Opinion ID: 545510
Heading Depth: 2
Heading Rank: 1

Heading: Federal Rehabilitation Act of 1973

Text: 19 Leckelt primarily challenges the district court's judgment against him on his claim under section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Sec. 794. 9 Leckelt contends that he was discriminated against on the basis of a perceived handicap, in violation of section 504. 10 Section 504 prohibits a federally funded program from discriminating against an otherwise qualified handicapped individual solely because of the individual's handicap. See 29 U.S.C. Sec. 794; School Bd. of Nassau County, Fla. v. Arline, 480 U.S. 273, 107 S.Ct. 1123, 1126, 94 L.Ed.2d 307 (1987). In the present case, the district court determined that Leckelt failed to prove any of the following three elements of his section 504 claim: (1) that he was regarded as being handicapped; (2) that he was discriminated against solely because of this perceived handicap; and (3) that he is otherwise qualified as a licensed practical nurse. 11
20 The threshold issue of a section 504 claim is whether the plaintiff is handicapped as defined in the Rehabilitation Act. A handicapped individual under section 504 is defined as 21 any person who (i) has a physical or mental impairment which substantially limits one or more of such person's major life activities, (ii) has a record of such an impairment, or (iii) is regarded as having such an impairment. 29 U.S.C. Sec. 706(7)(B) (emphasis added). 22 The phrase is regarded as having such an impairment means, inter alia, is treated ... as having such an impairment. See 45 C.F.R. Sec. 84.3(j)(2)(iv)(C) (1989); Carter v. Orleans Parish Pub. Schools, 725 F.2d 261, 262-63 (5th Cir.1984) (per curiam). For purposes of this appeal, we assume that seropositivity to HIV antibodies is an impairment protected under section 504 and that TGMC officials treated Leckelt as though he had such an impairment. Cf. Arline, 107 S.Ct. at 1128 n. 7 (not reaching the questions whether a carrier of a contagious disease such as AIDS could be considered to have a physical impairment, or whether such a person could be considered, solely on the basis of contagiousness, a handicapped person as defined by the Act). 23
24 A section 504 plaintiff must prove that he was discriminated against solely by reason of his handicap (or perceived handicap). 29 U.S.C. Sec. 794 (emphasis added); see Norcross v. Sneed, 755 F.2d 113, 117 n. 5 (8th Cir.1985) ([I]t is significant that the section 504 plaintiff must show that handicap was the sole reason for the decision, while the Title VII plaintiff pursuing a disparate treatment claim need only show that a protected classification was a factor influencing the decision. (emphasis in original; citations omitted)). The district court concluded that Leckelt was discharged because he had violated the hospital infection control policies on reporting infectious or communicable diseases, and not because he was regarded as being seropositive for HIV. Leckelt, 714 F.Supp. at 1387. 25 In order to protect patients and employees from the spread of communicable diseases, health care facilities, such as TGMC, have promulgated infection control policies based on the guidelines of the CDC and the AHA. As the district court found TGMC did not have a specific written policy concerning HIV infection or AIDS, but had infection control procedures regarding communicable and infectious diseases which would encompass HIV or AIDS. Id. at 1379. TGMC's policies required employees to report any exposure to infectious diseases to the infection control practitioner--Growe--and, where appropriate, to undergo testing and working restrictions for such diseases. For example, an employee exposed to HBV--a blood-borne disease like HIV--was required to undergo testing, and if the test results were positive, to take at least a three-week leave of absence. After receiving medical clearance, such an employee could return to active employment. At trial, Leckelt testified that he understood that TGMC employees were required to report infections to Growe. Leckelt reflected this knowledge by reporting a draining lesion to Growe in April 1986 and, apparently, by reporting to her in December 1984 a rash diagnosed as syphilis. TGMC's employee handbook stated that employees committing serious infractions of TGMC policy, including insubordination, were subject to immediate termination. Leckelt had signed a statement that he had read and understood this handbook. 26 Smith knew that Leckelt had been the roommate for eight years of a TGMC patient--Potter--who died of AIDS-related complications, and that Leckelt was known to be homosexual. 