ITHACA, N.Y. — One of the nurses fired from Cayuga Medical Center testified Wednesday in the ongoing National Labor Relations Board hearing.

Anne Marshall and Lauren Lamb were terminated after a blood transfusion in September. The patient involved in the blood transfusion filed a complaint after the procedure at Cayuga Medical Center. The hospital launched an investigation and ultimately terminated the two nurses involved.

Though the hospital said it dismissed the nurses for a clear breach in its blood policy protocol, the nurses say how they performed the transfusion was common practice among nurses and they were disciplined to the extent they were because they were active in nurse unionizing efforts.

The National Labor Relations Board hearing into this case initially began in January, but adjourned Jan. 12 after an attorney had a personal issue come up. The case resumed Monday. The hearing is public, and a full list of the hearing locations for this week and next are available here.

Catch up with previous coverage: NLRB case with Cayuga Medical Center adjourned until Jan. 30; breaking down the case so far

Marshall testified Wednesday morning into early afternoon.

Until she was terminated in October, Marshall had worked as a registered nurse at Cayuga Medical Center for 10 years in the Intensive Care Unit. She began her testimony by explaining exactly how she performed the blood transfusion at the center of the case.

Marshall said the patient’s doctor called for blood. Once she received the order for the blood, she filled out paperwork. She made sure the patient had a consent form, which she said she did. The blood bank called to say the blood was ready. A courier was sent to retrieve the blood and bring it back up.

Marshall said when she received the blood, she asked the charge nurse to check the blood with her, but she said he told her to check it with another nurse, Lauren Lamb. So Marshall took the blood and chart and asked Lamb to check the blood with her, and they did at the nurses’ desk. Together, Marshall testified that she and Lamb checked to make sure they had the right patient, right blood, that they had an order and a consent form. They checked identifiers for the patient — name, date of birth, account number, blood order, consent form and they also checked the blood itself, including donor information, blood type and expiration date.

Together, Marshall testified that she and Lamb checked to make sure the patient information lined up with the correct blood. They checked identifiers for the patient like name, date of birth, account number, blood order, consent form and they also checked the blood itself, including donor information, blood type and expiration date.

After the Marshall and Lamb checked everything at the nurses’ desk, Marshall said she went into the patient’s room to hang the blood.

Marshall said it was not the first time she was in the patient’s room. She had gone in previously to pre-medicate the patient with Benadryl and Tylenol, she testified. Taking those medications help make sure the patient doesn’t have a reaction to the blood. To administer medications before, Marshall said she had to go into the medication room, bring them back to the patient’s room, log onto the computer in the patient’s room and scan the patient’s wristband with name and date of birth.

When back in the room to hang the blood, Marshall said she explained the “blood was here and I’d be hanging the blood.”

She said she then primed the tubing and got the blood ready to be transfused. Marshall said she asked the patient for her name and date of birth at the start of the transfusion. She also said she had been speaking off and on conversationally with the patient and other family members there.

Marshall said she did remember the patient asking at one point if Marshall had checked the blood, and Marshall said she told her “absolutely, out at the nurses’ desk.”

Jessica Noto, field attorney for the National Labor Relations Board, asked Marshall if at any time she felt she was disregarding the patient’s concerns, and Marshall said she did not because she had answered her questions.

The way Marshall described administering the blood transfusion differs from Cayuga Medical Center’s blood transfusion policy.

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

According to hospital policy as explained in testimony so far, 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.

However, several 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.

Marshall and Lamb have acknowledged that they breached protocol, but believe they were singled out for their union activity.

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.

Last year, Cayuga Medical Center was investigated by the NLRB and found to have violated federal labor laws by interfering with unionizing efforts. The judge presiding over that case also found that nurse Anne Marshall was unlawfully suspended and demoted. Cayuga Medical Center has said it does not agree with the judge’s ruling and has filed an appeal.

Cayuga Medical Center began investigating the the blood transfusion performed by Marshall after the patient involved complained to the hospital. (Read the complaint here.)

Marshall’s testimony and the patient’s complaint differed in some parts. The patient wrote that she remembered asking “What about the protocol?” but Marshall said she did not recall the patient asking that. Earlier in the hearing, the patient’s sister also testified that the patient asked that.

On Monday, patient safety officer Karen Ames, who lead the investigation involving Lamb and Marshall, said she personally got involved because this case involved a “total system failure” and arose from a patient complaint. Ames said the incident involved a high-risk procedure with a potentially lethal outcome.

When questioning Ames, Satter asked Ames about other incidents at the hospital that put patients at risk, like a patient getting the wrong medication.

Regarding Marshall and Lamb’s case, Satter asked: “They were treated differently weren’t they?”

“No, they were not,” Ames said.

On Wednesday, Marshall testified that she was terminated on Oct. 6 and not given the option to resign, like Lamb had been.

When cross-examining Marshall, Raymond Pascucci, who is representing Cayuga Medical Center, asked Marshall if she understood if nurses have a responsibility to follow hospital policies. He also asked if Marshall agreed that the two-nurse verification at the bedside is the final safeguard in place to prevent the wrong blood from being administered. Marshall said ideally no policy should be skipped, but cited understaffing of nurses as a reason for why the checks are performed at the nurses’ desk.

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.