Knatt v. Hosp Svc Dist ( 2009 )


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  •        IN THE UNITED STATES COURT OF APPEALS
    FOR THE FIFTH CIRCUIT  United States Court of Appeals
    Fifth Circuit
    FILED
    May 12, 2009
    No. 07-31027             Charles R. Fulbruge III
    Clerk
    THEODORE KNATT
    Plaintiff-Appellant-Cross-Appellee
    v.
    HOSPITAL SERVICE DISTRICT NO. 1 OF EAST BATON ROUGE PARISH,
    doing business as Lane Memorial Hospital; HERBERT C OWEN, JR,
    Individually and in the capacity as the Board of Commissioners of Lane
    Memorial Hospital; NICK F ADAMS, Individually and in the capacity as the
    Board of Commissioners of Lane Memorial Hospital; ETTA K HEARN,
    Individually and in the capacity as the Board of Commissioners of Lane
    Memorial Hospital; STEVE STEIN, Individually and in the capacity as the
    Board of Commissioners of Lane Memorial Hospital; CATHERINE A
    POURCIAU, Individually and as the capacity as the Board of Commissioners
    of Lane Memorial Hospital; ROBERT WILLIAMS, SR, Individually and in
    the capacity as the Board of Commissioners of Lane Memorial Hospital;
    RICHARD RATHBORNE, Individually and in the capacity as the
    Executive/Bylaws Committee of Lane Memorial Hospital; JUAN MEDINA,
    Individually and in the capacity as the Executive/Bylaws Committee of Lane
    Memorial Hospital; DONALD FONTE, Individually and in the capacity as the
    Executive/Bylaws Committee of Lane Memorial Hospital; TERRY
    WHITTINGTON, FACHE, Individually and in his capacity as an Employee
    and Chief Executive Officer of Lane Memorial Hospital; A KEITH
    HEARTSILL, Certified Public Accountant, Fellow of the Healthcare Financial
    Management Association, Individually and in his capacity as and Employee
    and Chief Financial Officer of Lane Memorial Hospital; JENNIFER S
    JOHNSON, Registered Nurse, Master of Science in Human Services
    Administration, Individually and in her capacity as an Employee and Chief
    Nursing Officer of Lane Memorial Hospital
    Defendants-Appellees-Cross-Appellants
    JERRY BOUDREAUX, Individually and in the capacity as the Board of
    No. 07-31027
    Commissioners of Lane Memorial Hospital; RONNIE MATTHEWS, Medical
    Doctor, Individually and as Chief of Surgery at Lane Memorial Hospital;
    KAREN REDMOND, Registered Nurse, Individually and in her capacity as
    an Employee of Lane Memorial Hospital; JEANNE PARTIN, Registered
    Nurse, Individually and in her capacity as Unit Director and an Employee of
    Lane Memorial Hospital; LISA SHEPPARD, Individually and in her capacity
    as an Employee of Lane Memorial Hospital; ELIZABETH FAYE POLLARD,
    Licensed Practical Nurse, Individually and in her capacity as an Employee of
    Lane Memorial Hospital; LAURA L PEEL, Licensed Practical Nurse,
    Individually and in her capacity as an Employee of Lane Memorial Hospital;
    KATHLEEN MATTHEWS, Individually and in her capacity as an Employee
    of Lane Memorial Hospital; CLINO MELKER, Certified Registered Nurse
    Anesthetist, Individually and in her capacity as an Employee of Lane
    Memorial Hospital; JULIE W AUSTIN, Individually and in her capacity as an
    Employee of Lane Memorial Hospital; DENISE S DUNN, Individually and in
    her capacity as an Employee of Lane Memorial Hospital
    Defendants-Appellees
    Appeal from the United States District Court
    for the Middle District of Louisiana
    USDC No. 3:03-CV-00442
    Before DAVIS, CLEMENT, and ELROD, Circuit Judges.
    EDITH BROWN CLEMENT, Circuit Judge:*
    Dr. Theodore Knatt appeals the district court’s dismissal of several of his
    claims against the hospital where he practiced, its administration and various
    doctors and nurses who worked there. After hearing argument, considering the
    briefs and undergoing an extensive review of the record, we affirm in part,
    vacate in part, and remand to the district court.
    *
    Pursuant to 5TH CIR . R. 47.5, the court has determined that this opinion should not
    be published and is not precedent except under the limited circumstances set forth in 5TH CIR .
    R. 47.5.4.
    2
    No. 07-31027
    FACTS AND PROCEEDINGS
    In 1995, Knatt, who is black, was recruited by Lane Memorial Hospital
    (“Lane”) to locate his orthopaedic surgery practice in Zachary, Louisiana. He
    was very successful there.2 In early 2001, Knatt announced he intended to
    invest in and spearhead development of Howell Place, a hospital-surgery center
    and office building that would compete with Lane.                Lane was invited to
    participate in the project but declined. Knatt alleges that “[s]hortly after [he]
    made it known that it was his intent to go forward with the Howell Place
    Project,” he became subject to harassment and discrimination as part of a
    conspiracy to destroy his practice.             According to Knatt, the retaliation
    culminated in his suspension from practice at Lane by the hospital’s Medical
    Executive Committee (MEC).
    The following facts were presented by the defendants relative to Knatt’s
    summary suspension. Knatt suffered from personal medical problems in the
    first half of 2002. He went to the emergency room twice for gastroesophageal
    reflux disease (GERD), which sometimes caused his heart to race and his chest
    to hurt. He also had neck pain with associated left shoulder pain. On April 26,
    2002, Knatt saw an endodontist who initiated a root canal procedure. That
    afternoon, he performed surgery at Lane.             The OR technician and scrub
    technician who assisted Knatt that day said that his behavior was different—he
    scrubbed faster, was blank faced, moved slowly, and said he was not feeling well.
    He asked for a stool to sit on, which they said was different from his usual
    practice. The OR staff also reported that he had trouble putting instruments
    together, dropped instruments and did not put them back in their slots, all of
    which was out of character. The same technician observed Knatt acting in the
    same way in surgery a week later and made a similar report to her supervisor.
    2
    For example, a study conducted by Lane in 2001 concluded that 29% of the income it
    earned from the five orthopedic surgeons on staff was generated from Knatt’s surgeries.
    3
    No. 07-31027
    On May 6, 2002, Knatt returned to the endodontist for the completion of the root
    canal. On May 7, Knatt performed a hip procedure at Lane. He was late and
    had to be awakened twice because he was sleeping in the doctor’s lounge. Knatt
    had trouble putting drapes on the patient and seemed sluggish. The nurses took
    their concerns about Knatt to Jennifer Johnson, Lane’s Chief Nursing Officer,
    and reported to her that they were concerned about the welfare of patients and
    the working conditions with Knatt in the operating room.
    The MEC, which consisted of Dr. Juan Medina, Dr. Donald Fonte, and Dr.
    Richard Rathbone, had a regular meeting scheduled the next day on May 8.
    After the committee concluded its regular business, Johnson told the MEC that
    she had a confidential physician issue to bring to it.      The MEC went into
    executive session and Johnson presented the concerns about Knatt that the
    nurses had reported. The next day, Fonte and Johnson met with some of the
    nurses who were the source of the complaints about Knatt so Fonte could hear
    them directly. Fonte reported back to Medina and Rathbone and they agreed,
    under the MEC bylaws, to summarily suspend Knatt’s privileges at Lane. Their
    decision was issued in a letter to Knatt. They asked Knatt to voluntarily submit
    himself for an evaluation by the Physician’s Health Program of the Louisiana
    State Board of Medical Examiners. The letter noted that Knatt had the right to
    request a hearing in writing within seven days. Knatt hired an attorney and
    requested a hearing, which was scheduled for May 22, 2002. The hearing was
    later cancelled by Knatt’s counsel because of a conflict. Knatt, upon his request,
    was also provided with documents concerning the basis of the peer review action.
    On May 30, 2002, Knatt agreed to a compromise. The MEC withdrew the
    suspension, which had been in place for 21 days, and replaced it with a separate
    peer review action in the form of a “letter of reprimand.” Knatt agreed to the
    language of the letter of reprimand, which addressed performing surgery after
    dental treatments as well as other complaints by nurses about Knatt’s behavior,
    4
    No. 07-31027
    including anger, cursing, pushing or shoving hospital staff, not timely reporting
    and starting scheduled surgeries, and utilizing support personnel who lacked
    permission to practice at Lane.
    Knatt apparently became unsatisfied with this resolution, and a second
    appeal hearing was scheduled in October 2002. Prior to the hearing date, Knatt
    and the MEC agreed to another compromise, under which the letter of
    reprimand stood, but the MEC retroactively voided the summary suspension.
    As part of this compromise, Knatt agreed not to sue the MEC members.
    Knatt did not consider the matter resolved. In May, 2003 he filed suit in
    Louisiana state court against the three MEC members, as well as Lane, Lane’s
    CEO, CFO, and CNO, nine individual nurses, Dr. Ronnie Mathews, and the
    individual members of the Lane Board of Commissioners.                       The allegations
