Ms A is a nurse who provided direct care to geriatric patients at a hospital’s outpatient facility. She began working for the hospital in 2001. In 2012, the hospital adopted a system-wide policy requiring influenza vaccination of all employees unless a specific exemption was requested and approved. The hospital’s policy was based on recommendations by the Centers for Disease Control and Prevention (CDC) and the Joint Commission on Accredited Healthcare Organizations (JCAHO) in order to protect patients.

The hospital’s position was that any exemption to its mandatory influenza vaccination policy would weaken the efficacy of the organization’s ability to protect patients from a potentially dangerous communicable disease. Ms A received a flu vaccine in 2012, 2013, 2014, 2015, and 2016, and did not request an exemption. In the spring of 2017, however, Ms A began feeling concerned about immunization.

In the fall of 2017, Ms A became pregnant and became worried that the influenza immunization might increase her risk for miscarriage. She asked her midwife to certify her for a medical exemption from the mandatory flu shot. The midwife refused. Ms A then asked her obstetrician to provide her with a medical exemption and notified her employer that she was seeking a medical exemption. After the request to the obstetrician was refused, Ms A made a post to a Facebook group “Vaccine Re-education Discussion Forum,” explaining her situation. Members of the group responded to Ms A and encouraged her to avoid vaccination. Several members of the group instructed Ms A to seek a religious-based exemption. “It’s so very easy,” wrote one member of the group, “all I had to do was say I do not vaccinate for religious reasons.”

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In mid-November, Ms A filed a request for a religious exemption for the influenza vaccine. A retired chief judge of the United States District Court served as a third-party reviewer for religious exemption requests by the hospital’s employees. The judge interviewed Ms A and questioned her about her claims of religious beliefs that prevented her from being vaccinated. The judge was in possession of Ms A’s post to the Facebook group and the responses from the members. After his discussion with Ms A, the judge authored a report concluding that Ms A had a medical objection to the requirement, not a religious objection, and recommended that the hospital deny her request. The judge recommended that Ms A be vaccinated by mid-December, at which point she would be past her first trimester of pregnancy.

The hospital followed the judge’s recommendation and denied Ms A’s religious objection and instructed her to get vaccinated. Ms A refused. The hospital terminated her contract in January, solely for her refusal to comply with the hospital’s vaccination policy. Ms A filed a religious discrimination lawsuit against the hospital.

Legal Background

Title VII makes it unlawful for an employer to “fail or refuse to hire or to discharge any individual, or otherwise to discriminate against any individual … because of such individual’s race, color, religion, sex, or national origin.” Under Title VII, employees may assert 2 different theories of religious discrimination: failure to accommodate and disparate treatment. Ms A alleged that the hospital failed to accommodate her based on its refusal to exempt her from its vaccine requirement.

The hospital made a motion to dismiss the case, alleging that the plaintiff had failed to show religious discrimination.

To decide the hospital’s motion, the court examined what is necessary to support a Title VII failure to accommodate claim. First, the court noted that the plaintiff has the initial burden of proving her case; if she does, then the burden shifts to the hospital to show that it either made a good faith attempt to reasonably accommodate Ms A’s religious belief or that such accommodation would cause undue hardship to the employer. To establish her case, the court noted that Ms A must be able to show that:

  • She holds a sincere religious belief that conflicts with a job requirement;
  • She informed her employer of this conflict; and
  • She was disciplined for failing to comply with the conflicting requirement.

It’s the plaintiff’s burden to prove that they hold a sincere religious objection to the influenza vaccine. “Anti-vaccination beliefs themselves are not religious and therefore are not entitled to accommodation under Title VII,” wrote the court in its decision.

During questioning, Ms A said that she only requested her religious-based exemption after she had researched vaccines from a medical perspective. She did not request a religious exemption until after she had unsuccessfully petitioned her midwife and obstetrician for a medical-based exemption. The court also pointed out that Ms A’s religious beliefs regarding vaccination only developed days before she filed her religious exemption request. Finally, the court pointed out that Ms A’s consulting with a secular, antivaccination Facebook group does not lead to the conclusion that she requested an accommodation for religious reasons.

The court noted that Ms A had received the vaccine and not asked for an exemption from 2012 through 2016, and that her multiple tattoos and piercings did not align with her claim that the bible compelled her to keep her blood “pure under all circumstances and free from contaminates.” Although Ms A introduced a letter from a pastor, the court pointed out that it wasn’t written until after Ms A was fired from her job. “Based on the record before the court,” the decision stated, “no reasonable jury could find that plaintiff had a sincerely held religious belief objection to the influenza vaccine.” The court dismissed the case against the hospital.

Protecting Yourself

Religious objections to vaccinations must be sincere to be protected. Religious views that are expressed abruptly will be viewed suspiciously. Clinicians should not attempt a religious objection to vaccination if they don’t have a history of those beliefs to back it up.

Ann W. Latner, JD, a former criminal defense attorney, is a freelance medical writer in Port Washington, New York.