Auburn Hospital - WSLHD
Interfaces with physicians and hospital management staff in a positive and professional manner. Mount Auburn Hospital's logo. Meet Mount Auburn Hospital . HR Coordinator, Talent Acquisition & Development. Emergency Department Technician jobs available in Mount Auburn, MA on Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center. Mt. Auburn Hospital, Harvard Medical School and The Schwartz Center Max Planck Institute for Human Cognitive and Brain Sciences, Leipzip, Germany This course is designed to meet the following Institute of Medicine.
Works collaboratively with members of the CareTeam to ensure that patients receive skilled nursing care that meets their individual needs. This will be measured by Picker results. Participates in team meetings. Establishes relationships with staff that promote a professional and productive work environment. Evaluates and documents outcomes of patient care. Actively participates in quality assurance programs. Communicates with other team members regarding patients.
Serves as a resource for difficult or complex situations. Refers appropriate problems to nurse coordinator. Participates in presenting education programs to team members to ensure competence. Works with team members to monitor patient satisfaction and develop appropriate interventions.
Provides direct patient care as a member of the CareTeam. Provides and documents competent nursing care based on scientific principles and uses the nursing process and meets policy. Administers medications according to nursing, hospital, unit policy and procedures and meets outcome measures.
Education is planned and provided according to care plan and predicted Length of Stay for every patient who is alert and able to comprehend. Flint made the decision that in the interest of patient safety at Mount Auburn Hospital, Dr. Bulwer should be immediately relieved of his responsibilities as a medical intern. No mention of them is in the transcripts of the first or second sessions. Instead, the decision to terminate Bulwer was made after the last meeting of the ad hoc committee.
Indeed, the hospital admits that Bulwer was never informed that the ad hoc committee was considering terminating him due to alleged patient safety risks. The hospital also admits that the first Bulwer learned of this possibility was when he was notified of his termination. On May 17,Flint sent a mass e-mail to employees of the hospital informing them that Bulwer had been terminated. He concluded the e-mail: Yet the need to take this action was most unfortunate and the consequences for Dr.
Bulwer's future are large. I wish him the best in his future endeavors and I hope he finds a career path that is best suited to his strengths. Over the winter, the issues regarding Dr. Bulwer were discussed and shared with him in a way that was supportive and geared towards allowing him to use the feedback constructively to improve. After a time, with no improvement noted in key areas, a decision was made not to continue him in the program.
Bulwer appealed this decision. An ad hoc committee chaired by Dr. Hatem and including members of other departments reviewed the CCC concerns, allowed Dr. Bulwer to offer his perspective and supporting materials, reviewed his records and patient care activities to date, and after all that decided to support the CCC decision not to continue him in the program. There was much deliberation both by the CCC and during the appeals process.
It is difficult to take this action because of the consequences for Dr. I personally and on behalf of all the staff in the Department of Medicine wish him success in the future in a career path best suited for his strengths. The hospital did not give patient safety as its reason for the termination; instead, it represented that Bulwer had been terminated for "[f]ailure to make appropriate progress in processing and applying evaluations and other constructive criticism and feedback to patient care responsibilities.
We review a grant of summary judgment de novo, with "no deference to the decision of the motion judge. The defendants, as the moving parties, "have the burden of establishing that there is no genuine issue as to any material fact and that they are entitled to judgment as a matter of law. The moving party may satisfy its burden by demonstrating that the opposing party has no reasonable expectation of proving an essential element of the case at trial.
Under this framework, the plaintiff bears the initial burden of establishing a prima facie case of racial discrimination. Once the plaintiff meets this burden, unlawful discrimination is presumed. The burden then shifts to the defendant to articulate a legitimate, nondiscriminatory reason for its hiring decision, and to produce credible evidence to show that the reason or reasons advanced were the real reasons.
The defendant's burden of production is not onerous. The reasons given for a decision may be unsound or even absurd, and the action may appear arbitrary or unwise, nonetheless the defendant has fulfilled its obligation. The defendant is not required to persuade the fact finder that it was correct in its belief.
Once the defendant meets its burden, the presumption of discrimination vanishes, and the burden returns to the plaintiff to persuade the court, by a fair preponderance of the evidence, that the defendant's proffered reason for its employment decision was not the real reason, but is a pretext for discrimination. The plaintiff bears the burden of persuasion on the ultimate issue of discrimination, and therefore must produce evidence sufficient to support a jury verdict that it was more likely than not that the articulated reason was pretext for actual discrimination.
