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Antaki v. Saint Francis Medical Center

United States District Court, D. Nebraska

March 21, 2018

GEORGE ANTAKI, M.D., an individual; Plaintiff,
SAINT FRANCIS MEDICAL CENTER, a Nebraska not-for-profit corporation; Defendant.


          Laurie Smith Camp Chief United States District Judge.

         This matter is before the Court on the Defendant's Motion for Summary Judgment, ECF No. 23. For the reasons stated below, the Motion will be granted and this action will be dismissed, with prejudice.


         The following facts are those stated in the parties' briefs, supported by pinpoint citations to evidence in the record, and admitted, or not properly resisted, by the opposing party as required by NECivR 56.1[1] and Federal Rule of Civil Procedure 56.[2]

         Defendant Saint Francis Medical Center (Saint Francis) is a hospital in Grand Island, Nebraska. Grand Island Radiology Associates, P.C. (GIRA) is a radiology medical practice in Grand Island, and it conducts radiology services at Saint Francis. GIRA hired Dr. Antaki as a radiologist in March 2008. As a radiologist for GIRA, Dr. Antaki-and its other radiologists-worked at Saint Francis and at an off-site imaging center in Grand Island. The group's radiologists also read studies for other medical providers in the region.

         A. Radiology Services Agreement

         Saint Francis and GIRA entered into an Exclusive Radiology Services Agreement (the “Services Agreement”), dated September 29, 2006.[3] See Services Agreement, ECF No. 25-3, Page ID 203-29. Under the terms of the Services Agreement, GIRA was the exclusive provider of radiology services and radiologists for Saint Francis at all times relevant to this matter. GIRA agreed to provide a medical director for Saint Francis's radiology department, who would oversee and work with Saint Francis's non-physician radiology department staff. In turn, Saint Francis agreed to permit radiology staff to assist and serve GIRA's radiologists while working in the radiology department.

         Under the Services Agreement, GIRA agreed to comply with the Catholic Health Initiatives (CHI) Standards of Conduct and agreed that those standards were applicable to each Covering Physician. Services Agreement at 8-9, § 2.8, ECF No. 25-3, Page ID 210-11. Each physician at GIRA, including Dr. Antaki, signed an Acknowledgement and Certification (Acknowledgement), attached as Exhibit 1 to the Services Agreement. As part of the Acknowledgement, each physician agreed to the CHI Standards of Conduct. See ECF No. 25-3, Page ID 231. The CHI Standards of Conduct were identical to the Saint Francis Medical Center Medical Staff Professional Conduct Standards (Conduct Standards). Each radiologist with privileges at Saint Francis, including Dr. Antaki, agreed to uphold those standards. Under the Conduct Standards, Dr. Antaki and the other radiologists agreed to “[t]reat colleagues, consultants, nurses, clinical and other support staff with respect as team members working to care for our mutual patients. Handle disagreements civilly, professionally and through established mechanisms. Seek to understand where processes may have failed.” ECF No. 25-3, Page ID 284.

         Under § 2.8 of the Agreement, if Saint Francis determined that those standards were violated by GIRA or any of its physicians, Saint Francis had the right to terminate the Services Agreement for cause. ECF No. 25-3, Page ID 211. The Services Agreement stated that if Saint Francis, in good faith, determined that a physician breached his obligations to comply with the Standards of Conduct, then GIRA “shall, upon notice from Hospital, immediately exclude the Covering Physician from the performance of any services required by this Agreement.” Id.

         B. Dr. Antaki's Behavior at Saint Francis

         Shortly after Dr. Antaki was hired, his behavior became a concern for GIRA. Dr. Daniel Novinski, shareholder and president of GIRA, stated that Dr. Antaki did well during his first year, but “had several incidents where he had problems with some of the techs, and complaints. And so after six months, we sat down with him and explained that he's got to work on how he interacts with techs and clinicians.” Novinski Dep. 23:21-24:1, ECF No. 25-1.[4] Because of Dr. Antaki's issues, the other radiologists at GIRA required him to undergo anger management therapy in Grand Island, which he completed along with online programming for anger management. Antaki Dep. 131:12-21, 132:19- 25, 138:23-25, 143:1-6, ECF No. 25-7.

