In the

    United States Court of Appeals
                 For the Seventh Circuit
                     ____________________
No. 22-2096
CYLINDA SCOTT and MICHAEL SCOTT, individually and on be-
half of their minor child, BABY A.
                                      Plaintiffs-Appellants,

                                 v.

UNIVERSITY OF CHICAGO MEDICAL CENTER and
STEPHANIE LIOU,
                                    Defendants-Appellees.
                     ____________________

         Appeal from the United States District Court for the
           Northern District of Illinois, Eastern Division.
             No. 1:21-cv-00820 — Sara L. Ellis, Judge.
                     ____________________

No. 22-2108
BRIAN BOUGHER and ANGELA BOUGHER, individually and on
behalf of their minor daughter, BABY B., et al.,
                                           Plaintiffs-Appellants,

                                 v.

SILVER CROSS HOSPITAL AND MEDICAL CENTERS, et al.,
                                    Defendants-Appellees.
Nos. 22-2096 & 22-2108                                                  2

                       ____________________

          Appeal from the United States District Court for the
            Northern District of Illinois, Eastern Division.
              No. 1:19-cv-06324 — Sara L. Ellis, Judge.
                       ____________________

        ARGUED MAY 23, 2023 — DECIDED JULY 11, 2024
                 ____________________

   Before SYKES, Chief Judge, and BRENNAN and PRYOR, Circuit
Judges.
   PRYOR, Circuit Judge. These cases concern three sets of par-
ents who declined preventative medical care for their new-
born babies in private hospitals. 1 Because the parents refused
the treatment, hospital employees contacted the Illinois De-
partment of Children and Family Services (“DCFS”), which in
turn investigated the parents for medical neglect. In one case,
hospital staff took temporary protective custody of the child.

   The parents sued under 

, alleging that the
hospitals and certain medical professionals violated their
families’ Fourth and Fourteenth Amendment rights. Because
private entities are susceptible to § 1983 liability only when
engaged in state action, the district court dismissed both
cases. We affirm.



1 The parents are Cylinda and Michael Scott, parents to Baby A; Brian and

Angela Bougher, parents to Baby B; and Jason and Sarah Kosek, parents
to Baby K. In the district court, the parents were parties in two separate
cases, both presided over by the same judge. The cases have been consol-
idated for the purposes of this appeal.
Nos. 22-2096 & 22-2108                                                      3

                            I. BACKGROUND
     For purposes of this appeal, we accept as true all well-
pleaded factual allegations in plaintiffs’ complaints and draw
all reasonable inferences in the parents’ favor. Fehlman v. Man-
kowski, 

 (7th Cir. 2023) (noting that facts are
viewed in favor of the party who did not move for dismissal).
    A. The Vitamin K Shot
    The State of Illinois requires all obstetric departments to
administer a shot of Vitamin K—the vitamin that allows
blood to clot normally—to newborns shortly after birth. See
ILL. ADMIN. CODE tit. 77, § 250.1830(g)(8). The shot has been
routinely given to babies since 1961 to protect against hemor-
rhagic bleeding, which, although rare, can cause brain dam-
age or death in infants. 2 The shot itself comes with risks,
which are also rare, including death. 3 The plaintiffs refused
the shot for their newborns due to concerns about these risks
and for religious reasons. 4




2 Vitamin K Deficiency Bleeding, CENTERS FOR DISEASE CONTROL AND PRE-

VENTION, https://www.cdc.gov/vitamin-k-deficiency/fact-sheet/.

3 The Vitamin K shot carries a “Black Box Warning,” the highest safety-

related warning the Food and Drug Administration can assign to a drug.
See Cynthia M. Ho, A Dangerous Concoction: Pharmaceutical Marketing, Cog-
nitive Biases, and First Amendment Overprotection, 94 IND. L.J. 773, 814 n.188
(2019) (citing 

(c)(1) (discussing “Black Box Warnings”)).
4 The parents also declined the administration of erythromycin eye oint-

ment, another preventative procedure meant to avoid eye infections in
newborns. Because the parents explicitly “focus their argument on the de-
nial of Vitamin K injections,” we do too.
Nos. 22-2096 & 22-2108                                       4

