STATE OF RHODE ISLAND, DEPARTMENT OF MENTAL HEALTH, RETARDATION AND HOSPITALS (MHRH)
RHODE ISLAND COMMISSION FOR HUMAN RIGHTS, AND THE ESTATE OF DR. JOHN SATTI, JULIA SATTI CONSENTINO, ADMINISTRATRIX
Providence County Superior Court.
For Plaintiff: Sue Ellen Dunn, Esq.
For Defendant: John M. Roney, Esq., Lynette J. Labinger, Esq., Cynthia M. Hiatt, Esq.
Before the Court is an appeal filed by the State of Rhode Island, Department of Mental Health, Retardation and Hospitals (MHRH) from a Decision and Order issued by the Rhode Island Commission for Human Rights (Commission) in favor of the Complainant, Dr. John Satti (Dr. Satti). In its Decision and Order, the Commission concluded that MHRH had retaliated against Dr. Satti for filing previous charges of discrimination and that it also had discriminated against him on the basis of age. Jurisdiction is pursuant to G.L. 1956 § 28-5-28 and G.L. 1956 § 42-35-15.
I Facts and Procedural History
The controversy giving rise to this litigation had its genesis on August 18, 1987 when Dr. Satti, born May 16, 1926, filed his first charge against MHRH before the Commission (Satti I). In that complaint, Dr. Satti accused MHRH of age discrimination. At the time, he had been working as a physician consultant at MHRH since 1986. On March 26, 1992, while Satti I was pending, Dr. Satti filed a second charge against MHRH, this time for discrimination with respect to hire and in retaliation for filing the previous charge (Satti II). In November 1993, the Commission issued a Complaint and Notice of Hearing in the Satti I matter, and on March 28, 1994, it issued a Complaint and Notice of Hearing in Satti II. On March 30, 1995, the Commission concluded in Satti I that MHRH had discriminated against Dr. Satti on the basis of age.
Meanwhile, in 1995, Dr. Satti was approved for appointment and clinical privileges at the Eleanor Slater Hospital. In accordance with practice, such appointments and privileges are reviewed every two years by another physician, by the Chief of Medical Staff, and by the Executive Committee of the Medical Staff (Executive Committee).
In March 2001, Dr. Satti's clinical privileges at the Eleanor Slater Hospital were renewed after his regular biennial review. At the time, Dr. Satti, who was categorized as a Physician II (General), worked on the third floor of the Virks building (Virks III), where he was responsible for all of that floor's patients. The Virks building housed psycho-geriatric patients, who generally were long-term patients over fifty-five years of age with psychiatric issues. Dr. Satti's renewal was supported by his direct supervisor, Dr. Marco Calvo (Dr. Calvo), as well as by the Chief of Medical Staff, Dr. Edward Martin (Dr. Martin). Dr. Calvo was a primary-care physician who had been Dr. Satti's direct supervisor for several years. He rated Dr. Satti as "Good" in every category, while Dr. Martin rated him as "Meets Standard" or "Exceeds Standard" in every category.
In May 2001, Dr. Satti voluntarily agreed to a request from Dr. Calvo and Dr. Alex Andronic (Dr. Andronic) to switch floors with Dr. Andronic in order that Dr. Andronic avoid a conflict that he had been having with a nurse on the first floor (Virks I). Accordingly, Dr. Satti moved to Virks I and assumed responsibility for Dr. Andronic's twenty-two patients. This responsibility required him to review each patient's medical chart, some of which were sizeable.
According to MHRH policy, medication orders should be reviewed on a monthly basis. It is undisputed that between May 2001 and August 2001, Dr. Satti did not adjust the then-existing medication orders of certain patients.
On July 12, 2001 and August 24, 2001, the Commission conducted a hearing on the Satti II matter. Before the hearing concluded, Dr. Satti returned from vacation to find that, during his absence, Dr. Calvo had changed medications and ordered endocrine tests on some of his patients. Dr. Satti was upset with the changes and, on August 21, 2001, he spoke to Dr. Martin about Dr. Calvo's actions. Dr. Satti threatened to report the incident to the Board of Medical Licensure and Discipline (Medical Board). However, Dr. Martin advised him against pursuing such course of action. Dr. Satti took Dr. Martin's advice and also asked him for a second medical opinion with respect to Dr. Calvo's measures. Accordingly, Dr. Martin conducted a review of Dr. Satti's patients during the end of August 2001 and made some recommendations for changes in treatment. Dr. Satti duly accepted and adopted said recommendations.
