Opinion ID: 201973
Heading Depth: 4
Heading Rank: 1

Heading: Contacts as Alleged by Harlow

Text: We review the facts in two different categories: first, the evidence before and around the alleged tort, and second, the evidence after and unrelated to the alleged tort. i. Evidence From Before and During the Period of the Alleged Tort -12- Harlow's pediatrician in Maine was the person who recommended that Harlow be examined at the Hospital; the referral was made in the spring of 1993. After recommending an examination at the Hospital and before Harlow's first appointment there, Harlow's pediatrician sent Harlow's medical records from Maine to the Hospital. Harlow had her first appointment at the Hospital on April 27, 1993, and she underwent the contested procedure there on May 10, 1993. It appears that the Hospital discharged Harlow on May 19 or 20, 1993. It is unclear whether Harlow visited the Hospital again after being discharged. The district court believed that there were some follow-up visits, but Harlow did not so allege.4 At Harlow's April 27, 1993, appointment, her mother explained to the doctor that she was concerned about the family's ability to pay for the recommended procedure, and the doctor stated that his office would take care of making the necessary arrangements. Before Harlow underwent the procedure, the Hospital obtained authorization from the Maine Medical Assistance Program (Maine Medicaid), which approved and agreed to pay for the 4 Harlow alleged only that the Hospital sought and obtained authorization from Maine Medicaid for follow-up care at the Hospital. From the part of the record to which she cites, it appears that the Hospital obtained authorization for a visit during April or May 1995, but Harlow does not claim (or cite any part of the record to show) that such a visit, or any other visit, in fact occurred. There are only two actual visits, then, that Harlow has alleged and provided record support for: the first appointment, and the procedure itself. -13- procedure.5 Ultimately, Maine Medicaid paid over $20,000 to the Hospital for Harlow's procedure and immediate follow-up care at the Hospital. It appears that the Hospital, before discharging Harlow, performed various tests, including a cerebral CT scan, an MRI, and an ultrasound study of the carotid artery, and that it administered phenobarbital treatment (for an unspecified length of time, but at least on May 17) for left-sided simple partial seizures. If the state of Maine had not paid for the procedure at the Hospital, the Harlows would not have been able to afford it, and they would have sought other treatment. After Harlow was discharged from the Hospital, she received most of her follow up care from Maine health care practitioners. Harlow was discharged from the Hospital to the Maine Medical Center for an extensive course of rehabilitation. Since then, she has been in a special education program and requires a one-on-one aide at school. According to a physician who evaluated Harlow and reviewed her records, Harlow needs individual psychological counseling as well as a group social training program, and she will have difficulty 5 The district court correctly refused to consider Harlow's contention that the Hospital has maintained for decades an active relationship with Maine Medicaid, that it had a Provider ID Number before and after May 1993, and that under Maine law it was required to regularly submit documentation to the State of Maine in order to keep its active Provider ID number. This was because Harlow failed to cite any record evidence to support this contention. Harlow did cite record evidence to support, and the district court did consider, the Hospital's arranging for Maine Medicaid to pay for Harlow's own treatment. -14- living independently, maintaining family and social relationships, and earning a living. Harlow alleged that the cost of her future care will be over $800,000. Harlow alleged a number of communications between the Hospital and various individuals in Maine. There is a letter, dated April 30, 1993,6 from a Hospital doctor to Harlow's pediatrician, which refers to a prior phone call that the writer made to the pediatrician, and which thanks the pediatrician for referring Harlow to the Hospital. The evidence as to postprocedure communications is sparse. After the procedure, Hospital staff had further communications with Harlow's pediatrician, another pediatrician in Maine, Harlow's mother, and Maine Medicaid. Harlow states that the Hospital sent multiple correspondence to [these] individuals regarding Danielle, and that when a Hospital doctor spoke with Harlow's mother on the telephone in January 1997, he also sent correspondence, including various medical articles. ii. Evidence From After the Alleged Tort Much of Harlow's evidence concerned the second category: for periods after and unrelated to the alleged malpractice on May 6 Harlow alleged only one pre-1993 contact: that since 1988, the Hospital has sent relations specialists to meet with pediatricians and family practitioners. The district court did not consider this contention, because Harlow had not indicated that these relations specialists ever visited or had any connection with Maine (or even New England). On appeal, Harlow has still failed to specify whether this outreach program ever included Maine doctors in general or her pediatrician in particular. -15- 10, 1993. We detail the evidence before we address whether the post-tort evidence can be considered for either the specific jurisdiction analysis or the general jurisdiction analysis. Harlow presented evidence that in 1998 and 1999, roughly 100 inpatients per year were referred to the Hospital from Maine. In 1998, the Hospital charged $2.4 million to Maine Medicaid. In 1999, the Hospital charged $1.6 million to Maine Medicaid for inpatient services plus another $500,000 for outpatient services. The Hospital was not incorporated in Maine and is not registered to do business there. Harlow alleged that, nevertheless, the Hospital actively markets and promotes its business and services within Maine's borders. Her proffered evidentiary materials are largely undated and, to the extent they are dated, they post-date her May 1993 procedure. In particular, Harlow alleged, the Hospital's marketing department specifically targets physicians located in Maine. Harlow alleged that the Hospital has initiated a campaign to mail every single pediatrician located in the State of Maine an informational packet. Harlow alleged no time frame here; her only record citation reveals that eighty-two copies of a Pediatric Specialist Guide were mailed to Maine pediatricians in 2000, and the Hospital's representative testified that he was unaware of any other referral guides being sent. The Hospital also publishes a monthly newsletter on pediatrics that, since 1999, has been mailed -16- to pediatricians who practice in Maine. The Hospital has also mailed a number of brochures to Maine pediatricians. Harlow did not allege any specific dates on which brochures were mailed; at the Hospital's deposition, the Hospital's representative testified that some brochures were mailed on one occasion in the spring of 2000 to eighty-two pediatricians in Maine, and that none of these items that have been marked as exhibits go to patients or consumers. The Hospital has advertised in the Journal of Pediatrics. The exhibit Harlow cited for this allegation does not indicate when (or, for that matter, whether) the advertisement was published. The Hospital's representative testified at the Hospital's July 2000 deposition that this advertisement is the first I've ever heard of in a national magazine, and the advertisement had only been created around two or three weeks ago. The Hospital has run advertisements in the Boston Globe, which is widely circulated in Maine. Harlow alleged that this was in the 1990's. At the Hospital's deposition, the representative testified that he was only aware of one paid advertising campaign in the Boston Globe, and it ran for a threeor four-week period in 1997. Harlow also alleged that the Hospital has run an advertisement in a Maine newspaper on at least one occasion in October 1996. She also alleged that the Hospital has advertised on Maine television and radio stations. She gives -17- no dates, and the exhibit she cites is a webpage that was apparently last updated in August 2002 and printed in February 2005; the webpage describes then-current and planned broadcast promotions. Harlow also pointed to other parts of the Hospital's website that provide information for Maine physicians to refer patients to Children's Hospital, as well as driving directions from Maine to Massachusetts.