Court Opinion

ID: 2963510
Source: CourtListenerOpinion
Date Created: 2015-09-21 21:11:11.593096+00
Date Added: 2024-06-11T15:01:43.098489
License: Public Domain

USCA1 Opinion

	

                            United States Court of Appeals
                            United States Court of Appeals
                                For the First Circuit
                                For the First Circuit
                                 ____________________

        No. 94-2024

                              JAMES BENJAMIN, JR., M.D.,

                                Plaintiff, Appellant,

                                          v.

                     THE AROOSTOOK MEDICAL CENTER, INC., ET AL.,

                                Defendants, Appellees.

                                 ____________________

                     APPEAL FROM THE UNITED STATES DISTRICT COURT

                              FOR THE DISTRICT OF MAINE

                     [Hon. Morton A. Brody, U.S. District Judge]
                                            ____________________

                                 ____________________

                                        Before

                                 Selya, Circuit Judge,
                                        _____________
                            Bownes, Senior Circuit Judge,
                                    ____________________
                              and Stahl, Circuit Judge.
                                         _____________

                                 ____________________

            James P.  Chandler with whom Chandler & Robertson was on brief for
            __________________           ____________________
        appellant.
            Christopher  D.  Nyhan with  whom Elizabeth  J.  Wyman and  Preti,
            ______________________            ____________________      ______
        Flaherty, Beliveau & Pachios were on brief for appellees.
        ____________________________

                                 ____________________

                                    June 19, 1995
                                 ____________________

                      STAHL, Circuit  Judge.  This appeal  arises from an
                      STAHL, Circuit  Judge.
                             ______________

            action brought by Dr. James Benjamin, Jr., and several of his

            patients  against  the  Aroostook  Medical  Center  ("TAMC"),

            alleging  the  racially-motivated  termination of  Benjamin's

            staff  privileges.1    The   district  court  dismissed   the

            patients'  claims,  holding  that  they  lacked  standing  to

            challenge TAMC's actions.   Subsequently, the court dismissed

            Benjamin's claims with prejudice, explaining  that Benjamin's

            counsel had failed to  make himself available for proceedings

            and  to respond  to notices  from the court.   We  affirm the

            dismissal  of the  patients' claims  and modify  the district

            court's  order   dismissing  Benjamin's  claims  so  that  it

            operates without prejudice.

                                          I.
                                          I.
                                          __

                                      Background
                                      Background
                                      __________

                      On February  12,  1992, Benjamin,  a  physician  of

            African-American descent, submitted  a completed  application

            for  staff   privileges  to  TAMC.    TAMC  did  not  approve

            Benjamin's  application, but  instead, on  October  12, 1992,

            granted  him  a  "provisional  appointment."    Benjamin  had

            licenses  to practice  medicine  in California,  Connecticut,

            Minnesota and Maine, and had received a certification in  the

                                
            ____________________

            1.  In addition  to  TAMC, the  complaint designates  several
            named and unnamed TAMC  officers, agents, employees and staff
            physicians as defendants.   For purposes of this  opinion, we
            will refer to all defendants collectively as "TAMC." 

                                         -2-
                                          2

            "Specialty of  Internal Medicine" from the  American Board of

            Internal Medicine.    TAMC, which is located in Presque Isle,

            Maine, has approximately forty-five physicians on its medical

            staff  and  it  does   not  allow  physicians  without  staff

            privileges  to treat patients at its facilities.  At the time

            of  Benjamin's  appointment,  TAMC  had  no  African-American

            physician on its staff.

                      On October 11, 1993, TAMC's Medical Staff Executive

            Committee   recommended   that   TAMC  terminate   Benjamin's

            provisional staff  privileges.  Subsequently,  on January  7,

            1994, Benjamin  and seventeen of his  patients commenced this

            action pro se  in federal district court  alleging that TAMC,
                   ___ __

            through  discriminatory  policies and  practices,  had denied

            Benjamin  staff  privileges  on  account of  his  race.    On

            February  11, 1994,  the district  court issued  a scheduling

            order setting forth discovery deadlines and an expected trial

            date  for  August  1994.    The  district court  amended  the

            scheduling order twice to extend the time, first for Benjamin

            and then for TAMC,  to designate expert witnesses.   On March

            4,  1994, TAMC filed a motion to dismiss the patients' claims

            for  lack  of standing.    After  Benjamin and  the  patients

            responded through newly obtained counsel,  the district court

            granted  the  motion,  finding  that  the  patients  had  not

            sufficiently alleged  that they had  suffered any "injury-in-

            fact" as a result of the hospital's actions.

