16 F.4th 20
1st Cir.2021Background
- Maine promulgated an emergency rule (effective Aug. 12, 2021) requiring COVID-19 vaccination for workers in licensed healthcare facilities; only a medical exemption is permitted under Maine law (2019 amendment).
- The rule responded to the delta variant, low healthcare-worker vaccination rates, multiple facility outbreaks, and a Maine CDC determination that ~90% coverage is needed to prevent community transmission. Maine concluded alternatives (periodic testing, PPE, exemptions for prior infection) were inadequate.
- Plaintiffs are unvaccinated Maine healthcare workers (and one provider) asserting religious objections tied to fetal-cell–line associations and challenging the rule under the Free Exercise Clause, Equal Protection Clause, Title VII, the Supremacy Clause, and 42 U.S.C. § 1985; they sought a preliminary injunction.
- The district court denied a temporary restraining order and a preliminary injunction; the First Circuit denied relief pending appeal and then affirmed the district court's denial.
- The court held the rule is facially neutral and generally applicable, subject to rational-basis review (and found that even under strict scrutiny Maine’s interests are compelling and the rule is narrowly tailored).
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Free Exercise (neutrality / general applicability) | Rule singles out religious objectors by allowing only medical exemptions; strict scrutiny should apply | Rule is facially neutral, applies generally; medical exemption is objective and does not invite individualized exemptions; rational-basis review applies | Rule is neutral and generally applicable; rational basis suffices; plaintiffs unlikely to succeed (and even under strict scrutiny state wins) |
| Narrow tailoring / alternatives (Free Exercise strict-scrutiny fallback) | Less intrusive alternatives (testing, masking, limited exemptions) would sufficiently protect health | Maine considered alternatives and explained they were inadequate given delta’s transmissibility and testing limitations; vaccination is necessary to meet public-health goals | Maine reasonably considered and rejected alternatives; mandate is narrowly tailored to compelling public-health interests |
| Equal Protection / Supremacy Clause / Title VII injunctive relief | State and hospitals discriminate by denying religious exemptions; employers must accommodate under Title VII; Supremacy Clause preempts state action conflicting with federal law | When Free Exercise fails, Equal Protection is subject to rational-basis review; Title VII remedies (administrative/monetary) exist and plaintiffs have not exhausted administrative remedies; hospitals would face undue hardship granting exemptions | Plaintiffs unlikely to succeed on Equal Protection or Supremacy claims; preliminary injunction on Title VII grounds denied—no extraordinary irreparable harm and plaintiffs failed to exhaust; hospitals need not grant requested accommodations due to undue hardship |
| 42 U.S.C. § 1985 conspiracy | Hospitals and state conspired to deprive plaintiffs of rights | Plaintiffs plead no plausible agreement or overt acts showing a conspiracy | § 1985 claim unlikely to succeed for failure to plausibly allege an agreement or causative acts |
Key Cases Cited
- Fulton v. City of Philadelphia, 141 S. Ct. 1868 (2021) (governs neutral/generally applicable analysis and when strict scrutiny applies)
- Emp. Div., Dep’t of Human Res. of Or. v. Smith, 494 U.S. 872 (1990) (neutral, generally applicable laws subject to rational-basis review)
- Church of the Lukumi Babalu Aye, Inc. v. City of Hialeah, 508 U.S. 520 (1993) (law not neutral or generally applicable if it targets religious conduct)
- Tandon v. Newsom, 141 S. Ct. 1294 (2021) (comparability test for activities in Free Exercise contexts)
- Roman Catholic Diocese of Brooklyn v. Cuomo, 141 S. Ct. 63 (2020) (Free Exercise limits on differential treatment of religious gatherings)
- Winter v. Natural Res. Def. Council, Inc., 555 U.S. 7 (2008) (preliminary injunction standard)
- Jacobson v. Massachusetts, 197 U.S. 11 (1905) (upholding state public-health vaccination authority)
- McCullen v. Coakley, 573 U.S. 464 (2014) (narrow tailoring and requirement to consider less restrictive alternatives)
- Cloutier v. Costco Wholesale Corp., 390 F.3d 126 (1st Cir. 2004) (undue hardship in accommodation contexts)
- Sampson v. Murray, 415 U.S. 61 (1974) (extraordinary preliminary-relief standard where money damages are adequate)