Court Opinion

ID: 2964674
Source: CourtListenerOpinion
Date Created: 2015-09-21 21:29:15.509063+00
Date Added: 2024-06-11T11:42:59.575475
License: Public Domain

USCA1 Opinion

	

                           United  States Court of Appeals
                           
                                For the First Circuit

                                 ____________________

        No. 96-1837

                       EQUAL EMPLOYMENT OPPORTUNITY COMMISSION,

                                Plaintiff, Appellant,

                                          v.

                                     AMEGO, INC.,

                                 Defendant, Appellee.

                                 ____________________

                    APPEAL FROM THE UNITED STATES DISTRICT COURT 

                          FOR THE DISTRICT OF MASSACHUSETTS

                  [Hon. George A. O'Toole, Jr., U.S. District Judge]
                                                ___________________

                                 ____________________

                                        Before

                            Cyr and Lynch, Circuit Judges, 
                                           ______________
                           and McAuliffe,* District Judge.
                                           ______________

                                 ____________________

            Karen   M.   Moran,   Attorney,   Equal   Employment   Opportunity
            __________________
        Commission, with  whom C. Gregory Stewart,  General Counsel, Gwendolyn
                               __________________                    _________
        Young  Reams, Associate  General  Counsel, and  Vincent J.  Blackwood,
        ____________                                    _____________________
        Assistant General Counsel, were on brief, for appellant.
            Mary  Jo Hollender, with  whom Hollender  & Carey,  L.L.P., was on
            __________________
        brief, for appellee.

                                 ____________________
                                    April 7, 1997
                                 ____________________

        *Of the District of New Hampshire, sitting by designation.

                      LYNCH, Circuit Judge.  Amego, Inc., is a small not-
                      LYNCH, Circuit Judge.
                             _____________

            for-profit organization  which  cares for  severely  disabled

            people  suffering from  autism,  retardation, and  behavioral

            disorders.    It   serves  twenty-five  to   thirty  clients,

            including  six  in  a   residential  program  in   Mansfield,

            Massachusetts,  where  Ann Marie Guglielmi  was employed as a

            Team Leader.   The Team  Leader position required  her to  be

            responsible for the care of these disabled clients, including

            the  responsibility  of  administering vital  medications  to

            them.  After an  unresolved investigation of improprieties in

            the  administering of  medication  to patients  at a  related

            facility, Amego  learned that other staff  felt Guglielmi was

            not performing her job adequately and was putting patients at

            risk.    Amego also  learned  that  Ms. Guglielmi  had  twice

            attempted to commit suicide within the previous six  weeks by

            overdosing on  medications.  This, Amego  decided, meant that

            Guglielmi could not safely dispense medications, an essential

            job function,  and that  there was  no  other job  reasonably

            available to her.  Her employment was thus terminated. 

                      The   Equal   Employment   Opportunity   Commission

            ("EEOC")  sued  Amego  on   behalf  of  Guglielmi  under  the

            Americans with Disabilities Act ("ADA"), 42 U.S.C.   12101 et
                                                                       __

            seq.  The district court entered summary judgment against the
            ____

            EEOC, holding  that the EEOC had  not made out  a prima facie

            case  that Guglielmi was an otherwise "qualified" individual,

                                         -2-
                                          2

            that  an accommodation  could  be reasonably  made, and  that

            there was discrimination "because of" her disability. 

                       The EEOC  appeals and argues that  the question of

            whether  an  employee  poses  a  significant  risk  to  other

            individuals  in the  workplace is  an affirmative  defense on

            which the employer bears the burden of  proof and is thus not

            part  of   the  plaintiff's  burden  that   the  employee  is

            qualified.  Those issues of qualification and  risk, the EEOC

            says,  are matters for  the jury to resolve  at trial and may

            not be resolved on  summary judgment.  The EEOC  also invites

            this  court to  hold  that "adverse  employment action  taken

            because of conduct  related to a disability  is tantamount to

            action taken because of a disability itself" for purposes  of

            the ADA. 

                      We affirm the judgment of the district court.

                                          I.

                      The following facts are undisputed.

                      Founded in 1972 by parents of autistic individuals,

            Amego receives public  funding and is  licensed by two  state

            agencies.   A condition  of licensing is  that Amego  provide

            conditions  that  ensure the  safety  and  well-being of  its

            clients.   Amego maintains a very  low client-to-staff ratio,

            usually one  staff member to  two clients.   One particularly

            aggressive  client   required  supervision  by   three  staff

            members, eighteen hours a day. 

                                         -3-
                                          3

                      Amego has a policy of not  rejecting those who seek

            its help.  Most of its clients engage in aggressive and self-

            injuring behavior, including self-mutilation.  Many have been

            rejected  by,  or  discharged  from, other  agencies.    Most

            clients are on prescription medications, and in June of 1992,

            all  clients  at  the  Mansfield residence,  save  one,  were

            receiving prescription medications. 

                      Consistent   with   its  philosophy   of  attempted

            integration,  Amego  provides  its  clients  with  access  to

            community activities on a regular basis.  Residential clients

            are  transported daily  to the  Day Treatment  Program, where

            they frequently  are taken  by direct  care staff  to stores,

            bowling alleys, banks, and the like. 

                      In  September  1990,  Amego hired  Guglielmi  as  a

            Behavior Therapist.  She was then about 21 years old  and did

            not represent  herself to  have any  disability.  In  January

            1991, she was diagnosed  as bulimic and clinically depressed;

            however, she did not tell her employer about these conditions

            until  after her first suicide attempt, over a year after the

            diagnosis.   She was prescribed  Prozac in 1991,  but it only

            partially alleviated the depression.   She stopped taking the

            drug in April.  In the fall of 1991, she  started living with

            her boyfriend, David Andrade, who worked at a different Amego

            residence.   That  relationship  was fraught  with  problems.

            Andrade used  cocaine; Guglielmi,  however, says she  did not

                                         -4-
                                          4

            confirm  her suspicions  of that  until late  June 1992.   In

            early  1992, she  started  seeing a  social worker,  Margaret

            Posever, for bimonthly therapy sessions.  

                      Earlier,  in July  1991, Guglielmi was  promoted to

            the  position of Team Leader at the Mansfield residence.  The

            essential  functions of  that position  included: supervising

            the   day-to-day   implementation  of   individual  clinical,

            educational, and vocational programs and  data collection for

            all programs; serving as a role model for  staff in all areas

            of  client programming,  client  services,  and  professional

            practice; assessing staff  performance, providing  additional

            training,  support, and  counseling as  appropriate; ensuring

            that Amego's policies and  procedures on clients' rights were

            implemented  and  documented;  responding   appropriately  in

            crisis situations; and administering and  documenting the use

            of prescribed medications.

                      On March 4, 1992, Guglielmi received a  performance

            evaluation which  said she was an  "exceptional" Team Leader.

            The evaluation  was based on her  performance through January

            1992.  In the spring of 1992, Guglielmi applied for promotion

            to  the position  of  Program Coordinator  for the  Mansfield

            residence.   The  promotion  instead went  to Kristen  Stone.

            Stone assumed her new responsibilities on May 4, 1992.

                      That  same  day,  Guglielmi  deliberately  took  an

            overdose  of  nonprescription sleeping  pills  which she  had

                                         -5-
                                          5

            purchased for that purpose.  After taking the pills, she told

            Andrade what she had done; he took her to the emergency room.

