All Care Nursing Svs. v. Bethesda , 135 F.3d 740 ( 1998 )


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  •                                                                      PUBLISH
    IN THE UNITED STATES COURT OF APPEALS
    FOR THE ELEVENTH CIRCUIT
    _____________________________________
    No. 95-4714
    _____________________________________
    D. C. Docket No. 88-8568-CIV-JCP
    ALL CARE NURSING SERVICE, INC., BENSON HEALTH
    CARE SERVICES, INC., et. al.,
    Plaintiffs-Appellees,
    versus
    HIGH TECH STAFFING SERVICES, INC.,
    Defendant-Appellant.
    __________________________________
    No. 95-5218
    __________________________________
    D. C. Docket No. 88-8568-CIV-JCP
    ALL CARE NURSING SERVICE, INC.,
    Plaintiff-Appellant,
    A COMPLETE HEALTH SERVICE, INC., QUALITY
    PROFESSIONAL NURSING, INC., et al.,
    Plaintiffs-Appellants,
    JULIE MONAHAN,
    Counter-Defendant-
    Appellant,
    versus
    BETHESDA MEMORIAL HOSPITAL, INC., NME
    HOSPITALS, INC., et. al.,
    Defendants-Appellees,
    HIGH TECH STAFFING SERVICES, INC.,
    Defendant-Appellant-
    Cross-Appellee.
    ______________________________________
    Appeals from the United States District Court
    for the Southern District of Florida
    _______________________________________
    (February 18, 1998)
    Before EDMONDSON and BARKETT, Circuit Judges, and WELLFORD*, Senior Circuit
    Judge.
    EDMONDSON, Circuit Judge:
    Two separate actions (with different plaintiffs) against the
    same defendants for alleged antitrust violations have been
    consolidated and are treated as one appeal. Plaintiffs appeal a
    jury verdict for defendants on antitrust claims.                       They also
    appeal the jury verdict against them on counterclaims for state
    and federal RICO violations.                 Many issues were raised on
    appeal. But we conclude that most of the challenges obviously
    lack merit, and we do not discuss them in this opinion. We do
    discuss a couple of issues in some detail, and we affirm the
    district courts’ judgments.
    __________________
    *Honorable Harry W. Wellford, Senior U.S. Circuit Judge Sixth Circuit, sitting by
    designation.
    2
    Background
    Beginning in the mid-1980's the United States experienced
    a severe nursing shortage. Southern Florida was hit especially
    hard due to its increased demand for nurses in winter months
    to accommodate the high influx of people to the area at that
    time of year.      This shortage, along with other market
    considerations, caused an increase in prices for nursing
    services and a difficulty in staffing hospitals (and other
    facilities) with sufficiently licensed nurses.1
    Hospitals use full or part-time hospital nurses, contract
    nurses (nurses hired for a specified period of time), travel
    nurses (contract nurses hired from different areas of the
    country), and temporary nurses (nurses employed by agencies
    1
    Nurse qualifications fall into at least three different licensing
    categories: Registered Nurse (RN), Licensed Practical Nurse
    (LPN), and Certified Nursing Assistant (CNA).
    3
    and hired by hospitals for a shift at a time)2. Temporary nursing
    agencies send their nurses to hospitals, nursing homes, clinics,
    doctors’ offices, and patients’ homes. They have the choice to
    provide services for any facility or person in need of such care.
    They are not limited to providing nurses to hospitals.
    During the pertinent period, hospitals were faced with
    quality concerns, as well as rising prices. No efficient means
    existed to share information with other hospitals about agency
    nurses. This lack of information resulted in problems with
    some agencies, including plaintiff-appellant All Care Nursing
    Services, Inc. (“All Care”).3 These problems included “phantom
    booking” -- where a hospital requests a specific nurse with
    whom it has dealt in the past, only to be sent a different nurse;
    2
    These temporary nursing agencies are also providers of
    travel and contract nurses to hospitals.
    3
    The problems described formed the basis of the
    counterclaim against All Care and Monahan for federal and
    state RICO violations.
    4
    “blind booking” -- where a hospital sets up to receive the
    services of a nurse from an agency only to have the agency
    cancel at the last minute; fraudulent billing -- billing hospitals
    for services of an RN when actually a less qualified LPN or CNA
    performed the services; cheating on certification exams; and
    altering certification documents.
    In response to the problems the South Florida Hospital
    Association (“SFHA”) approached hospitals in Palm Beach
    County about a potential purchasing arrangement. In 1988,
    twelve (12) Palm Beach County hospitals set up an arrangement
    whereby they would solicit bids from temporary nursing
