United States: Healthcare Worker's Vaccine Refusal Not Immunized By Americans With Disabilities Act (US)

Last Updated: December 19 2018
Article by Daniel B. Pasternak and Melissa Legault

On December 7, 2018, a three-judge panel of the U.S. Court of Appeals for the Eighth Circuit unanimously held in Hustvet v. Allina Health System that an employer did not unlawfully terminate an employee who refused to receive a rubella vaccination.  The plaintiff, a healthcare specialist working with potentially vulnerable patients, requested an accommodation exempting her from receiving the measles, mumps, and rubella vaccine due to her "many allergies and chemical sensitivities."  She also refused to complete a mandatory health screening.  Because she refused to be immunized and examined, her employer terminated her employment.  The plaintiff sued under the Americans with Disabilities Act ("ADA") and Minnesota Human Rights Act ("MHRA"), claiming unlawful inquiry, discrimination, and retaliation.

The appeals court concluded that the plaintiff's unlawful inquiry claim failed because her employer's mandatory health examination was consistent with the requirements under the ADA and MHRA.  Under the ADA, employers cannot require medical examinations unless those examinations are "job-related and consisted with business necessity."  Here, the court concluded that the examination constituted a valid inquiry because the purpose of the exam was to ensure that employees who interact with patients have evidence of immunity to communicable diseases, and that the exam was job-related, consistent with business necessity, and no more intrusive than necessary.

In addition, the court rejected the plaintiff's failure-to-accommodate and retaliation claims.  Both the ADA and MHRA prohibit discrimination against qualified individuals with a disability, which includes an employer's failure to grant requests for reasonable accommodations.  When an employee requests a disability accommodation, the employer and employee must engage in an interactive process to determine the necessity and reasonableness of the accommodation.  But, the essential first step of the process is a conclusion that employee indeed has a disability – some physical or mental impairment that substantially limits a major life activity.  Here, the court found that the record did not support that the plaintiff's alleged chemical sensitivities and/or allergies substantially or materially impaired her ability to perform major life activities.  The plaintiff was never hospitalized due to an allergic or chemical reaction, and the court classified her condition as "garden variety allergies to various items that moderately impact her daily living."  Accordingly, the court held that it did not need to reach the failure to accommodate issue, since the plaintiff was not disabled and thus not entitled to any accommodation.   Similarly, the court rejected the plaintiff's retaliation claim as a matter of law.

Although the Eighth Circuit found no discrimination or retaliation in Hustvet because there was insufficient evidence of the plaintiff's disability, a different federal appeals court recently came to the opposite conclusion in a case involving similar facts.  In Ruggiero v. Mount Nittany Medical Center, the Third Circuit reversed a district court's dismissal of a lawsuit under the ADA brought by a registered nurse terminated by her employer because she refused to receive required vaccinations.  In that case, the employee refused to be vaccinated because she suffered from severe anxiety regarding some of the side effects of the vaccine.  The court reasoned that (unlike in Hustvet), the plaintiff in Ruggiero had a documented disability that limited her ability to perform certain major life functions, and she made her desire for an accommodation known to her employer.  Therefore, the court held that the district court's dismissal of the plaintiff's discrimination and retaliation claims was premature.

The ADA is not the only federal law implicated by an employee's refusal to receive employer-required vaccinations.  Employers should be aware that Title VII of the 1964 Civil Rights Act entitles employees to reasonable accommodation of sincerely-held religious beliefs – including those that prohibit employees from being vaccinated or seeking medical treatment – unless the accommodation would impose undue hardship on the employer (an issue that most commonly arises in the healthcare industry context).  It is also important to note that courts have broadly interpreted both "disability" and "religion" in the mandatory vaccination context.  For example, at least one federal court has held that veganism can constitute a sincerely-held religious belief exempting an employee from an employer requirement to be inoculated with a vaccine containing albumen from chicken eggs.  Employers with mandatory vaccination policies must tread lightly and explore accommodations (assuming that there are sufficient facts supporting that the employee has a disability implicated by the vaccination requirement), because despite the Eighth Circuit's recent ruling in Hustvet, employees with documented disabilities or sincerely-held religious beliefs regarding vaccinations may still be legally entitled to refuse immunizations.

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