Darrow v. Integris Health, Inc.

Decision Date15 January 2008
Docket NumberNo. 103,281.,103,281.
Citation2008 OK 1,176 P.3d 1204
PartiesChris Eugene DARROW, Plaintiff/Appellant, v. INTEGRIS HEALTH, INC., Defendant/Appellee.
CourtOklahoma Supreme Court

Jana B. Leonard, Shannon C. Smith, Leonard & Associates, P.L.L.C., Oklahoma City, OK, for Appellant.

Leonard Court, Courtney Warmington, Crowe & Dunlevy, P.C., Oklahoma City, OK, for Appellee.1

OPALA, J.

¶ 1 The question presented is whether the Court of Civil Appeals (COCA) erred when it affirmed the trial judge's decision that granted appellee's (Integris Health, Inc.) motion to dismiss the action for failure to state a claim upon which relief can be granted?2 We answer in the affirmative.

I. THE ANATOMY OF LITIGATION

¶ 2 Chris Eugene Darrow (Darrow) brought suit against his former employer Integris Health, Inc. (Integris),3 a home health-care agency, for wrongful termination based on the public-policy exception to the at-will employment rule. His petition states he worked for Integris for approximately eight (8) years before he was dismissed on or about 7 March 2005. According to Darrow, he originally worked as a home health aide, then did data entry and eventually progressed to the positions of administrative assistant and administrative coordinator. He described his duties as those of providing advanced secretarial and administrative support for various departments and auditing all billing activities associated with computer input for proper customer invoicing. This included billing for Medicare reimbursement. His job was to seek payment for services provided to patients covered by Medicare, Medicaid and insurance benefits. He had to verify the accuracy of patient information that was to be submitted to payor entities.

¶ 3 On or about 2 March 2005 Darrow received an e-mail from the clinical manager of Samaritan Home Based Care.4 It notified him of the death of an Integris patient and three (3) family members as a result of a home fire. Because Darrow was aware that some of the equipment used in home health care posed an increased risk of fire, he responded to the e-mail.

¶ 4 That very day Darrow received conflicting information concerning the patient's age. Because age discrepancies can delay billing, he attempted to verify the patient's correct age by checking the source documents in the chart. In doing so, he noticed that the signature authorizing Integris' services appeared to be that of a minor grandchild of the patient who also died in the fire. According to Darrow, media reports about the fire included information inconsistent with that contained in Integris' documents. In addition to the age discrepancy, the news reports indicated the lack of smoke detectors and the use of non-breakaway security bars on windows at the patient's residence. This differed from the admitting nurse's initial evaluation of the home which noted "no discrepancies" on the patient's initial intake form.5

¶ 5 Darrow notified the company's Quality Assurance Supervisor about these problems. She indicated she would talk with his supervisor when the latter returned to work later that week. Darrow's employment was terminated approximately five days later for an alleged HIPAA (Health Insurance Portability and Accountability Act of 1996) violation in the course of his review of the deceased patient's chart.6

¶ 6 Darrow filed an amended petition7 urging his dismissal was retaliatory, and asserted his right to relief in accordance with the public-policy exception to the at-will employment doctrine established in Burk v. Mart Corp.8 Integris filed a motion to dismiss Darrow's amended petition for failure to state a claim upon which relief can be granted.9 The trial court sustained this motion. COCA affirmed the trial judge's decision. It ruled the petition presented no set of facts which would entitle Darrow to relief because (1) he has not sufficiently identified an Oklahoma law that makes an alleged violation of the federal Medicare Act a breach of this state's public policy and (2) his reports implicating patient safety dealt with loyalty to his employer which involved merely the latter's private and proprietary interests that do not support a Burk claim.