If the defendant's reasons are not discriminatory, and if the plaintiff does not prove that they are pretexts, the plaintiff cannot prevail. Ocean Spray Cranberries, Inc. Our standard of review in discrimination cases based on disparate impact is the same as in any other summary judgment case. And, as in all other types of cases, the defendant, "as the moving party, 'has the burden of affirmatively demonstrating the absence of a genuine issue of material fact on every relevant issue, even if [the defendant] would not have the burden on an issue if the case were to go to trial.
The hospital accepted, for purposes of summary judgment, that Bulwer had met his burden of demonstrating a prima facie case of discrimination. And Bulwer does not seriously argue that the hospital failed to meet its non-onerous burden of articulating a Page legitimate reason for his termination. Instead, the issue is whether the hospital met its burden of establishing that there is no genuine issue of fact concerning pretext.
See also DeWolfe v. Put another way, the defendant is entitled to summary judgment only if "the summary judgment record demonstrates that the defendant has shown that the plaintiff will be unable to prove at trial that the stated reason for terminating him was a pretext.
Pretext, like other inquiries into the minds and motivations of individuals, is generally not appropriate for disposition on summary judgment. Husky Injection Molding Sys. See also Matthews v. Page There was sufficient evidence of pretext to withstand the defendants' summary judgment motion in this case.
Although there was certainly ample evidence that Bulwer's performance in the residency program fell short of expectations, there was also evidence that he performed well. There was no dispute that he was a well-trained physician coming into the program, or that his fund of medical knowledge was sufficient. His problems appear to arise in areas of performance less susceptible to objective measurement: There is room for much subjectivity when evaluating these areas.
He also testified that physicians who reviewed Bulwer favorably were treated harshly, behavior that was unprecedented at the hospital. When Bulwer was informed of the criticisms against him, he repeatedly asserted that they were not objective and that other physicians with whom he worked should be asked their views.
Flint did not followup with those physicians. There was also evidence that Bial, who had a particularly negative view of Bulwer's performance, harbored animosity toward him and had behaved inappropriately toward him in public.
Moreover, there was evidence that Bulwer was not given the same remediation opportunities as other first-year residents who struggled in the program. Others were permitted to repeat rotations or to repeat the full year.
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Similarly, although the hospital gave Bulwer a six-point improvement plan that included weekly meetings with his adviser, those meetings never occurred. Dvorak's observation over her lengthy career at the hospital was "that non-minorities who have significant performance or behavioral issues in the institution. She described "white supremacist doctrine" left in the staff room, and that the hospital administration took inadequate Page action in response.
She testified that a bumper sticker she had on her office door that read, "We are all one people in the world," was torn off, as was another that expressed a similar support of diversity. She testified that during her lengthy tenure at the hospital only two black physicians remained.
The weight and credibility of Dvorak's testimony is clearly the province of the jury, not ours.
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There is also evidence of how other residents fared in the program. The hospital typically has forty-two residents in any given year. Sincethree residents have been terminated from the program. Two were of African descent; one was Caucasian. In addition, "the hospital admits that another intern of African descent did not continue in the program. See Smith College v.
Against Discrimination, Mass. See also Sullivan v. Irregularities in the ad hoc committee process could support an inference that it was not fair or that Bulwer was treated in an Page unusual fashion from which pretext could be inferred.
As discussed in more detail below, the hospital did not abide by its own rules or those required by the ACGME with respect to the review process. Of particular significance, Bulwer was not allowed to be present for two of the three ad hoc committee meetings, and was not provided with the materials from those meetings despite his request. He was never informed that the ad hoc committee was considering terminating him for an issue relating to patient safety or given an opportunity to address or rebut the criticisms of his performance with respect to the patient at issue.
Song, who tried to convey his positive view of Bulwer's performance to Flint, received the impression from Flint that "the train had already left the station" and that positive feedback about Bulwer would not make a difference. Finally, shifting explanations for the hospital's actions could also support an inference of pretext.
The hospital's position in the statement of undisputed facts on summary judgment was that it did not promote Bulwer because of "poor performance in the internal medicine department. Instead, the hospital stated that Bulwer was terminated because he "[f]ail[ed] to make appropriate progress in processing and applying evaluations and other constructive criticism and feedback to patient care responsibilities. Bulwer argues that the hospital breached its contractual obligations to him by a failing to comply with the ACGME's nondiscrimination requirement; [Note 15] b failing to include a resident on the ad hoc committee, as required by the hospital's Page written due process procedures; c failing to provide him with advance notice of specific patients or allegations considered by the ad hoc committee; d failing to provide him with required resources and supervision; and e failing to provide him with an appeal from the ad hoc committee decision.
