Case Name: Shanti S. YERRA, M.D., Respondent, v. MERCY CLINIC SPRINGFIELD COMMUNITIES, f/k/a St. Johns Health System, Inc., Appellant
Court: Missouri Court of Appeals
Jurisdiction: Missouri
Decision Date: 2017-11-01
Citations: 536 S.W.3d 348
Docket Number: No. SD 34448 and SD 34545 Consolidated
Parties: Shanti S. YERRA, M.D., Respondent, v. MERCY CLINIC SPRINGFIELD COMMUNITIES, f/k/a St. Johns Health System, Inc., Appellant.
Judges: NANCY STEFFEN RAHMEYER, C.J./P.J.—DISSENTS IN SEPARATE OPINION
Reporter: South Western Reporter Third Series
Volume: 536
Pages: 348–356

Head Matter:
Shanti S. YERRA, M.D., Respondent, v. MERCY CLINIC SPRINGFIELD COMMUNITIES, f/k/a St. Johns Health System, Inc., Appellant.
No. SD 34448 and SD 34545 Consolidated
Missouri Court of Appeals, Southern District, Division Two.
FILED: November 01, 2017
Motion for Rehearing and/or Transfer to Supreme Court Denied November 22, 2017
Application for Transfer Denied January 23, 2018
Appellant’s attorneys: Frank M. Evans, III, Joshua B. Christensen & J. Taylor White, Springfield.
Respondent’s attorneys: Benjamin A. Stringer & Timothy A. Ricker, Springfield.

Opinion:
DANIEL E. SCOTT, J.
REVERSED AND REMANDED WITH DIRECTIONS
Dr. Shanti Yerra successfully sued Mercy Clinic for wrongful discharge on a whis-tleblower theory. Mercy appeals, urging in part that Dr. Yerra failed to make a sub-missible case. We agree, reverse the judgment, and remand with directions to enter judgment in Mercy's favor.
General Legal Principles
Generally, an at-will employee can be discharged for any reason or no reason. Fleshner v. Pepose Vision Inst., P.C., 304 S.W.3d 81, 92 (Mo. banc 2010). A "very narrowly drawn" public-policy exception, often called the wrongful-discharge doctrine (Margiotta v. Christian Hosp. NE NW, 315 S.W.3d 342, 346 (Mo. banc 2010)), applies to both at-will and contract employees. Keveney v. Missouri Military Acad., 304 S.W.3d 98, 103 (Mo. banc 2010).
In this context, a public-policy claim "must be based on a constitutional provision, a statute, a regulation based on a statute or a rule promulgated by a governmental body." Margiotta, 315 S.W.3d at 346. "Absent such explicit authority, the wrongful discharge claim fails as a matter of law." Id. "Moreover, not every statute or regulation gives rise to an at-will wrongful termination action." Id. "A vague or general statute, regulation, or rule cannot be successfully pled under the at-will wrongful termination theory, because it would force the court to decide on its own what public policy requires." Id.
That said, "a plaintiff need not rely on an employer's direct violation of a statute or regulation." Fleshner, 304 S.W.3d at 96. "Instead, the public policy must be reflected by a constitutional provision, statute, regulation promulgated pursuant to statute, or a rule created by a governmental body." Id. The pertinent inquiry is whether the cited authority "clearly prohibits the conduct at issue in the action." Margiotta, 315 S.W.3d at 347.
Subject to these parameters, Missouri's public-policy exception protects an employee who reports legal violations or wrongdoing to superiors or third parties ("whistleblowing") or refuses to perform an illegal act. Id. at 346, 347; Fleshner, 304 S.W.3d at 92. An employee terminated for either reason has a common-law tort action for wrongful discharge. Fleshner, 304 S.W.3d at 92.
To summarize, a whistleblower plaintiff must demonstrate that: (1) she reported serious misconduct that constituted a violation of the law and of well-established and clearly-mandated public policy; (2) her employer discharged her; and (3) her report causally contributed to the discharge. Van Kirk v. Burns & McDonnell Eng'g Co., Inc., 484 S.W.3d 840, 844-45 (Mo.App. W.D. 2016).
However, the public-policy exception affords no "protected status for making complaints about acts or omission he merely believes to be violations of the law or public policy." Margiotta, 315 S.W.3d at 348. To merely cite a statute, regulation, etc., without demonstrating how the reported conduct violated it cannot form the basis for a wrongful-discharge action. Id.
