Full opinion text
TABLE OF CONTENTS L Preliminary Statement..................... 1069 IL Standards Under Which Defendants* Motion Must be Decided................... 1070 A. Rule 12(e).......................... 1070 B. Summary Disposition of Cases in Federal Courts............................. 1070 1. Notice Pleading Policy........... 1070 2. Efficiency Policy ............... 1071 3. Summary ..................... 1072 III. Plaintiffs’ Sherman Act Allegations.......... 1072 A. Sections 1 and 2 of the Sherman Act ... 1073 1. Presence of Interstate Commerce .. 1074 2. Substantial and Adverse Effect ... 1074 3. Nexus Requirement............. 1074 4. Conclusion..................... 1076 B. Standards for Reviewing Interstate Commerce Allegations.................... 1078 G. Plaintiffs’ Interstate Commerce Allegations ............................... 1079 D. Sufficiency of Plaintiffs’ Interstate Commerce Allegations.................... 1080 1. Presence of Interstate Commerce .. 1080 2. Substantial and Adverse Effect on Interstate Commerce............ 1082 3. Nexus Between Defendants’ Challenged Activities ami Interstate Commerce ........................ 1083 4. Conclusion..................... 1084 E. Appropriate Relief................... 1084 IV. Plaintiffs’ Civil Rights Claims............... 1085 A. Section 1983 ........................ iog6 1. Deprivation of a Federally Protected Interest .................... 1086 2. Color of State Law ............. 1087 B. Standards for Reviewing State Action Allegations ........................... 1088 C. Plaintiffs’ State Action Allegations ..... 1089 D. Sufficiency of Plaintiffs’ State Action Allegations ........................... 1090 1. Nexus Requirement............. 1091 2. Symbiotic Relationship .......... 1091 a. Specific elements .......... 1092 (i) Receipt of Hill-Burton funds 1092 (ii) Governmental regulation .... 1093 (iii) Receipt of Medicare and Medicaid funds................ 1093 (iv) Tax-exempt status......... 1094 (v) Monopoly status........... JQ94 b. Facts and circumstances test.. 1096 E. Appropriate Relief................... 1097 V. Conclusion............................... 1098 OPINION JOSEPH S. LORD, III, Chief Judge. I. Preliminary Statement This action is one of a burgeoning number of cases brought by physicians who have been denied full or specialized staff privileges at a particular hospital. CardioMedical Associates, Ltd., and its four physician members, filed this complaint against Crozer-Chester Medical Center (hereinafter referred to as “CCMC”), members of the CCMC Board of Directors, the Chief of the Department of Medicine at CCMC, and several individual doctors practicing cardiology under the name of Cardiology Associates of Delaware County. Plaintiffs allege in Count I of their complaint that the denial to them of the opportunity to perform certain specialized cardiology procedures at CCMC is the result of an unlawful conspiracy on the part of defendants which has restrained trade in violation of sections 1 and 2 of the Sherman Act. 15 U.S.C. §§ 1, 2. In Count II of their complaint, plaintiffs further allege that the denial of the opportunity to perform these specific cardiology procedures is a violation of their fourteenth amendment rights. This violation, plaintiffs allege, constitutes a deprivation of a constitutionally protected property interest within the meaning of section 1983. 42 U.S.C. § 1983. Further, plaintiffs allege that defendants acted under color of state law when they denied the individual plaintiff physicians the right to practice the specified procedures. Finally, plaintiffs allege, also in Count II of their complaint, that their fourteenth amendment procedural due process rights were violated by defendants’ failure to afford them a hearing at any time during the period of their exclusion from the performance of the specified cardiology procedures. On the basis of these allegations, plaintiffs seek a declaratory judgment and a permanent injunction compelling defendants to permit plaintiffs to perform the specified procedures from which they allegedly have been wrongfully excluded. Further, plaintiffs seek an award of damages for the injuries allegedly sustained as a result of the denial of the opportunity to perform these procedures. Pursuant to rule 12(c) of the Federal Rules of Civil Procedure, defendant CCMC, the members of the CCMC Board of Directors, and James C. Clark, M.D. moved for judgment on the pleadings with respect to both Counts I and II of plaintiffs’ complaint. Defendants assert that plaintiffs have (1) failed to state a claim for relief or establish that this court has subject matter jurisdiction under the antitrust laws and (2) failed to state a claim for relief or establish that this court has subject matter jurisdiction under the Constitution or section 1983. For the reasons stated below, I grant defendants’ motion for judgment on the pleadings as to both counts of plaintiffs’ complaint and dismiss Count I without prejudice and Count II with prejudice. In deciding defendants’ motion, I write at some length because of the increasing significance — to doctors, to hospitals, and to the federal courts — of this genre of cases. The large financial and administrative burdens imposed on hospital defendants and the courts as a result of the growing number of denial of hospital staff privileges cases, notwithstanding the infrequency with which plaintiffs prevail, is only one reason for this topic’s current importance. Further, my analysis of the case law discloses no comprehensive discussion of the theories underlying and of the standards to be applied in deciding claims of this type. As a result, I write to explain fully my doubts that the ordinary denial of staff privileges claim states a federal cause of action in any case. II. Standards Under Which Defendants’ Motion Must Be Decided A. Rule 12(c) A motion for judgment on the pleadings may be used to assert the failure of plaintiffs to state a claim upon which relief can be granted or the lack of subject matter jurisdiction. Fed.R.Civ.P. 12(h)(2), (3). See C. Wright & A. Miller, Federal Practice and Procedure § 1368, at 688 (1969). Motions for judgment on the pleadings should not be “lightly given.” Moss v. School District of Norristown, 33 F.R.D. 518, 519 (E.D.Pa.1963). The applicable standard for ruling on a 12(c) motion has been summarized as follows in Professor Moore’s treatise: Under the orthodox rule, a motion for judgment on the pleadings must be sustained by the undisputed facts appearing in all the pleadings, supplemented by any facts of which the court will take judicial notice. For the purposes of the motion, all well-pleaded material allegations of the opposing party’s pleading are to be taken as true, and all allegations of the moving party which have been denied are taken as false. Conclusions of law are not deemed admitted. Judgment on the pleadings may be granted only if, on the facts as so admitted, the moving party is clearly entitled to judgment. 