Nigro v. Virginia Commonwealth University/Medical College

492 F. App'x 347
CourtCourt of Appeals for the Fourth Circuit
DecidedJune 21, 2012
Docket10-2425
StatusUnpublished
Cited by6 cases

This text of 492 F. App'x 347 (Nigro v. Virginia Commonwealth University/Medical College) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fourth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Nigro v. Virginia Commonwealth University/Medical College, 492 F. App'x 347 (4th Cir. 2012).

Opinion

Affirmed by unpublished opinion. Judge DUNCAN wrote the opinion, in which Chief Judge TRAXLER and Judge KING joined.

Unpublished opinions are not binding precedent in this circuit.

DUNCAN, Circuit Judge:

Claudine Nigro, a former medical resident in the Shenandoah Valley Family Residency Program (the “Program”), brought a myriad of state and federal law claims against the Program, Valley Health System (‘WHS”), VCU/Medical College of Virginia (“VCU”), Warren Memorial Hospital (the “Hospital”), and Dr. Francis X. Dennehy (collectively, the “Defendants”), after she was not permitted to advance to the second year of the Program. The district court granted the Defendants’ motion to dismiss on most of her claims and, shortly thereafter, granted summary judg *350 ment on the rest. For the reasons below, we affirm.

I.

The facts are lengthy and somewhat involved. For the sake of clarity, we divide them into three parts. We first describe the Program. We next discuss Nigro’s tenure in the Program. Finally, we detail the proceedings leading to this appeal.

A.

We turn first to the Program, which consists of three years: R-l, R-2, and R-3. Residents contract with the Program for each year. For example, Nigro’s contract (the “Contract”) covered her R-l year, which was to run from July 1, 2008 to June 30, 2009. The residents’ contracts stipulate salary, certain professional responsibilities, and the terms under which they may be renewed or terminated. The American Council for Graduate Medical Education (“ACGME”) also plays a role. ACGME has guidelines applicable to many aspects of the contracts that the Program signs with its residents. In addition to their contracts, residents receive separate documents containing additional procedures (the “Procedures”), which detail the finer points about how the residency operates. ACGME guidelines influence the Procedures as well. However, unlike their contracts, neither the residents nor representatives from the Program sign the Procedures.

Residents in the Program rotate through several practices in their R-l year and therefore work with different faculty members during that period. They work primarily at the Hospital, which is owned by VHS. Throughout their rotations, both “Core” and “Specialty” Faculty members supervise the residents and provide them with ongoing instruction, mentoring, and evaluations. The Core Faculty, in addition to teaching in rotations, assists the Program Director, Dr. Francis Dennehy, in running the Program. The Core Faculty meets regularly to discuss the performance of individual residents and votes to take action against underperforming residents. The Specialty Faculty focuses on instructing residents in their rotations. Each resident has a faculty advisor who reviews the resident’s progress and proffers advice on any areas of concern. All of the Program’s faculty members are professors at VCU.

Faculty members assess the residents at several points during the year. At the end of each rotation, the doctors supervising that rotation fill out a standard form evaluating the resident on several substantive criteria and various aspects of professionalism. These forms instruct the faculty that 80 percent of the residents should be marked “average.” The residents’ contracts and the Procedures describe how the Program typically deals with residents who perform below average. The relevant provisions of Nigro’s contract follow.

First, § 3.7, the only provision to speak of non-renewal, provides that:

When deciding not to renew Resident’s agreement, the Residency Program agrees to provide Resident with as much advance written notice of its decisions as may be reasonably permitted under the circumstances. To the extent possible, the Residency Program will try to provide four months’ advance written notice before the end of the then-current term. However, the Residency Program will not be bound by the foregoing and it reserves the right to provide Resident with less than four monthsf] written notice.

J.A. 66. Next, § 5 contemplates performance review policies. Relevant to this appeal, it provides that:

*351 The Residency has a procedure whereby any resident terminated by the Residency for deficiencies in Clinical Competence, Technical Skill, and/or Professional Behavior is granted due process. Residents will be notified at least four months in advance through the winter semi-annual review process if promotion or reappointment is in jeopardy, unless behavior preventing reappointment occurs during the four months prior to the start of each academic year.

J.A. 68. Finally, § 14 is an integration clause stating that:

This agreement contains the final and entire agreement between the parties, and they shall not be bound by any terms, conditions, statements or representations, oral or written, not herein contained or contained in a written amendment to this Agreement executed by the parties hereto. This Agreement may be amended only by written agreement executed by the parties.

The Procedures provide for a slightly different course for dealing with underper-forming residents. They specify that an underperforming resident should first be placed on probation and given four months to improve before any dismissal action is taken. They further provide for a process by which a resident may appeal any disciplinary action to a subcommittee of the faculty.

B.

Nigro signed the Contract with the Program in March of 2008. Nigro claims that she passed all of her rotations and that she did a satisfactory job in each of them. While it is correct that she technically passed every rotation, the record contradicts her claim that her performance was consistently satisfactory. For example, Dr. Sherry Whisenant, who was assigned as her advisor, testified that Nigro had performed poorly in medical school and that she received a very low score on an exam administered during orientation.

Nigro’s reviews from her rotations indicate that her performance grew worse as the year went on. Most of the reviews from her first rotations in the summer of 2008 describe her work as average; Dr. Dennehy’s review was not entirely positive. Moving into the fall, Nigro received mixed reviews in her pediatrics and family practice rotations, receiving several poor marks on substantive criteria, but garnering positive reviews in “Professional Characteristics,” which includes nonsubstantive criteria such as appropriate dress. The reviews from her ER and internal medicine rotations were less consistent — some doctors rated her “knowledge base” above average and others found her to be lagging behind her peers. Cumulative reviews of her performance in the fall of 2008 also describe her substantive skills as being significantly below her peers.

Some of Nigro’s faculty supervisors became very concerned by her performance during Nigro’s rotation in the neonatal intensive care unit (“NICU”) in December 2008. Dr. Lee, a Specialty Faculty member overseeing that rotation, informed Dr. Dennehy that Nigro was in danger of failing and did not seem concerned about patient care. According to Dr. Dennehy, Dr.

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492 F. App'x 347, Counsel Stack Legal Research, https://law.counselstack.com/opinion/nigro-v-virginia-commonwealth-universitymedical-college-ca4-2012.