Full opinion text
ORDER JOHN ANTOON II, District Judge. This case arises from what Plaintiff, Raymond H. Pierson, III, characterizes as “a sham, malicious medical peer review.” (Am.Compl., Doc. 3, ¶ 1). Plaintiff is an orthopedic surgeon who formerly practiced in Orlando, Florida, and was on the trauma and emergency call schedules at two hospitals operated by Defendant Orlando Regional Healthcare System, Inc. (“ORHS”) — Orlando Regional Medical Center (“ORMC”) and Sand Lake Hospital (“Sand Lake”). In the 73-page, 325-paragraph Amended Complaint, Plaintiff recounts events occurring from 1996 to 2004 that culminated in the passage of a resolution by the ORHS Board indefinitely suspending his emergency and trauma call and consulting privileges. The nineteen-count Amended Complaint names twenty-six Defendants-ORHS, ORHS’s CEO, fifteen individual physicians, two physician groups, and seven governmental entities — and includes claims ranging from antitrust violations to breach of contract to allegations of unconstitutionality of federal and state statutory provisions. Now pending before the Court are the six motions to dismiss (Does. 107, 108, 109, 121, 131, & 142) filed by the Defendants. The Court heard argument on these motions on June 13, 2008 (see Mins., Doc. 150; Hr’g Tr., Doc. 155) and August 5, 2008 (see Mins., Doc. 167; Hr’g Tr., Doc. 199) and now issues the following rulings. I. Background The chain of events leading to the suspension of Plaintiffs privileges is described at great length in the Amended Complaint but can be more succinctly summarized as follows. In May 1996, Defendant Diebel, the Chief of Staff, received two letters — one from Defendant Bott and one from Defendant Csencsitz — expressing concerns over Plaintiffs surgical practices; the letters complained of Plaintiffs late night/early morning surgeries and the length of the surgeries. (Am.Compl^ 61). On May 21, 1996, an Investigation Committee (“IC”) comprised of Defendants Bone, Galceran, and Rivero was formed to conduct an in-house review. (Id. ¶ 64). The IC selected three doctors-Defendants Connolly, Bott, and Evans-to review cases that Plaintiff had conducted from January 1,1995 on. (Id. ¶ 65). On October 21, 1996, the IC met and “was presented with a summary of patients whose cases were performed by [Plaintiff] at ORMC and Sand Lake between January 1, 1995 and June 30, 1996.” (Id. ¶ 68). “[T]he IC was unable to determine whether it had a basis to ... suspend [Plaintiffs] trauma and emergency call privileges,” so it “asked for an outside review of the cases.” (Id. ¶ 72). “In the interim, the IC recommended that [Plaintiff] be summarily suspended and removed from the emergency and trauma call schedule ‘due to the increased number of trauma patients who have had an extended operating time.’ ” (Id. ¶ 73). During the five months (May to October) of this initial investigation, Plaintiff was not notified that there was concern about his surgical practices. (Id. ¶ 76). On November 25, 1996, Defendants Moser and Bott informed Plaintiff in a meeting that he was being investigated and that his trauma and emergency call privileges would be summarily suspended while the hospital conducted a peer review. (Id. ¶ 77). On December 3, 1996, Plaintiff received a letter from the President and CEO of ORHS, Defendant Hillenmeyer, informing him that he had been removed from the trauma and emergency call schedule and from consulting on trauma and emergency patients, pending completion of the investigation. (Id. ¶ 78). Pursuant to the ORHS Bylaws, Plaintiff immediately requested a hearing, but ORHS denied the request on the basis that the IC had not yet made a final report and recommendation. (Id. ¶ 81). The IC requested an outside review of Plaintiffs cases, and in December 1996 Defendant Moser retained Defendant Spiegel, who was not on the staff of ORMC or Sand Lake, to conduct that review. (Id. ¶ 83). On February 6, 1997, Defendant Spiegel submitted a 91-page report (“the Spiegel Report”), stating, inter alia, that Plaintiffs performance was not consistent and that the length of Plaintiffs procedures placed patients at increased risk. (Id. ¶¶ 87-88). The Spiegel Report also noted that Plaintiff performed all Emergency Room cases on an urgent or emergent basis. (Id. ¶ 89). Plaintiff was provided with a copy of the Spiegel Report and was invited to meet with the IC before the IC made its next report and recommendation to the Medical Executive Committee (“MEC”). (Id. ¶ 90; see also id. ¶ 105 (defining “MEC”)). Between July 1997 and January 1998, Plaintiff provided the IC with a response to the Spiegel Report, explaining his approach and technique. (Id. ¶ 91). On January 13, 1998, Plaintiff met with the IC to discuss his response. (Id. ¶ 92). After that meeting, the IC “requested a second, ‘unbiased’ review by an academic medical reviewer.” (Id. ¶ 93). Plaintiff asked to be permitted to assist in choosing the outside reviewer, but that request went unanswered. (Id. ¶ 94). Defendant Moser denied the IC’s request for a review by an academic reviewer and instead enlisted Defendant Spiegel to review the materials that Plaintiff had submitted to the IC. (Id. ¶¶ 95-96). On November 30, 1998, the four-volume “Spiegel Rebuttal” was provided to Plaintiff. (Id. ¶¶ 96, 98). In December 1998, Plaintiff met with Defendant Wolfram, and Wolfram told Plaintiff that Plaintiff had done nothing wrong in treating patients and that Wolfram “believed no patient suffered adversely” from Plaintiffs care. (Id. ¶ 100). Additionally, Wolfram “intimated that Defendant Csencsitz had expressed the opinion to the Credentials Committee that [Plaintiff] had done nothing wrong and was a good orthopedic surgeon.” (Id. ¶ 101). However, “Wolfram, who was in an authority position with ORHS[,] did nothing to call the peer review into question.” (Id. ¶ 102). On July 1, 1999, the IC made another report and recommendation to the Credentials Committee, recommending the continued suspension of Plaintiffs emergency and trauma call and consulting privileges and an ongoing mentoring and peer review. (Id. ¶¶ 103-04). The Credentials Committee seconded this recommendation in a report to the MEC, and on August 30, 1999, the MEC recommended exclusion of Plaintiff from trauma call and emergency department call and that peer review or mentoring of Plaintiff be conducted on an ongoing basis. (Id. ¶ 105). “In response to the MEC recommendation, [Plaintiff] renewed his request for a hearing under the Bylaws.” (Id. ¶ 108). The Hearing Panel commenced a hearing on April 23, 2003 and found that Plaintiff was slower than his peers but that his surgical time was not excessive and no harm to patients had been demonstrated. (Id. ¶¶ 109, 119). Additionally, the Hearing Panel found that Plaintiff had a different philosophy than the reviewers regarding the necessity of urgent surgical intervention for some types of injuries but that medical literature supported both views. (Id. ¶ 120). Further, the Hearing Panel expressed surprise that Plaintiff was not counseled or given an opportunity to correct perceived deficiencies before the IC was appointed. (Id. ¶ 122). The Hearing Panel recommended that Plaintiffs privileges be temporarily restored so that his practices could be reviewed by an experienced trauma surgeon. (Id. ¶ 123). Both Plaintiff and the MEC appealed the Hearing Panel’s recommendation. (Id. ¶ 124). On December 12, 2003, Plaintiff was notified that the Appeal Panel