Barbara Robinson v. John WilliamsBarbara Robinson v. John Williams
A cardiothoracic surgeon, Dr. Barbara L. Robinson, sued another cardiothoracic surgeon, Dr. John Mark Williams, alleging that his remarks about her performance during an aborted surgery defamed her. On summary judgment, the district court determined that Williams‘s statements—that Robinson “misread” or “failed to recognize” the findings on the patient‘s echocardiogram before beginning surgery—were not false, as Robinson admitted she did not read the echocardiogram at all before operating. The district court therefore concluded the statements could not be actionable under North Carolina law.
We disagree with the district court‘s appraisal on summary judgment. To say that Robinson “misread” the echocardiogram presupposes that she read it in the first place, which she did not. And the defamatory sting of Williams‘s statements—that Robinson either lacked skill in applying her medical judgment to interpret the echocardiogram or deviated from the standard of care by failing to evaluate the echocardiogram results before operating—presents a conclusion about which the parties, and the evidence, sharply disagree. For these reasons, the district court erred in finding no dispute of material fact as to the falsity of Williams‘s statements. We accordingly vacate the summary judgment order and remand for further proceedings.
I.
Because this appeal follows the award of summary judgment, “we recount the facts below in the light most favorable to [Robinson], the non-moving party.” SD3 II LLC v. Black & Decker (U.S.) Inc., 888 F.3d 98, 103 (4th Cir. 2018).
Patient M was scheduled for elective aortic valve replacement surgery on April 14, 2015. Seven months earlier, Dr. Brian Cabarrus diagnosed Patient M with severe aortic insufficiency (AI) based on the results of a transesophageal echocardiogram (TEE), a procedure that produces images of a patient‘s heart. Cabarrus determined that Patient M required surgical evaluation and referred her to East Carolina Heart Institute, a clinical practice associated with the School of Medicine at East Carolina University and the Vidant Medical Center in Greenville, North Carolina. Williams, a surgeon at the Institute, accepted Patient M as a new patient without verifying Cabarrus‘s diagnosis. Eventually, Williams scheduled Patient M for elective aortic valve replacement surgery to remediate her purportedly severe AI.
The night before Patient M‘s operation, Robinson sought to review Patient M‘s medical records. Robinson, a clinical fellow at the Institute, was the assistant surgeon for Patient M‘s upcoming procedure, which meant she would actually perform the surgery. Williams was Robinson‘s direct supervisor and the attending surgeon with “ultimate responsibility for the entire preop[erative] and intraoperative course” of Patient M‘s operation. J.A. 1194. When Robinson could not find the preoperative TEE results in Patient M‘s file on the eve of surgery, she contacted Williams. Rather than produce the TEE images, Williams assured Robinson that he had looked at them himself, telling her, “[i]t‘s severe AI, don‘t worry about it.” J.A. 132.
On the morning of the surgery, Robinson and Williams discussed Patient M‘s case again. No new issues were raised, and Williams directed Robinson to “[g]o ahead and
Instead, Robinson began the operation, proceeding with a sternotomy—an incision made through the breastbone to open the sternum and allow access to the heart. As Robinson understood it, this approach was “consistent with [Williams‘s] usual and customary practice, which was not to wait for the intraoperative [TEE results] before commencing the surgery.” J.A. 1650. Minutes after the sternotomy, however, Duncan informed Robinson that the TEE images showed that Patient M‘s AI was moderate, not severe. Robinson halted the surgery and called Williams, who determined from the intraoperative TEE that Patient M did not require operation. Williams then cancelled the elective surgery.
B.
Williams reported the incident to various third parties. He first spoke to Patient M and her family. Responding to their questions about “how this could have happened,” Williams accepted responsibility as the attending surgeon but told them that Robinson and Duncan had “failed to recognize the findings on the intraoperative TEE” before the sternotomy was made. J.A. 569. Shortly after the incident, Williams told the risk management teams at ECU Medicine and Vidant Medical Center that Robinson had “misread” the TEE, absent which error, the sternotomy would not have occurred. J.A. 1346–1347, 1349. In conversations with Jody Cook, the Director of Risk Management for ECU Medicine, Williams attributed the “unnecessary” surgery to Robinson‘s and Duncan‘s “misread . . . regarding the severity of the aortic insufficiency of the patient.” J.A. 1349.
