Court Opinion

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Source: CourtListenerOpinion
Date Created: 2024-02-21 15:01:13.086835+00
Date Added: 2024-06-11T13:48:09.341310
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USCA11 Case: 23-11291   Document: 32-1    Date Filed: 02/21/2024   Page: 1 of 16

                                                 [DO NOT PUBLISH]
                                 In the
                 United States Court of Appeals
                        For the Eleventh Circuit

                         ____________________

                               No. 23-11291
                         Non-Argument Calendar
                         ____________________

        TIPTON D. SHOLES,
        M.D.,
                                                    Plaintiﬀ-Appellant,
        versus
        ANESTHESIA DEPARTMENT, et al.,

                                                          Defendants,

        BOARD OF REGENTS OF THE UNIVERSITY SYSTEM OF
        GEORGIA,
        d.b.a. Augusta University,
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        2                      Opinion of the Court                  23-11291

                                                        Defendant-Appellee.

                             ____________________

                   Appeal from the United States District Court
                      for the Southern District of Georgia
                    D.C. Docket No. 1:19-cv-00022-JRH-BKE
                            ____________________

        Before WILLIAM PRYOR, Chief Judge, and WILSON and LUCK, Cir-
        cuit Judges.
        PER CURIAM:
                Tipton Sholes, M.D., a former resident anesthesiologist, ap-
        peals the summary judgment in favor of the Board of Regents of
        the University System of Georgia and its Augusta University and
        against his complaint of disability discrimination in violation of sec-
        tion 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794. The dis-
        trict court ruled that although Sholes had a disability of narcolepsy,
        he failed to establish that he was a “qualified individual” under the
        Act and that the Board did not fail to accommodate his disability
        because his request to be transferred to a different program with-
        out engaging in the application process was untimely and unrea-
        sonable. We affirm.
                                 I. BACKGROUND
              On July 1, 2016, Sholes began his residency in the Augusta
        University Anesthesiology and Perioperative Medicine
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        23-11291               Opinion of the Court                        3

        Department. The anesthesiology program ordinarily requires
        three years to complete, and the American Board of Anesthesiol-
        ogy and an accreditation council oversee various aspects of the pro-
        gram, which consists of a defined academic schedule and work in
        the operating room. If a resident fails to attend at least 80 percent
        of the educational component, he receives an “unsatisfactory” eval-
        uation in the core competency of professionalism, which is re-
        ported to the Anesthesiology Board. Residents are required to ar-
        rive at work no later than 6:30 a.m. and have their operating room
        set up and patient interviews completed by 7:00 a.m. Residents re-
        ceive evaluations from faculty, providers, and senior residents, and
        these evaluations are provided to the Clinical Competency Com-
        mittee. Every six months, the Committee evaluates each resident’s
        progress and shares its evaluation with the Anesthesiology Board.
        Any resident who receives an “unsatisfactory” report is placed on
        remediation, and two consecutive unsatisfactory reports require a
        residency extension of at least six months.
                Within Sholes’s first three weeks of residency, the director
        of the anesthesiology program, Dr. Mary Arthur, and the chief res-
        ident met with Sholes after receiving complaints from faculty and
        senior residents about him arriving to work and coming back from
        breaks late, missing lectures, being unable to be in a room by him-
        self, using his phone during a case, and failing to have his rooms
        and instruments ready before a case, which suggested he was una-
        ble to run anesthetic procedures safely at the level of his peers. On
        November 22, 2016, after Dr. Arthur continued receiving com-
        plaints about Sholes repeatedly arriving late to work and patient
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        4                      Opinion of the Court                 23-11291

