Court Opinion

ID: 9368223
Source: CourtListenerOpinion
Date Created: 2023-02-03 15:05:19.641576+00
Date Added: 2024-06-11T17:16:06.190347
License: Public Domain

RENDERED: JANUARY 27, 2023; 10:00 A.M.
                         NOT TO BE PUBLISHED

                  Commonwealth of Kentucky
                             Court of Appeals

                                NO. 2020-CA-1539-MR

STEPHANIE HUTCHISON, M.D.                                                   APPELLANT

                     APPEAL FROM BOYD CIRCUIT COURT
v.                   HONORABLE GEORGE DAVIS, JUDGE
                          ACTION NO. 16-CI-00377

KING’S DAUGHTERS MEDICAL
SPECIALISTS, INC.                                                             APPELLEE

                            OPINION
      AFFIRMING IN PART, REVERSING IN PART, AND REMANDING

                                     ** ** ** ** **

BEFORE: ACREE, DIXON, AND K. THOMPSON,1 JUDGES.

THOMPSON, K., JUDGE: Stephanie Hutchison, M.D., appeals from the

summary judgment granted in favor of King’s Daughters Medical Specialists, Inc.

(KDMS) on a breach of contract action which also dismissed her claims of

1
 Judge Kelly Thompson authored this Opinion before his tenure with the Kentucky Court of
Appeals expired on December 31, 2022. Release of this Opinion was delayed by administrative
handling.
discrimination, retaliation, fraud, and intentional infliction of emotional distress

(IIED). Dr. Hutchison was not able to establish that any factual issues remain on

her counterclaims except as to breach of contract regarding whether KDMS’s

actions improperly shut down her practice during the contractually obligated

ninety-day notice period between when she was informed of the decision to

terminate her employment and when the termination took effect. Therefore, we

affirm the dismissal of Dr. Hutchison’s other claims, but reverse the grant of

summary judgment in KDMS’s favor on the breach of contract claim and remand

as factual issues remain on the narrow issue of whether KDMS thereby violated the

contract and damaged Dr. Hutchison.

                   FACTUAL AND LEGAL BACKGROUND

             Dr. Hutchison is an obstetrician/gynecologist (OB/GYN) who worked

for KDMS for approximately twenty-one months, from September 19, 2011, until

June 7, 2013. Previous to this employment, Dr. Hutchison worked with Dr. Kelsey

James from July 2010 until August 2011. Dr. James was not an employee of

KDMS. During this time, Dr. Hutchison obtained privileges at King’s Daughters

Medical Center (KDMC) and performed surgeries there.

                                          -2-
   I.     The Agreement

             On September 19, 2011, Dr. Hutchison entered into a Physician

Employment Agreement (the Agreement) with KDMS. Dr. Hutchison continued

to have a Wednesday block surgery schedule in operating room 8 (OR 8).

             The Agreement specified in relevant part that KDMS is a controlled

subordinate organization of KDMC (also referred to as the hospital). Dr.

Hutchison agreed to work as a full time OB/GYN for KDMS, which made her the

only OB/GYN employed by KDMS at this time. Dr. Hutchison specifically agreed

to provide “professional Obstetrics and Gynecology Services and related services

to the patients of KDMS” and “on call services and call coverage for the practice

and the Hospital[.]” She also agreed that she “shall not during the Term seek

medical staff privileges at any other hospital without KDMS’ prior written consent,

which may be granted or withheld in KDMS’ sole discretion.”

             KDMS’s duties to Dr. Hutchison included that “KDMS will provide

appropriate space, staffing, equipment, supplies, furnishings and other resources

(“Resources”) at levels necessary, in KDMS’ reasonable discretion, to operate an

Obstetrics/Gynecology practice.” KDMS was also required to provide Dr.

Hutchison with a salary as set out in Exhibit A, to “use its best efforts to market

Physician’s medical practice,” and to “bill and collect all fees for Physician’s

services provided under this Agreement” with “Physician agree[ing] to work with

                                         -3-
KDMS’ staff to bill all patients and/or third parties promptly for services rendered

and to use her best efforts to help KDMS to collect all patient accounts.” The

Agreement provided that “KDMS, or a third party acting on KDMS’ behalf, shall

bill and collect all charges or fees for Physician’s services provided under this

agreement and such charges or fees shall be the sole and exclusive property of

KDMS.” KDMS was responsible to “use its best efforts to provide

Obstetrics/Gynecology coding education for its billing staff and Physician’s office

staff (as requested), within thirty (30) days of the execution of this agreement.”

             As to the effective term of the Agreement, it provided that “[u]nless

otherwise terminated as provided herein, this Agreement shall be for a term of

three (3) years commencing on September 19, 2011 and terminating on September

18, 2014 (the “Term”).” The Agreement provided three ways that it could be

terminated early: (1) termination by KDMS for cause; (2) termination by Dr.

Hutchison for cause; and (3) termination without cause by either party. As to this

third option, other than a heading it only specifies: “Either party may terminate

this Agreement without cause, upon ninety (90) days notice to the other party.”

             Exhibit A regarding compensation calculated Dr. Hutchison’s total

annual compensation as follows:

             Total compensation shall mean:

             [1]    Physician’s Professional Fees collected during the
                    applicable measurement period,

                                         -4-
               minus

               [2] Physician’s Direct Expenses[2] paid during the
               applicable measurement period,

               minus

               [3] Physician’s Allocable Share of all General
               Expenses[3] paid during the applicable measurement
               period.

               Exhibit A explained that during the first year of the Agreement (the

twelve month period following the start date of the contract) Dr. Hutchison would

be paid a bi-weekly draw equal to $5,128.49.4 Amounts for future draws were

subject to further adjustment, but it was provided that “the amount of the Bi-

Weekly draw may be reduced upon request by Physician from time to time, and

may be increased upon request by Physician from time to time if such increase is

supported by collections of Physician’s Professional Fees.” Further adjustments

2
  “Direct expenses” were defined as “those direct expenses of the Practice that are paid during
the applicable measurement period and allocable to a physician in the Practice (including
Physician)[.]” They included things like malpractice insurance, licensure fees, salaries and
benefits of any employed nurse directly supporting that physician, and other expenses “within
the four walls” of the Practice site directly allocable to that physician.

3
  “General expenses” were defined as meaning “all expenses of the Practice allocable to the
Practice paid during the applicable measurement period . . . that do not constitute Direct
Expenses that are allocable to any physician in the Practice (including Physician)” and included
things such as “salaries and benefits of any support staff” that did not constitute direct expenses,
office supplies, occupancy expenses, general utilities, medical supplies, and payroll taxes.
4
  This draw was contingent upon a second practitioner sharing space with Dr. Hutchison and if
that did not occur “the Bi-Weekly Draw amount is subject to immediate adjustment by KDMS.”
However, although another practitioner never shared her space, Dr. Hutchison’s initial draw was
never reduced.

                                                -5-
were to be made depending upon actual revenues and actual payouts would be

made to Dr. Hutchison if her revenues exceeded her draws or her draws would be

decreased if revenues were too low.5

               Exhibit A further stated that if Dr. Hutchison’s employment

terminated for any reason how compensation would be paid out and what would

occur if she owed KDMS for draws after the end of the quarter in the year in which

employment terminated, providing:

               If Physician’s compensation for such quarter . . . is less
               than the sum of the amounts already paid to Physician for
               such quarter . . . then Physician shall repay such
               difference to KDMS within ten days after KDMS notifies
               Physician in writing of its determination of the amount to
               be repaid by Physician to KDMS[.]

