The Trials of a Diabetic Diplomat

by james s. hirsch

It dawned on Anna Balogh, the full significance of her action, when she Googled her name and found the link to her lawsuit: “Anna Balogh vs. Condoleezza Rice,” the U.S. Secretary of State. Balogh was suing the State Department for its refusal to allow her to be a Foreign Service officer on grounds that she has type 1 diabetes. Born to Hungarian refugees, she was challenging the very government, and country, that had provided safe haven to her parents.

“I was horrified,” she says. “That’s not the way I envisioned seeing my name.”

But there was a higher principle at stake – to try to shatter a glass ceiling of ignorance that was preventing her and other insulin-dependent patients from filling jobs for which they are qualified. For decades, people with diabetes have been fighting against job bias and discrimination, though most of those battles have been against private employers, such as trucking companies and automakers. In this case, Balogh was battling the federal government, which is supposedly charged with protecting those rights.

Hers is surely one of the more unusual, though also precedent-setting, efforts to chip away at employment barriers for those with diabetes.

Her Hungarian parents, Karoly and Judith Balogh, sought a new homeland in 1956 when the Soviet Union crushed a revolt against that country’s Stalinist government. They found refuge in the United States and settled in the Boston suburb of Lincoln, where they raised their three children.

Anna, born in 1971, was their youngest, and she was soon well traveled. Her parents, both physicians, took her and her two brothers on two different trips to Eastern Europe, and Anna traveled to the Soviet Union with her high school class. After her freshman year in college, she also lived in Hungry for a summer.

Balogh earned a master’s degree from Tufts University’s Fletcher School of Law and Diplomacy. With an interest in public service, an ability to speak three languages, and a desire to represent America abroad, she was hired in 2003 to be a Foreign Service officer. “It’s a front row to history,” she says – and a fitting position for a woman whose very family was testimony to the American dream.

But it wasn’t to be. About six or seven months after she received the job offer, the nurse who examined her called and said that her medical clearance had been denied. Balogh recalls: “In one of these conversations, she said to me, ‘You’ve been diabetic a long time,’ which I thought was incredibly rude, making the assumption that I’d be developing complications soon.”

Balogh appealed the decision, but it was rejected. She says the State Department “just wished me a good life. I just thought, ‘this can’t be.’”

The nurse got one thing right: Balogh had been diabetic a long time. She was diagnosed when she was 2 ½, and, remarkably, she recalls the experience: how she was with her family at a vacation home in Maine, how thirsty she was and wanting to drink more ginger ale and grape Hi-C; and how her mother drove her to a hospital in Boston while she sat on a six-pack of Tab. “I remember at the hospital watching a puppet show with a dragon,” she says.

Though 1974 was the relative dark ages in diabetic care – before home glucose monitoring and pure, fast-acting insulin – Anna’s condition did not limit her. “My parents wanted me treated like every other kid,” she says. “This was a non-topic. You do everything you can. You challenge yourself.”

She learned at a young age that health care providers are not always knowledgeable or sensitive. “I got a lot of castigation as a young child for lack of [blood sugar] control,” she says. She was doing the best she could given the tools of the day, but “I went to Mass General. I was 12 or 13 years old, and a resident said to me, ‘Don’t you want to have children some day?’”

Her dream of becoming diplomat crystallized when she lived in Hungry in the summer of 1990 and, with Communism collapsing in the Eastern bloc, she could discuss German reunification with her East German roommate. Her travels taught her something else: There are people with diabetes everywhere, all over the world, and that means so too are supplies of insulin. She’s never had any concerns about being overseas.

“If local diabetics can do it, then I can do it,” she says.

She’s also learned to adapt. She began using a Medtronic insulin pump in 2003 and lived in Belgium for two years. Medtronic wouldn’t ship pump supplies abroad, so she would haul them back on her own when she visited the States or have her parents send them. When her pump died, it took two weeks to get a new one – but she was prepared with syringes and a basal insulin.

All along, Balogh believed her diabetes would be a non-factor as a Foreign Service officer because her own health has been so good. She has never gone to a hospital emergency room for hypoglycemia or any other diabetic calamity. She catches falling blood sugars before she needs assistance. In the 1980s, she had eye surgery for incipient diabetic retinopathy. The procedure was a success, and she currently suffers from no diabetic complications.

But that mattered little when her medical clearance was denied. “I had this misplaced idea that if they only paid attention to my individual case, everything would be fine,” she says. “It was a slap in the face, like I was being told I was worth less than a non-diabetic person. There are blind and deaf people in the Foreign Service. I took the whole thing very personally.”

She initially reached out to the American Diabetes Association and the U.S. Equal Employment Opportunity Commission, but eventually she had to hire her own lawyer, Hillary Schwab. Balogh gave her an article about U.S. Army Sergeant Mark Thompson, a type 1 diabetic who fought in the Iraq war. “If he can fight in Iraq,” Balogh says, “then I can do a desk job somewhere.”

Balogh’s lawsuit against the State Department, filed in 2007, alleged that her rights had been violated under the 1990 American with Disabilities Act, which prohibits employers from discriminating against people with physical or mental impairments. In court filings, the government denied that it had discriminated against Balogh. It argued that, with some 270 posts worldwide, diplomats had to be able to go anywhere, but insulin-dependent diabetics do not meet that standard because they could be sent to posts where diseases such as malaria and dengue fever are prevalent, and those maladies could complicate a diabetic’s ability to maintain proper glucose levels.

Balogh’s response: those mosquito-borne diseases could complicate anyone’s health, and the government’s view of diabetes is antiquated, given the worldwide prevalence of the disease and the increasingly sophisticated tools to treat it.

The case was to begin in December in U.S. District Court in Boston. In effect, diabetes would be on trial.

But days before it was to start, the government and Balogh reached a settlement. Balogh will be appointed as a Foreign Services officer for what she describes as a three-year “trial period.” The State Department calls it a “limited non-career appointment,” which is a non-tenured track position. After three years, her job performance will be assessed, and she will undergo another medical review. The government is also giving her an undisclosed financial settlement for wages lost when she was not hired. The job itself pays $70,000 a year. Balogh won’t say how much she has paid in legal fees.

Balogh, who is single, will learn in the coming months where she will be located. She says she is satisfied with the outcome, “but what would have brought me the most happiness is if I had started this job six years ago and on time.” The irony is that until now, Balogh rarely disclosed that she had diabetes, even to friends or teachers, and she resents that this controversy has forced her to come out. But she hopes it’s a “teaching moment” for all concerned.

Indeed, the battle is hardly won.

In the settlement, the State Department admitted no wrongdoing, and the ban that prohibited Anna Balogh from serving her country is still in place.