            She was  transferred to  a psychiatric hospital  and released

            later  that evening.  She  told health care  workers that she

            attempted suicide  because she was  upset by problems  in her

            relationship with  her boyfriend, her failure  to receive the

            promotion, and other work-related stress.  She was readmitted

            to  the psychiatric hospital on May 6, 1992, and stayed there

            until  May 12 because  of concerns about her  safety.  On the

            day  of her readmission to the hospital -- two days after her

            suicide  attempt -- Guglielmi  was not able  to "contract for

            safety" with  her therapist Posever.   Guglielmi told Posever

            that even  if she were to  so contract, her mood  was in such

            flux that  she could not be  sure she would not  hurt herself

            anyway.  A week after returning to work, and again  two weeks

            later, she told Posever that she felt suicidal.

                      When Guglielmi returned to work on May 13, she told

            her  supervisor  only  that  she had  been  hospitalized  for

            bulimia  and  depression.   She  did  not  say  that she  had

            attempted  suicide.  She  asked her supervisor  to modify her

            work  schedule so  that  she could  attend  therapy twice  or

            thrice weekly.  Her  supervisor agreed to this accommodation.

            However, Guglielmi  stopped  going to  the  therapy  sessions

            after a few weeks. 

                                         -6-
                                          6

                      On May 21, 1992, Guglielmi began seeing Dr. Kenneth

            Levin for psychopharmacological treatment.  He  diagnosed her

            as suffering  from bulimia and  major depression,  prescribed

            Prozac  and  trazodone, and  saw her  to  monitor her  use of

            medication.   Prozac  was  one of  the medications  regularly

            administered to Amego's clients.   On June 4, 1992,  she told

            Dr.  Levin  that she  had  experienced  periodic feelings  of

            increased   depression,   including   a   period   when   she

            contemplated overdosing.   She assured Dr. Levin that if such

            thoughts recurred, she would not act on them but would inform

            her boyfriend  or a health care  provider.  She did  not keep

            her word.

                      On June 13, Guglielmi deliberately overdosed again,

            this  time using  her  prescription  medications, Prozac  and

            trazadone, as  well as aspirin.   After taking  the overdose,

            she  called  the Plainville  police,  who  took  her  to  the

            hospital.   She was released on June 15, 1992.   She told her

            health care  providers that she was not really depressed when

            she  overdosed  but wanted  to  provoke a  reaction  from her

            boyfriend.  When Guglielmi  returned to work on June  17, she

            again  did  not tell  her  employer  that she  had  attempted

            suicide.  

                      On   the  day  Guglielmi   returned  to  work,  the

            Executive Director of Amego, Caryn Driscoll, and the Director

            of  Administrative  Services,  Karen  Seal,  met  with  David

                                         -7-
                                          7

            Andrade  about his  job  performance problems.   During  this

            meeting, Andrade  mentioned  rumors that  clients were  being

            drugged  at  the Fales  Road residence.    He worked  at that

            location  regularly, and Guglielmi worked there occasionally.

            Around that time, Driscoll learned  that Klonopin, one of the

            medications prescribed for clients, was either missing or was

            being  used  at   an  accelerated  rate  at  the  Fales  Road

            residence.  Some cocaine users take Klonopin  as an antidote,

            to calm them down from the effects of cocaine. 

                      Amego  investigated  and  found  that  four  of the

            clients at the Fales  Road residence (two of whom  should not

            have  had Klonopin at all) had blood levels of Klonopin which

            were too high.   Amego asked any employees who  had pertinent

            information  to  step forward.    Guglielmi  did so  and  was

            interviewed  on June  26  by Driscoll,  Amego's Human  Rights

            Officer, and  a private investigator.   During the interview,

            Guglielmi focused  on her relationship with  Andrade, who she

            feared might be targeted in the investigation.  She said that

            she was  suffering from  bulimia and depression  and revealed

            for  the first time  her two recent suicide  attempts.  In an

            attempt  to explain  Andrade's performance  issues, she  said

            that he had helped  her when she attempted suicide  two times

                                         -8-
                                          8

            by  overdosing  on  both  prescription  and  over-the-counter

            drugs.1 

                      Earlier,  on  June 5,  a  shift  supervisor at  the

            Mansfield residence,  Chester Millet,  had  noticed that  the

            medication log was missing.   He conducted a thorough search,

            including behind the medication cabinet, and did not find it.

            Guglielmi also  helped look for it.   On the same  day of her

            interview with Driscoll, June 26, Guglielmi reported that she

            had found the missing medication  log.  She said the log  had

            been behind  the medication cabinet, between  the cabinet and

            the wall.  Millet told Driscoll that he had previously looked

            there  and  had  not seen  it.    Although  Driscoll did  not

            initially consider Guglielmi under suspicion for the improper

            drugging  of patients  at  Fales Road,  she  and other  staff

            members  found the discovery of  the book by  Guglielmi to be

            peculiar.  A  review of  the medication log  showed that  the

            supply  of  drugs  on  hand at  the  Mansfield  residence was

            excessive.  It  was not  possible to determine  from the  log

            whether medications were missing.  

                      On  June 26,  Driscoll  spoke  with the  Plainville

            police about her  concerns about the drugging  of patients at

                                
            ____________________

            1.  During the interview, Guglielmi was asked whether she had
            observed or  suspected that Andrade  was using cocaine.   She
            answered "no" to both  questions.  The latter answer  was not
            true.  Discovery in this case revealed that she had spoken to
            her therapist about her suspicions of her boyfriend's cocaine
            use as early as May 27, 1992.  

                                         -9-
                                          9

            Fales  Road.  The police told Driscoll that they found pills,

            initially thought to be Klonopin, in Guglielmi's apartment on

            the night they responded to her suicide call. 

                      Around June  28,  Driscoll  received  a  call  from

            Carlos  Andrade,   an  Amego  employee  and  David  Andrade's

            brother.  He told her that staff members felt Guglielmi's job

            performance  was suffering and had  asked him to do something

            about it.  He reported that staff  members were uncomfortable

            with her job performance,  that she was erratic in  behavior,

            had  mood  swings,  seemed to  be  focussed  on her  personal

            problems,  that she was seen walking outside and crying, that

            she was heard fighting  on the phone with David  Andrade, and

            that she  was self-absorbed and unable to  concentrate on her

            job.  

                      Carlos  Andrade  also passed  on  that  Millet, the

            shift  supervisor and one of the most senior staff members at

            the  Mansfield residence,  was  concerned that  Guglielmi had

            suddenly handed him the  drug log, saying that she  had found

            it in the residence  when he had searched everywhere  for it.

            Driscoll confirmed  Carlos Andrade's report with  Millet, who

            had never  before complained about another  employee.  Carlos

            Andrade felt that Guglielmi was not performing her job safely

            and was putting clients at risk.  Driscoll knew  there was no

            way  to prevent  Guglielmi from  having access  to medication

            while she worked at Amego.  

                                         -10-
                                          10

                      A  few days  later,  on July  1, Driscoll  informed

            Guglielmi in  writing that  she was temporarily  removed from

            her  position  as Team  Leader  and  would be  reassigned  to

            perform clerical  and other light duties.   The letter stated

            that the fact that  Guglielmi's recent hospitalizations  were

            the   result   of   deliberate  overdoses   of   prescription

            medications raised  "concerns about [her] ability  to perform

            [her]  present job  functions including  medication ordering,

            dispensing and shift supervision."  The letter also indicated

            that Amego's Safety Committee would meet to determine whether

            Guglielmi could  perform her  job, or another  available job,

            with  or  without accommodations.    Driscoll  said that  the

            Committee  should seek  medical information  from Guglielmi's

            treating physician.

                      In an  attempt to obtain a  professional opinion on

            Guglielmi's  ability to  resume her  duties, Driscoll  sent a

            letter  to Posever on  July 1 asking  whether Guglielmi could

            perform  eleven  duties  that a  Team  Leader  would  need to

            perform,  set forth on a checklist.   The letter came back to

            Amego on July 8 with a check in the "yes" column for each job

            duty.  Only Guglielmi had signed the bottom of the checklist.

