Due Process, Stigma-Plus, and Age Discrimination in Hospital Privilege Non-Renewals:
Commentary on Hanley v. NYC Health & Hospitals Corp. (2d Cir. 2025) (Summary Order)

Note: The decision commented on is a Second Circuit summary order. As the panel itself emphasizes, such orders do not have precedential effect, although they may be cited under Federal Rule of Appellate Procedure 32.1 and Local Rule 32.1.1. The analysis below discusses its persuasive value and its application of existing doctrine; it does not treat the order as binding precedent.

I. Introduction

A. Factual and Institutional Background

Dr. Claire Hanley, a 70-year-old breast imaging radiologist, held:

clinical responsibilities at Kings County Hospital Center (“KCH”), part of the New York City Health & Hospitals Corporation (“HHC”), and
an academic appointment at SUNY Downstate Medical Center (“SUNY Downstate”).

Her position was a hybrid one: she both treated patients at KCH and trained SUNY medical students, residents, and fellows rotating there. That dual role was structured under an affiliation agreement between SUNY and HHC, under which SUNY assigned academic staff to act as clinical practitioners at HHC facilities.

In May 2018:

Defendant Dr. Patrick Hammill, Chief of Service for Radiology at KCH, relieved Hanley of her clinical duties and placed her on administrative leave, citing a failed performance evaluation and patient-safety concerns (including “potential delay in diagnosis and missed cancer”).
In June 2018, on Hammill’s recommendation, the KCH medical board decided not to renew her clinical privileges or reappoint her to the KCH medical staff.
Thereafter, SUNY Downstate declined to renew her academic appointment, which the record reflects was expressly contingent on her maintaining KCH privileges.

Hanley brought suit against:

Hospital Defendants: HHC, KCH, Hammill, and Dr. Neesha Patel, Director of Breast Imaging at KCH; and
SUNY Defendants: SUNY Downstate, Dr. Wayne Riley (President), and Dr. Deborah Reede (Chair of Radiology), both officially and, in some instances, individually.

She alleged:

Age discrimination in violation of:
- the federal Age Discrimination in Employment Act (ADEA), 29 U.S.C. § 621 et seq.,
- the New York State Human Rights Law (NYSHRL), N.Y. Exec. Law § 296 et seq., and
- the New York City Human Rights Law (NYCHRL), N.Y.C. Admin. Code § 8-101 et seq.; and
Due process violations (federal constitutional claims) relating to:
- a purported property interest in clinical staff privileges and medical staff appointment at KCH, and
- a purported liberty interest (via “stigma plus”) in her reputation and employability as a radiologist.

B. Procedural Posture

The United States District Court for the Eastern District of New York (Judge Block) ruled as follows:

Granted summary judgment on:
- all due process claims against all defendants; and
- all age discrimination claims as to the SUNY Defendants.
Denied summary judgment on age discrimination as to the Hospital Defendants, and held a jury trial on those claims.
The jury returned a verdict for the Hospital Defendants on age discrimination.

On appeal, Hanley challenged:

The grant of summary judgment to the SUNY Defendants on age discrimination.
The grant of summary judgment to the Hospital Defendants on all due process claims.
The fairness of the trial, arguing that errors in evidentiary rulings and jury instructions required a new trial.

The Second Circuit (Judges Robinson, Merriam, and District Judge Stein, sitting by designation) affirmed in full.

C. Core Legal Questions

The decision centrally addresses:

How the McDonnell Douglas burden-shifting framework for age discrimination applies where:
- an arguably age-related remark is made by a decisionmaker, but
- the employer has a contract-based, structurally neutral explanation (loss of required hospital privileges) for its action.
What procedural due process is required when a public hospital non-renews a physician’s clinical privileges based on alleged performance and safety concerns.
How stringent the “stigma-plus” standard is for claiming a deprivation of liberty interest in the context of negative internal assessments of a physician’s performance.
The scope of harmless error and plain error review of:
- trial evidentiary rulings, and
- jury instructions on issues such as aiding-and-abetting liability, vicarious liability, and joint-employer theories.

