Interlocutory Limits: No Pendent Appellate Review of a Primary-Jurisdiction Stay When Appealing a Preliminary-Injunction Denial

Introduction

In Mezu-Ndubuisi v. Univ. of Rochester (2d Cir. Feb. 18, 2026) (summary order), the Second Circuit addressed two recurring procedural flashpoints in employment-related litigation involving medical institutions: (i) whether an appeal from the denial of a preliminary injunction permits appellate review of an accompanying stay entered under the primary jurisdiction doctrine, and (ii) what constitutes irreparable harm sufficient to justify preliminary injunctive relief in an employment/privileges dispute.

Plaintiff-Appellant Dr. Olachi Mezu-Ndubuisi sued the University of Rochester and related hospital entities and supervising physicians, alleging employment discrimination and retaliation. She sought emergency relief restoring her clinical role in the neonatal intensive care unit (“NICU”) and preventing termination of her clinical privileges based on losing that role. The district court denied a preliminary injunction and stayed the case, deferring factual/technical issues to the New York State Public Health and Health Planning Council (“PHHPC”). On appeal, the Second Circuit dismissed in part for lack of jurisdiction (as to the stay) and affirmed in part (as to the injunction denial).

Summary of the Opinion

  • Jurisdiction: The court held it lacked appellate jurisdiction to review the district court’s stay order at this interlocutory stage. The denial of a preliminary injunction is appealable under 28 U.S.C. § 1292(a)(1), but the stay was not independently appealable, and the court declined to exercise pendent appellate jurisdiction because the stay issue was not “inextricably intertwined” with the injunction ruling.
  • Merits: The court affirmed denial of the preliminary injunction because Dr. Mezu-Ndubuisi failed to demonstrate irreparable harm. Alleged career-ending consequences were deemed too speculative, and asserted reputational/professional harms were treated as typical adverse employment consequences remediable by damages or reinstatement after final judgment.
  • Procedural notes: Any challenge to denial of a temporary restraining order was not addressed due to forfeiture (undeveloped argument). The panel also clarified that the claims were ripe under Article III due to an “actual loss” of clinical role, and that exhaustion of state administrative remedies is not constitutionally required.

Analysis

Precedents Cited

The panel’s reasoning is built from several well-established lines of Second Circuit and Supreme Court authority:

1) Appellate jurisdiction must be resolved first

  • Marquez v. Silver, 96 F.4th 579, 582 (2d Cir. 2024) (quoting Steel Co. v. Citizens for a Better Env't, 523 U.S. 83, 94 (1998)): The court reiterated the foundational requirement that jurisdiction is the “first and fundamental question” in every appeal. This framing matters here because the appellant attempted to broaden interlocutory review beyond what § 1292(a)(1) authorizes.

2) Primary jurisdiction as a basis for a stay

  • Tassy v. Brunswick Hosp. Ctr., Inc., 296 F.3d 65, 69 (2d Cir. 2002): The court described primary jurisdiction as permitting a district court to stay an action pending an agency’s resolution of issues where agency expertise would aid resolution of technical factual questions or promote uniformity and consistency. Here, the district court deferred to the PHHPC’s technical competence in evaluating the medical basis for termination of clinical privileges.

3) No “bootstrapping” unrelated issues into an interlocutory injunction appeal

  • Merritt v. Shuttle, Inc., 187 F.3d 263, 268 (2d Cir. 1999) (citing Swint v. Chambers Cnty. Comm'n, 514 U.S. 35, 51 (1995)): Even when an injunction order is appealable, the appellate court may not simultaneously review “unrelated questions” lacking independent interlocutory footing. This directly foreclosed review of the stay order unless a separate jurisdictional path existed.
  • Mancuso v. N.Y. State Thruway Auth., 86 F.3d 289, 292 (2d Cir. 1996): The panel emphasized that pendent appellate jurisdiction should be exercised “sparingly, if ever,” reinforcing a narrow approach to interlocutory expansion.

4) Irreparable harm is the “single most important prerequisite” for a preliminary injunction

  • State Farm Mut. Auto. Ins. Co. v. Tri-Borough NY Med. Prac. P.C., 120 F.4th 59, 80 (2d Cir. 2024): The panel applied the principle that irreparable harm must be shown before other injunction factors matter. It also adopted State Farm’s definition: harm must be continuing, not adequately redressable by final relief, and not compensable by money damages.
  • The Patriots USA, Inc. v. Hochul, 17 F.4th 266, 294 (2d Cir. 2021): Cited for the proposition that certain alleged harms—such as reputational harm in comparable contexts—often amount to “adverse ... consequences” insufficient to justify preliminary relief.

5) Evidentiary hearings are not automatic on preliminary injunction motions

  • Charette v. Town of Oyster Bay, 159 F.3d 749, 755 (2d Cir. 1998): The court relied on Charette to reject the demand for an evidentiary hearing where the relevant facts are undisputed, already shown at earlier stages, or resolvable on a paper record.

6) No per se irreparable harm presumption for retaliation allegations

  • Holt v. Continental Group, Inc., 708 F.2d 87, 91 (2d Cir. 1983): The panel distinguished Holt and underscored Holt’s own limitation: it “explicitly rejected a presumption of irreparable injury in every action” alleging retaliation. A plaintiff must show, in their specific circumstances, why consequences are irreparable (e.g., deterrence of witnesses/rights).

