J.M. Vasil, D.O. v. DMVA ( 2020 )


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  •            IN THE COMMONWEALTH COURT OF PENNSYLVANIA
    John M. Vasil, D.O.,                           :
    Laura O’Farrell, RN and                        :
    ADARA Healthcare Staffing, Inc.,               :
    Petitioners            :
    :
    v.                               :    No. 344 M.D. 2013
    :    Argued: February 10, 2020
    Department of Military and                     :
    Veterans Affairs,                              :
    Respondent            :
    BEFORE: HONORABLE RENÉE COHN JUBELIRER, Judge
    HONORABLE P. KEVIN BROBSON, Judge
    HONORABLE J. ANDREW CROMPTON, Judge
    OPINION BY JUDGE BROBSON                            FILED: April 24, 2020
    Petitioners John M. Vasil, D.O. (Dr. Vasil), Laura O’Farrell, RN (O’Farrell),
    and ADARA Healthcare Staffing, Inc. (ADARA)1 filed a second amended petition
    for review (Petition) in the Court’s original jurisdiction, asserting claims against
    Respondent Department of Military and Veterans Affairs (DMVA) under the
    Whistleblower Law2 and the Medical Care Availability and Reduction of Error Act
    1
    ADARA and O’Farrell both filed a “Praecipe to Settle, Discontinue and End with
    Prejudice” their involvement in this case on February 4, 2019. The Court, by order dated
    February 6, 2019, directed the Chief Clerk, now Prothonotary, to mark the matter as discontinued
    and ended as to the aforementioned petitioners.
    2
    Act of December 12, 1986, P.L. 1559, as amended, 43 P.S. §§ 1421-1428. “[T]he
    Whistleblower Law is . . . chiefly a remedial measure intended to ‘enhance openness in government
    and compel the government’s compliance with the law by protecting those who inform authorities
    of wrongdoing.’” O’Rourke v. Dep’t of Corr., 
    778 A.2d 1194
    , 1202 (Pa. 2001) (citations omitted).
    (MCARE Act).3 Following the Court’s discontinuance of the matter as to ADARA
    and O’Farrell, DMVA filed a motion for summary relief as to the sole remaining
    claim—i.e., Dr. Vasil’s claim in Count II of the Petition that DMVA retaliated
    against Dr. Vasil in violation of the Whistleblower Law and MCARE Act.
    Specifically, Dr. Vasil contends that DMVA retaliated against him for reporting
    serious events or incidents at the Hollidaysburg Veterans’ Home (HVH) pertaining
    to the quality of medical care received by patients at HVH when it terminated a
    contract with ADARA and when it interfered with his attempts to secure
    employment elsewhere. For the reasons that follow, we deny the application for
    summary relief concerning DMVA’s alleged retaliation against Dr. Vasil by
    terminating its contract with ADARA and grant the application for summary relief
    concerning DMVA’s alleged interference with Dr. Vasil’s prospective contract with
    Liberty Healthcare Corporation (Liberty).
    I.     BACKGROUND
    A. Hollidaysburg Veterans’ Home
    DMVA is an executive administrative department of the Commonwealth that
    oversees the operation of the HVH, located in Blair County, Pennsylvania. DMVA
    requested bids to provide certain on-site medical services at HVH. ADARA,
    through its president, O’Farrell, responded to the invitation to bid. DMVA selected
    ADARA to be the HVH medical provider.
    The terms of the contract between DMVA and ADARA (Contract) required
    ADARA to provide a physician as the Medical Director, a physician as the Assistant
    Medical Director, two certified registered nurse practitioners (CRNP), and
    The Whistleblower Law is “not primarily designed to punish an employer for harboring retaliatory
    motives.”
    Id. 3 Act
    of March 2, 2002, P.L. 154, as amended, 40 P.S. §§ 1303.101-.910.
    2
    laboratory and radiology services at HVH. The Contract’s scope of work specified
    that “[t]he physician will be providing communications/physician orders to
    Commonwealth staff, but will not supervise Commonwealth staff. The physician
    [M]edical [D]irector shall be under the general supervision of the Commandant with
    clinical performance monitored by the Chief of Clinical Services of [DMVA’s]
    Bureau of Veterans Homes.” (Petition, ¶ 11, Exhibit A-Bid and Contract, HVH
    Medical Services Scope of Work, ¶ 17.) The Contract, in part, required ADARA to
    provide, on an as-required basis, a Problem Identification Report, identifying
    problem areas and possible course of action and/or recommendations.