II. Summary of the Second Circuit’s Decision

A. Age Discrimination Claims Against SUNY Defendants

The Court assumed, without definitively deciding, that Hanley had made a prima facie case of age discrimination against SUNY (largely based on an alleged remark by Dr. Reede about older doctors “not knowing when to retire”). Nonetheless, applying the McDonnell Douglas framework, it held:

SUNY articulated a legitimate, nondiscriminatory reason for declining to renew her academic appointment:
- Under the affiliation agreement, SUNY academic appointments were conditioned on the appointee’s maintenance of clinical privileges at KCH.
- Once KCH non-renewed her privileges, Hanley could no longer fulfill the clinical and teaching duties expected of her SUNY role.
Hanley failed to produce sufficient evidence that this explanation was pretextual or that age was the but-for cause of SUNY’s decision under the ADEA/NYSHRL, or even a partial cause under the more liberal NYCHRL standard.

Accordingly, summary judgment in favor of the SUNY Defendants on all age discrimination claims was affirmed.

B. Due Process Claims Against Hospital Defendants

As to the procedural due process claims, the Court:

Assumed without deciding that Hanley had a property interest in renewing her clinical privileges at KCH, based on hospital bylaws (tracking Greenwood v. New York, Office of Mental Health).
Held that, even assuming such an interest, the process provided under the KCH Bylaws (formal hearing, right to call and cross-examine witnesses, and appeal to the HHC president) was constitutionally adequate.
Rejected the claim that:
- the delay in the hearing process itself violated due process, or
- Hanley was constitutionally entitled to a full pre-deprivation hearing before suspension or non-renewal of privileges in light of alleged patient safety issues (citing Ezekwo v. NYC Health & Hospitals Corp.).

Regarding the claimed liberty interest (the “stigma-plus” theory), the Court concluded:

Non-renewal of privileges, even if damaging to reputation and employment prospects, is not defamatory in itself.
Hanley had not identified a false, stigmatizing statement by defendants that was:
- “capable of being proved false,” and
- published or made sufficiently public (e.g., disseminated to other hospitals or prospective employers).

Thus, the Court affirmed summary judgment for the Hospital Defendants on all due process claims.

C. Evidentiary Rulings and Jury Instructions

The Second Circuit rejected Hanley’s challenge to the fairness of her trial against the Hospital Defendants, holding that:

The district court did not commit reversible error in its evidentiary rulings:
- Some claimed errors did not occur (e.g., there was no actual exclusion of the “Shouldn’t she be retiring by now?” remark, as plaintiff never attempted to introduce it at trial).
- Other rulings—such as admitting prior discipline, or testimony about a later-discovered missed cancer—were within the court’s discretion or rendered harmless by limiting clarifications and cross-examination.
- The references to the “medical board” and the court’s questioning of the expert witness fell within permissible bounds and did not affect substantial rights.
Any potential deficiencies in the jury instructions (on:
- aiding-and-abetting liability,
- HHC’s vicarious liability,
- and joint-employer theories between SUNY and HHC)
were harmless:
- The jury expressly found that Hammill did not discriminate, which foreclosed aiding-and-abetting and vicarious liability issues.
- There was no evidentiary basis to impose joint-employer liability on HHC for SUNY’s conduct (and, in any event, there was no triable age discrimination claim against SUNY).

Accordingly, the Second Circuit held that Hanley received a fair trial and affirmed the jury verdict and all underlying rulings.

III. Detailed Analysis

A. Age Discrimination: The SUNY Defendants

1. The McDonnell Douglas Framework and Applicable Standards

The Court analyzed Hanley’s ADEA and pre-2019 NYSHRL claims under the familiar McDonnell Douglas Corp. v. Green, 411 U.S. 792 (1973), burden-shifting framework, as reaffirmed in Bucalo v. Shelter Island Union Free Sch. Dist., 691 F.3d 119 (2d Cir. 2012).

