federal
trade
commission
phoebe
putney
health
system
et
argued
november
decided
february
georgia
hospital
authorities
law
law
political
subdivisions
may
create
public
entities
called
hospital
authorities
provide
operation
maintenance
needed
health
care
facilities
several
counties
municipalities
th
state
law
permits
authorities
exercise
public
essential
governmental
functions
delegates
numerous
general
powers
including
ability
acquire
lease
hospitals
public
health
facilities
code
ann
hospital
authority
county
authority
owns
phoebe
putney
memorial
hospital
memorial
one
two
hospitals
county
authority
formed
two
private
nonprofit
corporations
manage
memorial
phoebe
putney
health
system
pphs
phoebe
putney
memorial
hospital
ppmh
authority
decided
purchase
second
hospital
county
lease
subsidiary
pphs
federal
trade
commission
ftc
issued
administrative
complaint
alleging
transaction
substantially
reduce
competition
market
hospital
services
violation
federal
trade
commission
act
clayton
act
ftc
georgia
subsequently
sued
authority
pphs
ppmh
others
collectively
respondents
seeking
enjoin
transaction
pending
administrative
proceedings
district
denied
request
preliminary
injunction
granted
respondents
motion
dismiss
holding
respondents
immune
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liability
doctrine
eleventh
circuit
affirmed
concluded
authority
local
governmental
entity
entitled
immunity
challenged
anticompetitive
conduct
foreseeable
result
law
reasoned
state
legislature
readily
anticipated
anticompetitive
effect
given
breadth
powers
delegated
hospital
authorities
particularly
leasing
acquisition
powers
lead
consolidation
hospital
ownership
held
georgia
clearly
articulated
affirmatively
expressed
policy
allowing
hospital
authorities
make
acquisitions
substantially
lessen
competition
immunity
apply
pp
recognized
parker
brown
federal
antitrust
laws
prevent
imposing
market
restraints
act
government
doctrine
immunity
federal
antitrust
law
may
extend
nonstate
actors
carrying
state
regulatory
program
see
patrick
burget
given
antitrust
laws
values
free
enterprise
economic
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immunity
disfavored
ftc
ticor
title
ins
recognized
clear
challenged
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conduct
undertaken
pursuant
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regulatory
scheme
immunity
attach
activities
substate
governmental
entities
undertaken
pursuant
clearly
articulated
affirmatively
expressed
state
policy
displace
competition
community
communications
boulder
state
legislature
need
expressly
state
intent
hallie
eau
claire
anticompetitive
effect
must
foreseeable
result
state
authorized
pp
respondents
immunity
defense
fails
test
evidence
state
affirmatively
contemplated
hospital
authorities
displace
competition
consolidating
hospital
ownership
authority
powers
including
acquisition
leasing
powers
mirror
general
powers
routinely
conferred
state
law
private
corporations
required
establish
immunity
authority
must
show
delegated
authority
act
act
regulate
anticompetitively
columbia
omni
outdoor
advertising
boulder
concluded
colorado
law
granting
municipalities
power
enact
ordinances
governing
local
affairs
satisfy
test
state
position
one
mere
neutrality
respecting
municipal
actions
challenged
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state
said
anticompetitive
actions
principle
controls
grants
general
corporate
power
allowing
substate
governmental
entities
participate
competitive
marketplace
typically
used
without
raising
federal
antitrust
concerns
state
said
contemplated
powers
used
anticompetitively
though
law
allows
authority
acquire
hospitals
clearly
articulate
affirmatively
express
state
policy
empowering
authority
make
acquisitions
existing
hospitals
substantially
lessen
competition
pp
concluding
otherwise
eleventh
circuit
applied
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foreseeability
loosely
recognizing
legislature
expected
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entity
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approached
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without
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state
parker
thus
found
state
policy
displace
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antitrust
law
sufficiently
expressed
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result
exercise
authority
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state
legislature
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must
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consistent
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see
hallie
omni
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grants
entity
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power
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federal
antitrust
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exercising
powers
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ability
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clearly
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circuit
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respondents
case
falls
within
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used
hallie
omni
rejected
pp
respondents
additional
arguments
also
unpersuasive
contend
hospital
authorities
granted
unique
powers
responsibilities
fulfill
georgia
objective
providing
access
adequate
affordable
health
care
foreseeable
decide
