The Ninth Circuit has been grappling with specific personal jurisdiction ever since the Supreme Court altered the playing field ever so slightly in 2021 with Ford Motor Co. v. Montana. That grappling includes an opinion published just last week, where the Ninth Circuit found specific personal jurisdiction over out-of-state medical providers. The medical providers had not entered the forum state, and the care at issue occurred entirely outside the forum state. But the providers had offices just outside state borders, and they transmitted prescriptions to pharmacies in the forum state. That, according to the court, was enough to establish personal jurisdiction over the providers in a case alleging harm caused by those prescriptions.
The case is Cox v. Gritman Medical Center, No. 24-1947, 2026 WL 378500 (9th Cir. Feb. 11, 2026) (to be published in F.4th). In Cox, a physician in Moscow, Idaho, treated a resident of Eastern Washington for six years and prescribed multiple prescription medicines over that time. After the patient sadly died, allegedly because of a fatal overdose, her heirs sued the doctor and the clinic. Again, the providers were entirely in Idaho, and they provided all the medical care at issue in Idaho, including determining which medicines to prescribe.
The district court thus dismissed the complaint for lack of personal jurisdiction, but the Ninth Circuit reversed. In the years leading up to Ford, the Supreme Court performed yeoman’s work in restoring discipline to the jurisprudence of personal jurisdiction. The Bauman opinion in 2014 held that general personal jurisdiction would lie only where the defendant was “at home,” which for a corporation generally means the state of incorporation or its principal place of business. The Supreme Court followed Bauman in 2017 with Bristol-Myers Squibb, which held that state courts cannot exercise specific personal jurisdiction over non-resident defendants for claims brought by out-of-state plaintiffs who did not buy or use the defendant’s product in that state.
Then came Ford, which gave resident plaintiffs (not forum shoppers) some leeway in reaching out-of-state defendants based on forum contacts “related to” the alleged injury, as opposed to “arising out of.”
For better or for worse, that leeway is what allowed the Ninth Circuit’s opinion in Cox. According to the court, the Idaho physician and the Washington patient had a long-term relationship that “was intertwined with [the physician’s] relevant contacts with Washington.” Cox, at *5. What were those contacts? Well, not much. Sure, the physician treated the Washington patient for a long time, but the patient came to her in Idaho—not the other way around. She also practiced at a clinic near Washington whose “business model includes serving patients throughout a rural region encompassing an area that spans Idaho and Washington.” Id. at *6. But such vague contacts are what Bristol-Myers Squibb shut down. Even Ford famously cautioned that “relate to” does not mean “anything goes.” To the contrary, the “relate to” prong still requires a close connection between the forum contacts and the injury.
As far as we can tell, it came down to the prescriptions. At the patient’s request, the physician electronically transmitted prescriptions to Washington pharmacies for the patient’s convenience. Does that forum contact “relate to” the patient’s alleged injury? We suppose it does, seeing as how the complaint alleged a prescription drug overdose. It’s a stretch though. An electronic transmission across state lines will not always be sufficient, but evidently it was here. Compare Cox with another Ninth Circuit opinion that went the other way, Yamashita v. LG Chem, Ltd., which we covered here. In that case, the out-of-state defendants shipped products through the forum state and sold products in the forum state, including some that contained components similar to those at issue. Third parties sold the defendant’s product on the Internet, including in the forum state. The Ninth Circuit, however, held that those forum contacts were not sufficient to support specific personal jurisdiction.
It is difficult to square Cox with Yamashita. Regardless, the practical impact of the Cox opinion is that it arguably expands the ways in which courts can exercise personal jurisdiction over out-of-state service providers. So look out. In the end, we take comfort in the Supreme Court’s admonition in Ford: “Some relationships will support jurisdiction without a causal showing. That does not mean anything goes. In the sphere of specific jurisdiction, the phrase ‘relate to’ incorporates real limits, as it must to adequately protect defendants foreign to a forum.” Ford Motor Co. v. Montana Eighth Jud. Dist., 141 S. Ct. 1017, 1026 (2021). The Ninth Circuit is still feeling out where those “real limits” lie.