Katayoon Bereston v. UHS of Delaware, Inc. & District Hospital Partners, LP, d/b/a George Washington University Hospital
Katayoon Bereston v. UHS of Delaware, Inc. & District Hospital Partners, LP, d/b/a George Washington University Hospital
Opinion of the Court
Opinion by Associate Judge McLeese, concurring in part and dissenting in part, at page 117.
Glickman, Associate Judge:
Katayoon Bereston appeals the dismissal of her complaint under Superior Court Civil Rule 12 (b)(6) for failure to state a claim upon which relief can be granted. At issue are two counts in which Ms. Bereston invoked the District of Columbia's judicially-created public policy exception to the doctrine of at-will employment. In the first count, Ms. Bereston asserted that George Washington University Hospital ("the Hospital") wrongfully terminated her employment as its Director of Admissions due to her refusal to violate federal law. In the second count, Ms. Bereston complained that she was subjected to harassment at the Hospital prior to her termination in retaliation for her insistence on strict compliance with federal health care laws and regulations.
Although an at-will employee who is discharged for refusing to violate the law (or for other reasons that transgress a clear mandate of public policy) may have a common-law cause of action for wrongful termination, we affirm the dismissal of Ms. Bereston's claims. We hold that the first count of her complaint fails to plead facts sufficient to state a plausible claim that Ms. Bereston's refusal to break the law was the sole or predominant reason for her firing. As to the second count, Ms. Bereston concedes that it does not state a cognizable claim under current law. Although this court has held that termination of employment in contravention of public policy may be actionable, we have not extended that holding to adverse employment actions other than termination. Ms. Bereston urges us to expand the public-policy exception to the at-will employment doctrine so as to permit claims "where the employee has been harassed, retaliated against, and suffered other adverse employment actions short of termination for conduct in furtherance of public policy."
*99I.
Before summarizing the allegations in Ms. Bereston's complaint, we set forth the standards under which we will evaluate their sufficiency. We review de novo a trial court's dismissal of a complaint for failure to state a claim upon which relief can be granted.
A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged. The plausibility standard is not akin to a "probability requirement," but it asks for more than a sheer possibility that a defendant has acted unlawfully.... Where a complaint pleads facts that are "merely consistent with" a defendant's liability, it "stops short of the line between possibility and plausibility of 'entitlement to relief.' "[5 ]
"When there are well-pleaded factual allegations, a court should assume their veracity[,]"
II.
Ms. Bereston's complaint presents the facts underlying her claims as follows.
The Hospital hired Ms. Bereston on October 3, 2011, to serve as its Director of Admissions. Her duties in this position included "ensuring" that the Hospital complied with laws and regulations affecting its operations. On several occasions, as the complaint details and we shall describe, Ms. Bereston called attention to improper practices that could have exposed the Hospital to significant legal and financial liability. Her successful insistence on changing those practices allegedly alienated staff and physicians, and while her superiors agreed to the changes, they found fault with Ms. Bereston's rigorous performance of this aspect of her job. The discontent and hostility that Ms. Bereston encountered is the subject of the second count of her complaint (for retaliatory harassment). It also set the stage for the Hospital's ultimate decision to terminate Ms. Bereston's employment after a physician threatened to leave the Hospital because of her adamant refusal to satisfy a long-standing request for additional staffing-a refusal based on Ms. Bereston's belief that granting the request would jeopardize the privacy of patient health information in violation of the federal Health Insurance Portability and Accountability Act of 1996 ("HIPAA"). Ms. Bereston's termination is the subject of the first count of her complaint (for wrongful discharge).
Ms. Bereston's compliance-related difficulties at the Hospital allegedly began at the outset of her two-year tenure as Director of Admissions, in October 2011, when she found that Emergency Room patients were being asked how they would pay for treatment before they were screened by a triage nurse. Understanding this practice to be in violation of the federal Emergency Medical Treatment and Active Labor Act ("EMTALA"),
Instead of receiving support and appreciation for her efforts, Ms. Bereston alleges that she encountered opposition and hostility. When Ms. Bereston reported the changes she had made to the Emergency Room admissions process to comply with EMTALA to Rick Davis, the Hospital's Chief Financial Officer and her supervisor at the time, he initially disagreed with them and thought them unnecessary. However, Mr. Davis "reluctantly agreed" to the changes after the Hospital's Director of Risk confirmed that Ms. Bereston was correct. Even so, unhappy members of the admitting staff, who "wanted to do things the way they had always been done," allegedly "called Ms. Bereston names, made remarks about her race, and were openly insubordinate"; one of them "screamed in her face" when she tried to explain the new procedures.
