Academic Medical-School Dismissals: Minimal Horowitz Process, Ewing “Beyond the Pale” Substantive Review, and Waiver of Unbriefed Title VI Issues

1. Introduction

In Gilani v. UTSW Medical Center (5th Cir. Jan. 30, 2026) (per curiam, unpublished), Al Gilani, a former medical student at the University of Texas Southwestern Medical Center (“UTSW”), challenged his dismissal from medical school after repeated academic difficulties. Gilani sued under 42 U.S.C. § 1983, asserting violations of Title VI of the Civil Rights Act of 1964 and the Fourteenth Amendment Due Process Clause against UTSW and several UTSW employees (including Dr. Angela Mihalic and Dr. Dwain Thiele), in both individual and official capacities.

The Fifth Circuit addressed two central issues: (1) whether Gilani preserved (briefed) his Title VI arguments on appeal; and (2) whether his pleadings plausibly alleged procedural or substantive due process violations arising from an academic dismissal, sufficient to overcome dismissal and (for individuals) qualified immunity.

Although the decision is not designated for publication under 5th Cir. R. 47.5, it is a clear application—useful for litigants and institutions—of the Supreme Court’s academic-dismissal due process framework and the Fifth Circuit’s pleading/waiver principles.

2. Summary of the Opinion

  • Title VI: The court affirmed summary judgment for UTSW because Gilani did not brief his Title VI claims on appeal, thereby waiving/forfeiting them.
  • § 1983 / Due Process: The court affirmed dismissal of Gilani’s due process claims against UTSW employees because the complaint did not plausibly allege:
    • a procedural due process violation, given the reduced process constitutionally required for academic dismissals; or
    • a substantive due process violation, because the alleged actions did not constitute a substantial departure from accepted academic norms “beyond the pale of reasoned academic decision-making” when viewed against Gilani’s overall record.
  • Qualified immunity: Because no plausible constitutional violation was alleged, the court did not reach the “clearly established law” prong for the individual-capacity claims.

3. Analysis

3.1 Precedents Cited

Waiver/Forfeiture on Appeal

  • United States v. Griffith, 522 F.3d 607 (5th Cir. 2008): Cited for the principle that failure to raise an issue on appeal constitutes waiver (often described as forfeiture in appellate practice). This was dispositive for Title VI: even if Gilani had arguments, the appellate court would not reach them absent briefing.

Pleading-stage materials the court may consider

  • Inclusive Cmtys. Project, Inc. v. Lincoln Prop. Co., 920 F.3d 890 (5th Cir. 2019): Provided the baseline Rule 12(b)(6) record (complaint, attachments, judicial notice), and the additional principle that documents referenced in the complaint and central to the claims may be considered even if attached to a motion.
  • Causey v. Sewell Cadillac-Chevrolet, Inc., 394 F.3d 285 (5th Cir. 2004): Quoted via Inclusive Cmtys. Project to support considering such referenced/central documents.
  • Taylor v. Books A Million, Inc., 296 F.3d 376 (5th Cir. 2002): Cited for the standard that well-pled facts are taken as true and viewed in the plaintiff’s favor at the motion-to-dismiss stage.

Standard of review (dismissal and qualified immunity)

  • Inclusive Cmtys. Project, Inc. v. Lincoln Prop. Co., 920 F.3d 890 (5th Cir. 2019): De novo review for Rule 12(b)(6) dismissals.
  • Davila v. United States, 713 F.3d 248 (5th Cir. 2013): De novo review for qualified-immunity rulings.

