IN THE SUPREME COURT OF IOWA

No. 12–0924

Filed June 27, 2014

Amended September 23, 2014

PALMER COLLEGE OF CHIROPRACTIC,

Appellee,

vs.

DAVENPORT CIVIL RIGHTS COMMISSION and AARON CANNON,

Appellants.

Appeal from the Iowa District Court for Scott County, Gary D. 

McKenrick, Judge.

Chiropractic school sought judicial review of civil rights 

commission’s determination school had discriminated on the basis of 

disability. The district court reversed the decision of the civil rights 

commission. REVERSED AND REMANDED WITH INSTRUCTIONS.

Judith J. Morrell, Davenport, for appellant Davenport Civil Rights 

Commission.

Scott C. LaBarre and Susan Rockwood Kern of LaBarre Law 

Offices, P.C., Denver, Colorado, and Alan O. Olson of Olson Law Office, 

P.C., Des Moines, for appellant Aaron Cannon.

Robert D. Lambert of Stanley, Lande & Hunter, P.C., Davenport, 

for appellee.
2

Mary Kay Klimesh and Karen L. Stephenson of Seyfarth Shaw LLP, 

Chicago, Illinois, and Amanda G. Jansen of Ahlers & Cooney, P.C., Des 

Moines, for amicus curiae National University of Health Sciences.

Debra L. Hulett and Katie L. Graham of Nyemaster Goode, P.C., 

Des Moines, for amicus curiae Logan College of Chiropractic.

Meghan Sidhu, Baltimore, Maryland, and Alan O. Olson of Olson 

Law Office, Des Moines, for amicus curiae National Federation of the 

Blind. 

Thomas G. Abram of Vedder Price, P.C., Chicago, Illinois, and 

Mark E. Weinhardt, William B. Ortman, and Danielle M. Shelton of 

Weinhardt & Logan, P.C., Des Moines, for amicus curiae National Board 

of Chiropractic Examiners.
3

HECHT, Justice.

A student requested a chiropractic school make accommodations 

for his visual disability. When the school denied the requested 

accommodations, the student filed a complaint with the civil rights 

commission in the community where the school is located. The 

commission found the school failed to comply with applicable federal and 

state disability laws and granted the student relief. The school sought 

judicial review, and the district court reversed the commission’s ruling. 

Upon appellate review, we reverse the district court’s ruling and remand 

to the district court for reinstatement of the commission’s final agency 

action.

I. Background Facts and Proceedings.

Palmer College of Chiropractic (Palmer) is a chiropractic school

with campuses located in Iowa, Florida, and California. At its Davenport, 

Iowa location, Palmer administers bachelor of science and doctor of 

chiropractic programs. Aaron Cannon applied to Palmer’s bachelor of 

science program at its Davenport, Iowa location, in the early spring of 

2004. 

Cannon had informed Palmer he was blind early in the application 

process. Palmer directed him to its contact person for students with 

disabilities, and Cannon met with the representative that spring. At that 

meeting, Cannon explained he had sometimes taken examinations with 

the assistance of a sighted reader in the past, he planned on completing 

the graduate program’s undergraduate prerequisites and matriculating 

in the graduate program in March 2005, and he was in the process of 

registering and exploring additional accommodations for his blindness 

with the Iowa Department for the Blind (IDOB). The Palmer 

representative told Cannon she would discuss this information further 
4

with key representatives of Palmer. She also revealed to Cannon, 

however, that Palmer had in the summer of 2002 adopted certain 

technical standards for admission to and graduation from its degree 

programs. 

The technical standards adopted for each of Palmer’s three 

campuses across the country require that degree candidates have 

“sufficient use of vision, hearing, and somatic sensation necessary to 

perform chiropractic and general physical examination, including the 

procedures of inspection, palpation, auscultations, and the review of 

radiographs as taught in the curriculum.” Based on these standards, 

the Palmer representative explained, Cannon would find it difficult, if not 

impossible, to enter and complete Palmer’s graduate program. 

Despite the caution Palmer’s representative expressed in the spring 

2004 meeting, Cannon was admitted to Palmer’s undergraduate program 

a few months later. He was also provisionally admitted to the graduate 

program, contingent on his successful completion of the required 

undergraduate coursework—without, apparently, any further inquiry as 

to if or how Cannon might satisfy Palmer’s technical standards. Cannon 

enrolled in July 2004 and began coursework in the undergraduate

program. 

In August, shortly after enrolling, Cannon met again with Palmer’s

disability representative to discuss possible accommodations. The 

Palmer representative indicated she would arrange a meeting with 

Palmer’s Disability Steering Committee in the next two weeks to further 

discuss possibilities. While waiting for that meeting to materialize, 

Cannon sent the Palmer representative an email detailing his skills and 

capabilities for dealing with certain visual challenges. He noted in the 

email his familiarity with various adaptive technologies, including 
5

technologies for note taking and producing tactile versions of images and 

diagrams, and his history of success in previous classes having 

significant visual components. Two trimesters later, Cannon had 

successfully completed the graduate program’s required undergraduate 

coursework, achieving a cumulative grade point average of 3.44 on a 4.0-

point scale.1

As he neared completion of the undergraduate coursework, a 

meeting with Palmer’s Disability Steering Committee was finally arranged 

in February 2005. Cannon reiterated his interest in preparing for and 

enrolling in the graduate program at the meeting. The steering 

committee again expressed doubt Cannon would be able to complete the 

program because Palmer’s technical standards required sufficient use of 

vision. Cannon suggested several possible accommodations for the 

visual components of the curriculum, including a sighted reader and 

modifications of certain practical examinations, while acknowledging he 

could not yet anticipate each challenge that might present itself in the 

graduate program. The steering committee suggested these could not 

constitute acceptable accommodations for certain diagnostic portions of 

the curriculum and explained Cannon would therefore reach a “stoppage 

point,” after which he would no longer be able to meet Palmer’s 

requirements for advancement in the program. That point, the steering 

committee advised, would occur at the beginning of the fifth semester—

the point at which students were slated to begin radiology and other 

diagnostic coursework. Cannon proposed that a sighted assistant might 

1The record reveals Cannon’s grade point average may have been negatively 

affected by the fact he missed his anatomy final in the winter of 2005 to be with his 

wife, who gave birth on the same day. 

 
6

communicate to him the pertinent visual information in these courses 

enabling him to analyze it and to learn to make diagnoses accordingly. 

The steering committee expressed doubt as to the feasibility of 

Cannon’s proposed accommodation, suggesting it would place too much 

responsibility on the assistant. The committee thus repeated its position 

that the beginning of the fifth semester would constitute the stoppage 

point, but Cannon proposed they cross that bridge later after further 

investigation. Given the committee’s apparent reliance on the recently 

adopted technical standards in concluding Cannon’s proposed 

accommodations were unacceptable, Cannon asked about the purpose of 

the standards and whether they might be modifiable. The committee 

explained modification would compromise Palmer’s compliance with 

standards promulgated by the Council on Chiropractic Education (CCE), 

the national accreditation body. The CCE standards, the committee 

explained, were “not negotiable.” 

Cannon was undeterred and enrolled in the graduate program, 

apparently without objection from Palmer, a few days later. Cannon

believed with further investigation, he and Palmer could find an 

accommodation that would allow him to continue in the program and 

eventually graduate. Two weeks after his meeting with the steering 

committee, Cannon sent a letter to Palmer’s president, expressing his 

frustration with the trajectory the meeting had taken. In the letter, 

Cannon noted he was aware of numerous blind individuals who had 

become successful chiropractors in the past, including at least two who 

had graduated from Palmer. In addition, Cannon explained IDOB had at 

its disposal “a wealth of information about strategies and techniques” for 

coping with some of the challenges Palmer foresaw and suggested Palmer 
7

should consult with IDOB before rejecting out of hand his requests and 

suggestions for accommodation.

Palmer responded to Cannon’s letter a month and a half later in 

mid-April. Palmer explained its adoption of technical standards was 

consistent with the purposes of the Americans with Disabilities Act (ADA) 

of 1990 and the earlier-existing Section 504 of the Rehabilitation Act 

(Rehabilitation Act). Those laws proscribed discrimination on the basis 

of disability, Palmer explained, but they did not require an institution to 

provide accommodations or curricular modifications if they would 

fundamentally alter the institution’s educational program. The 

curricular modifications Palmer had granted to blind students in the 

past, Palmer explained, would not satisfy its current technical standards, 

and thus any similar modification now would constitute a fundamental 

alteration of its new program as defined by the technical standards. 

Nevertheless, Palmer explained, it would contact IDOB to inquire about 

other possible accommodations. 

A month later, two Palmer representatives met with a 

representative from IDOB. Notes from the meeting indicate “no new 

information” was presented—Palmer explained its technical standards 

were necessary for accreditation and the accommodations proposed by 

Cannon would not satisfy these standards. The IDOB representative 

pointed out a blind individual had recently graduated from medical 

school in Wisconsin and the school had maintained its accreditation, but 

the Palmer representatives declined to explore further the investigation 

and accommodations the school had made. Instead, they stressed the 

importance of their own technical standards and their concern about the 

time, effort, and money Cannon had already expended and would 

continue to expend despite their indications he would be unable to 
8

complete the program. Although the IDOB representative noted the 

meeting “concluded with no real progress made,” the Palmer 

representatives stated they remained open to further guidance from the 

IDOB.

Cannon received a meeting report, summarizing the Palmer–IDOB 

conversation, from the IDOB representative shortly thereafter. 

Frustrated, and without any indication Palmer intended further

investigation, Cannon filed a notice of withdrawal from the graduate 

program a few weeks later in early June 2005, before completing final 

coursework for his first trimester in the program. His grade report for 

the incomplete trimester indicated two grades of “C,” five grades of “No 

Credit,” and withdrawal from one class. Cannon later testified that prior 

to withdrawal, he had been confident he would receive strong grades for 

the term given his prior record at Palmer, but because he had withdrawn 

before final examinations and therefore missed and received no credit for 

them, he was left with the weak record on the report.2

Cannon filed a complaint with the Davenport Civil Rights 

Commission (commission) in July, contending Palmer had discriminated 

against him on the basis of his disability in violation of the Davenport 

Civil Rights Ordinance (DCRO), the Iowa Civil Rights Act (ICRA), and 

federal antidiscrimination laws. After reviewing the facts and applicable 

laws, the commission found probable cause existed to demonstrate 

discrimination, and the matter came before the commission for public 

hearing in February 2010. The two-day hearing featured testimony and 

exhibits from Cannon, Cannon’s wife, three Palmer faculty members and 

2The record reveals Cannon’s withdrawal near the end of the trimester came too 

late for Cannon to receive grades of “Incomplete.” He nevertheless chose to withdraw 

and miss his final examinations, which resulted in the grades of “C” and “No Credit.”

