Court: District Court, E.D. Tennessee; January 15, 2019; Federal District Court
Plaintiff Paula E. Babb, a Certified Registered Nurse Anesthetist (CRNA) at Maryville Anesthesiologists, alleges she was wrongfully terminated due to a perceived disability related to her vision impairment, violating the Americans with Disabilities Act (ADA). In contrast, the defendant contends her termination was due to serious clinical errors that compromised patient safety. Maryville Anesthesiologists has filed a motion for summary judgment, which plaintiff opposes.
The case outlines that Maryville Anesthesiologists, serving Blount Memorial Hospital, employs CRNAs to perform critical anesthetic duties, often independently. Shortly after Babb's employment began in June 2015, Dr. Cheryl Coleman noted her unusually close proximity to computer screens and learned from Babb about her degenerative retinal condition. Coleman reported these concerns to Dr. Candace Robertson of the personnel committee, who began monitoring Babb’s performance closely.
Subsequent reports from Dr. Gaelan Luhn and Dr. Daniela Apostoaei highlighted further concerns regarding Babb's ability to read patient records and monitor vital signs, raising alarms about her readiness to safely perform her duties. This culminated in a consensus among physicians that Babb's visual impairment posed a risk to patient care, leading to her termination. The court, considering these factors, has decided to grant the defendant's motion for summary judgment.
Plaintiff acknowledges her inability to read the patient record but contends that Dr. Apostoaei requested precise blood work readings instead of confirming if results were normal. She claims to have previously verified that the blood work results were acceptable prior to surgery. On October 30, 2015, Dr. Robertson and Dr. Proffitt raised concerns about her ability to read medical records and monitors, emphasizing the impact on patient care and safety. The plaintiff asserted that her vision was stable and that she could fulfill her job responsibilities, noting a decade-long awareness of her eye condition and ongoing care from an ophthalmologist. She claimed to have disability insurance and was advised by the doctors to seek help for unreadable records and to provide an objective vision assessment from her ophthalmologist, which she never submitted.
Multiple CRNAs reported widespread knowledge of the plaintiff's vision issues, and staff raised concerns regarding her ability to read monitors and records, with some surgeons requesting she not operate in their rooms. On January 2, 2016, Dr. Proffitt emailed Dr. Robertson about staff concerns regarding the plaintiff's vision, including an incident where a patient nearly fell from a fracture table due to the plaintiff's oversight. The plaintiff admitted the patient moved but stated that other staff prevented a fall. A separate incident reported by Dr. Luhn involved the plaintiff inadequately sedating a patient for robotic surgery, leading to observable muscle twitches. Another CRNA, Lisa Green, noted these twitches and took action, conveying concerns about patient safety to Dr. Luhn, who later observed the same issue. Failure to ensure adequate sedation during robotic surgery poses significant risks of patient injury.
Dr. Luhn informed the plaintiff about differing methods of practice, leading to a report on January 8, 2016, by Dr. Apostoaei that the plaintiff documented an incorrect medication dosage, which a nurse corrected. The plaintiff admitted to this mistake. During a physician-owners’ meeting on January 13, 2016, they discussed recent surgical incidents involving the plaintiff and concerns from hospital staff regarding her visual limitations. Based on these clinical errors, particularly two surgical incidents, the physician-owners unanimously decided to terminate the plaintiff's employment due to her inability to provide safe patient care. Dr. Robertson differentiated between clinical errors and reading difficulties, asserting that such errors indicate a lack of clinical knowledge or judgment.
On January 14, 2016, Drs. Luhn and Shivers notified the plaintiff of her termination, citing the surgical incidents and the dosage error. The plaintiff requested reconsideration, but Dr. Luhn agreed to discuss it again with the other physicians. On January 18, the plaintiff emailed Dr. Robertson about her employment status, confirming her termination due to the cited incidents. Following this, Dr. Proffitt instructed a scheduling assistant, Crystal Aycocke, to inform other CRNAs of the plaintiff's departure without disclosing the reasons. Aycocke then sent an email to the CRNAs, attributing the decision to the plaintiff's eyesight issues and lack of documentation from her eye specialist, stating this had led to their difficult decision.
