NOT RECOMMENDED FOR PUBLICATION File Name: 26a0318n.06
No. 25-2154
UNITED STATES COURT OF APPEALS FOR THE SIXTH CIRCUIT
FILED Jul 20, 2026 ) JOSEPH CHRISTOPHE ISAAC KELLY L. STEPHENS, Clerk ROBITAILLE, ) ) Plaintiff-Appellant, ) ON APPEAL FROM THE UNITED ) STATES DISTRICT COURT FOR v. ) THE WESTERN DISTRICT OF ) MICHIGAN TRINITY HEALTH GRAND RAPIDS, ) Defendant-Appellee. ) OPINION )
Before: KETHLEDGE, NALBANDIAN, and HERMANDORFER, Circuit Judges.
HERMANDORFER, Circuit Judge. Trinity Health Grand Rapids Hospital suspended
Doctor Joseph Christophe Isaac Robitaille’s clinical privileges and conditioned their reinstatement
on a fitness-for-duty evaluation. Rather than submit to that evaluation, Robitaille sued. He alleged
that Trinity’s evaluation condition—and his continued suspension for refusing it—violated state
and federal law. The district court granted summary judgment to Trinity. We affirm.
I
Robitaille joined Trinity in 2022 under a three-year contract. In late 2023, after an
unplanned disruption of Trinity’s computer systems, Robitaille began pressing management to
adopt additional safety protocols for system outages. Tensions flared when Robitaille again raised
concerns about Trinity’s system-disruption preparedness during a December staff meeting.
According to attendees, Robitaille diverted the meeting’s topic, interrupted several colleagues, and No. 25-2154, Robitaille v. Trinity Health Grand Rapids
appeared agitated and frustrated. Trinity’s Chief Medical Officer, Doctor Brandon Francis, asked
Robitaille to “step outside,” but Robitaille refused. Robitaille Decl., R.79-1, PageID 1925.
After the meeting, Francis referred the matter to Trinity’s human-resources department.
That department investigated Robitaille’s conduct and determined that it did not align with hospital
standards. Around the same time, Trinity’s peer-review body, the Practitioner Excellence
Committee (Practitioner Committee), got involved. The Practitioner Committee is made up of
hospital staff. It is responsible for investigating physicians’ disruptive or unprofessional behavior
and for routinely reviewing treatment decisions to improve Trinity’s operations. After conducting
its own investigation of Robitaille’s recent conduct, the Practitioner Committee similarly
concluded that his professionalism fell short of hospital expectations.
Over the months that followed, Trinity’s staff reported still further concerns with both
Robitaille’s clinical performance and his interpersonal conduct. Coworkers observed that he
appeared increasingly hesitant to handle complex cases, refused to treat patients on several
occasions, struggled to manage his assigned rooms, and became increasingly guarded and
uncommunicative. One clinical supervisor reported that Robitaille was not providing the same
standard of care as other anesthesiologists and that several staff members were uncomfortable
working with him. Colleagues also described him as increasingly paranoid, citing instances where
he claimed that he was being watched or that Trinity’s administration was out to get him. To avoid
accusations of mishandling controlled substances, Robitaille would hold up medications to
operating room cameras. And he showed hesitancy to dispose of excess controlled substances
with other medical personnel.
Doctor Ashley Screws, the head of anesthesiology, communicated many of these concerns
to Francis. She stated that “Dr. Robitaille’s paranoia [was] affecting his ability to see patients and
2 No. 25-2154, Robitaille v. Trinity Health Grand Rapids
function as a member of [the] team” and that his behavior was “becoming quite burdensome” to
the department by forcing others to absorb his workload. Screws Email 2/5/24, R.72-26, PageID
1564.
As these concerns escalated, several of Robitaille’s clinical choices also came under
scrutiny by the Practitioner Committee. That committee sent Robitaille letters requesting
explanations for certain patient-care choices, including multiple instances in which he refused to
provide care. Robitaille responded to the first two requests with a brief email that referred the
Practitioner Committee to the patient’s file and accused it of making “assumptions regarding [his]
intentions.” Robitaille Email 2/6/24, R.72-20, PageID 1537. The record contains no response to
the next batch of requests.
