The Graduate Medical Education Compliance Project (GMECP)

Rice v. St. Louis University, et al.

Dr. Rice is a PGY-5 (5th year) surgery resident at St. Louis University (SLU) Medical School. She filed suit on August 25, 2017, alleging, in part, breach of contract, defamation, and violation of multiple evaluation procedures as set forth by the ACGME and the University itself. The crux of her case centers on the argument that Dr. Rice is being remediated to repeat her fourth year of residency by her program director, Dr. Wittgen, not on the basis of objective data, on her many attending surgeon faculty evaluations (which do not support the remediation), or on the prescribed evaluation and promotion procedures set forth in established requirements, but rather based on Dr. Wittgen’s personal opinions of Dr. Rice – that she is “too much of a nurse” (a reference to Dr. Rice’s first career as a pediatric critical care and air transport nurse) and “too nice” to become a surgeon – and on hearsay accusations, such as the claim that Dr. Rice had left clinic and abandoned her resident responsibilities to go shopping at the mall (which she adamantly denies).

Dr. Rice alleges that these subjective opinions and hearsay about her were used in lieu of the necessary objective evaluation and promotion processes (despite her months-long attempts via written communications with attendings and university leadership, as well as many faculty interviews requested by her, to obtain any evidence that would explain Dr. Wittgen’s negative findings against her), that these opinions and hearsay were purposefully spread among faculty in order to create a case against her for remediation and to harm her reputation, that multiple levels of university leadership were blatantly dismissive of the violations that Dr. Rice pointed out to them, and that false statements were also purposefully made against her by the trauma surgery director, Dr. Freeman, in support of the program director’s agenda to hold back Dr. Rice. These allegations may be read in full in the Rice v. SLU petition.

Among additional allegations against the defendants, such as disruptive physician behavior and retaliation, Dr. Rice points to a letter crafted by Dr. Freeman in which he writes a false “consensus” opinion for all of the trauma surgeons regarding Dr. Rice’s rotations with them, and concludes for them all that Dr. Rice should be remediated. Dr. Rice rebuts those findings with specific data and formal, positive and contradictory evaluations submitted by multiple of those same trauma attendings who are supposed to be of Dr. Freeman’s consensus. In that rebuttal, Exhibit 9, Dr. Rice requests evidences for his “consensus” findings. As is custom in the surgery department, the negative findings would never be justified. Of note, Dr. Rice reports that one of the trauma attendings confided to her that Dr. Wittgen had met with them prior to the rotations in question to inform them all of Dr. Wittgen’s personal opinions of Dr. Rice and her performance. This attending reported commenting with another, “What did Dr. Rice do to get on Dr. Wittgen’s bad side?” Dr. Rice alleges that this is just one example of Dr. Wittgen’s efforts to build a case against her, to taint the opinions of other faculty in the program, and to retaliate against her for standing up for herself.

Dr. Rice’s specific allegations span almost a year and describe the defendants’ violations, their refusals to conform to required processes, and their avoidance of her requests for substantiation of multiple severe critiques which are in contradiction of the mass of actual positive evaluations. In the petition, she provides a glimpse into the exposure of additional offenses as revealed to her by other faculty and her fellow residents, at times unwittingly, and other times surreptitiously, in whistle blower fashion.

It will be interesting to observe St. Louis University’s response to the legal action. Will it entrench itself, attack the resident, support the faculty in question, and perpetuate the purported dysfunctions? Will it condone the described disruptive behavior or clearly repudiate it? Will it excuse the failures to comply with the procedures, policies and processes upon which it must maintain its residency programs’ accreditations (and subsequently the Medicare GME funding for which accreditation is a prerequisite)? Are these violations restricted to and contained within the surgery department, or are they systemic? How many other residents have experienced similar violations, unjustified remediation, or retaliation, but are too busy, broke, overwhelmed and/or intimidated to speak out and fight back? What happens if there are a few more residents that surface who have similar stories,… or perhaps a dozen more? What are the litigation risks for the University? And why has it refused to acknowledge them prior? Can the leadership claim ignorance, even in the face of multiple prior ACGME investigations and reports of disruptive physician behavior? What is SLU Hospital’s legal exposure? How can institutions which purport to champion the high moral, religious, and humanistic principles outlined in their mission statements appear to be entirely indifferent to, or incapable of, correcting the wrongdoing that is repeatedly revealed to them?

Update, 15 Sept 2018: Now, over a year has passed since Dr. Rice filed her petition against SLU. The general surgery program did not offer her a contract for her final year of residency, 2018-2019. On review of public records at, some of the case details can be followed (by any member of the public – reiterated for the lawyers). The judge has quashed any of Dr. Rice’s requested depositions from any SLU witnesses or parties to date, and denied Dr. Rice’s subpoenas of ACGME materials that might support her case against SLU. Meanwhile, SLU has been granted subpoenas for their desired ACGME materials. SLU’s deposition of a non-party individual was apparently not quashed. SLU has been granted “letters rogatory” in order to collect out-of-state information about Dr. Rice, been granted a waiver to access spousal privilege into Dr. Rice’s and her husband’s communications, and has requested access to Dr. Rice’s psychological testing and counseling. Meanwhile, multiple set trial dates have been postponed.

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