recommended that Plaintiff not be placed on emergency call until the MEC determined he was able to work within guidelines; that the MEC verify Plaintiffs surgical procedures during the prior twelve months; that Plaintiff not be placed on emergency or trauma call unless and until the MEC determined he had current clinical competency to handle emergency surgical procedures; and that Plaintiff perform non-emergent elective cases before attempting emergency or trauma cases as appropriate in the best interest of patient care. {Id. ¶ 125). On January 26, 2004, “the ORHS Board passed a resolution affirming the recommendation to indefinitely maintain a suspension of [Plaintiffs] emergency and trauma call and consulting privileges.” {Id. ¶ 126). Plaintiff received notice of the resolution on or after February 3, 2004. (Id. ¶ 128). Once the resolution was passed, ORHS filed a complaint with Defendant Florida Department of Health (“FDH”), which initiated an investigation of Plaintiffs medical license. {Id. ¶ 129). ORHS also filed an Adverse Action Report with Defendant National Practitioner Data Bank (“NPDB”), “a mandatory reporting and alert system for the comprehensive review of the professional credentials of physicians and other health care professionals in the United States” that was established as part of the Health Care Quality Improvement Act of 1986 (“HCQIA”), 42 U.S.C. § 11101 et seq. {Id. ¶¶ 130, 23). The report allegedly was false and misleading, but Plaintiffs request that ORHS correct the report was refused. {Id. ¶¶ 130-31). On January 25, 2008, Plaintiff filed this lawsuit in the Tampa Division of this court (Compl., Doe. 1). The initial Complaint — ■ 138 pages long and containing twenty-two counts — was dismissed without prejudice by the previously-assigned judge as a “shotgun pleading.” (Order, Doc. 2). Three days later, on February 1, 2008, Plaintiff filed his Amended Complaint (Doc. 3). The case was transferred to the Orlando division of the court in March 2008, {see Doc. 58), and was reassigned to the undersigned. Plaintiff alleges that as a result of the peer review and the reporting of its outcome to state and federal entities, he “is labeled incompetent and a ‘dangerous’ doctor for the rest of his career.” (Am. ComplV 1). He seeks damages and declaratory relief. The Amended Complaint contains nineteen counts: Combination and Conspiracy in Violation of Federal and State Law (Count I); Breach of Contract (Count II); “Judicial Review of Reasonableness and/or Fairness in Peer Review” (Count III); Defamation: Libel and Slander (Count IV); Intentional and Unjustifiable Interference with Existing Contractual Relations (Count V); Interference with Advantageous Business Relationship (Count VI); False Light (Count VII); Intentional Infliction of Emotional Distress (Count VIII); Negligent Hiring And Supervision (Count IX); Fraud (Count X); Application for Permanent Injunction (Count XI); Request for Declaratory Relief-Compliance with Bylaws, Rescission, and Expungement (Count XII); Request for Declaratory Relief-Denial of Immunity (Count XIII); Request for Declaratory Relief-Unconstitutionality of HCQIA and Florida Immunity Statutes (Due Process) (Count XIV); Request for Declaratory Relief-Unconstitutionality of HCQIA and Florida Immunity Statutes (Equal Protection) (Count XV); Request for Declaratory Relief-Unconstitutionality of HCQIA (Commerce Clause) (Count XVI); Request for Declaratory Relief-Unconstitutionality of HCQIA (Tenth Amendment and Federalism Principles) (Count XVII); Request for Declaratory Relief-Unconstitutionality of HCQIA (Delegation of Governmental Function) (Count XVIII); and Civil Conspiracy (Count XIX). Plaintiff is no longer pursuing Count XVI, having conceded in a memorandum “that the HCQIA is adequately supported under the commerce clause.” (Doc. 161 at 20). Additionally, the sufficiency of the pleading of Count II (Breach of Contract) and Count XIII (Declaratory Relief-Denial of Immunity) has not been challenged by any of the Defendants against whom those counts are brought. The sufficiency of the pleading of all of the other counts, however, has been challenged in one or more of the pending motions to dismiss (Docs. 107, 108, 109, 121, 131, & 142). II. Legal Standards “[W]hen ruling on a defendant’s motion to dismiss, a judge must accept as true all of the factual allegations contained in the complaint.” Erickson v. Pardus, 551 U.S. 89, 127 S.Ct. 2197, 2200, 167 L.Ed.2d 1081 (2007). Generally, “Federal Rule of Civil Procedure 8(a)(2) requires only ‘a short and plain statement of the claim showing that the pleader is entitled to relief.’ Specific facts are not necessary; the statement need only ‘give the defendant fair notice of what the ... claim is and the grounds upon which it rests.’ ” Id. (quoting Fed.R.Civ.P. 8(a)(2) and Bell Atl. Corp. v. Twombly, 550 U.S. 544, 127 S.Ct. 1955, 1964, 167 L.Ed.2d 929 (2007)). However, “[t]o survive dismissal, the complaint’s allegations must plausibly suggest that the plaintiff has a right to relief, raising that possibility above a speculative level; if they do not, the plaintiffs complaint should be dismissed.” James River Ins. Co. v. Ground Down Eng’g, Inc., 540 F.3d 1270, 1274 (11th Cir.2008) (internal quotation omitted). III. Discussion There are six motions to dismiss pending before the court, filed by subsets of the twenty-six Defendants. After addressing one overarching issue made by some of the Defendants, the claims in the Amended Complaint will be discussed on a count-by-count basis. A. “Group Pleading” of Allegations Against the “Peer Review Defendants” The individual Defendants and two physician groups — referred to by Plaintiff throughout the Amended Complaint as “the Peer Review Defendants” — complain that the Amended Complaint improperly groups them together and does not describe what action each of them allegedly took against Plaintiff. Although Plaintiff maintains that he has appropriately stated claims against these Defendants by referring to them as a group, the Court disagrees. The first, introductory, unnumbered paragraph of the Amended Complaint lists all of the Defendants by name. (Am. Compl. at 1). Each of paragraphs 4 through 19 then describes an individual Defendant separately, in most instances setting forth the residence and medical specialty of each. (Id. at 3-8). Paragraphs 20 and 21 describe Defendants Musculoskeletal Institute and Wolverine, respectively. (Id. ¶¶ 20-21). Musculoskeletal Institute, Chartered, d/b/a Florida Orthopedic Institute “(FOF) is alleged to be a Florida corporation that is vicariously liable for the actions of Defendant Spiegel, who allegedly acted as FOI’s agent. (Id. ¶ 20). Wolverine is described as a professional association that acted through Defendants Murbach and Appelblatt and which had an exclusive contract with Defendant ORHS to provide anesthesiology services at ORMC and Sand Lake. (Id. ¶ 21). All of these Defendants-the individual doctors and the two business entities with which some of them are associated-are then collectively referred to at Paragraph 37 as the “Peer Review Defendants”: 37. As pleaded herein, the actions of those Defendants who participated in and conducted the peer review at issue (Spiegel, Murbach, Appleblatt [sic], Bone, Bott, Csencsitz, Cole, Hillenmeyer, [] Moser, Diebel, Evans, Galceran, Rivero, Wolfram, Sanders, [Connolly], FOI and Wolverine, sometimes referred to herein collectively as the “Peer Review