Disability Discrimination Ordinance Has More Teeth Than A Denture Provider

Mr. Larry McDowell presented to our office for a consultation on the afternoon of Thursday, March 17, 2016. When Mr. McDowell arrived, he needed to be guided by holding on to someone in order to get places in the office; he will need to bring someone with him who can assist him in walking as it is a liability for the office staff to physically guide him themselves. Mr. McDowell will also need assistance in going over treatment, signing paperwork, and etc.

We Apologize for Any Inconvenience.

When Larry McDowell went to Affordable Dentures in West Palm Beach, Florida, to have a dental procedure on March 17th, there was no reason that he could possibly believe that he wouldn’t be able to get the same services as anybody else. But once Mr. McDowell reached the front desk, he was directed to follow someone to the examination room. Mr. McDowell then said, “I’m blind, could you help to where I’m going?” The employee at the desk said nothing. Once a member of the office staff arrived, Mr. McDowell asked for assistance to the examination room – Mr. McDowell asked to hold her elbow.

She said, “No. We can’t help you unless you have someone to help you. We can’t treat you unless you bring someone to assist you.” Mr. McDowell then asked to speak to the dentist. When Mr. McDowell asked where the dentist was, the employee replied that he was in surgery and would be there for the next two hours. A patient who was watching the interaction told Mr. McDowell, “No he’s not. He’s standing right there.” After the patient’s remark, the employee said to Mr. McDowell, “The dentist doesn’t want to speak to you today.”

Mr. McDowell requested Affordable Dentures to email a copy of written reason to his sister, and they sent the above letter. It was then while Mr. McDowell was waiting in the office, an employee approached him and informed him he could not wait inside the office any longer and must leave, since the dentist would not be seeing him today—with the knowledge that Mr. McDowell had taken public transportation.

The Human Rights Ordinance of Palm Beach County provides more remedies than the Americans with Disabilities Act or the Florida Civil Rights Act by providing both monetary damages and requiring changes of businesses that discriminate against persons with disabilities. It also investigates complaints and attempts to resolve complaints before a lawsuit is necessary.

On July 18, 2016, Mr. McDowell filed a complaint against Affordable Dentures for disability discrimination in violation of the Housing and the Places of Public Accommodation Ordinance. The County did a full investigation and made a finding that Mr. McDowell was the subject of discrimination on March 7, 2017, and with the facilitation of the Palm Beach Office of Equal Opportunity, entered into a Conciliation agreement. While Affordable Dentures did not admit liability, it agreed to the following in an enforceable settlement with Palm Beach County.

1. Pay Larry McDowell thirty-five thousand dollars;
2. Provide Mr. McDowell a written apology in an accessible format so he can read it in his screen reader;
3. Affordable Dentures will not exclude persons with disabilities from its business;
4. Affordable Dentures will revise its policies and procedures to ensure that persons with disabilities (or their family members or companions) will receive accommodations and its policies will be modified to ensure that persons with disabilities will be provided necessary assistance when patronizing their business; and
5. Affordable Dentures will provide appropriate auxiliary aids and services to ensure effective communication.

Larry McDowell’s needs were basic human needs, and the outright denial of needs bases solely on his disability transforms him, in the eyes of this medical provider into a human who is not worthy of these basic needs. Notwithstanding that the ADA is over 25 years old, it is common-place that medical professionals, who are dedicated to the health of their patients, are too often dismissive of their patient’s disability-related needs. Most discrimination against persons with disabilities are not so blatant and ignorant as what occurred with Mr. McDowell.

Mr. McDowell did receive a written apology, not in an accessible format, but, it stated as follows:

Dear Mr. McDowell:

We are aware that your visit to our office for dental consultation on March 17, 2016 did not meet your expectations for the level of service that we strive to deliver. This entire incident has been the subject of substantial scrutiny and review and has resulted in changes to some of our procedures to avoid any such occurrences in the future.

Please understand that it is my personal policy and the practice in my office that all patients and other visitors to our facility are treated with dignity and respect. My staff and I sincerely regret that you left our office feeling that you had not received the level of care you deserve. We apologize for any shortcoming on our part, no matter how unintended it was.

