LENK, J.
Massachusetts law prohibits employers from discriminating against their employees on the basis of, among other things, race or national origin. See G. L. c. 151B, § 4. Because direct proof of such discrimination is rarely available, employees filing claims under G. L. c. 151B, § 4, are permitted to prove discrimination without direct evidence of discriminatory intent, by relying on evidence that their employers gave a "false reason,"
The plaintiff, Bernard E. Bulwer, is a black male of African descent who is originally from the Central American country of Belize. The plaintiff has a medical degree from the University of the West Indies, and practiced medicine outside the United States until 2002, when he came to this country. In order to become certified to practice medicine in the United States, he was required to complete a residency program here. During the first year of his residency at the defendant Mount Auburn Hospital (hospital), the plaintiff received diametrically opposing reviews from supervising physicians, some laudatory and others deeply critical, after which the hospital terminated his employment. The plaintiff filed a ten-count complaint in the Superior Court against the hospital and three physicians who supervised his work, asserting, among other things, employment discrimination under G. L. c. 151B, § 4, and breach of contract.
We summarize facts drawn from the summary judgment record, reserving certain details for later discussion. See LeBlanc v. Logan Hilton Joint Venture, 463 Mass. 316, 318 (2012) (LeBlanc). The plaintiff, in addition to his medical degree, has postgraduate training in a number of fields, including cardiovascular disease. He practiced medicine in Trinidad, Belize, and the United Kingdom from 1989 through 2002. In 2002, the plaintiff came to the United States as a research associate and fellow in a subresidency cardiology program at another hospital in Boston, where he worked until 2005.
In August, 2005, the plaintiff signed the hospital's standard medical resident agreement (agreement), setting forth the terms and conditions of his employment. The agreement was for a one-year term, renewable for an additional two years upon satisfactory completion of the first-year program.
The agreement stated that the hospital and its residency program would comply with the requirements promulgated by the national Accreditation Council for Graduate Medical Education (ACGME). ACGME requires, among other things, that member programs not discriminate against residents on grounds including race and national origin. It also requires that programs provide residents with written procedures that must be followed in the event a program seeks "academic or other disciplinary action" against a resident.
The hospital's written procedures state that, should a resident's supervisors decide to terminate a resident's employment, a resident has the right to convene an ad hoc committee
After signing the agreement, the plaintiff began his residency in September, 2005. The first-year program consisted of twelve one-month rotations in a number of different "services" throughout the hospital. The plaintiff's performance was to be evaluated by attending physicians and resident supervisors in each of the services where he worked. The evaluating physicians were to fill out evaluation forms, which called for numerical ratings of various aspects of the plaintiff's performance, as well as for written comments. These evaluations in turn would be given to the clinical competence committee (CCC), a panel of thirteen physicians who met regularly to discuss the progress of all of the residents. The plaintiff was also assigned a mentor, the defendant Dr. Lori Balestrero.
The plaintiff's first rotation in September was in the hospital's emergency department. The plaintiff received strongly positive evaluations in that department. Two physicians rated him as "outstanding," and five others rated him "above average." They described him as knowledgeable, mature, and pleasant to work with. Dr. Gary Setnik, head of the emergency department, provided a more lengthy written evaluation:
"Dr. Bulwer is universally held in high regard by the staff I polled and by myself. He has been totally reliable, coming in early, and staying late on most shifts. He aggressively works to see as many patients as possible. His presentations are complete, his management plans appropriate, and his procedural skills very good."
The next month, the plaintiff rotated into the medical intensive care unit (MICU). There, he received mixed evaluations. In an October, 2005, electronic mail message to a colleague, Dr. Soon-Il Song wrote positively that
Setnik reported that both he and other members of his department received harsh comments from members of the MICU staff for his positive evaluations of the plaintiff. He described this as "[a]n experience that I hadn't previously had at Mount Auburn."
In November, 2005, Balestrero, the plaintiff's mentor, met with the plaintiff to discuss the negative feedback. The plaintiff told her that he thought the negative impressions were inaccurate. Balestrero then met with the CCC to discuss ways in which the plaintiff could improve. Following this meeting, Balestrero presented the plaintiff with a plan for improvement that she had developed together with the CCC. The plan included a provision for weekly meetings with Balestrero and a follow-up meeting, to be held after evaluations from the December rotation were received, with the plaintiff, Balestrero, and a CCC representative. Neither the weekly meetings nor the follow-up meeting took place.
