Ms J was a certified adult nurse practitioner (NP) in her state when Dr C, an infectious disease specialist, hired her. Under a collaborative practice agreement, Ms J’s job was to assist in communicating with patients, gathering patient information, and conducting prerounds at hospitals.

After several months of work, it became apparent to Ms J that the position was not a good fit for her. She decided to wait until she had worked for a year before she gave notice. Dr C seemed happy with her work, as evidenced by positive performance reviews he provided to the hospitals where Ms J had practice privileges.

When Ms J had been employed for about a year, Dr C prepared a performance review for her, rating her “excellent” in every category and stating that there had been no complaints about her. The next day, Ms J was offered a job with a competing infectious disease specialty practice that she thought was a better fit. She gave Dr C a resignation letter, allowing for 3 weeks’ notice as required by their agreement.

Dr C did not take the news well. He seemed shocked and surprised at Ms J’s desire to leave “a wonderful working relationship.” Dr C met with Ms J twice after receiving the resignation letter. During the first meeting, which occurred the week she had given notice, he tried to convince her to stay with his practice. Ms J declined. The second meeting took place after Dr C discovered that Ms J would be going to a competitor. It was at this meeting that he showed her a letter criticizing her professional competence, work commitment, and moral character. He implied that he was going to send this letter to the state Nursing Board and to others and suggested that Ms J might want to reconsider her decision to leave the practice.


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Ms J did not reconsider. Dr C sent the letter to the state Nursing Board and the hospitals at which Ms J had privileges. The letter triggered an investigation by the Nursing Board and resulted in temporary suspension of her privileges at the hospitals.

Dr C defended the letter to the Nursing Board, claiming that he rated Ms J “excellent” in her evaluation in error and had meant that evaluation for a different NP.

After a 9-month investigation and review, the Nursing Board dismissed the complaint against Ms J, finding no evidence of any wrongdoing on her part.

However, Ms J’s new employer had not wanted to hire her while a Nursing Board investigation was going on, so she was out of work for almost a year. After the Nursing Board’s decision, Ms J hired a plaintiff’s attorney and sued Dr C for defamation.

The case went to a full jury trial, during which it was determined that the physician’s statements about Ms J were false and had been harmful to her career. The jury did not agree with Dr C’s argument that the letter was not designed to negatively affect Ms J but to protect her future patients.

At the end of the trial, the jury found for Ms J and awarded her $150,000 for damage to her professional reputation caused by the false statements in the letter. Dr C declared bankruptcy and sought to have his debts, including the judgment owed to Ms J, discharged under Chapter 11 of the US Bankruptcy Code. Ms J appealed to the US Bankruptcy Court asking it to find the debt nondischargeable.

The Court Decision

The court noted that Section 523(a)(6) of the Bankruptcy Code excepts debts from discharge for “willful and malicious injury by the debtor to another entity or to the property of another entity.” To prevail, it must be shown that the debtor (Dr C): “1) deliberately and intentionally, 2) injured the plaintiff or the plaintiff ’s property; 3) by a willful and malicious act.” The Court pointed out that willfulness and malice are separate and distinct. Willfulness implies intentional behavior; malice connotes a malevolent purpose.

The court noted that most of the facts were established in the defamation trial and that these facts established that Dr C deliberately and intentionally injured Ms J’s career, reputation, and prospects. The only thing to determine was whether the false statements were made “willfully and maliciously.”

The court held that, as to the willfulness prong, Dr C deliberately wrote the letter, initially as a threat to get Ms J to stay in his employ, and then sent it to the Board of Nursing and the hospitals at which Ms J practiced. Dr C, the court noted, is a highly intelligent individual and knew exactly what would happen when he sent that letter — an investigation would start and Ms J might lose her license and practice privileges. They agreed that statements were made willfully.

Dr C also acted maliciously in sending the letter, according to the court. He made false and defamatory statements intended to harm Ms J. The statements were not made for some altruistic purpose of helping future patients, as he claimed, but rather they were made in anger because Ms J was leaving to work for a competitor. The court held that Dr C’s actions were willful, malicious, and deliberately caused harm to Ms J’s professional reputation and, thus, the debt Dr C owed to Ms J could not be discharged by bankruptcy.

Protecting Yourself

This scenario took years to unfold. The original events took place in 2005, yet this decision by the Bankruptcy Court occurred in 2020. Legal actions can be agonizingly protracted.

It is always best to act professionally. Dr C reacted poorly, immediately, and emotionally to the news that his employee was leaving. He compounded his unprofessional response by threatening Ms J with a letter containing false information. When the threat itself did not work, he followed through. Was he entitled to feel upset that a valued employee was leaving? Yes. But that should have been the extent of it. Everything he did after that was unprofessional and wrong.

Ann W. Latner, JD, a former criminal defense attorney, is a freelance medical writer in Port Washington, New York.