Case Title: Bulwer v. Mount Auburn Hospital

Citation: 

Docket Number: SJC-11875

State: massachusetts

Court: Massachusetts Supreme Court

Date: 2016-02-29T00:00:00Z

Document:
NOTICE:  All slip opinions and orders are subject to formal 
revision and are superseded by the advance sheets and bound 
volumes of the Official Reports.  If you find a typographical 
error or other formal error, please notify the Reporter of 
Decisions, Supreme Judicial Court, John Adams Courthouse, 1 
Pemberton Square, Suite 2500, Boston, MA, 02108-1750; (617) 557-
1030; SJCReporter@sjc.state.ma.us 
 
SJC-11875 
 
BERNARD E. BULWER  vs.  MOUNT AUBURN HOSPITAL & others.1 
 
 
 
Middlesex.     November 3, 2015. - February 29, 2016. 
 
Present:  Gants, C.J., Spina, Cordy, Botsford, Duffly, & Lenk, 
JJ. 
 
 
Hospital, Appointment to staff.  Anti-Discrimination Law, Race, 
Employment.  Employment, Discrimination.  Contract, 
Employment, With hospital, Performance and breach.  
Practice, Civil, Summary judgment. 
 
 
 
 
Civil action commenced in the Superior Court Department on 
February 22, 2008. 
 
 
The case was heard by S. Jane Haggerty, J., on a motion for 
summary judgment. 
 
 
After review by the Appeals Court, the Supreme Judicial 
Court granted leave to obtain further appellate review. 
 
 
 
Robert R. Hamel, Jr. (Megan E. Kures with him) for the 
defendants. 
 
Denzil D. McKenzie (James E. Clancy, IV, with him) for the 
plaintiff. 
 
James A.W. Shaw, for Massachusetts Employment Lawyers 
Association, amicus curiae, submitted a brief. 
 
 
                                                 
 
1 Eric Flint, Ricardo Wellisch, and Lori Balestrero. 
2 
 
 
 
LENK, J.  Massachusetts law prohibits employers from 
discriminating against their employees on the basis of, among 
other things, race or national origin.  See G. L. c. 151B, § 4.  
Because direct proof of such discrimination is rarely available, 
employees filing claims under G. L. c. 151B, § 4, are permitted 
to prove discrimination without direct evidence of 
discriminatory intent, by relying on evidence that their 
employers gave a "false reason,"2 or pretext, for terminating 
their employment.  In this case, we address whether the 
plaintiff has produced sufficient evidence of pretext to survive 
his former employer's motion for summary judgment.  In doing so, 
we clarify the evidentiary burdens each party faces after one 
party has moved for summary judgment.  We address, in 
particular, three concerns:  whether the evidence on which an 
employee relies to survive a defendant's motion for summary 
judgment need show not only that the defendant's stated reason 
was false, but also that it concealed a discriminatory purpose; 
whether it is the plaintiff's burden to persuade the motion 
judge based on that evidence that there is an issue of material 
fact appropriate for trial; and, finally, whether, in discerning 
                                                 
 
2 A "false reason" is one that is not the real reason for 
terminating an individual's employment, regardless whether the 
false reason is factually accurate.  See Lipchitz v. Raytheon 
Co., 434 Mass. 493, 502 (2001) (Lipchitz); Wheelock College v. 
Massachusetts Comm'n Against Discrimination, 371 Mass. 130, 139 
(1976). 
3 
 
 
the existence of an issue of material fact, the motion judge may 
weigh or otherwise evaluate the evidence. 
 
The plaintiff, Bernard E. Bulwer, is a black male of 
African descent who is originally from the Central American 
country of Belize.  The plaintiff has a medical degree from the 
University of the West Indies, and practiced medicine outside 
the United States until 2002, when he came to this country.  In 
order to become certified to practice medicine in the United 
States, he was required to complete a residency program here.  
During the first year of his residency at the defendant Mount 
Auburn Hospital (hospital), the plaintiff received diametrically 
opposing reviews from supervising physicians, some laudatory and 
others deeply critical, after which the hospital terminated his 
employment.  The plaintiff filed a ten-count complaint in the 
Superior Court against the hospital and three physicians who 
supervised his work, asserting, among other things, employment 
discrimination under G. L. c. 151B, § 4, and breach of contract.3  
Concluding that the plaintiff had not produced sufficient 
evidence of the defendants' discriminatory intent, a Superior 
Court judge allowed the defendants' motion for summary judgment 
                                                 
 
3 The plaintiff also alleged retaliation in violation of 
G. L. c. 151B, § 4; breach of a health insurance obligation in 
violation of G. L. c. 175, § 110D; defamation; intentional 
infliction of emotional distress; negligent infliction of 
emotional distress; and three counts of tortious interference 
with a contractual relationship. 
4 
 
 
on all claims.  The plaintiff appealed, and a divided Appeals 
Court reversed the judgment as to the discrimination and breach 
of contract claims, while affirming the decision on all of the 
other claims.  We allowed the defendants' application for 
further appellate review, limited to the claims for 
discrimination under G. L. c. 151B, § 4, and breach of contract.  
We conclude that the defendants were not entitled to summary 
judgment and that the plaintiff has presented evidence 
sufficient to allow a jury to hear his claims. 
 
1.  Background.  We summarize facts drawn from the summary 
judgment record, reserving certain details for later discussion.  
See LeBlanc v. Logan Hilton Joint Venture, 463 Mass. 316, 318 
(2012) (LeBlanc).  The plaintiff, in addition to his medical 
degree, has postgraduate training in a number of fields, 
including cardiovascular disease.  He practiced medicine in 
Trinidad, Belize, and the United Kingdom from 1989 through 2002.  
In 2002, the plaintiff came to the United States as a research 
associate and fellow in a subresidency cardiology program at 
another hospital in Boston, where he worked until 2005. 
 
In the spring of 2005, hoping to obtain a medical license 
to practice in the United States, the plaintiff contacted the 
defendant Dr. Eric Flint, director of the internal medicine 
residency program at the hospital.  In June, 2005, after an 
interview with Flint, the plaintiff was offered a residency at 
5 
 
 
the hospital.  Because of delays in the processing of his visa, 
he began his residency in September, 2005, two months later than 
the other residents in his cohort. 
 
