Managing medical staff disability issues: liability of private hospitals under ADA Titles I and III

This Article examines the extent to which private hospital are liable for discrimination against medical staff members with disabilities, under the Americans with Disabilities Act ("ADA"). Specifically, the discussion focuses on the ways in which Title I, covering employment relationships, and Title III, covering places of public accommodation, apply to hospitals and their medical staff physicians. With respect to Title I, the author focuses on possible liability with respect to independent contractor physicians who have staff privileges at a hospital. The focus with respect to Title III involves claims filed by physicians against hospitals as places of public accommodation. The author concludes that the courts have applied the ADA in a manner broader than intended by Congress, and that private hospitals should assume that both Title I and Title III are applicable to staff privilege decisions. Therefore, any action that adversely affects a disabled physician should be supported by well-documented, objective evidence of a nondiscriminatory reason for that action.     

Why courts cannot deny ADA protection to plaintiffs who do not use available mitigating measures for their impairments

Congress intended the Americans with Disabilities Act ("ADA") to provide strong standards for addressing and eliminating discrimination against individuals with disabilities. Many commentators have concluded, however, that the federal courts are undermining the goals of the ADA by too narrowly construing membership in the statute's protected class. One example of this trend is courts' hostile treatment of ADA plaintiffs who do not use medications or devices that might alleviate their impairments ("nonmitigating plaintiffs"). Numerous district and appellate decisions have held or suggested that nonmitigating plaintiffs are not protected by the ADA. In addition, some commentators have proposed that courts should evaluate the reasonableness of a plaintiff's decision not to use mitigating measures; they argues that it is unfair to burden an employer with the cost of accommodating a disability that continues to exist only because an employee unreasonably refuses to mitigate it. Contrary to the views of these courts and commentators, however, this Comment will show that nonmitigating plaintiffs are entitled to ADA protection from employment discrimination. It argues that the statute's language, history, and structure, as well as Supreme Court precedent, demonstrate that courts cannot deny ADA protection based on a plaintiff's nonuse of available mitigating measures. It also presents several considerations that weigh against any future congressional enactment that would tie ADA protection to the reasonableness of a plaintiff's decision not to mitigate an impairment.     

Managing AIDS in the workplace

Because of the AIDS epidemic and the protections afforded individuals with AIDS under the Americans with Disabilities Act (ADA), employers are well advised to ensure compliance under applicable law to reduce exposure to employee claims of discrimination and to efficiently manage workplace issues associated with AIDS. Employers should implement AIDS policies and programs designed to educate their workforce to reduce the spread of AIDS and to clear up any misunderstandings about the disease which could wreak havoc in the workplace. This article summarizes suggested action steps for employers and outside resources to consult for guidance.     

Stigma as a barrier to employment: mental disability and the Americans with Disabilities Act

In a controversial expansion of workplace civil rights, the 1990 Americans with Disability Act (ADA) extended anti-discrimination protection to individuals with "mental impairments." One of the most critical barriers to the employment of individuals with mental disabilities is the degree of social stigma such disabilities incur, and there is compelling evidence that employers have stigmatizing attitudes and have discriminated against those with mental disabilities. This study examines the role played by stigma in employers' response to the 1990 Americans with Disability Act (ADA). A stratified sample of one hundred ninety employers were surveyed in 1996-1997 in a major Southern metropolitan area. Telephone interviews were completed with one hundred seventeen employers (response rate of 61.6%). The article describes employers' experiences with employees with mental disabilities and accommodations, specific employment practices, and attitudes towards those with mental disabilities. Stigma played an important role in conformity to the ADA (operationalized as either hiring or having specific recruiting policies for hiring individuals with mental disabilities). Furthermore, employers expressing coercive (fear of a lawsuit) as opposed to normative (belief that it is the right thing to do) rationales for compliance were more likely to hold stigmatized attitudes. Employers' beliefs about mental disability form a crucial foundation for truly supportive work environments (those that value difference and diversity), and further research is needed to determine if over time the ADA is successful in changing attitudes as well as behavior.     

