Reaves v. Immediate Medical Care, P.A.

UNITED STATES DISTRICT COURT

MIDDLE DISTRICT OF FLORIDA

)

ERIN REAVES, )

)

Plaintiff, )

)

v. ) CIVIL ACTION

) NO. 3:23-00403-WGY-SJH

IMMEDIATE MEDICAL CARE, P.A. )

)

Defendant. )

YOUNG, D.J.1 March 12, 2025

FINDINGS OF FACT AND RULINGS OF LAW

The Court enters the following findings of fact and rulings

of law pursuant to Rule 52 of the Federal Rules of Civil

Procedure.

I. INTRODUCTION

Erin Reaves (“Reaves”) brought this action against

Immediate Medical Care, P.A. (“Immediate”) for declaratory and

injunctive relief pursuant to Title III of the Americans with

Disabilities Act (“ADA”), 42 U.S.C. §§ 12181-12189. See Am.

Compl., ECF No. 63. Reaves alleges that she arrived at

Immediate’s clinic in Jacksonville, Florida for an appointment

on April 5, 2023, but was unlawfully denied access to

Immediate’s public accommodation due to the presence of her

1 Of the District of Massachusetts, sitting by designation.

service dog Malia. The parties filed cross-motions for summary

judgment, ECF Nos. 85 & 91.

On January 30, 2025, this Court held a status conference at

which it denied Reaves’s motion for summary judgment, and set

the date for a prompt bench trial to begin on February 3, 2025.

See Minute Entry, ECF No. 106. On the first day of trial, the

Court denied Immediate’s motion for summary judgment. See

Minute Entry, ECF No. 109. After a three-day bench trial, the

Court ruled in favor of Immediate. See Minute Entries, ECF Nos.

109, 111, and 119. The Court now provides its written findings

of fact and rulings of law.

II. FINDINGS OF FACT2

After reviewing the testimonial, documentary, and video

evidence admitted at trial, the Court finds the following facts

by a preponderance of the evidence.

Immediate operates a medical facility in Jacksonville,

Florida.

Reaves suffers from post-traumatic stress disorder

(“PTSD”), anxiety, and bipolar disorder. The Court credits

Reaves’s testimony that each of these conditions substantially

2 The Court issued initial findings of fact from the bench

immediately upon the conclusion of the final arguments when

matters were freshest in the Court’s mind. What follows is

completely consistent with the transcript. If it is not, of

course, the transcript governs.

limit one or more major life activities, including the jobs she

is able to perform and, on bad days, her ability to perform

basic tasks. Reaves’s testimony is further buttressed by the

testimony of her fiancée Mariah Hockman (“Hockman”), and by

other record evidence. Hockman testified that Hockman has

observed Reaves’s panic attacks, destructive behaviors, and

regular fainting incidents.

Reaves has a service dog, Malia, who is trained to perform

tasks to alert Reaves and to mitigate self-harming behavior.

Malia was trained by Hockman and Reaves, and attended

specialized service training at East Tennessee Canine Academy in

Lenoir City, Tennessee.

On April 5, 2023, Reaves and her fiancée Hockman arrived at

Immediate’s facility where Reaves had an appointment in her

search for a new primary care physician. Reaves and Hockman,

who have family in the area, resided in the area at the time.

Eve Hochstetler (“Hochstetler”), a patient of Immediate,

was in Immediate’s waiting area and provided an affidavit that

was stipulated as admissible in lieu of testimony. See Minute

Entry, ECF No. 111. Hochstetler averred that she witnessed the

incident in question, and that, after Reaves arrived, Immediate

employee Julia Smith (“Smith”) asked Reaves what kind of dog

Malia is, and was told that Malia is her “emotional support

dog.”3 Hochstetler Aff., Ex. 20. Hochstetler then observed the

following:

Then, Julia said to Erin that Dr. Gargin has an

allergy to dogs. Erin’s friend stated that allergy is

not an exception to the ADA policy. Julia said that

Dr. [Kathleen] Gargin [Bechen] has a very bad allergy

to dogs and it could cause her to breath [sic] with

difficulty. She is able to see you if you leave the

dog in the lobby or outside the front door with your

friend. Again, Erin’s friend stated now in a much

louder voice that allergy is not one of the exceptions

to the ADA policy. Julia tried to explain to Erin

Reaves again about the allergy and offered to see

[Immediate’s owner] Dr. Moosavi but she was

argumentative. Julia went to the back office and came

back to her desk and called the police for assistance

with the situation. In addition, . . . Erin Reaves .