         After Dr. Antaki completed anger management, some of his behavior problems continued. For example, one of GIRA's radiologists, Dr. David Hadford, stated “[I]f George [Antaki] was on rotation and I was on the other one, all the techs would be coming to me . . . . they didn't want to interact with Dr. Antaki.” Hadford Dep. 13:7-15, ECF No. 25-15. Dr. Hadford explained this was because “Dr. Antaki would yell at them.” Id. 13:17, 26:24). Another radiologist, Dr. Cody Evans, testified that he “was told, from technologists, [that Dr. Antaki] was difficult to work with; that he was - not all of them, but he was sometimes rude, and I had heard of two potential, I guess, physical touching of female technologists.” Evans Dep. 13:18-22, Page ID 25-16.

         Jenna Coe, an x-ray student and, after graduation, a technologist at Saint Francis, had several interactions with Dr. Antaki. For example, as an x-ray student at Saint Francis, she presented information about a patient to Dr. Antaki. Dr. Antaki yelled at her because she did not tell him one of the patient's lab values. She stated in her affidavit that she was just starting and learning and did not know that would have been important to Dr. Antaki. She was thereafter wary of interacting with him. Coe Aff. ¶ 7, 25-17. Coe asserted that her interactions with Dr. Antaki were always negative. Id. ¶ 8. During one occasion, as Coe was leaving Saint Francis after a shift, Dr. Antaki confronted her in the hallway about a study she had done. Id. ¶ 10. She apologized but he followed her, continuing to belittle and criticize her. Id. Coe reported the incident to Ron Neseth, Saint Francis's radiology department imaging manager. Id.

         In addition to verbal complaints to Neseth about Dr. Antaki's behavior, Coe also reported the abuse to her direct supervisor in the CT/MRI department, Jodi Nielsen. Coe Aff. ¶¶ 10, 14. Nielsen personally observed Dr. Antaki's conduct and was also subjected to it herself. Nielsen Dep. 24:20-25, 25:12-20, 26:2-24, ECF No. 25-18. Other staff supervisors, such as Ultrasound Supervisor Sheri Hitchler, also received complaints about Dr. Antaki's behavior. Hitchler Dep. 21:2-5, ECF No. 25-20. Hitchler recalled frequent complaints from her staff of Dr. Antaki yelling at them. Id. 15:1-16:1. Based on his treatment of Coe, Nielsen, and others, GIRA radiologists instructed Dr. Antaki not to communicate directly with Coe or Nielsen but instead to take any of his concerns to Neseth. Antaki Dep. 148:21-25, ECF No. 25-7.

         The radiology group and Neseth frequently discussed the staff's complaints about Dr. Antaki, often at group meetings where Dr. Antaki was present. Neseth Dep. 57:15-58:13, ECF No. 25-19. Dr. Antaki reacted to those issues at the meetings by becoming “very loud.” Id. 58:14-23. Neseth testified that he could not schedule Dr. Antaki for Mondays if he had worked all weekend on call because he would have such a bad temper. Id. 51:8-13. Dr. Antaki's interactions with staff were not typical of other physicians' interactions. Id. 50:12-14. Neseth had to make special scheduling accommodations to limit staff exposure to Dr. Antaki. Id. 95:9-14.

         Neseth also noticed that although Dr. Antaki would frequently complain about staff work product, other radiologists found no bases for the complaints. For example, Neseth testified:

Usually after Dr. Antaki would make the complaint [about a technologist's image], we would pull up the images on the computers and start going through them.
. . . . Dr. Stevens . . . was in charge of CT/MR [and] I would usually go to him and say, would you pull up the study and tell me what you think, and leave it at that. Then he could come back and say, I think it's fine. I think it was the right call and that. And I would ask him about image quality, and he'd say, no, it's fine.

Id. 45:6-17. Neseth testified that this happened “beyond occasionally.” Id. 45:6-46:24.