Thus it is essential that a reported act did violate public policy, not merely that the plaintiff so believed, even if her belief was reasonable. Newsome v. Kansas City, Missouri Sch. Dist., 520 S.W.3d 769, 779 (Mo. banc 2017). Whether a reported act violated public policy is a legal question for the trial court in determining whether the plaintiff has made a prima facie case. Id.
In other words, only after the circuit court decides an act constitutes a violation of public policy as "reflected by a constitutional provision, statute, regulation promulgated pursuant to statute, or a rule created by a governmental body," Fleshner, 304 S.W.3d at 96, may the circuit court then submit an instruction to the jury based on the act.
Id.
Case Background
Dr. Yerra worked for Mercy as an internal medicine physician. She treated a pa tient in her 60's who had been hospitalized several times over several weeks for heart issues and other conditions. The patient's condition stabilized and Dr. Yerra referred her to a surgeon, Dr. Cavagnol, for gall bladder removal.
Dr. Cavagnol accepted the referral, admitted the patient, and asked a cardiologist to confirm that the patient could tolerate anesthesia and surgery. Dr, Yerra learned of the planned cardiac consult and canceled it, deeming it unnecessary given her prior evaluation of the patient.
Dr. Cavagnol re-ordered the consult and a cardiologist cleared the patient for surgery. When Dr. Yerra learned of this, she called Mercy's Medical Staff Services, where her complaint was summarized and emailed to several administrators:
Dr. Yerra called me this afternoon around 2:30. I made no statements to her except to request the patient's medical record number. When Dr. Yerra was finished with her comments, I told her I would convey the message that follows:
Dr. Yerra admitted a patient (Medicare) for surgery by Dr, Cavagnol. Dr. Yerra's documentation did not indicate a need for a cardiology consult but Dr. Cavag-nol called for one anyway which was inappropriate and resulted in unnecessary cost. Dr. Yerra said there was no difference in what she documented and what Dr. Cochran documented. She said again, Dr. Cavagnol's action was inappropriate, resulted in unnecessary cost and was disrespectful to her—she will not tolerate it. She will report this to Medicare if it continues. "This type of care sucks!" "If we are an [Accountable Care Organization], these things should not happen."
Mercy's investigation concluded that the cardiology consult was appropriate, within the standard of care, and not an . unnecessary cost. But issues were discerned regarding Dr. Yerra, who had been put on several improvement plans previously. A new improvement plan was devised for her,, but .after further events, including an intensive care incident, Mercy terminated Dr. Yerra's employment.
Dr. Yerra sued, citing RSMo § 334.100 & 197.285 as public-policy sources for her claim that Mercy wrongfully discharged her for reporting the cardiology consult obtained by Dr. Cavagnol, At trial, the court agreed to give the whistleblower verdict-directing instruction requested by Dr. Yerra, but was skeptical:
The Court is concerned that the statutes cited by the Plaintiff do not support a clear public policy prohibiting or supporting the conduct of the Plaintiff. The Court's concern that the statute [sic] cited, both of which I've had an opportunity to read this morning, are nonspecific, and therefore do not state a clear public policy that is not vague and is not general and is a rule or regulation or constitutional requirement supporting the Plaintiffs conduct.
The jury returned a verdict for Dr. Yer-ra, leading to this appeal., We must decide whether Dr, Yerra's cited statutes reflect a clear public-policy mandate that applied to the facts in this case. Kirk v. Mercy Hosp. Tri-County, 851 S.W.2d 617, 621 (Mo.App. S.D. 1993).
Analysis
Dr, Yerra's first-cited statute requires designated healthcare facilities to offer protection for employees who re- port certain matters; Dr. Yerra claims her complaint could have fit. three such categories: facility mismanagement, fraudulent activity, or violations of applicable laws related to patient care. See § 197.285.1-.2, She cites the other statute for a .physician's duty not to "willfully and continually" perform "inappropriate or unnecessary treatment, diagnostic tests or medical or surgical services." See § 334.100.2(4)(c).
The record does not demonstrate that Dr. Cavagnol's request for a pre-surgery cardiac consult violated any such provision - or was serious misconduct contrary to well-established, clearly-mandated public policy reflected by the cited statutes. See Newsome, 520 S.W.3d at 779; Fleshner, 304 S.W.3d at 96; Van Kirk, 484 S.W.3d at 844-45. Thus, Dr. Yerra was not entitled to a whistleblower instruction for reporting what Dr. Cavagnol did.. See Newsome, 520 S.W.3d at 779, which also debunks Dr. Yerra's theory that "reasonable belief' was enough for common-law whistleblower liability. "Whether a plaintiff. reasonably believes an act violates public policy is irrelevant to a wrongful discharge claim." Id. (citing Margiotta, 315 S.W.3d at 348).
