The Setup: A Healthcare Giant and One Worker’s Privacy

Bethany Scheer worked for Sisters of Charity of Leavenworth Health System (SCL) from 2014 to 2019, processing and appealing outstanding medical billing claims in SCL’s Physician Billing Department. Her job title changed over the years, but her core responsibilities stayed the same. She researched claims, contacted insurance companies, and handled special projects assigned by supervisors.

SCL’s own records show Scheer received seven corrective actions in four years, all tied to productivity targets. The company also flagged her for behavioral and professional conduct issues during that same period. By mid-2019, her supervisors were pushing to put her on a formal Performance Improvement Plan, and a draft was sent to HR on August 23, 2019.

Here is where the story takes a sharp turn. On August 22, 2019, the day before that draft was written, Scheer told a coworker, a supervisor, and her department manager that she was struggling with personal issues. All three reported concerns about her mental well-being and safety to SCL’s HR director. The HR director then revised the PIP to add a mandatory mental health counseling component.

The Corporation Spotted Vulnerability and Moved Fast

SCL’s HR director, Karen Oxenford, adjusted the Performance Improvement Plan to include what the court documents call an “action plan”: a mandatory referral to SCL’s Employee Assistance Program (EAP) for counseling, administered by a third-party provider called New Directions. When Scheer was presented with the revised PIP on August 28, 2019, supervisors told her that visiting with the EAP was a condition of her continued employment.

Scheer said she was not opposed to seeing a counselor. Her concern was specific and reasonable: she did not want her employer to have access to her medical records. Oxenford told her that no one at SCL would see her records through the New Directions program, and Scheer agreed to the PIP and signed it. Then, later the same day, Oxenford presented a second document: the New Directions EAP Formal Referral Form.

That form was not about treatment or support. That form would authorize New Directions to disclose to SCL whether Scheer attended sessions and whether she was complying with the program’s recommendations. Scheer consulted an attorney, refused to sign the authorization form, and SCL fired her.

The Non-Financial Ledger: What They Took From Her

Bethany Scheer went to her supervisors on August 22, 2019 and did something vulnerable: she told people she was struggling. She disclosed personal distress to a coworker, a supervisor, and a department manager. That act of honesty, the kind of honesty that mental health advocates spend years encouraging people in workplaces to feel safe enough to do, was immediately weaponized against her by the institution she trusted with it.

Within 24 hours, SCL’s HR director had received a written summary of Scheer’s disclosures, including a “summary of the talks of suicide,” and used that information to rewrite Scheer’s Performance Improvement Plan. The PIP she had been on track to receive was about productivity. The PIP she actually received added a behavioral compliance component built entirely around what she had disclosed in what she reasonably believed was a moment of personal candor. SCL converted her vulnerability into a leverage point.

Privacy Was the Line They Forced Her to Cross

Scheer did not refuse counseling outright. She told her supervisors she was open to seeing a counselor but did not want anyone to have access to her medical records. This is a legal right. This is a basic human expectation. SCL’s HR director reassured her that the third-party provider would not share her records with the company. Scheer, in good faith, agreed and signed the PIP.

Then SCL produced a second document, later the same day, that directly contradicted that assurance. The EAP Formal Referral Form would have authorized New Directions to tell SCL whether Scheer showed up and whether she was complying with recommendations. That is employer surveillance of mental health treatment, wrapped in HR paperwork. The reassurance had been real enough to get her signature; the form that followed made the reassurance irrelevant.

She Consulted a Lawyer and They Fired Her for It

Scheer did exactly what any person should do when a corporation presents them with a document that contradicts a verbal promise: she consulted an attorney. She did not ghost her employer. She did not abandon her job. She sought legal counsel, made an informed decision about her privacy rights, and declined to sign the authorization form. SCL terminated her employment for that refusal.

What SCL effectively communicated is this: if you disclose mental health struggles to your manager, we will require you to attend employer-monitored counseling, and if you refuse to let us monitor your attendance and compliance, you lose your job. That is a corporate policy that punishes disclosure and punishes resistance to surveillance simultaneously. The workers most likely to be harmed by this framework are the ones who need workplace mental health support the most.

Legal Receipts: What the Documents Actually Say

“Visiting with the EAP was a condition of [Scheer’s] continued employment.”

SCL Supervisors to Bethany Scheer, August 28, 2019 — App’x Vol. I at 66, as quoted in the Tenth Circuit Opinion

“Stowell emailed Oxenford with a ‘summary of the talks of suicide.'”

Tenth Circuit Opinion describing events of August 22, 2019 — App’x Vol. II at 265

The Form would authorize New Directions to disclose to SCL whether Scheer (1) attended counseling sessions and (2) complied with the EAP’s recommendations. Oxenford explained that the Form was a term of Scheer’s employment, and that if she did not sign it, her employment would be terminated.