The Effects of Attribution of Responsibility and Work History on Perceptions of Reasonable Accommodations

Under the Americans with Disabilities Act (ADA), employers must provide employees with disabilities reasonable accommodations that will enable them to perform job duties, as long as the accommodations do not financially burden the organization. Two studies were conducted to investigate whether disability origin and/or prior work history impermissibly influence the granting of reasonable accommodations under the ADA. In both studies, participants granted more accommodations for employees whose disability was caused by some external factor than for those whose disability was caused by the employee's own behavior. In Study Two, participants also granted more and costlier accommodations for an employee with an excellent work history than for an employee with an average work history. Implications of the use of extralegal factors in accommodation decisions are discussed.     

Mental disabilities under the ADA: a management rights approach

While numerous sources have focused on employee rights and employer obligations under the Americans with Disabilities Act, this article will emphasize employer rights with respect to mental disabilities under the ADA. Specifically, it addresses the ADA's definition of "mental disability," the right of employers to screen job applicants in spite of the ADA, the conditions under which an employer may require an employee to undergo a "fitness for duty" examination, and the limits of the duty to "reasonably accommodate" an employee with a mental disability.     

Equal employment opportunity for individuals with disabilities--EEOC. Final rule

On July 26, 1990, the Americans With Disabilities Act (ADA) was signed into law. Section 106 of the ADA requires that the Equal Employment Opportunity Commission (EEOC) issue substantive regulations implementing title I (Employment) within one year of the date of enactment of the Act. Pursuant to this mandate, the Commission is publishing a new part 1630 to its regulations to implement title I and sections 3(2), 3(3), 501, 503, 506(e), 508, 510, and 511 of the ADA as those sections pertain to employment. New part 1630 prohibits discrimination against qualified individuals with disabilities in all aspects of employment.     

Asymptomatic HIV as a disability under the Americans with Disability Act

The Americans with Disability Act (ADA) does not state whether it prohibits discrimination against individuals who are infected with HIV but asymptomatic. Some courts have held that the language of the ADA is unambiguous and does not cover asymptomatic HIV as a disability because the virus is not an "impairment" that substantially limits a "major life activity." Other courts have looked behind the statutory language and found that Congress intended to protect asymptomatic individuals with HIV because the virus impairs one's ability to procreate and/or engage in sexual relations. This Comment argues that asymptomatic individuals with HIV are indeed protected under the ADA, but that the analytic framework thus far employed by the courts is flawed. Asymptomatic HIV is a protected disability not because it is independently debilitating, but because the prejudices and fears of other may prevent HIV-infected persons from fully participating in society. The ADA was enacted to prevent exactly this type of discrimination.     

EEOC guidance on psychiatric disabilities: many problems, few workable solutions

The EEOC recently issued "Enforcement Guidance" on psychiatric disabilities under the Americans with Disabilities Act. Although the Guidance provides clarification of a few issues involving mental disabilities under the ADA, in most respects the Guidance is problematic. For example, the Guidance suggests that the inability to get along with a supervisor or coworkers may constitute a disability under the ADA, that an employer may have to "accommodate" a disabled employee's misconduct, that an employer cannot require an employee to follow doctor's orders as a condition of employment, and that an employer may be obligated to modify work rules and procedures to accommodate a mentally disabled employee but is prohibited from explaining to coworkers why it is making such modifications. As the EEOC's Guidance exceeds or conflicts with the ADA in some respects and is largely unworkable in many respects, it remains to be seen how many courts will actually follow it.     

The Limitations of Disability Antidiscrimination Legislation: Policymaking and the Economic Well‐being of People with Disabilities

Although Congress passed the Americans with Disabilities Act (ADA) to address, in large part, the declining economic well‐being of people with disabilities—twenty years later—the trend has not reversed. To shed light on this puzzle, we use multilevel models to analyze Current Population Survey data from 1988 through 2012 matched with state‐level predictors. We take a more nuanced approach than previous research and consider institutional factors related to the creation, enforcement, and interpretation of legislation, as well as individual demographics and employment situations. Our results show continual gaps in employment and earnings by disability status connected to the enactment of state‐level antidiscrimination legislation, the number of ADA charges brought to the Equal Employment Opportunity Commission, and the results of ADA court settlements and decisions. Our findings suggest a complex relationship between legislative intent and policy outcomes, showcasing the multilayered institutional aspects behind the implementation of disability antidiscrimination legislation.     