II. Standard of Review

¶ 7 In reviewing a nisi prius disposition by dismissal, this court examines the issues de novo.10 Motions to dismiss are generally viewed with disfavor.11 The purpose of a motion to dismiss is to test the law that governs the claim in litigation, not the underlying facts.12 A motion to dismiss for failure to state a claim upon which relief may be granted will not be sustained unless it should appear without doubt that the plaintiff can prove no set of facts in support of the claim for relief.13 When considering a defendant's quest for dismissal, the court must take as true all of the challenged pleading's allegations together with all reasonable inferences that may be drawn from them.14 A plaintiff is required neither to identify a specific theory of recovery nor to set out the correct remedy or relief to which he may be entitled.15 If relief is possible under any set of facts which can be established and is consistent with the allegations, a motion to dismiss should be denied.16 A petition can generally be dismissed only for lack of any cognizable legal theory to support the claim or for insufficient facts under a cognizable legal theory.17 This recapitulation of the standards that govern when a case is decided on a motion to dismiss guides our review in this case.18

III.
A. The Parties' Certiorari Arguments

¶ 8 According to Darrow's certiorari petition, his internal reports to personnel about Integris' record discrepancies dealing with allegations of falsification of documents submitted to Medicare, possible Medicare fraud and concerns about patient safety are violations of public policy and hence are actionable in accordance with Burk19 and its progeny.20 Darrow bases his claims on (1) three federal statutes (the False Claims Act, 31 U.S.C. § 3730; the False Statements Act, 18 U.S.C. § 1001; as well as the criminal Medicare and Medicaid anti-fraud and abuse provision in 42 U.S.C. § 1320a-7)21; (2) several state statutes [including 21 O.S. § 1635 that deals with falsification of papers; the provisions of 21 O.S. § 455(A) that address prevention of witness testimony; and the terms of 63 O.S.2001 § 1960 et seq. (addressing health care issues)] and (3) judicial decisions (dealing with an implied obligation or duty to exercise ordinary care in the delivery of professional services). Integris continues to urge (l ) Darrow has failed to identify any breach of actionable Oklahoma public policy on which his claim may be bottomed, (2) claims he may have identified as based on breached public policy describe merely a private rather than a public matter, and (3) the public policy that is relied on must, touch the employment relationship.

B. Burk's Modification of the Common Law

¶ 9 Oklahoma adheres to the so-called American employment-at-will doctrine.22 Employers are free to discharge at-will employees in good or bad faith, with or without cause. At-will employees do not have a cognizable cause of action for wrongful discharge unless the claim falls within the narrow class of complaints in which the discharge may be characterized as contrary to a clear mandate of public policy and violates some law articulated in state constitutional, statutory or decisional sources.23 This exception was introduced into Oklahoma's legal system by. Burk's singular modification of the common-law employment-at-will doctrine. The exception's application should be tightly circumscribed.24 Circumstances in which this actionable "Burk tort" is said to arise are where an employee is discharged for (1) refusing to violate an established and well-defined public policy or (2) performing some act consistent with a clear and compelling public policy25 The implication of a sufficiently discernible public policy presents a question of law to be resolved either at nisi prius or ultimately by an appellate court.26

C. A Public-Policy Exception to the At-Will Employment Doctrine May Not Rest Solely on Federal Law

¶ 10 The public-policy exception to the at-will employment rule is not easily applied. This is so because (1) a wide variety of scenarios potentially comprise this common-law tort27 and (2) it is not always easy to identify what is a specific, well-established, clear and compelling public policy.28 We have stated an employer's violation of a state-declared public policy is the fundamental predicate for a Burk tort.29 The first step in a Burk analysis is to identify the offending employer's conduct in terms of its conformity to, or discord with, Oklahoma's public policy.

¶ 11 Darrow's claim is that he was wrongfully discharged for reporting possible Medicare fraud. He urges three federal statutes (the False Claims Act, 31 U.S.C. § 3730; the False Statements Act, 18 U.S.C. § 1001; as well as the Medicare and Medicaid anti-fraud and abuse provision in 42 U.S.C. § 1320a-7) make his dismissal wrongful for reporting Medicare fraud. Darrow relies on Tyler v Original Chili Bowl, Inc., 1997 OK CIV APP 3, 934 P.2d 1106, for support of his position that the breach of a federal statute may serve as a basis for a public-policy breach in tort.30 Tyler, a Court of Civil Appeals decis...

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