B. LYNN WINMILL, Chief District Judge.
WHEREAS, the Court is entering this Order, with the parties' agreement, to fully achieve the Court's February 28, 2014, Judgment ("Judgment") enjoining St. Luke's acquisition of Saltzer and requiring St. Luke's to "divest itself of Saltzer's physicians and assets and take any further action needed to unwind the Acquisition."
WHEREAS, the Court finds it appropriate to appoint a Monitor to monitor the asset maintenance requirements of this Order pending the divestiture of the Saltzer Assets and Business.
WHEREAS, the Court finds it appropriate to appoint a Trustee to accomplish the divestiture of the Saltzer Assets and Business as provided herein, so that the Saltzer Assets and Business will be operated as a viable, independent medical practice that will restore competition in the market for adult primary care physician services sold to commercially insured patients in Nampa, Idaho.
WHEREAS, the Court retains the authority to oversee and approve all aspects of the implementation of this Order including, but not limited to, hearing any issues raised by the Plaintiffs or Defendants concerning the Monitor, the Trustee, the divestiture process, the asset maintenance, and retaining the ultimate authority to interpret the Judgment and approve the divestiture, in whatever form, as proposed by the Trustee.
WHEREAS, the purpose of the Judgment and this Order is to remedy the likely lessening of competition resulting from St. Luke's acquisition of Saltzer, as found by this Court, and to restore the competitive intensity of Saltzer as a viable, independent competitor in the market for adult primary care physician services sold to commercially insured patients in Nampa, Idaho.
WHEREAS, this Order shall be interpreted broadly so as to fully achieve the requirements and purpose of the Judgment.
THEREFORE, in light of the stipulation of the parties and the Court otherwise being advised in the premises, and in consideration of the Court's review, it is hereby ORDERED:
Until the divestiture is completed as required by the Judgment, and pursuant to this Order, and any further orders of the Court:
A. St. Luke's and Saltzer shall fully and completely maintain the economic viability and marketability of the Saltzer Assets and Business, and SIHP. Among other things, and without limitation, St. Luke's and Saltzer shall:
B. Defendants shall not take any actions that might risk the loss of competitive potential, viability or marketability of the Saltzer Assets and Business, or SIHP, and shall take all actions necessary or appropriate to prevent the destruction, removal, wasting, deterioration, or impairment of any of the assets, relationships or goodwill related to the Saltzer Assets and Business and SIHP. In particular, and without limitation, St. Luke's shall provide sufficient financial assistance to maintain the competitiveness and viability of Saltzer Assets and Business and SIHP as reasonably determined by the Monitor subject to approval by the Court.
C. St. Luke's, and Saltzer shall not:
4. Enter any contract that is exclusive or that otherwise irrevocably would bind any Saltzer Asset or Business beyond the time when the divestiture occurs, except with the approval of the Monitor in consultation with the Government Plaintiffs; or
5. Take any action that might create a material change in the operations of any Saltzer Asset or Business, or of SIHP, except with the approval of the Monitor in consultation with the Government Plaintiffs.
PROVIDED, HOWEVER, that, subject to III.B.5. and III.B.6., nothing in this Order shall (i) require St. Luke's to terminate any Saltzer Physician Individual Contract, (ii) prohibit St. Luke's from extending any Saltzer Physician Individual Contract so long as St. Luke's or Saltzer give prior notice to the Monitor and Trustee of such extensions, or (iii) require St. Lukes' to terminate any Current Recruitment Agreement.
D. Except as otherwise limited by this Order, and under the review of the Monitor, until the divestiture approved by the Court is complete, Saltzer may operate as an independent medical group with control over the Saltzer Assets and Business, and St. Luke's shall maintain the economic viability and marketability of the Saltzer Assets and Business.
A. Pursuant to the agreement between St. Luke's and R. Shermer & Company, R. Shermer & Company, with Mr. Richard Shermer as primary contact, is appointed as the Asset Maintenance Monitor ("Monitor") to monitor the asset maintenance requirements of this Order.
