Seventh Circuit Affirms Summary Judgment for Hospital Employer in Religious Vaccine Exemption Case

In a recent decision providing important guidance for health care employers navigating religious accommodation requests related to vaccination policies, the Seventh Circuit Court of Appeals affirmed summary judgment in favor of a hospital employer that terminated a pharmacist who refused to receive the COVID-19 vaccine on religious grounds. The decision in Mason v. Cook County, Illinois underscores that employers in health care settings can successfully demonstrate undue hardship when denying religious exemptions to vaccine mandates, though a vigorous dissent highlights the evidentiary showings courts may expect.

The Employer’s COVID-19 Vaccination Policy

In Mason v. Cook County, Illinois, the plaintiff worked as a pharmacist in a room with approximately twenty other pharmacists and forty pharmacy technicians and also frequently interacted with patients and visited patient floors.

In August 2021, Cook County implemented a policy mandating that staff members receive the COVID-19 vaccine by October 2021. The County based this policy on guidance from federal and state public health authorities, including the Centers for Disease Control and Prevention’s (CDC) finding that COVID-19 vaccination was the best way to reduce transmission and prevent severe illness, hospitalization, and death. The County determined that other mitigation methods alone — such as masking, social distancing, and testing — did not sufficiently address patient and employee safety. Under the policy, employees could request a religious exemption, but the County determined that exemptions could only be granted to employees whose jobs could be performed fully remotely.

In September 2021, the plaintiff requested an exemption from the vaccine mandate based on her Christian faith. In her request, the plaintiff explained that her beliefs required her “to keep [her] body and soul pure” and that her body was “the temple of the Holy Spirit and shall not be defiled.” The County denied her request, stating that granting it would “compromise workplace safety” and “pose an undue hardship.” The County allowed the plaintiff 90 days to apply to a remote position within their system, but no such positions were available. At the end of the 90-day period, in May 2022, the County terminated the plaintiff’s employment.

The plaintiff filed suit in November 2023, alleging that the County’s denial of her religious accommodation request and subsequent discharge violated Title VII of the Civil Rights Act of 1964. She also raised a disparate treatment claim, pointing to another County employee who allegedly violated the vaccine policy but was not terminated. The district court granted summary judgment to the County, and the plaintiff appealed.

Majority’s Focus on Health Care Setting

On appeal, the Seventh Circuit affirmed. The court assumed, without deciding, that the Plaintiff had established a prima facie case of failure to accommodate based on a sincerely held religious belief and focused its analysis on the undue hardship question. Under Title VII, an employer suffers undue hardship when “granting an accommodation would result in substantial increased costs in relation to the conduct of its particular business.” The court emphasized that this inquiry is fact-specific, requiring consideration of “all relevant factors … including the particular accommodations at issue and their practical impact in light of the nature, size, and operating cost” of the employer.

The court found that the County made an adequate showing that accommodating the plaintiff could not be accomplished without undue hardship. The County presented declarations from its Associate Chief Human Resources Officer, Equal Employment Opportunity Director, and Department Chair of Infection Control and Epidemiology. These declarations described the County’s decision-making process, explained that health care workers faced high risk of contracting and transmitting COVID-19, and established that outbreaks among staff strained the County’s ability to provide necessary services. The County’s officials attested that, based on scientific research and CDC guidance, masking and social distancing alone did not adequately reduce risks to patient and employee safety.

The court noted that the plaintiff’s workplace context was critical to its analysis. She worked as a pharmacist in a hospital setting alongside other pharmacists and technicians, regularly interacted with patients, and visited patient floors where the risks and consequences of spreading COVID-19 were high. The court distinguished this situation from other religious accommodation cases like Groff v. DeJoy (Sunday mail delivery) and EEOC v. Abercrombie & Fitch Stores, Inc. (headwear policy), noting that the healthcare context presented “markedly different” considerations.

The court also rejected the plaintiff’s comparator argument that the County allowed another employee to continue working despite knowing she was unvaccinated. The court found this comparison “inapt,” noting that: (1) the County did not know the coworker was definitely unvaccinated; (2) once HR realized the employee might not be in compliance, the County actively sought to confirm her status and required prompt vaccination; and (3) there was no evidence the coworker worked in-person with frequent patient and staff interactions like plaintiff’s. Regardless, the court found that the proposed comparator was not similarly situated because they had “completely different jobs, in different locations, with different supervisors” — the Plaintiff worked as a pharmacist at Stroger Hospital in Chicago, while the coworker worked for the Department of Public Health in Rolling Meadows, Illinois.

Dissent’s Focus on Undue Hardship Evidence

Notably, Judge Taibleson filed a vigorous dissent, arguing that the case should have proceeded to trial. The dissent emphasized that under Title VII, the County bore the burden of proving undue hardship — meaning an “excessive” or “unjustifiable” burden that would result in “substantial increased costs.” The dissent argued that the County’s evidence was insufficient, consisting largely of conclusory statements that masking and social distancing “did not sufficiently address” safety risks without quantifying the specific burden accommodating the plaintiff would have imposed. In contrast, Judge Taibleson noted that in other cases where a health care employer succeeded on summary judgment, the employer put forth evidence of the cost of doing testing and contact tracing and why the population that the health care system served as particularly vulnerable to COVID-19.

Guidance for Employers

This decision, and perhaps especially the dissent, provide several important takeaways for employers when evaluating religious accommodation requests related to vaccination or other workplace health and safety policies:

• Document the specific undue hardship. While the majority found the County’s evidence sufficient, the dissent’s criticism highlights the value of building a robust evidentiary record. Employers should document specific facts demonstrating how accommodating a particular employee would impose substantial costs — not merely general policy justifications. This may include expert declarations, quantified safety risks, operational impacts, and analysis of the specific employee’s job duties and work environment.

• Conduct individualized assessments. The dissent faulted the County for applying a blanket rule denying all religious exemptions for in-person employees rather than meaningfully considering individual accommodations. Employers should evaluate each accommodation request on a case-by-case basis, considering the specific employee’s job duties, work environment, frequency of patient or customer contact, availability of alternative safety measures, and potential for remote or modified work arrangements.

• Consider the employee’s work context. The majority emphasized that the health care setting — where the Plaintiff worked in close quarters with other staff and had regular patient contact — was critical to finding undue hardship. Employers should carefully document the specific nature of each employee’s role, including physical workspace conditions, frequency and duration of contact with vulnerable populations, and the availability of mitigation measures in that particular work environment.

• Ensure consistent enforcement. The dissent’s focus on the treatment of Sanitarian I underscores the importance of consistent policy enforcement. Employers should ensure that similarly situated employees are treated consistently and should be prepared to explain any apparent differences in treatment. Inconsistent enforcement can undermine claims of undue hardship and create exposure to disparate treatment claims.

• Rely on authoritative guidance. The court credited the County’s reliance on CDC guidance in formulating its vaccination policy and determining that other mitigation measures were insufficient. Employers should document their reliance on applicable public health guidance and scientific evidence when making accommodation decisions, though such guidance alone may not be sufficient to establish undue hardship without additional evidence specific to the employer’s operations.

• Remember the burden of proof. As the dissent emphasized, the employer bears the burden of proving undue hardship at trial and must demonstrate that the record is “so one-sided” as to warrant summary judgment. Mere assertions that an accommodation would be difficult are insufficient; employers must present facts and evidence quantifying the actual costs or burdens. This decision serves as a reminder that even successful defense of accommodation claims requires careful documentation and evidentiary preparation.