Rights Watch
IDEA Ruling: How It Adds Up

A landmark Supreme Court decision declares schools must cover one-on-one health care for disabled students.

Garret Frey was only four years old when a motorcycle accident severed his spinal column.

Now a high school sophomore in Cedar Rapids, Iowa, he motors around his school in a specially equipped wheelchair that allows him to steer by blowing into a straw.

Because he is paralyzed from the neck down, Garret needs constant one-on-one assistance to feed him, perform bladder catheterizations, suction his tracheotomy tube, and monitor his ventilator.

When he first went to school, Garret's 18-year-old aunt tended to his health care needs. Later, his family used the proceeds from an insurance settlement to hire a licensed practical nurse to care for him at school.

In 1993, his mother asked the Cedar Rapids Community school district to foot the bill for Garret's school-related health care. When the District refused, she sued.

Frey argued that the district should pay for his nurse under the Individuals with Disabilities Education Act (IDEA).

In an important 7-2 ruling handed down in March, the U.S. Supreme Court agreed.

IDEA requires schools to provide disabled students with whatever "health services" the student needs to attend school--except that schools don't have to provide "medical services."

In an opinion by Justice John Paul Stevens in Cedar Rapids Community School District v. Garret F., the High Court said that a "medical service" is a service that can be performed only by a licensed physician. Since Garret's medical needs can be met by a nurse or trained layperson, the Court reasoned, it is a "health service" for which the school must pay.

The Court rejected the school district's plea that hiring a full-time nurse to care for Garret would be too costly.

"The District cannot limit educational access simply by pointing to the limitations of existing staff," the Court said, even if it means that the school has "to hire specially trained personnel to meet disabled student needs."

Dissenting, Justice Clarence Thomas complained that the majority "blindsides unwary States with fiscal obligations that they could not have anticipated.

"Congress enacted IDEA to increase the educational opportunities available to disabled children, not to provide medical care for them," he emphasized.

It's too early to assess the impact of the Court's ruling, but critics warn that it imposes yet another burden on schools, an unfunded mandate that will drain resources from regular education programs.

The Cedar Rapids school district claims it will cost $30,000 to $40,000 a year to comply with the Court's order. "Who is going to provide that money?" asked Sue Seitz, the school district's attorney.

The National School Boards Association estimates that there are 17,000 "medically fragile" students who will need continuous assistance from a nurse or aide--services with a total price tag of $500 million a year. NSBA executive director Anne Bryant criticizes the Court's decision, saying "it takes the focus of schools away from being educators" and makes them "medical service providers."

And in the end, a Los Angeles Times editorial cautioned, the decision "may shortchange more students than it helps."

Advocates for the disabled were pleased by the ruling and down-played its potential impact on school coffers.

Judith Heumann, assistant secretary for special education at the U.S. Department of Education, said the decision "will help advance the inclusion of disabled children into society. It says they have a right to get an education in an inclusive setting."

Mary Fitzsimmons, a Chicago-area mother of a disabled student, told the Associated Press: "Every child should have the right to what they need, and if that means spending a little more money so that the child can have the same benefits that other children get, that should be done."

Other advocates argue that these costs can be borne by Medicaid in many cases, and that teachers and aides can be trained to perform most health care services.

The problem is money, or rather the lack of it. The federal government is not paying its fair share. When IDEA was first enacted, Congress promised to fund 40 percent of the costs of educating students with disabilities. But then Congress reneged.

According to the U.S. Department of Education, the average excess cost of educating a child with disabilities is $7,021. Yet the federal government contributes only $702 for each disabled student. That's just 10 percent. It would take additional appropriations of $13.5 billion per year to "fully" fund IDEA at the 40 percent level.

People on both sides of the debate agree on at least one thing: Home-bound students with chronic health problems that require constant monitoring will now be able to attend school full-time.

--Michael D. Simpson
NEA Office of General Counsel