B. Pursuant to the agreement between St. Luke's and Cain Brothers, Cain Brothers, with Mr. James Moloney as primary contact, is appointed as Divestiture Trustee ("Trustee") and to effectuate the divestiture, as promptly as reasonably possible, of the Saltzer Assets and Business and to make such other arrangements as appropriate, in compliance with the terms of this Order, to achieve the requirements and purpose of the Judgment and this Order.
C. The Monitor and the Trustee shall perform their duties according to the terms of this Order and under the day-to-day direction of the Government Plaintiffs, as provided herein and pursuant to the agreement entered between the Monitor and Trustee and St. Luke's. St. Luke's and Saltzer shall transfer and provide to the Monitor and the Trustee all rights and powers reasonably necessary or desirable to permit the Monitor and Trustee to effect the powers, duties, authority, and responsibilities enumerated herein.
D. The Monitor and the Trustee:
E. The Monitor's powers, duties, authority, and responsibilities shall include the following, without limitation:
F. The Trustee's powers, duties, authority, and responsibilities shall include the following, without limitation:
5. Among other things, the Trustee shall have the authority to:
6. The Trustee shall use commercially reasonable best efforts to negotiate the most favorable price and terms available in each divestiture contract that is submitted to the Court and to the Government Plaintiffs, subject to St. Luke's absolute and unconditional obligation to divest expeditiously and at no minimum price. PROVIDED, HOWEVER, that the Trustee's priority in identification and selection of a purchaser and negotiation of terms shall be on the most timely divestiture to the party most likely to maintain Saltzer as a viable, independent, competitive entity, and not on any particular price to be paid for the assets. Before the divestiture contract is signed by the Trustee and the potential Acquirer, and subject to Paragraph II.J. of the Order, the Trustee shall allow St. Luke's and Saltzer a five (5) day period to comment on such divestiture contract. Such comments shall not be considered a right to reject or veto the divestiture contract in whole or in part. The divestiture shall be made in the manner and to an Acquirer as required by this Order. After completion of the negotiated divestiture contract or contracts for the divestiture, or at any time that the Trustee deems appropriate, St. Luke's and Saltzer will be given a copy of the divestiture contract or contracts for information.
G. St. Luke's shall indemnify the Monitor and the Trustee and hold the Monitor and the Trustee harmless against any losses, claims, damages, liabilities, or expenses arising out of, or in connection with, any claim concerning or related to the performance of the Monitor's and the Trustee's duties (including any claim initiated by St. Luke's), including all reasonable fees of counsel and other expenses incurred in connection with the preparation for, or defense of, any claim, whether or not resulting in any liability except to the extent that such losses, claims, damages, liabilities, or expenses result from gross negligence, willful or wanton acts, or bad faith by the Monitor or the Trustee, as determined by the Court. For purposes of this Order, the terms "Monitor" and "Trustee" shall include all persons retained by the Monitor and the Trustee pursuant to this Order. St. Luke's may discharge, in whole or in part, the indemnification obligations of this paragraph for either the Monitor or Trustee, or both, through an insurance policy, so long as the Monitor or Trustee, respectively, and the Government Plaintiffs have agreed to the terms of such insurance policy as part of the agreements with the Monitor and Trustee in Paragraphs II.A. and II.B. of this Order. PROVIDED, HOWEVER, that any gaps in such insurance shall be covered by St. Luke's.
