Abbott v. Bragdon

163 F. 3d 87 (1st Cir. 1998)
Download Judgment: English
Country: United States
Year: 1998
Court: United States Court of Appeals, First Circuit
Health Topics: Disabilities, Health care and health services, HIV/AIDS
Human Rights: Freedom from discrimination, Right to health
Tags: Access to treatment, Access to treatment Health facilities, HIV, HIV positive, Transmission

The plaintiff (Sidney Abbott), an asymptomatic HIV-individual, brought a discrimination suit against the defendant (Randon Bragdon), a dentist who refused to fill the plaintiff’s cavity in his dental office.

Plaintiff asserted that this refusal of dental treatment was a violation of the American with Disabilities Act (ADA), 42 U.S.C. §12182 (1994), and the Maine Human Rights Act, 5 Me.Rev.Stat. Ann. tit.5, § 4592 (West Supp. 1998).

The question before the Court was whether a cavity-filling procedure of an asymptomatic HIV patient posed a direct threat to others and thus was considered an exception under the ADA.

The United States District Court for the District of Maine granted summary judgment for the plaintiff. The defendant appealed to the U.S. Court of Appeals (First Circuit), which affirmed the district court’s decision. The defendant petitioned for certoriari, and The United States Supreme Court affirmed the Court of Appeals decision, but remanded to the Court of Appeals for reevaluation of evidence.

Relevant Legal Provisions:

“No individual shall be discriminated against on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation by any person who . . . operates a place of public accommodation.” § 12182(a).

“The term “public accommodation” is defined to include the “professional office of a health care provider.” § 12181(7)(F).

“A qualified individual with a disability, by reason of that disability, being excluded from participation in or being denied the benefits of the services, programs or activities of a public entity, or being subjected to discrimination by any such entity;” §4592.

“Unlawful public accommodations. “This section does not require an entity to permit an individual to participate in or benefit from the goods, services, facilities, privileges, advantages and accommodations of that entity when the individual poses a direct threat to the health or safety of others. For the purposes of this section, the term “direct threat” means a significant risk to the health or safety of others that can not be eliminated by a modification of policies, practices or procedures or by the provision of auxiliary aids or services.” (emphasis supplied) §4592.


The Court of Appeals affirmed the summary judgment in favor of the plaintiff.

In the earlier proceeding of this case, the Supreme Court raised questions about whether the 1993 Centers for Disease Control (CDC) Dentistry Guidelines, which state that universal precautions “should reduce the risk of disease transmission in the dental environment“ implied reduction of risk below that required to be a direct threat. Upon reexamination of these guidelines, the Court of Appeals found that there was no evidence to suggest that additional precautions outside of the universal ones were required. Thus, the Court determined that public health officials had considered dental treatment of the type the plaintiff needed to be safe if undertaken using the universal precautions.

The Supreme Court also suggested that the Court of Appeals reexamine the defendant’s evidence of a potential direct threat of HIV infection from performing the dental procedure on the plaintiff. The defendant submitted seven cases that the CDC considered “possible” HIV patient to dental worker transmissions. After reviewing scientific literature, the Court determined that this evidence did not demonstrate a genuine issue as to material fact.

The defendant also submitted a CDC report of 42 documented cases of HIV transmission to health care workers.  The Court held that the report could not be extrapolated to dental workers since there was not documentation to establish that the risks to dentists and other healthcare workers were comparable. Therefore, the defendant did not submit evidence overall to show a genuine issue of material fact on the direct threat issue.