Defendants”), and ORHS’s conduct surrounding such actions, cause ORHS to be vicariously liable for such actions and the resulting damages. (Id. ¶ 37). The term “Peer Review Defendants” is then used throughout the Amended Complaint. Because of Plaintiffs extensive reliance on the term “Peer Review Defendants” without differentiation among individual Defendants, some of these Defendants are mentioned by name only two or three times in the entire Amended Complaint. For example, Defendant Appleblatt is mentioned only: in a descriptive paragraph (¶ 6) stating that he is an anesthesiologist who resides in Orlando and was a member of ORHS’s medical staff; in paragraph 50, which states that the treatment philosophy of Plaintiffs wife resulted in disputes with anesthesiologists including Appleblatt; and in paragraph 58, which alleges that Plaintiffs treatment approach was resisted by anesthesiologists including Appleblatt. Everywhere else in the Amended Complaint, Plaintiff relies on the label “Peer Review Defendants” in support of his claims against Appleblatt. The Amended Complaint in places breaks down the peer review process, but in others the reader is left to wonder about the identities of the parties involved. For instance, Plaintiff describes an Investigation Committee (“IC”)-made up of Defendants Bone, Galceran, and Rivero-that was formed to conduct an in-house focused review. (Id. ¶ 64). However, the Amended Complaint later refers to an “MEC” in paragraph 90-defined fifteen paragraphs later as “Medical Executive Committee,” (see id. ¶ 105) — without defining who the members of the MEC are; it is not clear whether some of the named Defendants served on this MEC or whether the MEC consisted of individuals whom Plaintiff has not sued. Also mentioned is a “Credentials Committee” (“CC”), (see, e.g., id. ¶¶ 103 & 105), but no description of who served on this committee is given, even though Plaintiff alleges that “the IC, CC and MEC maliciously disregarded [medical] literature,” (id. ¶ 107). As with the MEC, it is far from clear whether the CC is made up of some of the named Defendants or if there are other parties who allegedly acted maliciously but have not been sued. Continuing this theme, a “Hearing Panel” and its “Presiding Officer” are mentioned, (see, e.g., id. ¶¶ 109-13), but the membership of this panel and the identity of this Presiding Officer are not given. Again, the Court cannot tell whether any of the named individual Defendants were allegedly on the Hearing Panel or served as its Presiding Officer; absent such clarification, the allegations regarding this entity and person are impossible to put into context. An “Appeal Panel” and the ORHS Board are also mentioned, but their membership is undefined as well. (See, e.g., id. ¶¶ 125-26). “Although [Rule 8] does not demand that a complaint be a model of clarity or exhaustively present the facts alleged, it requires, at a minimum, that a complaint give each defendant ‘fair notice of what the plaintiffs claim is and the ground upon which it rests.’ ” Atuahene v. City of Hartford, 10 Fed.Appx. 33, 34 (2d Cir.2001) (quoting Ferro v. Ry. Express Agency, 296 F.2d 847, 851 (2d Cir.1961)). In Atuahene, the court held that “[b]y lumping all the defendants together in each claim and providing no factual basis to distinguish their conduct, [the plaintiffs] complaint failed to satisfy this minimum standard.” Id. The Amended Complaint in the instant case suffers from these same flaws. The grouping of Defendants as “Peer Review Defendants” does not afford these Defendants fair notice of the basis for the claims against them, especially considering that as to some of these Defendants, no role in the peer review process is even generally described. Although Plaintiff asserts that the Amended Complaint “alleges facts as to each Movant’s role in the peer review process,” (Doc. 138 at 4 n. 4); “alleges the role each Movant played in the peer review at issue,” (id. at 5); and “alleges facts showing how each Movant’s role was instrumental and intertwined in the alleged conspiracy to abuse peer review,” (id.), the Amended Complaint absolutely does not do this. As to most of the Peer Review Defendants, no role is described at all beyond the bare labeling as a “Peer Review Defendant.” Because of the grouping together of these Defendants without differentiation or some sort of description of actions that could provide “fair notice” of the basis for the claims against them, the claims against the “Peer Review Defendants” are not sufficiently pled. Any claim that is brought against these Defendants that otherwise survives the rulings in this Order must be repled. The Court now turns to analysis of the motions to dismiss on a count-by-count basis. B. Sufficiency of the Pleading of Each Challenged Count 1. Count I (Antitrust) In Count I, which is brought against ORHS and the Peer Review Defendants, Plaintiff alleges “Combination and Conspiracy in Violation of Federal and State Law in Market for Orthopedic Services and in Market for Healthcare Services.” Plaintiff contends that these Defendants violated the Sherman Act, 15 U.S.C. § 1, and the Florida Antitrust Act of 1980, Section 542.15, Florida Statutes, et seq., “by engaging in an unlawful combination and conspiracy to (1) blacklist and boycott [Plaintiff] and to exclude him from practicing medicine at ORHS facilities” and “(2) intentionally destroy and derail [Plaintiffs] development of The Physician Patient Alliance.™” (Am.Compl.f 161). Later in this same count, Plaintiff alleges that these Defendants “conspired with one another to monopolize or attempt to monopolize the orthopedic services in the relevant market in Central Florida in violation of 15 [U.S.C.] §§ 1 and 2 and/or Florida Antitrust Act of 1980.” (Am.Compl. 176). This count is not sufficiently pled. As an initial matter, Plaintiff seems to be attempting to allege two separate violations of the Sherman Act in one count. Although Federal Rule of Civil Procedure 8(d)(2) allows for alternative statements of a claim “either in a single count or ... in separate ones,” Rule 8(d)(1) requires that “[e]aeh allegation must be simple, concise, and direct.” Here, Plaintiff refers to both § 1 and § 2 of the Antitrust Act in Count I, but these sections proscribe very different conduct, and the combination of references to both sections renders this count confusingly pled. This claim is confusing both for the Court and for the Defendants and does not give fair notice to the Defendants of that against which they must defend. For this reason alone^ — even without reaching the substantial arguments raised by Defendants in support of dismissal of Count I — this claim would have to be repled. However, as set forth below, no repleading will be necessary or permitted because whether brought under section 1 or section 2, Plaintiff lacks standing to bring an antitrust claim and has not set forth an actionable antitrust claim in any event. Antitrust Standing Antitrust suits are not novel in the medical peer review arena. Indeed, among the statement of Congressional findings in the Health Care Quality Improvement Act (“HCQIA”)—a statute which Plaintiff challenges in several other counts of the Amended Complaint and which is discussed later in this Order—is that “[t]he threat of private money damage liability under Federal laws, including treble damage liability under Federal antitrust law, unreasonably discourages physicians from participating in effective professional peer review.” 