    agencies and would then select agencies to be preferred
    providers of such services, the Preferred Provider Program
    (“PPP”). The selection of the preferred agencies was to be
    made based upon competence, services provided, quality, and
    bid price.    Under this joint-buying arrangement all the
    participating hospitals agreed to seek first nurses from
    5
    preferred providers before going to nonpreferred agencies for
    nurses on each occasion.
    All agencies were invited, either by letter or by
    advertisement in the Palm Beach newspaper (Palm Beach
    Post), to participate in the bidding.   Sixteen (16) agencies
    presented bids and eight (8) were selected as preferred.4
    In November 1988, the PPP began operation.            Each
    hospital entered into individual contracts with each of the
    preferred agencies. All the agencies selected as preferred
    providers were required to agree to things like treating their
    nurses as employees by providing workers’ compensation,
    4
    Some of the appellant agencies participated in the bidding
    process, others did not. Following the submission of the initial
    bids four (4) agencies were eliminated based on their bid
    prices, which in some instances were 50% higher than other
    agencies’ bids. The remaining twelve (12) rebid and were
    considered using the established criteria. Which agencies
    actually resubmitted bids is unclear. But, all of the accepted
    agencies bid prices higher than the price ranges suggested by
    the SFHA in its invitation to bid. None of the appellants was
    selected as preferred providers.
    6
    paying taxes, and providing necessary insurance. Before the
    PPP, agencies had treated their nurses as independent
    contractors, not employees; and the higher costs associated
    with unprotected workers were borne by the hospitals.5
    The preferred agencies did not contract with the hospitals
    at the same prices, but instead at the prices that each particular
    agency had bid. Agencies were also required to agree in the
    contracts not to change their prices for one year -- the length of
    each contract -- and, thus, were somewhat tied into their bid
    prices. But to allow for shifts due to market changes, each
    agency could terminate its contract with a particular hospital
    upon 30 days notice (the “escape clause”).
    After the creation of the PPP, plaintiffs-appellants filed suit
    against the participating hospitals, preferred agencies, and the
    5
    The hospitals felt the need to place some of the financial
    burden on the agencies because after the bidding, agency
    services were actually costing more than before the PPP.
    These contract provisions were a way to shift some of the cost
    back to the agencies.
    7
    SFHA6 alleging antitrust violations under sections 1 and 2 of the
    Sherman Act, 
    15 U.S.C. §§ 1
    , 2, and under Florida Statutes §§
    542.18 and 542.19.      Defendants then filed a counterclaim
    against All Care, and its operator Monahan, for violations of
    federal and state RICO statutes by billing fraudulently, aiding
    cheating on certification exams, and aiding persons to obtain
    false certification.7
    Awaiting trial, plaintiffs-appellants sought and received a
    preliminary injunction, which halted implementation of the PPP.
    That preliminary injunction, however, was vacated by this court
    because of the district court’s failure to hold the necessary
    6
    Plaintiffs-appellants include: All Care Nursing Services, Inc.;
    A Complete Health Care Services, Inc.; Benson’s Health Care
    Services, Inc.; Critical Health Care, Inc.; Quality Professional
    Nursing of Florida, Inc.; and P.D.Q. Nurse, Inc.
    Defendants-appellees include the SFHA, twelve (12) Palm
    Beach County hospitals, and four (4) remaining agency
    defendants (four (4) agencies settled with plaintiffs before final
    disposition in the district court).
    7
    Claims of fraud, civil theft, and false representation against
    All Care and Monahan were dismissed before trial.
    8
    evidentiary hearing. All Care Nursing Serv., Inc. v. Bethesda
    Memorial Hosp., Inc., 
    887 F.2d 1535
     (11th Cir. 1989). The request
    for an injunction was never reinstated.
    After a four-week jury trial, a verdict was entered in favor
    of defendants on all relevant claims. Plaintiffs filed motions for
    new trial, for judgment as a matter of law, and for amendment
    of the pleadings to conform with the evidence.           All these
    motions were denied by the district court; and we now affirm
    those denials.8 Plaintiffs-appellants also appeal the antitrust
    and RICO counterclaim verdicts against them; but we affirm
    those judgments, too.
    Discussion
    I. Federal and State RICO Claims
    8
    Also affirmed is the district court’s decision in the bench
