Mandated influenza vaccination programs for healthcare workers have proved highly effective at raising immunization rates, but hospitals that fail to navigate religious exemptions have found themselves on the wrong end of court rulings.

For example, six healthcare workers fired for refusing mandatory flu shots for religious reasons won back pay and offers of reinstatement from Saint Vincent Hospital in Erie, PA, according to the U.S. Equal Employment Opportunity Commission (EEOC).¹ The hospital agreed to compensate the workers some $300,000 for lost wages and compensatory damages after the EEOC filed suit in September 2016. (See the February 2017 Hospital Infection Control & Prevention.)

These legal challenges can be avoided if hospitals try to work with employees and provide some alternative accommodation for those claiming religious exemption from influenza vaccinations, said Douglas Opel, MD, MPH, assistant professor of pediatrics at the University of Washington School of Medicine. Opel recently published a review of the legal issues in the New England Journal of Medicine and commented in an accompanying podcast.

“For employees with patient contact, reasonable accommodation may mean having them wearing a mask to prevent them spreading influenza to patients,” Opel said. “For employees without patient contact, it might be reasonable to simply require them to stay home if symptomatic.”

Reviewing several cases involving this issue, Opel cited a North Carolina health system that failed to provide religious exemptions from an influenza vaccination requirement. The resulting lawsuit, which alleged religious discrimination in violation of Title VII of the Civil Rights Act of 1964, was settled in January 2018. The healthcare system agreed to compensate the employees and revise its vaccination exemption policy.

The EEOC defines “religion” as “moral or ethical beliefs as to what is right and wrong which are sincerely held with the strength of traditional religious views.” Courts are not bound by that definition; still, it is broad enough to create “uncertainty” about the line between religious and philosophical objections, he noted in the paper.

“We wrote this perspective to alert hospitals to the legal challenges, specifically based on religious discrimination claims, in order to help them ensure their influenza vaccination mandates are legally sound,” Opel said. “It requires that [policies] are well written, consistent, and reasonably applied.”

In another case, an employer “required masks only when unvaccinated employees were near a patient care area,” but their employee ID badges showed an “unvaccinated” status.

“An accountant whose job involved little patient contact objected, claiming that the sticker was stigmatizing,” Opel reported. “The parties settled before a court ruling was issued.”

However, hospitals that have made reasonable efforts to accommodate workers also have won subsequent challenges to their flu immunization policies.

“Hospitals prevailed in lawsuits when they developed ways to accommodate their employees’ religious views yet still protect patients,” Opel said. “So, it seemed to make sense, in our reading of these cases, for hospitals to tailor their policies based on where employees work.”

A common theme in many cases is that hospitals are arbitrary in evaluating religious objections and enforcing deadlines. Concerning the latter, one hospital suit arose in part because workers who missed the vaccination deadline had a grace period, but the exemption request deadline was strictly enforced.

“Litigation is often inspired by employees feeling that the process used to weigh their opt-out requests was not fair,” he said. “Hospitals can avert problems like these by allowing employees adequate opportunity to explain their beliefs — not inserting unnecessary administrative requirements or being unduly rigid in filing deadlines.”

In addition, they should explain their reasons for denying an exemption request and treat the religious objector with respect, he added. While these approaches can prevent lawsuits, healthcare facilities also must stress the safety of vaccine and importance of immunization as the annual flu season approaches.

“It is really important to emphasize that healthy adults can spread influenza one day before symptoms begin and continue to expose others several days after getting sick,” Opel said. “It is possible for someone to feel fine and unknowingly spread the virus to someone at high risk of serious complications from flu.”

REFERENCES

1. EEOC. Saint Vincent Health Center to Pay $300,000 To Settle EEOC Religious Accommodation Lawsuit. Dec. 23, 2016: http://bit.ly/2ibTFSg.
2. Opel DJ, Sonne JA, Mello MM. Vaccination without Litigation — Addressing Religious Objections to Hospital Influenza-Vaccination Mandates. N Engl J Med (Perspective) 2018; 378:785-788. DOI: 10.1056/NEJMp1716147.