Lownsbury v. VanBuren

Lownsbury v. VanBuren

STATE OF OHIO, COUNTY OF SUMMIT

IN THE COURT OF APPEALS NINTH JUDICIAL DISTRICT

C.A. NO. 19365

REBECCA LOWNSBURY, et al.

Appellants

v.

GEORGE VANBUREN, M.D., et al., Appellees

APPEAL FROM JUDGMENT ENTERED IN THE COURT OF COMMON PLEAS

COUNTY OF SUMMIT, OHIO

CASE NO. CV 96 01 0275

 

DECISION AND JOURNAL ENTRY

 

 

Dated: August 2, 2000

This cause was heard upon the record in the
trial court. Each error assigned has been reviewed and the following disposition
is made:

______________________________________________________________________________________

 

Per Curiam.

Appellants-plaintiffs appeal from a judgment
of the Summit County Court of Common Pleas that granted summary judgment in
favor of appellee-defendant Dr. Thomas Stover, M.D. This Court affirms.

I.

On January 6, 1995, Cathy Lownsbury ("Lownsbury")
went to Akron City Hospital?s ("ACH") maternal-fetal medicine center
for a prenatal visit. Lownsbury was seen by a third year resident-physician. The
resident-physician ordered an ultrasound and Non-Stress Test be completed. These
tests were completed and evaluated by a perinatologist (specialist in
maternal-fetal medicine), Dr. George VanBuren. Based on the results of the
tests, Lownsbury was sent to labor and delivery. A dispute exists as to whether
the doctor who sent Lownsbury to labor and delivery ordered that labor be
induced, or that a Contraction Stress Test ("CST") be performed.
Lownsbury was seen on an outpatient basis in labor and delivery. A
resident-physician performed a physical examination and a CST. The
resident-physician consulted with a more senior resident-physician to interpret
the CST. Based on the test results interpreted by the senior resident-physician,
Lownsbury was sent home. She was instructed to follow up and to have another CST
within one week. The results of the CST were reviewed the next morning, January
7, 1995, by the perinatologist. The reviewing doctor agreed with the
interpretation by the senior resident.

Dr. Stover was never notified and was not
aware that Lownsbury was at the hospital. He was never consulted regarding the
tests or interpretation of the test results. He never examined, treated,
evaluated or consulted with anyone about Lownsbury. He had no contact with the
patient.

On January 10, 1995, Lownsbury gave birth to a
severely brain damaged child, Rebecca. Appellants? medical experts opine that
if labor had been induced earlier, the child would not have suffered permanent
neurological injury.

Upon learning that Dr. Stover was the
supervisory physician of ACH?s labor and delivery department on January 6,
1995, the day Lownsbury had been seen for testing, appellants filed suit against
Dr. Stover charging that he was responsible for Rebecca?s injuries. Appellants?
complaint alleged that Dr. Stover is liable for Rebecca?s injuries because he
failed to supervise the residents on duty and ensure that the requisite prenatal
care was provided to Lownsbury. After extensive discovery, Dr. Stover moved for
summary judgment. Because he did not treat, evaluate, consult, or even know of
Lownsbury?s hospital visit, Dr. Stover argued that he did not owe a duty to
Lownsbury or Rebecca because a physician-patient relationship had never been
established. The trial court granted summary judgment in favor of Dr. Stover.

Appellants appeal, asserting one assignment of
error.

II.

ASSIGNMENT OF ERROR

The Trial Court Erred In Granting Defendant
Thomas Stover, M.D.?s Motion For Summary Judgment When There Were Genuine
Issues of Material Fact With Respect To Plaintiffs? Medical Malpractice
Claim. (R. 290).

 

Appellants argue that, because there were
genuine issues of material fact, the trial court erred in granting summary
judgment. This Court disagrees.

In reviewing a trial court?s entry of
summary judgment, an appellate court applies the same standard used by the trial
court. Perkins v. Lavin (1994), 98 Ohio App.3d 378, 381. Pursuant to
Civ.R. 56(C), summary judgment is proper if: (1) no genuine issue as to any
material fact remains to be litigated; (2) the moving party is entitled to
judgment as a matter of law; and (3) it appears from the evidence that
reasonable minds can come to but one conclusion, and viewing such evidence most
strongly in favor of the party against whom the motion for summary judgment is
made, that conclusion is adverse to that party. Temple v. Wean United, Inc.
(1977), 50 Ohio St.2d 317, 327. The party seeking summary judgment initially
bears the burden of informing the trial court of the basis for the motion and
identifying portions of the record demonstrating an absence of genuine issues of
material fact as to the essential elements of the nonmoving party’s claims. Id.
The movant must point to some evidence in the record of the type listed in
Civ.R. 56(C) in support of his motion. Id. Once this burden is satisfied,
the nonmoving party has the burden, as set forth in Civ.R. 56(E), to offer
specific facts showing a genuine issue for trial.
Id.

In his summary judgment motion, Dr. Stover
argued that he did not owe a legal duty to Lownsbury or Rebecca because a
physician-patient relationship was never established, and, absent a duty, the
appellants? cause of action fails. Appellants argued that they were entitled
to pursue their medical malpractice claim because a physician-patient
relationship had been established by express and implied contracts.

To establish a medical malpractice action, a
plaintiff must show (1) the existence of a duty, (2) a breach of that duty, and
(3) proximate causation between the breach of duty and the injury. Littleton
v. Good Samaritan Hosp. & Health Center
(1988), 39 Ohio St.3d 86, 92
(discussing the elements necessary to establish an underlying medical
malpractice claim in a survivorship action). "In a medical malpractice
case, the existence of a duty is dependent on whether there was a
physician-patient relationship." Pena v. N.E. Ohio Emergency Affiliates
(1995), 108 Ohio App.3d 96, citing Ryne v. Garvey (1993), 87 Ohio App.3d
145, 155. "?[T]he existence of a duty in a negligence action is a
question of law for the court to determine.?" Spence v. Oberlin
Laundry & Dry Cleaners, Inc.
(Oct. 7, 1998), Lorain App. No. 97CA006913,
unreported, quoting Mussivand v. David (1989), 45 Ohio St.3d 314, 318.

In support of their contention that summary
judgment should not have been granted, appellants point to the deposition
testimony of two doctors. The doctors expressed their opinion that Dr. Stover
was obligated to supervise the residents working in labor and delivery and to
make required contact with patients, that Dr. Stover failed to do so, that in
failing to do so Dr. Stover failed to meet the minimum standard of care, and
that as a result, Dr. Stover caused Rebecca?s injuries. Appellants assert that
this expert testimony "alone entitles [them] to maintain their medical
malpractice claim against Dr. Stover." For additional support, appellants
cite to various medical standards and regulations, such as the standards of the
Accreditation Council on Graduate Medical Education.

Discussing the nature of the physician-patient
relationship, the Ohio Supreme Court held that:

The physician-patient relationship arises
out of an express or implied contract which imposes on the physician an
obligation to utilize the requisite degree of care and skill during the
course of the relationship. The relationship is a consensual one and is
created when the physician performs professional services which another
person accepts for the purpose of medical treatment.

The physician-patient relationship is a
fiduciary one based on trust and confidence and obligating the physician to
exercise good faith. As a part of this relationship, both parties envision
that the patient will rely on the judgment and expertise of the physician.
The relationship is predicated on the proposition that the patient seeks out
and obtains the physician?s services because the physician possesses
special knowledge and skill in diagnosing and treating diseases and injuries
which the patient lacks. (Citations omitted.)

 

Tracy v. Merrell Dow Pharmaceuticals (1991),
58 Ohio St.3d 147, 150. The fact that appellants? experts believe that
Dr. Stover breached a standard of care does not establish the existence of a
duty for purposes of a medical malpractice claim, nor do the regulations and
standards cited by appellants. In a medical malpractice claim, evidence
concerning the appropriate standard of care and breach of duty are only relevant
after a duty is established because the duty of care owed by a physician to a
patient arises out of the physician-patient relationship. The duty of care does
not exist in the absence of a physician-patient relationship.

The physician-patient relationship is one of a
personal nature. It is a relationship based on the trust of the patient and the
services of the doctor. In order to establish a physician-patient relationship
there must be some contact between the doctor and the patient. This may be
direct or indirect where the doctor takes an active part in diagnosing or
treating the patient even without the patient?s knowledge. Dr. Stover?s
advice was never sought by any of the resident-physicians or the specialist.
Taking the appellants? argument to its conclusion would be to hold the medical
director of any department responsible for other doctors? patients despite the
fact that the medical director had never seen or treated the patient or advised
the treating doctor.

Appellants also aver that summary judgment was
improper because a physician-patient relationship was established by virtue of
an express and an implied contract. At the time in question, Dr. Stover was
under contract with the East Market Group ("EMG"), an organization of
obstetricians who had contracted with ACH to provide twenty-four hour attending
and supervisory functions over ACH?s residents. Appellants assert that
pursuant to the contract between EMG and ACH, Dr. Stover was responsible to
supervise the residents who cared for Lownsbury, and that this contract created
a physician-patient relationship by implied contract. Appellants contend that a
physician-patient relationship was also established by express contract on
January 6, 1995, when Dr. Stover was the attending physician and Lownsbury
signed a consent to treatment form, because the form stated that "the
patient will be under the care of a Medical Doctor called the attending
physician who arranges for services and care of the patient."

Appellants state that "Ohio law has long
held that the physician-patient relationship arises out of an express or implied
contract," and, therefore, despite the fact that Dr. Stover did not treat,
diagnose, consult, or know of Lownsbury?s existence, a physician-patient
relationship was established by the ACH-EMG contract and the consent form. In
support, appellants cite to this Court?s decision in Pena, supra, and McKinney
v. Schlatter, M.D.
(1997), 118 Ohio App.3d 328. However, both of those cases
are markedly distinguishable from the present case. Although the physician in McKinney
did not have any direct contact with the patient, the physician was actively
involved in the patient?s care. In Pena the physician was consulted,
had agreed to provide coverage for the patient?s primary physician, and
permitted the patient to be admitted under his name.

The necessary element missing in appellants?
argument is the nexus between the doctor and the patient. The contract between a
hospital and doctor does not in and of itself create a doctor-patient
relationship between that doctor and all the patients that come to the hospital.
While the consent form signed by Lownsbury may establish a contract between
Lownsbury and the hospital, it fails to establish a contract between the
Lownsbury and Dr. Stover. This is because there is a conspicuous absence of an
acceptance by Dr. Stover. Had Dr. Stover undertaken some form of service to
Lownsbury, there may have been an implied acceptance. However, that is not the
case.

This Court notes that there is a dispute over
three separate issues: (1) whether the provisions of the EMG-ACH contract,
signed in 1992, were still in effect at the time in question; (2) whether
Lownsbury signed the consent form on January 6, 1995; and (3) whether Dr. Stover
was an attending physician or an "on-call" physician on January 6,
1995. These issues are not material to this case, however, because what is not
in dispute is that Dr. Stover never saw, evaluated, treated, consulted, or knew
that Lownsbury was in the hospital.

This Court is mindful of the Ohio Supreme
Court?s explanation that the physician-patient relationship "is created
when the physician performs professional services which another person accepts
for the purpose of medical treatment," and that it "is predicated on
the proposition that the patient seeks out and obtains the physician?s
services," Tracy, supra. Therefore, this Court declines appellants?
request to find that, as a matter of law, a physician-patient relationship
exists between a supervisory physician and each and every patient who is seen in
his or her department while he or she is on duty.

Accordingly, construing the evidence most
strongly in favor of appellants, this Court finds that reasonable minds could
not have found that Dr. Stover owed a duty to Lownsbury or Rebecca. Therefore,
the grant of summary judgment was appropriate.

III.

The judgment of the common pleas court is
hereby affirmed.

Judgment affirmed.

– –

The Court finds that there were reasonable
grounds for this appeal.

We order that a special mandate issue out of
this Court, directing the County of Summit, Court of Common Pleas, to carry this
judgment into execution. A certified copy of this journal entry shall constitute
the mandate, pursuant to App.R. 27.

Immediately upon the filing hereof, this
document shall constitute the journal entry of judgment, and it shall be file
stamped by the Clerk of the Court of Appeals at which time the period for review
shall begin to run. App.R. 22(E).

Costs taxed to Appellant.

Exceptions.

___________________________ LYNN C. SLABY

FOR THE COURT

 

 

SLABY, P.J.

BATCHELDER, J.

CONCUR

 

CARR, J.

DISSENTS, SAYING:

Because I disagree with the majority opinion?s
holding that no physician-patient relationship was established between Dr.
Stover and Lownsbury and Rebecca, I must respectfully dissent.

The majority declines to recognize a
physician-patient relationship in situations where a physician had no knowledge
of a patient?s existence. However, once a physician-patient relationship has
been established by contract, as in the present case, whether the physician
actually knows that the patient is in the hospital is irrelevant.

Deposition testimony established that Dr.
Stover was the attending physician on duty on January 6, 1995, that Dr. Stover
had the obligation to supervise ACH?s labor and delivery residents, and that
Dr. Stover, as attending physician, had the duty to oversee the care of
department patients. In his deposition, Dr. Stover testified that while
Lownsbury was a patient in his department he was "wasting time" in the
hospital staff room. EMG?s managing director testified that a fully trained
and credentialed physician should review each patient?s chart. Further, the
consent form signed by Lownsbury stated that "[t]he patient will be under
the professional care of a Medical Doctor called the attending physician
***."

Construing the evidence most strongly in favor
of appellants, reasonable minds could find the existence of a physician-patient
relationship between Dr. Stover and Lownsbury and Rebecca based on the consent
form that Lownsbury signed and the EMG-ACH contract. See Schendel v. Hennepin
County Medical Ctr.
(Minn.App.1992) 484 N.W.2d 803. The physician-patient
relationship is a consensual relationship in which the patient knowingly seeks
the physician’s assistance and in which the physician knowingly accepts the
person as a patient. Tracy v. Merrell Dow Pharmaceuticals (1991) 58 Ohio
St.3d 147, 150. Here, Dr. Stover consented to the relationship when he entered
into the agreement to be the supervisory physician. In turn, Lownsbury consented
to the relationship when she signed the consent form to be under the care of an
attending physician. See Mozingo v. Pitt County Memorial Hosp. (1991),
331 N.C. 182, 189, 415 S.E.2d 341, 345. Dr. Stover was the only attending
physician.

Those doctors who are employed to teach,
supervise, and guide residents are not only permitted but also implicitly
encouraged by the rationale of the majority?s decision to shield themselves
from liability with bureaucratic armor. Such a result is erroneous in light of
Dr. Stover?s contractual agreement and the obligations arising therefrom.

Accordingly, I would reverse and remand.

 

APPEARANCES:

 

ROBERT D’ANNIBALLE, JR., Attorney at Law, 3173
Main Street, Weirton, West Virginia 26062, for Appellants.

 

JEFFREY E. SCHOBERT, Attorney at Law, 3721
Whipple Avenue, N.W., P.O. Box 35548, Canton, Ohio 44735, for Appellee, George
VanBuren, M.D.

 

MARK D. FRASURE, Attorney at Law, 3721 Whipple
Avenue, N.W., P.O. Box 35548, Canton, Ohio 44735, for Appellee, Linda Parenti,
M.D.

 

ANDREW S. MUTH, Attorney at Law, 301 West
Michigan Avenue, Suite 302, Ypsilanti, Michigan 48197.

 

JACK BEAM, Attorney at Law, 5910 S. University
Blvd., Suite C-18, No. 429, Littleton, Colorado 80121.

 

 

Lumpkin v. Wayne Hosp.

Lumpkin v. Wayne Hosp.

[Cite as Lumpkin v. Wayne Hosp., 2004 -Ohio-264.]

IN THE COURT OF APPEALS FOR DARKE COUNTY, OHIO

:

:

:

Plaintiffs-Appellants

:

:

C.A. Case No. 1615

T.C. Case No. 00-CV-58721

(Civil Appeal from Common
Pleas Court)

KIMBERLY LUMPKIN, ET AL.

v.

WAYNE HOSPITAL, ET AL.

Defendants-Appellees

. . . . . . . . . . .

O P I N I O N

Rendered on the 23rd day of January , 2004.

. . . . . . . . . . .

DAVID P. KAMP, Atty. Reg. #0020665, 1700 Fourth & Vine Street, Cincinnati, Ohio
45202-3621

Attorney for Plaintiffs-Appellants

JOHN B. WELCH, Atty. Reg. #0055337, 130 West Second Street, Suite 940,
Dayton, Ohio 45402

Attorney for Defendants-Appellees

. . . . . . . . . . . . .

FAIN, P.J.

{¶1} Plaintiff-appellant Kimberly Lumpkin appeals from a judgment rendered in

favor of defendant-appellee John C. Mobley, M.D., in her medical malpractice action

against Dr. Mobley. Lumpkin contends that the trial court erred by excluding evidence

that the mistake Dr. Mobley made during Lumpkin’s surgery – the transection of her

common bile duct instead of her cystic duct – was identical to a mistake he had recently

2
made in a surgery he performed upon another patient, because this evidence

demonstrates that Dr. Mobley was on notice that his surgical technique was flawed.

We conclude that the trial court did not abuse its discretion in excluding evidence of the

prior incident, because the record does not reflect any proffer to show how the

circumstances of

the other patient’s surgery were substantially similar

to

the

circumstances of Lumpkin’s surgery. We also conclude that the trial court did not abuse

its discretion in excluding evidence of the prior incident upon the ground that the

prejudicial effect of the inference arising from this evidence – that the doctor had a

similar bad result once before, so he must be a bad surgeon – outweighs any legitimate

probative value it might have.

{¶2} Lumpkin also contends that the trial court erred by excluding evidence

regarding Dr. Mobley’s proctorship, because it was relevant to his credibility as a

witness and his ability to meet accepted standards of care. We conclude that the trial

court did not abuse its discretion in denying Lumpkin the opportunity to impeach Dr.

Mobley with his deposition testimony regarding his proctorship, because that testimony

only weakly implicates Dr. Mobley’s credibility, and is unduly prejudicial to the extent

that it suggests the forbidden inference that one previous, similar bad result implies that

Dr. Mobley is an incompetent surgeon.

{¶3} Because we reject both of Lumpkin’s assignments of error, the judgment

of the trial court is affirmed.

