Opinion ID: 782811
Heading Depth: 2
Heading Rank: 1

Heading: The individualized assessment requirement

Text: 9 Chevron defends its assessment disqualifying Echazabal from employment with three arguments: (1) It satisfied the individualized assessment requirement by relying on the facially proper opinions of competent physicians. (2) There were no genuine issues of material fact with regard to the four Arline factors. (3) The opinions of Echazabal's medical experts cannot be considered in evaluating its employment decision because they were made long after the fact. 1. The standard for evaluating medical judgments 10 Chevron argues that its reliance on the advice of its own doctors, and allegedly upon that of Echazabal's doctors, constitutes a facially reasonable and thus a legally sufficient individualized assessment of Echazabal. This is an erroneous interpretation of the governing standard. 3 The regulation presents a much more specific matrix against which to measure the reasonableness of the employer's action: 11 Direct Threat means a significant risk of substantial harm to the health or safety of the individual or others that cannot be eliminated or reduced by reasonable accommodation. The determination that an individual poses a direct threat shall be based on an individualized assessment of the individual's present ability to safely perform the essential functions of the job. This assessment shall be based on a reasonable medical judgment that relies on the most current medical knowledge and/or on the best available objective evidence. In determining whether an individual would pose a direct threat, the factors to be considered include: 12 (1) The duration of the risk; 13 (2) The nature and severity of the potential harm; 14 (3) The likelihood that the potential harm will occur; and 15 (4) The imminence of the potential harm. 16 29 C.F.R. § 1630.2(r). 17 In Bragdon v. Abbott, 524 U.S. 624, 118 S.Ct. 2196, 141 L.Ed.2d 540 (1998), the Supreme Court considered a direct threat defense presented by a dentist concerned about treating an HIV-infected patient. The Court stated that the health care provider had a duty to assess the risk based on the objective, scientific information available to him and others in his profession. Id. at 649, 118 S.Ct. 2196. A subjective belief in the existence of a risk, even one made in good faith, will not shield the decisionmaker from liability. Id. This Circuit has held that an employer must gather substantial information about an employee's work history and medical status. Nunes, 164 F.3d at 1248. The decision must be based upon particularized facts using the best available objective evidence as required by the regulations. Lowe v. Ala. Power Co., 244 F.3d 1305, 1309 (11th Cir.2001); cf. McGregor v. Nat'l R.R. Passenger Corp., 187 F.3d 1113, 1116 (9th Cir.1999) (holding that policies requiring employees to be 100% healed before returning to work violate the ADA because they preclude individualized assessment of whether employee can perform the essential functions of the job with or without accommodation). 18 Echazabal has raised a material issue of fact as to whether Chevron's decision was based on a reasonable medical judgment that relies on the most current medical knowledge and/or the best available objective evidence. 29 C.F.R. § 1630.2(r). As part of the physical examinations ordered by Chevron, Dr. Baily, and later Dr. McGill, administered and relied upon tests that measure the levels of three enzymes in the bloodstream. Based on results demonstrating abnormally high levels of certain enzymes, Drs. Baily and McGill concluded that Echazabal's liver was not functioning properly, and recommended that Echazabal not be exposed to chemicals that could be toxic to his liver. 4 Neither Dr. Baily nor Dr. McGill has any special training in liver disease. Baily's area of medical expertise is in preventive medicine, while McGill is a generalist, with no board certification in any specialty. In contrast, Echazabal's experts, Dr. Fedoruk and Dr. Gitnick, are specialists in toxicology and liver disease. 5 Their opinions demonstrate that enzyme tests do not produce information regarding liver function. Rather, enzyme tests reflect only that an infection is ongoing. According to Fedoruk and Gitnick, the only tests that do measure liver function — blood albumin levels and prothrombin time — revealed that Echazabal's liver was functioning properly. Far from showing cutting edge research, as Chevron argues, these opinions offered the unequivocal assessment that Echazabal could work at the refinery without facing a substantial risk of harm, beyond that faced by other workers. The required assessment could not be based upon common sense, as Chevron argues, but rather only after — at a minimum — a consultation with a medical professional who had made an objective, scientific judgment. Bragdon, 524 U.S. at 629, 118 S.Ct. 2196. 