Missing narcotics. A dazed nurse. Co-workers whispering. A trip to the ER. It sounds like the plot of a medical drama, but it was the real backdrop for a recent Seventh Circuit employment case. The outcome offers lessons for every employer, not just hospitals.

TL;DR: A nurse fired after opioids went missing from her hospital unit sued under Title VII, the ADA, the FMLA, and Illinois state law. The Seventh Circuit affirmed summary judgment for the employer, holding that the hospital had ample evidence of impairment, acted reasonably in its investigation, and did not violate any of these laws. The case highlights the importance of consistent drug and alcohol policies, clear documentation, and timely investigations.
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The situation every employer dreads

On October 12, 2018, opioids went missing from a hospital’s medication-dispensing system. Several co-workers reported that a nurse looked “out of sorts,” with heavy eyes, slurred speech, and delayed responses.

Supervisors sent her for a fitness-for-duty exam. An ER nurse documented intoxication-like signs, and the attending physician later testified that she “did seem to me, at least, to be possibly under the influence of drugs,” yet she was discharged as appearing well enough to drive. Later that evening, a drug test came back positive for opiates.

Security and Pyxis logs showed the nurse swiping into the equipment room around the times both morphine and fentanyl went missing. A known clock offset explained why her access appeared seconds after the withdrawals.

A hospital committee investigated further, interviewing staff, reviewing records, and meeting with the nurse. She explained she had taken prescribed Norco for shingles the night before her shift, which the hospital’s medical review officer later treated as explaining the positive test result. Co-workers still reported impairment and unsafe behavior, and the committee concluded she had been unfit for duty and likely diverted drugs. She was terminated.

While suspended, the day before her termination, she applied for FMLA leave. Her doctor’s certification used phrases like “To Be Determined” and “We Don’t Know.” HR initially placed a preliminary FMLA flag, then closed the request after the termination.

She sued under Title VII (color, national origin, and retaliation), the ADA (disability discrimination and retaliation), the FMLA (interference and retaliation), and the Illinois Human Rights Act. The district court ruled for the employer, and the Seventh Circuit affirmed.

Why the claims failed

The employee’s Title VII case stumbled out of the gate. She pointed to other ICU nurses as comparators, but the Seventh Circuit explained that none of them had been reported as impaired. Several co-workers specifically described her as drowsy, slurring her speech, and struggling to stay alert. That distinction alone meant she could not show that she was treated less favorably than similarly situated co-workers.

She also argued that the hospital deviated from its own policies by allowing her to finish charting and drive herself home instead of arranging a ride. The court acknowledged those missteps, but treated them as minor and not evidence that bias motivated the decision to terminate. Even allegations that some colleagues had made anti-Hispanic remarks did not carry the day, because the hospital relied on multiple other witnesses, medical assessments, and access logs. That independent investigation broke the chain of any alleged co-worker bias.

Her Title VII retaliation claim failed as well. She argued that appealing her termination was protected activity and that the hospital retaliated against her. The court found no evidence that her grievance caused any adverse action. The hospital followed its normal grievance process, and nothing suggested it handled her appeal differently because she raised discrimination. Filing the mandatory nursing report also was not objectively unreasonable or retaliatory.

Her ADA claim failed because she did not establish that her conditions — shingles, anxiety, and depression — substantially limited a major life activity, nor did she show she had a record of impairment or that the hospital regarded her as disabled. (Courts often recognize that conditions such as anxiety and depression can qualify as ADA disabilities, but here she did not supply the evidence needed.) Without proving she was legally “disabled,” her ADA theories could not go forward.

Her FMLA case also collapsed. The paperwork she submitted was too vague; the doctor’s certification used “To Be Determined” and “We Don’t Know,” which did not provide enough notice to trigger FMLA protection. And while she submitted her request the day before her termination, the court explained that timing by itself was not enough to prove retaliation. She had already been suspended and was under investigation for missing opioids and patient safety issues. HR closed the FMLA request only after her termination, which undercut her theory that the request caused it.

Finally, her Illinois Human Rights Act claims fell alongside her federal ones.

Takeaways for employers

• Move quickly when safety is at stake. Courts will look at whether you investigated immediately and reasonably.
• Documentation is your shield. Witness statements, system logs, and fitness-for-duty notes gave the hospital a strong defense.
• Policy missteps are risky, but not fatal. Letting an impaired employee finish charting or drive home was sloppy, and the court flagged it, but the overall record still carried the day.
• Scrutinize medical certifications. “To Be Determined” is not enough to create FMLA protection. Train HR to check that forms are specific.
• Separate bias from process. Independent corroboration from multiple witnesses and system records can undercut arguments that a co-worker’s discriminatory comments tainted the investigation.

Bottom line

This may sound like the script of a hospital TV show, but it is the kind of scenario any employer can face. When safety concerns and suspected impairment collide with discrimination or leave requests, the lesson is clear: act quickly, investigate thoroughly, apply policies consistently, and document every step. That is the defense that holds up in court.