BEVERLY LAMBERSON, as Administratrix, of the Estate of Melinda Lamberson Reynolds, Deceased, Plaintiff
COMMONWEALTH OF PENNSYLVANIA, PENNSYLVANIA DEPARTMENT OF STATE, PENNSYLVANIA BUREAU OF PROFESSIONAL & OCCUPATIONAL AFFAIRS, PENNSYLVANIA DIVISION OF PROFESSIONAL HEALTH MONITORING PROGRAMS, PENNSYLVANIA STATE BOARD OF NURSING, BASIL L. MERENDA, LINDA TANZINI AMBROSO, K. STEPHEN ANDERSON, CHRISTOPHER BARTLETT, RAFAELA COLON, KATHLEEN M. DWYER, JUDY A. HALE, SUZANNE M. HENDRICKS, JOSEPH J. NAPOLITANO, ANN L. O'SULLIVAN, JANET H. SHIELDS and JOANNE L. SORENSEN, Defendants
JAMES M. MUNLEY, District Judge.
Before the court are cross-motions for summary judgment. Plaintiff filed the first motion, which seeks partial summary judgment with respect to the invalidity of the Methadone Prohibition Policy at issue in this case. (Doc. 84). Defendants filed the second motion, which contends that no genuine issues of material fact exist and that they are entitled to judgment as a matter of law. (Doc. 85). These motions are fully briefed and ripe for disposition.
This case arises out of Melinda Lamberson Reynolds' attempts to challenge the suspension of her license as a registered nurse in the Commonwealth of Pennsylvania. Reynolds was a licensed practical nurse ("LPN") and a registered nurse ("RN") in the Commonwealth for over fifteen years. (Doc. 9, Am. Compl. ¶ 18; Doc. 43, Answer ¶ 18). Reynolds suffered from substance abuse problems, and in 2007, the Pennsylvania Boar of Nursing suspended her license to practice nursing. (Doc. 9, Am. Compl. ¶¶ 17, 64; Doc. 43, Answer ¶¶ 17, 64). After her license was taken away, Reynolds initiated the instant action against Defendants Commonwealth of Pennsylvania, Pennsylvania Department of State, Pennsylvania Bureau of Professional and Occupational Affairs, Pennsylvania Division of Professional Health Monitoring Programs, Pennsylvania State Board of Nursing, Basil L. Merenda, Linda Tanzini Ambroso, K. Steven Anderson, Christopher Bartlett, Rafaela Colon, Kathleen M. Dwyer, Judy A. Hale, Suzanne M. Hendricks, Joseph J. Napolitano, Ann L. O'Sullivan, Janet H. Shields and Joanne L. Sorensen (collectively "defendants"). (Doc. 9, Am. Compl.). Plaintiff contends that she is a qualified individual with a disability because of her drug addiction and she asserts that defendants revoked her nursing license pursuant to a policy that violates both the Americans with Disabilities Act, 42 U.S.C. § 12132, et seq., and the Rehabilitation Act, 29 U.S.C. § 701, et seq. The undisputed material facts as presented by both parties are as follows.
A. Opioid Addiction and History of Treatment
Reynolds was addicted to "opioid" drugs and used heroin off and on since the late 1970s. (PSOF ¶ 1; DSOF ¶ 2). Addiction to opioids-whether illicit drugs such as heroin or prescription opioids for use as analgesics-has been recognized for almost a century to be a chronic medical condition and not a "bad habit" that can be eliminated given sufficient motivation. (PSOF ¶ 2). Chronic addiction to opioids is a physical or mental impairment that substantially limits one or more life activities. (Id. ¶ 3).