19 Echazabal presents evidence that there was no scientific basis for the contrary opinions of Chevron's doctors. Both Dr. Gitnick and Dr. Fedoruk stated that there is no medical or scientific evidence supporting a finding that Echazabal's chemical exposures from working as a plant helper or in the coker unit would present an appreciable or clinically significant risk. Dr. Fedoruk indicated that for some of the chemicals identified as potentially risky for Echazabal, an individual would receive a higher dosage from a daily multivitamin tablet than Echazabal would receive from working in the refinery. Based on the opinions of Drs. Fedoruk and Gitnick, a reasonable jury could conclude that Chevron failed to rely upon a reasonable medical judgment that relies on the most current medical knowledge and/or on the best available objective evidence. 20 In addition, the record does not support the district court's conclusion that the medical opinion letters from Echazabal's doctors evaluating his specific position all concurred that the job posed a serious, immediate risk to him. On April 5, 1993, Dr. Ha wrote: In my opinion the patient is now capable of carrying on with the work that he has applied for and there is no restriction on his activity at work as outlined by the working condition sheet GO 308 that was sent to me. 6 Dr. Ha stated that Echazabal's prognosis should be very good. Dr. Ha's opinion, based on her knowledge of Echazabal's potential work environment, does not support the view that she concurred in Chevron's assessment. 7 On November 10, 1993, and July 20, 1994, Dr. Suchov wrote two letters indicating that there was no limitation on Echazabal's ability to work and that he could return to his usual duties. Although the district court dismissed these letters because they did not address Echazabal's specific job duties, Echazabal's declaration states that he informed all of his doctors of the type of work that he performed. These letters, together with Echazabal's own declaration, raise a material issue of fact as to the objective reasonableness of Chevron's opinion. 21 The dissent describes as clincher the communications between Dr. McGill and Dr. Weingarten, one of Echazabal's treating physicians, in which Dr. Weingarten recommended against exposure to hepatotoxic hydrocarbons. The sum total of the recommendation was as follows: 22 In your letter, it is mentioned that Mr. Echazabal has applied for return of his job and it mentioned that this may entail exposure to hepatotoxic hydrocarbons. This, of course, is recommended not to be the case. 23 This general statement, which followed a statement that Echazabal was in good health and showed no sign of liver failure, is insufficient to carry Chevron's burden of establishing that it relied on the most current medical knowledge and/or the best available objective evidence and that it considered the likelihood of harm, its possible severity, and imminence. Notably missing from this statement is any indication that Dr. Weingarten was asked to consider the specific chemical exposures, to indicate the levels at which they would become dangerous or the likelihood that they would injure Echazabal, or even whether the risk to Echazabal was any greater than that for a healthy individual. (Indeed, it is difficult to imagine that any responsible doctor would recommend exposure of even his healthiest patient to an unspecified amount of hepatotoxic chemicals.) The district court notably found that Dr. Weingarten was not informed by Dr. McGill about the specific chemicals to which plaintiff would be exposed, or the levels of concentration of those chemicals. 24 Chevron was required to do more than consider generalized statements of potential harm. Before refusing to hire Echazabal, Chevron was required, under the terms of 29 C.F.R. § 1630.2(r), to consider the severity, imminence, and potential likelihood of harm. Based on consideration of these factors, Chevron had the burden of demonstrating at least a significant risk of substantial harm to Echazabal. Id. The EEOC's Interpretive Guidance for this section explains that where the employer invoking the direct threat defense relies on threats to the employee, the employer must determine that there is a high probability of substantial harm to the individual. 29 C.F.R. pt. 1630 App. (EEOC Interpretive Guidance on Title I of the ADA) ( Interpretive Guidance ). Echazabal has raised a material question of fact as to whether Chevron made an adequate analysis. Dr. Weingarten's general statement, unrelated to the demands and conditions of the particular position or the likelihood, imminence, or potential severity of harm (or even whether Echazabal was at greater risk than a healthy individual), would not preclude a reasonable juror from concluding that Chevron failed to make the required assessment. 2. Evaluation of the Arline factors 25 Had Chevron conducted the individualized assessment required by law, it would have considered in detail the four Arline factors as they applied to Echazabal's condition. Chevron argues that there are no genuine issues of material fact with regard to the four Arline factors to be considered in assessing whether Echazabal's condition posed a direct threat. While Echazabal concedes that the first Arline factor — the duration of his condition — is not disputed, he has raised material issues of fact about the three remaining factors. 