Leitgen v. Franciscan Skemp Healthcare, Inc. (Full Text)

In th e
Un ited S tates Court o f Appea ls
F o r th e S ev en th C ircu it

No . 09-1496

CHRISTINE LEITGEN,

P la inti ff-Appe l lant ,

v .

FRANCISCAN SKEMP H EALTHCARE , INC . ,

D efendant-A pp ellee .

Appeal from the United States District Court
for the Western District of Wisconsin.
No. 08-cv-038-bbc—Barbara B. Crabb, Judge.

ARGUED SEPTEMBER 17 , 2009—D EC IDED JANUARY 13 , 2011

Be fore ROVNER, SYKES, and T INDER, C ircu it Judges .
ROVNER, C ircu it Judge . Dr . Chr is t ine Le i tgen sued
he r form er emp loyer , Franc iscan Skemp H ea l thca re
(“ the Hosp ita l” ), under T it le V II of the C iv il R igh ts A c t
o f 1964 , c la im ing as re levan t here tha t it re talia ted
aga inst her by fo rc ing her to res ign after she com –
p la ined tha t i ts com pen sa t ion schem e un law fu l ly und er-
paid phys icians based on gender . Th e H osp ita l poo ls
revenue re ce ived for ch ildb irth de liveries and red is trib –

No . 09-1496

u te s the rece ip t s equa l ly am ong a ll phys ic ians in the
obs te tr ic s d epar tm en t , bu t Le i tgen advoca ted for a
sys tem tha t wou ld pay phys ic ians on a p e r-de l ivery
bas is . The d is tric t cour t gran ted summ ary judgm en t for
the Hosp ita l . W e affirm .

I .
L e i tgen began wo rk ing as a phys ic ian in the Ho sp ital ’s
Departm en t of Obs tetrics and Gyneco logy in 1993 .
The num ber o f doc tors in the group fluc tu a t ed w i th
t im e , bu t when Le itgen jo ined she becam e the four th
phys ic ian and second woman in the group . O ver the
years Le itgen deve loped her prac tice and becam e on e of
th e depar tm en t ’s mos t in -dem and and h ighes t pa id
doc tors , frequen t ly perform ing more than 100 de liveries
per year . In January 1999 , the depar tm en t appo in ted her
to serv e as cha irperson , and in 2002 it reappo in ted her to
a second te rm . Le itgen stepped dow n be fore her second
term exp ired , how ever , to d ed ica te more t im e to h e r
c l in ica l prac t ice , and af ter abou t a yea r of in ter im lead er-
sh ip , th e Hosp ita l even tually h ired Dr . Edward Sandy
in Augus t 2004 to serve as the d epar tm en t ’s new cha ir .

A .
Throughou t Le itgen ’s emp loym en t , the Hosp ita l b illed
pregnan t wom en for a package of services tha t inc lud ed
both p rena ta l c a re and de livery . And a lthough the
Hosp ita l compensa ted the pa t ien t ’s pr im ary phys ic ian
d irect ly for p rov id ing p rena ta l se rv ice s , it poo led the

No . 09-1496

revenue genera ted from th e de livery and red is tribu ted
it equa lly among the phys ic ians in the group . B ecause
of th is po l icy of shar ing de l ivery revenue , the doc tors
the m os t de liveries— regard less o f
who perform ed
gender— rece ived less paym en t than th ey wou ld und e r
a sys tem wh ere each d oc tor was pa id pu rely for
serv ices rendered .
A t seve ra l po in ts du r ing Le itgen ’ s em p loym ent , she
and o ther fem a le phys ic ians expressed c oncern tha t ,
becau se each woman in the p rac t ice had a la rge r pat ient
base and thu s tended to per form more de liveries than
each man , the Hosp ita l’s po licy o f p ooling de livery reve-
nue m ean t tha t the wom en we re un fair ly compensa ted
for the ir b ir th ing services . Be tween 1993 and 1999 , even
though her sa lary w as one of the h ighes t in h er g rou p ,
Le itgen comp la in ed num erous tim es abou t the pay s truc –
ture to the then -cha ir of the dep a r tm en t . A t one po in t
the cha ir raised the issue w ith the Hosp ita l’s compensa –
tion comm ittee and learned that any change wou ld
have to be made w i th in the d ep ar tm en t . No change w as
m ade a fter these in it ia l inqu iries .
The fema le phys ic ians aga in raised the is sue du ring
L e i tgen ’s tenure as chair . A t that po in t it rema in ed
unc lear wh e ther a change requ ired a unan im ous vo te of
the departm en t , bu t regard less , Le i tg en d id no t try to
m od ify the sys tem becau se the fema le d oc to rs in the
group feared tha t a change wou ld adversely affect the
dep ar tm en t ’s mora le . In 2003 , one of the depar tm en t ’s
other fem ale phys icians , D r . Karen K eil , com p lained again
to Le itgen abou t the compensat ion se tup , po in t ing ou t

