Hospital Established Undue Hardship In Denying Nurse’s Religious Exemption From Vaccine Mandate

MacDonald v. Oregon Health & Sci. Univ., 2026 WL 2966688 (9th Cir. 2026)

Brittany MacDonald, a registered nurse who provided hands-on care to pregnant mothers, newborns, and immunocompromised patients at Oregon Health and Science University (OHSU), was terminated after OHSU denied her request for a religious exemption from the State’s COVID-19 vaccine mandate for healthcare workers. MacDonald sued individual OHSU officials for violating the Free Exercise Clause and sued OHSU for failure to accommodate under Title VII. In a 2-1 decision, the Ninth Circuit affirmed the dismissal of the Free Exercise claim on qualified immunity grounds, holding that in 2021 there was no clearly established law that denying such an exemption to a healthcare worker in close contact with vulnerable patients during a pandemic was unconstitutional (Judge Tung dissented on this point). The Court also affirmed summary judgment for OHSU on the Title VII claim, holding under Groff v. DeJoy, 600 U.S. 447 (2023), that OHSU established undue hardship based on the health, safety, operational, and financial costs of accommodating an unvaccinated nurse, and that there is no basis for importing a “pretext” analysis into the undue hardship inquiry.