Roundtable #17 | Disability Law

Τhe views in these articles are those of the individual authors and not of the Columbia Undergraduate Law Review

Section I: History of Disability Law

With great public support for protecting the rights of all people with disabilities, President George H.W. Bush signed the Americans with Disabilities Act (ADA) into law on July 26, 1990, marking a historic moment in the fight for disability justice. [1] Since its passage, the ADA has been cited in numerous U.S. Supreme Court cases on the topic of disability discrimination. In several of these cases, the Court extended the law to apply to groups for whom the ADA was not thought applicable according to its original understanding. By doing so, the Court not only protected those who were explicitly mentioned in the ADA but also groups that are not as often considered under the umbrella of “disabled.”

The definition of disability itself has been addressed in several cases, the first of which is Bragdon v. Abbott (1998). In the case, petitioner Randon Bragdon refused to provide services to respondent Sidney Abbott, who carried the human immunodeficiency virus (HIV) but was asymptomatic, in his dentist’s office, but offered to treat her at the hospital [2]. Abbott challenged this policy in federal and appeals courts, which ruled in her favor, and Bragdan appealed to the Supreme Court, which ruled that the infection constituted a disability under the ADA because it was a physical impairment that affected significant parts of life [3]. Because of this decision, courts generally prohibit discrimination against HIV-poisitive individuals in employment, support HIV-positive individuals’ rights to equal housing opportunities, and enable HIV-positive individuals to gain equal access to healthcare services [4]. This case therefore applied ADA protections to individuals who are asymptomatic HIV positive by determining that HIV did constitute a disability under the ADA. 

With Olmstead v. L.C. (1999), the ADA also protects individuals with mental illness and developmental disabilities. In Olmstead, Lois Curtis and Elaine Wilson, individuals with mental illness and developmental disabilities, were voluntarily admitted to the psychiatric unit at the Georgia Regional Hospital, and after treatment, caregivers recommended that they transition to community-based programs; the women, however, stayed at the state hospital for several years after treatment had concluded [5]. The Court ruled that unjustified isolation of disabled individuals violated title II of the ADA, which forbids discrimination on the basis of disability in state and local government programs, and required that the state provide community-based services when there was reason for the services, the affected party accepts the treatment, and the public entity can accommodate such services. [6] With this ruling, the Court recognized that unwarranted institutionalization negatively impacts an individual with mental illness because they benefit from interactions with the community and completion of “everyday life activities.” [7] The Court therefore reflected a greater awareness of the needs of the disabled by advocating the importance of integration of the mentally ill. However, because the modification of programs can lead to an inequitable allocation of resources between the community and state populations of individuals with mental illness, how states interpret the reasonable modification stipulation can affect how such concepts are interpreted in housing and employment of individuals with mental disabilities. 

Title II of the ADA also applies to state prisons. In Pennsylvania Department of Corrections v. Yeskey (1998), Ronald Yeskey, who was sentenced to eighteen to thirty-six months in prison, was recommended to the Motivational Boot Camp, a program that would result in Yeskey’s early parole after six months. The Pennsylvania Department of Corrections denied him admission to the Boot Camp after learning of his medical history of hypertension. Yeskey challenged the rejection as discriminatory, and the Supreme Court ruled in favor of Yeskey because state prisons are covered under title II of the ADA. [8] With this ruling, the Court certified that the protections granted under the ADA apply to prisoners. With the number of prison cases, this ruling means that prisoners are also protected under the law and that disabled prisoners in government facilities cannot be denied a right on the basis of their disability. 

With the passage of the ADA, the Supreme Court guaranteed that the protections provided to able-bodied individuals also apply to the disabled, and the Court ensured that disabled individuals who were denied these rights were given relief through several rulings. In Bragdon v. Abbott, the Court applied the definition of disability to asymptomatic HIV-positive individuals, yielding several positive implications for this group. Then, in Olmstead v. L.C., the Court protected the rights of mentally-ill individuals by preventing unjustified institutionalization, and in Pennsylvania Department of Corrections v. Yeskey, the Court ensured that ADA protections applied to prisoners as well. This law, therefore, has been positively applied in numerous cases, although there is still much room for improvement in terms of protecting the rights of disabled persons.

by Olivia Sieler

Section II: Disability Discrimination

As the mental health crisis in the United States grows, the U.S. Census Bureau reveals that clinically significant symptoms of depression and anxiety have more than tripled since the coronavirus pandemic began. [1] The question of what legal protections exist for those with mental illness within the realm of healthcare is more prevalent than ever. There are certain protections in place through the ADA for individuals suffering from mental health illnesses such as blocking employers from discriminating against individuals with mental illness conditions, right to privacy of medical information, and providing accomodations when needed. [2] Since the inception of the ADA, there have been great strides in the implementation of the ADA’s provisions within covered entities. However, many barriers still existed despite the implementation of the ADA. Stemming from inadequate provisions in the policy itself, the ADA failed to mandate parity between mental and physical disability benefits. 