In August, 2005, the plaintiff signed the hospital's 
standard medical resident agreement (agreement), setting forth 
the terms and conditions of his employment.  The agreement was 
for a one-year term, renewable for an additional two years upon 
satisfactory completion of the first-year program. 
 
The agreement stated that the hospital and its residency 
program would comply with the requirements promulgated by the 
national Accreditation Council for Graduate Medical Education 
(ACGME).  ACGME requires, among other things, that member 
programs not discriminate against residents on grounds including 
race and national origin.  It also requires that programs 
provide residents with written procedures that must be followed 
in the event a program seeks "academic or other disciplinary 
action" against a resident. 
 
The hospital's written procedures state that, should a 
resident's supervisors decide to terminate a resident's 
employment, a resident has the right to convene an ad hoc 
committee4 consisting of the heads of various departments, the 
resident at issue, and another resident to be chosen by mutual 
                                                 
 
4 The hospital's rules refer to this committee variously as 
the "ad hoc committee," the "due process committee," and the "ad 
hoc due process committee." 
6 
 
 
agreement.  Such a committee would then be empowered to conduct 
an independent review of the employment decisions made by the 
resident's supervisors.  The procedures provide further that 
"[t]he resident is assured of the fundamental aspects of a 
fair hearing including written statement of the specific 
issues from the Department Chair, at least [five] days 
notice of the Due Process Committee meeting, the 
opportunity to be present and to rebut the evidence, and 
the opportunity to present any other information. 
 
". . . 
 
"All matters upon which any decision is based must be 
introduced into evidence at the proceeding before the Ad 
Hoc Due Process Committee in the presence of the resident." 
 
Residents may then appeal the committee's decision to the 
"President of the Medical Staff." 
 
After signing the agreement, the plaintiff began his 
residency in September, 2005.  The first-year program consisted 
of twelve one-month rotations in a number of different 
"services" throughout the hospital.  The plaintiff's performance 
was to be evaluated by attending physicians and resident 
supervisors in each of the services where he worked.  The 
evaluating physicians were to fill out evaluation forms, which 
called for numerical ratings of various aspects of the 
plaintiff's performance, as well as for written comments.  These 
evaluations in turn would be given to the clinical competence 
committee (CCC), a panel of thirteen physicians who met 
regularly to discuss the progress of all of the residents.  The 
7 
 
 
plaintiff was also assigned a mentor, the defendant Dr. Lori 
Balestrero. 
 
The plaintiff's first rotation in September was in the 
hospital's emergency department.  The plaintiff received 
strongly positive evaluations in that department.  Two 
physicians rated him as "outstanding," and five others rated him 
"above average."  They described him as knowledgeable, mature, 
and pleasant to work with.  Dr. Gary Setnik, head of the 
emergency department, provided a more lengthy written 
evaluation: 
 
"Dr. Bulwer is universally held in high regard by the staff 
I polled and by myself.  He has been totally reliable, coming in 
early, and staying late on most shifts.  He aggressively works 
to see as many patients as possible.  His presentations are 
complete, his management plans appropriate, and his procedural 
skills very good." 
 
The next month, the plaintiff rotated into the medical 
intensive care unit (MICU).  There, he received mixed 
evaluations.  In an October, 2005, electronic mail message to a 
colleague, Dr. Soon-Il Song wrote positively that 
"[the plaintiff] had procedural skills and knowledge base 
well above someone at an intern level.  He also was 
pleasant to work with.  He had a good sense of his own 
limitations, and asked questions often in order to clarify 
issues.  I think his ability to gather information in 
history taking was quite good and thorough.  Above all, he 
maintained composure and a good attitude, despite the fact 
8 
 
 
that we had an especially difficult night of no sleep and 
challenging patients requiring multiple attending input in 
the middle of the night." 
 
Other physicians, however, viewed the plaintiff's performance 
negatively.  One wrote that the plaintiff "[m]ade drastic and 
potentially dangerous/life threatening decisions about [patient] 
care [without] consulting [the] attending [physician]. . . . [He 
is] [t]oo confident for his own good and [the patient's] own 
good without showing any proof of capability to perform at the 
level of an intern or resident yet."  Another commented that the 
plaintiff was "eager to learn" but that "[h]e does not seem to 
be aware of his responsibilities as an intern despite being told 
them repeatedly."  In response, the plaintiff sent an electronic 
mail message to Flint stating that he did not believe these 
negative reviews were objective, and asking Flint to obtain 
evaluations from four named physicians with whom the plaintiff 
had seen patients.  Flint did not do so. 
 
Setnik reported that both he and other members of his 
department received harsh comments from members of the MICU 
staff for his positive evaluations of the plaintiff.  He 
described this as "[a]n experience that I hadn't previously had 
at Mount Auburn." 
 
In November, 2005, Balestrero, the plaintiff's mentor, met 
with the plaintiff to discuss the negative feedback.  The 
plaintiff told her that he thought the negative impressions were 
9 
 
 
inaccurate.  Balestrero then met with the CCC to discuss ways in 
which the plaintiff could improve.  Following this meeting, 
Balestrero presented the plaintiff with a plan for improvement 
that she had developed together with the CCC.  The plan included 
a provision for weekly meetings with Balestrero and a follow-up 
meeting, to be held after evaluations from the December rotation 
were received, with the plaintiff, Balestrero, and a CCC 
representative.  Neither the weekly meetings nor the follow-up 
meeting took place.5 
 
During November and December of 2005, the plaintiff was 
assigned a "wards" rotation in which he provided general 
internal medicine care for patients who had been admitted to the 
hospital.  The three evaluations from that rotation that appear 
in the record were positive, with one evaluator noting "much 
improvement," and another stating that the plaintiff was 
"[o]verall . . . pretty good."  The third evaluator assigned a 
passing grade, but stated that the plaintiff needed improvement 
in "practice-based learning," professionalism, and organization 
of notes charting patients' progress. 
 
