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Ruggiero v. Mount Nittany Medical Center

United States District Court, M.D. Pennsylvania

May 15, 2017



          Matthew W. Brann United States District Judge

         I. Background

         Plaintiff, Alexa Ruggiero, is a nurse who was terminated from her employment with Defendant, Mount Nittany Medical Center. Plaintiff maintains that her termination was in violation of the Americans with Disabilities Act[2] and filed the instant one-count action against her former employer. Defendant countered with a motion to dismiss, which is the subject of the instant Memorandum Opinion. Additionally, Plaintiff has filed a motion to amend the complaint to add a claim under the Pennsylvania Human Relations Act.[3] For the reasons that follow, both motions will be granted.

         Plaintiff should be cautioned, however, that for the reasons expressed in this Memorandum Opinion, I consider her claim tenuous, at best, and I will not hesitate to summarily dismiss the amended complaint if the deficiencies identified herein are not rectified.

         II. Discussion

         A. Standard of Review

         Under Federal Rule of Civil Procedure 12(b)(6), a defendant may file a motion to dismiss for “failure to state a claim upon which relief can be granted.” Such a motion “tests the legal sufficiency of a pleading” and “streamlines litigation by dispensing with needless discovery and factfinding.”[4] “Rule 12(b)(6) authorizes a court to dismiss a claim on the basis of a dispositive issue of law.”[5]This is true of any claim, “without regard to whether it is based on an outlandish legal theory or on a close but ultimately unavailing one.”[6]

         Beginning in 2007, the Supreme Court of the United States initiated what some scholars have termed the Roberts Court's “civil procedure revival” by significantly tightening the standard that district courts must apply to 12(b)(6) motions.[7] In two landmark decisions, Bell Atlantic Corporation v. Twombly and Ashcroft v. Iqbal, the Roberts Court “changed . . . the pleading landscape” by “signal[ing] to lower-court judges that the stricter approach some had been taking was appropriate under the Federal Rules.”[8] More specifically, the Court in these two decisions “retired” the lenient “no-set-of-facts tes”" set forth in Conley v. Gibson and replaced it with a more exacting “plausibility” standard.[9]

         Accordingly, after Twombly and Iqbal, “[t]o survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.'”[10] “A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.”[11] “Although the plausibility standard does not impose a probability requirement, it does require a pleading to show more than a sheer possibility that a defendant has acted unlawfully.”[12] Moreover, “[a]sking for plausible grounds . . . calls for enough facts to raise a reasonable expectation that discovery will reveal evidence of [wrongdoing].”[13]

         The plausibility determination is “a context-specific task that requires the reviewing court to draw on its judicial experience and common sense.”[14] No matter the context, however, “[w]here a complaint pleads facts that are ‘merely consistent wit' a defendant's liability, it ‘stops short of the line between possibility and plausibility of entitlement to relief.'”[15]

         When disposing of a motion to dismiss, a court must “accept as true all factual allegations in the complaint and draw all inferences from the facts alleged in the light most favorable to [the plaintiff].”[16] However, “the tenet that a court must accept as true all of the allegations contained in the complaint is inapplicable to legal conclusions.”[17] “After Iqbal, it is clear that conclusory or ‘bare-bones' allegations will no longer survive a motion to dismiss.”[18] “Threadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice.”[19]

         As a matter of procedure, the United States Court of Appeals for the Third Circuit has instructed that:

Under the pleading regime established by Twombly and Iqbal, a court reviewing the sufficiency of a complaint must take three steps. First, it must tak[e] note of the elements [the] plaintiff must plead to state a claim. Second, it should identify allegations that, because they are no more than conclusions, are not entitled to the assumption of truth. Finally, [w]hen there are well-pleaded factual allegations, [the] court should assume their veracity and then determine whether they plausibly give rise to an entitlement to relief.[20]

         I turn now to the Plaintiff's factual allegations, which I must accept as true on a Rule 12(b)(6) motion.

         B. Facts alleged in the complaint

         Plaintiff, Alexa Ruggiero, hereinafter “Ruggiero, ” commenced employment with Defendant, the Mount Nittany Medical Center, hereinafter “MNMC” in 2008. Ruggiero is a registered nurse, who, according to the complaint, was “a dedicated and hard-working employee who performed her job well.”[21] Ruggiero suffers from both anxiety and eosinophilic esophagitis. The complaint describes eosinophilic esophagitis as a “chronic immune system disease.”[22] Ruggiero asserts that because of these health conditions, “she is (at times) limited in her ability to perform some daily life activities, including but not limited to eating, sleeping, and engaging in social interactions.”[23]

