"It’s the end of the road as relates to the legal process with this particular merger," Geller told NorthJersey.com. “After nearly four years of merger planning, hospital leaders and trustees will "catch our collective breath.”

Hackensack began acquiring independent hospitals over a decade ago that have struggled to compete against consolidated healthcare entities and negotiate with insurance companies. Englewood was slated to be its 13th acute-care facility, with Hackensack pledging to invest $439.5 million in improvements for its facilities and services over eight years.

The New Jersey attorney general and the state Health Department signed off on the merger when it was first proposed. Backing it were The American Hospital Association, Association of American Medical Colleges, the New Jersey Hospital Association (NJHA) and the African American Chamber of Commerce of New Jersey.

The FTC’s request to halt it made national headlines and prompted 26 state Attorney Generals to file a friend of the court brief supporting the FTC, while nine major hospital trade associations filed briefs in support of the deal, including the NJHA.

U.S. District Court Judge John Michael Vasquez in Newark ruled in favor of the FTC last August for its injunction, pending a full review. The hospitals filed an appeal in September.

Englewood was founded over 130 years ago and is one of the last independent hospitals in New Jersey. It sought the merger to improve its finances, which have dropped, as market pressures have cut into margins and forced most hospitals in the state to partner with one another.

"Can a hospital like Englewood survive or continue to be competitive on its own? That remains to be seen," John Fanburg, an attorney who chairs the health care law practice at Brach Eichler, a Roseland law firm, told NorthJersey.com.

In February, the FTC stopped another merger from going through in Rhode Island between Lifespan Corporation and Care New England Health System, the state’s two largest healthcare systems. The two saw the deal as a combination of their complementary medical specialties and biomedical research that would offer patients more options for protocol-driven therapies, eliminate health disparities and improve access to women’s health.

The FTC said this would decrease competition, possibly increase overall healthcare costs and would create a “healthcare conglomerate with outsized power” as the new system would oversee 70% to 80% of all treatments in the Rhode Island market that require hospital stays.

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