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Knapik v. Mary Hitchcock Memorial Hospital

United States District Court, D. Vermont

February 3, 2015


For Thersia J. Knapik, Plaintiff: Anthony Z. Roisman, Norman E. Watts, Jr., Watts Law Firm, PC, Woodstock, VT.

For Mary Hitchcock Memorial Hospital, Defendant: Edward M. Kaplan, Esq., William D. Pandolph, Sulloway & Hollis, P.L.L.C., Concord, NH.

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Geoffrey W. Crawford, United States District Judge.

Plaintiff Thersia Knapik brought suit against Mary Hitchcock Memorial Hospital (MHMH) for wrongful termination and breach of contract after she was dismissed from MHMH's general surgery residency program for sending a letter concerning another resident to a medical fellowship program and state licensing board. Currently before the court is MHMH's motion for summary judgment on all of Dr. Knapik's claims. A hearing was held on MHMH's motion on January 7, 2015. The parties agree that this case is governed by the law of New Hampshire.

I. MHMH's Request to Strike Post-Hearing Letter

Following the oral argument on January 7, plaintiff's counsel filed a letter with the court addressing two issues which came up during MHMH's final remarks. (Doc. 148.) MHMH has filed a detailed response. In addition, MHMH requests that the court strike plaintiff's letter. (Doc. 149.) The court declines to strike the letter. As occasionally happens, new issues arose at the end of the oral argument. Both sides have now addressed these issues. The court was assisted both by the letter from plaintiff's counsel and by the additional memorandum filed by MHMH. The record should include both statements, and the court considered both in drafting this decision. The request to strike the letter from plaintiff's counsel (Doc. 148) is DENIED.

II. Factual Background

The undisputed facts are as follows. In June 2007 two young physicians commenced their residency training in general surgery at MHMH. (Doc. 138 ¶ 8.) Dr. Knapik and her colleague, who is identified as " Dr. Doe," became friends in the early years of their training. Over time and as a result of several small slights and disputes, the friendship between the two women cooled. (Doc. 138-8 at 41.)

In February 2011, Dr. Samuel Finlayson, program director for the general surgery residency program, sent Dr. Doe a letter detailing serious concerns about her performance as a resident. (Doc. 138-3 at 31-32.) The letter urged her to address

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these shortcomings in order to complete the residency program on time. The letter expressed Dr. Finlayson's concern that Dr. Doe needed to show improvement in the areas of patient care, medical knowledge, clinical decision-making, and professional relations. It warned that without " [c]lear improvement in your performance . . . you will either have to repeat the 4th year [of residency], or end your training at DHMC." [1] ( Id. at 32.) The letter noted that informal reviews of Dr. Doe's recent performance in the vascular service were good and that this " hopefully signals that you have begun to turn the comer in your progress from junior to senior level work." ( Id.)

The letter from Dr. Finlayson does not state that Dr. Doe was placed on probation, and Dr. Doe was never on probation at any time during her residency at MHMH. ( Id. at 32, 47; Doc. 138-9 at 4-5.)

At some point in the spring of 2011, Dr. Knapik came into possession of a copy of Dr. Finlayson's letter. The parties disagree about whether Dr. Doe voluntarily shared the letter with Dr. Knapik. (Doc. 9 ¶ 24; Doc. 138 ¶ 33.) For purposes of MHMH's motion for summary judgment, the court assumes that Dr. Knapik's version--that Dr. Doe gave her a copy of the letter--is correct.

Residents at MHMH, including Dr. Knapik, serve successive one-year terms and sign a new residency agreement for each term. (Doc. 138-3 at 2-3, 9-11, 14-16, 20-22, 25-27.) Their stipend increases slightly each year. In other respects, the conditions of their employment remain the same. Dr. Knapik signed the residency agreement for her fifth and final year of the residency program in June 2011. ( Id. at 27.) Paragraph 5 of the residency agreement incorporates the provisions of MHMH's Graduate Medical Education Policies and Procedures Manual for Residents and Fellows (the Manual) into the residency agreement. ( Id. at 25.) The paragraph identifies twelve provisions of the Manual which govern the resident's relationship with the residency program. " Grievance procedures and due process" are specifically identified at paragraph 5(a). ( Id.)

