DR. LESLEY WILLIAMS

v.

BOARD OF REGENTS OF THE UNIVERSITY SYSTEM OF GEORGIA

GEORGIA, DR. BROOKS KEEL, in his individual capacity, DR. STEFFEN MEILER, in his individual capacity, DR. MARY ARTHUR, in her individual capacity, et al., Defendants-Appellees, DR. WALTER MOORE, in his individual capacity, et al., Defendants. USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page:² of 35

2 Opinion of the Court 23-12878 ____________________ Appeal from the United States District Court for the Southern District of Georgia D.C. Docket No. 1:20-cv-00100-JRH-BKE ____________________

Before NEWSOM, GRANT, and ABUDU, Circuit Judges. ABUDU, Circuit Judge: Dr. Lesley Williams appeals the district court’s grant of sum- mary judgment on her federal and state law claims against the Board of Regents (“BOR”) of the University System of Georgia and affiliated defendants stemming from the termination of her anes- thesiology residency at Augusta University (“AU”). Her lawsuit al- leged that her dismissal was a result of sex discrimination, sex retal- iation, disability discrimination, and whistleblower retaliation, and constituted a denial of procedural due process and a breach of con- tract. After careful review of the record, and with the benefit of oral argument, we affirm the district court’s judgment.

I. FACTUAL BACKGROUND & PROCEDURAL HISTORY

Williams began a three-year anesthesia residency at AU’s Medical College of Georgia in 2017 as a second-year resident. Like all AU residents, she worked under annual employment contracts, and signed agreements covering July 2017 through June 2018, and July 2018 through June 2019. In March 2018, Williams was the vic- tim of a horrific crime wherein she was beaten and raped. The An- esthesiology Residency Department (“ARD”) sent out emails to de- partment staff asking for their emotional and financial support for USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page:³ of 35

Williams, raising more than $3,000. Williams was subsequently di- agnosed with Post-Traumatic Stress Disorder (“PTSD”). Following her diagnosis, Williams reported attention and concentration difficulties and requested modified duties. AU placed her on a one-month elective research rotation, before re- turning her to clinical duties, including obstetrics and pediatrics ro- tations. During pediatrics, Director Ellen Basile reported that Wil- liams wandered during shifts, disappeared from assigned duties, missed three shifts, and once collapsed at work. She nonetheless received positive evaluations for rotations completed prior to her traumatic experience. Steffen Meiler, the Chairperson of the Department of Anes- thesiology and Perioperative Medicine, requested that Dr. Jeremy Hertza, the Fitness for Duty Program Director at a company called LifeGuard, complete a “Physician Back to Work Evaluation” on Williams. AU’s Residency Program Director, Mary Arthur, asked Dr. Hertza to determine: (1) “Is [Williams] cognitively and psycho- logically able to perform in the high stress environment of the op- erating room?” and “(2) What would be the potential impact of a tragic outcome in the operating room on [Williams’s] recovery?”¹

Then ARD informed Williams she was limited to an “ob- server” role and should not treat patients during rotations.² ARD also directed her to delete case logs of patient care performed and not submit them to the Accreditation Council for Graduate Medi- cal Education (“ACGME”), the institution that accredits graduate medical training programs. Williams then filed a formal complaint with the ACGME, alleging she was being denied credit for com- pleted cases. Eleven days later, Williams fainted while working in the op- erating room. Emergency room records noted recent alcohol use and referenced recent substance abuse. After being summoned to the Chair’s Office, Williams reported consuming alcohol while on PTSD medication at graduation parties the prior weekend and us- ing (“THC”) gummies, a controlled substance, to sleep a few weeks prior. ARD then requested she be drug tested.³ The test was initially scheduled through Quest Diagnostics, but Williams was directed to return to AU for in-house testing while en route. She objected that the test was unfounded, and signed the authorization form after crossing out “voluntary” and writing “mandated.” She later stated that she had agreed to take the test “so they could shove it up their ass when it came back neg- ative.” Williams underwent testing for both a standard drug panel

dents and faculty because of the profession’s high-risk. USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 5 of 35

and operating room drugs, such as fentanyl and ketamine. AU con- fiscated her badge and barred her from work pending the results, which took about a month. The tests were negative except for her prescribed PTSD medication. During this period, Williams passed her “Physician Back to Work Evaluation.” Dr. Hertza recommended seven accommoda- tions.⁴ The ARD declined to implement them, asserting that they were unreasonable given the nature of anesthesiology and depart- mental resources. 5 After Williams alleged that following her return to work, she had experienced a series of negative employment ac- tions, the Director of Employment Relations and the Director of Employment Equity produced a confidential report summarizing their investigation into her claims of disability and gender discrim- ination for Dean of the Medical College of Georgia, David Hess. The report found “the interactive process was not utilized in deny- ing the accommodations, and no justification was approved (per the AU process for denying each).” It further found that only two alternative accommodations had been presented and not matched to each of the seven requests.

quent breaks, avoiding serial days on call with little sleep or high stress, and frequent meetings with supervisors. 5 The report the Director of Employment Relations and the Director of Em-

ployment Equity prepared concluded that “there [was] no record of the de- partment having an approved written undue hardship justification for each accommodation that was denied.” USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page:⁶ of 35

Members of the ARD also required Williams to undergo a medical simulation. Williams explained she felt fine months ago and needed the same breaks and supervision as any resident. AU refused to permit her to return to work without the simulation, and Williams eventually agreed. While awaiting the results, ARD offered her an elective research rotation for credit and possible pub- lication and provided assistance in preparing for the simulation. Af- ter LifeGuard issued its final simulation report, Williams restarted her rotations in December 2019 and initially received positive eval- uations. AU sent Williams a written warning based on her earlier statement that she would take the drug test so that, if it came back clean, they could “shove it up their ass.” Williams acknowledged making the remark but noted she had apologized, and objected to the warning because it was issued four months after the incident. According to Williams, the drug test was prompted by her disclo- sure to Basile that she had eaten THC gummies to help her sleep. Williams was accused of abnormal examination behavior on an in-training examination, after leaving the room to use the re- stroom and being found in another room with her test prep book open. Williams denied cheating, stating she merely opened her book during a break and did not believe it was improper because she had not been required to store materials as on prior exams. She further argued she would have used her phone if she intended to cheat, and claimed she was simply “refreshing her knowledge,” noting others also used phones or notes. USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page:⁷ of 35

