Cowan v. University of Louisville School of Medicine
| Decision Date | 24 May 1990 |
| Docket Number | No. 89-5677,89-5677 |
| Citation | 900 F.2d 936 |
| Parties | 59 Ed. Law Rep. 1021 Jonathan COWAN, Ph.D., Plaintiff-Appellant, v. UNIVERSITY OF LOUISVILLE SCHOOL OF MEDICINE; Leah Dickstein, M.D.; Donald Kmetz, M.D.; and Other Unknown Persons, Defendants-Appellees. |
| Court | U.S. Court of Appeals — Sixth Circuit |
Philip C. Kimball (argued) and J. Leonard Rosenberg, Louisville, Ky., for plaintiff-appellant.
Holland N. McTyeire (argued), Robert F. Matthews, Greenebaum, Doll & McDonald, Thomas H. Lyons, University Counsel, University of Louisville, Louisville, Ky., for defendants-appellees.
David A. Harris, Louisville, Ky., for defendant, Darrell Franks, M.D.
Before WELLFORD and GUY, Circuit Judges, and ENGEL, Senior Circuit Judge.
The plaintiff, Jonathan D. Cowan, appeals entry of summary judgment in his suit alleging unlawful dismissal from the University of Louisville School of Medicine. Because plaintiff's claims against the University of Louisville are barred by the eleventh amendment to the United States Constitution, and all federal claims against defendants Leah Dickstein and Donald Kmetz are without merit, we affirm the district court's disposition of the case.
Cowan's record of academic accomplishment before entering the University of Louisville School of Medicine is impressive. After receiving B.S. and B.A. degrees from Brown University in 1970, Cowan held Danforth and Woodrow Wilson Fellowships while earning a Ph.D. in comparative pharmacology and toxicology from the University of California Medical Center. Plaintiff appears to have carried his academic success over to the study of medicine for the first few semesters in which he was enrolled at the University of Louisville. In fact, during this time, plaintiff was ranked in the top one quarter of his class. Things began to change, however, toward the beginning of 1982.
On February 11, 1982, Associate Dean for Student Affairs Leah Dickstein received a telephone call from a woman identifying herself as Phyllis Noe who indicated that she had recently ended a relationship with the plaintiff, and that since that time he had been harassing her. Three days later, Dickstein called Cowan's roommate to inquire into Cowan's psychological state. On February 15, 1982, Dr. Joseph LeRoy, the Director of Medical Student Education in Psychiatry, wrote Dickstein to express his concern with the plaintiff's clinical performance in a recently completed psychiatry clerkship rotation. Dr. LeRoy noted that plaintiff's performance was "in the doubtful to unsatisfactory range," particularly due to his inability to relate to either the patients or the nursing staff. On February 22, Dickstein received a letter from Steven Lippmann, M.D., Cowan's clinical supervisor during his psychiatry rotation. Lippmann requested that Dickstein contact the plaintiff to "remediate several apparent deficiencies," including Cowan's failure to practice medicine "within his expertise level," "[i]nadequate attention to, detail in, and performance of histories and physicals," and "difficulty maintaining productive patient, staff and peer relationships." That same day, Dickstein wrote Cowan to inform him that his reported behavior was "not in keeping with the standards of the University of Louisville nor of the medical profession at large." Dickstein requested that Cowan meet with her to discuss the matter further. At the meeting, Dickstein suggested to Cowan that he see one of several psychiatrists at the school to aid him in resolving his personal difficulties. Cowan chose to see Dr. Darrell Franks.
On March 12, 1982, Christopher Shields, M.D., wrote Dickstein to relate an incident in which Cowan exhibited behavior "totally inappropriate for a medical student." Cowan apparently had incorrectly informed the parents of a child with a malignant brain tumor that the child was receiving improper treatment, causing the parents a great deal of distress. Dickstein received yet another letter complaining about Cowan on April 21, 1982. Dr. Ennu Surrender, a resident in psychiatry, wrote that the plaintiff had seen patients after being advised not to, and had followed improper procedures leading to incorrect diagnoses.
After examining Cowan during five office visits, Dr. Franks wrote to Dickstein on April 10 that he considered the plaintiff's condition "to be very ominous." The letter continues as follows:
I have serious doubts, in my professional opinion, as [to] the ability of this person to conform his conduct to that required by either the University o[r] the greater medical profession. In my opinion, he is a seriously disturbed person, and potentially dangerous to patients. I have serious reservations regarding his continuing in medical education.
