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Nelson v. Advocate Bethany Hospital and Advocate Health & Hospital Corp.

November 23, 2009


The opinion of the court was delivered by: Matthew F. Kennelly, District Judge


Ruthie Nelson filed this action against Advocate Bethany Hospital and Advocate Health & Hospital Corporation (Advocate) under Title VII of the Civil Rights Act of 1964, 42 U.S.C. § 2000e-5. Nelson, who was employed by Advocate as a nurse in its Continuity of Care Department, alleges that her supervisor, Audrey Young-Lee, discriminated against her on the basis of her skin color. Advocate has moved for summary judgment, and for the reasons stated below, the Court grants the motion.


On a motion for summary judgment, the Court draws "all reasonable inferences from undisputed facts in favor of the nonmoving party and [views] the disputed evidence in the light most favorable to the nonmoving party." Harney v. Speedway SuperAmerica, LLC, 556 F.3d 1099, 1104 (7th Cir. 2009). The Court takes the following facts from the plaintiff's complaint and from the parties' statements of facts as to which there is no material dispute.

Advocate Bethany Hospital (Bethany) is a Long Term Acute Care Hospital that provides care for patients with complex medical conditions requiring a long hospital stay. On November 13, 2006, Nelson began working at Bethany as a Case Manager in the Continuity of Care Department (COCD).

Organization of the COCD

At the time Nelson was hired, the COCD had a total of four employees: three case managers and one social worker. The case managers were Audrey Young-Lane (who was also the head of the department and Nelson's supervisor), Pamela Smith, and Nelson. Brenda Bragg was and continues to be the social worker for the COCD and the entire Bethany facility. All four COCD employees are African-American women.

The COCD is responsible for monitoring patients from admission to discharge, including insuring that patients are properly admitted to and retained at Bethany. The COCD also arranges for post-hospital care for patients upon discharge.

COCD case managers have several job responsibilities, including working with physicians, nurses and social workers to ensure quality patient care; planning for and assisting with timely discharge of patients; reviewing patient admissions and the files of current patients to ensure they are eligible for the kind of services Bethany provides; interacting with external review agencies to assure compliance with regulations affecting financial reimbursement to the hospital; consulting with and educating patients, families, and staff; and participating in multi-disciplinary team meetings. The social worker is responsible for providing social services to patients, providing discharge planning, assessing the need for social services, reporting known or suspected patient abuse to the appropriate protection agencies, and documenting and reporting her work with patients.

To initially determine a patient's eligibility for Bethany's services, a case manager conducts a pre-admission review comparing the doctor's initial assessment of the patient to the criteria for eligibility laid out in InterQual, a book that establishes the standards for determining whether a patient qualifies for admission to a long term acute care hospital. If the patient is admitted, the case manager thereafter conducts concurrent/continued stay reviews, using InterQual criteria, every seven days. As the patient approaches the anticipated end of his or her stay, these concurrent/continued stay reviews become more frequent, so that the patient can be discharged as soon as possible. Each case manager in the COCD, including Nelson, was trained in the pre-admission and patient review procedures. Because Pamela Smith was particularly proficient in pre-admission reviews, she was assigned to perform most pre-admission duties.

At the time Nelson was hired, Young-Lane allocated patient assignments to the various COCD case managers based on building units or floors. In or around June 2007, Bethany administrators asked Young-Lane to change how she assigned patients to case managers, requesting that she do so on a "product line" basis (i.e., based on the insurance carrier of a particular patient) instead of on a unit or floor basis. Young-Lane did so, and as a result the caseloads for Nelson and the other case managers changed. Shortly after this reorganization, Advocate changed the job title for all case managers in COCD to "Utilization Review Nurse." In or around November 2007, Young-Lane again adjusted COCD case assignments. The June and the November changes resulted in changed responsibilities for all members of the COCD.

Nelson's Performance Reviews

Advocate conducts ninety-day reviews of newly hired employees. Employees receive one of four ratings: exceeds expectations, meets expectations, approaching expectations, or does not meet expectations. Nelson's ninety-day performance review was completed by Young-Lane on February 12, 2007. Young-Lane gave Nelson a rating of "meets expectations" but noted that Nelson required more time to master the pre-admission process, had difficulty adapting to change and multiple or shifting priorities, and occasionally failed to foster trust and respect within the team. Young-Lane scheduled a follow-up evaluation for thirty days later based on these concerns. Nelson, pursuant to an Advocate process, filed a rebuttal of her ninety-day performance evaluation, contesting Young-Lane's observations. At the thirty-day follow -up review, Nelson again received a rating of "meets expectations."

In the fall of 2007, Advocate's corporate offices conducted an audit of Bethany and identified several concurrent/continued stay reviews that did not meet InterQual criteria. Around the same time, Advocate Health Partners, one of the commercial insurance carriers that worked with Bethany, complained that several of its patients' concurrent/continued stay reviews were untimely or improper. Young-Lane, after investigating, believed that Nelson had performed all the reviews at ...

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