best
way
serve
communities
acquire
existing
local
hospital
instead
incurring
additional
expense
regulatory
burden
expanding
constructing
facility
even
though
authorities
may
differ
private
corporations
offering
hospital
services
neither
law
provision
clearly
articulates
state
policy
allowing
authorities
exercise
general
corporate
powers
without
regard
anticompetitive
effects
respondents
also
contend
doubt
whether
test
satisfied
federal
courts
err
side
recognizing
immunity
avoid
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policy
choices
law
ambiguous
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suggestion
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ticor
title
pp
reversed
remanded
sotomayor
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opinion
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notice
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subject
formal
revision
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preliminary
print
reports
readers
requested
notify
reporter
decisions
washington
typographical
formal
errors
order
corrections
may
made
preliminary
print
goes
press
federal
trade
commission
petitioner
phoebe
putney
health
system
et
al
writ
certiorari
appeals
eleventh
circuit
february
justice
sotomayor
delivered
opinion
immunity
doctrine
local
governmental
entity
acts
pursuant
clearly
articulated
affirmatively
expressed
state
policy
displace
competition
exempt
scrutiny
federal
antitrust
laws
case
must
decide
whether
georgia
law
creates
public
entities
called
hospital
authorities
gives
entities
general
corporate
powers
including
power
acquire
hospitals
clearly
articulates
affirmatively
expresses
state
policy
permit
acquisitions
substantially
lessen
competition
georgia
grant
general
corporate
powers
hospital
authorities
include
permission
use
powers
anticompetitively
hold
test
satisfied
immunity
apply
state
georgia
amended
constitution
allow
political
subdivisions
provide
health
care
services
laws
state
concurrently
enacted
hospital
authorities
law
law
code
ann
et
seq
provide
mechanism
operation
maintenance
needed
health
care
facilities
several
counties
municipalities
th
state
purpose
constitutional
provision
statute
based
thereon
create
organization
carry
make
workable
duty
state
owed
indigent
sick
dejarnette
hospital
auth
albany
citations
omitted
amended
law
authorizes
county
municipality
certain
combinations
counties
municipalities
create
public
body
corporate
politic
called
hospital
authority
hospital
authorities
governed
boards
appointed
governing
body
county
municipality
area
operation
law
hospital
authority
exercise
public
essential
governmental
functions
delegated
powers
necessary
convenient
carry
effectuate
law
purposes
giving
content
general
delegation
law
enumerates
powers
conferred
upon
hospital
authorities
including
power
acquire
purchase
lease
otherwise
operate
projects
defined
include
hospitals
public
health
facilities
construct
reconstruct
improve
alter
repair
projects
lease
operation
others
project
provided
certain
conditions
satisfied
establish
rates
charges
services
use
facilities
authority
hospital
authorities
may
operate
construct
project
profit
accordingly
must
set
rates
cover
operating
expenses
create
reasonable
reserves
year
law
adopted
city
albany
dougherty
county
established
hospital
authority
county
authority
authority
promptly
acquired
phoebe
putney
memorial
hospital
memorial
operation
albany
since
authority
restructured
operations
forming
two
private
nonprofit
corporations
manage
memorial
phoebe
putney
health
system
pphs
subsidiary
phoebe
putney
memorial
hospital
ppmh
authority
leased
memorial
ppmh
per
year
years
lease
ppmh
exclusive
authority
operation
memorial
including
ability
set
rates
services
consistent
ppmh
subject
lease
conditions
require
provision
care
indigent
sick
limit
rate
return
memorial
one
two
hospitals
dougherty
county
second
palmyra
medical
center
palmyra
established
albany
located
two
miles
memorial
time
suit
brought
case
palmyra
operated
national
hospital
network
hca
hca
together
memorial
palmyra
account
percent
market
hospital
services
provided
commercial
health
care
plans
customers
six
counties
surrounding
albany
memorial
accounts
percent
market
pphs
began
discussions
hca
acquiring
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following
negotiations
pphs
presented
authority
plan
authority
purchase
palmyra
pphs
controlled
funds
lease
palmyra
pphs
subsidiary
per
year
memorial
lease
agreement
authority
unanimously
approved
transaction
federal
trade
commission
ftc
shortly
thereafter
issued
administrative
complaint
alleging
proposed
transaction
create
virtual
monopoly
substantially
reduce
competition
market
hospital
services
violation
federal
trade
commission
act
stat
clayton
act
stat
ftc
along
state
subsequently
filed
suit
authority
hca
palmyra
pphs
ppmh
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pphs
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manage
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collectively
respondents
seeking
enjoin
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pending
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proceedings
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district
middle
district
georgia
denied
request
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injunction
granted
respondents
motion
dismiss
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district
held
respondents
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appeals
