Wilk v. American Medical Association

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.

Prior to the trial cases
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 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." Also, up until 1974, the AMA had a Committee on quackery that openly challenged what it considered to be many unscientific forms of healing. Wilk has said this committee was established specifically to undermine chiropractic.

The first trial
In 1976, Chester Wilk and three other chiropractors sued the AMA, several nationwide healthcare associations, and several physicians for violations of sections 1 and 2 of the Sherman Antitrust Act. 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).

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 suddenly dropped their demand for damages and sought only an injunction. Therefore, the resulting trial in May and June of 1987 was a bench trial 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 trade "to contain and eliminate the chiropractic profession." (Wilk v. American Medical Ass'n, 671 F. Supp. 1465, N.D. Ill. 1987). She 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 Council 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:

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). The AMA petitioned the U.S. Supreme Court three times, but each time the Court denied certiorari (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.