On August 24, 2001, the Satti II hearing concluded. Meanwhile, sometime between August 21 and August 29, 2001, Dr. Satti received a quarterly peer review relating to one patient. The review raised an issue with respect to the dispensing of a salt tablet and diuretic combination of medications. On August 29, 2001, Dr. Martin wrote a memorandum to Dr. Satti requesting him to respond to the peer review comments by September 7, 2001. One day later, before Dr. Satti responded to the peer review comments, Dr. Martin informed Dr. Satti that he was transferring him to the Adult Psychiatric Services facility (APS) to serve as an adjunct physician to psychiatrist/primary-care physicians. The position involved a diminution of authority from his then-current position of Physician II (General). Dr. Martin made his decision to transfer Dr. Satti without consulting with Dr. Calvo or seeking his input. At the time, Dr. Martin was aware that the last physician who was transferred involuntarily to APS had resigned rather than take the position.
Dr. Satti strongly objected to the transfer and requested Dr. Martin to memorialize the transfer in writing. Accordingly, on September 6, 2001, Dr. Martin issued a written memorandum detailing the transfer in which he stated: "I believe your expertise in substance abuse can be put to good use with the many dual diagnosis patients." (Mem. from Dr. Martin, dated Sept. 6, 2001.)
Dr. Satti commenced work at APS in September 2001, and was replaced by a younger physician at Virks I. Shortly thereafter, Dr. Satti went out on sick leave. While on sick leave, Dr. Satti was terminated, effective November 30, 2001, for failure to provide adequate sick leave documentation. Dr. Satti filed a union grievance with respect to his transfer to APS and his termination. The matter duly went to arbitration and resulted in an arbitration ruling in Dr. Satti's favor on July 1, 2002. In that ruling, the arbitrator found that MHRH had violated the collective bargaining agreement when it transferred Dr. Satti. The arbitrator further found that, although Dr. Satti had provided insufficient sick leave documentation, MHRH had neither given Dr. Satti sufficient notice that it was a disciplinary matter nor had it given him sufficient time to rectify the problem before terminating him. As a result, the arbitrator ordered MHRH to reinstate Dr. Satti to his former position at Virks I.
One week later, on July 8, 2002, Dr. Martin urged the Executive Committee to recommend to the Department Director, A. Katherine Power (the Director), that she suspend Dr. Satti's hospital privileges at the Eleanor Slater Hospital on an emergency basis. He took this action without the benefit of the advice of legal counsel. That same day, the Executive Committee voted to recommend the emergency suspension of Dr. Satti's privileges, and, on the following day, July 9, 2002, Dr. Martin informed the Director of the Executive Committee's recommendation. At the same time, Dr. Martin also referred Dr. Satti to the Medical Board for review.
In his letter to the Medical Board, Dr. Martin stated that the Executive Committee had recommended the suspension of Dr. Satti's privileges and that said recommendation had been forwarded to the hospital's governing body for final action. Dr. Martin further informed the Medical Board that he had questions about Dr. Satti's patient management skills and willingness to accept clinical supervision. He also raised concerns about Dr. Satti's medical judgment and ability to safely practice medicine. In so doing, Dr. Martin mentioned Dr. Satti's use of salt tablets with diuretics; his transfer to APS; and the arbitrator's subsequent order of reinstatement. Dr. Martin wrote this letter without the advice of legal counsel and before the Director had acted upon the Executive Committee's recommendation to suspend Dr. Satti's hospital privileges.
On July 12, 2002, the Medical Board replied to Dr. Martin's letter of complaint by notifying him that it would look into the matter. It then informed Dr. Martin that, should an investigation be warranted, the Medical Board would forward an unedited copy of the letter to Dr. Satti and provide him with the opportunity to respond.
On the same day, July 12, 2002, Dr. Martin sent an inter-office memorandum to the Director informing her that, according to legal counsel, Dr. Satti's return was not imminent because he had not submitted an acceptable medical certification of his fitness for duty and that, consequently, no immediate action was warranted. Dr. Martin further stated that, in the event that Dr. Satti were to provide acceptable certification, the Executive Committee intended to consider immediate suspension of Dr. Satti's privileges, but that, in the meantime, it would follow the procedures set forth in the Medical Staff Bylaws.