US: Supreme Court adopts narrow definition of "disability" under anti-discrimination law

In January 2002, the US Supreme Court issued the latest in a series of court judgments adopting a narrow interpretation of the Americans with Disabilities Act (ADA). The unanimous decision is fundamentally flawed in several important respects. It does not bode well for people with disabilities seeking protection from discrimination in employment.     

Genetic discrimination: Huntington's disease and the Americans with Disabilities Act

This Note discusses the potential for genetic discrimination, current views as to whether genetic conditions will be covered by the Americans with Disabilities Act ("ADA"), and the specific issue of whether presymptomatic persons who test positive for Huntington's disease should be classified as persons with a "disability" within the meaning of the ADA. In considering whether presymptomatic Huntington's individuals have a disability under the ADA, an analogy is made between Huntington's disease and HIV-positive status. Inter alia, Huntington's disease and HIV-positive status are analogous in that, at the time of diagnosis, victims of both diseases may have no symptoms and may remain healthy for a number of years; but even though the exact time of onset of both diseases is unascertainable, death of both victims within a given range of years is highly likely. Further, both Huntington's disease and HIV are transmitted to offspring at a relatively high rate. Given these similarities, the author argues that Huntington's individuals should be afforded the protections of the ADA for the same reasons that HIV-positive persons are protected.     

The costs of class actions: allocation and collective redress in the US experience

Once a preserve of the American legal landscape, the class action device today transcends geographic boundaries. In the past decade, efforts have intensified to establish collective litigation instruments in diverse legal terrains outside the United States—including Europe—often with the common goal of allowing some form of collective legal redress while avoiding perceived disadvantages of class actions in the American experience. Today more than ever, from legislators to litigants to scholars, European reformers face the challenge—and the opportunity—of making fundamental choices about the scope and shape of the collective legal remedies they wish to make available. Choices about the shape of the class action device reflect foundational judgments about the proper allocation of costs, and there is much from the US experience that can inform Europe’s prospective reformers. This article describes the history and current status of class action rules in the US, and then compares class actions and another form of extra-compensatory damages—one type of punitive damages—as means of doing the same thing. Although neither punitive damages of this sort nor class actions generally have traditionally existed in civil law systems, they both—and especially this particular form of punitive damages—can, from an economic view, be made to vindicate the same kind of social cost accounting goals. By considering these legal devices together, we hope to shed light on crucial choices facing Europe as it grapples with how best to provide collective legal redress in light of the lessons of the US experience with class actions.     

Conceiving harm: disability discrimination in assisted reproductive technologies

Applying the Americans with Disabilities Act (ADA) to denials of treatment by assisted reproductive technology (ART) practitioners raises particularly challenging legal and ethical issues. On the one hand, the danger that physicians will inappropriately deny treatment to patients with disabilities is especially worrisome in the context of ARTs, given the widespread stigma associated with reproduction by individuals with disabilities. On the other hand, patients' disabilities may sometimes have potentially devastating implications for any child resulting from treatment, including the possibility that the child will be born with life-threatening or seriously debilitating impairments. Some physicians have strong ethical objections to helping patients become pregnant in the face of such risks. In this Article, Professor Coleman develops a framework for applying the ADA to disability-based denials of ARTs that addresses these competing considerations. In recognizing risks to the future child as a potential defense to a disability discrimination claim, Professor Coleman rejects the view of some commentators that such risks are relevant to reproductive decisions only if the child is likely to suffer so much that he or she would prefer not to exist. Instead, he proposes that, when a patient's disabilities create significant risks to the future child, the question should not be whether the child's life is likely to be so awful that nonexistence would be preferable, but how the risks and benefits of the requested treatment compare to those associated with other available reproductive and parenting options. Professor Coleman provides a theoretical justification for adopting this comparative framework, and examines how ADA precedents developed in other contexts should be applied to decisions about ARTs.     