2A J. Moore, Moore’s Federal Practice ¶ 12.15, at 2343-44 (1981) (footnotes omitted). Accord, Huntt v. Government of Virgin Islands, 339 F.2d 309 (3d Cir. 1964); Can-Tex Industries v. Safeco Insurance Company of America, 460 F.Supp. 1022 (W.D.Pa.1978); Commerce National Bank v. Baron, 336 F.Supp. 1125 (E.D.Pa.1971); M.L. Lee & Co. v. American Cardboard & Packaging Corp., 36 F.R.D. 27 (E.D.Pa. 1964). See C. Wright & A. Miller, supra, at §§ 1367-68. B. Summary Disposition of Cases in Federal Courts The stringent requirements for the granting of a rule 12(c) motion for judgment on the pleadings are wholly consistent with the general disfavor in which all motions for summary disposition of cases are treated in federal courts. But, where appropriate, the Federal Rules of Civil Procedure mandate the summary dismissal of cases, even before any discovery is completed. See generally C. Wright & A. Miller, supra, at § 1369, at 698. This line between permissible and impermissible summary disposition of cases is determined in large part by the interaction of two competing policies: the “notice pleading” policy and the “efficiency” policy. 1. Notice Pleading Policy The classic statement of what I have referred to as the notice pleading policy is provided by the Supreme Court in Conley v. Gibson, 355 U.S. 41, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957): [T]he Federal Rules of Civil Procedure do not require a claimant to set out in detail the facts upon which he bases his claim. To the contrary, all the Rules require is “a short and plain statement of the claim” that will give the defendant fair notice of what the plaintiff’s claim is and the grounds upon which it rests.... Such simplified “notice pleading” is made possible by the liberal opportunity for discovery and the other pretrial procedures established by the Rules.... Id. at 47-48, 78 S.Ct. at 102-03. Accord, Foman v. Davis, 371 U.S. 178, 83 S.Ct. 227, 9 L.Ed.2d 222 (1962); Kauffman v. Moss, 420 F.2d 1270 (3d Cir.), cert. denied, 400 U.S. 846, 91 S.Ct. 93, 27 L.Ed.2d 84 (1970); Deakyne v. Commissioners of Lewes, 416 F.2d 290 (3d Cir. 1969). The Supreme Court has also made clear that this notice pleading policy applies with full force in the context of complex antitrust cases: We have held that “a complaint should not be dismissed for failure to state a claim unless it appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief.” [Conley, 355 U.S. at 45-46, 78 S.Ct. at 101-02 (footnote omitted).] And in antitrust cases, where “the proof is largely in the hands of the alleged conspirators,” [Poller v. Columbia Broadcasting System, Inc., 368 U.S. 464, 473, 82 S.Ct. 486, 491, 7 L.Ed.2d 458 (1962) ], dismissals prior to giving the plaintiff ample opportunity for discovery should be granted very sparingly. Hospital Building Co. v. Trustees of the Rex Hospital, 425 U.S. 738, 746, 96 S.Ct. 1848, 1853, 48 L.Ed.2d 338 (1976). Accord, Mortensen v. First Federal Savings & Loan Ass’n, 549 F.2d 884, 896 (3d Cir. 1977). 2. Efficiency Policy Judge Weinfeld of the Southern District of New York provides an excellent statement of what I refer to here as the efficiency policy. In a suit by employees and their union against the trustees of an ERISA pension plan challenging certain aspects of administration of that plan, the court dismissed plaintiffs’ claims of alleged imprudent investment by the trustees on the ground that they failed to state a cause of action. Judge Weinfeld wrote: This is no matter of technical pleading. Defendants should not be put to the heavy burden and expense of litigation unless a properly pleaded complaint requires them to defend. This is not a case where plaintiffs cannot ascertain whether there is a factual basis to support a proper claim.. . . It is not sufficient to say that appropriate allegations to plead a sufficient cause of action will be made after pre-trial discovery. Conley v. Gibson, pressed by plaintiffs, does not authorize parties to use an insufficient complaint with a conclusory allegation as a hunting license to discover whether in fact a viable claim may be alleged. The discovery rules are designed to support a properly pleaded cause of action and to prepare defenses to charges made — not to discover whether a claim exists. American Communications Ass’n v. Retirement Plan for Employees of RCA Corp., 488 F.Supp. 479, 483-84 (S.D.N.Y.) (footnotes omitted), aff’d mem. 646 F.2d 559 (2d Cir. 1980). In the proper circumstances, this efficiency policy has been deemed sufficiently powerful to override the notice pleading policy discussed above. See, e.g., Kadar Corp. v. Milbury, 549 F.2d 230, 233, 233 n.2 (1st Cir. 1977); Cohen v. Illinois Institute of Technology, 524 F.2d 818, 827 (7th Cir. 1975), cert. denied, 425 U.S. 943, 96 S.Ct. 1683, 48 L.Ed.2d 187 (1976); McLaughlin v. Copeland, 455 F.Supp. 749, 753 (D.Del.1978), aff’d mem. 595 F.2d 1213 (3d Cir. 1979); EEOC v. Carter Carburetor, 76 F.R.D. 143 (E.D.Mo.1977), vacated on other grounds, 577 F.2d 43 (8th Cir. 1978), cert. denied, 439 U.S. 1081, 99 S.Ct. 865, 59 L.Ed.2d 52 (1979). See generally Blue Chip Stamps v. Manor Drug Stores, 421 U.S. 723, 741, 95 S.Ct. 1917, 1928, 44 L.Ed.2d 539 (1975); Kirkham, Complex Civil Litigation-Have Good Intentions Gone Awry?, 70 F.R.D. 199, 204 (1976); Pollack, Discovery-Its Abuse and Correction, 80 F.R.D. 219 (1978); Renfrew, Discovery Sanctions: A Judicial Perspective, 67 Calif.L.Rev. 264, 266-67 (1979). 3. Summary Upon an analysis of the two competing policies discussed above, the following synthesis emerges from those precedents. Generally, summary disposition of claims on the merits is disfavored. If a complaint contains even the most basic of allegations that, when read with great liberality, could justify plaintiff’s claim for relief, motions for judgment on the pleadings should be denied. Nevertheless, a district court judge still must scrutinize complaints to ensure that they contain even these most basic and minimum allegations. This scrutiny is particularly appropriate in a case in which a party questions the jurisdiction of the court because of the federal trial judge’s special responsibility to determine that there is jurisdiction in each case. When the district court judge determines that the complaint fails to meet even the minimal notice pleading requirements of the federal rules, he has a number of options. In most circumstances, the court should permit a plaintiff to file an amended complaint and/or to conduct limited discovery in order to supplement his initial allegations. See Kauffman, 420 F.2d at 1276 (amendments pursuant to rule 15(a) should be freely permitted). Notwithstanding the liberal amendment provisions of the federal rules, summary dismissal of a facially deficient complaint, without leave to amend or conduct discovery, is appropriate in the following situations: (1) if “the merits of the controversy can be fairly and fully decided” without amendment or discovery, as, for example, if plaintiff’s complaint is legally deficient and, after inquiry by the court, plaintiff can suggest no way in which it can be made legally sufficient, see C. Wright & A. Miller, supra, at § 1369, at 698; note 4 supra; (2) if there is a valid reason for refusing such a request, such as delay, bad faith, or dilatory motives, see Foman, 371 U.S. 178, 83 S.Ct. 227, 9 L.Ed.2d 222; or (3) if the pleadings are wholly inadequate and discovery would serve no demonstrably useful purpose. Defendant’s motion for judgment on the pleadings is decided in accordance with this synthesis of applicable precedents, rules, and scholarly analyses. III. Plaintiffs’ Sherman Act Allegations Plaintiffs’ Count I allegations that defendants’ conduct violated the antitrust laws raise complex jurisdictional issues under the Sherman Act. Essentially, plaintiffs allege that the denial to them of the opportunity to perform certain specialized cardiology procedures