OPINION OF THE COURT

HARDIMAN, Circuit Judge.

These cross-appeals require us to decide whether mentally ill residents of New Jersey who have been committed to state custody are entitled to judicial process before they may be forcibly medicated in nonemergency situations. At issue is Administrative Bulletin 5:04B, a procedure regulating the forcible administration of psychotropic drugs in New Jersey psychiatric hospitals, and its validity under the *295 Americans with Disabilities Act and the United States Constitution. The District Court held that AB 5:04B is valid, except as to patients who have been found by a court not to require continued commitment but who remain in custody pending transfer. Disability Rights N.J., Inc. v. Velez, 974 F.Supp.2d 705 (D.N.J.2013). We will affirm the result reached by the District Court, though not for all its stated reasons.

I

A

The New Jersey Department of Human Services operates four psychiatric hospitals that house civilly committed adults and those who have been found incompetent to stand trial or not guilty by reason of insanity. See N.J. Stat. Ann. § 30:1-7. Temporary civil commitment may be ordered by a New Jersey court only upon a showing of probable cause to believe that the person is “in need of involuntary commitment to treatment,” id. § 30:4-27.10(g), which means that he is dangerous to himself, others, or property by reason of mental illness and is unwilling to accept treatment voluntarily, id. § 30:4-27.2(m). Within 20 days of the patient’s initial admission to a facility, the court must hold a final commitment hearing at which the State must make the same showing by clear and convincing evidence in order to prolong the commitment. Id. § 30:4— 27.15(a); N.J. Ct. R. 4:74-7(c)(l).

The final hearings occur at New Jersey’s psychiatric hospitals but have many of the trappings of conventional judicial proceedings. Each patient has the right to be represented by counsel, to be present at the hearing, to present evidence, and to cross-examine witnesses. N.J. Stat. Ann. § 30:4-27.14; N.J. Ct. R. 4:74-7(e). A psychiatrist on the patient’s treatment team who has examined the patient within five days of the hearing must testify. N.J. Ct. R. 4:74-7(e). Commitment hearings take place one or two days per week at each hospital, and most are uncontested and brief.

If a patient is committed, his status is subject to judicial review three months after the final hearing and periodically thereafter. N.J. Stat. Ann. § 30:4-27.16(a). At every review hearing, the State is required to prove by clear and convincing evidence that the involuntary commitment standard remains satisfied. Id. If the court concludes that the patient no longer requires commitment, it can order him discharged or enter a judgment of “conditional extension pending placement” (CEPP). N.J. Ct. R. 4:74-7(h)(l)-(2). Patients on CEPP status remain in the hospital only because an appropriate alternative placement is unavailable; their status is reviewed within 60 days of the CEPP order’s issuance and then periodically at intervals no longer than six months. N.J. Ct. R. 4:74-7(h)(2).

B

The recent history of civil commitment of the mentally ill in this country is inextricably linked with the development of psychotropic drugs — antipsychotics, antidepressants, mood stabilizers, and the like. According to an expert report submitted to the District Court, effective psychotropic medications emerged in the 1950s and “rapidly became a mainstay of treatment” in psychiatric hospitals “because of their effectiveness in reducing or eliminating psychotic symptoms, including delusions, hallucinations, disordered thinking and speech, and disruptive and aggressive behavior.” App. 468 (report of Dr. Paul S. Appelbaum). Witnesses testified that the proper use of psychotropic drugs is “an almost essential component of treatment for a patient who is severely enough disturbed to require involuntary hospitalization,” App. 765, and agreed that “psycho *296 tropic medications are almost universally a part of successful treatment for patients in psychiatric hospitals,” App. 781.

For all their benefits, psychotropic drugs can cause serious side effects, including muscle cramps, dizziness, metabolic syndrome, parkinsonism, akathesia (motor restlessness), dystonia (involuntary muscle contractions), and tardive dyskine-sia (involuntary movement of the limbs or facial muscles). Disability Rights alleges that side effects that have been observed in New Jersey’s psychiatric hospitals include fatigue, difficulty walking, confusion, anxiety, sexual dysfunction, and allergic or toxic reactions to the drugs. For these reasons (and perhaps others), significant numbers of civilly committed psychiatric patients refuse to take psychotropic medication voluntarily, however beneficial it might be from a clinical perspective. In 2011 and 2012, between 29 and 48 patients were on “refusing status” and subject to forcible medication at each of the State’s four psychiatric hospitals. App. 1144.

The Supreme Court has never decided whether civilly committed individuals have a constitutional right to refuse psychotropic drugs. It issued a writ of certiorari in 1981 in a case posing this question, but an intervening state court decision ultimately prevented the Court from reaching the merits. Mills v. Rogers, 457 U.S. 291, 102 S.Ct. 2442, 73 L.Ed.2d 16 (1982). And although the Court has spoken time and again on the right to refuse unwanted treatment generally, it has not addressed this issue in the civil commitment context. See, e.g., Sell v. United States, 539 U.S. 166, 123 S.Ct. 2174, 156 L.Ed.2d 197 (2003) (concerning the right of a criminal defendant to refuse antipsychotic medication intended to render him competent to stand trial); Washington v. Harper, 494 U.S. 210, 110 S.Ct. 1028, 108 L.Ed.2d 178 (1990) (concerning the due process rights of prisoners subject to forcible medication for mental illness); Parham v. J. R., 442 U.S. 584, 99 S.Ct. 2493, 61 L.Ed.2d 101 (1979) (concerning the due process rights of children institutionalized for mental health care). In Harper, the most relevant of these cases for our purposes, the Court held that the Due Process Clause permits a State to forcibly medicate a dangerous, mentally ill prisoner without providing a judicial hearing as long as certain “essential procedural protections” are provided. 494 U.S. at 236, 110 S.Ct. 1028.

Unlike the Supreme Court, we have squarely addressed the right of civilly committed psychiatric patients to refuse psychotropic drugs. In 1977, a man involuntarily committed to a psychiatric hospital in New Jersey filed suit in federal court challenging the State’s use of forcible medication in nonemergency situations. Rennie v. Klein, 462 F.Supp. 1131, 1134 (D.N.J.1978). Shortly thereafter, New Jersey adopted Administrative Bulletin 78-3, which became known as the “Rennie process” and generally consisted of three steps:

[1] At the first level, when a patient refuses to accept medication, the treating physician must explain to the patient the nature of his condition, the rationale for using the particular drug, and the risks or benefits of it as well as those of alternative treatments. [2] If the patient still declines, the matter is discussed at a meeting of the patient’s treatment team, which is composed of the treating physician and other hospital personnel, such as psychologists, social workers, and nurses who have regular contact with the patient. The patient is to be present at this meeting if his condition permits.

[3] If, after the team meeting, the impasse remains, the medical director of the hospital or his designee must personally examine the patient and review *297 the record. In the event the director agrees with the physician’s assessment of the need for involuntary treatment, medication may then be administered. The medical director is also authorized, but not required, to retain an independent psychiatrist to evaluate the patient’s need for medication. Finally, the director is required to make a weekly review of the treatment program of each patient who is being drugged against his will to determine whether the compulsory treatment is still necessary.

Rennie v. Klein {Rennie I), 653 F.2d 836, 848-49 (3d Cir.1981) (en banc) (citations omitted), judgment vacated and remanded, 458 U.S. 1119, 102 S.Ct. 3506, 73 L.Ed.2d 1381 (1982). We upheld this procedure in Rennie I, id. at 851-52, and then upheld it again in Rennie v. Klein {Rennie II), 720 F.2d 266 (3d Cir.1983) (en banc), after the Supreme Court vacated the judgment in Rennie I and remanded the matter for further consideration in light of Youngberg v. Romeo, 457 U.S. 307, 102 S.Ct. 2452, 73 L.Ed.2d 28 (1982). We essentially held in the Rennie cases that civilly committed psychiatric patients “have a qualified constitutional right to refuse antipsychotic medication” in non-emergency situations and “the procedures set forth in Administrative Bulletin 78-3 accommodate [that right] in a manner consistent with the Due Process Clause.” Rennie II, 720 F.2d at 272 (Seitz, C.J., concurring). Notably, we indicated in Rennie I that committed individuals are entitled to at least as much constitutional protection in this context as prisoners. See 653 F.2d at 845-46. The Rennie process was incorporated into a consent order entered by the District Court in August 1984 that governed the forcible medication of the mentally ill in New Jersey for almost 30 years.

C

Disability Rights New Jersey, a nonprofit organization that advocates for the disabled, filed a complaint in August 2010 in the District Court against New Jersey and the Commissioner of the New Jersey Department of Human Services, alleging that the Rennie process violated various provisions of the United States Constitution, as well as the ADA and the Rehabilitation Act of 1973. The crux of the suit was that the Rennie process was nothing more than a “rubber stamp” for hospital staff members who wished to forcibly medicate their patients, App. Ill (Compl. ¶ 85), though Disability Rights also alleged that New Jersey’s hospitals failed to properly comply with the procedure. As amended, the complaint requested declaratory and injunctive relief invalidating the Rennie process and ordering the State to provide judicial hearings before involuntarily committed psychiatric patients could be forcibly medicated in nonemergent situations. The complaint also demanded additional procedural protections accompanying a judicial hearing, including: a requirement that nonemergent forcible medication take place only after a finding that the patient is incompetent to make medical decisions; a right to counsel at the hearing; establishment of a system of “experienced and knowledgeable” counsel to advocate for patients’ interests; a right to have independent expert witnesses appointed; imposition of a “clear and convincing evidence” burden of proof in forcible medication proceedings; assurance that hospital staff would be properly trained in the administration of psychotropic drugs; and a requirement that the State report monthly to Disability Rights on its use of psychotropic medication in psychiatric hospitals. • App. 321-22 (Am. Compl. ¶6). In sum, Disability Rights demanded that the State “provide patients who refuse the non-emergency administration of psychotropic medication with *298 meaningful due process protections — including legal counsel, notice and a hearing before a judicial decision-maker — before such persons may be involuntarily medicated.” App. 248 (Am. Compl. ¶ 11).

The State moved to dismiss and argued that Disability Rights’ claims were precluded by our decisions in the Rennie cases, but the District Court disagreed. Disability Rights N.J., Inc. v. Velez, 2011 WL 2976849, at *6-11 (D.N.J. July 20, 2011). The Court observed that Rennie I “specifically held that the involuntarily committed patients were to be accorded no fewer constitutional protections than prisoners,” id. at *9 (citing 653 F.2d at 846), and the Supreme Court held in Harper (several years after Rennie) that mentally ill prisoners facing forcible medication were entitled to procedural protections that “dwarf[ed]” what the Rennie process provided, id. at *10. After the District Court denied most of the motion to dismiss, the State moved to vacate the 1984 Rennie consent order, and the Court obliged in March 2012.