5
  Draw amounts were to be adjusted within forty-five days after the end of each quarter to
provide a quarterly settlement based on estimates of the actual revenues that would be collected
for professional services each quarter based on billings multiplied by a collection rate of 50%
and the physician’s share of actual expenses. If this amount was in excess of the bi-weekly
draws, the physician would receive the excess, with additional adjustment 120 days after the end
of the first year based on “actual revenues collected during the First Year and within three
months thereafter from services performed during the first year as well as expenses paid during
the First Year.”

Then after the first year, at the end of each quarter, compensation was to be “calculated based on
the actual revenues collected and expenses paid during such quarter, and not on revenues
collected or expenses paid before or after such quarter.” It was specified that KDMS would pay
out compensation exceeding the draws within thirty days after each quarter, and “to the extent
Physician’s Quarterly Compensation for the quarter is less than the sum of the Bi-Weekly Draws
paid to Physician for such quarter, then the difference will be deducted from the calculation of
Physician’s Quarterly Compensation for the next quarter and each quarter thereafter until the full
amount of such difference has been repaid by Physician to KDMS.” KDMS had the option to,
after two quarters of this, reduce the physician’s biweekly draw to avoid future repetition of this
problem.

                                                -6-
   II.    Staffing Issues

             Dr. Hutchison was unhappy with the staff she was given to run her

practice and wanted to share space and work with an OB/GYN nurse practitioner.

Dr. Hutchison testified in her deposition that her staff’s prior experience was

extremely limited, and she did not believe her staff had appropriate training to

work in OB/GYN or to bill for her services, and the thirty days of training

specified in the Agreement were never provided. She alleged she was forced to

pay salaries for incompetent staff who were not permanent staff, with staff not

filling out patient consent forms required to be completed thirty days before

surgery for preauthorization to collect from Medicaid patients, and then having the

forms filled out incorrectly and having to be done a second time. She reported that

KDMS staff told her that the preauthorizations were not done and that billings

were not being made for ultrasounds and other in-office services. She further

testified that her licensed practical nurse (LPN), who did not have training in

obstetrics and gynecology, was emailing her rather than contacting her directly

about “pregnant patients being seen at urgent care with blood pressures 140s over

90s, which could have been a stroke.”

   III.   The Robots

             While working with Dr. James in 2010-2011, Dr. Hutchison used

KDMC’s one da Vinci S Robot (S Robot) to perform robotic surgeries. The S

                                         -7-
Robot was located in KDMC’s OR 8, and Dr. Hutchison had a Wednesday block

surgery schedule in OR 8. She, thus, had unlimited access to the S Robot for her

surgery schedule.

             In March 2012, KDMC purchased a second robot, the da Vinci Si

Robot (Si Robot). The Si Robot was a newer model which included advanced

features. KDMC purchased the Si Robot with federal funds for cancer surgeries

for single incision procedures. KMDC promoted that Dr. Eric Smith, a general

surgeon, could perform single incision laparoscopic surgeries with the Si Robot,

and that the OB/GYNs with privileges at KDMC could also perform minimally

invasive surgeries using it.

             The S Robot was moved to operating room seven (OR 7) and Dr.

Hutchison’s Wednesday block schedule was moved to OR 7. The Si Robot was

placed in OR 8 and was available to all physicians but was not subject to being

reserved through block scheduling. Instead, all the physicians were supposed to be

given access to the Si Robot on their assigned surgery days based on the need and

complexity of each procedure. Dr. Smith had Monday and Wednesday surgery

days, Dr. Hutchison had Wednesday surgery days, and other OB/GYNs had

                                        -8-
Tuesday and Thursday surgical days. According to Dr. Hutchison, there was a lot

more demand for the Si Robot, because it was a superior machine.6

              When there were competing requests for access to the Si Robot,

KDMC’s robotic team lead, Chrystal Lemaster, decided which procedure took

priority based on the complexity and expected duration of the procedure. When a

physician could not have access to the Si Robot, the S Robot continued to be

available for their use in OR 7. Dr. Hutchison began complaining that Dr. Smith

was performing some of his surgeries on Wednesdays which interfered with her

access to the Si Robot on Wednesdays.

              Dr. Hutchison testified she was unhappy with the amount of surgery

time she was getting in general and with the Si Robot in particular. She believed

“the Boys” a group of male OB/GYN physicians with privileges at KDMC, did not

want her competing with them for patients and conspired to deprive her of surgical

6
  Dr. Hutchison testified that she could perform certain surgeries better with the Si Robot and
was on the cutting edge when it came to performing deep endometriosis resections which
restored fertility. She explained that while the S Robot showed images in 2D, the Si Robot
showed 3D high definition images, allowing her to remove more endometriosis rather than just
what was visualized on the surface. She explained that the S Robot did not offer much of an
advantage over a regular laparoscopic surgery (with someone else operating a camera) as she
could not see any better with it, but it did allow her to always have the camera where she wanted
it, and the S Robot caused less pain to patients because the robotic instruments could move more
ways. Dr. Hutchison noted that she was one of three physicians that used the S Robot, with the
other two also being OB/GYNs (Dr. James and Dr. Brian Frederick), while other physicians, like
Dr. Smith, did not bother to use the S Robot for laparoscopic surgeries. However, the other
physicians saw the advantages offered by the Si Robot and used it. She explained that when only
the S Robot was available, she was performing 75% of all robotic surgeries.

                                              -9-
time and KDMC staff assisted them with this goal.7 Dr. Hutchison claimed that as

a result of having less surgical time, she was running three months behind in her

surgical schedule, which resulted in her losing patients to other physicians.

               During the rest of 2012, Dr. Hutchison continued to complain about

her access to the Si Robot. In text messages sent in November 2012, she

7
  Dr. Hutchison specifically testified that the OR schedules submitted as exhibits were inaccurate
and that the other surgeons ended up getting two ORs at once, so they could flip back and forth
between surgeries and perform more surgeries, with male surgeons getting more operating rooms
than female surgeons, with the schedule continually being changed. Dr. Hutchison testified that
initially she was supposed to get the Si Robot on all Wednesdays, then she was supposed to get it
on alternating Wednesdays with Dr. Smith, but then her reserved days were taken away. She
stated that if surgeries were not scheduled at least three days in advance, reserved days could be
taken away but said that this rule did not apply when Dr. Smith scheduled surgeries at the last
minute, with her having to give way instead, and that the male surgeons were given preference
over the female surgeons, with the female surgeons getting their surgeries bumped (not just Si
Robot surgeries) while the male surgeons did not. She also complained that she lost access to
outpatient surgery and was not given the NovaSure and other equipment needed because male
surgeons got preference. While Dr. Hutchison acknowledged performing surgeries on the Si
Robot in late 2012, she was not sure if she performed any surgeries with it in 2013. “It was a
concerted effort. They took all my surgery away.” She testified to asking to have her block time
moved to a different day than those assigned to Dr. Smith or Dr. Frederick because those were
the surgeons who got her time, but that her request was refused. She testified she believed Dr.
Smith was receiving preferential treatment from Lemaster regarding scheduling beginning in
September 2012, due to them having an affair, and that he was actually purposefully scheduling
single-port surgeries for which he wanted the Si Robot for Wednesdays rather than Mondays.
She also testified that the three other male gynecologists were making up false accusations
against her, with Dr. Ford calling Dr. Fioret and telling him she had abandoned a patient, which
was untrue, and Dr. Fioret told her “the boys want you gone,” referring to Dr. Frederick, Dr.
Ford, and Dr. Dotson (who shared office space together). She explained that she was told by Dr.
James before she started with him that they did not want a “white homegirl” practicing there
because they did not want the competition and would not even say “hi” to her the first four
months she was there. She stated that Dr. James and Dr. Fioret referred to them as “the boys”
and they were referred to by others that way when discussions were made regarding covering
vacations and on-call. Dr. Hutchison stated she discussed with other female doctors how they
were all subject to sexual discrimination, with Dr. Katrina Briggs agreeing that the OR schedules
were not fair, and Dr. Navita Modi complaining about her time with the Si Robot being limited
because Dr. Boykin apparently told Dr. Modi “it was a man’s world.”