This non-apology does not admit that there was anything wrong with the refusal of services to Mr. McDowell and further implies that Mr McDowell was hypersensitive or irrational in taking offense at the discrimination that he felt.

However, this is not an issue of perception of slight, the greater issue is that because of the type of behavior exhibited by Affordable Dentures, persons with disabilities are less likely to receive needed health care. According to a Disability Healthcare Access Brief published by the Disability Rights Education and Defense Fund, 19% of people with disabilities reported that they did not receive medical care needed in the previous year, compared to 6% of able-bodied persons.People with disabilities tend to be in poorer health and to use health care at a significantly higher rate than people who do not have disabilities.

However, a biding conciliation agreement and a substantial settlement ensures compliance, especially when a law with teeth is more powerful than a pair of dentures.

Katy Daniel-Rivera wins $75,000 jury verdict from Keiser University

On April 19, 2017, a jury of eight people, none of whom were deaf or knew anyone who was deaf, awarded Katy Daniel-Rivera $ 75,000 and found that she was subject to intentional discrimination based on disability because she was not provided the opportunity to enter into Keiser University’s Radiologic Technology program.

Katy is a Deaf woman who lives in Florida, and works at the Bay Pines Veterans Administration (“VA”) Hospital as a Radiology Medical Support Assistant in the Imaging Service Department.  After receiving many positive performance reviews over her three years at the VA, Katy sought to advance her career by becoming licensed by the State of Florida in Radiologic Technology.  As a Deaf woman, Katy has been successful in her chosen career and has had sign language interpreters or other services through all of her education and other licensing opportunities.

As Katy began researching programs in 2014, Keiser University had reached out to Katy and told her what a good match she would be for the University and its program in Radiologic Technology.  After finding out about the program, Katy wanted to meet personally with the admission counselor to discuss the assessment test and the program, and requested a sign language interpreter for the meeting.  The counselor denied her request, but assured her that Keiser would provide accommodations once she was admitted.  Over a twelve-month period, Katy had numerous meetings about the accommodations she needed, but was not provided an interpreter for any of them. On September 29, 2015, Keiser accepted Katy into the Radiologic Technology Program and told her to show up at orientation on October 22^nd, where they finally would provide an interpreter.  At the orientation Katy was handed a letter from the Office of the Chancellor of Keiser rejecting her from the Keiser program because she is deaf, claiming that she posed a safety risk to others and that providing interpreters would be “inordinately expensive and extremely difficult to maintain.”  Further, Keiser claimed that they could not find clinical placements for her.   Katy was crushed.

On April 10, 2016, Matthew Dietz and Lisa Goodman from Disability Independence Group, and Caroline Jackson from National Association of the Deaf Law and Advocacy Center tried the case in the U.S. District Court behalf of Ms. Daniel-Rivera.   After a six day trial and two days of deliberation, the jury of seven men and one woman found in favor of Ms. Daniel-Rivera, finding that she was subject to intentional discrimination based on her disability, and rejected Keiser’s defense that hearing was an eligibility criteria that was required for a student that was entering its Radiology Technologist program.  The jury awarded 75,000 for her mental pain and suffering as a result of this denial.  However, contrary to the verdict of the jury of Ms. Daniel-Rivera’s peers, the court felt that Ms. Daniel Rivera was not entitled to injunctive or declaratory relief, such as requiring the school to enroll Ms. Daniel Rivera.

Keiser’s reasons for rejecting Katy Daniel-Rivera were based on stereotypes and out-moded beliefs and not on the actual capabilities of Ms. Daniel-Rivera.  She has been successfully practicing in this field for several years, not once compromising other’s safety because she is deaf. Further, numerous ASL-using deaf and hard of hearing individuals have successfully trained for and performed healthcare jobs that exceed the demands of Radiologic Technology. For example, ASL-using deaf individuals currently or previously have worked as pediatricians, and as hospitalists in teaching hospitals.  Regarding expense, universities routinely provide sign language interpreters for all programs or services, as required by law.  Indeed, Keiser accepts tens of millions of dollars of federal financial assistance each year conditioned on a promise to provide interpreters when needed.  All Katy Daniel-Rivera was requesting was the opportunity to succeed in her chosen career and earn a license to be a Radiologic Technologist.  With appropriate auxiliary aids and services, a person who is Deaf can perform any job.  To deny a person that opportunity is discrimination.

