Opinion ID: 602
Heading Depth: 2
Heading Rank: 3

Heading: analysis

Text: Cossaboon contends that MMC purposefully established continuous and systematic contacts with New Hampshire sufficient to subject it to general jurisdiction in the state. She does not dispute that MMC is organized under Maine law, has its principal place of business in Portland, Maine, does not own property or maintain medical facilities in New Hampshire, and does not employ any healthcare professionals who provide medical services in New Hampshire. However, she points to evidence that MMC (1) advertised to New Hampshire residents, (2) operated a website accessible in New Hampshire, (3) registered to do business in New Hampshire and employed one person to work in New Hampshire, (4) participated in REMIS, a system that facilitates patient transfers, (5) entered into an agreement with Dartmouth Medical School in New Hampshire, and (6) treated a substantial number of New Hampshire residents at its Maine facility. Our analysis of whether MMC's contacts with New Hampshire are constitutionally sufficient to support the exercise of general jurisdiction ultimately depends upon those contacts viewed in the aggregate. See, e.g., Noonan, 135 F.3d at 93. However, we cannot determine whether MMC's contacts as a whole support the assertion of general jurisdiction without first exploring each type of contact to assess its quality, frequency, and, of particular importance, the extent to which it is purposefully directed toward New Hampshire residents. Therefore, we examine separately each of the contacts Cossaboon relies on to support her claim of general jurisdiction.
Cossaboon argues that MMC has consistently advertised its services in New Hampshire and these advertising efforts support the exercise of general jurisdiction. However, where defendant's only activities consist of advertising and employing salesmen to solicit orders, we think that fairness will not permit a state to assume jurisdiction. Harlow, 432 F.3d at 66 (internal quotation marks and citations omitted). In Harlow, we held that the hospital's advertising activities, which included sending monthly newsletters and other mailings directly to physicians in the forum state, were insufficient to support the exercise of general jurisdiction. Id. at 60, 65-66; see also Sandstrom, 904 F.2d at 89-90 (holding that defendant company's placement of help wanted ads in forum-based newspaper was neither pervasive nor even substantial advertising, and fell far short of bridging the jurisdictional gap). In prior cases, we have found even extensive advertising contacts with the forum state inadequate to permit an assertion of general jurisdiction. In Glater, the defendant, a pharmaceutical company, advertised in trade journals that circulated in the forum state, employed eight sales representatives to market products to potential customers in the state, and sold products to wholesale distributors located in the state. 744 F.2d at 215. We concluded that these advertising and solicitation activities did not meet the stringent standard for general jurisdiction. Id. at 217; see also Seymour v. Parke, Davis & Co., 423 F.2d 584, 585 (1st Cir.1970) (finding no general jurisdiction where defendant drug company advertised in the forum state by mail and employed six sales representatives in forum state to disseminate product information and take orders). MMC's advertising to New Hampshire residents is less purposeful and less extensive than the advertising contacts found insufficient in prior cases. MMC does not purchase advertisements in any New Hampshire-based newspapers, telephone directories, or radio or television stations. Although it issues periodic press releases to forty-five media outlets, only two of those outlets are based in New Hampshire, and no press releases are sent to only New Hampshire-based media. Moreover, there is no evidence regarding the content or frequency of these press releases. MMC has placed advertisements in one regional trade publication produced in New Hampshire, but it appears that it merely advertised job openings at MMC. Finally, MMC advertises on Maine-based radio and television stations, some of which have signals that reach parts of New Hampshire. However, this advertising, although it may incidentally reach some New Hampshire viewers or listeners, is not targeted toward New Hampshire residents in particular. Cossaboon relies on Soares v. Roberts, 417 F.Supp. 304 (D.R.I.1976), to argue that advertising activities similar to those engaged in by MMC have been found to support an assertion of personal jurisdiction. In Soares, the court held that the defendant, a Boston, Massachusetts medical facility that performed abortions, was subject to personal jurisdiction in Rhode Island. Id. at 307. The court based its conclusion in part on evidence that the facility placed advertisements in local Rhode Island newspapers, received regular referrals from Rhode Island healthcare providers, and employed a staff-person to inform Rhode Island healthcare providers about its services. Id. Soares does not support a finding of general jurisdiction in this case. The Soares court exercised specific jurisdiction over the defendant, but made it clear that it was hesitant to assert general jurisdiction. Id. at 307-08 (noting that the facility's advertising had a direct connection with the case at bar because the plaintiff was within the class of persons the advertising was designed to reach, and holding that personal jurisdiction extended at least as to those individuals whose business the solicitation was designed to obtain). Furthermore, the advertising to forum state residents in Soares was more extensive and more purposeful than MMC's occasional press releases and help-wanted advertisements that may have been viewed by New Hampshire residents.