No . 09-1496

tha t becau se she and Le i tgen cu rren t ly perform ed more
de liveries than anyone e lse in the group , the sys tem
wa s mo s t de tr im ental to them . When Sandy becam e the
dep ar tm en t chair , both Keil and Leitgen info rm ed h im
that they though t th e c om pen sa tion system was un fair
to them , both as wom en and as h igh -vo lum e phys ic ians .
(The par t ies d ispu te w he ther Le itgen and K e il fram ed
the ir p rob lem w ith the com pensa t ion sys tem as im –
p l ica t ing pos s ib le gender d iscr im ina t ion , bu t for pu r-
poses of summ ary judgm en t we resolve tha t d ispu te
in Leitgen ’s favo r .)
In ligh t o f these com p lain ts , the d ep ar tm en t’s phys i-
c ians d iscussed compensa t ion schem es severa l t im es .
W h en Sandy becam e cha ir , he pu t the issue on th e
agenda for mu l tip le depar tmen t m ee tings and d is trib –
u ted s chola rly work ou tlin ing d ifferen t poten tia l mod els
o f compensa t ion . Sandy a lso expressed a concern tha t
pay ing doc tors based pure ly on
the ir num ber of
delive r ies wou ld temp t them to schedu le m ed ica lly
unnecessary induc t ions so tha t p a t ien ts wou ld g ive
b irth du ring a part icu la r sh ift . A t no po in t du ring any
o f these d iscuss ions d id Le itgen or any o ther doc to r ask
for a vo te on th e issue , and the shared -revenue arrange –
m en t rem a ined in p lace .
W hen Le i tg en ’s in tra-depar tm en ta l comp lain ts proved
unp rodu c t ive , she took her concerns d irec t ly to Tom
T igge laar , who was t he secre tary of the Hosp ita l’s com –
pensa t ion comm it tee , the Hosp ita l’s vice pres iden t o f
finance , and the ch ie f financ ia l officer . On Augus t 14 ,
2006 , Le itgen em a iled T igge laar reques ting a mee ting , and

No . 09-1496

T igge laar re sponded by speak ing to Sandy abou t the
issue and by reach ing ou t to other emp loyees to
reques t sta t ist ics regard ing Le itgen ’s p roduc t ion as com –
pared to other m em bers of the depar tm en t . A fter
rece iv ing de livery sta tis t ics , T iggelaar m e t w i th L e itgen
on Sep tember 5 , 2006 , to d iscuss the ma t ter . Le itgen
com p lained that the com pen sa tion system adve rsely
a ffected her pay and tha t she though t the poo ling and
sharing of d e l ivery revenues was d iscr im ina tory to
wom en . (The Hosp ita l d ispu tes tha t gende r -based d is –
cr im ina t ion w as part of th is conversa t ion , bu t aga in , w e
assum e for purposes of summ ary judgm en t tha t Le itgen
commun icated the po ten t ia l d iscrim ina tory impor t of
her con cerns .) A fter the br ie f m ee ting , ne ither par ty
fo llow ed th rough on p rom ises to resum e th eir conve rsa –
t ion . Bu t , accord ing to T igge laar , he repor ted “ the essence”
of the m eet ing to both Sandy and D iane Ho lm ay (one
o f L e i tgen ’s superv isors ) w i th in a day or two . Le itgen
herse lf a lso in form ed Sand y th a t the m ee ting had taken
p lace . A ccord ing to Le itgen , Sandy was annoyed tha t
she had taken her concerns ou ts ide o f the depar tm en t ,
and the ir re la tion sh ip sudden ly sou red a fter her mee ting
w i th T igge laar .

B .
A lthough Le itgen generated sub s tan t ia l revenue on
beha lf o f the Hosp ita l, her t ime w i th the OB /GYN depar t –
m en t wa s ma rred by con flic ts w i th pat ient s and staff .
Le i tgen takes issue w i th the way o ther s taff m em bers
pe rceived her behavior du ring these con flic ts , bu t she

