Vaccine Exemptions for Clinical Rotation Students

Guest Post by Allison R. Lucas, Esq, Siri & Glimstad LLP

It is of utmost importance for clinical rotation students to empower themselves with knowledge of their rights. This article provides a high-level overview of religious and medical vaccine exemptions and provides important information to help these students make informed decisions and protect their rights in clinical rotation settings.

Religious Exemptions

It is a common misconception among clinical rotation students that they are definitely protected by the prohibition against religious discrimination in the workplace by Title VII of the Civil Rights Act of 1964 (Title VII). Unfortunately, while this federal law safeguards employees and job applicants from religious discrimination in the workplace, it may not cover independent contractors and non-paid individuals like volunteers or clinical rotation students. The good news is that other laws may offer protections, depending on the state and type of institution involved (i.e., private, public, or religious). Understanding these potential protections is crucial as a clinical rotation student.

            For instance, public institutions are required to adhere to the U.S. Constitution. Recent cases have held that the First Amendment’s Free Exercise Clause requires that if a public institution offers a discretionary secular (medical) vaccine exemption, it must also provide an option for a religious exemption. This was clearly established in a Supreme Court case, Fulton v. City of Philadelphia, 141 S. Ct. 1868 (2021). In another case, Tandon v. Newsom, 141 S. Ct. 1294 (2021), the Supreme Court ruled that an institution undermines the neutrality and general applicability of a policy that doesn’t allow religious exemptions when it allows comparable secular activities. This means that if a public institution allows medical exemptions and other unvaccinated individuals in the hospital and patient setting, then a policy that categorically prohibits religious exemptions for clinical rotation students is likely unconstitutional. These cases are particularly relevant for clinical rotation students as they are often required to receive childhood vaccinations such as MMR, varicella, and polio. If these vaccines are not required for employees, then the policy is likely unconstitutional, according to the rulings in Fulton and Tandon. Similarly, if the clinical rotation student is mandated to receive the Tdap, flu, and COVID-19 vaccines, but hospital employees are regularly exempted from these requirements, the policy is likely unconstitutional under Fulton and Tandon.

       While the U.S. Constitution doesn’t apply to private colleges or medical facilities, other arguments are available. For example, we’ve found it fruitful for our clients to present some of the following legal arguments, depending on the facts, circumstances, and applicable state law, with regard to the institution’s vaccine mandate and/or denial of a religious exemption:

•    Breach of contract, including of the implied covenant of good faith and fair dealing;

• Violation of the institution’s mission statement, policies, or procedures regarding discrimination;

• Violation of the institution’s accreditation requirements;

• Contrary to local, state, or national health guidance;

• Contrary to other local facilities’ policies;

• Impermissible coercion and retaliation;

• Contrary to published science or otherwise unscientific, for example mandates for vaccines that do not prevent transmission of the targeted pathogen (COVID-19, IPV, Tdap, etc.); or 

• Violation of federal and state housing laws, such as the federal Fair Housing Act or California’s Fair Employment and Housing Act, if denial requires vacating student housing.

Critically, many of these arguments depend on the student submitting a robust and legally sound religious exemption request. Absent submitting a legally sound exemption, the grounds for most of the arguments listed above fall away because the student failed to meet the legal requirements for an exemption.

When writing an exemption, it is important to understand that the law regarding religious exemptions is complex and non-intuitive. Many people are denied an exemption simply because they used common sense and expected the employer, school, or clinical rotation site to do the same. Some of the basics regarding a religious exemption are summarized below.   

• Generally speaking, to qualify for a religious exemption to a vaccine mandate, the student must articulate a sincere religious belief that he or she holds which prevents him or her from receiving the vaccine(s) at issue. Therefore, simply reciting statements such as, “I have sincere religious beliefs against vaccination” is generally insufficient.

• In most instances, institutions can question the sincerity or the religious nature of the beliefs.

• The terms “sincere” and “religious” are what the legal profession calls “terms of art,” meaning they don’t have the ordinary meaning that most people would ascribe to them. These terms are defined by case law.

• The student must clearly explain why his or her religious beliefs prevent vaccination with each vaccine that is mandated.  Simply reciting religious beliefs is not sufficient.  

• Whether the student qualifies for the religious exemption is not a theology question. It is a legal question and must meet legal strictures. The student can have a deeply held belief, but if the student presents the beliefs in a way that violates the “rules” for what is considered a valid religious exemption, it may get denied.

• Legal arguments or citations should never appear in a statement describing religious beliefs or in an application for religious accommodation.  

Medical Exemptions

Medical exemptions are also complicated and nuanced, and a full review of the law for medical vaccine exemptions is beyond the scope of this article. However, the basics of a medical exemption are as follows:

• Medical exemptions are based on a physician-diagnosed medical condition, impairment, disability, condition, or history of the same. Examples include anaphylactic allergies, diabetes, neurological conditions, depression, arthritis, genetic conditions, previous adverse vaccine reactions, eye conditions, and asthma.

• A healthcare provider writes a medical exemption (but the student can propose language for the medical professional to use).

• The language in a medical exemption should follow the language used by the U.S. Centers for Disease Control and Prevention (CDC) in its vaccine contraindications and precaution guidance and the language found in the Americans with Disabilities Act (ADA). However, strict adherence to the CDC’s contraindications and precautions table isn’t necessarily required.

• The ADA and the state law equivalent govern medical exemptions. The ADA is a federal statute that applies to private and public institutions (but not necessarily private religious institutions). 

• The ADA’s definition of “disability” is very broad, so many people are surprised to learn that they likely qualify for ADA protection and may be eligible for a medical vaccine exemption. 

• Medical exemptions must be very specific and clearly connect the student’s medical condition with the need to avoid the required vaccine(s). Most physicians aren’t familiar with writing a legally sufficient vaccine exemption, so it is helpful to work with a knowledgeable attorney regarding the required language.

The additional arguments listed above can also apply to medical exemptions.  In addition, a clinical rotation student seeking a medical exemption should be familiar with any state and city anti-discrimination statutes. For example, New York’s State and City Human Rights Laws apply to people in New York City. Likewise, for students in California, the Unruh Act and the Disabled Persons Act prohibit disability-based discrimination by any business establishment and grant all California citizens full and equal accommodations in all business establishments. These laws may come into play if the clinical rotation student has an impairment or condition that is protected by these statutes if the condition or impairment supports that vaccination is more of a risk than a benefit.

Working with a knowledgeable attorney at the outset can prove beneficial to getting a vaccine exemption granted.  When seeking out an attorney, it is best to ask for the firm’s experience and success rate in obtaining vaccine exemptions for clinical rotation students, college students, and employees.   

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Allison R. Lucas is a partner at Siri Glimstad LLP and has experience in a wide range of litigation matters and administrative proceedings. In her current practice, she has assisted over a thousand clients seeking medical and religious accommodation to a vaccine mandate, including requests, appeals, and litigation. 

Vaccine Exemption Attorneys - Siri & Glimstad LLP (sirillp.com).  

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