42 U.S.C. § 11101(4). However, a threshold requirement in any privately-brought antitrust suit is that the plaintiff have standing to bring such a suit. Doctors have sometimes been found to have standing to bring antitrust claims against hospitals or competitors, but the factual scenario described by Plaintiff in the instant case does not support the requisite “antitrust standing.” “Standing in an antitrust case involves more than the ‘case or controversy’ requirement that drives constitutional standing.” Todorov v. DCH Healthcare Auth., 921 F.2d 1438, 1448 (11th Cir.1991). “[A]ntitrust standing is not simply a search for an injury in fact; it involves an analysis of prudential considerations aimed at preserving the effective enforcement of the antitrust laws. Antitrust standing is best understood in a general sense as a search for the proper plaintiff to enforce the antitrust laws.” Id. (citations omitted). As the Eleventh Circuit explained in Todorov, the Supreme Court has determined that “ ‘Congress did not intend the antitrust laws to provide a remedy in damages for all injuries that might conceivably be traced to an antitrust violation.’ ” Id. (quoting Associated Gen. Contractors, Inc. v. Cal. State Council of Carpenters, 459 U.S. 519, 534, 103 S.Ct. 897, 74 L.Ed.2d 723 (1983)). “Thus, the Court fashioned an approach for analyzing antitrust standing that requires [courts] to ‘evaluate the plaintiffs harm, the alleged wrongdoing by the defendants, and the relationship between them.’ ” Id. at 1448-49 (quoting Associated Gen., 459 U.S. at 535, 103 S.Ct. 897). Over time, a two-pronged approach to analyzing antitrust standing has developed in federal jurisprudence. See id. at 1449. Under this approach, “[f]irst, a court should determine whether the plaintiff suffered ‘antitrust injury’; second, the court should determine whether the plaintiff is an efficient enforcer of the antitrust laws, which requires some analysis of the directness or remoteness of the plaintiffs injury.” Id. (1) Antitrust Injury “Antitrust injury is defined as: ‘injury of the type the antitrust laws were intended to prevent and that flows from that which makes the defendants’ acts unlawful. The injury should reflect the anti-competitive effect either of the violation or of anticompetitive acts made possible by the violation. It should, in short, be ‘the type of loss that the claimed violations ... would be likely to cause.’ ” Todorov, 921 F.2d at 1449 (quoting Brunswick Corp. v. Pueblo Bowl-O-Mat, Inc., 429 U.S. 477, 489, 97 S.Ct. 690, 50 L.Ed.2d 701 (1977)); accord Davies v. Genesis Med. Ctr., 994 F.Supp. 1078, 1093 (S.D.Iowa 1998) (“A private plaintiff can recover on an antitrust claim only where the loss ‘stems from a competition-reducing aspect or effect of the defendant’s behavior.’” (quoting Atl. Richfield Co. v. USA Petroleum Co., 495 U.S. 328, 344, 110 S.Ct. 1884, 109 L.Ed.2d 333 (1990))). “This limitation ... ‘requires the private antitrust plaintiff to show that his own injury coincides with the public detriment tending to result from the alleged violation ... [,] increasfing] the likelihood that public and private enforcement of the antitrust laws will further the same goal of increased competition.’ ” Todorov, 921 F.2d at 1449-50 (quoting Austin v. Blue Cross & Blue Shield, 903 F.2d 1385, 1389-90 (11th Cir.1990)) (all but first alteration in original). The “antitrust injury” requirement derives from the fact that the antitrust laws “were enacted for ‘the protection of competition[,] not competitors.’ ” Brunswick Corp., 429 U.S. at 488, 97 S.Ct. 690 (quoting Brown Shoe Co. v. United States, 370 U.S. 294, 320, 82 S.Ct. 1502, 8 L.Ed.2d 510 (1962)). The Amended Complaint alleges many detriments to Plaintiff, but it does not allege “antitrust injury.” Plaintiffs generalized allegations of “diminished competition” and the “competitive significance” of his exclusion via increased patient load for competing orthopedists do not state the requisite injury. The cases upon which Plaintiff relies for his assertion of antitrust standing are distinguishable. In Angelico v. Lehigh Valley Hospital, 184 F.3d 268 (3d Cir.1999), the court reversed the district court’s finding of lack of antitrust standing, noting that the plaintiff had been completely shut out of competition; such is not the case here. In Nilavar v. Mercy Health System-Western Ohio, 142 F.Supp.2d 859 (S.D.Ohio 2000), a radiologist brought antitrust claims after a hospital awarded an exclusive contract for radiological services to a radiologist group of which the plaintiff was not a part. The plaintiff alleged, inter alia, that the defendant was one of only two hospital systems in the area; that he, as well as other physicians, had been limited in them ability to compete; that consumers had been deprived of free and open competition; that patient care had been harmed by lack of competition; and that consumers were forced to purchase services from the exclusive-provider radiologist group. The Nilavar plaintiff also alleged that because of the exclusive contract, he had been completely foreclosed from the market and that prices had risen due to the contract. These allegations are vastly different from those made by Plaintiff in the instant case. Instead, the scenario presented in the case at bar is more akin to that in Feldman v. Palmetto General Hospital, Inc., 980 F.Supp. 467 (S.D.Fla.1997), upon which Defendants rely. In Feldman, a podiatrist who was denied staff privileges at a hospital attempted to bring claims under sections 1 and 2 of the Sherman Act, alleging, respectively, that the Defendants conspired to boycott him in his privilege application and conspired to monopolize ER call referral of patients. The court found no antitrust injury suffered by Dr. Feldman, noting that “[a] plaintiff ‘simply looking to increase his profits, like any competitor[,]’ does not have antitrust standing.” 980 F.Supp. at 469; see also Volm v. Legacy Health Sys., Inc., 237 F.Supp.2d 1166, 1173-74 (D.Or.2002) (finding that lactation consultant who was banned from providing services at any of defendant’s facilities did not suffer antitrust injury, distinguishing Angelico and noting that the plaintiff was still able to work at other hospitals and thus had not been completely shut out of the market). In the instant case, Plaintiff was not excluded from practicing in Central Florida or even at either of the two ORHS hospitals at issue here; his emergency and trauma call privileges were suspended, but he was still able to, and did, treat patients at ORMC and Sand Lake. Although Plaintiff alleges in the Amended Complaint that ORHS and the Peer Review Defendants conspired to blacklist and boycott him and “to exclude him from practicing medicine at ORHS facilities and in Central Florida by summarily suspending his privileges at both ORMC and Sand Lake without cause,” (Am.Compl.l 161), these allegations fall short of alleging antitrust injury. Plaintiff does not allege that he was prevented from treating patients at any other hospitals in Central Florida, and there are several other hospitals in the vicinity of ORMC and Sand Lake. Plaintiff also alleges that the suspension of his call privileges increased the patient load for other orthopedists; however, this would be true in any case and cannot be sufficient to confer antitrust standing. In sum, Plaintiff does not have standing to bring an antitrust claim, and