Cossaboon contends that MMC's user-friendly and interactive website, www.mmc.org, supports the exercise of general jurisdiction. It is clear that the mere existence of a website that is visible in a forum and that gives information about a company and its products is not enough, by itself, to subject a defendant to personal jurisdiction in that forum. McBee v. Delica Co., 417 F.3d 107, 124 (1st Cir.2005) (addressing analogous issue of extraterritorial jurisdiction under the Lanham Act). Given the omnipresence of internet websites, such a rule would eviscerate the limits on personal jurisdiction over out-of-state defendants. Id. Instead, for website activity to support the exercise of personal jurisdiction, [s]omething more is necessary, such as interactive features which allow the successful online ordering of the defendant's products. Id. In addressing what more is required to support the exercise of general jurisdiction based on website activity, courts have focused on the extent to which the defendant has actually and purposefully conducted commercial or other transactions with forum state residents through its website. See, e.g., Dagesse v. Plant Hotel N.V., 113 F.Supp.2d 211, 223 (D.N.H.2000) ([A] proper analysis of the jurisdictional effects of an internet web site must focus on whether the defendant has actually and deliberately used its website to conduct commercial transactions or other activities with residents of the forum.); Coastal Video Commc'ns Corp. v. Staywell Corp., 59 F.Supp.2d 562, 571-72 (E.D.Va.1999) (finding the mere existence of an interactive website insufficient to support general jurisdiction); 4A Charles A. Wright & Arthur R. Miller, supra, § 1073.1. We employed such an analysis in Harlow, reasoning that the hospital's website, although accessible in the forum state, did not support a finding of general jurisdiction because the hospital did not actually do business through its website. 432 F.3d at 65-66. Cossaboon emphasizes that MMC's website is not purely informational, but has interactive features. The website permits users to make online donations, complete patient pre-registration, register for classes, find a doctor, and apply for employment. Although it has these interactive features, MMC's website does not sell or render services online. Instead, the site is primarily informational and discusses the healthcare services provided at MMC's facility in Maine. Moreover, MMC's website is available to anyone with internet access and does not target New Hampshire residents in particular. Although MMC's interactive website advertises MMC's services and may increase the chance that users turn to MMC for their healthcare needs, that is no more true of New Hampshire residents than it is of any other visitors to the website. The mere fact that such an interactive site is accessible in New Hampshire does not indicate that MMC purposefully availed itself of the opportunity to do business in New Hampshire. Cossaboon asserts that MMC's website is designed to reach and appeal to New Hampshire residents specifically. However, she points only to evidence that a keyword search of MMC's site for New Hampshire yields four web pages that mention the state. [4] These four stray references to New Hampshire on MMC's website do not indicate that MMC intentionally uses its website to target New Hampshire residents. Indeed, the homepage of MMC's website does not mention New Hampshire at all but instead focuses on MMC's services to the Portland area and the state of Maine, stating that MMC fills a dual role: it is Maine's premier referral hospital, offering services not available elsewhere in the state, and it is a community hospital serving the greater Portland region. MMC's website, although available to New Hampshire residents, is not purposefully directed toward them. [5]
Cossaboon emphasizes that at the time of E.C.'s alleged injury, MMC was registered to do business in New Hampshire and employed one person in New Hampshire to do work related to the Poison Control Center. Corporate registration in New Hampshire adds some weight to the jurisdictional analysis, but it is not alone sufficient to confer general jurisdiction. See Sandstrom, 904 F.2d at 89 (finding no general jurisdiction where, inter alia, company was registered to do business in forum and conducted limited advertising in forum). [P]reparations to do business at an indeterminate future date, without more, cannot be confused with actually doing business in the forum state. Id. We do not find it significant that MMC stated on its application for business registration that its principal business purpose was including but not limited to poison control serv[ic]es. There is no evidence that MMC conducted any services in New Hampshire apart from those described above related to the Poison Control Center. At most, MMC's broad statement of its business purposes on its registration application suggests preparations to do additional business in New Hampshire at some point in the future. Here, MMC's lone Poison Control Center employee in New Hampshire did not provide any medical services, poison-related or otherwise, in New Hampshire. Calls to the Poison Control Center are handled by MMC staff in Maine, and all of MMC's poison-related medical services are provided in Maine. Instead, MMC's one New Hampshire-based employee simply provided information and consultation services to healthcare providers and others interested in the Poison Control Center's work. MMC's employment of one person to educate New Hampshire residents about the availability of MMC's poison-related services is akin to a company's employment of individuals to advertise company products to forum residents. We have held that far more extensive advertising and marketing activities in the forum state fell short of establishing general jurisdiction. See Glater, 744 F.2d at 215 (employment of eight salesmen to market products in forum state); Seymour, 423 F.2d at 585 (employment of six salesmen in forum state). Furthermore, while in cases like Glater and Seymour the products advertised are then sold for use in the forum state, here MMC's advertised services are available only in Maine.
