PATEL v. SAINT VINCENT HEALTH CENTER

Filing 33

MEMORANDUM OPINION re: 2 Motion for Preliminary Injunction. Signed by Judge Arthur J. Schwab on 08/28/13. (jmm)

IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF PENNSYLVANIA
Rachna J. Patel,
Plaintiff,
v.
Saint Vincent Health Center,
Defendant.

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Civil Action No. 12-0298 ERIE

MEMORANDUM OPINION1
This matter is before the Court upon Plaintiff Rachna Patel’s (“Plaintiff’s”) Motion for
Preliminary Injunction. Doc. No. 2. In her preliminary injunction motion, Plaintiff alleges that
Defendant Saint Vincent Health Center (“SVHC”) terminated her employment in the SVHC
Osteopathic Emergency Medicine Residency Program (“SVHC Residency Program”) in
violation of the Family and Medical Leave Act, 29 U.S.C. § 2601 et seq. (“FMLA”). Plaintiff
seeks a Court Order directing Defendant to reinstate plaintiff into the SVHC Residency Program.
In the underlying Complaint, filed concurrently with her preliminary injunction motion, Plaintiff
also seeks monetary damages for lost income as a resident, lost income as an emergency
medicine physician, and attorneys’ fees and costs.
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This Opinion was drafted under the direction of then Chief Judge McLaughlin, who reviewed it
prior to his resignation. The Court has revised the Opinion after a careful review of the record,
as set forth in the Certification filed at doc. no. 32. The Court is not bound by the draft that
Judge McLaughlin had prepared. See Havey v. Kropp, 458 F.2d 1054, 1055–56 (6th Cir. 1972);
cf. Mergentime Corp. v. Wash. Metro. Area Transit Auth., 166 F.3d 1257, 1263–64 (D.C. Cir.
1999) (successor Judge had duty to reconsider rulings of prior Judge). The Court performed a de
novo review of the record and agreed with the findings of fact and conclusions of law drafted by
then Chief Judge McLaughlin. Accordingly, this Court finds that this case is one of the “limited
circumstances” in which Rule 63 contemplates a successor Judge making findings of fact and
conclusions of law based upon the record. See Mergentime, 166 F.3d at 1266 (quoting Fed. R.
Civ. P. 63 advisory committee’s note); see also Canseco v. United States, 97 F.3d 1224, 1227
(9th Cir. 1996).

