Innovative Health LLC v. Biosense Webster, Inc.

UNITED STATES DISTRICT COURT

CENTRAL DISTRICT OF CALIFORNIA

CIVIL MINUTES - GENERAL

Case No. §8:19-cv-01984-JVS-KES Date July 31, 2025

Title Innovative Health LLC v. Biosense Webster, Inc.

Present: The Honorable James V. Selna, U.S. District Court Judge

Elsa Vargas Not Present

Deputy Clerk Court Reporter

Attorneys Present for Plaintiffs: Attorneys Present for Defendants:

Not Present Not Present

Proceedings: [IN CHAMBERS] Order Regarding Motion for Permanent

Injunction [535]

Plaintiff Innovative Health LLC (“Innovative”) moves for a permanent injunction

against Biosense Webster, Inc. (“Biosense”). (Mot., Dkt. No. 535.) Biosense opposed.

(Opp’n, Dkt. No. 546.) Innovative replied. (Reply, Dkt. No. 556.) Parties appeared for

oral argument on July 21, 2025.

For the foregoing reasons, the Court GRANTS the motion but with modifications

as to the scope of the proposed injunction.

The Court grants Innovative seven (7) days from this order to submit a revised

proposed injunction. Biosense may oppose any language in Innovative’s proposed

injunction within seven (7) days following Innovative’s filing. Both parties may submit

additional briefings of no longer than one page if necessary.

I. BACKGROUND

The facts of this case are well known to the Court and the parties. The Court

recites them here only as necessary to resolve this Motion.

Biosense, owned by Johnson & Johnson (“J&J”), is a corporation that

manufactures and sells the CARTO 3 cardiac mapping system and electrophysiology

(“EP”) products, including catheters, that can be used with that system. (Corrected

Second Amended Complaint (“SAC”), Dkt. No. 59 49 12, 31.) Innovative is an Arizona

company that reprocesses and sells EP catheters that can be used with cardiac mapping

systems. (Id. § 1.) Innovative alleged that Biosense’s case coverage policy prohibits its

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clinical account specialists (“CAS”) from supporting CARTO 3 mapping procedures

using another manufacturer’s catheters. (Id. ¶ 19.) Biosense’s anti-reprocessing

technology, like its Falcon security chip, also hindered the expedient market entry of

Innovative’s reprocessed catheters. (Id. ¶ 34.) Innovative brought this instant action

alleging that Biosense violated federal and California antitrust laws. (See id.)

The trial commenced on May 6, 2025, and the jury reached its verdict on May 16,

2025. They returned a verdict in favor of Innovative on claims for unlawful tying under

Section 1 of the Sherman Act, unlawful monopolization under Section 2 of the Sherman

Act, attempted monopolization under Section 2 of the Sherman Act, and unlawful tying

under Section 16720 of California’s Business and Professions Code, the Cartwright Act.

(Verdict, Dkt. No. 527.) The jury awarded Innovative damages in the amount of

$147,406,481.00, which is automatically trebled to $442,219,443.00 pursuant to 15

U.S.C. § 15(a) and Cal. Bus. & Prof. Code § 16750(a). (Judgment, Dkt. No. 532.) The

Court entered judgment in favor of Innovative on June 5, 2025. (Id.)

II. LEGAL STANDARD

The standard for determining whether a permanent injunction should be granted is

“essentially the same as the standard for a preliminary injunction, except that the court

determines the plaintiff’s success on the merits rather than the plaintiff's likelihood of

success on the merits.” Amoco Prod. Co. v. Village of Gambell, Alaska, 480 U.S. 531,

546 n.12 (1987).

To obtain a permanent injunction, a plaintiff must demonstrate “(1) that it has

suffered an irreparable injury; (2) that remedies available at law, such as monetary

damages, are inadequate to compensate for that injury; (3) that, considering the balance

of hardships between the plaintiff and defendant, a remedy in equity is warranted; and

(4) that the public interest would not be disserved by a permanent injunction.” eBay Inc.

v. MercExchange, L.L.C., 547 U.S. 388, 391 (2006). The Court’s “decision to grant or

deny permanent injunctive relief is an act of equitable discretion by the district court.”

Id. at 391.

In antitrust cases, district courts should fashion injunctive reliefs “to redress the

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Title Innovative Health LLC v. Biosense Webster, Inc.