Faculty also reported clinical concerns, including that Wil- liams overlooked serious problems with a high-risk patient, failed to use basic monitoring tools, and removed a breathing tube with- out checking oxygen levels. The patient quickly and critically de- clined, causing the hospital staff to call for extra help. Williams re- portedly apologized, though faculty expressed concern that her confidence masked questionable judgment. Williams disputed that she improperly extubated the patient. Williams left her on-call coverage of Obstetrics and Gyne- cology thirty minutes early. The Chief Medical Officer, Dr. Phillip Coule, stated that the lack of coverage could have caused the death or serious injury of a mother or child if an emergency had occurred. Williams claims there was no lack of coverage as her replacement had arrived early, but she still acknowledged that she left thirty minutes before her shift ended. In the same anesthesiology program, three male residents were also facing disciplinary issues. Dr. AT lied about having mul- tiple convictions for public intoxication, he had multiple unsatisfac- tory performance reviews, and repeatedly refused to take call as scheduled. However, there was no finding that he engaged in aca- demic dishonesty or placed patients at significant risk. Dr. R left work early without providing notice, ignored patient requests, ad- ministered unreasonably large doses of medicine, and ultimately entered substance abuse treatment after being placed on leave. Ad- ditionally, a third resident faced behavioral misconduct in the USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page:⁸ of 35

operating room, received disciplinary leave, and was later indicted for a felony. With respect to Williams, the BOR initiated termination proceedings against her, which culminated in her dismissal from the residency program. Williams appealed, and an ad hoc commit- tee concluded termination was unwarranted, finding her clinical evaluations were generally average or above average and often rec- ommended increased autonomy, with no consistent concerns for unprofessional behavior. However, the committee acknowledged serious concerns regarding her conduct on the in-training exami- nation, describing it as “egregious and worthy of sanction.” Dean Hess accepted the findings and ordered Williams to be reinstated in AU’s residency program. The reinstatement letter (“zero-tolerance letter”) stated there “will be zero tolerance for any unprofessional behavior. Any future problems with your perfor- mance or behavior will result in further action up to and including termination.” Although ARD initially considered appealing, it ul- timately did not. Chairperson Meiler and Residency Program Director Arthur called a special faculty meeting about Williams, attended by twenty-six of thirty faculty members. Faculty expressed concerns related to her disability, program and faculty burdens, and poten- tial litigation; one member also offered to mentor her. This meet- ing resulted in new performance evaluations. That same day, Arthur drafted a patient safety letter to send to Coule and circulated it to Meiler and Basile for input. She noted USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page:⁹ of 35

that Williams’s prior evaluations did not reflect concerns expressed at the meeting, and asked faculty to submit “360 evaluations,” stat- ing that Williams’s prior evaluations were “well below average.” In response, seven faculty members submitted reviews, with two consistently rating some of Williams’s skills beyond the category of “Compassion/Empathy” as “good.” Only the two lowest evalua- tions, submitted by Drs. Taghizadeh and Basile, were ultimately included with the patient safety letter.⁶ Arthur then sent Coule a letter summarizing ARD’s con- cerns regarding Williams. The letter included the faculty evalua- tions, the American Board of Anesthesiology’s letter about cheat- ing on the exam, the Clinical Competency Committee’s agenda about and disciplinary hearing with Williams, and the minutes from a November 2018 meeting with Williams. Based on the

tion incident. Earlier in the year, Taghizadeh had served on the Clinical Com- petency Committee that participated in the disciplinary review regarding the alleged exam misconduct. Taghizadeh marked the box to say that the evalu- ation was provided to the resident, though it was completed four months after the underlying incident. Basile’s June⁴, 2019 evaluation addressed Williams’s June 2018 rotation. It noted that Williams was absent from work, wandered away from the rooms she was assigned to watch, was unreliable and late, and frequently failed to adequately complete required forms documenting her work during rotations, leaving them incomplete or not completed at all. It also stated that Williams showed small improvement, but she did not respect feedback or change and was unprofessional. Basile concluded that Williams’s “presence in the department created an unsafe environment to patients, su- pervisors, and peers” that could cause direct physical harm to her patients. USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page:¹⁰ of 35

cumulative record, Coule suspended Williams from practicing medicine due to patient safety concerns. Williams was terminated from the program based on her loss of clinical privileges and revocation of hospital access. Wil- liams appealed the termination. AU President Keel upheld the ter- mination, and the BOR’s Discretionary Review Committee af- firmed. Williams filed this action in state court. Her original com- plaint asserted claims against the institutional defendants for sex discrimination under Title IX, unlawful retaliation under Title IX, and the Georgia Whistleblower Act (“GWA”). She also brought claims under 42 U.S.C. § 1983 against Keel, Coule, Meiler, Moore, and Arthur in their individual capacities for alleged violations of the Equal Protection Clause, along with state-law claims for libel and slander against all defendants and a claim for litigation expenses under O.C.G.A. § 13-6-11. The defendants removed the case to federal court. Williams filed an amended complaint, expanding her factual allegations and asserting additional theories of liability, including disability dis- crimination and retaliation, due process violations, and Fourth Amendment claims, as well as additional statutory and constitu- tional claims arising out of her suspension and termination from the residency program. The district court granted in part Defend- ants’s motion for judgment on the pleadings, dismissing Williams’s Section 1983 Equal Protection and Fourth Amendment claims against Meiler, Moore, Arthur, and Keel on qualified immunity USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 11 of 35

grounds, Americans with Disabilities Act (“ADA”) and Rehabilita- tion Act claims against the individual defendants, and state-law li- bel and slander claims against the BOR on sovereign immunity grounds, while allowing the remaining claims to proceed. The dis- trict court then granted summary judgment on all remaining claims. Williams moved for reconsideration of the district court’s summary judgment order, but the district court denied her motion. Williams timely appealed.⁷

