Opinion ID: 757566
Heading Depth: 2
Heading Rank: 3

Heading: Are Medical Staff Members individuals Protected by

Text: 16 Title III When they Are Denied the full and equal enjoyment 17 of the goods, services, facilities, privileges, advantages, 18 or accommodations of any place of public accommodation? 19 Given the language of the statute and the parties' arguments, we now turn to the issue directly posed in this appeal--may a medical doctor with staff privileges properly assert a cause of action under Title III? It is not argued on appeal that the appellant failed to allege that the hospital's conduct would be discriminatory within the meaning of the ADA. Appellant has, in addition, alleged that the discrimination occurred on the basis of a disability as understood under the Act. Also, the parties do not dispute on appeal that appellant is disabled as that term is defined in the ADA. 2 Hence, the only remaining issue is whether the appellant is an individual who was denied the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of [the] place of public accommodation. 42 U.S.C. § 12182(a). 20 While the ADA does not define the terms individual or goods, services, facilities, privileges, advantages, or accommodations, we would ordinarily seek to construe these words under their ordinary, plain meaning without a more involved inquiry into legislative history, congressional intent, or otherwise. See Curtiss-Wright Corp. v. Schoonejongen, 514 U.S. 73, 81, 115 S.Ct. 1223, 131 L.Ed.2d 94 (1995); Ford v. Schering-Plough Corp., 145 F.3d 601, 613 (3d Cir.1998). Reading the language of the statute, however, immediately raises several problems in its construction. First, it is not abundantly clear whether an individual protected by the general rule in Title III refers only to clients or customers of the covered public accommodation, as contained in 42 U.S.C. § 12182(b)(1)(A)(iv). Although the term clients or customers does not directly apply to the general rule itself, the district court surmised from this phrase that Title III protects members of the public--actual and would be guests, customers, and clients--who seek the 'full and equal enjoyment' of the services, facilities, or other accommodations of places that serve the public. 21 Perhaps more importantly, the term individual in Title III, if read broadly, may encroach upon the scope of Title I, which grants a cause of action not to an individual but to a qualified individual with a disability. 42 U.S.C. § 12112(a). Title I explicitly defines the phrase qualified individual with a disability, see 42 U.S.C. § 12111(8), and federal courts have long since explored and construed its meaning. Nevertheless, it is by now well established that [h]owever inclusive may be the general language of a statute, it 'will not be held to apply to a matter specifically dealt with in another part of the same enactment.'  Fourco Glass Co. v. Transmirra Prods. Corp., 353 U.S. 222, 228, 77 S.Ct. 787, 1 L.Ed.2d 786 (1957) (citations omitted). This canon of construction carries particular force where, as here, Congress has enacted a comprehensive legislative scheme and has deliberately targeted specific problems with specific solutions. Varity Corp. v. Howe, 516 U.S. 489, 519, 116 S.Ct. 1065, 134 L.Ed.2d 130 (1996) (Thomas, J., dissenting); HCSC-Laundry v. United States, 450 U.S. 1, 6, 101 S.Ct. 836, 67 L.Ed.2d 1 (1981) (per curiam). Hence, we face a statutory puzzle; because of the potentially expansive nature of the term individual, and ultimately the scope of Title III protection, we run the risk of rendering meaningless in many cases the differences between Title I and Title III. This would include, for example, significant disparities in coverage, remedies, and construction. As a result, we are compelled to explore the ADA's legislative history in order to fully understand the scope and meaning of Title III as applied to this case. 22
23 Among the broadly stated purposes of the ADA, see 42 U.S.C. § 12101(b), is the intent to invoke the sweep of congressional authority ... in order to address the major areas of discrimination faced day-to-day by people with disabilities. Id. § 12101(b)(4). This comes after a specific finding by Congress that discrimination against individuals with disabilities persist in many critical areas, including health services. 42 U.S.C. § 12101(a)(3). Indeed, there is little doubt that Congress intended the ADA as a comprehensive remedial statute with broad ramifications. See 42 U.S.C. § 12101(b)(1); Penny v. United Parcel Serv., 128 F.3d 408, 414 (6th Cir.1997). 