During November and December of 2005, the plaintiff was assigned a "wards" rotation in which he provided general internal medicine care for patients who had been admitted to the hospital. The three evaluations from that rotation that appear in the record were positive, with one evaluator noting "much improvement," and another stating that the plaintiff was "[o]verall . . . pretty good." The third evaluator assigned a passing grade, but stated that the plaintiff needed improvement in "practice-based learning,"
In January, 2006, the plaintiff rotated into the cardiology department. He received three evaluations of his work on that service. One rated him as failing in five of six competencies, but another gave him high marks in all competencies, and the third described his presentations as "very commendable" and his knowledge as "excellent." In mid-January, 2006, the plaintiff met with Balestrero, who told him that he had received positive evaluations and that "the past [was] behind [him]."
In February, 2006, the plaintiff rotated again into the wards service. One evaluator there rated him positively, while the other, Dr. Erica Bial, wrote a lengthy and negative evaluation in which she described her experience with the plaintiff as "horrendous." She stated that "[t]here is no aspect of the central competencies in which [the plaintiff] is even modestly competent." She described him as "less-than-fully-honest" and as having "a difficult time being appropriate with . . . women in the professional environment," and recommended that the plaintiff be expelled from the residency program. During this period, Bial "berated" the plaintiff publicly in a manner that a witness, Song, described as not "appropriate," and as unprecedented in his experience with Bial. Song also reported that Bial spoke negatively to other residents about the plaintiff, outside of the plaintiff's presence.
In March, 2006, the CCC discussed the plaintiff's mixed evaluations. On April 5, 2006, the CCC sent the plaintiff a letter stating that it would not renew his contract because of concerns about his ability to analyze complex information, his inability to "build effective therapeutic relationships," and his difficulty presenting information to other members of his teams. The letter stated also that the plaintiff could finish his first year of residency, working until the end of his contract term in August, 2006. The letter was signed by Flint and by the defendant Dr. Ricardo Wellisch, chair of the CCC.
The plaintiff invoked his right to convene an ad hoc committee pursuant to the hospital's "due process" policy. Although the committee consisted of most of the individuals specified in that written policy, no resident was seated on it, as required by the policy. Further, of the committee's three meetings, the plaintiff was invited to attend only the first one, which took place on April 24, 2006. At that first meeting, as well as at the second, on May 2, 2006, the committee heard testimony from physicians who had
On May 9, 2006, the committee sent a letter to Dr. Stephen Zinner, chair of the department of medicine, stating that it would affirm the decision of the CCC not to renew the plaintiff's contract. On May 17, 2006, Zinner informed the plaintiff verbally that, because of "serious additional concerns" for "patient safety" that had arisen "in the past [three] weeks," the plaintiff would "be immediately relieved of his responsibilities."
The plaintiff sent a letter dated May 18, 2006, to the president and chief executive officer of the hospital stating his desire to appeal, as provided in the due process policy, from the committee's decision not to renew his contract and to terminate his employment immediately. The president responded with a certified letter, return receipt requested, saying that she would convene such a committee. The plaintiff did not retrieve the letter from the postal service, which attempted delivery three times, and did not pursue the appeal.
In August, 2006, the plaintiff filed a charge of discrimination against the hospital with the Massachusetts Commission Against Discrimination. In February, 2008, the plaintiff filed his complaint in the Superior Court, naming the hospital, Balestrero, Flint, and Wellisch as defendants. During discovery, depositions were taken of various doctors who had worked with the plaintiff, including Dr. Ramona Dvorak, an African-American internist and psychiatrist formerly employed at the hospital, who described what she believed to have been incidents of racism she experienced during her employment. Following discovery, in December, 2010, the defendants sought summary judgment on all counts; in June, 2011, their motion was allowed.
The plaintiff contends that the motion judge erred in allowing the defendants' motion for summary judgment on his claim for employment discrimination on the basis of his race and national origin, in violation of G. L. c. 151B, § 4, and on
A motion for summary judgment under Mass. R. Civ. P. 56 (c), as amended, 436 Mass. 1404 (2002), is appropriate where "the moving party . . . `show[s] that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law' based on the undisputed facts." Premier Capital, LLC v. KMZ, Inc., 464 Mass. 467, 474 (2013), quoting Mass. R. Civ. P. 56 (c). "In reviewing the . . . grant of a motion for summary judgment, we conduct a de novo examination of the evidence in the summary judgment record . . . and view the evidence in the light most favorable to the part[y] opposing summary judgment" (citation omitted)," LeBlanc, supra at 318, "drawing all reasonable inferences in [the nonmoving party's] favor." Sullivan v. Liberty Mut. Ins. Co., 444 Mass. 34, 38 (2005) (Sullivan).
