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Reed v. Columbia St Mary's Hospital

United States District Court, E.D. Wisconsin

February 15, 2017

LINDA REED, Plaintiff,


          J.P. Stadtmueller, U.S. District Judge

         1. INTRODUCTION

         Plaintiff 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 impairments.

         She 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).[1] The parties' motions are fully briefed and, for the reasons stated below, the Court must grant Columbia's motion and dismiss this action.


         Federal 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).

         3. RELEVANT FACTS

         3.1 Reed's Treatment at Columbia

         Reed 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).

         Reed 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).

         While 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 batteries.)

         Second, 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).

         The 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 100.

         Additionally, 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.

         Further, 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).

         Andrew 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.

         Miller 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.

         According 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 isolation. Id.

         Reed tells the story differently.[2] 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).[3] 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).

         Fry 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).

         The 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).

         At the 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.

         3.2 Columbia's Ownership Structure

         Columbia's 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.

         On June 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.[4] 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. Id.

         Ascension 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.

         Ascension 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.

         Ascension 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 orders. Id.

         Columbia 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. ΒΆ 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 ...

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