There was sufficient evidence in the summary judgment record to support each of these arguments, with the exception of the last.
See note 4, supra. Second, it is undisputed that the ad hoc committee did not include a resident member as required by the hospital's due process policy.
Third, it is undisputed that Bulwer did not receive any notice that the ad hoc committee was considering his immediate termination, nor does the record show that he was provided any of the information concerning the patient whose care precipitated the hospital's decision to terminate him immediately. Instead, Bulwer was informed that the decision to terminate him was based on "additional" information that came to light during the review process, and there is no indication that that information was disclosed to Bulwer before his termination or that it was discussed during any of the three meetings of the ad hoc committee.10 People Who Narrowly Escaped Death Row
Indeed, the decision to terminate Bulwer immediately was made after the third and final meeting of the ad hoc committee, and was communicated by Zinner chair of the department of medicine to Flint. Bulwer's requests for materials considered during the second and third meetings of the ad hoc committee went unanswered.
Fourth, as discussed in the previous section, there was evidence that Bulwer was not given the same remediation opportunities as his peers and that the weekly meetings with his supervisor that were part of his remediation plan did not occur. We are unpersuaded by the hospital's argument that, even if the jury were to accept that the hospital breached its obligations, those breaches were immaterial as a matter of law. The ad hoc committee's decision rested in large part on information considered and aired during the two meetings from which Bulwer was excluded, and the decision to terminate him appears to have stemmed from a process that did not afford any of the procedural Page protections of the hospital's policies or the ACGME guidelines.
Bulwer's defamation claim is based on the two mass e-mails sent to hospital personnel after his termination. He contends that the false implication of the e-mails was that his incompetence as a physician was such that he should not be engaged in a medical career.
Even were we to accept this as a reasonable reading of the e-mails, and that the statements were false neither view we hereby endorsesummary judgment properly entered on the claim. An employer has the conditional privilege to "disclose defamatory information concerning an employee when the publication is reasonably necessary to serve the employer's legitimate interest in the fitness of an employee to perform his or her job.
Here, there is no suggestion in the summary judgment record that the e-mails were sent for any reason other than to notify physicians and staff at the hospital of Bulwer's departure. The first e-mail was sent on the day of his termination and included instructions that Bulwer was not permitted to see or treat patients.
The second e-mail was sent the very next day to Bulwer's fellow residents in the residency program. It is true that an employer may lose its privilege if it " 1 knew the information was false, 2 had no reason to believe it to be true. Beth Israel Deaconess Med. However, Bulwer did not meet his burden of putting forward a record on summary judgment that would permit a rational factfinder to conclude that the hospital was not entitled to the conditional privilege with respect to the two e-mails.
A prima facie case of retaliation requires the plaintiff to show 1 his engagement in protected conduct; 2 the infliction of some adverse Page action; and 3 a causal connection between the two. Bulwer alleges that the hospital unlawfully retaliated against him by 1 terminating him because on two occasions he responded to Flint in writing about certain criticisms of his performance, and 2 not providing him with a process to appeal from the ad hoc committee's decision after he had filed his complaint with the Massachusetts Commission Against Discrimination MCAD on August 25, The record shows that the hospital offered Bulwer a discretionary appeal from the ad hoc committee decision, and that Bulwer never pursued the offer of appeal.
Moreover, the fact that Bulwer's MCAD complaint was filed more than two months after the hospital offered him an appeal defeats his ability to demonstrate any causal connection between the protected activity and the supposed retaliation. To prove that Flint, Wellisch, and Balestrero intentionally interfered with his contractual relationship with the hospital, Bulwer must prove that they acted "malevolently, i.
Dana Farber Cancer Inst. Although, as set out above, we conclude that the record is sufficient to put the claim of discrimination to a jury, that record does not suffice to raise a genuine issue of fact regarding malevolence on the part of the three individual defendants.
For the reasons stated above, we reverse that portion of the judgment dismissing the claims of discrimination in violation of G. The judgment is otherwise affirmed. I concur in the affirmance of summary judgment entered by the Superior Court judge on Dr. Bernard Bulwer's claims of 1 retaliation against his complaint of discrimination, as prohibited by G. I dissent from the reversal of summary judgment entered by the judge against Bulwer's remaining claims of 1 discrimination based on his race and national origin within the meaning of G.
The rationale offered by the majority in support of its discrimination analysis constitutes an extraordinary aberration from basic principles of evidence. It violates settled standards of summary judgment practice and draws appellate judges into the act of second guessing professional medical judgments. A gaping deficiency extends through the core of its position: The majority's treatment of the breach of contract claim relies in part upon the premise of MAH's possible engagement in racial discrimination and fails in part with that claim.