26 First, Echazabal has raised a material issue of fact as to whether Chevron properly assessed the nature of the potential harm. The record indicates that the Chevron doctors were unfamiliar with the specific risks of Echazabal's position. Dr. Baily stated in his deposition that he did not know the types or concentrations of toxin, liquid, or vapor exposures Echazabal would face in the coker unit, that he made no attempt to ascertain this information and did not contact either the Industrial Hygiene Department or an outside specialist to determine whether Echazabal could perform the plant helper job. He indicated that solvents are only liver toxic in sufficient quantities, but he made a blanket recommendation that all exposure be avoided. He made only a general recommendation that Echazabal not be exposed to hepatotoxins, unrelated to any specific position, assuming that it was management's responsibility to determine Echazabal's fitness for a particular job, and that he was not charged with considering specific exposure levels or chemicals. In fact, Dr. Baily anticipated that management would contact a specialist. He stated that the limitations were not specifically based on any . . . individual work place exposure. The limitations were placed in general fashion to give guidance to management so that they would then be able to work with the specialist in determining which jobs might be appropriate for that applicant or employee. 27 Similarly, Dr. McGill testified in his deposition that, at the time he assessed Echazabal, he did not know the levels of hydrocarbons to which a plant helper would be exposed, was not aware if any regulatory levels would be exceeded, and that he did not attempt to contact the Industrial Hygience Department to determine whether the industrial setting in the coker unit would be harmful to Echazabal. 8 Although he contacted Industrial Hygiene with regard to other employees, Dr. McGill did not do so in Echazabal's case because he assumed that it had been thoroughly worked over in the 1992 phase [a]nd [he] was assuming that it had been investigated. 9 28 Moreover, neither of the Chevron doctors had expertise in this area. Dr. Baily stated that he was not a liver specialist, that his experience with patients with chronic liver diseases was very limited, that he was not familiar with the specific biochemistry of liver abnormalaties, that he had not spoken with a liver specialist about Echazabal's case, and that he was not aware of specific evidence that hepatotoxins pose a risk to individuals with hepatitis. Dr. Baily had no knowledge of whether Chevron ever contacted a specialist about the position. Similarly, Dr. McGill had not treated any patients in the prior 15 years for chronic liver disease, did not consult any treatises on the issue, did not research the likelihood of liver failure due to exposure to liver toxins, and did not consult a specialist. 29 According to Dr. Fedoruk, who did review Chevron's records, the level of toxins present at the coker unit placed Echazabal at no greater risk of injury than other workers. He also stated that there was no reliable scientific or medical evidence to suggest that the other exposures would lead to hepatoxicity and most of the potential exposures identified by Chevron were insignificant. Dr. Gitnick opined that Echazabal was at no greater risk of injuring himself and specifically his liver than any other employee. He stated that the contrary opinions of Chevron's doctors were simply wrong and unsupported by medical evidence. 30 Second, the declarations of Fedoruk and Gitnick suggest that, at the time of Chevron's evaluation, there was little indication that Echazabal faced potential harm that was (a) likely, or (b) imminent. For example, Dr. Gitnick stated that I can say to a reasonable degree of medical certainty that Mr. Echazabal is in no greater risk of injuring himself and specifically his liver by working in the refinery than other employee [sic]. His liver is functioning properly and there is no evidence of liver failure. Dr. Fedoruk also indicated that his tests had remained stable over years of work at the refinery. These statements were not, as Chevron implies, merely differences of medical opinion. In several instances, Fedoruk and Gitnick declared that Chevron doctors were simply wrong in their assessment of Echazabal's condition and that their analysis is inconsistent with the literature on liver function. The Chevron doctors, unlike Fedoruk and Gitnick, were not experts in this field. 31 Finally, this Circuit has cautioned that individualized risk assessment also requires consideration of relevant information about an employee's past work history. See Nunes, 164 F.3d at 1248; Mantolete v. Bolger, 767 F.2d 1416, 1423 (9th Cir.1985) (holding that, in assessing elevated risk to an employee under the Rehabilitation Act, the employer must gather [and assess] all relevant information regarding the applicant's work history and medical history); see also Anderson v. Little League Baseball, Inc., 794 F.Supp. 342, 345 (D.Ariz.1992) (giving great weight to fact of disabled plaintiff's three years of service without incident in rejecting employer's direct threat defense). Chevron gave no weight to the fact that Echazabal had worked at the El Segundo refinery, without incident or injury, for over 20 years. A reasonable jury could find that this injury-free work history provided evidence that Echazabal would not pose a direct threat to himself as a coker unit employee. 