Based on this pattern of conduct, and after an unsuccessful meeting with Robitaille, Screws
summarily suspended Robitaille’s clinical privileges in February 2024. On March 6, 2024, the
Medical Executive Committee (Executive Committee)—Trinity’s “clinical governing body,”
Screws Dep., R.72-5, PageID 1218, comprising various members of the medical staff, including
senior management, department chairs, and elected members—reviewed the suspension. Before
the review, Screws sent the Executive Committee members a summary of the concerns with
Robitaille’s clinical performance and his behavioral conflicts. After considering Screws’s report,
the Executive Committee voted to uphold Robitaille’s suspension based on his “disruptive
behavior adversely affecting the effective operation of the Hospital.” Executive Committee
Meeting Minutes 3/6/24, R.72-29, PageID 1574. The Executive Committee conditioned any
reconsideration of the suspension on Robitaille completing a fitness-for-duty examination that
included both drug testing and a forensic psychiatric evaluation.
3 No. 25-2154, Robitaille v. Trinity Health Grand Rapids
Robitaille took the drug test, which returned negative. But he refused the psychiatric
evaluation and thus remained suspended. In August 2024, when his current privileges were
already set to expire, Robitaille submitted a reappointment application. The Executive Committee
denied reappointment and explained that it could not adequately assess Robitaille’s ability to
provide satisfactory patient care without the psychiatric evaluation. Robitaille appealed the
Executive Committee’s decision through Trinity’s internal-review process. His three-year
employment contract expired in August 2025, and Trinity elected not to renew it.
While the internal-review process was pending, Robitaille obtained a right-to-sue letter
from the Equal Employment Opportunity Commission and initiated this suit, asserting claims
under the Americans with Disabilities Act (ADA) and state law. The district court granted Trinity
summary judgment on Robitaille’s ADA claims and declined supplemental jurisdiction over his
state-law claim. Robitaille timely appealed.
II
We review the district court’s grant of summary judgment de novo. Kroll v. White Lake
Ambulance Auth., 763 F.3d 619, 623 (6th Cir. 2014). We accept all the non-movant’s evidence as
true and draw all reasonable inferences in the non-movant’s favor. Id. But we need not accept
“bare” or “conclusory” allegations. Harbin-Bey v. Rutter, 420 F.3d 571, 580 (6th Cir. 2005)
(citation omitted). Rather, non-movants must “substantiate their theories” by “point[ing] to
record-based evidence.” Cahoo v. SAS Inst., Inc., 71 F.4th 401, 406 (6th Cir. 2023).
A
Robitaille claims that Trinity violated the ADA in two ways. First, he claims that the
fitness-for-duty examination was a prohibited medical inquiry under the ADA. Second, he
4 No. 25-2154, Robitaille v. Trinity Health Grand Rapids
contends that Trinity unlawfully retaliated against him when he refused the psychiatric test. We
reject both arguments.
We start with Robitaille’s challenge to the fitness-for-duty examination.
Under the ADA, a covered employer may not “require a medical examination” of an
employee unless it is both “job-related and consistent with business necessity.” 42 U.S.C.
§ 12112(d)(4)(A). The employer must show that the decision-maker who ordered the examination
formed “a reasonable belief based on objective evidence that the employee’s behavior threatens a
vital function of the business.” Kroll, 763 F.3d at 623. If so, the employer can “requir[e] mental
and physical exams as a precondition to” continued employment. Sullivan v. River Valley Sch.
Dist., 197 F.3d 804, 812 (6th Cir. 1999).
The statutory standard authorizing medical examinations can be met by performance- or
safety-based issues. On the performance side, an examination is proper if an employer has “a
reasonable basis” to believe that the employee is “unable to perform the essential functions of [his]
job.” Kroll, 763 F.3d at 624. Thus, when an employee’s “aberrant behavior” affects his “job
performance,” an employer may be justified in “ordering a mental examination.” Sullivan, 197
F.3d at 812. On the safety side, requests are proper if the employer has a “reasonable basis” to
believe that the employee “pose[s] a direct threat to [his] own safety or the safety of others.” Kroll,
763 F.3d at 624. Safety-based concerns carry particular weight in high-stress environments—like
hospitals—where “employees are in positions where they can do tremendous harm if they act
irrationally.” Id. at 626 (citation modified). In such settings, employers “may be justified in
requesting a psychological exam on slighter evidence than in other types of workplaces.” Id.
