United States Court of Appeals For the First Circuit
No. 24-1832
J.S.H., in her individual capacity, and as legal guardian and on behalf of a minor child known as G.H.,
Plaintiff, Appellant,
v.
ALICE NEWTON; MASSACHUSETTS GENERAL HOSPITAL,
Defendants, Appellees.
APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MASSACHUSETTS
[Hon. Margaret R. Guzman, U.S. District Judge]
Before
Montecalvo, Kayatta, and Rikelman, Circuit Judges.
Luke Rosseel, with whom Rosseel Law, John T. Martin, Michaela Weaver, and Sullivan & Sullivan, LLP were on brief, for appellant.
Christine D. Cooledge, with whom John D. Cassidy, Madeline P. Poole, and Ficksman & Conley, LLP were on brief, for appellee Alice Newton.
Emily A. Moellers, with whom Daniel E. Murphy and Faggiano & Associates, P.C. were on brief, for appellee Massachusetts General Hospital. January 14, 2026
- 2 - RIKELMAN, Circuit Judge. This tragic case concerns
G.H., a child who suffered from debilitating medical conditions
that required extensive treatment throughout his short life.
During G.H.'s treatment in 2018, Dr. Alice Newton, a specialist at
Massachusetts General Hospital (MGH), reported suspected medical
child abuse of G.H. by his mother, J.S.H. After an investigation,
that report was deemed unsubstantiated. Several years later,
J.S.H. filed this lawsuit against Dr. Newton and MGH, bringing
state-law emotional distress claims and federal claims, including
a disability discrimination claim against MGH under Section 504 of
the Rehabilitation Act of 1973, 29 U.S.C. § 794(a). The district
court granted summary judgment to Dr. Newton and MGH, concluding
that J.S.H. had failed to offer enough facts to send the case to
trial. We agree with the district court's ruling and thus affirm.
I. BACKGROUND
A. Relevant Facts1
In 2011, J.S.H.'s daughter died at the age of four from
a mitochondrial disorder, a long-term, often genetic disorder that
adversely affects the body's mitochondria but is difficult to
In reviewing the district court's summary judgment ruling, 1
we recount the facts in the record in the light most favorable to J.S.H. and G.H., drawing all reasonable inferences in their favor. See Appleton v. Nat'l Union Fire Ins. Co. of Pittsburgh, 145 F.4th 177, 181 (1st Cir. 2025) (citing Sutherland v. Peterson's Oil Serv., Inc., 126 F.4th 728, 734 (1st Cir. 2025)).
- 3 - diagnose.2 Her daughter had been receiving treatment at Boston
Children's Hospital, and because of the "complex and frustrating
nature" of the disorder, the hospital conducted an internal ethics
review to evaluate the parents' and medical team's actions. In
the end, the ethics review concluded that both the parents and
medical team had acted appropriately.
Shortly after J.S.H.'s daughter died, her son, G.H.,
also began exhibiting concerning health symptoms, and the family
once again sought care at Boston Children's Hospital. Among other
symptoms, G.H. had poor muscle tone and needed medical assistance
to oxygenate and receive nourishment. As a result, G.H. required
extensive, ongoing treatment and specialized services from a team
of highly skilled medical providers. His clinical team came to
suspect that he, like his sister, suffered from a mitochondrial
disorder. G.H. continued to suffer from this "complex
constellation of multi-systemic symptoms" for most of his life.
Ultimately, there was "no unifying or confirmed diagnosis" that
fully explained his condition.
When G.H. began treatment at Boston Children's Hospital,
Dr. Newton was the head of the hospital's child protection team.
In that role, she became familiar with both G.H. and J.S.H.
2 J.S.H. relies on and cites to allegations in the amended complaint in setting out certain background facts. We recite these facts as if they were part of the summary judgment record, given that the defendants do not dispute them.
- 4 - Dr. Newton's position at Boston Children's Hospital rendered her
a "mandated reporter" of suspected child abuse under Massachusetts
law. Mass. Gen. Laws ch. 119, § 51A(a). As a mandated reporter,
she was legally obligated to file a "51A report" with the
Massachusetts Department of Children and Families (DCF) if she had
"reasonable cause to believe that a child [was] suffering physical
or emotional injury resulting from . . . abuse inflicted upon him
which cause[d] harm or substantial risk of harm to the child's
health or welfare."3 Id.
