MATTHEW W. BRANN, District Judge.
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.
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.
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.
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,
But according to Dr. Ramalingam, his performance remained exemplary as other physicians rated him highly on periodic evaluations of his work
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.
Dr. VanderMeer communicated the RPC's decision to Dr. Ramalingam,
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. Ramalingam in June 2015.
At some point, Dr. Ramalingam began to correspond directly with ACGME. In May 2015, ACGME told Dr. Ramalingam that he need not complete the 750-procedure requirement to graduate. This announcement, however, came after Dr. Molinari withdrew the fellowship offer.
Dr. Ramalingam ultimately graduated from RPH's surgical residency program in September 2015 after completing Defendants' remediation program. He explains that because Defendants' wrongful actions deprived him of his HPB fellowship, he has been unable to secure the type of full-time employment he otherwise may have been able to obtain.
Dr. Ramalingam later filed a four-count complaint in this Court. In Count I, he alleges that Defendants breached their contract with him by, inter alia, not seeking a waiver of the 750-procedure requirement from ACGME. In Count II, a promissory estoppel claim, he alleges that Defendants made "multiple representations, promises, and assurances" to him, which he reasonably relied on to his detriment. In Count III, he alleges that Defendants' actions amounted to tortious interference with his contractual relationship with Dalhousie University — i.e., with his HPB fellowship there. In Count IV, he alleges that Defendants' actions amounted to tortious interference with prospective business relations — i.e., with job offers he could have sought had he successfully completed the HPB fellowship at Dalhousie University. Defendants moved to dismiss Count II, Count III, and Dr. Ramalingam's claim for punitive damages for failure to state a claim upon which relief may be granted.
Defendants presently move for summary judgment on all counts of Dr. Ramalingam's complaint.
Summary judgment is granted when "the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law."
Defendants argue that they are entitled to immunity under the HCQIA for all of Dr. Ramalingam's state law claims.
Congress passed the HCQIA to immunize professional review bodies from state law claims for money damages in an effort "to improve the quality of medical care by encouraging physicians to identify and discipline physicians who are incompetent or who engage in unprofessional behavior."
For an individual or entity to enjoy HCQIA's immunity, the challenged decision must have been made as part of a "professional review action," defined as:
However, if the challenged decision was primarily based on "any other matter that does not related to the competence or professional conduct of a physician," — i.e. if the peer review action was pretextual — it cannot be considered a "professional review action" and accordingly, the challenged decision lies outside of the HCQIA's immunizing umbrella.
Here, although courts may decide whether HCQIA immunity applies as a matter of law once the record becomes sufficiently developed,
On the other hand, a jury could credit evidence favorable to Dr. Ramalingam and find that the RPC was convened and ultimately decided to hold Dr. Ramalingam back primarily to protect the general surgery program and Dr. VanderMeer's position as program director.
Accordingly, because the jury must decide who to believe, the Court cannot at this time decide the applicability of the HCQIA, and summary judgment on this basis must be denied.
Defendants argue that Dr. Ramalingam's breach of contract claim must fail because Dr. Ramalingam does not attach a contract to his complaint, does not set forth specific contractual terms, does not identify which of those terms were breached, and any damages flowing from the alleged breach were unforeseeable.
To prevail on his breach of contract claim under Pennsylvania law, Dr. Ramalingam must establish "(1) the existence of a contract, including its essential terms, (2) a breach of a duty imposed by the contract, and (3) resultant damages."
Here, although Dr. Ramalingam spends time in his brief setting forth the law related to written contracts and claims that he has "stated the specific terms Defendants breached and the manner by which they breached," he points this Court to no written contract between the parties.
To the extent Dr. Ramalingam argues that Defendants breached an enforceable contract because of their "failure to timely secure the necessary waivers, [and Dr.] Ramalingam did not graduate at the time promised, and lost his fellowship as a result, causing damages,"
Defendants attempt to argue that any promises made to Dr. Ramalingam were fulfilled, and accordingly, Dr. Ramalingam's promissory estoppel claim must fail.
To prevail on his claim for promissory estoppel claim under Pennsylvania law, Dr. Ramalingam must establish "(1) the promisor made a promise that he should have reasonably expected would induce action or forbearance on the part of the promisee; (2) the promisee actually took action or refrained from taking action in reliance on the promise; and (3) injustice can be avoided only by enforcing the promise."
Here, a jury could conclude that Defendants promised Dr. Ramalingam that they would contact ABS and ACGME to obtain a waiver for the 750 procedure requirement so that Dr. Ramalingam could graduate in July 2015,
Defendants further argue that Dr. VanderMeer did not contact Dr. Molinari intending to harm Dr. Ramalingam's contractual relationship with Dalhousie University.
To prevail on his claim for tortious interference with a contract under Pennsylvania law, Dr. Ramalingam must establish, inter alia, that Defendants intended to harm an existing contractual relation and had no justification in doing so.
In the matter at hand, a jury could infer that Dr. VanderMeer unjustifiably intended to harm Dr. Ramalingam's contractual relationship with Dalhousie University by crediting evidence that Dr. Molinari revoked the extension that Dr. Ramalingam negotiated for himself after Dr. VanderMeer contacted Dr. Molinari to discuss Dr. Ramalingam's delayed graduation.
Defendants additionally argue that Dr. Ramalingam has failed to adduce evidence of any prospective business relations with which Defendants allegedly interfered.
To prevail on a claim of tortious interference with prospective business relations under Pennsylvania law, Dr. Ramalingam must establish, inter alia, the existence of a prospective contractual relation.
Here, although Dr. Ramalingam argues that had he completed the HPB fellowship at Dalhousie University he would have been eligible for job offers in the HPB field, he adduces no evidence identifying prospective employers or prospective business relationships that were allegedly harmed by Defendants.
Finally, Defendants argue that Dr. Ramalingam has put forward insufficient evidence to warrant an award of punitive damages.
Accordingly, Defendants' motion to preclude the award of punitive damages as to Dr. Ramalingam's promissory estoppel claim is granted; but as to his tortious interference with a contract claim, the motion is denied.
For the foregoing reasons, Defendants motion for summary judgment is granted in part and denied in part. An appropriate Order follows.
