Clay, Pamela R. v. Holy Cross Hospital ( 2001 )


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  • In the
    United States Court of Appeals
    For the Seventh Circuit
    No. 00-2916
    Pamela R. Clay,
    Plaintiff-Appellant,
    v.
    Holy Cross Hospital,
    Defendant-Appellee.
    Appeal from the United States District Court
    for the Northern District of Illinois, Eastern Division.
    No. 99 C 3835--James F. Holderman, Judge.
    Argued February 16, 2001--Decided June 14, 2001
    Before Easterbrook, Manion, and Diane P.
    Wood, Circuit Judges.
    Manion, Circuit Judge. Dr. Pamela Clay
    sued her former employer, Holy Cross
    Hospital, alleging that the Hospital
    terminated her because of her pregnancy
    in violation of Title VII. The Hospital
    moved for summary judgment. The district
    court granted the motion, concluding that
    Clay failed to demonstrate that the
    Hospital’s legitimate, non-discriminatory
    reason for her termination was a pretext
    for discrimination (the Hospital
    administration asserted that Clay failed
    to demonstrate the dedication necessary
    to grow her practice into a profitable
    enterprise). Clay appeals./1 We affirm.
    I.
    Holy Cross Hospital is located in
    Chicago, Illinois. In 1992, the Hospital
    embarked on a plan to create a
    Neighborhood Affiliate Network
    ("Network") of primary care physicians
    who would practice in offices in the
    community surrounding the Hospital. The
    Hospital’s strategy was to subsidize the
    network of physicians with
    guaranteedsalaries until their practices
    matured into profitable enterprises, thus
    eliminating the need for the Hospital’s
    subsidy. A Practice Management Department
    managed the daily operations of the
    Network. Bill Seliga, the Hospital’s Vice
    President of Practice Management, headed
    the Practice Management Department and
    reported directly to the Hospital’s Chief
    Executive Officer, Mark Clement.
    The Hospital hired its first physician
    for the Network in 1993. From the
    beginning of the Network’s creation,
    Clement explained to the Network’s
    physicians that they were expected to
    "hustle" to build a profitable practice
    because, at some point, they would be on
    their own.
    In June 1996, the Hospital hired Dr.
    Pamela Clay to work as a pediatrician at
    its Ford City Neighborhood Affiliate.
    Clay signed a written employment contract
    entitling her to an initial salary of
    $100,000. The contract allowed either
    Clay or the Hospital to terminate the
    employment relationship upon 90 days’
    notice. The Ford City Affiliate was under
    the administrative control of Julie
    Rudolph, a clinical operations manager in
    the Hospital’s Practice Management
    Department.
    Clay became pregnant in late October
    1997. (She did not disclose her pregnancy
    to the Hospital’s administration until
    May 1998.) By early 1998, the Network
    failed to reach a break-even point and
    continued to need the Hospital’s subsidy.
    Additionally, the Hospital was having
    financial difficulties of its own at that
    time. Clement concluded that the Hospital
    could no longer afford to subsidize the
    Network at then-present levels, in part
    due to reductions in Medicare payments
    caused by the Balanced Budget Act of
    1997. In the first few months of 1998,
    the Hospital was losing approximately
    $300,000 per month on the Network.
    Due to the Network’s poor financial
    performance, on April 14, 1998, Clement
    met with Seliga to review the Network’s
    subsidy and the fact that some physicians
    and their practices were not performing
    as well as expected. Clement asked Seliga
    to assess the practice of each physician
    in the Network to determine which
    physicians "were going to get the
    hospital where it needed to be," and
    which physicians should be "prune[d]"
    from the Network. Clement asked Seliga to
    assess each physician’s practice,
    including subjective factors like how
    hard a physician was working, and whether
    the physician was participating in the
    Hospital’s marketing efforts in order to
    build a profitable practice.