In June 2012, while Disability Rights’ lawsuit remained pending, the State replaced the Rennie process with two separate policies for forcible treatment in emergencies (AB 5:04A) and nonemergent situations (AB 5:04B). Under the emergency procedure of AB 5:04A, which Disability Rights has not challenged, a patient who “presents a risk of imminent or reasonably impending harm or danger to self or others” can be forcibly medicated for up to 72 hours unless a less restrictive alternative method is available. App. 1423, 1425. The patient must be reassessed every 24 hours to determine whether the emergency persists.

The nonemergency policy challenged here, AB 5:04B (the Policy), imposes more stringent requirements because it permits longer-term forcible medication. The Policy provides that a psychiatric patient can be forcibly medicated only if he has been involuntarily committed, “has been diagnosed with a mental illness, and, as a result of mental illness, poses a likelihood of serious harm to self, others, or property if psychotropic medication is not administered!;.]” App. 1393. This means that there must be a “substantial risk” that the patient will do physical harm to himself, another person, or property “within the reasonably foreseeable future.” App. 1396. A risk of harm to self must be indicated by “threats or attempts to commit suicide, or to inflict physical harm on one’s self, or by such severe self-neglect as evidenced by a dangerous deterioration in essential functioning and repeated and escalating loss of cognitive and volitional control as is essential for the individual’s health and safety”; a risk of harm to others must be indicated by “behavior which has caused [physical] harm or which places another person or persons in reasonable fear of sustaining such harm”; and a risk of harm to property must be indicated by “behavior which has caused substantial loss or damage to property.” Id.

Patients thought to satisfy the substantive requirements of the Policy may be forcibly medicated only pursuant to procedures that, though extensive, stop short of prior judicial review. First, the patient’s treating physician must complete an involuntary medication administration report, which documents the patient’s diagnosis, the medication and dosage contemplated, the rationale for concluding that the patient satisfies the substantive standard outlined above, the less restrictive alternatives considered and rejected, the efforts made to explain to the patient the need for medication, and any objections expressed by the patient. Next, the hospital’s medical director appoints a three-person panel chaired by a psychiatrist who may be a hospital employee but who may not be currently involved in the patient’s treatment. The other members of the panel *299 must be a hospital administrator and a clinician, neither of whom may be currently involved in the patient’s treatment.

At a medication review hearing held on the patient’s ward within five days of the involuntary medication administration report being submitted to the medical director, the panel hears evidence to determine whether to approve involuntary medication. The patient has the right to be notified of the hearing, attend the hearing, testify, present evidence and witnesses, cross-examine witnesses, and have a mental health professional or legal counsel present (at the patient’s expense). The patient is also afforded the assistance of the hospital’s client services advocate, a psychiatric nurse who consults with the patient and assists him in presenting evidence and making objections at the hearing. After the hearing, involuntary medication will be authorized only if the chair and at least one other member of the panel agree that the substantive standard is satisfied. The patient has 24 hours to appeal the panel’s decision to the medical director, and administration of the medication can begin immediately if the panel’s decision is affirmed. Any further appeal must be made to the Appellate Division of the New Jersey Superior Court. See N.J. Ct. R. 2:2 — 3(a)(2).

The initial approval of forcible medication is valid for 14 days. Within 12 days of that approval, the treating psychiatrist must report on “the patient’s positive and negative responses to the medication, what less restrictive interventions have been attempted or ruled out, and whether the patient is continuing to withhold consent.” App. 1400. A panel — which need not comprise the same people as before — may then authorize forcible medication lasting up to 90 days. Throughout that period, the treating prescriber must submit biweekly reports to the medical director detailing the patient’s progress. If, at the end of 90 days, the patient still does not consent to. medication, the hospital must start the entire process over again in order to continue the forcible medication.

The Policy applies to all involuntarily committed psychiatric patients in New Jersey — including CEPP patients, though the State says it has been invoked against them “very rarely.” N.J. Br. 69 n. 14. In 255 total medication review hearings held during the six months following the Policy’s implementation, panels approved medication in all but six cases, and medical directors affirmed in 55 out of 56 appeals. App. 2658. In the District Court, Disability Rights attributed this near-uniformity at least in part to the hospitals’ noncompliance with various components of the Policy and reliance on weak and stale evidence of dangerousness.

II

New Jersey’s replacement of the Rennie process with the Policy did not resolve the litigation because the Policy did not go as far as Disability Rights requested in its complaint. For example, the Policy did not require premedication judicial process, a “clear and convincing” showing of incompetence, a right to counsel in medication review proceedings, or a right to appointed experts. See supra Section I-C. In November 2012, the parties filed cross-motions for summary judgment. At that point, the District Court had before it Disability Rights’ claims that the Policy on its face 1 violated the ADA, the Rehabilitation *300 Act, and the Due Process Clause of the Fourteenth Amendment (encompassing due process generally, the right of access to the courts, the right to counsel, and the incorporated First Amendment right to freely think and communicate). 2 See Disability Rights, 974 F.Supp.2d at 711.

The District Court held that the Policy withstood Disability Rights’ statutory and constitutional challenges, except with respect to CEPP patients. As to non-CEPP patients, the Court rejected Disability Rights’ ADA and Rehabilitation Act claims on two grounds: first, that the Policy is a “legitimate safety requirement” permitted by federal regulation, id. at 739 (citing 28 C.F.R. § 35.130(h)); and second, that “ ‘adequate justification’ exists for differential treatment of the relevant class because the treatment is not based on disability, but based on a finding of dangerousness,” id. (quoting Olmstead v. L.C. ex rel. Zimring, 527 U.S. 581, 612, 119 S.Ct. 2176, 144 L.Ed.2d 540 (1999) (Kennedy, J., concurring in judgment)). As to CEPP patients, however, the Court granted summary judgment to Disability Rights on the statutory claims because those patients have already been found by a court of law not to be dangerous, and any “volatility” or relapse into dangerousness could be addressed using the emergency provisions of AB 5:04A or the recommitment process. Id. at 738.

The due process inquiry yielded the same results. With respect to non-CEPP patients, the District Court concluded that the Supreme Court’s analysis of the due process rights of prisoners in Harper required a decision in New Jersey’s favor.The Court concluded that the Policy and the procedure upheld in Harper are “strikingly similar” and applied the logic of that decision to the civil commitment context. Id. at 724, 728. Again, the Court declined to extend this ruling to CEPP patients, holding that the State had “no interest in continuing to forcibly medicate” such people after they have been adjudicated not to be dangerous. Id. at 729. As for Disability Rights’ claims based on the right to counsel, the right of access to the courts, and the right to think and communicate freely, the Court held that these claims were either duplicative of the general due process claim or could be resolved on the same grounds. See id. at 728, 729 n. 9.

Having found the Policy valid except as to CEPP patients, the District Court enjoined New Jersey’s hospitals from using it to forcibly medicate CEPP patients but otherwise let it stand. See id. at 740. Disability Rights filed a timely notice of appeal, and the State followed with a timely cross-appeal.

Ill

The District Court had jurisdiction under 28 U.S.C. §§ 1331 and 1343(a). We have jurisdiction to review the District Court’s summary judgments under 28 U.S.C. § 1291.

We review summary judgments de novo, applying the same test as the District Court. MBIA Ins. Corp. v. Royal Indem. Co., 426 F.3d 204, 209 (3d Cir.2005). Summary judgment is appropriate when “the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a). “We may affirm a district court for any reason sup *301 ported by the record.” Brightwell v. Lehman, 637 F.3d 187, 191 (3d Cir.2011).

IY

Title II of the ADA prohibits discrimination against the disabled in public services, programs, and activities. Tennessee v. Lane, 541 U.S. 509, 517, 124 S.Ct. 1978, 158 L.Ed.2d 820 (2004). Its core provision states: “no qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity.” 3 42 U.S.C. § 12132. To state a prima facie case, a plaintiff must show that he is a “qualified individual with a disability”; that he was excluded from a service, program, or activity of a public entity; and that he was excluded because of his disability. Id. Public entities include States and their subdivisions, id. § 12131(1), and mental illness qualifies as a disability under the statute, id. § 12102(1)(A).

The antidiscrimination mandate of Title II is not absolute. Federal regulations excuse States from complying with the ADA with respect to disabled people who pose a “direct threat” to others, as long as the States make these determinations using comprehensive “individualized assessment[s].” 28 C.F.R. § 35.139. States may also “impose legitimate safety requirements necessary for the safe operation of [their] services, programs, or activities” so long as such requirements “are based on actual risks, not on mere speculation, stereotypes, or generalizations about individuals with disabilities.” id. § 35.130(h). Finally, the regulations permit States to avoid Title II’s requirements when the modifications needed to ensure compliance would “fundamentally alter the nature of the service, program, or activity” at issue. id. § 35.130(b)(7).

Consistent with the District Court’s opinion, New Jersey’s defense of the Policy rests largely on these exceptions to Title II’s antidiscrimination mandate. In our view, however, there is a dispositive threshold question: does the Policy exclude civilly committed psychiatric patients from a service, program, or activity of the State? In other words, is it actually discriminatory within the meaning of the ADA?

A

First we must determine the nature of the service, program, or activity posited by Disability Rights. At oral argument, Disability Rights limited the “service, program, or activity” from which psychiatric patients in New Jersey are allegedly excluded under the Policy to the right to judicial process before being administered medication in nonemergent situations. Yet in its briefing to the Court, Disability Rights inconsistently referred to the “service, program, or activity” as the right to refuse medical treatment. Our Court has made clear that the phrase “service, program, or activity” is extremely broad in scope and includes “anything a public entity does.” Yeskey v. Pa. Dep’t of Corr., 118 F.3d 168, 171 (3d Cir.1997); 28 C.F.R. § 35.130(b)(l)(vii) (Title II regulations provide that “[a] public entity, in providing any aid, benefit, or service, may not, directly or through contractual, licensing, or *302 other arrangements, ... limit a qualified individual with a disability in the enjoyment of any right, privilege, advantage, or opportunity enjoyed by others receiving the aid, benefit, or service.” (emphasis added)). Although we assume that the right to refuse medical treatment (or another such right, whether it be common-law or statutory) could be a service, program, or activity within the meaning of Title II, this is not the service, program, or activity posited by Disability Rights.

