## Facts

- Rome Ambulatory Surgical Center, LLC (RASC) operated a freestanding ambulatory surgery center in Rome, New York, competing with Rome Memorial Hospital’s outpatient surgery services.
- RASC alleged the hospital and its affiliate undertook a campaign to force RASC from the outpatient surgery market.
- The alleged conduct included exclusive contracts with major commercial payors (including MVP and BCBS) that allegedly foreclosed RASC from a large share of commercially insured patients.
- RASC also alleged the hospital and aligned physicians restricted referrals to RASC and pressured physicians who referred patients to RASC.
- RASC asserted that during its operation prices were lower and patient choice greater, and that after RASC exited the market prices increased and choice declined.
- RASC ceased operations in 2001 and attributed its closure to the hospital’s exclusionary conduct.
- RASC sued under Sherman Act §§ 1 and 2 (with damages sought under Clayton Act § 4) and asserted related New York tort claims.
- Defendants moved for summary judgment on all claims; RASC cross-moved for summary judgment on parts of its § 1 conspiracy theories.

## Issues

1. Whether RASC had antitrust standing under Clayton Act § 4 by showing causation and antitrust injury.
2. Whether the challenged conduct supported liability under Sherman Act § 1 for tying, exclusive dealing, market allocation, conspiracy to restrain trade, or a per se group boycott.
3. Whether defendants’ conduct supported liability under Sherman Act § 2 for monopolization, monopoly leveraging, attempted monopolization, or conspiracy to monopolize in a properly defined market.
4. Whether the record supported RASC’s New York tort claims, including tortious interference.

## Decision

- The court held RASC had antitrust standing, finding evidence from which a factfinder could conclude defendants’ conduct was a substantial factor in RASC’s injury and that the alleged harm reflected reduced competition (not merely harm to a competitor).
- The court denied summary judgment on the Sherman Act § 1 exclusive-dealing claim based on the hospital’s payor exclusivity arrangements, finding triable issues on foreclosure, market effects, and procompetitive justifications under the rule of reason.
- The court granted summary judgment to defendants on the Sherman Act § 1 tying claims for failure to show coercion or conditioning sufficient to establish an illegal tie.
- The court granted summary judgment to defendants on the § 1 market-allocation claim, finding it abandoned and unsupported by evidence of an agreement to divide markets.
- The court granted summary judgment to defendants on the § 1 conspiracy-to-restrain-trade and per se boycott theories for lack of evidence of a qualifying agreement and required anticompetitive effects, including the absence of a horizontal agreement necessary for per se boycott treatment.
- The court granted summary judgment to defendants on certain § 2 theories (including monopoly leveraging and actual monopolization) for failure to prove the requisite monopoly power and elements of those claims.
- The court denied summary judgment on certain § 2 claims for attempted monopolization and conspiracy to monopolize, concluding that evidence of foreclosure and exclusionary conduct could support findings of specific intent and a dangerous probability of achieving monopoly power in outpatient surgery.
- The court granted summary judgment to defendants on the state-law tort claims for insufficient proof of required elements.

## Legal Principles

- Antitrust standing under Clayton Act § 4 requires proof that the challenged conduct was a substantial factor in causing plaintiff’s injury and that the injury is of the type the antitrust laws are designed to prevent.
- Exclusive dealing under Sherman Act § 1 is evaluated under the rule of reason; substantial foreclosure of a relevant market can support an unreasonable-restraint finding, but defendants may rebut with procompetitive justifications that require fact-specific assessment.
- An illegal tying claim requires proof, among other elements, of coercion or conditioning—i.e., that buyers were forced to take a tied product to obtain a tying product.
- Per se group-boycott treatment generally requires proof of a qualifying horizontal agreement; absent such proof, claims are not condemned per se.
- Sherman Act § 2 monopolization and monopoly leveraging require proof of monopoly power in a relevant market (and the other elements of the specific theory); attempted monopolization requires evidence supporting specific intent to monopolize and a dangerous probability of success.

## Conclusion

The court found RASC had standing and allowed a limited set of federal antitrust claims—centered on payor exclusive dealing and certain § 2 attempted and conspiracy-to-monopolize theories—to proceed, while dismissing the tying, boycott, and most other federal theories and all state tort claims on summary judgment.


Rome Ambulatory Surgical Ctr., LLC v. Rome Mem'l Hosp., Inc., 349 F. Supp. 2d 389 (N.D.N.Y. 2004)