Does a surgeon's abusive behavior give an employee the right to refuse to work with him? Not necessarily, according to a court ruling this week, especially if the facility did everything in its power to accommodate the emotionally battered employee's request to avoid the allegedly disruptive doc.

In his complaint, which is based on a series of incidents in late 2011, James Howell Jr., the director of perfusionists at McLeod Regional Medical Center in Florence, S.C., blames cardiothoracic surgeon Fred Holland, MD, for his emotional free fall, one that resulted in diagnoses of depression, post-traumatic stress disorder, stress and anxiety, among other problems.

The situation came to a head, according to court papers, after Mr. Howell complained to the hospital's vice-president about Dr. Holland's surgical practices. The surgeon responded, he says, with an "aggressive and abusive" phone call, and threateningly told Mr. Howell to "watch his back." During an internal investigation that followed, Dr. Holland later sent Mr. Howell a letter, apologizing for the threats.

Mr. Howell, however, refused to work with Dr. Holland anymore, and, as director of perfusionists, tried to schedule assignments such that the burden fell on other staff. But since Dr. Holland was performing 80% of the hospital's open-heart surgeries, that approach wasn't practical.

In early 2012, the hospital accepted Mr. Howell's workers' compensation request, acknowledging that he'd been emotionally injured and needed further treatment. Mr. Howell then formally requested an accommodation by way of the Americans with Disabilities Act that he not be required to work with Dr. Holland anymore. Once he was cleared to work again, the hospital tried to accommodate him in several ways, including extending his leave of absence until he felt comfortable, having another physician present in the OR and eventually giving him several months, while he was still on leave, to secure a transfer to another department.

When the deadline to find a new position or return to his old one finally came, with Mr. Howell unable to secure a transfer and still refusing to work with Dr. Holland, the hospital fired him.

This week, a District Court in South Carolina dismissed Mr. Howell's claims of federal employment discrimination and retaliation, ruling that Mr. Howell wasn't disabled under the ADA, that he wasn't a qualified individual with a disability and that he hadn't proved that the hospital failed to make reasonable accommodations that would have let him keep working.

But the hospital and surgeon aren't completely out of the woods yet. The court remanded the case to a Court of Common Pleas to decide state law claims against McLeod for wrongful discharge, and against Dr. Holland for assault, intentional infliction of emotional distress, intentional interference with economic relations and negligence.

The hospital declined to comment, saying in an e-mail that "McLeod must maintain the integrity of its relationship with its employees, present and former. This matter is under litigation and therefore it is inappropriate for us to comment." Dr. Holland did not respond to requests for comment.

Jim Burger