By Wheeler Cowperthwaite
Special to the SUN

A nurse is suing the Presbyterian Española Hospital for allegedly firing her a day after she complained about the unprofessional behavior of a medical assistant, and months after she filed a series of complaints about issues with patient care.

Registered Nurse Stephanie Roybal, who had been with the Española Hospital for six years, filed the lawsuit in Tierra Amarilla District Court on April 3, for retaliatory firing in violation of state policy and retaliation for patient safety reporting. She worked in the orthopedic and podiatry department.

Santa Fe Attorney John Day, who is representing Roybal, wrote in the lawsuit that Roybal is seeking back pay and benefits, reinstatement in her job or “front pay,” damages for emotional distress and reputational harm, punitive damages “sufficient to punish” the hospital and deter future misconduct and attorneys fees.

While Roybal was fired a day after complaining about the unprofessional conduct of a medical assistant she worked with, she sent memos and raised concern about patient care for months, Day wrote.

Roybal started documenting her concerns in November, with both medical assistants and registered occupational therapists when they were performing orthopedic procedures. The hospital fired her on Feb. 11.

She reported that the assistants and therapists didn’t have the proper training to put casts on and take them off of patients, “and that these deficiencies posed risks to patient safety,” Day wrote.

“Plaintiff requested that Defendants provide additional training support to ensure that patients received proper care and that nursing staff were not compelled to interrupt postoperative triage responsibilities to correct these deficiencies,” he wrote.

She sent a memo on Jan. 15 “identifying systemic failures in the documentation of suture and staple removal procedures.” Getting sutures and staples removed is a medical procedure with its own billing code and order number in the system, Day wrote.

Suture and staple removal was not being documented, which is an issue with healthcare accreditation standards and “billing integrity requirements” that exposed “Defendants to potential regulatory and financial liability,” Day wrote.

Roybal’s memo was meant to address orders for removal being properly entered and signed, that “providers” assessed patients prior to the sutures or staples being removed and that medical assistants weren’t performing “incision assessments or exercise nursing judgment in removing sutures or staples, which falls outside their scope of practice,” Day wrote.

“Multiple staff members responded that they had never been trained on these documentation requirements, corroborating Plaintiffs concerns regarding systemic training deficiencies,” he wrote.

Issues came to a head on Feb. 10 when a medical assistant Roybal had complained about told Roybal not to talk to her, turned her back to her, refused to do her job and told her a “the line in the sand has been drawn,” Day said in an interview. Roybal submitted a complaint about the assistant on Feb. 11, and on Feb. 12, she was fired.

Manager Robin Valdez wrote that Roybal was fired for “unsatisfactory work performance” citing multiple informal coaching sessions and “feedback regarding your professionalism, approachability and performance,” Day wrote.

The “informal coaching” was never documented in Roybal’s personnel file, she never received a written warning or performance improvement plan and “no notice at any point during her six-year employment that her position was at risk,” Day wrote.

“The performance-based justification set forth in the dismissal document is pretextual,” he wrote. “The dismissal document contains no reference to patient safety, clinical competency, scope-of-practice compliance, or the documented concerns Plaintiff had raised over the preceding months — the actual subject matter of her protected activity.”

Roybal’s core concerns, backed up by feedback she received, was that medical assistants were not qualified and trained to do some of the procedures they were doing.

“The problem is the hospital blew her off,” he said. “They didn’t care that she was raising these issues but they had an obligation to.”

New Mexico has a law, which Day is suing under, specifically to protect healthcare workers from retaliation, as well as a public policy standard that “strongly protects employees who report patient safety concerns and clinical deficiencies in healthcare setting.

“It’s easier to fire a nurse making the reports than to fix the problem,” he said.

To Day, Roybal’s firing raises more troubling questions about patient safety at the hospital, he said.

An email was sent to Presbyterian Española Hospital, asking for comment on the lawsuit. Though receipt of it was acknowledged, they did not respond by press time.