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"para_398", "para_399", "para_400", "para_401", "para_402", "para_403", "para_404", "para_405", "para_406", "para_407", "para_408", "para_409", "para_410", "para_411", "para_412", "para_413" ], "kind": "front_matter" } ], "paragraphs": [ { "text": "IN THE MISSOURI COURT OF APPEALS", "paragraph_id": "para_1" }, { "text": "WESTERN DISTRICT", "paragraph_id": "para_2" }, { "text": "ROSE HOWLAND, )", "paragraph_id": "para_3" }, { "text": ")", "paragraph_id": "para_4" }, { "text": "Appellant, )", "paragraph_id": "para_5" }, { "text": ")", "paragraph_id": "para_6" }, { "text": ") WD87521", "paragraph_id": "para_7" }, { "text": ")", "paragraph_id": "para_8" }, { "text": "TRUMAN MEDICAL CENTER, INC. ) Opinion filed: July 1, 2025", "paragraph_id": "para_9" }, { "text": "d/b/a UNIVERSITY HEALTH )", "paragraph_id": "para_10" }, { "text": "LAKEWOOD MEDICAL CENTER, )", "paragraph_id": "para_11" }, { "text": ")", "paragraph_id": "para_12" }, { "text": "Respondent. )", "paragraph_id": "para_13" }, { "text": "APPEAL FROM THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI", "paragraph_id": "para_14" }, { "text": "THE HONORABLE JOEL P. FAHNESTOCK, JUDGE", "paragraph_id": "para_15" }, { "text": "Division Three: Edward R. Ardini, Jr., Presiding Judge,", "paragraph_id": "para_16" }, { "text": "Alok Ahuja, Judge and Thomas N. Chapman, Judge", "paragraph_id": "para_17" }, { "text": "Rose Howland appeals the judgment of the Circuit Court of Jackson County (the", "paragraph_id": "para_18" }, { "text": "“trial court”) dismissing her claims for lack of standing. Howland’s claims arose from an", "paragraph_id": "para_19" }, { "text": "incident that occurred in 2021, when she was both employed by and a patient of Truman", "paragraph_id": "para_20" }, { "text": "Medical Center, Inc. (“Truman Medical”). Howland alleged that her co-workers accessed", "paragraph_id": "para_21" }, { "text": "her patient files without authority, discovered she was not vaccinated for COVID-19,", "paragraph_id": "para_22" }, { "text": "harassed and ostracized her for her vaccination decision, and, as a result, her workplace", "paragraph_id": "para_23" }, { "text": "became “intolerable,” causing her to resign. Howland asserted six claims against Truman", "paragraph_id": "para_24" }, { "text": "Medical: (1) breach of fiduciary duty of confidentiality; (2) breach of implied contract; (3)", "paragraph_id": "para_25" }, { "text": "v.", "paragraph_id": "para_26" }, { "text": "2", "paragraph_id": "para_27" }, { "text": "violation of the Missouri Merchandising Practices Act (“MMPA”); (4) negligence; (5)", "paragraph_id": "para_28", "court_paragraph": 2 }, { "text": "negligent training and supervision; and (6) negligence per se. Truman Medical moved to", "paragraph_id": "para_29" }, { "text": "dismiss Howland’s claims for lack of standing and failure to state a claim upon which relief", "paragraph_id": "para_30" }, { "text": "can be granted. The trial court granted Truman Medical’s motion in part, dismissing all", "paragraph_id": "para_31" }, { "text": "claims for lack of standing except for the MMPA claim. Howland then voluntarily", "paragraph_id": "para_32" }, { "text": "dismissed the MMPA claim without prejudice. The trial court entered a final judgment and", "paragraph_id": "para_33" }, { "text": "this appeal followed.", "paragraph_id": "para_34" }, { "text": "We find the trial court erred in dismissing Howland’s claims for lack of standing.", "paragraph_id": "para_35" }, { "text": "However, we find the trial court did not err in dismissing the negligence per se count, as it", "paragraph_id": "para_36" }, { "text": "failed to state a claim upon which relief can be granted. As a result, we affirm the dismissal", "paragraph_id": "para_37" }, { "text": "of Howland’s negligence per se claim and reverse the dismissal of her claims for breach of", "paragraph_id": "para_38" }, { "text": "fiduciary duty, breach of implied contract, negligence, and negligent training and", "paragraph_id": "para_39" }, { "text": "supervision.", "paragraph_id": "para_40" }, { "text": "Factual and Procedural Background", "paragraph_id": "para_41" }, { "text": "Howland initiated this action against Truman Medical in September 2022. Truman", "paragraph_id": "para_42" }, { "text": "Medical filed a motion to dismiss for lack of standing and failure to state a claim upon", "paragraph_id": "para_43" }, { "text": "which relief can be granted. The trial court denied Truman Medical’s motion without", "paragraph_id": "para_44" }, { "text": "prejudice “to allow [Howland] to cure the pleading deficiencies.” The trial court ordered", "paragraph_id": "para_45" }, { "text": "Howland file an amended petition in compliance with Rule 55.05 within ten days.1", "paragraph_id": "para_46" }, { "text": "1 Rule 55.05 provides that a pleading “shall contain (1) a short and plain statement of the facts", "paragraph_id": "para_47" }, { "text": "showing that the pleader is entitled to relief and (2) a demand for judgment for the relief to which", "paragraph_id": "para_48" }, { "text": "the pleader claims to be entitled.”", "paragraph_id": "para_49" }, { "text": "3", "paragraph_id": "para_50" }, { "text": "Howland filed her Second Amended Petition for Damages, which is the operative", "paragraph_id": "para_51", "court_paragraph": 3 }, { "text": "petition in this matter. Howland alleged that she was an employee and patient of Truman", "paragraph_id": "para_52" }, { "text": "Medical, and on November 12, 2021, “without authorization or any working need, [her]", "paragraph_id": "para_53" }, { "text": "co-workers accessed her patient records maintained with [Truman Medical] to discover if", "paragraph_id": "para_54" }, { "text": "[she] was vaccinated for COVID-19.” Howland had “declined to be vaccinated for the", "paragraph_id": "para_55" }, { "text": "COVID-19 virus.” Howland alleged that her co-workers “shared [Howland’s] vaccination", "paragraph_id": "para_56" }, { "text": "status with their follow co-workers and other employees of [Truman Medical],” Howland’s", "paragraph_id": "para_57" }, { "text": "co-workers and supervisors “ostracize[d],” “ridicule[d] and harass[ed]” her for her", "paragraph_id": "para_58" }, { "text": "“medical