Opinion ID: 3010988
Heading Depth: 2
Heading Rank: 2

Heading: Does Taylor have a disability under the ADA?

Text: According to the statutory language quoted above, Taylor can establish that she has a disability if she has a mental impairment that substantially limits a major life activity, has a record of such an impairment, or is regarded as having such an impairment. 42 U.S.C. S 12102(2). Taylor argues that she can satisfy each of these standards, but because we conclude that she raises genuine factual disputes about whether her bipolar disorder substantially limits a major life activity, we need not reach her arguments on the second and third definitions of a disability.2 _________________________________________________________________ 2. The parties' briefing on appeal has focused heavily on the first standard -- does Taylor have an impairment that substantially limits a major life activity? What discussion there was of the second and third standards for having a disability did not address whether a plaintiff who relies exclusively on either the regarded as standard or the record of a substantially limiting impairment standard is legally entitled to reasonable accommodations. 10 No one disputes that bipolar disorder counts as a mental impairment under the ADA; the contested issue is whether Taylor's bipolar disorder substantially limits a major life activity. In determining whether a plaintiff's impairment substantially limits a major life activity, the Supreme Court has stressed that courts should determine the existence of disabilities on a case-by-case basis. Albertsons, Inc. v. Kirkingburg, ___ U.S. ___, 119 S.Ct. 2162, 2169 (1999). To make that individualized assessment, we must begin by identifying the specific life activity or life activities that Taylor says her disorder affected and then evaluate whether her condition substantially limits those life activities. When Taylor relied upon our prior holding that disabilities are judged in their untreated state, she contended that while she was hospitalized, her bipolar disorder affected a number of her major life activities, such as the ability to think and care for herself. Following the decisions in Sutton and Murphy, which require courts to evaluate disabilities in their treated condition, Taylor submitted supplemental briefing that shifted the emphasis to her ability to think. We accept that thinking is a major life activity. We have previously observed that [t]he ADA does not define `major life activities,'  Kelly, 94 F.3d at 105 (citation omitted), but despite the comparative lack of guidance in the statute, we conclude that it is reasonable to include thinking as a _________________________________________________________________ We have previously identified, without deciding, the issue of whether a regarded as plaintiff is entitled to accommodations. See Taylor v. Pathmark Stores, Inc., 177 F.3d 180, 195-96 (3d Cir. 1999); Deane v. Pocono Medical Center, 142 F.3d 138, 140-41 (3d Cir. 1998)(en banc). Although those cases addressed the regarded as standard, the record of an impairment standard may raise similar considerations. We need not resolve these difficult issues in our present decision. Given that we have other grounds for reversal, intervening law has affected the regarded as standard, and important issues were left unaddressed by the parties, we will allow the parties to pursue on remand whether Taylor is regarded as disabled or has a record of a substantially limiting impairment and, if so, whether she would be entitled to reasonable accommodations under either of those standards. 11 major life activity. We hardly need to point out that thinking is inescapably central to anyone's life. Perhaps the activity is rather broad, but given the difficulty of specifying the different constituents of thinking or otherwise narrowing this central activity (especially when discussing the effects of psychosis or its subclinical manifestations), we will not try to constrict Taylor's arguments about how her condition affects her ability to think. We think that most objections about the broadness of thinking as a life activity can be captured in the analysis of when the activity is substantially limited. The Supreme Court has said, The ADA does not define `substantially limits,' but `substantially' suggests `considerable' or `specified to a large degree.'  Sutton, 119 S.Ct. at 2150. But while substantial limitations should be considerable, they also should not be equated withutter inabilities. Kirkingburg, 119 S.Ct. at 2168 (quoting Bragdon v. Abbott, 524 U.S. 624, 641, 118 S.Ct. 2196 (1998)). The EEOC's regulations define substantially limits as follows: (i) Unable to perform a major life activity that the average person in the general population can perform; or (ii) Significantly restricted as to the condition, manner or duration under which an individual can perform a particular major life activity as compared to the condition, manner, or duration under which the average person in the general population can perform that same major life activity. 