Labor & Employment Law Daily Wrap Up, DISCRIMINATION—RELIGIOUS—9th Cir.: Legacy Health showed undue hardship from proposed religious COVID vaccine exemptions, (May 7, 2026)

By Jason Albright, J.D.

“‘Health and safety costs’ matter, too.”

Legacy Healthcare was entitled to summary judgment against the Title VII and state-law claims of employees of the Willamette Valley regional healthcare system who were denied religious exemptions from a mandatory COVID-19 vaccination policy it had implemented in August 2021, the Ninth Circuit affirmed. Applying the “undue hardship” test set out by the U.S. Supreme Court in Groff v. DeJoy, 600 U.S. 447 (2023), the appeals court found that, although Legacy did not assert that vaccine exemptions would cause prohibitive financial hardship, the employer established “realistic” health, safety, and staffing concerns that threatened a “substantial” burden on its business of providing quality healthcare (Williams v. Legacy Health, No. 24-5977 (9th Cir. May 6, 2026)).

Legacy Healthcare is a regional healthcare system that operates eight hospitals throughout the Willamette Valley. The plaintiffs all worked at Legacy’s Salmon Creek medical center in Vancouver, Washington. Though their particular jobs varied—from physician assistant, to respiratory therapist, to nurse, to technician—their roles all necessitated close contact with either patients or staff.

August 2021 policy. On August 5, 2021, shortly before the state of Washington imposed its own, complementary requirement, Legacy announced a vaccination policy across its hospitals. Legacy had previously encouraged voluntary vaccination, but it changed course in summer 2021 with the onset of the Delta variant of COVID-19, which caused a surge of infections and hospitalizations, particularly among unvaccinated individuals.

Legacy’s vaccination policy required anyone who performed services at its hospitals to become fully vaccinated or receive an exemption by September 30, 2021. The policy created a process for requesting religious or medical exemptions and established a working group to review such requests.

Exemptions denied. Subsequently, the plaintiffs all submitted timely applications for religious exemptions, but Legacy denied their requests. Consistent with the vaccination policy, Legacy placed the employees on administrative leave and notified them that termination would follow. One plaintiff received the vaccine shortly after going on leave and later returned to work. All others were fired.

Religious discrimination suits. The employees filed separate lawsuits alleging religious discrimination under Title VII and Washington state law. The district court consolidated the suits, the case proceeded to discovery, and the district court granted summary judgment for Legacy.

Decision below and appeal. In issuing its decision, the district court assumed that the employees made out a prima facie case of religious discrimination based on Legacy’s failure to accommodate their religious beliefs. It found, however, that the vaccine exemption denials were justified because Legacy had established the affirmative defense of undue hardship, and the employees had failed to present relevant evidence disputing Legacy’s showing. Uncontroverted evidence, in the district court’s view, showed that accommodating the employees’ religious beliefs would impose “outsize[d] risks” to Legacy’s patients and staff, thereby “jeopardizing [Legacy’s] ability to provide healthcare” in a safe and effective manner.

The employees appealed to the Ninth Circuit.

Title VII and undue hardship. Affirming, the federal appeals court initially observed that Title VII religious discrimination claims follow a well-established burden-shifting framework. The employee must first make out a prima facie case of “a bona fide religious belief” that conflicted “with an employment duty.” The employer must have been “informed... of the belief,” and have threatened or taken discriminatory action. The burden then shifts to the employer to show “either that it initiated good faith efforts to accommodate reasonably the employee’s religious practices or that it could not reasonably accommodate the employee without undue hardship.” The appeal, the court noted, turns on the employer’s burden to demonstrate undue hardship.

Groff. In Groff v. DeJoy, 600 U.S. 447 (2023), the U.S. Supreme Court held that “showing ‘more than a de minimis cost’” is insufficient “to establish ‘undue hardship’ under Title VII.” Rather, “‘undue hardship’ is shown when a burden is substantial in the overall context of an employer’s business.” That inquiry is “fact-specific” and requires courts to “account [for] all relevant factors in the case at hand, including the particular accommodations at issue” and the accommodations’ “practical impact” given the “nature, size, and operating costs” of the employer.

Petersen. The Ninth Circuit noted that it recently applied the Groff test in Petersen v. Snohomish Regional Fire & Rescue, 150 F.4th 1211 (9th Cir. 2025), a case very similar to this one. In Petersen, a group of firefighters requested religious exemptions from a newly imposed COVID-19 vaccine requirement. The employer denied the exemptions because it could not find a reasonable accommodation “that would allow [the] firefighters to remain in their roles” without undue hardship. The court held that the employer adequately justified the denials under Groff based on various hardships, including the health risk to fellow firefighters and the public, the “operational cost” that would result if other firefighters were infected, and the “textbook economic hardship” of losing a “lucrative contract” to provide emergency medical services.

Costs need not be exclusively monetary. Petersen, according to the appeals court, “crystalized several aspects of the Groff test.” To start, the “substantial additional costs” the Supreme Court referred to need not be exclusively monetary. Instead, they can extend to “health and safety costs” and “operational burdens” as well.

Particularized. Next, costs need not be realized prior to raising an undue hardship defense. A “risk of undue hardship” will suffice, provided it is “realistic” and “not ‘merely conceivable or hypothetical.’” And finally, the Ninth Circuit does not “judge [a given employer] by the responses taken by other [employers].” Instead, the test “boils down to undue hardship in the context of the ‘particular business’ before us.”

Undue hardship. The appeals court found that Legacy’s undue hardship showing readily satisfied the Groff standard. Based on Legacy’s showing, granting the employees’ exemption requests posed three distinct risks. First, there was a risk that the employees themselves would become ill and cause staffing issues from their absence. Second, much like the firefighters in Petersen, the employees’ risk of infection posed concerns for other staff needed to treat patients. Finally, the transmission risk would also affect Legacy’s patient population, many of whom had preexisting conditions or comorbidities that could cause an even greater strain on Legacy’s services. At several points in the record, Legacy’s expert examined alternative safety protocols—masking, using other personal protective equipment, and regular testing—and concluded that each such alternative was not a sufficient replacement for vaccination.

Taken together, the Ninth Circuit concluded, Legacy’s “realistic” concerns threatened a “substantial” burden on its business of providing quality healthcare. Though it did not assert that vaccine exemptions would cause prohibitive financial hardship, “‘[h]ealth and safety costs’ matter, too,” and “in the context of Legacy’s particular business, they make all the difference.”

The judgment of the district court was affirmed.

The case is No. 24-5977.

Judge: McKeown, M.

Attorneys: Corey Evan Parker (The Appellate Law Firm) for Harold C. Williams, Jr. Whitney Alexis Brown (Stoel Rives) for Legacy Health.

Companies: Legacy Health

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