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`DANIEL HOROWITZ (SBN: 92400)
`LAW OFFICE OF DANIEL HOROWITZ
`3650 Mt. Diablo Blvd., Ste. 225
`Lafayette, CA 94549
`Telephone: (925) 283-1863
`horowitz@physiciandefense.lawyer
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`CHARLES BOND (SBN: 60611)
`PHYSICIANS’ ADVOCATES
`2033 N. Main St., Ste. 340
`Walnut Creek, Ca 94596
`Telephone: (510) 841-7500
`cb@physiciansadvocates.com
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`KARINA JOHNSON (SBN: 243099)
`c/o PHYSICIANS ADVOCATES
`2033 N. Main St., Ste. 340
`Walnut Creek, Ca 94596
`Telephone: (510) 841-7500
`kjohnsonlaw@outlook.com
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`Attorneys for Plaintiff
`Gail Mallard-Warren, M.D.
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`
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`IN THE UNITED STATES DISTRICT COURT EASTERN DISTRICT OF
`CALIFORNIA - FRESNO DIVISION
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`GAIL MALLARD-WARREN, M.D.
`Plaintiff,
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`vs.
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`SAINT AGNES MEDICAL CENTER, THE
`MEDICAL STAFF OF SAINT AGNES
`MEDICAL CENTER and TRINITY
`HEALTH INC., NANCY
`HOLLINGSWORTH, and DOES 1-100.
`Defendants
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`Case No.:
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`COMPLAINT FOR DAMAGES AND
`INJUNCTIVE RELIEF
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`JURY TRIAL DEMANDED
`(Rule 201 - Fed. R. Civ. P. 38)
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`COMPLAINT
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`COMES NOW Plaintiff, GAIL MALLARD-WARREN, M.D. and by and through her
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`attorneys as to Defendants SAINT AGNES MEDICAL CENTER, THE MEDICAL
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`STAFF OF SAINT AGNES MEDICAL CENTER, TRINITY HEALTH, NANCY
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`HOLLINGSWORTH, AND DOES 1-100, and hereby files this Complaint, alleging as
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`follows:
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`1. Dr. Gail Mallard-Warren was one of the first Black doctors in Fresno and the first
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`female surgeon at Defendant St. Agnes Medical Center (“St. Agnes”). In spite of her
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`outstanding training, when she arrived at St. Agnes in 1983, her Department Chief wasted
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`no time in telling her that he would “make her life hell.” Saint Agnes has done just that.
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`Over the years, Dr. Mallard-Warren has constantly suffered disparate treatment, harassment,
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`and a hostile work environment. She has withstood overtly sexist and racist comments (as
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`well as unwanted advances by male physicians), along with ageist and racist treatment from
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`the nurses, doctors, and hospital administration. Conversations about her – even in her
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`presence – have been riddled with microaggressions and stereotypes. Nurses call her “Gail”
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`or “hey you,” while they address other doctors - especially white males – as “Doctor
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`[Surname].” For Dr. Mallard-Warren’s first-person account of her experiences at St. Agnes
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`Medical Center, please see Exhibit A which is attached and incorporated by this reference.
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`2. At St. Agnes, the pattern of disrespect and discrimination is pervasive and extends
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`throughout the hospital — all the way up to the CEO. Dr. Mallard-Warren has been
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`presumed to be a housekeeper or an orderly. When she stands up for herself or her patients,
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`she is accused of having an “attitude.” This ongoing hostile work environment is clearly the
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`product of a corporate culture of racism and sexism - a culture Dr. Mallard-Warren wishes
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`to address head-on. When Dr. Mallard-Warren has had to advocate for herself and her
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`patients, Defendants have stereotyped her as an “angry Black woman” and have punished
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`her unjustly in an effort to silence her and discredit her. 1
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`PARTIES
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`3. Plaintiff, Dr. Gail Mallard-Warren (“Dr. Mallard-Warren”) is a Black Physician
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`specializing in Obstetrics, Gynecology, and Infertility in Fresno, California. She received
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`her B.S. from the University of California, Riverside in 1975 and her M.D. Degree from the
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`University of California, Davis in 1979. She completed her internship and residency in
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`Obstetrics and Gynecology at the University of California, San Francisco affiliated program
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`at Valley Medical Center of Fresno in 1983. She is a Diplomate of the American Board of
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`Obstetrics and Gynecology and holds memberships in the National Medical Association,
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`American Medical Association, and several other professional medical associations.
