Amanda Jackson v. Methodist Health Services Corporation , doing business as UNITY POINT HEALTH…

In the
United States Court of Appeals
For the Seventh Circuit
____________________
No. 23-1464
A MANDA J ACKSON ,
Plaintiff-Appellant,
v.
M ETHODIST HEALTH S ERVICES
C ORPORATION , doing business as
U NITY POINT HEALTH —C ENTRAL
I LLINOIS ,
Defendant-Appellee.
____________________
Appeal from the United States District Court for the
Central District of Illinois.
No. 1:22-cv-01307-MMM-JEH — Michael M. Mihm, Judge.
____________________
A RGUED DECEMBER 4, 2023 — DECIDED NOVEMBER 20, 2024
____________________
Before R OVNER , S CUDDER , and PRYOR , Circuit Judges.
R OVNER , Circuit Judge. Plaintiff-appellant Amanda Jack-
son, a healthcare worker, filed suit against her former em-
ployer, Methodist Health Services (“Methodist”), after Meth-
odist placed her on unpaid leave and then discharged her
when she refused either to be vaccinated for Covid-19 or to

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2 No. 23-1464
undergo weekly testing for the virus. Jackson alleges that
Methodist discriminated against her on the basis of her reli-
gion, in violation of Title VII of the Civil Rights Act of 1964,
42 U.S.C. § 2000e, by failing to accommodate her religious ob-
jections to the vaccine. But because we agree with the district
court that Jackson’s complaint and the attachments thereto re-
veal that Methodist did reasonably accommodate her reli-
gious objections, see Jackson v. Methodist Hosp. Servs. Corp.,
2023 WL 2486599 (C.D. Ill. Feb. 10, 2023), we affirm the dis-
missal of her complaint.
I.
For purposes of this appeal, we accept the following alle-
gations of Jackson’s complaint as true. E.g., Esco v. City of Chi-
cago, 107 F.4th 673, 678 (7th Cir. 2024). Jackson has attached a
number of documents to her complaint that she both cites and
relies upon in support of her claims. We will consider those
documents, which are central to her claims, and incorporate
them into our summary of the facts alleged. See id.; Zablocki v.
Merchants Credit Guide Co., 968 F.3d 620, 623 (7th Cir. 2020);
Williamson v. Curran, 714 F.3d 432, 435–36 (7th Cir. 2013); Fed.
R. Civ. P. 10(c); 5A Charles A. Wright & Arthur R. Miller,
F EDERAL PRACTICE & PROCEDURE § 1327 (updated through
June 2024).
Jackson worked as a healthcare professional for Methodist
in Central Illinois. (Her brief indicates that she is a nurse.)
On September 3, 2021, Illinois Governor J.B. Pritzker is-
sued an executive order requiring that healthcare workers in
Illinois begin the vaccination process for the Covid-19 virus
by September 19, 2021, or be excluded from their places of
employment unless granted an exemption from the vaccine

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No. 23-1464 3
requirement by their employers. R. 1-1 at 4 § 2(b) & (e). A copy
of the executive order is among the documents attached to the
complaint.1
Jackson sought an exemption from the vaccine require-
ment due to her sincerely held religious beliefs (she objected
to the use of fetal cell lines in the development and testing of
Covid-19 vaccines, see R. 1 at 4 ¶ 17), and on September 13,
2021, Methodist granted Jackson a permanent religious ex-
emption from the vaccination requirement, requiring as a
condition of the exemption that Jackson wear a mask when
she was working. The exemption was memorialized by way
of a written letter from Methodist to Jackson which she has
attached to her complaint. Methodist’s directive that Jackson
wear a mask while working was consistent with what Gover-
nor Pritzker’s executive order required as of September 13. See
R. 1–1 at 2–3 § 1 (requiring that masks be worn in healthcare
settings regardless of vaccination status effective August 30,
2021).
However, beginning September 19, 2021, the Governor’s
executive order required that healthcare workers who were
not fully vaccinated undergo, at a minimum, weekly testing
for Covid-19. R. 1–1 at 4 § 2 (c)–(e). This requirement applied
to persons who were granted an exemption from the vaccine
mandate—including those for whom vaccination would re-
quire them to violate or forgo a sincerely held religious belief,
practice, or observance, individuals for whom the vaccine
1 The complaint alleges that the vaccination requirement took effect
on September 27, 2021, but the executive order itself indicates that the ef-
fective date was September 19, 2021, so we shall rely on the date indicated
in the executive order. The discrepancy is irrelevant to our evaluation of
the legal sufficiency of Jackson’s complaint.

