OPINION
Plaintiff Carolyn T. Rodgers brought this action pursuant to 42 U.S.C. § 1983, alleging, inter alia, that Defendant wrongfully terminated Plaintiff from her employment in violation of Plaintiffs First Amendment right to free speech. Plaintiff appeals from the district court’s granting of Defendant Elizabeth Banks’ motion for summary judgment and dismissal of Plaintiffs case. We hold that although the Eleventh Amendment bars Plaintiff from seeking money damages from Defendant, Plaintiff produced sufficient evidence of a First Amendment retaliation claim to survive summary judgment, and that the district court’s dismissal of this claim was inappropriate. We therefore REVERSE the judgment of the district court.
*592 I.
Plaintiff was employed by the Panline Warfield Lewis Center (“Lewis Center”), an Ohio state mental hospital in Cincinnati. She began her employment at the Lewis Center as a social worker and was eventually promoted to Director of Quality Management, a position designated in the unclassified civil service of Ohio. According to Plaintiff, the “principal task” of this position was to “prepare the Center for surveys by the Joint Commission on Accreditation of Hospitals [JCAH] and other surveying organizations.” (J.A. at 7.) Defendant was the CEO of the Lewis Center. Plaintiff reported to Alice Gray, Director of Support Services, and Gray reported to Defendant.
On January 21,1999, Defendant revoked Plaintiffs unclassified appointment. In a memo informing Plaintiff of the revocation, Defendant stated, “I no longer have confidence in your ability to function as the hospitals [sic] Quality Management Director, your verbal and written communication skills are not conducive to a cooperative work environment.” (J.A. at 53.)
Specifically, the dispute concerns various statements Plaintiff made during her tenure at the Lewis Center. Defendant maintains that Plaintiffs manner and method of communication had offended and inflamed her coworkers and subordinates at the Lewis Center. In particular, Defendant highlighted an incident which began when one of the Lewis Center’s psychiatrists requested that his office be moved to one of the patient units. Defendant granted the psychiatrist’s request, ostensibly to encourage doctors to maintain closer physical proximity to their patients. Plaintiff, who apparently was concerned that the psychiatrist’s move had compromised patient privacy in the unit, sent a memorandum to Defendant, dated August 7, 1998, in which she discussed the allocation of space in the Lewis Center’s psychiatric units as it related to an upcoming JCAH survey. We reproduce the memorandum below in its entirety:
DATE: August 7,1998'
TO: L. Banks, CEO
FROM: C. Rodgers, LISW
Director, Quality Management
SUBJECT: Survey Preparedness
Patient Rights and Ethics
In the Supplemental Recommendations last survey, we had a recommendation regarding privacy for patients. This area will be scrutinized in the coming survey with a risk of a Type I.
Patient visiting in privacy is hindered by lack of space — especially on Units 1 through 6. There are the dining room and two days [sic] rooms. The day rooms are also used for group process— we have worked very hard the last three years to have more groups on the units. In doing a walk-around during the Mock Survey, I was amazed to see that a patient/program/visiting area had been turned into an MD’s office on Unit 4.
— The forensic units need more space for patients who have low level privileges and cannot leave the unit.
— The nature of Forensic patients on a confined unit would indicate a need for as much “personal space” as possible.
— This sets a precedent for the other psychiatrists to have “special” needs that rationalize taking large patient and visiting areas for office space.
Dr. Natarajan-Unit 1
Dr. Mannava-Unit 2
Dr. Holtman-Unit 5
The 1199 psychiatrist on Unit 5
Dr. Rodgers Wilson on Unit 6
*593 In the new architectural plan there may be a space for the unit psychiatrist, and no one is denying that this would, be optimal. However, the patient’s needs, including space for visits with families and privacy for visiting should be the most important factor.
R/pp/daw
cc: Alice Gray
Paul Blackwell
M. Russ
(J.A. at 139.)