    included breach of contract, tortious interference with contract, unfair trade
    practices, defamation, and race discrimination. Defendants removed the action
    to the district court, where Knatt unsuccessfully moved to amend to add
    additional claims and defendants. The denial of one motion to amend is before
    the court on this appeal, and is discussed below. In a previous appeal, we
    affirmed the dismissal of another set of new claims.3                   The present appeal
    concerns claims asserted in the original state court petition.
    Knatt asserts that the summary suspension was a sham and part of a
    larger conspiracy to ruin his practice. Among the evidence in a voluminous
    record, he put forth evidence that several months before the suspension, the
    hospital formed a committee consisting of doctors (who Knatt claims would be
    3
    Knatt attempted to amend to allege a conspiracy to destroy his business by
    constructively evicting him from office space he leased from Lane. The district court denied
    the motion to amend and Knatt instead filed a separate lawsuit, alleging breach of contract,
    wrongful eviction, unfair trade practices, and discrimination, which the court consolidated
    with this case. All claims in the second suit were dismissed and appealed to this court, which
    affirmed the district court on bases that do not affect the resolution of the present appeal. See
    Knatt v. Hosp. Serv. Dist. No. 1 of E. Baton Rouge Parish, 289 F. App’x 22 (5th Cir. 2008).
    5
    No. 07-31027
    harmed by Howell Place) to investigate Knatt for “on call incidents.” There is
    testimony that, while hospital staff were not asked to lie, they were told to place
    Knatt under a microscope and report even minor infractions. Fonte, who led the
    investigation, is a competing orthopedic surgeon, and the hospital admitted to
    Knatt that it would be hurt by the Howell Place project. Jeanne Partin, Fonte’s
    sister, played a role in assigning nurses to monitor Knatt and bring complaints
    to the attention of the administration. The summary suspension immediately
    followed a confrontation between Knatt and Partin in the operating room during
    one of Knatt’s surgeries on May 7, 2002.4 Knatt argues that the incidents that
    led to the summary suspension did not affect patient care, and that the real
    reason for the suspension was a conspiracy against him among Fonte, Partin,
    and the other defendants, based on unfair competition and race.
    In a series of decisions, the district court dismissed all of Knatt’s claims
    except three state law contract and tortious interference claims, which it
    remanded to state court. In the last of its orders dismissing Knatt’s claims, the
    district court expressed frustration with the advocacy on behalf of Knatt:
    At the outset, this court notes that it was extremely generous in
    deviating from the local rules by granting Plaintiff’s numerous
    motions for leave to file excess pages and for extension of time to file
    opposition. In considering the Plaintiff’s arguments, the court was
    not helped by an 87-page opposition in which claims were not
    specifically addressed or directly presented. Quoting pages of the
    Magistrate Judge’s Report did not serve to advance Plaintiff’s
    arguments with respect to the issues before this court. Additionally,
    despite of [sic] all of the extensions granted, Plaintiff’s arguments
    lacked conclusions, expressed incomplete thoughts, and in one
    instance a blank needed filling in. Plaintiff’s counsel is admonished
    to carefully proofread, edit, and complete future memoranda
    submitted to this court.
    4
    Knatt asked that a particular physician assistant be called to assist him in the
    procedure. Partin refused to call the physician assistant because she said he did not have
    privileges at Lane, and a heated discussion ensued.
    6
    No. 07-31027
    These comments reflect a general pattern of a disjointedness in the presentation
    of Knatt’s claims. His papers have been rich in conspiratorial narrative, but
    frequently fail to explain how the alleged facts satisfy the requirements of
    applicable law for the various claims.
    Knatt now appeals the dismissal of his claims, and defendants appeal the
    remand of the remaining state law claims to the state court.5
    DISCUSSION
    A. Questions Decided Unanimously
    We begin with a discussion of issues on appeal upon which the court
    unanimously agrees.
    1. Motion to Amend
    Knatt argues first that the district court abused its discretion in denying
    his first motion to amend. This court reviews a district court’s ruling on a
    motion to amend for abuse of discretion. Cambridge Toxicology Group, Inc. v.
    Exnicios, 
    495 F.3d 169
    , 177 (5th Cir. 2007). In deciding whether to allow an
    amendment under Federal Rule of Civil Procedure 15(a), a district court may
    consider factors such as undue delay, bad faith or dilatory motive on the part of
    the movant, repeated failure to cure deficiencies by amendments previously
    allowed, undue prejudice to the opposing party, and futility of amendment. Price
    v. Pinnacle Brands, Inc., 
    138 F.3d 602
    , 608 (5th Cir. 1998).
    5
    Knatt’s briefing on appeal suffers from problems similar to those discussed by the
    district court. His brief includes no genuine statement of the issues, see FED R. APP . P.
    28(a)(5), attempts to incorporate by reference entire pleadings filed below, fails to provide
    consistent, appropriate citations to the appellate record (as opposed to the trial docket), and
    repeatedly cites evidence and authority without grounding the discussion in the precedents
    applicable to the particular claims under review. We do not mention these issues—some of
    which would be minor concerns in isolation—to single out Knatt’s counsel. Unfortunately, we
    receive many briefs with one or more of these problems. We consider it useful to set out of this
    background, however, because the degree to which Knatt adequately presents certain
    arguments is a matter of disagreement between this opinion and the dissent.
    7
    No. 07-31027
    The first claim sought to be added by Knatt in his amended petition
    involved an allegation that Matthews (a previously named defendant) had
    suggested to employees of another hospital that Knatt was impaired and had
    problems at Lane. This exchange between Matthews and employees of the other
    hospital allegedly occurred when Matthews inquired about Knatt’s conduct when
    he practiced at that hospital. The incidents occurred before Knatt filed his
    original complaint and he offers no explanation for omitting this claim in his
    original petition. The district court did not abuse its discretion in refusing this
    amendment.
    The second claim relates to events that occurred after the filing of the
    lawsuit and alleges that Matthews told another doctor that Knatt showed up
    late for surgeries and that disciplinary actions had been taken against him. The
    district court concluded that this allegation was being added solely to prevent
    dismissal on the basis that the support for the allegation was an unsworn
    statement from the physician who heard Matthews’ comments. Denying the
    motion to amend was proper because the amendment would be futile. If the
    allegation is true, Matthews was merely repeating allegations that had already
    been made public by the filing of Knatt’s suit. These allegations cannot support
    any claim against Matthews.
    The final claim Knatt sought to add was that Richard Sessoms, a Lane
    Board member who was not a named defendant, brought a malicious complaint
    against Knatt that falsely accused Knatt of inadequate patient care. Knatt’s
    motion in support of the amendment states that Sessoms brought the complaint
    as a board member to the board of directors. The board investigated the claim
    and no action was taken against Knatt. Knatt does not explain how these facts,
    if proven, would support any type of claim. The district court did not abuse its
    discretion in denying Knatt’s motion.
    2. Statute of limitations
    8
    No. 07-31027
    Knatt argues next that the district court erred in dismissing defendant
    Matthews on the basis of prescription. As noted by the district court, all of the
    allegations in Knatt’s petition that refer to Matthews concern events that
    occurred more than one year before the lawsuit was filed. There is no dispute
    that one year is the applicable prescriptive period. Knatt argues that because
    he alleges a conspiracy including Matthews, acts extending beyond the
    prescriptive period are actionable. This argument has no merit on the facts of
    this case.   Under Louisiana Civil Code Article 2324(C), prescription is
    interrupted against all joint tortfeasors by the filing of a timely lawsuit against
    one joint tortfeasor.    This provision works prospectively only, by tolling
    prescription against even unnamed joint tortfeasors. Article 2324(C) does not,
    however, revive a prescribed claim against a joint tortfeasor by filing a timely
    claim against another joint tortfeasor.
    3. Summary Judgment for Drs. Rathbone, Medina, and Fonte
    Knatt’s next issue on appeal concerns the district court’s decision to grant
