Day v. Fallon Community Health Plan, Inc.
| Decision Date | 21 February 1996 |
| Docket Number | Civil Action No. 94-40148-NMG. |
| Citation | 917 F. Supp. 72 |
| Parties | Dr. Robert C. DAY, et al., Plaintiffs, v. FALLON COMMUNITY HEALTH PLAN, INC., et al., Defendants. |
| Court | U.S. District Court — District of Massachusetts |
COPYRIGHT MATERIAL OMITTED
Jeffrey S. Raphaelson, Raphaelson & Raphaelson, Worcester, MA, William E. Weber, Weber, Waxman & Brown, Hauppauge, NY, for Plaintiffs.
Thomas I. Elkind, Epstein, Becker & Green, P.C., Boston, MA, Daly D.E. Temchine, William G. Kopit, Epstein, Becker & Green, P.C., Washington, DC, for Fallon Community HEA.
Robert M. Buchanan, Jr., Sarah C. Columbia, James Roosevelt, Jr., Jeffrey A. Levinson, Choate, Hall & Stewart, Boston, MA, for Kaiser Foundation and Harvard Community Health Plan, Harvard Community Health Plan of New England, Inc., U.S. Healthcare U.S., Stacy Lundin, M.D., Marshall V. Rozzi, M.D. and Manuel Ferris, M.D.
Thane D. Scott, Michael T. Gass, Palmer & Dodge, Boston, MA, for Bay State Health Care, Inc., Pilgrim Health Care, Michael Kaufman, M.D., Samuel Nussbaum, M.D.
Mark E. Cohen, Stephen D. Rosenberg, McCormack & Epstein, Boston, MA, for Central Massachusetts Health Care, Richard E. Myer, M.D.
Philip A. Proger, Kevin D. McDonald, Jones, Day, Reabis & Pogue, Washington, DC, for CIGNA Healthcare.
Neil P. Motenko, Nutter, McClennen & Fish, Boston, MA, for Community Health PLA.
Francis D. Dibble, Jr., Kevin C. Maynard, Bulkley, Richardson & Gelinas, Springfield, MA, for Health New England, Inc.
Joseph D. Halpern, Blue Cross and Blue Shield of Mass., Boston, MA, for HMO Blue, Inc., Seth Blumberg, M.D.
Steven E. Snow, Partridge, Snow & Hahn, Providence, RI, for HMO Rhode Island.
James S. Franchek, Kevin Hern, Jr., Riemer & Braunstein, Boston, MA, Frank E. Reardon, Hassan & Reardon, Boston, MA, for Matthew Thorton Health Plan, Jon Vore, M.D.
William N. Berkowitz, Charles L. Janes, Charles L. Solomont, Bingham, Dana & Gould, Boston, MA, for Metlife Health Care.
Susan Hughes Banning, Hemenway & Barnes, Boston, MA, for Neighborhood Health.
Thomas I. Elkind, Epstein, Becker & Green, P.C., Boston, MA, William G. Kopit, Epstein, Becker & Green, P.C., Washington, DC, for Prucare of Mass., Ernest Bourass, M.D., Joel Kaufman, M.D., Fallon Clinic, Inc., Morris Spierer, M.D.
Steven W. Kasten, Boston, MA, Donald R. Frederico, McDermott, Will & Emory, Boston, MA, for Tufts Associated Health Plan, Joseph Gerstein, M.D.
Amy K. Posner, Metropolitan Life Insurance Company, New York City, for William T. Friedewald, M.D.
Francis D. Dibble, Jr., Buckley, Richardson & Gelinas, Springfield, MA, for Donald P. Burt, M.D.
William E. Weber, Weber, Waxman & Brown, Hauppauge, NY, for Mark A. Davini.
This antitrust class action suit was brought by the plaintiffs against 21 health maintenance organizations ("HMOs") and their medical directors. Pending before this Court is a joint motion by defendants to dismiss the plaintiffs' second amended Complaint. For the reasons stated below, the defendants' motion will be allowed.
Two classes of plaintiffs have joined together in filing the instant action. The first class consists of chiropractic physicians licensed to practice in Massachusetts. The second class consists of individual enrollees who are provided health insurance under plans purchased from one of the defendant HMOs. The Complaint, which has been twice amended since the suit was originally filed, arises out of the contention that, even where chiropractic care is more cost-effective than medical care, the defendant HMOs have limited the ability of their enrollees to obtain chiropractic services.
More specifically, the defendants' conduct is said to violate the Sherman Antitrust Act, 15 U.S.C. §§ 1 and 2, and its Massachusetts counterpart, M.G.L. c. 93, §§ 4, 5 and 12. The Complaint alleges, in three separate counts, that there are: (1) combinations within each defendant HMO to limit enrollee access to chiropractic care in restraint of trade, (2) combinations between an unspecified number of defendant HMOs to tolerate those "intra-HMO" conspiracies in restraint of trade, and (3) combinations within each defendant HMO to monopolize the provision of health care services.
