California Court Splits on Hospital Tracking Pixel Class Ruling

California Appellate Court Splits Ruling on Hospital Tracking Pixel Class Certification

California's Second District Court of Appeal certified Doe v. Adventist Health System/West (No. B344951) for publication on August 24, 2026, affirming part and reversing part of a Los Angeles judge's refusal to certify patient classes over Meta and Google tracking pixels. The court decided class certification, not liability.

Information last verified on September 5, 2026.

Status: Decided on class certification only, and only as to two subclasses. The Court of Appeal (Second Appellate District, Division Three) filed the opinion on July 24, 2026 and certified it for publication on August 24, 2026, stating "There is no change in the judgment." No court has decided whether Adventist Health System/West violated the California Invasion of Privacy Act (CIPA) or the Confidentiality of Medical Information Act (CMIA). The matter returns to Los Angeles County Superior Court (Case No. 22STCV36304) for further proceedings.

Jurisdiction scope: This covers California state law only, specifically CIPA (Penal Code sections 630 through 638.55) and the CMIA (Civil Code Part 2.6, sections 56 through 56.37), as applied by one California Court of Appeal. It decides no federal claim, does not address HIPAA, and does not change the law of any other state.

What Happened

Four plaintiffs proceeding as Does, all current or former patients of Adventist Health System/West, filed a putative class action in Los Angeles County Superior Court alleging that Adventist shared their information with Meta and Google through the Meta Pixel and Google Analytics installed on its websites. Adventist is a nonprofit, faith based health system serving communities on the West Coast and in Hawaii (slip op. p. 7).

The opinion describes three surfaces. Adventist's public site at adventisthealth.org carried tracking code. Its public health risk assessment site at adventisthealthhra.org, run with a partner called HealthAware from roughly 2019 or 2020, let members of the public complete health questionnaires. Its password protected patient portal, hosted by Cerner, carried Google Analytics but not the Meta Pixel, and Cerner removed Google Analytics from the portal in May 2023 (slip op. pp. 7 to 9).

Plaintiffs sought certification of a general class of California patients for the period November 16, 2017 through April 30, 2024, plus four subclasses. Only two subclasses were on appeal: patients who were logged into the patient portal up until May 2023, and patients who submitted an online HRA form (slip op. pp. 2 to 3).

Judge Laura A. Seigle denied the certification motion in its entirety. She found the patient portal class was not ascertainable, that common issues did not predominate for either subclass, and that plaintiffs had not shown superiority or manageability. She also found plaintiffs had dropped any attempt to certify a class under Penal Code section 632 (slip op. p. 3).

Her central reason on predominance was that deciding whether the data the pixels sent contained the "contents" of a communication under CIPA, or "medical information" under the CMIA, would require looking at what was transmitted for each individual user.

The Court of Appeal disagreed in part. It first concluded the patient portal subclass was ascertainable from Adventist's and Cerner's login records, reasoning that whether the transmissions were actually unlawful is a merits question plaintiffs did not have to answer to show ascertainability (slip op. p. 26). On the HRA subclass, it held the trial court had implicitly decided a merits question:

"And whether the transmission of those URLs linking to completed reports ... is the transmission of 'contents' under CIPA or medical information under CMIA, is a merits question." Source: Doe v. Adventist Health System/West, No. B344951, slip op. at 34.

On the patient portal subclass, the panel split the two statutes. For CIPA, the panel noted that no portal URL carried a query string, but it declined plaintiffs' framing that this alone disposed of the individual issues, and it accepted that the descriptive terms still conveyed different levels of information. Its stated reason was different: inside an authenticated portal each descriptor denotes the activity the patient chose, so a URL such as one containing "health-record/radiology" arguably conveys the purport of the patient's communication, and whether such URLs actually satisfy CIPA's contents element is a merits question (slip op. pp. 52 to 54). It also noted plaintiffs' theory that simply logging in disclosed patient status, and concluded that because the tracking technology transmitted the same baseline information for every subclass member, plaintiffs met their burden on the contents element (slip op. pp. 52 to 56).