    trial of Defendant High Tech’s Lanham Act counterclaim.
    9
    Plaintiffs-appellants All Care and Monahan argue that the
    Florida and Federal RICO claims against them are barred by the
    economic-loss rule.    That rule provides that “parties to a
    contract can only seek tort damages if conduct occurs that
    establishes a tort distinguishable from or independent of [the]
    breach of contract.” Jones v. Childers, 
    18 F.3d 899
    , 904 (11th
    Cir. 1994) (citations and quotations omitted). The rule is based
    upon the idea that “contract principles are more appropriate
    than tort principles for resolving economic loss claims.”
    Florida Power & Light Co. v. Westinghouse Elec. Corp., 
    510 So.2d 899
    , 901 (Fla. 1987).
    Neither All Care nor Monahan can use the economic-loss
    rule to escape liability under the federal RICO statutes.9 We
    Defendants argue that Monahan cannot
    9
    be afforded the benefit of the economic-loss
    rule because she, individually, entered into
    10
    have already ruled that Florida’s economic-loss rule does not
    bar a plaintiff from “bringing a [federal] RICO action where a
    breach of contract claim also exists . . . . many RICO cases
    no contract with the defendant hospitals:
    she      lacked    privity         of    contract.            All
    contracts were between her agency, All
    Care, and the hospitals. Because we conclude
    that the economic-loss rule does not bar
    RICO claims, state or federal, we need not
    decide     this    question.            But,   the        Florida
    Supreme Court has held, at least under one
    set of facts, that privity is not required
    for the economic-loss rule to apply.                          See
    Casa Clara Condominium Ass’n v. Charley
    Toppino and Sons, Inc., 
    620 So.2d 1244
     (Fla.
    1993);    see     also   Hoseline,        Inc.       v.     U.S.A.
    Diversified Products, Inc., 
    40 F.3d 1198
    , 1200
    (11th Cir. 1994) (where this court applied Casa
    Clara to make “meritless” a claim that the
    rule does not bar tort claims between
    parties who lack contractual privity).
    11
    involve contract disputes.”      Arabian American Oil Co. v.
    Scarfone, 
    939 F.2d 1472
    , 1478 (11th Cir. 1991).
    About the state RICO claims, Florida’s RICO statutes have
    consistently been interpreted using federal RICO claims cases.
    No reason has been presented to us to justify applying the
    economic-loss rule differently to RICO claims made under state
    and federal RICO statutes.10 Thus, the economic-loss rule does
    not bar these claims.
    II. Antitrust Claims
    10
    Plaintiffs-appellants also challenged the RICO
    counterclaims on another ground: that reliance on the alleged
    misrepresentations made by All Care and Monahan was not
    proved by defendants. Reliance is only an element of a RICO
    claim to the extent that a RICO plaintiff must prove he was
    injured by reason of the RICO defendant’s deception and fraud.
    Pelletier v. Zweifel, 
    921 F.2d 1465
    , 1499 (11th Cir. 1991). But, no
    argument is made by the plaintiffs-appellants that injury was
    inadequately shown. So, lack of reliance does not require
    reversal on this claim.
    12
    Plaintiffs-appellants argue that the formation and operation
    of the Palm Beach County PPP is a violation of the antitrust
    laws of the Sherman Act and Florida Statutes §§ 542.18 and
    542.19,11 prohibiting restraints on trade. The Sherman Act, in
    relevant part, sets out these rules:
    Section 1: Every contract, combination in the form of
    trust or otherwise, or conspiracy, in restraint of trade
    or commerce among the several States, or with
    foreign nations, is hereby declared to be illegal. . . .
    11
    Federal and Florida antitrust laws are analyzed under the
    same rules and case law. 
    Fla. Stat. § 542.32
     (“It is the intent of
    the Legislature that, in construing this chapter, due
    consideration and great weight be given to the interpretations
    of the federal courts relating to comparable federal antitrust
    statutes.”); see also St. Petersburg Yacht Charters, Inc. v.
    Morgan Yacht, Inc., 
    457 So.2d 1028
    , 1032 (Fla. Dist. Ct. App.
    1984) (“[T]he Florida legislature has, in effect, adopted as the
    law of Florida the body of antitrust law developed by the federal
    courts under the Sherman Act.”); 
    Fla. Stat. §§ 542.16
     (Florida
    antitrust laws complement federal antitrust laws), 542.18
    (analogous to § 1 of the Sherman Act). So, for purposes of this
    opinion discussion of the law under the Sherman Act is equally
    applicable to the plaintiffs-appellants’ state antitrust claims.
    13
    Section 2: Every person who shall monopolize, or
    attempt to monopolize, or combine or conspire . . . to
    monopolize . . . shall be deemed guilty of a felony.
    