 
9

officials, and a blind graduate of Palmer who now works as a 

chiropractor.

A few months after the hearing, the commission hearing officer 

issued a proposed order, finding Cannon had proved by a preponderance 

Palmer had discriminated on the basis of his blindness and granting

proposed relief of damages equal to Cannon’s previous cost of 

attendance, emotional distress damages, and attorney fees and costs. 

Cannon submitted exceptions to the proposed order, requesting 

readmission with reasonable accommodation and an order enjoining 

Palmer’s strict application of its technical standards to blind individuals. 

Palmer submitted its own exceptions, requesting that the commission

reject the proposed order in its entirety, dismiss the complaint, and 

assess costs to Cannon. 

The parties addressed their exceptions at oral argument before the 

commission in August. After deliberations at its next two closed 

sessions, the commission issued a final order adopting the hearing 

officer’s proposed conclusion that Cannon had proven disability 

discrimination by a preponderance of the evidence. The commission

supplemented its final order with the injunctive readmission and 

accommodation Cannon had requested.

In support of its order, the commission set forth extensive findings 

of fact and conclusions of law. More specifically, the commission found 

Cannon was a person with a disability and “an otherwise qualified” 

student under the relevant federal, state, and municipal code provisions; 

he had requested specific accommodations for his blindness from Palmer 

on multiple occasions; and Palmer had denied these requests and failed 

to engage in the interactive investigative process required by federal and 

state disability law. Further, the commission found, Cannon’s requested 
10

accommodations would not fundamentally alter Palmer’s curriculum, 

because Palmer had previously graduated blind students from its Iowa 

campus, Palmer’s California campus already waived certain visionspecific competencies in its technical standards based on California 

antidiscrimination law, Palmer had presented no evidence its 

accreditation had been compromised by accommodations similar to those 

Cannon had requested or by the California competency waivers, and 

Palmer had presented no evidence state licensing boards would exclude 

blind individuals from practice. Based on these factual findings, the 

commission concluded Cannon was otherwise qualified to participate in 

Palmer’s graduate program and was denied participation in the program

on the basis of his disability. The commission therefore concluded 

Palmer’s strict application of its technical standards to Cannon violated 

the DCRO, ICRA, and the ADA. 

Palmer sought judicial review of the final order. The district court, 

explaining it was reviewing the commission’s legal conclusions for errors 

of law and the commission’s factual findings for substantial evidence, 

reversed the commission’s order. Without explicitly suggesting the 

commission’s factual findings were unsupported by substantial evidence, 

the district court determined the commission had failed, as a matter of 

law, to give appropriate deference to Palmer’s identification of its 

curricular requirements, and therefore concluded substantial evidence 

supported Palmer’s claims that Cannon’s suggested accommodation was 

unreasonable and would constitute a fundamental alteration of the 

Palmer curriculum. 

Cannon appealed the district court decision and we retained the 

appeal.
11

II. Scope and Standards of Review.

Our general assembly has directed that final decisions of 

municipal civil rights commissions shall be reviewable to the same extent 

as final decisions of the Iowa Civil Rights Commission (ICRC). See Iowa 

Code § 216.19 (2013). We review decisions of the ICRC according to the 

standards delineated in Iowa’s Administrative Procedure Act, set forth in 

chapter 17A of the Iowa Code. Id. § 216.17; see Botsko v. Davenport Civil 

Rights Comm’n, 774 N.W.2d 841, 844 (Iowa 2009). We are therefore 

bound by the commission’s findings of fact if supported by substantial 

evidence. Botsko, 774 N.W.2d at 844; see also Iowa Code § 17A.19(10)(f). 

We will not, however, give deference to the commission’s interpretation of 

provisions of law not vested in its discretion and will review those 

interpretations for legal errors. See Rent-A-Ctr., Inc. v. Iowa Civil Rights 

Comm’n, 843 N.W.2d 727, 730 (Iowa 2014); Botsko, 774 N.W.2d at 844; 

see also Iowa Code § 17A.19(10)(c). We apply the standards of chapter 

17A on appeal to determine if our conclusions are the same as the 

district court’s conclusions. See Sunrise Ret. Cmty. v. Iowa Dep’t of 

Human Servs., 833 N.W.2d 216, 219 (Iowa 2013). 

III. Discussion.

Section 216.9 of ICRA provides, in general terms, that “[i]t is an

unfair or discriminatory practice for any educational institution to 

discriminate on the basis of . . . disability in any program or activity.” 

Iowa Code § 216.9. The DCRO sets forth the same general language in 

extending its own protections against disability discrimination, to 

“provide for the execution within the city of the policies embodied in the 

Iowa Civil Rights Act of 1965 and” related federal civil rights laws. See

Davenport, Iowa, Mun. Code § 2.58.010(B) (2013); id. § 2.58.125(A). 

Federal law extends its own disability discrimination protections in both 
12

the ADA and Section 504 of the Rehabilitation Act. See Americans with 

Disabilities Act of 1990, as amended, 42 U.S.C. §§ 12101–12213 (2006); 

Rehabilitation Act of 1973, as amended, 29 U.S.C. § 794. 

We have often explained we will look to the ADA and cases 

interpreting its language, as well as cases interpreting the Rehabilitation 

Act, for guidance as we analyze disability discrimination claims brought 

under ICRA. See, e.g., Fuller v. Iowa Dep’t of Human Servs., 576 N.W.2d 

324, 329 (Iowa 1998). We have also explained we may look to the 

regulations underlying the federal acts in our analysis. Id. While these 

authorities are often persuasive, we note we are also guided by the

breadth of the protections very clearly set forth in both ICRA and the 

DCRO. See Iowa Code § 216.18(1) (“This chapter shall be construed 

broadly to effectuate its purposes.”); Davenport, Iowa, Mun. Code 

§ 2.58.020 (“This chapter shall be construed broadly to effectuate its 

purpose.”).

While ICRA and the DCRO set forth their protections in general 

terms, without language of limitation, the Rehabilitation Act and the ADA 

contain additional content in their statutory provisions. The ADA, 

applicable to all academic institutions receiving federal funding, provides 

that “no qualified individual with a disability shall, by reason of such 

disability . . . be denied the benefits of the . . . programs . . . of a public 

entity, or be subjected to discrimination by any such entity.” 42 U.S.C. 

§ 12132. The Rehabilitation Act sets forth a similar standard, providing 

“[n]o otherwise qualified individual with a disability . . . shall, solely by 

reason of her or his disability . . . be denied the benefits of . . . any 

program or activity receiving Federal financial assistance.” 29 U.S.C. 

§ 794. Both the ADA and the Rehabilitation Act specifically prohibit 

discrimination against those with disabilities based not just on 
13

“affirmative animus,” but also any discrimination based on 

thoughtlessness, apathy, or stereotype.3 See, e.g., Alexander v. Choate, 

469 U.S. 287, 295–97, 105 S. Ct. 712, 717–18, 83 L. Ed. 2d 661, 668–69

(1985). 

In the context of higher education, Rehabilitation Act regulations 

explain a qualified individual is one “who meets the academic and 

technical standards requisite to admission or participation in the 

recipient’s education program or activity.” 34 C.F.R. § 104.3(l)(3) (2013). 

Educational institutions are required, however, to provide “such 

modifications . . . as are necessary” to aid individuals in meeting these 

academic and technical standards, to ensure requirements do not 

discriminate on the basis of disability. Id. § 104.44(a). The ADA 

incorporates a closely related accommodation requirement in defining a 

“qualified individual with a disability” as one “who, with or without 

reasonable modifications to rules, policies, or practices . . . or the 

provision of auxiliary aids and services, meets the essential eligibility 

requirements for the receipt of services or the participation in programs 

or activities provided.” 42 U.S.C. § 12131(2). Various courts have 

explained the ADA’s “reasonable modification” requirement and the 

Rehabilitation Act’s accommodation requirement impose coextensive 

3The ADA goes further, defining discrimination in the context of public 

accommodation to include: (1) any use of criteria that unnecessarily “screen out” or 

“tend to screen out” individuals with disabilities; (2) failure to make nonfundamental, 

reasonable modifications of “policies, practices or procedures” when modification is 

necessary to accommodate those with disabilities; and (3) failure to take necessary 

steps “to ensure that no individual with a disability is excluded, denied services, 

segregated or otherwise treated differently than other individuals.” 42 U.S.C. 

§ 12182(b)(2)(A) (defining “discrimination” under the ADA); see also 34 C.F.R. 

§§ 104.43–.44 (2013) (implementing Section 504 of the Rehabilitation Act); 28 C.F.R. § 

36.103 (explaining the ADA “shall not be construed to apply a lesser standard than the 

standard to be applied” under Section 504).

 
14

obligations, and the terms and standards may often be used 

interchangeably. See, e.g., Wong v. Regents of Univ. of Cal., 192 F.3d 

807, 816 n.26 (9th Cir. 1999). 

Evaluating these statutory and regulatory standards in cases 

involving claims of disability discrimination in higher education, courts 

have required a claimant establish the following elements: (1) the 

claimant is a person with a disability under the relevant statute or 

statutes; (2) the claimant is qualified to participate in the program or, in 

other words, can meet the essential eligibility requirements of the 

program with or without reasonable accommodation; and (3) the 

claimant was denied the benefits of the program because of his or her

disability.4 See, e.g., id. at 816; Ohio Civil Rights Comm’n v. Case W. 

Reserve Univ., 666 N.E.2d 1376, 1383 (Ohio 1996). We have previously 

adopted a substantially similar framework for analysis in the context of 

employment discrimination claims brought under ICRA and its federal 

analogues. See, e.g., Boelman v. Manson State Bank, 522 N.W.2d 73, 79 

(Iowa 1994) (requiring discharge based on disability in place of denial of 

benefits based on disability). The parties have not suggested we apply a 

different framework for purposes of analyzing education discrimination

claims brought under ICRA and the DCRO, and thus we apply our 

familiar disability discrimination framework to each of the claims at 

issue here. Further, because the parties do not dispute that Cannon is a 

person with a disability under each of the relevant statutes and do not 

seriously dispute that he was denied the benefits of the program because

4In analyzing claims brought under the ADA and Rehabilitation Act, courts have 

added a fourth element: evidence the institution receives federal financial assistance or 

is a public entity. See, e.g., Wong, 192 F.3d at 816. The parties concede here Palmer 

receives federal financial assistance for purposes of Cannon’s federal claims and the 

federal assistance requirement is inapplicable to Cannon’s state and municipal claims. 

