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Parties Involved:
Florida International University Board of Trustees
Appellee
Elie Nehme
Appellant

Document Text:

[PUBLISH]

In the

United States Court of Appeals

For the Eleventh Circuit

____________________

No. 22-13945

____________________

ELIE NEHME, 

Plaintiff-Appellant, 

versus

FLORIDA INTERNATIONAL UNIVERSITY BOARD OF 

TRUSTEES, 

Defendant-Appellee.

____________________

Appeal from the United States District Court

for the Southern District of Florida

D.C. Docket No. 1:20-cv-24649-AMC

____________________

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2 Opinion of the Court 22-13945

Before JILL PRYOR, BRANCH, and GRANT, Circuit Judges.

GRANT, Circuit Judge:

Elie Nehme did not do well in medical school. All told, he

failed nine courses—including six while on academic probation—

and was even forced to repeat a full year of classes. His tenure was 

also marred by a complaint from three professors lamenting his 

general unprofessionalism. Given these deficiencies, it is no 

surprise that Florida International University dismissed him for 

academic underperformance instead of allowing him to complete 

medical school—and ultimately become a practicing physician. 

Nehme does not see it that way. He says that his removal 

was because of disability discrimination rather than his academic 

failures. But Nehme’s argument fails for a basic reason: he cannot 

show that he is a “qualified individual” under the Americans with 

Disabilities Act. Why? He could not meet the university’s 

minimum academic standards, even with reasonable

accommodations for his disability. See 42 U.S.C. § 12132; 34 C.F.R. 

§ 104.3(l)(3). We affirm the district court’s grant of summary 

judgment for the University.

I.

Florida International University’s medical school curriculum 

is divided into four years. The first two years involve mainly 

classroom study, while the last two add hands-on experience in 

hospitals and clinics. To graduate, students must achieve “overall 

competency” across nine separate domains, showing that they 

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22-13945 Opinion of the Court 3

possess “the skills and knowledge necessary to competently 

assume the responsibilities of a medical doctor.” 

The medical school’s approach, however, is not as 

unforgiving as one might assume; significant remediation 

opportunities are available for students. Even failure is not 

dispositive, at least to a certain point: students who fail a course 

“may be offered the opportunity to demonstrate competency with 

satisfactory performance on a remediation assessment.” That 

second chance usually takes the form of a “comprehensive exam.” 

But passing a remediation exam does not erase the original failure 

from a student’srecord, and a second failure is treated as just that—

a second failure. 

Nehme did not get off to a good start. During his first year, 

he failed the Genes, Molecules, and Cells class, a “basic medical 

science course introducing the fundamental concepts of biology.” 

And while he passed the remediation exam for that course, the rest 

of his transcript still revealed problems. In three other courses he 

showed only “marginal competency.” These scores, an associate 

dean explained, suggested a “significant lack of knowledge in basic 

sciences.” 

The second year was no better. In fact, it was worse. Nehme 

failed Cardiovascular and Respiratory Systems, “a basic medical 

science course introducing foundational concepts of cardiac and 

pulmonary medicine.” And this time, he failed the remediation 

exam, too. At that point, one of his professors directed him to the 

medical school’s wellness center to see if he qualified for any 

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accommodations. He did. Diagnoses for attention-deficit 

hyperactivity disorder and an unspecified anxiety disorder led to 

two accommodations: fifty percent extra time on exams and a 

minimally distracting testing room. 

Around that same time, the medical school’s student 

evaluation and promotion committee held a hearing on Nehme’s 

academic standing. The members did not like what they heard. 

They placed Nehme on academic probation and warned him that 

continued poor performance would trigger further review. 

The warning made no difference. A few months later, three

different professors complained in a “Professional Incident Report” 

that Nehme (1) made several requests to delay exams; (2) missed 

multiple classes without an excuse; and (3) displayed a lack of 

professionalism regarding a quiz. And to make matters worse, he

failed yet another second-year course just a few weeks later. This 

time it was Systems Based Practice, a “basic medical course providing 

students with [a] fundamental understanding of United States 

healthcare systems and policies.” 

The school’s promotion committee was not pleased with 

these developments and scheduled a second hearing with Nehme. 

