Ramalingam v. Robert Packer Hospital/Guthrie Healthcare System Auxiliary et al

Filing 22

ORDER denying 15 Motion to Dismiss. Pursuant to Federal Rule of Civil Procedure 12(a)(4)(A), Defendants shall file an answer to Plaintiff's Complaint, ECF No. 1, within 14 days of the date of this Order. Signed by Honorable Matthew W. Brann on 12/4/2017. (jn)

IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF PENNSYLVANIA
SARAVANAN RAMALINGAM,
M.D.,

No. 4:17-CV-00216
(Judge Brann)

Plaintiff.
v.
ROBERT PACKER HOSPITAL, et al.,
Defendants.

ORDER
DECEMBER 4, 2017
1.

On February 5, 2017, Plaintiff Saravanan Ramalingam, M.D., filed a
Complaint against Defendants, ECF No. 1, alleging the following facts:
a.

Dr. Ramalingam graduated from Stanley Medical College in India in
1998. In 2005, he completed a general surgery residency at that
institution, and in 2006, he was certified in general surgery by the
National Board of Examiners in New Dehli, India. ECF No. 1 ¶ 8.

b.

After further training, Dr. Ramalingam decided he wanted to become
a board-certified general surgeon in the United States. To accomplish
that goal, however, he needed to complete a general surgery residency
at an accredited institution in this country. Id. ¶ 11.

c.

Graduate medical education programs, including general surgery
residencies, are governed in the United States by the American Board
of Surgery (“ABS”) and the Accreditation Council for Graduate
Medical Education (“ACGME”). Id.

d.

General surgery residencies in the United States normally last five
years, but due to his prior experience and training, the ABS gave Dr.
Ramalingam permission to enter a general surgery residency program
as a 4th year resident – i.e., as a “Post Grad Year Four” (“PGY-4”)
resident. Id. ¶ 12.

e.

Defendant Robert Packer Hospital/Guthrie Healthcare System
Auxiliary (“GHS”) offered Dr. Ramalingam a spot in its General
Surgery Residency Program (“Residency Program”), starting in
October 2013. Because of his PGY-4 status, he was scheduled to
graduate in September 2015. Id. ¶ 13.

f.

Defendant Thomas VanderMeer, M.D., was the Director of GHS’s
Residency Program. Defendant Burt Cagir, M.D., was the program’s
Assistant Director. ¶¶ 4, 5.

g.

The relationship between GHS and Dr. Ramalingam was governed by
GHS’s “House Officer Agreement,” which obligated GHS to assign
Dr. Ramalingam to the rotations required by ABS. Id. ¶ 14.

-2-

h.

From October 2013 through January 2014, Dr. Ramalingam
performed well in GHS’s Residency Program. Id. ¶ 15.

i.

ACGME normally requires general surgery residency program
participants to perform at least 750 procedures during their residency,
but because he would be in GHS’s Residency Program for only two
years, Dr. Ramalingam asked GHS and Dr. VanderMeer to contact
ABS and ACGME to obtain a waiver for the 750-procedure
requirement. Dr. VanderMeer and Laura Warner (GHS’s residency
coordinator) confirmed that they would “promptly” secure those
waivers. Subsequently, Dr. VanderMeer and others at GHS advised
Dr. Ramalingam that he had no minimum surgery volume
requirements. Id. ¶ 16.

j.

In February 2014, Dr. VanderMeer told ABS that Dr. Ramalingam
was on track to complete the GHS Residency Program, and requested
that Dr. Ramalingam’s completion date be accelerated to June 2015.
ABS granted this request on February 24, 2014. Id. ¶ 17.

k.

Dr. Ramalingam successfully completed his PGY-4 requirements and
was approved to advance to the PGY-5 class. Correspondingly, GHS
and Dr. Ramalingam entered another “House Officer Agreement.” Id.
¶ 18.

-3-

l.

Based on his newly-established June 2015 graduation date, Dr.
Ramalingam began looking for a hepato-pancreato-biliary (“HPB”)
fellowship, to begin after completing GHS’s Residency Program. Id.
¶ 20.

m. Dr. VanderMeer wrote a recommendation letter for Dr. Ramalingam
during this process. Id. ¶ 21.
n.

In June 2014, Dr. Ramalingam was accepted into a HPB fellowship at
Dalhousie University in Nova Scotia, Canada. The fellowship was
scheduled to begin in July 2015. Id. ¶ 22.

o.

While in GHS’s Residency Program, Dr. Ramalingam worked closely
with GHS’s trauma surgeons. His “positive working relationship”
with those surgeons, however, “adversely impacted his relationships”
with Dr. VanderMeer and Dr. Cagir. Id. ¶¶ 5, 25, 28.

p.

On January 15 and February 5, 2015, Dr. Ramalingam participated in
two peer review conferences, where he presented on two cases
involving one of Dr. VanderMeer’s patients. Dr. VanderMeer wanted
Dr. Ramalingam to present the cases “in a manner critical” of a
“certain general surgeon with whom [Dr.] VanderMeer had a
conflict.”

Dr. Ramalingam, however, presented the cases “in the

objective and factual manner in which he had been trained.”

-4-

In

response, Dr. VanderMeer “openly characterized” Dr. Ramalingam as
“intellectually dishonest” and stated that Dr. Ramalingam “had
engaged in a serious ‘breach of medical professionalism.’” Id. ¶¶ 31,
32.
q.

Although Dr. VanderMeer and Ms. Warner told Dr. Ramalingam that
they would secure a waiver of ACGME’s 750-procedure requirement,
see supra, they in fact never contacted ACGME about that issue. Id.
¶¶ 19, 23.

r.

