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Legal Case Casts Light on Accessibility Issues in Medical Education

Scheck, Anne

doi: 10.1097/01.HJ.0000429417.31044.ed


Win or lose, the medical student who filed a federal complaint against Creighton University for failure “to provide him with auxiliary aids and services to ensure effective communication and an equal opportunity to participate in and benefit from the School of Medicine” is galvanizing advocates throughout the healthcare community and raising awareness of the educational barriers that can exist for those who are deaf and hard-of-hearing (DHoH).

Michael Argenyi, who has bilateral cochlear implants, uses lipreading and cued speech to communicate. He took action against Creighton after his repeated requests for Communications Access Real-Time Transcription (CART) and interpreter services were denied, as detailed in court documents. After a year, the university agreed to provide him oral interpreters and note-taking services for large group lectures, as well as oral interpreters for certain laboratory classes, but prohibited him from using interpreters in the clinic, according to the court papers. Mr. Argenyi then took a leave of absence at the beginning of his third year of medical school, which would have consisted of clinical clerkships.

In January, the United States Court of Appeals for the Eighth Circuit reversed a summary judgment granted to Creighton, giving new life to Mr. Argenyi's complaint. Now the case is remanded back to the district court for a trial.

“This was a huge win,” said attorney Mary Vargas, who represented Mr. Argenyi. In oral arguments, she asserted that “Creighton University stuck its head in the sand,” providing this student “accommodation that didn't work” rather than making sure the doctor-in-training could understand the information presented so that he could be adequately prepared for a career in medicine.



“It is not enough to simply allow a deaf student into the classroom; the university must ensure that the student has full and equal access to all of its programs and activities, including classroom content,” she said.

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Around the same time the appellate court ruling was handed down, another kind of conclusion was being drawn, this one based on inaugural research looking at physicians and physician trainees with hearing losses (Acad Med 2013;88[2]224-232). According to the findings, deaf and hard-of-hearing medical students become the kind of doctors who are likely to be happy with their choice of profession and whose ranks can potentially help fill the growing primary care gap.

Darin Latimore, MD, one of the study authors, said he hopes that the publication will spur the medical education community to do more outreach, providing encouragement and technological support for deaf premedical students. The group of practicing physicians responding to the survey showed a preference for primary care specialties. Primary care physicians are becoming both more scarce and more necessary (JAMA 2012;308[21]:2241-2247), and there is evidence that deaf and hard-of-hearing individuals face healthcare disparities in treatment and preventive care (J NY State Nurses Assoc 2009;40[1]:4-10).

“Recruitment and retention efforts by organizations to increase diversity should include DHoH physicians,” wrote Christopher J. Moreland, MD, MPH, lead author of the new study looking at deafness among physicians and trainees, and his coauthors. “Such efforts would benefit hearing clinicians as well as increase the availability of hearing- and language-concordant care to underserved DHoH patients,” added Dr. Moreland, of the University of Texas Health Science Center at San Antonio.

Given what's been observed in other underserved patient populations, such as racial or ethnic minority groups, it makes sense that there would be higher patient satisfaction among members of the deaf community who are seen by deaf physicians, said Dr. Latimore, assistant dean for student and resident diversity at the University of California, Davis. Communication barriers are lower, and cultural understanding better.

“I'd say it is likely this would improve patient compliance,” he said.



This perspective is right in line with what Philip Zazove, MD, has experienced.

“I totally agree,” said Dr. Zazove, professor and George A. Dean, MD, chair of family medicine at the University of Michigan in Ann Arbor. “I have patients who travel two to three hours to see me because I can sign with them,” he said, adding that there are confidentiality issues when someone else is in the room doing the interpreting. “I understand what they're going through.”

Deaf patients who consider themselves part of the Deaf community and use sign language “know I'm able to keep that in mind when caring for them,” added Dr. Zazove, who was diagnosed with profound hearing loss at age 4.

About 15 years ago, published studies began to show that deaf and hard-of-hearing patients are likely to receive a different level of care from hearing physicians. In one study, by Dr. Zazove and colleagues, physicians who were asked about deaf patients expressed different attitudes toward these patients and reported significantly more problems communicating with them compared with physicians surveyed about their patients in general (J Am Board Fam Pract 1996;9[3]:167-173).

More recently, research from the University of California, San Diego, revealed that medical faculty display less knowledge of cultural competency in treating deaf patients than do medical students who have undergone a Deaf community training program (J Cancer Educ 2011;26[1]:175-182).

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Several amicus curiae, or “friend-of-the court,” briefs filed to support Mr. Argenyi's appeal argued that the Americans with Disabilities Act and the Rehabilitation Act “require covered entities to provide auxiliary aids and services to enable individuals with an auditory disability to participate fully and equally in their programs.” Weighing in with briefs were the United States Department of Justice, the Alexander Graham Bell Association for the Deaf and Hard of Hearing, the National Disability Rights Network, and the Association of Medical Professionals with Hearing Losses.

Despite those arguments and the order to send the case back for possible trial, the appeals court did leave open the possibility that Creighton could submit evidence to show that accommodations would create an undue burden for the university, which could exclude it from the tenets of the Americans with Disabilities Act.

In the wake of the recent decision, the university filed a “petition for rehearing” with the United States Court of Appeals for the Eighth Circuit. “Until the court has ruled on the petition, there is nothing that can be said regarding the matter,” said Scott Moore, the attorney for Creighton University in the case.

Meanwhile, other students are speaking out.

“I'm glad that, here at Yale, I'm not facing the same problems,” said Joseph Heng, who was so concerned about not being able to hear like his peers that he considered not attending medical school at all. Now, he is happy with the decision he made. At his institution, faculty and other individuals “are always available at a moment's notice if I need any help,” he said.

“My dean for student affairs, Dr. [Nancy Rockmore] Angoff, and my clerkship directors have been incredibly supportive people who have made this place a really welcoming environment for me.”

Asked about this medical student, who came close to foregoing a medical education altogether, Dr. Latimore said that the message needs to be conveyed “that he and others like him are needed, and that their community will be waiting for them when they graduate.”

© 2013 Lippincott Williams & Wilkins, Inc.