24 Navigating the sea of the ADA's legislative history and supporting documentation is a considerable task, but several important beacons emerge as to what Congress intended to cover under Title III as opposed to Title I of the ADA. First, it is evident that Congress sought to regulate disability discrimination in the area of employment exclusively through Title I, notwithstanding the broad language of Title III. As the Senate report makes clear, Title III is not intended to govern any terms or conditions of employment by providers of public accommodations or potential places of employment; employment practices are governed by [T]itle I of this legislation. S.Rep. No. 101-116, at 58 (1989). See also Ford v. Schering-Plough Corp., 145 F.3d 601, 612 (3d Cir.1998); Parker v. Metropolitan Life Ins. Co., 121 F.3d 1006, 1014 (6th Cir.1997) (en banc); Motzkin v. Trustees of Boston Univ., 938 F.Supp. 983, 996 (D.Mass.1996). Similarly, the House Report states that Title I sets forth prohibitions against discrimination on the basis of disability by employers, employment agencies, labor organizations, or joint labor-management committees ... with respect to hiring and all terms, conditions, and privileges of employment. H.R.Rep. No. 101-485, pt. 2, at 54 (1990), reprinted in 1990 U.S.C.C.A.N. 303, 336; see also id. at 99, reprinted in 1990 U.S.C.C.A.N. 303, 382. Accordingly, it is apparent that Congress did not intend Title III--despite the breadth of its language--to govern discrimination within the employment setting and we cannot construe Title III in a manner that would eviscerate such a salient legislative mandate. 25 Our conclusion is reinforced by Congress' 1992 amendment of the Rehabilitation Act, providing that [t]he standards used to determine whether [section 504] has been violated in a complaint alleging employment discrimination under this section shall be the standards applied under title I of the Americans with Disabilities Act of 1990. 29 U.S.C. § 794(d). The Senate Report explains that this and similar provisions, see 29 U.S.C. § 793(d), were intended to ensure uniformity and consistency of interpretations. S.Rep. No. 102-357, at 71 (1992), reprinted in 1992 U.S.C.C.A.N. 3712, 3782. 26 Apart from the potential intersection between Title I and Title III, the legislative history sheds little light on the intended meaning of an individual who is denied the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of a place of public accommodation as those words are used in 42 U.S.C. § 12182(a). What is clear, however, is that the legislative use of the phrase customers or clients of the covered public accommodation that enters into a contractual arrangement was not intended to restrict the general class of persons entitled to sue under Title III, contrary to the district court's conclusion. The House Report observes that in restricting the term individuals to clients or customers of the covered public accommodation, the intent was to ensure that a public accommodation's obligations are not extended or changed in any manner by virtue of its lease with another entity. H.R. Rep. 101-485, pt. 2., at 104 (1990), reprinted in 1990 U.S.C.C.A.N. 303, 387. To illustrate, the report states: 27 [A] store located in an inaccessible mall or other building, which is operated by another entity, is not liable for the failure of that other entity to comply with this Act by virtue of having a lease or other contract with that entity. This is because, as noted, the store's legal obligations extends only to individuals in their status as its own clients or customers, not in their status as the clients or customers of other public accommodations. Likewise, of course, a covered entity may not use a contractual provision to reduce any of its obligations under this Act. 28 Id. Thus, Congress intended the phrase customers or clients of the covered public accommodation that enters into a contractual, licensing or other arrangement, 42 U.S.C. § 12182(b)(1)(A)(iv) (emphasis added), to encompass the relatively narrower situation where several entities enter into a contractual or other relationship. See H.R. Rep. 101-485, pt. 2., at 101 (1990), reprinted in 1990 U.S.C.C.A.N. 303, 384 (The section has never been intended to encompass the clients or customers of other entities.) (emphasis in original). It is therefore not surprising that the term clients or customers does not appear in Title III or its legislative history other than in reference to contractual or other arrangements. Indeed, the clients or customers limitation set forth in 42 U.S.C. § 12182(b)(1)(A)(iv) does not directly apply to the general rule established in section 12182(b) but instead covers the instances of discrimination described in sections 12182(b)(1)(A)(i)-(iii), all of which encompass contractual, licensing, or other arrangement. 