A Utah nursing student fights to get proper accommodations for her disability

Maria Thomson’s lawsuit against a nursing school highlights a debate over how the Americans With Disabilities Act is enforced.

(Bethany Baker | The Salt Lake Tribune) Maria Thomson, who suffers from Postural orthostatic tachycardia syndrome or POTS, at the U.S. District Court in Salt Lake City, with her service dog, Daisy, on Monday, Feb. 5, 2024. After Thomson was expelled from Joyce University, she sued the school claiming they failed to provide proper accommodations for her disability.

Nursing student Maria Thomson thought she would be OK going to class this one time without her service dog, Daisy.

Thomson couldn’t afford another absence on her record, she said. Besides, her medical provider said she would be safe attending without Daisy, a sheepadoodle who helps alert Thomson when she starts feeling the symptoms of her condition, postural orthostatic tachycardia syndrome, or POTS, which affects the autonomic nervous system.

It had been a rough few weeks for Thomson, then a student at the private, for-profit Joyce University of Nursing & Health Sciences in Draper. She was working to balance a demanding class load with flare-ups of her POTS symptoms.

Thomson asked to be excused early from an onsite class in February 2023 at St. Mark’s Hospital in Millcreek, and Joyce officials told her she would be marked absent, she said. Eventually, St. Mark’s gave her permission to leave, she said. Thomson learned later that the school counted her absent — and cited her for violating Joyce’s code of conduct, she said, because she contacted St. Mark’s officials about her POTS flare-up rather than going through Joyce’s protocols.

After seeking clarification about Daisy from Joyce officials — including sending a letter written by her lawyers — Thomson arrived at St. Mark’s on March 21, 2023, for another onsite class (called a “clinical”), without Daisy. When she got there, Thomson said, the head of clinicals for Joyce told her she was “a liability without Daisy,” and her instructor asked her to leave.

Two days later, Joyce’s legal team sent Thomson a letter, dismissing her from the school — and disrupting her dream of becoming a nurse.

Thomson — who said she was the school’s first student with a service dog — filed a federal lawsuit in June against Joyce, alleging the school did not give her proper accommodations for her disability under Title III of the Americans with Disabilities Act.

In the letter informing Thomson of her expulsion, Joyce’s lawyers wrote, “Joyce University is confident it has complied with its obligations under the ADA and any other pertinent standard.”

A representative from Joyce University declined to comment for this article, because of the ongoing court case.

It’s a case, said Emily Shuman, director of the Rocky Mountain ADA Center, that illustrates what many people with disabilities say is a recurring problem with enforcing the ADA.

“There’s a lot of ignorance of the law,” Shuman said. “Civil rights laws for people with disabilities are not something anyone typically thinks about until they have to.”

‘I want to be like this one day’

Because of her health problems, Thomson has spent a lot of time in the company of nurses — and watching them work made her want to become one.

Once Thomson was flown by air ambulance, and the nurses who helped her through it stuck in her memory. “Those nurses were the ones that I was, like, ‘You guys are so smart. … I want to be like this one day,’” she said. “I wanted to give back to the nursing community and those who have helped me.”

Thomson, a 26-year-old who lives in Salt Lake City, has been dealing with POTS for seven years, but encountering the symptoms for 12. POTS is triggered by standing up after lying down. “Anything that you don’t have to think about — like your heart rate, blood pressure, all that kind of stuff — is dysregulated,” she said.

There’s no cure yet for POTS. Thomson said she’s able to manage the condition with medication, her central line (which “provides IV fluid therapy” to help with her blood pressure and heart rate), and the assistance of Daisy — who helps alert her for POTS symptoms, like when her heart rate elevates.

“The big part with Daisy — which I feel like people kind of miss — is that Daisy is an alert system,” Thomson said. “She’s not a cure. She will just tell me when my symptoms are flaring before they get bad.”

(Bethany Baker | The Salt Lake Tribune) Daisy, the service dog for Maria Thomson who suffers from Postural orthostatic tachycardia syndrome or POTS, at the U. S. District Court in Salt Lake City on Monday, Feb. 5, 2024. After Thomson was expelled from Joyce University, she sued the school claiming they failed to provide proper accommodations for her disability.

With Daisy’s assistance, Thomson said, she thought she would be able to fulfill her dream and attend nursing school. In January 2022, she enrolled in Ameritech College (which later changed its name to Joyce University), because, she said, of the school’s “decent reputation,” high job placement rate, its nurse licensure exam and the quality of its equipment.

At first, Thomson said, the school granted her some accommodations — for example, giving her time-and-a-half to complete tests, so she could deal with the brain fog that accompanies POTS. Thomson and her advocate, Joey Ramp-Adams, worked with the school in advance to establish those accommodations.

“We knew it was going to be harder, but we thought we would be able to present research and help kind of guide them down that path,” Thomson said.