H. Saltzer shall indemnify the Monitor and the Trustee and hold the Monitor and the Trustee harmless against any losses, claims, damages, liability or expenses arising out of, or in connection with any claim brought by Saltzer, or by any Saltzer Physician, Saltzer Medical Professional, or Designated Employee concerning or related to the performance of the Monitor's or the Trustee's duties, whether or not resulting in any liability, except to the extent that such losses, claims, damages, liabilities or expense result from gross negligence, willful or wanton acts, or bad faith by the Monitor or the Trustee as determined by the Court. For purposes of this Order, the terms "Monitor" and "Trustee" shall include all persons retained by the Monitor and the Trustee pursuant to this Order. Saltzer may discharge, in whole or in part, the indemnification obligations of this paragraph for either the Monitor or Trustee, or both, through an insurance policy, so long as the Monitor or Trustee, respectively, and the Government Plaintiffs have agreed to the terms of such insurance policy as part of the agreements with the Monitor and Trustee in Paragraphs II.A. and II.B. of this Order. PROVIDED, HOWEVER, that any gaps in such insurance shall be covered by Saltzer.
I. If the Government Plaintiffs determine that either the Monitor or the Trustee has ceased to act or failed to act diligently, they may recommend that the Court appoint a substitute Monitor or Trustee, to be nominated by the Government Plaintiffs. PROVIDED, HOWEVER, that the Court, on its own motion, may make the determination that the Monitor or the Trustee has ceased to act or failed to act diligently. In selecting a substitute Monitor or Trustee the Government Plaintiffs shall consult with the Defendants. Defendants shall notify Government Plaintiffs in writing concerning any objections about the substitute Monitor's or Trustee's qualifications or potential conflicts of interest within five (5) days of notification by Government Plaintiffs of the proposed substitute Monitor or Trustee. PROVIDED, HOWEVER, the Defendants shall not have any right to approve or veto any selection by the Government Plaintiffs. The terms of the Order shall fully apply to such Monitor or Trustee, as appropriate. The Trustee shall be a person with experience and expertise in acquisitions and divestitures in the healthcare field. Within ten (10) days of appointment, St. Luke's shall enter an agreement with the substitute Monitor or substitute Trustee, subject to approval by the Government Plaintiffs in their sole discretion, that fully empowers the substitute Monitor or substitute Trustee to perform his or her duties pursuant to this Order.
J. St. Luke's, and Saltzer shall take no action to interfere with or impede the Trustee's accomplishment of the divestiture or with the Monitor monitoring the asset maintenance requirements. St. Luke's and Saltzer shall not (i) instruct or otherwise direct the Monitor or the Trustee concerning the performance of their duties under this Order, and under the Monitor's agreement and the Trustee's agreement with St. Luke's, or (ii) instruct, direct, discourage or otherwise attempt to influence the Saltzer Physicians, the Orthopedic Surgeons, and the Designated Employees in cooperating with the Monitor and the Trustee. PROVIDED, HOWEVER, Defendants may provide their views on any issue arising under this Order directly to the Monitor and the Trustee so long as they do not interfere with the Monitor's duties and the Trustee's efforts to divest. Any delays in divestiture caused by St. Luke's or Saltzer shall extend the time for divestiture in an amount equal to the delay, as determined by the Court. PROVIDED FURTHER, HOWEVER, that the Saltzer Physicians (without interference from St. Luke's and Saltzer) shall have the right to review and provide input to the Trustee regarding the specific provisions of any proposed agreement to divest the Saltzer Assets and Business relating to individual Physician's scope of service, work site, compensation, work and call schedule, and the term and termination of professional services, before such agreement is submitted to the Court; and the Saltzer Physicians may discuss issues, including any proposed agreement relating to these terms, among themselves and as a group (so long as St. Luke's and Saltzer do not interfere with or direct such discussions). If any individual Saltzer Physician decides not to enter any agreement regarding these terms that is to be submitted to the Court as part of any proposed divestiture, such Physician may exercise such rights as the Physician has under any contractual arrangement that Physician has with Saltzer.
