(CN) - Like being at risk for a heart attack, the risk of drug-abuse relapse entitles a Massachusetts doctor to long-term disability benefits, a federal judge ruled.
In 2004, Dr. Julie Colby, an anesthesiologist based in Newburyport, Ma., began to self-medicate using fentanyl to cope with severe back pain caused by her degenerative disc disease.
Fentanyl is a powerful controlled substance - a synthetic, opioid painkiller 80 to 100 times stronger than morphine. Colby took leftover narcotics from the operating room and eventually became addicted to the drug. When co-workers discovered Colby asleep on a table in a hospital hallway, she submitted to a drug screen and tested positive for opiates. Colby then voluntarily stopped practicing medicine and enrolled in a substance-abuse recovery program.
Her employee benefits plan, administered by Union Security Insurance Company (USIC) and others, provided her with long-term disability benefits while she was in rehab, but terminated them when she was discharged. USIC justified the termination, arguing that "the potential for relapse into substance abuse is not the same as a current disability," according to an administrative record.
After filing multiple administrative appeals and one lawsuit in 2007, Colby again sued USIC in 2009, claiming that the termination of her benefits was arbitrary and capricious. Both parties moved for summary judgment.
U.S. District Judge William Young granted Colby's motion for summary judgment on Oct. 12 and awarded her 36 months of retroactive long-term disability benefits in addition to attorneys' fees.
Young repeated much of what the court held in its prior 2007 judgment. "USIC may not categorically exclude the risk of drug abuse relapse as a qualifying disability under the plan," he said.
Given that, by law, the plan may not distinguish between physical and mental impairments, the court found that "it is a moralistic error to distinguish the risk of drug abuse relapse for a recovering addict from a physical ailment."
The court acknowledged that its interpretation of the plan differed from other circuits, particularly the 4th Circuit's 2008 holding in Stanford v. Continental Casualty.
"The plaintiff's legal argument in Stanford is the same as Dr. Colby's position: if a person with a heart condition qualifies for long-term disability benefits because of his severe risk of a heart attack if he returns to a high-stress job, then a recovering addict should recover benefits if her employment exposes her to a high risk of drug abuse relapse," the 44-page decision states.
Young rejected the 4th Circuit's reasoning that the drug addict should be treated differently because she has a choice, whereas the heart-attack prone individual does not.
He cited from the Stanford dissent, which said that "the majority's reasoning necessarily rests on moral considerations of choice and temptation on the one hand, and medical considerations of physical inability on the other. The moral and medical choices are not this court's to make."
"If a risk of drug abuse relapse would render Dr. Colby unable to perform at least one of the material duties of her occupation, then she must be considered disabled under the plan," the court concluded, awarding both damages and attorney fees to Colby.
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