In November 2011, Dr. Newton filed a 51A report about
G.H. with DCF, alleging medical child abuse4 based on her suspicion
that J.S.H. had been misrepresenting G.H.'s health status to his
pediatrician. As grounds for the report, Dr. Newton cited what
she viewed as inconsistencies between J.S.H.'s descriptions of
G.H.'s health and G.H.'s behavior and level of functioning during
We cite to the language of the statute as it existed at the 3
time of the relevant events in this case. Medical child abuse, also known as "Munchausen syndrome by 4
proxy," involves a person, typically a parent, who "fabricates or exaggerates illnesses or physical ailments suffered by another person, typically the child of [that parent]." In re Adoption of Willamina, 881 N.E.2d 771, 772 n.3 (Mass. App. Ct. 2008). "Its effect on the cared-for individual results from the obstacles it creates for health care providers striving to identify the cared-for individual's nonexistent illness, thereby making the matter worse." N.J. Dep't of Child. & Fams. v. L.O., 213 A.3d 187, 189 n.1 (N.J. Super. Ct. App. Div. 2019) (citing medical dictionaries).
- 5 - his hospital stays. At the time, G.H. was three years old. DCF
ultimately determined that the report was unsubstantiated.
After Dr. Newton filed the 51A report, J.S.H. switched
G.H.'s care from Boston Children's Hospital to Tufts Medical
Center. The parties agree that from 2011 until August 2018, Dr.
Newton did not have any contact with J.S.H. or G.H. Nevertheless,
DCF received additional 51A reports about G.H. during that period,
although the parties have not pointed to anything in the record
that indicates who made such reports. DCF determined that those
additional reports were also unsubstantiated.
In the time period between Dr. Newton's initial 51A
report in 2011 and the events that led to this lawsuit, Dr. Newton
switched employers. In 2013, she became the Medical Director of
the Child Protection Program at MGH. The MGH Child Protection
Program specializes in identifying and responding to suspected
child abuse and provides children's medical providers with
information related to suspected child abuse. In her role at MGH,
Dr. Newton continued to be a mandated reporter of suspected child
abuse under Massachusetts law. See id.
In July 2018, J.S.H. was identified as a witness in an
unrelated state court trial against Dr. Newton. According to
J.S.H., although she ultimately did not participate in the trial,
she intended to testify that Dr. Newton had made unfounded
- 6 - allegations of child abuse against parents of children with complex
medical conditions.5
In August 2018, G.H. was receiving treatment from Dr.
Susan Goode, a medical provider affiliated with MGH. J.S.H.
contends that Dr. Newton contacted Dr. Goode, unprompted, soon
after learning that Dr. Goode was treating G.H. Allegedly, this
contact came just weeks after J.S.H. was identified as a witness
against Dr. Newton. Although Dr. Newton was not part of G.H.'s
medical team at the time, she reviewed G.H.'s medical record at
MGH that was available to her. In her view, that record reinforced
her prior concerns of suspected medical child abuse.
After reviewing G.H.'s medical record at MGH, Dr. Newton
documented her findings, as well as her renewed concerns of medical
child abuse, in G.H.'s MGH medical chart. She then copied G.H.'s
known providers on her medical note, dated September 6, 2018, which
relayed her suspicions of abuse.6 In the note, Dr. Newton claimed
that J.S.H. had "exaggerated [G.H.'s] symptoms" "[t]hroughout his
5The parties dispute whether Dr. Newton was aware that J.S.H. was identified as a witness in the unrelated state court trial before Dr. Newton ultimately filed another 51A report about G.H. in September 2018. 6 Dr. Newton maintains, but J.S.H. disputes, that Dr. Goode agreed to a consultation by the Child Protection Program at MGH. During discovery, however, Dr. Newton acknowledged that Dr. Goode has subsequently denied requesting any such consultation. Dr. Goode was not deposed and did not submit a declaration in this case.
- 7 - life" and "sought invasive testing and surgical procedures which
were not clearly clinically indicated and which were both painful
and harmful."
On September 10, 2018, Dr. Newton filed another 51A
report with DCF, again alleging suspected medical child abuse of
G.H. An investigation followed, which included home visits with
G.H., as well as interviews with J.S.H., Dr. Newton, and G.H.'s
MGH medical team, and a review of G.H.'s medical record.
