Private Hospital COVID-19 Vaccine Mandates Are Not State Action; EUA Statute Creates No Private Right of Action

Introduction

In Beth Boyd v. Shriners Hospitals for Children (3d Cir. Apr. 14, 2026) (not precedential), a group of former employees of Shriners Hospital for Children–Erie (the “Former Employees”) challenged their termination after they refused to comply with the hospital’s COVID‑19 vaccination policy. Shriners required certain employees—particularly those working with patients or entering hospital buildings—to be fully vaccinated by the end of 2021, while allowing medical and religious exemption requests. The Former Employees refused vaccination and did not seek exemptions; Shriners terminated them for noncompliance.

The Former Employees sued Shriners and affiliated individuals/entities asserting: (i) federal constitutional/statutory violations under 42 U.S.C. § 1983 on the theory that Shriners was a state actor; (ii) an asserted claim under the Emergency Use Authorization statute, 21 U.S.C. § 360bbb‑3, arguing it impliedly grants individuals a right to sue; and (iii) Pennsylvania state-law claims (including breach of contract, wrongful termination, and intentional infliction of emotional damage).

The district court dismissed the federal claims with prejudice under Rule 12(b)(6) and declined supplemental jurisdiction over state-law claims. The Third Circuit affirmed.

Summary of the Opinion

  • No state action under § 1983: Shriners is a private hospital and the complaint did not plausibly allege that its employee vaccine mandate constituted state action under any of the invoked tests (public function, symbiotic relationship, or state-enforced custom).
  • No private right of action under the EUA statute: The court aligned with “numerous federal courts” holding that 21 U.S.C. § 360bbb‑3 does not contain an implied private right of action.
  • Supplemental jurisdiction properly declined: Once all federal claims were dismissed, the district court acted within its discretion to dismiss the remaining state-law claims under 28 U.S.C. § 1367(c)(3).

The judgment dismissing the suit was affirmed. The disposition is designated “NOT PRECEDENTIAL,” meaning it does not bind future Third Circuit panels under the court’s internal operating procedures, though it may be persuasive.

Analysis

Precedents Cited

1) Core § 1983 “state action” framework

The court began from the foundational requirement that § 1983 liability attaches only to conduct “under color of state law.” It relied on Groman v. Twp. of Manalapan, 47 F.3d 628 (3d Cir. 1995), for the proposition that § 1983 reaches private actors only where the challenged conduct is “made possible only because the wrongdoer is clothed with the authority of state law.”

2) Public function test: exclusivity is decisive

The Third Circuit applied the “traditionally the exclusive prerogative of the State” standard from Rendell-Baker v. Kohn, 457 U.S. 830 (1982), which itself quotes Jackson v. Metro. Edison Co., 419 U.S. 345 (1974). The court emphasized (echoing the Third Circuit’s own articulation in Mark v. Borough of Hatboro, 51 F.3d 1137 (3d Cir. 1995)) that the public function test is “rigorous” and rarely satisfied.

To reinforce that vaccine mandates are not exclusively governmental, the court relied on out-of-circuit authority squarely addressing COVID‑19 mandates: Pearson v. Shriners Hosps. for Child., Inc., 133 F.4th 433 (5th Cir. 2025), and Ciraci v. J.M. Smucker Co., 62 F.4th 278 (6th Cir. 2023). Those cases support the proposition that a private employer’s vaccine requirement—even when related to public health—is not a function “traditionally handled just by the State.”

3) Symbiotic relationship: funding and regulation are not enough; nexus to challenged act matters

The Former Employees invoked the “symbiotic relationship” concept associated with Burton v. Wilmington Parking Auth., 365 U.S. 715 (1961), which describes circumstances where the State is so interdependent with a private entity that it becomes a “joint participant in the challenged activity.” The Third Circuit’s analysis, however, tracked the limits recognized in Rendell-Baker v. Kohn, emphasizing that even extensive government funding does not transform a contractor into the government for § 1983 purposes.

The court also cited Robert S. v. Stetson Sch., Inc., 256 F.3d 159 (3d Cir. 2001), which in turn underscores that Rendell-Baker rejected state action arguments even where “virtually all” revenue came from government sources. In effect, the Third Circuit reaffirmed a two-part constraint: (i) money and regulation do not suffice; and (ii) there must be a meaningful connection between the state’s involvement and the specific conduct challenged.

