Gurbani v. Johns Hopkins Health Sys. Corp., 1825, Sept. Term, 2016

• Decision Date: 01 June 2018
• Docket Number: No. 1825, Sept. Term, 2016,1825, Sept. Term, 2016
• Citation: 185 A.3d 760,237 Md.App. 261
• Parties: Barkha GURBANI v. JOHNS HOPKINS HEALTH SYSTEMS CORP., et al.
• Court: Court of Special Appeals of Maryland

237 Md.App. 261

185 A.3d 760

Barkha GURBANI

v.JOHNS HOPKINS HEALTH SYSTEMS CORP., et al.

No. 1825, Sept. Term, 2016

Court of Special Appeals of Maryland.

June 1, 2018

Argued by: David A. Branch of Washington, DC, (Sanjiv Singh of San Francisco, CA on the brief) for Appellant.

Argued by: Maria E. Rodriguez (James L. Shea and Venable LLP on the brief) all of Baltimore, MD, for Appellee.

Panel: Wright, Arthur, Anne K. Albright (Specially Assigned), JJ.^*

Arthur, J.

In this case, a physician brought an action seeking damages resulting from her academic dismissal from an orthopaedic surgery residency program at the Johns Hopkins University School of Medicine. After extensive discovery and briefing, the Circuit Court for Baltimore City entered summary judgment against the physician on all of her claims. We affirm, primarily because of the principle that courts must defer to good-faith academic decisions concerning promotion and dismissal.

FACTUAL AND PROCEDURAL BACKGROUND

Appellant Barkha Gurbani, M.D., makes allegations that concern multiple years of her graduate medical education. In connection with the summary judgment motion, the parties submitted transcripts from dozens of depositions, as well as a deluge of evaluations, memos, and emails relating to the residency.

Dr. Gurbani seeks to prove that she was improperly dismissed because the program failed to live up to its end of the residency contracts or because of deliberate actions by two faculty members and the program director. The defendants assert that Dr. Gurbani failed to advance because of her numerous, well-documented deficiencies as a surgical resident, and they contend that the decisions of the University faculty should not be second-guessed through a jury trial.

Three main principles guide our examination of this voluminous record. In an appeal from the grant of a defendant's motion for summary judgment, we review the facts and all inferences drawn from those facts in the light most favorable to the plaintiff. See, e.g. , Jackson v. Dackman Co. , 422 Md. 357, 370, 30 A.3d 854 (2011). The inferences drawn in favor of the plaintiff, however, "must be reasonable ones." Clea v. Mayor & City Council of Baltimore , 312 Md. 662, 678, 541 A.2d 1303 (1988) (emphasis in original). Furthermore, a dispute of fact, in itself, will not prevent the entry of summary judgment; rather a court is precluded from entering summary judgment only when the record reveals a genuine dispute of a material fact. See, e.g. , Castruccio v. Estate of Castruccio , 456 Md. 1, 34, 169 A.3d 431 (2017).

A. Dr. Gurbani's Path to the Residency Program at Johns Hopkins

Barkha Gurbani earned a bachelor's degree from Johns Hopkins University in 2004 and a medical degree from the University of California, Los Angeles, in 2009. During her fourth year of medical school, she took an elective course in the pediatric orthopaedics department at Johns Hopkins. At that time, the Johns Hopkins faculty rated her performance as "outstanding" in all categories. Because Dr. Gurbani aspired to become an orthopaedic surgeon, she pursued a residency in that field.

A residency is a form of education structured so that a medical school graduate can develop into an independent practitioner in a particular specialty. See Accreditation Council for Graduate Medical Education (ACGME), Glossary of Terms, at 5, 8 (2013), https://www.acgme.org/Portals/0/PDFs/ab_ACGMEglossary.pdf. Residencies in orthopaedic surgery last for five years. ACGME Program Requirements for Graduate Medical Education in Orthopaedic Surgery, at 1 (2017), https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/260_OrthopaedicSurgery_2017-07-01.pdf. The first-year curriculum focuses on basic surgical skills, and the curriculum for the remaining four years is more specialized in orthopaedics. Id. at 16–17.