At the end of DCF's investigation, the agency again
concluded that the allegations of medical child abuse were
unsubstantiated. The final investigative report stated:
Multiple letters were provided to [DCF] from other medical providers working with the family. Concerns were raised that [Dr. Newton] was filing a report against the family after not being a part of his medical care since 2011.
In speaking with . . . medical doctors, specialist [sic], in home medical providers, therapists and more[,] none reported any concerns for Medical Child Abuse, or even neglect of the child by the parents. All . . . report[] that the mother is appropriate and advocates for her son[']s medical care. [They] expressed significant frustration with [Dr. Newton's] allegations, given that she has not been involved in the child's care for many years. . . .
[T]here are no indications of Medical Child Abuse from any of the medical team. There are currently no concerns for Medical Child Abuse by the parents.
- 8 - G.H. passed away on May 8, 2024, during the course of
this litigation.
B. Procedural History
J.S.H. filed this lawsuit on behalf of herself and G.H.
in 2021. The nine-count amended complaint included both
Massachusetts state-law claims and federal claims. In particular,
J.S.H. alleged that Dr. Newton's conduct in the summer of 2018,
including her medical note to G.H.'s medical providers, caused
J.S.H. and G.H. emotional distress and led to a loss of medical
treatment by G.H.
After J.S.H. voluntarily dismissed certain claims in the
complaint, and the district court granted the defendants' motion
to dismiss others, the parties proceeded to discovery on five
claims. These included the state-law emotional distress claims
against Dr. Newton and the Section 504 disability discrimination
claim against MGH.
Before discovery ended, Dr. Newton and MGH moved for
summary judgment on the remaining five claims, and the district
court granted their motions. As part of her opposition to the
motions, J.S.H. submitted an affidavit describing the distress and
physical symptoms that she had experienced as a result of Dr.
Newton's actions, including "sleeplessness, anxiety, nightmares,
fatigue, and headaches on a weekly basis, occurring multiple times
a week."
- 9 - The district court determined that J.S.H. had failed to
put forward enough facts to bring the case to a jury. In so
ruling, the court declined to consider J.S.H.'s affidavit
submitted in opposition to the defendants' summary judgment
motions, concluding that it was untimely.
J.S.H. timely appealed. She continues to pursue claims
on her own behalf and on behalf of the estate of G.H.
II. STANDARD OF REVIEW
We review de novo the district court's grant of summary
judgment to Dr. Newton and MGH, "scrutiniz[ing] the facts in the
light most agreeable" to J.S.H. and G.H. as the nonmoving parties
and drawing all reasonable inferences in their favor. Cruz-Cedeño
v. Vega-Moral, 150 F.4th 1, 5 (1st Cir. 2025) (alteration in
original) (quoting Klunder v. Brown Univ., 778 F.3d 24, 30 (1st
Cir. 2015)). We are mindful that the role of summary judgment is
"to pierce the pleadings and to assess the proof in order to see
whether there is a genuine need for trial." Burt v. Bd. of Trs.
of Univ. of R.I., 84 F.4th 42, 59 (1st Cir. 2023) (quoting Garside
v. Osco Drug, Inc., 895 F.2d 46, 50 (1st Cir. 1990)). Thus, once
Dr. Newton and MGH "start[ed] the ball rolling" by filing properly
supported summary judgment motions, J.S.H. was obligated to come
forward with enough evidence to support her and G.H.'s claims such
that a reasonable factfinder could decide in their favor. Id.
- 10 - In evaluating the district court's ruling, we may affirm
on alternative grounds, including any ground apparent from the
record. See Rodrique v. Hearst Commc'ns, Inc., 126 F.4th 85, 90
(1st Cir. 2025). Ultimately, we can uphold the grant of summary
judgment only if the record "discloses that there is no genuine
issue as to any material fact" and Dr. Newton and MGH are "entitled
to judgment as a matter of law." Cruz-Cedeño, 150 F.4th at 5
(quoting Klunder, 778 F.3d at 30).
III. DISCUSSION
J.S.H. challenges the district court's summary judgment
ruling on four claims: her claim for negligent infliction of
emotional distress (NIED) against Dr. Newton, both her and G.H.'s
claims for intentional infliction of emotional distress (IIED)
against Dr. Newton, and G.H.'s Section 504 claim against MGH.7 The
crux of the parties' dispute is whether J.S.H. and G.H. presented
sufficient evidence to withstand summary judgment. On the record
before us, we agree with the district court that they did not.
