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Related Medical Services Under the IDEA

October 30, 2016

Under the Individuals with Disabilities Education Act ("IDEA"), local boards of education have a duty to ensure that a free appropriate public education is available to all children with disabilities between the ages of three (3) and twenty-one (21).  The term "free appropriate public education" means special education and related services which, among other criteria, are provided in conformity with a student's Individualized Education Program ("IEP").

Since the enactment of the IDEA, there has been an ongoing attempt to discern the scope of services which fall within the definition of related services and, therefore, must be provided at public expense.1  The federal regulations promulgated for guidance in IDEA implementation define "related services" to include health services (those services provided by a qualified school nurse or other qualified person).  34 C.F.R. § 300.16(a), (b)(11).  In contrast, the regulations define medical services as those "provided by a licensed physician."  34 C.F.R. § 300.16(b)(4).

In light of these fine distinctions, courts have struggled with the issue of whether the obligation to provide a service should depend on the nature of the service to be provided or on the provider of that service.  However, on March 3, 1999, the United States Supreme Court, in a 7-2 decision, decided on the latter, affirming the narrow definition of "medical services" to include those services which must be rendered by a physician, and not school health services which may be rendered by a school nurse or other qualified person.

In Cedar Rapids Community School District v. Garret F., No. 96-1793, __ U.S. __ (1999), the Court addressed the question of whether the IDEA definition of "related-services" required the Cedar Rapids Community School District ("District") to provide disabled student, G.F., with one-on-one nursing care during school hours.  Specifically, G.F. is paralyzed from the neck down and requires continuous one-on-one care, including assistance with urinary bladder catheterization and the suctioning of a tracheotomy tube.  G.F.'s care provider must be familiar with his ventilator in the event of a malfunction or electrical problem and be able to perform certain emergency procedures should complications arise, but the care provider need not be a physician.

The District argued that providing the requested services to G.F. would place an undue financial burden on the District, as they would have to employ a full-time nurse to care for just one student.  In support of its argument, the District proposed a cost-based analysis by which to determine what services fall within the medical services exclusion.

The Court rejected the District's cost-based approach, instead approving continued use of the two-step analysis set forth in Irving Independent School Dist. v. Tatro, 468 U.S. 883 (1984).  In Tatro the Court asked: (1) whether the requested services are supportive services necessary for the child to be educated with nondisabled children to the maximum extent appropriate; and (2) whether the services are excluded as medical services (provided only by a physician).  Using this analysis, the Court found that the District must bear financial responsibility for all of the disputed services.

Although the Court recognized the legitimate financial concerns of the District, the Court declined to engage in "judicial lawmaking" by using a cost-based standard in determining the scope of related services.  Rather, in accordance with the Congressional intent underlying the IDEA, the Court noted that its decision must "open the door of public education to all qualified children" and require public school districts to educate disabled children with nondisabled children whenever possible.  Therefore, the Court concluded that "nder the statute, our precedent, and purposes of the IDEA, the District must fund such 'related services' in order to help guarantee that students like [G.F.] are integrated into the public schools."

In light of this decision, local school boards must continue to employ the Tatro two-step analysis in determining whether a service must be provided at public expense.  In order to ensure meaningful access to public schools, the Court has cautioned against a cost-based approach, and affirmed that the determination of whether services fall within the medical exclusion turns on the provider of the services.


1 The IDEA defines the term "related services" to mean transportation, and such developmental, corrective and other supportive services (including, among others, psychological services, physical and occupational therapy, social work services, counseling services, - and medical services, except that such medical services shall be for diagnostic and evaluation purposes only) as may be required to assist a child with a disability to benefit from special education.  20 U.S.C. §1401(22).

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