A preliminary injunction hearing was held on May 13, 2013 before then Chief Judge
McLaughlin. This Court has jurisdiction pursuant to 29 U.S.C. § 2601 and 28 U.S.C. §§ 1331
and 1334(a)(4). For the reasons which follow, the Motion for Preliminary Injunction (doc. no. 2)
will be DENIED.
I. Findings of Fact
The facts underlying the instant action concern Plaintiff’s enrollment and subsequent
termination from a four-year medical residency program operated by SVHC, a health care
provider located in Erie, Pennsylvania. See Defendant’s Revised Proposed Findings of Fact and
Conclusions of Law, Doc. No. 21, ¶2 (“Defendant’s Proposed Findings”). Plaintiff was admitted
as a resident to the SVHC Residency Program in July 2009, with an initial enrollment term
extending from July 1, 2009, through June 30, 2010. Id. at ¶3; Hearing Tr., 112.2 The term of
Plaintiff’s second year residency appointment extended from July 1, 2010, through June 30,
2011. Defendant’s Proposed Findings at ¶4.
In order to advance to the third year of the residency program, SVHC residents are
required to demonstrate proficiency in seven “core competencies” and to pass the Level III
Comprehensive Osteopathic Medical Licensing Examination (the “COMLEX”). Id. at ¶5;
Hearing Tr. 121. During her second term, however, Plaintiff’s academic performance began to
suffer. Hearing Tr. 117. In October 2010, the Resident Program Director, Dr. Matthew T.
McCarthy, held a meeting with Plaintiff to address several of the academic and clinical
deficiencies identified by members of the residency program. Defendant’s Proposed Findings at
¶8; Hearing Tr. 117-18. In April 2011, Plaintiff advised Dr. McCarthy that she had failed the
COMLEX. Hearing Tr. 121. Dr. McCarthy placed Plaintiff on a performance improvement plan
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References to the May 13, 2013 hearing transcript (doc. nos. 20, 20-1, 20-2, 20-3, and 20-4)
will use the following format: “Hearing Tr. XX.”
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to address her deficient performance and advised her that she would be placed on an academic
leave of absence if she was unable to pass the COMLEX by June 30, 2011. Defendant’s
Proposed Findings at ¶¶10-11; Hearing Tr. 119-120, 126, 212.
On June 1, 2011, near the end of her second residency term, Plaintiff requested FMLA
leave time to treat a heart condition known as supraventricular tachycardia. Defendant’s
Proposed Findings at ¶12; Defendant’s Ex. 7; Hearing Tr. 189. SVHC approved Plaintiff’s
request and granted leave from June 1, 2011, through June 26, 2011. Defendant’s Ex. 2. The
FMLA leave request form signed by Plaintiff acknowledged that she would be terminated if she
“[did] not return to work after the expiration of [the] leave.” Hearing Tr. 194; Defendant’s Ex. 2.
On June 23, 2011, Plaintiff underwent a heart ablation procedure performed by Dr.
Jaydutt Patel (“Dr. Patel”), a board certified cardiac surgeon. Hearing Tr. 29-34. Following her
surgery, Dr. Patel prepared a discharge summary for Plaintiff indicating that she “may return to
work after 3 days” (i.e., June 27, 2011). Hearing Tr. 43-44. The discharge summary also
ordered Plaintiff to follow-up with her primary care physician in one to two weeks and to followup with Dr. Patel on July 22, 2011. Hearing Tr. 43-44; Defendant’s Ex. 28.
Plaintiff initially accepted the decision by the human resources staff at SVHC to grant her
FMLA leave through June 26, 2011, consistent with Dr. Patel’s discharge summary. Hearing Tr.
48, 194. However, on June 27, 2011, Plaintiff contacted SVHC’s human resources director to
request an indefinite extension of her leave as the result of continued heart palpitations. Hearing
Tr. 199, 222. On July 11, 2011, the SVHC human resources department sent Plaintiff a letter
informing her that she needed to obtain an extension from her treating physician. Hearing Tr.
158-60, 201, 204, 224; Plaintiff’s Ex. 7. On July 13, 2011, SVHC human resources again
contacted Plaintiff requesting recertification of her need for continued medical leave. Hearing

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Tr. 224. On July 18, 2011, SVHC human resources sent a follow-up email stating, “Rachna, we
need your treating physician to fax a statement extending your medical leave until the end of
July.” Hearing Tr. 161-63, 205-06, 225; Defendant’s Ex. 2. Despite receiving these
notifications, Plaintiff failed to obtain or provide recertification of her condition until after she
was eventually terminated. Hearing Tr. 161, 226.
Despite her ongoing heart palpitations, Plaintiff never contacted a physician or nurse, as
instructed in Dr. Patel’s discharge summary, and cancelled her July 22, 2011, post-surgery
follow-up appointment with Dr. Patel. Hearing Tr. 196-97, 203-04. Plaintiff acknowledged that,
as of July 22, 2011, no physician had authorized her to be off work. Hearing Tr. 207.
On July 28, 2011, Plaintiff called Dr. Patel’s office seeking certification to extend her
leave for the time period that had elapsed since her surgery. Hearing Tr. 207-08. Dr. Patel’s
office staff indicated that they would not provide any such statement. Hearing Tr. 209. Plaintiff
contacted Dr. Patel’s office again several times between July 29, 2011, and August 1, 2011,
seeking to speak directly with Dr. Patel. Hearing Tr. 210. However, Dr. Patel concluded that
there was no medical necessity for additional leave and, consequently, denied the requested
recertification. Hearing Tr. 55, 58-59, 210-11.
In the meantime, Plaintiff took the COMLEX for the second time on July 26, 2011, and
received a passing score. Hearing Tr. 146, 212. She testified that one of the things that she had
done at home following her surgery was to study for the COMLEX. Hearing Tr. 211.
On August 1, 2011, SVHC dismissed Plaintiff from the residency program based upon
her unauthorized leave of absence and her failure to return to work on June 27, 2011. Hearing
Tr. 100, 132, 211; Defendant’s Ex. 5. On or about August 3, 2011, Plaintiff was examined by
Dr. Joan M. Orloski, a physician located in Duryea, Pennsylvania, near where Plaintiff was

