A recent case brought by female physicians against Yale University highlights the difficulty of disentangling an academic medical center from a university when assessing the reach of Title IX of the Education Amendment Act of 1972.[1]  Title IX prohibits sex-based discrimination in “any educational program or activity receiving Federal financial assistance.”  20 U.S.C. § 1681(a).  The District Court of Connecticut’s conclusion that academic medical centers are subject to Title IX reflects a growing trend among courts and highlights the legal exposure of academically affiliated hospitals.

Female Physicians File Lawsuit Based on Sex Discrimination and Retaliation by Resident Supervisor

A group of female physicians (“Plaintiffs”) brought an action against Yale University (“Yale”), Yale New Haven Hospital, Inc. (“the Hospital”), and the resident supervisor at the Hospital for sex discrimination and retaliation in violation of Title VII of the Civil Rights Act of 1964, 42 U.S.C. § 2000e, and Title IX.[2]

Plaintiffs – all female doctors in the Yale Department of Anesthesiology and involved with the residency program at the Hospital – alleged that their supervisor sexually harassed them by “making inappropriate and sexualized comments, forcibly touching and kissing them, and professionally punishing them for speaking out.”[3]  The offensive behavior was similar towards all of the women, and included, for example, the following: unwanted hugging, kissing, and touching; whispered sexual advances, particularly when alone with the women; and aggressive behavior and professional retaliation following rebuffed advances.[4]  According to Plaintiffs, Yale and the Hospital “turned a blind eye” to the supervisor’s actions and instead elevated him to the Vice Chair of Diversity, Equity, and Inclusion of the Department, despite repeated complaints about the supervisor’s own behavior.[5]

Defendants moved to dismiss Plaintiffs’ lawsuit on various grounds, including: (1) Title IX does not apply to the Hospital, an entity “not principally engaged in the business of education”; (2) Title IX does not provide a private remedy based on sex; (3) Plaintiffs did not establish that the Hospital had “actual notice of the alleged wrongdoing”; and (4) several of the women’s relationships to an educational program or activity were “too attenuated to entitle them to Title IX coverage.”[6] 

Title IX Applies to Academic Medical Centers When Certain Factors Are Met

The court found that Plaintiffs adequately pled facts to demonstrate that the Hospital – a teaching hospital that receives federal funds for its residency program – is subject to the requirements of Title IX.  In rejecting the Hospital’s argument that academic medical centers are not postsecondary institutions, the court pointed to the “clear comment given by the Department of Education that ‘Congress did not exempt academic medical centers that receive Federal financial assistance from Title IX’” and a “factual determination” is necessary to determine Title IX’s applicability.[7] 

To evaluate the educational nature of the Hospital’s residency and fellowship programs, the court looked to a series of factors that federal appellate courts have used to determine the “educational nature” of a program or activity:

the structure of the program, including the involvement of instructors and inclusion of examinations or formal evaluations; whether tuition is required; the benefits conferred through the program, such as degrees, diplomas, or other certifications; the ‘primary purpose’ of the program; and whether regulators accrediting the institution ‘hold it out as educational in nature.’[8]

With these factors as a backdrop, the following allegations, among others, convinced the court to conclude that the Hospital is subject to Title IX:

• Yale and the Hospital have a “contractual arrangement formally integrating” the Hospital with Yale to share both staff and resources;

• instructors at the Hospital are employed by both Yale and the Hospital;

• the Hospital receives federal funding because of its status as a “teaching hospital”; and

• the Hospital’s website boasts that it is the “‘primary teaching hospital of Yale School of Medicine,’” thereby affiliating itself with Yale and holding itself out to the public as an educational institution.[9]

Accordingly, Plaintiffs pled sufficient facts to survive the Hospital’s motion to dismiss their Title IX claims.

Employees of Educational Institutions May Bring A Lawsuit for Sex-Based Discrimination Under Title IX, Even If They Also Seek Remedies Under Title VII

The court also addressed whether Title IX provides a private right of action for employment discrimination based on sex – an issue not yet tackled by the Second Circuit.  In the absence of controlling precedent, the court approached its analysis grounded in the primary purpose of Title IX’s private right of action: it is an “enforcement tool used to hold educational institutions accountable for their actions.”[10]  As such, the “educational nature of the employer, not the position of the litigant, determines its applicability.”[11]  The court ultimately construed Title IX “with the breadth intended by Congress,” and held that “employees of educational programs may bring suit against their federally-funded employers for sex-based discrimination, including retaliation, even if they could also seek remedy by suit under Title VII.”[12]

The potential overlap between Title IX and Title VII’s private rights of action did not deter the court because “the enforcement mechanisms of each statute apply to different categories of employers and serve independent ends.”[13]  Specifically, Title VII provides a means for individual employees to challenge the discriminatory actions of their employers, while Title IX “encompasses both individual redress and systemwide compliance by recipients of federal funds.”[14]  The court therefore rejected Yale and the Hospital’s argument that Title IX does not allow for a private right of action for employment discrimination based on sex.

Yale and the Hospital May Have Had “Actual Notice” of the Title IX Violations

Yale and the Hospital’s attempts to escape liability by blaming the other for lack of notice of the Title IX violations fared no better.  To succeed under a Title IX claim, a plaintiff must demonstrate, among other things, that “the educational program or activity was deliberately indifferent to the alleged discrimination.”[15]  The Hospital insisted that it did not have actual notice of the supervisor’s abusive behavior because Plaintiffs either failed to make any complaints or only informed Yale staff and faculty members, rather than the Hospital staff.[16]  Yale relied on the same arguments, alleging that Plaintiffs either failed to make a complaint or only complained to members of the Hospital staff.

Plaintiffs, on the other hand, alleged that they made complaints to individuals who were employed by both Yale and the Hospital and were persons of authority at both institutions.[17]  In addition, the Hospital’s employee handbook directed residents and fellows to file harassment complaints through Yale.  Because “both institutions could be at fault,” the court denied dismissal on these grounds.[18]

Attending Physicians May Pursue Title IX Claims

The court also rejected an argument by the Hospital that its relationship with three of the attending physician-plaintiffs was too attenuated to sustain claims against the Hospital under Title IX.  As these Plaintiffs were employed by the Hospital and served as faculty members of Yale who participated in the residency program at the Hospital, the court could not “disentangle[]” their relationship with the Hospital from the Hospital’s relationship with Yale.[19]  Accordingly, the court denied the Hospital’s motion to dismiss on this basis.

Take-Away

The relationship between a university and an academic medical center is complex and the line between the two institutions is not always clear.  As courts increasingly find that Title IX applies to academic medical centers, universities and teaching hospitals alike should work to promote policies to properly handle discrimination and retaliation claims arising from residency and fellowship programs.  Implementing a robust system for evaluating such claims on the front-end will help avoid litigation that would otherwise be difficult to successfully defend with a motion to dismiss in light of the factual determinations necessary to assess the connection between a university and an academic medical center.