Some school administrators fear a dramatic increase in special education costs in the wake of a U.S. Supreme Court ruling last week that districts must pay for individual nursing help needed by students with severe medical disabilities to attend school.
“The potential impact of this is going to be tremendous,” said Lewis Finch, the superintendent of the Cedar Rapids, Iowa, school district, which had fought requests to pay for a nursing aide for a paralyzed boy who is dependent on a ventilator and other assistance to attend school.
Anne L. Bryant, the executive director of the National School Boards Association, estimated that as many as 17,000 children nationwide have severe disabilities that could require continuous, one-on-one help.
“The question is, ‘How do we pay for it?’ ” she said.
But disability-rights advocates said the court’s 7-2 ruling in Cedar Rapids Community School District v. Garret F. (Case No. 96-1793) was a narrow interpretation of the Individuals with Disabilities Education Act, the federal law guaranteeing a free public education for children with disabilities.
“I don’t think there are going to be floodgates that will open,” said Curtis Decker, the executive director of the Washington-based National Association of Protection and Advocacy Systems.
The group filed a friend-of-the-court brief in support of 16-year-old Garret Frey, the Cedar Rapids student who has depended on a ventilator since he was paralyzed in a motorcycle accident at age 4.
The Supreme Court on March 3 held that the IDEA requires districts to pay for continuous, one-on-one care of the sort required by medically fragile students such as Mr. Frey to attend school.
“This case is about whether meaningful access to the public schools will be assured” for students such as Mr. Frey, said the majority opinion by Justice John Paul Stevens.
The law makes districts responsible for special education and “related services” for students with disabilities. Related services include transportation, counseling, and support services such as speech pathology.
But under the statute, districts are generally not responsible for “medical services.” The question for the court was whether continuous, one-on-one nursing care for a medically fragile student is a covered related service or an excluded medical service under the law.
The majority said that the care required by Mr. Frey was a related service that was necessary for him to benefit from school. It endorsed the Clinton administration’s interpretation that only services that require the participation of a physician fall under the medical-services definition.
“Under the statute, our precedent, and the purposes of the IDEA, the district must fund such ‘related services’ in order to help guarantee that students like Garret are integrated into the public schools,” Justice Stevens wrote.
He was joined by Chief Justice William H. Rehnquist and Justices Sandra Day O’Connor, Antonin Scalia, David H. Souter, Ruth Bader Ginsburg, and Stephen G. Breyer.
Justice Clarence Thomas, joined by Justice Anthony M. Kennedy, wrote a dissent that expressed fears about the costs that districts will now face in providing care to students with severe disabilities.
“Congress enacted IDEA to increase the educational opportunities available to disabled children, not to provide medical care for them,” Justice Thomas wrote. The majority’s approach “blindsides unwary states with fiscal obligations that they could not have anticipated,” he said.
Motorcycle Accident
Garret Frey was riding on the back of a motorcycle with his father in 1987 when his blanket caught in the cycle’s drive mechanism. His head was jerked back and his spinal cord was severed.
Paralyzed from the neck down, the boy must use a wheelchair and a ventilator. But his mental abilities did not suffer.
He entered kindergarten in the 18,000-student Cedar Rapids district in 1988, and he is now a sophomore at Jefferson High School there.
During Mr. Frey’s early years in school, an aunt attended to his medical needs. He requires periodic catheterization of his urine, suctioning of his tracheotomy once during the school day, and constant monitoring for any trouble with his breathing.
Later, his family used the proceeds of a settlement with the motorcycle manufacturer to pay for a licensed practical nurse to attend to him in school.
In 1993, Charlene Frey, the boy’s mother, asked the district to begin paying for the health aide.
The district refused, contending that it was not obligated under the IDEA to provide continuous, one-on-one nursing services. The district does provide a full-time educational aide for Mr. Frey.
The district has argued that it could cost as much as $30,000 to $40,000 a year to provide the student with an individual nurse. But there has been considerable disagreement about the potential costs to the district.
The Frey family has argued that a properly trained individual could attend to both the boy’s health and educational needs at an annual cost to the district of less than $20,000.
Mr. Finch, the district superintendent, disagreed last week.
He said the district would need to provide a well-trained aide, probably a licensed practical nurse, for Mr. Frey’s health services. And the health aide would not also be able to serve as a teaching aide, according to the superintendent, so the cost to the district would be at least $30,000 a year.
The NSBA argued in a brief filed in support of the district that the costs of providing an individual nurse to a student would be particularly difficult for smaller school districts.
Ms. Bryant said last week that multiplying the estimated 17,000 students with severe disabilities times $30,000 a year on average for an individual aide would result in added costs to districts of some $510 million.
Jim Bradshaw, a spokesman for the Department of Education, said the agency had no figure available on the number of medically challenged students who might require one-on-one nursing services.
Federal Boost Needed?
Underlying school districts’ worries about the ruling is their long-standing argument that the federal government has failed to provide full funding for the entitlement to special education granted by the IDEA.
Jay Diskey, a spokesman for the Republicans on the House Education and the Workforce Committee, said the ruling was being widely discussed last week by members of Congress concerned about the funding levels for special education.
“This demonstrates once again the tremendous expense associated with this federal mandate,” he said. He added that GOP lawmakers would like to increase funding for special education, while the Clinton administration has proposed level funding in its fiscal 2000 budget.
Perry F. Zirkel, a professor of law and education at Lehigh University in Bethlehem, Pa., said the high court has consistently interpreted the IDEA as imposing a clear obligation on districts to make education available for all students.
He said he doubted there were a huge number of medically fragile children who require continuous, one-on-one care.
“If there is a strong backlash of school districts, then they could go to Congress” and seek changes in the law, he said.
Mr. Decker of the disability-rights group argued that most school districts have assumed they were responsible for nursing services for students with disabilities at least since 1984, when the Supreme Court ruled in Irving Independent School District v. Tatro that the clean intermittent catheterization required several times a day by a student with spina bifida was a related service covered by the special education law.
The Tatro ruling endorsed a test formulated by the Education Department for interpreting the “related services” provision of the special education law. If a service had to be performed by a physician, it was a medical service excluded from district responsibility under the law, according to a department regulation. If it did not involve a physician, it was a “related” service.