Medical Marijuana – Effects on Your Home and Job

By: Matthew Dietz

On November 8^th, over 71% of Florida voters approved Amendment 2, which explicitly allowed medical marijuana to be provided as a treatment for patients with the following disabilities: “cancer, epilepsy, glaucoma, positive status for human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), post-traumatic stress disorder (PTSD), amyotrophic lateral sclerosis (ALS), Crohn’s disease, Parkinson’s disease, multiple sclerosis, or other debilitating medical conditions of the same kind or class as or comparable to those enumerated, and for which a physician believes that the medical use of marijuana would likely outweigh the potential health risks for a patient.”

Florida joins the 27 other states and the District of Columbia to approve medical marijuana for the treatment of conditions or recreational use. The legal questions that it raises are important.  When can it be used?  Can you lose your job if you use marijuana, or can you lose your housing if you use medical marijuana?

Primarily, a person with a disability could not rely on the Americans with Disabilities Act for protection for a right to use medical marijuana.  Marijuana is treated like every other controlled substance, such as cocaine and heroin and continues to be illegal under federal law. The federal government regulates drugs through the Controlled Substances Act (CSA) and cannabis is classified as a Schedule 1 drug, which means that the federal government views marijuana as highly addictive and having no medical value.  Accordingly, under the ADA, marijuana is considered to be an illegal drug, and users of it are explicitly exempted. ( See https://www.law.cornell.edu/uscode/text/15/1114 .) In addition, there is no protection under the Federal Fair Housing Act for the use of controlled substances as defined under the CSA.  ( See https://www.law.cornell.edu/uscode/text/42/3602 .)

However, the Florida Fair Housing Act and the Florida Civil Rights Act contain no such limitations based upon the federal definitions of Controlled Substances.  Instead, the regulations under these laws rely on the definitions of controlled substances under Chapter 893, Florida Statutes.

 Can you be fired from your job?

While there is a right that allows the use of medical marijuana for certain disabilities, whether employers can refuse to hire or fire a person who uses medical marijuana is not that clear.  Similar to many other states, Florida has promoted drug free workplaces, and if an employer implements a drug-free workplace and complies with the drug-free workplace requirements, an employer may require testing for drugs and alcohol, including marijuana.  See § 440.101, Fla. Stat. et seq.  To the extent that an employer does not comply with the requirements of Florida law for a drug free workplace, it cannot rely on the exemption to test, fire or hire employees.  However, all workplaces for state employees are deemed to be drug-free workplaces.( § 112.0455, Florida Statutes.)

To the extent that an employer is not a “drug free” workplace as defined by Section 440 or 112, then medical marijuana would be treated as any other prescribed medication that may impair a person’s ability to do a job. The employer must consider each individual’s circumstances to determine whether a reasonable accommodation of the underlying disability is possible and the person can still do the job with the accommodation.  In other words, if a person can do the essential requirements of the job while on medical marijuana, then the accommodation may be appropriate.

There are two exceptions.  The first is whether the use of marijuana creates an undue hardship to the operation of a business, which means an action requiring significant difficulty or expense.  The other issue is whether the use marijuana causes a real, and not stereotypical, direct threat to the safety of the employee with a disability and other employees, then the employer may be permitted to not hire an applicant or terminate an existing employee for the use of medical marijuana.

 Can you be evicted from your home?

Similar to other entities that are obligated to follow federal law, federally subsidized housing is established by the United States Housing Act of 1937, and is administered by United States Department of Housing and Urban Development. The Anti-Drug Abuse Act of 1988, required HUD to enact guidelines that landlords must maintain a drug-free housing policy on the premises of public housing, and defines “drug-related criminal activity” as illegal use or possession with intent to use a controlled substance as defined in the CSA.

However, there are no similar restrictions for housing that is not public or HUD subsidized housing that must follow HUD guidelines.  As such, the use of marijuana would be treated like any other medication or legal smoking device.  If a person lives in a facility that bans smoking, the resident would need to ask for a reasonable accommodation under the Fair Housing Act to smoke.  However, because of the effects on other residents, some housing providers may deem the accommodation not to be reasonable, or to cause a fundamental alteration to the housing services offered.  In order to respond to issues regarding reasonableness or fundamental alteration, I would suggest an ionizer or other devices to ensure that the smoke smell does not leave the confines of the home.

