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BMS Case No. 08PA1446State of Minnesota Case No. 08-257
of HUMAN SERVICES, STATEOPERATED SERVICES, ADULT MENTAL Grievant: Heather MewhorterHEALTH
COUNTY and MUNICIPAL EMPLOYEES,AFSCME, MINNESOTA COUNCIL 5
Ann Elizabeth Thompson, Labor Relations Representative, Minnesota
Management and Budget, appearing on behalf of the Employer.
Amanda Prince , Business Representative, AFSCME MN Council 5, AFL-
CIO, appearing on behalf of the Union.
The State of Minnesota, Department of Human Services, State Operated
Services, Adult Mental Health, hereinafter the Employer, and AFSCME MinnesotaCouncil 5, hereinafter the Union, are parties to a Collective Bargaining Agreementthat provides for the arbitration of grievances. On October 2, 2008, the partiesnotified Sherwood Malamud of his selection to hear this grievance concerning theEmployer’s discipline of Grievant with a one-day suspension. Hearing in thematter was held on January 29, 2009 at the Administration Building on thecampus of the Anoka Metro Regional Treatment Center in Anoka, Minnesota. Theparties presented testimony, documentary evidence and argument at the hearing.
At the conclusion of the hearing on January 29, 2009, the record in the matterwas closed. A transcriptual record of the proceeding was not made. Based on theevidence and arguments presented, the Arbitrator issues the following Award.
The parties were able to stipulate to the formulation of an issue to be
Did the Employer have just cause to issue the Grievanta one-day suspension? If not, what shall be the remedy?
Heather Mewhorter, Grievant herein, has 11 years of experience as a
Licensed Practical Nurse (LPN) and approximately 4 years seniority with this
Employer at the time of the imposition of the one-day suspension which is the
subject of this arbitration proceeding. Grievant had served two and a half years
on Unit H and six months on Miller South, when the Employer suspended her for
one day. Miller South houses the Treat to Competency Program. Patients in this
program receive treatment to enable them to progress to a point that they are able
The events leading to the imposition of the discipline at issue stretch over
a period beginning September 2006 through January 2008. During that period
of time, Grievant made 10 medical transcription errors.
The precipitating events that resulted in the decision of Grievant’s
immediate supervisor, Registered Nurse Stephanie Kuznia, to impose discipline
occurred on January 3 and 8. Grievant made the same medical transcription
error on both January 3 and January 8, 2008. She entered on the Medical
Administration Record (the MAR) the notation from a Physician’s Order form to
administer the Mantoux tuberculin test at a dosage level of 0.01 rather than at the
standard dosage of 0.1 milliliters. The Physician form just indicates whether the
medication should be administered or not. The form in use on January 3 and 8
The Mantoux Tuberculin test is administered with some frequency on this
unit. The dosage level is known. Grievant knew the Mantoux dosage level to be
0.1 milliliter. She erroneously moved the decimal in transcribing the dosage onto
A dosage of 0.01 milliliters is insufficient to indicate whether or not the
patient has Tuberculosis. Among those who are tested are new patients. The
Employer tests for TB to prevent the introduction of this highly communicable
disease into the facility to prevent its exposure to staff and patients. Since the
dosage level for Mantoux is well known by staff, the Employer attributed lack of
diligence as the reason for Grievant’s transcription error.
The Employer’s policy requires that medical transcriptions from physician’s
orders to the MAR be checked by a second LPN. The January 3 transcription error
was missed by the second LPN.1 The erroneous dosage level was administered on
January 3 and the results read on January 6. The Employer did not catch the
transcription error until January 14, 2008. In addition to the double-check of the
transcription by a second LPN, the day nurse/ the evening nurse review the MAR.
It was the final administrative check that caught the transcription error.
On January 8, Grievant made the same transcription error for a prescribed
Mantoux test for another patient. This transcription was double-checked by a
float LPN from another unit. Both errors, although separated by five days, were
caught on January 14. However, on January 8, Mantoux was not administered
at the dosage level, the erroneous level, that Grievant transcribed to the MAR.