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4 No. 23-1464
was medically contraindicated, and those who had not yet
completed a multi-shot vaccine regimen. Persons who were
not vaccinated but did not submit to testing were to be ex-
cluded from healthcare workplaces. R. 1–1 at 4 § 2(c)–(e).
Jackson alleges that Methodist then “verbally”—i.e.,
orally—withdrew the vaccine exemption it had granted her
on the 13th, advising her that the Governor’s executive order
“did not allow for such exemption.” R. 1 at 2 ¶ 9. But what the
balance of the complaint makes clear is that Methodist was
now conditioning the vaccine exemption on her compliance
with the executive order’s requirement that she be tested
weekly. Indeed, the complaint expressly alleges that Method-
ist “adopted policies which mandated Plaintiff to become vac-
cinated or submit to invasive testing.” R. 1 at 21 ¶ 100. Jackson
was opposed to testing in the absence of Covid symptoms and
concluded that choice between vaccination or regular, asymp-
tomatic testing violated her “moral conscience.” R. 1 at 3–4 ¶¶
11–16, 18; 10 ¶ 44. Jackson cited two principal reasons for that
conclusion: (1) she was opposed to “health care procedures
which she, a competent adult, does not believe are medically
necessary” (R. 1 at 3–4 ¶ 16), and (2) she “holds sincere beliefs
that prevent her from submitting to or participating in work-
place procedures which arbitrarily discriminate between em-
ployees on the basis of health care choices made pursuant to
freedom of conscience.” (R. 1 at 4 ¶ 18). She was therefore un-
willing to comply with the testing requirement, and as a result
she was put on unpaid leave and ultimately discharged.
Jackson filed suit contending that the conditions Method-
ist imposed on her continuing employment were unlawful.
Count I of her complaint alleged that Methodist violated Title
VII in that the company failed to accommodate her religious

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No. 23-1464 5
beliefs. Count III alleged that the requirement that she either
be vaccinated or undergo weekly testing violated “the sub-
stantive and procedural due process requirements” set forth
in section 2 of the Illinois Department of Public Health Act
(“IDPHA”), 20 ILCS 2305/2. R. 1 at 24 ¶ 127.2
The district court dismissed her complaint for failure to
state a claim pursuant to Federal Rule of Civil Procedure
12(b)(6). Although Jackson’s theory of the case was that Meth-
odist withdrew the vaccine exemption it had previously
granted to her on religious grounds, the court found it plain
from the complaint and the exhibits thereto that Methodist
had neither denied nor withdrawn the exemption, but rather
had modified the terms of the exemption to include the con-
dition subsequently mandated by the Governor’s executive
order—i.e., that she undergo weekly testing for Covid—and
that Jackson had refused to comply. Jackson, 2023 WL 2486599,
at *4.
Jackson secondarily argued in Count III that the testing re-
quirement itself was discriminatory because, in her view, test-
ing in the absence of Covid-19 symptoms was medically un-
necessary and because the testing mandate imposed differen-
tial requirements based on her healthcare choices. (Jackson
did not object to testing in the event she experienced symp-
toms of Covid-19, but she regarded the requirement that she
undergo regular asymptomatic testing based on her unvac-
cinated status as arbitrary and irrational.) R. 1 at 3–4 ¶¶ 15–
2 Count II of the complaint asserted a claim under the federal Emer-
gency Use Authorization Act (“EUAA”), 21 U.S.C. § 360bbb-3, et seq., as it
relates to Covid-19 vaccines, a claim which the district court dismissed on
the ground that the EUAA does not provide for a private cause of action.
Jackson does not appeal that ruling.

