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Labor & Employment – Unemployment Compensation – Hospital – Flu Shot Requirement – Refusal

AnMed Health v. South Carolina Department of Employment & Workforce (Lawyers Weekly No. 011-075-13, 7 pp.) (John C. Few, Ch.J.) Appealed from the Administrative Law Court (John D. McLeod, ALJ) S.C. App.

Holding: While it was reasonable for a hospital to require its employees to get a flu shot, it was also reasonable for the respondent-employee to refuse, given that she has no direct contact with patients and that her daughter had died from possibly genetically-based complications from a flu shot.

We affirm the Administrative Law Court’s ruling that respondent is entitled to unemployment benefits.


In 2001, respondent’s 19-year-old daughter, Nicole, got a flu shot. Within a few days, she developed symptoms of what was diagnosed first as Guillian-Barré syndrome and later as multiple sclerosis. A neurologist told respondent that Nicole’s flu shot “very well could have activated” the disease. The medications Nicole took to treat her disease eventually caused complications that led to her death in 2007.

In 2010, the hospital – where respondent had worked since 1984 without taking a flu shot and where she had no direct contact with patients – instituted a policy of requiring all employees to have flu shots. Respondent’s situation did not fall within any of the policy’s exceptions.

Respondent’s doctor told her she should not get a flu shot. She wrote a note saying, “This patient must be medically exempt from the flu shot. She has a strong family history of Guillian-Barré and MS. The flu shot can activate these processes and must be avoided.”

The hospital refused respondent’s request for an exemption. Respondent refused to get the shot, and she was fired. The hospital contested respondent’s application for unemployment benefits, maintaining that she had been fired for cause.


The issue in this case is very narrow. It is not whether the hospital’s policy is reasonable as it applies to other hospital employees, or even whether the hospital acted reasonably in applying it to respondent. It is not whether Guillain–Barré syndrome or multiple sclerosis are genetic disorders, or whether getting a flu shot can, in fact, cause someone to suffer from those diseases. To determine whether respondent was disqualified from receiving unemployment benefits, the only question for the Department of Employment and Workforce to answer was whether respondent’s refusal to comply with the hospital’s policy was reasonable under her unique circumstances.

Initially, we disagree with the ALC’s determination that the hospital’s flu-shot policy was unreasonable. The record does not support this ruling. The determination of how to protect patients from life-threatening illnesses such as influenza is a complicated medical and scientific evaluation that should be made by hospitals, not the Department of Employment and Workforce, the ALC, or this court. We vacate the department’s finding that the hospital’s application of the policy to respondent was unreasonable.

However, under the circumstances of this case, the department’s finding was not a prerequisite to its ruling in respondent’s favor. Generally, in an analysis of whether an employee was discharged for cause, where the employer’s request is reasonable, a refusal to comply will constitute misconduct. Nevertheless, the court must evaluate not only the reasonableness of the employer’s request but also the employee’s reason for noncompliance.

Respondent refused to get a flu shot because she believed doing so could cause her to suffer and die from a debilitating disease. Respondent watched that happen to Nicole several years earlier, and Nicole’s doctor said the flu shot Nicole received just weeks before her symptoms began “very well could have” caused them. When respondent asked her own doctor for advice about getting a shot, the doctor wrote that the vaccination “must be avoided!” These facts support the department’s finding that respondent’s refusal was reasonable under the circumstances.

The correctness of respondent’s subjective beliefs and the reliability of her doctor’s opinion are relevant to the objective reasonableness of respondent’s decision, but they are not dispositive.



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