This barrier is seen in Ford v. Schering-Plough Corp, where the Third Circuit directly addressed the issue of "whether a disparity between disability benefits for mental and physical disabilities violates the [ADA]." [4] In this case, the plaintiff was a disabled employee suffering from a mental disorder who was unable to continue her employment. She sued her employer and its insurance carrier for having implemented a two-year cap on mental disability benefits, but not physical disability benefits. Determining that the ADA and subsequent legislation did not contain parity requirements for mental and physical disability benefits, the court held: “So long as every employee is offered the same plan regard…then no discrimination has occurred even if the plan offers different coverage for various disabilities.” [5] Additionally, the court also held that, "The ADA does not require equal coverage for every type of disability; such a requirement, if it existed, would destabilize the insurance industry in a manner definitely not intended by Congress when passing the ADA.” [6] Ultimately, Ford v. Schering-Plough Corp set a precedent that the ADA does not require equal coverage for “every type of disability”, which primarily affects individuals with mental health illnesses. 

The Mental Health Parity and Addiction Equity Act (2008) was created in part to address the issue of mental health parity and fix the limitations present in the ADA. [7] The act states that mental health must be treated equally to other health conditions under an insurance plan and requires insurers to cover mental illnesses such as depression and addiction in the same way they cover medical illnesses of the body such as heart disease, diabetes, and cancer. 

A landmark case in determining the limitations of the Mental Health Parity Act was the Wit v United Behavioral Health (2019). [8] Plaintiffs allege that they were improperly denied coverage for mental health and substance use disorder treatment by Defendant United Behavioral Health ("UBH"), which administers mental health and substance use disorder benefits under their health insurance plans. The ruling found that UBH was manipulating their coverage guidelines to bypass the MHPA. The judge ruled that UBH had created discriminatory policies for patients with mental health and substance abuse disorders in order to save money. Wit v United Behavioral Health demonstrated how the MHPA broadens the expansion of mental health parity through recognizing mental illnesses as legitimate as physical disabilities. 

Though there are still areas for improvement in the MHPA, such as consistent regulation across different state policies [9], the MHPA has been a vital piece of legislation for the protection of individuals with mental health illnesses and has helped to resolve many of the issues that were originally present in the ADA. The MHPA, working in congruence with the ADA, have been hopeful steps in the right direction of achieving mental health parity and proper protections for individuals with mental health illnesses. 

by Melissa Yu

Section III: Intellectual Disabilities and the Law

With respect to mental health, criminal justice has struggled to provide equitable and detailed laws and instructions on how to assist people with mental disabilities. In one sense, people who struggle with intellectual disabilities, including developmental disabilities, are treated inhumanely by the prison-industrial system and are often more susceptible to violence and cruel punishment within these boundaries. [1] On the other hand, neurodivergent communities also experience inequities within the legal system. However, despite these limitations, there have been monumental strides that resulted in real progress for people with disabilities. While disadvantages for the disabled community still exist within the legal and prison systems, there is still a prospect of long-standing improvements for the disabled community.

Currently, over 30% of inmates in the United States have reported experiencing a cognitive disability that has negatively impacted their livelihood; in comparison, in the United States’ general population, 5% self-report cognitive disabilities. [2] One reason for this overrepresentation in prisons is due to disparities between neurotypical and neurodivergent communities in regards to communication to police officers. Typically, officers are more likely to arrest individuals who don’t respond to social cues in their surroundings. [3] Hence, neurodivergent communities endure increased suspicion during arrests. 

Because of the overrepresentation of cognitive disabilities within the courts, there is a stronger need for equitable laws and regulations providing resources for the disabled community. There have been previous events that have placed a precedent on improving the mental health of neurodivergent communities. Specifically, Clark v. California (1997) implemented accommodations for neurodivergent prisoners through the Clark Remedial Plan which provides accommodating procedures for these officers when arrests are given.  Within this court case, two plaintiffs argued under the Disabilities Act and the Rehabilitation Act. [4] It was found that the defendants have been confining people with disabilities in small state prisons with no accommodations given, defying the Equal Protection Clause. Eventually, the plaintiffs won the class-action lawsuit, and with the Clark Remedial Plan, the Governor proposed $1.8 million to hire 12 additional headquarters staff to facilitate each state prison’s accommodations for prisoners with disabilities. [5] With the persistence of the court, it is clear that the criminal justice system is striving over barriers and opposition in order to provide more accommodations for people with disabilities. Specifically, Clark vs. California (1997) provided one of the earliest progressive changes within marginalized communities, especially in overseen discriminated areas. 

