ITHACA, N.Y. — Testimony is expected to wrap up this week in the National Labor Relations Board case with Cayuga Medical Center.

The hearing resumed Monday and has continued intermittently since January. The NLRB is investigating claims that Cayuga Medical Center fired two nurses for their union activity. The hospital says it was justified terminating the two nurses because they violated blood transfusion policy.

The two nurses terminated – Anne Marshall and Loran Lamb – have not denied they violated the hospital’s blood transfusion policy. One of the key questions in this case has been whether how they performed the transfusion was common practice or not.

Per hospital policy, when a blood transfusion is ordered, two registered nurses are supposed to perform a two-tiered check to ensure the right blood is going to the right patient. Before the blood enters the room, two nurses must make sure the patient’s information lines up with the blood product. If everything matches, the nurses are supposed to then go to the patient’s bedside and perform additional checks to verify the identity of the patient.

However, some 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 verify identity and administer the blood transfusion.

During the hearing, nurses including and in addition to the two nurses fired, have said it is common practice to check the blood for the transfusion at the nurses’ desk. However, Karen Ames, director of quality and patient safety at Cayuga Medical Center, testified Monday that she found no evidence when conducting her investigation that it was common practice.

When interviewing other registered nurses in the Intensive Care Unit, Ames said, none told her they did not perform the two-RN bedside check. Ames also said there were no other complaints of nurses not performing a two-nurse check at the bedside.

Ames said based on her investigation, she concluded that it is common practice that nurses perform the beside check and that Lamb and Marshall chose not to follow protocol.

Cayuga Medical Center launched an investigation into a blood transfusion performed Sept. 11, 2016, after a patient complained protocol was not followed. The patient who filed the complaint had received many transfusions prior to the one on Sept. 11, 2016, according to testimony, and said in all other transfusions there had been two nurses performing the bedside check.

Prior to their termination, Ames interviewed Marshall and Lamb about the blood transfusion. Ames said she taped Marshall’s interview, but not Lamb’s.

In the interview played during the hearing, Marshall told Ames in the 10 years she had worked at Cayuga Medical Center, it was common practice to check the blood at the desk. She said two nurses often don’t go into the room because it’s busy and they are often short-staffed. Marshall said they have to weigh what is more dangerous, checking at the desk or not monitoring all patients.

Ames asked Marshall how she can give her full attention to checking the blood at the nurses’ desk when there are so many distractions. Marshall said nurses often have to multi-task and said there are distractions in rooms too.

When Marshall was asked if she chose not to follow the protocol, Marshall said she weighed the risks and benefits and “did nothing more than what we’ve been doing for years as common practice.”

Ames informed Marshall at that point that she was suspended with pay until the investigation was concluded.

In the hearing, Ames said Marshall took it upon herself to “bypass a safeguard in place and disregard following protocol.” She said there is no excuse for not following protocol when it comes to administering blood because the consequences of administering the wrong blood could be “catastrophic.”

Ames said the case had nothing to do with union activity. Ames was called to testify earlier in the hearing as well and was asked a similar question by Mimi Satter, a legal representative for 1199 SEIU United Healthcare Workers East. At that time, Ames was asked if Marshall and Lamb were treated differently, which Ames denied.

Marshall was a vocal union supporter at Cayuga Medical Center. When the hearing began, Satter called Marshall the “face” of union activity at the hospital and said the hospital was “more than anxious” to rid itself of its most vocal union advocate.

Marshall and Lamb were ultimately terminated in early October. However, a federal judge recently ordered that Marshall and Lamb be reinstated to their jobs at Cayuga Medical Center while the hearing continues.

The hearing will likely wrap up Tuesday or Wednesday, but it may take months to hear a decision. In the last hearing involving Cayuga Medical Center, it took about five months for the judge to release a ruling.

The hearing will resume at 8:30 a.m. Tuesday at the Administration/CFR building at Ithaca Tompkins Regional Airport.

Miss a story? Catch up on previous coverage related to this case: 

Kelsey O'Connor

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