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6 No. 23-1464
18. But the district court pointed out that Jackson had not
identified any religious tenet that was inconsistent with the
testing requirement, which is what mattered for purposes of
her Title II religious discrimination claim. Jackson, 2023 WL
2486599, at *4.
As noted, Jackson also asserted that Methodist’s vaccina-
tion and/or testing requirements were contrary to the “due
process” provisions of the IDPHA: she contended that Meth-
odist had failed to follow the prescriptions of the statute,
failed to consult with the Illinois Department of Public
Health, otherwise exceeded its authority under that act, and
had imposed burdens on Jackson and its other employees that
were not the least restrictive means of furthering the legiti-
mate state interest in protecting public health. R. 1 at 18–19 ¶¶
86–88, 24 ¶¶ 124–28. Construing this claim as a Fourteenth
Amendment due process claim, the district court concluded
that the claim failed because Methodist was a private actor
and it did not become a state actor simply by complying with
state law (the governor’s executive order), which mandated
regular testing for unvaccinated individuals. Jackson, 2023 WL
2486599, at *5.
II.
We review the district court’s dismissal of Jackson’s com-
plaint pursuant to Rule 12(b)(6) de novo. E.g., Kahn v. Walmart
Inc., 107 F.4th 585, 593 (7th Cir. 2024). We treat the complaint’s
allegations as true and draw factual inferences in the plain-
tiff’s favor. Id. at 593–94. To survive a motion to dismiss, the
factual allegations of the complaint must state a claim for re-
lief that is plausible on its face. Ashcroft v. Iqbal, 556 U.S. 662,
678 (2009); see also Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570
(2007). The complaint meets that standard when the plaintiff

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No. 23-1464 7
“pleads factual content that allows the court to draw the rea-
sonable inference that the defendant is liable for the miscon-
duct alleged.” Iqbal, 556 U.S. at 678; see also Bilek v. Fed. Ins. Co.,
8 F.4th 581, 586–87 (7th Cir. 2021). Jackson challenges the dis-
missal of her Title VII and IDPHA claims.
A. Title VII claim
Title VII makes it unlawful for an employer to discharge
or otherwise discriminate against any individual with respect
to the terms and conditions of her employment because of
such individual’s religion. § 2000e-2(a)(1); Passarella v. Aspiris,
Inc., 108 F.4th 1005, 1008 (7th Cir. 2024). One’s religion, for
purposes of the statute, includes all aspects of one’s religious
belief, observance, and practice, and the employer’s duty not
to discriminate on the basis of religion includes a duty to rea-
sonably accommodate such belief, observance, and practice,
unless the employer shows that it cannot make an accommo-
dation without undue hardship. § 2000e(j); Passarella, 108
F.4th at 1008–09. A reasonable accommodation of one’s reli-
gion is one that “eliminates the conflict between employment
requirements and religious practices.” Rodriguez v. City of Chi-
cago, 156 F.3d 771, 775 (7th Cir. 1998) (quoting Ansonia Bd. of
Educ. v. Philbrook, 479 U.S. 60, 70 (1986)).
The claim of religious discrimination as Jackson has ini-
tially framed it is premised on the notion that Methodist re-
fused to grant Jackson an exemption from the vaccination re-
quirement, or that Methodist granted but then refused to
honor the exemption. But, as the district court reasoned, Jack-
son’s complaint makes clear that Methodist in fact granted
Jackson an exemption from the vaccine mandate, at first re-
quiring only that she be masked at all times, and then subse-
quently mandating that she undergo weekly testing—in

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8 No. 23-1464
compliance with the governor’s executive order—which she
refused to do. So, in the end, her objection is not to the vac-
cination requirement but to the requirement that she undergo
regular, asymptomatic testing for Covid-19 as a condition of
her exemption from the vaccination requirement.
Jackson has identified no objection to testing that is
grounded in her religious beliefs. She opposes the testing re-
quirement, yes, but she cites no religious tenet that is at odds
with the testing requirement and no religious practice with
which testing would interfere. Jackson has alleged that the
testing requirement offends her “moral conscience” because,
in her view, asymptomatic testing is medically unnecessary
and effectively singles her out for discriminatory and arbi-
trary treatment based on her healthcare choices—including in
particular her decision to opt out of vaccination on religious
grounds. There certainly may be rejoinders to Jackson’s criti-
cisms of the testing requirement. It is worth noting, for exam-
ple, that the testing requirement applied not just to those who
were granted religious exemptions from the vaccine, but also
individuals who had taken only the first of a two-shot vaccine
regimen, as well as persons for whom the vaccine was medi-
cally contraindicated. And if, in lieu of testing, Jackson simply
had been required to continue masking up while working—a
condition to which she apparently did not object—that too
could have been described as differential treatment based on
her healthcare decisions. See Bowlin v. Bd. of Dir. of Judah Chris-
tian Sch., 695 F. Supp. 3d 1003, 1008 (C.D. Ill. 2023), appeal filed,
No. 23–3049 (7th Cir. Oct. 25, 2023). More to the point, what
matters for purposes of Title VII is whether the testing re-
quirement burdens Jackson’s religious beliefs and practices,
and in neither her complaint nor her briefs has Jackson

