Special Education
April 24, 2012

Fact Sheet 12-14: Supreme Court Rules on Nursing Services Under the IDEA

Source: Research and Educational Services

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On March 3, 1999, the Supreme Court ruled in Cedar Rapids Community School District v. Garret F. (119SCt.992) that an Iowa school district must provide health services to a "ventilator dependent" boy under the Individual with Disabilities Education Act (IDEA). The Supreme Court decided that the IDEA's definition of related services requires school districts to provide students with health services that are necessary for them to attend school, if these services can be provided by qualified individuals other than physicians. The following is background information on the court decision, its implications for New York State, and advice to local leaders.

Background Information

Garret F. is a teenager whose spinal column was severed in a motorcycle accident when he was four years old. Justice Stevens states that Garret's mental capacities were unaffected, though paralyzed from the neck down. He is able to speak, to control his motorized wheelchair through use of a puff and suck straw, and to operate a computer with a device that responds to head movements.

Garret attends regular classes; however, he is quadriplegic ventilation dependent and therefore, requires an individual to attend to certain physical needs while in school. He also needs assistance with urinary bladder catheterization, the suctioning of his tracheotomy, and providing food and drink, repositioning in his wheelchair, monitoring his blood pressure and someone familiar with his ventilator, if problems arise.

The Cedar Rapids Community School District declined to accept financial responsibility for the services Garret needs, believing that it was not legally obligated to provide continuous one-on-one nursing care. In its petition for certiorari, the District pointed out that some federal courts have not asked whether the requested health services must be provided by a physician, but instead have applied a multi-factor test that considers the nature and extent of the service at issue. Such factors include: "(1) whether the care is continuous or intermittent, (2) whether existing school health personnel can provide the service, (3) the cost of the service, and (4) the potential consequences if the service is not properly performed."

The Court rejected the District's multi-factor test as the characteristics are not supported by any "recognized source of legal authority." The Court further stated that the District offers no explanation why these characteristics make one service any more "medical" than another. The Court concluded that "this case is about whether meaningful access to public schools will be assured, not the level of education that a school must finance once access is attained.

Under the statute, our precedent and the purposes of the IDEA, the district must fund such related services to help guarantee that students like Garret are integrated into the public schools."

Implications for New York State

Need to Examine Local Policy/Procedure on Provision of Nursing Services

In a March 1995 guidance memorandum entitled, The Provision of Nursing, Tasks and Health-Related Activities in the School Setting for Students with Special Health Care Needs, the State Education Department indicated that "although the public schools' responsibility to provide such services [school health services] is broad, it is not without limits." The State Education Department cited the decision of the United States Court of Appeals for the Second Circuit, Detsel v BOE, 820 F 2nd 587 [2nd Cir. 1987], in which the Second Circuit declined to order a school district to provide a child with a severe disability constant professional health care, as opposed to the intermittent care necessary to provide "clean intermittent catheterization" ordered by the United States Supreme Court in its prior decision in Irving Independent School District v Tatro, 468 US 883.


Download complete bulletin. (230k pdf)

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