No . 09-1496

acknow ledge s that pa tient s and nurses comp la ined abou t
her commun icat ion style . Even though we con st rue the
fac ts in Le i tgen ’s favor , we need no t ignore the und is –
pu ted fac t that th ese un fla t ter ing comp la in ts w ere mad e
by pa t ien ts and s ta ff . For exam p le , in 2001 a nu rse com –
p la ined tha t Le i tgen chas t ised her abou t her perfor-
m ance and stated tha t i t wa s “typ ical of the poor nu rs ing
care” in the d epa rtmen t . The fo llow ing year , a pat ient
exper ienc ing an ec top ic pregnancy reported tha t Le itgen
re fu sed to treat her . Later in 2002 , a d iffe ren t nu rse con –
fron ted Le itgen , te lling her that m emb ers o f th e sup –
por t s ta ff found her dem eanor condescend ing . In 2003 ,
Le itgen m e t w ith mem bers of the Ho sp ital’s m anagemen t
to d iscuss her com ba t ive commun icat ion w i th o ther
emp loyees , and af ter tha t m ee t ing one of the m anagers
recomm ended to Ho lm ay tha t Le itgen be fired because
o f h er commun icat ion prob lem s . Bu t the Hosp ita l
d id no t fire L e i tgen at tha t tim e , and the fo llow ing year
she and H o lm ay m e t w ith the sam e manager again to
d iscu ss s im ila r is sues of teamwo rk and co llabora tion .
Du r ing tha t m eet ing Ho lm ay con fron ted Le itgen abou t
new inc iden t s inv o lv ing conduc t tha t Ho lm ay con –
s idered d isrup t ive to pa t ien t sa fe ty and sta ff camarader ie .
Even after these conve rsat ion s w ith managemen t
abou t resp ec t fu l commun icat ion , nurses con t inued to
take issue w i th L e itgen ’s behavior , and they reported
the ir concerns to Bonn ie Young , the d irec tor o f the depar t –
m ent ’s nu rs ing staff . He re aga in , Le itgen d ispu te s the
way her behav ior was perce iv ed by th e sta ff invo lved ,
bu t adm its tha t she rece ived mu l tip le ora l w arn ings
between 2004 and 2006 tha t her commun icat ion w ith the

No . 09-1496

support sta ff was prob lem a t ic . For examp le , Le itgen
acknow ledges tha t a t least two nurses told Young that
they re fu sed to con t inue wo rk ing in the depa rtmen t
because of the way Le itgen had trea ted them .
Desp ite these con tinued commun ica tion p rob lem s , in
h er performance eva luat ion in M arch 2006 , bo th Sandy
and H o lm ay
iden t ified pos i t ive con tribu t ions
tha t
Le itgen m ad e to the departm en t . They to ld Le i tgen tha t
she had show n some imp rovem ent in he r in te ract ion s
w ith suppor t s ta ff and was an asse t to th e Hosp ita l .
Sandy a lso asked Le itgen to serve on the recru it ing com –
m it tee , and he inv ited her to rep re sen t the depa rtmen t
a t a con ference a t the end o f the year . A s o f M ar ch 20 06 ,
both H o lm ay and Sandy agreed tha t Le itgen faced no
r isk of te rm ina t ion .
Bu t fou r mon th s after th is pe rform ance evalua t ion ,
nu rses began to renew the ir comp la in ts abou t Le itgen .
In Ju ly 2006 , Young reported to Sandy tha t ano ther
nurse , W endy Ston e , had comp la in ed that L eitgen had
hum ilia ted and verba lly abused h er in fron t of a pa t ien t .
(Le itgen adm i ts to hav ing m ade comm en ts tha t up se t
Stone in fron t of a pa t ien t bu t c on tend s tha t the com –
m en ts w ere jus t ified by Stone ’s perform ance .) T he sam e
day tha t Sandy learned o f the in c iden t he wro te the first
o f a num ber o f em a ils to Ho lm ay abou t th e p oss ib ility
of d iscip lin ing Le itgen . In th is ema il , Sandy said tha t he
had to le ra ted Le itgen because she added value to the
depar tm en t , bu t he a lso comm en ted tha t h er behavior
cou ld no t “go on forever .” A f ter m ee ting w i th S tone to
d iscuss the inc iden t , Sandy sen t ano ther ema il to Ho lm ay

No . 09-1496

s tat ing that they needed to m ee t in p er son because , upon
re flect ion , he be lieved tha t Le itgen ’s in te rpe rsona l con –
f lic ts w ere m o re se r ious than he had prev ious ly under-
s tood . Bo th Stone ’s comp lain t and Sandy ’s dec is ion
to exp lore d isc ip l ine aga ins t L e i tgen occurred more
than a m on th be fo re Leitgen m et w ith T iggelaar in ear ly
Sep tember 2006 to comp lain abou t the compensa t ion
sys tem .
Le itgen ’s de te riora ting
re la tion sh ip w i th nu rs ing
s taff and pa tien ts con t inued throughou t Sep tember . For
examp le , wh ile Le itgen was in the m idd le of a de l ivery ,
a nu rse ca lled a sk ing for as sis tance w ith a non -u rgent
m a tter . Le itgen cou ld not take the call herself , bu t she
told the person re laying the me s sage to “go h it” the
nu rse who had reques ted assis tance . Leitgen later test i-
fied tha t she had m ean t th is comm ent face tiou s ly , bu t
sh e adm itted that som e peop le in the room apparen tly
d id no t take it as a joke . Tha t sam e m on th a pa t ien t com –
p lained tha t Le itgen had b lam ed her for the d i fficu lt ies
tha t had ar isen dur ing her em ergency Caesarean sec –
t ion . And around the sam e t im e , Young rece ived tw o
add it ional comp la in ts from staff mem be r s abou t Le itgen :
a nu rse com p la ined tha t she had been be lit t led , and a
m idw ife reported tha t she w as unab le to bu ild a collabora –
t ive prac tice w ith Le itgen . Young d id no t no t i fy L e itgen
abou t e ither of these inc iden ts or comp lain ts .
Du ring Sep tem ber (the exac t date is uncer ta in ) , wh ile
she was s till serving on the recru it ing comm i t tee , Le itgen
a lso m ade comm en ts tha t m embers of the Hosp ita l
view ed as d isloya l to its recru iting m iss ion . Leitgen to ld

