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Blind Students and Health Professions

June 30, 2014

The Iowa Supreme Court on Friday ruled 5 to 2 that a chiropractic college violated the rights of a blind student by denying him the use of a sighted reader to describe X-rays to him. The student, blind from birth, was unable to stay in the program when his request was rejected, and the Iowa court's decision may represent a shift in how courts consider the issue of health professions students with certain disabilities.

The ideas in the decision, if embraced elsewhere, could lead to more options in health professions programs for students who are deaf or blind. The Iowa court found that a health professions college cannot simply assert that seeing an X-ray or patient is the only way a chiropractor or student could make a diagnosis. And the court ruled that it is relevant that there are blind medical doctors and medical students, suggesting that there are ways that blind students can meet academic requirements that in most cases may require vision.

The Iowa court also rejected the approach of the Ohio Supreme Court in 1996 ruling upholding the right of Case Western Reserve University to reject a blind applicant to its medical school.

And the Iowa court offered a new emphasis on a 1979 decision by the U.S. Supreme Court that upheld the right of Southeastern Community College, in North Carolina, to reject a deaf applicant to a nursing program. The Iowa court said some parts of the nursing case in fact suggest a higher bar than has been assumed for colleges to meet in denying accommodations to students with disabilities.

L. Scott Lissner, Americans With Disabilities Act coordinator at Ohio State University and president of the Association on Higher Education And Disability, said via email that while the ruling will apply only in Iowa, the issues in the case extend broadly to health professions programs.

"I think health professions are conservative when it comes to risk," Lissner said. "Because of their clinical focus they have a tendency to treat all requirements and standards as a patient safety issue whether it is or not and are slow to accept different ways of accomplishing tasks (the essence of accommodation) until others have proven it."

While the Iowa ruling will likely be hailed by advocates for students with disabilities, the dissent in the case shows that many people (and judges) remain sympathetic to idea that health professions colleges should have the right to say that vision is a basic requirement. The dissent states that the opinion in the case "elevates political correctness over common sense."

The dissent asks: "What is next? 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?"

The ruling is about Aaron Cannon, who enrolled at Palmer College of Chiropractic, although he was warned that there might be some portions of his education that he could not complete due to his blindness. The decision says that Cannon believed he could work something out, and that he succeeded in much of the coursework required by the college.

The conflict came when he was required to take radiology and Palmer rejected his request that a sighted reader be used to describe X-rays so he could demonstrate his ability to diagnose based on X-rays. The college said that its academic judgment was that its students needed vision to view X-rays themselves. Palmer is not unique in having the view that vision is a basic requirement for a medical professional; the technical admissions requirements of medical schools at such institutions as the University of Pennsylvania and the University of California at Los Angeles (among many others) specifically state that candidates for admission must have good vision.

The Iowa opinion, however, found that Palmer was engaged in discrimination (as defined by the federal Rehabilitation Act and the Americans with Disabilities Act) in not considering whether Cannon could function without being able to see the X-rays himself. The court faulted Palmer for not considering alternatives to its traditional requirements and asked how the college, having apparently granted waivers to some blind students in the past, could now insist that it could not do so.

And the court cited Palmer's acknowledgment that about 20 percent of practicing chiropractors don't have X-ray technology in their offices, but rely on others to make X-rays. This suggests, the opinion said, that what matters to a chiropractor is getting information from an X-ray in some way, not being fully involved in the process itself.

The U.S. Supreme Court's 1979 decision, the Iowa court said, certainly established the idea that a college could demonstrate that certain requested changes from students with disabilities would be unreasonable to approve. But the Iowa court noted parts of the U.S. Supreme Court ruling that may give more hope to students like Cannon. The U.S. Supreme Court said that changes in technology and practice could well make it possible for students with disabilities in subsequent cases to be able to meet academic requirements that couldn't have been achieved in 1979. The U.S. Supreme Court said that it could "envision situations" in the future “where an insistence on continuing past requirements and practices” could deny an education to “genuinely qualified” people. It is this part of the decision, the Iowa Supreme Court ruled, that was relevant to Cannon's case.

The press office for Palmer did not respond to a request for comment.

The Iowa dissent argued, however, that the court should have followed the model of its counterpart in Ohio when it considered a blind applicant to the Case Western medical school. That court specifically cited reading X-rays as one of the tasks a blind person could not do, and affirmed the right of the Case Western faculty to define that as a requirement.

A "misinterpreted X-ray could lead to improper treatment and lifelong paralysis," the dissent said. "X-ray interpretation requires training and skilled judgment to reach correct conclusions based on shades and shadows of complex bony structures. That is why many physicians with 20–20 vision choose to outsource interpretation of X-rays to radiologists. It is ludicrous to override Palmer’s academic decision and require it to permit a blind person to interpret X-rays for patient treatment based on what someone else claims he or she is seeing."

The dissent added that the opinion intrudes on academic decision-making. Said the dissent: "The majority’s intrusion into academic judgment on professional health care standards is unprecedented. No other court in the country has forced an academic institution to allow a blind student to interpret X-rays relying on an untrained sighted assistant."

Lissner of Ohio State said he didn't know if the ideas in the Iowa ruling would take hold. But he said that, given all the disability issues raised by the case, it would be "a wonderful teaching tool."

 

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