Legal Document

343 U.S. 326 72 Supreme Court Reporter 690 96 L.Ed. 978 UNITED STATESv.OREGON STATE MEDICAL SOC. et al. Number 19. Argued Jan. 4 and 7, 1952. Decided April 28, [Syllabus from pages 326-327 intentionally omitted] Mr. Stanley M. Silverberg, Washington, D.C., for appellant. Nicholas Jaurequy, Portland, Or., appellees. Justice JACKSON delivered the opinion of Court. 1 This is a direct appeal by United States1 dismissal District Court2 its complaint seeking an injunction to prevent restrain violations §§ 2 Sherman Act. 26 Statutes-at-Large 209, as amended, 15 States Code KF62 1, 2, Annotated KF65 U5 2.3 Appellees are Oregon State Medical Society, eight county medical societies, Physicians Service (an corporation engaged in sale prepaid care), doctors who or have been at some time responsible officers those organizations. 3 controversy centers about two forms 'contract practice' medicine. In one, private corporations organized profit sell what amounts policy insurance which small periodic payments purchase right certain hospital facilities attention. other, railroad large industrial employers labor contract with one more treat their ailing injured employees. Both practice,' rendering promised surgical service, depend upon panels cooperate on fee basis associate themselves plan full part-time employment basis. Objections profession practice both monetary ethical. Such diverts patients independent practitioners doctors. It tends standardize fees. The ethical objection has that intervention employer company makes tripartite matter doctor-patient relation. Since doctor owes his looks pay rather than patient, he serves masters conflicting interests. many cases companies assumed liability service only if they approved treatment advance. There was evidence instances where promptly needed delayed while obtaining approval, lay official disapproved advised doctor. 5 1936, five associations were selling certificates Oregon, State, alarmed extent being invaded superseded practice, commenced crusade stamp it out. A tooth-and-claw struggle ensued between profession, hand, organizations employing other. campaign bitter sides. societies adopted resolutions statements condemning physicians it. They brought pressure individual decline abandon threatened expulsion society did expel several refusal terminate practices. 6 However, 1941, seven years before this action commenced, there abrupt about-face part Oregon. apparently convinced public demanded entitled protection against unexpected costs disease accident, catastrophic persons without reserves. completely reversed strategy, and, instead trying discourage decided render nonprofit themselves. 7 year, Physicians' Service, defendants action, formed. corporation, furnishing medical, surgical, care As charged complaint, 'It sponsored Society controlled operated members society. sponsors, approves, cooperates component latter offer plans.' 95 F.Supp. page 121. After successful operation, Government suit doctors, professional company, asserting basic charges: first, conspired monopolize business providing second, competition doctor-sponsored plans within would not furnish area serviced local plan. 8 Judge, after long trial, dismissed ground had proved none charges preponderance evidence. procedure does give us benefit review Appeals findings fact. 9 brings no important questions law unsettled problems statutory construction. much like versus Yellow Cab Co., 338 338, 70 177, 94 150. Its issues solely ones record long, replete conflicts testimony, includes quantities documentary material taken appellees' files letters written employers, appellees each put score witnesses stand. At close trial judge stated work 'does permit preparation formal so complex case. & N Dec. Immigration Nationality Decisions will state my conclusions main then append notes made various stages throughout trial. These may be aid counsel Findings Fact Conclusions Law submitted final judgment.' 104. indicated disposition issues, but predicates suggestion bias irrelevant soliloquies socialized medicine, law, like, contained. Admitting these do add strength persuasiveness opinion, becloud clear case, all ruled Government. Counsel detailed accordance therewith. submit requests find, letter raised objections proposals 10 found conspire attempt period 1936—1941, that, even such conspiracy during proved, abandoned 1941 formation marking entry into business. He restraints could justified reasonable maintain proper standards ethics. supplying constitute trade commerce meaning Act, declined rule question whether interstate commerce. 11 asks overrule contrary evidence, find We asked facts reverse remand case 'for decree granting appropriate relief.' substance try de novo record, make determine nature form relief. heretofore scope our review. supra. 12 While Congress provided Court, also tried court jury 'findings fact shall set aside unless clearly erroneous, due regard given opportunity credibility witnesses.' Rule 5i(a), Fed.Rules Civ.Proc., 28 adherence complaining party creates vast cumulative long-past transactions, motives, purposes, effect depends largely witnesses. 13 rejected grouping evidentiary four periods, 1930—1936, year That proposal projected inquiry over eighteen-year instituted. accepted since organization significant earlier 'ancient history' 'when Doctors * groping correct position take accord changing times.' 