1. Morris County Aftercare Center (1997-2004)
Reynolds received methadone maintenance treatment for her opioid addiction at Morris County Aftercare Center ("MCAC"), in Randolph, New Jersey, from approximately October 1997 to February 2004. (Id. ¶ 8; DSOF ¶ 1). Methadone is useful in treatment of opioid drug dependence both as a short-term medication to control withdrawal symptoms ("detoxification") and as a long-term ("maintenance") medication to assist opioid dependent patients to refrain from use of illicit drugs. (PSOF ¶ 4). Methadone maintenance treatment is extremely effective. (Id. ¶ 6). A person with chronic opioid drug dependency must often continue to receive methadone maintenance treatment on a long term basis. (Id. ¶ 7). Clinics that provide methadone maintenance treatment are subject to exacting regulatory standards. (Id. ¶ 5; DSOF ¶ 12).
The physician and nurse progress notes from Reynolds' first visit to (Id.) MCAC on October 2, 1997 reflect that she used Xanax in addition to heroin. (DSOF ¶¶ 2-3). In a June 4, 2003 doctor's note, a MCAC physician recorded, "Benzos given by psychiatrist." (Id. ¶ 5). This note also stated that Reynolds was "[a]dvised to try to get off Benzos." (Id.) On August 18, 2003, MCAC health providers strongly urged Reynolds to enter an inpatient detox program for benzodiazepines. (Id.) A note dated October 6, 2003 states that Reynolds was discharged on September 27, 2003 after successfully completing an eleven day benzodiazepine detox program at Saint Claire Hospital. (Id. ¶¶ 6-7).
2. New Directions Treatment Services (2004)
On March 29, 2004, Reynolds enrolled in New Directions Treatment Services ("NDTS"), in Bethlehem, Pennsylvania, where she received methadone maintenance treatment from March 2004 to July 2010 and September 2010 to February 2012. (DSOF ¶ 11; PSOF ¶ 8). Monique Hightower was assigned as Reynolds' counselor at NDTS. (DSOF ¶¶ 19-23).
On April 12, 2004, Hightower assessed Reynolds and noted that she was vague with her answers, and information. (Id. ¶ 20). Hightower recorded that Reynolds "seems to be vague when disclosing information regarding her family history and past experiences with drugs. She also seems to minimize her use and makes light of it. Client is guarded and is feeling out her therapy session." (Id.) Hightower completed a psychological evaluation of Reynolds on April 29, 2004 and identified "Benzo addiction" as one of her underlying problems. (Id. ¶ 21).
From the time she began treatment with NDTS to the end of 2004, NDTS staff members cautioned Reynolds against using benzodiazepines for her anxiety and attempted to help her detox from them. In an October 2004 summary of Reynolds' progress, Hightower noted that "benzo use is now being monitored by our program doctor for a successful detox, who is simultaneously treating her anxiety." (Id. ¶ 25). In the final summary note of 2004, dated December 29, 2004, Hightower stated that Reynolds successfully detoxed from benzodiazepines. (Id. ¶ 26).
From April 1, 2004 through the end of December 2004, Reynolds submitted to thirty-three drug tests. (Doc. 87-3, NDTS Med. R. at 17772-17773). Reynolds tested positive for opiates once on July 1, 2004. (Id. at 17772; DSOF ¶ 13). Reynolds tested positive for benzodiazepines from the time she began treating with NDTS until September 2004, after which time she tested negative for benzodiazepines until the final drug test of the year on December 30, 2004. (Doc. 87-3, NDTS Med. R. at 17772).
3. New Directions Treatment Services (2005)
Despite NDTS staff members' attempts to detox Reynolds from benzodiazepines, she resumed using them in early 2005. (DSOF ¶¶ 27-30). On March 1, 2005, NDTS sent Reynolds a notice stating, "[i]t is our determination that you are not ready, willing or able to respond to this level of care. Therefore, beginning on the date of Fri 3/4/05 you will be placed on and begin a mandatory detox from this program. The detox will last for 21 days followed by a discharge for non-compliance with treatment expectations." (Id. ¶ 31). Reynolds appealed the decision to place her on mandatory detox, and on March 3, 2005, a multi-disciplinary team reversed the decision and directed Reynolds to Cedar Point Family Services, a division of NDTS, for treatment of her anxiety disorder. (Id. ¶¶ 32-34).
