BALBOA v. TEXAS CHILDREN HOSPITAL (2025)

OPINION

Appellant Elizabeth Balboa was terminated by her employer, appellee Texas Children's Hospital (the Hospital), for failing to comply with the Hospital's COVID-19 vaccination policies. Balboa sued the Hospital, alleging religious discrimination for failure to accommodate, in violation of Title VII of the Civil Rights Act of 1964, 42 U.S.C. § 2000e, et seq. The district court granted summary judgment in favor of the Hospital, which Balboa now appeals.

Balboa first argues that the trial court erred because the Hospital did not disprove as a matter of law that she has a bona fide religious belief. Because the determination of sincerity of Balboa's religious beliefs turns almost entirely on her credibility, the Hospital did not meet its burden to disprove her prima facie case as a matter of law. Credibility determinations are not appropriate for summary judgment. Next, Balboa argues the Hospital did not conclusively prove each element of its undue hardship affirmative defense. Although the Hospital did provide some evidence of its hardship, we conclude that the Hospital did not establish as a matter of law that it would have been subject to an undue hardship. We reverse the final judgment of the trial court and remand for further proceedings.

I. Background

Appellant Elizabeth Balboa was a nurse at Texas Children's Hospital from 2018 to 2021 in the Labor and Delivery Department. In August 2021, the Hospital promulgated its COVID-19 vaccine policy requiring all employees to receive the vaccine. Balboa filed a request for exemption from receiving the vaccine based on her Christian beliefs, which she explained as follows:

I do not wish to be labeled as anti-vaccine or anti-science, however, the well-documented process of this vaccine developed from animal and aborted human fetal tissue has compelled me to stand by my beliefs and refuse to take the covid-19 vaccination. I have deeply held Biblical convictions as a believer in, and follower of Jesus Christ and any of my peers to resist the pressure for vaccinations, while at the same time seeking an alternative for their safety and the safety of others. I am convinced that the nature of many other contaminants within this vaccine should be a reason to grant exemptions to believers whose bodies are, as the Scripture states, the “temple of the Lord.”

• 1 Corinthians 3:16-17 – “Don't you know that you yourselves are God's temple and that God's Spirit dwells in your midst? If anyone destroys God's temple, God will destroy that person; for God's temple is sacred, and you together are that temple.”

• 2 Corinthians 7:1 – “Therefore, since we have these promises, dear friends, let us purify ourselves from everything that contaminates body and spirit, perfecting holiness out of reverence for God.”

As a child of God, we must follow the Word of God and we also exhort others to a conscientious objection to these vaccines. To go against the Word of God is to elevate myself above him and in so I am sinning against our creator. Yet, my deep love and care for others makes me more determined to exercise whatever alternatives possible to ensure others' safety in each individual case. Therefore, I am asking for a religious exemption and I thank you for respecting religious freedoms.

The Hospital denied her request. Pertinent to the Hospital's decision was the fact that Balboa had previously received flu shots, had otherwise complied with all vaccines mandated by the Hospital and received a variety of medications during her 2020 pregnancy. Although the Hospital granted many exemption requests, the Hospital questioned “the credibility of Appellant's exemption request.” Balboa did not receive the vaccine by the September 2021 deadline and was terminated.

Balboa filed suit in November 2022 against the Hospital in Harris County district court. She alleged that her termination was in violation of the Texas Labor Code because the Hospital had discriminated against her based on her religious beliefs. In January 2024, the Hospital filed a motion for summary judgment. In March 2024, the Hospital filed its amended motion for summary judgment. The trial court granted that motion, and Balboa now appeals the trial court's final judgment.¹

II. Analysis

Balboa presents a single issue on appeal arguing that the trial court “abused its discretion” by granting the Hospital's amended motion for summary judgment. However, Balboa raises two sub-arguments that the trial court erred because (1) the Hospital did not disprove as a matter of law that she has a bona fide religious belief and (2) the Hospital did not conclusively prove each element of its undue hardship affirmative defense.

A. Religious accommodation under the TCHRA

The Texas Commission on Human Rights Act (TCHRA) provides that an employer commits an unlawful act when the employer “fails or refuses to hire an individual, discharges an individual, or discriminates in any other manner against an individual” on the basis of “race, color disability, religion, sex, national origin or age[.]” Tex. Lab. Code Ann. § 21.051(a). One of the purposes of the TCHRA is “to provide for the execution of the policies of Title VII of the Civil Rights Act of 1964” in Texas. Tex. Lab. Code Ann. § 21.001(1).

