Sentencia de Tribunal Apelativo de 14 de Septiembre de 2018, número de resolución KLRA201800097
| Emisor | Tribunal Apelativo |
| Número de resolución | KLRA201800097 |
| Tipo de recurso | Recursos de revisión administrativa |
| Fecha de Resolución | 14 de Septiembre de 2018 |
| Dr. CÉSAR GÓMEZ RUIZ Recurrente v. RECINTO DE CIENCIAS MÉDICAS de la UNIVERSIDAD de PUERTO RICO Recurrido | | REVISIÓN procedente de la Universidad de Puerto Rico, Junta de Gobierno Apelación Adm.: JG-17-03 |
Panel integrado por su presidenta, la Jueza Jiménez Velázquez, la Jueza Cintrón Cintrón y la Juez Rivera Marchand.
Cintrón Cintrón, Jueza Ponente
En San Juan, Puerto Rico, a 14 de septiembre de 2018.
El Dr. César Gómez Ruiz (Recurrente) nos solicita la revocación de la decisión administrativa del Recinto de Ciencias Médicas de la Universidad de Puerto Rico (UPR) que rechazó promoverlo al tercer año de residencia en el Programa de Cirugía.
Con el beneficio del alegato de la UPR, y al amparo del marco fáctico-jurídico que a continuación esbozamos, resolvemos confirmar la determinación administrativa de la UPR.
Según surge del expediente, el 3 de mayo de 2013 el Recurrente fue admitido al Programa de Cirugía de Ciencias Médicas como residente categórico.
Para su continuidad en el Programa, tenía que cumplir con todos los requerimientos reglamentarios y las evaluaciones de desempeño durante un periodo de 5 años.[1] Tanto en la misiva de admisión como en el Contrato de Residencia, el Recurrente fue advertido de que su desempeño general sería evaluado, y que la renovación anual del contrato y su continuidad en el programa promoción al próximo año de residencia dependían del resultado de sus evaluaciones. Específicamente, al Recurrente se le informó lo siguiente:
Your continuation in our Program will be bound to your general performance (general surgery knowledge, diagnostic acumen, problem solving skills, attendance and availability, surgical skills, interpersonal skills and overall evaluation). Enclosed is a copy of the evaluation form that will be used to monitor your performance. Failure to approve one of these areas will put you in probation status or prevent promotion or continuation as a categorical resident. We will be contacting you in the near future to discuss the promotion requirements of the training program. (énfasis suplido) Misiva de admisión, Apéndice del Recurrente, pág. 791.
EVALUACIÓN
DIEZ Y SIETE: La Segunda Parte [el Recurrente] se someterá al proceso de evaluación vigente, el cual será notificado a comienzo del año (académico) en forma regular y de acuerdo a las normas establecidas en el Programa donde realiza su adiestramiento. Este contrato se renovará solo en aquellos casos donde la Segunda Parte evidencie en sus evaluaciones aprovechamiento y progreso en conocimiento destrezas y actitudes conmensurables a su nivel de adiestramiento, a satisfacción del Comité de Evaluación y Promoción Departamental y del Director del Programa de Adiestramiento en dicho Departamento, para poder ser promovido de año. (énfasis suplido) Contrato de residencia, Id., pág.
1042.
En lo aquí pertinente, del expediente ante nuestra consideración, en particular las evaluaciones del Recurrente, se desprende que desde sus inicios en el Programa de Cirugía (julio de 2013) el Recurrente presentó problemas con su desempeño. Las evaluaciones utilizadas por el Programa de Cirugía son: pruebas de desempeño ABSITE (American Board of Surgery In-Training Examination); Hitos (Milestones); E-Value (luego de cada rotación); Evaluaciones 360 (anónimas por pacientes, familiares y otro personal de salud); evaluaciones de pares; Evaluaciones Bianuales.[2] Para una mejor compresión del caso, a continuación explicamos los fundamentos del sistema evaluativo del Programa de Cirugía.
El Departamento de Cirugía[3] es acreditado por el American Council for Graduate Medical Education (ACGME). En el Common Program Requirements el ACGME establece los estándares y procedimientos que debe observar el Departamento de Cirugía para ser acreditado. Entre estos figuran las destrezas de los estudiantes residentes y sus evaluaciones, para lo cual, el Departamento de Cirugía tiene que aprobar normas y procedimientos.
