Ex parte Tanner: Extending Ford’s “Relate-To” Specific Jurisdiction to Cross‑Border Health Systems; AMLA Venue Applicability to Out‑of‑State Malpractice Unresolved

Ex parte Tanner: Extending Ford’s “Relate-To” Specific Jurisdiction to Cross‑Border Health Systems; AMLA Venue Applicability to Out‑of‑State Malpractice Unresolved

Introduction

This commentary analyzes the Alabama Supreme Court’s September 12, 2025 decision in Ex parte Tanner Medical Center, Inc., denying a petition for writ of mandamus in a medical-malpractice case brought by an Alabama resident against a Georgia hospital system. The core dispute centered on whether an Alabama trial court may exercise personal jurisdiction over a Georgia health system for negligence that occurred in Georgia, when the patient’s course of treatment began at an affiliated facility in Alabama and the health system markets an integrated suite of services spanning the Alabama–Georgia border. The petition also challenged venue under the Alabama Medical Liability Act (“AMLA”) and, alternatively, under general venue law.

The parties are:

  • Petitioner: Tanner Medical Center, Inc. (“Tanner”), a Georgia corporation headquartered in Carrollton, Georgia, operating hospitals and clinics in West Georgia, and—through an affiliate—operating a community hospital and a few clinics in East Alabama.
  • Respondent/Plaintiff: Richard Terry Cole, an Alabama resident, who presented to Tanner’s affiliated Wedowee, Alabama hospital and was transferred to Tanner’s Carrollton facility for a heart catheterization by a Georgia-licensed physician, Dr. Christopher Arant.

Key issues:

  • Personal jurisdiction: Whether Alabama courts have specific jurisdiction over an out-of-state hospital system where the alleged malpractice occurred in Georgia but the care commenced at a Tanner-affiliated Alabama facility and Tanner markets and serves East Alabama.
  • Venue: Whether AMLA’s venue statute (§ 6-5-546) applies when a plaintiff alternatively pleads Georgia medical malpractice law and the alleged acts occurred outside Alabama; and if not, whether general venue statutes govern.
  • Mandamus posture: Whether Tanner demonstrated a clear legal right to dismissal based on lack of personal jurisdiction or improper venue.

Summary of the Opinion

The Alabama Supreme Court denied Tanner’s petition. The Court held:

  • No general jurisdiction over Tanner in Alabama (Tanner is a Georgia corporation with its principal place of business in Georgia; its Alabama operations are not so “exceptional” as to render it “at home” here under Goodyear/Daimler and BNSF).
  • Specific jurisdiction is proper under Ford Motor Co. v. Montana Eighth Judicial District Court: Tanner purposefully availed itself of the Alabama market and created an integrated regional care model for East Alabama that includes transfer to Georgia for advanced procedures. Cole’s claims “relate to” those Alabama contacts even though the alleged negligent acts occurred in Georgia.
  • Venue: The Court declined to dismiss for improper venue on mandamus. It flagged, but did not decide, a first‑impression question whether AMLA’s venue statute applies to out-of-state medical negligence claims governed by another state’s substantive law. Tanner did not sufficiently brief this point to establish a “clear legal right” to mandamus relief; hence, Alabama’s default venue provisions appear applicable on the present record.

Concurring and dissenting opinions emphasize the case’s broader stakes. Justice Cook concurred specially, underscoring (1) substantial reasons why Georgia may be the more appropriate forum and (2) that forum non conveniens (§ 6‑5‑430) was not invoked. Justices Shaw and Sellers dissented, arguing Alabama lacks specific jurisdiction under Ford where the alleged malpractice and injury occurred in Georgia and stressing the prudential and doctrinal concerns of trying Georgia malpractice law in Alabama courts.

Detailed Analysis

I. Precedents and Authorities Cited

1. International Shoe and its Progeny

The Court reiterated the due-process minimum-contacts standard (International Shoe Co. v. Washington) and the bifurcation of personal jurisdiction into general and specific (Goodyear Dunlop Tires; Daimler AG v. Bauman). General jurisdiction exists where a corporation is “at home”—typically place of incorporation and principal place of business—with “exceptional case” exceptions (e.g., Perkins). Specific jurisdiction requires the suit to “arise out of or relate to” the defendant’s forum contacts (Bristol–Myers Squibb).

2. General Jurisdiction: BNSF Railway Co. v. Tyrrell

BNSF confirms that substantial in-state business does not alone render a corporation “at home.” The Court analogized: even with a 15‑bed hospital and a few Alabama clinics, Tanner’s corporate home and the bulk of its operations are in Georgia, precluding general jurisdiction in Alabama.