I. du Pont de Nemours & Co., 366 U.S. 316, 323, 326 (1961); see Ford Motor Co. v.

United States, 405 U.S. 562, 573 (1972). Accordingly, it may be necessary for a district

court to “order an injunction ‘beyond a simple proscription against the precise conduct

previously pursued.’” Optronic Techs., Inc. v. Ningbo Sunny Elec. Co., 20 F.4th 466,

486 (9th Cir. 2021) (citing Nat’l Soc’y of Prof’l Eng’rs v. United States, 435 U.S. 679,

698 (1978)). Nevertheless, the injunctive relief must not be “more burdensome to the

defendant than necessary to provide complete relief to the plaintiff.” Epic Games, Inc. v.

Apple, Inc., 67 F.4th 946, 1002 (9th Cir. 2023), cert. denied, 144 S. Ct. 681, 217 L. Ed.

2d 382 (2024), and cert. denied, 144 S. Ct. 682, 217 L. Ed. 2d 382 (2024) (cleaned up)

(citations omitted). An “injunction will only issue if the wrongs are ongoing or likely to

recur,” and the scope of the injunction is within antitrust law. Fed. Trade Comm’n v.

Qualcomm Inc., 969 F.3d 974, 1005 (9th Cir. 2020); see United States v. Borden Co.,

347 U.S. 514, 520 (1954).

Further, the district court must adhere to the basic precept set forth in Rule 65(d),

which requires “fair and precisely drawn notice of what the injunction actually

prohibits.” Fed. R. Civ. P. 65(d); In re Nat’l Collegiate Athletic Ass’n Athletic

Grant-in-Aid Cap Antitrust Litig., 958 F.3d 1239, 1263 (9th Cir. 2020), aff’d sub nom.

Nat’l Collegiate Athletic Ass’n v. Alston, 594 U.S. 69 (2021) (citing Fortyune v. Am.

Multi-Cinema, Inc., 364 F.3d 1075, 1086–87 (9th Cir. 2004)).

III. DISCUSSION

Innovative prevailed on all claims at trial: (1) unlawful tying arrangement under

Section 1 of the Sherman Act; (2) unlawful monopolization under Section 2 of the

Sherman Act; (3) attempted monopolization under Section 2 of the Sherman Act; (4) and

unlawful tying arrangement under the Cartwright Act. (See Verdict.)

Innovative now requests the Court issue a permanent injunction that:

1. Terminates Biosense’s illegal case coverage policy by enjoining Biosense

from:

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A. conditioning the provision of Clinical Support on the purchase of

Biosense’s catheters or Consumable1, and

B. discriminating in the provision of clinical support or the availability

of CARTO to parties other than Biosense.

2. Permanently enjoins Biosense from implementing its blocking Technology2

that conditions the availability or use of CARTO on Biosense’s or a third

party’s Consumable.

3. Permanently enjoins Biosense’s collection of used Consumable that does

not have (i) regulatory approval to reprocess under section 510(k) of the

Food, Drug and Cosmetic Act or (ii) has a pending application for approval

to reprocess under section 510(k) of the Food, Drug and Cosmetic Act, with

the exception of:

A. Used Consumable to the extent necessary to support a 510(k)

application to reprocess that Consumable,

B. Used Consumable to the extent necessary to investigate and

remediate a defect, and

C. Ablation catheters that no other person reprocesses.

4. Orders Biosense’s executive with the relevant knowledge and compliance to

submit a report3 to the Court every six months during the injunction term.

5. Requires notification of the injunction in writing, agreed by both parties, to:

i. Past and current CARTO users within 21 days of entry of the

injunction that specify that Biosense will provide Clinical Support to

every customer or end user on nondiscriminatory terms and without

1Biosense defines Consumable as a device (including, but not limited to, an electrophysiology

catheter) originally manufactured by Biosense for use with CARTO. (Proposed Permanent Injunction,

Dkt. No. 535-2 ¶ 1.3.) The Court does not find this term overbroad given there are other devices, not

limited to catheters, that Biosense used to hinder competition in the relevant market. (Declaration of

Matthew Reade (“Reade Decl.”), Dkt. No. 535-1, Ex. 3, 40:1-18) (discussing the reprocessed Vizigo

sheath, which was neither a catheter nor sensor-enabled, but was still included in Biosense’s coverage

policy).)