    After his meeting with Clement, Seliga
    met with several managers in the Practice
    Management Department, including Julie
    Rudolph, and Theresa Gaffney, the
    Hospital’s Marketing Director. At that
    meeting, Seliga told the practice
    managers that the Hospital needed to
    reduce the Network’s subsidy, and that it
    would likely have to lay off some
    physicians. He solicited the managers’
    opinions on which physicians to
    terminate. The practice managers
    commented on each physician’s willingness
    to participate in practice-building
    efforts, and on their likelihood to grow
    their practices. The group created a
    preliminary list of physicians they
    perceived to be less likely to grow their
    practices to profitability. That initial
    list included Clay and eight other
    physicians.
    Between April 14 and April 20, 1998,
    Seliga reviewed Clay’s numbers concerning
    her revenues, expenses, participation in
    community events, hours in the office,
    marketing activities, procedures provided
    to patients, and patient volume. Then on
    April 20, Seliga met again with Gaffney
    and the practice managers to discuss the
    list of proposed layoffs. According to
    Seliga, the group reached a consensus
    that each physician on the list was
    unlikely to grow their practice to
    profitability because they lacked the
    willingness to participate in marketing
    activities or to make the other efforts
    required to see, attract, and service
    more patients. The issue of pregnancy was
    never brought up in the decision-making
    process.
    After some additional meetings between
    Seliga, Clement, and other Hospital
    administrators, the list of physician
    layoffs was finalized on May 1, 1998. The
    reduction-in-force ("RIF") was termed the
    "Neighborhood Affiliate Reorganization"
    and was expected to save the Hospital
    approximately $2 million. As the head of
    the Practice Management Department, Bill
    Seliga had the ultimate authority,
    subject to Mark Clement’s review, to
    decide which physicians would be
    terminated under the RIF.
    Seliga testified that he decided to
    terminate Clay because he concluded that
    she would not achieve a financially-self-
    sufficient practice regardless of the
    amount of assistance she received from
    the Hospital. According to Seliga, he
    based his decision on his own knowledge
    of Clay’s performance and on the advice
    he received from other Hospital
    employees, including Julie Rudolph and
    Theresa Gaffney. Seliga testified that he
    was advised by Gaffney that Clay was
    uncooperative with the Hospital’s
    marketing efforts, and that she failed to
    participate in any of the Hospital’s 25
    marketing events. Seliga also states that
    he was told that Clay had low patient
    accessibility. Patient accessibility
    means the amount of time that a physician
    is in her office and her receptivity to
    walk-in patients. It is undisputed that
    patient accessibility is "the key" to
    building a successful practice. According
    to Seliga, Gaffney and Rudolph told him
    that Clay was unwilling to see patients
    outside of her scheduled office time, and
    that she would turn patients away who
    were waiting in her office at the end of
    her schedule. Seliga also testified that
    Rudolph informed him that Clay was
    reluctant to take advantage of
    opportunities to grow her practice by
    covering for other physicians who were
    unavailable. And Seliga determined that
    Clay’s practice had low growth and low
    revenue, and that she had a generally
    uncooperative attitude. Therefore, Seliga
    claims that he concluded that Clay failed
    to demonstrate the entrepreneurial spirit
    and commitment necessary to grow her
    practice into a profitable enterprise.
    Clement, Rudolph and Gaffney
    corroborated Seliga’s testimony.
    According to Clement, physicians were
    selected for termination because "what
    they might have been looking for in a
    position may not have been consistent
    with what we were looking for in a
    physician." Clement testified further as
    to the kind of physician that the
    Hospital was not seeking: "Some
    physicians, some employees are looking
    for a j-o-b, an entitlement; I’ll do my
    40 hours; I’m not going to be responsible
    for growing the practice; I’m not going
    to be an owner." Rudolph affirmed that
    the physicians selected for termination
    were assessed to be less likely to grow
    their practices than those who were
    retained. Rudolph also testified that she
    commented to Seliga about Clay’s
    reluctance to see patients after hours.
    And Rudolph noted Clay’s inadequate
    revenue, as her net collections amounted
    to $22,453 for the six-month period from
    July 1997 to December 1997, while she
    received a $50,000 salary for that same
    period. Furthermore, Gaffney testified
    that she told Seliga about Clay’s
    unwillingness to participate in the
    Hospital’s marketing efforts.
    On May 14, 1998, Seliga met with Clay
    about her termination. Seliga testified
    that he first learned of Clay’s pregnancy
    at that meeting. The following day, on
    May 15, the Hospital formally announced
    the Reorganization.