A. J.S.H.'s NIED Claim
The district court held that J.S.H. did not put forward
enough evidence to create a triable issue on two elements of her
7J.S.H. does not appeal the district court's ruling rejecting G.H.'s NIED claim. Rather, she "concedes that there was insufficient evidence of G.H. experiencing physical manifestations of his emotional distress" for this claim to withstand summary judgment.
- 11 - NIED claim: emotional distress and physical harm. We affirm the
district court's ruling but on the alternative ground urged by Dr.
Newton. We conclude that J.S.H. needed to present expert evidence
to prove another element of her NIED claim -- negligence -- but
failed to do so.
To recover for NIED under Massachusetts law, J.S.H.
needed to "prove '(1) negligence; (2) emotional distress;
(3) causation; (4) physical harm manifested by objective
symptomatology; and (5) that a reasonable person would have
suffered emotional distress under the circumstances of the case.'"
Lanier v. President & Fellows of Harvard Coll., 191 N.E.3d 1063,
1072 (Mass. 2022) (quoting Payton v. Abbott Labs., 437 N.E.2d 171,
181 (Mass. 1982)). To establish the first element, negligence,
J.S.H. was required to show that Dr. Newton both "owed a duty" to
her and breached that duty by "fail[ing] to exercise reasonable
care." Id. at 1073.
To recap, as a mandated reporter of child abuse under
Massachusetts law, Dr. Newton had a legal obligation to file a 51A
report with DCF if she reasonably believed that J.S.H. was abusing
G.H. See Mass. Gen. Laws ch. 119, § 51A(a). At oral argument,
J.S.H. conceded that her NIED claim against Dr. Newton would fail
if Dr. Newton reasonably concluded that J.S.H. had put G.H. at
risk, thus triggering Dr. Newton's duty to report the suspected
abuse. J.S.H. also conceded that a jury might require expert
- 12 - testimony to determine whether Dr. Newton's medical judgment
regarding whether to make a report was reasonable under the
circumstances.
We hold that, even if Dr. Newton owed a duty of care to
J.S.H., expert testimony was required to establish whether Dr.
Newton breached any such duty. To be sure, as J.S.H. points out,
expert medical testimony is generally required for claims of
medical negligence that involve a doctor-patient relationship, and
there was no such relationship between Dr. Newton and J.S.H. But
Massachusetts law also recognizes that expert testimony may be
needed when a jury is required to decide issues outside the
ordinary experience of a layperson. See LeBlanc v. Logan Hilton
Joint Venture, 974 N.E.2d 34, 44 (Mass. 2012) ("We generally
require expert testimony because 'laymen, including the
jury, . . . could not be, and are not, in a position to
determine . . . the requirements of professional conduct' in the
relevant circumstances." (second omission in original) (quoting
Haggerty v. McCarthy, 181 N.E.2d 562, 566 (Mass. 1962))); cf. Silva
v. Norfolk & Dedham Mut. Fire Ins. Co., 75 N.E.3d 1132, 1138 (Mass.
App. Ct. 2017) ("The test for determining whether a particular
matter is a proper one for expert testimony is whether the
testimony will assist the jury in understanding issues of fact
beyond their common experience." (quoting Herbert A. Sullivan,
Inc. v. Utica Mut. Ins. Co., 788 N.E.2d 522, 536 (Mass. 2003))).
- 13 - Indeed, because all professionals "are expected to exercise 'that
skill and judgment which can be reasonably expected from similarly
situated'" individuals in their field, "[e]xpert testimony is
generally needed to establish th[e] professional standard of care"
owed even to "third parties." LeBlanc, 974 N.E.2d at 43-44
(quoting Klein v. Catalano, 437 N.E.2d 514, 525 (Mass. 1982)).
Here, the critical question is whether Dr. Newton acted
negligently in submitting a 51A report about G.H. And the answer
to that question depends on the standard of care for a mandated
reporter of medical child abuse, including what factual
circumstances would trigger a statutory obligation to report such
suspected abuse. Those issues are fundamentally medical
questions, even though they are not strictly questions of medical
malpractice. And under Massachusetts law, expert testimony is
ordinarily required for a plaintiff to prove that a health-care
professional deviated from the standard of care for their specialty
in exercising medical judgment. See Earley v. Slavin, 190 N.E.3d
538, 542 (Mass. App. Ct. 2022) (explaining that for a claim
"aris[ing] from [the defendant's] 'exercise of medical
judgment' . . . the plaintiff would be obliged to prove, among
other things, that the defendant deviated from the applicable
standard of care, which ordinarily would require expert testimony"
(citing Palandjian v. Foster, 842 N.E.2d 916, 921 (Mass. 2006)));
cf. Zaleskas v. Brigham & Women's Hosp., 141 N.E.3d 927, 942 (Mass.