A medical residency is a "physically, emotionally, and intellectually demanding" experience which "requires longitudinally-concentrated efforts on the part of the resident." Id. at 1. Residents develop through a combination of "didactic" and "clinical" experiences. Id. at 3. In regular didactic sessions, residents receive formal instruction to increase their knowledge and understanding of medicine. Id. at 11. Most of a resident's education occurs in the clinical setting, "within the context of the health care delivery system." Id. at 1. The resident participates directly in patient care under the guidance and supervision of the attending physicians on the program faculty. Id. Over time, as the resident demonstrates growth, the attending physicians delegate to the resident a progressively larger share of the responsibility for patient care. Id. at 28. The faculty members also evaluate the resident's progress and advise the program director on decisions such as the promotion, remediation, or dismissal of a resident. Id. at 20.

In July 2009, Dr. Gurbani started a residency in orthopaedic surgery at the University of Pennsylvania. She was placed on probation at the end of her first postgraduate year. She was reinstated as a resident in good standing as of November 2010, at which point she left that program. In a letter protesting the probation, she acknowledged that "the decision to place [her] on probation was based on [her] performance for [her] entire" first postgraduate year. In the present litigation, Dr. Gurbani seeks to characterize that probation as "nonacademic." ¹

Dr. Dawn LaPorte, director of the orthopaedic surgery residency program at Johns Hopkins University School of Medicine, spoke with Dr. Gurbani while she was serving out her probation. The University of Pennsylvania disclosed in writing that, although Dr. Gurbani had satisfied the requirements of the first year of her residency, she had been subject to "disciplinary action in the form of probation[.]" Although Dr. LaPorte knew about the probation, she invited Dr. Gurbani to transfer to Johns Hopkins.

Along with the transfer, Dr. Gurbani registered with the Maryland Board of Physicians as an unlicensed practitioner. On her application, she answered "No" to a question that asked whether she had ever been "placed on probation ... while in a postgraduate residency training program[.]" Dr. Gurbani claims that Dr. LaPorte had advised her that she should not disclose her previous probation to the Board of Physicians. Dr. LaPorte denies that she ever advised Dr. Gurbani in that way. When Dr. Gurbani renewed her registration in the following year (without consulting with Dr. LaPorte), she again represented to the Board of Physicians that she had never been on probation during a residency.

B. The Initial Resident Contract: July 2011 through June 2012

On July 1, 2011, Dr. Gurbani entered into a one-year contract with Johns Hopkins University through its School of Medicine. Under the contract, she was appointed as a second-year postgraduate resident in the five-year program in orthopaedic surgery. The contract required her to provide clinical services at Johns Hopkins medical facilities in exchange for a stipend, liability insurance, and other benefits.

The residency contract covered both employment and educational services. It required Dr. Gurbani to "[f]ulfill the educational requirements of the Program." It required the University to provide "appropriate and adequate faculty and Medical Staff supervision for all educational and clinical activities." It stated that the program director and faculty would "[e]valuate" Dr. Gurbani's "educational and professional progress and achievement ... on a regular and periodic basis."

The contract authorized the program director, Dr. LaPorte, to take "corrective action" under the University's general policy for probation, suspension, and termination if she deemed Dr. Gurbani's performance to be deficient. It required the University to "[p]rovide a mechanism to fairly deal with academic or disciplinary actions" through the University's general grievance policy. The contract included a list of references to those written policies, which were available to Dr. Gurbani through the University's website.

The University expressly disclaimed any commitment to promote Dr. Gurbani at the end of the one-year term. The contract stated: "Reappointment and/or promotion to the next level of training is in the sole discretion of the Program Director and is expressly contingent on several factors, including ... satisfactory completion of all training components, [and] satisfactory performance evaluations[.]" The contract required the University to give written notice at least four months before the end of the term in the event that it might decline to renew the appointment. But if the "primary reason" for the nonrenewal occurred within those last four months, the contract required written notice as far in advance "as the circumstances w[ould] reasonably allow."

The contract stated that, although the parties anticipated that the appointment would continue for the one-year term, the University could terminate the contract at any time on the grounds specified in the contract. The contract identified a resident's failure to satisfy educational or professional responsibilities as a ground for termination. The contract permitted Dr. Gurbani to pursue a grievance with the University in the event of non-renewal of her appointment or termination from the program.

C. Assessments from Dr. Gurbani's First Three Rotations

Beginning in July 2011, Dr. Gurbani progressed through a series of rotations focusing on different aspects of orthopaedic medicine at Johns Hopkins. Each rotation lasted for about 10 weeks. Her first rotation was at the Bayview Medical Center, her second was on the Hopkins spine service, and her third was in sports medicine.

Members of the program faculty completed formal evaluations. On mid-rotation evaluations, faculty members used a scale of 1 to 3 to assess whether a resident was meeting expectations in different areas. On end-rotation evaluations, faculty members used a...