¶ 16. dissenting. The logic underlying the Court’s conclusion that the Department of Corrections did not discriminate against plaintiff on the basis of a physical disability, although it indisputably denied him access to a community-based prison work camp solely because of his heart condition, recalls the old children’s adage: “I saw a man upon the stairs. I looked again, he was not there. I wish he’d go away.” There is a strangely similar disconnects the Court’s reasoning, and while the fault may lie to some extent in the inherent difficulty of enforcing a civil rights statute inside a prison setting, we have a responsibility nevertheless to protect even our prison population from invidious discrimination on the basis of physical or mental disability. Because I do not believe that the Court has adequately addressed this responsibility, I must respectfully dissent.
¶ 17. The facts here were generally undisputed. The State conceded that plaintiff, an inmate at the Northern State Correctional Facility in Newport, has a “physical impairment” under the Americans with Disabilities Act. 42 U.S.C. § 12102. His condition, known as Prinz-Metil angina, results in occasional spasms of the coronary artery and requires that plaintiff initially take several nitroglycerin tablets and then, if the pain persists, have an EKG to determine if further treatment is necessary. Failure to diagnose and treat within two hours of the spasm could result in a heart attack. Accordingly, as the trial court here found, “proximity to, and availability of 24-hour EKG capability is critical to successful monitoring, and management of [plaintiff’s condition].” *146Northern State is one of the few correctional facilities in Vermont that has twenty-four hour medical coverage.
¶ 18. Plaintiff sought to transfer to the Caledonia prison work camp, located adjacent to the Northeast Regional Correctional Facility in St. Johnsbury, to take advantage of the opportunity offered there to earn double “good time” credit. Inmates at the camp generally work during the day on projects in local communities, although jobs in the camp laundry and elsewhere on site are also available. The camp is staffed by an on-duty nurse from 6:00 a.m. to 2:30 p.m. Additional medical care is available sixteen hours per-day at the nearby Northeast Regional Facility, but neither has twenty-four hour care. The Department determined that plaintiff was not “medically qualified” to participate in the work camp because of the lack of twenty-four hour medical coverage to monitor and manage his heart condition. The trial court affirmed the Department’s decision, concluding, among other things, that plaintiff is not “disabled” under the ADA because he is barred from working in only one location, the work camp, and therefore is not substantially limited in his ability to work. See id. § 12102(2)(A) (defining “disability” as a physical or mental impairment that “substantially limits” one or more major life activities, which includes “working”).
¶ 19. The Court here, like the trial court below, reaches the same paradoxical conclusion that plaintiff is not disabled within the meaning of the ADA because — with access to adequate medical care — his condition does not generally limit his ability to work, although it is undisputed that plaintiff was denied access to the prison camp solely because the Department determined that his medical condition precludes him from working there. To be fair, responsibility for this anomaly does not rest entirely with the Court, but may be traced to the federal rule defining a “substantial limitation” on work as an inability to perform “either a class of jobs or a broad range of jobs in various classes,” and precluding from the definition the inability to perform “a single, particular job.” 29 C.F.R. § 1630.2(j)(3)(i); see Sutton v. United Airlines, Inc., 527 U.S. 471, 491 (1999) (“substantially” limited in the ability to work requires that plaintiffs allege they are unable to work in a “broad class of jobs”). Yet the federal regulations also recognize that a-substantial limitation may arise from a significant restriction on the “condition, manner or duration under which an individual” can perform his or her work, 29 C.F.R. § 1630.2(j)(l)(ii) (emphasis added), as well as from the “geographical area to which the individual has reasonable access.” Id. § 1630.2(j)(3)(ii)(A) (emphasis added).
*147¶ 20. Thus, the evidence here plainly supports the conclusion that plaintiff has a medical impairment that restricts his employment to work sites that, as his physician testified, afford relatively “quick and easy” access to sophisticated medical care. It is inconceivable, for example, that plaintiffs condition would allow him to work at any job located more than one hour’s drive from a medical facility equipped with EKG-monitoring equipment, or in a job where he was alone. It is reasonable to conclude, therefore, that plaintiffs heart ailment imposes a significant “condition” on the circumstances in which he can work, and significantly limits the “geographic area” of employment to which he reasonably has access.2 See, e.g., Guice-Mills v. Derwinski, 967 F.2d 794, 797 (2d Cir. 1992) (plaintiff with illness that generally restricted ability to arrive at work during early morning hours had physical impairment that substantially limited ability to work under analogous provisions of Rehabilitation Act of 1973); Potvin v. Champlain Cable Corp., 165 Vt. 504, 510, 687 A.2d 95, 99 (1996) (plaintiff with gastrointestinal ailment that made it impossible to work evening hours was substantially limited in ability to work under ADA and Rehabilitation Act); 29 C.F.R. Pt. 1630 App. § 1630.2 (individual with allergy to substance found in most high rise buildings is substantially limited in ability to performrange of jobs). It follows that plaintiff s heart condition significantly limits his ability to work, and therefore constitutes a disability under the ADA.
