Justices rule that anti-bias law covers even those without AIDS
symptoms In a case with sweeping ramifications for HIV patients
and others with disabilities, the U.S. Supreme Court ruled
Thursday that HIV-infected people are protected by the
Americans With Disabilities Act, even if they suffer no
symptoms of AIDS.
It was the first AIDS-related ruling by the Supreme Court and
only the second involving the 8-year-old disabilities act.
"This ruling has incredibly important ramifications, not only
for people with HIV but with all people with disabilities,"
said Benjamin Schatz, spokesman for the San Francisco-based Gay
and Lesbian Medical Association, which has more than 2,000
physician members in all 50 states.
In another AIDS-related discrimination case, the state Supreme
Court allowed Wednesday a suit by a bank employee with HIV who
quit Wells Fargo when the bank stopped letting him telecommute
one day a week.
Tony Varona, chief counsel for the Human Rights Campaign in
Washington, D.C., said Thursday's 5-4 ruling by the U.S. high
court sent a clear message to health care providers that
"discrimination against people living with HIV is
scientifically unjustified and forbidden under law."
In New York, Tracey Conaty, spokeswoman for the National Gay
and Lesbian Task Force, said, "The task force is thrilled with
this decision, because what we've long known is that people
with AIDS and HIV are discriminated against and deserve
"This will go a long way toward ensuring they get redress and
hopefully will act as a deterrent against discrimination."
Thursday, the justices ruled in a Maine case in which a dentist
refused to fill an HIV-infected woman's tooth in his office.
The lower court had ruled in favor of the patient, Sidney
Abbott, but the case was appealed on the question of whether
asymptomatic HIV infection constituted a disability.
Saying it does, Thursday's ruling set aside the lower court
decision that dentist Randon Bragdon violated the ADA. The
Supreme Court ordered the appeals court to reconsider the case
in the context of the justices' conclusion.
The ruling emphasized that it does not "foreclose the
possibility that the Court of Appeals may reach the same
conclusion it did earlier."
The ruling could have an effect on a similar lawsuit in San
Francisco in which an HIV patient is suing UC-San Francisco for
allegedly refusing to perform surgery on him because of his HIV
Writing for the majority in the Maine case, Justice Anthony M.
Kennedy said, "HIV infection satisfies the statutory and
regulatory definition of a physical impairment during every
stage of the disease.
"(The dentist) had the duty to assess the risk of infection
based on the objective, scientific information available to him
and others in his profession."
In deciding whether a health care provider has violated the
ADA, Kennedy wrote, "courts should assess the objective
reasonableness of the views of health care professions without
deferring to their individual judgments."
Bush signed the ADA
The ADA, signed by President Bush in 1990, prohibits
discrimination against the disabled in jobs, housing and public
accommodations, including medical offices.
Bragdon argued that the possibility of HIV transmission from
Abbott to him merited his refusal of treatment, despite the
fact that public health authorities, including the U.S. Centers
for Disease Control and Prevention and the American Dental
Association, have determined that people with HIV may be
treated safely with standard precautions.
When he found a cavity near Abbott's gum line, he told her that
his infectious disease policy was that he would not fill the
cavity in his office but he would treat her only at a hospital
at her expense. She sued, contending that the contagious and
fatal nature of AIDS limited her ability to have sexual
relations and bear children.
A U.S. District judge and the First Circuit Court of Appeals
agreed. The ADA allows disabled people to be treated
differently if they pose a direct threat to the health or
safety of others, but public health authorities say there is no
documented case of a dentist contracting the AIDS virus from a
Bragdon's attorneys argued he should be permitted to use his
own judgment on how to safely treat such patients; they also
argued that having sex and bearing children should not be
considered major life activities under the ADA, similar to
seeing, hearing and walking.
Abbott's lawyers said that if HIV-infected people did not have
clear protection under the law, many would hide their
condition, a point with which GLMA's Schatz heartily agreed.
"The real fear in the (gay and lesbian) community was that the
Supreme Court would rule the other way," he said, "which would
create a climate of discrimination against people with HIV,
which in turn creates the exact climate in which HIV is most
Added HRC's Varona: "Many people who submit to voluntary HIV
testing do so comforted by the knowledge that all persons with
HIV infections are protected from discrimination under the
How justices voted
Kennedy was joined in the majority by Justices John Paul
Stevens, David Souter, Ruth Bader Ginsburg and Stephen Breyer.
Dissenting in part were Chief Justice William Rehnquist and
Justices Antonin Scalia, Clarence Thomas and Sandra Day
Rehnquist, writing for the minority except O'Connor, said
decisions on whether the ADA covers asymptomatic HIV-infected
individuals should be case by case. He said he didn't believe
Abbott had shown her infection substantially limited a major
life activity. O'Connor agreed in a separate dissent.
The same issue, although not tied to the ADA, is the key to a
suit by Guerneville HIV patient Stephen Iacovino against UCSF
orthopedic surgeon Dr. Franklin Hoagland.
In that case, Iacovino v. UC Regents, in San Francisco Superior
Court, Iacovino charges that Hoagland discriminated against him
by not performing surgery. Hoagland claims surgery would have
put Iacovino at high risk of post-operative infection.
The suit does not make outright ADA claims but says Iacovino
was discriminated against under the state Unruh Civil Rights
Iacovino said his avascular necrosis of the right shoulder was
so painful that he was taking daily doses of morphine and could
not lift his arm. Physical therapy had not helped and his
physicians recommended shoulder replacement. After being
rejected by Hoagland, Iacovino had the procedure performed in