Document ID: ./input/supremecourt_opinions/opinions/19pdf/18-1323_c07d.pdf
Page Number: 94.0

Cite as:  591 U. S. ____ (2020) 

13 

ALITO, J., dissenting 

this is clear: The District Court ignored a factor of the ut-
most importance, the incentives of the doctors in question.
When the District Court made its assessment of the doc-
tors’ “good faith,” enforcement of Act 620 had been prelimi-
narily enjoined, and the doctors surely knew that enforce-
ment  would  be  permanently  barred  if  the  lawsuit  was 
successful.  Thus,  the  doctors  had  everything  to  lose  and 
nothing  to  gain  by  obtaining  privileges.7    Two  of  the  doc-
tors—Does 1 and 2—are petitioners and cross-respondents
in this Court.  Two others, Does 5 and 6, were plaintiffs ear-
lier  but  dropped  out  for  unexplained  reasons.  See  App.
1327.  And Doe 3, although not a plaintiff, is the medical 
director of June Medical, a party to this case.  Id., at 186, 
206, 245. 

If these doctors had secured privileges, that would have
tended to defeat the lawsuit.  Not only that, acquiring priv-
ileges would have subjected all the doctors to the previously
described hospital monitoring, as well as any other obliga-
tions  that  a  hospital  imposed  on  doctors  with  privileges, 
such as providing unpaid care for the indigent.  See infra, 
at 21.  Thus, in light of the situation at the time when the 
doctors made their attempts to get privileges, they had an 
incentive to do as little as they thought the District Court
would demand, not as much as they would if they stood to
benefit from success. 

—————— 

7 Petitioners maintain that an unsuccessful admitting privileges appli-
cation  is  a  “stain”  on  a  doctor’s  medical  record,  because  the  rejection
could  appear  in  a  federal  database  and  would  need  to  be  disclosed  on
future applications for admitting privileges.  Brief for Petitioners in No. 
18–1323, p. 41, n. 7.  As the record in this case shows, there is reason to 
doubt  that  the  prospect  of  rejection  provides  a  sufficient  incentive  for 
doctors  to  pursue  privileges  vigorously.    See  infra,  at  15–23.    Perhaps 
that  is  because  only  rejections  for  lack  of  “professional  competence  or 
professional conduct” need to be disclosed to the relevant federal data-
base.  45 CFR §§60.12, 60.3 (2019).  Petitioners also have not explained
how a non-competence-based rejection would have any bearing on future
applications for privileges.