Science and Law: School Board of Nassau County v. Arline: Do people with a contagious disease qualify for disability protection?

July 11, 2016

Science and Law

gavel


SCHOOL BOARD OF NASSAU COUNTY v. ARLINE
480 U.S. 273 (1987)

The case of Gene Arline and the Nassau County School Board represents an important part of case law regarding the way our society defines disability and what factors employers are allowed to consider when hiring new employees.

Case Background

In 1987, the Supreme Court heard the case of Gene Arline in Nassau County, Florida. Arline taught at an elementary school in the county beginning in 1966, but was discharged in 1979 after suffering a third relapse of tuberculosis in a two year period. She was denied relief in state administrative proceedings, and subsequently chose to sue in court. Her argument was that her dismissal violated Section 504 of the Rehabilitation Act, essentially the precursor to the Americans with Disabilities Act. (The Rehabilitation Act prevented disability-based discrimination by the federal government, federal contractors, and recipients of federal funds, and the ADA then expanded this to private employers, public entities, and public accommodations.) The pertinent part of the Rehabilitation Act reads:

No otherwise qualified handicapped individual…shall, solely by reason of his handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistant….

So what exactly is the definition of “handicapped individual”? Arvine’s case essentially depends on this point, since she would not qualify for disability discrimination protection if her condition did not qualify. In 1974 Congress expanded the definition of this term specifically to address Section 504 and it states:

[A]ny person who (i) has a physical or mental impairment which substantially limits one or more of such person’s major life activities, (ii) has a record of such an impairment, or (iii) is regarded as having such an impairment.

This brings us to Arline’s diagnosis – tuberculosis. Let’s look at some of the basic facts of TB, also available through the website for the Centers for Disease Control and Prevention and the Mayo Clinic.

  • TB is an infectious bacterial disease that most often affect’s the sufferer’s lungs, and frequently causes weakness, fever, weight loss, and the coughing up of blood (frequently used to indicate TB in media depictions).
  • TB is particularly dangerous in underdeveloped countries. However, mortality rates have dropped over the past several decades, going from around 30% in 1990 to around only 15% by 2015. (WHO)
  • TB is transmitted through aerosol droplets when a person with Active TB speaks, coughs, or sneezes. However, people with Latent TB (infected, but without symptoms) are not contagious, but may become contagious often due to a compromised immune system, caused by other conditions such as HIV.
  • Like other bacterial infections, TB is treated with antibiotics, but has proven to be an unusually difficult condition to manage. Treatment can sometimes take up to a full year, and while in most cases TB can be cured after around 6 months, a small percent will relapse or develop drug-resistant TB.

How was the law interpreted and applied in this case?

Justice William J. Brennan Jr. wrote the majority opinion for the court, stating that Arline does indeed meet the legal definition for being handicapped. While the school board did accept the fact that Arline’s condition demonstrated characteristics of being handicapped, the school board and majority of the court differed on an important point – the court ruled that in defining a handicapped person with section 504, it is not possible to make a meaningful distinction between the contagious effects of a disease and the disease’s physical effects on a claimant. While the school board argued that it was not her disability, but rather the public health risk Arline posed that justified her dismissal, the court ruled that this was insufficient justification without further evaluation of Arline’s condition.

If contagiousness alone did not allow an employer to fire an employee, then the crux of this case would be whether or not Arline was otherwise qualified for this position, and so an expert evaluation of her condition would be necessary to determine whether or not she presented a public health risk to third parties. The court agreed with the amicus filed by the American Medical Association that such an inquiry should include:

[finding of] facts, based on reasonable medical judgments given the state of medical knowledge, about (a) the nature of the risk (how the disease is transmitted), (b) the duration of the risk (how long is the carrier infectious), (c) the severity of the risk (what is the potential harm to third parties) and (d) the probabilities the disease will be transmitted and will cause varying degrees of harm.

In essence, it is necessary to ask for the advice of public health experts, and then determine whether or not an employer could reasonably accommodate an individual based on the findings of the evaluation. However, the majority opinion stated that this court and the lower district court were both incapable of determining whether or not Arline was “otherwise qualified” and so remanded the case to the district court, meaning that the judgment of the court of appeals was affirmed.

Aftermath and Further Analysis

On remand, the district court actually found that Arline did not pose a significant risk to the health and safety of those around her, and thus earned the right to disability discrimination protection under the Rehabilitation Act. This case has had important implications for persons with HIV/AIDS, as it established an important precedent for the legal understanding of disability, which was made exceedingly clear in the case Bragdon v. Abbott, which we will discuss in a future post.

In the author’s view, the court made a smart and sound decision in deferring to medical expertise, and helping to combat the damaging and often unscientific stigma that is attached to many medical conditions. While tuberculosis may not fit our mental image of disability, there is no reason an employer should be allowed to deny a person employment simply based on that fact as long as that person has undergone medical evaluation showing that they will not endanger those around them.

For further reading on this subject, please also refer to Bioethics and Public Health Law by Orentlicher, Bobinski, and Hall.

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About jslachman381

I'm a Yale graduate who majored in History of Science, Medicine, and Public Health.

View all posts by jslachman381

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