                      Driscoll  called  Posever to  ask if  the checklist

            accurately  reflected Posever's opinion  that Guglielmi could

            complete  the duties  or  whether the  list merely  reflected

            Guglielmi's own opinion.  Posever told Driscoll she was not a

                                         -11-
                                          11

            medical  doctor,  that  the  checklist did  not  represent  a

            medical competency  evaluation as to each  specific job duty,

            nor was  it a guarantee regarding  each duty.  It  was rather

            that,  based  on  her  discussions  with  Guglielmi  and  her

            knowledge of her  work and treatment history,  Posever had no

            reason  to think  Guglielmi could  not perform  those duties.

            Posever's  checking "yes"  was based  on her  observations of

            Guglielmi's demeanor and  on Guglielmi's  statement that  she

            felt comfortable giving out psychotropic medications at work,

            even in light  of her  suicide attempts.   Driscoll  appeared

            dissatisfied  with  the  response  and  pressed  for  a  more

            definitive opinion,  which Posever declined to  give.  Later,

            Driscoll   told   Guglielmi  that   Posever's   response  was

            inadequate. 

                      On  July  22,  Driscoll  sent Dr.  Levin  a  letter

            requesting his opinion as  to whether Guglielmi could perform

            the eleven functions of her job and  enclosing the checklist.

            In  a  letter  dated July  27,  1992,  Dr.  Levin wrote  that

            Guglielmi  was  no longer  on  prescription  medication.   He

            concluded:  "My understanding  is that  she has  consistently

            performed  her  regular job  responsibilities conscientiously

            and I see  no difficulty  with her returning  to her  regular

            position."   There  was no  checklist with  the letter  Amego

            received.   Driscoll  viewed  Dr.   Levin's  conclusions   as

            largely being based on  what Guglielmi said she could  do and

                                         -12-
                                          12

            her representation that she had no performance problems.  But

            Driscoll  knew from  staff  complaints that  Guglielmi had  a

            range of performance  problems.  And Driscoll  knew Dr. Levin

            had not checked with anyone at Amego about whether  Guglielmi

            was in  fact performing well.   Driscoll told  Guglielmi that

            Dr.  Levin's letter  did  not adequately  deal  with the  job

            functions issue.  

                      Driscoll  was  also concerned  that the  parents of

            Amego's charges would feel  that their children would be  put

            at   risk  by  being  in  the  care  of  someone  who  abused

            prescription drugs.  The parents, she felt, would contact one

            of the state agencies which licensed Amego.  

                      On  July  21,  the   Safety  Committee  met.    The

            Committee  was comprised  of four  administrators: Seal,  the

            Director   of   Administrative   Services;   Amego's   Health

            Coordinator,   who  was  a   nurse;  the   Staff  Development

            Coordinator;   and   the  Administrative   Assistant/Workers'

            Compensation Coordinator.  The Committee found that Guglielmi

            was not in fact performing her  job duties conscientiously or

            performing them well.  The Committee concluded that Guglielmi

            could not  safely perform the  Team Leader position  and that

            there  was  no  Amego  position  that  could  be  modified to

            accommodate her.

                      On July  27, 1992,  Amego's Board of  Directors was

            informed of  the recommendation of the  Safety Committee and,

                                         -13-
                                          13

            after  additional  discussion, concluded  that  there  was no

            alternative  position that could  accommodate Guglielmi.  The

            following day Driscoll informed Guglielmi that her employment

            was  terminated.    Amego  says  its  core  concern  was that

            Guglielmi  could  not  meet  the essential  job  function  of

            handling prescription medication. 

                                         II.

                      The district  court  entered summary  judgment  for

            Amego,  finding that the EEOC  had failed to  meet its burden

            under the ADA of showing that Guglielmi was qualified for the

            position  of Team  Leader and  that Amego  could have  made a

            reasonable accommodation.  The district court also found that

            the EEOC  had failed to meet its burden of showing that Amego

            had   discriminated   against   Guglielmi   "because   of"  a

            disability. 

                      The scope  of appellate review of  entry of summary

            judgment in ADA cases, as in all others, is de novo.  Soileau
                                                        __ ____   _______

            v. Guilford, 105 F.3d 12, 14  (1st Cir. 1997).  The EEOC bore
               ________

            the  burden  of  showing  that  Guglielmi  was  qualified  to

            perform, either with or without reasonable accommodation, the

            essential  functions of  her job.   See  Jacques v.  Clean-Up
                                                ___  _______     ________

            Group, Inc., 96 F.3d 506, 511 (1st Cir. 1996).2
            ___________

                                
            ____________________

            2.  To  establish a  claim under  the ADA,  a plaintiff  must
            prove  by a preponderance of  the evidence: (1)  that she was
            disabled within the  meaning of  the ADA; (2)  that, with  or
            without reasonable accommodation, she was able to perform the
            essential  functions of her job (in other words, that she was

                                         -14-
                                          14

                      For summary judgment  purposes, the parties do  not

            dispute  that  Guglielmi was  a  disabled  person within  the

            meaning of the ADA.  It  is also undisputed that an essential

            function  of the  Team Leader position  is to  administer and

            monitor the medication  of Amego's clients.   The written job

            description provides that this  is an essential job function,

            and the EEOC concedes that Team Leaders have access to locked

            medicine cabinets containing  large quantities  of drugs  and

            are expected to administer medications to clients.

                       This case initially turns  on whether the EEOC has

            met  its burden of  showing that Guglielmi  was a "qualified"

            person.   Amego's position is that  it terminated Guglielmi's

            employment because  she showed by her conduct  -- by behavior

            leading co-workers to  have concerns about whether  she was a

            risk to clients  and by  her two attempts  to commit  suicide

            using prescription  and  non-prescription drugs  -- that  she

            could not reasonably be  trusted to meet her responsibilities

            as to medications.  Although the qualification analysis could

            be   understood  to   subsume  the   concept   of  reasonable

            accommodation, we think it  analytically sounder to treat the

                                
            ____________________

            "qualified");  and (3)  that the  employer discharged  her in
            whole or  in part because of her disability.  See Jacques, 96
                                                          ___ _______
            F.3d at  511; Katz v.  City Metal Co.,  Inc., 87 F.3d  26, 30
                          ____     ____________________
            (1st Cir. 1996); see also 42 U.S.C.   12112(a).  The district
                             ___ ____
            court  used  the  largely  similar  formula  under  McDonnell
                                                                _________
            Douglas Corp. v. Green, 411 U.S. 792 (1973), for establishing
            _____________    _____
            a  prima facie  case of  discrimination.   Either  formula is
            appropriate here.  See Katz, 87 F.3d at 30.
                               ___ ____

                                         -15-
                                          15

            two topics separately.  Cf. Southeastern Community College v.
                                    ___ ______________________________

            Davis,  442  U.S.  397,  406  (1979)("An otherwise  qualified
            _____

            person [under the Rehabilitation  Act] is one who is  able to

            meet  all  of  a  program's  requirements  in  spite  of  his

            handicap.").3

            Qualification/Direct Threat Under Title I of the ADA
            ____________________________________________________

                      To understand the EEOC's  burden of proof argument,

            it is necessary to  understand the ADA statutory scheme.   At

            its core, Title I of the ADA is about protecting the disabled

            from  discriminatory employment  action based  on stereotypes

            and fear.   See H.R. Rep.  No. 101-485, pt. 3,  at 45 (1990),
                        ___

            reprinted in 1990 U.S.C.C.A.N. 445, 468; see also Jacques, 96
            _________ __                             ___ ____ _______

            F.3d at 511.   The prima facie case establishes  that because

            an  individual  with  a  disability  is  qualified,  yet  has

            suffered   adverse   employment   action  because   of   that

            disability,  the employer  may have  engaged in  the  type of

            discrimination  the ADA is  designed to  prevent.   Here, the

            plaintiff has failed to  establish a prima facie case:  there

            is  no evidence  suggesting the  presence of  any disability-

            based discrimination. 

