Nicholas Knapp v. Northwestern University, an Illinois Not-For-Profit Corporation, and Rick Taylor
Docket: 96-3450
Court: Court of Appeals for the Seventh Circuit; January 3, 1997; Federal Appellate Court
Nicholas Knapp, a competent adult and valedictorian, seeks to play NCAA basketball for Northwestern University despite a history of serious heart issues, including a near-fatal cardiac arrest during a pick-up game. Despite Northwestern's initial commitment to honor his athletic scholarship, the university prohibits him from participating in intercollegiate basketball due to concerns about his health. Although Knapp can engage in recreational basketball and physical activities independently, the central legal question is whether Northwestern's refusal to allow him to play violates Section 504 of the Rehabilitation Act of 1973. Prior to his cardiac incident, Knapp had been a highly recruited basketball player. After his medical emergency, he underwent surgery to receive an internal cardioverter-defibrillator, designed to restart his heart if necessary. Following his recovery, he signed a national letter of intent to attend Northwestern, emphasizing his academic and athletic potential.
On November 7, 1995, Dr. Howard Sweeney, head physician at Northwestern, ruled that Knapp was ineligible to play for the men's basketball team based on medical recommendations against competitive play, Dr. Gardner's physical examination findings, and guidelines from national medical conferences. Subsequently, both Northwestern and the Big Ten declared Knapp permanently medically ineligible. Northwestern’s athletic director, Rick Taylor, confirmed that Knapp would never be allowed to play intercollegiate basketball for the university. Despite this, Knapp's scholarship remains intact, allowing him to attend practices and receive benefits typically available to athletes.
On the same day of his ineligibility declaration, Knapp filed a lawsuit in federal court claiming violations of the Rehabilitation Act, seeking to compel Northwestern to permit him to play. In May 1996, Northwestern motioned for summary judgment, while Knapp requested a permanent injunction. A court hearing on September 6, 1996, concluded with a finding that Knapp was medically eligible to play, leading to a ruling against Northwestern for violating the Rehabilitation Act. The court issued a permanent injunction preventing Northwestern from excluding Knapp from the basketball team due to his cardiac condition.
The court’s decision relied on affidavits and testimonies from both Knapp and various cardiologists. All experts acknowledged Knapp's history of sudden cardiac death due to ventricular fibrillation and the heightened risk associated with playing basketball, particularly given his internal defibrillator. Northwestern's experts emphasized the significant risks, while Knapp's cardiologists argued that the risks were manageable with the defibrillator in place.
Northwestern filed an emergency notice of appeal on September 27, 1996, seeking to stay the enforcement of an injunction after losing in the district court. The proceedings were expedited, and a stay was granted pending a decision, with oral arguments heard on November 7, 1996. The court reviews the district court's grant of a permanent injunction for abuse of discretion, with factual determinations assessed under a clearly erroneous standard and legal conclusions reviewed de novo. The Rehabilitation Act is the basis for Knapp's discrimination claim, which prohibits exclusion from participation in programs receiving federal assistance based solely on disability. To succeed, Knapp must demonstrate: 1) he is disabled under the Act, 2) he is otherwise qualified for the position, 3) exclusion was solely due to his disability, and 4) the position exists within a federally assisted program. Northwestern acknowledges receiving federal assistance and excluding Knapp due to his cardiac condition, focusing on whether he qualifies as an "otherwise qualified individual with a disability." To establish disability, Knapp must prove he has a physical impairment that substantially limits major life activities, has a record of such impairment, or is regarded as having one. Knapp meets the first criterion, as his cardiovascular issue is classified as a physical impairment. The dispute lies in whether playing intercollegiate basketball is a major life activity and if his condition substantially limits him in that activity. Regulations clarify "major life activities" to include basic functions like caring for oneself, walking, and working, which are activities that an average person can perform with little difficulty.
Regulations under the Rehabilitation Act do not define "substantial limitation," which is acknowledged by both the Department of Education and the Department of Health and Human Services. The court must evaluate whether an impairment significantly hinders a major life activity for an individual. In this case, Knapp’s claimed disability does not fit neatly within the Act, as it only presents a risk when his heart fails, making it fundamentally different from ongoing disabilities like blindness. His condition presents an all-or-nothing scenario where, if his heart functions, he experiences no limitations, but if it stops, all major life activities are affected.
