SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
DOCKET NO. A-2017-99T5 AND
A-5581-99T5
CARLA V. ENRIQUEZ, M.D.,
Plaintiff-Appellant,
v.
WEST JERSEY HEALTH SYSTEMS,
WEST JERSEY CENTER FOR BEHAVIOR
LEARNING & ATTENTION, WEST
JERSEY PHYSICIANS ASSOC., a/k/a
WEST JERSEY CLINICAL ASSOCIATION,
CENTER FOR FAMILY GUIDANCE, LES
PASCAL, JAMES VARRELL, M.D., JOHN
P. COSSA, M.D., RICHARD MILLER,
MAUREEN MILLER, ELLEN FEINSTEIN,
GREG MADDISON, ED DUNN, KEVIN
MANLEY, and TONY CHIGOUNIS,
Defendants-Respondents.
_________________________________________________________________
Argued May 31, 2001 - Decided July 3, 2001
Before Judges King, Lefelt and Axelrad.
On appeal from the Superior Court of
New Jersey, Law Division, Camden
County, Docket Nos. L-9328-98 and
L-7543-99.
Arthur B. Jarrett, of the Pennsylvania
bar, admitted pro hac vice, argued the
cause for appellant (James & Jarrett,
attorneys; Mr. Jarrett and Walter D.
Schirrmacker, also of the Pennsylvania
bar and also admitted pro hac vice, and
Brem Moldovsky, on the brief).
William M. Honan argued the cause
for respondents West Jersey Health
Systems, West Jersey Center for
Behavior, Learning & Attention,
Darren H. Goldstein argued the cause
for respondents Family Guidance
Center, Les Pascal & James Varrell,
M.D. (Speziali, Greenwald, Goldstein
& Hawkins, attorneys; Mr. Goldstein,
on the brief).
The opinion of the court was delivered by
LEFELT, J.A.D.
These consolidated appeals arise from the summary judgment
dismissal of two complaints filed by plaintiff Carla Enriquez, a
male-to-female transsexual, for wrongful termination of her
employment as medical director of a learning behavior center
owned and managed by the various corporate and individual
defendants. Most significantly, this appeal raises the novel
issues of whether gender dysphoria or transsexualism is a
handicap under the New Jersey Law Against Discrimination,
N.J.S.A. 10:5-1 through -49 ("LAD"), and whether the LAD
precludes an employer from discriminating on the basis of
someone's sexual identity or gender. We answer both questions in
the affirmative and reverse and remand for further proceedings.
I.
We recount only those portions of the procedural history and
facts necessary to explain our resolution of the issues raised in
these consolidated appeals. Plaintiff was born a biological male
and, until February 1998, was legally known as "Carlos."
Plaintiff is a licensed New Jersey physician who was in the
private practice of general and developmental pediatrics from
1974 to 1995.
On November 20, 1995, defendant West Jersey Health Systems
("West Jersey") hired plaintiff as medical director of defendant
outpatient treatment facility, West Jersey Center for Behavior,
Learning and Attention ("Center"). Plaintiff and West Jersey
entered into a written Professional Services Agreement that could
be terminated by either party upon ninety days' written notice.
In September 1996, less than a year after plaintiff's
employment with West Jersey commenced, she began the external
transformation from male to female. Plaintiff shaved her beard
and eventually removed all vestiges of facial hair. She sculpted
and waxed her eyebrows, pierced her ears, started wearing emerald
stone earrings, and began growing breasts.
In the early months of 1997, plaintiff was confronted by
defendants John Cossa, Maureen Miller, and Ellen Feinstein
regarding their discomfort over her transformation. Cossa was
West Jersey's vice president and president and chief executive
officer of defendant West Jersey Clinical Association, also known
as defendant West Jersey Physicians' Associates ("Physicians'
Associates"), the entity which assumed control of the Center's
professional staff in September 1997. Miller was vice president
of outpatient services at West Jersey and Feinstein was her
assistant.
By February 1997, plaintiff began manicuring and polishing
her nails, growing long hair, and wearing a ponytail. On
February 13, 1997, Cossa expressly questioned plaintiff about her
appearance. According to plaintiff, Cossa asked if plaintiff
would be willing to go back to her prior appearance if West
Jersey asked her to. Cossa told plaintiff, "stop all this and go
back to your previous appearance!"
In June 1997, plaintiff was diagnosed with gender dysphoria,
which is a gender identity disorder listed in the Diagnostic and
Statistical Manual of Mental Disorders, (fourth edition,
1994)("DSM-IV"), published by the American Psychiatric
Association. This disorder is also known as transsexualism.
On July 22, 1997, plaintiff received a letter from Miller
stating that the hospital, pursuant to the professional services
agreement, was terminating the agreement, without cause,
effective in ninety days, on October 22, 1997. According to this
letter, the Center's program was being assumed by Physicians'
Associates as of the end of October. Plaintiff was advised that
she would be contacted by Cossa to discuss a new contract with
that entity.
From July 22 to September 29, 1997, plaintiff repeatedly
tried to discuss a new contract with Cossa, without any success.