eleventh
circuit
affirmed
initial
matter
agree
ftc
facts
alleged
joint
operation
memorial
palmyra
substantially
lessen
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tend
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create
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transaction
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liability
see
appeals
explained
local
governmental
entity
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georgia
legislation
according
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conduct
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legislature
necessary
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ordinarily
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routinely
occurs
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hospital
bd
directors
lee
applying
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law
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eminent
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specifically
reasoned
georgia
legislature
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grant
power
hospital
authorities
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projects
produce
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effects
oreseeably
acquisitions
consolidate
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hospitals
eliminating
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appeals
also
rejected
ftc
alternative
argument
immunity
apply
transaction
substance
involved
transfer
control
palmyra
one
private
entity
another
authority
acting
mere
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sale
evade
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liability
see
granted
certiorari
two
questions
whether
georgia
legislature
powers
vested
hospital
authorities
clearly
articulated
affirmatively
expressed
state
policy
displace
competition
market
hospital
services
whether
immunity
nonetheless
inapplicable
result
authority
minimal
participation
negotiating
terms
sale
palymra
authority
limited
supervision
two
hospitals
operations
see
concluding
answer
first
question
reverse
without
reaching
second
ii
parker
brown
held
nothing
language
sherman
act
et
seq
history
suggested
congress
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parker
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certain
circumstances
immunity
federal
antitrust
laws
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actors
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see
patrick
burget
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motor
carriers
rate
conference
given
fundamental
national
values
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time
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must
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displace
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authority
delegated
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legislature
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must
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implicitly
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goals
example
hallie
wisconsin
statutory
law
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provision
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services
expressly
permitted
cities
limit
service
surrounding
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see
unincorporated
towns
alleged
city
exercise
power
constituted
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tying
arrangement
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concluding
alleged
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effects
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state
clear
logically
result
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authority
described
wisconsin
state
legislature
annexation
city
surrounding
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reasonable
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require
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services
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hallie
chippewa
falls
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immunity
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antitrust
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undermined
arrangement
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option
state
clearly
intended
cities
similarly
omni
respondents
alleged
city
used
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power
protect
incumbent
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provider
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found
test
easily
satisfied
even
though
state
statutes
delegating
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authority
city
explicitly
permit
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purpose
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regulation
displace
unfettered
business
freedom
manner
regularly
effect
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normal
acts
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ordinance
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location
spacing
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protects
existing
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newcomers
cases
found
clear
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state
intent
displace
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explicit
