Dr. Dennar’s Open Letter

Below is the email Dr. Dennar sent to President Fitts and her colleagues on February 16, 2021

Dear President Fitts,

Tulane has now publicly released two inaccurate and misleading statements about my February 11th position and teaching termination. As a result, thereof and because I was only given until February 17th to respond to the dense 47-page Graduate Medical Education Committee (GMEC) Special Review Report first given to me on February 11th, I write to correct several errors, including some from your letter.

  • Tulane told the public that the GMEC review was “automatic” because the program as to which I was director, Medicine-Pediatrics, was placed on continued accreditation with a warning status.  That statement is false as the Review was not “automatic”. Moreover, the Medicine-Pediatrics program was not on “accreditation with warning” on the date my position was terminated.  ACGME removed the Medicine-Pediatrics from continued accreditation warning before I was advised of the termination of my position.

  • Jeffrey Wiese, a Caucasian male, whose conduct I challenge in my complaints and lawsuit was the Program Director of Internal Medicine. His program was also placed on continued accreditation with warning.  Yet, Dr. Wiese’s program was not subject to a GMEC review, and Dr. Weise’s position as Program Director was not terminated.

  • The 47-page report contends that I was given an opportunity to review the report before it was finalized.  While that is a policy requirement, IT NEVER HAPPENED. Tulane did not perform as it was required.  As you know, I was only given until February 17, 2021, to respond to the 47-page GMEC report even though I received it on February 11, 2021. 

  • The 47 pages of the Special Review report were filled with errors from the beginning to the end, including, as noted above, stating that the report was shared with me then submitted to GMEC for approval.

  • Your letter represents that there are four similar circumstances involving termination of a program director whose program was placed on continued accreditation with a warning status.  Neither you nor Tulane’s public statement informs anyone of the fact that ACGME had removed the Med-Peds program from continued accreditation with warning as of January 22, 2021, more than two weeks before I was advised of my termination as Program Director on February 11th.

  • Your public letter claims I have a right to appeal the decision.  No policy document I know of provides for an appeal.  On the contrary, Dean Hamm’s letter to me informing me of my termination and his statements to me confirm that I only have a right to respond to this fait accompli. It was never suggested that I have a right to appeal.

  • I was replaced by a Caucasian woman when my immediate Associate Program Directors were each a woman of color.  While this should have raised questions about the suppression of opportunities for a woman of color, it did not.

I address certain issues related to the report below.  However, this is not my comprehensive response to that report.

For full transparency, the following is the series of events that occurred regarding ACGME and Tulane’s Special Review conducted by GMEC:

  1. Jan 2018– A Med Peds resident wrote to Accreditation Council for Graduate Medical Education (ACGME) regarding work hour limits violations and safety concerns relating to the IM caps on patient census and new patient admissions in the Internal Medicine Department.

2. April 2018– Seven Black female Med-Peds residents filed an egregious complaint against members of the Internal Medicine (IM) and GME leadership with ACGME and Tulane’s Office of Institutional Equity (OIE), that focused on (1) racial and gender discrimination in regards to Med-Peds residents’ rotation schedules in comparison to Internal Medicine (IM) residents (2) patient safety concerns with work hour violations (3) procedure monitoring concerns that affected our vulnerable patient population and (4) lack of authority of the Med-Peds Program Director. 

3. April 2018– I filed a complaint with ACGME as outlined in my lawsuit.

4. June 2018– ACGME extended a site visit to both the IM and Med-Peds residency and opined that there were (1) violations with extended duty hours in the Internal Medicine department, (2) lack of monitoring in the Internal Medicine department, and (3) an overburdening of the Med-Peds residency program and deficiencies in certain rotations. Also, the lack of authority of the Combined Med-Peds Program Director and Dr. Jeffrey Wiese’s conflict due to his holding both the DIO (Designated Institutional Official) position and Internal Medicine Program Directorship were identified as core issues. All of the aforesaid caused both programs (both IM and Med-Peds) and the hospital itself to receive citations and the status of continued accreditation with warning status. Some corrective actions were put in place and summarized in the ACGME citation responses in ACGME webads.

5. Oct 2019– ACGME conducted a hospital site visit from which GME attempted to exclude me, which prompted my Oct 20, 2019 letter to you asking for help.

6. Dec 2019– ACGME conducted a follow-up site visit (and not what is known as an “egregious site visit” follow-up which should have occurred) for both Internal Medicine and Med Peds residency programs.

