Surgical towels are counted to ensure that none remain inside a patient during a surgical procedure. As a result of Scotten's report, an investigation was conducted, leading to changes in operating room procedures and the use of a new type of surgical towel that can been seen by x-ray.

Almost immediately after making the report in April 2014, Associate Director for Patient Care Services Norlynn Nelson reprimanded Scotten, reassigned her duties, cut off communication with her, shut her out of meetings and prevented her from participating in corrective actions following another operating error, said Jill Gerdrum, Scotten's attorney.

Scotten filed a grievance that Ginnity was late in responding to, and she left the VA in December to take a job with the Montana Department of Public Health and Human Services.

"She felt she had to resign because she had no other choice," Gerdrum said.

Scotten was underperforming in her job and had alienated the nurse managers under her by talking about them to other staff, Nelson testified. That upset an already tense situation among operating room staff members who had been in conflict with one another before Scotten's arrival, Nelson said.