 Emerging treatment options

Choosing how a person with a disability enhances their lives or ameliorates the effects of a disability is an element of the right of self-determination. To have persons without disabilities remove this choice is invidious discrimination.

IS HEALTH CARE ONLY FOR THE “ABLE BODIED”?

Mr. Larry McDowell presented to our office for a consultation on the afternoon of Thursday, March 17, 2016. When Mr. McDowell arrived, he needed to be guided by holding on to someone in order to get places in the office; he will need to bring someone with him who can assist him in walking as it is a liability for the office staff to physically guide him themselves. Mr. McDowell will also need assistance in going over treatment, signing paperwork, and etc.

 We Apologize for Any Inconvenience.

(Actual copy of letter)

When Larry McDowell went to Affordable Dentures in West Palm Beach, Florida, to have a dental procedure on March 17^th, there was no reason that he could possibly believe that he wouldn’t be able to get the same services as anybody else.  But once Mr. McDowell reached the front desk, he was directed to follow someone to the examination room. Mr. McDowell then said, “I’m blind, could you help to where I’m going?” The employee at the desk said nothing. Once a member of the office staff arrived, Mr. McDowell asked for assistance to the examination room – Mr. McDowell asked to hold her elbow.

She said, “No. We can’t help you unless you have someone to help you. We can’t treat you unless you bring someone to assist you.” Mr. McDowell then asked to speak to the dentist. When Mr. McDowell asked where the dentist was, the employee replied that he was in surgery and would be there for the next two hours.  A patient who was watching the interaction told Mr. McDowell, “No he’s not. He’s standing right there.” After the patient’s remark, the employee said to Mr. McDowell, “The dentist doesn’t want to speak to you today.”

Mr. McDowell requested Affordable Dentures to email a copy of written reason to his sister, and they sent the above letter.   It was then while Mr. McDowell was waiting in the office, an employee approached him and informed him he could not wait inside the office any longer and must leave, since the dentist would not be seeing him today—with the knowledge that Mr. McDowell had taken public transportation.

 Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity.

 Martin Luther King, Jr.

Larry McDowell’s needs were basic human needs, and the outright denial of such services based solely on his disability transforms him, in the eyes of this medical provider, into a human who is not worthy of basic services.  Mr. McDowell is a man who has transformed his life to assist others.  He is a member of the National Federation of the Blind and is currently the  President of the Braille Club of Palm Beach County.  The Braille Club of Palm Beach County organizes social activities and weekly meeting among the blind and visually impaired community in Palm Beach. In his free time, Mr. McDowell seeks to live an ordinary life filled with friends and outings.

“Aside from the public health issues that most racial/ethnic minorities face, minorities with disabilities experience additional disparities in health, prejudice, discrimination, economic barriers, and difficulties accessing care as a result of their disability—in effect, they face a “double burden.”[1]   “Disability-based discrimination in health care is illegal under the Americans with Disabilities Act and will not be tolerated,” said Eve L. Hill, Deputy Assistant Attorney General for the Civil Rights Division at the Department of Justice. “All types of health care providers – from hospitals to nursing homes, from surgeons to general practitioners – all across the country – need to provide equal access to people with disabilities, including people who are deaf…, the time for compliance is now.”[2]

Notwithstanding the fact that the ADA is over 25 years old, it is common-place that medical professionals, who are dedicated to the health of their patients, are too often dismissive of their patient’s disability-related needs.  Most discrimination against persons with disabilities are not so blatant and ignorant as what occurred with Mr. McDowell.  Some of the issues which serve as barriers to persons with disabilities include inaccessible physical environments, and inflexible policies and procedures that, for example, assume that everyone must be able to independently fill out forms, undress unaided, transfer to high examination tables, and communicate in spoken English to receive standard health care services.[3]

The failure to provide accommodations and an accessible environment will, at the least, lead to health care disparities, and at the worst, lead to injury and death.