Knapp argues that playing college basketball is integral to his learning process, asserting that participation in the sport fosters essential skills. The district court concurred, finding that Knapp was substantially limited in learning due to the university's actions. The parties have treated "substantially limited" and "major life activities" as separate criteria; however, it is suggested that they should be viewed as interconnected, particularly concerning learning and working. A Sixth Circuit comment indicates that an impairment impacting a limited range of jobs might not substantially limit a major life activity. The same reasoning is applied to learning; if playing NCAA basketball qualifies as a major life activity, then being deprived of it likely constitutes a substantial limitation. Conversely, if it does not qualify as a major life activity, then the deprivation is unlikely to be seen as substantial.
The definition of "major life activity" cannot be narrowed to include specific activities like playing intercollegiate basketball, which is not a fundamental life function comparable to walking or breathing. While intercollegiate sports can enhance the college experience, they are not essential for all students, as many graduate without participating in such activities. Previous cases have touched on school sports as potentially major life activities, but none are binding, and the relevance of these activities to the major life activity of learning remains debated. The Rehabilitation Act offers little clarity on whether the definition should rely on subjective or objective standards. There is a consensus that determining disability is individualized, but the definition of "major life activity" must encompass basic life functions rather than specific pursuits, such as playing sports or working at a desired job. Thus, the major life activity of learning cannot be defined in a way that encompasses all desires to engage in intercollegiate athletics. The regulatory definition includes fundamental activities like caring for oneself, walking, and learning, but excludes narrower interpretations.
Major life activities are evaluated individually during the "substantial limitation" analysis, focusing on whether an impairment significantly restricts a person's ability in a specific context. For example, the impact of an impairment on a person pursuing a third doctorate differs from its effect on a typical tenth grader. Coverage under the Rehabilitation Act is not unlimited; not all impairments affecting major life activities qualify as substantially limiting. The degree of restriction is crucial, as demonstrated in cases where inability to perform specific tasks for particular employers or institutions does not equate to a general disability.
In the case of Knapp, participation in intercollegiate basketball is deemed a limited part of his overall education at Northwestern. His scholarship allows him access to all other academic and nonacademic services, suggesting that his learning is not substantially hindered. Even without playing, alternative educational opportunities remain available, and his inability to engage in basketball does not significantly restrict his educational experience. Therefore, Knapp is not considered disabled under the Rehabilitation Act.
Moreover, even if he were deemed disabled, he fails to meet the criteria of being "otherwise qualified" to play intercollegiate basketball, as the regulations require individuals to satisfy all academic and technical standards necessary for admission and participation in educational programs.
Section 794 mandates that educational institutions must not exclude "otherwise qualified" disabled individuals from federally funded programs solely due to their disabilities. A person is deemed "otherwise qualified" if they can meet the program's requirements despite their handicap, provided reasonable accommodations are made by the employer. Legitimate physical qualifications may be essential for participation in specific programs. The terminology shift from "otherwise qualified handicapped person" to "qualified handicapped person" in regulatory definitions reflects the intent to avoid misinterpretation that could allow individuals to be deemed qualified despite failing essential qualifications due to their disabilities. While blanket exclusions based on disabilities are generally impermissible, legitimate physical requirements are permissible. Additionally, disqualification due to significant risks of personal injury is valid only if the risk cannot be mitigated, and such disqualifications must be evaluated carefully to avoid undermining the Rehabilitation Act, especially since disabled individuals often face elevated injury risks.
The Ninth Circuit established a standard for assessing whether an individual is physically qualified for a job when future injury risk is a concern. To exclude a qualified individual based on potential harm, there must be a reasonable probability of substantial injury, supported by objective evidence rather than solely subjective evaluations or medical reports. An employer is required to gather comprehensive information about the applicant's work and medical histories and conduct a thorough case-by-case analysis of the associated risks.
In the case of Nick Knapp, the severity of potential injury is extremely high, with the possibility of death. Expert testimony indicated that Knapp's risk of death due to his cardiac condition was estimated at 2.4% annually, increasing to 2.93% with participation in intercollegiate basketball. Other experts placed his risk for the 1996-97 basketball season at no greater than 1 in 100. Although Knapp's experts considered this risk acceptable, Northwestern's experts disagreed, citing a significantly higher average risk of non-traumatic death for male college basketball players. They highlighted Knapp's previous experience of sudden cardiac death during basketball as a critical factor in evaluating his current risk.
While there was disagreement among experts regarding how time affects Knapp's risk, most concurred that his internal defibrillator had not been tested under conditions typical of high-intensity sports, raising questions about its reliability in such scenarios. Nonetheless, Knapp's regular monitoring of the defibrillator provided some reassurance regarding its functionality.