5 No. 25-2154, Robitaille v. Trinity Health Grand Rapids
The fitness-for-duty examination ordered by the Executive Committee included both a drug
test and a psychiatric evaluation. Though a test for illegal drug use “shall not be considered a
medical examination” for ADA purposes, 42 U.S.C. § 12114(d)(1), Trinity has not disputed that
the drug test it ordered triggers ADA protections. Because Trinity has not raised the issue, we
assume without deciding that the drug test went beyond illegal substances and could be categorized
as a medical examination. See Bates v. Dura Auto. Sys., Inc., 767 F.3d 566, 574 (6th Cir. 2014).
For the reasons below, we conclude that the Executive Committee had a reasonable basis,
grounded in objective evidence, to require both the drug-test and psychiatric component of the
examination.
At its March 6 meeting, the Executive Committee reviewed Screws’s summary report on
Robitaille’s performance issues and peculiar behavior. That report contained recaps of Screws’s
own experiences with and opinions of Robitaille’s performance as his department head. And it
included concerns from numerous other staff members. Robitaille does not contest that the
Executive Committee based its decision on Screws’s report. Nor does he offer any reason why
the Executive Committee should have doubted the report’s contents.
The clinical shortcomings Screws presented—Robitaille’s hesitation to perform routine
tasks, avoidance of higher-risk patients, and inability to handle the standard caseload—could all
cause a reasonable person to question whether Robitaille was “still capable of performing his job.”
Sullivan, 197 F.3d at 811. Likewise, Robitaille’s reported “aberrant behavior”—including
paranoid ideation and excessive risk-aversion—noticeably impaired his job performance by
causing inefficiencies and delays. Id. at 812. Because Robitaille practiced anesthesiology, these
performance concerns were inextricably linked with patient safety. Administering life-threatening
anesthetic agents is inherently high-stakes work where a single careless or “irrational[]” decision
6 No. 25-2154, Robitaille v. Trinity Health Grand Rapids
by Robitaille could “do tremendous harm” to patients in his care. Kroll, 763 F.3d at 626 (citation
modified).
The combination of documented performance shortfalls and behavioral red flags thus gave
the Executive Committee reasonable grounds to question both whether Robitaille was “still
capable of performing his job,” Sullivan, 197 F.3d at 811, and whether he “posed a direct threat”
to patient safety, Kroll, 763 F.3d at 624. Given the nature of these concerns, the Executive
Committee reasonably sought to rule out underlying impairments related to substance abuse or
mental health that could be hindering Robitaille’s fitness to practice. The decision to require the
medical examination was therefore both “job-related and consistent with business necessity.” 42
U.S.C. § 12112(d)(4)(A).
Robitaille’s counterarguments fail. At the outset, Robitaille contends that the district court
misapplied the summary judgment standard by accepting as true some of Screws’s allegations in
her report to the Executive Committee. But the district court did not rely on “the underlying truth”
of those allegations. Dist. Ct. Op., R.89, PageID 2757. Rather, it correctly identified that “the
relevant question is whether the [Executive Committee] had a ‘reasonable belief’ that a medical
exam was warranted.” Id. (quoting Kroll, 763 F.3d at 623). And it explained that “the underlying
truth of Screws’[s] claim does not impact whether the [Executive Committee] was reasonable in
relying on it.” Id. So the district court did not improperly assume the truth of Screws’s report.
Next, Robitaille argues that the district court erred by relying on a peer-review transcript
from Trinity’s internal appeals process, which took place in January 2025. Robitaille’s objection
is that Michigan law restricts the use of such records in litigation. See Mich. Comp. Laws
§ 333.20175(13). That argument also fails. Robitaille does not contest that the statute he cites
forms part of Michigan’s peer-review privilege regime, see Krusac v. Covenant Med. Ctr., Inc.,
7 No. 25-2154, Robitaille v. Trinity Health Grand Rapids
865 N.W.2d 908, 911 (Mich. 2015), and he agrees that privilege does not apply in this case, see
Fed. R. Evid. 501; Univ. of Pennsylvania v. E.E.O.C., 493 U.S. 182, 189 (1990). And indeed, in
an earlier round of motions practice, Robitaille successfully persuaded the district court that
“Michigan’s state law regarding the use and maintenance of patient records and the protection of
peer review documents” did not apply to this case. Resp. in Opp’n to Defs.’ Mot. to File Docs.
