This Date in UCSF History: Former Surgery Resident Wins Discrimination Suit

Originally published in Synapse on March 3, 1983. In what may be a landmark case for women and minorities in residency training programs was decided in San Francisco last month.

Dr. Ramona Tascoe, a black woman physician, was awarded $225,000 by a U.S. District Court jury for her suit based on illegal discrimination, defamation, violation of due process, intentional infliction of emotional distress, and discriminatory retaliation, which she charged had occurred while she was a resident in the surgery program at Highland Hospital.

Tascoe, a UCSF graduate, dates the onset of problems at Highland to October 1980, when she was a second year resident (Post-Graduate Year II) in the surgery program.

She had done a rotating internship at Highland and then entered the general surgery residency, planning to acquire one or two years of background training in general surgery before going on to complete her training for a career in obstetrics and gynecology (Ob/Gyn) as a specialist in fertility microsurgery.

During the first months of her PGYII year, Dr. Buford Burch, then Chief of Surgery at Highland, wrote a letter or recommendation for Tascoe, remarking that “She has outstanding manual dexterity and excellent judgment... good knowledge of current literature and a great capacity for work and maintains excellent relationships with colleagues and nurses.”

According to Tascoe, during those months Burch “was extremely ingratiating with me to the point that he made remarks that I certainly considered sexually harassing — but they weren’t so harassing that I felt the need to report it to anybody.

“I felt that it was appropriate just to tell him ‘I’m not interested in that; please stop doing this... I want to be treated just like the other surgery residents’,” she said.

Also in October that year, Tascoe — at that time the only woman in the surgery I residency program — decided that she wanted to complete the full five-year training program in general surgery before going on to additional Ob/Gyn training.

She informed Burch at this time, she told Synapse, of her intention to become board-certified in both fields and of her ambition to become someday the director of Highland’s Ob/Gyn department.

According to Tascoe, Burch responded by questioning her ability to accomplish her goals because of her responsibility to her family. (Tascoe’s daughter was 4 years old at the time.)

Temporary demotion

Tascoe charged that subsequent to these events, she was demoted to role of an intern on the surgery team, and that her decision-making authority on the team was undercut in such a way that both patient care and the quality of her clinical training were adversely affected.

“There will always be times when the patient care and the staffing might be such that you’ll have to do things that you wouldn’t ordinarily expect to do as part of your job assignment,” she said. But “that wasn’t the issue. I was the only resident who was asked to serve as an intern and to have the interns treat me as an intern,” she stated.

Tascoe approached the chief resident about the situation.

He sent her to talk to Burch, whose response to her complaints, according to Tascoe, was that,

“He came from the old school and the chief resident came from the old school and that the old school was going to dictate the operation of the program, and to that extent I was going to have to learn to ‘eat it.’”

It was following this meeting that Tascoe felt she “began to be perceived as a woman in surgery who was going to cause trouble,” she said.

In early December of that year, she received an anonymous note under her call room door referring to her as a “n***** bitch.”

That same day she noticed that her housestaff photograph had been defaced.

She also received a call from Burch that day in which Burch told her that he had been thinking of transferring her to a different service because the chief resident wasn’t pleased with her attitude.

But he had changed his mind because none of the other services wanted her.

This accumulation of events led Tascoe to approach the hospital administration.

“I told them I didn’t know whether all the events that were going on were racially related. I felt that some of them were certainly sexually related.

“Because of it, I felt that I was being set up for termination based on discrimination,” she said.

Burch’s behavior had changed over the months, according to Tascoe.

“Initially he was very ingratiating and supportive — ‘we want you in, you’re wonderful, you’re charming, you’re delightful, I find it difficult to be objective with you’… In the operating room, brushing into my breasts and making overly solicitous apologies… and continuing these apologies out in the hallway so that everybody could hear that he bumped into my breasts.

“He went from that type of behavior to ‘Well you’re a mother, you have a husband, you have a child, how do you square that with being a surgeon?’

“He told me, ‘If you stayed in surgery you would have to don a pair of 10-ton balls to make it in this program, and you’re too much of a lady to do that,’” Tascoe said.

In January of 1981, Tascoe asked Burch whether she would be continued in the program the following year.

When he told her that all the positions had been filled, she filed a complaint with the Equal Employment Opportunity Commission (EEOC).

More trouble

After filing the complaint, charged Tascoe, her car was tampered with and she received threatening phone calls.

“I was told not to sleep at night because fires burned; I was told when I left the hospital to make sure to look over my shoulder,” she told Synapse.

Also, from that time on, said Tascoe, she was isolated from her colleagues: they no longer socialized with her, and she was not informed when conferences and meetings were held.

And then in March 1981, according to court records, Burch wrote to Dr. Robert Cooper, deputy director of Alameda County Health Care Services Agency.

