The Safety Grade Fight: Five Florida Hospitals Challenge A Nationwide Ranking System
Edited by Madison Choi
The Two Sides
Around 2021, amidst the Covid-19 pandemic, five Palm Beach County hospitals (Good Samaritan; St. Mary’s; Delray; Palm Beach Gardens; and West Boca Medical Centers) owned by Tenet Healthcare stopped responding to The Leapfrog Group’s voluntary hospital survey (Palm Beach Post). Leapfrog, a D.C. healthcare watchdog nonprofit, publishes hospital safety grades used by patients, insurers, and employers, grading hospitals across the nation on an A-F scale (Reuters). From 2021 until 2024, Leapfrog ranked the hospitals using publicly available records and peer averages for the survey data the hospitals did not provide (Miami Herald). In 2024, Leapfrog changed this methodology. The nonprofit began to mark unavailable information as “Limited Achievement”, the lowest possible score, rather than the typically used peer averages (Miami Herald). The five hospitals, none of which had previously scored under a C, received Ds and Fs as a result. The five hospitals sued in April 2025, arguing that the grades were misleading.
The Court's Decision
In January 2026, U.S. District Judge Donald M. Middlebrooks held a five-day bench trial in the Southern District of Florida (Miami Herald). The case was in federal court: the hospitals are Florida citizens, and Leapfrog is a D.C. nonprofit (Reuters). Middlebrooks ruled in favor of the hospitals on their one successful claim, finding that Leapfrog’s 2024 methodology violated Florida’s Deceptive and Unfair Trade Practices Act (Miami Herald). The hospitals argued that Leapfrog assigned the lowest survey scores to hospitals that declined to participate, then published letter grades that appeared to reflect measured safety data (Miami Herald). The judge agreed. He called the method punitive, lacking a scientific basis, and designed to coerce participation (Miami Herald). He ordered Leapfrog to withdraw the Fall 2024, Spring 2025, and Fall 2025 grades for the five hospitals, to stop grading them under that method or a similar one, and to send corrective disclosures to entities that had licensed those grades (Sun Sentinel). He also ordered Leapfrog to pay the hospitals’ attorney fees, though the amount remains open while Leapfrog’s appeal is pending (Reuters).
The Appeal
Leapfrog appealed the March ruling to the U.S. Court of Appeals for the Eleventh Circuit (Reuters). The D.C. nonprofit filed its opening brief on September 10, 2026, and the hospitals’ response is due around November 13th; no date for oral argument has been set (Leapfrog Group. Opening Brief; Georgetown Litigation Tracker; Eleventh Circuit, Briefing Notice). Leapfrog intends to argue throughout this appeal that its safety grades are protected opinion, and that the injunction violates the First Amendment (Reuters). The organization contends that a state-consumer protection statute cannot impede a watchdog organization's First Amendment right to voice opinion on matters of public concern (Reuters). Several organizations, such as the Cato Institute, the American Civil Liberties Union, and the Reporters Committee for Freedom of the Press, have filed briefs in support of Leapfrog's position (Reuters). The hospital's stance is expected to advance and defend the arguments it won in the prior trial, arguing that the dispute is not about protected free speech. Tenet Healthcare will argue that Leapfrog misrepresented its grades as a conclusion drawn from safety data, when, under the 2024 method, these grades rested in part on scores that were assigned because those hospitals had submitted no data (Reuters). Judge Middlebrooks agreed with Tenet Healthcare's argument and held that the First Amendment defense did not apply, but now the Eleventh Circuit will reevaluate that decision. Ultimately, this could determine how far a court can go in policing the methodology of a private ratings system that insurers, employers, and patients rely on, as well as whether these rankings are considered pure opinion or whether they can be considered factual (Reuters).
The Nationwide Impact
The March injunction ordered by Judge Middlebrooks applied only to the five Florida hospitals; however, Leapfrog responded by changing its methodology for every hospital it grades nationwide (Sun Sentinel; Chief Healthcare Executive). Facilities that do not respond to its survey will not receive a hospital safety grade; this includes roughly 450 hospitals, or 16 percent of the organization's database nationwide (Leapfrog Group). Leapfrog has said that it applies one methodology nationwide, and thus in order to comply with the district court's ruling as the appeals proceed, all hospitals across the country must be held to that same methodology (Chief Healthcare Executive). What began as a dispute over five Florida hospitals in Palm Beach County over state-consumer protection claims has evolved into a nationwide reevaluation of a healthcare grading system. It raises the question of how private ratings systems that patients, insurers, and employers rely on can be challenged in court, and how much a judge can require them to change, especially when the organization that produces the grades claims the protection of free speech.