In November 2016, Patient M‘s attorney sent a demand letter to Cook, asserting several claims of negligence. Cook notified Robinson, who had left East Carolina Heart Institute in October 2016. Robinson told Cook that, in her experience, “95%” of
After evaluating Williams‘s and Robinson‘s competing accounts and having the case reviewed by an outside expert, Cook “recommend[ed] that any settlement amount be made on behalf of Dr. Robinson and not Dr. Williams.” J.A. 1565. Accepting this recommendation, ECU Medicine and its healthcare liability insurer settled Patient M‘s case for $74,999, identifying Robinson as the sole party at fault. The insurer submitted a medical malpractice payment report to the National Practitioner‘s Data Bank (NPDB), a database that collects adverse action reports filed against medical professionals. The report to NPDB was accompanied by a supplemental statement prepared for the North Carolina Medical Board, which faulted Robinson for performing the sternotomy “before Dr. Williams arrived and without reviewing the [TEE] results.” J.A. 1598. As initially filed, both reports allocated 100% of the responsibility for Patient M‘s aborted surgery to Robinson.1 The reports were submitted simultaneously to each state board where Robinson
Robinson alleges that, because of these reports, she was terminated from her then-temporary employment, was denied the opportunity to apply for a permanent position with the same employer, and has since been rejected by almost a dozen potential employers. As a result, Robinson‘s annual income fell to roughly 65% of what it previously had been.
C.
Robinson filed suit in the Eastern District of North Carolina shortly after the initial reports of the incident were filed with NPBD and the state boards. Although her operative complaint alleged seven causes of action against five defendants, only her defamation claim against Williams survived the defendants’ motions to dismiss.
In May 2020, the district court granted Williams summary judgment on the defamation claim, finding that Robinson could not establish the required element of falsity. Regarding Williams‘s statement that Robinson had “misread” the intraoperative TEE, the district court noted that Robinson had no experience interpreting intraoperative TEEs but had relied on Duncan, who claimed to have known “at the outset” that the TEE showed “moderate AI,” yet Robinson “insist[ed] that she was not made aware” of the moderate AI diagnosis prior to operating. J.A. 1693. The district court concluded that “the only reasonable inference to be drawn from these facts is that [Robinson] proceeded to surgery based on an incomplete understanding of Duncan‘s interpretation of the intraoperative TEE,” therefore Williams‘s statement that Robinson “misread” the TEE “was not false” and could not support a defamation claim. J.A. 1693.
II.
We review de novo whether a defendant is entitled to summary judgment, Brooks v. Johnson, 924 F.3d 104, 111 (4th Cir. 2019), bearing in mind that “a judge‘s function” at this stage “is not to weigh the evidence and determine the truth of the matter but to determine whether there is a genuine issue for trial,” Tolan v. Cotton, 572 U.S. 650, 656 (2014) (per curiam) (internal quotation marks omitted). To prove defamation under North Carolina law, which applies here, Robinson must show that Williams made “[1] false, [2] defamatory statements [3] of or concerning [Robinson], [4] which were published to a third person.” Boyce & Isley, PLLC v. Cooper, 568 S.E.2d 893, 897 (N.C. Ct. App. 2002); see Desmond v. News & Observer Publ‘g Co., 846 S.E.2d 647, 661 (N.C. 2020). Only the first element is at issue on appeal, so we ask simply whether there is a genuine dispute of fact about the falsity of Williams‘s statements.
“[T]he issue of falsity . . . focuses on substantial truth.” Desmond, 846 S.E.2d at 675 (internal quotation marks omitted); see Masson v. New Yorker Mag., Inc., 501 U.S. 496, 516 (1991). “Thus, a plaintiff must establish that ‘the sting,’ the aspect causing injury to the plaintiff‘s reputation, is materially false.” Desmond, 846 S.E.2d at 675. In making this assessment, we consider the allegedly defamatory statement and the facts implied by that statement “within their full context.” Boyce & Isley, 568 S.E.2d at 899; see Desmond, 846 S.E.2d at 675.
After reviewing the evidence and the parties’ arguments, we find a genuine dispute exists regarding the substantial truth of Williams‘s assertion that Robinson “misread”
First, the accusation that Robinson misread or misapprehended the TEE results implies that she read those results in the first place, which she did not. Williams responds that the difference between “misread” and “did not read” is immaterial. In his view, the injurious sting of either statement is that Robinson performed a sternotomy on Patient M without knowing whether the intraoperative TEE showed severe or moderate AI, which is true. But a jury could interpret the gist of that statement differently, and we think it is premature to decide otherwise. Saying that a person has misread something communicates not only that she read it, but that she did so incorrectly—implying, in this case, that she lacks skill in applying her medical judgment. A jury might reasonably conclude that this accusation constitutes a distinct critique of Robinson‘s professional competence. A statement like “Robinson did not read the TEE,” by contrast, says nothing about her ability to do so or about her judgment to proceed with a sternotomy despite supposedly having viewed the concerning TEE results.2 In other words, Williams‘s assertion that Robinson misread the TEE—a statement that all concede is literally false—may be viewed as
Second, Williams‘s statements that Robinson “misread” and “failed to recognize” the findings of the intraoperative TEE before the sternotomy could be understood to imply that Robinson had an obligation to read and understand the TEE before beginning the surgery, which she failed to fulfill. Whether such an obligation exists is hotly disputed in this case. Robinson has produced evidence suggesting that the medical standard in Patient M‘s case did not require Robinson to await intraoperative TEE results before beginning the sternotomy; Williams has produced evidence reaching the opposite conclusion. At this juncture, it suffices to observe that if a jury believed Robinson‘s evidence, it could conclude that the sting of Williams‘s implication—that Robinson had a professional obligation she admittedly did not fulfill—is materially false. See Desmond, 846 S.E.2d at 675 (“[T]he issue of falsity relates to the defamatory facts implied by a statement.” (internal quotation marks omitted)).