Disability Rights’ briefs betray considerable confusion over the nature of the service, program, or activity in question. At two pages of its opening brief, for example, Disability Rights indicates that the relevant service, program, or activity is the right to refuse treatment. See, e.g., Disability Rights Br. 22, 26. In between those statements, it contends that the service, program, or activity is New Jersey’s “provision of a wide range of medical services for persons with and without disabilities.” Id. at 23. Still other parts suggest that the service, program, or activity is actually the use of judicial process prior to forcible medication. See, e.g., id. at 1 (“[AB 5:04B] permits the State to override the most fundamental right of a person to be free of unwanted medical treatment ... without any court authorization or supervision.” (emphasis added)); Disability Rights Reply Br. 13-14 (“The issue here is whether the State can subject involuntarily committed persons with mental illness to special non-judicial procedures, taking away on ‘dangerousness’ grounds their right to refuse treatment for mental illness when no other person and no other type of illness (even if it is a dangerous illness) is subjected to this type of restriction.” (emphasis added)); id. at 23 (“The discrimination is evident from the face of AB 5:04B, because it only takes away the right of persons with mental illness to refuse medical treatment, while all other persons— regardless of their disease — retain the right to refuse treatment absent a court order requiring otherwise.” (emphasis added)). The same confusion is evident in Disability Rights’ memorandum in opposition to the State’s motion for summary judgment. Compare App. 2375-76 (describing the service, program, or activity as either the right to refuse treatment or the provision of medical services) with App. 2378 (“DRNJ does not dispute that psychotropic medication may be an impor-tantr — even necessary — part of any individual patient’s treatment plan. However, this issue is factually and legally distinct from the necessity of a disparately applied policy permitting the forcible medication without a hearing and without representation.” (emphasis in original)).

This ambiguity prompted the Court to inquire about the identity of the relevant service, program, or activity at oral argument. Disability Rights cabined the service, program, or activity in question as a premedication judicial process:

The Court: What is the serviee[,] program or activity of the state from which your clients are excluded?

Disability Rights: The service[,] program or activity would be the right to refuse treatment that will not be overcome by a judicial hearing, only by a judicial hearing.

The Court: Please define as succinctly and slowly as you can' — because I think this is critical for the ADA claim — what is the service^] program or activity!?] You started by saying it’s a process.... What process?

Disability Rights: A judicial hearing.

The Court: Okay.... All right. Then it’s not about forcible medication. You agree that people can be forcibly medicated, but you say [they] can’t be forcibly medicated unless they have a judicial hearing.

*303 Disability Rights: Correct.

Tr. of Oral Arg. at 17-18. Other representations by Disability Rights during oral argument demonstrate that the relevant service, program, or activity is not the right to refuse treatment in general, but instead premedication judicial process. See, e.g., id. at 3 (“This case is about whether the state of New Jersey can, in the absence of an emergency, forcibly medicate competent persons in the state mental hospitals without a judicial hearing when no other group, no other illness can be forcibly treated without a judicial hearing.”); id. at 16 (“And the process is key to providing these individuals the same rights that every other person enjoys, which goes to our ADA argument, that every other person in New Jersey will not have the right to refuse treatment overridden absent a court order.”); id. at 45 (“[T]he issue is not that no other person is being forcibly medicated. It’s that if the state wants to forcibly medicate those individuals with those illnesses, they have to follow the process with a judicial hearing.”). These representations are consistent with the relief requested in Disability Rights’ amended complaint. See App. 321-22 (requesting as relief, inter alia, a “plan and schedule” to ensure that patients refusing to consent to the administration of psychotropic drugs receive a “judicial hearing,” “representation by counsel at said hearing,” a system for “appointing experienced and knowledgeable counsel,” appointing “independent expert witnesses” for patients, and requiring a “clear and convincing evidence” standard of proof for involuntary medication).

Courts routinely invite litigants to clarify their positions and legal theories at oral argument, and when litigants accept such invitations, courts routinely hold them to their representations. See, e.g., Wilkinson v. Austin, 545 U.S. 209, 221, 125 S.Ct. 2384, 162 L.Ed.2d 174 (2005) (recognizing a party’s withdrawal of a concession at argument); Frisby v. Schultz, 487 U.S. 474, 483, 108 S.Ct. 2495, 101 L.Ed.2d 420 (1988) (construing a municipal ordinance narrowly in accordance with the view expressed by the municipality during argument); Coar v. Kazimir, 990 F.2d 1413, 1415 n. 2 (3d Cir.1993) (narrowing the scope of the dispute at issue based on a party’s representations at argument). We accept at face value Disability Rights’ assertions during oral argument that the relevant service, program, or activity is the right to premedication judicial process.

And it is proper to hold Disability Rights to its word because there is significant evidence that the service, program, or activity at issue in this case is, in fact, procedural in nature. As a general matter, the scope of a remedy for a violation of law is necessarily limited by the scope of the law itself. See, e.g., Missouri v. Jenkins, 515 U.S. 70, 88, 115 S.Ct. 2038, 132 L.Ed.2d 63 (1995) (“The nature of the ... remedy is to be determined by the nature and scope of the constitutional violation.” (internal quotation marks omitted)). In the context of a Title II case, the equitable remedy sought is generally an injunction requiring the defendant public entity to give the disabled plaintiff “meaningful access” to the service, program, or activity from which he has unlawfully been excluded on the basis of his disability. See, e.g., Lonberg v. City of Riverside, 571 F.3d 846, 851 (9th Cir.2009) (“[Title II’s] prohibition against discrimination is universally understood as a requirement to provide ‘meaningful access.’ ”); Henrietta D. v. Bloomberg, 331 F.3d 261, 282 (2d Cir.2003) (noting that a “reasonable accommodation” is one that gives an otherwise qualified plaintiff with a disability “meaningful access” to the program or service sought). In other words, there is a nexus between the remedy sought and the service, program, or activity.

*304 Here, there is no debate that the remedy demanded by Disability Rights is an order requiring New Jersey to provide judicial hearings (and associated procedural protections) prior to nonemergent forcible medication. Where, as here, a party clearly articulates the remedy sought but offers shifting or perhaps ambiguous indications as to the corresponding service, program, or activity, we can (and should) infer from that remedy the true identity of the service, program, or activity. See, e.g., Yeskey, 118 F.3d at 169-72 (holding that a prison “boot camp” program qualified as an service, program, or activity after a disabled prisoner sued to be allowed to participate), aff'd, 524 U.S. 206, 118 S.Ct. 1952, 141 L.Ed.2d 215 (1998). The undisputed fact that Disability Rights seeks only a procedural remedy is thus compelling evidence that the service, program, or activity is procedural too.

We have determined — by looking to the briefs, the record, and oral argument — the nature of the claim Disability Rights itself chose to pursue. A party’s confusion over the contours of its own claim (whether inadvertent or strategic) does not excuse a court from construing it. And there is surely a difference between “constru[ing] ambiguous filings to make sense out of them,” as we do here, and “recharacteriz-ing” a claim in order to give it a better chance of success. Mata v. Lynch, — U.S. -, 135 S.Ct. 2150, 2157, 192 L.Ed.2d 225 (2015) (Thomas, J., dissenting). We therefore proceed on the understanding that the relevant service, program, or activity for purposes of the ADA claim is the right to judicial process before medication is forcibly administered in no-nemergent situations.

B

The fatal defect in Disability Rights’ ADA claim is that this right does not exist in New Jersey for nondisabled people, which means the denial of that right to psychiatric patients is not discriminatory. All New Jersey citizens are entitled to the judicial processes attendant to civil commitment. After that point, however, and once an individual's care is entrusted to the State, there are no additional premedication judicial processes available to anyone. In fact, Disability Rights repeatedly states in its opening brief that no one in the State but civilly committed psychiatric patients is subject to forcible medication at all. See, e.g., Disability Rights Br. 1 (“Notably, the State cannot forcibly treat persons with other illnesses without their consent, even if the State unequivocally believes those persons ‘need’ the treatment to get better.”); id. at 25 (“AB 5:04B deprives persons with mental illness in state psychiatric hospitals of the right to refuse medical treatment even though persons without mental illness retain their right to refuse treatmentf.]”). Our own review of New Jersey law persuades us that Disability Rights is basically correct. For example, mentally ill prisoners are subject to forcible medication, but they are entitled only to procedures that closely track the Policy. See N.J. Admin. Code § 10A: 16-11.1 et seq. Beyond prisoners and the civilly committed, New Jersey law broadly protects the right of hospital patients to refuse medication and treatment. See id. § 8:43G-4.1(a)(8). The nonexistent provision of specific procedural protections before such forcible treatment occurs cannot be a service, program, or activity of the State.

In its reply brief, Disability Rights suggests that some other New Jerseyans are subject to court-ordered treatment without their consent. See, e.g., Disability Rights Reply Br. 6 (“New Jersey courts consistently have held that legally competent adults have the right to refuse unwanted medical treatment, except in rare instances of an overriding court order.”). And, indeed, New Jersey law allows courts to *305 order incompetent or incapacitated — ie., disabled — people to undergo certain forms of medical treatment even though they are incapable of consenting. See, e.g., N.J. Stat. Ann. § 30:4-24.2(d)(2) (allowing courts to order necessary “experimental research, shock treatment, psychosurgery or sterilization” of psychiatric patients adjudicated to be incapacitated); Matter of Jobes, 108 N.J. 394, 529 A.2d 434, 451 (1987) (suggesting that judicial action can sometimes forestall the withdrawal of life-sustaining treatment from incompetent patients whose wishes are unknown).

