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Phares v. Gustafsson

decided: September 16, 1988.

JOYCE A. PHARES, PLAINTIFF-APPELLANT,
v.
BORJE GUSTAFSSON, ET AL., DEFENDANTS-APPELLEES



Appeal from the United States District Court for the Central District of Illinois, Danville Division, No. 83 C 2456--Harold A. Baker, Judge.

Wood, Jr. and Flaum, Circuit Judges, and Will, Senior District Judge.*fn*

Author: Wood

HARLINGTON WOOD, JR., Circuit Judge.

Plaintiff Joyce A. Phares claims that the defendants, administrators of the University of Illinois College of Veterinary Medicine and Personnel Services Office, violated her first and fourteenth amendment rights. Phares presented her claims at a jury trial; after Phares had finished presenting her case, the district court directed a verdict for the defendants. Phares appeals the directed verdict.

I. FACTUAL BACKGROUND

On November 5, 1967, Phares was hired as a Clerk Typist II in the medical records unit of the Small Animal Clinic of the University of Illinois College of Veterinary Medicine Teaching Hospital. Phares received two promotions while working at the Small Animal Clinic: on May 1, 1969, Phares was promoted to Clerk Typist III and, on November 14, 1976, Phares' position was reclassified from Clerk Typist III to Medical Records Technician. During the 1970's, a conflict developed between Phares and her supervisors. This conflict resulted in part from Phares' frustrated attempts to obtain a promotion to Medical Records Librarian. The main problem, however, was the difference of opinion between Phares and her supervisors regarding how the medical records unit should operate.

A. Operation of the Medical Records Unit

Shortly after she was hired, Phares was assigned the duty of setting up a medical records program at the Small Animal Clinic. After receiving training at Michigan State University, Phares designed case summary forms, as well as other forms, and established a filing and indexing system.

Clinicians used the case summary forms developed by Phares. Clinicians would complete a case summary form for each patient, indicating the diagnosis, prognosis, operation, and vaccination. The clinicians would then sign the form and submit it to Phares for abstracting.

Phares' duties basically entailed abstracting the information provided to her by the clinicians.*fn1 Phares reviewed the forms for accuracy and completion, ensuring that all of the laboratory reports and other materials were included in the medical record. Phares then abstracted the information from the case summary forms. This involved assigning code numbers to the diagnoses, prognoses, vaccinations, operations, and other pertinent information. Phares used standard reference texts and other coding lists to determine the proper code number to be assigned to each item. For each medical record, Phares entered the appropriate code numbers onto an abstract form. Phares then submitted the abstract form for entry into a computerized data retrieval system. Ultimately, the recorded data was sent to the Veterinary Medical Data Program at Cornell University, which gathers medical data from various institutions of veterinary medicine.

During the 1970's, an ongoing dispute developed between the veterinary clinicians and Phares concerning what information was required on the medical record to make it complete. Phares testified at trial that at times the diagnosis listed on a case summary form would appear to her to be incomplete. For example, lab reports might be added to the medical record after the clinician had completed the case summary form. If Phares believed that the lab report might change the diagnosis, she would send the medical record back to the clinician for review. Likewise, a clinician might list a diagnosis generally rather than specifically; for example, the diagnosis might be listed as "cystitis" as opposed to "cystitis due to staphylococcus aureus." Rather than listing the code number for the general diagnosis on the abstract form, Phares sometimes returned the medical record to the clinician to determine whether a more specific diagnosis was appropriate. Many clinicians were unhappy with Phares' practice of returning the medical records to them for review. Because the records were sent to clinicians for review and were not promptly returned, a serious backlog was created in the medical records unit. In addition, difficulties arose in locating specific medical records because they were not in the appropriate files.

B. Phares' Attempts to Obtain a Promotion

While a Clerk Typist III, Phares began her efforts to obtain a promotion to Medical Records Librarian. Phares took the civil service exam for the position of Medical Records Librarian I on June 20, 1974. On March 11, 1975, she requested the University of Illinois Personnel Services Office to reclassify her current position as Medical Records Librarian I. Dr. Erwin Small, head of the Teaching Hospital's Medical Records Committee, sent a letter to Phares on October 4, 1976, advising her that he would support her reclassification as Medical Records Technician, but not as Medical Records Librarian I. Phares subsequently was reclassified as a Medical Records Technician.

Phares repeatedly requested that her position be reclassified as Medical Records Librarian. In April 1981, responding to Phares' request, the Personnel Services Office audited Phares' position, concluding that the position should be reclassified as Medical Records Librarian I. In response to the audit, defendant H. William Tredway, hospital administrator for the Teaching Hospital, restructured Phares' job duties*fn2 so that she could maintain her position as Medical Records Technician.

In November 1981, Tredway announced that the Teaching Hospital had created the position of Medical Records Librarian I and invited Phares to submit her resume. Although Phares was interviewed by the Medical Records Committee, the Teaching Hospital eventually decided to forego filling the Medical Records Librarian I position.*fn3

On August 24, 1982, Tredway informed Phares that the Teaching Hospital had created a Medical Records Librarian II position. Phares applied to take the civil service exam for the position, but was refused because the new position required applicants to be certified records technicians, which Phares was not. The Teaching ...


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