Tenth Circuit Opinion describing events of August 28, 2019

Scheer sued under the Americans with Disabilities Act Amendments Act and the Rehabilitation Act, alleging SCL had fired her “based upon its erroneous perception that she suffers from a disability of mental illness.”

Tenth Circuit Opinion, summarizing Scheer’s complaint — App’x Vol. I at 6

An employer’s action “must have left [the plaintiff] worse off, but need not have left her significantly so.”

Muldrow v. City of St. Louis, 601 U.S. 346, 359 (2024) — the Supreme Court standard the appeals court applied to overturn SCL’s dismissal

Societal Impact: This Is Bigger Than One Worker

Public Health: When Disclosure Becomes a Trap

Mental health professionals, advocates, and public health researchers have spent decades trying to reduce the stigma around workplace mental health disclosure. The core message of that effort is that workers should feel safe telling their supervisors when they are struggling, because early support prevents crises. SCL’s conduct in this case is a direct attack on that public health goal.

What SCL demonstrated is a replicable institutional playbook: when a worker discloses mental health distress, classify it as a behavioral performance issue, attach employer-monitored counseling to their performance plan, and fire them if they object to the monitoring. Any worker who hears about this case, in any industry, now has a documented reason to stay silent about their mental health at work. The chilling effect on disclosure is real and lasting.

The Equal Employment Opportunity Commission’s decision to file an amicus brief in Scheer’s support signals that the federal agency charged with enforcing workplace discrimination law sees this case as a broader threat. The EEOC does not typically spend resources on cases with only individual stakes. Its involvement tells you this pattern is happening at scale.

Economic Inequality: The Law Protected the Powerful Until the Supreme Court Changed It

The lower court dismissed Scheer’s case on a legal standard that required workers to prove a “significant change” in their employment status to claim discrimination. Under that standard, SCL’s mandatory counseling referral did not count as an adverse employment action, which meant the company could not be held liable for the discrimination that flowed from it. The legal structure protected corporate conduct that harmed a worker with fewer resources than the corporation using those protections.

The appeals court acknowledged that the district court correctly followed the precedent available to it at the time. That precedent, built by years of appellate decisions, effectively required workers to absorb a significant injury before they could even access anti-discrimination law. The Supreme Court’s ruling in Muldrow v. City of St. Louis (2024) changed that standard to require only “some harm.” For workers without the ability to absorb years of litigation costs fighting uphill legal battles, that distinction is the difference between a case and no case at all.

Scheer’s case also illustrates a specific economic vulnerability: workers in administrative and billing roles at large healthcare corporations have almost no individual leverage. SCL issued seven corrective actions in four years against one employee. The performance improvement plan process in this case operated not as a rehabilitation tool but as a documentation mechanism, building a paper trail that legitimized termination while also grafting on a mental health surveillance component after a disclosure event. Workers in these positions cannot afford to refuse a PIP’s terms; the threat of job loss is immediate and severe.

The Cost of a Life Metric

What Now: What You Can Do With This Information

The Institutions Responsible

• Sisters of Charity of Leavenworth Health System, Inc. — the healthcare corporation that fired Scheer. The case is now remanded for further proceedings.
• SCL’s HR Director (Karen Oxenford) — the individual who revised the PIP and presented the surveillance authorization form as a condition of employment.
• SCL’s Department Manager (Danielle Stowell) — sent the email summarizing “talks of suicide” to HR, initiating the chain of events.

Regulatory Watchlist

• Equal Employment Opportunity Commission (EEOC) — already engaged; filed an amicus brief supporting Scheer. File a charge at eeoc.gov if your employer has required mental health monitoring as a condition of employment.
• Department of Labor (DOL) — EAP programs and their authorization structures exist in a regulatory gray zone. The DOL has authority over certain employee benefit program structures.
• State Civil Rights Agencies — Colorado has its own civil rights enforcement structure. Workers in other states should identify their state-level equivalent of the EEOC for faster action.

What Collective Action Looks Like Here

If you are a worker at a large healthcare system, or any large employer, and you have been required to sign an EAP authorization that allows your employer to monitor your attendance or compliance, document everything. Keep copies of every form you are asked to sign. Talk to coworkers and find out if this is standard practice at your company. Mutual aid networks and worker centers in your city can help you connect with employment attorneys who take contingency cases. National organizations like the National Employment Law Project and the Disability Rights Advocates track exactly this kind of corporate misconduct. This case is going back to court. The outcome will affect workers at every company that runs an EAP program, which is the majority of large American employers.