On March 15, 2005, Reynolds began treatment at Cedar Point Family Services. (Id. ¶ 35). The initial evaluation form completed on Reynolds' first day of treatment at Cedar Point Family Services recorded her symptoms as follows: "Symptoms of anxiety, panic attacks, hyperactivity, insomnia. Impairments include being less aware in the daytimes, more groggy. Tired in the afternoon. Has trouble concentering when anxious. Feels ill and shaky when having panic attacks." (Id.) This same initial evaluation form also states that Reynolds' use of benzodiazepines to manage anxiety led to her need for mental health services. (Id. ¶ 36). Cedar Point Family Services and/or NDTS care providers eventually approved Klonapin-a benzodiazepine-for Reynolds. (Id. ¶ 39).
In a file note dated August 17, 2005, Hightower recorded, "I explained to client her urine [sample drug tests] have been coming back positive for Xanax and she has been approved for Klonapin only.... When asked about Xanax use client had very little to say." (Id.) In her next file note, recorded on August 24, 2005, Hightower wrote, "We continued discussion regarding unauthorized benzo use. Client reports her liver doctor is prescribing the xanax and she has to take them.... Client is concerned about losing [her] takes outs.... she is exhibiting addictive behaviors by not informing her treating psychiatrist about additional xanax...." (Id. ¶ 40; Doc. 87-3, NDTS Med. R. at 18564). In her August 31, 2005 progress summary, Hightower wrote that "Mrs. Reynolds continues to remain opiate free. However, client continues to struggle with recurring benzo use." (DSOF ¶ 41).
On September 8, 2005, Candice S. Cerracchio of Gastroenterology Associates, Ltd. wrote a letter to Dr. William Santoro of NDTS to explain their prescription of Xanax to Reynolds. (Id. ¶ 42; Doc. 87-3, NDTS Med. R. at 18375-18376). Cerracchio explained that they were unaware that Reynolds was taking methadone when Xanax was first prescribed to her and that Xanax may not be best given Reynolds' history. (Doc. 87-3, NDTS Med. R. at 18375). Notwithstanding Cerracchio's letter, NDTS revoked Reynolds' "take out" privileges because she had been taking Xanax prescribed by a doctor outside of the clinic without first obtaining NDTS's permission. (DSOF ¶ 37). Losing "take outs" was a hardship for Reynolds, and she was increasingly depressed and anxious because she had to drive to NDTS every day to receive methadone. (Doc. 87-5, Cedar Point Med. R. at 21100-21101). NDTS physicians eventually approved Reynolds' use of Xanax to manage her anxiety; however, as of October 2005, NDTS care providers remained concerned that Reynolds would self-medicate with family members' medications when she suffered headaches. (DSOF ¶¶ 43-44).
Although Reynolds continued to receive methadone maintenance treatment at NDTS, she was discharged from Cedar Point Family Services on November 22, 2005. (Id. ¶ 38). Reynolds' discharge summary form states that she was discharged because of "non-compliance with appts, no response to letter inquiring about interest in services, " and it appears that she had not been at Cedar Point for treatment since September 8, 2005. (Doc. 87-5, Cedar Point Med. R. at 21051-21052).
Throughout 2005, Reynolds submitted to thirty-six drug tests. (Doc. 87-3, NDTS Med. R. at 17773-17775). Reynolds tested positive for benzodiazepines in the first eleven drug tests. (Id.) The final twenty-two drug tests Reynolds submitted to in 2005, covering the period from March 24 to December 15, came back negative for unapproved substances. (Id.)
4. New Directions Treatment Services (2006-2008)
Reynolds continued to receive methadone maintenance treatment at NDTS from 2006 through 2008. (Id. at 17775-17778). Reynolds also continued to submit herself to regular drug screens during this time. (Id.) Reynolds' tested positive for unauthorized drugs four times out of the approximately seventy-five urine samples she submitted from January 2006 to December 2008. (Id. at 17775-17778). Reynolds tested positive for cocaine on August 2, 2007, August 16, 2007 and September 13, 2007. (Id. at 17776). Additionally, Reynolds tested positive for opiates on July 10, 2008. (Id. at 17777).
