## Facts

- William C. Mauro worked for Borgess Medical Center as an operating-room/surgical technician from 1990 to August 1992 and was HIV-positive.
- After an anonymous report about Mauro’s condition, Borgess officials became concerned about patient exposure during surgical procedures.
- Borgess created and offered Mauro a new full-time “case cart/instrument coordinator” position intended to eliminate any HIV transmission risk; Mauro refused.
- Borgess convened a task force to assess whether an HIV-positive employee could safely perform surgical technician duties.
- The task force concluded that duties requiring hands in a patient’s body cavity in the presence of sharp instruments presented a direct threat to patient safety.
- Borgess informed Mauro he could no longer work as a surgical technician and could either accept the new position or be laid off; when he did not accept, Borgess terminated his employment.
- Mauro sued under the ADA and § 504 of the Rehabilitation Act; the district court granted summary judgment for Borgess on the ground that Mauro posed a direct threat that could not be eliminated by reasonable accommodation.
- After Mauro’s death, his estate was substituted as plaintiff and appealed.

## Issues

1. Whether an HIV-positive surgical technician who may be required to participate in exposure-prone procedures is “otherwise qualified” under the ADA and Rehabilitation Act, or may be excluded as posing a “direct threat”/“significant risk.”
2. Whether the risk assessment properly relied on reasonable medical and public-health judgments, including CDC guidance and expert evidence, in granting summary judgment.

## Decision

- The Sixth Circuit affirmed summary judgment for Borgess.
- The court held that an individual with an infectious disease who poses a significant risk of transmission to others in the workplace is not “otherwise qualified” for the job under the ADA and Rehabilitation Act.
- Based on Mauro’s job duties and the evidence regarding exposure-prone procedures, the court concluded Mauro’s continued work as a surgical technician posed a direct threat to patient health and safety.
- The court found no reasonable accommodation would allow Mauro to remain in the surgical technician role without maintaining that threat, particularly given Borgess’s offered reassignment to a non-exposure-prone position.
- The court concluded the plaintiff failed to create a genuine dispute of material fact sufficient to defeat summary judgment.

## Legal Principles

- Under the ADA, an employer may exclude an employee who poses a “direct threat,” meaning a significant risk of substantial harm that cannot be eliminated or reduced by reasonable accommodation.
- The ADA “direct threat” analysis aligns with the Rehabilitation Act’s “significant risk” standard for determining whether a person is “otherwise qualified.”
- Risk must be assessed on an individualized basis by considering the nature, duration, severity, and probability of harm, and the availability of effective accommodations.
- Courts may defer to reasonable medical judgments of public-health officials, including guidance on exposure-prone procedures, when evaluating transmission risk in health-care settings.
- Reassignment to an available position that removes the relevant risk can constitute a reasonable accommodation; refusal of such reassignment may defeat a claim that the employee could be accommodated in the original role.

## Conclusion

The court held that Borgess lawfully removed an HIV-positive employee from surgical-technician duties because the position could involve exposure-prone procedures creating a significant transmission risk to patients, and the employer’s reassignment offer eliminated that risk without violating the ADA or the Rehabilitation Act.


Estate of Mauro v. Borgess Med. Ctr., 137 F.3d 398 (6th Cir. 1998)