    ADARA hired Dr. Vasil to be the Medical Director. O’Farrell, in addition to
    being ADARA’s president, served as a nurse, assisting Dr. Vasil in his work at HVH.
    Deborah Nesbella, who was not a physician, served as the Commandant at HVH,
    and John Bart, D.O. (Dr. Bart) held the position of Chief of Clinical Services of
    DMVA’s Bureau of Veterans Homes.
    1. Quality of Medical Care Concerns at HVH
    After ADARA assumed its responsibilities under the Contract, O’Farrell
    reported concerns about the quality of medical care being provided to patients at
    HVH to Dr. Bart, who scheduled a meeting with Dr. Vasil and O’Farrell for
    August 21, 2012.4 Dr. Vasil and O’Farrell reported a concern to Dr. Bart that
    involved a patient in hospice care. Specifically, Dr. Vasil expressed his opinion that
    4
    Dr. Vasil and O’Farrell contend that, prior to reporting concerns to Dr. Bart, they reported
    various issues, including patients not having necessary and required tests performed, not getting
    required blood work completed, not being provided with appropriate medication, and not being
    given a choice of providers for hospice care, to Commandant Nesbella. DMVA disputes that
    Commandant Nesbella or the director of nursing at HVH, Rebecca Dale, were aware of any
    concerns during the time frame averred in the Petition.
    3
    the patient did not require hospice care and that DMVA was improperly referring
    psychiatric patients at HVH to hospice care.
    Thereafter, on September 3, 2012, O’Farrell sent via email a report to Dr. Bart,
    in which she expressed additional concerns about the quality of medical care
    at HVH. In the report, O’Farrell identified eighteen specific issues, including:
    (1) a patient in need of oxygen but not receiving it; (2) a patient with untreated high
    cholesterol and triglycerides; (3) a patient with untreated anemia; (4) a patient with
    untreated cellulitis on the leg; (5) a patient with an infection for which no antibiotics
    were prescribed; and (6) a patient with undiagnosed and untreated shingles.
    The following day, on September 4, 2012, O’Farrell again sent a report to Dr. Bart
    via email, this time identifying new quality of medical care issues found that day:
    (1) a patient with a urinary tract infection but not prescribed an antibiotic;
    (2) a patient with a history of heart problems but not prescribed Coumadin;
    (3) a patient with a wound but not prescribed antibiotics; and (4) a patient with high
    blood pressure but not treated properly.
    O’Farrell sent yet another report to Dr. Bart on September 5, 2012, describing
    the following issues identified that day:       (1) a patient with an untreated low
    potassium level; (2) a patient with an unreported gastrointestinal bleed; (3) a patient
    with unreported and untreated pink eye; and (4) a patient with a low white blood cell
    count for which there was no follow-up medical care. In that email, O’Farrell wrote
    that she was “getting extremely anxious of the care of these residents” and requested
    an “emergency plan of action” be put in place “immediately” due to concerns
    regarding the quality of medical care that ADARA observed at HVH.                  Soon
    thereafter, O’Farrell met with DMVA staff, including Dr. Bart, at DMVA’s
    headquarters to discuss these concerns.
    4
    2. DMVA’s and ADARA’s Actions Following Reports
    After the meeting at DMVA’s headquarters, DMVA sent a letter to ADARA
    on September 28, 2012 (cure letter), requesting ADARA provide a written and
    detailed Corrective Action Plan concerning deficiencies DMVA observed in
    ADARA’s performance under the terms of the Contract. It appears that DMVA
    asserted in the letter that Dr. Vasil was not providing all the functions outlined in the
    Contract’s statement of work, including attending morning meetings, quality
    assurance meetings, department head meetings, and behavioral health team sessions,
    and DMVA also expressed concerns regarding Dr. Vasil’s professionalism related
    to inappropriate language in front of the residents at HVH.
    ADARA responded to the cure letter via letter dated October 9, 2012. In its
    response, ADARA noted that HVH department meetings were not clearly defined
    and informed DMVA that a second physician would be attending the scheduled
    meetings. ADARA addressed the professionalism concerns with Dr. Vasil and
    explained to DMVA that, while ADARA does not condone the inappropriate
    language issues noted, Dr. Vasil was “extremely frustrated and under a lot of
    pressure with the overwhelming issues that have been part of HVH.”
