[Enforcement library](/enforcement)

# Santoro v. Tower Health: patients have standing when a hospital's pixel sends their health browsing to Meta

Open a condition page on your health site and watch what the Meta Pixel sends. In the Third Circuit, a patient who says a hospital's pixel passed their health information to Meta has suffered a concrete injury and can be heard in federal court. Tower Health still won this appeal, but only because the patients' lawyers waited too long to fix their complaint.

US Court of Appeals, Third Circuit · Federal Wiretap Act and Article III standing · Precedential opinion, 28 August 2026

## The problem

Patrick Santoro and Jessica Landis are Tower Health patients. They alleged that the Meta Pixel on towerhealth.org captured what they viewed and clicked, including "information about specific health conditions, treatments, and medications" and specific providers and locations, and sent it with identifiers to Meta for advertising ([opinion, pp. 2–3](https://www2.ca3.uscourts.gov/opinarch/243173p.pdf)). Tower Health's website privacy policy, as quoted in the complaint, said information collected on the site "will not be sold or given to a third party" ([Dkt. 70, pp. 3–4](https://www.govinfo.gov/content/pkg/USCOURTS-paed-5_22-cv-04580/pdf/USCOURTS-paed-5_22-cv-04580-0.pdf)). No court decided whether any of this happened.

- The problem
- Case record
- What was alleged
- Technical issue
- Timeline
- Outcome
- What it cost
- Why it matters
- How Inth catches this
- Checks for your own systems
- Sources and limits

## Case record

| Fact | Record |
| --- | --- |
| Court | US Court of Appeals, Third Circuit; appeal from the Eastern District of Pennsylvania (Judge John F. Murphy) |
| Case number | No. 24-3173; district court No. 5:22-cv-04580 |
| Parties | Patrick Santoro and Jessica Landis v. Tower Health. Claims against Meta were transferred to another district (\[opinion, p. 3\](https://www2.ca3.uscourts.gov/opinarch/243173p.pdf)) |
| Counsel | Appellants: Stephan Zouras. Tower Health: Shook, Hardy & Bacon (\[opinion, p. 15\](https://www2.ca3.uscourts.gov/opinarch/243173p.pdf)) |
| Laws | Federal Wiretap Act with a HIPAA predicate; negligence; intrusion upon seclusion |
| Stage | Precedential opinion of 28 August 2026 affirming dismissal with prejudice and the denial of leave to amend |
| Amount | None |
| Source review | 17 October 2026 |

## What was alleged

| Claim | What the law requires | Facts alleged | Result |
| --- | --- | --- | --- |
| Federal Wiretap Act (ECPA) | Interception of contents; a party's consent fails if the interception is for a criminal purpose, here disclosing health information in breach of HIPAA (42 U.S.C. § 1320d-6) | The pixel sent page URLs, buttons and links viewed, with IP addresses and device and account identifiers, to Meta (\[opinion, pp. 2–3\](https://www2.ca3.uscourts.gov/opinarch/243173p.pdf)) | Dismissed with prejudice as too "bare-bones" (\[opinion, p. 5\](https://www2.ca3.uscourts.gov/opinarch/243173p.pdf)); not challenged on appeal |
| Negligence | Breach of a duty causing harm | Disclosure of health information to Meta | Dismissed for the same lack of specifics |
| Intrusion upon seclusion | A highly offensive intrusion into private affairs | Same | Dismissed for the same lack of specifics |

## Technical issue

- **Tools or vendors:** the Meta Pixel.
- **Where:** Tower Health's public website. The complaint did not allege a pixel on the MyTowerHealth patient portal ([Dkt. 70, p. 2 n.3](https://www.govinfo.gov/content/pkg/USCOURTS-paed-5_22-cv-04580/pdf/USCOURTS-paed-5_22-cv-04580-0.pdf)).
- **What data:** the complaint's example was a visitor clicking "Services & Conditions", then "Cancer Care", then "Breast Cancer", reaching `https://towerhealth.org/services/breastcancer`. Because the pixel captures URLs, the fact that a person looked up that condition went to Meta ([Dkt. 70, pp. 2–3](https://www.govinfo.gov/content/pkg/USCOURTS-paed-5_22-cv-04580/pdf/USCOURTS-paed-5_22-cv-04580-0.pdf)).
- **When:** on page view and click, as the visitor browsed. The record does not describe a consent banner.
- **How it came to light:** not stated in the cited record. The proposed third amended complaint added the URLs the plaintiffs visited and alleged they later saw Facebook ads about their conditions ([opinion, p. 5](https://www2.ca3.uscourts.gov/opinarch/243173p.pdf)).