                                         -3-
                                          3

                      On  April  29, 1994,  Benjamin's counsel  sought to

            withdraw,  citing  irreconcilable differences  with Benjamin.

            The district court granted  the motion, pending an appearance

            by replacement  counsel (or by Benjamin pro  se).  On May 31,
                                                    ___  __

            1994, Benjamin's counsel renewed  the motion to withdraw, and

            the  district court ordered Benjamin to show cause why he had

            not obtained  new counsel.   On June  8, 1994,  TAMC filed  a

            motion to dismiss, arguing that  Benjamin had failed to  make

            himself available for a  deposition and had obstructed TAMC's

            efforts  to complete discovery.  Two days later, TAMC filed a

            second motion to dismiss and/or for summary judgment, arguing

            that Benjamin's claims  failed on  the merits.   On June  16,

            1994, James P. Chandler of Washington, D.C., entered a notice

            of appearance on behalf  of Benjamin and simultaneously moved

            to enlarge the time  to respond to TAMC's pending  motions to

            dismiss.   The  district  court granted  this motion,  giving

            Benjamin and his new counsel until July 15, 1994, to respond.

                      On July 7, 1994,  Chandler became seriously ill and

            was  hospitalized in  Washington, D.C.   At  the time  of his

            hospitalization, Chandler had not  responded to TAMC's motion

            nor consulted  with Benjamin's former  counsel.  On  July 15,

            1994,  a law  clerk  for  Chandler  moved for  an  additional

            enlargement of time on  account of Chandler's sudden illness.

            The  district court  denied  the motion  in  light of  TAMC's

            objection  and   because  it  was  improperly   filed  by  an

                                         -4-
                                          4

            individual without authority  to practice  before the  court.

            On  August  2,  1994,   Chandler  filed  another  motion  for

            enlargement  of  time, which  the  district  court denied  by

            endorsement.

                      On  August  17, 1994,  the  district  court held  a

            hearing on TAMC's pending motions to dismiss at which neither

            Chandler  nor   Benjamin  appeared.     Noting   that,  since

            Chandler's  appearance  on  Benjamin's  behalf,  Chandler had

            neither  made  himself  available  for  any  proceedings  nor

            responded  to  notices from  the  court,  the district  court

            granted TAMC's motion to dismiss with prejudice.  This appeal

            followed.

                                         II.
                                         II.
                                         ___

                                      Discussion
                                      Discussion
                                      __________

                      We address two issues on appeal.  First, Benjamin's

            patients contest the district  court's finding that they lack

            standing  to  assert  their  claims against  TAMC.    Second,

            Benjamin argues that his  counsel's sudden and severe illness

            should  excuse  his failure  to  make  himself available  and

            respond to notices from the court.

            A.  The Patients' Claims
            ________________________

                      At  oral  argument, counsel  for  the  patients and

            Benjamin asserted that the patients' standing argument rested

                                         -5-
                                          5

            primarily  on 42 U.S.C.    1981.2  The  patients contend that

            they have  standing  because TAMC's  actions interfered  with

            their    1981-protected  right to  contract with  Benjamin, a

            minority  physician.    TAMC,  however,  maintains  that  the

            patients themselves have no legally cognizable injury and, at

            best, only assert the third-party rights of Benjamin.   After

            careful review,  we conclude  that, on  the facts alleged  in

            this case, the patients do not have standing.  

                      The burden of alleging facts necessary to establish

            standing  falls   upon  the  party  seeking   to  invoke  the

            jurisdiction of the federal court.  Warth v. Seldin, 422 U.S.
                                                _____    ______

            490,  518 (1975); United States  v. AVX Corp.,  962 F.2d 108,
                              _____________     _________

            114 (1st  Cir. 1992).  We  review de novo  a district court's
                                              __ ____

                                
            ____________________

            2.  42 U.S.C.   1981 provides in relevant part:

                      (a) Statement of equal rights
                          Statement of equal rights
                           All persons  within the jurisdiction
                      of the United States shall have  the same
                      right in  every  State and  Territory  to
                      make  and enforce  contracts, to  sue, be
                      parties, give  evidence, and to  the full
                      and   equal  benefit  of   all  laws  and
                      proceedings for the  security of  persons
                      and  property  as  is  enjoyed  by  white
                      citizens . . . .