In the meantime, Nehme had requested and received voluntary 

medical leave from January 2018 through April 2018. At the March 

hearing, which Nehme attended while still on leave of absence, he

explained that while he was now feeling much better, medical 

issues had made it hard for him to attend class before. The 

committee again extended Nehme grace. Despite its “serious 

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concern” about his performance, the promotion committee

allowed Nehme to repeat the second year of medical school and 

graduate a year later than expected. He remained on academic 

probation, but when he managed to pass his courses the second 

time around, he was allowed to start the third year. 

That’s when clinical clerkships began—and those too went 

poorly. Though Nehme did receive positive physician evaluations, 

his exam performance deteriorated. He failed five final exams,

scoring below the fifth percentile nationally in (1) Family Medicine; 

(2) Surgery; (3) Neurology; (4) Psychiatry; and (5) the Psychiatry

remediation. He also had scores below the tenth percentile for the 

OB/GYN exam and the Neurology exam retake; these were passing, 

but qualified as “poor.” All told, Nehme scored below the tenth

percentile on seven different exams in his third year alone. 

This record was not the progress that the promotion 

committee had hoped to see. Unsurprisingly, Nehme was 

summoned for a third hearing. At the hearing, Nehme blamed his

Psychiatry failure on a fire in his neighbor’s apartment on the 

morning of the exam. He added that he had failed his initial Surgery

exam because he was distracted by his father’s medical issues. 

What he did not claim was that he lacked proper disability 

accommodations for those exams (or any others). Hearing only 

weak explanations for two failures, and nothing at all to justify the 

rest, the promotion committee recommended that Nehme be 

allowed to voluntarily withdraw from medical school. Barring 

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6 Opinion of the Court 22-13945

that, the committee said, he should be involuntarily withdrawn—in 

other words, dismissed. 

Nehme appealed that decision to the school’s appeals 

committee. He reiterated that the fire in his neighbor’s apartment 

and his father’s medical issues contributed to his academic 

shortcomings. And he offered a few new justifications, too: 

physical therapy after a car accident during his Family Medicine

clerkship for one, plus the stress of a random drug test one week 

before the Psychiatry remediation. Still absent was any suggestion 

that he lacked proper accommodations for his disability. Also 

missing? Any explanation for why he failed the other two final 

exams. The appeals committee did not find Nehme’s arguments 

persuasive, and recommended that the dean affirm Nehme’s 

dismissal. The dean agreed. 

Nehme was not done yet. He appealed to the University’s 

interim provost. It was there that Nehme first claimed that he 

received improper accommodations for one exam, the Psychiatry

retake. But he did not dispute the adequacy of his

accommodations for the other four exams that he had failed that 

year. The provost referred Nehme’s new lack-of-accommodations 

claim to the school’s Office of Inclusion, Diversity, Equity, and 

Access, which found “sufficient evidence to support” the claim. In 

response, the university undertook a full audit of Nehme’s record. 

After reviewing the report, though, the provost saw “no indication 

that the allegations regarding a lack of accommodations made by 

Mr. Nehme had an adverse impact on his academic performance.” 

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The medical school formally dismissed Nehme on October 16, 

2020. 

Nehme’s complaint, filed a month after his dismissal, raises

two claims, each under Title II of the ADA. First, that the medical 

school failed to provide reasonable accommodations for his 

Psychiatry remediation exam, which he says ultimately led to his 

dismissal. Second, that his dismissal was because of illegal disability 

discrimination. The University moved for summary judgment on

both claims, arguing (among other things) that Nehme could not

show a violation of the ADA because he was not a “qualified 

individual” within the meaning of the Act. The magistrate judge 

recommended that the district court deny the University’s motion, 

but the district court rejected that recommendation. Agreeing 

with the University that Nehme was not a qualified individual, it

granted summary judgment on both counts. Nehme now appeals.

II. 

We review the district court’s grant of summary judgment 

de novo, viewing the evidence in the light most favorable to Nehme

and drawing all inferences in his favor. Pizarro v. Home Depot, Inc., 

111 F.4th 1165, 1172 (11th Cir. 2024). Summary judgment is 

appropriate if “there is no genuine dispute as to any material fact” 

such that Florida International University is “entitled to judgment 

as a matter of law.” Fed. R. Civ. P. 56(a). 

III.