    After the announcement of her
    termination, Clay sued the Hospital,
    alleging that she was terminated because
    of her pregnancy in violation of Title
    VII. The Hospital moved for summary
    judgment, arguing that Clay could not
    establish a prima facie case of pregnancy
    discrimination because Seliga, the
    Hospital’s decision-maker, was unaware of
    Clay’s pregnancy when he selected her for
    termination. The Hospital also argued
    that Clay could not show that the
    Hospital’s legitimate, non-discriminatory
    reason for her termination (Seliga’s
    belief that Clay failed to demonstrate
    the potential to grow her practice to
    profitability) was a pretext for
    discrimination.
    In her response to the Hospital’s
    motion, Clay argued that she established
    a prima facie case because Seliga knew
    about her pregnancy before he selected
    her for termination. Clay became pregnant
    in late October 1997, and was pregnant
    for a full nine months until she
    delivered her baby on July 16, 1998.
    According to Clay, she started to become
    visibly pregnant in February 1998. She
    testified that it is her "belief" that
    Seliga knew of her pregnancy because she
    and Seliga had attended a few Hospital
    conferences and meetings in February,
    March, and April of 1998. But Clay also
    testified that she did not disclose her
    pregnancy to the Hospital’s
    administration until May 6, 1998, when
    she faxed her request for maternity leave
    to the Practice Management Office.
    Clay also responded to the Hospital’s
    motion for summary judgment by presenting
    evidence that the Hospital ranked her
    number 32 out of 70 physicians in the
    Network according to the financial
    performance of her practice. Thus, Clay
    presented evidence that she treated more
    patients and generated more revenue
    during her first year of practice than
    other physicians who were not terminated
    by the Hospital.
    The district court granted summary
    judgment for the Hospital, concluding
    that Clay failed to create a genuine
    issue of material fact that the
    Hospital’s proffered reason for her
    termination was a pretext for
    discrimination. The court determined that
    Clay failed to "squarely rebut" the
    reason offered by the Hospital for her
    termination: the Hospital
    administration’s belief that Clay lacked
    the willingness to do what was necessary
    to make her practice profitable, like
    participate in the Hospital’s marketing
    efforts, increase her patient
    accessibility, and see patients at other
    locations. Clay appeals.
    II.
    Clay argues on appeal that the district
    court erroneously granted summary
    judgment for the Hospital. We review de
    novo the district court’s decision to
    grant summary judgment, construing all
    facts, and drawing all reasonable
    inferences from those facts, in favor of
    Clay, the non-moving party. Oest v.
    Illinois Dep’t. of Corrections, 
    240 F.3d 605
    , 610 (7th Cir. 2001). Summary
    judgment is proper when the "pleadings,
    depositions, answers to interrogatories,
    and admissions on file, together with the
    affidavits, if any, show that there is no
    genuine issue as to any material fact and
    that the moving party is entitled to a
    judgment as a matter of law."
    Fed.R.Civ.P. 56(c).
    According to Clay, the Hospital violated
    Title VII when it terminated her because
    of her pregnancy. "The Pregnancy
    Discrimination Act amended Title VII of
    the Civil Rights Act to clarify that
    pregnancy discrimination is included in
    Title VII’s prohibition on sex
    discrimination."/2 Ilhardt v. Sara Lee
    Corp., 
    118 F.3d 1151
    , 1154 (7th Cir.
    1997). Clay presents no direct evidence
    of discrimination, and thus she proceeds
    under the burden-shifting approach of
    McDonnell Douglas Corp. v. Green, 
    411 U.S. 792
     (1973). According to this
    method, Clay must first present a prima
    facie case of discrimination by
    establishing that: (1) she was pregnant
    (a member of a protected class) and her
    employer knew that she was pregnant; (2)
    she was performing her duties
    satisfactorily; (3) she was discharged;
    and (4) similarly situated employees not
    in the protected class were treated more
    favorably. Ilhardt, 
    118 F.3d at 1154-55
    .
    If Clay presents a prima facie case, then
    the burden of production shifts to the
    Hospital to articulate a legitimate, non-
    discriminatory reason for her
    termination. See Bekker v. Humana Health
    Plan, Inc., 
    229 F.3d 662
    , 672 (7th Cir.
