UV0024 This case is based on ideas and discussions with University of Washington students and prepared by Research Assistant Jenny Mead under the supervision of Andrew C. Wicks, Associate Professor of Business Administration. It was written as a basis for class discussion rather than to illustrate effective or ineffective handling of an administrative situation. Copyright © 2004 by the University of Virginia Darden School Foundation, Charlottesville, VA. All rights reserved. To order copies, send an e-mail to [email protected] No part of this publication may be reproduced, stored in a retrieval system, used in a spreadsheet, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without the permission of the Darden School Foundation. DANVILLE AIRLINES In a matter of hours, Julie Taylor, director of Human Resources at Danville Airlines in Milwaukee, Wisconsin, would have to make a difficult recommendation to the airline’s board of directors. One of the airline’s best pilots, David Reiger, 42, had recently lost his father to Huntington’s disease, a progressive, inherited neurological disorder that causes severe movement disorder and eventual dementia. Danville officials had been concerned about Reiger’s susceptibility to Huntington’s. In a routine blood test for alcohol and drug use, Danville had determined—after discreetly sending the blood elsewhere to be tested—that Reiger did indeed have the gene for Huntington’s disease. That meant that, at some point, Reiger would develop the disease. The airline had then informed Reiger that he had the gene. Furious that Danville had tested him without his consent, Reiger insisted that he be allowed to keep flying despite the discovery. If he developed Huntington’s while still flying for the airline, Reiger told Danville, he was willing to be reassigned to a position in the company that did not involve flying. He had threatened legal action if Danville grounded him before any symptoms appeared. The Danville Board of Directors had asked Taylor for a recommendation on how to handle the situation. She investigated and found there was no established protocol for dealing with this type of situation within Danville Airlines or the airline industry in general. As she contemplated her choices, Taylor felt a huge headache coming on. Huntington’s Disease Huntington’s disease (HD) was discovered in 1872 by American physician George Huntington. The disease causes nerve cells in the brain to gradually deteriorate, leaving its victims incapacitated both physically and mentally; the prognosis is dementia and death. Symptoms include jerky movements, spasms, and increasing dementia (sometimes the depression caused by the disease transforms into schizophrenia). Over time, HD affects the patient’s ability to walk, talk, and reason. The disease strikes men and women of all races and UVA-E-0265 -2- ethnic backgro ...

1. UV0024
This case is based on ideas and discussions with University of
Washington students and prepared by Research Assistant
Jenny Mead under the supervision of Andrew C. Wicks,
Associate Professor of Business Administration. It was written
as a basis for class discussion rather than to illustrate effective
or ineffective handling of an administrative situation.
Copyright © 2004 by the University of Virginia Darden School
Foundation, Charlottesville, VA. All rights reserved.
To order copies, send an e-mail to [email protected] No part of
this publication may be reproduced, stored
in a retrieval system, used in a spreadsheet, or transmitted in
any form or by any means—electronic, mechanical,
photocopying, recording, or otherwise—without the permission
of the Darden School Foundation.
DANVILLE AIRLINES
In a matter of hours, Julie Taylor, director of Human Resources
at Danville Airlines in
Milwaukee, Wisconsin, would have to make a difficult
recommendation to the airline’s board of
directors. One of the airline’s best pilots, David Reiger, 42, had
recently lost his father to
Huntington’s disease, a progressive, inherited neurological

2. disorder that causes severe movement
disorder and eventual dementia. Danville officials had been
concerned about Reiger’s
susceptibility to Huntington’s. In a routine blood test for
alcohol and drug use, Danville had
determined—after discreetly sending the blood elsewhere to be
tested—that Reiger did indeed
have the gene for Huntington’s disease. That meant that, at
some point, Reiger would develop
the disease. The airline had then informed Reiger that he had
the gene. Furious that Danville had
tested him without his consent, Reiger insisted that he be
allowed to keep flying despite the
discovery. If he developed Huntington’s while still flying for
the airline, Reiger told Danville, he
was willing to be reassigned to a position in the company that
did not involve flying. He had
threatened legal action if Danville grounded him before any
symptoms appeared. The Danville
Board of Directors had asked Taylor for a recommendation on
how to handle the situation. She
investigated and found there was no established protocol for
dealing with this type of situation
within Danville Airlines or the airline industry in general. As
she contemplated her choices,
Taylor felt a huge headache coming on.
Huntington’s Disease
Huntington’s disease (HD) was discovered in 1872 by American
physician George
Huntington. The disease causes nerve cells in the brain to
gradually deteriorate, leaving its
victims incapacitated both physically and mentally; the

