The Cochran Firm Legal Blog

In 2005, one Lester Fleming, M.D. entered into a contract to provide anesthesiology services to a medical center in Yuma, Arizona. Before he began work there in November that year, he was asked to sign an addition to his contract and refused to do so. It would have disallowed him to keep a work schedule that accommodated his Sickle Cell anemia. Because he would not sign this paperwork, his contract was canceled.

Fleming sued the medical center for breach of contract and claimed that the center was in violation of Section 504 of the Rehabilitation Act.

What is Sickle Cell Anemia?

Anemia is a general term for conditions where the blood has too few red cells or the cells have too little hemoglobin. Hemoglobin carries iron and oxygen around the body and gives blood its red color. With a deficiency of red cells and hemoglobin, a person has too little oxygen in the body’s organs.

Sickle cell anemia is an inherited disease where the red blood cells have a sickle shape instead of a donut shape. They are sticky and stiff and cannot flow easily through the blood vessels. They tend to form clumps and block blood flow. They live only ten to twenty days instead of the normal 120 days, and the body cannot replace them fast enough.

Symptoms of sickle cell anemia include fatigue, poor concentration, and a feeling of malaise. The heart may race in an effort to circulate the blood faster. The legs may be painful and tend towards cramping.

An anesthesiologist would spend a lot of time standing, as the job includes monitoring each patient’s vital signs for the duration of their surgery. He would visit all patients in the recovery room to determine when they are awake and alert enough to be discharged or sent back to a ward. With sickle cell anemia this could be exhausting and painful in the legs and the doctor might need shorter shifts or more days off.

The Rehabilitation Act

The Rehabilitation Act is a provision in a 1973 federal law designed to protect qualified people from discrimination based on their disability. When Fleming sued, the court ruled in favor of the medical center on the basis that Fleming was not an employee, but a contractor. Fleming appealed on the basis that Section 504 of the Rehabilitation Act did cover him even if he was a contractor.

The Ninth Circuit court reversed the dismissal, claiming that Section 504 does not incorporate the American with Disaiblities Act’s definitions of who is covered; it incorporates only the ADA’s standards for defining a violation of the Act. The Rehabilitation Act is broader than the ADA and covers “otherwise qualified individuals” as well as employees.

The Sixth and Eighth circuit courts have previously ruled otherwise but the Tenth has agreed with this current ruling. Therefore the issue will probably make its way to the U.S. Supreme Court at some point for a final determination.

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