choices,” she “was demoted as a result of the improper disclosure,” and her", "paragraph_id": "para_59" }, { "text": "“workplace became untenable,” such that “she could no longer effectively work for", "paragraph_id": "para_60" }, { "text": "[Truman Medical] and she was forced to resign.”", "paragraph_id": "para_61" }, { "text": "Howland asserted that Truman Medical improperly handled and inadequately", "paragraph_id": "para_62" }, { "text": "protected her confidential medical information, resulting in its wrongful disclosure. She", "paragraph_id": "para_63" }, { "text": "claimed that, as a direct result, she suffered emotional distress, embarrassment,", "paragraph_id": "para_64" }, { "text": "humiliation, loss of enjoyment of life, loss of privacy and confidentiality, “exposure to", "paragraph_id": "para_65" }, { "text": "heightened future risk of identity theft,” “out-of-pocket expenses associated with the", "paragraph_id": "para_66" }, { "text": "wrongful disclosure,” “out-of-pocket expenses incurred to mitigate the effects” of the", "paragraph_id": "para_67" }, { "text": "wrongful disclosure, “the value of her time spent mitigating the effects” of the wrongful", "paragraph_id": "para_68" }, { "text": "disclosure, and “the lost benefit of her bargain when she paid for her privacy to be protected", "paragraph_id": "para_69" }, { "text": "and it was not.”", "paragraph_id": "para_70" }, { "text": "Howland asserted six claims against Truman Medical: (1) breach of fiduciary duty", "paragraph_id": "para_71" }, { "text": "of confidentiality; (2) breach of implied contract; (3) violation of the MMPA; (4)", "paragraph_id": "para_72" }, { "text": "4", "paragraph_id": "para_73" }, { "text": "negligence; (5) negligent training and supervision; and (6) negligence per se, based on", "paragraph_id": "para_74", "court_paragraph": 4 }, { "text": "violations of the Health Insurance Portability and Accountability Act (“HIPAA”) and the", "paragraph_id": "para_75" }, { "text": "Health Information Technology for Economic and Clinical Health Act (“HITECH”).2", "paragraph_id": "para_76" }, { "text": "Truman Medical again moved to dismiss for lack of standing and failure to state a", "paragraph_id": "para_77" }, { "text": "claim upon which relief can be granted. After briefing on the motion, on November 16,", "paragraph_id": "para_78" }, { "text": "2023, the trial court granted Truman Medical’s motion in part and denied it in part. The", "paragraph_id": "para_79" }, { "text": "trial court concluded Howland lacked standing to assert the majority of her claims, finding", "paragraph_id": "para_80" }, { "text": "Howland “failed to identify” how “the disclosure of her vaccination status caused her harm", "paragraph_id": "para_81" }, { "text": "or presented a material risk of causing harm,” her “alleged injuries are purely conjectural", "paragraph_id": "para_82" }, { "text": "and hypothetical,” and “[v]ague assertions are not enough to establish concrete injury.”", "paragraph_id": "para_83" }, { "text": "The trial court further found Howland “failed to plead or support how the alleged harm", "paragraph_id": "para_84" }, { "text": "caused the damage and the need for such things as monitoring or mitigation.” As a result,", "paragraph_id": "para_85" }, { "text": "the trial court dismissed all claims except for the MMPA claim. As to that claim, the trial", "paragraph_id": "para_86" }, { "text": "court found Howland had standing because “Plaintiffs can satisfy the injury in fact", "paragraph_id": "para_87" }, { "text": "requirement for contract-related claims by alleging they did not receive the full benefit of", "paragraph_id": "para_88" }, { "text": "their bargain.”", "paragraph_id": "para_89" }, { "text": "Howland filed a motion for reconsideration, or in the alternative, for leave to amend", "paragraph_id": "para_90" }, { "text": "her petition. The trial court denied the motion. Howland voluntarily dismissed her MMPA", "paragraph_id": "para_91" }, { "text": "2 “HIPAA is a federal law designed to establish standards to protect private health information", "paragraph_id": "para_92" }, { "text": "from being disclosed without the patient’s consent or knowledge.” J.J. v. Poplar Bluff Reg’l Med.", "paragraph_id": "para_93" }, { "text": "Ctr., L.L.C., 675 S.W.3d 259, 262 n.3 (Mo. App. E.D. 2023). HITECH “widens the scope of", "paragraph_id": "para_94" }, { "text": "privacy and security protections available under HIPAA; it increases the potential legal liability", "paragraph_id": "para_95" }, { "text": "for non-compliance; and it provides for more enforcement.” Newton v. Compass Health Network,", "paragraph_id": "para_96" }, { "text": "4:22-CV-239, 2022 WL 1154522, at *3 n.7 (E.D. Mo. Apr. 19, 2022).", "paragraph_id": "para_97" }, { "text": "5", "paragraph_id": "para_98" }, { "text": "claim without prejudice and filed a motion for judgment, requesting the trial court “make", "paragraph_id": "para_99", "court_paragraph": 5 }, { "text": "its November 16, 2023 [order] a Final Judgment for which the Appellate Court can", "paragraph_id": "para_100" }, { "text": "review.” The trial court entered a final judgment, from which Howland appeals. Howland", "paragraph_id": "para_101" }, { "text": "asserts the trial court erred in finding that she did not have standing and dismissing her", "paragraph_id": "para_102" }, { "text": "claim for breach of fiduciary duty of confidentiality (Point I), claim for breach of implied", "paragraph_id": "para_103" }, { "text": "contract (Point II), and negligence claims (Point III).", "paragraph_id": "para_104" }, { "text": "Standard of Review", "paragraph_id": "para_105" }, { "text": "“Our review of a dismissal for lack of standing is de novo.” Corozzo v. Wal-Mart", "paragraph_id": "para_106" }, { "text": "Stores, Inc., 531 S.W.3d 566, 572 (Mo. App. W.D. 2017) (internal marks omitted). We", "paragraph_id": "para_107" }, { "text": "determine standing as a matter of law on the basis of the petition, assessing whether it", "paragraph_id": "para_108" }, { "text": "invokes principles of substantive law. Id. In doing so, we construe the petition “liberally", "paragraph_id": "para_109" }, { "text": "and accept all alleged facts as true and construe them in a light most favorable to