    On October 29, 2012, DMVA sent to ADARA a second letter, seeking a revised
    Corrective Action Plan to cure the issues it felt were not adequately addressed in
    ADARA’s October 9, 2012 letter.          ADARA responded to DMVA’s letter on
    November 8, 2012.
    Sometime in November 2012, Dr. Bart, Commandant Nesbella, the
    Commandant’s supervisor (Dee McPherson), and O’Farrell attended an emergency
    meeting. At the meeting, O’Farrell again complained about the quality of medical
    care at HVH, and DMVA denied that there were ongoing quality of medical care
    5
    issues. O’Farrell, not satisfied with the outcome of the aforementioned meeting, sent
    an email to DMVA Deputy Adjutant General Michael Gould (Gould) concerning
    the “many issues” at HVH. Dr. Vasil and O’Farrell requested a face-to-face meeting
    with Adjutant General Gould. Although the email came from O’Farrell, both
    O’Farrell’s and Dr. Vasil’s names appear as part of the signature line of the email.
    On or about January 2, 2013, O’Farrell attempted to arrange with HVH a start
    date and orientation for a second CRNP hired by ADARA; specifically, ADARA
    sought to arrange a start date of January 9, 2013. As of January 10, 2013, DMVA
    had not been able to accommodate orientation and a start date.
    3. Influenza Outbreak
    On January 10, 2013, a HVH patient was diagnosed with influenza. While
    standard operating procedure required notification to the Medical Director of such a
    diagnosis, HVH did not inform Dr. Vasil that day. Once aware of the diagnosis the
    following day, Dr. Vasil expressed concern regarding the level of preventative
    measures being taken to avoid a widespread influenza outbreak. Dr. Vasil advocated
    for the administration of Tamiflu (a medication used to treat symptoms of influenza
    virus) to all residents at HVH, but DMVA did not have enough doses to treat
    proactively all residents and staff. Dr. Vasil also advocated for HVH to quarantine
    the building where the influenza patient was located, but HVH initially quarantined
    only the influenza patient. Eventually, other HVH residents in the building began
    to display influenza symptoms, and HVH quarantined the entire building. On
    January 13, 2013, O’Farrell sent an email to Dr. Bart and other high level DMVA
    staff, complaining about the failure of DMVA to inform Dr. Vasil of the positive
    influenza test and follow-up with him.          O’Farrell demanded a “full-scale
    investigation.”
    6
    4. Termination of Contract
    By letter dated January 14, 2013, DMVA informed ADARA that it was
    terminating the Contract for cause for the following reasons: (1) ADARA’s failure
    to provide two CRNPs as required by the Contract; (2) Dr. Vasil’s failure to provide
    all the duties of the Medical Director under the Contract; (3) Dr. Vasil’s bypassing
    of HVH’s policy and procedures on hospice referrals; and (4) ADARA’s schedule
    changes that resulted in unnecessary overtime hours for HVH staff. DMVA, by
    terminating the Contract, effectively removed Dr. Vasil as Medical Director at HVH,
    as he was an ADARA employee.
    B. Ebensburg Center
    The Department of Public Welfare (DPW)5 contracted with Liberty to provide
    medical services to the residents at the Ebensburg Center, located in Cambria
    County, Pennsylvania. Following termination of the Contract, Dr. Vasil sought
    employment as a physician at the Ebensburg Center. The Liberty Medical Director
    at the Ebensburg Center interviewed Dr. Vasil on July 9, 2013, and subsequently
    approved Dr. Vasil to work at the Ebensburg Center. Dr. Vasil signed a Subcontract
    Agreement with Liberty. Liberty, thereafter, sent Dr. Vasil a letter, which provided:
    “As you were made aware, in light of the fact that Ebensburg Center . . . has not
    provided its approval for the commencement of your services, Liberty . . . must
    revoke its offer to you for the provision of your services for Liberty at Ebensburg
    [Center].” (Petition, Exhibit R.)
    5
    In November 2014, the General Assembly renamed DPW as the Department of Human
    Services; however, during the relevant time period of this case it was still DPW, so we will refer
    to it as DPW herein. See Section 103 of the Human Services Code, Act of June 13, 1967, P.L. 31,
    as amended, added by the Act of September 24, 2014, P.L. 2458, 62 P.S. § 103 (effective
    November 24, 2014).