In this case, Balboa alleged accommodation-type religious discrimination. Under both Title VII and the TCHRA, employers must accommodate religious beliefs once they are informed of them, unless the employer shows that it cannot “reasonably accommodate” the employee's religious needs without “undue hardship on the conduct of the employer's business.” 42 U.S.C. § 2000e(j); Tex. Lab. Code Ann. § 21.108. An employee establishes a religious accommodation claim by showing that: (1) she has a bona fide religious belief that conflicts with an employment requirement; (2) she informed the employer of this belief; and (3) she suffered an adverse consequence for failure to comply with the conflicting employment requirement. See Ansonia Bd. of Educ. v. Philbrook, 479 U.S. 60, 65, 107 S.Ct. 367, 93 L.Ed.2d 305 (1986); Turpen v. Missouri–Kansas–Texas R.R. Co., 736 F.2d 1022, 1026 (5th Cir. 1984). Once this is established, the burden then shifts to the employer to show that it could not accommodate the plaintiff's religious beliefs without undue hardship. See Groff v. DeJoy, 600 U.S. 447, 468, 143 S.Ct. 2279, 216 L.Ed.2d 1041 (2023). To avoid Title VII liability, the employer need not offer the accommodation the employee prefers. Philbrook, 479 U.S. at 69, 107 S.Ct. 367. Instead, when any reasonable accommodation is provided, the statutory inquiry ends. Id.

“Due to the dearth of case law interpreting the TCHRA, the Texas Supreme Court has directed Texas courts to seek guidance from federal interpretations of Title VII when construing the TCHRA.” Grant v. Joe Myers Toyota, Inc., 11 S.W.3d 419, 423 (Tex. App.—Houston [14th Dist.] 2000, no pet.) (citing Speer v. Presbyterian Children's Home & Serv. Agency, 847 S.W.2d 227, 232 (Tex. 1993)). Therefore, a plaintiff seeking to bring a religious accommodation case under the TCHRA must establish a prima facie case by establishing the same elements required under the federal test.

B. The Hospital's motion for summary judgment

The Hospital argued in its amended traditional motion that summary judgment was appropriate because Balboa could not establish one of the prima facie elements of her claim: that she had a bona fide religious belief that conflicted with an employment requirement. The Hospital explains that Balboa's exemption request was primarily based on her concerns with the safety of the vaccine and her opposition to abortion. The Hospital asked the trial court to grant summary judgment because it conclusively proved as a matter of law that Balboa's request for an exemption was not based on a sincere religious belief.

Alternatively, the Hospital argued that even if Balboa could demonstrate a bona fide or sincere religious belief, the only requested accommodation would have caused the Hospital undue hardship. It asserted that although it had approved 387 of the approximately 480 religious exemptions requests it received that it would be an undue hardship to grant an exemption for a labor and delivery nurse based on Balboa's “highly specious grounds.”

C. Balboa's religious-accommodation claim

The parties do not dispute that Balboa informed the Hospital of her religious beliefs and that she suffered an adverse employment action. Rather, the issue in this appeal is whether the Hospital met its burden to show that Balboa failed, as a matter of law, to establish that her request was based on a sincere or bona fide religious belief.

To qualify for Title VII protection, a plaintiff must show her professed belief is (1) sincerely held and (2) religious in nature. See United States v. Seeger, 380 U.S. 163, 185, 85 S.Ct. 850, 13 L.Ed.2d 733 (1965) (stating “courts ․ are not free to reject beliefs because they consider them ‘incomprehensible[,]’ ” rather, “[t]heir task is to decide whether the beliefs professed ․ are sincerely held and whether they are, in [her] own scheme of things, religious”).

1. Sincerely held belief

“Bona fide religious beliefs include ‘moral or ethical beliefs as to what is right and wrong which are sincerely held with the strength of traditional religious views.’ ” Davis v. Fort Bend Cnty., 765 F.3d 480, 485 (5th Cir. 2014) (quoting 29 C.F.R. § 1605.1 (citing Seeger, 380 U.S. at 163, 85 S.Ct. 850)). “The sincerity of a person's religious belief is a question of fact unique to each case.” Davis, 765 F.3d at 485.