        safety concerns, she met with him again and implemented a plan
        for him to complete daily time logs. When Sholes mentioned that
        he had trouble waking up and hearing his pager, she suggested that
        he reach out to his primary care physician and consider an alarm
        clock with blinking lights. After this meeting, Dr. Arthur continued
        to receive complaints about Sholes.
                After several months, the Committee issued Sholes an over-
        all clinical competency grade of unsatisfactory. His deficiencies
        were “continued tardiness,” “lack of engagement” that “impact[ed]
        his peers and faculty alike,” and “lack of situational awareness, pre-
        paredness and an unwillingness to follow directions[, which] is an
        ongoing problem.” His performance was marked unsatisfactory in
        the following areas: “Demonstrates honesty, integrity, reliability,
        and responsibility,” “Learns from experience; knows limits,” and
        “Reacts to stressful situations in an appropriate manner.” In Janu-
        ary 2017, Sholes took the Anesthesiology Knowledge Test and
        scored below 99 percent of test-takers.
                In March 2017, the Committee held an emergency meeting
        and placed Sholes on a 90-day remediation plan to address the on-
        going complaints. Under the plan, faculty members were to evalu-
        ate Sholes daily and closely supervise him in the operating room,
        and Sholes was to meet with his mentor weekly. The plan warned
        Sholes that “another serious complaint” by a department member
        or patient “shall constitute possible grounds for dismissal,” and in-
        sufficient improvement at the end of the plan would result in “for-
        mal disciplinary action,” including non-renewal of his contract.
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        23-11291               Opinion of the Court                         5

        The plan also required an evaluation of his fitness for duty, but the
        physician found no issues. After Sholes’s wife learned about the re-
        mediation plan, she scheduled additional medical evaluations.
              In April 2017, Dr. Vaughn McCall diagnosed Sholes with
        narcolepsy without cataplexy. On May 5, 2017, Sholes and his wife
        met with Dr. Arthur along with the anesthesiology department
        chairman, Dr. Steffen Meiler, and Assistant Dean of the Medical
        College, Dr. Walter Moore, about the diagnosis. After the meeting,
        Sholes was placed on a 90-day medical leave of absence to regulate
        his medications.
                On July 17, 2017, Sholes informed Dr. Meiler and Dr. Arthur
        that Dr. McCall had cleared him to return to work with no re-
        strictions effective August 1. But after Dr. Arthur contacted
        Dr. McCall with Sholes’s permission, Dr. McCall stated that he
        never cleared Sholes to return to work. Dr. McCall forwarded
        Dr. Meiler an e-mail in which Dr. McCall had asked a prominent
        sleep physician “whether a treated narcoleptic can be trusted to
        safely execute medical procedures when up all-night.” The physi-
        cian responded that he was “not sure if there is a way to fully ensure
        safety.” As a result, Dr. McCall believed that he could not clear
        Sholes to take night calls or say with a reasonable degree of cer-
        tainty whether Sholes would be able to function as an anesthesiol-
        ogist during night calls without endangering his patients. The de-
        partment held several meetings regarding Sholes’s diagnosis and
        the legal risk it posed to both Sholes and the department. Although
        the department planned to tell Sholes that his contract would not
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        6                       Opinion of the Court                  23-11291

        be renewed due to patient safety and liability concerns, the univer-
        sity’s employment equity director, Glenn Powell, and in-house
        counsel advised them to wait to discuss possible accommodations.
               On August 28, 2017, Dr. Arthur informed Sholes by e-mail
        that the program would “provide reasonable accommodations that
        will enable [him] to perform [his] essential work functions” and ad-
        vised him to meet with Powell to discuss the accommodation pro-
        cess. Sholes testified that he met with Powell but “never really
        asked for any accommodations” or filed any formal accommoda-
        tion requests but instead told Powell that his condition was “ac-
        commodated with medicine.” Powell testified that he did not recall
        Sholes requesting an accommodation. After Powell requested a list
        of essential functions of a resident anesthesiologist, Dr. Arthur
        compiled a list including daily responsibilities such as arriving at the
        hospital no later than 6:30 a.m. each day and continuous on-site
        duty and in-house call up to 24 hours.
                On September 1, 2017, Sholes returned from medical leave.
        According to the department, Sholes still was required to success-
        fully complete the remediation plan upon his return, and Sholes
        was not permitted to work certain rotations or night call. Over the
        next three months, Dr. Arthur received reports that Sholes was late
        or out sick at least 16 times, often waiting until several hours after
        his shift to notify anyone. Due to his unreliability, the department
        had a contingency plan for when Sholes was scheduled to work.
        Sholes’s evaluations after he returned stated, among other things,
        that he needed “to be more prepared and on time for his cases [and
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        23-11291               Opinion of the Court                          7