at CCMC is the result of an unlawful conspiracy on the part of defendants that has restrained trade in violation of sections 1 and 2 of the Sherman Act. Defendants argue, however, that plaintiffs have failed to state a claim for relief or to establish that this court has subject matter jurisdiction under the antitrust laws because of the absence of sufficient allegations to establish the requisite relationship with interstate commerce. A. Sections 1 and 2 of the Sherman Act Section 1 of the Sherman Act declares that contracts, conspiracies, and combinations in restraint of trade or commerce among the states are illegal. In addition, section 2 prohibits attempts to monopolize the sale of products or services in trade or commerce among the states. Coverage of the Sherman Act, legislation passed pursuant to the authority granted Congress by the commerce clause, extends both to activities that are actually in interstate commerce and to activities that, though purely intrastate in character, nevertheless substantially affect interstate commerce. McLain v. Real Estate Board of New Orleans, 444 U.S. 232, 241, 100 S.Ct. 502, 508, 62 L.Ed.2d 441 (1980); Hospital Building Co. v. Trustees of Rex Hospital, 425 U.S. 738, 743, 96 S.Ct. 1848, 1851, 48 L.Ed.2d 338 (1976); United States v. Employing Plasterers Ass’n, 347 U.S. 186, 189, 74 S.Ct. 452, 454, 98 L.Ed. 618 (1954); Atlantic Cleaners & Dyers, Inc. v. United States, 286 U.S. 427, 435, 52 S.Ct. 607, 609, 76 L.Ed. 1204 (1932). Although the distinction between those activities that are “in” commerce and those that merely “affect” commerce is still important for some purposes under the antitrust laws, “[i]t can no longer be doubted ... that the jurisdictional requirement of the Sherman Act may be satisfied under either the ‘in commerce’ or the ‘effect on commerce’ theory.” McLain, 444 U.S. at 242, 100 S.Ct. at 509. Accord, Hospital Building Co., 425 U.S. at 743, 96 S.Ct. at 1851-52; Gulf Oil Corp. v. Copp Paving Co., 419 U.S. 186, 194-95, 95 S.Ct. 392, 398, 42 L.Ed.2d 378 (1974); Mandeville Island Farms, Inc. v. American Crystal Sugar Co., 334 U.S. 219, 235-37, 68 S.Ct. 996, 1005-06, 92 L.Ed. 1328 (1948); Crane v. Intermountain Health Care, Inc., 637 F.2d 715, 720 (10th Cir. 1981) (en banc); Mortensen v. First Federal Savings & Loan Ass’n, 549 F.2d 884, 896 (3d Cir. 1977); Barr v. National Right to Life Committee, Inc., No. 79-420-OLR-CIV-y (M.D.Fla. July 23, 1981); Grigg v. Blue Cross and Blue Shield of Michigan, 1980-2 Trade Cases ¶ 63,500, at 76,665-66 (E.D.Mich.1980); Robinson v. Magovern, 456 F.Supp. 1000, 1004 (W.D.Pa.1978); De Gregorio v. Segal, 443 F.Supp. 1257, 1267 (E.D.Pa.1978). In order to survive a motion for judgment on the pleadings under the standards enunciated in part II of this opinion and the applicable precedents under the affecting commerce theory of interstate commerce, plaintiffs’ complaint must contain factual allegations that, if proved, would sustain each of three findings: (1) the presence of interstate commerce; (2) the existence of a substantial and adverse effect on interstate commerce, and (3) the requisite nexus between the challenged activities of defendants and the identified element of interstate commerce. Failure to allege sufficient facts on any one of these jurisdictional prerequisites requires dismissal of plaintiffs’ complaint. 1. Presence of Interstate Commerce In order to invoke the jurisdiction of the district court, plaintiffs’ complaint must identify specifically the interstate commerce at issue in this case. “Although the cases demonstrate the breadth of Sherman Act prohibitions, jurisdiction may not be invoked under that statute unless the relevant aspect of interstate commerce is identified ; it is not sufficient merely to rely on identification of a relevant local activity and to presume an interrelationship with some unspecified aspect of interstate commerce.” McLain, 444 U.S. at 242, 100 S.Ct. at 509. (emphasis supplied). 2. Substantial and Adverse Effect Plaintiffs’ complaint additionally must contain specific factual allegations that, if proved, would demonstrate that the alleged restraint “substantially and adversely affects interstate commerce." Gulf Oil Corp. v. Copp Paving Co., 419 U.S. 186, 195, 95 S.Ct. 392, 398, 42 L.Ed.2d 378 (1974). Accord, Hospital Building Co. v. Trustees of the Rex Hospital, 425 U.S. 738, 743, 96 S.Ct. 1848, 1851, 48 L.Ed.2d 338 (1976); Mandevilie Island Farms, Inc. v. American Crystal Sugar Co., 334 U.S. 219, 234, 68 S.Ct. 996, 1005, 92 L.Ed. 1328 (1948); Doctors, Inc. v. Blue Cross of Greater Philadelphia, 490 F.2d 48, 51-53 (3d Cir. 1973) (collecting cases); Grigg v. Blue Cross and Blue Shield of Michigan, 1980-2 Trade Cases ¶ 63,500, at 76,666 (E.D.Mich.1980). 3. Nexus Requirement Plaintiffs’ complaint must also contain factual allegations that, if proved, would demonstrate the existence of a logical nexus between the challenged activities of defendants (in this case, denying plaintiffs the right to practice specialized cardiology procedures) and the effect on the relevant channel of interstate commerce discussed previously. This final and most significant jurisdictional prerequisite has its roots in a long line of Supreme Court precedent. In Hospital Building Co. v. Trustees of the Rex Hospital, 425 U.S. 738, 96 S.Ct. 1848, 48 L.Ed.2d 338 (1976), the operator of a small hospital in Raleigh, North Carolina brought suit against Rex Hospital alleging that Rex had conspired with others to block a proposed expansion of plaintiff’s hospital and to monopolize hospital services in Raleigh. The Supreme Court reversed the district court’s dismissal finding that the complaint satisfied the Sherman Act’s “effect on commerce test.” A major focus of the Court’s opinion was the adequacy of the nexus between the challenged activity by defendant and the relevant channels of interstate commerce identified by plaintiff. See Hospital Building Co., 425 U.S. at 742 n.1, 743-44, 96 S.Ct. at 1851 n.1, 1851-52. A cornerstone of the Court’s Hospital Building Co. opinion was its earlier decision in Burke v. Ford, 389 U.S. 320, 88 S.Ct. 443, 19 L.Ed.2d 554 (1967). The district court in Burke had dismissed the plaintiff liquor retailers’ complaint alleging unlawful restraint of interstate commerce by the defendant liquor wholesalers who had divided the Oklahoma liquor market into distributional territories. The Supreme Court reversed the court of appeals affirmance because of the substantial volume of liquor in interstate commerce and, most critically, because of the logical relationship between defendants’ division of an intrastate market and that interstate commerce. See Burke, 389 U.S. at 322, 88 S.Ct. at 444. Goldfarb v. Virginia State Bar, 421 U.S. 773, 95 S.Ct. 2004, 44 L.Ed.2d 572 (1975), although it involved the “in commerce” jurisdictional test, rather than the “effect on commerce” test, also sheds light on the nexus issue. Goldfarb involved the challenge by real estate purchasers to the Virginia State Bar’s minimum fee schedule for real estate title searches. The Supreme Court held that, because an attorney’s services are an “integral” and “inseparable” part of interstate real estate financing, the jurisdictional interstate commerce requirement was met. “The necessary connection between the interstate transactions and the restraint of trade provided, by the minimum-fee schedule is present because, in a practical sense, title examinations are necessary