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Rodrigo v. Carle Foundation Hospital

United States Court of Appeals, Seventh Circuit

January 2, 2018

Yasas Rodrigo, Plaintiff-Appellant,
Carle Foundation Hospital d/b/a Carle Foundation Hospital & Family Medical Residency, an Illinois Corporation, Defendant-Appellee.

          Argued October 24, 2017

         Appeal from the United States District Court for the Central District of Illinois. No. 2:14-cv-02274-HAB Harold A. Baker, Judge.

          Before Easterbrook, Rovner, and Hamilton, Circuit Judges.


         Yasas Rodrigo sued his employer, Carle Foundation Hospital ("Carle"), for violations of the Americans With Disabilities Act, 42 U.S.C. § 12101 et seq. ("Act"). The district court granted summary judgment in favor of Carle on Rodrigo's claims for disability discrimination, failure to provide a reasonable accommodation, and retaliation. Rodrigo appeals and we affirm.


         Rodrigo was a resident in Carle's Family Medicine Residency Program ("Program") beginning in July 2010. Medical residency programs provide training to medical school graduates who are seeking to become licensed physicians certified in various specialties. Residents provide patient care under the supervision of experienced doctors in settings such as acute care hospitals like Carle. Unlike medical school, this part of physician training includes an employment component. The three-year Program at issue here was governed by annual contracts between Carle and its residents and by policies adopted by the hospital. The standard contract was designed to be renewed each year as a resident completed the Program's requirements. Residents were required to successfully complete certain mandatory and elective rotations through various medical specialties before proceeding from one Program year to the next.

         Residents were also required to pass the Step 3 test, the third part of the United States Medical Licensing Examination ("USMLE") before advancing to the third year of the Program. The Step 1 test and the two-part Step 2 test (encompassing clinical knowledge and clinical skills) are usually completed in medical school, prior to residency. Carle adopted a policy in July 2012 that "[m]ore than two failures of USMLE Step 3 ... will result in termination from the program." R. 18-23. Passing the Step 3 exam is a prerequisite for obtaining a license to practice medicine in the United States, and a license, in turn, is necessary to be eligible to take the Family Medicine board exam. Carle did not graduate residents from its Program unless they completed licensing requirements and were eligible to take the board exam. The State of Illinois (where Carle is located) has its own limits on licensure: a medical student with a total of five failures in the Step tests is not eligible for further testing or licensure in Illinois without significant remediation. See 68 111. Admin Code § 1285.60(a)(8) (setting forth the nine- to twelve-month remediation programs required by law).

         Rodrigo failed his first attempt to pass Step 1 as well as his first attempt to pass Step 2 before successfully completing those tests. He followed this performance with difficulties in rotations during his first year in Carle's Program. In the fall of 2010, he was placed in remediation and directed to repeat two rotations. He completed remediation and was returned to good standing. Shortly thereafter, his performance in two other rotations was deemed insufficient and he was again placed in remediation. At that time, his supervisors at Carle considered whether a neuropsychological examination might help identify any physical or cognitive issues that were affecting his performance. Rodrigo never underwent the recommended testing, but he successfully completed the second round of remediation and returned again to good standing in the Program. Carle extended Rodrigo's first Program year by nearly five months to allow him to complete the first year requirements.

         In May 2012, near the end of his second year in the Program, Rodrigo took the Step 3 test and failed. With only two months left before he was to begin the third year of the Program, Carle agreed to allow Rodrigo to extend his second Program year by twelve weeks in order to allow him to take the Step 3 test a second time. Around this same time, Carle adopted its policy limiting residents to three attempts at the Step 3 test. The policy requiring passage of Step 3 before advancing to the third Program year remained in effect.

         In August 2012, Rodrigo reported to Carle that he had failed a second time. After the second failure, Rodrigo informed the director of the Program, Dr. Bharat Gopal, that he had a sleep disorder and that he had been diagnosed with Restless Leg Syndrome. Like most medical residents working long hours in stressful circumstances, he had complained of fatigue at various points in his residency but he had never previously reported having a diagnosed sleep disorder. He attributed his first two Step 3 failures to fatigue brought on by his sleep disorder and told Dr. Gopal that he had scheduled a third attempt. Although Rodrigo did not request an accommodation, Dr. Gopal suggested that he take a leave of absence to focus on passing Step 3. Dr. Gopal reminded Rodrigo that he would be terminated from the Program if he failed the test a third time. After initially rejecting the offer of a leave of absence, Rodrigo changed his mind and took three weeks off to prepare for his third attempt. His twelve-week extension for the second Program year ended on September 22, 2012. Soon thereafter, he took Step 3 for the third time. On October 29, 2012, he reported to Dr. Gopal that he had failed a third time.

         In reporting his score to Dr. Gopal via email, Rodrigo remarked that, unlike his first two attempts at Step 3, he remained awake during the exam and simply felt fatigued. He wrote that he was "confident that an addition of a review course or another month off would not have changed [his] score." R. 18-26. He told Dr. Gopal that, "Test taking has always been an issue, " and that it was an inherited trait in his family. He said, "The only regret I have it [sic] the fact that [I] didn't seek help early for my sleep until it was too late and this played the biggest role on my test score." He acknowledged that he "was not the easiest resident to understand from day one, " but that he believed in retrospect that, "fair decision[s] [were] taken." R. 18-26.

         After assuring Dr. Gopal that he was open to whatever decision Dr. Gopal made about his future, and acknowledging that termination of his residency was a "valid option, " Rodrigo asked to be promoted to third-year status in the Program so that he could continue his residency and attempt to pass Step 3 in California in May 2013. Illinois, of course, was no longer an option because he had accumulated five total failures in the Step tests. He anticipated he would receive his score by June 2013 and conceded that "at that point, there will NOT be another option for me." He declined any scenario that would require him to repeat any additional months beyond July 2013, which would have been the natural end date for his three-year residency. R. 18-26.

         Dr. Gopal informed Rodrigo that he was not eligible to continue in the Program. Rodrigo asked to resign from the Program in lieu of termination and Carle honored the request, announcing his resignation. Two days later, in a letter taking a decidedly different tone, Rodrigo requested reinstatement so that he could finish his residency in Carle's Program by July 1, 2013. He asserted that he had been placed under ...

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