UNPUBLISHED

UNITED STATES COURT OF APPEALS

FOR THE FOURTH CIRCUIT

No. 12-1544

BRANELL HARRIS,

Plaintiff - Appellant,

v.

RESTON HOSPITAL CENTER, LLC,

Defendant – Appellee.

Appeal from the United States District Court for the Eastern

District of Virginia, at Alexandria. Claude M. Hilton, Senior

District Judge. (1:10-cv-01431-CMH-TCB)

Argued: March 19, 2013 Decided: April 24, 2013

Before DUNCAN, FLOYD, and THACKER, Circuit Judges.

Affirmed by unpublished per curiam opinion.

ARGUED: Annette Kay Rubin, Leesburg, Virginia, for Appellant. 

Sarah Aiman Belger, MCGUIREWOODS, LLP, Tysons Corner, Virginia, 

for Appellee. ON BRIEF: Ronda Brown Esaw, MCGUIREWOODS, LLP, 

Tysons Corner, Virginia, for Appellee. 

Unpublished opinions are not binding precedent in this circuit.
2

PER CURIAM:

Branell Harris (“Appellant”) appeals from an order 

entered March 26, 2012, granting summary judgment to Reston 

Hospital Center (“Appellee” or “Reston Hospital”) on her claim 

of discriminatory discharge brought pursuant to the Americans 

with Disabilities Act (“ADA”), as amended by the ADA Amendments 

Act of 2008 (“ADAAA”). Appellant contends the district court 

erred by concluding Reston Hospital did not “regard” her as 

disabled because the evidence actually indicates the hospital 

was aware she suffered from a drug and alcohol addiction. She 

further asserts that the district court ignored proof

establishing other elements of her claim, and, thus, improperly 

granted summary judgment. We disagree. In our view, Appellant

failed to establish that she was a “qualified individual” with a 

disability because the undisputed facts indicate she could not 

objectively perform the essential functions of her job. Because 

Harris failed to establish this necessary ingredient of her 

claim, we affirm.

I.

Appellant began working as a registered nurse for 

Reston Hospital in its surgical unit in 2002. She was 

interviewed and hired by Nancy Susco, director of the surgical 

unit, who continued to act as Appellant’s direct supervisor 

throughout her employment. As part of her job, Appellant 
3

provided direct care to patients recovering from surgery, 

including the administration of medications and narcotics.

A.

After approximately one year of work at Reston 

Hospital, Appellant attempted suicide on two occasions in 2003. 

During her first attempt, she intentionally overdosed on the 

prescription sleep aid Ambien. Appellant attempted suicide a 

second time, when, after taking several over-the-counter sleep 

aids, she crushed Ambien, mixed it with Dilaudid -- a narcotic 

prescribed to treat moderate to severe pain -- and water, and 

injected it into her veins. Appellant obtained the Dilaudid by 

impermissibly diverting it from leftover pain pumps at Reston 

Hospital.

As a result of her diversion of a narcotic, Appellant

submitted to the Commonwealth of Virginia’s Health 

Practitioners’ Intervention Program (“HPIP”) in 2003 as an 

alternative to discipline by Reston Hospital and also as a 

requirement for retaining her nursing license. HPIP is 

administered by the Commonwealth, and Susco served as an on-site 

monitor for the program at Reston Hospital. As part of her 

participation in HPIP, Appellant was required to seek ongoing 

treatment, submit to random drug screenings, and “abstain 

completely from alcohol, marijuana, stimulants, cocaine, 

narcotics, sedatives, tranquilizers, and all other potentially 
4

addicting or mind-altering medications or drugs.” J.A. 386.1 

Thus, Appellant was prohibited from taking Ambien and other 

sleep aids during her participation in the program. As the work 

site monitor for the HPIP program, Susco submitted periodic 

reports to HPIP regarding Appellant’s work performance.

