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Christman v. State, Department of Health and Social Services

Supreme Court of Delaware

July 25, 2014

JACQUELINE J. CHRISTMAN, M.D., Appellant Below-Appellant,
v.
STATE OF DELAWARE DEPARTMENT OF HEALTH AND SOCIAL SERVICES and MERIT EMPLOYEE RELATIONS BOARD, Appellees Below-Appellees

Submitted June 18, 2014

Case Closed August 4, 2014.

Editorial Note:

This decision has been designated as "Table of Decisions Without Published Opinions." in the Atlantic Reporter.

Court Below: Superior Court of the State of Delaware, in and for Kent County. C.A. No. K12A-10-003.

Before HOLLAND, BERGER, and RIDGELY, Justices.

OPINION

ORDER

Henry duPont Ridgely, Justice

On this 25th day of July 2014, it appears to the Court that:

(1) Appellant-Below/Appellant Jacqueline J. Christman, M.D. appeals from a judgment of the Superior Court affirming the decision of the Merit Employee Relations Board (the " MERB" ) in favor of Appellees-Below/Appellees State of Delaware Department of Health and Social Services (" DHSS" ) and the MERB. Christman raises two claims on appeal. First, Christman argues that the MERB erred when it found that the DHSS had granted her authority to enforce compliance with standing orders and that she had no reasonable belief that signing standing orders would jeopardize her medical license. Second, Christman contends that the MERB erred when it found that she was insubordinate in refusing to obtain a personal National Provider Identifier (" NPI" )[1] because she had no reasonable belief that the DHSS's use of her NPI would subject her to personal liability. We find no merit to Christman's claims. Accordingly, we affirm.

(2) In November 2011, Dr. Herman Ellis retired from his position of Medical Director at the Division of Public Health (" DPH" ) of the DHSS. Prior to his retirement, DPH had only one other Medical Director, Christman. Upon Ellis's retirement, Dr. Karyl Rattay, the Director of DPH, decided to combine the two Medical Director positions into a single position, which would be held by Christman. As part of the consolidation of the two positions, Rattay and Crystal Webb, the Deputy Director of DPH, provided Christman with a list of tasks with three discrete deadlines, the last of which fell on November 16, 2011. Rattay and Webb required Christman to sign a revised performance plan, obtain medical malpractice insurance, acquire an NPI, and sign standing orders.[2] She was also instructed to sign collaborative agreements with the Advanced Practice Nurses (" APNs" ).[3]

(3) Christman refused to sign the standing orders because she believed that she lacked sufficient authority to comply with state regulations that require physicians to supervise non-physicians who carry out standing orders. Christman also refused to obtain an NPI, citing concerns over the possibility of incurring personal liability. DPH sought to reassure Christman that she had the necessary amount of authority under the regulation when it requested legal advice from Deputy Attorney General (" DAG" ) Allison Reardon. DAG Reardon, as counsel for the Board of Medical Licensure and Discipline (the " Medical Board" ), informed Christman that DPH was exempted from the most stringent supervision requirements of the regulation and that she did not need " line" supervisory authority to comply with the Medical Board requirements.

(4) Despite these reassurances, Christman continued to believe that she did not have sufficient authority to carry out the DPH directives. In a series of emails, Christman was repeatedly warned that failure to meet deadlines would result in disciplinary action. This culminated in a final warning from Rattay on November 23rd, which advised Christman that her failure to complete the required tasks by November 28th would result in her termination. The November 28th deadline was later extended to November 30th to accommodate Christman's pre-scheduled leave. But Christman failed to complete any of the tasks before the final deadline. On November 30th, Rattay sent Christman a letter notifying her of Rattay's intent to terminate her for insubordination for failure to sign standing orders and collaborative agreements and obtain an NPI. Christman requested and received a pre-termination hearing. After the hearing, the Secretary of the DHSS terminated Christman on December 29, 2011. Christman grieved her termination before the MERB, which upheld the termination following a hearing.

(5) Christman appealed the MERB's decision to the Superior Court, arguing that the MERB erred by finding that Christman had sufficient supervisory authority as required by the regulation, had no reasonable belief that signing the standing orders without that authority violated the regulation or put her medical license at risk, and was insubordinate in refusing to obtain an NPI. Christman also claimed that the MERB erred when it failed to admit into ...


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