Babb v. Gibson

CourtDistrict Court, M.D. Florida
DecidedAugust 19, 2022
Docket8:14-cv-01732
StatusUnknown

This text of Babb v. Gibson (Babb v. Gibson) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Babb v. Gibson, (M.D. Fla. 2022).

Opinion

UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION NORIS BABB,

Plaintiff,

v. Case No. 8:14-cv-1732-VMC-TBM

DENIS McDONOUGH, Secretary, DEPARTMENT OF VETERANS AFFAIRS,

Defendant. _______________________________/ ORDER This matter comes before the Court upon consideration of Defendant Secretary of the Department of Veterans Affairs’ Motion for Summary Judgment (Doc. # 52), filed on April 11, 2016. Defendant filed a supplemental memorandum in support of the Motion for Summary Judgment on October 14, 2021. (Doc. # 124). Plaintiff Noris Babb responded on November 5, 2021. (Doc. # 127). Defendant replied on November 18, 2021 (Doc. # 129), and on November 30, 2021, with leave of Court, Dr. Babb filed a Sur-Reply. (Doc. # 132). For the reasons that follow, the Motion is granted in part and denied in part. I. Background A. Dr. Babb’s Role as a VA Pharmacist in Geriatrics Dr. Babb is a clinical pharmacist who is currently employed at the C.W. Bill Young VA Medical Center. (Doc. # 27 at ¶ 8). At the time of the events in question, she was approximately 52 years old and was in a GS-12 position. (Id.). Dr. Babb worked in the geriatric primary care clinic at the VA from 2006, until June of 2013. (Babb Decl. Doc. # 68-2 at ¶¶ 1, 26). During her time in the geriatrics clinic, she was part of an “interdisciplinary team.” (Hull Dep. Doc. # 54 at 8:21). One of her supervisors at the geriatrics clinic, Dr.

John Hull, explained: “the interdisciplinary team is a team of caregivers that work closely together to achieve better outcomes for complex patients. . . . [T]he idea is that a group of people working together and sharing information can achieve success in complex situations much better than a solo practitioner.” (Id. at 8:23-9:4). Dr. Hull explained that the patients seen at the geriatrics clinic were “the oldest of the old” facing “frailty . . . usually psychosocial problems and a high rate of dementia.” (Id. at 8:2-10). Dr. Hull noted, “we try to select patients that have multiple medical, psychosocial and

functional problems, which means that our rate of death is much, much higher than a regular primary care environment, and dealing with the issues of death and dying palliative care.” (Id. at 7:21-25). At that time, Dr. Babb held an Advanced Scope, which means that she could perform Disease State Management. (Babb Decl. Doc. # 68-2 at ¶ 5). Disease State Management entails a pharmacist independently managing patient care for specific conditions (diabetes, hypertension, and cholesterol), including writing prescriptions for these ailments without consulting a physician. (Id.; Justice Decl. Doc. # 52-2 at ¶

2). B. Dr. Babb Experiences Tribulations at Work Starting in 2011, Dr. Babb’s clinic was part of a national “Patient Aligned Care Team” or PACT program, which resulted in many staffing changes at the VA. (Doc. # 68-2 at 22; Babb Decl. Doc. # 68-2 at ¶ 8). In 2012 and 2013, the VA was in the process of implementing national qualifications standards so that pharmacy employees who spent at least 25% of their time practicing under an Advanced Scope would be promoted to a GS-13. (Justice Dep. Doc. # 55 at 63-65; Babb Decl. Doc. # 68-2 at ¶ 11). Understandably, Dr. Babb ― a GS-

12 pharmacist with an Advanced Scope ― sought such a promotion. In June of 2012, Dr. Marjorie Howard, who was Dr. Babb’s supervisor at that time, ask Dr. Babb whether she would consider a primary care position in “Module B” of the VA that had recently been vacated. (Howard Dep. Doc. # 57 at 52:8- 10). Dr. Howard brought up the Module B position because she did not think that Dr. Babb could meet the 25% requirement for the GS-13 promotion in geriatrics. (Id. at 54:19-25, 55:19-20). Dr. Babb declined, even though Dr. Babb recognized that her direct supervisor said that moving to Module B “was the only way [Dr. Babb] could get a GS-13.” (Babb Dep. Doc.