Appellant was on an approved leave of absence from 

Reston Hospital to seek treatment through HPIP beginning in June 

2003. She initially received three months of leave under the 

Family and Medical Leave Act (“FMLA”), and when she exhausted 

her FMLA leave, Reston Hospital permitted Appellant to take an 

additional three months of extended leave. After her return to 

work, and for a period of several months during her 

participation in HPIP, Appellant was prohibited from 

administering narcotics to patients. Reston Hospital assigned 

another nurse to administer narcotics to Appellant’s patients 

during this time.

The original length of Appellant’s participation in 

HPIP was five years with a completion date of 2008; however, it 

was extended by one year after she violated the terms of her 

agreement with HPIP in 2007 by obtaining a prescription for 

Lunesta, a sedative in the same family as Ambien. Yet Reston 

 1 Citations to the “J.A.” refer to the Joint Appendix filed 

by the parties in this appeal.
5

Hospital did not discipline her as a result. Instead, Appellant 

took another approved leave of absence between August and 

November 2007 relating to additional treatment through the HPIP 

program, and successfully completed the program in June 2009.

B.

In general, Appellant’s periodic performance reviews 

at Reston Hospital indicate a “satisfactory” performance.2

 Even 

so, on four occasions in 2008, Appellant made mistakes 

administering medications to patients. She was responsible, as 

part of her duties on the surgical unit, for verifying that what 

is entered into the hospital’s medication administration record 

by the pharmacist is the correct dosage, route, and frequency 

ordered by the physician.3

 According to Susco, it is rare for 

 2 According to the employee performance evaluation form, a 

score of “2” or below indicates unsatisfactory/below 

expectations. Appellant received scores of 3.04 in 2007, 3.04 

in 2008, and 2.81 in 2009. Appellant’s evaluations also 

indicated that she had consistent problems assisting peers. As 

a result, Susco met with Appellant annually to discuss her 

performance and counseled her on at least three additional 

occasions to address the issue.

3 The first error took place on April 30, 2008, when a 

patient was to receive a dose of medication at 11:00 a.m. Due 

to Appellant’s failure to catch the mistake, the patient did not 

receive the medication until 11 hours later. The second mistake 

occurred on August 12, 2008, when Appellant failed to notice 

that the pharmacy forgot to order a certain medication for a 

patient. As a result, the patient did not receive the 

medication that the physician ordered. The third mistake 

occurred on October 18, 2008, when one of Appellant’s patients 

was to receive a medication orally. Due to her failure to 

(Continued)
6

nurses on the surgical unit to make more than one or two 

medication errors in a given year, whereas Appellant made four 

medication errors during a six month period.

C.

According to Appellant, the events culminating in her

dismissal on August 11, 2009, began earlier that month. 

Sometime during the morning of August 4, 2009, while walking 

into her house, Appellant tripped and fell onto a set of cement 

steps and suffered a head injury and a loss of consciousness. 

She woke up at the emergency room of Inova Loudoun Hospital 

sometime later, having been brought there by ambulance. 

Appellant has no recollection of anything that happened after 

falling and striking her head until she woke up in the hospital.

The record from Appellant’s emergency room visit 

indicates “altered mental status” and “trauma.” The attending 

physician noted that Appellant appeared groggy and planned to 

observe her overnight to determine whether the symptoms were 

connected to some substance or to the head trauma. The results 

of the toxicology report were negative for all substances with 

 

monitor the chart properly, the patient instead received the 

dose intravenously. The fourth error occurred three days later, 

on October 21, 2008, when one of Appellant’s patients was given 

twice as much medication as the physician had ordered.
7

the exception of Appellant’s regularly prescribed anti-anxiety 

medication, Klonopin.

Having been hospitalized overnight, Appellant received 

a telephone call from her supervisor, Susco, on the morning of 

August 5 at 9:45 a.m., while still in Loudoun Hospital. 

Following an explanation of the events of the previous two days, 

Susco suspended Appellant for three days for a “no call/no show”

because Appellant failed to show up for her shift or to call her 

supervisor within two hours after her shift began at 3:00 p.m. 

in accordance with Reston Hospital policy. Appellant was 

released from Loudoun Hospital later that day.

