Document: 486 U.S. 94 108 S.Ct. 1658 100 L.Ed.2d 83 Timothy A. PATRICK, Petitioner,v.William M. BURGET et al. No. 86-1145. Argued Feb. 22, 1988. Decided May 16, Rehearing Denied June 30, See 487 1243, 2921. Order on remand, 852 F.2d 1241. Syllabus Petitioner, an Astoria, Oregon, surgeon, declined invitation by respondents to join them as a partner in the Astoria Clinic, and instead began independent practice competition with Clinic. Thereafter, petitioner experienced difficulties his professional dealings Clinic physicians, culminating respondents' initiation of, participation in, peer-review proceedings terminate petitioner's privileges at Astoria's only hospital (a majority of whose staff members were employees or partners Clinic), ground that care patients was below hospital's standards. Petitioner filed suit Federal District Court, alleging had violated §§ 1 2 Sherman Act initiating participating order reduce from rather than improve patient care. Ultimately, court entered judgment against respondents, but Court Appeals reversed conduct immune antitrust scrutiny under state-action doctrine Parker v. Brown, 317 341, 63 307, 87 L.Ed. 315, its progeny, because Oregon has articulated policy favor peer review actively supervises process. Held: The does not protect physicians federal liability for their activities committees. "active supervision" prong test used determine whether private parties may claim immunity requires state officials have exercise power such parties' particular anticompetitive acts disapprove those fail accord policy. This requirement is satisfied here, since there been no showing State Health Division, Board Medical Examiners, judiciary reviews—or even could decisions regarding comport regulatory correct abuses. argument effective essential provision quality medical any threat will prevent openly essentially challenges wisdom applying laws sphere care, properly directed Congress. Pp. 99-106. 800 1498 (CA 9 1986), reversed. MARSHALL, J., delivered opinion which all other Members joined, except BLACKMUN, who took part consideration decision case. Barbee B. Lyon, Portland, Or., petitioner. Thomas Triplett, respondents. Justice MARSHALL Court. question presented this case 315 (1943), protects * where events giving rise lawsuit place, city approximately 10,000 people located northwest corner State. Columbia Memorial Hospital (CMH). also home group-medical called At times relevant case, CMH 3 Patrick general vascular surgeon. He became employee member CMH's 1972. One year later, are case,1 invited become offer surgical continued serve CMH. 4 After established practice, associated consistently refused him. received virtually referrals though did surgeon staff. Rather refer surgery petitioner, doctors referred surgeons far 50 miles Astoria. In addition, showed reluctance assist own patients. often give consultations, provide backup coverage same time, repeatedly criticized failing obtain outside consultations adequate coverage. 5 1979, respondent Gary Boelling, complained executive committee about incident left recently hired associate, then unattended. decided complaint, along information cases handled Examiners (BOME). Respondent Franklin Russell, another chaired BOME investigated these matters. practices full BOME, issued letter reprimand drafted Russell. retracted entirety after sought judicial proceedings. 6 Two years request Richard Harris, initiated privileges. voted recommend termination standards hospital. demanded hearing, provided bylaws, five-member ad hoc committee, heard charges defense. requested testify personal bias him, they accommodate request. Before rendered decision, resigned risk termination.2 7 During course proceedings, United States Oregon. alleged Act, ch. 647, 26 Stat. 209, 15 U.S.C. 1, 2. Specifically, contended participated Respondents denied assertion, submitted dispute jury instructions it rule if found result specific intent injure destroy competition. 8 returned verdict Harris § claim. It awarded damages $650,000 two claims taken together. required law, see 15(a), 38 731, trebled damages. Ninth Circuit (1986). substantial evidence acted bad faith process.3 held, however, process disadvantage competitor scrutiny. reasoned fall within exemption process.4 therefore claims. 10 We granted certiorari, 484 814, S.Ct 65, 98 29 (1987), decide challenge.5 now reverse. II 11 considered prohibits actions raisin producer brought California Director Agriculture enjoin enforcement marketing plan adopted State's Agricultural Prorate Act. That statute restricted among food producers stabilize prices economic waste. Relying principles federalism sovereignty, find "an unexpressed purpose nullify state's control over officers agents." Id., 351, S.Ct., 313. intended "to restrain action official state." Ibid. 12 Although involved official, subsequently recognized Parker' rationale apply certain suits parties. See, e.g., Southern Motor Carriers Rate Conference, Inc. States, 471 48, 105 1721, 85 36 (1985). If Government litigant always enforce parties, effectively implement program restraining them. ensure when truly product regulation. accordingly rigorous two-pronged engaged should be deemed thus shielded laws. Retail Liquor Dealers Assn. Midcal Aluminum, Inc., 445 97, 937, 233 (1980). First, "the challenged restraint must 'one clearly affirmatively expressed policy.' " 105, 943, quoting Lafayette Louisiana Power & Light Co., 435 389, 410, 1123, 1135, 55 364 (1978) (opinion BRENNAN, J.). Second, "must 'actively supervised' itself." supra, U.S., quotingLafayette 1135 Only act party meets both requirements fairly attributable 13 we need consider "clear articulation" test, satisfied. active supervision stems recognition "[w]here engaging activity, real danger he acting further interests, governmental interests State." Hallie Eau Claire, 34, 47, 1713, 1720, 24 (1985); id., 45, 1719-1720 ("A . presumed primarily behalf"). designed shelter that, State, actually policies. 