Opinion ID: 706855
Heading Depth: 1
Heading Rank: 3

Heading: the requirements of the idea

Text: 10 Congress enacted the IDEA as remedial legislation in order to enhance the educational opportunities of handicapped children. Thomas, 918 F.2d at 619. The Act's overall objective is to guarantee handicapped children a substantive right to a free appropriate public education. 20 U.S.C. Sec. 1412(1). The IDEA defines the phrase, free appropriate public education (FAPE), as special education and related services that are provided at public expense and supervision, that meet state educational standards, and that conform with the IEP developed for each child. Id. Sec. 1401(a)(18). Section 1401(a)(16) defines special education as specially designed instruction, at no cost to parents or guardians, to meet the unique needs of a child with a disability, including--(A) instruction conducted in the classroom, in the home, in hospitals and institutions, and in other settings; and (B) instruction in physical education. Id. Sec. 1401(a)(16)(A),(B). Section 1401(a)(17) states that related services include 11 transportation, and such developmental, corrective, and other supportive services (including speech pathology and audiology, psychological services, physical and occupational therapy, recreation, including therapeutic recreation, social work services, counseling services, including rehabilitation counselling, and medical services, except that such medical services shall be for diagnostic and evaluation purposes only) as may be required to assist a child with a disability to benefit from special education. 12 Id. Sec. 1401(a)(17) (emphasis added). 13 The issue in the case at bar is whether the care requested by Samantha is a related service under the IDEA. If the requested care is a related service, the IDEA obligates Rutherford County to provide the service free of charge. 14 In deciding whether a service is a related service under Sec. 1401(a)(17), we must first answer two subsidiary questions. See Irving Indep. Sch. Dist. v. Tatro, 468 U.S. 883, 890, 104 S.Ct. 3371, 3375-76, 82 L.Ed.2d 664 (1984). We must initially determine whether the requested service is a  'supportive service[ ] ... required to assist a child with a disability to benefit from special education.'  Id. (quoting 20 U.S.C. Sec. 1401(a)(17)). If not, then the IDEA imposes no obligation on the school system to provide the service. Id. at 894, 104 S.Ct. at 3378 (explaining that if requested service can be performed at some time other than during the school day than it is not a service necessary to aid a handicapped child to benefit from special education). If the requested service is a supportive service, then we must also decide whether the service is a medical service which is excluded from the requirements of Sec. 1401(a)(17). Id. at 890, 104 S.Ct. at 3376. 15 Rutherford County concedes that the cleaning of Samantha's tracheostomy is a supportive service that is necessary to enable the child to enjoy the benefit of special education. It argues, however, that the requested care is a medical service performed for other than diagnostic and evaluative purposes. The district court acknowledged that the care requested is clearly medical in nature, but it held that, [a]bsent evidence that the care requested would be unduly burdensome to the school district, the nursing care will be deemed a related, supportive service that falls outside the medical services exclusion. 16 By its own terms, Sec. 1401(a)(17) would seem to indicate that a school district pay for only those medical services which are performed for diagnostic and evaluation purposes. Thus, one might assume that a school district is not required under the Act to provide a medical service that is performed for any other purpose. 4 In Tatro, however, the Supreme Court did not focus on the purpose for which the service is performed but determined that the application of the medical services exclusion depends on who provides the service and the burdens associated therewith. Tatro, 468 U.S. at 892-94, 104 S.Ct. at 3377-78. 17 Tatro involved an eight year old girl who was born with spina bifida, a congenital birth defect. Id. at 885, 104 S.Ct. at 3373. The birth defect caused a neurogenic bladder which prevented her from urinating voluntarily. Id. As a result, the child had to undergo intermittent catheterizations every three or four hours. 