 
15

of his disability, we consider here only the question of whether Cannon 

was qualified to participate in the Palmer program with reasonable 

accommodation.5 

1. The meaning of “Qualified with Reasonable Accommodation.” As 

noted, the relevant federal acts and regulations define qualified 

individuals as those individuals who, with reasonable accommodation or 

“modification,” can meet the “essential eligibility requirements”6 of the 

institution. 42 U.S.C. § 12131(2).7 In interpreting the meaning of 

reasonable accommodation, the United States Supreme Court has noted 

regulations implementing the Rehabilitation Act provide reasonable 

“[m]odifications may include changes in the length of time permitted for 

the completion of degree requirements, substitution of specific courses 

required for the completion of degree requirements, and adaptation of the 

5Palmer notes other courts have sometimes expressed the “was denied the 

benefits of the program” element of the analysis as a requirement that a claimant has 

been “dismissed” from the program. See, e.g., Wong, 192 F.3d at 816. Because Cannon 

withdrew from the graduate program on his own, Palmer suggests he may not have met 

a “dismissal” requirement. We note, however, the relevant statutes here require only 

that a claimant be “denied the benefits” of the program for purposes of making out a 

claim. 42 U.S.C. § 12132; 29 U.S.C. § 794; Iowa Code § 216.9(1)(a); Davenport, Iowa,

Mun. Code § 2.58.125(A)(1). Palmer concedes Cannon would have been denied the 

benefits of the program by the fifth trimester, if not earlier, based on his blindness, and 

thus we need not address the element further here.

6As noted, relevant Rehabilitation Act regulations set forth slightly different 

language in explaining a qualified individual may be required to “meet[] the academic 

and technical standards requisite to admission or participation in the recipient’s 

education program or activity.” 45 C.F.R. § 84.3(l)(3).

7We note the Rehabilitation Act adds the term “otherwise” in prohibiting 

discrimination against an “otherwise qualified individual with a disability.” 29 U.S.C. 

§ 794(a). Numerous courts have explained despite this slight difference in terminology, 

the analyses of claims under both laws proceeds in much the same way. See, e.g.,

Forest City Daly Hous., Inc. v. Town of North Hempstead, 175 F.3d 144, 150 n.7 (2d Cir. 

1999) (noting this linguistic difference between ADA and Rehabilitation Act); Nelson v. 

Miller, 170 F.3d 641, 649 (6th Cir. 1999) (noting analyses under the two provisions do 

not differ significantly). See generally Zukle v. Regents of Univ. of Cal., 166 F.3d 1041, 

1045 n.11 (1999) (collecting cases pointing out relationship between the ADA and 

Rehabilitation Act).

 
16

manner in which specific courses are conducted.” See Se. Cmty. Coll. v. 

Davis, 442 U.S. 397, 408 n.9, 99 S. Ct. 2361, 2368 n.9, 60 L. Ed. 2d 

980, 990 n.9 (1979) (quoting 45 C.F.R. § 84.44); see also 29 C.F.R. 

§ 1630.2(o)(2) (providing, in employment discrimination context, 

“[r]easonable accommodation may include but is not limited to: . . . 

acquisition or modifications of equipment or devices; appropriate 

adjustment or modifications of examinations, training materials or 

policies; the provision of qualified readers or interpreters; and other 

similar accommodations for individuals with disabilities” (emphasis 

omitted)).

Further, the Supreme Court has noted, reasonable modifications 

in the form of “[a]uxiliary aids may include taped texts, interpreters or 

other effective methods . . ., readers in libraries for students with visual 

impairments, classroom equipment adapted for use by students with 

manual impairments, and other similar services and actions.” Davis, 

442 U.S. at 408 n.9, 99 S. Ct. at 2368 n.9, 60 L. Ed. 2d at 990 n.9 

(quoting 45 C.F.R. § 84.44); Nelson v. Thornburgh, 567 F. Supp. 369, 380 

(E.D. Pa. 1983) (“[T]he provision of readers is an express HHS example of 

reasonable accommodation.” (Internal quotation marks and brackets 

omitted.)). Reasonable modification need not include, however, “ ‘devices 

or services of a personal nature.’ ”8 Davis, 442 U.S. at 408 n.9, 99 S. Ct.

8Palmer suggests this “personal nature” principle might apply to Cannon given 

his status as the only student at Palmer currently requesting accommodation. We find 

the suggestion unpersuasive—we cannot conclude the implementing regulation in 

question simply absolves institutions of their obligation of accommodation in cases 

where requests are made by individuals, as opposed to groups of students. Instead, we 

believe the regulation indicates the “personal nature” principle is directed to services 

and devices dedicated exclusively to individuals—services that cannot, by their nature, 

typically also be used as accommodation by other individuals. See 34 C.F.R. 

§ 104.44(d)(2). Palmer has not suggested Cannon’s requests fit that latter description.

 
17

at 2368 n.9, 60 L. Ed. 2d at 990 n.9 (quoting 45 C.F.R. § 84.44). In 

addition, an accommodation may not be reasonable, the Supreme Court 

has explained, if it imposes “undue financial [or] administrative burdens” 

on the institution, or if it requires “a fundamental alteration in the 

nature of [the] program” offered. Id. at 410–12, 99 S. Ct. at 2369–70, 60 

L. Ed. 2d at 990–92. Because the parties have not raised below or on 

appeal an issue of undue burden with respect to possible 

accommodations, and because Cannon’s requests fit plausibly within the 

range of accommodations recognized as reasonable by courts and the 

ADA’s implementing regulation, we consider here only the issue of 

whether accommodation would constitute a fundamental alteration of 

Palmer’s program.

2. The general contours of the fundamental alteration analysis. In 

Davis, the Supreme Court encountered a case of a student with 

substantial hearing loss who sought nursing training at Southeastern 

Community College, in pursuit of her eventual goal of state nursing 

certification in North Carolina. Id. at 400, 99 S. Ct. at 2364, 60 

L. Ed. 2d at 985–86. Upon learning of the student’s hearing loss in the 

application process, Southeastern consulted its entire nursing faculty, 

an outside audiologist, and the director of the North Carolina nursing 

board, as part of its process of determining whether the student could be 

admitted to the Southeastern program and whether the student could 

later safely participate in Southeastern’s clinical training program. Id. at 

401–02, 99 S. Ct. at 2364–65, 60 L. Ed. 2d at 985–86. Based largely on 

the views of the nursing board director that the student had “hearing 

limitations which could interfere with her safely caring for patients,” and 

limitations that could make it “impossible for [the student] to participate 

safely in the normal clinical training program,” Southeastern denied the 
18

student admission. Id. at 401–02, 99 S. Ct. at 2365, 60 L. Ed. 2d at 

985–86.

Relying on those conclusions, the Supreme Court explained 

“Southeastern, with prudence, could [therefore] allow [the student] to 

take only academic classes.” Id. at 409–10, 99 S. Ct. at 2369, 60 

L. Ed. 2d at 990. Whatever benefits the student might have received

from an academic course of study, the Court explained, “she would not 

receive even a rough equivalent of the training a nursing program 

normally gives.” Id. at 410, 99 S. Ct. at 2369, 60 L. Ed. 2d at 990. That 

kind of modification, the Court concluded, would constitute a 

“fundamental alteration” of Southeastern’s nursing program far greater 

than the reasonable “modification” required by federal laws and 

regulations. Id.

In reaching its conclusion on the fundamental alteration question

thirty-five years ago, however, the Supreme Court explained the line 

between reasonable accommodation and fundamental alteration would

not always be so neatly drawn in the future. Id. at 412, 99 S. Ct. at 

2370, 60 L. Ed. 2d at 992. “It is possible to envision situations,” the 

Court observed, “where an insistence on continuing past requirements 

and practices” may deprive “genuinely qualified” persons of opportunities 

for participation in educational programs. Id. Technological advances, 

the Court explained, should be expected to enhance and appropriately 

adapt opportunities for individuals with disabilities without undue 

burden, and refusals to modify programs accordingly may then

constitute discrimination under the relevant laws. Id. at 412–13, 99 

S. Ct. at 2370, 60 L. Ed. 2d at 992. Identification of instances where 

refusal to accommodate constitutes discrimination, the Court 

emphasized, would therefore remain an important and ongoing 
19

responsibility of those tasked with implementation and application of our 

disability discrimination laws. Id.

Courts later applying the teachings of Davis have explained it 

“struck a balance” between the statutory rights ensuring those with 

disabilities “meaningful access” to the benefits offered by educational 

institutions, and “the legitimate interests” of those institutions “in 

preserving the integrity of their programs.” Alexander, 469 U.S. at 300, 

105 S. Ct. at 720, 83 L. Ed. 2d at 671; Case W. Reserve Univ., 666 

N.E.2d at 1384 (quoting Alexander). To strike that balance 

appropriately, the Supreme Court has observed, courts and educational 

institutions alike must take great care not to define the benefit or 

program “in a way that effectively denies otherwise qualified . . .

individuals [with disabilities] the meaningful access to which they are 

entitled.” Alexander, 469 U.S. at 301, 105 S. Ct. at 720, 83 L. Ed. 2d at 

672.

Recognizing this fine line, lower courts have elucidated two 

principles in the fundamental alteration analysis that guide us in our 

inquiry here. First, courts have recognized that in considering the 

interests of educational institutions in the integrity of their programs, 

some deference to the institution’s professional or academic judgment 

may often be appropriate. See, e.g., Wong, 192 F.3d at 817; Wynne v. 

Tufts Univ. Sch. of Med., 932 F.2d 19, 25 (1st Cir. 1991). Second, 

however, whether and the extent to which that deference is appropriate 

depends heavily on the institution’s satisfaction of several obligations. 

See Wong, 192 F.3d at 817–18; Wynne, 932 F.2d at 25–26. The 

institution, for example, has a “real obligation” to seek out “suitable 

means of reasonably accommodating” individuals with disabilities and to 

submit “a factual record indicating” it “conscientiously carried out this 
20

statutory obligation.” Wynne, 932 F.2d at 25–26; see also Wong, 192 

F.3d at 818 (“Subsumed within this standard is the institution’s duty to 

make itself aware of the nature of the student’s disability [and] to explore 

alternatives for accommodating the student[.]”). That obligation requires 

an individualized and extensive inquiry—an institution must “carefully 

consider[] each disabled student’s particular limitations and analyz[e] 

whether and how it might accommodate that student in a way that 

would allow the student to complete the school’s program without 

lowering academic standards.” Wong, 192 F.3d at 826; see Mark H. v. 

