Date: 08-05-2014

Case Style: Lenox MacLaren Surgical Corporation v. Medtronic, Inc., et al.

Case Number: 13-1307

Judge: Bacharach

Court: United States Court of Appeals for the Tenth Circuit on appeal from the District of Colorado (Denver County)

Plaintiff's Attorney: Henk Brands, Washington, DC (G. Stephen Long and Nicole A. Westbrook, Jones
& Keller, Denver, CO, on the briefs), for Plaintiff-Appellant.

Defendant's Attorney: Pratik Shah (Z.W. Julius Chen and C. Fairley Spillman, Washington, DC; Michael
Simons and David C. Lawrence, Austin, TX, on the briefs), Akin Gump Strauss
Hauer & Feld LLP, for Defendants-Appellees.

Description: Lenox MacLaren Surgical Corporation manufactures bone mills, which are
medical devices used in spinal-fusion surgery. In 2000, Lenox began to sell some
of its bone mills through a Medtronic entity, Medtronic Sofamor Danek USA.
The arrangement ended badly: Medtronic Sofamor Danek USA initiated a recall
of Lenox’s bone mills, and another Medtronic entity began to manufacture and
sell its own bone mill. The result, according to Lenox, was that four Medtronic
entities acquired an unfair competitive advantage; thus, Lenox sued these entities1
for monopolization and attempted monopolization from 2007 to 2010. See 15
U.S.C. § 2 (2012). The district court granted the defendants’ motion for summary
judgment on both claims.
Lenox appeals, and we must address five issues:
! Res Judicata. The first issue is one that was not raised in
Medtronic’s summary judgment motion. But on appeal, Medtronic
argues that even if the district court erred on the merits, res judicata
would foreclose the monopolization and attempted monopolization
claims because Lenox could have raised them in an earlier
arbitration. But we will not entertain this argument. Res judicata
requires privity of the parties in the first and second suit, and this
element involves a disputed issue of fact. Because Medtronic did not
1 We collectively refer to the Medtronic entities sued in this case as
“Medtronic.”
2
raise summary judgment based on res judicata, Lenox had no reason
to present evidence disputing privity with the entity sued in the
arbitration. Thus, we decline to entertain Medtronic’s effort to
salvage the summary judgment ruling based on res judicata.
! Product Market. The second issue involves definition of the product
market, which is based on cross-elasticity of demand. If price
increases for one product would not affect demand for the other
product, the products would involve separate markets.
Lenox defines the product market as surgical bone mills. Medtronic
argues that the product market should include hand tools because
they (like bone mills) are used in spinal-fusion surgeries. Lenox
defends its definition of the product market based on evidence that
large price increases for a hand tool or bone mill would not affect
demand for the other item. We conclude that this issue involves a
fact-issue for the jury to resolve.
! Monopoly Power. With this conclusion, we must confront a third
question: Does a triable fact-issue exist regarding Medtronic’s
monopoly power from 2007 to 2010 in a market consisting solely of
bone mills? We conclude that a triable fact-issue exists.
Monopoly power involves two factors: market-share and barriers to
entry. Lenox presented evidence that: (1) Medtronic’s market share
was 97-98% in 2007 and decreased over the next three years, but
remained as high as 62% in 2010, and (2) new competitors faced
substantial barriers to entry, including the need to avoid infringing
existing patents, obtain significant capital in a market with relatively
small revenues, and overcome entrenched buyer preferences among
spinal surgeons. We conclude that Lenox’s evidence of market-share
and entry barriers creates a jury question on monopoly power.
! Exclusionary Conduct. The second and third issues lead to a fourth:
If Medtronic acquired monopoly power from 2007 to 2010, did it
acquire this power innocently or through exclusionary conduct? We
conclude that the fact-finder could reasonably infer exclusionary
conduct.
Lenox points to the recall, presenting evidence that it constituted a
ruse and that the various Medtronic entities contrived the alleged
3
defects because one of them was planning to manufacture its own
bone mill and wanted to eliminate competition by Lenox. This
evidence creates a jury issue on exclusionary conduct.
! Harm to Competition. The second, third, and fourth issues lead to a
fifth: harm to competition. Medtronic argues that Lenox has shown
injury only to itself, not to competition in the marketplace. Lenox
responds with evidence that the product recall served to concentrate
power between Medtronic and another firm (Stryker), which
inhibited competition by other smaller firms. This evidence creates a
jury question on harm to competition.
With these conclusions, we hold that genuine issues of material fact exist
regarding market definition, monopoly power, exclusionary conduct, and harm to
competition. Thus, we reverse the district court’s grant of summary judgment to
Medtronic on the claims involving monopolization and attempted monopolization.
I. Lenox’s Business
Because this appeal involves the grant of summary judgment to Medtronic,
we view the evidence in the light most favorable to Lenox. See Adler v. Wal-
Mart Stores, Inc., 144 F.3d 664, 670 (10th Cir. 1998).
Spinal-fusion surgery constitutes a form of orthopedic surgery in which two
adjacent vertebrae are fused with the help of small particles of bone. To obtain
these small bone particles, technicians traditionally used hand tools such as
scalpels, scissors, forceps, and rongeurs to grind bone during the surgery.
Lenox was one of the first manufacturers to design a tool specifically for
spinal-fusion surgery: the bone mill. Lenox’s bone mill uses a hand-cranked
4
design that helps ensure a more consistent output than one might get from hand
tools.
II. The Arbitration
Lenox claimed that Medtronic Sofamor Danek USA interfered with
prospective business relations. The claim was decided through a binding
arbitration. There a panel found that Medtronic Sofamor Danek USA had
insufficient proof to justify the recall and that the company had taken action to
clear the Lenox bone mill from the market. With these findings, the panel
awarded damages to Lenox.
