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TO INVOKE the jurisdiction of a federal court over the subject matter of a lawsuit under the Sherman Antitrust Act, a plaintiff physician must demonstrate a logical connection between a denial of privileges and interstate commerce. Ordinarily, a defendant's anticompetitive conduct is subject to Sherman Act scrutiny if it has occurred "within the flow of commerce" or if it has "substantially affected interstate commerce." Hospital Building Co v Trustees of Rex Hospital, 425 US 738, 743 (1976). Since denials of privileges usually relate only to local markets for medical services rather than to interstate transactions, the first test rarely applies in hospital privilege controversies. The federal courts have adopted various approaches with respect to the nature and extent of impact that suffices to establish jurisdiction under the "effect on commerce" test, although a consensus position recently has begun to emerge.
Until recently, federal courts remained unconvinced that denials of privileges
Tabor WJ. Antitrust and Hospital Privileges: I. Federal Jurisdictional Requirements. JAMA. 1984;251(20):2654–2655. doi:10.1001/jama.1984.03340440014004
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