In March 2012, Mr. Davis convened a meeting of the Hospital's entire admissions staff. The meeting provided an opportunity for staff to "voice their frustration" with Ms. Bereston and her disruption of their work routine; she "was forced to listen to a long list of frivolous and petty complaints" from admissions staff who "condemned her for being mean and difficult to approach." After the meeting, Mr. Davis took Ms. Bereston aside and "told her one-on-one that she needed to be more friendly and 'to ease up on the regulations.' "
Ms. Bereston perceived that her subsequent efforts to bring the Hospital into compliance with federal laws and regulations were also unpopular; the complaint alleges in general terms that Ms. Bereston was treated with hostility and "bullied and ridiculed by both staff and her superiors[,]" but it provides few if any specifics to substantiate that she suffered such treatment or that her superiors opposed the changes she recommended. In addition to what has been quoted already in this opinion, the complaint states only that when Ms. Bereston advised Hospital officials of the "Stark Law" violation, "an associate administrator ... ridiculed [her] for not spelling the name of the law correctly in an email," and Mr. Davis admonished her for spelling and grammar mistakes.
*102Ms. Bereston also alleges that she "sought psychiatric care to cope with the intense hostility she faced on an almost daily basis" from the staff and the physicians who were discontented with the new processes and procedures she instituted.
The complaint states that in 2013, Kimberly Russo, the Hospital's Chief Operating Officer, "accused" Ms. Bereston of lacking "influence leadership" and not being "a team player." Ms. Russo allegedly blamed Ms. Bereston for her staff's poor performance and high turnover rate (which Ms. Bereston acknowledges were problems), while physician and staff complaints about her "were always taken at face value and often handled unprofessionally by both Ms. Russo and [Hospital] human resources staff."
Ms. Bereston asserts that, by tolerating the discontent and hostility she allegedly endured and withholding their full support for her efforts, senior Hospital officials were "deliberately undermining [her] authority and diminishing her ability to perform her duties" because her efforts to "stop the Hospital from continuing to break the law" were (supposedly) having "a perceived and actual effect on [the Hospital's] immediate revenue stream." The complaint does not substantiate these conclusory allegations of wrongful motive, however; nor does it allege that Ms. Bereston's ability to perform her duties actually was impaired. On the contrary, Ms. Bereston alleges that "adherence to compliance was her job and responsibility, which she took seriously and performed well"; that she "fulfill[ed] her employment responsibilities with extreme care"; and that she again and again had "proven her value" to the Hospital by "performing her job" and correcting unlawful practices at the Hospital.
The incident that allegedly precipitated Ms. Bereston's termination arose not from a change that she initiated, but rather from a requested staffing change that she refused to make. The request came in the summer of 2012, when a physician, Dr. Rachel Brem, sought changes in the intake process at the Hospital's radiology clinic (which Dr. Brem managed) because patient registration was too slow. Dr. Brem requested that six admissions registrars be assigned to the clinic to handle the patient registration in situ . Ms. Bereston told her that because the registration area was small and insufficiently private, it would be "impossible" to install more than three registrars without violating HIPAA and its privacy regulations.
In May 2013, when a solution had not been devised,
On September 6, 2013, Ms. Russo met with Ms. Bereston and issued her a Performance Improvement Plan ("PIP"). The PIP gave Ms. Bereston ninety days to improve but also provided for a review after thirty days, at which time she could be terminated pursuant to the Hospital's progressive discipline policy. Ms. Bereston's complaint does not recite the PIP's contents except to say that it "accused" her of lacking qualities of "leadership" and "satisfaction" and mentioned "feedback from our corporate partner" as the reason for the discipline.
According to the complaint, "[i]t was clear to Ms. Bereston that this PIP was issued by Ms. Russo to lay the groundwork to fire her at the next opportunity." Nonetheless, after thirty days, Ms. Bereston had not come up with a HIPAA-compliant solution to Dr. Brem's problem (and the complaint does not allege that Ms. Bereston made progress in any other area). On October 18, 2013, Dr. Brem confronted Ms. Bereston at the radiology clinic.
Ms. Bereston was given no official explanation for her discharge. Her complaint asserts that the Hospital terminated her because of her refusal to break the law to satisfy Dr. Brem and other MFA physicians.
III.
A. Wrongful Discharge
1. Ms. Bereston's Invocation of the Adams - Carl Exception to Employment at Will
Ms. Bereston was an at-will employee of the Hospital. "It has long been settled in the District of Columbia that an employer may discharge an at-will employee at any time and for any reason, or for no reason at all."
