Disabled Pupils Win Right to Medical Aid
Washington Post Staff Writer
Thursday, March 4, 1999; Page A1
The Supreme Court ruled yesterday that public schools must provide a wide array of medical care for disabled children attending classes, over protests that the decision would seriously strain the resources of many school districts.
With more and more young accident victims and chronically ill children able to attend school with the help of respirators, feeding tubes and other technological advances, school officials across the country increasingly are being called upon to furnish medical services with the regular curriculum.
About 6 million students nationwide have disabilities, including tens of thousands who require "significant assistance," according to federal figures. Yesterday's decision could dramatically ratchet up local school boards' costs for meeting those medical needs.
"No one argues that these children need services," said Ray Bryant, special education director of Montgomery County. "But extending services to education like maintaining ventilators and . . . skilled nursing really seems to go beyond what education does."
By a 7 to 2 vote, the court expansively interpreted a federal law intended to improve educational prospects for the disabled and ruled that a school district in Cedar Rapids, Iowa, must provide all-day nursing care to a quadriplegic boy.
"Congress intended to open the door of public education to all qualified children," Justice John Paul Stevens wrote for the court, emphasizing that states are "to educate handicapped children with non-handicapped children whenever possible."
Citing federal law dating back to the 1970s that requires schools to provide "special education and related services" to disabled children, Stevens said the court concluded that schools must offer any assistance necessary to keep a student in school, short of a physician's care.
Justices Clarence Thomas and Anthony M. Kennedy dissented, asserting that the majority's interpretation transforms a law that was designed to boost educational opportunities into a mandate for medical care.
"It takes the focus of schools away from being educators and into being medical service providers," said Anne Bryant, executive director of the National School Boards Association.
But the U.S. Department of Education, which had backed the Cedar Rapids student, praised the ruling. "This is a very important decision for . . . all of America's disabled children," said Judith E. Heumann, assistant secretary for special education.
The case revolved around Garret Frey, who at age 4 was paralyzed from the neck down after a motorcycle accident. Now a high school sophomore, Frey's mental capacity was not affected and he can speak, control his motorized wheelchair with a puff-and-suck straw and operate a computer with a device that responds to head movements. He uses a ventilator to breathe.
While at school, Garret needs help with bladder catheterization and the suctioning of his tracheotomy tube. In kindergarten, an 18-year-old aunt accompanied him to school; then the family used insurance money from the accident and other resources to hire a nurse to assist him through fourth grade.
In 1993, Garret's mother asked the Cedar Rapids Community School District to pick up the nursing cost, but the district refused, saying such services were not part of school health care but rather "medical services," which are not covered by the Individuals with Disabilities Education Act (IDEA), as the law is now called.
Lower courts ruled against the district. In its appeal to the justices, the school district argued that it should be able to weigh its ability to provide the requested service and its costs, among other factors.
Spurning that appeal, Stevens relied on a 1984 ruling on the disabilities law that laid out a two-part standard for determining what is meant by "related services" and what care is excluded. Parents had to show that the care was essential to their child's ability to attend class and that it could be provided in school by a nurse or other qualified individual, but not a physician. On both counts, Stevens said, Garret met the test.
Stevens was joined by Chief Justice William H. Rehnquist and Justices Sandra Day O'Connor, Antonin Scalia, David H. Souter and Ruth Bader Ginsburg.
In their dissent, Thomas and Kennedy said the majority's interpretation strains constitutional limits on how Congress can put financial obligations on the states.
The Cedar Rapids school district already had been providing Garret a teaching assistant and other services but balked at spending an additional $30,000 to hire a nurse.
Federal IDEA funds are distributed to states on a sliding scale based on the number of disabled students in each state and other factors, but they only meet a fraction of the local costs. Garret's lawyer has estimated that Iowa receives as much as $12,000 a year to assist Garret in class, but the school district says the amount is much less.
School district lawyer Sue Luettjohann Seitz expressed dismay at the budget implications of the ruling in Cedar Rapids v. Garret F. "Special education has really come to the forefront in the last 10 years," she said, "and the nature of the claims are very different. Medically fragile children were not in school before."
But Garret's lawyer, Douglas R. Oelschlaeger, insisted that: "This case is about meaningful access. It's about getting in the front door. It's about surviving at school. And it's about getting home at the end of the day."
Staff writers Amy Argetsinger, Victoria Benning and Ellen Nakashima contributed to this report.
© Copyright 1999 The Washington Post Company