         Neseth recounted that “typically, after the weekend, I would get calls from the radiology directors from the other towns that Dr. Antaki was upset about one thing or another, maybe not following protocol, maybe image quality, but, typically, it involved him raising his voice and yelling.” Id. 51:19-25. Neseth recalled specific incidents of Dr. Antaki becoming “verbally abusive” and raising his voice enough that multiple people would have heard. Id. 51:19-52:14. Neseth testified that “Dr. Antaki routinely was upset, yelling, would come to me and say, you need to fire these people, and/or threaten that he would fire these people, and that's not normal behavior.” Id. 67:18-68:7.

         In October 2013, Neseth became aware of a call from Dr. Antaki to a nurse on the floor of the radiology department. Neseth testified that Dr. Antaki yelled at the nurse over the phone, “and that the nurse took the opportunity to hold the phone out, away from her ear, so other people could witness his yelling at her, for, basically, inappropriately ordering an exam that did not need to be done during the weekend.” Id. 70:13-19. The incident was reported to Dr. Michael Hein, Saint Francis's chief medical officer, and some of the other radiologists at GIRA. Antaki Dep. 179:3-12, ECF No. 25-7; Novinski Dep. 120:6-7, ECF No. 25-1.

         On January 7, 2014, Louise Burson, an employee in the scheduling/patient access department at Saint Francis, received a phone call from Dr. Antaki who was upset about how a procedure was scheduled and he demanded that a scheduler be written up for what Dr. Antaki perceived as an error. Burson Aff. ¶¶ 7-8; ECF No. 25-21. Burson recalled that Dr. Antaki yelled and cursed during the call, and accused the schedulers of being “incompetent and dumb.” Id. ¶ 6. Dr. Antaki yelled so loudly that Burson had to pull the phone from her ear and other schedulers in the room with her could hear Dr. Antaki's yelling. Id. ¶ 9. Burson discussed the call with her supervisor, Anna Novotny, and then emailed a description of the encounter to Novotny. Id. ¶ 10; Ex. A, ECF No. 25-21, Page ID 526. Novotny forwarded Burson's email to Dale Hartwig, Saint Francis's Vice President of Ancillary Services; Jackie Huldt, director of radiology; Kara Urkoski, Novotny's direct supervisor; Neseth; and Dr. Novinski. Novotny Aff. ¶ 5, ECF No. 25-22, Page ID 530-31.

         C. The McElligott Letter

         Following Burson's encounter and Novotny's report of it, on approximately January 8, 2014, Saint Francis's leadership called a meeting with GIRA's leaders to discuss Dr. Antaki's conduct. Novinski Dep. 50:15-20, 51:3-8, 67:24-68:7, ECF No. 25-1. Dr. Novinski and Dr. Marsh, another shareholder at GIRA, attended the meeting with the hospital's president, Daniel McElligott. Id. 50:15-20, 51:3-8, 67:24-68:7. Hartwig and Dr. Hein also attended the meeting. Id. 61:5-7; Hartwig Dep. 32:17-33:7, ECF No. 25-2. During the meeting, Dr. Hein expressed concern about Dr. Antaki's anger, opining that Dr. Antaki was a disruptive physician, and that he might be a good radiologist but a bad physician if he was not working well with staff. Novinski Dep. 62:11-17, ECF No. 25-1.

         Although the hospital's leadership expressed their concerns and demanded improvement in his behavior, no one demanded that Dr. Antaki be fired. Id. 63:1-13. Hartwig explained at the meeting that he “didn't want [Dr. Antaki] subjecting the staff, patients, and our organization to his behavior anymore.” Hartwig Dep. 35:19-21, ECF No. 25-2. Saint Francis's leaders noted previous incidents of Dr. Antaki's conflicts with staff. Marsh Dep. 19:2-7, ECF No. 25-14. McElligott informed Dr. Marsh and Dr. Novinski that the hospital could not have disruptive physicians. Id. 19:20-22. Dr. Marsh and Dr. Novinski asked Dr. Hein and McElligott ...

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