Almost four years ago, a District of Columbia woman with outstanding grades in her medical school class was summoned to the dean's office shortly before graduation and summarily expelled. She was charged with lacking personal hygiene, occasionally wearing dirty clothes and not being able to get along with patients, doctors on the medical school staff and fellow students.
That expulsion now has escalated into a legal battle with ramifications that extend potentially to every graduate and professional school in the nation. At issue is whether students in such schools are entitled under the due-process clause of the 14th Amendment to a notice of charges and a hearing before academic dismissal.
At stake is the traditional prerogative of professional educators to decide unilaterally whether a student measures up to standards.
Principals in the dispute are Charlotte Horowitz, who lives at the Van Ness Centre in Northwest of Missouri Medical School at Kansas City.
In court documents and depositions, Horowitz was described "overweight, unattractive and unkemptk, the joke of the medical school." Witnesses testified that she quently wore lab coats that were dirty or yellow and that, on at least two occasions, her fingernails were inadequately cleaned.
Her high academic standing, both in course grades and tests, was not disputed.
"In the eyes of the members of the medical school community, she did not exemplify what they were looking for in terms of personal apperance," Dr. Marjorie Siridger, a member of the medical school faculty, testified.
The dispute is pending before the U.S. Supreme Court. The medical school had petitioned for a review of an Eighth U.S. Circuit Court of Appeals decision holding the Horowitz dismissal unconstitutional in that she was denied due process.
If the Supreme Court agrees to hear the case and finds for Horowitz the due-process principle could become binding in graduate schools nationwide.
Unless the principle is set aside by the Supreme Court, it already is binding in the Eighth Circuit, which includes Missouri Arkansas, Iowa, Minnesota, North Dakota, South Dakota and Nebreska.
Dr. Richard K. Noback, dean of the medical school, refused to discuss the case, but Marvin Wright, lawyer for the University of Missouri, said the decision sets a precedent that concerns him. "The courts have traditionally left academic judgments up to professional educators," he said.
Horowitz, unemployed here since her expulsion in the summer of 1973, said she has been unable to find work in a field related to medicine. She is being supported by her family, she said.
At medical school, Horowitz, said, she was the victim of sexist and anti-Semitic prejudices. She disputed the validity of the charges against her.
As set forth in briefs filed at the Supreme Court, the Horowitz case begins in the summer of 1971 with her admission to the medical school with advanced standing.
A graduate of Barnard with a masster's degree in psychology from Columbia, she scored in the 99th percentile on the Medical College Admissions Test. On the Graduate Record Exams, she scored above the 99th percentile in verbal aptitude, advanced psychology and advanced chemistry.
By the summer of 1972, Horowitz was leading her class but already incurring the displeasure of the medical school faculty.
"Several physicians were disturbed by her lack of personal hygiene," one court document noted, and her rapport with patients and staff was said to be deficient. She was put on probation.
In February, 1973, she was notified formally by letter that "you must make very marked and very substantial improvements in several areas. These are clinical competence, peer and patient relationships, personal hygiene and ability to accept criticism."
Disputing the charges, Horowitz said she always combed her hair and groomed herself in the mornings, adding, "I have very thick hair. Sometimes by five o'clock it gets a little bit mussed."
As to the dirty fingernails and lab coats, she said "I always wear red nail polish. I don't know how you can see dirt through red nail polish. My lab coats were washed every week, even if they weren't the whitest."
A student who graduated one year before Horowitz left - said in a deposition that Horowitz was "overweight, unattractive and unkempt, but not uncleanly."
In the matter of faculty and student relationships, Horowitz said she got along reasonably well. "There were two or three exceptions, but that's par for the course. Basically, I came to medical school to get an education. Many of the students spent their time in the taverns, so we didn't socialize much. When our paths did cross, we got along fine," she said.
She also disputed the contention that she lacked clinical competence and was deficient in relationships with patients.
She received a superior or satisfactory rating in eight of nine areas of clinical evaluation, she said. She said she could have made up the one unsatisfactory rating had she been given time.
In quarterly examination given in February, 1973, Horowitz scored fourth in her class and in May quarterlies, she ranked second. In examinations that year of the National Board of Medical Examiners, she scored first in the class. Nevertheless, according to the medical school, she was not moving to correct what the school felt were her deficiencies.
In the spring of 1973, a panel of seven medical school doctors - none of whom had any previous contact with Horowitz - was appointed to evaluate her case. Two recommended that she graduate that spring on schedule, to recommended she be expelled, two said she should remain at medical school on probation and one said she was not ready to graduate.
Those recommendations were screened by two faculty committees, both of which concluded that she should be dismissed. In early July, Horowitz was summoned to the dean's office and told she was being expelled.
At no time during these deliberations was Horowitz permitted to appear at a hearing in her own defense and, shortly after her dismissal, she filed the lawsuit claiming denial of due process.
At the trial level, the medical school prevailed as the judge specifically found no evidence to support Horowitz's contention that she was the victim of sexist and anti-Semitic prejudices. According to trail testimony, Horowitz had been promised a job at the University of North Carolina Medical School if she obtained her degree. When she was expelled, she lost the job.
When the case reached the appeals court, the trial court was reversed outright and the case sent back with instructions that Horowitz be given a notice of chorges and a hearing before receiving an academic dismissal.
In effect, the ppellate court held the consequences of dismissal were so severe as to constitute a deprivation of liberty within the meaning and intent of the due-process clause of the 14th Amendment.
"The unrefuted evidence here established that Horowitz has been stigmatized by her dismissal in such a way that she will be unable to continue her medical education and her chances of returning to employment in a medically related field are severely damaged," the appeals court ruled. "The dismissal was effected without the hearing required by the 14th Amendment."