In 2002, Joel Prell, a local resident of Baltimore County, Maryland, established A Helping Hand, LLC ("the clinic"), a for-profit methadone clinic to treat people with severe and chronic opioid addiction. In preparation to open the clinic, Prell contacted the County Department of Permits and Development Management and was told that the Slade Avenue cite he had chosen for his clinic was currently being used as a medical office, so a change of occupancy permit would not be required and he would not need to submit any additional documentation. After receiving this information Prell signed a lease for the Slade Avenue site, arranged for incorporation of the clinic, and applied for the required state and federal certifications and permits.
When the local community learned of Prell's plan to open a methadone clinic, efforts were undertaken to oppose the plan. Flyers were distributed, meetings were scheduled, public demonstrations were held, and letter writing and telephone campaigns were organized. Kevin Kamenetz, the County councilman for the district in which the clinic was to open, enlisted the support of state officials, communicated with community leaders, and participated in open community meetings to develop strategies to prevent the clinic from opening. The community opposition reached such extremes that police officers were needed to control a particularly heated protest outside of the clinic's community open house.
On April 1, 2002, Councilman Kamenetz introduced Bill 39-02 ("the bill") to the County Council. The bill would created a new category of state-licensed medical clinics (including methadone clinics), and proposed new zoning requirements for facilities within this category. Additionally, the bill required state-licensed medical clinics to obtain special exception prior to opening and operating, which could be obtained only through a permit and after a public hearing.
On April 2, 2002, the day after the bill was introduced, during a visit to the clinic site, state officials told Prell that the clinic was "in compliance, and . . . should be receiving [its necessary state] license shortly." At this point Prell had received approval from all relevant federal agencies. A week later, the state officials notified Prell that the license could not be issued because the state had been advised by the County that Prell had failed to submit materials demonstrating that the clinic's site plan and parking were adequate. When Prell contacted the County, the County indicated it had erred in November 2001 when it informed him the clinic did not need an occupancy permit or supporting documentation. Prell submitted the paperwork, and obtained both the occupancy permit and the state license on April 15, 2002.
On April 16, 2002, only fifteen days after it was first introduced, the County Council enacted the bill into law. Although the default is for bills to become effective forty-five days after enactment, the County Council voted that the bill would become effective on the date of enactment (April 16, 2002). The County Council also amended the bill at the last minute to remove the six-month grace period granted to clinics established prior to the bill's effective date, and instead provided that only clinics established and operating prior to the bill's effective date would be granted a grace period. The Council then began assessing fines against the clinic. The clinic, joined by some of its clients, filed a lawsuit alleging intentional discrimination and disparate impact under Title II of the ADA. (Although not discussed in this brief, the clinic also alleged violation of the due process clause.)
At trial, the court issued judgment as a matter of law in favor of the clinic and the clients with regard to the ADA disparate impact claims and one element of their ADA intentional discrimination claims. The jury then returned a verdict in favor of the clinic and the clients on the ADA intentional discrimination claims, and awarded them declaratory and injunctive relief. The county appealed.
The County's position was that the clinic was attempting to assert the rights and legal interests of its clients, and that Title II does not recognize an associational cause of action.
Specifically, the County argued that if anyone regarded the clients as disabled, it was the community and not the County.
On the issue of prudential standing, the court noted that Congress can expressly or by clear implication, write exceptions into statutes that allow a party to bring suit because of harm it suffered as a result of unlawful discrimination against another party. The court held that the broad language of Title II's enforcement provision, which provides a remedy for "any person alleging discrimination on the basis of disability," is evidence that Congress intended the issue of standing to be interpreted broadly. Furthermore, the court found support for this interpretation in the text of the ADA as a whole, the accompanying legislative history, and the Title II regulations that bar associational discrimination. Title II interpretive guidance specifically states that the associational discrimination provision was meant to "ensure that entities such as health care providers . . . who provide professional services to persons with disabilities are not subjected to discrimination because of their professional association with persons with disabilities."
The court next addressed whether the clinic had established that their clients were "regarded as" disabled within the meaning of the ADA. The County argued that the lower court's decision was based on community opposition to the clinic and that the County was unaware of the community opposition. However, the court noted that community views can be attributed to government entities when the government acts in response to those views. In this instance, the court found sufficient evidence to show that the County Council knew of the community opposition to the clinic and legislated in response to that opposition.
The court next explained that the clinic clientele would be "regarded as" disabled under the ADA if the clients have impairments that do not substantially limit a major life activity but they are treated as if they are substantially limited, or if they have impairments that do substantially limit a major life activity as a result of the attitudes of others toward the impairments. Although drug addiction can constitute a disability under the ADA, the court held that there was no evidence that the County Council regarded the clients to be substantially limited in a major life activity because of their drug addictions. Accordingly, the court reversed the lower court's judgment as a matter of law and ordered a new trial so that a jury can decide the issues.
The Fourth Circuit has determined that even though Title II does not explicitly provide a remedy for associational discrimination (i.e., discrimination against a person because of their association with a person with a disability), this remedy does in fact exist under Title II.
Because the clinic only argued that its clients were regarded as persons with disabilities, and did not argue that the clients were in fact disabled, their options were limited as to how the court could find in their favor. Had the clinic also argued that its clients were in fact disabled, the court's holding that the County Council did not regard the clients as disabled would not necessarily have required the case to go back to trial.
Although not at issue before this court, the ADA prohibits disparate impact, which occurs when administrative standards or criteria have the effect of discriminating based on disability. In this case, the clinic could argue that although the bill appeared to be neutral on its face, because the clinic would be the only entity required to obtain special approval prior to being granted a permit, and because the clinic serves clients with disabilities, the practical effect of the bill is discriminatory having a disparate impact on people with disabilities.