III. Standard of Review
We engage in de novo review of the district court’s grant of summary
judgment. Sports Racing Servs., Inc. v. Sports Car Club of Am., Inc., 131 F.3d
874, 882 (10th Cir. 1997). Summary judgment is appropriate “if the movant
shows that there is no genuine dispute as to any material fact and the movant is
entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a). The party seeking
summary judgment must identify portions of the record that demonstrate the
absence of a genuine issue of material fact. Celotex Corp. v. Catrett, 477 U.S.
317, 323 (1986).
IV. Res Judicata
Medtronic moved for dismissal based on res judicata, arguing that Lenox
could have asserted its claims in the arbitration. The district court denied the
5
motion, and Medtronic did not renew the res judicata argument in its motion for
summary judgment.
On appeal, Medtronic argues that we can affirm the grant of summary
judgment based on the alternative ground of res judicata. But, Medtronic did not
seek summary judgment based on res judicata, and we decline to address the issue
in the first instance.2
In the absence of notice to the plaintiff, our cases ordinarily disfavor an
award of a summary judgment based on a ground omitted from the defendants’
summary judgment motion. See Evers v. Regents of the Univ. of Colo., 509 F.3d
1304, 1309-10 (10th Cir. 2007); Tavery v. United States, 32 F.3d 1423, 1427 n.5
(10th Cir. 1994). In oral argument, Medtronic tried to avoid this line of cases by
characterizing res judicata as a “purely legal argument.” Oral Arg. 17:19-20:22.
For the sake of argument, we can assume that res judicata generally
involves a purely legal argument. But we must consider the specifics of the issue
as it is invoked here.
Res judicata involves multiple elements, including identity or privity of the
parties in the two suits. Pelt v. Utah, 539 F.3d 1271, 1281 (10th Cir. 2008).
When the facts are undisputed, the application of res judicata involves a question
of law. King v. Union Oil of Cal., 117 F.3d 443, 445 (10th Cir. 1997). But
2 Lenox also argues that we cannot consider res judicata because Medtronic
did not file a cross-appeal. We need not address this argument.
6
Lenox contests privity, and this element involves a question of fact. See Pelt, 539
F.3d at 1280-81 (“[T]he issue of whether privity exists is a question of fact.”);
Lowell Staats Min. Co. v. Phila. Elec. Co., 878 F.2d 1271, 1276 (10th Cir. 1989)
(“The ‘determination of identity between litigants for the purpose of establishing
privity is a factual question.’” (quoting Astron Indus. Assocs. v. Chrysler Motors
Corp., 405 F.2d 958, 961 (5th Cir. 1968))). At a minimum, privity requires a
showing that the parties in the two actions are “‘really and substantially in
interest the same.’” Pelt, 539 F.3d at 1281 (quoting Lowell Staats Min. Co. v.
Phila. Elec. Co., 878 F.2d 1271, 1275 (10th Cir. 1989)).
This showing might have been made if Lenox had notice of a dispute
regarding privity. But because Medtronic did not raise res judicata in the
summary judgment motion, Lenox had no reason to present evidence disputing
privity. In these circumstances, we decline to decide the issue of res judicata in
the first instance. See Schramm v. Oakes, 352 F.2d 143, 150 (10th Cir. 1965) (per
curiam) (order on pet. for reh’g) (stating that application of res judicata should be
left to the district court to decide in the first instance); see also Hatch v. Boulder
Town Council, 471 F.3d 1142, 1151 (10th Cir. 2006) (leaving res judicata for the
district court to decide in the first instance).
V. The Merits of the Monopolization Claim
On the monopolization claim, Lenox had to prove three items:
(1) monopoly power in the relevant market; (2) willful acquisition or maintenance
7
of this power through exclusionary conduct; and (3) harm to competition.3 See
United States v. Grinnell Corp., 384 U.S. 563, 570-71 (1966) (monopoly power in
the relevant market and willful acquisition or maintenance of monopoly power);
City of Chanute, Kan. v. Williams Natural Gas Co., 955 F.2d 641, 654-55 (10th
Cir. 1992) (discussing exclusionary conduct in connection with the creation or
maintenance of monopoly power), overruled in part on other grounds,
Systemcare, Inc. v. Wang Labs. Corp., 117 F.3d 1137 (10th Cir. 1997) (en banc);
Four Corners Nephrology Assocs., P.C. v. Mercy Med. Ctr. of Durango, 582 F.3d
1216, 1225 (10th Cir. 2009) (harm to competition). The district court held that
Lenox had not created a triable issue of fact on: (1) the relevant product market,
(2) monopoly power, (3) willful acquisition of monopoly power through
exclusionary conduct, or (4) harm to competition. We disagree with these
conclusions.
3 The district court concluded that Lenox had failed to show antitrust injury.
Appellant’s App. (unsealed) at 195, 198. Attacking this conclusion, Lenox argues
that it could have incurred an antitrust injury even if competition had not been
lessened. Appellant’s Opening Br. at 63 (Oct. 2, 2013); see 15 U.S.C. § 15(a)
(2012) (authorizing recovery for persons injured in their “business or property by
reason of anything forbidden in the antitrust laws”). Responding, Medtronic
argues that harm to competition must be proven either as a part of antitrust
standing or as an element of the Sherman Act claims. Appellee’s Response Br. at
51 n.18 (Dec. 2, 2013). For the sake of argument, we may assume that Medtronic
is correct. Thus, for purposes of our opinion, we assume that Lenox had to prove
harm to competition either as a part of antitrust standing or as an element of the
Sherman Act.
8
A. Product Market Definition
In assessing the existence of monopoly power, we must begin by
identifying the relevant product market. SCFC ILC, Inc. v. Visa U.S.A., Inc., 36
F.3d 958, 966 (10th Cir. 1994). Lenox bears the burden on this issue. Campfield
v. State Farm Mut. Auto Ins. Co., 532 F.3d 1111, 1118 (10th Cir. 2008).
