Decision
Filed: December 5, 2011
State of Louisiana
Civil Service Commission
Docket No. S-17204
Adrian Todd White
Versus
Louisiana Department of Veterans Affairs,
Northwest Louisiana War Veterans Home
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Rule(s): 12.2; 12.8; 12.8.1; 12.10
Topic(s): Dismissal; failure to follow agency policy; suspension pending investigation; prospective notice of disciplinary action; disparate treatment
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Appearances: Adrian Todd White, self-represented
David LaCerte, counsel for LDVA, NWLWVH
Statement of the Appeal
Adrian Todd White was employed by the Louisiana Department of Veterans Affairs (LDVA) at the Northwest Louisiana War Veterans Home (NWLWVH) as a Licensed Practical Nurse 2 (LPN-2) and he served with permanent status. By letter dated June 10, 2011, LDVA dismissed Mr. White from his position effective June 24, 2011. LDVA charges that on January 12, 2011, and in violation of agency policy, Mr. White: 1) made a significant medication administration error, 2) failed to assess or monitor the affected resident after the medication error occurred, and 3) failed to notify the Registered Nurse Supervisor and the physician of the medication error.
On July 8, 2011, Mr. White filed an appeal contesting his dismissal. Mr. White does not deny the factual allegations of the dismissal letter. Instead, he contends that his dismissal violated the Civil Service Rules, Article X, § 8 of the Louisiana Constitution, and the settlement agreement of his previous appeal bearing docket number S-17095.[1] He further contends he was not aware of the policies and procedures LDVA alleges he violated, the penalty of dismissal is disproportionate, and disparate treatment. As relief, Mr. White requests reinstatement to his former position, back wages, legal interest, and expungement of his personnel file.
I held a public hearing on October 6, 2011, in Bossier City, Louisiana. Based upon the evidence presented and pursuant to the provisions of Article X, § 12(A) of the Louisiana Constitution of 1974, as amended, I make the following findings and reach the following conclusions.
Findings of Fact
1. Adrian Todd White worked for the Louisiana Department of Veterans Affairs (LDVA) at the Northwest Louisiana War Veterans Home (NWLWVH) as an LPN-2 and he served with permanent status. Mr. White began working for LDVA on July 9, 2008.
2. NWLWVH is a residential facility for veterans that provides long-term health care, including medical and psychiatric treatment.
3. C.M.[2] is a male resident at NWLWVH. He suffers from hypertension (high blood pressure), for which he receives five milligrams of Lisinopril every morning. C.M. is predisposed to hypotensive (low blood pressure) episodes at his prescribed dosage of Lisinopril. He shares a room with another male resident, G.S., on Wing 200.
4. Mr. White worked on Wing 200 from 7:00 p.m. on January 12, 2011, until 7:00 a.m. on January 13, 2011. Joanie Philips, Registered Nurse Supervisor, was Mr. White’s direct supervisor. The physician on call was Dr. Flenikin.
5. At approximately 9:15 p.m., Mr. White entered the room of C.M. and G.S. to administer their medication. G.S. was sitting in a wheelchair at a table, located at the foot of his bed, eating his dinner. C.M. was standing at the sink in the bathroom. Mr. White placed G.M.’s medications, which he had crushed and mixed with applesauce, on the edge of the table, and told G.M. to remember to take his medication when he finished eating. G.M. told Mr. White that he would. Mr. White told C.M. that he was placing his medication on his nightstand and reminded him to take it when he finished in the bathroom. C.M. told Mr. White that he would. Mr. White left that room and went to the room next door to administer medication to other residents.
6. While in the room next door, Mr. White saw G.S. enter the hallway and place a cup of pills on the medication cart. At that time, Mr. White discovered that C.M. had taken G.S.’s medication, which resulted in C.M. receiving eight times the prescribed dosage of Lisinopril and an antidepressant medication that can cause drowsiness and low blood pressure.
7. Mr. White knew that leaving the medications at the bedside for the two residents and leaving the room prior to administering their medications was a violation of LWVH policy and nursing standards.
8. Although Mr. White knew that he was supposed to report the medication error immediately to Ms. Philips, he did not do so; nor did he contact Dr. Flenikin. Instead, he looked up the medications that C.M. had taken in a pharmacology book and determined that the side effects, if any, would not present for several hours.
9. Mr. White visually checked on C.M. several times throughout the night, but he did not evaluate or monitor C.M.’s vital signs, including his blood pressure.
10. At approximately 5:00 a.m., Ms. Philips asked Mr. White if he had anything to report regarding Wing 200. Mr. White admitted that he had made a medication administration error. He stated that although he had observed C.M. sleeping several times, he had never obtained C.M.’s vital signs.
11. LWVH Nursing Manual 10-08, Medication Administration Guidelines, Procedure, provides in pertinent part as follows:
Medications are not to be left at the bedside. They are to be taken by the resident in the presence of the administering nurse.
12. LWVH Nursing Manual 10-08, Medication–Error, Policy, provides in pertinent part as follows:
In the event a medication error occurs, steps to ensure the resident’s safety will be implemented.
Administration of wrong medication(s), dosage, route, time, resident, allergic to, or failure to administer a medication may be considered medication errors.
13. LWVH Nursing Manual 10-08, Medication–Error, Procedure, provides in pertinent part as follows:
. . .
Notify the Registered Nurse and Physician.
. . .
Provide care to the resident;
. . .