I

{¶4}

In December, 1999, Kimberly Lumpkin went

to

the Emergency

Department at Wayne Hospital complaining of abdominal pain. Lumpkin was admitted

3
under the care of Dr. John C. Mobley, and underwent an ultrasound, which revealed

that she had several gallstones. Dr. Mobley recommended that Lumpkin undergo a

laparoscopic cholecystectomy to remove the gall bladder. During the surgery, Dr.

Mobley realized that he had transected the common bile duct instead of the cystic duct.

Dr. Mobley proceeded to remove the gallbladder, and then performed a static

cholangiogram and confirmed the injury to the common bile duct. Dr. Mobley then

referred Lumpkin to Dr. Richard Welling, a surgeon at Good Samaritan Hospital in

Cincinnati, Ohio, for surgical treatment of the injury to the common bile duct. Lumpkin

was transferred to Good Samaritan Hospital, and Dr. Welling performed a roux-en-Y

hepaticojejunostocmy to repair the injury to the common bile duct. Lumpkin was

hospitalized for nine days.

{¶5} A year later, Lumpkin and her husband, Travis Lumpkin, filed a complaint

against Wayne Hospital and Dr. Mobley, alleging that Dr. Mobley’s treatment of

Lumpkin fell below the accepted standards of care, and that his negligence proximately

caused her to undergo a static cholangiogram, a roux-en-Y hepaticojejunostocmy, and

nine days in the hospital. Lumpkin later amended her complaint to include a claim for

negligent credentialing against Wayne Hospital, alleging tha t Wayne Hospital was

negligent in its hiring, supervising, training and retaining of Dr. Mobley, because it had

knowledge of a previous identical act of negligence by Dr. Mobley and failed to prevent

future acts of negligence by Dr. Mobley.

{¶6} Wayne Hospital and Dr. Mobley moved to bifurcate Lumpkin’s negligent

credentialing claim against Wayne Hospital from the negligence claim against Dr.

Mobley. The trial court bifurcated the claims finding that “[t]he proof necessary to

4
establish the claim against Wayne Hospital, including any prior medical negligence by

Dr. Mobley, would possibly be more prejudicial than probative in determining whether

there was any medical negligence by Dr. Mobley in his treatment of Kimberly Lumpkin.”

In February, 2003, Lumpkin voluntarily dismissed Wayne Hospital, without prejudice.

{¶7} Dr. Mobley filed a motion in limine to prevent Lumpkin from “introducing

any evidence of any prior malpractice claims against Dr. Mobley,” and “from introducing

any evidence or asking any questions concerning whether Dr. Mobley was investigated

or ‘proctored’ by any executive committee members, for quality assurance purposes at

Wayne Hospital, relative to any complications from laparoscopic procedures.” The trial

court granted this motion in part, prohibiting Lumpkin from “introducing any testimony

about a specific prior incident of a bad outcome with this procedure either by name or

by general reference.” The trial court denied the motion in part, allowing evidence

regarding

the proctoring process and

the observations, suggestions and

recommendations of the two proctoring physicians, Dr. Leroy Steinbrecher and Dr.

Samuel Brubaker, who observed Dr. Mobley’s surgical performance.

{¶8} This case proceeded to a jury trial. The jury rendered a verdict in favor of

Dr. Mobley. From the judgment rendered against her, Lumpkin appeals.

{¶9} Lumpkin’s First Assignment of Error is as follows:

II

{¶10} “THE TRIAL COURT COMMITTED REVERSIBLE ERROR BY

EXCLUDING EVIDENCE THAT THE MISTAKE DR. MOBLEY MADE DURING THE

SURGERY OF KIMBERLY LUMPKIN WAS IDENTICAL TO THE MISTAKE HE HAD

RECENTLY MADE IN THE SURGERY OF DEBORAH THOMAS BECAUSE THE

5
EVIDENCE DEMONSTRATED THAT DR. MOBLEY WAS ON NOTICE THAT HIS

SURGICAL TECHNIQUE WAS FLAWED.”

{¶11} Lumpkin contends that evidence showing Dr. Mobley made the same

surgical “mistake” on another patient, Deborah Thomas, a year prior to Lumpkin’s

surgery, using the same surgical technique used on her, is probative of the fact that Dr.

Mobley had knowledge that his surgical technique was flawed. Lumpkin argues that,

pursuant to Renfro v. Black (1990), 52 Ohio St.3d 27, 31, 556 N.E.2d 150, evidence of

the prior incident is admissible, because the circumstances of Thomas’s surgery were

substantially similar to the circumstances of her surgery.

{¶12} “A trial court has broad discretion in determining whether to admit or

exclude evidence. Absent an abuse of discretion that materially prejudices a party, the

trial court’s decision will stand.” Krischbaum v. Dillon (1991), 58 Ohio St.3d 58, 66, 567

N.E.2d 1291 (citations omitted). A trial court abuses its discretion when it makes a

decision that is unreasonable, arbitrary, or unconscionable. Blakemore v. Blakemore

(1983), 5 Ohio St.3d 217, 219, 450 N.E.2d 1140 (citations omitted). In applying the

abuse of discretion standard, an appellate court is not free to substitute its own

judgment for that of the trial court. Berk v. Matthews (1990), 53 Ohio St.3d 161, 169,

559 N.E.2d 1301 (citations omitted).

{¶13} “Prior occurrences are sometimes relevant ‘to show that a party knew or

had notice of a dangerous condition.’ ‘[I]n order for such occurrences to have been

admissible to show prior knowledge on the part of [the defendant], these incidents must

have occurred under circumstances substantially similar to those in [the plaintiff’s] case.’

The trial court has the discretion to determine whether the prior occurrences were

6
substantially similar to the accident in question. Furthermore, the proponent of prior

occurrence evidence has the burden of showing the substantial similarity of the

circumstances.” Eakes v. K-mart Intern. Headquarters, Inc., Montgomery App. No.

17334, 1999 WL 252481, at *3 (internal citations omitted).

{¶14} In Renfro, 52 Ohio St.3d at 32, the Ohio Supreme Court held that the trial

court did not abuse its discretion in excluding prior occurrence evidence where there

had been no proffer to show how the circumstances of the prior occurrences were

substantially similar to the circumstances at issue. We reached the same decision in

Eakes, 1999 WL 252481, at *4, concluding that the trial court did not abuse its

discretion in excluding prior occurrence evidence where the plaintiff failed to discuss the

prior occurrence with sufficient specificity to meet his burden of showing that the

circumstances of the prior occurrence were substantially similar to the circumstances at

issue.

{¶15} Lumpkin contends that she was never given the opportunity to establish

that

the circumstances of Thomas’s surgery were substantially similar

to

the

circumstances of her surgery, because the trial court refused to admit the evidence that

would have demonstrated the substantial similarity. But the record reflects that Lumpkin

made no proffer to show how the circumstances of Thomas’s surgery were substantially

similar to the circumstances of he r surgery. Lumpkin failed to address the prior incident

with any specificity, so as to satisfy her burden of showing that the circumstances of

Thomas’s surgery were substantially similar to the circumstances of her surgery. We

conclude that the trial court did not abuse its discretion in excluding the prior incident of

Thomas’s surgery.

7
{¶16} We reach the same result by concluding that the trial court did not abuse

its discretion in excluding the prior incident of Thomas’s surgery as unfairly prejudicial.

Evid. R. 403(A) provides that “[a]lthough relevant, evidence is not admissible if its

probative value is substantially outweighed by the danger of unfair prejudice * * *.” In

McGarry v. Horlacher, Montgomery App. No. 18901, 2002-Ohio-3161, at ¶43, we

concluded that the trial court properly excluded, as unfairly prejudicial, evidence of the

existence of a prior medical malpractice case against the defendant physician, the facts

of that case, and its result.

{¶17} In this case, the trial court ruled as follows:

{¶18} “THE COURT: The potential for damage comes in the jury somehow

making an extrapolation or an interpretation that a prior bad outcome is somehow

evidence of negligence, okay. The Court’s troubled with specific refe rences to any

other prior case. So whether or not you bring up specifically Deborah Thomas or a prior

procedure with a similar bad outcome, that’s where the most likely damage occurs.

{¶19} “Other aspects that the Plaintiff would like to hear, specifically the

proctoring process and recommendations from other surgeons seems to be probative

as to whether or not there was a deviation and whether there’s a standard of care for

one process or not, okay. This is somewhat dividing the baby.

{¶20} “The Court finds that the Motion will be granted in part and would prohibit

the Plaintiff from introducing any testimony about a specific prior incident of a bad

outcome with this procedure either by name or by general reference.

{¶21} “* * *

{¶22} “So we would at least eliminate the possible prejudicial affect of a prior

8
case, and I don’t have any idea whether there’s a breach of standard of care in that

case or not, okay. I don’t have any idea if the facts apply or are similar enough in the

Deborah Thomas case or whether there was just the Deborah Thomas case as a part of

the proctoring process or other surgical procedures. I don’t want to get into what

Wayne Hospital was trying to accomplish and allow an inference that there was a bad

outcome of the same procedure. That’s outside the scope of anything we can

comfortably say is related to this surgery.”

{¶23} Consistent with our conclusion in McGarry, supra, we conclude that the

trial court did not abuse its discretion in excluding, as unfairly prejudicial, the existence

of a prior medical malpractice case involving Thomas’s surgery, the facts of that case

and its result. The circumstances of the case before us are even stronger than those in

McGarry, supra, because there was, at the time of trial, no finding of prior medical

malpractice. The evidence Lumpkin sought to present merely established that in a

previous gall bladder surgery, Dr. Mobley had transected the common bile duct instead

of the cystic duct. This is a known risk of the procedure. Proof of one bad result in a

previous, similar surgery, without more, promotes an improper inference that because a

doctor has had one bad result on a previous occasion, the doctor is incompetent. In the

circumstances of this case, we agree with the trial court that this unfair inference

outweighs any probative value this evidence might have.

{¶24} Lumpkin’s First Assignment of Error is overruled.

III

{¶25} Lumpkin’s Second Assignment of Error is as follows:

{¶26} “THE TRIAL COURT COMMITTED REVERSIBLE ERROR BY

9
EXCLUDING EVIDENCE ABOUT DR. MOBLEY’S PROCTORSHIP AS IT WAS

DIRECTLY RELEVANT TO HIS CREDIBILITY AS A WITNESS AND HIS ABILITY TO

MEET ACCEPTED STANDARDS OF CARE.”

{¶27} Lumpkin contends that the trial court abused its discretion in excluding Dr.

Mobley’s deposition testimony regarding his proctorship, because it was relevant to his

credibility. Dr. Mobley testified, under oath, as follows:

{¶28} “Q. As a consequence did [sic] the Deborah Thomas case, were your

surgical privileges at Wayne County Hospital restricted in any way?

{¶29} “A. No, sir.

{¶30} “Q. You weren’t asked

to proctor under anybody with respect

to

laparoscopic procedures as a consequence of that?

{¶31} “A. No, sir.

{¶32} “Q. So you continued to perform your routine surgical services there and

rotate every three nights as you had traditionally?

{¶33} “A. Yes, sir.”

{¶34} Lumpkin contends that the trial court erred in denying her the opportunity

to impeach Dr. Mobley with his deposition testimony, because Dr. Mobley falsely denied

that he was asked to undergo a proctorship as a consequence of the complications in

Thomas’s surgery. Lumpkin argues that Dr. Mobley’s false denial is evident, based on

a letter from Douglas A. Riffell, the President of the Executive Committee, dated July 7,

1998, in which Riffell wrote, in pertinent part, the following:

{¶35} “The surgical complication rates for gallbladder surgeries over the last

year and a half were recently reviewed by the Executive Committee. This review was

10
performed to evaluate a series of reported surgical complications by physician #475 [Dr.

Mobley]. Physician #475 had one case of laparoscopic common bile duct injury, one

case of cystic duct leakage after laparoscopic cholecystectomy, and one laparoscopic

iliac vein injury. Also reported during open cholecystectomy was a common duct injury

and injury to the hepatic flexure of the colon.

{¶36} “The committee had at hand, literature from the textbook, Current Surgical

Therapy, which indicated major bile duct injury rate in laparoscopic cholecystectomies is

between .3 and .6%. The one major bile duct injury occurring in one of the laparoscopic

cholecystectomies performed by physician #475 since 1995, falls statistically within this

range of occurrence. None the less, the committee concluded that this small but real

accumulation of complications merited a response designed to enhance professional

growth and to ensure the medical staff and the Hospital that biliary surgery is being

performed in [sic] proper and safe manner. The committee was unanimous in its

sentiment that the data does not provide justification for reduction of privileges.”

{¶37} The record shows that Thomas’s surgery occurred approximately one year

prior to Lumpkin’s surgery. Lumpkin’s surgery was on December 19, 1999. Therefore,

Thomas’s surgery was approximately in December, 1998. Lumpkin’s contention that

the trial court abused its discretion in denying her the opportunity to impeach Dr. Mobley

with his deposition testimony, where he denied that he was asked to undergo a

proctorship as a consequence of the surgical complication involving Thomas, is based

on a letter from Riffell, which was dated July 7, 1998, approximately five months prior to

Thomas’s surgery.

{¶38} We conclude that the trial court did not abuse its discretion, because Dr.

11
Mobley’s deposition testimony, denying that he was asked to undergo a proctorship as

a consequence of his surgical complication involving Thomas, is only weakly probative,

at best, of Dr. Mobley’s credibility. Obviously, if the Riffell letter recommending the

proctorship preceded the surgery Dr. Mobley performed upon DeborahThomas, then

the proctorship was not a consequence of the bad result in that surgery, and Dr.

Mobley’s deposition answer was entirely truthful. Even if the Thomas surgery preceded

the Riffell letter, and is one of the matters referred to in that letter, Dr. Mobley’s

deposition answer would not clearly be erroneous. As phrased, Dr. Mobley could

reasonably have construed the question as asking whether the proctorship was caused

solely by the bad result in the Thomas surgery. At most, the Riffell letter might establish

that the bad result in the Thomas surgery was one of a “small but real accumulation of

complications [following surgeries]” that led to the proctorship recommendation.

{¶39} Because Dr. Mobley’s deposition answer only weakly implicated his

credibility, if at all, the trial court could reasonably have concluded that the unfair

prejudice resulting from that line of questioning – that the bad result in the Thomas

surgery implies that Dr. Mobley is incompetent – outweighed its probative value.

{¶40} Lumpkin also contends that the trial court abused its discretion when it

excluded evidence explaining the basis for Dr. Mobley’s proctorship, because it was

relevant to demonstrate that Dr. Mobley’s surgical technique was below the accepted

standards of care. Specifically, Lumpkin contends that the trial court erred in refusing to

admit the full depositions of Dr. Leroy Steinbrecher and Dr. Samuel Brubaker and

letters written by the two physicians showing that Dr. Mobley’s proctorship was a result

of his surgical complications in laparoscopic cholecystectomies and common bile duct

injuries in prior incidents.

12

{¶41} The trial court allowed evidence regarding the proctoring process and the

observations, suggestions and recommendations of the two proctoring physicians, Dr.

Steinbrecher and Dr. Brubaker, who observed Dr. Mobley’s surgical performance.

However, the trial court prohibited evidence, as unfairly prejudicial, of “any testimony

about a specific prior incident of a bad outcome with this procedure either by name or

by general reference.”

{¶42} At trial, Dr. Steinbrecher testified as follows:

{¶43} “Q. I have a letter here which will be Exhibit C. Did you author this letter?

{¶44} “A. I authored this letter, yes.

{¶45} “Q. This

letter contains your

thoughts and comments about your

mentorship of Dr. Mobley.

{¶46} “A. Yes.

{¶47} “Q. Let’s see, in the fourth paragraph of the letter it states, ‘I find his work

at the present time satisfactory. There are some concerns I have about his techniques.

We have discussed some of these. I have tried to impress upon him the need for

careful dissection around the common duct and a bit perhaps more care with placement

of the trocar system.’ Is that a correct reading of that paragraph?

{¶48} “A. That’s correct.

{¶49} “Q. Can you explain to me the concerns you have about Dr. – or had

about Dr. Mobley’s techniques at the time you mentored him?

{¶50} “A. The concerns were two -fold. As I discussed here, number one, that the

concern about his placement of the trocar systems. Two, about his dissection around

the common duct.”

{¶51} Dr. Brubaker also testified as follows:

13

{¶52} “Q. The next exhibit has been marked as Exhibit B which is a letter dated

November 28th, 1998. It states Samuel M. Brubaker, M.D., is the author. Is that your

signature?

{¶53} “A. It is.

{¶54} “Q. In this letter you state, ‘Since surgery is an art as well as a science,

there are a myriad of minor technical points from variation from surgeon to surgeon. I

have shared with Dr. Mobley several details of technique which I have found useful in

my work and which I feel could increase further the finesse and margin of safety of his

performance of those procedures.’ Is that a correct reading?

{¶55} “A. Yes.

{¶56} “Q. Could you describe for me what details of technique that you shared

with Dr. Mobley to improve his technique in laparoscopic cholecystectomy?

{¶57} “A. I recall mentioning two such details. One was that the skin incisions at

the trocar placement be made of adequate length so that the trocar is not impeded

unnecessarily

in

its entry

through

the abdominal wall.

And

the other was

encouragement to be diligent in exposure of the common bile duct for positive

identification.”

{¶58} While the trial court did allow evidence of the observations, suggestions

and recommendations made by Dr. Steinbrecher and Dr. Brubaker in their letters, the

trial court excluded evidence that Dr. Mobley’s proctorship was a result of his surgical

complications in laparoscopic cholecystectomies and common bile duct injuries in prior

14
incidents, as unfairly prejudicial. Consistent with our disposition of Lumpkin’s First

Assignment of Error, we conclude that the trial court did not abuse its discretion in

excluding evidence of prior

incidents of bad outcomes with

laparoscopic

cholecystectomies, as unfairly prejudicial.

{¶59} A fair inference of medical malpractice from prior, similar bad outcomes in

similar medical procedures would seem to require, at a minimum, some expert

testimony that the frequency of bad outcomes exceeds the statistical norm that would

be expected in the absence of malpractice. Evidence of this kind, while not necessarily

sufficient, by itself, to prove malpractice, would appear to support a fair, reasonable

inference of malpractice that would make it probative and admissible. In the case

before us, there was no evidence, or proffer of evidence, to establish that Dr. Mobley’s

frequency of bad outcomes in similar surgeries exceeded the statistical norm that could

be expected in the absence of malpractice. Indeed, the letter of Dr. Riffell, cited by

Lumpkin, suggests the contrary.