the", "paragraph_id": "para_110" }, { "text": "pleader.” Id. “If the petition sets forth any set of facts that, if proven, would entitle the", "paragraph_id": "para_111" }, { "text": "plaintiffs to relief, then the petition states a claim.” Id.", "paragraph_id": "para_112" }, { "text": "“To state a claim, a petition must contain a short and plain statement of the facts", "paragraph_id": "para_113" }, { "text": "showing that the pleader is entitled to relief.” Stanton v. City of Skidmore, 620 S.W.3d 245,", "paragraph_id": "para_114" }, { "text": "250 (Mo. App. W.D. 2021) (internal marks omitted). “Missouri is a fact pleading state,”", "paragraph_id": "para_115" }, { "text": "but “[t]he facts that must be pleaded are the ultimate facts, not evidentiary facts.” Gruhn v.", "paragraph_id": "para_116" }, { "text": "Schwermer, 710 S.W.3d 103, 109 (Mo. App. W.D. 2025). “Ultimate facts are those the", "paragraph_id": "para_117" }, { "text": "jury must find to return a verdict for the plaintiff.” Id.", "paragraph_id": "para_118" }, { "text": "6", "paragraph_id": "para_119" }, { "text": "Finally, “[t]his court must affirm the dismissal if it can be sustained on any ground", "paragraph_id": "para_120", "court_paragraph": 6 }, { "text": "which is supported by the motion to dismiss, regardless of whether the circuit court relied", "paragraph_id": "para_121" }, { "text": "on that ground.” Corozzo, 531 S.W.3d at 572.", "paragraph_id": "para_122" }, { "text": "Analysis", "paragraph_id": "para_123" }, { "text": "Standing", "paragraph_id": "para_124" }, { "text": "Howland asserts the trial court erred in dismissing her claims for lack of standing", "paragraph_id": "para_125" }, { "text": "because she “has a justiciable interest in and has suffered a concrete harm related to her", "paragraph_id": "para_126" }, { "text": "claims against [Truman Medical].” We agree that the trial court erred in dismissing her", "paragraph_id": "para_127" }, { "text": "claims for lack of standing.", "paragraph_id": "para_128" }, { "text": "“Before a case may be heard by Missouri courts, a plaintiff must present a justiciable", "paragraph_id": "para_129" }, { "text": "controversy.” City of St. Louis v. State, 682 S.W.3d 387, 398 (Mo. banc 2024) (citing", "paragraph_id": "para_130" }, { "text": "Schweich v. Nixon, 408 S.W.3d 769, 773 (Mo. banc 2013)). “A justiciable controversy", "paragraph_id": "para_131" }, { "text": "exists where (1) the plaintiff has a legally protectable interest at stake, (2) a substantial", "paragraph_id": "para_132" }, { "text": "controversy exists between parties with genuinely adverse interests, and (3) that", "paragraph_id": "para_133" }, { "text": "controversy is ripe for judicial determination.” Schweich, 408 S.W.3d at 773. “The first", "paragraph_id": "para_134" }, { "text": "two elements of justiciability are encompassed jointly by the concept of ‘standing.’” Id. at", "paragraph_id": "para_135" }, { "text": "774.", "paragraph_id": "para_136" }, { "text": "“A party’s standing to bring an action is one of the requirements of justiciability", "paragraph_id": "para_137" }, { "text": "under both federal and Missouri law.” Courtright v. O’Reilly Auto., 604 S.W.3d 694, 700", "paragraph_id": "para_138" }, { "text": "(Mo. App. W.D. 2020); see also Corozzo, 531 S.W.3d at 574 (Standing “is the state", "paragraph_id": "para_139" }, { "text": "analogue to the federal ‘case or controversy’ requirement.”). “Standing requires that a party", "paragraph_id": "para_140" }, { "text": "have a personal stake arising from a threatened or actual injury.” Schweich, 408 S.W.3d at", "paragraph_id": "para_141" }, { "text": "7", "paragraph_id": "para_142" }, { "text": "774. “The requirement that the plaintiff have a threatened or real injury concerns whether", "paragraph_id": "para_143", "court_paragraph": 7 }, { "text": "the plaintiff suffered an injury in fact.” Mathews v. FieldWorks, LLC, 696 S.W.3d 382, 392", "paragraph_id": "para_144" }, { "text": "(Mo. App. W.D. 2024). “To establish injury in fact, a plaintiff must show that he or she", "paragraph_id": "para_145" }, { "text": "suffered ‘an invasion of a legally protected interest’ that is ‘concrete and particularized’", "paragraph_id": "para_146" }, { "text": "and ‘actual or imminent, not conjectural or hypothetical.’” Courtright, 604 S.W.3d at 700", "paragraph_id": "para_147" }, { "text": "(quoting Spokeo, Inc. v. Robins, 578 U.S. 330, 339 (2016)). “An injury is ‘particularized’", "paragraph_id": "para_148" }, { "text": "if it ‘affect[s] the plaintiff in a personal and individual way.’” Mathews, 696 S.W.3d at 392", "paragraph_id": "para_149" }, { "text": "(quoting Spokeo, 578 U.S. at 339). “An injury is ‘concrete’ if it actually exists, whether as", "paragraph_id": "para_150" }, { "text": "a tangible or as an intangible injury.” Id.", "paragraph_id": "para_151" }, { "text": "Howland’s allegations were sufficient to establish standing. She alleged that", "paragraph_id": "para_152" }, { "text": "Truman Medical improperly handled and inadequately protected her confidential medical", "paragraph_id": "para_153" }, { "text": "information resulting in its wrongful disclosure. She asserted that such wrongful disclosure", "paragraph_id": "para_154" }, { "text": "led to a demotion, as well as harassment, ostracization, and ridicule that rendered her", "paragraph_id": "para_155" }, { "text": "workplace “intolerable” and “untenable,” forcing her to resign because “she could no", "paragraph_id": "para_156" }, { "text": "longer effectively work” for Truman Medical. She claimed to have suffered emotional", "paragraph_id": "para_157" }, { "text": "distress, embarrassment, humiliation, loss of enjoyment of life, loss of privacy and", "paragraph_id": "para_158" }, { "text": "confidentiality, and “the lost benefit of her bargain when she paid for her privacy to be", "paragraph_id": "para_159" }, { "text": "protected and it was not.”3 These allegations—which we accept as true for purposes of our", "paragraph_id": "para_160" }, { "text": "3 In refusing to dismiss Howland’s MMPA claim, the trial court found Howland had “standing to", "paragraph_id": "para_161" }, { "text": "pursue her MMPA claim” because “Plaintiffs can satisfy the injury in fact requirement for contract-", "paragraph_id": "para_162" }, { "text": "related