Don't put pen to paper in anger. That's the lesson to be learned from the case of a Texas gastroenterologist who must pay a colleague $181,000 in damages for defaming him in a letter. "The lesson is, don't fly off the handle," says Robert W. St. Clair, attorney for plaintiff Easwaran P. Variyam, MD. "Count to 10 before you start writing a letter you may regret."

A Texas appeals court recently upheld the jury's decision in the trial, but the defendant in this case, Joseph E. Hancock, MD, plans to appeal the case to the Texas Supreme Court, according to Donald M. Hunt, one of his attorneys, who wouldn't discuss the case further. Both physicians were gastroenterologists at Texas Tech University School of Medicine in Lubbock, Texas. Mr. St. Clair says defamation lawsuits are rare, and when they are filed, they're usually thrown out on summary judgment or are settled between parties before going to trial, but Dr. Hancock wouldn't accept requests made by Dr. Variyam to retract his letter. "Retracting the letter would have cost him much less than the jury's damage award," says Mr. St. Clair.

Dr. Hancock's letter was in reaction to a letter he received from Dr. Variyam criticizing him for not providing sufficient information when handing off patients while both were on call over the New Year's holiday in 2006. At that time, Dr. Variyam was chief of the university's gastroenterology division and Dr. Hancock's supervisor. In the subsequent letter, sent to the dean of the medical school, Dr. Hancock tendered his resignation and wrote that "it is Dr. Variyam's ethical behavior that should be challenged" in the patient handoff, rather than Dr. Hancock's behavior. Writing that "Dr. Variyam deals in half-truths, which legally is the same as a lie," he copied the letter to 2 other university officials and to the Accreditation Council for Graduate Medical Education. The ACGME had closed the university's GI fellowship program, which Dr. Variyam headed, the year before, and Dr. Variyam was trying to convince the ACGME to reinstate the program.

Dr. Hancock's letter was "like using a nuclear bomb to kill a gnat," says Mr. St. Clair. "He did not need to go outside the boundaries of the university and contact the ACGME, knowing the position the program was in." After the letter was sent, the ACGME refused to reaccredit the program and Dr. Variyam was removed as GI department chief. Dr. Hancock became the new chief about a year later, before the trial took place, but has subsequently left the post.

Dr. Variyam was "devastated, very distraught and disappointed" about the fallout from the letter, says Mr. St. Clair. He was embarrassed about what colleagues might be thinking of him, he slept fitfully and the incident was continually on his mind. After the trial, Dr. Variyam decided he would resign from Texas Tech and now has a teaching position at the University of Texas Medical Branch across the state in Galveston.

In his lawsuit, Dr. Variyam didn't allege any economic damages from losing his post as chief (since he had retained his faculty position). Instead, he limited his claims to non-economic damages, such as mental anguish and loss of reputation. In the 2009 trial, Dr. Hancock contended that other courts had dismissed slander lawsuits for calling the plaintiff a "liar," but the appeals court noted that cases involving written defamation, such as Dr. Hancock's, are viewed more seriously than off-the-cuff verbal comments.

Mr. St. Clair says defamation claims against an individual are easier to prove than against a media outlet, because the media have the purported purpose of informing the public. In addition to awarding Dr. Variyam $90,000 in actual damages, the jury also awarded him $85,000 in exemplary damages, which meant that all 12 jurors had to conclude that Dr. Hancock committed the libel with "intentional malice," says Mr. St. Clair. The appeals court upheld the exemplary damages, noting that Dr. Hancock had sent his letter to the ACGME with full knowledge that the future of the fellowship program was in the balance. The court also added $6,455.68 in pre-judgment interest to the award.

Leigh Page