Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca4-15-01839/USCOURTS-ca4-15-01839-0/pdf.json

Parties Involved:
Board of Directors of Carroll Hospital Center, Inc.

Carroll Hospital Center, Inc.
Appellee
Jaime Elliott
Appellee
John Sernulka
Appellee
Cimenga M. Tshibaka
Appellant

Document Text:

UNDER SEAL

UNPUBLISHED

UNITED STATES COURT OF APPEALS

FOR THE FOURTH CIRCUIT

No. 15-1839

CIMENGA M. TSHIBAKA, M.D.,

Plaintiff – Appellant,

v.

JOHN SERNULKA, individually and in his official capacity as 

CEO of Carroll Hospital Center, Inc.; CARROLL HOSPITAL 

CENTER, INC.; JAIME ELLIOTT, individually,

Defendants – Appellees,

and

BOARD OF DIRECTORS OF CARROLL HOSPITAL CENTER, INC.,

Defendant.

Appeal from the United States District Court for the District of 

Maryland, at Baltimore. J. Frederick Motz, Senior District 

Judge. (1:13-cv-02760-JFM)

Argued: September 20, 2016 Decided: December 13, 2016

Before GREGORY, Chief Judge, and KING and AGEE, Circuit Judges.

Affirmed in part, vacated in part, and remanded by unpublished

per curiam opinion.

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ARGUED: Conrad W. Varner, VARNER & GOUNDRY, Frederick, 

Maryland, for Appellant. Robin Locke Nagele, POST & SCHELL, 

P.C., Philadelphia, Pennsylvania, for Appellees. ON BRIEF: 

Sheila A. Haren, Elizabeth M. Hein, POST & SCHELL, P.C., 

Philadelphia, Pennsylvania, for Appellees.

Unpublished opinions are not binding precedent in this circuit.

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PER CURIAM:

Cimenga M. Tshibaka, a Maryland physician, appeals from the 

district court’s rulings that dispensed with a civil suit 

concerning the termination of his hospital privileges. 

Tshibaka, who had privileges at Carroll Hospital Center, Inc.

(“CHC”), in Westminster, Maryland, was accused of sexual 

harassment by a patient care technician. After CHC terminated 

Tshibaka’s privileges, he initiated litigation in state court

against the patient care technician, CHC, and its CEO. The 

complaint alleged a race discrimination claim under 42 U.S.C. 

§ 1981, plus various state law claims. The defendants removed 

the matter to the District of Maryland, where the court

dismissed the patient care technician and awarded summary 

judgment to CHC and its CEO. Tshibaka has appealed, and as 

explained below, we affirm in part, vacate in part, and remand.

I.

A.

1.

Dr. Tshibaka, who is African-American, is a native of the 

Democratic Republic of the Congo and a naturalized citizen of 

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the United States.1

 Tshibaka thereafter completed a residency in 

cardiothoracic surgery at the University of Illinois. 

In 2005, Tshibaka sought to join the medical staff at CHC. 

During the credentialing process,

 On April 11, 2006, CHC granted Tshibaka 

unrestricted hospital privileges. 

Tshibaka’s tenure at CHC proceeded without incident until 

October 2008,

 1 Because we are assessing a summary judgment award, we 

recount the facts in the light most favorable to Tshibaka. See 

Rossignol v. Voorhaar, 316 F.3d 516, 523 (4th Cir. 2003). 

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See J.A. 468. By the Early Resolution Agreement, Tshibaka 

waived certain of his rights under CHC’s Medical Staff Bylaws 

(the “M.S. Bylaws”). 

Shortly thereafter, pursuant to the Early Resolution 

Agreement, CHC hired two experts — clinical sexologists Kate 

Thomas and Chris Kraft — to evaluate Tshibaka. The expert 

report concluded that Tshibaka was a safe medical practitioner 

who posed no danger to the staff or patients at CHC. The report

found that, although Tshibaka did not have a sexual disorder, 

his interpersonal skills were occasionally deficient. It 

recommended that Tshibaka undergo monthly individual 

psychotherapy sessions. By mutual agreement, those sessions

were conducted by Thomas. On March 28, 2011, Thomas advised CHC 

that she was discharging Tshibaka as her patient because he had

completed the recommended therapy. 

On June 24, 2013, defendant Jaime Elliott was working as a 

patient care technician in CHC’s Wound Care Center. Tshibaka 

routinely worked at the Wound Care Center on Monday afternoons 

and often interacted with Elliott.

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For 

his part, Tshibaka maintains that Elliott fabricated each of the 

foregoing instances of 

2. 

