Armstrong v. Flowers Hosp., Inc.
| Decision Date | 03 October 1994 |
| Docket Number | No. 93-6502,93-6502 |
| Citation | 33 F.3d 1308 |
| Parties | 65 Fair Empl.Prac.Cas. (BNA) 1742, 63 USLW 2275 Pam ARMSTRONG, Plaintiff-Appellant, v. FLOWERS HOSPITAL, INCORPORATED, Defendant-Appellee. |
| Court | U.S. Court of Appeals — Eleventh Circuit |
Truman H. Hobbs, Jr., Copeland, Franco, Screws & Gill, Montgomery, AL, for appellant.
L. Traywick Duffie, Terri L. Rosen, Hunton & Williams, Atlanta, GA, for appellee.
Appeal from the United States District Court for the Middle District of Alabama.
Before ANDERSON and BIRCH, Circuit Judges, and CONWAY *, District Judge.
In January 1992, Pamela Armstrong filed suit against Flowers Hospital, Inc. alleging a violation of Title VII of the Civil Rights Act of 1964 ("Title VII"), 42 U.S.C. Sec. 2000e-2(a)(1) and (2), as amended by the Pregnancy Discrimination Act of 1978 ("PDA"), 42 U.S.C. Sec. 2000e(k). Armstrong's complaint also asserted claims of fraudulent misrepresentation and breach of contract. The district court granted summary judgment in favor of Flowers Hospital on Armstrong's claim of disparate treatment and disparate impact under Title VII, and on her claim of fraudulent misrepresentation. Armstrong v. Flowers Hosp., Inc., 812 F.Supp. 1183 (M.D.Ala.1993). The parties then settled the breach of contract issue, and this appeal followed. For the reasons stated below, we affirm.
We review a grant of summary judgment de novo, applying the same legal standard employed by the district court. Hairston v. Gainesville Sun Publishing Co., 9 F.3d 913, 918 (11th Cir.1993). A motion for summary judgment is properly granted "if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law." Fed.R.Civ.P. 56(c).
The party seeking summary judgment bears the initial burden of demonstrating the basis for its motion and the absence of a genuine issue of material fact. Hairston, 9 F.3d at 918. In determining whether this burden has been met, the district court must review the evidence and all factual inferences drawn from that evidence in the light most favorable to the non-moving party. Id. If this initial burden is met, the burden shifts to the non-moving party to establish that there exist genuine issues of material fact. Id.
In June 1989, Armstrong received an associate's degree in nursing from Wallace College in Dothan, Alabama. Following her graduation, she was employed as a nurse in the newborn nursery of Southeast Alabama Medical Center ("SAMC"). After one year with SAMC, Armstrong concluded that her evening shift at SAMC made it difficult to meet her family's needs, and she decided to look for a day job. She responded to an advertisement for a position in the Home Care Services division ("HCS") of Flowers Hospital. Shortly after an interview with Cheryl Wynn, the administrator of the Dothan, Alabama office of HCS, Armstrong accepted a position as a home health care nurse, based in the Dothan office. As part of the terms of her employment, Armstrong understood that her SAMC student loan would be repaid by Flowers Hospital.
Armstrong began her new position in early August 1990. During orientation, she read the HCS policy and procedure manual and also reviewed a handbook on universal precautions. 1 At the end of her orientation, Armstrong assumed responsibility for approximately 25 patients. She periodically visited these patients in their homes and provided whatever nursing services were required.
On Wednesday, December 12, 1990, Mary O'Connell, the HCS admissions nurse, informed Armstrong that, beginning on Friday, December 14, a new patient would be assigned to her. The patient was HIV-positive and had been diagnosed with cryptococcal meningitis. Armstrong understood that the patient had problems with nausea and vomiting and that his medical needs would require her to provide nursing care for four hours each day. 2 Additionally, she understood that it would be necessary for her to draw his blood for lab work. O'Connell explained that special bags would be provided for contaminated materials, and Sharps containers would be available for used needles.
The addition of an HIV positive patient to her schedule caused Armstrong considerable alarm. 3 She had recently learned that she was pregnant, and her primary concern was that caring for an HIV-positive patient would put her fetus at risk. The HIV-virus causes a patient to be more susceptible to various opportunistic diseases. 4 According to Armstrong, it was the risk of these opportunistic diseases and their potential effect on her fetus that made her apprehensive. Her concern was heightened by two factors. First, she was in her first trimester of pregnancy and believed that her fetus was more vulnerable during this period. Second, she had gestational diabetes, which is a form of diabetes that occurs only during pregnancy and which can weaken a woman's immune system.
