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Civil Rights

Brown v. Gaalla, 460 Fed. Appx. 469 (5th Cir. 2012)

Also under Hospitals, Medical Staff

Outcome:     Very favorable


The issue in this case was whether the individual defendants were entitled to governmental immunity against a claim that a county-owned hospital abridged the medical staff privileges of the plaintiff cardiologists on account of their race and national origin.

AMA interest

The AMA opposes race and national origin discrimination against physicians, and it opposes the consideration of factors other than the best interests of patients in the granting of medical staff privileges.

Case summary

Three cardiologists, all of whom were of Asiatic Indian origin, held medical staff privileges at Citizens Medical Center (CMC), a county-owned hospital located in Victoria, Texas.  Until 2007, the Indian cardiologists regularly admitted patients and exercised their privileges at CMC without problem.  At that time, however, CMC hired a cardiovascular surgeon as an employed physician.  The Indian cardiologists refused to refer their patients to the cardiovascular surgeon, contending that he had a high mortality rate and performed unnecessary surgeries.

At about the same time, CMC brought several new cardiologists of non-Indian origin onto its medical staff.  The new cardiologists were CMC employees , while the Indian employees were not.  The new cardiologists referred all of their cardiology surgery patients to the CMC cardiovascular surgeon.

Friction between the Indian cardiologists and CMC continued to escalate.  In February 2010, the CMC Board of Directors, acting pursuant to the advice of an independent consultant, “closed” the cardiology department to the Indian cardiologists.  The cardiology department was open only to employed physicians on the CMC staff.

On February 24, 2010, the Indian cardiologists sued CMC, its Board of Directors, its CEO, and one of the non-Indian cardiologists.  On August 6, 2010, the Indian cardiologists filed a second amended complaint, which alleged that the reduction of their medical staff privileges had been motivated by ethnic discrimination, as well as economic reasons.  They claimed constitutional violations of substantive and procedural due process, equal protection of the laws, and various common law rights.


The defendants moved for summary judgment on the basis of governmental immunity.  They alleged that the decision to reduce the Indian cardiologists’ privileges had been based on the best interests of the county and CMC, rather than ethnic discrimination.  However, the trial court denied the motion, in part, finding evidence of ethnic discrimination.  That evidence included a 2007 memo from the CMC CEO which stated, “I feel a sense of disgust but am more concerned with what this means to the future of the hospital as more of our Middle Eastern born physicians demand leadership roles and demand influence over situations that are hospital issues…..[This] will change the entire complexion of the hospital and create a level of fear among our employees.”

The defendants other than CMC brought an interlocutory appeal of the denial of their motion for summary judgment.  They contended that there had been no reduction of the Indian cardiologists’ property interests or violation of their constitutionally protected rights.

On January 13, 2012, the Fifth Circuit partially affirmed and partially reversed the trial court’s denial of summary judgment.  The court ruled that the plaintiffs do not have a valid claim for denial of due process, but they could sue for violation of their equal protection rights.  The case was remanded to the trial court.

Ultimately the parties settled, with the defendants paying the plaintiff physicians approximately $8 million.

Litigation Center involvement

The Litigation Center, along with the Texas Medical Association and the American Association of Physicians of Indian Origin, filed an amicus brief supporting the plaintiff cardiologists in the appeal.  The brief argued that medical staff privileges are valuable rights, protectable under federal law against ethnic origin discrimination.

United States Court of Appeals for the Fifth Circuit brief.

Fields v. Smith, 653 F.3d 550 (7th Cir. 2011)

Also under Gay, Lesbian, Bisexual, Transsexual Rights

Outcome:     Very favorable


The issue in this case was whether a Wisconsin law that prohibited prison doctors from using hormonal therapy or sex reassignment surgery to treat inmates with gender identity disorder (GID) caused the inmates to suffer cruel and unusual punishment under the Eighth Amendment or deprived them of equal protection of the laws under the Fourteenth Amendment.

AMA Interest

The AMA supports the provision of competent medical care for all patients, and it opposes limiting medical treatment options because of moral idiosyncrasies or social stigmas.

Case Summary

Persons suffering from GID feel that their physical sexual characteristics are the opposite of their internal sexual identity.  Thus, a GID sufferer is a man trapped in a woman’s body or vice versa. In addition to feeling depressed and frustrated, a sufferer may attempt self-mutilation or suicide.

A Wisconsin law prohibited prison doctors from using hormonal therapy or sex reassignment surgery to treat inmates with GID, regardless of the medical necessity of such therapies and regardless of the resultant disruption or financial cost to the prison system from withholding the therapy.  Several inmates in Wisconsin prisons sued to have the law declared facially unconstitutional.  Following an evidentiary hearing, the trial court judge found that the law violated the Eighth and Fourteenth Amendments.

The State of Wisconsin appealed to the Seventh Circuit.  The Seventh Circuit affirmed, holding that it would be cruel and unusual punishment, in violation of the Eighth Amendment, to withhold hormone therapy or sex reassignment surgery from prisoners with acute GID.

AMA Involvement

The AMA filed an amicus brief in the Seventh Circuit to support the prisoners.

Seventh Circuit Brief

Fisher v. University of Texas at Austin (S.Ct.)

758 F.3d 633 (5th Cir. 2014), 133 S.Ct. 2411 (2013)

Also under Medical Education

Outcome of first Supreme Court decision:    Highly favorable


The principal issue in this case is the extent to which the University of Texas can consider the race of applicants in determining qualifications for admission.

AMA interest

In order to reduce racial disparities in health outcomes, the AMA supports improved diversity in medical education.

Case summary

Abigail Fisher, who was white, applied to but was rejected from the University of Texas undergraduate college.  She then sued the university, asserting that the school preferred African-American students over whites and that she would have been accepted if the racial preferences had not been in place.  In 2013, the Supreme Court held that the University of Texas could use racial preferences in its admission decisions, but only under limited circumstances.  It remanded the case for determination of whether those limited circumstances applied in this case.

On remand, the lower federal courts found that the University of Texas had applied the specified limited circumstances which the Supreme Court had elucidated.  Thus, the denial of Ms. Fischer’s application was justified.  The Supreme Court  again granted certiorari, to review this finding.  Oral argument was heard on December 9, 2015.

AMA involvement

Prior to the first Fisher ruling, the AMA, along with the American Association of Medical Colleges and numerous other organizations, filed an amicus brief, which argued, in support of the University of Texas, that racial diversity is a vital component of a successful medical education and that medical school admission officers should be allowed to consider applicants’ race in order to achieve the schools’ educational goals.  The same organizations filed a second amicus brief in the present appeal, along much the same lines as  in the earlier amicus brief.

First United States Supreme Court brief

Second United States Supreme Court brief