Table 6.

Graduate Medical Education Dismissal Cases That Raised Lack of Due Process.

Case and Year Decided	Type of Dismissal	Type of Residency	Reason for Dismissal	Outcome
Failure of in-service exams
Brown v Hamot Medical 34 (2008)	Academic	Orthopedics	Dr Brown was an orthopedic resident in an ACGME-approved residency at Hamot Medical Center. Her program was 5 years in duration with yearly renewable contracts. During her residency, she performed poorly on the orthopedic-in-training examination placing in the bottom 2% during her third year of residency. Issues in clinical judgment were also raised throughout the program. Dr Brown was counseled by her Program Director that she needed to improve her medical knowledge and clinical performance. During her third year, she was notified that her contract would not be renewed. Dr Brown’s case was reviewed by a grievance committee, who supported nonrenewal of the contract, which was affirmed by the Medical Education Committee, the Medical Staff Executive Committee, and upheld by the Board of Directors. Dr Brown filed a lawsuit alleging discrimination, breach of contract, and due process concerns.	Nonrenewal of contract upheld
Schaefer v Brookdale University Hospital 35 (2008)	Academic	Urology	Dr Schafer was a urology resident in a 6-year ACGME-approved residency that consisted of PGY-1 and PGY-2 years in general surgery and the PGY-3 to PGY-6 years in urology. During his PGY-3 year, he scored in the lowest 6 percentile on the urology-in-service examination and had his clinical skills rated below acceptable performance. His annual performance evaluation noted his skills needed to be improved and that his technical skills and hand dexterity were lacking. Despite the above findings, he was promoted to a PGY-4 year to improve his performance. During his PGY-4 year, his in-service-exam score was in the lowest third percentile and his clinical skills were lacking. He was advised to consider a different specialty. He was allowed to enter his PGY-5 year where his in-service exam score was still in the lowest third percentile and his clinical skills did not match his level of training. During a midyear conference with faculty, he was informed he would not be promoted to the PGY-6 year and his contract would not be renewed and that he had no further recourse. Dr Schafer subsequently filed a lawsuit alleging breach of contract, defamation, tortious interference with a business relationship, and due process concerns.	Nonrenewal of contract upheld
Lack of clinical skills and judgment
Hernandez v Overlook Hospital 36 (1997)	Academic	Internal medicine	See text Case 6.	Dismissal upheld
Samper v University of Rochester 37 (1987)	Academic	Anesthesiology	Dr Samper was an anesthesiology resident who claimed to have received unsatisfactory academic evaluations during her residency. She filed a lawsuit claiming sex discrimination, defamation, intentional infliction of emotional distress, breach of contract, and violation of her due process rights based in part on inadequate notice of a meeting to discuss her performance and being denied the right to have an attorney present.	Due process claim dismissed
Shaboon v Duncan 38 (2001)	Academic	Internal medicine	Dr Shaboon was a PGY-2 internal medicine resident who presented with mental health issues after working an alleged 108-hour workweek. She was found to be suffering from depression and from psychological and physical exhaustion and had deprived herself of sleep, a normal appetite, and relaxation. She was treated in a mental health facility and left under her own volition before her treatment had been completed. Her Program Director would not allow her to see patients without approval from her treating psychiatrist and she was directed to report to the department conference room to read medical literature. She was subsequently put on probation for mental health reasons and failure to cooperate with mental health practitioners. Several committees that reviewed her case requested access to her medical and psychiatric records in order to reinstate her clinical privileges, which she refused. She was continued on probation and received notice of potential termination due to failure to meet academic requirements and was eventually dismissed. She subsequently filed a lawsuit alleging due process issues and other claims.	Due process claim dismissed
