## Facts

- Laura Pemberton was near term and in labor after a prior cesarean using a vertical uterine incision extending into thickened myometrium, increasing rupture risk in later labor.
- Unable to find a physician willing to support vaginal delivery given her scar type, she planned a home birth with a midwife.
- After prolonged labor and dehydration, she went to the hospital for IV fluids but intended to return home to deliver and refused a recommended cesarean section.
- She left the hospital against medical advice while still in labor.
- Hospital physicians concluded a cesarean was medically necessary to avoid a substantial and imminent risk of uterine rupture and fetal death; risk estimates ranged from about 2% to 4–6%.
- Following an internal protocol for refusal of medically necessary care, the hospital sought an emergency state-court order compelling a cesarean based on medical testimony.
- A state judge ordered the cesarean; Pemberton was transported back to the hospital against her will, and surgery was performed.
- The baby was delivered healthy; Pemberton had no physical complications.
- Pemberton sued the hospital in federal court under 42 U.S.C. § 1983 and Florida tort law; the hospital accepted responsibility for physicians’ actions and moved for summary judgment.

## Issues

1. Whether the hospital and physicians acted under color of state law for purposes of 42 U.S.C. § 1983 by seeking and following a state-court order compelling treatment.
2. Whether compelling a competent pregnant patient to undergo a cesarean violated substantive due process rights to bodily integrity, refusal of treatment, and decisional autonomy regarding childbirth.
3. Whether the expedited emergency hearing and order provided constitutionally sufficient procedural due process.
4. Whether the hospital was liable under Florida law for negligence, false imprisonment, or related torts arising from the compelled transport and surgery.

## Decision

- The court granted summary judgment for the hospital on all claims.
- The court held that Pemberton did not establish a constitutional violation; even assuming state action, the state’s interest in preserving the life of a viable, near-term fetus outweighed her refusal of a cesarean in these circumstances.
- The court held the emergency judicial proceeding provided adequate procedural due process given the time-sensitive risk to the fetus.
- The court rejected the state-law tort claims, finding no actionable negligence and no unlawful confinement where actions were taken pursuant to a facially valid court order and medical necessity as determined by qualified physicians.

## Legal Principles

- A competent adult has a protected liberty interest in bodily integrity and refusing medical treatment, but the interest is not absolute when countered by sufficiently weighty state interests.
- When a fetus is viable and at or near term, and credible medical evidence shows a substantial and imminent risk of fetal death absent intervention, a court may conclude the state’s interest in preserving fetal life outweighs the pregnant patient’s refusal in a narrowly limited emergency setting.
- Substantive due process analysis may treat a dispute over method of delivery differently from decisions to avoid pregnancy or childbirth; the balancing can turn on imminence and magnitude of harm and relative burdens of the intervention.
- In emergency circumstances, an expedited hearing can satisfy procedural due process when there is judicial authorization based on medical testimony and an opportunity for the patient to be heard.
- Tort liability for confinement or compelled treatment is generally negated where conduct is authorized by a valid court order and undertaken in reliance on medical necessity consistent with the standard of care.

## Conclusion

The court entered summary judgment for the hospital, holding that the emergency, court-ordered cesarean did not violate federal due process rights and did not support negligence or false-imprisonment liability where medical evidence showed an imminent, substantial risk of fetal death and the intervention was authorized through an expedited judicial process.


Pemberton v. Tallahassee Mem'l Reg'l Med. Ctr., Inc., 66 F. Supp. 2d 1247 (N.D. Fla. 1999)