Legal Aspects Of Health Care Administration 11th Edition by George Pozgar

Exercise 1

Facts
The nurse-plaintiff was employed as a charge nurse with supervisory duties. A short time after one of her patients had been admitted to the hospital, the charge nurse determined the patient was suffering from toxic shock syndrome. Knowing that death would result if left untreated, the charge nurse assumed the physician would order antibiotics. After a period of time passed without having received such orders, the charge nurse discussed the patient's condition with the nursing director. She was informed by the director to document, report the facts, and stay out of it.
The charge nurse discussed the patient's condition and lack of orders with the chief of staff. Although the chief of staff took appropriate steps to treat the patient, the patient died. After the nursing director was informed by a member of the patient's family that the charge nurse offered to obtain the medical records and was later told that the charge nurse was heard to say that the physician was paving the patient's way to heaven, the charge nurse was terminated.
After her termination, the charge nurse received a service letter from the hospital that directed her to refrain from making any further false statements about the hospital and its staff.
The trial court entered a summary judgment for the defendant-hospital, stating that there were no triable issues of fact and that there was no public policy exception to the charge nurse's at-will termination. The court could not find any law or regulation prohibiting the hospital from discharging her as a nurse. The nurse appealed.
Issue
Was there a public policy exception to the Missouri employment-at-will doctrine?
Holding
The Missouri Court of Appeals reversed the granting of summary judgment and remanded the case for trial, holding that the Nursing Practice Act (NPA) provided a clear mandate of public policy that nurses had a duty to provide the best possible care to patients.
Reason
Public policy clearly mandates that a nurse has an obligation to serve the best interests of patients. Therefore, if the plaintiff refused to follow her supervisor's orders to stay out of a case where the patient was dying from a lack of proper medical treatment, there would be no grounds for her discharge under the public policy exception to the employment-at-will doctrine. Pursuant to the NPA, the plaintiff risked discipline if she ignored improper treatment of the patient. Her persistence in attempting to get the proper treatment for the patient was her absolute duty. The hospital could not lawfully require that she stay out of a case that would have obvious injurious consequences to the patient. Public policy, as defined in case law, holds that no one can lawfully do that which tends to be injurious to the public or against the public good.
Explain how a public policy would be analyzed and then determined to apply in an employment-at-will case.