Megan Duncan, Alanda Watson and Denise Mercurius will report to work Friday morning, as they have done every day for years. Once there, they expect to be fired.
The three women -- employees of Lutheran Social Ministries of New Jersey, an agency that helps the elderly and the disadvantaged throughout the state -- are among a rising number of workers facing termination for refusing to get a flu shot or, as an alternative, wear a surgical mask in the workplace.
The trend -- supported by anecdotal evidence, a proliferation of lawsuits in recent years and interviews with employment attorneys -- has been driven by an increase in corporate policies mandating flu shots for all employees in hospitals and other health care settings.
What differentiates Duncan, Watson and Mercurius from most of those fired, however, is that they're not doctors or nurses, and they don't work in a hospital.
They spend their days in a corporate office in suburban Burlington Township, crunching numbers or dealing with billing issues.
The women say they are deeply opposed to receiving a flu shot for a variety of reasons, and they contend it is ostracizing, embarrassing and an invasion of privacy to force them to wear surgical masks in a business setting. Lutheran Social Ministries said it instituted the mandatory flu shot policy this year as a safeguard for its clients.
UPDATE: Office workers who refused flu shot suspended without pay
"This is insane," said Watson, 36, a Willingboro resident who says she desperately needs her job to support her four children.
"It doesn't make sense because they're requiring the staff to wear a mask if we don't get the vaccine, but we have vendors coming in all the time, and they're not required to wear a mask or show proof of vaccination," she said. "If families come to visit, they're not required to wear a mask or show proof of vaccination. This is wrong."
No contact with clients
Watson and Mercurius say they have never had direct contact with the agency's clients. Duncan, 30, of Howell, said that while she occasionally visited elder care facilities in the past to discuss billing issues with residents, her direct supervisor told her she would no longer be required to do so.
"I've never been fired from a job in my whole life," Duncan said. "I'm a hard worker. I always get great reviews. This is so upsetting."
After declining to wear the surgical masks at work earlier this week, the women said, they were reprimanded and sent home, with instructions to report to work Friday to meet with the chief financial officer.
All three said they expect they will be fired, a presumption based on the repeated warnings they received and the fact that they were locked out of the agency's computer system this week. In addition, Duncan discovered her job already has been posted on the agency's website.
Duncan said she has since contacted the federal Equal Employment Opportunity Commission, and the women are shopping for a lawyer to take up their case.
A question of safety
Colleen Frankenfield, Lutheran Social Ministries' president, said privacy laws prevented her from addressing specific employees, but she defended the vaccination mandate, calling it a common-sense measure to protect the people the agency serves.
The non-profit, which employs about 630 people across the state, runs senior citizens' homes in West Caldwell and Moorestown, a day treatment center for the homeless in Camden, an immigration center in Trenton, a satellite office providing social services for the elderly in Jersey City and shelters for at-risk children and battered women in undisclosed locations.
A Google street view image of the Burlington Township headquarters of Lutheran Social Ministries of New Jersey
Of the 32 people who work in the Burlington headquarters, Frankenfield said, about half frequently or occasionally visit the agency's facilities, putting them in direct contact with people who often are under stress or who have compromised immune systems. That raises the concern of cross-contamination, she said.
In addition, she said, the corporate headquarters houses an adoption agency, which parents and children sometimes visit. Duncan, Watson and Mercurius said they have rarely, if ever, seen children in the office.
"The health and safety of those we serve is really of paramount importance," said Frankenfield, a registered nurse and attorney. "We're trying to improve people's lives instead of making them sicker."
She said some agency employees have been granted religious or medical exemptions to the flu shot requirement, and she stressed that no employee has been fired strictly for refusing the shot. Employees who declined the vaccine have been given "reasonable alternatives," she said, a reference to the surgical masks.
A rise in mandates
Frankenfield didn't approve the policy in isolation.
In the past two to three years, hospitals and health care agencies across the country have increasingly required flu vaccinations, according to the American Hospital Association.
A small number of states have made the mandates law. New Jersey has not done so, but the state Department of Health, like the federal Centers for Disease Control and Prevention, strongly recommends flu vaccinations for health care workers, said Donna Leusner, a Health Department spokeswoman.