in real estate transactions to assure a lien on a valid title of the borrower.” Goldfarb, 421 U.S. at 783-84, 95 S.Ct. at 2011. The Court’s recent McLain decision, involving a challenge by real estate purchasers to alleged price fixing by brokers in the New Orleans area, reaffirms the importance of the nexus requirement. Defendants’ pretrial motion to dismiss on jurisdictional grounds was granted by the district court and affirmed by the court of appeals as a result of their focus on Goidfarb’s “integral and inseparable” rationale. The Supreme Court reversed, finding that the lower courts’ reliance on Goldfarb, which involved only the “in commerce” test, was incomplete. The Court stated the applicable test for the nexus requirement in the jurisdictional inquiry as follows: To establish jurisdiction a plaintiff must allege the critical relationship in the pleadings and if these allegations are controverted must proceed to demonstrate by submission of evidence beyond the pleadings either that the defendants’ activity is itself in interstate commerce or, if it is local in nature, that it has an effect on some other appreciable activity demonstrably in interstate commerce. ... ... To establish federal jurisdiction in this case, there remains only the requirement that respondents’ activities which allegedly have been infected by a price fixing conspiracy be shown “as a matter of practical economics” to have a not insubstantial effect on the interstate commerce involved. Id. 444 U.S. at 242, 246, 100 S.Ct. at 509, 511 (emphasis supplied). Plaintiffs cite two other sentences from McLain in support of their position: To establish the jurisdictional element of a Sherman Act violation it would be sufficient for petitioners to demonstrate a substantial effect on interstate commerce generated by respondents’ brokerage activity. Petitioners need not make the more particularized showing of an effect on interstate commerce caused by the alleged conspiracy to fix commission rates, or by those other aspects of respondents’ activity that are alleged to be unlawful. McLain, 444 U.S. at 242-43, 100 S.Ct. at 509-10. This language has been interpreted to broaden “significantly ... the effect-on-commerce jurisdictional test by requiring proof of a nexus merely between interstate commerce and the defendants’ general business activity rather than the defendant’s allegedly unlawful conduct.” Comment, The Interstate Commerce Test for Jurisdiction in Sherman Act Cases and Its Substantive Applications, 15 Ga.L.Rev. 714, 715 (1981). Accord, Bain v. Henderson, 621 F.2d 959, 961 n.2 (9th Cir. 1980); Western Wastes Systems v. Universal Waste Control, 616 F.2d 1094, 1097 (9th Cir.), cert. denied, 449 U.S. 869, 101 S.Ct. 205, 66 L.Ed.2d 88 (1980). I reject this interpretation and, in the absence of any binding Third Circuit precedent, choose to follow the Tenth Circuit’s lead, explicated below, on this issue. See Crane v. Intermountain Health Care, Inc., 637 F.2d 715, 721-24 (10th Cir. 1980) (en banc). Within the context of the facts and entire opinion of McLain, the Court must have been referring to the challenged activities of defendants and not the brokers’ overall business activities, as suggested by the student comment and the Ninth Circuit cases. The reference to “particularized showing” was merely intended as an affirmation of the earlier holdings in Hospital Building Company, Burke, and Goldfarb that, for jurisdictional purposes, a plaintiff is under no obligation to make a particularized showing: In other words, an elaborate analysis of interstate impact is not necessary at the jurisdictional stage, only an allegation showing a logical connection as a matter of practical economics between the unlawful conduct and interstate commerce. The emphasis was intended to be that a ‘particularized’ showing is not necessary, not that a showing of a nexus between unlawful conduct and effect is unnecessary.” Crane, 637 F.2d at 723. I therefore decline to hold that the Supreme Court squarely reversed the holdings of a fourteen-year-old-line of precedent without even mentioning that such a dramatic shift in policy was occurring. 4. Conclusion At this point in my analysis of the substantive prerequisites for jurisdiction in a Sherman Act case, a crucial issue arises. In order to vest a federal court with jurisdiction, plaintiffs must (1) identify a relevant channel of interstate commerce (2) substantially and directly affected (3) by the allegedly improper activities of defendants. The crucial issue is whether the “relevant channel of interstate commerce" requirement in denial of hospital staff privileges cases relates to plaintiffs’ or defendants’ activities, or both. I hold that, in any denial of hospital staff privileges case, the only relevant jurisdictional inquiry involves a determination of whether the defendant hospitals’ denial of staff privileges to the plaintiff physician substantially and directly affects the plaintiff’s activities in interstate commerce. My survey of the case law discloses a virtual lack of discussion of this issue. Some courts reviewing plaintiffs’ factual allegations or the evidence in a particular case routinely mention both defendants’ and plaintiffs’ activities in interstate commerce during the jurisdictional inquiry. See, e.g., Stone v. William Beaumont Hospital, No. 79-74212 (E.D.Mich. Aug. 17, 1981); Robinson v. Magovern, 521 F.Supp. 842 (W.D.Pa.1981). More frequently, courts analyze only the plaintiffs’ activities in interstate commerce, without any explanation of why that approach is adopted. See, e.g., Hospital Building Co. v. Trustees of the Rex Hospital, 425 U.S. 738, 96 S.Ct. 1848, 48 L.Ed.2d 338 (1976) (plaintiff satisfied jurisdictional element of Sherman Act by alleging that it purchases a large percentage of its medical supplies from out-of-state manufacturers, that it attracts a significant number of patients from out-of-state, that it obtains a substantial portion of its revenues from out-of-state sources, and that it plans to finance the construction of a new facility through the use of out-of-state lenders); Wolf v. Jane Phillips Episcopal-Memorial Medical Center, 513 F.2d 684, 688 (10th Cir. 1975) (facts supporting jurisdiction over Sherman Act claim found insufficient when plaintiff alleges only that his business involves interstate commerce in general; no suggestion that defendants’ conspiracy threatens plaintiff’s purchase of interstate goods or that the flow of goods in interstate commerce would be affected in any way by plaintiff’s exclusion from defendants’ medical staff); Doctors, Inc. v. Blue Cross of Greater Philadelphia, 490 F.2d 48 (3d Cir. 1973) (jurisdiction under Sherman Act sustained when plaintiff alleged that it purchased a large volume of interstate goods and that its ability to continue to purchase such goods was jeopardized by defendant’s actions); Riggall v. Washington County Medical Society, 249 F.2d 266, 268 (8th Cir. 1957) (plaintiff’s Sherman Act complaint dismissed because of insufficient allegations that plaintiff’s business involved or affected interstate commerce), cert. denied, 355 U.S. 954, 78 S.Ct. 540, 2 L.Ed.2d 530 (1958); Hahn v. Oregon Physicians’ Service, 508 F.Supp. 970, 974 (D.Or.1981) (plaintiffs’. Sherman Act claims dismissed on jurisdictional grounds as a result of finding that “plaintiffs’ interstate activities are so insubstantial” that “defendants’ business activities could not ‘as a matter of