                                              -10-
complained that Lemaster and Dr. Smith were conspiring to limit her access to the

Si Robot on her scheduled days and that robotic team members assigned for her

robotic-assisted surgeries were less experienced. Dr. Hutchison explained in her

deposition that this was an ongoing issue and not having more experienced team

members in each robot room was problematic as they could not troubleshoot the

robots, which led to delays mid-surgery which was dangerous for patients, and that

she simply wanted equally experienced team members divided up between the ORs

equipped with robotics.

            Because Dr. Hutchison was not satisfied with the amount of time she

was getting with the Si Robot at KDMC, in late 2012 she began pursuing obtaining

privileges at Our Lady of Bellefonte Hospital (OLBH) and began performing

surgeries there in January 2013. Although it was a breach of her contract for Dr.

Hutchison to obtain privileges at another hospital without getting KDMS’s prior

permission and it appears that Dr. Hutchison did not ask before pursuing privileges

there, Dr. Hutchison and Sara Marks (KDMS’s Executive Director of Integrated

Services at the time Dr. Hutchison worked for KDMS) both stated in their

depositions that KDMS did not object to Dr. Hutchison obtaining privileges at

                                       -11-
OLBH or performing robotic-assisted surgeries there on OLBH’s Si Robot as

KDMS was still receiving Dr. Hutchison’s surgical fees.8

              On January 8, 2013, Dr. Hutchison complained in a text message that

all of her surgeries scheduled for the next day, a Wednesday, had been moved to

the S Robot so that Dr. Smith could have the Si Robot. However, surgery records

demonstrate that Dr. Hutchison performed four procedures in operating OR 8 with

the Si Robot on that day.

              Dr. Hutchison testified she believed she was being retaliated against

when she made complaints about patient safety with her staff being untrained and

there being insufficient experienced robot staff during surgeries as her access to the

Si Robot was further limited as 2012 went on. However, according to the affidavit

of Deanna Milum (KDMC’s Director of Surgical Services who oversaw the

scheduling of physicians in KDMC’s operating rooms), which summarized

surgical records, Dr. Hutchison continued to have more Si Robot surgeries than

any other OB/GYNs through the end of 2012, and only general surgeon Dr. Smith

had more Si Robot surgeries than she did overall.9

8
  Dr. Hutchison testified she continued to perform limited Si Robot surgeries at OLBH through
the end of her contractual period with KDMS, with KDMS continuing to receive this income.
9
 Neither party discusses or documents how many surgeries Dr. Hutchison performed with the Si
Robot at KDMC after January 9, 2013; this may be due in part to the fact that by this time Dr.
Hutchison was conducting many such surgeries at OLBH.

                                             -12-
     IV.   Pay and Profitability

               Pursuant to the Agreement with KDMS, Dr. Hutchison was originally

paid a bi-weekly draw of $5,128.49 ($11,111.66 per month). However, given her

initial profitability, and an excess payout of $68,610, Dr. Hutchison requested and

was granted a draw totaling $25,000 a month beginning in May 2012.

               After Dr. Hutchison’s draws were increased, she began to have

negative balances. As of June 30, 2012, the end of her third quarter, her total

compensation had fallen below her draws by $2,723.

               Despite having agreed to perform OB/GYN services and be on call, in

May 2012, Dr. Hutchison texted her manager, Lydia Horn, that she had decided to

stop seeing obstetrics patients. On July 3, 2012, she sent a letter to KDMC’s

medical executive committee asking to relinquish her call privileges for her OB

practice. The committee granted her request effective August 1, 2012. After that

time, she no longer saw obstetrics patients or provided call coverage for them.10

While this was a breach of her contract with KDMS, it apparently accepted her

decision and did not move to terminate the contract.

10
   Dr. Hutchison testified she stopped taking OB patients or providing call coverage for them as
none of the other OB/GYNs provided any call coverage for her and she could not keep working
eighty-hour weeks in which she had both office time and on-call time because it caused her
health problems. Dr. Hutchison testified she wanted to work with a nurse practitioner but
KDMS would not hire her, and she could have shared on-call coverage with her. Dr. Hutchison
stated that after leaving KDMS she has practiced as an OB/GYN as she has been given
appropriate call coverage.

                                              -13-
                 By the end of September 2012, Dr. Hutchison’s total compensation

for the quarter was $32,845 less than her draws that KDMS had paid her. Dr.

Hutchison continued to be “underwater” from October 2012 through April 2013,

accumulating a balance due KDMS of $122,788 for those months. Between

October 2011 and April 2013, she accumulated $198,069.30 in overpayments.

However, KDMS failed to reduce her draws until March 2013, and did not collect

for these losses out of her salary.11

                 Also in late 2012, Marks received complaints about Dr. Hutchison’s

unprofessional behavior from KDMC staff.12 However, during this timeframe Dr.

Hutchison also received a patient satisfaction award.

      V.     Termination

                 On March 7, 2013, Marks sent Dr. Hutchison a letter on behalf of

KDMS in which it exercised the option to terminate Dr. Hutchison’s employment

early. In the letter, Marks explained KDMS’s decision as follows:

11
     No data about or claims regarding overpayments were made from the period after April 2013.
12
   In her deposition, Dr. Hutchison admitted to using some inappropriate language in conjunction
with having a robot malfunction (cussing) and having insufficiently trained robot staff to
troubleshoot, resulting in her going to the other OR and having to pull Lemaster in to try to
correct the problem. Dr. Hutchison testified she was frustrated because Lemaster had previously
changed her operating room and time and not supplied her with an adequate team, when Dr.
Hutchison should have been allowed to use the original OR because the other doctor scheduled
for it had not confirmed surgeries for that day three days in advance as required. However, Dr.
Hutchison stated that Lemaster also acted unprofessionally and then made a complaint about her,
when Dr. Hutchison argued she could have appropriately reported Lemaster because she was
“very disrespectful and unprofessional.”

                                               -14-
             As you know, King’s Daughters Medical Specialties
             (KDMS) entered into an employment agreement with
             you on September 19, 2011 to provide
             obstetrics/gynecology services to KDMC and KDMS
             patients. Since that time, KDMS has worked with you to
             develop a successful obstetric/gynecology practice.
             However, a year and a half into the agreement it is clear
             that neither [of the] parties are satisfied with the current
             situation. As such, KDMS believes it is best if we part
             ways at this time. Please let this letter serve as KDMS’
             90 day notice of termination of this agreement “Without”
             cause in accordance with Section VII (D) of the above
             reference[d] employment agreement.

             According to Marks’s deposition testimony, KDMS was unhappy

with the relationship because of Dr. Hutchison’s declining financial performance,

complaints received about her behavior in the OR, Hutchison’s apparent

dissatisfaction with her operating room assignments and access to the Si Robot,

and concerns about some of her cases.

             Dr. Hutchison testified in her deposition that she believed her practice

was shut down in retaliation for her complaining about sexual discrimination in

being allowed to access the Si Robot, her surgeries being limited, and making

complaints regarding patient safety relating to robot staffing, when she had a very

successful practice of 3,000 to 4,000 patients. She also testified she believed her

employment was terminated because she obtained privileges at OLBH.

