A judge asked for more detail yesterday before ruling whether Swedish Medical Center can silence a former employee who believes the hospital's program for detecting medical mistakes is seriously flawed.

King County Superior Court Judge Linda Lau said she wants a "very, very clear" statement from the former employee, Riccardo Spurgeon, spelling out what he believes he is able to say without violating a confidentiality agreement. He signed the agreement before accepting a job as a performance-improvement coordinator at the Seattle medical center.

Spurgeon, 53, was fired July 29, three weeks after he took a job evaluating surgical work at Swedish.

Spurgeon was fired for "repeated angry outbursts, cursing and perceived threatening behavior," Swedish attorney Elizabeth Leddy said after yesterday's court hearing.

Leddy said Spurgeon didn't express his concerns until after his firing.

Spurgeon, a registered nurse, contends in court documents that he was dismissed after he began reviewing cases and raised questions about the medical center's commitment to improving care. He maintains he cursed once when he dropped a printer-toner cartridge, and that he discussed a troubling incident with a Swedish official.

When Spurgeon threatened to go to the media, lawyers for Swedish obtained a temporary court order Aug. 1 prohibiting him from publicly discussing his observations. They then asked for a preliminary injunction until the court can consider a permanent injunction.

Since then, Swedish has agreed that Spurgeon may go to government regulators with "good-faith" concerns, but that the confidentiality agreement prohibits him from publicly discussing his work.

Spurgeon has agreed not to disclose the names of patients and doctors or other identifying information, but has asked the court for permission to speak in general terms about his belief that the medical center's quality-improvement program is "fatally flawed."

In asking for the preliminary injunction, Swedish attorney Noelle Jackson told the judge yesterday that confidentiality is considered vital to quality-improvement programs.

State legislators addressed that in the law when they required hospitals to establish programs to identify and prevent medical mistakes, she said.

Hospital staff involved in peer review must be able to have "open and candid discussions," Jackson said, arguing that any information generated in the process must be kept confidential.

Spurgeon's attorney, Becky Roe, said Swedish's position was overly broad and an unconstitutional infringement on her client's free-speech rights.

"It's become abundantly clear Swedish is trying to protect its own reputation," Roe said.

Roe was prohibited yesterday from airing Spurgeon's specific concerns because of the court order issued last month.

But during the hearing she laid out hypothetical concerns her client might raise: a lack of credibility in the Swedish quality-improvement program; unqualified employees in the program; resistance by staff to meaningful reviews; and the quality of patient care and safety.

Both sides were given until Sept. 26 to file more briefs.

Steve Miletich: 206-464-3302 or smiletich@seattletimes.com