The outer bounds of the product market are defined by cross-elasticity of
demand, an economic measure of the substitutability of two products. See Brown
Shoe Co. v. United States, 370 U.S. 294, 325 (1962). This definition involves an
issue of fact. See Telecor Commc’ns, Inc. v. Sw. Bell Tel. Co., 305 F.3d 1124,
1131 (10th Cir. 2002) (“It is well settled that defining the relevant market is an
issue of fact.”).
The degree of substitutability turns on sensitivity of demand based on price
changes for the other item. David N. Hyman, Microeconomics 144 (4th ed.
1997). For example, if the demand for margarine increases 200% when the price
of butter increases 100%, the cross-elasticity of demand between margarine and
butter is 2. A high cross-elasticity of demand indicates that products are
substitutes; a low cross-elasticity of demand indicates that the products are not
substitutes and, as a result, do not compete in the same market. See United States
v. E. I. du Pont de Nemours & Co., 351 U.S. 377, 400 (1956). A relevant product
market excludes products with low or zero cross-elasticity of demand. See Times-
Picayune Publ’g Co. v. United States, 345 U.S. 594, 612 n.31 (1953).
9
Lenox defines the relevant product market as the surgical bone-mill market,
including both hand-cranked and electric-powered bone mills. This definition
excludes other tools used to mill bone, such as scalpels and surgical scissors.
Medtronic argues that this proposed market definition is too narrow and that the
relevant market consists of both bone mills and hand tools such as scalpels and
scissors.
The differing definitions create a fact question on the product market,
precluding summary judgment. For three reasons, a fact-finder could reasonably
conclude that the relevant product market includes bone mills but excludes hand
tools: (1) Lenox presented expert testimony that substantial price changes would
not lead surgeons to switch from bone mills to hand tools; (2) a substantial price
difference exists between hand tools and bone mills; and (3) Medtronic’s market
literature identifies its competition as other companies’ bone mills, not hand
tools.
First, Lenox presented expert testimony by a medical expert, Dr. Samuel J.
Chewning, Jr.:
! “Surgeons like myself would not select handtools over bone mills
even if the price of bone mills increased significantly above the
current level — say, even if the price of bone mills doubled.”4
4 Appellant’s App. (unsealed) at 165 ¶ 6.
10
! Surgeons do not view hand tools as reasonably interchangeable with
bone mills.5
! Using hand tools is time-consuming and generates inferior output;
thus, “no spinal surgeon who regularly practices in the field relies on
anything but a bone mill for use in spinal surgery.”6
From Dr. Chewning’s testimony, a fact-finder could reasonably infer a low or
zero cross-elasticity of demand between hand tools and bone mills. With this
inference, a fact-finder could reasonably conclude that the product market does
not include hand tools.
Medtronic downplays the reliability of Dr. Chewning’s testimony as
“anecdotal” extrapolations from his personal experience, citing Lantec, Inc. v.
Novell, Inc., 306 F.3d 1003 (10th Cir. 2002). Appellee’s Response Br. at 23
(Dec. 2, 2013). But the fact-finder could reasonably rely on Dr. Chewning’s
testimony.
Dr. Chewning testified that he had become “intimately familiar” with
medical devices to morselize bone, as well as the ways that bone mills are
marketed. Appellant’s App. (unsealed) at 97. From this testimony, the district
court could infer sufficient knowledge to qualify as an expert on purchasing
preferences among hospitals for medical devices used to morselize bone.
5 Appellant’s App. (unsealed) at 97-98 ¶ 4.
6 Appellant’s App. (unsealed) at 97-98 ¶ 4.
11
Medtronic’s reliance on Lantec, Inc. is misguided. There, we considered
whether the district court had abused its discretion in excluding expert testimony.
Lantec, Inc. v. Novell, Inc., 306 F.3d 1003, 1025 (10th Cir. 2002). Here,
however, the district court did not exclude Dr. Chewning’s opinion testimony or
question its admissibility. See Appellant’s App. (unsealed) at 191-92. Thus, we
are not limited by the abuse-of-discretion standard.
Instead, we view Dr. Chewning’s affidavit in the light most favorable to
Lenox as the party opposing summary judgment. When confronted with this
affidavit, Medtronic did not challenge its admissibility. See Appellant’s App.,
vol. 2 (sealed) at 630-31. In the absence of such a challenge, we assume the
affidavit was admissible for purposes of summary judgment. See McGarry v. Bd.
of Cnty. Comm’rs., 175 F.3d 1193, 1200 n.3 (10th Cir. 1999) (“[W]e assume that
Cumnock’s statements are evidence that would be admissible at trial, as required
by Fed. R. Civ. Pro. 56(c), because no objection to the statements’ inclusion in
McGarry’s Opposition to the Board’s summary judgment motion was raised.”);
Thrasher v. B & B Chem. Co., 2 F.3d 995, 998 (10th Cir. 1993) (holding that an
expert affidavit presented by the plaintiff would be considered on appeal of a
summary-judgment ruling because the defendant did not move to strike the
affidavit from “the summary judgment consideration”).
Second, Lenox presented evidence indicating a substantial difference
between the prices for hand tools and bone mills. For example, Dr. Chewning
12
testified that the cost of hand tools is effectively zero because hospitals already
have them for other procedures. Appellant’s App. (unsealed) at 164. In contrast,
bone mills cost thousands of dollars. See Appellant’s App., vol. 1 (sealed) at 251
(testimony that Medtronic’s price is $6250 for its bone mill and ten disposable
bowls), 258 (testimony that the average selling price is $7500 for a bone-mill
base), 266, 272, 274 (Medtronic stating that the prices were $1000 for a console
and $3000 for a base), 276 (Lenox sales data showing $4500-$6900 as the sales
price per bone mill); Medtronic’s Supplemental App. (unsealed) at 132 (showing
the suggested retail price of a Stryker bone mill as $8000); Medtronic’s
Supplemental App. (sealed) at 305 (stating that the average price paid to Lenox
for a bone mill was $5688).
