Health Law Daily Wrap Up, HEALTH CARE EMPLOYMENT ISSUES—6th Cir.: Doctor’s performance issues, paranoid behavior justified FTD exam, (Jul 22, 2026)

By Kathleen Kapusta, J.D.

The doctor’s colleagues, citing instances where he claimed he was being watched or that hospital administration was out to get him, described him as paranoid.

A hospital did not violate the ADA when it suspended the clinical privileges of a doctor and conditioned their reinstatement on a fitness-for-duty (FTD) evaluation, the Sixth Circuit ruled in an unpublished opinion affirming summary judgment against his claims. A combination of documented performance shortfalls and behavioral red flags gave the hospital’s executive committee reasonable grounds to question whether the doctor was still capable of performing his job, said the court, finding the decision to require the exam was both job-related and consistent with business necessity (Robitaille v. Trinity Health Grand Rapids, No. 25-2154 (6th Cir. July 20, 2026, unpublished)).

When an unplanned disruption of the hospital’s computer systems occurred in 2023, the doctor pressed management for additional safety protocols for system outages. During a December staff meeting, he interrupted colleagues to discuss his concerns and appeared agitated and frustrated to the point where the hospital’s chief medical officer (CMO) asked him to step outside.

Doctor’s conduct. The doctor refused and the CMO referred the matter to HR, which determined that the doctor’s conduct did not align with hospital standards. The hospital’s peer review body, the practitioner committee, conducted its own investigation and similarly concluded that the doctor’s professionalism did not meet hospital expectations.

Paranoia. The staff continued over the following months to report concerns, including that the doctor appeared increasingly hesitant to handle complex cases, refused to treat patients on several occasions, struggled to manage his assigned rooms, and became increasingly guarded and uncommunicative. Colleagues also described him as increasingly paranoid and noted that he claimed he was being watched or that hospital administrators were out to get him and the head of anesthesiology specifically noted that his paranoia was affecting his ability to see patients and his conduct was “becoming quite burdensome” to the department.

Suspension. As concerns escalated, the practitioner committee asked the doctor to explain certain patient-care choices including instances in which he refused to provide care. The head of anesthesiology ultimately suspended his clinical privileges in February 2024. The hospital’s executive committee not only upheld the suspension, but also the committee conditioned any reconsideration of the suspension on the doctor completing an FTD involving both drug testing and a forensic psychiatric evaluation.

Although the doctor took the drug test, which was negative, he refused the psychiatric evaluation and when his privileges were set to expire, the executive committee denied reappointment. The doctor subsequently sued under the ADA and the district granted summary judgment to the hospital.

Prohibited medical inquiry. On appeal, the doctor first argued that the FTD was a prohibited medical inquiry. After assuming without deciding that the drug test went beyond illegal substances and could be categorized as a medical examination, the court found the executive committee had a reasonable basis to require both components of the examination.

In upholding the suspension, the executive committee reviewed the anesthesiology head’s report on the doctor’s performance issues and behavior, including her own experiences and interactions with him as well as concerns from numerous staff members. The report detailed his hesitation to perform routine tasks, avoidance of higher-risk patients, and inability to handle the standard caseload along with his paranoid ideation. Noting that the doctor practiced anesthesiology, the court found that these performance concerns were inextricably linked with patient safety.

This combination of documented performance shortfalls and behavioral red flags, said the court, gave the executive committee reasonable grounds to question both whether the doctor was still capable of performing his job and whether he posed a direct threat to patient safety. Because the executive committee reasonably sought to rule out underlying impairments related to substance abuse or mental health that could be hindering his fitness to practice, its decision to require the medical examination was job-related and consistent with business necessity, the court stated.

Single decisionmaker. While the doctor argued that circuit precedent requires a single decisionmaker in ADA medical-examination claims and that the district court thus erred in focusing on the collective decision of the executive committee, this, said the court, “imports a new requirement into our caselaw.” The court noted that past decisions have explained that “the individual who decides to require a medical examination must have a reasonable belief based on objective evidence that the employee’s behavior threatens a vital function of the business.” But this statement, the court explained, simply describes what it takes to form a “reasonable belief” and does not restrict the medical-examination decision to a single individual.

Pretext. The court also rejected the doctor’s assertion that a pretext analysis is allowed in medical examination cases. In support, he cited the Sixth Circuit’s 2019 decision in Babb v Maryville Anesthesiologists PC. That decision, however, evaluated whether an employer’s termination decision was pretextual and did not involve an ADA medical-examination claim.

And even if pretext were relevant, in arguing that the medical examination request was motivated solely by his patient advocacy in the December staff meeting, the doctor failed to address the executive committee’s reliance on months’ worth of subsequent performance and behavior issues as well as his failure to cooperate with the practitioner committee. Those issues, said the court, provided the executive committee with an intervening, nonretaliatory basis to order the exam.

Nor was the court persuaded by the doctor’s assertion the hospital’s shifting rationale for his suspension showed pretext. The hospital, he argued, cited “disruptive behavior” as the rationale for his suspension, not “paranoia” and, in his view, disruptive behavior would not “necessitate intervention by a psychiatrist” whereas paranoia would. Thus, he claimed, the hospital’s current focus on paranoia was a post-hoc justification for the psychiatric exam.

Noting that paranoid behavior can be disruptive and that multiple staff members and the executive committee characterized his odd behavior as disruptive, the court affirmed summary judgment on his medical evaluation claim.

Retaliation. Finally, as to the doctor’s retaliation claim, in which he argued that refusing to take the psychiatric examination was per se protected activity, the court noted that because it found the hospital’s request did not violate the ADA, this claim failed.

The case is No. 25-2154.

Judge: Hermandorfer, W.

Attorneys: Bradley Kurt Glazier (Cunningham Dalman) for Joseph Christophe Isaac Robitaille. David A. French (Hall, Render, Killian, Heath & Lyman) for Trinity Health Grand Rapids.

Companies: Trinity Health Grand Rapids

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