RELATED: Read the flu shot policy for Lutheran Social Ministries
Kerry McKean Kelly, a spokeswoman for the New Jersey Hospital Association, said the Garden State is following the national mandate trend for health care workers. Earlier this year, for example, Kennedy Health put in place a mandatory flu shot policy for 4,400 employees at its three South Jersey hospitals.
Along with the increase in mandates has come a spike in terminations or suspensions for those who resist.
In Massachusetts, Michigan, Wisconsin and other states, groups representing nurses have protested the required shots and the firing of colleagues, in some cases filing suit.
In Ohio last year, a federal judge ruled in favor of a hospital employee who was terminated, ruling that her veganism was akin to a religion and that she should have been granted a religious exemption. Many flu vaccines are derived from eggs, which vegans do not eat.
Emerging legal issue
Other lawsuits continue to work through the courts.
"This is something very, very new," said Alan Schorr, a Cherry Hill lawyer who has seen a surge in clients who have been fired or threatened with termination over flu shots. "These flu-shot policies only reared their head two years ago. There's almost no case law on it at all. It's one of the emerging legal issues."
The possible firing of Duncan, Watson and Mercurius marked the first case Schorr said he had heard of involving office workers who don't work in a hospital or nursing home.
"I haven't seen that anywhere," he said.
POLL: Should office workers be fired for not following flu-prevention protocol?
If the women's resistance to the vaccine rises to the level of a "spiritual" opposition, they might be able to claim a religious exemption, he said.
Duncan, Watson and Mercurius said they are healthy women who are exceedingly careful about what they put into their bodies. They said they are also deeply suspicious of the vaccine, which, in rare cases, can cause serious side effects, including paralysis.
Mercurius, 45, of Maple Shade, said her mother became ill after receiving a flu shot years ago, and she has read stories about others suffering side effects. In addition, she noted, the shot is not always effective, depending on whether scientists correctly determine which strains will become predominant in a given year.
"If you want a vaccination, that should be a personal decision," she said. "It should not be forced on anyone."
An uphill battle
But the women's options appear to be limited, particularly if they refuse to wear a surgical mask.
As at-will employees, they must abide by the rules set by Lutheran Social Ministries as long as the regulations are not discriminatory, said Alan Hyde, a professor who teaches employment law at the Rutgers School of Law in Newark.
"If it's not discriminatory, if it's not illegal, if they're not whistleblowers in the public interest, nothing can be done," Hyde said. "An employer can insist on anything as a condition of the job. There's no legal theory under which they're protected for their refusal to get vaccinated."
If there is a sliver of hope for the women, it lies in a New Jersey appellate court ruling issued last year, said Charlie Sullivan, a professor of employment law and associate dean at the Seton Hall University School of Law.
In that case, a nurse who was fired from Hackettstown Community Hospital for refusing a flu shot filed suit against the state Department of Labor, which had denied her unemployment benefits on the basis of work-related "misconduct."
The appeals court ruled in favor of the nurse, June Valent, in June 2014, saying she should have received unemployment because her refusal of the flu shot did not amount to misconduct. Valent had been willing to wear a mask but did not seek an exemption on religious or medical grounds.
The court also took issue with the vaccination policy, saying that if the hospital offered religious and medical exemptions, it must also offer an exemption for secular opposition to the shot.
Schorr, the Cherry Hill lawyer, called the ruling the only one of its kind in the country. At the same time, he cautioned, it might not apply precisely because of Valent's willingness to wear a mask.
As she waits to learn her fate, Watson says she is committed to fighting the mandate, even if she's fired.
"I was taught to stand for something," she said. "This is my body. My job shouldn't have governance over my body."
Clarification: An earlier version of this story suggested all flu vaccines are derived from eggs. While that remains the case for many vaccines, manufacturers have developed egg-free vaccines in recent years.
Mark Mueller may be reached at mmueller@njadvancemedia.com. Follow him on Twitter @MarkJMueller. Find NJ.com on Facebook.