II. STANDARDS OF REVIEW

We review summary judgment de novo, viewing the evi- dence and drawing all reasonable inferences in the light most favor- able to the nonmoving party. Guevara v. Lafise Corp., 127 F. 4th 824, 828 (11th Cir. 2025). Summary judgment is warranted when “there is no genuine dispute as to any material fact and the movant is en- titled to judgment as a matter of law.” FED. R. CIV. P. 56(a). To survive summary judgment, the employee must put forward evi- dence from which a reasonable jury could conclude that the em- ployer unlawfully retaliated against her. Berry v. Crestwood Healthcare LP, 84 F. 4th 1300, 1311 (11th Cir. 2023). “‘[A] scintilla of evidence in support of the [employee’s] position’ is always insuffi- cient.” Id. (quoting Anderson v. Liberty Lobby, 477 U.S. 242, 252 (1986)). Summary judgment in the employer’s favor is awarded

her appeal as to her claims against Coule, AU Medical Center, and AU Medical System. The remaining claims on appeal are her claims against the BOR. USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 12 of 35

when the employer presents abundant, uncontroverted, and inde- pendent evidence demonstrating that no retaliation occurred. Id.

III. DISCUSSION

Williams challenges the district court’s grant of summary judgment on multiple claims arising from the termination of her medical residency, including sex discrimination, retaliation, viola- tions of the GWA, the ADA and Rehabilitation Act, procedural due process, and breach of contract. We address each claim in turn.

A. Sex Discrimination

Williams argues that the district court erred in granting sum- mary judgment on her Title IX sex discrimination claim. She con- tends her termination and performance evaluations were influ- enced by sex-based animus, and that similarly situated male resi- dents received more favorable treatment. Title IX prohibits discrimination “on the basis of sex” in any education program receiving federal funds. 20 U.S.C. § 1681(a). The statute provides students with a private right of action to chal- lenge sex discrimination by federally funded educational institu- tions. Cannon v. Univ. of Chicago, 441 U.S. 677, 690 n.13 (1979). By contrast, we have held that Title IX’s protections against discrimi- nation do not extend to employees of educational institutions. Jo- seph v. Bd of Regents of the Univ. Sys. of Ga., 121 F. 4th 855, 869 (11th Cir. 2024) (holding that Title IX does not create an implied cause of action for sex discrimination in employment while recognizing cir- cuits are split on the issue), cert. granted sub nom. Crowther v. Bd. of Regents of the Univ. Sys. of Ga, No. 25-183, 2026 WL 1377024 (U.S. USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 13 of 35

May 18, 2026). We need not definitively resolve whether Williams, a medical resident, was acting as an employee or as a student. As- suming without deciding that Williams may invoke Title IX as a student, her claim nevertheless fails for the reasons explained be- low. For purposes of this case, we can simply assume, without definitively deciding, that Williams’s Title IX claim is governed by the familiar disparate-treatment framework developed in Title VII cases. Under that framework, a plaintiff may survive summary judgment on a disparate treatment claim in two ways: (1) by pro- ceeding under the burden-shifting framework set forth in McDon- nell Douglas Corp. v. Green, 411 U.S. 792, 802–03 (1973), or (2) by pre- senting a “convincing mosaic” of circumstantial evidence that per- mits a reasonable inference of discriminatory intent. Yelling v. St. Vincent’s Health Sys., 82 F. 4th 1329, 1342 (11th Cir. 2023); Berry, 84 F. 4th at 1311. Under the McDonnell Douglas framework, a plain- tiff can establish a prima facie case by showing that she (1) is a member of a protected class, (2) suffered an adverse employment action, (3) was treated differently from similarly situated employ- ees outside her class, and (4) was otherwise qualified for the posi- tion. Burke-Fowler v. Orange Cnty., 447 F. 3d 1319, 1323 (11th Cir. 2006). To satisfy McDonnell Douglas’s comparator prong, Williams “must show that she and her comparators were ‘similarly situated in all material respects,’” meaning they engaged in “misconduct comparable in degree or kind.” Berry, 84 F. 4th at 1312 (citations USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 14 of 35

and internal quotations omitted). A comparator is similarly situ- ated if the individuals engaged in misconduct of comparable sever- ity, were subject to the same rules and supervision, and shared em- ployment or disciplinary history. Lewis v. City of Union City, Ga., 918 F. 3d 1213, 1227 (11th Cir. 2019) (en banc). Exact correlation is not required, but“[a]pples should be compared to apples.” Id. at 1226 (quoting Dartmouth Rev. v. Dartmouth Coll., 889 F. 2d 13, 19 (1st Cir. 1989), overruled on other grounds by Educadores Puertorriqueños en Acción v. Hernandez, 367 F. 3d 61 (1st Cir. 2004). Williams relies on Drs. AT and R, but the record shows ma- terial differences in both conduct and context.⁸ Although all were anesthesiology residents in the same department, comparator sta- tus requires more than a shared position. The nature, seriousness, and evaluative context of their misconduct differed in material re- spects, particularly with respect to patient safety and academic in- tegrity. Although Williams disputes the factual basis of some alle- gations against her—such as wandering during shifts, leaving early, and exam misconduct—those disputes do not alter the relevant