             Dr. Hutchison testified that the termination letter was essentially a

closure notice because after she received the termination letter, she was unable to

                                         -15-
continue her practice as she normally would have, with her practice essentially

being shut down at the beginning of the three-month period just after she received

her termination notice.13 She also believed that KDMS acted to prevent her from

obtaining new employment with OLBH after June 2013, as retaliation.

     VI.   Complaint and Counterclaims

               In May 2016, after having contacted Dr. Hutchison’s counsel about its

demand for repayment and not receiving repayment, KDMS filed its complaint

against Dr. Hutchison for breach of contract and unjust enrichment. It sought to

recover $198,069.30 against Dr. Hutchison based on its advancement of payments

to her that she did not earn and failed to repay, along with pre-judgment and post-

judgment interest.

               Dr. Hutchison answered and filed counterclaims against KDMS,

seeking to be excused from having to repay the money owed. She argued she was

wrongfully terminated from her employment “with discriminatory and retaliatory

13
   Dr. Hutchison testified that in “April 2013, the first of April, they cancelled all my surgeries
that had been scheduled out to June. I had discovered that April 3 or April 5 that all of my
surgeries were being cancelled without my knowledge.” She also testified that after her clinic
was closed she was told she would be able to assist in contacting her cancer patients and other
patients to ensure they had follow-ups, but was not allowed to do this and staff was giving out
prescriptions in her name after the clinic was closed, specifically for eight patients “using my
name on April the 18th [2013]” and wanting medication sample packages back so they could
give them out even though “[t]here was no one in that office medically able to give out
medications[.]” She also indicated that during this time period she could not follow up on high
risk patients and “was locked out of computers.” She was unhappy that her patients were sent
letters that she had closed her clinic during this time period, when it had not been her choice.

                                                -16-
intent and illegal, non-legitimate reasons.” Dr. Hutchison argued that KDMS

breached the contract by: failing to provide competent billing staff and coding

education for billing staff who engaged in improper billing practices, with KDMS

failing to timely submit charges for reimbursement, and failing to make adequate

space, equipment, supplies, and staffing available to her. She also alleged she was

subject to systematic discrimination as compared to similarly situated male

employees. She alleged KDMS took away and rearranged her operating time with

patients because of her gender and in retaliation for various legally protected

actions and comments; switched her surgeries “so that a lessor-trained [sic] or

experienced male counterpart would replace her in the operating room”; her male

colleagues received preferential treatment regarding scheduling and opportunities

to grow their practices; she received disparate treatment as compared to similarly

situated male counterparts regarding her employment including on multiple

occasions cancelling her scheduled surgeries without any valid reason; she was

denied access to the Si Robot; and was told “the boys want you gone.” She also

argued that in January 2013, without any reason or explanation her income was cut

in half and she was asked by Marks why she had not quit yet. Dr. Hutchison also

argued that when her termination letter was issued on March 7, 2013, she was

locked out of her office and the hospital computer system, which denied her access

to patient medical records, prevented her from being able to continue caring for

                                        -17-
patients until June 7, 2013 (when her termination became effective), and she was

unable to follow up with patients who had serious conditions.

             Dr. Hutchison’s specific counts on her counterclaim were that KDMS:

(1) breached its contract with her; (2) violated the Kentucky Health Care

Whistleblower Statute, Kentucky Revised Statutes (KRS) 216B.165; (3)

committed gender discrimination against her, KRS 344.040; (4) wrongfully

terminated her based on gender discrimination; (5) retaliated against her; (6)

retaliated against her by terminating her; (7) committed fraud against her by

engaging in irregular billing practices by allowing Dr. James to bill for her services

as his own; and (8) committed IIED. Dr. Hutchison sought compensatory

damages, back pay and front pay, punitive damages, attorney fees, pre- and post-

judgment interest, and taxable costs.

             The parties engaged in extensive discovery, which included taking the

depositions of Dr. Hutchison and Marks and the submission of numerous

accompanying exhibits.

             In April 2020, KDMS filed a motion for summary judgment on all

claims. Dr. Hutchison requested more time to complete discovery, which the

circuit court denied. In July 2020, Dr. Hutchison then filed her own motion for

partial summary judgment, seeking judgment in her favor on KDMS’s breach of

contract and unjust enrichment claims and her counterclaims. On November 4,

                                        -18-
2020, the circuit court granted KDMS’s motion for summary judgment and denied

Dr. Hutchison’s motion for partial summary judgment.

                                       APPEAL

             Pursuant to the Kentucky Rules of Civil Procedure (CR) 56.03,

summary judgment shall be rendered “if the pleadings, depositions, answers to

interrogatories, stipulations, and admissions on file, together with the affidavits, if

any, show that there is no genuine issue as to any material fact and that the moving

party is entitled to a judgment as a matter of law.”

             “The standard of review on appeal of a summary judgment is whether

the trial court correctly found that there were no genuine issues as to any material

fact and that the moving party was entitled to judgment as a matter of law.” Scifres

v. Kraft, 916 S.W.2d 779, 781 (Ky. App. 1996). Summary judgment “should only

be used ‘to terminate litigation when, as a matter of law, it appears that it would be

impossible for the respondent to produce evidence at the trial warranting a

judgment in his favor and against the movant.’” Steelvest, Inc. v. Scansteel Service

Center, Inc., 807 S.W.2d 476, 483 (Ky. 1991) (quoting Paintsville Hospital Co. v.

Rose, 683 S.W.2d 255, 256 (Ky. 1985)).

   I.     Breach of Contract

             KDMS and Dr. Hutchison each argued that the other party breached

the terms of the Agreement. KDMS argued that Dr. Hutchison breached the

                                          -19-
Agreement by failing to pay it back money it advanced to her through draws that

she had not earned, while Dr. Hutchison sought to avoid having to repay these

funds, claiming that KDMS breached the Agreement first by depriving her of

adequate staff, adequate billing, adequate access to the Si Robot, and cutting off

her access to the computer system and patients immediately after giving her notice

of termination.

             In its factual findings, the circuit court found that under the terms of

the Agreement Dr. Hutchison was required to pay KDMS back if her draws

exceeded her total compensation; her increased draws continued to exceed her total

compensation; KDMS exercised its option to terminate the employment

relationship without cause; and when the employment relationship ended, Dr.

Hutchison’s account with KDMS exceeded her actual total compensation by

$198,069.30. The circuit court specifically found:

             Hutchison has offered no evidence to challenge the
             accuracy of this amount owed under the Agreement. As
             stated above, the accuracy of this amount is established
             by the Affidavit of Sara Marks and by the spreadsheet
             summary of Hutchison’s financial performance submitted
             with KDMS’s motion.

             The circuit court considered Dr. Hutchison’s primary defense to

KDMS’s claims – that she was given inadequate or inferior access to a da Vinci Si

Robot for her operating room procedures during her employment – and made

factual findings that undisputed record evidence disproved that, including: the Si

                                         -20-
Robot was not purchased for the gynecologists or Dr. Hutchison; and Dr.

Hutchison was incorrect that her access to the Si Robot was limited based upon the

affidavit of Milum, who summarized operating room schedules and robotic

procedures performed during 2012 based on KDMC’s records, establishing that:

             [F]rom March 2012 until the end of 2012, Hutchison
             performed more procedures on the Si Robot than any of
             the other OB/GYN physicians, male or female.
             Hutchison had more, not less, access to this equipment
             than the other OB/GYNs. . . . Hutchison performed 66
             procedures on the Si Robot in 2012. Only one physician,
             Dr. Eric Smith, performed more procedures (76) on the
             Si robot during that time. Dr. Smith is a general surgeon
             who performed a large volume of single-site procedures
             that required the Si Robot. Thus, Hutchison had more
             access to the Si Robot than all but one of the other
             physicians.