Prima facie case: The plaintiff must show:
- (1) membership in the protected age group (40+),
- (2) qualification for the position,
- (3) an adverse employment action, and
- (4) circumstances giving rise to an inference of discrimination.
Employer’s burden of production: If a prima facie case is made, the burden (of production, not ultimate persuasion) shifts to the employer to articulate a legitimate, nondiscriminatory reason for the action.
Pretext and causation: The burden then shifts back to the plaintiff to show that the proffered reason is pretextual and that age actually caused the adverse decision.

The Court also separated the standards under each statute:

ADEA and NYSHRL (pre-amendment):
- Following Lively v. WAFRA Investment Advisory Group, Inc., 6 F.4th 293, 303 (2d Cir. 2021), Hanley had to show that age was the “but-for” cause of SUNY’s adverse action.
NYCHRL:
- Under Mihalik v. Credit Agricole Cheuvreux N. Am., Inc., 715 F.3d 102, 110 (2d Cir. 2013), she needed to show only that she was treated less well because of discriminatory intent.
- Yet, as Ya-Chen Chen v. CUNY, 805 F.3d 59, 76 (2d Cir. 2015), clarifies, summary judgment is still proper under NYCHRL if no reasonable jury could find either:
  - that the employer’s proffered reason is pretextual, or
  - that discrimination was at least one motivating factor for the adverse action.

2. SUNY’s Legitimate, Nondiscriminatory Reason

The key to the Court’s affirmance was the affiliation agreement between SUNY and HHC:

SUNY’s academic staff were appointed for clinical service at KCH and other hospitals.
Hanley’s SUNY role explicitly required that she maintain clinical privileges at KCH.
Once those privileges were not renewed:
- Hanley could no longer treat patients at KCH.
- She therefore could not fulfill the clinical teaching component of her SUNY appointment (training residents and students who rotate through KCH).

This structural feature of the affiliation arrangement provided SUNY with a facially neutral, contractually compelled reason for not renewing Hanley’s academic appointment. The Second Circuit held that this reason easily satisfies the “legitimate, nondiscriminatory” step under McDonnell Douglas.

3. The Alleged Ageist Remark and the Failure of Pretext

Hanley’s main evidence of age animus by a SUNY decisionmaker was an alleged remark by Dr. Reede that “older doctors do not know when to retire.” The Court was willing, arguendo, to assume that this remark helped her satisfy the prima facie burden by creating an inference of age bias.

However, under Sista v. CDC Ixis N. Am., 445 F.3d 161, 173 (2d Cir. 2006), once the employer has articulated a non-discriminatory explanation, the plaintiff must show that explanation is:

“unworthy of credence”, or
a cover for discrimination (i.e., pretext).

Here, Hanley did not:

Contest the existence or terms of the affiliation agreement.
Offer evidence that SUNY, in other cases, retained academic appointees lacking required hospital privileges, such that it might have selectively enforced the condition against older physicians.
Identify any procedural or factual inconsistency in SUNY’s application of this requirement that might allow a reasonable jury to view the explanation as contrived.

Thus, the Court found that “no reasonable jury could conclude”:

under ADEA/NYSHRL, that age was the but-for cause of SUNY’s decision; or
under the NYCHRL, that Hanley was treated “less well” because of her age, in light of the clear contractual condition tying her SUNY appointment to her KCH privileges.

The remark, standing alone against the structural explanation, became a “stray remark” in practical effect: probative at the prima facie stage but insufficient to carry the ultimate burden on causation once a robust non-discriminatory reason is articulated and unrebutted.

4. Doctrinal Significance

While nonprecedential, the decision is doctrinally illustrative on several points:

Conditional appointments: Where an academic appointment is explicitly conditioned on maintaining external clinical privileges, loss of those privileges is an especially compelling legitimate reason for non-renewal.
Ageist comments vs. structural constraints: Even arguably ageist remarks may not suffice to create a triable issue of pretext where:
- the employer’s explanation is grounded in clear institutional or contractual requirements, and
- the plaintiff provides no evidence those requirements were selectively enforced or otherwise manipulated.
NYCHRL’s liberal standard is still bounded: Despite NYCHRL’s more plaintiff-friendly causation standard, plaintiffs must still produce evidence from which a reasonable jury could infer that discriminatory intent actually played a causal role.