Plaintiff claimed that as of September 1997, all of the other
professional staff employed at the Center had become employees of
Physicians' Associates.
On September 29, 1997, when plaintiff finally met with Cossa
regarding a new contract for plaintiff, Cossa advised plaintiff
that "[N]o one's going to sign this contract unless you stop this
business that you're doing."
When Cossa and plaintiff next met, on October 13, plaintiff
presented Cossa with a letter she had drafted to her family and
patients, explaining her gender identity disorder and the
treatment she was following. She had not yet sent the letter to
anyone. Cossa asked plaintiff not to say anything yet and to let
Cossa try to work things out.
On October 22, 1997, Cossa handed plaintiff a termination
letter. According to this letter, Cossa and plaintiff had
discussed the possibility of moving plaintiff to Physicians'
Associates. However, defendants decided not to pursue that
option and had made arrangements for other doctors to be
available immediately to provide care to the Center's patients.
Cossa told plaintiff that the hospital would not allow
plaintiff to send her proposed letter to the patients, and that
the hospital had drafted a different letter. Plaintiff was also
told not to return to the office for the rest of that day and
that her patients had been canceled for the next three months.
In February 1998, plaintiff legally changed her name to
Carla. In July 1998, approximately nine months after she was
terminated, plaintiff underwent the surgical procedure to become
a female. Plaintiff stated that while she was a man, she was not
gay and was not sexually attracted to other men. No one at West
Jersey ever accused plaintiff of being gay. Since her surgery,
plaintiff has continued to live as a "spouse" with Monica, to
whom plaintiff was married while she was a man. Plaintiff
believes, according to her deposition testimony, that Monica is a
lesbian. Plaintiff believes that the course of treatment she
began, that ended with sex reassignment surgery, cured her gender
dysphoria.
In December 1998, plaintiff filed her first complaint
against defendants for disability discrimination under the LAD,
gender or sexual orientation-affection discrimination under the
LAD, breach of contract, and trade libel. The West Jersey
defendants filed a motion for partial summary judgment, seeking
dismissal of plaintiff's claim for disability discrimination.
The motion judge granted defendant's motion, noting that other
courts had concluded that transsexualism was not a recognized
mental or physical disability under statutes very similar to
ours.
Thereafter, all defendants moved for summary judgment
seeking dismissal of the remainder of plaintiff's claims. Before
these motions could be heard, plaintiff filed a separately
docketed complaint on October 21, 1999, naming the same
defendants and reciting the same factual allegations. This
complaint, however, alleged causes of action for intentional
interference with a contractual relationship, conspiracy,
wrongful refusal to continue a business, and unjust enrichment.
In dealing with the summary judgment motions made by all
defendants regarding the remaining counts of plaintiff's first
complaint, the motion judge found that plaintiff could not bring
a claim for sexual orientation discrimination because plaintiff
admitted that, while she was a male, she was not gay and was
never accused of being gay. The judge did not believe that the
Legislature has provided any remedy for persons who elected to
change their sex.
The judge dismissed the breach of contract claim on the
ground that plaintiff's employment contract contained a ninety-
day termination provision. With regard to the trade libel claim,
the judge noted that plaintiff had refused to identify those
patients she claimed had been told by defendants that something
was wrong with plaintiff and that plaintiff was no longer
practicing medicine. The judge acknowledged that plaintiff had
submitted two affidavits in opposition to summary judgment, but
did not comment on whether these affidavits would alter his
decision.
The affidavits that plaintiff had submitted in opposition to
the summary judgment motion were from the parents of two
patients. According to one parent, after plaintiff's
termination, West Jersey told her that they had no idea where
plaintiff was. The parent was also told that plaintiff might
have stopped practicing medicine and that the parent should look
for a new doctor for her child.
The affidavit from the other parent was similar. In
addition to telling this parent that they had no idea where
plaintiff went, defendants also said that plaintiff was going
through some personal issues and would probably not be practicing
medicine anymore.
In February 2000, all defendants moved for a summary
judgment dismissal of plaintiff's second complaint. In granting
these motions, a different motion judge concluded that the second
complaint was a "repackaging" of the first complaint, which had
been dismissed by the first motion judge.
Plaintiff appealed from the summary judgments dismissing the
two complaints, and we consolidated the two appeals. In addition
to contesting the dismissal of the entire first complaint, only
two of the causes of action alleged by plaintiff in the second
complaint, interference with economic opportunity and unjust
enrichment, are being challenged in the appeal.
II.
We first detail what the record discloses concerning
plaintiff's gender dysphoria or transsexualism. Essentially,
plaintiff claimed that she felt like a woman trapped in a man's
body from a very early age, and that she was called upon to act
manly even though she did not feel masculine. This is consistent
with general clinical findings regarding other transsexuals.
"Transsexuals do not alternate between gender roles; rather, they
assume a fixed role of attitudes, feelings, fantasies, and
choices consonant with those of the opposite sex, all of which
clearly date back to early development." Current Medical
Diagnosis & Treatment 928 (Lawrence M. Tierney, Jr. et al. eds.,
35th ed. 1996).
Though plaintiff is a physician, she did not diagnose
herself. Dr. William Stayton from the University of Pennsylvania
formally diagnosed plaintiff's condition. Plaintiff claims Dr.