In January, 2006, the plaintiff rotated into the cardiology 
department.  He received three evaluations of his work on that 
                                                 
 
5 The plaintiff states that these meetings did not occur 
because of Balestrero's schedule, while the defendants contend 
that it was the plaintiff's schedule that prevented the meetings 
from taking place. 
10 
 
 
service.  One rated him as failing in five of six competencies, 
but another gave him high marks in all competencies, and the 
third described his presentations as "very commendable" and his 
knowledge as "excellent."  In mid-January, 2006, the plaintiff 
met with Balestrero, who told him that he had received positive 
evaluations and that "the past [was] behind [him]." 
 
In February, 2006, the plaintiff rotated again into the 
wards service.  One evaluator there rated him positively, while 
the other, Dr. Erica Bial, wrote a lengthy and negative 
evaluation in which she described her experience with the 
plaintiff as "horrendous."  She stated that "[t]here is no 
aspect of the central competencies in which [the plaintiff] is 
even modestly competent."  She described him as "less-than-
fully-honest" and as having "a difficult time being appropriate 
with . . . women in the professional environment," and 
recommended that the plaintiff be expelled from the residency 
program.  During this period, Bial "berated" the plaintiff 
publicly in a manner that a witness, Song, described as not 
"appropriate," and as unprecedented in his experience with Bial.  
Song also reported that Bial spoke negatively to other residents 
about the plaintiff, outside of the plaintiff's presence. 
 
In March, 2006, the CCC discussed the plaintiff's mixed 
evaluations.  On April 5, 2006, the CCC sent the plaintiff a 
letter stating that it would not renew his contract because of 
11 
 
 
concerns about his ability to analyze complex information, his 
inability to "build effective therapeutic relationships," and 
his difficulty presenting information to other members of his 
teams.  The letter stated also that the plaintiff could finish 
his first year of residency, working until the end of his 
contract term in August, 2006.  The letter was signed by Flint 
and by the defendant Dr. Ricardo Wellisch, chair of the CCC. 
 
The plaintiff invoked his right to convene an ad hoc 
committee pursuant to the hospital's "due process" policy.  
Although the committee consisted of most of the individuals 
specified in that written policy, no resident was seated on it, 
as required by the policy.  Further, of the committee's three 
meetings, the plaintiff was invited to attend only the first 
one, which took place on April 24, 2006.  At that first meeting, 
as well as at the second, on May 2, 2006, the committee heard 
testimony from physicians who had previously evaluated the 
plaintiff during his rotations.  The transcripts of these 
meetings do not reflect discussion of the possibility that the 
plaintiff's contract would be terminated immediately, and the 
plaintiff did not receive any notice to that effect.6  He 
requested that the committee forward to him any materials 
                                                 
 
6 The record does not contain a transcript of the third 
meeting on May 9, 2006, at which the committee apparently 
deliberated and reached a decision. 
12 
 
 
considered during the meetings he did not attend; those requests 
were not answered. 
 
On May 9, 2006, the committee sent a letter to Dr. Stephen 
Zinner, chair of the department of medicine, stating that it 
would affirm the decision of the CCC not to renew the 
plaintiff's contract.  On May 17, 2006, Zinner informed the 
plaintiff verbally that, because of "serious additional 
concerns" for "patient safety" that had arisen "in the past 
[three] weeks," the plaintiff would "be immediately relieved of 
his responsibilities." 
 
The plaintiff sent a letter dated May 18, 2006, to the 
president and chief executive officer of the hospital stating 
his desire to appeal, as provided in the due process policy, 
from the committee's decision not to renew his contract and to 
terminate his employment immediately.  The president responded 
with a certified letter, return receipt requested, saying that 
she would convene such a committee.  The plaintiff did not 
retrieve the letter from the postal service, which attempted 
delivery three times, and did not pursue the appeal. 
 
In August, 2006, the plaintiff filed a charge of 
discrimination against the hospital with the Massachusetts 
Commission Against Discrimination.  In February, 2008, the 
plaintiff filed his complaint in the Superior Court, naming the 
hospital, Balestrero, Flint, and Wellisch as defendants.  During 
13 
 
 
discovery, depositions were taken of various doctors who had 
worked with the plaintiff, including Dr. Ramona Dvorak, an 
African-American internist and psychiatrist formerly employed at 
the hospital, who described what she believed to have been 
incidents of racism she experienced during her employment.  
Following discovery, in December, 2010, the defendants sought 
summary judgment on all counts; in June, 2011, their motion was 
allowed. 
 
2.  Discussion.  The plaintiff contends that the motion 
judge erred in allowing the defendants' motion for summary 
judgment on his claim for employment discrimination on the basis 
of his race and national origin, in violation of G. L. c. 151B, 
§ 4, and on his breach of contract claim based on his 
termination in violation of the procedures set forth in the 
medical resident agreement.  The plaintiff maintains that there 
were disputed issues of material fact as to both claims, and the 
matter should proceed to trial. 
 
a.  Standard of review.  A motion for summary judgment 
under Mass. R. Civ. P. 56 (c), as amended, 436 Mass. 1404 
(2002), is appropriate where "the moving party . . . 'show[s] 
that there is no genuine issue as to any material fact and that 
the moving party is entitled to a judgment as a matter of law' 
based on the undisputed facts."  Premier Capital, LLC v. KMZ, 
Inc., 464 Mass. 467, 474 (2013), quoting Mass. R. Civ. 
14 
 
 
P. 56 (c).  "In reviewing the . . . grant of a motion for 
summary judgment, we conduct a de novo examination of the 
evidence in the summary judgment record . . . and view the 
evidence in the light most favorable to the part[y] opposing 
summary judgment" (citation omitted)," LeBlanc, supra at 318, 
"drawing all reasonable inferences in [the nonmoving party's] 
favor."  Sullivan v. Liberty Mut. Ins. Co., 444 Mass. 34, 38 
(2005) (Sullivan). 
 
b.  Discrimination claim.  i.  Evidentiary burdens.  
General Laws c. 151B, § 4, provides that "[i]t shall be an 
unlawful practice . . . [f]or an employer . . . because of the 
race, color, . . . [or] national origin . . . of any 
individual . . . to discharge from employment such individual or 
to discriminate against such individual in compensation or in 
terms, conditions or privileges of employment."  In order to 
prevail at trial, an employee bringing a complaint under G. L. 
c. 151B, § 4, must demonstrate four things:  that he or she is a 
member of a protected class; that he or she was subject to an 
adverse employment action; that the employer bore 
"discriminatory animus" in taking that action; and that that 
animus was the reason for the action (causation).  See Lipchitz 
v. Raytheon Co., 434 Mass. 493, 502 (2001) (Lipchitz).  The 
question here is whether the plaintiff provided evidence from 
which a reasonable jury could infer the presence of the latter 
15 
 
 
two elements, i.e., that the defendants bore discriminatory 
animus and that the animus was the reason the defendants 
terminated the plaintiff's employment. 
 
