In Cedar Rapids Community School District v. Garret F. (1999), the U.S. Supreme Court ruled that the Individuals with Disabilities Education Act (IDEA) requires school boards to provide full-time nursing services to students with disabilities who need them during the school day. The decision ended a controversy that existed among the federal appeals circuits. This entry describes the case and the court’s ruling.
The student in Cedar Rapids, Garret F., was a quadriplegic who was ventilator-dependent due to his spinal column being severed in a severe motorcycle accident when he was 4 years old. During the school day, he required a personal attendant within hearing distance to see to his health care needs. He required urinary bladder catheterization, suctioning of his tracheostomy, observation for respiratory distress, and other assistance. He attended regular classes in a typical school program and was successful academically.
While he was in kindergarten through grade 4, his family provided the personal attendant. When he was in the fifth grade, his mother requested that the school board provide the needed nursing services, but the board refused. After the parent requested an administrative due process hearing under the IDEA, an administrative law judge decided that the school board was responsible for this service. A federal trial court in Iowa affirmed, concluding that such services did not fall within the medical exclusion clause of the IDEA’s related services provision. The school board appealed.
The Eighth Circuit affirmed that because the required services were provided by a nurse, not a physician, they fell under the umbrella of school health or supportive services rather than medical services. The appellate court noted that the Supreme Court’s earlier opinion in Irving Independent School District v. Tatro (1984) established a bright line test, whereby the services of a physician are exempted, but services that can be provided in the school setting by a nurse or qualified layperson are not. Again, the school board appealed, and the Supreme Court agreed to hear the case.
In a 7-to-2 decision, the Supreme Court affirmed the Eighth Circuit’s ruling. Writing for the majority, Justice Stevens noted that the IDEA’s definition of related services, the Court’s own decision in Tatro, and the overall statutory scheme all supported the appellate court’s decision. Stevens wrote that the related services definition broadly encompassed those supportive services that may be required to assist a student with disabilities to benefit from special education. The Court recognized that the cost of the services and the competence of school staff were justifications for drawing a line between the services of a physician and other services, but it stated that its own endorsement of that line was unmistakable.
The majority was of the opinion that it was settled that the phrase medical services in the IDEA did not embrace all forms of care that might loosely be described as medical in other contexts. Justice Stevens commented that while they might be more extensive, the services required by the student in Cedar Rapids were no more medical than the care required by the student in Tatro. Further, Stevens asserted that the continuous character of certain services associated with Garret F.’s ventilator dependency had no apparent relationship to medical services, much less a relationship of equivalence. Although continuous services, such as those required by Garret, may be more costly and may require additional school personnel, the Court did not see that these factors made them more medical.
Insofar as the IDEA does not use cost in its definition of related services or excluded medical services, the Court specifically rejected accepting a cost-based standard, as had been suggested by the school board, as the sole test for determining the scope of the provision. The Court thought that doing so would have required it to engage in judicial lawmaking without any congressional guidance. In the Court’s view, Congress intended to open the door of public education to all qualified students with disabilities and require school boards to educate those students with students who were not disabled whenever possible. Under the IDEA and the Court’s own precedent, the majority insisted that a school board must fund such related services to help guarantee that students such as Garret were integrated into the public schools.
Justices Thomas and Kennedy dissented, in essence because they disagreed with the Court’s application of Tatro, which had been decided before they joined the Court. Writing the dissent, Thomas said that Tatro could not be squared with the text of the IDEA, and thus should not have been adhered to in Cedar Rapids. Thomas noted that the IDEA regulations require school boards to provide disabled students with healthrelated services that school nurses can perform as part of their normal duties, but unlike the service at issue in Tatro (clean intermittent catheterization), a school nurse could not provide the services Garret needed and continue to perform her normal duties. Instead, Thomas observed, because Garret required continuous one-to-one care throughout the school day, the school board was required to hire an additional employee to attend to his needs.
Allan G. Osborne, Jr.
See also Disabled Persons, Rights of; Irving Independent School District v. Tatro; Related Services