29 C.F.R. S 1630.2(j)(1). The regulations include the following factors for evaluating when someone is substantially limited in a major life activity:(1) The nature and severity of the impairment; (ii) The duration or expected duration of the impairment; and (iii) The permanent or long term impact, or the expected permanent or long term impact of or resulting from the impairment. 29 C.F.R. S 1630.2(j)(2). The Supreme Court left unresolved in Sutton what deference, if any, these regulations are due. The Court stated that even though the EEOC is charged with issuing regulations for the employment provisions under Title I of the ADA, [n]o agency, however, has been given authority to issue regulations implementing the generally applicable provisions of the ADA, see SS 12101-12102, which fall 12 outside Titles I-V. Sutton, 119 S.Ct. at 2145. The Court concluded that it did not have to resolve the issue of deference because the parties in Sutton did not contest the validity of the regulations, including 29 C.F.R.S 1630.2(j), that interpret the generally applicable provisions. Id. Because we have previously applied 29 C.F.R. S 1630.2(j), see, e.g., Kelly, 94 F.3d at 105, we will follow it here as well. When Taylor had to be confined to a hospital because she was psychotic, increasingly agitated, and gripped by delusions, the limitations on her ability to think were severe: She suffered paranoid delusions that people were trying to kill her, inducing her to disguise herself at the train station. During the car ride to the hospital, she thought her son's life was in danger, believed that the highway patrol was escorting her, and thought the highway was filled with firefighters there to protect her. Unable to recognize that these beliefs were baseless, she explained at the time of her admission that she was there foracute stress. Both the school district's expert and Taylor's treating physician agreed that Taylor has bipolar disorder and that the condition is chronic. Dr. Rieger, the school district's expert, added, There is no doubt in my mind that Ms. Taylor experienced a biologic psychiatric illness in which genetic factors play a role. These illnesses can appear even fairly late in life regardless of life events and stressors. . . App. vol. I at 157. Dr. Sonnenberg, Taylor's treating physician, confirmed that Taylor has an ongoing condition that requires her to stay on lithium,3 and according to Dr. _________________________________________________________________ 3. The District Court evidently refused to consider Dr. Sonnenberg's opinion because the Court said, citing Gaul v. AT&T, Inc., 955 F. Supp. 346 (D.N.J. 1997), Taylor could not rely on the opinion of her own treating physician. But Gaul stated that[i]t is well settled that treating physicians may testify as to any subject relevant to the evaluation and treatment of their patients. Id. at 349. At issue in Gaul was whether testimony by the plaintiff's treating physician satisfied the New Jersey Supreme Court's holding that expert medical testimony is required to establish the fact of the employee's [handicap]. Id. (quoting Clowes v. Terminex International, Inc., 109 N.J. 575, 597 (1988)). Just as the District Court in Gaul deemed admissible the opinion of a plaintiff's treating physician, we hold that a plaintiff in an ADA case can rely on the testimony of his or her treating physician to demonstrate that the plaintiff has a disability. 13 Rieger's report, Taylor has continued to take 300 mgs. of lithium twice a day. In short, Taylor's impairment is not temporary,4 and it is clear that at the time of her hospitalization, her impairment was substantially limiting. But the central question, in light of Sutton and Murphy, is whether Taylor's continuing impairment remained a disability under the ADA by imposing substantial limitations even while treated. Specifically, Taylor must show that she was substantially limited during the year following her hospitalization, the time span when she says that she was denied reasonable accommodations. Taylor maintains that even though lithium has improved her condition and has reduced the risk of full-blown psychotic episodes, the drug has not perfectly controlled her symptoms, leaving her still substantially limited in her ability to think. She argues that Dr. Sonnenberg's notes indicated that she continued to suffer symptoms of her disorder, including paranoia. On November 9, 1994, a couple of months after Taylor started taking lithium, Dr. Sonnenberg wrote a short note to the school district, explaining that Taylor was temporarily unable to work. Taylor's claims of uncontrolled, ongoing symptoms are corroborated by a number of other sources as well. Lithium has a very narrow therapeutic range, and blood levels of the drug can fluctuate for a variety of reasons. See supra, at n.1. Throughout the 1993-94 school year following her hospitalization, she experienced