## Facts

- DCH Healthcare Authority operated DCH Regional Medical Center, the largest general hospital in the Tuscaloosa, Alabama area.
- Dr. Alexandre Todorov, a neurologist, held medical staff privileges at DCH to practice neurology.
- Todorov applied for additional privileges to administer and officially interpret head CT scans performed in the hospital’s radiology department.
- At DCH, CT scans were performed by hospital radiology technicians under radiologist supervision, following radiology protocols; radiologists made key technical decisions and issued the official interpretation.
- Todorov sought the additional privileges largely to submit the official interpretation and bill for the interpretation fee typically paid to radiologists.
- During credentialing, radiologists provided input; at least two questioned Todorov’s competence to perform the requested CT functions.
- DCH’s committees conducted a hearing process and recommended denial; concerns included operational effects and the risk that granting non-radiologists such privileges could disrupt radiology services.
- DCH’s board denied the application, and an internal appeal again resulted in a recommendation to deny.
- Todorov sued DCH and radiology defendants for alleged Sherman Act §§ 1–2 violations (via Clayton Act § 4), asserting monopolization/attempted monopolization and conspiracy to exclude him from CT interpretation; he also asserted a due process claim against DCH as a public authority.

## Issues

1. Whether Todorov suffered “antitrust injury” sufficient to confer standing to seek damages under Clayton Act § 4 for alleged Sherman Act §§ 1–2 violations based on denial of CT privileges.
2. Whether the denial of CT privileges constituted unlawful concerted action under Sherman Act § 1 or exclusionary monopolizing conduct under Sherman Act § 2.
3. Whether denial of additional CT privileges by a public healthcare authority deprived Todorov of a protected property or liberty interest without due process.

## Decision

- The Eleventh Circuit affirmed summary judgment for all defendants.
- Todorov lacked antitrust standing because his claimed harm was not antitrust injury; he sought access to the interpretation fees rather than relief from injury to competition.
- The court found no Sherman Act violation on the record; the decision was treated as a hospital privileging determination rather than an unlawful agreement or exclusionary scheme.
- DCH had state-action immunity for the challenged conduct undertaken pursuant to state authorization, providing an additional ground against antitrust liability for the hospital.
- The due process claim failed because Todorov had no protected property interest in additional privileges and no protected liberty interest (no stigma plus alteration of legal status); he retained his existing neurology privileges.

## Legal Principles

- A private antitrust plaintiff must show antitrust injury: harm of the type the antitrust laws are designed to prevent, flowing from the alleged unlawful conduct, and reflecting injury to competition rather than merely to a competitor.
- Loss of an opportunity to obtain fees or share in allegedly supracompetitive profits, without a showing of competitive injury, does not establish antitrust injury or antitrust standing.
- Hospital credentialing and privileging decisions, supported by quality-control and operational considerations, do not by themselves establish concerted action under Sherman Act § 1 or monopolization under § 2.
- State-action immunity can bar antitrust claims against a public hospital authority when the challenged conduct is undertaken pursuant to state authorization.
- Due process protections apply only if a plaintiff shows a constitutionally protected property interest (a legitimate entitlement) or liberty interest (including stigma plus a change in legal status); denial of additional privileges, without more, does not satisfy these requirements.

## Conclusion

The Eleventh Circuit held that a neurologist denied additional CT-scan privileges lacked antitrust standing because his asserted loss was not antitrust injury, found no Sherman Act violation in the hospital’s privileging decision, and rejected a due process claim because denial of new privileges did not implicate a protected property or liberty interest.


Todorov v. DCH Healthcare Auth., 921 F.2d 1438 (11th Cir. 1991)