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No. 23-1464 9
attempted to tie the testing requirement to any particular re-
ligious belief or practice.
The employer’s duty under Title VII is to reasonably accom-
modate an employee’s religious beliefs. In this case, Method-
ist accommodated Jackson’s religious beliefs by exempting
her from the vaccine requirement. Conditioning the exemp-
tion on weekly testing, a requirement imposed by the gover-
nor’s executive order, was reasonable. See Sutton v. Providence
St. Joseph Med. Ctr., 192 F.3d 826, 830 (9th Cir. 1999) (“courts
agree that an employer is not liable under Title VII when ac-
commodating an employee’s religious beliefs would require
the employer to violate federal or state law,” because “the ex-
istence of such a law establishes ‘undue hardship’”); see also
Yeager v. FirstEnergy Generation Corp., 777 F.3d 362, 363 (6th
Cir. 2015) (per curiam); Cassano v. Carb, 436 F.3d 74, 75 (2d Cir.
2006) (per curiam); Seaworth v. Pearson, 203 F.3d 1056, 1057
(8th Cir. 2000) (per curiam); Matthews v. Wal-Mart Stores, Inc.,
417 F. App’x 552, 554 (7th Cir. 2011) (non-precedential deci-
sion) (Title VII does not obligate an employer to adopt an ac-
commodation that would place it on the “razor’s edge” of le-
gal liability) (citing Flanagan v. Ashcroft, 316 F.3d 728, 729–30
(7th Cir. 2003)).
To the extent Jackson argues that a governor’s executive
order cannot qualify as a source of state law that Methodist
was bound to follow, her argument runs headlong into our
decision in Bradley Hotel Corp. v. Aspen Specialty Ins. Co., 19
F.4th 1002, 1008–09 (7th Cir. 2021). Bradley Hotel held that the
governor’s executive orders suspending in-person dining,
prohibiting large gatherings of people, and requiring all non-
essential businesses to cease operations constituted “law” for
purposes of an insurance policy provision excluding coverage

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10 No. 23-1464
for “loss or damage caused directly or indirectly by ... enforce-
ment of or compliance with any ordinance or law ... [r]egulat-
ing the construction, use or repair of any property.” As we
explained, when Governor Pritzker issued that order, he was
exercising the powers that the Illinois legislature granted to
him in the Illinois Emergency Management Agency Act, 20
ILCS 3305, section 7(12) of which authorized him to regulate
“the use, sale or distribution of ... materials, goods, or services;
and perform and exercise any other functions, powers, and
duties as may be necessary to promote and secure the safety
and protection of the civilian population.” See Bradley, 19 F.4th
at 1009. The executive order at issue here relied on the powers
vested in the Governor by the same statute. R. 1–1 at 2. To be
sure, the context of this case differs in certain respects from
that of Bradley Hotel, but Jackson does not acknowledge that
decision, let alone attempt to distinguish it.3
We therefore uphold the district court’s decision to dis-
miss Jackson’s Title VII claim. Methodist granted Jackson a
religious exemption from the vaccine mandate, subject to her
agreement to undergo regular Covid-19 testing. Jackson has
not made a case for why the testing requirement itself
3 Jackson instead cites Youngstown Sheet & Tube Co. v. Sawyer, 343 U.S.
579 (1952), for the proposition that an executive order cannot be elevated
to the status of law. What Youngstown held, however, was that President
Truman’s 1952 executive order directing the seizure of U.S. steel mills to
head off a nationwide work stoppage was not within the constitutional
power of the President because it was not authorized either by an act of
Congress or by any provision in the Constitution. By contrast, our decision
in Bradley Hotel concluded that the executive order at issue there was au-
thorized by the Illinois Emergency Management Agency Act. Jackson
does not acknowledge this legislation, let alone make a case for the notion
that it did not authorize the particular executive order at issue in this case.