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also
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authorizations
act
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inherently
contrast
simple
permission
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kay
elec
cooperative
newkirk
state
grants
entity
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power
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private
corporation
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entity
like
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antitrust
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see
ticor
title
course
private
parties
local
governmental
entities
conceivably
may
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requirements
exercising
general
powers
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ways
reasonable
legislature
ability
anticipate
potentially
undesirable
possibility
falls
well
short
clearly
articulating
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state
policy
displace
competition
regulatory
alternative
believing
case
falls
within
scope
foreseeability
standard
applied
hallie
omni
appeals
stated
defies
imagination
suppose
state
legislature
believed
every
geographic
market
georgia
replete
hospitals
authorizing
acquisitions
authorities
serious
anticompetitive
consequences
respondents
echo
argument
noting
georgia
counties
covers
small
geographical
area
sparsely
populated
nearly
fewer
residents
census
brief
respondents
even
accepting
arguendo
premise
facts
market
make
anticompetitive
use
general
corporate
powers
foreseeable
reject
appeals
respondents
conclusion
relatively
small
subset
conduct
permitted
matter
state
law
code
ann
potential
negatively
affect
competition
contrary
appeals
respondents
characterization
principally
concerned
hospital
authorities
ability
acquire
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hospitals
consolidate
operations
section
allows
authorities
acquire
projects
includes
hospitals
also
health
care
facilities
dormitories
office
buildings
clinics
housing
accommodations
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rehabilitation
centers
extended
care
facilities
public
health
facilities
narrowing
focus
market
hospital
services
power
acquire
hospitals
still
ordinarily
produce
anticompetitive
effects
section
source
power
newly
formed
hospital
authorities
acquire
hospital
first
instance
transaction
unlikely
raise
antitrust
concerns
even
small
markets
transfer
ownership
private
public
hands
increase
market
concentration
see
areeda
hovenkamp
ubstitution
one
monopolist
another
antitrust
violation
subsequent
acquisitions
authorities
potential
reduce
competition
raise
federal
antitrust
concerns
markets
large
enough
support
one
hospital
sufficiently
small
merger
competitors
lead
significant
increase
market
concentration
slender
reed
support
appeals
respondents
inference
iv
taking
somewhat
different
approach
appeals
respondents
insist
law
read
mere
authorization
hospital
authorities
participate
market
exercise
general
corporate
powers
rather
contend
hospital
authorities
granted
unique
powers
responsibilities
fulfill
state
objective
providing
residents
access
adequate
affordable
health
hospital
care
see
code
ann
respondents
argue
view
hospital
authorities
statutory
objective
specific
attributes
regulatory
context
operate
foreseeable
authorities
facing
capacity
constraints
decide
best
serve
communities
needs
acquiring
existing
local
hospital
rather
incur
additional
expense
regulatory
burden
expanding
facility
constructing
new
one
see
brief
respondents
support
argument
respondents
observe
hospital
authorities
simultaneously
empowered
act
ways
private
entities
also
subject
significant
regulatory
constraints
power
side
appeals
noted
hospital
authorities
may
acquire
eminent
domain
property
essential
authority
purposes
restraint
side
hospital
authorities
managed
publicly
accountable
board
must
operate
nonprofit
basis
may
lease
project
others
operate
determining
promote
community
public
health
needs
lessee
receive
reasonable
rate
return
investment
moreover
hospital
authorities
operate
within
broader
regulatory
context
georgia
requires
party
seeking
establish
significantly
expand
certain
medical
facilities
including
hospitals
obtain
certificate
need
state
regulators
see
et
doubt
georgia
hospital
authorities
differ
materially
private
corporations
offer
hospital
services
nothing
law
provision
georgia
law
clearly
articulates
state
policy
allow
authorities
exercise
general
corporate
powers
including
acquisition
power
without
regard
negative
effects
competition
state
legislature
objective
improving
access
affordable
health
care
logically
suggest
state
intended
hospital
authorities
pursue
end
mergers
create
monopolies
restrictions
imposed
hospital
authorities
including
requirement
operate
nonprofit
basis
reveal
policy
particularly
light
national
policy
favoring
competition
restrictions
read
reflect
modest
aims
legislature
may
viewed
profit
generation
incompatible
goal
providing
care
indigent
sick
addition
legislature
may
believed
hospital
authorities
operate
markets
characteristics
natural
monopolies
case
legislature
rely
competition
control
prices
see
cantor
detroit
edison
recognize
georgia
particularly
certificate
need
requirement
limit
competition
market
hospital
services
respects
regulation
industry
even
authorization
discrete
forms
anticompetitive
conduct
pursuant
regulatory
structure
establish
state