Hamamoto, 620 F.3d 1090, 1098 (9th Cir. 2010) (“ ‘[M]ere speculation 

that a suggested accommodation is not feasible falls short of the 

reasonable accommodation requirement; [the Rehabilitation Act] create[s] 

a duty to gather sufficient information from the disabled individual and 

qualified experts as needed to determine what accommodations are 

necessary.’ ” (quoting Duvall v. County of Kitsap, 260 F.3d 1124, 1136 

(9th Cir. 2001))); Hall v. U.S. Postal Serv., 857 F.2d 1073, 1079 (6th Cir. 

1988) (“[T]he determination of whether physical qualifications are 

essential functions of a job requires the [fact finder] to engage in a highly 

fact-specific inquiry. Such a determination should be based upon more 

than statements in a job description and should reflect the actual 

functioning and circumstances of the particular enterprise involved.” 

(Citation omitted.)); see also Sch. Bd. of Nassau Cnty. v. Arline, 480 U.S.

273, 287, 107 S. Ct. 1123, 1130–31, 94 L. Ed. 2d 307, 320 (“[T]he [fact 

finder] will need to conduct an individualized inquiry and make 

appropriate findings of fact. Such an inquiry is essential if § 504 is to 

achieve its goal of protecting handicapped individuals from deprivations 

based on prejudice, stereotypes, or unfounded fear . . . .”). 
21

Furthermore, institutions cannot merely look to “accepted 

academic norms,” in exploring reasonable accommodations—because 

reasonable alternatives may often “involve new approaches or devices 

quite beyond ‘accepted academic norms.’ ” Wynne, 932 F.2d at 26

(quoting Regents of Univ. of Mich. v. Ewing, 474 U.S. 214, 225, 106 S. Ct.

507, 513, 88 L. Ed. 2d 523, 532 (1985)); cf. Strathie v. Dep’t of Transp., 

716 F.2d 227, 231 (3d Cir. 1983) (rejecting “broad judicial deference 

resembling that associated with the ‘rational basis’ test [which] would 

substantially undermine Congress’ intent . . . that stereotypes or 

generalizations not deny handicapped individuals equal access to 

federally-funded programs” (footnote omitted)); Pushkin v. Regents of 

Univ. of Colo., 658 F.2d 1372, 1383 (10th Cir. 1981) (“[The Rehabilitation 

Act] provides that a recipient of federal financial assistance may not 

discriminate on the basis of handicap, regardless of whether there is a 

rational basis for so discriminating. The inquiry has to be on whether 

the University has, in fact, discriminated on the basis of handicap. The 

mere fact that the University acted in a rational manner is no defense to 

an act of discrimination.”). 

We require institutions to fulfill these obligations, courts have 

explained, because “courts still hold the final responsibility for enforcing 

the [disability discrimination laws] . . . [and w]e must ensure that 

educational institutions are not ‘disguis[ing] truly discriminatory 

requirements’ as academic decisions.” Wong, 192 F.3d at 817 (quoting 

Zukle v. Regents of Univ. of Cal., 166 F.3d 1041, 1048 (9th Cir. 1999)). 

Only if we determine an institution has satisfied its obligation of detailed, 

individualized inquiry is it appropriate to defer to the institution’s 

judgment regarding the integrity of its program. See Zukle, 166 F.3d at 

1048; see also Wong, 192 F.3d at 817–18; Pandazides v. Va. Bd. of Educ., 
22

946 F.2d 345, 349 (4th Cir. 1991) (“Accordingly, defendants cannot 

merely mechanically invoke any set of requirements and pronounce the 

handicapped applicant or prospective employee not otherwise qualified. 

The district court must look behind the qualifications. To do otherwise 

reduces the term ‘otherwise qualified’ and any arbitrary set of 

requirements to a tautology.”). 

3. The appropriate level of deference here. On appeal, Palmer 

contends the commission erred, as a matter of law, in failing to grant 

appropriate deference to Palmer’s position regarding Cannon’s ability to 

complete the graduate program without fundamental alteration, and 

relies on two distinct grounds. 

First, Palmer relies on an earlier Iowa higher education case where 

we explained we “ ‘may not override’ ” an institution’s professional 

judgment “ ‘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.’ ” See North 

v. State, 400 N.W.2d 566, 571 (Iowa 1987) (quoting Ewing, 474 U.S. at 

225, 106 S. Ct. at 513, 88 L. Ed. 2d at 532). In North, however, we were 

not faced with claims of disability discrimination under the ADA or 

ICRA—instead, we considered breach of contract, tortious interference, 

and substantive due process and § 1983 civil rights claims. See id. at 

568–71. We imported that principle of academic deference from a 

Supreme Court case that had also considered a due process claim, where 

the Court had no occasion to consider the level of deference to be 

accorded in discrimination cases and had taken pains to note it was not 

considering claims beyond those before it. See Ewing, 474 U.S. at 225, 

106 S. Ct. at 513, 88 L. Ed. 2d at 532 (“It is important to remember that 

this is not a case in which the procedures used by the University were 
23

unfair in any respect; quite the contrary is true. Nor can the Regents be 

accused of concealing nonacademic or constitutionally impermissible 

reasons for expelling Ewing[.]”); North, 400 N.W.2d at 571 (quoting 

Ewing). Given that context, we are unpersuaded by Palmer’s reliance on 

North because, as numerous courts have explained, the application of

deference based on “accepted academic norms” is inadequate in the 

disability discrimination context—courts must go significantly further in 

their inquiries to ensure inappropriate generalizations do not deny 

individuals meaningful access to the benefits provided by educational 

institutions. Wynne, 932 F.2d at 26 (“[Ewing] was a context where no 

federal statutory obligation impinged on the academic administrators; 

their freedom to make genuine academic decisions was untrammeled.”); 

Strathie, 716 F.2d at 231; Pushkin, 658 F.2d at 1383; see also

Guckenberger v. Boston Univ., 8 F. Supp. 2d 82, 89 (D. Mass. 1998) 

(noting “a court should not determine that an academic decision is a 

‘substantial departure from accepted academic norms’ simply by 

conducting a head-count of other universities”); Laura F. Rothstein, 

Health Care Professionals with Mental and Physical Impairments: 

Developments in Disability Discrimination Law, 41 St. Louis U. L.J. 973, 

995 (1997) [hereinafter Rothstein] (observing New Jersey federal court 

“recognized the importance of individualized determinations” in holding 

state medical boards’ use of physical and mental health inquiries “as a 

screening device” “were likely in violation of Title II of the ADA” and 

observing “these judges were affirming the principle that discrimination 

on the basis of disability cannot be justified by generalizations about 

such disabilities”). 

Perhaps just as importantly for purposes of our analysis here, the 

Supreme Court in Ewing explained it was granting deference there only 
24

after noting “the faculty’s decision was made conscientiously and with 

careful deliberation, based on an evaluation of the entirety of Ewing’s 

academic career.” Ewing, 474 U.S. at 225, 106 S. Ct. at 513, 88 

L. Ed. 2d at 532. To the extent the Ewing deference analysis may inform 

our analysis in the context of disability discrimination, then, we note the 

Ewing court’s emphasis on the extensive individualized investigation 

suggests, much like courts actually considering disability discrimination 

claims have, application of any deference may only be appropriate after 

an institution has established it has fulfilled its obligations of 

conscientious inquiry. Id.; see also Edward N. Stoner II & J. Michael 

Showalter, Judicial Deference to Educational Judgment: Justice 

O’Connor’s Opinion in Grutter Reapplies Longstanding Principles, As 

Shown by Rulings Involving College Students in the Eighteen Months 

Before Grutter, 30 J.C. & U.L. 583, 611 (2004) (noting one principle

“underlying judicial deference in ADA cases involving students is that 

persons trained to have educational judgment are not necessarily experts 

in disability accommodations”). 

Palmer’s second ground for its contention the commission erred in 

failing to extend appropriate deference—namely, that Palmer fulfilled its 

obligation of extensive individualized inquiry before denying Cannon the 

opportunity to participate in its program—is no more persuasive. Palmer

advances a two-pronged exposition of its investigation with respect to 

Cannon. First, Palmer recounts the numerous discussions its faculty 

had in developing the technical standards it seeks to apply here, points 

to the evidence it presented below supporting its initial creation and 

adoption of the standards, and notes the “standards are based upon 

[Palmer’s] teaching experiences with disabled students including those 

visually impaired.” Second, Palmer explains the “technical standards are 
25

applied on a case-by-case basis depending upon whether or not the 

disabled individual meets those standards.” Based on this exposition, we 

cannot conclude the commission’s findings regarding Palmer’s approach 

were unsupported by substantial evidence or that the commission erred 

in determining Palmer failed to advance evidence of an inquiry 

resembling anything like the fact-specific, individualized inquiry required 

by the caselaw. 

On the first point, Palmer appears to concede it seeks to invoke its 

standards in Cannon’s case as an “essential requirement” based on no 

investigation at all of Cannon’s condition or ability to perform with a 

reader or the various technologies he noted he had or could have at his

disposal. Instead, Palmer would invoke the standards based on its 

experiences with past individuals with disabilities. That strict, 

generalized invocation of Palmer’s technical standard falls far short, we 

think, of the conscientious, interactive, student-specific inquiry required 

by the caselaw. See, e.g., Wong, 192 F.3d at 819 (“Dean Lewis failed to 

discuss Wong’s proposal with any of the professionals who had worked 

with Wong to pinpoint his disability and help him develop skills to cope 

with it.”); Laura Rothstein, Disability Law and Higher Education: A Road 

Map for Where We’ve Been and Where We May Be Heading, 63 Md. L. 

Rev. 122, 142 (2004) (“In determining that it would not be a substantial 

alteration to accommodate Casey Martin by allowing the use of a golf cart 

in professional golf tournament play, the [Supreme Court] emphasized 

the importance of an individualized assessment. The Court noted that 

for Martin the use of a cart was not a fundamental alteration because the 

essential aspect of fatigue was still present for him. The Court added 

that other requests for golf carts would have to be individually assessed 

to ensure that others would not be unfairly advantaged.”); see also
26

D’Amico v. N.Y. State Bd. of Law Exam’rs, 813 F. Supp. 217, 223 

(W.D.N.Y. 1993) (“The Board’s opinion as to what is ‘reasonable’ for a 

particular applicant can be given very little weight when the Board has 

no knowledge of the disability or disease, no expertise in its treatment, 

and no ability to make determinations about the physical capabilities of 

one afflicted with the disability or disease.”). 