The circuit court also pointed out that Hutchison offered no evidence to challenge

the accuracy of this evidence.

             The circuit court found that Marks decided to terminate the

employment relationship without cause based on various factors including Dr.

Hutchison’s poor financial performance, complaints from operating room

employees about her unprofessional language and behavior, Dr. Hutchison’s

dissatisfaction with her operating room schedules, and the parties’ mutual

dissatisfaction with the employment relationship.

             The circuit court found that Marks’s unrefuted affidavit established

that Hutchison had appropriate office staff consistent with that provided to other

                                        -21-
KDMS physicians and that KDMS appropriately billed and collected for

Hutchison’s professional services, billing over $2.38 million and collecting over

$812,000, equating to a 34% collection rate which is within the normal range for a

surgery specialty physician billing at KDMS.

             Based on these factual findings, the circuit court determined that Dr.

Hutchison breached the Agreement by failing to reimburse KDMS; KDMS did not

breach the contract by failing to provide her sufficient support staff, office space,

access to the Si Robot, and not billing for her services appropriately; and “[a]s a

matter of law, there is no admissible evidence to support Hutchison’s claim that

KDMS breached its obligations under the employment agreement”; and therefore

as a matter of law “Hutchison breached the employment agreement” by failing to

reimburse KDMS and KDMS is entitled to judgment as a matter of law to recover

the amounts owed by Hutchison. It determined because there was a written

contract and breach of that contract, that KDMS’s claim for unjust enrichment was

moot.

             Dr. Hutchison argues that the circuit court erred in granting summary

judgment to KDMS. She argues that as to the breach of contract claim, KDMS

was not entitled to a judgment as KDMS breached the Agreement first by not

providing her with adequate staffing and endangering patients as a result; not

providing adequate billing staff; and not providing her with adequate space,

                                         -22-
equipment, supplies, or resources necessary to operate her practice including

denying her access to the Si Robot in favor of her male colleagues, due to her

gender. Dr. Hutchison argues that KDMS’s material breaches and discriminatory

actions effectively precluded her from practicing medicine, and rendered her

performance of the Agreement futile and/or impossible. She also argues that

despite stating in the March 7, 2013, termination notice that June 7, 2013, would

be her last day of employment, KDMS immediately denied her access to her

patients and the computer system, effectively ending her employment early.

             “To prove a breach of contract, the complainant must establish three

things: 1) existence of a contract; 2) breach of that contract; and 3) damages

flowing from the breach of contract.” Metro Louisville/Jefferson Cnty.

Government v. Abma, 326 S.W.3d 1, 8 (Ky. App. 2009).

             We are confident that KDMS established conclusively that Dr.

Hutchison breached her contract with it by failing to repay the excess money she

received through her draws and that the circuit court correctly found that this was

so based on the undisputed evidence. The only question is whether Dr. Hutchison

established there were factual disputes as to the breaches of the contract that she

alleged and damages following from those breaches which might mitigate this

total.

                                         -23-
               Having reviewed the evidence, it is evident that Dr. Hutchison has

failed in her burden to establish that there is a factual dispute that KDMS did not

provide her with adequate staffing; did not provide her with adequate billing staff;

and did not provide her with adequate space, equipment, supplies, or resources

necessary to operate her practice including denying her access to the Si Robot.

While Dr. Hutchison may have been unhappy that at times she did not have a full

complement of staff, or with the amount of training they had prior, the Agreement

does not require that she always have full staffing or any mandatory prior

experience they should have had, and Dr. Hutchison has failed to raise a factual

dispute that she was thereby harmed. While Dr. Hutchison made many claims

about inadequate billing, she has failed to identify any claims in which inadequate

billing led to non-collection of her fees.14

               While it is obvious that Dr. Hutchison would have preferred to have

“first-dibs” on all Si Robot time during her scheduled surgery slot, she has not

established that access to the Si Robot some of the time and access to the S Robot

14
   We recognize it is difficult to establish a non-event, especially years after the fact, but Dr.
Hutchison has also failed to present any affidavits from any people who she references as having
informed her of deficits in billing or provide any documentation that she made any complaints
about this to KDMS so that it could correct the situation. Specific claims regarding non-billing
of the ultrasounds she provided were refuted by KDMS records indicating that more than 500
ultrasounds were billed during her tenure at KDMS as related in Marks’s affidavit. Dr.
Hutchison was also unable to identify any procedures which were not collected upon due to lack
of proper prior consent and authorization, while Marks asserts that she searched the appropriate
records and was unable to find any instances when this occurred.

                                              -24-
some of the time was inadequate where previously she had only access to the S

Robot. While we can certainly understand that all surgeons would prefer the best

equipment to deliver the best results possible for all of their patients, Dr. Hutchison

has failed to establish that the S Robot was an inadequate option or if it was that

having a surgery delayed so that the Si Robot could be used was not a sufficient

solution, given that the Si Robot was a limited resource that had to be shared by all

of the surgeons.

             However, Dr. Hutchison’s unrefuted argument that despite stating in

the March 7, 2013, termination notice that June 7, 2013, would be her last day of

employment, KDMS immediately denied her access to her patients and the

computer system, effectively ending her employment early, merits further

consideration. Dr. Hutchison has repeatedly raised this argument, in her

counterclaim, in her motion for summary judgment, and in her appellate brief. We

note that KDMS did not address this argument and neither did the circuit court.

             The Agreement is silent as to what is supposed to occur in the ninety

days between when notice of termination is given and the actual termination of

employment. While certainly patients would need to be given notice so that they

could seek continuing care elsewhere, it is unclear whether Dr. Hutchison should

not have been allowed to continue to treat patients to the extent possible during

that period and to continue to earn income. The Agreement also does not provide

                                         -25-
an exception to the non-compete clause during that time. We believe that Dr.

Hutchison is certainly a proper witness as to the lack of such access and that if true

she would be damaged as it would limit her ability to produce income during the

last three months of her employment with KDMS while also preventing her from

working elsewhere.

             Therefore, while we affirm that Dr. Hutchison breached the

Agreement with KDMS by failing to pay it back the money she owed it, it was not

proper for summary judgment to be granted to KDMS on the breach of contract

issue without first resolving this issue regarding whether it may have also breached

the contract by effectively prematurely terminating her employment sooner than

ninety days by cutting off her access to the computer system and her patients,

preventing her from performing her employment between March 7, 2013, and June

7, 2013. As factual issues remain regarding what occurred in this limited period of

time, and the contract is ambiguous as to what should have occurred, summary

judgment cannot be granted to KDMS on its breach of contract claim. Whether

Dr. Hutchison may thereby be excused from having to repay any portion of the

$198,069.30 that it has been established she owes KDMS as a set off, if KDMS’s

actions during that time were indeed a breach of the contract, is an issue that

cannot be resolved at this time. Therefore, we reverse and remand on this issue.

                                         -26-
   II.   Gender Discrimination

             Dr. Hutchison argued she was discriminated against for her gender by

being denied access to the Si Robot and being terminated. The circuit court

rejected that Dr. Hutchison could establish gender discrimination where she had no

direct evidence of gender discrimination and could not present a prima facie case

of gender discrimination under the burden-shifting analysis of McDonnell Douglas

Corporation v. Green, 411 U.S. 792, 802, 93 S. Ct. 1817, 36 L. Ed. 2d 668 (1973),

as she failed to prove a similarly situated male received more favorable treatment.