                      The general  rule of  the ADA  is that  an employer

            shall not "discriminate against a qualified individual with a

            disability because  of the disability .  . . ."   42 U.S.C.  

                                
            ____________________

            3.  As    explained    below,   caselaw    interpreting   the
            Rehabilitation  Act of 1973 is applicable to the ADA.  See 29
                                                                   ___
            U.S.C.   794(d).

                                         -16-
                                          16

            12112(a).  It is generally accepted that, in a  Title I case,

            the  plaintiff  bears   the  burden  of  showing  she   is  a

            "qualified" individual.  See Jacques, 96 F.3d at 511.  
                                     ___ _______

                      A qualified  individual is one who  can perform the

            essential  functions  of  the job  held.    See  29 C.F.R.   
                                                        ___

            1630.2(m).     The   statute   also  says   that  "the   term

            'qualification standards'  may include a requirement  that an

            individual  shall not pose a  direct threat to  the health or

            safety of other individuals  in the workplace."  42  U.S.C.  

            12113(b).     It  defines  "direct  threat"   as  meaning  "a

            significant risk  to  the health  or  safety of  others  that

            cannot be eliminated by reasonable accommodation."  42 U.S.C.

               12111(3).     The   rub   is  that   the  language   about

            "qualification standards" under Title  I appears in a section

            of the  statute entitled "Defenses."   42  U.S.C.    12113(a)

            ("It may be  a defense  to a charge  of discrimination  under

            [the  ADA]  that  an  alleged  application  of  qualification

            standards . . . has been shown to be job-related.")  The EEOC

            argues  that the employer bears  the burden of  proof on this

            affirmative defense.  

                      The EEOC  argues further that whenever  an issue of

            threats to  the safety or health  of others is involved  in a

            Title I case, it  must be analyzed under the  "direct threat"

            provision   of      12113(b)   as  an   affirmative  defense.

            Specifically, the EEOC contends that the   12113(b) provision

                                         -17-
                                          17

            that qualification standards  may include a requirement  that

            an  individual not be  a direct threat  is to be  read in the

            context  of the  defense set  out in    12113(a).   The  EEOC

            supports  its position  by noting that    12113  is captioned

            "Defenses."4  Thus,  the EEOC says, the  district court erred

            in considering the matter of whether Guglielmi posed a threat

            to   the  safety   of  Amego's   clients  as   a   matter  of

            "qualification," on which plaintiff  bears the burden.  Amego

            contends  that the risks posed to others may be considered as

            part  of  the qualified  individual  analysis,  and that  the

            specific discussion  of a  direct threat defense  in    12113

                                
            ____________________

            4.  The  confusion   on  this  point  is   reflected  in  the
            legislative    history.   During    congressional   hearings,
            Representative   Dannemeyer   asked   a  witness,   who   had
            contributed to the drafting of the ADA, who had the burden of
            proof on the direct threat issue  in the communicable disease
            context.     Comm.  on  Educ.   and  Labor,  U.S.   House  of
            Representatives,  101  Cong., 1st  Sess., The  Americans with
                                                      ___________________
            Disabilities  Act  1896  (Comm.  Print 1990).    The  witness
            _________________
            replied  that the plaintiff, as part of his prima facie case,
            would have to put on  evidence that his communicable  disease
            would not pose a direct threat to others.  Id.
                                                       ___
                There  is also  caselaw establishing  that  even under  a
            "direct threat" analysis, the  "employee retains at all times
            the  burden of persuading the  jury either that  he was not a
            direct   threat  or   that  reasonable   accommodations  were
            available."   Moses v. American Nonwovens, Inc., 97 F.3d 446,
                          _____    ________________________
            447 (11th  Cir. 1996)(per curiam)(citing Benson  v. Northwest
                                                     ______     _________
            Airlines, Inc.,  62 F.3d 1108,  1112 (8th Cir.  1995)), cert.
            ______________                                          _____
            denied, 117 S. Ct. 964 (1997).  In affirming summary judgment
            ______
            for the employer  in an  ADA action brought  by an  epileptic
            product  inspector  who worked  near  exposed  machinery, the
            Moses  court  noted  that  to defeat  summary  judgment,  the
            _____
            nonmoving party must  raise "significant probative  evidence"
            that  is "sufficient" for the  jury "to return  a verdict for
            that party."  Id.  at 447 (citing Anderson v.  Liberty Lobby,
                          ___                 ________     ______________
            Inc., 477 U.S. 242, 249 (1986)).
            ____

                                         -18-
                                          18

            does not preclude the consideration of  safety risks in other

            prongs of the ADA analysis. 

                      Because  the  statutory  scheme  does  not  clearly

            resolve this debate,  we look to  the legislative history  to

            determine  whether   risks  posed  to  others   may  only  be

            considered in the direct threat defense context.   See United
                                                               ___ ______

            States v. Charter  Int'l Oil Co., 83 F.3d  510, 517 (1st Cir.
            ______    ______________________

            1996).  Upon such review, we discern  no congressional intent

            to preclude the consideration of essential job functions that

            implicate   the   safety   of   others   as   part   of   the

            "qualifications" analysis, particularly  where the  essential

            functions of a job involve the care of others  unable to care

            for  themselves.    The  House  Report5  said  that,  in  the

            definition of  "direct threat,"  "[t]he Committee  intends to

            codify  the direct threat standard used  by the Supreme Court

            in School Board of Nassau County  v. Arline."  H.R. Rep.  No.
               _____________________________     ______

            101-485, pt. 3, at 34 (1990), 1990  U.S.C.C.A.N. at 457.  The

            House  Report goes  on to  say that,  "[i]f the  applicant is

            otherwise  qualified  for  the  job,  he  or  she  cannot  be

            disqualified on the  basis of a physical or  mental condition

                                
            ____________________

            5.  The report  was concerned about exclusion  of individuals
            based  on fears  or stereotypes,  rather than  on "objective"
            evidence about the individual involved.  Thus, in the case of
            a person with mental illness there must be objective evidence
            from  the  person's behavior  that  the person  has  a recent
            history  of committing  overt  acts or  making threats  which
            cause harm or which directly threatened harm.  H.R. Rep. 101-
            485, pt. 3, at 45-46, 1990 U.S.C.C.A.N. at 468-69.

                                         -19-
                                          19

            unless  the  employer can  demonstrate  that  the applicant's

            disability  poses a direct threat to others in the workplace.

            . . .   The plaintiff is not required to prove that he or she

            poses no  risk."  Id. at  46, 1990 U.S.C.C.A.N. at  469.  The
                              ___

            intent to codify Arline suggests that   the   burden  is   on
                             ______

            plaintiff to show that he or she is qualified in the sense of

            not  posing a direct threat.  Arline considered that issue to
                                          ______

            be part of  the "qualification"  analysis under    504 as  to

            which plaintiff bears the  burden.6  See Arline, 480  U.S. at
                                                 ___ ______

            287-88.

                      The  ADA  also  contains  a directive  that  it  be

            enforced in a manner that is consistent with the requirements

            of the Rehabilitation  Act of  1973.  42  U.S.C.    12117(b).

