Patricia Conway v. Mercy Hospital St. Louis

United States Court of Appeals
For the Eighth Circuit
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No. 24-1388
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Patricia Conway
Plaintiff - Appellant
v.
Mercy Hospital St. Louis
Defendant - Appellee
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Appeal from United States District Court
for the Eastern District of Missouri - St. Louis
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Submitted: April 16, 2025
Filed: August 1, 2025
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Before KELLY, ERICKSON, and STRAS, Circuit Judges.
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ERICKSON, Circuit Judge.
During the COVID-19 pandemic, Patricia Conway, a registered nurse, was
terminated from Mercy Hospital St. Louis (“Mercy Hospital”)—a non-profit
healthcare facility owned and operated by Mercy Health Ministries—after she
refused to comply with the hospital’s vaccination policy. The policy required all
employees to receive the COVID-19 vaccine unless they obtained an approved
medical or religious exemption. Conway requested a religious exemption, which

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Mercy Hospital denied. After Conway was terminated for noncompliance with the
policy, she commenced this action alleging religious discrimination under Title VII
of the Civil Rights Act of 1964. Mercy Hospital moved for summary judgment
asserting, as a religious organization, it was exempt under 42 U.S.C. § 2000e-1(a).
The district court1 granted summary judgment. We affirm.
I. BACKGROUND
Mercy Hospital St. Louis is a wholly owned subsidiary of Mercy Health East
Communities, which in turn is wholly owned by Mercy Health. Mercy Health is the
civil business entity formed by Mercy Health Ministries—a public juridic person of
the Roman Catholic Church—to provide healthcare services in accordance with
Catholic doctrine. Mercy Health’s wholly owned subsidiary, MHM Support
Services, Inc. (“MHM”), is a Missouri nonprofit corporation that employs most
Mercy Health personnel, excluding physicians and certain other licensed
professionals. To summarize:
1 The Honorable Ronnie L. White, United States District Judge for the Eastern
District of Missouri.
Mercy Health Ministries
Public Juridic Person of the
Roman Catholic Church
Mercy Health
MHM Support
Services
(employer entity)
Mercy Health
East
Communities
Mercy Hospitals East
Communities
d/b/a Mercy Hospital St.
Louis

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MHM’s bylaws describe its mission as “witness[ing] . . . Christ’s concern for
the care of the sick and injured and the teaching of the Roman Catholic Church
regarding Christian health services and charity.” Conway was employed as a
registered nurse by MHM from January 2006 to July 2015 and again beginning in
July 2017.
In July 2021, Mercy Hospital implemented a mandatory COVID-19
vaccination policy in accordance with the Centers for Medicare and Medicaid
Services (“CMS”) vaccination requirement. Under the policy, unvaccinated
employees were permitted to work through September 30, 2021. After that date,
they were placed on unpaid suspension. If an employee remained unvaccinated for
twenty-eight days and did not obtain an exemption, the employee was subject to
termination.
On July 29, 2021, Conway submitted a request for a religious exemption. She
objected to the vaccine on the grounds that it contained fetal tissue cells and was
“possibly harmful to the human body,” asserting her faith required her not to
“participate in pharmacopeia.” She included a letter of support from Pastor David
W. Hall of True Hope Ministry. Mercy Hospital denied her request for a religious
exemption on August 2, 2021.
Conway did not engage in further discussions with management until
September 24, 2021, when her supervisor inquired about her vaccination status.
Upon confirming that she would not comply with the policy, Conway was informed
she could continue working until her last scheduled shift on September 30, 2021.
Her last day of work was October 1, 2021, and Conway was formally terminated on
October 28, 2021.
In early 2022, Conway filed a complaint with the Equal Employment
Opportunity Commission, which was cross-filed with the Missouri Commission on
Human Rights (“MCHR”). The MCHR administratively closed the case, concluding
that Mercy Health qualified as a religious organization not subject to the Missouri