The district court judge recognized that conflicting expert opinions existed regarding the risk associated with Nicholas Knapp's participation in sports, noting a lack of scientific data to quantify that risk. The judge observed that while highly qualified experts agreed on basic scientific principles, their medical judgments differed on the specific risk of recurrence and the time elapsed since prior incidents. The judge deemed it necessary to weigh these opinions to determine persuasiveness, despite feeling that a panel of physicians might have been a more suitable decision-making body. Ultimately, the judge found that the opinions of Drs. McAnulty, Rink, and Olshansky were compelling, concluding that Knapp's risk of a repeat episode was not substantial.
The text argues against the district court’s view that such medical determinations should be made by the courts, asserting that they are better suited for team doctors and universities, provided their decisions are rational and consider potential accommodations. It emphasizes that Northwestern University, having thoroughly evaluated Knapp’s medical history alongside expert opinions, has the authority to deem him medically unfit to play without infringing on the Rehabilitation Act. The role of the court should be to ensure that decision-makers have adequately considered relevant evidence rather than to assess the persuasiveness of that evidence themselves. The excerpt references other cases, such as Pahulu, where courts upheld educational institutions' decisions based on rational assessments of medical evidence, reinforcing the argument that school authorities' informed judgments should be respected.
In the case of Arline, the Supreme Court established that an "otherwise qualified" inquiry under the Rehabilitation Act must be individualized, relying on reasonable medical judgments regarding (a) the nature of the risk, (b) the duration of the risk, and (c) the severity of the risk. Courts are to defer to public health officials' reasonable medical judgments but did not clarify the weight of private physicians' judgments relied upon by employers. While Bethesda Conference guidelines should not replace individualized assessments, consensus recommendations from multiple physicians can support a team's evaluation.
In instances of conflicting expert opinions about risks of serious harm or death, courts should not make final medical decisions but ensure that an individual's exclusion was individualized, reasonable, and based on competent medical evidence. The district court found that Northwestern's decision regarding Knapp's substantial risk was rational and based on reliable evidence, leading to the reversal of the order requiring Knapp to play. The district court failed to differentiate between the reasonableness of Northwestern's decisions over the seasons. Testimonies from medical professionals indicated a consistent belief in Knapp's substantial risk of death while playing basketball. The conclusion emphasizes that Northwestern's decision, while not necessarily correct, was not illegal under the Rehabilitation Act.
A team physician from another university could reasonably conclude that Knapp met the physical qualifications to play intercollegiate basketball, highlighting that universities may assess risk differently. If substantial evidence supports Northwestern's decision, it must be upheld. Section 794 of the Rehabilitation Act prohibits decisions based on insufficient medical evidence regarding the risks for disabled individuals, stating that such choices cannot be made from a paternalistic standpoint. Knapp is an adult capable of making his own health decisions, with parental approval for his choices. Previous cases emphasize that schools cannot base perceptions of injury risk on unfounded fears but must rely on objective evidence. Northwestern’s actions were rational and based on reasoned medical judgments, thus no violation of the Rehabilitation Act occurred. The district court's permanent injunction against Northwestern is reversed, and summary judgment should be entered in favor of Northwestern. The document also notes that the team physician has the sole authority to determine a student’s medical eligibility to compete, referencing two Bethesda Conferences that established guidelines for athletes with cardiovascular issues, including recommendations against participation for certain conditions like Knapp's.
All moderate and high-intensity sports are deemed contraindicated. The regulations implementing the Rehabilitation Act by the Department of Health and Human Services are largely identical to those from the Department of Education. Knapp argues that these regulations, which prohibit discrimination in postsecondary athletics, imply that such athletics qualify as a major life activity. However, this interpretation is incorrect, as the regulations primarily address discrimination in programs or activities, not the definition of being "otherwise qualified with a disability."
Specifically, regulations state that no qualified student with a disability shall be excluded or discriminated against in athletics or extracurricular programs. Recipients of federal funds must provide equal opportunities for participation in physical education and athletics to qualified students. These regulations apply only after an individual is deemed disabled and qualified.
Despite the less-than-ideal learning environment for Knapp, there is potential for his increased involvement in the future. However, Northwestern's claim that Knapp has opportunities to participate in the basketball program is challenged by his statement that he only sits on the bench during practices and games. If true, this indicates a lack of meaningful participation.
Concerns are raised about why Knapp does not transfer to another school with a better opportunity to play basketball, but this overlooks the unique academic and social benefits Northwestern offers him. While alternative schools may exist, Knapp has not provided evidence that he cannot find a suitable transfer option where he could play. Consequently, the denial of the right to play basketball at Northwestern does not equate to a denial of his overall educational opportunities.
Lastly, the Rehabilitation Act was amended in 1992, replacing the term "handicap" with "disability," but the corresponding regulations have not yet been updated to reflect this change.