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No. 23-1464 11
burdened her religious beliefs and practices, nor has she ex-
plained why Methodist had the authority to exempt her from
testing when the governor’s executive order expressly re-
quired such testing as a condition of an exemption from vac-
cination.
B. Claim under Illinois Department of Public Health Act
Jackson’s claim under the IDPHA is premised on the no-
tion that when Methodist required her to undergo weekly
testing for Covid-19 as a condition of her exemption from the
vaccine, it deprived her of what the complaint describes as the
“procedural and substantive due process” protections of the
statute. Section 2 of the IDPHA sets forth the powers of the
Department to address dangerously contagious or infectious
diseases, including as relevant here the power to order the
quarantine and isolation of individuals, to conduct physical
examinations of individuals, administer tests and/or collect
specimens from them, and to order the administration of
medications, vaccines, and other treatments in order to pre-
vent the spread of such diseases. When an individual does not
consent to such actions, the exercise of the Department’s pow-
ers is conditioned on compliance with certain safeguards, in-
cluding notice and the right to a hearing for the affected per-
son, the right to counsel, and a court order authorizing the
Department to take such actions. Jackson contends that Meth-
odist’s actions in requiring that she submit either to vaccina-
tion or regular testing as a condition of her continued employ-
ment were inconsistent with the Act, in that Methodist as a
private employer was not authorized to exercise powers
given to the Department and Methodist did not afford her the
procedural protections specified in the statute.

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12 No. 23-1464
Although the district court quite understandably under-
stood Jackson to be asserting a Fourteenth Amendment due
process claim, given Jackson’s references to the substantive
and procedural due process components of the Illinois De-
partment of Public Health Act,4 Jackson’s counsel indicated at
oral argument that Jackson intended only to assert a claim for
violation of the Act, not a federal constitutional claim. We
therefore address the claim asserted in Count III of the com-
plaint solely as a statutory claim.
So understood, the claim fails, because Methodist was not
exercising (or purporting to exercise) the powers conveyed by
section 2 of the statute when it demanded that Jackson un-
dergo testing; rather, Methodist was acting as Jackson’s em-
ployer to set the terms of the workplace religious accommo-
dation that she requested. Illinois cases make clear that an Il-
linois employer has the inherent authority to adopt rules to
promote workplace safety. See Glass v. Dep’t of Corr., 2022 IL
App (4th) 220270, ¶¶ 27–30 (2022); Thornton v. Dep’t of Corr.,
2023 IL App (5th) 220300-U, ¶ 26 (2023) (non-precedential de-
cision); Allen v. Bd. of Educ. of North Mac Cmty. Unit Sch. Dist.
No. 34, 2022 IL App (4th) 220307-U, ¶ 19 (2022) (non-prece-
dential decision). And, of course, a healthcare provider has a
paramount interest in protecting the safety not only of its own
workforce, but of the individuals who seek medical care from
such a provider. Jackson’s sole rejoinder is to invoke the Su-
preme Court’s decision in Nat’l Fed. of Indep. Bus. v. Dep’t of
Labor, Occupational Safety and Health Admin., 595 U.S. 109
4 Notably, Jackson’s complaint did not invoke the district court’s sup-
plemental jurisdiction under 28 U.S.C. § 1367, an omission that also sug-
gested Jackson was asserting a federal rather than a state claim in Count
III of her complaint.

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No. 23-1464 13
(2022) (per curiam). But National Federation held only that
OSHA, as a federal agency charged with regulating work-
place safety, lacked the authority to require all employers
with more than 100 employees to compel their workers to ei-
ther become vaccinated for Covid-19 or submit to regular test-
ing. Id. at 117–20. The Court emphasized that although Covid-
19 presented a public health problem, it did not present an
occupational hazard in most workplaces. Id. at 118. Thus, alt-
hough OSHA had the authority to address the Covid-related
dangers presented in crowded or cramped workplaces where
person-to-person viral transmission was more likely, for ex-
ample (id. at 119), it did not have the authority to impose a
sweeping mandate applicable to nearly all workplaces (id. at
119–20). Nothing in National Federation deprives individual
employers of the power to address health and safety concerns
in their own workplaces, see Thornton, 2023 IL App (5th)
220300-U, ¶ 25, and certainly nothing precludes a healthcare
employer in particular from doing so.
III.
Because Jackson’s complaint fails to state a claim on which
relief may be granted, we AFFIRM the district court’s judg-
ment.

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