Palmer fares no better on the second point—it invokes the phrase 

“case-by-case basis,” but then concedes it applies its technical standards 

depending solely on whether the individual meets the standards. See 

Case W. Reserve Univ., 666 N.E.2d at 1391 (Resnick, J., dissenting) 

(“[B]lanket requirements are not ipso facto bona fide. CWRU cannot 

exclude all blind medical school applicants without first investigating 

and considering reasonable accommodations . . . any more than it can 

exclude an individual applicant without conducting such an 

investigation.”); Rothstein, 41 St. Louis U. L.J. at 994 (“One theme that is 

consistent in virtually all disability discrimination decisions, even those 

involving academic institutions or health care professions, is that an 

assessment about whether a particular individual is otherwise qualified 

should be made on an individualized basis. Courts have usually been 

wary of generalized determinations that a particular condition renders all 

persons with that impairment unqualified to carry out a particular job.”). 

If there is an inquiry hidden in that apparent tautology as to how or 

whether the standards might be modified in any individual case, or more 

importantly, an indication as to the way the inquiry was made for 

Cannon, we cannot discern it. Palmer’s generalized application did little 

to satisfy its obligation of individualized investigation here.9 See, e.g., 

9We think it important to emphasize here Palmer’s apparent concession that 

provision of Cannon’s requested accommodations would not fundamentally alter its 

 
27

Wynne, 932 F.2d at 26 (explaining institution must seek means of 

reasonably accommodating individual and “[i]f the institution submits 

undisputed facts demonstrating that the relevant officials within the 

institution considered alternative means . . . the court could rule as a 

matter of law that the institution had met its duty”); see also Pandazides, 

946 F.2d at 349 (“The district court must look behind the qualifications. 

To do otherwise reduces the term ‘otherwise qualified’ and any arbitrary 

set of requirements to a tautology.”); Bentivegna v. U.S. Dep’t of Labor, 

694 F.2d 619, 621 (9th Cir. 1982) (“[Davis] cannot mean [an institution] 

can discriminate by establishing restrictive ‘program requirements’ where 

it could not so discriminate in making individual employment 

decisions.”).

Turning to the commission’s analysis of the deference question, we 

note the commission set forth extensive factual findings bolstering its 

conclusion Palmer failed to satisfy its investigative obligation. More 

specifically, the commission offered substantial evidence in support of 

the following findings: Palmer engaged in minimal interaction with 

Cannon; Palmer failed to investigate, with or without Cannon, how he 

might actually use a reader given a specific task; Palmer failed to 

curriculum until the fifth trimester may constitute probative evidence of the 

reasonableness of duties to both provide and specifically investigate these 

accommodations in the preceding trimesters. See, e.g., Lane v. Pena, 867 F. Supp. 

1050, 1070 (D.D.C. 1994) (“Moreover, the Defendants admit that such requirements, if 

any, do not even apply to students such as Lane who have not yet reached their third 

year. Consequently, the Defendants cannot simply point to that statute and definitively 

conclude that maintaining eligibility for such a commission is an essential requirement 

to remaining at the USMMA and that, therefore, their actions were consistent with 

Section 504.”), vacated in part on other grounds, 518 U.S. 187, 116 S. Ct. 2092, 135 

L. Ed. 2d 486 (1996); Alicia Ouellette, Patients to Peers: Barriers and Opportunities for 

Doctors with Disabilities, 13 Nev. L.J. 645, 666 (2013) (“The available evidence indicates 

that medical schools graduate more medical students with sensory and motor 

disabilities than they admit, suggesting that they make accommodations for students 

who develop specific disabilities after they have started their course of study.”).

___________________
28

investigate with the requisite depth how other former blind students had 

performed specific tasks in the past; Palmer failed to investigate reports 

of successful blind students at other schools and successful blind 

chiropractic practitioners; Palmer failed to investigate reports of 

technologies used successfully elsewhere in school and professional 

settings; and Palmer failed to engage individuals with experience 

teaching Cannon or other blind individuals, among other failures. Given 

those findings, and given the principle from the relevant caselaw that an 

institution’s academic judgments are owed minimal, if any, deference in 

the absence of a showing the institution has fulfilled its investigative 

obligations, we cannot conclude the commission has erroneously 

interpreted the applicable law on deference here. See Iowa Code 

§ 17A.19(10)(c); Wong, 192 F.3d at 818 (“We do not defer to the academic 

institution’s decision in the present case because the record that the 

University presented falls short of [the requirement of in-depth, 

individual analysis].”).

4. The commission’s fundamental alteration analysis: specific 

fundamental alteration principles and their application here. Because 

Palmer has failed to establish it met the legal prerequisites for deference 

to its determination accommodation would constitute fundamental 

alteration here, we turn to the commission’s analysis of the fundamental 

alteration inquiry. Cf. Wong, 192 F.3d at 819–20 (noting, in different 

appellate posture, court would “not defer to the institution’s decision”—

instead, it would “examine the rejection of Wong’s request for an eightweek reading period de novo”). 

At the outset, we note numerous courts have explained 

determinations of reasonable accommodation and fundamental alteration 

within the meaning of the ADA generally require flexible, fact-specific 
29

inquiries and are typically resolved as questions of fact. See, e.g., 

Haschmann v. Time Warner Entm’t Co., 151 F.3d 591, 601 (7th Cir. 1998) 

(“The reasonableness of a requested accommodation is a question of 

fact.”); Long v. Howard Univ., 439 F. Supp. 2d 68, 80 (D.D.C. 2006)

(“Based on the evidence proffered by the parties thus far, whether the 

modifications would in fact constitute a fundamental alteration is a 

question requiring jury resolution.”); see also Staron v. McDonald’s Corp., 

51 F.3d 353, 356 (2d Cir. 1995) (“Although neither the ADA nor the 

courts have defined the precise contours of the test for reasonableness, it 

is clear that the determination of whether a particular modification is 

‘reasonable’ involves a fact-specific, case-by-case inquiry that considers 

among other factors, the effectiveness of the modification in light of the 

nature of the disability in question and the cost to the organization that 

would implement it.”); Crowder v. Kitagawa, 81 F.3d 1480, 1486 (9th 

Cir. 1996) (“[W]e have held that the determination of what constitutes 

reasonable modification is highly fact-specific, requiring case-by-case 

inquiry.”); Zimple v. Hancock Fabrics, Inc., 2013 WL 4069553, *3 (N.D. 

Iowa Aug. 12, 2013) (denying summary judgment on fundamental 

alteration question and noting “there are many questions of fact in the 

record on just what th[e] essential functions [of the job] were”); Powers v. 

MJB Acquisition Corp., 993 F. Supp. 861, 868 (D. Wyo. 1998) (“[C]ourts 

that have considered the issue in any depth have generally followed . . . a

fact-specific, case-by-case inquiry. . . . Regardless of how the standard is 

phrased, one thing is clear: in most circumstances, the determination of 

what constitutes a reasonable modification or accommodation is a factintensive question ill-suited for resolution at the summary judgment 

stage.” (quoting Staron, 51 F.3d at 356)); Boelman, 522 N.W.2d at 80

(explaining fact finder must answer question of whether claimant “could 
30

perform the essential functions of the job” and, if not, whether any 

reasonable accommodation would enable performance); cf. Kerri Lynn 

Stone, The Politics of Deference and Inclusion: Toward a Uniform 

Framework for the Analysis of “Fundamental Alteration” Under the ADA, 

58 Hastings L.J. 1241, 1270 (2007) (“Although the ultimate question [of 

fundamental alteration] is quite fact-driven and circumstance-specific, 

courts have no guidelines as to the scope of the considerations they 

ought to look at regarding the facts and the law surrounding this most

philosophical question . . . .”). But see Sande L. Buhai, Practice Makes 

Perfect: Reasonable Accommodation of Law Students with Disabilities in 

Clinical Placements, 36 San Diego L. Rev. 137, 146 (1999) (“In 

determining whether a function is essential, courts must address each 

case individually. Whether the plaintiff can perform the essential job 

functions with reasonable accommodations is a mixed question of law 

and fact, which involves primarily a factual inquiry.”).

Before examining the commission’s findings regarding fundamental 

alteration, however, we think it prudent to note several principles courts 

and commentators have developed to aid the fact finder in determining 

whether an accommodation is reasonable or might constitute a 

fundamental alteration in a given case. See Easley by Easley v. Snider, 

36 F.3d 297, 302 (3d Cir. 1994) (noting courts “cannot rely” on 

institution’s characterization of its program, because the institution “may 

attempt to define the benefit in a way that ‘effectively denies otherwise 

handicapped individuals the meaningful access to which they are 

entitled’ ” (quoting Alexander, 469 U.S. at 301, 105 S. Ct. at 720, 83 L. 

Ed. 2d at 672)). Courts considering education discrimination claims

have often looked to fundamental alteration considerations from the 

employment context for guidance. See, e.g., Wong, 192 F.3d at 820–21. 
31

Implementing regulations for the ADA’s employment provision suggest

courts consider several factors in determining whether particular duties 

constitute fundamental or essential functions of the job. See 29 C.F.R. 

§ 1630.2(n)(3); see also Moritz v. Frontier Airlines, Inc., 147 F.3d 784, 787 

(8th Cir. 1998). Those factors include, among others: job descriptions 

prepared for advertising or used when interviewing applicants for the job; 

the amount of time spent on the job performing the function in question; 

consequences of not requiring the person to perform the function; the 

work experience of persons who have held the job; and/or the current 

work experience of persons in similar jobs. 29 C.F.R. § 1630.2(n); see 

also Rothstein, 41 St. Louis U. L.J. at 976–77 (“The function may be 

essential because that function is the purpose of the position, because 

there are a limited number of employees among whom the function can 

be distributed, or because the function is highly specialized and the 

individual was hired specifically because of his or her expertise in that 

specialty.”).

