## Facts

- Ronen Halpern enrolled in a four-year M.D. program and attended from July 2004 until his dismissal in March 2009.
- The program required students to meet academic requirements and demonstrate professional attitudes and behavior, including integrity, respect, and effective interpersonal conduct.
- Halpern had ADHD and an anxiety disorder treated with medication; he did not disclose his ADHD or request accommodations when he entered the program.
- Beginning early in enrollment, Halpern accumulated reports of serious unprofessional conduct, including abusive interactions with staff and repeated interpersonal problems.
- In 2006, he failed his first clinical rotation due to regular lapses in professionalism, took medical leave, then returned and completed additional rotations, though incidents of unprofessional behavior continued.
- While on probation in 2008, Halpern failed to complete administrative obligations (sending donor thank-you letters) despite repeated reminders, prompting a review by the school’s promotions committee.
- The committee recommended dismissal based on professionalism concerns; Halpern proposed continued enrollment under strict probation, ongoing psychiatric treatment, and participation in a program for troubled physicians.
- The dean rejected the proposal and dismissed Halpern, citing continued professionalism deficiencies and concerns about fitness for the profession.
- Halpern sued under § 504 of the Rehabilitation Act and Title III of the ADA, alleging disability discrimination and failure to provide reasonable accommodation.

## Issues

1. Whether Halpern was “otherwise qualified” to continue in the medical program, with or without reasonable accommodation, despite documented unprofessional conduct linked to ADHD and anxiety.
2. Whether Halpern’s proposed accommodation—continued enrollment under strict probation plus treatment and participation in a physician-assistance program—was a reasonable accommodation under the ADA and Rehabilitation Act.

## Decision

- The Fourth Circuit affirmed summary judgment for Wake Forest.
- The court held that professionalism was an essential program requirement.
- The court concluded Halpern was not otherwise qualified because of a long-standing pattern of serious unprofessional behavior.
- The court held the requested accommodation was unreasonable because it would effectively waive or fundamentally alter essential standards and function as an indefinite second chance rather than an adjustment enabling compliance.
- The court found the dismissal rested on documented conduct, not discriminatory animus based on disability.

## Legal Principles

- Under the Rehabilitation Act and Title III of the ADA in an educational program context, a plaintiff must show disability, qualification (with or without reasonable accommodation), and exclusion on the basis of disability.
- A student is not “otherwise qualified” if the student cannot meet essential program requirements even with reasonable accommodation.
- Professionalism and appropriate conduct may constitute essential requirements in medical education, and courts generally defer to academic judgments about such standards and student fitness.
- Reasonable accommodation does not require an institution to lower, waive, or substantially modify essential standards, or to accept accommodations that only postpone compliance through open-ended remediation.
- An adverse academic decision grounded in documented performance or conduct deficiencies is not unlawful discrimination absent proof that the exclusion was on the basis of disability.

## Conclusion

The court upheld the medical school’s dismissal decision because consistent professionalism was an essential requirement, Halpern’s sustained misconduct showed he could not satisfy that requirement, and his proposed probation-and-treatment plan would have required a fundamental alteration of the program’s standards rather than a reasonable accommodation.


Halpern v. Wake Forest Univ. Health Scis., 669 F.3d 454 (4th Cir. 2012)