        that] he does not demonstrate readiness to progress,” was “missing
        the basic concepts of anesthesia,” and “has not shown the ability to
        think critically on his own.”
               In December 2017, Dr. McCall initially certified that Sholes
        should be able to perform the list of essential functions of a resident
        anesthesiologist, but he rescinded that assessment after receiving a
        summary evaluation report of Sholes’s performance since his re-
        turn from medical leave. The report recorded Sholes’s perfor-
        mance issues, listing the 16 dates on which he was reported late or
        called out sick in the previous three months, and included evalua-
        tions from supervising doctors. Except for evaluations by Dr. Ma-
        ria Bauer and Dr. Travis Hamilton, the evaluations reported that
        Sholes continued to be late to work, needed to improve his skills
        and knowledge, and was unreliable and uncommunicative. Several
        evaluations stated that Sholes left to take a nap and did not wake
        up on time. Even positive evaluations from Dr. Bauer noted that
        Sholes had been late before and still “needs the help and attention
        most of our [first year residents] no longer need.” Another doctor
        remarked that although other residents had some success with
        Sholes, he found Sholes sleeping in a call room for two and a half
        hours during a case, and he could not say that Sholes “is capable of
        improving enough to become a safe anesthesiologist. I hope that
        doesn’t sound too harsh, but I feel it is the truth.” The report con-
        cluded that Sholes was “[u]nable to consistently show up on time
        for lectures, grand rounds and the operating room”; “[c]annot be
        relied on to manage an [operating room] by himself (Room not set
        up and ready on a consistent basis)”; “[t]akes long breaks for naps”;
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        8                      Opinion of the Court                  23-11291

        and “[c]annot be relied on to take call.” Dr. McCall explained to
        Dr. Arthur that his initial assessment about Sholes’s capabilities
        “was lacking pertinent disclosure by Dr. Sholes of how he was per-
        forming his daily duties.” Dr. Arthur testified that if Dr. McCall had
        concluded that additional changes to Sholes’s medication could
        have caused Sholes to be timely and vigilant in caring for his pa-
        tients, she would have considered allowing more time for medica-
        tion adjustments.
               On January 24, 2018, after a meeting with Sholes and his
        mentor, Dr. Hamilton, Dr. Arthur stated in an e-mail to Powell
        that she advised Sholes that “it was in his best interest to reconsider
        a career in anesthesia” and that he had been reassigned to the pre-
        operative clinic. She also stated that Sholes “was very receptive and
        we reassured him we will be available to help him transition to a
        new career path when he makes that decision.”
                On February 1, 2018, six members of the Committee voted
        to non-renew Sholes’s contract, and one member abstained.
        Dr. Meiler agreed with the recommendation. Dr. Meiler testified
        that his decision was based on the numerous complaints and eval-
        uations about Sholes after he returned from medical leave, includ-
        ing his incomplete patient evaluations, inability to create a compre-
        hensive treatment plan, and errors made when completing pa-
        tients’ medical records. Dr. Meiler also testified that when he made
        the decision, he was unaware of any resident who had received as
        many complaints regarding his ability to practice anesthesiology.
        On February 19, 2018, Sholes was informed that the department
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        23-11291               Opinion of the Court                        9