Applying these “essential functions” principles from employment 

cases, numerous courts in the education context have found the fact that 

institutions have previously granted accommodations the same as or 

similar to the accommodation at issue persuasive evidence the 

accommodation is reasonable and does not fundamentally alter the 

institution’s curriculum. See, e.g., Wong, 192 F.3d at 820 (“The fact that 

the school previously made the exact modification . . . that Wong 

requested . . . is certainly persuasive evidence from which a [fact finder]

could conclude that the accommodation was reasonable.”); Zukle, 166 

F.3d at 1048–49 (considering student’s request for eight weeks off 

between medical school rotations and noting institution’s previous 

decisions to grant requests for decelerated schedule were probative of 
32

reasonableness); Matthews v. NCAA, 179 F. Supp. 2d 1209, 1226–27 

(E.D. Wash. 2001) (“Most notably, the NCAA already has granted Plaintiff 

two waivers, including one waiver of [its rule requiring student-athletes 

to earn seventy-five percent of their annual credit hours during the 

regular academic year]. The Court finds it difficult, particularly in light 

of the individualized inquiry required by [PGA Tour, Inc. v.] Martin, [532 

U.S. 661, 121 S. Ct. 1879, 149 L. Ed. 2d 904 (2001),] to see how granting 

a third waiver to Plaintiff would fundamentally alter the NCAA’s purpose, 

when the first two waivers did not.”); see also Forbes v. St. Thomas Univ.,

Inc., 768 F. Supp. 2d 1222, 1234 (S.D. Fla. 2010) (explaining school 

could not invoke “across-the-board” GPA requirement as basis for 

dismissal and noting court could not “ignore the fact that [school dean]

did provide accommodations, and with them Forbes earned a 

[satisfactory GPA].”). In so doing, these courts have applied the general 

principle from the ADA caselaw that an institution will bear a 

“particularly heavy” burden in establishing an accommodation is 

unreasonable where other institutions have provided accommodation for 

the same deficit without significant issue. Am. Council of the Blind v. 

Paulson, 525 F.3d 1256, 1272 (D.C. Cir. 2008) (“[B]ecause other currency 

systems accommodate the needs of the visually impaired, the [Secretary 

of the Treasury’s] burden in demonstrating that implementing an 

accommodation would be unduly burdensome is particularly heavy.”); 

see also Tamara v. El Camino Hosp., 964 F. Supp. 2d 1077, 1084–85 

(N.D. Cal. 2013) (“Tamara has provided the service animal policies for a 

number of stand-alone psychiatric hospitals and individual wards within 

general hospitals, whose policies allow for the admittance of service dogs. 

. . . In light of the broad allowance for service animals, El Camino has 

not met its burden to show that the presence of service dogs within the 
33

psychiatric ward is likely to fundamentally alter the nature of the facility 

nor has it sufficiently established that it conducted an intensive factbased inquiry.” (Citations omitted.)). 

Similarly, courts have considered the current and past job 

experiences of those with the same disability in considering whether 

modification might fundamentally alter a professional curriculum. See, 

e.g., Lane v. Pena, 867 F. Supp. 1050, 1070 (D.D.C. 1994) (“[G]iven that 

many people with diabetes have obtained merchant marine licenses, and 

at least 50 people with diabetes mellitus are currently operating under a 

merchant marine license at sea, the Court finds that the rigid naval 

reserve requirements are not ‘essential’ to at least one purpose of the 

program, namely, training officers for the merchant marine.”), vacated in 

part on other grounds, 518 U.S. 187, 116 S. Ct. 2092, 135 L. Ed. 2d 486 

(1996). Courts have also looked to an individual’s past academic success

and considered whether later professional licensure actually requires 

performance of the institution’s proposed function. Shaywitz v. Am. Bd. 

of Psychiatry & Neurology, 675 F. Supp. 2d 376, 390–91 (S.D.N.Y. 2009) 

(“Given Shaywitz’s alleged competence and success as a medical student, 

resident, and fellow, and that the Board has largely eliminated its Part II 

Oral Exam, the Court finds it plausible that certifying Shaywitz without 

his having to pass the live-patient portion of the Part II Oral Exam, based 

on the facts as alleged at the pleading stage, would not ‘fundamentally 

alter the nature of’ the Board-certification process.” (Internal citations 

omitted.)). 

With those propositions in mind, we turn to the commission’s 

findings with respect to fundamental alteration. We note we are 

concerned on appeal with two principles regarding the commission’s 

findings. First, in reviewing the commission’s factual findings we must 
34

determine merely whether the evidence “supports the findings actually 

made” by the commission and need not concern ourselves with whether 

the evidence might also support a different finding. See Meyer v. IBP, 

Inc., 710 N.W.2d 213, 218 (Iowa 2006). Second, in reviewing the 

commission’s application of the law to the facts, we may look to other 

grounds of error, such as erroneous interpretation of law, irrational 

reasoning, or failure to consider relevant facts, in determining whether 

the commission has abused its discretion in its application. Id. at 218–

19.

As noted above, the commission made several noteworthy findings

in support of its determination Cannon’s proposed accommodation was 

reasonable. First, the commission found the record revealed no evidence 

state licensing boards required sight, or interpretation of radiographic 

images in precisely the manner required by Palmer, for purposes of 

licensure. Second, Palmer presented no evidence the course 

modifications and waivers it grants at its California campus have 

jeopardized its accreditation with national accrediting bodies. Third, at 

least two blind students had graduated previously from Palmer’s 

Davenport campus and are currently licensed and practicing 

successfully. 

Palmer asserts, however, that it cannot accommodate Cannon, and 

the commission’s decision must therefore be reversed as a matter of law,

because all chiropractic students must be able to see radiographic 

images. We find this contention unpersuasive. Palmer itself concedes at 

least twenty percent of current chiropractic practitioners practice without 

“the ability to take plain film radiographs in their office[],” and concedes

the size of the fraction is currently on the rise. These concessions are at 

odds with the contention radiographic image interpretation—regardless 
35

whether in the narrow sense Palmer has defined it or even the more 

general sense of having the equipment available—must constitute an 

“essential” component of the education or practice of chiropractic. 

Furthermore, as Palmer has noted, frequent consultation between 

chiropractors and radiology specialists is “oftentimes” “part of the clinical 

practice [of chiropractic].” 

We also find it instructive that numerous medical schools, 

ostensibly recognizing these realities, have admitted blind students and 

made accommodation in recent years. See, e.g., Sarah M. Eickmeyer et 

al., North American Medical Schools’ Experience with and Approaches to 

the Needs of Students with Physical and Sensory Disabilities, 87 Acad. 

Med. 567, 569–70 (2012) (finding at least sixty partially- or totally-blind 

students matriculated at U.S. medical schools between 2001 and 2010 

and noting schools have provided accommodations ranging from “[an] 

assistant for observation” to “[an] assistant for physical exam[ination]”). 

The accommodations made by these schools, coupled with Palmer’s own 

previous accommodations, weigh particularly heavily against Palmer’s 

fundamental alteration defense. See Am. Council of the Blind, 525 F.3d 

at 1272; Tamara, 964 F. Supp. 2d at 1084–85. Recent proposed 

rulemaking by the Department of Justice bolsters this position, as it 

seeks “to ensure that medical diagnostic equipment, including 

examination tables, examination chairs, . . . and other imaging 

equipment used by health care providers for diagnostic purposes are 

accessible to and usable by individuals with disabilities.” Medical 

Diagnostic Equipment Accessibility Standards, 77 Fed. Reg. 6916, 6916 

(proposed Feb. 9, 2012) (to be codified at 36 C.F.R. pt. 1195); see also

Alicia Ouellette, Patients to Peers: Barriers and Opportunities for Doctors 
36

with Disabilities, 13 Nev. L.J. 645, 661 (2013) (“Congress also included 

incentives in the Affordable Care Act for accessibility.”).

We conclude substantial evidence supports each of the 

commission’s findings.10 Furthermore, given the widespread recognition 

that the fundamental alteration inquiry is fact-intensive and typically to 

be resolved as a question of fact, given the recognition in the caselaw 

that each of the factors considered by the commission may constitute 

persuasive evidence on the issue of reasonable accommodation, and 

given the high burden courts have imposed where the same institution or 

other institutions have made reasonable accommodation for the same 

deficit, we cannot conclude the commission has erroneously interpreted 

or irrationally applied the applicable law in concluding Palmer failed to 

10Despite Palmer’s representations to the contrary, the medical literature also 

provides substantial support for the proposition that accommodation of individuals with 

sensory and physical deficits need not fundamentally alter the provision of medical 

education. See, e.g., Sarah M. Eickmeyer et al., North American Medical Schools’ 

Experience with and Approaches to the Needs of Students with Physical and Sensory 

Disabilities, 87 Acad. Med. 567, 568–70 (2012) (emphasizing the substantial number of 

blind students accommodated at medical schools in recent years and explaining 

“[m]any have questioned the emphasis placed on specific physical and sensory 

capabilities in defining the technical skills required by medical schools”); Michael J. 

Reichgott, The Disabled Student as Undifferentiated Graduate: A Medical School 

Challenge, 279 JAMA 79, 79 (1998) (“In this era of technologic diagnostics and 

professional assistants, the ‘essential functions’ of medical education might be restated 

as acquiring fundamental knowledge; developing communication skills; interpreting 

data; integrating knowledge to establish clinical judgment; and developing appropriate 

professional attitudes and behaviors.”); see also Joel A. DeLisa & Peter Thomas, 

Physicians with Disabilities and the Physician Workforce: A Need to Reassess Our 

Policies, 84 Am. J. Physical Med. & Rehabilitation 5, 6 (2005) (“Healthcare professionals 

adequately trained for the future will need to know what informational resources to use; 

how to gather necessary data; how to integrate complex information, make diagnoses, 

and develop treatment plans; and how to effectively use changing technological 

resources, work with teams, and communicate with diverse populations. These skills 

are largely cognitive and not physical, raising questions about the adequacy of the 

current approach to medical training.”); cf. Demetrius Moutsiakis & Thomas Polisoto, 

Reassessing Physical Disability Among Graduating US Medical Students, 89 Am. J. 

Physical Med. & Rehabilitation 923, 926–27 (2010) (noting trend of steadily declining 

medical school graduation rates over the last four decades for individuals with physical 

and sensory disabilities and recommending schools “remove the requirement of the 

undifferentiated graduate to allow [individuals] with, for example, blindness to train in 

other capacities such as preventive medicine and public health”).

 
37

establish provision of Cannon’s requested accommodations would 

constitute fundamental alteration of its curriculum on these facts. See

Iowa Code § 17A.19(10)(c), (f), (i), (j), (l). 

IV. Conclusion.

We conclude substantial evidence supports the commission’s 

factual findings and the commission has not erred in interpreting the 

relevant laws or applying them to the facts at issue here. We therefore 

reverse the decision of the district court and remand the case to the 

district court with instructions to affirm the commission’s order.

REVERSED AND REMANDED WITH INSTRUCTIONS.

All justices concur except Waterman and Mansfield, JJ., who 

dissent. 
38

#12–0924, Palmer Coll. v. Davenport CRC

WATERMAN, Justice (dissenting). 

