Patrick v. Burget

Background

In Astoria, Oregon, surgeon Timothy Patrick set up an independent practice after declining partnership with the local group, the Astoria Clinic. Most Columbia Memorial Hospital staff were Clinic doctors. Clinic partners stopped referring patients and complained about Patrick to the hospital review committee and the State Board of Medical Examiners (BOME). The hospital committee later recommended terminating his privileges. Patrick resigned before a final decision and sued in federal court, alleging Clinic partners used peer review to harm his business under federal antitrust law. A jury awarded $650,000, which the District Court trebled; the Ninth Circuit reversed on state-action immunity.

Reasoning

The Court asked whether the state-action doctrine shields physicians who act in hospital peer review from federal antitrust law. Applying the Midcal two-part test, the Court found it unnecessary to decide whether Oregon clearly expressed a policy because Oregon failed the active supervision requirement. The Court examined the State Health Division, the BOME, and state courts and concluded none had authority to review and overturn particular privilege decisions. The Health Division could enforce hospital procedures but not reverse individual decisions; the BOME received reports but did not disapprove terminations; and Oregon courts would only check for basic fairness, not the merits. The Court therefore denied state-action immunity and reversed the Ninth Circuit.

Real world impact

This ruling means physicians and hospitals cannot assume peer-review committee actions are immune from federal antitrust suits unless a State clearly supervises those decisions. The Court noted concerns that antitrust exposure might chill peer review but said policy choices belong to legislatures. The opinion also notes Congress later enacted a law offering limited protection to some peer-review actions, but that law was enacted after these events and is not retroactive.