enough difficulty that she saw Dr. Sonnenberg twenty-five times even though Taylor, who earned a secretary's salary, cares for a disabled child, and is divorced, had to pay the $120 fee out of pocket and was reimbursed only half the cost by her insurance. One can infer that she would not have undertaken such expense without experiencing serious difficulty. Taylor also points out that prior to her hospitalization, she had received high praise for her work performance, but after the onset of her illness, she encountered a number of problems, as the school district's records document. Therapeutic levels of _________________________________________________________________ 4. See, e.g., Diagnostic and Statistical Manual of Mental Disorders, 4th Ed., American Psychiatric Association, at 353 (1994); Frederick Goodwin and Kay Redfield Jamison, Manic-Depressive Illness, Oxford University Press, ch. 23 (1990); Julien, supra, n.1 at 232. 14 lithium can cause a number of side effects. See supra, at n.1. Some of these effects, like the nausea Taylor complained of, may bear indirectly on the ability to think, while other side effects, such as impaired concentration and memory problems, bear directly on thinking. Taylor's problems at work may have been related to these drug side effects, and the Supreme Court has noted that drug side effects can be important in evaluating whether someone is disabled. Sutton, 119 S.Ct. at 2147. Given our prior holding in Matczak v. Frankford Candy & Chocolate Co., 136 F.3d 933 (3d Cir. 1997), Taylor not surprisingly focused on her untreated condition when she accumulated evidence to demonstrate that she had a disability, and as a consequence, the record is not as fully developed as it might be. Nevertheless, we believe that she has presented sufficient evidence to require a trial on whether she continued to be substantially limited even while receiving treatment. Although Taylor clearly was disabled at the time she was hospitalized, she need not prove that she continued to experience symptoms of that magnitude: paranoia and distorted mood can have a substantial orconsiderable impact on Taylor's thinking well before they force hospitalization. Substantial limitations need not rise to the level of the utter inabilities Taylor experienced at the time of her hospitalization. When we consider the nature and severity of the impairment, its duration, and its expected long-term impact, see 29 C.F.R. S 1630.2(j)(2), we find evidence that Taylor has had to contend with a serious, very much ongoing condition. Following the initial severe episode, she again had to leave work just a few months later; she sought treatment twenty-five times throughout the year; and every day throughout this period she took medication requiring careful monitoring. That she may not have experienced problems every day does not defeat her claim. Chronic, episodic conditions can easily limit how well a person performs an activity as compared to the rest of the population: repeated flare-ups of poor health can have a cumulative weight that wears down a person's resolve and continually breaks apart longer-term projects. 15 The school district argues vehemently that Taylor is not disabled and points to the report of its expert. After conducting an office visit with Taylor on June 24, 1997, Dr. Rieger concluded: When I examined Ms. Taylor[,] she had a normal mental state. Her chronic biological psychiatric illness was obviously well controlled by medication. If she continues to take her medications as instructed[,] she will be able to work. She is now not at all disabled from a psychiatric point of view. App. vol. I at 159. We do not think Dr. Rieger's report is sufficient to grant summary judgment in the school district's favor. Taylor has presented evidence that she is disabled, and on summary judgment we read the evidence in the light most favorable to the nonmoving party and resolve genuine factual disputes in favor of the nonmoving party. See Fed.R.Civ.P. 56; Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249-50, 106 S.Ct. 2505, 2510-11 (1986). Dr. Rieger's report also has a number of problems that could lead a reasonable jury to reject it. The passage quoted above, for example, says that Taylor is not presently, on June 24, 1997, exhibiting the symptoms of her disorder. That statement does not resolve what Taylor's condition was like between the fall of 1993 and the fall of 1994. Taylor may have gained better control over her condition by the time roughly four years had passed from the onset of her disorder. Another shortcoming of Dr. Rieger's report is that it is based on one office visit. A jury could question whether he relied on too slender a base of experience observing Taylor's condition. It is true that the doctor was able to review a number of documents, including Taylor's disciplinary reports from the school district and the reports from Coastal Plain Hospital, but these reports may not have given a very full or accurate picture