Sixth Circuit: Employees Must Give “Reasonably Specific” Notice of Religious Conflicts; Safety Risks and Testing Logistics Can Create Title VII Undue Hardship

Introduction

In Christina Henry v. Southern Ohio Medical Center, No. 24-3863 (6th Cir. Sept. 11, 2025), the Sixth Circuit affirmed summary judgment for a pediatric healthcare provider in a Title VII religious-accommodation case arising from COVID-19 vaccination and testing policies. The panel (Judges Griffin, Larsen, and Mathis; opinion by Judge Larsen) addressed two recurring questions in pandemic-era accommodation litigation that will outlast COVID-related disputes:

What does Title VII’s “notice” requirement demand of an employee seeking a religious accommodation—especially when the employer offers multiple testing modalities?
When does an accommodation pose an “undue hardship” under Groff v. DeJoy—particularly where patient safety and testing turnaround times are implicated?

Working as a Licensed Practical Nurse in a pediatric office with newborns, Christina Henry received a religious exemption from vaccination but refused the employer’s weekly nasopharyngeal testing requirement. She sought, in sweeping terms, an exemption from “COVID testing” altogether, later claiming she had asked for alternative methods (e.g., saliva). SOMC placed her on unpaid leave for refusing to comply with the vaccinate-or-test policy. Henry sued for failure to accommodate and retaliation under Title VII; the district court granted summary judgment to SOMC, and the Sixth Circuit affirmed.

Summary of the Opinion

The Sixth Circuit assumed—without deciding—that Henry’s beliefs were sincerely held and that she had made out a prima facie case, and it affirmed on two independent grounds:

Notice of conflict: Drawing on DeVore v. Univ. of Ky. Bd. of Trs., the court held that employees must provide “reasonably specific” notice of the religious conflict. Based on Henry’s repeated blanket objections (and her statements to SOMC’s representative that she would not permit “any type of instrument” in her body), SOMC reasonably understood her to be requesting either (a) an exemption from all COVID testing or (b) at most a non-invasive saliva test—not other invasive swabs (oropharyngeal or anterior nares). Her later deposition and affidavit did not put SOMC on timely notice that she would accept those invasive alternatives.
Undue hardship: Applying Groff’s “substantial burden in the overall context” standard, the court held that both accommodations Henry effectively requested would impose an undue hardship in a pediatric clinical setting:
- Exemption from all testing and vaccination—undue hardship because of heightened risk to vulnerable pediatric patients, aligning with Wise, Kizer, and Savel.
- Saliva testing in lieu of nasopharyngeal testing—undue hardship because saliva testing was less effective and would require off-site processing, doubling the turnaround from under 24 hours to at least 48 hours, thereby increasing exposure risk. Employers may rely on evidence “available at the time,” including lab-director declarations.

On Henry’s retaliation claim, the court assumed a prima facie showing but held that SOMC articulated a legitimate, non-discriminatory reason (patient and staff safety), and Henry failed to show pretext. Temporal proximity did not suffice given a preexisting compliance deadline for all employees, and there were no similarly situated comparators.