            Courts   therefore   use  caselaw   under       504  of   the

            Rehabilitation  Act,  29  U.S.C.      794,  for  guidance  in

            interpreting the ADA.   See 29 U.S.C.   794(d)("The standards
                                    ___

            used  to  determine  whether  this  section  [   504  of  the

            Rehabilitation Act] has been violated in a complaint alleging

            employment  discrimination under  this section  shall  be the

            standards applied under Title I of the [ADA]."); Katz v. City
                                                             ____    ____

            Metal  Co., Inc., 87 F.3d 26, 31 n.4 (1st Cir. 1996) (Section
            ________________

            504 of the  Rehabilitation Act "is interpreted  substantially

                                
            ____________________

            6.     While the language of the "direct threat" provision is
            not  limited  to  instances   where  the  threat  comes  from
            communicable  diseases,  the   provision  originated  in  the
            communicable disease context.  See H.R. Rep. No. 101-485, pt.
                                           ___
            2, at 76, 1990 U.S.C.C.A.N. at 358-59.

                                         -20-
                                          20

            identically to the ADA.").  Under   504, it is clear that the

            question  of whether  the employment  of the  plaintiff poses

            risks to  the health  of others  is analyzed  as a  matter of

            whether  the person  is "otherwise  qualified."   Arline, 480
                                                              ______

            U.S. at 287; see also Abbott  v. Bragdon, --- F.3d ---,  ---,
                         ___ ____ ______     _______

            1997 WL 85096,  at *7 (1st  Cir. March  5, 1997) ("A  court's

            goal  in conducting a direct threat analysis under the ADA is

            to achieve a reasonable balance, protecting service providers

            . . .  from  enforced  exposure  to  unacceptable health  and

            safety    risks"   while   protecting   the   disabled   from

            discrimination.).  
                               

                      In Arline,  the Court  held that  the issue  of the
                         ______

            threat  to others  posed by an  employee with  a communicable

            disease was  properly analyzed as  a question of  whether the

            employee was "otherwise qualified."  Arline, 480 U.S. at 287.
                                                 ______

            The Court noted that  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."

            Id.  at 287  n.16.   Arguably,  in  Arline, the  question  of
            ___                                 ______

            whether the plaintiff  could perform the core  functions of a

            school  teacher's  job  was  separate from  the  question  of

            whether  she   nonetheless  posed  a  risk   because  of  her

            communicable disease.  Here,  the questions are not separate:

                                         -21-
                                          21

            the issue of risk posed to others arises in the  context of a

            core function of the job.

                      The  EEOC correctly  points  out that,  unlike  the

            Rehabilitation   Act,  the  ADA's  definition  of  "qualified

            individual" does not address risk posed to others.   While it

            is  true   that  the   implementing  regulations   under  the

            Rehabilitation   Act   define   "qualified  individual   with

            handicaps"  specifically to include  "without endangering the

            health and safety of  the individual or others," 29  C.F.R.  

            1614.203(6),   Congress  intended  the  ADA's  definition  of

            "qualified individual with a disability" to be "comparable to

            the definition used in  regulations implementing section  501

            and section 504  of the  Rehabilitation Act of  1973."   H.R.

            Rep. 101-485, pt. 2, at 55, 1990 U.S.C.C.A.N. at 337.

                      The EEOC  stakes out a  position which  is far  too

            broad.  This is not a case where a person who can perform all

            essential job  functions nonetheless poses a  risk to others.

            The  district court  did  not, we  believe,  commit error  in

            considering  risk  posed  to  others under  the  category  of

            "qualification," where the risk  is expressly associated with

            performance of an essential job function.

                       The  precise  issue here  concerns  the employer's

            judgment that  Guglielmi could not  be trusted to  handle the

            medication-related functions  of her job.   In  this case,  a

            failure to  perform an  essential function --  overseeing and

                                         -22-
                                          22

            administering medication --  would necessarily create a  risk

            to  others.   That  a  failure  to  perform  a  job  function

            correctly  creates a  risk to  others does  not preclude  the

            ability   to  perform   that  function   from  being   a  job

            qualification.  The position argued by the EEOC would lead to

            the anomalous result that there is a lesser burden of proving

            qualifications on a plaintiff where the job involves the care

            of others, and necessarily entails risk to  others, than when

            the  job does not.   We do  not believe  Congress intended to

            weaken the burden on plaintiffs to show they are qualified in

            such circumstances.

                      In such  cases, where  the employee is  responsible

            for ensuring the  safety of  others entrusted to  his or  her

            care, other courts, without discussion  of the point the EEOC

            raises,  have simply considered the risk  question to be part

            of the "qualified" analysis.  See, e.g., Doe v. University of
                                          ___  ____  ___    _____________

            Maryland Med. Sys. Corp., 50 F.3d 1261, 1265 (4th Cir. 1995);
            ________________________

            Altman v. New York City Health and Hosp. Corp., 903 F.  Supp.
            ______    ____________________________________

            503, 509-10 (S.D.N.Y. 1995); Mauro v.  Burgess Med. Ctr., 886
                                         _____     _________________

            F. Supp. 1349, 1352-53 (W.D. Mich. 1995).  

                      We  hold that,  in a  Title I ADA  case, it  is the

            plaintiff's burden to  show that  he or she  can perform  the

            essential functions of the job, and is therefore "qualified."

            Where those essential job functions necessarily implicate the

            safety  of others,  plaintiff must  demonstrate that  she can

                                         -23-
                                          23

            perform  those  functions in  a  way that  does  not endanger

            others.  There may  be other  cases under  Title I  where the

            issue of direct threat is not  tied to the issue of essential

            job functions but is purely a matter of defense, on which the

            defendant would bear the burden.  This case does not raise or

            resolve  issues of  the  role of  "direct threat"  provisions

            under  other   parts  of   the  ADA,   such  as  the   public

            accommodation title.   Cf. Abbott,  1997 WL 85096.   For  the
                                   ___ ______

            reasons which follow, we  conclude plaintiff's burden was not

            met.

            Appropriateness of Summary Judgment
            ___________________________________

                      The EEOC argues that  a jury question is presented,

            in any event, as to whether the evidence showed Guglielmi was

            qualified.  This is not, we think, a close question.

                      We set  the context.   Guglielmi did  not meet  her

            burden of demonstrating that  she is qualified.  There  is in

            this record no suggestion that  the employer has applied  its

            standards differentially.  The EEOC presents no evidence that

            the employer has ever found a  similarly situated employee to

            be  qualified to  handle the  essential medication  function.

            Instead, the  EEOC attempts  to derive from  its disagreement

            with Amego  over whether Guglielmi is  qualified an inference

            that   the  employer's  different   assessment  is  based  on

            disability  discrimination.    However,  where,  as  here, no

            evidence  of animus  is present,  courts may  give reasonable

                                         -24-
                                          24

            deference to  the employer's assessment of  what the position

            demands.   See Doe v. New  York Univ., 666 F.2d  761, 776 (2d
                       ___ ___    _______________

            Cir.  1981)(finding  that,  in  case  involving  mentally ill

            applicant to medical school, "considerable judicial deference

            must  be  paid to  the  evaluation  made by  the  institution

            itself, absent  proof that its standards  and its application

            of them serve  no purpose other than to  deny an education to

            handicapped  persons");  cf. Southeastern  Community College,
                                     ___ _______________________________

            442  U.S.  at 406  (supporting  reasonable  deference to  the

            decisions made by administrators of federally funded programs

            so  long as no evidence is presented of discriminatory intent

            with regard to the handicapped person). 

                      The  requirement  of  showing "qualifications"  has

            substance, notwithstanding the frequent leapfrogging  of that

            analysis  to  get  to   the  pretext  issue  under  McDonnell
                                                                _________

            Douglas.7   In  the context  of academic  tenure  cases, this
            _______

            court has been attentive to the need  to balance the right of

            a  plaintiff  to  be  free from  discrimination  against  the

            undesirable result of having the court sit as a "super-tenure

            committee."   See Villanueva  v. Wellesley College,  930 F.2d
                          ___ __________     _________________

                                
            ____________________

            7.  The  ADA is interpreted in a manner similar to Title VII,
            Soileau, 105  F.3d at 16, and courts  have frequently invoked
            _______
            the familiar burden-shifting analysis of McDonnell Douglas in
                                                     _________________
            ADA cases.  The  qualification prong of the prima  facie case
            is frequently met  by a showing  that the employee  satisfied
            the  prerequisites for the position and  that she can perform
            the essential functions of the position held or desired.  See
                                                                      ___
            42 U.S.C.   12111(8); 29 C.F.R.   1630.2(m).