of the range of symptoms Taylor experienced while on medication. We think it is significant that Taylor had difficulty recognizing and expressing the symptoms of her condition. Not only did she believe at the time of her hospitalization that she was merely suffering from acute stress, but this difficulty seemed to continue. Dr. Rieger's own report reveals this problem. When he asked Taylor to describe the 16 events leading up to her hospitalization, she related that Ferrara told her she needed some rest. App. vol. I at 150. Upon my question Ms. Taylor revealed what prompted this recommendation: I was telling [Ferrara] about a person who was employed by the district. I remarked that the person was dead -- strike that -- was injured. I had passed an ambulance. That person was on my mind. It was a strange remark that wasn't true. Upon my question Ms. Taylor agreed that in retrospect what she just told me sounded like a delusion. She immediately continued her story: I had planned to take time off. I had Amtrak tickets to see my mother in Rocky Mount, North Carolina. I didn't get there. The train was canceled because of a hurricane. My son took me there by car. My brother made arrangements for me to go to the Coastal Plains Hospital. Upon my question she confirmed that the entire trip was planned so that she could go to a psychiatric hospital near her relatives. She could not recall what specific delusions she voiced upon entering the hospital. She recalled that she gave the doctors lots of information, that she was very talkative although very tired. [Elsewhere the report quotes Taylor as sayingsome nights I got only 3 to 4 hours of sleep.] Upon my question she admitted that she may have been euphoric. Id. One would expect a plaintiff to inflate the severity of her condition when talking to opposing counsel's expert. Taylor instead made her hospitalization sound like a simple trip to visit her mother and had obvious difficulty conveying the extent of her illness. We should not insist that all plaintiffs with bipolar disorder must have the self-awareness and expressive powers of a Robert Lowell (who had the illness) before we allow that their condition is substantially limiting. After reviewing the school district's records, Dr. Rieger did express the opinion that Taylor's misconduct was solely due to her basic personality, and [w]hatever subjective difficulties she experienced during her last year of employment were not due to her mental illness but due to her peculiar personality traits. . . . Id. at 158 and 156. In 17 a similar vein, he asserted that people with bipolar disorder can fulfill all their work duties to the full satisfaction of their superiors without engaging in misconduct and without requiring any accommodations. Id. at 159. A reasonable jury could question the doctor's conclusion that all of Taylor's problems at work were due solely to her peculiar personality traits and not to her mental illness. Taylor had performed very well at work prior to the onset of her illness; only after she became psychotic and was hospitalized did problems appear. Thus, a reasonable jury could find it surprising that the peculiar personality traits only manifested themselves after she became ill. It also is not clear that the doctor was in a position to judge when Taylor had engaged in misconduct at work; a reasonable jury could question any uncritical reliance on the school district's own reports about Taylor. Another reason that the school district denies that Taylor is disabled is that before the school district allowed Taylor to return to her job, she was required to submit a note from her doctor saying that she was able to work. Dr. Sonnenberg responded to this requirement by sending a one sentence message saying that Taylor is able to return to work and is not disabled. Supp. App. at 1. The school district argues that since the doctor said that Taylor was not disabled, Taylor must have been symptom free. But the doctor's remark appears to be simply another way of saying that Taylor was capable of working. It is hardly conclusive proof that Taylor was not substantially limited. That Dr. Sonnenberg used disabled as the equivalent of able to work is supported by her earlier note in November that said Taylor is temporarily disabled and not able to work at this time. App. vol. I at 77. While the doctor's use of the term disabled is not unusual, especially in the context of disability insurance, it is not an accurate definition for the purposes of the ADA. To say that no one is disabled under the ADA unless the person is unable to work would render all the provisions in the ADA governing reasonable accommodations at work entirely empty of meaning. If there has ever been a legal term of art, disabled certainly qualifies. And the Supreme Court recently rejected glib estoppel arguments that turn on the 18 different meanings carried by the term disability. Cleveland v. Policy Management Systems Corp., ___ U.S. ___, 119 S.Ct. 1597 (1999).