The lines of Cayuga Medical Center’s defense against allegations it broke federal labor law have become clearer in recent days as the second National Labor Relations Board trial about union organizing in less than a year continues.
The hospital, via its attorney Raymond Pascucci, of Bond Schoeneck & King, is arguing that intensive care unit nurses Anne Marshall and Loran Lamb were not singled out for their union organizing activity when they were fired in October 2016. Rather, CMC argues the two nurses committed a grave and unforgivable error when only Marshall went into a room to perform a blood transfusion on September 11, 2016 – and then both signed their names to a transfusion card saying both checked the patient’s identity at bedside. The two nurses admit they both did not check identifiers of a patient against a bag of blood at bedside, but rather it was common practice in the ICU to do that check at the nurses’ desk.
That the consequences of a blood transfusion gone bad can be deadly has been well-established through two-plus weeks of testimony. Pascucci has asked every professional who’s testified the question “what could be the consequence?” of a mistaken blood transfusion. “Death” is inevitably the response.
Beyond the high stakes of a transfusion, the hospital is furthermore arguing that the two nurses falsified records by signing their names to the blood transfusion card, an additional reason for dismissal. That card comes along with each bag of blood and is sent back to the blood laboratory where it serves as documentation the blood was given.
“We do not operate in a vacuum. We must document correctly in order that other people can know what we’ve done and can take appropriate actions based on that knowledge,” Barbara Goodwin, CMC’s director of staff development, testified on Monday. “Wrong decisions may be made for that patient based on wrong information or false information.”
The blood bank is “the most regulated area in the laboratory, which is the most regulated area in the hospital,” Dr. Daniel Sudilovsky, CMC’s laboratory director, testified on March 3. Sudilovsky stressed that documentation is how blood transfusions have become much safer since the procedure was first invented.
During cross-examination last week, Pascucci spent extensive amounts of time asking questions of the 10 nurses called by attorneys for the National Labor Relations Board and SEIU Local 1199.
“Are you allowed to make decisions that break hospital policy?” was a typical Pasucci question. The line of questioning, applied to the four ICU nurses who testified that they did not always follow the two-nurse bedside check, eventually forced the nurses to admit via “yes or no” answers that signing their name to such a card was falsifying records and thus a dereliction of professional duty.
Mike Doan, a former nurse manager in the CMC’s 4th floor telemetry unit, countered that narrative in his testimony on March 1. Doan said that on numerous occasions, he saw a “transfusion card bounce back from the lab” because there was no signature or no second signature, and he never disciplined any one for not signing a card.
Some of the ICU nurses, including Marshall, testified that they had not noticed a line on the card stating the bedside check policy until the September 11 incident. To emphasize that the nurses should have known about the bedside check, Pascucci has introduced evidence that Marshall and Lamb signed off on policies in HealthStream, CMC’s online continuing education module.
Cayuga Medical called its first defense witness on Friday, March 3, in Sudilovsky, and has called five managers and two nurses in its defense through noon on Wednesday, March 8. Pascucci told Judge Kimberly Soag Graves today that he has about 15 witnesses still to testify. Other topics of testimony have included a 2012 “near-miss” incident with a blood transfusion on the 4th floor, an incident that seems to be one the hospital would like to stand as evidence that nurses were highly aware of blood transfusion policy; and managers testifying to other employees they have dismissed in various departments.
Truthsayers will tackle these issues in future stories, as we keep covering Tompkins County’s only hospital.