In the pretrial context, an employee asserting a 
discrimination claim under G. L. c. 151B, § 4, may survive a 
motion for summary judgment by providing "[d]irect evidence of 
[the] elements" of discriminatory animus and causation.  
Sullivan, supra at 39.  Because such direct evidence "rarely 
exists," however, an employee plaintiff may also survive such a 
motion by providing "indirect or circumstantial evidence [of 
discriminatory animus and causation] using the familiar three-
stage, burden-shifting paradigm first set out in McDonnell 
Douglas Corp. v. Green, 411 U.S. 792, 802–805 (1973) (McDonnell 
Douglas)."  Sullivan, supra at 39-40. 
 
"In the first stage [of this paradigm], the plaintiff has 
the burden to show . . . a prima facie case of discrimination."  
Blare v. Husky Injection Molding Sys. Boston, Inc., 419 Mass. 
437, 441 (1995) (Blare).  To do so, a plaintiff must provide 
"evidence that:  (1) he [or she] is a member of a class 
protected by G. L. c. 151B; (2) he [or she] performed his [or 
her] job at an acceptable level; [and] (3) he [or she] was 
terminated."  Id.  "In the second stage, the employer can rebut 
the presumption created by the prima facie case by articulating 
a legitimate, nondiscriminatory reason for its [employment] 
16 
 
 
decision."  Id.  In the third stage, the burden of production7 
shifts back to the plaintiff employee, requiring the employee to 
provide evidence that "the employer's articulated justification 
[for the termination] is not true but a pretext."  Id. at 443. 
 
The defendants contend that, at this third stage, the 
plaintiff must present evidence that the "[hospital]'s reason 
for termination constituted a pretext concealing a 
discriminatory purpose" (emphasis supplied).  Bulwer v. Mount 
Auburn Hosp., 86 Mass. App. Ct. 316, 347 (2014) (Sikora, J., 
dissenting) (Bulwer).  See id. at 355 (Sikora, J., dissenting) 
(taking position that claim fails because plaintiff did not show 
"invidious intent").  This formulation, however, overstates the 
plaintiff's burden at the summary judgment stage because 
"Massachusetts is a pretext only jurisdiction."  Blare, supra at 
443.  See Abramian v. President & Fellows of Harvard College, 
432 Mass. 107, 114-115 (2000).  As we explained in Lipchitz, 
supra at 500-501: 
 
"The phrase 'pretext for discrimination' implies that 
the plaintiff must prove not only that a reason given by 
the employer for the adverse decision was false, but that 
the reason was given to cover a discriminatory animus.  Our 
                                                 
 
7 The "burden of production" refers to "a party's obligation 
to come forward with evidence to support its claim."  Director, 
Office of Workers' Compensation Programs, Dep't of Labor v. 
Greenwich Collieries, 512 U.S. 267, 272 (1994) (Greenwich).  
This is distinct from the burden of persuasion, often called the 
"burden of proof," which refers to "the notion that if the 
evidence is evenly balanced, the party that bears the burden of 
persuasion must lose."  Id. 
17 
 
 
decisions do not require this. . . .  If the employee were 
able to prove by direct evidence that discriminatory animus 
motivated the decision, [he] would not have to rely on the 
indirect method of proving animus by disproving at least 
one of the employer's articulated, nondiscriminatory 
reasons" (citations omitted). 
 
 
To survive a motion for summary judgment, the plaintiff 
need only present evidence from which a reasonable jury could 
infer that "the respondent's facially proper reasons given for 
its action against him were not the real reasons for that 
action."  Wheelock College v. Massachusetts Comm'n Against 
Discrimination, 371 Mass. 130, 139 (1976) (Wheelock College).  
The case can then proceed to trial, at which point, "if the fact 
finder is persuaded that one or more of the employer's reasons 
is false, it may (but need not) infer that the employer is 
covering up a discriminatory intent, motive or state of mind."8  
Lipchitz, supra at 501.  In other words, a fact finder at trial 
may infer that, "[c]ombined with establishment of a prima facie 
case . . . , a showing of pretext eliminates any legitimate 
                                                 
 
8 While Lipchitz, supra, involved a motion for judgment 
notwithstanding the verdict, see Mass. R. Civ. P. 50 (b), as 
amended, 428 Mass. 1402 (1998), rather than a motion for summary 
judgment, "[t]he standard for obtaining a judgment 
notwithstanding a verdict in Massachusetts is the same as the 
summary judgment standard."  Sarro v. Philip Morris USA Inc., 
857 F. Supp. 2d 182, 189 (D. Mass. 2012).  See Cahaly v. 
Benistar Prop. Exch. Trust Co., 451 Mass. 343, 350 (2008), cert. 
denied, 555 U.S. 1047 (2008), quoting Phelan v. May Dep't Stores 
Co., 443 Mass. 52, 55 (2004) ("We ask whether, construing the 
evidence most favorably to the plaintiff, and 'without weighing 
the credibility of the witnesses or otherwise considering the 
weight of the evidence, the jury reasonably could have returned 
a verdict for the plaintiff'"). 
18 
 
 
explanation for the adverse hiring decision and warrants a 
determination that the plaintiff was the victim of unlawful 
discrimination."9  Blare, supra at 446. 
 