7) Ripeness and exhaustion clarifications

  • Motorola Credit Corp. v. Uzan, 322 F.3d 130, 136 (2d Cir. 2003): Cited for the Article III principle that an “actual loss” constitutes a distinct injury in fact supporting ripeness. The panel used this to reject the notion that the case was constitutionally unripe merely because privileges were (then) in internal proceedings.
  • Palin v. N.Y. Times Co., 113 F.4th 245, 279 (2d Cir. 2024): Used to explain forfeiture: issues not developed in the opening brief are deemed forfeited (applied to the TRO-related argument).

Legal Reasoning

A) The jurisdictional holding: a strict boundary around interlocutory review

The court’s threshold move was to separate what is appealable now from what must await later review. While a preliminary injunction denial is immediately appealable under § 1292(a)(1), the stay order (entered under primary jurisdiction) was not shown to be independently appealable under 28 U.S.C. § 1291 or any other interlocutory statute.

The appellant attempted to use pendent appellate jurisdiction to “bootstrap” review of the stay into the injunction appeal. The panel rejected that attempt because:

  • The stay decision was not “inextricably intertwined” with the injunction denial: the injunction turned on irreparable harm and likelihood of success, while the stay turned on agency expertise and the benefits of administrative input.
  • Review of the stay was not “necessary to ensure meaningful review” of the injunction denial. The panel reasoned that even if it reversed on the injunction question, the district court could lift the stay as needed on remand.

Practically, this is a strong signal that litigants should not assume that an injunction appeal opens the door to appellate correction of other procedural rulings in the same order; each ruling must independently fit within an exception to the final-judgment rule, or satisfy the stringent pendent-jurisdiction tests.

B) The merits holding: speculative career harm and reputational effects are not enough

Turning to the injunction denial, the panel treated irreparable harm as dispositive. Dr. Mezu-Ndubuisi’s primary theory—that loss of her NICU role and resulting privileges proceedings would end her career as a clinician-scientist— was found too speculative at the preliminary stage. The court further characterized the remaining harms (professional standing and reputation) as typical adverse employment consequences generally compensable by traditional remedies (money damages, reinstatement).

The court also rejected two procedural/institutional arguments:

  • No evidentiary hearing entitlement: Invoking Charette v. Town of Oyster Bay, the court held the paper record sufficed and the plaintiff did not identify evidence showing damages would be so unmeasurable as to render the harm irreparable.
  • No per se irreparable harm in retaliation cases: The panel read Holt v. Continental Group, Inc. as requiring case-specific proof of irreparable consequences (e.g., deterrence/witness intimidation effects), not a blanket presumption.

Impact

  • Appellate strategy in mixed orders: The decision reinforces that § 1292(a)(1) review is not a vehicle for interlocutory review of other rulings (like stays) unless independently appealable. Parties facing a stay paired with an injunction ruling should anticipate that the stay may be effectively insulated from immediate appellate review absent a separate jurisdictional basis.
  • Primary jurisdiction in clinical-privileges disputes: While the panel did not reach the correctness of the stay itself, the case illustrates how primary jurisdiction may be invoked when state health bodies (here, PHHPC) possess technical competence over medical-justification questions underlying credentialing/privileges actions.
  • Preliminary injunctions in employment/credentialing contexts: The order signals a skeptical posture toward claims that employment or privileges changes are irreparable merely because they are professionally significant. Plaintiffs will likely need concrete, non-speculative evidence that later remedies cannot make them whole (for example, unique and imminent loss of licensure, unquantifiable destruction of a time-sensitive opportunity, or proven chilling effects fitting Holt’s logic).
  • Ripeness and exhaustion: The panel’s discussion suggests that tangible professional setbacks can satisfy injury-in-fact even while internal or administrative processes continue, and that Article III does not impose a state-remedy exhaustion requirement (a point that can matter when defendants argue plaintiffs must first proceed through specialized state mechanisms).

Complex Concepts Simplified

Primary jurisdiction (doctrine)
A court-created doctrine allowing a federal court to pause (stay) a lawsuit so an agency with specialized expertise can address certain technical or policy-laden issues first. The court does not “lose” the case; it waits for the agency’s input to improve accuracy and consistency.
Interlocutory appeal under 28 U.S.C. § 1292(a)(1)
A limited exception to the final-judgment rule allowing immediate appeal of orders granting or denying injunctions, because injunctions can cause immediate, difficult-to-fix consequences.
Pendent appellate jurisdiction
A narrow, discretionary doctrine allowing an appellate court to review a non-appealable issue alongside an appealable one only if the two are tightly linked (“inextricably intertwined”) or if review of the non-appealable issue is necessary to meaningfully decide the appealable one. The Second Circuit repeatedly cautions this should be rare.
Irreparable harm
Harm that cannot be adequately fixed by a later court judgment—typically because money damages are inadequate and the harm will continue or become irreversible before final resolution. In employment settings, reputational and professional harms often are viewed as compensable through damages or reinstatement, absent specific proof to the contrary.
Ripeness / injury in fact (Article III)
Constitutional standing requires a real, concrete injury. An “actual loss” (here, loss of a clinical role) can be enough even if other consequences are still unfolding through internal proceedings.

Conclusion

Mezu-Ndubuisi v. Univ. of Rochester draws a clear procedural line: an interlocutory appeal from a preliminary-injunction denial does not, without more, confer appellate jurisdiction to review an accompanying primary-jurisdiction stay, and pendent appellate jurisdiction will not be used where the issues are not tightly bound. On the merits, the court reaffirmed that irreparable harm is indispensable and that speculative career-impact claims and ordinary reputational/professional harms generally do not justify preliminary injunctions in employment and clinical-privileges disputes. Although issued as a nonprecedential summary order, the decision is a practical roadmap for litigants on both appellate-jurisdiction limits and the demanding evidentiary showing required for emergency injunctive relief.