    the motion for reconsideration of Rathbone, Medina, and Fonte on their motion
    for summary judgment.         As a result of the ruling on the motion for
    reconsideration, the district court granted their motion for summary judgment.
    The basis for the motion was that Knatt had compromised his claims against
    them as members of the MEC and agreed, as part of that compromise, not to sue
    these doctors “with respect to the issuance of the summary suspension.” The
    district court limited the ruling to grant summary judgment “only to the extent
    that plaintiff now attempts to assert a claim against these defendants ‘with
    respect to issuance of the summary suspension.’” Knatt argues that the ruling
    is in error because there was no meeting of the minds on the meaning of
    “issuance,” because he did not agree not to sue the defendants for failure to
    maintain the confidentiality of the peer review process and because the
    defendants’ fraud against him based on their alleged roles in the conspiracy
    9
    No. 07-31027
    vitiated the compromise.     These arguments are without merit.          Knatt was
    represented by counsel throughout the suspension process and the district court
    restricted the judgment to the plain language of the compromise agreement and
    the three defendants protected by that agreement.
    4. LUTPA
    Knatt also appeals the dismissal of his claims under LUTPA against the
    individual defendants and Lane. He alleged that the defendants conspired to
    prevent him from providing services in his medical practice outside of a
    conventional hospital setting by destroying his reputation in the Zachary
    community and interfering with his plans to move his practice to Howell Place.
    LUTPA declares unlawful “[u]nfair methods of competition and unfair or
    deceptive acts or practices in the conduct of any trade or commerce.” L A. R EV.
    S TAT. § 51:1405(A).    Trade or commerce is defined in the statute as “the
    advertising, offering for sale, sale, or distribution of any services and any
    property, corporeal or incorporeal, immovable or movable, and any other article,
    commodity, or thing of value wherever situated, and includes any trade or
    commerce directly or indirectly affecting the people of the state.” L A. R EV. S TAT.
    § 51:1402(9).
    The district court first found that Knatt lacked standing to bring a LUTPA
    claim against any defendants except Lane and Fonte. To have standing to bring
    a private action under LUTPA, the plaintiff must be a direct consumer or
    business competitor of the defendant. Computer Mgmt. Assistance Co. v. Robert
    F. DeCastro, Inc., 
    220 F.3d 396
    , 405 (5th Cir. 2000); Gardes Directional Drilling
    v. U.S. Turnkey Exploration Co., 
    98 F.3d 860
    , 868 (5th Cir. 1996). Knatt argues
    that all of the other defendants were co-conspirators with Fonte and Lane, and
    that he has standing to sue them pursuant to Louisiana Civil Code Article
    2324(A), which states that “He who conspires with another person to commit an
    intentional or willful act is answerable, in solido, with that person, for the
    10
    No. 07-31027
    damage caused by such act.”           Louisiana courts are split over whether co-
    conspirators may be sued under LUTPA. Compare Vermilion Hosp., Inc. v.
    Patout, 
    906 So. 2d 688
    , 692 (La. App. 3d Cir. 2005) (now allowing conspirators
    to be sued), with Strahan v. State, 
    645 So. 2d 1162
    , 1165 (La. App. 1st Cir. 1994)
    (holding that the State, a non-competitor, could be sued for conspiring with a
    competitor) and S. Tool & Supply, Inc. v. Beerman Precision, Inc., 
    862 So. 2d 271
    , 276 (La. App. 4th Cir. 2003) (finding that a supplier was liable to a
    distributor for “acting in concert” with two other distributors). The application
    of LUTPA to all of the defendants—including Lane and Fonte—presents difficult
    issues of state law. As we uphold summary judgment on all of Knatt’s federal
    claims, only state law claims remain. We therefore vacate the district court’s
    dismissal of Knatt’s LUTPA claims and remand for reconsideration to determine
    if, in comity, the district court should decline to exercise jurisdiction over these
    claims.
    5. Defamation
    The district court also dismissed Knatt’s claims for defamation against
    various defendants.6       To state a claim for defamation, the plaintiff must
    establish (1) defamatory words, (2) publication, (3) falsity, (4) malice, actual or
    implied, and (5) resulting injury. Cangelosi v. Schwegmann Bros. Giant Super
    Mkts., 
    390 So. 2d 196
    , 198 (La. 1980) (citations omitted).
    The district court dismissed the defamation claims against various nurses
    for lack of publication because Knatt’s complaint only alleges statements by the
    nurses to other hospital personnel related to their work. Statements made
    between employees in the course and scope of their employment are not
    6
    The issue was presented to the district court in a Motion to Dismiss Certain Claims
    or, in the Alternative for Partial Summary Judgment filed by the defendants. Because Knatt
    submitted affidavits and other evidence to the court, which was not excluded, the motion is
    treated as one for summary judgment. See FED . R. CIV . P. 12(d).
    11
    No. 07-31027
    statements communicated or publicized to third persons so as to constitute
    publication for a defamation claim. Doe v. Grant, 
    839 So. 2d 408
    , 416 (La. App.
    4th Cir. 2003). The defamation claim against Lane was dismissed for lack of an
    allegation that Lane acted to deter patients and medical professionals from
    associating with Knatt by means of defamatory statements. The defamation
    claim against Fonte was dismissed based on prescription because the statement
    Fonte was alleged to have made took place more than one year before suit was
    filed.
    Knatt argues generally that several affidavits he submitted in support of
    his opposition memo establish material issues of fact regarding the defamatory
    nature of the statements about him. After careful review, we conclude that this
    evidence cannot support a defamation claim against any of the defendants. It
    does not identify a speaker, a false statement, or the context in which the
    statement was made. Rather, it establishes only that there was general talk
    among a number of persons about Knatt’s suspension and the reason for it.
    Knatt also argues that Lane published Knatt’s suspension. The vague
    anonymous reference in the MEC’s minutes that “a physician” was referred to
    the Physicians Health Program is not actionable because the statement does not
    identify Knatt as the “physician” and because it is true. Knatt also takes offense
    at responses sent by Lane to hospitals seeking credential information about
    Knatt. A response sent by Lane states no disciplinary action had been imposed
    against Knatt with a parenthetical disclaimer “(exceeding 30 days).” Knatt
    reads the statement as stating that he has not been subject to disciplinary action
    in the last 30 days. That is not an accurate interpretation of the letter. The
    letter clearly states that Knatt has not been subject to disciplinary action that
    exceeded 30 days. The contents of the letter are also true and cannot support a
    defamation claim.
    12
    No. 07-31027
    In summary, the district court did not err in dismissing Knatt’s
    defamation claims.
    6. Motion for Certification
    Knatt argues that the district court abused its discretion in denying his
    motion for certification under Federal Rule of Civil Procedure 54(b) after most
    of his claims were dismissed before discovery commenced. He recognizes that
    the court has great latitude on this issue and we find that there was no abuse of
    discretion.
    B. Section 1983 and 1985 Claims
    While we have unanimously agreed on the outcome of the issues discussed
    above, the dissent takes issue with the court’s disposition of two final claims. We
    provide a more detailed discussion of these issues, in order to address the
    concerns of the dissent.
    1. Section 1983
    Knatt contends that the conspiracy to ruin his practice and subject him to
    a “sham peer review” after he announced his involvement in Howell Place also
    included race discrimination actionable under 42 U.S.C. § 1983. Knatt testified
    that the defendants treated him differently because of his race from the
    beginning of his association with Lane,7 but that, as summarized in his brief,
    “after Lane declined participation with Dr. Knatt in the Howell Place project, a
    pattern and practice of harassment and discrimination, [sic] escalated and peer
    review activity and unfair trade practices were initiated . . . against Dr. Knatt.”
    The district court dismissed Knatt’s claim under 42 U.S.C. § 1983 on a motion
    for summary judgment. We review a grant of summary judgment de novo. Paul
    v. Landsafe Flood Determination, Inc., 
    550 F.3d 511
    , 513 (5th Cir. 2008).
    Summary judgment is appropriate only where there are no genuine issues of
    7
    For example, he claims this included “doctors wanting to send him all of the indigent
    and Medicaid patients.”
    13
    No. 07-31027
    material fact and the moving party is entitled to judgment as a matter of law.
    