3. prognosis is dementia and death.
Symptoms include jerky movements, spasms, and increasing
dementia (sometimes the
depression caused by the disease transforms into
schizophrenia). Over time, HD affects the
patient’s ability to walk, talk, and reason. The disease strikes
men and women of all races and
UVA-E-0265
-2-
ethnic backgrounds.1 The culprit is a single faulty gene on
chromosome number 4. Children of a
parent who has the gene stand a 50–50 chance of inheriting it.
Those who have not inherited the
gene cannot pass it (and the disease) on to their children; those
who have it will inevitably
develop the disease, usually in adulthood. The first symptoms
generally appear in 30- to 40-year-
old adults and the disease claims its victims within 15 to 20
years. There is no cure, only
treatment aimed at alleviating the patient’s symptoms; that
treatment includes drugs and life
adaptations (changing a person’s physical environment to
accommodate his or her physical
deterioration). In some cases, HD strikes victims in their late
teens or early 20s. In 2004, an
estimated 30,000 people in the United States had HD, and
75,000 carried the abnormal gene
that would cause them to develop the disease.2

4. In most cases, HD’s onset is slow and gradual, and the first
symptoms are mild: muscle
twitches and slight memory loss. In a small percentage of
cases—fewer than 3%—the initial
onset is more severe and dramatic and results in significant
impairment of motor skills. That type
of onset could prove extremely hazardous if a person were
driving or operating heavy machinery
at the time.
In 1993, as part of the Human Genome Project,3 U.S. and
British scientists identified the
gene that causes Huntington’s disease, making early detection
possible. HD was then added to a
growing list of illnesses such as amyotrophic lateral sclerosis
(ALS, or Lou Gehrig’s disease),
sickle cell anemia, myotonic dystrophy, and cystic fibrosis that
can be identified through genetic
testing. Unfortunately, like some other diseases, including ALS
and sickle cell anemia, HD is not
one that can be prevented or avoided through early detection.
Reiger, Risks and Redundancies
As a Danville pilot, David Reiger flew four to five times a
week, with a weekly average
of eight to 10 hours in the air. None of his routes was long, and
each required no more than two
and a half hours at the controls. Taylor knew that all Danville
flights had various backup plans
and mechanisms, including a copilot and an autopilot, should
the primary pilot on a flight
become incapacitated. Aeronautical and airline engineers had

5. calculated that those redundancies
would be effective in preventing an in-flight crash 99% of the
time should the pilot lose control
on a flight. During the critical periods of taking off and landing
(roughly two minutes each),
1 Probably one of the best-known people to succumb to
Huntington ’s disease was the American folk singer
Woody Guthrie, who died in 1967. Before he was diagnosed, his
slurred words and jerky movements were
interpreted as drunkenness. His son, folk singer Arlo Guthrie,
does not have the gene and consequently is not at risk
for developing the disease.
2 “Learning About Huntington’s Disease,”
http://www.genome.gov/page/cfm?pageID=10001215 (accessed
11
February 2006)
3 The Human Genome Project, which ran from 1990 through
2003, was a project coordinated by the U.S.
Department of Energy and the National Institutes of Health. The
project’s goals were to identify the approximately
20,000 to 25,000 genes in human DNA, determine the sequence
of the three billion chemical base pairs making up
DNA, create databases of that information, improve data
analysis, and transfer many of the specific technologies it
used to the private sector.
UVA-E-0265

6. -3-
however, tests showed that the redundancies would be less
effective, preventing roughly 89% of
the catastrophic failures caused by pilot error.
Like all pilots at Danville and other airlines, Reiger regularly
went through a physical
exam given by the Federal Aviation Administration (FAA),
which tested coordination, eyesight,
and reflexes, among other things. He had passed his most recent
physical and was cleared by the
FAA to fly. If Reiger did become symptomatic, however, the
FAA would bar him from taking
the controls. Despite the safeguards and the FAA’s required
annual physical, Reiger’s uncertain
medical condition made him a risk both to his coworkers and to
Danville passengers.
Genetic Testing and Screening
At that point, the FAA and Danville, along with most other
airlines, had no policy in
place about genetic screening, and there were no FAA plans in
the foreseeable future to
introduce that testing. Since the mapping of the human genome,
genetic tests could be performed
(or were being developed) to identify the presence of genes for
almost 5,000 diseases. The
benefits as well as the drawbacks of genetic testing were readily
identified. With genomics (the
study and application of genetic testing), those individuals
without symptoms could find out