    15 U.S.C. § 1
    ; 
    15 U.S.C. § 2
    .
    Despite the expansive language of the statute, the
    Supreme Court has interpreted this statute to prohibit only
    “unreasonable” restraints on trade.       “A restraint may be
    violative of the Sherman Act because it is solely a naked
    restraint of trade so offensive to competition as to be
    unreasonable per se, or because it runs afoul of the more
    detailed rule of reason inquiry.”      Retina Assocs., P.A. v.
    Southern Baptist Hosp. of Florida, Inc., 
    105 F.3d 1376
    , 1380 (11th
    Cir. 1997).
    Some acts have been said to be so facially anticompetitive
    that by their very nature they are deemed unreasonable and,
    thus, per se violative of antitrust laws. These “practices are ‘so
    plainly anticompetitive,’ and so often ‘lack . . . any redeeming
    virtue,’ that they are conclusively presumed illegal without
    14
    further examination under the rule of reason . . . .” Broadcast
    Music, Inc. v. Columbia Broadcasting System, Inc., 
    441 U.S. 1
    ,
    7-8, 
    99 S.Ct. 1551
    , 1556 (1979) (internal citations omitted)
    (“BMI”).   Price fixing, horizontal market divisions, tying
    arrangements, and group boycotts have emerged as practices
    that are generally illegal per se. See National Bancard Corp.
    (NaBanco) v. Visa U.S.A., Inc., 
    779 F.2d 592
    , 598 (11th Cir. 1986)
    (citing United States v. Parke, Davis & Co., 
    362 U.S. 29
    , 
    80 S.Ct. 503
    , 
    4 L.Ed.2d 505
     [1960]); State Oil Co. v. Khan, 
    118 S.Ct. 275
    (1997); International Salt Co. v. United States, 
    332 U.S. 392
    , 
    68 S.Ct. 12
    , 
    92 L.Ed. 20
     (1947); Fashion Originators’ Guild of
    America v. FTC, 
    312 U.S. 457
    , 
    61 S.Ct. 703
    , 
    85 L.Ed. 949
     (1941).
    “But easy labels do not always supply ready answers.”
    BMI, 
    441 U.S. at 8
    , 
    99 S.Ct. at 1556
    . Since the emergence of
    these per se categories, we have stressed that “whether the
    ultimate finding is the product of a presumption or actual
    market analysis, the essential inquiry remains the same --
    15
    whether or not the challenged restraint enhances competition.”
    National Bancard Corp., 
    779 F.2d at 598
     (citation and quotation
    omitted). The Supreme Court, as well, has refused to force
    various practices into “pigeonhole[s] and [to invoke] the per se
    rule.” FTC v. Indiana Federation of Dentists, 
    476 U.S. 447
    , 458,
    