# 59 at 86:2-3; Doc. # 52-2 at 29). According to Dr. Babb, treating geriatric patients was her professional calling. (Babb Decl. Doc. # 68-2 at ¶ 10). In August of 2012, the service agreement between the pharmacy and the geriatrics clinic was being renegotiated. (Williams Dep. Doc. # 56 at 6:2-5). Dr. Babb worked with Dr. Hull and others in the geriatrics clinic on a separate draft service agreement that supported Dr. Babb’s use of an Advanced Scope in the geriatrics clinic performing Disease State Management. (Id. at 17:2-10). However, the service agreement that was ultimately signed did not call for Dr. Babb to

perform Disease State Management, and in February of 2013, Dr. Babb’s Advanced Scope was removed. (Babb Dep. Doc # 59 at 35:6-9; Wilson Dep. Doc. # 53 at 16:17). Dr. Leonard Williams is the Chief of Geriatrics and Extended Care at the VA, Bay Pines. (Williams Dep. Doc. # 56 at 4:15-17). He was the person who decided that Dr. Babb should not perform Disease State Management on VA geriatric patients. (Id. at 18:14-19). In his opinion, Dr. Babb’s role as a geriatrics pharmacist was to check for dangerous drug interactions and answer patient and caregiver questions about medications because geriatric patients are often prescribed multiple medications. (Id. at 13:1-7).

Dr. Williams provided several reasons for omitting Dr. Babb’s provision of Disease State Management from the service agreement. As Dr. Williams explained, “[m]any times in very frail, elderly patients we don’t need to treat their hypertension or we don’t need to treat it aggressively as you would through [Disease State Management] protocols, because basically the damage that was going to be done by high blood pressure by that time was done.” (Id. at 11:22-12:1). And “it could be injurious to the patient” to try to control conditions such as high blood pressure through Disease State Management in the geriatrics department. (Id. at 12:3).

Dr. Williams indicated that a geriatrics pharmacist needed to be available to “let the patient know of significant potential side effects and what to look for” and “see [a] patient before they left the clinic and make sure that the patient or the caregiver understood what we were doing.” (Id. at 13:19-24). If Dr. Babb was performing Disease State Management consultations with patients, “she wouldn’t be able to work in the essential role of a clinical pharmacist or consulting pharmacist in the geriatric clinic; and that is one of seeing the patients and going over what was usually a very complicated and long list of medications, and looking to see if there were any obvious possibilities of drug/drug

interactions, that the physician should have known about.” (Id. at 12:22-13:7). In September of 2012, Dr. Babb sought to participate in a multi-day training, but Dr. Howard specified that Dr. Babb could not attend because (1) Dr. Babb had patients scheduled at the time of the training and Dr. Babb’s attendance of the course would therefore impact patient care, (2) Dr. Babb would not benefit from the training because she already had knowledge of the information being presented, and (3) it was too late to register for the program. (Doc. # 52-3 at 59). In October of 2012, Dr. Howard and Dr. Babb discussed

Dr. Babb’s “mid-term evaluation,” where Dr. Babb received “fully successful” instead of “outstanding” in mentoring. (Babb Decl. Doc. # 68-2 at ¶¶ 14-15). Dr. Babb filed a grievance with respect to her score, and eventually the “fully successful” was “upgraded” to reflect “outstanding,” but Dr. Babb “felt belittled that she [was treated] this way.” (Id. at ¶¶ 15-16). C. Dr. Babb is not Selected for Anticoagulation At the time Dr. Babb realized that her Advanced Scope was in jeopardy, she started asking for training in anticoagulation, but that training was not provided. (Babb Dep. Doc. # 59 at 9:4-7, 116:1-3). The anticoagulation clinic

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