Mares v. Miami Valley Hosp.

671 F.Supp.3d 812

Jacquelyn MARES, M.D., Plaintiff, v. MIAMI VALLEY HOSPITAL, et al., Defendants.

Case No. 3:20-cv-453

United States District Court, S.D. Ohio, Western Division

Signed May 2, 2023

Marc D. Mezibov, Mezibov Butler, Cincinnati, OH, Rachel Catherine Rutter, Pro Hac Vice, Marek Weisman LLC, Chicago, IL, for Plaintiff.

Karen T. Dunlevey, Jackson Lewis P.C., Dayton, OH, for Defendants Miami Valley Hospital, Premier Health Partners.

Drew Corner Piersall, Zashin & Rich Co., L.P.A., Columbus, OH, for Defendants Wright State University, Jerome L. Yaklic, M.D., G. Theodore Talbot, M.D., Albert F. Painter, Psy.D.

ORDER: (1) GRANTING DEFENDANTS' MOTIONS FOR SUMMARY JUDGMENT; AND (2) TERMINATING THIS CASE ON THE DOCKET

Michael J. Newman, United States District Judge

This civil case, consisting of federal claims and state law claims between diverse parties, is before the Court on two motions for summary judgment filed by: (1) Defendants Albert F. Painter, Psy.D. ("Dr. Painter"); Theodore Talbot, M.D. ("Dr. Talbot"); Jerome L. Yaklic, M.D. ("Dr. Yaklic"); and Wright State University, d/b/a Boonshoft School of Medicine ("Wright State") (collectively, "Wright State Defendants"; or, as to the individual doctors, "individual Wright State Defendants"); and (2) Miami Valley Hospital ("MVH"); and Premier Health Partners ("Premier Health"). Doc. Nos. 49, 57. Plaintiff Jacquelyn Mares, M.D. ("Dr. Mares") filed a response in opposition. Doc. No. 66. The Wright State Defendants, MVH, and Premier Health replied. Doc. Nos. 67, 68. This matter is ripe for review.

I. Undisputed Facts

A. Wright State's Residency Program

Wright State runs a medical residency program through the Boonshoft School of Medicine ("Boonshoft"), where it educates aspiring obstetricians and gynecologists. See Doc. Nos. 52-9, 54-1. Wright State partners with MVH and Premier Health to employ the residents. Doc. No. 54-1. Three documents govern a resident's relationship with Boonshoft: (1) the Resident Program Manual; (2) the Graduate Medical Agreement, which is between Boonshoft and the resident and serves as the resident's enrollment contract; and (3) an individualized Resident-Fellow Agreement, which serves as the resident's employment contract with MVH and Premier Health. Doc. Nos. 54-1, 54-23.

Boonshoft put together its manual to comply with the Accreditation Council for Graduate Medical Education's ("Accreditation Council") program requirements for Obstetrics and Gynecology programs nationwide. See Doc. No. 54-24 at PageID 2117. The Accreditation Council notes, "[g]raduate medical education transforms medical students" into practitioners, while mandating that residency programs follow its requirements to "serve as role models of excellence, compassion, professionalism, and scholarship." Doc. No. 54-20 at PageID 1884. The Accreditation Council provides that residency "educational programs" should last 48 months and impose evaluations of a resident's performance "at the end of each rotation[,]" while the residency program director reviews the evaluations "every six months." Id. at 1914. For those residents who struggle to meet the program's requirements, the Accreditation Council advises institutions to develop an "individual remediation plan" to resolve a resident's deficiencies. Id. When an institution deems it appropriate to dismiss a resident, the Accreditation Council warns that the program directors must "ensure the program's compliance with the Sponsoring Institution's policies and procedures for due process when action is taken to suspend or dismiss[.]" Id.

Inculcating professionalism is an important part of a residency program, according to the Accreditation Council. See, e.g., id. at PageID 1927. Among other things, a resident "must demonstrate an understanding of their personal role in the . . . provision of patient[ ] and family-centered care[,]" and the "safety and welfare of the patients entrusted to their care, including the ability to report unsafe conditions and adverse events[.]" Id. at PageID 1928. "[A]ccurate reporting of clinical and educational work hours, patient outcomes, and clinical experience data" are also essential facets of any residency program. Id.

Boonshoft's manual provides several academic and professional standards that its residents must follow. Doc. No. 54-23 at PageID 2056, 2077. Professionalism is a resident's core competency, manifested through good behavior. Id. at PageID 2049. Boonshoft requires that "resident[s] must perform all responsibilities . . . competently, efficiently, and maturely." Id. at PageID 2077. If a resident violates any standard of professionalism, Boonshoft warns that this "constitute[s] sufficient grounds for disciplinary suspension, disciplinary termination, or disciplinary non-renewal of the resident's appointment." Id.

