Nurse's Anxiety over Side Effects of Vaccine Supports ADA Claim

​A hospital nurse with anxiety and allergies who was terminated after seeking an exception to receiving a vaccine for tetanus, diphtheria and pertussis could state a claim of discrimination under the Americans with Disabilities Act (ADA), the 3rd U.S. Circuit Court of Appeals ruled.

The plaintiff worked as a registered nurse at Mount Nittany Medical Center (MNMC). She had severe anxiety and an inflammatory condition of the esophagus, which limited her ability to perform certain life activities, such as eating, sleeping and engaging in social interactions. Despite her impairments, the plaintiff was able to perform her duties as a nurse at MNMC.

On April 22, 2015, the plaintiff received a memorandum from MNMC advising her that all clinical employees were required to receive a vaccine for tetanus, diphtheria and pertussis (the "Tdap vaccine"). The memorandum set May 15 as the deadline to receive the vaccine and provided a telephone number for employees to call with questions about the vaccine. The plaintiff did not receive the vaccine by the deadline.

When MNMC notified the plaintiff that she had missed the deadline, she responded that she had made an appointment with her doctor regarding the vaccine. On June 5, the plaintiff faxed MNMC a note from her doctor, which read "The above-named patient is medically exempt from receiving Tdap immunization for medical concerns."

On June 10, MNMC responded to the plaintiff's doctor, enclosing information from the vaccine manufacturer and asking which of the eight contraindications, warnings or precautions listed by the manufacturer prevented the plaintiff from receiving the vaccine. On July 10, the doctor replied that the plaintiff was medically exempt from receiving the Tdap immunization due to severe anxiety over some side effects she had read about with regard to this injection, especially with her history of having many food allergies, environmental allergy and esophagus allergy. Because of the plaintiff's anxiety, the doctor believed the risk of the Tdap injection outweighed the benefits.

The doctor did not say that the plaintiff suffered from any of the contraindications, warnings or precautions listed by the vaccine's manufacturer. On July 15, MNMC issued a letter to the plaintiff stating that the documentation provided "does not meet the definition of medical contraindication as detailed in the manufacturer's vaccine literature and thus Tdap immunization is required." The letter set July 21 as the new deadline for receiving the vaccination.

At some point, the plaintiff suggested a possible accommodation—permission to wear a mask instead of receiving the vaccine. The plaintiff alleges that other nurses were permitted to wear masks to accommodate their refusals to receive the flu vaccine. In any event, the plaintiff did not receive the vaccine by the newly imposed deadline. MNMC removed the plaintiff from work on July 22 and formally terminated her on July 31.

The plaintiff brought claims for violations of the ADA. The district court dismissed her discrimination claim on the grounds that her allegations were too conclusory and she had failed to plead the requisite causation. The district court also dismissed her retaliation claim on the grounds that her allegations were too conclusory and that she had failed to allege protected activity.

The appeals court disagreed, finding that the plaintiff sufficiently alleged that MNMC knew of her alleged disability and her desire for an accommodation from the two doctor's notes that it received, as well as the plaintiff's alleged request to wear a mask as an alternative accommodation. The appeals court further found that the plaintiff's termination supported an inference of discrimination based on her allegation that other MNMC employees were allowed to refuse to get the Tdap vaccine and remain employed with MNMC.

[SHRM members-only toolkit: How to Handle an Employee's Request for an ADA Accommodation]

Finally, the appeals court held that the requests for an accommodation qualified as a form of protected activity and thus the termination of the plaintiff shortly thereafter might establish retaliation.

The appeals court thus reversed the district court's dismissal of the plaintiff's ADA claims.

Ruggiero v. Mount Nittany Medical Center, 3rd Cir., No. 17-2227 (June 5, 2018).

Professional Pointer: Employers often limit their view of working conditions to which the ADA applies to those that affect the symptoms of a physical disability. However, the ADA defines accommodations more broadly and may require an employer to change conditions that trigger impairments attributable to mental health issues.

Jeffrey Rhodes is an attorney with Doumar Martin in Arlington, Va.