    Id. We view
    facts and inferences in the light most favorable to Knatt. 
    Id. The summary
    judgment test for discrimination claims under § 1983 is the
    same as the test for discrimination claims under Title VII. See Patel v. Midland
    Mem’l Hosp. & Med. Ctr., 
    298 F.3d 333
    , 342 (5th Cir. 2002). A plaintiff may use
    either direct or circumstantial evidence to prove a case of intentional
    discrimination, though “[b]ecause direct evidence is rare, a plaintiff ordinarily
    uses circumstantial evidence to meet the test set out in McDonnell Douglas.”
    Portis v. First Nat’l Bank of New Albany, 
    34 F.3d 325
    , 328 (5th Cir. 1994).
    Analysis under the well-established McDonnell Douglas framework proceeds as
    follows: (1) the plaintiff must first establish a prima facie case of discrimination;
    (2) the burden then shifts to the defendant to provide a legitimate,
    nondiscriminatory reason for the employment action; and if that burden is
    satisfied, (3) the plaintiff must offer evidence that the proffered reason is a
    pretext for racial discrimination. See McDonnell Douglas Corp. v. Green, 
    411 U.S. 792
    , 802–04 (1973). The district court evaluated Knatt’s discrimination
    claims under McDonnell Douglas, and Knatt briefs them on appeal within that
    framework.8
    We agree with the district court—and the dissent appears to as well—that
    Knatt failed to establish a prima facie case sufficient to survive summary
    judgment under the McDonnell Douglas standard. To establish a prima facie
    case, Knatt must show that: (1) he is a member of a protected class, (2) he was
    qualified for staff privileges, (3) he suffered an adverse employment action, and
    8
    Knatt’s arguments regarding race discrimination are at times, to quote the district
    court, “difficult . . . to discern.” Nonetheless, it is clear that the legal framework guiding his
    arguments is the McDonnell Douglas framework applied below. He states that “[c]laims
    brought pursuant to 42 U.S.C. § 1983 require analysis under a burden shifting analysis,” citing
    case law applying McDonnell Douglas, and devotes nine pages to discussing the “others
    similarly situated” element of the prima facie case, which we consider to be the determinative
    element in the analysis.
    14
    No. 07-31027
    (4) others similarly situated were more favorably treated. See Rutherford v.
    Harris County, 
    197 F.3d 173
    , 184 (5th Cir. 1999). There is no dispute that Knatt
    satisfies the first two requirements, and we presume that the 21 day summary
    suspension constituted an adverse employment action.9 We agree with the
    district court, however, that Knatt failed to show that others similarly situated
    were more favorably treated.
    “[I]n order for a plaintiff to show disparate treatment, [he] must
    demonstrate that the misconduct for which [he] was discharged was nearly
    identical to that engaged in by an employee not within [his] protected class
    whom the [hospital] retained.” Wallace v. Methodist Hosp. Sys., 
    271 F.3d 212
    ,
    221 (5th Cir. 2001) (internal quotation marks and alteration omitted). “[T]he
    conduct at issue is not nearly identical when the difference between the
    plaintiff’s conduct and that of those alleged to be similarly situated accounts for
    the difference in treatment received from the employer.” 
    Id. Knatt provides
    evidence of five white doctors who he alleges were more
    favorably treated. In only one of those cases, however, was the doctor impaired
    while in the operating room, and that doctor was also suspended. The alleged
    doctors were:
    1)     Demerol Dr.—This doctor stole Demerol from the emergency room
    and was allowed to resign; there are no allegations that he operated
    while under the influence of the drug.
    2)     Pneumothoraxes Dr.—This doctor performed an operation badly,
    causing the patient’s lung to collapse. This event allegedly occurred
    almost 20 years ago, and concerned a doctor performing an
    operation incorrectly, not performing while impaired.
    9
    The district court held there was no adverse employment action, because only the
    summary suspension qualified, and Knatt had agreed not to sue the individuals who made
    that decision. We do not decide whether this analysis was correct, because we find the prima
    facie case deficient on other grounds.
    15
    No. 07-31027
    3)     Unknown Dr.—Fonte testified that there was at one point a doctor
    who was acting strangely in the operating room and that he was
    suspended from performing operations.
    4)     Dr. RD—This doctor failed to show up to work and there are
    allegations of a car accident and drug abuse. He failed to meet with
    any of the doctors who contacted him, and was summarily
    suspended. Again, there is no question of impairment during
    surgery, and this doctor was in fact summarily suspended.
    5)     Dr. WM—This doctor inserted a subclavian in an unprofessional
    manner, ignoring proper technique. There are no allegations that
    he was impaired when he performed the operation.
    With this evidence, Knatt has not identified a case where a white doctor
    was impaired in the operating room and was not suspended. In fact, some of
    these cases demonstrate that when doctors at Lane were impaired, they were
    suspended.    Knatt has failed to establish a prima facie case of disparate
    treatment, and we need go no further under the McDonnell Douglas framework.
    The dissent suggests, however, that Knatt should survive summary
    judgment on the theory that he presented sufficient direct evidence of actionable
    race discrimination to survive summary judgment without satisfying McDonnell
    Douglas. We consider this an inappropriate basis to decide the case, because
    Knatt presents no such argument.
    It is our general policy to treat litigants as masters of their own legal
    theories, and to require that they adequately present an issue or theory before
    we will consider it. A party that asserts an argument on appeal, but fails to
    adequately brief it, is deemed to have waived it. United States v. Skilling, 
    554 F.3d 529
    , 568 n.63 (5th Cir. Jan. 6, 2009) (citing United States v. Lindell, 
    881 F.2d 1313
    , 1325 (5th Cir. 1989)). It is not enough to merely mention or allude
    to a legal theory. See, e.g., McIntosh v. Partridge, 
    540 F.3d 315
    , 325 n.12 (5th
    Cir. 2008) (“McIntosh occasionally mentions an ‘equal protection’ claim in
    conjunction with his due process claim, but this claim is inadequately briefed
    16
    No. 07-31027
    and is hence waived.”). We have often stated that a party must “press” its
    claims. See, e.g., Davis v. Maggio, 
    706 F.2d 568
    , 571 (5th Cir. 1983) (“Claims not
    pressed on appeal are deemed abandoned.”). At the very least, this means
    clearly identifying a theory as a proposed basis for deciding the case—merely
    “intimat[ing]” an argument is not the same as “pressing” it. Cf. FDIC. v. Mijalis,
    
