Required Health Services Under Special Education

On March 3, 1999, the Supreme Court's decision in Cedar Rapids Community School District v. Garret F., 1999 WL 104410 (1999), addressed the issue of whether certain intensive nursing services should be categorized as "medical services" for which the school is not required to pay or as "related services" for which the school would be required to pay.

The case arose because Garret F., a high school student who had been paralyzed at age four, required a variety of services for his physical needs while in school. The services require some degree of training, but are not required to be performed by a physician. They are, nonetheless, intensive, and costly. The obligation of the educational agency to pay for these services during school hours depends on the interpretation of the terms "medical services" and "related services" under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. sections 1400 et seq. IDEA requires students with disabilities to be provided related services at agency expense, but not medical services other than those needed for diagnostic and evaluation purposes. The Court addressed the meaning of these terms.

The Court, in a 7-2 opinion, affirmed the lower court's holding that the services needed by Garret F. are related services that must be funded by the educational agency. In so doing, it rejected the school district's argument that a cost-based, multifactor test that considers the nature and extent of services should be used to make the distinction. This is a test that had been accepted by some lower courts.

The Court rejected the school district's argument about the potential financial burden, by deciding that while this may be a legitimate concern, the case must turn on Congressional intent, and Congress did not allow for an undue burden defense in IDEA cases.

The case is significant, not only because it clarifies an important unresolved issue, but also because it raises an important policy issue about who should bear the costs in cases involving individuals with expensive and intensive health care needs and who should bear these costs between various educational funding sources.

With respect to the cost burden between the individual and the public agency, it is important to note that this case only resolves the cost issue until Garret F. graduates from high school. Once a student graduates from high school, he or she is no longer eligible for services under the IDEA. That student must then rely on a patchwork of coverage under vocational education programs, federal benefits programs for indigent and disabled individuals, private health and disability coverage, and damage recoveries in tort cases. This case serves as a reminder of the cost burden that is placed on individuals and their families when catastrophic illness and impairment occurs. As a policy matter, it seems that a funding source to cover the health- related costs of these conditions over a lifetime should be in place.

Among educational agencies, this case raises the problem that for the small school district with a limited budget, an expensive special education service such as this or a placement such as a residential placement can be an extreme burden. A larger school district with a larger budget will be in a much better position to offset these high cost placements. The case highlights the need to have such services directly funded by the state educational agency or even the federal Department of Education.

Thus, while the decision resolves the legal responsibility for these cases under statutory interpretation for students in public schools, it certainly does not resolve the policy questions about how these costs should best be shared by society.

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©2006 Texas Medical Center

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