Ohio Civ. Rights Comm. v. Case W. Res. Univ.

• Citation: 76 Ohio St.3d 168,666 N.E.2d 1376
• Decision Date: 31 July 1996
• Docket Number: No. 95-387,95-387
• Parties: , 110 Ed. Law Rep. 1202, 8 NDLR P 245 OHIO CIVIL RIGHTS COMMISSION et al., Appellants, v. CASE WESTERN RESERVE UNIVERSITY, Appellee.
• Court: United States State Supreme Court of Ohio

Page 168

76 Ohio St.3d 168

666 N.E.2d 1376, 110 Ed. Law Rep. 1202, 8 NDLR P 245

OHIO CIVIL RIGHTS COMMISSION et al., Appellants, v. CASE WESTERN RESERVE UNIVERSITY, Appellee.

No. 95-387.

Supreme Court of Ohio.

Submitted March 6, 1996.

Decided July 31, 1996.

SYLLABUS BY THE COURT

1. A prima facie case of discrimination in education under R.C. 4112.022(A) includes three elements: (1) the plaintiff is a handicapped person within the meaning of R.C. 4112.01(A)(13); (2) the plaintiff is otherwise qualified to participate in the program; and (3) the plaintiff is being excluded from the program on the basis of a handicap.

2. An "otherwise qualified" handicapped person is one who is able to safely and substantially perform an educational program's essential requirements with reasonable accommodation. An accommodation is not reasonable where it requires fundamental alterations in the essential nature of the program or imposes an undue financial or administrative burden.

Plaintiff-appellant, Ohio Civil Rights Commission ("OCRC"), appeals from a decision approving Case Western Reserve University's ("CWRU") denial of a blind candidate's application for admission to its medical school.

Plaintiff-appellant, Cheryl A. Fischer ("Fischer"), completely lost her vision during her junior year of undergraduate study at CWRU. To accommodate Fischer's handicap while she pursued a chemistry degree, CWRU provided Fischer with lab assistants and readers, modified the written exams to oral ones, and extended the time periods in which to take exams. Fischer also used a closed circuit television to magnify images before she totally lost her sight, and books on tape to assist her. Thus, in spite of her handicap, Fischer successfully completed all of CWRU's academic requirements and received her baccalaureate degree, cum laude, in 1987.

Following graduation, Fischer sought admission to medical school. All medical colleges in the United States belong to the Association of American Medical Colleges ("AAMC"). In January 1979, the AAMC adopted the "Report of the Special Advisory Panel on Technical Standards for Medical School Admission." The AAMC Technical Standards Report requires candidates for a medical school degree to have the ability to observe. Specifically, the report states, "[t]he candidate must be able to observe demonstrations and experiments in the basic sciences * * *. A candidate must be able to observe a patient accurately at a distance and close at hand. Observation necessitates the functional use of the sense of vision and somatic sensation." The Technical Report further states, "a candidate should be able to perform in a reasonably independent manner. The use of a trained intermediary means that a candidate's judgment must be mediated by someone else's power of selection and observation." Although medical colleges are not required to follow the Technical Standards Report, the AAMC encouraged medical schools to use it as a guideline in developing their own standards.

In 1987, Cheryl applied to the medical school at CWRU. ¹ CWRU used the AAMC Technical Standards Report as a guideline in evaluating the four thousand to five thousand preliminary applications received annually for a class total of one hundred thirty-eight. ² Due to Fischer's sufficient academic credentials and extraordinary letters of recommendation, Dr. Albert C. Kirby, Associate Dean for Admissions and Student Affairs at CWRU's medical school, granted Fischer an interview. Subsequently, Dr. Kirby placed Fischer on an alternate list but ultimately denied her application. The following year, Fischer reapplied to CWRU. ³

In this second application process, Fischer was one of seven hundred applicants granted an interview and the only applicant to be interviewed by three Admission Committee members: Dr. Kirby, Dr. Richard B. Fratianne and Dr. Mildred Lam. Dr. Kirby believed that CWRU should accept Fischer into the class. Drs. Fratianne and Lam concluded that a blind student would be unable to complete the requirements of the medical school program.