Our court, like other courts, has held that a substantial price difference can
support an inference that the products belong in different markets. See Bd. of
Regents of the Univ. of Okla. v. NCAA, 707 F.2d 1147, 1158 (10th Cir. 1983)
(noting that a 2½ times differential in the price of advertising constitutes evidence
that NCCA football is a distinct market), aff’d, 468 U.S. 85, 111 (1984); accord
Geneva Pharms. Tech. Corp. v. Barr Labs. Inc., 386 F.3d 485, 497 (2d Cir. 2004)
(“Here we find a substantial gap in pricing indicative of separate markets.”); U.S.
Anchor Mfg., Inc. v. Rule Indus., Inc., 7 F.3d 986, 996 (11th Cir. 1993) (stating
that the fact that prices for one product were higher provides evidence “that a
distinct group of customers” would not “switch products “in response to price
13
increases above competitive levels”); Kaplan v. Burroughs Corp., 611 F.2d 286,
292 (9th Cir. 1979) (“[P]rice differential between competing products and
services is a relevant factor to consider, though price differential alone does not
govern the scope of the relevant market.”).
Medtronic cites one circuit opinion for the proposition that a substantial
price difference is not enough to create a jury question on the product market.
Appellee’s Response Br. at 26-27 (Dec. 2, 2013) (citing HDC Med., Inc. v.
Minntech Corp., 474 F.3d 543, 548-49 (8th Cir. 2007)). But, that decision did not
preclude consideration of a price differential as one factor among many bearing
on product definition; the court simply held that a price difference was
insufficient by itself to create a fact question on the product market. HDC Med.,
Inc. v. Minntech Corp., 474 F.3d 543, 548-49 (8th Cir. 2007). Indeed, the
Supreme Court has held that a substantial price difference, along with other
factors, can bear on definition of the product market. United States v. Aluminum
Co. of Am., 377 U.S. 271, 277 (1964).
Third, Lenox submitted Medtronic’s marketing literature, which identifies
two competing bone mills (but no hand tools) as the “Competition.” Appellant’s
App., vol. 2 (sealed) at 576-77.
Medtronic downplays this evidence, arguing that its marketing literature
also lists hand tools. That is true. Medtronic’s literature lists “manual
preparation” tools when discussing “[p]roblems with current methods.”
14
Appellant’s App., vol. 1 (sealed) at 290, 352, 358; Appellant’s App., vol. 2
(sealed) at 575, 578, 582. But, Medtronic’s literature does not refer to hand tools
as the “competition.” That description is used only for bone mills.
The fact-finder could consider Medtronic’s marketing literature as evidence
that large price increases might lead surgeons to switch to other bone mills, but
not to hand tools. See Spirit Airlines, Inc. v. Nw. Airlines, Inc., 431 F.3d 917,
933-34 (6th Cir. 2005) (relying in part on the defendant’s internal documents
regarding pricing to conclude that business and leisure travel constitute separate
markets for purposes of Section 2 of the Sherman Act).
For these three reasons, a fact-finder could reasonably conclude that crosselasticity
of demand of bone mills and hand tools is low or zero, meaning that the
products are not substitutes. Thus, a fact-finder could reasonably conclude that
the relevant product market consists of bone mills.7 On the other hand, a fact-
7 At oral argument, defense counsel stated that Medtronic had to lower its
prices when another powered bone mill entered the market, but not when manual
bone mills entered. Oral Arg. 24:46-26:41. Based on this statement, Medtronic’s
counsel argued that Lenox had improperly defined the market under its own
theory, as the Lenox hand-operated bone mill did not constrain the price of
electric bone mills. Id.
But Medtronic did not raise this argument in its motion for summary
judgment. Even in its appeal brief, Medtronic did not raise the argument.
Instead, Medtronic simply stated in a footnote that Lenox’s legal theory suggested
“that . . . powered bone mills constituted a distinct market,” separate from handcranked
bone mills. Appellee’s Resp. Br. at 25 n.6 (Dec. 2, 2013) (emphasis
omitted).
With only this passing mention in a footnote of Medtronic’s appeal brief
15
finder might conclude that the relevant product market consists of both hand tools
and bone mills, relying on evidence that both can be used to grind bone for spinal
surgery. Because both conclusions would be reasonable, the factual dispute on
the product market would preclude summary judgment on this issue.
B. Monopoly Power
Lenox must not only identify the product market, but also show monopoly
power in that market. United States v. Grinnell Corp. 384 U.S. 563, 570-71
(1966). The district court held that Lenox had failed to create a fact question on
monopoly power even under its proposed market definition. We disagree. A factfinder
could reasonably conclude that Medtronic had monopoly power in the
bone-mill market.
The parties agree that “monopoly power” involves two aspects: the power
to control prices and the power to exclude competition. The parties disagree,
however, about whether the plaintiff must establish one or both of these powers.
Compare Shoppin’ Bag of Pueblo v. Dillon Cos., 783 F.2d 159, 162-64 (10th Cir.
1986) (stating that both must be proven), with Four Corners Nephrology Assocs.,
and complete omission in its summary judgment brief filed in the district court,
we decline to consider Medtronic’s assertion in oral argument that powered mills
and hand-cranked mills constitute separate markets. See Gross v. Burggraf
Constr. Co., 53 F.3d 1531, 1547 (10th Cir. 1995) (declining to consider a matter
presented in oral argument when it was inadequately briefed); United States v.
Williamson, __ F.3d __, 2014 WL 998409, at 4 n.1 (10th Cir. Mar. 17, 2014)
(declining to consider an argument presented in oral argument because the Court
does not address arguments omitted or inadequately presented in an appellant’s
opening brief).
16
P.C. v. Mercy Med. Ctr. of Durango, 582 F.3d 1216, 1220 (10th Cir. 2009)
(“Monopoly power . . . consists of ‘the power to control prices or exclude
competition . . . .’” (quoting United States v. Grinnell Corp., 384 U.S. 563, 570-
71 (1966))). For the sake of argument, we can assume that both must be proven.
