## Facts

- Pauline Kirk, a registered nurse, worked for Mercy Hospital Tri-County and became a full-time charge nurse with supervisory duties, reporting to the hospital’s Director of Nursing.
- Kirk assessed a patient, Debbie Crain, diagnosed toxic shock syndrome, and believed immediate antibiotic treatment was necessary to prevent death.
- According to Kirk, physician orders for antibiotics were not issued; she repeatedly reported her concerns to her supervisor and was told to “document, report the facts and stay out of it.”
- When permitted by protocol, Kirk raised the situation with the Chief of Medical Staff; the patient later died from massive internal infection.
- The hospital terminated Kirk shortly thereafter and stated in a service letter that the discharge was based on “untrue and detrimental” statements reflecting lack of support for administration and the medical staff.
- Kirk sued on multiple counts; the appeal concerned only her claim that the discharge violated Missouri public policy reflected in the Nursing Practice Act and related nursing regulations.

## Issues

1. Whether Missouri recognizes a wrongful-discharge claim by an at-will employee terminated in violation of a clear mandate of public policy.
2. Whether the Nursing Practice Act and nursing regulations can constitute a clear mandate of public policy sufficient to support a wrongful-discharge claim.
3. Whether summary judgment was proper where evidence could permit a finding that the hospital discharged Kirk for attempting to comply with statutory and regulatory patient-safety duties.

## Decision

- The Missouri Court of Appeals reversed the summary judgment on the wrongful-discharge count and remanded for further proceedings.
- The court held that Missouri recognizes a public-policy exception to at-will employment.
- The court held that the Nursing Practice Act and related regulations may supply the requisite clear mandate of public policy.
- Viewing the record in the light most favorable to Kirk, the court found triable fact issues on whether the discharge was motivated by Kirk’s efforts to fulfill her professional and legal duties to protect the patient.

## Legal Principles

- An at-will employee may have a tort claim for wrongful discharge when terminated in violation of a clear mandate of public policy.
- A clear mandate of public policy may be found in statutes and regulations adopted to protect the public, including professional licensing laws.
- Where statutes and regulations impose patient-protection duties on a licensed professional and expose the professional to discipline for noncompliance, an employer may not lawfully terminate the employee for attempting to carry out those duties.
- Summary judgment is improper when evidence permits competing inferences about the employer’s motive and whether the employee was discharged for compliance with legally imposed duties.

## Conclusion

The court reinstated the nurse’s wrongful-discharge claim, holding that Missouri’s public-policy exception can protect at-will employees who are terminated for acting consistently with patient-safety duties imposed by nursing licensing statutes and regulations, and that the record presented fact questions requiring trial.


Kirk v. Mercy Hosp. Tri-Cnty., 851 S.W.2d 617 (Mo. Ct. App. 1993)