Under Seal, R.20, PageID 440. He then reversed course when opposing Trinity’s motion for
summary judgment, seeking to bar consideration of the internal-appeals-process documents. But
Robitaille fails to show that the district court’s rejection of his about-face constitutes an abuse of
discretion. See Griffin v. Finkbeiner, 689 F.3d 584, 592 (6th Cir. 2012); cf. Allied Erecting &
Dismantling Co. v. United States Steel Corp., 2023 WL 5322213, at *10 (6th Cir. Aug. 18, 2023).
Robitaille’s remaining contentions reframe the case to focus on the actions of one man:
Chief Medical Officer Francis. Robitaille asserts that circuit precedent requires a single decision-
maker in ADA medical-examination claims and that the district court thus erred in focusing on the
collective decision of the Executive Committee rather than Francis alone. According to Robitaille,
Francis ordered the fitness-for-duty examination as part of a crusade of retaliation kickstarted by
Robitaille’s patient advocacy during the December 2023 staff meeting. From here, Robitaille
asserts that all subsequent performance and safety concerns were pretext for Francis’s vendetta.
Robitaille then invokes agency principles to seek to hold Trinity liable for Francis’s actions.
Robitaille’s arguments stumble at each turn. To start, as Trinity points out, this focus on
Francis makes its first appearance on appeal. Before the district court, Robitaille never claimed
that Francis unilaterally drove the fitness-for-duty examination requirement. “As a general rule in
this Circuit, arguments raised for the first time on appeal are forfeited.” Kreipke v. Wayne State
Univ., 807 F.3d 768, 781 (6th Cir. 2015). We see no reason to deviate here.
8 No. 25-2154, Robitaille v. Trinity Health Grand Rapids
Aside from forfeiture, Robitaille faces several hurdles. His claim that medical-examination
decisions must be attributable to a single individual—not a collective body—imports a new
requirement into our caselaw. It’s true that past decisions have explained that “the individual who
decides to require a medical examination must have a reasonable belief based on objective
evidence that the employee’s behavior threatens a vital function of the business.” Kroll, 763 F.3d
at 623 (emphasis added). But that statement simply describes what it takes to form a “reasonable
belief.” Id. It does not restrict the medical-examination decision to a single individual. See
Painter v. Ill. Dep’t of Transp., 715 F. App’x 538, 543 (7th Cir. 2017) (order) (Kroll “cannot be
read as defining a rule of law that a single decision-maker must be readily identifiable”). To the
contrary, our caselaw recognizes that the ultimate choice may be made by a collective body. E.g.,
Sullivan, 197 F.3d at 809.
Nor are we convinced by Robitaille’s attempt to inject a pretext analysis into his ADA
medical-examination claim. For starters, our decision in Sullivan adopted the objective-evidence
standard for ADA medical-examination claims and held that “there is no need to assess an
employer’s intent in ordering a fitness-for-duty examination.” 197 F.3d at 813. Robitaille counters
that “more recent cases from this circuit show that a pretext analysis is allowed in medical
examination cases” and points us to Babb v Maryville Anesthesiologists PC, 942 F.3d 308 (6th
Cir. 2019). Robitaille Br. 54. Babb, though, evaluated whether an employer’s termination
decision was pretextual. 942 F.3d at 322-24. The plaintiff did not bring an ADA medical-
examination claim. So the opinion does not alter Sullivan’s approach to medical examinations.
Regardless, Robitaille could not prevail even if pretext were relevant. He maintains that
the medical-examination request was motivated solely by his patient advocacy in the December
staff meeting. But he fails to address the Executive Committee’s reliance on months’ worth of
9 No. 25-2154, Robitaille v. Trinity Health Grand Rapids
subsequent performance and behavior issues as well as Robitaille’s failure to cooperate with the
Practitioner Committee. Those issues, as mentioned, provided an intervening, non-retaliatory
basis for the Executive Committee to order the medical examination. See Wasek v. Arrow Energy
Servs., Inc., 682 F.3d 463, 472 (6th Cir. 2012).