    15 F.3d 1314
    , 1326–27 (5th Cir. 1994) (“If a litigant desires to preserve an
    argument for appeal, the litigant must press and not merely intimate the
    argument during the proceedings before the district court.”). In addition, among
    other requirements to properly raise an argument, a party must ordinarily
    identify the relevant legal standards and “any relevant Fifth Circuit cases.”
    
    Skilling, 554 F.3d at 568
    n.63; see also F ED. R. A PP. P. 28(a)(9) (stating that
    briefs must include “contentions and the reasons for them, with citations to the
    authorities . . . on which the appellant relies.”); Coury v. Moss, 
    529 F.3d 579
    , 587
    (5th Cir. 2008) (deeming estoppel argument waived where defendants cited cases
    but failed to “explain how these cases constitute authority for their bare
    assertion that [plaintiff] is estopped to bring this litigation”). We look to an
    appellant’s initial brief to determine the adequately asserted bases for relief. See
    Cinel v. Connick, 
    15 F.3d 1338
    , 1345 (5th Cir. 1994) (“An appellant abandons all
    issues not raised and argued in its initial brief on appeal.”).
    In light of these standards, Knatt did not adequately present for our
    review a direct evidence discrimination theory.            None of the sixteen
    discrimination-related headings in the Table of Contents to Knatt’s brief (which
    doubles as his statement of issues) mentions direct evidence analysis. Knatt
    argues multiple elements of McDonnell Douglas, which was the basis on which
    the district court decided the case, but nowhere acknowledges direct evidence as
    an alternative to the McDonnell Douglas analysis.
    Indeed, Knatt’s discrimination arguments mention “direct . . . evidence”
    only once, under a heading addressing an element of the district court’s
    17
    No. 07-31027
    McDonnell Douglas analysis.10 This section argues, with practically no authority
    to place the argument in legal context,11 that the entire peer review process
    should be considered an adverse employment action. As the brief puts it, the
    adverse action was “not simply the summary suspension, but is a pattern and
    practice of conspired bad-faith activity clothed as peer-review to [sic] in an effort
    to have the defendants hide behind a shield of immunity and a defense to
    legitimate claims.” It then argues that the peer-review process was motivated
    by racial animus, because Knatt presented testimony that certain doctors and
    nurses who contributed to it had employed racial epithets.12 It is at this point
    that Knatt mentions direct evidence, stating that “[t]his case is plagued with
    direct and circumstantial evidence of racial animus being a motivating factor in
    the harassment, deception and discrimination that led to the sham peer-review.”
    Thus, Knatt recites the phrase “direct and circumstantial evidence”
    without acknowledging the difference between the two categories, and without
    citing any authority. He does not argue (1) that the district court should have
    applied a direct evidence standard rather than McDonnell Douglas, or (2) that
    his claim satisfies a direct evidence standard as set forth in relevant precedent.
    Finally, he uses the phrase in the context of a meritless argument criticizing the
    district court’s McDonnell Douglas analysis. The entire peer review cannot be
    an adverse employment action, because “an adverse employment action consists
    of ultimate employment decisions such as hiring, granting leave, discharging,
    10
    The heading reads: “(3) Whether the trial court erred in finding that the adverse
    action was the suspension as opposed to the bad faith ‘sham’ peer-review.”
    11
    At the outset of this section, Knatt does briefly reference the “hostile work
    environment” theory of discrimination. See generally Frank v. Xerox Corp., 
    347 F.3d 130
    , 138
    (5th Cir. 2003). The district court held, however, that in the proceedings below Knatt
    abandoned his hostile work environment claims through inadequate briefing. Knatt fails to
    show that this ruling was erroneous.
    12
    The defendants contest these allegations, but we interpret the record in the light
    most favorable to Knatt, and assume they are true.
    18
    No. 07-31027
    promoting, and compensating.” Pegram v. Honeywell, Inc., 
    361 F.3d 272
    , 282
    (5th Cir. 2004) (internal quotation omitted). In this context, Knatt’s mention of
    the phrase “direct and circumstantial evidence” does not raise an adequately-
    briefed argument that Knatt can survive summary judgment because of direct
    evidence of discrimination. Because Knatt failed to adequately raise, argue, or
    brief any issue regarding the direct evidence method before us on appeal, he has
    waived any such argument.
    Even assuming, arguendo, that it were appropriate to consider a direct
    evidence theory, the district court’s grant of summary judgment on these claims
    would still be correct. Direct evidence is evidence which, on its face and without
    inference or presumption, shows that an improper criterion served as a basis for
    an adverse employment action. See Fabela v. Socorro Indep. Sch. Dist., 
    329 F.3d 409
    , 416 (5th Cir. 2003). As espoused by the dissent, the direct evidence theory
    depends almost entirely on the deposition of Marlene Bucionne, a nurse
    terminated by Lane who at one point maintained a lawsuit against Lane with
    representation from Knatt’s counsel.13 She testified, vaguely and equivocally,
    that various nurses and doctors at Lane used the “N-word.” Her testimony does
    not support a direct evidence theory of discrimination.
    Our cases have recognized, and we repeat, that “the term ‘nigger’ is a
    universally recognized opprobrium, stigmatizing African-Americans because of
    their race.” Brown v. East Miss. Elec. Power Ass’n, 
    989 F.2d 858
    , 861 (5th Cir.
    1993); see also Jones v. Robinson Prop. Group, L.P., 
    427 F.3d 987
    , 993 (5th Cir.
    2005) (“[R]acial epithets undoubtably demonstrate racial animus.”) There is no
    disagreement between the majority and dissent on this point. To establish
    illegal employment discrimination, however, it is not enough to present evidence
    that an employer or coworker used racial epithets at some point in the past.
    13
    The dissent states this testimony provides merely the “most graphic” evidence in the
    midst of other “extensive” evidence, but only cites additional circumstantial evidence.
    19
    No. 07-31027
    Under the established case law of this circuit, for comments in the workplace to
    serve as evidence of discrimination, they must be: (1) related to the protected
    class, (2) proximate in time, (3) made by an individual with authority, and (4)
    related to the employment decision. Jenkins v. Methodist Hosps. of Dallas, Inc.,
    