But even if we set aside the critical distinctions between such scenarios and the treatment program at issue here, New Jersey’s provision of judicial process in those circumstances does not establish actionable discrimination under the ADA in this case. The fact that other disabled people in the State may be entitled to judicial process before they are treated without their consent does not mean New Jersey violates the ADA by forcibly medicating psychiatric patients under the Policy. The ADA does not require procedural uniformity in all public efforts to deal with the various challenges associated with caring for the disabled. In Traynor v. Tur-nage, the Supreme Court held that “nothing in the Rehabilitation Act” — which, as we have discussed, substantively parallels Title II — “requires that any benefit extended to one category of handicapped persons also be extended to all other categories of handicapped persons.” 485 U.S. 535, 549, 108 S.Ct. 1372, 99 L.Ed.2d 618 (1988); see also Ford v. Schering-Plough Corp., 145 F.3d 601, 608 (3d Cir.1998) (“The ADA does not require equal coverage for every type of disability[.]”); Nondiscrimination on the Basis of Disability in State and Local Government Services, 56 Fed.Reg. 35,694, 35,705 (July 26, 1991) (“State and local governments may provide special benefits ... that are limited to individuals with disabilities or a particular class of individuals with disabilities[ ] without thereby incurring additional obligations to persons without disabilities or to other classes of individuals with disabilities.” (discussing 28 C.F.R. § 35.130(c))). The mere fact that a State’s law provides for judicial process before certain disabled people can be medically treated without their informed consent does not mean the State must follow identical procedures when it permits other disabled people to be treated against their will. In short, Disability Rights has not cited and we are unaware of any case holding that a Title II violation can be stated in the absence of an allegation that a qualified person with a disability has been denied access to a public service, program, or activity to which nondisabled people have access. 4

In support of its ADA claim, Disability Rights leans heavily upon Hargrave v. Vermont, in which the Court of Appeals for the Second Circuit held that a Vermont statute violated Title II. 340 F.3d 27 (2d Cir.2003). The statute at issue altered Vermont law relating to the durable power *306 of attorney for health care (DPOA), a document that appoints a guardian to make health-care decisions in the event of the executor’s incapacity and “articulat[es] preferences for or limitations on treatment.” Hargrave, 340 F.3d at 31. Prior to the law, a DPOA could be revoked only by the executor himself or by a probate court in conjunction with the appointment of a guardian for the executor. Id. The law authorized health care professionals at state psychiatric hospitals to petition a court to override a civilly committed person’s DPOA to permit forcible medication in nonemergency situations. See id. Nancy Hargrave, an involuntarily committed woman suffering from schizophrenia, sued to enjoin enforcement of the law after being forcibly medicated and executing a DPOA refusing further treatment with “any and all anti-psychotic, neuroleptic, psychotropic or psychoactive medications.” Id. at 32 (internal quotation marks omitted).

In holding that the law violated Title II, the Second Circuit concluded that it unlawfully discriminated against mentally ill people by enabling Vermont to override their refusal of medical treatment, a power the State could not exert over others. Id. at 38 (characterizing the relevant service, program, or activity as “the statutorily created opportunity to execute a DPOA for health care and the right to have it recognized and followed ” (internal quotation marks omitted)). Hargrave identified a service, program, or activity that was made available to everyone (i.e., Vermont’s policy of recognizing DPOAs that could not be overridden on the motion of a doctor) and alleged that she had been excluded therefrom because of her disability. Conversely, here Disability Rights posits a service, program, or activity (the use of judicial hearings and attendant procedural protections prior to nonemergency forcible medication) that does not exist for any nondisabled people. Hargrave thus supports our view that a Title II claim must allege that a disabled person has been denied some benefit that a public entity has extended to nondisabled people — a burden Disability Rights does not carry here.

C

Excusing this defect in Disability Rights’ legal theory would be problematic. We note that Disability Rights would have us unravel a policy that may well be equal or superior to the judicial model it demands. 5 The State asserts that the Policy was developed at least in part with bona fide concerns for patient welfare in mind. See N.J. Br. 10-11. Disability Rights has not produced any evidence that judicial hearings would more effectively prevent unnecessary medication than the Policy — for example, it has not shown that psychiatric patients are medicated with appreciably less frequency in States that do provide judicial process. 6 See App. 298 (Am. *307 Compl. ¶ 147) (listing 29 States in which psychiatric patients are entitled to judicial hearings before being forcibly medicated). While it urges us to extend the coverage of Title II beyond what the statute will bear, Disability Rights also fails to show that invalidating the Policy would actually serve the interests of psychiatric patients in New Jersey.

For the reasons stated, we hold that Disability Rights has failed to allege a prima facie violation of Title II of the ADA because the provision of judicial process before the nonemergent administration of psychotropic drugs is not a “service, program, or activity” of New Jersey from which the civilly committed are excluded. Since this flaw in Disability Rights’ ADA claim applies equally to CEPP and non-CEPP patients, we will affirm the District Court’s summary judgment for New Jersey as to the non-CEPP patients and reverse the summary judgment for Disability Rights as to the CEPP patients on the ADA claim.

V

Having rejected Disability Rights’ statutory claims, we turn now to its constitutional claims. The District Court split its analysis of the due process claim into substantive and procedural components, but we focus on procedural due process. Because the due process analysis is different for non-CEPP and CEPP patients, we evaluate them separately.

A

As the Policy relates to non-CEPP patients, our analysis is guided by Harper, in which the Supreme Court held that a prison procedure virtually identical to the Policy satisfied due process. In that case, Washington State confined Harper, a convicted felon, to its Special Offender Center, a facility housing prisoners with serious mental illnesses. 494 U.S. at 214, 110 S.Ct. 1028. After the State treated Harper with antipsychotic drugs against his will, Harper filed a § 1983 suit “claiming that the failure to provide a judicial hearing before the involuntary administration of antipsychotic medication” violated the Due Process Clause. Id. at 217, 110 S.Ct. 1028. As Disability Rights admits, New Jersey’s Policy is essentially identical to the Washington policy at issue in Harper, which required approval of forcible medication by a three-person committee accompanied by various other procedural protections. See Disability Rights Reply Br. 33 n. 6 (resisting New Jersey’s argument that the Policy is more protective by claiming that the only two differences are illusory).

The Supreme Court began its review of the Washington policy by holding that, in light of the side effects and mind-altering nature of psychotropic drugs, Harper had “a significant liberty interest in avoiding the unwanted administration of antipsy-chotic drugs under the Due Process Clause,” Harper, 494 U.S. at 221, 110 S.Ct. 1028, but that this interest could be outweighed in appropriate circumstances by “the State’s interests in prison safety and security,” id. at 223, 110 S.Ct. 1028. It rejected the notion that the Due Process Clause forbids a State from forcibly medicating a prisoner unless he has been found *308 to be incompetent. Id. at 222, 110 S.Ct. 1028. The Court then proceeded to consider the procedural sufficiency of the Washington policy using the balancing test of Mathews v. Eldridge, 424 U.S. 319, 96 S.Ct. 893, 47 L.Ed.2d 18 (1976). Although the Court acknowledged Harper’s strong interest in refusing unwanted treatment, it rejected the notion that forcible medication decisions had to be made by judges rather than medical professionals. See Harper, 494 U.S. at 229-31, 110 S.Ct. 1028. “The risks associated with antipsychotic drugs are for the most part medical ones, best assessed by medical professionals,” the Court said. Id. at 233, 110 S.Ct. 1028. “A State may conclude with good reason that a judicial hearing will not be as effective, as continuous, or as probing as administrative review using medical decisionmakers.” Id. The Court also specifically dismissed Harper’s complaints that the Washington policy did not require a “clear and convincing” standard of proof or the right to counsel. Id. at 235-36, 110 S.Ct. 1028.

Attempting to distinguish Harper, Disability Rights insists repeatedly: “New Jersey psychiatric hospitals are not prisons and their patients are not prisoners.” Disability Rights Reply Br. 30 (emphasis in original); see also Disability Rights Br. 2, 46, 53, 55-57. For support, it quotes caselaw holding that involuntarily committed people “are entitled to more considerate treatment and conditions of confinement than criminals.” Disability Rights Br. 53 (quoting Youngberg, 457 U.S. at 321-22, 102 S.Ct. 2452). But Disability Rights omits a critical part of the quotation from Youngberg: “Persons who have been involuntarily committed are entitled to more considerate treatment and conditions of confinement than criminals whose conditions of confinement are designed to punish,” the Court wrote. 457 U.S. at 321-22, 102 S.Ct. 2452 (emphasis added). It is indisputable that the Due Process Clause permits harsher treatment of prisoners than civilly committed people insofar as the harsher treatment relates to the punitive nature of incarceration. But the Supreme Court has repeatedly stated that forcible treatment of mentally ill prisoners cannot be a component of a State’s program of punishment. See Harper, 494 U.S. at 241, 110 S.Ct. 1028 (“Forced administration of antipsychotic medication may not be used as a form of punishment.”); Vitek v. Jones, 445 U.S. 480, 493, 100 S.Ct. 1254, 63 L.Ed.2d 552 (1980) (“[Ijnvoluntary commitment to a mental hospital is not within the range of conditions of confinement to which a prison sentence subjects an individual.”). This principle is borne out by the Supreme Court’s indication that the logic of Harper applies to the forcible medication of pretrial detainees. See Riggins v. Nevada, 504 U.S. 127, 135, 112 S.Ct. 1810, 118 L.Ed.2d 479 (1992).

Because forced administration of psychotropic drugs can be used only for safety and treatment reasons in both the prison and civil commitment contexts, there is no relevant distinction between Harper and this case for due process purposes, at least with respect to non-CEPP patients. See Jurasek v. Utah State Hosp., 158 F.3d 506, 511 (10th Cir.1998) (rejecting a similar due process challenge to forcible medication on the ground that Harper applies in the civil commitment context as long as similar procedural protections are afforded). It would be passing strange if due process were to permit the State to forcibly medicate a criminal whose conviction bears no suggestion of physical dangerousness without a judicial hearing, while mandating judicial hearings for mentally ill people who have already been adjudicated to be so dangerous as to require civil commitment. Therefore, we will affirm the District Court’s summary judgment in favor of New Jersey on the due process claim with respect to non-CEPP patients.

*309 B

As for CEPP patients — individuals who have been found by a court to no longer be sufficiently dangerous to need involuntary confinement, but who remain in custody pending transfer to an appropriate community-based placement — we agree with the District Court that the due process claim has merit. Disability Rights is correct that Harper, which did not address situations in which a State wishes to forcibly medicate a person who has already been adjudicated by a court to be nondan-gerous, does not control with respect to CEPP patients. Accordingly, we turn to the familiar Mathews v. Eldridge balancing test. See Harper, 494 U.S. at 229, 110 S.Ct. 1028 (using Mathews to analyze procedural due process rights in the forcible medication context).

Mathews requires us to weigh three factors: (1) “the private interest that will be affected by the official action”; (2) “the risk of an. erroneous deprivation of such interest through the procedures used, and the probable value, if any, of additional or substitute procedural safeguards”; and (3) “the Government’s interest, including the function involved and the fiscal and administrative burdens that the additional or substitute procedural requirement would entail.” 424 U.S. at 335, 96 S.Ct. 893. Application of these factors persuades us to agree with the District Court that the Policy violates the Due Process Clause with respect to CEPP patients.