B. Procedural Due Process: Property Interest and Adequate Procedures

1. Property Interest in Medical Staff Privileges

The Court cites Greenwood v. New York, Office of Mental Health, 163 F.3d 119, 122–23 (2d Cir. 1998), which held that:

Public hospital bylaws can create a property interest in clinical staff privileges when they meaningfully constrain the hospital’s discretion to deny or revoke privileges.

Rather than definitively deciding whether KCH’s bylaws created such a right, the panel assumed that Hanley had a protected property interest and proceeded to address whether she received adequate process.

2. Adequacy of Process Under the KCH Bylaws

The Court describes the procedural framework set forth in the KCH Bylaws:

Upon notice of non-renewal of privileges, the physician may:
- Request a formal hearing before the medical board.
- At that hearing, both the physician and the hospital may:
  - Call witnesses, and
  - Cross-examine witnesses.
- If the medical board affirms non-renewal, the physician may appeal to the HHC president or a designee.

By the time of trial, Hanley had in fact received:

the hearing, and
the appeal provided in the bylaws.

The panel held these procedures adequate under the Due Process Clause, particularly in light of the specific context:

The case implicated patient safety (alleged missed cancers and risk of delayed diagnosis), a concern that often justifies more rapid administrative action, followed by more comprehensive post-deprivation procedures.

3. Pre-Deprivation vs. Post-Deprivation Hearing and Patient Safety

Hanley argued that she was entitled to a pre-deprivation hearing before KCH could effectively remove her from practice by not renewing her privileges.

The Court, relying in part on Ezekwo v. NYC Health & Hospitals Corp., 940 F.2d 775, 785–86 (2d Cir. 1991), rejected any constitutional requirement of a “full-blown pre-deprivation hearing” in this setting:

Where administrators reasonably believe that a clinician threatens patient safety, due process does not require a full adversarial hearing before acting to remove or limit that clinician’s privileges.
A robust post-deprivation hearing with the right to call and cross-examine witnesses, followed by an internal appeal, can satisfy due process under such circumstances.

While the Court did not explicitly invoke the Mathews v. Eldridge balancing test by name, its reasoning is consistent with that framework: the strong governmental interest in immediate patient protection and the availability of substantial post-deprivation procedures weigh heavily in favor of allowing swift initial action with more elaborate process later.

4. Delay in the Hearing Process

At the time the district court granted summary judgment, Hanley’s medical board hearing was still pending. By the time of trial, the process was complete. Hanley argued that the delay itself violated due process.

The panel rejected that theory, holding that:

The delay did not rise to the level of a constitutional violation, particularly given the complexity of medical-privilege disputes and the fact that the full procedures were ultimately provided.

This reinforces the principle that while excessive delay can, in some circumstances, undermine the adequacy of process, not all delays—even when burdensome to the individual—are constitutionally unreasonable, especially in specialized institutional settings.

C. “Stigma Plus” and Liberty Interests in Professional Reputation

1. The Stigma-Plus Doctrine

To prevail on a “stigma plus” claim, a plaintiff must show both:

Stigma:
- A defamatory statement by a government actor that:
  - injures the plaintiff’s reputation,
  - is “capable of being proved false,” and
  - is sufficiently public to create or threaten a stigma (e.g., published externally or likely to be disclosed to future employers).
Plus:
- A tangible burden—typically a change in legal status or the loss of some government-conferred right or entitlement (e.g., termination or non-renewal of employment).

See, e.g., Greenwood, 163 F.3d at 124; Velez v. Levy, 401 F.3d 75, 87 (2d Cir. 2005); Donato v. Plainview-Old Bethpage Cent. Sch. Dist., 96 F.3d 623, 630–31 (2d Cir. 1996).

In O’Connor v. Pierson, 426 F.3d 187, 195 (2d Cir. 2005), the Second Circuit also stressed that termination or non-renewal, by itself, is not defamatory; there must be some further publicized statement accusing the person of misconduct or incompetence.