2Technology is defined as any technology installed by or for Biosense on CARTO, on hardware

or software supporting the operation of CARTO or of any Consumable (e.g., remote server), or on a

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regard to whether that person uses Consumables of someone other

than Biosense4;

ii. New CARTO purchasers of the injunction’s terms;

iii. All sales employees, including all clinical account specialists, within

14 days of entry of the injunction and on an annual basis, of their and

Biosense’s obligation under the injunction; and

iv. All new sales employees, including all clinical account specialists, of

this injunction within 10 days of the commencement of their

employment.

6. Permits Innovative to establish, at its expense, a hotline for reporting actual

or potential noncompliance with this injunction, and requires Biosense to

notify, within 21 days of receiving confirmation that it has been created, its

employees and past and current CARTO users.

7. Stays in effect for ten years from the date of entry of the permanent

injunction subject to modification, extension, or termination for good cause.

(Modified Proposed Permanent Injunction, Dkt. No. 556-2.)

In sum, Innovative seeks a permanent injunction with respect to three categories of

Biosense’s practices: (1) case coverage policy regarding clinical support, (2) use of anti-

reprocessing blocking technology, and (3) collection of catheters. (See Mot.) The Court

discusses the eBay factors as to each category in turn. This Court will also address

whether the requested relief is appropriate in scope and adequate to restore competition

in the relevant market.

A. Case Coverage Policy

Innovative seeks to enjoin Biosense from conditioning its clinical support of

CARTO on the use of Biosense’s or a third party’s catheters. Its proposed injunction

also has a non-discriminatory clause that enjoins Biosense from limiting access to

4Innovative seeks the notice be sent to “all persons who Biosense understands have responsibility

for contracting or procurement on behalf of past or current customers who have or have had a CARTO”

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CARTO or its clinical support for those who use non-Biosense catheters. (See Proposed

Permanent Injunction ¶ 2.)

1. Entitlement to Injunctive Relief

First, Innovative must demonstrate that it faces an irreparable antitrust injury.

There is an irreparable injury if the “wrongs are ongoing or likely to reoccur.”

Qualcomm, 969 F.3d at 1005 (citations omitted); Zenith Radio Corp. v. Hazeltine Rsch.,

Inc., 395 U.S. 100, 139 (1969) (“[Plaintiff] need only demonstrate a significant threat of

injury from an impending violation of the antitrust laws or from a contemporary

violation likely to continue or recur.”) Loss of business, goodwill, reputation, as well as

a “lessening of competition constitutes an irreparable injury.” Boardman v. Pac. Seafood

Grp., 822 F.3d 1011, 1023 (9th Cir. 2016); Steves & Sons, Inc. v. JELD-WEN, Inc., 988

F.3d 690, 719 (4th Cir. 2021). On the other hand, economic injuries or “readily

calculable money damages” are not considered irreparable. Epic Games, 67 F.4th at

1003.

Biosense argues that there is no irreparable harm because the damages from the

clinical support policy are readily calculable money damages as Innovative’s expert has

shown. (Opp’n at 8.) However, this argument misses the mark. The question is whether

there is an ongoing or likelihood of recurring violation of the antitrust laws. A lessening

of competition resulting from Biosense’s years of anticompetitive behavior is one that

cannot be remedied by a single check. See In re Google Play Store Antitrust Litigation,

No. 20-CV-05671-JD, 2024 WL 4438249, at *4 (N.D. Cal. Oct. 7, 2024). Moreover, an

award of damages does not foreclose injunctive relief. See Image Tech. Servs., Inc. v.

Eastman Kodak Co., 125 F.3d 1195, 1221–26 (9th Cir. 1997) (upholding both damages

and the district court’s permanent injunction).

Biosense also contends that there is no irreparable harm because Innovative’s

business operated for years with Biosense’s clinical support policy in place. (Opp’n at

10.) Again, the irreparable harm factor does not turn on the mere existence of a business.

The “threat of being driven out of business” or long-term harm to a business, such as the

losing its market position, may be sufficient to demonstrate the requisite showing of

irreparable harm. Am. Media Corp. v. Cass Commc’ns, Inc., 750 F.2d 1470, 1474 (9th

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reflects instances where customers like Marin Health Medical stated they wish to use

reprocessed Pentaray catheters from Innovative but was unable to do so because

Biosense would stop covering their cases. (See, e.g., Trial Tr. 5/7/25 PM 88:11-14.)

While the loss in revenue does not constitute irreparable harm on its own, alienating

businesses by preventing customers from buying Innovative’s reprocessed devices and

depriving them of choice exacerbates the harm to Innovative’s business, reputation, and

goodwill. See Boardman, 822 F.3d at 1023.