- 14 - App. Ct. 2020) ("The standard of care [in the medical context] is
'what the average qualified [health care provider] would do in a
particular situation.' Expert testimony is generally required to
prove medical malpractice." (second alteration in original)
(citation omitted) (quoting Palandjian, 842 N.E.2d at 921)).
In opposing summary judgment, however, J.S.H. did not
offer any expert's opinion on the standard of care that would have
applied to Dr. Newton's decision about whether to file a report of
suspected medical child abuse. Nor did she introduce any expert
testimony on whether and how Dr. Newton may have breached that
standard of care.
To support her NIED claim, J.S.H. did point to testimony
by some of G.H.'s medical providers that they had no concerns about
medical child abuse. The record also reflects that several of
these providers commented on what they viewed as the unprecedented
and "unwarranted" nature of Dr. Newton's actions in September 2018.
For example, these providers questioned Dr. Newton's decision to
place a note about suspected medical child abuse into G.H.'s
medical record even though she had not interacted with him in years
and then distribute that note to his treating physicians. One of
G.H.'s medical providers referred to these actions by Dr. Newton
as a serious "invasion of . . . privacy." And the testimony by
other medical providers who treated G.H., including his primary
care physician, that they did not have any concerns about medical
- 15 - child abuse was certainly relevant to and supported J.S.H.'s
claims.
Nevertheless, these statements by G.H.'s treating
physicians did not address the standard of care for reporting
suspected medical child abuse or whether Dr. Newton's conduct
violated that standard. Nor is it apparent from the record that
any of these physicians were specialists in medical child abuse
such that they could offer an opinion on when such reports would
be reasonable. And, as we have discussed, there generally must be
expert testimony to establish that a physician failed to meet the
relevant professional standard of care. Cf. Bellmar v. Moore, 253
N.E.3d 1224, 1227, 1231 (Mass. 2025) (concluding that a genuine
dispute of material fact arose based on expert witness testimony
that a medical provider's care "deviated from common accepted
practice and fell below the standard of care expected of the
average qualified doctor" (emphases added)). Thus, we must
conclude that there was not enough evidence in the record to create
a triable issue on the first element of J.S.H.'s NIED
claim -- negligence -- and that summary judgment was appropriate
on this claim.
Given our holding, we do not address the parties'
arguments about whether J.S.H. created a genuine dispute of
material fact about other elements of her claim, such as emotional
distress and physical harm, including whether her affidavit
- 16 - describing such distress and harm was timely. In concluding that
we need not decide these issues, we cast no doubt on the emotional
distress that a parent would experience from being accused of
abusing their child.
B. J.S.H.'s IIED Claim
Next, J.S.H. challenges the district court's ruling
rejecting her IIED claim against Dr. Newton. The court concluded
that J.S.H. did not create a triable issue on two elements of this
claim: that Dr. Newton's conduct was "extreme and outrageous" and
that J.S.H. suffered "severe" emotional distress. We agree that
J.S.H. failed to create a genuine dispute of material fact about
the "extreme and outrageous" element of this claim.
To sustain an IIED claim under Massachusetts law, J.S.H.
was required to show that (1) Dr. Newton "intended to cause, or
should have known that [her] conduct would cause, emotional
distress"; (2) Dr. Newton's conduct was "extreme and outrageous";
(3) her conduct caused J.S.H.'s distress; and (4) J.S.H. suffered
"severe distress." Roman v. Trs. of Tufts Coll., 964 N.E.2d 331,
341 (Mass. 2012) (quoting Sena v. Commonwealth, 629 N.E.2d 986,
994 (Mass. 1994)). "The standard for making [an IIED claim] is
very high." Polay v. McMahon, 10 N.E.3d 1122, 1128 (Mass. 2014)
(quoting Doyle v. Hasbro, Inc., 103 F.3d 186, 195 (1st Cir. 1996)).