The Supreme Court has cautioned that religious practitioners may not have their beliefs rendered “suspect before the law,” because faiths that are “incomprehensible” to some “are as real as life” to others. United States v. Ballard, 322 U.S. 78, 86–87, 64 S.Ct. 882, 88 L.Ed. 1148 (1944); see e.g., Burwell v. Hobby Lobby Stores, Inc., 573 U.S. 682, 724, 134 S.Ct. 2751, 189 L.Ed.2d 675 (2014) (emphasizing that “federal courts have no business addressing [ ] whether the religious belief asserted in a [Religious Freedom Restoration Act] case is reasonable”); Frazee v. Ill. Dep't of Emp. Sec., 489 U.S. 829, 833, 109 S.Ct. 1514, 103 L.Ed.2d 914 (1989) (discussing that the orthodoxy of a claimant's belief is “irrelevant” under the Free Exercise Clause).

The Fifth Circuit has long held that courts “must refrain from making credibility determinations or weighing the evidence” at the summary judgment stage with respect to the sincerity of a person's religious beliefs. Davis, 765 F.3d at 487 (internal quotation marks omitted); see generally Sambrano v. United Airlines, Inc., No. 21-11159, 2022 WL 486610, at *1 n.2 (5th Cir. Feb. 17, 2022) (usual approach of the Fifth Circuit is to take “parties at their word regarding their own religious convictions”). Judicial restraint in these matters “is particularly important here, where a court must refuse to dissect religious tenets just because the believer['s] ․ beliefs are not articulated with the clarity and precision that a more sophisticated person might employ.” Davis, 765 F.3d at 487 (internal quotation marks omitted). Most other federal circuit courts similarly accept an assertion of a sincere religious belief. See e.g., Doe v. San Diego Unified Sch. Dist., 19 F.4th 1173, 1176 n.3 (9th Cir. 2021) (“We may not and do not question the legitimacy of Jill Doe's religious beliefs regarding COVID-19 vaccinations.”); Kay v. Bemis, 500 F.3d 1214, 1219 (10th Cir. 2007) (“The inquiry into the sincerity of a free-exercise plaintiff's religious beliefs is almost exclusively a credibility assessment, ․ and therefore the issue of sincerity can rarely be determined on summary judgment, let alone a motion to dismiss.”) (internal quotation marks omitted).

Although the Hospital effectively argues that this court can make a credibility determination on the sincerity of Balboa's religious beliefs at the summary-judgment stage, we disagree and conclude the better course is to follow the precedent of numerous federal circuit courts, which take parties at their word regarding the legitimacy of their religious beliefs and convictions.

2. Religious in nature

The Hospital also challenges Balboa's request for exemption on the basis it was not actually religious in nature. Using language from Balboa's exemption request in which Balboa addresses her concerns as to the safety or development of the vaccine, the Hospital pairs those statements with Balboa's vaccine history, known to the Hospital, in arguing that Balboa articulated a secular reason for requesting an exemption.²

Balboa's exemption request does express both religious concerns as well as non-religious concerns with the COVID-19 vaccine. However, even if there were overlap between Balboa's religious and secular objections to the vaccine, this overlap does not defeat her prima facie claim. The EEOC Guidance Manual in effect at the time of Balboa's exemption request says, “overlap between a religious and political view does not place it outside the scope of Title VII's religious protections, as long as the view is part of a comprehensive religious belief system.” U.S. Equal Emp. Opportunity Comm'n, EEOC-CVG-2021-3, Compliance Manual on Religious Discrimination § 12-IV(A)(1) (2021) (hereinafter “EEOC Compliance Manual”). Federal courts have similarly followed and adopted that language into their Title VII decisions. See Sturgill v. American Red Cross, 114 F.4th 803, 810 (6th Cir. 2024); Ringhofer v. Mayo Clinic, Ambulance, 102 F.4th 894, 901 (8th Cir. 2024). In other words, a “coincidence of religious and secular claims in no way extinguishes the weight appropriately accorded the religious one.” Sturgill, 114 F.4th at 810 (quoting Callahan v. Woods, 658 F.2d 679, 684 (9th Cir. 1981)).

