Mandatory Flu Vaccines: Understanding Religious Accommodation Under Title VII

April 24, 2017

Religious objections to certain forms of preventative care or medical treatment are not new issues under the law.  In recent years, individuals who dispute the efficacy or safety of vaccines and immunizations have sought various forms of relief from compulsory vaccination and immunization requirements.  Some employers, however, such as health clinics, hospitals, and community-based care facilities, mandate certain annual vaccinations such as the flu shot as a condition of continued employment.  In administering such a policy, employers must understand the breadth of the definition of religion under Title VII of the Civil Rights Act, prohibited bases for denial of religious accommodation under the Act, and the consequences for failure to provide a reasonable accommodation when doing so would not cause undue hardship.  The circumstances underlying the 2016 case EEOC v. Saint Vincent Health Care, as well as the terms of the corresponding consent decree, are particularly instructive for employers seeking to implement such a policy. 

Religion under Title VII

Title VII of the Civil Rights Act (“Title VII”) precludes employers from discriminating against any individual with respect to his or her “compensation, terms, conditions, or privileges of employment, because of such individual’s race, color, religion, sex, or national origin.”  Under Title VII, “‘religion’ includes all aspects of religious observance and practice, as well as belief, unless an employer demonstrates that he is unable to reasonably accommodate to an employee’s or prospective employee’s religious observance or practice without undue hardship on the conduct of the employer’s business.”  That is, an individual’s sincerely held religious belief does not need to originate from a common, organized religion such as Christianity, Judaism, Islam, Hinduism, or Buddhism, etc. to require reasonable accommodation by the employer.

The United States Supreme Court has held that religious beliefs can include both theistic and non-theistic moral or ethical beliefs as to what is right and wrong, if they are sincerely held in the same manner as traditional religious beliefs.   In an attempt to distinguish between other strongly held viewpoints and religious beliefs, federal courts have reasoned that religious beliefs typically address “ultimate ideas” concerning “life, purpose, and death.”  Specifically, federal courts have clarified that personal preferences and social, political, or economic ideals do not constitute “religious” beliefs protected by Title VII.

EEOC v. Saint Vincent Health Center

On December 23, 2016, U.S. District Judge Barbara J. Rothstein approved and entered a consent decree in a case brought by the U.S. Equal Employment Opportunity Commission (“EEOC”) against Saint Vincent Health Center (“Health Center”) wherein the Health Center agreed to pay $300,000 for back pay and compensatory damages to six individuals who alleged they were fired for not receiving a flu shot despite their requests for an exemption to the employer’s policy on the basis of their respective religious beliefs.

The policy at issue was implemented in October 2013 and required that all employees receive an annual flu vaccine as a condition of their continued employment.  Under the policy, employees could request an exemption based on either medical contraindication or religious accommodation.  If an employee sought an exemption based on religion, he or she was required to complete a “Mandatory Influenza Vaccination Exemption Request Form” and obtain certification from a clergy member or third-party that the requestor “practices a religion where influenza vaccination is contraindicated according to doctrine or accepted religious practices.”  Any employee who did not receive a flu shot and had not been approved for an exemption was to be discharged from their employment with the Health Center.  The EEOC alleged that in the 2013-14 flu vaccination period, the employer received 11 requests for exemption based on religious grounds, all of which were denied, while during the same period, the employer granted 14 vaccination exemption requests based on medical contraindication. Notably, in this instance, the employees who made requests for religious accommodation were not all affiliated with the same belief system.

Two employees who applied for religious exemption avowed adherence to the Russian Orthodox faith, noting that their beliefs required them to keep the body and spirit pure and that vaccines would constitute a contaminant. After their respective requests were denied, they each submitted revised requests citing Bible passages in support of their religious objections to vaccinations. These requests were also denied and the employees were discharged.  Within a week of the employees’ termination, their priest e-mailed a letter to the employer outlining the basis for the religious objection and advised he was available to discuss the matter further, if necessary.

An employee adhering to the Baptist faith and attending an Independent Fundamentalist Baptist church advised the employer of his religious beliefs that prohibited him from defiling his body, which included being vaccinated.  He included on his exemption request form citations to several Bible passages. His request was also denied.  In response to his request for a meeting to clarify and further explain his beliefs, the employer responded, advising that in its opinion, there was no conflict between the employee’s religious beliefs and vaccinations.

