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PATEL v. HOWARD UNIVERSITY

August 1, 1995

SMITH ARUN PATEL, Plaintiff,
v.
HOWARD UNIVERSITY, Defendant.



The opinion of the court was delivered by: STANLEY S. HARRIS

 Plaintiff, now a licensed physician in the State of Maryland, worked in a residency program in the Department of Anesthesiology at Howard University Hospital ("Howard") from 1987 to 1990. She alleges that she entered into a series of three one-year employment contracts with Howard under which Howard was to provide plaintiff with advanced training and education in anesthesiology as a postgraduate physician. Plaintiff alleges that defendant Howard University breached the second and third contracts by: (1) denying her credit for her third year of postgraduate work (PGY-3/CA-2) and refusing to permit her to progress to the fourth and final year of postgraduate work; and (2) failing to accord plaintiff the procedural protections set forth in the contracts regarding performance evaluations and notice of nonrenewal. Plaintiff also alleges that defendant was negligent in failing to maintain a performance evaluation system adequate to fairly evaluate postgraduate physicians. *fn1"

 The Court held a two-day bench trial beginning on April 19, 1995. *fn2" This Opinion sets forth the Court's findings of fact and conclusions of law as required by Fed. R. Civ. P. 52(a). Based on the credible evidence presented at trial, the Court finds that defendant did breach some of the terms of the contracts, but that defendant was not negligent in its administration of the performance evaluation system. However, the Court also finds that plaintiff did not suffer damages as a result of the breach, and, therefore, awards only nominal damages in the amount of one dollar.

 Findings of Fact

 Plaintiff was trained in medicine and anesthesiology in India. In 1980, she immigrated with her husband to the United States, where plaintiff intended to enter a residency program in anesthesiology. Because she received her medical training in a foreign country, she was required to take the Educational Commission for Foreign Medical Graduates Examination, which she took and passed in 1981. In 1987, plaintiff was accepted into Howard's residency program in the Department of Anesthesiology ("Department").

 A. The Course of Plaintiff's Residency

 In the normal path of a resident's training, the resident completes a "clinical base year" -- the first year of postgraduate work, also referred to as PGY-1 -- before specializing in a field such as anesthesiology. Because of plaintiff's educational background, Howard decided to waive the clinical base year, and allow plaintiff to start her training as a second-year postgraduate physician (PGY-2) and first-year resident in clinical anesthesiology (CA-1).

 Accordingly, on March 24, 1987, Howard offered and plaintiff accepted an appointment as a PGY-2/CA-1 resident in anesthesiology for the period June 26, 1987, to June 25, 1988. Plaintiff completed and was given full credit for this year, and this contract is not in dispute.

 On April 26, 1989 -- two months after the PGY-4/CA-3 contract for 1989-1990 had been signed -- Dr. Olly Duckett, Chairman of the Department's Competence Committee, notified plaintiff that she would be required to repeat nine months of the PGY-3/CA-2 year, incorporating three months of general medicine, because of unsatisfactory performance. The reason Howard initially renewed plaintiff's contract for the fourth year, yet then required plaintiff to repeat the third year, is that renewal decisions generally are made several months in advance of the next contract year, which starts on July 1. Because of plaintiff's continued poor performance during the interim period, Howard decided to modify its decision.

 By letter dated June 8, 1989, plaintiff requested reconsideration of the decision. By letter dated June 27, 1989, Dr. Kwesi Edusei, Chairman of the Education Committee, informed plaintiff that the Department had held a faculty meeting on June 9, 1989, and that her request for reconsideration had been denied.

 As a result of the April 26, 1989, notice, plaintiff worked in general medicine from July 1, 1989, to October 1, 1989, and repeated nine months of her PGY-3/CA-2 year from October 1, 1989, to June 30, 1990.

 By letter dated December 21, 1989, Dr. Melville Wyche, Chairman of the Department of Anesthesiology, informed plaintiff that she would not be offered a reappointment for the period beginning July 1, 1990, because "[her] progress in the area of anesthesia [was] minimal to nonexistent." Because of plaintiff's poor performance, plaintiff also was not given credit for her PGY-3/CA-2 year.

 By letter dated May 22, 1990, plaintiff appealed her termination from the program. On May 25, 1990, a faculty meeting was held, and the faculty voted to uphold the termination. Plaintiff was informed of the decision by letter dated June 27, 1990.

 B. The Deficiencies In Plaintiff's Performance That Resulted In Her Termination

 The evidence at trial overwhelmingly demonstrated that plaintiff was sorely lacking in her fund of knowledge and failed to make any progress in learning. These deficiencies were demonstrated by the testimony of Department faculty members Dr. Barbara Roberts, Dr. Kwesi Edusei, and Dr. Melville Wyche; the performance evaluations; and plaintiff's standardized test scores. *fn3" The testimony of the doctors indicated that, overall, plaintiff was competent in the "technical," i.e., manual, aspects of anesthesiology, but lacked the knowledge base, judgment, and analytical skills that are required. As Dr. Wyche testified, competence in the technical aspects of anesthesia, i.e., executing the procedures, can be achieved without an adequate knowledge base. Thus, for example, nurses can and do perform many anesthesia procedures; similarly, plaintiff was allowed to perform many anesthesia procedures -- and performed them well -- despite her deficient knowledge base. However, the distinguishing characteristic of a physician -- knowledge and judgment -- were qualities in which plaintiff was significantly lacking. *fn4"

  The evaluations indicate that, overall, plaintiff's fund of knowledge was poor and her progress was minimal. See Defendant's Exs. 3a-3e (Evaluations of Plaintiff by Drs. Edusei, Roberts, Lim, Kulkumar, and Burruss). *fn5" The testimony of Drs. Roberts and Edusei elaborated on the problems mentioned in the evaluations. Plaintiff's fund of knowledge was deficient from her start in the program because plaintiff was not required to do the clinical base year, PGY-1 -- an erroneous decision, in Dr. Roberts's opinion. This deficiency was compounded by plaintiff's failure to do much of the required reading due to personal problems in plaintiff's home life. Specifically, plaintiff's parents-in-law were living at home with plaintiff and her husband, and, due to certain Indian customs, this living arrangement made it difficult for plaintiff to reserve an adequate amount of time for her reading, which is essential to building up a knowledge base. *fn6"

 In addition to performance evaluations, plaintiff's standardized test scores indicated both a severe deficiency in plaintiff's fund of knowledge and a failure to progress in her learning. Each year, the residents take a national standardized test called the in-training examination, sponsored by the American Board of Anesthesiologists and the American Society of Anesthesiologists ("ABA/ASA In-Training Exam"), an exam that prepares the residents for the certification examination administered by the ABA ("boards" or "board certification"). *fn7" The ABA/ASA In-Training Exam is administered every July. The grades are returned by the following October, and are made available to the residents. When the scores are extremely low, as plaintiff's were, an attending staff physician meets with the resident to discuss the test. Howard considers these tests very important because one of the primary goals of the Department's residency program is to prepare its ...


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