12 It is undisputed, and indeed virtually common knowledge, that homosexuals are a high risk group for contracting HIV and AIDS. Further, Smith discovered that Leckelt was an HBV carrier and had a history of syphilis and lymphadenopathy (a condition that is symptomatic of recent HIV infection), and that Leckelt had failed to report at least some of these matters to Growe. Smith reasonably suspected that Leckelt had been exposed to HIV and, therefore, determined that TGMC needed to know Leckelt's HIV status in order to determine what, if any, precautions were necessary. An April 11, 1986 memorandum by Smith reflects that if Leckelt tested positive for HIV antibodies, he would be placed on leave with pay pending further review; and if he refused to submit his test results, he would be suspended, pending termination review, for insubordination. Although Smith and the TGMC board discussed the possibility of termination, among other alternatives, if Leckelt tested seropositive for HIV antibodies, no decision was ever made as to what measures would be taken in such a case. When it became apparent that Leckelt was not going to submit his test results, he was terminated for failure to comply with hospital policy. Thus, the district court was not clearly erroneous in finding that Leckelt failed to establish that he was discriminated against solely because of a perception that he was infected with HIV. 27 Leckelt contends that the purported reason for his dismissal--failure to comply with hospital policy by not submitting the results of his HIV antibody test--was a pretext for his termination because of the perception that he was infected with HIV. Leckelt points to the disparity in TGMC's treatment of him as opposed to that of a registered nurse (RN) who had been stuck by a needle contaminated with Potter's blood in late March or early April 1986. When Leckelt did not submit the results of his HIV antibody test on April 11, 1986, Smith decided that Leckelt would not be allowed to work until he submitted his test results to Growe. The RN, on the other hand, was allowed to continue working while she awaited the results of her HIV antibody testing. Leckelt emphasizes that an individual who has contracted HIV likely would not have seroconverted until several weeks or months after his initial exposure to HIV. 28 Any disparity in the hospital's treatment of Leckelt and the RN, however, may be explained by the fact that the RN, unlike Leckelt, complied with Growe's request that she undergo HIV antibody testing and submit her results to Growe. Further, Leckelt, unlike the RN, had already, as a result of his own health concerns, taken an HIV antibody test by the time that Growe requested that he submit to such a test. Thus, even though Leckelt was not allowed to work until he submitted his test results, he, unlike the RN, did not have to await these results for any meaningful period of time. Leckelt represented that he could have picked up these results on April 11--the same day on which Smith decided that Leckelt could not work until he submitted his test results to Growe. At that time, Leckelt was on leave from work because of a draining lesion (there was no indication that the RN had any adverse medical condition when the decision concerning her was made). Leckelt did not receive medical clearance with respect to the lesion until April 14, and was not otherwise scheduled to work until April 16. Further, the evidence supports the conclusion that Leckelt, unlike the RN, was known to be a homosexual, a group at high risk for contracting HIV and AIDS. Therefore, there is adequate evidence that TGMC reasonably suspected that Leckelt had been exposed to HIV at some point during his eight-year relationship with Potter, who suffered from (and soon died of) AIDS-related complications. It could reasonably be concluded that, if Leckelt were infected with HIV, there probably was an enhanced likelihood, as compared to the RN when she was tested, that Leckelt would have seroconverted by the time that he voluntarily submitted to HIV antibody testing in New Orleans. We are unable to conclude that the district court was clearly erroneous in finding that Leckelt did not establish pretext. 29
30 Finally, a section 504 plaintiff must show that, notwithstanding his handicap (or the perception of being handicapped), he is otherwise qualified for the position in question. 29 U.S.C. Sec. 794; see Arline, 107 S.Ct. at 1131 n. 17 (In the employment context, an otherwise qualified person is one who can perform 'the essential functions' of the job in question. (Quoting 45 C.F.R. Sec. 84.3(k) (1985)). 13 As the Supreme Court pointed out in Arline, courts normally should defer to the reasonable medical judgments of public health officials in making this inquiry. 107 S.Ct. at 1131 & n. 18 (not addressing whether courts should also defer to the reasonable medical judgments of private physicians on which an employer has relied). The district court determined that because Leckelt would not allow defendants to conduct the inquiry necessary to protect patients, co-workers and plaintiff himself from any possible risk he may pose because of his particular situation, defendants had a reasonable belief that plaintiff was not 'otherwise qualified' for employment at TGMC. Leckelt, 714 F.Supp. at 1389. We will not reverse such a finding of fact unless it is clearly erroneous. See Brennan v. Stewart, 834 F.2d 1248, 1260-62 (5th Cir.1988). 