First, as the Supreme Court held in Harper, an individual’s interest in avoiding the unwarranted administration of psychotropic drugs is, to say the least, “not insubstantial.” 494 U.S. at 229, 110 S.Ct. 1028. Psychotropic medication alters and regulates the patient’s cognitive processes and can trigger serious side effects. Id. at 229-30, 110 S.Ct. 1028. A patient’s interest in avoiding such an invasion of his bodily integrity can only be greater when a court of law has already declared him fit to return to life in the community.

Meanwhile, the risk of erroneous results in the absence of a judicial hearing is considerably higher than in the non-CEPP context. When New Jersey applies the Policy to a CEPP patient, it effectively vacates a court’s prior determination that the patient is not dangerous. Such a decision may be appropriate in some circumstances — CEPP patients are only entitled to judicial review hearings every six months after their first 60 days on CEPP status, so they have plenty of time in State custody in which to relapse into dangerousness. See N.J. Ct. R. 4:74-7(h)(2). But allowing the Policy to be applied to CEPP patients would permit the State to forcibly medicate a patient just a few days after a judge has deemed the patient no longer dangerous. In such circumstances, due process may require the hospital and the commitment court to agree that the basis for a previous judicial finding of non-dangerousness no longer exists.

Finally, the State’s interest in denying judicial process to CEPP patients seems slight. Although we disagree with the District Court’s statement that the State “has no interest in continuing to forcibly medicate” CEPP patients, Disability Rights N.J., 974 F.Supp.2d at 729, New Jersey admits that it has “very rarely” sought to forcibly medicate CEPP patients pursuant to the Policy, N.J. Br. 69 n. 14. For those CEPP patients who do relapse while in custody, the State may invoke AB 5:04A to address any emergency until a judicial hearing can be held. And if providing judicial process for all psychiatric patients would result in just a five-percent increase in hearings, as Disability Rights asserts and the State does not contest, see Disability Rights Br. 37, then the “fiscal or administrative burden[ ]” imposed on New Jersey by a judicial hearing requirement *310 for CEPP patients would be light indeed, Mathews, 424 U.S. at 335, 96 S.Ct. 893.

The balance among these three factors convinces us that, as the District Court held, the State cannot apply the Policy to CEPP patients consistent with due process of law. To hold otherwise would permit psychiatric hospitals to forcibly treat patients with mind-altering drugs even after a judge has ruled that the factual basis for their continued civil commitment has disappeared. If a patient actually remains so dangerous as to require long-term, nonem-ergent forcible medication, the appropriate course for the State is to recommit the patient through normal judicial channels, not to leave the patient on CEPP status. We will therefore affirm the District Court’s summary judgment for Disability Rights on the due process claim with respect to CEPP patients.

Our analysis effectively disposes of the constitutional claims arising under the right of access to the courts, the right to counsel, and the right to freely think and communicate. Harper, as discussed above, squarely rejects the first two of those claims. See 494 U.S. at 231, 110 S.Ct. 1028 (“[W]e conclude that an inmate’s interests are adequately protected, and perhaps better served, by allowing the decision to medicate to be made by medical professionals rather than a judge.”); id. at 236, 110 S.Ct. 1028 (“[I]t is less than crystal clear why lawyers must be available to identify possible errors in medical judgment.” (quoting Walters v. Nat’l Ass’n of Radiation Survivors, 473 U.S. 305, 330, 105 S.Ct. 3180, 87 L.Ed.2d 220 (1985))). The claim based on the right to freely think and communicate is duplicative of the general due process claim and can be resolved on the same grounds. We have long held that a civilly committed person’s right to be free from unwanted treatment with mind-altering drugs is a qualified one, see Rennie II, 720 F.2d at 272 (Seitz, C.J., concurring), and there is no reason to think that the Harper hearings provided under the Policy impermissibly infringe upon that right.

In implementing the Policy, the State of New Jersey discharged one of its most important and daunting responsibilities: the care and custody of people too mentally ill to live in freedom. New Jersey determined that, while judges have an important role to play in the civil commitment process, matters of medical treatment are more appropriately handled by medical professionals. We conclude that the State’s approach comports with the demands of the Constitution and the Americans with Disabilities Act, except as to CEPP patients, whose constitutional rights entitle them to judicial process before psychotropic medication may be forcibly administered. An appropriate order follows.

MEMORANDUM AND ORDER

ALEXANDER HARVEY, II, Senior District Judge.

In this civil action, Glenda Ann Robinson (“Mrs. Robinson” or “plaintiff’) and her husband are seeking a recovery from a physician and a hospital for damages allegedly sustained during an operative procedure when Mrs. Robinson’s sixth child was delivered by way of an emergency cesarean section (“C-Section”). Named as defendants are Dr. Joseph H. Cutchin, Jr. *490 (“Dr.Cutchin”) and Peninsula Regional Medical Center (the “Hospital”).

On September 17, 1997, Mrs. Robinson’s sixth child was delivered by way of an emergency C-Section performed by Dr. Cutchin at the Hospital. Plaintiff alleges that during the course of the operation, Dr. Cutchin performed a bilateral tubal ligation and that she did not give her informed consent for such a procedure. She further alleges that, as a result, she is unable to have a seventh child and that she has accordingly suffered emotional distress. In addition to compensatory damages, plaintiffs are here seeking punitive damages.

The complaint contains four counts. In Count I, plaintiff alleges that Dr. Cutchin negligently failed to obtain her informed consent for the tubal ligation and that defendant’s negligence was the proximate cause of damages suffered by her and her husband. Count II is based on a claim of battery allegedly committed by Dr. Cutch-in with malice. In Count III, plaintiff seeks a recovery for the intentional infliction of emotional distress, and in Count IV, Mrs. Robinson and her husband jointly seek damages for loss of consortium. Diversity jurisdiction exists under 28 U.S.C. § 1332, and Maryland law is controlling.

Pursuant to Scheduling Orders entered by the Court, the parties have engaged in discovery. Discovery has now been completed; a pretrial conference has been held, and a trial date has been set. Presently pending in the case is defendants’ motion in limine. By way of that motion, defendants seek to preclude Mrs. Robinson from asserting a claim for battery and a claim for intentional infliction of emotional distress. It is also asserted that plaintiff is not entitled to a recovery of punitive damages in this case.

Since defendants’ pending motion has asked the Court to enter judgment as a matter of law as to some of plaintiffs’ claims, the motion will, as discussed at the pretrial conference, be treated as a motion for summary judgment. In support of defendants’ motion, defendants have submitted memoranda of law and exhibits, including the deposition testimony of Mrs. Robinson and Dr. Cutchin. Plaintiffs in turn have filed an opposition to defendants’ motion for summary judgment, together with exhibits. Recently, defendants have submitted a reply to plaintiffs’ opposition, together with additional exhibits. In particular, the parties rely on depositions taken during discovery and on exhibits produced during the discovery period.

Following its review of the pleadings, memoranda and exhibits, this Court has concluded that no hearing is necessary for a decision on the pending motion. See Local Rule 105.6. For the reasons stated herein, defendants’ motion in limine, treated as a motion for summary judgment, will be granted.

I

Background Facts

On the morning of September 17, 1997, Mrs. Robinson was admitted to the Hospital for delivery of her sixth child. A vaginal delivery was anticipated, and her labor was augmented with a drug which stimulates the uterus and aids in the normal progression of labor. However, her labor did not progress properly. In the early evening, she was taken to the operating room, and Dr. Cutchin, her obstetrician, made arrangements to deliver the baby by way of an emergency C-Section.

A healthy baby boy was later delivered by way of the C-Section procedure. However, during the operation, Dr. Cutchin, believing that Mrs. Robinson had consented, performed a bilateral tubal ligation. According to plaintiff, she did not learn *491 that this procedure had been performed until June of 1999 when she approached Dr. Cutchin and the Hospital and asked to see records pertaining to the operation.

Plaintiff maintains that Dr. Cutchin did not obtain her informed consent for the tubal ligation. In response, defendants assert that the sterilization procedure was performed with plaintiffs prior knowledge and consent. Hospital records and the testimony of several nurses indicate that plaintiff did in fact consent to a tubal ligation if it became necessary that her sixth child be delivered by way of a C-Section. However, no signed consent form has been located by defendants.

Mrs. Robinson contends that she and her husband were planning on having a seventh child 1 and that she has sustained emotional damages because of Dr. Cutch-in’s wrongful acts. There is no claim here for lost wages or medical expenses, but plaintiffs have asked for an award of punitive damages.

II

Summary Judgment Principles

It is well established that a defendant moving for summary judgment bears the burden of showing the absence of any genuine issue of material fact and that it is entitled to judgment as a matter of law. Barwick v. Celotex Corp., 736 F.2d 946, 958 (4th Cir.1984). Where, as here, the nonmoving party will bear the ultimate burden of persuasion at trial, “the burden on the moving party [at the summary judgment stage] may be discharged by ‘showing’ — that is, pointing out to the district court — that there is an absence of evidence to support the nonmoving party's case.” Celotex Corp. v. Catrett, 477 U.S. 317, 325, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986).

One of the purposes of Rule 56 of the Federal Rules of Civil Procedure is to require a plaintiff, in advance of trial and after a motion for summary judgment has been filed and properly supported, to come forward with some minimal facts to show that the defendant may be liable under the claims alleged. See F.R.Civ.P. 56(e). If the nonmoving party “fail[s] to make a sufficient showing on an essential element of his case with respect to which he has the burden of proof,” then “the plain language of Rule 56(c) mandates the entry of summary judgment.” Catrett, 477 U.S. at 323, 106 S.Ct. 2548.

While the facts and all reasonable inferences drawn therefrom must be viewed in the light most favorable to the party opposing the motion, Ross v. Communications Satellite Corp., 759 F.2d 355, 364 (4th Cir.1985), “when the moving party has carried its burden under Rule 56(c), its opponent must do more than simply show that there is some metaphysical doubt as to the material facts.” Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). “ ‘A mere scintilla of evidence is not enough to create a fact issue; there must be evidence on which a jury might rely.’ ” Barwick, 736 F.2d at 958-59 (quoting Seago v. North Carolina The atres, Inc., 42 F.R.D. 627, 640 (E.D.N.C.1966),’ aff 'd, 388 F.2d 987 (4th Cir.1967), cert. denied, 390 U.S. 959, 88 S.Ct. 1039, 19 L.Ed.2d 1153 (1968)). Moreover, only disputed issues of material fact, determined by reference to the applicable substantive law, will preclude the entry of summary judgment. “Factual disputes that are irrelevant or unnecessary will not be count *492 ed.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986).

