Leckelt v. Board of Commissioners of Hospital District No. 1, 909 F.2d 820 (5th Cir. 1990)

The Leckelt case concerns a nurse who was discharged by his hospital employer when he refused to provide the hospital with HIV test results. The hospital requested Leckelt’s test result when it determined that he was gay and was the “roommate” of a patient believed to have AIDS. Leckelt informed the hospital that he had already been tested for HIV but had not yet obtained the results. The hospital refused to schedule him to work until he provided his results, and eventually terminated his employment when he refused to do so. Leckelt brought claims under the Rehabilitation Act, as well an equal protection claim and a privacy claim under the Constitution’s Fourth and Fourteenth Amendments. The Fifth Circuit affirmed judgment in favor of the employer. With regard to the Rehabilitation Act claim, the Fifth Circuit held that the district court was not clearly erroneous in determining that Leckert was not discriminated against solely by reason of his impairment, reasoning that he was also terminated for failure to comply with policies on reporting infectious disease exposure. It also reasoned that he was not “otherwise qualified” for the position because his duties involved potential opportunities for HIV transmission, and that his HIV-status was necessary to determine if additional precautions were necessary. With regard to his equal protection claim, the court held that the hospital had a reasonable basis for requiring his test results. With regard to the Fourth Amendment claim that the hospital had violated his right to be free from unreasonable searches and seizures, the court held that the hospital’s interests in “maintaining a safe workplace through infection control outweighed the limited intrusion on any privacy interest of Leckelt in the results of his [test].”

This 1990 opinion contains several significant flaws in its reasoning. For example, the opinion cites no medical evidence to support its assumption that Leckelt could pose a direct threat to others, when the Rehabilitation Act places the burden on the employer to demonstrate a direct threat, relying on public health authorities. Indeed, most public health authorities agree that there is no threat of transmission, and no need to restrict employment, for people living with HIV holding positions such as Leckelt’s nursing job. Although the court purported to rely on CDC guidelines to support the hospital’s insistence on testing Leckert, these guidelines did not call for testing health care workers in the circumstances presented. However, this case and subsequent decisions demonstrate the cover for irrational discrimination that the CDC’s outdated guidelines on health care workers continue to provide. Moreover, the court’s view that an individual has a minimal privacy interest in HIV test results is both questionable and contrary to more recent decisions that have held that individuals have a constitutional privacy interest (and, in most jurisdictions, state statutory privacy protections) in their HIV tests results, regardless of whether they have voluntarily submitted to the test. The court’s repeated reference to Leckelt’s sexual orientation as providing grounds for the hospital to require a test demonstrates the extent to which even courts rely on stereotypes and bias related to sexual orientation in formulating responses to HIV discrimination.