7. whether they or their children were susceptible to a particular
disease. With that knowledge, they
could seek prophylactic treatment, if available. In all instances,
people who carried an inherited
gene base could make a more informed decision about a myriad
of important choices such as
whether or not to have children.
The drawbacks—most notably, potential discrimination in
employment or health
insurance coverage based on test results—immediately became a
controversial topic. People
feared that genetic testing could adversely affect them if the
information ended up in the
possession of employers, insurers, mortgage companies, or any
other institution with power over
their economic future.4 Because of that potential for
discrimination, scientists involved in the
Human Genome Project and politicians immediately sought to
put safeguards in place. The
Constitution offered a modicum of protection, as did Congress’s
1974 Privacy Act. But specific
federal regulations that protected people from genetic
discrimination in employment did not
exist.5 The only federal legislation in place at that point was the
Health Insurance Portability and
Accountability Act of 1996 (HIPAA), which stated that “genetic
information shall not be
considered a preexisting condition in the absence of a diagnosis
of the actual condition.” That
protection was limited, however, as it did not prohibit rate
increases based on the results of
genetic testing, it did not cover individuals not in a group plan,
and it offered no protection
against discrimination by employers6 Only a handful of states,
including California, had laws

8. 4 Sharona Hoffman, “Ask the Expert: Your Genetic Privacy,”
National Women’s Health Report 22, no. 6
(December 2000): 6.
5 Anita Silvers and Michael Ashley Stein, “An Equality
Paradigm for Preventing Genetic Discrimination,”
Vanderbilt Law Review 55, no. 5 (1 October 2002): 1,139.
6 Robert A. Curley Jr. & Lisa M. Caperna, “The Brave New
World Is Here: Privacy Issues and the Human
Genome Project,” Defense Counsel Journal 70, no. 1 (1 January
2003): 22.
UVA-E-0265
-4-
specifically prohibiting (in most cases) insurers from denying
coverage based on the results of
genetic testing and for using those tests to determine insurance
rates and health benefits.7
There was also the 1990 Americans with Disabilities Act
(ADA), which barred adverse
employment decisions based on an individual’s actual physical
or mental disabilities and was
designed to protect people with mental or physical impairments
from discrimination. To be
considered disabled, one had to have a physical or mental

9. disability that limited the ability to
perform at least one major life activity, such as walking. An
individual could be covered under
ADA if he or she had a history of disability, such as having had
cancer, or the perception of
having a disability, such as having a gene for a disease but not
yet showing symptoms.
Under the ADA, disabled employees could not be dismissed
from a job if they performed
“with reasonable accommodation.” For example, an employee
whose job was answering the
phone and who was hard of hearing could not be dismissed.
Under the law, an employer must
accommodate that employee by providing, for example, a phone
amplifier. On the other hand, if
the only job available in a workplace was highly physical and
required mobility and the
employee was wheelchair-bound or otherwise physically
constrained, the company could fire
that worker with no repercussions. In the latter situation, the
law was on the employer’s side
given that accommodating such a person could subject that
business to undue hardship.
High cost was a deterrent to employers using genetic testing as
part of the application
process; in 2004, a genetic test cost approximately $1,000. Still,
some people envisioned a future
where those tests were a routine part of screening potential
employees. In 2000, the American
Management Association reported that approximately 70% of
major employers required medical
testing in the job-seeking process, and a handful of those
companies were “already doing genetic

10. testing, for sickle cell anemia, breast and colon cancer, and
susceptibility to workplace hazards.”8
Many employers also required a family medical history, which
often gave clues as to what
diseases a potential employee had inherited.
One specific incident revealing how the ADA offered
protection involved a dental school
graduate who had a late-onset form of Tay-Sachs disease, a fatal
genetic disorder usually
afflicting children that causes progressive destruction of the
central nervous system. The dental
graduate was competent both physically and mentally, but was
at increased risk of developing
muscle weakness, movement disorders, and possibly early-onset
dementia. Claiming that she
posed a serious risk to her patients, the state licensing board
denied her a license to practice
dentistry. The board noted that the ADA permitted application
denial if an applicant “poses a
direct threat to the health and safety of others.”9 Interpretation
of the regulations implementing
the ADA, however, stated that the concerns for the health and
safety of others must be balanced
against the “goal of protecting disabled individuals from
discrimination.”10 The interpretation
7 “Genetic Discrimination,” Los Angeles Caregiver Resource
Center,
http://geroweb.usc.edu/lacrc/Diseases/FactSheets/genetic.htm
(accessed 12 February 2006)
8 Hoffman, 6.
9 ADA Section 302[b][3], 56 Fed. Reg. 35701.
10 ADA.