The defendants also argue that, at this third stage, the 
burden of persuasion is on the "the plaintiff . . . to 
demonstrate that there is a genuine issue of material fact 
whether the defendants' proffered reason is a pretext" (emphasis 
in original).10  Bulwer, supra at 347 (Sikora, J., dissenting).  
See id. at 348 (Sikora, J., dissenting) ("plaintiff must 
substantiate a genuine issue of" material fact).  While the 
plaintiff does bear "the burden of producing evidence" that the 
employer's reasons are pretextual, see Matthews v. Ocean Spray 
                                                 
 
9 We nonetheless reiterate that, at trial, 
 
"[p]ermitting the fact finder to infer discriminatory 
animus from proof that the employer has advanced a false 
reason does not . . . eliminate the plaintiff's burden to 
prove this essential element. . . .  Stated differently, 
the 'indirect evidence' moniker derives from the type of 
evidence (pretext) that may establish one or both statutory 
elements (discriminatory animus and causation)" (citation 
omitted). 
 
Lipchitz, supra at 502. 
 
 
10 This burden is described as requiring the plaintiff to 
demonstrate that the "the employer's articulated reason lack[s] 
reasonable support in evidence or is . . . wholly 
disbelievable."  Bulwer v. Mount Auburn Hosp., 86 Mass. App. Ct. 
316, 347 (2014) (Bulwer) (Sikora, J., dissenting), quoting Lewis 
v. Area II Homecare for Senior Citizens, Inc., 397 Mass. 761, 
765 (1986) (Lewis).  This language, drawn from Lewis, supra, 
described the plaintiff's burden at trial and not, as here, at 
summary judgment.  See id. at 765 ("judge found [after bench 
trial] . . . that the plaintiff failed to prove pretext"). 
19 
 
 
Cranberries, Inc., 426 Mass. 122, 127 (1997) (Matthews), the 
burden of persuasion at summary judgment remains with the 
defendants, who, "as the moving part[ies], 'ha[ve] the burden of 
affirmatively demonstrating the absence of a genuine issue of 
material fact on every relevant issue, even if [they] would not 
have the burden on an issue if the case were to go to trial.'"  
Sullivan, supra at 39, quoting Matthews, supra. 
 
ii.  Questions of material fact.  In opposing the 
defendants' motion for summary judgment, the plaintiff relies on 
indirect evidence of discrimination, which we analyze using the 
McDonnell Douglas three-stage paradigm.  The defendants concede, 
with regard to the first stage, that the plaintiff has satisfied 
his obligation to make out a prima facie case of 
discrimination.11  With regard to the second stage, the 
defendants assert that the plaintiff's employment was terminated 
based on his poor performance evaluations, included in the 
record, that express doubts about his abilities and raise 
concerns for patient safety.  This satisfies the defendants' 
obligation to produce both "lawful . . . reasons for [their] 
employment decision" and "credible evidence to show that 
                                                 
 
11 The defendants' concession that the plaintiff "could 
establish a prima facie case" is "for summary judgment purposes 
only." 
20 
 
 
the . . . reasons advanced were the real reasons."12  See Blare, 
supra at 442, quoting Wheelock College, supra at 138.  We 
therefore move to the third stage, and consider whether the 
plaintiff has provided evidence sufficient to allow a reasonable 
jury to infer that "the employer's articulated justification is 
not true but a pretext."  Blare, supra at 443. 
 
We begin by reciting more specifically the reasons provided 
by the hospital for terminating the plaintiff's employment.  In 
April, 2006, Wellisch and Flint sent a letter to the plaintiff 
citing his "inability to adequately analyze clinical data in 
complex cases," "inability to consistently build effective 
therapeutic relationships," and "inability to gain insight into 
feedback that is offered."  In May, 2006, Zinner decided to 
terminate the plaintiff's employment immediately due to asserted 
"additional clinical errors, failures to document or comply with 
our clearly stated expectations about chart notes, and failures 
to call for appropriate help with severely ill patients." 
 
The record contains at least five categories of evidence 
from which a jury might infer that these stated reasons were not 
the real reasons that the plaintiff's employment was terminated.  
When "taken as a whole rather than viewed in isolation," such 
                                                 
 
12 As the Appeals Court noted, the plaintiff "does not 
seriously argue that the hospital failed to meet its non-onerous 
burden of articulating a legitimate reason for his termination." 
Bulwer, supra at 329-330. 
21 
 
 
evidence could lead a rational jury to conclude that the reasons 
for the plaintiff's discharge were pretextual.  See Dorman v. 
Norton Co., 64 Mass. App. Ct. 1, 9-10 (2005). 
 
First, while the record plainly contains negative 
evaluations tending to support the aforementioned criticisms, 
the record also contains numerous evaluations inconsistent with 
these criticisms.  See Cole v. Ruidoso Mun. Schs., 43 F.3d 1373, 
1380 (10th Cir. 1994) (reversing summary judgment for employer 
where conflicting evaluations raised fact questions about true 
reasons for adverse employment action).  See also Bonefont-
Igaravidez v. International Shipping Corp., 659 F.3d 120, 124 
(1st Cir. 2011), quoting Gómez–González v. Rural Opportunities, 
Inc., 626 F.3d 654, 662–663 (1st Cir. 2010) ("pretext can be 
established by showing . . . 'weaknesses [or] implausibilities 
. . . in the employer's offered reasons'"); 59 Causes of Action 
2d, Cause of Action under Age Discrimination in Employment Act 
§ 24 (2013) ("evidence of satisfactory or superior performance 
evaluations . . . may tend to show . . . the illegitimate nature 
of the defendant's articulated reason"). 
 
For example, some evaluators wrote of the plaintiff's 
"excellent" "ability to interpret and analyze clinical data, and 
formulat[e] a plan of management," even as the plaintiff was 
dismissed ostensibly because he could not "adequately analyze 
clinical data in complex cases."  Similarly, some evaluators 
22 
 
 
praised the plaintiff's "progress notes" as "very detailed and 
informative," "very thorough," and "generally well thought out," 
while others criticized him for "fail[ing] to document or comply 
with . . . expectations about chart notes."  Moreover, 
evaluations noting that "several patients have commented on [the 
plaintiff's] thoroughness and humanistic qualities" and that 
"patients' family members told [the evaluator] several times how 
helpful he had been during an emotionally difficult time" are in 
some tension with the view that the plaintiff evinced an 
"inability to consistently build effective therapeutic 
relationships."  The record also contains evaluations noting 
that the plaintiff "had a good sense of his own limitations" and 
that he took "in feedback well."13  These disparate evaluations 
prompted the chair of the ad hoc committee to note that "it is 
                                                 
