In the

United States Court of Appeals

For the Seventh Circuit ____________________ 

No. 22-1040 

PAUL HALCZENKO, Doctor, on behalf of himself and all those 

similarly situated, 

Plaintiff-Appellant, 

v.

ASCENSION HEALTH, INC., et al., 

Defendants-Appellees. 

____________________ 

Appeal from the United States District Court for the

Southern District of Indiana, Indianapolis Division.

No. 1:21-cv-02816 — James P. Hanlon, Judge. 

____________________ 

ARGUED MAY 31, 2022 — DECIDED JUNE 23, 2022 

____________________ 

Before SCUDDER, ST. EVE, and KIRSCH, Circuit Judges. 

SCUDDER, Circuit Judge. Dr. Paul Halczenko lost his position as a pediatric critical care specialist at St. Vincent Hospital in Indianapolis, Indiana, for failing to comply with the hospital’s vaccine mandate. He objects to being vaccinated on religious grounds. Dr. Halczenko sued under Title VII for religious discrimination and sought a preliminary injunction requiring the hospital to reinstate him to its pediatric intensive 
2 No. 22-1040 

care unit. The district court denied the motion, concluding not 

only that Dr. Halczenko had failed to show irreparable injury 

from losing his job, but also that Title VII afforded him adequate remedies other than a preliminary injunction compelling St. Vincent to reinstate an unvaccinated physician to its 

pediatric ICU. We affirm.

I 

A 

Owned by Ascension Health, Inc., St. Vincent Hospital, 

like many organizations, adopted a COVID-19 vaccine requirement in the summer of 2021. Employees had until November 12, 2021 to get vaccinated unless they received a medical or religious exemption. In reviewing requests for exemptions, St. Vincent and Ascension considered, among other factors, the employee’s position and amount of contact with others, the current health and safety risk posed by COVID, and 

the cost and effectiveness of other safety protocols.

Until his suspension and ultimate termination, Dr. 

Halczenko treated gravely ill children, including those suffering from or at risk of organ failure. He did this within a pediatric ICU, and St. Vincent operates one of only three such 

units in Indiana. St. Vincent denied Dr. Halczenko’s request 

for religious accommodation on the ground that “providing 

an exemption to a Pediatric Intensivist working with acutely 

ill pediatric patients poses more than a de minim[i]s burden 

to the hospital because the vaccine provides an additional 

level of protection in mitigating the risk associated with 

COVID.”

Dr. Halczenko and four other St. Vincent employees, including two pediatric ICU nurses, responded by filing an 
No. 22-1040 3

EEOC complaint alleging religious discrimination. All five 

were suspended without pay in November 2021, and St. Vincent terminated Dr. Halczenko’s employment in January 

2022. Since losing his job, Dr. Halczenko has tried to find similar work at other hospitals. He attributes his lack of success 

to a non-compete agreement he has with St. Vincent, his preference not to move his family, and otherwise limited demand 

at other hospitals for an unvaccinated physician in his area of 

specialized care.

In November 2021 Dr. Halczenko and the four other St. 

Vincent employees filed a putative class action seeking injunctive relief and damages, alleging St. Vincent violated Title VII 

by denying their religious exemption requests. St. Vincent 

subsequently afforded the other named plaintiffs—a nurse 

practitioner and three nurses, including two in the pediatric 

ICU—religious accommodations. The record does not tell us 

why or how St. Vincent differentiated between Dr. Halczenko 

and these other employees. Regardless, Dr. Halczenko was 

the only named party left seeking injunctive relief.

B 

The district court denied preliminary relief, concluding 

that Dr. Halczenko had shown neither irreparable harm nor 

an inadequate remedy at law. Relying on E. St. Louis Laborers' 

Loc. 100 v. Bellon Wrecking & Salvage Co., 414 F.3d 700, 704 (7th 

Cir. 2005), the district court explained that “a permanent loss 

of employment, standing alone, does not equate to irreparable 

harm.” And “the possibility of reinstatement or back-pay at 

the end of litigation,” the court added, “is usually enough to 

show that preliminary injunctive relief is unnecessary.”
4 No. 22-1040 

As to irreparable harm, Dr. Halczenko staked out a stark 

litigating position in the district court. He submitted a sworn 

declaration stating that his professional skills would dull so 

rapidly and so extensively during any period of extended 

leave that within six months of being suspended—that is, by 

May 12, 2022—he would no longer be fit to work in a pediatric 

ICU. He therefore insisted that court-ordered reinstatement 

to his position at St. Vincent was the only way to avoid this 

deterioration of skills.

