The ADA’s employment provisions applies to all businesses with 15 or more employees, which would include many medical practices. (It would include all practices that are owned by a hospital because the count is of all the employees in the entire corporation.) The ADA also has access provisions that apply to all businesses that are deemed a public accommodation, irrespective of how many employees they have. Physicians’ offices are deemed a public accommodation under the Act and must meet the standards for handicapped access, such as wheelchair- accessible offices. The Act also bars discrimination in treatment based on disability. The leading Supreme Court case concerns a dentist who wanted to fill the cavity of an HIV-infected patient at the hospital, rather than in his office. The Court found that a medical care practitioner could not refuse to treat a patient, or treat a patient differently, based on a disability, unless there was a valid medical reason for the disparate treatment.

In this case, the dentist invoked the exception in the ADA for situations that pose a risk to others. The dentist argued, with little support, that filling a cavity would pose an infection risk because of the aerosolized blood and tissue containing HIV. The dentist said he would rather do this in the hospital operating room because it had better protections against contamination. The U.S. Supreme Court said that he must treat the patient unless he could prove that there was a risk of transmission and sent the case back to the lower court to investigate the evidence of risk. The lower court found that the dentist did not prove his case for risk and sanctioned him for failing to treat the patient. [Abbott v. Bragdon, 163 F.3d 87 (1st Cir. 1998) .] (The dentist did not put on a very strong case, and it is not clear whether he might have prevailed with better evidence.)

What the Court left unsaid was the extent to which the ADA prevents physicians from refusing to treat patients with disabilities when the objection is because the physician does not want to treat the underlying condition. Can an internist choose to not treat diabetics because he or she does not want keep up with diabetes treatment? What if a family practitioner does not know how to handle the new drugs for HIV? Does he or she have to treat HIV patients anyway, with the risk that they will not receive optimal treatment?