¶ 21. The Court concludes, nevertheless, that plaintiff is not substantially limited in his ability to work, and therefore is not disabled under the Act, because the only prison work site from which plaintiff is precluded as a result of his medical condition is the community work camp.- As the Court explains, “plaintiffs choice of work sites may be limited, but the limitation is not a factor of his medical condition, it is a factor of his incarceration.” Ante, at ¶ 11 (emphasis added).
¶ 22. With all due respect, I believe the majority’s analysis is deficient. The United States Supreme Court has determined that Title II of the Americans with Disabilities Act (ADA), 42 U.S.C. § 12131 et seq., “unmistakably includes State prisons and prisoners within its coverage.” Pa. Dep’t of Corr. v. Yeskey, 524 U.S. 206, 209 (1998). As many commentators have observed, however, the Court’s holding in Yeskey raised more *148questions than it answered for purposes of actually applying the anti-discrimination provisions of the ADA in the unique context of a state prison. Yet the Court fails even to mention Yeskey, much less come to grips with its implications for the case at bar. See, e.g., S. Carnahan, The Americans with Disabilities Act in State Correctional Institutions, 27 Cap. U. L. Rev. 291, 314-15 (1999) (Court of Appeals decision in Yeskey did not resolve, and Supreme Court did not address, difficult question of whether, and to what extent, traditional principles of deference to decisions of prison administrators in constitutional context apply to statutory claims under ADA); Comment, Broad Statutory Language Is Not Ambiguous: The Americans Disability Act Applies in State Prisons, 15 J. Contemp. Health L. & Pol'y 275, 304 (1998) (Yeskey raises fundamental issue as to “how the ADA will be applied in the prison setting”); Note, Winning the Battle, Losing the War?: Judicial Scrutiny of Prisoners’Statutory Claims Under the Americans with Disabilities Act, 98 Mich. L. Rev. 482, 483-84 (1999) (Yeskey promises to have “far-reaching ... consequences,” having left unresolved fundamental issue concerning “the level of judicial scrutiny that prisoners’ ADA claims should réceive”); see also Turner v. Safley, 482 U.S. 78, 89-91 (1987) (courts must generally consider four factors in balancing prisoner’s constitutional claims against reasonableness of prison regulation, including nexus between regulation and claimed governmental interest, existence of alternative means of exercising right, impact of accommodation of right on prison population and prison resources, and availability of ready alternatives to regulation).
¶ 23.1 submit that the only way to give real meaning to the ADA’s overarching “national mandate for the elimination of discrimination against individuals with disabilities,” 42 U.S.C. § 12101(b)(1) — in an institutionalized prison setting — is to require equal access to the programs and services to which the inmates realistically have access. Chief Judge Richard Posner of the United States Court of Appeals for the Seventh Circuit eloquently articulated this position in a case that anticipated the Court’s holding in Yeskey. Disabled prisoners, he wrote:
have the same interest in access to the programs, services, and activities available to the other inmates of their prison as disabled people on the outside have to the counterpart programs, services, and activities available to free people. They have no right to more services than the able-bodied inmates, but they *149have a right, if the Act is given its natural meaning, not to be treated even worse than those more fortunate inmates.
Crawford, v. Ind. Dep’t of Corr., 115 F.3d 481, 486 (7th Cir. 1997).3 ****8
¶ 24. What this means, in my view, is that just as the prison context must be considered in evaluating the burden on the Department of a particular proposed accommodation, so too must the unique circumstances of prison life be recognized in evaluating the legitimacy of an inmate’s claimed disability. The reality of prison life cuts both ways. Courts must recognize the Department’s special security needs, but must equally acknowledge an inmate’s truncated opportunities for work, service, education, and other benefits and programs. See Note, supra, 98 Mich. L. Rev. at 505 (courts must “incorporate the unique circumstances of prison life into their determinations under the [ADA]”). The Court’s facile rejection of plaintiffs claim simply because his medical condition restricts him from only one work site — the only community work-camp available — ignores this reality. The Court’s further suggestion that plaintiffs argument would lead to the absurd result of measuring a prison guard’s “geographic” access to employment by the opportunities available in prisons is equally misguided, as the guard obviously has a broad range of employment choices outside the prison context. The inmate has no choice.
