UNPUBLISHED

UNITED STATES COURT OF APPEALS 

FOR THE FOURTH CIRCUIT 

No. 22-2224

JAMES MICHAEL ISERNIA, 

 Plaintiff - Appellant, 

 v. 

DANVILLE REGIONAL MEDICAL CENTER; HSCGP, LLC, 

 Defendants - Appellees. 

Appeal from the United States District Court for the Western District of Virginia, at 

Danville. Thomas T. Cullen, District Judge. (4:21-cv-00045-FL) 

Submitted: January 5, 2024 Decided: May 13, 2024 

Before KING, GREGORY, and HARRIS, Circuit Judges. 

Reversed and remanded by unpublished opinion. Judge Gregory wrote the opinion, in 

which Judge King and Judge Harris joined. 

ON BRIEF: Thomas E. Strelka, Brittany M. Haddox, STRELKA EMPLOYMENT LAW, 

Roanoke, Virginia, for Appellant. Yvette Gatling, Laura Saracina, LITTLER MENDELSON,

P.C., Tysons Corner, Virginia, for Appellees.

Unpublished opinions are not binding precedent in this circuit. 

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GREGORY, Circuit Judge:

Appellant Dr. James Michael Isernia filed suit asserting various claims under 

Virginia state law against Danville Regional Medical Center and HSCGP, LLC 

(“Appellees”). At the core of this case is an employment agreement between Dr. Isernia 

and Martinsville Physicians Practices, LLC, which assigned Dr. Isernia to work at a 

hospital owned and operated by Appellees. Although neither of the Appellees was party 

to the agreement, Appellees moved below to compel arbitration pursuant to a provision in 

the agreement. The district court granted Appellees’ motion but certified the matter for 

interlocutory appeal asking us to determine who has jurisdiction over questions of 

arbitrability where a non-signatory seeks to compel arbitration pursuant to an agreement 

that delegates questions of arbitrability to an arbitrator.

Based on our decision in Rogers v. Tug Hill Operating, LLC, 76 F.4th 279 (4th Cir. 

2023)*

, we conclude that a court, not an arbitrator, must determine whether a non-signatory 

to an agreement that contains an arbitration provision can enforce that provision against a 

signatory to the agreement. The district court held that the arbitrator had jurisdiction to 

determine questions of arbitrability between Dr. Isernia and Appellees without first

assessing whether Appellees, as non-signatories, were entitled to invoke the arbitration 

provision under Virginia law. We therefore reverse the district court’s decision and remand 

this case for further proceedings consistent with this opinion.

* We recognize that the district court, when it decided this case, lacked the benefit 

of our Tug Hill decision, rendered more than a year after its contested ruling.

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I.

James Michael Isernia, M.D. is a physician with over twenty-five years of 

experience. J.A. 8 ¶ 10. Danville Regional Medical Center, LLC and HSCGP, LLC own 

Sovah Health-Martinsville (“Sovah Health”), a hospital Dr. Isernia worked at for several 

years until he was terminated. Throughout that period, Dr. Isernia held several leadership 

positions at Sovah Health, including Director of Cardiac Rehab, Director of Home Care, 

Medical Director of Hospice for over ten years, President of the Medical Staff, and Director 

of Peer Review.

In early 2020, Sovah Health conducted several staffing reassignments in response 

to the severe staffing shortages caused by the onset of the Coronavirus pandemic. As a 

part of this reassignment process, several members of Dr. Isernia’s team were assigned to 

assist in other departments and at the hospital’s front entrance. Dr. Isernia did not support 

the reassignment process. He repeatedly complained about the “lack of proper staffing” 

that it caused and reminded hospital officials that properly trained staff were necessary to 

ensure patient and employee safety. J.A. 9–10 ¶ 16. In response, he was told to “stick to 

doctoring.” J.A. 9 ¶ 16. At some point before December 2020, Dr. Isernia also complained 

that outsourcing “scanning duties” for patient and narcotics records resulted in those 

records being “lost or scattered in different places.” J.A. 12 ¶ 30. Dr. Isernia therefore 

kept his records in his office.

In August 2020, Dr. Isernia entered into a Physician Employment Agreement (the 

“Agreement”) with Martinsville Physicians Practices, LLC. The Agreement, which 

became effective on September 1, 2020, defined “Employer” as “Martinsville Physician 

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Practices, LLC,” and assigned Dr. Isernia to work at the “Affiliated Hospital,” defined as 

“Sovah Health-Martinsville,” for a three-year term. J.A. 35. The Agreement refers to 

Sovah Health several times, but was signed only by Dr. Isernia and Pamela J. Kane. J.A. 

36. Dr. Isernia signed on behalf of himself and Kane signed on behalf of Martinsville 

Physician Practices, LLC. Id. Dr. Isernia began working at Sovah Health under the 

Agreement on September 1, 2020, although, as noted above, he had worked there for 

several years prior.