On June 25, 2013, Elliott lodged an internal sexual 

harassment complaint. CHC’s Vice President of Human Resources, 

Tracey Ellison, and Chief Compliance Officer, Joyce Romans, 

promptly investigated Elliott’s complaint pursuant to the 

hospital’s Medical Staff Conduct Policy (the “M.S. Conduct 

Policy”). In their investigation, they interviewed Elliott, her 

supervisors, and her co-workers. Romans and Ellison shared the 

evidence with CEO Sernulka, who found Elliott’s complaint to be 

credible. Sernulka thus concluded that Tshibaka had violated 

the last chance provision of the Early Resolution Agreement. 

Later that day, Sernulka decided to terminate Tshibaka’s 

hospital privileges at CHC. To that end, he issued a 

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cause to believe that sexual harassment occurred. Id.

§ 10.3.2.1.

First, the CEO is empowered to impose a summary suspension. 

See M.S. Bylaws § 10.3.2.1.1. If a summary suspension is 

imposed, CHC’s Medical Executive Committee (the “MEC”) is 

obliged to review the suspension within four days and recommend

that it be continued, modified, or terminated. Id. § 10.2.3.1. 

The MEC notifies the suspended physician of its decision and his 

right to review by the Board of Directors (the “Board”). Id.

§ 10.2.3.2.1. Finally, the suspended physician may submit a 

written request for Board review within seven business days of

notification. Id. § 10.2.3.2.2. If requested, the Board 

reviews the MEC’s decision and decides whether it is justified. 

Id. § 10.2.3.5.

In this situation, CEO Sernulka issued the Determination of 

Probable Cause on June 25, 2013, relating therein that Tshibaka 

had sexually harassed Elliott and violated the Early Resolution 

Agreement. Sernulka also decided to summarily suspend Tshibaka 

and promptly advised him of that decision. According to 

Tshibaka, Sernulka stated that he was “not interested” in 

hearing Tshibaka’s side of the story and warned Tshibaka to get 

a good attorney because he would never practice medicine again. 

See J.A. 672.

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On June 26, Sernulka notified the Medical Staff President

(the “M.S. President”) of Tshibaka’s summary suspension. 

Sernulka advised Tshibaka that the MEC would review his 

suspension within four days and that he would be promptly 

informed of the MEC’s decision. On June 27, the MEC voted to 

continue Tshibaka’s summary suspension. Sernulka notified 

Tshibaka the following day of the MEC’s decision and his right 

to appeal to the Board.5 Tshibaka requested Board review, and on 

July 2, the Board voted to continue his summary suspension.

b.

Simultaneous with the summary suspension process, CEO 

Sernulka also pursued the second process — a merits hearing —

seeking to terminate Tshibaka’s hospital privileges. To obtain 

a merits hearing, the CEO of CHC issues a probable cause 

determination and provides written notice to the accused 

physician, the M.S. President, and the Board. See M.S. Bylaws 

§ 10.3.2. Within three days of receiving the CEO’s written 

notice, the M.S. President must appoint a three-member hearing 

panel, designate a panelist as chairman, schedule the hearing, 

and notify the accused physician of the hearing date. Id.

§ 10.3.3.

 5 Sernulka was carrying a weapon when he hand-delivered the 

MEC’s decision to Tshibaka, who said that Sernulka exposed the 

weapon in an effort to intimidate.

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After conducting the merits hearing, the hearing panel 

issues a written decision, which includes findings of fact and 

recommendations with respect to disposition of the complaint and 

disciplinary action. See M.S. Bylaws § 10.3.4. During the 

evidentiary portion of the merits hearing, the panel cannot 

consider any prior-adjudicated incidents of sexual harassment. 

Id. § 10.3.4. The panel is entitled to consider such incidents, 

however, in determining the appropriate disciplinary action. 

Id. Following issuance of its written decision, the hearing 

panel provides the accused physician, the M.S. President, the 

CEO, and the Board with the decision and the record. Id.

Either party is entitled to pursue an appeal to the Board 

within five days. See M.S. Bylaws § 10.3.5. The Board hears 

oral argument within seven days — ensuring that each party has 

five days’ advance notice — and accepts written arguments either 

before or at oral argument. Id. The parties’ contentions on 

appeal must be based on the record made at the merits hearing 

and on the hearing panel’s decision and recommendation. Id. 

Moreover, the Board cannot accept or consider any evidence that 

was not before the hearing panel. Id. Within five days of oral 

argument, the Board issues its final written decision on the 

merits. Id.

