Opinion ID: 627205
Heading Depth: 2
Heading Rank: 1

Heading: The IDEA and Cochlear Implants

Text: Congress enacted IDEA in 1970 to ensure that all children with disabilities are provided a free appropriate public education. . . designed to meet their unique needs [and] to assure that the rights of [such] children and their parents or guardians are protected. Forest Grove Sch. Dist. v. T.A., 557 U.S. 230, 129 S.Ct. 2484, 2491, 174 L.Ed.2d 168 (2009) (second and third alterations in original) (footnote omitted) (citation omitted) (internal quotation marks omitted). The cornerstone of the Act is the condition that schools provide children with a free appropriate public education. See 20 U.S.C. §§ 1412(a)(1)(A), 1413(a)(1). A free appropriate public education must be tailored to each child's needs pursuant to an individualized education program (IEP) designed by the child's IEP Team. Id. §§ 1401(14), 1414(d). The Act defines free appropriate public education to mean special education and related services. Id. § 1401(9). However, in Board of Education of the Hendrick Hudson Central School District, Westchester County v. Rowley, 458 U.S. 176, 102 S.Ct. 3034, 73 L.Ed.2d 690 (1982), the Supreme Court refused to interpret the phrase to require schools to maximize the potential of handicapped children `commensurate with the opportunity provided to other children,' id. at 189-90, 102 S.Ct. 3034 (citation omitted). Instead, the Court interpreted the Act to require schools to provide a `basic floor of opportunity.' Id. at 200, 102 S.Ct. 3034 (quoting H.R. REP. No. 94-332, at 14 (1975)). A school satisfies the requirement of a free appropriate public education by providing personalized instruction with sufficient support services to permit [a] child to benefit educationally from that instruction. Id. at 203, 102 S.Ct. 3034. The special education component of free appropriate public education is not directly at issue in this case. The related services component, however, is of critical importance. For each child with a disability, the IEP Team is responsible for determining which related services must be made available by the school district. See 20 U.S.C. § 1414(d)(1)(A)(i)(IV). All such services must be specified in a child's written IEP. Id. Related services under the IDEA include, inter alia, transportation, and such developmental, corrective, and other supportive services (including speech-language pathology and audiology services, interpreting services, psychological services, physical and occupational therapy, recreation, including therapeutic recreation, social work services, school nurse services designed to enable a child with a disability to receive a free appropriate public education as described in the individualized education program of the child, [and] counseling services . . .) as may be required to assist a child with a disability to benefit from special education, and includes the early identification and assessment of disabling conditions in children. Id. § 1401(26)(A). In 2004, Congress amended this definition by adding an express exception. See Individuals with Disabilities Education Improvement Act of 2004, Pub.L. No. 108-446, § 602(26), 118 Stat. 2647, 2657 (codified at 20 U.S.C. § 1401(26)(B)). The exception states that the term related services excludes a medical device that is surgically implanted, [and] the replacement of such device. 20 U.S.C. § 1401(26)(B). The Supreme Court first addressed the meaning of related services in Irving Independent School District v. Tatro, 468 U.S. 883, 104 S.Ct. 3371, 82 L.Ed.2d 664 (1984). There, the Court interpreted the phrase to include services that enable the child to reach, enter, or exit the school as well as [s]ervices . . . that permit a child to remain at school during the day. Id. at 891, 104 S.Ct. 3371. The Court reaffirmed that interpretation in Cedar Rapids Community School District v. Garret F. See 526 U.S. 66, 73, 119 S.Ct. 992, 143 L.Ed.2d 154 (1999) (As a general matter, services that enable a disabled child to remain in school during the day provide the student with `the meaningful access to education that Congress envisioned.' (citation omitted)). The Court has yet to address the meaning of the exception for surgically implanted medical devices that was added to the IDEA in 2004. In addition to related services, the Act also directs each child's IEP team to consider whether the child needs assistive technology devices and services. 