In the absence of the necessary minimal showing by the plaintiff that the defendant may be liable under the claims alleged, the defendant should not be required to undergo the considerable expense of preparing for and participating in a trial. See Catrett, 477 U.S. at 323-24, 106 S.Ct. 2548; Anderson, 477 U.S. at 256-57, 106 S.Ct. 2505. Indeed, the Fourth Circuit has stated that, with regard to motions for summary judgment, the district courts have “an affirmative obligation ... to prevent ‘factually unsupported claims and defenses’ from proceeding to trial.” Felty v. Graves-Humphreys Co., 818 F.2d 1126, 1128 (4th Cir.1987) (quoting Catrett, 477 U.S. at 323-24, 106 S.Ct. 2548).

Applying these principles to the facts of record here, this Court has concluded that defendants’ motion in limine, treated herein as a motion for summary judgment, must be granted.

Ill

Battery

In seeking summary judgment as to Count II of the complaint, defendants argue that, based on facts of record, plaintiffs are not entitled to present to the jury a claim of battery arising under Maryland law. An assault and battery consists of the unpermitted application of trauma by one person upon any part of the body of another. Saba v. Darling, 72 Md.App. 487, 491, 531 A.2d 696 (1987), aff'd 320 Md. 45, 575 A.2d 1240 (1990). As the tort is more fully described in MPJI 15:2:

A battery is the intentional touching of a person without that person’s consent. Touching includes the intentional putting into motion of anything which touches another person, or which touches something that is connected with, or in contact with, another person. In order to be a battery, the touching must be harmful or offensive. A touching is harmful if it causes physical pain, injury or illness. A touching is offensive if it offends the other person’s reasonable sense of personal dignity.

This malpractice suit is an informed consent case in which Mrs. Robinson claims, inter alia, that Dr. Cutchin committed a battery. The intentional touching sought to be proved is that of a physician occurring during an operative procedure. Plaintiffs do not here contend that Mrs. Robinson did not consent to the emergency C-Section procedure. Moreover, Mrs. Robinson has not claimed that she suffered increased pain and discomfort because Dr. Cutchin, during the course of the operation to which she had consented, 2 performed a tubal ligation in addition to the C-Section procedure. Although Mrs. Robinson consented to the initial touching by the doctor, the fact that the touching was more extensive than agreed upon does not amount to a battery in a case where the critical issue is whether or not there was informed consent.

Under Maryland law, a cause of action for lack of informed consent is treated as a tort action in negligence and not as a battery or assault. Sard v. Hardy, 281 Md. 432, 440 n. 4, 379 A.2d 1014 (1977); see also Faya v. Almaraz, 329 Md. 435, 450 n. 6, 620 A.2d 327 (1993). Based on Maryland law, the Fourth Circuit applied that principle in Lipscomb v. Memorial Hospital, 733 F.2d 332, 335 (4th Cir.1984). *493 In that case, the patient had agreed to gall bladder surgery, but the doctor had repaired her hiatal hernia during the operation while she was under anesthesia. After judgment had been entered against him, the doctor argued that plaintiffs claim was one of battery and was barred by the one-year statute of limitations applicable to a battery claim. Judge Ramsey of this Court held that under Maryland law the case before him presented a claim grounded upon lack of informed consent, that under the informed consent doctrine such a claim must be cast as a tort action for negligence, and that the three-year Maryland statute of limitations applicable to a negligence claim was controlling. In affirming Judge Ramsey’s decision, the Fourth Circuit held that since the action was an informed consent case, it did not present a claim of battery but rather one of negligence, and that therefore the case was not barred by the one-year statute of limitations but had been timely filed under the three-year statute. Id. at 335.

Similarly here, evidence of record does not support a claim of battery. 3 There is no proof that Dr. Cutchin acted “intending to cause a harmful or offensive contact. ...” Nelson v. Carroll, 355 Md. 593, 601, 735 A.2d 1096 (1999) (quoting RESTATEMENT (SECOND) OF TORTS § 13 (1965)). The touching by Dr. Cutchin was not harmful because it did not cause any additional physical pain, injury or illness other than that occasioned by the C-Section procedure. 4 See MPJI 15:2. Indeed, Mrs. Robinson claims that she was not even aware that the tubal ligation procedure had occurred until June of 1999, more than 21 months after the delivery of her baby. 5 Moreover, what occurred here did not offend Mrs. Robinson’s reasonable sense of personal dignity. Id. She may, as claimed, have sustained emotional injury, and that claim will be presented to the jury in this case by way of her own testimony. However, the fact that she was not able to have a seventh child after previously giving birth to six children is hardly something which would offend her reasonable sense of personal dignity.

On the record here, plaintiff is entitled to present her claim of negligence to the jury. Disputed questions of material fact exist as to that claim, and defendants have conceded that the issue of informed consent is one for the jury. However, Maryland law does not permit a plaintiff like Mrs. Robinson to assert a claim of battery against a physician under circumstances like those present in this case.

For these reasons, this Court concludes that defendants are entitled to the entry of summary judgment as a matter of law as to plaintiffs’ claim of battery asserted in Count II of the complaint.

IV

Intentional Infliction of Emotional Distress

In Count III of the complaint, plaintiffs seek a recovery for the intentional infliction of emotional distress. It is alleged that the actions of Dr. Cutchin were intentional, reckless, extreme and outrageous and that they caused severe emotional distress to Mrs. Robinson.

*494 The tort of intentional infliction of emotional distress is rarely viable in a case brought under Maryland law. Bagwell v. Peninsula Reg’l Med. Ctr., 106 Md.App. 470, 514, 665 A.2d 297 (1995), cert. denied, 341 Md. 172, 669 A.2d 1360 (1996). The tort is to be used “sparingly” and only for “opprobrious behavior that includes truly outrageous conduct.” Kentucky Fried Chicken Nat’l Mgmt. Co. v. Weathersby, 326 Md. 663, 670, 607 A.2d 8 (1992). The elements of such a claim were set forth by the Court of Appeals of Maryland in Harris v. Jones, 281 Md. 560, 566, 380 A.2d 611 (1977), as follows:

(1) The conduct must be intentional or reckless;

(2) The conduct must be extreme and outrageous;

(3) There must be a causal connection between the wrongful conduct and the emotional distress; and

(4) The emotional distress must be severe.

Each of these elements must be pled and proved with specificity. Foot v. Juvenile Services Admin., 78 Md.App. 151, 175, 552 A.2d 947, cert. denied, 316 Md. 364, 558 A.2d 1206 (1989). A plaintiff must set forth and prove facts which would suffice to demonstrate that all the elements exist. Id.

Following its review of the record here, this Court has concluded that the claim asserted by plaintiff in Count III of the complaint may not be presented to the jury. Maryland courts have established a high standard of culpability before conduct can be considered “extreme and outrageous.” Harris, 281 Md. at 566-572, 380 A.2d 611. Plaintiff has failed to produce proof of conduct on the part of Dr. Cutchin which was “so outrageous in character and so extreme in degree as to go beyond all possible bounds of decency, and to be regarded as atrocious and utterly intolerable in a civilized society.” Id. at 567, 380 A.2d 611. To be actionable, the conduct relied upon in this case “must strike to the very core of one’s being, threatening to shatter the frame upon which one’s emotional fabric is hung.” Hamilton v. Ford Motor Credit Co., 66 Md.App. 46, 59-60, 502 A.2d 1057, cert. denied, 306 Md. 118, 507 A.2d 631 (1986). Neither the allegations nor the proof satisfy the requirement of the Maryland cases that a plaintiff must specifically plead and prove extreme and outrageous conduct. See Farasat v. Paulikas, 32 F.Supp.2d 244, 247-48 (D.Md.1997).

Moreover, plaintiff has not pointed to evidence in the case indicating that she suffered “severe emotional distress” and “mental anguish.” To satisfy the requirements of Maryland law, a plaintiff must furnish proof of “‘a severely disabling emotional response,’ so acute that ‘no reasonable [woman] could be expected to endure it.’ ” Leese v. Baltimore County, 64 Md.App. 442, 471, 497 A.2d 159, cert. denied, 305 Md. 106, 501 A.2d 845 (1985). To prove her claim of emotional distress, plaintiff does not in this case intend to call as an expert witness a psychiatrist or psychologist. There is no indication in the record here that Mrs. Robinson was ever treated by a physician for her mental anguish or that she was ever hospitalized because of her allegedly severely disabling emotional condition. 6 Proof of severe emotional distress does not exist in this case.

For these reasons, defendants’ motion for summary judgment as to Count III of the complaint will be granted.

*495 v

Punitive Damages

To prevail on her claim that she is entitled to a recovery of punitive damages in this case, Mrs. Robinson must prove that Dr. Cutchin acted with actual malice. Montgomery Ward v. Wilson, 339 Md. 701, 733, 664 A.2d 916 (1995). Actual malice in this context refers to “conscious and deliberate wrongdoing, evil or wrongful motive, intent to injure, ill will or fraud.” Id. Existence of actual malice must be established by clear and convincing evidence. Bowden v. Caldor, Inc., 350 Md. 4, 23-24, 710 A.2d 267 (1998); Pippin v. Potomac Elec. Power Co., 78 F.Supp.2d 487, 494 (D.Md.1999).

Only plaintiffs’ negligence claim remains in this case. The Court of Appeals of Maryland has emphatically stated “that negligence alone, no matter how gross, wanton or outrageous, will not” satisfy the actual malice standard. Owens-Illinois, Inc. v. Zenobia, 325 Md. 420, 463, 601 A.2d 633 (1992).

The proof relied upon by plaintiffs here falls far short of that necessary to support a recovery of punitive damages. Whether under the circumstances Dr. Cutchin exercised due care before performing the tubal ligation is an issue to be decided by the jury at the trial. However, Dr. Cutchin did not act maliciously and with an evil motive when, believing that Mrs. Robinson had consented, he performed a sterilization procedure during the course of the emergency C-Section.

Accordingly, plaintiffs will not be permitted to recover punitive damages in this case.

VI

Conclusion

For all the reasons stated, this Court conclude that plaintiff will not be permitted to present to the jury her claim for battery and her claim for the intentional infliction of emotional distress. Moreover, plaintiff may not seek punitive damages.

