Document: 526 U.S. 66119 S.Ct. 992143 L.Ed.2d 154 106 F.3d 822. affirmed. SUPREME COURT OF THE UNITED STATESCEDAR RAPIDS COMMUNITY SCHOOL DISTRICT, PETITIONERv.GARRET F., a minor by his mother and next friend, CHARLENE F. No. 96 1793 [March 3, 1999] ON WRIT CERTIORARI TO STATES APPEALS FORTHE EIGHTH CIRCUIT Justice Stevens delivered the opinion of Court. 1 The Individuals with Disabilities Education Act (IDEA), 84 Stat. 175, as amended, was enacted, in part, "to assure that all children disabilities have available to them free appropriate public education which emphasizes special related services designed meet their unique needs." 20 U.S.C. § 1400(c). Consistent this purpose, IDEA authorizes federal financial assistance States agree provide disabled "related services." See §§1401(a)(18), 1412(1). question presented case is whether definition services" §1401(a)(17)1 requires school district participating State ventilator-dependent student certain nursing during hours. I 2 Respondent Garret friendly, creative, intelligent young man. When four years old, spinal column severed motorcycle accident. Though paralyzed from neck down, mental capacities were unaffected. He able speak, control motorized wheelchair through use puff suck straw, operate computer device responds head movements. currently Cedar Rapids Community School District (District), he attends regular classes typical program, academic performance has been success. is, however, ventilator dependent,2 therefore responsible individual nearby attend physical needs while school.3 3 During Garret's early at family provided for care day. kindergarten, 18-year-old aunt attended him; years, used settlement proceeds they received after accident, insurance, other resources employ licensed practical nurse. In 1993, requested accept responsibility health denied request, believing it not legally obligated continuous one-on-one services. 4 Relying on both Iowa law, hearing before Department Education. An Administrative Law Judge (ALJ) extensive evidence concerning needs, District's treatment students, parts country. 47-page report, ALJ found about 17,500 whom approximately 2,200 need some form or Although only District, most are already students.4 "The primary difference between situation students dependency life support." App. Pet. Cert. 28a. noted parties disagreed over training licensure required supervision such those providing country ranged nonlicensed personnel registered nurses. However, did contend physician could question. 5 explained law variety impairments be "special when adversely affect performance, should educated maximum extent who disabled. addition, applicable regulations distinguish "school services," "qualified nurse qualified person," "medical physician. 34 CFR §§300.16(a), (b)(4), (b)(11) (1998). must former, but latter (except, course, diagnostic evaluation purposes, §1401(a)(17)). According ALJ, distinction does just depend "the title person service"; instead, exclusion limited "in training, knowledge, judgment carry out." 51a. thus concluded bear dispute, including services.5 6 challenged ALJ's decision Federal Court, Court approved ruling granted summary against District. Id., 9a, 15a. Appeals 822 (CA8 1997). It that, recipient funds under IDEA, statutory duty "free education," includes id., 824. read our Irving Independent Dist. v. Tatro, 468 883 (1984), two-step analysis §1401(a)(17) asking first, included within phrase "supportive services"; second, excluded F.3d, 824 825. succinctly answered questions favor. first step plainly satisfied, since cannot unless As second step, reasoned Tatro "established bright-line test: (other than purposes) subject medical exclusion, can setting layperson not." Ibid. 7 its petition certiorari, Appeals' analysis. pointed out courts asked physician, instead applied multi-factor test considers, generally speaking, nature issue. See, e.g., Neely Rutherford County School, 68 965, 972 973 (CA6 1995), cert. denied, 517 1134 (1996); Detsel Board Ed. Auburn Enlarged City Dist., 820 F.2d 587, 588 (CA2) (per curiam), 484 981 (1987). We resolve conflict. 523 __ II 8 contends require "continuous day, even though remain without care. Brief Petitioner 10. IDEA's overall scheme support Appeals. 9 text definition, see n. 1, supra, broadly encompasses supportive "may assist child disability benefit education." we noted, challenge conclusion in-school issue covered category general matter, enable day meaningful access Congress envisioned." U.S., 891 (" 'Congress sought primarily make handicapped children' 'to meaningful' " (quoting Hendrick Hudson Central Westchester Cty. Rowley, 458 176, 192 (1982)). This illuminated parenthetical listing examples particular statute's coverage. §1401(a)(17). "Medical enumerated list, "for purposes." statute contain more specific excepted coverage 10 scope matter impression Secretary had reasonably determined term referred performed 892 894. Accordingly, held (clean intermittent catherization) often, always, an service. referenced likely cost competence staff justifications drawing line services, ibid., endorsement unmistakable.6 settled embrace forms might loosely described "medical" contexts, claim income tax deduction. 