On February 6, 2015, Dr. VanderMeer told Dr. Ramalingam that he
would not complete GHS’s Residency Program by June 2015 because
he had not completed the 750-procedure requirement. Id. ¶ 34.

s.

Sometime after March 2, 2015, Dr. Ramalingam learned that GHS’s
Residency Promotion Committee (“Committee”) – over which Dr.
VanderMeer and Dr. Cagir “exercised great influence” – decided that
Dr. Ramalingam would not graduate in June 2015, noting that Dr.
Ramalingam did not complete the 750-procedure requirement and did
not complete rotations in pediatric surgery, endoscopy, thoracic
surgery, and plastic surgery. The Committee reached this conclusion
“based, at least in part, on false representations” by Dr. VanderMeer
and Dr. Cagir. Id. ¶ 35, 36, 38.

-5-

t.

Dr. VanderMeer and Dr. Cagir were responsible for assigning Dr.
Ramalingam to surgical rotations. Dr. Ramalingam did not complete
the Committee-identified rotations because they had not been assigned
to him. Id. ¶ 38-39.

u.

As a result of the Committee’s decision, Dr. Ramalingam contacted
Dr. Michele Molinari, the fellowship director at Dalhousie University,
and arranged a later start date for his HPB fellowship. Id. ¶ 37, 46.

v.

Subsequently, however, Dr. VanderMeer called Dr. Molinari to advise
him – falsely – that Dr. Ramalingam would not complete GHS’s
Residency Program “as. . . previously advised.” Dr. VanderMeer also
made “numerous” comments to Dr. Molinari “solely out of personal
animus against [Dr.] Ramalingam.”

As a result, Dr. Molinari

withdrew Dr. Ramalingam’s fellowship offer. Id. ¶ 48.
w. In May 2015, in response to direct correspondence by Dr.
Ramalingam, ACGME indicated that Dr. Ramalingam did not need to
complete the 750-procedure requirement in order to complete his
Residency Program. This announcement, however, came after Dr.
Molinari withdrew the fellowship offer. Id. ¶ 53.
x.

Dr. Ramalingam graduated from GHS’s Residency Program in
September 2015. Id. ¶ 54.

-6-

2.

Dr. Ramalingam’s Complaint contains four counts.
a.

In Count I, he alleges that Defendants breached their contract with
him by, inter alia, not assigning him to the necessary rotations and not
seeking a waiver of the 750-procedure requirement from the ACGME.

b.

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.

c.

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.

d.

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.

3.

On April 10, 2017, Defendants moved to dismiss portions of Dr.
Ramalingam’s Complaint, ECF No. 15.
a.

Defendants moved to dismiss Count II because “any contact
Defendants had with Dr. Molinari[ and] Dalhousie University
regarding Dr. Ramalingam was made with justification.” Specifically,
Defendants argue that Dr. VanderMeer’s comments to Dr. Molinari

-7-

about Dr. Ramalingam were “truthful” or were “honest advice” and
could not, therefore, constitute tortious interference with a contractual
relationship under Pennsylvania law.
b.

Defendants also moved to dismiss Count III because Dr. Ramalingam
“has not sufficiently pled the existence of a prospective contract that
is something more than mere hope,” as is required under Pennsylvania
law for a claim of tortious interference with prospective business
relations.

c.

Finally, Defendants moved to “dismiss all language indicative of
punitive damages,” because such damages are “applicable to only the
most limited circumstances.”

4.

When considering a motion to dismiss for failure to state a claim upon
which relief may be granted, 1 a court assumes the truth of all factual
allegations in a plaintiff’s complaint and draws all inferences in favor of
that party; 2 the court does not, however, assume the truth of any of the
complaint’s legal conclusions.3 If a complaint’s factual allegations, so
treated, state a claim that is plausible – i.e., if they allow the court to infer

1

Federal Rule of Civil Procedure 12(b)(6).

2

Phillips v. Cnty. Of Allegheny, 616 F.3d 224, 228 (3rd Cir. 2008).

3

Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). See also Connelly v. Lane Const. Corp., 809
F.3d 780, 786 (3rd Cir. 2016).

-8-

the defendant’s liability – the motion is denied; if they fail to do so, the
motion is granted.4
5.

Dr. Ramalingam has adequately pled his claim for tortious interference
with a contractual relationship.

Dr. Ramalingam alleges that Dr.

VanderMeer made false comments to Dr. Molinari, “solely out of personal
animus.” Although Defendants argue that these comments were in fact
truthful (or were honest advice), this Court must assume the truth of Dr.
Ramalingam’s allegations at this stage of the proceedings.
6.

Dr. Ramalingam has also adequately pled his claim for tortious interference
with prospective business relations. Dr. Ramalingam alleges that, had he
completed the HPB fellowship at Dalhousie University, he would have
been eligible for job offers in the HPB field. Defendants argue that these
job offers are nothing more than “mere hope.” At this stage, based on the
competitive nature of hiring in the medical field, this Court can infer that
Dr. Ramalingam would have received at least one such offer.

7.

Dr. Ramalingam has also adequately pled his claim for punitive damages.
Among other things, and as noted supra, Dr. Ramalingam alleges that Dr.
VanderMeer made “numerous” false comments to Dr. Molinari “solely out
of personal animus.”

4

Id.

-9-

Therefore, IT IS HEREBY ORDERED that:
1. Defendants’ Motion to Dismiss, ECF No. 15, is DENIED.
2. Pursuant to Federal Rule of Civil Procedure 12(a)(4)(A), Defendants shall
file an answer to Plaintiff’s Complaint, ECF No. 1, within 14 days of the
date of this Order.

BY THE COURT:

s/ Matthew W. Brann
Matthew W. Brann
United States District Judge

- 10 -