Here's a quick question to test your understanding of the Americans with Disabilities Act: Which of these employees would you consider disabled?

a. An OR nurse tests positive for hepatitis and must be reassigned to less-sensitive duties.
b. A scrub tech says her back injury doesn't let her lift and position patients and equipment.
c. A business manager whose cancer is in remission requests a shortened schedule.
d. All of the above.

Under an expanded federal law, the answer is d. Each employee could be considered disabled. Failing to accommodate their situations might land you in an employment discrimination lawsuit.

Expanded effects
Your staff may have or may acquire disabilities that limit their capacity to carry out their job responsibilities. As a result, they may ask you to make staffing or facility changes that let them continue working. These requests might include a modification of their non-essential job functions, additional leave beyond their allotted time off or the purchase of such assistive devices as patient lifting equipment.

For 20 years, the Americans with Disabilities Act has required "reasonable accommodations" in the workplace for employees who are considered disabled. In general, the courts have interpreted the ADA conservatively, subjecting claims of disability to careful analysis to curb abuse.

That changed when Congress passed the ADA Amendments Act, which took effect on Jan. 1, 2009. The legislation aimed to make it easier for disabled individuals to meet the definition of disability. But to many observers, it opened a floodgate, potentially exposing employers to more disability claims involving a wider range of conditions and more requests for accommodations. Compliance with the law could now be a lot more taxing.

While the amendments haven't changed the ADA's definition of disability — which is "a physical or mental impairment that substantially limits a major life activity" — they've expanded its scope, directing that governing authorities should view it broadly and "should not demand extensive analysis" when determining whether an employee is disabled. The changes tend to side with the employee. "The focus of an ADA case should be on whether discrimination occurred," says the federal Equal Employment Opportunity Commission, "not on whether an individual meets the definition of 'disability.'"

What is a disability?
The amendments include examples of impairments that "will consistently meet the definition of a disability" as well as those that "may be disabling for some individuals but not for others." (View a question-and-answer overview at www.eeoc.gov/policy/docs/qanda_adaaa_nprm.html.)

In the past, an employee wasn't considered disabled unless his condition substantially limited his major life activities (which include not only walking, seeing and hearing, but also standing, lifting and interacting with others). Now an employee can be considered disabled even by an impairment that is episodic or in remission, and even if it does not at present limit him, as long as it limits his abilities when it is active.

In a similar fashion, short-term impairments that last as little as 6 months or less (such as chronically recurring migraine headaches, for instance) can be considered substantially limiting and may result in a legal determination of disability.

You may no longer take into account the effects of such mitigating measures as medications and corrective devices when legally determining whether an individual is disabled, even if those measures eliminate the impact of the claimed disability.

Acting on accommodations
These broader applications of the ADA mean it's increasingly likely that you'll be asked to accommodate an employee's condition. Under the law, an employee with a disability is entitled to a reasonable accommodation, but not necessarily the accommodation he demands. It remains imperative, however, for employers to be sensitive to what may now be considered a disability.

First and foremost, you're obligated to discuss the issue with an employee who makes a request for accommodation. There are no formal rules to this process. The purpose is to address the specific limitations an employee is experiencing and determine whether accommodations exist to overcome these limitations and let the employee continue to perform essential job functions.

Don't make these decisions without input from the employee. Ask the employee what accommodations he has previously received or have been recommended by a treating physician or therapist. The possibilities are not limited to those suggested by the employee; in fact, employers should develop their own list of potential accommodations. Each one should be assessed for its effectiveness and potential hardship, particularly with regard for its impact on the performance of patient care.

While some limitations can't be reasonably accommodated without creating an undue hardship on the facility or other staff, it's vitally important that employers demonstrate an effort to consider the possibilities before reaching that decision. An employer who documents each step of this interactive process to demonstrate that she has fulfilled her responsibilities to the employee can use this documentation as a database that can be consulted and expanded as new requests for accommodations are received.