Fetal protection and potential liability: judicial application of the Pregnancy Discrimination Act and the disparate impact theory

"Fetal vulnerability programs," which are employer attempts to protect employees' unborn fetuses from harm caused by the mothers' exposure to hazardous material in the workplace, have been challenged as a form of employment discrimination. This Note analyzes the recent judicial application of the Pregnancy Discrimination Act (PDA) and the disparate impact theory to fetal vulnerability cases. The Note also examines the business necessity defense's accommodation of legitimate employer interests. The Note concludes that a more potent business necessity defense, a stricter standard for evaluating alternative protective measures, and a judicial interpretation of the PDA which is more consistent with congressional intent are necessary for fair and reasonable resolution of these cases.     

Expanding ADA coverage to employee benefit plans: recent judicial and administrative developments

The Americans with Disabilities Act has been heralded as the Emancipation Proclamation for persons with disabilities. The purpose of the law is to provide nothing less than a "clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities." Precisely how the nondiscrimination principles of the ADA will be applied to an employer's provision of health benefits to its employees has been the subject of much debate since the Act's passage in 1990. Although the statutory language and the legislative history support a limited application of the ADA to benefits issues, recent court decisions and enforcement actions by the Equal Employment Opportunity Commission indicate that the ADA may have a much more profound impact in the area of benefits plan design and administration. Moreover, as benefits administrators take a much more active role in managing health care decisions, the ADA may become a vehicle for legal challenges to those decisions that affect the disabled.     

Working women making it work: intimate partner violence, employment, and workplace support

Partner violence may have significant consequences on women's employment, yet limited information is available about how women cope on the job with perpetrators' tactics and the consequences of her coping methods on employment status. This article investigates whether there is an association between workplace disclosure of victimization and current employment status; and whether there is an association between receiving workplace support and current employment status among women who disclosed victimization circumstances to someone at work. Using a sample of partner victimized women who were employed within the past year (N = 485), cross-tabulation and ANOVA procedures were conducted to examine the differences between currently employed and unemployed women. Binary logistic regressions were conducted to examine whether disclosure and receiving workplace support were significantly associated with current employment. Results indicate that disclosure and workplace support are associated with employment. Implications for clinical practice, workplace policies, and future research are discussed.     

Not disabled enough: the ADA's "major life activity" definition of disability

Michelle Friedland argues in this note that the Americans with Disabilities Act fails to adequately distinguish between the separate goals of preventing pure discrimination and providing affirmative accommodation. The Act's conflation of these two different objectives, and its reliance on a single definition of disability for both, hinders its effectiveness in improving the status of individuals with disabilities in the employment setting. To illustrate this, she points to the counterintuitive results reached in recent court decisions. Friedland further traces the legislative origins of the Act's definition of disability and the ambiguity it leaves as to Congress's goals for the Act's employment provisions. She posits three possible goals the Act might be designed to achieve and recommends basic reforms for accomplishing each. Her ultimate conclusion is that provisions dealing with accommodation and discrimination need to be divided so that each can have its own definition of disability. In addition, she believes funding mechanisms for providing accommodation should be altered to ameliorate inequalities in burdens borne by employers and to avoid improper incentives to circumvent the Act.     

AIDS, employment, and the direct threat defense: the burden of proof and the circuit court split

This Note examines disability-related discrimination in light of the protections afforded by the Americans with Disabilities Act (ADA) and in the context of an HIV- or AIDS-infected employee. Under the ADA, an employer may legally fire a worker who poses a direct threat to the individuals around him or her. It is unclear, however, whether the burden of proving or disproving the claim that an individual is a direct threat lies with the employer or the employee. This Note analyzes the circuit split over which party bears the burden of proof under the direct threat standard in light of prospective HIV-related litigation.