The circuit court explained Dr. Hutchison “failed to produce any evidence of a

similarly situated employed male physician whose employment agreement was not

terminated under similar circumstances as Hutchison’s employment was

terminated” and could not establish denial of access to the Si Robot compared to a

similarly situated male OB/GYN physician employee, requiring dismissal of her

discrimination claims as a matter of law. The circuit court determined that even if

Dr. Hutchison could make out a prima facie case of gender discrimination, she

failed to identify any admissible evidence that KDMS’s stated reason for

terminating her employment was pretext for gender discrimination. It further

indicated that her subjective belief now was insufficient, noting that “during her

deposition, Hutchison testified that she believed she was terminated because she

had applied for privileges at OLBH, not because of gender discrimination.” The

                                        -27-
circuit court specifically rejected that Dr. Hutchison could properly qualify or

soften her damaging deposition testimony via her later affidavit, explaining “an

affidavit that contradicts earlier sworn testimony cannot be used to defeat a motion

for summary judgment.”15

                 Dr. Hutchison argues that she has established a prima facie case for

gender discrimination because: as a woman she is a member of a protected group,

it is undisputed that her employment was terminated early even though she was

objectively qualified for the position and KDMS’s only female OB/GYN, male

doctors were treated better than she was at KDMS with OB/GYN Dr. Richard Ford

being hired after she was terminated and then being promoted to Chief Medical

Officer, and Dr. James also being hired by KDMS. She states that the burden of

production thus shifted to KDMS to articulate a non-discriminatory reason for her

termination, but that KDMS’s shifting reasons for why it terminated her makes all

of these justifications suspicious, and “[t]here is significant evidence that KDMS

15
     In Dr. Hutchison’s affidavit, she stated the following:

          7. I stated in my deposition that KDMS terminated me due to my seeking hospital
          privileges at Our Lady of Bellefonte Hospital among other reasons. To clarify,
          this was not the only reason that I believe that KDMS terminated my
          employment. More specifically, I think that KDMS terminated my employment
          because I raised concerns about my working conditions, specifically, that KDMS
          increasingly denied me access to the Si Robot based on my gender, that KDMS
          did not provide me adequate staff for my procedures or for my billing purposes,
          and that KDMS endangered patients by cancelling my procedures on the Si Robot
          on short notice.

                                                 -28-
terminated Hutchison’s employment because she raised concerns about her

working conditions and about KDMS denying her access to the Si Robot based on

her gender,” which was “also the reason that she was afforded fewer opportunities

than ‘the Boys’ at KDMS.”

             KRS 344.040(1)(a) provides in relevant part that: “It is an unlawful

practice for an employer: . . . to discharge any individual, or otherwise to

discriminate against an individual with respect to compensation, terms, conditions,

or privileges of employment, because of the individual’s . . . sex[.]” To establish a

prima facie discrimination action on the basis of gender, Dr. Hutchison must

provide proof that: “(1) she was a member of a protected group; (2) she was

subjected to an adverse employment action; (3) she was qualified for the position;

and (4) similarly situated males were treated more favorably.” The Board of

Regents of Northern Kentucky University v. Weickgenannt, 485 S.W.3d 299, 306

(Ky. 2016) (footnote omitted). If Dr. Hutchison can establish a prima facie case of

discrimination, then the burden shifts to KDMS to offer a “legitimate,

nondiscriminatory reason” for its actions, then the burden shifts a final time, with

Dr. Hutchison then needing to “be afforded a ‘fair opportunity’ to show that [the

adverse employment action] was ‘in fact pretext’ for discrimination.” Id. (citation

omitted).

                                         -29-
             We agree with the circuit court that Dr. Hutchison cannot establish a

prima facie case because she cannot establish that similarly situated males received

better treatment. The problem for Dr. Hutchison is that the male OB/GYNs were

not employees of KDMS; instead, they only had privileges at KDMC. They were

thus not similarly situated, and their employment could not be terminated by

KDMS. However, even had she established a prima facie case of gender

discrimination, KDMS provided several reasonable explanations as to why it

decided to terminate her employment and we are confident that her objective

failure to continue to perform well in generating income for KDMS was a

legitimate reason to terminate her.

             The circuit court incorrectly characterized Dr. Hutchison’s deposition

testimony to indicate that she believed she was terminated for seeking privileges at

OLHB, as her deposition testimony provided this as one reason she believed she

was terminated while she had also testified earlier that she believed her termination

was in retaliation for complaining about her lack of access to the Si Robot, changes

in her surgery schedule, and inadequate staffing for the Si Robot and her clinic,

with her obtaining privileges elsewhere essentially being “the straw that broke the

camel’s back” and causing KDMS to finally decide to terminate her. Dr.

Hutchison’s deposition testimony was sufficiently clear on this point and her

                                        -30-
affidavit simply reiterated this position. However, this characterization by the

circuit court was not dispositive.

              While seeking privileges at OLBH without prior permission was

indeed a violation of the Agreement, this was not listed as a basis for the

termination. Just because KDMS had a variety of bases to choose from when it

came to deciding to terminate her, and its agents may not have been entirely

consistent when explaining its reasoning, does not imply that in fact her

termination was discriminatory.

              As to access to the Si Robot, the unrefuted evidence shows that Dr.

Hutchison’s subjective perception that she was granted less time with the Si Robot

than similarly situated physicians was incorrect based on the KDMC records which

indicate that she performed more procedures with the Si Robot than any other

physicians with privileges at KDMC other than general surgeon Dr. Smith.16 Dr.

16
  This is according to Milum’s affidavit. As to the Si Robot, Milum summarized that from
April 1, 2012, through December 31, 2012, only general surgeon Dr. Smith (who had Monday
and Wednesday surgery days) performed more procedures on the Si Robot, 76 to Dr.
Hutchison’s 66, but Dr. Hutchison performed 57 Si Robot surgeries on Wednesdays compared to
33 for Dr. Smith on Wednesdays. In comparing the rates of using the Si Robot by all the
OB/GYN physicians in that same period, Milum stated that Hutchison’s rate was 66 compared to
her next closest OB/GYNs of Dr. Modi at 37, Dr. Dodi at 34, and Dr. Frederick at 29.

        In contrast, Dr. Hutchison made claims in her affidavit that were not objectively
verifiable and were in contradiction of the records and Marks’s testimony but failed to explain
why the records or Marks’s testimony was incorrect. These included Dr. Hutchison’s statement
that: “At the end of 2011, I performed seventy-five percent (75%) of all robotic procedures at
KDMS. At the end of 2012, this number decreased to less than ten percent (10%).”

                                             -31-
Hutchison cannot be considered similarly situated to a general surgeon who simply

performed more operations than she. Assuming she was similarly situated to the

OB/GYNs who had privileges at KDMC regarding her right to access the Si Robot

on her surgery days, the undisputed evidence was that she performed more

operations using the Si Robot than those male OB/GYNs.

             While Dr. Hutchison repeatedly states her belief that she was not

given equal access to the Si Robot, KDMC records belie that belief. As explained

in Humana of Kentucky, Inc. v. Seitz, 796 S.W.2d 1, 3 (Ky. 1990), “‘[b]elief’ is not

evidence and does not create an issue of material fact. A plaintiff must present

affirmative evidence in order to defeat a properly supported motion for summary

judgment.” However, Dr. Hutchison has not been able to present any evidence that

her belief that she had less access than similarly situated male physicians is in fact

true and she does not challenge the accuracy of the records establishing otherwise.

             We do not dispute that Dr. Hutchison may indeed have been subjected

to sexual animus by some male physicians that had privileges at KDMC, but

KDMS’s ability to control the actions of these physicians who were not its

employees was severely limited. Additionally, while they may have made

complaints about her and treated her differently, Dr. Hutchison has not established

that KDMS acted on unfounded complaints to her detriment or that these

physician’s actions caused KDMS to discriminate against her and provide her with

                                         -32-
decreased access to surgical resources. Dr. Hutchison has failed to connect any

alleged sexism by these physicians to a deprivation of access to the Si Robot by

KDMC staff or to her termination by KDMS.