I respectfully dissent. The majority elevates political correctness 

over common sense. Obscured in its lengthy decision is the fact our 

court and the Davenport Civil Rights Commission are requiring Palmer 

College of Chiropractic to permit a student, blind since birth, to interpret 

X-rays based on what an untrained reader tells him the X-ray films 

depict and treat patients through vigorous spinal adjustments relying on 

that interpretation. Aaron Cannon failed to prove such an 

accommodation is reasonable. As the district court recognized, “vision is 

indispensable for several critical functions that chiropractic students and 

professionals must perform, such as reviewing X-rays, analyzing 

radiographs, and assessing physical symptoms.” I defer to no one in my 

admiration for Cannon and his blind attorney and the challenges they 

both have overcome, but there is a point at which an accommodation 

ceases to be reasonable, and it has been met here. 

What is next? Are we going to require the Federal Aviation 

Administration to hire blind air traffic controllers, relying on assistants to 

tell them what is appearing on the screen? The principle is the same 

here. A misinterpreted X-ray could lead to improper treatment and 

lifelong paralysis. X-ray interpretation requires training and skilled 

judgment to reach correct conclusions based on shades and shadows of 

complex bony structures. That is why many physicians with twenty–

twenty vision choose to outsource interpretation of X-rays to radiologists. 

It is ludicrous to override Palmer’s academic decision and require it to 

permit a blind person to interpret X-rays for patient treatment based on 

what someone else claims he or she is seeing. 
39

The majority’s intrusion into academic judgment on professional 

healthcare standards is unprecedented. No other court in the country 

has forced an academic institution to allow a blind student to interpret 

X-rays relying on an untrained sighted assistant. The majority fails to 

confront the well-reasoned decision of the Ohio Supreme Court applying 

the Rehabilitation Act of 1973, as amended, 29 U.S.C. §§ 701–797b, to 

uphold a medical school’s decision to deny admission to a blind student 

who, like Cannon, requested a personal assistant to read X-rays and 

help with clinical examinations. Ohio Civil Rights Comm’n v. Case W. 

Reserve Univ., 666 N.E.2d 1376, 1383, 1386 (Ohio 1996). The district 

court correctly followed Case Western in concluding such an 

accommodation was unreasonable and would fundamentally alter 

Palmer’s program. I would affirm. Our court and the local commission 

comprised of laypersons have no business second-guessing the 

professional academic judgment of our nation’s leading college of 

chiropractic. Palmer has reasonably concluded that its graduates 

personally must be able to see and interpret X-rays. A student who has 

never seen a spine cannot reliably interpret spinal X-rays based on what 

someone else tells him the films show. 

I would follow the Ohio Supreme Court’s reasoning in Case 

Western, the facts of which are strikingly similar to this case. A blind 

student, Cheryl Fischer, applied to medical school at Case Western 

Reserve University. Id. at 1379. To evaluate applicants, Case Western 

applied technical standards promulgated by the Association of American 

Medical Colleges (AAMC), which required that candidates must be able to 

“observe a patient accurately at a distance and close at hand.” Id. at 

1379–80. The AAMC technical standards explained, “The use of a 

trained intermediary means that a candidate’s judgment must be 
40

mediated by someone else’s power of selection and observation.” Id. at 

1380. Case Western “concluded that a blind student would be unable to 

complete the requirements of the medical school program.” Id. An 

associate professor of surgery at Case Western emphasized that “Fischer 

would be unable to exercise independent judgment when reading an 

X-ray, unable to start an I.V., and unable to effectively participate in the 

surgery clerkship.” Id. (noting further that Fischer would be unable to 

“identify tissue and organ structures through a microscope” or “observe 

how such structures are affected by disease”). “In the[] medical 

educators’ opinions, the use of an intermediary would interfere with the 

student’s exercise of independent judgment—a crucial part of developing 

diagnostic skills.” Id. at 1387. 

The Ohio Supreme Court deferred to Case Western’s academic 

judgment, as we should defer to Palmer’s. The Ohio Supreme Court 

emphasized that an educational institution is in the best position to 

determine whether a student will be able to successfully complete the 

program: 

[Case Western]’s decision not to modify its program by 

waiving course requirements or permitting intermediaries to 

read X-rays or perform physical examinations is an academic 

decision. Courts are particularly ill-equipped to evaluate 

academic requirements of educational institutions. As a 

result, considerable judicial deference must be paid to 

academic decisions made by the institution itself unless it is 

shown that the standards serve no purpose other than to 

deny an education to the handicapped. 

Id. at 1386 (citations omitted). Deferring to the AAMC technical 

standards and the medical educators’ opinions, the court acknowledged 

that waiving the requirement to read an X-ray—or using an intermediary 

to perform that function—would fundamentally alter the nature of Case 

Western’s program. Id. at 1387; see also Cunningham v. Univ. of N.M. Bd. 
41

of Regents, 531 F. App’x 909, 919–20 (10th Cir. 2013) (affirming 

dismissal of vision-related disability claims by medical student, noting 

“[t]o the extent [the plaintiff] avers UNM should have changed its 

program requirements, such an accommodation would not be 

reasonable”). The Case Western court further recognized that providing a 

blind student additional supervision and waiving courses for the student 

is not required under the United States Supreme Court’s decision in 

Southeastern Community College v. Davis, 442 U.S. 397, 410, 99 S. Ct. 

2361, 2369, 60 L. Ed. 2d 980, 990 (1979), when such accommodations 

would not change the fact that the student will be unable to satisfy the 

degree requirements. Case W. Reserve Univ., 666 N.E.2d at 1386–87. 

Our case is also analogous to Davis. In Davis, the United States 

Supreme Court upheld a nursing college’s decision to deny admission to 

an applicant with a hearing disability, holding the law “does not 

encompass the kind of curricular changes that would be necessary to 

accommodate [the applicant] in the nursing program.” Davis, 442 U.S.

at 409, 99 S. Ct. at 2369, 60 L. Ed. 2d at 990. Similarly to the nursing 

applicant, Cannon “would not receive even a rough equivalent of the 

training” Palmer normally gives. Id. at 410, 99 S. Ct. at 2369, 60 

L. Ed. 2d at 990. “Such a fundamental alteration in the nature of a 

program is far more than the ‘modification’ the regulation requires.” Id. 

Like the proposed accommodations for the deaf applicant in Davis, it 

appears unlikely “Cannon could benefit from any affirmative action that 

the regulation reasonably could be interpreted as requiring.” Id. at 409, 

99 S. Ct. at 2368, 60 L. Ed. 2d at 990. Therefore, Palmer, “with 

prudence,” could not allow Cannon to graduate from the program. Id. at 

409, 99 S. Ct. at 2369, 60 L. Ed. 2d at 990. 
42

As the majority notes, many practicing chiropractors lack X-ray 

equipment and rely on other professional radiologists or chiropractors to 

interpret their patients’ X-rays. Cannon, however, is not asking for a 

waiver to allow him to rely on the interpretation of a qualified expert. 

Rather, his requested accommodation is to interpret X-rays himself, 

based on what an untrained sighted assistant tells him. In any event, 

the law does not obligate Palmer to waive program requirements. The 

plaintiff in Case Western argued the school should waive certain medicalschool skill requirements because she planned to pursue a practice in 

psychiatry, in which those skills were unnecessary. 666 N.E.2d at 1386. 

The Ohio Supreme Court rejected this argument, stating: 

The goal of medical schools is not to produce 

specialized degrees but rather general degrees in medicine 

which signify that the holder is a physician prepared for 

further training in any area of medicine. As such, graduates 

must have the knowledge and skills to function in a broad 

variety of clinical situations and to render a wide spectrum 

of patient care. All students, regardless of whether they 

intend to practice in psychiatry or radiology, are required to 

complete a variety of course requirements, including 

rotations in pediatrics, gynecology, and surgery. 

Id. at 1387. In the same way, it is Palmer’s prerogative to decide the 

skills necessary to graduate with a chiropractic degree. A student’s 

choice to focus his or her practice on certain skills to the exclusion of 

others does not exempt that student from successfully completing degree 

requirements. 

The majority recognizes that it is appropriate to give deference to 

an institution’s professional or academic judgment, yet refuses to defer to 

Palmer because the commission concluded Palmer did not seek out 

“suitable means of reasonably accommodating” individuals with 

disabilities. I disagree that Palmer’s investigation fell short. Palmer met 

with Cannon multiple times, met Iowa Department of the Blind 
43

representatives, and expressed a willingness to continue the dialogue. 

Nothing in the record supports a conclusion that further investigation by 

Palmer would have found a way for Cannon to personally see and 

interpret X-rays. Technological advancements may one day allow blind 

individuals to interpret X-rays. No such “app” exists today. Cannon 

simply has not satisfied his burden to prove a reasonable 

accommodation is possible regarding X-ray interpretation. See Boelman 

v. Manson State Bank, 522 N.W.2d 73, 80 (Iowa 1994) (“[T]he plaintiff 

must produce enough evidence to make a facial showing that reasonable 

accommodation is possible.”). The majority would require Palmer to 

jump through additional hoops to establish what the record already 

makes clear—Cannon cannot satisfy the chiropractic program 

requirement that students master X-ray interpretation. 

We should defer to Palmer’s conclusion that accommodating 

Cannon would fundamentally alter its chiropractic program. In North v. 

State, we recognized “ ‘[c]onsiderations of profound importance counsel 

restrained judicial review of the substance of academic decisions.’ ” 400 

N.W.2d 566, 571 (Iowa 1987) (quoting Regents of Univ. of Mich. v. Ewing, 

474 U.S. 214, 225, 106 S. Ct. 507, 513, 88 L. Ed. 2d 523, 532 (1985)). 

Though North did not involve a claim under the ADA, the principle of 

deference expressed in that opinion is a truism with broad application. 

When presented with ADA claims, courts “have overwhelmingly extended 

some level of deference to schools’ professional judgments regarding 

students’ qualifications when addressing disability discrimination 

claims.” Halpern v. Wake Forest Univ. Health Scis., 669 F.3d 454, 463 

(4th Cir. 2012) (collecting cases and noting, “[b]ecause we are . . . at a 

comparative disadvantage in determining whether Halpern is qualified to 

continue in the Doctor of Medicine program and whether his proposed 
44

accommodations would effect substantial modifications to the Medical 

School’s program, we accord great respect to Wake Forest’s professional 

judgments on these issues”). I would follow the United States Supreme 

Court’s guidance: “When judges are asked to review the substance of a 

genuinely academic decision . . . they should show great respect for the 

faculty’s professional judgment.” Ewing, 474 U.S. at 225, 106 S. Ct. at 

513, 88 L. Ed. 2d at 532. 