claims by alleging they did not receive the full benefit of their bargain,” quoting Boone v.", "paragraph_id": "para_163" }, { "text": "PepsiCo, Inc., 653 F. Supp. 3d 635, 643 (E.D. Mo. 2023). Yet the trial court nonetheless dismissed", "paragraph_id": "para_164" }, { "text": "Howland’s breach-of-implied-contract claim for lack of standing, despite Howland asserting that", "paragraph_id": "para_165" }, { "text": "she suffered a “loss of the benefit of the bargain” as a result of the breach.", "paragraph_id": "para_166" }, { "text": "8", "paragraph_id": "para_167" }, { "text": "review—demonstrated an injury to Howland that was actual and not merely conjectural or", "paragraph_id": "para_168", "court_paragraph": 8 }, { "text": "hypothetical (thus it was concrete) and affected her in a personal and individual way (thus", "paragraph_id": "para_169" }, { "text": "it was particularized). In other words, Howland sufficiently alleged an injury in fact.4", "paragraph_id": "para_170" }, { "text": "In finding Howland’s injuries “purely” conjectural and hypothetical, and her", "paragraph_id": "para_171" }, { "text": "assertions of injury too “vague,” the trial court relied on cases which we find inapposite.", "paragraph_id": "para_172" }, { "text": "The trial court first relied on cases involving violations of the federal Fair Credit Reporting", "paragraph_id": "para_173" }, { "text": "Act (“FCRA”)—Campbell v. Adecco USA, Inc., 561 S.W.3d 116 (Mo. App. W.D. 2018)", "paragraph_id": "para_174" }, { "text": "and Courtright v. O’Reilly Automotive, 604 S.W.3d 694 (Mo. App. W.D. 2020)—in which", "paragraph_id": "para_175" }, { "text": "the plaintiffs alleged that the defendants failed to provide them with consumer reports and", "paragraph_id": "para_176" }, { "text": "other information as required by the FCRA. In both cases, we determined that the plaintiffs", "paragraph_id": "para_177" }, { "text": "could not establish standing by alleging a mere procedural violation of the statute, and the", "paragraph_id": "para_178" }, { "text": "plaintiffs did not have standing to assert certain of their claims because they did not allege", "paragraph_id": "para_179" }, { "text": "they suffered a concrete injury from the defendants’ claimed violations of the FCRA. See", "paragraph_id": "para_180" }, { "text": "Campbell, 561 S.W.3d at 122-23; Courtright, 604 S.W.3d at 703-04. Here, however,", "paragraph_id": "para_181" }, { "text": "4 While we find Howland sufficiently alleged an injury in fact, we agree with the trial court that", "paragraph_id": "para_182" }, { "text": "Howland’s allegations of harm relating to an “exposure to heightened future risk of identity", "paragraph_id": "para_183" }, { "text": "theft”—including monitoring and mitigation efforts—were too conjectural and hypothetical to", "paragraph_id": "para_184" }, { "text": "establish standing, given the circumstances of the wrongful disclosure alleged here. See McMorris", "paragraph_id": "para_185" }, { "text": "v. Carlos Lopez & Assocs., LLC, 995 F.3d 295, 300-03 (2d Cir. 2021) (whether a plaintiff", "paragraph_id": "para_186" }, { "text": "establishes standing based on an increased risk of identity theft depends on the specific facts", "paragraph_id": "para_187" }, { "text": "alleged, and “where plaintiffs have not alleged a substantial risk of future identity theft, the time", "paragraph_id": "para_188" }, { "text": "they spent protecting themselves against this speculative threat cannot create an injury” (internal", "paragraph_id": "para_189" }, { "text": "marks omitted)). But—as discussed above—these were not the only harms alleged, and the other", "paragraph_id": "para_190" }, { "text": "injuries pleaded by Howland were sufficient to establish standing. Cf. TransUnion LLC v. Ramirez,", "paragraph_id": "para_191" }, { "text": "594 U.S. 413, 441 (2021) (“the risk of future harm on its own does not support Article III standing", "paragraph_id": "para_192" }, { "text": "for the plaintiffs’ damages claim” (emphasis added)).", "paragraph_id": "para_193" }, { "text": "9", "paragraph_id": "para_194" }, { "text": "Howland’s allegations of injury concerned more than a mere procedural violation of a", "paragraph_id": "para_195", "court_paragraph": 9 }, { "text": "statute and—as discussed above—asserted an injury that was actual and concrete.", "paragraph_id": "para_196" }, { "text": "The trial court next relied on Sims v. Kahrs Law Offices, P.A., No. 22-2112-JWB,", "paragraph_id": "para_197" }, { "text": "2023 WL 2734317 (D. Kan. Mar. 31, 2023), stating that in Sims, the “plaintiff failed to set", "paragraph_id": "para_198" }, { "text": "forth any facts supporting claims of emotional distress, aggravation, inconvenience,", "paragraph_id": "para_199" }, { "text": "embarrassment, and frustration” and that “bare assertions of emotional harms [are] not", "paragraph_id": "para_200" }, { "text": "sufficient to establish standing.” But here, Howland alleged facts supporting her claims of", "paragraph_id": "para_201" }, { "text": "emotional harm, including that she was harassed, ridiculed, ostracized, and demoted, such", "paragraph_id": "para_202" }, { "text": "that it was untenable for her to continue working for Truman Medical. Thus, the bare", "paragraph_id": "para_203" }, { "text": "assertions of emotional harm deemed to be insufficient in Sims to support standing are", "paragraph_id": "para_204" }, { "text": "unlike Howland’s allegations here.5", "paragraph_id": "para_205" }, { "text": "Finally, the trial court relied on Mallak v. City of Brainerd, No. 13-2119", "paragraph_id": "para_206" }, { "text": "(DWF/LIB), 2017 WL 3668759 (D. Minn. Aug. 23, 2017), noting that in Mallak, the “court", "paragraph_id": "para_207" }, { "text": "found standing when plaintiff supported [her] emotional distress claim as the result of the", "paragraph_id": "para_208" }, { "text": "release of private information with deposition testimony and affidavit.” But Mallak was", "paragraph_id": "para_209" }, { "text": "decided on summary judgment, where a trial court may—and sometimes must—consider", "paragraph_id": "para_210" }, { "text": "matters outside the pleadings in making its determination. Here, the trial court decided", "paragraph_id": "para_211" }, { "text": "standing on a motion to dismiss, where the allegations in the petition are to be taken as true", "paragraph_id": "para_212" }, { "text": "5 Additionally, the district court’s discussion of standing in Sims was in the context of a statutory", "paragraph_id": "para_213" }, { "text": "violation: the plaintiff alleged the defendant violated the federal Fair Debt Collection Practices Act", "paragraph_id": "para_214" }, { "text": "(“FDCPA”) when it disclosed her personal information. 