. . exited from her car and walked perfectly fine to

her car’s trunk. She stood unassisted, unsupported,

and walked around before sitting in her wheelchair.

The wheelchair did not have any foot or leg support.

She was moving her legs freely on the ground to move

her wheelchair forward. She did not use the wheels

and her arms to move the wheelchair as someone who has

a disability and is wheelchair bound. The reason I

noticed her actions are due to my advanced training

with Veterans and their ADA needs at my tenure at

Wounded Warrior Project, Inc. Upon entering the

office Erin Reaves blocked the front desk and she

instructed to her friend to pull her phone out to

start recording and stated “We are going to get them.”

Id. (emphasis added). The Court credits Hochstetler’s

testimony.

Malia was at all times on a leash, in a harness identifying

Malia as a service animal, and at all times relevant here, was

well-behaved. Malia was neither disruptive nor aggressive.

3 The Court is aware that an emotional support animal is not

necessarily a service animal under the ADA.

Dr. Gargin testified that she is severely allergic to dogs.

As for the incident, Dr. Gargin was not an eyewitness to most of

this encounter, having spotted the dog as she passed by the

front desk and immediately told Smith, “the dog has to go,”

before returning to her office. Dr. Gargin did, however,

confirm that she soon discussed with Smith in her office

possible modifications with Smith, such as an alternative

appointment with another doctor or going ahead with the

appointment herself while Malia waited outside. The Court

credits that Smith relayed Dr. Gargin’s options to Reaves and

Hockman, but at that point their backs were up, and they

insisted that Reaves’s ADA rights had been violated.

This is approximately where Reaves’s video recording of the

incident picks up: Reaves asks an employee (apparently Smith, as

she was identified at trial) to “confirm that [Reaves is] being

denied [her] appointment because of [her] task trained medical

alert service dog,” Smith tells her that Immediate “cannot see

[her] today” because it “cannot have animals inside [its]

office” due to “patients with allergies,” and then informs

Reaves that Immediate will have to cancel her appointment and

that she must leave immediately with her dog, while Reaves and

(as was clarified at trial) Hockman describe their rights under

the ADA and its lack of an allergies exception. Ex. 2.

Immediate called the Sheriff’s Office and, shortly after

the Sheriff’s Deputy arrived, Reaves and Hockman left the

facility with Malia. Portions of the Sheriff’s Deputy’s body

camera video were admitted into evidence, including discussions

between the Sheriff’s Deputy, Reaves, and Hockman just after

Reaves and Hockman left Immediate. Ex. 1.

III. RULINGS OF LAW

To prevail on her ADA claim, Reaves must prove: (1) that

she is disabled; (2) that the defendant owns, leases, or

operates a place of public accommodation; and (3) that the

defendants discriminated against the plaintiff within the

meaning of the ADA. Norkunas v. Seahorse NB, LLC, 444 Fed.

App’x 412, 416 (11th Cir. 2011) (citing 42 U.S.C. § 12182(a)).

“[T]he plaintiff has the burden of proving discrimination in an

ADA claim.” Id. The parties do not dispute that Immediate is a

place of public accommodation. See Pl.’s Mot. Summ. J. & Mem.

Law Supp. 2-3, ECF No. 91.

The Court rules on the above facts that Reaves was disabled

within the meaning of the ADA, but that Immediate did not

unlawfully discriminate against Reaves because Malia posed a

threat to the health and safety of the doctor Reaves was

scheduled to see, and Immediate attempted to offer safe

alternatives to the scheduled appointment. That attempt shows

the required “individualized assessment” of a direct threat to

safety, including a determination of whether “reasonable

modifications” would mitigate the threat, that stands as an

exception to the general rule that service dogs must be allowed

in places of public accommodation. 28 C.F.R. § 36.208(b).

Accordingly, judgment shall enter in favor of Immediate.