The majority relies on Wong v. Regents of University of California, 

192 F.3d 807 (9th Cir. 1999), and Wynne v. Tufts University School of 

Medicine (Wynne I), 932 F.2d 19 (1st Cir. 1991), but the standards 

elucidated in those cases favor Palmer. The Court of Appeals for the 

Ninth Circuit recognized in Wong that: 

Faculty members and administrators of a professional 

school are unquestionably in the best position to set 

standards for the institution and to establish curricular 

requirements that fulfill the school’s purpose of training 

students for the work that lies ahead of them. 

192 F.3d at 825–26. The court noted deference to an academic 

institution is inappropriate only if the institution has not “carefully 

consider[ed] each disabled student’s particular limitations and analyz[ed] 

whether and how it might accommodate that student in a way that 

would allow the student to complete the school's program without 

lowering academic standards.” Id. at 826. The court declined to defer to 

the University of California’s decision to dismiss a student because “the 

record contain[ed] facts from which a reasonable jury could conclude 

that the school made th[at] decision[] for arbitrary reasons unrelated to 

its academic standards.” Id. In contrast, the record shows Palmer 

carefully considered whether it could accommodate Cannon’s disability 

with a sighted assistant to look at X-rays. Palmer ultimately and 
45

reasonably concluded it could not. No reasonable fact finder could 

conclude Palmer’s decision was unrelated to academic standards. 

In Wynne I, the Court of Appeals for the First Circuit set forth the 

appropriate analysis “to assess whether an academic institution 

adequately has explored the availability of reasonable accommodations 

for a handicapped individual.” 932 F.2d at 26. 

If the institution submits undisputed facts demonstrating 

that the relevant officials within the institution considered 

alternative means, their feasibility, cost and effect on the 

academic program, and came to a rationally justifiable 

conclusion that the available alternatives would result either 

in lowering academic standards or requiring substantial 

program alteration, the court could rule as a matter of law 

that the institution had met its duty of seeking reasonable 

accommodation. 

Id. (noting “[i]n most cases, we believe that, as in the qualified immunity 

context, the issue of whether the facts alleged by a university support its 

claim that it has met its duty of reasonable accommodation will be a 

‘purely legal one’ ” (quoting Mitchell v. Forsyth, 472 U.S. 511, 528 n.9, 

105 S. Ct. 2806, 2816 n.9, 86 L. Ed. 2d 411, 426 n.9 (1985))). The 

student in Wynne I asked Tufts University School of Medicine to 

accommodate his disability by using a different testing method than 

multiple choice to evaluate his progress. Id. at 22. The court concluded 

the evidence was insufficient to grant summary judgment in favor of 

Tufts because the record did not demonstrate the school considered 

possible alternatives or discussed the unique qualities of multiple choice 

examinations. Id. at 28. The court therefore remanded the case for 

further fact-finding. Id. 

Following remand, Tufts provided additional evidence explaining 

why “ ‘the multiple choice format provides the fairest way to test the 

students’ mastery of the subject matter of biochemistry.’ ” Wynne v. 
46

Tufts Univ. Sch. of Med. (Wynne II), 976 F.2d 791, 794 (1st Cir. 1992). 

With the additional evidence, the district court concluded Tufts met the 

standard elucidated in Wynne I and entered summary judgment in favor 

of Tufts. Wynne II, 976 F.2d at 793. The student again appealed to the 

First Circuit. See id. The Wynne II court acknowledged that “Tufts’ 

explanations, though plausible, are not necessarily ironclad.” Id. at 795. 

But, the court emphasized “the point is not whether a medical school is 

‘right’ or ‘wrong’ in making program-related decisions.” Id. Rather, “[t]he 

point is that Tufts, after undertaking a diligent assessment of the 

available options,” decided “no further accommodation could be made 

without imposing an undue (and injurious) hardship on the academic 

program.” Id. The First Circuit therefore affirmed summary judgment 

for Tufts, stating “the undisputed facts contained in the expanded 

record, when considered in the deferential light that academic 

decisionmaking deserves, meet the required standard.” Id. at 796 

(emphasis added) (citation omitted). Likewise, Palmer has provided 

compelling explanations why accommodating Cannon’s disability with a 

sighted assistant to look at X-rays for him would fundamentally alter the 

chiropractic program. We owe deference to Palmer’s explanations. 

In order to accommodate Cannon, Palmer would have had to lower 

its academic standards—something the law does not require. See Wong, 

192 F.3d at 826 (noting an institution is responsible for “carefully 

considering each disabled student’s particular limitations and analyzing 

whether and how it might accommodate that student in a way that 

would allow the student to complete the school’s program without 

lowering academic standards” (emphasis added)); Wynne II, 976 F.2d at 

795 (deferring to Tufts’ conclusion that accommodating the student 

“would require substantial program alterations, result in lowering 
47

academic standards, and devalue Tufts’ end product—highly trained 

physicians carrying the prized credential of a Tufts degree”). As a 

professor explained, the Palmer radiology curriculum has three primary 

goals: to teach students to (1) produce diagnostic-quality X-rays, (2) 

interpret and glean clinical information off of X-ray film, and (3) apply the 

information in a clinical sense for case management. The district court 

summarized how Cannon’s proposed accommodation—a sighted 

assistant to describe X-rays to him—would work: “Cannon asks a series 

of questions to the assistant, gradually posing those questions more and 

more specifically as needed in order to obtain the information necessary 

for him to visualize the displayed image or text.” A professor explained 

why this accommodation would compromise Palmer’s academic 

requirements: 

I haven’t been able to determine how a sighted assistant 

could give information to the blind student that would not 

compromise [the student’s] independent judgment of those 

films. [For the student to ask] the question, is the film too 

dark or is the film too light, immediately [the reader’s] 

answer to that is a judgment and it compromises the 

student’s ability to independently make that judgment 

themselves. 

. . . . 

And so if a student is told . . . the film is too dark, 

somebody has already made the judgment for them . . . . If 

they are told the patient is not aligned or they ask the 

question is the patient aligned and the answer is no, then 

that, once again, leverages their independent judgment as to 

whether or not the film needs to be repeated and/or what 

needs to be done to make the film better. 

Essentially, a sighted assistant would have to interpret the X-rays and 

then relay that interpretation to Cannon; Cannon would not be 

interpreting the X-rays himself. In light of these realities, Palmer 

determined that Cannon would be unable to attain the goals of the 
48

radiology curriculum. Palmer has demonstrated that a sighted assistant 

is not a reasonable accommodation. 

It is not as if Palmer adopted the technical standards lightly or did 

not consider Cannon’s arguments for why he should be admitted. 

Palmer has carefully considered the skills necessary to become a 

chiropractor and determined that the ability to read X-rays is integral. 

As one Palmer professor explained, the technical standards Palmer

adopted are “clearly based from an educational perspective on 

individuals that we have interacted with in the curriculum and what has 

worked and what has not worked.” Palmer adopted its technical 

standards in order to comply with the Council on Chiropractic 

Education’s national accreditation standards, further supporting the 

school’s conclusion that vision is necessary to earn a chiropractic degree. 

See Case W. Reserve Univ., 666 N.E.2d at 1379–80, 1385–86 (deferring to 

Case Western’s application of technical standards promulgated by the 

AAMC). As noted, Palmer met with Cannon multiple times, met with 

Iowa Department of the Blind representatives, and expressed a 

willingness to continue the dialogue. Cf. Wong, 192 F.3d at 819, 821 

(reversing summary judgment in favor of university when “Dean Lewis 

failed to discuss Wong’s proposal with any of the professionals who had 

worked with Wong to pinpoint his disability and help him develop skills 

to cope with it.”). Yet, Palmer remained convinced that the program 

modifications necessary to accommodate Cannon would fundamentally 

alter its program. 

I do not find it legally significant that Palmer modifies its course 

requirements and grants certain waivers for blind students enrolled at its 

California campus. California law mandates these accommodations by 

statute. See Cal. Bus. & Prof. Code § 1000–8 (West, Westlaw through ch. 
49

25 of 2014 Reg. Sess., Res. ch. 1 of 2013–2014 Ex. Sess., and all 

propositions on the 6/3/2014 ballot) (stating “[n]o blind person shall be” 

denied (1) admission to a chiropractic school, (2) the right to take a 

chiropractic exam, (3) a chiropractic diploma, (4) admission into an 

examination for a state chiropractic license, or (5) a chiropractic license 

“on the ground that he is blind”). That California statute does not apply 

extraterritorially in Iowa. Unlike California, the Iowa legislature has not 

enacted a statute requiring Palmer to waive requirements for blind 

persons. Simply because another state imposes such accommodations 

on an institution does not mean that those accommodations are not 

fundamental alterations of Palmer’s Iowa academic program. Palmer has 

provided ample evidence supporting why Cannon’s proposed 

accommodation would fundamentally alter its program, and our inquiry

should end there. 

Nor am I convinced otherwise by the fact that blind individuals 

have previously graduated from Palmer. These individuals attended 

Palmer many years ago. See Case W. Reserve Univ., 666 N.E.2d at 1385 

(discounting testimony of blind doctor who graduated from Case Western 

because the doctor “attended [the university] twenty years ago, under 

entirely different circumstances than proposed today”). The academic 

standards of the profession have changed since those individuals 

graduated, and uniform technical standards have been adopted. Under 

the majority’s analysis, a school could never strengthen its program 

requirements for legitimate reasons if the result excludes a disabled 

person. 

The commission erred, as a matter of law, by failing to defer to 

Palmer’s decision that Cannon could not satisfy its academic standards. 

See Wynne I, 932 F.2d at 26 (explaining institution must seek means of 
50

reasonably accommodating individual and “[i]f the institution submits 

undisputed facts demonstrating that the relevant officials within the 

institution considered alternative means . . . the court could rule as a 

matter of law that the institution had met its duty”). Palmer fulfilled its 

obligation of inquiry before denying Cannon’s requested accommodation 

of a sighted assistant to read X-rays. Palmer has reasonably concluded 

that the ability to personally see and interpret X-rays is essential in order 

to successfully diagnose and treat patients, without relying on the 

observations of an untrained sighted assistant. Considering the safety of 

future patients, there is nothing unreasonable about this requirement. 

The majority has not “struck a balance” between the statutory rights 

ensuring those with disabilities “meaningful access” to the benefits 

offered by educational institutions and “the legitimate interests” of those 

institutions in preserving the integrity of their programs. See Alexander 

v. Choate, 469 U.S. 287, 300–01, 105 S. Ct. 712, 720, 83 L. Ed. 2d 661, 

671–72 (1985). Rather, the majority and the commission have run 

roughshod over Palmer’s legitimate interests and the integrity of Palmer’s 

chiropractic program. Accordingly, I respectfully dissent. 

Mansfield, J., joins this dissent.