    2000). Once the Hospital has proffered a
    legitimate reason, the inference of
    discrimination disappears, and Clay must
    prove by a preponderance of the evidence
    that the Hospital’s proffered reason was
    a pretext for intentional discrimination.
    
    Id.
     The ultimate burden to prove
    intentional discrimination remains with
    Clay. 
    Id.
    The district court bypassed
    consideration of whether Clay established
    a prima facie case, stating that
    "[b]ecause [Clay] has made no showing of
    pretext, this court need not decide
    whether she has established a prima facie
    case of discrimination." Clay argues on
    appeal that she presented sufficient
    evidence to create a genuine issue of
    material fact that the Hospital’s
    proffered reason for her termination was
    a pretext for discrimination. Pretext
    "means a dishonest explanation, a lie
    rather than an oddity or an error." Kulu
    mani v. Blue Cross Blue Shield Ass’n.,
    
    224 F.3d 681
    , 685 (7th Cir. 2000). "A
    ’pretext for discrimination’ means more
    than an unusual act; it means something
    worse than a business error; ’pretext’
    means deceit used to cover one’s tracks."
    
    Id. at 684
    . "On the issue of pretext, our
    only concern is the honesty of the
    employer’s explanation." O’Connor v.
    DePaul University, 
    123 F.3d 665
    , 671 (7th
    Cir. 1997). Thus, even if Seliga’s
    reasons for Clay’s termination were
    "mistaken, ill considered or foolish, so
    long as [Seliga] honestly believed those
    reasons, pretext has not been shown."
    Jordan v. Summers, 
    205 F.3d 337
    , 343 (7th
    Cir. 2000).
    Clay first argues that she established
    pretext because she presented facts
    demonstrating that Seliga lied when he
    testified that he did not know about
    Clay’s pregnancy before selecting her for
    termination under the RIF, and thus
    Seliga lacks credibility. In support of
    her contention, Clay testified that she
    "started becoming visibly pregnant in
    February 1998," and that it was her
    "belief" that Seliga knew about her
    pregnancy because she and Seliga attended
    approximately two or three Hospital
    conferences or meetings in early 1998.
    Clay also asserts in her response brief
    that her "husband announced his wife’s
    pregnancy to Bill Seliga" at a conference
    in March 1998. According to Clay, these
    facts demonstrate that Seliga lacks
    credibility, and thus "it should follow
    that everything he [Seliga] says
    regarding Dr. Clay is either suspect or
    wholly without merit." Hence, Clay
    contends that her case turns on the issue
    of Seliga’s credibility, which is best
    resolved by a jury.
    The district court considered Seliga’s
    credibility as an issue pertinent only to
    whether Clay had established her prima
    facie case. The court chose not to sort
    out the question of whether Seliga did or
    did not know Clay was pregnant; instead,
    the court bypassed the prima facie
    analysis and proceeded to the question of
    whether Clay raised a triable issue of
    fact regarding pretext./3
    Although the court left that step of the
    prima facie case unanswered, Clay insists
    that the timing of Seliga’s knowledge of
    her pregnancy is pivotal to her pretext
    claim. Yet a review of the record does
    not establish the inference that Seliga
    knew about her pregnancy before he
    selected her for the RIF. No doubt there
    were earlier occasions when he had an
    opportunity to make that discovery. But
    Clay’s assertion that her husband
    announced her pregnancy to Seliga lacks
    support in the record. Mr. Clay’s
    affidavit states that he "discussed [his]
    impending fatherhood in the company of
    Bill Seliga" at a conference in March
    1998. Mr. Clay does not allege that
    Seliga heard his conversation or acknowl
    edged it in any way. Dr. Clay testified
    that the conference was held in a "large
    room" and was attended by "approximately
    30 or 40" people./4 Just because Seliga
    was in the same large room with a number
    of people does not justify the inference
    that he heard Mr. Clay’s discussions with
    others about his wife’s pregnancy./5
    Moreover, Dr. Clay testified that she
    "was trying to keep things quiet"/6
    about her pregnancy from the Hospital’s
    administration (including Seliga) until
    May 6, 1998, when she faxed in her
    request for maternity leave. Precisely
    because Dr. Clay was "trying to keep
    things quiet" about her pregnancy from
    Hospital officials until May 6 supports
    the inference that she was not certain
    that Seliga knew about her pregnancy at
    that time. We conclude that the record
    does not support Clay’s allegation that
    Seliga knew about her pregnancy before he
    selected her for the RIF./7
    But even if Clay presented sufficient
    evidence to create a triable issue that
    Seliga lied about when he became aware of
    Clay’s pregnancy, Clay’s pretext argument
    is still unavailing. To prove pretext,
    Clay must present facts that cast doubt
    on the Hospital’s specific reasons for
    her termination. Paluck v. Gooding Rubber
    Co., 
    221 F.3d 1003
    , 1013 (7th Cir. 2000);
    see also Sweeney v. West, 
    149 F.3d 550
    ,
    557 (7th Cir. 1998) ("The plaintiff must
    call the employer’s honesty into question
    by rebutting the reason given.").
