In Chaney v. Plainfield Healthcare Center, a case that “pits a health-care worker’s right to a non-discriminatory workplace against a patient’s demand for white-only health-care providers,” the Seventh Circuit Court of Appeals came down strongly on the side of the employee, finding that a nursing home’s acquiescence to the patient’s demand created a racially hostile work environment that violated Title VII of the Civil Rights Act.

A number of residents at Plainfield Healthcare Center, a nursing home in Southern Indiana, had expressed a preference for white-only nursing assistants, and the nursing home acknowledged that it had a policy of honoring such racial preferences. The policy was made clear to Brenda Chaney, an African American Certified Nursing Assistant (CNA), and all other CNAs working at Plainfield, through the nursing home’s assignment sheet, which  expressly requested that CNAs adhere to a resident’s preference for “No Black CNAs.” Some Plainfield employees also used racial epithets and made racially hostile comments to Chaney. Although the nursing home stopped what the court called “the most vulgar racial epithets,” the court found that it “never corrected the principle source of the racial hostility in the workplace--its willingness to accede to a patient’s racial preferences.” This policy, the court concluded, was not only a source of humiliation for Chaney, but also fodder for her coworkers, “who invoked it regularly.”

In support of its determination that Plainfield’s policy violated Title VII, the federal anti-discrimination law, the Seventh Circuit stated that “[i]t is now widely accepted that a company’s desire to cater to the perceived racial preferences of its customers is not a defense under Title VII for treating employees differently based on race.” The nursing home argued that this principle did not apply in a long-term care setting because, among other things, federal and state laws governing long-term care facilities provide residents the right to choose their attending physicians and other providers of healthcare services. As to Indiana state law, the Seventh Circuit held that if Indiana law could be read to require that long-term care facilities honor a patient’s racial preferences, it would conflict with Title VII and, in such situations, federal law would prevail. In any event, the court concluded, Indiana law does not require a nursing home to acquiesce to a patient’s racial preferences, but rather requires long-term care facilities to allow residents to employ, at their own expense, healthcare providers of their choice. As to the federal Medicare law cited by the nursing home, the court concluded that the provisions allowing Medicare recipients in long-term care facilities to choose “a personal attending physician” did not apply to other healthcare service providers. Even if it did, the court reasoned, like the Indiana regulation, the Medicare law would not require a nursing home to honor racial preferences but instead would merely require the nursing home to allow patients access to providers of their choosing.

In response to Plainfield’s claim that its racial preference policy reduced the risk of exposing black employees to racial harassment from biased residents, the Seventh Circuit suggested a number of other ways to avoid this problem without discharging residents: (1) warn residents of the facility’s non-discrimination policy before admitting them and secure the resident’s consent prior to admission; (2) attempt to change the residents’ behavior after admission [unlikely to be successful]; or (3) assign staff based on race-neutral criteria and minimize the risk of conflict by, for example, advising employees that they could ask for protection from racially harassing residents. The court acknowledged that although these efforts might not “guarantee full racial harmony, they exemplify reasonable measures that an employer can undertake to avoid liability for known workplace harassment.”