For the CMIA, it reached the opposite result on the same record. The panel agreed with the trial court that "those same descriptive terms did not uniformly convey 'medical information.'" A URL showing a patient downloaded a radiology report might disclose information regarding the patient's condition or treatment; a URL showing an unspecified download, a message, or an appointment would not, without more (slip op. pp. 56 to 57).

The panel also reversed on superiority and manageability, writing: "In sum, we conclude the record does not support finding the HRA form subclass, and the patient portal subclass for plaintiffs' CIPA claim, raised individual issues that cannot be managed." (slip op. p. 64.)

On the section 632(a) claim, the panel affirmed. Plaintiffs argued their motion's CIPA arguments encompassed both sections 631 and 632, pointing to a brief mention of a "reasonable expectation of privacy." The panel held that was not enough: plaintiffs never mentioned section 632(a) in their moving or reply papers and never set out its elements, and raising the issue in a post hearing trial plan came too late (slip op. pp. 64 to 66).

The disposition, in full:

"We affirm the court's order finding plaintiffs forfeited their section 632(a) claim and denying class certification of their CMIA claims for the patient portal subclass. We reverse the court's order denying class certification for the HRA form subclass and the surviving claims for the patient portal subclass and remand the matter for further proceedings." Source: Doe v. Adventist Health System/West, No. B344951, slip op. at 67.

Acting Presiding Justice Egerton wrote for the panel, joined by Justices Adams and Hanasono.

What the Law Actually Says

CIPA section 631(a), the wiretapping provision. Penal Code section 631(a) reaches, among other conduct, anyone who "willfully and without the consent of all parties to the communication, or in any unauthorized manner, reads, or attempts to read, or to learn the contents or meaning of any message, report, or communication while the same is in transit or passing over any wire, line, or cable," anyone who uses information so obtained, and anyone who aids, agrees with, employs, or conspires with another to do those acts. Plaintiffs pleaded the aiding and abetting theory against Adventist for Meta's and Google's alleged conduct. California's all party consent framework, which is what our page on California's recording and eavesdropping statutes explains, comes from this same chapter of the Penal Code.

CIPA section 632(a), the recording provision. Section 632(a) is a different statute with different elements. It reaches a person who "intentionally and without the consent of all parties to a confidential communication, uses an electronic amplifying or recording device to eavesdrop upon or record the confidential communication." Section 632(c) then defines a "confidential communication" as one carried on in circumstances reasonably indicating a party wanted it confined to the parties, excluding communications the parties could reasonably expect to be overheard or recorded. That confidentiality element has no counterpart in section 631(a), which is exactly the distinction plaintiffs' counsel raised on appeal. We walk through when a California conversation counts as confidential on our page about audio recording rules in California.

The forfeiture here was procedural. The panel did not say a section 632(a) pixel claim fails. It said these plaintiffs did not brief it in the papers that mattered.

What "contents" means. CIPA does not define "contents." Courts borrow the federal Wiretap Act definition at 18 U.S.C. section 2510(8), which covers "any information concerning the substance, purport, or meaning of that communication." Under In re Zynga Privacy Litigation (9th Cir. 2014) 750 F.3d 1098, a URL carrying only basic identification and address information is record information, while a URL reproducing a user's search query may be contents. That federal backdrop is covered in our explainer on the federal Wiretap Act and the ECPA. The Adventist panel's contribution is narrower and specific to authenticated portals: inside a logged in patient portal, it reasoned, the descriptor for the activity a patient chose arguably conveys the purport of the communication even when the term is generic, and whether it actually satisfies CIPA's contents element is for the merits.

The CMIA. The CMIA lives at Civil Code Part 2.6, sections 56 through 56.37. Section 56.10(a) bars a provider of health care from disclosing "medical information regarding a patient" without first obtaining an authorization, subject to listed exceptions. Section 56.05(j)(1) defines "medical information" as individually identifiable information held by or derived from a provider "regarding a patient's medical history, mental health application information, reproductive or sexual health application information, mental or physical condition, or treatment." Plaintiffs pleaded violations of sections 56.10 and 56.101. The definitional narrowness of "medical information" is why the CMIA claim and the CIPA claim came out differently on the same portal record. For the wider California privacy picture, see our overview of California data privacy law, and for the separate rules on holding and releasing patient files, our guide to medical records retention requirements.

