Salvation Army Has First Amendment Right to Ban Methodone Use by People in Its Adult Rehabilitation Centers

From Tassinari v. Salvation Army, decided Monday by Judge Leo Sorokin (D. Mass.); I’d love to hear what list members think of it:

[Plaintiffs] assert that TSA [The Salvation Army] maintains a policy at its Adult Rehabilitation Centers that prevents such individuals from accessing medication for their disorder [including methadone and buprenorphine for Opiod-Use Disorder [OUD]], in violation of Section 504 of the Rehabilitation Act, 29 U.S.C. § 794, and the Fair Housing Act, 42 U.S.C. § 3604…. [The Salvation Army] operates twenty-nine Adult Rehabilitation Centers (“ARCs”) in that territory. TSA refers to ARC participants as “beneficiaries.” ARCs provide beneficiaries with housing and basic living necessities for six to twelve months, during which time beneficiaries live on site and participate in “work therapy” by working full time at the ARCs or processing donated goods for resale at Salvation Army thrift stores….

TSA views ARCs as “residential churches,” and it considers the operation of ARCs to be one of the ways it practices its religion. TSA considers “the highest priority of the ARCs” to be “bring[ing] the beneficiaries into a personal relationship with God.” ARCs “serve[ ] men and women with social, emotional and spiritual needs who have lost the ability to cope with their problems and provide for themselves.”

Beneficiaries need not be Salvationists—the vast majority are not—and they may continue to practice their own religion if they do so on their own time. But all beneficiaries are required to acknowledge that The Salvation Army is a church and must agree to participate in Salvationist religious activities as a condition of their ARC participation. Beneficiaries meet at least biweekly with their assigned spiritual counselor. They must also attend Sunday morning chapel services, a midweek service, daily devotions, and weekly Bible classes.

Abstinence from alcohol and addictive substances is a core tenet of The Salvation Army’s religious beliefs. sincerely believes, as a matter of its religion, that long-term use of narcotics to treat addiction is not true rehabilitation, and that “abstinence and the power of God unto salvation is the only form of successful rehabilitation.”

TSA requires, as a condition of ARC participation, that beneficiaries abstain from alcohol and certain drugs [including methadone and buprenorphine]. Beneficiaries must submit to urine drug testing when they apply for ARC admission and at regular intervals thereafter. Applicants with positive urine tests for a proscribed drug are generally required to “detox” before admission, although under some circumstances ARC policy permits such an applicant to be admitted if they have not used drugs for the prior forty-eight hours….

TSA operates other social-service programs, and in some of those programs, it permits—and even provides—buprenorphine and methadone to participants with OUD. At TSA’s Harbor Light Centers, for instance, TSA permits participants to use buprenorphine and methadone if those MOUDs are deemed medically appropriate for the participant and as consistent with state and federal guidelines. Harbor Light Centers include state-licensed halfway houses and certified “residential subacute detox” and “intensive outpatient treatment” facilities….

The court concluded that TSA was immune from liability under the church autonomy doctrine:

The undisputed facts establish that TSA regards ARCs as residential churches whose highest priority is to “bring the beneficiaries into a personal relationship with God.” The facts describe a lengthy evangelist program, running six to twelve months, aimed at rehabilitation through spiritual healing—essentially, a religious conversion program that requires beneficiaries to practice Salvationism…. The Court can no sooner order TSA to abandon its Salvationist understanding of “abstinence” than it can order an Orthodox Jewish synagogue not to separate its congregants by sex….

Plaintiffs assert that the Medication Policy reflects a flawed, outdated understanding of
“addiction” and is internally inconsistent, permitting beneficiaries to use some substances with the potential for abuse or addiction while prohibiting prescribed MOUD [medications for OUD]. They note TSA permits or provides methadone and buprenorphine as MOUD in some of its other social-service programs, and they hold up that fact as evidence both that nonbelievers’ use of those medications does not violate TSA’s sincerely held religious beliefs and that TSA could, as a practical matter, permit beneficiaries to safely use these medications.

On the facts of this case, these contentions miss the mark. The Salvation Army—not the Court—determines Salvationist doctrine. That TSA drew some aspects of its Medication Policy from a secular source does not render its policy nonreligious. Indeed, from a lay perspective, any number of religious rules or doctrines can be viewed as arbitrary, inconsistent, or irrational—but these rules or doctrines are matters of faith, not susceptible to civil adjudication under our Constitution. The Court may not and does not evaluate the correctness, internal consistency, or centrality of TSA’s religious beliefs. See Hernandez v. Comm’r of Internal Revenue (1989) (“It is not within the judicial ken to question the centrality of particular beliefs or practices to a faith, or the validity of particular litigants’ interpretations of those creeds.”); cf. Thomas v. Rev. Bd. (1981) (“Courts are not arbiters of scriptural interpretation.”). The “abstinence” rule is part and parcel of TSA’s evangelist efforts to bring ARC beneficiaries into a “personal relationship with God.” Judicial scrutiny of this church doctrine is precluded by the First Amendment.

And the court rejected the argument that TSA had waived its rights by accepting federal funding:

To the extent TSA may waive its church-autonomy defense (something the Court assumes without deciding), such a waiver must be knowing and voluntary. A generic agreement to abide by all terms of federal funding does not sufficiently put TSA on notice that, by accepting federal funds, it waived its fundamental constitutional right to determine matters of faith and doctrine free from governmental interference….

Andrew Holmer, Daniel William Wolff, and Thomas P. Gies (Crowell & Mooring LLP) and Kevin M. Hensley (Barton Gilman LLP) represent The Salvation Army.