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`4. Dr. Mallard-Warren is suing on her own behalf and in her representative capacity on
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`behalf of her patients - especially her Black patients. In line with Dr. Mallard-Warren’s deep
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`spiritual beliefs, she is bringing this suit to help the Hospital and the community address and
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`resolve its problems with racial and gender discrimination. Her patients are being
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`stereotyped. She wants to help because she has witnessed Black patients at Saint Agnes
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`getting a level of care that is far, far below the care given to other patients – care that inflicts
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`unnecessary suffering and harm to patients. Dr. Mallard-Warren has witnessed the Labor
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`1 Research has shown that Black women in the United States are often victims of bias, and resultant
`aggressions, due to the pervasive trope of the “angry Black woman.” A paper published in the Iowa Law
`Review in 2017 entitled “Aggressive Encounters & White Fragility: Deconstructing the Trope of the Angry
`Black Woman” (Iowa Law Review, vol. 102, no. 5, July 2017) describes a pattern in which Black women in
`America face frequent denigration, and those who dare to challenge those actions or the underlying bias itself
`wind up being blamed. The article further comments on the “risk that if a Black woman were to challenge
`embedded assumptions, the focus would shift from the aggressor’s act to the appropriateness of the Black
`woman’s response… a Black woman who pushes back against her marginalization gets transformed by society
`into the “Angry Black Woman… The problem becomes the Black woman as opposed to the conditions to
`which she is responding” (Jones 28; emphasis added). This precise behavior has been going on at St. Agnes
`for a long time.
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`and Delivery nurses treat Black patients2 differently than other patients. They ignored Black
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`patients’ needs, choosing to treat white patients before Black patients, even though the Black
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`patients were in more urgent need of care. She has seen Black patients shoved into the
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`hallway in wheelchairs and forgotten for hours while white patients were given beds. She
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`has seen Black patients neglected, having to lie in their own filth; and she has seen care
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`withheld to Black patients and heard the nurses say things like, “Black people don’t feel
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`pain as much, so don’t give them as much painkilling medicine” or “Don’t give Black
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`patients pain medicines, they are all just addicts.” In Fresno County, a Black mother and
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`infant are three times as likely to die as white patients. The injustice of unequal care must be
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`addressed.
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`THE DEFENDANTS AND UNNAMED PARTIES
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`5. Saint Agnes Medical Center (“St. Agnes”) is a California non-profit corporation,
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` and is an affiliated corporation with Trinity Health, Inc. It operates Saint Agnes Medical
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`Center in Fresno, California. Dr. Mallard-Warren has applied for, received, and held
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`privileges to practice at St. Agnes since 1983. Saint Agnes has a pattern and practice of
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`discrimination, especially against older Black women. It is part of their larger campaign to
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`keep Black doctors and patients out of St. Agnes Medical Center. St. Agnes has over 400
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`physicians on the medical staff. Fewer than 20 are Black. Within the course of a year, St.
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`Agnes disciplined two older Black female physicians in an effort to drive them and their
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`patients away from the hospital.
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`6. The Medical Staff of Saint Agnes Medical Center (“The Medical Staff”) is a self-
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`governing organization of health providers at St. Agnes. The Medical Staff is governed by
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`2 Including Dr. Mallard-Warren’s patients on whose behalf she brings this lawsuit.
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`its Medical Executive Committee (“MEC”) which is chaired by its Chief of Staff. The
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`Medical Staff is regulated by its by-laws. In all matters, including peer review, the Medical
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`Staff is accountable to the Board of Trustees of St. Agnes, and thus was, at all times relevant
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`herein, acting as the agent of St. Agnes.