Count I will be dismissed. (2) Efficient Enforcer The second prong of the antitrust standing analysis entails examination of factors other than antitrust injury “to determine whether a particular plaintiff is an efficient enforcer of the antitrust laws.” Todorov, 921 F.2d at 1450. These “factors include (1) the directness or indirectness of the asserted injury; (2) whether there exists an identifiable class of persons motivated to vindicate the public interest in antitrust enforcement; (3) the nature of the damages; (4) the importance of avoiding duplicate recoveries; and (5) whether the plaintiff can enforce an antitrust judgment.” Feldman, 980 F.Supp. at 470 (citing Todorov). “In the context of health care antitrust litigation, courts have observed that physicians may not be the most efficient enforcer of the antitrust laws. Nevertheless, where a physician’s interest coincides with the patient’s interest, a physician may be a proper enforcer of the antitrust laws.” N.Y. Medscan LLC v. N.Y. Univ. Sch. of Med., 430 F.Supp.2d 140, 146-47 (S.D.N.Y. 2006) (citations omitted). Here, Plaintiffs interest does not coincide with patients’ interests. See Feldman, 980 F.Supp. at 470 (concluding that the plaintiff was not an efficient enforcer because his “asserted interest is that he has been denied privileges; not that podiatrists generally have been denied privileges or that patients have been unable to obtain podiatric services at competitive prices,” and “[tjhere are others ... who would be a more appropriate class of persons to vindicate the public interest in maintaining prices and services at competitive levels”). Thus, Plaintiff also lacks antitrust standing on the basis of not being an efficient enforcer. Failure to State a Sherman Act Violation Defendants contend that even if Plaintiff has antitrust standing, he has failed to allege a cause of action under Section 1 or Section 2 of the Sherman Act. The Court agrees. Section 1 of the Sherman Act Section 1 of the Sherman Act provides that “[ejvery contract, combination in the form of trust or otherwise, or conspiracy, in restraint of trade or commerce among the several states, or with foreign nations, is hereby declared to be illegal.” 15 U.S.C. § 1. Plaintiff contends that ORHS and the Peer Review Defendants violated this section “by engaging in an unlawful combination and conspiracy to (1) blacklist and boycott [him] and to exclude him from practicing medicine at ORHS facilities and in Central Florida by summarily suspending his privileges at both ORMC and Sand Lake without cause; and/or (2) intentionally destroy and derail [Plaintiffs] development of The Physician Patient AllianeeJM” (Am.Compl.l 161). Per Se Violations and the “Rule of Reason” Restraints of trade are characterized either as “per se” unreasonable restraints or as violations of the “rule of reason.” Schering-Plough Corp. v. F.T.C., 402 F.3d 1056, 1064 (11th Cir.2005). “Generally, a per se analysis is applied only in limited circumstances, and after experience and pattern establish that a particular class of restraint is manifestly anticompetitive.” Schering-Plough, 402 F.3d at 1064 n. 11. During oral argument on the motions to dismiss, Plaintiffs counsel acknowledged that she was unable to cite a case setting forth that use of a “sham peer review” to knock out a competitor is a per se section 1 violation. (Hr’g Tr., Doc. 155, at 45). Thus, Plaintiff must rely on the “rule of reason” to attempt to set forth a § 1 violation. “The rule of reason tests ‘whether the restraint imposed is such as merely regulates and perhaps thereby promotes competition or whether it is such as may suppress or even destroy competition.’ ” Schering-Plough, 402 F.3d at 1064 (quoting FTC v. Ind. Fed’n of Dentists, 476 U.S. 447, 457, 106 S.Ct. 2009, 90 L.Ed.2d 445 (1986) (further internal quotation and citation omitted)). “Under Eleventh Circuit case law, alleged Section One agreements analyzed under the rule of reason require a plaintiff ‘to prove (1) the anticompetitive effect of the defendant’s conduct on the relevant market, and (2) that the defendant’s conduct has no pro-competitive benefit or justification.’ ” Spanish Broad. Sys. of Fla., Inc. v. Clear Channel Comm’ns, Inc., 376 F.3d 1065, 1071 (11th Cir.2004) (quoting Levine v. Cent. Fla. Med. Affiliates, Inc., 72 F.3d 1538, 1551 (11th Cir.1996)) (footnote omitted). “In alleging ‘the anticompetitive effect of the defendant’s conduct,’ an antitrust plaintiff must show harm to competition rather than to competitors. That is, the ‘anticompetitive effects’ are measured by their impact on the market rather than by their impact on competitors.” Id. Plaintiff has not defined an appropriate market; while Plaintiffs description of the relevant market fluctuates, all of his proposed relevant markets must be rejected. After variously describing the relevant market in the Amended Complaint, at oral argument Plaintiff set forth two proposed relevant markets: (1) “the market for specialized level one trauma services and emergency medicine in Central Florida,” (Doc. 155 at 37), and (2) “the Physician Patient Alliance,” (id. at 42). Addressing the second proposed market first, the Court agrees with Defendants that Plaintiffs attempt to base an antitrust claim on The Physician Patient AllianceTM must fail. The Physician Patient Alliance is not described in detail in the Amended Complaint, but it appears to be some sort of entity that Plaintiff hoped to develop at some time. However, it had not come into existence by the time that Plaintiffs privileges were suspended. Plaintiffs contentions that the “market is the Physician Patient Alliance,” (Doc. 155 at 42) and that Defendants’ actions “diminish competition in ... the field of healthcare services to be provided by The Physician Patient Alliance in the Central Florida market” do not set forth a relevant market and make no sense. Plaintiff may be attempting to allege the failure of the development of The Physician Patient Alliance as a consequence of Defendants’ actions, but this entity is not a market — -there has been no diminution in competition within this entity, nor, seemingly, could there be. In sum, The Physician Patient Alliance is not the relevant market for an antitrust claim. Plaintiffs other alleged market — “the market for specialized level one trauma services and emergency medicine in Central Florida,” (Doc. 155 at 37), is too narrow. Plaintiffs counsel asserted at oral argument that this market is “not one hospital, it’s not two hospitals, it is the Central Florida area.” (Id.). However, she then said, “Now, the hospital here, Orlando Regional, is the only level one trauma center in the area.” (Id.). So, in essence, this proposed market is only a single hospital — ORMC—and does not even include Sand Lake, the other hospital discussed throughout the Amended Complaint; this narrowing obviously required some backpedaling by Plaintiff, who plainly alleged Sand Lake as part of the market in the Amended Complaint. Plaintiffs attempt to narrow the relevant market to one hospital as the sole “level one trauma center” is rejected. There are many other hospitals in the Orlando area where orthopedic services — even urgent or emergency orthopedic services — are provided. The relevant market is either the market for orthopedic surgery services or the market for emergency orthopedic surgery services within a geographic area — here, Orlando or even “central Florida” — not the market