Accordingly, for all the reasons stated, it is this _ day of April, 2001 by the United States District Court for the District of Maryland,

ORDERED:

1. That defendants’ motion in limine, treated herein as a motion for summary judgment, is hereby granted;

2. That defendants are entitled to the entry of summary judgment in their favor as to Count II of the complaint;

3. That defendants are entitled to the entry of summary judgment in their favor as to Count III of the complaint; and

4. That plaintiffs are not entitled to seek punitive damages in this case.

ORDER GRANTING SUMMARY JUDGMENT FOR DEFENDANT

HINKLE, District Judge.

This action arises from a state court’s order compelling plaintiff Laura L. Pem- *1249 berton, who was in labor attempting vaginal delivery at home at the conclusion of a full-term pregnancy, to submit to a caesarean section that was medically necessary in order to avoid a substantial risk that her baby would die during delivery. Based on the state court’s order, physicians on the medical staff of the defendant hospital performed the caesarean section, resulting in the birth of a healthy baby. Ms. Pember-ton suffered no complications.

Ms. Pemberton asserts the procedure was not medically necessary. She claims the physicians who rendered opinions that the procedure was medically necessary (and for whose actions the hospital has accepted responsibility), as well as the hospital itself, acted under color of state law. Ms. Pemberton claims the hospital and physicians violated her substantive constitutional rights and her right to procedural due process. Ms. Pemberton also alleges Florida common law theories of negligence and false imprisonment. Concluding that Ms. Pemberton’s constitutional rights were not violated and that the hospital and physicians were not negligent, I grant summary judgment in favor of the hospital.

Background

Ms. Pemberton delivered a prior baby in 1995 by caesarean section. Most caesarian sections are performed using a horizontal incision. Ms. Pemberton’s 1995 caesarian, however, was performed using a vertical incision. Moreover, the vertical incision extended well beyond a traditional low vertical incision up into the thickened myome-trium. The nature of this caesarean presented a greater risk of uterine rupture during any subsequent vaginal delivery than would be the case with a more typical caesarean section.

When she became pregnant again in 1996, Ms. Pemberton attempted to find a physician who would allow her to deliver vaginally. She was unable to find any physician who would do so. Every physician she contacted advised her that, because of the type of caesarean section she had undergone previously, vaginal delivery was not an acceptable option.

Undeterred, Ms. Pemberton made arrangements to deliver her baby at home, attended by a midwife, without any physician attending or standing by and without any backup arrangement with a hospital. On January 13, 1996, after more than a full day of labor, Ms. Pemberton determined she needed an intravenous infusion of fluids; she had been unable to hold down food or liquids and was becoming dehydrated. She went with her husband, plaintiff Kent Pemberton, to the emergency room of defendant Tallahassee Memorial Regional Medical Center (“the hospital”), where she requested an IV.

Ms. Pemberton first saw a family practice resident on call for obstetrics, who brought the case to the attention of Dr. Wendy Thompson, a board-certified family practice physician whose practice included obstetrics. Dr. Thompson advised Ms. Pemberton that she needed a caesarean section. Ms. Pemberton refused, saying she wanted only an IV so she could return home to deliver vaginally. Dr. Thompson declined to assist in that plan by ordering only an IV and instead notified hospital officials of the situation. Hospital officials set about securing additional opinions from board certified obstetricians Dr.' A.J. Brickler and Dr. David R. O’Bryan, the chairman of the hospital’s obstetrics staff. Dr. Brickler and Dr. O’Bryan each separately concurred in the determination that a caesarean was medically necessary. Meanwhile, the Pembertons left the hospital against medical advice, apparently surreptitiously.

The hospital set in motion a procedure devised several years earlier (and used once previously) to deal with patients who refuse to consent to medically necessary treatment. The hospital called its longtime attorney, John D. Buchanan, Jr., who in turn called William N. Meggs, the State Attorney for Florida’s Second Judicial Circuit, where Tallahassee is located. Mr. Meggs, who had the responsibility under Florida law to institute any court proceeding seeking to compel a medical procedure *1250 without a patient’s consent, 1 deputized Mr. Buchanan as a special assistant state attorney for purposes of dealing with this matter. Mr. Buchanan contacted Second Circuit Chief Judge Phillip J. Padovano, advised Mm of the situation and of Mr. Buchanan’s intent to file a petition on behalf of the State of Florida seeking a court order requiring Ms. Pemberton to submit to a caesarean section, and requested a hearing.

Judge Padovano went to the hospital and convened a hearing in the office of hospital Senior Vice President and CMef Medical Officer Dr. Jack MacDonald. In response to the judge’s questions, Drs. Thompson, Brickler and O’Bryan testified unequivocally that vaginal birth would pose a substantial risk of uterine rupture and resulting death of the baby.

Judge Padovano ordered Ms. Pemberton returned to the hospital. Mr. Meggs and a law enforcement officer went to Ms. Pemberton’s home and advised her she had been ordered to return to the hospital. She returned to the hospital by ambulance against her will.

Judge Padovano then continued the hearing in Ms. Pemberton’s room at the hospital. Both she and Mr. Pemberton were allowed to express their views. The judge ordered that a caesarean section be performed.

Dr. Brickler and Dr. Kenneth McAlpine performed a caesarean section, resulting in delivery of a healthy baby boy. Ms. Pem-berton suffered no complications.

In due course, Mr. Buchanan prepared a written petition setting forth the claim for relief previously submitted orally and a proposed order. Judge Padovano entered the order on February 2, 1996. Ms. Pem-berton did not appeal. 2

Ms. Pemberton now seeks in this federal court an award of damages against the hospital. She has not named the physicians as defendants because the hospital has agreed, for purposes only of the claims at issue in this lawsuit, that the physicians acted as agents of the hospital, thus allowing entry of a judgment against the hospital for any claim established against any or all of the physicians.

Ms. Pemberton claims that the forced caesarean violated her substantive constitutional rights and that the procedure that led to entry of the order violated her right to procedural due process. She seeks relief under 42 U.S.C. § 1983 and, alleging conspiracy, under 42 U.S.C. § 1985. Ms. Pemberton also alleges common law negligence, in effect, medical malpractice, as well as false imprisonment arising from her forced return to the hospital. Mr. Pemberton joins as a plaintiff alleging loss of consortium. 3

The hospital has moved for summary judgment. For the reasons that follow, I grant the motion. 4

*1251 Discussion

I. SUBSTANTIVE CONSTITUTIONAL RIGHTS

Ms. Pemberton invokes a variety of theories in support of her claim that requiring her to undergo a caesarean section was unconstitutional. She asserts a right to bodily integrity, a right to refuse unwanted medical treatment, and a right to make important personal and family decisions regarding the bearing of children without undue governmental interference. She also invokes her right to religious freedom, although she does not specifically delineate the belief she says was violated or specifically identify its religious mooring. 5

All of these are important interests of constitutional dimension. With the exception of religion, the Constitution does not explicitly address these various interests, but their constitutional stature has been recognized repeatedly. 6 Ms. Pemberton invokes the First, Fourth, Eighth and Fourteenth Amendments of the United States Constitution; all of these save the Eighth probably speak to the interests at issue. While the precise reach of these various constitutional principles in this context remains unclear, it cannot be doubted that Ms. Pemberton had important constitutional interests that were implicated by the events the hospital set in motion.

Recognizing these constitutional interests, however, is only the beginning, not the end, of the analysis. Ms. Pemberton was at full term and actively in labor. It was clear that one way or the other, a baby would be born (or stillborn) very soon, certainly within hours. Whatever the scope of Ms. Pemberton’s personal constitutional rights in this situation, they clearly did not outweigh the interests of the State of Florida in preserving the life of the unborn child. 7

This is confirmed by Roe v. Wade, 410 U.S. 113, 93 S.Ct. 705, 35 L.Ed.2d 147 (1973). There the Court recognized the state’s increasing interest in preserving a fetus as it progresses toward viability. The Court concluded that by the point of viability — roughly the . third trimester of pregnancy — the state’s interest in preserving the life of the fetus outweighs the mother’s own constitutional interest in determining whether she will bear a child. 8

The balance tips far more strongly in favor of the state in the case at bar, because here the full-term baby’s birth was imminent, and more importantly, here the mother sought only to avoid a particular procedure for giving birth, not to avoid giving birth altogether. Bearing an unwanted child is surely a greater intrusion on the mother’s constitutional interests than undergoing a caesarean section to deliver a child that the mother affirmatively desires to deliver. 9 Thus the state’s *1252 interest here was greater, and the mother’s interest less, than during the third trimester situation addressed in Roe. Here, as there, the state’s interest outweighed the mother’s. 10

Ms. Pemberton of course does not explicitly argue that her interest in avoiding a caesarean was greater than the baby’s interest in living. Merely to state such a proposition is to refute it. 11 Nor does Ms. Pemberton explicitly assert that the state could not consider the baby’s interest in living as a basis for overriding her own refusal to consent to a caesarean section. 12

Ms. Pemberton does assert, however, that what was at stake was not the baby’s interest in living, because, she says, vaginal delivery did not pose an appreciable risk of the baby’s death as the doctors claimed. She says she could and would have delivered her baby vaginally without harming him in any way.

The medical evidence belies Ms. Pem-berton’s bravado. The evidence is this. After a caesarean section of the type Ms. Pemberton previously had undergone (that is, a caesarean involving a vertical incision extending well beyond a traditional low vertical incision up into the thickened myo- *1253 metrium), it is possible for a woman to deliver vaginally without uterine rupture or other complications. Nonetheless, there is a very substantial risk of uterine rupture and resulting death of the baby (as well as serious injury to the mother).

The record includes testimony of six physicians on this subject. Five — those whose testimony has been offered by the hospital 13 — uniformly assert the risk of uterine rupture from any vaginal delivery in these circumstances is unacceptably high and the standard of care therefore requires a caesarian. Dr. O’Bryan, for example, placed the risk at four to six percent. 14 When the consequence is almost certain death, this is a very substantial risk; as the physician convincingly explained, if an airline told prospective passengers there was a four to six percent chance of a fatal crash, nobody would board the plane.

In response, Ms. Pemberton offered the affidavit of a sixth physician, Dr. Marsden G. Wagner. 15 Dr. Wagner placed the risk of uterine rupture slightly lower, at between two and 2.2 percent, and said the risk the baby would die if there was a rupture was 50 percent. If these are the facts, it is hardly surprising that Ms. Pem-berton could find no physician willing to attend an attempted vaginal delivery. Presumably there would still be no passengers on a plane if the risk of a crash was only two percent and if, in any crash, only half the passengers would die.