practical economics,’ substantially affect them.”); Nankin Hospital v. Michigan Hospital Service, 361 F.Supp. 1199, 1210 (E.D.Mich.1973) (plaintiff’s Sherman Act complaint dismissed because of finding that plaintiff “is not engaged in interstate commerce” and did not demonstrate “that its sale of hospital services has any effect on interstate commerce”). Only one published decision discusses this critical issue in any detail. In Nara v. American Dental Ass’n, 526 F.Supp. 452 (W.D.Mich.1981), the court explained why it would consider only plaintiff’s involvement in interstate commerce: The issue raised by defendants’ motions is whether defendants’ conduct has substantially affected interstate commerce. If not, this court cannot exercise jurisdiction over the claims asserted by plaintiff under The Sherman Act. ... It should be noted that the interstate commerce in question here consists of the extent of plaintiff’s practice of dentistry.... It does not concern the generalized interstate activities of any of the defendants. Plaintiff has spent much effort to demonstrate that the ADA, for example, is a nationwide association of which the state and local organizations are constituent members. What is relevant is not the interstate character of defendants’ activities, but the effect that the objectionable restrictions have on interstate commerce. ... Of necessity, therefore, one must look to the extent to which plaintiff is engaged in interstate commerce. Id. at 455 (citations omitted). I subscribe fully to the views expressed by the Nara court. As a matter of logic, the extent of defendants’ activities in interstate commerce is irrelevant in a denial of hospital staff privileges case. For example, in this case, it is the effect on plaintiffs as a result of the denial to them by defendants of the right to practice cardiology procedures at CCMC that is the appropriate source of concern under the antitrust laws. The extent of defendants’ involvement in interstate commerce is irrelevant for the purposes of this lawsuit because their denial of staff privileges to plaintiffs has no possible effect on their own activities in interstate commerce; the only potential effect relates to plaintiffs’ practice of medicine. In sum, unless plaintiffs’ complaint contains factual allegations that, if proved, would satisfy all three jurisdictional requirements — presence of interstate commerce, substantial effect on interstate commerce, and nexus between defendants’ challenged activities and plaintiffs’ activities in interstate commerce — defendants are entitled to judgment on the pleadings. B. Standards for Reviewing Interstate Commerce Allegations Before proceeding to a discussion of the sufficiency of plaintiffs’ interstate commerce allegations under the applicable legal precedents, I briefly review the specific standards used by federal courts making such an inquiry. Of course, these standards merely supplement the standards discussed in part II of this opinion. As a result of the limitations on the scope of federal judicial power that inhere in article III of the Constitution, it is well established that the jurisdiction of a federal court can never be presumed. Smith v. McCollough, 270 U.S. 456, 46 S.Ct. 338, 70 L.Ed. 682 (1926); Hanford v. Davies, 163 U.S. 273, 16 S.Ct. 1051, 41 L.Ed. 157 (1896). As emphasized by former Chief Judge John Lord in Valanga v. Metropolitan Life Insurance Co., 259 F.Supp. 324, 326 (E.D.Pa.1966), the jurisdiction of a federal district court “must always be properly demonstrated” under the body of federal statutes implementing the judiciary provisions of the Constitution. As a result of a perceived potential for abuse inherent in an antitrust action for treble damages, many courts attempted to tighten the standard federal notice pleading requirements in such cases by forcing the pleader to allege facts in greater detail than ordinarily would be required by the Federal Rules of Civil Procedure. E.g., Hohensee v. Akron Beacon Journal Publishing Co., 174 F.Supp. 450 (N.D.Ohio 1959), aff'd, 277 F.2d 359 (6th Cir. 1960), cert. denied, 364 U.S. 914, 81 S.Ct. 277, 5 L.Ed.2d 227 (1960); Bader v. Zurich General Accident & Liability Insurance Co., 12 F.R.D. 437 (S.D.N.Y.1952). The suggestion that simplified pleading requirements were inappropriate in the context of complex antitrust litigation has been flatly rejected by all modern courts considering the issue. See 2A J. Moore, Moore’s Federal Practice ¶ 8.17[3], at 8-165 n.24 (1981). Accord, Knuth v. Erie-Crawford Dairy Co-operative Ass’n, 395 F.2d 420 (3d Cir.), cert. denied, 410 U.S. 913, 93 S.Ct. 966, 35 L.Ed.2d 278 (1968); Nagler v. Admiral Corporation, 248 F.2d 319 (2d Cir. 1957). It is still necessary, however, that the antitrust complaint contain factual allegations that, if proved, would sustain a finding on each essential jurisdictional element. In Klebanow v. New York Produce Exchange, 344 F.2d 294 (2d Cir. 1965), the court stated: While Nagler v. Admiral Corp. ... repudiated the idea that “some special pleading ... is required in antitrust cases,” it is no authority that in such cases the pleader is socially privileged to plead nothing but the statutory words. A mere allegation that defendants violated the antitrust laws as to a particular plaintiff and commodity no more complies with Rule 8 than an allegation which says only that a defendant made an undescribed contract with the plaintiff and breached it, or that a defendant owns a car and injured plaintiff by driving it negligently. Id. at 299-300. Although summary disposition of complex antitrust claims is discouraged, see, e.g., McLain v. Real Estate Board of New Orleans, 444 U.S. 232, 100 S.Ct. 502, 62 L.Ed.2d 441 (1980); Timberlane Lumber Co. v. Bank of America, 549 F.2d 597, 602 (9th Cir. 1976), in certain cases such a procedure is fully justified. As the trial judge in Searer v. West Michigan Telecasters, Inc., 381 F.Supp. 634 (W.D.Mich.1974), aff’d mem. 524 F.2d 1406 (1975), held: It is true that summary procedure should be used sparingly' in complex antitrust litigation.... However, this policy of restraint is no warrant for every plaintiff who can draft an antitrust complaint, no matter how groundless or improbable its allegations, to force his claim to trial despite its deficient factual underpinning. Id. at 643. Thus, the standard federal pleading requirements outlined in part II of this opinion apply with full force to complaints in complex antitrust matters. It is under these standards, more fully explained in this section, that I must judge the substantive merit of defendants’ motion for judgment on the pleadings. C. Plaintiffs’ Interstate Commerce Allegations It is agáinst this legal background that I must determine whether defendants are entitled to judgment on the pleadings or whether plaintiffs’ complaint includes sufficient factual allegations to support jurisdiction under the Sherman Act. Because neither party has attempted to introduce materials outside the pleadings, my decision must be based strictly on a reading of plaintiffs’ complaint, in a light most favorable to plaintiffs, together with any facts of which I am entitled to take judicial notice. See part II A supra; note 3 supra. Seven paragraphs in plaintiffs’ complaint contain allegations relating to the interstate commerce issue. These allegations, when read in a light most favorable to plaintiffs, are of three types. First, paragraph two of the complaint alleges that