This article originally was published in the North Carolina Employment Law Letter, which is written and edited by Richard Rainey and Patricia Heyen.

Many healthcare providers in North Carolina have instituted policies requiring their employees who have patient contact to receive the flu vaccine each year. Such policies will typically include a process by which an employee can object to receiving the vaccine based on religious beliefs or medical concerns, such as an allergy to the vaccine’s ingredients. When an employee lodges an objection based on religious beliefs, the employer must consider whether it can make an accommodation or whether the request for accommodation presents an undue hardship.

In a case filed in the U.S. District Court in Asheville, the Equal Employment Opportunity Commission (EEOC) alleged that a hospital failed to reasonably accommodate three employees who opposed the vaccination on religious grounds. The hospital recently settled the case. Let’s take a closer look.

Employees Object to Hospital’s Vaccine Policy

According to the lawsuit, the hospital maintains a staff immunization policy (SIP) that requires employees to receive a flu vaccination no later than December 1 of each year. Under the SIP, an employee may request a religious exemption to the vaccination requirement.

The SIP provides that a religious exemption request must be made on or before September 1 of the year the vaccination is required or it may be denied. Once an employee requests a religious exemption, the hospital’s manager of HR processes the request and determines whether to approve or deny it. The EEOC claimed the hospital failed to accommodate several employees who objected to the vaccine based on a variety of different religious beliefs.

Christine Bolella was hired on May 21, 2012, to work as a preschool teacher at the hospital’s child development center. Bolella is a practicing member of the Church of the Nazarene, a Protestant Christian church. Based on her religion, she believes the human body can naturally fight illnesses through prayer and she shouldn’t receive vaccinations or immunizations. Until late 2012, she hadn’t received an immunization or vaccination since childhood.

In late 2012, while she was employed by the hospital, Bolella received a flu vaccination as required by the hospital because she thought she had no other option and she had to choose between her religion and her livelihood. After receiving the flu vaccination in 2012, she recommitted to her faith and beliefs and refused to receive any further vaccinations or immunizations because of her sincerely held religious beliefs.

On November 19, 2013, Bolella requested a religious exemption from the hospital’s flu vaccination requirement by completing and submitting a “Request for Religious Exemption” form. The next day, the hospital denied her request for a religious exemption from the vaccine requirement because she submitted it after the September 1 deadline.

On December 2, 2013, the hospital suspended Bolella without pay because she failed to receive a flu vaccination by midnight on December 1. She was given two weeks to receive the vaccination. When she didn’t, her employment was terminated.

Melody Mitchell was hired by the hospital on August 25, 2014, to work as a psychiatric intake clinician. Mitchell is a Christian who claims to closely adhere to the teachings of Jesus Christ. She believes, based on the Bible, that her body is a temple and putting vaccinations into her body is wrong and disrespectful to God. She believes it is God’s job to protect her from illnesses, and she has not received a vaccination or immunization since childhood.

On or about November 26, 2014, Mitchell requested a religious exemption from the hospital’s flu vaccination requirement. The hospital denied her request for a religious exemption because she submitted it after the September 1 deadline. The HR manager told her that her employment would be terminated unless she received the flu vaccination. When she didn’t get it, her employment was terminated.

Titus Robinson was employed to work as a psychiatric technician at the hospital on April 15, 2013. Robinson professes to be a member of the Islamic faith and has been a practicing Muslim since he was nine years old. As a practicing Muslim, he believes he shouldn’t be subjected to vaccinations/inoculations on the grounds that his body is a temple and natural herbs should be used for healing the body. He believes vaccinations and inoculations are artificial, unproven, and unsafe medical processes that are contrary to his religious beliefs. Since his 1998 conversion to Islam, he hasn’t received any immunizations or vaccinations.

When he was hired, Robinson provided the hospital a signed document titled “Declaration of Vaccination Exemption” in which he sought an “exemption from all vaccination and immunization requirements” based on his religion. On November 26, 2013, the hospital asked him why he hadn’t received a flu vaccination. He replied that he had requested a religious exemption when he was hired and gave his supervisor a copy of his request. He also completed the hospital’s exemption request form.

The hospital ended up denying Robinson’s request because it was submitted after the September 1 deadline. When he continued to refuse to get the vaccination, his employment was terminated.

Terms of the Settlement

After several months of litigation, the EEOC announced a settlement of the case. The hospital agreed to pay $89,000 to Bolella, Mitchell, and Robinson. In addition, the hospital entered into a two-year consent decree that, among other things, requires it to revise its immunization policy to permit employees to request an exemption during the same period in which flu vaccines are given.

The hospital must also conduct annual training for supervisors and managers on Title VII and employers’ religious accommodation obligations, post a notice about the lawsuit for employees, and provide the EEOC periodic reports about requests for religious exemptions from the flu vaccination.

It’s important to note that this case doesn’t mean mandatory flu vaccination policies are unlawful. Rather, if you have such a policy, you must structure it in such a way that employees with religious objections may express their concerns and you can consider and implement reasonable accommodations as appropriate.

Richard Rainey is a labor and employment attorney with extensive experience litigating employment disputes on behalf of employers in the courtroom and before administrative agencies such as the Equal Employment Opportunity Commission, the National Labor Relations Board, and the U.S. and N.C. Department of Labor. His litigation practice also includes actions involving covenants not to compete, theft of trade secrets, unfair competition, employee raiding, fair housing and equal credit. Rainey practices in Womble Bond Dickinson’s Charlotte, N.C. office.