Why publication matters. Under California Rules of Court, rule 8.1115(a), an opinion of a Court of Appeal that is not certified for publication or ordered published "must not be cited or relied on by a court or a party in any other action," subject to narrow exceptions in rule 8.1115(b). Rule 8.1115(d) provides that a published California opinion may be cited as soon as it is certified for publication. Rule 8.1105(c) lists the standards for certification, including that an opinion applies an existing rule to significantly different facts or involves a legal issue of continuing public interest. The July 24 opinion, in other words, resolved this appeal from the day it was filed, but it became usable authority for other litigants on August 24.

Analysis: Why This Matters

The following is analysis from the Recording Law Editorial Team.

The most useful thing in this opinion is the line it draws between two questions that pixel litigation constantly collapses. Question one is whether transmitted URL and event data is "contents" or "medical information." Question two is whether that question can be answered the same way for everyone in a proposed class. The trial court answered question one against the plaintiffs and used that answer to dispose of question two. The Court of Appeal said that is backwards at the certification stage, citing Linder v. Thrifty Oil Co. (2000) 23 Cal.4th 429 and Sav-On Drug Stores, Inc. v. Superior Court (2004) 34 Cal.4th 319 for the proposition that certification does not ask whether an action is meritorious.

The second useful thing is that the panel refused to treat CIPA and the CMIA as interchangeable. Reporting that describes this as a win for patients, or as a ruling that pixels violate health privacy law, misses that the CMIA claim for the portal subclass stayed dead on the certification record. The reason is textual. CIPA's "contents" concept, borrowed from 18 U.S.C. section 2510(8), turns on the purport of a communication, and the panel could see a common answer in the fact that every portal user was communicating about their own care. The CMIA's "medical information" definition in Civil Code section 56.05(j)(1) turns on whether the disclosure regards a medical history, condition, or treatment, and the panel could not see a common answer when one URL says "radiology" and another says "download."

The third point is about litigation hygiene rather than privacy. The section 632(a) forfeiture cost the plaintiffs an entire theory because it was not briefed. A claim pleaded in a complaint does not carry itself into a certification motion.

For health systems, the operational reading is narrow and does not depend on predicting the outcome. The record here turned on things a compliance team can actually inventory: which tracking tags sit on which hosts, whether a vendor strips query strings, whether URL paths carry descriptive service terms, and whether any of it runs behind an authenticated login. The panel repeatedly distinguished the public website from the portal on exactly those facts.

How This Affects You

If you are a California patient who used a hospital website or portal during a period covered by a pending case, this decision does not determine whether anything unlawful happened to your data, and it does not create any claim for you. Class certification decides who litigates together, not who wins.

If you work in health system compliance or marketing in California, the practical takeaway is that the authenticated portal and the public marketing site are being analyzed differently, and that vendor side configuration such as IP truncation and URL obfuscation was central to the record the courts examined.

If you are a litigator, note that the opinion is now citable statewide, and that its reasoning is confined to whether these elements can be proved with common evidence.

What Happens Next

The matter goes back to Los Angeles County Superior Court, Case No. 22STCV36304, for further proceedings consistent with the opinion. On remand the trial court addresses certification of the HRA form subclass and the surviving patient portal claims. The merits questions the panel flagged, whether the transmitted URLs are "contents" under CIPA and whether Adventist's conduct violates the statute at all, remain open and undecided.

On the appellate timeline, California Rules of Court, rule 8.264(b)(1) makes a Court of Appeal decision in a civil appeal final in that court 30 days after filing, and rule 8.264(b)(3) provides that when a court certifies an opinion for publication after filing and before the decision becomes final, the finality period runs from the filing date of the publication order. Rule 8.500(e)(1) requires a petition for review in the California Supreme Court to be served and filed within 10 days after the Court of Appeal decision is final in that court. Applying those rules to a publication order filed August 24, 2026 puts finality in late September 2026 and the review window shortly after. As of September 5, 2026, we could not reach the California appellate case docket to confirm whether any party has filed or announced a petition for review, and we make no prediction about what any court will do.

