ADA § 12112(d)(4): Mandatory Leadership Coaching Is Not a “Medical Examination” Absent a Procedure or Test Seeking Health/Impairment Information

Case: K. Jeff Carney, M.D., PHARMD v. Emory University (11th Cir. Apr. 15, 2026) (per curiam; not for publication)
Court: U.S. Court of Appeals for the Eleventh Circuit
Core Statute: Americans with Disabilities Act, 42 U.S.C. § 12112(d)(4)(A)

1. Introduction

This appeal arose from Emory University’s directive that Dr. K. Jeff Carney—an Emory urologist and residency-program leader at Grady Hospital—participate in leadership coaching after an internal review of residents’ complaints concerning professionalism, respectfulness, and inappropriate conduct. Although the review “did not find cause for disciplinary action,” Emory concluded that certain behaviors “warrant guidance,” and required coaching focused on conflict navigation, leadership, and responding to feedback.

Dr. Carney refused to engage in coaching with Gordon Tuttle (a licensed psychologist in Emory’s Faculty Staff Assistance Program (FSAP)), later was offered an alternative coach (Rick Brandt), and ultimately was notified that his appointment would not be renewed. He sued under the ADA, alleging Emory unlawfully required him to undergo a non-job-related “medical examination” (or disability-related inquiry) in violation of § 12112(d)(4)(A).

The key issue on appeal was narrow but important: whether requiring “leadership coaching” under these facts could reasonably be treated as a prohibited “medical examination” (or inquiry into disability) under the ADA—especially where the coaching provider is a psychologist and the FSAP offers mental-health-related services.

2. Summary of the Opinion

The Eleventh Circuit affirmed summary judgment for Emory. The court held that the record did not support a reasonable inference that the required coaching included a “medical examination” or a prohibited disability-related inquiry. The directive was framed as leadership/conflict coaching intended to improve workplace communication and the learning environment—not as psychological testing or counseling. The court further emphasized that speculative inferences about what might have occurred in coaching (or what a psychologist might do) cannot defeat summary judgment.

Bottom line: Leadership coaching, even when administered by a psychologist and offered through a program that can provide clinical services, is not a “medical examination” under 42 U.S.C. § 12112(d)(4)(A) without evidence of a procedure/test (or probing inquiry) designed to elicit information about an impairment or health condition.

3. Analysis

3.1 Precedents Cited

  • Owens v. Governor's Office of Student Achievement, 52 F.4th 1327 (11th Cir. 2022)
    Cited for the summary-judgment standard on de novo review: courts view evidence in the nonmovant’s favor, but only draw “justifiable” inferences. The citation frames the decision’s evidentiary posture—particularly the court’s refusal to accept conjecture about the coaching’s content.
  • Cordoba v. Dillard's, Inc., 419 F.3d 1169 (11th Cir. 2005) and Boyle v. City of Pell City, 66 F.3d 1280 (11th Cir. 2017)
    These cases anchor the court’s insistence that speculation does not create a genuine issue of fact. The opinion repeatedly treats Dr. Carney’s theory as “a stretch” without concrete evidence of a medical procedure/test or disability-probing inquiry.
  • Owusu-Ansah v. Coca-Cola Co., 715 F.3d 1306 (11th Cir. 2013)
    Used to clarify a critical doctrinal point under § 12112(d)(4): a plaintiff need not be disabled (or regarded as disabled) to sue for an unlawful examination/inquiry. This matters because the dispute is not about whether Dr. Carney had a disability, but whether Emory compelled an impermissible medical exam/inquiry in the first place.
  • Mullin v. Sec'y. v. U.S. Dep't of Veterans Affs., 162 F.4th 1296 (11th Cir. 2025)
    Cited for the threshold trigger: § 12112(d)(4) applies when an employer requests a medical examination or inquires into medical status. The court uses Mullin to emphasize that the statute is not implicated by every workplace directive involving a clinician; the directive must actually request an exam or disability-probing inquiry.
  • Harrison v. Benchmark Electronics Huntsville, Inc., 593 F.3d 1206 (11th Cir. 2010)
    Supports reliance (non-binding but persuasive) on EEOC enforcement guidance regarding medical examinations and disability-related inquiries. The court expressly uses the guidance as “experience and informed judgment.”
  • Kroll v. White Lake Ambulance Auth., 691 F.3d 809 (6th Cir. 2012)
    A central comparator. Kroll adopted/used the EEOC guidance definition: a medical examination is a “procedure or test” seeking information about physical/mental impairments or health. Kroll also cautioned that employer-mandated counseling can be a medical exam if it is “likely to probe and explore” disability. The Eleventh Circuit distinguished Kroll on its facts: Dr. Carney was not referred broadly for psychological counseling; he was directed to leadership/conflict coaching, and the record lacked evidence of testing or diagnosis-oriented assessment.
  • Karraker v. Rent-A-Center, Inc., 411 F.3d 831 (7th Cir. 2005)
    Cited as an example where an employer used a tool (the Minnesota Multiphasic Personality Inventory) that functioned as a medical exam because it was designed to diagnose mental disorders. The contrast highlights what was missing in Emory’s coaching requirement: no standardized psychological testing, no diagnostic instrument, no medical-record review, and no diagnosis.
  • Fernandez v. Seaboard Marine LTD., 135 F.4th 939 (11th Cir. 2025)
    Reinforces the “reasonable inference” boundary: an inference that is only a guess is not evidence. The court used Fernandez to reject the leap from “coach is a psychologist” (and an alleged comment about “mental issues”) to “coaching necessarily involves medical testing or impairment-focused evaluation.”
  • Timson v. Sampson, 518 F.3d 870 (11th Cir. 2008)
    Included for an appellate-practice point: issues not briefed are abandoned. While not part of the ADA holding, it reflects the court’s strict approach to narrowing what is actually decided.