Stayton is an "internationally renowned expert in gender and
sexual medicine." According to the letter plaintiff wanted to
send her patients explaining her situation, there are
"internationally accepted norms for treatment of this condition."
These encompass the steps that plaintiff went through including
"extensive psychological counseling, extended planning for
'transition,' the use of contrahormonal therapy, hair removal,
living in the putative gender role full time (the so called 'Real
Life Test') and finally, in some cases, sex reassignment
surgery."
Also in the letter she planned to send her patients,
plaintiff further explained gender dysphoria in this fashion:
Current research tells us that early in fetal
development, the infant's brain undergoes
masculinization or feminization unrelated to
chromosomal complement. Later, as we grow
up, we identify with the 'cortical' or brain
gender we were endowed with. Happily, for
the majority of the population, the genetic
(or chromosomal gender) and the cortical (or
brain gender) are congruent. Later in
development, we develop sexual preferences,
sexual orientation, gender attribution, and
gender function. Again, in the majority of
the population, all of these are congruent
and society and the individual are happy.
But some people do not have this harmony. We
call these feelings 'dysphoria' in medicine.
Literally, this means 'unhappy,' but doctors
have expanded its meaning to describe
conditions that significantly effect the
individual. Gender Dysphoria describes a
condition in which there is not this harmony.
The physical and the inner selves are at
odds.
Plaintiff argues that the court erred in dismissing her
claim of discrimination based on either gender or sexual
orientation/affection. The LAD provides in pertinent part that
it is unlawful for an employer to terminate someone's employment
based on that person's "affectional or sexual orientation,
genetic information, sex or atypical hereditary cellular or blood
trait," N.J.S.A. 10:5-12(a). The part of the LAD dealing with
"affectional or sexual orientation" was added by the Legislature
in 1992. L. 1991, c. 519, § 8, effective January 19, 1992.
"'Affectional or sexual orientation' means male or female
heterosexuality, homosexuality or bisexuality by inclination,
practice, identity or expression, having a history thereof or
being perceived, presumed or identified by others as having such
an orientation." N.J.S.A. 10:5-5(hh). "Heterosexuality" is
defined as affectional, emotional or physical attraction or
behavior primarily directed towards persons of the other gender,
"homosexuality" is directed towards persons of the same gender,
and "bisexuality" is directed towards persons of either gender.
N.J.S.A. 10:5-5(ii)-(kk).
We conclude that plaintiff failed to establish a prima facie
case for discrimination based on her affectional or sexual
orientation because she was not a homosexual or bisexual or
perceived to be homosexual or bisexual. This portion of the
statute refers to one's relations with others and not to his or
her own sexual identity, and plaintiff presented no evidence that
she was discriminated against because of her "affectional,
emotional or physical attraction" to others.
Plaintiff's complaint, however, also included a claim for
gender discrimination. Plaintiff specifically charged that her
"sexual affectation and/or orientation and/or gender, real or as
perceived by the defendants was and is a determining factor in
connection with defendants ongoing discriminatory, retaliatory
and harassing treatment of Plaintiff." Thus, we proceed to
consider whether plaintiff has set forth a viable LAD cause of
action based on her gender.
We note preliminarily that the LAD bars discrimination on
the basis of "sex" and gender is not specifically mentioned in
the law. "Sex" is generally understood to mean "whether a person
is anatomically male or female." Taylor Flynn, Transforming the
Debate: Why We Need to Include Transgender Rights in the
Struggles for Sex and Sexual Orientation Equality,
101 Colum. L.
Rev. 392, 394 (2001). Gender is "whether a person has qualities
that society considers masculine or feminine." Ibid.
Title VII of the Civil Rights Act of 1964, 42 U.S.C.A.
§ 2000e-2(a)(1), does not contain language barring discrimination
based on one's affectional or sexual orientation. Moreover, the
federal courts construing Title VII have unanimously concluded
that discrimination on the basis of gender dysphoria is not sex
discrimination. Basically, the federal courts conclude that
discrimination on the basis of sex outlaws discrimination against
women because they are women, and against men because they are
men. E.g., Ulane v. E. Airlines, Inc.,
742 F.2d 1081, 1085 (7th
Cir. 1984), cert. denied,
471 U.S. 1017,
105 S. Ct. 2023,
85 L.
Ed.2d 304 (1985); Sommers v. Budget Mktg., Inc.,
667 F.2d 748,
750 (8th Cir. 1982); Holloway v. Arthur Andersen & Co.,
566 F.2d 659, 662-63 (9th Cir. 1977); Grossman v. Bernards Tp. Bd. of
Educ., 11 Fair Empl. Prac. Cas. (BNA) 1196 (D.N.J. 1975), aff'd,
538 F.2d 319 (3d Cir.), cert. denied,
429 U.S. 897,
97 S. Ct. 261,
50 L. Ed.2d 181(1976).
In 1989, however, the United States Supreme Court signaled a
possible change in the federal approach to gender dysphoria. In
Price Waterhouse v. Hopkins,
490 U.S. 228,
109 S. Ct. 1775,
104 L. Ed.2d 268 (1989), the Court held that Title VII barred
discrimination of a woman who failed to "act like a woman" or to
conform to socially-constructed gender expectations. This
approach would seem to indicate that the word "sex" in Title VII
encompasses both gender and sex, and forbids discrimination
because of one's failure to act in a way expected of a man or a
woman. Schwenk v. Hartford,
204 F.3d 1187, 1201-02 (9th Cir.
2000). The United States Supreme Court has stated that Congress,
in barring discrimination based on sex, "intended to strike at
the entire spectrum of disparate treatment of men and women
resulting from sex stereotypes." Price Waterhouse v. Hopkins,
supra, 490 U.S. at 251, 109 S. Ct. at 1791, 104 L. Ed.
