United States District Court, E.D. Wisconsin
Stadtmueller, U.S. District Judge
Linda Reed (“Reed”) suffers from several
disabilities, including tardive dyskinesia (“TD”)
and bipolar disorder. Her TD makes it difficult for her to
speak, so she often uses a computer-based communication
device. In March 2012, she sought treatment at Defendant
Columbia St. Mary's Hospital (“Columbia”)
because she was feeling suicidal. In this lawsuit, she
asserts that during her four-day stay, Columbia staff
discriminated against her on the basis of her disabilities
and refused to make adequate accommodations for her
brings claims for violations of Title III of the Americans
with Disabilities Act (“ADA”), 42 U.S.C. §
12181, and Section 504 of the Rehabilitation Act, 29 U.S.C.
§ 794. She also asserts several claims arising under the
Wisconsin Mental Health Act, Wis.Stat. § 51.61, for
violations of her rights as a medical patient. Columbia filed
a motion for summary judgment on October 14, 2016. (Docket
#49). Columbia seeks dismissal of all of Reed's federal
claims. First, it argues that it enjoys a religious exemption
from liability under the ADA. Second, it asserts that there
is inadequate evidence to show that it discriminated against
Reed solely based on her disabilities, as is required to
sustain a claim under the Rehabilitation Act. Finally,
Columbia requests that the Court decline to exercise
supplemental jurisdiction over the remaining state-law
claims. Reed opposed Columbia's motion and filed a motion
to strike Columbia's religious exemption defense,
contending that it had not been timely asserted. (Docket #54
and #55). The parties' motions are fully briefed
and, for the reasons stated below, the Court must grant
Columbia's motion and dismiss this action.
STANDARD OF REVIEW
Rule of Civil Procedure 56 provides that the court
“shall grant summary judgment if the movant shows that
there is no genuine dispute as to any material fact and the
movant is entitled to judgment as a matter of law.”
Fed.R.Civ.P. 56(a); see Boss v. Castro, 816 F.3d
910, 916 (7th Cir. 2016). A fact is “material” if
it “might affect the outcome of the suit” under
the applicable substantive law. Anderson v. Liberty
Lobby, Inc., 477 U.S. 242, 248 (1986). A dispute of fact
is “genuine” if “the evidence is such that
a reasonable jury could return a verdict for the nonmoving
party.” Id. The court construes all facts and
reasonable inferences in the light most favorable to the
non-movant. Bridge v. New Holland Logansport, Inc.,
815 F.3d 356, 360 (7th Cir. 2016). The court must not weigh
the evidence presented or determine credibility of witnesses;
the Seventh Circuit instructs that “we leave those
tasks to factfinders.” Berry v. Chicago Transit
Auth., 618 F.3d 688, 691 (7th Cir. 2010). The party
opposing summary judgment “need not match the movant
witness for witness, nor persuade the court that [her] case
is convincing, [she] need only come forward with appropriate
evidence demonstrating that there is a pending dispute of
material fact.” Waldridge v. American Hoechst
Corp., 24 F.3d 918, 921 (7th Cir. 1994).
Reed's Treatment at Columbia
suffers from TD, bipolar disorder, post-traumatic stress
disorder, and acute anxiety. (Docket #55 ¶ 11). TD is a
neurological disorder that substantially limits a
person's ability to speak and swallow due to
uncontrollable, involuntary movements in the mouth, limbs,
and hands. To cope with the disease, Reed uses various
communication techniques and aids, including a computer-based
communication device called a Dynavox. See (Docket
#37 ¶ 9).
entered the Columbia emergency department in mid-afternoon on
Thursday, March 8, 2012, reporting suicidal thoughts. (Docket
#55 ¶ 11). She was admitted for treatment to
Columbia's inpatient behavioral health unit. Id.