    7
    II.    ISSUES
    Dr. Vasil alleges that DMVA’s reasons for terminating the Contract were
    pretextual. Specifically, Dr. Vasil contends that DMVA terminated the Contract
    because ADARA, Dr. Vasil, and O’Farrell had repeatedly complained about
    substandard care being provided to patients; escalated their concerns over the heads
    of Commandant Nesbella and Dr. Bart when they contacted those individuals’
    superiors; and complained of the inadequate and improper response to the flu
    outbreak, which Dr. Vasil contends led to the death of patients. He maintains that
    his actions were protected by the MCARE Act. Dr. Vasil asserts that DMVA
    retaliated against him by terminating its Contract with ADARA and by improperly
    and illegally interfering in his contract with Ebensburg Center, resulting in the
    revocation of Ebensburg Center’s approval of his entering into a subcontract
    agreement with Liberty. He contends that he has been financially harmed by this
    retaliation.
    DMVA, in its motion for summary relief, argues that Dr. Vasil failed to allege
    facts essential to prove an element of his claim under the Whistleblower Law,
    because he failed to assert that DMVA retaliated against him regarding his
    compensation, term, conditions, location, or privileges of his employment with
    DMVA. DMVA notes that it was ADARA that retained Dr. Vasil to be the Medical
    Director of HVH, and, despite HVH’s termination of the Contract, DMVA entered
    into a provider agreement with Dr. Vasil to continue to treat patients at HVH. Quite
    simply, DMVA contends that Dr. Vasil has not alleged that his ability to continue to
    provide medical services at HVH was terminated because of his reports of
    wrongdoing, and, therefore, DMVA is entitled to summary relief.
    8
    DMVA further argues that if this Court considers the legal theory that the
    Whistleblower Law prevents DMVA from retaliating against Dr. Vasil by
    interfering with prospective employment, DMVA is still entitled to summary relief
    because there is no causal connection between Dr. Vasil’s alleged reports of
    wrongdoing and Dr. Vasil’s failure to secure employment with Liberty at Ebensburg
    Center. DMVA contends that: (1) Dr. Vasil never alleged that he was instructed
    not to file complaints concerning quality of medical care issues and that, in fact, the
    Contract required such concerns to be provided to DMVA in reports; (2) six months
    lapsed between Dr. Vasil’s last claimed report of wrongdoing and the revocation of
    his prospective contract with Liberty; (3) Dr. Vasil has failed to produce any facts
    to prove that DMVA interfered in any way with his prospective contract with
    Liberty; and (4) as asserted by Dr. Vasil, his prospective contract with Liberty was
    subject to a renovation clause by the DPW—not DMVA. DMVA contends that,
    without any causal connection between Dr. Vasil’s reports that he was obligated to
    provide DMVA and the alleged retaliation or evidence to prove that DMVA
    interfered with his prospective contract with Liberty, DMVA is entitled to summary
    relief on this alternative theory.
    III.   DISCUSSION
    A. Motion for Summary Relief
    “At any time after the filing of a petition for review in an appellate or original
    jurisdiction matter the court may on application enter judgment if the right of the
    applicant thereto is clear.” Pa. R.A.P. 1532(b); see also Summit Sch., Inc. v. Dep’t
    of Educ., 
    108 A.3d 192
    , 195 (Pa. Cmwlth. 2015). A court “must determine, based
    on the undisputed facts, whether ‘either party has a clear right to the relief
    requested.’”
    Id. (quoting Bell
    Atl.-Pa., Inc. v. Tpk. Comm’n, 
    703 A.2d 589
    , 590 (Pa.
    9
    Cmwlth. 1997), aff’d, 
    713 A.2d 96
    (Pa. 1998)). “The record, for purposes of [a]
    motion for summary relief is the same as a record for purposes of a motion for
    summary judgment.” Summit Sch., 
    Inc., 108 A.3d at 195-96
    .
    The Pennsylvania Supreme Court has cautioned that when “the parties’
    disparate takes on the record and the interpretations they draw from it suggest . . .
    there are disputed issues of material fact . . . when viewed in the light most favorable
    to appellant as the non-moving party, [the court] should have precluded summary
    [relief] in favor of [the] appellees.” Bailets v. Pa. Tpk. Comm’n, 
    123 A.3d 300
    ,
    307 (Pa. 2015). “In summary [relief] proceedings, . . . the court’s function [is not
    to] determine facts, but only to determine if a material issue of fact exists.” French
    v. United Parcel Serv., 
    547 A.2d 411
    , 415 (Pa. Super. 1988) (citation omitted).