In the spring of 2012, both Dr. Doe and Dr. Knapik were approaching the end of their residencies. Graduation was scheduled for June 2012. Prior to graduation, Dr. Doe was accepted into a surgery fellowship at the University of Kentucky. (Doc. 138 ¶ 54.) As part of the application she submitted to the Kentucky Board of Medical Licensure, she was required to disclose any disciplinary proceeding against her, including whether she had ever been placed on probation by MHMH. (Doc. 138-3 at 41-46.) The specific question was " Have you ever been dismissed from, resigned while under investigation, been placed on a disciplinary probation or reprimanded at a medical school or a postgraduate training program? (Academic probation is not reportable.)" ( Id. at 42.)

Dr. Doe checked with Dr. Finlayson to make certain that his letter of February 2011 did not place her on probation. (Doc. 138-8 at 24-25.) He advised her that she had not been placed on probation. ( Id.) She answered the question concerning probation and other discipline " No." (Doc. 138-3 at 42.)

Through an informal conversation with Dr. Doe's mother at a social gathering in the spring of 2011, Dr. Knapik learned that Dr. Doe had not disclosed the February

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2011 letter to the fellowship program or the licensing authority in Kentucky. (Doc. 138-8 at 26-27.) In May 2012, Dr. Knapik mailed a copy of the letter to both offices in anonymous envelopes that bore the MHMH return address. (Docs. 138-2 at 10; 138-13 at 16.)

The director of the Kentucky fellowship program, Dr. Endean, was disturbed when he received the anonymous mailing. (Doc. 138-7 at 2.) He contacted the director of the vascular surgery fellowship program at MHMH. ( Id.) Through a process of tracing computer inquiries on the MHMH system, the MHMH administration developed a suspicion that Dr. Knapik was the source of the anonymous letter. (Doc. 138 ¶ ¶ 119-21.)

When confronted by administrators of the residency program, Dr. Knapik first denied and later admitted that she had sent the letter. (Docs. 138-13 at 17; 138-6 at 5.) Dr. Knapik believed she was required to send the letter as a matter of professional ethics because in her view, Dr. Doe had been dishonest with the medical authorities in Kentucky. (Docs. 9 ¶ ¶ 42-43; 138-13 at 9.)

The administrators of the residency program determined that Dr. Knapik had acted in a manner incompatible with the role of a physician and in violation of the Dartmouth-Hitchcock Code of Ethical Conduct. On June 13, 2012, Dr. Paul Kispert, director of the General Surgery Residency Program, and Dr. Marc Bertrand, Associate Dean for Graduate Medical Education, sent Dr. Knapik a letter which informed her of her dismissal from the General Surgery residency program. (Doc. 138-2 at 1.) The letter stated in part:

On or about May 5, 2012, you sent a Dartmouth-Hitchcock privileged Quality Assurance (QA) document regarding a colleague to that colleague's future employer. You have admitted to anonymously sending this QA document to the fellowship director. Your printing and forwarding of this document was not authorized by your colleague, nor was it authorized by the author of the document. This egregious action violates the Dartmouth-Hitchcock (D-H) Code of Ethical Conduct (Practice Respect for Persons; Protect Confidential and Proprietary Information; Maintain Personal Honesty and Integrity; Respect for Property and Laws) and Dartmouth-Hitchcock Information Systems Policies (Appropriate Use of Computer Resources; Electronic Mail). Additionally, according to the ACGME [Accreditation Council for Graduate Medical Education], " residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles." Your actions violate the ACGME core competency of Professionalism.
Furthermore, you have not taken responsibility for the consequences of your actions. Although you admit to sending the QA documents without permission, you do not appear to understand the seriousness of this behavior and have shown no remorse for your actions. . . .
Included with this notice of termination is a copy of our GME grievance process and procedures. Should you choose to pursue the grievance option described in these attachments, you must notify Dr. Bertrand in the Offices of Graduate Medical Education within five (5) days of receipt of this letter. ( Id.)

The Policies and Procedures Manual for the Dartmouth-Hitchcock Residency and Fellowship Programs describes the grievance process in several related chapters. First, it ...

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