*105In the first count of her complaint, Ms. Bereston invokes this Adams - Carl exception. She claims the Hospital fired her for refusing to increase the number of admissions registrars and patient intake stations in the radiology clinic from three to six, even though her reason for refusing to do so was that it would have increased the likelihood of unintentional disclosures of confidential patient health information in violation of HIPAA.
*106of health information and "to protect against any reasonably anticipated ... unauthorized uses or disclosures of the information."
We conclude that Ms. Bereston's complaint fails in two respects to present a plausible claim for relief from her discharge under the Adams - Carl exception to the at-will employment doctrine. First, the well-pleaded factual allegations of the complaint do not show that putting six registrars in the radiology clinic actually would have violated HIPAA by jeopardizing the confidentiality of patient health information. Second, the well-pleaded factual allegations of the complaint also are insufficient to support a plausible claim that the Hospital's sole or predominant reason for firing Ms. Bereston was her refusal to break the law, or that the Hospital's expressed reasons for putting her on a PIP were pretextual. In each of these two respects, we find that the complaint pleads facts that are at best "merely consistent with" the Hospital's alleged liability and so "stops short of the line between possibility and plausibility of 'entitlement to relief.' "
2. Failure to Plausibly Allege a Violation of HIPAA
As to the first deficiency, in order to state a plausible claim for relief under the Adams - Carl exception, it is not enough for Ms. Bereston merely to assert that acceding to Dr. Brem's request for six registrars would have endangered the privacy of protected patient information in violation of HIPAA. That is only a conclusion of law. Nor is it enough for Ms. Bereston merely to allege that she acted as she did because she reasonably believed she was refusing to break the law. This court has never held that an employee's reasonable (but wrong) belief that what her employer required her to do was illegal is enough to support a wrongful-discharge claim under the Adams - Carl exception to employment at will. On the contrary, we have expressly declined to "alter our requirement for a remedy for wrongful discharge of an at-will employee to a lesser requirement that the employee have a reasonable belief that he or she is being wrongfully discharged."
The public policy exception to the doctrine of employment at-will does not exist ... to protect the employee. Rather it is the protection of society from public harm, or the need to vindicate fundamental individual rights, that undergird[s] an at-will employee's common law action for wrongful discharge ....
The employee's good intentions are not enough to create a cause of action for wrongful discharge .... If an employee can avoid discipline whenever he reasonably believes his employer is acting unlawfully, it is the employee, not the public, who is protected by the good intentions. A company acting within the law is presumed to pose no threat to the public at large. The creation *107of a cause of action based on an employee's reasonable belief about the law would leave a private employer free to act only at the sufferance of its employees whenever reasonable men or women can differ about the meaning or application of a law governing the action the employer proposes. The effect such a rule might have on corporate governance and the efficient operation of private business organizations is not insignificant.... [W]e therefore conclude that a clear violation of public policy depends on an actual violation of law.[32 ]
Thus, to state a plausible wrongful discharge claim, Ms. Bereston's complaint must contain factual allegations that substantiate her conclusory assertions and beliefs regarding the illegality of granting Dr. Brem's request. Ms. Bereston's complaint lacks the necessary factual substantiation.
Absent are any factual allegations clarifying whether, how, or to what extent raising the number of registrars in the radiology clinic from three to six actually would have exposed patient health information to a heightened risk of unintentional disclosure. For example, the complaint does not describe the dimensions or layout of the radiology clinic's admissions area or the space allotted for the transmission and receipt of confidential patient information. It says nothing about the volume of patients the radiology clinic currently serves and how adding registrars would affect the number of persons present at any given time. It does not describe the nature and duration of the registration process or why it might subject protected patient information to increased exposure to bystanders. Assuming that Ms. Bereston's concern was with crowding in the admissions area, her complaint does not identify and describe that putative problem in any way. It says nothing about how close bystanders already were or would be to patients being admitted; whether their proximity already did or would permit them to overhear or glimpse confidential information; or how often such opportunities already occurred or realistically might occur. Similarly, the complaint does not address the availability and efficacy of safeguards to avoid the inadvertent exposure of patient data, such as the placement of partitions between registrars and in positions to block computer screens and sensitive documents from public view.
In short, the complaint fails to explain in any factual way why the confidentiality of patient health information could be preserved in the radiology clinic admissions area with three registrars, and indeed with the five registrars plus a roving manager that Ms. Bereston counter-offered, but not with six registrars. It is not obvious that increasing the number of registrars to six would be likely to increase the risk of such unintentional disclosures or that measures could not be taken to minimize that risk.