Around December 2020, Sovah Health audited Dr. Isernia’s prescribing practices. 

As part of that review, “Compliance and Pharmacy/Quality team members” randomly 

selected ten patients from a list of “printed/faxed prescriptions” from September and 

October 2020. J.A. 10 ¶ 17. Neither Dr. Isernia nor his staff were included in or consulted

during the audit. Rather, the auditors obtained information from individuals who lacked 

medical knowledge and knowledge of Dr. Isernia’s recordkeeping or prescribing practices. 

J.A. 11 ¶ 26. Sovah Health concluded that the results of the audit indicated that Dr. Isernia 

did not adhere to management’s earlier recommendations regarding his prescribing 

practices, and that he failed to comply with best practices of chronic opioid management 

per federal, state, and practice-specific standards. 

In February 2021, an internal Sovah Health corporate group met to review the 

results of the audit. The next month, the group issued a final warning to Dr. Isernia, 

although Dr. Isernia claims that he never received any previous warnings regarding his 

work or prescribing practices. In April 2021, a Sovah Health employee filed a complaint 

with the Department of Health Professions (“DHP”), as required by state law, informing 

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DHP that Sovah Health had taken disciplinary action against Dr. Isernia. The DHP 

complaint noted that the action taken against Dr. Isernia included a final written warning 

“as a result of conduct that may cause injury to patients.” J.A. 13 ¶ 31.

At some point Sovah Health conducted a follow-up audit of Dr. Isernia’s practices. In 

December 2021, Dr. Isernia received notice of the results of the follow-up audit, which alleged 

continued violations and non-compliance with various policies and procedures. Dr. Isernia

was placed on administrative leave later that month and was terminated in January 2022. 

After he was terminated, Sovah Health informed Apogee Physicians, (another hospital in 

Martinsville, VA where Dr. Isernia worked as a hospitalist) that Dr. Isernia was no longer 

allowed to work at Apogee Physicians.

II.

Dr. Isernia filed a complaint in federal court in April 2022, asserting claims under 

Virginia state law for defamation per se, tortious interference, tortious interference with 

business expectancy/prospective economic advantage, and illegal retaliation against an 

employee. Appellees moved to compel arbitration, contending that they were third-party 

beneficiaries and thus entitled to enforce the arbitration provision in the Agreement. They 

also argued that Dr. Isernia was equitably estopped from refusing to arbitrate his claims 

against them. Dr. Isernia opposed the motion asserting that neither theory was applicable 

to his claims because he did not have any agreement with Appellees.

The district court identified the operative question before it as “whether the parties 

clearly and unmistakably committed disputes over arbitrability to arbitration.” Isernia v. 

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Danville Reg’l Med. Ctr., LLC, 615 F. Supp. 3d 434, 439 (W.D. Va. 2022), reconsideration 

denied, 2022 WL 4076113 (W.D. Va. Sept. 6, 2022). The district court concluded that the 

parties had agreed to arbitrate issues of arbitrability because the Agreement incorporated

the American Health Lawyer’s Association’s (“AHLA”) arbitration rules. Id. The AHLA 

rules state:

If the filing party (Claimant) produces a document that arguably requires 

arbitration of the claim under the Rules, the Administrator will appoint an 

arbitrator pursuant to the process described in this Section. After receiving 

appropriate evidence and argument, the arbitrator, once appointed, shall have 

the power to determine his or her jurisdiction and any issues of arbitrability. 

AHLA’s decision to accept a claim has no bearing on the arbitrator’s 

determination regarding jurisdiction.

AHLA Section 3.1 Criteria: J.A. 52.

Applying that rule to the parties’ dispute, the district court held that an arbitrator 

must determine whether Dr. Isernia agreed to arbitrate his claims against Appellees. 

Isernia v. Danville, 615 F. Supp. 3d at 440. The district court granted Appellees’ motion

to compel arbitration and stayed the case pending resolution of the arbitration. Id.

Dr. Isernia moved for reconsideration. He argued that courts must determine a nonsignatory’s entitlement to enforce a contract before the non-signatory can enforce an 

arbitration provision. He also argued that an agreement by signatory parties to arbitrate 

arbitrability, without more, does not grant any rights to a non-signatory. Appellees

opposed the motion and provided several bases for the district court to consider them thirdparty beneficiaries of the Agreement. The district court denied Dr. Isernia’s motion for 

reconsideration without determining whether Appellees qualified as third-party 

beneficiaries. Isernia v. Danville Reg’l Med. Ctr., LLC, 2022 WL 4076113, at *5 (W.D. 