**Inth's technical interpretation:** the Meta Pixel reports the page address on every `PageView`, and Meta's own cookies tie that request to a person. On a hospital site the URL path is the sensitive part: a slug such as `/services/breastcancer` names a condition before any custom event is defined. Removing parameters is not enough; the safe pattern is to keep the ad pixel off clinical pages altogether.

Illustrative pattern, not the defendant's code.

```js
// Bad: the pixel runs site-wide, so every condition URL goes to Meta
fbq('init', PIXEL_ID);
fbq('track', 'PageView'); // Meta reads document.location: /services/breastcancer
```

Illustrative pattern, not the defendant's code. Generic consent check, not a specific c15t API.

```js
// Fixed: no ad pixel on clinical, provider or location routes; elsewhere only with consent
const CLINICAL = [/^\/services\//, /^\/conditions\//, /^\/providers\//, /^\/locations\//];
const isClinical = CLINICAL.some((re) => re.test(location.pathname));
if (!isClinical && consent.has('marketing')) {
  fbq('init', PIXEL_ID);
  fbq('track', 'PageView');
}
```

## Timeline

| Date | Event |
| --- | --- |
| 2022 | Putative class action filed against Tower Health and Meta (\[opinion, p. 3\](https://www2.ca3.uscourts.gov/opinarch/243173p.pdf)) |
| 13 March 2024 | District court hears argument on the motion to dismiss the second amended complaint (\[Dkt. 70, p. 5\](https://www.govinfo.gov/content/pkg/USCOURTS-paed-5\_22-cv-04580/pdf/USCOURTS-paed-5\_22-cv-04580-0.pdf)) |
| 24 April 2024 | Second amended complaint dismissed with prejudice (\[Dkt. 71\](https://www.govinfo.gov/content/pkg/USCOURTS-paed-5\_22-cv-04580/pdf/USCOURTS-paed-5\_22-cv-04580-1.pdf)) |
| 13 November 2024 | Reconsideration and leave to file a third amended complaint denied for undue delay (\[Dkt. 83\](https://www.govinfo.gov/content/pkg/USCOURTS-paed-5\_22-cv-04580/pdf/USCOURTS-paed-5\_22-cv-04580-2.pdf)) |
| 21 October 2025 | Third Circuit argument |
| 28 August 2026 | Precedential opinion: standing found; both orders affirmed (\[opinion\](https://www2.ca3.uscourts.gov/opinarch/243173p.pdf)) |

## Outcome

**Standing.** The court raised standing itself, in light of [Cook v. GameStop](/enforcement/cook-v-gamestop), and found it. It compared the alleged harm with intrusion upon seclusion, as it had for card numbers in [In re BPS Direct](/enforcement/in-re-bps-direct), and said "The same is true of health conditions, treatments, and medications that a patient communicates to her healthcare provider" ([opinion, p. 7](https://www2.ca3.uscourts.gov/opinarch/243173p.pdf)). Tower Health argued the patients had to name the specific information shared. The court disagreed: "a provider's surreptitious disclosure of a patient's confidential medical information is analogous to the kind of harm caused by an intrusion upon seclusion. … That suffices to establish standing" (p. 8). The patients' voluntary disclosure to their own provider was "beside the point" (p. 9). The analogy to public disclosure of private facts failed, because nothing was disclosed publicly (p. 8 n.4).

**Limits.** The court confined the holding to patients who shared information about their own health with their provider, and it did not decide whether the complaint stated a claim (p. 8 n.5). The patients had not argued on appeal that it did, so the court took "no position" on the merits (p. 14). It did not reach the Wiretap Act's crime-tort exception.

**Why Tower Health still won.** At the March 2024 hearing the district court said it was "showing \[Plaintiffs\] \[its\] cards" about the missing detail (p. 12). The patients sought leave to amend only two weeks after the dismissal, eight weeks after argument. On that record, denying leave for undue delay was not an abuse of discretion (pp. 11–14). The opinion is precedential and binds federal courts in the Third Circuit.

