Shaboon v. Duncan
| Decision Date | 24 May 2001 |
| Docket Number | No. 00-50175,00-50175 |
| Parties | (5th Cir. 2001) MAY SHABOON, M.D. Plaintiff-Appellee, v. CHARLES A. DUNCAN, M.D., ETC.; ET AL., Defendants, CHARLES A. DUNCAN, M.D.; TONI DOLLINGER, M.D.; UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO, TEXAS, Defendants-Appellants, |
| Court | U.S. Court of Appeals — Fifth Circuit |
Appeal from the United States District Court for the Western District of Texas.
Before JONES and DeMOSS, Circuit Judges, and BARZILAY,* Judge.
Plaintiff-appellee Dr. May Shaboon sued the appellants, and many other parties, on numerous federal and state claims after she was terminated from a state school's medical residency program. The trial court painstakingly sifted through Shaboon's claims, granting dismissals or summary judgment to most of the defendants. Drs. Duncan and Dollinger were denied summary judgment on some of their claims of qualified immunity, and the medical school unsuccessfully sought Eleventh Amendment immunity against Shaboon's ADA claim. On appeal by these remaining defendants, we sustain the doctors' contentions but conclude that the Health Science Center's immunity claim is best reviewed by the district court in the first instance, following a recent Supreme Court decision.
Appellant University of Texas Health Science Center at San Antonio ("Health Science Center") is a state-sponsored medical school.
Under a contractual arrangement, doctors in post-medical-school residency programs at the Health Science Center have clinical privileges at a hospital owned by the Bexar County Hospital District ("Hospital District") and the local VA Hospital. Residents receive a stipend from one of the hospitals and may treat patients under the supervision of hospital staff physicians. The residents sign a memorandum of understanding with the hospitals stating that, "under no circumstances will either Party terminate this agreement prior to its expiration date without prior notice and without providing the other party the opportunity to discuss freely any differences, dissatisfactions, or grievances that may exist." If the Health Science Center terminates a doctor's residency, that doctor loses clinical privileges at the hospitals.
Shaboon began the second year of a three-year internal medicine residency at the Health Science Center in August 1993. The director of her residency program was appellant Dr. Charles Duncan, a professor at the Health Science Center. Duncan also served on the Hospital District's executive committee, which plays a central role in administering corrective actions.
On August 2, Shaboon had just finished a week in which she claimed to have worked one hundred and eight hours. Duncan sent her home because she looked tired. Shaboon returned on August 3 and observed a morning report in which Duncan and several residents were discussing a mentally ill patient. Shaboon stated that the residents were pointing and laughing at her, and she believed that the group was talking about her. According to Duncan, Shaboon actually believed she was the patient. Based on this event, he persuaded her to see a psychiatrist.
Appellant Dr. Toni Dollinger, the Chief Resident in psychiatry at the Health Science Center, examined Shaboon. Dollinger's notes from the exam state that Shaboon was very tense, guarded, and moderately depressed. Shaboon discussed the morning incident and stated that she was not recording her patient interactions on charts. Shaboon reportedly was having trouble sleeping and could not manage her patients and interns. She was not violent or suicidal. Dollinger testified in deposition that Shaboon was not thinking rationally, but was capable of making an informed decision about seeking hospitalization.
Dollinger concluded that Shaboon satisfied the criteria for involuntary hospitalization. She urged Shaboon to check into a mental hospital voluntarily, and threatened to fill out involuntary commitment paperwork if Shaboon did not.
Shaboon has a different account of Dollinger's warning. Dollinger reportedly said the police would take Shaboon to a mental hospital in handcuffs if she did not go voluntarily. Dollinger allegedly said that Shaboon's friends would witness this and laugh, which would be bad for Shaboon's mental health. Dollinger allegedly also stated that an involuntary commitment would taint Shaboon's professional record.
Although Dollinger said that she did not threaten to have the police escort Shaboon to the hospital, she testified that it was "fairly common" for police to escort patients involuntarily to a hospital. Dollinger testified that she had initiated involuntary commitments over fifty times, and that she had called the police to escort patients on some of those occasions. She could not specifically recall whether the police had handcuffed her patients, but said "I imagine if they were combative they were [handcuffed]."