We find further support for reversal in Dr. Yerra's own cited statute, which authorizes state action against a physician who seeks, by intimidation or coercion, to •directly or indirectly "discourage the use of a second- opinion or consultation." § 334.100.2(4)(b), Since § 334.100 express ly protects second opinions and consults, it cannot reflect a clear public policy against those practices, and there is no basis to disharmoniously construe § 197.285.
In short, Dr. Yerra failed to show that public policy forbade Dr. Cavagnol to have a cardiologist confirm this heart-troubled patient's cardiac fitness for surgery. If anything, Missouri law and public policy purported to protect Dr. Cavagnol in seeking the "second opinion or consultation" that Dr. Yerra tried to cancel and of which she later complained. § 334.100.2(4)(b).
Dr. Yerra did not make a submissible whistleblower case. We need not reach Mercy's other points. We reverse the judgment and remand the case to the trial court with directions to enter judgment in Mercy's favor.
NANCY STEFFEN RAHMEYER, C.J./P.J.—DISSENTS IN SEPARATE OPINION
JEFFREY W. BATES, J.—CONCURS
. Mercy actually filed two appeals which we consolidated for all purposes.
. Keveney, Margiotta, and Fleshner were companion opinions handed down the same day.
. Effective August 2017, a new "Whistleblower's Protection Act," RSMo § 285.575, purports by its terms "to codify the existing common law exceptions to the at-will employment doctrine and to limit their future expansion by the courts," and "in addition to chapter 213 and chapter 287, [to] provide the exclusive remedy for any and all claims of unlawful employment practices."
. Or in a preventative-whistleblowing claim (see Newsome, 520 S.W.3d at 778), that the reported act actually would have violated public policy, not just that the plaintiff thought it would. Id. at 779. Note 9 infra suggests a reason—the reprehensibility of an employee's report of wrongdoing playing any role in her discharge justifies 100% employer liability for as little as 1% causation, but if the reported act was not illegal or against public policy (the plaintiff just thought so), it would be 100% liability for 0% causation or reprehensible employer behavior. Statutory civil actions for non-retaliation, of course, may have different requirements. See, e.g., RSMo § 213.070.1(2) & § 213.111 (human rights), § 287.780 (worker's compensation).
.Limited to the submissibility issue, which the parties agree that w& review de novo.
. Given our disposition, we .need not reach Mercy's claim that it was not subject to this statute.
. In closing argument, Dr. Yerra's counsel denied that Dr. Yerra's complaint had accused anyone of fraud or Medicare fraud, which may explain the record's dearth of relevant proof:
To commit health-care fraud, one must "knowingly and willfully execute[], or attempt ] to execute, a scheme or artifice to defraud any health care benefit, program" or fraudulently obtain "any of the money or property owned by, or under the custody or control of, any health care benefit program in connection with the delivery of or payment for health care benefits, items, or services," 18 U.S.C. § 1347. A conviction under this statute requires that the government prove beyond a reasonable doubt that the defendant (1) knowingly devised a scheme or artifice to defraud a health care benefit program in connection with the delivery of or payment for health care benefits, items or services; (2) executed or attempted to execute this scheme or artifice to defraud; and (3) acted with intent to defraud.
U.S. v. Persaud, 866 F.3d 371, 380 (6th Cir. 2017) (citations and some quotation marks omitted).
. Or would have violated any such provision if repeated in the future, should Dr. Yerra's complaint be cast in terms of preventative whistleblowing per Newsome, 520 S.W.3d at 778.
.Alongside Newsome's reasoning, consider also Fleshner's explanation for requiring only contributing-factor causation in wrongful-discharge cases; i.e., if illegality played a role in the firing, "[t]he employer's action is -no less reprehensible because that factor was not the only reason," so if an employee's report of legal violations or refusal to violate law or public policy contributed to her discharge, "the discharge is still reprehensible regardless of any other reasons of the employer." 30S.W.3d at 94-95 (our emphasis). This concern with employer behavior so., "reprehensible" that slight causation justifies full recovery (1) assumes there actually was reprehensible behavior, not merely an unproved claim, allegation, or. belief; and (2) tracks our high court's insistence, in common-law wrongful-discharge claims, that:
• It is not enough to cite a law without demonstrating how reported conduct violated it, Margiotta, 315 S.W.3d at 348.
• A plaintiff's belief that an act violated public policy is irrelevant, even if such . belief is reasonable, Newsome, 520 S.W.3d at 779.
• The trial court must determine that an act constituted a public-policy violation before it can submit-a jury instruction based on the act. Id.