A recent case sheds some light on a trending social issue – an individual’s reluctance to be vaccinated because of fears of adverse reactions. A federal district court in Pennsylvania granted a hospital’s motion to dismiss an ADA discrimination case by a nurse whose doctor stated that she should be exempted for medical reasons from having to receive an employer-mandated vaccine for Tetanus, Diphtheria, and Pertussis (Tdap). The court concluded that the hospital acted reasonably in denying the employee’s request because the medical reason given by the doctor for the exemption was not one of the contraindications recognized by the manufacturer of the vaccine. The case is Ruggiero v. Mount Nittany Medical Center (M.D. PA 5/15/17).

Medical Issue: Anxiety caused by fear of Adverse Effects. The doctor initially advised that the nurse should be exempt from the Tdap vaccine “for medical concerns” without detail. The hospital responded with a letter asking the doctor to identify the medical contraindication that applied to her patient.  The hospital advised the doctor that the manufacturer had identified two contraindicated limitations (hypersensitivity caused by anaphylaxis or encephalopathy) and six warnings/precautions (latex sensitivity; Guillain-Barre Syndrome and Brachial Neuritis; syncope; progressive or unstable neurologic disorders; arthus-type hypersensitivity; or altered immunocompetence). The doctor responded advising that the nurse should be medically exempted because she had “severe anxiety with some side effects she read with this injection, especially with her history of having many food allergies, environmental allergy and eosinophilic esophagitis.” The hospital denied the exemption.

Accommodation of Wearing a Mask Rejected. The employee argued that the hospital should have permitted the exemption and allowed her to wear a mask. The court disagreed and concluded that the hospital had engaged in a good faith attempt to accommodate the employee’s medical condition by offering to exempt her if she suffered from any of the contraindications/warnings identified by the manufacturer. The court stated that the ADA does not mandate that an employer “accommodate what amounts to a ‘purely personal preference.’” 

Lessons for employers. There are lessons to be gleaned from this decision. First, the employer demonstrated a willingness to engage in a good faith interactive process. When the doctor provided incomplete documentation, the hospital sent a letter describing the inadequacy and requesting specific additional information.  Some employers act quickly to deny accommodations when a doctor’s note is not adequate. This exposes them to greater legal risk for failure to engage in the good faith interactive process.  Second, this case is another example of a court demonstrating deference to a medical organization’s concerns about patient safety.  A third interesting fact is that the employee’s Health Services records indicated that the nurse had a record of past vaccination history that included “all standard childhood vaccinations plus school and college related vaccinations” and the nurse had not identified any medical contraindications or adverse reactions.  While the court does not mention this fact as having influenced its decision, one must wonder.