*108Moreover, even if there would have been a somewhat greater risk of unintentionally exposing confidential patient health information to bystanders, that does not necessarily mean adding registrars would have violated HIPAA. The Privacy Rule makes clear that HIPAA does not require covered entities to eliminate all avoidable risk of unintentional disclosures of confidential patient information. Rather,
Thus, the factual allegations in Ms. Bereston's complaint not only fail to show there would have been a greater risk of inadvertent disclosure of confidential patient health information had she acceded to Dr. Brem's request for three more registrars in the radiology clinic. They also fail to show that any heightening of the risk would have been consequential enough that it would have been forbidden by HIPAA or offensive to a "clear mandate" of the privacy policy declared by that legislation.
3. Failure to Plausibly Allege an Improper Motive for Discharge
Turning to the second shortcoming of Ms. Bereston's claim of wrongful discharge, while it is true that her termination came on the heels of her blow-up with Dr. Brem, we perceive the factual allegations of the complaint to be insufficient to support a plausible assertion that the Hospital's sole or predominant reason for firing her was her refusal to violate HIPAA. First, the complaint does not allege that the Hospital ever ordered Ms. Bereston to violate HIPAA in order to keep her job.
Second, as recounted above, the complaint alleges that the Hospital was seriously dissatisfied with Ms. Bereston's performance as Director of Admissions for significant and identified reasons other than her refusal or inability to satisfy Dr. Brem's request for more registrars (or her insistence on compliance with health care laws and regulation in general). Staff allegedly were dismayed by the disruption of their working arrangements and complained that Ms. Bereston was "mean and difficult to approach." Numerous physicians allegedly complained that Ms. Bereston was not addressing their problems with registration delays and inadequate admissions staffing. Ms. Bereston's supervisors-the Hospital's Chief Financial Officer and its Chief Operating Officer-had counseled her without apparent success on the need to be friendlier and to improve her leadership and personnel management skills. It got to the point that Ms. Bereston's own staff were insubordinate, and that physicians (again, not only Dr. Brem) were threatening to leave the Hospital because she was failing to satisfy their concerns. Eventually, Ms. Bereston was given a Performance Improvement Plan that identified "leadership" and "satisfaction" as the areas in which she needed to show progress. The factual, non-conclusory allegations of the complaint do not support Ms. Bereston's charge that the stated reasons for the PIP were euphemistic or pretextual. It also affirmatively appears from the complaint that, after being placed on the PIP, Ms. Bereston continued to make no progress in accommodating or mollifying the unhappy physicians (nor does she allege that she made progress in any other area). If anything, the situation was only getting worse, as Ms. Bereston's final meeting with Dr. Brem demonstrated. Ms. Bereston attributes the discontent and hostility she encountered to the unreasonableness of staff and physicians unwilling to change their ways or moderate their demands, and there may have been fault on all sides. But as this court said in Wallace ,
The narrow exceptions to the "employment at-will" doctrine which we have recognized in Adams and Carl were not designed to prevent an employer from terminating an at-will employee in order to eliminate unacceptable internal conflict and turmoil. It matters little, if at all, who was most at fault. An employer is not required to tolerate an intolerable working environment.
*110[37 ]
At best, Ms. Bereston's complaint pleads facts that are merely consistent with her theory of the Hospital's liability. It stops well short of making a plausible showing that the Hospital's sole or even predominant reason for discharging her was her refusal to violate the law or a clear mandate of public policy.
B. Harassment and Retaliation
1. Uncertain Cognizability of the Proposed Cause of Action
The second count of Ms. Bereston's complaint asserts that the Hospital violated "District of Columbia public policy" by harassing her and retaliating against her "for her efforts to bring the employer into compliance with the several laws and regulations governing its operation."
Although many states recognize public policy claims for wrongful discharge, only a handful of courts have considered whether to extend that recognition (in the absence of statutory authorization) to wrongful-discipline claims, and "[t]he few decisions on the subject are divided."
*111Arguably, creation of a wrongful-discipline tort is "a necessary and logical extension"
We are wary of attempting to resolve these competing policy considerations by judicial fiat. We have appreciated that in matters such as this, the legislature "is in a far better position than a court to make policy decisions on behalf of the citizenry."
2. Insufficiency of the Allegations of Retaliation and Harassment
In this case, however, it is unnecessary for us to decide whether to recognize a common-law cause of action for retaliation and harassment offensive to public policy. Were we to do so, we would require the same prima facie showing as is required for comparable claims of retaliation and harassment under the District of Columbia *112Human Rights Act and other statutes. Under our employment discrimination laws (as under their federal counterparts), a prima facie showing of actionable retaliation requires the employee to show "employer action[ ] that would have been materially adverse to a reasonable employee."
Appellant also claims that the retaliatory harassment to which she was subjected created a hostile work environment. A prima facie showing of a hostile work environment similarly requires the employee to show, inter alia , "that the harassment is severe and pervasive enough to affect a term, condition, or privilege of employment."