26 213(d)(1) (1994 ed. Supp. II) (defining care"). 11 ask us define so broadly. Indeed, argue any items considered individually, §1401(a)(17).7 argument, considering one (catheterization) others may competently trained personnel. 15a, 52a. concluded, necessitated demand 51a While extensive, no Tatro. 12 Instead, points combined character care, proposes outcome would "depend upon series factors, [1] intermittent, [2] existing service, [3] [4] potential consequences if service properly performed." 11; also 35. 13 supported recognized source legal authority. proposed factors neither nor upheld Moreover, offers explanation why these characteristics another. associated apparent relationship much less equivalence. Continuous costly additional personnel, thereby "medical." Whatever imperfections, rule limits exemption unquestionably reasonable workable interpretation statute. Absent elaboration terms convincing reviewed there good reason depart law.8 14 Finally, raises broader concerns burden stay school. problem deliver them; problem, contends, responsibilities same time.9 Through test, seeks establish kind undue-burden based two seen cost-based distinctions: often expensive cheaper hiring employees. third factor then encompass two. relevance fourth likewise because extra necessary especially serious. 15 legitimate concerns, role dispute interpret law. Defining manner accommodates had, cf. 892, altogether different using itself definition. Given accepting standard sole determining provision engage judicial lawmaking guidance Congress. create tension purposes IDEA. schools maximize commensurate opportunities children, 200; burdens imposed relevant arriving sensible construction 892. But intended open door education" "require[d] educate nonhandicapped whenever possible." 192, 202; 179 181; Honig Doe, 305, 310 311, 324 (1988); §§1412(1), (2)(C), (5)(B).10 16 will assured, level finance once attained. undisputed Under statute, precedent, fund order help guarantee like integrated into schools. 17 accordingly 18 Affirmed. Thomas, J., dissenting 19 Kennedy joins, dissenting. majority, relying heavily concludes 1400 et seq., continuous, children. Because squared adhere case. Even assuming correct instance, majority's extension unwarranted ignores constitutionally mandated rules legislation enacted pursuant Congress' spending power. 21 majority recounts, ante, provide, inter alia, §1401(a)(18). clean catheterization several times holding, relied regulations, interpreted services"1 districts (of assumed subcategory) "services physician." 893. holding contrary plain reliance Education's misplaced. 22 * Before consider deference agency regulation appropriate, "we 'directly spoken precise If intent clear, end matter; court, well agency, give effect unambiguously expressed Congress.' National Credit Union Admin. First Nat. Bank & Trust Co., 522 479, 499 500 (1998) Chevron A. Inc. Natural Resources Defense Council, Inc., 467 837, 842 843 (1984)). 23 Unfortunately, failed antecedent turning implementing provision. began "with Education, which," said, "are entitled deference." looked beyond expressly indicates except purposes. 1401(a)(17). asserts precludes reading include "all 'medical.' Ante, 8. explain, "services" Not rejects consistent uses law,2 avoids anomalous result (as case), nonetheless qualify 24 today, focused provider rather themselves. do typically think automotive mechanic, example. Rather, anything done repair car, work, thought fall category. Similarly, "food service" work chef. similarly Tatro's provider-specific approach, "of, relating to, concerned physicians practice medicine." Webster's Third New International Dictionary 1402 (1986) (emphasis added); 1551 "nurse" "a skilled caring waiting infirm, injured, sick; specif: esp. duties physician"). 25 structure purpose reinforce textual interpretation. increase educational them. 1400(c) ("It chapter education"); §1412 ("In shall demonstrate [that it] policy assures right (1982) ("The represents ambitious effort promote children"). such, where decided speech pathology, occupational therapy, audiology appears nature, took explicitly. specified precisely otherwise broad exclusion. crafted have, chose "nursing list. B wrongly multiple constructions, therefore, appropriate. never promulgated defining One year decided, issued defined 47 Fed. Reg. 33838 (1982). These represent Department's attempt disputed term, adopted. "[t]he actually 'medical services' owed children," 10) original), not. Now, 'by determine child's medically handicapping condition results services.' 300.13(b)(4) (1983), recodified amended 300.16(b)(4) 27 Extrapolating regulation, presumed meant "that 'services physician' serve deleted). defer itself, inference drawn speculate how one. Deference circumstances impermissible. exist.3 28 Assuming correctly power, 190, 11, governed construction. repeatedly emphasized places conditions receipt funds, "it unambiguously." Pennhurst Hospital Halderman, 451 (1981). South Dakota Dole, 483 203, 207 (1987); York United States, 505 144, 158 (1992). "condition[s] offer funding promise amounts essentially contract Government funds." Gebser Lago Vista 524 274, 276 legitimacy power legislate rests voluntarily knowingly accepts 'contract.' There can, knowing acceptance unaware unable ascertain what expected it." Pennhurst, (citations omitted). follows Spending Clause narrowly, avoid saddling obligations anticipate. 