The fact that Balboa gave additional reasons for her vaccine refusal that may have been non-religious does not transform her vaccine refusal into a personal preference, rather than a religious belief. Wright v. Honeywell Int'l, Inc., 148 F.4th 779, 783 (5th Cir. 2025) (“a reasonable jury could find that Wright held at least a mixed motive for his vaccine refusal: a bona fide religious belief alongside political beliefs and personal preference”).

At this stage, these allegations are sufficient to show that Balboa's beliefs are an essential part of a religious faith that must be given great weight, and are plausibly connected with her refusal to receive the COVID-19 vaccine. Multiple federal circuits presented with the issue have held the same. See Ringhofer, 102 F.4th at 901–02 (reversing dismissal of Title VII failure to accommodate claim at the motion-to-dismiss stage, finding plaintiff who alleged their “body is a temple” in objection to vaccination requirements “adequately identif[ied] religious views they believe[d] to conflict with taking the COVID-19 vaccine” and “plausibly connect[ed] their refusal to receive the vaccine with their religious beliefs”); Sturgill, 114 F.4th at 810–11 (same); Passarella v. Aspirus, Inc., 108 F.4th 1005, 1009 (7th Cir. 2024) (same). As nearly all of the Hospital's challenges to Balboa's prima facie case revolve around her credibility and sincerity, this evidence should be weighed by a jury rather than a court on a motion for summary judgment. Wright, 148 F.4th at 784; see also Sturgill, 114 F.4th at 810 (“The Red Cross's proffered obvious alternative explanation for Sturgill's accommodation request—that it was rooted in medicine, not religion—is one we cannot simply credit at this stage.”) (internal quotation marks omitted).

We conclude that Balboa met her burden to raise a fact issue that her request for accommodation was based on a professed belief that is (1) sincerely held and (2) religious in nature. We sustain Balboa's first sub-argument.

D. Undue hardship

In her second sub-argument, Balboa argues that the Hospital did not conclusively prove its undue hardship defense. The hospital contends that it remains entitled to summary judgment as any accommodation would have resulted in undue hardship. Undue hardship is a defense under Title VII. See Davis, 765 F.3d at 487.

Courts analyze accommodation claims under a burden-shifting framework. Id. at 485. The employee must first establish a prima facie case of religious discrimination. Antoine v. First Student, Inc., 713 F.3d 824, 831 (5th Cir. 2013). Once that occurs, “the burden shifts to the defendant to demonstrate either that it reasonably accommodated the employee, or that it was unable to reasonably accommodate the employee's needs without undue hardship.” Id.

The United States Supreme Court recently addressed reasonable accommodation and undue hardship. It explained that: “Title VII requires that an employer reasonably accommodate an employee's practice of religion, not merely that it assess the reasonableness of a particular possible accommodation or accommodations.” Groff, 600 U.S. at 473, 143 S.Ct. 2279 (citing 28. U.S.C. § 2000e(j)). The unanimous Court rejected the prior “de minimis” standard, noting that, “under any definition, a hardship is more severe than a mere burden.” Id. at 469, 143 S.Ct. 2279. Rather than attempt to reduce the appropriate standard to “one phrase,” the Court called for a more complete approach: “[C]ourts must apply the test in a manner that takes into account all relevant factors in the case at hand, including the particular accommodations at issue and their practical impact in light of the nature, size, and operating cost of an employer.” Id. at 470–71, 143 S.Ct. 2279. In sum, “an employer must prove that the burden of accommodation ‘is substantial in the overall context of an employer's business.’ ” Hebrew v. Texas Dep't of Criminal Justice, 80 F.4th 717, 721 (5th Cir. 2023) (quoting Groff, 600 U.S. at 468, 143 S.Ct. 2279).

1. The Hospital's summary-judgment evidence

In its amended motion, the Hospital argues that it is “charged with protecting the health and safety of not only its employees but its patients who are vulnerable.” It also argues that the only accommodation requested by Balboa was to be exempted from the COVID-19 vaccine requirement. The Hospital asserts that it was not possible for Balboa to “work in the same capacity as a labor and delivery nurse unvaccinated without increasing the risk of COVID-19 transmission among TCH staff and patients.”

