Opinion ID: 1196968
Heading Depth: 1
Heading Rank: 7

Heading: Applicability in Disciplinary Proceedings.

Text: The Wyoming Medical Practice Act defines an impaired physician as: (vii) Impaired means a person who cannot practice medicine with reasonable skill and safety to patients by reason of one (1) or more of the following: (A) Medical incompetence; (B) Mental illness; (C) Physical illness, including but not limited to deterioration through the aging process or loss of motor skill;.... Wyo. Stat. Ann. § 33-26-102(a)(vii) (LEXIS 1999). Kirbens states in his brief he is an impaired physician, and thus, his continued practice of medicine would constitute a significant risk to the health or safety of the public. He contends, however, that the ADA required the Board to permit him relief under state statutes assisting physically and mentally impaired physicians. He relies upon the statute permitting voluntary relinquishment of his license, or, alternatively, Wyo. Stat. Ann. § 33-26-202(a)(xii), mandating that the Board provide a program to assist physically and mentally impaired physicians. He directs our attention to Wyo. Stat. Ann. § 33-26-202(b)(ix), obliging the Board to comply with all federal law. Evidentiary rulings at the hearing prevented him from establishing the applicability of the ADA, although his offer of proof at the hearing established that the sole state-sponsored physicians' assistance program exists for physicians impaired by substance abuse. He requests that the Board's order be set aside until he determines whether any discipline against him (other than voluntary relinquishment of his license) is discriminatory under the ADA. Precisely, he contends that the ADA does not permit the Board to treat him differently from doctors with an alcohol or drug dependence issue for whom the Board may have established a state sponsored rehabilitative program as provided for in Wyo. Stat. Ann. § 33-26-202(b)(xii). The Board contends that the ADA does not protect a physician who is not a qualified individual with a disability under the ADA. It claims a physician who poses a significant risk to the health or safety of others by virtue of his disability is not qualified. Because Kirbens' witness, Dr. Irons, testified that Kirbens did pose a significant risk to the health and safety of others because of his disability, the Board asserts that Kirbens is not qualified under the ADA, the ADA does not protect him, and the ADA does not apply to Board proceedings and final orders. Wyo. Stat. Ann. § 33-26-202 (LEXIS 1999) states in relevant part: (a) The board shall pass upon the qualifications and determine the fitness of all persons desiring to practice medicine in this state. (b) The board is empowered and directed to: (i) Grant, refuse to grant, suspend, restrict, revoke, reinstate or renew licenses to practice medicine; (ii) Investigate allegations and take disciplinary action on the following grounds: (A) A licensee is impaired or has engaged in errant conduct; (B) A person has violated an applicable provision of this chapter or the board's regulations. (iii) Conduct informal interviews and contested case proceedings;    (ix) Comply with all applicable federal law;    (xii) Participate in and contribute to a program to assist in the return to practice of licensees who are physically or mentally impaired; (xiii) Take all reasonable action, including the promulgation of rules and regulations, necessary to enforce this chapter. (emphasis added). Kirbens does not contend that section (xii) in and of itself entitles him to avoid revocation of his license and be placed in a treatment program. Rather, he argues that because a public entity program apparently exists for disabled physicians, the ADA requires that he be treated similarly to other disabled physicians. Kirbens asserts that the applicable federal law is Title II of the ADA and those regulations implementing its provisions. Title II is one of five titles contained in the ADA: Employment (Title I), Public Services (Title II), Public Accommodations and Services Operated by Private Entities (Title III), Telecommunications (Title IV), and Miscellaneous Provisions (Title V). Zimmerman v. Oregon Dept. of Justice, 170 F.3d 1169, 1172 (9th Cir.1999) (citing Americans with Disabilities Act of 1990, Publ.L. No. 101-336, 104 Stat. 327, 327-28 (1990). As a whole, Congress intended that the ADA provide a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities. Olmstead v. L.C., 527 U.S. 581, 119 S.Ct. 2176, 2182, 144 L.Ed.2d 540 (1999) (quoting 42 U.S.C. § 12101(b)(1)) (1994)). Bipolar disorder is a disability under the ADA. The Florida Bar v. Clement, 662 So.2d 690, 699 (Fla.1995), cert. denied, 517 U.S. 1210, 116 S.Ct. 1829, 134 L.Ed.2d 933 (1996). The Title II provision at issue states: [N]o 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. 42 U.S.C. § 12132 (1994). Title II defines public entity as any state or local government and any department, agency, or special purpose district. 42 U.S.C. §§ 12131(1)(A), (B) (1994). At the hearing, the Board conceded that it is a public agency within this definition. The ADA defines qualified individual with a disability as: an individual with a disability who, with or without reasonable modifications to rules, policies, or practices, the removal of architectural, communication, or transportation barriers, or the provision of auxiliary aids and services, meets the essential eligibility requirements for the receipt of services or the participation in programs or activities provided by a public entity. 42 U.S.C. § 12131(2) (1994). Kirbens directs us to an accompanying regulation promulgated under the ADA, providing [a] public entity may not administer a licensing or certification program in a manner that subjects qualified individuals with disabilities to discrimination on the basis of disability, nor may a public entity establish requirements for the programs or activities of licensees or certified entities that subject qualified individuals with disabilities to discrimination on the basis of disability. 