A few weeks before graduation, a medical school tried to expel one of its students on the basis of unprofessional behavior. What happened?

According to Cleveland.com, a US District Court judge ruled that the student could not be dismissed because Case Western Reserve University “went beyond its scope of authority.”

The school based its accusation of unprofessional behavior on several incidents, some of which were disputed by the student:

As a first-year student, he was late for class three times and asked the instructor not to mark him as late. He was drunk at a school dance, harassed two women, and possibly grabbed another. After the dance he tried to avoid paying a driver by jumping out of a moving cab. A patient’s family requested that he not be involved with the care of their relative. A classmate had said that he had presented the case of a patient he had not personally examined. He did not report to the school that he had been charged with driving under the influence of alcohol in 2013 in another state.

The student had satisfied all academic requirements and had received many favorable evaluations. He did a year of research in dermatology for which he received honors and had published more than a dozen papers and book chapters.

The judge pointed out that among other things, the school’s student handbook contained no requirement to report any arrest to the school.

But most damning to the school’s argument was the existence of positive letters of recommendation from the school to residency programs the student applied to.

The judge pointed out that the incidents that occurred before the DUI had been reviewed by the school’s Committee on Students, which did not move to dismiss the student and were not mentioned in the recommendation letters. The same committee voted to expel him after finding out about the DUI.

From the opinion of the judge: If the earlier incidents were actually no big deal, then the earlier incidents do not warrant expulsion even when followed by [the student’s] failure to report the North Carolina arrest. Alternatively, if the earlier incidents were important, then Case cannot rely on any lack of candor because Case demonstrated worse in giving glowing recommendations without mention of [the student’s] supposed character flaws. That Case did not to explain any concerns to potential residency programs shows these incidents were more innocuous than the University now argues.

Again, the judge: Although courts should give almost complete deference to university judgments regarding academic issues, the same deference does not follow university character judgments, especially on character judgments only distantly related to medical education.

What have we learned here?

“Professionalism” is difficult to define, especially when trying to do so in a courtroom.

Four years ago, I wrote that deans’ letters lacked candor and resembled “public relations releases.” I guess that is still true.

If you are trying to build a case for dismissing a medical student or a resident, you had better be sure that the individual’s dossier, and your communications with other institutions are consistent with your proposed actions.

You might want to have a written policy on how your dismissal process works such as verbal warning for the first offense, written warning for the second, and expulsion for the third

This is not the first time a situation like this has occurred with a student or a resident nor will it be the last.

What do you think about the student’s behavior, the school’s actions, and the judge’s decision?

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 9600 followers on Twitter.