According to Defendant, other communications Defendant considered inappropriate included (1) arguing with the housekeeping director about the cleanliness of the restrooms in front of other Lewis Center employees, (2) arguing with another employee and then detailing the incident in an e-mail to the Lewis Center’s director of operations, and (3) presenting a quality management report at an administrative meeting in a “very angry and hostile manner” and accusing management of not caring about quality standards. Plaintiff acknowledges that these various “instances of communication” occurred (J.A. at 10-11), but she contests the manner and disruptive nature of her statements as characterized by Defendant.
Following her termination, Plaintiff filed a complaint with the district court,'alleging “reverse” racial discrimination in violation of Title VII of the Civil Rights Act of 1964, 42 U.S.C. § 2000e-2(a)(l). In this complaint she requested injunctive relief ordering reinstatement of Plaintiff to her job, as well as compensatory and punitive damages. 1 Plaintiff subsequently filed an amended complaint, alleging that Defendant wrongfully terminated her for exercising her First Amendment right to free speech, and requesting “damages and other relief’ provided under 42 U.S.C. § 1983. (J.A. at 10-12.)
Discovery ensued, during which the depositions of Plaintiff and Defendant were taken. During Defendant’s deposition, she was asked. what factors contributed to Plaintiffs termination, Defendant pointed to, among other incidents, Plaintiffs August 7,1998 memo regarding the upcoming JCAH survey and patient privacy. Defendant characterized the memo as offensive, overly critical, and inaccurate.
After discovery, Defendant filed a motion for summary judgment on both of Plaintiffs claims. Plaintiff filed a memorandum in opposition, at which time she withdrew the Title VII “reverse” racial discrimination claim but opposed summary judgment on her § 1983 First Amendment claim. In support of her First Amendment claim, Plaintiff further asserted that her termination was motivated by the August 7, 1998 memorandum she sent to Defendant.
On August 23, 2001, the district court granted summary judgment to Defendant, reasoning that Plaintiffs August 7, 1998 memo to Defendant did not touch upon a matter of public concern and, therefore, Plaintiffs First Amendment claim necessarily failed. Plaintiffs timely appeal followed.
II.
Defendant first argues that, pursuant to the Eleventh Amendment, she is immune from Plaintiffs § 1983 action to the extent that the lawsuit seeks money damages. This argument presents a legal question, which we review
de novo. Timmer v. Mich. Dept of Commerce,
104 F.3d
*594
833, 836 (6th Cir.1997) (citing
Williams v. Kentucky,
In general, “[s]tate governments and entities that can be considered arms of the state are immune from suits for money damages under the Eleventh Amendment.”
Alkire v. Irving,
However, a plaintiffs failure to explicitly state “individual capacity” in the complaint is not necessarily fatal to the lawsuit. Rather, in this situation we employ a “course of proceedings” test to ascertain whether a § 1983 defendant was on notice that the plaintiff intended to hold him or her personally liable, notwithstanding the plaintiffs failure to provide explicit notice.
Id.
at 967-68 (citing
Moore v. City of Harriman,
Like the plaintiff in
Moore,
Plaintiff did request compensatory and punitive damages in the original complaint, which we have held provides some notice of her intent to hold Defendant personally liable.
See Moore,
We do note that the original complaint only alleged a Title VII violation, and the complaint was subsequently amended to add the § 1983 First Amendment claim. Although the amended complaint presented an opportunity for Plaintiff to clarify the issue, it failed to provide sufficient notice that Defendant was being sued in her individual capacity, as required by
Moore.
The amended complaint’s caption still lists Defendant’s name and official title, and the amended complaint incorporates by reference paragraphs 2-7 of the original complaint, including the statement that Defendant was being sued in her official capacity. The amended complaint is otherwise silent as to whether Defendant is being sued in her official or individual capacity. Moreover, Defendant has not moved for summary judgment on the issue of qualified immunity, yet another indication that Defendant was not adequately notified that she was being sued in her individual capacity.