It provided evidence in the form of testimony from its assistant general counsel, David Stockel, who sat on the committee that reviewed exemption requests:

[T]he reason for the vaccine requirement in the first place and then the reason why it could have been problematic to have a large amount of unvaccinated employees was really threefold. You know, number one, Texas Children's really cares about the health and safety of its employees and workforce and believed that at that time in the pandemic, vaccination was the best way to combat the spread of COVID-19. I think number two is perhaps most importantly [ ] to protect the very vulnerable patient population at Texas Children's, which is some of the sickest and most vulnerable children in the world who at that time did not have any vaccine available to them, so the organization wanted to do everything we can to protect those very vulnerable children. And then third, we were facing some very severe staffing shortages at that time because people were contracting COVID-19 at a pretty rapid pace, and when somebody did, they were automatically off work for an extended period of time. And so it was becoming very, very challenging to meet the clinical needs of all of our vulnerable and sick pediatric patients given the uncertainty of people's schedule and availability because they were contracting the disease at a high rate. And so it became very important and urgent for us to find solutions and do what we can to address those three issues.

Stockel ultimately opined that the risk to the patients and employees of the Hospital grew with each granted request:

So the more unvaccinated individuals in the workforce amongst our employees would — and I'm not an infectious disease expert by any means, but the more unvaccinated individuals we had in the workforce would increase the likelihood and frequency of employees contracting the disease and therefore potentially spreading it to other employees and patients and patients' families and resulting in some of the staffing concerns I mentioned earlier[.]

The Hospital argues that its summary-judgment evidence of undue hardship was unconverted. Balboa supported her argument using other evidence produced by the Hospital to controvert the Hospital's claim of undue hardship—the number of exemption requests granted by the Hospital. As Balboa points out, the fact that the Hospital was able to grant approximately 387 religious exemptions, of which she alleges many were nurses,³ undercuts the hospital's argument that it could not accommodate her request. Balboa also argued in the trial court there were ways in which she could have been accommodated safely, such as being allowed to work remotely, test daily, receive daily temperature checks, or wear a mask.

As this case was resolved through summary judgment, we consider the Hospital's evidence. The only evidence presented by the Hospital was from an assistant general counsel for the Hospital, who admittedly had no expertise in infectious diseases or infectious disease control. Although he was very familiar with the Hospital's policies, decisions, and conclusions, he could not be characterized as an expert witness on the topic. Stockel did not provide any evidence or science as to how many employees could be accommodated safely without risk to the patient population and in what capacity.

2. Federal case law

In its summary-judgment motion, the Hospital also argued that other federal courts had concluded that the risk to vulnerable hospital patient populations was conclusive evidence of undue hardship and cited a single district court case from the Eastern District of Pennsylvania. Aukamp-Corcoran v. Lancaster Gen. Hosp., No. CV 19-5734, 2022 WL 507479, at *7 (E.D. Pa. Feb. 18, 2022). However, Aukamp-Corcoran is distinguishable. First, the trial court in Aukamp-Corcoran had expert testimony from a doctor with expertise on vaccination effectiveness. Further, the vaccine at issue in Aukamp-Corcoran was the influenza vaccine and not the COVID-19 vaccine. Because the Eastern District of Pennsylvania was dealing with a different virus and a different vaccine, we cannot assume or translate into this case the expert testimony that was specific to the efficacy of the influenza vaccine at a different hospital with a different patient population, confronting a different virus. No court, including this court, has the knowledge or expertise to determine what risk an unvaccinated labor and delivery nurse presents for a pediatric hospital addressing a COVID-19 pandemic. Given the reality that the Hospital had already granted many exemptions, we decline the Hospital's invitation to determine as a matter of law that the Hospital “would have endured an undue hardship in granting Plaintiff's specific religious exemption request, especially considering the specious nature thereof.”