2d at 288
(citation omitted). Again, as further evidence of this change in
approach, Rosa v. Park West Bank & Trust Co.,
214 F.3d 213 (1st
Cir. 2000), found under the Equal Credit Opportunity Act,
15 U.S.C. §1691(1994), that discrimination against a man because he
was wearing a dress could constitute sex discrimination. Id. at
214.
The states are split on this issue. For example, in Sommers
v. Iowa Civil Rights Comm'n,
337 N.W.2d 470, 474 (Iowa 1983), the
Iowa Supreme Court concluded that the word "sex" in Iowa's Civil
Rights Act did not include transsexuals and that sexual
discrimination was intended to prohibit conduct which, had the
victim been a member of the opposite sex, would not have
otherwise occurred.
Similarly, in James v. Ranch Mart Hardware, Inc.,
881 F.
Supp. 478, 481, n.4 (D. Kan. 1995) (applying Kansas law), the
federal court held that under the Kansas Act Against
Discrimination, a male-to-female transsexual could not sue for
discrimination. Moreover, because male employees constituted the
"majority," the plaintiff had to prove a case of "reverse"
discrimination, that is, that her employer was the rare employer
who discriminated against the majority. Id. at 481.
In Underwood v. Archer Mgmt. Servs., Inc.,
857 F. Supp. 96,
98 (D.D.C. 1994), the court, applying local federal law, held
that "sex" in the District of Columbia's Human Rights Act did not
include transsexuality because the District's Commission on Human
Rights had defined the term to mean the state of being male or
female and the conditions associated therewith. Moreover,
although the statute also included a prohibition against sexual
orientation discrimination, transsexuality was not the same thing
as homosexuality, and the complaint had been devoid of any
reference to plaintiff's sexual orientation. Ibid.
We disagree with the rationale of these decisions. A person
who is discriminated against because he changes his gender from
male to female is being discriminated against because he or she
is a member of a very small minority whose condition remains
incomprehensible to most individuals. The view of sex
discrimination reflected in these decisions is too constricted.
Rather, we believe that the New York case Maffei v. Kolaeton
Indus., Inc.,
626 N.Y.S.2d 391 (Sup. Ct. 1995), is better
reasoned. In Maffei, a state law prohibited sex discrimination
and a city law also prohibited sexual orientation discrimination.
Id. at 392. The court agreed with the reasoning of Underwood
that sexual orientation discrimination did not apply to a
transsexual because such discrimination dealt only with the sex
of the person's sexual partner. Id. at 393.
However, in concluding that discrimination against a
transsexual constituted sex discrimination, the New York court
held that the contrary holdings of the federal courts under Title
VII were unduly restrictive and should not be followed in
interpreting state and local statutes. Id. at 394-95. Although
the city statute used the term "gender" whereas the state statute
used the term "sex," the court held that harassment based on the
fact an employee changed his sexual status also constituted sex
discrimination. Id. at 395-96. Such behavior was similar to
harassment based on one's secondary sexual characteristics. Id.
at 396.
The Minnesota Human Rights Act is unique because it is one
of the only state statutes to include in its definition of sexual
orientation, "having or being perceived as having . . . a self-
image or identity not traditionally associated with one's
biological maleness or femaleness." Minn. Stat. §363.01, subd.
45 (added by L. 1993, c. 22, §§ 1, 2). In Goins v. West Group,
619 N.W.2d 424, 428 (Minn. Ct. App. 2000), this statute was held
to include within its protected class an individual who was born
male, who changed her legal name to that of a female, and who
took female hormones to identify herself as a female, even though
she elected not to undergo sexual reassignment surgery. Id. at
426, 428.
We conclude that the reasoning reflected in Goins, Maffei,
as well as Price Waterhouse, Schwenk, and Rosa is more closely
connected to our own state's historic policy of liberally
construing the LAD. Fraser v. Robin Dee Day Camp,
44 N.J. 480,
486 (1965). There is also some New Jersey support for the
position that precluding discrimination on the basis of sex also
precludes gender discrimination.
In Zalewski v. Overlook Hosp.,
300 N.J. Super. 202 (Law Div.
1996), Judge Menza decided that the LAD applied to sexual
harassment of a heterosexual male by other heterosexual males
when the harassment was based on gender stereotyping. In
Zalewski, the plaintiff's coworkers harassed him because they
thought he was a virgin. They never suggested his sexual
orientation was anything other than heterosexual and there was no
evidence that he was homosexual or bisexual. Id. at 203-04.
