Bragdon v. Abbot (1998)

By: Eowyn Dautrich

Overview:

Bragdon v. Abbott (1998) is a Supreme Court case in which plaintiff Sidney Abbott filed suit against dentist Randon Bragdon, who refused to treat her in his office because she had human immunodeficiency virus (HIV). Abbott alleged discrimination based on her disability in violation of § 302 of the Americans with Disabilities Act (ADA). Abbott had been diagnosed with HIV in 1986 and had not yet developed symptoms of the disease. After the United States District Court for the District of Maine granted summary judgment in Abbott’s favor, Bragdon, the defendant in the original lawsuit, appealed to the Supreme Court as the petitioner. Abbott, the original plaintiff, was the respondent. The Supreme Court granted certiorari to review the case. The primary issues were whether HIV constitutes a disability under the ADA, whether an asymptomatic HIV infection substantially limits a major life activity, and whether dental practices fall under the ADA.

Summary: 

In September 1994, Sidney Abbott went to the office of the practitioner Randon Bragdon in Bangor, Maine, for a dental appointment. She had disclosed her HIV infection during her registration. The petitioner completed a dental examination, discovered a cavity, and informed the patient of his policy against filling cavities of patients who were infected with HIV. He offered to perform the work at a hospital with no added fees for his services, though Abbott would be responsible for the hospital's costs. Abbott declined the offer.

Abbott brought suit under state law and § 302 of the ADA, alleging discrimination on the basis of her disability. Section 302 of the ADA states: “No individual shall be discriminated against on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation by any person who ... operates a place of public accommodation [1].” Professional offices of health care providers are included under the defined term of “public accommodation.” Additionally, a later subsection states that there is an exception if “such individual(s) pose a direct threat to the health or safety of others” [1]. This became part of the defendant’s argument, claiming that performing dental treatment created a risk to him due to the plaintiff's HIV infection.

After the United States and the Maine Human Rights Commission intervened as plaintiffs, the District Court ruled that the original plaintiff’s HIV infection satisfied the ADA’s definition of a disability based on the following definition:

“(A) a physical or mental impairment that substantially limits one or more of the major life activities of such individual;

(B) a record of such an impairment; or

(C) being regarded as having such an impairment.” [§ 12102(2)].” 

The court further held that the defendant did not raise a genuine issue of material fact as to whether the plaintiff’s HIV infection would have posed a direct threat to his or others’ safety during the dental treatment. The court relied on affidavits from Donald Wayne Marianos, Director of the Division of Oral Health at the Centers for Disease Control and Prevention (CDC), stating that dental offices can treat patients with HIV as long as they follow universal precautions described in the Recommended Infection-Control Practices for Dentistry issued by the CDC in 1993 (1993 CDC Dentistry Guidelines). 

The Court of Appeals affirmed, holding that an HIV infection was a disability under the ADA, despite the original plaintiff’s infection not being in the symptomatic stage. The Court of Appeals also agreed that treating her in the office would not have posed a threat to the health and safety of others. However, the Court of Appeals did not rely on the Marianos affidavits like the District Court. Instead, the court relied on the 1993 CDC Dentistry Guidelines, as well as the Policy on AIDS, HIV Infection and the Practice of Dentistry, promulgated by the American Dental Association in 1991 (1991 American Dental Association Policy on HIV) [1].

From the moment an individual contracts HIV, it must be regarded as a physiological disorder due to its constant effects on the individual's hemic and lymphatic systems. HIV, therefore, satisfies the statutory and regulatory definition of a physical impairment during every stage of the disease, but this alone did not satisfy the ADA’s definition of a disability. An impairment must also substantially limit a major life activity, which the original plaintiff supported with the claim that her HIV infection placed a substantial limitation on her ability to have children. Given the fatal course of the disease, its effect on major life activities of many kinds could have been relevant to the Court. The Court had little doubt that the parties who brought suit could have argued that an HIV infection imposes substantial limitations on other major life activities. However, because this case involved reproduction as the major life activity allegedly limited by HIV, the Court had to determine whether reproduction is a major life activity under the ADA. This determination would ultimately be made by the Supreme Court.

As the Court of Appeals held, reproduction falls within the bounds of a “major life activity.” This led the defendant to concede that reproduction is important but argue that Congress only intended the ADA to cover aspects of life that have a public, economic, or daily character, so it should not be considered a major life activity. The Supreme Court rejected this argument, explaining that the ADA does not limit major life activities to the defendant’s definition of “public, economic, or daily character.” Based on the Rehabilitation Act regulations, the Court held that reproduction is a major life activity under the ADA, agreeing with the decision by the Court of Appeals [1]. 

Thus, the Court held that Abbott’s asymptomatic HIV infection qualified as a disability under the ADA by a 5–4 majority. Justice Kennedy wrote the majority opinion, joined by Justices Stevens, Souter, Ginsburg, and Breyer. Chief Justice Rehnquist and Justices Scalia, Thomas, and O’Connor disagreed with the majority’s disability analysis [1].

Impact: 

The Supreme Court’s decision expanded the scope of the Americans with Disabilities Act (ADA) to include chronic illnesses and conditions such as HIV when they substantially limit a major life activity. This also allows asymptomatic conditions that may become more limiting later in the course of a disease to qualify as disabilities under the ADA. Additionally, the decision reinforced that health care providers must comply with the ADA because their professional offices are considered places of public accommodation. Providers also cannot rely on assumptions or stereotypes when invoking the ADA’s direct-threat defense, which must be supported by appropriate evidence. The decision also reinforced that health care providers cannot deny treatment based on assumptions about a patient’s disability and that a direct-threat defense must be supported by evidence. Most importantly, the case expanded recognition and awareness of disabilities that may not be visible to the naked eye.

Court Documents:

Bragdon v. Abbott, 524 U.S. 624 (1998).

Citations: 

[1] Bragdon v. Abbott. 524 U.S. 624. Supreme Court of the United States, 1998. Justia U.S. Supreme Court Center, supreme.justia.com.