Aycoke's email was based on her opinions without physician approval. The record indicates that Maryville Anesthesiologists previously discharged two CRNAs for insufficient clinical skills without prior warnings or progressive discipline, as the practice does not implement corrective actions when a CRNA displays inadequate skills, due to the inherent risks posed to patients.
Plaintiff has submitted the Declaration and Expert Report of Jennifer W. Hultz, a Certified Registered Nurse Anesthetist (CRNA), to support her opposition to summary judgment regarding her actions in two surgical cases. Hultz's report asserts that the plaintiff's actions met the standard of care for CRNAs in Tennessee and argues that there is no basis for questioning the plaintiff's ability to provide safe anesthesia care. She criticizes the credibility of the defendant's account of events and describes the confusion regarding the timing of the surgery as "very difficult to accept." Maryville Anesthesiologists seeks to exclude Hultz's expert testimony, contending it is unnecessary for the jury, does not aid in understanding the facts, and is not relevant to the standard of care. The court must ensure expert testimony is based on sufficient facts and reliable methods, and it should assist the jury without addressing credibility, which is their province. Hultz's statements questioning the credibility of other witnesses are deemed inappropriate for consideration in this context, as the jury must assess witness credibility without expert influence.
Ms. Hultz's statements regarding the plaintiff's actions and their relation to her termination are deemed inappropriate as they effectively direct the jury toward a specific conclusion. By expressing opinions about the legitimacy of the termination reasons, these statements infringe upon the jury's role in determining the ultimate legal question. Expert opinions that assess the legitimacy of an employer's reasons for termination are considered overreaching, as this is the jury's responsibility, as noted in relevant case law. Consequently, the Court agrees to exclude Ms. Hultz's declaration and expert report from consideration in the current rulings.
In reviewing the standard for summary judgment under Rule 56 of the Federal Rules of Civil Procedure, the moving party must demonstrate the absence of genuine disputes over material facts to be entitled to judgment as a matter of law. The burden lies with the moving party, and all evidence must be viewed favorably toward the non-moving party. The non-moving party must provide evidence that could lead a reasonable jury to find in its favor. The Court's role during this phase is to ascertain whether sufficient evidence exists to warrant a trial, without weighing the evidence or determining its truth.
The plaintiff's complaint includes four claims: 1) disability discrimination under the ADA, 2) violation of ADA confidentiality, 3) invasion of privacy, and 4) interference with prospective employment. The defendant, Maryville Anesthesiologists, has sought summary judgment on all claims. The plaintiff has conceded that summary judgment is appropriate for claims two through four, leaving only the claim of disability discrimination for the Court's consideration.
A prima facie case under the Americans with Disabilities Act (ADA) requires the plaintiff to establish five elements: (1) the plaintiff is disabled; (2) the plaintiff is otherwise qualified for the position, with or without reasonable accommodation; (3) the plaintiff suffered an adverse employment decision; (4) the employer knew or had reason to know of the plaintiff's disability; and (5) the disabled individual was replaced. The plaintiff must also demonstrate that the disability was a "but for" cause of the adverse employment action. Disability can be established if the employer regards the plaintiff as having a physical or mental impairment that substantially limits one or more major life activities, such as seeing, hearing, or working. The court assumes "seeing" is the major life activity in question. An employee is considered "regarded as" disabled if the employer mistakenly believes there is a substantial limitation due to a physical impairment, or if the employer believes a non-limiting impairment substantially limits major life activities. Additionally, for an individual to be regarded as having a disability, the perceived impairment must not be "transitory and minor." Thus, an employer's erroneous belief about an employee's ability to perform job functions due to a medical condition may qualify the individual as having a disability under the ADA.
Maryville Anesthesiologists contends that the plaintiff was not regarded as disabled merely due to performance issues that prompted a fitness for duty evaluation. The defendant asserts that a meeting in October 2015, involving the plaintiff and Drs. Proffitt and Robertson, was a justified response to concerns raised by other medical staff regarding the plaintiff’s conduct. The decision to terminate the plaintiff stemmed from two surgical incidents and a documentation error, leading the physician-owners to determine that she could not ensure safe patient care. The defendant argues the email from Ms. Aycocke, who was not a decision-maker, is irrelevant, and maintains that the plaintiff cannot establish a causal link between her perceived disability and her termination.
