Mohd Refaei v. John McHugh

624 F. App'x 142
CourtCourt of Appeals for the Fifth Circuit
DecidedJune 11, 2015
Docket14-51148
StatusUnpublished
Cited by9 cases

This text of 624 F. App'x 142 (Mohd Refaei v. John McHugh) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mohd Refaei v. John McHugh, 624 F. App'x 142 (5th Cir. 2015).

Opinion

PER CURIAM: *

Plaintiff-Appellant Mohd N. Refaei brings various claims arising out of his termination from a residency program at the William Beaumont Army Medical Center in El Paso, Texas. The district court dismissed Refaei’s state law claims and granted summary judgment in favor of the Government on his federal discrimination claims. For the following reasons, we AFFIRM in part, VACATE in part, and REVERSE and REMAND in part the judgment of the district court.

I. Factual and Procedural Background

Plaintiff-Appellant Mohd N. Refaei, a practicing Muslim, was born in 1965 in what is today the United Arab Emirates and became a naturalized United States citizen in 2001. Refaei obtained his medical degree in 2005 at the Belize Medical College. In 2008, Refaei was accepted into an internal medicine residency program with the Department of Veterans Affairs at the William Beaumont Army Medical Center (the “WBAMC”) in El Paso, Texas.

Each residency program at the WBAMC is headed by a Program Director, a specialist responsible for the day-to-day operations of the program. In addition, the WBAMC has a General Medical Education Committee (the “GMEC”), which supervises the various programs and Program Directors. The GMEC is comprised of representatives of the WBAMC’s residency programs and is chaired by the Director of Medical Education (the “DME”). 1 Moreover, each residency program has its own education committee.

Disciplinary action against residents at the WBAMC may take various forms, three of which are relevant here. First, there is Program Level Remediation (“PLR”) — which typically lasts 60 days— during which program leadership provides additional resources to residents who are struggling in their residency program. If a resident’s deficiencies persist, the resident may be placed on probation. This is a formal method of discipline, with more structured guidelines and expectations for the resident’s improvement; generally, probation is given where it is believed that a resident is not academically prepared to be an independent practitioner. If the WBAMC ultimately determines that a resident lacks necessary skills to perform as an independent practitioner, he or she may be terminated from the program and not allowed to graduate. A Program Director does not have the authority to take formal disciplinary action against a resident. *144 Rather, a Program Director may make a recommendation of discipline — either PLR, probation, or termination — to the program’s education committee. With respect to PLR, if the education committee agrees that such remediation is needed, the resident is placed on PLR. With respect to formal discipline — probation or termination — if the education committee agrees that such action is appropriate, the recommendation is forwarded to the GMEC. The GMEC then conducts a hearing, during which both the Program Director and the resident (who may be represented by counsel) have the opportunity to present their cases. After the hearing, the GMEC casts anonymous ballots on whether to take formal disciplinary action. If the GMEC recommends probation, the resident is placed on probation. If the GMEC recommends termination, the recommendation is forwarded to the Deputy Commander. If the Deputy Commander agrees, the resident may appeal to the Commander. After considering the evidence, the Commander then makes a final decision regarding termination.

The WBAMC’s three-year internal medicine residency program consists of three levels: PGY-1, PGY-2, and PGY-3. A resident must successfully complete each level in order to complete the program. As a PGY-1 resident, Refaei struggled. After a recommendation of the Program Director at the time, Dr. Kent DeZee, the internal medicine education committee voted to place Refaei on PLR in September 2008. Because Refaei continued to have deficiencies in patient care, practice-based learning, and professionalism, Dr. DeZee recommended that Refaei be placed on probation in November 2008. The internal medicine education committee concurred, as did the GMEC, and Refaei was placed on 90-day probation in December 2008. Refaei showed some improvement, completed his probationary period, and ultimately completed PGY-1. During Refaei’s second year, as a PGY-2 resident, Refaei was again placed on PLR for deficiencies in medical knowledge and professionalism; at this time, Dr. Michael Cole was the Program Director. Refaei ultimately made it to his PGY-3 year, during which he was again placed on probation on Dr. Cole’s recommendation. Refaei’s probation, beginning in July 2011, was triggered by, among other concerns, a report that Re-faei gave a poor sign-out to the oncoming night resident and failed to check the progress of both of his interns’ work. On July 28, 2011, Refaei was given a notice of probation, which advised Refaei of the minimum acceptable standards required to be an independent physician, including: (1) “provide appropriate AND adequate documentation on all clinical notes including the documentation of your ‘Assessment and Plan’ sections that is representative of a PGY[-]3 level resident;” (2) “[p]rovide appropriate AND adequate sign-out to your fellow residents;” and (3) “[djemons-trat[e] that you are ready to take a leadership role ... by accomplishing all of the above while teaching junior trainees.”

Two days after receiving the notice of probation, Refaei engaged in conduct prompting his termination from the program. According to the recommendation for termination written by Dr. Cole, Refaei was the senior resident on duty when one of his patients went into severe distress, prompting intervention from the WBAMC’s Rapid Response Team. Refaei failed to transfer the patient to the intensive care unit, and failed to inform the attending physician of the significant change in his patient’s status. Moreover, Refaei failed to ensure that the incident was adequately documented in the patient’s record. The recommendation for termination noted that Refaei’s conduct was in violation of the first and third con *145 ditions of probation discussed above. The internal medicine education committee voted unanimously to recommend Refaei’s termination, as did the GMEC (after a hearing at which Refaei was represented by counsel). The decision was affirmed both by the Deputy Commander and, after an appeal, by the Commander.

Refaei filed the present action on June 18, 2013. 2 Refaei asserted claims for: (1) discrimination, under Title VII of the Civil Rights Act of 1964 and the Age Discrimination in Employment Act of 1967 (“ADEA”), on the basis of national origin (Emerati), religion (Muslim), and age (over 40); (2) breach of contract; (3) intentional infliction of emotional distress (“IIED”); and (4) defamation. The Government filed a motion to dismiss the latter three claims, in response to which Refaei abandoned his claims for IIED and defamation. The district court dismissed the breach of contract claim with prejudice, concluding that the claim was preempted under Title VII, the ADEA, and the Civil Service Reform Act. The Government moved for summary judgment on the remaining claims, and the district court granted the motion. Refaei timely appeals.

II. Standard of Review

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624 F. App'x 142, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mohd-refaei-v-john-mchugh-ca5-2015.