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Ruling gives breast-feeding student extra break in exam

A state appeals court judge ruled yesterday in favor of a Harvard medical student who wanted extra time to pump breast milk during a licensing exam.

The woman, Sophie Currier of Brookline, argued that it would be uncomfortable and possibly pose a health problem if she took only the allowed breaks.

The National Board of Medical Examiners offered to let her pump while she took the test, but she said that would put her at a disadvantage during the exam, which she must pass to graduate and begin her residency at Massachusetts General Hospital.

"I now feel that I am able to take this test without putting my health or my child's health at risk," said Currier. "I hope this decision encourages moms to breast-feed and employers of moms to accommodate their needs."

Board attorney Joseph Savage said he would appeal the ruling, which he said compromised the test's fairness and could force the board to grant extra time to other test-takers with distracting medical conditions, such as men with prostate problems.

The decision to allow Currier an additional 60 minutes of break time per day is the latest in a legal battle that began Sept. 6, when Currier filed a lawsuit arguing the board violated her constitutional rights by denying her more than the 45 minutes of rest periods allotted to all test takers. She also accused the board of gender discrimination.

Last week, a superior court judge denied her claim, saying Currier could still find a way to express her milk during the test or allotted break time.

But Appeals Court Judge Gary Katzmann overturned that decision. "In order to put the petitioner on equal footing as the male and nonlactating female examinees, she must be provided with sufficient time to pump breast milk and to address the same physiological and other functions to which those examinees are able to attend," he wrote.

Currier, who has a 4-month-old daughter, originally planned to take the exam this week, but postponed it until Oct. 4 in hope of winning her appeal. She has already received permission from the board to take the test over two days instead of the usual one, because she has dyslexia and attention deficit hyperactivity disorder.

Lactating women can experience pain and risk developing infection of their breasts if they don't express milk at least once every three hours, breast-feeding specialists say.

Some doctors and breast-feeding advocates have called the board's resistance to Currier's request ironic when mainstream medical organizations overwhelmingly endorse breast-feeding. The American Academy of Pediatrics recommends that infants be exclusively breast-fed during the first six months of life.

Nancy Terres, an assistant professor of nursing at Massachusetts General Hospital's Institute of Health Professions who is researching social support for breast-feeding, said the case showed that breast-feeding still carries a stigma in today's society.

Dr. Ruth Hoppe, a spokeswoman for the Board of Medical Examiners, said the board supports breast-feeding but wants the freedom to apply its policies consistently, rather than engaging in "ad hoc decision making."

"We have about 30,000 individuals taking this test every year, many of whom have a variety of personal needs," she said. "It's not an easy day for them. We do our level best to respond to those needs but we also have to keep the testing circumstances uniform, and that includes the time of administration of the test."

Bills pending in Congress and the Massachusetts Legislature would prevent discrimination against nursing mothers, though it is unclear whether they would apply in Currier's case.

US Representative Carolyn Maloney, a New York Democrat who is sponsoring the federal legislation, praised yesterday's ruling. The medical exam board, she said, "flunked this test the first time around."

"But on the do-over, they can try and score a passing grade by giving Ms. Currier the extra hour of break time she requested," Maloney said.

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