No . 09-1496

a doc to r that the d ep ar tm en t w as rec ru iting th a t she fe lt
h er ideas were no t heard , tha t she had lit t le respec t for
th e nu rs ing s ta ff , and that she fe lt unhappy a t the H osp i-
tal . In the cou rse of tha t conve rsat ion , Le itgen to ld the
recru it tha t she wou ld no t have jo ined the Hosp i ta l
“know ing wha t she know s now” and tha t she m igh t
be gone by the tim e he arr ived . A f te r th is conversa tion
w ith Le itgen , the recru it con tac ted Sandy and expressed
a concern abou t accep t ing a pos i t ion w i th the Hosp ita l
because he feared tha t the phys ic ians were unhappy .

C .
By ear ly Sep tem ber 2006 , hav ing d ec ided the p revi-
ous m on th to d isc ip l ine Le i tgen for her abuse of s taff ,
Sandy and Ho lm ay began preparing a recomm enda t ion
tha t Le itgen be term ina ted . They m e t w ith a m em ber of
the m anagemen t comm it tee to determ ine wha t docu –
m en ts they wou ld need , and short ly a fter th is m ee t ing ,
H o lm ay asked Young to p repare a t im e line lis t ing in –
s tances where nurses or pa t ien ts had reported tha t
L e itgen w a s e ith er rude or d isrup t ive . Young p repared a
first draft of th is tim e line by Sep tem ber 8 , 2006 , based on
uno ffic ia l, pr iva te no tes tha t she kep t regard ing con f lic ts
be tween s ta ff m embers . A lthough Young m emoria lized
comp lain ts from nurses reg ard ing in terac t ions w ith
do c to rs and o th er s ta ff in th ese notes , sh e d id not , as a
genera l ru le , inve s t iga te the inc iden ts or take note o f
oppos ing v iew po in ts . Ho lm ay and Sandy had been ex –
chang ing ema ils abou t d iscip l in ing Le itgen s ince a t least
Ju ly 2006 , bu t b e fo re Sep tember 2006 no one had been

No . 09-1496

ga ther ing docum en ta t ion abou t Le i tgen “for the pur-
poses of
reques ting
to
In add i tion
te rm ina t ion .”
the t im e line , Sand y began exc lud ing Le itgen from con –
ve rsat ion s abou t recru iting and to ld her that she wou ld
no longe r be rep re sent ing the Ho sp ital at the upcom ing
con ference . Sandy d id no t in form L e i tgen tha t she was
in jeopardy of be ing fired .
On O c tober 31 , 2006 , Sandy form a l ly recomm ended to
the Hosp i ta l’s execu t ive comm it tee tha t it term ina te
Le itgen . He supported h is recomm enda tion w ith the
fo llow ing docum en ta tion : persona l le t ters from both
h im and Ho lm ay , Young ’s t im e l ine , and a separate
t im e line crea ted by Ho lm ay . Through these docum en ts
and the ir persona l s ta tem en ts to the comm it tee , both
Sandy and Ho lm ay expressed the ir op in ion tha t , a lthough
Le itgen was an amp ly qua lified phy s ic ian , her host ility
toward sta ff and pa t ien ts was unaccep tab le . In add it ion
to these concerns , one of the m embers of the execu t ive
comm i ttee empha sized tha t he wa s d is sa tis fied by the
nega tive comm ent s Le itgen had m ad e recent ly to the
phys ic ian the Hosp ita l had been try ing to recru i t . A fter
hea ring recomm enda tion s from Sandy and H o lm ay , the
comm it tee voted to fire Le itgen .
On Novem ber 14 , 2006 , Le itgen a t tended a “ term ina t ion
s ess ion” where m emb ers of th e ex ecu tive comm it t ee
to ld her tha t sh e cou ld either res ign or be fired . Le itgen
qu it the fo l low ing day . Ho lm ay at tended the m eet ing
w i th two o ther hosp ita l adm in is tra tors , bu t Sandy was
absen t . A t th e m ee ting , the Hosp ita l told Le i tgen tha t
it w as term ina t ing her because of the num e rou s com –