General Laws c. 151B, § 4, provides that "[i]t shall be an unlawful practice . . . [f]or an employer . . . because of the race, color, . . . [or] national origin . . . of any individual . . . to discharge from employment such individual or to discriminate against such individual in compensation or in terms, conditions or privileges of employment." In order to prevail at trial, an employee bringing a complaint under G. L. c. 151B, § 4, must demonstrate four things: that he or she is a member of a protected class; that he or she was subject to an adverse employment action; that the employer bore "discriminatory animus" in taking that action; and that that animus was the reason for the action (causation). See Lipchitz v. Raytheon Co., 434 Mass. 493, 502 (2001) (Lipchitz). The question here is whether the plaintiff provided evidence from which a reasonable jury could infer the presence of the latter two elements, i.e., that the defendants bore discriminatory animus and that the animus was the reason the defendants terminated the plaintiff's employment.
In the pretrial context, an employee asserting a discrimination claim under G. L. c. 151B, § 4, may survive a motion for summary judgment by providing "[d]irect evidence of [the] elements" of discriminatory animus and causation. Sullivan, supra at 39. Because such direct evidence "rarely exists," however, an employee plaintiff may also survive such a motion by providing
"In the first stage [of this paradigm], the plaintiff has the burden to show . . . a prima facie case of discrimination." Blare v. Husky Injection Molding Sys. Boston, Inc., 419 Mass. 437, 441 (1995) (Blare). To do so, a plaintiff must provide "evidence that: (1) he [or she] is a member of a class protected by G. L. c. 151B; (2) he [or she] performed his [or her] job at an acceptable level; [and] (3) he [or she] was terminated." Id. "In the second stage, the employer can rebut the presumption created by the prima facie case by articulating a legitimate, nondiscriminatory reason for its [employment] decision." Id. In the third stage, the burden of production
The defendants contend that, at this third stage, the plaintiff must present evidence that the "[hospital]'s reason for termination constituted a pretext concealing a discriminatory purpose" (emphasis supplied). Bulwer v. Mount Auburn Hosp., 86 Mass.App.Ct. 316, 347 (2014) (Sikora, J., dissenting) (Bulwer). See id. at 355 (Sikora, J., dissenting) (taking position that claim fails because plaintiff did not show "invidious intent"). This formulation, however, overstates the plaintiff's burden at the summary judgment stage because "Massachusetts is a pretext only jurisdiction." Blare, supra at 443. See Abramian v. President & Fellows of Harvard College, 432 Mass. 107, 114-115 (2000). As we explained in Lipchitz, supra at 500-501:
To survive a motion for summary judgment, the plaintiff need only present evidence from which a reasonable jury could infer that "the respondent's facially proper reasons given for its action against him were not the real reasons for that action." Wheelock College v. Massachusetts Comm'n Against Discrimination, 371 Mass. 130, 139 (1976) (Wheelock College). The case can then proceed to trial, at which point, "if the fact finder is persuaded that one or more of the employer's reasons is false, it may (but need not) infer that the employer is covering up a discriminatory intent, motive or state of mind."
The defendants also argue that, at this third stage, the burden of persuasion is on the "the plaintiff . . . to demonstrate that there is a genuine issue of material fact whether the defendants' proffered
In opposing the defendants' motion for summary judgment, the plaintiff relies on indirect evidence of discrimination, which we analyze using the McDonnell Douglas three-stage paradigm. The defendants concede, with regard to the first stage, that the plaintiff has satisfied his obligation to make out a prima facie case of discrimination.
The record contains at least five categories of evidence from which a jury might infer that these stated reasons were not the real reasons that the plaintiff's employment was terminated. When "taken as a whole rather than viewed in isolation," such evidence could lead a rational jury to conclude that the reasons for the plaintiff's discharge were pretextual. See Dorman v. Norton Co., 64 Mass.App.Ct. 1, 9-10 (2005).