The defendants filed this joint motion to dismiss each count of the Complaint pursuant to Fed.R.Civ.P. 12. They argue multiple grounds for dismissal, including failure to state a claim upon which relief can be granted, exemption under the McCarran-Ferguson Act, 15 U.S.C. §§ 1012-13 (1988), and lack of standing. Because this Court decides the motion on the first of defendants' stated grounds for dismissal, it does not consider the remaining grounds but proceeds under the standards governing a Rule 12(b)(6) motion.
In ruling upon a 12(b)(6) motion, the Court must accept all well-pleaded facts alleged in the Complaint as true and draw all reasonable inferences in favor of the plaintiff. Washington Legal Foundation v. Massachusetts Bar Foundation, 993 F.2d 962, 971 (1st Cir.1993). This Court neither weighs the evidence nor rules on the merits because the issue is not whether plaintiffs will ultimately prevail, but whether they are entitled to offer evidence to support their claims. If the allegations in the Complaint are sufficient to state a cause of action in accordance with the law under any theory, the Court must deny the motion to dismiss. Vartanian v. Monsanto Co., 14 F.3d 697, 700 (1st Cir.1994).
Despite this highly deferential standard, the Court will not accept any unsupported conclusions or interpretations of law. Washington Legal Foundation, 993 F.2d at 971. As the First Circuit Court of Appeals has stated, "In the menagerie of the Civil Rules, the tiger patrolling the courthouse gates is rather tame, but `not entirely ... toothless.'" Correa-Martinez v. Arrillaga-Belendez, 903 F.2d 49, 52 (1st Cir.1990) (citations omitted). This Court is obliged neither to "credit bald assertions, periphrastic circumlocutions, unsubstantiated conclusions, or outright vituperation", Id., nor to honor subjective characterizations, optimistic predictions, or problematic suppositions. Dartmouth Review v. Dartmouth College, 889 F.2d 13, 16 (1st Cir.1989). This Court is thus mindful that it must carefully balance the rule of simplified civil pleading against the need for more than conclusory allegations. Washington Legal Foundation, 993 F.2d at 971.
In attempting to distinguish that "often blurred" line between sufficient facts and insufficient conclusions, this Court is guided by the "general parameters" set out in Dartmouth Review, 889 F.2d at 16:
Most often, facts are susceptible to objective verification. Conclusions, on the other hand, are empirically unverifiable in the usual case. They represent the pleader's reactions to, sometimes called "inferences from", the underlying facts. It is only when such conclusions are logically compelled, or at least supported, by the stated facts, that is, when the suggested inference rises to what experience indicates is an acceptable level of probability, that "conclusions" become "facts" for pleading purposes.
Furthermore, the Court notes that it is the plaintiff's burden to make sufficient factual allegations in order to survive a Rule 12(b)(6) motion. This Court need not "conjure up unpled allegations or contrive elaborately arcane scripts" in order to allow the plaintiff's Complaint to survive at this early stage of the litigation. Gooley v. Mobil Oil Corp., 851 F.2d 513, 514 (1st Cir.1988).
In the antitrust context, a complaint containing vague pleadings lacking the requisite factual allegations of an antitrust claim is insufficient to state a cause of action. Gilbuilt Homes, Inc. v. Continental Homes of New England, 667 F.2d 209 (1st Cir.1981); Americana Industries, Inc. v. Wometco de Puerto Rico, Inc., 556 F.2d 625 (1st Cir. 1977). With that in mind, the Court turns to the allegations in this Complaint.
Count I alleges that each of the 21 defendant HMOs violated § 1 of the Sherman Act, which prohibits "every contract, combination in the form of trust or otherwise, or conspiracy, in restraint of trade or commerce among the several States...." 15 U.S.C. § 1. To state a claim under § 1, then, plaintiffs must allege that 1) each of the defendants entered into an agreement ("contract, combination ... or conspiracy"), and 2) that agreement was in "restraint of trade or interstate commerce." See Monahan's Marine, Inc. v. Boston Whaler, Inc., 866 F.2d 525, 526 (1st Cir.1989).
Defendants contend that plaintiffs have failed to identify any specific facts to support either element of their conspiracy claim and therefore the "conclusory and indiscriminate" allegations in the Complaint are so vague and lacking in detail as to warrant immediate dismissal. The plaintiffs counter that their Complaint is sufficiently specific, yet concentrate most of their brief on distinguishing the cases cited by the defendants, rather than directing this Court to those particular factual allegations in the Complaint which would tend to support their legal theories. Without much help from the plaintiffs, then, this Court has searched the Complaint for any such specific factual allegations and now turns to the relevant language of the Complaint itself.
Paragraphs one through twenty-two of the Complaint provide background material as to the general nature of the case (¶ 1), jurisdiction and venue (¶¶ 2-3) and the parties (¶¶ 4-22). Paragraphs 23 and 24 allege that the "MD boycott of chiropractic physicians" is not over. Commencing with paragraph 25, the Complaint describes, in not entirely comprehensible terms, the formation of the alleged "intra-HMO combinations" of Count I summarized as follows:
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