Case Law

Residents have been here before. Courts have written it down.

Every summary below comes from a published court opinion or an official government source, linked so you can read it yourself. The pattern across all of them is simple: the record decides.

Foundations

The cases programs rely on, and their limits

Courts defer to genuinely academic judgment. That deference has conditions, and the conditions are where cases are won and lost.

U.S. Supreme Court · 1978

Board of Curators of the Univ. of Missouri v. Horowitz

A medical student was dismissed for clinical deficiencies after being told repeatedly that her performance threatened her graduation, and after review by seven independent physicians. The Court held no formal hearing was required for a genuinely academic dismissal, because she had been fully informed and the decision was careful and deliberate. (435 U.S. 78: read the opinion)

What it means for you: Programs cite Horowitz to avoid hearings. Its protection depends on the facts they must prove: full notice of the deficiency and a careful, deliberate process. No notice, no deliberation, no Horowitz.

U.S. Supreme Court · 1985

Regents of the Univ. of Michigan v. Ewing

A student dismissed after the lowest board score in his program’s history lost, but the Court set the test that still governs: an academic decision stands unless it is “such a substantial departure from accepted academic norms as to demonstrate that the person or committee responsible did not actually exercise professional judgment.” (474 U.S. 214: read the opinion)

What it means for you: A program that departs from its own written norms (skipped remediation steps, retroactive paperwork, unimposed warnings) is describing the exact exception Ewing carved out.

2d Circuit · 1991

Ezekwo v. NYC Health & Hospitals Corp.

An ophthalmology resident was denied the Chief Resident position her program’s own materials promised to every third-year. The Second Circuit held the program’s policies and practices created a protected property interest, and that changing the selection criteria without telling residents until after the decision violated due process. (940 F.2d 775: read the opinion)

What it means for you: What your program publishes and practices can be legally enforceable. Rules invented after the fact are a due-process problem, not a technicality.

South Carolina Supreme Court · 1987

Small v. Springs Industries, Inc.

An employer published a handbook and bulletin promising a four-step discipline process (verbal reprimand, written warning, final warning, discharge), then fired an employee after a single written warning. South Carolina’s highest court held the handbook could form a unilateral contract, and the jury’s verdict for the employee stood on liability. (292 S.C. 481: read the opinion)

What it means for you: In South Carolina and many states, a handbook promising progressive discipline is not decoration. If the manual promises steps, skipped steps are evidence.

Residents in Court

Modern resident cases, in both directions

We include the losses on purpose. Read together, they say one thing: courts check whether the program followed its own rules and whether you can prove your version. Residents with records win arguments; residents with memories don’t.

4th Circuit · 2019 · South Carolina

EEOC v. McLeod Health, Inc.

A South Carolina health system ordered a 28-year employee with congenital orthopedic disabilities to fitness-for-duty exams after learning she had fallen, placed her on leave, and discharged her. The Fourth Circuit reversed summary judgment: a jury could find the exams were not job-related and consistent with business necessity, and could reject the employer’s “direct threat” theory. (914 F.3d 876: read the opinion) The EEOC later announced a $133,000 settlement with a two-year consent decree requiring new medical-exam procedures, ADA training, and EEOC reporting. (EEOC press release)

What it means for you: A forced medical exam is not automatically lawful. The employer needs objective evidence, and “we were worried” is not a standard.

U.S. Supreme Court · 2023

Groff v. DeJoy

A unanimous Supreme Court raised the bar for denying religious accommodations under Title VII: an employer must show the accommodation would cause “substantial increased costs in relation to the conduct of its particular business.” The old “more than de minimis” excuse is dead. (600 U.S. 447: read the opinion)

What it means for you: Fasting, prayer, and religious scheduling needs are entitled to real accommodation. A program that documents your religion in an evaluation instead of starting an accommodation conversation has the analysis backwards.

California Court of Appeal · 2022

Khoiny v. Dignity Health

An internal medicine resident dismissed after her second year won reversal on appeal. The court held the resident-program relationship is predominantly employer-employee, so “academic deference” does not shield a program from a jury deciding whether a dismissal was discriminatory or retaliatory. (Read the opinion)

What it means for you: “This was an academic decision” is a defense theory, not a magic phrase. In California, juries, not committees, decide whether discrimination was a substantial motivating factor.

3d Circuit · 2017

Doe v. Mercy Catholic Medical Center

A radiology resident alleged her program director harassed her and engineered her dismissal after she reported him. The Third Circuit held an ACGME-accredited residency can be an “education program or activity” under Title IX, letting her retaliation and quid pro quo claims proceed. (850 F.3d 545: read the opinion)

What it means for you: Residencies can face both employment law and education law. More statutes means more deadlines, and more reasons to get advice early.

6th Circuit · 2024

Mares v. Miami Valley Hospital

An OB/GYN resident dismissed after escalating discipline lost her due process and contract claims. The court’s reasoning: the program “followed its internal procedures closely” and gave “more than enough process.” (Read the opinion)

What it means for you: When the program follows its own rules, it usually wins. Which is precisely why a program that skips its own rules should worry, and why you should document every skipped step.

5th Circuit · 2024 · 11th Circuit · 2021

Daywalker v. UTMB · Okwan v. Emory Healthcare

Two discrimination claims by dismissed or non-renewed residents failed for the same structural reason: no adequate comparator and no evidence tying the decision to race or national origin. In Daywalker, the court found no comparator with a “comparable violation history” (read the opinion); in Okwan, the comparator was not “similarly situated in all material respects.” (read the opinion)

What it means for you: Discrimination cases live or die on evidence: comparators, timelines, and documents. This is exactly what an attorney helps you identify and preserve, before it disappears.

“The decision to dismiss a student where the entire student record has been reviewed, due process provided, and the institution complied with its own policies is usually upheld by the courts… Where academic decisions appear arbitrary and capricious, the courts take a different approach.”Due Process in Medical Education, Academic Pathology (2018)

A study of medical-education lawsuits from 1993–2002 found institutional defendants won more than 90% of decided cases, and that discrimination, wrongful termination, and due process claims made up nearly 75% of claims brought against institutions (Academic Medicine, 2003). Those numbers are not a reason to give up. They are a reason to build the record correctly from day one, while the facts are still yours to preserve.

The record decides. Start building yours.

If a proceeding has started, or a deadline exists, the earlier counsel sees your documents, the more options you have.

Start your confidential intake Know your rights first