K. The Court may, on its own initiative or at the request of any Party or the Monitor or the Trustee, issue such additional orders or directions as may be necessary or appropriate to accomplish the required divestiture and to assure Defendants' compliance with the obligations of the Judgment and of this Order. PROVIDED, HOWEVER, that nothing in this Order prohibits Defendants from seeking additional interpretations, or directions from the Court relating to the Monitor, the Trustee, the Monitor's or Trustee's actions or process, or any other issue related to this Order or any order of the Court in this matter. Moreover, all parties reserve the right to apply to the Court for an order modifying or amending the terms of this Order, either upon consent of the other Parties or upon a showing of good cause and other appropriate showing under the particular circumstances.
A. Within five (5) days of the date this Order is entered, St. Luke's shall send a communication, in the form of attached Exhibit A, to each Designated Employee, Orthopedic Surgeon, and Saltzer Physician notifying them that (i) St. Luke's and Saltzer will not take any action to restrict their discussions with and employment or affiliation by the Acquirer, (ii) St. Luke's and Saltzer will encourage them to remain with Saltzer pending any acquisition and will not change any employment or affiliation arrangement pending completion of the divestiture, and (iii) any previously mentioned plans toward transition to a primary care focused model are no longer in effect.
C. For a period of five (5) years following the divestiture, St. Luke's shall not, without the prior approval of the Government Plaintiffs, directly or indirectly employ or otherwise enter into any professional services agreement, or agreement involving an exclusive relationship, with any Saltzer Adult Primary Care Physician. PROVIDED, HOWEVER, that, if acceptable to the Acquirer, St. Luke's may continue (i) the Saltzer Physician Individual Contracts with Saltzer Adult Primary Care Physicians, (ii) the St. Luke's and Saltzer recruitment agreements, and (iii) the contract with a Saltzer Physician to practice at St. Luke's Ear, Nose, Throat facility in Eastern Oregon.
D. For a period of five (5) years following the divestiture, St. Luke's shall not, directly or indirectly, solicit, induce, or attempt to solicit or induce any Designated Employee who is employed by the Acquirer to terminate his or her employment relationship with the Acquirer, or any Physician who is employed or otherwise affiliated with the Acquirer to terminate his or her position or relationship with the Acquirer, unless that relationship has already been terminated by the Acquirer or the Physician. PROVIDED, HOWEVER, that this Paragraph III.D. shall not prohibit St. Luke's from advertising for employees or Physicians in newspapers, trade publications, or other media, including publicly accessible employment portals or websites, so long as these actions are not targeted specifically at any employee or Physician employed by the Acquirer. FURTHER PROVIDED, HOWEVER, that this Paragraph III.D. shall not prohibit St. Luke's from hiring or affiliating with Physicians (other than Saltzer Adult Primary Care Physicians) who seek relationships with St. Luke's, so long as St. Luke's did not solicit or induce (or otherwise attempt to solicit or induce) such Physician in violation of this paragraph.
For purposes of this Order, the following definitions shall apply:
A. "Government Plaintiffs" means Plaintiff Federal Trade Commission and Plaintiff State of Idaho.
B. "Saltzer" means Defendant Saltzer Medical Group, P.A., and any entities it controls, its directors, officers, employees, agents, representatives, successors, and assigns; and the joint ventures, subsidiaries, partnerships, divisions, groups, and affiliates in each case controlled by Saltzer Medical Group, P.A., and the respective directors, officers, employees, agents, representatives, successors, and assigns of each.
C. "St. Luke's" means Defendant St. Luke's Health System, Ltd., and any entities it controls, its directors, officers, employees, agents, representatives, successors, and assigns; and the joint ventures, subsidiaries, partnerships, divisions, groups, and affiliates in each case controlled by St. Luke's Health System, Ltd., and the respective directors, officers, employees, agents, representatives, successors, and assigns of each.
D. "Acquirer" means a Person who acquires the Saltzer Assets and Business or a Person who otherwise invests in or supports the Saltzer Assets and Business pursuant to this Order, or Saltzer if it acquires the Saltzer Assets and Business through a spin-off.