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`7. Trinity Health, Inc. (“Trinity”) is a major health corporation incorporated in
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`Indiana. Trinity owns approximately 92 hospitals and hundreds of primary, specialty and
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`continuing care centers in 22 states. It owns, operates, and controls Defendant, Saint Agnes
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`Medical Center in Fresno, California. It employs or contracts directly or indirectly other
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`persons who are identified herein. It is an affiliated corporation with St. Agnes Medical
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`Center (Cal. Corp. Code §150). All actions and conduct done by St. Agnes, its agents,
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`servants, employees, management, board, and executive team, were endorsed, ratified, and
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`adopted by Trinity.
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`8. Nancy Hollingsworth (“Hollingsworth”) is a registered nurse who functions as
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`the CEO and President of St. Agnes. She is an employee of Trinity and other corporations
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`affiliated with Trinity and St. Agnes. Nancy Hollingsworth is prohibited by law from
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`making medical decisions because she is not a licensed physician (Business & Professions
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`Code § 2052). All wrongful conduct by Nancy Hollingsworth was done in the course and
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`scope of her position as CEO and President of St. Agnes and as an agent of Trinity.
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`9. The Patient is the mother who is at the center of this case. She presented at the St.
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` Agnes Labor and Delivery Department as an extremely high-risk OB patient with a very
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`complicated case. The Patient was carrying twins, but she was only 22 or 23 weeks along in
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`her pregnancy.
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`10. Camilla Marquez, M.D. was the Chair of the OB/GYN Department at St. Agnes
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`and was the treating physician for The Patient. On June 16, 2016 Dr. Marquez attended the
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`birth of the Patient’s first twin (Twin A), but the baby did not survive. As soon as Twin A
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`was delivered, however, Dr. Marquez abandoned the patient and left on vacation to Hawaii,
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`leaving Twin B undelivered and The Patient in the Hospital. Dr. Marquez is a member of
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`Dr. Mallard-Warren’s call group, but Dr. Marquez never provided Dr. Mallard-Warren any
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`briefing or doctor-to-doctor handoff for this complicated, high-risk patient. Providing a
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`comprehensive doctor-to-doctor handoff is the standard of care in such complex cases.
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`Ironically, when Dr. Marquez came back, she led the charge in accusing Dr. Mallard-Warren
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`of wrongdoing. On the other hand, Dr. Marquez, (who is not Black), was not disciplined for
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`abandoning this patient and failing to assure that her covering doctors were informed
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`properly. Dr. Marquez is not named as a Defendant herein, but her conduct was ratified by
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`St. Agnes and the Medical Staff.
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`11. Plaintiff sues defendants Does 1-100 by their fictitious names as their true names
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` and/or capacities are presently unknown. When their true names and capacities are known,
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`plaintiff will amend this complaint to reflect the same over.
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`JURISDICTION & VENUE
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`28 U.S.C. § 1331 (Federal Question) / 28 U.S.C. § 1367 (Supplemental)
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`12. The claims that arise under 42 U.S.C. 1981 are filed in the United States District
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` Court pursuant to 28 U.S.C. § 1331 as they present a federal question. This Court has
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`supplemental jurisdiction pursuant to 42 U.S.C. 1367 over all other claims as they arise from
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`the same facts and circumstances that are contained in the claims under 42 U.S.C.
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`1981.Venue is proper as the conduct took place primarily in the city of Fresno, California.
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`DR. MALLARD-WARREN KEEPS ST. AGNES FROM REPRODUCTIVELY
`MAIMING A PATIENT AND GETS DISCIPLINED FOR IT
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`13. At 5:31 in the morning of June 19, 2016, Dr. Mallard-Warren was awakened by a
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` phone call. At the other end of the line was an inexperienced nurse from the St. Agnes
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`Labor and Delivery room who started talking about a patient Dr. Mallard-Warren had never
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`heard of before. The nurse identified the patient as being the patient of Dr. Albuquerque.