These powers can be proven through identification of “a relevant product
and geographic market,” with a showing that the defendant had a sufficient
market share and that new competitors would face significant barriers to entry.
Novell, Inc. v. Microsoft Corp., 731 F.3d 1064, 1071 (10th Cir. 2013), cert.
denied, 82 U.S.L.W. 3626 (U.S. Apr. 28, 2014) (No. 13-1042). Lenox has
presented sufficient evidence of market share and barriers to entry for a factfinder
to infer that Medtronic had monopoly power in the bone-mill market.
Though market-share percentages bear on the existence of monopoly
power, they are not ordinarily conclusive. See Reazin v. Blue Cross & Blue
Shield of Kan., Inc., 899 F.2d 951, 968 (10th Cir. 1990) (“We prefer the view that
market share percentages may give rise to presumptions, but will rarely
conclusively establish or eliminate market or monopoly power.”). When the
market-share percentages are viewed favorably to Lenox, they could support a
finding of monopoly power.
Lenox’s economic expert testified that in 2007, Medtronic had a 97-98%
share of the bone-mill market. Appellant’s App., vol. 1 (sealed) at 249. The
17
expert added that Medtronic’s market share had “dropped somewhat,” but had
remained “as high as 62 percent” as late as 2010. Id. at 250.
Medtronic questions these figures. For example, Medtronic argues that
“the undisputed evidence shows that Stryker had captured a third of the
disposable bone bill market revenue in the latter half of 2008 . . . .” Appellee’s
Response Br. at 30 (Dec. 2, 2013). For this characterization of evidence as
“undisputed,” Medtronic cites one page (Appellant’s App., vol. 1 (sealed) at 344),
which is from its own marketing documents. See Appellant’s App., vol. 1
(sealed) at 221-22. On this page, Medtronic states that its share of bone-mill
revenue was 100% throughout 2007 and the first half of 2008. Id. at 344. For the
third and fourth quarters of 2008, Medtronic refers to its share of market revenues
as 76.3% and 65%. Id. Other Medtronic literature refers to its market share as
73.6% for the year ending in the first quarter of 2009 and only a 26.4% market
share for Stryker during the same period. Appellant’s App., vol. 2 (sealed) at
460. Medtronic’s reliance on its own marketing literature is neither “undisputed”
nor inconsistent with a finding of monopoly power throughout 2007 and 2008.
In addition, Medtronic argues that its 2010 market share was overstated by
Lenox. Appellee’s Response Br. at 30 (Dec. 2, 2013). For this argument,
Medtronic relies on a page from its own summary judgment brief. Id. There,
Medtronic compares the number of disposable units it sold in 2010 by the sum of
disposable units sold in 2010 by both Medtronic and Stryker. Id.; see Appellant’s
18
App., vol. 1 (sealed) at 423. This reference shows Medtronic’s calculation of
market share,8 not Lenox’s.
A fact-finder could reasonably consider a 97-98% or 62% market share as
evidence of monopoly power. See Reazin v. Blue Cross & Blue Shield of Kan.,
Inc., 899 F.2d 951, 969-70 (10th Cir. 1990) (holding that evidence of monopoly
power was sufficient when the defendant had a market share between 47% and
62%); accord Arthur S. Langenderfer, Inc. v. S.E. Johnson Co., 917 F.2d 1413,
1443-44 (6th Cir. 1990) (holding that an average market share of 58% was
sufficient, along with other factors, to support a finding of monopoly power).
Medtronic not only presents evidence of a lower market share, but also
questions the durability of its alleged market dominance. Market power is
meaningful only if it is durable. See Reazin v. Blue Cross & Blue Shield of Kan.,
Inc., 899 F.2d at 968 (“[M]arket power, to be meaningful for antitrust purposes,
must be durable.”); see also IIB Phillip E. Areeda, Herbert Hovenkamp, & John
L. Solow, Antitrust Law ¶ 506d, at 128 (2d ed. 2002) (“The ability profitably to
charge a supracompetitive price indicates market power, but transitory power may
8 In its response brief, Medtronic refers to Lenox’s figure as 63.3% of market
revenues, but does not explain how it derived this figure from the chart that it
cited (at Appellant’s App., vol. 1 (sealed) at 423). This chart includes
Medtronic’s data regarding the number of disposable units sold by Medtronic and
Stryker. Id. From this chart, one could calculate Medtronic’s share of disposable
units sold (not revenue) at 58%, not 63.3%. But Lenox’s economic expert
calculated Medtronic’s market share in 2010 as 62% (not 63.3%) of revenues (not
units sold) for all bone-mill manufacturers. Appellant’s App., vol. 1 (sealed) at
250, 257.
19
safely be ignored by antitrust law.”). We conclude that durability involves a fact
question for the jury.
From Lenox’s evidence, a fact-finder could reasonably conclude that
Medtronic’s market domination was durable. Lenox’s evidence showed a fouryear
period in which Medtronic had 62% to 97-98% of the bone-mill market.
Viewing the evidence favorably to Lenox, a fact-finder could reasonably infer
that Medtronic’s market dominance was sufficient to impede competition between
2007 and 2010.
Though Medtronic’s market share could support a finding of monopoly
power, we must also consider barriers to entry, which are characteristics of the
market impeding new entries. See Reazin v. Blue Cross & Blue Shield of Kan.,
Inc., 899 F.2d at 967-68; Novell, Inc. v. Microsoft Corp., 731 F.3d 1064, 1071
(10th Cir. 2013), cert. denied, 82 U.S.L.W. 3626 (U.S. Apr. 28, 2014) (No. 13-
1042). On the issue of entry barriers, Lenox has created a genuine fact question
through expert testimony on economics and design of medical devices.
