Business 8th Edition by Marianne Jennings

تمرين 10

Jefferson Parish Hosp. Dist No. 2 v Hyde
466 U.S. 2 (1984)
B.Y.O. Anesthesiologist: Tying Hospital Arrangements
Facts
Dr. Edwin G. Hyde, a board-certified anesthesiologist, applied for permission to practice at East Jefferson Hospital (petitioners) in Louisiana. An approval was recommended for his hiring, but the hospital's board denied him employment on grounds that the hospital had a contract with Roux Associates for Roux to provide all anesthesiological services required by the hospital's patients. Dr. Hyde filed suit, which the district court dismissed. The court of appeals reversed that decision and held that the contract for the services with Roux was illegal per se. The hospital appealed.
Judicial Opinion
STEVENS, Justice
The exclusive contract had an impact on two different segments of the economy: consumers of medical services, and providers of anesthesiological services. Any consumer of medical services who elects to have an operation performed at East Jefferson Hospital may not employ any anesthesiologist not associated with Roux. No anesthesiologists except those employed by Roux may practice at East Jefferson.
There are at least twenty hospitals in the New Orleans metropolitan area and about 70 percent of the patients living in Jefferson Parish go to hospitals other than East Jefferson. Because it regarded the entire New Orleans metropolitan area as the relevant geographic market in which hospitals compete, this evidence convinced the District Court that East Jefferson does not possess any significant "market power"; therefore it concluded that petitioners could not use the Roux contract to anticompetitive ends. The same evidence led the Court of Appeals to draw a different conclusion. Noting that 30 percent of the residents of the Parish go to East Jefferson Hospital, and that, in fact, "patients tend to choose hospitals by location rather than price or quality," the Court of Appeals concluded that the relevant market was the East Bank of Jefferson Parish. The conclusion that East Jefferson Hospital possessed market power in that area was buttressed by the facts that the prevalence of health insurance eliminates a patient's incentive to compare costs, that the patient is not sufficiently informed to compare quality, and that family convenience tends to magnify the importance of location.
The Court of Appeals held that the case involves a "tying arrangement" because the "users of the hospital's operating rooms (the tying product) are also compelled to purchase the hospital's chosen anesthesia service (the tied product)."
It is clear, however, that every refusal to sell two products separately cannot be said to restrain competition. For example, we have written that "if one of a dozen food stores in a community were to refuse to sell flour unless the buyer also took sugar it would hardly tend to restrain competition if its competitors were ready and able to sell flour by itself." Buyers often find package sales attractive; a seller's decision to offer such packages can merely be an attempt to compete effectively-conduct that is entirely consistent with the Sherman Act.
Accordingly, we have condemned tying arrangements when the seller has some special ability-usually called "market power"-to force a purchaser to do something that he would not do in a competitive market. When "forcing" occurs, our cases have found the tying arrangement to be unlawful.
The hospital has provided its patients with a package that includes a range of facilities and services required for a variety of surgical operations. At East Jefferson Hospital the package includes the services of the anesthesiologist. Petitioners argue that the package does not involve a tying arrangement at all-that they are merely providing a functionally integrated package of services.
Unquestionably, the anesthesiological component of the package offered by the hospital could be provided separately and could be selected either by the individual patient or by one of the patient's doctors if the hospital did not insist on including anesthesiological services in the package it offers to its customers. As a matter of actual practice, anesthesiological sendees are billed separately from the hospital services petitioners provide. There was ample and uncontroverted testimony that patients or surgeons often request specific anesthesiologists to come to a hospital and provide anesthesia, and that the choice of a hospital is particularly frequent in respondent's specialty, obstetric anesthesiology.
Thus, the hospital's requirement that its patients obtain necessary anesthesiological services from Roux combined the purchase of two distinguishable services in a single transaction. As noted above, there is nothing inherently anticompetitive about packaged sales. Only if patients are forced to purchase Roux's services as a result of the hospital's market power would the arrangement have anticompetitive consequences.
It is safe to assume that every patient undergoing a surgical operation needs the services of an anesthesiologist; at least this record contains no evidence that the hospital "forced" any such services on unwilling patients. The record therefore does not provide a basis for applying the per se rule against tying to this arrangement.
In order to prevail in the absence of per se liability, respondent has the burden of proving that the Roux contract violated the Sherman Act because it unreasonably restrained competition.
All the record establishes is that the choice of anesthesiologists at East Jefferson has been limited to one of the four doctors who are associated with Roux and therefore have staff privileges. Even if Roux did not have an exclusive contract, the range of alternatives open to the patient would be severely limited by the nature of the transaction and the hospital's unquestioned right to exercise some control over the identity and number of doctors to whom it accords staff privileges.
Petitioner's closed policy may raise questions of medical ethics, and may have inconvenienced some patients who would prefer to have their anesthesia administered by someone other than a member of Roux Associates, but it does not have the obviously unreasonable impact on purchasers that has characterized the tying arrangements that this Court has branded unlawful.
Reversed.
Is the arrangement illegal per se?