Rule riles a diabetic test-taker

Says medical equipment viewed as cheating device

Sara Kingsley showed insulin pump mistaken for an iPod. (Ellen Harasimowicz for The Boston Globe)

The small device with a digital screen that Sara Kingsley keeps in her front pocket is her lifeline. For nearly a decade, it has injected insulin into her body through slender tubes attached to her back, helping prevent her blood sugar levels from running too high or too low.

Yet when Kingsley, 24, who is diabetic, showed up last month in Lowell to take the Graduate Record Examination, the standardized test necessary for entrance to many graduate school programs, the proctor told her to remove it.

"He was convinced it was an iPod," Kingsley said in a telephone interview last week. "I never thought anyone would question my insulin pump. People don't question if you have glasses or a hearing aid. It was a really humiliating experience for me."

The proctor eventually allowed her to keep the pump but often hovered over her during the exam, worried she was using the device to cheat, she said. But he refused to let her bring in a bottle of cranberry juice and a blood-sugar monitoring kit, which she said she needed to keep her blood sugar levels stable. Kingsley said she reported the proctor's action to the company that administered the exam by telephone more than a week ago, but the company has not yet assigned a case number, which is necessary before she can file a formal complaint.

The National Center for Fair & Open Testing, a longtime critic of standardized testing, said the incident highlights a culture more concerned about preventing cheating than protecting someone's life.

"The concern about security in these exams is understandable . . . but they almost fetishize security beyond the realm of rationality," said Robert Schaeffer, public education director for the nonprofit advocacy group, which also goes by the name FairTest.

Tom Ewing, spokesman for Educational Testing Service, in a phone interview last week said Kingsley should have sought prior written approval to have the medical device, cranberry juice, and blood-sugar testing kit. Ewing was speaking on behalf of his company, the creator of the GRE, and its contractor Prometric: Testing and Assessment, which administered the exam in Lowell.

"It's unfortunate that Ms. Kingsley had to go through that, but it could have been avoided if Ms. Kingsley went through the same procedure that thousands of other students go through," Ewing said. "Obviously, we want everyone to test to the best of their abilities."

The testing company has set strict rules for the high-stakes exam not only to prevent cheating but also to protect test takers from disruptions. The rules are outlined in a 52-page booklet sent to each test taker. Participants cannot consume food or beverages during the exam and must empty pockets of all personal items, which are then placed in a secured area.

The rules explicitly state no electronic devices are allowed into the exam room. Offered as examples are items such as cellphones, calculators, and BlackBerries, but not medical equipment.

In pleading her case on the morning of Oct. 24, Kingsley said she lifted up the back of her shirt to show the proctor how the device's tubes were inserted underneath her skin. After he relented, he kept a watchful eye and told her during a break he still did not believe the device was legitimate, Kingsley said. She considered his treatment of her unnecessary harassment.

"There are cameras in the room," said Kingsley, a senior at the University of Massachusetts at Amherst, who grew up in Acton. "If he had any doubt I was cheating, there was no reason for him to stand behind me."

During the exam, Kingsley tried muffling the device because it occasionally emitted quick double beeps.

"During the majority of the test, I spent more time anxious about my blood sugar than concentrating on the test," Kingsley said. "I don't think I did so well."

That amount of stress could have caused changes in her blood sugar levels, said Howard Wolpert, director of the insulin pump program at Joslin Diabetes Center in Boston.

Wolpert said he found it surprising that a test taker would have to seek advance approval for such basic necessities as a blood sugar testing kit, carbohydrates, and an insulin pump, which eliminates the need for daily injections with a syringe.

"Diabetes has become so commonplace," Wolpert said. "I can imagine with a student busy studying for an exam, the last thing they are thinking about is getting permission for something like juice."

Carbohydrates can quickly boost low-blood sugar levels, while a testing kit is essential in quantifying insulin levels, even for a person who uses an insulin pump.

Failure to respond to an insulin emergency could lead to serious illness and hospitalization.

Educational Testing Service granted 3,500 requests for special accommodations last year for the GRE. "If a person registers in advance, testing can go smoothly," Ewing said. "We have a supervisor charged with not allowing any electronic devices, food, or drinks. This adviser was probably caught off guard."

Kingsley said she had been torn about going to graduate school or law school, but she now intends to become a lawyer to fight discrimination.

"No one should have to go through this," Kingsley said.