20 U.S.C. § 1414(d)(3)(B)(v). The term `assistive technology device' means any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a child with a disability. Id. § 1401(1)(A). Pursuant to the 2004 amendments, this definition excludes a medical device that is surgically implanted, [and] the replacement of such device. Id. § 1401(1)(B). The term `assistive technology service' means any service that directly assists a child with a disability in the selection, acquisition, or use of an assistive technology device . . . [including] selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices. . . . Id. § 1401(2)(C). The Department has consistently maintained that, as a general matter, the IDEA does not require a school district to provide a personal device that [a] student would require regardless of whether he/ she was attending school. Letter from Thomas Hehir, Dir. Office of Special Educ. Programs, to Peter J. Seiler, Superintendent, Ill. Sch. for the Deaf 1 (Nov. 19, 1993) (Seiler Letter), reprinted in Joint App. (J.A.) 8. For example, the Department generally does not require school districts to provide hearing aids or eyeglasses as assistive technology devices. Id.; see also Letter from Thomas Hehir to Terry K. Bachus, Dir. Dep't of Special Educ., Wichita Pub. Sch. 2 (Jan. 13, 1995) (Bachus Letter), J.A. 13. But the Department does require school districts to provide personal devices if they are specified in a child's IEP as necessary for him or her to receive a free appropriate public education. See Bachus Letter 2, J.A. 13; Seiler Letter 1, J.A. 8.
As Appellants explain, a cochlear implant is a type of hearing aid for an individual whose hearing loss is too severe for the use of a traditional acoustical hearing aid. The device consists of both an external component and a surgically implanted internal component. The external componenta microphone, a speech processor, and a transmitter systemdetects and processes sound and then transmits the sound to the internal component in the form of radio waves. The internal componenta receiver connected to an electrode arrayreceives the radio waves and stimulates the corresponding electrodes so that the brain can process the audio signals. A cochlear implant periodically must be mapped to function properly. Mapping is the process by which an audiologist optimizes the amount of stimulation that the electrodes provide to the auditory nerve. According to Appellants, an audiologist maps an implant by measuring the user's response to electrical stimulation by connecting the device's speech processor to a computer with specialized software. Based on the user's response to the stimuli, the audiologist calibrates the speech processor so that the electrodes stimulate the auditory nerve in a way that the user can process. Periodic mapping is essential, because, without it, the cochlear implant may transmit auditory information to the brain that does not accurately reflect the sounds around the user. Mapping must be performed by an audiology specialist who possesses a specific set of skills. See Letter from Am. Acad. of Audiology to Troy R. Justesen, U.S. Dep't of Educ. (Aug. 12, 2005) (Academy Letter), J.A. 43. Moreover, the audiologist must have familiarity with the speech coding, processing and programming parameters of all . . . manufacturers of cochlear implants. Id., J.A. 44. Thus, the American Academy of Audiology requires that, even to sit for the examination for Board Certification in Audiology with Speciality in Cochlear Implants, an audiologist must have two years experience as an audiologist, 450 hours of direct contact with individuals with cochlear implants, and 50 hours of case management of individuals with [cochlear implants]. Id., J.A. 43. Marilyn Neault, the Director of Habilitative Audiology at the Children's Hospital in Boston, has explained why mapping must be performed by a specialist: Programming (mapping) of a cochlear implant processor alters the electrical stimulation that the implant provides to the surrounding tissue inside the inner ear. Too much stimulation can cause pain or facial twitching. Programming that is poorly done can result in a lower outcome in terms of the child's ability to hear. Failure of the programming audiologist to notice changes in the child's electrical stimulation requirements that signal partial extrusion or malfunction of the internal device can result in poor outcome. Failure of the audiologist to notice that the headpiece magnet is too tight can result in skin breakdown over the magnet which can require hospitalization and surgery. Lack of communication access between the programming audiologist and the implant surgeon can delay action regarding internal device problems. Letter from Marilyn W. Neault to Troy R. Justesen 1 (Sept. 6, 2005) (Neault Letter), J.A. 48.