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[Brian Nelson]

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When Can (and Should) a School Require a Student to Undergo a Medical Evaluation?
By Myra Creighton 
(Education Labor Letter, March/April 2008)
A ninth grade student is sitting in your office because he said "wouldn't it be nice if you died tomorrow" to another student. And you learned that days prior to the comment, the same student had punched the student to whom he made the comment. Your first inclination is to require the student to submit to a psychiatric evaluation. But should you do so? Teachers and school administration frequently take a holistic view of dealing with students. Such an approach at times may be inconsistent with the Americans with Disabilities Act and Section 504 of the Rehabilitation Act (for schools receiving federal funding).
When Does the Law Permit an Evaluation?
Both Title III of the ADA, as well as the Rehabilitation Act, restrict a school's ability to require students to provide medical information or to submit to independent medical examinations. Generally, such inquiries or examinations must be related to the student's performance or participation at school, a request for accommodation, or a direct threat situation. For example, a school may require a student who requests an extra hour to take an examination because he has Attention Deficit Disorder or dyslexia to submit medical documentation showing that he has a "disability," meaning that his impairment substantially limits him in a major life activity. The school has no obligation to provide the accommodation unless the student is disabled. 
Second, a school may require a medical examination to ensure that a student is fit to participate in school athletics. And finally, a school may require a student to submit to a medical examination when there is objective evidence that a student is a direct threat to himself or to others. 
A student is a direct threat if he poses a significant risk of immediate harm to himself or to others. For example, a student athlete with a diagnosed heart condition may be a direct threat to himself if he engages in certain school athletic activities. A school may make a medical inquiry to that student's doctor on this issue or require the student to submit to a medical examination. 
What About Threats of Violence?
When a student makes threats of violence, the school's first inclination may be to address the matter from a medical perspective rather than a disciplinary matter. But generally, the school should deal with the situation as a disciplinary matter for several reasons. First, a student threat most likely will become fuel for gossip and eventually parents will hear about it. Assuming that a medical examination reveals that the student has a mental disability, and requires treatment, other parents may be uncomfortable when this student eventually returns to school at a later point in time, and his return may generate controversy. 
There is no need for the school to establish that a student engaging in misconduct has a mental disability, especially when such knowledge does not excuse the misconduct, but may require the school to accommodate the disability, e.g., time off for treatment. Further, in such a situation, the school has created an incentive for the parents to obtain a second opinion or find a way to excuse clearly unacceptable behavior. If the second opinion contradicts the first opinion and indicates the student is not impaired/disabled or is not a direct threat, the school runs the risk that the parents will claim that the school perceived that their child was disabled if the school acts on the first opinion.
Because the threat is blatant misconduct, it should be addressed as such. If the school desires, it can always put a student to a treatment or expulsion election under the terms of a "last chance agreement." Of course, in order to do so, whatever misconduct the student engaged in would have to be conduct that would permit the school to expel the student under the school handbook or the school contract. The school can then include terms in the last chance agreement that will require that the student (parents) prove that the student is receiving ongoing therapy or treatment in accordance with the recommendations of the student's outside provider. Moreover, the school can condition the student's continued enrollment on the student not engaging in any other misconduct for a period of time, regardless of the severity of the misconduct.
Other Considerations
Another issue that arises periodically is whether a student who tries (or threatens) to commit suicide is a direct threat to himself or to others. Although there are no cases under Title III of the ADA (governing the school's relationship with its students), under Title I of the ADA (governing employment), the Equal Employment Opportunity Commission takes the position that such an individual is not a direct threat to others. Therefore, this is not a situation where the school should send the student for a medical evaluation without advice from counsel. 
But once a student who has attempted or threatened suicide seeks to return to school, the school may require a statement from the student's doctor that indicates that the student is fit to return to school, that the student is able to handle the pressure that being in school presents for the student, and outlines any accommodations the student may require. 
Moreover, if teachers observe conduct or performance issues that set off alarms or concerns, they first should talk to school administrators about their concerns and develop a unified approach to addressing the issue with the student's parents. Teachers should not suggest to a parent that their child needs psychological counseling, treatment, etc. on their own initiative or "diagnose" the student with a particular disability or impairment. Parents are not always ready to hear this information from educators and will frequently "punish" those persons who first disclose the concern. For this reason, we recommend that these types of issues be brought to the attention of guidance and the teacher's department head so that the school can assess the appropriate method for communicating any such concerns to parents.
Conclusion
In summary, although schools want to do what is best for the student, they should be cognizant of the restrictions the ADA and the Rehabilitation Act impose on medical examinations and inquiries. Performance and misconduct issues are just that and should be treated in accordance with the school's disciplinary procedures, not as a psychiatric issue.


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