Labor & Employment Law Daily Wrap Up, DISCRIMINATION—RELIGIOUS—9th Cir.: Nurse revives COVID-19 vaccination claim after court overlooked objection letter to employer, (Sep 25, 2026)

By Todd Harrison, J.D.

Although it was not attached to her complaint, the Ninth Circuit determined that under the incorporation-by-reference doctrine, the lower court should have considered the contents of the letter.

Reversing a district court’s dismissal of a registered nurse’s Title VII and state-law claims alleging religious discrimination in the face of a COVID-19 vaccine mandate, the Ninth Circuit found the lower court erred when it dismissed the claim without leave to amend. In her opposition to the motion to dismiss, the nurse requested leave to amend if the court found her pleading insufficient and attached a copy of her objection letter to the employer. Under the incorporation-by-reference doctrine, the district court should have considered the contents of the letter, as it was central to her claim. Once the letter was taken into consideration, the appellate court found the nurse easily satisfied the plausibility threshold for a prima facie Title VII claim (Ridings v. PeaceHealth, No. 24-7282 (9th Cir. Sept. 24, 2026)).

The plaintiff in this case worked as a registered nurse for a hospital system in Oregon. When the governor issued a mandate requiring all health care workers in the state to vaccinate themselves against COVID-19, the nurse’s employer followed suit.

Objection letter. Objecting to the vaccination mandate, the nurse sent a letter to the employer asserting her fear of safety risks because she was pregnant at the time. She also stated that getting vaccinated would violate her religious beliefs against abortion, given the vaccine’s development using aborted fetal stem cells. She then cited a passage from the Bible. In response to this letter, the employer placed her on indefinite leave, without benefits or pay.

Lawsuit. Subsequently, the nurse sued, alleging religious discrimination in violation of Title VII and state law. Her complaint did not have a copy of her objection letter attached, though it did reference “her religious exception” request. It also briefly explained the nurse’s religious rationale for refusing the vaccine. The employer moved to dismiss for failure to state a claim.

Initially, a federal magistrate judge assigned to the case issued a recommendation to deny the motion to dismiss. The employer objected and, on further review, the district court rejected the magistrate’s recommendation, finding the complaint too conclusory to state a plausible claim for relief. The court did not discuss the religious exemption letter the nurse had sent to the employer. It then dismissed the nurse’s claims “without prejudice,” but did not give leave to amend. This appeal followed.

Incorporation by reference. In deciding a motion to dismiss, courts will ordinarily consider only the facts alleged on the face of the document. However, an exception to this rule can be made under the incorporation-by-reference doctrine, which holds that if a plaintiff’s claim necessarily relies on a document’s existence, and there is no dispute about its authenticity, courts may treat that document as part of the complaint itself.

Here, the nurse’s claims of religious discrimination turned on the reasons she gave in her religious exemption letter for refusing to take the COVID-19 vaccine. In the Ninth Circuit, plaintiffs are not only required to show that an employment duty conflicted with a sincere religious belief or practice, but to also show that they informed their employer of that belief and conflict.

In this instance, without knowing the basis for the nurse’s request to the employer, the court noted that it would be unable to assess her claim. Thus, the merits of her claim necessarily relied on the religious exemption letter she sent to the employer. Further, her complaint expressly mentioned the letter, putting the district court on notice of its existence. Because the complaint referenced the letter and no party contested its authenticity, the district court should have considered its contents in deciding the motion to dismiss, said the court.

Detwiler. Taking the religious-based objections explained in the letter into consideration, the appellate court found the nurse had adequately alleged a prima facie case of failure to accommodate her religious beliefs. In response, the employer argued that the Ninth Circuit has recalibrated its framework for religious discrimination claims, citing its recent holding in Detwiler v. Mid-Columbia Med. Ctr., 156 F.4th 886 (9th Cir. 2025). In that case, the court held that a plaintiff must plead “enough facts to show her belief [opposing an employment policy] is religious” in nature, “rather than purely secular.”

Although the court here acknowledged that Detwiler explicitly created a circuit split in allowing courts to “wade a bit more deeply into this fraught area,” it did not create such a vast sea change as to sink the nurse’s claims in the present action. Indeed, explained the court, Detwiler emphasized that courts must still exercise caution to not examine the sincerity or reasonableness of a party’s religious beliefs. “The central question remains whether an employee’s professed religious beliefs, taken at face value, conflict with the employer’s policy,” said the court.

In many instances, continued the court, a personal or scientific judgment may overlap with a religious duty. When that occurs, the area of overlap is presumably protected. In Detwiler, the issue was not that a secular judgment was intertwined with a religious judgment, but the opposite. The Detwiler court noted that the plaintiff failed to “present a case where a religious belief overlaps with a medical one.” The plaintiff failed to cure this problem by generally pleading that the Holy Spirit revealed to her that she “must not participate in COVID testing that causes harm.” Importantly, she did not plead that her prayers gave her a religious definition or standard for “harm” that overlapped her personal fears surrounding nasal swabs.

Here, in contrast, the nurse’s complaint easily satisfied the plausibility standard to survive dismissal, said the court. Her letter stated with specificity the religious nature of her objection to the COVID vaccine—the use of aborted fetal cells in vaccine development. Because she sufficiently pleaded a religious objection based on the use of fetal cells, the court did not weigh in on her other objections, such as her religion requiring her to treat her body as a temple. Accordingly, the district court’s dismissal of the nurse’s claim for relief was reversed and the matter was remanded for further proceedings.

The case is No. 24-7282.

Judge: Lee, K.

Attorneys: Caroline Janzen (Rugged Law) for Karly Ridings. Megan Breen (Schwabe, Williamson & Wyatt) for PeaceHealth.

Companies: PeaceHealth

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