In addition, here, the jury found Biosense had “violated Section 1 of the Sherman

Act through a tying arrangement.” (Verdict ¶ 1.) The instructions for the tying claim

require that the jury find that there was a substantial harm to competition or reduction in

competition in the relevant market. (See Jury Instructions, Dkt. No. 521, Nos. 16-17.)

So long as Biosense clinical support policy is tied to the purchase of its catheters,

Innovative’s business will continue to suffer. Thus, both the first and second5 eBay

factors weigh in favor of an injunction.

The public interest factor also favors granting injunctive relief. The injunction

should “unfetter a market from anticompetitive conduct” and effectively “pry open to

competition a market that has been closed by defendant[’s] illegal restraints.” Ford

Motor Co., 405 U.S. at 577 (citing Int’l Salt Co. v. United States, 332 U.S. 392, 401

(1947), abrogated on other grounds by Illinois Tool Works Inc. v. Indep. Ink, Inc., 547

U.S. 28 (2006)). This factor looks at the impact of the injunction on non-parties. Epic

Games, 493 F. Supp. 3d at 852.

Here, the injunction regarding the tying arrangement would allow other

competitors in the relevant markets to develop their own CARTO-compatible catheters

or devices. Ensuring customers have a variety of options and access to higher quality

products is a fundamental goal of antitrust law. In this regard, Innovative makes the

more persuasive argument for enjoining Biosense’ case coverage policy, as well as its

anti-reprocessing technology, and catheter collection policies. Innovative contends that

5The second eBay factor, the adequacy of legal remedies, requires district courts to ascertain

whether remedies available at law, such as monetary damages, are inadequate to compensate for the

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the injunction will “benefit all independent reprocessors of CARTO-compatible

products,” not just Innovative’s position in the market. (Mot. at 23.) Since contingent

clinical support for CARTO on the use of Biosense’s catheters locks in buyers, the

injunction would help unfetter locked-in customers. (Id. at 22–23; see, e.g., Reade Decl.,

Ex. 3, 106:15-20.) Moreover, as Innovative argues, a competitive market may result in

lower prices and higher quality products that contribute to better patient care. (Mot. at

28–29; Reade Decl., Ex. 3, 79:9-25 (“[D]ata sources indicate that Innovative has higher

quality than Biosense or Sterilmed.”).) In sum, there is no doubt that the eBay factors

support granting an injunction.6

2. Scope and Effectiveness of the Injunction

Biosense sets forth various arguments as to why the non-discriminatory clause in

particular is overbroad and unnecessarily burdensome. The clause states in relevant part:

Biosense is further enjoined from discriminating in the

provision of Clinical Support or the availability of CARTO

because of the purchase or use of (or the intention to use) a

Consumable of someone other than Biosense. Without

limitation, and by way of example only, Biosense may not

refuse, withdraw, or degrade the availability of Clinical

Support or CARTO, or charge a higher price for Clinical

Support or for the sale, lease, or use of CARTO, because a

hospital or doctor has used, is using, will use, or may use a

Consumable of someone other than Biosense.

(Proposed Jury Instruction ¶ 2.2.)

As an initial matter, non-discriminatory provisions are not an unprecedented

antitrust remedy. Courts have previously granted injunctions with nondiscriminatory

6Although Biosense argued at oral argument that it has authorized CAS to support any CARTO

procedures and has no intention of resuming its case coverage policy, especially if the verdict is

sustained on appeal, the grave antitrust violation under both sections of the Sherman Act clearly warrants

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provisions. See Kodak, 125 F.3d at 1227; Optronic Techs., 20 F.4th at 486; see also In

re Google Play Store Antitrust Litig., at *7. Biosense argues that Kodak and Optronic

are inapposite because they involved sales of goods, which are the “same regardless of

the circumstances of the sale” whereas clinical support depends on the catheter used or

the arrhythmias being treated. (Opp’n at 15.) However, the distinction is of no material

difference. The terms and conditions of sale or service are both subject to change. The

language in Innovative’s proposed injunction also largely replicates that in Kodak.

(Reply at 16.) The Ninth Circuit affirmed a non-discriminatory clause that states,

“Kodak shall not discriminate against any customer or other party on the basis that such

customer or other party has used the parts or services of someone other than Kodak in

connection with Kodak equipment.” Kodak, 125 F.3d at 1227. Nevertheless, the Court

is mindful that each individual case requires a unique set of injunctions tailored to the

specific needs of the case.