Ms. Bereston's complaint fails to allege sufficient facts to support a plausible claim of actionable retaliation (i.e., apart from her termination) or hostile work environment. First, Ms. Bereston does not allege that she was demoted or reassigned to a position with different responsibilities, that her salary or benefits were reduced, that she was denied a promotion, salary increase, or bonus, or that she suffered any other significant change in her employment status or materially adverse employment action. We do not deny that "the [mere] imposition of a PIP-even one that does not result in a negative impact on salary, grade or performance appraisal-can constitute an adverse action."
Second, although Ms. Bereston's complaint repeatedly alleges in conclusory terms that she was "bullied, harassed, ridiculed, sabotaged, [and] humiliated" because of her insistence that the Hospital comply with applicable laws, the well-pleaded factual allegations in the complaint fail to demonstrate it. To be sure, Ms. Bereston alleges that she received what she considered unmerited criticism of her job performance (charges of unfriendliness, aloofness, poor leadership and management of her department, excessive rigor in enforcing regulations, not being a "team player") and was counseled by her superiors to improve. On one occasion she was obliged to listen to complaints of her staff that she deemed "frivolous and petty." She encountered disagreement with and opposition to her "unpopular" changes in Hospital procedures and did not receive the credit she believes she deserved. Allegedly, the Hospital's "executives, administrators, and physicians did not respect nor always accept her recommendations to comply with existing law and regulations because it meant changing the status quo, creating inconvenience, and making less profit." Simply put, these allegations may show serious work-related disagreements, criticisms, and dissatisfaction, but without greater specificity, they do not evince the kind of severe and pervasive ridicule, intimidation, threats, or other abuse that would create a hostile work environment or otherwise constitute actionable harassment *114or retaliation under our law.
At most, Ms. Bereston's complaint cites a few more or less offensive incidents. It alleges that members of Ms. Bereston's staff were rude and hostile to her after she changed Emergency Room admissions procedures to their displeasure; that Mr. Davis and another Hospital administrator ridiculed her spelling and grammar in an email; that she was given "lip service" when she reported pharmacy billing irregularities; and that Dr. Brem lost her temper with her and screamed at her. By themselves, these were isolated incidents in a two-year period of employment (and at least some of them might fairly be characterized as trivial). They cannot be said to have been severe and pervasive enough to have altered the conditions of Ms. Bereston's employment and created a hostile work environment, or to have constituted materially adverse actions against her by the Hospital.
We conclude that Ms. Bereston's complaint fails to set forth sufficient factual allegations to plausibly allege actionable harassment and retaliation. Accordingly, we hold that Count Two (Unlawful Harassment and Retaliation), like Count One (Wrongful Discharge), fails to state a claim upon which relief can be granted.
IV.
For the foregoing reasons, we affirm the judgment of the Superior Court dismissing *115appellant's complaint pursuant to Civil Rule 12 (b)(6) for failure to state a claim on which relief can be granted.
Brief for Appellant at 20.
See Potomac Dev. Corp. v. District of Columbia ,
Potomac Dev. Corp. ,
Twombly ,
Potomac Dev. Corp. ,
Iqbal ,
Logan v. LaSalle Bank Nat'l Ass'n ,
Twombly ,
In Iqbal , the Court held that bare allegations that the Attorney General and the FBI Director agreed to, implemented, and condoned a discriminatory policy subjecting Arab Muslim men to arrest, detention, and harsh conditions of confinement solely on account of their religion, race, or national origin, and for no legitimate penological reason, were conclusory and did not deserve to be assumed true.
[Fed. R. Civ. Proc.] Rule 9 (b) requires particularity when pleading 'fraud or mistake,' while allowing '[m]alice, intent, knowledge, and other conditions of a person's mind [to] be alleged generally.' But .... Rule 9 merely excuses a party from pleading discriminatory intent under an elevated pleading standard. It does not give him license to evade the less rigid-though still operative-strictures of Rule 8.... And Rule 8 does not empower respondent to plead the bare elements of his cause of action, affix the label 'general allegation,' and expect his complaint to survive a motion to dismiss.
See, e.g. , Carter v. Verizon ,
42 U.S.C. § 1395dd (h) (2011).
42 U.S.C. § 1395nn (2010).
The complaint alleges only one instance in which the Hospital did not correct a problem Ms. Bereston sought to have corrected. In July 2013, Ms. Bereston alleges, her reports that the Hospital pharmacy had billed patients who had not been treated there for prescription drugs "were given only lip service, marginalized, and then flatly ignored."