No . 09-1496

p lain ts tha t nurses and pa t ien ts had m ade aga ins t her
over the years . In d ischarging Le itgen , the Hosp ita l
elec ted not to fo llow its policy recomm end ing that it
no t ify emp loyees in w r i t ing of po ten t ia l d isc ip l ina ry
ac t ion s resu l t ing from d isrup t ive behav ior .
The d is t r ic t cou rt gran ted summ a ry judgm ent for the
Hosp i ta l . It byp a s sed the que s t ion whe ther Le i tgen ’s
com p la in t s regard ing the compen sa t ion sys tem were
p ro tec ted conduc t and conc luded that , even if th ey quali-
fied , no reasonab le jury cou ld f ind a causa l connec t ion
between Le itgen ’s comp la in ts and he r forced re signa t ion .
The court found i t s ign ifican t tha t L e i tgen had been
comp lain ing abou t the compensa t ion sys tem for years ,
bu t the Hosp ita l d id no t forc e her to res ign un t il a fter
a flurry of comp lain ts from nurses regard ing her conduc t .

II .
On app ea l, Le itgen re l ies exc lus ive ly on the d irec t
m e thod o f proo f to argue tha t genu ine issues of m a ter ia l
fact p revent summ a ry judgm ent fo r the Ho sp ital . To
su rv ive summ ary judgm en t on her retalia tion cla im
und er th e d irec t m e thod , L eitgen n eed ed to prov id e
su ffic ien t d irec t or c ircum s tan t ia l evidence to estab lish
(1 ) tha t she engaged in p ro tec ted conduc t , (2 ) tha t she
su ffered an adverse emp loym en t ac t ion , and (3) tha t there
w as a cau sa l connec tion be tw een the two . See Jones v .
R es-Ca re, Inc ., 613 F .3d 665 , 671 (7 th C ir . 2010) ; Casna v . C ity
o f Loves P ark , 574 F .3d 420 , 426 (7 th C ir . 2009 ) . Th ere is
no d ispu te tha t Le itgen ’s forced res igna t ion con s t i tu tes
an adve rse emp loym ent act ion , so we a re le ft w i th the

No . 09-1496

ques t ions whe ther Le itgen engaged in pro tec ted conduc t
and whe ther tha t conduc t was causa lly connec ted to
her forced re s igna t ion . The d is tr ic t cou rt bypa ssed the
issue o f protec ted conduc t , bu t because Le itgen focuses
on her conve rsat ion w ith T iggelaar as the app licab le
pro tec ted conduc t and tha t conversa t ion is re levan t to
the ques tion of causat ion , we beg in our ana lys is there .

A .
For Le itgen to show tha t she engaged in pro tec ted
conduc t , sh e had to prove tha t she had a reasonab le ,
good – fa ith belie f tha t the compensa t ion sys tem w as
d iscr im ina tory when she comp la ined abou t it , bu t she
need no t p rove tha t the sys tem w a s ac tua lly d iscr im –
inatory such that she wou ld have p reva iled on a c laim
of in ten tional d isc rim inat ion under T itle V II . See T a te v .
Exec . M gm t . Servs . , Inc ., 546 F .3d 528 , 532 (7 th C ir . 2008) ;
Fin e v . Ryan In t’l A irlines , 305 F .3d 746 , 752 (7 th C ir . 2002) .
Our requ ir em en t that L eitgen have a reasonab le , good –
fa ith be lie f t ha t her com p la in t invo lved gender d iscr im –
ina t ion is not onerous . See M a t tson v . Ca terp il lar, Inc ., 359
F .3d 885 , 892 (7 th C ir . 2004 ). She s imp ly had to show tha t
her be lie f tha t she wa s comp la in ing abou t un law fu l
d iscr im ina t ion was no t “ ‘comp lete ly ground less .’ ” See
F ine, 305 F .3d a t 752 (quo t ing M cDonnel l v . C isneros , 84
F .3d 256 , 259 (7 th C ir . 1996)) .
In her appella te br ief , Leitgen acknow ledges the H osp i-
ta l’s argum en t tha t she n ev er engaged in pro tec ted
conduc t bu t resp ond s tha t the Sup rem e Court ’s dec is ion
in Craw ford v . M etro . Gov ’t o f N ashv il le & D av idson Cn ty .,