3.2 Legal Reasoning

The court’s analysis proceeds in three disciplined steps: (1) identify what § 12112(d)(4)(A) prohibits, (2) define “medical examination” using EEOC guidance (given the statute/regulations do not define it), and (3) test the plaintiff’s evidence against that definition under summary-judgment standards.

(a) The statutory prohibition and its trigger.
Section 12112(d)(4)(A) bars an employer from requiring a medical examination or making disability-related inquiries unless the examination/inquiry is job-related and consistent with business necessity. The Eleventh Circuit did not reach the “business necessity” defense because it found the threshold element missing: no reasonable jury could conclude that Emory required a medical exam or prohibited inquiry.

(b) The operative definition: “procedure or test” seeking impairment/health information.
Borrowing from the EEOC guidance (as discussed in Kroll v. White Lake Ambulance Auth.), a medical examination is a “procedure or test” that seeks information about physical/mental impairments or health. The court also referenced the guidance’s multi-factor approach (e.g., administered by healthcare professional; designed to reveal impairment; invasiveness; medical setting/equipment), and its distinction between (i) psychological tests designed to identify a mental disorder and (ii) tests measuring traits such as habits or preferences.

(c) Application to the record: leadership coaching ≠ medical examination.
The court treated the documentary record as decisive: Dr. Sanda’s communications described “coaching regarding navigating conflict, leadership, and responding to feedback,” “avoiding and resolving conflict,” and “communicating effectively.” The requirement was tethered to workplace functioning and leadership responsibilities within the residency learning environment. Crucially, the plaintiff produced no evidence that Emory required a procedure or test—no psychological test, no diagnostic interview designed to determine impairment, no medical-record review, no required diagnosis, and no clinical finding.

(d) Why plaintiff’s evidence did not create a triable issue.

  • FSAP’s broad service menu and a broad consent form were not enough.
    The fact that FSAP can provide clinical services does not show that Emory required clinical services. The court demanded evidence about what Dr. Carney was actually required to undergo—not what was hypothetically available.
  • The “well-being” questions in the June 1 session did not convert coaching into a medical exam.
    Tuttle asked about sleep, appetite, exercise/energy, stress management, and worrying—topics that can relate to depression/anxiety. The court held this did not support an inference of a disability-probing exam on these facts: Dr. Carney had just lost his job, “check-in” questions can be permissible, and there was no evidence of follow-up probing, testing, diagnosis, or clinical conclusions. The EEOC guidance expressly allows general inquiries about well-being and how someone is doing after significant life events.
  • The Brandt “mental issues” comment was too speculative.
    Even accepting Dr. Carney’s account, the court found it conjectural to infer that Brandt would administer any test or procedure designed to reveal impairment—particularly because Dr. Carney never met Brandt and offered no evidence of what Brandt’s sessions entailed.
  • Timing and comparability mattered.
    The court declined to assume that the questions asked after the nonrenewal decision (when the plaintiff had just lost his job and refused to discuss the coaching’s intended topics) would mirror what would have occurred had the coaching begun earlier.