2023 WL 2734317, at *2-10. The district", "paragraph_id": "para_215" }, { "text": "court found that plaintiff’s “alleged intangible injuries” of emotional distress, aggravation,", "paragraph_id": "para_216" }, { "text": "inconvenience, embarrassment, and frustration, were “not sufficient to establish a concrete injury", "paragraph_id": "para_217" }, { "text": "under the FDCPA.” Id. at *7.", "paragraph_id": "para_218" }, { "text": "10", "paragraph_id": "para_219" }, { "text": "without the need for any supporting evidence. Thus, to the extent the trial court determined", "paragraph_id": "para_220", "court_paragraph": 10 }, { "text": "Howland’s allegations of emotional harm were insufficient to establish standing because", "paragraph_id": "para_221" }, { "text": "they were not supported by evidence, such determination was erroneous.", "paragraph_id": "para_222" }, { "text": "Truman Medical argues that Howland’s briefing before the trial court “made little", "paragraph_id": "para_223" }, { "text": "to nothing of the now-claimed harassment and ostracization,” and thus Howland cannot", "paragraph_id": "para_224" }, { "text": "argue on appeal that these harms established standing. While Howland’s arguments to the", "paragraph_id": "para_225" }, { "text": "trial court relating to standing did not emphasize the workplace harassment and", "paragraph_id": "para_226" }, { "text": "ostracization she suffered due to the disclosure of her medical information, she did contend", "paragraph_id": "para_227" }, { "text": "that the “disclosure of [her] medical records directly caused [her] harm,” which included", "paragraph_id": "para_228" }, { "text": "emotional distress, embarrassment, humiliation, and the loss of enjoyment of life.6 The trial", "paragraph_id": "para_229" }, { "text": "court understood Howland’s claims of emotional harm to relate to her working conditions,", "paragraph_id": "para_230" }, { "text": "as the trial court in its dismissal order described Howland’s allegations to include that the", "paragraph_id": "para_231" }, { "text": "“disclosure of her vaccination status” resulted in harassment, ostracization, and demotion,", "paragraph_id": "para_232" }, { "text": "making it “untenable to continue working” for Truman Medical, and as a result she suffered", "paragraph_id": "para_233" }, { "text": "emotional distress, embarrassment, humiliation, and loss of enjoyment of life. Thus, we", "paragraph_id": "para_234" }, { "text": "disagree with Truman Medical that this argument was not preserved for appeal.", "paragraph_id": "para_235" }, { "text": "For these reasons, we find Howland sufficiently alleged an injury in fact, and thus", "paragraph_id": "para_236" }, { "text": "the trial court erred in dismissing her claims for lack of standing.", "paragraph_id": "para_237" }, { "text": "6 Howland’s briefing to the trial court included other arguments relating to standing, such as the", "paragraph_id": "para_238" }, { "text": "assertion that her loss of privacy relating to her medical information, in and of itself, was a concrete", "paragraph_id": "para_239" }, { "text": "injury sufficient to establish standing. The trial court did not acknowledge or address this", "paragraph_id": "para_240" }, { "text": "argument, nor do we address it on appeal, because we find that, considering all of Howland’s", "paragraph_id": "para_241" }, { "text": "allegations of harm and not just her loss of privacy, she sufficiently alleged standing.", "paragraph_id": "para_242" }, { "text": "11", "paragraph_id": "para_243" }, { "text": "Failure to State a Claim", "paragraph_id": "para_244", "court_paragraph": 11 }, { "text": "Our determination that Howland had standing does not end our analysis, however,", "paragraph_id": "para_245" }, { "text": "because Truman Medical argues we can affirm the trial court’s judgment of dismissal on", "paragraph_id": "para_246" }, { "text": "alternative grounds. In its motion to dismiss, Truman Medical asserted Howland failed to", "paragraph_id": "para_247" }, { "text": "state a claim upon which relief can be granted, and contends on appeal that we can affirm", "paragraph_id": "para_248" }, { "text": "the dismissal of her claims on this basis. See Corozzo, 531 S.W.3d at 572 (“[T]his court", "paragraph_id": "para_249" }, { "text": "must affirm the dismissal if it can be sustained on any ground which is supported by the", "paragraph_id": "para_250" }, { "text": "motion to dismiss, regardless of whether the circuit court relied on that ground.”). We find,", "paragraph_id": "para_251" }, { "text": "however, that only one of Howland’s claims—her claim for negligence per se—failed to", "paragraph_id": "para_252" }, { "text": "state a claim upon which relief can be granted; all other claims should have survived", "paragraph_id": "para_253" }, { "text": "Truman Medical’s motion to dismiss.", "paragraph_id": "para_254" }, { "text": "Truman Medical first argues that we should affirm the dismissal of Howland’s claim", "paragraph_id": "para_255" }, { "text": "for breach of fiduciary duty of confidentiality because Howland failed to allege all", "paragraph_id": "para_256" }, { "text": "necessary elements of her claim.", "paragraph_id": "para_257" }, { "text": "Under Missouri law, “a physician has a fiduciary duty of confidentiality not to", "paragraph_id": "para_258" }, { "text": "disclose any medical information received in connection with his treatment of the patient.”", "paragraph_id": "para_259" }, { "text": "Brandt v. Med. Def. Assocs., 856 S.W.2d 667, 670 (Mo. banc 1993). “This duty arises out", "paragraph_id": "para_260" }, { "text": "of a fiduciary relationship that exists between the physician and the patient.” Id. “If such", "paragraph_id": "para_261" }, { "text": "information is disclosed