 
13 Two other points along these lines are noteworthy.  
First, the plaintiff received contradictory advice from 
evaluators.  While one evaluator criticized him for making 
"drastic" decisions on his own, another suggested, only one 
month earlier, that the plaintiff "work on his independence and 
self-initiative, mainly in terms of seeing patients primarily on 
his own and getting out of a 'shadowing' mode."  Second, a 
letter from the hospital to the Board of Registration in 
Medicine, sent pursuant to G. L. c. 111, § 53B, explained that 
the plaintiff's employment had been terminated immediately 
because he "[f]ail[ed] to make appropriate progress in 
processing and applying evaluations and other constructive 
criticism and feedback to patient care responsibilities."  The 
plaintiff himself was told, however, that the immediate 
termination was not because of delays in his progress, but 
rather because of an immediate "risk to patient safety."  
Although these statements might be reconcilable, a jury could 
find in them inconsistency suggestive of the pretextual nature 
of the proffered reasons. 
23 
 
 
interesting how one set of behaviors can elicit such different 
perception." 
 
There is, secondly, evidence that the plaintiff was treated 
differently from similarly situated interns who are not black.  
See Matthews, supra at 129 ("The most probative means of 
establishing that the plaintiff's termination was a pretext for 
racial discrimination is to demonstrate that similarly situated 
white employees were treated differently").  For example, Song 
named two foreign interns (one white and one apparently Asian) 
who experienced "similar issues" but who, unlike the plaintiff, 
"were given opportunities to remediate or repeat rotations."14  
The plaintiff identified a third.15  The suggestion that the 
plaintiff was treated differently from these individuals based 
on his race also finds support in Setnik's statement that "[i]t 
is hard to understand the underlying basis for [the negative] 
perceptions of [the plaintiff's] work." 
                                                 
 
14 The defendants argue that Dr. Soon-Il Song's testimony is 
"inadmissible as opinion testimony."  We discern no basis for 
this argument, given that Song can testify about the treatment 
of these two interns from "personal knowledge." See Mass. G. 
Evid. § 602 (2016) (witness may testify if he or she "has 
personal knowledge of the matter"; evidence of that knowledge 
"may consist of the witness's own testimony"). 
 
 
15 There was only one other intern not promoted from among 
the first-year residents in the plaintiff's cohort; that 
individual was black and from Uganda.  He was forced to leave 
the residency program when, following a poor evaluation from the 
hospital, his medical license was not renewed. 
24 
 
 
 
Third, Dvorak, an African-American internist and 
psychiatrist, described three separate instances of Caucasian 
doctors whose deficient performances she and other staff members 
noticed and brought to the attention of hospital administrators, 
but who were not subject to disciplinary action until months or 
years after the complaints were made -- and then only because of 
pressure from patients and other hospitals.  Dvorak also noted 
an incident in which she found "white supremacist" literature in 
the break room.  Although she told administrators "how upsetting 
[this] was, particularly [to her] as a[n] African-American," she 
maintains that the administrators rejected requests to 
discipline employees who displayed such literature in the 
workplace.16 
 
Fourth, a reasonable jury could interpret a number of 
comments by the plaintiff's evaluators and supervisors as 
reflecting "[s]tereotypical thinking . . . categorizing people 
on the basis of broad generalizations."  Lipchitz, supra at 503 
                                                 
 
16 The defendants contend that the entirety of Dr. Ramona 
Dvorak's testimony is inadmissible because it is "opinion 
testimony."  To the extent that Dvorak points to specific 
incidents and individuals of which she had personal knowledge, 
however, we discern no basis on which to exclude it.  See Mass. 
G. Evid. § 602.  That being said, the admissibility of any 
proffered evidence at trial is for the judge to determine.  See 
Commonwealth v. Drayton, 473 Mass. 23, 38 (2015) ("In 
identifying these elements that arguably may support" 
plaintiff's case, "we do not in any way suggest that the 
[evidence] ultimately is admissible").  See also Commonwealth v. 
Alcide, 472 Mass. 150, 162 n.14 (2015). 
25 
 
 
n.16.  Although such statements in isolation would not be 
adequate to support a finding of discrimination, when considered 
with evidence of disparate or unfair treatment in the evaluation 
process, they may lend support to such a finding.  See Conway v. 
Electro Switch Corp., 825 F.2d 593, 597 (1st Cir. 1987) ("While 
evidence of a discriminatory atmosphere may not be conclusive 
proof of discrimination against an individual plaintiff, such 
evidence does tend to add 'color' to the employer's 
decisionmaking processes and to the influences behind the 
actions taken with respect to the individual plaintiff"). 
 
For instance, one evaluator criticized the plaintiff for 
being "too confident for his own good."  Another said that 
someone in the plaintiff's position as an "intern is not 
supposed to be smart" and "[t]hat is why all of this [criticism] 
is happening."  Yet another, Bial, stated that the plaintiff was 
"the least respectful person with whom [she had] ever worked" 
and that he "has no capacity whatsoever for self-assessment."  
Bial also spoke negatively to other residents and interns about 
the plaintiff outside of the plaintiff's presence and "berated 
him" publicly in a manner that a witness identified as both not 
"appropriate" and unprecedented in his experience with Bial.  
Additionally, in informing the plaintiff of the decision not to 
promote him, Zinner noted that the plaintiff "is not well suited 
for a career in internal medicine in this country."  These kinds 
26 
 
 
of comments can, of course, admit of different interpretations 
by a jury, including ones reflecting only untainted professional 
judgment.  One interpretation that a jury could make of such 
comments, however, is that, combined with Bial's behavior, they 
reflect a subconscious sense that the plaintiff, as a black man 
and a foreigner, did not "know his place."17  See Ash v. Tyson 
Foods, Inc., 546 U.S. 454, 456 (2006) (judgment as matter of law 
for employer inappropriate where employer used ambiguous term 
that, though "not always . . . evidence of racial animus," is 
not "always benign"). 
 