Nevertheless, Judge Menza found a violation and noted that we
should not "condone severe sexual harassment of a person because
he is perceived or presumed to be less than someone's definition
of masculine." Id. at 211.
A generation ago, when Justice Handler served in the
Appellate Division, he found that "[t]he evidence and authority
which we have examined, however, show that a person's sex or
sexuality embraces an individual's gender, that is, one's self-
image, the deep psychological or emotional sense of sexual
identity and character." M.T. v. J.T.,
140 N.J. Super. 77, 86
(App. Div.), certif. denied,
71 N.J. 345 (1976). We agree with
Justice Handler that "sex" embraces an "individual's gender," and
is broader than anatomical sex. "[S]ex is comprised of more than
a person's genitalia at birth." Flynn, supra,
101 Colum. L. Rev.
at 415. The word "sex" as used in the LAD should be interpreted
to include gender, protecting from discrimination on the basis of
sex or gender.
It is incomprehensible to us that our Legislature would ban
discrimination against heterosexual men and women; against
homosexual men and women; against bisexual men and women; against
men and women who are perceived, presumed or identified by others
as not conforming to the stereotypical notions of how men and
women behave, but would condone discrimination against men or
women who seek to change their anatomical sex because they suffer
from a gender identity disorder. We conclude that sex
discrimination under the LAD includes gender discrimination so as
to protect plaintiff from gender stereotyping and discrimination
for transforming herself from a man to a woman.
III.
Plaintiff also contends that gender dysphoria is a handicap
and a recognized disability under the LAD. It is unlawful to
discriminate against an employee because of a handicap "unless
the nature and extent of the handicap reasonably precludes the
performance of the particular employment." N.J.S.A. 10:5-4.1.
The LAD has defined "handicapped" as:
suffering from physical disability,
infirmity, malformation or disfigurement
which is caused by bodily injury, birth
defect or illness, . . . or from any mental,
psychological or developmental disability
resulting from anatomical, psychological,
physiological or neurological conditions
which prevents the normal exercise of any
bodily or mental functions or is
demonstrable, medically or psychologically,
by accepted clinical or laboratory diagnostic
techniques. . . .
[N.J.S.A. 10:5-5(q).]
In this case we are not dealing with any "physical disability,
infirmity, malformation or disfigurement which is caused by
bodily injury, birth defect or illness." We are dealing with the
portion of the statute that provides that a person can be
handicapped if they suffer from a "mental, psychological or
developmental disability resulting from anatomical,
psychological, physiological or neurological conditions which
prevents the normal exercise of any bodily or mental functions or
is demonstrable, medically or psychologically, by accepted
clinical or laboratory diagnostic techniques."
Plaintiff is, however, relying exclusively on the clinical
or laboratory diagnostic portion of the definition. She does not
argue that transsexualism prevented the normal exercise of any
bodily or mental functions. And, according to plaintiff, her
condition did not interfere with the adequate performance of her
work at the Center. Termination of a "handicapped" employee,
whose condition does not prevent the employee from doing her job,
is actionable under the LAD. Gimello v. Agency Rent-A-Car Sys.,
Inc.,
250 N.J. Super. 338, 365 (App. Div. 1991).
Therefore, in this case plaintiff asks us to determine
whether gender dysphoria is a handicap and protected by the LAD
because it is a "mental, psychological or developmental
disability resulting from anatomical, psychological,
physiological or neurological conditions which . . . is
demonstrable, medically or psychologically, by accepted clinical
or laboratory diagnostic techniques."
As remedial social legislation, the LAD is deserving of a
liberal construction, especially with regard to handicaps.
Clowes v. Terminix Int'l, Inc.,
109 N.J. 575, 590 (1988);
Andersen v. Exxon Co., U.S.A.,
89 N.J. 483, 495 (1982). The
statutory definition of handicapped under N.J.S.A. 10:5-5(q) is
very broad in its scope, Clowes v. Terminix, supra, 109 N.J. at
593, and is not limited to "severe" disabilities. Andersen v.
Exxon, supra, 89 N.J. at 494-95. Rather, it prohibits
discrimination against those suffering from any disability. Id.
at 495.
The parties agree that gender dysphoria is listed in the
DSM-IV as a disorder. Defendants argue correctly, however, that
this listing is not dispositive for classification as a
disability under the LAD. Merely because a condition is a
disorder listed in the DSM-IV does not mean it is also a handicap
under the LAD. A.B.C. v. XYZ Corp.,
282 N.J. Super. 494, 508
(App. Div. 1995) (Petrella, J.A.D., concurring).
A disorder is not necessarily the equivalent of a disease,
disability, illness, or defect, especially where these terms
carry legal significance. Id. at 507-08 (Petrella, J.A.D.,
concurring). Moreover, the LAD itself does not preclude
discrimination based on conduct. N.J.S.A. 10:5-2.1. In
addition, the DSM-IV also cautions that categorization of
conditions contained in the manual "may not be wholly relevant to
legal judgments, for example, that take into account such issues
as individual responsibility, disability determination, and
competency." DSM-IV, supra, Cautionary Statement at xxvii.
