Wilk v. American Medical Association
Encyclopedia
Wilk v. American Medical Association, 895 F.2d 352 (7th Cir.
1990), was a federal antitrust
suit brought against the American Medical Association
(AMA) and 10 co-defendants by chiropractor
Chester A. Wilk, DC, and four co-plaintiffs. It resulted in a ruling against the AMA.
Before 1980, Principle 3 of the AMA Principles of medical ethics
stated: "A physician should practice a method of healing founded on a scientific basis; and he should not voluntarily professionally associate with anyone who violates this principle." In 1980 during a major revision of ethical rules (while the Wilk litigation was in progress), it replaced Principle 3, stating that a physician "shall be free to choose whom to serve, with whom to associate, and the environment in which to provide medical services." Also, up until 1974, the AMA had a Committee on quackery
which challenged what it considered to be unscientific forms of healing. Wilk argued that this committee was established specifically to undermine chiropractic.
. The plaintiffs lost at the first trial in 1981, then obtained a new trial on appeal in 1983 because of improper jury instructions
and admission of irrelevant and prejudicial evidence (Wilk v. American Medical Ass'n, 735 F.2d 217, 7th Cir. 1983).
Just before the second trial, the plaintiffs dropped their demand for damages and sought only an injunction
. Therefore, the resulting trial in May and June 1987 was a bench trial
in which Judge Susan Getzendanner personally heard the evidence and made factual findings.
"to contain and eliminate the chiropractic profession." (Wilk v. American Medical Ass'n, 671 F. Supp. 1465, N.D. Ill. 1987). She further opined that the "AMA had entered into a long history of illegal behavior". And, she then issued a permanent injunction
against the AMA under Section 16 of the Clayton Act to prevent such future behavior. However, she exonerated the two other remaining defendants, the Joint Commission on Accreditation of Hospitals and the American College of Physicians
, and dismissed them from the case.
Judge Getzendanner also went out of her way to make clear what she was not doing:
However Judge Getzendanner went on:
She concluded that the AMA had been too restrictive in its campaign:
(on June 11, August 13, and November 26, 1990). The Court grants certiorari only when a case presents a novel question of law, and the Wilk case was a straightforward application of the Sherman Act.
The AMA eliminated Principle 3 in 1980 during a major revision of ethical rules (while the Wilk litigation was in progress). Its replacement stated that a physician "shall be free to choose whom to serve, with whom to associate, and the environment in which to provide medical services." Thus, the AMA now permits medical doctors to refer patients to doctors of chiropractic for such manipulative therapy if the medical doctor believes it is in the best interests of the patients. As noted by Judge Getzendanner, the AMA also took credit during the Wilk litigation for forcing chiropractors to put their own field on a sounder theoretical footing.
Following a decade of litigation, the Seventh Circuit Court upheld the ruling by U.S. District Court Judge Susan Getzendanner that the AMA had engaged in a "lengthy, systematic, successful and unlawful boycott" designed to restrict cooperation between MDs and chiropractors in order to eliminate the profession of chiropractic.
United States Court of Appeals for the Seventh Circuit
The United States Court of Appeals for the Seventh Circuit is a federal court with appellate jurisdiction over the courts in the following districts:* Central District of Illinois* Northern District of Illinois...
1990), was a federal antitrust
Antitrust
The United States antitrust law is a body of laws that prohibits anti-competitive behavior and unfair business practices. Antitrust laws are intended to encourage competition in the marketplace. These competition laws make illegal certain practices deemed to hurt businesses or consumers or both,...
suit brought against the American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
(AMA) and 10 co-defendants by chiropractor
Chiropractic
Chiropractic is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. It is generally categorized as complementary and alternative medicine...
Chester A. Wilk, DC, and four co-plaintiffs. It resulted in a ruling against the AMA.
Pre-trial environment
Until 1983, the AMA held that it was unethical for medical doctors to associate with an "unscientific practitioner," and labeled chiropractic "an unscientific cult."Before 1980, Principle 3 of the AMA Principles of medical ethics
Medical ethics
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...
stated: "A physician should practice a method of healing founded on a scientific basis; and he should not voluntarily professionally associate with anyone who violates this principle." In 1980 during a major revision of ethical rules (while the Wilk litigation was in progress), it replaced Principle 3, stating that a physician "shall be free to choose whom to serve, with whom to associate, and the environment in which to provide medical services." Also, up until 1974, the AMA had a Committee on quackery
Quackery
Quackery is a derogatory term used to describe the promotion of unproven or fraudulent medical practices. Random House Dictionary describes a "quack" as a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or publicly, to have skill, knowledge, or...
which challenged what it considered to be unscientific forms of healing. Wilk argued that this committee was established specifically to undermine chiropractic.