Ms. Bereston interpreted this advice as a warning that "her insistence on legal compliance would be detrimental to her job security and the financial well-being of the Hospital." The complaint also alleges that the March staff meeting was held for the purpose of undermining Ms. Bereston's authority and ability to perform her job "in direct retaliation" for her identification and correction of deficient Hospital procedures. We view this latter allegation as conclusory, and we do not see that it is supported by well-pleaded factual allegations.
The complaint so states without providing any specific factual substantiation.
The complaint does not clarify the basis for Ms. Bereston's judgment that it would have been impossible to avoid violating HIPAA if more than three registrars were placed in the radiology clinic registration area. In describing HIPAA's requirement to maintain the privacy of individually identifiable patient health information, the complaint states only that "[f]or example, if a registration for one patient was taking place within earshot of other patients in a waiting room, or if patients waiting in line could see another patient's information on a computer screen, the hospital would be violating HIPAA and subject to fines and penalties." We discuss the insufficiency of Ms. Bereston's allegations of a violation of HIPAA in Section III.A.2, infra .
The complaint states that Ms. Bereston had completed her part of the project by "identify[ing] new processes to help Dr. Brem," but that another administrator, who had been tasked with redesigning the layout of the radiology clinic, "had done nothing." The complaint does not indicate what "new processes" Ms. Bereston had proposed, to whom (if anyone) she communicated them, or how her ideas were received.
The complaint states that the "corporate partner" to which the PIP referred was presumably Medical Faculty Associates, Inc. ("MFA"), the large physician practice group with which Dr. Brem and other Hospital physicians were affiliated. According to the complaint, MFA "wields significant power within the Hospital" because it is "practically the sole source" of its patient referrals.
According to the complaint, Dr. Brem "ambush[ed]" her and was "screaming" at her so loudly that they were asked to move into Dr. Brem's office and close the door.
The complaint states that "[b]ecause of its almost total reliance on MFA for patient referrals and revenue, ... [t]he Hospital would not tolerate an employee who considered [its] obligations under the law to be more important than an unlawful demand from an MFA physician." Ms. Bereston further alleges that "[t]he purpose of the PIP was clear and unambiguous: Ms. Bereston must acquiesce to the physicians' demands, and in this particular situation, to Dr. Brem's unlawful demands or lose her job." We view these assertions as too conclusory to merit the assumption of truth granted to well-pleaded factual allegations.
"For instance," the complaint elaborates,
the physicians and staff had to change the way they had "always" done things. They had to learn new processes and procedures designed to protect privacy concerns. [The Hospital] did not want to shoulder the responsibility of managing physician and staff discontent, and found it desirable to allow Ms. Bereston to take the blame and suffer the brunt of physicians' and staff's daily hostility.
Here, too, we view the complaint's allegations regarding the Hospital's motivations as conclusory.
Adams v. George W. Cochran & Co. ,
See
See Carl v. Children's Hosp. ,
Although Count I of Ms. Bereston's complaint attributes her firing only to her refusal to violate HIPAA, the complaint elsewhere suggests that her other efforts to prevent the Hospital from violating the law also motivated the decision. However, Ms. Bereston's briefs in this court describe her allegedly wrongful termination as based solely on her refusal to violate HIPAA by acceding to Dr. Brem's demand for six registrars, and not on any other legally protected conduct. Ms. Bereston has not argued that her wrongful-discharge claim should survive even if it is not adequately supported by the allegations concerning her refusal to violate HIPAA. Accordingly, we construe Count I to predicate her wrongful termination claim on this refusal.
In pertinent part, 42 U.S.C. § 1320d-6 (a) reads as follows:
Offense. A person who knowingly and in violation of this part [42 U.S.C. §§ 1320d et seq. ] ... (3) discloses individually identifiable health information to another person, shall be punished as provided in subsection (b). For purposes of the previous sentence, a person (including an employee or other individual) shall be considered to have ... disclosed individually identifiable health information in violation of this part if the information is maintained by a covered entity (as defined in the HIPAA privacy regulation described in section 1180 (b)(3) [42 U.S.C. § 1320d-9 (b)(3) ] ) and the individual ... disclosed such information without authorization.
At Congress's direction, see P.L. 104-191, Title II, Subtitle F, § 264,
(1) Standard: Safeguards. A covered entity must have in place appropriate administrative, technical, and physical safeguards to protect the privacy of protected health information.
(2)(i) Implementation specification: Safeguards. A covered entity must reasonably safeguard protected health information from any intentional or unintentional use or disclosure that is in violation of the standards, implementation specifications or other requirements of this subpart.
(ii) A covered entity must reasonably safeguard protected health information to limit incidental uses or disclosures made pursuant to an otherwise permitted or required use or disclosure.