   B. DCFS’s Vitamin K Policy
   DCFS is the Illinois agency charged with receiving and in-
vestigating reports of child abuse and neglect. In 2015, DCFS
adopted an internal policy—identified as Section H—stating
that Vitamin K shots or pills were a “medically necessary”
procedure for purposes of child protective services, and that
any reports of Vitamin K refusal would be taken as reports of
“medical neglect.”
    Section H also provided guidance to DCFS employees for
what to do when a physician informed the agency that she
had taken temporary protective custody of a child because the
child’s parents had refused to consent to necessary medical
care for religious reasons. It provided that these physicians
should contact the local State’s Attorney’s Office, and that
DCFS would not open an investigation “unless there [was]
additional information supporting other allegations of abuse
or neglect.”
   In June 2017, Dr. Paula Jaudes—who, at the time, was
DCFS’s medical director and a professor of pediatrics at Uni-
versity of Chicago Medical Center—informed the Illinois De-
partment of Health that DCFS had decided to rescind Section
H so that refusal of the Vitamin K shot would no longer be
considered per se medical neglect, mandate a call to DCFS, or
prompt a DCFS investigation.
    Dr. Jill Glick, a pediatrician at the University of Chicago
Medical Center and a member of the DCFS Advisory Board,
disagreed with the agency’s decision to rescind Section H. She
and other pediatricians encouraged high-ranking DCFS offi-
cials, including Dr. Jaudes, to re-implement the policy so that
refusal of Vitamin K would again be considered neglect and
Nos. 22-2096 & 22-2108                                          5

investigated accordingly. They also asked DCFS to explicitly
encourage physicians to take protective custody of children in
instances of Vitamin K refusal.
   In response to this lobbying, DCFS sent an email to its net-
work in October asking doctors to report refusals of the Vita-
min K shot as medical neglect. Both the University of Chicago
Medical Center as well as Silver Cross Hospital and Medical
Centers agreed that they would do so. In November 2017,
DCFS re-adopted Section H as the official agency policy.
   The change did not last long. Parents soon began advocat-
ing against the policy and, by August 2018, DCFS rescinded
Section H for the second time. In a letter to its staff and stake-
holders, DCFS explained that it would no longer consider a
parent’s refusal of Vitamin K to be medical neglect because
determining what treatments are considered “medically nec-
essary” fell outside the confines of the agency’s “statutory and
professional mission and judgment.”
   C. Statutory Background
    Physicians are “mandatory reporters” in Illinois, meaning
they have a statutory duty to “immediately report” cases
where “they have reasonable cause to believe that a child” is
being neglected. 325 ILCS 5/4(a)(1). The Illinois Abused and
Neglected Child Reporting Act defines medical neglect as
“not receiving the proper or necessary support or medical or
other remedial care recognized under State law as necessary
for a child’s well-being.” 325 ILCS 5/3 ¶ 9. The State has also
endowed medical professionals with the power to take pro-
tective custody of a child if they believe that leaving the child
in the guardians’ care would put the child’s health or safety
Nos. 22-2096 & 22-2108                                         6

at risk and there is no time to apply for a court order. 325 ILCS
5/5 ¶ 1.
   D. The Parents’ Experiences
    All three sets of plaintiff parents had similar experiences
after refusing the Vitamin K shot on behalf of their newborn
children. Despite the efforts of hospital staff to convince the
parents to consent to the procedure, none of the newborns
ever received the shot.
       1. The Scotts
    Baby A was born to Cylinda and Michael Scott in February
2019 at the University of Chicago Medical Center. At the time,
the hospital had an internal policy detailing what staff should
do in cases of Vitamin K refusal. It provided that if a parent
declined the shot, staff were to notify the attending physician
and the hospital’s on-call social worker. The physician would
then speak with the parents about the risks of Vitamin K re-
fusal. If the parents continued to decline the shot, the physi-
cian was to notify DCFS and take protective custody of the
child. Hospital staff would then administer Vitamin K with-
out the parents’ consent. Only then would temporary custody
be lifted.
   Pursuant to this plan, the University of Chicago Medical
Center staff attempted to convince the Scotts to consent to the
Vitamin K shot shortly after Baby A’s birth. The parents re-
fused the procedure, prompting Dr. Stephanie Liou, a defend-
ant, to threaten to take Baby A into protective custody and
administer the shot without their consent. The Scotts ulti-
mately called the police, who ordered hospital staff not to take
the child. Still, the University of Chicago Medical Center re-
ported the Scotts to DCFS, which later investigated the case.
Nos. 22-2096 & 22-2108                                        7

