Canadian Employment Law Today

6 | June 20, 2018 Canadian HR Reporter, a Thomson Reuters business 2018 Cases and Trends for more than 30 minutes — after that time, there is a risk of bacterial contamination. As a result, laboratory attendants were only supposed to retrieve the number of units they could label within 30 minutes. is was also specified in standard operating proce- dures. Laboratory attendants use software to test the suitability of the blood component and print labels. Following a visual inspec- tion, the units are labelled and returned to refrigerators. It typically takes laboratory at- tendants about 30 seconds to complete end labelling for a unit of blood. At the conclu- sion of an end labelling session, they must complete an end labelling record to confirm they have complied with the time-limit rule for each batch and fill out the timed intervals for sessions. e form includes a warning to check elapsed time during the labelling ses- sion to ensure it will be completed during the acceptable timeframe. On Aug. 22, 2015, a supervisor was re- viewing a software-generated report for a la- belling session from the previous day that the worker had performed and found the time the red blood cell units spent out of storage didn't match with the times recorded by the worker on the end labelling record. Accord- ing to the generated report, the labelling ses- sion lasted 36 minutes, which exceeded the acceptable limit for red blood cell units to be out of storage. A total of nine units were af- fected. Further investigation showed that the worker didn't follow standard operating procedure for units that had been out of refrigeration past the time limit, which was to place the units back in the refrigerator, notify a supervisor about it, and prepare a non-conformist report (NCR) that would confirm the units of blood were contained and segregated from outgoing blood prod- ucts. However, since the worker hadn't filled out an NCR and didn't record that the blood units exceeded the time limit, three of the units involved were distributed to hospitals. e supervisor quickly created an NCR and segregated the six other units involved. e three that had been distributed were re- trieved before they were used. Worker initially played dumb e assistant manager of quality assur- ance began an investigation and met with the worker and the production manager on Sept. 16, following the worker's return from a scheduled vacation — there was an attempt to schedule the meeting be- fore the worker's vacation, but the worker declined. He was particularly concerned about whether the false labelling was an iso- lated incident or had happened before. e worker was unable to explain the discrep- ancy between the software report and her end labelling record, but said another staff member may have taken blood products back to the refrigerator for her. is didn't make sense to the assistant manager since the electronic records indicated the time limit had still been exceeded, and a check with other attendants on duty revealed this wasn't the case. e worker also said she couldn't recall any other occasions where she hadn't fol- lowed proper end labelling procedures, but mentioned one instance two or three years earlier when she had falsely documented a batch of plasma units that had exceeded the time limit so the plasma wouldn't be dis- posed of. A second meeting was held two days lat- er, when the worker said she had removed nine red blood cell units from overloaded trays from the refrigerator and placed them on the middle shelf of her cart. She said she completed the end labelling in 30 minutes and put the trays back into the refrigerator, but realized she had forgotten to label the units in the middle shelf of the cart. She took them back to her workstation to label them, though acknowledged she knew this would put the units beyond the time limit. She also mentioned she was feeling stressed that evening, as she had "a lot of things going on," including her dog passing away earlier that week. CBS determined that the worker was dis- honest when she falsely represented that the nine units of blood were a safe product, which posed a safety risk to the blood prod- ucts and patients who might receive them. e worker then compounded her dishon- esty by trying to shift the blame to co-work- ers when she indicated she knew what had happened in the second meeting. CBS ter- minated the worker's employment effective Sept. 25, 2015. e union grieved the dismissal, arguing it was too severe under the circumstances for a long-term employee without previous discipline. It also pointed to another incident involving another laboratory attendant who had recorded blood units returned to the re- frigerator two minutes earlier than they ac- tually were after running into a problem with the label printer. e actual time out of stor- age in that instance was right on the 30-min- ute time limit, and that attendant received a one-day suspension for the discrepancy. High standards must be maintained e arbitrator noted that CBS had a pro- gressive discipline policy but that policy allowed for bypassing the steps in more se- rious cases. He also noted that the worker should be given credit for disclosing the earlier incident, but it wasn't a timely dis- closure. Given that she repeated the earlier misconduct, there was a "serious trust con- cern that she might fall into a similar pattern again if she finds herself in a situation where she is short of time," the arbitrator said. In addition, the arbitrator noted that the worker had admitted she clearly knew that she was outside the 30-minute time limit when she labelling the nine units in question, and her actions "were not just negligent but do amount in my view to an act of deception on her part to bypass the established end la- belling protocols," said the arbitrator. e arbitrator also found that as a team lead, the worker had higher standards of per- formance and leadership, including ensur- ing proper procedures are followed and doc- umenting non-conformance issues — which in this case, the worker didn't follow herself. e worker also knew there was an inves- tigation into her actions, but put off efforts to schedule a meeting until she was back from vacation — suggesting the worker "was more concerned about her vacation than any potential disciplinary investigation." e arbitrator found more reason for concern about trusting the worker's job given that the position involves "the ability to completely focus on the job at hand. e (standard operating procedure and good documentation practices) are strict guide- lines that must be precisely followed or risk potentially disastrous results of contamina- tion in the blood supply." e worker's ex- planation indicated she had difficulty with focusing on her task, skipped reporting her error, and was evasive about it in the face of CBS' investigation, which cast doubt on fu- ture trust in her, said the arbitrator. "e (worker's) 11 years of service and otherwise discipline-free record unfortu- nately do not tip the scales in favour of re- instatement when there is such grave doubt concerning her ability to be honest about her work going forward," the arbitrator said in dismissing the grievance and upholding the worker's termination. "is is an indus- try that simply cannot assume any risk of employing an individual who does not show they are committed and honest about fol- lowing the protocols required to maintain a safe blood supply." For more information see: • Canadian Blood Services and HSAA (Sera- fin), Re, 2018 CarswellAlta 895 (Alta. Arb.). Failure to report error risked public health « from DANGEROUS on page 1 Worker's explanation cast doubt on ability to 'completely focus on the task at hand.'

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