On June 26, 2013, Sernulka notified the M.S. President that 

Tshibaka was entitled to a merits hearing and asked him to

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appoint a hearing panel. On June 27, Sernulka advised Tshibaka 

that he was seeking termination of Tshibaka’s hospital 

privileges. Sernulka informed Tshibaka of his rights under the 

M.S. Bylaws, and Tshibaka requested a merits hearing. On June 

28, the M.S. President advised Tshibaka that he had appointed 

the hearing panel, and that the hearing would be held on July 9. 

The panel delegated its responsibility for objections and other 

“lawyerly interactions” to the Medical Staff Attorney, Gertrude 

Bartel. 

Pursuant to M.S. Bylaws § 10.3.4, the hearing panel decided 

to bifurcate its proceedings to consider the allegations of 

sexual harassment separately from the issue of disciplinary 

action. On July 9, the panel heard and evaluated the evidence 

concerning Elliott’s accusations of sexual harassment; as per 

the Bylaws, it excluded all evidence of prior sexual harassment 

allegations against Tshibaka. The panel concluded that CHC had 

proven by a preponderance thereof that Tshibaka had engaged in 

sexual harassment On the other 

hand, the panel ruled that CHC had not proven the incident 

involving the allegation that Tshibaka 

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J.A. 230. 

Six days later, on July 15, the hearing panel reconvened to 

decide the appropriate disciplinary action. The panel again 

excluded from consideration all prior sexual harassment 

allegations against Tshibaka, ruling that they did not 

constitute prior-adjudicated incidents under the M.S. Bylaws. 

The panel concluded that a termination of Tshibaka’s hospital 

privileges was neither mandated by the Early Resolution 

Agreement nor warranted. Instead, the panel agreed that 

Tshibaka should be suspended until a psychiatrist determined 

whether he was fit for duty. Both Tshibaka and CHC appealed the 

panel’s decision. 

On July 26, the Board conducted an oral argument session. 

Both CHC and Tshibaka had made written pre-argument submissions. 

CHC urged the Board to determine that Tshibaka had sexually 

harassed Elliott twice on June 24, and to terminate his hospital 

privileges. For his part, Tshibaka contended that CHC had 

conducted a biased investigation, that the hearing panel’s 

conclusions were illogical and contradictory, and that Sernulka 

and Bartel had violated his due process rights. Tshibaka 

requested an immediate reinstatement. 

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 After concluding the oral argument session, the Board 

deliberated and decided that Tshibaka had twice engaged in 

sexual harassment,

 The Board found Elliott to be 

credible and declined to find Tshibaka credible. The Board thus 

terminated Tshibaka’s privileges to practice medicine at CHC. 

B. 

On August 9, 2013, Tshibaka filed this action against CHC, 

Sernulka, and Elliott in the Circuit Court for Baltimore City, 

Maryland. His state law claims included breach of contract, 

defamation, tortious interference with prospective advantage, 

and false light invasion of privacy. He also made a claim of 

race discrimination under 42 U.S.C. § 1981.6 The defendants 

removed the matter to the District of Maryland on September 19, 

2013. The district court possessed federal question 

jurisdiction over Tshibaka’s § 1981 claim and supplemental 

jurisdiction with respect to his state law claims. See 28 

U.S.C. §§ 1331, 1367(a). 

Tshibaka filed an amended complaint in federal court on 

October 1, 2013, which Elliott promptly moved to dismiss for 

failure to state a claim. On November 14, 2013, the district 

 6 Tshibaka initially alleged national origin discrimination 

as part of his § 1981 claim, but has since abandoned that 

theory. 

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court dismissed the complaint as to Elliott, concluding that, as 

a nonsupervisory co-worker who was not involved in the decision 

to terminate Tshibaka’s hospital privileges, Elliott cannot be 

liable under § 1981. See Tshibaka v. Sernulka, No. 1:13-cv02670 (D. Md. Nov. 14, 2013), ECF No. 20-21. The court also 

ruled that Elliott is entitled to immunity under Maryland law 

with respect to the only state law claim — defamation — lodged 

against her.

More than a year later, following the completion of 

discovery, CHC and Sernulka (together, “the CHC defendants”)

moved for summary judgment, and Tshibaka filed his own summary 

judgment motion. On June 30, 2015, the district court denied 

Tshibaka’s request for summary judgment and awarded summary 

judgment to the CHC defendants. See Tshibaka v. Sernulka, No. 

