Ramalingam v. Robert Packer Hospital/Guthrie Healthcare System Auxiliary

CourtDistrict Court, M.D. Pennsylvania
DecidedAugust 21, 2019
Docket4:17-cv-00216
StatusUnknown

This text of Ramalingam v. Robert Packer Hospital/Guthrie Healthcare System Auxiliary (Ramalingam v. Robert Packer Hospital/Guthrie Healthcare System Auxiliary) is published on Counsel Stack Legal Research, covering District Court, M.D. Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ramalingam v. Robert Packer Hospital/Guthrie Healthcare System Auxiliary, (M.D. Pa. 2019).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA

SARAVANAN RAMALINGAM, No. 4:17-CV-00216 M.D., (Judge Brann) Plaintiff. v.

ROBERT PACKER HOSPITAL, et al.,

Defendants.

MEMORANDUM OPINION

AUGUST 21, 2019

Defendants Robert Packer Hospital/Guthrie Healthcare System Auxiliary, Robert Packer Hospital, Dr. Thomas VanderMeer and Dr. Burt Cagir have moved for summary judgment against Plaintiff Dr. Saravanan Ramalingam. For the following reasons, that motion is granted in part and denied in part. I. BACKGROUND1 Dr. Ramalingam graduated from Stanley Medical College in India and eventually became certified in general surgery by India’s National Board of Examiners. He later emigrated to the United States and sought to become board- certified under American standards. To become board-certified in the United States, Dr. Ramalingam needed to complete a general surgery residency.

1 Unless otherwise noted, the facts are derived from the parties’ statements of material facts, Robert Packer Hospital (“RPH”) in Sayre, Pennsylvania, offered Dr. Ramalingam a place in its general surgery residency program. Such residency programs are subject to requirements promulgated by the American Board of

Surgery (“ABS”) and the Accreditation Council for Graduate Medical Education (“ACGME”). Due to his extensive prior experience and training, the ABS gave Dr. Ramalingam permission to enter RPH’s five-year residency program as a

fourth year resident – i.e., as a “Post Grad Year Four” (“PGY-4”) resident. Because of his PGY-4 status, Dr. Ramalingam was scheduled to graduate in October of 2015. Dr. Ramalingam commenced his general surgery residency in October 2013.

In early 2014, Defendant Thomas VanderMeer, M.D., the Director of RPH’s Residency Program, advised Dr. Ramalingam to apply for a post-residency fellowship. Such a fellowship, however, would have to commence in July 2015 –

three months before Dr. Ramalingam was scheduled to graduate from the general surgery residency program. In early 2014, Dr. VanderMeer contacted the ABS and requested that Dr. Ramalingam be allowed to graduate in June 2015 rather than October 2015. The ABS agreed so long as Dr. Ramalingam achieved a requisite

score on a qualifying examination and demonstrated the necessary clinical skills for a PGY-4 as attested to by Dr. VanderMeer.2 Dr. Ramalingam exceeded the minimum score required and Dr. VanderMeer authored a letter attesting to Dr.

2 Exhibit H - Letter from Dr. Frank Lewis 2/26/14 (ECF No. 52-4). Ramalingam’s clinical skills. The ABS then approved the June 2015 graduation date. Dr. Ramalingam’s early graduation should have been approved by the

ACGME. ACGME requires surgical residents to complete 750 procedures over the length of their residencies, which typically last five years. Because Dr. Ramalingam entered RPH’s program as a PGY-4, he would have to squeeze

requirements designed to be completed over a five-year period into two years. Consequently, Dr. Ramalingam asked Dr. VanderMeer to contact ACGME to obtain a waiver for the 750-procedure requirement. Dr. VanderMeer and RPH’s residency coordinator assured Dr. Ramalingam that they would. However,

Defendants did not contact ACGME at the time they contacted ABS; they waited until February 2015 to do so. Meanwhile, believing that he would be able to graduate in June 2015, Dr.

Ramalingam applied to various hepatobiliary and pancreatic (“HBP”) surgery fellowship programs. He was ultimately accepted into such a program at Dalhousie University in Nova Scotia, Canada. That fellowship would have started in July 2015, given that Dr. Ramalingam was set to graduate in June 2015.