First, Biosense contends that the injunction would force Biosense’s CAS, who also

sell and market Biosense’s products, to do the same for Innovative’s products. (Opp’n at

13–14.) This argument is meritless. The language of the non-discriminatory clause does

not lend itself to such interpretation and the definition of Clinical Support is limited to

“services provided to operate the CARTO.” (Proposed Jury Instruction ¶ 1.4.)

Second, Biosense avers that the non-discriminatory provision restricts Biosense’s

ability to provide competitive pricing for its clinical support, which is currently free and

only benefits buyers of Biosense catheters. (Opp’n at 14–15.) But that is precisely the

issue. The current case coverage policy discriminates against non-Biosense catheter

users and thus, the goal of this injunction is to level the playing field. Biosense also does

not claim that they cannot continue to provide free clinical support. Prior to their case

coverage policy, they provided their services to all users. (Reade Decl., Ex. 18, 69:16-

19.) Innovative’s expert witness also testified that other mapping system manufacturers

provide free clinical support where a third-party catheter is used. (Reade Decl., Ex. 17,

84:24-85:1.) The Court also notes that it does not seek to encourage free-riding. As

such, the proposed injunction does not prevent Biosense from charging for its clinical

support; it merely prohibits Biosense from engaging in discriminatory pricing.

Third, Biosense argues that the non-discriminatory clause does not provide any

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at 15.) For instance, Biosense claims that the provision is unclear on how Biosense

should respond to simultaneous requests for case support where one involves only

Biosense’s products and the other uses Innovative reprocessed catheters. (Id.) However,

the proposed non-discriminatory provision is purposefully broad in that regard. It does

not require that Biosense take on one case over another, but only that it not limit the

availability of its clinical support based on the manufacturer. (See Proposed Permanent

Injunction ¶ 2.2.)

Fourth, Biosense contends that conditioning the availability of CARTO, including

its “sale, lease, or use,” not just its clinical support policy, is overbroad. (Opp’n, at 16.)

Biosense argues that its customers commonly finance CARTO through their commitment

to buying their catheters. (Id.) Though the injunction would limit one method of

financing CARTO, Biosense’s own expert, Dr. Wu, testified that “there are many ways

to finance a system purchase.” (Reade Decl., Ex. 18, 28:24–29:5.) The sufficient

alternative methods of acquiring CARTO put Biosense at a minimal competitive

disadvantage. Innovative also makes the more persuasive argument that prohibiting the

conditioning of clinical support on the purchase of Biosense’s catheters without touching

upon CARTO “would leave a giant loophole.” (Reply at 18.) Without this provision,

Biosense could limit access to CARTO without strictly tying its products. It was

Biosense’s position at trial that “clinical account specialist is not a separate market,” but

“simply part of the system that each of the mapping system companies provide.” (Trial

Tr. 5/6/25 PM, 89:17–25.) Biosense claimed there are “three pieces” to the

system—cardiac mapping machine, catheters, and CAS. (Id. 87:3–7.) An injunction that

focuses only on two of the three pieces would fail to remedy the lack of competition in

the relevant market. Prohibiting Biosense from conditioning access to CARTO or its

clinical support based on the manufacturer of the catheters for a discrete period is a step

towards restoring competition. Given that district courts have “broad power to restrain

acts which are of the same type or class as unlawful acts which the court has found to

have been committed,” the Court determines that the provisions regarding the

availability of CARTO are not overly broad. See Zenith Radio, 395 U.S. at 132

(citations omitted).

Finally, Biosense claims that the clause is vague as to what “discriminating” or

“degrading” entails. (Opp’n at 12.) For instance, although Biosense’s CAS do not have

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be required to “interpret[] maps and provid[e] insight on the images generated by the

CARTO” under the proposed injunction. Biosense contends that its CAS would be

placed in an untenable position attesting to the accuracy of the maps generated by non-

Biosense catheters. (Id.) According to Biosense, the gap in knowledge and the required

clinical support is likely to not only burden Biosense’s CAS, but ultimately affect

doctors and patient care. (Opp’n at 12–13.)

