Schools Must Pay for Health Care of Disabled Students

Published April 1, 1999

In a March 3 decision likely to strain school district budgets across the country, a divided U.S. Supreme Court ruled 7-2 that the 1975 Individuals with Disabilities Education Act requires the non-medical needs of disabled students in school to be met at public expense.

So long as the child’s needs can be serviced by someone other than a doctor, determined the Court, meeting those needs is considered “related services,” not “medical services,” and thus the cost must be shouldered by the school district.

The Court rejected an Iowa school district’s argument that it was not responsible for paying for a disabled student’s nursing services because the services were burdensome, complex, and expensive. In deciding what services to provide to disabled students, the school district wanted to be allowed to base its decisions largely on cost, but the Court rejected the use of a cost-based standard.

“Congress intended to open the door of public education to all qualified children and required participating states to educate handicapped children with non-handicapped children whenever possible,” said Justice John Paul Stevens, writing for the majority in Cedar Rapids Community School District v. Garret F. “This case is about whether meaningful access to the public schools will be assured” for students who are “medically fragile” or dependent on technology.

Joining Stevens in the majority opinion were Chief Justice William H. Rehnquist and justices Stephen G. Breyer, Ruth Bader Ginsburg, Sandra Day O’Connor, Antonin Scalia, and David H. Souter. Justices Anthony M. Kennedy and Clarence Thomas dissented.

The case was brought by the parents of Garret Frey, a 16-year-old paraplegic from Cedar Rapids, Iowa, who has been paralyzed from the neck down since 1987, when–at age four– he was involved in a motorcycle accident while on a ride with his father. After his blanket got caught in the vehicle’s drive mechanism, Frey’s head was jerked back, severing his spinal cord.

Physically disabled but unimpaired intellectually, Frey now must use a wheelchair and a respirator. A “friendly, creative, and intelligent young man,” according to Justice Breyer, he has attended public school in Cedar Rapids since kindergarten.

In order to stay in school, Frey needs a series of essential daily health care services. Those services include periodic urine catheterization, suctioning of the tracheotomy, the provision of food and drink, repositioning in the wheelchair, monitoring blood pressure, and monitoring for breathing problems or ventilator alarms. Those services, said the Court, did not have to be provided by a doctor.

Until 1993, Frey was assisted in school by a licensed practical nurse, who was paid for through insurance and a $1.3 million settlement with the motorcycle company. When Frey’s mother asked the school district to pay for the nurse in 1993, the district refused, arguing that the student’s complicated and expensive treatment constituted “medical services” and thus not the responsibility of the district under the terms of the federal special education law.

The high court disagreed. While the IDEA statute does not require school districts to pay for a special education student’s medical services, it does make the districts responsible for “related services” associated with the education of disabled students. Such services include transportation, counseling, and support services. The Court’s majority deemed Frey’s health care was a related service necessary for his education.

“It is undisputed that the services at issue must be provided if Garret is to remain in school,” wrote Justice Breyer. “Under the statute, our precedent, and the purposes of the Individuals with Disabilities Education Act, the District must fund such ‘related services’ in order to help guarantee that students like Garret are integrated into the public schools.”

While acknowledging that the school district “may have legitimate financial concerns” about the cost of providing such individualized health care, the Court said its job was to interpret the requirements of the federal IDEA law that Congress had written.

According to school district estimates, the total cost of providing nursing and educational services to Frey could be over $50,000 a year.

George A. Clowes is managing editor of School Reform News.

For more information …

The text of the majority and dissenting opinions in Cedar Rapids Community School District v. Garret F. is available in HTML and as Adobe Acrobat PDF files on the Internet at The opinions also are available through PolicyBot. Point your Web browser to and click on the PolicyBot icon. Search for old documents #2116801 (syllabus, 2 pp.), #2116802 (majority opinion, 13 pp.), and #2116803 (dissenting opinion, 6 pp.)