1:13-cv-02760 (D. Md. June 30, 2015), ECF No. 89-90. The court 

ruled that the § 1981 claim failed because Tshibaka had not made

a prima facie showing that the CHC defendants terminated his 

hospital privileges on the basis of racial animus. The court

also determined that the state law contract and tort claims 

failed because the CHC defendants are entitled to immunity under 

federal law, i.e., the Health Care Quality Improvement Act

(“HCQIA”), see 42 U.S.C. § 11111(a). Tshibaka has timely noted 

this appeal, and we possess jurisdiction pursuant to 28 U.S.C. 

§ 1291.

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II.

We review de novo a district court’s award of summary 

judgment, viewing the facts in the light most favorable to the 

nonmoving party. See Boyer-Liberto v. Fontainbleau Corp., 786 

F.3d 264, 276 (4th Cir. 2015) (en banc). Summary judgment is 

inappropriate unless the movant shows that there is no genuine 

dispute as to any material fact and that the movant is entitled 

to judgment as a matter of law. See Fed. R. Civ. P. 56(a).

We also review de novo a district court’s dismissal of a 

complaint, accepting as true all factual allegations therein and 

drawing all reasonable inferences in favor of the non-moving 

party. See Franks v. Ross, 313 F.3d 184, 192 (4th Cir. 2002). 

In order to survive a Rule 12(b)(6) motion to dismiss, a 

complaint must allege sufficient facts to state a facially 

plausible claim. See Fed. R. Civ. P. 12(b)(6); E.I. du Pont de 

Nemours & Co. v. Kolon Indus., Inc., 637 F.3d 435, 440 (4th Cir. 

2011) (citing Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 

(2007)).

III.

On appeal, Tshibaka contends that the district court erred 

in awarding summary judgment to the CHC defendants on his claim 

under 42 U.S.C. § 1981, and in dismissing that claim as to

Elliott. He also maintains that the court erroneously

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determined that HCQIA immunity bars liability of the CHC 

defendants on his state law claims, and that the court further 

erred in ruling that state law immunity bars Elliott’s liability 

on his defamation claim.

A.

We first assess Tshibaka’s § 1981 claim against the CHC 

defendants and Elliott. Section 1981 prohibits racial 

discrimination in public and private contracts. See Guessous v. 

Fairview Prop. Inv., LLC, 828 F.3d 208, 225 n.6 (4th Cir. 2016) 

(citing Runyon v. McCrary, 427 U.S. 160, 168-69 (1976)). The 

statute provides, in pertinent part, that 

[a]ll persons within the jurisdiction of the United 

States shall have the same right in every State and 

Territory to make and enforce contracts . . . as is 

enjoyed by white citizens.

42 U.S.C. § 1981(a). The term “make and enforce contracts” 

includes “the making, performance, modification, and termination 

of contracts, and the enjoyment of all benefits, privileges, 

terms, and conditions of the contractual relationship.” Id.

§ 1981(b).

1.

Tshibaka maintains that the district court erred in 

awarding summary judgment to the CHC defendants on his § 1981 

claim for failure to establish a prima facie case, as required 

under the framework set forth by the Supreme Court in McDonnell 

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Douglas Corp. v. Green, 411 U.S. 792, 802 (1973). According to 

Tshibaka, he proved not only a prima facie case of race 

discrimination against the CHC defendants, but also that their 

explanation for terminating his hospital privileges is a mere 

pretext. On the other hand, the CHC defendants contend that 

Tshibaka failed to forecast sufficient evidence to prevail at 

any stage of the McDonnell Douglas analysis. Our review of the 

record convinces us that Tshibaka failed to make the necessary 

prima facie showing.

a.

It is settled that the McDonnell Douglas framework applies 

to a § 1981 claim. See Guessous, 828 F.3d at 216. An employee 

is entitled to prove discrimination under McDonnell Douglas’s 

framework by establishing a prima facie case and demonstrating 

that the employer’s proffered nondiscriminatory reason for 

taking an adverse employment action is pretextual. See Holland 

v. Wash. Homes, Inc., 487 F.3d 208, 214 (4th Cir. 2007).

In the employee discipline context, a prima facie case 

consists of the following factors:

(1) The employee is a member of the protected class; 

(2) The employer took an adverse employment action 

against the employee; and

(3) The employee engaged in prohibited conduct 

similar to that of a person outside the protected 

class and was subject to more severe disciplinary 

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measures than those enforced against the other 

person. 