See Moore,
*595 Having applied the course of proceedings test, we hold that insufficient indicia exists in the original complaint and amended complaint suggesting that Defendant was on notice that she was being sued in her individual capacity. Therefore, the Eleventh Amendment bars Plaintiffs suit to the extent that she seeks money damages. Plaintiffs claim is hereafter limited to seeking other relief arising under 42 U.S.C. § 1983. We will now proceed to the merits of Plaintiffs First Amendment claim.
III.
We review a district court’s order granting summary judgment
de novo. Johnson v. Univ. of Cincinnati,
The party bringing the summary judgment motion has the initial burden of informing the district court of the basis for its motion and identifying portions of the record that demonstrate the absence of a genuine dispute over material facts.
Mi Lebanon Pers. Care Home, Inc. v. Hoover Universal, Inc.,
In evaluating the evidence, we “draw all reasonable inferences therefrom in a light most favorable to the non-moving party.”
PDV Midwest Ref., L.L.C. v. Armada Oil & Gas Co.,
Plaintiff argues on appeal that the district court erred in granting Defendant’s motion for summary judgment because the evidence in the record, if believed, establishes that Defendant violated Plaintiffs First Amendment rights. We agree with Plaintiff and therefore reverse the district court’s dismissal of this claim.
Section 1983 provides a federal cause of action for the violations of federal statutory or constitutional rights by state officials acting under color of law.
Lomaz v. Hennosy,
*596
While public employees may not be required to sacrifice their First Amendment free speech rights in order to obtain or continue their employment,
Rankin v. McPherson,
A. Prong One: A Matter of Public Concern
The threshold inquiry is whether Plaintiffs speech addressed a matter of public concern.
Rankin,
Matters of public concern include speech that “relat[es] to any matter of political, social, or other concern to the community.”
Connick,
Along these lines, the. Supreme Court has emphasized that the employee must be speaking as a citizen, not as an employee for personal interest purposes.
Connick,
Additionally, in distinguishing between matters of public and private concern, we focus not on “what might incidentally be conveyed by the fact that the employee spoke in a certain way, [but] the
point
of the speech in question.”
Dam-brot,
In granting summary judgment to Defendant on Plaintiffs First Amendment claim, the district court determined that Plaintiffs August 7, 1998 memo did not relate to an issue of public interest or concern. 2 The district court’s entire analysis of this inquiry was as follows:
The Court does not find this letter to be of public concern. “First Amendment protection extends to a public employee’s speech when he speaks as a citizen on a matter of public concern, but does not extend to speech made in the course of acting as a public employee.” Thomson v. Scheid,977 F.2d 1017 , 1021 (6th Cir.1992). The Court finds this letter to address internal [Lewis Center] issues that were of concern to Rodgers as Director of Qualify Management, not as a citizen. As the letter does not address a matter of public concern, this Court’s inquiry is at an end.
(J.A. at 17.) We disagree with the district court’s reasoning, because this narrow interpretation of what speech addresses a public concern misinterprets the guidelines enunciated by the Supreme Court in Con-nick.
In
Connick,
Nevertheless, the district court relied on one sentence found in our decision in
Thomson v. Scheid,
First of all, a review of the facts in
Thomson
reveal that the
Thomson
court did not draw the narrow boundaries the district court attributed to it. In
Thomson,
the plaintiff was hired by the county to investigate suspected fraud by the county commissioner. During the course of his investigation, the plaintiff spoke with his supervisors about his desire to file formal charges against the county commissioner, but the supervisors warned the plaintiff not to proceed without following the established department policies and procedures. In the plaintiffs subsequent lawsuit, he pointed to this conversation with his supervisors and alleged that he was retaliated against for the statements he made during that conversation.
Thomson
began by observing that “[n]ot all matters discussed within a government office are of public concern, and thus internal office communication does not necessarily give rise to a constitutional claim.”
Id.
at 1020-21.
