## Facts

- Four licensed chiropractors sued the American Medical Association (AMA), alleging that the AMA orchestrated a concerted effort to restrict cooperation between physicians and chiropractors.
- The AMA’s ethical rules historically discouraged or prohibited physicians from “voluntarily professionally associat[ing]” with practitioners viewed as lacking a “scientific basis,” and the AMA labeled chiropractic an “unscientific cult.”
- The AMA maintained a Committee on Quackery and engaged in organized activity the district court found was aimed at “contain[ing] and eliminat[ing] chiropractic.”
- The alleged restraints included discouraging referrals, consultations, hospital privileges, and cooperative practice arrangements involving chiropractors.
- After an initial jury verdict for defendants was reversed and remanded, the case proceeded as a bench trial limited to injunctive relief.
- The district court found the AMA violated Sherman Act § 1 through an unlawful boycott and entered an injunction under Clayton Act § 16; it dismissed claims against the Joint Commission on Accreditation of Hospitals (JCAH) and the American College of Physicians (ACP) for lack of participation in the conspiracy.
- The AMA appealed liability and the injunction; the chiropractors cross-appealed the dismissal of JCAH and ACP.

## Issues

1. Whether the AMA’s coordinated restrictions on physicians’ professional association with chiropractors constituted an unlawful group boycott in violation of Sherman Act § 1.
2. Whether the AMA established a “patient care” (quality-of-care) justification by proving a genuine, reasonable patient-safety concern that could not be addressed through less restrictive means.
3. Whether JCAH and ACP participated in the alleged conspiracy such that they were liable under Sherman Act § 1.
4. Whether injunctive relief under Clayton Act § 16 was appropriate despite later changes in AMA ethical rules.

## Decision

- The court affirmed the finding that the AMA’s concerted conduct constituted an illegal boycott in restraint of trade violating Sherman Act § 1.
- The court affirmed rejection of the AMA’s patient-care defense because the AMA failed to show the restraint was necessary and that less restrictive means were inadequate.
- The court affirmed dismissal of JCAH and ACP, holding the finding that they acted independently and did not join the conspiracy was not clearly erroneous.
- The court upheld the injunction, including provisions requiring broad publication of the order, as a proper exercise of equitable authority under Clayton Act § 16 to prevent recurrence and dissipate lingering anticompetitive effects.

## Legal Principles

- Professional associations are subject to Sherman Act § 1, and coordinated refusals to deal implemented through ethical rules can constitute an unlawful group boycott.
- A quality-of-care or patient-care justification is available in principle but is narrowly applied; the defendant must prove both (a) a genuine and reasonable patient-welfare concern and (b) that the restraint is no broader than necessary because less restrictive alternatives would not adequately address the concern.
- Courts may grant forward-looking injunctive relief under Clayton Act § 16 to prevent threatened continued or recurrent antitrust injury, including remedial measures aimed at eliminating residual effects of an established boycott.
- Liability for conspiracy requires proof of participation; independent parallel conduct by related organizations is insufficient absent agreement.

## Conclusion

The Seventh Circuit affirmed that the AMA’s organized restrictions on physician collaboration with chiropractors amounted to an unlawful boycott under Sherman Act § 1, that the asserted quality-of-care justification failed for lack of necessity and lack of narrow tailoring, and that equitable relief—including publication requirements—was warranted under Clayton Act § 16, while JCAH and ACP were properly dismissed for nonparticipation in the conspiracy.


Wilk v. Am. Med. Ass'n, 895 F.2d 352 (7th Cir. 1990)