In June 2022, Thomson, Ramp-Adams and the school’s ADA coordinator met to discuss a publication from The Journal of Professional Nursing, about how to accommodate students with service dogs in clinical settings. After that, Thomson said, she met with lab instructors at the start of every semester to introduce them to Daisy and work out logistics.

When the school changed its name to Joyce, Thomson said, it replaced its ADA coordinator with an employee who didn’t have training in that field. “That’s kind of where my problems began,” she said, “just because there wasn’t that person there that understood and was able to help me navigate certain situations.”

In June 2022, Thomson missed a pharmacology class because her central line was infected. She had a four-hour lab and exam scheduled the next day, which she missed and had to make up later. In the days that followed, she said she had problems getting the absence excused.

“When I asked for medical absences, they were like, ‘We’re not going to grant that for you.” She also asked to have more time to complete her test, because she was hospitalized for a couple of days.

Both women recalled one virtual meeting where Thomson had wanted Ramp-Adams to advocate for her, and Joyce would not give Ramp-Adams access. Shortly after that, Thomson said, the school’s dean said they would not excuse all medical-related absences but would review them on a “case-by-case” basis.

In November 2022, Thomson’s medical provider, Brad D. Richards, a physician assistant who specializes in POTS, wrote a letter to the school, explaining her need for accommodations — including time-and-a-half for testing, and double time for more complicated courses. Later that month, Thomson said, she was told that “extending the days for exams is not an ADA accommodation that Joyce University grants.”

Around the same time, Thomson and her peers were getting to start their “clinicals” — placements at different health care facilities for onsite education. Finding a facility where Thomson could bring Daisy, she said, was difficult.

Thomson said the school “waited till the last minute to get me placements. Everybody else in my cohort was allowed to register themselves. … I was always told because you’re an ADA student, we register you. I was told, ‘Our normal students register themselves.’”

Absences and expulsion

The cascade of issues that led to Thomson’s expulsion from Joyce happened in a stretch of just over a month.

The first incident was on Feb. 22, 2023, when Thomson started her clinical at St. Mark’s. The next day, Daisy had a partially ruptured eardrum. “She was having vestibular issues, too, so she couldn’t really stand up,” Thomson said.

Thomson’s doctor, Dr. Richards, said she could attend her clinical without Daisy, so she did. A few hours into the clinical, though, her POTS symptoms flared up. Eventually, she said, St. Mark’s gave her permission to leave.

In the weeks that followed, Thomson said she would be asked by the assistant director of human resources at St. Mark’s and the head of risk management invasive questions about her disability, in front of her peers. She also received a notice that she violated the school’s code of conduct when Thomson contacted someone at St. Mark’s to schedule a meeting to talk about her POTS incident.

On March 14, Thomson went in again without Daisy, who was sick. She said she went in because she didn’t have another excused absence. When she arrived, she was told she already had used two absences — meaning the school had counted the absence from her February POTS flare-up.

Two days later, on March 16, Thomson’s lawyers sent a letter to the school, saying that she had been “treated in a discriminatory manner by Joyce University.” The letter demanded the school change her accommodations to allow for her absences, and remove the code-of-conduct violations from her record.

Thomson attended her clinical on March 21, because she said she had not received clarification about whether she could attend without Daisy, and she feared being marked for another absence. The head of clinicals at Joyce, she said, told her she was “a liability without Daisy.” Her clinical instructor then asked Thomson to leave.

Two days later, March 23, Thomson said she received a letter from Joyce’s legal team, dismissing her from the school. The letter went on at length to respond to the letter from Thomson’s lawyers, and argued that Thomson understood that Daisy should be with her during her clinicals.

On March 25, Thomson wrote to the school, seeking to appeal her dismissal. “I believe a failure of communication led to the events for which I have been dismissed,” she wrote. “At no time after the [February] episode did Joyce tell me they thought it unsafe for me to work without Daisy. Nor did they clearly state that I could not attend clinicals without her.”

Thomson filed her lawsuit on June 19. She received notification on Sept. 11 that the appeal of her dismissal was denied.

What is the ADA law? How does it help?

Thomson is suing Joyce under Title III of the Americans with Disabilities Act. Title III is the part of the law that applies to private businesses, said Nate Crippes, a supervising attorney at the Disability Law Center of Utah. (The first section covers employment, the second part state and local government entities.)

“The vast majority of [private institutions] also probably take federal funding, because they have students who get loans and pay their tuition,” Crippes said. (Joyce, on its website, notes that it accepts loans through FAFSA.)

The ADA defines a service animal as a dog or a miniature horse, Crippes said. “It has to be trained to perform a task that helps with a disability,” he said. Service animals can only be asked to leave, he said, “if it is out of control.”

(Bethany Baker | The Salt Lake Tribune) Maria Thomson, who suffers from Postural orthostatic tachycardia syndrome or POTS, at the U. S. District Court with her service dog Daisy in Salt Lake City on Monday, Feb. 5, 2024. After Thomson was expelled from Joyce University, she sued the school claiming they failed to provide proper accommodations for her disability.