See, e.g., Moore v. City of Charlotte, N.C., 754 F.2d 1100, 

1105-06 (4th Cir. 1985) (applying McDonnell Douglas to Title VII 

discriminatory discipline claim); see also Gairola v. Va. Dep’t 

of Gen. Servs., 753 F.2d 1281, 1285 (4th Cir. 1985) (recognizing

that elements of prima facie Title VII claim and prima facie 

§ 1981 claim are identical).

If the employee makes a prima facie showing, the burden 

shifts to the employer to articulate a legitimate, 

nondiscriminatory reason for the adverse employment action. See

Holland, 487 F.3d at 214. The employer’s burden is one of 

production, not persuasion. Id. After the employer presents a 

legitimate, nondiscriminatory reason for the adverse employment 

action, the burden shifts to the employee to prove, by a 

preponderance of the evidence, that the employer’s proffered 

reason for the action is merely a pretext for discrimination. 

Id. The employee can establish pretext by “showing that the 

employer’s proffered explanation is unworthy of credence.” Id.

(quoting Tex. Dep’t of Cmty. Affairs v. Burdine, 450 U.S. 248, 

256 (1981)).

b.

The CHC defendants do not dispute that Tshibaka satisfies 

the first two prongs of the prima facie test. As an AfricanAppeal: 15-1839 Doc: 70 Filed: 12/13/2016 Pg: 19 of 32
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American, he is within the class protected by § 1981. See

Holland, 487 F.3d at 210, 214. CHC terminated his hospital 

privileges, which certainly qualifies as an adverse employment 

action. See Moore, 754 F.2d at 1105-06.7 It is on the final 

prong of the applicable inquiry that Tshibaka falters. He 

asserts that CHC had already permitted similarly situated 

Caucasian physicians to remain on the medical staff after they 

engaged in similar — or worse — conduct than Tshibaka allegedly 

perpetrated. The Caucasian physicians Tshibaka presents as 

comparators, however, are not similarly situated for purposes of 

§ 1981, thereby dooming his claim.

It is axiomatic that “[t]he similarity between comparators 

and the seriousness of their respective offenses must be clearly 

established in order to be meaningful.” Lightner v. City of 

Wilmington, N.C., 545 F.3d 260, 265 (4th Cir. 2008). That

showing normally includes evidence “that the two employees dealt 

with the same supervisor, were subject to the same standards,

 7 The parties quibble somewhat over whether Tshibaka was 

qualified for his position at CHC, which would be a factor under 

the traditional prima facie test. See Holland, 487 F.3d at 214

(relating that, under traditional prima facie test, plaintiff 

must show: (1) membership in protected class; (2) satisfactory 

job performance; (3) adverse employment action; and (4) 

different treatment from similarly situated individuals outside 

of protected class). Here, however, we need not decide whether 

Tshibaka was qualified for his position. See Moore, 754 F.2d at 

1005-06.

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and had engaged in similar conduct without such differentiating 

or mitigating circumstances that would distinguish their conduct 

or the employer’s treatment of them.” Radue v. Kimberly-Clark 

Corp., 219 F.3d 612, 617-18 (7th Cir. 2000) (quoting Mitchell v. 

Toledo Hosp., 964 F.2d 577, 583 (6th Cir. 1992)), overruled on 

other grounds by Ortiz v. Werner Enters., No. 15-2574, slip op. 

at 5 (7th Cir. Aug. 19, 2016). As we have recognized, “[t]he 

most important variables in the disciplinary context, and the 

most likely sources of different but nondiscriminatory 

treatment, are the nature of the offenses committed and the 

nature of the punishments imposed.” Moore, 754 F.2d at 1105. 

Three of the comparator physicians identified by Tshibaka —

, , and — had allegedly 

sexually harassed female employees of CHC. Senior Vice 

President and Chief Medical Officer Smothers met with those 

physicians and warned them to refrain from further harassment, 

much as Smothers had admonished Tshibaka after the first 

complaint at CHC surfaced against him in 2008. Unlike Tshibaka, 

those physicians heeded Smothers’s warnings; CHC is unaware of 

any subsequent allegations of sexual harassment against them. 

In other words, CHC did not treat those physicians more 

leniently than Tshibaka because they did not engage in any 

misconduct after receiving the first warnings. See Radue, 219 

F.3d at 617-18 (observing that appropriate comparator must 

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engage in similar conduct without differentiating or mitigating 

factors that would distinguish employer’s treatment). 

A fourth physician, , allegedly 

 prior to working at CHC. 

Because alleged misconduct occurred before his tenure at 

CHC — and had been investigated by the Maryland Board of 

Physicians, rather than CHC — is an inappropriate 

comparator. See Radue, 219 F.3d at 617-18 (noting that proper 

comparator deals with same supervisor, is subject to same 

standards as plaintiff, and engages in similar conduct). 