A. Reaves Proved She Is Disabled

The ADA defines “disability” as “a physical or mental

impairment that substantially limits one or more major life

activities.” 42 U.S.C. § 12102(1)(A). The ADA’s implementing

regulations define “major life activities” broadly to encompass

“[c]aring for oneself, performing manual tasks, seeing, hearing,

eating, sleeping, walking, standing, . . . breathing, learning,

reading, concentrating, thinking, writing, communicating,

interacting with others, and working,” and the like. 28 C.F.R.

§ 36.105(c)(1)(i). “[T]he threshold issue of whether an

impairment substantially limits a major life activity should not

demand extensive analysis.” Id. § 36.105(d)(1)(ii).

At least some of the disabilities Reaves identified,

including PTSD and bipolar disorder, qualify as protected

disabilities for purposes of the ADA provided that they

substantially limit one’s life activities, and Reaves has

presented some evidence that she was diagnosed with PTSD as

early as 2013. Ex. 5, at 33; see 28 C.F.R. §

36.105(d)(2)(iii)(K) (listing bipolar disorder and PTSD as among

those impairments that should “easily be concluded” will

“substantially limit . . . major life activities”); C.L. v. Del

Amo Hospital, Inc., 992 F.3d 901 (9th Cir. 2021) (treating PTSD

as a protected disability under Title III of the ADA). As the

Court has found that Reaves suffers from medical conditions that

interfere with one or more major functions, the Court rules that

she is a disabled person within the meaning of the ADA.

B. Reaves’s Service Dog Malia

Malia is a “service dog” under the ADA. The ADA does not

set a demanding standard for evaluating the qualifications and

training of service dogs:

The ADA’s implementing regulations define a service

animal as “any dog that is individually trained to do

work or perform tasks for the benefit of an individual

with a disability,” including a psychiatric

disability, where the work or tasks are “directly

related to the individual’s disability.” The

regulations do not specify by whom the dog must be

trained.

Del Amo Hosp., Inc., 992 F.3d at 910–11 (quoting 28 C.F.R. §

36.104). More specifically, “DOJ regulations and commentary

make clear that individuals may self-train service animals

without obtaining formal certification.” Id. at 911.

Consistent with these regulations, the Ninth Circuit has

rejected a strict formal certification requirement, on the

grounds that the ADA defines a service dog by its function, not

its training, and that such a requirement would frustrate the

purposes of the ADA and its implementing regulations. Id. at

910. Indeed, in only the most egregious circumstances have

courts ruled that a service animal fails based upon its

training. See, e.g., Salari v. Walt Disney Parks & Resorts

U.S., Inc., No. 8:23-cv-01406, 2024 WL 4867567, at *3 (C.D. Cal.

Sept. 6, 2024) (finding that dog was not a service animal where

it had received no formal service animal training and performed

no identified tasks beyond comforting presence); Rose v.

Springfield-Greene Cnty. Health Dept., 668 F. Supp. 2d 1206,

1214-15 (W.D. Mo. 2009) (finding evidence of training

insufficient where there was no link between monkey’s comforting

presence and aggressive behaviors toward others and any training

or cues).

Reaves and Hockman testified that they both trained Malia.

Reaves testified that Malia performs specific tasks that assist

with her disability, such as pressing on her body, licking, and

clawing her to “ground” her when she is struggling with anxiety,

and noticing and responding to symptoms such as picking at her

skin. Hockman testified that Malia is very attentive to Reaves

and does as she is trained. Immediate misconstrues the one

piece of evidence that suggests Malia received professional

service training: the certificate from East Tennessee Canine

Academy states that “we can consider the service training of the

dog Malia to be completed and . . . they are ready to assist her

owner Erin Reaves to live their life to the fullest,” indicating

that the Academy considered Malia’s service training to be

“completed,” not, as Immediate contends, that it was still to be

completed in the future. Def.’s Ex. 7, ECF No. 93-5.

While the eyewitness affidavit, discussed above, represents

that Reaves initially identified Malia as an “emotional support

dog” that “helps with [her] anxiety” when she arrived at

Immediate for her appointment, see Hochstetler Aff., the

preponderance of the evidence supports a ruling that Malia

qualifies as a “service animal.” This Court credits Reaves’s

and Hockman’s consistent representations as to Malia’s training,

supported by record evidence. Immediate’s attempt to undercut

this evidence at trial by pointing out that Reaves represented

Hockman to be Malia’s “primary trainer” in response to an

interrogatory, and that Hockman admits to not being a

professional trainer, is not relevant, since even a self-trained

dog may qualify as a service animal if, as here, she performs

specific, trained tasks. See Frequently Asked Questions about

Service Animals and the ADA (“DOJ FAQ”), ADA.gov (Feb. 28,

2020), Question 5, https://www.ada.gov/resources/service-

animals-faqs/ (“People with disabilities have the right to train

the dog themselves and are not required to use a professional

service dog training program.”). This Court also directly

observed Malia at trial and in video evidence responding to

Reaves’s mental state. The weight of the evidence paints a

consistent picture of Malia as trained, by Reaves and others, to

perform specific tasks that assist her in dealing with her

disabilities. Thus, this Court rules that Malia is a “service

animal” for purposes of the ADA.

C. Immediate Did Not Discriminate Against Reaves

As a general rule, “[p]ublic accommodations . . . must

permit disabled individuals to use service animals unless they

can show a regulatory exception applies.” Matheis v. CSL

Plasma, Inc., 936 F.3d 171, 174 (3d Cir. 2019). Allowing

service animals in a place of public accommodation is a

presumptively reasonable modification to that accommodation’s

policies: “Generally a public accommodation shall modify

policies, practices, or procedures to permit the use of a

service animal by an individual with a disability.” 28 C.F.R. §

36.302(c)(1). Given that the Court has ruled that Reaves was

disabled and that Malia is a service animal, then, the case

hinges on whether some exception to this general rule applies to

Reaves’s visit.

As a general proposition, allergies are not enough to

except a place of public accommodation from accommodating a

service animal. See ADA Requirements: Service Animals, ADA.gov

(Feb. 28, 2020), https://www.ada.gov/resources/service-animals-

2010-requirements/ (“Allergies and fear of dogs are not valid

reasons for denying access or refusing service to people using

service animals. When a person who is allergic to dog dander

and a person who uses a service animal must spend time in the

same room or facility, for example, in a school classroom or at

a homeless shelter, they both should be accommodated by

assigning them, if possible, to different locations within the

room or different rooms in the facility.”). Despite this rule,

a service animal may nonetheless be excluded if it poses a

direct threat to the health and safety of persons providing or

receiving services from an accommodation. 28 C.F.R. § 36.208;

see, e.g., Lockett v. Catalina Channel Express, Inc., 496 F.3d

1061, 1066 (9th Cir. 2007) (applying direct threat exception to

potential threat to train passengers’ allergies posed by service

dog).

Whether a service animal poses a “direct threat” for

purposes of the ADA must be determined by:

an individualized assessment, based on reasonable

judgment that relies on current medical knowledge or

on the best available objective evidence, to

ascertain: The nature, duration, and severity of the

risk; the probability that the potential injury will

actually occur; and whether reasonable modifications

of policies, practices, or procedures or the provision

of auxiliary aids or services will mitigate the risk.

28 C.F.R. § 36.208(b) (emphasis added); see also Bennett, 86 F.

4th at 327-28. “Service animals need not be accommodated under

every circumstance, and the regulations specify the situations

in which a public entity may reasonably exclude a service

animal” -- safety among them, such that “if an individual’s use

of a service animal poses a direct threat, it may be excluded

under this provision.” Bennett, 86 F. 4th at 327. “‘The

existence, or nonexistence, of a significant risk must be

determined from the standpoint of the person who [makes the

decision], and the risk assessment must be based on medical or

other objective evidence.’ The belief that a significant risk

existed . . . does not relieve a defendant of liability.” R.W.

v. Board of Regents of the Univ. Sys. of Ga., 114 F. Supp. 3d

1260, 1283-84 (N.D. Ga. 2015) (quoting Bragdon v. Abbott, 524

U.S. 624, 649 (1998)). Specifically, courts “should assess the

objective reasonableness of the views of health care

professionals without deferring to their individual judgments.”

Id. (quoting Bragdon, 524 U.S. at 650).

It is not entirely clear what special burden, if any, ought

be placed on Immediate to show that it has conducted an

individualized assessment of an alleged safety risk, given that

the burden to show discrimination rests, in general, on Reaves.

See Matheis, 936 F.3d at 179 (rejecting the burden-shifting

framework used in other discrimination contexts in favor of a

requirement that the defendant “establish[] exceptions that

permit . . . [it] . . . to deny a disabled individual’s use of a

service animal” (emphasis added) (citing Berardelli v. Allied

Servs. Inst. of Rehab. Med., 900 F.3d 104 (3d Cir. 2018)));

Johnson v. Gambrinus Co./Spoetzl Brewery, 116 F.3d 1052, 1058-60

(5th Cir. 1997) (placing the burden of proof to show that a

proposed reasonable modification would fundamentally alter the

nature of the public accommodation or jeopardize its safety on

the defendant, and characterizing these exceptions as

“affirmative defense[s],” without addressing the regulations at

issue here)).4 The Eleventh Circuit has placed the burden on the

defendant to show that the analogous exception for modifications

that would “fundamentally alter the nature of” a public

accommodation’s services and facilities applies, A.L. by and

through D.L. v. Walt Disney Parks and Resorts US, Inc., 900 F.3d

1270, 1292-93 (11th Cir. 2018), and the parties here agree that

the burden shifts to Immediate on this issue. Accordingly, this

4 One federal district court has recently stated that

“[d]irect threat is an affirmative defense,” Bennett v. Hurley

Med. Ctr., 2023 WL 319925, at *11 (E.D. Mich. Jan. 19, 2023)

(citing Tamara v. El Camino Hosp., 964 F. Supp. 2d 1077, 1085

(N.D. Cal. 2013)), and in the Ninth Circuit this defense comes

with a “heavy burden” on the defendant to show that it applies,

Tamara, 964 F. Supp. 2d at 1085 (quoting Lockett v. Catalina

Channel Express, Inc., 496 F.3d 1061, 1066 (9th Cir. 2007)).

Another federal district court has recently described it as “the

defendants’ burden to demonstrate” that a reasonable

modification would pose a direct threat to health and safety.

Doe v. Rhode Island Interscholastic League, 735 F. Supp. 3d 99,

114 (D.R.I. 2024) (emphasis added); see also Doe v. Deer

Mountain Day Camp, Inc., 682 F. Supp. 2d 324, 347 (S.D.N.Y.

2010) (similar).

Court presumes that it does, while noting that the Eleventh

Circuit has not squarely ruled on this issue.5

Based upon the facts found above by a preponderance of the

evidence, the Court rules that the direct threat exception

applies, and thus Immediate has not discriminated against Reaves

for purposes of the ADA as matter of law. Even the Ninth

Circuit, which has decisively held that the burden to show

direct threat shifts to the plaintiff and that it is a “heavy

burden,” Tamara, 964 F. Supp. 2d at 1085 (quoting Lockett, 496

5 In the Eleventh Circuit, in the context of deciding

whether an employee’s disability poses a “direct threat” to its

employer (a question governed by Title I, not Title III, of the

ADA), “[t]he employee retains at all times the burden of

persuading the jury either that he was not a direct threat or

that reasonable accommodations were available.” Moses v.

American Nonwovens, Inc., 97 F.3d 446, 447 (11th Cir. 1996).

The circuits are not uniform in this interpretation. See

Borgialli v. Thunder Basin Coal Co., 235 F.3d 1284, 1292-94

(10th Cir. 2000) (collecting cases across circuits on this

issue, some of which place the burden on the employer). There

are good reasons to distinguish Title I of the ADA from Title

III on some issues, see Dudley v. Hannaford Bros. Co., 333 F.3d

299, 308-09 (1st Cir. 2003) (noting Title I’s assumption that

employers have basic familiarity with their employees, as

opposed to Title III’s dealing with the citizenry at large), but

the “fundamentally alter” and “direct threat” exceptions stem

from distinct parts of the relevant statutes and regulations, so

it is not clear that they should always be interpreted in the

same way, see 42 U.S.C. §§ 12182(b)(2)(A)(ii),

12182(b)(2)(A)(iii), 12182(b)(3); 28 C.F.R. §§ 36.208,

36.301(b), 36.302(a). Thus, Eleventh Circuit case law on the

issue of whether the burden shifts to the defendant to show that

the plaintiff posed a “direct threat,” including a showing that

the defendant considered reasonable modifications to mitigate

the threat, is inconclusive. Nevertheless, the weight of

persuasive authority suggests that the burden ought shift to

Immediate, and this Court presumes that it does.