29 Finally, the legislative history to the ADA demonstrates that in enacting Title III, Congress intended to extend the scope of protection afforded to those individuals under the Rehabilitation Act. The House Report, for example, states that Section 504 of the Rehabilitation Act of 1973 prohibits Federal agencies and recipients of Federal financial assistance from discriminating against persons with disabilities. The purpose of [T]itle III ... is to extend these general prohibitions against discrimination to privately operated public accommodations and to bring individuals with disabilities into the economic and social mainstream of American life. H.R.Rep. No. 101-485, pt. 2, at 99 (1990), reprinted in 1990 U.S.C.C.A.N. 303, 381-82. Much of the remaining legislative history echoes this intention. See generally 1 Henry H. Perritt, Americans with Disabilities Act Handbook § 1.2, at 4 (1997) (collecting examples). The ADA itself states that [N]othing in this chapter shall be construed to apply a lesser standard than the standards applied under title V of the Rehabilitation Act of 1973. 42 U.S.C. § 12201(a). Courts, including our own, have accordingly examined Rehabilitation Act precedent in examining the scope of coverage under the ADA. See Yeskey v. Commonwealth of Pennsylvania Dep't of Corrections, 118 F.3d 168, 170 (3d Cir.1997), aff'd, --- U.S. ----, 118 S.Ct. 1952, 141 L.Ed.2d 215 (1998); 1 Perritt, supra, § 1.2, at 4.
30 With these principles in mind, we turn to the question of whether the appellant is an individual who is denied the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of a place of public accommodation as those terms are used in Title III. We do not write on a blank slate and it is appropriate at this juncture to examine precedent interpreting this phrase within the framework of Title III's language. 31 In Ford v. Schering-Plough Corp., 145 F.3d 601 (3d Cir.1998), this court considered whether a disparity between disability benefits for mental and physical disabilities violated Title III of the ADA. Id. at 612-14. The plaintiff in that case argued that insurance benefits offered by her employer, and indirectly its insurance carrier, contained unequal disability benefits and therefore denied her the equal enjoyment of a service or privilege offered by a place of public accommodation. Our analysis of that contention led us to reach two important conclusions relevant to this appeal. First, relying on the ADA's legislative history, we dismissed the plaintiff's claim under Title III against her employer because Title I, and not Title III, governed the terms and conditions of employment by providers of public accommodations. Id. at 612 (quoting S.Rep. No. 101-116, at 58 (1989)). Before even reaching the interpretation of the words service or privilege under Title III, we noted that insurance benefits were offered in the context of her employment and therefore the terms of Title I exclusively governed her action against her employer. 32 With respect to the plaintiff's claim in Ford against her insurance carrier, this court concluded that while insurance benefits may be ordinarily considered a type of service, privilege, or advantage, they are not services of the place of public accommodation. Id. We reasoned that under the plain meaning of Title III, a public accommodation is a physical place and therefore the phrase goods, services, facilities, privileges, advantages, or accommodations refer to what these places of public accommodation provide. Id. at 613. In aligning ourselves with the Court of Appeals for the Sixth Circuit, see Parker v. Metropolitan Life Ins. Co., 121 F.3d 1006 (6th Cir.1997) (en banc), we required at the very least some nexus between the physical place of public accommodation and the services denied in a discriminatory manner. Ford, 145 F.3d at 613; see also Parker, 121 F.3d at 1011 (looking to a nexus between the disparity in benefits and the services which [the defendant] offers to the public from its insurance office); but see Carparts Distribution Ctr., Inc. v. Automotive Wholesaler's Ass'n of New England, Inc., 37 F.3d 12, 19-20 (1st Cir.1994) (holding that Title III is not limited to physical structures). Because the disparate insurance benefits offered by an insurance office do not relate to the insurance office itself--that is, the physical place of public accommodation--the plaintiff in Ford could not state a cause of action under Title III of the ADA.