defendants operate in interstate commerce and that plaintiffs provide health care to patients who travel in interstate commerce. Paragraph nine expands on the paragraph two allegation that CCMC operates in interstate commerce by listing the states from which the hospital’s patients arrive. Second, paragraphs thirty-nine and forty-four contain bare legal conclusions, without any factual allegations, to the effect that defendants engaged in an unlawful conspiracy in restraint of interstate commerce and that various nonspecified acts of defendants constituted unreasonable restraints on interstate commerce crippling the business of plaintiffs. Finally, paragraphs forty and forty-two contain broad, conclusory allegations on the effects of defendants’ activities on plaintiffs’ business. D. Sufficiency of Plaintiffs’ Interstate Commerce Allegations My review of plaintiffs’ factual allegations under the applicable legal standards leads me to the conclusion that plaintiffs have failed to satisfy even their minimal burden and that defendants therefore are entitled to judgment on the pleadings. I note first that, generally, plaintiffs’ interstate commerce allegations are so vague, broad, and conclusory that plaintiffs’ complaint is probably dismissable on that ground alone under the standards discussed above. See Searer, 381 F.Supp. at 643. I decline to rest my holding solely on this technical pleading ground, however. My holding that plaintiffs’ factual allegations on the interstate commerce issue are insufficient, as a matter of law, to vest this court with jurisdiction is based on a subset of three independent findings. 1. Presence of Interstate Commerce Plaintiffs have failed to allege or identify in their complaint any relevant aspect of interstate commerce legally cognizable under the antitrust laws. Only three specific factual references to interstate commerce appear in plaintiffs’ complaint: (1) defendants are health care providers who operate in interstate commerce, Plaintiffs’ Complaint ¶ 2; (2) plaintiffs provide cardiology services to patients in interstate commerce, id., and (3) CCMC is a health care facility that provides services to patients from several states, id. at ¶ 9. Under the standards described fully in part III A of this opinion, defendants’ treatment of patients in interstate commerce, alleged in paragraphs two and nine of the complaint, is entirely irrelevant for purposes of this motion. Thus, plaintiffs’ remaining interstate commerce theory appears to be premised on the allegations that plaintiffs provide service to patients who travel in interstate commerce. The suggestion that the interstate commerce jurisdictional requirement can be satisfied through the treatment of patients who travel in interstate commerce has been uniformly rejected by all courts considering the issue. In Capili v. Shott, 487 F.Supp. 710 (S.D.W.Va.1978), aff’d, 620 F.2d 438 (4th Cir. 1980), plaintiff brought an action alleging antitrust and civil rights violations in connection with the denial to him of the privilege to practice anesthesiology at the defendant hospital. Dr. Capili’s application for anesthesiology privileges had been denied allegedly because the hospital had entered into an exclusive contract with a group of anesthesiologists for the use of its anesthesiology department. The district court, in an unpublished opinion, granted defendants’ motion to dismiss plaintiffs’ antitrust claims, ruling that the complaint was jurisdictionally deficient in that it did not “support the proposition that the [defendants’] conduct substantially affected interstate commerce.” Capili, No. 78-1009-BL (S.D.W.Va. March 15, 1978), slip op. at 3. The court noted that plaintiffs’ interstate commerce allegations focused on the treatment of patients in both West Virginia and Virginia. The court ruled, however, that these allegations, which were more specific and extensive than plaintiffs’ claims in this case, were inadequate as a matter of law because “the treatment of patients who must ‘travel in interstate commerce’ does not constitute the practice of medicine in ‘interstate commerce as the transportation of such patients is incidental.’” Id. Thus, allegations relating to the treatment of patients who travelled in interstate commerce do not satisfy the interstate commerce requirement of the antitrust laws. See also Riggall, 249 F.2d at 268; Nara v. American Dental Ass’n, 526 F.Supp. 452 (W.D.Mich.1981); Hahn v. Oregon Physicians’ Service, 508 F.Supp. 970, 974 (D.Or.1981); Nankin Hospital v. Michigan Hospital Service, 361 F.Supp. 1199 (E.D.Mich.1973). In the instant case, in which plaintiffs have identified no relevant aspect of interstate commerce other than the travel of their own patients between states, the jurisdictional prerequisite that a relevant channel of interstate commerce be identified has not been met. Plaintiffs’ complaint is therefore subject to dismissal on this ground. 2. Substantial and Adverse Effect on Interstate Commerce Plaintiffs have not met their burden to allege a substantial and adverse effect on interstate commerce. I note initially in this regard that plaintiffs’ allegations of effects on interstate commerce are both vague and conclusory. Further, plaintiffs have pointed to only one single area of interstate activity — the flow of patients from out of state — that could possibly be affected by defendants’ activities. Plaintiffs have cited, and I have located, no case in which a federal court has sustained its jurisdiction on the basis of such paltry and insubstantial interstate commerce allegations. For example, in Hospital Building Co. v. Trustees of the Rex Hospital, 425 U.S. 738, 96 S.Ct. 1848, 48 L.Ed.2d 338 (1976), a case relied on heavily by plaintiffs, the alleged effects on interstate commerce were substantially greater than those in the instant complaint. Plaintiffs’ complaint in Hospital Building Co. identified four relevant aspects of interstate commerce affected by defendants’ activities:. (1) plaintiff purchased medicine and supplies from out-of-state; (2) plaintiff derived revenues from out-of-state insurance companies; (3) plaintiff paid management fees to its out-of-state parent corporation, and (4) financing for plaintiff’s planned expansion would come from out-of-state lenders. The Supreme Court found that plaintiffs’ complaint contained sufficient factual allegations to support a retention of federal jurisdiction. “This combination of factors is certainly sufficient to establish a ‘substantial effect’ on interstate commerce under the Act.” Hospital Building Co., 425 U.S. at 744, 98 S.Ct. at 1852 (emphasis supplied). Even assuming that the flow of out-of-state patients could be considered interstate commerce, an assumption that I am not willing to make, see part III D 1 supra, such activity alone is clearly not the “combination of factors” considered sufficient to meet the interstate commerce requirement in Hospital Building Co. Plaintiffs’ allegations are strikingly similar to the allegations made by the plaintiff in the Tenth Circuit case of Wolf v. Jane Phillips Episcopal-Memorial Medical Center, 513 F.2d 684 (10th Cir. 1975). In Wolf, the plaintiff physician sought to base Sherman Act jurisdiction on allegations that his own business involved the purchase of interstate goods and that the business of the defendant hospital had a similar interstate nature. The court of appeals affirmed the trial judge’s dismissal of the