qualify. Williams focuses on Dr. AT and Dr. R, and does not discuss the third comparator in her appellate brief. We need not address whether this failure to discuss amounts to forfeiture because this comparator also fails on the mer- its: he engaged in misconduct in the operating room, received disciplinary leave, and was indicted for a felony. Unlike Williams, he was not accused of academic dishonesty or evaluated under the same combination of academic and professionalism concerns that ultimately led to her dismissal. As his disci- plinary history arose in a materially different context, he is not similarly situ- ated. USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 15 of 35

inquiry: how the decisionmakers perceived and evaluated her con- duct. Dr. AT’s misconduct involved professionalism issues such as false statements about criminal convictions and refusal to take call. While serious, these do not mirror Williams’s alleged academic misconduct or direct patient-care risks. Berry, 84 F. 4th at 1312; Lewis, 918 F. 3d at 1226. Dr. R left work early without notice, ig- nored patient requests for assistance, administered unreasonably large doses of medicine, and later entered substance abuse treat- ment after being placed on leave. Dr. R’s conduct, while more se- rious, was handled differently, as he was removed from clinical du- ties and did not continue in the program. In short, Williams failed to identify a male resident “similarly situated in all material re- spects,” and her claim fails under the McDonnell Douglas frame- work. Jenkins v. Nell, 26 F. 4th 1243, 1249 (11th Cir. 2022) (quoting Lewis, 918 F. 3d at 1224). However, the McDonnell Douglas framework is not the ex- clusive way a plaintiff can survive summary judgment. Yelling, 82 F. 4th at 1342; Ismael v. Roundtree, 161 F. 4th 752, 761 (11th Cir. 2025) (explaining that our precedent “makes clear that a plaintiff who cannot establish the McDonnell Douglas prima facie case is en- titled to a full review under the convincing mosaic standard”). The convincing mosaic approach allows a plaintiff to establish retalia- tion through circumstantial evidence that permits a reasonable in- ference of retaliatory intent. McCreight v. AuburnBank, 117 F. 4th 1322, 1335 (11th Cir. 2024); Berry, 84 F. 4th at 1311; Ismael, 161 F. 4th USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 16 of 35

at 763. Such intent may be inferred from, among other things, sus- picious timing or ambiguous remarks, disparate treatment of simi- larly situated employees, or evidence that the employer’s stated reasons are pretextual. Yelling, 82 F. 4th at 1342. Under that standard, Williams also fails to present a convinc- ing mosaic of circumstantial evidence from which a reasonable jury could infer discriminatory intent. Berry, 84 F. 4th at 1310. She pri- marily relies on the temporal proximity between her complaints and subsequent disciplinary actions. However, timing alone is in- sufficient where independent, legitimate reasons for adverse ac- tions exist. Id. at 1311. Here, the record documents repeated con- cerns regarding patient safety, unprofessional conduct, academic dishonesty, and failure to follow supervisory instructions. As those concerns arose in the same period as Williams’s complaints and continued through her termination, no reasonable jury could infer discriminatory intent from timing alone. Nor does the record con- tain evidence that decisionmakers made remarks reflecting sex- based animus. Instead, faculty discussions and correspondence fo- cused on professional competence, patient safety, and residency re- quirements. Such focus cannot reasonably be construed as discrim- inatory. Yelling, 82 F. 4th at 1342. Even under the convincing mosaic standard, Williams can- not show that similarly situated residents engaged in comparable conduct and were treated more favorably. Although comparator evidence may be considered despite some factual differences, and weight is generally for the jury, it must still support a reasonable USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 17 of 35

inference of discriminatory intent. Ismael, 161 F. 4th at 764; Jenkins, 26 F. 4th at 1251. Here, it does not. None of the comparators combined patient-safety lapses, exam irregularities, unprofessional behavior, and loss of clinical privileges in the same way. These differences go to the nature and severity of the misconduct and the resulting discipline; the compar- ator evidence does not support an inference of sex-based animus. Berry, 84 F. 4th at 1312; Lewis, 918 F. 3d at 1227. Accordingly, Wil- liams’s comparator evidence does not create a convincing mosaic of discrimination. Finally, we can consider whether the defendants’s stated rea- sons were pretextual. The defendants consistently cited perfor- mance and patient-safety concerns as the basis for their actions. These reasons are documented in contemporaneous evaluations, faculty reports, and Medical Center determinations regarding clin- ical privileges. Even the internal review noting procedural errors in handling accommodation requests does not indicate discrimina- tory intent in the termination decision. Viewed cumulatively, the evidence reflects professional and patient-safety concerns rather than sex-based discrimination. Yelling, 82 F. 4th at 1342. As the de- fendants’s reasons are independent and well-documented, no rea- sonable jury could infer discriminatory intent. Berry, 84 F. 4th at 1311. Accordingly, Williams fails to establish a prima facie case un- der McDonnell Douglas and also cannot show a convincing mosaic sufficient to survive summary judgment on her Title IX sex-dis- crimination claim. USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 18 of 35

B. Retaliation

Williams argues the district court erred in granting sum- mary judgment on her retaliation claims under Title IX, the ADA, and the Rehabilitation Act. According to Williams, after she com- plained of discrimination and refused to alter her ACGME-required work logs, the BOR retaliated by escalating discipline, gathering negative evaluations, and dismissing her from the residency pro- gram. Retaliation claims can also be evaluated under the McDonnell Douglas burden-shifting framework. 411 U.S. at 802–03. To estab- lish a prima facie case retaliation claim, a plaintiff must allege facts showing that (1) she engaged in statutorily protected activity, (2) she suffered a materially adverse employment action, and (3) there was a causal connection between the two. Berry, 84 F. 4th at 1307; Crawford v. Carroll, 529 F. 3d 961, 970 (11th Cir. 2008). If the plaintiff satisfies this burden, the employer must articulate a legiti- mate, nonretaliatory reason for the adverse action. Berry, 84 F. 4th at 1307; Tolar v. Bradley Arant Boult Cummings, LLP, 997 F. 3d 1280, 1289 (11th Cir. 2021). The burden then returns to the plaintiff to show that the employer’s proffered reason was pretextual. Johnson v. Miami-Dade Cnty., 948 F. 3d 1318, 1325 (11th Cir. 2020). Williams engaged in protected activity when she resisted re- quests to delete ACGME-required work logs and filed formal com- plaints with ACGME. She suffered adverse employment actions, including placement on leave, negative evaluations, probation, and ultimately termination. The dispositive question for McDonnell USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 19 of 35