Grievant’s supervisor, Kuznia, elected to impose a one-day suspension. Her
decision to do so is based on Grievant’s record of medical transcription errors, the
additional training opportunities she received, the policy review conducted with
Grievant by both by the supervisor and the Employer’s Education Trainer and the
imposition of progressive discipline, a verbal and a written reprimand. All the
discipline and additional corrective actions occurred over a period of one and a
1The second LPN, who checked and missed the error, received a 1-day suspension, as well.
A review of Grievant’s work history from 2006 to 2008 reveals that while on
Unit H, Grievant made transcription errors on September 8 and 26, October 10,
2006, and on January 4, 2007. Her supervisor on Unit H, Elaine Fitzgerald,
directed that Grievant receive re-training and attend a transcription review class
with the Employer’s Educational Trainer DeFoe. Grievant participated in a one-
on-one policy review covering medical transcription with DeFoe on January 14,
2007. She participated in the three hour medical transcription review class taught
by DeFoe on January 16, 2007. All LPN staff are required to attend a medical
In a Performance Review in February 2007, Fitzgerald, Grievant’s supervisor
on Unit H graded Grievant’s medical transcription errors as below expectations.
The supervisor’s rating of Grievant’s other duties and responsibilities included
many exceeds expectations and meets expectations for an overall performance
On June 5, 2007, Grievant failed to follow policy and omitted making an
entry on the MAR. She failed to enter the results of an Accuchek. Fitzgerald
issued a verbal reprimand for this transcription error. On July 17, Grievant made
another medical transcription error. She failed to note that the prescribed
medication Haldol 15 mg, was to begin on July 20. The omission resulted in the
order beginning on July 17 rather than on July 20 as ordered by the physician.
Fitzgerald issued a written reprimand in response to this medical transcription
Shortly after this incident, Grievant transferred to Miller South. On the
July 25, 2007 performance review completed by her former supervisor Fitzgerald,
again medical transcription errors were identified as the deficiency in her work
Shortly after her transfer to Miller South, Grievant failed to note on the MAR
that the prescribed medication, Ativan, had been administered to the patient. Her
new supervisor, Kuznia, reviewed the medical transcription policy, Employer
Exhibit 15, with Grievant. The supervisor did not impose discipline, inasmuch as,
Grievant had just transferred to Miller South.
The next two errors, one on January 3 and the other on January 8, 2008,
are the medical errors described above which precipitated the imposition of the
discipline which is the subject of this arbitration. Grievant served the one-day
suspension on January 25. In addition to the discipline imposed, Kuznia required
that Grievant follow a Medical Error Corrective Action Plan. Beginning on January
18 through July 18, 2008, Kuznia directed that Grievant’s completed medical
transcriptions be checked and co-signed by a Registered Nurse. In addition,
Kuznia directed that Grievant attend a medical transcription review. Grievant
attended the annual medical transcription review on February 13, 2008.
In Grievant’s February 21, 2008 performance review completed by Kuznia,
the supervisor notes excessive medical errors as the only area where Grievant’s
On March 31, 2008, Grievant filed the within grievance protesting the
Employer’s imposition of a one-day suspension. The parties processed the
grievance through the grievance procedure. It is properly before the Arbitrator.
The Employer argues that ten transcription errors in a year and a half are
too many. The Employer applied progressive discipline. It imposed a verbal
reprimand, a written reprimand, and followed that discipline with a one-day
suspension. Grievant admits she committed the errors. The Union’s defense that
no one was injured is more a matter of luck.
Grievant’s errors continued until the Employer imposed a suspension. The
Employer maintains that it had just cause to impose the suspension. It requests
The Union argues that the errors are the product of the Employer’s
procedures. The transcription errors were the product of the form. The Physician
Order form did not specify the dosage. Once the form was corrected in April 2008,
Furthermore, the Union notes that it took two weeks before the Employer
discovered the January 3 transcription error. Had Grievant received timely
notification of the dosage transcription error, she would not have repeated the
The Union notes that the Employer has abandoned the manual
transcription of forms and has gone all electronic. The factual circumstances that
would give rise to the kinds of errors involved in this case are no longer in place.