    Therefore, Clay’s pretext claim turns on
    Seliga’s credibility on his stated
    reasons for her termination only after
    Clay has offered "specific evidence from
    which the finder of fact may reasonably
    infer that the proffered reasons do not
    represent the truth." Collier v. Budd
    Co., 
    66 F.3d 886
    , 893 (7th Cir. 1995).
    Clay’s "burden is to squarely rebut the
    articulated reason for [her] discharge."
    Plair v. E.J. Brach & Sons, Inc., 
    105 F.3d 343
    , 349 (7th Cir. 1997). Moreover,
    she must present facts to rebut each and
    every legitimate, non-discriminatory
    reason advanced by the Hospital in order
    to survive summary judgment. See Adreani
    v. First Colonial Bankshares Corp., 
    154 F.3d 389
    , 399 (7th Cir. 1998) ("The
    existence of a genuine issue of triable
    fact with respect to some of the reasons
    for discharge proffered by the employer
    is of no consequence as long as at least
    one reason is uncontested."). Clay has
    not met her burden in this case.
    The Hospital’s stated reason for Clay’s
    discharge under the RIF is that the
    administration (especially the decision-
    maker, Bill Seliga) honestly believed
    that Clay "lacked the drive, work ethic,
    and dedication to grow her practice to
    profitability in the future." More
    specifically, the Hospital asserts that
    Seliga believed that Clay had a generally
    uncooperative attitude, failed to
    participate in the Hospital’s marketing
    events, was unwilling to maintain a high
    level of patient accessibility, was
    reluctant to cover for other physicians,
    and maintained a practice that had low
    growth and low revenue.
    Clay attempts to prove pretext by
    presenting evidence that the financial
    performance of her practice ranked number
    32 out of the 70 physicians in the
    Network, and that she treated more
    patients and generated more revenue
    during her first year of practice than
    other physicians who were not terminated
    by the Hospital.
    While Clay’s evidence indicates that her
    practice may have performed better
    financially than other physicians who
    were not terminated by the Hospital, Clay
    does not show that her practice was
    profitable, as it was losing money for
    the Hospital. Therefore, compared to a
    profitable practice, Clay’s practice did
    indeed have low revenue. Moreover, Clay’s
    evidence does not rebut Seliga’s other
    reasons for his decision to select Clay
    for termination under the RIF. See
    Adreani, 154 F.3d at 399.
    Seliga selected physicians for the RIF
    according to his assessment of each
    physician’s potential to build his or her
    practice into a profitable enterprise, as
    well as on the current financial
    performance of the practice. It is
    undisputed that Clement asked Seliga to
    assess each physician’s practice,
    including subjective factors like how
    hard a physician was working and whether
    she was participating in the hospital’s
    marketing efforts to build a profitable
    practice. It is also undisputed that
    Seliga solicited the opinions of the
    Hospital’s marketing and practice
    managers on the "physicians’
    participation and receptivity to volume
    building, and the physicians’ likelihood
    to grow their practices." Clay’s evidence
    does not rebut these reasons regarding
    Seliga’s assessment of her efforts at
    building her practice into a profitable
    enterprise.