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`Dr. Mallard-Warren did not cover for Dr. Albuquerque, so Dr. Mallard-Warren did not
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`understand why she was being called about another doctor’s patient. It would have been a
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`breach of the standard of care and of medical ethics for Dr. Mallard-Warren to have taken
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`over the care of another doctor’s patient.
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`14. The nurse was ordering Dr. Mallard-Warren to come into the Hospital and perform
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`a Cesarean section on this patient. Nurses do not give orders to doctors. Normally such
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`communications are doctor-to-doctor.
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`15. Upon further questioning of the nurse, Dr. Mallard-Warren learned that the patient
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`was extraordinarily high risk, as she was only 22-23 weeks along in her pregnancy. The
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`grossly premature (22-23 weeks gestational age). For sound medical reasons, the American
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`College of Obstetrics and Gynecology advises that it is below the standard of care to
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`perform a C-section at that early gestational stage. Dr. Mallard-Warren’s personal policy
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`(consistent with these standards) is not to perform C-sections on women who are less than
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`24 weeks because the surgery reproductively maims the mother and does not significantly
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`impact infant mortality or morbidity. Instead, the standard of care in such cases is to
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`vaginally deliver the child, not to do a C-section. For these reasons, Dr. Mallard-Warren told
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`the nurse that she would not do a C-section on this patient.
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`16. Once it was established that this would be a vaginal delivery, Dr. Mallard-Warren
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` agreed to come in when it was appropriate to do so. The hospital has established protocols
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`for vaginal deliveries, whereby the nurses attend the patient until the mother is ready to
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`deliver. The nurses then call the doctor to come in and deliver the baby if it is a live birth.3
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`This was the protocol to be followed in this case; the nurse was to call Dr. Mallard-Warren
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`to come in when the delivery was imminent. That call never came.
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`17. Thus, to save a patient she had never heard of before from having unnecessary
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` surgery that would have resulted in permanent harm, Dr. Mallard-Warren had to
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`countermand the “order” from the nurse. The nurse apparently got angry that Dr. Mallard-
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`Warren didn’t obey her “order”, so she decided to “take it up the chain.” She told her
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`supervisor that Dr. Mallard-Warren was refusing to come in, which was not true. In fact, Dr.
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`Mallard-Warren told the nurse she would come in when the patient was ready to deliver
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`vaginally. The nurse attempted to amplify the urgency of the situation by telling her
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`supervisor that the doctor needed to come in because the patient was “bleeding.” In fact, one
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`of the OB/GYNs on site examined the patient and described her bleeding as “normal show.”
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`No abnormal blood loss was recorded in the patient’s medical chart and no transfusion was
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`needed. So, the nurse engaged in hyperbole – at Dr. Mallard-Warren’s expense. Rather than
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`checking the facts with Dr. Mallard-Warren, the supervisor called her boss, who in turn
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`passed the report on to the CEO of the entire hospital system, Nancy Hollingsworth. By the
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`time Hollingsworth became involved, the facts had passed through many hands and had
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`become garbled.
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`3 The commonly accepted practice at St. Agnes is that physicians are not required to attend the delivery of a
`stillborn infant. Given the gestational age of this baby and the trauma of delivery it was very possible the fetus
`would be stillborn.
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`18. The CEO immediately took the very unusual step of calling Dr. Mallard-Warren,
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`demanding that she come to the hospital and perform the C-section. Dr. Mallard -Warren
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`was taken aback that the highest-level hospital executive was trying to tell her how to treat a
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`patient, especially ordering her to do harmful surgery. Keeping in mind that Dr. Mallard-
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`Warren had just heard of this case moments before, she tried to explain her medical
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`judgments (which ultimately proved to be 100% correct). The CEO kept trying to bully Dr.