D.

After serving her suspension, Appellant reported to 

work timely on August 11, 2009, for her 3:00 p.m. shift. Per 

Appellant, she felt fine when she arrived. Shortly after 

clocking in, however, she began to feel woozy and to experience 

disorientation and nausea, “like the room was starting to spin.” 

J.A. 73-74. She described her experience as episodic and coming 

over her in waves and said that she felt at some points as if 

she would lose consciousness. Several coworkers on the unit 

reported her behavior to the assistant director of the surgical 

unit, Cathy Hannon, who escorted Appellant off the floor and to 
8

a conference room.4 Susco and Gina Gerard, the hospital’s human 

resources director, were thereafter summoned to the conference 

room. 

Appellant characterizes the meeting as very tense, 

stating that Susco and Gerard “hammer[ed]” her with questions 

about what medications she had taken and whether she was under 

the influence of alcohol and/or narcotics. J.A. 77-78. Susco 

testified regarding the meeting:

So at that time, when I got there [Appellant] and 

[Hannon] were already in the conference room waiting 

for me. And Gina Gerard came in and we talked to 

[Appellant]. And at that point she appeared impaired. 

 4 Choon “Tina” Kim, a registered nurse who had worked on the 

surgical unit for 30 years, noticed that Appellant was acting 

strangely while she was reporting to Appellant on their shared 

patients. Kim noticed that Appellant was not responding 

appropriately to the questions, and she was slurring her words. 

J.A. 198. Additionally, the nurse who is taking over the shift 

will usually write down all of the patient information, but Kim 

observed Appellant just staring at the piece of paper she had in 

her hand. Id. Approximately 20 minutes after giving Appellant 

the report, Kim saw her staring blankly for several minutes at a 

computer monitor with a screensaver displayed rather than 

entering patient information into the computer. Id. Concerned 

that something was wrong, Kim approached Hannon and told her 

that she should check on Appellant because she was acting 

strangely. Id.

Alisa Rooney, another veteran nurse on the surgical unit, 

also noticed that Appellant was slow to respond to questions. 

J.A. 200. Rooney observed Appellant standing near the nurses’ 

station appearing lost and not responding to at least two 

patient calls for assistance. Id. Rooney finally approached 

Appellant and offered to administer medication to one of her 

patients. Id. She then approached Hannon and expressed her 

concerns about Appellant’s behavior. Id.
9

She couldn’t keep her eyes open. She was slumping 

over. Her speech was slow and slurred. So Gina felt 

it was the right next step to do to ask her [for]

permission for a drug test.

* * * *

She was having trouble staying awake. She was not 

focusing. She was slurring her speech. We asked her 

if she had anything to drink or taken any drugs before 

she came to work. And she said that at midnight she 

had had two glasses of wine and had taken 20 

milligrams of Ambien because she was nervous about 

coming back to work after her suspension. The 11th 

was the first day back to work after her suspension. 

And then when she couldn’t go to sleep, and at 6:30 in 

the morning she had another glass of wine. And she 

took her regular prescriptive pills and she took some 

Klonopin, some Tylenol, and what she said was 

Methotrexate that she was taking for arthritis pain.

J.A. 117-18. At her deposition, Appellant testified that Gerard 

told her during the meeting in the conference room that she was 

fired, and denied telling those present that she had drank two 

glasses of wine the night before and one glass that morning. 

However, she admitted to drinking two glasses of wine around 

noon on the day before, August 10. 

Appellant further testified regarding her condition on 

August 11:

Q. So at any time during August 11th when you were at 

Reston Hospital, did you tell anyone there something to the 

effect of, hey, I don't feel good or, hey, I feel sick, 

something like that?

A. Not that I recall.

* * * *
10

Q. When you were describing before lunch how you felt when 

this wave came over you, and I want to make sure I get your 

testimony right, I think you said you felt woozy, you felt 

nauseated, you felt like you were going to lose 

consciousness; is that correct?