Shaboon agreed to go to the Villa Rosa mental hospital on her own. Dr. Christopher Ticknor examined Shaboon there. In an admission history dictated August 4, he wrote: "[h]ospitalization is indicated because of the severity of the patient's depression and the paralyzing nature of her obsessive-compulsive disorder." He later wrote that upon admission Shaboon was fully oriented to person, place, date, and time, and that she was not a danger to herself or to others. Ticknmor found that Shaboon was suffering from major depression, and that she was suffering from severe psychosocial stressors and obsessive ruminations about her professional performance. He found that she was "psychologically and physically exhausted and ha[d] deprived herself of sleep, normal appetite and relaxation...." Ticknor concluded that "[h]ospitalization is indicated because of the severity of the patient's depression and the paralyzing nature of her obsessive-compulsive disorder."
Shaboon remained at Villa Rosa until August 11. She decided to leave against Ticknor's recommendation, but did not immediately return to work or ask for time off. Despite his efforts to contact Shaboon, Duncan did not see her until August 16. When he saw her, he said she was absent without leave and required her to produce a psychiatric report confirming that she could resume treating patients.
Dr. Eileen Smith then evaluated Shaboon. Shaboon had stopped taking psychiatric medications that Ticknor had prescribed for her because they made her sick. Smith told Duncan that Shaboon was not ready to return to work. Ticknor confirmed this to Duncan. With Shaboon's consent, Duncan received copies of psychiatric records from Ticknor and Smith. According to records from Ticknor's hospital, Shaboon told doctors that her father sexually abused her when she was a child.
Duncan decided to keep Shaboon away from patients and told her to report daily to a conference room next to his office and read medical literature. He testified that he lacked authority to suspend her clinical privileges, and that only the Hospital District could do so. Duncan stated that he removed her from practicing temporarily on August 3, and characterized this as "redirecting" her activities. He said that he really wanted her to seek care and resolve her mental illness.
In an August 20 letter, Duncan and another professor at the Health Science Center placed Shaboon on probation with respect to her residency because of her mental illness and her refusal to cooperate with psychiatrists. The letter stated that Shaboon was not cooperating with Duncan and warned that the Health Science Center would dismiss her if she did not improve her behavior and performance.
Concurrently, Duncan began to discuss procedures to revoke Shaboon's clinical privileges with Dr. Nicholas Walsh, president of the Hospital District's medical-dental staff, and the district's legal counsel. Duncan wrote in a personal memorandum of August 18 that he had ordered Shaboon to prepare a statement about her difficulties in the program, but she did not initially cooperate with the order.
Duncan wrote to Walsh on August 19, requesting assistance under Hospital District bylaws to discipline Shaboon. Duncan testified in deposition that he believed the bylaws allowed Walsh to suspend Shaboon's privileges unilaterally.
The appellants assert that the Hospital District suspended Shaboon's clinical privileges at this point. They point to testimony and an October 4 Advocacy Committee letter suggesting that the Hospital District suspended her on an unspecified date in late August. Hospital District records show, however, that the district never suspended Shaboon. Walsh also could not recall suspending her.
At Duncan's suggestion, Shaboon met with doctors on the Hospital District Physicians Advocacy Committee ("Advocacy Committee"), which assists disciplined physicians in Hospital District proceedings. The committee members, themselves psychiatrists, asked to see Shaboon's psychiatric records and talk to her psychiatrist at the time, Dr. Malathi Koli. Shaboon offered only to give them Koli's opinion on her medical fitness and to receive written questions for Koli. She stated in her deposition that she did not want doctors in the hospital to know about her childhood sexual abuse. Duncan also asked to speak to Koli, but Shaboon offered him the same limited disclosure.
Rather than treat patients, Shaboon continued to report to the conference room, and later the hospital library, during September. Shaboon said that Duncan would not permit her to talk to other doctors about her situation or attend resident conferences and meetings. She alleged that during this period, Duncan taunted her about the descriptions of sexual abuse in her medical records. He reportedly made statements such as "I guess you don't want to talk about your father, huh," and "I guess you don't like being touched."
On September 10, the Advocacy...
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