E. "Acquisition Date" means December 31, 2012, the date on which St. Luke's acquired Saltzer.
F. "Current Recruitment Agreement" means the six (6) recruitment agreements between Saltzer Physicians, Saltzer, and St. Luke's identified in the list attached as Exhibit B to this Order.
G. "Defendants" means St. Luke's and Saltzer.
H. "Designated Employees" means:
I. "Maintenance Services" means any services or assistance agreements provided by St. Luke's to Saltzer or SIHP, and any other services as requested by Saltzer or SIHP or any Acquirer and agreed to by the Trustee and Government Plaintiffs.
J. "Monitor" means the person appointed pursuant to Paragraph II. of this Order as the Asset Maintenance Monitor.
K. "Orthopedic Surgeons" refers to Kenneth Lindley, M.D., Jared Armstrong, M.D., and Jared Johnson, M.D. II.
L. "Payor" means any Person that purchases for, or otherwise pays for medical goods or services for themselves or for any other person, including, but not limited to: health insurance companies; preferred provider organizations; point of service organizations; prepaid hospital, medical, or other health service plans; health maintenance organizations; government health benefits programs; employers or other persons providing or administering self-insured health benefits programs; and patients who purchase medical goods or services for themselves.
M. "Person" means any natural person, partnership, corporation, association, trust, joint venture, government, government agency, or other business or legal entity.
N. "Physician" means a doctor of allopathic medicine ("M.D.") or a doctor of osteopathic medicine ("D.O.").
O. "Saltzer Adult Primary Care Physician" means a Saltzer Physician as described by the Court's finding #49 in its Finding of Fact who: (1) spends, or has spent during any three-month period since the Acquisition, more than 25% of their time providing any one of or a combination of internal medicine, family practice, or general practices for Saltzer in Nampa, Idaho; and (2) provides, or has provided during any three-month period since the Acquisition, these services to commercially insured patients aged 18 and over.
P. "Saltzer Assets and Business" means all physical, tangible, and intangible assets owned, leased, or operated by Saltzer, at the time of the Acquisition or at any time since, whether or not currently owned leased, or operated by Saltzer, St. Luke's, or SIHP including, but not limited to:
Q. "Saltzer Facilities" means any locations where Saltzer or SIHP provides or has provided medical services, including without limitation:
1. In Nampa, Idaho:
2. In Boise, Idaho:
3. In Meridian, Idaho: Portico and Hearing and Balance, located at 3277 E. Louise Dr., Suite 200, Meridian ID, 83642
4. In Caldwell, ID: Caldwell, 1818 S. 10th Avenue, Caldwell ID, 83605.
R. "Saltzer Medical Professional" means a physician assistant, nurse practitioner, nurse, occupational or health technician or therapist, lab technician, or other non-physician provider who was employed by Saltzer on the Acquisition Date, or has become affiliated with Saltzer and employed by St. Luke's, or was recruited by Saltzer, but hired by St. Luke's, since the Acquisition Date.
S. "Saltzer Physician" means a Physician who was affiliated with Saltzer at the time of the Acquisition Date, or who has become affiliated with Saltzer since the Acquisition Date, or who was recruited by Saltzer, but became affiliated with St. Luke's.
T. "Saltzer Physician Individual Contracts" means the following current contracts, identified in the list attached as Exhibit C to this Order, between individual Saltzer Physicians and St. Luke's:
1. Medical Director agreements for:
2. One (1) Physician contract to provide supervision of Advanced Practice Clinicians in Saltzer's Quick Care Clinics;
3. Four (4) Physician contracts to provide medical research services;
4. One (1) Physician contract to provide services as a medical review officer to review workplace drug testing results.
U. "SIHP" means Southern Idaho Health Partners, LLC, a wholly-owned subsidiary of St. Luke's, which holds some of the Saltzer Assets and Business. Southern Idaho Health Partners, LLC, may include assets from the Saltzer Assets and Business and from St. Luke's that are added after the date of this Order.