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staying following her surgery. Hearing Tr. 213-14. Dr. Orloski is not a cardiologist, does not
perform ablation surgeries, and examined Plaintiff only once. Hearing Tr. 213. Based upon this
examination, Dr. Orloski wrote a letter to SVHC indicating that she “agree[d] with [Plaintiff’s]
decision to return to her studies as of August 1, 2011.” Hearing Tr. 214.
At some point during the fall of 2012, Plaintiff filed a complaint against Dr. Patel with
the Pennsylvania Department of State alleging that she had not received proper follow-up care
after her surgery. Hearing Tr. 60, 216. Following an investigation, the Department of State
cleared Dr. Patel of any wrongdoing. Hearing Tr. 60.
In December 2012, Plaintiff obtained her physician’s license in California and
commenced part-time work in a general practice clinic. Hearing Tr. 216-18. Plaintiff testified
that she is unable to find a better position because she is not eligible to be board certified.
Hearing Tr. 218.

II. Conclusions of Law
A preliminary injunction is “an extraordinary remedy that may only be awarded upon a
clear showing that the plaintiff is entitled to such relief.” Winter v. Natural Resources Defense
Counsel, Inc., 555 U.S. 7, 22 (2008) (citing Mazurek v. Armstrong, 520 U.S. 968, 972 (1997)).
In determining whether to grant a preliminary injunction
a district court must consider: (1) whether the movant has shown a reasonable
probability of success on the merits; (2) whether the movant will be irreparably
injured by denial of the relief; (3) whether granting preliminary relief will result
in even greater harm to the nonmoving party; and (4) whether granting the
preliminary relief will be in the public interest.
Iles v. Dejongh, 638 F.3d 169, 172 (3d Cir. 2011) (citing McTernan v. City of N.Y., 577 F.3d
521, 526 (3d Cir. 2009)). A preliminary injunction can issue “only if all four factors favor

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preliminary relief.” The Pitt News v. Fisher, 215 F.3d 354, 366 (3d Cir. 2000). The Court will
consider each factor in turn.
A. Success on the Merits
In order to demonstrate a reasonable probability of success on the merits, a plaintiff must
establish a prima facie entitlement to relief by producing sufficient evidence to satisfy the
essential elements of the underlying cause of action. See Punnett v. Carter, 621 F.2d 578, 582–
83 (3d Cir.1980). With respect to a claim pursuant to the FMLA, as in the instant case, an
employee must demonstrate that she was entitled to benefits under the FMLA and that she was
denied those benefits. Sommer v. The Vanguard Grp., 461 F.3d 397, 399 (3d Cir. 2006) (citing
Callison v. City of Phila., 430 F.3d 117, 119 (3d Cir. 2005)). In broad brush, the FMLA
provides that eligible employees “shall be entitled to a total of twelve workweeks of leave during
any twelve-month period” if the employee has a “serious health condition that makes the
employee unable to perform the functions of the position of such employee.” 29 U.S.C. §
2612(a)(1)(D). An employer may require that a request for leave be supported by a certification
from a health care provider. 29 U.S.C. § 2613.
It is undisputed that Plaintiff was granted an initial period of FMLA leave from June 1,
2011, through June 26, 2011. The crux of the underlying dispute concerns whether Plaintiff was
entitled to (and properly requested) additional FMLA leave for the period of time between her
anticipated return to work on June 27, 2011, and her termination from the residency program on
August 3, 2011. In order to establish a likelihood of success on the merits, Plaintiff must
demonstrate that she was entitled to FMLA leave benefits for that time period and was
improperly denied those benefits by SVHC.

