Fired for protecting patients?

So, you think that a large group offers greater job security than solo practice? Think again. That security can be fragile if you're employed "at will," a contractual term meaning that you can be fired without cause at the employer's discretion, as long as the action isn't discriminatory.

In the case we describe here, a doctor fought an "at will" termination, claiming he was fired for refusing to refer patients to some of his group's specialists because of his concerns about their competence. In a decision reached last fall, Vermont's Supreme Court ruled that if patient safety was an issue, a doctor may indeed have grounds for overturning his termination.

FP Leigh LoPresti was hired in 1994 by Rutland Regional Physician Group, a large multispecialty practice in south-central Vermont, and assigned to a satellite office in Manchester. He was expected to refer patients to the group's specialists, and, at first, he did. But he gradually became concerned about the quality of care provided by a few of those doctors.

At some point, the group's president, Thomas Huebner, told LoPresti that he'd received complaints about his lack of referrals to certain of the group's specialists. In a later deposition, the group's medical director recalled hearing similar complaints about LoPresti's referrals at a medical practice committee meeting, including accusations that he was thereby jeopardizing his patients' health.

In July 1998, RRPG informed LoPresti that it was considering closing the Manchester office, where he practiced with one other primary care physician, because it wasn't producing sufficient revenue. LoPresti claimed that the office could attract more patients and produce more revenue if the group increased its advertising budget. He was given a chance to present his plan to the group's medical practice committee, but apparently didn't convince them.

After LoPresti had left that meeting, the group's medical practice committee voted to fire him, close the Manchester office, and move its other doctor to a different office. LoPresti protested, arguing that he had more seniority and experience than his colleague, saw more patients, served on more group committees, and had received higher patient satisfaction ratings. His colleague, however, had made regular referrals to the specialists whom LoPresti had avoided. As for the office's profitability, that's unclear: After firing LoPresti, the group decided to keep the office open after all.

A suit for wrongful discharge LoPresti sued RRPG in 2001, alleging breach of contract, bad faith, and "wrongful discharge in violation of public policy." In an amended complaint, he also claimed he'd been fired mainly because of his failure to refer patients to three of the group's specialists. That, he asserted, represented a violation of professional ethics and public policy regarding patient safety. When questioned in a deposition by the group's attorney, however, he admitted that the group had never asked him to do anything unethical or harmful to his patients.

RRPG argued that according to his contract as an "at will" employee, LoPresti could be fired 180 days "after written notice of termination, with or without cause," and that the group's reasons for firing him were, therefore, legally irrelevant. The trial judge agreed, and issued summary judgment for the group in February 2003.