        would not renew his contract due to his “inability to perform the
        Essential Duties required of a House Officer/Resident. Specifically
        lack of dependability and reliability caused by continued tardiness.”
               On February 27, 2018, Dr. Arthur met with Sholes and
        Dr. Hamilton. Sholes testified that he told Dr. Arthur that he
        would be eager to switch to another specialty and that “any pro-
        gram that would consider [him]” would be excellent, and he re-
        quested assistance with transferring to internal medicine. Dr. Ham-
        ilton attested that Sholes requested assistance with transferring and
        that he later wrote a letter of recommendation for Sholes. Dr. Ar-
        thur testified that although she and Sholes had “a couple of inter-
        actions” about how to facilitate a transfer, she understood that
        Sholes would continue to work in the preoperative clinic until the
        end of his contract, which would prevent a gap in training, help
        him improve his skills, and allow him to work on obtaining his let-
        ters of recommendation. Regarding a former anesthesiology resi-
        dent who had transferred into the internal medicine program,
        Dr. Arthur testified that the former resident actively pursued the
        transfer by applying and going through the interview process.
        Dr. Meiler testified that although the department could make a rec-
        ommendation and support the transfer process, it was entirely up
        to the other program whether to accept Sholes based on its own
        selection criteria. Sholes testified that when he followed up with
        Drs. Meiler, Arthur, and Moore, he was directed to apply through
        the matching process, and Dr. Moore advised him to meet with the
        student director of the internal medicine program.
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        10                     Opinion of the Court                  23-11291

                In April 2018, Dr. Arthur e-mailed the medical college office
        that Sholes failed to show up to work for two weeks. After she
        reached out to his family, Sholes explained that he thought he had
        been fired but later admitted that the letter stated that his last day
        of employment was June 30, 2018. Dr. Arthur e-mailed the office
        and stated that Sholes had returned to the preoperative clinic and
        that the “understanding is that, if he is able to do well in the next 2
        months, both Dr[.] Hamilton and I would give him a letter of rec-
        ommendation reflecting his performance in the preoperative
        clinic.” But a week later, Dr. Arthur sent another e-mail explaining
        that Sholes failed to show up to work two additional days, no one
        could reach him by phone, and he told her that he had retained
        counsel. Regarding the transfer, Dr. Arthur believed that Sholes
        had “dropped the ball” on starting another program based on the
        “inconsistencies from [him] in showing up in the pre-op clinic” and
        him failing to reach out to another program director after she en-
        couraged him to gather his application materials.
               Sholes filed a complaint against the Board, which moved for
        summary judgment. The Board argued that the undisputed facts
        established that Sholes could not perform the essential functions of
        the job and posed a risk to patient safety. The Board argued that it
        did not fail to accommodate Sholes’s disability because the alleged
        transfer request was untimely and unreasonable. Sholes opposed
        the Board’s motion and relied on declarations from Dr. Hamilton
        and Dr. Bauer about his ability to perform the job.
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        23-11291               Opinion of the Court                         11

                The district court granted the Board summary judgment.
        The district court ruled that Sholes could not establish that he was
        an otherwise qualified individual because he could not perform the
        essential functions of the job consistently and dependably. The dis-
        trict court ruled that Sholes could not establish that the only reason
        for the adverse action was his diagnosis because of the pattern of
        negative performance evaluations and reports of patient safety con-
        cerns that occurred before and after his diagnosis. The district court
        also ruled that Sholes could not prove that the Board failed to rea-
        sonably accommodate his disability because regardless of whether
        his transfer request was sufficiently specific, he conceded that he
        did not ask to be transferred until his contract was not renewed,
        and there was no evidence that the department could “automati-
        cally” transfer Sholes without effort on his part.
                           II. STANDARD OF REVIEW
                We review the grant of summary judgment de novo, drawing
        all factual inferences in the light most favorable to the nonmoving
        party. Johnson v. Bd. of Regents of Univ. of Ga., 263 F.3d 1234, 1242–
        43 (11th Cir. 2001). Summary judgment is appropriate when “there
        is no genuine dispute as to any material fact and the movant is en-
        titled to judgment as a matter of law.” Fed. R. Civ. P. 56(a).
                                 III. DISCUSSION
               The Rehabilitation Act prohibits discrimination on the basis
        of disability by recipients of federal financial assistance. 29 U.S.C.
        § 724; see Garrett v. Univ. of Ala. at Birmingham Bd. of Trs., 507 F.3d
        1306, 1310 (11th Cir. 2007). Because of its textual similarities with
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        12                     Opinion of the Court                  23-11291

