Discrimination
MacDonald v. OHSU (9th Cir., 2026): Officials Have Qualified Immunity on Free Exercise Claim
Updated
In MacDonald v. Oregon Health and Science University, the Ninth Circuit affirmed two rulings in favor of a hospital and its officials after a registered nurse was denied a religious exemption from a COVID-19 vaccine mandate and then terminated. The panel held that the individual defendants were entitled to qualified immunity on the nurse’s Free Exercise claim, and it affirmed summary judgment for the hospital on her Title VII failure-to-accommodate claim. Judge Tung dissented from the qualified immunity ruling.
Background
Brittany MacDonald was a registered nurse in the Mother Baby Unit of OHSU’s Doernbecher Children’s Hospital, where she provided direct, hands-on care to pregnant mothers, newborns, and immunocompromised patients. OHSU is Oregon’s largest public hospital system, with roughly 20,000 employees caring for about 330,000 patients in 2021.
In August 2021, in response to the Delta variant, Oregon’s governor issued an executive order requiring all healthcare workers to be vaccinated against COVID-19 by October 18, 2021. OHSU required its personnel to comply unless they received an approved religious or medical exemption.
MacDonald, a practicing Christian who opposes abortion, requested a religious exemption, citing her beliefs about the sanctity of life and objections to vaccines connected to fetal cell lines. OHSU had earlier notified employees that objections based on “fetal cell concerns” or “bodily integrity or sanctity” would be treated as personal moral choices rather than tenets of a religious faith.
OHSU denied the request and terminated MacDonald after she remained unvaccinated. She sued in the U.S. District Court for the District of Oregon, bringing a section 1983 Free Exercise claim against individual board and committee members and a Title VII failure-to-accommodate claim against OHSU. The district court dismissed the Free Exercise claim on qualified immunity grounds and later granted OHSU summary judgment on the Title VII claim.
What the Court Held on Qualified Immunity
Reviewing the dismissal de novo, the panel held that the individual defendants were entitled to qualified immunity. Under the governing standard, an official is immune unless existing precedent placed the constitutional question beyond debate, assessed in the specific context of the case rather than at a high level of generality.
The panel found no clearly established law in 2021 giving the defendants fair notice that denying a religious exemption—to a healthcare worker in close contact with vulnerable patients during a pandemic—would violate the Free Exercise Clause. It distinguished the COVID-era and religious-accommodation cases MacDonald cited as involving different government actions and contexts, or as postdating the conduct.
The panel also reasoned that the policy arguably treated religious objectors more favorably than secular ones, since employees with secular objections had no exemption process at all, and that protecting public health during a deadly pandemic was a legitimate—and compelling—government interest.
As of 2021, no clearly established law gave hospital officials fair notice that denying a healthcare worker’s religious exemption from a state COVID-19 vaccine mandate violated the Free Exercise Clause, so the individual defendants were entitled to qualified immunity.
What the Court Held on Title VII
On the failure-to-accommodate claim, the only issue before the panel was undue hardship. Under Groff v. DeJoy, an employer must show substantial increased costs in relation to its particular business, which can include health, safety, and operational burdens, not just monetary ones.
The panel held that OHSU met that bar. Its undisputed evidence established that allowing an unvaccinated nurse to continue working with vulnerable patients posed substantial health and safety risks, and that removing or replacing her amid a nursing shortage would have imposed substantial operational and financial costs.
The panel also rejected MacDonald’s pretext argument, noting that no authority imports a pretext or discriminatory-motive analysis into the undue-hardship inquiry. Even assuming it applied, she had not raised a triable issue that OHSU’s cost and safety concerns were a mere pretext for religious discrimination.
The Dissent
Judge Tung dissented from the qualified immunity ruling, arguing that the policy singled out certain religious beliefs—such as objections to fetal cell lines—as categorically not religious, which he viewed as plain religious targeting barred by established law. In his view, that discrimination was obvious enough that qualified immunity should have been denied.
What This Means for You
This decision addresses whether officials who denied religious exemptions from a pandemic-era vaccine mandate were entitled to qualified immunity, holding that no clearly established law in 2021 gave them fair notice of a Free Exercise violation in that specific context. It also applies the Groff undue-hardship standard to a healthcare employer’s Title VII failure-to-accommodate defense and declines to read a pretext requirement into that analysis.
I write these summaries as general information about developments in California employment law. They are not legal advice and don’t create a mediator–client relationship. For guidance on a specific matter, consult a qualified attorney.