         On April 22, 2015, MNMC sent a memo to all clinical employees, including Ruggiero, stating that it was instituting a new requirement that all clinical employees would be required to obtain a Tetanus, Diphtheria, and Pertussis, hereinafter “TDAP, ” vaccine. In response, Ruggiero's physician, Suzanne Dib, M.D., issued a note advising MNMC that Ruggiero “is medically exempt from receiving tdap immunication for medical concerns.”[24] Emma Smith, RN, hereinafter “Smith, ” the employee health coordinator for MNMC, replied to Dr. Dib by letter dated June 10, 2015, requesting that Dr. Dib identify the medical contraindication that applied to Ruggiero. Precisely one month later, Dr. Dib sent MNMC a letter in response that stated “Alexa Ruggiero is medically exempt from receiving the Tdap immunization due to 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.”[25]

         On July 15, 2015, Smith sent a letter to Ruggiero stating that “the documentation provided by Dr. Dib does not meet the definition of medical contraindication as detailed in the manufacturer's vaccine literature and thus Tdap immunization is required.”[26] Ruggiero was “effectively”[27] terminated on July 22, 2015, for not having obtained the Tdap vaccine. Her termination was finalized on July 31, 2015, in a writing entitled a “Record of Corrective Action.”[28] Ruggiero asserts that her termination was in violation of the ADA.

         C. Analysis

         1. Plaintiff's Failure to Accommodate Claim will be dismissed .[29]

         The ADA was designed to “eliminate” and “address discrimination against individuals with disabilities.”[30] Ruggiero argues that she has an “actual/perceived/record” of disability and MNMC retaliated against her and/or failed to accommodate her reasonable accommodation request. “To state a claim for employment discrimination under the ADA, a plaintiff must demonstrate that he or she is a ‘qualified individual with a disability' within the meaning of the Act, and that he or she has suffered an adverse employment decision as a result of the discrimination.”[31]

         Although, pursuant to Connelly[32], Ruggiero does not need to set forth a prima facie case of discrimination at this stage of the litigation, the elements of an ADA case nevertheless provide a useful roadmap as previously delineated by the United States Supreme Court, as follows.

         First, the ADA says that an employer may not “discriminate against a qualified individual with a disability.” 42 U.S.C. § 12112(a). Second, the ADA says that a “qualified” individual includes “an individual with a disability who, with or without reasonable accommodation, can perform the essential functions of” the relevant “employment position.” § 12111(8). Third, the ADA says that “discrimination” includes an employer's “not making reasonable accommodations to the known physical or mental limitations of an otherwise qualified ... employee, unless [the employer] can demonstrate that the accommodation would impose an undue hardship on the operation of [its] business.” § 12112(b)(5)(A) Fourth, the ADA says that the term “reasonable accommodation” may include [job restructuring, part-time or modified work schedules, reassignment to a vacant position, acquisition or modification of equipment or devices, appropriate adjustment or modifications of examinations, training materials or policies, the provision of qualified readers or interpreters, and other similar accommodations for individuals with disabilities.]” § 12111(9)(B).[33]

         a. Ruggiero has alleged that she is a qualified individual with a disability

         “A ‘qualified individual with a disability' is ‘an individual with a disability who, with or without reasonable accommodation, can perform the essential functions of the employment position that such individual holds or desires.'”[34] For the purposes of the ADA, a “disability” is “a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or being regarded as having such an impairment.”[35] Major life activities can include, among other things, “caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working.”[36] Ruggiero alleges, and under Rule 12(b)(6) I must accept as true, that she is limited in “her ability to perform some daily life activities, including but not limited to eating, sleeping, and engaging in social interactions.”[37] MNMC first argues that Ruggiero is not disabled as defined by the ADA, because she did not allege how her conditions “substantially limit” any major life activity, she has merely made a “naked assertion to that effect.”[38] The EEOC has issued regulations defining the undefined terms from the statute. “An impairment is a disability within the meaning of this section if it substantially limits the ability of an individual to perform a major life activity as compared to most people in the general population.”[39] “The comparison of an individual's performance of a major life activity to the performance of the same major life activity by most people in the general population usually will not require scientific, medical, or statistical analysis.”[40] “The primary object of attention in cases brought under the ADA should be whether covered entities have complied with their obligations and whether discrimination has occurred, not whether an individual's impairment substantially limits a major life activity.”[41]

         “Given the rules of construction set forth in paragraphs (j)(1)(i) through (ix) of this section, it may often be unnecessary to conduct an analysis involving most or all of these types of facts.”[42] “This is particularly true with respect to impairments such as those described in paragraph (j)(3)(iii) of this section, which by their inherent nature should be easily found to impose a substantial limitation on a major life activity, and for which the individualized assessment should be particularly simple and straightforward.”[43] That subsection states:

