Nepali Plaintiffs Double Down on 'Severe Harm' Caused by Invalidated USMLE Scores

The Nepali medical graduates who filed a class action lawsuit against the National Board of Medical Examiners (NBME) have amended and refiled their complaint.

In their latest suit, the plaintiffs alleged that having their U.S. Medical Licensing Examination (USMLE) scores invalidated caused "severe harm" and was the result of discrimination based on national origin, citing the Civil Rights Act. They demanded $80 million in damages, which would equal just over $96,000 per person with invalidated scores.

Back in February, the USMLE invalidated test scores for 832 examinees after an ongoing investigation identified "a pattern of anomalous exam performance" primarily associated with Nepal, with many Nepali test-takers scoring much higher and answering questions faster than average.

Shortly after this, Latika Giri, MBBS, a Nepali medical graduate, launched a class action lawsuit. However, a judge quickly denied an emergency motion to restore score validity.

Now, Swechha Shrestha, MD, has joined the lawsuit as another class representative.

Giri and Shrestha have a few notable differences. Both hold Nepali citizenship, but Giri lives in Kathmandu, while Shrestha lives in Nevada. All three of Giri's scores were invalidated, while Shrestha only had Step 3 invalidated.

Educational Commission for Foreign Medical Graduates (ECFMG) certification, which evaluates international medical graduates (IMGs), is required for IMGs to enter Accreditation Council for Graduate Medical Education (ACGME) residencies. One requirement for ECFMG certification is passing Steps 1 and 2 of the USMLE.

Bryan Carmody, MD, who runs the popular medical education blog, "The Sheriff of Sodium," and has been following the scandal closely, told MedPage Today that many IMGs take Step 3 earlier than required to boost their chances of matching into residency.

On X, Carmody noted that the judge had previously said that someone who had already matched into residency before their scores were invalidated, and therefore were at risk of being removed from the program and losing their visa, would be a more compelling plaintiff. While Shrestha is in residency, she is not required to leave the country since her ECFMG certification is intact, though she will have to retake Step 3 while "maintaining a demanding schedule."

"I don't know that many people would find that to be that severe -- all she has to do is pass the retake and she'll be okay," Carmody noted. He also pointed out that U.S. medical graduates take Step 3 during residency and because the test costs nearly $1,000, it's not uncommon for people to take it later in residency.

However, Giri, who was applying to residency this year, became ineligible for the Match when her scores were invalidated. The complaint said that those like Giri "will effectively be barred from the practice of medicine in the U.S. for many years and their careers will be derailed permanently."

The lawsuit also included the USMLE policy on score validation, which details that people who had their scores invalidated will be able to retake the tests for free. The retake for Step 1 will be in August, Step 2 in September, and Step 3 in December, with more retake dates in 2025. If an examinee fails their retake, they will be suspended from the USMLE for 3 years. Invalidated outcomes will remain on USMLE transcripts "in perpetuity" and marked with "Score Not Available."

Carmody doesn't think having that mark on their transcript will have major consequences unless licensing bodies change policies to prohibit licensing people who have had a score invalidated.

In terms of "severe harm" to plaintiffs, the refiled complaint also noted that "perhaps worst of all, NBME, by loudly and publicly invalidating Nepali doctors' scores, has cast a discriminatory stigma over their whole community."

A spokesperson for the Federation of State Medical Boards, which co-runs the USMLE alongside the NBME, declined to answer MedPage Today's questions about whether they are looking into cheating in other countries or if scores from other countries have been invalidated. The spokesperson said they cannot comment on pending litigation.

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