After some discussion, Armstrong stated that, because of her pregnancy, she "did not need" to see this new patient. R.19, Deposition of Pam Armstrong, dated March 26, 1992 (hereinafter, "Armstrong"), at 55. O'Connell told her to discuss the matter with Cheryl Wynn, who had made the initial patient assignment. Before calling Wynn, Armstrong consulted her nursing textbooks and called her sister and a friend, both of whom are nurses. Based on the advice she received and on the material in her textbooks, she concluded that she should not treat an HIV-positive patient.
Wynn and Armstrong discussed the patient assignment later that evening. The parties agree that Armstrong voiced her concerns about seeing an HIV-positive patient during the first trimester of her pregnancy. The parties also agree that Wynn reviewed the HCS policy regarding patient treatment. That policy provided that refusal to treat a patient was grounds for termination. Wynn also indicated that Armstrong was given this patient assignment because she was in the best position to handle the time required.
Several aspects of the Wednesday evening conversation are in dispute. 5 Armstrong asserts that she discussed her gestational diabetes with Wynn. 6 Armstrong at 68. Wynn does not recall being told about gestational diabetes. R.19, Deposition of Cheryl Wynn, dated March 27, 1992 (hereinafter "Wynn"), at 70. Wynn claims that she offered to provide any equipment that Armstrong believed she needed to work with the HIV-positive patient. Wynn at 57. Armstrong denies this offer was made. Armstrong at 108. At the end of the conversation, Armstrong understood that Wynn would consider the possibility of reassigning this patient to another nurse in order to accommodate Armstrong's concerns. Armstrong at 72. Wynn did, in fact, arrange for another nurse to see the HIV-positive patient. However, this schedule change was made simply in anticipation of Armstrong's refusal to treat him. Wynn at 60.
Immediately after this conversation, Wynn discussed the situation with her supervisor, Donna McPherson, who was the director of clinical services for HCS. Wynn and McPherson have stated that they did not understand why Armstrong would refuse to see an HIV-positive patient. At no time did they consider modifying the HCS policy requiring nurses to treat all patients.
Flowers Hospital has noted that between Wednesday evening and Friday, Armstrong did not take certain steps. She did not inquire more closely into the nature of the nursing services the HIV-positive patient required. Nor did she inquire into the availability of masks, gloves, gowns or other items that could decrease the risk of infection. She did not talk to a physician or her obstetrician-gynecologist. She did not obtain a statement from her physician indicating that she had gestational diabetes. This lack of initiative is explained to some extent by her view of the risks involved in working with HIV-positive patients. Armstrong was convinced that universal precautions, even if properly executed, would not provide sufficient protection. Accordingly, she decided that she would not treat the patient. Armstrong at 95.
On Friday, December 14, Wynn confirmed that Armstrong would not treat the HIV-positive patient. Armstrong then chose to be terminated, rather than to resign.
Prior to Armstrong's termination, another HCS nurse refused to treat an HIV-positive patient. In that case, the nurse was not pregnant. After considering the situation for two or three days, the nurse remained firm in her refusal to treat the patient, and then chose to resign rather than be terminated. According to McPherson, these are the only instances in which a nurse in any of the HCS offices has refused to treat a patient.
At her deposition, Wynn testified that she knew of six nurses who became pregnant while working at HCS. Three of those nurses became pregnant after Armstrong was terminated. All three treated AIDS patients after they became pregnant. 7 Wynn at 102.
A single policy and procedure manual contains the written policy statements for Flowers Hospital and HCS. However, as Wynn and McPherson have noted, many of the policies are applicable only to Flowers Hospital. If the administrators at HCS determine they need to create a policy in order to address a situation, they turn to hospital staff members for guidance. They do not, however, simply adopt existing hospital policies. Instead, they assess the suitability of a given hospital policy to the home health care setting. In the end, HCS administrators may adopt the hospital's policy or, instead, draft a revised policy to meet their own needs.
Only one of the HCS policies in the manual is relevant to this case. That policy, entitled "AIDS-Universal Precautions," has an effective date of September 9, 1988. R.25, Exhibit 6. The policy includes guidelines to be used in the care of...
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