United States: One Cross – Two Cross – Red Cross – Blue Cross: Trademark Development Traps

Last Updated: April 24 2013
Article by Andrea C. Barach


Trademarks and service marks are valuable in all areas of commerce, and health care is not an exception. Providers of health care-related goods and services rely upon trademarks and service marks to identify the sources of their goods and services and to enhance brand loyalty. And, like those in other industries, these providers protect their valuable marks by registration in the U.S. Patent and Trademark Office under the Lanham Act.

Trademarks containing variations of "cross" designs are popular with many companies which market products or services related to health care. But companies in this industry area, as well as their advertising and marketing experts and trademark practitioners, should take heed of several barriers regarding the use of cross designs in connection with health care products and services.

Red Cross Blue Cross, What a Cross to Bear!

Historically, many health care providers have been affiliated with Christian religious organizations. Thus, marks which include crosses have been popular with hospitals and others in the health care industry for decades. There are barriers, however, to the use of crosses, and these barriers restrict the styles and colors of cross designs which are available as trademarks and service marks. Additionally, at least one of these barriers (the Red Cross statute discussed below) is not readily apparent in a typical trademark search.

Red Crosses – Under the Charter Act adopted by Congress in 1900 in connection with the Geneva Convention (and later amended in 1905 and 1910), the American Red Cross has the exclusive right to use a red, Greek cross on a white field. (A "Greek cross" is a cross of which the four arms are all equal in size and do not extend to the edges of the field.) The only exception to this right to exclusive use is that any user of such an emblem (that is, of a red, Greek cross) prior to 1905 continued to have the right to use that emblem. 

Johnson & Johnson (J&J) had used red cross marks since at least as early as 1898; thus, its use of those marks was specifically permitted under the Charter Act. As early as 1906, J&J filed applications to register its use of those marks with the U.S. Patent and Trademark Office, claiming first-use dates of 1898.

J&J continues using similar trademarks today, such as


Some might see the J&J trademark registrations and assume that other red cross marks could be registered, so long as they were not confusingly similar, under general principles of trademark law, to the J&J marks. Nothing in the trademark search record will reference the Charter Act and the special rights of the American Red Cross. Consequently, parties may be tempted to use a red Greek cross for their own goods or services. However, such parties and their trademark counsel should recall that J&J's rights to its red, Greek cross marks are the result of common law trademark rights that preceded both the American Red Cross Charter Act and the adoption of the Lanham Act and are recognized under the Charter Act. This arena is truly a trap for the unwary.

Moreover, the relationship between J&J and the American Red Cross continues to evolve. In 2007, J&J sued the American Red Cross claiming that the American Red Cross infringed J&J's trademark by including a red Greek cross on first aid and disaster preparedness products which licensees of the American Red Cross were distributing and selling commercially. In this litigation, one issue was whether the American Red Cross's rights under the Charter Act included the right to license its mark for commercial use. The suit was settled in 2008 by the parties, after the initial court decision upheld American Red Cross's right to use the mark even for commercial purposes. 

Special notice also should be given to the American Red Cross's diligence in reviewing Trademark Office filings and its consistent and vigorous defense of its rights in its red, Greek cross design. In addition, the American Red Cross is persistent in identifying and objecting to uses of the red, Greek cross that constitute common law trademark use, particularly where the mark has been adopted by a third party as its brand or logo for goods or services related in some manner to health care.

For these reasons, the best course is to avoid using a red, Greek cross as part of a mark that will be used for any type of goods or services that are remotely related to health care. In contrast, a white Greek cross against a red background will not violate the Charter Act and should be permissible (absent conflict with other trademark owners).

Blue Crosses – Blue crosses also should be avoided, since there also is another large barrier in this arena: the famous marks owned and registered by Blue Cross Blue Shield Association (BCBSA), including the number of its registered service marks for blue, Greek cross designs for various health care and insurance services. (For example, U.S. registrations 554,817; 1,699,627; 1,632,320; 1,639,079; and 1,826,582 are active registrations of a Greek cross with the color blue and no other distinguishing features, and all claim a first-use date of 1934.) Other BCBSA registrations include the superimposed human figure and the shield designs. Thus, the BCBSA family of marks includes any blue, Greek cross used in connection with various health care-related services.

It is possible that BCBSA would not object to a mark that contained a different type of cross (such as one with arms of unequal length) or a shade of blue that is dramatically different from its own. Unlike the American Red Cross, BCBSA does not have the benefit of any specific legislation and so its rights are based on the general principles of trademark law and an evaluation of the likelihood that other marks will be confused with its blue, Greek cross marks. However, members of the health care industry that use a shade of blue which is the same as or substantially similar to that used by BCBSA should not be surprised by the delays and costs this course engenders. They should anticipate a BCBSA objection and the costs of changing the conflicting mark which may soon follow.

A more efficient and less expensive route would be to select another color for the cross (assuming there are no conflicts with other marks). In the alternative, the health care provider could select a white cross against a blue background; this approach should avoid conflict with the BSBSA trademarks.

Trademarks and Service Marks in the Health Care Arena – Avoid the Traps

The use of cross shapes in trademarks and service marks for hospitals and other members of the health care industry is only one of the issues that can arise when the trademark world collides with the health care world. However, it is one that can result in an unhappy, and potentially costly, surprise if it is unexpected.

A simple solution: Health care providers (including biotech and other companies and institutions whose products or services are marketed or sold in the healthcare arena) can work with marketing and advertising experts, as well as experienced trademark lawyers, to develop new marks and brand identities that are uniquely their own and that avoid red Greek crosses and blue Greek crosses.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Similar Articles
Relevancy Powered by MondaqAI
Bradley Arant Boult Cummings LLP
In association with
Related Topics
Similar Articles
Relevancy Powered by MondaqAI
Bradley Arant Boult Cummings LLP
Related Articles
Related Video
Up-coming Events Search
Font Size:
Mondaq on Twitter
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
Email Address
Company Name
Confirm Password
Mondaq Topics -- Select your Interests
 Law Performance
 Law Practice
 Media & IT
 Real Estate
 Wealth Mgt
Asia Pacific
European Union
Latin America
Middle East
United States
Worldwide Updates
Registration (you must scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.


The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.


Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions