Labor & Employment Law Daily Wrap Up, DISCRIMINATION—DISABILITY—S.D. Ind.: Positive drug test defeats anesthesiologist’s ADA claim, (Feb 13, 2026)

By George Basharis, J.D.

Hospital’s adherence to substance abuse policy forecloses inference that prior substance abuse disorder caused discharge.

A hospital did not violate the Americans with Disabilities Act (ADA) when it terminated its medical director of anesthesia following a certified positive drug test, a federal court in Indiana determined. Granting the hospital’s motion for summary judgment and denying the physician’s cross-motion, the court concluded that the record lacked evidence from which a factfinder could determine that disability was a but-for cause of the termination. No reasonable jury, the court concluded, could find that the physician was discharged because of his prior substance abuse disorder rather than pursuant to the hospital’s substance abuse policy (Carter v. The Health and Hospital Corporation of Johnson County, No. 1:23-cv-01048-SEB-MKK (S.D. Ind. Feb. 11, 2026)).

Past substance abuse disclosure. The physician was hired in October 2020 as medical director of anesthesia and a practicing anesthesiologist at Johnson Memorial Hospital. During the hiring process, the physician disclosed that he had received treatment approximately seven years earlier for a substance abuse disorder and had remained sober since that time.

Beyond his clinical duties, the physician oversaw the anesthesiology department and worked with the pharmacy department to strengthen auditing procedures for controlled substances. He also helped to implement more frequent audits and established criteria for when discrepancies would trigger drug testing. The hospital’s chief executive officer and vice president of medical affairs testified that he had no concerns about the physician’s performance before the events that led to his discharge, and the physician received a quality bonus in 2021.

Department-wide audit and drug testing. In September 2021, the hospital conducted a department-wide audit of controlled substances after identifying discrepancies between the amounts of narcotics anesthesia providers had withdrawn from the automated dispensing system and the amounts documented as administered to patients or properly wasted. The hospital also was concerned about unexplained usage patterns.

The audit revealed that two providers had discrepancies exceeding peer ranges: the physician and a certified registered nurse anesthetist. Both were required to undergo drug testing. The nurse anesthetist’s test returned negative. The physician’s test was reported as “non-negative” and was sent for confirmation. Confirmatory testing detected hydromorphone above the screening cutoff level. Hydromorphone was one of the drugs for which discrepancies had been identified in the audit.

The hospital’s substance abuse policy provided that drug tests were to be reviewed by a medical review officer, defined as a licensed physician designated by hospital administration with appropriate medical training to evaluate positive test results and determine whether there was a legitimate medical explanation. If the medical review officer determined that no legitimate explanation existed beyond unauthorized drug use, the policy stated that employees with verified positive test results would be discharged.

Dispute over medical explanation. After being notified of the results, the physician explained that he had recently been prescribed hydrocodone by a podiatrist for foot pain and believed that hydrocodone metabolizes into hydromorphone. He provided photographs of his prescription bottle and later submitted medical literature supporting his position.

The medical review officer considered the explanation but determined that the level of hydromorphone detected could not be explained by the hydrocodone prescription. She concluded that the prescription did not negate the positive result and verified the test as positive. The court emphasized that the medical review officer had never met the physician and had no knowledge of his prior substance abuse disorder when she made that determination.

The physician sought a second opinion, but hospital management refused, stating that the hospital’s substance abuse policy did not provide for additional review once a result had been certified. The chief executive officer testified that the hospital policy required termination following a certified positive test and directed human resources to proceed accordingly. The physician’s employment was terminated in October 2021.

Although hospital policy required that employees be notified of the option to retest original test samples, the physician asserted that he was not informed of that right and that no retest occurred. Nonetheless, he did not dispute the accuracy of the laboratory findings themselves but instead challenged the medical review officer’s interpretation of those findings.

Disability discrimination. The physician filed suit after receiving a right-to-sue notice from the EEOC, alleging that the hospital terminated him because of his prior substance abuse disorder in violation of the ADA. He argued that the hospital’s reliance on the certified positive drug test was a pretext for discrimination, while the hospital maintained that it acted pursuant to its substance abuse policy following the medical review officer’s final determination. In assessing the physician’s ADA claim, the court explained that the central inquiry was whether the evidence would allow a reasonable factfinder to conclude that disability caused the termination.

The court found that, even assuming the prior substance abuse disorder qualified as a disability and that the physician was otherwise qualified for his position, there was no evidence that the termination occurred because of that disability. The undisputed evidence showed that the physician voluntarily submitted to a department-wide audit and drug test, that the medical review officer independently evaluated the confirmed result, and that hospital management acted in accordance with a policy mandating discharge following a verified positive test.

No evidence of pretext. The court rejected the argument that the hospital’s failure to obtain a second opinion or to allow additional review demonstrated pretext. It noted that the substance abuse policy vested final authority in the medical review officer and did not provide for discretionary override once a positive result was certified.

The existence of competing expert testimony regarding the scientific interpretation of the toxicology results did not create a material dispute, the court reasoned, because the issue was not whether the employer’s decision was correct but whether it was a lie masking discrimination. The court found no evidence that the medical review officer harbored bias or was aware of the physician’s past addiction history. Nor was there evidence that the hospital had ever permitted other employees to obtain second opinions, overturned certified positive results, or treated similarly situated employees with positive tests more leniently.

The physician also pointed to alleged concerns expressed by the chief executive officer about narcotics issues and hydromorphone appearing in an anesthesiologist’s drug test. The court concluded that those views were immaterial because the chief executive officer did not conduct the audit or certify the test result. The hospital’s substance abuse policy vested final authority in the medical review officer and did not provide management discretion to override test results. Consequently, the medical review officer’s determination was final, and the chief executive officer’s views could not have affected the hospital’s termination decision.

The case is No. 1:23-cv-01048-SEB-MKK.

Judge: Barker, S.

Attorneys: Courtney E. Endwright (Betz + Blevins) for Jason G. Carter. Lyndsay I. Ignasiak (Reminger Co.) for The Health and Hospital Corp. of Johnson County d/b/a Johnson Memorial Hospital.

Companies: The Health and Hospital Corp. of Johnson County; Johnson Memorial Hospital

Cases: DisabilityDiscrimination Discrimination Discharge IndianaNews