En ese orden, el Departamento de Cirugía cuenta con el Housestaff Manual (Manual General[4]) y el Residency Training Program (Manual de Cirugía[5]). El Manual General aplica a todos los residentes de distintos departamentos, mientras que el Manual de Cirugía aplica sólo a los residentes del Departamento de Cirugía. A continuación citamos varias disposiciones pertinentes:
RESIDENTS EVALUATION
Formative Evaluation
1. The faculty must evaluate resident performance in a timely manner during each rotation or similar educational assignment, and document this evaluation at completion of the assignment.
2. The program must:
Provide objective assessments of competence in patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.
Use multiple evaluators (e.g., faculty, peers, patients, self, and other professional staff).
Document progressive resident performance improvement appropriate to educational level.
Provide each resident with documented semiannual evaluation of performance with feedback.
The evaluations of resident performance must be accessible for review by the resident, in accordance with institutional policy. (énfasis suplido) Apéndice de la UPR, pág. 394.
PROMOTION OF FELLOWS AND RESIDENTS
All residents/fellows enter into annual contracts with the University of Puerto Rico School of Medicine, regardless of the expected duration of their training program. Residents will be promoted from each level of training after satisfying all requirements for that training level, and offered subsequent annual contracts through program completion unless:
They are dismissed or their contracts are not renewed based on academic performance which is below satisfactory.
They are dismissed or their contracts are not renewed based on non-academic behavioral violations.
Their residency/fellowship program is reduced in size or closed. (énfasis suplido) Id., pág. 397.
TRAINING GRIEVANCE POLICY AND PROCEDURE
[ ]
PROCEDURAL GUIDELINES
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Preliminary Academic Actions
Program directors are encouraged to use the following preliminary measures to resolve minor instances of poor performance or misconduct. If these preliminary measures are unsuccessful the Program Director may initiate formal disciplinary actions.
Report Letter
[ ]
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Formal Disciplinary Actions
Causes
Formal disciplinary action may be taken for any appropriate reason, including but not limited to any of the following:
Failure to satisfy the academic or clinical requirement or standards of the training program.
Professional incompetence, misconduct or conduct that might be inconsistent with or harmful to patient care and/or safety
Conduct which calls into question the professional qualifications, ethics, or judgment of the trainee, or which could prove detrimental to patients, employees, staff, or volunteers
Violation of the policies or procedures of the any participating institution, or applicable department, section or training program
Scientific misconduct
Procedures:
Formal disciplinary actions may include but are not limited to
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Probation
[ ]
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Suspension
[ ]
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Dismissal
Dismissal occurs when the trainee is permanently withdrawn of all institutional responsibilities and privileges. The trainee has the right to request formal review of the dismissal decision. Written notice of the dismissal must include the reasons for the decision and the effective date. The Program Director must send a written notification to the Department Chair and the DIO.
The Program Director shall have the authority to dismiss a trainee from training program for reasonable cause, including but not limited to:
a) [ ]
d) Failure to achieve or maintain programmatic requirements or standards in the GME training program. (énfasis suplido) Id., págs. 398-401.
Junior Resident: [ ]
In order for a resident to be promoted to the next level of training, he/she must be competent in the six competencies: knowledge, patient care, communication skills, professionalism, practice based learning and improvement, and system based practice. Failure to perform average or above in any of this competencies, will be reason enough to deny promotion. No resident is allowed to repeat the same level of training.
All categorical residents will take the annual ABSITE test. The Program expects that each resident will perform close to, or above national average. Also, there should be a progressive improvement in the standard score as he/she progresses in level of training. Failure to perform as expected in the ABSITE will result in academic warning. If poor performance recurs, probation status will follow. If poor performance occurs for a third time, the Program Director may not recommend the resident to the American Board of Surgery for the board exam. The years of training will be certified.
[ ]
INTERMEDIATE RESIDENTS:
PGY-2:
[ ]
There are 5 categorical PGY-2 positions and a variable number ranging from 6-8 preliminary positions. Promotion to PGY-2 preliminary positions is not automatic as the commitment to provide training to these residents is on a yearly basis. The residents will be evaluated according to the competencies established by the ACGME, and ABSITE performance. (énfasis suplido) Id., págs. 422-424.
Asimismo, los Common Program Requirements del ACGME establecen que los residentes deberán ser evaluados en las siguientes 6 áreas de competencias: Patient Care and Procedural Skills; Medical Knowledge; Practice-Based Learning and Improvement; Interpersonal and Communication Skills; Professionalism; Systems-Based Practice.[6] Los instrumentos de evaluación, además de los que la UPR apruebe de conformidad con los principios del ACGME, son: evaluaciones luego de cada...
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