Moreover, Dr. Wagner’s analysis assumes a delivery in a hospital attended by a physician. In fact, however, Ms. Pem-berton was in the process of attempting vaginal delivery at home without a physician either participating or standing by. Prior to attempting to deliver vaginally at home, Ms. Pemberton was unable to locate a single physician willing to attend the birth; this shows just how widely held was the view that this could not be done safely. Ms. Pemberton’s request to the hospital was not that she be allowed to deliver vaginally at the hospital but instead that the hospital provide an IV so that she could return home to deliver there. 16 Even Dr. Wagner does not suggest that Ms. Pemberton could have delivered safely at home without an attending or even a standby physician. 17

*1254 Medicine is not an exact science. The physicians who, on the night at issue, rendered opinions regarding the risk Ms. Pemberton faced from vaginal delivery did not and could not know with certainty whether that risk would be realized in her case. Similarly, the hospital, state attorney and state court who relied on the physicians’ opinions could not know with certainty the outcome Ms. Pemberton would encounter. In anything other than an extraordinary and overwhelming case, the right to decide would surely rest with the mother, not with the state. But based on the evidence disclosed by this record, this was an extraordinary and overwhelming case; no reasonable or even unreasonable argument could be made in favor of vaginal delivery at home with the attendant risk of death to the baby (and concomitant grave risk to the mother). On the clear and uncontradicted evidence, the interests of the baby required a caesarean section. 18

Because of the very substantial risk that the course Ms. Pemberton was attempting to pursue would result in the death of her baby, requiring her to undergo an uncon-sented caesarean section did not violate her constitutional rights. 19

II. PROCEDURAL DUE PROCESS

Ms. Pemberton also claims she was denied procedural due process. This claim is unfounded on the merits and in any event would provide no basis for relief in this court.

First, the merits. The state judge afforded Ms. Pemberton notice and an opportunity to be heard prior to ordering performance of the caesarean section. She and Mr. Pemberton took the opportunity and were in fact heard by the court. Under the circumstances, this was all the process that was feasible. The baby’s birth was imminent; convening a full adversary hearing with greater advance notice would have been impossible. The notice and opportunity to be heard that the Pembertons in fact received thus constituted all the process that was due. See, e.g., Goss v. Lopez, 419 U.S. 565, 581-82, 95 S.Ct. 729, 740, 42 L.Ed.2d 725 (1975) (recognizing that Due Process Clause does not invariably require full adversary hearing but that more limited process may be sufficient in given circumstances); Nash v. Auburn Univ., 812 F.2d 655, 660 (11th Cir.1987) (noting that “[w]hat process is due is measured by a flexible standard that depends on the practical requirements of the circumstances”); Fed.R.Civ.P. 65 (recognizing court’s ability to enter emergency order with less than full adversary hearing and even, in appropriate circumstances, without notice).

Second, this court would in any event have no authority to review the pro *1255 cedures followed by a state court in deciding a case within its jurisdiction. If the Pembertons were dissatisfied with the state court’s procedures or decision, their remedy was to appeal. Federal review of any ultimate decision of the Florida state courts would have been available only in the United States Supreme Court by petition for writ of certiorari. Federal district courts do not have jurisdiction to hear challenges to state court rulings. See, e.g., Rooker v. Fidelity Trust Co., 263 U.S. 413, 44 S.Ct. 149, 68 L.Ed. 362 (1923); District of Columbia Court of Appeals v. Feldman, 460 U.S. 462, 103 S.Ct. 1303, 75 L.Ed.2d 206 (1983). Ms. Pemberton’s procedural due process claim is a challenge to the state court’s order and, as such, is barred by the Rooker-Feldman doctrine. 20

III. PROFESSIONAL NEGLIGENCE

Ms. Pemberton also asserts that the physicians were negligent in rendering their opinions concerning the risks of vaginal birth and that the hospital was negligent in admitting these physicians to its medical staff and relying on their opinions.

Physicians owe their patients the duty to use reasonable care. Reasonable care on the part of a physician is that level of care, skill and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by similar and reasonably careful physicians, that is, the prevailing professional standard of care. See, e.g., § 766.102, Fla. Stat. (1997); Fla. Standard Jury Instructions (Civil) § 4.2a. 21 Hospitals owe then-patients an analogous duty, determined with reference to reasonably careful hospitals.

In the case at bar, the duty of the treating physicians extended not only to the actual performance of the caesarean section but also to the diagnosis, advice and informátion that they provided. Making a diagnosis, advising the patient of options, and informing the patient of risks are part of the services that physicians have a duty to perform with appropriate care.

The hospital asserts, however, that Ms. Pemberton did not voluntarily seek care from the hospital or physicians, was therefore not a “patient” to whom they owed any duty, and in any event did not rely on the physicians’ advice. Thus, says the hospital, Ms. Pemberton would have no claim against the physicians (or the hospital on their behalf) based on the advice they gave, even if the advice was rendered negligently. I disagree.

A physician’s duty with respect to advice and information extends not only to the actual patient but, in appropriate circumstances, to the person who makes the treatment decision on the patient’s behalf. When the patient is a competent, consenting adult, the duty is to use due care in providing advice and information to the patient. But when someone else— a parent pr guardian, for example — is responsible for making the relevant medical decision, the physician’s duty surely encompasses the advice and information provided to that person. I assume, for purposes of this decision, that when the decision maker is the state court, the treating physician’s duty to use due care in providing advice and information is the same. 22

*1256 Ms. Pemberton’s claim here founders not on the procedural hurdles the hospital puts in her way but instead on the merits. The physicians were not negligent. The hospital was not negligent. Not only did they carry out the caesarean section without a hitch, but their actions that set the process in motion and led to entry of the state court’s order were unassailable.

When a patient presents at a hospital emergency room, a hospital ordinarily acts reasonably when it relies on the medical advice of appropriate physicians. Dr. Thompson, who first determined that Ms. Pemberton needed a caesarean section, was board certified in family practice and routinely treated obstetrics patients. Ms. Pemberton has cast not the slightest doubt on her credentials or competence. When Dr. Thompson said Ms. Pemberton needed a caesarean section to avoid an unacceptable risk of death or injury to the baby, the hospital did precisely what it should have done: it invoked the legal process. The hospital also took the additional and quite reasonable step of securing additional medical opinions from board certified obstetricians Dr. Briekler and Dr. O’Bryan. Again, Ms. Pemberton has cast not the slightest doubt on the credentials or competence of these physicians.

In invoking the legal process, the hospital again proceeded reasonably, relying on the advice of its duly licensed and fully competent attorney. The hospital ultimately took no action except as ordered by the state court on petition fully approved by the State Attorney. 23

That leaves for analysis the advice provided by the physicians. The uncontra-dicted evidence in this record is that the physicians’ advice was correct in all material respects. They have testified that a vaginal birth in these circumstances would have presented a substantial risk of uterine rupture and resulting death of the baby, as well as a substantial risk to the health of the mother. Dr. Wagner’s testimony is not to the contrary. He too acknowledges that a vaginal .birth would have presented a substantial risk of uterine rupture, death of the baby, and danger to the mother. And there is no evidence contradicting the seemingly obvious conclusion that attempting vaginal delivery at home posed unnecessary risk.

To be sure, Dr. Wagner disagrees with the other physicians concerning what level of risk is “acceptable,” and she quantifies the risk as slightly lower — a two percent risk of rupture and resulting 50 percent risk of death of the baby, as compared to a four to six percent risk of rupture and resulting near certain death — but there is no indication these numbers were given to or asked for by the state court judge who made the decision. Dr. Wagner says a one percent risk of the baby’s death (calculated *1257 based on a fifty percent death rate in the two percent of cases that result in uterine rupture) is acceptable, but there is no reason to think the state court would have agreed, and in any event it is not negligent for a physician to classify as “unacceptable” an avoidable one percent risk of fetal death. Nor is such a physician required to quantify in percentage terms the “unacceptable” risk he or she identifies.

The hospital, physicians who considered the matter on the night at issue, and ultimately the state court were faced with a mother who had decided to deliver her baby vaginally at home. Ms. Pemberton’s own expert now places the risk of the baby’s death from attempted vaginal delivery in a hospital at one percent. As is uncontested, the risk of death from attempted vaginal delivery at home would have been higher. With little time to act, the physicians gave what they believed, and still assert, was correct advice. Regardless of whether the actual risk of the baby’s death was one percent or six percent or 60 percent, the risk was substantial, as the physicians testified at the time. The advice that the risk of. death was substantial was not negligent.

Had Dr. Wagner been available to attend an attempted vaginal delivery in a hospital where he had privileges, the state court almost surely would have allowed him to do so. This hospital and these physicians would surely have been pleased not to be involved. But Ms. Pemberton had found neither Dr. Wagner nor any other physician who believed vaginal delivery could be attempted safely. Ms. Pem-berton was proceeding at home without medical care or backup. This hospital sought opinions of three qualified physicians on its medical staff; they rendered unassailable opinions that there was a substantial risk the baby would die if a vaginal delivery was attempted; and the hospital submitted the matter to the state court based on the best (and only) medical evidence then available.

In short, Ms. Pemberton has presented insufficient evidence to support her claim that the hospital or physicians were negligent. The hospital has established the contrary and is entitled to summary judgment.

IV. FALSE IMPRISONMENT

Finally, Ms. Pemberton alleges that her transportation from her home to the hospital against her will pursuant to the state court’s order constituted false imprisonment. This theory adds nothing to Ms. Pemberton’s other claims. Any order requiring a patient to submit to a procedure against her will necessarily restrains the patient’s movement; if the order is valid, the restraint is not false imprisonment. That Ms. Pemberton was moved across town, rather than' across the hospital, does not change the analysis. In any event, if a patient can be and is lawfully ordered by a court to submit to a procedure, the patient obviously cannot nullify the court order by simply leaving the hospital. Bringing Ms. Pemberton back to the hospital pursuant to court order was not false imprisonment.

Conclusion

Because Ms. Pemberton’s constitutional rights were not violated and the hospital and physicians on its medical staff were not negligent,

IT IS ORDERED:

The motions of defendant Tallahassee Memorial Regional Medical Center, Inc. for summary judgment (documents 88 and 102) are GRANTED. The clerk shall enter judgment providing, “All claims are dismissed with prejudice.” The clerk shall close the file.

SO ORDERED.