We pause to note our agreement with the district court‘s emphasis that “the instant claim is not one for medical negligence.” J.A. 1694. Robinson‘s claim “turns on whether [Williams‘s] statements about [her] are false,” not Williams‘s own “shortcoming regarding [P]atient M‘s care and any statements or omissions connected to such shortcomings.” J.A. 1694. As such, this case is not the forum for assigning fault for Patient M‘s outcome. At
III.
We conclude that Williams‘s allegedly defamatory statements—that Robinson “misread” or “failed to recognize” the findings of Patient M‘s intraoperative TEE—are capable of more than one reasonable interpretation as to which there exists a genuine dispute regarding material falsity. We therefore vacate the district court‘s ruling on summary judgment and remand for further proceedings consistent with this opinion.
VACATED AND REMANDED
I agree that the record before us shows the existence of material questions of fact, and I therefore concur in the opinion reversing the district court‘s grant of summary judgment in favor of Dr. John Mark Williams on the defamation claim asserted against him by Dr. Barbara Robinson.
Robinson and Williams are both board-certified cardiothoracic surgeons with extensive experience. At the time of the events giving rise to this case, Robinson was a clinical fellow at the East Carolina Heart Institute, and Williams was her supervisor. This case centers on an aortic valve replacement surgery for “Patient M.” Valve-replacement surgery is warranted only for patients who have severe aortic valve insufficiency; patients with only moderate valve insufficiency are treated medically rather than surgically. The existence and degree of valve insufficiency is determined with a transesophageal echocardiogram (TEE), which sends a probe down the esophagus to capture images of the heart. Patient M was accepted for surgery by Williams based on a report from her doctor that she was suffering from severe aortic insufficiency. Robinson had begun the valve-replacement surgery and had cut through Patient M‘s sternum when it was determined through an intraoperative TEE that Patient M had only moderate aortic insufficiency, at which point Robinson halted the surgery,
Robinson contends that Williams defamed her when he told the family of Patient M and others that Robinson misread the intraoperative TEE and performed an unnecessary surgery by failing to recognize that Patient M was suffering from moderate, not severe, valve insufficiency.
The district court‘s analysis was based on an implicit assumption that Robinson had some kind of duty regarding the results of the intraoperative TEE—either a duty to review and interpret the TEE herself before proceeding with the surgery, or a duty to inquire about the anesthesiologist‘s interpretation of the TEE before proceeding. Although Williams presented evidence indicating that Robinson in fact was obliged to determine the results for herself or inquire about them, Robinson’ evidence indicated that she had no such duty. According to Robinson‘s expert witness, it is within the standard of care for a cardiothoracic surgeon to “simultaneously proceed[] with the chest incision while the TEE is being performed.” J.A. 458. The expert explained that Robinson “was not in a position, either by training or status, to make a direct determination of the severity of the aortic insufficiency as displayed on the intraoperative TEE,” and that, instead, “the onus” was on
In my view, this dispute about the existence and scope of Robinson‘s duty regarding the intraoperative TEE precludes summary judgment. Williams’ attribution of the unnecessary surgery to Robinson‘s misreading of the TEE and her failure to recognize the findings of the TEE must be understood as accusing Robinson of breaching her duties as a cardiothoracic surgeon. If Robinson did not read the TEE and had no duty to do so, then Williams’ statements are false and therefore support her claim of defamation. See Cohen v. McLawhorn, 704 S.E.2d 519, 527 (N.C. Ct. App. 2010) (“North Carolina has long recognized the harm that can result from false statements that impeach a person in that person‘s trade or profession—such statements are deemed defamation per se.“) (cleaned up). Likewise, if Robinson did not have a duty to inquire about the results of the TEE, her failure to do so before proceeding with the surgery was not improper and was not the cause of the unnecessary surgery.
Accordingly, because there are genuine issues of material fact about whether Robinson had a professional duty to interpret the intraoperative TEE or to inquire about the results before commencing the surgery, the district court erred by granting summary judgment in favor of Dr. Williams.