Opinion ID: 2982544
Heading Depth: 3
Heading Rank: 1

Heading: Medical Examination

Text: The relevant EEOC guidance defines “medical examination” as “a procedure or test that seeks information about an individual’s physical or mental impairments or health,” and identifies several factors bearing on this determination: (1) whether the test is administered by a health care professional; (2) whether the test is interpreted by a health care professional; (3) whether the test is designed to reveal an impairment or physical or mental health; (4) whether the test is invasive; (5) whether the test measures an employee’s performance of a task or measures his/her physiological responses to performing the task; (6) whether the test normally is given in a medical setting; and, (7) whether medical equipment is used. EEOC, Enforcement Guidance: Disability-Related Inquiries and Medical Examinations of Employees Under the Americans with Disabilities Act (ADA) Part B.2 (July 27, 2000) (hereinafter “DRI&ME Guidance”), available at http://www.eeoc.gov/policy/docs/guidance-inquiries.html. “In many cases, a No. 11-6088 Bates, et al. v. Dura Automotive Sys. Page 11 combination of factors will be relevant in determining whether a test or procedure is a medical examination,” but in others “one factor may be enough.” Id.; see also Kroll, 691 F.3d at 815–16. Examples of medical examinations include vision tests, blood pressure and cholesterol screening, range-of-motion tests, and diagnostic procedures such as x- rays, CAT scans, and MRIs. The guidance also identifies two qualifying urine tests: (1) to discover alcohol use, and (2) to detect disease or genetic markers. The district court bypassed the above medical-examination considerations, focusing instead on the guidance’s prohibition of testing for alcohol use and the ADA’s limited drug-testing exemption. If the ADA prohibits urinalysis testing for the use of a legal substance (alcohol), the court reasoned, it must ban testing for other legal substances, like prescription medications. (See R. 237, Trial Tr. at 621–23.) While this logic has facial appeal—especially given alcohol’s association with vice and medicine with virtue—it fails here. First, the guidance itself gives contrary instructions on alcohol testing. See DRI&ME Guidance Part B.2 n.31 (cross-referencing n. 26, which states that employers “may maintain and enforce rules prohibiting employees from being under the influence of alcohol in the workplace and may conduct alcohol testing for this purpose” upon reasonable suspicion); see also id. Part B.1 (authorizing employers to ask employees whether they have been drinking); but see EEOC, Enforcement Guidance: Preemployment Disability-Related Questions & Medical Examinations (Oct. 10, 1995) (hereinafter “Preemployment Guidance”), available at http://www.eeoc.gov/policy/docs/preemp.html (explaining that an employer cannot give alcohol tests to job applicants because such tests “are medical, and there is no statutory exemption”).5 The ADA’s allowance that employers “may require that employees shall not be under the influence of alcohol . . . at the workplace,” 42 U.S.C. § 12114(c)(2) 5 The Preemployment Guidance also sheds light on our inquiry because the ADA’s ban on medical examinations and disability inquiries also applies to the preemployment stage. 42 U.S.C. § 12112(d)(2)(A); Kroll, 691 F.3d at 816 n.9. No. 11-6088 Bates, et al. v. Dura Automotive Sys. Page 12 (emphasis added), further cautions against extending the guidance’s alcohol-testing example to these circumstances. Second, the ADA’s drug-testing exemption, while not applicable to plaintiffsappellees’ prescribed medications, reaches further than the district court acknowledged. By permitting testing as to the “illegal use of drugs,” 42 U.S.C. § 12114(d)(1) (emphasis added)—as opposed to the use of illegal drugs—the exemption contemplates circumstances where employees abuse medications not prescribed to them. See 29 C.F.R. § 1630.3(a)(2) (“Illegal use of drugs means the use of drugs the possession or distribution of which is unlawful under the Controlled Substances Act,” but “does not include the use of a drug taken under the supervision of a licensed health care professional, or other uses authorized by the Controlled Substances Act or other provisions of Federal law”). So, while the illegality of use bears on whether the employer may invoke the drug-testing exception, the legality of a substance does not settle the medical-examination question. For that, we turn to the EEOC’s definition and the medical-examination factors. The first, second, sixth, and seventh factors—what one might call the optics—tip the scales toward medical examination because FFS administered urine-based tests in a quasi-medical setting, with medical equipment, and health professionals interpreted the results. The fifth factor (task performance/physiological response) appears inapplicable. The fourth factor (invasiveness), meanwhile, offers little guidance. Though a urine sample certainly intrudes on a private bodily function, neither plaintiffs-appellees nor the EEOC argues that Dura’s tests were invasive, and we have recognized in other legal contexts that urine tests typically “are not invasive of the body.” Norris v. Premier Integrity Solutions, Inc., 641 F.3d 695, 699 (6th Cir. 2011) (Fourth Amendment search, quoting Skinner v. Ry. Labor Execs.’ Ass’n, 489 U.S. 602, 626 (1989)). That said, the EEOC’s Preemployment Guidance suggests that the “drawing of blood, urine or breath” may demonstrate invasiveness. That brings us to the third factor, “arguably the most critical in this analysis”: whether the test is designed to reveal an impairment or the employee’s health. Kroll, No. 11-6088 Bates, et al. v. Dura Automotive Sys. Page 13 691 F.3d at 819. The Preemployment Guidance doubles down on this point, adding an eighth factor: whether “the employer [is] trying to determine the applicant’s physical or mental health or impairments.” This emphasis on a diagnostic purpose aligns with the EEOC definition of medical-examination and links that term to its sister term, disability inquiries. See DRI&ME Guidance (looking to whether the “procedure or test . . . seeks information about an individual’s physical or mental impairments or health”); 42 U.S.C. § 12112(d)(4)(A) (prohibiting medical examinations and inquiries “as to whether such employee is an individual with a disability or as to the nature or severity of the disability”). The “uncovering of [health] defects at an employer’s direction is the precise harm that § 12112(d)(4)(A) is designed to prevent.” Kroll, 691 F.3d at 819. The test-design inquiry entails both subjective and objective considerations. Though not dispositive, “the employer’s purpose must be considered in the larger factual context of a particular test or assessment’s typical uses and purposes.” Id. at 816. “[W]hen an employer’s purported intentions mismatch the predominant purpose and design of a particular test or assessment, . . . those intentions are accorded less weight and significance in the analysis.” Id. at 817. As with other anti-discrimination protections, this standard reflects that wrongdoers seldom admit their misdeeds. Here, Dura denies using its drug-testing protocol to reveal impairments or health conditions, and a fair reading of the record supports this. Far from a “free peek into a[n] . . . employee’s medical history,” see Connolly v. First Pers. Bank, 623 F. Supp. 2d 928, 931 (N.D. Ill. 2008), the evidence shows that Dura abstained from asking plaintiffs about their medical conditions, and only one plaintiff suggested that Dura directly asked her to identify the medications she was taking, albeit with conflicting testimony. (See R. 236, Bates Test. at 389–91.) Importantly, the plaintiffs-appellees offer no evidence showing how FFS’s urinalysis or post-test reporting of machine-restricted medications revealed information to Dura about plaintiffs-appellees’ medical conditions. The urine test itself revealed only the presence of chemicals—amphetamines, barbiturates, benzodiazepines, cocaine, ecstasy, marijuana, methadone, methamphetamine, opiates, oxycodone, phencyclidine, and propoxyphene. No one suggests that the consumption No. 11-6088 Bates, et al. v. Dura Automotive Sys. Page 14 of prescription medications containing these chemicals constitutes protected medical information (or even an “impairment”) under the EEOC definition of medical examination. FFS’s post-test reporting, meanwhile, disclosed to Dura only the machinerestricted medications. When asked at oral argument how Dura’s third-partyadministered test exposes information about employee health, the EEOC responded “it can,” noting that the presence of anti-seizure medication would divulge that specific condition. (O.A. at 34:40–35:00.) In the absence of specific evidence making this connection, we decline to elevate this possibility into the probability necessary for ruling on this issue as a matter of law. Although some prescription medications may reveal more than meets the eye because of brand-name recognition and ubiquitous marketing campaigns, an employer might struggle to discern medical conditions from the prescription drugs discovered here, which included a number of prescription pain relievers. Arguably, this attenuated testing protocol—with a narrow focus on substances containing machine-operation restrictions, as opposed to all prescription drugs—reflects Dura’s effort to avoid obtaining information about employees’ medical conditions and to avoid discriminating against all employees who take prescription drugs. Of course, an employer cannot hire a third party to discriminate on its behalf. See 42 U.S.C. § 12112(b)(2) (prohibiting employers from “participating in a contractual . . . relationship that has the effect of subjecting a[n] . . . employee with a disability to the discrimination prohibited by this subchapter”); see also DRI&ME Guidance Part B.1 n.20 (explaining that the “prohibition against making disability-related inquiries applies to . . . indirect or surreptitious inquiries”). But, viewing the evidence in its favor, we cannot say as a matter of law that Dura used FFS’s drug tests to seek information about plaintiffs-appellees’ medical conditions, or even that such revelations likely would result. Still, much depends on Dura’s credibility. Inconsistencies between Dura’s written and actual drug-testing policies and its disparate treatment of individual employees may evince a pernicious motive. For instance, one plaintiff (Bates) claims that Dura asked her directly about her prescription medications and fired her for not No. 11-6088 Bates, et al. v. Dura Automotive Sys. Page 15 reporting them, and Dura allowed another plaintiff (Long) to return to work despite testing positive. If credited, a jury could reject Dura’s explanation as a pretext for screening out potentially disabled employees. Moreover, plaintiffs-appellees may present evidence that the disclosure of machine-restricted medications typically reveals confidential health information, such that the jury could determine that the test targets information about an employee’s physical or mental health, regardless of Dura’s intent. This fact-sensitive inquiry presents a genuine issue of fact inappropriate for judgment as a matter of law. See Kroll, 691 F.3d at 819–20 (vacating the district court’s grant of summary judgment to the employer, finding a genuine issue of fact regarding whether prescribing psychological counseling to an employee constituted an impermissible medical examination under § 12112(d)(4)(A)). The EEOC acknowledged as much during oral argument, conceding that there “may be a fact question” regarding whether Dura’s drug tests were designed to reveal information about their employees’ health. (O.A. at 33:40–34:00.) Plaintiffs-appellees argue that the majority of guidance factors compel a legal conclusion here, but, in the absence of statutory or regulatory language specifically prohibiting this type of testing, simple arithmetic does not carry the day. In our view, the test-design factor and the EEOC definition of medical examination would permit a reasonable jury to decide the matter in Dura’s favor. If one credits Dura’s explanation and the objective evidence shows its drug-testing protocol is unlikely to reveal employees’ medical information, then the testing does not qualify as a medical examination under the EEOC definition.