under circumstances where this duty of confidentiality has not", "paragraph_id": "para_262" }, { "text": "been waived, the patient has a cause of action for damages in tort against the physician” or", "paragraph_id": "para_263" }, { "text": "medical facility. Id.; Fierstein v. DePaul Health Ctr., 949 S.W.2d 90, 92-93 (Mo. App.", "paragraph_id": "para_264" }, { "text": "E.D. 1997) (the plaintiff stated a cause of action for breach of fiduciary duty of", "paragraph_id": "para_265" }, { "text": "12", "paragraph_id": "para_266" }, { "text": "confidentiality against defendant medical center by alleging the defendant released the", "paragraph_id": "para_267", "court_paragraph": 12 }, { "text": "plaintiff’s medical records to her ex-husband’s attorney without the plaintiff “waiv[ing]", "paragraph_id": "para_268" }, { "text": "her physician/patient privilege”).", "paragraph_id": "para_269" }, { "text": "Truman Medical asserts Howland’s claim for breach of fiduciary duty failed", "paragraph_id": "para_270" }, { "text": "because Howland was both a patient and employee of Truman Medical, and she did not", "paragraph_id": "para_271" }, { "text": "allege whether Truman Medical “obtained her vaccination status as part of her employment", "paragraph_id": "para_272" }, { "text": "or in her capacity as a patient.” Truman Medical contends that, absent an allegation that", "paragraph_id": "para_273" }, { "text": "Truman Medical obtained Howland’s vaccination records through a privileged patient-", "paragraph_id": "para_274" }, { "text": "physician relationship, her breach of fiduciary duty claim must be dismissed. We find,", "paragraph_id": "para_275" }, { "text": "however, that Howland alleged Truman Medical disclosed her “patient” medical", "paragraph_id": "para_276" }, { "text": "information. In her Second Amended Petition, Howland alleged that she was a patient of", "paragraph_id": "para_277" }, { "text": "Truman Medical and that her co-workers “accessed her patient records maintained with”", "paragraph_id": "para_278" }, { "text": "Truman Medical, without being part of her care team, and discovered her COVID-19", "paragraph_id": "para_279" }, { "text": "vaccination status. (Emphasis added). Howland also alleged that had Truman Medical", "paragraph_id": "para_280" }, { "text": "represented it would not protect her confidentiality and privacy, she would have sought", "paragraph_id": "para_281" }, { "text": "treatment elsewhere. Given these allegations, we find Howland sufficiently pleaded her", "paragraph_id": "para_282" }, { "text": "claim for breach of fiduciary duty.", "paragraph_id": "para_283" }, { "text": "Truman Medical next argues we should affirm the dismissal of Howland’s breach-", "paragraph_id": "para_284" }, { "text": "of-implied-contract claim. Truman Medical contends that “[t]he remedy of implied", "paragraph_id": "para_285" }, { "text": "contract like [Howland] appears to seek here are equitable remedies under Missouri law,”", "paragraph_id": "para_286" }, { "text": "and to state a claim for equitable relief, Howland must plead she lacks an adequate remedy", "paragraph_id": "para_287" }, { "text": "13", "paragraph_id": "para_288" }, { "text": "at law, which she did not do. We disagree, however, that Howland’s implied-contract claim", "paragraph_id": "para_289", "court_paragraph": 13 }, { "text": "was equitable in nature.", "paragraph_id": "para_290" }, { "text": "There are two types of implied contracts: contracts that are implied in law and", "paragraph_id": "para_291" }, { "text": "contracts that are implied in fact.7 A breach of contract implied in law is an equitable claim;", "paragraph_id": "para_292" }, { "text": "a breach of contract implied in fact is not. See Nickel v. Stephens Coll., 480 S.W.3d 390,", "paragraph_id": "para_293" }, { "text": "397 n.6 (Mo. App. W.D. 2015) (“There is no difference in legal effect between an express", "paragraph_id": "para_294" }, { "text": "contract and one implied in fact.”). Although Howland broadly designated her claim in her", "paragraph_id": "para_295" }, { "text": "Second Amended Petition as a “Breach of Implied Contract,” it is evident from her", "paragraph_id": "para_296" }, { "text": "allegations that she asserted a breach of contract implied in fact: she alleged that “as part", "paragraph_id": "para_297" }, { "text": "of her agreement” with Truman Medical she provided certain information to Truman", "paragraph_id": "para_298" }, { "text": "Medical, and in doing so she and Truman Medical entered into an implied contract wherein", "paragraph_id": "para_299" }, { "text": "Truman Medical was obligated to reasonably safeguard her information.8 Because a claim", "paragraph_id": "para_300" }, { "text": "7 “[A] contract implied in law is not actually a contract and, instead, is an obligation to do justice", "paragraph_id": "para_301" }, { "text": "where no promise was ever made or intended.” Am. Eagle Waste Indus., LLC v. St. Louis Cnty.,", "paragraph_id": "para_302" }, { "text": "379 S.W.3d 813, 828-29 (Mo. banc 2012); see also 66 Am. Jur. 2d Restitution & Implied Contracts", "paragraph_id": "para_303" }, { "text": "§ 4 (2025) (“A contract implied in law is a legal fiction, an obligation created by the law” and", "paragraph_id": "para_304" }, { "text": "“imposed regardless of any actual agreement between the parties”; it is “adopted to achieve justice", "paragraph_id": "para_305" }, { "text": "or for obtaining just results.”). “Courts sometimes use the term ‘quasi-contract’ to refer to this", "paragraph_id": "para_306" }, { "text": "phenomenon.” Am. Eagle Waste Indus., 379 S.W.3d at 829; see also Hammond v. Toole, 644", "paragraph_id": "para_307" }, { "text": "S.W.3d 289, 297 (Mo. App. W.D. 2022) (“The principle of unjust enrichment has given rise to the", "paragraph_id": "para_308" }, { "text": "doctrine of quasi-contract, also known as contract implied in law, as a theory of recovery.”).", "paragraph_id": "para_309" }, { "text": "Unlike a contract implied in law, a contract implied in fact is a true contract, albeit one that", "paragraph_id": "para_310" }, { "text": "is not stated orally or in writing. See 17A Am. Jur. 2d Contracts § 11 (2025) (“A contract is express", "paragraph_id": "para_311" }, { "text": "if stated either orally