             Additionally, despite Dr. Hutchison’s repeated conflating of KDMS as

encompassing KDMC, these are separate (although related) entities. KDMC is not

a party to this suit and it was responsible for providing the Si Robot (not KDMS),

and KDMC was not Dr. Hutchison’s employer or the employer of the male

physicians at issue.

             Therefore, we agree with the circuit court that it was appropriate to

grant summary judgment to KDMS on Dr. Hutchison’s gender discrimination

claim.

   III.   Patient Safety Act

             Dr. Hutchison argued that a report she made while employed by Dr.

James about another physician and not having sufficient staff in relation to robotic

surgery and reporting that should be protected pursuant to KRS 216B.165, the

Patient Safety Act, and that she was terminated in retaliation for reporting these

concerns about patient safety. The circuit court determined that this claim failed as

a matter of law for failure to present a prima facie case because Dr. Hutchison

failed to prove she engaged in a protected activity under the Act. The circuit court

rejected Dr. Hutchinson’s claim that her complaint on December 20, 2012, over

                                        -33-
her access to the Si Robot could qualify, explaining that the “complaint was not

related to patient safety or care, but rather to what she believed to be unfair

scheduling changes and her access to the Si Robot.”17 The circuit court noted that

even if that complaint “could be considered protected activity, Hutchison’s own

testimony regarding the reason for her termination precludes the Court from

finding pretext” as she believed she was terminated because she applied for

privileges at OLBH rather than in retaliation for making complaints relating to

patient safety. Accordingly, the circuit court dismissed these claims as a matter of

law.

               Dr. Hutchison argues she established a prima facie case that she

engaged in a protective activity by reporting her safety concerns to KDMS

regarding its failure to provide her with a sufficient number of adequately trained

staff members, which went unaddressed, and she was retaliatorily terminated by

KDMS just weeks after she made these reports.

               KRS 216B.165 states in relevant part that:

               (1) Any . . . employee of a health care facility or service
               licensed under this chapter who knows or has reasonable
               cause to believe that the quality of care of a patient,
               patient safety, or the health care facility’s or service’s
               safety is in jeopardy shall make an oral or written report
               of the problem to the health care facility or service . . .

17
  We do not address the circuit court’s rejection of Dr. Hutchison’s prior claim regarding
protected activity in reporting another physician’s endangerment of patient safety prior to her
being employed by KDMS because she waived that argument by not renewing it on appeal.

                                               -34-
             ...

             (3) No health care facility or service licensed under this
             chapter shall by policy, contract, procedure, or other
             formal or informal means subject to reprisal, or directly
             or indirectly use, or threaten to use, any authority or
             influence, in any manner whatsoever, which tends to
             discourage, restrain, suppress, dissuade, deter, prevent,
             interfere with, coerce, or discriminate against any agent
             or employee who in good faith reports, discloses,
             divulges, or otherwise brings to the attention of the health
             care facility or service the circumstances or facts to form
             the basis of a report under subsections (1) or (2) of this
             section.

“KRS 216B.165(1) requires employees of a health care facility to report quality of

care and safety problems” and “KRS 216B.165(3) states that health-care facilities

shall not hinder the ability of employees to make these reports.” Foster v. Jennie

Stuart Medical Center, Inc., 435 S.W.3d 629, 635 (Ky. App. 2013).

             The problem for Dr. Hutchison is that even if we assume that her

reports about inadequate staffing of the Si Robot in that the staff were not able to

troubleshoot the robot which could have been problematic for patient care

constituted a prima facie case for violation of the Patient Safety Act, KDMS amply

established a myriad of objective reasons for her termination. Furthermore, it

appears that her reports were buried and subsumed within a variety of complaints

having to do with her supposed lack of access to the Si Robot and her disagreement

with how that resource was allocated and cannot be connected with her discharge.

Therefore, this claim was appropriately dismissed.

                                         -35-
   IV.   Retaliation

             Dr. Hutchison brought a claim that she was wrongfully retaliated

against for the complaints she made regarding gender discrimination and patient

safety, as is prohibited under the Civil Rights Act, KRS 344.280(1), by rearranging

her operating times and discharging her. The circuit court found these were

restatements of her rejected gender discrimination claims, which must also be

dismissed as a matter of law.

             Dr. Hutchison argues that she was retaliated against for raising

concerns about gender discrimination and patient safety by being denied

opportunities to use the Si Robot, by being sent a termination letter and then

immediately denied access to her patients, and then by being terminated. She

states that the causal connection between her complaints and termination is

undeniable because she made her complaints to Marks, Marks was aware she made

complaints to others as they had a meeting regarding her concerns, and Marks

testified that Dr. Hutchison’s complaints played a role in the decision to terminate

her.

             KRS 344.280 states in relevant part:

             It shall be an unlawful practice for a person, or for two
             (2) or more persons to conspire:

             (1) To retaliate or discriminate in any manner against a
             person because he has opposed a practice declared
             unlawful by this chapter, or because he has made a

                                        -36-
              charge, filed a complaint, testified, assisted, or
              participated in any manner in any investigation,
              proceeding, or hearing under this chapter[.]

              We note that the Patient Safety Act does not fall within this chapter

and, thus, KRS 344.280 cannot apply to such a claim. As to gender discrimination,

we agree with the circuit court that the prior disposal of such claim precludes the

application of KRS 344.280(1).

     V.    Fraud

              Dr. Hutchison argued that KDMS participated in Dr. James’s fraud

toward her and was legally responsible for it. The circuit court rejected this claim,

determining that “Hutchison has neither alleged nor identified any

misrepresentation made by KDMS that could support a claim for fraud” as these

were claims involving Dr. James’s billing for her professional services when she

was employed by him.18 It found that Dr. James was not an employee of KDMC

or KDMS while Dr. Hutchison worked for him, and KDMS was not involved in

billing for Dr. Hutchison’s services during that time.19 The circuit court rejected

18
   Dr. Hutchison denied being employed by Dr. James; instead, in her deposition she described a
recruiting agreement by King’s Daughters (which appears to refer to the hospital) to set up a
practice there, and that she had an office sharing arrangement with Dr. James and Dr. Modi in
which they would share expenses and paid a third party to do billing, with her functioning more
like a partner to Dr. James. However, the exact nature of their relationship is immaterial.
19
  Dr. Hutchison specifically denied in her deposition testimony that Dr. James worked for
KDMC or KDMS or that the person doing billing for those three doctors worked for either
entity.

                                             -37-
the ostensible agency could apply here as “Hutchison has cited no case where a

hospital was held responsible to an independent physician’s employee for conduct

between the independent physician and that employee.” It also noted that

Hutchison’s deposition testimony established she understood that Dr. James was

not an employee of KDMS. Therefore, it dismissed that claim.

            Dr. Hutchison again alleges that Dr. James was KDMS’s Chief of its

OB/GYN department at the time he engaged in fraud against her, and KDMS

should be liable as it “not only held James out to be an agent of KDMS, but as a

leader of one of its clinical departments.” She argues this is shown by

            contemporaneous KDMS advertising material from the
            time, listing James, along with Hutchison, on KDMS
            advertising materials with KDMS’ logo. As a
            department chair, James was more than just a physician
            with privileges at KDMS and had specific authority from
            KDMS to set policy for the OB/Gyn Department and,
            thus, to ostensibly act as an agent of KDMS, its board,
            and its leadership.