Wright State's Resident-Fellow Agreement notes that it, too, requires residents to adhere to the Accreditation Council's standards. Doc. No. 54-1 at PageID 1826. The Resident-Fellow Agreement is between Wright State (doing business as Boonshoft), the individual resident, and a sponsoring hospital—in this case, MVH. See id. The agreement permits MVH to remove a resident from its employment if he or she "is terminated" from or "substantially fails to meet any of the general requirements" of his or her residency. Id. at PageID 1828. Additionally, the agreement notes that it "abide[s] by . . . Ohio law[ ] concerning employment at will[,]" and "either party may terminate this agreement by giving written notice to the other at any time . . . for any reason that does not contradict the . . . due process procedures . . . for residents." Id. at PageID 1827 (internal quotation marks omitted).

To monitor a resident's progression through the program, Boonshoft faculty regularly provide feedback to residents in informal and formal meetings. Doc. No. 54-23 at PageID 2056. Boonshoft also has a "Clinical Competency Committee" ("Competency Committee"), made up of obstetrics and gynecology faculty members. Doc. No. 54 at PageID 1754, 1804. The Competency Committee meets every six months to evaluate whether a resident is meeting the Accreditation Council's twenty-four resident education "milestones." Id. at PageID 1755-56. The Competency Committee cannot dismiss a resident, but it may recommend dismissal to the program director if the majority of the Competency Committee so recommends. Id. at PageID 1757.

To officially dismiss a resident from the program, however, Boonshoft has procedures—which it dubs its "due process procedures" or "Item 504"—that it first must follow. Doc. No. 54-23 at PageID 2078. Initially, if a resident is not meeting Boonshoft's academic or professional standards, the program must submit a written notice of intent to take adverse action, like suspension or termination, against the resident no later than 120 days before the end of his or her contract. Id. Next, Item 504 requires the program abide by the following seven¹ steps:

1. Five days after receiving the written notice, the resident can request review of Boonshoft's anticipated action. Id.

2. Sixty days after receiving the resident's request, Boonshoft must hold a hearing. Id.

3. Boonshoft must compose a review panel for the hearing consisting of three faculty members, "who are knowledgeable of the program's academic content." Id. The dean of Boonshoft and MVH's CEO appoint the members jointly. Id. The resident nominates one member and may submit a list of nominees, from which the dean and MVH's CEO pick one member. Id. The dean and MVH's CEO pick the final member. Id.

4. The review's stated purpose "is to determine if there is substantial evidence" to support the action. Id. The resident may have an attorney as an observer at the hearing, but the attorney may not represent the resident during the hearing. Id. Boonshoft—through its director—can call witnesses (after giving a 15-day advanced notice to the resident) and question the resident and his or her witnesses. Id. The resident may speak at the hearing; question the evidence, director, and Boonshoft's witnesses; present witness testimony; and have a faculty advisor assist him or her. Id. at PageID 2079. Finally, the hearing panel may question the witnesses called, but it "will not consider any information related to the resident's performance after the program's decision." Id.

5. Ten days after the hearing, the panel submits a written recommendation to the dean and CEO. Id. By a majority vote, the panel recommends affirming the intended action, taking revised action, or not acting. Id. 6. The dean and CEO, fifteen days after receiving the recommendation, send their written decision to affirm, take revised action, or reject the intended action. Id.

7. Ten days later, the resident may appeal the decision to Wright State's provost in writing. Id. Fifteen days after receiving the appeal, the provost "must notify the resident in writing of the decision to affirm or not affirm the action." Id.

B. Dr. Mares's Residency

Dr. Mares, an aspiring OB/GYN, graduated from George Washington University's medical school in 2015.² Doc. No. 52 at PageID 876, 884-85. After completing a preliminary year at Hofstra University, she entered Boonshoft's OB/GYN residency program in June 2016. Id. at PageID 885-86; Doc. No. 52-1.

She completed her first rotation at MVH on November 16, 2016, and met with Dr. Michael Galloway, Boonshoft's program director, for her first evaluation. Doc. No. 52 at PageID 919; see Doc. No. 52-26. It was generally favorable, but Dr. Galloway noted that Dr. Mares was behind her peers in surgical skills and struggled with communication. Doc. No. 52-26 at PageID 1319.

Next came Dr. Mares's rotation at Wright-Patterson Air Force Base, which lasted until December 21, 2016. Doc. No. 52-28. Her supervisor found her punctual, attentive, and efficient. Id. at PageID 1322. But her supervisor also identified her surgical skills, her knowledge base, and her understanding of...