    106 S.Ct. 2009
    , 2018 (1986).
    A “rule of reason” is generally applied to determine what
    acts are permissible. Standard Oil Co. of New Jersey v. United
    States, 
    221 U.S. 1
    , 60 (1911). Thus, a presumption exists that
    the circumstances of a case will be looked at in the light of the
    rule of reason standard and will not be deemed per se
    unreasonable. Business Electronics Corp. v. Sharp Electronics
    Corp., 
    485 U.S. 717
    , 723, 726 (1988). But, there are no bright
    lines. “The decision to apply the per se rule [instead of the rule
    of reason] turns on ‘whether the practice facially appears to be
    one that would always or almost always tend to restrict
    competition and decrease output . . . or instead one designed
    16
    to ‘increase economic efficiency and render markets more,
    rather than less, competitive.’” Northwest Wholesale Stationers,
    Inc. v. Pacific Stationery and Printing Co., 
    472 U.S. 284
    , 289-90,
    
    105 S.Ct. 2613
    , 2617 (1985).
    In Northwest, the Supreme Court observed that what
    activities might fall into a per se category is “far from certain.”
    
    Id. at 294
    , 
    105 S.Ct. at 2619
    . Considerable inquiry into the
    market conditions and market power of the defendant is often
    necessary    before    conduct        can   be   presumed   to   be
    anticompetitive. 
    Id. at 296
    , 
    105 S.Ct. at 2620-21
     (addressing
    group boycotts).
    Plaintiffs-appellants claim that the PPP’s arrangement is
    per se illegal as both price fixing and as a group boycott. Thus,
    plaintiffs-appellants have the burden to make a threshold
    showing that the PPP falls into one of these forbidden
    categories. See 
    Id. at 298
    , 
    105 S.Ct. at 2621
    . In this case,
    plaintiffs-appellants allege that, because price bids were a
    17
    consideration in determining which temporary nurse agencies
    would become preferred providers, this conduct falls into the
    forbidden category of price fixing. They also claim that the
    exclusion of the nonpreferred agencies from the PPP amounts
    to a group boycott.
    The decision whether the PPP established by defendants-
    appellees amounts to either a price fix or a group boycott,
    deserving of per se treatment, determines the antitrust issue on
    appeal.12
    A. Per se Violations
    12
    If we decide the PPP is deserving of per se treatment the
    case ends; plaintiffs-appellants must win. But if we decide that
    conduct such as the establishment of the PPP does not rise to
    the level of anticompetitiveness necessary to hold it per se
    illegal, the rule of reason applies; and we will defer to the
    determination of the jury -- that plaintiffs-appellants failed to
    establish the relevant market in which to judge the PPP’s
    reasonableness.
    18
    1. Price Fixing
    That the PPP has some impact on the prices of obtaining
    temporary nurses is undisputed. That price fixing is equally
    violative of antitrust laws whether it is done by buyers or sellers
    is also undisputed. Mandeville Island Farms, Inc. v. American
    Crystal Sugar Co., 
    68 S.Ct. 996
    , 1005-06 (1948). And, it is no
    excuse that the price “fixed” is reasonable. FTC v. Superior
    Court Trial Lawyers Ass’n, 
    110 S.Ct. 768
    , 775 (1990).             But
    whether the per se rule should apply “is not a question simply
    of determining whether two or more potential competitors have
    literally ‘fixed’ a ‘price.’” BMI, 
    441 U.S. at 9
    , 
    99 S.Ct. at 1556-57
    .
    Plaintiffs-appellants argue that the intent of the PPP was
    to stabilize prices and that such intent makes this practice a per
    se violation. But anticompetitive effects -- not intent -- is the
    focal point of antitrust legislation. The question is not did
    defendants intend to fix prices, but instead whether the PPP did
    19
    so. In defining “price fixing” the Supreme Court wrote in these
    terms:
    That price-fixing includes more than the mere
    establishment of uniform prices is clearly evident . . . .
    [P]rices are fixed . . . if the range within which purchases
    or sales will be made is agreed upon, if the prices paid or
    charged are to be at a certain level or on ascending or
    descending scales, if they are to be uniform . . . . They are
    fixed because they are agreed upon.
    United States v. Socony-Vacuum Oil Co., 
    310 U.S. 150
    , 222-23
    (1940). In forming the PPP, the hospitals, among themselves,