Title II of the Americans with Disabilities Act forbids public 

entities from denying the benefits of their “services, programs, or 

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8 Opinion of the Court 22-13945

activities” to any “qualified individual with a disability . . . by reason 

of such disability.” 42 U.S.C. § 12132. So for Nehme to establish a 

violation of the Act, he must show that he (1) has a disability, (2) is 

a qualified individual, and (3) was subjected to unlawful 

discrimination because of his disability. Cash v. Smith, 231 F.3d 1301, 

1305 (11th Cir. 2000). 

A “qualified individual,” in turn, is someone who can meet 

“the essential eligibility requirements for the receipt of services or 

the participation in programs or activities” either “with or without 

reasonable modifications to rules, policies, or practices.” 42 U.S.C.

§ 12131(2). To meet this standard in the postsecondary education 

context, a student must be able to meet the program’s academic 

standards when she is given reasonable accommodations for her 

disability. See 34 C.F.R. § 104.3(l)(3); Onishea v. Hopper, 171 F.3d 

1289, 1300 (11th Cir. 1999) (en banc).

That burden is not trivial. After all, federal courts are not 

universities or academic administrators. We therefore must “show 

great respect for the faculty’s professional judgment” when it 

comes to a “genuinely academic decision”—such as a claimant’s

“fitness to remain a student.” Regents of Univ. of Michigan v. Ewing, 

474 U.S. 214, 225 (1985). Indeed, the faculty “must have the widest 

range of discretion in making judgments as to the academic 

performance of students and their entitlement to promotion or 

graduation.” Id. at 225 n.11 (quotation omitted). 

Here, the decisionmakers were unanimous—the promotion 

committee, appeals committee, dean, and interim provost all 

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agreed that Nehme did not have the academic skills necessary to 

succeed, and thus could not be promoted to the fourth year of 

medical school. They based their decision on Nehme’s exceedingly 

poor academic record, which reflected his inability to meet the 

medical school’s “essential eligibility requirements,” even when he 

received full accommodations. 42 U.S.C. § 12131(2). 

The record thoroughly supports the university’s conclusion. 

Setting aside the disputed Psychiatry retake, Nehme still failed a 

total of eight courses. And five of those failures came after he was 

already on academic probation—a designation marking

“unsatisfactory progress toward the medical degree,” and one that

often serves as a “precursor to dismissal from medical school.” The 

medical school’s handbook is plain: a student on probation “may 

be recommended for dismissal” if her “academic performance does 

not improve.” That is exactly what happened here.

Nehme concedes that he received proper accommodations

for all his third-year exams except the Psychiatry retake. That means 

he failed four final exams that year—and scored below the tenth 

percentile on two others—despite getting fifty percent extra time 

and a special testing room. That is not the improvement required

of students on academic probation. And it shows that Nehme was 

unable to meet the minimum requirements even when the medical 

school made “reasonable modifications” to its standard “rules, 

policies, or practices.” 42 U.S.C. § 12131(2). 

For his part, Nehme maintains that his failure of the 

Psychiatry exam retake was the only reason that he was called 

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10 Opinion of the Court 22-13945

before the promotion committee and ultimately dismissed. Not so. 

One of the medical school’s associate deans explained that while 

Nehme’s (second) failure of Psychiatry was the “initiating event” for 

the hearing, that did not mean his poor performance on the other 

exams would not have triggered a review. And the interim provost 

confirmed that the decision to dismiss Nehme was based on “the 

technical standards of the discipline” and Nehme’s “holistic[]” 

performance. In short, the medical school expected more of its 

students than (at least) eight failed courses and nine unexcused 

absences, with ten final exams showing either marginal 

competency or poor understanding on top of that. 

Florida International University gave Nehme chance after 

chance to save his medical career—a leave of absence, many exam 

remediations, and even a full repeat of his second year of medical 

school. Those second (and third and fourth) chances did not lead 

to improvements. Nehme seems to think that because the school 

tolerated his failures for several years, it was legally obligated to 

keep doing so. But the law does not require medical schools to 

retain students who cannot perform the coursework, and neither 

will we. 

* * *

Because Nehme is not a qualified individual under the ADA,

a necessary element for both of his claims, he cannot show that his 

rights were violated. The judgment of the district court is

AFFIRMED.

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