She remained there until her discharge on the morning of
Monday, March 12, 2012. Id. ¶ 12; see
also (Docket #59 ¶ 36).
being treated at Columbia, Reed claims she was subjected to
discrimination because of her disabilities. First, Columbia
staff would repeatedly refuse to give her the Dynavox when
she asked for it, including during her discharge meeting on
March 12, 2012. (Docket #37 ¶ 13); (Docket #55
¶¶ 17, 24). (The Dynavox was held at the
nurse's station at night in order to recharge its
she says she was prescribed psychotropic medication despite
telling Columbia staff that she is allergic to it. (Docket
#37 ¶ 14). She refused to take it when offered.
Id. At times, she asked to see her medication
records so she could determine whether she was being given
any such medications, but these requests were refused.
Id. ¶¶ 14, 23; (Docket #55 ¶ 13).
Third, she was repeatedly denied use of the telephone to call
her “case manager.” (Docket #37 ¶ 21).
Fourth, she was denied access to the hospital chaplain.
(Docket #55 ¶ 22). Finally, she was escorted off the
hospital grounds by two security guards after the March 12
discharge meeting. Id. In her original complaint,
she claimed that the guards injured her, but the amended
complaint omits such allegations. See id.; see
also (Docket #55-26 at 3-5).
record reveals that Reed's stay at Columbia was fraught
with difficulty and punctuated by confrontations between her
and the staff. See (Docket #55-11 at 21)
(examination note stating that Reed was discharged for
“behavior issues” and was “sent away by
staff”). At the intake interview on March 8, 2012 with
psychiatrist Dr. Eric Kaplan (“Dr. Kaplan”), she
was “angry and agitated” and in a “manic
state”-so much so that Dr. Kaplan had to leave the
intake interview and another doctor completed it later.
See Id. at 46, 83-84. It was also noted by a nurse
that at intake, Reed communicated in “explosive verbal
volleys” along with using her Dynavox. Id. at
throughout her stay, Reed refused some of Columbia's
treatment recommendations, including certain medications on
her stated fear that she was allergic to them. (Docket #55-22
at 2 ¶ 3); (Docket #55 ¶ 75); (Docket #55-11 at 24)
(progress note that Reed was “all over the map, refuses
to take any psych meds”); see also (Docket
#55-13 at 30-31) (May 30, 2013 note from Dr. Kathryn Gaines,
who treated Reed for over a decade, that Reed visited her in
a disturbed stated and refused to take her medication).
Although Reed claims that she was prescribed psychotropic
drugs at Columbia after warning the staff of her allergy,
there is no evidence that she was ever administered such
medications, only that she was concerned about the
possibility. (Docket #55 ¶ 76); (Docket #59 ¶¶
75-76); but see (Docket #55-11 at 17) (March 8, 2012
note showing order for psychotropic medications). In any
event, she claims she refused all such medications when they
were offered to her. (Docket #59 ¶ 75); (Docket #55-11
at 34). Similarly, while she asserts that she was not allowed
to see her medication records, (Docket #59 ¶ 77), Donna
Taylor, Director of Risk Management at Columbia, later
explained to her that this was due to Columbia policy, which
provides that a patient can review her records after
discharge, (Docket #55-22 at 1). The right to review records
is not, as Reed believed, an unfettered right to see all such
records immediately upon request. See id.
she was often disruptive, loud, agitated, and could not
easily be understood in her speech as a result of her TD.
See (Docket #55-11 at 34) (Reed describing her
disabilities as “noisy”); id. at 35
(Reed writing that on one occasion, she became
“spooked” and “los[t] control over [her]
disorder”); id. at 42 (progress note that Reed
exhibited bipolar disorder with “severe mania”);
id. at 85 (progress note that Reed became
“distraught” in the afternoon on March 10 and was
“unable to speak”); id. at 86 (progress
note that Reed's mood was “up and down all
shift” late on March 11). Her behavior was so hard to
control that the nursing supervisor, William Fry
(“Fry”), testified that staff would only provide
Reed her Dynavox “if her behavior was
appropriate.” (Docket #55 ¶¶ 62-64); (Docket
#59 ¶ 64). There is also evidence that she became
belligerent when counseled about appropriate behavior during
group therapy sessions and while she was being escorted out
of the hospital at discharge. (Docket #55-22 at 3 ¶ 7, 4
¶ 13); (Docket #55-11 at 86-87).
