A physicians group—alleging a rival violated antitrust law by trying to put their lone competition out of business—convinced the court it appeared a jury would believe that just such a conspiracy took place.
But U.S. District Judge Xavier Rodriguez of the Western District of Texas-San Antonio Division granted summary judgment, dismissing the case with prejudice in favor of the defendants.
Rodriguez concluded that even though elements of a conspiracy were credible, the plaintiffs ultimately did not suffer an injury that could justify an antitrust action.
The lawsuit, filed four years ago, was between plaintiffs Doctors Hospital of Laredo and Laredo Physicians Group and defendants Dr. Ricardo Cigarroa, Cigarroa Heart and Vascular Institute and Laredo Medical Center.
Yetter Coleman attorneys James E. Zucker and Justice S. Rowinsky prepared the case for the plaintiffs.
Rowinsky provided a prepared statement attributed to his clients, which said, “Although Doctors Hospital of Laredo and Laredo Physicians Group are disappointed with the court’s ultimate ruling, we are encouraged by the court’s acknowledgment of evidence that Dr. Ricardo Cigarroa and Laredo Medical Center conspired to unfairly compete and to preclude a qualified cardiologist from practicing in the Laredo community. We are evaluating our appellate options.”
Interventional cardiology services in Laredo are the health care services at issue. These services involve monitoring, diagnosing and treating diseases of the cardiovascular system.
According to the court’s order, the plaintiffs tried to expand their practice in 2020 but ran into obstacles created by the defendants. The plaintiffs allege these roadblocks were the result of illicit agreements and conspiracies, specifically:
- An agreement between defendants at Dr. Cigarroa to not deal with Doctors Hospital of Laredo (DHL)
- An agreement beween Cigarroa, Laredo Medical Center and Dr. Santos to solicit Santos’s staff in violation of Santos’s noncompete and non-solicitation agreement.
- A concerted action among Cigarroa and another physician to threaten a physician based in another city not to practice in Laredo.
- Circumstantial evidence of concerted action among Cigarroa and other cardiologists to coerce yet another physician to not practice in Laredo.
Plaintiffs brought claims under the Sherman Act and Texas state law.
The discord between the two physicians groups had its roots in a doctor, Cigarroa’s decision—after practicing primarily at DHL for a decade—to set up a new practice. Cigarroa allegedly began recruiting from DHL.
Looking at the allegations, the court found in every case there was direct evidence that the alleged conspiracies took place.
For example, Dr. Marc Feldman, an adjunct professor at the University of Texas Health Science Center in San Antonio wanted to practice at DHL. The court noted he had practiced in a similar capacity in McAllen and Kerrville without opposition.
“The only time he faced opposition was when he attempted to practice in Laredo, immediately following the conversation between Dr. Cigarroa and Dr. Allen Anderson. Because the record does not support any historic behavior of opposing part-time work of its employees, including Dr. Feldman, a reasonable jury could find this change in practice supports a conspiracy,” Rodriguez said.
Jason M. Powers of Vinson & Elkins was lead counsel for the defendants. James Lewis Leader Jr. at V&E also worked the case.
“Dr. Cigarroa believes the federal court’s dismissal of DHL’s lawsuit is a victory for independent doctors,” Powers said. “We agree with the judge that doctors, not courts, should decide where and how they practice medicine, and because they can, there are now more procedures being performed, more patients being treated, and more treatment options available in Laredo than ever before. As the evidence showed and as the court held, there simply was no harm to competition here.”
The plaintiffs tried to prove the Cigarroa defendants committed an antitrust violation regardless of any specific circumstances, or a “per se” violation.
Rodriguez disagreed, finding that although the circumstances involving provided services established a market for purposes of standing, there are differences.
Even assuming the competitors have a relationship with equal powers and status, “as defendants correctly point out,” the Cigarroa defendants’ refusal to deal did not cut off access to the resources DHL needed to compete.
“DHL hired two additional interventional cardiologists since the alleged boycott began and used locums physicians to staff shifts,” Rodriguez noted.
The defense also pointed out that there were pro-competitive reasons for shifting the Cigarroa practice. This benefited physicians and patients, since “there are now more catheterization labs and more interventional cardiology procedures being performed, with a higher proportion of those procedures being low-cost outpatient procedures.
Rodriguez concluded, “Plaintiffs’ theory of harm would require that the Cigarroas stay put at DHL to avoid antitrust liability and render this court into a ‘central planner’ of interventional cardiology services—a role that it is ‘ill suited’ for.”