{¶60} Lumpkin’s Second Assignment of Error is overruled.

III

{¶61} Both of Lumpkin’s Assignments of Error having been overruled, the

judgment of the trial court is affirmed.

. . . . . . . . . . . . .

WOLFF and YOUNG, JJ., concur.

Copies mailed to:
David P. Kamp
John B. Welch
Hon. Jonathan Hein

Luke v. Redlands Cmty. Hosp. (Summary)

Luke v. Redlands Cmty. Hosp. (Summary)

MEDICAL STAFF HEARING

Luke v. Redlands Cmty. Hosp., No. E046969 (Cal. Ct. App. Feb. 10, 2011)

In a case that was a full decade in the making, the California Court of Appeal reversed a trial court ruling and ordered a hospital to provide the physician with a new hearing based on the suspension and subsequent termination of his privileges. The underlying event that led to the termination of privileges involved a terminally ill patient. The physician, allegedly at the urging of the family, substantially increased the patient’s morphine. The patient died shortly thereafter.

A concern was raised that the physician had not followed hospital protocol regarding comfort care. The department chair and chief of staff reviewed the matter and concluded that the physician had increased the morphine at the family’s urging because the family was upset that the patient had not passed away. Finding that the physician posed an imminent threat to patients, his privileges were summarily suspended and the suspension was upheld by the MEC pending an investigation.

After the investigation, the MEC decided to lift the suspension and impose proctoring. However, when it received a second coroner’s report, which listed the cause of death as “homicide” and “acute morphine toxicity,” and when it discovered a second discharge summary, the Medical Executive Committee imposed a suspension. A lengthy hearing and appeal process followed.

The state medical board also conducted an inquiry. Initially, the state medical board revoked the physician’s license. However, after considering additional information from the physician and receiving a third report from the coroner which changed the cause of death to “undetermined,” the state board rescinded the termination and imposed a lesser sanction.

The physician sued the hospital claiming he did not have a fair hearing based on the composition of the hearing panel. His main argument was that the department chair (who was the witness for the Medical Executive Committee) also had a close professional relationship with one of the hearing panel members. The department chair and the hearing panel members were also both members of the same practice group.

The physician also argued that the hearing was not fair because of the admission into evidence of an erroneous toxicology report and the second coroner’s report which had listed the cause of death as “homicide.”

The trial court ordered the hospital to reconsider its decision in light of a third coroner’s report and new evidence supporting that the toxicology report was erroneous. After a review of this evidence, the Board reaffirmed its decision and the trial court concluded that the physician’s due process rights had not been violated.

The Court of Appeal disagreed and found that several factors, including the possibility of “adjudicator bias” tainted the process so as to deny the physician a fair hearing. Although the court did not find evidence of any pecuniary conflict of interest, it was concerned that one of the hearing panel members might not be impartial based on his “professional embroilment in the dispute.” In support of this position, the court pointed to the fact that the hearing panel member had been involved in the development of the protocol at issue and had asked rather pointed questions about euthanasia during the hearing. The court was also persuaded that the close professional relationship between the department chair and the hearing panel member “created a strong appearance – and perhaps even probability – of professional and personal bias.”

The appeals court was even more disturbed by the unreliable toxicology report and second death certificate which was based on that report. According to the court: “the toxicology report and amended (second) death certificate were so intimately entwined with the actions and decision in this case as to undermine the fairness of the peer review proceedings and hospital board decisions.” Thus, the court ordered that the hospital go back and give the physician a new and fair hearing.

 

Lownsbury v. VanBuren,

Lownsbury v. VanBuren,

Lownsbury v. VanBuren,
No. 00-1655 (Ohio Feb. 20, 2002)

The Ohio Supreme Court held that a physician-patient relationship (and thus
a duty) can be established between a physician who contracts, agrees, undertakes,
or otherwise assumes the obligation to provide resident supervision at a teaching
hospital and a hospital patient with whom the supervising physician had no direct
or indirect contact. Whether the physician actually breached that duty depends
on the language in the contract, specifically what duties the physician agreed
to assume. After reviewing all relevant documents, the testimony of other hospital
physicians and residents that the supervising physician has no responsibility
to a hospital patient unless and until he is contacted by a resident, and the
testimony of experts for the plaintiffs to the contrary, the court concluded
that, in this case, there was sufficient evidence for a jury to decide the question
either way and reversed and remanded the case for further proceedings.

Lumpkin v. Wayne Hosp.

Lumpkin v. Wayne Hosp.

NEGLIGENT
CREDENTIALING

Lumpkin v. Wayne Hosp.,
No. 1615 (Ohio Ct. App. Jan. 23, 2004)

A patient sued her physician for medical malpractice when,
during the course of an operation to remove her gallbladder, he transected the
common bile duct instead of the cystic duct. She subsequently required surgery
to repair the injury, and was hospitalized for nine days. The plaintiff’s amended
complaint included a claim for negligent credentialing against the hospital,
alleging that the hospital was negligent in its hiring, supervising, training
and retaining of the physician, because it had knowledge of a previous identical
act of negligence by the physician and failed to prevent future acts of negligence
by him. Prior to trial, the plaintiff voluntarily dismissed her negligent credentialing
claim against the hospital. A jury found in favor of the physician. The plaintiff
appealed.

The Ohio Court of Appeals affirmed the judgment of a trial
court, holding that it did not abuse its discretion in excluding evidence of
the prior incident, because the record did not reflect any proffer to show how
the circumstances of the other patient’s surgery were substantially similar
to the circumstances of the plaintiff’s surgery. The court also found that the
prejudicial effect of the inference arising from this evidence outweighed any
legitimate probative value it might have. The appeals court concluded that the
lower court did not abuse its discretion in denying the plaintiff the opportunity
to impeach the physician with his deposition testimony regarding his proctorship,
because that testimony only weakly implicated his credibility, and was unduly
prejudicial to the extent that it suggested the forbidden inference that one
previous, similar bad result implied that the physician was an incompetent surgeon.

Lurie v. Mid-Atl. Permanente Med. Group (Summary)

Lurie v. Mid-Atl. Permanente Med. Group (Summary)

AGE DISCRIMINATION IN EMPLOYMENT ACT

Lurie v. Mid-Atl. Permanente Med. Group, Civil Action No. 06-01386 (D. D.C. Aug. 9, 2010)

The United States District Court for the District of Columbia, in a lawsuit brought by a surgeon against his former employer, granted an employer’s motion for summary judgment on the Age Discrimination in Employment Act ("ADEA"), breach of contract and tortious interference claims, among others.

A surgeon, after being terminated by his employer for disciplinary issues and falsifying time sheets, brought a lawsuit alleging violations under the ADEA, and also brought breach of contract and tortious interference claims, alleging that he was terminated unlawfully.

The court granted summary judgment for the employer on the ADEA claim because the surgeon failed to provide evidence that the employer’s reasons for firing him were a pretext for age discrimination or that "but for" the surgeon’s age, he would not have been fired. Also, the court also granted summary judgment on the surgeon’s breach of contract claim holding that the employer retained the right to terminate the surgeon and did not breach the contract when the surgeon was fired. The court granted summary judgment on the tortious interference claim because the surgeon suffered no damages and the relationships the surgeon established with patients while working for the employer were not independent economic relationships with which the employer may interfere, since the patients were also the employer’s patients.

 

Lowrey v. Fairfield Med. Ctr. (Full Text)

Lowrey v. Fairfield Med. Ctr. (Full Text)

[Cite as Lowrey v. Fairfield Med. Ctr., 2009-Ohio-4470.]

COURT OF APPEALS
FAIRFIELD COUNTY, OHIO
FIFTH APPELLATE DISTRICT

Plaintiff-Appellant

CHARLES LOWREY, M.D.

-vs-

FAIRFIELD MEDICAL CENTER, et al.

Defendants-Appellees

JUDGES:
Hon. W illiam B. Hoffman, P. J.
Hon. John W . W ise, J.
Hon. Julie A. Edwards, J.

Case No. 08 CA 85

O P I N I O N

Civil Appeal from the Court of Common
Pleas, Case No. 04 CV 1196

Affirmed

August 28, 2009

For Defendant-Appellee Fairfield

RICHARD S. LOVERING
ERIC S. BRAVO
BRICKER & ECKLER
100 South Third Street
Columbus, Ohio 43215

CHARACTER OF PROCEEDING:

JUDGMENT:

DATE OF JUDGMENT ENTRY:

APPEARANCES:

For Plaintiff-Appellant

D. JOSEPH GRIFFITH
NICHOLAS R. GRILLI
DAGGER, JOHNSTON, MILLER
OGILVIE & HAMPSON
144 East Main Street, P. O. Box 667
Lancaster, Ohio 43130-0667

Fairfield County, Case No. 08 CA 85

2

Wise, J.

{¶1} Appellant Charles Lowrey, M.D. appeals the decision of the Fairfield

County Court of Common Pleas granting summary judgment in favor of Fairfield

Medical Center.

STATEMENT OF THE FACTS AND CASE

{¶2} After a series of incidents involving Dr. Lowrey’s conduct at Fairfield

Medical Center (“the Hospital”), the Hospital Board of Directors recommended that Dr.

Lowrey’s medical staff privileges be suspended. The parties subsequently entered into a

January 8, 2003, Settlement Agreement which provided, inter alia, that Dr. Lowrey

could reapply for staff privileges and that his application “will be evaluated on the same

basis as any other physician applying for Medical Staff Appointment and Clinical

Privileges.”

{¶3} On December 17, 2004, Dr. Lowrey filed the initial Complaint in this case

alleging, among other cla ims, various breaches of the Sett lement Agreement by the

Hosp ita l. Through amend ing h is Comp la int, Dr. Lowrey eventually a lleged e leven

counts aga inst the Hosp ital and former defendants. A ll but two of these Counts were

e lim inated via vo luntary d ism issa l, summary judgment, or both. Th is left on ly Counts

One and S ix. In Count One, Dr. Lowrey a lleged that the Hosp ita l breached

Paragraphs 4(a) and 4(b)(1)(2) of the Settlement Agreement by “fa iling to supp ly

[h is] patients with appropriate contact information and by fa iling to inform [h im] of

pat ient requests.” In Count S ix, he a lleged that the Hosp ita l breached Paragraph

Two of the Settlement Agreement by fa iling to cons ider h is applicat ion for med ical

Fairfield County, Case No. 08 CA 85

3

staff appo intment and clin ica l privileges at the Hosp ita l “on the same basis as any

other physician app lying for med ical staff appointment and clin ical privileges.”

{¶4} On September 26, 2003, Dr. Lowrey signed a Consent and Re lease of

App licant and reapp lied for Med ical Staff privileges on October 2, 2003.

{¶5} On March 3, 2004, Dr. Dominquez advised Dr. Lowrey that “the

Credentia ls Comm ittee has comp leted its review for appo intment and privileges and

has

forwarded a

recommendation

to

the Medical Executive Committee not

recommend ing emp loyment and privileges.”

{¶6} On March 18, 2004, Dr. Lowrey was sent a Not ice of Adverse

Recommendation.

{¶7} On March 23, 2004, Dr. Lowrey’s counsel questioned the basis of the

Credentials Committee’s recommendation to not grant privileges to Dr. Lowrey and on

April 12, 2004, Dr. Lowrey requested a hearing to take place after June 12, 2004,

relating to the Credential Committee’s recommendation to not grant medical staff

privileges.

{¶8} On April 21, 2004, Mina Ubbing, President and CEO of the Hospital,

advised Dr. Lowrey by certified mail that the requested hearing was scheduled to take

place June 15 – 18, 2004. Dr. Lowrey’s counsel requested a continuance of the hearing,

which was rescheduled to August 23 – 27, 2004.

{¶9} On August 18, 2004, Dr. Lowrey submitted written notice withdrawing his

application and cancelling the August 23 – 27, 2004 hearing.

Fairfield County, Case No. 08 CA 85

4

{¶10} In the nine months following the time Dr. Lowrey withdrew his staff

privileges application and cancelled the August 23 – 27, 2004 hearing, he filed four

separate lawsuits against Fairfield Medical Center.

{¶11} The case at issue before this Court is the third and only remaining of these

four lawsuits.

{¶12} In the litigation below, Dr. Lowrey sought discovery of certain peer review

materials, to which the Hospital asserted the peer review privilege and filed a Motion for

Protective Order based on R.C. §2305.252.

{¶13} On May 30, 2006, the trial court issued a Protective Order, which

remained in place throughout the litigation.

{¶14} Prior to trial, on August 29, 2008, the Hospital filed a Motion in Limine

based on the peer review privilege.

{¶15} On September 23, 2008, the date of the scheduled jury trial, the parties

submitted an Agreed Entry Continuing Trial, signed by the trial court and journalized on

September 26, 2008, wherein the parties agreed as follows:

{¶16} “The Court should reconsider Defendant’s prior Motion for Summary

Judgment if the Court determines that there has not been a waiver of the peer review

privilege of R.C. §2305.252. The Court hereby continues the trial of this matter until a

decision is reached on the admissibility of said peer review documents.”

{¶17} On October 28, 2008, the Court sustained the Hospital’s Motion in Limine

based on R.C. §2305.252, and on October 29, 2008 issued the following Entry:

{¶18} “Upon consideration of this Court’s ruling in its Entry filed on October 28,

2008 and pursuant to this Court’s Entry of September 26, 2008, the parties are hereby

Fairfield County, Case No. 08 CA 85

5

ordered to submit Memorandum fully briefing the issue(s) to be considered by this Court

[i.e., whether summary judgment should be granted on the two remaining counts] on or

before November 17, 2008.”

{¶19} In Plaintiff’s Memoranda Contra

to

the Hospital’s Motion

for

Reconsideration submitted pursuant to the Court’s October 29, 2008 Entry, Dr. Lowrey

did not contest the Hospital’s Motion for Reconsideration of the ruling on Count One,

only contesting the Entry as to Count Six.

{¶20} On December 3, 2008, after consideration of the Hospital’s Motion for

Reconsideration and Plaintiff’s Memorandum Contra, the trial court sustained the

Hospital’s Motion for Summary Judgment and dismissed remaining Counts One and

Six.

{¶21} Appellant now appeals, assigning the following errors for review:

ASSIGNMENTS OF ERROR

{¶22} “I. THE TRIAL COURT ERRED IN RECONSIDERING AND GRANTING

SUMMARY JUDGMENT AS TO COUNT SIX OF DR. LOWREY’S COMPLAINT.

{¶23} “II. THE TRIAL COURT ERRED IN RECONSIDERING AND GRANTING

DEFENDANT’S MOTION FOR SUMMARY JUDGMENT AS TO COUNT ONE OF

APPELLANT’S COMPLAINT.

{¶24} “III. THE TRIAL COURT ERRED IN GRANTING DEFENDANT’S MOTION

IN LIMINE AS TO CERTAIN PEER REVIEW MATERIALS DUE TO THE FACT THAT

PRIVILEGE WAS WAIVED IN THE INSTANT CASE.”

{¶25} Appellant has failed to comply with Local App.R. 4(A) which requires

appellant to attach to his brief a copy of the judgment entry appealed from. Although

Fairfield County, Case No. 08 CA 85

6

failure to comply with these rules is failure to prosecute for which dismissal may be

entered sua sponte, we decline to dismiss on procedural grounds and proceed to

address the merits of this appeal.

{¶26} For clarity and ease of analysis, we shall address Appellant’s assignments

of error out order.

III.

{¶27} In his third assignment of error, Appellant argues that the trial court erred

in granting defendant’s motion in limine as to certain peer review materials. We

disagree.

{¶28} Revised Code §2305.252 and §2305.253 set forth the confidentiality of

records and proceedings in the peer review process. R.C. §2305.252 provides an

umbrella of protection to information which is collected and maintained by a peer review

committee during a peer review process. R.C. §2305.252 addresses the confidentiality

of peer review committee proceedings and provides in pertinent part as follows:

{¶29} “Proceedings and records within the scope of a peer review committee of

a health care entity shall be held in confidence and shall not be subject to discovery or

introduction in evidence in any civil action against a health care entity or health care

provider, including both individuals who provide health care and entities that provide

health care, arising out of matters that are the subject of evaluation and review by the

peer review committee. No individual who attends a meeting of a peer review

committee, serves as a member of a peer review committee, works for or on behalf of a

peer review committee, or provides information to a peer review committee shall be

permitted or required to testify in any civil action as to any evidence or other matters

Fairfield County, Case No. 08 CA 85

7

produced or presented during the proceedings of the peer review committee or as to

any finding, recommendation, evaluation, opinion, or other action of the committee or a

member thereof. Information, documents, or records otherwise available from original

sources are not to be construed as being unavailable for discovery or for use in any civil

action merely because they were produced or presented during proceedings of a peer

review committee, but the information, documents, or records are available only from

the original sources and cannot be obtained from the peer review committee’s

proceedings or records. An individual who testifies before a peer review committee,

serves as a representative of a peer review committee, serves as a member of a peer

review committee, works for or on behalf of a peer review committee, or provides

information to a peer review committee shall not be prevented from testifying as to

matters within the individual’s knowledge, but the individual cannot be asked about the

individual’s testimony before the peer review committee, information the individual

provided to the peer review committee, or any opinion the individual formed as a result

of the peer review committee’s activities. An order by a court to produce for discovery or

for use at trial the proceedings or records described in this section is a final order.”

{¶30} R.C. §2305.25(E)(1) defines “peer review committee” in part as follows:

{¶31} “ ‘Peer review committee’ means a utilization review committee, quality

assessment committee, performance improvement committee, tissue committee,

credentialing committee, or other committee that does either of the following:

{¶32} “(a) Conducts professional credentialing or quality review activities

involving the competence of, professional conduct of, or quality of care provided by

Fairfield County, Case No. 08 CA 85

8

health care providers, including both individuals who provide health care and entities

that provide health care;

{¶33} “(b) Conducts any other attendant hearing process initiated as a result of a

peer review committee’s recommendations or actions….”