We cannot discern why Dr. Halczenko seemed to chisel a 

specific date into stone. After pressing the same point in his 

appellate briefs, his counsel backed off the position at oral argument (held on May 31, 2022) when we observed that he was 

essentially asking a federal court to order the reinstatement of 

a physician who, by his own admission, had lost his competency to practice.

Regardless, the district court determined that Dr. 

Halczenko’s alleged harm was speculative. The court was 

“not convinced that without immediate injunctive relief,” Dr. 

Halczenko—a highly trained physician with years of practice 

experience—would be unable to continue his career as a pediatric ICU physician, even if doing so required a touch of 

training to freshen his skills. The district court also had trouble accepting that Dr. Halczenko, though unvaccinated, was 

unable to secure any other work as a physician during the 

pendency of the litigation.

Dr. Halczenko now appeals the denial of his motion for a 

preliminary injunction.
No. 22-1040 5

II

A 

“A plaintiff seeking a preliminary injunction must establish [1] that he is likely to succeed on the merits, [2] that he is 

likely to suffer irreparable harm in the absence of preliminary 

relief, [3] that the balance of equities tips in his favor, and [4] 

that an injunction is in the public interest.” Winter v. Nat. Res. 

Def. Council, Inc., 555 U.S. 7, 20 (2008). Dr. Halczenko proceeds 

under Title VII of the Civil Rights Act of 1964, which prohibits 

an employer from taking an adverse employment action because of a protected ground, including religion. See 42 U.S.C. 

§ 2000e-2(a). This religious protection has a limit, however. 

An employer need not grant an accommodation if it can 

demonstrate that doing so would pose an “undue hardship 

on the conduct of the employer’s business.” Id. § 2000e(j). 

Title VII provides a range of remedies to successful plaintiffs, including reinstatement, back pay, front pay, compensatory damages, and “any other equitable relief as the court 

deems appropriate.” Id. §§ 1981a(b)(2); 2000e-5(g)(1). So too 

may plaintiffs receive punitive damages upon a finding that 

an employer engaged in a discriminatory practice with malice 

or reckless indifference. See id. § 1981a(b)(1). Given this broad 

remedial scheme, “an insufficiency in savings or difficulties in 

immediately obtaining other employment—external factors 

common to most discharged employees and not attributable 

to any unusual actions relating to the discharge itself—will 

not support a finding of irreparable injury.” Sampson v. Murray, 415 U.S. 61, 92 n.68 (1974). 
6 No. 22-1040 

B 

The district court was right to conclude that none of Dr. 

Halczenko’s alleged harms are irreparable. 

First, Dr. Halczenko continues to contend that because he 

is only able to practice his pediatric critical care skills in a hospital setting, he will “rapidly lose his skills to the point that he 

will be unable to practice as a pediatric critical care specialist” 

if not reinstated by May 2022. Despite these contentions, Dr. 

Halczenko did not move to expedite his appeal. And now, of 

course, we are beyond his self-assessed May 2022 deadline. 

Taking Dr. Halczenko at his word, an injunction now would 

do nothing to prevent this alleged harm. See Winter, 555 U.S. 

at 20 (requiring that a plaintiff be “likely to suffer irreparable 

harm in the absence of preliminary relief”) (emphasis added). 

Even more, though, and like the district court, we have a hard 

time seeing this alleged harm as anything but speculative—

too much so to warrant the extraordinary remedy of preliminary injunctive relief.

To be sure, we have recognized that “there might be some 

basis for a finding of irreparable injury” for “a deterioration 

in professional skills pending the outcome of the litigation.” 

Dos Santos v. Columbus-Cuneo-Cabrini Med. Ctr., 684 F.2d 1346, 

1350 (7th Cir. 1982). But we have yet to encounter a fact pattern where a plaintiff made that showing. Rather, we have 

consistently concluded that such alleged harm is too speculative to be irreparable. See, e.g., id. (“[P]laintiff has neither alleged nor proven an atrophy in her skills.”); Bedrossian v. 

Northwestern Mem’l Hosp., 409 F.3d 840, 846 (7th Cir. 2005) 

(“We have consistently held that physicians are awarded no 

special treatment ... even when, like Bedrossian, they assert 

that termination will cause a ‘deterioration in skills.’”).
No. 22-1040 7

Just so here. Dr. Halczenko has not proven a deterioration 

in skills that could only be prevented by the issuance of an 

injunction. Speculation about how his skills may deteriorate 

during the pendency of the litigation is insufficient, especially 

when Dr. Halczenko’s contention comes without regard to his 

extensive training and past experience or an explanation for 

why a training course or two would fail to position him to 

resume active practice in a pediatric ICU.