Academic vs. disciplinary dismissals and procedural due process

  • Bd. of Curators of Univ. of Mo. v. Horowitz, 435 U.S. 78 (1978): The cornerstone. The court used Horowitz for multiple propositions:
    • Even “assuming the existence” of a protected interest, the question is what process is constitutionally required.
    • Academic dismissals require “far less stringent” procedures than disciplinary dismissals.
    • Courts are ill-equipped to second-guess academic judgments; constitutionally sufficient process includes being fully informed of dissatisfaction and risk of dismissal, and the ultimate decision must be “careful and deliberate.”
    • Academic evaluation includes personal/professional qualities necessary to practice medicine (not just test scores).
  • Barnard v. Inhabitants of Shelburne, 102 N.E. 1095 (Mass. 1913): Quoted by Horowitz to highlight the conceptual distinction between misconduct and failure to meet academic standards.
  • Goss v. Lopez, 419 U.S. 565 (1975): Provided the more robust baseline for disciplinary deprivations—notice of charges, explanation of evidence, and an opportunity to respond—while also emphasizing that the required hearing can be informal.

Substantive due process review of academic judgments

  • Regents of Univ. of Mich. v. Ewing, 474 U.S. 214 (1985): The court applied Ewing’s exceptionally deferential substantive review: relief is available only for a “substantial departure from accepted academic norms” showing no exercise of professional judgment—i.e., “beyond the pale of reasoned academic decision-making,” assessed against the student’s entire academic career.
  • Wheeler v. Miller, 168 F.3d 241 (5th Cir. 1999): Used to reinforce that a dismissal can be “academic” even when it concerns academic ethics/professionalism and not merely grades; the focus remains the student’s shortcomings.

Qualified immunity sequencing

  • Doe v. Ferguson, 128 F.4th 727 (5th Cir. 2025): Cited for the common qualified-immunity approach: if the complaint fails to plausibly allege a constitutional violation, the court need not address whether the law was clearly established.

3.2 Legal Reasoning

(A) Title VI claims: appellate waiver controls

The Fifth Circuit’s Title VI disposition is procedural rather than merits-based. By invoking United States v. Griffith, the court treated the absence of appellate briefing as dispositive: the district court’s summary judgment stands because the appellant did not present argument for reversal.

(B) Due process: institutional policy violations are not the constitutional yardstick

A key framing move is the court’s reminder that “the Due Process Clause is not coterminous with good institutional practice.” Even if UTSW deviated from its own internal rules, the constitutional inquiry remains whether the procedures actually provided satisfied the Fourteenth Amendment’s minimum requirements.

(C) Procedural due process turns on academic vs. disciplinary characterization

The court “assume[d] without deciding” a protected interest in continued enrollment, then determined which due process standard applies. Gilani attempted to recharacterize his dismissal as “disciplinary,” arguing (in effect) that UTSW’s alleged “academic dishonesty” transformed the nature of the case. The court rejected that pivot as conclusory and misdirected: the relevant classification is based on the student’s deficiencies and the school’s stated basis for dismissal.

On the pleadings, the dismissal was academic: multiple failed courses, a failed elective, failure of the GI Block exam, an allowed remediation opportunity, and then failure of the re-exam—followed by a dismissal letter and a Dean’s affirmance explicitly grounded in academic standards. Under Horowitz, academic dismissals demand reduced process: notice of dissatisfaction and risk, plus a “careful and deliberate” decision. The court found those elements met, emphasizing:

  • Gilani was on notice (academic probation/warning and explicit warnings about consequences).
  • UTSW reconsidered and reversed the initial dismissal conditionally, demonstrating deliberation.
  • Gilani received an opportunity to present orally to the Student Promotions Committee.

(D) Substantive due process: extreme deference under Ewing, evaluated against the full record

The court described substantive review of academic dismissals as a “narrow avenue,” applying Ewing’s “beyond the pale” threshold and the “entire career” unit of analysis. Gilani’s strongest allegation was differential treatment on the GI Block curve (excluded from a two-point curve that would have changed pass/fail). The panel characterized it as “troubling,” but treated it as insufficient, even if true, to establish arbitrariness at the constitutional level.

Critically, the court analogized to Ewing, where unequal retesting opportunities did not render the ultimate academic judgment unconstitutional when assessed in context. Here, the committee considered Gilani’s broader record (multiple failures across years, including the elective and both GI assessments), and Dr. Thiele—an internal medicine professor and gastroenterology specialist—reviewed the examinations and concurred they reflected insufficient mastery, even verifying individual questions marked incorrect. In that posture, the court held the pleaded facts did not plausibly show a substantial departure from accepted academic norms.