As far as criminal charges go, there have been numerous strides in progressive action. One particular case is Atkins v. Virginia (2002), which eliminated execution charges for people with mental disabilities. In particular, Atkins was charged with conviction and capital murder, and brought a forensic psychologist to testify as his witness. The forensic psychologist suggested that Atkins had a mental disability, which suggested to the court to overturn the ruling. Eventually, the court overruled, suggesting that the ‘evolving standards of decency’ should provoke equitable strides in improving the quality of life for people with disabilities. [6] Specifically, Justice John P. Stevens notes that capital punishment isn’t necessarily suited for intellectually disabled people who have more challenging obstacles to gathering evidence, negotiating with their attorney, as well as testifying on the case. [7] In a 6-3 decision (APA), the Supreme Court ruled that this case violated the clause on the prohibition against “cruel and unusual punishment.” More specifically, the Supreme Court decided that individuals with disabilities deserved a “degree of reduction in moral blameworthiness,” which then “renders imposition of the death penalty unconstitutional.” [8] This rhetoric was mainly influenced by the previous Supreme Court case Penry v Laughner, which informed the court’s decision in Atkins. [9] In Penry v. Laughner, the petitioner raised an insanity defense against his capital punishment. His psychologist testified that he was moderately disabled, which is the mental age of a 6-year-old. This resulted in behaviors such as poor impulse control and an inability to learn. Despite these circumstances, the judge ruled for the petitioner to endure capital punishment, the justification stemming from three “special issues”: the defendant committed the crime deliberately that had resulted in death, the defendant would be a threat to society, and the killing of the victim was unreasonable. Under these conditions, the judge convicted the petitioner to the death penalty. 

Although the results of Penry and Atkins were drastically different, it still showed how society has progressed in terms of acknowledging the intersections of intellectual disabilities within criminal law. Society’s morality has shifted towards identifying the struggles of people with disabilities, especially in decision-making. This is especially crucial because intentions and impacts of decision-making are now considered significantly within each case. There is hope for people with intellectual disabilities to experience justice within the criminal justice system. 

by Aishwarya Thiyagarajan

Section IV: The Future of Disability Law

Disability laws have many gaps that need to be filled to have an egalitarian society that gives disabled individuals dignity and protection under the law. The future of gender dysphoria discrimination, compensation for emotional distress, and Supplemental Social Security Program eligible for Puerto Rico are all hanging in the balance and address the finer aspects of disability law that allow for widespread equality in American society. 

For 25 years, transgender rights have not been protected under the ADA, however, the landmark holding of Blatt v. Cabela’s Retail, Inc marked the beginning of a path to secure legal protections for transgender individuals who are impacted by biases and stigmas related to Gender Dysphoria. In Blatt v. Cabela’s Retail, Kate Blatt was given a diagnosis of Gender Dysphoria and was hired at Cabela’s Retail in 2006. At work, Blatt was prevented from using the women’s restroom and forced to wear a nametag with the name ‘James’. [1] The court questioned if Blatt’s negative treatment violated the ADA through disability discrimination and whether Gender Identity Disorder’s exclusion from the ADA is constitutional. It was ruled by the Supreme Court that transgender individuals are not ‘categorically barred from seeking relief’ from discrimination based on Gender Dysphoria under the ADA. The Court reasoned that while being transgender is not a medical condition, Gender Dysphoria is a medical condition. Therefore Gender Dysphoria is not excluded from the ADA. 

This case highlighted that Gender Dysphoria is protected by ADA, which reduces the distress and stigma transgender people face. This historic decision is important as it aligns with the current medical practices and acknowledges that many transgender individuals face ‘clinically significant distress’. This case paves the way to alter the long-standing history of transgender individuals who have a medical condition facing stigma and biases. Since the final holding, transgender litigants have broadened the scope of gender dysphoria discrimination. 