In response, the plaintiff cites Dr. Robertson’s inquiry about disability insurance, suggesting recognition of a possible disability, and disputes a claim made by Dr. Coleman regarding her future blindness. Additionally, concerns about her vision raised by other CRNAs and Ms. Aycocke’s email noting significant eyesight issues are presented as evidence of how she was perceived. The plaintiff argues this evidence supports the claim that the perception of her vision was a "but for" cause of her termination.
The defendant refers to Sixth Circuit precedents, emphasizing that directing an employee to undergo a fitness for duty evaluation does not imply the employer regards the employee as disabled. In the case of Sullivan v. River Valley School District, the court determined that concerns about an employee's job performance, leading to a request for medical examinations, do not inherently indicate that the employer perceives the employee as having a substantial impairment affecting major life activities.
The Sixth Circuit upheld the Sullivan ruling in Pena v. City of Flushing, affirming that the expanded "regarded as" definition in the 2008 ADA amendments does not automatically imply that an employer's actions indicate an employee is regarded as disabled. The Court rejected the notion that an employer's referral for a fitness for duty examination, with knowledge of an employee's medical condition, constitutes a per se violation of the ADA. It emphasized that Congress allows such examinations if they are job-related and necessary for business. Therefore, the request for an objective assessment of the plaintiff's vision does not imply the defendant regarded her as disabled.
The determination of whether an employee is regarded as disabled largely depends on the employer's subjective mindset, making it challenging for plaintiffs to prove such claims. Mere awareness of an employee's health issues does not suffice to demonstrate that this knowledge influenced employment decisions. In this case, while the employer was aware of the plaintiff's vision issues, this knowledge alone does not establish that it was the basis for her termination.
Additionally, although the plaintiff submitted a draft performance evaluation that commented on her vision issues, the evaluation was incomplete and not finalized prior to her termination. The comments indicated concerns about her job performance related to her eyesight but did not suggest that the employer perceived her as disabled in her daily life. The evaluation's focus was on her ability to perform job functions rather than the broader implications of her impairment on her overall life, which is the critical factor in the "regarded as" analysis. Thus, the draft performance review does not provide evidence that the plaintiff was regarded as disabled.
Plaintiff cites Ms. Aycocke's email, which indicates her "major issues with her eyesight" were worsening, as evidence that the defendant regarded her as disabled. However, Ms. Aycocke authored the email independently and was not involved in the decision to terminate the plaintiff's employment. Therefore, her email cannot be deemed a statement by the employer regarding the plaintiff's perceived disability. Additionally, Dr. Robertson's inquiry about the plaintiff's disability insurance during an October 2015 meeting and the discussion of her vision at the termination meeting are presented as evidence supporting the claim that she was regarded as disabled. The defendant contends that while her vision was discussed, it was not a reason for her termination. The court acknowledges that these facts could satisfy the first prong of the prima facie case, suggesting that the plaintiff was regarded as disabled.
Regarding the causal connection between the perceived disability and the termination, the defendant argues that neither the October meeting nor the email establishes such a link. The plaintiff counters by highlighting the discussions about her vision impairment, while the defendant maintains that any surgical errors were due to clinical judgment, not her vision issues. The court finds that Dr. Robertson's belief that the plaintiff "might have a disability" and the acknowledgment of her vision impairment during the termination meeting provide sufficient evidence to suggest a factual question regarding the causal connection.
Once a prima facie case is established, the burden shifts to the defendant to provide a legitimate, non-discriminatory reason for the termination. The defendant argues that the plaintiff's lack of clinical skill and judgment, as evidenced by specific surgical incidents, justified her termination. Although the plaintiff does not dispute the legitimacy of these reasons, she claims they are a pretext for discrimination. The court agrees that the defendant has presented a legitimate reason for termination focused on patient safety. To survive summary judgment, the plaintiff needs only to demonstrate enough evidence to raise a genuine issue regarding whether the defendant's rationale is pretextual.