Fifth, there is evidence that the defendants did not follow 
their written procedures in deciding to terminate the 
                                                 
 
17 In addition to these comments, which were made by the 
plaintiff's evaluators, some comments made during a meeting of 
the ad hoc committee might suggest that the plaintiff was 
evaluated critically in part because of his race.  Specifically, 
the doctors compared the plaintiff to a trainee from fifteen 
years earlier, whom they identified as a "woman of color from 
Washington" and who, like the plaintiff, had difficulty with 
"interpersonal skills, communication skills, [and] 
professionalism."  They said that this trainee "would have 
flunked on a number of those [more subjective] competencies" in 
which the plaintiff was deficient, despite the fact that she had 
no deficiencies in "intelligence and IQ."  A jury might see 
these comments as reflecting a tendency to evaluate black 
trainees unfavorably in subjective areas like interpersonal 
communication, even when those trainees perform well in 
objectively measurable areas like intelligence and medical 
knowledge.  See Douglas v. J.C. Penney Co., 474 F.3d 10, 14 
(2007) (evidence of racial animus inferred from "disparities in 
subjective performance evaluations between employees of 
different races" when those subjective evaluations "did not 
correlate with the individualized objective performance factors 
for those employees"). 
27 
 
 
plaintiff's employment.  A "'failure to follow established 
procedures or criteria' . . . [may] support a reasonable 
inference of intentional discrimination."  Nesbitt v. Holder, 
966 F. Supp. 2d 52, 56 (D.D.C. 2013), quoting Brady v. Office of 
the Sergeant at Arms, 520 F.3d 490, 495 (D.C. Cir. 2008).  See 
1 A. Larson, Employment Discrimination § 8.04, at 8-81 to 8-82 
(rev. ed. 2015) ("pretext can be shown by demonstrating . . . 
irregularities in . . . the procedures for discharge"). 
 
Here, the defendants departed from their written due 
process policy by failing to include a resident on the ad hoc 
committee, by not allowing the plaintiff to attend two of the 
three meetings of that committee, and by failing to heed the 
plaintiff's request for materials from those meetings.  The 
defendants further departed from this policy when they 
immediately terminated the plaintiff's employment without having 
informed him, either before or after the ad hoc committee 
meeting, that this step was being considered. 
 
The defendants argue that these five categories of evidence 
do not suffice to raise a question of material fact.  They note 
that, even if all of the inferences drawn by the plaintiff from 
the above evidence were reasonable, the ad hoc committee 
conducted "an expanded review" of the CCC's decision to 
terminate his employment and "concluded that the [plaintiff's] 
deficiencies remained serious."  Bulwer, supra at 355 (Sikora, 
28 
 
 
J., dissenting).  A "third [party]'s independent decision to 
take adverse action," they argue, "breaks the causal connection 
between [any] retaliatory or discriminatory animus [harbored by 
the plaintiff's evaluators] and the adverse action."  Mole v. 
University of Mass., 442 Mass. 582, 598 (2004).  This argument 
is unavailing. 
 
In addition to input from the plaintiff, the ad hoc 
committee based its conclusions on the evaluations relied on by 
the CCC, as well as on testimony from the physicians who wrote 
those evaluations and on statements and memoranda from the CCC 
itself.  Where "the decision makers relied on the 
recommendations of supervisors [whose motives have been 
impugned], the motives of the supervisors should be treated as 
the motives for the decision. . . .  An employer [may not] 
insulate its decision by interposing an intermediate level of 
persons in the hierarchy of decision, and asserting that the 
ultimate decision makers acted only on recommendation" (citation 
omitted).  Trustees of Forbes Library v. Labor Relations Comm'n, 
384 Mass. 559, 569-570 (1981).  See Cariglia v. Hertz Equip. 
Rental Corp., 363 F.3d 77, 83 (1st Cir. 2004) ("liability can 
attach if neutral decision makers, when deciding to terminate an 
employee, rely on information that is inaccurate, misleading, or 
incomplete because of another employee's discriminatory 
animus"). 
29 
 
 
 
The defendants also argue, in essence, that criticisms of 
the plaintiff's performance, even if harsh, are best read to 
reflect "professional" judgment rather than racial animus.  
Bulwer, supra at 350 (Sikora, J., dissenting).  Even assuming 
the defendants are correct such that they could prevail on this 
point at trial, at the summary judgment stage "a court does not 
resolve issues of material fact, assess credibility, or weigh 
evidence."  Kernan v. Morse, 69 Mass. App. Ct. 378, 382 (2007).  
The question of whose interpretation of the evidence is more 
believable, "raised by the [parties'] conflicting evidence as to 
the defendant[s'] motive, is not for a court to decide on the 
basis of [briefs and transcripts], but is for the fact finder 
after weighing the circumstantial evidence and assessing the 
credibility of the witnesses."18  Lipchitz, supra at 499, quoting 
Blare, supra at 445. 
                                                 
 
18 Our decision in Sullivan v. Liberty Mut. Ins. Co., 444 
Mass. 34 (2005), is not to the contrary.  In affirming summary 
judgment for the employer, we noted that the plaintiff there 
essentially conceded that the adverse employment action was 
motivated by her supervisor's perception of her performance as 
poor, as evidenced by the fact that she "[did] not challenge 
whether [the defendant] truly believed that her mishandling" of 
certain matters warranted her discharge.  Id. at 57 (plaintiff 
did not present any "evidence . . . that [the defendant] 
selected her for layoff for any reason other than her own 
performance" and "[t]here [was] ample, uncontroverted evidence 
that the negative impression [plaintiff's supervisors] had 
formed of [plaintiff]'s abilities was a primary reason she was 
selected for layoff"). 
30 
 
 
 
In this regard, summary judgment remains "a disfavored 
remedy in the context of discrimination cases based on disparate 
treatment . . . because the ultimate issue of discriminatory 
intent is a factual question" (citations omitted).19  Blare, 
supra at 439.  A defendant's motive "is elusive and rarely is 
established by other than circumstantial evidence," therefore 
"requir[ing] [a] jury to weigh the credibility of conflicting 
explanations of the adverse hiring decision." 20  Id. at 439-440. 
 
c.  Breach of contract claim.  To prevail on a claim for 
breach of contract, a plaintiff must demonstrate that there was 
an agreement between the parties; the agreement was supported by 
consideration; the plaintiff was ready, willing, and able to 
perform his or her part of the contract; the defendant committed 
a breach of the contract; and the plaintiff suffered harm as a 
                                                 
 
19 Because the plaintiff questions the legitimacy of his 
employer's motive in terminating his employment, "[t]his is a 
disparate treatment case[,] not a disparate impact case."  See 
Blare v. Husky Injection Molding Sys. Boston, Inc., 419 Mass. 
437, 439 n.3 (1995).  See also Cox v. New England Tel. & Tel. 
Co., 414 Mass. 375, 384-385 (1993). 
 