F.3d at 1066), has allowed for the “one-time” exclusion of a

service dog from certain areas, informed by a prior policy of

exclusion of such dogs from an allergy-free zone, which forced

employees to “decide on the spot whether to potentially expose

[allergic customers] to dander or to ask [the plaintiff to move

to a different area],” Lockett, 496 F.3d at 1065-66. Since this

Court credits that Smith did, indeed, offer Reaves an

alternative appointment with Dr. Moosavi, or an appointment with

Dr. Gargin herself so long as Malia was taken outside, Immediate

has shown that it conducted an “individualized assessment” of

the risks posed by Malia based on “the best available objective

evidence,” and considered “reasonable modifications” to mitigate

those risks. 28 C.F.R. § 36.208(b); see also Bennett, 86 F. 4th

at 329-31 (affirming district court’s determination that

defendant reasonably concluded service animal was a direct

threat to medical center based on an individualized assessment

factoring in previous allergic reactions, particularly

threatened allergic individual, and lack of knowledge regarding

other potentially allergic patients).

This ruling is supported by the evidence presented at trial

and by the comparative credibility of the witnesses. Immediate

produced evidence suggesting that it weighed the best available

objective evidence -- Dr. Gargin’s testimony regarding her

severe allergy to dogs, based on her prior consultation with her

doctor and her own knowledge of her allergy and its symptoms --

in determining that Dr. Gargin could not conduct the scheduled

visit with Reaves with Reaves’s service animal present, and

evidence that it weighed reasonable modifications in deciding

that this was the case -- particularly Hochstetler’s affidavit,

relaying her eyewitness testimony of what occurred during

Reaves’s visit.6

Conversely, Reaves’s failure to produce medical records

pertaining to serious medical conditions and incidents to which

she testified, while not determinative on the issue of whether

she has a protected disability, raises concerns that she may

exaggerate and may not have been fully forthcoming in her

representations to this Court. Additionally, Reaves’s seemingly

conflicting representations in the record as to whether she does

or does not smoke further raises concerns with her credibility

on other issues. See Ex. 5, at 19, 29. Hochstetler, on the

other hand, is an apparently disinterested eyewitness, and her

testimony by affidavit is consistent with the testimony of Dr.

Gargin about her allergy and her instructions to Smith at trial,

which this Court finds credible.

6 In addition to Hochstetler’s affidavit, the sheriff’s

bodycam video of the incident shows that Immediate at least

discussed Dr. Gargin’s allergy with Reaves at some point -- a

fact which Reaves minimized at trial -- which fits better with

Immediate’s version of the events. Ex. 1.

Given that this appears to have been a one-time decision,

based on Dr. Gargin’s warning and informed by a previous

incident involving her severe allergy, as Dr. Gargin testified

at trial, even the apparently somewhat expedient decision to

exclude Malia clears the bar for establishing the direct threat

exception. The regulation requires only a “reasonable

judgment,” not a perfect one. 28 C.F.R. § 36.208(b).

Therefore, this Court rules that Immediate has carried its

burden and shown that it conducted an individualized assessment

of the direct threat posed by Malia and reasonably concluded

that, without the reasonable modifications it proposed to

Reaves, this threat to Dr. Gargin’s health and safety required

Malia’s exclusion from Reaves’s appointment with Dr. Gargin.

There was, therefore, no ADA violation as matter of law when

Immediate canceled Reaves’s appointment and required Reaves to

leave with Malia upon Reaves’s rejection of the alternatives

that Immediate offered.

IV. CONCLUSION

Accordingly, this Court rules in favor of Immediate and

finds that there was no ADA violation as matter of law based

upon a preponderance of the evidence adduced at trial.

SO ORDERED.

_/s/ William G. Young_

WILLIAM G. YOUNG

JUDGE

of the

UNITED STATES7

7 This is how my predecessor, Peleg Sprague (D. Mass. 1841-

1865), would sign official documents. Now that I’m a Senior

District Judge I adopt this format in honor of all the judicial

colleagues, state and federal, with whom I have had the

privilege to serve over the past 47 years.