Even if aspects of this alleged harm somehow came to 

pass, Congress has provided adequate remedies in Title VII 

such that a preliminary injunction is not warranted. Title VII 

itself provides courts with substantial equitable authority to 

craft remedial measures, including ordering training programs. See, e.g., Patzer v. Bd. of Regents of Univ. of Wisconsin 

Sys., 763 F.2d 851, 854 n.2 (7th Cir. 1985) (“Title VII authorizes 

any equitable remedies the court deems appropriate.”). And 

if Dr. Halczenko’s skills have so dulled that he must change 

to a less lucrative specialty, “[l]ost future earning capacity is 

a nonpecuniary injury for which plaintiffs may be compensated under Title VII.” Williams v. Pharmacia, Inc., 137 F.3d 944, 

953 (7th Cir. 1998). 

Second, Dr. Halczenko contends that he will be irreparably 

harmed because he faces an unusually difficult job search. The 

“CMS vaccine mandate,” he advances, “puts legal and economic pressure on healthcare providers to only hire vaccinated individuals.” Perhaps. But career jeopardy alone does 

not amount to irreparable harm. See, e.g., E. St. Louis, 414 F.3d 

at 704 (“A permanent loss of employment, standing alone, 

does not equate to irreparable harm.”); Dos Santos, 684 F.2d at 

1349 (“Under these circumstances it is irrelevant that plaintiff 
8 No. 22-1040 

claims she may be unable to find other employment as an anesthesiologist in the Chicago area.”). 

Third, Dr. Halczenko urges us to adopt a presumption of 

irreparable harm in Title VII religious discrimination cases, 

much like he sees the law do with Free Exercise Clause claims. 

See, e.g., Joelner v. Vill. of Washington Park, 378 F.3d 613, 620 

(7th Cir. 2004). This position likewise misses the mark. 

“[U]nless the statute under which he is suing excuses a showing of irreparable harm,” “[i]n every case in which the plaintiff wants a preliminary injunction he must show that he has 

‘no adequate remedy at law,’ and ... that he will suffer ‘irreparable harm’ if the preliminary injunction is not granted.” Roland Mach. Co. v. Dresser Indus., Inc., 749 F.2d 380, 386 (7th Cir. 

1984). Unlike statutes such as the Lanham Act, see 15 U.S.C. 

§ 1116(a), Title VII does not excuse a showing of irreparable 

harm. Our case law is clear on this point. See, e.g., Anderson v. 

U.S.F. Logistics (IMC), Inc., 274 F.3d 470, 477–78 (7th Cir. 2001).

The Fifth Circuit’s non-precedential decision in Sambrano 

v. United Airlines, Inc., No. 21-11159, 2022 WL 486610 (5th Cir. 

Feb. 17, 2022), provides Dr. Halczenko no refuge. Sambrano

involved United Airlines employees given the choice of receiving a COVID vaccine or being placed on indefinite unpaid 

leave. The Fifth Circuit concluded that there existed an irreparable harm that was “ongoing and cannot be remedied later: 

[the employees] are actively being coerced to violate their religious convictions.” Id. at *6. Here, however, St. Vincent fired 

Dr. Halczenko. He has therefore not suffered a similar harm. 

Indeed, the Sambrano court took care to recognize that if 

United had fired the plaintiffs, it “would preclude injunctive 

relief.” Id. at *7; see also Together Emps. v. Mass Gen. Brigham 

Inc., 19 F.4th 1, 8 (1st Cir. 2021) (“Moreover, as the deadline 
No. 22-1040 9

for being vaccinated has passed, the appellants cannot point 

to an ‘impossible choice’ as a special factor here; they have 

already made their choices.”).

C 

Because Dr. Halczenko has not shown an irreparable harm 

or that legal remedies available under Title VII would be inadequate, we need not address the other injunction factors. 

See Winter, 555 U.S. at 31–33. We nevertheless pause to comment that, although the record before us is thin on the point, 

it does not support an inference that St. Vincent’s actions were 

motivated by an animus towards religion. Rather, it seems St. 

Vincent ultimately chose to accommodate around 300 workers who had applied for religious exemptions, including two 

PICU nurses who joined Dr. Halczenko in bringing this lawsuit. That it chose not to do so for Dr. Halczenko raises questions about the reasons for the differential treatment. But it 

does not suggest an institutional hostility towards religion—

at least not on the record before us.

Nothing in today’s opinion precludes Dr. Halczenko from 

pursuing the point further in the district court. And with litigation being a two-way street, Ascension and St. Vincent will 

be able to offer their own explanation for affording nurses religious exemptions but choosing to terminate Dr. Halczenko.

For these reasons, we AFFIRM.