First, while the record plainly contains negative evaluations tending to support the aforementioned criticisms, the record also contains numerous evaluations inconsistent with these criticisms. See Cole v. Ruidoso Mun. Schs., 43 F.3d 1373, 1380 (10th Cir. 1994) (reversing summary judgment for employer where conflicting evaluations raised fact questions about true reasons for adverse employment action). See also Bonefont-Igaravidez v. International Shipping Corp., 659 F.3d 120, 124 (1st Cir. 2011), quoting Gómez-González v. Rural Opportunities, Inc., 626 F.3d 654, 662-663 (1st Cir. 2010) ("pretext can be established by showing . . . `weaknesses [or] implausibilities . . . in the employer's offered reasons'"); 59 Causes of Action 2d, Cause of Action under Age Discrimination in Employment Act § 24 (2013) ("evidence of satisfactory or superior performance evaluations . . . may tend to show . . . the illegitimate nature of the defendant's articulated reason").
For example, some evaluators wrote of the plaintiff's "excellent" "ability to interpret and analyze clinical data, and formulat[e] a plan of management," even as the plaintiff was dismissed ostensibly because he could not "adequately analyze clinical data in complex cases." Similarly, some evaluators praised the plaintiff's "progress notes" as "very detailed and informative," "very thorough," and "generally well thought out," while others criticized him for "fail[ing] to document or comply with . . . expectations about chart notes." Moreover, evaluations noting that "several
There is, secondly, evidence that the plaintiff was treated differently from similarly situated interns who are not black. See Matthews, supra at 129 ("The most probative means of establishing that the plaintiff's termination was a pretext for racial discrimination is to demonstrate that similarly situated white employees were treated differently"). For example, Song named two foreign interns (one white and one apparently Asian) who experienced "similar issues" but who, unlike the plaintiff, "were given opportunities to remediate or repeat rotations."
Third, Dvorak, an African-American internist and psychiatrist, described three separate instances of Caucasian doctors whose deficient performances she and other staff members noticed and brought to the attention of hospital administrators, but who were not subject to disciplinary action until months or years after the complaints were made — and then only because of pressure from patients and other hospitals. Dvorak also noted an incident in which she found "white supremacist" literature in the break room. Although she told administrators "how upsetting [this] was, particularly [to her] as a[n] African-American," she maintains that the administrators rejected requests to discipline employees who displayed such literature in the workplace.
Fourth, a reasonable jury could interpret a number of comments by the plaintiff's evaluators and supervisors as reflecting "[s]tereotypical thinking . . . categorizing people on the basis of broad generalizations." Lipchitz, supra at 503 n.16. Although such statements in isolation would not be adequate to support a finding of discrimination, when considered with evidence of disparate or unfair treatment in the evaluation process, they may lend support to such a finding. See Conway v. Electro Switch Corp., 825 F.2d 593, 597 (1st Cir. 1987) ("While evidence of a discriminatory atmosphere may not be conclusive proof of discrimination against an individual plaintiff, such evidence does tend to add `color' to the employer's decisionmaking processes and to the influences behind the actions taken with respect to the individual plaintiff").
For instance, one evaluator criticized the plaintiff for being "too confident for his own good." Another said that someone in the plaintiff's position as an "intern is not supposed to be smart" and "[t]hat is why all of this [criticism] is happening." Yet another,
Fifth, there is evidence that the defendants did not follow their written procedures in deciding to terminate the plaintiff's employment. A "`failure to follow established procedures or criteria' . . . [may] support a reasonable inference of intentional discrimination." Nesbitt v. Holder, 966 F.Supp.2d 52, 56 (D.D.C. 2013), quoting Brady v. Office of the Sergeant at Arms, 520 F.3d 490, 495 (D.C. Cir. 2008). See 1 A. Larson, Employment Discrimination § 8.04, at 8-81 to 8-82 (rev. ed. 2015) ("pretext can be shown by
Here, the defendants departed from their written due process policy by failing to include a resident on the ad hoc committee, by not allowing the plaintiff to attend two of the three meetings of that committee, and by failing to heed the plaintiff's request for materials from those meetings. The defendants further departed from this policy when they immediately terminated the plaintiff's employment without having informed him, either before or after the ad hoc committee meeting, that this step was being considered.
The defendants argue that these five categories of evidence do not suffice to raise a question of material fact. They note that, even if all of the inferences drawn by the plaintiff from the above evidence were reasonable, the ad hoc committee conducted "an expanded review" of the CCC's decision to terminate his employment and "concluded that the [plaintiff's] deficiencies remained serious." Bulwer, supra at 355 (Sikora, J., dissenting). A "third [party]'s independent decision to take adverse action," they argue, "breaks the causal connection between [any] retaliatory or discriminatory animus [harbored by the plaintiff's evaluators] and the adverse action." Mole v. University of Mass., 442 Mass. 582, 598 (2004). This argument is unavailing.