Douglas, then, is causation: whether these actions were caused by her protected activity rather than legitimate concerns about her performance. See, e.g., Gogel v. Kia Motors Mfg. of Ga., Inc., 967 F. 3d 1121, 1150 (11th Cir. 2020) (en banc). To establish causation, a plaintiff must show that the deci- sionmakers were aware of the protected conduct and that the pro- tected activity and the adverse action were not unrelated. Shannon v. BellSouth Telecomms., Inc., 292 F. 3d 712, 716 (11th Cir. 2002). The ultimate standard is “but-for” causation, meaning the protected ac- tivity must be the determinative reason for the adverse action. Univ. of Tex. Sw. Med. Ctr. v. Nassar, 570 U.S. 338, 352 (2013); Gogel, 967 F. 3d at 1135. A plaintiff may rely on close temporal proximity between the protected activity and the adverse action to support an inference of causation. Thomas v. Cooper Lighting, Inc., 506 F. 3d 1361, 1364 (11th Cir. 2007). However, at summary judgment, tem- poral proximity alone is sufficient only where it is “very close.” Id. (quoting Clark Cnty. Sch. Dist. v. Breeden, 532 U.S. 268, 273 (2001)). The district court correctly noted that the BOR articulated legitimate, nonretaliatory reasons for its actions: concerns about patient safety, professionalism, and trust. Williams left an assigned shift early, made clinical errors that jeopardized patient safety, en- gaged in academic dishonesty, and exhibited unprofessional con- duct. These reasons might legitimately motivate a reasonable em- ployer to terminate an employee. Patterson v. Ga. Pac., LLC, 38 F. 4th 1336, 1352 (11th Cir. 2022); Smith v. PAPP Clinic, P.A., 808 F. 2d 1449, USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 20 of 35

1452–53 (11th Cir. 1987). Williams had to address these reasons “head on and rebut” them. Patterson, 38 F. 4th at 1352. In attempting to show pretext, Williams points to discus- sions by faculty about her disability, negative evaluations after a special faculty meeting, and awareness by the institution of her ac- commodation requests. However, an employer’s mere awareness of an accommodation request, standing alone, does not suggest a causal link or support an inference of retaliation. Shannon, 292 F. 3d at 716. While these discussions reflect awareness of her PTSD and potential complaints, they were largely separate from the evalua- tions that documented concrete performance deficiencies. Wil- liams also cites prior positive evaluations, the Dean Hess report re- garding accommodations, and the timing of faculty meetings to ar- gue pretext. At most, this evidence suggests internal debate or pro- cedural missteps; it does not undermine the legitimate reasons for her discipline and termination. Patterson, 38 F. 4th at 1352; Gogel, 967 F. 3d at 1336. Williams was the first resident ever terminated from the pro- gram; ordinarily, residents had resigned or were not renewed. The severity of her documented misconduct, including patient safety incidents and unprofessional behavior, distinguishes her situation from other residents who received lesser discipline. No reasonable factfinder could conclude that BOR’s stated reasons were not the actual basis for her termination. Hurlbert v. St. Mary’s Health Care Sys., Inc., 439 F. 3d 1286, 1298 (11th Cir. 2006). USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 21 of 35

As established above, Williams cannot satisfy the McDonnell Douglas framework and fares no better under the alternative con- vincing mosaic approach. The Court applies the convincing mo- saic framework in equal measure to retaliation and discrimination claims. Ismael, 161 F. 4th at 760; Berry, 84 F. 4th at 1310. While McDonnell Douglas and the convincing mosaic framework are dis- tinct analytical tools, both ultimately ask whether the evidence per- mits a reasonable inference of intentional retaliation at summary judgment. Ismael, 161 F. 4th at 762; Berry, 84 F. 4th at 1310–11; Yell- ing, 82 F. 4th at 1342. For the same reasons she fails on sex discrimination, the rec- ord contains no circumstantial evidence from which a reasonable jury could infer retaliatory intent. Ismael, 161 F. 4th at 760. Tem- poral proximity alone is insufficient given independently docu- mented concerns about patient safety, professionalism, academic dishonesty, and failure to follow supervisory instructions. Gogel, 967 F. 3d at 1137 n.15; Tanner v. Stryker Corp. of Mich., 104 F. 4th 1278, 1290 (11th Cir. 2024). There are no ambiguous remarks reflecting retaliatory animus, and the cited comparators engaged in materi- ally different conduct, so alleged disparate treatment does not sup- port an inference of retaliation. The defendants’s articulated rea- sons (patient safety, performance, and professionalism) are well documented and unrebutted. Viewed cumulatively, the record re- flects legitimate, escalating professional concerns rather than un- lawful retaliation, and Williams offers nothing additional to create a genuine dispute. Young v. City of Palm Bay, 358 F. 3d 859, 860 (11th Cir. 2004). Accordingly, the district court properly concluded that USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 22 of 35

Williams failed to establish pretext, and summary judgment on her retaliation claims was warranted.