Following a home visit, DCFS concluded the medical neglect
report was unfounded and closed the case.
       2. The Boughers
    Baby B was born to Angela and Brian Bougher in February
2018 at Silver Cross Hospital and Medical Center. The
Boughers promptly informed the treating nurse—Monika Ko-
zuch, a defendant in this case—that they did not want Baby B
to receive a Vitamin K shot. In response, Nurse Kozuch re-
moved Baby B from the delivery room and told the new par-
ents that she would report them to DCFS.
    When Dr. Miroslaw Skalski, also a defendant, came to the
Boughers’ hospital room to inform them that their child had
low blood sugar and needed formula, the parents had yet to
hold their child. When they expressed a desire for Baby B to
breastfeed, Dr. Skalski allowed Angela to visit the child in the
nursery. After nursing, Angela was told she could not bring
the baby back to her room. Nearly thirteen hours after the
birth, hospital staff returned Baby B to the Boughers.
   The next day, a DCFS case worker notified the Boughers
that Silver Cross had confirmed there were no health risks to
Baby B, and the medical neglect report would be deemed un-
founded. The case worker explained, however, that she
would still need to complete a house visit to check on the
Boughers’ other children. DCFS later contacted the police,
who then conducted a welfare check at the Boughers’ home
the next week. The day after the welfare check, DCFS closed
the investigation and concluded the medical neglect report
was unfounded.
Nos. 22-2096 & 22-2108                                        8

       3. The Koseks
    Baby K was born to Sarah and Jason Kosek in June 2018,
also at Silver Cross. During the pregnancy, the Koseks had
signed a form indicating their intent to refuse the Vitamin K
shot. Following Baby K’s birth, however, a Silver Cross nurse
informed the Koseks that their decision would trigger a report
to DCFS.
    About an hour later, a DCFS case worker appeared in the
Koseks’ hospital room in response to a report of medical ne-
glect. Shortly thereafter, Silver Cross’s Head of Pediatrics ap-
peared and introduced himself. He informed the Koseks that
Baby K could be taken away from them if they continued to
refuse the Vitamin K shot and that he could administer the
shot without their consent. Another Silver Cross administra-
tor and a DCFS case worker spoke with the Koseks and ech-
oed these warnings. Ultimately, no one removed Baby K from
the parents during their hospital stay. Following a home visit
and witness interviews, DCFS closed the investigation and
determined the medical neglect report was unfounded.
   E. Procedural History
    All three sets of parents brought Fourteenth Amendment
claims against the hospitals and the medical professionals
with whom they interacted. They alleged that by attempting
to coerce them into consenting to the Vitamin K shot by taking
away or threatening to take away their newborns, the defend-
ants violated their substantive due process right to family in-
tegrity. The Boughers also brought a Fourth Amendment
claim against Nurse Kozuch and Dr. Skalski, alleging that the
removal of their child constituted an illegal seizure. Because
the parents failed to plead sufficiently that the defendants
Nos. 22-2096 & 22-2108                                                  9

acted under color of state law when they contacted DCFS and
temporarily removed—or threatened to remove—the new-
borns, the district court granted the defendants’ motions to
dismiss. Holderman v. Walker, No. 19 C 6324, 

(N.D. Ill. Mar. 30, 2021); Scott v. Walker, No. 21 C 820, 

 (N.D. Ill. May 5, 2022). The parents appeal. 5
                             II. ANALYSIS
    We review de novo a Rule 12(b)(6) dismissal for failure to
state a claim, meaning we take a fresh look at the legal issues.
Patrick v. City of Chicago, 

 (7th Cir. 2023). To
survive dismissal, the plaintiffs need to allege “only enough
facts to state a claim to relief that is plausible on its face.” Bell
Atl. Corp. v. Twombly, 