CWRU's four-year curriculum consists of three basic components: the core academic program, the flexible program, and the patient-based program. The core academic program occupies the medical student's first two years, and is taught using traditional methods such as lectures, lab experiments and textbooks. The core academic program consists of study in the basic sciences, such as anatomy, histology, pathology, and physiology. The flexible program consists of electives, allowing students to engage in independent research and study in a specific area. The patient-based program includes clerkships in internal medicine, pediatrics, surgery, obstetrics and gynecology, psychiatry and primary care. In these different clerkships, students provide direct patient care. For example, students must perform a complete physical exam, review laboratory test results, review patient charts and perform basic medical procedures, such as starting an I.V., administering medications through veins, drawing blood, and responding in emergency situations. The surgery clerkship includes rotations in the emergency room and intensive care unit.

After interviewing Fischer, Dr. Fratianne, Associate Professor of Surgery at CWRU, concluded that Fischer would be unable to complete the medical school program. He believed that due to her lack of vision, Fischer would be unable to exercise independent judgment when reading an X-ray, unable to start an I.V., and unable to effectively participate in the surgery clerkship.

Following an interview with Fischer, Dr. Lam, Associate Professor of Medicine at CWRU, concluded that a blind student would be unable to complete the first and second year courses in the basic sciences which required the student to observe and identify various tissues and organ structures. For example, histology requires a student to identify tissue and organ structures through a microscope and pathology requires a student to observe how such structures are affected by disease. She believed that no accommodation would enable a blind student to complete these course requirements. Dr. Lam further opined that a blind medical student could not complete the third and fourth year clerkships. A blind student would be unable to start an I.V., draw blood, take night call, react in emergency situations, or pass the objective clinical exam which required a student to perform a physical exam and to read an EKG and an X-ray. Dr. Lam prepared a list of forty-three medical conditions, such as jaundice or a patient's state of consciousness, which require good vision to diagnose. Dr. Lam also listed twenty-one medical procedures, such as arterial line placement, which require good vision. Dr. Lam concluded that an intermediary could not assist a blind medical student because use of an intermediary would require extra time that is not available in an emergency situation, and the observations during and the accuracy of the physical exam would be "only as good as the intermediary." Fischer recalled that during the interview, Dr. Lam commented that the "whole concept" of a blind medical student was "ridiculous."

After the three interviews and after consulting other CWRU medical school professors and students, CWRU's Admissions Committee, by a unanimous vote, denied Fischer's application. ⁴ Although the committee was aware of Dr. David W. Hartman, a psychiatrist who graduated from Temple University School of Medicine while totally blind in 1976, the committee did not contact Dr. Hartman or Temple University.

Dr. Hartman's experience affected the decision-making in this case. Temple University, in 1972, voluntarily increased the size of the incoming class by one to accept Dr. Hartman. To facilitate his first two years of study in the basic sciences, Dr. Hartman used a raised line drawing board to diagram and illustrate various structures. Postdoctoral or graduate students privately tutored Dr. Hartman by describing to him the slides of structures under microscope and using the raised line drawing board. Other medical students also assisted Dr. Hartman by describing experiments they conducted and otherwise sharing information. Dr. Hartman also listened to books on tapes, used readers, and relied on his sense of touch for classes such as anatomy.

In virtually all of his first and second year courses, Dr. Hartman required one-on-one assistance from his professors. Dr. Hartman estimated that the professors in the anatomy department, which included courses in gross anatomy, neuroanatomy, embryology and histology, spent double or triple the time tutoring him than they spent tutoring the average student. John R. Troyer, Ph.D., a professor who was on the faculty at Temple when Dr. Hartman attended, believed that the extra time he spent with Dr. Hartman took away from time he had to tutor other students. For this reason, Dr. Troyer had reservations about accepting another blind student.

Professors at Temple also modified their lectures to accommodate Dr. Hartman. For example, professors diagrammed structures on the raised line drawing board that the other students viewed under a microscope and verbally described processes instead of visually demonstrating them. One professor even sat next to Dr. Hartman during class and described procedures being conducted in a class demonstration.

To facilitate his clerkships, Dr. Hartman would have a nurse, another student, the resident or intern perform parts of a physical examination which required visual observations and describe their observations to him. Another student or a nurse would read patient charts and laboratory test results to him. Dr. Hartman could not start an I.V. without the supervision and assistance of a nurse and could not read an X-ray without relying on a radiologist.

During the surgical clerkship, Dr. Hartman spent only one or two days a week for three to four hours a day in surgery,...