## Facts

- West Virginia required specified immunizations as a condition of admission to public school, allowing exemption only upon a physician’s certificate that vaccination was “impossible or improper” or for another sufficient medical reason.
- Jennifer Workman refused to vaccinate her daughter (M.W.), claiming a prior child (S.W.) suffered health problems after vaccination.
- Workman obtained a “Permanent Medical Exemption” certificate from a child psychiatrist recommending against vaccinating M.W. based on S.W.’s condition.
- A county health officer initially approved the certificate, and M.W. attended public pre-kindergarten for about one month.
- After a nurse questioned the certificate, the county superintendent sought guidance from the state health director, who recommended denial of the exemption.
- The county program notified Workman that M.W. could no longer attend as of October 12, 2007; M.W. later attended a different program that accepted the certificate.
- Workman asserted religious objections to vaccination and alleged constitutional violations arising from the absence of a religious exemption and from the denial of her requested exemption.

## Issues

1. Whether a generally applicable school immunization mandate that provides only medical exemptions violates the Free Exercise Clause, including under a “hybrid-rights” theory combining free exercise and parental rights.
2. Whether conditioning school attendance on vaccination violates substantive due process parental rights to direct a child’s upbringing and medical care.
3. Whether allowing medical exemptions but not religious exemptions violates the Equal Protection Clause.
4. Whether the record supported a claim that officials denied the exemption due to religious discrimination, and whether Eleventh Amendment immunity barred claims against state entities and officials.

## Decision

- The Fourth Circuit affirmed summary judgment for the defendants.
- The court held the immunization requirement, without a religious exemption, did not violate the Free Exercise Clause, Equal Protection, or substantive due process.
- The court declined to resolve whether “hybrid-rights” doctrine applies in the circuit, concluding that the mandate would survive even if strict scrutiny were assumed.
- The court found no evidence that the exemption decision reflected religious hostility rather than enforcement of the statutory criteria.
- The court held state entities and certain officials sued in their official capacities were protected by Eleventh Amendment immunity from damages, and there was no basis for prospective relief given no ongoing federal violation.

## Legal Principles

- Neutral, generally applicable laws that incidentally burden religious exercise ordinarily do not violate the Free Exercise Clause.
- A state has compelling authority to protect public health through school vaccination requirements and may condition school attendance on immunization, subject to constitutionally sufficient exceptions.
- Parental rights are fundamental but not absolute; they may be limited to protect children and the community from communicable disease.
- Distinguishing medical exemptions from non-medical exemptions is constitutionally permissible where it rationally advances disease-prevention goals.
- Eleventh Amendment immunity bars damages claims in federal court against state agencies and officials in their official capacities absent a valid exception; prospective relief requires an ongoing federal-law violation.

## Conclusion

The Fourth Circuit upheld West Virginia’s school immunization mandate and its medical-exemption-only framework, concluding that denying a requested exemption in these circumstances did not violate free exercise, equal protection, or parental substantive due process rights and that certain claims against state defendants were barred by sovereign immunity.


Workman v. Mingo Cnty. Bd. of Educ., 419 F. App’x 348 (4th Cir. 2011)