That second constraint was decisive here: the “challenged conduct” was Shriners’ internal employment mandate, and the court found no plausible allegation that the policy “was compelled or even influenced by any state regulation,” quoting Rendell-Baker v. Kohn. Participation in a broader state vaccination effort did not plausibly connect the Commonwealth to the employment decision at issue.

4) State-enforced custom: “custom[] having the force of law” requires more than parallel conduct

For the “state-enforced custom” concept, the court cited Adickes v. S. H. Kress & Co., 398 U.S. 144 (1970), and quoted its invocation of the Civil Rights Cases, 109 U.S. 3 (1883), for the requirement that the deprivation stem from “custom[] having the force of law.” The court held the Former Employees’ allegations were “convoluted” and impermissibly conflated Shriners’ alleged participation in a state public vaccination program with an internal employment mandate; the complaint lacked factual allegations showing the mandate was enforced pursuant to a state custom or practice with legal force.

5) EUA statute: no implied private right of action

The panel adopted the prevailing judicial consensus that 21 U.S.C. § 360bbb‑3 creates no implied private right of action, citing: Pearson v. Shriners Hosps. for Child., Inc., 133 F.4th 433 (5th Cir. 2025); Bridges v. Houston Methodist Hosp., 543 F. Supp. 3d 525 (S.D. Tex. 2021); Kiss v. Best Buy Stores, No. 3:22-CV-00281, 2022 WL 17480936 (D. Or. Dec. 6, 2022); Roberts v. Shriners Hosps. for Child., No. 2:23-CV-0295, 2024 WL 5517091 (E.D. Wash. Feb. 8, 2024); Sweeney v. Univ. of Colo. Hosp. Auth., No. 23-CV-02451, 2024 WL 3713835 (D. Colo. July 12, 2024); and Timken v. S. Denver Cardiology Assocs., P.C., No. 23-CV-02859, 2024 WL 4407003 (D. Colo. Aug. 29, 2024). While the opinion did not re-derive the full implied-right-of-action framework, its reasoning is categorical: the statute does not authorize private lawsuits, so the claim fails.

6) Supplemental jurisdiction after dismissal of federal claims

On the state-law claims, the Third Circuit relied on 28 U.S.C. § 1367(c)(3) and cited Hedges v. Musco, 204 F.3d 109 (3d Cir. 2000), to confirm that once all claims within original federal jurisdiction are dismissed, it is typically within the district court’s discretion to decline supplemental jurisdiction.

Legal Reasoning

1) Distinguishing “public health context” from “state action”

The Former Employees’ theory implicitly treated COVID‑era public health measures as converting private decisions into governmental ones. The court rejected that move. Even if Shriners contributed to public vaccination goals, the dispositive question under § 1983 was whether the specific act challenged—an internal condition of employment— is attributable to the state under recognized state-action tests.

2) Public function: vaccine mandates are not exclusively governmental

The court held that imposing an employee vaccine mandate is not “traditionally the exclusive prerogative of the State.” The reasoning is practical and categorical: private employers (including hospitals) commonly impose health and vaccination requirements. Because exclusivity is required, common private practice defeats the public function argument.

3) Symbiotic relationship: “funding + regulation” does not equal “joint participation” in the challenged decision

The Former Employees alleged Shriners was “intimately regulated, licensed, and funded” and that Pennsylvania relied on private parties to achieve vaccine administration. The court accepted, arguendo, that such relationships might exist at a high level, but ruled them insufficient for state action absent a plausible allegation that the state compelled, influenced, or was meaningfully intertwined with the particular employment mandate.

The court’s key move was narrowing the inquiry to the “challenged conduct” and insisting on a nexus: even pervasive public-private collaboration around vaccination does not automatically tether every private policy choice (like an internal HR mandate) to the state.

4) State-enforced custom: no facts showing a custom “having the force of law”

The court found the pleadings lacked allegations that Pennsylvania had a custom requiring or effectively imposing Shriners’ mandate. The “pressure and punish” theory was treated as rhetorical rather than factual: it did not identify a state custom that operated as law, nor facts connecting such a custom to Shriners’ terminations.