    478 F.3d 255
    , 261 (5th Cir. 2007).
    The dissent claims that “at least two of the three doctors on the MEC, Dr.
    Rathbone and Dr. Medina, used racial epithets in reference to Dr. Knatt at a
    meeting involving the investigation of Dr. Knatt.” If this were correct, it would
    satisfy Jenkins. But Bucionne’s deposition does not support this assertion, and
    does not otherwise support the conclusion that members of the MEC used the N-
    word in a manner that was proximate in time, and related to, the summary
    suspension decision. Knatt’s counsel repeatedly sought to elicit testimony that
    the MEC members used the N-word in connection with Knatt’s summary
    suspension, but Bucionne testified only that (1) she had heard the MEC
    members use the word at unspecified times, (2) other nurses had used the word
    to refer to Knatt (and in one case, his wife), and (3) on certain occasions during
    the summary suspension controversy numerous individuals used the word.
    When pressed for detail (by Knatt’s attorney) on who exactly used the word in
    what context, Bucionne either changed the subject, changed her testimony, or
    related instances where nurses had used the word.
    In particular, counsel tried to elicit testimony that the three members of
    the MEC used the N-word in a May 16, 2002 meeting with nurses,
    approximately a week after the suspension decision. Bucionne said she did not
    remember the meeting, and that “[y]ou will have to refresh my memory,” but
    then said she recalled it when counsel informed her that others had testified
    about it. Bucionne initially stated that Rathbone and Medina used the N-word
    at the meeting, but then retreated from that testimony and ultimately testified
    20
    No. 07-31027
    that she remembered literally nothing concerning the meeting. The discussion
    included the following exchange:
    Q     . . . And what physicians do you say were using the nigger
    word constantly?
    A     Dr. Rathbone.
    Q     Anybody else?
    A     Dr. Medina.
    Q     Anybody else?
    A     In that particular meeting?
    Q     Well, I guess anywhere in the hospital.
    A     Oh, anywhere. I could not begin to give you the string of
    names.
    Q     So in this meeting on May 16, 2003, Dr. Rathbone and Dr.
    Medina used the word nigger?
    A     I believe it was in the conference call that we all sat around,
    but afterwards, when we were leaving, the N word was used
    a lot.
    Q     Who was using it a lot?
    A     Pretty much everyone. At this time I didn’t know this was
    going to blow into this. So when the N word was brought up,
    I didn’t turn and say I am going to remember you said that
    word.
    Q     In what context was it being used?
    A     I just told you. They are going to bring in their own kind.
    This last answer suggested that Bucionne had confused this meeting with
    lunchroom conversations, at an earlier unspecified time, regarding a different
    21
    No. 07-31027
    black doctor, Dr. Lewis.14 Counsel asked “maybe I am misunderstanding. I
    thought the meeting that you were meeting with was in connection with Dr.
    Knatt’s suspension; is this some other meeting?” Bucionne did not clarify her
    answer, instead stating “There were numerous meetings that we had about Dr.
    Knatt.” Counsel tried to return to the subject of the May 16 meeting several
    times thereafter, until Bucionne finally clarified that she remembered nothing
    at all about it:
    Q      . . . I only want to know about this meeting on May 16, with
    the three doctors. What do you know?
    A      Due to the traumatic experience I experienced at the end,
    right before my surgery, I don’t recall anything.
    Q      What traumatic experience did you have?
    A      I was having a vaginal hysterectomy, and I was very upset
    about this, and on women who have children, your
    children—once it was their home. As a female, it is pretty
    personal. I feared for my life. . . . I was fixing to go on leave,
    and then the phone rang and it was Ms. Partin, and she
    stated I no longer had a job, that they were downsizing. So I
    went to the hospital; my vitals were unstable. . . . So I think,
    because of all this trauma, I just don’t recall a meeting.
    These exchanges are typical of the indefiniteness and confusion that pervade the
    Bucionne deposition.
    The only individuals with authority over the summary suspension were
    members of the MEC,15 and Nurse Bucionne provided no specific comments and
    14
    Bucionne previously testified that “when Dr. Lewis came into practice,” nurse Karen
    Redmond had been “the ringleader of” lunchroom discussions speculating that black doctors
    would attract patients incapable of paying their medical bills.
    15
    The dissent argues that we should consider racist comments made by hospital staff
    in determining whether the summary suspension was racially motivated. But it does
    not—and cannot—point to any cases where racist comments by co-workers or staff were
    evidence of racial discrimination by the employer. Our case law is very clear that for
    22
    No. 07-31027
    no context for when and how the members of the MEC may have used racial
    epithets.    She never alleges with sufficient particularity that any of those
    members used racial epithets in connection with the employment decision at
    issue, and none of the comments she discusses meet the Jenkins criteria.16
    Accordingly, her testimony would not allow Knatt to survive summary judgment
    on a direct evidence theory.
    Knatt has failed to present evidence that would allow him to avoid the
    McDonnell Douglas framework—an argument he failed to brief—nor does he
    have sufficient evidence to survive summary judgment under that framework.
    We therefore affirm the district court’s grant of summary judgment in favor of
    the defendants on the § 1983 claim.
    2. Section 1985(3)
    Section 1985(3) has unusual wording and a complex set of elements. See
    generally Ernest v. Lowentritt, 
    690 F.2d 1198
    , 1202 (5th Cir. 1982). Knatt
    alleges that the district court failed to consider his § 1985(3) claim using the
    correct standard of proof.          But the only argument offered consists of the
    statement that “This issue is fully briefed in plaintiff’s opposition . . . and
    incorporated herein as if copied in enxtenso [sic],” as well as citation to a single
    case that discusses not § 1985(3) but § 1983. We will not go searching through
    the record to find Knatt’s arguments on this issue. Based on the principles
    comments to serve as evidence of discrimination, they must be made by an individual with
    authority. See 
    Jenkins, 478 F.3d at 261
    . These nurses were certainly not in a position of
    authority over Knatt.
    16
    This case differs from Jones v. Robinson Property Group, where we noted that the
    testimony “cite[d] specific statements and, especially in light of the summary judgment
    standard, [the plaintiff] prove[d] with sufficient particularity when the statements were made
    and generally who made 
    them.” 427 F.3d at 993
    . We found that the “testimony clearly and
    explicitly indicate[d] that decision maker(s) . . . used race as a factor in employment decisions,
    which is by definition direct evidence of discrimination.” 
    Id. In contrast,
    no rational
    fact-finder could conclude that the MEC suspended Knatt on account of his race based on the
    testimony of Nurse Bucionne.
    23
    No. 07-31027
    articulated above, Knatt has waived his § 1985(3) claim through inadequate
    briefing.
    C. Remand of remaining claims to state court
    Finally, the defendants cross appeal the district court’s decision to remand
    the remaining state law claims to Louisiana state court. Though we find no
    error or abuse of discretion in the district court’s remand of these claims to state
    court, we vacate this decision and remand so that the district court may consider
    all of the state law claims together, including the remanded LUTPA claim.
    Conclusion
    For the foregoing reasons, the judgment of the district court is affirmed
    except as to the dismissal of Knatt’s LUTPA claims and the remand of the
    remaining claims to state court. These decisions are vacated and the case is
    remanded to the district court for further proceedings consistent with this
    opinion.
    AFFIRMED in part, VACATED in part, REMANDED.
    DAVIS, Circuit Judge, dissenting:
    I respectfully dissent from section B. of the majority opinion. In that
    section, the majority gives its reasons for affirming the district court’s dismissal
    of Dr. Knatt’s claims under § 1983 and § 1985(3) on summary judgment. The
    district court dismissed the § 1983 claims on the basis that Dr. Knatt failed to
    establish a prima facie case of discrimination under the McDonnell Douglas test.
    On both the § 1983 claim and the § 1985 claim, the district court concluded that
    Dr. Knatt did not establish that race played a part in his summary suspension.
    The main question we have in this case is the usual one we face in
    summary judgment cases: whether the plaintiff produced sufficient evidence to
    raise a genuine issue of material fact on a key issue. In this case the key issue
    24
    No. 07-31027
    is whether race played a role in the defendants’ suspension of Dr. Knatt from
    practicing as a physician at Lane.
    Dr. Knatt was entitled to raise genuine issues of fact on this issue in two
    ways. First, he could present direct evidence of discrimination. Portis v. First
    Nat’l Bank, 
    34 F.3d 325
    , 328 (5th Cir. 1994). Because Dr. Knatt’s claims are
    employment related and in that context direct evidence of discrimination is rare,
    Dr. Knatt could alternatively use the standard set out in McDonnell Douglas to
    establish an inference of discrimination.        
    Id. Contrary to
    the majority’s
    description, the McDonnell Douglas approach is simply an additional, easier
    weapon a plaintiff has in his arsenal to prove the fact at issue: discrimination.
    The invocation of McDonnell Douglas does not supplant the traditional direct
    evidence method of proof. If the plaintiff can demonstrate the existence of a
    material fact tending to show discrimination either by direct evidence or through
    the method established by McDonnell Douglas, he can avoid summary judgment.
    Therefore, when Knatt alleged and argued that race played a role in his
    employer’s decision to suspend him, Knatt was entitled to prove this fact either
    by direct evidence or the McDonnell Douglas standard. Once the district court
    grants summary judgment, our task is to review that ruling de novo and
    consider “the record taken as a whole” drawing “all reasonable inferences in
    favor    of   the   nonmoving   party”   and   refrain    from   making   credibility
    determinations or weighing of the evidence. Reeves v. Sanderson Plumbing
    Prods., Inc., 
    530 U.S. 133
    , 150 (2000)(internal quotation marks and citations
    omitted).
    This review includes consideration of whether a fact issue has been raised
    either under the McDonnell Douglas standard or the traditional direct evidence
    method of proof.       For example in Jatoi v. Hurst-Euless-Bedford Hospital
    Authority, although the plaintiff failed to meet all four criteria of the McDonnell
    25
    No. 07-31027
    Douglas test, this court went on to examine the summary judgment record as a
    whole to determine if summary judgment was appropriate.
    While proof of all four of the McDonnell Douglas criteria will
    establish a circumstantial prima facie case, such proof is not the
    exclusive means of establishing a plaintiff's preliminary burdens. In
    Byrd v. Roadway Express, Inc., 
    687 F.2d 85
    , 86 (5th Cir.1982) the
    plaintiff established the first three criteria but could not establish
    the fourth because his position had been filled by another minority.
    As we stated in Byrd, "the focus of the inquiry may not be obscured
    by the blindered recitation of a 
    litany." 687 F.2d at 86
    . If a plaintiff
    cannot establish some or all of the McDonnell Douglas steps, the
    district court must examine all the evidence that has been adduced
    for other indicia of racial discrimination relating to his discharge
    and determine whether it is more likely than not that the
    employer's actions were based on illegal discriminatory criteria. 
    Id. Jatoi v.
    Hurst-Euless-Bedford Hospital Authority, 
    807 F.2d 1214
    , 1219 (5th Cir.
    Tex. 1987)(emphasis added).
    Racial animus, like any other fact, can be established by direct or
    circumstantial evidence. For example, in Fierros v. Tex. Dep't of Health, 
    274 F.3d 187
    , 195 (5th Cir. Tex. 2001), to determine whether the district court erred
    in granting summary judgment in favor of defendants on the element of
    causation, this court reviewed Fierros’ direct evidence of a statement her
    supervisor made to her that she had been denied a pay increase because she had
    filed a discrimination claim against him. It also considered the circumstantial
    evidence that supported the finding that discriminatory motive was present.
    The summary judgment record includes an affidavit in which
    Fierros states that Arnold told her that she had been denied the pay
    increase because she filed a discrimination complaint against him.
    Such an affidavit is direct evidence that Arnold had a retaliatory
    motive because it "is evidence which, if believed, proves the fact [of
    intentional retaliation] without inference or presumption."
    ...
    Our determination that Fierros has raised a jury question about
    whether Arnold intended to retaliate against her when he denied
    26
    No. 07-31027
    her the merit pay increase is further supported by circumstantial
    evidence.
    
