HA 635 Unit 6 discipline case file example

A Phone Under the Gown, Then a Photo in the Group Chat: A Discipline Case File for a Surgical Technologist, Built to Be Read by Someone Who Was Not There

Student Name

Health Care Administration, Herzing University

HA 635: Healthcare Human Resources Management

Instructor Name

February 19, 2026

A Phone Under the Gown, Then a Photo in the Group Chat: A Discipline Case File for a Surgical Technologist, Built to Be Read by Someone Who Was Not There

The Standard the Employee Was Held To

Employee: surgical technologist, Grade II, main operating room, employed four years. Standards, quoted from the documents the employee received and acknowledged:

Operating room policy on personal electronic devices, section 3, acknowledged at annual education in March 2025: "Personal phones and other personal electronic devices may not be carried into a restricted area of the operating room suite, including under surgical attire. Devices are kept in lockers or the designated charging station outside the restricted area."

Hospital privacy policy, section 7, acknowledged at hire and annually: "Workforce members may not photograph, record or share images of patients except as part of treatment, using hospital-approved devices and systems, and with required consent."

Code of conduct, signed annually: violations of privacy policy "may result in discipline up to and including termination."

The standards were communicated in writing, and the employee's signed acknowledgments are in the file. That matters, because discipline for an expectation that was never communicated fails at the first review.

Incident Record

Entry 1, September 18, 2025. Observed by: charge nurse. During room turnover, the employee was seen reading a personal phone inside the operating room while the next case's instruments were open on the back table. When asked, the employee said, "I was just checking the time for my kid's pickup." Action: verbal coaching the same day; policy reviewed; documented as coaching, not formal discipline.

Entry 2, November 6, 2025. Observed by: circulating nurse. Between cases, the employee's phone vibrated audibly from a scrub pocket under the surgical gown; the employee broke scrub to answer a text in the room. Employee's reply at the time: "It might have been the school." Action: first formal step, written warning, issued November 10 by the nurse manager with human resources present. Notice given: violation of device policy section 3, second occurrence after coaching. Improvement expected: no personal device in the restricted area; urgent family calls to be routed through the front desk, whose number was given to the employee's children's school. Review date: February 10, 2026. Consequence stated: further violation may lead to final written warning or termination.

Entry 3, January 14, 2026. Reported by: a surgical technologist colleague to the nurse manager, with a screenshot. During a spine case, the employee used a personal phone, carried into the room in a scrub pocket, to photograph the open surgical site, then posted the photo in a group chat of nine perioperative staff with the comment "look at this hardware." No face appeared in the photo, but the image showed the patient's back, a visible tattoo and the room's case display board with the date and room number. Employee's account at the investigatory meeting on January 15: the employee acknowledged taking and posting the photo, said it was "for teaching," and said the tattoo was not noticed. The employee was placed on paid administrative leave pending review. The employee deleted the photo from the phone in the presence of the privacy officer, and all nine chat members confirmed deletion in writing.

Privacy and Reporting Obligations

The photo is protected health information: an image of the patient's body taken during treatment, with a tattoo and a date that could identify the patient to someone who knew them. Its disclosure to nine staff through a personal phone and a consumer messaging application was not for treatment and used no approved system. The privacy officer opened a breach risk assessment under the federal Breach Notification Rule (45 C.F.R. § 164.402). Because the recipients were hospital workforce members bound by the same privacy policy, all confirmed deletion, and none had a treatment reason to see the image, the privacy officer's written assessment weighed whether a low probability of compromise could be shown; that decision, and any notice to the patient, belongs to the privacy office and is recorded in its file, not this one.

The Privacy Rule also requires the hospital to have and apply appropriate sanctions against workforce members who fail to comply with its privacy policies, and to document the sanctions applied (45 C.F.R. § 164.530). This file serves as that documentation. Surgical technologists in Texas are not licensed by a state board, so there is no licensing board report; the employment requirements for surgical technologists run through the facility rather than a license. The employee's national certification is not affected by this file, and the hospital has no obligation to report to the certifying body.

How Similar Conduct Was Handled

Consistency is the first test a challenge applies. Human resources reviewed perioperative discipline for the past three years. Device policy violations: five employees had first violations; all received coaching; one had a second violation and received a written warning, as this employee did. Patient images: one registered nurse in 2023 photographed a patient's wound on a personal phone and sent it to a friend outside the hospital; the nurse was terminated. No employee who shared a patient image on a personal device has been retained. The treatment of this employee's first two incidents matched the treatment of others, and the proposed decision on the third matches the only comparable case.

Mitigating and Aggravating Factors

Mitigating: four years of satisfactory performance evaluations; honesty at the investigatory meeting; the image was shared with staff rather than the public, and was deleted promptly; family pressures described in Entry 1. Aggravating: the conduct occurred during the warning period, after two documented reminders of the device policy; it involved taking a personal device into a sterile case; and the image was taken for no treatment purpose. Under a just culture approach, errors are handled through system fixes and coaching, but conscious disregard of a known rule is treated differently (Boysen, 2013). The employee knew the rule, had been warned twice, and chose to carry the phone into the room and use it.

Decision and Reasoning

Decision: termination of employment, effective February 20, 2026, approved by the director of perioperative services and the human resources business partner. Reasoning: the standards were written, acknowledged and repeated; each formal step gave notice, an expectation and a review date; the third incident occurred during the review period, went beyond the device policy to a privacy violation involving a patient under anesthesia, and matches the one comparable case, which ended in termination. A final written warning was considered and rejected because the conduct was a deliberate choice rather than an error, and because retaining the employee would be inconsistent with the 2023 decision. The employee may appeal through the hospital's grievance procedure within ten business days. The hospital will also remind all perioperative staff of the device policy and add lockable storage at each entrance to the restricted area, a system fix the review identified. The people and events are composite.

References

Administrative requirements, 45 C.F.R. § 164.530 (2025).

Boysen, P. G., II. (2013). Just culture: A foundation for balanced accountability and patient safety. The Ochsner Journal, 13(3), 400-406.

Definitions, 45 C.F.R. § 164.402 (2025).