                                         -25-
                                          25

            124, 129 (1st  Cir. 1991).   Thus, plaintiffs  who have  been

            denied  tenure must  show  that their  qualifications are  at

            least  comparable  to those  of  a  "middle group  of  tenure

            candidates as to whom both a decision  granting tenure  and a

            decision denying  tenure could  be justified as  a reasonable

            exercise of  discretion by the tenure-decision  making body."

            Banerjee  v. Board  of Trustees,  648 F.2d  61, 63  (1st Cir.
            ________     __________________

            1981).  Aware of the fine balance of competing considerations

            that  preserve academic  freedom, this  court has  noted that

            "[i]n tenure cases, courts must take special care to preserve

            the University's autonomy in making lawful tenure decisions."

            Brown v. Trustees  of Boston  Univ., 891 F.2d  337, 346  (1st
            _____    __________________________

            Cir. 1989).  

                      Similar care is required here.  Where the plaintiff

            has presented no  evidence of discriminatory intent,  animus,

            or even pretext, we think there should be special sensitivity

            to  the  danger  of  the court  becoming  a  super-employment

            committee.   Unlike the  academic institutions in  the above-

            cited  cases,  Amego is  a small  employer.   Its  history of

            employment decisions is neither  lengthy nor detailed, making

            it difficult to assume, without help from plaintiff, that the

            qualification   standards  it   asserts  for   Guglielmi  are

            different from those required  of other employees.  Plaintiff

            has failed to provide such help.   It is in this context that

            we  review the  facts.   We are  also mindful  of the  Arline
                                                                   ______

                                         -26-
                                          26

            factors for assessing whether an employee poses a significant

            risk to others.  Cf. Arline, 480 U.S. at 288.8
                             ___ ______

                      It  was  eminently  reasonable  for  Amego  to   be

            concerned    about   whether   Guglielmi   could   meet   her

            responsibilities, and also reasonable for it to conclude that

            the risk was too great to run.   The employer's judgment here

            about the risks of future behavior by an employee is based on

            past behavior and reasonable indicia of future behavior.  

                      First,  the nature of the risk was such that it was

            extremely  difficult  to guard  against.    The clients  were

            particularly vulnerable to abuse  or neglect.  The mechanisms

            to  insure that  they were  properly treated  with regard  to

            their medications, other than  having trustworthy staff, were

            not obvious.  Amego had just learned that, despite its normal

            procedures, four  patients at  the Fales Road  residence were

            overly medicated and  that it could not determine whether any

            medications  were missing.    Testing the  clients' blood  to

            determine whether they had received the correct dosage level,

            or  indeed  the  correct  drugs,  has  to  be  considered  an

            extraordinary step, and not a safeguard which could routinely

                                
            ____________________

            8.  In  determining whether  an individual  poses significant
            health  and safety risk  to others in  the contagious disease
            context, the Arline Court  suggested the consideration of the
                         ______
            following factors:  the nature of  the risk; the  duration of
            the  risk; the  severity of  the risk  (potential of  harm to
            third  parties), and  the probabilities  the disease  will be
            transmitted and will cause varying degrees of harm.  Id.   We
                                                                 ___
            conduct  our analysis of  the safety risk  Guglielmi poses to
            Amego clients against this backdrop.

                                         -27-
                                          27

            be  taken.  Additionally, the severity of the risk, i.e., the
                                                                ____

            potential  harm to third parties, Arline, 480 U.S. at 288, is
                                              ______

            great.   The  potential outcomes  of administering  the wrong

            medication to a client are obvious and extreme.

                      Second,   there   were  performance   issues  which

            enhanced  the likelihood  that  the clients  could be  harmed

            unless  steps were  taken.   Amego received  complaints, from

            other  staff members, that  Guglielmi was unable  to focus on

            her job  and  was a  risk  to patients.   The  situation  was

            serious  enough  that  staff  members  sent  an  emissary  to

            management, asking  that something be done.   The peculiarity

            of Guglielmi  finding the missing  medication log at  a place

            which had  been searched earlier would  reasonably give Amego

            pause.   Amego had reason  to fear that  Guglielmi would take

            medications  from  Amego.    When  the  police  came  to  her

            apartment on the  night of her  second suicide attempt,  they

            found  pills they believed to be Klonopin.  Klonopin is taken

            by cocaine  users, and management suspected the man with whom

            Guglielmi lived of being a cocaine user and of drugging Amego

            clients.9

                                
            ____________________

            9.  Amego  did  not  learn  until after  it  had  decided  to
            terminate Guglielmi's  employment that Guglielmi had  lied to
            them about  whether she  suspected Andrade of  using cocaine.
            Because  it is unnecessary to the decision, we do not address
            the issue  of whether this after-acquired  evidence could, in
            the context of the ADA, be used for purposes other  than as a
            rationale for  terminating her employment, e.g.,  to buttress
                                                       ____
            the  employer's  judgment that  Guglielmi's untrustworthiness
            affected her  ability to  perform an essential  job function.

                                         -28-
                                          28

                      Third, other measures  had not eliminated the  risk

            of  Guglielmi  mishandling  medication.    Amego  knew  that,

            despite counselling  and medication, Guglielmi  had attempted

            suicide  a second  time using medication  and that  she would

            have access  to Prozac at work, one of the drugs used in this

            second attempt.   The EEOC  says that Amego  should have  had

            greater  confidence in Guglielmi because  she no longer had a

            prescription  for drugs after  the second attempt.   There is

            cold comfort in that: this fact increased the likelihood that

            Guglielmi  would use the drugs available to her at work for a

            third attempt.  Amego also knew that despite its provision of

            a work schedule accommodation,  Guglielmi soon stopped  going

            to the therapy sessions  she said she wanted to  attend after

            her first suicide attempt.  Amego knew that by concealing her

            suicide attempts  Guglielmi had misled them  about the nature

            of her previous absences from work. 

                      Fourth,   when   Amego   sought  reassurance   from

            Guglielmi's health  care providers,  the  responses were  not

            confidence-building.    Posever, the  social  worker, neither

            responded to the substance of the request for information nor

                                
            ____________________

            Cf.  Mantolete  v. Bolger,  767  F.2d  1416, 1424  (9th  Cir.
            ___  _________     ______
            1985)(holding  that,  in  Rehabilitation  Act   case,  later-
            discovered   evidence  as   to  plaintiff's   actual  medical
            condition  is  admissible to  rebut  plaintiff's  prima facie
            showing  of qualification).   But  cf. McKennon  v. Nashville
                                          ___  ___ ________     _________
            Banner  Publ'g Co., 115 S. Ct. 879, 885 (1995) (holding that,
            __________________
            in ADEA  cases, after-acquired evidence  may not  be used  to
            justify discriminatory  discharge, though  it may be  used to
            limit plaintiff's recovery).

                                         -29-
                                          29

            signed  her  name  to the  checklist.    After receiving  the

            checklist,  Driscoll telephoned Posever.   Posever explicitly

            declined to give  a psychiatric medical opinion.   Dr. Levin,

            the psychopharmacologist, gave  a brief response  which Amego

            could  reasonably   understand  to  be  unresponsive  to  its

            concerns and to be based on Guglielmi's own assessment of her

            ability to do the work.

                      We also  credit  the deliberative  process  through

            which Amego made its decision.10  It sought additional input,

            including  that  from   Guglielmi's  medical  advisors,   and

            considered  other information  before reaching  its decision.

