By Linda C. Schoonmaker and Elizabeth L. Humphrey

Seyfarth Synopsis: Hospitals spend copious amounts of time developing hiring systems to ensure that the most-qualified applicants are selected for jobs in the healthcare field. The lives of millions of Americans depend on a hospital’s ability to provide access to knowledgeable healthcare providers, which ensures excellence in patient care. EEOC v. Methodist Hospitals of Dallas, a recent opinion from the Fifth Circuit, suggests that hospitals may not be able to hire the most qualified applicant when faced with certain accommodation requests under the Americans with Disabilities Act. 

Adriana Cook worked as a patient care technician (PCT) at Methodist Hospital in Dallas. In 2012, Cook injured her back on the job while turning a patient. Following her injury, Cook was unable to return to her PCT position and was assigned to a temporary light-duty role in the pharmacy. After unsuccessfully attempting to return to her PCT job, Cook’s physicians certified that she was physically unable to work for several months.

Between April and July 2012, Cook submitted five requests for FMLA leave and Methodist’s third-party administrator approved each request. While on FMLA leave, Cook requested accommodations that she believed would enable her to perform the more strenuous tasks of the PCT position. Instead of offering reasonable accommodations, Cook was encouraged to seek other work. On July 2, Cook applied for a scheduling coordinator job, which she would not have needed an accommodation to perform. Cook met the minimum qualifications, however, another candidate was selected.

On July 12, Cook’s physician sent Methodist a letter stating that Cook “is unable to physically return to the type of work involved in patient care at the hospital” and that the restriction was permanent. On August 3, Methodist began discussing Cook’s need for accommodations. Ultimately, Methodist determined that Cook should take personal leave so it could fill her position. On August 7, Methodist sent Cook a letter offering her six months of unpaid personal leave with no guarantee of reemployment. The letter requested medical documentation certifying Cook’s inability to work, and stated that, if Cook failed to submit the requested certification, Methodist would presume that she resigned. Cook did not submit the documentation requested and was terminated.

The EEOC sued Methodist for allegedly violating the Americans with Disabilities Act (ADA). The EEOC alleged that Methodist’s categorical policy of hiring the most qualified candidate violates the ADA when a qualified disabled employee requests reassignment to a vacant role, even if he or she is not the most qualified applicant. The EEOC also alleged that Methodist failed to reasonably accommodate Cook, who was not reassigned to the vacant position for which she applied. The district court granted Methodist’s motion for summary judgment on both claims. The EEOC appealed, arguing that the Supreme Court’s ruling in US Airways, Inc. v. Barnett requires Methodist to make exceptions to its most-qualified-applicant policy and that Cook was entitled to a reasonable accommodation under the ADA.

The Fifth Circuit vacated the judgment of the district court as to Methodist’s most-qualified-applicant policy and remanded for further proceedings consistent with its opinion. In rendering its opinion, the Fifth Circuit discussed the Barnett opinion, which held that reassignment is not a reasonable accommodation when an employer has an established seniority system. Barnett also set out a two-step test for determining whether an accommodation is reasonable. First, the employee must show that the requested accommodation seems reasonable on its face, i.e. in the “run of cases.” If an employee makes that showing, the employer must then demonstrate that the requested accommodation poses an undue hardship in the particular circumstances. If the employee fails to show that the accommodation is reasonable in the “run of cases,” he or she may show that special circumstances warrant a finding that the requested accommodation is reasonable on the particular facts of the case.

The Fifth Circuit upheld the district court’s holding that mandatory reassignment in violation of Methodist’s most-qualified applicant policy is not reasonable in the run of cases. The Court noted that “[t]he level of preferential treatment the EEOC asks for would compromise the hospital’s interest in providing excellent and affordable care to its patients and would be unfair to [Methodist’s] other employees.” The Court stated that the “EEOC’s proposed course of action turns the shield of the ADA into a sword” and “imposes substantial costs on the hospital and potentially on patients.” The Court recognized that “[w]hen lives of patients are on the line, mandatory reassignment in violation of a best-qualified system is unreasonable in the run of cases.”

However, the Court found that the district court failed to address the second step of Barnett, that is, whether the requested accommodation is reasonable as applied to Cook. Therefore, the Court remanded the case to the district court, with instructions that it focus on determining whether the EEOC can raise a genuine issue of material fact as to whether Cook’s case presents special circumstances that justify an exception to Methodist’s most-qualified application policy.


Although sympathetic to healthcare employers’ need to hire the most-qualified employees in their endeavor to provide excellent patient care, the Cook opinion invites employees to argue that they are entitled to a mandatory reassignment based on the specific facts of their case. This position has the potential to have considerable impact on the costs of hiring in the healthcare industry (and beyond). A healthcare employer seeking to avoid a lawsuit may be more inclined to incorporate an additional layer of legal assessment in its hiring process – one that considers the litigation risk associated with hiring the most-qualified applicant (an ADA suit) versus the risk of hiring a less-qualified applicant (a malpractice suit).

Healthcare employers should consider adopting clear, written policies that explain the business criteria for selecting applicants. An employee seeking mandatory reassignment as an accommodation may have more difficulty showing that the assignment is reasonable in the face of express policies delineating the employer’s justification for hiring the most-qualified applicant, i.e. to secure patient safety and to provide outstanding patient care. Healthcare organizations should regularly review their hiring policies in order to ensure their business and hiring principles are clearly articulated in a manner that insulates the employer from litigious employees.

For more information on this or any related topic, please contact the authors, your Seyfarth attorney, or any member of the Workplace Counseling & Solutions Team or the Workplace Policies and Handbooks Team.