        Title II of the Americans with Disabilities Act, “the same standards
        govern claims under both, and we rely on cases construing Title II
        and section 504 interchangeably.” Ingram v. Kubik, 30 F.4th 1241,
        1256 (11th Cir. 2022) (alteration adopted).
                To succeed on his claim, Sholes had to establish “(1) that he
        is a qualified individual with a disability; (2) that he was either ex-
        cluded from participation in or denied the benefits of a public en-
        tity’s services, programs, or activities, or was otherwise discrimi-
        nated against by the public entity; and (3) that the exclusion, denial
        of benefit, or discrimination was by reason of his disability.” Id. at
        1256–57 (alteration adopted). To be “otherwise qualified,” Sholes
        must “show either that he can perform the essential functions of
        his job without accommodation, or, failing that, show that he can
        perform the essential functions of his job with a reasonable accom-
        modation.” Davis v. Fla. Power & Light Co., 205 F.3d 1301, 1305 (11th
        Cir. 2000). “‘Essential functions’ are the fundamental job duties of
        a position that an individual with a disability is actually required to
        perform.” Earl v. Mervyns, Inc., 207 F.3d 1361, 1365 (11th Cir. 2000).
        “[C]onsideration shall be given to the employer’s judgment as to
        what functions of a job are essential . . . .” 42 U.S.C. § 12111(8);
        Holly v. Clairson Indus., L.L.C., 492 F.3d 1247, 1257 (11th Cir. 2007).
               The district court did not err in ruling that Sholes failed to
        establish that he was “otherwise qualified.” The evidence estab-
        lished that Sholes could not perform the essential functions of a
        resident anesthesiologist. After returning from medical leave and
        receiving several warnings about the importance of being on time
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        23-11291              Opinion of the Court                      13

        to procedures and lectures, supervising doctors documented that
        he was late or a no-show, often without any advance notice or ar-
        ranging for coverage, 16 times in less than three months. Supervis-
        ing doctors documented their frustrations and “disappoint[ment]”
        with Sholes for frequently showing up late, taking unauthorized
        breaks, and sleeping for several hours during the day when the su-
        pervising physician was counting on him to work on his case. Su-
        pervising doctors recorded their concerns about patient safety and
        whether Sholes could be trusted. And other supervising doctors,
        including the chief resident, reported that they would not be able
        to rely on him and “will always need a backup plan” when Sholes
        was on the schedule.
               Sholes contends that other residents had performance issues
        too, but Dr. Meiler testified—and Sholes does not dispute—that he
        received more complaints than any other resident. Sholes asserts
        that he was unfairly scrutinized. But his remediation plan, which
        was implemented before his diagnosis and lasted 90 days, specifi-
        cally required faculty members to complete daily evaluations and
        to closely supervise him both to ensure patient safety and to allow
        the Committee to determine whether to non-renew his contract
        based on his performance, not his diagnosis.
               Sholes also argues that the declarations by Dr. Bauer and
        Dr. Hamilton establish a genuine issue whether Sholes was quali-
        fied. But both doctors conceded that Sholes had issues with tardi-
        ness, and Sholes does not dispute that timeliness is an essential
        function of the job of a resident anesthesiologist. Moreover,
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        14                      Opinion of the Court                   23-11291