 (2007).
    The parents bring constitutional claims under 

. Because § 1983 liability only extends to private parties
when they act “under color of state law,” Alarm Detection Sys.,
Inc. v. Village of Schaumburg, 

 (7th Cir. 2019),
the threshold question at the heart of this appeal is whether
the defendants—private hospitals and healthcare workers—
were engaged in state action at the time of the alleged consti-
tutional violations. This “state action” inquiry is fact-inten-
sive, Burton v. Wilmington Parking Auth., 

(1961), and is “one of the more slippery and troublesome ar-
eas of civil rights litigation,” Rodriguez v. Plymouth Ambulance
Serv., 

 (7th Cir. 2009) (quoting Int'l Soc'y for


5 At the district court, several other parents were named as plaintiffs.

Some parents also brought claims against current and former DCFS em-
ployees for their roles in the incidents. This appeal, however, deals only
with claims brought by the Scotts, Koseks, and Boughers against the pri-
vate hospitals and their employees.
Nos. 22-2096 & 22-2108                                                  10

Krishna Consciousness v. Air Canada, 

, 255 (2d Cir.
1984)). 6
    We are not, however, without guidance. The Supreme
Court has recognized several scenarios when private entities
will be considered state actors for the purpose of a claim pur-
suant to § 1983. Under the “joint action” or “conspiracy” the-
ory, a private party who conspires with the government to in-
fringe on a plaintiff’s rights will be classified as a state actor.
Adickes v. S.H. Kress & Co., 

 (1970). So, too,
will a party performing a function that has traditionally been
“the exclusive prerogative of the State.” Jackson v. Metro. Edi-
son Co., 

 (1974). Courts will also find state ac-
tion when a private party and the State are interdependent “to
the point of largely overlapping identity.” Brentwood Acad. v.
Tenn. Secondary Sch. Athletic Ass’n, 

 (2001). Fi-
nally, the plaintiffs assert that we outlined another set of fac-
tors in Rodriguez v. Plymouth Ambulance Service, 

, that likewise supports a finding of state action.
    Although we recognize that these scenarios “do not so
much enunciate a test or series of factors, but rather demon-
strate examples of outcomes in a fact-based assessment,” Hal-
linan v. Fraternal Order of Police of Chicago Lodge No. 7, 

 (7th Cir. 2009), it is helpful to organize our analysis
along these lines, especially given that the parties have struc-
tured their arguments based on these scenarios.
   Before proceeding, though, we must address the issue of
waiver. The Boughers and Koseks presented only the

6 The state action requirement of the Fourteenth Amendment and the “un-

der color of state law” requirement of § 1983 are treated as identical. See
Lindke v. Freed, 

 (2024).
Nos. 22-2096 & 22-2108                                                       11

conspiracy theory of state action to the district court. They
have, therefore, waived any argument that the remaining sce-
narios support a finding of state action against Silver Cross or
its employees. See Teumer v. General Motors Corp., 

 (7th Cir. 1994) (“The failure to draw the district court’s
attention to an applicable legal theory waives pursuit of that
theory in this court.”). The Scotts are the only plaintiffs to
have preserved all theories of state action argued on appeal,
which we address in turn.
    A. Conspiracy or Joint Action
    The parents allege that private hospitals and their staff
conspired with state officials from DCFS to violate the par-
ents’ constitutional rights. They argue that this conspiracy
had two aims: to force parents to consent to Vitamin K shots
for their newborns and, failing that, to take—or threaten to
take—protective custody of the infants. The parents assert
that these joint actions show that the private hospitals and
their staff acted “under color of state law” for purposes of
§ 1983. 7


7 The parents’ counsel explicitly waived at oral argument any contention

that the hospitals’ policy of reporting Vitamin K refusal to DCFS is what
forms the basis of joint action with the state. Oral Arg. at 7:47–57. Rightly
so, for it is well-established that “merely filing a report of child neglect
with a state actor, even if false, is insufficient to create liability under Sec-
tion 1983.” Brokaw v. Mercer County, 