            This  deliberative process  undercuts any  argument  that the

            employer  based   its  decision   as  to   qualifications  on

            stereotypes about disability.  There  can be no serious claim

            that Amego, which  had considerable  experience dealing  with

            mentally  handicapped persons and  integrating them  into the

            community,  acted on the  basis of the  stereotypes and fears

            which  Congress wished to counteract in the ADA.  Also, Amego

            had  earlier made  accommodations.   It  modified Guglielmi's

            schedule  so  that  she   could  receive  treatment  and  was

            supportive  of her efforts to  deal with her  condition.  See
                                                                      ___

            Soileau, 105 F.3d at 17.
            _______

                                
            ____________________

            10.  As the district court noted, the irony is that, if Amego
            had acted with less deliberation, the employment action would
            have  been taken before the  effective date of  the ADA.  The
            ADA became effective a few days before Guglielmi's discharge.

                                         -30-
                                          30

                      Amego also operated in a context which added weight

            to the risks it  thought Guglielmi posed.  Amego  is licensed

            by two state agencies and is required to take steps to assure

            the  safety of  its patients.   If a  single client  had been

            harmed from misuse  of medication, then Amego  stood the risk

            of losing its licenses and its ability to care for any of its

            clients.11 

                      Under these  circumstances,  where no  evidence  of

            differential  treatment,  discrimination, or  stereotyping is

            proffered,  the  employer's  judgment  is  entitled  to  some

            weight.    The  EEOC's  "Interpretive Guidance"  to  its  ADA

            regulations notes that the  inquiry into essential  functions

            is  not  intended  to  second-guess  an  employer's  business

            judgment regarding production standards,  whether qualitative

            or  quantitative.  EEOC, Interpretive Guidance  on Title I of
                                     ____________________________________

                                
            ____________________

            11.  In Arline, the Supreme Court noted that deference should
                    ______
            be  given to the judgments  of public health  officials as to
            the  analysis   of  whether  an  individual  is  "qualified."
            Arline, 480  U.S. at 288;  cf. Abbott,  1997 WL 85096,  at *9
            ______                     ___ ______
            (reasoning that deference of "prima facie force is due public
            health officials").   No  such direct evidence  was presented
            here.   But it  is noteworthy that  Amego was subject  to the
            regulatory  requirements  of  two  public  agencies.    As  a
            condition of  receipt of public funds, Amego must be licensed
            to  operate  by  the   Massachusetts  Department  of   Mental
            Retardation and  the Massachusetts Office for  Children.  One
            of  the  requirements  for licensure  included  ensuring  the
            safety  and well-being  of the  clients entrusted  to Amego's
            care. 

                                         -31-
                                          31

            the Americans with  Disabilities Act, app.  to 29 C.F.R.  pt.
            ____________________________________

            1630.12

                      In somewhat similar  factual settings, other courts

            have affirmed summary judgment on the issue of qualification.

            In Doe  v. University  of Maryland  Medical System  Corp., 50
               ___     ______________________________________________

            F.3d  at 1261,  the defendant  medical center  terminated the

            employment  of an  HIV-positive doctor.   The  court affirmed

            summary  judgment on the grounds  that the doctor  was not an

            "otherwise   qualified"  individual   because   he  posed   a

            significant  risk to  patients that  could not  be eliminated

            through  reasonable accommodation.   Id. at 1266.   The court
                                                 ___

            rejected the doctor's argument  that the risk of transmission

            was  so  infinitesimal  that   it  could  not  be  considered

            significant.  Id. The  employer had relied on recommendations
                          ___

            from the Center for Disease Control in analyzing  whether the

            doctor's  job functions fit  the definition of exposure-prone

            procedures.  Id. at 1264.  The court expressed its reluctance
                         ___

            to substitute  its judgment for  that of the  medical center.

            Id. at 1266.  In Bradley v. University of Texas M.D. Anderson
            ___              _______    _________________________________

            Cancer  Center, 3 F.3d 922 (5th Cir. 1993), the Fifth Circuit
            ______________

                                
            ____________________

            12.  It is  true that  the Interpretive Guidance  also states
            that the determination  whether someone is qualified  "should
            not  be based  on speculation  that the  employee may  become
            unable in the future."  Id.   This not such a case.   Rather,
                                    ___
            Amego based its determination on Guglielmi's capabilities "at
            the  time  of  the  employment  decision,"  as  the  Guidance
            suggests is appropriate.  Id.
                                      ___

                                         -32-
                                          32

            affirmed  entry  of summary  judgment for  the employer  on a

            Rehabilitation Act claim with similar facts.  

                      Similarly,  the  Fourth  Circuit  in  Martinson  v.
                                                            _________

            Kinney  Shoe Corp.,  104 F.3d 683  (4th Cir.  1997), affirmed
            ______  __________

            summary judgment on the ground that an epileptic employee was

            not qualified  to perform an  essential job  function of  his

            salesperson's  job   at  a   retail  store,   which  entailed

            maintaining  store  security.   See  also  Kohl v.  Woodhaven
                                            ___  ____  ____     _________

            Learning Ctr., 865 F.2d  930 (8th Cir. 1988) (finding  that a
            _____________

            Hepatitis  -  B  carrier  patient  who  displayed  aggressive

            behavior would pose an  unreasonable risk of transmitting the

            disease to other patients and staff); cf. Arline, 480 U.S. at
                                                  ___ ______

            288. 

            Reasonable Accommodation
            ________________________

                      The  EEOC argues  that Amego  was required  to move

            Guglielmi  from  the  Team  Leader  position  to  a  Behavior

            Therapist  position as  a reasonable  accommodation.   If the

            Behavior Therapist  position required no  responsibility with

            respect  to  medication, there  would  be more  force  to the

            EEOC's position.   See Hurley-Bardige v. Brown, 900  F. Supp.
                               ___ ______________    _____

            567, 570 (D.  Mass. 1995)(finding  that there is  "no per  se

            rule against transfers  as reasonable accommodations").   But

            the position did entail that responsibility. 

                      Although   medication-related    duties   are   not

            specifically   mentioned  in   the  Behavior   Therapist  job

                                         -33-
                                          33

            description, the ability to handle,  administer, and document

            medication  was inherently part  of the  Behavior Therapist's

            function,   as  listed   in   Amego's  job   description,  of

            "implementing individual clinical and  educational programs."

            13 

                      All  Behavior Therapists  receive  training in  the

            administration of medications.  Behavior Therapists accompany

            clients  on frequent  off-site trips  into the  community and

            must dispense  medications  to clients  at appropriate  times

            without  supervision.   When  no  Shift  Supervisors or  Team

            Leaders  are present,  the Behavior Therapists  must dispense

            medications  at  the  residences.   Behavior  Therapists also

            accept   deliveries  of   client   medications   in   Amego's

            facilities.    Keys  to   the  medicine  cabinet  are  easily

            accessible to Behavior Therapists. 

                      There is  no  material factual  dispute;  only  the

            legal  implications  of  these  facts are  in  true  dispute.

            Medication-related duties of  the Behavior Therapist position

            are  essential, and not marginal, to the position.  While the

            amount  of  time  a   Behavior  Therapist  spends  dispensing

                                
            ____________________

            13.  Evidence of whether  a particular function  is essential
            includes, but  is not  limited to, written  job descriptions;
            the employer's judgment as  to which functions are essential;
            the  amount of time spent on the job performing the function;
            the consequences  of not  requiring the plaintiff  to perform
            the  function; and the work experience of those who are doing
            or have done similar jobs.  29 C.F.R.   1630.2(n).  

                                         -34-
                                          34

            medication is not great, the consequences of getting it wrong

            are quite great indeed.  

