The ruling puts teeth into the new 'undue hardship' standard – and HR leaders need to take note
A federal appeals court has handed healthcare employers a significant win on vaccination mandates – with clear lessons for HR leaders beyond hospital walls.
On May 6, 2026, the Ninth Circuit affirmed summary judgment in favor of Legacy Health in a Title VII religious discrimination case brought by nine employees who were denied religious exemptions from the company's COVID-19 vaccination policy. The court noted it has had few opportunities to apply the Supreme Court's 2023 Groff v. DeJoy undue-hardship standard, and this decision draws a clearer line for employers navigating the tension between workplace safety and religious accommodation.
Legacy Health operates eight hospitals in Washington and Oregon. In August 2021, as the Delta variant was driving a sharp rise in hospitalizations among unvaccinated individuals, Legacy moved from encouraging voluntary vaccination to requiring it. Every person performing services at its facilities had until September 30, 2021, to get fully vaccinated or secure an exemption. A working group was set up to review religious and medical exemption requests.
Nine employees at Legacy's Salmon Creek medical center in Vancouver, Washington – working in roles that included physician assistant, respiratory therapist, nurse, and technician – submitted religious exemption applications. Legacy denied all of them. The employees were placed on administrative leave and subsequently terminated, with one exception: Toby Higa, who worked at a Legacy facility through a contractor, received the vaccine shortly after going on leave and returned to work.
The employees sued under Title VII and Washington state law, arguing that Legacy failed to reasonably accommodate their religious beliefs. The district court granted summary judgment to Legacy, and the Ninth Circuit agreed.
At the heart of the decision is the undue-hardship test from Groff v. DeJoy, which in 2023 replaced the old standard that allowed employers to refuse accommodations based on anything more than a trivial cost. Under Groff, an employer must show that an accommodation would impose a burden that is substantial in the overall context of its business. The court also relied on its own 2025 decision in Petersen v. Snohomish Regional Fire & Rescue, which established that those substantial costs do not have to be financial – health and safety risks and operational disruptions count, too. Petersen also confirmed that an employer does not need to wait for harm to materialize; a realistic risk of hardship is enough.
Legacy's case rested on three distinct risks. Unvaccinated employees in patient-facing roles were more likely to become ill and miss work, causing staffing issues. Their heightened infection risk also endangered the colleagues they worked alongside. And the possibility of transmission to patients – many with preexisting conditions or comorbidities – threatened Legacy's ability to provide safe and effective medical care. Legacy supported these arguments with unrebutted expert testimony showing that alternative measures like masking, protective equipment, and regular testing were not adequate substitutes for vaccination in a clinical setting.
The employees pushed back on several fronts. They argued that Legacy's blanket denials, issued without individualized review of each exemption request, should disqualify the employer from claiming undue hardship. The court disagreed, pointing to longstanding precedent holding that when no accommodation can be made without undue hardship, requiring individual consideration serves no purpose. The employees also pointed to other hospitals that had granted religious exemptions, but the court was unmoved – the test looks at the particular employer's circumstances, not what other organizations chose to do. And when the employees suggested that later data might have shown the risk of accommodating a small number of objectors was minimal, the court rejected that hindsight reasoning, holding that employers are judged on the scientific evidence available at the time they made their decisions.
For HR professionals, the takeaway is practical and immediate. The decision confirms that employers – particularly those in healthcare and other safety-sensitive settings – can defend vaccination mandates without showing a direct financial hit. Documented, expert-backed risk assessments tied to the specific nature of the business remain the strongest shield against religious accommodation challenges. And blanket denials, when supported by evidence that no workable accommodation exists, will not automatically sink an undue-hardship defense. The ruling does not give employers a free pass, but it does make clear that when the risks are real and well-documented, courts will uphold the employer's decision.
