State law requiring madatory vaccination as a condition of attending school is constitutional

Workman v. Mingo County Sch., No. 09-2352 (4th Cir. Mar. 22, 2011)

Abstract: A three-judge panel of the U.S. Court of Appeals for the Fourth Circuit (MD, NC, SC, VA, WV) has ruled, in an unpublished opinion, that a West Virginia statute requiring mandatory vaccination of children as a condition of attending school in the state is constitutional. The panel concluded that the parent’s Free Exercise, Equal Protection, and Due Process Clauses challenges were without merit.

The panel concluded that the weight of U.S. Supreme Court precedent regarding state mandatory vaccination laws supported the conclusion that the statute does not infringe on either the parent’s or child’s free exercise of religion rights. The panel likewise rejected the as-applied and facial equal protection challenges, finding the statute’s lack of a religious exemption was not discriminatory on its face. Finally, the panel found the mother’s substantive due process right to refuse to have her child immunized as a condition to attending school in West Virginia was not a fundamental right subject to Fourteenth Amendment due process protection.

Facts/Issues: Jennifer Workman is the mother of S.W. and M.W. Because S.W. developed health problems after receiving vaccinations, she decided not have M.W. vaccinated. Under West Virginia law “no child shall be admitted to any of the schools of the state until the child has been immunized for diphtheria, polio, rubeola [measles], rubella, tetanus, and whooping cough. ” The sole exception to this provision “exempts a person who presents a certificate from a reputable physician showing that immunization for these diseases ‘is impossible or improper or other sufficient reason why such immunizations have not been done.’” Workman obtained a certificate from a child psychiatrist and was allowed to enroll M.W. in a Mingo County Schools (MCS) pre-kindergarten class. However, a school nurse challenged the certificate and MCS eventually barred Workman from enrolling M.W. in any of MCS’ schools until she complied with the mandatory vaccination law.

Workman filed suit against MCS and a number of state and school officials in federal district court. She alleged that defendants’ denial of her application for a medical exemption violated her First Amendment, equal protection and due process rights, as well as the state statute allowing a medical exemption. Concluding her constitutional claims were without merit, the district court dismissed the federal claims, and granted the defendants summary judgment on the remaining claims.

Ruling/Rationale: The Fourth Circuit panel affirmed the lower court’s decision. Before addressing the federal constitutional issues, it upheld the district court’s finding that there were no triable issues of fact that precluded the district court from granting summary judgment. Specifically, the panel agreed that the questions of whether defendants acted “properly” in overturning Workman’s medical exemption pursuant to state law and whether Workman’s religious beliefs are sincere and genuine were not questions of fact, but rather “purely legal determinations.” In regard to Workman’s religious beliefs, the panel pointed out that the sincerity of her beliefs were immaterial to resolution of the suit because those “beliefs do not exempt her from complying with West Virginia’s mandatory immunization program.”

Regarding Workman’s First Amendment free exercise of religion claim, the panel first noted that it was unnecessary to determine what level of scrutiny should be applied because even if strict scrutiny applied, “prior decisions from the Supreme Court guide us to conclude that West Virginia’s vaccination laws withstand such scrutiny.” U.S. Supreme Court precedent confirmed that it is a valid exercise of a state’s police power to require its residents to be vaccinated against communicable diseases that threaten the public health and safety. In support of the proposition that the right to free exercise of religion does not “include liberty to expose the community or the child to communicable disease,” the panel cited Prince v. Massachusetts, 321 U.S. 158 (1944). It also pointed out that a number of federal and state court decisions supported the conclusion that a state law “requiring vaccinations as a condition of admission to school does not unconstitutionally infringe [a parent’s] right to free exercise” of religion.

The panel next analyzed Workman’s equal protection claim, which included as-applied and facial challenges. On the as-applied challenge, the court found, “Although Workman asserts that [MCS officials] used the statute and accompanying regulations improperly, she points to no evidence of unequal treatment, and we see none.” The district court, therefore did not err in ruling Workman’s as-applied challenge was without merit. As to the facial challenge, the panel stressed that because it is well-established that mandatory immunization statutes are constitutional, there is no requirement that such statutes provide any exemptions, including one for religion. It found that Workman’s arguments fell short of showing facial invalidity based on religion because her complaint “is not that [the statute] targets a particular religious belief but that it provides no exception from general coverage for hers.”

Lastly, the panel tackled the substantive due process claim. It concluded that Workman does not possess under the Due Process Clause a fundamental “right [as a parent] to refuse to have her child immunized before attending public or private school where immunization is a precondition to attending school.” It reemphasized that the “Supreme Court has consistently recognized that a state may constitutionally require school children to be immunized.” Consequently, the panel concluded “Workman has failed to demonstrate that the statute violates her Due Process rights.”

Workman v. Mingo County Sch., No. 09-2352 (4th Cir. Mar. 22, 2011)

[Editor's Note: In April 2010, a federal district court in New York ruled  in favor of the school district in a similar dispute.  Unlike West Virginia's, however, the New York immunization statute provides an exmption for “children whose parent, parents, or guardian hold genuine and sincere religious beliefs which are contrary to the practices herein required, and no certificate shall be required as a prerequisite to such children being admitted or received into school or attending school.”  The federal district court, therefore, had to determine whether the parents' objection to vaccinating their child was based on "genuine and sincere" religious beliefs. The court determined that it was not.  A summary of the opinion is available at the first link below.

Meanwhile, the Seattle Times reports that public health officials are supporting a proposal in the Washington legislature to make it more difficult for parents to avoid school-entry immunization requirements. The measure under consideration has drawn strong support in both houses of the legislature and faced little opposition until recently, when vaccine-resisting parents mobilized to pack hearings and lobby lawmakers.  The proposal would require parents who seek exemption from current state law to submit proof that a health provider has informed them of the risks and benefits of immunization. The article is available at the second link below.]

NSBA School Law Issues pages on Cavielzel v. GNPS

Source: Seattle Times, 3/22/11, By Carol M. Ostrom

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