FARGO – Kelli Sem knew she would face obstacles in pursuing her dream to become a pharmacist. Cerebral palsy requires her to use a motorized wheelchair and hampers her dexterity.
Those limitations haven't stopped her from excelling in her studies at North Dakota State University, where chemistry instructors have allowed other students to perform manual laboratory tasks at her direction on her behalf.
Sem can walk short distances, but relies on her motorized wheelchair for mobility. Spasticity makes it difficult or impossible for her to do anything with her hands, which she often keeps clasped.
Before embarking on academic courses aimed at gaining admission to NDSU's School of Pharmacy, Sem appeared before the North Dakota Board of Pharmacy and asked for an assessment: Would her disability bar her from practicing pharmacy?
The verdict: a unanimous position that, with certain "reasonable accommodations," she would be able to complete the academic program and gain a license despite her disabilities.
"I thought we were moving forward," Sem said, recalling her reaction to the board's encouraging assessment in 2012. "NDSU was the only door that I thought was wide open. Of course, in meetings after that, the door kept closing a little more and a little more."
The biggest door closed to Sem when faculty in the School of Pharmacy imposed new technical standards — including newly adopted physical requirements — that she would have to meet in order to gain admission into the program.
The school also refused her request for a "reasonable accommodation" to allow other students to perform manual laboratory experiments she can't handle.
She was seeking permission to have fellow students do manual tasks at her direction, so the results would be her work.
Charles Peterson, dean of the College of Health Professions at NDSU, declined to comment on Sem's request for accommodations or the decision to adopt new physical standards. The requirements were imposed after she made inquiries and expressed interest in applying to the pharmacy program. An NDSU spokeswoman said the university cannot comment because of student privacy requirements and pending litigation.
Email messages between faculty at the School of Pharmacy obtained by Sem's lawyer through an open records request provide a glimpse of their deliberations of Sem's disabilities and the new physical requirements.
Peterson, according to an email exchange with colleagues in fall 2013 after Sem contacted faculty about the program, initially expressed support for her admission. But the dean was careful to say they could make no guarantees about her acceptance or completion of the program, or of her ultimately getting hired as a pharmacist.
"We will provide her a reasonable chance of being admitted, and we will provide her with reasonable accommodations in order to give her the best chance of completing the program," Peterson wrote in an email to colleagues.
Also in fall 2013, Dan Friesner, an associate dean, asked for Peterson's review of a draft response to "legally sensitive" questions posed by Sem. In his draft response to Sem, Friesner wrote," I do not doubt in any way your ability to succeed in our program academically. That is not an issue as far as I am concerned."
He went on to explain in the draft why pharmacy programs, having evolved to offer a single doctoral degree for graduates, had to be able to ensure graduates would be qualified for all major practice settings. The result, he lamented, was a "very complex clinical and legal conundrum" involving technical standards, a challenge confronting all health professions.
By spring 2014, the picture darkened for Sem when pharmacy faculty started revising the program's technical standards, including physical requirements to bring them more in line with other programs.
In contacting NDSU faculty, Sem had noted that its technical requirements were not as stringent as other programs she looked into, and asked if she could be "grandfathered in" under the existing standards.
After Sem visited the School of Pharmacy, including a tour of the lab, Peterson wrote colleagues
to update them about the technical standards revisions under discussion — a discussion "a prospective student" "seems to be driving," Friesner had observed earlier in an email to colleagues.
"As far as proposed revisions to our technical standards policy, I would only be concerned about the timing of these changes and that it could be perceived that we are changing it now because of Kelli and that could become a real issue and problem for us, especially if the proposed changes would be making it harder for her to be admitted to the program," Peterson wrote.
"If the changes are actually in her favor or a benefit to her, they would likely not become a big issue for us."
Peterson, still grappling over the standards in summer 2014, brought the issue back before the North Dakota Board of Pharmacy. He explained that the new standards were intended to ensure the program meets new accreditation standards coming next year.
Board members thought disability experts should be consulted, according to minutes for the meeting. "However, based on the Board's current practical examination, an individual with certain disabilities may still be able to obtain a license," the minutes said.
Many of the lab skills are tested verbally, and not by manual completion, the minutes added.
"Certainly the use of technicians could allow a person with a disability to practice as a pharmacist, while being able to guide or instruct the supervised individual actually doing the work."
Chemistry professors at Minot State University, where Sem studied before transferring to NDSU, and at Minnesota State University Moorhead, in a course taken through Tri-College, approved that arrangement, she said.
"I was responsible for my own work," Sem said. "They were just my hands to get the lab experiment completed in the amount of time it needed to be done."
Bob Crackle, associate professor of chemistry at Minot State University, taught Sem in a general chemistry course, allowing a fellow student to serve as Sem's assistant in laboratory classes.
"We used an upperclass student to be what we called her hands," Crackle said. The other student was instructed not to correct any mistakes or offer any guidance.
"I think it worked out OK," Crackle said. "Her experience in the class was the same as other students."
When Sem transferred to NDSU, when pharmacy faculty seemed to support her application, she gave up a full tuition scholarship at Minot State University, and has incurred tuition bills of more than $10,000.
Sem plans to apply for the pharmacy program during the Christmas break. She hopes that, in the end, her request for accommodations will be accepted and she will not be forced to mount a legal challenge to gain entrance.
"At the end of the day, all we want is for Kelli to be given a fair shot," said her lawyer, Scott Haider, who noted that her grade-point average and pharmacy admission test scores exceed the school's average.
She also is very determined. As a high school student, Sem said, she devoted hours of extra work to overcome difficulties in math classes, ultimately excelling in the work. "I'm stubborn," she said.
Apparently, Sem said, the NDSU School of Pharmacy has not faced a situation like hers before, and has stumbled in considering her case.
"This is not a fight against people," she said. "This is a fight against prejudice."