Lenox’s economic expert opined that significant barriers to entry had
existed in the bone-mill market, including: (1) the need to develop and research
the product, (2) comply with FDA rules, (3) develop a sales channel, and (4)
overcome existing relationships between market incumbents and large-scale
purchasers. Appellant’s App., vol. 1 (sealed) at 252.
20
Lenox also presented sworn testimony by a designer and engineer of
medical devices. Appellant’s App. (unsealed) at 172-74. This expert testified
about the significance of five barriers to new entry into the bone-mill market:
! the necessity of a design and development phase,
! the need to find a manufacturer offering sufficient reliability at
attractive prices,
! the need to make a name for oneself among influential surgeons,
! the need to build and supervise a distribution channel, and
! the need to overcome powerful bundling tactics employed by existing
competitors in the sale of medical devices.
Id.
From the testimony of Lenox’s experts on economics and design of medical
devices, a fact-finder could infer the existence of significant barriers to entry in
the bone-mill market. These barriers, combined with Medtronic’s market share of
62 to 97-98% (from 2007 to 2010), could lead a reasonable fact-finder to infer
monopoly power.
Medtronic argues that Lenox’s own entry into the bone-mill market shows
that entry was neither time-consuming nor costly. But we measure entry barriers
for new entrants, not incumbents. See Rebel Oil Co. v. Atl. Richfield Co., 51 F.3d
1421, 1439 (9th Cir. 1995). To measure the barriers for new entrants, we must
view the evidence in the light most favorable to Lenox. Viewing the evidence in
21
this manner, the fact-finder could infer significant barriers to entry for companies
wanting to compete in the bone-mill market.
One competitor, Stryker, broke through the entry barriers. The district
court viewed Stryker’s success as indisputable proof that barriers to entry were
insignificant. We disagree. A single competitor’s breakthrough does not
preclude a finding of significant barriers to entry. See Rebel Oil Co. v. Atl.
Richfield Co., 51 F.3d 1421, 1440 (9th Cir. 1995) (“The fact that entry has
occurred does not necessarily preclude the existence of ‘significant’ entry
barriers.”); IIB Phillip E. Areeda, Herbert HovenKamp, & John L. Solow,
Antitrust Law ¶ 422e, at 99 (3d ed. 2007) (“a single instance of entry over recent
years need not show low barriers”); see also Multistate Legal Studies, Inc. v.
Harcourt Brace Jovanovich Legal & Prof’l. Publ’ns, Inc., 63 F.3d 1540, 1555-56
(10th Cir. 1995) (holding that the plaintiff’s evidence of entry barriers, showing
that two of three attempted entries into the market were “largely unsuccessful,”
would preclude summary judgment to the defendant on a claim of attempted
monopolization).
From Lenox’s evidence, the fact-finder could regard Stryker as an atypical
competitor, for it enjoyed three attributes―an existing distribution network,
credibility among institutional buyers, and a vast supply of capital to invest in a
market generating limited revenues―that provided a competitive edge uniquely
suited to the bone-mill market.
22
When entering the bone-mill market, Stryker was already a major
manufacturer of medical devices. As a result, it had a ready-made distribution
network and an existing reputation among hospital purchasers. Appellant’s App.
(unsealed) at 173-74; Appellant’s App., vol. 1 (sealed) at 252. Both proved
beneficial because other competitors would have experienced difficulty in
overcoming entrenched buyer preferences and the absence of a reputation in the
industry. See Image Tech. Servs., Inc. v. Eastman Kodak Co., 125 F.3d 1195,
1208 (9th Cir. 1997) (stating that “entrenched buyer preferences” are common
entry barriers); Am. Council of Certified Podiatric Physicians & Surgeons v. Am.
Bd. of Podiatric Surgery, 185 F.3d 606, 623 (6th Cir. 1999) (“[E]stablishing
credibility naturally seems to be a significant barrier to entry, particularly for an
enterprise that depends heavily upon reputation, such as certification of medical
specialists.”).
The fact-finder could also infer that Stryker had ample financial resources
to take advantage of its existing distribution network and established credibility
among medical purchasers. With these resources, Stryker was able and willing to
spend roughly $1.5 million to develop its bone mill. Appellant’s App. (unsealed)
at 144. A fact-finder could view this investment as unique because the entire
bone-mill market produced only about $7-8 million in revenue. See Reazin v.
Blue Cross & Blue Shield of Kan., Inc., 899 F.2d 951, 968 (10th Cir. 1990)
(“Entry barriers may include high capital costs . . . .”); Appellant’s App., vol. 1
23
(sealed) at 344 (Medtronic literature showing 2008 revenues for 4 disposable
bone mills as $7,806,000).
Stryker’s entry into the bone-mill market would not preclude the jury from
finding significant barriers to entry in the bone-mill market. Notwithstanding
Stryker’s successful entry, a fact-finder could reasonably infer that Medtronic had
monopoly power in the bone-mill market from 2007 to 2010 based on its high
market share and the presence of barriers to entry. Thus, Medtronic is not
entitled to summary judgment on the issue of monopoly power.
C. Exclusionary Conduct
Lenox must show not only monopoly power, but also anticompetitive
conduct. Christy Sports, LLC v. Deer Valley Resort Co., Ltd., 555 F.3d 1188,
1192 (10th Cir. 2009). On the existence of anticompetitive conduct, the district
court held that Lenox had failed to create a fact question, reasoning that Lenox
demonstrated injury to itself but not to the competitive market. In articulating
this reasoning, the district court analyzed Medtronic’s conduct under a six-factor
test for trade disparagement. Medtronic urges us to do the same. But even if we
were to apply this test, Lenox has presented sufficient evidence for a fact-finder
to infer anticompetitive conduct.
1. Analysis Under the Test for Trade Disparagement
Lenox alleges that Medtronic engaged in anticompetitive conduct by: (1)
telling potential customers that the Lenox mill was dangerous, and (2) helping to
24
initiate a recall. The district court treated these allegations as involving trade
disparagement rather than general anticompetitive conduct.