Assess respiratory, cardiac, and circulatory status.
Obtain vital signs.
Discussion and Conclusions of Law
An employee with permanent status in the classified civil service may be disciplined only for cause expressed in writing. Cause for disciplinary action is conduct of the employee that is prejudicial to the public service or detrimental to its efficient operation. Bannister v. Dept. of Streets, 666 So.2d 641 (La. 1996). The right of a classified state employee with permanent status to appeal disciplinary actions is provided for in Article X, § 8(A) of the Louisiana Constitution of 1974. That section states that “[t]he burden of proof on appeal, as to the facts, shall be on the appointing authority.” The appointing authority is required to prove its case by a preponderance of the evidence, which is evidence that is of greater weight or more convincing than that which is offered in opposition thereto. Proof is sufficient to constitute a preponderance when, taken as a whole, it shows the fact or causation sought to be proved as more probable than not. Wopara v. State Employees’ Group Benefits Program, 2002-2641 (La. App. 1 Cir. 7/2/03); 859 So.2d 67.
LDVA alleges that Mr. White made a significant medication administration error, and thereafter failed to assess or monitor the affected resident. LDVA also alleges that Mr. White failed to notify the Registered Nurse Supervisor and the physician of the medication error.
The evidence adduced at the hearing indicates that Mr. White left the medications with the two residents and exited their room without observing them take the medications. This resulted in one of the residents being improperly medicated. Mr. White then failed to monitor that resident’s condition. He also failed to promptly notify Ms. Philips and Dr. Flenikin of the medication error.
Although Mr. White admits these events occurred, he attempts to defend his conduct by claiming that he was not aware of the applicable policies and procedures. I find this claim unconvincing. Mr. White testified that he knew that leaving the medications at the bedside for two residents and exiting their room prior to administering their medications was a violation of LWVH policy and nursing standards, and that he was supposed to report the medication error immediately to the Registered Nurse Supervisor. He contends that he was unaware that the policy required that he contact Dr. Flenikin, but I reject this contention, as LWVH Nursing Manual 10-08, Medication–Error, Procedure, clearly provides that both the Registered Nurse Supervisor and the physician be contacted. Moreover, given the serious nature of the medication error, Mr. White should have known that notification to Dr. Flenikin was required.
Mr. White contends that LDVA violated Civil Service Rule 12.10 by placing him on paid suspension pending investigation for 280 hours, which exceeded the maximum of 260 hours allowed under that rule. Because Mr. White was paid for those hours, there is no relief I can grant him. I therefore conclude that this claim is moot under Civil Service Rule 13.14(a)4.
Mr. White further contends that LDVA violated Civil Service Rule 12.8, in that he did not receive notice of his dismissal prior to its effective date. This contention is without merit. At the hearing, Byron Hines, Administrator, and Cassandra Bell-Atkins, Human Resources Specialist, testified and provided documentation that on June 10, 2011, LDVA mailed the dismissal letter, with proper postage, to the most recent address that Mr. White had provided in writing to the LDVA human resource office, as allowed by Civil Service Rule 12.8.1. Mr. White did not present any credible evidence to the contrary. I therefore conclude that LDVA complied with the requirements of Civil Service Rule 12.8.
Mr. White claims that LDVA prevented him from exercising his right to appeal under Article X, § 8 of the Louisiana Constitution of 1974 and Civil Service Rule 13.10 by offering to enter into a settlement agreement with him. However, Civil Service Rule 13.31 authorizes settlements, and Mr. White exercised his right to appeal.
It is the contention of Mr. White that he is the victim of disparate treatment, as LDVA did not dismiss other employees who committed medication errors. Disparate treatment is a form of non-merit factor discrimination; therefore, under Civil Service Rule 13.19(s)2, Mr. White has the burden of proof on this issue. However, Mr. White failed to present any evidence in support of this claim. Mr. White has thus failed to prove that he is the victim of disparate treatment.
Mr. White’s failure to follow NWLWVH policy resulted in C.M. receiving eight times the prescribed dosage of his hypertension medication, which even at normal dosages may cause low blood pressure, and also caused C.M. to ingest another resident’s antidepressant medication that can cause low blood pressure. Despite the seriousness of the situation, Mr. White failed to adequately monitor the affected resident’s condition, and failed to properly inform Ms. Philips and Dr. Flenikin of what had occurred. The consequences of his misconduct could have been tragic, and were manifestly detrimental to the state service. LDVA has proved cause for discipline against Mr. White.
The Civil Service Commission and its Referees have a duty to decide “whether the punishment imposed is commensurate with the dereliction.” Guillory v. Department of Transp. & Development, 475 So.2d 368, 370-371 (La. App. 1st Cir. 1985). Mr. White contends that the penalty imposed, dismissal, is too severe. I disagree. A single aggravated incident alone can constitute legal cause for the dismissal of a classified employee. Brown v. Department of Health & Hospitals Eastern Louisiana Mental Health System, 917 So.2d 522, 2004-2348 (La.App. 1 Cir. 11/4/05). Mr. White’s failure to properly discharge his duties could have resulted in serious harm to C.M. as well as G.S., and thus was detrimental to the state service. Based upon the forgoing reasons, I find that LDVA proved legal cause for discipline and that the penalty imposed, dismissal, is commensurate with the offenses.
Accordingly, I hereby deny this appeal.
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Kathe Zolman-Russell
Civil Service Commission Referee