No . 09-1496

129 S . C t . 846 (2009) , es tab l ishes tha t he r comp la in t s w ere
p ro tec ted . C raw ford add re ssed on ly whe ther coope ra t ing
w ith an em p loyer ’s in terna l invest iga t ion of d iscr im –
in a t ion was p ro tec ted conduc t , id . a t 850 -51 , and is
not d ispos itive here . Ins tead , the ques tion here
is
w he ther Le itgen reasonab ly be lieved tha t her com –
p lain ts abou t the compensa t ion sys tem amoun ted to
m ore than a gender -neu tral accu sa tion tha t the sys tem
un fa ir ly pena lized her as a h igh -volum e phys ic ian and
in stead cha rged gende r d iscr im ina t ion .
T i tle V II, of course , proh ib its d iscr im ina tory compensa –
tion based on gender , see 42 U .S .C . § 2000 e-2(a)(1) ;
Goodm an v . N at ’ l Sec . Agency , Inc ., 621 F .3d 651 , 656 (7 th
C ir . 2010) . The Hosp ita l recogn izes tha t a d ispar ity
in p ay based on gende r wou ld v io la te T it le V II, bu t
argues that Leitgen lacked an ob jec tively rea sonab le
be lie f tha t the Hosp ita l’s pay sys tem in ten t iona lly d is –
cr im ina ted aga ins t wom en . The Hosp i ta l suppor ts its
pos it ion by po in t ing ou t tha t the compensa t ion sys tem
had rema ined the sam e throughou t Le itgen ’s emp loy –
m en t , tha t L e itgen d id no t try to change the sys tem
du r ing her tenu re a s depa rtmen t cha ir , and that the
H osp i ta l jus t ified the pay schem e w ith the nond iscr im –
ina tory
in d iscourag ing e lec t ive induc t ions .
in teres t
Bu t these reasons do no t underm ine the s incerity or
reasonab leness of Le itgen ’s comp lain t tha t she be lieved
the H osp i tal’s pay schem e to be d iscrim ina tory based
on gender . Th roughou t her oppos it ion to summ ary judg –
m en t , Le itgen has repea ted ly po in ted to ev idence tha t
sh e ha s a lways fram ed her comp la in ts as a po ten tia l
is sue of gende r d iscr im ina t ion . M oreover , the ongoing

No . 09-1496

na ture of her comp lain ts du r ing her tenure , and her
to lerance of the sys tem wh ile she w as cha ir , do no t con –
c lus ive ly show tha t her comp lain ts abou t the pay
system were unreasonab le or ins incere . In s tead , these
fac ts sugges t tha t the im ped im en ts to chang ing the com –
pensat ion sys tem a t the Ho sp ital we re s ign ifican t and
endur ing . Thus , we cred i t Le i tgen ’s c on ten t ion for pur-
poses of summ ary
judgm en t tha t her conversa tion
w i th T igge laar w as p ro tec ted conduc t . W e no te , how ever ,
tha t Le itgen ’s focus on her conversa t ion w i th T iggelaar
as the part icu lar ins tance of protec ted conduc t tha t
caused her term ina t ion is re levan t to th e issue o f causal
connec tion .

B .
Leitgen nex t argues that she p resen ted su fficien t evi-
dence tha t the Hosp ita l’s dec is ion to fire her was
m o t iva ted by her comp la in ts abou t the compensa t ion
sys tem , part icu la rly her conve rsat ion w ith T igge laar . To
es tab lish a cau sa l connec t ion be tw een her alleged ly
p rotec ted condu ct and her forced res ignat ion , L eitg en
had to show tha t her comp lain ts were “a subs tan t ia l or
m o t iva t ing fac tor” in the H o sp i ta l ’s dec is ion to f ire her .
S ee Gates v . Ca terp i llar , Inc ., 513 F .3d 680 , 686 (7 th C ir .
2008) (c ita tion and quo ta tion om it ted ) . Le i tg en po in ts to
c ircum s tan t ia l ev idence tha t , in he r v iew , show s tha t the
H osp ita l based its de c is ion , at leas t in part , on her com –
p la in ts abou t the compensa t ion sys tem . W e add ress her
evidence and , like the d is tr ic t cou rt , conc lude tha t the
in ferences Le itgen a t t em p ts to draw from it are too a t –