33 Under the language of Title III, its legislative history, and the principles announced in Ford, we must conclude that the appellant has properly stated a cause of action as an individual discriminated against in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation. At the outset, we cannot accept the district court's blanket interpretation that Congress intended Title III to apply only to members of the public, which the district court defined as those guests, clients, or customers who seek the services, facilities, or privileges offered by a place of public accommodation. The operative rule announced in Title III speaks not in terms of guests, patrons, clients, customers, or members of the public, but instead broadly uses the word individuals. Looking to the term public accommodation, a term of art defined in 42 U.S.C. § 12181(7), does not aid the inquiry either because that phrase does not define the rights protected under the ADA and there can be no question that an operator of a hospital falls under the prohibitions associated with Title III. Similarly, the district court's reliance on the term clients or customers is equally misplaced. As both the language of Title III and its legislative history clearly demonstrate, the phrase clients or customers, which only appears in 42 U.S.C. § 12182(b)(1)(A)(iv), is not a general circumscription of Title III and cannot serve to limit the broad rule announced in 42 U.S.C. § 12182(a). 34 Equally unavailing is the hospital's argument that illustrations cited by the ADA's legislative history all describe instances of members of the public as clients or customers. That a statute can be applied in situations not expressly anticipated by Congress does not demonstrate ambiguity. It demonstrates breadth. Sedima, S.P.R.L. v. Imrex Co., 473 U.S. 479, 499, 105 S.Ct. 3275, 87 L.Ed.2d 346 (1985) (citation omitted); see also Pennsylvania Dep't of Corrections v. Yeskey, --- U.S. ----, ----, 118 S.Ct. 1952, 1955, 141 L.Ed.2d 215 (1998). Nor can we agree with the hospital's argument that Title III offers no protection against disability discrimination by virtue of the appellant's unique business relationship with the hospital. This contention runs contrary to the plain language and legislative history of Title III which in no way mentions any sort of business relationship that would preclude an individual from asserting a cause of action if denied the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation. 35 Similarly unpersuasive is the hospital's attempt to read significance into the absence of the phrase qualified individual from Title III, which appears in Title I, Title II, and the Rehabilitation Act. While the hospital argues that the absence of such a phrase indicates that Title III was never meant to apply in the workplace, we find no support for such a contention in the broadly drafted language of Title III itself, which prohibits operators of a public accommodation from discriminating against individuals. Moreover, as stated by the United States Court of Appeals for the First Circuit, the absence of the qualified individual language from Title III would make little difference in a case, such as this, where the plaintiff seeks reasonable accommodation: 36 We find little difference in this distinction, because many of the issues that arise in the qualified analysis, also arise in the context of the reasonable modifications or undue burden analysis. That is, if more than reasonable modifications are required of an institution in order to accommodate an individual, then that individual is not qualified for the program. 37 Bercovitch v. Baldwin Sch., Inc., 133 F.3d 141, 154 (1st Cir.1998). Thus, because the appellant in this case alleges that the hospital failed to accommodate his disability, see Pl.'s Compl. p 46(a), App. at 18, the hospital is free to show that the relief requested would fundamentally alter the nature of such goods, services, facilities, privileges, advantages, or accommodations. See 42 U.S.C. § 12182(b)(2)(A)(ii). Similarly, in no way would a hospital be forced to accommodate an unqualified physician if he poses a direct threat to the health and safety of others. 42 U.S.C. § 12182(b)(3). 38 We do agree with the hospital, however, that Title III was not intended to govern disability discrimination in the context of employment. See Ford, 145 F.3d at 612; S.Rep. No. 101-116, at 58 (1990). But the appellant in this case never alleged that he is an employee of the hospital or that he was denied the benefits associated with employment. The appellant's complaint instead alleges that he was appointed to the Medical Staff of PMMC, App. at 8, and both parties maintain that his relationship with the hospital is not strictly one of employment but more in the nature of an independent contractor. See Pl.'s Br. at 23; Mem. in Support of Def.'s Motion to Dismiss Compl. at 9 n. 4. Federal courts, including our own, have commented on the indicia of employment for purposes of the disability discrimination laws, see, e.g., EEOC