A. That is correct.

Q. Do you think that you could safely administer medication 

when you were in that state on August 11th?

A. When that wave happened upon me, no.

Q. Do you think you were able to treat patients when that 

wave came upon you on August 11th?

A. No.

J.A. 83-84; see also id. 109-10.

While in the conference room, Appellant completed a 

form indicating what medications she had taken. She signed a 

drug test consent form and admitted that she was taking the 

following medications: Cymbalta, Clonazepam (Klonopin), Ambien, 

Tylenol, and Methotrexate -- each of which were regularly 

prescribed or over-the-counter. A phlebotomist arrived and drew 

Appellant’s blood. She was then sent home. The results of the 

blood test, which were reported on August 17, 2009, were 

negative for narcotics and alcohol.5

 5 Appellant claims she was fired on August 11, 2009, whereas 

Susco contends Appellant was not discharged until August 19, 

after the blood test results had been reported. While we credit 

Appellant’s version for purposes of summary judgment, this 

dispute has no bearing on our disposition of her appeal.
11

Even so, Gerard and Susco discussed the situation and 

decided that given Appellant’s inability to perform her job and 

safely treat patients on August 11, termination of her 

employment was warranted. Susco testified regarding the 

decision to discharge Appellant:

Q. Why do you believe she was unable to - you the 

institution, Reston Hospital, why does Reston Hospital 

believe that she was unable to perform her job duties that 

day?

MS. BELGER: Objection to form and foundation. You may 

answer.

A. When she presented to work on that day at three o’clock 

she could not stay awake. She could not -- she was slurring 

her speech. She –

Q. Appeared impaired?

A. Could not -- appeared impaired. And I could not let her 

take responsibility for a patient load. First priority is 

to our patients. And that’s why she was removed from the 

floor that day.

Q. And I understand why she would be removed from the floor 

that day. Why was she fired?

MS. BELGER: Same objection.

A. This was just the last straw in many things that had 

gone on with Branell [Harris].

J.A. 121:9-122:5. 

Susco further testified that she also took into 

account Appellant’s past disciplinary and performance record in 

making the decision to discharge, including her interactions 
12

with her peers, her medication errors, and her recent no call/no 

show:

Q. Okay. So what conversation did you have with Gina Gerard 

about terminating Branell?

A. She asked me what my thought process was and the fact 

that this was not the first issue that we had with 

Branell’s performance. And she told me that she had 

consulted with Lesley and with HCA corporate, and that the 

decision was made to go ahead with the termination.

Q. Did you offer any insight or input to Gina Gerard as 

part of these discussions?

A. Gina already knew about the performance history with 

Branell.

Q. When you say the performance history with Branell, can 

you be more specific?

A. She knew about any of her previous counselings.

J.A. 123:3-124:11.6

In Appellant’s view of events, her impairment on 

August 11 was caused by a latent manifestation of the head 

injury she received as a result of her fall on August 4, rather 

than by drugs or alcohol. In this regard, Appellant directs us 

to evidence from her primary treating physician, Dr. Michael G. 

Bowers, D.O., whom she visited on September 15, 2009, several 

weeks after she was fired by Reston Hospital. Upon examining 

Appellant, who had complained of ongoing headaches, Dr. Bowers 

 6 The “previous counselings” refer to the response by the 

hospital to Appellant’s past performance evaluations. See supra

note 2.
13

reported that she “may have been suffering from post-concussion 

syndrome.” J.A. 187. He testified regarding post-concussion 

syndrome, “Post[-]concussion syndrome [. . . ] is like kind of a 

timeline. So, if you have still concussive issues, meaning 

headaches, memory loss, you know, maybe some cognizant deficits 

during the day, even nausea.” Id. 277. When asked during his 

disposition whether his testimony could be characterized as not 

“definitively” diagnosing Appellant as having a concussion, Dr. 

Bowers testified:

I would say based on [sic] because I have to rely 

solely on her history of present illness, not having 

records, and then when I examine her, that is correct. 