    DMVA, as the moving party, has the burden of proving the non-existence of
    any genuine issue of fact. See Thompson Coal Co. v. Pike Coal Co., 
    412 A.2d 466
    ,
    468-69 (Pa. 1979). “A material fact is one that directly affects the outcome of the
    case.” Dep’t of Envtl. Prot. v. Delta Chems., Inc., 
    721 A.2d 411
    , 416 (Pa. Cmwlth.
    1998) (en banc) (Delta Chemicals). “The facts which directly affect the outcome of
    the case are gleaned from considering the substantive law underlying the cause of
    action.”
    Id. B. Whistleblower
    Law and MCARE Act
    The gist of Dr. Vasil’s claim is based on his contention that he, as a health
    care worker, is entitled to protection under the Whistleblower Law because DMVA
    retaliated against him for reporting, as required by Section 308(c) of the MCARE
    Act, 40 P.S. § 1303.308(c), serious events or incidents that occurred at HVH.
    “The Whistleblower Law provides protection for employees of a public employer
    who report a violation or suspected violation of state law.” 
    Bailets, 123 A.3d at 307
    .
    10
    An employee asserting a whistleblower claim “must show by a preponderance of the
    evidence that, prior to the alleged reprisal, [he] or a person acting on behalf of the
    employee had reported or was about to report in good faith, verbally or in writing,
    an instance of wrongdoing or waste to the employer or an appropriate authority.”6
    Section 4(b) of the Whistleblower Law, 43 P.S. § 1424(b).
    The Whistleblower Law, however, “is not designed to provide insurance
    against discharge or discipline for an employee who informs on every peccadillo of
    his fellow employees.” Evans v. Thomas Jefferson Univ., 
    81 A.3d 1062
    , 1070 (Pa.
    Cmwlth. 2013) (quoting Golaschevsky v. Dep’t of Envtl. Res., 
    683 A.2d 1299
    , 1304
    (Pa. Cmwlth. 1996), aff’d, 
    720 A.2d 757
    , 759 (Pa. 1998)). For purposes of a claim
    under the Whistleblower Law, a report of a “serious event or incident” under the
    MCARE Act constitutes a report subject to protection under the Whistleblower Law.
    See Section 308(c) of the MCARE Act. Section 308(c) of the MCARE Act provides
    that “[a] health care worker who reports the occurrence of a serious event or incident
    in accordance with subsection (a) or (b) shall not be subject to any retaliatory action
    for reporting the serious event or incident and shall have the protections and
    remedies set forth in . . . the Whistleblower Law.”7 Furthermore, Section 308(a) of
    6
    The Whistleblower Law defines a “good faith report” as “[a] report of conduct defined
    in this act as wrongdoing or waste which is made without malice or consideration of personal
    benefit and which the person making the report has reasonable cause to believe is true.” Section 2
    of the Whistleblower Law, 43 P.S. § 1422.
    7
    Section 302 of the MCARE Act, 40 P.S. § 1303.302, defines “health care worker” as
    “[a]n employee, independent contractor, licensee or other individual authorized to provide services
    in a medical facility.” It further defines “serious event” as “an event, occurrence, or situation
    involving the clinical care of a patient in a medical facility that results in death or compromises
    patient safety and results in an unanticipated injury requiring delivery of additional health care
    services . . . . The term does not include an incident.” 40 P.S. § 1303.302. As to the term
    “incident,” Section 302 of the MCARE Act defines it as:
    11
    the MCARE Act, 40 P.S. § 1303.308(a), mandates that a health care worker report
    the occurrence of a serious event or illness:
    A health care worker who reasonably believes that a
    serious event or incident has occurred shall report the
    serious event or incident according to the patient safety
    plan of the medical facility unless the health care worker
    knows that a report has already been made. The report
    shall be made immediately or as soon thereafter as
    reasonably practicable, but in no event later than 24 hours
    after the occurrence or discovery of a serious event or
    incident.