affirmatively
contemplated
forms
anticompetitive
conduct
tangentially
related
thus
goldfarb
virginia
state
bar
rejected
defense
claims
state
bar
adopted
compulsory
minimum
fee
schedule
although
state
heavily
regulated
practice
law
found
evidence
adopted
policy
displace
price
competition
among
lawyers
cantor
concluded
state
commission
regulation
rates
electricity
charged
public
utility
confer
immunity
claim
utility
free
distribution
light
bulbs
restrained
trade
market
case
fact
georgia
imposes
limits
entry
market
medical
services
apply
hospital
authorities
private
corporations
clearly
articulate
policy
favoring
consolidation
existing
hospitals
engaged
active
competition
accord
ftc
university
health
authority
eminent
domain
power
exercised
find
relevant
question
whether
state
authorized
hospital
authorities
consolidate
market
power
potentially
anticompetitive
acquisitions
existing
hospitals
finally
respondents
contend
extent
doubt
whether
test
satisfied
context
federal
courts
err
side
recognizing
immunity
avoid
improper
interference
state
policy
choices
see
brief
respondents
find
law
ambiguous
question
whether
clearly
articulates
policy
authorizing
anticompetitive
acquisitions
fundamentally
respondents
suggestion
inconsistent
principle
immunity
disfavored
ticor
title
parker
progeny
premised
understanding
respect
coordinate
role
government
counsels
reading
federal
antitrust
laws
restrict
sovereign
capacity
regulate
economies
provide
services
citizens
federalism
state
sovereignty
poorly
served
rule
construction
allow
essential
national
policies
embodied
antitrust
laws
displaced
state
delegations
authority
intended
achieve
limited
ends
amici
brief
filed
support
ftc
contends
loose
application
test
attach
significant
unintended
consequences
frequent
delegations
corporate
authority
local
bodies
effectively
requiring
disclaim
intent
displace
competition
avoid
inadvertently
authorizing
anticompetitive
conduct
brief
state
illinois
et
al
amici
curiae
see
also
surgical
care
center
hammond
hospital
serv
dist
en
banc
decline
set
trap
unwary
state
legislatures
hold
georgia
clearly
articulated
affirmatively
expressed
policy
allow
hospital
authorities
make
acquisitions
substantially
lessen
competition
judgment
appeals
reversed
case
remanded
proceedings
consistent
opinion
ordered
footnotes
georgia
join
notice
appeal
filed
ftc
longer
party
case
tension
appeals
decision
circuits
held
analogous
circumstances
substate
governmental
entities
exercising
general
corporate
powers
entitled
immunity
see
kay
elec
cooperative
newkirk
first
title
devaugh
surgical
care
center
hammond
hospital
serv
dist
en
banc
lancaster
community
hospital
antelope
valley
hospital
issuing
decision
appeals
dissolved
temporary
injunction
granted
pending
appeal
transaction
closed
case
moot
however
district
remand
enjoin
respondents
taking
actions
disturb
status
quo
impede
final
remedial
decree
see
knox
service
employees
slip
case
becomes
moot
impossible
grant
effectual
relief
whatever
prevailing
party
internal
quotation
marks
omitted
see
also
ftc
whole
foods
market
cadc
opinion
brown
rejecting
mootness
argument
similar
posture
amicus
curiae
contends
recognize
apply
market
participant
exception
immunity
georgia
hospital
authorities
engage
proprietary
activities
brief
national
federation
independent
business
see
also
columbia
omni
outdoor
advertising
leaving
open
possibility
market
participant
exception
argument
raised
parties
passed
lower
courts
consider
parcel
service
mitchell
eleventh
circuit
held
georgia
hospital
authorities
unique
entities
lie
somewhere
local
governing
body
city
county
corporation
qualify
instrumentality
agency
subdivision
georgia
purposes
state
action
immunity
crosby
hospital
auth
valdosta
lowndes
ftc
challenged
characterization
georgia
hospital
authorities
accordingly
operate
assumption
hospital
authorities
akin
political
subdivisions
compare
code
ann
authorizing
hospital
authorities
acquire
projects
enter
lease
agreements
outlining
general
powers
private
corporations
georgia
include
ability
acquire
lease
property
allowing
corporate
mergers
allowing
sales
corporate
assets
corporations
see
southern
motor
carriers
rate
conference
finding
state
commission
decision
encourage
collective
ratemaking
common
carriers
entitled
immunity
legislature
left
details
inherently
anticompetitive
process
agency
discretion
hallie
eau
claire
describing
new
motor
vehicle
bd
cal
orrin
fox
case
express
intent
displace
antitrust
laws
regulatory
structure
issue
restricting
establishment
relocation
automobile
dealerships
inherently
displaced
unfettered
business
freedom
internal
quotation
marks
brackets
omitted
appeals
also
invoked
code
ann
provides
hospital
authorities
power
assess
taxes
allows
applicable
governing
body
authority
area
operation
impose
taxes
cover
authority
expenses
see
provision
applies
cases
county
municipality
entered
contract
hospital
authority
use
facilities
see
contract
exists
case
respondents
relied
provision
briefing
argument
us
georgia
first
adopted
certificate
need
legislation
part
comply
federal
law
conditioning
federal
funding
number
health
care
programs
state
enactment
certificate
need
laws
see
laws
amended
code
ann
et
seq
see
also
national
health
planning
resources
development
act
stat
repealed
stat
many
also
certificate
need
laws
see
national
conference
state
legislatures
certificate
need
state
health
laws
programs
online
http
visited
available
clerk
case
file
indicating
con
programs
table
retained
type
certificate
need
program
december
programs
repealed