(E) Allegations of a “shadow campaign” were implausible in context

Gilani alleged that Dr. Mihalic engineered several failures. The court viewed this theory as implausible given the multiple independent institutional checkpoints alleged in the complaint itself: SPC review, a prior SPC reversal of dismissal, and separate review by Dr. Thiele and Dr. Lee. The opinion thus illustrates a practical pleading point: where the complaint depicts layered review and reasoned academic assessment, conclusory claims of orchestration may fail plausibility.

(F) Qualified immunity: no plausible violation, no need to reach “clearly established”

Following Doe v. Ferguson, the court stopped at step one. Without a plausible procedural or substantive due process violation, individual defendants are entitled to qualified immunity without litigating whether existing precedent clearly established the right in question.

3.3 Impact

  • Reinforces the Horowitz/Ewing framework in academic dismissals: Even when a student alleges irregularities (grading curves, access to review), the constitutional standard remains deferential if the dismissal is academic and the institution can show notice and deliberation.
  • Limits “policy-violation equals due process violation” arguments: Institutional handbooks and internal procedures may inform arbitrariness evidence, but do not themselves define Fourteenth Amendment minima.
  • Signals the importance of characterizing the dismissal correctly: Plaintiffs attempting to obtain the more protective Goss-type disciplinary procedures must plausibly allege that the dismissal is actually for misconduct; merely alleging unfairness in academic evaluation will not automatically convert it into a disciplinary case.
  • Raises the bar for conspiracy/animus narratives in academic settings: Where the complaint itself shows multi-layer review by committees and faculty, courts may deem “engineered failure” theories implausible absent concrete supporting facts.
  • Appellate practice lesson: Failure to brief an issue (here, Title VI) can be fatal irrespective of underlying merit.
  • Precedential weight: As an unpublished decision, it is not binding precedent under Fifth Circuit rules, but it is a detailed roadmap of how the circuit applies binding Supreme Court doctrine to common medical-school dismissal disputes.

4. Complex Concepts Simplified

  • Procedural due process: The “how” of a decision—what notice and opportunity to respond the government must give before depriving someone of a protected interest (like continued enrollment, if recognized).
  • Substantive due process (in academic dismissals): Not about the steps taken, but whether the outcome was so arbitrary it violates the Constitution. Under Ewing, courts intervene only in extreme cases—when the academic decision is a substantial departure from accepted norms.
  • Academic vs. disciplinary dismissal: Academic dismissals rest on failure to meet academic/professional standards; disciplinary dismissals rest on misconduct. The label matters because academic dismissals require less process under Horowitz.
  • Qualified immunity: A protection for government officials sued personally under § 1983. If the complaint does not plausibly allege a constitutional violation, the official wins without further analysis.
  • Waiver/forfeiture on appeal: If an appellant does not argue an issue in their appellate brief, the appellate court typically treats it as abandoned and will not decide it.
  • Plausibility pleading: Under Rule 12(b)(6), courts accept well-pled facts as true but do not accept mere conclusions; allegations must be plausible in light of the full context alleged.

5. Conclusion

Gilani affirms a highly deferential constitutional posture toward academic medical-school dismissals. Applying Bd. of Curators of Univ. of Mo. v. Horowitz, the Fifth Circuit held that academic dismissals require only minimal process—notice of academic jeopardy and a careful, deliberate decision—not strict adherence to internal policies. Applying Regents of Univ. of Mich. v. Ewing, the court underscored that substantive due process relief is available only for extraordinary departures from academic norms, assessed against the student’s full academic record. The decision also illustrates two recurring litigation constraints: (1) unbriefed appellate issues (Title VI) are waived, and (2) without a plausible constitutional violation, qualified immunity ends the case at the pleading stage.