    The employee asserting a claim under the Whistleblower Law must
    demonstrate “by concrete facts or surrounding circumstances that the report . . . led
    to . . . [his] dismissal, such as that there was specific direction or information
    received not to file the report or that there would be adverse consequences because
    the report was filed.”         
    Evans, 81 A.3d at 1070
    (Pa. Cmwlth. 2013) (citing
    
    Golaschevsky, 720 A.2d at 759
    ). “Only where [the] plaintiff has satisfied the
    threshold showing of a causal connection” does the burden shift “to the defendant to
    show a separate and legitimate reason for its actions.”
    Id. (citing O’Rourke,
    778 A.2d at 1200). This is borne out in Section 4(c) of the Whistleblower Law,
    43 P.S. § 1424(c), which provides that “[i]t shall be a defense to an action under this
    section if the defendant proves by a preponderance of the evidence that the action
    by the employer occurred for separate and legitimate reasons, which are not merely
    pretextual.”
    An event, occurrence or situation involving the clinical care of a patient in a medical
    facility which could have injured the patient but did not either cause an
    unanticipated injury or require the delivery of additional health care services to the
    patient. The term does not include a serious event.
    A “medical facility” is defined as “[a]n ambulatory surgical facility, birth center, hospital or
    abortion facility.”
    Id. 12 1.
    Loss of Medical Director Position
    DMVA argues that Dr. Vasil has failed to assert that DMVA retaliated against
    him regarding his compensation, term, conditions, location, or privileges of his
    employment with DMVA. Instead, DMVA maintains that the action it took—i.e.,
    terminating the Contract—was directed at ADARA only and not at Dr. Vasil, who
    was merely an employee of ADARA. Dr. Vasil counters that DMVA’s action in
    terminating the Contract necessarily resulted in an adverse employment action
    against him, as he was stripped of his position as Medical Director. He argues that
    he is not required to allege or establish that DMVA completely eliminated his ability
    to perform medical services at HVH because of his reports of wrongdoing in order
    to prevail on his whistleblower claim. Instead, Dr. Vasil submits that he only needs
    to allege and ultimately establish that he suffered an “adverse employment action”
    because of the reports of wrongdoing. Dr. Vasil argues that his discharge as Medical
    Director because of his reports of wrongdoing was an adverse employment action.
    The Whistleblower Law does not define the terms “adverse employment
    action” or “adverse consequences.”          Section 2 of the Whistleblower Law,
    43 P.S. § 1422. Section 3 of the Whistleblower Law, 43 P.S. § 1423(a), provides
    that:
    No employer may discharge, threaten or otherwise
    discriminate or retaliate against an employee regarding the
    employee’s compensation, terms, conditions, location or
    privileges of employment because the employee or a
    person acting on behalf of the employee makes a good
    faith report or is about to report, verbally or in writing, to
    the employer or appropriate authority an instance of
    wrongdoing or waste by a public body or an instance of
    waste by any other employer defined in this act.
    “Generally speaking, the Whistleblower Law precludes a public body from taking
    any adverse employment action against an employee in retaliation for the
    13
    employee’s good faith report of wrongdoing or waste.”                       Scrip v. Seneca,
    
    191 A.3d 917
    , 925 (Pa. Cmwlth. 2018) (en banc) (emphasis added), appeal denied,
    
    201 A.3d 151
    (Pa. 2019). Cases by Pennsylvania courts have not discussed adverse
    employment actions under the Whistleblower Law in any great detail, so a review
    of federal cases on what constitutes an “adverse employment action” is helpful.8
    An adverse employment action is an action that a reasonable employee would
    have found to be materially adverse, “such that the action well might have dissuaded
    a reasonable worker from taking a protected action.” Greineder v. Masonic Homes
    of the R.W. Grand Lodge, (E.D. Pa., No. 13-2376, filed Apr. 23, 2014) 
    2014 WL 1632143
    , at *5 (reviewing Family and Medical Leave Act (FMLA), 29 U.S.C.
    §§ 2611-2654, Americans With Disabilities Act (ADA), 42 U.S.C. §§ 12101-12213,
    and Pennsylvania Human Relations Act, Act of October 27, 1955, P.L. 744, as
    amended, 43 P.S. §§ 951-963). An employee “must show only that a reasonable
    person would believe their working conditions had been altered to establish an
    adverse employment action.”              Valenti v. Maher Terminals LLC, (D.N.J.,
    No. 14-7897(JLL)(JAD), filed June 30, 2015) 
    2015 WL 3965645
    , at * 4 (reviewing
    FMLA). Adverse employment actions may include demotion and transfers to less
    desirable positions. Johnson v. Cmty. Coll. of Allegheny Cty., 
    566 F. Supp. 2d 405
    ,
    430 (W.D. Pa. 2008) (reviewing Title VII of Civil Rights Act of 1964, 42 U.S.C.