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Human Rights Act. Conway then filed suit in Missouri state court, asserting a claim
of religious discrimination under Title VII of the Civil Rights Act of 1964. Mercy
Hospital removed the action to federal court and moved for summary judgment
based on Title VII’s exemption for religious organizations. It submitted a statement
of uncontroverted facts, which Conway admitted. The district court granted
summary judgment in Mercy Hospital’s favor. This appeal followed.
II. DISCUSSION
We review the district court’s grant of summary judgment de novo. Meek v.
Kan. City Life Ins. Co., 126 F.4th 577, 585 (8th Cir. 2025). Summary judgment is
appropriate when, viewing the record in the light most favorable to the nonmoving
party, there is no genuine dispute of material fact and the movant is entitled to
judgment as a matter of law. Houston v. Saint Luke’s Health Sys., Inc., 76 F.4th
1145, 1149 (8th Cir. 2023).
Title VII generally prohibits employers from discriminating against
employees on the basis of their religious beliefs. However, Congress created a
limited exemption for “religious organizations.” See Corp. of Presiding Bishop of
Church of Jesus Christ of Latter-Day Saints v. Amos, 483 U.S. 327, 329 (1987)
(discussing 42 U.S.C. § 2000e-1(a)). The exemption provides:
[Title VII] shall not apply to . . . a religious corporation, association,
educational institution, or society with respect to the employment of
individuals of a particular religion to perform work connected with the
carrying on by such corporation, association, educational institution, or
society of its activities.
Because Congress did not define what makes an organization “religious,” we
look to the ordinary meaning of the term. Taniguchi v. Kan Pac. Saipan, Ltd., 566
U.S. 560, 566 (2012). Beginning with the statutory text, we first consider whether
the term “religious” is unambiguous when read in context. United States v. Goad,
788 F.3d 873, 875 (8th Cir. 2015).

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The ordinary meaning of “religious” is broad. A religious organization is
commonly understood to be one “committed, dedicated, or consecrated to service of
the divine” or “relating to religion.” Religious, Webster’s Third New International
Dictionary (3d. ed.1968); see also Corporation, Black’s Law Dictionary (4th rev.
ed. 1968) (defining “religious corporation” as “[a] corporation formed for the
purpose of maintaining or propagating religion . . . and incidentally owning and
administering real and personal property for religious uses.”). These definitions
guide our analysis, as do the uncontroverted material facts regarding Mercy
Hospital’s structure and mission:
• Mercy Hospital St. Louis is a nonprofit, tax-exempt healthcare provider that
receives monetary support from the Catholic Church.
• It operates as a d/b/a of Mercy Hospitals East Communities, a wholly owned
subsidiary of Mercy Health East Communities, which is itself owned by
Mercy Health, a civil nonprofit corporation.
• Mercy Hospital’s mission is: “As the Sisters of Mercy before us, we bring to
life the healing ministry of Jesus through our compassionate care and
exceptional service.”
• The hospital’s environment reflects its religious identity, with Catholic
imagery throughout and daily prayers broadcast over the public address
system.
• Mercy Health is the civil corporate entity through which the Catholic Church
conducts its healthcare ministry, and its governing documents commit it to
advancing the healing ministry of Jesus Christ in accordance with Catholic
doctrine.