Cossaboon points to MMC's participation in REMIS to support her claim of general jurisdiction. REMIS is a twenty-four-hour communication center that facilitates transfers to MMC once other hospitals and caregivers have contacted MMC with a transfer request. For example, when a caregiver calls MMC to request a transfer, REMIS facilitates determination of the appropriate services to contact and then monitors the call to collect transfer information. Transfer requests are initiated by the patient's own caregiver, not by MMC, and patients still must travel to Maine to receive MMC's medical services. MMC has no agreement with New Hampshire physicians whereby patients are directed to MMC for medical services, and there is no indication that MMC participates in REMIS in order to attract more referrals from New Hampshire in particular. MMC's participation in REMIS does not reflect any act by which MMC purposefully directs its activities toward New Hampshire residents. Cossaboon relies on Kenerson v. Stevenson, 604 F.Supp. 792 (D.Me.1985), to argue that MMC's participation in REMIS supports a finding of general jurisdiction. In Kenerson, the district court held that a New Hampshire hospital was subject to general jurisdiction in Maine. Id. at 795. The court based its exercise of jurisdiction on the hospital's treatment of Maine patients (approximately 8% of total patient admissions), receipt of reimbursement from the Maine Department of Human Services, and participation in REMIS, a system that contemplates emergency transfer of patients. Id. The district court's opinion in Kenerson, although not expressly overruled by Harlow, is clearly in tension with that decision. See Harlow, 432 F.3d at 65 n. 9 (neither approving of or distinguishing Kenerson, but instead stating that [w]hether Kenerson is correct or not, the evidence here does not establish general jurisdiction). In light of our subsequent holding in Harlow, we find Kenerson unpersuasive here. [6]
Finally, Cossaboon relies on evidence that MMC treats a substantial number of patients from New Hampshire and derives revenue from its treatment of those residents. However, MMC treats New Hampshire residents only in Maine; it provides no medical services in New Hampshire. As we explained in Harlow, [t]reating patients from Maine in Massachusetts, even on a regular basis, is not the same as engaging in continuous and systematic activity in Maine. A hospital that treats Maine residents in Massachusetts is, quite simply, in a different position from a hospital that treats Maine residents in Maine. Harlow, 432 F.3d at 66. Our conclusion in Harlow was not altered by the fact that the Massachusetts hospital derived revenue from treating Maine patients, a portion of which came from Maine Medicaid. Id. at 66 (citing Wolf v. Richmond County Hosp. Auth., 745 F.2d 904, 906 (4th Cir. 1984), which held that defendant hospital was not subject to general jurisdiction even though hospital derived approximately one-fifth of its income from forum-state residents). In this case, New Hampshire residents represent only 1.23% of all patients treated at MMC and 2.9% of all in-patient admissions to MMC. Similarly, payments for treatment of New Hampshire residents, whether from New Hampshire Medicaid or private insurers, account for just 3.24% of MMC's total revenue. MMC's treatment of some patients from the bordering state of New Hampshire does not indicate that MMC purposefully attracted New Hampshire patients or otherwise directed its services toward New Hampshire residents. We cannot subject MMC to general jurisdiction based on the unilateral activity of New Hampshire patients who choose to travel to Maine for medical treatment at MMC. Burger King, 471 U.S. at 475, 105 S.Ct. 2174.