C. GWA

Williams argues that the district court erred in granting summary judgment on her GWA claims. She contends that the BOR and AU retaliated against her for reporting violations of ACGME work log requirements. The GWA prohibits a public employer from retaliating against a public employee in two ways: (1) for disclosing a violation of, or noncompliance with, a law, rule, or regulation to a supervisor or government agency, and (2) for objecting to, or refusing to par- ticipate in, any activity, policy, or practice that the employee rea- sonably believes violates a law, rule, or regulation. See O.C.G.A. § 45-1-4(d)(2)–(3). A “law, rule, or regulation” includes federal, state, or local law or regulations adopted under those authorities. See O.C.G.A. § 45-1-4(a)(2). ACGME work log requirements, codi- fied at 42 C.F.R. §§ 413.75 and 415.152, are binding for AU to main- tain Medicare funding. Accordingly, the BOR and AU have a con- tractual obligation to act in accordance with ACGME guidelines. The central question is whether Williams reported the alleged ACGME work log violation to her supervisor, Dr. Moore. The rec- ord shows that Williams disclosed the violation only to ACGME, a certifying entity, not her supervisor or a governmental body. Williams relies on her grievance hearing transcript to sug- gest she “brought [her case logs] to Dr. Moore’s attention.” That transcript, however, shows she sought credit for procedures USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 23 of 35

performed, not that she “blew the whistle” on a legal violation. The statement demonstrates only that she discussed receiving aca- demic credit, not that she reported noncompliance to a supervisor. Without actually objecting to or refusing to sound the alarm of a legal violation to a proper supervisor, Williams cannot satisfy Sec- tion 45-1-4(d)(2), and no genuine issue of material fact exists on this element. See O.C.G.A. § 45-1-4(d)(2). 9 The district court therefore correctly granted summary judgment on her GWA claims.

D. ADA and Rehabilitation Act

Williams next argues that the district court erred in granting summary judgment on her ADA and Rehabilitation Act claims. She contends that AU subjected her to unlawful testing during her fitness-for-duty evaluation and failed to provide reasonable accom- modations for her PTSD. Title II of the ADA prohibits public entities from denying a qualified individual with a disability the benefits of services, pro- grams, or activities because of that disability. 42 U.S.C. § 12132; see Nehme v. Fla. Int’l Univ. Bd. of Trs., 121 F. 4th 1379, 1383 (11th Cir. 2024). As the Rehabilitation Act imposes an identical standard to

jected to deleting logs in violation of ACGME rules—is raised for the first time on appeal. This claim was not addressed below, and Williams identifies no reason she could not have raised it. Although we may consider a new claim in “special circumstances,” Williams identifies none, and we discern none. Ac- cess Now, Inc. v. SW Airlines Co., 385 F. 3d 1324, 1332 (11th Cir. 2004). USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 24 of 35

recipients of federal funding, we address the two claims together. Silberman v. Miami Dade Transit, 927 F. 3d 1123, 1133 (11th Cir. 2019). To prevail, a plaintiff must show that she: (1) has a disability, meaning an impairment that substantially limits a major life activ- ity; (2) is a qualified individual who can satisfy the program’s essen- tial requirements with or without reasonable accommodations; and (3) was subjected to discrimination because of her disability. 42 U.S.C. §§ 12102(1), 12131(2); Nehme, 121 F. 4th at 1383; Cash v. Smith, 231 F. 3d 1301, 1305 (11th Cir. 2000). A student is entitled to reasonable accommodations for a disability, but must still be able to meet the program’s essential academic requirements. Onishea v. Hopper, 171 F. 3d 1289, 1300 (11th Cir. 1999) (en banc). Courts defer heavily to faculty regarding academic matters, including whether a student is capable of continuing in a program, because they are not academic decisionmakers. Nehme, 121 F. 4th at 1383 (“[F]ederal courts are not universities or academic administrators”); see also Re- gents of Univ. of Mich. v. Ewing, 474 U.S. 214, 225 (1985) (“When judges are asked to review the substance of a genuinely academic decision . . . they should show great respect for the faculty’s profes- sional judgment.”). Accordingly, academic decisions are granted broad discretion and will be disturbed only where they so substan- tially depart from accepted academic norms that they cannot be considered the product of professional judgment. Id. Here, the threshold problem for Williams is that the record does not support her claim that she was a qualified individual with a disability requiring accommodations at the relevant time. At a USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 25 of 35

November 2018 faculty meeting, Williams stated she “felt fine months ago,” needed no special accommodations beyond those provided to all residents, and could perform her duties without modification. These admissions undermine her claim of ongoing need for accommodations. Nehme, 121 F. 4th at 1384 (finding a med- ical student was not a qualified individual for failing to meet the academic requirements of the program). Moreover, even assuming residual symptoms, Williams was still required to be “otherwise qualified” by meeting the anesthesi- ology residency program’s academic and clinical requirements. Onishea, 171 F. 3d at 1300. The essential requirements included safe patient care, sound clinical judgment, professionalism, and inde- pendent functioning in the operating room. Faculty repeatedly expressed concerns about Williams’s clinical performance and pro- fessional conduct—concerns that were unrelated to any disability and instead focused on patient safety and trust. As Williams could not demonstrate that she both had a qualifying disability and could meet the program’s essential requirements with reasonable accom- modations, she failed to satisfy the second element of her ADA and Rehabilitation Act claims. Under the ADA, a public entity may require medical exami- nations or inquiries when they are “job-related and consistent with business necessity,” including when necessary to determine whether an individual can perform essential functions safely. 42 U.S.C. § 12112(d)(4)(A)–(B). As we have discussed, in the aca- demic context, particularly in medical training programs, courts USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 26 of 35