    Clay presents no evidence to rebut
    Seliga’s testimony that Gaffney advised
    him that Clay was uncooperative with the
    Hospital’s marketing efforts, and that
    Clay failed to participate in any of the
    Hospital’s 25 marketing events. Clay
    attempts to refute this reason with her
    own testimony that she solicited new
    patients by participating in a radio
    broadcast, appearing at a mall, visiting
    a local factory and joining a community
    board. But this evidence does not
    indicate that Clay participated in the
    Hospital’s marketing events, and thus it
    does not rebut Gaffney’s assertion, or
    the fact that Gaffney notified Seliga
    about her frustration with Clay’s lack of
    participation. Thus, Clay’s testimony
    does not demonstrate pretext because it
    does not show that Seliga did not
    honestly believe that Clay was unwilling
    to participate in the Hospital’s
    marketing events. See O’Connor, 
    123 F.3d at 671
    .
    Clay also fails to show that Seliga did
    not honestly believe that she was
    unwilling to increase her patient
    accessibility. According to Seliga,
    Gaffney and Rudolph informed him that
    Clay would refuse to see patients outside
    of her scheduled office time. Rudolph’s
    deposition testimony confirmed Seliga’s
    assertion. And Clay presents no evidence
    to rebut the basis of Seliga’s belief, or
    to show that he did not honestly believe
    that Clay was unwilling to increase her
    patient accessibility.
    Another reason for Seliga’s decision to
    terminate Clay was his belief, based on
    Rudolph’s information, that Clay was
    reluctant to build her practice by
    covering for other physicians. Clay
    attempts to refute this reason by
    identifying excerpts of her deposition
    testimony where she stated that she had
    in fact covered for other doctors. But
    Clay made no such argument at summary
    judgment, and thus it is waived. See
    Arendt v. Vetta Sports, Inc., 
    99 F.3d 231
    , 237 (7th Cir. 1996) ("’We have long
    refused to consider arguments that were
    not presented to the district court
    inresponse to summary judgment
    motions.’") (quoting Cooper v. Lane, 
    969 F.2d 368
    , 371 (7th Cir. 1992)). Moreover,
    her testimony does not show pretext
    because it does not rebut the basis of
    Seliga’s belief (Rudolph’s comments that
    Clay was reluctant to cover for other
    physicians), or that Seliga honestly
    believed that Clay was lacking in this
    area./8 Therefore, Clay has failed to
    prove pretext because she has not
    presented facts to refute Seliga’s
    reasons for her termination.
    We also note that the Hospital did not
    rely solely on Seliga’s testimony, as
    Clement, Rudolph and Gaffney corroborated
    Seliga’s description of his methodology
    in conducting the RIF, and the basis for
    his belief that Clay had failed to
    demonstrate the dedication necessary to
    build her practice into a profitable
    enterprise. It is also undisputed that
    the issue of pregnancy was never brought
    up in the decision-making process, and
    that Seliga collaborated with other
    practice managers to compose the list of
    physicians to be terminated. We conclude,
    therefore, that Clay’s pretext arguments
    are unavailing.
    III.
    Clay has failed to demonstrate that the
    Hospital’s proffered reason for her
    termination was a pretext for intentional
    discrimination. Clay has not shown that
    the Hospital’s decision-maker, Bill
    Seliga, did not honestly believe that
    Clay lacked the drive, work ethic, and
    dedication to grow her practice into a
    profitable enterprise. We thus AFFIRM the
    district court.
    FOOTNOTES
    /1 Clay claimed to the district court that the
    Hospital terminated her, and failed to offer her
    a transfer, in violation of Title VII and the
    Family and Medical Leave Act ("FMLA"). Although
    the district court granted summary judgment for
    the Hospital on all of her claims, Clay has only
    presented a sufficient argument on appeal to
    challenge her termination as a violation of Title
    VII. See Kalis v. Colgate-Palmolive Co., 
    231 F.3d 1049
    , 1057 n.5 (7th Cir. 2000) ("’We repeatedly
    have made clear that perfunctory and undeveloped
    arguments, and arguments that are unsupported by
    pertinent authority, are waived.’") (quoting
    United States v. Berkowitz, 
    927 F.2d 1376
    , 1384
    (7th Cir. 1991)). Therefore, the only argument
    that Clay has not waived on appeal is that the
    district court erred in granting summary judgment
    for the Hospital on her claim that she was
    terminated because of her pregnancy in violation
    of Title VII.