{¶34} The language in R.C. §2305.252, “manifests the legislature’s clear intent

to provide a complete shield to the discovery of any information used in the course of a

peer review committee’s proceedings.” Tenan v. Huston, 165 Ohio App.3d 185, 2006-

Ohio-131, 845 N.E.2d 549, at paragraph 23. However, the purpose of the statute is not

to hinder lawsuits, but to provide limited protection to individuals who provide

information to review committees or boards, thereby encouraging a free flow of

information without fear of reprisal in the form of civil liability. Browning v. Burt (1993),

66 Ohio St.3d 544, 562, 613 N.E.2d 993.

{¶35} A party asserting the privilege set forth in R.C. §2305.252 has the burden

of establishing that the privilege is applicable. See, e.g., Waldmann v. Waldmann

(1976), 48 Ohio St.2d 176, 178, 358 N.E.2d 521; Svoboda v. Clear Channel Commun.,

Inc., 156 Ohio App.3d 307, 2004-Ohio-894, 805 N.E.2d 559; Perfection Corp. v.

Travelers Cas. & Sur., 153 Ohio App.3d 28, 2003-Ohio-2750, 790 N.E.2d 817.

{¶36} Generally, the review of a trial court’s discovery order is pursuant to an

abuse of discretion standard; but when the trial court’s order contains an error of law in

misconstruing or misapplying the law, then the appellate court reviews the matter de

novo. Quinton v. MedCentral Health Sys., Richland App. No. 2006CA0009, 2006-Ohio-

4238, 2006 WL 2349548, at paragraph 13. The issue of the confidentiality of information

pursuant to R.C. §2305.252 is one of law. Id. See also, Smith v. Manor Care of Canton,

Fairfield County, Case No. 08 CA 85

9

Inc., Stark App. Nos. 2005-CA-00100, 2005-CA-00160, 2005-CA-00162, and 2005-

CA00174, 2006-Ohio-1182; Huntsman v. Aultman Hospital, Stark App. Nos.

2004CA00124 and 2004CA00142, 2005-Ohio-1482, 160 Ohio App.3d 196, 826 N.E.2d

384.

{¶37} Specifically, Appellant argues that the Hospital waived the peer review

privilege by failing to object to, move to strike or otherwise respond to Appellant’s

Motion of Extension of Time which was filed under seal and which attached certain peer

review documents. Appellant argues that once the trial court had reviewed the

privileged documents, such privilege was waived.

{¶38} Upon review, we find Appellant’s waiver argument unpersuasive. We do

not find that Appellee’s alleged inaction in not objecting to the peer review documents

Appellant attached to his Motion for Extension of Time, which was filed under seal,

resulted in a waiver of the peer review privilege.

{¶39} The trial court in this matter had granted a protective order which

prohibited Appellant from seeking “any evidence or other matters produced or

presented during the proceedings of the peer review committee or as to any finding,

recommendation, evaluation, opinion, or other action of the committee or member

thereof.” The trial court never modified or withdrew such protective order. There was

no reason for Appellee to object to the documents which Appellant attached to his

Motion as the trial court had already granted a protective order as to same.

{¶40} Ohio courts have recognized that such a broad concept of waiver would

negate the purpose of the peer review confidentiality statute. Atkins v. Walker (1981), 3

Ohio App.3d 427, 445 N.E.2d 1132.

Fairfield County, Case No. 08 CA 85

10

{¶41} Based on the foregoing, we find Appellant’s waiver argument not well-

taken and hereby overrule same.

{¶42} Appellant’s third assignment of error is denied.

I., II.

{¶43} In his first and second assignments of error, Appellant claims the trial

court erred in granting summary judgment in favor of Appellee as to Counts One and

Six of his Complaint. We disagree.

“Summary Judgment Standard”

{¶44} Summary judgment proceedings present the appellate court with the

unique opportunity of reviewing the evidence in the same manner as the trial court.

Smiddy v. The Wedding Party, Inc. (1987), 30 Ohio St.3d 35, 36. Civ.R. 56(C) provides,

in pertinent part:

{¶45} “Summary

judgment shall be rendered

forthwith

if

the pleadings,

depositions, answers to interrogatories, written admissions, affidavits, transcripts of

evidence in the pending case, and written stipulations of fact, if any, timely filed in the

action, show that there is no genuine issue as to any material fact and that the moving

party is entitled to judgment as a matter of law. * * * A summary judgment shall not be

rendered unless it appears from such evidence or stipulation and only therefrom, that

reasonable minds can come to but one conclusion and that conclusion is adverse to the

party against whom the motion for summary judgment is made, such party being

entitled to have the evidence or stipulation construed most strongly in his favor.”

{¶46} Pursuant to the above rule, a trial court may not enter a summary

judgment if it appears a material fact is genuinely disputed. The party moving for

Fairfield County, Case No. 08 CA 85

11

summary judgment bears the initial burden of informing the trial court of the basis for its

motion and identifying those portions of the record that demonstrate the absence of a

genuine issue of material fact. The moving party may not make a conclusory assertion

that the non-moving party has no evidence to prove its case. The moving party must

specifically point to some evidence which demonstrates the non-moving party cannot

support its claim. If the moving party satisfies this requirement, the burden shifts to the

non-moving party to set forth specific facts demonstrating there is a genuine issue of

material fact for trial. Vahila v. Hall, 77 Ohio St.3d 421, 429, 1997-Ohio-259, citing

Dresher v. Burt, 75 Ohio St.3d 280, 1996-Ohio-107.

{¶47} It is based upon this standard that we review Appellant’s assignments of

error.

{¶48} Upon review, we find that the issues in this case are governed by the

Supreme Court’s decision in Nemazee v. Mt. Sinai Medical Ctr. (1990), 56 Ohio St.3d

109, where the syllabus states:

{¶49} “A physician in a private hospital whose employment and/or hospital

privileges have been terminated must exhaust all internal administrative remedies prior

to seeking judicial review.”

{¶50} In the instant case, Appellant, like the doctor in Nemazee, originally

requested a hearing under the hospital’s due process policy to contest the termination

or non-renewal of his privileges, but later withdrew that request and brought suit for

breach of contract. Id. at 110.

{¶51} The Supreme Court held that the doctor was required to exhaust the

administrative remedies provided in his employment contract prior to initiating suit. After

Fairfield County, Case No. 08 CA 85

12

analyzing the general doctrine of exhaustion of remedies from administrative agencies,

the Court noted that the same principle applied to decisions on staff competence under

administrative due process procedures in hospitals, stating:

{¶52} “[t]he great weight of case authority in the United States is that a board of

trustees of a private hospital has the authority to appoint and remove members of the

medical staff of the hospital and to exclude members of the medical profession in its

discretion from practicing in the hospital.” ***

{¶53} Based upon Nemazee, supra, we find that Appellant failed to exhaust all

internal administrative remedies provided by the Hospital prior to seeking judicial

review. “The purpose of the exhaustion doctrine is to afford the hospital the ability to

correct its own errors; to provide a trial court with an adequate factual record upon

which to make an informed decision as established by the expert testimony of the

medical staff; and to promote judicial economy through the resolution of these disputes

without the premature need for judicial intervention.” O’Neill v. St. Luke’s Medical

Center, (1996) Cuyahoga App. No. 70372.

{¶54} Additionally, we find that Appellant failed to produce any evidence in

support of Counts One and Six of his Complaint.

Fairfield County, Case No. 08 CA 85

13

{¶55} Appellant’s first and second assignments of error are denied.

{¶56} For the foregoing reasons, the judgment of the Court of Common Pleas of

Fairfield County, Ohio, is hereby affirmed.

By: W ise, J.

Hoffman, P. J., concurs in part and dissents in part.

Edwards, J., concurs separately.

JWW/d 721

___________________________________

___________________________________

___________________________________

JUDGES

Fairfield County, Case No. 08 CA 85

14

Hoffman, P.J., concurring in part and dissenting in part

{¶57} I concur

in

the majority’s analysis and disposition of Appellant’s

Assignments of Error I and III. W ith respect to the first assignment, I reject Appellant’s

argument exhaustion of administrative remedies was not necessary because

Appellant’s claim was for breach of the Settlement Agreement. Because the Settlement

Agreement required Appellant’s application for privileges to be considered on the same

basis as the application of any other physician, and all such other applications were

subject to administrative review, as set forth in the Consent and Release of Applicant

executed by Appellant, I find Appellant was also required to exhaust all administrative

remedies before initiating his lawsuit with respect to Count Six.

{¶58} I respectfully dissent from the majority’s disposition of Appellant’s

Assignment of Error II. Unlike Count Six, I do not find Count One subject to the

exhaustion of administrative remedies requirement.

{¶59} I disagree with Appellees’ assertion Appellant’s failure to specifically

address Count One in his reply to Appellees’ Motion for Reconsideration of the trial

court’s previous denial of summary judgment waives his right to raise the issue in this

appeal. Appellant’s initial reply to Appellees’ original summary judgment motion must

still be considered.

{¶60} Appellant states in his Affidavit, his contact information was not shared

with his patients in breach of the Settlement Agreement.1 While Appellees have

1 In the absence of a motion of strike Appellant’s Affidavit for lack of personal knowledge
or hearsay, such averment should be accepted when offered in defense of a motion for
summary judgment. Had a motion to strike been filed, Appellant would have had the
opportunity to cure any deficiency with additional affidavits from his patients. That is not

Fairfield County, Case No. 08 CA 85

15

submitted the Affidavits of Connie Fisher and Kevin Schmelzer to prove otherwise, a

genuine issue of this material fact remains in dispute. As such, I would sustain

Appellant’s Assignment of Error II.

________________________________
HON. W ILLIAM B. HOFFMAN

to say a motion to strike the movant’s affidavit based upon lack of personal knowledge
or hearsay is necessary to defeat summary judgment.

Fairfield County, Case No. 08 CA 85

16

EDWARDS, J., CONCURRING OPINION

{¶61} I concur with the analysis and disposition of this case by Judge W ise with

one exception.

{¶62} The exception is that I do not agree that Count I is subject to the

exhaustion of administrative remedies requirement. However, this disagreement does

not lead to a different disposition of the second assignment of error. This is because I

find that appellant waived his right to raise the second assignment of error on appeal by

not addressing the issue in his reply to appellee’s Motion for Reconsideration of the trial

court’s previous denial of summary judgment.

JAE/rmn

______________________________

Judge Julie A. Edwards

CHARLES LOWREY, M.D.

Plaintiff-Appellant

-vs-

FAIRFIELD MEDICAL CENTER, ET AL.

Defendant-Appellees

:
:
:
:
:
:
:
:
:

JUDGMENT ENTRY

Case No. 08 CA 85

Fairfield County, Case No. 08 CA 85

17

IN THE COURT OF APPEALS FOR FAIRFIELD COUNTY, OHIO
FIFTH APPELLATE DISTRICT

For the reasons stated in our accompanying Memorandum-Opinion, the

judgment of the Court of Common Pleas of Fairfield County, Ohio, is affirmed.

Costs assessed to Appellant.

___________________________________

___________________________________

___________________________________

JUDGES

Lurie v. Mid-Atl. Permanente Med. Group (Full Text)

Lurie v. Mid-Atl. Permanente Med. Group (Full Text)

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 1 of 41

DEAN KEVIN LURIE, M.D.

Plaintiff,

v.

UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
____________________________________
)
)
)
)
)
) Civil Action No. 06-01386 (RCL)
)

)
MID-ATLANTIC PERMANENTE
)
)

MEDICAL GROUP, P.C.

)
Defendant.

____________________________________)

MEMORANDUM OPINION

I.

Introduction

The case concerns an employment dispute between plaintiff Dr. Dean Kevin Lurie, a

surgeon, and his former employer defendant Mid-Atlantic Permanente Medical Group. After

many years of working for defendant, plaintiff was terminated for allegedly falsifying his time

sheets and his history of disciplinary problems, reasons plaintiff claims are a mere pretext for

disposing of an old employee who challenged unprofessional conduct at his workplace. In

addition to a number of common law claims for breach of contract, tortious interference, and

wrongful discharge, plaintiff alleges violations of the Age Discrimination in Employment Act

(ADEA) and the Employee Retirement Income Security Act (ERISA). Defendant filed a

counterclaim seeking recovery for breach of contract, fraud, negligent misrepresentation, and

unjust enrichment. Currently, before the Court are defendant’s motion [78] to strike plaintiff’s

statement of material fact, defendant’s motion [68] for summary judgment and plaintiff’s motion

[69] for summary judgment on the counterclaim. Based on the following considerations, the

Court will DENY defendant’s motion to strike and GRANT defendant’s motion for summary

1

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 2 of 41

judgment. The Court does not reach plaintiff’s motion for summary judgment, because the Court

lacks jurisdiction over defendant’s counterclaim. Therefore, the Court will DISMISS

defendant’s counterclaim on jurisdictional grounds.

II.

Factual Background

Plaintiff is a vascular surgeon residing in the District of Columbia. (Pl.’s Verified

Compl. [72-3] ¶ 5.) Defendant is a professional corporation with its principal place of business

in Maryland that employs physicians who provide medical services to members of the Kaiser

Foundation Health Plan of the Mid-Atlantic States. (Id. ¶ 6; Cahill Aff. [68-3] ¶ 3.) Plaintiff’s

employment with defendant began in 1998. In addition to substantive terms of employment,

plaintiff’s job offer letter included a provision mandating that plaintiff abide by defendant’s

“policies, rules and regulations.” (Pl.’s Ex. 2 [69-4] at 2.) Plaintiff signed the letter and

commenced working for defendant as a surgeon in the District of Columbia and its Maryland

suburbs. (Id. at 3; Cahill Aff. [68-3] ¶ 5.)

As part of his duties with defendant, plaintiff was assigned to treat patients at various

local hospitals. 1

(Lurie Dep. [68-4] at 67:13.) While working at the Washington Hospital Center

(WHC), plaintiff came into conflict with his colleagues over concerns about safety and quality of

care. (Id. at 107:18–108:13, 115:13–116:21.) When he raised his concerns with his superiors, he

received some hostile responses. (Def.’s Ex. 3 [68-5] at 2–3; Def.’s Ex. 5 [68-7] at 2.)

Citing plaintiff’s troubled relations with the surgical residents, the head of surgery

requested and obtained plaintiff’s reassignment in 2001. (Def.’s Ex. 4 [68-6] at 2; Lurie Dep.

[68-4] at 83:7–11.) Official admonitions from defendant followed, and when plaintiff was

1 Although defendant maintained outpatient clinics like the Largo Medical Center, it also needed to be able to see
patients at hospitals. (See Lurie Dep. at 54:8–15.) Consequently, its physicians were assigned to independent,
partner hospitals like the Washington Hospital Center where they could treat Kaiser patients. (See Lurie Dep. [68-4]
at 52:3–54:21.)

2

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 3 of 41

reassigned to WHC two years later, the head of surgery complained about his behavior once

again. (Def.’s Ex. 5 [68-7] at 2; Lurie Dep. [68-4] at 102:1–13; Def.’s Ex. 6 [68-8] at 3.) In late

2003, plaintiff was suspended with pay and an investigation was conducted of his conduct.

(Lurie Dep. [68-4] 152:11–153:12.)

Not long after this last round of disciplinary action, plaintiff was transferred to

defendant’s Largo, Maryland medical center. (Lurie Dep. [68-4] at 118:15–120:10.) When

plaintiff first arrived, he felt pressured to see many double-booked patients. (Id. at 300:7–10.)

Plaintiff’s colleagues told him that, at the Largo Center, these extra patients were handled by

establishing evening clinics or ghost clinics. (Id. at 300:10–15.) The phrase “ghost clinic” is

defendant’s terminology for a billing method utilized by certain physicians employed by

defendant. (Mem. in Supp. of Def.’s Mot. for Summ. J. [68-2] at 5.) Physicians who had many

sessions double booked during the day would include hand-written addendums with their time

sheets that specified hours worked during the evening. (Lurie Dep. [68-4] at 284:16–286:12,

300:4–18, 301:15–302:6.) Physicians could thereby be compensated for the extra patients seen

during regular hours. (Id. at 302:4–12.) In reality, no patients were actually treated in the

evening, thus the expression, ghost clinic. (Id. at 289:5–290:8.)

Defendant was not alone in making use of ghost clinics. Dr. Cohen, an orthopedist, and

Dr. McCanty, a urologist, billed for double-books in the same manner as plaintiff. (Cohen Dep.

[72–9] at 18:12–19:14; McCanty Dep. [72-14] at 25:5–21.) Additionally, Dr. Krolik, a surgeon

who worked with plaintiff, established ghost clinics on three occasions in 2004. (Cahill Aff. [68-

3] ¶ 14.) None of these physicians were subject to disciplinary action as a result of their billing

practices. (Pl.’s Opp’n [72] at 16.) Although plaintiff followed the example and advice of his

fellow doctors in creating ghost clinics, (Lurie Dep. [68-4] at 300:4–301:8, 302:19–303:11), his

3

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 4 of 41

manager gave a negative response when he asked about receiving extra compensation for days

when doctors were overbooked. (Manning Dep. [68-27] at 99:2–102:10.)

Eventually, plaintiff’s use of ghost clinics came to the attention of a compliance officer

named Ann Cahill. (Cahill Aff. [68-3] ¶¶ 2, 12.) She launched an investigation of plaintiff’s

time sheets and discovered that he was reporting more hours than the other doctors on

defendant’s payroll. (Id. ¶ 12.) Indeed, Cahill found that plaintiff was the only physician in the

medical group to have created ghost clinics in the preceding six month period. (See id. at 15.)

Based on Cahill’s finding as well as plaintiff’s poor discipline history, defendant terminated

plaintiff during an October 2005 meeting at its Maryland headquarters. (Id.) At that time,

plaintiff was forty-eight years old. (Compl. [1] ¶ 24.)

While at the Largo facility, defendant had arranged to conduct a clinical trial of a new

surgical device. (See Lurie Dep. [74-1] at 240:2–12.) To govern the clinical trial, plaintiff,

defendant, and the device company (Graftcath) signed a document outlining the terms of their

relationship and naming plaintiff principal investigator. (Def.’s Ex. 18. [70] at 2.) When

plaintiff was terminated, he was unable to continue serving as principal investigator. (Pl.’s

Verified Compl. [72-3] ¶ 38.)

After his removal, plaintiff opened a private medical practice. (Pl.’s Verified Compl.