The Americans with Disabilities Act (ADA) expressly excludes
"transvestism, transsexualism, pedophilia, exhibitionism,
voyeurism, gender identity disorders not resulting from physical
impairments, other sexual behavior disorders."
42 U.S.C.A.
§12211(b)(1). That statute also contains a requirement that the
impairment be one which substantially limits a major life
activity.
42 U.S.C.A.
§12102(2)(A). Our own statute does not
contain such a restriction. Moreover, our own Legislature has
not considered or addressed similar exclusions. A.B.C. v. XYZ,
supra, 282 N.J. Super. at 508 n.3 (Petrella, J.A.D., concurring).
Other state courts, however, appear to be split on this
issue when construing their own statutes. For example, a
Pennsylvania court has concluded that transsexualism is not a
disability under the Pennsylvania Human Relations Act because
that statute requires that the disability substantially limit a
major life activity and because petitioner did not contend that
transsexualism affected any bodily function. Holt v. Northwest
Pa. Training P'ship Consortium, Inc.,
694 A.2d 1134, 1139 (Pa.
Commw. Ct. 1997).
A Washington state court, however, has construed gender
dysphoria as a handicap under the Washington Law Against
Discrimination, finding that it is a medically cognizable and
diagnosable condition, that those who suffer from it endure great
mental and emotional agony, and that it has a prescribed course
of treatment. Doe v. Boeing Co.,
846 P.2d 531, 535-36 (Wash.
1993).
An Iowa court reached the contrary conclusion construing its
statute which also contains a "major life activity" restriction.
Sommers v. Iowa Civil Rights Comm'n, supra, 337 N.W.
2d at 475.
The court noted that a person who is anatomically of one sex but
psychologically and emotionally of the other sex has a problem
that does not necessarily constitute the kind of mental condition
that the Legislature intended to be treated as a substantial
handicap. Id. at 476. Transsexualism should not ordinarily
affect a person's capacity to engage in major life activities.
Ibid.
Our problem with the out-of-state cases concluding that
gender dysphoria is not a disability is that our statute is very
broad and does not require that a disability restrict any major
life activities to any degree. In Olson v. Gen. Elec.
Astrospace,
966 F. Supp. 312< (D.N.J. 1997), for example, the
federal court found that plaintiff's conditions of depression and
multiple personality disorder were recognized disabilities under
the LAD because they were demonstrable, medically or
psychologically, by accepted clinical or laboratory diagnostic
techniques, because these ailments were generally understood by
the medical profession as diseases, and because the plaintiff had
sought legitimate treatment for them. Id. at 315.
Our courts have held that the LAD recognizes as disabilities
such conditions as alcoholism, Clowes v. Terminix, supra, 109
N.J. at 593-94; obesity, Gimello v. Agency Rent-A-Car, supra, 250
N.J. Super. at 361-62; and substance abuse, In re Cahill,
245 N.J. Super. 397, 400 (App. Div. 1991). The LAD has thus been
broadly and liberally construed to include what otherwise might
be termed emotional or mental disorders, in order to eradicate
the evil of discrimination in New Jersey. "Employment
discrimination due to sex or any other invidious classification
is peculiarly repugnant in a society which prides itself on
judging each individual by his or her merits." Peper v.
Princeton Univ. Bd. of Trs.,
77 N.J. 55, 80 (1978).
Gender dysphoria is regarded medically as a "mental disorder
occurring in an estimated frequency of 1:50,000 individuals."
Cole, Emory, Huang, Meyer, Treatment of Gender Dysphoria,
90 Tex.
Med. 68 (1994). Moreover, treatment for the disorder can now "be
regarded as accepted medical practice." Ibid. See also Farmer
v. Brennan,
511 U.S. 825, 829,
114 S. Ct. 1970, 1975,
128 L. Ed.2d 811, 820 (1994) (transsexualism is a rare psychiatric disorder
in which a person feels persistently uncomfortable about his or
her anatomical sex and seeks medical treatment including hormonal
therapy and surgery to bring about permanent sex change)
(citations omitted).
The disorder is recognized within DSM-IV, thus confirming
that the condition can be diagnosed by accepted clinical
techniques. In fact, the DSM-IV lists four criteria necessary
for diagnosing a gender identity disorder. Furthermore, gender
dysphoria does not cause violations of the law as does
exhibitionism, which was the DSM-IV disorder Judge Petrella
struggled with in A.B.C. v. XYZ, supra, 282 N.J. Super. at 506-
09; N.J.S.A. 2C:14-4.