must further defer to faculty determinations regarding whether a student can safely and competently meet program requirements. Ewing, 474 U.S. at 225; Nehme, 121 F. 4th at 1383. Here, the undisputed record establishes that AU’s decision to require a fitness-for-duty evaluation and simulation test was driven by legitimate concerns about Williams’s ability to safely per- form essential clinical functions, not by discriminatory animus or impermissible medical probing. Williams had been away from clinical duty for an extended period following a traumatic event and subsequent leave. When faculty considered her return, they faced the question central to any residency program: whether a resident could safely provide patient care in a high-risk operating-room en- vironment. Arthur’s request to LifeGuard explicitly framed the evaluation around Williams’s ability to function cognitively and psychologically in the operating room. That inquiry goes directly to the core responsibilities of an anesthesiology resident and falls squarely within the ADA’s allowance for job-related assessments. See 42 U.S.C. § 12112(d)(4)(B). Williams argues the testing exceeded the ADA’s limits with regards to two questions she was asked, with one focusing on the impact of a tragic operating-room event. However, Williams con- ceded that she was never actually asked this question, and the evi- dence shows only that Arthur submitted it to LifeGuard at the ini- tial request for an evaluation. Nor does Williams identify any im- permissible inquiries into her medical history, family history, or un- related mental-health treatment. Absent such evidence, no USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 27 of 35

reasonable jury could find that the fitness-for-duty evaluation ex- ceeded the scope permitted by Section 12112(d)(4)(B). The simulation test likewise reflected a standard patient- safety measure, not unlawful testing. Faculty explained that simu- lations are routinely used for residents returning after extended ab- sences to ensure patient safety and clinical competence. Williams offered no evidence that this requirement was unique to her, disa- bility-driven, or inconsistent with accepted residency practices. Courts do not second-guess such academic safety determinations absent a substantial departure from accepted norms, which is not shown here. Ewing, 474 U.S. at 225. Williams emphasizes procedural irregularities identified in the Dean’s Investigation Report, such as ARD’s failure to submit certain forms to HR, but such imperfections do not transform an otherwise legitimate academic evaluation into discrimination. Doe v. Samford Univ., 29 F. 4th 675, 688 (11th Cir. 2022). The investigation itself confirms that Legal Affairs approved the fitness-for-duty eval- uation and that its purpose was to assess Williams’s readiness to return to patient care. At most, the report reflects internal compli- ance concerns, not ADA violations. Williams effectively asks this Court to substitute its judg- ment for that of medical educators charged with safeguarding pa- tient welfare. Id. Where, as here, the challenged evaluations were narrowly focused on essential clinical competencies, supported by documented safety concerns, and consistent with academic prac- tice, they are lawful and entitled to deference. USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 28 of 35

E. Procedural Due Process

Williams argues the district court erred in granting sum- mary judgment on her procedural due process claim. She contends that AU deprived her of constitutionally required process by termi- nating her residency without adequate notice or a meaningful op- portunity to be heard, and by delivering her suspension and termi- nation simultaneously. To establish a procedural due process violation, a plaintiff must show (1) a protected property interest and (2) a deprivation of that interest without constitutionally adequate process. Ross v. Clayton Cnty., 173 F. 3d 1305, 1307 (11th Cir. 1999). Assuming, with- out deciding, that a medical resident has a protected property in- terest in continued enrollment in a residency program, the dispos- itive question is what process is constitutionally required. The level of process due depends on whether the dismissal is academic or disciplinary. Academic dismissals require far less process. Bd. of Curators of Univ. of Miss. v. Horowitz, 435 U.S. 78, 86 (1978); Haberle v. Univ. of Ala., 803 F. 2d 1536, 1539 (11th Cir. 1986) (same). In such cases, due process is satisfied if the decision was “careful and deliberate,” a formal pre-termination hearing is not required. Horowitz, 435 U.S. at 85–90 (refusing to impose a hearing requirement that would formalize academic dismissals and over- ride academic judgment). Courts instead defer to faculty judgment on academic fitness, absent a substantial departure from accepted norms. Ewing, 474 U.S. at 225. Even where the pre-deprivation process is imperfect, no due process violation occurs if adequate USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 29 of 35

post-deprivation remedies are available to correct the error. McKin- ney v. Pate, 20 F. 3d 1550, 1557 (11th Cir. 1994) (en banc). Although the record reflects allegations of misconduct, and lapses in judgment, Williams’s termination ultimately rested on faculty determinations concerning patient safety, clinical judg- ment, and her ability to meet residency standards. These determi- nations are quintessentially academic. The Dean’s decision fol- lowed the suspension of Williams’s hospital privileges based on pa- tient care concerns. Determining whether a resident can safely care for patients is an exercise of academic judgment, even where it overlaps with behavioral concerns. Ewing, 474 U.S. at 225; Horo- witz, 435 U.S. at 86–90. We therefore defer to AU’s academic judg- ment that Williams was not fit to continue in the program. Williams additionally contends she received inadequate no- tice because the zero-tolerance letter could not have warned her of termination, given no intervening behavioral incidents, and be- cause the suspension and termination letters were delivered simul- taneously. The record shows otherwise. Williams received multi- ple warning letters, including the zero-tolerance reinstatement let- ter advising that further issues could result in termination. A Clin- ical Competency Committee hearing, and an ad hoc committee proceeding, occurred regarding her actions. Horowitz makes clear that formal hearings and perfectly timed warnings are not required. 435 U.S. at 86–90. Over months, Williams had repeated opportuni- ties to respond to faculty concerns, satisfying the careful and delib- erate standard. Id. USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 30 of 35

Even if pre-termination notice was imperfect, AU provided robust post-deprivation process. Williams received notice of the Dean’s termination decision, appealed to the University President, received a written affirmance, and then appealed to the BOR, which also issued a written decision. This post-termination review afforded Williams meaningful opportunities to challenge her dis- missal, curing any pre-deprivation defects. McKinney, 20 F. 3d at 1557 (holding that defects pre-termination process may be cured by meaningful post-termination review satisfying due process). Ac- cordingly, the district court correctly concluded that Williams re- ceived adequate process, and summary judgment was proper.