or in writing, and it is implied [in fact] if its terms are not so stated”; a contract", "paragraph_id": "para_312" }, { "text": "implied in fact is a “true contract, which arises if the assent of the parties is manifested by conduct", "paragraph_id": "para_313" }, { "text": "rather than words”); see also Nickel v. Stephens Coll., 480 S.W.3d 390, 397 n.6 (Mo. App. W.D.", "paragraph_id": "para_314" }, { "text": "2015) (“A true contract is said to be express or implied in fact”).", "paragraph_id": "para_315" }, { "text": "8 Howland also clarified in her suggestions in opposition to the motion to dismiss that she was", "paragraph_id": "para_316" }, { "text": "asserting a claim for breach of contract implied in fact.", "paragraph_id": "para_317" }, { "text": "14", "paragraph_id": "para_318" }, { "text": "for breach of contract implied in fact is not an equitable action, Howland was not required", "paragraph_id": "para_319", "court_paragraph": 14 }, { "text": "to plead she lacked an adequate remedy at law, and her breach-of-contract claim should", "paragraph_id": "para_320" }, { "text": "not have been dismissed on this basis.", "paragraph_id": "para_321" }, { "text": "Next, Truman Medical argues we should affirm the dismissal of Howland’s", "paragraph_id": "para_322" }, { "text": "negligence claims due to the economic loss doctrine. “In Missouri, the economic loss", "paragraph_id": "para_323" }, { "text": "doctrine has been observed to prohibit a plaintiff from seeking to recover in tort for", "paragraph_id": "para_324" }, { "text": "economic losses that are contractual in nature.” Autry Morlan Chevrolet, Cadillac, Inc. v.", "paragraph_id": "para_325" }, { "text": "RJF Agencies, Inc., 332 S.W.3d 184, 192 (Mo. App. S.D. 2010); see also Child.’s Wish", "paragraph_id": "para_326" }, { "text": "Found. Int’l, Inc. v. Mayer Hoffman McCann, P.C., 331 S.W.3d 648, 652 (Mo. banc 2011)", "paragraph_id": "para_327" }, { "text": "(“many states, including Missouri, traditionally have restricted the availability of tort", "paragraph_id": "para_328" }, { "text": "damages in cases alleging only economic loss”). However, we find the doctrine did not", "paragraph_id": "para_329" }, { "text": "apply to bar Howland from asserting her negligence claims, as she alleged that she suffered", "paragraph_id": "para_330" }, { "text": "not only economic loss that was contractual in nature, but harm resulting from Truman", "paragraph_id": "para_331" }, { "text": "Medical’s alleged improper disclosure of her medical information, including emotional", "paragraph_id": "para_332" }, { "text": "distress, embarrassment, humiliation, and loss of enjoyment of life.", "paragraph_id": "para_333" }, { "text": "Finally, Truman Medical asserts we should affirm the dismissal of Howland’s", "paragraph_id": "para_334" }, { "text": "negligence per se claim, in which Howland asserted Truman Medical committed", "paragraph_id": "para_335" }, { "text": "negligence per se by violating HIPAA and HITECH. Truman Medical contends that,", "paragraph_id": "para_336" }, { "text": "because these federal statues do not provide a private right of action, Howland could not", "paragraph_id": "para_337" }, { "text": "state a claim for negligence per se based on these statutes. We agree.", "paragraph_id": "para_338" }, { "text": "“Negligence per se is a form of ordinary negligence that results from the violation", "paragraph_id": "para_339" }, { "text": "of a statute.” Lowdermilk v. Vescovo Bldg. & Realty Co., 91 S.W.3d 617, 628 (Mo. App.", "paragraph_id": "para_340" }, { "text": "15", "paragraph_id": "para_341" }, { "text": "E.D. 2002) (internal marks omitted). “Negligence per se arises where the legislature", "paragraph_id": "para_342", "court_paragraph": 15 }, { "text": "pronounces in a statute what the conduct of a reasonable person must be, whether or not", "paragraph_id": "para_343" }, { "text": "the common law would require similar conduct, and the court then adopts the statutory", "paragraph_id": "para_344" }, { "text": "standard of care to define the standard of conduct of a reasonable person.” Id. (internal", "paragraph_id": "para_345" }, { "text": "citation omitted). “As a result, the jury is instructed on the statutory standard of care rather", "paragraph_id": "para_346" }, { "text": "than the care of the reasonable person.” Id.", "paragraph_id": "para_347" }, { "text": "However, not all statutes support a cause of action for negligence per se. Indeed,", "paragraph_id": "para_348" }, { "text": "only those statutes which create a private right of action can form the basis for a negligence", "paragraph_id": "para_349" }, { "text": "per se claim. See Bradley v. Ray, 904 S.W.2d 302, 314 (Mo. App. W.D. 1995) (affirming", "paragraph_id": "para_350" }, { "text": "dismissal of negligence per se claim: “Because this Court finds no private cause of action", "paragraph_id": "para_351" }, { "text": "can be implied under the Child Abuse Reporting Act, the alleged breach of the Act also", "paragraph_id": "para_352" }, { "text": "does not amount to negligence per se” (internal citation omitted)).", "paragraph_id": "para_353" }, { "text": "Although Howland asserted a claim for negligence per se based on alleged", "paragraph_id": "para_354" }, { "text": "violations of HIPAA and HITECH, it is well-settled that there is no private right of action", "paragraph_id": "para_355" }, { "text": "to sue for a HIPAA violation. See Dodd v. Jones, 623 F.3d 563, 569 (8th Cir. 2010)", "paragraph_id": "para_356" }, { "text": "(“HIPAA does not create a private right of action.”); Payne v. Taslimi, 998 F.3d 648, 660", "paragraph_id": "para_357" }, { "text": "(4th Cir. 2021) (“Every circuit court to consider whether HIPAA created a private right to", "paragraph_id": "para_358" }, { "text": "sue has found that it does not.” (emphasis omitted)).9 Similarly, there is no private right of", "paragraph_id": "para_359" }, { "text": "action to sue for a HITECH violation. See Newton v. Compass Health Network, No. 4:22-", "paragraph_id": "para_360" }, { "text": "9 “This is because HIPAA does not expressly allow for a private cause of action but delegates", "paragraph_id": "para_361" }, { "text": "enforcement authority to the Secretary of the Department of Health and Human