Lenox contends that Medtronic’s conduct extended beyond trade
disparagement into a comprehensive scheme of exclusionary conduct. Thus,
Lenox urges us to apply the less stringent test, which does not presume a de
minimis effect on competition. We need not decide which test applies because
Lenox has demonstrated a fact question regarding anticompetitive conduct under
the more stringent trade-disparagement test.
This test presumes that trade disparagement bears only a de minimis effect
on competition. E.g., Nat’l Ass’n of Pharm. Mfrs., Inc. v. Ayerst Labs., 850 F.2d
904, 916 (2d Cir. 1988); Am. Council of Certified Podiatric Physicians &
Surgeons v. Am. Bd. of Podiatric Surgery, Inc., 323 F.3d 366, 371 (6th Cir. 2003).
A Section 2 plaintiff may rebut this presumption by satisfying a six-factor test,
showing that the disparagement was: (1) clearly false, (2) clearly material, (3)
clearly likely to induce reasonable reliance, (4) made to buyers without
knowledge of the subject matter, (5) continued for prolonged periods, and (6) not
readily susceptible to neutralization or other offset by rivals. E.g., Am. Prof’l
Testing Serv., Inc., 108 F.3d at 1152.
The district court held that Lenox could satisfy the first three factors, and
Medtronic supplies no reason to disturb that portion of the district court’s
25
conclusion. We also conclude that Lenox presented sufficient evidence for a
favorable finding on the last three factors.
Factor 4 requires Lenox to demonstrate that Medtronic made false
statements to buyers without knowledge of the subject matter. In analyzing this
factor, the district court noted that hospitals and hospital purchasing groups are
“sophisticated consumers.” Appellant’s App. (unsealed) at 197. But Lenox
presented evidence that even sophisticated consumers would rely on Medtronic’s
false statements. And Lenox’s medical expert opined that “hospitals are
extremely hesitant to acquire a product that has been the subject of a product
recall” when they have a choice among competing products. Id. at 99. From this
evidence, a fact-finder could reasonably infer that Medtronic made its
representations to hospital buyers who would not have known whether the bone
mills were dangerous.
Factor 5 requires Lenox to show that the materially false statements
continued for prolonged periods. To make this showing, Lenox’s president
submitted a declaration stating that “the Lenox bone mill remains on the FDA
website for recalled products and the hospitals find the taint of a prior
recall—regardless of its validity—to be too much of a liability risk to justify the
purchase and use of a Lenox bone mill.” Id. at 184. From this declaration, a factfinder
could reasonably conclude that Medtronic’s false statements affected
demand for a prolonged period.
26
Factor 6 requires Lenox to show that it could not readily neutralize the
disparaging statements. To make this showing, Lenox presented testimony from
its medical expert and company president. Both witnesses opined that because of
worries involving malpractice liability, hospitals are unwilling to purchase bone
mills that have been recalled. Id. at 99, 184. From this testimony, a fact-finder
could reasonably infer that Lenox could not have neutralized the effects of the
recall: Once the bone mill appeared on the FDA’s recall list, it became too risky
because of the threat of malpractice liability.
Lenox has presented sufficient evidence to create a question of material
fact on each prong of the trade-disparagement test.9 Thus, a fact-finder could
reasonably infer that Lenox rebutted the presumption of a de minimis impact on
competition.
2. Medtronic Sofamor Danek USA’s Role
Medtronic also challenges Lenox’s reliance on the recall, stating that it was
instigated by Medtronic Sofamor Danek USA and that this entity is not a party in
the present case. In earlier litigation, Lenox had sued Medtronic Sofamor Danek
USA for breach of contract. This entity sought to intervene in the present case,
but Lenox successfully objected. According to Medtronic, Lenox represented that
9 We need not determine whether a plaintiff must satisfy all six factors to
overcome the de minimis presumption. See Am. Council of Certified Podiatric
Physicians & Surgeons v. Am. Bd. of Podiatric Surgery, Inc., 323 F.3d 366, 371
(6th Cir. 2003) (declining to consider whether each factor must be met).
27
the prior litigation “was ‘utterly collateral’ to this case.” Appellant’s App.
(unsealed) at 188 (district court’s order).
Plaintiff’s counsel argued to the district court that: (1) in the antitrust case,
Lenox is focusing on exclusionary conduct by PS Medical, not Medtronic
Sofamor Danek USA, and (2) the prior litigation had involved “different facts,
claims, parties, and damages . . . .” Appellee’s Supplemental App. (unsealed) at
94, 156. Lenox’s present theory is consistent with the representations made to the
district judge.
Medtronic appears to assume that the present defendants—Medtronic, Inc.,
Medtronic Sofamor Danek, Inc., Medtronic PS Medical, Inc., and Medtronic
Sofamor Danek Co., Ltd.—had no role in the recall. But, Medtronic does not
expressly advance this argument, and we doubt that it could: On January 4, 2012,
the district court directed the parties to focus discovery on market share; then the
court prohibited further discovery in November 2012. Appellant’s App.
(unsealed) at 156; Mots. Hearing Tr. at 14-15 (Nov. 14, 2012). The district court
could not have required evidence regarding the role of the affiliated companies in
the recall when Medtronic lacked an opportunity to conduct discovery on the
issue. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 257 (1986).
Though Medtronic assumes that Medtronic Sofamor Danek USA is solely
responsible for the recall, the defendants do not defend the summary judgment
ruling on this ground and their roles were not subject to discovery. As a result,
28
Medtronic cannot salvage the summary judgment ruling based on its assumption
that none of the present defendants played a role in the recall.
3. Our Prior Opinion
Lenox represented to a prior panel that it was not alleging concerted action
between the four Medtronic defendants and Medtronic Sofamor Danek USA.