for such services at one hospital because it is the only “level one trauma center.” Again, Plaintiff was not even excluded from that single hospital; instead, the hospital stopped referring him trauma and emergency cases. In characterizing the relevant market, courts “cannot ignore commercial realities.” Davies v. Genesis Med. Ctr., 994 F.Supp. 1078, 1095 (S.D.Iowa 1998); see also Oksanen v. Page Mem’l Hosp., 945 F.2d 696, 709 (4th Cir.1991) (“Although Page Memorial may be where Oksanen prefers to practice, this preference alone does not justify excluding other hospitals and other doctors from the relevant market definition. Oksanen’s narrow market definition violates a fundamental tenet- of antitrust law that the relevant market definition must encompass the realities of competition.”) (citations omitted). Additionally, Plaintiff has not sufficiently alleged an anticompetitive effect; he has only alleged an adverse effect on himself and his profitability. Plaintiff has alleged that he “was deprived of access to the care and treatment of emergency and trauma patients, which denied those patients ... the opportunity to seek or benefit from [Plaintiffs] services or from The Physician Patient Alliance.™” (Am.Compl.f 166). He alleges that the suspension of privileges “is a black mark on [his] career,” (id. ¶ 167), and that the emergency and trauma call consulting cases from which he was barred represented over 60% of his practice, “effectively put[ting] him out of business, (id. ¶ 172).” However, as noted in the discussion of “antitrust injury,” Plaintiff was not excluded from either of the two hospitals at issue; instead, ORHS stopped referring emergency and trauma cases to him. He could still treat patients at these hospitals, and there is no allegation that he was prevented from competing at other hospitals in the Orlando area. Plaintiffs § 1 claim fails. Section 2 of the Sherman Act Section 2 of the Sherman Act proscribes monopolization, attempted monopolization, and combinations and conspiracies “with any other person or persons, to monopolize any part of the trade or commerce among the several States, or with foreign nations.” 15 U.S.C. § 2. Plaintiff alleges that ORHS and the Peer Review Defendants conspired “to monopolize or attempt to monopolize the orthopedic services in the relevant market in Central Florida” (Am.Compl^ 176), though this allegation seems somewhat halfhearted; as noted earlier, in this count Plaintiff combines allegations of violation of both section 1 and section 2, though most allegations seem geared toward a section one violation. The Court agrees with the Defendants that no actionable claim under § 2 has been stated. Plaintiff alleges that Defendants conspired “to monopolize” and “attempted] to monopolize.” (See id. ¶ 176). The elements of a claim of “conspiracy to monopolize” under section 2 are “ ‘(1) concerted action deliberately entered into with the specific intent of achieving a monopoly; and (2) the commission of at least one overt act in furtherance of the conspiracy.’ ” Levine v. Cent. Fla. Med. Affiliates, Inc., 72 F.3d 1538, 1556 (11th Cir.1996) (quoting Todorov, 921 F.2d at 1460 n. 35). The elements of attempted monopolization are “ ‘(1) an intent to bring about a monopoly and (2) a dangerous probability of success.’ ” Id. at 1555 (quoting Norton Tire Co. v. Tire Kingdom Co., 858 F.2d 1533, 1535 (11th Cir.1988)). Just as in a claim under § 1 of the Sherman Act, a § 2 claim requires definition of the relevant market. See, e.g., Spectrum Sports, Inc. v. McQuillan, 506 U.S. 447, 455-56, 113 S.Ct. 884, 122 L.Ed.2d 247 (1993). As noted earlier, Plaintiffs market allegations are inadequate with regard to § 1; they are at least as deficient with regard to § 2. Plaintiff alleges that Defendants conspired to monopolize or attempted to monopolize “the orthopedic services in the relevant market in Central Florida.” (Am.Compl.t 176). Plaintiff does not otherwise define the market in connection with his section 2 claim. Regardless of what market definition is chosen, Plaintiffs claim fails. The Court rejects out of hand the assertion that Defendants attempted to monopolize or conspired to monopolize the market for orthopedic services in Central Florida as a whole. There are numerous other hospitals in central Florida, as well as other outlets for the provision of such services. For the reasons noted in the discussion of the § 1 claim, the Court also rejects a definition of market that includes “emergency orthopedic services” or “level one trauma center”; there are many other emergency rooms than the two at ORMC and Sand Lake. In sum, Plaintiff has not alleged an appropriate relevant market, nor has he otherwise characterized the supposed monopoly that Defendants aspired to obtain by suspending some of his hospital privileges. While ORHS may have the power to grant or deny staff privileges at its hospitals, it is not alleged to have — and as a practical matter cannot have — the power to grant or deny privileges in the entire central Florida area. Plaintiffs attempt to raise a claim under § 2 of the Sherman Act fails. 2. Count III (“Judicial Review”) In Count III, Plaintiff “requests that this court judicially review and determine the validity, reasonableness^] and fairness of ORHS’s and the Peer Review Defendants’ actions.” (Am.Compl^ 193). Plaintiff asserts in this count that the peer review “was committed in bad faith, in violation and in breach of the Bylaws, and in violation of [his] fundamental right to due process and fairness.” (Id. ¶ 191). He avers that these Defendants “intentionally misapplied the Bylaws and/or intentionally conducted the peer review in violation of the Bylaws.” (Id. 192). ORHS and the Peer Review Defendants have moved to dismiss this claim. (See Docs. 107, 108, 109, & 131). ORHS contends that Count III fails to state a cause of action and is redundant to the breach-of-contract claim in Count II, characterizing Count III as merely a claim of “intentional breach of contract.” Some of the Peer Review Defendants (see Doc. 109) argue, in urging dismissal of this count, that Plaintiff does not allege that they had any control over how the peer review was conducted or whether the bylaws were followed; thus, they contend that this count should be directed at ORHS only. It is far from obvious what the legal basis for Count III is-Plaintiff titles it “Judicial Review of Reasonableness and/or Fairness in Peer Review.” In his response (Doc. 134) to ORHS’s motion, Plaintiff asserts that “[t]here is no Florida rule, statute[,] or decision that prevents a physician from asking a court to review a hospital’s decision to suspend or terminate existing privileges.” (Doc. 134 at 33). However, it is not incumbent on a plaintiff to show that there is no bar to a claim, but instead to set forth a basis for one in the first instance. Plaintiff contends that “Florida case law suggests a court may review a hospital’s peer review process to determine whether rules or bylaws by which such a decision was reached are fair and/or were fairly applied.” (Doc. 134 at 33). Plaintiff cites two Florida cases, but neither of them plainly stands for the proposition that a doctor may file a claim titled “judicial review” without an underlying basis for such a claim. In North Broward Hospital District v. Mizell, 148 So.2d 1 (Fla.1962), a hospital appealed a decree declaring a Florida statute that created a hospital district to be unconstitutional; it