11. UVA-E-0265
-5-
further provided that “objective evidence” must be used to
determine “the probability that the
potential injury will actually occur and whether reasonable
modification of policies will mitigate
risk.” The dental graduate planned to appeal her denial.
One of the acknowledged risks of genetic testing was the
potentially damaging
psychological impact it could have on individuals susceptible to
an inherited debilitating illness
as well as to their families. Deep depression and anger were
common emotions for those
individuals; the flip side, should the person not be at risk, was
guilt. Nonetheless, the emotional
and psychological fallout of genetic testing was well known in
medical circles.
Airlines Under Pressure
Since 1978, when the federal government had deregulated the
airline industry to
encourage competition, it had been the survival of the fittest,
with many carriers going out of
business and declaring bankruptcy. Some such as Continental
had survived bankruptcy, but
others (TWA) had ceased doing business. Many airlines
survived by maintaining service while

12. slashing costs, negotiating tough new contracts with employees,
and limiting wage increases,
health benefits, and work rule demands. Many carriers reduced
the cost of their insurance by
maintaining strict safety standards and good safety records.
Nonetheless, in the post-9/11 and
post-2000 Internet bubble era, airlines were struggling again.
There were fewer passengers and
the competition from low-fare carriers such as Southwest
further increased the financial pressure.
The year 2002 had seen the bankruptcies of two prominent
airlines, U.S. Airways and United,
and the near-bankruptcy of American Airlines. The airline
industry’s losses for that year were
expected to exceed $9 billion.
The Investigation
In an effort to determine what recommendation to make, Julie
Taylor had—without using
Reiger’s name—interviewed a number of key players, both
within and outside of Danville. She
had started with Steve Hillman, the Danville medical
administrator, who had this feedback:
This pilot with Huntington’s disease could make the company’s
medical
insurance unaffordable, with premiums that would take a severe
bite out of our
profits. He could need 24/7 care for 30 years. I’m advising
genetic screenings for
all new employees. We won’t get stuck with this sort of expense
if we never hire
these people.

13. Chris Bowman, public relations manager for Danville:
This is a tough one. On the one hand, the flying public will
panic if they even
suspect that we employ a pilot with a neurological disorder—
okay, a potential
neurological disorder. You know what the public hears when
you say potential
UVA-E-0265
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disorder? Potential plane crash, that’s what. If the pilot claims
discrimination,
well, that’s not good either. We serve an affluent, educated
business class. You
think they’ll find it politically correct to climb aboard a “bigot”
airline?
Danville Director of Operations Donald Berger had the bottom
line and Danville’s
spotless accident-free record in mind when he commented:
Small airlines face a lot of competition. It’s a tough business.
Our airline has an
advantage because we’ve never had an accident. Believe me, in

14. my position I’m
well aware of what can cause accidents. Nearly 70% of airline
accidents are
linked to pilot error. I appreciate the pilot’s feelings, but what
are hurt feelings
compared with an airplane full of people?
Taylor also spoke to Danville’s insurance company and got this
response from Atta
Commercial Insurance agent Carolyn Jennings:
I watch these companies very carefully. Airline employees have
routine drug and
alcohol testing, extensive training, and periodic on-the-job
reviews. We hold
equipment and maintenance to the highest standards—to protect
passengers, of
course, but also to protect the airline’s liability. Why shouldn’t
we hold
employees, particularly pilots, to the same high standards?
Thank goodness for
blood testing, which now can screen for potentially dangerous
situations. Can you
imagine what would happen if a pilot with HD slipped through?
If there were an
accident? We would have a major insurance disaster, and the
airline might be out
of business.
Taylor had also consulted with a physician, Patti Hicks, who
was not affiliated with the

15. airline:
It is important for anyone who has been found to have the
Huntington’s disease
gene to know exactly what it means. The HD gene is a bad copy
of a normal gene.
Scientists do not yet know what this gene normally does, nor do
they know how
the abnormal gene causes the disease. Scientists around the
world are working to
learn more about this gene so that effective treatments can be
developed.
It is impossible to predict when the disease will strike and how
quickly symptoms
will develop. For some people, the disease can be quite severe
with movement
problems developing while they are still children. But in many
cases, no
symptoms develop until very late in life. I’ve heard of some
people with this gene
who do not have any problems until they are well into their
sixties or seventies.
UVA-E-0265
-7-
Civil rights activist Sylvia Gasca offered this perspective:

16. Employers can make reasonable demands for performance;
that’s not job
discrimination. But when they fire a person for reasons that
have nothing to do
with work performance, that’s discrimination, whether it’s
racial or gender- or
disability-based. And in the case of genetic information, it can
be even more
extreme, because the person may not even have a disease—just
a gene. It’s
genetic discrimination.
The Decision
Taylor thought about the various points of view that these
people had expressed. In
particular, she remembered the words of Reiger’s wife, who was
furious about the whole
situation:
Giving him the test without his consent is inexcusable, but
saying he can’t fly is
preposterous. He’s not a child. He’s a responsible adult, who
knows all about
Huntington’s disease. If he experiences even a hint of a
symptom, he’ll ground
himself immediately. There’s no disease here now: just the gene
that will cause
the disease some day in the future.
Taylor also knew that Reiger himself had been devastated by the
grueling experience of

17. watching his father die. The knowledge that he, too, stood a
very good chance of living through
that ordeal had to be earth-shattering for him and his family.
Taylor had never before faced a
decision that involved such a difficult variety of factors.