Of the physicians mentioned by Tshibaka, is the 

best argument for a true comparator. , a Caucasian 

physician, had allegedly sexually harassed 

 while he was employed by Carroll Hospital Group 

(“CHG”), a subsidiary of CHC. 

 CHG 

and made a letter of disciplinary action in January 2012, 

which contained provisions similar to those in Tshibaka’s Early 

Resolution Agreement. To resolve the allegations, 

agreed, by the letter, to cease and desist from all activities 

that could be construed as sexual harassment, undergo a mental 

health evaluation, attend treatment sessions, and abide by a 

last chance agreement similar to Tshibaka’s. 

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After CHG and executed the letter of disciplinary 

action, a patient reported that had made her feel 

uncomfortable. When the patient was interviewed, however, she 

spoke highly of and failed to confirm the complaint. CHG

therefore decided that the complaint was not credible and took 

no disciplinary action. CHG later declined to renew 

employment contract, but unlike Tshibaka, he yet has full 

hospital privileges at CHC. 

A significant difference precludes us from deeming 

to be an appropriate comparator: was not treated more 

leniently than Tshibaka. Each entered into an agreement with a 

last chance provision, and each was subject to a psychological 

evaluation and counseling. Although a subsequent complaint 

alleged that , the 

complaint was unsubstantiated. CHG therefore concluded that 

 had not contravened his last chance agreement. Elliott’s 

complaint against Tshibaka, on the other hand, was substantiated 

through several layers of review. Tshibaka has thus failed to 

show that is an appropriate comparator because 

“differentiating circumstances” distinguish their conduct and 

their employers’ treatment of them. See Radue, 219 F.3d at 618. 

In these circumstances, there is no genuine dispute of 

material fact concerning the prima facie test. Because Tshibaka 

has failed to forecast sufficient evidence to make a prima facie 

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showing, we are satisfied to affirm the summary judgment award

to the CHC defendants on the § 1981 claim.

2.

Next, Tshibaka contends that the district court erred in 

dismissing his § 1981 claim as to Elliott on the ground that she 

was a mere nonsupervisory co-worker who was not involved in the 

decision to terminate Tshibaka’s hospital privileges. As we 

have recognized, there may be circumstances where § 1981 

liability could be imposed on individuals. See, e.g., Tillman 

v. Wheaton-Haven Recreation Ass’n, 517 F.2d 1141 (4th Cir. 

1975). We have not decided, however, whether a nonsupervisory 

co-worker can be liable under § 1981.

To revive his § 1981 claim against Elliott, Tshibaka relies 

on Smith v. Bray, where the Seventh Circuit concluded that a 

subordinate employee with an unlawful motive may be individually 

liable under § 1981 for intentionally causing the employer to 

take an adverse employment action against the subordinate’s 

fellow employee. See 681 F.3d 888, 896-99 (7th Cir. 2012), 

overruled on other grounds by Ortiz v. Werner Enters., Inc., No. 

15-2574, slip op. at 4 (7th Cir. Aug. 19, 2016). The Smith

court explained that such individual liability flows from the 

“cat’s paw” theory of employer liability, under which the 

employer can be liable “when a biased subordinate who lacks 

decision-making power uses the formal decision-maker as a dupe 

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in a deliberate scheme to trigger a discriminatory employment 

action.” Id. at 897 n.3 (internal quotation marks omitted).

Tshibaka has alleged in his amended complaint that Elliott 

“intentionally sought to revoke [his] hospital privileges on the 

grounds of race,” and that the CHC defendants’ proffered reason 

for terminating his privileges was based on Elliott’s false 

allegations of sexual harassment. See Am. Compl. ¶¶ 65-66. 

Arguably then, the operative complaint alleges under Smith a 

colorable theory of Elliott’s § 1981 liability, as well as the 

“cat’s paw” theory of the CHC defendants’ liability.

We will not decide here whether to adopt the reasoning of 

Smith, however, because Tshibaka has foreclosed imposing § 1981 

liability on Elliott by admitting — under oath — that he did 

not believe Elliott made her internal sexual harassment 

complaint on the basis of race. Specifically, Tshibaka was 

asked during discovery, “So you don’t believe that [Elliott] 

herself was racially motivated in making her allegations; is 

that right?” See J.A. 726. Tshibaka responded, “That’s 

correct.” Id. Consistent with that testimony, Tshibaka failed 

to pursue the “cat’s paw” theory against the CHC defendants, 

instead maintaining only that they had acted out of their own 

racial animus. In these circumstances, we are constrained to 

affirm the district court’s judgment in favor of Elliott on the 

§ 1981 claim. See MM v. Sch. Dist. of Greenville Cty., 303 F.3d 

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523, 536 (4th Cir. 2002) (recognizing our authority “to affirm 

[a] judgment on alternate grounds, if such grounds are apparent 

from the record”); see also Boston Prop. Exch. Transfer Co. v. 