    never agreed to a uniform price, to an acceptable price range,13
    or to a scale for determining price.
    The PPP has an impact on price; all preferred agencies
    contracting with the hospitals will, to some degree, be tied into
    13
    That the SFHA -- when it requested bids --
    suggested           a      price        range          to      the
    participating agencies does not create an
    agreement on the prices they would accept.
    As shown by the accepted bids, prices outside
    the range were acceptable.
    20
    a set price for their services. But this point of law must be
    remembered: “Not all arrangements among actual or potential
    competitors that have an impact on price are per se violations
    of the Sherman Act or even unreasonable restraints.” BMI, 
    441 U.S. at 23
    , 
    99 S.Ct. at 1564
    . And, it cannot be forgotten that
    market fluctuations could result in a preferred agency’s
    exercise of the escape clause -- allowing that agency to reenter
    the market free to charge the prices it chooses.          Most
    important, this case involves lots of distinct contracts.     A
    pricing agreement of some kind is necessary in the contracting
    for goods and services; and competitive bidding is an
    acceptable way to decide with whom the hospitals wish to
    contract.
    Earlier Supreme Court cases were faced with more direct
    price fixing, which led to the per se categorization of such
    schemes. In the context of a blatant agreement to fix prices,
    21
    [i]t makes no difference whether the motives of the
    participants are good or evil; whether the price fixing
    is accomplished by express contract or by some
    more subtle means; whether the participants possess
    market control; whether the amount of interstate
    commerce affected is large or small; or whether the
    effect of the agreement is to raise or to decrease
    prices.
    United States v. McKesson & Robbins, Inc., 
    351 U.S. 305
    , 310
    (1956). But we do not have an agreement to fix prices in this
    case: no prices were preset for nursing services.
    The Supreme Court has recently taken another step away
    from per se treatment, particularly in vertical price fixing
    arrangements.14 See State Oil Co. v. Khan, 
    118 S.Ct. 275
     (1997).
    Vertical price fixing is no longer a per se violation. 
    Id. at 278
    .
    The key to per se treatment is whether the conduct is of
    the kind that can only be anticompetitive.        But, the PPP,
    14
    The alleged attempt to fix prices by the hospitals’
    agreement with each other would be horizontal -- an agreement
    among competitors. The alleged attempt to fix prices by the
    hospitals’ agreements with the preferred agencies would be
    vertical and is not per se illegal after State Oil Co. v. Kahn.
    22
    arranged by the SFHA and the Palm Beach County hospitals, is
    not inherently an anticompetitive practice.       No temporary
    nursing agency was precluded from competing to become a
    preferred agency. Also, all agencies are still able to provide
    nurses to medical facilities other than hospitals and even to
    hospitals should the need for nurses not be met by the
    preferred agencies. Although the PPP may stabilize prices to
    some degree, it is not the kind of “stabilization” that can be
    viewed as price fixing, especially when the escape clauses in
    the contracts are taken into account. These escape clauses
    allow the market and not the SFHA to be the ultimate
    decisionmaker for each hospital and each agency on the issues
    of price, demand, supply, and terms of dealing.
    2. Group Boycotts
    23
    The same principles apply to a consideration of application
    of the per se rule whether the act complained of is labeled price
    fixing or a group boycott. “[T]he recent jurisprudence of the
    Supreme Court and of the Court of Appeals of this Circuit
    cautions against the haphazard expansion of the ‘group boycott
    label’ and the concomitant imposition of per se liability.”
    Retina Assocs., 
    105 F.3d at 1381
    . “Not all concerted refusals to
    deal are predominantly anticompetitive.” Northwest, 
    472 U.S. at 298
    , 
    105 S.Ct. at 2621
    . In cases of group boycotts where the
    per se rule has been applied, “the boycott often cut[s] off
    access to a supply, facility, or market necessary to enable the
    boycotted firm to compete, . . . and frequently the boycotting
    firms possessed a dominant position in the relevant market.”
    
