Americans with Disabilities Act

Medical Staff Privileges under the ADA - Menkowitz v. Pottstown Memorial Medical Center, 154 F.3d 113 (3rd Cir.(Pa.) 1998)

This is a key medical legal case because it is the first appeals case to deal with medical staff privileges under the ADA.  More generally, it provides guidance for the general problem of independent contractors under the Americans With Disabilities Act (ADA).  Plaintiff had been on the hospital's medical staff for more than 20 years when he was diagnosed with attention deficit disorder (ADD).  He reported the diagnosis to the medical staff committee, but stressed that it would not affect his relations with other staff or his ability to treat patients.  At least in the documents before the court in this review of the district court's motion granting defendant's motion to dismiss there was no evidence that plaintiff had any previous problems with other medical staff or patient care.

Soon after plaintiff reported his disorder the hospital brought disciplinary proceedings against him, summarily suspended his medical staff privileges without notice or hearing, and executed the medical staff death penalty - the hospital reported plaintiff to the National Practitioner Databank, foreclosing his chance at working on other hospitals.  Plaintiff brought this action, claiming that defendant's actions violated the ADA and section 504 of the Rehabilitation Act.  The district court dismissed the ADA claim because it found that the ADA applied only to employees or patients of the hospital, not medical staff members.  The 504 claim was dismissed because the court found it did not meet the standard that the dismissal from the staff be based solely on the alleged disability.

The parties agreed that a hospital is a place of public accomodation, subject to this standard: "No individual shall be discriminated against on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation by any person who owns, leases (or leases to), or operates a place of public accommodation."  The difficulty is that the ADA has several possible definitions of "individual." The defendant urged that the court adopt the definition that limited the reach of the ADA to persons seeking medical care at the hospital.  The rationale for this narrow ruling is the Title I of the ADA deals with employees, and that if the definition of covered persons under Title III (public accommodations) is expanded to include everyone at the hospital, it will include employees and thus conflict with Title I.  (For example, Title I only applies to businesses with more than 15 employees, but Title III applies to all public accommodations, regardless of size.)  After an excellent and detailed analysis of plain language and legislative history of the ADA, the court determined that defendant's construction must be invalid because it would leave a large class of persons with no protection under the ADA.  While the court agreed that Title III does not apply to employees, plaintiff was not an employee. Including plaintiff under Title III would cause no conflicts with Title I, and is the only way to satisfy the clear intent of Congress that the protections of the ADA be extended to all persons dealing with a public accomodation.

The court next addressed plaintiff's claim under the Rehabilitation Act.  (While the ADA has eclipsed the Rehabilitation Act in public consciousness, it is important to consider Rehabilitation Act claims when the defendant is a covered entity.) The causation standard under the Rehabilitation Act requires plaintiff to provide that the discrimination was solely related to the disability.  Interestingly, one of the hospital's alleged alternative grounds for terminating plaintiff was that he had complained about the hospital's quality assurance activities.  The court pointed out that he had been complaining for a long time before his diagnosis of ADD and had not been sanctioned.  The court ignored the question of whether this would also be a prohibited reason to dismiss plaintiff.  The court found that plaintiff was entitled to put on evidence to support his claim that his disability was the sole cause of the termination and that dismissal was inappropriate.

This is a key case for all health care lawyers.  It clearly extends the protection of the ADA Title III to medical staff members.  Interestingly, because of the broad reach of Title III, this may give medical staff members more protection in some matters than employed physicians.  It also reminds us that hospitals are covered entities under the Rehabilitation Act and that these claims should be considered whenever there is allegation of disability related discrimination in a health care setting.