31 According to the district court's adequately supported findings, HIV is transmitted through intimate sexual contact, exposure to infected blood or blood components, or perinatally from mother to neonate. 14 As many as one hundred percent of those persons infected with HIV may become symptomatic of AIDS. At this time, there is no known cure for AIDS. Thus, a person diagnosed with AIDS may be regarded as terminally ill. 32 Under the November 1985 CDC guidelines, asymptomatic health care workers who are not involved in invasive procedures need not be subjected to routine mandatory HIV antibody testing because of the extremely low risk that such health care workers could transmit HIV to patients, which can be further minimized with the use of appropriate universal precautions. 15 If a health care worker has a parenteral exposure (e.g., needle stick or cut) or a mucous membrane exposure (e.g., splash to the eye or mouth) to the blood or body fluids of a patient, and if the patient is seropositive for HIV antibodies or refuses to consent to a HIV antibody test, these CDC guidelines state that the health care worker should be evaluated clinically and serologically for evidence of HIV infection. 16 Dr. Peter Mansell (Dr. Mansell), the defendants' expert in infection control, testified that this protocol should be followed regardless of whether health care workers are exposed to HIV inside or outside of the health care facility. Noting that health care workers infected with HIV and with defective immune systems are at an increased risk of contracting other infectious diseases from patients, the CDC guidelines also recommended that a health care worker infected with HIV should be counseled concerning the risks of infection and that the employer, in conjunction with the health care worker's personal physician, should determine what duties the health care worker can adequately and safely fulfill. 17 All of the infection control experts testifying at trial stated that this latter recommendation could not be fulfilled without knowledge of the HIV status of the health care worker in question. In January 1986, the AHA articulated guidelines almost identical to those of the CDC discussed above. 18 33 Although noting that there is some debate in the medical community as to whether starting IVs is an invasive procedure, the district court did not expressly find that any of Leckelt's duties required his involvement in invasive procedures (contrary to Leckelt's suggestion otherwise). Nevertheless, the court found that some of Leckelt's duties--namely, starting IVs, injecting medication, performing catheterizations, changing dressings, and administering enemas--provided routes to a patient's blood and body fluids and, therefore, were potential opportunities for HIV transmission. The court also noted that Leckelt's occasional assignments to the emergency room would bring him into contact with patients experiencing a high degree of trauma. 34 Leckelt contends that it was not necessary for TGMC to require that he submit the results of his HIV antibody test because even if he were infected with HIV, he would not have posed a significant risk of transmission as a licensed practical nurse. At first glance, Arline seems to require that district courts make a specific finding in this respect. See Arline, 107 S.Ct. at 1131 n. 16 (A person who poses a significant risk of communicating an infectious disease to others in the workplace will not be otherwise qualified for his or her job if reasonable accommodation will not eliminate that risk. (emphasis added)). It is clear, however, that the probabilities of whether an infectious disease will be transmitted is but one of four relevant factors: 35 In the context of the employment of a person handicapped with a contagious disease, ... [the otherwise qualified] inquiry should include: 36 '[findings of] facts, based on reasonable medical judgments given the state of medical knowledge, about (a) the nature of the risk (how the disease is transmitted), (b) the duration of the risk (how long is the carrier infectious), (c) the severity of the risk (what is the potential harm to third parties) and (d) the probabilities the disease will be transmitted and will cause varying degrees of harm.'  Id. at 1131 (citation omitted). 37 Even though the probability that a health care worker will transmit HIV to a patient may be extremely low and can be further minimized through the use of universal precautions, there is no cure for HIV or AIDS at this time, and the potential harm of HIV infection is extremely high. 38 Leckelt emphasizes that so long as he followed the appropriate universal precautions, there was little to no risk of transmitting HIV to patients. Although none of Leckelt's duties apparently fell within the technical definition of an invasive procedure, at least some of these duties provided potential opportunities for HIV transmission to patients. Leckelt and the defendants stipulated that Leckelt generally complied with TGMC's policies concerning universal precautions. Some