                      (b) "Make and enforce contracts" defined 
                          "Make and enforce contracts" defined 
                           For  purposes  of this  section, 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.

                                         -6-
                                          6

            standing   determination,  employing  an  approach  that,  in

            practice,  differs little from that used to review motions to

            dismiss under Fed. R. Civ. P.  12(b)(6).  AVX Corp., 962 F.2d
                                                      _________

            at 114.  In conducting our review, we are obliged  to "accept

            as true all  material allegations of the complaint, and . . .

            construe the  complaint in  favor of the  complaining party."

            Warth, 422 U.S. at 501; see also Adams v. Watson 10 F.3d 915,
            _____                   ___ ____ _____    ______

            919 (1st Cir. 1993).

                      "Standing  is   the  determination  of   whether  a

            specific person is  the proper  party to  bring a  particular

            matter to  the Court  for adjudication."   Erwin Chemerinsky,

            Federal  Jurisdiction    2.3,  at 48  (1989).   The  "inquiry
            _____________________

            involves  both  constitutional  limitations on  federal-court

            jurisdiction and  prudential  limitations on  its  exercise."

            Warth,  422  U.S.  at 498;  see  also  Vote  Choice, Inc.  v.
            _____                       ___  ____  __________________

            DiStefano, 4 F.3d 26, 36 (1st Cir. 1993).  The constitutional
            _________

            limitations  derive from  the  language of  Article III  that

            provides, inter  alia,  that  federal  courts  shall  resolve
                      _____  ____

            disputes  involving  only  "Cases" or  "Controversies."   AVX
                                                                      ___

            Corp.,  962 F.2d at 113.   The Supreme  Court has interpreted
            _____

            this  general constitutional  proscription  as setting  forth

            three fundamental requisites of standing  that every litigant

            invoking the jurisdiction of the federal courts must possess:

            (1)  injury-in-fact --  an  invasion of  a  legally-protected

            interest that is both concrete and particularized, and actual

                                         -7-
                                          7

            or imminent; (2) causation; and (3) redressability.  Lujan v.
                                                                 _____

            Defenders of Wildlife, 504  U.S. 555, 560-61 (1992); Libertad
            _____________________                                ________

            v. Welch, No.  94-1699, slip op. at 10-11 (1st  Cir. Apr. 28,
               _____

            1995).

                      Several   prudential  considerations   also  infuse

            standing   determinations.     These   considerations,  which

            militate  against standing,  principally concern  whether the

            litigant (1)  asserts  the rights  and interests  of a  third

            party and not his or  her own, (2) presents a claim  arguably

            falling  outside  the  zone  of interests  protected  by  the

            specific law  invoked, or (3) advances  abstract questions of

            wide public significance essentially amounting to generalized

            grievances more appropriately addressed to the representative

            branches.   Libertad, slip op. at 11.  Consideration of these
                        ________

            prudential factors enables  the federal  judiciary "to  avoid

            deciding questions of broad social import where no individual

            rights would be vindicated and to limit access to the federal
                                       ___

            courts to  those litigants best suited to assert a particular
                                       ____ ______

            claim."  Gladstone, Realtors v. Village of Bellwood, 441 U.S.
                     ___________________    ___________________

            91, 99-100 (1979) (emphasis added); see also Conservation Law
                                                ___ ____ ________________

            Found.  of New England v.  Reilly, 950 F.2d  38, 41 (1st Cir.
            ______________________     ______

            1991).

                      For purposes  of this  appeal, we need  not resolve

            whether the  patients have met  the constitutional requisites

            of standing,  rather we  believe that, because  the patients'

                                         -8-
                                          8

            allegedly  infringed-upon  rights fall  outside what  we have

            previously  found to  be protected  by    1981,  the patients

            essentially assert the third-party rights of Benjamin  rather

            than their  own.  Furthermore, because the  patients have not

            satisfied the  minimum requirements  for an exception  to the

            prudential rule against third-party standing, and because the

            reasons  underlying the rule obtain  in this case, we believe

            the district court did not err in dismissing their claims. 