antitrust claims on the ground, inter alia, that the plaintiffs’ jurisdictional allegations were insufficient, and stated: [A]side from a general allegation that his business involves interstate commerce, the plaintiff does not suggest that the defendants’ conspiracy threatens his purchase of interstate goods or that the flow of such goods would be affected in any way by exclusion from the defendants’ medical staff. . . . The facts alleged by the plaintiff cannot support the proposition that his exclusion from the medical staff has affected, or threatens to affect, the defendants, their hospitals, or through them interstate commerce. Wolf, 513 F.2d at 688. The United States District Court for the Eastern District of Michigan was faced with a similar complaint in Grigg v. Blue Cross and Blue Shield of Michigan, 1980-2 Trade Cases ¶ 63,500 (E.D.Mich.1980). Grigg involved a private antitrust action alleging that the operation of a health care program violated the Sherman Act. Defendants moved to dismiss the antitrust counts arguing that plaintiffs had alleged the interstate commerce aspect of their claims only through a sweeping statement that the defendants’ challenged activities “affect interstate trade and commerce.” Grigg, 1980-2 Trade Cases at 76,666. These allegations are remarkably similar to the allegations contained in paragraphs thirty-nine, forty, and forty-four of plaintiffs’ complaint in the instant case. In considering the motion to dismiss, the district court invoked the line of jurisdictional cases cited above. See part III A supra. Finding that the plaintiffs had offered only a “conclusory allegation” in this regard, the court was compelled to dismiss the antitrust counts for lack of jurisdiction because the “[pjlaintiffs have failed to plead any specific factual allegations that the challenged activities have a substantial adverse effect on interstate commerce." Id. (emphasis supplied). Finally, in Barr v. National Right to Life Committee, Inc., No. 79-420-ORL-CIV-Y (M.D.Fla. July 27, 1981), the court was faced with the following interstate commerce allegations: plaintiff treats patients who travel in interstate commerce; plaintiff receives payment from government agencies or insurance companies located outside the State of Florida; plaintiff uses or prescribes drugs, medical supplies, equipment, products, and materials purchased outside the State; and plaintiff travels in interstate commerce as part of his business. Following the Hospital Building Co. test, the court concluded that, “[t]aken in the aggregate, the impact upon interstate commerce of the denial of staff privileges to Dr. Barr cannot be more than minimal and accordingly is insufficient to confer Sherman Act coverage.” Barr, slip op. at 9. In sum, plaintiffs’ allegations in the instant case fail to allege with specificity any substantial effect on interstate commerce. A comparison of plaintiffs’ allegations in this regard to the allegations of other plaintiffs in similar contexts demonstrates conclusively the inadequacies of plaintiffs’ complaint. 3. Nexus Between Defendants' Challenged Activities and Interstate Commerce Finally, and most significantly, plaintiffs’ complaint is deficient because it does not allege any specific nexus between defendants’ activities and some aspect of interstate commerce. It is this “required ‘critical relationship’ ” which must be alleged, for the court cannot “presume the nexus between the challenged activity and interstate commerce.” Crane v. Intermountain Health Care, Inc., 637 F.2d 715, 724 (10th Cir. 1980) (en banc). Plaintiffs have alleged, at best, merely that both they and defendants provide services to out-of-state patients. They have specified no connection, however, between these patients and the action of defendants in not allowing plaintiffs to perform the specified cardiology procedures at CCMC. Thus, plaintiffs have not demonstrated any “logical connection” between the challenged activity of defendants and interstate commerce, Crane, 637 F.2d at 723, and therefore have not alleged the requisite nexus to establish jurisdiction under the antitrust laws. Language from Hospital Building Co. paraphrased by plaintiffs in their brief, see Plaintiffs’ Memorandum of Points and Authorities in Opposition to Defendants’ Motion for Judgment on the Pleadings 9, illustrates conclusively this deficiency in plaintiffs’ complaint. In Hospital Building Co., the Court stated the following: The complaint, fairly read, alleges that if respondents and their coconspirators were to succeed in blocking petitioner’s planned expansion, petitioner’s purchases of out-of-state medicines and supplies as well as revenues from out-of-state insurance companies would be thousands and perhaps hundreds of thousand dollars less than they would otherwise be. Similarly, the management fees the petitioner pays to its out-of-state parent corporation would be less if the expansion were blocked. Moreover, the multimillion-dollar financing for the expansion, a large portion of which would be from out of State, would simply not take place if the respondents succeeded in their alleged scheme. Hospital Building Co., 425 U.S. at 744, 98 S.Ct. at 1852 (emphasis supplied). In stark contrast, plaintiffs in the instant case have not identified one single specific effect that defendants' actions have had in the past, or will have in the future, on plaintiffs’ operations in interstate commerce. Judge Becker’s recent decision in Daley v. St. Agnes Hospital, Inc., 490 F.Supp. 1309 (E.D.Pa.1980), is also instructive in this regard. In Daley, a former hospital nursing director brought suit under the Sherman Act and the Civil Rights Act alleging that he was discharged and blacklisted because of his vigorous advocacy of the rights, privileges, and professional status of his nursing staff. In granting defendants’ motion for summary judgment on the antitrust claim, the court rejected plaintiff’s argument that an effect on interstate commerce could be established merely by showing that the defendant hospital was “in commerce” through statements alleging the general involvement of out-of-state patients, interstate transportation, interstate media, or interstate purchase of supplies at the hospital: “it is plain that, to meet the necessary jurisdictional requisite, the alleged violation must have some nexus with interstate commerce.” Daley, 490 F.Supp. at 1317 (emphasis supplied). 4. Conclusion In sum, I hold that plaintiffs’ complaint fails to meet even the most minimal standards for properly pleading a cause of action under the antitrust laws. A substantial number of plaintiffs’ factual interstate commerce allegations are broad, vague, and conclusory. The remainder fail even to approach the level of specificity required for a district court to sustain its own jurisdiction. As noted by the Tenth Circuit in Crane, “interstate commerce is not implicated for Sherman Act purposes, every time someone is excluded from a staff, organization, association, or other membership.” 