I could not definitively say yes, you had a 

concussion. But based on symptomatology and 

discussion I would have to label it as a concussion.

Id. 188. 

E.

On December 21, 2010, Appellant commenced this action 

by filing a complaint against Reston Hospital in the Eastern 

District of Virginia. She filed an amended complaint on June 

21, 2011, asserting that Reston Hospital wrongfully discharged 

her on the basis of a drug and alcohol addiction disability. 

Following discovery, the hospital moved for summary judgment, 

which was granted by the district court on March 26, 2012. 

In the main, the district court concluded that 

Appellant failed to present evidence “indicating that Reston 
14

Hospital knew or believed that Plaintiff had any problems with 

alcohol prior to her termination” such that she met her burden 

to show that Appellee “regarded” her as disabled. See Harris v. 

Reston Hosp. Ctr., LLC, 1:10-CV-1431, 2012 WL 1080990, at *5 

(E.D. Va. Mar. 26, 2012). The district court likewise refused 

to consider an additional theory of recovery introduced by 

Appellant for the first time in response to Appellee’s motion 

for summary judgment, namely, that Appellant was fired because 

she had a “record” of impairment. The district court reasoned 

that to allow Appellant’s assertion of a new legal theory --

outside of the complaint and after discovery -- to defeat 

summary judgment would unfairly prejudice Reston Hospital.

The district court also determined that Appellant 

failed to present sufficient evidence indicating she was a 

“qualified individual.” The district court explained as 

follows:

Plaintiff has not demonstrated that she was performing 

her job at a level that met Reston Hospital’s 

legitimate expectations at the time or her termination 

in August 2009. Plaintiff had been counseled at least 

three times since 2007 regarding the need to be more 

consistent in assisting her peers. Additionally, 

Plaintiff had been given a written warning in 2008 for 

four medication occurrences in one year. Plaintiff 

was suspended for three days for a No Call/No Show on 

August 4, 2009. Finally, on the day that Plaintiff 

returned from her suspension, on August 11, 2009, 

Plaintiff’s behavior concerned multiple coworkers. 

Plaintiff slurred her words, did not respond 

appropriately to questions, failed to respond to 

several patient calls for medication, stared blankly 
15

at a Screensaver on a computer monitor, and had 

trouble staying awake.

Harris, 2012 WL 1080990 at *6.

The district court next concluded that even if 

Appellant presented a prima facie case, “Plaintiff’s actions 

gave Reston Hospital legitimate, nondiscriminatory reasons to 

terminate Plaintiff’s employment, and Plaintiff’s claim that 

Reston Hospital illegally terminated her due to a perceived 

disability is belied by the fact that Reston Hospital 

continually accommodated Plaintiff and allowed Plaintiff to 

maintain her employment.” Id. Finally, the district court 

observed that Appellant failed to produce any evidence that 

Appellee “had any discriminatory intent or that Reston 

Hospital’s reasons for terminating Plaintiff’s employment were 

pretextual,” or that “Plaintiff’s inability to perform the 

essential functions of her job were not Reston’s [sic] 

Hospital’s legitimate reasons for terminating her employment.” 

Id. at *7. Harris timely appealed.

Appellant presents two issues on appeal: 1) whether 

the district court improperly declined to consider Appellant’s 

new legal theory that the hospital terminated her due to a 

“record” of impairment; and 2) whether the district court erred 

when it found that Appellant failed to present a prima facie 
16

case for discrimination pursuant to the “regarded as” definition 

of disability.7

II.

We review de novo a district court’s order granting 

summary judgment. See Webster v. U.S. Dep’t of Agric., 685 F.3d 

411, 421 (4th Cir. 2012).

III.

The Americans with Disabilities Act of 1990, 42 U.S.C. 