Appellee’s Br. at 25, Lenox MacLaren Surgical Corp. v. Medtronic, Inc., Case
No. 11-1251 (10th Cir. Aug. 3, 2011); see Oral Arg. 17:47-18:38. In oral
argument, the Medtronic defendants contended that this representation was fatal
because: (1) the prior panel had held that the present claims require proof of
cooperation between Medtronic Sofamor Danek USA and the four Medtronic
defendants, and (2) without Medtronic Sofamor Danek USA’s conduct, there
would be no evidence of coordination between MSD Japan and Medtronic PS
Medical. Oral Arg. 20:27-23:07. We disagree.
The Medtronic defendants err in characterizing the prior panel’s holding.
The prior panel simply held that Lenox did not need to arbitrate its claims for
monopolization and attempted monopolization. Lenox MacLaren Surgical Corp.
v. Medtronic, Inc., 449 F. App’x 704, 710-11 (10th Cir. 2011). For this holding,
the panel reasoned that the antitrust claims had not been founded in or intertwined
with the contract between Lenox and Medtronic Sofamor Danek USA. Id. at 710.
The antitrust claims were based on actions by the four Medtronic defendants, not
Medtronic Sofamor Danek USA: “What matters is whether the Medtronic
29
defendants used the recall as a way to clear the market of [Lenox’s] bone mill so
Medtronic PS Medical could substitute its own bone mill.” Id.
Focusing on the conduct of the four Medtronic defendants, the prior panel
did not say that the monopolization and attempted monopolization claims could
succeed only with proof of collusion with Medtronic Sofamor Danek USA.
Instead, the panel correctly pointed to the need to prove exclusionary conduct by
the entities being sued. Their conduct was either exclusionary or it was not. If
the conduct was exclusionary, there would be no need to prove complicity by
Medtronic Sofamor Danek USA. As a result, we reject the contentions by defense
counsel in oral argument.
D. Harm to Competition
The district court concluded that Lenox had not shown harm to
competition. Appellant’s App. (unsealed) at 195, 198. For this conclusion, the
district court relied on the availability of other bone mills. Id. at 196.
Notwithstanding evidence of other bone mills, a fact-finder could reasonably have
inferred harm to competition.
This inference was possible in part because Lenox presented evidence that
from 2007 to 2010: (1) Medtronic was able to charge supracompetitive prices,
and (2) other bone mills remained insubstantial. Lenox’s economic expert stated
under oath that by eliminating Lenox from the market, Medtronic raised the price
of spinal surgeries. Appellant’s App., vol. 1 (sealed) at 253-56.
30
Medtronic pointed to continued sales by Biomet and Tracer, two
competitors, but Lenox’s evidence indicated that these two companies had
accounted for only about 2% of the market in 2007. See id. at 340-41, 344, 413-
33; Appellant’s App., vol. 2 (sealed) at 447, 462.
Unlike Bryant and Tracer, Stryker did emerge as a significant competitor.
But the fact-finder could infer harm to competition from concentration of the
market in Medtronic and Stryker. See LePage’s Inc. v. 3M (Minn. Mining & Mfg.
Co.), 324 F.3d 141, 159 (3d Cir. 2003) (en banc) (stating that foreclosure of even
a single significant competitor can lead to higher prices and reduced output);
Conwood Co. v. U.S. Tobacco Co., 290 F.3d 768, 790 (6th Cir. 2002) (holding
that evidence of injury to competition was sufficient when the plaintiff presented
evidence that two of the three other manufacturers grew more slowly than they
otherwise would have).
VI. Claim of Attempted Monopolization
Lenox also claims attempted monopolization under § 2 of the Sherman Act.
This claim involves three elements:
! predatory or anticompetitive conduct,
! a specific intent to monopolize, and
! a dangerous probability of achieving monopoly power.
See Christy Sports, LLC v. Deer Valley Resort Co., 555 F.3d 1188, 1192 (10th
Cir. 2009). Each element could be decided favorably to Lenox.
31
We have elsewhere concluded that the fact-finder could reasonably infer
monopoly power and exclusionary conduct. With these inferences, the jury could
also find an intent to monopolize. See M & M Med. Supplies & Serv., Inc. v.
Pleasant Valley Hosp., Inc., 981 F.2d 160, 166 (4th Cir. 1992) (“Specific intent
may be inferred from the defendant’s anticompetitive practices.”); Gen. Indus.
Corp. v. Hartz Mountain Corp., 810 F.2d 795, 802 (8th Cir. 1987) (“Specific
intent need not be proven by direct evidence, but can be inferred from the
defendant’s anticompetitive practices or other proof of unlawful conduct.”); Volvo
North America Corp. v. Men’s Int’l. Prof’l. Tennis Council, 857 F.2d 55, 74 (2d
Cir. 1988) (stating that specific intent to monopolize can be inferred from proof
of “anticompetitive or exclusionary conduct”); Penn. Dental Ass’n v. Med. Serv.
Ass’n of Penn., 745 F.2d 248, 261 (3d Cir. 1984) (“Direct evidence of specific
intent . . . may be inferred from predatory or exclusionary conduct.”). Thus,
Lenox presented sufficient evidence to survive summary judgment not only on its
claim of actual monopolization, but also on its claim of attempted
monopolization. See E.I. du Pont de Nemours & Co. v. Kolon Indus., Inc., 637
F.3d 435, 453 (4th Cir. 2011) (“Given that we held above that [the plaintiff] pled
actual monopolization, we can reach no conclusion other than that [the plaintiff]
adequately pled a dangerous probability of success as to [the defendant’s]
attempted monopolization.”).

Outcome: Lenox has presented sufficient evidence to support a finding on each
element of its Section 2 claim for actual monopolization: monopoly power in the
relevant product market, exclusionary conduct, and harm to competition. Thus,
fact questions also exist on Lenox’s claim of attempted monopolization. These
disputes of material fact preclude summary judgment to Medtronic. In these
circumstances, we reverse the district court’s grant of summary judgment to
Medtronic and remand for further proceedings.

Plaintiff's Experts:

Defendant's Experts:

Comments: