Lorraine Austin v. INOVA Health Care Services

CourtCourt of Appeals for the Fourth Circuit
DecidedMarch 3, 2026
Docket24-1518
StatusPublished

This text of Lorraine Austin v. INOVA Health Care Services (Lorraine Austin v. INOVA Health Care Services) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fourth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lorraine Austin v. INOVA Health Care Services, (4th Cir. 2026).

Opinion

USCA4 Appeal: 24-1518 Doc: 51 Filed: 03/03/2026 Pg: 1 of 17

PUBLISHED

UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT

No. 24-1510

KELLY M. HOFFMAN,

Plaintiff – Appellant,

v.

INOVA HEALTH CARE SERVICES; NORTH AMERICAN PARTNERS IN ANESTHESIA (VIRGINIA) LLC,

Defendants – Appellees.

No. 24-1518

LORRAINE BIONDI AUSTIN,

INOVA HEALTH CARE SERVICES,

Defendant – Appellee.

Appeals from the United States District Court for the Eastern District of Virginia, at Alexandria. Michael Stefan Nachmanoff, District Judge. (1:23-cv-01696-MSN-IDD; 1:23-cv-01698-MSN-JFA)

Argued: September 12, 2025 Decided: March 3, 2026 USCA4 Appeal: 24-1518 Doc: 51 Filed: 03/03/2026 Pg: 2 of 17

Before KING, RUSHING, and BENJAMIN, Circuit Judges.

Affirmed by published opinion. Judge Rushing wrote the opinion, in which Judge King and Judge Benjamin joined.

ARGUED: Timothy Bosson, BOSSON LEGAL GROUP, Fairfax, Virginia, for Appellants. Nancy North Delogu, LITTLER MENDELSON, P.C., Washington, D.C.; Scott Andrew Siegner, OGLETREE DEAKINS, Richmond, Virginia, for Appellees. ON BRIEF: Isaiah R. Kalinowski, Arie M. Jones, BOSSON LEGAL GROUP, Fairfax, Virginia, for Appellants. W. Ryan Waddell, OGLETREE DEAKINS, Richmond, Virginia, for Appellee North American Partners in Anesthesia (Virginia), LLC. Alexander P. Berg, Lauren M. Bridenbaugh, LITTLER MENDELSON, P.C., Tysons Corner, Virginia, for Appellee Inova Health Care Services.

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RUSHING, Circuit Judge:

Inova Health Care Services suspended clinical privileges at its medical facilities for

Plaintiffs Kelly Hoffman and Lorraine Austin after they refused Covid-19 vaccinations.

North American Partners in Anesthesiology (NAPA) subsequently terminated Plaintiffs’

employment. In separate complaints, Hoffman and Austin both sued Inova for

discrimination, and Hoffman also sued NAPA. The district court dismissed both

complaints for failure to state a claim, finding that neither Plaintiff plausibly alleged Inova

was her employer and that Hoffman did not exhaust the administrative process before suing

NAPA. Considering these two cases together, we affirm in full.

I.

Plaintiffs Hoffman and Austin are Certified Registered Nurse Anesthetists

(CRNAs) who were employed by American Anesthesiology of Virginia, a subsidiary of

NAPA. American Anesthesiology contracted exclusively with Inova facilities, while

NAPA maintained contractual arrangements with other medical facilities beyond Inova.

By contract, American Anesthesiology had the sole and exclusive right to provide

anesthesia services at Inova Loudoun Hospital and Inova Loudoun Ambulatory Surgery

Center. Consistent with that arrangement, American Anesthesiology supplied the

physicians and CRNAs to perform anesthesia services at both facilities. During their

employment with American Anesthesiology, Hoffman and Austin worked exclusively at

these Inova facilities—Hoffman for five years and Austin for twenty.

In 2022, Inova denied Plaintiffs’ requests for exemptions from its Covid-19

vaccination policy. After Plaintiffs refused to be vaccinated, Inova suspended their clinical

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privileges effective August 1. Approximately two months later, NAPA terminated their

employment.

Austin sued Inova, alleging it violated Title VII of the Civil Rights Act of 1964, 42

U.S.C. § 2000e et seq., and the Virginia Human Rights Act (VHRA), Va. Code § 2.2-3900

et seq. Separately, Hoffman sued Inova and NAPA, asserting claims under Title VII, the

Americans with Disabilities Act (ADA), 42 U.S.C. § 12101 et seq., and the VHRA. Both

Plaintiffs alleged that Inova was their joint employer with NAPA. Both NAPA and Inova

moved to dismiss the complaints.

After a hearing, the district court granted the motions to dismiss. The court

dismissed Hoffman’s claims against NAPA because her charge of discrimination with the

Equal Employment Opportunity Commission (EEOC) did not name NAPA but only Inova.

As a result, the court concluded, Hoffman had failed to exhaust the administrative process

with respect to her claims against NAPA. As for Inova, the court found Plaintiffs’

allegations insufficient to allege it was their employer, as was necessary for liability under

each statutory scheme on which Plaintiffs relied. But the court granted Plaintiffs’ requests

for the opportunity to amend their complaints regarding Inova. After Plaintiffs filed

amended complaints, Inova again moved to dismiss and the district court dismissed both

complaints with prejudice. Applying the factors from this Court’s decision in Butler v.

Drive Automotive Industries of America, Inc., 793 F.3d 404 (4th Cir. 2015), the district

court concluded that Plaintiffs again had not plausibly alleged that Inova was their

employer for purposes of Title VII, the ADA, or the VHRA.

Plaintiffs each appealed, and we consolidated their cases for oral argument.

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II.

We review de novo a decision to grant a motion to dismiss. Bing v. Brivo Sys., LLC,

959 F.3d 605, 615–616 (4th Cir. 2020). “When doing so, we ‘accept the factual allegations

of the complaint as true and construe them in the light most favorable to the nonmoving

party.’” Corder v. Antero Res. Corp., 57 F.4th 384, 401 (4th Cir. 2023) (quoting Rockville

Cars, LLC v. City of Rockville, 891 F.3d 141, 145 (4th Cir. 2018)). “To survive a motion

to dismiss, a complaint must contain sufficient facts to ‘state a claim to relief that is

plausible on its face.’” Id. (quoting Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009)). Mere

“labels and conclusions . . . will not do.” Iqbal, 556 U.S. at 678 (internal quotation marks

omitted).

III.

We begin with whether Plaintiffs plausibly alleged that Inova was their employer.

Title VII, the ADA, and the VHRA prohibit covered employers from engaging in certain

types of discrimination. See 42 U.S.C. §§ 2000e-2(a), 12111(2), 12112(a); Va. Code § 2.2-

3905(B)(1). It is undisputed that NAPA, not Inova, formally employed Plaintiffs. But

“multiple entities may simultaneously be considered” an individual’s employer for

purposes of Title VII under the “joint employment doctrine” adopted by this Court. Butler,

793 F.3d at 410. That doctrine focuses on “the substance of the employment relationship”

to “prevent[] those who effectively employ a worker from evading liability by hiding

behind another entity, such as a staffing agency.” Id. (internal quotation marks omitted).

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This Court uses a nine-factor test to determine “which entities actually exercise

control over an employee” such that they can rightly be considered an employer under Title

VII. Id. at 409. Those factors are:

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