The first trial
In 1976, Chester Wilk and four other chiropractors sued the AMA, several nationwide healthcare associations, and several physicians for violations of sections 1 and 2 of the Sherman Antitrust ActSherman Antitrust Act
The Sherman Antitrust Act requires the United States federal government to investigate and pursue trusts, companies, and organizations suspected of violating the Act. It was the first Federal statute to limit cartels and monopolies, and today still forms the basis for most antitrust litigation by...
. The plaintiffs lost at the first trial in 1981, then obtained a new trial on appeal in 1983 because of improper jury instructions
Jury instructions
Jury instructions are the set of legal rules that jurors should follow when the jury is deciding a civil or criminal case. Jury instructions are given to the jury by the jury instructor, who usually reads them aloud to the jury...
and admission of irrelevant and prejudicial evidence (Wilk v. American Medical Ass'n, 735 F.2d 217, 7th Cir. 1983).
The second trial
In the second trial case the AMA had the burden of proof, needing to establish the validity of the boycott. The court recognized a "patient care defense," but imposed a difficult burden. The defendants had to show their concern could not have been adequately satisfied in a manner less restrictive of competition. So Wilk and later cases greatly limit the use of "quality of care" defense in boycott cases.Just before the second trial, the plaintiffs dropped their demand for damages and sought only an injunction
Injunction
An injunction is an equitable remedy in the form of a court order that requires a party to do or refrain from doing certain acts. A party that fails to comply with an injunction faces criminal or civil penalties and may have to pay damages or accept sanctions...
. Therefore, the resulting trial in May and June 1987 was a bench trial
Bench trial
A bench trial is a trial held before a judge sitting without a jury. The term is chiefly used in common law jurisdictions to describe exceptions from jury trial, as most other legal systems do not use juries to any great extent....
in which Judge Susan Getzendanner personally heard the evidence and made factual findings.
Judge's findings in the second trial
On September 25, 1987, Getzendanner issued her opinion that the AMA had violated Section 1, but not 2, of the Sherman Act, and that it had engaged in an unlawful conspiracy in restraint of tradeRestraint of trade
Restraint of trade is a common law doctrine relating to the enforceability of contractual restrictions on freedom to conduct business. In an old leading case of Mitchell v Reynolds Lord Smith LC said,...
"to contain and eliminate the chiropractic profession." (Wilk v. American Medical Ass'n, 671 F. Supp. 1465, N.D. Ill. 1987). She further opined that the "AMA had entered into a long history of illegal behavior". And, she then issued a permanent injunction
Injunction
An injunction is an equitable remedy in the form of a court order that requires a party to do or refrain from doing certain acts. A party that fails to comply with an injunction faces criminal or civil penalties and may have to pay damages or accept sanctions...
against the AMA under Section 16 of the Clayton Act to prevent such future behavior. However, she exonerated the two other remaining defendants, the Joint Commission on Accreditation of Hospitals and the American College of Physicians
American College of Physicians
The American College of Physicians is a national organization of doctors of internal medicine —physicians who specialize in the prevention, detection, and treatment of illnesses in adults. With 130,000 members, ACP is the largest medical-specialty organization and second-largest physician group in...
, and dismissed them from the case.
Judge Getzendanner also went out of her way to make clear what she was not doing:
However Judge Getzendanner went on:
She concluded that the AMA had been too restrictive in its campaign:
Following the second trial
Both sides cross-appealed, and the district court's decision was affirmed by the U.S. Court of Appeals on February 7, 1990 (Wilk v. American Medical Ass'n,895 F.2d 352, 7th Cir. 1990). In their opinion, the Appellate Court wrote "The court found the AMA failed to establish that throughout the relevant period (1966-1980) their (the AMA's) concern for scientific methods in patient care had been objectively reasonable". The AMA petitioned the U.S. Supreme Court three times, but each time the Court denied certiorariCertiorari
Certiorari is a type of writ seeking judicial review, recognized in U.S., Roman, English, Philippine, and other law. Certiorari is the present passive infinitive of the Latin certiorare...
(on June 11, August 13, and November 26, 1990). The Court grants certiorari only when a case presents a novel question of law, and the Wilk case was a straightforward application of the Sherman Act.
The AMA eliminated Principle 3 in 1980 during a major revision of ethical rules (while the Wilk litigation was in progress). Its replacement stated that a physician "shall be free to choose whom to serve, with whom to associate, and the environment in which to provide medical services." Thus, the AMA now permits medical doctors to refer patients to doctors of chiropractic for such manipulative therapy if the medical doctor believes it is in the best interests of the patients. As noted by Judge Getzendanner, the AMA also took credit during the Wilk litigation for forcing chiropractors to put their own field on a sounder theoretical footing.
Following a decade of litigation, the Seventh Circuit Court upheld the ruling by U.S. District Court Judge Susan Getzendanner that the AMA had engaged in a "lengthy, systematic, successful and unlawful boycott" designed to restrict cooperation between MDs and chiropractors in order to eliminate the profession of chiropractic.