 (7th Cir. 2000); see
also Lugar v. Edmondson Oil Co., 

 (1982) (warning against
subjecting private parties to constitutional litigation “whenever they seek
to rely on some state rule governing their interactions with the community
surrounding them”). Reporting medical neglect to DCFS is an independ-
ent undertaking, meaning private hospitals and their employees may file
as many such reports as they wish without any “badge of [state]
Nos. 22-2096 & 22-2108                                                      12

    To get past the pleading stage on this theory, the parents
must point to more than “mere allegations of joint action or a
conspiracy” to demonstrate that the defendants acted under
color of state law. Fries v. Helsper, 

 (7th Cir.
1998). Instead, the plaintiffs must have alleged that the hospi-
tals and DCFS “had a meeting of the minds and thus reached
an understanding … to deny” the parents “a constitutional
right.” Wilson v. Warren County, 

 (7th Cir.
2016) (alterations and citation omitted). We stress that there
must have been a real agreement—explicit or implicit—be-
tween the parties. Merely working in parallel toward “a com-
mon goal” is not the same as conspiring together. Tarkowski v.
Robert Bartlett Realty Co., 

 (7th Cir. 1980)
(citation omitted).
    We analyze the parents’ claims against each hospital (and
its employees) separately.
        1. University of Chicago Medical Center
    The Scotts allege that the University of Chicago Medical
Center had an internal policy allowing doctors to take protec-
tive custody of newborns whose parents refused to allow the
administration of Vitamin K shots. They claim that this policy
was “developed” and “adopted” “in concert with high-rank-
ing DCFS officials,” and that it was inspired by Section H, the
DCFS regulation that considered Vitamin K refusal to be tan-
tamount to “medical neglect.” As proof of this joint action, the
Scotts point to the fact that two employees of the Medical Cen-
ter—Dr. Jaudes and Dr. Glick—were involved with this DCFS


authority,” Fries v. Helsper, 

 (7th Cir. 1998) (citation omit-
ted), and DCFS retains the discretion to respond to those reports as it sees
fit.
Nos. 22-2096 & 22-2108                                                  13

policy. Ultimately, the hospital’s internal policy was brought
to bear when Dr. Liou threatened to—but ultimately did
not—take the Scotts’ newborn into protective custody to ad-
minister the Vitamin K shot.
    The Scotts’ allegations against the University of Chicago
Medical Center and Dr. Liou do not reveal a conspiracy with
DCFS to infringe on the Scotts’ constitutional right to family
integrity. 8 While the allegations reveal that the hospital and
DCFS shared “a common goal” of administering Vitamin K
shots to newborns, Tarkowski, 

, there are no
allegations that the hospital and DCFS “reached an under-
standing … to deny” the Scotts their constitutional rights, Wil-
son, 

. As the Medical Center rightly notes, the
Scotts have not identified who “among the state’s many offi-
cials” were allegedly a part of the conspiracy. See Adickes, 

 (finding plaintiff entitled to relief under § 1983 if
“she can prove that a Kress employee … and a Hattiesburg
policeman somehow reached an understanding” to infringe
on her constitutional rights). Moreover, while the Scotts
broadly assert that the Medical Center’s policy was devel-
oped “in concert” with DCFS, our caselaw requires more than
“mere allegations of joint action or a conspiracy.” Fries, 

.
    The Scotts’ arguments also run into several other road-
blocks. For one, the Medical Center staff appeared to be oper-
ating within the bounds of—or at least inspired by—


8 In their complaint, the Scotts allege that two University of Chicago Med-

ical Center employees—Dr. Jaudes and Dr. Glick—were involved in the
reinstatement of the DCFS policy. These individuals, however, are not de-
fendants in this case and did not report the Scotts to DCFS.
Nos. 22-2096 & 22-2108                                        14

applicable Illinois regulations and law. Illinois regulations re-
quire the administration of Vitamin K to newborns “shortly
after birth, but usually within the first hour after delivery.”
ILL. ADMIN. CODE tit. 77, § 250.1830(g)(8). And Illinois law
specifies that “a physician treating a child may take or retain
temporary protective custody of the child” to administer nec-
essary medical care under appropriate circumstances. 325
ILCS 5/5 ¶ 1. To the extent the Medical Center may have mod-
eled its internal procedures around public guidelines, this
cannot support an inference of “joint action.” See Lugar v. Ed-
mondson Oil Co., 

