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Mahar v. Meharry Medical College

United States District Court, M.D. Tennessee, Nashville Division

December 18, 2017

DR. MONA MAHAR, Plaintiff,



         Dr. Mona Mahar (“Mahar”) brought this action against Meharry Medical College (“Meharry”) and Dr. Medhat Kalliny (“Kalliny”), pursuant to Title VII of the Civil Rights Act of 1964, the Tennessee Human Rights Act, and Tennessee common law, arising out of Mahar's experience during the first year residency program at Meharry and Meharry's decision not to renew Mahar's residency contract for a second year. (Doc. No. 1-4.) Before the Court is Defendants' Motion for Summary Judgment (Doc. No. 24); Plaintiff's Response in Opposition (Doc. No. 35); Defendants' Reply (Doc. No. 36); Defendants' Statement of Undisputed Material Facts (Doc. No. 26); Plaintiff's Response to Defendants' Statement of Undisputed Material Facts (Doc. No. 35-2); and numerous exhibits. The Motion is ripe for decision. For the following reasons, Defendants' motion will be GRANTED IN PART AND DENIED IN PART.


         A. Background

         Mahar received her medical degree from Baqai Medical College in 2002. (Doc. No. 27-1 at 8, 128-29.) Mahar did not practice between 2002 and 2014, choosing instead to help out at a family business. (Id. at 128.) In 2012, Mahar was an extern in Meharry's Psychiatry Department, (id. at 12), and, in 2013, she was a volunteer (id. at 13). In 2014, Meharry hired Mahar as a first year resident in its Department of Family and Community Medicine (the “Department”) under a one-year Postgraduate Physician Contract (the “PPC”). (Doc. No. 27-1, Ex. 49.)

         The PPC was effective for the term of July 1, 2014 to June 30, 2015. (Id.) In order for Mahar to continue into her second year of residency, the Department had to renew her employment contract. (Doc. No. 27-2 at 38-39.) Renewal of a resident's employment contract is not automatic; rather, it has to be renewed by Meharry based, in part, on evaluations of clinical performance. (Doc. No. 27-1, Ex. 49 at 4.) The PPC provided that the Department's faculty members “shall meet and review the postgraduate physician's evaluations and vote on the disposition of his/her status no later than the last working day of January of each academic year” and that “postgraduate physician shall be notified of the disposition of their status no later than the first working day of March of each academic year.” (Id. at 4-5.)

         During Mahar's year of residency at Meharry, Dr. Millard Collins was Interim Chair of the Department. (Doc. No. 27-2 at 7-8.) Collins was responsible for operational day-to-day activities of the Department, including overall supervision of the Residency Program. (Id. at 9.) Collins participated in Department meetings discussing resident performance. (Id. at 8.) As of November 1, 2014, Defendant Kalliny was the Associate Residency Program Director, reporting to Dr. Collins.[1] (Doc. No. 27-3 at 6.) In this role, Kalliny directed the day-to-day operations of the Residency Program, assigning Department faculty to residents, directly supervising residents, and working with residents on a daily basis. (Id.)

         Kalliny began working with Mahar during her first week of the Residency Program in July 2014. (Id. at 9.) Kalliny would interact with Mahar at least once a week as part of the Residency Program. (Id. at 14.) In addition, Mahar came to Kalliny's office three or four times to discuss her performance. Kalliny and the Department's Residency Program Coordinator, Stephani Glenn, have testified that, for each such meeting, Glenn was present. (Doc. No. 27-3 at 15; Doc. No. 27-4 at 1.)

         B. Mahar's Performance

         Mahar's residency included a different rotation each month. (Doc. No. 27-1 at 13-14.) From July through February 2015, Plaintiff participated in rotations external to the Department “core” residency, except for in November 2014. Mahar's evaluations for each of these rotations was generally the same - she performed satisfactorily or above average. (Id. at Exs. 13, 16, 17, 19, 20, 29.)