Since Biosense’s does not “dispute that [Innovative] has FDA clearances that find

[Innovative] devices [] substantially equivalent to predicate Biosense devices,” the Court

finds that Biosense’s CAS can effectively support clinical procedures where Innovative’s

catheters are used. (Opp’n at 12.) It is also not evident that doctors ask CAS about the

accuracy of catheters during clinical procedures.7

Nevertheless, even a hypothetical situation where a doctors asks CAS about

Innovative’s catheter technical specifications is a legitimate concern for Biosense that

provides the clinical support. In the event that CAS are asked about specifications

during procedures, the Court orders Innovative to add specific language in the modified

proposed injunction that Biosense’s CAS have no responsibility to make any

representations as to the accuracy, performance, or specifications of a competitor’s

products.

For the foregoing reasons, the Court grants the injunction as to the case coverage

policy with necessary modifications.

B. Anti-reprocessing Technology

Innovative seeks to prohibit Biosense from implementing any future blocking

technologies that condition the availability or use of CARTO on Biosense’s devices.

(Mot. at 15.) The jury found that Biosense violated Section 2 of the Sherman Act and

awarded all $147 million that Innovative sought, including $8 million in damages for the

delay in Innovative’s market entry due to Biosense’s blocking technology. (See Verdict;

7 See, e.g., Trial Tr., 5/7/25 PM, 49:17–22 (“Q: But you don’t know the process for Sterilmed to

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Reade Decl. Ex. 3, 84:15-25.)

Biosense contends that Innovative cannot seek an injunction for its past conduct,

including its electronically erasable programmable read-only memory chips (“EEROM”)

such as the Falcon chip, which was developed nearly a decade ago. (Opp’n at 17.)

Innovative makes clear that it was not their intention to enjoin past conduct, but only

future blocking technologies. (Reply at 19.) This eliminates much of the concern

Biosense raises regarding the broad definition of “Technology.” (Id. at 17–20.) To

prevent further confusion, Innovative filed a modified proposed injunction that

adequately clarifies that the injunction does not apply to technology deployed before

June 5, 2025. (See Modified Proposed Permanent Injunction ¶ 4.2.3.)

The Court further finds that Innovative is entitled to its requested relief under the

eBay factors. There is an ongoing irreparable injury, though to a lesser degree than that

suffered due to the coverage policy. Here, Innovative overcame the hindrances of

Biosense’s current anti-reprocessing technology since around 2018 and has been

compensated $8 million for the delay in market entry. (Cavanaugh Decl., Ex. 8, 109:4-6;

Reade Decl. Ex. 3, 84:15-25.) The technology in the Falcon chip has remained the same

since 2014 and Innovative provides no evidence other than its consideration to create a

new version of this technology seven years ago. (See Declaration of Avi Shalgi (“Shalgi

Decl.”), Dkt. No. 546-18 ¶ 7.)

However, the Court finds an irreparable harm in that Biosense’s technology has

limited the use of CARTO to only Biosense’s catheters, thereby lessening competition in

the market. See Boardman, 822 F.3d at 1023. Although there may no longer be an

ongoing harm, it is entirely possible that Biosense may seek to evade the injunction by

creating a new version of its EEPROMs to exclude non-Biosense devices from

functioning with CARTO. Allowing room for Biosense to continue developing anti-

reprocessing technology would minimize Innovative’s success at trial and make obsolete

the positive competitive effects of this case. Furthermore, to restore effective

competition in this market, the Court finds that a provision prohibiting future anti-

blocking technology goes hand in hand with the injunction on Biosense’s case coverage

UNITED STATES DISTRICT COURT

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hospitals, doctors, and patients, serving public interest. Since Innovative does not

request that Biosense change or eliminate its current EEPROMs, the proposed injunction

would also impose no hardship on Biosense. Thus, for the same reasons that Innovative

was entitled to injunctive relief as to the tying arrangement, the Court comes to the same

conclusion as to the anti-reprocessing technology provision. (See Supra Section III.A.1.)

Biosense disputes that this provision will hinder innovation. (Opp’n 20–21.) For

instance, Biosense avers that the center lumen of some Biosense catheters allows for

more precise mapping, but simultaneously makes reprocessing more challenging. (Id. at

20.)

The goal of antitrust law is not to stifle innovation nor sacrifice patient care. In

fact, it is very much the opposite. Injunctions, therefore, require a careful balance of

considerations, weighing the requisite level of judicial power needed to restore

competition with the defendants’ hardships, business objectives, and ability to innovate.

