Fighting Their Way Into Medical School

A student whose admission to Pacific Northwest University of Health Sciences was revoked because he was deaf will start classes this fall, a federal judge ordered Tuesday.

The student, Zachary Featherstone, was accepted into the university's College of Osteopathic Medicine in the spring of 2013, and began working with the university to figure out the logistics of his accommodation requests, according to emails obtained by Inside Higher Ed. The State of Washington Division of Vocational Rehabilitation agreed to cover the costs of his captioning and interpreting services if PNWU could not.

Saying that it needed more preparation time to prepare the accommodations, the university deferred Featherstone’s admission for a year. Then the university withdrew his acceptance altogether.

“Based on our conclusion that your education and that of your classmates will be compromised; that we cannot provide an equivalent education, particularly in clinical environments; and that risks to patient safety would be increased, we cannot support your matriculation,” Thomas Scandalis, the college's dean, wrote in a letter to Featherstone in April 2014.

In his preliminary injunction, U.S. District Judge Salvador Mendoza called the concerns "unfounded" and "wholly speculative," but medical colleges have made the argument for decades. Evolving technology and recent court rulings – three of them just in the last year – are starting to chip away at the legality of their reasoning.

Last month, the Iowa Supreme Court ruled that Palmer College of Chiropractic violated the rights of a blind student by denying him the use of a sighted reader to describe X-rays to him. In December, after four years of legal battles, a hearing-impaired student won a court order forcing Creighton University's medical school to provide him with accommodations. Creighton is appealing the decision.

In Featherstone’s case, the university said its primary concern was one of patient safety. In the “rapid-response environments” of emergency departments and intensive care units – required rotations for most medical students – verbal communication is critical, Scandalis wrote in his letter. Translating verbal cues into visual ones, the university argued, would result in a loss of precious time and endanger patients’ lives.

“In general, it’s common in academia for concerns and issues to come up when looking at accommodations,” Stephen Shannon, the president of the American Association of Colleges of Osteopathic Medicine, said. “But in medical schools it’s a more complex issue. There’s federal laws, state laws, the professional standards around the education itself. And then there’s the responsibility to the patient.”

The American Association of Medical Colleges declined to comment for this article, but its guidelines released in 2005 tell medical colleges that they are not required to waive any essential elements of a program – such as a surgery rotation – to accommodate students with disabilities, as it would fundamentally alter the requirements of the degree. On that point, courts have tended to so far side with the institutions. The parameters for denying a student admission based on safety concerns, however, are far more narrow.

According to the AAMC, the institution must demonstrate that the disabled student poses a direct threat that “cannot be eliminated by a modification of policies, practices, or procedures.”

In a case that made it to the Supreme Court in 1979, a prospective nursing student was denied admission at Southeastern Community College because of her hearing impairment. Though the woman could lip read, the college said it was concerned about the safety of patients in situations where she and her colleagues would have their mouths covered by surgical masks.

The court sided with Southeastern, but it included a forward-looking caveat in its decision. While the limited technology in 1979 made Southeastern’s argument a reasonable one, Justice Lewis Powell wrote in the court’s opinion, there would come a time when that was no longer the case.

“Technological advances can be expected to enhance opportunities to rehabilitate the handicapped or otherwise to qualify them for some useful employment,” Powell wrote. “Such advances also may enable attainment of these goals without imposing undue financial and administrative burdens upon a State. Thus, situations may arise where a refusal to modify an existing program might become unreasonable and discriminatory.”

L. Scott Lissner, Americans With Disabilities Act coordinator at Ohio State University and former president of the Association on Higher Education and Disability, said those technological advances have now taken place for many disabilities.

“I think captioning technology, for example, has vastly improved.” Lissner said. “It wasn’t even on the list of considerations of the 1979 case. It just wasn’t a practical tool at that point in time. In many of these cases, the accommodations are now affordable and reasonable. But there are misconceptions that still exist. Historically, doctors don’t like ‘sick’ doctors. They think, 'That’s for the patients. That’s not for us.’ ”

A study published in the journal Academic Medicine in 2013 found that technology is allowing a growing number of deaf students, in particular, to participate and succeed in medical school. When it comes to setting up those accommodations, however, many of the students said they were on their own. Most students spend two hours per week arranging accommodations, according to the survey, with a handful even saying they spend as much as ten hours on the task every week.

It may take extra effort and planning, but hearing impaired medical students now have access to an array of technology including amplified stethoscopes, advanced text-to-speech technology, and amplified telephones. In 2011, a deaf medical student at the University of California at Davis completed her surgery rotation by using a tablet to send the sounds of an operating room to an off-site transcriber. The transcriber then turned the audio into typed messages that appeared on an overhead monitor back in the operating room. 

For blind students, there are visual describers, raised line drawings, and devices that translate flat images into a series of vibrating pins that can be felt with a student’s fingers. A blind student used those technologies to help him graduate from the University of Wisconsin's medical school in 2005.

“I think we’ve absolutely reached that time where colleges can’t make this excuse anymore,” Kyle Shachmut, president of National Federation of the Blind of Massachusetts, said. “The students know that with the right technology and good, high expectations that they can do this. But I think college administrators' thinking and low expectations haven’t caught up with the reality and abilities students now have."

And the anxiety concerning patient safety continues to persist – even outside medical colleges.

"What is next?” the dissent in the Iowa Supreme Court decision asked. “Are we going to require the Federal Aviation Administration to hire blind air traffic controllers, relying on assistants to tell them what is appearing on the screen?"