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Fourth Circuit Rules That Transgender Status May Be Covered Under the ADA

A recent decision by the United States Court of Appeals for the Fourth Circuit has broken new ground in the area of transgender rights under federal law. While the decision directly involved the rights of an incarcerated individual to access to medical care, its reasoning—if followed by other courts and in analogous contexts—could have broader implications for employers nationwide.

In Williams v. Kincaid, the Fourth Circuit, which hears appeals from federal district courts in North Carolina, Virginia, West Virginia, Maryland, and South Carolina, held that a transgender woman who had been denied hormone treatments in a county jail in Virginia qualified as disabled under the Americans with Disabilities Act (the “ADA”). In so doing, the court took an expansive view of federal protections available to transgender plaintiffs under Title II of the ADA—the section that governs services provided by state and local governments.

The Williams ruling, viewed broadly, could be seen as applying to private employers as well, since the Title I of the ADA governs workplace disability accommodations.

The Williams Lawsuit

The Williams opinion not only decided an issue of first impression in federal courts—whether gender dysphoria qualifies as a disability under the ADA—but also applied a developmental–historical method for interpreting the statute. Both because of its holding and its underlying analytical method, Williams could have important implications for future litigation involving private-sector employers.

The case was brought by Kesha T. Williams, a former inmate who was denied hormone replacement therapy during her incarceration in a Virginia county detention facility. The facility initially classified Ms. Williams as a woman—which matched her Maryland driver’s license and her identity in general—but reversed that classification when Ms. Williams disclosed during a medical exam that she was transgender.

Ms. Williams had been on hormone replacement therapy for fifteen years, but the prison system repeatedly refused her treatments. This led to Ms. Williams experiencing severe gender dysphoria—a condition resulting from acute distress over the difference between a person’s physically-expressed gender and the person’s gender identity. Ms. Williams experienced significant mental and emotional distress, as well as the changes in muscle and bone composition, body hair, and the “re-masculinization” of her body that accompanied the withdrawal of her hormone therapy.

In response to Ms. Williams’s lawsuit, the correctional facility filed a motion to dismiss the case. The district court granted the motion, noting that the ADA specifically excludes “gender identity disorders” from coverage.

Fourth Circuit’s Opinion

On appeal, the Fourth Circuit reversed, holding that gender dysphoria can be a covered disability under Title II of the Americans with Disabilities Act (“ADA”), at least when it results in physical distress or requires physical treatment. The key to the decision is the Fourth Circuit’s holding that gender dysphoria does not fall under the ADA’s exclusion of “gender identity disorders not resulting from physical impairments.”

The Fourth Circuit held that at the time the ADA was drafted, the concept of gender dysphoria had not even been developed. Previously, medical science viewed being transgender as aberrant, a mental health issue to be treated. By contrast, the Fourth Circuit held that being transgender is no longer seen as a mental or behavioral health problem but is now understood by medical science, psychology, and psychiatry as an identity like any other. The mental health aspect at issue—gender dysphoria—is not coextensive with being transgender. It is a condition that results when the differences between a person’s assigned gender and their gender identity cause them clinical levels of distress (including depression, suicidality, anxiety, and other forms of acute emotional distress).

This approach breaks new ground for ADA cases. To achieve its result, the court turned originalism on its head, distinguishing the original textual exclusion in the ADA—“gender identity disorders”—on the basis that gender dysphoria did not exist at the time the ADA was drafted, so that this exception to the ADA could not possibly have included gender dysphoria. The Fourth Circuit combined this historical-developmental approach with Congress’s mandate to interpret the concept of “disability” broadly to arrive at its conclusion that gender dysphoria was not excluded from the ADA’s protections.

The Fourth Circuit also held that Ms. Williams’s condition had a physical basis, so that even if the ADA exception applied, hers was not a gender identity disorder “not resulting from physical impairments,” and so her claim fell under the statute’s purview.

Implications Of The Decision

Although the Williams decision arises under Title II of the ADA, which applies to disability discrimination in public services, private employers should also expect to begin seeing ADA accommodation requests from employees who are experiencing gender dysphoria.

Williams suggests at least two potential scenarios in which such issues might arise for private employers: employee leave requests for gender-affirming treatment, such as surgery, or employees seeking to use restrooms or other facilities matching their gender identities (rather than their assigned sex). It is also possible that transgender employees may request other types of accommodations, such as in employer-provided housing and task and shift assignments.

The Fourth Circuit’s holding is the first of its kind, and it is not yet clear whether other courts – including, potentially, the Supreme Court – will reach the same conclusion. Nonetheless, given the broad expansion in transgender rights that has taken place in recent years, employers nationwide should be mindful of the decision in formulating their personnel policies and responding to requests for disability accommodations.

If you have questions or concerns about the Williams decision or any related workplace issues, please feel free to contact one of the experienced members of our employment law team.

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