By Greg Care

A recent federal court decision provides a cautionary tale about the rights of resident physicians accused of misconduct, and importance of taking full advantage of internal “due process” hearings.

According to Knapik v. Mary Hitchcock Memorial Hospital, a recent federal court decision from Vermont, Dr. Thersia Knapik sued her program after she was terminated in the last year of her general surgery residency. According to the court’s opinion, one of Dr. Knapik’s co-residents (dubbed “Dr. Doe” by the court for privacy reasons) received a letter from the residency program warning her that she was deficient in the competency of professionalism. Approximately a year later, Dr. Knapik learned that Dr. Doe had been accepted to a fellowship program that did not know about the deficiency letter. Believing it to be her ethical duty, Dr. Knapik anonymously sent the letter to Dr. Doe’s fellowship program. Unbeknownst to Dr. Knapik, however, Dr. Doe had specifically consulted with her present program director, who told her that she need not disclose the letter or state that she was ever on probation.

After discovering that Dr. Knapik was the one who sent the anonymous letter, the residency program terminated Dr. Knapik because it deemed her actions to be a serious lapse in professional judgment and contrary to the program’s policies. The program also immediately informed Dr. Knapik’s fellowship program of her termination, which resulted in that position being rescinded.

Dr. Knapik’s residency contract allowed her to contest the termination through an internal “due process,” or grievance, proceeding. Instead, Dr. Knapik filed suit in federal court – and lost. The court granted a motion for summary judgment in favor of the program to end Dr. Knapik’s lawsuit against it.

It is not clear why Dr. Knapik chose not to pursue the internal due process hearing route afforded to her. Perhaps she believed the hearing did not actually offer “due process” – an opinion for which she can hardly be blamed. The hearing process required extremely short notice (five days) for the resident to submit a statement as to why the termination was improper, the hearing would have been limited to five witnesses per side, and the resident would not have been permitted to have an attorney present at the hearing. I’ve written in other blog posts about the problems these kinds of restrictions create.

In any event, Dr. Knapik’s decision to forgo the grievance process nearly ended her case. The program argued that, under the so-called “exhaustion-of-remedies rule,” Dr. Knapik was obligated to pursue the grievance process before going to court. The court ruled that ordinarily a resident would have to follow the internal grievance process until completion before bringing a court case, but that in this case, the program’s actions rendered the grievance process futile since there was no chance the Program would change its mind.

However, Dr. Knapik’s legal challenge ultimately foundered on the shoals of judicial deference to discretionary judgments of medical training programs. The court found that the program’s decision to terminate Dr. Knapik because of professionalism concerns was an exercise of its significant discretion in an academic matter, as opposed to a strictly employment matter in which the program has less discretion. Under the circumstances, the court was reluctant to second-guess the program’s decision as to who was unfit to continue in and graduate from a medical training program.

Regardless of how heavily the deck may seem stacked against residents in internal due process hearings, they can be strategically valuable, particularly with experienced counsel to help residents prepare. In some cases, a carefully planned presentation at a due process hearing can convince a panel of peers with arguments that a court will be reluctant to entertain because of its deference to residency programs. Further, an attorney can help residents create the most advantageous record of evidence to be used after a due process hearing, either in negotiations with the program’s attorneys or in a later court case. In short, internal hearings are an opportunity that ordinarily should not be forfeited.

If you are facing discipline in your residency program, consider contacting us as early as possible to assist you in planning to most effective presentation for your due process hearing.

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