Miller (“Miller”), a Columbia patient care
assistant, witnessed the incident which is the central
feature of this case. (Docket #55 ¶ 38). Early in the
morning on Sunday, March 11, 2012, Miller was seated at the
nurse's station in the behavioral health unit.
Id. Reed approached him and asked for her Dynavox,
which was charging at the nurse's station. Id.
This request was apparently denied for reasons not explained
by the parties. Id. Reed then walked into the dining
room, which faced the nurse's station, to get a napkin on
which to write Miller a note. Id. Reed contends that
the note contained a request to speak with her case manager,
whom she had been trying to contact for several days. See
Id. Miller then observed Reed walk out of the dining
room, sit on the ground, and begin to cry. Id. Reed
told Miller that she needed help. Id.
claims that Reed refused to move although he explained
several times that she needed to return to her room so that
the nurses could help her. Id. ¶¶ 38-45.
During this time, she was screaming so loudly that other
patients came out of their rooms to see what the commotion
was. Id. He decided that she was not going to move
voluntarily, so he helped her stand. Id. At this,
she screamed at Miller, asking him to stop, but he responded
that she could not stay in the middle of the floor, that she
was causing a disturbance, and that the nurses could help her
once she was back inside her room. Id.
to Miller, Reed's screaming continued at such a volume
that the nurses came out of their morning meeting as he was
escorting her to her room. Id. ¶¶ 46-51.
Fry, who was at the meeting, directed Miller to take Reed to
a “seclusion” room instead of her own room.
Id. Fry helped Miller walk Reed to this room, and
she did not resist. Id. They then lowered her gently
to the bed on the floor. Id. She remained in the
room, which was unlocked and open, for two hours.
Id. Fry claims that Reed was never placed in forced
tells the story differently. She claims that after Miller
initially denied her request for her Dynavox, she went to the
dining room, wrote a note about contacting her case manager,
and obtained a cup of coffee. Id. ¶¶
38-45. She then returned to the nurse's station and, as
she tried to pass Miller her note, her TD caused her to spill
hot coffee on herself. Id. She fell to the floor in
pain. Id. She admits that Miller then told her
“that she could not stay in the middle of the
floor.” Id. ¶ 43. At some point, Miller
yelled, “that's it!”, grabbed Reed, and took
her to an “isolation” room. Id.
According to Reed, Miller threw her on a mattress on the
floor of the room and left. Id.; see also
(Docket #59 ¶¶ 42-44). She claims she was
“never violent during the entire incident, ”
though she never denies that she was on the floor or that she
was crying out during the incident. (Docket #55 ¶ 43);
(Docket #55-11 at 30) (Reed noting on her discharge form that
she had fallen to the floor before Miller
“attacked”); (Docket #59 ¶ 63) (Fry
testifying that during the incident “it was impossible
to understand [her] because she was really just screaming and
yelling”); see also (Docket #52 at 22)
(stating that Reed “became even more agitated”
after falling to the floor). Furthermore, Reed avers that Fry
never participated in the seclusion incident at all. (Docket
#55 ¶¶ 46-51). As for the period of segregation,
Reed claims that she did not know or believe that she was
free to leave the room. Id. In fact, she states that
“[a] patient care attendant remained present outside
the door” for the entire period, suggesting that he or
she was ensuring that Reed stayed in the room. See
(Docket #59 ¶ 46).
testified that he chose the seclusion room for Reed to
decrease her stimulation and allow her an opportunity to calm
herself down. (Docket #55 ¶ 48). Reed asserts that Fry
chose the seclusion room as a punitive measure without first
attempting less drastic methods for de-escalating the
situation, which was a violation of Columbia policy.
Id. She also argues that Columbia's existing
policies were insufficient for the situation, claiming that
they were threadbare on how to accommodate speech-impaired
patients. (Docket #59 ¶¶ 49-55).
medical record shows that sometime later in the day on March
11, Reed expressed a desire to leave Columbia. (Docket #55
¶ 52); (Docket #55-11 at 32-36). Columbia staff
counseled her not to go, informing her that she was at a risk
of experiencing worsening psychiatric symptoms and that she
was a danger to herself and others. (Docket #55-11 at 33). On
this advice, she rescinded her notice of intent to leave.