Franks also expressed concern for Dickstein's personal safety, noting "strong reservations" regarding Dickstein seeing Cowan alone.
Dickstein showed Franks' letter to Dr. Donald Kmetz, the Dean of the School of Medicine. Kmetz then met with Cowan on April 21 and arranged for him to take a leave of absence until his personal and academic difficulties could be reviewed by the Medical School Student Affairs Committee.
The Student Affairs Committee (SAC), chaired by Dr. Bernard Weisskopf, met on April 29 to determine whether Cowan should take a medical leave of absence from the school. The SAC considered, among other things, the letters received by Dr. Dickstein, including the letter from Franks. Cowan appeared personally before the committee and presented a defense of his behavior. The SAC recommended to Dean Kmetz that Cowan be reinstated pending his submission to two independent psychiatric examinations to determine whether he was suffering from serious behavioral or emotional problems. Kmetz accepted the committee's recommendation and reinstated Cowan immediately. Cowan thereupon saw a psychiatrist and a psychologist, both of whom indicated that he had no "serious pathology." Cowan was present at the next meeting of the SAC on June 4, in which he again presented an explanation of his behavior. The committee also heard testimony from Dr. Martin Raff who presented material relating to Cowan's relationship with Phyllis Noe. The SAC notified Dr. Raff that this information was irrelevant to Cowan's competence to proceed with his medical studies and agreed to ignore the information. At the conclusion of the second meeting, the SAC took "no specific action against Dr Cowan" who requested that any disposition of the matter be delayed until he returned from a summer in California. The SAC never discussed the Cowan matter again, and Cowan was never disciplined for any aspect of his conduct.
From August 16, 1982, to October 15, 1982, plaintiff was enrolled in the clinical course of junior medicine, a part of the core curriculum required of all medical students at the University. Cowan received a failing grade in the course which was relayed to the Committee on Student Promotions (CSP) according to routine University procedure. The CSP recommended that Cowan not be dismissed immediately from the school but instead be allowed to repeat junior medicine and be placed on academic probation.
By letter dated October 28, Kmetz notified Cowan that he was upholding the recommendation of the CSP, but that further failure could result in Cowan's dismissal from the medical school as provided in the University catalog. The letter provides, in pertinent part:
Because of your failure in a core course, you will be on academic probation throughout the 1982-83 academic year. Failure to pass all your courses within this year could result in dismissal from school....
Plaintiff's next rotation, from October 18 through December 17, 1982, was in junior surgery, another core course required for graduation. On January 6, 1983, plaintiff received a failing grade in junior surgery. Dr. Neal Garrison, the course director, testified that a student could fail junior surgery in any one of three ways: (i) by obtaining a failing score on the final examination; (ii) by failing the ward work component of the course; or (iii) by obtaining an average on the final examination and the ward work of less than 65%. This grading procedure was explained to all students at the beginning of the junior surgery class. Cowan failed the ward work with an extraordinarily low score, and also obtained a combined average of less than 65%. On January 6, two resident assistants who had been heavily involved in determining Cowan's ward grade wrote to Dr. Garrison explaining why they felt that Cowan's performance in the ward work component of junior surgery was unsatisfactory. The letter notes that Cowan's work was deficient in five separate respects: (i) he was unable to apply material taught in the classroom to the care of patients; (ii) he refused or was unable to accept responsibility; (iii) he was absent from the hospital while on call in direct contravention of a resident's request; (iv) he constantly complained of physical and mental fatigue; and (v) he resisted attending surgery for patients under his care. In addition, the letter notes that Cowan was unable to communicate with others "in a manner required for participation as a member of the medical community."
The letter goes on to explain that one of the residents met with Cowan two weeks into the rotation and delineated his specific areas of weakness, explaining that his performance was, at that time, "marginal at best" and that improvement was expected. These same admonitions were repeated to Cowan in a meeting with the chief and two junior residents one week later. At this time, Cowan was notified that "his performance was failing and marked improvement would be needed for a passing score." Because no improvement was noted, the letter explains, Cowan received a failing mark.
The plaintiff requested and received several meetings to...
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