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Kathleen, director of physical therapy at Wabash Community Health Center, smiled as she reflected on her meeting with Jerry, the chief medical officer (CMO) of the health center. Jerry had just made the decision to unfreeze a vacant position in Kathleen’s department, a position that had been vacant for more than a year. Since one of the physical therapists (PTs) retired one year ago, the remaining four PTs in the department had begun to feel burned out. Only one PT could take vacation or be off work at a time so that the health center would have enough PTs to staff its physical therapy clinic. Until now, the vacant position had been frozen by the CMO because of the health center’s recent financial troubles and declining volumes. Even if the position had been available, finding a PT to fill it would have been difficult because the health center was located in a rural county in Mississippi.
Kathleen was interested in finding a new hire, not only to fill a much-needed position in the department, but also to introduce some diversity into the team. The current PTs were all white women, the youngest aged 42 years. Kathleen was concerned that in the future she would struggle to keep the clinic staffed because the current PTs would continue to retire with a shortage of replacements to fill the void.
Kathleen was therefore very pleased when she received the application of Keith, an African-American man who had just graduated from the University of Alabama at Birmingham. She received the application one week after HR posted the position, and thus far Keith was the only applicant. Kathleen was unsure whether she should interview Keith immediately or wait for more applications to emerge. I should probably reel in the first catch I get, she thought. After all, a bird in the hand is worth two in the bush.
While looking over Keith’s application materials, Kathleen noticed that he did not have any physical therapy experience on his resume, but he had only graduated from the program a month ago. Kathleen wondered why Keith chose to move to Wabash County after living in a large city like Birmingham, where he might find higher-paying work, but she surmised that he might have been from the area originally and that he probably moved back to be around family.
Kathleen decided to bring Keith in for an interview. When Keith walked into her office on Monday morning, he seemed very polite and professional. He appeared to be in his midtwenties and to be in good health, capable of doing the necessary work of a PT. Before proceeding with the official interview questions, Kathleen wanted to make some brief conversation, during which she curiously inquired about what brought Keith to Wabash County. Expecting to hear something about family, she was surprised when she heard him explain, “My partner lives here, and I moved to Wabash to be close to them.” Kathleen did not notice a ring on Keith’s finger and was surprised that when Keith referred to his partner in the previous statement, he used the pronoun “them.” Kathleen thought nothing of it at the time, and she began asking the professional questions. Keith did very well when answering the questions concerning clinical physical therapy practices, and he even showed promise as a leader when answering questions about his methods of interpersonal conflict resolution and personal initiative. When the interview was complete, Kathleen thanked Keith for coming in. She sat at her desk for a moment, reviewing her notes from the interview. She was certain that Keith would be a great fit for the team and that Keith had terrific competency concerning the duties of the job. While Kathleen was reflecting on this, one of the PTs whom she supervised rushed into her office and closed the door behind her without saying a word. Kathleen’s head shot up from her paperwork and she stared, bewildered, at the very concerned face of Linda. The PT clinical supervisor, Linda managed the other three PTs on staff, creating work schedules and serving as support if needed. “That young man that was just in here, who just walked out, that’s one of the men who just moved into my neighborhood!” Linda exclaimed, taking a seat while slowly regaining composure. She cleared her throat and explained, “One of my neighbors, Becky, told me that two men just moved into our neighborhood, you know, together. They’re living an ‘alternative lifestyle.’” She demonstrated the quotes with her fingers in the air as she said the last two words. Kathleen was taken aback by this remark, almost in shock that her PT clinical supervisor, who was usually very professional and appreciative of diversity, was choosing to point out this fact to her. After coming back from two seconds of speechlessness, Kathleen asked, “Well, if in fact what you have just said is true, is that an issue for you?” “Yes,” Linda stated, almost with a pedagogical tone. “I can accept a lot of things about people. But I will not accept someone who lives that kind of lifestyle. It’s just not morally right.” Kathleen was once again taken aback, but she tried to calm Linda down and to perform damage control in the situation. “Linda,” she softly said, “I advise you to think about what you’re saying. We don’t know that this information is true about Keith. Even if it is true, this is not a factor that I would consider when assessing an applicant. I realize that his choices may violate your personal beliefs, but you and I both know that we need to work with people who have different beliefs from our own.” “You’re going to hire him, aren’t you? I can see it already. Why, the job has only been posted for one week and you’re just going to hire the first guy that comes in?” Linda held up her index finger as she ordered, “Do not hire him. I do not want him on my staff.” Kathleen leaned forward in her chair and answered, “Keith is an excellent applicant and he will be considered for this position. If you have a behavioral or experiential issue to point out about him I’m happy to hear about it, but I will not entertain the issue of sexual orientation among our criteria for hiring someone.” Linda became very angry and rose from her chair. “If you think I’m going to have a homosexual on my staff, you’re dead wrong.” She pointed at the door and continued, “If you hire him, I’m going to walk right out that door and you will have to find another supervisor.” With a huff, she marched out of the room. Kathleen sat at her desk, unsure of how to react to this situation. Was Linda simply blowing off steam, or was she making a real threat to leave if Keith was hired? Linda did have a tendency to get emotional, especially when changes occurred around the health center. Perhaps she would get over this in a day or two. Kathleen decided to leave the matter alone for now and to have a talk with Linda the next day. At 8:05 the next morning, Kathleen got a phone call from the personal assistant of Jerry, the CMO of the health center, asking for Kathleen to be present in the secondfloor conference room at 8:30 a.m. When Kathleen walked into the room, Linda and Jerry were already sitting at the conference table. Jerry motioned for Kathleen to take a seat, and began speaking. “I understand that you and Linda had a disagreement yesterday concerning an applicant that is under consideration for employment. I understand and appreciate diversity as much as you do, Kathleen, but Linda has raised some important concerns about this applicant. The residents of this county do not appreciate the lifestyle that this applicant is alleged to have, and the practice of physical therapy involves a great deal of touching and general interaction with patients. I am concerned that his sexual orientation will lead to problems in our delivery of care. You know how quickly news travels in this community, and patients will not want to receive services from a homosexual physical therapist. If he is hired here, I am concerned that patients will either mistreat him or that they will take their business elsewhere. The health center is already hurting due to lack of volume, and I am afraid that the decision to hire this applicant would ultimately result in a collapse of your department. I, therefore, ask that you do not hire him. If you’re concerned about staffing, keep in mind that the job has only posted for one week. If we have made it this long without a fifth PT, we can make it until the right applicant comes along. Do you understand?”
Discussion Questions
1. What would you do in Kathleen’s situation?
2. Identify the facts of the case. Try to distinguish the facts of the case from what has been alleged or perceived.
3. Is it feasible for Kathleen to not hire Keith without liability?
4. Do you think Linda has any hidden motives to prevent Keith from being hired?
5. How often do you think this type of discrimination occurs in healthcare?

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