On appeal, the Hospital also suggests that because another federal circuit court concluded it was an undue hardship for a hospital to grant an exemption to a particular health care provider that we could follow that holding without the corresponding evidence. The Hospital cites to Kizer v. St. Jude Children's Research Hosp., which did grant summary judgment in favor of a hospital on an employee's request for religious accommodation relating to the COVID-19 vaccine. Kizer v. St. Jude Children's Research Hosp., No. 24-5207, 2024 WL 4816856, at *1 (6th Cir. Nov. 18, 2024). In Kizer, St. Jude Children's Research Hospital did provide evidence relating to the safety risk “to its vulnerable and unable-to-be vaccinated juvenile patient population” on which the trial court relied. Id. at *5. Although it is not clear from the 6th Circuit opinion, the trial court opinion makes clear that St. Jude's COVID-19 policy relied upon “experts in the areas of patient safety, biomedical operations, infectious disease, infection control, information technology, security, facilities planning, risk communication, human resources, law, and occupational health.” Kizer v. St. Jude Children's Research Hosp., Inc., 741 F. Supp. 3d 726, 733 (W.D. Tenn. 2024). Similarly, the Hospital also cited to Wise v. Children's Hosp. Med. Ctr. Of Akron for the proposition that allowing unvaccinated employees to work with vulnerable patients would have created undue hardship. No. 24-3674, 2025 WL 1392209, at *3 (6th Cir. May 14, 2025). In that case, the Sixth Circuit concluded there was evidence to establish the undue hardship standard.⁴ Those cases are not persuasive here.

Another similar federal district court case grappled with the question of risk to a patient population and how that can be conclusively established at the summary-judgement stage. Several doctors challenged their termination over their refusal to receive the COVID-19 vaccine by their hospital employer. See Bellard v. Univ. of Tex. MD Anderson Cancer Ctr., 716 F. Supp. 3d 503, 506–07 (S.D. Tex. 2024), appeal dismissed sub nom., Bellard v. Univ. of Tex. M.D. Anderson Cancer Ctr., No. 24-40161, 2024 WL 5459155 (5th Cir. July 25, 2024). MD Anderson argued that granting the plaintiffs' accommodation requests would force “patients to bear the risk of infection” and place their immunocompromised cancer patients “in jeopardy.” Id. at 514. The federal district court considered the viewpoint of the hospital, as well as the fact that the hospital had granted a number of exemption requests already. Ultimately, the court determined that the issue was one of risk to be evaluated by physicians and epidemiologists, and not courts. Id. at 516. We find the following analysis and conclusion persuasive:

At a macro-level, MD Anderson's potential hardship is evident, not hypothetical or speculative. MD Anderson treats cancer patients exclusively, meaning their patient population is among the most immunocompromised in the country. [ ] At the time of the plaintiffs' accommodation request, the Secretary of Health and Human Services deemed vaccination “necessary for the health and safety of individuals to whom care and services are furnished,” especially those in poor health․

The difficulty here, however, is at what magnitude MD Anderson's hardship rose to the level of “undue.” While a small group of unvaccinated caregivers may have posed a real, but manageable, hardship to MD Anderson, a larger group may have presented an unduly dangerous risk. So at a macro-level, this hardship may be apparent, but at an individualized level, the inquiry is more difficult. See Adams v. Mass Gen. Brigham Inc., No. CV 21-11686-FDS, 2023 WL 6318821, at *6 (D. Mass. Sept. 28, 2023) (noting the undue-hardship analysis may not necessarily “focus on the nature of the requested accommodation, but on the number of persons to whom such an accommodation can be given.”).

Suppose, for illustration, that MD Anderson granted each of the 590 religious-accommodation requests it received in November of 2021, but then rejected the 591st request purely on undue-hardship grounds. [ ] It would be difficult for MD Anderson to establish that this single incremental request altered the risk of infection such that the hardship, which they previously found acceptable, now became too much to bear. In isolation, it is hard to see how any one request could tip the scales of the hardship inquiry. Nevertheless, “it is surely true that the additional risk posed by granting hundreds, or indeed thousands, of additional exemptions would have been substantial.” Adams, 2023 WL 6318821 at *8. Even if the line cannot be defined with precision, there surely exists some degree of epidemiological risk at which MD Anderson's hardship becomes undue.

As to where this threshold of risk ought to sit, the court declines to substitute its own opinion for those of physicians and epidemiologists. As reasonable minds may differ as to the specific impact of each plaintiff's requested accommodation, this question poses a genuine issue of material fact.

Id. at 515–16.