 
20 See Clermont and Schwab, Employment Discrimination 
Plaintiffs in Federal Court:  From Bad to Worse?, 3 Harv. L. & 
Pol'y Rev. 103, 128 (2009) ("pretrial adjudication particularly 
disfavors employment discrimination plaintiffs").  See also 
Donald and Pardue, Bringing Back Reasonable Inferences:  A 
Short, Simple Suggestion for Addressing Some Problems at the 
Intersection of Employment Discrimination and Summary Judgment, 
57 N.Y.L. Sch. L. Rev. 749, 752 (2012-2013) ("Federal Judicial 
Center has noted that '[s]ummary judgment motions by defendants 
are more common in [employment discrimination] cases [than in 
other civil actions], are more likely to be granted, and [are] 
more likely to terminate the litigation'"). 
31 
 
 
result.  Singarella v. Boston, 342 Mass. 385, 387 (1961).  At 
issue here is the fourth element, i.e., whether the defendants 
committed a breach of the contract embodied in the medical 
resident agreement. 
 
The plaintiff maintains that the defendants committed such 
a breach in five ways:  by failing to comply with the ACGME's 
nondiscrimination policy; by failing to include a resident on 
the ad hoc committee as required by the hospital's written 
procedures; by failing to advise the plaintiff, in advance, of 
certain items to be discussed by the ad hoc committee; by 
failing to provide him with the resources and supervision 
necessary to perform his job; and by failing to offer him an 
opportunity to appeal from the decision of the ad hoc 
committee.21  To prevail on a motion for summary judgment on 
these claims, the defendants must demonstrate that "there are no 
material facts in dispute."  Somerset Sav. Bank v. Chicago Title 
Ins. Co., 420 Mass. 422, 426 (1995). 
                                                 
 
21 Although the complaint contained a general breach of 
contract claim, the motion judge declined to address directly 
any of these particular assertions because the specific grounds 
mentioned were first identified in the plaintiff's opposition to 
the summary judgment motion.  In its de novo review, the Appeals 
Court nonetheless addressed these claims, see Bulwer, supra at 
333-334, apparently concluding that they were properly before 
the motion judge.  The Appeals Court noted, however, that the 
evidence does not support the plaintiff's contention that the 
defendants failed to offer him an opportunity to appeal from the 
ad hoc committee's decision.  See Bulwer, supra at 334 n.16.  We 
do not disagree. 
32 
 
 
 
With regard to the first allegation, the defendants were 
bound by the ACGME's nondiscrimination policy prohibiting 
discrimination based on race or national origin.  This policy 
was incorporated by reference in the medical resident agreement.  
See Chicopee Concrete Serv., Inc. v. Hart Eng'g Co., 398 Mass. 
476, 478 (1986) ("incorporation by a clearly stated general 
reference will suffice").  Whether the defendants violated this 
policy requires analysis of much the same evidence noted in our 
discussion of the plaintiff's discrimination claim.  For similar 
reasons, we conclude that the defendants have failed to 
establish the absence of any issue of material fact with regard 
to the assertion of a violation of the ACGME's nondiscrimination 
policy. 
 
Turning to the second allegation -- failure to include a 
resident on the ad hoc committee -- it is undisputed that the ad 
hoc committee did not include a resident.  The inclusion of a 
resident was required by the hospital's grievance policy, which 
the hospital was to follow under the terms of the ACGME 
requirements and thereby under the medical resident agreement as 
well.  Although the defendants claim that the plaintiff was not 
harmed by this failure to comply with the medical resident 
agreement, that is a question of fact for the jury. 
 
It is also undisputed that the plaintiff was not invited to 
the latter two meetings of the ad hoc committee and that the 
33 
 
 
defendants failed to notify the plaintiff, in advance of those 
meetings, that they were considering immediately terminating his 
employment.  There is also no indication in the record that the 
plaintiff was ever given any information about "additional" 
concerns cited by the committee regarding patient safety 
notwithstanding the plaintiff's request for pertinent 
information.  The hospital's grievance policy, however, requires 
that a resident receive from the department chair in advance of 
the meeting a "written statement of the specific issues [to be 
discussed at the meeting]."22  Although the defendants gave the 
plaintiff an opportunity to submit written rebuttal evidence, a 
reasonable jury could find that this was not equivalent to an 
opportunity to participate fully in the initial proceedings.  
They could also find that the plaintiff's lack of notice and 
diminished participation in the meetings reduced the 
effectiveness of his participation in those meetings and, 
accordingly, affected the outcome of the committee's 
deliberations. 
 
The plaintiff contends further that the defendants failed 
to provide him, as required by the ACGME, with the "appropriate 
supervision" and "resources" necessary to perform his work.  In 
                                                 
 
22 The policy also requires that all bases for the 
committee's decision "be introduced into evidence at the 
proceeding" and, more generally, that the resident will receive 
"a fair hearing." 
34 
 
 
this regard, the plaintiff has proffered evidence that his 
mentor did not hold weekly meetings with him as outlined in his 
remediation plan.  More generally, he points to evidence, 
detailed earlier, that he was not offered the same remediation 
opportunities as similarly situated peers, which could be 
construed as a failure to provide "appropriate supervision."23 
 
3.  Conclusion.  The judgments in favor of the defendants 
on the plaintiff's claims for employment discrimination under 
G. L. c. 151B, § 4, and breach of contract are vacated and set 
aside.  The matter is remanded to the Superior Court for further 
proceedings consistent with this opinion. 
 
 
 
 
 
 
 
So ordered. 
 
                                                 
 
23 A jury could find that the plaintiff's lack of 
familiarity with hospital procedures, mentioned by Song in his 
deposition, could have resulted from the absence of close 
mentoring or supervision.