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In support of her claims, Plaintiff testified at the hearing that she continued to experience
heart palpitations following her ablation procedure and that she was concerned that her
symptoms might threaten a patient’s safety if she were to return to work. Plaintiff also presented
the testimony of Dr. Henry L. Weiner, a board-certified cardiologist and clinical
electrophysiologist with over 20 years of experience performing heart ablation procedures.
Hearing Tr. 69. Dr. Weiner opined that Dr. Patel’s discharge instructions were unrealistic in
light of Plaintiff’s clinical history and job function. Hearing Tr. 70-71. Dr. Weiner testified that
recurrent or residual symptoms may occur following an ablation procedure and explained the
distinction between a procedural success, where a surgery ends successfully, and a clinical
success, where a patient remains symptom free over a long period of time. Hearing Tr. 70-73.
The efficacy of Dr. Weiner’s testimony is limited, however, by several factors. As an
initial matter, Dr. Weiner acknowledged that he has never examined or even spoken with
Plaintiff. Hearing Tr. 74-75. Rather, his medical opinions were based entirely upon an
examination of Plaintiff’s medical records, including the letter authored by Dr. Orloski, and what
he referred to as “difference[s] in practice strategy.” Hearing Tr. 75-77, 80, 213. Dr. Weiner
conceded that there was nothing in Plaintiff’s medical records to indicate that Plaintiff had
actually experienced any recurring symptoms or complications following her surgery. Hearing
Tr. 75. He also acknowledged that it is highly recommended for ablation patients to follow up
with their treating physicians, particularly if re-evaluation is necessary because of recurrent
symptoms. Hearing Tr. 81-82. Because Plaintiff failed to seek additional medical care for her
condition or attend her scheduled follow-up appointments, Dr. Weiner lacked the type of medical
corroboration required for him to testify with any specificity concerning Plaintiff’s post-surgery
condition.

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The letter from Dr. Orloski, sent following Plaintiff’s termination, suffers from similar
deficiencies. As noted above, Dr. Orloski is not a cardiologist, does not perform ablation
procedures, and examined Plaintiff only once, upon Plaintiff’s request, in order to confirm
Plaintiff’s self-diagnosed inability to return to work following her surgery. Hearing Tr. 213-14.
Dr. Orloski’s letter makes clear that her opinion is based entirely upon representations from
Plaintiff concerning her condition and general information contained in medical literature.
Plaintiff’s Ex. 4.
In short, none of the testimony and evidence submitted by Plaintiff in support of her
preliminary injunction motion is based upon an actual examination of the Plaintiff during the
relevant time period. Moreover, Plaintiff’s evidence is further rebutted by the testimony of Dr.
Patel, the surgeon who performed Plaintiff’s surgery, who opined that her heart ablation surgery
was a “success” with “an excellent result” and “no complications.” Hearing Tr. 42, 44. Dr. Patel
also stated that Plaintiff’s procedure was completed in less than the normal amount of time and
that, in his view, there was “no medical reason” for Plaintiff to take additional time off of work.
Hearing Tr. 45, 52.
Finally, even if the Court were to assume, arguendo, that Plaintiff’s medical condition
was sufficiently impaired following her surgery to warrant additional FMLA leave, it is
undisputed that she failed to provide SVHC with any recertification of her condition, as
requested. The FMLA explicitly permits an employer to “require that a request for leave . . . be
supported by a certification issued by the health care provider of the eligible employee . . . in a
timely manner.” 29 U.S.C. § 2613(a). Plaintiff has not provided any compelling evidence to
adequately explain her failure to seek and obtain recertification of her condition in a timely
manner.