3. The Hospital did not meet its summary-judgment burden

The Hospital's position appears to be that there was a safety risk rising to the level of an undue hardship by allowing even a single unvaccinated nurse to work in the labor and delivery department of the hospital. However, the Hospital's summary judgment evidence does not match up with this proposition. Stockel's testimony does not support the proposition that the Hospital could not have accommodated Balboa's requested accommodation, had it been determined to be sincere, under any situation without “undue hardship” to the operation of the hospital. Rather, the evidence from Stockel was that each exemption granted increased the risk of transmission of the disease to the employees and patients generally. Stockel's testimony suggests, as was discussed at length in the Bellard case, that the Hospital did not view a single unvaccinated employee as an undue hardship but rather it was the risk that increased as the number of unvaccinated employees rose.

It is this threshold risk faced by the Hospital that has not been established as a matter of law. Stockel's testimony, which touched on the issue, did not provide any concrete or scientific evidence that established the risks and hardships faced by the Hospital. The evidence reflects that the Hospital was able to grant many exemptions, but there is no evidence on several other important questions that arise. Therefore, although the Hospital's evidence was uncontroverted, we cannot say the Hospital met its burden in establishing its undue hardship defendant as a matter of law.⁵

Because we concluded that the Hospital did not meet its summary-judgment burden to conclusively establish its undue hardship affirmative defense, we sustain Balboa's second sub-argument.⁶

III. Conclusion

Having sustained both of Balboa's sub-arguments, we reverse the judgment of the trial court and remand for further proceedings.

FOOTNOTES

1.   The final judgment “actually disposes of all claims and parties then before the court.” Lehmann v. Har-Con Corp., 39 S.W.3d 191, 192 (Tex. 2001).

2.   Balboa's vaccine history reflected that she had received the influenza vaccine, as well as several other vaccines and had taken various medicines during her recent pregnancy. As an answer to the Hospital's reliance on her vaccination history, Balboa explains that she had a conversion event after she began working for the Hospital. While we agree with the Hospital that Balboa cannot rely on information in this litigation that was not presented in her request for exemption, we disagree with the Hospital that there is a requirement that an employee keep her employer apprised of changes in her religious beliefs. The Hospital offers no authority for the proposition that an employee must explain changes in her beliefs or that the employee must justify all of her past actions as consistent with her current beliefs. The law simply requires that an employee must inform her employee of her beliefs at the time she is requesting an accommodation. The Hospital's position is troubling and at odds with precedent in most federal district courts, including the Fifth Circuit. In Sambrano, the Fifth Circuit noted that an employer's behavior was “bizarre” and inconsistent with the usual legal approach when the employer asked employees for their vaccine history and inquired why employees' religious beliefs prevented them from receiving the COVID-19 vaccine but not taking other types of medicines. Sambrano, 2022 WL 486610, at *1, n.2.The Fifth Circuit case of Moussazadeh v. Texas Dep't of Criminal Justice, 703 F.3d 781 (5th Cir. 2012), as corrected (Feb. 20, 2013), is instructive here. In Moussazadeh, a prisoner sought kosher meals arguing that it was part of his duty to only eat kosher meals according to his Jewish faith. Id. at 785. The inmate in that case had, on some past occasions, purchased non-kosher food items including cookies, soft drinks, coffee, tuna, and candy. Id. at 791. In that context, the Fifth Circuit determined that those past actions did not make the inmate's current beliefs insincere. Id. 791–92.

3.   There is no evidence in the record of the type of position in which the individuals who received exemptions were employed.

4.   Again, similar to Kizer, the 6th Circuit noted there was testimony from Dr. Brower supporting the hospital's mandatory COVID-19 policy. 2025 WL 1392209, at *3.

5.   The Hospital repeatedly mentions in its discussion of undue hardship the “specious grounds” or “specious nature” of Balboa's exemption request raising the possibility that the Hospital's disbelief of Balboa drove the Hospital's denial of her request more so than its concern over undue hardship.

6.   Balboa also argues on appeal that the Hospital “did not engage in any interactive process to evaluate a potential transfer to another department, or a shift change, or a remote opportunity, but simply denied appellant's religious exemption request.” This argument is really just a repackaging of her undue hardship arguments, as she is asserting the Hospital could and should have sought out ways for her to continue to do her job safely without receiving the COVID-19 vaccine. Because we have already concluded the Hospital did not meet its summary-judgment burden on undue hardship, we need not separately address Balboa's arguments about the interactive process.

Tonya McLaughlin, Justice