See E. I. du Pont de Nemours, 366 U.S. at 323. Thus, “caution is key” when it comes to

fashioning an antitrust remedy. Alston, 594 U.S. at 106.

Here, Innovative agrees with Biosense that it does not seek to condemn benign

innovations like the Pentaray’s center lumen. (Reply at 19.) Accordingly, the Court

finds that it is necessary to revise Innovative’s No-Blocking Technology clause to reflect

that the technology may delay reprocessing but may not be intentionally designed to

prevent non-Biosense devices from functioning with CARTO. For example, the Falcon

chips, designed to recognize non-Biosense reprocessed catheters and shut down CARTO

in those instances, would be a clear violation of the injunction.

The Court grants seven (7) days for Innovative to revise the terms of the

injunction.

C. Catheter Collection

UNITED STATES DISTRICT COURT

CENTRAL DISTRICT OF CALIFORNIA

CIVIL MINUTES - GENERAL

Case No. 8:19-cv-01984-JVS-KES Date July 31, 2025

Title Innovative Health LLC v. Biosense Webster, Inc.

that they do not have regulatory approval to reprocess under Section 510(k) or have a

pending application for approval to reprocess. (Modified Proposed Permanent

Injunction ¶ 4.)

Generally, the scope of the injunction must be coterminous with the antitrust

violation. See In re Google Play Store Antitrust Litig., at *4. However, the injunction

may be broad as to limit “practices connected with acts actually found to be illegal”

United States v. U.S. Gypsum Co., 340 U.S. 76, 89 (1950), and to “ensure that there

remain no practices likely to result in monopolization in future,” Optronic, 20 F.4th at

486.

Biosense argues that Innovative failed to demonstrate an irreparable injury due to

its catheter collection practices. (Opp’n at 22.) Contrary to the aforementioned

categories for injunctive relief, neither Innovative’s damages nor the verdict form

includes Biosense’s collection practices. Indeed, the verdict form only shows that

Biosense violated Section 2 of the Sherman Act by creating or attempting to create a

monopoly through “anticompetitive practices,” which may or may not include Biosense’s

catheter collection. (See Verdict ¶¶ 2–3.)

Although the jury did not make findings specific to Biosense’s catheter collection

practices, the Court is persuaded that Biosense’s case coverage policy is sufficiently

“connected with” its collection practices. Gypsum, 340 U.S. at 89. While the case

coverage policy focuses on sensor-enabled catheters, Biosense’s collection practicies

target catheters like AcuNav that are outside the scope of the case coverage policy, an

alternative avenue for Biosense to choke competition in the catheter markets. Innovative

demonstrated at trial that Biosense collected catheters that it could not even reprocess to

intentionally restrict the supply of catheters. (Mot. at 17; Reade Decl., Ex. 3,

44:17–46:12 (explaining Biosense’s internal documents show it expanded the collections

to DECANAV, which it does not reprocess); Reade Decl. JX-221 (“If we control supply,

we can greatly minimize competitive activity”); Reade Decl. JX-298 (“If we control

AcuNav collections, we control the market. In fact, it’s not far fetched to believe that if

we were able to collect back 75% of the OEM AcuNav we sell, we could drive Stryker

UNITED STATES DISTRICT COURT

CENTRAL DISTRICT OF CALIFORNIA

CIVIL MINUTES - GENERAL

Case No. 8:19-cv-01984-JVS-KES Date July 31, 2025

Title Innovative Health LLC v. Biosense Webster, Inc.

due to Biosense’s catheter collection of AcuNav and restricting supply, Stryker has

ultimately stopped selling them).) Although Biosense argues that Innovative’s own

employee claimed that there was a sufficient supply of catheters to meet the demand,

Meredith Snider’s testimony pertained to sensor-enabled catheters. (Opp’n at 22;

Cavanaugh Decl., Ex. 1, 19:1–17.) But there was a sufficient supply of sensor-enabled

catheters, accordingly to Innovative, because of low demand as a result of Biosense’s

case coverage policy. (July 21, 2025 Hr’g Tr. (forthcoming); see Reade Decl, Ex. 6,

56:2–7.))