The DSM-IV also notes that each recognized disorder
contained within the manual "is associated with present distress
(e.g., a painful symptom) or disability (i.e., impairment in one
or more important areas of functioning) or with a significantly
increased risk of suffering death, pain, disability, or an
important loss of freedom." DSM-IV, supra, at xxi. With regard
to gender dysphoria specifically, the manual notes that the
"disturbance causes clinically significant distress or impairment
in social, occupational, or other important areas of
functioning." DSM-IV, supra, §302.85 at 537-38. Transsexualism
can be accompanied by a profound sense of loathing for an
individuals's primary and secondary sexual characteristics, which
is overwhelming and unalterable. Dr. L. Gooren, An Appraisal of
endocrine theories of homosexuality and gender dysphoria. In:
Handbook of Sexology vol. 6, 410-24 (Sitsen JMA, Amsterdam,
Elsevier Science Publishers 1988). Thus, gender dysphoria is a
recognized mental or psychological disability that can be
demonstrated psychologically by accepted clinical diagnostic
techniques and qualifies as a handicap under the LAD. N.J.S.A.
10:5-5(q).
To establish the first element of a discriminatory discharge
case under the LAD, however, an employee must submit proof that
he or she was handicapped. Maher v. N.J. Transit Rail
Operations, Inc.,
125 N.J. 455, 480-81 (1991); Clowes v. Terminix
Int'l, Inc., supra, 109 N.J. at 596. Here, the dismissal of
plaintiff's complaint was based solely on the motion judge's
conclusion that gender dysphoria was not a handicap under the
LAD. While we have concluded that gender dysphoria can
constitute a handicap, we have problems with the proofs submitted
by plaintiff during the summary judgment proceedings.
We note that plaintiff's proofs are not clear regarding
the quality and quantity of impairment plaintiff may have
suffered from this disorder. While the LAD does not require
proof that some major life activity was impaired, plaintiff must
suffer a disability. There is some evidence that before the
surgery plaintiff's stress increased and her "moods worsened."
There is also evidence that before her surgery plaintiff was
argumentative and had difficulty controlling her temper. Since
the surgery, plaintiff acknowledged experiencing greater
"humanity," with her patients noting "how much more open and able
to talk to me they are, particularly the adolescents."
In addition, we recognize that as part of her treatment
protocol, plaintiff underwent sexual reassignment surgery, a
process that most persons would not undertake unless necessary to
eliminate great stress or extreme discomfort. Solely from the
circumstances of plaintiff's course of treatment, we can infer
sufficient impairment of plaintiff's emotional and mental well
being to constitute a disability under the LAD. Plaintiff's
proofs were adequate to at least raise a factual issue for
summary judgment purposes establishing that her condition was a
disability under the LAD. Brill v. Guardian Life Ins. Co. of
Am.,
142 N.J. 520, 540 (1995).
To constitute a handicap, however, the disability must also
result "from anatomical, psychological, physiological or
neurological conditions which . . . is demonstrable . . .
psychologically, by accepted clinical . . . diagnostic
techniques. N.J.S.A. 10:5-5(q). The record is completely silent
on this issue.
There is an absence of evidence from Dr. Stayton confirming
that he diagnosed gender dysphoria in plaintiff, explaining the
condition as it manifested itself in plaintiff, and detailing the
methods the doctor utilized to diagnose plaintiff. While
"[n]othing . . . prevents a medical doctor from testifying as an
expert in [her] own case," Carey v. Lovett,
132 N.J. 44, 64
(1993), evidence of her specific disorder and its diagnosis
appear to be beyond plaintiff's training and specialty.
While the DSM-IV does detail the elements necessary to
diagnose a gender disorder, there has been some criticism of
these elements. Dr. Herbert Bower contends, for example, that
the classification "neglects a number of diagnostically
significant symptoms and characteristics of classical
transsexualism." The doctor argues that:
The initially mentioned four criteria omit
the overwhelming desire to have the genitalia
altered. The symptomatology does not include
important features such as masturbation with
fantasy of intercourse with a person of the
same anatomical gender, occasional arousal
during cross-dressing in the initial phase,
lack of sexual interest during adolescence,
stressful puberty and an essentially normal
child rearing process.
[Herbert Bower, The gender identity disorder
in the DSMIV classification - a critical
evaluation, at
http://www.pfc.org.uk/
congress/abstract/abs-005.html.]
Thus, to establish that she is handicapped under the LAD,
plaintiff must prove that she had gender dysphoria and that the
disorder was diagnosed by "accepted clinical or laboratory
diagnostic techniques." N.J.S.A. 10:5-5(q). The record is
silent regarding whether the diagnostic technique utilized by Dr.
Stayton was "accepted."
The motion judge rejected plaintiff's complaint solely
because he believed that gender dysphoria could not be a handicap
under the LAD. We disagree with this assessment and reverse on
that basis. Because the case must be remanded for trial on
plaintiff's gender discrimination claim, we leave plaintiff to
her proofs on whether she had gender dysphoria and whether her
condition was diagnosed in a fashion sufficient to qualify as a
handicap under the LAD.
IV.
Because the matter must be remanded, we briefly consider the
other claims raised by this appeal.
A.
Summary judgment was granted the Center for Family Guidance
("CFG") defendants, and plaintiff's complaint was dismissed as to
them. According to plaintiff's complaint, defendant CFG was the
successor to the Center and was owned by defendant James Varrell,
M.D. Defendant Les Pascal was the chief financial officer of
CFG. There is nothing in the summary judgment record to support
plaintiff's allegation that the CFG defendants refused to hire
plaintiff for her gender or any other discriminatory reasons.