    §§ 2000e to 2000e-17).
    When Dr. Vasil served as HVH’s Medical Director pursuant to DMVA’s
    contract with ADARA, he received a salary for the services he provided as Medical
    Director. About two months after DMVA terminated the Contract, DMVA entered
    8
    Federal district court decisions “may offer guidance, but they are not binding precedent
    upon this Court.” Gould v. City of Aliquippa, 
    750 A.2d 934
    , 938 (Pa. Cmwlth. 2000).
    14
    into a provider agreement with Dr. Vasil. The provider agreement did not reinstate
    Dr. Vasil as Medical Director, and, while DMVA did not completely eliminate his
    ability to perform medical services at HVH, Dr. Vasil still lost his Medical Director
    salary. An employee’s loss of income is an adverse consequence that would
    dissuade a reasonable worker from reporting serious events or incidents under the
    MCARE Act. Thus, we disagree with DMVA that Dr. Vasil has not advanced any
    facts that could establish that DMVA retaliated against him with regard to his
    employment with DMVA. DMVA’s motion for summary relief, therefore, is denied
    to the extent that it is based on DMVA’s contention that Dr. Vasil cannot establish
    that DMVA took any adverse action against him with regard to his employment with
    DMVA.9
    2. Loss of Liberty Position at Ebensburg Center
    DMVA’s alternative argument is that Dr. Vasil cannot establish any facts in
    support of his contention that DMVA took steps to interfere with his prospective
    employment with Liberty in retaliation for his earlier reports regarding the quality
    of medical care at HVH. At oral argument in this case on February 10, 2020,
    Dr. Vasil’s counsel conceded that he could not prove that DMVA interfered with his
    prospective contract with Liberty at Ebensburg Center. For these reasons, we will
    grant DMVA’s motion for summary relief on this claim.
    9
    We are cognizant of DMVA’s argument that Dr. Vasil never alleged that he was instructed
    not to file complaints concerning quality of medical care issues and that, in fact, the Contract
    required such concerns to be provided to DMVA in reports. (Brief in Support of Respondent’s
    Motion for Summary Relief at 9). The fact that Dr. Vasil was required to provide quality of
    medical care reports to DMVA pursuant to the Contract does not eliminate the possibility that
    DMVA could have retaliated against him in violation of the MCARE Act for submitting the
    reports.
    15
    IV.    CONCLUSION
    Accordingly, we deny DMVA’s application for summary relief concerning
    DMVA’s alleged retaliation against Dr. Vasil by terminating its Contract with
    ADARA, and we grant DMVA’s application for summary relief concerning
    DMVA’s alleged interference with Dr. Vasil’s prospective contract with Liberty.
    P. KEVIN BROBSON, Judge
    16
    THE COMMONWEALTH COURT OF PENNSYLVANIA
    John M. Vasil, D.O.,                   :
    Laura O’Farrell,, RN and               :
    ADARA Healthcare Staffing, Inc.,       :
    Petitioners   :
    :
    v.                         :   No. 344 M.D. 2013
    :
    Department of Military and             :
    Veterans Affairs,                      :
    Respondent    :
    ORDER
    AND NOW, this 24th day of April, 2020, the Department of Military and
    Veterans Affairs’ (DMVA) motion for summary relief (Motion) as to the sole
    remaining count (Count II) of Petitioners’ second amended petition for review is
    DENIED, in part, and GRANTED, in part. The Motion is DENIED to the extent
    DMVA seeks summary relief on Petitioner John M. Vasil, D.O.’s (Dr. Vasil) claim
    that DMVA unlawfully retaliated against him by terminating its contract with
    ADARA Healthcare Staffing, Inc., and the Motion is GRANTED to the extent that
    DMVA seeks summary relief on Dr. Vasil’s claim that DMVA unlawfully retaliated
    against him by allegedly interfering with Dr. Vasil’s prospective contract with
    Liberty Healthcare Corporation.
    P. KEVIN BROBSON, Judge