2. Application to Hanley’s Case

The panel acknowledged that Hanley’s non-renewal of privileges and subsequent loss of her SUNY position adversely affected her professional reputation and employability. But it held that:

The non-renewal itself (and its effect on job prospects) is not a defamatory statement.
Hanley did not identify any false, stigmatizing statement by the Hospital Defendants that:
- accused her of unethical conduct or stark incompetence in a way that could be “proved false,” and
- was published or placed where it was likely to be shared with potential future employers.
Even assuming she relied on allegedly false internal reports by Hammill and Patel to the medical board, she offered no evidence that those were:
- disseminated beyond internal decisionmakers, or
- placed in a personnel file likely to be disclosed externally (as in Donato).

The panel distinguished situations in which employers publicly circulate highly critical “statements of reasons” that function like a “bill of indictment” against an employee’s professional competence (Donato), or disseminate “defamatory information about [a physician’s] medical skills to other hospitals and law enforcement” (Greenwood). No such public dissemination was shown here.

Accordingly, Hanley did not satisfy the “stigma” element of stigma-plus, and her liberty-interest due process claim failed as a matter of law.

D. Evidentiary Rulings

1. Standards of Review

The Court applied the usual standards:

Abuse of discretion for trial-level evidentiary rulings to which objections were preserved (Henry v. Wyeth Pharms., Inc., 616 F.3d 134, 149 (2d Cir. 2010)).
Plain error review for challenges not properly preserved (Cruz v. Jordan, 357 F.3d 269, 271 (2d Cir. 2004)).
Even if a ruling exceeds the court’s discretion, reversal is warranted only if the error “affects a substantial right”—that is, if the Court cannot say with fair assurance that the ruling did not substantially influence the jury (Phoenix Associates III v. Stone, 60 F.3d 95, 104–05 (2d Cir. 1995); Warren v. Pataki, 823 F.3d 125, 138 (2d Cir. 2016)).

2. Key Evidentiary Disputes

The “Shouldn’t she be retiring by now?” comment

Hanley claimed the district court barred her from testifying that Hammill, when reviewing another doctor’s reappointment package, asked a staffer, “Shouldn’t she be retiring by now?” The record, however, showed:

The court only tentatively expressed concern about hearsay pre-trial and said it would decide based on how the issue arose.
At trial, Hammill was asked about the comment and denied it twice.
Hanley (or any other witness) never actually attempted to introduce contrary evidence.

The Second Circuit held Hanley could not claim the court “excluded” evidence that she never offered (United States v. Valenti, 60 F.3d 941, 944–45 (2d Cir. 1995)). Accordingly, there was no adverse ruling to review.

2015 disciplinary incident

The district court admitted evidence that Hanley had been disciplined in 2015 after an incident with a former supervisor. The Second Circuit found this within the court’s discretion:

The 2015 incident was part of Hanley’s employment record.
Hammill testified he considered that history in recommending non-renewal of privileges.
Thus, the evidence bore directly on his decision-making and was not solely propensity evidence.

Post-termination missed cancer diagnosis

Dr. Patel testified that after Hanley’s privileges were terminated, it came to light that Hanley had missed a cancer diagnosis in another patient. This raised a concern of undue prejudice. The panel concluded any error was harmless because:

The district court immediately clarified through questioning that Patel only learned of this missed diagnosis after Hanley left KCH and thus:
- It “had nothing to do with her discharge.”
Hanley’s counsel elicited testimony from Hammill that all radiologists miss cancers sometimes, thereby contextualizing the issue and mitigating any unfair inference of unique incompetence.

References to the “medical board”

Hanley argued that use of the term “medical board” (rather than an agreed euphemism like “prior proceeding”) suggested she had done something professionally wrong. The record, however, showed:

No clear, on-the-record agreement to avoid the term “medical board.”
Both sides routinely used the term at trial.
The medical board’s role was central to the factual narrative and could not realistically be obscured.

The panel found no abuse of discretion in allowing the accurate term to be used, particularly where plaintiff herself had used it.