“It is my considered opinion that retaining Dr. Tascoe will have an adverse effect on the training of other physicians in the program… she is almost universally disliked and feared for her vindictiveness by both junior and senior residents…

“It is my professional opinion that Dr. Tascoe does not meet the minimal standards of our program, especially in her relationsips (sic) with attending and housestaff,” he wrote.

Court records also show that Cooper apparently disagreed. He responded to Burch.

“I believe it would be in the best interests of the program, Highland Hospital, the Agency, and the County if she (Dr. Tascoe)… were offered positions in that program.

“I do not believe staff physicians and house officers generally are likely to fear any junior housestaff officer, and I do not believe that the surgery program is so fragile that severe harm will result from the inclusion in it of a junior house officer whose documented performance to date is such as that of Dr. Tascoe.”

Burch versus the administration

According to Timothy Murphy, attorney for Burch, Highland and the Alameda County Health Care Service Agency, after Burch made the decision not to retain Tascoe, Cooper and Dr.

Tom Miller (director of Clinical Services and Medical Education at Highland) wanted to expand the program and offer her a spot.

But “Dr. Burch took the position that as director of the program, he had an obligation to make all decisions” regarding retention of the surgery residents, said Murphy.

“He was concerned about the effect on the program if administrators at the hospital were making these decisions.”

According to the attorney, Burch feared that the Residency Review Committee would react adversely to this and that the accreditation of the program would be jeopardized.

The jury in the ensuing trial, said Murphy, was strongly influenced by this ongoing dispute between Burch and hospital and county administrators over whether to retain Tascoe.

Burch, Miller, Cooper, and Alameda County, all defendants named in the suit, have not decided whether they will appeal the verdict.

John Burris, an attorney for Tascoe, suspects that an appeal will not be filed.

“It would only increase the size of the damages and delay the inevitable,” he said.

“They don’t have a substantial basis on which an appeal would be granted. It was clear that different criteria were applied to Dr. Tascoe in the selection process.”

But Murphy has defended Burch’s record on recruitment and retention of minorities and women.

“He took over a program that was all white males,” Murphy said.

“He actively recruited blacks, Asians, and women with children. He offered positions and promotions to a number of women at the PGYII and PGYIII level, but they decided to go elsewhere.”

(Tascoe was offered, and she rejected, in April 1981, a PGYII position in the surgery program. She felt that it was not a bona fide offer, she said, and that discrimination against her would continue.)

Tascoe left her position at Highland in early June, after spending her last month in the program at Livermore Hospital (an affiliate of the Highland program).

She had hoped to make a fresh start at the new hospital, but according to Tascoe, Burch had contacted the surgery department there ahead of time, making allegations that prevented her from being treated fairly by the Livermore staff.

After leaving the Highland program, Tascoe received a telephone offer for a position in the Oakland Kaiser Ob/Gyn program.

Although she expressed interest, several days later — after the head of the program made routine inquiries to the surgery program at Highland — the offer was withdrawn.

Tascoe was hospitalized in intensive care with toxic shock syndrome later that June.

She had several relapses in the ensuing year and only now feels that she is regaining her former health.

Her recurrent bouts of toxic shock have left her with a mild sensory loss in her hands, which, if it persists, may prevent her from doing microsurgery.

She has not decided on future career plans, but states that under no circumstances will she return to Highland.

“The worst of the emotional distress was when I realized that my reputation had been so seriously impugned that the guys hated me, and that their hate for me was predicated on Burch’s libel.

“The options that I had to continue to achieve as a professional were gone… you can’t dream those kinds of dreams with the reputation he made me appear to have.”

Burch left Highland Hospital in October 1981.

He now is Director of the Residency Training Program at the Veterans Administration Hospital in Saginaw, Michigan.

He was not available for comment.

The verdict in the Ramona Tascoe case has broad implications, according to attorney Burris.

Training programs will have to be more careful to use objective standards in the selection process, and to establish due process mechanisms for those who feel they have been discriminated against, he predicted.

Residency programs must realize that they “cannot arbitrarily and capriciously make decisions affecting someone’s career.”

If she had it to do over again, she would not have conducted herself differently, Tascoe said.

“Being a physician does not mean so much to me that I am willing to put some basic sense of integrity, what’s right and what’s wrong, aside just so I can call myself a doctor, because I’ve got to live with myself day in and day out.

“In your residency training if your rights are abused you have a responsibility to yourself, to your colleagues, and to the medical profession to exercise your rights,” she said.

“I don’t want to be perceived as a women’s libber waving a banner for women’s rights, but I do want to be perceived as somebody who had a basic sense of fairness, who has a sense of self respect and dignity.”

Read about the celebrated career that lay ahead for Dr. Ramona Tascoe here.