In addition to input from the plaintiff, the ad hoc committee based its conclusions on the evaluations relied on by the CCC, as well as on testimony from the physicians who wrote those evaluations and on statements and memoranda from the CCC itself. Where "the decision makers relied on the recommendations of supervisors [whose motives have been impugned], the motives of the supervisors should be treated as the motives for the decision. . . . An employer [may not] insulate its decision by interposing an intermediate level of persons in the hierarchy of decision, and asserting that the ultimate decision makers acted only on recommendation" (citation omitted). Trustees of Forbes Library v. Labor Relations Comm'n, 384 Mass. 559, 569-570 (1981). See Cariglia v. Hertz Equip. Rental Corp., 363 F.3d 77, 83 (1st Cir. 2004) ("liability can attach if neutral decision makers, when deciding to terminate an employee, rely on information that is inaccurate, misleading, or incomplete because of another employee's discriminatory animus").
The defendants also argue, in essence, that criticisms of the plaintiff's performance, even if harsh, are best read to reflect "professional"
In this regard, summary judgment remains "a disfavored remedy in the context of discrimination cases based on disparate treatment . . . because the ultimate issue of discriminatory intent is a factual question" (citations omitted).
To prevail on a claim for breach of contract, a plaintiff must demonstrate that there was an agreement between the parties; the agreement was supported by consideration; the plaintiff was ready, willing, and able to perform his or her part of the contract; the defendant committed a breach of the contract; and the plaintiff suffered harm as a result. Singarella v. Boston, 342 Mass. 385, 387 (1961). At issue here is the fourth element, i.e., whether the defendants committed a breach of the contract embodied in the medical resident agreement.
The plaintiff maintains that the defendants committed such a breach in five ways: by failing to comply with the ACGME's nondiscrimination policy; by failing to include a resident on the ad hoc committee as required by the hospital's written procedures; by failing to advise the plaintiff, in advance, of certain items to be discussed by the ad hoc committee; by failing to provide him with the resources and supervision necessary to perform his job; and by failing to offer him an opportunity to appeal from the decision of the ad hoc committee.
With regard to the first allegation, the defendants were bound by the ACGME's nondiscrimination policy prohibiting discrimination based on race or national origin. This policy was incorporated by reference in the medical resident agreement. See Chicopee Concrete Serv., Inc. v. Hart Eng'g Co., 398 Mass. 476, 478 (1986) ("incorporation by a clearly stated general reference will suffice"). Whether the defendants violated this policy requires analysis of much the same evidence noted in our discussion of the plaintiff's discrimination claim. For similar reasons, we conclude that the
Turning to the second allegation — failure to include a resident on the ad hoc committee — it is undisputed that the ad hoc committee did not include a resident. The inclusion of a resident was required by the hospital's grievance policy, which the hospital was to follow under the terms of the ACGME requirements and thereby under the medical resident agreement as well. Although the defendants claim that the plaintiff was not harmed by this failure to comply with the medical resident agreement, that is a question of fact for the jury.
It is also undisputed that the plaintiff was not invited to the latter two meetings of the ad hoc committee and that the defendants failed to notify the plaintiff, in advance of those meetings, that they were considering immediately terminating his employment. There is also no indication in the record that the plaintiff was ever given any information about "additional" concerns cited by the committee regarding patient safety notwithstanding the plaintiff's request for pertinent information. The hospital's grievance policy, however, requires that a resident receive from the department chair in advance of the meeting a "written statement of the specific issues [to be discussed at the meeting]."
The plaintiff contends further that the defendants failed to provide him, as required by the ACGME, with the "appropriate supervision" and "resources" necessary to perform his work. In this regard, the plaintiff has proffered evidence that his mentor did not hold weekly meetings with him as outlined in his remediation plan. More generally, he points to evidence, detailed earlier, that he was not offered the same remediation opportunities as similarly situated peers, which could be construed as a failure to provide
The judgments in favor of the defendants on the plaintiff's claims for employment discrimination under G. L. c. 151B, § 4, and breach of contract are vacated and set aside. The matter is remanded to the Superior Court for further proceedings consistent with this opinion.
So ordered.
Lipchitz, supra at 502.