Tops among your legal and ethical responsibilities to your staff is creating a workplace that is free of harassment and discrimination. But you may not be aware that your duty to protect your staff from such unlawful conduct extends beyond your own employees (see "Make Your OR a Bully-free Zone," May, page 34) to anyone who sets foot in your facility. Under Title VII, the principal federal anti-discrimination statute, you're responsible for protecting your employees from independent contractors - be they physicians, nurses, anesthesia providers and other staff - and even patients. Here's a case in point.

Dunn v. Washington County Hospital
Lisa Dunn was a nurse at Washington County Hospital, a small facility in Nashville, Ill. Thomas Coy, MD, the head of the hospital's obstetric and emergency services, "made life miserable for [Lisa] and other women on the staff," according to court records. Male staff members didn't experience similar problems. The hospital either didn't or couldn't control Dr. Coy despite Ms. Dunn's complaints.

Ms. Dunn finally sued both the hospital and Dr. Thomas under Title VII. A district judge granted the hospital summary judgment on grounds that Dr. Coy wasn't a hospital employee but an independent contractor who had staff privileges at the hospital. The Seventh Circuit Court of Appeals quickly reversed this ruling, saying that Title VII liability is direct rather than derivative.

The appeals court's point: The employer must provide its employees with nondiscriminatory working conditions. Since the hospital was obligated to address and remedy Dr. Coy's harassment of its female nurses as soon as it learned about it, the court ruled that Ms. Dunn's allegations that the hospital "did nothing to stop" Dr. Coy unquestionably gave her a viable Title VII claim.

Putting a stop to hostile acts
If you take only one thing from this article, make it this: You're responsible for preventing harassment, regardless of the source. It makes no difference whether the instigator is an employee, an independent contractor or, for that matter, a patient. The source of the misbehavior is irrelevant because your handling of the problem is what matters. So how can you provide a good, lawful workplace for employees while at the same time preserving relationships with and among physicians, nurses and other staff? Here are eight steps to follow.

• Write it up. Publish a policy that prohibits all forms of unlawful harassment (not just sexual harassment) and that includes a non-punitive complaint mechanism.
• Spread the word. Train managers and employees about the policy in mandatory in-services. Make the point that there may be legal consequences of harassment. Provide your policy to all staff.
• Print it out. Provide and explain your policy to physicians who work in your facility.
• Make it mandatory. When your board adopts a non-discrimination policy, you may also wish to include, as a condition of credentialing, a requirement that physicians comply with all your policies and procedures, including those covering harassment.
• Don't let anything go. Follow your policy. Show zero tolerance for inappropriate conduct and address complaints of inappropriate conduct directly when they arise.
• Be fair and adaptable. Because each compliant will involve a different set of allegations, personalities and practical realities, there is no blueprint for responding to complaints of harassment. But any good response will include a prompt, thorough investigation coupled with correction action to remedy the problem where appropriate.
• Be inclusive. Determine who'll conduct investigations: a peer review committee (for physicians), human resources or yourself (depending on the size of your facility, you may be the HR department). Even when HR conducts the investigation, it may be helpful to have a respected colleague, such as a medical director or the director of nursing, help deliver the message and address the issue.
• Don't be afraid. If there is no way to fix the workplace short of suspension or revocation of privileges, then you must certainly consider these more severe steps. Sometimes drastic measures are necessary to both end a problem and send the message that you won't tolerate harassment in your facility.

Serious business
Whether you employ or contract, it's up to you to ensure that a suitable work environment exists under your roof. Your goal is to ensure zero tolerance of harassment and discrimination acts and protect your facility against claims. Take your policy seriously, and it'll have a dual effect: You'll stop harassment before it starts, and you may be able to prove you're not liable for a hostile situation should it go to court.