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• Mercy Health’s Board of Directors includes four Sisters of Mercy and is
accountable to the Vatican Dicastery for the Institutes of Consecrated Life and
Societies of Apostolic Life.
• Mercy Health applies the Ethical and Religious Directives for Catholic Health
Care Services promulgated by the United States Conference of Catholic
Bishops and requires employees to adhere to them.
• Mercy Health is wholly owned by Mercy Health Ministries, a public juridic
person of the Roman Catholic Church formed under Canon Law and not
incorporated under civil law.
• Mercy Health Ministries, Mercy Health, and Mercy Hospital St. Louis are all
listed in the Official Catholic Directory, which confers IRS recognition of
their religious and tax-exempt status and authorizes them to hold property in
the name of the Church.
• The MCHR has recognized Mercy and its affiliates as religious organizations
operated by the Catholic Church.
These undisputed facts overwhelmingly support the conclusion that Mercy Hospital
qualifies as a “religious organization” within the meaning of § 2000e-1(a). See
Corporation, Black’s Law Dictionary (4th rev. ed. 1968).
That Mercy Hospital generates revenue or employs a predominantly non-
Catholic workforce does not alter this determination. We may not assess whether
an organization is “religious” based on the nature of its religious expression. See
Bogen v. Doty, 598 F.2d 1110, 1113 (8th Cir. 1979) (“[R]ecognition of religion is
tolerated, but excessive entanglement between government and religion is
impermissible.”). To deny an exemption based on inherently religious decisions—
such as whether to proselytize or employ only co-religionists—would risk
unconstitutional denominational discrimination. See Catholic Charities Bureau, Inc.

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v. Wisconsin Lab. & Indus. Rev. Comm’n, 145 S. Ct. 1583, 1591–92 (2025). We
may not refuse to apply § 2000e-1(a)’s exemption based on the hospital’s choice to
employ non-Catholics or provide services to the broader public. See id. at 1592.
Nor may we construe § 2000e-1(a) in a manner that raises serious constitutional
concerns when a straightforward reading avoids them. See Edward J. DeBartolo
Corp. v. Fla. Gulf Coast Bldg. & Constr. Trades Council, 485 U.S. 568, 575 (1988).
The statutory text plainly sets out the exemption, and Mercy Hospital falls within its
ambit.
Having concluded Mercy Hospital qualifies as a religious organization under
§ 2000e-1(a), we next consider Conway’s argument that its conduct nonetheless
renders the exemption inapplicable. Conway advances two theories: waiver and
equitable estoppel.
Conway first contends Mercy waived its right to claim the Title VII exemption
by complying with the CMS mandate, which required covered providers to offer a
religious exemption process. But compliance with a federal regulation does not
waive a statutory exemption that Congress conferred. See Hall v. Baptist Mem’l
Health Care Corp., 215 F.3d 618, 625 (6th Cir. 2000) (observing that parties cannot
typically waive exemptions from Title VII claims); see also Little v. Wuerl, 929 F.2d
944, 951 (3d Cir. 1991) (rejecting waiver argument and explaining that Title VII’s
religious exemption is not “a privilege or interest granted to [religious]
organizations”). Moreover, while the CMS rule required employers to provide a
process for requesting exemptions, it did not abrogate Title VII or suspend § 2000e-
1(a)’s application to religious organizations. See Biden v. Missouri, 595 U.S. 87
(2022) (upholding CMS mandate without limiting Title VII protections). There is
no indication in the rule—or in the record—that a religious employer forfeits its
exemption by following a federal requirement to evaluate accommodation requests.
Conway next argues Mercy should be estopped from invoking the exemption
at summary judgment because its internal vaccine policy invited employees to
submit religious exemption requests. But equitable estoppel requires more than a

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general invitation; it requires (1) a clear representation, (2) reasonable reliance, and
(3) resulting detriment. Farley v. Benefit Tr. Life Ins. Co., 979 F.2d 653, 659 (8th
Cir. 1992). Mercy Hospital’s policy stated only that “[e]xemptions to the mandatory
COVID-19 vaccination may be granted for certain medical contraindications . . . [or]
if vaccination conflicts with the tenets of a sincerely held religious belief.” The
conditional language does not guarantee approval. Nor does it suggest Mercy was
abandoning its exemption from Title VII’s liability framework. See 86 Fed. Reg.
61555-01, 61568–69 (employers implementing the vaccine mandate are still bound
by Title VII). Because Mercy made no promise that would have induced detrimental
reliance, Conway’s estoppel argument fails.
III. CONCLUSION
For the foregoing reasons, we affirm the judgment of the district court.
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