Id. at 32; (Docket #55 ¶ 52).
discharge meeting with Dr. Kaplan on the morning of Monday,
March 12, 2012, he noted that although Reed had sought help
for suicidal thoughts, “from the moment she came to the
ward, she has been totally uncooperative.” Id.
For instance, as noted above, at the intake interview on
March 8, she “practically kicked [Dr. Kaplan]
out.” Id. Similarly, “over the weekend
she signed an intent to leave [form], but then rescinded
it.” Id. Dr. Kaplan observed that there was
“no reason to believe that she is acutely suicidal. At
this point, [Reed] is being disruptive to the milieu and I do
not think [she] would benefit from an acute inpatient
hospitalization.” Id. Reed was then discharged
from Columbia's care.
Columbia's Ownership Structure
complex chain of ownership is relevant to its religious
exemption defense to Reed's ADA claims, and so the Court
must describe it in some detail. To better illustrate the
parties' competing views on the matter, the Court will
first set out Columbia's account of that structure, then
describe Reed's challenges to it.
30, 2011 the Congregation of Consecrated Life and Societies
of Apostolic Life of the Vatican (the
“Congregation”) conferred public juridic
personality on Ascension Health Ministries. Id.
¶ 16. Ascension Health Ministries, in turn, was
empowered to “carry out its apostolic works through
various civil entities and primarily through Ascension
Health, a Missouri nonprofit corporation.” Id.
¶ 17. The governing documents of Ascension Health
Ministries provide that it would be governed in accordance
with canon law and that its mission would be “to
further the healing ministry of Jesus Christ with special
attention to those persons who are poor and
vulnerable.” Id. ¶¶ 18, 20. To do
this, it would serve as “canonical sponsor” of
subsidiaries which would in turn provide healthcare services.
Health Ministries is subject to and accountable to the
Congregation. Id. ¶ 19. It must submit an
annual report to the Congregation which provides evidence
that the integrity of faith and morals is preserved and that
its apostolic activity is in accord with the
Congregation's purposes. Id. Its 2011 report
confirms that it is a ministry of the Catholic Church.
Id. ¶ 25. Seven of the eleven members of
Ascension Health Ministries for fiscal year 2012 were members
of religious orders. Id. ¶ 20.
Health Alliance, a Missouri non-profit corporation, was
formed to carry out the mission of Ascension Health
Ministries. Id. ¶ 21. Its bylaws provide that
it would be governed according to the “mission, vision,
and values” of Ascension Health Ministries and
“in accordance with the official teachings of the Roman
Catholic Church.” Id. ¶ 22. Ascension
Health Ministries approved the creation of Ascension Health
Alliance as the new parent organization for the Ascension
healthcare system. Id. ¶¶ 23-24, 26.
Health is a Missouri non-profit and a subsidiary of Ascension
Health Alliance. Id. ¶ 27. Its articles of
incorporation (in effect at the relevant time) provided that
it was to serve in the health ministry of the Roman Catholic
Church, “to carry out its mission and ensure that the
elements of Catholic identity are integrated and implemented
throughout the health ministry.” Id. At the
relevant time, five members of the Ascension Health board of
trustees, including the chair, were members of religious
St. Mary's, Inc., a Wisconsin non-profit corporation, is
“sponsored” by Ascension Health and Columbia
Health System, Inc., which is a non-sectarian community
health system. Id. ¶ 28. Ascension Health
enjoys broad powers with respect to Columbia St. Mary's,
Inc., including the power to approve its mission and vision
statements; approve changes to its governing documents;
appoint or remove directors, including the chairman; approve
transfer of assets and reallocation of debt among Columbia
St. Mary's, Inc. and other Ascension Health ministries;
and approve of the incurrence of debt. Id. ¶
31. Columbia St. Mary's, Inc.'s bylaws provide that
it will control any subsidiaries, including having the power
to approve the subsidiary's mission and value ...