"[L]iability [may be] found only where the conduct has been so
outrageous in character, and so extreme in degree, as to go beyond
- 17 - all possible bounds of decency, and to be regarded as atrocious,
and utterly intolerable in a civilized community." Roman, 964
N.E.2d at 341 (second alteration in original) (quoting Foley v.
Polaroid Corp., 508 N.E.2d 72, 82 (Mass. 1987)).
The critical question on appeal boils down to the second
element: whether Dr. Newton's conduct was extreme and outrageous
under the circumstances. But like J.S.H.'s NIED claim, whether
Dr. Newton engaged in extreme and outrageous conduct by writing
the medical note in 2018 and then reporting suspected medical child
abuse depends on whether Dr. Newton made a reasonable medical
judgment under the circumstances. And whether her medical
judgment, based on the facts known to her, was reasonable is an
issue that requires expert testimony for a factfinder to resolve.
Cf. Earley, 190 N.E.3d at 542; LeBlanc, 974 N.E.2d at 44.
As the district court explained, "[i]t is not 'utterly
intolerable' in a 'civilized community' for medical professionals
that specialize in child protection to make reasonable claims of
neglect, even if they are later found by DCF to be
unsubstantiated." J.S.H. v. Newton, et al., 765 F. Supp. 3d 1, 25
(D. Mass. 2025) (quoting Agis v. Howard Johnson Co., 355 N.E.2d
315, 319 (Mass. 1976)). Without expert testimony about what facts
may trigger a duty to report suspected medical child abuse, a jury
would not be able to discern whether Dr. Newton's conduct crossed
the line into extreme and outrageous territory. Cf. Silva, 75
- 18 - N.E.3d at 1138. Because J.S.H. did not introduce any expert
testimony to support her IIED claim in opposing summary judgment,
she failed to create a triable issue of fact about whether Dr.
Newton's conduct amounted to extreme and outrageous behavior. Cf.
Kelly v. Brigham & Women's Hosp., 745 N.E.2d 969, 979-80 (Mass.
App. Ct. 2001) (rejecting the plaintiff's IIED claim when the
record did not "support a theory that [the physician] recklessly
misled the plaintiff or that he had actual knowledge that the
procedure would be so intrusive"). Thus, the district court did
not err in granting summary judgment to Dr. Newton on this claim.
C. G.H.'s IIED Claim
J.S.H. also contests the district court's ruling on
G.H.'s IIED claim against Dr. Newton. The district court applied
largely the same reasoning in rejecting the IIED claims of both
G.H. and J.S.H. We affirm the court's ruling as to G.H. because
the summary judgment record shows no genuine dispute of material
fact on the third element of an IIED claim: causation. See Roman,
964 N.E.2d at 341 (identifying causation as the third element).
To support G.H.'s IIED claim, J.S.H. pointed to Dr.
Newton's September 2018 medical note to his medical providers.
But J.S.H. did not identify any evidence in the record
demonstrating that Dr. Newton's medical note caused G.H. severe
distress. See Howell v. Enter. Publ'g Co., 920 N.E.2d 1, 28 (Mass.
2010) (explaining that an IIED claim requires proof "that the
- 19 - actions of the defendant were the cause of the plaintiff's
distress"). The facts before us do not indicate that G.H. ever
knew about, let alone saw, Dr. Newton's medical note. Nor does
the record reflect that Dr. Newton's medical note resulted in G.H.
being separated from his parents during the time period at issue
in this lawsuit. Without evidence of causation, G.H.'s IIED claim
cannot withstand summary judgment.
D. G.H.'s Section 504 Claim
Finally, we turn to G.H.'s claim against MGH for
disability discrimination in violation of Section 504 of the
Rehabilitation Act. We agree with the district court that, based
on the record, there was no triable issue on a critical element of
G.H.'s claim.
Section 504 provides that "[n]o otherwise qualified
individual with a disability . . . shall, solely by reason of her
or his disability, be excluded from the participation in, be denied
the benefits of, or be subjected to discrimination under any
program or activity receiving Federal financial assistance."
29 U.S.C. § 794(a). To prevail on a Section 504 claim, a plaintiff
must prove four elements: "(1) that [he] is disabled; (2) that
[he] sought services from a federally funded entity; (3) that [he]
was otherwise qualified to receive those services; and (4) that
[he] was denied those services solely by reason of
[his] . . . disability." Thiersaint v. Dep't of Homeland Sec., 85
- 20 - F.4th 653, 669 (1st Cir. 2023) (alterations in original) (internal
quotation marks omitted) (quoting Lesley v. Hee Man Chie, 250 F.3d
47, 53 (1st Cir. 2001)).