None of the CFG defendants ever worked with plaintiff, employed
plaintiff or were parties to her employment contract. In
addition, there is nothing in this record establishing that these
defendants uttered any false or defamatory statements about her.
Indeed, plaintiff was never involved in any business relationship
or transaction with the CFG defendants. Consequently, all of
plaintiff's claims against these defendants were properly
dismissed.
B.
Plaintiff argues that the court erred in dismissing her
claim for breach of contract. Plaintiff acknowledges that her
contract permitted West Jersey to terminate her services on
ninety-days notice for any reason or no reason. She nevertheless
contends that the contract contained a good faith provision, and
her written notice of termination also advised that she would be
contacted by Cossa to discuss a new contract with Physicians'
Associates, the entity which would be assuming control over the
Center's program. Thus, plaintiff contends that she reasonably
relied on defendants to negotiate with her in good faith leading
to a new contract. This is not the kind of good faith breach
that is actionable. Noye v. Hoffmann-LaRoche, Inc.,
238 N.J.
Super. 430, 433 (App. Div.), certif. denied,
122 N.J. 146, 147
(1990). There is no breach of any kind in this case. Nothing
in plaintiff's contract required defendants to re-hire her once
they chose to terminate her. Also, this claim is nothing more
than her LAD claim restated as a common-law contract claim.
Plaintiff also argued that there were other provisions of
her contract, such as educational leave, equipment requirements
and billing procedures that were breached by defendants. As
pointed out by defendants, however, plaintiff is unable to
demonstrate any compensable loss to her relating to defendants'
alleged "breach" of these provisions. Most, if not all, of these
alleged "breaches" relate to plaintiff's displeasure regarding
the manner in which the Center operated. Consequently,
plaintiff's breach of contract claim was correctly dismissed.
C.
Plaintiff argues that the court erred in dismissing her
claim for trade libel. Trade libel consists of communications
made to a third person of false statements concerning the
plaintiff, or plaintiff's property or business. Henry V. Vaccaro
Constr. Co. v. A.J. DePace, Inc.,
137 N.J. Super. 512, 514 (Law
Div. 1975). The communication must be made to a third person,
and it must be false and play a material part in inducing others
not to deal with plaintiff. Prosser & Keeton on Torts § 128 at
967 (5th ed. 1984). It can include a false statement that
plaintiff has gone out of business. Id. at 963. It is also
essential that the plaintiff establish damages. Id. at 965.
In such an action brought against a former employer for
publishing defamatory information about the employee to
prospective new employers, a qualified privilege extends to the
defendant who responds in good faith to specific inquiries about
the employee's qualifications. Kass v. Great Coastal Express,
Inc.,
152 N.J. 353, 355-56 (1998). This privilege will be abused
if the defendant knows the statement is false or acts in reckless
disregard of its truth or falsity, if the publication serves a
purpose contrary to the interests of the qualified privilege, or
if the statement is excessively published. Id. at 356.
Here, plaintiff's trade libel claim was dismissed on summary
judgment, despite the fact that in opposition, plaintiff
submitted two affidavits from parents of two patients who alleged
that defendants had lied to them about the status of plaintiff's
medical license and practice following her termination.
If plaintiff's allegations are true, she has established a
prima facie case of trade libel. Whether plaintiff can
ultimately prevail on this claim will depend on the proofs
plaintiff can marshal regarding defendants' conduct and on
whether defendants can validly assert a qualified privilege.
Defendants also argue, however, that plaintiff failed to
prove that any patient chose to go elsewhere as a result of what
defendants said about her. While plaintiff's damages for this
tort appear, at this time, to be nebulous, we believe that
plaintiff submitted sufficient opposition to withstand summary
judgment. Brill v. Guardian Life Ins. Co. of Am., supra, 142
N.J. at 535.
The affidavits together with plaintiff's deposition
testimony lead to a reasonable inference that plaintiff may have
suffered some damage from defendants' alleged conduct.
Plaintiff's deposition indicated that of the approximate fifty
patients who communicated with her after her termination by West
Jersey, she retained about half as patients. Thus, plaintiff
should be given an opportunity to establish her damages, if any,
through further discovery or trial, and we reinstate plaintiff's
trade libel claim.
D.
Plaintiff claims that the court erred in dismissing her
claims for malicious interference with economic relations and
unjust enrichment. These claims were asserted in plaintiff's
second complaint, the one she filed right before the court ruled
on defendants' motions for summary judgment regarding her first
complaint. These claims are based on the same set of facts as
plaintiff's trade libel claim.
The West Jersey defendants assert that plaintiff's
employment contract provided that all patients treated at the
Center and all of their medical records were solely those of West
Jersey. Defendants claim that the contract negates any finding
that they were unjustly enriched or maliciously interfered with
plaintiff's relationships with her patients because none of the
patients belonged to plaintiff.
Even if the patients did not "belong" to plaintiff, the
contract between West Jersey and plaintiff cannot prevent the
patients from seeing any medical professional they choose. If
patients who wished to continue their relationships with
plaintiff were dissuaded solely because of defendants' malicious
or unjust behavior, plaintiff may have valid causes of action.