                      Whether  a party  is asserting  its own  rights, as

            opposed  to seeking to vindicate the rights of a third party,

            is often  a  difficult question.    See generally,  Henry  P.
                                                ___ _________

            Monaghan, Third Party Standing, 84 Colum. L. Rev. 277 (1984).
                      ____________________

            Though  the patients  claim  a direct  infringement of  their

            right to contract with a  minority physician, at its essence,

            we believe  their claim is  more accurately  described as  an

            assertion  of Benjamin's third-party  right to a race-neutral

            review process.

                      Primarily,  the patients'  allegedly infringed-upon

            rights  fall   outside  what  we,  and   other  courts,  have

            previously found to be protected by 42 U.S.C.    1981.3  Most

                                
            ____________________

            3.        Although  standing in  no way  depends on
                      the merits of the  plaintiff's contention
                      that particular conduct is illegal, e.g.,
                                                          ____
                      Flast v. Cohen,  392 U.S. 83, 90  (1968),
                      _____    _____
                      it often turns on  the nature and  source
                      of the claim asserted. . . . [T]he source
                      of  the  plaintiff's   claim  to   relief
                      assumes critical  importance with respect
                      to the prudential rules of standing that,

                                         -9-
                                          9

            cases  brought  pursuant to     1981  involve allegations  of

            discriminatory  conduct  prompted  by  hostility  towards the

            plaintiff's race.  See Dartmouth Review v. Dartmouth College,
                               ___ ________________    _________________

            889 F.2d  13, 17  (1st  Cir. 1989).   Occasionally,  however,

            courts  have  allowed  cases  to proceed  where  a  plaintiff

            challenges  a discriminatory  action  motivated by  animosity

            towards another  person's race.   See,  e.g., Des Vergnes  v.
                                              ___   ____  ___________

            Seekonk Water  Dist.,  601 F.2d  9,  13-14 (1st  Cir.  1979);
            ____________________

            Winston v.  Lear-Siegler, Inc.,  558 F.2d 1266,  1268-70 (6th
            _______     __________________

            Cir. 1977); DeMatteis  v. Eastman  Kodak Co.,  511 F.2d  306,
                        _________     __________________

            311-12 (2d  Cir.), modified  on other grounds,  520 F.2d  409
                               ________  __ _____ _______

            (1975).  Such cases have generally been limited to situations

            in  which  the  plaintiff  was  the  direct  target  of   the

            defendant's discriminatory action.  In   Des   Vergnes,   for
                                                     _____________

            example,  a water  district acted  directly against  the non-

            minority developer  by  refusing the  developer's request  to

            include  a tract  of  land proposed  for low-income  minority

            housing in the water district.  Des Vergnes, 601 F.2d at  11-
                                            ___________

            12.   Consequently, we  held that the  non-minority developer

                                
            ____________________

                      apart    from    Art.    III's    minimum
                      requirements,  serve to limit the role of
                      the courts in resolving  public disputes.
                      Essentially,  the  standing  question  in
                      such cases, is whether the constitutional
                      or statutory provision on which the claim
                      rests  properly  can  be   understood  as
                      granting  a  person  in  the  plaintiff's
                      position a right to judicial relief.

            Warth, 422 U.S. at 500. 
            _____

                                         -10-
                                          10

            had standing under    1981 even  though the water  district's

            alleged  discriminatory  action  was  motivated  by animosity

            towards  the race of the prospective tenants and not the race

            of the developer.   Id. at  14.  Other  cases most  typically
                                ___

            involve a  discriminatory  employment action  (e.g.,  firing)
                                                           ____

            taken by an employer directly against a non-minority employee

            because of that employee's  association with, or advocacy of,

            minorities.  See, e.g., Alizadeh v. Safeway Stores, Inc., 802
                         ___  ____  ________    ____________________

            F.2d 111,  114 (5th Cir. 1986) (white plaintiff fired because

            married to minority spouse); Winston, 558 F.2d at 1270 (white
                                         _______

            employee fired for advocating rights of minority); cf. Phelps
                                                               ___ ______

            v. Wichita  Eagle-Beacon, 886  F.2d 1262, 1266-67  (10th Cir.
               _____________________

            1989)  (white  lawyer  had  standing  under     1981  to  sue

            newspaper that  published allegedly false articles  about him

            because he represented minorities).

