Hospital antitrust

Hospital antitrust concerns the many precedents relating to antitrust challenges to hospital monopolization. Leading precedents include the following 18 decisions, of which many were on motions for summary judgment:

Am. Chiropractic v. Trigon Healthcare, 367 F.3d 212, 217–18, 224 (4th Cir. 2004) (the lawsuit challenged an alleged "conspiracy that used Trigon's reimbursement policies and treatment guidelines to limit severely the flow of insurance dollars to chiropractors and steer those monies toward medical doctors. The district court [held for defendant], dismissing two counts of the complaint for failure to state a claim and disposing of the remaining counts by granting Trigon's motion for summary judgment. [The Fourth Circuit affirmed on different grounds.] ... [M]edical doctors, in their role as members of the peer review committee, had a unity of interest with the hospital: ensuring patient care. We believe that Oksanen's reasoning is not only instructive but persuasive here.").

Austin v. McNamara, 979 F.2d 728 (9th Cir. 1992) (This precedent has been widely followed to exclude evidence of bad faith from lawsuits against hospitals for sham peer review. The Ninth Circuit affirmed a grant of summary judgment to the defendant hospital and doctors affiliated with it.).

BCB Anesthesia Care v. Passavant Memorial Area Hosp. Ass’n, 36 F.3d 664, 669 (7th Cir. 1994) (in affirming a dismissal of a claim by nurse anesthetists at a central Illinois hospital the court held, "Although we hesitate to say that [a staffing decision at one hospital] . . . can never state an antitrust claim, we believe it is incumbent upon the plaintiff to plead some additional facts from which it can be inferred that the case falls within the ambit of the Sherman Act." Seglin v. Esau, supra. [769 F.2d 1274 (7th Cir.1985)] Before we enlist this court in the micromanagement of the staffing arrangements at Passavant under the aegis of the antitrust laws, we need better reasons than the plaintiffs have given us.").

Gabaldoni v. Washington County. Hospital Ass'n, 250 F.3d 255 (4th Cir. 2001) (affirming summary judgment by the district court in a lawsuit challenging a termination of a physician's clinical privileges and denied his application for reappointment to the medical staff, in a lawsuit contract and tort claims against hospital entities; there were no antitrust or Sherman Act claims in this case).

Hein-Muniz v. Aiken Regional Med. Ctrs., 532 Fed. App’x 342 (4th Cir. 2013) (affirming summary judgment against a physician who challenged a hospital's termination of his privileges, but no mention of antitrust or the Sherman Act in this appeal or in district court. Instead the claims were for: breach of contract, breach of contract accompanied by a fraudulent act, violations of the South Carolina and the United States Constitutions and HCQIA, illegality, conspiracy, unfair trade practices, breach of fiduciary duty, and interference with prospective contract. Relief sought included declaratory judgment, actual and compensatory damages, punitive damages, special damages, injunction, and attorney's fees.).

Imperial v. Suburban Hosp. Ass’n, 37 F.3d 1026 (4th Cir. 1994) (applying HCQIA immunity to affirm a grant of summary judgment against damages, but found that HCQIA immunity did not apply to requests for injunctive but the plaintiff-physician who was denied reappointment to the medical staff had waived a claim for injunctive relief)

Mathews v. Lancaster Gen. Hosp., 87 F.3d 624 (3d Cir. 1996) (affirmed summary judgment under HCQIA immunity on a Sherman Act Section 1 claim because the plaintiff-physician did not provide evidence of a concerted action and an antitrust injury)

Moore v. Williamsburg Regional Hosp., 560 F.3d 166 (4th Cir. 2009) (not an antitrust case, the Fourth Circuit applied HCQIA immunity to affirm summary judgment for a hospital in a lawsuit brought by a physician who challenged his summary suspension)

Oksanen v. Page Memorial Hosp., 945 F.2d 696, 699 (4th Cir.1991) (en banc) (affirming summary judgment affirmed based on intra-corporate doctrine: "the Board of Trustees and the medical staff of Page Memorial comprised a single entity during the peer review process. Because an entity cannot conspire with itself, the Board and the staff lacked the capacity to conspire. While the members of a medical staff may have the capacity to conspire among themselves, such a conspiracy did not occur in this case. We likewise affirm the district court's dismissal of Oksanen's other claims and its refusal to cloak in federal antitrust law what is in essence a workplace dispute.") (citing Copperweld Corp. v. Independence Tube Corp., 467 U.S. 752 (1984)).

Poliner v. Tex. Health Sys., 537 F.3d 368 (5th Cir. 2008) (reversal of a jury trial judgment for the physician).

Sugarbaker v. SSM Health Care, 190 F.3d 905 (8th Cir. 1999) (applying HCQIA immunity to affirm a grant of summary judgment against a Sherman Act claim for the restriction and then termination of hospital medical staff privileges of a physician).

Tshibaka v. Sernulka, 673 Fed. App’x. 272 (4th Cir. 2016) (hospital “[i]mmunity applies unless—viewing the totality of the circumstances in an objectively reasonable manner—the aggrieved physician rebuts the presumption that the professional review action satisfied HCQIA.” The Fourth Circuit thereby affirmed a district court grant of summary judgment to the hospital and its CEO, while remanding in favor of plaintiff's claim for defamation; no mention of antitrust or Sherman Act in this case).

Wahi v. Charleston Area Med. Ctr., 562 F.3d 599, 601 (4th Cir. 2009) ("The district court concluded most of Wahi's claims were barred because CAMC qualified for immunity from suit under the Health Care Quality Improvement Act ("HCQIA" or "the Act"), 42 U.S.C.A. § 11101, et seq. (West 2005). For this reason, and because the district court found Wahi's other claims failed on the merits, the court awarded CAMC and [its Executive VP and CMO] summary judgment.").

Wieters v. Roper Hosp., 58 Fed. App’x 40, 41, 46 (4th Cir. 2003) ("The district court granted summary judgment to the hospital on immunity grounds, and we affirm. ... Although [the physician] has pointed out parts of the process that did not hew strictly to the bylaws and the safe harbor provisions, he has presented nothing that would lead a reasonable jury to find by a preponderance of the evidence that the hospital treated him unfairly under the circumstances.” This case did not involve antitrust or the Sherman Act).

Non-hospital antitrust cases

American Needle v. NFL, 560 U.S. 183 (2010) (Sherman Act ban applies when a conspiracy “joins together independent centers of decision making”).

Copperweld Corp. v. Independence Tube Corp., 467 U.S. 752 (1984) (general rule against a subsidiary being considered to have conspired with a parent corporation for the purposes of the Sherman Act).

Monsanto Co. v. Spray-Rite Serv. Corp., 465 U.S. 752 (1984) (affirming a jury verdict in a price-fixing case under Section 1 of the Sherman Act).

Procedure

Brooks v. City of Winston-Salem, 85 F.3d 178 (4th Cir. 1996)

Francis v. Giacomelli, 588 F.3d 186 (4th Cir. 2009)

Nemet Chevrolet v. Consumeraffairs.com, 591 F.3d 250 (4th Cir. 2009)

Tortious Interference

Torbett v. Wheeling Dollar Sav. & Tr. Co., 314 S.E.2d 166 (W. Va. 1983) (pleading and proving deliberate intent to harm a contractual relationship is required on a claim for tortious interference in West Virginia)