10 32 3. Consideration of Echazabal's medical experts' opinions 33 Chevron argues that the opinions offered by Echazabal's experts, Drs. Fedoruk and Gitnick, should not be considered because they were offered after the employment decision to exclude Echazabal from the refinery. Expert evidence of this nature, however, elucidates the very issue the court must assess — whether the opinion that a direct threat existed was objectively reasonable. See Bragdon, 524 U.S. at 649, 118 S.Ct. 2196; Nunes, 164 F.3d at 1248 (analysis of direct threat requires the employer to gather `substantial information' about the employee's work history and medical status, and disallows reliance on subjective evaluations by the employer). The two expert opinions were directed in significant part to the state of medical knowledge — the best available objective evidence — at the time of Chevron's employment action. At the very least, they were highly relevant to that question. The subjective belief of Chevron's doctors is not relevant. Id. 34 Chevron also argues that to consult the Fedoruk and Gitnick opinions would be contrary to Cook v. United States Dep't of Labor, 688 F.2d 669 (9th Cir.1982). Cook addressed a claim under the Comprehensive Employment and Training Act of 1973, and preceded Bragdon, as well as the 1990 enactment of the ADA and the 1991 issuance of the EEOC regulation. See Equal Employment Opportunity for Individuals With Disabilities, 56 Fed.Reg. 35734 (1991) (codified at 29 C.F.R. pt. 1630) (issuing regulations pursuant to the ADA and noting that the ADA was signed into law on July 26, 1990). Moreover, Cook did not involve the application of a regulatory requirement that the employer's assessment be based on a reasonable medical judgment that relies on the most current medical knowledge. Thus, because of these differing circumstances, Cook is unhelpful, much less controlling, in determining whether an employer has complied with the EEOC's ADA regulations requiring an individualized assessment based on the Arline factors and the most current medical knowledge and/or the best available objective evidence. As the Supreme Court emphasized, the requirement of an individualized assessment in 29 C.F.R. § 1630.2(r) serves an important role in protecting against the risk of pater nalism the ADA was enacted to discourage. See Echazabal, 122 S.Ct. at 2052-53. 35 Finally, we note that there is no medical evidence in the record to support Chevron's assertion that the opinions of Drs. Fedoruk and Gitnick were not available to Chevron when it made its assessment. Neither is there a showing that the body of medical knowledge on which those opinions were based was not available at the time, i.e., was beyond the then most current medical knowledge. Given this medical knowledge, there is an issue of material fact whether the medical judgments which formed the basis of Chevron's assessment were based on the most current medical knowledge and/or the best available objective evidence, as required by the EEOC's regulation. 29 C.F.R. § 1630.2(r). 11 36 At the heart of Chevron's arguments lies an unfounded fear that a proper application of the individualized assessment standard requires employer awareness of cutting-edge medical research not generally known to or accepted within the medical community. This is not the case. Chevron asserts that by relying primarily upon the advice of a generalist and an expert in preventive medicine in order to come to a conclusion about Echazabal's liver problem, it met the statute's requirements. Before terminating an individual's livelihood, the ADA requires more. 37 The dissent contends that Chevron did enough. The dissent's quibble, however, is less with our opinion and more with the requirements of the ADA. The dissent makes little mention of the rigorous requirements of § 1630.2(r) and the employer's burden of proving that it complied with those requirements before it can rely on the direct threat defense. Rather, it states vaguely that Chevron's decision was made after appropriately and thoroughly considering all relevant factors, that the process [was not] defective or unreasonable, that Chevron did not have to seek an outside expert in liver disease so long as its decision was objectively reasonable under the circumstances, and it dismisses the Fedoruk and Gitnick opinions as irrelevant to the bona fides and quality of Chevron's decision. None of these statements, however, expresses the governing standard for reviewing Chevron's decision. 38 Were we reviewing an administrative agency's decision under the substantial evidence standard of review and limited to the administrative record made before the agency, we might agree that the decision was not an abuse of discretion. That, however, is not our task on this appeal. Rather, without weighing the evidence at this summary judgment stage, we must decide only whether Echazabal has raised a material question of fact as to whether Chevron has met its burden under § 1630.2(r). 12 See Suzuki Motor Corp. v. Consumers Union of United States, Inc., 330 F.3d 1110, 2003 WL 21137731, at  (9th Cir.2003) (it is not our role, at this stage, to take sides in this way). He has succeeded in doing so. 39