evidence was presented, however, that even though Leckelt may have had a cut on one of his fingers, he failed to wear rubber gloves (or take equivalent precautions) in changing the dressing on a surgical wound and adjusting an IV of a patient in 1984. One of Leckelt's experts--Dr. Eickhoff--also testified that approximately five to ten percent of the time health care workers do not comply with recommended universal precautions. Further, it is clear that well prior to Leckelt's discharge, Smith discovered that Leckelt had a medical history of HBV, syphilis, and lymphadenopathy (a condition that is symptomatic of recent HIV infection), and that by failing to report at least some of these facts to Growe, Leckelt had violated TGMC's infection control policies. 39 One of the essential practices of health care facilities, such as TGMC, is to establish and enforce policies and procedures for controlling the risk of transmission of infectious diseases. Although TGMC did not have a written policy specifically applicable to HIV infection or AIDS, it generally required that health care workers report exposure to infectious diseases and undergo testing and work restrictions where necessary. These policies were based on the CDC and AHA guidelines. According to Smith's trial testimony, when he was apprised of Leckelt's relationship with Potter, he consulted legal counsel, familiarized himself with the hospital's infection policies, and read excerpts of the CDC and AHA guidelines. As noted, the then applicable CDC guidelines recommended that a health care worker relevantly exposed to the blood or body fluids of a patient infected with HIV should be tested for the presence of HIV antibodies. As Dr. Mansell testified, there is no logical reason that this guideline should be restricted to HIV exposure in the hospital setting. The CDC guidelines also recommended that a health care worker infected with HIV should be counseled about the risks of infection and that the facility, in conjunction with the health care worker's personal physician, should determine what duties the health care worker could safely perform. As Smith concluded, it is clear that TGMC could not comply with these guidelines without first knowing Leckelt's HIV status. 40 In Arline, the Supreme Court stated, Employers have an affirmative obligation to make a reasonable accommodation for a handicapped employee. 107 S.Ct. at 1131 n. 19. For example, employers cannot deny an employee alternative employment opportunities reasonably available under the employer's existing policies. Id. (citations omitted). Assuming that Leckelt had tested seropositive for HIV antibodies and that such an impairment is protected under section 504, TGMC might have modified Leckelt's duties (or use of universal precautions) in order to reduce the risk of HIV transmission to others or to decrease the risk of Leckelt's exposure to other infectious diseases of patients. If nothing else, TGMC might have monitored Leckelt's health status and compliance with universal precautions on a periodic basis to determine whether he could adequately and safely fulfill his duties. By refusing to submit the results of his HIV antibody test, Leckelt prevented TGMC from ever knowing his HIV status and from deciding what, if any, measures were necessary to protect the health of Leckelt, other TGMC employees, and TGMC patients. In other words, Leckelt prevented TGMC from knowing whether he had a handicap for which federal law arguably required reasonable accommodations. Accordingly, we conclude that the district court was not clearly erroneous in finding that Leckelt was not otherwise qualified to perform his job as a licensed practical nurse because of his failure to comply with TGMC's policies for monitoring infectious diseases, such as HIV. 19 II. The Louisiana Civil Rights for Handicapped Persons Act 41 Leckelt contends that the defendants violated the Louisiana Civil Rights for Handicapped Persons Act (the Louisiana Act), La.Rev.Stat. Sec. 46:2251, et seq., by discharging him on the basis of a physical examination. Section 46:2254(C)(5) of the Louisiana Act, which was enacted in 1980 and has not been construed by any court (aside from the district court here), provides in pertinent part that employers may not 42 discharge or take other discriminatory action against an otherwise qualified individual on the basis of physical or mental examinations or preemployment interviews that are not directly related to the requirements of the specific job or which are not required of all employees. Id. (emphasis added). 43 The district court found this section of the Louisiana Act to be inapplicable because Leckelt's discharge was based on his failure to submit his test results, not on the basis of the test itself or its results. 20 We concur with the district court's interpretation of the Louisiana Act. See also, e.g., Matter of Hyde, 901 F.2d 57, 59 (5th Cir.1990) (deference is appropriate to the determination of unsettled questions of state law by the district court sitting in that state). 44