has no application here. It is difficult to discern how Dance v. North Broward Hospital District, 420 So.2d 315 (Fla. 4th DCA 1982), arrived at the appellate court; it is described as an appeal of a physician’s permanent suspension from the medical staff as a hospital, and the Fourth District Court of Appeal concluded “that there was adequate evidence upon which to base permanent suspension.” Id. at 316. The Dance court noted that the administrative bodies who imposed the suspension were obligated to ensure quality patient care “in accordance with the by-laws” of the hospital district and that “ judicial intervention is only necessary or appropriate when suspension procedures are unfair or when the standards set by the hospital are unreasonable or applied arbitrarily or capriciously.” Id. This suggests that the bylaws and the procedures thereunder were reviewed; in the instant case, Plaintiff has not challenged the bylaws themselves, and his challenge to the manner in which the bylaws were applied has already been made in Count II. Plaintiff also cites three non-Florida cases in support of his asserted claim for “judicial review.” However, these cases cut against Plaintiffs position rather than supporting it. In Brinton v. IHC Hospitals, Inc., 973 P.2d 956 (Utah 1998), a doctor brought nine discrete causes of action-none of which was for bald “judicial review” — and the appellate court, in affirming, noted that the trial court had “decided that each of [the plaintiffs] claims was ultimately grounded in the assertion that IHC had violated the contractual bylaws governing [the] staff privileges.” Id. at 959 n. 1; see also id. at 963 (“[T]he court held that all of Dr. Brinton’s claims depended upon his ability to show that the Hospital had violated its contractual fair process obligations.”). The other two cases cited by Plaintiff also note that compliance with hospital bylaws was at the root of the claims. See Mahmoodian v. United Hasp. Ctr., Inc., 185 W.Va. 59, 404 S.E.2d 750, 755 (1991) (“Utilizing breach of contract principles, most courts explicitly addressing the issue presented here have held, and we hereby hold, that the decision of a private hospital to revoke, suspend, restrict or to refuse to renew the staff appointment or clinical privileges of a medical staff member is subject to limited judicial review to ensure that there was substantial compliance with the hospital’s medical staff bylaws governing such a decision, as well as to ensure that the medical staff bylaws afford basic notice and fair hearing procedures, including an impartial tribunal.”); Adkins v. Sarah Bush Lincoln Health Ctr., 129 Ill.2d 497, 136 Ill.Dec. 47, 544 N.E.2d 733, 737-38 (1989) (noting that in most jurisdictions, generally “internal staffing decisions of private hospitals are not subject ... to judicial review” but that “when the decision involves a revocation, suspension or reduction of existing staff privileges ... the hospital’s action is subject to a limited judicial review to determine whether the decision made was in compliance with the hospital’s bylaws”). This count must be dismissed. Plaintiff has already brought a claim (Count II) based on failure to comply with the Bylaws. Plaintiff does not allege that the Bylaws were unfair but only that they were not complied with during the peer review. Plaintiff has not presented a basis for a claim of “judicial review” beyond the breach of contract claim. The Court agrees with Defendants that the claim for “judicial review” in Count III is redundant to Count II. 3. Count IV (Defamation) Plaintiff brings a defamation claim in Count IV. The allegations of this count are as follows: 195. ORHS and the Peer Review Defendants made and published false and defamatory written and spoken statements about [Plaintiff] during and after the peer review, including statements that [Plaintiff] was justifiably summarily suspended. 196. Further, Defendants ORHS and Hillenmeyer provided false, erroneous[,] and defamatory information about [Plaintiff] to the NPDB, to the Florida Department of Health and to other third parties. These entities and third parties have published and republished these defamatory statements, which [Plaintiff] has also been required to self-publish. 197. Throughout the peer review process, ORHS and the Peer Review Defendants made defamatory statements about [Plaintiffs] surgical technique, surgical judgment, methods and practice, operative durations, operating times[,] and surgical decisions. 198. These defamatory statements, both written and spoken, were made with knowledge of their falsity or with reckless disregard of their truth or falsity. Further, the defamatory statements are defamatory per se or per quod. 199. As a direct and proximate result of ORHS’s and the Peer Review Defendants’ defamatory statements, both written and spoken, [Plaintiff] has suffered and continues to suffer actual and special damages, including but not limited to harm to his reputation, economic loss, extreme embarrassment, humiliation, outrage^] and indignity. (Am. Compl. at 45). In Caster v. Hennessey, the Eleventh Circuit held, in addressing a Florida defamation claim, that “a federal court need not adhere to a state’s strict pleading requirements but should instead follow Fed.R.Civ.P. 8(a). In contrast to Florida’s strict pleading requirements, Fed.R.Civ.P. 8(a)(2)[ ] simply requires that a complaint must contain ‘a short and plain statement of the claim showing that the pleader is entitled to relief.’ ” 781 F.2d 1569, 1570 (11th Cir.1986) (citation omitted); accord Leavitt v. Cole, 291 F.Supp.2d 1338, 1341 (M.D.Fla.2003) (“Although a forum state may apply a heightened pleading requirement, a federal court should, with limited exceptions, look instead to Federal Rule of Civil Procedure ... 8(a).”); see also Greif v. Jupiter Med. Ctr., No. 08-80070-CIV, 2008 WL 2705436, at *5 (S.D.Fla. July 9, 2008) (“While pleading a defamation claim with a certain level of particularity may be required under Florida law, this requirement is procedural and not applicable in this Court. Federal Rule of Civil Procedure 9(b) only requires specific pleading in limited circumstances, and a state law defamation claim is not one of those enumerated circumstances. Thus, in federal court, a defamation claim can be pled generally, so long as it meets the requirements of Rule 8(a) and Twombly.”) (citations omitted). The Court cannot conclude at this point that there is no actionable defamation claim in this case. And, as noted above, heightened pleading requirements do not apply to this claim. However, because of the problem with “group pleading” of the Peer Review Defendants as discussed previously, the count must be repled so that each Defendant is put on fair notice of the claim against him. This count shall be dismissed without prejudice and with leave to amend. J. Counts v. and VI (Interference) Plaintiff brings two interference claims: Intentional and Unjustifiable Interference with Existing Contractual Relations (Count V) and Interference with Advantageous Business Relationship (Count VI). Defendants contend that these claims are not sufficiently pled because Plaintiff does not allege direct and intentional interference but only that his relationships were interfered with as an indirect consequence of the peer review. Defendants rely on Lawler v. Eugene Wuesthoff Memorial Hospital Ass’n, 497 So.2d 1261 (Fla. 5th DCA 1986), and Lake Hospital & Clinic, Inc. v. Silversmith, 551 So.2d 538 (Fla. 4th DCA 1989). In Lawler, the appellate court affirmed dismissal of a claim of intentional interference with an advantageous business relationship, noting that an essential element of such a claim “is that the interference be both direct and intentional.” 