Judicial questioning of the expert

Hanley challenged the trial judge’s questioning of her expert witness. Under Fed. R. Evid. 614(b), a trial court has broad discretion to question witnesses, including experts, so long as it does not display undue partiality or usurp the role of counsel. The panel found:

No plain error in the judge’s structuring and clarifying questions.
Hanley’s counsel had ample opportunity for redirect examination to rehabilitate or expand on the expert’s testimony.

Viewed individually and cumulatively, the evidentiary rulings did not render the trial unfair.

E. Jury Instructions and Harmless Error

1. Standards

On jury instructions, the Court reviewed de novo whether the jury was misled regarding controlling law (Henry, 616 F.3d at 146). Under Fed. R. Civ. P. 51(d):

Preserved objections are reviewed for error and harmlessness (Rasanen v. Doe, 723 F.3d 325, 331 (2d Cir. 2013)).
Unpreserved objections are reviewed only for plain error.

2. Aiding and Abetting; Vicarious Liability; Joint Employer

Hanley argued the district court erred by failing to instruct the jury that:

Hammill could be liable for aiding and abetting discrimination.
HHC could be liable in addition to Hammill (vicarious liability) for his discriminatory acts.
HHC and SUNY were joint employers, so each could be liable for the other’s discriminatory conduct.

The panel disposed of these issues primarily on harmlessness grounds:

The jury found that Hammill did not engage in discrimination:
- If Hammill committed no discrimination, he could not have aided and abetted it.
- HHC’s vicarious liability was irrelevant in the absence of any underlying discrimination by its employee.
As to joint-employer liability, Hanley’s counsel had not preserved a specific objection to the instructions:
- There was no evidence that SUNY played a causal role in the decision not to renew Hanley’s KCH privileges.
- And as the Court had already held, no triable age discrimination case existed against SUNY in any event.
- Thus, there was no plain error in failing to instruct on joint-employer liability.

Even if the instructions could have been more expansive, the Court concluded they did not mislead the jury or affect the outcome given the jury’s core finding: there was no discrimination by Hammill.

F. Precedents Cited and Their Influence

The opinion is grounded in and constrained by an existing line of Second Circuit and Supreme Court authorities, including:

McDonnell Douglas Corp. v. Green, 411 U.S. 792 (1973) – burden-shifting in discrimination cases.
Bucalo v. Shelter Island UFS Dist., 691 F.3d 119 (2d Cir. 2012) – application of McDonnell Douglas and pretext analysis.
Lively v. WAFRA Inv. Advisory Grp., Inc., 6 F.4th 293 (2d Cir. 2021) – “but-for” causation standard for ADEA/NYSHRL.
Mihalik v. Credit Agricole, 715 F.3d 102 (2d Cir. 2013) – NYCHRL’s “treated less well” standard.
Ya-Chen Chen v. CUNY, 805 F.3d 59 (2d Cir. 2015) – NYCHRL summary judgment standard.
Greenwood v. New York, Office of Mental Health, 163 F.3d 119 (2d Cir. 1998) – property interest in clinical privileges; stigma-plus.
Ezekwo v. NYC HHC, 940 F.2d 775 (2d Cir. 1991) – limits on pre-deprivation hearing requirements in medical contexts.
Velez v. Levy, 401 F.3d 75 (2d Cir. 2005); Donato v. Plainview-Old Bethpage CSD, 96 F.3d 623 (2d Cir. 1996); O’Connor v. Pierson, 426 F.3d 187 (2d Cir. 2005) – contours of the stigma-plus doctrine.
Henry v. Wyeth, 616 F.3d 134 (2d Cir. 2010); Phoenix Assocs. III v. Stone, 60 F.3d 95 (2d Cir. 1995); Warren v. Pataki, 823 F.3d 125 (2d Cir. 2016) – standards for evidentiary rulings and harmless-error analysis.
Cruz v. Jordan, 357 F.3d 269 (2d Cir. 2004); Rasanen v. Doe, 723 F.3d 325 (2d Cir. 2013) – plain-error and harmless-error review of jury instructions.
Bruh v. Bessemer Venture Partners III L.P., 464 F.3d 202, 205 (2d Cir. 2006) – appellate court may affirm on any ground supported by the record.

