“if I were you, I would watch what you say and who you say it to”

💡 This quote shows how NCG Regional Director Ross allegedly intimidated the clinical supervisor who raised concerns about patient care, creating a climate of fear for employees who speak up.

“[Tewell] failed to demonstrate competency – she failed to sign a letter for [the Client] that was requested by probation and forwarded to her by Substance Abuse Intensive Outpatient Program (SAIOP) staff referencing a need for a higher level of care for 7 business days, from 3/22/21–4/2/21 and edited information in the letter; the edited information included inaccuracies regarding lack of progress in the program, and a recommendation for a different service that was not recommended by the clinicians; [Tewell] based her edits upon review of the client record. She had never met [the Client].”

💡 The official North Carolina Department of Health and Human Services investigation confirmed that the supervisor who overruled the counselors violated state law by altering their clinical recommendation despite having no direct patient contact.

“Tewell modified the treatment recommendation for the Client from a ‘higher level of care’ to a ‘different level of care.'”

💡 This seemingly small edit prevented the client from qualifying for inpatient hospitalization, which the counselors believed was clinically necessary and potentially life-saving.

“to safeguard the public health, safety, and welfare, to protect the public from being harmed by unqualified persons, to assure the highest degree of professional care and conduct on the part of credentialed substance use disorder professionals”

💡 This is the stated purpose of the North Carolina Substance Use Disorder Professional Practice Act, the law the counselors were following when they were allegedly fired.

“there can be no right to terminate [an at-will employee] for an unlawful reason or purpose that contravenes public policy. A different interpretation would encourage and sanction lawlessness, which law by its very nature is designed to discourage and prevent.”

💡 The North Carolina Supreme Court established that even in an at-will employment state, firing someone for following the law is wrongful termination.

“At the very least public policy is violated when an employee is fired in contravention of express policy declarations contained in the North Carolina General Statutes.”

💡 This principle from North Carolina case law forms the basis for why the Fourth Circuit allowed the counselors’ lawsuit to proceed.

“if Deerman, as alleged, was terminated for meeting the minimum requirements of the practice of nursing as established and mandated by the NPA and regulations thereunder, then such termination violated the public policy of this state to ensure the public a minimum level of safe nursing care.”

💡 The Fourth Circuit applied this precedent from a nearly identical nursing case to find that the counselors plausibly alleged wrongful termination for complying with professional standards.

“Without a recommendation for a ‘higher level of care,’ the Client could not be moved to inpatient hospitalization, which the Counselors believed was clinically indicated.”

💡 This shows the direct link between the supervisor’s language change and the client’s inability to access potentially life-saving treatment.

“Three days after Shook sent the letter, the Client died of a drug overdose.”

💡 The client died just 72 hours after the modified letter was sent, underscoring the urgency of the counselors’ original recommendation.

“Shook was precluded from completing an incident report, however, because Tewell insisted upon completing the incident report herself. Tewell did so without any direct knowledge of the Client’s condition and without conferring with Shook or the other Counselors.”

💡 This shows how NCG management controlled official documentation to potentially minimize corporate liability, preventing the only employee with firsthand knowledge from filing the required report.

“The Counselors plausibly allege NCG terminated them in retaliation for complying with their professional obligations under SUDPPA and its attendant regulations.”

💡 The Fourth Circuit’s finding validates that this was not just a personnel dispute but a case where corporate interests allegedly overrode legally mandated patient care standards.

“employ their knowledge, skill and proficiencies within their scope of practice”

💡 This regulation required the counselors to use their professional judgment to recommend appropriate care, which is exactly what they did before being fired.

“The distinction between a ‘higher level of care’ and ‘different level of care’ is an obvious one—’different’ can also mean a lower level of care—but also, inpatient hospitalization would only be available under a higher of level of care in accordance with the standards established by the American Society of Addiction Medicine.”

💡 The court recognized this was not a semantic quibble but a clinically significant change that determined whether the client could access inpatient treatment.

“the Counselors attempted repeatedly for over a week to persuade Tewell to approve their recommendation of a ‘higher level of care’ for the Client. Tewell steadfastly refused”

💡 This shows the counselors made sustained efforts to secure proper care for their client, demonstrating their commitment to professional ethics before being terminated.

“We also reject NCG’s attempt to justify dismissal of the Counselors’ case by asking us to consider its proffered reasons for terminating the Counselors. This we cannot do. It is well-established that courts must not entertain factual disputes on a Rule 12(b)(6) motion to dismiss.”

💡 The appeals court refused to let NCG use alternative explanations for the terminations to dismiss the case at this early stage, requiring the claims to be heard on their merits.