40 F.4th 582
7th Cir.2022Background
- Dr. Ricardo Vasquez, a vascular surgeon, has practiced independently in Bloomington, IN since 2006 and performed most inpatient procedures at Bloomington Hospital.
- Indiana University Health (IU Health) acquired Bloomington Hospital in 2010 and purchased Premier Healthcare (a large local physician group) in May 2017; Vasquez alleges IU Health now employs ~97% of Bloomington primary-care physicians.
- Vasquez alleges that beginning around 2017 IU Health waged a campaign to harm his practice for resisting employment, culminating in revocation of his Bloomington admitting privileges in April 2019.
- Vasquez sued IU Health in June 2021 asserting Sherman Act §2 and Clayton Act §7 antitrust claims; the district court dismissed for failure to plead a plausible geographic market and (as to Clayton claims) as time-barred, and denied leave to amend.
- The Seventh Circuit reviewed de novo, held the geographic-market allegations plausible for pleading purposes and that timeliness was not established as a matter of law, and reversed and remanded.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the complaint plausibly alleges a relevant geographic market for vascular surgery (Bloomington) | Bloomington is a discrete, local market: vascular care is ongoing and depends on local continuity; IU Health controls hospital, equipment, and referrals (via PCP employment) | The market is not plausible because many patients travel from rural areas and to larger nearby cities, defeating a Bloomington market | Reversed: allegations that Bloomington is a distinct, plausible geographic market survive pleading; hypothetical‑monopolist inquiry is factual and appropriate at summary/expert stage |
| Whether Vasquez’s Clayton Act claims are time‑barred | The operative injury and discovery occurred after acquisition and/or when privileges were revoked (April 2019), so suit filed June 2021 is timely under the discovery rule | The cause accrued at the May 2017 Premier acquisition, so the June 2021 suit missed the 4‑year limitations period | Reversed: complaint does not plead itself out of court; multiple plausible accrual/discovery dates exist and timeliness is an affirmative defense not resolvable at dismissal stage |
| Whether dismissal with prejudice without leave to amend was proper | (Requested) Leave to amend should have been allowed | District court denied leave and dismissed with prejudice | Not reached: because reversal and remand, court did not decide; district court’s denial not affirmed |
Key Cases Cited
- FTC v. Advocate Health Care Network, 841 F.3d 460 (7th Cir. 2016) (endorsing hypothetical‑monopolist test for geographic markets in healthcare)
- Bell Atl. Corp. v. Twombly, 550 U.S. 544 (2007) (pleading standard—plausibility and discovery expectation)
- In re Copper Antitrust Litig., 436 F.3d 782 (7th Cir. 2006) (antitrust accrual and discovery rule for limitations period)
- Xechem, Inc. v. Bristol‑Myers Squibb Co., 372 F.3d 899 (7th Cir. 2004) (standard for dismissals on timeliness at pleading stage)
- Fishman v. Estate of Wirtz, 807 F.2d 520 (7th Cir. 1986) (relevant market boundaries are questions of fact)
- United States v. E. I. du Pont de Nemours & Co., 353 U.S. 586 (1957) (relevant market need not be coextensive with total market)