Iantosca, 720 F.3d 1, 12 (1st Cir. 2013) (affirming the 

dismissal of claims that “would inevitably have failed at the 

summary judgment stage”).

B.

1.

We turn to Tshibaka’s state law contract and tort claims. 

The district court awarded summary judgment to the CHC 

defendants on the tort claims after determining that those 

defendants are entitled to HCQIA immunity. The court separately 

analyzed the merits of the breach of contract claim before 

awarding summary judgment to the CHC defendants on that claim as 

well. Because HCQIA immunity encompasses breach of contract 

claims, however, a separate analysis of the contract claim was 

unnecessary. That is, if the CHC defendants are entitled to 

HCQIA immunity on the tort claims, they also get such immunity 

on the contract claim. See, e.g., Wahi v. Charleston Area Med. 

Ctr., Inc., 562 F.3d 599, 610-14 (4th Cir. 2009) (affirming 

dismissal of contract and tort claims pursuant to HCQIA).8

 8 Notably, HCQIA does not provide immunity to defendants in 

civil rights lawsuits, including those under 42 U.S.C. § 1981. 

See 42 U.S.C. § 11111(a)(1).

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Congress enacted HCQIA in 1986, seeking to encourage good 

faith professional review activities, and thereby reduce medical 

malpractice and enhance the quality of medical care. See 42 

U.S.C. § 11101. HCQIA immunizes the professional review actions

of professional review bodies from civil damages. Id.

§ 11111(a). A “professional review action” is defined, in 

relevant part, as

an action or recommendation of a professional review 

body which is taken or made in the conduct of 

professional review activity, which is based on the 

competence or professional conduct of an individual 

physician (which conduct affects or could adversely 

affect the health or welfare of a patient or patients) 

and which affects (or may affect) adversely the 

clinical privileges, or membership in a professional 

society, of the physician.

Id. § 11151(9). “Professional review activities” are the 

activities of a health care entity seeking to determine “whether 

[an individual] physician may have clinical privileges with 

respect to, or membership in, the entity.” Id. § 11151(10). A 

professional review body is a health care entity — along with 

the governing body or any committee of a health care entity —

that conducts professional review activities. Id. § 11151(11).

To obtain HCQIA immunity, a health care entity’s

professional review action must fall within the breadth of the 

statute, in that the action was taken or made:

(1) in the reasonable belief that the action was in 

furtherance of quality health care,

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(2) after a reasonable effort to obtain the facts of 

the matter,

(3) after adequate notice and hearing procedures 

[were] afforded to the physician involved or 

after such procedures as [were] fair to the 

physician under the circumstances, and

(4) in the reasonable belief that the action was 

warranted by the facts known after such 

reasonable effort to obtain facts and after 

meeting the requirement of [sub]paragraph (3).

42 U.S.C. § 11112(a)(1)-(4). Notably, the requirements of 

subparagraph (a)(3) are couched in the disjunctive. That is, a 

health care entity can obtain HCQIA immunity by acting either 

“after adequate notice and hearing procedures [were] afforded to 

the physician” or, in the alternative, “after such procedures as 

[were] fair to the physician under the circumstances.” Id.

§ 11112(a)(3). Moreover, we have recognized that HCQIA provides 

a safe harbor for professional review actions that is “but one 

way a health care entity can comply with the requirements of 

[subparagraph] (a)(3).” See Wahi, 562 F.3d at 607-08

(discussing safe harbor provisions of § 11112(b)). HCQIA does 

not preclude a hospital from suspending or restricting a 

physician’s clinical privileges “subject to subsequent notice 

and hearing or other adequate procedures,” if a failure to take 

such an action “may result in an immediate danger to the health 

of any individual.” See 42 U.S.C. § 11112(c)(2).

Importantly, a professional review action presumptively 

qualifies for HCQIA immunity “unless the presumption is rebutted 

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by a preponderance of the evidence.” See 42 U.S.C. § 11112(a). 