F. Breach-of-Contract

Finally, Williams argues that the district court erred in grant- ing summary judgment on her breach-of-contract claim. She con- tends that AU breached her 2019 employment contract by failing to provide a pre-termination hearing before terminating her resi- dency. Under Georgia law, a plaintiff asserting breach of contract must show: (1) a breach, (2) resultant damages, and (3) that the plaintiff is a party with the right to enforce the contract. Moore v. Lovein Funeral Home, Inc., 852 S.E. 2d 876, 880 (Ga. Ct. App. 2020). The mere failure to follow procedural guidelines in a policy or manual does not constitute a breach absent a due process violation. Jones v. Chatham Cnty., 477 S.E. 2d 889, 893 (Ga. Ct. App. 1996). Sub- stantial compliance with contractual terms is sufficient; the breach USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 31 of 35

must be more than de minimis to support a claim. Kuritzky v. Emory Univ., 669 S.E. 2d 179, 181 (Ga. Ct. App. 2008). The House Staff Policy (HS 13.0) governs disciplinary and grievance procedures for graduate medical students at AU, provid- ing that serious disciplinary actions trigger written notice, the right to request a hearing, and an ad hoc committee review. Section 2.3 establishes that decisions will be in writing, personally delivered to the house officer, and inform the house officer of their “right to request a hearing in cases of serious disciplinary actions.” Section 2.4 gives the house officer ten days to request a hearing. Upon a hearing, an ad hoc committee is appointed. Williams contends that AU breached her 2019 employment contract by failing to provide a pre-termination hearing. This ar- gument fails for two reasons: first, Williams received all process due under the contract; second, AU substantially complied with the House Staff Policy. Williams received notice of the allegations that could lead to her termination, satisfying the contractual require- ment for written notice. Specifically, upon her reinstatement on May 17, Williams was notified in writing that any unprofessional conduct would not be tolerated and that any future issues with her performance or behavior could lead to additional discipline, includ- ing termination. She participated in an ad hoc committee hearing where she could present evidence and respond to the charges, ful- filling the policy’s hearing requirement. She then had multiple op- portunities to appeal. Together, these steps far exceed the minimal procedural protections required under Georgia law. Jones, USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 32 of 35

477 S.E. 2d at 893 (holding that process provided through alterna- tive procedural means satisfied contract obligations). Even if there were minor procedural deviations—such as the timing of certain notices or simultaneous delivery of performance evaluations and the termination letter—these were cured by the appeals and committee process. Jones, 477 S.E. 2d at 893; Kuritzky, 669 S.E. 2d at 181. The record shows Williams had meaningful op- portunities to challenge her termination and received all process due. Williams argues she was entitled to a pre-termination hear- ing distinct from the ad hoc committee process. However, Georgia law requires only substantial, not perfect, compliance. Kuritzky, 669 S.E. 2d at 181 (explaining that minor procedural deviations do not defeat contractual compliance). AU’s process included: (1) two written notices of performance and behavioral concerns, (2) an ad hoc committee hearing, (3) an appeal to the University President, and (4) a final appeal to the BOR. Each of these steps was required or explicitly contemplated by the House Staff Policy. Williams identifies no procedural deficiency or resulting prejudice. The pro- cess therefore satisfied the contract.¹⁰ As Williams received all pro- cess due and AU substantially complied with its contractual obliga- tions, there is no genuine issue of material fact to support a breach-

the law only requires substantial compliance, and Williams was afforded mul- tiple opportunities to challenge the termination and present her case. Jones, 477 S.E. 2d at 893; Kuritzky, 669 S.E. 2d at 181. USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 33 of 35

of-contract claim. The district court therefore correctly granted summary judgment in favor of BOR on Williams’s breach-of-con- tract claim.

IV. CONCLUSION

For these reasons, we affirm the district court’s grant of summary judgment in favor of the BOR on all claims.

AFFIRMED.

USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 34 of 35

ABUDU, Circuit Judge, Concurring: The Majority Opinion assumes that Williams may pursue her claim under Title IX as a student and, therefore, evaluates her claim under the familiar disparate-treatment framework developed in Title VII cases. Although Title IX and Title VII are distinct stat- utory schemes, courts consistently treat Title VII precedent as the appropriate interpretive guide for evaluating discrimination claims under Title IX. See, e.g., Weinstock v. Columbia Univ., 224 F. 3d 33, 42 n.1 (2d Cir. 2000) (“The identical standards apply to employ- ment discrimination claims brought under Title VII [and] Title IX . . . .”); Preston v. Virginia ex rel. New River Cmty. Coll., 31 F. 3d 203, 206–07 (4th Cir. 1994) (holding Title IX covers sex discrimination in federally funded educational programs, including employment discrimination, and applying Title VII causation principles); Brine v. Univ. of Iowa, 90 F. 3d 271, 276 (8th Cir. 1996) (rejecting the argu- ment that Title VII and Title IX employment-discrimination claims require different elements of proof and holding that the same standards govern claims under both statutes); Mabry v. State Bd. of Cmty. Colls. & Occupational Educ., 813 F. 2d 311, 316–17 n.6 (10th Cir. 1987) (finding “no reason to establish different substantive standards for sex discrimination under Title IX and under Title VII.”). These decisions recognize that Title VII provides the most developed body of law governing claims of sex discrimination and supplies the appropriate analytical framework for Title IX claims.¹

often relied on Title VII caselaw to develop its Title IX jurisprudence . . . And USCA11 Case: 23-12878 Document: 58-1 Date Filed: 09/04/2026 Page: 35 of 35

Accordingly, this Court should continue to evaluate Title IX disparate-treatment claims under the well-established standards de- veloped in Title VII jurisprudence.

it makes sense to do so here.” C.W. ex rel. Doe v. Smith, 178 F. 4th 1278, 1286 (11th Cir. 2026).