    Id. at 294
    , 
    105 S.Ct. at 2619
     (emphasis added).
    In dealing with group boycott situations, market analysis
    has found its way into the determination of whether a given
    practice should be per se illegal. No longer is relevant market
    24
    a factor only after it has been decided that the rule of reason
    applies. “Unless the cooperative possesses market power or
    exclusive access to an element essential to effective
    competition, the conclusion that [the conduct] is virtually
    always likely to have an anticompetitive effect is not
    warranted.” Northwest, 
    472 U.S. at 296
    .
    In this case, no refusal to deal has been shown.          All
    agencies were able to participate in the bidding to become
    preferred providers, and generally a hospital will still deal with
    any nursing agency when the preferred agencies with which the
    hospital has contracted for nursing services fail to meet its
    needs. The record shows, in fact, that more than a trifling
    portion of hospital nursing business in Palm Beach County
    continued to go to nonpreferred agencies after the PPP was in
    operation. Also, due to the rise in HMOs, home care, and
    similar trends in the medical world, facilities other than
    hospitals provide the market, the supply, and the facilities
    25
    necessary for nonpreferred agencies to compete with each
    other and with preferred agencies in the marketplace.
    Per se treatment has been given to those practices which
    history has shown have only anticompetitive effects.
    “[A]nalyzing this case under the per se rubric would remain
    inappropriate absent some demonstration that the practice at
    issue historically leads to anticompetitive effects in the
    market.” Retina Assocs., 
    105 F.3d at 1381
    . No history of this
    kind seems to exist for health-care preferred-provider programs
    materially similar to what we have before us now.
    We conclude, based upon undisputed facts, that the
    practice of this PPP is not deserving of per se treatment and
    was properly evaluated under the rule of reason.
    B. Rule of Reason
    26
    The rule of reason requires “the factfinder [to weigh] all of
    the circumstances of the case in deciding whether a restrictive
    practice should be prohibited as imposing an unreasonable
    restraint on competition.” Continental T.V., Inc. v. GTE Sylvania
    Inc., 
    433 U.S. 36
    , 49 (1977). The rule of reason should be
    applied to practices designed to “increase economic efficiency
    or render markets more, rather than less, competitive.” BMI,
    
    441 U.S. at 19-20
    ; see also Northwest, 
    472 U.S. at 289-90
    .
    “[T]o satisfy the rule of reason, the plaintiff must prove
    that the [conduct] had an adverse effect on competition.”
    Coffey v. Healthtrust, Inc., 
    955 F.2d 1388
    , 1392 (10th Cir. 1992).
    But, competition occurs only in a market. Thus, “before we can
    reach the larger question of whether [defendants] violated any
    of the antitrust laws, we must confront the threshold problem
    of defining the relevant market.” Thompson v. Metropolitan
    Multi-List, Inc., 
    934 F.2d 1566
    , 1572 (11th Cir. 1991).15
    15
    Because this case is subject to the rule of reason and
    27
    Interrogatories went to the jury.16 The jury found that
    plaintiffs-appellants failed to establish the relevant market.
    Because no definable market was proved, plaintiffs could show
    no adverse effect on competition. Plaintiffs-appellants try to
    debate the required showing of market power.             But their
    argument is based upon per se treatment of the antitrust claim.
    Because we have decided, as did the district court, that the PPP
    triggers no per se analysis, relevant market was critical to
    plaintiffs-appellants’ claims.
    because of the importance of relevant market and market power
    in evaluating the reasonableness of a purported restraint, the
    district court’s jury instructions and interrogatories directing
    that the jurors must find for defendants if plaintiffs failed to
    establish the relevant market were proper applications of the
    law governing this case.
    16
    The interrogatories, among other
    things, directed the jury to find for the
    defendants            if    the        plaintiffs     did    not
    establish the necessary relevant market.
    28
    The jury found that no relevant market was shown; and we
    will reverse the jury’s determination on this factual issue only
    if it is clearly erroneous. United States v. E.I. du Pont de
    Nemours & Co., 
    351 U.S. 377
    , 381, 
    76 S.Ct. 994
    , 999 (1956). We
    cannot say the finding that no relevant market was established
    is clearly erroneous.   The failure to establish the relevant
    market (either by product or geography) was fatal to plaintiffs-
    appellants’ antitrust claims. So, we accept the jury verdict
    against them.
    AFFIRMED.
    29
    

Document Info

Docket Number: 95-4714

Citation Numbers: 135 F.3d 740

Filed Date: 2/18/1998

Precedential Status: Precedential

Modified Date: 12/21/2014

Authorities (25)

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