The most common issue at Disability Independence Group is doctors and hospitals that refuse to provide sign language interpreters for people who are deaf. Instead these professionals choose to communicate in English by writing notes or using technology that fails to work accurately and timely.  This leads to miscommunication and does not allow the deaf patient to have the full opportunity for medical choice as any hearing person would expect. This failure to communicate leads to misdiagnosis, failure to take the appropriate medicines, and continued illness.  When it comes to psychiatric treatment, it often exacerbates the symptoms. Other issues that often arise are as follows:

• Medical professionals often ignore persons with disabilities and speak to their family member or caretaker, solely because of the assumption that the person with a disability cannot fully grasp the issues regarding their care and treatment.
• Doctor’s offices and hospitals do not always have medical equipment such as a wheelchair-accessible weight scale or a height-adjustable exam table. Due to barriers, individuals with disabilities are less likely to get routine preventative medical care than people without disabilities.[4]
• Further, despite universal precautions, health care providers may still be hesitant to treat patients who are HIV positive or live with AIDS.

However, the main issue is the fact that because of the difficulties that persons with disabilities encounter, such persons are less likely to receive needed health care.  According to a Disability Healthcare Access Brief published by the Disability Rights Education and Defense Fund, 19% of people with disabilities reported that they did not receive medical care needed in the previous year, compared to 6% of non disabled persons.[5]

People with disabilities tend to be in poorer health and to use health care at a significantly higher rate than people who do not have disabilities.  Larry McDowell is not a statistic, but instead a blatant example of an issue which needs to be addressed.  Equality in health care is not a benefit, but a basic right.

Institutionalization of Medically Complex Children

A.R. v. Dudek – the efforts to give children with disabilities the care they need.

Florida has been home for approximately three thousand children with severe disabilities who require constant nursing care or supervision on a 24-hour per day basis to stay alive. These disabilities could be the result of a trauma, such as a shaken baby syndrome, near drowning, or an auto accident, or could be a condition with which the child was born. Many of these children have tracheotomies, gastrostomy tubes, or ventilators, and as a result of their conditions, most of these children have degrees of developmental or intellectual disabilities.

At least since 2010, it has been the policy of the State of Florida to rely on the parents and caregivers, including siblings, of these children to provide such life-sustaining nursing care to these children, despite the requirement of Medicaid to pay for as much nursing care as is medically necessary. These parents or caregivers are not medical professionals, yet they are entrusted with life sustaining care of their children. These parents are pushed into the position of placing their child in a nursing facility to obtain the medically-necessary services they could not receive in their own homes. As a result, the State of Florida pushed many of these children into institutionalized settings, such as residential geriatric nursing homes or 12-hour pediatric prescribed extended care centers. Due to their efforts, Florida saved over $ 25 million dollars by denying claims for nursing services for our most fragile children in 2011 to 2012 alone. For those children in foster care, nursing homes is the only option because of the lack of medical foster homes.

Disability Independence Group, Inc., the North Florida Center for Equal Justice, Inc. and the FSU College of Law Public Interest Law Center are representing these children to ensure that these families receive services in the most integrated setting with appropriate and necessary supports and services to allow these kids with disabilities to live at home. In the landmark United States Supreme Court case of

Olmstead v. L.C. ex rel. Zimring, the Court recognized that the unjustified isolation of individuals with disabilities is discrimination under the Americans with Disabilities Act. In so concluding, the Olmstead Court found that “institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life.” Children should be with a loving family and are worthy and capable of participating in community life. Unlike one’s own family, medical foster home, or even a group home, such restrictive, medically-based nursing facilities lack required integration with other persons, children, and the community.

This action seeks class-wide injunctive relief and requires the states and their agents to (1) provide all children with disabilities the opportunity to receive services in the most integrated settings; (2) make reasonable modifications to the Defendants’ community service system to accommodate the needs of qualified children the opportunity to live in more integrated settings; (3) implement a professionally-adequate screening and assessment process of children in nursing facilities that will accurately identify children with developmental disabilities, including whether they can be appropriately served in the most integrated settings; and (4) for those children who are medically fragile or medically complex, to ensure that they receive adequate nursing care based upon their medical needs and not based on their parents or caretakers schedule, in the most integrated setting.

Every month, our website will update this matter and provide a description of a few of these children and the families that love their kids and care for them. Each of the families have fought for the care that they have and continuously fight for the lives of their kids.