                      There was no accommodation that Amego could make to

            the Behavior Therapist position that would not cause it undue

            hardship.  See  42 U.S.C.    12112(b)(5)(A),  12111(9).14  To
                       ___

            retain  Guglielmi   while  eliminating  all   of  Guglielmi's

            medication-related duties,  it would  have been  necessary to

            hire another  Behavior  Therapist to  be paired  with her  to

            ensure that she would never  be left alone with a client  who

            needed  medication.     Amego  might  also   have  needed  an

            additional supervisor  to ensure that Guglielmi  did not have

            access to  client medications.   The expense of  hiring these

            additional  staff would  be too great  for a  small nonprofit

            like  Amego to be reasonably  expected to bear.15   See Vande
                                                                ___ _____

                                
            ____________________

            14.  In determining whether an accommodation  would impose an
            undue hardship under  the ADA, the  factors to be  considered
            include:  the  nature  and  cost of  the  accommodation;  the
            overall financial  resources of  the facility; the  number of
            persons employed at the facility; the effect on expenses  and
            resources, or the impact otherwise of such accommodation upon
            the  operation  of   the  facility;  the   overall  financial
            resources  of  the covered  entity; the  overall size  of the
            business of a covered entity; the number, type,  and location
            of  its facilities; and the type of operations of the covered
            entity including the composition, structure, and functions of
            the workforce  of such entity;  the geographic  separateness,
            administrative,  or fiscal  relationship of  the facility  in
            question to the covered entity.  42 U.S.C.   12111(10)(B).

            15.  The  cost  of  an  additional  Behavior  Therapist,  for
            example, would be approximately $20,000 (base  wages annually
            with benefits).  Given that Amego ended the fiscal years 1992
            and  1993 with a deficit, this would require additional funds
            which Amego does not have. 

                                         -35-
                                          35

            Zande v. Wisconsin  Dep't of  Admin., 44 F.3d  538, 542  (7th
            _____    ___________________________

            Cir. 1995)(holding that employer  may prove undue hardship by

            establishing that the costs of the proposed accommodation are

            excessive  in relation  either  to  its  benefits or  to  the

            employer's financial health or survival).

                      Another  possible  option, rearranging  Guglielmi's

            assignment to clients so that she was never with a client who

            required medication, would  obviously be difficult since,  at

            the time  of Guglielmi's employment,  only one client  at the

            Mansfield  residence  did  not  take  medication.   Assigning

            Guglielmi to  that one  client would disrupt  Amego's crucial

            one-staff-member-to-two-clients  ratio,16  or  result in  the

            need  for an  additional  Behavior Therapist.   Both  options

            would alter the basic  operations of Amego and go  beyond the

            scope of  a reasonable accommodation.   See Reigel  v. Kaiser
                                                    ___ ______     ______

            Found. Health Plan, 859 F. Supp. 963, 973 (E.D. N.C. 1994).
            __________________

                      Deploying another Behavior Therapist to Guglielmi's

            location   and  shift   or   changing  Guglielmi's   clients'

            programming  to  ensure that  they were  on site,  near other

            staff members, whenever they  needed to take medication would

            have  an equally  disruptive  effect on  Amego's clients  and

                                
            ____________________

            16.  Altering  these  staff/client  ratios  would  contravene
            specific  provisions that  are  included  in Amego's  funding
            contracts  and  the  clients'  individualized  educational or
            service plans. 

                                         -36-
                                          36

            staff   as   well   as   interfere   with   Amego's   funding

            requirements.17  See Ricks v. Xerox Corp., 877 F. Supp. 1468,
                             ___ _____    ___________

            1477  (D. Kan. 1995)(holding that the ADA does not require an

            employer to  hire a  full-time  helper to  assist a  disabled

            employee as a reasonable accommodation).

                      In   sum,   Amego    cannot   make   a   reasonable

            accommodation. To do what the EEOC asks would be to alter the

            very  nature  of  the  Behavior Therapist  position.    "Such

            redefinition exceeds  reasonable accommodation."   Bradley, 3
                                                               _______

            F.3d at 925.  

             "Because Of" and the Conduct/Disability Distinction
             ___________________________________________________

                      The EEOC argues that it met its burden on causation

            because, it says, the ADA prohibits adverse employment action

            that is based on conduct related  to a disability to the same

            extent that  it prohibits adverse employment  action based on

            the  underlying  disability  itself.    It  says  that  Amego

            terminated Guglielmi because of her suicide attempts and that

            the  termination was, therefore, "because of" her disability.

            Even if Amego terminated  Guglielmi for misusing  medication,

            rather  than  for  attempting  suicide,  the  EEOC  says  the

            termination decision was still "because of" her disability.  

                                
            ____________________

            17.  Amego's  philosophy  of   maximizing  community   access
            opportunities is  incorporated into its funding contracts and
            into clients'  individualized  programs.   Amego  would  have
            violated  those   agreements  if  it  were   to  diminish  or
            artificially  restrict  community  access  opportunities  for
            either Guglielmi's or another employee's clients. 

                                         -37-
                                          37

                      To the extent that the EEOC is arguing that conduct

            connected to  a disability  always must be  considered to  be

            action  "because  of"  a  disability, that  is  too  broad  a

            formulation.  While one may hypothesize certain conduct which

            is in  fact more  closely compelled  by the  disability (e.g.
                                                                     ____

            profanity from Tourette's Syndrome sufferers), this case does

            not provide the occasion to explore what merit there might be

            to  a more refined formulation  of the EEOC's  position.  The

            syllogism which the EEOC presents -- Guglielmi was depressed,

            therefore Guglielmi attempted suicide, therefore any response

            to  the attempted suicide  is "because of"  her disability --

            breaks down.  Apart from the evidence that staff believed she

            was  a threat to clients based on her at-work behavior alone,

            Amego has  been clear, for  purposes of the  summary judgment

            motion, that it was the manner of the suicide attempts -- use

            of  medications, including  prescription medications  -- that

            motivated its decision.18

                      There  is  simply   no  evidence  that  Guglielmi's

            depression  compelled her  to  overdose  on  medications,  as

            opposed to  other methods  of attempting suicide.   At  best,

            EEOC's evidence  was that individuals suffering  from bulimia

            and depression sometimes  have suicidal  thoughts or  attempt

                                
            ____________________

            18.  Amego,  through  its Safety  Committee,  determined that
            Guglielmi  could  not  safely   perform  any  of  the  eleven
            responsibilities  of the  Team  Leader position  but did  not
            raise this argument on summary judgment. 

                                         -38-
                                          38

            suicide.  In  Taub v. Frank, 957 F.2d 8 (1st Cir. 1992), this
                          ____    _____

            court  held  that  a  plaintiff  could  not  show  under  the

            Rehabilitation Act  that he was  discharged by reason  of his

            handicap,  drug addiction,  because his heroin  addiction was

            "simply  too  attenuated  when   extended  to  encompass   an

            addiction-related  possession  of  heroin for  distribution."

            Id.   at  11.    Similarly,   in  Leary  v.  Dalton,  another
            ___                               _____      ______

            Rehabilitation  Act case,  this  court found  that where  the

            discharge from employment was for absenteeism  resulting from

            incarceration   for  driving   under   the   influence,   the

            plaintiff's disability of alcoholism  was not the sole reason

            for his termination.  58 F.3d 748, 752 (1st Cir. 1995). 

                      The  facts   of  this  case  do   not  present  the

            disability   and  conduct   connection  the   EEOC  suggests.

            Accordingly,  there  was no  error  in  the district  court's

            determination  that the EEOC also  has not met  its burden of

            showing  the   job  action  was   "because  of"   Guglielmi's

            disability.

                      The entry  of summary judgment for  Amego, Inc., is

            affirmed.
            ________

                                         -39-
                                          39