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Va. Sept. 6, 2022). In the district court’s view, Dr. Isernia “delegated the resolution of . . . 

third-party enforcement questions to an arbitrator” by entering into the Agreement. Id. at 

*9. However, because the court recognized that there was “conflicting authority” and 

“substantial grounds for difference of opinion” on the issue, as evinced by a split among 

our sister circuits, it certified the following question for Fourth Circuit review:

Whether a non-signatory to an arbitration provision that clearly and 

unmistakably incorporates arbitral rules delegating questions of

“arbitrability” and “jurisdiction” to an arbitrator can move to compel 

arbitration of a third-party enforcement issue such that an arbitrator – and not 

a court – determines whether the non-signatory is entitled to enforce the 

arbitration provision against the signatory.

Id. at *11.

Although we had not yet opined on the issue at the time of the district court’s 

decision, we clarified our position months later in Rogers v. Tug Hill Operating, LLC, 76 

F.4th 279 (4th Cir. 2023), cert. denied, 2024 WL 674823 (U.S. Feb. 20, 2024). In Tug Hill, 

the plaintiff filed a Fair Labor Standards Act suit against a gas company for whom he had 

worked for approximately a year and a half. Id. at 282. He alleged that he qualified as an 

employee (though the company classified him as an independent contractor) and thus was 

owed overtime wages for time worked over forty hours per week. Id. at 282, 284. The 

plaintiff had contractually agreed to arbitrate all claims relevant to his agreement with 

RigUp, the parent of a company that helped him secure the gas company job. Id. at 282–

83. The gas company, however, was not a party to that agreement. Id. at 282.

RigUp moved to intervene and the gas company moved to dismiss the action and 

compel arbitration based on the agreement between the plaintiff and RigUp. Id. at 284. 

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The district court granted both motions – allowing RigUp to intervene and compelling 

arbitration. Id. at 284–85; see also Rogers v. Tug Hill Operating, LLC, 598 F. Supp. 3d 

404, 417, 421 (N.D. W. Va. 2022). The district court held that the gas company’s nonsignatory status was irrelevant because the contract’s delegation clause assigned all 

questions regarding arbitrability to an arbitrator. Id. at 425. It alternatively concluded, 

based on an incorrect application of West Virginia law, that the gas company was permitted 

to enforce the contract as a third-party beneficiary. Id. at 427. 

We reversed, concluding that the district court erroneously granted the motion to 

compel without first evaluating whether the gas company was entitled to enforce the 

agreement. Tug Hill, 76 F.4th at 288. In doing so, we recognized the longstanding 

principle that because “arbitration obligations are grounded in contract law” they are “as 

enforceable as other contracts, but not more so.” Id. at 286 (citations omitted). As such, a 

litigant who was not party to an arbitration agreement may only compel arbitration pursuant 

to the agreement and the Federal Arbitration Act “if the relevant state contract law allows 

him to enforce the agreement.” Id. at 287 (citation and emphasis omitted). Thus, we said, 

“as a precondition to granting [the gas company] the right to enforce any portion of an 

arbitration clause to which it was not a party,” the district court was required to determine 

whether the relevant state contract law allowed the gas company to enforce the underlying 

agreement. Id. at 288. 

That brings us to this case. The district court granted Appellees’ motion to compel 

arbitration based on its mistaken belief that the incorporation of the AHLA rules in the 

Agreement automatically delegated all questions of arbitrability between the parties in this 

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case to an arbitrator. J.A. 82. The district court was mistaken. In fact, the inclusion of the 

AHLA rules in the Agreement has no bearing on the parties’ dispute here unless Appellees 

can show that they are entitled to enforce the Agreement. Absent such a showing, an 

arbitrator would have no authority to make any determinations in this matter because a 

party who cannot demonstrate its entitlement to enforce an agreement cannot be entitled to 

any of the agreement’s provisions. See id. at 287 (stating that nothing in the Federal 

Arbitration Act or Supreme Court jurisprudence allows such a “counterintuitive” result as 

permitting “a party with no contractual right to compel arbitration”). Thus, as in Tug Hill, 

the district court was required to determine whether Appellees were entitled to enforce the 

Agreement under Virginia law before compelling arbitration. Because “[w]e are a court of 

review, not first view,” Est. of Van Emburgh by & through Van Emburgh v. United States, 

95 F.4th 795 (4th Cir. 2024), we remand the case to permit the district court to evaluate 

Appellees’ entitlement to enforce the contract in the first instance.

III.

For the foregoing reasons, we reverse the district court’s grant of Appellees’ motion 

to compel arbitration and remand for the district court to determine whether Appellees are 

entitled to enforce the agreement between Dr. Isernia and Martinsville Physicians 

Practices, LLC under Virginia law. We dispense with oral argument because the facts and 

legal contentions are adequately presented in the materials before this court and argument 

would not aid the decisional process.

REVERSED AND REMANDED

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