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Based on the foregoing, the Court concludes that Plaintiff has failed to establish a prima
facie case of interference with her FMLA rights because she has not established that she properly
requested and was entitled to leave during the relevant time period. See, e.g., Callison, 430 F.3d
at 119 (requiring an employee to establish entitlement to benefits under the FMLA). Although
her failure to establish a likelihood of success on the merits is fatal to her request for a
preliminary injunction, the Court, in the interests of a thorough and complete review, will
proceed to examine the remaining factors.
B. Irreparable Harm
The second factor requires a plaintiff seeking an injunction to demonstrate a “clear
showing of immediate irreparable injury.” Continental Grp., Inc. v. Amoco Chems. Corp., 614
F.2d 351, 359 (3d Cir.1980). The “requisite feared injury or harm must be irreparable - not
merely serious or substantial,” and it “must be of a peculiar nature, so that compensation in
money cannot atone for it.” Glasco v. Hills, 558 F.2d 179, 181 (3d Cir.1977). In other words, a
plaintiff must demonstrate potential harm which cannot be redressed by a legal or an equitable
remedy following a trial; the preliminary injunction must be the only way of protecting the
plaintiff from harm. Campbell Soup Co. v. ConAgra, Inc., 977 F.2d 86, 91 (3d Cir. 1992).
Plaintiff contends that, in the absence of injunctive relief, she will be irreparably harmed
because she will not be able to gain admission to another residency program specializing in
emergency medicine. Patel Decl. ¶15; Hearing Tr. 98. Consequently, she will be ineligible to
take the Board Certification Exam in Emergency Medicine or obtain a position as an emergency
medicine physician. Patel Decl. ¶15. She also suggests that, in the absence of preliminary relief,
her clinical skills will deteriorate as the result of the interruption in her training. Patel Decl. ¶13.

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Despite Plaintiff’s assertions, the Court concludes that this factor vitiates against an
award of injunctive relief. As an initial matter, the 16-month delay between Plaintiff’s
termination from the SVHC Residency Program and her initiation of this action undermines her
assertion that irreparable harm is imminent. See, e.g., Kobell v. Suburban Lines, Inc., 731 F.2d
1076, 1092 n.27 (3d Cir. 1984) (“The district court may legitimately think it suspicious that the
party who asks to preserve the status quo through interim relief has allowed the status quo to
change through unexplained delay.”); Quad/Tech, Inc. v. Q.I. Press Controls B.V., 701
F.Supp.2d 644, 657 (E.D. Pa. 2010) (holding that a 14-month delay in seeking injunctive relief
“undercuts the urgency that forms the cornerstone of injunctive relief; indeed, this delay
indicates a lack of urgency”). Moreover, although Plaintiff has testified that she has been unable
to find a spot in another emergency medicine residency program, she has failed to adequately
explain why the potential for equitable reinstatement to the emergency medicine program at
SVHC and/or monetary relief following a trial would be an inadequate remedy. Her own delay
in seeking judicial relief, and her ability to obtain employment as a licensed physician in
California while pursuing the instant lawsuit, each factor against the need for the “extraordinary
remedy” of preliminary relief. See Winter, 555 U.S. at 22.
C. Harm to Nonmoving Party
In considering this factor, the Court “must undertake to balance the hardships to the
respective parties.” Pappan Enters., Inc. v. Hardee’s Food Sys., Inc., 143 F.3d 800, 805 (3d Cir.
1998). Unlike each of the previous two prongs of the preliminary injunction test, this factor
appears to slightly favor Plaintiff. While her immediate reinstatement to the SVHC Residency
Program would likely be inconvenient for SVHC, there is no evidence to suggest that it would
create an enormous burden or undue hardship.

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D. Public Interest
The final factor considers "whether there are policy considerations that bear on whether
the order should issue." 11 A Charles Alan Wright, Arthur R. Miller & Mary Kay Kane § 2948.4
at 200-01 (2d ed. 1995). In the instant case, the Court finds that this factor is neutral. Although
there is a strong public interest in favor of protecting FMLA rights, Plaintiff has failed to make a

primafacie showing that her FMLA rights were improperly denied.

III. Conclusion
After careful consideration of each of the four pertinent factors, the Court concludes that
Plaintiff has failed to demonstrate the need for preliminary relief. Specifically, Plaintiff has not
demonstrated a likelihood of success on the merits of her FMLA claim or that irreparable harm
will occur in the absence of immediate judicial intervention. Consequently, for the reasons set
forth above, Plaintiffs Motion for Preliminary Injunction will be DENIED. An appropriate
order follows.

cc: All Registered ECF Counsel and Parties

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