§§ 12101-12213, as amended by the ADA Amendments Act of 2008, 

Pub. L. No. 110-325, 122 Stat. 3353, prohibits an employer from 

“discriminat[ing] against a qualified individual on the basis of

disability in regard to job application procedures, the hiring, 

advancement, or discharge of employees, employee compensation, 

job training, and other terms, conditions, and privileges of 

employment.” 42 U.S.C. § 12112(a).8 A “disability” is defined 

as (A) a physical or mental impairment that substantially limits 

one or more of the major life activities of an individual; (B) a 

 7 In making her case, Appellant relies on statements taken 

from the administrative proceedings before the Virginia 

Employment Commission and the Virginia Board of Nursing. The 

district court properly disregarded these statements because the 

use of such information in judicial proceedings is prohibited by 

Virginia law. See Va. Code Ann. § 60.2-623(B) (Virginia 

Employment Commission); id. § 54.1-2400.2 (Virginia Board of 

Nursing). We likewise disregard these statements.

8 Because Appellant’s claim arose after the effective date 

of the ADAAA, we apply the amended version.
17

record of such impairment; or (C) being regarded as having such 

an impairment. Id. § 12102(1).

A.

Appellant first argues that the district court 

improperly refused to consider an additional theory of recovery,

asserted for the first time in her opposition to Appellee’s 

motion for summary judgment, that she has a “record” of a 

physical or mental impairment that substantially limits one or 

more major life activities.9 

Addressing the new theory, the district court stated, 

“any such ‘record’ does not appear in the Charge of 

Discrimination that Plaintiff filed with the Equal Employment 

Opportunity Commission (“EEOC”) or her Amended Complaint, nor 

did Plaintiff assert any such record in her answers to 

interrogatories or at her deposition.” Harris, 2012 WL 1080990, 

at *4. Because the district court determined that asserting a

new legal theory for the first time in opposing summary judgment 

amounted to constructive amendment of the amended complaint and 

thus unfairly prejudiced the defendant, the district court

refused to consider it. Id. (citing United States ex rel. DRC, 

Inc. v. Custer Battles, LLC, 472 F. Supp. 2d 787, 795–96 (E.D. 

 9 This theory implicates the second definition of 

disability. See 42 U.S.C. § 12102(1)(B) (“disability” means “a 

record of such an impairment. . . .”).
18

Va. 2007) aff’d, 562 F.3d 295 (4th Cir. 2009)). The district 

court also concluded that Appellant failed to exhaust her 

administrative remedies as to the “record” of impairment

argument. Id. (citing Miles v. Dell, Inc., 429 F.3d 480, 491 

(4th Cir. 2005)). 

We conclude that the district court did not err in 

refusing to consider the new argument as an impermissible 

attempt to constructively amend the complaint. Because a 

complaint “guides the parties’ discovery, putting the defendant 

on notice of the evidence it needs to adduce in order to defend 

against the plaintiff’s allegations,” constructive amendment of 

the complaint at summary judgment undermines the complaint’s 

purpose and can thus unfairly prejudice the defendant. Coleman 

v. Quaker Oats Co., 232 F.3d 1271, 1292-93 (9th Cir. 2000); see

Deasy v. Hill, 833 F.2d 38, 40-42 (4th Cir. 1987); Josey v. John 

R. Hollingsworth Corp., 996 F.2d 632, 642 (3d Cir. 1993).10

 10 See also Cloaninger v. McDevitt, 555 F.3d 324, 336 (4th 

Cir. 2009) (“[A] plaintiff may not raise new claims after 

discovery has begun without amending his complaint.”); Priddy v. 

Edelman, 883 F.2d 438, 446 (6th Cir. 1989) (“A party is not 

entitled to wait until the discovery cutoff date has passed and 

a motion for summary judgment has been filed on the basis of 

claims asserted in the original complaint before introducing 

entirely different legal theories in an amended complaint.”); 

Feldman v. Allegheny Int’l, Inc., 850 F.2d 1217, 1225 (7th Cir. 

1988) (“Defense of a new claim obviously will require additional 

rounds of discovery, in all probability interview of new 

witnesses, gathering of further evidence, and the identification 

(Continued)
19

Indeed, Appellant did not at any time request leave to 

amend her pleadings. As a result, Appellee conducted discovery 

and crafted defenses based on Appellant’s claim as set forth in 

the amended complaint, which alleges Appellee “regarded [her]

as” disabled. See 42 U.S.C. § 12102(1)(C). Defense of the 

claim that Appellant had a “record of such an impairment,” id.

