The ruling also exposes a costly EEOC mistake that HR teams must avoid
A healthcare company's vaccine mandate did not make it the joint employer of outside clinical staff, a federal appeals court ruled March 3, 2026.
The case started the way many workplace disputes do: a policy, a refusal, and a termination. Two nurse anesthetists, Kelly Hoffman and Lorraine Austin, lost their clinical privileges at Inova Health Care Services facilities in Virginia after they sought exemptions from the company's Covid-19 vaccination requirement, were denied, and then refused to be vaccinated. North American Partners in Anesthesia, or NAPA – the anesthesiology company that formally employed them – let them go about two months later. The nurses then sued, arguing that Inova shared responsibility for what happened to them.
The United States Court of Appeals for the Fourth Circuit disagreed.
Hoffman and Austin were Certified Registered Nurse Anesthetists employed by American Anesthesiology of Virginia, a NAPA subsidiary. Under a service contract, American Anesthesiology provided anesthesia staff exclusively to Inova facilities. Hoffman had worked there for five years; Austin for twenty. When Inova denied their exemption requests in 2022 and suspended their clinical privileges at its facilities, both nurses argued that the company's role in their professional lives was substantial enough to make it their employer too – a legal concept known as joint employment.
The court was not persuaded.
To determine whether an organization qualifies as a joint employer, courts in the Fourth Circuit examine nine factors, with the three most important being whether the entity had the power to hire and fire, whether it supervised day-to-day work, and whether it controlled the physical workspace and equipment. On the first two, Inova fell short. On the third – use of its equipment and facilities – the court found that factor carried little weight in a hospital setting, where all clinical staff use the same tools and spaces regardless of who employs them.
The court found that NAPA – not Inova – held the authority to terminate the nurses. While Hoffman's contract allowed Inova's removal demand to serve as grounds for dismissal, the final call still belonged to NAPA. The nurses also alleged that Inova "exercised oversight" over their work, but offered little to support that claim beyond a single incident where Inova staff told them they could leave early and other Inova staff later disciplined them for it. One apparently erroneous instruction, the court said, does not amount to daily supervision.
The nurses also pointed to Inova's control over medication approvals. The court acknowledged it but found it carried no real weight as evidence of employment. Hospitals, it noted, must exercise a baseline level of clinical oversight over everyone working in their facilities – employees and outside contractors alike. That kind of control comes with running a healthcare facility, not with employing the staff.
On the question of training, Inova had provided the nurses with instruction on its charting system and equipment, workplace harassment, and patient privacy law, and also debriefed staff after negative patient outcomes. Again, the court was unimpressed. That training reflected Inova's obligations under federal law and standard patient care practice – not the kind of professional development that signals an employer-employee relationship. Neither nurse alleged that Inova had trained them in anesthesia, which was their core specialty and a responsibility that belonged exclusively to American Anesthesiology staff.
The court also pointed to the nurses' own complaints, which acknowledged they were NAPA employees throughout. That admission undercut any claim that they intended to enter into an employment relationship with Inova.
Hoffman's case carried an additional complication. She had also sued NAPA directly, but her original discrimination charge filed with the Equal Employment Opportunity Commission named only Inova. Eight months later, she sent a letter through the EEOC's online portal attempting to bring NAPA into the picture. It did not work. The court ruled that a private letter to the EEOC does not amend a formal charge – and since NAPA never received official notice of any claim against it before the lawsuit was filed, Hoffman could not proceed against the company.
For HR professionals, the ruling offers two clear takeaways. First, operating a facility that contractor staff work in – even exclusively – does not automatically expose a company to joint employer liability under federal discrimination law. The degree of actual, day-to-day control over those workers is what matters, and oversight tied to clinical standards or facility safety policies will not clear that bar on its own. Second, anyone involved in helping employees navigate discrimination complaints should understand that the EEOC charge is the foundation of any future lawsuit. Every intended respondent must be named from the start. Informal follow-up communications with the agency will not fill that gap.
The Fourth Circuit affirmed the dismissal of both complaints in full.