Services, reflecting", "paragraph_id": "para_362" }, { "text": "Congress’s intent to forgo creating a private remedy.” Payne, 998 F.3d at 660.", "paragraph_id": "para_363" }, { "text": "16", "paragraph_id": "para_364" }, { "text": "CV-239, 2022 WL 1154522, at *3 n.7 (E.D. Mo. Apr. 19, 2022) (“Like HIPAA, the", "paragraph_id": "para_365", "court_paragraph": 16 }, { "text": "HITECH Act does not allow an individual to bring a cause of action against a provider.”).10", "paragraph_id": "para_366" }, { "text": "Because these statutes do not provide a private right of action, a breach of these statues", "paragraph_id": "para_367" }, { "text": "does not constitute negligence per se. See Bradley, 904 S.W.2d at 314. Accordingly,", "paragraph_id": "para_368" }, { "text": "Howland failed to state a claim for negligence per se upon which relief can be granted, and", "paragraph_id": "para_369" }, { "text": "her claim was rightfully dismissed.11 See id.; see also J.R. v. Walgreens Boots All., Inc.,", "paragraph_id": "para_370" }, { "text": "No. 20-1767, 2021 WL 4859603, at *7 (4th Cir. Oct. 19, 2021) (affirming district court’s", "paragraph_id": "para_371" }, { "text": "10 “However, it does allow a state attorney general to bring an action on behalf of his or her", "paragraph_id": "para_372" }, { "text": "residents.” Newton, 2022 WL 1154522, at *3 n.7.", "paragraph_id": "para_373" }, { "text": "11 We do not believe our holding is at odds with the Eastern District’s opinion in J.J. v. Poplar", "paragraph_id": "para_374" }, { "text": "Bluff Regional Medical Center, L.L.C., 675 S.W.3d 259 (Mo. App. E.D. 2023). The sole issue in", "paragraph_id": "para_375" }, { "text": "J.J. was whether the plaintiff’s claims (which were similar to the claims raised in this action) were", "paragraph_id": "para_376" }, { "text": "properly dismissed by the trial court due to the plaintiff’s failure to file an affidavit of merit", "paragraph_id": "para_377" }, { "text": "pursuant to section 538.225.1, RSMo (requiring affidavit of health care provider certifying merit", "paragraph_id": "para_378" }, { "text": "of medical malpractice case). See 675 S.W.3d at 262-63. The Eastern District reversed the trial", "paragraph_id": "para_379" }, { "text": "court’s dismissal, finding that the affidavit requirement of section 538.225.1 did not apply to the", "paragraph_id": "para_380" }, { "text": "plaintiff’s claims. Id. at 267. In making this determination, the Eastern District—in dicta—", "paragraph_id": "para_381" }, { "text": "described the elements of the plaintiff’s claims. See id. at 266 (“Although this Court is not asked", "paragraph_id": "para_382" }, { "text": "to determine the merits of J.J.’s claims against PBRMC, the elements of each particular claim can", "paragraph_id": "para_383" }, { "text": "clarify the application of Section 538.225.1’s affidavit requirement.”). The Eastern District stated", "paragraph_id": "para_384" }, { "text": "the following relating to negligence per se: “If a defendant health care provider does not comply", "paragraph_id": "para_385" }, { "text": "with its duties under HIPAA and HITECH, and the plaintiff is injured as a result of a statutory", "paragraph_id": "para_386" }, { "text": "violation, then the defendant is liable for negligence per se.” Id. In so stating, the Eastern District", "paragraph_id": "para_387" }, { "text": "relied on Dibrill v. Normandy Associates, Inc., 383 S.W.3d 77, 84-85 (Mo. App. E.D. 2012), a", "paragraph_id": "para_388" }, { "text": "case that did not involve violations of HIPAA or HITECH. We also note that the Eastern District", "paragraph_id": "para_389" }, { "text": "acknowledged elsewhere in its opinion that “[a]lthough HIPAA establishes rules for the", "paragraph_id": "para_390" }, { "text": "protections and dissemination of protected health information, it creates no private cause of action", "paragraph_id": "para_391" }, { "text": "for a violation of those rules,” and “[i]nstead, a plaintiff may pursue an action under Missouri", "paragraph_id": "para_392" }, { "text": "common law seeking damages for invasion of privacy on the basis of the public disclosure of", "paragraph_id": "para_393" }, { "text": "private facts, for a breach of duty of confidentiality, and for breach of implied contract.” Id. at 262", "paragraph_id": "para_394" }, { "text": "n.3 (internal citations omitted). Given that the Eastern District’s discussion of negligence per se", "paragraph_id": "para_395" }, { "text": "was dicta, the Eastern District relied on a negligence per se case that did not involve HIPAA or", "paragraph_id": "para_396" }, { "text": "HITECH, and it acknowledged HIPAA does not create a private right of action, we do not perceive", "paragraph_id": "para_397" }, { "text": "J.J. to stand for the proposition that a plaintiff may prevail on a claim of negligence per se based", "paragraph_id": "para_398" }, { "text": "on HIPAA or HITECH.", "paragraph_id": "para_399" }, { "text": "17", "paragraph_id": "para_400" }, { "text": "dismissal of claim for negligence per se based on HIPAA, as no private right of action", "paragraph_id": "para_401", "court_paragraph": 17 }, { "text": "exists under HIPAA).", "paragraph_id": "para_402" }, { "text": "Conclusion", "paragraph_id": "para_403" }, { "text": "For the reasons described above, we find the trial court erred in determining", "paragraph_id": "para_404" }, { "text": "Howland lacked standing. Nonetheless, the trial court did not err in dismissing Howland’s", "paragraph_id": "para_405" }, { "text": "count of negligence per se, as that count failed to state a claim upon which relief can be", "paragraph_id": "para_406" }, { "text": "granted. Dismissal of the negligence per se claim is affirmed. We reverse the dismissal of", "paragraph_id": "para_407" }, { "text": "Howland’s claims for breach of fiduciary duty, breach of implied contract, negligence, and", "paragraph_id": "para_408" }, { "text": "negligent training and supervision, and remand to the trial court for further proceedings", "paragraph_id": "para_409" }, { "text": "consistent with this opinion.", "paragraph_id": "para_410" }, { "text": "__________________________________", "paragraph_id": "para_411" }, { "text": "EDWARD R. 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