968 F.3d 251
3rd Cir.2020Background
- Jessica Ramsay, a third-year medical student, sought extra testing time for USMLE Steps 1 and 2 CK based on ADHD and dyslexia diagnoses and prior academic accommodations.
- She submitted multiple evaluations (family physician, social worker, neuropsychologists, treating psychiatrist) showing low processing speed, attention deficits, and very low percentile scores on reading measures; the Board’s outside reviewers concluded she was not substantially limited.
- Ramsay took Step 1 without accommodations, failed by one point, renewed her accommodation requests with additional neuropsychological testing, and the Board again denied them based on reviewers’ conclusions and her academic achievements.
- WMed conditioned Ramsay’s continued enrollment on passing Step 1 by a set date, prompting her to seek a preliminary injunction under the ADA requiring the Board to provide accommodations.
- The District Court held an evidentiary hearing, credited the experts who examined Ramsay, found she was disabled under the ADA, and granted a preliminary injunction ordering double time for Steps 1, 2 (CK and written/reading portions of CS), and 3.
- The Third Circuit affirmed: it held the District Court’s factual findings were not clearly erroneous, the court properly applied ADA standards and DOJ guidance, and the injunction was justified by irreparable harm, balance of equities, and public interest.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Ramsay has a "disability" under the ADA (substantially limits major life activities compared to most people) | Ramsay: neuropsychological testing and low percentile reading/processing scores show she is substantially limited in reading, writing, concentrating and thinking. | Board: her academic success and test-taking history show no substantial limitation compared to the general population. | Court: Ramsay likely meets ADA disability standard; district court reasonably credited clinicians who personally examined her and abnormal test scores. |
| Whether past accommodations may be considered in assessing disability | Ramsay: past accommodations are probative and support finding of disability and need for accommodations. | Board: past accommodations should be considered only after a disability is established. | Court: Regulations permit and even give ‘‘considerable weight’’ to documentation of past accommodations; district court did not err. |
| Whether the court erred by favoring experts who personally examined Ramsay over Board reviewers | Ramsay: examiners who met her provided individualized, firsthand assessments entitled to greater weight. | Board: its reviewers’ record-based analyses were valid and district court improperly deferred to treating examiners. | Court: district court properly favored experts with personal examinations consistent with DOJ guidance; not compelled deference but permissible factfinding. |
| Whether preliminary injunction factors (irreparable harm, balance of equities, public interest) were satisfied | Ramsay: likely dismissal from medical school, no adequate remedy at law, public interest in ADA compliance and training physicians. | Board: concern about exam integrity and mission to ensure qualified physicians. | Court: irreparable harm shown, equities and public interest favor injunction; no evidence accommodations would undermine test integrity. |
Key Cases Cited
- Ass'n of N.J. Rifle & Pistol Clubs, Inc. v. Att'y Gen. N.J., 910 F.3d 106 (3d Cir. 2018) (standard of review for preliminary injunctions)
- J.D. by Doherty v. Colonial Williamsburg Found., 925 F.3d 663 (4th Cir. 2019) (learning-disability comparison to general population)
- Enyart v. Nat’l Conf. of Bar Exam’rs, 630 F.3d 1153 (9th Cir. 2011) (irreparable harm where licensing-exam denial jeopardizes professional opportunity)
- Winter v. Nat. Res. Def. Council, Inc., 555 U.S. 7 (2008) (injunction requires likelihood of irreparable harm and balance of equities)
- United States v. Olhovsky, 562 F.3d 530 (3d Cir. 2009) (trial court discretion to credit firsthand observations of a witness/examiner)
- Greater Phila. Chamber of Commerce v. City of Philadelphia, 949 F.3d 116 (3d Cir. 2020) (discussion of preliminary injunction factors)