Blatt’s holding can be applied to other fields and can help reduce the distress that transgender people encounter. Apart from employment discrimination, Doe v Arrisi questioned the state law that asks for proof of gender confirmation surgery to change the genders on an individual's birth certificate. The plaintiff argued that asking an individual with gender dysphoria to undergo medical treatment constitutes disability discrimination. The ADA exclusion was cited and refuted based on the holding in Blatt. Blatt’s holding questions the interpretation of the ADA and can be applied to similar clauses in the Rehabilitation Act of 1973. Consequently, the Rehabilitation Act’s affirmative actions requirements for individuals with disabilities should be pertinent to people with gender dysphoria. [2]

The Rehabilitation Act was also relevant in Cumming v Premier Rehab Keller, which addressed the question of compensation for emotional distress under the Title VI of the Civil Rights Act of 1964, the Affordable Care Act, and the Rehabilitation Act. The plaintiff Jane Cumming was deaf and legally blind, and she reached out to Premier Rehab Keller to treat chronic back pain and asked for an ASL interpreter. They responded by telling her to get her own ASL interpreter or communicate with her psychologist to get other accommodations. [3] The district court and the US court of appeals found that the only faults found were “humiliation, frustration and emotional distress.” [4] Therefore, the issue before the Supreme Court is whether compensatory damages under disability discrimination can be granted for emotional distress. [5] The Court under the Civil Rights Act prohibits federal assistance if there is discrimination based on race, disability and sex. The Supreme Court verdict will tell us if emotional distress falls under this category. This holding is vital as apart from economic losses, victims also face mental anguish and humiliation that stays with them for years to come. The outcome of this holding will decide if the court values emotional damages on par with economic damages for discriminated individuals. [6]  

Moreover, in United States v. Vaello-Madero SCOTUS will also address whether Supplemental Social Security Program (SSI), can be denied to eligible individuals in US territories based on their residence, which might result in dire personal consequences. Vaello-Madero suffered from health problems and received SSI benefits when living in New York State. The following year, Vaello-Madero moved to Puerto Rico and didn't know the change in his address made him ineligible for SSI benefits. In 2016, the Social Security Administration realized that Vaello-Madero changed his address and wanted him to recover $28,000 in benefits. [7] 

The district court found that, since the program wasn't extended to Puerto Rico, it violated the equal protection section of the Due Process Clause in the Fifth Amendment. In his defense, Valello-Madero questioned the court whether it is unconstitutional to prevent SSI benefits to United State citizens as they live in a territory instead of a state. [8] The Supreme Court will assess whether this differentiation causes a citizenship-based apartheid that stems from individual social and historical ethnicity in the United States. This case is important as it highlights the disadvantaged treatment Puertoricans experience as citizens and highlights the ignorance of the federal government in the socio-economic challenges faced by Puerto Rico, which are aggravated by the lack of SSI. [9] 

In conclusion, the succeeding cases since Blatt v. Cabela’s Retail and SCOTUS decision in upcoming cases Cumming v Premier Rehab Keller and the United States v. Vaello-Madero will highlight the finer aspects of disability law that allow for widespread equality and whether disabled individuals are protected from emotional and economic damages due to discrimination. 

by Nayantara Batra

This Roundtable was edited by Elissa Kim

Section I Sources:

[1] “Mental Health - Household Pulse Survey - Covid-19.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, October 20, 2021. https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm. 

[2] A guide to disability rights laws. Accessed December 1, 2021. https://www.ada.gov/cguide.htm. 

[3] Signorello, Pamela (2001) "The Failure of the ADA - Achieving Parity with Respect to Mental and Physical Health Care Coverage in the Private Employment Realm," Cornell Journal of Law and Public Policy: Vol. 10: Iss. 2, Article 5.

[4] “Findlaw's United States Third Circuit Case and Opinions.” Findlaw. Accessed December 1, 2021. https://caselaw.findlaw.com/us-3rd-circuit/1455118.html. 

[5] id

[6] id

[7] “The Mental Health Parity and Addiction Equity Act (MHPAEA).” CMS. Accessed December 1, 2021. https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/mhpaea_factsheet. 

[8] “Issue Brief: Parity.” Mental Health America, https://www.mhanational.org/issues/issue-brief-parity. 

[9] id

Section II Sources:

[1] The History of the Americans with Disabilities Act, Disability Rights Education & Defense Fund, online at https://dredf.org/about-us/publications/the-history-of-the-ada/, (visited October 27, 2021).

[2] Bragdon v. Abbott, 524 US 624 (1998).

[3] Id.