28 C.F.R. § 35.130(b)(6) (1999). Virginia interprets this provision as specifically prohibiting public entities from acting discriminatorily in administering licensing programs. Clark v. Virginia Bd. of Bar Examiners, 880 F.Supp. 430, 442 (E.D.Va.1995). Kirbens asserts this regulation prohibits the Board from assisting substance dependent physicians while denying assistance to him for his particular disability, and discriminatorily refusing to allow him to voluntarily relinquish his license. Maintaining its position that Kirbens is not a qualified individual under ADA, the Board relies upon Alexander v. Margolis, 921 F.Supp. 482 (W.D.Mich.1995), affirmed on appeal, 98 F.3d 1341 (6th Cir.1996), and quotes the following passage: Considering the text of section 12132(2), it is questionable whether the Board's duty to license physicians can be characterized as a service being denied to plaintiff or whether the Board's refusal to reinstate his license denies him participation in programs or activities provided by a state entity. The Board of Medicine is, if anything, a service, program or activity provided for the public's benefit and safety, not for the benefit of any given individual who does not meet the state's requirements for practicing medicine. In any event, plaintiff is not a qualified individual with a disability under the ADA. The very nature of the police powers exercised by state boards of medicine require[s] the state to discriminate on the basis of, among other considerations, a mental condition harmful to the public's safety. By the very nature of the practice of medicine, given the physician's necessary independence to practice his art, no reasonable modification can be made to a policy of restricting medical practice to those without evidence of mental disabilities. Id. at 488. The Board directs our attention to Doe v. Univ. of Maryland Medical System Corp., 50 F.3d 1261 (4th Cir.1995), [1] which held: [A] hospital does not violate § 504 of the Rehabilitation Act or Title II of the ADA when it terminates an HIV-positive neurosurgical resident based upon the risk of transmission of the disease during performance of exposure-prone procedures. Such individuals pose a significant risk to the health or safety of their patients that cannot be eliminated by reasonable accommodation, and therefore are not otherwise qualified within the meaning of the Rehabilitation Act and the ADA. Id. at 1267. Kirbens distinguishes Doe as a Title I employment termination case inapplicable to a request of voluntary relinquishment on Title II disability grounds. We agree that Kirbens' contentions must be examined under Title II of the ADA which is applicable to public entities, rather than Title I, which is applicable to employment. Nevertheless, we find that the federal regulations promulgated under the ADA support the Board's position. Because Congress explicitly authorized the Attorney General to implement Title II through these regulations, see 42 U.S.C. § 12134, they `must be given legislative and hence controlling weight unless they are arbitrary, capricious, or plainly contrary to the statute.' Medical Society of New Jersey v. Jacobs, 1993 WL 413016 at  (D.N.J. Oct. 5, 1993) (quoting United States v. Morton, 467 U.S. 822, 834, 104, S.Ct. 2769, 81 L.Ed.2d 680 (1984)). The federal regulations discuss the relationship between safety questions and protecting disabled individuals under the ADA in this way: Where questions of safety are involved, the principles established in § 36.208 of the Department's regulation implementing title III of the ADA, to be codified at 28 C.F.R., part 36, will be applicable. That section implements section 302(b)(3) of the Act, which provides that a public accommodation is not required to permit an individual to participate in or benefit from the goods, services, facilities, privileges, advantages and accommodations of the public accommodation, if that individual poses a direct threat to the health or safety of others. A direct threat is a significant risk to the health or safety of others that cannot be eliminated by a modification of policies, practices, or procedures, or by the provision of auxiliary aids or services.... Although persons with disabilities are generally entitled to the protection of this part, a person who poses a significant risk to others will not be qualified, if reasonable modifications to the public entity's policies, practices, or procedures will not eliminate that risk. 28 C.F.R. pt. 35, App. A at 481 (1999) (emphasis added). The regulatory language establishes that the ADA will not protect a disabled individual whose disability constitutes a direct safety threat to the public. Other jurisdictions have determined that the ADA does not prevent disciplining disabled attorneys whose misconduct substantially harmed or threatened their clients. State ex rel. Oklahoma Bar Ass'n v. Busch, 919 P.2d 1114, 1119-20 (Okla.1996); Matter of Wolfgram, 1995 WL 506002 at  (Cal.Bar Ct. Aug.22, 1995). We agree that the appropriate rule in Kirbens' case should be that the ADA will not protect him from Board disciplinary proceedings if his conduct significantly risks the health or safety of others. Under a standard of clear and convincing evidence, the Board concluded that Kirbens had violated several provisions of the Act by performing inappropriate or unnecessary surgeries upon several patients. Kirbens' treating physician, Dr. Irons, testified that in his opinion, Kirbens cannot practice medicine with reasonable skill and safety and would pose a significant risk to the health and safety of others by virtue of his disability. Based on this opinion, the Board concluded that a physician cannot be qualified under the ADA if he poses a significant risk to the health or safety of others by virtue of his disability. From hospital records of adverse actions against Kirbens, the Board concluded two hospitals suspended his privileges because of either possible incompetence or misconduct. The Board established that Kirbens cannot practice medicine without substantial harm or threat to his patients. Kirbens does not challenge either these findings or conclusions. We agree that the ADA does not consider Kirbens as a qualified individual with a disability. We hold that the ADA did not prevent the Board from revoking Kirbens' medical license.