• A
  • |
  • A
  • Text size

Americans with Disabilities Act

Bragdon v. Abbott, 524 U.S. 624 (1998)

Outcome:    Neutral

Issue

The issue in this case was whether a Maine dentist was required to treat an HIV-positive patient under the Americans with Disabilities Act (ADA).

AMA interest

The AMA encourages vigorous enforcement of anti-discrimination laws, such as the ADA, with respect to people who are HIV-positive.

Case summary

Sidney Abbott, who had been infected with HIV for eight years but was largely asymptomatic, disclosed her infection on a patient registration form when she arrived at the office of Randon Bragdon, D.D.S. for a dental appointment. During the dental examination, Dr. Bragdon discovered that Ms. Abbott had a cavity and informed her of his policy against filling cavities of HIV-infected patients. Dr. Bragdon offered to perform the work at a hospital with no added fee for his services there, although Ms. Abbott would be responsible for the cost of using the hospital's facilities. Ms. Abbott declined this offer.

She then sued Dr. Bragdon under the ADA, alleging discrimination on the basis of her disability. The United States and the Maine Human Rights Commission intervened as plaintiffs. The federal trial court granted summary judgment in favor of the plaintiffs, holding that Ms. Abbott's HIV infection satisfied the ADA's definition of disability and that Dr. Bragdon had raised no genuine issue of material fact as to whether Ms. Abbott's HIV infection would have posed a direct threat to the health and safety of others during the course of a dental treatment. In that regard, the court relied on affidavits submitted by the Center for Disease Control and Prevention's (CDC) Director of the Division of Oral Health, which asserted that dentists could safely treat HIV-infected patients in dental offices when following precautions in the 1993 CDC Dentistry Guidelines.

Dr. Bragdon appealed and the Court of Appeals for the First Circuit affirmed, holding that HIV infections was a disability under the ADA and that Dr. Bragdon's treating Ms. Abbott in his office would not have posed a direct threat to the health and safety of others. Rather than relying on the affidavits as had the trial court, though, the First Circuit relied directly on the 1993 CDC Dentistry Guidelines, as well as the 1991 American Dental Association Policy on HIV.

Dr. Bragdon sought review by the United States Supreme Court, which affirmed the First Circuit's determination that Ms. Abbott's HIV infection was a disability under the ADA.  However, the Court vacated the judgment and remanded for further briefing and arguments on whether Dr. Bragdon was warranted in his determination that treating Abbott in his office would have threatened the health and safety of others. The Supreme Court reasoned that notwithstanding the protection given Ms. Abbott by the ADA's definition of disability, Dr. Bragdon properly could have refused to treat her if he reasonably believed, based on a credible scientific basis (even if that scientific basis differed from the prevailing medical consensus), that her infectious condition posed a direct threat to the health or safety of others.

Litigation Center involvement

The Litigation Center submitted an amicus brief in the Supreme Court which argued that Dr. Bragdon was obliged under the ADA to treat a patient who tested positive for HIV.

Gerena v. Fogari (N.J.Sup.Ct., App. Div.)

Outcome:    Neutral

Issue

The issue in this case was whether a physician was required to provide a sign language interpreter under the Americans with Disabilities Act (ADA).

AMA interest

The AMA opposes use of the ADA to subject physicians to undue burdens in their efforts to assure effective communication with hearing impaired patients.  The AMA is also committed to reducing the incidence and costs of professional liability lawsuits.

Case summary

Irma Gerena started seeing Robert A. Fogari, MD, a New Jersey rheumatologist, in May, 2004.  Following a blood test, Dr. Fogari diagnosed her with lupus and prescribed steroids.  She would then visit him monthly, at which times he would give her a new prescription.  During these visits, Ms. Gerena asked Dr. Fogari to provide her with a sign language interpreter.  He refused to do so, as the cost of providing such an interpreter would have exceeded his charge for his medical services.  Therefore, they would communicate through gestures and in writing.

In June, 2005, Ms. Gerena consulted with an attorney who specializes in discrimination lawsuits for the hearing impaired.  In August, 2005, she saw another physician for a second opinion as to her condition.  During her September, 2005, visit to Dr. Fogari, she brought along her friend, Ms. Torres, and Ms. Torres' 12 year old daughter to help her interpret.  During that visit, Ms. Gerena mentioned her meeting with the other physician.  On hearing this, Dr. Fogari is alleged to have said "Don't blame me if she dies because you've changed doctors", a statement Dr. Fogari denied making.

Ms. Gerena claimed that she became nervous, upset, and sleepless as a result of her interactions with Dr. Fogari, particularly his comment about her possible death if she were to change doctors.  She said that she did not understand the nature or seriousness of her condition or the reason for taking steroids.  However, she did not seek medical treatment for the mental distress from her interactions with Dr. Fogari and she continued her monthly appointments with Dr. Fogari until March, 2006.

Notwithstanding that she continued to be Dr. Fogari's patient, Ms. Gerena sued Dr. Fogari for emotional damages.  She contended that he had breached an obligation to provide a sign language interpreter to accommodate her disability.  Dr. Fogari raised an affirmative defense that it would cause him an undue financial burden to provide an interpreter.  However, the evidence showed that the income from his medical practice exceeded $400,000 per year.

The trial court found that Dr. Fogari had indeed breached a duty to Ms. Gerena.  It awarded a verdict against him for $200,000 in compensatory damages and $200,000 in punitive damages.  The court entered judgment in this amount, plus $202,514.71 in attorney's fees and costs and $33,000 in prejudgment interest, for a total judgment of $635,514.71.

Dr. Fogari appealed, but the case was settled before the Appellate Division ruled.

Litigation Center involvement

The Litigation Center, along with the Medical Society of New Jersey was prepared to file an amicus curiae brief to support Dr. Fogari, had the case not settled.

Zamora-Quezada v. Health Texas Medical Group of San Antonio

34 F.Supp.2d 433 (W.D. Tex. 1998)

Also under Employment and Termination of employment

Outcome:     Favorable

Issue

The issue in this case was whether physicians had been wrongly terminated from their medical group because they recommended proper medical care for their disabled patients who were enrolled in capitated managed care plans.

AMA interest

The AMA supports the right and duty of physicians to adhere to medical ethical rules and practice standards even when otherwise improperly directed by employers or third party payors.

Case summary

Physicians contended that they had been discharged from their employment because they had recommended proper medical care for their disabled and chronically ill patients who were enrolled in capitated managed care plans. The lawsuit was designed to broaden the scope of remedies available to such physicians. Defendants included a medical clinic, a management services organization, and four health plans. The case was filed in a Texas State court and was removed to the federal district court in San Antonio.

The federal district court held that the plaintiffs had adduced sufficient evidence to defeat a motion by defendants for summary judgment on the primary issues in the case. This published opinion established the right of physicians, under appropriate circumstances, to sue for wrongful discharge under the Americans with Disabilities Act (ADA) and the Rehabilitation Act, if the discharge was motivated by the physicians’ patient advocacy.

The court also entered summary judgment against Martin Guerrero, one of the physician plaintiffs, based on the release language in his employment severance agreement. He was found liable to HealthTexas for filing suit in violation of his agreement. Some of Dr. Guerrero’s claims, however, survived. The defendants made numerous additional motions, but they were all defeated, at least in part.

Ultimately, after the jury began its deliberations, the case settled under confidential terms.

Litigation Center involvement

The Litigation Center, in conjunction with the Texas Medical Association (TMA), contributed financial support to the plaintiffs.