                      Here, the  patients  challenge an  action  by  TAMC

            neither motivated by animosity towards the patients' race nor

            specifically  targeted  at, or  taken  directly against,  the

            patients.    The patients'  alleged injury  arises only  as a

            derivative  effect of  TAMC's administration  of its  general

            policies governing  the grant  and review of  physician staff

            privileges.  Cf.  Department of Labor  v. Triplett, 494  U.S.
                         ___  ___________________     ________

            715, 720 (1990)  (standing may exist where  "enforcement of a

            restriction against  a litigant  prevents a third  party from
                                   ________

            entering into  a relationship with the  litigant (typically a

                                         -11-
                                          11

            contractual  relationship), to  which the  third party  has a

            legal entitlement") (emphasis added); see generally Monaghan,
                                                  ___ _________

            84  Colum.  L. Rev.  at  306-11  (discussing the  distinction

            between  direct  and  indirect  interference  with  right  to

            interact as a  limit on standing).  The direct injury in this

            case   is  TAMC's   alleged   discriminatory  revocation   of

            Benjamin's staff privileges, which TAMC directed specifically

            at Benjamin on account of Benjamin's race.

                      Furthermore, the patients do not allege that TAMC's

            action  completely precluded  them from  receiving treatment.

            TAMC has other physicians on staff who practice in Benjamin's

            specialty,  and the  patients  do not  allege  that TAMC  has

            refused to admit them as patients.  Finally, neither does the

            fact  that  Benjamin  cannot   treat  the  patients  at  TAMC

            completely disrupt the  patients' relationship with Benjamin:

            TAMC's revocation  of  Benjamin's staff  privileges does  not

            preclude  him  from treating  the  patients  outside of  TAMC

            facilities.    Accordingly,   because  the  patients'  injury

            occurs,  if at  all, only  as a  derivative effect  of TAMC's

            action against Benjamin, we hold that, in attempting to bring

            their  claims under     1981, they  are asserting  Benjamin's

            third-party  rights,  and  not  their  own.    See  Mackey v.
                                                           ___  ______

            Nationwide Ins.  Co., 724  F.2d 419,  421-22 (4th  Cir. 1984)
            ____________________

            (insurance  agent challenging  insurer's redlining  policy is

            asserting  third-party rights  of homeowners);  Capital Nat'l
                                                            _____________

                                         -12-
                                          12

            Bank  of  N.Y. v.  McDonald's Corp.,  625  F. Supp.  874, 882
            ______________     ________________

            (S.D.N.Y.  1986) (non-minority lender  to minority franchisee

            asserts  only third-party  rights  of minority  franchisee in

            challenge to franchisor's alleged  discriminatory termination

            of franchisee's contract).

                      While  the  general  proscription   on  third-party

            standing is not absolute,  Powers v. Ohio, 499 U.S.  400, 410
                                       ______    ____

            (1991); Warth, 422 U.S. at 500-01, no exception to the ban is
                    _____

            applicable in this case.  In Powers, the Supreme Court stated
                                         ______

            that  an individual seeking to  assert the rights  of a third

            party   must,  as  a  prerequisite,  satisfy  three  specific

            criteria:  "The litigant  must  have suffered  an 'injury  in

            fact,' . . . ; the litigant must have a close relationship to

            the third party; and  there must exist some hindrance  to the
                                        ____ _____ ____ _________

            third  party's ability to protect his  or her own interests."

            Powers, 499 U.S. at 411 (citations omitted) (emphasis added);
            ______

            see  also Playboy Enters. v. Public Serv. Comm'n of P.R., 906
            ___  ____ _______________    ___________________________

            F.2d 25, 37-39 (1st Cir.), cert. denied, 498 U.S. 959 (1990).
                                       _____ ______

                      Assuming arguendo that  the patients could  satisfy
                               ________

            the  first two criteria,  they clearly fail  to establish the

            third.   No hindrance exists  in this case  that prevents the

            third  party, Benjamin,  from asserting his  own rights.   In

            order  to satisfy this criterion, a party must show that some

            barrier  or   practical  obstacle  (e.g.,   third  party   is
                                                ____

            unidentifiable,  lacks  sufficient interest,  or  will suffer

                                         -13-
                                          13

            some  sanction)  prevents  or  deters the  third  party  from

            asserting  his or her own  interest.  See,  e.g., Powers, 499
                                                  ___   ____  ______