Plaintiff can establish pretext through three methods: demonstrating that the employer's given reasons lack factual basis, did not genuinely motivate the employer's decision, or were inadequate for the employer's actions. The Sixth Circuit emphasizes that assessing pretext should not be formulaic but should focus on whether the employer's stated reason for termination is credible. The central issue is whether the employer invented its reason to disguise discrimination. To prove pretext, a plaintiff must show that the employer's explanation is not the true reason for the adverse action and that the real reason is unlawful.
In this case, the plaintiff argues that the surgical incidents cited by the defendant do not sufficiently justify her termination, which relates to the third method of demonstrating pretext. She claims there are disputed facts surrounding both incidents and that inconsistencies, alongside discussions about her vision during the termination meeting, indicate pretext. The defendant counters that the termination was based on information available at the time, invoking the "honest belief" doctrine, and argues that discussing her vision does not imply dishonesty in their reasoning.
Specifically, regarding a fracture table surgery incident, the plaintiff asserts discrepancies in reports by Mr. Price, who incorrectly described the patient’s gender and confused two surgeries. She maintains that the surgery was successful despite its complexity and refutes claims of a "near fall." Furthermore, she highlights that Mr. Price later corrected his timeline regarding the incident. In the case of a robotic surgery, the plaintiff defends her actions by stating she did not administer a muscle relaxant before the robot was positioned, adhering to her standard practice. She also contends that the presence of patient twitches prior to surgery is acceptable and useful for monitoring anesthesia metabolism.
Plaintiff contends that the surgeon failed to request additional relaxation drugs for a patient, and previous records of her robotic surgeries faced no criticism. To establish a pretext for summary judgment, a defendant must demonstrate reasonable reliance on the facts available at the time of the employment decision, emphasizing the need for a reasonably informed decision before adverse action is taken. The court assesses whether the employer had an honestly held belief regarding the employee's conduct warranting termination and whether the decision was adequately informed. The plaintiff must provide evidence to dispute the employer's non-discriminatory rationale, rather than merely contesting the facts leading to her discharge.
At a January 2016 physicians’ meeting, several specific incidents were presented: Ms. Green observed a patient experiencing four twitches and immediately informed Dr. Luhn, who later confirmed the observation. Mr. Price reported an incident where a patient awoke prematurely due to the plaintiff reversing anesthetic too soon. Additionally, Dr. Apostoaei noted an error in medication documentation by the plaintiff. Concerns about the plaintiff's vision and ability to perform her duties safely had been raised by other CRNAs and hospital staff. Overall, the employer had documented evidence of the plaintiff's clinical mistakes and reported concerns regarding her competency, contributing to their decision to take adverse action against her.
Mr. Price's change in testimony regarding the timing of the fracture table surgery emerged during litigation and was not available to the physicians when making their decision about the plaintiff's clinical skills. The critical issue is whether the physicians believed the plaintiff lacked the judgment necessary for safe patient care based on their understanding at the time, rather than the exact timing of the surgery. The plaintiff's disagreements about when Dr. Luhn entered the surgery and the patient's reactions do not alter the physicians' perceptions. Despite disputing the reasons for her discharge, the plaintiff has not demonstrated that the physicians did not honestly believe in the facts that led to her termination. The evidence indicates that clinical errors, as understood at the time, justified the defendants' conclusion regarding her lack of clinical judgment, providing sufficient grounds for her dismissal. There is no indication that the termination was motivated by discrimination. Consequently, the plaintiff cannot prove that the reasons for her discharge were pretextual, warranting summary judgment in favor of the defendant. The court also addresses the plaintiff’s claims about her vision and the nature of the twitch monitor used in anesthesia. The dispute over the surgery's date has been settled as occurring in October 2015, with a report of the incident reaching the relevant physicians in early 2016. The court notes that the plaintiff must demonstrate that she was regarded as disabled in a broad range of jobs, not merely her position, but she has failed to provide such evidence.