46-47, 1720. To accomplish purpose, mandates ultimate conduct. Cf. 51, 1723 (noting public service commissions "have authority intrastate rates"); 352, 314 (stressing proposed growers take effect unless approved board). mere presence some involvement monitoring suffice. 324 Corp. Duffy, 479 335, 345, n. 7, 107 720, 726, 93 667 (1987) (holding forms constitute "exer[t] significant over" terms restraint). Absent supervision, realistic assurance party's promotes policy, merely individual interests. 14 contend through system. Appeals, finding satisfied, relied powers responsibilities actors. Neither nor succeeded actors review—private Oregon's Division supervisory "matters relating preservation life health," Ore.Rev.Stat. 431.110(1) including licensing hospitals, 441.025, health laws, 431.120(1), 431.150, 431.155(1). Hospitals statutory obligation establish procedures regular basis. 441.055(3)(c), (d). exercising powers, initiate violating law. 431.155. deny, suspend, revoke license failure comply requirement. 441.030(2). law specifies ways supervise 16 scheme decisions. Division's relates procedures;6 encompass actual made (and most kind) consists privileges, itself. exercises privilege determinations. authority: scheme, overturn fails Thus, cannot satisfy doctrine. 17 Similarly, engage principal function regulate As note, hospitals notify promptly restrict 441.820(1) (1987). other, indicates apparent reporting opportunity additional part, revocation physician's license, warranted.7 Certainly, shown reviews ever asserted reverse 18 remaining judiciary. claim, agreed, courts directly privilege-termination constitutes supervision. previously courts, capacity, can adequately purposes All our prior concerning administrative agencies, see, (1985), Supreme Courts agency-like organized bar, Bates Bar Arizona, 433 350, 97 2691, 53 810 (1977). require us broad exists all, falls short satisfying 19 initial matter, clear affords direct expressly providing terminations. Moreover, aware held available. cited certainly do hold physician terminated entitled review. each cases, assumed, decide, complaining kind requested. Straube Emanuel Lutheran Charity Board, 287 Or. 375, 383, 600 P.2d 381, 386 (1979) ("We assumed (but decided) plaintiff 'fair procedure' common right"); Huffaker Bailey, 273 273, 275, 540 1398, 1399 (1975) ("In view conclusion prevail assuming before us, unnecessary interesting questions [of reviewability]. Therefore, assume, subject mandamus. ."). 20 indicated would very limited nature. recent addressing stated "should [not] merits plaintiff's dismissal" "[i]t unwise more make sure sort reasonable procedure afforded posed care." 384, P.2d, 386. doctrine's Under standard suggested accorded Such constricted convert terminating into 21 Because conclude actor decisions, application so holding, unmindful amici advanced reaching opposite conclusion. They argument, legislative branch. extent Congress exempt reach laws,8 own. done so. Accordingly, Appeals. 22 ordered. 23 BLACKMUN originally named defendants. partner, dismissed close trial. address issues arising resign committee's determination, raise matter response petition certiorari. significance, any, resignation. Viewing light favorable appropriate verdicts jury, characterized "shabby, unprincipled unprofessional." F.2d, 1509. determined Russell's likewise read writ certiorari challenge holding Indeed, asserts makes difference him suffered little damage therein. aspect Appeals' express correctness. whether, form basis liability, admissible insofar nonimmune conspiracy Russell others engaged. A reading below, reveals question. usually decline lower court. Youakim Miller, 425 231, 234, 96 1399, 1401, 47 701 (1976) (per curiam). reason depart bar. position evidentiary raised procedures. authorizes force regularly procedures, empower adopts. requiring inform one several involving BOME. provides licensees shall report medically incompetent 677.415(2) Further, malpractice insurers 743.770. appear learn instances substandard warranted. fact insulated Care Quality Improvement 1986, 42 11101 seq. (1982 ed., Supp. IV). enacted well issue retroactive, immunizes "in belief [it] furtherance 11112(a). change "immunities law," 11115(a), immunity, allowing immunize meet standard. enacting measure, noted responded concern possibility discourage believe insufficient fully, up

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