Tufts Medical Center v. Dalexis

Massachusetts Appeals Court·Decided September 21, 2023·No. AC 22-P-15·Published

Opinion

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22-P-15 Appeals Court

TUFTS MEDICAL CENTER vs. MARIE LUNIE DALEXIS1 & another.2

No. 22-P-15.

Suffolk. October 13, 2022. - September 21, 2023.

Present: Green, C.J., Henry, & Englander, JJ.

Massachusetts Commission Against Discrimination. Anti-

Discrimination Law, Employment, Handicap, Termination of employment. Employment, Discrimination, Constructive discharge. Handicapped Persons. Nurse.

Civil action commenced in the Superior Court Department on January 17, 2020.

The case was heard by Jeffrey A. Locke, J., on motions for judgment on the pleadings.

Gregory A. Brown for the plaintiff. Caitlin A. Sheehan for Massachusetts Commission Against Discrimination.

Howard Mark Fine for Marie Lunie Dalexis.

GREEN, C.J. Tufts Medical Center (Tufts) appeals from a judgment of the Superior Court affirming the decision and order of the Massachusetts Commission Against Discrimination (commission), which found that Tufts had discriminated against one of its nurses, Marie Lunie Dalexis, on the basis of her disability.3 See G. L. c. 151B, § 4 (16). The commission's finding (which followed a public hearing before a hearing officer) was based on adverse employment actions taken against Dalexis after her doctor informed Tufts that, due to her medical conditions, Dalexis could not work overtime. The commission concluded that, by refusing to excuse Dalexis from the obligation to work overtime when needed, Tufts had failed to offer Dalexis a reasonable accommodation for her disability. In addition, the commission concluded that Tufts had failed to engage in the dialogue required by G. L. c. 151B, and had constructively discharged Dalexis. For these statutory violations, the commission awarded Dalexis damages and attorney's fees. Our review of the administrative record reveals that the commission's decision was supported by

substantial evidence and free from error of law. See G. L. c. 30A, § 14 (7). Accordingly, under the deferential standard we apply to our review of such decisions, we affirm the judgment of the Superior Court affirming the commission's decision.

Background. We summarize the relevant facts found by the hearing officer and adopted by the commission.

In 2002, Dalexis was hired by Tufts, a major medical institution in Boston, as an inpatient registered nurse (registered nurse or inpatient nurse). During the relevant time period, Tufts operated twenty-two inpatient units and employed 694 registered nurses to work those units. Nurses in the inpatient units operated on three shifts: the day shift (7 A.M. to 3:30 P.M.), the evening shift (3 P.M. to 11:30 P.M.), and the night shift (7 P.M. or 11 P.M. to 7:30 A.M.). No nurse worked solely on the day shift. Instead, the majority of nurses worked a combination of day and evening (day-evening) shifts or, alternatively, day and night (day-night) shifts as "day/rotators."

At Tufts, Dalexis first worked in an oncology unit and then in an oncology medical-surgical unit. In 2005, she transferred to Proger 5 North (PG5N), a medical-surgical unit, where she worked as a "day/rotator" on the day-evening shift. On

occasion, Dalexis also worked as a charge nurse.4 Dalexis generally performed well; in the hearing officer's words, she "received an overall rating of 'excels' on her 2008 performance appraisal –- the last one submitted into evidence."

On any given day at Tufts, administrators had to ensure that all the various nursing posts were properly staffed, which included accounting for nurses out on vacation, out sick, or who became ill over the course of the day. Patient demand could change over the course of the day as well, sometimes substantially. At the relevant time, Tufts utilized a specific staffing system to fill the required nursing shifts when the need arose. Open shifts were filled first by the so-called "float pool" nurses, then by per diem nurses,5 then by staff nurses not scheduled on that day, then by staff nurses present on the floor who volunteered to stay through the next shift on an overtime basis, and finally by nurses present on the floor who were required to stay until a replacement was found. Nurses also could be required to stay past the end of their scheduled

shifts if, for instance, a nurse on the next shift called out sick or a patient became critically ill. A nurse scheduled to work on the evening shift in this scenario then would work some portion of the night shift on an overtime basis. A critical consideration for Tufts in making overtime decisions was the need to ensure that a sufficient number of nurses were on duty at all times to provide an appropriate level of patient care.

The collective bargaining agreement (CBA) between Tufts and Dalexis's union, the Massachusetts Nurses Association, provided Tufts "the right to require reasonable overtime work," and defined overtime work to include any work performed in excess of a forty-hour work week and any work in excess of five, full-time shifts in a week.6,7 The job description for the registered nurse position listed as one of the "physical demands/working conditions" that the employee is "[s]ubjected to irregular hours."

During the 2009 fiscal year when Dalexis sought to return to work with an accommodation, 94.67 percent of inpatient nurses worked at least some overtime. However, the amount of overtime worked by individual nurses varied greatly, with some nurses working hundreds of hours of overtime and others working minimal amounts -- as little as three hours. Of the nurses who worked some overtime, fifty-seven percent worked in excess of a forty- hour work week; the remainder worked overtime in excess of their scheduled shifts but not more than forty hours per week. And some nurses -- 5.33 percent -- worked no overtime at all. Nurses averaged a little less than one hour of overtime per week.8 As the hearing officer found, Dalexis "never had to force a nurse to work overtime when she served as charge nurse and she never had to work overtime against her will." Moreover, the commission relied on the hearing officer's finding that Dalexis assured Tufts that in the event of an emergency requiring overtime, she would never abandon a patient.9 Near the end of 2005, Dalexis began to experience health

issues. The following year, she was diagnosed with rheumatoid arthritis, which caused her to feel "really sick" and stiff, and to have low energy. Dalexis's rheumatoid arthritis also caused her to contract interstitial lung disease. As a result, Dalexis experienced difficulty breathing, pain and "crackles" in her lungs, and an inability to run or climb stairs. During this time, Dalexis continued to work the day-evening shift on PG5N, but took intermittent leave for her health issues.

In 2007, Dalexis submitted a note from her doctor explaining that Dalexis could not work past the normal hours of her shift due to her interstitial lung disease. As a temporary accommodation, Dalexis's nurse manager at the time excused her from working overtime.10 From October 2008 to May 2009, Dalexis continued to take intermittent leave as needed under the Family and Medical Leave Act (FMLA). In late May 2009, Dalexis took FMLA leave but her absence from work was prolonged after she underwent emergency surgery. In July 2009, Tufts determined that Dalexis had exhausted her FMLA leave and her protected medical leave under

the terms of the CBA.11 Dalexis was accordingly informed that her position on PG5N would be filled, and she would need to apply for open positions when she was ready to return.

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