3. Specific Jurisdiction: Ford Motor Co. v. Montana Eighth Judicial District Court

Ford is the fulcrum of the Court’s analysis. Ford holds that specific jurisdiction does not require strict causation between a defendant’s in-state conduct and the plaintiff’s injury. Instead, the litigation must “arise out of or relate to” the defendant’s forum contacts. When a company purposefully serves a market in a state, it may be sued there for claims sufficiently related to that conduct—even if design, manufacture, or first sale occurred elsewhere.

Alabama applied Ford in Sawyer v. Cooper Tire & Rubber Co. (2024), holding specific jurisdiction over a tire manufacturer whose dealer network and sales in Alabama related to an in‑state crash caused by an allegedly defective tire.

4. Limits on Specific Jurisdiction: Walden v. Fiore

Walden emphasizes that the defendant’s own suit-related contacts with the forum matter; mere effects felt in the forum are insufficient. The officer there lacked Nevada contacts. Tanner relied on Walden to argue that its alleged negligent acts were wholly in Georgia. The majority distinguished that Tanner purposefully engaged Alabama by operating and marketing an integrated cross-border system linking Alabama patients to Georgia specialty care.

5. Mandamus and Venue Standards

  • Mandamus lies to review denials of motions to dismiss for lack of personal jurisdiction or improper venue. The petitioner must show a clear legal right. See Ex parte Gulf Health Hospitals, Inc.; Ex parte Kennedy; Ex parte Chin; Ex parte Kentucky Farm Bureau Mut. Ins. Co. (2025).
  • AMLA venue (§ 6‑5‑546): Requires filing in the county where the alleged breach occurred; but its applicability to out‑of‑state malpractice governed by foreign law is unsettled. Alabama’s default venue statute for corporations (§ 6‑3‑7(a)(3)) otherwise allows venue where the plaintiff resides and the corporation does business by agent.
  • Forum non conveniens (§ 6‑5‑430): Authorizes dismissal without prejudice in favor of a more appropriate forum outside Alabama when properly moved and supported; not raised here.

II. The Court’s Legal Reasoning

A. No General Jurisdiction

Applying BNSF/Goodyear/Daimler, the Court found Tanner’s Alabama footprint insufficient to render it “at home.” Tanner is a Georgia corporation with its principal place of business in Georgia; its Alabama operations are limited relative to its regional footprint. No “exceptional case” (like Perkins) was shown.

B. Specific Jurisdiction Exists Under Ford’s “Relate-To” Prong

The pivotal holding is that Alabama may exercise specific jurisdiction over Tanner even though the alleged malpractice occurred in Georgia, because the claims “relate to” Tanner’s Alabama contacts in a non‑causal but sufficiently connected way:

  • Tanner purposefully availed itself of Alabama by operating an Alabama hospital and clinics and marketing a regional “Tanner Health System” that expressly serves East Alabama and connects Alabama patients to Georgia-based specialty services (including heart care).
  • Cole’s course of treatment began at the Alabama hospital, from which he was transferred—“per Tanner’s instructions”—to a Tanner facility in Georgia for the procedure at issue. The transfer and procedure were presented as parts of a single, integrated continuum of care that Tanner designed and marketed to East Alabama residents.
  • Under Ford, strict causation is not required. The “relationship among the defendant, the forum, and the litigation” is close enough: the Alabama-initiated, Tanner-orchestrated care pathway was the avenue through which the allegedly negligent Georgia procedure was performed.

In effect, the Court extended Ford’s “relate-to” analysis—developed in the products context—to the provision of professional services, specifically cross-border, integrated health care. The opinion explicitly invokes Tanner’s marketing and operations model, which positions Tanner as a regional provider offering Alabama patients access to Georgia specialty services, to find the requisite affiliative link to Alabama.

C. Venue: AMLA Statute Unresolved; No Clear Legal Right to Dismissal

Tanner argued AMLA’s venue statute (§ 6‑5‑546) mandates suit “in the county wherein the act or omission … actually occurred,” and because the alleged malpractice occurred in Georgia, there is no proper Alabama county—hence dismissal. The Court did not accept that sweeping conclusion at the mandamus stage. It observed:

  • There is a serious, unresolved question whether § 6‑5‑546 applies when the claim is governed by another state’s substantive medical liability law and the core conduct occurred outside Alabama. The materials show the alleged malpractice is by a Georgia-licensed physician practicing solely in Georgia.
  • The concurrence highlights statutory text indicating the AMLA’s definition of “health care provider” turns on Alabama licensure. If the alleged negligent actor is not an AMLA “health care provider,” AMLA’s venue rule may not apply at all—reinforcing the unsettled nature of Tanner’s argument.
  • Tanner’s mandamus petition did not adequately brief the threshold question whether § 6‑5‑546 governs such out-of-state, foreign-law claims. Under Alabama’s preservation and briefing standards (e.g., Ex parte Drury Hotels Co.), that omission defeats a “clear legal right” to mandamus relief on venue.

