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FOR IMMEDIATE RELEASE: July 26, 2001

U.S. DISTRICT JUDGE ALLOWS TRIGON CASE TO MOVE FORWARD

Latest Ruling Gives Significant Boost to ACA/VCA Lawsuit

ARLINGTON, VA - A federal judge has ruled that the American Chiropractic Association (ACA)/Virginia Chiropractic Association (VCA) lawsuit against Trigon Blue Cross/Blue Shield - one of the largest health plans in the country - may move forward. In a momentous decision, Judge James P. Jones of the U.S. District Court in Abingdon, VA, allowed 6 of the 8 counts against the plan to remain in the case.

Judge Jones ruled that the claims against Trigon, if proven at trial, are sufficient to support a judgment. Jones made his ruling after extensive briefing by defendant Trigon and the lawyers representing the American Chiropractic Association (ACA), the Virginia Chiropractic Association (VCA), five doctors of chiropractic and 18 chiropractic patients.

The court's ruling opens the door to the discovery phase of the trial, which will include detailed examination of Trigon documents and the taking of sworn depositions of Trigon executives, policy makers, third-party physicians (including medical directors) and other third parties with whom they deal.

It is expected that Trigon will oppose the plaintiff's initiatives wherever possible, but as stated by ACA President James A. Mertz, DC, "We will pursue this action until its legitimate end on behalf of the doctors of chiropractic and their patients and until we achieve equity in health care insurance programs."

VCA President Greg Walter, DC, was also supportive. "We are proud that the VCA and VCA doctors have joined with the ACA to initiate this lawsuit. This is a very important case in the Commonwealth of Virginia that should have ramifications for doctors and patients they serve throughout the United States. We understand the road ahead will be difficult but we intend to stay the course."

Excerpts of critical statements from Judge Jones' opinion follow, and a matrix of the court order in the Trigon lawsuit is attached.

# # #

(George McAndrews' excerpts of critical

statements from Judge Jones' Opinion)

IN THE UNITED STATES DISTRICT COURT

FOR THE WESTERN DISTRICT OF VIRGINIA

ABINGDON DIVISION

AMERICAN CHIROPRACTIC )
ASSOCIATION, INC., ET AL., )
) Case No. 1:00CV00113
Plaintiffs, )
) OPINION AND ORDER
v. )
) By: James P. Jones
TRIGON HEALTHCARE, INC., ET AL., ) United States District Judge
)
Defendants. )

B. The Conspiracy Counts.

[H]owever, the plaintiffs correctly note that the doctrine of intra corporate immunity is excepted when an agent of the corporation has an "independent personal stake" in achieving the corporation's impermissible objectives. Such personal stake must be wholly separable from the more general and indirect corporate benefit. See Selman, 697 F. Supp. at 239.

On the face of the complaint, the plaintiffs have pleaded sufficient facts to satisfy the personal stake exception, namely, that the agents of Trigon, as competing physicians, had a direct interest in the market for healthcare services which was distinct and independent from their roles as agents of Trigon.

* * *

The plaintiffs have clearly alleged that the members of the PPC [Provider Policy Committee], in their roles as agents of Trigon and during corporate meetings on Trigon's behalf, conspired to injure doctors of chiropractic and their patients in the practice of chiropractic medicine. The allegations thus have been made with sufficiently specificity.

C. The Monopolization Count.

To prove attempted monopolization, the plaintiff must in turn show: (1) a specific intent to monopolize a relevant market; (2) predatory or anti competitive acts; and (3) a dangerous probability of successful monopolization. It is this last prong that Trigon argues cannot be proved based upon the plaintiffs' pleading since Trigon does not compete in the market for spinal manipulation.

The doctors that make up the PPC, however, are alleged to be in that market and thus, on the face of their complaint, the plaintiffs' claim is sufficient.

E. The Tortious Interference Count.
The requisite elements for a prima facie showing of a tortious interference with a contract that is terminable at will are: (1) the existence of a valid contractual relationship of business expectancy; (2) knowledge of the relationship or expectancy on the part of the interferor; (3) not only an intentional interference that caused the termination of the at-will contract, but also that the defendant employed improper methods; and (4) resultant damage to the party whose relationship or expectancy has been disrupted.

Assuming without deciding that Trigon's assertion that the contracts at issue were terminable at will is correct, I find that the plaintiffs have pleaded sufficient impermissible conduct to state a cause of action.

F. The Breach of Contract Count.
In the "Introduction" to the complaint, the plaintiffs assert that "doctors of chiropractic have received...unconscionably inadequate compensation." (Compl. p2.) Thus, under rule 8(a), Trigon was put on notice of the plaintiffs' unconscionability claim.

* Doctors of chiropractic and patients may recover for themselves only, not in a representative capacity.