42 U.S.C. § 1320d-2 (d)(2).
Potomac Dev. Corp. v. District of Columbia ,
Rosella v. Long Rap, Inc. ,
Clark v. Modern Grp. Ltd. ,
Adding registrars even might work to decrease the disclosure risk by reducing wait times and expediting the movement of patients out of the admissions area, thereby reducing the crowding and the number of bystanders present to whom information might be revealed inadvertently.
See supra note 28. Our reading of 42 U.S.C. § 1320d-6 (a), the criminal provision prohibiting the knowing and unauthorized disclosure of personal health information in violation of HIPAA, is informed by this Privacy Rule provision. Thus, even if Ms. Bereston foresaw that Dr. Brem's request for additional registrars would increase the risk of unintentional disclosures of protected patient health information, we are not persuaded that Ms. Bereston would have violated § 1320d-6 (a) by acceding to the request. She has cited, and we are aware of, no case in which a criminal violation of HIPAA was predicated on an increased risk of unintentional disclosures.
For the same reasons, the complaint's factual allegations do not show the requisite "close fit" between the policy of HIPAA and Ms. Bereston's rejection of Dr. Brem's request for six registrars.
Cf. Rosella ,
Wallace v. Skadden, Arps, Slate, Meagher & Flom ,
It may be debatable whether Ms. Bereston's harassment and retaliation claim satisfies Carl 's requirements of a clear public policy mandate and a close fit between its furtherance and her conduct, but we do not reach this issue in view of our rejection of the claim on other grounds.
Cf. Darrow v. Dillingham & Murphy, LLP ,
Restatement of Employment Law § 5.01 cmt. c. Compare Trosper v. Bag 'N Save ,
Brigham ,
See, e.g. , Touchard ,
Zimmerman ,
Mintz ,
See Rosella ,
See
See
See
Burlington N. & Santa Fe Ry. v. White ,
Stewart v. Evans ,
Burlington N. ,
Markel v. Bd. of Regents of the Univ. of Wis. Sys. ,
Nicola v. Washington Times Corp. ,
Daka ,
Harris v. Forklift Sys., Inc. ,
Nicola ,
Crowley v. Vilsack ,
See, e.g. , Simpson v. Welch ,
In point of fact, the factual allegations in Ms. Bereston's complaint suggesting that her superiors or Hospital management were unwilling or reluctant to comply with the Hospital's legal obligations are very thin and fall well short of showing bad motives; the only unwillingness alleged with any specificity was that of Mr. Davis to agree to Ms. Bereston's alteration of Emergency Room admissions procedures early in her tenure, and even Mr. Davis changed his mind when the Hospital's Risk Director sided with Ms. Bereston on the legal need for the change.
Moreover, while Ms. Bereston rests her claim of retaliatory harassment in part on abusive behavior by her staff and physicians like Dr. Brem, "an employer can only be liable for co-workers' retaliatory harassment where its supervisory or management personnel either (1) orchestrate the harassment or (2) know about the harassment and acquiesce in it in such a manner as to condone and encourage the co-workers' actions." Gunnell v. Utah Valley State College ,
Concurring Opinion
More than two decades ago, in our Adams
In this case, we conclude, first, that appellant Bereston's complaint did not sufficiently allege a wrongful discharge claim. We then decline her request to recognize a common law exception justifying damages for her employer's alleged "unlawful harassment and retaliation"
According to paragraph 74 of her complaint, Ms. Bereston alleges that her hospital employer violated the District's public policy "by retaliating, harassing and eventually terminating" her employment because of her efforts to bring the hospital "into compliance with the several laws and regulations governing its operation." Although a few jurisdictions have recognized common law exceptions based on public policy for alleged retaliation against an employee short of discharge-commonly demotion for filing a workers' compensation or whistleblower claim
A discharge for a clear-cut, easily discernable employee act, such as a refusal to drive ( Adams ) or a decision to testify ( Carl ), can be held unlawful rather easily by reference to public policy clearly reflected in a particular statute or regulation. To the contrary, to recognize Ms. Bereston's common law claim for harassment/retaliation would require substantial fact-finding based on employer/employee interactions over time necessitating definitions *116of terms, burdens of production and proof, and ultimately resolution of swearing contests involving multiple actors in environments with fluid dynamics. This would take judge-made law to an extreme, from creating a right to creating a regime.
It is obviously true that the kind of fact-finding and law-applying I have just outlined is something the courts do every day, but we do so by applying statutes that spell out all the required ground rules. Thus, as illustrated in the opinion of the court,
I am not, however, averse to extending common law rights of recovery when appropriate.