 (1982). Thus, the Scotts’
complaint fails to support the assertion that the University of
Chicago Medical Center defendants’ actions were made pos-
sible by Section H.
    What’s more, the Scotts’ allegations reveal more conflict
between the University of Chicago Medical Center and state
actors than joint action. Nothing in DCFS’s Section H policy
required doctors to take temporary custody of newborns, but
the Medical Center’s internal policy did. Moreover, DCFS ul-
timately rescinded Section H—determining it “inappropri-
ately identifie[d]” what can and should be considered as
“medically necessary.” The Medical Center, however, contin-
ued recommending protective custody for newborns in in-
stances of Vitamin K refusal. Indeed, the Scotts’ baby was
born six months after Section H was rescinded and the Medi-
cal Center’s restrictive Vitamin K policy was still in place. Fi-
nally, when Dr. Liou threatened to take protective custody of
the Scotts’ newborn, Chicago police officers that were called
to the scene put a stop to it. By including these allegations in
their complaint, the Scotts have shown the absence of a con-
spiracy between the Medical Center and DCFS.
Nos. 22-2096 & 22-2108                                      15

      2. Silver Cross Hospital
   Two sets of parents—the Boughers and the Koseks—al-
lege that Silver Cross Hospital, several of its doctors, and a
nurse acted under color of state law by conspiring with DCFS.
They claim that the hospital had a policy or practice of coerc-
ing parents into consenting to Vitamin K shots for newborns
under the threat of reporting the parents to DCFS or taking
protective custody of the newborn. Indeed, after the Boughers
refused administration of Vitamin K for their newborn, Nurse
Kozuch took the newborn and told the Boughers that she was
reporting them to DCFS. Similarly, Dr. Skalski threatened the
Boughers with a DCFS investigation to try to get them to ac-
cept the Vitamin K shot.
   For the Koseks, a Silver Cross nurse allegedly told them
that DCFS would be called due to their refusal of the Vitamin
K shot. The head of pediatrics at Silver Cross reinforced this
by telling the Koseks that the hospital could take their baby
away if they continued to refuse the Vitamin K shot.
   When reviewing these allegations, it appears Silver Cross
employees invoked DCFS as a threat to coerce the parents to
agree to the administration of the Vitamin K for their new-
borns, but there is nothing to suggest that the hospital and
DCFS “had a meeting of the minds” about this issue. Wilson,

.
    The fact that Illinois’s statutory and regulatory backdrop
permitted Silver Cross’s conduct confirms this conclusion.
While we recognize that DCFS’s Section H policy—which
deemed the refusal of Vitamin K administration to be “medi-
cal neglect”—was in place when Baby B and Baby K were
born, Illinois regulations also required the administration of
Nos. 22-2096 & 22-2108                                          16

Vitamin K to newborns “shortly after birth, but usually within
the first hour after delivery.” ILL. ADMIN. CODE tit. 77,
§ 250.1830(g)(8). Also, the law allowed physicians “treating a
child [to] take or retain temporary protective custody of the
child” to administer necessary medical care under appropri-
ate circumstances. 325 ILCS 5/5 ¶ 1. The allegations in the
complaint show that Silver Cross and its staff were aware of
and acted in accordance with this guidance. Mere compliance
with state regulations or guidelines cannot transform a pri-
vate entity into a state actor. See Am. Mfrs. Mut. Ins. Co. v. Sul-
livan, 

 (1999) (“[T]he mere fact that a business is
subject to state regulation does not by itself convert its action
into that of the State … .”). Nor is there merit to the parents’
argument that the state regulations were implemented as
“cover” for the hospital’s policy, as neither Silver Cross nor
any of its employees are alleged to have participated in the
creation of any of the state rules, including DCFS’s Section H
policy. At most, the Bougher and Kosek complaint asserts that
Silver Cross’s internal policy of reporting parents who re-
fused Vitamin K shots to DCFS was inspired by already-in-
place state agency guidelines. This is not enough. Lugar, 