    Id. Thus, this
    court can look at all evidence in the record, both direct and
    circumstantial, to determine if Dr. Knatt has raised a genuine issue of material
    fact for trial. Dr. Knatt argued both in the district court and in this court that
    he was entitled to defeat the summary judgment motion based on the direct and
    circumstantial evidence which he described in his brief. Two full pages of Dr.
    Knatt’s brief are dedicated to a discussion of evidence of racial animus and how
    that evidence establishes discrimination. The remainder of the circumstantial
    evidence is discussed throughout his brief. Despite the fact that this is Dr.
    Knatt’s central argument in this appeal, the majority concludes that this issue
    is inadequately briefed to preserve the argument on appeal. Apparently the
    majority would require Knatt to tag each item of evidence as either supporting
    his argument of discrimination under the McDonnell Douglas standard or his
    argument of discrimination based on direct and circumstantial evidence. Such
    a requirement makes no sense.       If a plaintiff can raise a genuine issue of
    material fact tending to show discrimination, the defendant’s motion for
    summary judgment must be denied.
    Dr. Knatt complains of a conspiracy at the hands of the defendants that
    began before his suspension. Beginning in October 2001, an Ad Hoc Committee
    was appointed by the Executive Bylaws Committee of the Board of Lane
    Memorial to single out Dr. Knatt to review complaints about him, particularly
    any on-call incidents. The review lasted until January 2002. According to the
    deposition testimony of Dr. Rathbone and Dr. Fonte, the Board has never
    appointed a committee to investigate a hospital physician for on-call violations
    except Dr. Knatt.
    27
    No. 07-31027
    The most graphic evidence of racial animus was provided by surgical nurse
    Marlene Bucionne. She testified that the nurses were ordered by Jeanne Partin
    (nurse supervisor and sister of orthopedic surgeon Dr. Fonte), Dr. Fonte and
    Terry Whittington, CEO, to monitor Dr. Knatt’s activities closely and document
    anything they could find on which to base a reprimand. This documentation was
    to be delivered to hospital officials and administration. Dr. Knatt argues that
    this supports his argument that hospital officials were looking for a reason to get
    rid of him and supports his statements that the complaints by the nurses of Dr.
    Knatt’s behavior in surgery were false or exaggerated. Lane Memorial Board
    Member Etta Hearn wrote to CEO Whittington complaining of the baseless
    complaints about Dr. Knatt by the nurses in March 2002. Dr. Knatt testified
    that the complaints of the nurses in general and those that led to his suspension
    were false or overstated. He also provided evidence that similar complaints
    about other doctors, including Dr. Fonte, were not acted upon.
    The extensive evidence presented by Dr. Knatt supports an inference that
    Dr. Knatt was being targeted for mistreatment and more intense scrutiny than
    other doctors because of his race. Nurse Bucionne’s testimony went directly to
    the defendants’ racial animus. She testified in her deposition that at least two
    of the three doctors on the MEC, Dr. Rathbone and Dr. Medina, used racial
    epithets in reference to Dr. Knatt at a meeting involving the investigation of Dr.
    Knatt. She also testified that she heard the third member of the MEC, Dr.
    Fonte, using racial epithets several times but did not provide the context for
    those comments.      These are the same doctors who ordered Dr. Knatt’s
    suspension. Although her testimony is not entirely clear, the hospital CEO,
    Jeanne Partin and other nurses on the operating staff were part of that meeting
    and also used racial epithets in relation to Dr. Knatt. These are the same nurses
    who brought the complaints that were used to support Dr. Knatt’s suspension.
    This direct evidence raised an issue of fact that racial animus played a role
    28
    No. 07-31027
    in the suspension of Dr. Knatt. The statements refer to race; they were made by
    the members of the MEC who ordered Dr. Knatt’s suspension, i.e. the applicable
    decision makers; and they were related to the decision process because they
    occurred in a meeting at which the nurses were directed to gather evidence
    which was used as a basis for the suspension. Patel v. Midland Mem. Hosp. &
    Med. Ctr., 
    298 F.3d 333
    , 343-44 (5th Cir. 2002). The use of racial epithets by the
    nursing staff who submitted the evidence on which the suspension was based is
    also relevant.
    Use of racial epithets in an employment context is direct evidence of
    discrimination sufficient to defeat summary judgment. In Brown v. East Miss.
    Elec. Power Ass’n, the plaintiff presented evidence that his supervisor used
    racial epithets both generally and in reference to him. We said -
    Unlike certain age-related comments which we have found too
    vague to constitute evidence of discrimination, the term "nigger" is
    a universally recognized opprobrium, stigmatizing African-
    Americans because of their race.
    Brown v. East Miss. Elec. Power Ass'n, 
    989 F.2d 858
    , 861 (5th Cir. Miss.
    1993)(footnote omitted). See also footnote 8 of that case, listing cases dealing
    with use of this racial epithet as direct evidence of discrimination.
    See Kendall v. 
    Block, supra
    (calling an employee "nigger" may be
    direct evidence of discrimination); EEOC v. Alton Packaging Corp.,
    