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`Mallard-Warren into performing a C-section. Dr. Mallard-Warren tried to explain that she
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`and the nurse had agreed that Dr. Mallard-Warren would come in to attend a live birth. The
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`CEO did not listen and continued to be irate that Dr. Mallard-Warren would not come into
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`the hospital to do the surgical procedure, even though the course of treatment had been
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`changed to a vaginal delivery. Dr. Mallard-Warren never refused to come in.
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`19. During their telephone conversation, the CEO threatened Dr. Mallard-Warren with
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`suspension of her hospital privileges and a disciplinary investigation. Soon after she hung
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`up, the CEO started the wheels in motion for just such an investigation. She emailed the
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`L&D nurses soliciting their complaints about the incident and asking them to comment on
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`Dr. Mallard-Warren’s “attitude.” The word “attitude” is often used as a racially charged dog
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`whistle, leaning on the trope of the “angry Black woman.” After receiving the CEO’s email,
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`the nurses made several “late entries” into the medical records.4 All were written in a tone
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`critical of Dr. Mallard-Warren. All used the phrase Dr. Mallard-Warren “refused” to come
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`in. These notes, however, contained significant inaccuracies and contradictions throughout,
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`evidencing a conspiracy against Dr. Mallard-Warren.
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`4 Nurses’ notes are supposed to be entered in real time. Notes entered later are suspect and often motivated by
`an agenda other than simply recording the medical care rendered.
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`20. The nurses in Labor and Delivery have had a longstanding bias against Dr. Mallard-
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`Warren based on her race, age, and gender. They have repeatedly filed secret complaints
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`against Dr. Mallard-Warren that were baseless and rooted in racism, sexism, and ageism.
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`21. In the telephone confrontation, the CEO did not disclose to Dr. Mallard-Warren
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`that she had already asked the two hospital-employed OB hospitalists who were on site in
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`the L&D Department to perform the C-section. Both refused. In fact, both doctors felt so
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`strongly that the procedure was inappropriate that the hospital CEO later reported that they
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`were at the bedside and “refused to do the C-Section for a 23-week gestation unless the
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`Hospital Administrator was in attendance.” This was unusually confrontational language,
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`indicating how strongly they agreed with Dr. Mallard-Warren’s medical judgement not to
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`perform a C-section. Accordingly, the hospitalists went to the Patient and got the Patient to
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`change her consent from a C-section to vaginal delivery. Shortly after the patient changed
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`her consent, she very rapidly delivered the baby vaginally. Neither of the white hospitalists
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`were disciplined for refusing to do the C-section, but Dr. Mallard-Warren was.
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`22. After hanging up with the CEO – even though she had not heard from the nurse that
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`the patient was ready to deliver – Dr. Mallard-Warren went to the hospital and arrived in
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`time to deliver the placenta.
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`23. Two months later, following up on the CEO’s threat to discipline Dr. Mallard-
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`Warren, Defendants suspended Dr. Mallard-Warren’s privileges. Summary suspensions are
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`supposed to be used in cases where a doctor poses a risk of imminent patient harm. The fact
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`that it took two months for the hospital to act (during which time Dr. Mallard-Warren held
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`complete privileges without incident) is evidence that there was no real threat that could
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`Case 1:21-at-00969 Document 1 Filed 10/15/21 Page 11 of 46
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`possibly be labeled “imminent” – especially since the underlying facts in this case were very
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`unusual and the outcome was completely as expected.
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`24. The suspension was initially imposed for ten (10) days, during which time Dr.
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`Mallard-Warren was summoned before the Medical Executive Committee of the hospital
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`medical staff to explain. Dr. Mallard-Warren had not been provided the medical records of
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`the incident when she initially met with Medical Staff representatives on August 8, 2016 and
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`was expected to talk from memory about events that had occurred almost two months
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`before. In her meeting before the Medical Executive Committee, she was unaware of the
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`criticisms in the notes or the fact that they were “LE” (late entries). In a meeting with the
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`MEC, she affirmed the medical correctness of her decision not to perform a C-section,
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`because it would cause permanent harm the patient. In spite of the fact that she was right,
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`and the patient suffered no harm or unexpected outcome, the Executive Committee extended
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`the suspension to thirty (30) days — because Dr. Mallard-Warren was “unrepentant.”