         In November 2014, Plaintiff's rotation was in the Department, and her evaluation by Kalliny listed very low marks across the board.[2] (Id. at 68-70, Ex. 18.) During that same time, Kalliny also conducted Mahar's milestone evaluation, and gave her low marks. (Id. at Ex. 39.) In early 2015, Meharry began to limit the patient procedures Mahar was permitted to perform. (Id. at 73.) When Mahar started her clinical rotations in March 2015, she was told by her supervising Department residents, Drs. Ashley Fields and Cyree Collier, that, in accordance with faculty directives, she would be given only one or two patients per day, and that she was prohibited from admitting or discharging patients, writing any orders, or performing any inpatient procedures. (Id. at 51-52, 55-56, 73, 94-95). On March 16, 2015, Mahar sent Kalliny an email inquiring about these limitations. (Id. at 93-94, Ex. 7). The next day, Kalliny confirmed that the limited number of patients Mahar was permitted to see was based on her performance. (Id., Ex. 37). On March 22, 2015, Mahar had a confrontation with Fields and Collier about her restrictions; Kalliny counseled Mahar by email. (Id. at 56-58.) Mahar apologized to Collier and Fields by email in April. (Id., Ex. 9.)

         In March 2015, Mahar began receiving a string of very poor evaluations. Mahar's resident advisor, Dr. Jayashee Nathan, gave Mahar low marks in her March 2015 evaluation. (Id. at 71, Ex. 21.) Nathan stated that she “didn't think [Mahar] will be able to care for patient without close supervision.” (Id.) Nathan submitted another evaluation in March, again with consistently low marks. (Id. at 73-74, Ex. 23.) Another faculty member in the Department, Dr. Vincent Morelli, submitted an evaluation of Mahar's performance dated March 16, 2015, also giving consistently below average marks. (Id. at 74-76, Ex. 24.) Kalliny's March 2015 evaluation of Mahar stated that she “lacks the fundamentals of medical knowledge and clinical skills. Lacks time management skills. Has been having a hard time to work [sic] as a team member. Lacks proper medical documentations. Lacks proper planning of management plan.” (Id., Ex. 25.) Department faculty member Dr. Tamika Pinn's March 2015 evaluation of Mahar concluded that “Dr. Mahar does not demonstrate skills or knowledge in order to be promoted to the 2nd year of Residency.” (Id., Ex. 26.) Around this time, Mahar was also criticized for poorly completing patient notes (by Pinn) and not timely completing hospital records (by Kalliny). (Id. at 85, Ex. 27; Id. at 47-48, Ex. 5.)

         Following discussions with Mahar about these negative evaluations and that Mahar did not believe she was being evaluated fairly, Collins looked into the evaluations. (Doc. No. 27-2 at 19-21.) Collins concluded that Mahar had problems with basic medical knowledge, communication and professionalism. (Id.) Collins believed that Mahar's file contained significant documentation indicating a failure to show up for assignments or complete tasks. (Id.) Collins had also developed the opinion that Mahar had difficulty managing patients independently. (Id. at 28.)

         C. The Disciplinary Meeting and Probation

         On March 25, 2015, Collins, Kalliny, Pinn, and Glenn met with Mahar to discuss her performance concerns (the “Disciplinary Meeting”). (Doc. No. 27-1 at 41-45.) At the Disciplinary Meeting, Mahar was told “[her] performance was not good.” (Id. at 43.) More specifically, the faculty leaders informed Mahar that she lacked performance in the following areas:

• Clinical skills and knowledge. Dr. Mahar lacks the fundamentals of clinical knowledge and understanding of basics of medicine (Failure of In-Service Exam; score of 200)
• Poor clinical performance in both inpatient and outpatient settings as determined by core faculty. Dr. Mahar was given the evaluations by Core Faculty that indicated unsatisfactory performance
• Inability to handle patient number that is appropriate to her level of training
• Cannot conduct a proper H&P exam
• Poor concentration during patient care that place[s] patient safety in jeopardy
• Poor conduct and professionalism
• Attendance (tardiness and no shows)
• EMR (notes) deficiencies in both inpatient and outpatient settings
• Prescription Errors (5 have been identified by Dr. Pinn). Dr. Pinn stated that she spent one (1) hour with Dr. Mahar teaching her to write a pediatric prescription and at this stage in her training she should already know these things
• Lacks professionalism and her attitude is unacceptable

(Id., Ex. 38.) Mahar refused to accept these criticisms. (Id.) Collins “informed Dr. Mahar that she should listen willingly and with an open mind to constructive criticism.” (Id.) Regarding the evaluations of core faculty versus outside faculty, Collins explained to Mahar that:

[C]ontinuation/promotion in a residency program is ultimately determined by the observations and evaluations by the Core Faculty of her behavior both clinically and professionally i.e. completion of notes, proper triage, interactions with patients, staff and other residents, following directions provided to her by her Attending or supervising senior residents, etc. A good evaluation in various rotations indicates that she passed requirements of a particular rotation, however, satisfactory/good performance in each of the core competency areas shape the total assessment by which the Program Director and core faculty determine her readiness and competency for promotion.

(Id.) Mahar was then informed by Kalliny and Collins that “[i]n looking and listening for patterns they feel Dr. Mahar cannot adequately manage multiple complex patients. She must know basics, complete documentation and know how to write prescriptions.” (Id.) Kalliny testified that he felt probation was the only option that remained to improve Mahar's performance. (Doc. No. 27-3 at 20.) Collins testified that “[b]ecause we were close to the time where we had to make critical decisions, we decided to put [Mahar] on a two-month probationary period with specific improvement areas that we wanted to see and that we would be tracking during that time.” (Doc. No. 27-2 at 29.)

         Collins, Kalliny and Pinn placed Mahar on the two-month probationary period. They informed Mahar that, “based on her performance during the probation period and adherence to the remediation plan, Mahar face[d] 1) possible extension of probation past the June 30th standard promotion date; 2) possibility of repeating [first year] of residency; or 3) termination from residency training in [the Department] @ Meharry.” (Doc. No. 27-1, Ex. 38.) They explained that Mahar was “expected to show marked improvement during this two-month probationary period as follows:

• Improve Clinical Knowledge and Clinical Skills (to be assessed by evaluations completed by Core Faculty)
• Charts must be completed within 24 hours (to be assessed by proof of documentation)
• Must demonstrate Ability to handle an appropriate number of patients
• Work cooperatively and professionally as a team member
• Improve Attendance (Tardiness and Absenteeism)
• Must undergo counseling and show proof of such. A professional assessment and/or recommendation will be required from the Counselor at end of probationary period.

(Id.) Mahar received a formal letter informing her that she was being placed on probation for two months and memorializing what had been discussed at the Disciplinary Meeting. (Id., Ex. 38.)

         Mahar signed the letter, noting that she “accept[ed] the terms of my probation and understand the areas of which I am expected to show improvement.” (Id.) During this same time frame, a fellow resident of Mahar, Dr. Isabella Uche, a female, was also placed on probation for a period of two months for deficient performance due to slow completion of records.[3] (Doc. No. 27-2 at 20-21.)

         D. Performance Evaluations While on Probation

         Mahar continued to receive negative evaluations. On March 30, 2015, Mahar received another negative evaluation from Pinn, noting that Mahar lacked accountability and would not accept feedback. (Doc. No. 27-1, Ex. 26.) In April 2015, Mahar had an inpatient pediatrics rotation at Vanderbilt University Medical Center (“VUMC”), during which she was supervised by VUMC attending physicians and upper level residents.[4] (Doc. No. 27-1 at 33.) On April 3, 2015, VUMC notified Glenn that Mahar had not shown up for her rotation, had not picked up her parking pass or pager, and could ...

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