## What it cost

| Item | Amount or term |
| --- | --- |
| Damages or settlement | None |
| Fees | Not stated in the cited record |
| Practice changes | None ordered |

## Why it matters

Read it with two other recent Third Circuit standing decisions. [Cook](/enforcement/cook-v-gamestop) found no standing for session replay of ordinary shopping. [BPS Direct](/enforcement/in-re-bps-direct) found standing where full card numbers were captured. *Santoro* adds health information that patients share with their provider, without requiring them to plead each condition. For hospitals in Pennsylvania, New Jersey and Delaware, a standing motion is no longer an easy exit from a Meta Pixel suit.

The merits are still open. The district court's demand for specifics and the crime-tort question were not reviewed, and district courts elsewhere still split on HIPAA-predicate Wiretap Act claims. See [Federal Wiretap Act](/enforcement/laws/federal-wiretap-act), [standing](/enforcement/laws/article-iii-standing) and [sensitive context in event data](/enforcement/issues/sensitive-context-in-event-data). Health-system settlements built on the same pixel facts include [Advocate Aurora](/enforcement/advocate-aurora) and [Kaiser Permanente](/enforcement/kaiser-permanente).

## How Inth catches this

- **Code audit:** flags a pull request that adds the Meta Pixel to site-wide templates that render condition, provider or location pages outside the consent check, and traces the page URL into the pixel's `PageView`.
- **Website audit:** records a request to `facebook.com/tr` from a page such as `/services/breastcancer`, with the page, time, visitor region and consent state.
- **Consent banner:** holds the Meta Pixel until the visitor grants marketing, under an opt-in policy. Pennsylvania is not in the default opt-in regions, so a hospital would need to create a policy for it. Whether a banner choice is a sufficient authorisation for health information is for your legal team.
- **Evidence:** consent records with the choice, country and policy, runtime observations, and the commit that added the pixel.

None of this shows what Meta did with the data after receipt or whether ads followed; that needs vendor records.

## Checks for your own systems

### In the repository

- Find every place the Meta Pixel or another ad tag is initialised, and list the routes that render through those templates.
- Flag URL slugs that name conditions, treatments, medications or specialists.
- Check server-side forwarding (Conversions API, server-side tag manager) for the same page data.

### In the browser and network

- Open a condition page and filter the network panel for `facebook.com/tr`. Check whether the `dl` parameter carries the condition URL.
- Repeat while logged in to Facebook in the same browser, and note which cookies travel with the request.
- Compare the results with what your privacy policy promises about third parties.

### With the people responsible

- Ask who approved each ad tag on clinical pages and under what HIPAA analysis.
- Ask whether vendor agreements cover health information, and whether the vendor will sign a business associate agreement.

## Sources and limits

- [Santoro v. Tower Health, 3d Cir. No. 24-3173, opinion filed 28 August 2026 (precedential)](https://www2.ca3.uscourts.gov/opinarch/243173p.pdf)
- [E.D. Pa. memorandum, 24 April 2024 (Dkt. 70)](https://www.govinfo.gov/content/pkg/USCOURTS-paed-5_22-cv-04580/pdf/USCOURTS-paed-5_22-cv-04580-0.pdf); [order, 24 April 2024 (Dkt. 71)](https://www.govinfo.gov/content/pkg/USCOURTS-paed-5_22-cv-04580/pdf/USCOURTS-paed-5_22-cv-04580-1.pdf); [memorandum denying reconsideration, 13 November 2024 (Dkt. 83)](https://www.govinfo.gov/content/pkg/USCOURTS-paed-5_22-cv-04580/pdf/USCOURTS-paed-5_22-cv-04580-2.pdf)

Source review: 17 October 2026. This page describes the cited records and procedural stage. The courts accepted the complaint's allegations as true for these motions. It does not audit Tower Health's current systems. Inth wrote the technical checks; they cannot decide which laws apply or prove compliance.

Related: [In re BPS Direct](/enforcement/in-re-bps-direct) · [Cook v. GameStop](/enforcement/cook-v-gamestop) · [Standing](/enforcement/laws/article-iii-standing) · [Federal Wiretap Act](/enforcement/laws/federal-wiretap-act)