This opinion concerns a case brought against a hospital by a surgical resident who was permanently suspended from surgical practice due to his HIV-status. The surgical resident brought claims under Title II of the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act, as well as the equal protection clause of the U.S. Constitution.
With regard to the ADA and Rehabilitation Act claims, the hospital defendants did not dispute that Doe's asymptomatic, HIV-positive status constituted a disability under both laws and that he was terminated because of his HIV-positive status. However, the defendants argued that Doe was not a "qualified individual" for the residency because he posed a "significant risk" of transmitting HIV to others during surgery and reasonable accommodations would not eliminate that risk. The Fourth Circuit agreed, and upheld summary judgment for the hospital defendants. The Fourth Circuit's conclusion broadly interprets "significant risk" to include almost any risk, given that it reached its conclusion "[i]n spite of the low risk of transmission" during surgery, because such transmission was "possible." The Fourth Circuit's decision is at odds even with the recommendations of the Center for Disease Control and Prevention (CDC) as well as the defendant hospital's panel of experts on blood-borne pathogens (whose recommendations were ignored by the hospital administration). The decision also ignored the fact that the status of health care workers is impossible to know at a given time, and thus the CDC recommends universal precautions to significantly reduce any risk of transmission. Indeed, the court admitted there had never been a case of surgeon-to-patient transmission.
With regard to the equal protection claim, the plaintiff argued that the hospital only limited HIV-positive health care workers (HCWs) whose status was known, and that this differential treatment between HCWs whose status was known and unknown violated the equal protection clause. The court held that the distinction was rationally related to a legitimate state interest of protecting the health of patients.
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