In the 1992 case of Saudi Arabia, King Faisal Specialist Hospital and Royspec v. Scott Nelson et ux., the U.S Supreme Court ruled in favor of Saudi Arabia and its hospital due to sovereign immunity under the Foreign Sovereign Immunities Act (FSIA). The plaintiffs, Scott Nelson and his wife, had filed a lawsuit against these entities after Mr. Nelson suffered serious injury while working at a hospital in Riyadh, which they alleged was due to negligence on part of his employers. However, FSIA provides foreign states with immunity from jurisdiction within U.S courts unless certain exceptions apply - none of which were found relevant by the court in this case. Therefore, despite acknowledging that Mr.Nelson's injuries were severe and life-altering; it held that neither Saudi Arabia nor its state-run hospital could be sued for damages within American courts.

In the dissenting opinion for the case of Saudi Arabia, King Faisal Specialist Hospital and Royspec v. Scott Nelson et ux., Justice Blackmun argued that sovereign immunity should not be extended to cover personal injury claims arising from commercial activities conducted by foreign states within U.S. territory. He contended that such an extension contradicts both international law principles and the intent of Congress when it enacted the Foreign Sovereign Immunities Act (FSIA). According to him, FSIA was designed to restrict, rather than expand, sovereign immunity protections for foreign states engaged in commercial activities on American soil. Furthermore, he pointed out that other nations do not extend such broad immunities to the United States or its agencies when they engage in similar activities abroad. Therefore, granting this level of protection would put American citizens at a disadvantage while providing no reciprocal benefits for them overseas.