637 F.2d at 726. Accord, Harron v. United Hospital Center, Inc., 522 F.2d 1133 (4th Cir. 1975), cert. denied, 424 U.S. 916, 96 S.Ct. 1116, 47 L.Ed.2d 321 (1976); Riggall v. Washington County Medical Society, 249 F.2d 266 (8th Cir. 1957), cert. denied, 355 U.S. 954, 78 S.Ct. 540, 2 L.Ed.2d 530 (1958); Nankin Hospital v. Michigan Hospital Service, 361 F.Supp. 1199 (E.D.Mich.1973). Plaintiffs’ complaint fails to allege any legally relevant channel of interstate commerce, any substantial effect on interstate commerce, and any connection between the challenged actions of defendants and interstate commerce. As a result, defendants’ motion for judgment on the pleadings must be granted. E. Appropriate Relief Having determined that defendants are entitled to judgment on the pleadings on Count I of plaintiffs’ complaint, the only issue remaining is whether plaintiffs’ complaint should be dismissed with, or without, prejudice, and if without prejudice, whether plaintiffs should be granted leave to continue discovery. For the reasons noted below, I hold that Count I of plaintiffs’ complaint should be dismissed without prejudice. Plaintiffs will be granted leave to amend their complaint, but all discovery in the instant litigation will be stayed pending the filing by plaintiffs of a complaint vesting jurisdiction in this court. Plaintiffs’ complaint fits within the category of complaints that fail to meet even the minimal notice pleading requirements of the federal rules. See part II B supra. Yet, under the applicable precedents, particularly in the Third Circuit, no matter how inadequate the pleading, summary dismissal of complex antitrust actions without granting leave to amend is a highly disfavored practice. See part III B supra. As a result, I have decided not to dismiss Count I with prejudice. Although I have my doubts whether these plaintiffs will ever be able to draft a complaint vesting this court with jurisdiction, this case does not fit within any of the exceptions to the standard rule that leave to amend should be granted almost as a matter of course. See part II supra. This is not a ease in which the merits of the controversy can be thoroughly and fully decided without amendment, as it is conceivable that plaintiffs could amend their complaint to state jurisdiction properly. Further, the record does not disclose any valid reason — such as delay, bad faith, or dilatory motives — for refusing to permit plaintiffs to amend their complaint. My holding that plaintiffs’ Count I allegations should not be dismissed with prejudice has given full effect to the notice pleading policy discussed in part II of this opinion. Similarly, my holding that all discovery should be stayed in this litigation until plaintiffs file a jurisdictionally appropriate complaint gives effect to the efficiency policy also outlined above. The case law is clear that, in a case in which discovery is both necessary and demonstrably useful, a plaintiff’s cause of action should not be dismissed before he has an opportunity to conduct discovery. But, in a case in which discovery would serve no demonstrably useful purpose, granting plaintiffs extensive discovery is an abuse of discretion by the trial judge. In this case, granting plaintiffs discovery at this point in the proceedings would be of no use to them under the applicable substantive jurisdictional standards. In order to state a jurisdictionally proper cause of action under the Sherman Act, plaintiffs must identify their contacts with interstate commerce, not CCMC’s or any of the other defendants’. They then must identify the effects on that channel of interstate commerce. Finally, they must allege a nexus between defendants’ denial of hospital staff privileges and the effects on interstate commerce. None of that information is in the control of defendants. Thus, I hold that, in any denial of hospital staff privileges case, including the instant case, discovery by plaintiffs on the jurisdictional issue is unnecessary as no information gathered in that process is relevant to the court’s jurisdictional inquiry. Thus, until plaintiffs draft a minimally adequate complaint vesting this court with jurisdiction, they are not entitled to engage in costly discovery inquiries. IV. Plaintiffs' Civil Rights Claims Plaintiffs’ Count II allegation that defendants’ conduct violated plaintiffs’ civil rights raises simpler issues than those just discussed with respect to plaintiffs’ antitrust claims. Essentially, plaintiffs allege that the denial of the opportunity to perform the cardiology procedures specified in the complaint constitutes a deprivation of plaintiffs’ equal protection and substantive due process rights guaranteed by the fourteenth amendment. Further, plaintiffs allege that the lack of any hearing in connection with CCMC’s failure to allow them to perform these procedures resulted in the denial of procedural due process under the fourteenth amendment. Defendants argue, however, that plaintiffs have failed to allege specifically a required element of their cause of action — that defendants acted under color of state law — and that the complaint should therefore be dismissed. A. Section 1988 It is axiomatic that, in order to state a cause of action under section 1983, “the plaintiff must prove that the official [1] acted under color of state law and [2] caused an injury to his constitutional or federal rights.” M. Avery & D. Rudovsky, Police Misconduct: Law and Litigation § 2.2, at 2-3 (2d ed. 1981). 1. Deprivation of a Federally Protected Interest “Property interests, of course, are not created by the Constitution. Rather, they are created and their dimensions are defined by existing rules or understandings that stem from an independent source such as state law .... ” Arnett v. Kennedy, 416 U.S. 134, 151, 94 S.Ct. 1633, 1643, 40 L.Ed.2d 15 (1974), quoting Board of Regents v. Roth, 408 U.S. 564, 577, 92 S.Ct. 2701, 2709, 33 L.Ed.2d 548 (1972). Thus, in order to state a cause of action under section 1983, the exclusion of plaintiffs from the performance of certain specified cardiology procedures must be found to be a deprivation of a federally protected interest within the meaning of section 1983. The clarity with which this issue is presented to the court leaves a great deal to be desired. Apparently, defendants would not be averse to my deciding this issue: “For purposes of this motion, the moving defendants do not concede that CCMC’s action in excluding the Plaintiffs from the performance of certain procedures did, in fact, violate any rights of the plaintiffs which are protected by the Constitution or § 1983.” Memorandum of Points and Authorities in Support of Defendants’ Motion for Judgment on the Pleadings 17 n.6 (emphasis supplied). Yet, defendants did not fully brief this issue, and plaintiffs’ responsive memorandum does not even mention it. As a result, I have concluded that it would be inappropriate for me to decide this issue at this time 2. Color of State Law In considering plaintiffs’ constitutional and section 1983 claims, I must determine whether plaintiffs have shown that the challenged activity constitutes action taken under color of state law or “state action.” It is uncontroverted that the fourteenth amendment due process clause inhibits only such action as may be said to be that of the state. The Civil Rights Cases, 109 U.S. 3, 3 S.Ct. 18, 27 L.Ed. 835 (1883). “While the principle that private action is immune from the restrictions of the Fourteenth Amendment is well established and easily stated, the question whether particular conduct is ‘private,’ on the one hand, or ‘state action’ on the other, frequently admits of no easy answer.” Jackson v. Metropolitan Edison Co., 419 U.S. 345, 349-50, 95 S.Ct. 449, 452-53, 42 L.Ed.2d 477 (1974). Notwithstanding this difficulty, the Third Circuit has categorized the decisions in which courts have “pierced the see