For example, applying the principles set forth in paragraphs (j)(1)(i) through (ix) of this section, it should easily be concluded that the following types of impairments will, at a minimum, substantially limit the major life activities indicated: Deafness substantially limits hearing; blindness substantially limits seeing; an intellectual disability (formerly termed mental retardation) substantially limits brain function; partially or completely missing limbs or mobility impairments requiring the use of a wheelchair substantially limit musculoskeletal function; autism substantially limits brain function; cancer substantially limits normal cell growth; cerebral palsy substantially limits brain function; diabetes substantially limits endocrine function; epilepsy substantially limits neurological function; Human Immunodeficiency Virus (HIV) infection substantially limits immune function; multiple sclerosis substantially limits neurological function; muscular dystrophy substantially limits neurological function; and major depressive disorder, bipolar disorder, post-traumatic stress disorder, obsessive compulsive disorder, and schizophrenia substantially limit brain function.[44]

         Plaintiff argues that the Court cannot, and should not, determine if she has a disability as statutorily defined. This issue is a question of fact, best answered on summary judgment or at trial. That said, “whether the impairment substantially limits a major life activity is ordinarily a question of fact for the jury.”[45] On a Rule 12(b)(6) motion, I must accept the factual assertions as true. Accordingly, I accept the factual assertions underlying her contention that she is a “qualified individual with a disability” because Ruggiero has alleged that she is substantially limited in what the EEOC has defined as major life activities.

         b. Defendant has not disputed whether or not Ruggiero can perform the essential functions of the position with or without accomodation.

         Defendant does not dispute that Ruggiero could perform the essential functions of her position as a nurse. Ruggiero alleged that “during her employment with Defendant, Plaintiff was a dedicated and hard-working employee who performed her job well.”[46] Accordingly, it is undisputed that she has sufficiently stated this element of her claim.

         The claim fails, however, primarily on the next two elements - Ruggiero did not advise MNMC that she had any sort of limitation necessary of accommodation and MNMC engaged in a good faith effort to accommodate her.

         c. Ruggiero's mental and physical limitations were not known to MNMC

         MNMC next argues that it was unaware of Ruggiero's disability. “To establish discrimination because of a disability, an employer must know of the disability”[47] and “and the employee's desire for accommodations for that disability.”[48] “The fact that plaintiff conveyed a health care professional's initial findings [a medical impairment] does not support an inference that Defendants were aware of a disability.”[49] “Simply informing an employer of a particular condition is not tantamount to providing the employer with knowledge that the employee is substantially limited in some major life activity.”[50] “Vague or conclusory statements revealing an unspecified incapacity are not sufficient to put an employer on notice of its obligations under the ADA.”[51]

         Beginning in July 2011, the MNMC required all new employees to provide documentation of having received the TDAP vaccine or have it administered through the employee health center.[52] On April 22, 2015, MNMC sent a memo to Ruggiero notifying her that she, along with all clinical employees, was now required to obtain the TDAP vaccine.[53] That memo is attached in full.

         (Image Omitted)

         Ruggiero could have, but did not, allege facts that she advised MNMC that she was unable to take the TDAP vaccine because of her alleged disabilities. What transpired was, as follows. On May 18, 2015, Christina Duck, the MNMC employee health assistant, sent an email to Ruggiero notifying her that her vaccination was overdue.[54] On May 20, 2015, Ruggiero responded by email that she had “a doctor's appointment on June 2nd regarding the TDAP vaccine.”[55] She did not tell MNMC either prior to the vaccine due date, nor in this May 2015 email exchange, that she did not intend to obtain the vaccine as required. Instead, on June 2, 2015, her physician, Dr. Suzanne Dib, sent the following note[56] to MNMC:

         (Image Omitted)

         On June 10, 2015, in response, MNMC sent a letter to Dr. Dib explaining that the TDAP is mandatory for all employees, and asked Dr. Dib to provide the documented medical contraindication that provided the basis for non-compliance.[57]The letter was sent by Emma Smith and a copy was sent to Ruggiero. The text of that letter, in its entirety, reads as follows:

         Dear Dr. [Dib];

I am in receipt of your note regarding Ms. Aleka Ruggiero dated June 2, 2015, wherein you request that Ms. Ruggiero be “medically exempt from receiving tdap immunization for medical concerns.”
Boostrix vaccine is the Tdap vaccine that is supplied at Mount Nittany Medical Center to all employees for our mandatory vaccination program. I have enclosed applicable information from the manufacturer (GSK) regarding Boostrix vaccine for your review. The manufacturer lists the following contraindication:
1. Hypersensisitivy (anaphylaxis)
2. Encephalopathy

         Additionally, the following warnings/precautions are listed:

1. Latex sensitivity
2. Guillain-Barre Syndrome and Brachial Neuritis
3. Syncope
4. Progressive or unstable neurologic disorders
5. Arthus-type ...

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