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`25. That extension carried with it huge consequences for Dr. Mallard-Warren. Any
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`suspension lasting 30 days gets reported to the National Practitioner Data Bank. The NPDB
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`was intended to be a national database of disciplined and malpracticing doctors, i.e. “bad
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`doctors.” A report to the Data Bank is a serious stain on a doctor’s reputation, and it carries
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`significant economic consequences. Every credentialing body (i.e. any institution looking
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`into the doctor’s background) is required by law to check with the Data Bank to see if the
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`doctor has been disciplined. The average doctor fills out about twelve (12) credentialing
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`applications per year. This includes applications for hospital medical staff privileges, state
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`medical licensure, specialty board certification, medical society memberships, malpractice
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`insurance, etc. All must check the Data Bank. Most importantly, health insurers and health
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`Physicians’ Advocates
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`plans must check the Data Bank before adding a doctor to their panel of participating or
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`“contracting” physicians. Some health insurers automatically exclude doctors with a Data
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`Bank entry (e.g. Anthem/Blue Cross). A Data Bank entry is never erased, so the doctor lives
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`with a lifelong stigma that has to be explained every time they fill out a credentialing
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`application. A 30-day summary suspension, therefore, not only deprives a doctor of access
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`to the hospital where she makes her living (especially an OB/GYN), but it can also carry
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`with it lifelong reputational and economic harm.
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`26. The Chair of the Hospital Obstetrics Department, Dr. Marquez, (who happened
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`to be the doctor who abandoned the patient to go on vacation) was a member of the MEC.
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`Dr. Marquez went to Dr. Mallard-Warren and told her that if she would just confess and say
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`that she should have come in when she was called, the Committee would roll back the
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`suspension to fifteen (15) days so it would not be reportable. This was unadulterated
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`extortion.5 To escape allegations of extortion the hospital has claimed that Dr. Marquez was
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`not acting in her official capacity as Department Chair or as a Committee member, but to
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`Dr. Mallard-Warren she sure did seem like she had the power and official sanction to coerce
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`a confession. The proof that Dr. Marquez’s maneuver was extortive is that when Dr.
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`Mallard-Warren furnished what Dr. Marquez wanted, the Committee did what Dr. Marquez
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`said they would do and rolled back the suspension. The extorted confession was a carefully
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`orchestrated effort to get Dr. Mallard-Warren to accept all the blame and extract the hospital
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`from liability.
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`5 Extortion is the “obtaining of property or other consideration from another, with his or her consent, induced
`by a wrongful use of force or fear, or under cover of official right” (Penal Code 878).
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`27. Simultaneously, Hospital counsel sent Dr. Mallard-Warren’s attorney a blanket
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`release and expected Dr. Mallard-Warren would sign it on a take-it-or-leave-it basis, and the
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`Chief of Staff also approached Dr. Mallard-Warren directly with an attorney-prepared
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`release and told her she had to sign it. She did not. When put in its factual context, this is
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`just another example of the Hospital’s abuse of its power in its shameful treatment of Dr.
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`Mallard-Warren.
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`DEFENDANTS’ EXTORTIONATE BEHAVIOR FORCES DR. MALLARD-
`WARREN TO SEEK A HEARING TO CLEAR HER NAME
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`28. After Dr. Mallard-Warren did not sign the release, Defendants refused to confirm
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`or deny whether Dr. Mallard-Warren’s suspension was rolled back to the non-reportable
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`fifteen (15) days. This left Dr. Mallard-Warren in serious procedural limbo: the Medical
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`Staff Bylaws require the physician to request a hearing within thirty (30) days of the
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`suspension or forever lose her right to pursue any administrative remedy or seek any remedy
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`in a court of law.6 By the Hospital hiding the ball, Dr. Mallard-Warren had no choice but to
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`request a hearing. Since that time, as a part of its discriminatory scheme to drive her from
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`the Medical Staff, the Hospital has made the hearing process as unfair and oppressive as
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`possible.