This is general legal information, not legal advice. It describes California state law, specifically the California Invasion of Privacy Act and the Confidentiality of Medical Information Act, as addressed in one published Court of Appeal opinion, and details were verified on September 5, 2026. Class certification law and privacy litigation move quickly. Consult a licensed California attorney about your situation.

Related articles

• California Recording Laws: who has to consent before a conversation is recorded
• Recording audio in California: what makes a conversation confidential
• How the ECPA and the federal Wiretap Act work
• What California privacy statutes require of businesses
• How long providers must keep your medical records

Last updated: 2026-09-05. Details verified as of 2026-09-05.

Frequently Asked Questions

Did the California Court of Appeal rule that hospital tracking pixels violate CIPA?

No. Doe v. Adventist Health System/West, No. B344951, decided class certification, not liability. The panel expressly treated whether transmitted URLs are 'contents' under CIPA or 'medical information' under the CMIA as merits questions that remain undecided (slip op. pp. 34, 54).

What exactly did the court affirm and what did it reverse?

It affirmed the finding that plaintiffs forfeited their Penal Code section 632(a) claim and affirmed the denial of certification of the CMIA claims for the patient portal subclass. It reversed the denial of certification for the HRA form subclass and for the surviving patient portal claims, and remanded (slip op. p. 67).

What is the difference between CIPA section 631 and section 632?

Penal Code section 631(a) is the wiretapping provision and reaches reading or learning the contents of a communication in transit, or using information so obtained. Section 632(a) is the recording provision and reaches using an electronic amplifying or recording device to eavesdrop on or record a 'confidential communication,' which section 632(c) defines by the parties' reasonable expectations. Only section 632 requires confidentiality.

Why did the section 632(a) claim fail here?

For a procedural reason, not a substantive one. The Court of Appeal held the trial court did not abuse its discretion in finding the claim forfeited because plaintiffs never mentioned section 632(a) in their moving or reply certification papers and never set out its elements, and raised it only in a post hearing trial plan (slip op. pp. 64 to 66).

What does 'certified for publication' mean in California?

Under California Rules of Court, rule 8.1115(a), an unpublished Court of Appeal opinion generally may not be cited or relied on by a court or party in another action. Rule 8.1115(d) provides a published California opinion may be cited as soon as it is certified for publication. The panel certified this opinion on August 24, 2026 and stated there was no change in the judgment.

Why did the CIPA claim survive for the patient portal but the CMIA claim did not?

The panel reasoned that inside an authenticated portal each descriptive term denotes the activity the patient chose, and that the tracking technology transmitted the same baseline login information for every subclass member, so the CIPA contents element could be addressed with common proof. Portal URLs uniformly lacked query strings, but the panel still recognized that the descriptive terms conveyed differing levels of information (slip op. pp. 52 to 55). It agreed with the trial court that the same varying descriptive terms 'did not uniformly convey medical information' under the CMIA definition in Civil Code section 56.05(j)(1) (slip op. pp. 56 to 57).

Where does the CMIA live in California law?

The Confidentiality of Medical Information Act is Civil Code Part 2.6, sections 56 through 56.37. Section 56.10(a) bars a provider of health care from disclosing medical information regarding a patient without first obtaining an authorization, subject to listed exceptions. Plaintiffs in this case pleaded violations of sections 56.10 and 56.101.

Does this decision mean I have a claim against a hospital that used tracking pixels?

No. This decision does not create or confirm any individual claim. It addresses only whether two proposed subclasses in one Los Angeles case may proceed collectively, and it leaves liability undecided. Anyone with a specific concern should consult a California attorney.

Can this opinion be cited in other California cases?

Yes, as of the August 24, 2026 publication order, under California Rules of Court, rule 8.1115(d). Note that under rule 8.1115(e)(1), if the California Supreme Court grants review, a published Court of Appeal opinion has no binding or precedential effect while review is pending and may be cited for potentially persuasive value only.