            U.S. at 414-15 (lack  of economic incentive); Clifton Terrace
                                                          _______________

            Assocs. v. United Technologies Corp., 929 F.2d 714, 721 (D.C.
            _______    _________________________

            Cir. 1991)  (no barriers  because, inter alia,  third parties
                                               _____ ____

            are plainly identifiable); Playboy Enters., 906 F.2d at 37-38
                                       _______________

            (threat of  official sanction)   Here,  the injured party  is

            clearly  identified  and  has  sufficient   interest  in  the

            litigation (e.g., professional reputation) to pursue (and, in
                        ____

            fact,  has pursued)  the action.   Accordingly,  the patients

            have not met the minimum requisites for third-party standing.

                      Furthermore,  our holding,  that Benjamin,  and not

            the  patients, is the proper party to bring an action against

            TAMC,  is   consistent  with  the  policies   underlying  the

            prudential rule against third-party standing.   See Singleton
                                                            ___ _________

            v.  Wulff, 428 U.S. 106,  114 (1976) (general proscription on
                _____

            third-party  standing may  be  avoided where  the "underlying

            justifications are  absent").   Indeed, one of  the principal

            justifications for the rule is that it assures that the party

            bringing the litigation will  be the "most effective advocate

            of the rights at  issue."  Duke Power Co.  v. Carolina Envtl.
                                       ______________     _______________

            Study Group, Inc., 438 U.S. 59, 80 (1978); see also Secretary
            _________________                          ___ ____ _________

            of State  v. Joseph H.  Munson Co., 467 U.S.  947, 955 (1984)
            ________     _____________________

            (rule  against third-party  standing  guarantees that  issues

            essential   to  litigation  will  be  "concrete  and  sharply

                                         -14-
                                          14

            presented").  Here,  because the  merits of  the action  turn

            largely on  an evaluation of Benjamin's  performance at TAMC,

            he, and not the patients, is clearly the best party to assert

            the claim.   Not only would Benjamin  be best able to contest

            TAMC's  assertion  of  professional  incompetence,   but,  in

            addition,  he would  likely  be far  more  able to  point  to

            specific  instances  of  conduct attributable  to  TAMC  that

            suggest a  discriminatory  motive.   Indeed, it  is far  from

            clear  that the patients,  who would not be  privy to all the

            particulars  of  Benjamin's relationship  with  the hospital,

            could effectively proceed without Benjamin's participation.

                      To  summarize, because  the  patients' claims  fall

            outside what  we, and other courts, have  previously found to

            be  protected by   1981,  we believe the  patients assert the

            third-party   rights   of  Benjamin   and   not   their  own.

            Furthermore, because  the patients  have not met  the minimum

            requisites  for  third-party  standing,  we  hold  that   the

            district court did not err in dismissing their claims.

            B.  Benjamin's Claims
            _____________________

                      Benjamin contends that the  district court erred in

            granting TAMC's  motion to dismiss with  prejudice.  Benjamin

            maintains  that  the   district  court  granted  the   motion

            essentially  because  his  counsel  failed  to prosecute  the

            action  by not  responding  to TAMC's  motion  to dismiss  or

            appearing  at  the  August  17  hearing.    Benjamin  argues,

                                         -15-
                                          15

            however, that these  failures are excusable  in light of  his

            attorney's sudden and serious illness.

                      We treat  the district court's  dismissal as issued

            pursuant  to Rule 41(b).4   We  review  dismissals under Rule

                                
            ____________________

            4.  Fed R. Civ. P. 41(b) provides in relevant part:

                      For failure of the plaintiff to prosecute
                      or  to comply  with  these rules  or  any
                      order of court, a  defendant may move for
                      dismissal  of an  action or of  any claim
                      against  the defendant.  Unless the court
                      in  its  order  for  dismissal  otherwise
                      specifies,   a   dismissal   under   this
                      subdivision   and   any   dismissal   not
                      provided for  in this rule,  other than a
                      dismissal  for  lack of  jurisdiction for
                      improper  venue, or for failure to join a
                      party  under  Rule  19,  operates  as  an
                      adjudication upon the merits.