7. April 2020- ACGME issued citations, which resulted in continued accreditation with warning status to the Med-Peds Residency.  One of the reasons for the core requirement citation that resulted in the continued “warning status” to the Med-Peds Residency program was my refusal to change my response to the citation issued by ACGME regarding the Program Director’s authority. In good conscience, I could not state that the current Med-Peds Program Director—meaning I, had sufficient authority and resources to enact any required changes to the combined program. I call to your attention that I was provided neither the authority nor the resources to manage the Med-Peds Program because of my race and gender and as an act of retaliation.

8. April 2020- GME revised the policy for who initiates a special review. According to the 2019-2020 GME Resident and Staff Policies and Procedures Handbook, the DIO may select, with GMEC’s approval, any program for special review based on certain criteria. However, the updated April 2020 policy conveniently removed the DIO’s name to now state that any member of the GMEC can nominate a program to undergo a special review based on certain criteria.

9. June 2020– Tulane’s GMEC decided to conduct its internal review of the Med-Peds program after IM was taken off the continued accreditation with a warning status. The manner for which the special review was conducted included mandating an interview with individual residents in isolation after some of them had already been interviewed as a group was irregular and deviation from normal procedures. It is from those isolated interviews (absent any witnesses) that Tulane alleges that there were reasons to remove me from this position.

10. Dec 2020– I testified in a lawsuit brought by a former Med-Peds resident who filed claims in federal court against Dr. Wiese, Dean Hamm, and Tulane for race and gender discrimination and retaliation while she was resident in the Med-Peds residency program.

11. Jan 2021– ACGME officially removed Tulane’s Med-Peds from the warning status on Jan 22, 2021.

12. Jan 2021– Individuals from GMEC electronically signed on various days the inaccurate Special Review Report. For the record, Tulane has not provided transparency on their definition of “diverse” and exactly who they are defining as my peer. The Special Review report had errors as noted above, the report stated that the final report was shared with me then submitted to GMEC for approval. While that would have been the normal process, it did not occur.  I received the report for the first time on Feb 11, 2021, a few hours after Dean Hamm informed me that I had been “relieved of my administrative duties as program director and clinical teaching responsibilities.” The fact that the entire review committee agreed to a report that made this fundamental error, unfortunately, suggests much about the committee’s work.

13. Feb 2021– On Monday before my dismissal, I sent an email to both the IM and Peds Chairs about continuous acts of intimidation and discrimination. In my mandatory Chair monthly meetings that I am punitively forced to attend, after reporting my concerns to ACGME, I requested a discussion on racism to the proposed agenda items.  I did so knowing that a Black female Pediatrics resident, who had been suffering silently from race and gender bullying, approached me for help several weeks back. For the record, she was emotionally assaulted by someone who maliciously left an opened dirty condom in her bag (left in the call room) one night when working in the hospital. The response to her from our institution was similarly inadequate.

As I stated in my Oct 2019 letter to you, “the system (including the Office of Institutional Equity) that we currently have in place to investigate and mitigate discriminatory practices in our medical institution is broken and conflictual, and the collateral damage is consequential.”  We have seen the devastation of systemic and personally mediated racism in the healthcare system, especially highlighted by the COVID pandemic.

Thus far, Tulane’s response has been unabashedly self-serving, dismissing the truth about racism and sexism at Tulane. Tulane’s Special Report, as it contains both sexist and racist undertones and stereotypes towards several Black female physicians, is problematic and embodies and perpetuates an indefensible double standard. The report itself is an affront to the truth. 

President Fitts, you have at this critical juncture an opportunity to make a palpable change at Tulane by starting to right the injustice that has been done to me and many others. Unfortunately, I do not believe racism and sexism can conveniently wait until you have a “deepened understanding” of the Black experience at Tulane or until the fall of 2021 schedule as you suggest in your recent letter to the community. While I understand that this might be an uncomfortable letter that might evoke an uncomfortable experience when reading it, you must understand that living through “misogynoir” at Tulane is even more uncomfortable.

Please accept this open letter as a response to the Feb 11, 2021 letter from Dean Hamm and the GMEC Special Review due on Feb 17, 2021. I look forward to a fair and progressive response to justice.

Sincerely,

PD

Princess E. Dennar, MD, FAAP, FACP, CCHC
Program Director, Tulane Medicine/Pediatric Residency Program (in protest)
Medical Director, Tulane Internal Medicine & PCAT Clinic at UMCNO
Clinical Assistant Professor of Internal Medicine and Pediatrics 
Tulane University School of Medicine
1430 Tulane Avenue, #8716 
New Orleans, LA  70112 

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