V. "Trustee" means the person appointed pursuant to Paragraph II. of this Order as the Divestiture Trustee.
This Court shall retain jurisdiction of this matter for all purposes and for five (5) years or the full duration of this Order, whichever comes later. SO ORDERED.
Date
Dear __________________,
I am writing to you, a valued employee, to share some information about how you will be affected by a recent court order in the St. Luke's antitrust litigation. This settlement order was approved by the Federal District Court on ____________and is intended to implement the Court's 2014 judgment that requires St. Luke's to divest Saltzer. It also requires St. Luke's to keep Saltzer as a viable operation until it is divested or spun-off as an independent competitor. Pursuant to the settlement order, we are notifying you as follows:
Although the divestiture process may be somewhat unsettling, we assure you that St. Luke's and Saltzer are committed to supporting all of your needs so that you can continue to provide our patients the excellent care they have come to expect.
If you desire a copy of the settlement order, have questions about the settlement order, or questions about any other issue relating to the divestiture process, please feel free to call or email me. You may also contact the Trustee, Mr. James Moloney, of Cain Brothers, at (415) 962-2961 or
CURRENT RECRUITMENT AGREEMENTS:
1. Recruitment Agreement by and between St. Luke's, Saltzer, and Megan Kasper, M.D., F.C.O.G. (October 1, 2015).
2. Recruitment Agreement by and between St. Luke's, Saltzer, and Joshua Lundberg, M.D. (October 1, 2015).
3. Recruitment Agreement by and between St. Luke's, Saltzer, and Laura Danis, D.O. (October 1, 2015).
4. Recruitment Agreement by and between St. Luke's, Saltzer, and Brian D. Affleck M.D. (August 30, 2013); First Amendment, (December 31, 2013); Second Amendment, (January 1, 2015).
5. Recruitment Agreement by and between St. Luke's, Saltzer, and Andrea Dimichele-Manes, M.D. (May 1, 2014).
6. Recruitment Agreement by and between St. Luke's, Saltzer, and Mari Ann Riley, M.D. (December 1, 2015).
SALTZER PHYSICIAN INDIVIDUAL CONTRACTS:
1. Medical Director Agreement by and between St. Luke's and Elaine Davidson, M.D. (September 1, 2013)(Medical Director for Ideal Protein Nutritional Program at Saltzer); First Amendment (September 1, 2014); Second Amendment (October 1, 2015).
2. Medical Director Agreement by and between St. Luke's and Stanley Stringam, M.D. (May 1, 2013)(Medical Director for the Anti-Coagulation Clinic).
3. Medical Director Agreement by and between St. Luke's and Harold Kunz, M.D. (April 18, 2015)(Medical Director for Quick Care at St. Luke's).
4. Administrative Services Agreement by and between St. Luke's and Jeff Hansen, M.D. (May 1, 2013)(Clinical Oversight and Supervision for the Physician Assistants and Nurse Practitioners in Saltzer's Quick Care Clinic).
5. Professional Services Agreement for Clinical Research by and between St. Luke's and Richard Aquilar, M.D. (January 1, 2013).
6. Professional Services Agreement for Clinical Research by and between St. Luke's and Kristyn Schelhaas, D.O. (October 1, 2013); First Amendment (October 1, 2015).
7. Professional Services Agreement for Clinical Research by and between St. Luke's and Stanley O. Stringam, M.D. (January 1, 2013); First Amendment (December 31, 2013); Second Amendment (January 1, 2015).
8. Professional Services Agreement for Clinical Research by and between St. Luke's and Elaine M. Davidson, M.D. (September 1, 2014); First Amendment (September 29, 2015).
9. Limited Professional Services Agreement by and between St. Luke's and Howard Shoemaker (October 1, 2014)(A Back-up Medical Review Officer for Occupational Health Services and St. Luke's Employee Health and Wellness Officer); First Amendment (July 1, 2015).