Opinion ID: 2630566
Heading Depth: 3
Heading Rank: 3

Heading: The Agency May Have Discriminated Against Garner in Violation of the ADA by Failing To Reasonably Accommodate Garner's Disability.

Text: Under Title II of the ADA, no qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity. [23] The regulations issued by the Department of Justice to implement Title II provide in relevant part: (b)(1) A public entity, in providing any aid, benefit, or service, may not ... on the basis of disability (i) Deny a qualified individual with a disability the opportunity to participate in or benefit from the aid, benefit, or service; .... (3) A public entity may not, directly or through contractual or other arrangements, utilize criteria or methods of administration: (i) That have the effect of subjecting qualified individuals with disabilities to discrimination on the basis of disability; .... (7) A public entity shall make reasonable modifications in policies, practices, or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program, or activity.[ [24] ] To prove that a public program or service violated Title II of the ADA, it is incumbent upon the individual alleging discrimination to show that: (1) he is a qualified individual with a disability; (2) he was either excluded from participation in or denied the benefits of a public entity's services, programs, or activities, or was otherwise discriminated against by the public entity; and (3) such exclusion, denial of benefits, or discrimination was by reason of his disability.[ [25] ] Thus, where a service or benefit is defined in such a way as to deny an otherwise eligible disabled individual from gaining meaningful access to it, that individual has suffered discrimination as defined by the ADA. [26] In order to remedy the discrimination, the public entity may be required to provide the individual with a reasonable accommodation. [27] A disabled individual who has suffered discrimination under Title II bears the initial burden of demonstrating that a reasonable accommodation exists and that it would enable him to access the services or benefits he has been denied by virtue of his disability. [28] Once he has met this obligation, the burden shifts to the public entity to demonstrate that the requested accommodation is unreasonable. [29] The answer to this question will depend on a fact-specific individualized analysis of the disabled individual's circumstances and the accommodations that might allow him to meet the program's standards. [30] The process of ascertaining what constitutes a reasonable accommodation should be an interactive one, in which the public entity has an obligation to gather sufficient information from the disabled individual to determine what accommodations are necessary and feasible, rather than rejecting the request out of hand. [31] This process is triggered upon notification of the individual's disability and his desire for accommodation. [32] Should the public entity offer the disabled individual an accommodation the individual believes will not be sufficient to accommodate his disability, the individual must demonstrate that the offered accommodation was not reasonable, and that the individual was therefore unable to participate in the service in question. [33] Garner contends that by requiring Medicaid recipients to verbalize their pain in order to obtain dental services for the immediate relief of pain and acute infection, the agency's regulations discriminate against disabled individuals, such as him, who are unable to express pain and therefore unable to access these services. Thus, he argues that because the agency has made it a requirement that the proposed recipient of the emergency dental care be able to verbally express his need for such care, and because he is unable to do so, he has been discriminated against by the agency on the basis of his disability. The agency responds by alleging that Garner is asking for discriminatory treatment based on a disability. The agency claims that because the same medically necessary dental services are provided to disabled and nondisabled individuals, no discrimination in the provision of services has occurred. Finally, the agency contends that requiring it to provide Garner with routine dental services in order to determine whether he is experiencing severe pain or acute infection would necessitate a fundamental alteration of its program and, as such, is barred by the ADA. The parties agree that appellant is a qualified individual with a disability and that the agency is an entity covered by Title II. Additionally, the agency concedes that Garner is unable to express pain verbally. Because these facts are undisputed, Garner has successfully made out a prima facie case of disability-based discrimination. [34] The only remaining questions, then, are whether relying on Garner's caretakers to determine when he is experiencing pain or acute infection constitutes a reasonable accommodation, or whether the agency should instead cover the dental examination and root planing procedure performed by his doctor. The agency's position appears to be that it is offering Garner a reasonable accommodation by allowing his caregivers to express his pain for him. According to the agency, his care providers may observe his demeanor, gestures, reactions to stimuli, and other physical manifestations to determine if he may have pain or an infection, and whether he requires medical or dental attention. Garner contests the reasonableness of this accommodation, citing the undisputed evidence in the record that it is often impossible for his family, doctors, and caretakers to determine when he is in pain. The record evidence of Garner's inability to effectively communicate his status, and the inability of those around him to determine when he is in pain, is striking. For example, Garner's live-in caregiver, Vincent F. Goodsell, Jr., wrote that the complexities of performing a thorough dental exam and cleaning on someone in Garner's condition made it possible for Garner to afford such treatment only every five years or so. Given the infrequency of these routine visits, Goodsell expressed concern because I often would not be able to determine if he was having a significant problem until perhaps he was in need of emergency care. In come cases, I may not even be able to determine that he is, in fact, in need of such care. Goodsell then described the following situation: For instance, when John was 29 years old his dentist found that he had an abscessed tooth. This condition was a surprise to everyone and one can only speculate on how long he experienced the problem. Garner had been unable to communicate to anyone that he was experiencing that painful condition. On another occasion Garner fell in his bathroom and broke his arm, but several hours passed before anyone realized he was injured (when he was observed wincing trying to get up from a sofa). Because his family and caretakers are unable to know when he is in pain, Garner argues that in order to access the services provided to all Medicaid recipients, the agency must cover his otherwise routine dental services as a reasonable accommodation for the purpose of treating painful conditions that, unlike the non-disabled, he is unable to communicate either promptly or at all. The question of which accommodation the state's or Garner'sif either, is to be preferred under the ADA regulations requires factual findings. Accordingly, we remand to the superior court with instructions to remand to the agency for findings on this issue. As a preliminary matter, it is for the agency to decide whether a reasonable accommodation exists, and if so, what it is. Finally, the agency argues that providing the accommodation requested by Garner would result in a fundamental alteration in the nature of the service provided. The state offers no support for this position, and therefore we decline to consider it at this time. [35] The state remains free to present this argument to the agency on remand.