.
                              * * *
    For these reasons, we are unable to infer that DCFS con-
spired with the defendants to deprive the parents of their con-
stitutional rights.
   B. Public Function
    The parents next invoke the “public function” theory of
state action, whereby a private individual acts under color of
law when he or she “exercise[s] … powers traditionally
Nos. 22-2096 & 22-2108                                                      17

exclusively reserved to the State.” Jackson, 

; see
Flagg Bros., Inc. v. Brooks, 

 (1978). In these
cases, the private actors are “clothed with the authority of
state law.” Rodriguez, 

. The parents argue that
taking children into protective custody is exclusively a public
function.
    Notably, only the Boughers’ newborn was taken into pro-
tective custody and, as explained above, they waived any ar-
gument that Silver Cross or its employees were performing a
public function. And while the Scotts preserved the public
function argument for appeal, they allege only that Dr. Liou
threatened to take custody of their child.
   We assume—but do not decide—that taking temporary
protective custody of a child is an exclusive and traditional
function of the state. But, here, the University of Chicago
Medical Center did not “exercise” that function, Jackson, 

, given that Dr. Liou never took the Scotts’ newborn
away from them. The Scotts have pointed to no case in which
the mere threat of performing a traditional state function
transforms a private actor into one acting “under color of state
law.” Given that the Scotts have failed to show Dr. Liou and
the University of Chicago Medical Center performed a public
function, this theory fails. 9


9 The parents argue that our decision in Rodriguez v. Plymouth Ambulance

Service, 

, outlined a fourth set of state action factors that like-
wise supports their theory that the hospitals and their employees were
acting under color of state law. That decision, however, simply considered
the “public function” question as it applies to medical providers in state
prisons. Rodriguez, 

. The case focused primarily on “the re-
lationship among the state, the health care provider and the prisoner,”
Nos. 22-2096 & 22-2108                                                     18

    C. Symbiotic Relationship or Entwinement
    Lastly, the parents contend that the hospitals and their em-
ployees were interdependent “to the point of largely overlap-
ping identity.” Brentwood Acad., 

. As before,
only the Scotts have preserved this “entwinement” theory of
state action, so we only consider their allegations against the
University of Chicago Medical Center and Dr. Liou.
    The Scotts argue that, when Dr. Liou threatened to call
DCFS if the Scotts did not consent to the Vitamin K shot, “any
reasonable person would see the two entities as working to-
gether.” But this type of state action is premised on whether
the entities are actually entwined, not whether they appear to
be. See Brentwood Acad., 

. And even taking the
Scotts’ argument on its own terms, “working together” is not
enough. Instead, there is state action only when public and
private entities are interdependent “to the point of largely
overlapping identity.” 

 at 300–03 (allowing § 1983 claims to
proceed against a private athletic association when the asso-
ciation was entwined with the state from the “bottom up”
through membership largely made up of public schools and
from the “top down” through state appointment of board
members and association employees’ inclusion in state



recognizing that, in a prisoner context, the state is “the ultimate responsi-
ble party for the prisoner’s health care.” Id. at 826–27 (emphasis in origi-
nal). Here, the state had no control or coercion over the newborns’ medical
care, nor was there a contract between the state and the defendant provid-
ers to care for the newborns (an “important factor” in Rodriguez). Id. at 827.
Thus, Rodriguez does little to guide our analysis. We have never applied
the factors from Rodriguez outside of the prison context and will not do so
here.
Nos. 22-2096 & 22-2108                                                         19

retirement plans). The Scotts’ allegations reveal no such inter-
dependence here. 10
                             III. CONCLUSION
    Without state action there can be no § 1983 liability. For
this reason, we AFFIRM the district court’s dismissals of the
parents’ claims.




10 Because Silver Cross was not acting under color of state law, we need

not address the parties’ argument that Monell liability applies. See Iskander
v. Village of Forest Park, 

 (7th Cir. 1982) (noting that, to state
a Monell claim against a private corporation, a plaintiff must allege that
the corporation was acting under color of state law). Similarly, because
none of the hospital employees acted under color of state law, we need not
address the parents’ invitation to overturn our holding in Iskander that
plaintiffs cannot premise § 1983 claims on respondeat superior liability. See
id.