Unlike the factual fight in the typical harassment/retaliation case like Ms. Bereston's, where the sides have conflicting stories to tell, a typical demotion for assertion of whistleblower protection or worker's compensation would generate controversy only over an employer's reasons for demoting an employee who asserts an unquestionable right or duty. I say "typical" demotion because, of course, even that predicate for a common law action on occasion may invite controversy and dilute my point here. Nonetheless, I perceive a material distinction between challenging retaliation for clear-cut, right-or-duty-based assertions by employees, and an employee's effort to establish harassment/retaliation as a common law basis for challenging *117employer discipline, short of discharge, in an area requiring a superstructure of rules and where, in part, the legislature has already spoken.
I, therefore, concur separately in the opinion of the court to assure that nothing we say here forecloses efforts to achieve common law causes of actions, as appropriate, in the employment area.
Adams v. George W. Cochran & Co. ,
Carl v. Children's Hosp. ,
Compl. ¶¶ 73-75.
See Trosper v. Bag 'N Save ,
See ante text accompanying notes 49-56.
District of Columbia Human Rights Act,
District of Columbia Whistleblower Protection Act,
Carl ,
Trosper ,
Trosper ,
Concurring in Part
The opinion for the court affirms the trial court's dismissal of Ms. Bereston's complaint. I agree as to Ms. Bereston's wrongful-termination claim, for the reason stated in Part III.A.2, which I join: the complaint fails to adequately allege that Ms. Bereston was being directed to violate HIPAA in connection with patient-registration procedures. The court need not address whether the complaint was deficient in the other respects identified in Part III.A.3, and I therefore do not join that part of the court's opinion. Although I see no reason to belabor the point, I do not agree with the conclusions reached in Part III.A.3. In my view, the complaint sufficiently alleges that Ms. Bereston's employment was terminated because Ms. Bereston refused to do what she was being directed to do with respect to patient-registration procedures.
I respectfully dissent as to Ms. Bereston's claim of what might be called wrongful discipline in violation of public policy. As the opinion for the court notes, ante at 110, this court has not yet decided whether to recognize such a claim. Other courts have divided on the question, ante at 110 n.40, and the Restatement of Employment Law "expresses no view" on the question. § 5.01 cmt. c (Am. Law Inst. 2015). I agree with the courts that have concluded that the relevant considerations on balance favor recognizing such claims. We initially recognized a claim for wrongful termination because it would be "patently contrary to the public welfare" to permit an employer "to require [its] employees to break the law as a condition of continued employment." Adams v. George W. Cochran & Co. ,
In my view, it would also be patently contrary to the public welfare to permit employers to impose harsh adverse employment consequences short of termination on employees to coerce employees to violate the law or to punish employees for refusing to break the law. I acknowledge the court's concern about injecting the courts unduly into the employment relationship. Ante at 110-11. As the court notes, ante at 111, other statutes-such as the Human Rights Act, the Whistleblower Protection Act, and the Workers' Compensation Act-provide employees with causes of action based on retaliation short of termination. Judicial enforcement of those provisions has not proven infeasible, and I see no reason why claims of wrongful discipline would be any more difficult to resolve.
*118I also note that the Supreme Court has held that several federal statutes contain an implied right to be free from retaliation. See, e.g. , CBOCS W., Inc. v. Humphries ,
I agree with the court that a claim of wrongful discipline in violation of public policy would require the employee to show "employer action that would have been materially adverse to a reasonable employee." Ante at 112 (brackets and internal quotation marks omitted). I do not agree, however, that Ms. Bereston's complaint was properly subject to dismissal under that standard. Ante at 113-15. The complaint alleges that staff called Ms. Bereston names, made remarks about her race, and screamed in her face; supervisory personnel failed to discourage that conduct and refused to let Ms. Bereston respond; a supervisor suggested that Ms. Bereston's job security would be endangered if she insisted on compliance with the law; supervisory personnel made unwarranted accusations that Ms. Bereston was not a good leader or team player; Ms. Bereston was ridiculed and admonished for minor errors even though other employees were not treated similarly; and Ms. Bereston was unjustifiably placed on a Performance Improvement Plan (PIP). I do not view those allegations as conclusory, and if they are proven it seems to me that a reasonable factfinder could conclude that Ms. Bereston was subjected to "materially adverse" employer action. See, e.g. , Crowley v. Vilsack ,
In sum, I would vacate the dismissal of Ms. Bereston's wrongful-discipline claim and remand for further proceedings. I therefore respectfully dissent in part.
Reference
- Full Case Name
- Katayoon BERESTON, Appellant, v. UHS OF DELAWARE, INC. and District Hospital Partners, LP, D/B/A George Washington University Hospital, Appellees.
- Cited By
- 16 cases
- Status
- Published