5 Id. When the child's school district refused to hire personnel to perform the catheterizations, her parents filed suit, alleging that the requested service was a related service which the school district was obligated to provide. Id. at 886, 104 S.Ct. at 3373-74. The Supreme Court found that the catheterization service was a support service which enabled the child to enjoy the benefits of special education. Id. at 891, 104 S.Ct. at 3376. The Court then turned its attention to whether the requested service was a medical service excluded under the Act. Id. In finding that the catheterization was not a medical service, the Court relied heavily on regulations issued by the Department of Education which included school health services within the definition of related services. Id. at 892, 104 S.Ct. at 3377 (quoting 34 C.F.R. Sec. 300.13(a)). School health services were defined, in turn, as  'services provided by a qualified school nurse or other qualified person.'  Id. (quoting 34 C.F.R. Sec. 300.13(b)(10)). The Court also noted that the Secretary of Education defined the term medical services as those  'services provided by a licensed physician.'  Id. (quoting 34 C.F.R. Sec. 300.13(b)(4)). 18 The Court concluded that, when read together, these regulations required the school to provide services which could readily be performed by a school nurse while services performed by a physician were excluded. Id. The Court found that the Secretary's interpretation of the statutory language warranted deference, because it was reasonable to believe that Congress included the medical services exception in order to spare schools from an obligation to provide a service that might well prove unduly expensive and beyond the range of their competence. Id. In such a case, Tatro pointed out, [c]hildren with serious medical needs are still entitled to an education ... [since] the Act specifically includes instruction in hospitals and at home within the definition of 'special education.'  Id. at 892 n. 11, 104 S.Ct. at 3377 n. 11 (citing 20 U.S.C. Sec. 1401(a)(16)). Because the catheterization could be provided by a school nurse or trained layman, however, the Court held that is was reasonable for the Secretary to conclude that school nursing services are not the sort of burden that Congress intended to exclude as a 'medical service.'  Id. at 893, 104 S.Ct. at 3377. 19 Tatro is subject to several interpretations. It may be read as adopting a bright line rule that any medical service that can be performed by someone other than a licensed physician falls outside the scope of the exception and must be provided by the school. See, e.g., Macomb County Intermediate Sch. Dist. v. Joshua S., 715 F.Supp. 824, 828 (E.D.Mich.1989). The majority of courts, however, have rejected such a per se rule. See, e.g., Granite Sch. Dist. v. Shannon, 787 F.Supp. 1020, 1027 (D.Utah 1992); Bevin H. ex rel. Michael H. v. Wright, 666 F.Supp. 71, 75 (W.D.Pa.1987); Detsel ex rel. Detsel v. Board of Educ. of Auburn Enlarged City Sch. Dist., 637 F.Supp. 1022, 1026-27 (N.D.N.Y.1986). In Shannon, the United States District Court for the District of Utah stated that it did notread Tatro to stand for the proposition that all health services performed by someone other than a licensed physician are related services under the Act regardless of the amount of care, expense, or burden on the school system and, ultimately, on other school children. 20 .... 21 ... Rather, the Court held only that services which must be provided by a licensed physician, other than those which are diagnostic or evaluative, are excluded and that school nursing services of a simple nature are not excluded. 22 Shannon, 787 F.Supp. at 1027 (emphasis added). In the instant case, the district court found this rationale persuasive and refused to follow a per se rule. Instead, the court concluded that Tatro required it to measure the burden on the school district to provide the requested care and to require the school to provide the service if the burden was not excessive. 23 Rutherford County argues that the district court misapplied the Tatro rationale by engaging in a balancing of interests analysis after it had already determined that the requested care was a medical service. Defendant maintains that the only relevant inquiry is whether the service is medical in nature and, if that question is answered in the affirmative, it is inappropriate for a court to employ any further cost-benefit analysis. 24 The district court found the service in question to be medical in nature. We believe the better interpretation of Tatro to be that a school district is not required to provide every service which is medical in nature. The services at issue in Tatro could be provided by someone other than a nurse and a layperson, with minimum training, could provide it. Tatro, 468 U.S. at 894, 104 S.Ct. at 3378. It was, therefore, the kind of service that was not unduly expensive or beyond the range of the school system's competence. Id. at 892, 104 S.Ct. at 3377. We believe it is appropriate to take into account the risk involved and the liability factor of the school district inherent in providing a service of a medical nature such as is involved in this controversy. 25