ITHACA, N.Y. — The National Labor Relations Board has adjourned the hearing involving Cayuga Medical Center until the end of the month.

The board has been investigating charges that Cayuga Medical Center terminated two nurses because of their union involvement. However, the hospital claims dismissing the two nurses was fair because they violated the hospital’s blood transfusion policy.

Between Monday and early Thursday, four witnesses testified. The witnesses included two nurses in the Intensive Care Unit, a nurse’s aide and the sister of the patient who filed a complaint about her blood transfusion.

On Thursday, the case was adjourned until Jan. 30 due to an attorney’s personal medical issue. No location has been determined yet for when the hearing resumes.

For more information on each day of the hearing, check out reports from Monday, Tuesday and Wednesday.

Blood transfusion policy

What is policy and what is common practice have been discussed extensively so far in the hearing.

According to hospital policy as explained in testimony, blood or products being used in a transfusion are supposed to be checked in two places with two nurses. First, the nurses verify information at a nurses’ station where the two nurses compare patient name, date of birth, consent form, account number, expiration date of the blood and other information. The two nurses are then supposed to do additional checks to verify the identity of the patient at the bedside, like look at the patient’s wristband.

Portion of blood transfusion policy regarded two-nurse check /provided by Cayuga Medical Center.

However, two nurses have testified in the hearing that it’s “common practice” that everything is checked and signed off on at the nurses’ station and then the primary nurse goes into the patient’s room to do the blood transfusion.

In a statement, John Turner, vice president for public relations, said on Sept. 11, the two nurses did not verify the patient’s identity which concerned the patient.

The two nurses that were terminated, Anne Marshall and Lauren Lamb, do not deny that they violated protocol, Jessica Noto, field attorney for the NLRB, said. Noto said the evidence will show that Marshall and Lamb performed the transfusion like many other nurses in the Intensive Care Unit.

During the Sept. 11 transfusion, Noto said Marshall and Lamb made sure the blood was for the correct patient at the nurses’ station rather than at the patient’s bedside.

“The evidence will show that there was no medical error made in this case, simply a deviation from written policy. The required checks were performed by two nurses, except the checks took place right outside rather than inside the patient’s room,” Noto said in opening statements.

The blood transfusion which launched the hospital’s investigation took place Sept. 11, 2016.

The patient involved in the blood transfusion had had many blood transfusions prior and said she had been walked through the protocol by nurses during every other transfusion. Typically, the patient wrote in a statement, the nurse would call for blood, give the patient Tylenol and Benadryl. When the blood would arrive, she said, two nurses would be in the room to scan her name band, ask her name and birth date and compare it to the paperwork. They would then read the numbers on the blood bag and compare it to the paperwork numbers, the patient said. If everything matched, then the nurses would start the blood.

However, the patient said, when she received her transfusion on Sept. 11, according to her statement she said “Nurse calls, we wait.  My sister and aunt were in the room.  The nurse comes in hangs the bag and starts the blood.  I looked at her and said ‘What about the protocol?’ And she said ‘Oh, we did that at the desk.’–and left the room.  My sister, who is an RN in the state of Maine, ran over to the blood to check the numbers.  I said ‘This isn’t how it’s ever been done.’” 

Where does unionizing come in?

Last May, the National Labor Relations Board held a hearing in Ithaca to investigate charges that Cayuga Medical Center was interfering with nurses’ unionizing efforts. In a decision released in October, Judge David Goldman largely sided the nurses. In the introduction, Goldman wrote “it is clear to me that while the hospital, while permitting a significant amount of union activity — which the law requires it to do — took issue with the activism of certain of its nurses.”

Nurses hold signs in May 2016 regarding “Unionizing CMC”
Nurses hold signs in May 2016 regarding “Unionizing CMC”

Cayuga Medical Center disputes the decision and has filed an appeal.

The nurse Goldman mentions is Anne Marshall, who is one of the nurses who was terminated.

Related: Federal judge decides Cayuga Medical Center violated labor laws

On the first day of the hearing, Mimi Satter, a legal representative for 1199 SEIU United Healthcare Workers East, which has brought the charges against Cayuga Medical Center, said Marshall was the “face” of the union activity at the hospital. She said the hospital was “more than anxious” to rid itself of its most vocal union advocate.

However in opening statements, Raymond Pascucci, representing Cayuga Medical Center, said the last thing the hospital wanted was to be in front of a patient complaint involving Marshall because any “negative consequences” from the incident would lead to an accusation that the hospital was targeting her due to her protected union activity.

Testimony

Four witnesses have testified in the case so far: two registered nurses in the Intensive Care Unit, a nurse’s aide and the sister of the patient who was unhappy with her blood transfusion.

Two nurses in the Intensive Care Unit have testified that nurses commonly don’t follow the full protocol when administering a blood transfusion. The two nurses have also testified that a former director also did not follow exact protocol.

Christine Monacelli, a nurse in the ICU who has worked at Cayuga Medical Center for 16 years, was asked if she knew of anyone ever being disciplined for not following the hospital’s blood transfusion policy. She said she did not. Monacelli also told Noto that that she was never told she or other nurses could be disciplined for not performing the policy at the patient’s bedside.

After Marshall and Lamb were terminated, both Monacelli and another nurse that testified earlier in the hearing said nurses changed their behavior and began following the hospital policy more carefully.

Noto asked Monacelli if she had observed anyone in the ICU following the hospital’s policy every time prior to Marshall and Lamb’s termination. Monacelli said “No.”

Though it was out of order with the hearing, Pascucci called the patient’s sister to testify Wednesday because she had travel constraints. She said she was in the room with her sister when she received the transfusion, as were her aunt and uncle. The sister’s recollection was similar to the patient’s statement.

After the incident, the sister said was called by two people from Cayuga Medical Center to follow up on the blood transfusion. In addition to recalling concerns with the blood transfusion, the sister said she also voiced concerns about the inconsistent use of gloves and masks she noticed while visiting her sister at the hospital. The sister said this was a big concern for her because her sister was septic.

Asked if nurses could face repercussions for testifying about not following policies at Cayuga Medical Center, Turner said “At Cayuga Medical Center we expect strict compliance with all policies and procedures by our employees.”

The hearing is expected to continue Jan. 30 in Ithaca. No location has been set yet.

Kelsey O'Connor

Kelsey O'Connor is the managing editor for the Ithaca Voice. Questions? Story tips? Contact her at koconnor@ithacavoice.com and follow her on Twitter @bykelseyoconnor.