Washington County Health Care Authority, Inc. v. Baxter International Inc.

CourtDistrict Court, N.D. Illinois
DecidedJuly 5, 2018
Docket1:16-cv-10324
StatusUnknown

This text of Washington County Health Care Authority, Inc. v. Baxter International Inc. (Washington County Health Care Authority, Inc. v. Baxter International Inc.) is published on Counsel Stack Legal Research, covering District Court, N.D. Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Washington County Health Care Authority, Inc. v. Baxter International Inc., (N.D. Ill. 2018).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF ILLINOIS EASTERN DIVISION WASHINGTON COUNTY HEALTH ) CARE AUTHORITY, INC., CESAR ) CASTILLO, INC., WARREN ) GENERAL HOSPITAL, and ERIE ) COUNTY MEDICAL CENTER ) No. 16 CV 10324 CORPORATION, ) Judge John J. Tharp, Jr. ) Plaintiffs, ) ) v. ) ) BAXTER INTERNATIONAL INC., ) BAXTER HEALTHCARE ) CORPORATION, HOSPIRA, INC., and ) HOSPIRA WORLDWIDE, INC., ) ) Defendants. ) MEMORANDUM OPINION AND ORDER Salt water composes almost three-fourths of the planet, so some may be surprised to learn that the United States has a salt water shortage, of sorts. Specifically, for the last several years, the US has lacked sufficient quantities of intravenous saline solution, a medical product used to treat dehydration that consists of sodium chloride (or, as it is commonly known, salt) dissolved in water. The plaintiffs in this antitrust suit allege that the shortage was no accident; they assert that it was artificially manufactured by intravenous saline solution suppliers in an effort to increase prices. The complaint posits that the defendants, the two largest producers of intravenous saline products, violated Section 1 of the Sherman Act by colluding to increase prices by initiating a series of bogus voluntary recalls that depleted the saline inventories of health care facilities throughout the nation, precipitating a health care crisis. Defendants assert that this theory is implausible and move to dismiss the complaint. This Court agrees and grants the defendants’ motions without prejudice. BACKGROUND1 With over one billion units used in the United States each year, intravenous saline solution (“IV saline”) is among the most ubiquitous and essential products in emergency medicine. Consolidated Amended Complaint (“CAC”), ECF No. 35 at ¶¶ 4, 106. Consisting of various concentrations (0.9% being the most prevalent) of sodium chloride dissolved in water,

IV saline is used to prevent and treat dehydration and to dilute other intravenous medications. Id. ¶¶ 39-40. Hospitals, predictably, are the largest purchasers of IV saline. Defendants Baxter and Hospira are the biggest sellers, each with about 45% market share. Id. ¶ 43. One other seller, B. Braun Medical Inc., has the remaining 10%. Id. ¶ 96. In part because there are so few sellers, the Department of Justice and the Federal Trade Commission classify the IV saline market as highly concentrated. Id. ¶ 98. The IV saline market also has high barriers to entry, as a new manufacturer would have to build or develop manufacturing plants that meet strict FDA requirements. Id. ¶ 100. An FDA economist estimated that it would take three to five years and hundreds of millions of dollars to

open a new IV saline plant. Id. Moreover, because Baxter and Hospira are vertically integrated with respect to the production of IV saline (i.e., they acquired companies providing goods and performing services in the IV saline supply chain), it would be onerous for a competitor to gain the economies of scale necessary to compete. Id. ¶ 101. In November 2013, Baxter informed customers that there was an IV saline shortage, purportedly resulting from a harsher than expected flu season. Id. ¶ 44. No previous major flu outbreak, however, had resulted in an IV saline shortage, including the 2009-2010 swine flu