Rather than breaking new doctrinal ground, the panel’s work lies in its careful application of these precedents to a fact pattern combining:

academic-medical affiliation structures,
hospital bylaws that promise internal hearings, and
alleged discrimination intertwined with legitimate patient-safety and competence concerns.

IV. Complex Concepts Simplified

A. Summary Judgment

Summary judgment is a mechanism to resolve cases without a full trial when there is “no genuine dispute as to any material fact” and the movant is entitled to judgment as a matter of law. A “genuine dispute” exists if a reasonable jury could return a verdict for the non-moving party on that issue. The appellate court reviews such rulings de novo (without deference to the trial court), as noted in Peoples v. Leon, 63 F.4th 132, 137 (2d Cir. 2023).

B. McDonnell Douglas Burden-Shifting

The McDonnell Douglas framework is used when there is no direct, smoking-gun evidence of discrimination:

The plaintiff must clear a low bar to make a prima facie case.
The employer then must produce (not prove) a legitimate, non-discriminatory reason for its decision.
The burden shifts back to the plaintiff to show:
- the employer’s reason is false or incomplete, and
- discrimination was the real reason (the causation standard depends on the statute).

Importantly, the ultimate burden of persuasion always remains with the plaintiff.

C. “But-For” vs. “Treated Less Well” (ADEA/NYSHRL vs. NYCHRL)

But-for causation (ADEA, pre-2019 NYSHRL):
- Age must be the decisive reason—i.e., “but for” the plaintiff’s age, the adverse decision would not have been made.
“Treated less well” (NYCHRL):
- The plaintiff must show they were treated less favorably at least in part because of a protected characteristic (e.g., age).
- However, courts still dismiss NYCHRL claims on summary judgment where no reasonable jury could infer discriminatory intent from the record.

D. Property Interest vs. Liberty Interest

Property interest:
- Arises when a person has a legitimate claim of entitlement (not just a unilateral expectation) to a benefit, such as employment or, in some cases, clinical privileges spelled out in hospital bylaws.
Liberty interest (stigma-plus):
- In the employment context, this requires:
  - a stigmatizing, false, publicly disseminated statement by the government (stigma), plus
  - a concrete burden, such as termination or non-renewal (plus).
- Mere reputational harm or job loss, without a publicly disseminated false statement, does not suffice.

E. Pre- vs. Post-Deprivation Hearings

Due process does not always require a full hearing before the government takes action. Courts evaluate:

how serious and urgent the government’s interests are (e.g., patient safety),
how reliable the initial decisionmaking is likely to be, and
what kind of post-deprivation review is available.

In sensitive settings like hospital privileges, the law often allows swift action first (to protect patients), followed by a more robust hearing later to test whether that action was justified.

F. Harmless Error and Plain Error

Harmless error:
- An error that likely did not affect the outcome of the trial. Appellate courts will not reverse if they are reasonably certain the jury’s verdict would have been the same absent the error.
Plain error:
- A clear or obvious error that affects substantial rights and seriously affects the fairness, integrity, or public reputation of judicial proceedings. This is a high bar, applied mainly when an error was not properly objected to at trial.

V. Practical and Doctrinal Impact

Although this is a summary order without precedential effect, it offers instructive guidance on how Second Circuit panels are likely to evaluate similar issues.

A. For Public Hospitals and Academic-Medical Affiliations

Affiliation agreements matter:
- Clearly drafted agreements tying academic appointments to the maintenance of specific clinical privileges can be powerful defenses against discrimination claims, so long as they are applied consistently and non-pretextually.
Bylaws as due-process instruments:
- Hospitals should maintain and follow bylaws that:
  - specify grounds for non-renewal of privileges,
  - provide for notice and a hearing (with rights to call and cross-examine witnesses), and
  - offer an internal appeal path (e.g., to the hospital system’s president).
- When such procedures are followed, courts are more likely to find that due process has been satisfied—even if initial actions are taken before the hearing to protect patients.
Balancing safety vs. process:
- This decision, read with Ezekwo and Greenwood, confirms that patient-safety concerns support a regime where:
  - clinicians can be immediately removed from duty or have privileges restricted,
  - provided they later receive a meaningful opportunity to contest the decision.