The remaining bases of the majority's contract reasoning rest upon an erroneous interpretation of the contract and fail as a matter of law. I would affirm in full the thorough analysis of all claims by the Superior Court judge in her lengthy memorandum of decision and her entry of summary judgment on all counts.
A full and accurate account of the relevant summary judgment record of this unfortunate case requires substantial enlargement of the majority's portrayal. Bulwer achieved his medical degree in from the University of the West Indies. From that date intohe practiced in TrinidadBelizethe United Kingdomand again in Belize He received a master of science degree in nutrition in in the United Kingdom. His practice during those years centered in subjects of nutrition and diabetes. His curriculum vitae lists author- Page ships of seven journal articles, ten book chapters, and either authorship or editorship of seven books.
Bulwer came to the United States in His first experience in the American medical system was participation as a research associate and fellow in a subresidency cardiology program at Brigham and Women's Hospital in Boston from to In the course of that work he brought a charge of discrimination against a supervisor. An ombudsman resolved that dispute by terms omitted from our record.
In April,Bulwer wrote to Dr. Eric Flint, the director of MAH's internal medicine residency program, and inquired about a position. Flint interviewed Bulwer and thought him personable, capable, and well trained.
Bulwer did not inform Flint of his discrimination claim at Brigham and Women's Hospital. He would begin his residency in September oftwo months after the normal commencement in July. He signed a one-year medical resident agreement MRA.
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With the approval of MAH, it was renewable on an annual basis for two additional years. Various supervising physicians evaluated residents' performances within the rotations. In addition, the clinical competence committee CCCcomprised of thirteen physicians and advisers, met periodically to assess residents' progress. The CCC determined whether MAH should retain and advance residents on the basis of satisfactory completion of educational and training objectives.
The ACGME mandated a member hospital to require demonstrated competence in 1 patient care, 2 medical knowledge, 3 practice-based learning, 4 interpersonal and communication skills with patients, families, and other health professionals, 5 professionalism, and 6 systems-based high technology practice.
MAH supervisory physicians graded residents in each of these six core competencies at the conclusion of each monthly rotation. His supervisors viewed his work favorably, with one exception. One gave him failing "needs improvement" grades in all six core competencies; another in five; and a third in three. Critical commentary accompanied the grades. Was not always honest about [patient] care and his role as the intern i. Too confident for his own good and [patient's] own good without showing any proof of capability to perform at the level of an intern or resident yet.
The October evaluations identified weaknesses in three of the residency program's six prescribed areas of core competency: Bulwer disagreed with the October evaluations, and sent written objections to his supervisors and to Flint. Lori Balestrero, his adviser, met with Bulwer to discuss the evaluations. A memorandum resulting from the meeting and signed by Bulwer acknowledged that he "understands [that] continuation in the program is contingent on his improved performance.
Three evaluations from that rotation appear in the summary judgment record. One supervisor graded Bulwer positively, urged him to communicate more concisely, but credited him with "much improvement. Bulwer's January,rotation occurred in the cardiology department and generated three evaluations.
One supervising physician gave Bulwer high marks in all competencies without narrative comment. A second gave him passing grades and favorable comments, and a recommendation for deeper patient presentations. However a third supervisor gave him predominantly failing grades in five of the six competencies, with no additional commentary. In February, Bulwer returned to a wards rotation. Two supervisors evaluated him. One gave him over-all passing grades with two reservations: The other February wards evaluation was severely critical.
Erica Bial had supervised Bulwer throughout the month. She gave him failing grades in all six competencies: Her Page extended commentary was emphatic: Bernard Bulwer during our month together on the wards was horrendous. I feel that Bernard is a poor intern, and that he suffers major deficiencies, many of which I am gravely concerned are impossible to remediate.
There is no aspect of the central competencies in which Bernard is evenly modestly competent, and in truth I cannot envision his possessing the ability to ever function as a resident in this program.
My concerns can be summarized into four major areas: As to clinical knowledge, Bial found that Bulwer showed a specialized interest in echocardiology but that he failed to seek and integrate new clinical knowledge into his daily practice upon the general patient population in the wards. He seemed "intellectually disorganized, confused, and just plain ill-informed about physiologic processes, algorithmic evaluation, and options for treatment of most diseases.
She viewed his presentations on rounds to be incomplete and disorganized. He did not adequately communicate treatment plans to patients and families and treated coworkers, instructors, and nurses disrespectfully.