                      TAMC  contends that  the  district court  dismissed
            Benjamin's claims pursuant  to Local Rule 19(c)  and not Rule
            41(b).  Local Rule 19(c) provides  that the failure to file a
            timely written  response to a  pending motion will  waive any
            objections to that motion.  U.S. Dist. Ct. Me. Gen. R. 19(c).
                      Our reading of the district court's order, however,
            convinces us  that it was acting pursuant to Rule 41(b).  The
            district  court did not cite Local Rule 19(c) in ordering the
            dismissal  of the case.  Neither did the district court state
            that the  dismissal was compelled because  Benjamin's failure
            to  respond constituted  a  waiver of  any  objection to  the
            motion.   Instead, the district court  reasoned, "Because the
            plaintiff,  through  counsel,  has  failed  to  make  himself
            available  for any  proceedings since  the appearance  of Mr.
            Chandler and  since the  plaintiff, through counsel,  has not
            responded to  notices from  the Court, defendant's  Motion to
            Dismiss   plaintiff's   actions   is   hereby   GRANTED  with
                                                            _______
            prejudice."    We think  this  rather  terse statement  makes
            apparent that  the court's  motivation stemmed more  from its
            displeasure  at  Benjamin  and Chandler's  failure  either to
            appear  at the hearing or  to notify the  court (and opposing
            counsel) of  their expected  absence, than just  Benjamin and
            Chandler's (arguably) excusable failure to respond to  TAMC's
            motion to dismiss.

                                         -16-
                                          16

            41(b) for abuse of discretion.  Capo v. United States, 7 F.3d
                                            ____    _____________

            283, 284  (1st  Cir. 1993);  Enlace Mercantil  Internacional,
                                         ________________________________

            Inc.  v. Senior  Indus., Inc.,  848 F.2d  315, 317  (1st Cir.
            ____     ____________________

            1988).   Claims  of  abuse  of  discretion under  Rule  41(b)

            typically  have "not  received  a sympathetic  ear from  us."

            Damiani  v. Rhode  Island Hosp.,  704 F.2d  12, 17  (1st Cir.
            _______     ___________________

            1983) (collecting cases).   At the same time, this  "does not

            mean  we have  rubber-stamped the  decisions of  the district

            court."  Id.  Dismissal with prejudice "is a harsh sanction,"
                     ___

            Richman v. General Motors Corp., 437  F.2d 196, 199 (1st Cir.
            _______    ____________________

            1971),  which runs counter to our "strong policy favoring the

            disposition  of cases  on the  merits."   Zavala Santiago  v.
                                                      _______________

            Gonzalez  Rivera, 553  F.2d 710, 712  (1st Cir. 1977).   As a
            ________________

            result,  we have  indicated  that such  an  option should  be

            employed only when  a plaintiff's misconduct is  particularly

            egregious  or extreme.  See,  e.g., Estate of Solis-Rivera v.
                                    ___   ____  ______________________

            United States, 993 F.2d 1, 2 (1st  Cir. 1993); see also Cosme
            _____________                                  ___ ____ _____

            Nieves v. Deschler, 826 F.2d 1, 2 (1st Cir. 1987) ("[i]n  all
            ______    ________

            the cases in  which we  have upheld a  dismissal for want  of

            prosecution,  we  have  found  either   extremely  protracted

            inaction (measured  in years), disobedience of  court orders,

            ignorance  of  warnings, contumacious  conduct or  some other

            aggravating  circumstance").  In  reviewing the trial court's

            actions, we engage in  an "open-ended balancing test," giving

            appropriate  consideration to all relevant factors.  Figueroa
                                                                 ________

                                         -17-
                                          17

            Ruiz  v. Algria, 896 F.2d 645,  648 (1st Cir. 1990); see also
            ____     ______                                      ___ ____

            HMG  Property Investors,  Inc.  v. Parque  Indus. Rio  Canas,
            ______________________________     __________________________

            Inc., 847 F.2d 908, 917 n.13 (1st Cir. 1988).
            ____

                      If the district court's order ensued solely because

            Attorney   Chandler's  sudden  illness   prevented  him  from

            responding to  TAMC's motion to dismiss,  Benjamin's argument

            would  have  significantly  more   bite.    Indeed,  we  have

            suggested that,  in  deciding a  motion for  an extension  of

            time, a  district court's failure to allow for factors beyond

            a party's control, such as the unexpected illness of counsel,

            may,  in a certain  case, constitute an  abuse of discretion.