Thomson
then examined the speech at issue and concluded that the conversation concerned how the plaintiff would proceed with his investigation, and that the plaintiff was not speaking out in that conversation about a topic of public concern, for instance,
whether
or not an investigation should proceed. In so doing,
Thomson
correctly applied the principle that a conversation generally pertaining to an issue of public concern (in
Thomson,
the investigation of allegedly fraudulent activity) does not automatically convert all statements made in that conversation into Firsfi-Amendment-protected speech. Rather, the First Amendment inquiry requires us to examine the point of the speech in question and determine whether the point advances a public or private interest.
Dambrot,
Thus, the one sentence in Thomson on which the district court relied— “First Amendment protection extends to a public employee’s speech when he speaks as a citizen on a matter of public concern, but does not extend to speech made in the course of acting as a public employee,” id. at 1021—cannot properly be read in isolation, for it could mislead courts into believing that an employee who speaks out about a matter of public concern, while in the course of his or her employment, is never entitled to First Amendment protec *599 tion. Such a proposition is incorrect. 3
Our subsequent First Amendment jurisprudence further confirms that we have never applied such a narrow interpretation of
Connick.
In
Charvat v. Eastern Ohio Regional Wastewater Authority,
Even more recently we have expressly eschewed applying a “course of employment” gloss on the
Connick
analysis. In
Cockrel v. Shelby County School District,
Thus, in analyzing whether an employee’s speech touches upon a matter of public concern, we consistently have observed the dichotomy
Connick
presented: speaking as a
citizen
(albeit in the employee role) versus speaking as an employee
for personal interest.
As
Connick
emphasized, the focus of the speech is on the point of the speech as opposed to the role of the speaker in saying it.
See
Citing
Rahn,
In contrast to the focus of the press release in
Rahn,
the focus of Plaintiffs August 7, 1998 memo is on patient care. Plaintiffs memo described its purpose as “Survey Preparedness” and “Patient Rights and Ethics.” The memo explained that the Lewis Center would be subject to an upcoming JCAH survey, and that the last survey conducted there had found a deficiency at the Lewis Center regarding patient privacy. Plaintiffs memo then commented that patient privacy was hindered by a lack of space and that Plaintiff was “amazed” to see that some of that scarce space had been converted into a psychiatrist office. (J.A. at 139.) The memo then listed three reasons as to why this conversion was not a good decision. The first two reasons were particularly patient-oriented (the forensic units needed more space for patients who could not leave the unit and such patients needed as much “personal space” as possible), and the last reason was less patient-oriented (such a practice set a precedent for other psychiatrists to use scarce patient space). The memo concluded by emphasizing that “the patient’s needs ... should be the most important factor.” (J.A. at 139.) Although Plaintiffs underlying motive in writing the memo might have been to complain about incompetent management, our duty is not to discern her underlying motive, but rather to evaluate her point as it is presented in the speech.
Chappel v. Montgomery County Fire Prat. Dist. No. 1,
Furthermore, the focus of Plaintiffs memo pertained to a matter of political, social, or other concern. The parties do not dispute that the JCAH’s finding in its previous survey that the Lewis Center had failed to provide adequate patient space and/or privacy constituted a deficiency, or that a finding of a continuing deficiency by JCAH could mean eventual de-certification for the hospital. If the Lewis Center was in danger of being decertified, this would be an indication that the hospital (an arm of the state of Ohio) was operating with substandard care for its patients. The quality of patient care in
*601
state hospitals presents an issue of public concern.
See Jackson,
Therefore, drawing all reasonable inferences from the evidence in a light most favorable to Plaintiff,
Williams,
B. Prong Two: A Balancing of the Parties’ Interests
Because Plaintiff has successfully established that her speech touched upon an issue of public interest or concern, we now must balance Plaintiffs interest, as a citizen, in making her speech against Defendant’s interest, “as an employer, in promoting the efficiency of the public services” performed at the Lewis Center.
Rankin,
We previously have observed that in balancing an employee’s and an employer’s respective interests, we “should consider whether an employee’s comments meaningfully interfere with the performance of her duties, undermine a legitimate goal or mission of the employer, create disharmony among co-workers, impair discipline by superiors, or destroy the relationship of loyalty and trust required of confidential employees.”
