By Josh Brokaw
Attorneys for the National Labor Relations Board and SEIU Local 1199 rested their case against Cayuga Medical Center on Thursday, March 2, after eight days of testimony.
Anne Marshall and Loran Lamb, the two intensive care unit nurses allegedly fired for their union activity by Cayuga Medical Center [CMC], took the stand on Wednesday and Thursday, respectively.
Marshall has been telling her side of the events of September 11, 2016, for months now, most of which can be read in this Truthsayers story published when her firing became public.
Lamb’s testimony on Thursday added a new dimension to this story. The ICU nurse, slender and soft-spoken, was a supporter of the registered nurse union organizing campaign that started early in 2015 at CMC. She was fired for signing a blood transfusion card that said she was in the room when Marshall hung a bag of blood, when Lamb had in fact signed it at the nursing desk. A patient complained that two nurses hadn’t checked the blood at bedside, a violation of policy for which CMC says they fired the nurses with just cause. Nurses say – and at least five nurses other than Marshall and Lamb have testified to this – that in the ICU it was a standard practice for both nurses to sign off on blood transfusions at the desk.
NLRB attorney Alicia Pender started her questioning by establishing that Lamb was a union supporter. Lamb said she had worn a Rosie the Riveter button in support of the union, attended a meeting at the Plumbers’ Hall, and once spent 10 minutes at a CMC cafeteria table with pro-union material alongside Marshall.
On September 11, 2016, a Sunday, Lamb said she had two patients: one had a leg wound and had gone “into septic shock overnight.” He was unresponsive, on mechanical ventilation. Her other patient had just had a pacemaker installed and was awaiting a Monday appointment in the cardiac catheterization lab.
Lamb said Marshall came to her when she was at her desk, by her patient monitor, and asked her to witness blood.
“We went through the checks that we had doctor’s order, or consent,” Lamb said. “We used the sticker on the bag to confirm the name. She read it off aloud and I would look at that sticker – she would read off the name, the date of birth, and the account number of that patient …”
“Why did you do it at the desk?” Pender asked.
“That’s just how we did it,” Lamb replied. “Rarely did we ever witness blood in the room on our unit.”
Why not? Pender asked.
“The best answer I can give is efficiency,” Lamb said. “We’d try to be efficient. It was common practice.”
Lamb, who started working in the CMC ICU in 2011, said she was aware of the two-nurse bedside check policy, but at the moment she witnessed the blood transfusion, she “wasn’t aware of the policy per se.”
What were you thinking of? Pender asked.
“You go through a checklist every time,” Lamb said. “Is this the right blood? I knew that was the only patient on the unit receiving blood that day. Many times I would go in and witness blood in the room. This wasn’t the kind of time I felt like I needed to.”
Sometimes, Lamb said, she relied on “nursing intuition” when she decided to go into the room; sometimes it was because she was working with a new nurse; and sometimes it was when two people with similar names were on the unit.
Lamb became aware she was going to be disciplined on September 20, when she was called by Robin, CEO John Rudd’s secretary, and told to come to a meeting to talk about a safety incident. She was under the impression it was about a previous death in the ICU that management had been making inquiries about, a story Truthsayers will explore in more depth later.
Ames and Linda Crumb, assistant vice president of patient services, were awaiting Lamb. They told Lamb a patient had complained about the blood transfusion, and asked her if she was aware of the bedside check policy. Lamb was suspended that morning and had to go home and explain what had happened to her two girls, who hadn’t left yet for school.
“Within five minutes of the meeting, I knew I was going to get fired,” Lamb said.
Pender asked her why.
“I knew I was going to get fired because it was Anne. It was Anne I was witnessing the blood with and they wanted Anne gone. And they wanted me gone.”
Ames called Lamb an hour or so later, asking if she would confirm her signature on the transfusion card via email or text. That, Lamb said, she would not do. She asked for information about what might happen to her nursing license from Brian Forrest, CMC vice president of human relations. She asked about bringing an attorney to meetings with the hospital; Forrest said “it’s not how we do things.”
“At that point I was very distraught,” Lamb said. “I loved working there. I never did anything wrong.”
Lamb went into the hospital on September 15 to review the card and asked for a written letter of suspension. On that Friday, September 16, she found she was locked out of her work email. The next Monday Forrest left a voicemail saying her letter would be sent by mail. On Tuesday, Crumb called and asked why she hadn’t picked up the letter yet.
Finally, on October 5, Forrest called Lamb and asked her to come into the hospital later that morning. There, Deb Raupers, vice president of patient services, told Lamb that she was terminated.
“I was pleading,” Lamb said, “saying it was unfair, that I was a good nurse and worked really hard. At that point they told me a lot of nurses spoke up on my behalf. They asked me if I’d considered resigning. They told me I couldn’t work there anymore.”
Lamb said she thought about her two kids – “there’s just the three of us” – and decided to submit a resignation so she could have health insurance for a while longer and get her time off paid out.
After that decision, the CMC administrators handed Lamb a notepad to write her resignation.
“I didn’t know what to write, so they told me what to write,” Lamb said. “And I wrote it and signed my name.”
This reporter missed Marshall’s testimony under questioning from the NLRB and union attorneys, when nurses tell their side of the story. Under cross-examination, Raymond Pascucci, CMC attorney, asked Marshall about an interview with Karen Ames, CMC’s chief patient safety officer, on October 4. Marshall had returned from a vacation she had left for shortly after the September 11, 2016 blood-transfusion incident that led to this trial.
“You said [to Ames] if we do two nurses at bedside,” Pascucci asked, “it means taking nurses away from monitoring other patients. What was your point?”
“It means there are no nurses at the monitors at the nurses’ station,” Marshall replied. “Because of that a patient died. We learned from that [incident] that taking nurses off floor with no one monitoring what was going on could have adverse consequences.”
“What I was saying,” Marshall continued after further questioning about the interview with Ames, “was we needed more staff. Chronic short staffing which was why that policy wasn’t being followed.”
“Did you know the right thing to do was check with both nurses at bedside?” Pascucci persisted.
“After they pointed it out to me, yes,” Marshall replied.
Marshall and Pascucci are both pugnacious, so head to head their exchanges had the effect of two rams locking horns – a real brawl, but not very edifying. Pascucci tries to cut off any discussion of why a decision might be made by a nurse, boiling everything down to their responsibility vis-à-vis policy, with no room for the witness to explain circumstances. Marshall, after two years of union organizing, can’t be stopped from uttering her protest about what she feels to be the overwhelming circumstance in the ICU – short staffing.
A typical exchange:
Pascucci: “Is it an option for a nurse to skip a policy because both are too busy?”
Marshall: “It’s not OK for a nurse to skip policy, but it’s also not OK to be that short staffed.”
Marshall also disputed in her testimony the dialogue between she and the patient, released in a statement provided by CMC when all this went public. That statement says the patient told Marshall a transfusion had “never been done like this before” without a second nurse, and Marshall responded, “It must’ve been a new nurse.”
The trial is being held Friday, March 3, at the Tompkins County courthouse, with Daniel Sudilovsky, CMC’s laboratory director, currently on the stand. It will return to the Ithaca Tompkins airport’s administration building on Monday, March 6 for two days, then move to King-Shaw Hall at Cornell’s Industrial Labor Relations school for Wednesday through Friday of next week.
The trial is open to the public. Come keep me company.