Analysis

Precedents Cited and Their Influence

Groff v. DeJoy, 600 U.S. 447 (2023): Recalibrated Title VII’s undue hardship standard from de minimis to a “substantial” burden in the “overall context of an employer’s business.” Henry operationalizes that test in a healthcare setting by emphasizing concrete safety risks and testing logistics.
DeVore v. Univ. of Ky. Bd. of Trs., 118 F.4th 839 (6th Cir. 2024): In a COVID-testing dispute, DeVore underscored that employees must identify the specific nature of their religious conflict with the employer’s requirements. Henry builds on this by requiring “reasonably specific” objections that delineate which modalities conflict and which do not.
Wise v. Children’s Hosp. Med. Ctr. of Akron, 2025 WL 1392209 (6th Cir. May 14, 2025): Exempting a pediatric staff pharmacist from both vaccination and testing posed undue hardship due to patient vulnerability. Henry extends this principle to an LPN in a pediatric office, treating patient-safety risks as dispositive.
Kizer v. St. Jude Children’s Research Hosp., 2024 WL 4816856 (6th Cir. Nov. 18, 2024) & Savel v. MetroHealth Sys., 2025 WL 1826674 (6th Cir. July 2, 2025): Reinforce that exemptions in patient-facing healthcare roles may create undue hardship, especially for vulnerable populations.
Draper v. U.S. Pipe & Foundry Co., 527 F.2d 515 (6th Cir. 1975): “Title VII does not require that safety be subordinated to the religious beliefs of an employee.” Safety considerations are “highly relevant” to undue hardship; Henry applies this longstanding principle post-Groff.
Temporal proximity & pretext precedents: Seeger v. Cincinnati Bell (temporal proximity is not enough by itself), Barrett v. Lucent Techs. and Montell v. Diversified Clinical Servs. (preexisting plans or deadlines blunt any inference from timing).
Evidence “available at the time”: The court favorably cites the principle (via the district court and MacDonald) that undue hardship is assessed based on information available when the decision is made, analogizing to Smith v. Chrysler in the ADA context. This undergirds reliance on SOMC’s lab director for turnaround times.
Sham-affidavit rule: While the district court invoked it (Reich), the Sixth Circuit affirmed without needing to rely on that ground and found no abuse of discretion in the district court’s assessment.

Legal Reasoning

1) The Notice Requirement: “Reasonably Specific” Objections

Title VII requires an employee to “inform[] the employer” of the religious conflict. In practice, Henry demands more than a generalized statement of objection: the employee must provide enough specificity to allow the employer to discern which job requirements (and which variants of those requirements) conflict with the employee’s beliefs.

Henry’s communications were broadly framed. Her letters and her pastor’s letter objected to “COVID testing” as a category and invoked “foreign objects,” “substances in the test,” and “experimentation,” not just nasopharyngeal swabs. In her call with SOMC’s representative, she opposed “any type of instrument” in her body, and proposed only “self-screening.”
Context matters to what “notice” conveys. Even crediting Henry’s later statement that she asked about “other forms of testing,” the court held that, in context, SOMC reasonably understood that to refer only to non-invasive (saliva) testing, not to invasive alternatives (throat or anterior nares swabs). Crucially, her follow-up letter did not signal any change in stance or willingness to accept invasive alternatives.
Concrete example of adequate notice. When Henry changed her position on masking, she explicitly told SOMC she could comply—a model of the clarity the law expects when an employee revises the scope of her religious conflict.

Takeaway: Employees must specify, at the time of the interactive process, which modalities they can accept and which they cannot; employers may reasonably interpret ambiguous or blanket objections in light of the entire record of communications.

2) Undue Hardship Under Groff: Safety and Testing Logistics in a Pediatric Setting

Applying Groff, the court evaluated whether the proposed accommodations would impose a “substantial” burden in the overall context of SOMC’s pediatric practice.

Total exemption from testing and vaccination. Following Wise and related cases, the court held this would unduly burden a pediatric facility responsible for highly vulnerable patients. Patient safety need not be subordinated to religious accommodations.
Saliva testing as a substitute for nasopharyngeal testing. The record showed:
- Saliva tests were less effective at detecting infection at the time—heightening transmission risk.
- SOMC lacked in-house saliva testing capacity; off-site processing would “at least” double turnaround (from under 24 hours to 48 hours), lengthening the period an asymptomatic, infectious employee might interact with patients and staff.
The court affirmed that such delay and reduced test sensitivity substantially burdened SOMC’s mission to protect vulnerable patients; no contrary evidence created a genuine dispute.
Evidence assessed at the time. SOMC could rely on its lab director’s declaration and contemporaneous operational realities. The court approved this approach.

3) Retaliation: Pretext and Preexisting Deadlines

Assuming a prima facie case, SOMC offered a legitimate, non-discriminatory reason—preventing COVID spread among staff and patients. Henry’s pretext showing failed:

Temporal proximity alone was insufficient where SOMC acted immediately after a well-publicized and preexisting compliance deadline. That timing “negate[d]” any inference of retaliatory motive.
Alternative testing argument collapsed because Henry had not put SOMC on notice that she would accept invasive alternatives.
Comparator evidence was forfeited and, in any event, weak, as all other accommodation recipients agreed to weekly testing; none were similarly situated “in all relevant respects.”