[72-3] ¶ 19.) Though he applied for membership in defendant’s network of outside providers, he

was rejected. (Id.) Efforts to develop his new practice have been hindered by his reduced access

to Kaiser Health Group patients, (see Lurie Dep. [68-4] at 354:19–355:11), some of whom may

have been dissuaded by defendant from seeking treatment with plaintiff despite his status as their

preferred surgeon. (See Pl.’s Ex. 3 [72-5] ¶ 5; Pl.’s Ex. 4 [72-6] ¶ 5.)

4

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 5 of 41

III. Defendant’s Motion to Strike

Local rule 7(h) requires that a party opposing summary judgment include a “separate

concise statement of genuine issues setting forth all material facts as to which it is contended

there exists a genuine issue to be litigated, which shall include references to the parts of the

record relied on to support the statement.” LCvR 7(h). The purpose of the rule is to aid courts in

deciding motions for summary judgment by refining the record to focus on disputed factual

issues. Burke v. Gould, 286 F.3d 513, 517 (D.C. Cir. 2002). In interpreting the rule, the Circuit

Court has prescribed caution, warning of the drastic consequences of striking a party’s statement

of fact. Id. at 517. The remedy should be reserved for those cases involving “egregious

conduct.” Id.

Defendant contends that plaintiff’s statement of material fact violates local rule 7(h) and

should be stricken. In support of its motion, defendant argues that plaintiff’s statement is

overlong at 117 pages, is suffused with argument, and fails to squarely address defendant’s

statements of fact. (Def.’s Mem. in Supp. of Mot. to Strike [78-1] at 2, 4, 11.)

Although plaintiff’s statement needlessly extends to 117 pages, it cites to the record and

rightfully does not contain legal argument. (See, e.g., id. ¶¶ 14, 21, 22, 87, 123.) For example,

defendant’s statement of material fact affirms, “The letter was sharply critical of WHC’s surgery

department chairman, John Kirkpatrick in particular.” (Def.’s Local Rule 7(h) Statement [68-28]

¶ 14.) In his own statement, plaintiff denies this assertion then launches into a four page

description of hospital policy on official complaints and the Code of Ethics of the American

Medical Association. (Pl.’s Statement [72-1] ¶ 14.)

While the plaintiff’s statement is inappropriately long and evasive, the Court cannot say

that a statement of fact which otherwise comports with local rule 7(h) by citing to the record,

5

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 6 of 41

separately responding to each of defendant’s statements, and refraining from legal argument is

egregious and ought to be stricken. Compare Chambliss v. Nat’l R.R. Passenger Corp., No. 05-

2490, 2007 WL 581900, at *2 (D.D.C. 2007) (granting a motion to strike where plaintiff’s

statement did not properly cite the record, interspersed legal argument, and did not correspond to

paragraphs in defendant’s statement). Accordingly, defendant’s motion [78] to strike plaintiff’s

statement [72-1] is denied.

IV. Defendant’s Motion for Summary Judgment

A. Summary Judgment Standard

Generally, summary judgment should be granted only if the moving party has shown that

there are no genuine issues of material fact and that the moving party is entitled to judgment as a

matter of law. FED.R.CIV.P. 56; Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986); Waterhouse

v. District of Columbia, 298 F.3d 989, 991 (D.C.Cir.2002). A genuine issue of material fact

exists if the evidence, when viewed in a light most favorable to the non-moving party, “is such

that a reasonable jury could return a verdict for the non-moving party.” Anderson v. Liberty

Lobby, Inc., 477 U.S. 242, 248 (1986). In determining whether a genuine issue of material fact

exists, the Court must view all facts in the light most favorable to the non-moving party. See

Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986). The non-moving

party’s opposition, however, must consist of more than mere unsupported allegations or denials

and must be supported by affidavits or other competent evidence setting forth specific facts

showing that there is a genuine issue for trial. FED.R.CIV.P. 56(e); see Celotex Corp., 477 U.S.

at 324. At the summary judgment stage, a judge may not make credibility determinations, as that

is the function of a jury. George v. Leavitt, 407 F.3d 405, 413 (D.C. Cir.2005).

6

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 7 of 41

B. ADEA

The Age Discrimination in Employment Act (ADEA) forbids an employer from

firing an employee on the basis of his age. 29 U.S.C. § 623(a)(1) (2006). The Circuit Court has

clearly articulated the standard to be used in evaluating motions for summary judgment in

employment discrimination disputes:

[I]n considering an employer’s motion for summary judgment or judgment as a
matter of law in those circumstances, the district court must resolve one central
question: Has the employee produced sufficient evidence for a reasonable jury to
find that the employer’s asserted non-discriminatory reason was not the actual
reason and that the employer intentionally discriminated against the employee on
the basis of race, color, religion, sex, or national origin?

Brady v. Office of the Sergeant of Arms, 520 F.3d 490, 494 (D.C. Cir. 2008) (citing St. Mary’s

Honor Ctr. v. Hicks, 509 U.S. 502, 507–08, 511 (1993), and U.S. Postal Serv. Bd. of Governors

v. Aiken, 460 U.S. 711, 714–716 (1983)). 2

Subsequent to Brady, the Supreme Court further focused the ADEA standard. It held, “A

plaintiff bringing a disparate-treatment claim pursuant to the ADEA must prove, by a

preponderance of the evidence, that age was the ‘but-for’ cause of the challenged adverse

employment action.” Gross v. FBL Fin. Servs., Inc., 129 S. Ct. 2343, 2352 (2009). Put

differently, it is not enough that age was one motivating factor in an adverse employment action;

rather, it must be the case that the adverse action would not have occurred in the absence of age

as a consideration. See id. at 2350.

Therefore, the Court must decide whether sufficient evidence exists for a reasonable juror

to find that defendant’s proffered reasons for terminating plaintiff mask discriminatory intent that

rendered age the but-for cause of plaintiff’s termination. Evidence of pretext may include

2 Brady does not expressly address age discrimination claims. However, this Court and the other courts of this
district have regularly extended Brady’s methodology to claims under the ADEA. Chappell-Johnson v. Blair, 574
F. Supp. 2d 87, 96 n.9 (D. D.C. 2008), aff’d, 358 Fed. App’x 200 (D.C. Cir. 2009). Hence, the Court does not
hesitate in applying Brady to the present case.

7

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 8 of 41

variant treatment of similarly situated employees, discriminatory statements by decision makers,

and irregularities in the stated reasons for the adverse employment decision. Brady, 520 F.3d at

495 & n.3. However, discrimination will not be inferred from the fact that defendant’s reasons

prove unfounded so long as they are held reasonably and in good faith. Brady, 520 F.3d at 495.

Similarly, an inference of discrimination should not be drawn from disparate treatment of

comparable employees unless “all of the relevant aspects of [a plaintiff’s] employment situation

[are] ‘nearly identical’” to those of the comparator. Neuren v. Adduci, Mastriani, Meeks, &

Schill, 43 F.3d 1507, 1514 (D.C. Cir. 1995).

In the instant case, defendant asserts that plaintiff was fired for falsifying his time sheets

and for his long history of disciplinary problems. (Mem. in Supp. [68-2] at 5.) In order to

demonstrate that defendant’s stated reasons were only a pretext for age discrimination, plaintiff

pursues roughly five distinct lines of argument: (1) plaintiff was replaced by a less qualified,

younger physician; (2) plaintiff completed his time sheets consistent with company practice and

was the only physician disciplined for so doing; (3) plaintiff’s disciplinary history was

undeserved and a contrived, post hoc justification for his termination; (4) defendant’s managers

were aware that the defendant stood to reap financial benefits from terminating older physicians

like plaintiff; and (5) defendant’s managers made depreciatory remarks about plaintiff’s age.

(Pl.’s Opp’n to Def.’s Mot. for Summ. J. [72] at 13–14, 16–18.)

1. Plaintiff was not “replaced” by a younger doctor

Plaintiff claims that Dr. Aryavand was hired as his more youthful but less meritorious

replacement. Specifically, plaintiff alleges that Dr. Aryavand was offered a job only one day

before defendant began the investigation which led to plaintiff’s termination. (See Pl.’s Ex. 37

[69-39] at 2; Cahill Aff. [68-3] ¶ 18.) Dr. Aryavand was thirty-eight at the time he was hired

8

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 9 of 41

while plaintiff was forty-eight at the time he was fired. (Aryavand Dep. [72-7] at 22:5–8;

Compl. [1] ¶ 24.) Both plaintiff and Dr. Aryavand were vascular surgeons. (Pl.’s Verified

Compl. [72-3] ¶ 12; Aryavand Dep. [72-7] at 14:9–12.)

However, plaintiff’s evidence provides little basis for a jury to infer that Dr. Aryavand

was hired as plaintiff’s replacement, much less that plaintiff suffered discrimination thereby.

After Dr. Aryavand was hired, he and plaintiff worked at different facilities; whereas plaintiff

was employed at defendant’s Largo, Maryland center, Dr. Aryavand worked for defendant in

Kensington, Maryland and in Washington DC. (Lurie Dep. [68-4] at 120:3–10; Aryavand Dep.

[72-7] at 22:11–23:16, 46:13–16.) Furthermore, Dr. Aryavand possessed qualifications that

plaintiff lacked; he was a fellowship-trained vascular surgeon while plaintiff did not have such

training. (Aryavand Dep. [72-7] at 12:17–21; Lurie Dep. [68-4] at 14:14–18.) Finally, in

regards to the timing of personnel decisions, the alleged connection between defendant’s offer of

employment to Dr. Aryavand and its decision to investigate plaintiff is terribly attenuated. Other

than pointing out the conjunction, plaintiff furnishes no evidence from which a reasonable juror

could find that the timing of defendant’s actions was anything more than a coincidence.

2. Defendant acted in good faith in terminating plaintiff for his timesheet
practices

Plaintiff alleges that his timesheet practices were in accord with defendant’s policies and

that he alone was punished for the common practice of creating so-called ghost clinics. In

support of his contentions, plaintiff claims that a document obtained from defendant entitled

“MAPMG Pay Practices, July 2005” [72-34] verifies that defendant sanctioned the use of ghost

clinics. The document, however, cannot be fairly read to support plaintiff’s position; nothing

indicates that physicians could be paid for multiple double-books during the day by charging for

dummy patients treated in the evening. (See Pl.’s Ex. 32 [72-34].) For instance, where the report

9

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 10 of 41

refers to payments for “extra sessions,” it appears to be indicating medical work actually

performed after-hours such as “urgent cases in late afternoon or evening,” not services for

fictitious evening patients. (Id. at 2.) In sum, plaintiff’s conclusory characterization of this

document would not permit a jury to find that ghost clinics were authorized by defendant.

Next, plaintiff argues that establishing ghost clinics was a common practice in which

defendant’s managers acquiesced. After arriving at defendant’s Largo, Maryland medical center,

plaintiff’s colleagues told him that these extra patients were handled by establishing evening

clinics (ghost clinics). (Id. at 300:10–15.) Despite the reassurances of his fellow surgeons,

plaintiff remained hesitant and prompted the head nurse Sharon Stewart to seek authorization

from her manager Ms. Williams who then consulted her manager Mr. Labash. (Id. at 301:2–11.)

Afterwards, Ms. Lawrence informed plaintiff that her managers had given instructions to operate

ghost clinics. (Id. at 301:12–15.) Note however, that as a surgeon, plaintiff’s immediate

supervisors were Dr. Manning and Dr. Schwartz. (Id. at 40:1–4, 304:6–10.) Though neither Dr.

Manning nor Dr. Schwartz ever expressly authorized the use of ghost clinics, plaintiff believed

that they tacitly endorsed the practice. (See id. at 303:18–306:6). However, neither Dr. Manning

nor Dr. Schwartz, plaintiff’s immediate supervisors, ever expressly authorized the use of ghost

clinics. (See id. at 303:18–306:6).

While a jury could infer that if plaintiff was not violating company policy, that

defendant’s stated reasons for terminating plaintiff were pretextual, the record does not support

that conclusion. The evidence that defendant approved of the use of ghost clinics addresses the

perception of plaintiff and his colleagues, rather than the understanding of his supervisors and

the managers involved in his termination. See George v. Leavitt, 407 F.3d 405, 415 (D.C. Cir.

2005) (stating that a defendant may prevail on summary judgment if there is no genuine issue as

10

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 11 of 41

to whether the manager making the termination decision honestly and reasonably believed in

defendant’s reasons).

There is evidence that relevant managers did not share plaintiff’s belief about the

acceptability of ghost clinics. For example, when plaintiff asked his supervisor about receiving

additional payment for multiple double books, the matter was taken to a higher manager who

expressly rejected the idea. (Manning Dep. [68-27] at 99:2–100:5.) Whereas plaintiff’s

evidence goes to his belief in the propriety of ghost clinics and his understanding that his

supervisors’ acquiesced in the practice, the supervisors themselves rejected it.

More importantly, the managers participating in the investigation preceding defendant’s

termination, Traci Holsteen and Ann Cahill, did not accept the legitimacy of ghost clinics.

Holsteen was defendant’s Director of Regional Access Services. (Holsteen Aff. [68-16] ¶ 2.) In

June 2005, whilst conducting a “routine review of physician schedules,” Holsteen noticed that

evening sessions had been opened for plaintiff in which patients he had seen earlier in the day

were booked. (Id.) Subsequently, Holsteen sent an email to plaintiff’s supervisors, Dr. Manning

and Dr. Schwartz, expressing her concern at her findings. (Id. ¶ 3.) She wrote,

Dr. Lurie is the only surgeon that I am aware of that sees his double books during
the day and places them in an extra session in the evening. His timesheet will
reflect an additional four hours that was filled with one hour’s equivalent of
patients that were seen during his regular day. This is not the routine for our
approach to scheduling.

(Id. at 4.) Eventually, the matter was referred to Cahill. (Cahill Aff. [68-3] ¶¶ 2, 12.) After

reviewing plaintiff’s time sheets, Cahill recognized that plaintiff was reporting many more hours

than his fellow physicians. (Id. ¶ 12.) Further exploring company files, she found that no other

physician in 2004 or 2005 had created ghost clinics except for plaintiff’s surgical colleague Dr.

Krolik who created just three ghost clinics in 2004. (Id. ¶¶ 12, 14). Following Cahill’s

11

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 12 of 41

investigation, defendant terminated plaintiff in October of 2005. (Id. ¶ 15.) By all appearances,

Holsteen and Cahill honestly and reasonably believed that plaintiff’s timesheets were improper.

Accordingly, no reasonable jury could infer discrimination from the time sheet evidence.

Plaintiff also maintains that while other physicians, including his surgical colleague Dr.

Krolik, created ghost clinics, only he was disciplined for doing so. He alleges his disparate

treatment is indicative of discrimination. Plaintiff is correct that evidence that similarly situated

employees were treated differently is proper fodder for an employment discrimination case.

Brady, 520 F.3d at 495. However, plaintiff’s long disciplinary history and the magnitude of his

use of ghost clinics serve to distinguish him from doctors who were not disciplined. 3

Doctors who used ghost clinics but were not punished include Dr. Cohen, an orthopedist,

Dr. McCanty, a urologist, and plaintiff’s surgical colleague Dr. Krolik. (Cohen Dep. [72–9] at

18:12–19:14; McCanty Dep. [72-14] at 25:5–21; Cahill Aff. [68-3] ¶ 14; Pl.’s Opp’n [72] at 16.)

Plaintiff can be distinguished from Dr. Cohen and Dr. McCanty as neither physician worked in

the department of surgery with plaintiff. (See Lurie Dep. [68-4] at 287:18–21, 38:13–15.)

Additionally, neither doctor is alleged to possess a comparable disciplinary record. As a fellow

surgeon, Dr. Krolik is a better candidate for comparison but still possesses significant differences

from plaintiff. For one, she used ghost clinics relatively little. (See Cahill Aff. [68-3] ¶ 14.)

From the beginning of 2004 to October 2005, Dr. Krolik recorded ghost clinics on three

occasions while plaintiff did so at least fourteen times during the same period. (Id.) What is

more, Dr. Krolik had a spotless record. (Id.) In contrast, plaintiff had often been in trouble with

the company, a fact that defendant considered in deciding to discharge him. (Cahill Aff. [68-3] ¶

15; see discussion infra Part IV.B.2.c) Given the different employment situations of the three

3 Comparators must be nearly identical to a plaintiff in all relevant aspects of their employment situation. Neuren,
43 F.3d at 1514.

12

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 13 of 41

doctors, the Court should not infer discrimination from the fact that they were not similarly

punished for maintaining ghost clinics. See Childs-Pierce v. Util. Workers Union of Am., 383 F.

Supp. 2d 60, 74–75 (D.D.C. 2005) (refusing to find pretext where plaintiff had accumulated

record of deceit and insubordination while comparators had never been disciplined).

3. Defendant could have terminated plaintiff in good faith based on his
disciplinary history

Plaintiff’s third argument contests defendant’s appeal to past disciplinary incidents as a

reason for plaintiff’s termination. Evidence of falsehood and inconsistency vis-à-vis stated

reasons for termination may be used to infer discriminatory intent. Brady, 520 F.3d at 495 &

n.3. Plaintiff, however, fails to contest the existence of his disciplinary record and its use as a

basis for his firing.

Plaintiff drew the ire of company officials on several occasions. The history of plaintiff’s

troubles begins in 2001 when he was reassigned from WHC after the head of surgery there

complained about his behavior. (Def.’s Ex. 4 [68-6] at 2; Lurie Dep. [68-4] at 83:7–11.) In

response to this incident, defendant saw fit to officially warn plaintiff and admonish him about

his behavior. (See Def.’s Ex. 5 [68-7] at 2.) Two years later, plaintiff was reassigned to WHC,

but again the head of surgery complained about his behavior. (Lurie Dep. [68-4] at 102:1–13;

Def.’s Ex. 6 [68-8] at 3.) In late 2003, defendant suspended plaintiff with pay and an

investigation was conducted of his conduct. (Lurie Dep. [68-4] 152:11–153:12.) It also issued

him a reprimand letter and a Performance Improvement Plan. (See Def.’s Ex. 8 [68-10]; Def’s

Ex. 9 [68-11].) Afterwards, plaintiff kept encountering trouble with patients and co-workers

alike. (See, e.g., Def.’s Ex. 11 [68-13].)