105. Of course, present events roots past, quite trace currently questioned conduct backwards illuminate connections meanings. But we think rejecting pre-1941 establishing cause maintain, adopt division involved 14 simplify consideration keep sight target relief aimed. sole function forestall future violations. unrelated punishment reparations past pendency decision concurrent later remedy indictment damages injured. All takes real threat violation contemporary likely continue recur. established, adds nothing calendar gone might filled transgressions. Even mandatory form, undo existing conditions, because otherwise continue. forward-looking this, examination 'a great amount archeology'4 when illuminates explains predicts shape things come. When shown settled continuing entered violative anti-trust laws, courts assume proof. Local 167 International Brotherhood Teamsters, etc. States, 291 293, 298, 54 396, 398, 78 804. duty beware efforts defeat injunctive protestations repentance reform, especially abandonment seems timed anticipate suit, probability resumption. Cf. Steel Corp., 251 417, 445, 40 297, 64 343. 16 slightest reason doubt genuineness, good faith permanence changed attitude strategy defendant-appellees took place 1941. occurred far informed, predictable. consist merely pretensions promises overt visible reversal policy, carried out extensive operations every appearance permanent wise advantageous discloses resumption warfare entails. agree discontinued warrant issuance 1949. Industrial Association San Francisco 268 64, 84, 45 403, 408, 69 849. 17 Appellees, care, engage activities violate antitrust laws. now competitors field restraints, any expected, methods promotion operation own Our inquire character enjoined. 18 Striking prior Government's except purposes illustration background information, little left. derived coloration support almost entirely prolong beyond useful length, details peculiar mention appear highlights. 19 Only Multnomah County resorted expulsions contract-practice activities, hints testimony reviving short came it, limits membership necessarily indicate joint venture other 20 Some emphasis placed report meeting House Delegates voted 'private patient status' theretofore applied cmmercial association contracts extended type contracts. Any significance provision neutralized another paragraph same report, reads: 'A receipt should furnished visit, understood (industrial plan) concerned probably establish program reimbursement affected employees.' strike restrict reimbursing employees expenses can say ambiguity properly resolved favor court. 21 contains number refusing accept checks directly them. base society, others silent reasons. attributed writers' personal resistance dealing health associations, objected filling required preferred confine leaving deal associations. writers mistaken misunderstood Others avoided disclosure opposition handy impersonal excuse 'policy.' value, compelling weighed post-1941 satisfy court's 'clearly erroneous.' 22 concerted need decide observe passing, however, considerations historic relationship physician different usual prevailing ordinary commercial matters. recognized world demoralizing profession. Semler Board Dental Examiners, 294 608, 55 570, 79 1086. 23 Appellees' disprove conclusive, negative, too persuasive error 1948, 1,210 1,660 licensed January 1947, June 30, 1,085 billed received payment Hospital Association, operating State. Surely effective boycott, ineffectiveness, view power attributes strongly suggests lack boycott parade parts reputable, credible, informed men, testified discrimination attempts cooperating Members governing councils Societies 1940 suggestions meetings serving manager conferences attended him hear cooperation plans. 24 If credit, finding sustained. Certainly cannot erroneous. 25 charge here, understand 33(i) 124, state-wide organization, county-medical-society-sponsored agreed compete another. Apparently stay out, wanted inaugurate plan, withdraw area. situation suppliers commodities divide territories reciprocal agreements exploit allotted market, thereby depriving allocated communities competition. supply to, allocation withhold from, community description. No certificate, performed, main, certificate prepay result, enter association, inhabitants services through either channels. least proof duplicating sources them cheaper, available result improved beneficial anybody. Through locality, practical effect, hospitalization cash credit To hold illegal simultaneously locality require certificates. Under circumstances agreement unreasonable restraint 27 With charge, found, 'The services, Doctor Sponsored Organizations, conducted Section Anti-Trust Law, nor constitutional grant 'To regulate Commerce among States'.' 118. aspects overturned disposes commerce, fall prohibitions Almost everything pointed relates across-state-line proven, adversely So attention discloses, wholly intrastate. show out-of-state hospitals, presumably polycyholders happened remove temporarily away arose. were, few, sporadic incidental. supra, 29 American 317 519, 63 326, 87 434, stand proposition plane prosecution under § Act Columbia. Interstate necessary statute there. 30 conclude charges. Court's erroneous' although reviewing entire left definite firm conviction mistake committed.' Gypsum 333 364, 395, 68 525, 542, 92 746. contentions plausibly earnestly argued leave 'definite 31 aptly New York Appeals, substantive nature: 'Face face living witnesses, original trier holds advantage appellate judges excluded. doubtful cases, exercise observation often proves most accurate method ascertaining truth. How wrong? never saw sophistication sagacity confides appraisal.' Boyd Boyd, 252 N.Y. 422, 429, 169 Northeastern KF135 N59 632, 634. 32 Affirmance is, prejudice practices threaten Reading 226 324, 373, 33 90, 104, 57 243. Judgment affirmed. 34 BLACK judgment below erroneous reversed. 35 CLARK Pursuant Expediting 1903, 823, 29, 29. 103. 1: 'Every contract, combination trust otherwise, conspiracy, declared *.' 2: person monopolize, combine persons, deemed guilty misdemeanor Judge Augustus Hand, 'Trial Efficiency,' Business Practices Federal Antitrust Laws, Symposium, Bar Assn. (C.C.H., 1951) 31—32. See Sec. VIII, Procedure Other Protracted Cases, Report September 26, 1951, Judicial Conference States.

Classification Label: 7