Immunity applies unless — viewing the totality of the 

circumstances in an objectively reasonable manner — the 

aggrieved physician rebuts the presumption that the professional 

review action satisfied HCQIA. See Wahi, 562 F.3d at 610. At 

the summary judgment stage, a court must assess

whether a reasonable jury, viewing all facts in a 

light most favorable to [the physician], could 

conclude that he had shown, by a preponderance of the 

evidence, that [the professional review body’s] 

actions fell outside the scope of [the requirements 

specified in § 11112(a)(1)-(4)].

Id. at 607 (quoting Gabaldoni v. Wash. Cty. Hosp. Ass’n, 250 

F.3d 255, 260 (4th Cir. 2001)).

Here, the parties agree that the hearing panel and the 

Board both qualify as professional review bodies and that the

termination of Tshibaka’s hospital privileges was a professional 

review action. Tshibaka contends, however, that the CHC 

defendants failed to satisfy HCQIA in multiple ways:

(1) CEO Sernulka failed to properly investigate 

Elliott’s sexual harassment complaint and

determine whether Tshibaka constituted an 

immediate threat of danger before suspending him;

(2) Sernulka refused to listen to Tshibaka’s side of 

the story;

(3) Sernulka improperly prohibited Tshibaka from 

appearing before the MEC to defend himself in the 

summary suspension proceeding;

(4) Sernulka deliberately withheld the report of 

clinical sexologists Thomas and Kraft, and 

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instead presented to the MEC only Elliott’s 

statements and the Early Resolution Agreement;

(5) Medical Staff Attorney Bartel improperly presided 

over and bifurcated the merits hearing, and her 

actions prevented Tshibaka from presenting 

pertinent facts and argument concerning 

Sernulka’s conduct; 

(6) Bartel improperly introduced into evidence the 

last chance provision of the Early Resolution 

Agreement but excluded the clinical sexologists’ 

report;

(7) The CHC defendants failed to give Tshibaka a fair 

hearing before the Board; and 

(8) The Board erroneously decided that Elliott was 

credible as to both incidents, although it did 

not observe or hear her testimony.

Having carefully and fully assessed the record and the 

written submissions of the parties to this appeal, together with 

the argument of counsel, we discern no error in the district 

court’s application of HCQIA immunity. We are therefore content 

to adopt the court’s reasoning in that regard and affirm the 

judgment in favor of the CHC defendants on the state law 

contract and tort claims.

2.

Finally, Tshibaka alleged one additional state law claim —

the defamation claim against Elliott — which the district court 

dismissed by ruling that Elliott is entitled to immunity under 

Maryland law. Specifically, the court concluded that Elliott is 

entitled to the absolute immunity that Maryland common law 

utilizes to protect witnesses in judicial or quasi-judicial 

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proceedings. See Gersh v. Ambrose, 434 A.2d 547, 550-52 (Md. 

1981). Our assessment of that question leads us to be somewhat 

hesitant.

First, we are unable to identify any decision of a Maryland 

appellate court that has extended absolute immunity to a witness 

in a non-governmental administrative proceeding, such as a peer 

review process at a health care facility. Second, Maryland has 

enacted certain statutory provisions that grant a qualified or 

conditional privilege for those involved in the medical review 

process. See Md. Code, Health Occ. § 1-401(a)(3) and (4); Md. 

Code, Cts. & Jud. Proc. § 5-637(b). We can only speculate on 

whether Maryland intended for that statutory privilege to 

abrogate common law absolute immunity — which may or may not 

apply to Elliott — or whether the statutory privilege was meant

to complement common law immunity.

Put succinctly, the district court did not evaluate the 

applicability of the statutory privilege to Tshibaka’s 

defamation claim against Elliott. It is therefore appropriate

for that court to first assess the statutory privilege and its 

potential interplay with common law immunity. We will thus

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vacate the dismissal of Tshibaka’s defamation claim and remand 

for further proceedings thereon.9

IV.

Pursuant to the foregoing, we affirm the judgment against 

Tshibaka on his 42 U.S.C. § 1981 claim, as well as on his 

contract and tort claims against the CHC defendants. We vacate 

the dismissal of the defamation claim against Elliott, however, 

and remand for such other and further proceedings as may be 

appropriate.

AFFIRMED IN PART,

VACATED IN PART,

AND REMANDED

 9 Further proceedings in the district court might include

certification to the Court of Appeals of Maryland, see Md. Code,

Cts. & Jud. Proc. § 12-603, or remand to the state trial court, 

see 28 U.S.C. § 1367; Hinson v. Norwest Fin. S.C., Inc., 239 

F.3d 611, 616 (4th Cir. 2001).

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