Trisha Doran v. Denis McDonough

Court of Appeals for the Sixth Circuit·Decided November 9, 2021·No. 20-3694·Unpublished

Opinion

NOT RECOMMENDED FOR PUBLICATION File Name: 21a0511n.06

No. 20-3694

UNITED STATES COURT OF APPEALS FOR THE SIXTH CIRCUIT

) FILED TRISHA DORAN, M.D., ) Nov 09, 2021 ) DEBORAH S. HUNT, Clerk Plaintiff-Appellant, )

)

v. ) ON APPEAL FROM THE UNITED ) STATES DISTRICT COURT FOR DENIS MCDONOUGH; UNITED STATES ) THE SOUTHERN DISTRICT OF DEPARTMENT OF VETERANS AFFAIRS, ) OHIO )

Defendants-Appellees. )

)

Before: BOGGS, GRIFFIN, and MURPHY, Circuit Judges.

BOGGS, Circuit Judge. This employment-termination case comes before us for a second time, with appellant, Trisha Doran, M.D., appealing a summary-judgment ruling that upheld her termination by appellees, the Secretary of the United States Department of Veterans Affairs and the United States Department of Veterans Affairs (jointly referred to as the “VA”). Dr. Doran first challenged her termination through the VA’s multi-layered administrative process. Her termination was upheld at each step of this process, including reviews by the VA Medical Executive Board (“MEB”), the VA Administrative Investigation Board (“AIB”), the VA Professional Standards Board (“PSB”), and the VA Disciplinary Appeals Board (“DAB”). Dr. Doran then filed suit in federal court under 38 U.S.C. § 7462, challenging her termination as arbitrary and capricious (the “APA case”). Her termination was upheld by the district court, Doran v. McDonald, No. 2:16-cv-532, 2018 WL 806253, at *21 (S.D. Ohio Feb. 9, 2018), and then by

this court in Doran v. Wilkie, 768 F. App’x 340 (6th Cir. 2019). Contemporaneously with her APA case, Dr. Doran also filed a complaint for employment discrimination, which gives rise to this appeal. The parties agreed to stay this case pending a ruling in the APA case. After the ruling in Doran v. Wilkie, the parties entered a stipulation of facts in our case, and summary judgment was entered in favor of the VA. This appeal followed. Given the voluminous, well-documented record in this matter, we will focus on the facts and findings relevant to the claims raised in this appeal.

I. Facts and Proceedings Below Dr. Doran is a board-certified gastroenterologist and licensed physician in the State of Ohio. She was employed by the Chalmers P. Wylie VA Ambulatory Care Center in Columbus, Ohio from 2008 to 2015. For the first five years, Dr. Doran earned high praise from her supervisors and patients, with annual proficiency reports rating her as “outstanding,” the highest possible score. That all changed in 2014, when Dr. Glenn Borchers, who became Chief of Gastroenterology in 2010, took over the annual proficiency review of Dr. Doran’s performance, at which time her overall rating dropped to “low satisfactory” to “satisfactory.”

The 2013-14 proficiency report covered the period of October 1, 2013, through September 30, 2014. Dr. Borchers reported that Dr. Doran was consistently late or nearly late in completing mandatory training, recredentialing paperwork, and required peer reviews. He noted that her practice style was inefficient, she had higher rates of patient complications than other doctors, she was behind on administrative assignments, and she was frustrated by the amount of work she was required to complete. Dr. Borchers reported her as being distracted or preoccupied.

Dr. Doran claims that this poor review was a result of her complaining about the terms of her employment. Specifically, Dr. Doran alleged that when she was recruited to work for the VA

in 2008 by then Chief of Gastroenterology, Dr. Marc Cooperman, that she had been promised participation in the VA’s Educational Debt Reduction Program (“EDRP”), a form of student-debt relief. Dr. Doran never received those EDRP benefits, so she sought and obtained Dr. Cooperman’s assistance in getting those promised benefits in 2010 and 2013. Dr. Cooperman, who had become Chief of Staff, informed human resources that he had indeed promised EDRP recruitment benefits to Dr. Doran when she was hired, but she still did not receive EDRP benefits. In 2014, a male physician who had transferred recently to Columbus from another VA hospital, showed Dr. Doran a breakdown of his VA benefits, which included EDRP debt-reduction payments. It was also in 2014 that Congress passed the Veteran’s Choice Act doubling EDRP benefits from $60,000 to $120,000 for five years of service. And in 2014, Dr. Doran renewed her complaints about not receiving EDRP payments with Dr. Cooperman and the human-resources department. Dr. Doran alleges that it was after this 2014 complaint that Dr. Borchers wrote Dr. Doran’s “low satisfactory” proficiency report. Dr. Doran alleges that this is also when Dr. Borchers began to question her competency, treat her differently than male doctors, and exclude her from his inner circle.

On June 2, 2015, Dr. Cooperman issued Dr. Doran a notice of proposed removal and revocation of clinical privileges based on four charges relating to: 1) the treatment of Patients A, B, and C during esophagogastroduodenoscopy (“EGD”) and/or colonoscopy procedures on January 26, 2015, January 27, 2015, and October 17, 2014;1 2) inappropriately amending patient medical records; 3) lack of candor in attempting to have nurses corroborate her late addition to medical records of Patient A; and 4) performing a procedure (anal tattooing) on Patient D on June 20, 2014, without appropriate privileges. These charges, particularly those relating to the case of

1 For privacy purposes, patients were anonymized throughout the administrative review process and the APA case. The same anonymizers are used in this opinion.

Patient A, as detailed in Doran v. Wilkie, 768 F. App’x at 347-49, 350-52, led to Dr Doran’s dismissal in August 2015.

For purposes of this case, the events regarding Patient A are particularly relevant. Patient A, a 53-year-old male, presented on January 26, 2015 for an EGD and a colonoscopy. Despite Patient A’s complex medical history (diabetes, hypertension, coronary artery disease, obesity, sleep apnea, and chronic kidney disease), Dr. Doran considered him at relatively low risk and, instead of seeking assistance from an anesthesiologist, sedated him herself, administrating 100 micrograms of Fentanyl and 2 milligrams of Versed. Patient A became unresponsive, and a code blue was called. Dr. Doran claims that she called for reversal agents, but that nurses did not respond quickly, and the reversal medications were improperly locked away, against VA hospital policy. Before reversal agents could be administered, the code-blue team arrived and intubated Patient A, who was transferred by ambulance to a hospital where he remained for an extended period before being moved into assisted living. Patient A’s family sued the VA for three million dollars and the VA settled the claim for $300,000 in damages. Dr. Doran maintains that she treated Patient A properly and did not violate any medical or VA policies.

The parties stipulated to the following facts concerning Dr. Doran’s administrative review.

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