5) EUA statute claim fails at the threshold: no private enforcement mechanism

The Former Employees framed § 360bbb‑3 as granting an “explicit right to refuse” EUA products enforceable via private suit. The court rejected this not by debating the policy’s merits but by identifying a structural defect: Congress did not create (and courts have not found) an implied private right of action under the EUA statute. Without a cause of action, the claim cannot proceed regardless of how plaintiffs characterize statutory language about EUA conditions.

6) Supplemental jurisdiction: routine discretionary dismissal once federal anchors are gone

With the § 1983 and EUA claims dismissed, the district court’s decision to let Pennsylvania courts address Pennsylvania claims followed the mainstream § 1367(c)(3) practice, affirmed as within discretion by Hedges v. Musco.

Impact

1) Reinforcing a limiting principle on pandemic-era § 1983 claims

The opinion reinforces that pandemic-related subject matter does not relax state-action doctrine. Plaintiffs challenging private employer vaccine mandates must still satisfy the “exclusive public function” or nexus/interdependence requirements; general allegations of regulation, licensure, public funding, or participation in public health initiatives will not suffice without facts tying the state to the specific employment decision.

2) Continued foreclosure of EUA-based private lawsuits

The Third Circuit joined the prevailing line of authority rejecting an implied private right of action under 21 U.S.C. § 360bbb‑3. Practically, this channels EUA-related disputes away from standalone federal statutory damages suits and toward other vehicles (e.g., employment discrimination statutes where applicable, contractual claims, or administrative/public enforcement mechanisms).

3) Procedural consequence: state-law claims often will be dismissed without federal anchors

The affirmance confirms that when plaintiffs plead novel federal theories that fail at the motion-to-dismiss stage, their state-law claims may be dismissed from federal court under § 1367(c)(3), requiring refiling in state court (subject to limitations and tolling rules not addressed in the opinion).

4) Cautionary note on precedential force

Because the disposition is “NOT PRECEDENTIAL,” it does not bind future Third Circuit panels. Nonetheless, it is likely to be cited persuasively in district courts within the circuit, particularly in cases involving private healthcare employers, vaccine mandate terminations, and attempts to plead state action based on regulation and participation in public programs.

Complex Concepts Simplified

Rule 12(b)(6) (failure to state a claim)
A procedural motion arguing that—even if the complaint’s facts are accepted as true—the law does not provide a remedy on those facts. The court asks whether the complaint plausibly states a legally valid claim.
42 U.S.C. § 1983 and “state action”
Section 1983 is a civil rights statute that allows suits for constitutional violations, but typically only when the defendant acted with government authority. A private party can be treated like the government only in narrow situations (the “state action” tests).
Public function test
A private entity is treated as the state only if it performs a function that has been traditionally and exclusively done by the government. If private actors commonly do it, it is usually not a public function.
Symbiotic relationship / joint participation
A private entity may be a state actor if the state is so intertwined with it that they are effectively partners in the specific conduct challenged. Funding, licensing, and regulation alone generally are not enough—courts look for a direct connection between the state and the particular decision at issue.
State-enforced custom
A practice can count as “state action” if it operates like law—an established state custom with legal force—such that the private actor’s conduct is effectively an extension of state policy.
Implied private right of action
Not every statute gives private individuals the right to sue. An “implied” right of action exists only if courts conclude Congress intended private enforcement. Here, courts have consistently concluded the EUA statute does not allow private lawsuits.
Supplemental jurisdiction (28 U.S.C. § 1367)
Federal courts can sometimes hear state-law claims related to federal claims in the same case. But if the federal claims are dismissed early, courts often dismiss the state claims too, leaving them for state courts.

Conclusion

Beth Boyd v. Shriners Hospitals for Children reaffirms two core limits in pandemic-related employment litigation: (1) a private hospital’s employee COVID‑19 vaccine mandate—without state compulsion, influence, or a tight nexus to state authority—does not constitute state action for § 1983; and (2) 21 U.S.C. § 360bbb‑3 provides no implied private right of action. Having disposed of the federal claims, the court endorsed the district court’s discretionary decision to dismiss the remaining Pennsylvania claims under § 1367(c)(3). The opinion thus fits within the broader judicial pattern of treating private employer vaccine policies as private conduct and limiting federal statutory avenues absent explicit congressional authorization.