            See Maldonado-Denis v. Castillo-Rodriguez,  23 F.3d 576,  584
            ___ _______________    __________________

            (1st  Cir. 1994) (finding no abuse of discretion in denial of

            motion for enlargement of time  where, inter alia, party does
                                                   _____ ____

            not advert  to "circumstances beyond a  party's control, such

            as  an attorney's  illness"); cf.  Smith-Weik Mach.  Corp. v.
                                          ___  _______________________

            Murdock Mach. & Eng'g Co., 423 F.2d 842, 844 (5th Cir. 1970).
            _________________________

            In this case, however, other factors obtain, most importantly

            Chandler's failure to appear  at the August 17 hearing  or to

            notify the  court  and opposing  counsel  in advance  of  his

            expected absence.  See  Simpson v. Welch, 900 F.2d  33, 34-35
                               ___  _______    _____

            (4th Cir.  1990) (no abuse of discretion  to dismiss pursuant

            to  Rule  41(b) where  counsel  did  not respond  to  summary

            judgment  motion or appear at hearing  on motion).  Moreover,

            Chandler's  failure to  appear occurred  after the  court had

                                         -18-
                                          18

            already  extended  the time  to respond  to TAMC's  motion to

            dismiss upon Chandler's late  appearance in the case.   Cf. 9
                                                                    ___

            Charles A.  Wright & Arthur  R. Miller, Federal  Practice and
                                                    _____________________

            Procedure   2352, at 402 (2d ed. 1995) (prior delays relevant
            _________

            in evaluating denial of continuance).

                      On  the other  hand, though  Chandler's failure  to

            notify the district  court and opposing counsel that he would

            not be present at the August 17 hearing cannot be overlooked,

            we believe that, when viewed in context, the egregiousness of

            his  conduct  becomes  somewhat  mitigated.   TAMC  does  not

            dispute  that Chandler,  who lives  in Washington,  D.C., was

            seriously ill.   Indeed,  Chandler had apprised  the district

            court  and opposing  counsel of the  severity of  his illness

            through  two motions for enlargement of time filed on July 15

            and August 2.  The August 2 motion expressly states that "The

            prognosis of  [Chandler's]  primary care  physician  is  that

            [Chandler]  will not be able to resume his court duties until

            after mid-August."  Thus, we think that Chandler provided the

            court and TAMC at least some notice that he might not be able

            to  attend the  August 17  hearing.   Moreover,  the district

            court  scheduled the date of the August 17 hearing only after

            Chandler  filed the  second motion  for enlargement  of time.

            Finally,  the   litigation,  at  the  time   of  the  court's

            dismissal, was less than one year old.

                                         -19-
                                          19

                      We sympathize with the district court's frustration

            in  the face  of counsel's  failure to  appear, and  we fully

            appreciate the  district court's need to  control its docket.

            Furthermore,  we  "wholeheartedly endorse  the  use of  stiff

            sanctions,  including  dismissal   [with  prejudice],   where

            appropriate."  Velazquez-Rivera v.  Sea-Land Serv., Inc., 920
                           ________________     ____________________

            F.2d  1072,  1079  (1st Cir.  1990).    While  we agree  that

            Chandler's failure to appear or to notify  the court warrants

            punishment,  we  believe that,  in  this  case, the  district

            court's  use  of  the  ultimate sanction  of  dismissal  with

            prejudice was  a step too far.  Hence, we modify the order of

            the district court to  a dismissal without prejudice.   See 9
                                                                    ___

            Wright & Miller,  Federal Practice and  Procedure   2373,  at
                              _______________________________

            402  ("The  decision  of  the trial  court  to  dismiss  with

            prejudice  may be reviewed on appeal  and the appellate court

            may order the dismissal to be without prejudice.").

                                         III.
                                         III.
                                         ____

                                      Conclusion
                                      Conclusion
                                      __________

                      For the  foregoing reasons, we affirm the dismissal

            of the patients' claims and modify the district court's order

            dismissing Benjamin's claims to operate without prejudice.

                                         -20-
                                          20