On June 5, 2018, the Third Circuit Court of Appeals in Ruggiero v. Mount Nittany Medical Center, et al., reinstated a nurse’s disability discrimination and failure to accommodate claim under the Americans with Disabilities Act (ADA) against the hospital where she had worked, reversing the District Court’s decision to dismiss the lawsuit for failure to state a claim.

The Facts

Aleka Ruggiero worked as a registered nurse for Mount Nittany Medical Center (the Hospital) until her employment was terminated after Ruggiero refused to receive a required vaccine. Ruggiero suffers from severe anxiety and eosinophilic esophagitis. In May 2015, Ruggiero received a memorandum from the Hospital advising that she, along with other clinical employees, were required to receive a certain vaccine for tetanus, diphtheria, and pertussis (TDAP). Ruggiero refused to receive the vaccine and provided a medical note from her doctor which stated that she was medically exempt from receiving the vaccine for “medical concerns.” In response, the Hospital asked Ruggiero’s doctor to identify which of the eight contraindications, warnings, or precautions listed by the drug manufacturer prevented Ruggiero from receiving the vaccine. Ruggiero’s doctor explained that Ruggiero is exempt from receiving the vaccine “due to severe anxiety with some side effects she read with this injection, . . . [given] her history of . . . food allergies . . . and eosinophilic esophagitis. Patient being terrified, I feel the risk of this TDAP injection outweighs the benefits.” The Hospital responded that this reason was not justified because it did not meet the definition of medical contraindication as detailed from the manufacturer and gave Ruggiero fifteen days to receive the vaccine.  At some point, Ruggiero suggested permission to wear a mask as a possible accommodation, explaining that some other nurses were permitted to wear masks to accommodate refusals to receive the flu vaccine, but in any event did not receive the vaccine. The Hospital removed her from work the day after the new deadline and a week later terminated her employment.

The District Court’s Dismissal

Ruggiero filed a lawsuit alleging that the Hospital discriminated against her on the basis of a disability, failed to reasonably accommodate her, and retaliated against her for requesting an accommodation. The District Court granted the Hospital’s motion to dismiss on the following grounds. First, the District Court admitted that while Ruggiero had plausibly alleged that she was a qualified individual with a disability, she failed to allege that the Hospital was on notice of the disability and request for accommodation. The District Court held further that the Hospital had satisfied its obligation to engage in the interactive process when it wrote back to Ruggiero informing her that the reason for exemption identified by her doctor did not satisfy the drug manufacturer’s contraindications. Finally, the District Court dismissed Ruggiero’s discrimination and retaliation claims on the grounds that they were vague and conclusory.

The District Court provided Ruggiero an opportunity to file an Amended Complaint; however, she did not do so and filed an appeal instead. Interestingly, the Equal Employment Opportunity Commission (EEOC) appeared amicus in support of Ruggiero.

The Appeal

At issue on appeal was whether Ruggiero had stated plausible claims for relief against the Hospital. With regard to Ruggiero’s Failure to Accommodate claim, the Third Circuit stated that Ruggiero’s alleged disability (severe anxiety and eosinophilic esophagitis) were sufficiently pled in the Complaint. The Third Circuit further disagreed with the District Court’s conclusion that Ruggiero had failed to allege that the Hospital knew of her alleged disability and request for accommodation, explaining that Ruggiero had alleged that (1) she visited with her doctor to discuss the vaccine and her doctor recommended that she not receive the vaccine due to her medical condition and (2) submitted the medical documentation to the Hospital. The Third Circuit also disagreed with the District Court insofar as it explained that Ruggiero also alleged she sought permission to wear a mask as an alternative accommodation. Moreover, the Third Circuit stated that Ruggiero’s allegations raised a plausible inference that the Hospital failed to properly engage in the interactive process because the Hospital rejected Ruggiero’s requested accommodation, either an exemption or permission to wear a mask, without proposing an alternative. 

As for Ruggiero’s disability discrimination claim, the Third Circuit held that the District Court’s dismissal was premature insofar as it found that Ruggiero alleged that the Hospital discriminatorily terminated her employment after receiving two doctor’s notes requesting an exemption from the vaccine policy. Especially, in light of Ruggiero’s allegation that other employees were permitted to remain employed and not receive the TDAP vaccine.

Finally, the Third Circuit held that Ruggiero’s retaliation claim was similarly sufficiently pled explaining that her request for an accommodation—an exemption from the vaccine requirement—is a protected activity under the ADA at least to support a retaliation claim at the pleading stage. Ruggiero alleged an adverse action, her termination, and the temporary proximity between the request and termination raises a plausible inference of causation.

The Bottom Line

While this opinion was focused simply on whether Ruggiero has properly alleged an ADA claim, employers can discern from the Third Circuit’s analysis how to properly engage with employees during the interactive process. It is important to document these conversations and explain to employees why the requested accommodation is unreasonable and to propose alternative solutions.


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