Plaintiff responds by offering an alternate characterization of his time at the company,

one in which he plays the part of the white knight, victimized by defendant for insisting on high

13

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 14 of 41

standards of professionalism. (See Pl.’s Opp’n [72] at 17.) Yet regardless of whether plaintiff’s

sanctions were fair or right, defendant could legitimately take plaintiff’s record into account in

making its decision to terminate plaintiff. It is enough that defendant honestly and reasonably

believed in the validity of its bases for terminating plaintiff. See George, 407 F.3d at 415.

Plaintiff also tries to show that defendant’s invocation of his disciplinary record was

pretextual by pointing to awards he received and improvements in his official evaluations. (Pl.’s

Opp’n [72] at 17.) Regardless of whether plaintiff received the accolades, defendant still could

have honestly and reasonably relied on defendant’s past troubles as a basis for his termination. It

may well have been foolish to terminate a surgeon as talented as plaintiff but that does not

demonstrate that defendant’s appeal to plaintiff’s disciplinary record was insincere.

Finally, plaintiff contests that his discipline record was part of the original justification

for his termination and declares that it was only asserted later to “ress [d]efendant’s case.”

(See Pl.’s Opp’n [72] at 16.) Plaintiff’s position, however, is based on a mischaracterization of

Cahill’s deposition testimony. (See Pl.’s Opp’n [72] at 16–17.) In his brief, plaintiff quotes in

isolation the following bit of the deposition record: “Q. Was there any other reason why he was

terminated? A. No.” (Cahill Dep. [72-8] at 156:9–12.) Plaintiff relies on this response to

demonstrate that time sheets were the only justification for plaintiff’s termination, but when

placed in proper context, the cited testimony does not support plaintiff’s position. Specifically,

plaintiff omits important preceding lines that show Cahill and her questioner were discussing

only the text of plaintiff’s termination letter, not defendant’s reasons for termination more

generally. (Cahill Dep. [72-8] at 155:15–156:12.) Moreover, during the same deposition, Cahill

had already stated there were other reasons for plaintiff’s removal:

Q. Your testimony earlier today I recall is that this was the only reason he was
terminated and I wanted to ask you if, in fact, this is the only reason he was

14

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 15 of 41

terminated? A. I don’t remember saying it was the only reason. I know that also
in consideration was the behavior of Dr. Lurie on previous occasions. Concerns
about him were mitigating factors.

(Def.’s Reply Ex. 4 [77-4] 151:3–12.) At the end of the day, Cahill’s testimony establishes that

disciplinary problems played a role in plaintiff’s dismissal.

4. Defendant’s alleged pecuniary interest in plaintiff’s termination does not
show discrimination

Plaintiff alleges that defendant stood to gain financially by firing plaintiff as an older

doctor. Plaintiff’s position here rests on three pieces of evidence. First, he alleges that defendant

had changed the rules for its pension program so that physicians hired after 2000 could not retire

with full benefits until age 65. 4

(See Pl.’s Opp’n [72] at 17.) Second, Cahill once remarked to

plaintiff that he was “making too much money.” Third, Dr. Aryavand, plaintiff’s alleged,

younger replacement, was paid less money than and would retire at a later age than plaintiff.

Altering the pension program is not indicative of discriminatory intent. To begin,

plaintiff was hired well before the new policy took effect, (see Pl.’s Verified Compl. [72-3] ¶

10), and therefore, he and other longtime employees could not have been dissuaded from

remaining with defendant by the change. However, even if the changes did not affect plaintiff,

he may still contend that they are indicative of a generalized hostility towards older employees

harbored by defendant. On the contrary, increasing the retirement age is suggestive of a desire to

retain older physicians past the age of sixty rather than to hurry them out the door. At the end of

4 In his brief, plaintiff describes the pension rules as having been changed so as to exclude physicians hired after
2000 from retiring with full benefits at 65. (See Pl.’s Opp’n [72] at 17.) This may misrepresent the development of
defendant’s pension policy. The record is ambiguous; it may be the case that pre-2001 hires gained the ability to
retire at 60 while hires after that date were to be kept ineligible for full retirement until 65. (See Def.’s Reply Ex. 1
[77-1] ¶ 4; Pl.’s Ex. 13 [72-15] at 72:20–73:7.) Nonetheless, defendant does not dispute plaintiff’s account, and
either version of events should yield the same outcome on the discrimination question. Allowing full retirement at
sixty would only make employment with defendant more attractive for people in defendant’s age group, hardly a
way to purge one’s payrolls of workers between the ages of 40 and 60.

15

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 16 of 41

the day, the Court does not see how a reasonable jury could infer discrimination from changes in

the pension plan.

On one occasion, Cahill observed to plaintiff that he was “making too much money.”

(Lurie Dep. [68-4] at 188:8–10.) Plaintiff interprets her words as expressing a desire to

terminate an older, better remunerated employee. Yet what plaintiff omits to mention is that

Cahill made the comment while discussing plaintiff’s use of ghost clinics. (Id. at 188:14–17.)

When Cahill expressed her opinion about plaintiff’s earnings, the circumstances suggest she did

so in relation to the extra pay he was receiving for ghost clinics, not entitlements accrued as an

older physician. In proper perspective, there is nothing insidious about Cahill’s remark.

Nonetheless, plaintiff attempts to link Cahill’s comment to the fact that Dr. Aryavand, his

alleged replacement, was paid substantially less than plaintiff and would not have been eligible

for full retirement until age 65. The Court has already addressed the argument that Dr.

Aaryavand was plaintiff’s replacement in the negative.

5. Isolated, derogatory remarks about plaintiff’s age do not show
discrimination

Fifth and finally, plaintiff relies on comments made by one of defendant’s managers, Dr.

Beaverson, about his age. In the course of a meeting at her office, Dr. Beaverson told plaintiff

that he had “gotten so old.” (Lurie Dep. [68-4] at 59:6–8.) Plaintiff’s claims notwithstanding,

Dr. Beaverson’s comments are insufficient to infer discrimination in the decision to terminate

plaintiff. “[S]tray remarks, ‘even those made by a supervisor, are insufficient to create a triable

issue of discrimination where, as here, they are unrelated to an employment decision involving

the plaintiff.’” Talavera v. Fore, 648 F. Supp. 2d 118, 132 (D.D.C. 2009) (quoting Simms v.

U.S. Gov’t Printing Office, 87 F. Supp. 2d 7, 9 n.2 (D.D.C. 2000)). Dr. Beaverson’s statement

qualifies as a stray remark; after the meeting in question, she and plaintiff had no further contact.

16

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 17 of 41

(Lurie Dep. [68-4] at 195:9–14.) More to the point, although Dr. Beaverson was in management,

she was not involved in the decision to terminate plaintiff. (See Beaverson Aff. [77-2] ¶¶ 3, 7;

Lurie Dep. [68-4] 202:19–203:2.) In sum, Dr. Beaverson’s statement is insufficient to generate a

jury worthy issue on discrimination.

Having separately considered each of plaintiff’s arguments, the Court has discovered

nothing from which a reasonable jury could infer that the reasons given for plaintiff’s discharge

were a pretext for unlawful employment discrimination. Given the absence of evidence that

defendant’s stated reasons were insincere or that age was a factor in, let alone a but-for cause of,

plaintiff’s termination, the Court will grant summary judgment in defendant’s favor on plaintiff’s

ADEA claim.

C. ERISA

The Employee Retirement Income Security Act (ERISA) forbids an employer from

discharging a participant in an employee benefit plan for the purpose of interfering with the

attainment of any right under the plan. 29 U.S.C. § 1140. In interpreting ERISA, the Circuit

Court has followed the familiar burden shifting approach employed in Title VII and ADEA

cases. See May v. Shuttle, Inc., 129 F.3d 165, 169–70 (D.C. Cir. 1997). Under that framework,

the plaintiff is required to first make out a prima facie case of prohibited employer conduct

before the burden shifts to the defendant to articulate a legitimate reason for its action. Id. at

169. The burden then swings back to the plaintiff to prove that the presented reasons are

pretextual. Id. at 170.

Though May was following the state of the art in employment discrimination

jurisprudence, subsequent developments have altered the way courts in this circuit treat ADEA

and Title VII claims. See James v. Int’l Painters and Allied Trades Indus. Pension Plan, No. 07-

17

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 18 of 41

2107, 2010 WL 1741114, at *12 (D.D.C. April 30, 2010). Specifically, the Circuit Court

directed in Brady that courts considering motions for summary judgment focus on the pretext

question. See Brady, 520 F.3d at 494. Once the defendant has proffered non-discriminatory

reasons for its actions, the court need no longer concern itself with whether the plaintiff has

made out a prima facie case. Id.

So far, the Circuit Court has not extended the methodology in Brady to claims under

ERISA. See James, 2010 WL 1741114, at *12. However, a fellow court in this district has with

good reason opted to apply Brady to an ERISA claim. See id. Updating ERISA interpretation to

correspond with developments in the application of Title VII is consistent with the Circuit

Court’s approach of maintaining both areas of the law in parallel. See id. Thus, the Court’s task

is to determine whether the evidence is sufficient to allow a reasonable juror to find that

defendant’s reasons for terminating plaintiff are a pretext for depriving him of his pension

benefits.

Plaintiff’s evidence in support of his ERISA claim is sparse. Plaintiff relies in large part

on his verified complaint in order to make his argument. The relevant section states,

Upon information and belief, one of the determining factors causing his
[plaintiff’s] termination was Defendant Kaiser’s desire to deprive Plaintiff Dr.
Lurie of further participation in “Defendant Kaiser’s pension plan and to avoid the
adverse economic impact which Plainitff Dr. Lurie’s continuation in the plan
would cause. Such discrimination was for the purpose of interfering with Plaintiff
Dr. Lurie’s attainment of rights to which he was entitled under Defendant
Kaiser’s pension plan, contrary to the provisions of Section 510 of ERISA.

(Pl.’s Verified Compl. [72-3] ¶ 12.)

There is some question as to the evidentiary status of this statement. The Circuit Court

has established that a verified compliant may be treated as an affidavit for summary judgment

purposes. See Neal v. Kelly, 963 F.2d 453, 457 (D.C. Cir. 1997). Nevertheless, rule 56(e)

18

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 19 of 41

dictates that an “opposing affidavit must be made on personal knowledge, set out facts that

would be admissible in evidence, and show that the affiant is competent to testify on the matters

stated.” FED. R. CIV. P. 56(e).

Although plaintiff’s verified complaint may be dealt with as an affidavit, the statement in

question violates rule 56(e) and cannot be accorded weight in deciding the present motion for

summary judgment. Though plaintiff claims that his declaration derives from “information and

belief,” he does not point to specific facts or observations which would support his contention or

explain the provenance of his knowledge. (Pl.’s Opp’n [72] at 18.) The court, therefore, will not

consider the above section of plaintiff’s verified complaint in evaluating the sufficiency of the

evidence. See Greene v. Dalton, 164 F.3d 671, 675 (D.C. Cir. 1999) (refusing to credit

conclusory portion of plaintiff’s affidavit that stated, without support, that she was more

qualified than other applicants).

Aside from his verified complaint, plaintiff points to a few stray points in the evidence to

support his claim. (See Pl.’s Opp’n [72] at 19–20.) First, he relies on Cahill’s comment to

plaintiff that he was “making too much money.” (Pl.’s Opp’n [72] at 19.) As previously

addressed, plaintiff takes Cahill’s statement out-of-context. Cahill made the comment in the

course of a meeting about plaintiff’s use of ghost clinics; her reference to “making too much

money” was in regard to the extra hours plaintiff was billing, not his pension rights as a longtime

employee. (See Lurie Dep. [68-4] at 188:8–17.)

Second, plaintiff claims that defendant stood to save substantial sums by terminating him

and replacing him with younger doctors, like his alleged replacement Dr. Aryavand, who would

receive less lucrative pension packages. (Id. at 19–20). Plaintiff claims that his expert, Dr.

Bozilleri, is ready to testify that he would have been entitled to more than $900,000 in pension

19

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 20 of 41

benefits had he not been fired. (Id. at 20.) Plaintiff, though, does not cite to record evidence

which would confirm the content or availability of Dr. Borzilleri’s testimony. (See id.)

Conversely, the record does show that plaintiff was already vested in the pension plan at the time

of his termination. (See Lurie Dep. [68-4] at 205:18–21.) In fact, plaintiff reaped its benefits by

electing to accept a lump sum distribution of his pension entitlements shortly after his firing.

(Def.’s Reply Ex. 1 [77-1] at ¶ 6.)

Third, plaintiff directs the Court’s attention to the deposition testimony of defendant’s

Chairman of the Board, Dr. Michell. (See Pl.’s Opp’n [72] at 19.) Plaintiff reads Dr. Michell’s

testimony for the proposition that defendant “changed its pension plan so that new employees

would no longer be able to receive full benefits at age 60.” (Id.) The Court has already noted

that plaintiff may have misrepresented Dr. Michell’s testimony with respect to the historical

development of the pension plan. Still, for present purposes, the Court may accept plaintiff’s

characterization as true.

Even if one accepts that the pension plan was altered to prevent new employees from

retiring with full benefits at age 60 and that defendant reaped some pension savings by firing

plaintiff, a reasonable jury could not infer that defendant’s reasons for firing plaintiff were a

pretext for depriving him of his pension benefits. It cannot be the case that every time an

employer alters its pension program or choose to fire an employee, the possibility of savings will

render its motives sufficiently suspect to create a jury issue. See May, 129 F.3d at 171

(“Plaintiffs must show more than that Shuttle [their employer] furloughed plaintiffs to save

money”); Conkwright v. Westinghouse Elec. Corp., 933 F.2d 231, 239 (4th Cir. 1991)

(“[Plaintiff’s] suggestion that [defendant] acted illegally because it acted to save money proves

too much. Under that reasoning, any actions by an employer that result in savings would be

20

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 21 of 41

suspect.”). Something more is needed to show an illicit motive for the decision to sack an

employee, but no such additional evidence was forthcoming in this case. Therefore, defendant’s

motion for summary judgment on plaintiff’s ERISA claim will be granted.

D. Choice of Law

Plaintiff also asserts a number of common law claims over which the Court has

jurisdiction based on diversity of citizenship. When hearing diversity cases, the Court applies

the law of the forum state, including its choice of law rules. See Klaxon Co. v. Stenton Elec.

Mfg. Co., 313 U.S. 487, 496 (1941). According to the choice of law doctrine of the District of

Columbia, the Court’s first task is to determine if there is a conflict between the laws of relevant

jurisdictions. Eli Lilly and Co. v. Home Ins. Co., 64 F.2d 876, 882 (D.C. Cir. 1985) (citing

Fowler v. A&A Co., 262 A.2d 344, 348 (D.C. 1970); Gaither v. Meyers, 404 F.2d 216, 222 (D.C.

Cir. 1968)). If no conflict exists, it is unnecessary for the Court to make an ultimate choice of

law determination. See id.

Plaintiff is of the opinion that either District of Columbia law or that of California should

apply to his common law claims. (See Pl.’s Opp’n [72] at 22.) California, though, is not a

serious candidate. 5

For his part, defendant believes that the law of Maryland ought to govern.

(See Def.’s Reply to Opp’n to Mot. for Summ. J. [77] at 10 n.8, 23.) That being said, the Court

believes that identical results will be reached on all claims regardless of whether District of

Columbia or Maryland law is applied. Hence, the Court finds it unnecessary to conduct a choice

5 The only link between the present litigation and California is the affiliation of defendant with The Permanente
Medical Group, a medical group headquartered in California. (See Pl.’s Ex. 17 [72-19] at 2.) Just a glance at the
District of Columbia choice of law standard is enough to belie the notion that California law ought to apply. See
Drs. Groover, 917 A.2d at 1117; Greycoat, 657 A.2d at 767–68. The key events underlying this litigation took
place either in the District of Columbia or Maryland. (See, e.g., Pl.’s Verified Compl. [72-3] ¶¶ 10, 15, 16, 19.)
Plaintiff is a resident of the District of Columbia, and defendant has its principal place of business in Maryland.
(Pl.’s Verified Compl. [72-3] ¶¶ 5, 6.) Plaintiff admits the irrelevance of California law insofar as the majority of
his analysis follows Maryland and District of Columbia law with only sporadic references to California law and
policy preferences. (See Pl.’s Opp’n [72] at 22, 28).

21

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 22 of 41

of law analysis and instead will present both District of Columbia and Maryland law as it

analyzes each cause of action.

E. Wrongful Discharge

Plaintiff argues that “wrongful discharge is grounded in both tort and contract” and

therefore bases his claim on violations of both defendant’s internal policies, like the employee

manual, and public policy. Clarifying plaintiff’s position, defendant correctly recognizes that

plaintiff’s wrongful discharge claim actually constitutes two distinct causes of action. Where the

plaintiff is relying on defendant’s internal documents or employee manual, his claim is an

implied contract claim, and where the plaintiff relies on public policy, he is pursuing the tort of

wrongful discharge. Compare Fingerhut v. Children’s Nat’l Med. Ctr., 738 A.2d 799, 803 (D.C.

1999) (discussing the history of the intentional tort for wrongful discharge in violation of public

policy), and Wholey v. Sears Roebuck, 803 A.2d 482, 488 (Md. 2002) (recognizing wrongful

discharge as a tort based on violation of public policy), with Strass v. Kaiser Found. Health Plan

of Mid-Atlantic, 744 A.2d 1000, 1011 (D.C. 2000) (“The terms of an employer’s personnel or

policy manual may be sufficient to raise a jury question as to whether the manual creates

contractual rights for the employee.”), and Dahl v. Brunswick Corp., 356 A.2d 221, 224 (Md.

1976) (allowing that an “employer’s policy directives regarding aspects of the employment

relationship” may develop into contractual obligations).

1. Implied Contract

The District of Columbia and Maryland follow the common law rule that generally an

employment relationship is terminable at will. Strass, 744 A.2d at 1011 (quoting Nickens v.

Labor Agency of Metropolitan Washington, 600 A.2d 813, 816 (D.C. 1991)); Caldor Inc. v.