Dr. Hutchison argues as a department leader Dr. James should be considered an

agency of the hospital and “[b]ecause there is no material dispute that James was

the chair of KDMS’s OB/GYN Department when he took fraudulent actions,

KDMS was not entitled to summary judgment on Hutchison’s Counterclaim for

fraud.”

            “In a Kentucky action for fraud, the party claiming harm must

establish six elements of fraud by clear and convincing evidence as follows: a)

                                        -38-
material representation b) which is false c) known to be false or made recklessly d)

made with inducement to be acted upon e) acted in reliance thereon and f) causing

injury.” United Parcel Service Co. v. Rickert, 996 S.W.2d 464, 468 (Ky. 1999).

However, it does not matter if Dr. Hutchison has established a prima facie case of

fraud against Dr. James when he is not a party to this action and his actions cannot

be imputed against KDMS. Because Dr. Hutchison knew Dr. James was not an

employee of KDMS, it does not matter if advertising material might have implied

that he was an employee of it.

             Additionally, Dr. Hutchison again conflates KDMC with KDMS. The

advertisements in which she states that KDMS held out Dr. James as its agent were

in fact advertisements for KDMC which simply listed that he practiced at KDMC,

the same as advertisements it made for Dr. Hutchison while she was working with

Dr. James. None of these documents identifies Dr. James as being a department

leader, chief, or chair of KDMC’s or KDMS’s OB/GYN department. It is most

certainly disputed that he had such a role, especially as Dr. Hutchison specifically

admits that when she was hired by KDMS, she was their only OB/GYN employee.

Nothing but Dr. Hutchison’s subjective belief that Dr. James had such a connection

to KDMS appears to support this claim. This was insufficient to defeat the motion

for summary judgment and this claim was appropriately dismissed against KDMS.

                                        -39-
   VI.    Intentional Infliction of Emotional Distress

             Finally, Dr. Hutchison argued she was entitled to damages for IIED

due to her wrongful termination. The circuit court concluded that Dr. Hutchison

had not identified any admissible evidence that met the high standard required to

make out a prima facie case of IIED and “[m]ore importantly, it is settled that IIED

claims are subsumed by claims under the Kentucky Civil Rights Act and must be

dismissed when brought with claims under the Act.” It dismissed this claim.

             Dr. Hutchison argues that she suffered from retaliation and

discrimination, which were by definition outrageous and intolerable, as she was

sexually discriminated against by “the Boys,” told that “the boys want you gone,”

and then Marks asked her “why haven’t you quit yet?” She also argues she

suffered significant financial hardship and severe emotional distress as a result

because she lost her home and could not afford to send her son to a world premiere

school.

             “[T]he elements [of IIED] are: (1) intentional or reckless conduct; (2)

that was outrageous or intolerable and offends against the generally accepted

standards of decency and morality; (3) which caused emotional distress; and (4)

the distress was severe.” McDonald’s Corp. v. Ogborn, 309 S.W.3d 274, 293-94

(Ky. App. 2009). Not every case in which a wrong has been committed is

sufficient to establish IIED.

                                        -40-
Kentucky courts have found plaintiffs’ proof of
outrageous conduct sufficient to support an outrage/IIED
claim in cases where the defendants: (1) harassed the
plaintiff “by keeping her under surveillance at work and
home, telling her over the CB radio that he would put her
husband in jail and driving so as to force her vehicle into
an opposing lane of traffic”; (2) intentionally failed to
warn the plaintiff for a period of five months that
defendant’s building, in which plaintiff was engaged in
the removal of pipes and ducts, contained asbestos; (3)
engaged in “a plan of attempted fraud, deceit, slander,
and interference with contractual rights, all carefully
orchestrated in an attempt to bring [plaintiff] to his
knees”; (4) committed same-sex sexual harassment in the
form of “frequent incidents of lewd name calling coupled
with multiple unsolicited and unwanted requests for
homosexual sex”; (5) was a Catholic priest who “used his
relationship [as marriage counselor for] the [plaintiff]
husband and the wife to obtain a sexual affair with the
wife”; (6) agreed to care for plaintiff’s long-time
companion-animals, two registered Appaloosa horses,
and then immediately sold them for slaughter; and (7)
subjected plaintiff to nearly daily racial indignities for
approximately seven years.

       Outrageousness has been found lacking, however,
in less-egregious cases where the defendant: (1) refused
to pay medical expenses arising out of an injured
worker’s compensation claim; (2) wrongfully converted
the plaintiff’s property in a manner that breached the
peace; (3) negligently allowed his vehicle to leave the
road and struck and killed a child; (4) committed
“reprehensible” fraud during divorce proceedings by
converting funds belonging to his spouse for the benefit
of defendant and his adulterous partner; (5) wrongfully
terminated the plaintiff; (6) displayed a lack of
compassion, patience, and taste by ordering plaintiff,
who was hysterical over the fact that she had just
delivered a stillborn child in her hospital room, to “shut
up” and then informing her that the stillborn child would

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             be “disposed of” in the hospital; (7) erected a billboard
             referencing defendant’s status as a convicted child
             molester; (8) wrongfully garnished plaintiff’s wages
             pursuant to a forged agreement; and (9) impregnated
             plaintiff’s wife. Courts have found other elements of the
             prima facie case missing, or have otherwise found
             recovery pursuant to § 46 unavailable, in cases where the
             defendant: (1) a Catholic priest, sexually abused a ten-
             year-old boy; (2) breached a promise to marry; (3)
             chained a high school student to a tree by his ankle and
             neck; and (4) shot and killed a beloved family pet, which
             had been misidentified as a stray dog.

Stringer v. Wal-Mart Stores, Inc., 151 S.W.3d 781, 789-91 (Ky. 2004), overruled

on other grounds by Toler v. Süd-Chemie, Inc., 458 S.W.3d 276, 287 (Ky. 2014)

(citations omitted).

             Typically, a wrongful discharge, even if based on discrimination, is

not outrageous enough to qualify as IIED. See Benningfield v. Pettit

Environmental, Inc., 183 S.W.3d 567, 572 (Ky. App. 2005) (and cases cited

within); Bednarek v. United Food and Commercial Workers Intern. Union, Local

Union 227, 780 S.W.2d 630, 632 (Ky. App. 1989).

             As we have previously explained, Dr. Hutchison cannot establish any

discrimination took place; therefore, that alone is an appropriate basis for affirming

the dismissal of this claim. We also emphasize that even if the discrimination

claim was established, the evidence could not show that KDMS’s conduct was so

outrageous as to establish IIED.

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                                  CONCLUSION

             Accordingly, we affirm the Boyd Circuit Court’s grant of summary

judgment to KDMS dismissing all of Dr. Hutchison’s counterclaims, reverse the

grant of summary judgment to KDMS regarding the breach of contract claim to the

extent that Dr. Hutchison has established there is a question of fact as to whether

KDMS breached the contract by effectively terminating her without proper notice

where she alleged she was immediately denied access to the computer system and

her patients upon notice of termination but affirm that KDMS has established Dr.

Hutchison’s debt to it in the amount of $198,069.30 subject to a possible claim for

set off if Dr. Hutchison can establish that this specific breach occurred and

prevented her from earning money during the ninety days in which she was to

continue in her employment under the terms of the Agreement.

             ACREE, JUDGE, CONCURS IN RESULT ONLY.

             DIXON, JUDGE, CONCURS IN RESULT ONLY.

BRIEF FOR APPELLANT:                       BRIEF FOR APPELLEE:

Christopher B. Congeni                     W. Mitchell Hall, Jr.
Akron, Ohio                                Olivia Holbrook Gilkison
                                           Ashland, Kentucky

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