        Dr. Hamilton did not state that Sholes was qualified to be an anes-
        thesiologist but instead that he believed Sholes was qualified to be
        a “resident in internal medicine” because that specialty would “be
        a better fit for him given the restrictions placed on him due to his
        narcolepsy.” And although Dr. Bauer stated that Sholes was as
        qualified as any other resident anesthesiologist and that, despite not
        being his treating physician, she “believe[d] he could have per-
        formed better with accommodations,” her declaration fails to pro-
        vide any evidence based on personal knowledge that Sholes could
        have performed his job duties. In the light of the evidence of
        Sholes’s serious performance deficiencies that were recorded by
        over a dozen doctors and began during his first month of residency,
        more than nine months before his diagnosis, these two declarations
        fail to create a genuine dispute about whether Sholes could per-
        form the essential functions of the job.
                Insofar as Sholes argues that the discussions held during his
        medical leave about the potential legal risks of his diagnosis consti-
        tute direct evidence that he was unlawfully discriminated against,
        we disagree. To establish that he was discriminated against in vio-
        lation of the Rehabilitation Act, he must prove that the discrimina-
        tion occurred “solely by reason of [] his disability.” 29 U.S.C.
        § 794(a); see Ellis v. England, 432 F.3d 1321, 1326 (11th Cir. 2005) (“It
        is not enough for a plaintiff to demonstrate that an adverse employ-
        ment action was based partly on his disability.” (emphasis added)).
        Sholes was warned in March 2017, before he was diagnosed, that
        “another serious complaint” by a department member or patient
        “shall constitute possible grounds for dismissal” and that
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        23-11291               Opinion of the Court                       15

        insufficient improvement at the end of the remediation period
        would result in formal disciplinary action, including non-renewal
        of his contract. After more than three months of leave to regulate
        his medications and after he insisted that he was ready to return to
        work without any accommodation besides medication, his perfor-
        mance issues did not abate. The evidence establishes that the deci-
        sion to not renew Sholes’s contract was not based solely on his di-
        agnosis.
               Next, Sholes argues that the Board failed to accommodate
        him by facilitating his transfer into another specialty. He argues
        that the district court erred in ruling that his request was untimely
        because he remained in the program for several months after the
        decision was made, and he insists that he did everything he was
        required to do to obligate the Board to transfer him.
               We disagree. “An employer unlawfully discriminates against
        a qualified individual with a disability when the employer fails to
        provide ‘reasonable accommodations’ for the disability—unless
        doing so would impose undue hardship on the employer.” Lucas v.
        W.W. Grainger, Inc., 257 F.3d 1249, 1255 (11th Cir. 2001). But the
        “burden of identifying an accommodation that would allow a qual-
        ified employee to perform the essential functions of h[is] job rests
        with that employee, as does the ultimate burden of persuasion with
        respect to showing that such accommodation is reasonable.” Earl,
        207 F.3d at 1367.
               The district court correctly ruled that the department did
        not fail to accommodate Sholes with a transfer. The undisputed
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        16                     Opinion of the Court                 23-11291

        evidence establishes that although Dr. Arthur offered him support
        with the transfer process, neither she nor anyone else promised
        him that the department would or could obtain a transfer for him.
        Moreover, Sholes failed to present any evidence from which a rea-
        sonable jury could find that it was feasible for the department to
        unilaterally transfer him with only a phone call and without him
        submitting the necessary application materials, interviewing, and
        being accepted based on the requirements of the other program.
        See id. Sholes failed to identify any instance in which the depart-
        ment transferred a resident to a different specialty without that res-
        ident taking responsibility for compiling his application materials
        and meeting the selection criteria of the other program. Although
        Sholes argues that the district court failed to consider other poten-
        tial accommodations, such as additional leave to adjust his medica-
        tions or daytime naps, these requests either were not made or were
        unreasonable. Dr. Arthur testified that she would have considered
        additional leave for medication adjustments if Dr. McCall believed
        it would make a difference, but neither he nor Sholes requested
        more leave. And even if Sholes specifically requested an accommo-
        dation for daytime naps, Dr. Arthur testified that naps would not
        have been possible to accommodate because of Sholes’s well-doc-
        umented “inability to [] wake up when he took a nap” and to be
        alert when things “change on a dime.”
                                IV. CONCLUSION
               We AFFIRM the summary judgment in favor of the Board.