At some point after the arbitrator's ruling, Dr. Martin issued an undated report to the Executive Committee recommending termination of Dr. Satti's privileges. In that report, Dr. Martin referred to the subjects that had been raised at the August 2001 meeting between himself and Dr. Satti. Said subjects were: (1) Dr. Satti's plan to refer Dr. Calvo to the Medical Board; (2) Dr. Calvo's concerns about Dr. Satti's clinical management of patients with respect to his prescribing salt tablets and diuretics to two of his patients; and (3) Dr. Satti's belief that he was being singled out. Dr. Martin further stated in the report that his own review of Dr. Satti's patient records raised the same concerns that Dr. Calvo had raised and that, as a result, he had transferred Dr. Satti to APS. Dr. Martin also observed that after the transfer Dr. Satti went out on sick leave and filed a grievance, which he won.
Dr. Martin's report to the Executive Committee then concluded: "I have a serious concern about Dr. Satti's clinical competence. This is complicated by the fact that he has been very resistant to accepting clinical supervision. I do not feel that Dr. Satti can practice medicine safely. I would recommend that his clinical privileges be terminated." The report does not mention that Dr. Satti, in fact, had decided not to report Dr. Calvo to the Medical Board; that he had asked for, and implemented, Dr. Martin's recommendations; and that he had not submitted any paperwork certifying that he was medically fit to return to work.
Meanwhile, on July 16, 2002, the Executive Committee voted to recommend permanent termination of Dr. Satti's hospital privileges. That same day, Dr. Martin forwarded the Executive Committee's recommendation to the Medical Board. On July 17, 2002, Dr. Martin informed the Director about the Executive Committee's recommendation and the fact that he had referred the matter to the Medical Board. Dr. Martin, however, did not notify Dr. Satti about any of these events.
On July 25, 2002, the Medical Board notified Dr. Satti that it had initiated an investigation based upon a complaint from Dr. Martin. The Medical Board required Dr. Satti to respond to the notice within twenty-one days and informed him of his right to a hearing.
On September 3, 2002, Dr. Satti filed the instant complaint with the Commission, alleging that MHRH had discriminated against him with respect to the terms and conditions of employment. Specifically, he alleged: (1) unfair transfer; (2) refusal to reinstate in accordance with the arbitrator's award; (3) termination of employment due to age; and (4) retaliation for filing previous charges of discrimination.
Three weeks later, on September 24, 2002, the Director approved the Executive Committee's July 16, 2002 recommendation to terminate Dr. Satti's privileges permanently. She explained that her delay in responding to the recommendation was because it apparently had been misplaced, and that a copy of the letter had only just come to her attention. On the same day, MHRH formally rescinded Dr. Satti's November 11, 2001 employment termination and, instead, placed him on sick leave, effective December 23, 2001. MHRH informed Dr. Satti that should he wish to claim all of his accrued sick leave and vacation time, he would be paid through June 13, 2002.
On the following day, September 25, 2002, MHRH informed Dr. Satti that his clinical privileges had been revoked due to:
"substandard clinical practice and unwillingness to accept clinical supervision. Both the peer review process and the Medical Director himself found that you prescribed salt tablets and diuretics in combination for frail elderly patients under your care. You responded to your supervisor's suggestions about proper patient management with allegations that this oversight was retaliatory and might be unethical."
The letter concluded:
"Because your clinical privileges have been revoked you cannot return to work in your position, but in order to comply with the arbitration award you will remain on a 'leave without pay' status until September 8, 2003, so that your health-care coverage will remain in effect until that date. Providing the health-care coverage up to September 8, 2003, will restore that benefit and 'make you whole' for the health-care coverage which you lost during the period while your employment was terminated."
The letter also notified Dr. Satti of his right to grieve the Decision and Order.
On December 9, 2005 and December 16, 2005, Commissioner Alberto Aponte Cardona (the Hearing Officer) conducted a hearing on the instant matter. The following witnesses testified on behalf of Dr. Satti: his daughter, Julia Satti Consentino; his wife, Peggy R. Satti; and expert witness Philip O'Dowd, M.D. (Dr. O'Dowd). Dr. Martin testified on behalf of MHRH.
On November 30, 2007, after reviewing the evidence and the testimony of the witnesses, the Hearing Officer found in favor of Dr. Satti. In doing so, he concluded that MHRH had retaliated against Dr. Satti as a result of filing previous charges of discrimination. He also concluded that MHRH had discriminated against Dr. Satti on the basis of age with respect to terms and conditions of his employment, his termination of employment, and for reporting him to the Medical Board.
