Restriction to One 24-Hour Shift Per Week in ER Sinks ADA Claim

Takeaway: Employment contracts should describe all essential functions of a position to help an employer’s defense, if sued under the Americans with Disabilities Act (ADA), that the plaintiff was not qualified. 

When a hospital’s contract with emergency room (ER) physician assistants (PAs) required three 24-hour shifts each pay period, the hospital did not have to accommodate a PA whose doctor restricted her to one 24-hour shift per week, a federal appeals court decided.

The plaintiff worked as a PA for Mercy Health Services Iowa Corp., doing business as MercyOne Siouxland Medical Center, in the ER at Mercy’s facility in Hawarden, Iowa. Because the center was a critical access facility, the ER had to be staffed with at least one provider at all times — 24 hours, 365 days per year. 

Mercy usually staffed the Hawarden ER with four providers, including the plaintiff, referred to collectively as advanced practice providers. These providers worked under employment contracts with initial terms. The contracts stipulated that at the end of the initial term, the hospital and the providers could extend the contract by written agreement. Otherwise, the contracts would continue month to month for up to 90 days. This 90-day period was known as the temporary renewal period. If no extension agreement was reached during that period, the contract terminated after either 30 days’ written notice or at the end of the temporary renewal period.

The advanced practice providers worked 72 hours per two-week pay period. They did not have assigned shifts. Instead, a shift coordinator would circulate a calendar to the providers a month beforehand, and they would indicate their preferred shifts for that month. Pursuant to their contracts, advanced practice providers were required to work three 24-hour shifts per pay period and weekends. When a provider could not cover a shift, workers known as PRNs and locums (temporary replacements) covered them.

The plaintiff was diagnosed with multiple sclerosis (MS). Due to effects of her condition, she took Family and Medical Leave Act (FMLA) leave from June 3, 2021, to Aug. 1, 2021. Her doctor indicated on the FMLA paperwork that ongoing stress at work exacerbated the plaintiff’s MS and that episodic MS flare-ups could periodically prevent her from working.

The plaintiff’s employment contract was set to expire on Feb. 28, 2022. Before then, the Hawarden facility’s CEO presented her with a proposed contract extension. She declined the offer and never made a counteroffer. Neither party ever raised the issue of negotiating a new contract. The plaintiff took her second FMLA leave from Jan. 31, 2022, to March 14, 2022. 

On Feb. 25, 2022, the plaintiff’s doctor evaluated her and cleared her to return to work by the middle of March with the following limitations: no more than one 24-hour shift per week and no weekend shifts because weekend shifts in the ER tend to be more hectic. The doctor opined that 24-hour shifts seemed to be an extremely long time for someone with her condition. The plaintiff’s doctor informed Mercy that her restrictions were expected to last through Dec. 31, 2022. 

HR stated that Mercy could accommodate the restrictions but could not confirm that the accommodation could be made through Dec. 31, 2022.

The CEO emailed a Mercy executive stating that the plaintiff’s doctor’s notes said that she was working only one 24-hour shift through December. The CEO said that that was not working out and that Mercy would need to terminate her employment. Mercy decided to terminate the plaintiff’s employment on April 26, 2022, and notified her of its decision by letter dated April 28, 2022. The letter stated that, because the plaintiff’s employment contract was not renewed, her employment with Mercy was terminated effective May 30, 2022. 

On May 26, 2022, the plaintiff’s doctor noted that her MS appeared stable and signed a return-to-work statement that released her to return to work with no restrictions on June 13, 2022.

The plaintiff filed a lawsuit against Mercy in Iowa state court alleging violations of the Americans with Disabilities Act (ADA), the Iowa Civil Rights Act, and the FMLA. The case was removed to federal court and Mercy filed for summary judgment on all claims. The district court granted summary judgment, and the plaintiff appealed.

Toolkit: What You Need to Know About the ADA

On appeal, the 8th U.S. Circuit Court of Appeals considered whether Mercy had shown that the ability to work three 24-hour shifts per pay period and weekend shifts were essential functions of the plaintiff’s job. It found that Mercy had done so because it included both requirements in every advanced practice provider’s employment contract, including the plaintiff’s. 

In addition, the providers’ schedules comprised mostly 24-hour shifts and, if the plaintiff were not required to work these 24-hour shifts, other providers, PRNs, or locums would have to cover by working additional shifts. 

The plaintiff argued that patient care was her only essential function and that a reduced work schedule could be a reasonable accommodation. 

Toolkit: Accommodating Employees’ Disabilities

The 8th Circuit disagreed and upheld the decision of the district court granting summary judgment.

Siebrecht v. Mercy Health Services-Iowa Corp., 8th Cir., No. 24-3159 (Jan. 5, 2026).