[4]  Laura F. Rothstein, Supreme Court Decision Addresses Application of Americans with Disabilities Act to Individuals with HIV (1998), Health Law & Policy Institute, online at https://www.law.uh.edu/healthlaw/perspectives/disabilities/980626bragdon.html (visited October 27, 2021). 

[5] Olmstead v. L. C., 527 US 581 (1999).

[6] Id.

[7] Id.

[8] Pennsylvania Department of Corrections v. Yeskey, 524 US 206 (1998).

Section III Sources:

[1] Access to Justice System and Stereotypes, Disability Justice (July 27, 2021), online at https://disabilityjustice.org/justice-denied/elusive-and-inconsistent/#:~:text=People%20with%20intellectual%20and%2For,including%20reasonable%20accommodations%20as%20necessary. (visited Nov. 4, 2021) 

[2] Developmentally Disabled People in the Criminal Justice System, Lexipol, (Feb. 13, 2019), online at https://www.lexipol.com/resources/blog/developmentally-disabled-people-in-the-criminal-justice-system/. (Visted Nov. 4, 2021)

[3] id

[4] Clark v. California: Civil Rights Litigation Clearinghouse, Clark v. California | Civil Rights Litigation Clearinghouse, online at https://www.clearinghouse.net/detail.php?id=576. (Visited Nov. 4, 2021)

[5] Department of Corrections and Rehabilitation, Funding for Clark v. California compliance monitoring and training, Legislative Analyst’s Office (April 8, 2012), online at https://lao.ca.gov/Recommendations/Details/585 (Visited Nov. 4, 2021)

[6] Atkins v. Virginia, Oyez, online at https://www.oyez.org/cases/2001/00-8452 (visted Nov. 4, 2021)

[7] Atkins v Virginia (2002), 536 U.S. 304, American Psychology Association.

[8] Katelyn L. Steele and Scott Orth, The Legacy of Atkins v. Virginia and Its Impact on Fuston v. State, The Journal of American Academy of Psychiatry and the Law (Sep 2021), online at http://jaapl.org/content/early/2021/11/11/JAAPL.210091-21 (visited Nov. 4, 2021).

[9] Penry v Lynaugh, Oyez, online at https://wwPenry v. Lynaughw.oyez.org/cases/1988/87-6177 (Visited Nov. 4, 2021).

 [10] Penry v Lynaugh (1989), 492 U.S. 302, Justia Supreme Court.

Section IV Sources:

[1]Blatt v. Cabela's Retail Inc,  GLAD (2017), online at                 https://www.glad.org/cases/blatt-v-cabelas-retail-inc/ (visited August 15, 2021). 

[2]Barry, Kevin M. & Levi, Jennifer, Blatt v. Cabela's Retail, Inc. and a New Path for Transgender Rights (2017), Yale Law Journal Forum, Vol. 127, p. 373, 2017, online at       https://ssrn.com/abstract=3183409 (visited August 15, 2021)

[3]Cummings v. Premier Rehab Keller, PLLC, No. 19-10169 (5th Cir. 2020),  Justia US Law, online at https://law.justia.com/cases/federal/appellate-courts/ca5/19-10169/19-10169-2020-01-24.html (visited August 15, 2021).  

[4]Cummings v. Premier Rehab Keller P.L.L.C, OYEZ, online at https://www.oyez.org/cases/2021/20-219 (visited August 15, 2021). 

[5]Cummings v. Premier Rehab Keller P.L.L.C, No. 20-219,  American Civil Liberties Union, online at https://www.aclu.org/cases/cummings-v-premier-rehab-keller-pllc-no-20-219 (visited August 15, 2021). 

[6] Kohrman, Daniel, The Cost of a Broken Heart: Damages for Emotional Distress Under Civil Rights AARP Foundation, 2021 ​​(September 20, 2021), online at https://www.aarp.org/aarp-foundation/our-work/legal-advocacy/2021-supreme-court-preview/info-2021/civil-rights-abuse-compensatory-damages-for-emotional-distress-supreme-court-case.html (visited August 15, 2021).

[7]United States v. Vaello Madero,  Equally American,  online at https://www.equalrightsnow.org/vaello_madero (visited August 15, 2021).  

[8]Hamm Andrew,  United States v. Vaello-Madero,  SCOTUS Blog, online at https://www.scotusblog.com/case-files/cases/united-states-v-vaello-madero/ (visited     August 15, 2021). 

[9]United States v. Vaello-Madero, Harvard Law Review, online at https://harvardlawreview.org/2021/01/united-states-v-vaello-madero/ (visited August 15, 2021).