(D.C. Civil No. 97-cv-02669)
Before: Scirica, Nygaard and Seitz, Circuit Judges
The opinion of the court was delivered by: Seitz, Circuit Judge.
On Appeal from the United States District Court for the Eastern District of Pennsylvania
Dr. Eliot Menkowitz ("appellant") appeals the order of the district court granting defendants' Fed. R. Civ. P. 12(b)(6) motion to dismiss claims brought under the Americans with Disabilities Act, 42 U.S.C. §§ 12101-12213 (1994) ("the ADA"), and section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794 (1994) ("the Rehabilitation Act"). In contesting the district court's interpretation of the ADA, appellant raises an issue of first impression in our court-- namely, whether Title III of the ADA, 42 U.S.C. §§ 12181-12189 ("Title III"), prohibits disability discrimination against a medical doctor with "staff privileges" at a hospital. Appellant also disputes the district court's causation analysis under section 504 of the Rehabilitation Act. The district court exercised subject matter jurisdiction pursuant to 28 U.S.C. § 1331 (1994). Our jurisdiction to consider these issues arises under 28 U.S.C. § 1291 (1994). We will review a dismissal for failure to state a claim, and in particular the legal interpretation of the federal statutes at issue, under a plenary standard. Lake v. Arnold, 112 F.3d 682, 684 (3d Cir. 1997).
Because this appeal comes to us from an order granting defendants' motion to dismiss under Fed. R. Civ. P. 12(b)(6), we take as established the relevant facts alleged in the appellant's complaint. Appellant is an orthopedic surgeon who, in 1973, joined the Pottstown Memorial Medical Center ("PMMC" or "the hospital"), which is a private, non-profit, community hospital. He alleges that he holds an appointment to the medical staff at PMMC, which is defined as "[a]ny duly licensed physician, dentist or podiatrist who has been appointed to membership by the Board and is privileged to attend patients or to provide other diagnostic, therapeutic, teaching or research services at the Hospital." Medical Staff By-Laws of PMMC, App. at 189.
The complaint further alleges that upon being diagnosed for attention-deficit disorder in July of 1995, appellant provided the hospital with a written report from his clinical psychologist and treating physician stating that the disorder would not affect his ability to treat patients or properly interact with the hospital staff. Subsequently, the hospital accused appellant of various infractions of hospital policies -- accusations which the appellant considered "a pattern of harassment and intimidation." Pl.'s Compl. ¶ 26, App. at 14. On March 18, 1997, the hospital summarily suspended appellant's medical staff privileges without notice or a hearing in alleged violation of the hospital's own by-laws. The Medical Committee of the Board of Directors later heard testimony from various staff members, not including the appellant, and ultimately approved the decision to suspend staff privileges for a six month period. The hospital also reported the suspension to the National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners, which would result in deleterious consequences to the appellant's insurance coverage and professional reputation.
As a result of these alleged events, appellant instituted this action under Title III of the ADA, alleging that PMMC discriminated against him on the basis of his disability by denying him the opportunity to participate in the medical staff privileges offered by the hospital. He also alleged a violation of the Rehabilitation Act through the hospital's interference with patient relationships solely by reason of his disability. The district court, in considering the ADA claim, relied on the "normal usage" of the phrase "public accommodation," and the statutory limitation in 42 U.S.C. § 12182(b)(1)(A)(iv), to conclude that Title III addresses discrimination only against individuals who patronize places that accommodate the public -- such as patients, customers, guests, and so forth. In the context of health care providers, the district court surmised that Title III protects only "those persons seeking medical care, and not the employees and other staff who serve them." Because the appellant in this case was not a person seeking medical care, the district court dismissed the ADA claim. With respect to the section 504 Rehabilitation Act claim, the district court held that the appellant failed to allege facts showing that the hospital had suspended staff privileges "solely by reason of . . . his alleged disability," and dismissed that claim as well. We turn to these issues seriatim.*fn1
A. Plain Language of Title III
The question of whether Title III grants a cause of action to a doctor with hospital staff privileges is one of statutory construction and, as such, we begin with the language of the statute. Title III states as a "general rule":
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 owns, leases (or leases to), or operates a place of public accommodation.