Williams,
Defendant argues that Plaintiffs memo was “disruptive, inflammatory and interfered with working relationships at the Lewis Center,” and therefore the Lewis Center’s interest in promoting its efficiency overrode Plaintiffs First Amendment interests. (Defendant’s Br. at 20.) Plaintiff counters that Defendant has identified no evidence that Plaintiffs memo negatively impacted (or might have negatively impeached) the smooth operation of the Lewis Center.
We first note that Plaintiffs memo, on its face, does not appear to be particularly inflammatory. Although the memo is arguably critical of Defendant’s decision to use patient space for doctor’s offices, no abusive language is apparent and we do not discern any exceptionally insulting aspect of its presentation. Defendant notes *602 that Dr. Stewart Harris, the psychiatrist who was referred to in the August 7, 1998 memo by his union affiliation (i.e., as the “1199 psychiatrist”), filed a grievance complaining of the memo’s designation of him in this regard. However, other evidence in the record reflects that the Lewis Center fired Dr. Harris shortly thereafter for alleged sexual harassment, and there appears to be some sort of history of acrimony between Dr. Harris and the hospital which is unrelated to Plaintiff’s memo. 6 Defendant’s general assertions that the memo was disruptive are essentially con-elusory.
Although it is possible that the August 7, 1998 memo, which was carbon-copied to other employees in the department, might have, to some extent, “undermine[d] a legitimate goal or mission of the employer” in maintaining efficient operation of the hospital or “create[d] disharmony among co-workers,”
Williams,
C. Prong Three: A Substantial or Motivating Factor
Finally, an employee must demonstrate that the speech at issue represented a substantial or motivating factor in the adverse employment action.
Johnson,
The parties do not dispute that Plaintiffs August 7, 1998 memo at least played a role in Defendant’s decision to terminate Plaintiff. Indeed, Defendant identified that very memo during her deposition as a motivating factor. Therefore, Plaintiff has established a causal link between her First Amendment protected activity and her subsequent termination.
Defendant nevertheless argues that the August 7, 1998 memo could not have been a substantial or motivating factor because (1) the time period between the memo and the termination was almost six months (i.e., August 7, 1998 to January 21, 1999); and (2) several intervening incidents occurred, breaking the link. For support Defendant relies on
Wallscetti v. Fox,
IV.
For the foregoing reasons, we REVERSE the district court’s grant of summary judgment to Defendant on Plaintiffs First Amendment claim and REMAND this case to the district court for further proceedings consistent with this opinion.
Notes
. Although both Plaintiff and Defendant are white females, Plaintiff alleged in her original complaint that most of the employees at the Lewis Center were black and that she, as a "minority” in this employment setting, experienced employment discrimination.
. Because the district court found that Plaintiff failed to meet this threshold issue, it de-dined to reach the second and third prongs of the inquiry.
. We previously have clarified that
Thomson
does not stand for the proposition that the district court attributed to it. In
Williams,
. Moreover, other circuits have rejected the broader interpretation of
Connick
employed by the district court below.
See, e.g., Kennedy v. Tangipahoa Parish Library Bd. of Control,
. Although Defendant insisted in her deposition testimony that the issue of space was irrelevant to the issue of patient privacy, she also indicated that she did not think Plaintiff was lying; rather, she thought that Plaintiff was simply wrong in her opinion. We note that even if Plaintiff’s opinion ultimately proved to be incorrect, this does not deprive her statements of First Amendment protection.
See Chappel,
. Furthermore, it is unclear how Dr. Harris received a copy of the memo, inasmuch as Plaintiffs listed recipients were Defendant, Alice Gray, Paul Blackwell, and M. Russ. To the extent that Dr. Harris only received it because one or more of the recipients sent him a copy, Defendant could not have relied upon any disturbance that could not reasonably be traced back to Plaintiff, who limited her audience.
See Cockrel v. Shelby County Sch. Dist.,