The Union argues, therefore, that the discipline imposed is excessive. It requests
that the Arbitrator: sustain the grievance, remove the suspension from Grievant’s
record, and reimburse her for the pay lost as a result of the Employer’s imposition
The facts as described in the Background section of this Award are not in
dispute. Grievant acknowledges that she made the medical transcription errors
noted and brought to her attention by supervision.
The Employer established its case. Grievant made the medical transcription
errors noted. The Employer provided Grievant with additional training. Her
supervisor reviewed the medical transcription policy with her. The errors she
made in transcription to the MAR, the omission of indications that medication had
been administered, improper entry of dosage levels or times at which medication
is to be administered, all put patients at risk. Patients may receive an overdose
or may have a medical regimen begin before the time or at times at variance with
the physician’s orders. The fact that, over the course of the 10 errors she made,
no patient was harmed is a matter of good fortune rather than the description of
the manner in which an LPN should carry out her responsibilities.
The discipline imposed did not serve as a substitute for additional training,
but came with additional training. Even the imposition of the one-day suspension
was accompanied by a Corrective Action Plan to improve Grievant’s transcription.
The discipline and additional training were all geared towards correcting the
problem that resulted in the multiplicity of medical transcription errors over a
relatively short period of time of a year and a half.
Grievant alludes to reasons that may have caused the errors; she had to
work in circumstances that were noisy and distracting. An LPN is very busy
performing the other functions of her job. However, medical transcription
constitutes 20% of the job responsibilities of an LPN as delineated in the position
description for a licensed practical nurse, Employer Exhibit 17, paragraph 7. It
is an important responsibility of an LPN. The frequent training and double-
checking of the transcription performed by another LPN and the reviews of the
MAR indicate the importance that the Employer ascribes to this responsibility.
The Union was unable to establish a basis for mitigating the penalty
imposed. Its arguments that the Employer switched to an electronic system of
recording orders, and before that, changed the form to specify dosage level, do not
remove the basis for discipline. The Employer attributes the medical transcription
errors to a lack of diligence. It is the work characteristic, diligence, the Employer
seeks to improve through the discipline and training it provided to Grievant.
Whether an LPN implements or transcribes physicians’ orders and whether the
orders are in electronic form or appear on a more detailed form that specifies
dosage, route and location for the administration of medication, the need for
diligence remains. Technology may reduce the opportunity for error, it does not
In her performance reviews, the Employer acknowledges that Grievant is an
excellent employee who performs her responsibilities in a manner that exceeds
expectations in many respects. However, in this one respect, medical
transcription, her performance did not meet expectations. The Employer had just
cause to impose discipline. It used progressive discipline to alert Grievant to her
need to reduce her medical transcription errors. Grievant received verbal and
written reprimands for the errors that preceded the ones on January 3 and
January 8, 2008. In a progressive discipline system, the level of discipline
increases in response to each instance of misconduct that continues to occur.
The first instance warrants a verbal reprimand; the fourth instance of the same
error or infraction warrants greater discipline, in this instance a one-day
suspension. For all of the above reasons, the Arbitrator concludes that the
Employer had just cause to suspend Grievant for one day.
Based on the above discussion, the Arbitrator issues the following:
The Employer had just cause to issue the Grievant a one-day suspension.
Dated at Madison, Wisconsin, this 6th day of February, 2009.
Differences in Antidepressant Treatment Continuation Associated with Escitalopram and alternative SSRIs 1 Mathematica Policy Research, Inc., Princeton NJ 2 HealthCore Inc., Wilmington DE 3 Department of Health Services Administration and Population Health, Georgetown University School of Nursing and Health Sciences, Washington DC 4 Forest Research Institute, Jersey City, NJ 5 Mathematica Polic
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