But Dr. Ramalingam did not graduate in June 2015, and parties sharply differ as to why. According to Defendants, Dr. Ramalingam began to exhibit deficiencies in

his competence and professionalism. RPH faculty noted gaps his medical knowledge,3 clinical experience,4 operative skills,5 and ability to orally communicate and give presentations.6 Dr. VanderMeer and Burt Cagir, M.D., Assistant Director of the RPH General Surgery Residency Program, wrote in their

biannual resident review that they harbored “significant concerns about [Dr. Ramalingam’s] ability to learn from his practice and to seek out high quality medical literature in order to improve his practice.”7 Dr. Cagir specifically

described Dr. Ramalingam as lacking “intellectual honesty” because Dr. Ramalingam could not accept his own mistakes.8 But according to Dr. Ramalingam, his performance remained exemplary as other physicians rated him highly on periodic evaluations of his work9 and

assessment of his communication skills.10 Dr. Ramalingam contends that Dr. VanderMeer and Dr. Cagir’s efforts to undercut Dr. Ramalingam’s professional competency arose from either personal animus or Dr. Ramalingam’s perceived

misalignment in internal hospital politics. For example, Dr. Ramalingam participated in two peer review conferences, where he presented on two cases

3 Exhibit W - Biannual Resident Review (ECF No. 45-1) at 295. 4 Exhibit P - Review by Dr. Fanelli (ECF No. 45-1) at 267. 5 Exhibit U - Review by Dr. Fanelli (ECF No. 45-1) at 287; Exhibit V – Review by Dr. Larson Review (ECF No. 45-1) at 291. 6 Exhibit S – Review by Dr. Casos Review (ECF No. 45-1) at 279. 7 Exhibit W - Biannual Resident Review (ECF No. 45-1) at 295. 8 Exhibit X - Review by Dr. Cagir (ECF No. 45-1) at 297. 9 Exhibit – Review by Dr. Casos (ECF No. 45-1) at 279. 10 Exhibit K – Short Deposition (ECF No. 52-11) at 6-7. involving one of Dr. VanderMeer’s patients. According to Dr. Ramalingam, Dr. VanderMeer wanted Dr. Ramalingam to present the cases in a manner critical of a certain general surgeon with whom Dr. VanderMeer had a conflict.11 Dr.

Ramalingam, however, explains that he reported the cases objectively and substantiated his explanations with medical literature—a course of action that Dr. Ramalingam says earned him Dr. VanderMeer’s reproach when Dr. VanderMeer called Dr. Ramalingam “intellectually dishonest.”12

In March 2015, RPH’s Resident Promotion Committee (“RPC”), a faculty committee of surgeons who evaluate resident performance, convened and decided that Dr. Ramalingam was not prepared to graduate in 2015.13 The committee noted

that Dr. Ramalingam did not complete ACGME’s 750-procedure requirement and did not complete rotations in pediatric surgery, endoscopy, thoracic surgery, and plastic surgery. Dr. VanderMeer communicated the RPC’s decision to Dr. Ramalingam,14

identified the areas of Dr. Ramalingam’s practice that concerned the committee, and provided Dr. Ramalingam with a draft remediation plan to improve his perceived deficiencies. As a result of the RPC’s decision, Dr. Ramalingam

11 Exhibit G – Ramalingam Declaration (ECF No. 52-7) at 9. 12 Id. at 9-10. 13 Exhibit AA – RPC Meeting Minutes (ECF No. 45-1) at 309. 14 Dr. Ramalingam avers that in February 2015, Dr. VanderMeer told him that he would not graduate in June 2015 because he had not completed ACGME’s 750-procedure requirement. Exhibit G – Ramalingam Declaration (ECF No. 52-7) at 6. contacted Dr. Michele Molinari, the fellowship director at Dalhousie University, and arranged a later start date for his HPB fellowship.15 Dr. VanderMeer also decided to e-mail Dr. Molinari, explaining that Dr.

Ramalingam would not graduate in time to start the fellowship in July 2015, at least in part because he did not achieve a minimum case volume. Dr. Molinari ultimately decided to revoke Dr. Ramalingam’s fellowship offer, at least in part

because Dr. Ramalingam would not graduate in June 2015. Dr. Ramalingam appealed the RPC’s decision by filing a grievance with the Impartial Fair Procedure Review Panel, and the panel upheld the RPC’s decision not to graduate Dr.

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