He would not honestly acknowledge to her his failure to communicate with consultants, to write orders, and to keep up with his daily clinical tasks. In her assessment of patient care, Bial credited Bulwer with genuine concern with the well-being of patients but found him unable to function efficiently in the hospital environment. In particular, his average time to complete an initial history, physical, and admission note approximated three hours.
He did not stay informed of the results of laboratory and diagnostic tests and of new patient data. His histories and physical notes were unclear and meandering. He did not readily establish rapport, trust, and respect with patients and families. As to professionalism, Bial concluded that Bulwer "refuses to accept constructive criticism," "has no capacity whatsoever for self-assessment," treated her with hostility, and resented direction Page from women in a professional environment.
His age and experience caused him to describe his first-year residency status as a "grave indignity" and "beneath him. The majority does not set out the sequence of Bulwer's six rotations in clear order. In particular, it blurs the timing of the February,evaluations. The chronology is important. It indicates a failure of improvement and the resistance to remediation by Bulwer during the four months between the October and February evaluations. No positive trend had taken hold despite the involvement of his adviser Balestrero and the CCC during November and December.
His professional shortcomings remained persistent and thematic. The thirteen-member CCC considered the evaluations. On April 5,it notified Bulwer that it had confirmed "areas of concern" precluding his promotion to the second year. Its letter to Bulwer identified problems with 1 "analyz[ing] clinical data in complex cases"; 2 "interpersonal and communication skills"; and 3 "gain[ing] insight into feedback.
MAH's due process proceedings. The AHC consisted of four physicians: Charles Hatem, who served as chair of the AHC. The AHC process sought to assure sanctioned residents a fair hearing, including the right to attend and the opportunity to present evidence and argument. The AHC met three times. Bulwer attended the first meeting, on April 24, Flint submitted the evaluators' concerns about Bulwer's deficiencies in the three core competencies and offered Page examples of errors in patient care from three charts.
Bulwer disputed the deficiencies alleged by the evaluators and Flint. He did not express any feelings of discrimination. Three days after the meeting, he submitted a fourteen-page letter responding specifically to alleged patient care errors and the core competency concerns. The letter contained no complaint of discriminatory treatment.
At the conclusion of the first meeting, the AHC began deliberations and decided that it "need[ed] more data" and communications with other physicians to make sure that it had exercised "due diligence and due process. Robert WestlakeDr. Gary Setnik, chair of the department of emergency medicine, and Wellisch. Thomson, Westlake, and Wellisch viewed Bulwer as "dangerous" to patient safety. Setnik judged him to be "better than average" and free of any "specific shortcoming need[ing] drastic attention.
It reviewed all submitted materials, weighed the satisfactory emergency department and cardiology rotations against the criticized work in the intensive care units and on wards, and ultimately concluded that Bulwer's performance of the residency had been substandard.
On May 17,Flint and Dr. Stephen Zinner, the chair of the department of medicine, met with Bulwer. They informed him that MAH would not offer him further training. On the same day, Zinner wrote a "memo to file," summarizing the decision and its grounds, including concern for patient safety. The memorandum included the following passage: Bulwer that in the three week period during which the appeal was reviewed, I had received several Page communications from attending physicians that pointed out that Dr.
Bulwer had demonstrated additional clinical errors, failures to document or comply with our clearly stated expectations about chart notes, and failures to call for appropriate help with severely ill patients. In addition I told him I recently was made aware of a review by the Department of Quality and Safety at Mount Auburn Hospital of a patient under his care last January whose death might be attributable to an error made by Dr.
Despite three attempted deliveries by the post office, Bulwer did not claim the letter. Absence of disparate impact claim. Neither in the Superior Court nor on appeal has Bulwer presented or argued a claim of discrimination by reason of disparate impact. As the majority acknowledges, the summary judgment record shows that over the six years from throughapproximately residents matriculated at MAH; that three of them failed to complete the program; and that two of the three were of African descent and one Caucasian.
From these numbers the majority submits, "It is for the jury to decide whether Page the fact that two-thirds of the terminated residents are of African descent is a pattern from which discriminatory animus can be inferred in the termination of Bulwer.
No authority supports this remarkable proposition. Here Bulwer has not identified a suspect employment practice by MAH. Nor has he proposed that three terminations out of the residencies provide a statistical sample sufficient to qualify as evidence in support of any inference. The majority's reference to the minute incidence of residency failure cannot manufacture a triable issue of disparate impact or disparate treatment.
We study de novo the same record as the motion judge. The major- Page ity invokes the guidance that questions of intent or motivation are usually unsuitable for disposition of summary judgment.