No . 09-1496

judgm ent when con –

tenuated to su rv ive summ a ry
s ide red ind iv idua l ly or toge the r .
Le itgen relies m os t heavily on the temporal prox im ity
be tween her conversa tion w i th T igge laar and her forced
res igna t ion . A s w e have often observed , susp ic iou s
t im ing a lone is alm os t a lw ays insu ffic ien t to surv ive
summ ary judgm en t . Leonard v . E . Il l . Un iv ., 606 F .3d 428 ,
432-33 (7th C ir . 2010 ) ; Turner v . Sa loon , L td ., 595 F .3d 679 ,
687 (7 th C ir . 2010 ). Le itgen non e the less con tends tha t
th is case is the excep t ion because Sandy and Ho lm ay
b egan p repar ing for her term inat ion ju st days after h e r
m ee ting w ith T iggelaar . See Casna , 574 F .3d a t 427 (find ing
tha t susp ic ious t im ing crea ted tr iab le issue where em –
p loyee was term ina ted one day af ter pro tec ted conduc t) ;
Sp ieg la v . H u l l, 371 F .3d 928 , 943 (7 th C ir . 2004 ) (four days
later ) ; M cC lendon v . Ind iana Sugars , Inc ., 108 F .3d 789 , 796 –
97 (7 th C ir . 1997 ) (two or three days la ter ). A fter re –
v iew ing the ev iden ce , we f ind th a t Le i tgen canno t over-
com e the gen eral ru le that su sp icious t im ing a lone is
in su ffic ient to support a c la im of re ta lia tion .
F irs t , Le itgen ’s conve rsat ion w ith T igge laar w a s no t the
first tim e tha t she comp lained abou t th e compensa t ion
sys tem . To the con tra ry , she firs t pu rsued th is is sue
w ith the depar tmen t yea rs before the Hosp i ta l f ired her .
W hen an em p loyee ’s protec ted conduc t is separated by
a sign ifican t period o f t im e from the adverse emp loy –
m en t a c t ion , the prox im ity o f the inc iden ts does no t
supp or t a causa l connec tion be tw een them . See Leona rd ,
606 F .3d at 432 (find ing adve rse emp loym en t ac tion six
m on ths a fter protec ted cond uc t insu f fic ien t to es tab lish

No . 09-1496

re ta liat ion cla im ) ; Argyropou los v . C ity o f A lton , 539 F .3d
724 , 734 (7 th C ir . 2008) (seven weeks be tw een even ts) .
Le itgen re spond s tha t her comp la in ts we re ongoing
up un t il Sep tember 2006 , and th ere fore a large t im e gap
does no t separa te her protec ted conduc t from her d is –
cha rge . Bu t th is re spon se m is se s the po in t . Becau se she
had been comp la in ing to hosp ital execu tives abou t the
p ay sys tem for years , she mu s t offer a va lid reas on why
her conversa t ion w i th T iggelaa r wou ld sudden ly trigger
r e talia t ion . Sh e p roposes on e reason : It was th e f ir s t
t im e she ra ised her concern to anyone ou ts id e the de –
par tm en t . Bu t th is asser tion is incorrec t . Le itgen test ified
tha t , w i th the he lp o f the then -cha ir o f the depar tm en t ,
she ra ised these concerns w ith the com p ensa t ion com –
m i t tee (who are peop le ou tside the departm en t ) som et im e
be fore she herse lf becam e cha ir in 19 99 . E ven though
th e se ex tra-depar tm en ta l comp la in t s occu rred before
Sandy cam e to the Hosp i ta l, Le itgen adm it ted tha t bo th
Sandy and Ho lm ay— the execu t ives w ho recomm ended
her term ina t ion— knew of her con ce rn s abou t the com –
pensa t ion system years before the Hosp ita l forced her
to re sign . A c la im of re ta lia t ion ba sed on su sp ic iou s
t im ing dep end s on wha t the re levan t dec is ion-m akers
knew and when , see Sa las v . W is . D ep’t o f Corr ., 493 F .3d 913 ,
925 (7th C ir . 2007 ) ; Tomanov ich v . C ity o f Ind ianapo l i s , 457
F .3d 656 , 668 (7 th C ir . 2006 ), and here the evidence
shows
tha t
the re levan t dec is ion -m ak ers knew of
Le itgen ’s be lie f tha t the compensa t ion sys tem was d is-
cr im ina tory long before they dec ided to term ina te her .
Le i tgen ’s re liance on her conversa tion w i th T iggelaar
as the p ro tec ted conduc t that caused her term inat ion is