Robitaille counters that the record is disputed as to whether these performance issues in
fact occurred and the nature of his explanation for the cited instances. Robitaille insists that he
“responded to all of [the requests], explaining the reasons for his actions” and claims that those
“responses were ignored.” Robitaille Br. 50. But he admitted in a peer-review hearing that he
never responded. His brief does not address this inconsistency, and none of the documents he cites
suggests that he responded to the Practitioner Committee’s requests. It is Robitaille’s obligation
to provide the record support for his factual assertions. Fed. R. App. P. 28(a); cf. Cahoo, 71 F.4th
at 406. Because he failed to do so, we do not accept his unsupported assertions as true for purposes
of assessing pretext.
Finally, Robitaille gestures towards a shifting-rationales argument for showing pretext. On
this front, he claims that “the most compelling evidence supporting [his] ADA medical
examination claim” is that Trinity listed “disruptive behavior” as the rationale for his suspension,
not “paranoia.” Robitaille Br. 40 (citation modified). In Robitaille’s view, disruptive behavior
would not “necessitate intervention by a psychiatrist” whereas paranoia would. Id. So he sees
Trinity’s current focus on paranoia as a post-hoc justification for the psychiatric exam. But we
reject Robitaille’s premise that there’s any “shift[]” in these concepts. Id. at 43. Rather, paranoid
behavior can be disruptive, as the record in this case bears out: Multiple staff members and the
Executive Committee itself characterized Robitaille’s odd behavior as “disruptive,” Executive
Committee Meeting Minutes 3/6/24, R.72-29, PageID 1574, “burdensome,” Screws Email 2/5/24,
10 No. 25-2154, Robitaille v. Trinity Health Grand Rapids
R.72-26, PageID 1564, causing “issues/delays,” Forzley Email 1/31/24, R.72-23, PageID 1549,
and resulting in “in-efficiency [sic] and delays” in hospital operations, Screws Summary, R.72-18,
PageID 1534.
For the foregoing reasons, we affirm the district court’s grant of summary judgment to
Trinity on Robitaille’s medical-evaluation claim. Because this ground alone warrants affirmance,
we do not address Trinity’s other arguments in favor of summary judgment.
We next address Robitaille’s ADA-retaliation claim.
The ADA prohibits discrimination “against any individual because such individual has
opposed any act or practice made unlawful by this chapter.” 42 U.S.C. § 12203(a). To establish
retaliation, Robitaille must demonstrate “(1) that he engaged in protected activity; (2) that he
suffered adverse employment action; and (3) that a causal connection existed between the
protected activity and the adverse action.” Penny v. United Parcel Serv., 128 F.3d 408, 417 (6th
Cir. 1997). Robitaille’s retaliation claim fails at the first element.
All along, Robitaille has treated his retaliation claim as coterminous with his medical-
examination claim. He asserts that he had “a reasonable belief that Trinity acted unlawfully” for
the same reasons his medical-examination claim should survive. Robitaille Br. 59. So he argues
that refusing to take the psychiatric examination was per se protected activity. But, as discussed,
Trinity’s request did not violate the ADA, and Robitaille offers no other arguments that his
opposition was reasonable and grounded in good faith. Cf. Sullivan, 197 F.3d at 814. Robitaille’s
argument that he engaged in protected activity therefore fails.
We affirm the district court’s grant of summary judgment to Trinity on the retaliation claim.
11 No. 25-2154, Robitaille v. Trinity Health Grand Rapids
B
Finally, Robitaille appeals the dismissal of his state-law wrongful discharge claim. He
does not argue that the district court abused its discretion in declining supplemental jurisdiction.
See 28 U.S.C. § 1367(c)(3); Gamel v. City of Cincinnati, 625 F.3d 949, 951-52 (6th Cir. 2010).
He asks only that we reinstate the state-law claim if we reverse the district court’s grant of
summary judgment on either of his federal-law claims. Because we affirm the district court on
both, we also affirm its decision to decline supplemental jurisdiction.
* * *
We affirm the judgment of the district court.