1 As this is a motion to dismiss, the Court accepts all well-pleaded facts as true and construes all inferences in favor of the plaintiff. Zemeckis v. Global Credit & Collection Corp., 679 F.3d 632, 634 (7th Cir. 2012). outbreak that hospitalized 274,000 people in the United States in addition to those hospitalized for the common flu. /d. Jj 126-128. Two months after Baxter’s letter, the Food and Drug Administration publicly acknowledged the shortage and gave new approval for certain foreign plants—including one owned by Baxter—to ship IV saline to the United States. Id. 4 46. The new imports, however, were unable to eliminate the shortage. /d. {| 47. Health care facilities, including those operated by the Veterans Health Administration, subsequently implemented policies designed to conserve IV saline supplies. Jd. §] 50-51. This included use of oral hydration whenever possible and flushing central venous access devices less frequently. Id. 4] 50. There is, however, no true substitute for IV saline, and the FDA has indicated that the IV saline shortage “poses a serious threat to patients.” Id. J] 49, 107-108. Concurrent with the shortage, Baxter and Hospira issued a number of voluntary recalls of IV saline, which are summarized in the following table:* No. of Bags: No. of Bags: Recall Date Baxter Hospira Reason for Recall 05/21/13 845,520 Leakage 06/06/13 676,872 Leakage 10/14/14 16,500,000 Punctures 12/08/14 542,080 Particulate Matter 12/22/14 30,840 Leakage 03/18/15 597,498 Missing closures/Leakage 04/07/15 128,050 Leakage 07/02/15 314,600 Leakage 07/17/15 322,720 Particulate Matter Total Recalls 2,307,818 17,650,362 19,958,180 Percentage 11.56% 88.44%

* The complaint (4 61) identifies the number of bags recalled for only four of the nine recalls. Nevertheless, the Court takes judicial notice of the number of units recalled during each recall, as such information is publicly available on the FDA’s recall database. See FOOD AND DRUG ADMINISTRATION, FDA RECALL INFORMATION SEARCH, https://www.accessdata.fda.gov/ scripts/ires/index.cfm.

The summary reflects that in May and June 2013, Baxter and Hospira both recalled hundreds of thousands of IV saline bags, citing a potential for leakage. Id. ¶ 61. Neither company, however, followed up with any recall of IV saline solution for more than 16 months. Then, in October 2014, Hospira recalled 16.5 million IV saline bags due to the potential for punctures; Baxter, however, did not announce another recall until December, when it recalled

half a million bags because particulate matter had been discovered floating inside a sealed bag of saline solution. Later that month, Hospira issued a small recall of about 31,000 bags due to leakage. Id. And finally, within three weeks of each other in both the spring and summer of 2015, Baxter and Hospira again issued voluntary recalls, due to leaks and the presence of particulate matter (specifically, Baxter recalled two lots of saline bags after a customer reported a free-floating insect in one of the bags).3 The complaint alleges that these recalls substantially reduced the supply of IV saline solution and resulted in a dramatic increase in IV saline prices. The complaint includes no allegations about the defendants’ production levels during this time period, but alleges that in the

fourth quarter of 2014 Baxter and Hospira’s collective recalls removed approximately 28.5% of IV saline bags from the U.S. market. Id. ¶ 62.4 The complaint further alleges that prices rose 36% 3 See FOOD AND DRUG ADMINISTRATION, FDA RECALL INFORMATION SEARCH, Recall Nos. D-1335-2015 and D-1336-2015, https:// www.accessdata.fda.gov/scripts/ires/index.cfm. 4 The complaint does not identify a source for this statistic, but it can be derived using the Q4 2014 recall numbers on the summary chart and the estimate of monthly IV saline use in the United States that the plaintiffs cite in paragraph 62 of the complaint: 20 million bags/month x 3 months = 60 million bags x 28.5% = 17.1 million bags, the amount recalled in Q4 2014. Elsewhere in the complaint, however, the plaintiffs allege that “[o]ver a billion units of IV Saline Solution are used in the United States every year.” AC ¶ 4. Using that estimate, the Q4 2014 recalls would amount to only 6.8% of the IV saline solution used in the United States over that period: 1 billion/year = 250 million/quarter; 17.1 million/250 million = 6.8%).

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Bluebook (online)
Washington County Health Care Authority, Inc. v. Baxter International Inc., Counsel Stack Legal Research, https://law.counselstack.com/opinion/washington-county-health-care-authority-inc-v-baxter-international-inc-ilnd-2018.