Johnson & Johnson’s health technology subsidiary, Biosense Webster, has seen its $147 million antitrust trial loss increase to $442 million following a ruling by a federal jury in California. The jury found that Biosense Webster unlawfully stifled competition by conditioning cardiac mapping services on the purchase of its cardiac catheters.

The initial verdict in May favored plaintiff Innovative Health, a company licensed by the U.S. Food and Drug Administration to refurbish and resell Biosense’s cardiac catheters. The jury concluded that Biosense violated federal and state antitrust laws by refusing to provide cardiac mapping technicians for its Carto 3 system unless hospitals also purchased catheters directly from Biosense.

U.S. District Judge James Selna tripled the damages awarded to Innovative Health, citing violations of the Sherman Antitrust Act. The judge is expected to issue further rulings on injunctive relief.

Cardiac mapping, a critical procedure for diagnosing arrhythmias, relies on GPS-enabled catheters to create detailed 3D images of the heart. Innovative Health’s ability to provide refurbished catheters offers hospitals an alternative to Biosense’s products, a choice the court found Biosense unfairly restricted.

Innovative Health alleged Biosense implemented a “case coverage” policy in 2016 that barred its technicians from servicing refurbished catheters and even engineered a special chip to block unauthorized devices.

Biosense, which generates billions in catheter sales, defended its practices by emphasizing robust competition with major industry players like Abbott, Medtronic, and Boston Scientific. Biosense’s legal counsel argued that hospitals retain the ability to switch mapping systems and that no separate market exists for catheters and mapping support services.

The case, Innovative Health LLC v. Biosense Webster Inc., case number 8:19-cv-01984, is currently before the U.S. District Court for the Central District of California.