As a result, MHRH was ordered to establish and follow certain anti-discriminatory procedures pertaining to hiring and training. MHRH additionally was ordered to formally rescind its revocation of Dr. Satti's clinical privileges and to develop a written apology to Dr. Satti for publication in the Rhode Island Medical News, the Rhode Island Medical Society newsletter, and the Providence Journal. Finally, MHRH was ordered to pay compensatory damages and attorney fees, with interest. MHRH timely appealed the Decision and Order.
Additional facts will be provided as needed in the analysis portion of this Decision.
II Standard of Review
Chapter 35 of title 42, entitled the Administrative Procedures Act, governs the Superior Court's review of an administrative appeal. Section 42-35-15(g) provides:
"The court shall not substitute its judgment for that of the agency as to the weight of the evidence on questions of fact. The court may affirm the decision of the agency or remand the case for further proceedings, or it may reverse or modify the decision if substantial rights of the appellant have been prejudiced because the administrative findings, inferences, conclusions, or decisions are:
"(1) In violation of constitutional or statutory provisions;
"(2) In excess of the statutory authority of the agency;
"(3) Made upon unlawful procedure;
"(4) Affected by other error or law;
"(5) Clearly erroneous in view of the reliable, probative, and substantial evidence on the whole record; or
"(6) Arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion." Sec. 42-35-15(g).
In reviewing a decision of an administrative agency pursuant to § 42-35-15, this Court's review is limited in scope. See Mine Safety Appliances Co. v. Berry, 620 A.2d 1255, 1259 (R.I. 1993). Accordingly, the Court must accord great deference to an agency's final decision. See R.I. Temps, Inc. v. Dep't of Labor & Training, 749 A.2d 1121, 1125 (R.I. 2000). This is true even in cases where the Court, after reviewing the certified record and evidence, might be inclined to view the evidence differently than the agency. Berberian v. Dep't of Emp't Sec., 414 A.2d 480, 482 (R.I. 1980).
Accordingly, the Court's review is limited to an examination of the certified record to determine whether the agency's decision is supported by substantial evidence. See Ctr. for Behavioral Health, Rhode Island, Inc. v. Barros, 710 A.2d 680, 684 (R.I. 1998). Substantial evidence constitutes "such relevant evidence that a reasonable mind might accept as adequate to support a conclusion, and means an amount more than a scintilla but less than a preponderance." Newport Shipyard, Inc. v. R.I. Comm'n for Human Rights, 484 A.2d 893, 897 (R.I. 1984).
It is well settled that questions of law are not binding upon the court; rather, they are reviewed on a de novo basis. See Narragansett Wire Co. v. Norberg, 118 R.I. 596, 607, 376 A.2d 1, 6 (1977). The court may reverse an administrative agency decision where "factual conclusions of administrative agencies . . . are totally devoid of competent evidentiary support in the record." Baker v. Dep't of Emp't and Training Bd. of Review, 637 A.2d 360, 363 (R.I. 1994). However, with respect to issues of fact or the credibility of witnesses, the court may not substitute its judgment for that of the agency where substantial evidence exists to support the agency's findings. See Ctr. for Behavioral Health, 710 A.2d at 684; Mercantum Farm Corp. v. Dutra, 572 A.2d 286, 288 (R.I. 1990); Baker, 637 A.2d at 363.
MHRH contends on appeal that because the Hearing Officer did not require Dr. Satti to demonstrate that he had met MHRH's legitimate expectations at the prima facie stage of the case, the Hearing Officer erred in concluding that Dr. Satti had established his prima facie case of discrimination. It further maintains that there was insufficient evidence to support findings of pretext, discrimination, retaliation, or disparate treatment. Finally, MHRH avers that the Commission, through its Hearing Officer, exceeded its authority when it ordered MHRH to develop a written apology for publication in the Rhode Island Medical News, the Rhode Island Medical Society newsletter, and the Providence Journal.
A The State Fair Employment Practices Act
Chapter 5 of title 28, entitled the State Fair Employment Practices Act (FEPA), was established
"to foster the employment of all individuals in this state in accordance with their fullest capacities, regardless of their race or color, religion, sex, sexual orientation, gender identity or expression, disability, age, or country of ancestral origin, and to safeguard their right to obtain and hold employment without such discrimination." Sec. 28-5-3.
To accomplish this task, the Legislature set forth a list of unlawful employment practices. See ...