l y

a n d i s u n a v a i l a b l e t o C h o i c e t o a s s i s t i t i n e s t a b l i s h i n g p e r s o n a l j u r i s d i c t i o n o v e r

d e f e n d a n t s

.

I I I

F o r t h e f

o r e g o i n g r e a s o n s

, w e a g r e e w i t h t h e d i s t r i c t c o u r t t h a t p l a i n t i f f s

f a i l e d t o e s t a b l i s h p e r s o n a l j u r i s d i c t i o n o v e r t h e d e f e n d a n t s

. T h e j u d g m e n t o f

t h e d i s t r i c t c o u r t i s t h e r e f o r e a f f i r m e d

.

A F F I R M E D

.

to Calif orni a in ord er to obta in reha bilit ative tre atm ent.

. . . To char act erize her

dec isi on as an inte nt i o n a l act ion by [t he ins urer ], for pur pos es of me eti ng the

pur pos efu l availm ent req u i r e me nt of due pr oce ss

, wo uld fr ust rat e the very

pol icy behind that requ irem ent: ens uring that a “ def enda nt’s c o n d uct and

conne cti on wi th the for um Sta te are suc h that he sho uld reas onably antic ipat e

being haled in to cour t ther e.”

728 F.2d 1244, 1247 (9t h Cir. 1984) (quo ting Wor ld- Wid e Vo lks wa gen

, 444 U. S at 297)

(em phas is in origi nal)

.

It is tru e that this cir cuit has exten ded the st ream of com me rce analys is outs ide of the 9

pr oduc ts liabil ity cont ext. But thes e cas es are clos ely rela ted to pr oduc ts liabil ity cas es as they

all conc ern prod uct s introd uced into the stre am of om me rce by non- res ide nt def enda nts wh o

benef it fr om the pr oduc t’s fina l sal e in the for um. See, e. g.

, Luv N’ Care

, 438 F.3d 465 (s tre am

of com me rce analys is app lied to ass ert per so nal juris dic tio n for cop yright infr ingem ent clai m

over non- res ide nt man ufac tur er; the non- res ide nt man ufac tur er’ s infr inging pr oduc t wa s so ld

to Wal- Mar t wi th the hope and antic ipat ion that its pr oduc t wo uld be dis tri bute d to Wa l- Ma rts

acr os s the count ry); Nuov o Pignone

, SpA v. Storm an ASIA M/ V, 310 F.3d 374, 378 (5t h Cir.

2002) (p ers onal juris dic tio n over the for eign shi pp er for a brea ch of co n t r a c t clai m wh en

for eign shi pp er se nt def ect ive cra ne into the for um w h i c h c a u se d injury to for um res ide nt’ s

pr oduc t the shi pp er wa s del iveri ng; for eign shi pp er wa s “a volunt ary me mbe r of e cono mi c

chain that b ro ught pr oduc t to Louis iana” ); Gu lf Conso li dated Serv s.

, Inc. v. Cori nth Pip ew orks

, S.A

. , 898 F.2d 1071 (5t h Cir. 1990) (ap plying the st ream of com me rce pr incip le to a brea ch of

wa rra nty act ion wh en the dis tri buto r se nt the com pone nt par t cas ing to a dis tri buto r wi th the

expe cta tio n i t wo uld be so ld to all st ates ).

1 5 Case: 09-31056 Document: 00511201250 Page: 15 Date Filed: 08/11/2010