v. Zippo Mfg. Co., 713 F.2d 32, 36-38 (3d Cir.1983) (considering the Age Discrimination in Employment Act); Birchem v. Knights of Columbus, 116 F.3d 310, 312 (8th Cir.1997) (considering Title I of the ADA); Cilecek v. Inova Health System Services, 115 F.3d 256, 260-61 (4th Cir.1997) (considering Title VII of the Civil Rights Act); Alexander v. Rush North Shore Medical Center, 101 F.3d 487, 492 (7th Cir.1996) (same), and the analysis typically focuses in a myriad of fact-intensive considerations. The By-Laws of the hospital governing staff membership speak of staff privileges and prerogatives, and do not themselves characterize the relationship between a medical staff member and the hospital as one of employment. The definition set forth in the By-Laws of a member of the medical staff is [a]ny duly licensed physician, dentist or podiatrist who has been appointed to membership by the Board and is privileged to attend patients or to provide other diagnostic, therapeutic, teaching or research services at the Hospital. App. at 189. However, we cannot say more at this stage of the litigation because we must accept as true the facts as alleged in the appellant's complaint and any reasonable reading of the pleadings. See Holder v. City of Allentown, 987 F.2d 188, 193 (3d Cir.1993). It is quite clear in this case, as both the hospital and the district court have stated, that the appellant proceeded on the basis that he was not an employee of the hospital and therefore not within the province of Title I. 39 Assuming that the appellant is not an employee of the hospital as that term is understood under Title I, the only remaining question is whether he was denied the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation. We look for, as we did in Ford, some nexus between the services or privileges denied and the physical place of the hospital as a public accommodation. Ford, 145 F.3d at 613. There can be little doubt that the appellant fulfills such a requirement in this case. Because of the appellant's suspension from the active medical staff, he can no longer enjoy the hospital's physical facilities in providing the necessary medical and consulting services to his patients. See By-Laws p 8.3(b)(i), App. at 135. Hence, the hospital denied the appellant the requisite physical access that we found lacking in Ford. This case is quite unlike a disparity in insurance benefits which had nothing to do with the facilities of an insurance office, or the place of public accommodation. Here, we cannot imagine a greater nexus between the privileges, advantages, or services denied and physical access to hospital facilities simply because of the nature of medical staff privileges--privileges that lie at the very core of a hospital's facilities. 40 We therefore hold that a medical doctor with staff privileges--one who is not an employee for purposes of Title I--may assert a cause of action under Title III of the ADA as an individual who is denied the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation. Our conclusion is reinforced by several observations. First, we may effectively find no recourse under the ADA for the appellant if we were to hold that the he has no cause of action under Title III. That is, the appellant may not be a qualified individual under Title I because there was no employment relationship with a covered entity, and the appellant would not be protected under Title III because he is not an individual who is denied the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation. We cannot see how Congress intended such a result given the ADA's remarkable breadth of language and purpose--especially when Congress expressly states that it seeks to comprehensively regulate discrimination against individuals with disabilities in such critical areas as ... health services. 42 U.S.C. § 12101(a)(3). Second, nothing in the Rehabilitation Act would prevent a physician with staff privileges from asserting a cause of action based on disability discrimination. See Landefeld v. Marion General Hospital, 994 F.2d 1178 (6th Cir.1993). Not finding a similar cause of action under the ADA would lead to the perverse result that the ADA affords less protection than the Rehabilitation Act to a discrete class of disabled individuals. This squarely contradicts the language and intent of the ADA. See 42 U.S.C. § 12201(a). Finally, the administrative guidance issued by the Justice Department interprets Title III to allow a cause of action for physicians with staff privileges. See U.S. Dep't of Justice, Civil Rights Division, The Americans with Disabilities Act: Title III Technical Assistance Manual p 4.1100, illus. 4 (Nov.1993). As the agency charged by Congress to issue implementing regulations, the Department's views are entitled to deference. Bragdon v. Abbott, --- U.S. ----, ----, 118 S.Ct. 2196, 2199, 141 L.Ed.2d 540 (1998). 41 Accordingly, we will reverse the district court's order dismissing appellant's disability discrimination claim brought under Title III of the ADA.