29 approach turns presumption head. enacting wished "States possible," 202. Congress, steps limit fiscal attempting achieve laudable goal. requiring "appropriate" 1400(c); 200, recognizing integration environment always possible, §1412(5), clarifying few exceptions, §§1401(a)(17) (18). 30 For reason, previously intend "impos[e] unspecified proportions weight" 11. federalism provision, follows: health-related nurses perform part normal duties. although majority's, equally plausible certainly obligation narrowly. concluding Amber observed authorized "difficult [clean catheterization] handicapped." "[i]t strange indeed extend unwilling routinely nonhandicapped." 893 31 Unlike catheterization, respondent requires, continue her To contrary, throughout entire hire employee solely respondent. minimum $18,000 per year. recognizes fact, "more extensive" irrelevant 9. disregards principles blindsides unwary anticipated. 32 33 foregoing reasons, respectfully dissent. Notes 1. 'related means transportation, developmental, corrective, (including pathology audiology, psychological recreation, therapeutic social counseling rehabilitation counseling, only) education, identification assessment disabling children." Originally, Handicapped Act, 175. 1975, added All Children §4(a)(4), 89 775. Aside nonsubstantive changes see, Amendments 1997, §101, 111 45; 1991, §25(a)(1)(B), 105 605; 1990, §101(c), 104 1103, language 1975. references herein 1994 version codified Title Code arose. 35 2. report case, "[b]eing dependent [Garret] breathes external aids, usually electric ventilator, occasionally someone else's manual pumping air bag attached tracheotomy tube being maintained. later procedure called ambu bagging." 19a. 36 3. "He urinary bladder suctioning needed, least every six hours, food drink lunchtime, getting reclining position five minutes each hour, bagging needed checked proper functioning. familiar event malfunction electrical emergency procedures experiences autonomic hyperreflexia. Autonomic hyperreflexia uncontrolled visceral reaction anxiety full bladder. Blood pressure increases, heart rate flushing sweating occur. experienced frequently recent alleviated catheterization. ever capable communicating orally another fashion long rendered extended lack oxygen." 20a. 37 4. "Included drink, oxygen supplement positioning, suctioning." 28a; 53a. 38 5. contains thorough discussion "other tests criteria" pressed 52a, Garret. authority establishing went reject arguments merits. 42a reach here, met 54a 55a. 39 6. 'school services,' 300.13(a) turn person,' §300.13(b)(10). 'Medical physician.' §300.13(b)(4). Thus, [reasonably] qualifying service' service,' excludable such. . By limiting hospital, far expensive, given permissible provision." added) (footnote omitted); 894 ("[T]he state person, Based letters seems Secretary's post-Tatro view entirely clear. E.g., 64a. assume adopt explicitly taking account services; surely enumerate are, not, fairly §1407(a)(17). neither; and, she advocates affirming Amicus Curiae; Auer Robbins, 519 452, 462 (1997) (an agency's views amicus curiae deference). obviously rewrite sufficient revise either. 40 7. Tr. Oral Arg. 5, 12. 41 At oral suggested (either not); then, "medical," apply regulations. 7, 14. identifying disconnected (1984). "Medical" elaborate term. No cited inquiry "related" non-"medical." demanded hardly useful "nursing" simply pointing limitations staff. specially needs. 42 13; necessarily employs teacher associate (TA) assists 26a 27a. time, TA (LPN). light Nursing's decide delegate LPN, Curiae (filed Apr. 22, 1998), dissent's future-cost estimate speculative. 28a, 58a 60a (if assign expense"). 43 District's, unconvincing. rejection unanimous comes too late, Patterson McLean Union, 491 164, 172 173 (1989) (stare decisis force" interpretation), nothing constructive place. rejecting "provider-specific approach," dissent cites unrelated statutes circular Post, 'services' 'medical' 'nature' "). apparently exclude ordinary nondisabled children; easily attributable congressional intent. proposal: now (or rewrite) "health-related duties." "can perform" objection performing "normal duties" That "additional employee." proposal functionally similar ultimately withdrawn replaced 33838, 33854 (the made children). suggestion unacceptable reasons. Most important, revisions better left Secretary, staffing requirements 8, supra. 44 defines "transportation ." 1401(a)(17) added). 45 1701(6) includes, addition examination, rehabilitative surgical dental , optometric podiatric preventive [and] consultation, professional connection treatment"); §101(28) 'nursing home care' accommodation convalescents services"); paid diagnosis, cure, mitigation, treatment, prevention disease"). 46 Nor litigating ample opportunity address formal regulation. maintained conflicting positions circumstances, reflects "agency's fair judgment." (1997).

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