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`29. The Business and Professions Code § 809 et seq. and the Medical Staff Bylaws
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`guarantee physicians who are disciplined the right to clear their name in a prompt, fair
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`hearing. Because she never got a straight answer as to the length of her discipline or its
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`reportability, Dr. Mallard-Warren had to demand her right to have a hearing. It has now
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`6 Bylaws of the Medical Staff of Saint Agnes Medical Center 7.3-1(f)
`(Amended and Restated Effective: January 27, 2012)
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`Case 1:21-at-00969 Document 1 Filed 10/15/21 Page 14 of 46
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`been over six years since the events, and Defendants have not even been able to
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`assemble a fair panel of doctors to serve on the Judicial Review Committee. Hence the
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`hearing to clear Dr. Mallard-Warren’s name has not even started. All the while, her
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`reputation has been damaged by the hospital’s discriminatory discipline.
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`30. On August 24, 2016, the MEC voted to limit Dr. Mallard-Warren’s suspension to
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`14 days, but they did not tell Dr. Mallard-Warren. A suspension of 14 days or less does not
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`have to be reported to the Medical Board or the National Practitioner Data Bank. The
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`National Practitioners’ Data Bank (NPDB) is a federal data base that identifies doctors who
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`have a history of malpractice or medical discipline.
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`31. The consequences of such reporting can be devastating to the doctor's reputation
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`and career. Obviously, a report to the Medical Board could place her license to practice
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`medicine in jeopardy. At a minimum it would trigger an investigation by the Board that she
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`would have to defend and disclose on all future applications, regardless of the outcome.7
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`32. Similarly, a report to the Data Bank creates a stain on the physician's reputation
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`that can never be erased. The Data Bank must be consulted by virtually all bodies
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`credentialling Dr. Mallard- Warren in the future. Reporting, therefore, can create a cascade
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`of problems for a physician. Adverse reports can imperil privileges at other hospitals,
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`participation in payor panels, the underwriting and premiums for the doctor's malpractice
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`insurance, membership in medical organizations, especially specialty societies, continued
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`qualification for Board certification, etc.
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`33. Reporting is the single most powerful way to disrupt and even destroy a
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`7 The average physician fills out about 12 applications per year. Almost all applications now require the doctor
`to self-disclose whether she has been the subject of any Medical Board investigations—regardless of whether
`the Board takes any action or not.
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`Physicians’ Advocates
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`Case 1:21-at-00969 Document 1 Filed 10/15/21 Page 15 of 46
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`doctor's career. The monetary loss to the doctor can be incalculable, but the psychological
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`toll is always devastating. Thus, anyone who threatens to report a doctor to these
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`administrative agencies wields a heavy weapon capable of instilling real and palpable fear in
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`the hearts and minds of all reasonable physicians. The threat of reportable discipline is
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`overwhelmingly intimidating to a physician.
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`34. On August 24, 2016, the Chief of Staff, Dr. Sandhu, called Dr. Mallard-Warren.
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`Without telling her that the MEC had already voted to limit her suspension to the non-
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`reportable 14 days, he issued Dr. Mallard-Warren a clear ultimatum. He said that the MEC
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`would be willing to shorten the suspension to 14 days (thereby avoiding any reporting to the
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`Medical Board and NPDB) if she would sign a Release of all Claims that very same day. Dr.
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`Sandhu went on to say that the "lawyers" were finalizing the document and he would get it
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`to her for her signature that day. He was very insistent that she sign the Release that same
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`day if she wanted the suspension to be nonreportable. Because of Dr. Sandhu' s official
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`position as Chief of Staff, she understood him to be issuing an ultimatum: If she wanted the
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`suspension not to be reported she had to sign the Release. Dr. Sandhu made it clear that the
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`Release was offered on a take-it-or-leave-it basis. A Release extinguishes any claims for
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`monetary or other relief Dr. Mallard-Warren might have aga