B. PA Department of State Complaint Against Reynolds (2005)
Professional licensing in Pennsylvania, including the licensing of nurses, is administered by Defendant Pennsylvania Department of State ("DoS"). (PSOF ¶ 9). The DoS consists of a number of agencies, such as Defendant Pennsylvania Bureau of Professional and Occupational Affairs ("BPOA"), Defendant Pennsylvania Division of Professional Health Monitoring Programs ("PHMP") and the Pennsylvania Board of Nursing ("BoN"), that regulate and administer certain licensed professions. (Id. ¶ 11). The DoS receives federal financial assistance. (Id. ¶ 10).
On February 18, 2005, the complaints office of the DoS received a complaint from Reynolds' then employer, Intelistaf Healthcare. (DSOF ¶ 47). The complaint letter states that, while working at a long-term care facility in Easton, Pennsylvania, Reynolds tested positive for benzodiazepines. (Id.) The drug test was requested because there were incidents in which Reynolds "occasionally nodded off" and because "her charting was illegible, incorrect, or missing altogether." (Id. ¶ 49). The DoS complaints office forwarded the February 18, 2005 complaint letter to PHMP on February 24, 2005. (Id. ¶ 50).
1. Reynolds' Involvement with PHMP
PHMP was formerly known as the "Impaired Professionals Program, " and it is currently a division of BPOA. (PSOF ¶ 12; DSOF ¶ 45). PHMP provides a means for licensed professionals who suffer from a physical or mental impairment, such as chemical dependency, to be directed to appropriate treatment and receive monitoring to ensure that they can safely practice their licensed profession. (PSOF ¶ 14; DSOF ¶ 45). PHMP includes two programs, the Voluntary Recovery Program ("VRP") and the Disciplinary Monitoring Unit ("DMU"). (PSOF ¶ 14; DSOF ¶ 45).
PHMP operates the VRP for individual licensees who are suffering from a physical or mental impairment. (PSOF ¶ 15). VRP participants are monitored according to an agreement entered into between the participant and the PHMP. (DSOF ¶ 46). PHMP operates the DMU for licensees who are subject to a consent agreement or order by one of the licensing board, such as the BoN. (Id.; PSOF ¶ 15). DMU licensees are strictly monitored according to the terms of the consent agreement or licensing board order. (DSOF ¶ 46). The same PHMP employees are responsible for both VRP cases and DMU cases. (PSOF ¶ 16).
Throughout her interactions with PHMP, Pearl H. Harris ("Harris") was Reynolds' case manager and Kevin Knipe ("Knipe") served as the case supervisor. (Id. ¶ 13). On March 1, 2005, Harris sent Reynolds a letter informing her that she could enroll in VRP and receive treatment without the need for public action by the BoN. (DSOF ¶ 51). After receiving the letter, Reynolds contacted Harris and expressed her interest in enrolling in VRP and receiving an assessment at A Better Today (hereinafter "ABT")-an alcohol and drug treatment facility. (Id. ¶ 53).
On June 14, 2005, Reynolds received a drug and alcohol evaluation at ABT. (Id. ¶ 54). ABT deemed outpatient treatment appropriate, and from June 14, 2005 to September 7, 2005, Reynolds attended six of sixteen scheduled treatment sessions. (Id.) On October 6, 2005, Reynolds completed a Participation Cooperation form and submitted a verified statement in which she stated that her chemical dependency and/or abuse was limited to taking her mother's Restoril. (Id. ¶¶ 55-56). On October 7, 2005, Reynolds' VRP file had been closed and forwarded to BPOA for review regarding the initiation of formal public disciplinary procedures. (Id. ¶ 57). On November 16, 2005, Harris received a letter ...