Jokich v. Rush University Medical Center

District Court, N.D. Illinois·Decided August 9, 2021·No. 1:18-cv-07885·Unknown

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF ILLINOIS EASTERN DIVISION

PETER JOKICH, M.D., FSBI, FACR, ) ) Plaintiff, ) ) v. ) Case No. 18 C 7885 ) RUSH UNIVERSITY MEDICAL CENTER, ) Judge Joan H. Lefkow ) Defendant. )

OPINION AND ORDER

Peter Jokich, M.D., asserts claims for breach of contract based on his employment agreements (Counts IV and VI of First Amended Complaint) and the Rush Medical Staff Bylaws (Count V). Before the court is Rush’s motion for summary judgment on these1 claims. For the following reasons, the motion is granted. BACKGROUND2

Rush is a not-for-profit tax-exempt corporation whose governing Board of Trustees conducts business through roughly a dozen standing committees, including a Compensation and Human Resources Committee. (For purposes of this decision this committee may be referred to as “the Board” as well as the “Comp Committee.”) The Comp Committee reviews contracts for highly paid physicians.

1 In an Opinion and Order entered on May 11, 2021 (dkt. 172), the court granted summary judgment in favor of Rush on Jokich’s federal claims, relinquished jurisdiction over the state law claims, and entered final judgment in favor of Rush. Jokich moved to alter or amend the judgment, asking the court to retain jurisdiction over the state law claims because he is procedurally barred from refiling in the Illinois courts. The motion was granted. Those claims are the subject of this document.

2 The disputed facts in this Background section are stated in a light favorable to Jokich. The procedures and legal standards for summary judgment motions are set out in the May 11, 2021 Opinion. From 2001 until his termination, Jokich was employed by Rush in the Division of Breast Imaging (the DBI). By 2017, he was Director of the DBI. Throughout the years, Jokich, along with other faculty, had standard employment agreements with Rush. Beginning in 2012, Rush initiated the “Faculty Employment Agreement” (FEA) for its physicians. The FEA was a

standard “evergreen” contract that renewed annually unless either party gave 120 days advance written notice of termination. The FEA covered base compensation and standard benefits. In 2001, 2007, and 2013–14 (Jokich signed this letter on January 24, 2014), Jokich negotiated additional agreements providing multi-year terms. The terms were set out in an offer letter from Rush to Jokich, which upon Jokich’s signature of acceptance became what is referred to as a “letter agreement.” The 2001 letter agreement was for a seven-year term. The 2007 letter agreement was for a four-year term. In 2013–14, the term was three years, ending June 30, 2016. The 2013–14 letter agreement specified that Rush would begin discussions at the beginning of the third year (July 1, 2015) regarding a further extension. The various letter agreements included bonuses and

enhanced benefits for the DBI physicians and for Jokich that were not included in the FEA. Rush consults Sullivan, Cotter & Associates to advise the Comp Committee. According to Sullivan Cotter, anti-kickback laws require that financial relationships between tax-exempt institutions and physicians be fair market value and commercially reasonable. If not, the institution can incur treble-damage penalties. Sullivan Cotter uses a three-step test to judge whether compensation is fair market value. First, if proposed compensation for a physician within his or her specialty is at the 75th percentile or below by national standards, it will opine, absent unusual circumstances, that compensation is fair market value. Second, if the compensation is above the 75th percentile, there must be a strong relationship between pay and the physician’s clinical productivity. Third, if the physician’s compensation fails the first or second test, Sullivan Cotter offers no fair market value opinion and tells Rush it must present “business judgment factors” for the Board to decide whether the proposed compensation is a sound business judgment.

Because of these rules, Rush management’s policy is that any proposed contract whose compensation is over the 75th percentile may be submitted to the Comp Committee for approval, while anything over the 90th percentile must be submitted to it. Sullivan Cotter uses “Work Relative Value Units” (RVUs) to measure productivity. It considers this metric the “industry standard.”3 Rush tracks RVUs of its employed physicians4 and uses them to determine significant parts of their compensation and to judge their performance. Rush also assigns each a “Full Time Equivalent” percentage (FTE), i.e., the percentage of full time the physician is supposedly spending treating patients. Other things being equal, a lower FTE would lead to a lower expectation on what number of RVUs is expected from a given clinician.

Although, according to Sullivan Cotter, Jokich’s compensation in the 2013–14 letter agreement exceeded the benchmark at the 95th percentile by national standards and his productivity level was below 10 percent by those standards, Rush management argued to the Comp Committee that its “business rationale … was highly supportive of [Jokich’s] compensation level.” The Comp Committee approved it and informed Jokich that the three-year letter agreement had been approved. That letter agreement included the statement, “As you are

3 Jokich disputes this statement as self-serving and undocumented as a policy or industry standard. This is not a material fact. There is no dispute that these rules were imposed on Jokich.

4 Jokich disputes that this practice is universal, but he offers no evidence to the contrary. aware, your total achievable compensation benchmarks above the 90th percentile and has been approved by the Board.” During the seven-month period between June 30, 2013 and January 24, 2014, a period from when the previous letter agreement had expired and until a new letter agreement was signed

by Jokich, Rush did not change Jokich’s salary and benefits or the benefits for the breast imaging faculty that had been part of the 2013–14 letter agreement. In January 2016, Dr. Ranga Krishnan, Dean of the Medical College, sent Jokich a proposed two-year letter agreement which stated that its proposed compensation arrangement “will have to be approved by the Compensation Committee of the Board of Trustees.” On August 12, 2016, Krishnan and Jokich signed a letter agreement keeping him as Director of the DBI through at least June 30, 2020. The letter was different in some respects from the January letter, but it contained the sentence about approval by the Comp Committee of the Board of Trustees. Management submitted the signed August 12, 2016 letter agreement to the Comp

Committee for approval. At its meeting of October 21, 2016, based on advice from Sullivan Cotter, the Comp Committee declined to approve the agreement, asking management to develop and embed pre-determined qualitative metrics into the contract for further Comp Committee review. Thereafter, management and Jokich engaged in negotiations in efforts to reach an agreement that would be acceptable to the Comp Committee. Management insisted that the agreement would have to include productivity metrics according to Sullivan Cotter’s recommendations.5 These negotiations continued into April, 2017, but Jokich would not agree to any of Rush’s proposed metrics. On April 19, 2017, after further discussions within management, Krishnan authorized Dr. Antonio Bianco, then president of the practice group of employed Rush physicians, to send

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