Ross v University of Minnesota 39 (1989)	Academic	Psychiatry	Dr Ross was a psychiatry resident. From the start, the faculty were concerned about his performance due to anxiety, preoccupation, slurred speech, and difficulty remembering things. He was treated for depression and able to complete his rotations. Midyear, he was notified by the Program Director in writing that the Progress Committee was concerned about interpersonal issues to include failure to respond to pages, slurred speech, and incomplete notes. He was placed on probation due to difficulty to prioritize tasks, work efficiently, work rapidly, and lack of flexibility to manage various tasks. He was evaluated and found to have attention deficit disorder, treated with Ritalin, with some improvement. The Progress Committee recommended he repeat his PGY-2 year to gain more experience in patient care and emergency room management. He was offered a new 1-year contract. During his repeat PGY-2 year, he received mixed evaluations with 1 faculty member commenting that he had serious problems that would affect his ability to function as a psychiatrist. He was told his contract would not be renewed and to look for a new position. In spite of some positive research on tardive dyskinesia, his subsequent evaluations were mixed and he was dismissed. He subsequently filed a lawsuit arguing due process concerns and defamation.	Nonrenewal of contract upheld
Lack of professionalism
Allahverdi v Regents of University of New Mexico 40 (2006)	Academic	Family medicine	See text Case 7.	Due process claim dismissed
Easaw v St Barnabas 41 (1989)	Nonacademic	Internal medicine	Dr Easaw was a PGY-2 internal medicine resident whose academic record was positive. His final clinical evaluations during his PGY-2 year were good to excellent. He was offered and signed a contract for a PGY-3 year. After missing work in May of his PGY-2 year, his record was reviewed demonstrating he had the highest absentee record of any Intensive Care Unit (ICU) intern. He was found to have prefabricated having chickenpox. The Hospital Director of Medical Education found this a serious offense and brought it up to the Medical Education committee who terminated him. Dr Easaw alleged he had limited notice of the meeting, limited time to present his version of the facts, and was not notified of his termination until June 29 of his PGY-2 year. He subsequently filed a lawsuit for failure to provide procedural due process for not complying with ACGME requirements and the institution’s own policies.	Dismissal deferred. Court required medical center to comply with ACGME criteria and its own internal policy
Fenje v Feld 42 (2005)	Academic	Emergency medicine	Dr Fenje was dismissed from an emergency medicine residency 12 days into the program for his lack of competency to deliver patient care in Scotland. He filed a lawsuit against the Scotland hospital for breach of contract. He subsequently applied for an anesthesiology residency in the United States. Prior to his acceptance into the program, he was interviewed by the Program Director and asked if there were any issues the program needed to be aware about regarding his application, including work in previous training programs and whether he had any “skeletons in his closet.” Dr Fenje did not address the prior training in Scotland. He was admitted into the residency after an interview with an executed contract. Several days after execution of the contract, the Program Director received an anonymous phone call disclosing the Scotland residency and difficulties encountered which were confirmed in a phone call with the Scotland Program Director. Dr Fenje was confronted with this information and stated the incident was due to a clash in personalities. The Anesthesiology Department subsequently terminated Dr Fenje’s residency for dishonesty in the application and interview process. Dr Fenje filed lawsuit alleging violation of his due process and equal protection rights.	Dismissal upheld
Marmion v Mercy Hospital 43 (1983)	Academic	OB/GYN	Dr Marmion was a PGY-4 OB/GYN resident. During his final year, the Program Director discussed administrative and medical deficiencies in his performance that needed to be addressed for him to be promoted to chief resident and complete the program. His performance improved. As Chief Resident, he confronted the Program Director about a change in the institution’s anesthesia policy and that he would not comply with it. He was informed by the Program Director that he might be terminated for not complying with hospital policies. Dr Marmion met with the Program Director and Associate Program Director and was orally notified he was being put on probation and had a number of conditions to comply with. Subsequently, the Director of Medical Education met with Dr Marmion and informed him of the dissatisfaction and grievances the hospital had with him. Dr Marmion followed the conversation by filing a formal grievance according to the hospital policy manual. The Program Director provided Dr Marmion with written notice he was suspended and to vacate the premises until the OB/GYN Residency Review Committee met. The Committee recommended dismissal. The decision was upheld by the Medical Education Committee. Reasons for termination included the inability or willingness to function within the department structure, insubordination, and failure to comply with hospital policies. Litigation followed where due process concerns were raised.	Dismissal upheld

Abbreviation: ACGME, Accreditation Council for Graduate Medical Education.