Owners of a healthcare system in western North Carolina couldn't prevail in an early summary judgment attempt to avoid antitrust claims, after a North Carolina Business Court judge said the complexity of the request at hand precludes a "piecemeal" ruling.

Judge Mark A. Davis denied HCA Healthcare Inc., ANC Healthcare Inc. and Mission Hospital Inc.'s motion for summary judgment without prejudice, reasoning that an early ruling would not promote judicial economy in the 4-year-old case. Dueling filings over the motion, which included the contested admission of expert testimony, have added complexity to the request, according to his Monday order.

Instead, Judge Davis found it preferable to wait for a more complete factual record, and for dispositive motions that will include both parties' fully fleshed-out grounds for summary judgment. He said his initial sense that an early ruling on matters of law would promote efficiency changed after both sides submitted filings that exceeded the issue at hand, related to contracts with commercial insurers.

Combined, the parties submitted 300 exhibits, including 25 deposition transcript excerpts and multiple communications between key witnesses, according to the order.

The plaintiffs are a proposed class of western North Carolina citizens who claim they've had to pay higher premiums for health insurance since HCA acquired the formerly nonprofit Mission Health hospital system from ANC in 2019. Mission Health's flagship property is Mission Hospital-Asheville in the mountains of North Carolina.

Since the residents filed a second amended complaint in July 2023, the parties have been in fact discovery, according to the order. However, HCA and ANC asked the court to permit a preliminary motion for summary judgment before discovery closed. The court granted it, initially believing that an early motion might promote efficiency by allowing the court to rule on a matter of law, Judge Davis said.

The narrow issue at hand is if the residents' claims can survive when challenged contractual provisions — such as "tying" provisions, gag clauses or anti-steering provisions — aren't present in the defendants' managed care contracts with commercial health insurers, according to the order. The residents alleged that Mission Health coerced health insurers into contracts with these provisions in order to expand its monopoly.

In opposing HCA and ANC's summary judgment motion, the residents also filed two expert witness affidavits. HCA quickly asked to depose the witnesses and then exclude their testimony, arguing that designating them as expert witnesses was premature. The companies contended that their contract interpretation issues were purely a matter of law that did not need expert analysis, according to the order.

The residents disagreed, arguing that the court needs expert analysis to analyze the motion, particularly in how the contractual provisions affect relevant markets.

The residents first sued in 2021, alleging not only that ANC had run the Mission Health system as a monopoly before the 2019 sale, but also that competition continued to be stifled afterward, resulting in even higher premiums. The suit was trimmed in late 2022. The proposed class then avoided a dismissal request less than six months later, after Judge Davis ruled HCA and ANC must face the monopoly claims.

Several North Carolina cities and counties also sued in federal court over a similar grievance — that HCA drove up the price of health insurance to public employees — which settled in August.

Judge Davis also denied a motion to adjust the case schedule, saying the schedule contained in his February order remains intact.

Counsel for the parties did not respond Tuesday to requests for comment.

The proposed class is represented by Jamie Crooks of Fairmark Partners LLP, and Mona Lisa Wallace, John Hughes and Olivia B. Smith of Wallace & Graham PA.

HCA is represented by Abram J. Ellis, Sara Razi and Rachel S. Sparks Bradley of Simpson Thacher & Bartlett LLP, and Phillip T. Jackson, Ann-Patton Hornthal, John Noor, David Hawisher and Bryant G. Cross of Roberts & Stevens PA.

ANC is represented by Dana C. Lumsden of Seyfarth Shaw LLP, Kenneth M. Vorrasi, Jonathan H. Todt, Alison M. Agnew, Paul H. Saint-Antoine and John S. Yi of Faegre Drinker Biddle & Reath LLP.

The case is Davis v. HCA Healthcare Inc., case number 2021CVS3276, in the North Carolina Business Court.