## Facts

- Kelly Alexander and Donald Porter were profoundly deaf and primarily communicated using American Sign Language (ASL).
- After their longtime primary-care physician retired, Alexander and Porter needed to find new physicians.
- Alexander was referred to Dr. Abdallah Kujok, but alleged his office was unwilling to provide ASL interpreting services.
- Alexander then sought care from Dr. John Debruin, who allegedly did not provide an interpreter, told her she communicated well enough without one, and insisted she communicate technical medical terms in writing; Alexander left the appointment.
- Alexander next saw Dr. Karma, who allegedly promised an interpreter but did not provide one, misunderstood Alexander, and failed to record an iodine allergy.
- Dr. Karma referred Alexander to podiatrists Dr. Del Zotto and Dr. Larsen; Alexander alleged their office refused to provide ASL interpreting services.
- Porter was referred to Dr. Martinez, who provided an ASL interpreter at Porter’s initial intake visit; Porter alleged Martinez grabbed him and demanded that he lipread.
- Porter alleged that, after three appointments, Martinez stopped providing an ASL interpreter and that staff repeatedly hung up on relay calls, refused to communicate by text message, and required Porter to go in person to schedule appointments.
- After hearing about Porter’s experience, Alexander canceled her initial intake appointment with Martinez because she expected similar treatment.
- Alexander and Porter sued the physicians under Title III of the Americans with Disabilities Act (ADA) and related state disability laws, alleging failure to provide ASL interpreters and other effective communication accommodations.
- The physicians moved to dismiss, arguing plaintiffs lacked Article III standing for injunctive relief because they did not allege an intent to return for additional treatment.

## Issues

1. Whether profoundly deaf patients seeking injunctive relief under Title III of the ADA have Article III standing when they allege past denial of ASL interpreter accommodations but do not allege a concrete intent to return to the same providers.
2. Whether allegations that returning would be futile (and that plaintiffs are deterred from returning due to expected continued non-accommodation) can establish a real and immediate threat of future injury in this health-care setting.

## Decision

- The court denied the defendants’ motions to dismiss for lack of Article III standing.
- The court held the complaint adequately alleged a real and immediate threat of future injury because plaintiffs plausibly alleged they were deterred from returning based on the physicians’ past conduct and the expectation that requests for ASL interpreters would again be denied.
- The court accepted that, in the context of ongoing medical needs, plaintiffs are not required to return to the same providers and face repeated discrimination in order to seek injunctive relief under Title III.

## Legal Principles

- Title III of the ADA provides private plaintiffs injunctive relief, so Article III requires a real and immediate threat of future harm, not only past injury.
- In public-accommodation cases, a plaintiff may show future harm by alleging either an intent to return or that the plaintiff is deterred from returning because of the defendant’s unlawful conduct.
- A “futile gesture” theory may support standing where a plaintiff plausibly alleges that seeking the accommodation again would be pointless because the defendant has indicated, through policy or practice, that it will not provide the requested accommodation.
- Medical offices and physician practices qualify as places of public accommodation under Title III and must provide appropriate auxiliary aids and services when necessary for effective communication.

## Conclusion

Alexander v. Kujok held that profoundly deaf patients plausibly alleged Article III standing to pursue injunctive relief under Title III of the ADA against physicians and medical offices based on deterrence and futility: when patients allege they need ongoing medical care but are deterred from returning to particular providers because those providers previously refused ASL interpreters and are expected to continue doing so, the lack of an intent to return does not defeat standing at the pleading stage.


Alexander v. Kujok, 158 F. Supp. 3d 1012 (2016)