    /2 The Pregnancy Discrimination Act provides that
    "women affected by pregnancy, childbirth, or
    related medical conditions shall be treated the
    same for all employment related purposes . . . as
    other persons not so affected but similar in
    their ability or inability to work." 42 U.S.C.
    sec. 2000e(k).
    /3 The district court stated: "This court accepts
    Dr. Clay’s improperly-filed evidence that she and
    Seliga were in the same place at the same time on
    several occasions while Dr. Clay was visibly
    pregnant. This court also accepts Dr. Clay’s
    evidence casting doubt on Seliga’s credibility,
    so as to undercut his explanation that he did not
    know Dr. Clay was pregnant when he decided to
    terminate her employment. Nevertheless, this
    court declines to decide whether Dr. Clay’s
    evidence is sufficient to create a genuine issue
    of whether the decision-maker knew she was preg-
    nant at the time she was terminated under Title
    VII or whether Holy Cross would have terminated
    her but for her decision to take a maternity
    leave under the FMLA. Because plaintiff has made
    no showing of pretext, this court need not decide
    whether she has established a prima facie case of
    discrimination."
    /4 Dr. Clay also testified that she had no recollec-
    tion whether she was ever "face-to-face" with
    Seliga at that event.
    /5 On the one hand, Clay testified that she "was
    trying to keep things quiet" about her pregnancy
    from Hospital officials until May 1998, but the
    affidavit by her husband (in which he avers that
    he discussed and even celebrated his wife’s
    pregnancy in the proximity of the same Hospital
    officials in March 1998) obviously conflicts with
    her intent.
    /6 In Clay’s deposition, she was asked: "Why didn’t
    you send that maternity leave request form in
    earlier than you did [in early May]?" Clay
    answered: "Again, because I was trying to keep
    things quiet. I didn’t want those who were not
    friends of mine to be aware of the fact that I
    was pregnant, so that’s why I waited."
    /7 Without showing that Seliga actually knew of her
    pregnancy, Clay would not have established the
    first element of a prima facie case of pregnancy
    discrimination because she had not shown that her
    employer knew that she was pregnant. Ilhardt, 
    118 F.3d at 1154
    . As noted, the district court by-
    passed that question. Moreover, it is undisputed
    that eight other Holy Cross physicians had been
    pregnant, had taken maternity leave, and had not
    been terminated. Clay’s response to that fact is
    that all except one of those physicians were
    retained before Holy Cross began to lose substan-
    tial amounts of money. But one of the eight
    physicians, Dr. Beth Davis-Phillpotts, went on
    maternity leave, returned, was initially selected
    for the RIF, but then Seliga determined that she
    would "hustle" to build a profitable practice if
    she were given a second chance, and thus she was
    retained and placed at another location in the
    Network.
    /8 Clay also argues for the first time on appeal
    that because the Hospital produced no written
    standards for Network physicians, and no perfor-
    mance evaluations or other written assessments of
    Clay’s job performance, that is further evidence
    of pretext. Because Clay never made this argument
    to the district court, it is waived. Arendt, 
    99 F.3d at 237
    . Moreover, the argument lacks merit.
    There is no dispute that Clement asked Seliga to
    assess each physician’s practice, including
    subjective factors like the physician’s efforts
    to grow her practice. And it is discernable from
    the record that Seliga’s method in conducting the
    RIF involved his consultation with the Hospital’s
    marketing and practice managers before he select-
    ed the physicians for termination under the RIF.
    While more precise and objective criteria may
    have been possible, "any lack of precision in the
    articulated standards does not mean that [Clay’s]
    inclusion in the RIF was necessarily a pretext
    for [pregnancy] discrimination." Paluck, 
    221 F.3d at 1014
    . "The dispositive question is whether
    [Clay] has shown that [the Hospital’s] stated
    reason for including her in the RIF . . . was
    pretextual." 