    901 F.2d 920
    (11th Cir.1990) (general manager's statement that if
    it were his company he would not hire blacks is direct evidence of
    discriminatory animus in failing to promote the plaintiff); Brewer v.
    Muscle Shoals Bd. of Educ., 
    790 F.2d 1515
    (11th Cir.1986) (school
    superintendent's comment that he did not want to appoint plaintiff
    to an administrative position because he did not want to see the
    school system "nigger-rigged" is direct evidence of discriminatory
    animus, even though the comment was made with regard to an
    incident occurring after the alleged violation); Bibbs v. Block, 
    778 F.2d 1318
    (8th Cir.1985) (en banc ) (selection committee member's
    characterization of plaintiff as a "black militant" and reference to
    another black employee as "nigger" was direct evidence of
    29
    No. 07-31027
    discrimination in failure to promote), overruled on other grounds by
    Price 
    Waterhouse, supra
    .
    
    Id. at 862.
          The most obvious way of showing an unlawful employment practice
    is to offer “evidence that can be interpreted as an acknowledgment
    of discriminatory intent by the defendant or its agents . . .” [citing
    Troupe v. May Department Stores Company, 
    20 F.3d 734
    (7 th Cir.
    1994)] Examples include epithets or slurs uttered by an authorized
    agent of the employer . . . . When produced, such “direct” evidence
    will without more ordinarily suffice to show that an adverse
    employment condition, or limitation on an employment opportunity,
    was imposed “because of” the plaintiff’s protected group
    characteristic.
    Civil Rights and Employment Discrimination Law, Harold S. Lewis, Jr. (West
    1997), § 4.2.
    The direct and circumstantial evidence of discrimination set forth above
    creates a genuine issue of fact on the question whether the defendants conspired
    to find a reason–pretextual or otherwise--to get rid of Dr. Knatt and that racial
    animus played a role in Dr. Knatt’s suspension. For this reason I would vacate
    the dismissal of Dr. Knatt’s § 1983 and § 1985 claims and remand this case to
    the district court for trial.
    30
    

Document Info

Docket Number: 07-31027

Filed Date: 5/12/2009

Precedential Status: Non-Precedential

Modified Date: 12/21/2014

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samuel-brewer-v-muscle-shoals-board-of-education-donald-r-heidorn , 790 F.2d 1515 ( 1986 )

Equal Employment Opportunity Commission v. Alton Packaging ... , 901 F.2d 920 ( 1990 )

United States v. Skilling , 554 F.3d 529 ( 2009 )

united-states-v-earl-keith-lindell-united-states-of-america-v-charles , 881 F.2d 1313 ( 1989 )

Rutherford v. Harris County Texas , 197 F.3d 173 ( 1999 )

Jones v. Robinson Property Group, L.P. , 427 F.3d 987 ( 2005 )

Veronica A. Wallace v. The Methodist Hospital System , 271 F.3d 212 ( 2001 )

Fabela v. Socorro Independent School District , 329 F.3d 409 ( 2003 )

Salome Fierros v. Texas Department of Health , 274 F.3d 187 ( 2001 )

carol-frank-derrey-horn-cynthia-stubblefeild-walker-individually-and-on , 347 F.3d 130 ( 2003 )

p-v-patel-md-individually-p-v-patel-md-a-professional-association , 298 F.3d 333 ( 2002 )

gardes-directional-drilling-v-us-turnkey-exploration-co-lajfp , 98 F.3d 860 ( 1996 )

Coury v. Moss , 529 F.3d 579 ( 2008 )

Computer Management Assistance Company v. Robert F. ... , 220 F.3d 396 ( 2000 )

Henry P. Earnest, Jesse Earnest, Jr., Anita Earnest McCohn ... , 690 F.2d 1198 ( 1982 )

Henry Brown v. East Mississippi Electric Power Association , 989 F.2d 858 ( 1993 )

Carl Joseph Davis v. Ross Maggio, Jr., Warden, Louisiana ... , 706 F.2d 568 ( 1983 )

Cambridge Toxicology Group, Inc. v. Exnicios , 495 F.3d 169 ( 2007 )

A.M. Jatoi, Md v. Hurst-Euless-Bedford Hospital Authority , 807 F.2d 1214 ( 1987 )

Roy BYRD, Plaintiff-Appellant, v. ROADWAY EXPRESS, INC., ... , 687 F.2d 85 ( 1982 )

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