“The ADA has been around for 30-plus years, but there is still a lack of awareness about what it requires and how it works,” Crippes said.

Shuman, director of the Rocky Mountain ADA Center, said she can’t “see any reason” Joyce would be exempt from ADA provisions.

In academic settings, Shuman said, it’s up to individuals to contact the school or university, self-disclose their disability, and explain “things that they need put in place in order for them to have access to their education.”

But, it’s up to schools, she said, to work with the person with a disability, “and if necessary, make reasonable modifications to their policies, practices and procedures, in order to make sure that that person has the accommodations that they need.”The word “reasonable” is important. “They don’t have to do that if it causes a fundamental alteration to the operations of the organization, or if it causes some sort of undue financial or administrative burden,” Shuman said. “That’s always determined on a case-by-case basis.”

ADA law, Shuman said, is paradoxical because it’s meant to “level the playing field” for people with disabilities.

“It’s all about removing barriers for people with disabilities. The spirit of the law acknowledges that people with disabilities often have to work harder, just to have the same access to participate in everyday life as people without disabilities,” she said.

As ADA is practiced, though, people with disabilities constantly have to explain the law, Shuman said, and “take on the burden of educating everyone around them on their civil rights.”

Shuman said that 1-in-4 people in the United States has a disability, and 60% of people will acquire one as they age — so knowledge about the barriers the disability community faces is increasingly relevant to more people.

“People with disabilities have proven time and time again that they are totally capable of doing just about anything that people without disabilities can do, with the right accommodations and support in place,” Shuman said.

Can people with service dogs thrive in STEM settings?

Ramp-Adams, Thomson’s advocate, first connected with her in May 2020, and worked with her throughout her time at Joyce.

The two women have things in common, including an interest in the health care field — Ramp-Adams has a degree in biochemistry and neuroscience — and the fact that both rely on service dogs.

Ramp-Adams is founder and CEO of Empower Ability Consulting, a company that she said works with people, government agencies and academic institutions. “The reason I started the company was because of the obstacles I faced, so I have a very strong focus on people who are seeking a STEM education with service dogs,” she said.

Empower Ability Consulting has worked with the American Society for Microbiology, she said, helping the group write guidelines on how to accommodate service dog handlers in labs. The company has done similar work with the American Chemical Society, she said.

Working with those organizations, Ramp-Adams said, has shown her there’s a shift in making those industries more accessible and inclusive. Still, though, there are difficulties — and she called Thomson’s situation the “worst-case example” of what can happen.

STEM academics, Ramp-Adams said, are quite rigid by necessity — because of the safety protocols in labs. Often, she said, organizations like Joyce are hesitant to have an outside consultant like her come in, even if she’s an expert in her field.

Working with Joyce, Ramp-Adams said they found the school resistant in “trying to do any kind of reasonable accommodation or try and assist in any way.”

She added: “There was no empathy, no compassion. And beyond [that], they just trounced all her civil rights. Just a basic accommodation, like extended testing, they were not going to even budge on that.”

Ramp-Adams said she has never before encountered a case where, as Thomson claims, Joyce said Thomson could not attend classes or clinicals without her service dog.

Crippes called that “disability discrimination.” As an example, he said, “if a person who had a mobility impairment — say they utilize a walker or wheelchair occasionally, but didn’t need it at all times … I don’t think a business could be, like, ‘You can only come in here if you utilize the device you have.’ What they would be saying is: ‘You are required to meet our demands of how your disability works.’”

Advocating for herself

Ramp-Adams said it’s “absolutely” possible for people with service dogs to thrive in STEM settings, if they are allowed to advocate for themselves and their needs.

“A person knows how to manage their disability. If we listen to them, they can absolutely thrive in whatever they want to do,” she said. “We don’t know what a person with a disability has to bring to the table unless we let them sit there and unless we let them into the decision-making areas.”

Thomson said she’s never had the issues with getting accommodations that she had with Joyce.

“The big part about having accommodations,” Thomson said, “is that they’re there for you to use when you need them.”

As of early April 2024, a little over a year after Thomson was expelled, there has been little movement with her lawsuit.

“We pretty much asked if they wanted to settle again, they said no,” Thomson said. “We have been talking to them to see if I can fit for my LPN license. … So far, it looks like I might not qualify. I’m also requesting, like, transcripts and stuff from them, and they’re refusing.”

(Bethany Baker | The Salt Lake Tribune) Maria Thomson, who suffers from Postural orthostatic tachycardia syndrome or POTS, at the U. S. District Court with her service dog Daisy in Salt Lake City on Monday, Feb. 5, 2024. After Thomson was expelled from Joyce University, she sued the school claiming they failed to provide proper accommodations for her disability.

Thomson said she feels like she consistently tried to advocate for herself, but no one at Joyce was listening to her.

“I’ve had times where I’ve definitely had to go in and talk to and educate people, but the people I’ve talked to have always been willing to listen,” Thomson said. “Here, I just feel like they were just unwilling to listen.”