The parties do not dispute that the first three elements
of a Section 504 claim are satisfied here. Instead, their dispute
focuses on the fourth element: whether MGH "denied" G.H. treatment
based solely on his disability. On this issue, the parties'
dispute is largely legal; they disagree about whether a viable
Section 504 claim requires an outright denial of treatment or
whether a loss of meaningful access to services is enough.
Even assuming that a loss of meaningful access to
services is sufficient to maintain a Section 504 claim, G.H.'s
claim fails because there is no evidence in the record that Dr.
Newton's interventions in late 2018 had any impact on MGH's medical
services to G.H. To support G.H.'s Section 504 claim, J.S.H.
points only to Dr. Newton's medical note, Dr. Newton's report to
DCF, and the testimony of G.H.'s father. But none of this evidence
directly demonstrates that MGH limited, denied, or made any changes
that negatively impacted the medical services it offered to G.H.
Dr. Newton's medical note and the DCF report documented
her own suspicions of medical child abuse. Although the
allegations raised in these documents could have negatively
impacted the services that MGH offered to G.H., nothing in these
- 21 - documents indicates that MGH consequently altered its services to
G.H. in any way.
To be sure, G.H.'s father did claim that Dr. Newton's
actions in 2018 affected the medical services that G.H. received.
He testified that Dr. Newton's medical note "caused a significant
amount of trouble with [G.H.'s] medical care." He described the
medical note as "fairly inflammatory" because medical providers
did "not want[] to treat [G.H.]" after seeing the note in G.H.'s
medical record. And we have no doubt that G.H.'s father was
offering his honest assessment. But his testimony on this point
was not based on any direct observation or knowledge of a decrease
in or deterioration of care for his child; instead, it relied
largely on hearsay.
For example, although the Section 504 claim was brought
against MGH, G.H.'s father testified to a change in care by only
one medical provider affiliated with MGH. And as to that single
provider, G.H.'s father testified that G.H.'s caregivers "decided
that it was unsafe for [G.H.] to continue seeing [the provider]"
because of Dr. Newton's access to MGH records, suggesting that the
family itself made the decision not to pursue treatment. G.H.'s
father also admitted that he "did not" speak with the MGH provider
about whether it was unsafe to continue treatment or about the
family's ultimate decision to discontinue treatment. Nor did
G.H.'s father review any documents from the MGH provider related
- 22 - to the discontinuation of treatment. Thus, the record lacks any
evidence showing that MGH took any action to limit or deny care to
G.H.
G.H.'s father also identified two medical providers
associated with the University of Massachusetts ("UMass") who
allegedly refused to treat G.H. following Dr. Newton's medical
note. J.S.H. has not detailed how refusals of care by providers
unaffiliated with MGH could support a Section 504 claim against
MGH based on its own denial of care to G.H. But even assuming
that such denials of care could be relevant to the claim against
MGH, there was still insufficient evidence in the record to create
a genuine dispute of material fact about whether G.H.'s medical
care was negatively impacted. When G.H.'s father was asked to
elaborate on how and why the UMass providers had refused to treat
G.H., including any conversations he may have had with those
providers on the topic, G.H.'s father responded, "Well, it wasn't
really a conversation. [The UMass provider] said, I refuse to
treat, and that's it." Ultimately, G.H.'s father conceded that he
"did not" have any discussions with either UMass provider about
their reasons for not signing onto G.H.'s care plan. Further,
when asked to describe how Dr. Newton's actions were related to
any refusal of care by the UMass providers, G.H.'s father
acknowledged, "For the most part, I don't know how much of it is
related."
- 23 - Thus, we agree with the district court that there is no
triable issue of fact as to whether MGH violated Section 504.8
IV. CONCLUSION
For all these reasons, we affirm the district court's
ruling granting summary judgment to Dr. Newton and MGH.
8 Because we affirm the district court's Section 504 ruling on the ground that J.S.H. failed to introduce evidence that G.H. experienced any meaningful loss of services by MGH, we do not address the parties' arguments about whether a Massachusetts state law limiting the liability of charitable organizations applies here.
- 24 -