In short, the opinion is an evidentiary holding as much as a doctrinal one: the ADA’s medical-exam restriction is not triggered by labels (“psychologist,” “assessment,” “FSAP”) or possibilities, but by record evidence that the employer required something that functions as a medical exam or disability-related inquiry.

3.3 Impact

Although “NOT FOR PUBLICATION,” the decision has practical significance for workplace investigations and remediation plans—especially in healthcare, academic medicine, and other professional settings where “coaching” is common and coaches may hold clinical licenses.

  • For employers: The ruling supports the defensibility of mandatory leadership/coaching interventions following professionalism complaints, provided the requirement is framed and implemented as performance/behavior coaching rather than diagnostic evaluation, and the record does not show required testing or impairment-focused probing. Employers can reduce risk by clearly documenting the coaching purpose (communication, conflict resolution, feedback responsiveness) and avoiding disability-focused language.
  • For employees/plaintiffs: To survive summary judgment on § 12112(d)(4)(A), plaintiffs will likely need concrete evidence of a required procedure/test (or targeted disability-probing inquiry)—for example, required psychological testing, required diagnostic assessment, mandated disclosure of diagnoses/medications, or an explicit directive to obtain mental-health treatment as such.
  • For future litigation: The case reinforces that courts may treat “medical examination” as a functional, evidence-based category. The presence of a licensed psychologist or an EAP-like program alone does not necessarily trigger § 12112(d)(4)(A). The key is what the employer required and what the process was “designed” to elicit.
  • Interaction with the “business necessity” defense: Because the panel resolved the case on the threshold “medical examination” question, it leaves open (for another case on a stronger exam/inquiry record) how rigorously “job-related and consistent with business necessity” would be scrutinized in leadership/professionalism contexts within the Eleventh Circuit.

4. Complex Concepts Simplified

  • “Medical examination” (ADA § 12112(d)(4)(A)): Not every meeting with a clinician qualifies. Under the EEOC guidance used here, it generally means a procedure or test that seeks information about physical/mental impairments or health—like diagnostic psychological testing (as in Karraker v. Rent-A-Center, Inc.) or counseling likely to probe disability (as discussed in Kroll v. White Lake Ambulance Auth.).
  • “Disability-related inquiry”: Questions “likely to elicit information about a disability.” General check-ins—“How are you?”—and questions after a major life event can be permissible under the EEOC guidance, depending on context and follow-up.
  • “Job-related and consistent with business necessity”: Even if something is a medical exam/inquiry, an employer may require it if it is sufficiently connected to job performance and necessary for the business. The court did not reach this issue because it found no medical exam/inquiry requirement in the first place.
  • Summary judgment: A case can end before trial if the evidence, even viewed favorably to the plaintiff, would not allow a reasonable jury to find for the plaintiff. Courts will not let a case proceed on “pure conjecture and speculation” (as emphasized via Cordoba v. Dillard's, Inc. and Fernandez v. Seaboard Marine LTD.).
  • Fed. R. Civ. P. 30(b)(6) witness: A corporate representative who testifies on behalf of the organization about designated topics. Here, Emory’s 30(b)(6) testimony supported the characterization of physician coaching as non-clinical and not psychological counseling/treatment.

5. Conclusion

K. Jeff Carney, M.D., PHARMD v. Emory University underscores a practical rule for ADA § 12112(d)(4)(A) disputes: a mandatory leadership-coaching directive does not become a prohibited “medical examination” merely because the coach is a psychologist or the program can provide clinical services. Without evidence that the employer required a procedure/test (or probing inquiry) designed to elicit impairment or health information, a plaintiff cannot reach a jury—especially where the record shows the intervention was framed as leadership and conflict-resolution coaching tied to workplace functioning.

Even as an unpublished decision, the opinion provides a clear roadmap for how the Eleventh Circuit evaluates the “medical examination” threshold: focus on what was required, what it was designed to elicit, and whether the plaintiff’s inferences are evidence-based rather than speculative.