The Court therefore left § 6‑5‑546’s extraterritorial reach for another day and, on this record, implied that Alabama’s default venue statute likely governs—making venue in Randolph County facially proper because Cole resides there and Tanner does business by agent in Alabama.

D. Forum Non Conveniens: Flagged, Not Decided

Justice Cook’s special concurrence emphasizes that forum non conveniens (§ 6‑5‑430) may be the right tool for funneling such cross-border medical cases to Georgia, given the location of the conduct, witnesses, records, licensure, and probable Georgia substantive law. But because Tanner did not move for dismissal on forum non conveniens grounds, the Court could not grant that relief.

III. The Separate Opinions

Justice Cook (concurring specially)

Justice Cook fully joins the denial but stresses:

  • AMLA applicability is doubtful when the allegedly negligent physician is not Alabama-licensed—casting doubt on using AMLA’s venue rule for out-of-state events governed by foreign law.
  • Forum non conveniens likely points to Georgia as a “more appropriate forum,” but the defendant must timely move and show the requisite factors; absent such a motion, the Court cannot intervene sua sponte.

Justice Shaw (dissenting)

Justice Shaw would grant the writ for lack of specific jurisdiction. He reads Ford as anchored to the forum state being the place where the malfunction/accident and the injury occurred. Because here the procedure and injury occurred in Georgia, he concludes Alabama’s forum interests are weak and Tanner lacked “fair warning” of being sued in Alabama. He emphasizes interstate federalism and the suitability of Georgia law and forums for this dispute.

Justice Sellers (dissenting)

Justice Sellers would also grant mandamus, focusing on:

  • Practical and doctrinal difficulties of trying Georgia malpractice in Alabama courts (specialized standards, expert requirements, damages rules, etc.).
  • Potential problems with vicarious liability if the agent-physician is dismissed for lack of personal jurisdiction, citing Alabama’s rule that a principal’s liability under respondeat superior ordinarily depends on the servant’s negligence (University of Alabama Health Servs. Found., P.C. v. Bush).
  • Judicial economy and convenience overwhelmingly favor Georgia; Alabama courts should not bear this burden where all operative facts and regulatory interests are in Georgia.

Complex Concepts Simplified

  • General vs. Specific Jurisdiction:
    • General jurisdiction lets a court hear any claim against a defendant, but only where the company is “at home” (usually incorporation and principal place of business).
    • Specific jurisdiction is case-linked: the claim must “arise out of or relate to” the defendant’s forum contacts.
  • “Arise out of” vs. “Relate to” (Ford):
    • “Arise out of” suggests causation—forum conduct causes the claim.
    • “Relate to” is broader—there need not be strict causation if there is a close, meaningful connection between the claim and the defendant’s in-state activities (e.g., integrated marketing and service pathways that channel the plaintiff into the disputed transaction).
  • Purposeful Availment:
    • The defendant must deliberately engage with the forum (e.g., operating facilities, advertising, running clinics) so that being sued there is foreseeable.
  • Mandamus:
    • An extraordinary remedy; the petitioner must show a “clear legal right” to the requested relief and no adequate alternative. Procedural missteps, such as incomplete briefing on a dispositive legal question, typically defeat mandamus.
  • AMLA Venue (§ 6‑5‑546):
    • Ordinarily requires filing where the breach “actually occurred.”
    • Open question flagged here: whether that statute governs out-of-state malpractice actions governed by foreign law, particularly when the alleged negligent actor is not an AMLA “health care provider” because not Alabama-licensed.
  • Forum Non Conveniens (§ 6‑5‑430):
    • Allows Alabama courts to dismiss in favor of a more appropriate forum (e.g., Georgia) considering the location of acts, witnesses, records, convenience, and the interests of justice. The defendant must timely move and prove these factors.
  • Lex Loci Delicti vs. Lex Fori:
    • Alabama generally applies the substantive law of the place of the injury (here, likely Georgia) but uses Alabama procedural law unless a specific statute applies otherwise.