An employee who practiced Christian Mysticism also applied for an exemption, citing the book A Course in Miracles as the basis for his religious beliefs prohibiting him from being vaccinated. The employee’s request was denied.  He was initially placed on probation and subsequently sought to clarify the basis for his request.  He alleged that at that meeting, the human resources manager advised the employee that he had researched the quoted text for approximately one hour prior to the meeting, but could not find any mention of spiritual or religious practice in the document expressly prohibiting vaccinations.  The manager further advised that he was looking for something akin to the religious tenet by which Jehovah’s Witnesses abide regarding blood transfusions.

Another employee, a member of the Methodist faith, advised the employer of her Christian beliefs based on Biblical directives not to introduce toxins into her body.  She set these forth in her request for an exemption and advised that she was preparing an additional document detailing the basis for her request. She was advised that that would not be necessary.  She was subsequently informed that her request had been reviewed and denied.

The last employee, a member of a non-denominational Christian faith not affiliated with any particular church, based her request on her belief that God wants her to live a healthy lifestyle and use alternative medicine techniques in lieu of vaccines.  She submitted a note from her primary care provider requesting exemption from the flu shot mandate based on the employee’s “personal religious and moral beliefs.”  The employee was subsequently asked for additional information, in response to which the employee wrote a letter citing several Bible passages and noting that she also subscribes to the tenets of the Weston A. Price Foundation’s recommendations on nutrition (an organization self-described as a “nutrition education foundation”) that compel her to reject immunizations.

All of these individuals were employed in direct patient care roles, including: registered nurse, licensed practical nurse, echocardiogram technologist, and occupational therapist.  When asked by the EEOC about the basis for denying the employees’ requests for religious accommodation, however, the employer did not cite undue hardship, but rather the employees’ failure to “provide proof of religious doctrine.”

In its Complaint, the EEOC sought several forms of injunctive relief, many of which were included in the consent decree.  If the Health Center wishes to continue its flu vaccine requirement, it must grant exemptions from the mandate to all employees with sincerely held religious beliefs who request exemption “unless such exemption poses an undue hardship on the Health Center’s operations” and it must advise employees of their right to request a religious exemption to the policy and implement appropriate procedures for considering any such requests for accommodation.  Specifically, the agreement requires that in administering its policy, the Health Center must adhere to the definition of “religion” established by Title VII and interpreted in the applicable federal court decisions, including not rejecting accommodation requests because an employer disagrees with an employee’s belief, considers the belief to be unfounded, illogical, or inconsistent with other beliefs, or concludes that the belief “is not an official tenet or endorsed teaching of any particular religion or denomination.”  U.S. EEOC v. Saint Vincent Health Ctr., Case No. 16-cv-234 (W.D. Pa.), Compl. (filed Sept. 22, 2016) and Consent Decree (approved Dec. 23, 2016).

Bottom line 

While the debate surrounding immunizations and vaccinations has been in the news for the last several years, the recent enforcement actions by the EEOC indicate that this issue is not going away.  As with all employment policies, employers need to properly educate individuals charged with administering mandatory vaccination policies and ensure they are accurately conveying employees’ rights under the law.   Employers need to be particularly cognizant of the fact that terms such as “religion” and “belief” have a much broader definition under Title VII than what a layperson might initially assume, and tailor the training and procedures on these policies accordingly.  Finally, employers should be aware that if individuals with medical contraindications to vaccines can be accommodated without undue hardship, it is likely that a similarly situated employee requesting exemption on the basis of religion can also be accommodated.

This article, slightly modified to note recent updates, was featured in the March 2017 issue of the Wisconsin Employment Law Letter, which is co-edited by Axley Brynelson Attorneys Saul Glazer and Michael Modl and published by BLR®—Business & Legal Resources. Reproduced here with the permission of BLR®—Business & Legal Resources.

For more information about "Mandatory Flu Vaccines: Understanding Religious Accommodation Under Title VII," contact Kristin R. Pierre at kpierre@axley.com or 608.283.6719.