§ 12102(1)(B), plainly requires different discoverable 

inquiries. Allowing this new theory, asserted in a response 

brief no less, to defeat Appellee’s motion would amount to 

constructive amendment of the controlling complaint, placing a 

clear burden on Appellee’s ability to effectively and 

efficiently defend itself. We affirm the district court’s 

decision in this regard and thus need not address whether the 

“record” of impairment theory is barred by Appellant’s failure 

to exhaust her administrative remedies.

B.

A plaintiff establishes a prima facie case of wrongful 

discharge under the ADA if she demonstrates that (1) she is 

within the ADA’s protected class; (2) she was discharged; (3) at 

the time of her discharge, she was performing the job at a level 

that met her employer’s legitimate expectations; and (4) her 

 

of appropriate legal arguments. All this necessarily takes 

time.”).
20

discharge occurred under circumstances that raise a reasonable 

inference of unlawful discrimination. See Reynolds v. Am. Nat’l 

Red Cross, 701 F.3d 143, 150 (4th Cir. 2012); Rohan v. Networks 

Presentations LLC, 375 F.3d 266, 273 n.9 (4th Cir. 2004); 

Haulbrook v. Michelin N. Am., 252 F.3d 696, 702 (4th Cir. 2001). 

“Evidence of all four of these elements is necessary to survive 

summary judgment.” Reynolds, 701 F.3d at 150. Appellant’s 

claim falters on the first step.

“One is within the ADA’s protected class if one is a 

‘qualified individual with a disability.’” Haulbrook, 252 F.3d 

at at 702 (quoting 42 U.S.C. § 12112). Under the ADA, a 

“qualified individual” is one who, “with or without reasonable 

accommodation, can perform the essential functions of the 

employment position.” 42 U.S.C. § 12111(8). See Rohan, 375 

F.3d at 278-79; Tyndall v. Nat’l Educ. Ctrs., Inc. of Cal., 31 

F.3d 209, 213 (4th Cir. 1994). “A job function is essential if 

it ‘bear[s] more than a marginal relationship to the job at 

issue.’” Rohan, 375 F.3d at 279 (quoting Tyndall, 31 F.3d at 

213). Appellant bears the burden of establishing that she could 

perform the essential functions of her job. See Tyndall, 31 

F.3d at 213.

At the outset, we recognize the undisputed fact that 

an essential function of Appellant’s job as a registered nurse 

in the surgical unit at Reston Hospital was the care and 
21

treatment of patients, principally including the safe and 

accurate administration of medications. We agree with the 

district court that Appellant failed to demonstrate that she 

could perform this essential function. Indeed, Appellant’s 

concession that she was not capable of safely treating patients 

or administering medication on August 11, 2009, the date of her 

discharge, underscores her overall failure to satisfy this 

element. Her employment record is riddled with repeated 

absences stretching over several years and personnel evaluations

demonstrating barely satisfactory-level performance. 

Appellant’s extensive absences and physical incapacity --

regardless of their precise causes -- would significantly 

interfere with, if not wholly negate, her ability to perform the

essential functions of a surgical floor nurse. Because 

Appellant failed to establish that she was a “qualified 

individual” with a disability, the district court properly 

entered judgment in favor of Reston Hospital.11

 11 Even if we concluded Appellant had established that she 

was a “qualified individual” with a disability, we would 

nonetheless affirm the district court because she utterly failed 

to present evidence demonstrating that, at the time of 

discharge, she was performing her job at a level that met her 

employer’s legitimate expectations. See Ennis v. Nat’l Ass’n of 

Bus. and Educ. Radio, Inc., 53 F.3d 55, 61-62 (4th Cir. 1995).
22

IV.

For the foregoing reasons, the judgment of the 

district court is

AFFIRMED.