Impact and Practical Implications

A. Substantive Impact: Extending Ford to Cross-Border Health Care

The decision is a significant application—and practical extension—of Ford’s “relate-to” standard from products to professional services. Hospital systems that:

  • Operate facilities in Alabama,
  • Market integrated services to Alabama residents, and
  • Channel Alabama patients to out-of-state facilities for specialized care,

are now on clearer notice that Alabama courts may exercise specific jurisdiction over claims arising from the out-of-state procedures when the patient’s care began in Alabama and the integrated pathway is part of the provider’s Alabama-facing operations and marketing. This “continuum-of-care” nexus can satisfy Ford’s “relate-to” prong even absent strict causation within the forum.

B. Venue and Choice-of-Law: Open Questions

The Court expressly left unresolved whether AMLA’s venue statute regulates claims for out-of-state malpractice governed by foreign law. The concurrence’s textual analysis suggests the AMLA may not apply when the allegedly negligent physician is not Alabama-licensed, which—if adopted—would push these disputes into Alabama’s default venue rules when Alabama courts exercise jurisdiction at all.

Choice-of-law was not decided, but both separate opinions and the record point to Georgia substantive law under lex loci delicti. Expect litigants to brief forum non conveniens early and thoroughly to address the place of conduct, convenience, and interests of justice.

C. Litigation Strategy: Practice Pointers

  • Defense counsel for cross-border health systems should:
    • Raise forum non conveniens (§ 6‑5‑430) alongside personal jurisdiction and venue, and support the motion with detailed affidavits on witnesses, records, licensure, and governing law.
    • Scrutinize AMLA applicability where the actor is not Alabama-licensed; preserve arguments that AMLA’s venue rule does not govern foreign-law, out-of-state malpractice.
    • Reassess marketing and patient-transfer communications that explicitly promise “access” for Alabama residents to out-of-state specialty services; such materials were pivotal to jurisdiction.
  • Plaintiffs’ counsel should:
    • Document the in-state initiation of care, the system’s Alabama-facing marketing, and the system’s role in arranging transfers; these facts can anchor Ford “relate-to” jurisdiction.
    • Plead alternative substantive theories (e.g., Georgia med-mal) and be prepared to brief venue under Alabama’s general statutes if AMLA is inapplicable.

D. Federalism and Fairness Considerations

The dissents underscore a countervailing view: Ford’s jurisdictional logic is strongest when the injury occurs in the forum. Applying it to cross-border medical services where the procedure and injury are outside Alabama, they warn, risks encroachment on Georgia’s regulatory and judicial interests. Expect continued litigation that refines the limits of Ford’s “relate-to” standard in the services context.

E. Vicarious Liability Complications

Justice Sellers flags potential complications where the physician is dismissed for lack of personal jurisdiction. Alabama doctrine (e.g., Bush) can constrain respondeat superior claims absent an underlying finding of the agent’s negligence. Parties should anticipate and brief whether, and how, the principal can be held vicariously liable under Georgia substantive law tried in an Alabama forum when the agent is not before the court.

Key Takeaways

  • General jurisdiction: No—Tanner is not “at home” in Alabama.
  • Specific jurisdiction: Yes—Alabama may exercise specific jurisdiction where a health system purposefully serves Alabama and integrates Alabama-initiated care with out-of-state specialty services, and the claim “relates to” that integrated pathway (Ford applied to health care).
  • Venue: Mandamus relief denied; unresolved whether AMLA’s venue statute governs foreign-law, out-of-state malpractice. On this record, default venue statutes likely control.
  • Forum non conveniens: Strong candidate in future cases; must be timely raised and supported.
  • Doctrinal significance: The opinion meaningfully extends Ford’s “relate-to” analysis beyond products to professional services in integrated, cross-border health systems.

Conclusion

Ex parte Tanner cements an important jurisdictional principle in Alabama: where a regional health system deliberately integrates Alabama-facing operations and marketing with out-of-state specialty procedures, a malpractice claim arising from that continuum of care may “relate to” the system’s Alabama contacts, satisfying specific jurisdiction under Ford without strict causation in-state. At the same time, the Court declined to stretch the AMLA’s venue provision to foreign-law, out-of-state events on a mandamus record that did not squarely present or brief that first‑impression question, leaving venue largely to default statutes unless and until the AMLA’s reach is clarified.

The concurring and dissenting opinions collectively signal the next battlegrounds: forum non conveniens as the mechanism to redirect cases to Georgia where appropriate; the AMLA’s definitional limits when non‑Alabama-licensed providers are involved; and the line-drawing for Ford’s “relate-to” standard in professional services where the injury occurs outside the forum. Health systems operating across the Alabama–Georgia border should reassess their patient‑facing materials, transfer protocols, and litigation strategies in light of this decision.

Case Details

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