No . 09-1496

a lso flaw ed because Sandy and H o lm ay had begun d is –
cu ss ing ways to d iscip line Le itgen before tha t m e e t ing
ever took p lace . Sandy and Holm ay ex changed em ails
abou t how best to d iscip l ine Le i tg en a fter she be lit t led
Nurse Stone in fron t of a pa t ien t in Ju ly 2006 , weeks
before Le itgen w rote to T igge laar to reques t a mee ting
and more than a mon th be fore that m e e t ing occu rred .
W h en a re ta lia t ion c la im is based on su sp ic iou s t im ing ,
“ the orde r of even ts is even mo re importan t than the
t im e between them ; th e th eory doesn ’t work if the re-
ta lia tory ac t p recedes the pro tec ted act iv ity .” Leona rd , 606
F .3d at 432 . H ere , although Leitgen asse r t s that there is
a d ispu te of fac t , the ev id en ce is con clu sive that Sandy
and Ho lm ay had dec ided to con s ide r var ious d isc ip l ina ry
re spon se s to Le itgen ’s d is rup t ive behavior we ll be fore
she engaged in the a lleged ly p ro tec ted conduc t o f ta lk ing
to T igge laar . And Ho lm ay ’s adm iss ion tha t no one had
begun ga ther ing docum en ta t ion to support the recom –
m enda t ion
for Le itgen ’s
term ina t ion un t il Sep tem –
ber 2006 does no t refu te the und ispu ted ev id ence tha t
Sandy and Ho lm ay had a lready dec ided to pu rsue som e
type o f d iscip l ine agains t Le itgen w e ll be fore sh e ever
m e t w i th T igge laar .
Le itgen nex t argues tha t the Hosp ita l’s sudden crea t ion
o f a t im e line o f her “unaccep tab le behav ior” jus t three
days a fter her mee ting w ith T igge laar is susp ic iou s
enough to overcom e summ a ry judgm ent . A lthough a
reta lia t ion c la im can be supported by ev idence o f “sudden
d is sa tis fact ion w ith an emp loyee’s perform ance ,” pa rt icu –
lar ly when an em p loyee has a genera lly good re co rd ,
Cu lver v . Gorm an & Co ., 416 F .3d 54 0 , 5 46 (7 th C ir . 2005) ,

No . 09-1496

the evidence in th is case be lie s tha t cha racter izat ion .
Le itgen refers us to her “ou tstand ing” perform ance
eva luat ion in M arch 2006 , bu t in that eva luat ion , Sandy
and Ho lmay to ld her that her in t e rp ersonal re la t ion sh ip s
had m ere ly “ improved .” In any even t , Sandy and H o lm ay
d id no t sudden ly becom e d issa t isf ied w i th Le i tgen ’s
behav ior a fter she m e t w ith T iggelaar; the ev idence
shows tha t they bo th cons idered her behavior to be prob-
lem at ic befo re th e m eet ing , and they were a lready in
the m id s t of dev is ing me thod s to re spond when she
reques ted the m ee ting . The und ispu ted ev idence a lso
e stab lish es that Ho lmay had been d issa t is fied w ith
Le itgen ’s in terpersona l flaw s for a long t im e , so mu ch so
tha t she pa r t ic ipa ted in m ee t ings w i th adm in is tra tors
th ree years ear lier that had resu lted in a recomm enda –
t ion that L eitgen be fired .
Le itgen a lso fau lt s the Hosp ital for c reat ing and re ly ing
on a t im e line tha t wa s not based on p re -ex is ting docu –
m en ts and for fa iling t o c om p ly w ith its po licy recom –
m end ing w r it ten wa rn ings of unaccep table behav ior . The
Hosp ital’s po licy favors , bu t doe s not requ ire , the
w r it ten no t ic e that L eitgen c la im s sh e never rece ived . By
Le itgen ’ s ow n adm is sion , she learned of many of the
comp lain ts aga ins t her when she w as ora lly warned
abou t her behavior . And she doe s not deny tha t she
a t tend ed mu l t ip le m ee t ings w i th Hosp i ta l adm in is tra tors
where they no tified her of the ir p rob lem s w i th her
a t titude tow ard cowo rkers . G iven tha t Le itgen adm its
tha t she a t tended d iscip l inary m ee tings and received ora l
w arn ings , the Hosp ita l’s neg lec t to fo llow its recom –
m ended po licy o f docum en t ing those d iscuss ions is not
evidence of re ta lia tion .

No . 09-1496

F ina lly , Le itgen argues tha t the Hosp i ta l a lso reta lia ted
agains t Ke il , another fem a le phys ic ian , by forc ing her
to qu i t a fter she comp lained tha t the pay sys tem d is –
cr im ina ted aga in s t h er as a wom an . Th is trea tm en t ,
Le itgen u rge s , fu rthe r support s her c la im of re ta l ia tion .
A lthough the Hosp ita l’s d iscrim ina t ion aga in s t other
emp loyees who raised s im ilar comp lain ts wou ld be
c ircum s tan t ia l ev idence to support Le itgen ’s re ta lia t ion
c laim , see H asan v . Fo ley & Lardner LLP , 552 F .3d 5 20 , 527
(7th C ir . 2008 ) ; Troupe v . M ay D ep ’t S to res Co ., 20 F .3d 734 ,
737 (7 th C ir . 1994 ) , Le i tgen ’s re lian ce on Keil
is
unava iling because the re cord con ta ins no ev idence tha t
th e H osp ita l d id in fac t d isc rim inate aga inst Keil .
For the foregoing reasons , we there fore AFFIRM the
judgm en t of the d is tr ic t cour t .

1 -1 3 -1 1