A federal judge has cut surgery centers out of a proposed patient class action accusing Dallas-based U.S. Anesthesia Partners of monopolizing anesthesia in Texas, ruling that the woman who brought the claims never paid for anesthesia at an ASC.
In a Sept. 30 order, Judge Alfred Bennett of the U.S. District Court for the Southern District of Texas dismissed the ASC-based portions of three antitrust claims for lack of standing. The rest of the case, which centers on anesthesia delivered in hospitals, will move forward against USAP and two affiliated entities.
The ruling narrows the only USAP case that had tried to bring ASCs into the fight. The Federal Trade Commission’s 2023 lawsuit against USAP and a separate class action filed by two employee benefit plans both focus on hospital-only anesthesia, and the FTC’s case expressly excludes anesthesia that can be provided outside a hospital setting.
Christy Burbage, a Texas resident who alleged she paid USAP $916.55 for anesthesia at Texas Health Presbyterian Hospital Plano, replaced Basel Musharbash as the named plaintiff in February. Mr. Musharbash filed the suit in January 2025. Ms. Burbage’s amended complaint added a second market for anesthesia at ASCs, specialized clinics and other nonhospital sites, which she described as related to but distinct from the hospital market.
She alleged USAP increased its share of and pricing power in that market by acquiring ASC-focused providers and by leveraging its hospital market power to charge inflated prices to patients receiving anesthesia at ASCs. She sought to represent a second class of patients who paid for hospital or ASC anesthesia since Sept. 21, 2019, and asserted three claims in both markets: unlawful acquisition under the Clayton Act, and attempted monopolization and market division under the Sherman Act.
Mr. Bennett found the theory ran into Ms. Burbage’s own allegations. Her complaint described hospital and ASC anesthesia as services that are not interchangeable and belong to separate markets, and she did not allege that she ever purchased anesthesia at an ASC.
“Plaintiff alleges one course of conduct but two markets, and she was a purchaser in only one of them,” Mr. Bennett wrote.
Ms. Burbage argued that her injury flowed from the same overarching scheme that harmed ASC patients and that any mismatch with other class members was a question for class certification. The court disagreed, holding that a named plaintiff must have standing for each claim she personally brings before class certification is considered. It also rejected her argument in briefing that the two services are functionally identical from the patient’s perspective, noting that a plaintiff cannot amend her pleadings through briefs.
Nor did USAP’s own position in the FTC case, that hospital and non-hospital anesthesia belong to a single market, help her. At the pleading stage, the court said, it must take Ms. Burbage’s allegations as written rather than substitute USAP’s argument in another case.
The court also denied her request to amend the ASC claims, which she made in part by citing USAP’s recent production of documents about the ASC market.
“Plaintiff received anesthesia at a hospital, and no amendment can change that fact,” Mr. Bennett wrote.
The ruling does not fully close the door on ASC claims. The dismissal was without prejudice, and the court noted that Ms. Burbage has not asked to add a class representative who paid for ASC anesthesia. It expressed no view on whether such a request could meet the standard for amending pleadings after a scheduling deadline has passed.
The court also did not decide on USAP’s argument that the ASC claims were filed too late. USAP contended the FTC suit did not pause the statute of limitations for a market the agency expressly excluded. Because Ms. Burbage lacked standing, the court said it did not have jurisdiction to resolve that question.
The court kept USAP’s corporate parent, U.S. Anesthesia Partners Holdings, and its Texas professional association, U.S. Anesthesia Partners of Texas, in the case. The court had dismissed the Texas affiliate from the employee benefit plans’ case in March, but this time pointed to a 2014 agreement under which the affiliate, doing business as Greater Houston Anesthesiology, allegedly billed for Baylor College of Medicine anesthesiologists’ services at its own higher rates and collected the payments.
The court dismissed with prejudice a claim that USAP conspired to monopolize with Welsh Carson, its private equity backer, which Ms. Burbage did not defend. Claims against Welsh Carson were dismissed in August 2025.
Claims for monopolization, unlawful acquisition, attempted monopolization, price-fixing and market division will proceed to the extent they rest on the market for hospital-only anesthesia. Class certification proceedings are scheduled for late 2026 into early 2027, with trial set for January 2028.
The ruling comes as USAP works through its settlement with the FTC. The agency announced an agreement in principle April 23, and the terms remain confidential while USAP implements proposed relief over 180 days. A final order requires approval from the commission and the court.
The commission has not voted on a final order, and the FTC’s case is stayed until Nov. 18, an FTC spokesperson told Becker’s.
Becker’s has also reached out to USAP and Ms. Burbage’s legal counsel, and will update this article if more information becomes available.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
