Telemedicine has become a regular component of health care. During the current pandemic, it has helped healthcare providers, including nurses and nurse practitioners, maintain contact with patients.
Unfortunately in the following case, a telemedicine program’s policies and procedures for communicating with physicians was not followed, which resulted in an RN’s dismissal and a wrongful termination lawsuit.
Circumstances of the Case
In this case, the nursing home in question began using a telemedicine program in 2018. The program was used to consult with the telemedicine physicians virtually after “normal business” hours rather than contacting the patients’ personal physicians.
The policy developed by the nursing home required nurses to use the telemedicine program between the hours of 6:00 p.m. to 7:00 a.m. during the week and at all times during the weekend.
The program’s physicians were not to be contacted for certain conditions, such as routine labs or chronic pain, and were to be contacted through the program if a patient was suffering from GI distress, a fever, and other symptoms.
The second shift RN supervisor took the lead on making rounds and assisting nursing staff on that shift. When the RN needed help, or when there was a change in a patient’s condition, she would contact her supervisor, the unit manager on the day shift.
In early January 2019, the RN was caring for a chronically ill patient whose personal doctor ordered blood cultures from the patient’s central line. The lab results indicated an infection in the central line. Even though the results were received during the time period nursing staff was instructed to use the telemedicine physicians, the RN contacted the patient’s personal physician by phone.
The physician ordered the patient be transferred to the hospital immediately. The RN did so and notified her supervisor after the transfer had taken place.
The next day, the RN was told by a colleague responsible for training nursing staff on the telemedicine program that she did not follow the established procedure for contacting the telemedicine physicians and that her unit manager needed to be notified before contacting a personal physician.
Two days later, the RN was concerned that a patient had not been taking her medication, was not eating or drinking, and had loose stools and green vomitus.
The RN called the patient’s personal physician who ordered the patient be sent to the hospital. The RN arranged for the transfer and informed her unit manager after doing so.
The director of nursing met with the RN several days later and told her she would be suspended pending an investigation as a result of her “violating protocol,” referencing sending patients out of the facility.
Later, she was notified by phone that she was terminated.
Wrongful Termination Suit is Filed
In her lawsuit, the RN alleged that her termination was wrongful and against public policy as a result of her conduct when caring for the two patients described above.
Specifically, she alleged that firing her violated Ohio public policy that RNs are “not be interfered with, or prevented from, engaging in the practice of nursing and providing nursing care to individuals” as set forth in the Ohio Nurse Practice Act and Rules.
The nursing home filed an answer to the complaint and subsequently filed a Motion for Summary Judgment. It argued that the RN’s termination was a proper one because she was an at-will employee.
It further argued that there was no public policy exception to her at-will employment based on the situation for which she was terminated.
The nursing home also stated that it was justified in terminating her because she failed to follow its policies and procedures.
The RN responded that she had met all the elements for a claim of wrongful discharge in violation of public policy. She also stated that the reason for her termination was to keep the return to hospital rates from the home low, which she asserted improperly placed profits above medical care.
She also stressed there was no written or other policy requiring her to contact her supervisor when a patient needed to be transferred out of the facility.
The trial court granted the nursing home’s Summary Judgment Motion, holding that there was no clear public policy stated in the sections of the Act or Rules cited by the RN or that her conduct was covered by any public policy.
The RN appealed the trial court’s decision.
Appellate Court Decision
The Appellate Court carefully analyzed Ohio law relating to wrongful termination in violation of public policy, as well as the Ohio Nurse Practice Act and its Rules.
It held that the RN’s termination was not in violation of public policy and that the Nurse Practice Act and its Rules did not create public policy. In part, its exact words were:
“…requiring a nurse to consult with her superiors on action to be taken regarding a patient and to utilize a certain procedure to discuss patient conditions with qualified physicians does not interfere with her ability to give a patient care. It merely sets forth procedures that must be followed in providing that care, neither of which are particularly onerous.”
The trial court’s granting of Summary Judgment for the nursing home was affirmed.
What You Can Learn From This Case
The Appellate Court emphasized that its decision was based on the established law in Ohio for a wrongful termination that was in violation of public policy. That policy, the court discussed, must be a clear one.
Here, no such clarity existed, so the court had no choice but to rule in favor of the nursing home. This is an important issue if you’re considering filing a case for wrongful termination or any other cause of action for that matter.
Can you prove the requisite elements of the case? Is your proof reliable?
In this case, using the telemedicine program and notifying her supervisor before transferring the patients would have allowed the RN to keep her job. It is unknown why she did not do so.
It is clear that the patients were extremely ill and in need of immediate transfer to a hospital. She fulfilled her duty to those patients by protecting them from further harm, including death, as the nurse practice act and rules required.
Indeed, the Appellate Court’s discussion of the act’s sections and rules pointed to one of their purposes, protecting a patient from unqualified and unlicensed nurses.
She did so, though, by not following the home’s established policy and procedure concerning communicating a patient’s condition to “competent physicians” (the Court’s words) through the telemedicine program.
As an at-will employee, you can be fired for a good reason, a bad reason, or no reason at all (the latter with clear exemptions, including a violation of public policy.)
This case illustrates that not following an employer’s policies and procedures is a reason for terminating your employment if an exemption does not apply.
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