497 So.2d at 1263. The “only act complained of as wrongfully taken by the [defendants in Lawler ] was the termination of Dr. Lawler’s staff privileges,” and “[c]learly, the alleged interference with the[ ] relationships was only an indirect consequence of the termination of Dr. Lawler’s staff privileges.” Id. And, in Silversmith, the appellate court, citing Lawler, determined that the trial court erred in not directing a verdict for defendants on an interference claim where the plaintiff—a doctor whose privileges had been terminated — “did not present a case sufficient to suggest that appellants specifically interfered with particular relationships with his patients and other physicians.” 551 So.2d at 544-45. Plaintiff maintains that he has adequately alleged these counts, but the Court agrees with Defendants that Plaintiff has not stated claims for intentional interference. The Amended Complaint falls short of alleging direct and intentional interference as required under Florida law. Instead, as in Laivler, the allegations of the Amended Complaint allege interference as “only an indirect consequence of’ the termination of Plaintiffs privileges. Plaintiff does not seek leave to replead these claims, arguing instead that he has adequately stated them and that this case is distinguishable from Lawler and Silversmith. However, the Court finds this case-as pled by Plaintiff-to be indistinguishable from those Florida court decisions, and both interference counts will be dismissed with prejudice. 5. Count VII (False Light) In Count VII, Plaintiff brings a claim of false light. At the time of oral argument, the issue of whether false light is a viable cause of action in Florida was pending before the Supreme Court of Florida. (See Hr’g Tr., Doc. 155, at 15-16). That court has now expressly declined to recognize false light as a Florida cause of action distinct from defamation. Jews for Jesus, Inc. v. Rapp, 997 So.2d 1098, 1113-14 (Fla.2008), reh’g denied (Dec. 17, 2008). Thus, Count VII fails as a matter of law and must be dismissed with prejudice. 6. Count VIII (Intentional Infliction of Emotional Distress) In Count VIII, Plaintiff brings a claim for intentional infliction of emotional distress against ORHS and the Peer Review Defendants. Plaintiff contends that these Defendants “intentionally and recklessly labeled [him] ‘incompetent’ and a ‘dangerous’ doctor and excluded him from performing orthopedic trauma and emergency surgeries with the intended purpose of denying him the opportunity to perform the professional services for which he trained.” (Am.Compl.1f 236). Further, Plaintiff alleges that these Defendants “intentionally and recklessly harmed [him] through the use and abuse of the peer review process at ORHS.” (Id. ¶ 237). Defendants contend that Plaintiff has not stated a viable cause of action in this count because he has not alleged conduct sufficiently outrageous to support a claim for intentional infliction of emotional distress. To state a cause of action for intentional infliction of emotional distress, a plaintiff must plead “conduct ‘so outrageous in character, and so extreme in degree, as to go beyond all bounds of decency, and to be regarded as atrocious, and utterly intolerable in a civilized community.’ ” Allen v. Walker, 810 So.2d 1090, 1091 (Fla. 4th DCA 2002) (quoting Metro. Life Ins. Co. v. McCarson, 467 So.2d 277, 278-79 (Fla.1985)). “Whether alleged conduct is outrageous enough to support a claim of intentional infliction of emotional distress is a matter of law, not a question of fact.” Gandy v. Trans World Computer Tech. Group, 787 So.2d 116, 119 (Fla. 2d DCA 2001). Defendants argue that even if the allegations in the Amended Complaint are true, they do not rise to the requisite level of outrageousness to support this claim. The Court cannot conclude as a matter of law that, if established, Plaintiffs allegations do not rise to the requisite level of outrageousness. Plaintiff alleges that he was labeled “incompetent” and “dangerous” during a sham peer review. Though Plaintiff will likely have great difficulty establishing the requisite level of outrageousness — especially given his own description in the Amended Complaint of the review as entailing varying medical opinions about his technique — -the character of the conduct alleged is not plainly unactionable. However, this count does suffer the shortcoming of the group pleading of the “Peer Review Defendants,” and for this reason it must be repled. 7. Count IX (Negligent Hiring and Supervision) Plaintiff brings a claim of negligent hiring and supervision (Count IX) against Defendant ORHS only. ORHS seeks dismissal of this claim on the basis that it is barred by the economic loss rule because it is merely a restatement of the breach-of-contract claim in Count II. However, the Court need not reach the issue of the applicability of the economic loss rule in addressing this claim because more fundamentally, a prima facie case of negligent hiring in Florida ultimately “requires that a plaintiff demonstrate that: ‘(1) the employer was required to make an appropriate investigation of the employee and failed to do so; (2) an appropriate investigation would have revealed the unsuitability of the employee for the particular duty to be performed or for employment in general; and (3) it was unreasonable for the employer to hire the employee in light of the information he knew or should have known.’ ” Pycsa Panama, S.A. v. Tensar Earth Techs., Inc., No. 06-20624-CIV, 2008 WL 1775409, at *47 (S.D.Fla. Apr. 16, 2008) (quoting Malicki v. Doe, 814 So.2d 347, 361-62 (Fla. 2002)). “A necessary predicate for a claim of negligent hiring is the existence of an employment relationship.” Id. (citing Behrman v. Allstate Life Ins. Co., 388 F.Supp.2d 1346, 1350 (S.D.Fla.2005)). The Amended Complaint falls short of alleging an employment relationship between ORHS and those whom it allegedly negligently hired and supervised. Plaintiff alleges that the latter “were each agents and/or employees of ORHS,” (Am. Comply 247) (emphasis added), but in Behrman the court held, and this Court agrees, that allegations of an agency relationship are not enough; employment is required. See 388 F.Supp.2d at 1350-51. If Plaintiff has a good-faith basis for alleging that an employment relationship existed between ORHS and the persons whom ORHS allegedly negligently hired and supervised, he may replead this claim; otherwise, there is no viable cause of action for negligent hiring or supervision under Florida law. This claim thus will be dismissed without prejudice. 8. Count X (Fraud) In Count X, Plaintiff brings a claim of fraud against ORHS and the Peer Review Defendants. Defendants seek dismissal of this claim, noting that Federal Rule of Civil Procedure 9(b) requires that “a party must state with particularity the circumstances constituting fraud.” As the Eleventh Circuit Court of Appeals has explained, “[p]articularity means that a plaintiff must plead facts as to time, place, and substance of the defendant’s alleged fraud, specifically the details of the defendant’s] allegedly fraudulent acts, when they occurred, and who engaged in them.” U