¶ 25. Measuring plaintiffs access to work programs against that of the average inmate — rather than the average person in the general population — leads to the obvious conclusion that plaintiffs heart ailment substantially limits his ability to work, as it bars him from participation in the only community-based work program of its kind for inmates in plaintiffs position. The common-sense conclusion that plaintiff is disabled within the meaning of the ADA is, therefore, inescapable.
¶ 26. A similar focus on institutional context should also inform the Court’s reasonable-accommodation analysis. See 28 C.F.R. § 35.130(b)(7) (public entity must provide disabled individual with reasonable accommodation to assist the individual in becoming qualified for participation in program, but need not do so if it would cause undue hardship). To protect *150prisoners from discrimination based on physical or mental disability, and simultaneously acknowledge the needs of prison administration, a key consideration must be whether the inmate’s claim implicates prison security or institutional order. See, e.g., Pitts v. Thornburgh, 866 F.2d 1450, 1453-54 (D.C. Cir. 1989) (prisoner claims that implicate “general budgetary and policy choices” rather than security concerns do not require same level of administrative deference). There is no claim or evidence here that plaintiffs request for access to the work camp poses any security risk.
¶ 27. Another consideration is, of course, the cost of accommodating plaintiffs participation in the work program. As noted, any accommodation must be “reasonable,” and not impose an undue burden on prison administration. 42 U.S.C. § 12131(2); 28 C.F.R. § 35.130(b)(7). Although the Department adduced evidence of the potentially crippling cost of implementing twenty-four hour medical care at the work camp, there is no evidence that it explored any less costly alternatives. See Crawford, 115 F.3d at 483 (state has burden to show that there was no reasonable accommodation that would have enabled plaintiff to participate in program or that making necessary accommodation would place undue financial or administrative burden on prison system); 28 C.F.R. § 35.130(b)(7) (public entity must make reasonable modifications necessary to avoid discrimination, unless “public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program, or activity”). Although the trial court did not address the issue, the record suggests that some economically feasible solutions might have been available, such as simply equipping plaintiff with a cell phone to call for an ambulance in the event of a medical emergency either on the j ob or after working hours, to supplement the sixteen hour medical care available at the nearby St. Johnsbury prison. Flexible accommodations such as these will certainly become increasingly necessary if the ADA is to be applied to state prison facilities without undue disruption to prison administration or onerous costs to the state.
¶ 28. The ADA contains no specific provisions designed for application to state prisons; indeed, it makes no reference whatsoever to such facilities. Yet the United States Supreme Court saw fit to determine that the ADA’s prohibition against discrimination on the basis of physical or mental disability in the services, programs or activities of a public entity “unambiguously extends to state prison inmates.” Yeskey, 524 U.S. at 213. To give meaning to that holding, prison administrators — and courts —must adapt rules and regulations designed for the general populace to the special needs of administrators and inmates of a uniquely closed *151institution. Otherwise, as today’s holding suggests, the high court’s decision may be rendered a nullity, and prisoners with genuine disabilities will be denied the protection of the law.
¶ 29.1 am authorized to state that Justice Dooley joins this dissent.
The fact that plaintiff here, like most individuals with disabilities, insists that with reasonable accommodations his condition does not impose any significant restriction on his ability to work does not preclude a finding that he is disabled, or “regarded as” disabled, in the legal sense under the ADA. 42 U.S.C. § 12102(2)(C) (1995). Otherwise, no one with a disability could ever prove that he or she was “qualified” to perform the job. Id. § 12131(2); 28 C.F.R.§ 35.140(a) (2003).
In Erickson v. Bd. of Governors, 207 F.3d 945, 948 (7th Cir. 2000), a divided panel of the Seventh Circuitreversed Crawford’s holding that Congress had validly abrogated Eleventh Amendment state immunity under Title II of the ADA, but left undisturbed Crawford’s construction of the ADA as applying to state prisons, thus allowing actions by prisoners in state courts or by the United States. 207 F.3d at 952. Others have reached a different conclusion concerning state immunity from suit under the ADA. See, e.g., Miranda B. v. Kitzhaber, 328 F.3d 1181, 1184 (9th Cir. 2003) (Congress validly abrogated Eleventh Amendment state immunity under Title II of ADA).