The United Court of Appeals for the Eleventh Circuit, in Amstrong v. Flow ersffospital, Lnc. (33 F.3d 1308 (11th Cir. 1994)), held that a hospital's termination of a pregnant employee for refusal to treat an HIV-positive patient did not violate the Pregnancy Discrimination Act (PDA), based on either the disparate treatment or the disparate impact theory. As an employer, a hospital is not required to make policies specifically addressing the needs of pregnant employees and is not to be held liable for discrimination absent a showing of differential treatment based on the facial intent of employer policies or on actual impact through policy application. Hence, although women cannot be forced to decide between employment and pregnancy, they will not be afforded special treatment based on their pregnancy.

Pamela Armstrong worked for Southeast Alabama Medical Center (SAMC). After one year, Armstrong took a position with the Home Care Services (HCS) division of Flowers Hospital.