Impact

Immediate Doctrinal Significance

Notice specificity is now front-and-center in the Sixth Circuit. Employees must articulate which specific components of an employer’s policy conflict with their beliefs; generalized objections to “testing” or “vaccination” may be read as categorical unless the employee clearly carves out acceptable alternatives.
Healthcare safety risks readily meet Groff’s “substantial burden” standard. In patient-facing roles—especially pediatrics and other high-vulnerability settings—accommodations that materially increase infection risk (through less effective tests or longer turnaround) will often be undue hardships.
Operational logistics matter. In-house testing capacity, third-party turnaround times, and test sensitivity are legally salient facts. Employers that can show a meaningful increase in exposure risk due to slower or less sensitive testing are well-positioned to meet Groff’s standard.
Temporal-proximity pretext claims are blunted by preexisting deadlines. Consistently enforced compliance dates provide a powerful defense to retaliation claims premised on timing.

Practical Implications for Stakeholders

For employees:
- Be precise. If you object to a nasal swab but can accept throat or saliva testing, say so expressly and in writing at the time of the request.
- Update the employer promptly if your position changes. The court praised clear, contemporaneous notice (as with Henry’s mask-change).
For employers (especially healthcare):
- Document the interactive process. SOMC’s use of an ethics committee, HR outreach, and a lab director’s declaration were persuasive.
- Assess risk with contemporaneous evidence. Courts will evaluate undue hardship based on facts available at the time; internal capacity, vendor timelines, and clinical guidance (e.g., CDC preferences) are key.
- Apply deadlines consistently. Uniform enforcement supported the non-retaliatory rationale.
Beyond COVID-19: The opinion’s principles extend to other communicable-disease controls (e.g., TB screening, influenza), fitness-for-duty testing, and safety-sensitive environments (neonatal, oncology, long-term care). Testing modality, turnaround, and sensitivity will continue to be central in undue-hardship analyses.

Complex Concepts Simplified

Title VII religious accommodation: Employers must reasonably accommodate an employee’s sincerely held religious beliefs unless doing so would cause an undue hardship to the business.
Prima facie case: The employee must show (1) a sincere religious belief conflicting with a job requirement, (2) notice to the employer, and (3) discipline or discharge for noncompliance.
Notice (“informing” the employer): The employee must communicate with reasonable specificity which requirements (and which variations) conflict with the belief. Ambiguous, categorical objections can be read broadly.
Undue hardship after Groff: An accommodation causes undue hardship when it imposes a substantial burden in the employer’s overall operations. In healthcare, increased transmission risk, reduced test sensitivity, and longer result times can be substantial.
Sham-affidavit rule: A party cannot create a dispute of fact by submitting an affidavit that contradicts prior sworn testimony. The Sixth Circuit did not rely on this doctrine to affirm here, but noted the district court did not abuse its discretion in applying it.
Retaliation—pretext and temporal proximity: Even if an employer acts soon after protected activity, preexisting plans or deadlines can rebut an inference of retaliatory motive. The employee must show the employer’s reason is not the real reason.

Conclusion

Henry v. SOMC offers two durable holdings in the post-Groff landscape. First, the Sixth Circuit crystallizes Title VII’s notice requirement: employees must provide “reasonably specific” objections that delineate the contours of their religious conflict, enabling employers to evaluate concrete accommodations. Second, the court confirms that, in patient-facing healthcare settings, accommodations that materially heighten infection risk—through less sensitive testing modalities or slower turnaround—impose an undue hardship. The court also underscores that retaliation claims will fail where employers act under uniform, preexisting compliance deadlines and document contemporaneous safety rationales.

Taken together, these rulings encourage a disciplined, evidence-based interactive process in which employees articulate precise constraints and employers marshal real-time operational data—laboratory capacity, vendor timelines, and clinical risk—to assess feasibility. The decision’s reach extends beyond COVID-19 to any context where testing logistics intersect with workplace safety and religious accommodation.