    Id. at 1015
    . Because Clay has failed
    to refute the Hospital’s reason for her termina-
    tion, this argument fails.
    DIANE P. WOOD, Circuit Judge, concurring in the
    judgment. It may be true that there are some
    people so obtuse that they cannot recognize the
    condition of a woman six or seven months along in
    her pregnancy, and that there are some pregnan-
    cies that are not detectable until the day of
    delivery. These, however, are the rare cases. I
    make this point in order to disagree with the
    majority’s conclusion, ante at 12, that "the
    record does not support Clay’s allegation that
    Seliga knew about her pregnancy before he select-
    ed her for the RIF." To the contrary, as the
    district court recognized and as even the major-
    ity’s opinion tacitly acknowledges, there are
    genuinely disputed issues of fact about the state
    of his knowledge.
    The record shows that Pamela Clay became preg-
    nant in late October 1997 and that she delivered
    a full-term baby in mid-July 1998. It also shows,
    according to Clay’s affidavit, that she had
    become visibly pregnant by February 1998. This is
    not only a fact of which Clay obviously had
    personal knowledge; it is one she was willing to
    back up with contemporaneous photographs of
    herself, which she proffered at the summary
    judgment stage. Beyond that, common experience
    suggests that most women are "showing" well
    before that time, as a brief glance at the
    patrons in a maternity clothing store would
    confirm. The record, taken in the light most
    favorable to Clay’s position, also shows that she
    attended either two or three hospital conferences
    or meetings with Bill Seliga between February
    1998 and before April 1998, when he became en-
    gaged in the RIF process. The majority’s opinion
    does not take issue with any of these points. See
    ante at 7. Instead, it appears to place decisive
    weight on the fact that Clay did not "disclose"
    (verbally) her pregnancy to Seliga until May 6,
    1998, approximately two months before she deliv-
    ered the baby. A trier of fact might believe
    Seliga’s story that he (a hospital manager) was
    oblivious to Clay’s visible pregnancy at the time
    of those meetings, but a trier of fact with the
    photographs in front of it equally might find
    such a story incredible. I see no warrant for the
    majority’s decision to resolve this issue of fact
    in the Hospital’s favor, at the summary judgment
    stage. Indeed, in light of its subsequent discus-
    sion of pretext, this part of the opinion is
    little more than dicta in any event. I would find
    that Clay successfully established her prima
    facie case of discrimination.
    This case turns, as so many do, on the issue of
    pretext. If we now assume that Seliga knew that
    Clay was pregnant, lied about his knowledge, and
    chose her for termination in the RIF procedure,
    is this enough to cast doubt on the other reasons
    the Hospital proffered for asking Clay to leave?
    That, I believe, is a much closer question. The
    Hospital points to substantial evidence all of
    which shows that Clay was not the kind of "team
    player" or financial performer it wanted. Clay
    has made two mistaken assumptions here. First,
    she apparently believes that her case is won if
    she can prove that Seliga was lying about his
    knowledge of her condition; that, however, is not
    true. The question remains whether that lie is
    enough to taint all the rest of the Hospital’s
    evidence about its reasons for including her in
    the RIF. It is not, as the majority explains, if
    an untainted reason remains that independently
    supports the employment decision. Second, Clay
    appears to think that the way to raise a genuine
    issue of fact on the pretext question is to
    present evidence that would refute the Hospital’s
    ultimate conclusion that she was not likely to be
    a good doctor, a good business generator, and a
    good financial risk. That, too, is not correct;
    the question instead is whether there is any
    evidence that suggests that these were not bona
    fide reasons for the Hospital’s actions. If the
    Hospital wanted people to attend its own market-
    ing events rather than addressing the topic of
    marketing with a free-lance approach, it was
    entitled to take this position. Clay’s earnings
    hardly made her a star among the doctors; she was
    instead squarely in the middle, ranked financial-
    ly as number 32 out of 70. For these reasons, as
    well as the others the majority discusses in the
    opinion, ante at 12-16, I would affirm the dis-
    trict court’s decision on the basis that Dr. Clay
    has not raised a genuine issue of material fact
    on the question of pretext. I therefore concur in
    the judgment.