Court of Appeals affirms American Medical Association's guilt in antitrust case

Article Abstract:

The United States Court of Appeals agreed with the judgment of a United States District Court Judge that the American Medical Association (AMA) had unlawfully violated the antitrust laws by conspiring with its members and other medical professional societies to destroy the profession of chiropractic in the United States. The February 7th decision by the Court of Appeals in the 'Wilk versus the AMA' case is considered a landmark decision by the chiropractic profession because of its reference to consumer rights to freedom of choice. The right to select the practitioner who will care for one's health is a personal decision that was affirmed by this legal triumph. The District Court judge, after an eight-week trial, had decided that the AMA had engaged in ''lawless'' behavior, in that it had induced hospitals to prevent diagnostic assistance and facilities to chiropractors and their patients; interfered with chiropractic educational institutions; interfered with health insurance programs that reimburse chiropractic patients; and organized a nationwide attempt to ruin the reputations of chiropractors, as well as obstructed cooperation between medical doctors and chiropractors by declaring it to be unethical. The judge's opinion also held that there was evidence that chiropractic was more effective than the medical profession in treating certain kinds of problems such as workmen's back injuries, and that the AMA was aware that some medical doctors believed that chiropractors were better trained to deal with musculoskeletal problems than most medical physicians. The Court of Appeals stated in their opinion that the AMA intended to ''destroy a competitor'' and there was evidence ''showing that the AMA was motivated by economic concerns.'' The Court further stated that it had found recurrent violations, and was unimpressed with the AMA's expressed intent to comply with antitrust laws. George P. McAndrews, the lawyer for the chiropractors, stated that this experience should warn other medical associations and hospitals that chiropractors will fight for fair treatment by tax-supported institutions, hospitals, insurance plans, HMOs and other organizations. This was a step forward in the realization of free choice in selecting licensed health-care professionals. Paul Slater, another lawyer for the chiropractors, stated that the court's opinion reaffirms antitrust principles and applies them to the medical profession. According to Slater, the 14-year litigation established two fundamental propositions: that ''the AMA is not beyond the reach of the antitrust laws and competition; and that free enterprise, not a private group, must govern the medical marketplace.''

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Wilk case attorney looks at U.S. Court of Appeals victory

Article Abstract:

In 1976 an Illinois chiropractor, Dr. Chester Wilk, decided to sue the American Medical Association (AMA) for what he felt was a deceitful campaign against his profession. He was soon joined by three fellow chiropractors who went to court in 1980, when the jury ruled that the AMA had not been in violation of the Sherman Antitrust Act. This decision was overruled three years later in the U.S. Court of Appeals because the judge was found to have erred in his instructions to the jury. The case ended up back at the district court for a new trial. Before this new trial, the four chiropractors waived claims for damages and sought only an injunction to prevent the medical establishment from continuing its boycott of chiropractic. The judge ruled that the AMA was guilty of conducting a conspiracy against the chiropractic profession and issued an injunction against the AMA designed to eliminate its collective boycott of chiropractors. The AMA appealed this decision, which was again affirmed by three judges of the Court of Appeals on February 7, 1990. The Court of Appeals opinion clarified important areas such as free choice and removing anti-competitive barriers. Relief was also provided to all health-care consumers by removing the interference with consumers' free choice in choosing a product of their liking. The AMA has to abide by the original injunction, which forbids the AMA from engaging in any collective boycott against chiropractors. The ruling also forces the AMA to tell its members that it is ethical for them to professionally associate with chiropractors. The AMA was ordered to print the injunction in the Journal of the American Medical Association, and to send a letter to each of its 280,000 members informing them of the injunction. The AMA must also remove chiropractors from its list of ''unscientific practitioners'', and create a subtitle for its ethics opinions section designated ''chiropractic'', which will state that medical physicians should associate with chiropractors whenever it would benefit the patient. The lawyer for the chiropractors, George P. McAndrews, expects the AMA to continue to fight, and believes that the ruling may provide a precedent for further lawsuits trying to end the monopolistic control of the hospitals by the medical establishment. In addition, he believes that a refusal by an MD (medical doctor) to refer a patient with neuromusculoskeletal problems to a chiropractor will become grounds for malpractice. (Consumer Summary produced by Reliance Medical Information, Inc.)

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After Wilk ... now what?

Article Abstract:

According to a recent decision by the U.S. Court of Appeals, the American Medical Association (AMA) engaged in ''lawless'' behavior by instituting a nationwide boycott of doctors of chiropractic (DC) by declaring it unethical for medical doctors (MD) to associate professionally with them. The author, Chairman of the American Chiropractic Association Board of Governors, states that the AMA's boycott extended way beyond the formation of a ''Committee of Quackery'' by making hospitals the ''exclusive'' domain of medicine, by interfering with insurance programs designed to reimburse patients of chiropractors equally for services within their authority, by interfering with the participation of medical doctors as teachers and researchers in chiropractic institutions, and by blocking access to diagnostic services only available in hospitals. This latter attempt to deny access to diagnostic equipment was found to be designed to harm both the DC and the patient, and was intended to make the DC be perceived as a less than desirable provider. The central theme of the AMA's boycott was the destruction of the professional image of chiropractic through the above mentioned ploys and the distribution of a pamphlet entitled ''Facts About Quacks''. The result of this manipulation will mean that the chiropractic profession must now perform above and beyond the level of ethics and competence expected of other professionals. The American Chiropractic Association (ACA) should send a copy of the decision to every practicing physician, every newspaper and health-care journalist, every hospital administrator and board of trustees, every federal and state legislator, every attorney general, every insurance commissioner, every insurance company Chief Executive Officer, every health maintenance organization, and every health-care association. The cost of this project is estimated to be between $300-400 thousand, but the profession could not spend its money in a better way than to announce the most significant legal victory ever won against the AMA. If the information about this victory is distributed rapidly and professionally, the effects will not be translated into real benefits for chiropractic and the health-care consumers. It is the responsibility of the American Chiropractic Association to undertake this project, and this will require an increase in membership to achieve the financial support it needs. (Consumer Summary produced by Reliance Medical Information, Inc.)

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