Since Innovative demonstrated at trial that Biosense’s collection practices have

lessened competition and constantly posed a threat to the catheter reprocessing

businesses, the Court finds it is necessary to prevent Biosense from hoarding devices it

cannot or does not plan to reprocess. See Boardman, 822 F.3d at 1023; Am. Media

Corp., 750 F.2d at 1474. The proposed injunction, moreover, is not overly restrictive, as

it prohibits Biosense from collecting only those that lack regulatory approval or pending

application for approval, and allows for reasonable exceptions. (Modified Proposed

Injunction ¶ 4.) Accordingly, the Court grants the injunction regarding the collection

practices to ensure fair competition—that Biosense collects catheters for good faith

reasons, not to stockpile and limit their supply.

D. Ancillary Provisions

1. Reports to the Court

A district court is “not obliged to assume . . . that a violator will relinquish the

fruits of his violation more completely than the court requires him to do.” Nat’l Soc. of

Pro. Eng’rs, 435 U.S.at 698. However, the Supreme Court also cautioned district courts

from “continuing supervision of a highly detailed decree [as it] could wind up impairing

rather than enhancing competition.” Alston, 594 U.S. at 102 (quotations and citation

omitted).

Biosense contends that there is no basis to require semiannual reports because

UNITED STATES DISTRICT COURT

CENTRAL DISTRICT OF CALIFORNIA

CIVIL MINUTES - GENERAL

Case No. 8:19-cv-01984-JVS-KES Date July 31, 2025

Title Innovative Health LLC v. Biosense Webster, Inc.

(Opp’n at 25.) On the contrary, Innovative argues that it will not know whether or how

Biosense is complying with the injunction. Biosense does not provide any reason to find

that the reports are unnecessarily detailed, costly, or burdensome. See Alston, 594 U.S.

at 102. Accordingly, the Court finds that the biannual report requirement imposes a

minimal burden on Biosense.

2. Hotline

Biosense also contends that there is no reason to include a hotline provision in the

injunction because J&J already has its own publicly accessible hotline. (Opp’n at 26.)

Yet, it is reasonable to assume that customers or employees of J&J would be reluctant to

use their own company’s hotline to report a violation due to a lack of trust or in fear of

retribution. (Reply at 25.) Letting J&J collect reports of its own potential

noncompliance is like letting the fox in the henhouse. As Innovative seeks to create a

hotline at its own expense, it would not impose any burden Biosense. Biosense also

argues that the hotline provision “creates a strong inference that the Court supports

[Innovative’s] hotline,” and would interfere with Biosense’s ability to comply with the

injunction, federal and state law, and the company’s policies. (Opp’n at 26.) Biosense

does not address these vague assertions of potential consequences. Thus, the Court finds

no cause to deny this request.

Biosense additionally requests during the hearing that it seeks prompt notification

of the third party establishing the hotline and seven days to object in order to ensure the

third party is competent and reputable. Innovative may accommodate Biosense’s request

and add provisions in its proposed order if it finds it necessary.

3. Injunction Term

Finally, Innovative proposes a ten year term like that in Kodak. (Mot. at 25.) The

Court finds that the proposed term may be unduly long. The market realities today are

different from those in 1997, when the Kodak court granted the injunction. See id.

UNITED STATES DISTRICT COURT

CENTRAL DISTRICT OF CALIFORNIA

CIVIL MINUTES - GENERAL

Case No. 8:19-cv-01984-JVS-KES Date July 31, 2025

Title Innovative Health LLC v. Biosense Webster, Inc.

punitive” and that three years is sufficient. (Opp’n at 27.) Biosense contends that in In

re Google Play Store Antitrust Litigation, the Court granted an injunction of three years

where were network effects created barriers to entry. As granting the injunction as to the

case coverage policy would remove any barriers, Biosense argues that three years should

be sufficient.

However, both parties sagreed that supply contracts in the catheter industry often

last three years. (See July 21, 2025 Hr’g Tr. (forthcoming).) If the Court were to issue a

three-year injunction today, the injunction would terminate prior to Innovative’s future

contracts. To ensure that the term of the injunction does not disincentivize any

contractual relations and that it remains in place for at least one cycle of Innovative’s

contract, the Court is inclined to set a term for five years. In any event, the Court intends

to retain the power adjust the term, whether to shorten or lengthen, to reflect ongoing

market conditions and changes therein.

IV. CONCLUSION

For the foregoing reasons, the Court GRANTS the motion but with modifications

as to the scope of the proposed injunction. The Court grants Innovative seven (7) days

from this order to submit a revised proposed injunction. Biosense may oppose any

language in Innovative’s proposed injunction within seven (7) days following

Innovative’s filing.

IT IS SO ORDERED.