Bowden, 625 A.2d 959, 965 (Md. 1993). Both jurisdictions recognize that an employer’s

22

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 23 of 41

internal policies and employment literature may, in certain circumstances, give rise to a

contractual right to employment. Strass, 744 A.2d at 1011; Dahl, 356 A.2d at 224. However,

where the internal materials relied upon expressly disclaim contractual intent, “employees may

not rely on other statements in the handbook to argue that a contract has been formed.” Hyman

v. First Union Corp., 982 F. Supp. 8, 12 (D.D.C. 1997) (citing Castiglione v. Johns Hopkins

Hosp., 517 A.2d 786, 794 (Md. Ct. Spec. App. 1986). In the District of Columbia, the materials

also “must contain language clearly reserving the employer’s right to terminate at will” in order

to foreclose the possibility of a contractual interpretation. Boulton v. Inst. of Int’l Educ., 808

A.2d 499, 505 (D.C. 2002) (quoting Sisco v. GSA Nat’l Capital Fed. Credit Union, 689 A.2d 52,

55 (D.C. 1997)).

Although plaintiff comes before the Court with a heap of defendant’s internal papers, the

policy documents on which he relies either contain effective disclaimers or are irrelevant to his

employment status. Examples of irrelevant policies include defendant’s reporting requirements

for physicians, Kaiser Permanente’s National Patient Safety Program, defendant’s Electronic

Asset Usage Policy, and defendant’s Research and Publications Policy. (See Pl.’s Opp’n [72] at

26–27, 34–35.) Other documents which could be construed to alter plaintiff’s employment status

from that of an at-will employee emphatically disclaim contractual intent and alteration of the at-

will relationship. (See Pl.’s Ex. 19 [72-21] at 3,12, 25, 43). For instance, though the Progressive

Discipline Policy outlines steps to be taken before terminating an employee, it also includes

unequivocal terms disclaiming contractual intent and alteration of employees’ at-will status. (Id.

at 3–6.) Since plaintiff is unable to point the Court to any internal policy, not properly

disclaimed, that would alter the default at-will employment relationship, the Court will grant

summary judgment in favor of defendant on plaintiff’s implied contract claim.

23

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 24 of 41

2. Public Policy Wrongful Discharge

An employee may bring suit against an employer for wrongful termination in violation of

public policy. See Wholey, 803 A.2d at 488; Fingerhut, 738 A.2d at 803. In Maryland, “the

basis for the employee’s discharge must violate some clear mandate of public policy, and there

must be a nexus between the employee’s conduct and the employer’s decision to fire the

employee.” Wholey, 803 A.2d at 489. While it admitted to making exceptions, the Maryland

Court of Appeals strongly cautioned against applying broad notions of public policy that step

outside the boundaries of pre-existing law. See id. at 490–91. The court stated, “[a] limiting

factor in defining a public policy mandate as a cause of action in tort is the notion that the

policies should be reasonably discernible from prescribed constitutional or statutory mandates.”

Id.

Adopting similar standards, a majority of the District of Columbia Court of Appeals held

that “there must be a close fit between the policy thus declared and the conduct at issue in the

allegedly wrongful termination” which policy must be “firmly anchored either in the

Constitution or in a statute or regulation which clearly reflects the particular ‘public policy’

being relied upon.” See Fingerhut, 738 A.2d at 803 n.7 (quoting Carl v. Children’s Hosp., 702

A.2d 159, 162, 164 (D.C. 1997) (Terry, J., concurring)).

Plaintiff’s public policy arguments center on the claim that his termination was driven by

hostility against his unwelcome attempts at exposing and reforming bad medical practices. (See

Pl.’s Opp’n [72] at 36.) Even if one accepts plaintiff’s account of himself as a whistleblower

punished for his good deeds, plaintiff is unable to identify an appropriate public policy on which

to base his claim.

24

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 25 of 41

Some of the policy grounds that plaintiff advances are less appropriate than others. (See

Pl.’s Opp’n [72] at 27–29, 32.) For example, plaintiff references the professional standards of

the American Medical Association and the Medical and Chirurgical Faculty of Maryland. (See

Pl.’s Opp’n [72] at 27–28, 32.) Given that Maryland and District of Columbia courts have either

strongly cautioned against or forbidden the use of extralegal materials in formulating public

policy exceptions to the at-will employment doctrine, the Court will not consider the professional

standards cited by plaintiff but instead will confine itself to an examination of plaintiff’s

governmental policy sources. See Wholey, 803 A.2d at 490–91; Fingerhut, 738 A.2d at 803 n.7.

Plaintiff looks for applicable public policy in a District of Columbia statute, D.C. CODE §

7-161 (2010), requiring that health care providers submit reports of adverse medical events to

local government. (See Pl.’s Opp’n [72] at 28.) Plaintiff’s reliance is misplaced however.

Significantly, plaintiff does not allege that he was terminated for attempting to submit the

required reports or otherwise take his grievances about patient care to government authorities.

Thus, the Court is unable to find the requisite close fit between plaintiff’s conduct and a statute

clearly expressing favorable public policy.

Plaintiff also seeks support from a Maryland statute, MD. CODE ANN., HEALTH OCC. §

14-502 (West 2010), giving physicians protection from civil liability for reporting information

about other physicians to various health care institutions such as hospitals and licensing boards

“with the intention of aiding in the evaluation of the qualifications, fitness, or character of a

physician.” MD. CODE ANN., CTS. & JUD. PROC. § 5-638; (See Pl.’s Opp’n [72] at 28, 29–30.)

According to plaintiff, “such immunities are granted to physicians to provide incentive for

physicians and others to participate in medical peer review and other processes to insure quality

medical care.” (Pl.’s Opp’n [72] at 29–30.) The relationship, however, between the statute in

25

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 26 of 41

question and plaintiff’s behavior is too attenuated to meet the stringent standard for recognizing

public policy exceptions to the at-will employment doctrine. In particular, the statute makes no

mention of a physician’s employment status or job security but instead only assures protection

from litigation. See MD. CODE ANN., HEALTH OCC. § 14-502; cf. Makovi v. Sherwin Williams

Co., 561 A.2d 179, 190 (Md. 1988) (holding that plaintiff could not rely on sex discrimination

statute to establish a wrongful discharge claim as statute provided its own civil remedy). It also

is not specifically addressed to countering medical negligence but rather is explicitly directed to

aiding evaluation of physicians’ qualifications. See MD. CODE ANN., HEALTH OCC. § 14-502

(extending MD. CODE ANN., CTS. & JUD. PROC. § 5-638). Ultimately, the statute does not present

a clear mandate of public policy of the kind which the Maryland Court of Appeals cautiously

allowed could form the basis of a wrongful discharge claim. See Wholey, 803 A.2d at 490–91.

Plaintiff claims that “[f]ederal law encourages physicians to report quality of care issues

and grants physicians immunity for reporting quality of care issues.” (Pl.’s Opp’n [72] at 28

(citing Health Care Quality Improvement Act of 1986 (HCQIA), 42 U.S.C. § 11101, 11111–

11115, 11131–37, 11151–52.) However, the statute deals only with narrowly defined

professional review actions by professional review bodies, granting civil immunity to the

committees themselves and testifying physicians. See id. Plaintiff does not allege that he

participated on or gave testimony to such a committee. HCQIA is inappropriate as a policy basis

for plaintiff’s claim.

Plaintiff also cites a federal regulation, 45 C.F.R. pt. 88 (2010), which he interprets as

“protect[ing] physicians from being fired, disciplined or penalized . . . for refusing to participate

in any care they consider objectionable on ethical, moral or religious grounds.” (Pl.’s Opp’n [72]

at 28.) The rule is inapposite for several reasons. First, its express purpose is to implement

26

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 27 of 41

various statutes which bar recipients of Federal healthcare dollars from prejudicing physicians

who refuse on ethical or religious grounds to perform medical procedures or research. See 45

C.F.R. § 88.1. Plaintiff has not alleged that defendant is a recipient of such funds. Moreover,

the regulation is plainly limited to denying Federal financing to organizations that discriminate

on grounds of conscience, not to forbidding the discharge of scrupulous physicians in general.

See id. Second, though plaintiff objected to working with incompetent or dangerous residents

and felt a clash of values with WHC, one would be hard pressed to identify the specific moral

convictions underlying plaintiff’s objections. (See Lurie Dep. [68-4] at 108:3–6, 115:16–

116:21.)

Finally, plaintiff invokes another District of Columbia statute, D.C. Code § 44-507,

which prescribes procedures for evaluating the qualifications of health care professionals for

staff positions and clinical privileges. (See Pl.’s Opp’n [72] at 28.) Plaintiff is far off the mark

in presenting the statute as a basis for his wrongful termination claim. The law in question does

not apply to private medical groups like defendant. See D.C. Code § 44-501.

E. The Graftcath Contract (Breach of Contract and Implied Contract)

Plaintiff asserts two claims based on the Graftcath contract (Contract). First, plaintiff

claims that defendant breached the Contract by firing him, making it impossible for him to

perform the Contract.. (See Pl.’s Opp’n [72] at 36–37.) Second, plaintiff asserts that the

Contract created an implied employment agreement which defendant breached when it

terminated plaintiff. (See id. at 38.) In both cases, the defendant is alleged to have breached the

Contract by discharging plaintiff. The resolution of both claims thus turns on the question of

whether the Contract limited defendant’s right to terminate plaintiff.

27

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 28 of 41

Where employer and employee have not agreed upon a period of employment, the

District of Columbia and Maryland largely follow the common law rule that the employment

relationship is terminable at will. See Strass, 744 A.2d at 1011; Adler v. Am. Standard Corp.,

432 A.2d 464, 467 (Md. 1981). In this case, the alleged employment contract was memorialized

in writing. “As a general rule, the construction or interpretation of all written instruments is a

question of law for the court is a principle of law that does not admit of doubt.” Gordy v. Ocean

Park Inc., 145 A.2d 273, 277 (Md. 1958); accord 1010 Potomac Assocs. v. Grocery Mfrs. of Am.

Inc., 485 A.2d 199, 205 (D.C. 1984) (“[T]he interpretation of an integrated contract is a question

of law . . .”). For District of Columbia employment agreements, “[i]t has been required . . . that

the parties clearly state their intention to alter an at-will employment agreement in order to make

such an alteration effective.” Rinck v. Ass’n of Reserve City Bankers, 676 A.2d 12, 16 (D.C.

1996) (citing Littell v. Evening Star Newspaper Co., 120 F.2d 36, 37 (D.C. Cir. 1941)).

Nevertheless, “[w]here the intent is not clearly revealed by the express terms of the agreement,

the courts will look to evidence of surrounding circumstances to determine what was in the

minds of the contracting parties.” Littell, 120 F.2d at 37.

Although aspects of the Contract support plaintiff’s interpretation, the Court does not

believe that the document can be fairly interpreted to alter the employment relationship between

plaintiff and defendant. It is true that as Principal Investigator plaintiff possessed a host of

responsibilities for overseeing the clinical trial of the Graftcath device. (See, e.g., Def.’s Ex. 18

at 2.) Equally true, the Contract states, “The Institution [defendant] will conduct the Clinical

Trial during the period beginning May 2005, and ending May 2007.” (Id. at 1). Given his duties

on what was to be a multiyear project, plaintiff declares that he was “entitled to an expectation of

working for two years.” (Pl.’s Opp’n [72] at 39). Nevertheless, nothing in the Contract,

28

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 29 of 41

expressly or otherwise, speaks of plaintiff embarking on a course of employment with defendant.

In fact, certain language militates against that interpretation. Under the “Background” heading,

the Contract states, “The Institution [defendant] employs the Principal Investigator, Kevin Lurie,

MD.” (Def.’s Ex. 18 at 1). The use of the present tense apparently refers to plaintiff’s status as a

preexisting employee.

Similarly, under District of Columbia law, the evidence is inadequate to show alteration

of the at-will employment relationship. The parties did not clearly state their intention to change

plaintiff’s employment status. Additionally, plaintiff points to little evidence of surrounding

circumstances which would allow the Court to infer that it was the parties’ intent to guarantee

him employment until the end of the project. (See Pl.’s Opp’n [72] at 38). Prior to signing the

Contract, plaintiff did play a major role in procuring the clinical trial. (See Pl.’s Statement [72-1]

¶ 185; Pl.’s Ex. 10 [72-12] at 240:2–12.) Plaintiff may have felt entitled to remain involved in

the clinical trial given his role in procuring it, but since plaintiff had already performed this

service, there could have been no quid-pro-quo at the time the parties signed the Contract. Cf.

Riefkin v. E.I. Du Pont De Nemours & Co., 290 F. 286, 289 (D.C. Cir. 1923) (finding that where

contract spoke of permanent employment and plaintiff had given additional consideration by

promising to quit his former job, the parties could not have contemplated at-will employment).

The Maryland reporters contain an employment case similar to that before the Court but

with important differences that mark out the limits of Maryland doctrine on when an agreement

creates a right to employment for a defined period. Sperling v. Terry, 135 A.2d 309 (Md. 1957).

In Sperling, the Maryland Court of Appeals found that a contract to supervise the construction of

a house created an implied right of employment until the completion of the house. Id. at 311.

The Graftcath contract is significantly different in that it did not originate the employment

29

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 30 of 41

relationship or limit that relationship to completion of a single task. See Lubore v. RPM Assocs.,

674 A.2d 547, 554 (Md. Ct. Spec. App. 1996) (distinguishing Sperling where “the period of

appellant’s employment was not tied to the accomplishment of any particularly defined task, the

duration of which is fixed or finite”). 6

Standing alone, plaintiff’s expectation that he would

continue to be a part of the research project is not enough to prove alteration of the at-will

employment relationship. Cf. Lubore, 674 A.2d at 554 (finding that plaintiff’s employment was

at-will despite the fact that plaintiff’s contract contained salary projections for the next two years

and described job responsibilities involving long term planning).

Whether under Maryland or District of Columbia law, defendant retained the right to

terminate plaintiff and did not breach the Contract when it did so. Summary judgment will be

granted in favor of the defendant on plaintiff’s claims arising under the Contract.

F. Tortious Interference

Plaintiff alleges that defendant has tortiously interfered with his new and independent

surgical practice. (See Pl.’s Opp’n [72] at 39.) The elements of tortious interference with

contractual or business relations are well established. In Maryland, the tort requires: “(1)

intentional and willful acts; (2) calculated to cause damage to the plaintiffs in their lawful

business; (3) done with the unlawful purpose to cause such damage and loss, without right or

justifiable cause on the part of the defendants (which constitutes malice); and (4) actual damage

and loss resulting.” Kaser v. Fin. Prot. Mktg., Inc., 831 A.2d 49, 54 (Md. 2003) (quoting Willner

v. Silverman, 71 A. 962, 964 (Md. 1909)). In the District of Columbia, one must prove: “(1)

6 The interpretation put on Sperling by the Maryland Court of Special Appeals (the intermediate court) is well-
founded. In the Sperling opinion, the Maryland Court of Appeals (the high court) emphasized the contract’s one-off
character: “It will be noted that the appellant was not in the building business. He was going to erect a single
dwelling, for use as his abode. This, ordinarily, would require between two and four months. For him, it was an
isolated undertaking. He needed a supervisor, so he employed the appellee to ‘supervise and work on the
construction of a private dwelling’, ‘all labor and materials to be furnished by’ the appellant.” Sperling, 135 A.2d at
311 (emphasis added).

30

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 31 of 41

existence of a valid contractual or other business relationship; (2) the defendant’s knowledge of

the relationship; (3) intentional interference with that relationship by the defendant; and (4)

resulting damages.” NCRIC, Inc. v. Columbia Hosp. for Women Med. Ctr., 957 A.2d 890, 900

(D.C. 2008) (footnote omitted).

1. Defendant did not tortiously interfere with plaintiff’s practice by
misleading former patients

Plaintiff first argues that defendant discouraged patients from seeing him and misled

them about whether their insurance covered treatment by plaintiff. (See Pl.’s Opp’n [72] at 40.)

Plaintiff points to the experience of Geraldine Edwards and Judy Gantt. (See id.) Plaintiff

claims that he had an existing business relationship or expectancy with both women, likely

referring to care he provided for them while still employed with defendant (See id. at 41; Gantt

Dep. [72-10] at 27:14–28:9.)

Significantly, plaintiff does not allege that he had a relationship with Gantt or Edwards

outside that developed whilst treating them as an employee of defendant. (See Pl.’s Opp’n [72]

at 4041.). Thus, to the extent that they were plaintiff’s clients, they were also defendant’s

clients, a dispositive fact under Maryland law. Since defendant lacked an independent economic

relationship with these potential clients, the defendant could not have tortiously interfered with

that relationship. See Kaser, 831 A.2d at 59 (finding against insurance subagent who alleged

tortious interference against general agent but lacked an economic relationship with the client

that was separate and independent).

Plaintiff’s evidence is likewise inadequate per District of Columbia standards. Namely,

plaintiff fails to make an adequate showing on the elements of intent and damages. “To establish

a prima facie case of interference with business relations, ‘a plaintiff must show that the

interference was intentional and that there was resulting damage.’” Brown v. Carr, 503 A.2d

31

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 32 of 41

1241, 1247 (D.C. 1986) (quoting Alfred A. Altimont, Inc. v. Chatelain, Samperton & Nolan, 374

A.2d 284, 289 (D.C. 1977)).

If defendant’s doctors intentionally misled Gantt and Edwards about their insurance

coverage, one could infer intent to interfere with plaintiff’s business. However, the evidence that

defendants deceived the two patients is vague and equivocal; both women’s affidavits merely

state, “Drs. Lustgarten and Aryavand discouraged me from seeing Dr. Lurie and told me that my

insurance would not cover my care.” (Pl.’s Ex. 3 [72-5] ¶ 5; Pl.’s Ex. 4 [72-6] ¶ 5.) Plaintiff’s

reliance on the affidavits is undercut by the clarifying deposition testimony of Gantt. When

asked about her conversations with Drs. Lustgarten and Aryavand, Gantt claims they told her she

could not use plaintiff for her surgery. (See Gantt Dep. [72-10] at 914). She goes on to clarify

though that the doctors were speaking about Kaiser’s coverage for procedures performed by

plaintiff. (See id. at 25:15–26:5.) Gantt explains that she chose to use Kaiser initially but then

later opted to use Medicare and be treated by plaintiff. (See id. at 26:9–22.) While evidence of

deceit could serve as circumstantial evidence of intent to interfere, Gantt’s deposition testimony

seems to show Drs. Lustgarten and Aryavand explaining the status of Gantt’s coverage with

Kaiser. It would be a stretch to say they categorically claimed Gantt lacked insurance which

would allow her to see plaintiff if she so desired.

