Alexander v. Sandoval, 532 United States Supreme Court. 275 (2001). Pages: 29

In Alexander, the Alabama Department of Public Safety put a rule in place that required the driver’s license test be administered only in English. Sandoval brought suit under the Civil Rights Act of 1964 claiming that this rule has a disparate impact on those not born in the United States (i.e. national origin). This case solidifies a couple of propositions in relation to the Civil Rights Act of 1964: first, a person has a private right of action of intentional discrimination under section 601 and second, a person does not have a private right of action for disparate impact under section 602. The rationale for this conclusion is that private actions under section 602 are barred because there are enumerated penalties, such as termination of federal funds, for programs operating in a way that has a disparate impact on persons because of race, color, or national origin. The court concluded that because a private right of action was not expressly mentioned, the likely intent of Congress was for this remedy to be intentionally excluded.

Bryan v. Koch, 627 United States Court of Appeals, Second Circuit 612 (1980). Pages: 19.

The plaintiffs in this case challenged the closing of a municipal hospital that served a predominantly minority population, consisting of low-income Blacks and Hispanics. The closing of the facility was challenged under Title VI of the Civil Rights Act of 1964 as having a disparate impact on the basis of race. The closing of the hospital initially arose during lean financial times in the late 1970s when then-mayor of New York City Ed Koch assembled a Health Policy Task Force which conducted a thorough analysis of the 17 facilities in the municipal hospital system.

The closing of the hospital quite easily failed the intent requirement under Title VI, however the court also reviewed the decision under an “effects” test which will allow for a claim of racial discrimination to stand if it has a disparate impact on a minority group that is not justified by a legitimate governmental purpose. The concern of the low-income minority plaintiffs was that there would not be adequate facilities to take the uninsured and Medicaid patients in the community who primarily used the hospital slated for closing. Under a disparate impact theory, the court found that the decision to close the hospital did have a disparate impact on low-income minorities. After reviewing the findings of the Task Force, the court concluded that the closure was justified by the need for efficient operation of the municipal hospital system. This case shows the difficulty in proving discrimination, intentional and disparate impact, under Title VI and the rather easy “justifiability hurdle” placed on the State in disparate impact claims.

NAACP v. The Medical Center, 657 United States Court of Appeals, Third Circuit 1322 (1981). Pages: 31.

A group of advocacy organizations brought a claim of Title VI discrimination against the Wilmington Medical Center, consisting of a group of three non-profit healthcare facilities. The plaintiffs challenged the medical center’s decision to reorganize, moving many of the Medical Center’s services to suburbs away from the inner-city location. The court spent minimal time discussing the plaintiffs’ claim of intentional discrimination, finding no evidence of the requisite intent in the Medical Center’s decision to relocate.

The court discussed at length the framework for arguing a claim of disparate impact under Title VI. The plaintiff bears the initial burden of making a prima facie case, proving that the defendant’s action, although facially neutral, has a disparate impact on a protected class. However, even if a prima facie case is proved, the defendant may escape liability by demonstrating that less discriminatory means would not accomplish the defendant’s business purposes.

This case makes clear that most Title VI plaintiffs claiming disparate treatment or impact by a healthcare facility will likely find themselves between a rock and a hard place. Absent extreme carelessness by the defendant, proof of intentional discrimination by the defendant will not be readily available. On the other hand, a defendant can justify its business decisions that fall more harshly on minorities by showing that there was no other way to accomplish its goals or continuing to serve that population is expense prohibitive.