42 U.S.C. § 12182(a). The statute does not define the term "individual" for purposes of this subchapter, nor does it define the phrase "goods, services, facilities, privileges, advantages, or accommodations." However, a "place of public accommodation" is defined in 42 U.S.C. § 12181(7) and specifically includes a hospital, provided it affects interstate commerce. 42 U.S.C. § 12181(7)(F). No party on appeal challenges the hospital's status as a place of public accommodation within the meaning of the ADA. The same is true of the hospital's effect on interstate commerce.
The term "discrimination" is not directly and uniformly defined in Title III. Instead, the statute provides several "general prohibitions" that constitute discrimination for purposes of the general rule found in 42 U.S.C.§ 12182(a). See 42 U.S.C. §§ 12182(b)(1)(A)(i)-(iii). They include, for example, the "denial of participation" in which it is recited:
It shall be discriminatory to subject an individual or class of individuals on the basis of a disability or disabilities of such individual or class, directly, or through contractual, licensing, or other arrangements, to a denial of the opportunity of the individual or class to participate in or benefit from the goods, services, facilities, privileges, advantages, or accommodations of an entity.
42 U.S.C. § 12182(b)(1)(A)(i). The statute also defines as discrimination, and hence conduct prohibited under the general rule, the "participation in unequal benefit," 42 U.S.C. § 12182(b)(1)(A)(ii), and "separate benefit," 42 U.S.C. § 12182(b)(1)(A)(iii). It is noteworthy that these defining subparagraphs contain a limitation as set forth in 42 U.S.C. § 12182(b)(1)(A)(iv): "For purposes of clauses (i) through (iii) of this subparagraph, the term `individual or class of individuals' refers to the clients or customers of the covered public accommodation that enters into the contractual, licensing or other arrangement."
In addition to these delineations of discriminatory practices, Title III sets forth another set of "specific prohibitions" that define the term discrimination for purposes of the general rule announced in 42 U.S.C. § 12182(a). See 42 U.S.C. § 12182(b)(2)(A)(i)-(iv). Among these is:
[A] failure to make reasonable modifications in policies, practices, or procedures, when such modifications are necessary to afford such goods, services, facilities, privileges, advantages, or accommodations to individuals with disabilities, unless the entity can demonstrate that making such modifications would fundamentally alter the nature of such goods, services, facilities, privileges, advantages, or accommodations.
42 U.S.C. § 12182(b)(2)(A)(ii). Unlike the "general prohibition" demarcations of discriminatory practice set out in 42 U.S.C. § 12182(b)(1)(A)(i)-(iii), these definitions of discrimination contain no language limiting the scope of the phrase "individual or class of individuals" as is found in 42 U.S.C. § 12182(b)(1)(A)(iv).
B. The Arguments on Appeal
Appellant vigorously attacks the district court's conclusion that Title III proscribes discrimination only against members of the hospital's "public," who consist of persons seeking medical care and not hospital staff members. Appellant bases his position on two grounds. First, under a plain meaning approach, appellant contends that the general rule found in 42 U.S.C. § 12182(a) literally applies to any "individual" and contains no restriction that would limit the scope of protected persons only to those who patronize places that accommodate the public. Because a "privilege" offered by a hospital is staff membership to medical personnel, appellant maintains that he has a cause of action under Title III to the extent he was an "individual" who was denied the "full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of" the hospital. Second, appellant argues that a broad interpretation of those individuals affording Title III protection is consistent with the overall statutory scheme of the ADA and its legislative history.
The hospital disputes the appellant's analysis. It argues that Title III cannot be read to include any "individual" denied a privilege offered by a place of public accommodation. This reading, the hospital posits, would render Title I of the ADA, 42 U.S.C. §§ 12111-12117 ("Title I"), which relates to employment discrimination, a nullity and would accordingly violate Congressional intent. Thus, the hospital concludes that "individuals" for purposes of Title III are limited only to those persons who are "customers or clients" that patronize the place of public accommodation. In ...