Gantt’s testimony indicates plaintiff did not suffer damages. As Gantt explained, she was

always aware that treatment by plaintiff was an option and that Medicare would pay for that

treatment. (See id. at 26:3–8.) Though she originally chose to receive treatment from Kaiser

practitioners, she ultimately turned to plaintiff for her surgical needs. (See id. at 26:1222.)

Supporting that testimony, plaintiff admits that he eventually operated successfully on both

32

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 33 of 41

women. (See Pl.’s Opp’n [72] at 40.) If Gantt was unaffected by any misinformation on the part

of defendant’s employees, defendant did not cause plaintiff to lose her business.

2. Defendant’s decision to refuse plaintiff admission to its referring provider
network was not tortious interference

Plaintiff tries to ground his interference claim on defendant’s decision to refuse him entry

into the Kaiser referring provider network. (See id. at 42). Supporting his position, he writes,

“Plaintiff had a 17-year relationship with Defendant. He had relationships with the physicians

with whom he worked and with the patients he treated.” (Id.) There are several problems with

plaintiff’s argument. To begin, plaintiff does not point the Court to examples of harm to his

surgical practice produced by the ongoing fissure in the relationships he identifies. The Court is

thus unable to identify any evidence of damages suffered by plaintiff.

Further, the Court cannot discern with sufficient specificity the economic relationships or

business expectancies that were allegedly compromised by defendant’s actions. Blanket

accusations do not point the Court to the existence of particular “business expectancies” that are

“commercially reasonable to anticipate.” Carr v. Brown, 395 A.2d 79, 84 (D.C. 1978)

(describing those relationships that are protected from unjustified interference).

Plaintiff’s allegations of broken connections with coworkers and patients are particularly

deficient under Maryland law. To wit, the relationships with coworkers and patients that

plaintiff formed while employed with defendant are not independent economic relationships with

which defendant might interfere. See Kaser, 831 A.2d at 59.

3. If plaintiff was not paid for treating Kaiser patients, his grievance is not
with defendant, and his remedy is in contract, not tort.

Plaintiff claims that he has not received payment for seeing patients referred to him by

defendant’s physicians. (See Pl.’s Opp’n [72] at 41.) Even if true, this allegation is irrelevant for

33

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 34 of 41

two reasons. First, if plaintiff has not been paid for services rendered to patients covered by

Kaiser Health Plan insurance, then his grievance is with the Kaiser Health Plan, not with

defendant MAPMG. (See Lurie Dep. [68-4] at 340:20–342:3.) Second, if defendant or Kaiser

Health Insurance has wrongly refused to honor plaintiff’s bills, his remedy is in contract, not in

tort. Courts have steadfastly resisted efforts to convert an action for breach of contract into a suit

for tortious interference. See Alexander & Alexander, Inc. v. B. Dixon Evander & Assocs., 650

A.2d 260, 269–270 (Md. 1994); Raskauskas, 589 A.2d at 26 (explicating “the common sense

notion that a plaintiff should not be allowed to convert a breach of contract claim into a claim for

tortious interference”).

V. Defendant’s Counterclaims

Defendant asserts causes of action for breach of contract, fraud, negligent

misrepresentation, and unjust enrichment. It claims the Court may consider its counterclaim

pursuant to both its diversity, 28 U.S.C. § 1332, and supplemental jurisdiction, 28 U.S.C. § 1367.

(See Countercl. [2] at 1.)

A. Diversity of Citizenship

The Constitution and statutes limit the subject matter jurisdiction of the Federal Court.

See Kokkonen v. Guardian Life Insurance Co. of America, 511 U.S. 375, 377 (1994). The

Federal Courts have diversity jurisdiction over civil actions between citizens of different states

where the amount in controversy is greater than $75,000, exclusive of interests and costs. See 28

U.S.C. § 1332. In calculating the amount in controversy, “the sum claimed by the plaintiff

controls if the claim is apparently made in good faith.” St. Paul Mercury Indem. Co. v. Red Cab

Co., 303 U.S. 283, 288 (1938) (footnote omitted). Further, “it must appear to a legal certainty

34

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 35 of 41

that the claim is really for less than the jurisdictional amount to justify dismissal.” St. Paul, 303

U.S. at 289.

When appraising the amount in controversy, courts are not confined to examining the

amount of actual damages. For instance, courts should include the value of any injunctive or

declarative relief sought. See Hunt v. Wash. State Apple Adver. Comm’n, 432 U.S. 333, 347

(1977). “In actions seeking declaratory or injunctive relief, it is well established that the amount

in controversy is measured by the value of the object of the litigation.” Hunt, 432 U.S. at 347.

Further, the value may be measured from either the perspective of the plaintiff or the defendant.

See Comm. for GI Rights v. Calloway, 518 F.2d 466, 472 (D.C. Cir. 1975) (quoting Tatum v.

Laird, 444 F.2d 947, 951 (D.C. Cir. 1971), rev’d on other grounds, 408 U.S. 1 (1972)).

Requests for punitive damages should likewise be considered, Bell v. Preferred Life

Assurance Soc’y of Montgomery, Ala., 320 U.S. 238, 240 (1943), albeit with a skeptical eye. “In

applying the legal certainty test where the availability of punitive damages is the sine qua non

[essential element] of federal jurisdiction the District Court should scrutinize the punitive

damage claim to ensure that it has at least a colorable basis in law and fact.” Kahn v. J. W.

Wilson & Assocs, 673 F.2d 547, 549 (D.C. Cir. 1982) (citing Zahn v. International Paper Co.,

469 F.2d 1033, 1034 n.1 (2d Cir. 1972), aff’d, 414 U.S. 291 (1973); Nelson v. Keefer, 451 F.2d

289, 293–98 (3d Cir. 1971). “Liberal pleading rules are not a license for plaintiffs to shoehorn

essentially local actions into federal court through extravagant or invalid punitive damage

claims.” Id. at 549.

To evaluate punitive damages requests, “[f]irst, the court must determine whether the plaintiff

can recover punitive damages as a matter of governing substantive law. Nwachukwu v. Carl, 223

F.Supp. 2d 60, 66 (D.D.C. 2002) (citing Bell v. Preferred Life Assurance Soc’y of Montgomery,

35

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 36 of 41

Ala., 320 U.S. 238, 240 (1943)). If the plaintiff can recover as a matter of law, “the court has

subject matter jurisdiction unless it is clear beyond a legal certainty that the plaintiff would under

no circumstances be entitled to recover the jurisdictional amount.” Id. (citing Cadek v. Great

Lakes Dragaway, Inc., 58 F.3d 1209, 1212 (7th Cir.1995)). In this second step, the plaintiff must

present factual evidence of entitlement to punitive damages. Id. (citing Larkin v. Brown, 41 F.3d

387, 388–89 (8th Cir.1994)); see also McQueen v. Woodstream Corp., 672 F. Supp. 2d 84, 88

(D.D.C. 2009).

In contrast to the acceptance of punitive damages, courts in this circuit have refused to

take into account attorney’s fees when deciding whether a litigant has met the jurisdictional

minimum, albeit with an exception for fees provided for by statute or contract. See G. Keys

PC/Logis NP v. Pope, 630 F.Supp. 2d 13, 17 (D.D.C. 2009) (citing a number of examples).

In the instant case, although the defendant invokes the Court’s diversity jurisdiction, it

does not request a specific amount of damages or give an estimate of the amount of damages it

hopes to recover. (See Countercl. [2] at 1, 4.) Instead, at the bottom of its complaint, defendant

requests, “1. Consequential and punitive damages in an amount to be proven at trial; 2. An

accounting for all compensation received by Lurie based on falsified records and information

submitted to MAPMG; 3. The costs incurred by MAPMG in prosecuting this Counterclaim; and

4. Such other relief deemed appropriate by the Court.” (Id. at 4.) As a result, the Court must

look to the body of the complaint to ascertain the basis for the anticipated damages.

1. Defendant’s actual damages are far less than $75,000

With respect to actual damages, defendant seeks the same recovery for each of cause of

action. (See id. at 2–4.) For the breach of contract, fraud, and negligent misrepresentation

claims, defendant declares that it has sustained damages in the amount of compensation that was

36

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 37 of 41

paid to plaintiff for ghost clinics. (See id.) Similarly, defendant’s unjust enrichment claim is

presumably based on the monies retained by plaintiff that he derived from ghost clinics. (See id.

at 4.) Defendant’s alleged actual damages in this case are therefore equivalent to the payments

plaintiff received from operating ghost clinics.

To determine the magnitude of the ghost clinic payments defendant could prove at trial,

the Court looks to the record. The affidavit of Ann Cahill furnishes the most obvious guidepost;

she avers, “Dr. Lurie had obtained at least $8,344.96 in extra pay by submitting falsified time

sheets which showed that he had worked the ghost clinics.” (See Cahill Aff. [71-2] ¶ 7

(emphasis added.)) Assessing Cahill’s statement, the Court is aware that Cahill is literally

stating a minimum figure. Still, $8,344.96 is a reasonable estimate in light of the number of

ghost clinic hours that plaintiff claimed.

Looking at the alleged offending time sheets,

defendant added fifty-six hours to his timesheets for ghost clinics. (See Dr. Lurie’s Timesheets

Re: Ghost Clinics [71-6].) Though the Court has not located information in the record that

would allow it to determine the pay rate for the hours, useful assessments can be made from this

information nonetheless. If one divides the sum given by Cahill by fifty-six, one finds a

plausible hourly rate of $149.02. In contrast, plaintiff would have had to receive $1,339.29 for

each ghost clinic hour in order to reach the jurisdictional minimum of $75,000. 7

The number

referenced by Cahill, $8,344.96, appears then to be a reasonable estimate of the amount of actual

damages which defendant could prove at trial. A substantially greater estimate, one approaching

$75,000 for instance, would be unfounded.

7 For comparison, by the time he was fired in October of 2005, Dr. Lurie’s W2 wages for that year stood at
$317,424.17. (See Cahill Aff. [68-1] ¶ 19.) If he were generally being compensated at a rate of $1,339.29 per hour,
he would have only had to work approximately 237 hours to earn that sum, just roughly six forty hour weeks.

37

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 38 of 41

2. Defendant is not entitled to punitive damages

Given special circumstances, both the District of Columbia and Maryland allow a litigant

to recover punitive damages. “Maryland law has limited the availability of punitive damages to

situations in which the defendant’s conduct is characterized by knowing and deliberate

wrongdoing.” Ellerin v. Fairfax Sav., F.S.B., 652 A.2d 1117, 1123 (Md. 1995). In the District

of Columbia, “Punitive damages may be awarded ‘only if it is shown by clear and convincing

evidence that the tort committed by the defendant was aggravated by egregious conduct and a

state of mind that justifies punitive damages.’” Chatman v. Lawlor, 831 A.2d 395, 400 (D.C.

2003) (quoting Jonathan Woodner Co. v. Breeden, 665 A.2d 929, 938 (D.C. 1995)). The state of

mind required is similar to that in Maryland, “outrageous conduct which is malicious, wanton,

reckless, or in willful disregard for another’s rights.” Id. (quoting Vassiliades v. Garfinckel’s,

Brooks Brothers, Miller & Rhoades, Inc., 492 A.2d 580, 593 (D.C. 1985)). In either jurisdiction,

the requisite bad conduct for an award of punitive damages must be proven by clear and

convincing evidence. See Chatman, 831 A.2d at 400; Owens-Illinois, Inc. v. Zenobia, 601 A.2d

633, 657 (Md. 1992). Further, neither jurisdiction will allow punitive damages to be imposed for

a pure breach of contract. See Bowden v. Caldor, Inc., 710 A.2d 267, 276 (Md. 1998); Choharis

v. State Farm Fire and Cas. Co., 961 A.2d 1080, 1090 (D.C. 2008) (quoting Sere v. Group

Hospitalization, Inc., 443 A.2d 33, 37 (D.C. 1982)).

Though defendant requests punitive damages in its complaint, it does not explain the

basis for that request. (See Countercl. [2] at 4.) In particular, it fails to identify the specific

claims for which it believes imposition of punitive damages is appropriate. However, defendant

does allege facts in connection with its fraud claim which if properly proven would entitle it to

recover punitive damages. (See id. at 3.) It writes, “Lurie acted willfully, maliciously,

38

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 39 of 41

intentionally, knowingly, and in wanton disregard of MAPMG’s rights and interests by

submitting the falsified reports and information.” (Id.)

Defendant fails to substantiate its allegation with argument or evidence. In its brief,

defendant broadly claims that plaintiff engaged in “conduct which a jury could reasonably find

Dr. Lurie had pursued to circumvent MAPMG’s practice of not paying surgeons additional

compensation based on the number of patients seen during the normal work day.” (Def.’s Opp’n

[71] at 20.) Defendant’s representations notwithstanding, the Court cannot locate adequate

evidence speaking to plaintiff’s mental state. Since plaintiff is without a basis for justifying his

punitive damage request, the Court will not consider defendant’s request for punitive damages in

determining the amount in controversy. In making its decision, the Court is mindful of the

admonition of the Court of Appeals to carefully examine clams for punitive damages so as to

prevent unsubstantiated requests for punitive damages from becoming a password into the

Federal courts. See Kahal, 673 F.2d at 549.

3. The value of the declarative relief sought by plaintiff is negligible

Regardless of which method is used to quantify its value, the Court cannot imagine

attaching a high price tag to the accounting requested by defendant. Defendant assumedly

possesses all of the relevant documents; it produced plaintiff’s allegedly fraudulent timesheets in

discovery. (Lurie’s Timesheets [71-6].) Since the timesheets number just twenty-nine pages, the

Court was able to count the allegedly fraudulent hours in a matter of minutes with nothing more

than a pen and paper tally. One assumes that defendant could take the same steps then multiply

the number of hours by the rate it paid plaintiff and do it all for less than $10,000. At the end of

the day, the Court has no reason to assign a substantial value to the accounting sought by

defendant.

39

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 40 of 41

Of the possible bases for relief considered, only plaintiff’s request for consequential

damages involves a substantial sum. Nonetheless, the allegedly undeserved payments to plaintiff

plainly do not amount to more than the statutory minimum. Accordingly, the Court finds that it

“appear[s] to a legal certainty that the claim is really for less than the jurisdictional amount.” St.

Paul, 303 U.S. 283 at 289. As a result, the Court lacks jurisdiction pursuant to § 1332.

B. Supplemental Jurisdiction

“[I]n any civil action of which the district courts have original jurisdiction, the district

courts shall have supplemental jurisdiction over all other claims that are so related to claims in

the action within such original jurisdiction that they form part of the same case or controversy

under Article III of the United States Constitution.” 28 U.S.C. § 1367. However, district courts

have discretion to refuse to exercise supplemental jurisdiction in certain circumstances, including

when “the district court has dismissed all claims over which it has original jurisdiction.” Id.

The Court has determined that summary judgment is proper with respect to the claims in

plaintiff’s complaint over which it has original jurisdiction. All of the causes of action described

in defendant’s counterclaim are founded in state law and have been found to lack an independent

basis in the Court’s diversity jurisdiction. The Court can and will exercise its discretion to

dismiss them.8

See Shekoyan v. Sibley Int’l, 409 F.3d 414, 423 (D.C. Cir. 2005) (“Whether to

retain jurisdiction over pendent state and common law claims after the dismissal of the federal

claims is ‘a matter left to the sound discretion of the district court’ that we review for abuse of

discretion only.” (quoting Edmondson & Gallagher v. Alban Towers Tenants Ass’n, 48 F.3d

1260, 1265-66 (D.C. Cir.1995)).

8 Since the Court would exercise its discretion to dismiss the claims given either outcome, the Court need not decide
whether the counterclaim forms part of the same case or controversy as the claims in the original complaint over
which it has original jurisdiction.

40

Case 1:06-cv-01386-RCL Document 84 Filed 08/09/10 Page 41 of 41

V.

Conclusion

Despite its faults, plaintiff’s statement of material fact is not so improper as to justify

striking it. Accordingly, defendant’s motion [78] to strike will be DENIED. Since plaintiff fails

to present sufficient evidence from which a reasonable jury could find in his favor, the Court will

GRANT defendant’s motion [68] for summary judgment. Finally, the Court finds diversity

jurisdiction lacking over defendant’s counterclaims and declines to exercise supplementary

jurisdiction. Therefore, the Court will DISMISS defendant’s counterclaims and does not reach

plaintiff’s motion [69] for summary judgment.

A separate order shall issue this date.

August 9, 2010

_____/s/_________
ROYCE C. LAMBERTH
Chief Judge
United States District Court

41

Lyons v. Iowa Bd. of Med. (Summary)

Lyons v. Iowa Bd. of Med. (Summary)

PHYSICIAN LICENSURE

Lyons v. Iowa Bd. of Med., No. 08-1538 (Iowa Ct. App. June 17, 2009)

The Iowa Court of Appeals affirmed a lower court’s decision, upholding the Iowa Board of Medicine’s suspension of a physician’s license to practice medicine and its refusal to facilitate the production of certain medical records. The Board of Medicine imposed a 90-day suspension on a physician’s license, finding him professionally incompetent after complications had occurred during his treatment of a teenage girl. The physician argued that the Board did not have authority to discipline a license after only one "alleged simple negligence" case and because his license had lapsed prior to the suspension. The physician also sought the release of additional medical records. The court held that state law gave the Board of Medicine authority to suspend the physician’s license and refused to grant the release of additional medical records.

 

Lowrey v. Fairfield Med. Ctr. (Summary)

Lowrey v. Fairfield Med. Ctr. (Summary)

FAILURE TO EXHAUST ADMINISTRATIVE REMEDY

Lowrey v. Fairfield Med. Ctr., No. 08 CA 85 (Ohio Ct. App. Aug. 28, 2009)

After a physician’s medical staff privileges were suspended, he signed a Settlement Agreement providing that he could reapply for privileges. After his application for reappointment was denied, he first requested a hearing, but before the hearing could be held, he withdrew his request for a hearing and filed a lawsuit alleging that the hospital breached the Settlement Agreement by failing to consider his application for medical staff appointment and clinical privileges on the same basis as any other physician applying for medical staff appointment. The Ohio Court of Appeals found that, by withdrawing his request for a hearing, he failed to exhaust his administrative remedies and dismissed the breach of agreement claim. The Court of Appeals also held that the hospital’s failure to object to, move to strike, or otherwise respond to a motion he filed with the trial court, which had certain peer review documents attached to it, did not constitute the hospital’s waiver of any peer review privilege.