B. For Physicians and Other Medical Staff

Due process rights are limited but real:
- Physicians at public hospitals may have a property interest in privileges if hospital bylaws promise certain renewal and review procedures.
- However, they should expect that:
  - immediate administrative action can be taken in the name of patient safety, and
  - the main procedural protections will come through post-deprivation hearings and appeals, not necessarily before they’re removed from practice.
Stigma-plus is hard to prove:
- Even serious professional setbacks and internal criticisms are not enough to create a liberty-interest claim unless:
  - false, stigmatizing assertions are publicly disseminated or placed in records likely to be disclosed to employers, and
  - those assertions go hand-in-hand with a tangible loss such as non-renewal.

C. For Discrimination Litigants and Counsel

Stray remarks vs. structural reasons:
- Isolated ageist comments, even by decisionmakers, may not defeat summary judgment where the employer has:
  - a strong, documented, and structurally grounded legitimate reason (e.g., loss of required privileges under an affiliation agreement), and
  - the plaintiff cannot show that reason is selectively enforced or factually untrue.
NYCHRL still demands a factual nexus:
- NYCHRL’s more plaintiff-friendly standard does not eliminate the need for evidence that discriminatory intent played a role. Robust, non-discriminatory explanations—if left unrebutted—can still defeat NYCHRL claims on summary judgment.
Trial strategy and record preservation:
- Parties must:
  - actually move to introduce key evidence at trial to preserve any challenge to its exclusion, and
  - timely object to jury instructions and evidentiary rulings to avoid the stringent plain-error standard on appeal.

D. For Courts and Future Litigation

Nonprecedential but instructive:
- While not binding, the order reflects how a contemporary Second Circuit panel applies:
  - the McDonnell Douglas framework,
  - stigma-plus doctrine in the medical context, and
  - due-process requirements when patient safety is implicated.
Emphasis on record-driven analysis:
- The panel repeatedly notes the absence of evidence on key points (e.g., lack of proof that SUNY played a role in KCH’s decision; lack of evidence of public dissemination of allegedly defamatory statements), reminding litigants that doctrinal arguments cannot substitute for a well-developed factual record.

VI. Conclusion

Hanley v. NYC Health & Hospitals Corp. illustrates the intersection of age discrimination claims, hospital-privilege disputes, and constitutional due process in a complex academic-medical setting. The Second Circuit:

Upheld summary judgment for SUNY on age discrimination, emphasizing the decisive role of a clear affiliation agreement that made Hanley’s academic appointment contingent on her KCH clinical privileges.
Assumed, without deciding, that Hanley had a property interest in KCH privileges but held that the hospital’s bylaws—providing for notice, hearing with witness examination, and appeal—afforded all the process that was due, notwithstanding delays and the lack of a full pre-deprivation hearing.
Reaffirmed the demanding nature of the stigma-plus doctrine: reputational harm and difficulty finding work, absent a publicly disseminated false and stigmatizing statement by the government, do not create a liberty-interest claim.
Rejected attacks on evidentiary rulings and jury instructions, finding no reversible or plain error, and highlighting the importance of actual trial conduct and record preservation.

Although this summary order carries no precedential weight, it provides a detailed, practical application of established doctrines in a factually rich medical employment context. For hospitals, universities, and physicians, it underscores the importance of:

clear contractual and bylaw frameworks,
consistent and documented implementation of those frameworks, and
the high evidentiary bar plaintiffs must meet to convert workplace disputes—particularly around competence and safety—into viable federal due process or age discrimination claims.

This decision therefore functions as a valuable, if nonbinding, map of how the Second Circuit may approach similar disputes at the intersection of academic medicine, public employment, and constitutional and anti-discrimination law.

Due Process, Stigma-Plus, and Age Discrimination in Hospital Privilege Non-Renewals: Commentary on Hanley v. NYC Health & Hospitals Corp. (2d Cir. 2025) (Summary Order)