CRS Report for Congress
Cedar Rapids Community School District v. Garret
F.: The Individuals with Disabilities Education Act
and Related Services
Nancy Lee Jones
Legislative Attorney
American Law Division
The Supreme Court in Cedar Rapids Community School District v. Garret F. held
that the related services provision in the Individuals with Disabilities Education Act
(IDEA) required the provision of certain supportive services for a ventilator dependent
child despite arguments from the school district concerning the costs of the services.
Relying on a previous Supreme Court decision, Irving Independent School District v.
Tatro, 468 U.S. 883 (1984), the Court in a seven to two decision continued to support
the "bright line" rule stating that only medical services which must be provided by a
physician are not required to be supplied by the school districts. This decision has been
hailed by disability advocates as a substantial victory for families of children with
disabilities while the Court's dissent noted that the decision "blindsides unwary states
with fiscal obligations they could not have anticipated."
The Court's decision has increased interest in IDEA funding. Amendments have
been offered to S. 280, the Education Flexibility Partnership Act of 1999 to increase
IDEA funding.
IDEA, 20 U.S.C. §§1400 et seq.,provides federal funding to States and localities for
the education of children with disabilities and conditions the receipt of these funds on the
provision of a free appropriate public education which emphasizes special education and
related services for these children. The law defines "related services" as "...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 counseling, and medical services, except that such medical services

Congressional Research Service ˜ The Library of Congress

shall be for diagnostic and evaluation purposes only) as may be required to assist a child
with a disability to benefit from special education...." 1
The Supreme Court dealt with the interpretation of "medical services" in Irving
Independent School District v. Tatro, 468 U.S. 883 (1984). In Tatro the Court examined
the regulations on medical services which stated that medical services referred only to
services that must be performed by a medical doctor and could not be performed by school
health services. Finding the regulations a reasonable interpretation of the statute, the
Court held that clean intermittent catherization (CIC), a service that is usually performed
by a nurse, was not excluded. The Court stated: "By limiting the 'medical services'
exclusion to the services of physician or hospital, both far more expensive, the Secretary
has given a permissible construction to the provision." At 892-893.
The courts of appeals which have decided cases since Tatro have not always applied
the "bright line" distinction between medical doctors and other service providers. Several
have used other factors such as the nature and extent of the services and it was to resolve2
this issue that the Supreme Court granted certiorari in Cedar Rapids.
Cedar Rapids Community School District v. Garret F.
Majority Opinion.
Garret F. is paralyzed from the neck down as a result of a motorcycle accident when
he was four years old but retains his mental capacities, is able to speak and was described
by the Supreme Court as "a friendly, creative, and intelligent young man." Slip op. at 2.
Although his family arranged for his physical care during the school day by a combination
of settlement proceeds, insurance money, and family volunteers, eventually they requested
the school to accept financial responsibility for his health care services during the school
day. The school denied the request. An administrative law judge (ALJ) ordered that the
services be provided; the district court upheld the ALJ's ruling and granted summary
judgment. The court of appeals affirmed and the school district appealed to the Supreme
Court. The Supreme Court, in a majority opinion written by Justice Stevens, held that
IDEA requires a state receiving funds under the statute to provide Garret F, a ventilator-
dependent student, with certain nursing services during school hours.
In arriving at its conclusion, the majority found that IDEA's statutory definition of
related services, the Tatro decision, and "the overall statutory scheme" all support its
interpretation. Slip op. at 6. The Court noted that the school district had argued that the
combined and continuous character of the required care eliminated the need to provide
such care. The school district proposed a test where the outcome in a particular case
would depend on a series of factors such as whether the care was continuous or
intermittent, whether existing school health personnel can provide the service, the cost of
the service, and the potential consequences if the service is not properly performed.
Rejecting this test, Justice Stevens observed that it was not supported by any recognized

20 U.S.C. §1401(a)(22).1

See e.g.,Neely v. Rutherford County School, 68 F.3d 965 (6 Cir. 1995), cert. denied, 517 U.S.2th

981 (1987); Detsel v. Board of Ed. of Auburn Enlarged City School Dist., 820 F.2d 587 (2d Cir.

1987), cert. denied, 484 U.S. 981 (1987).

source of legal authority and that there was no indication concerning why these factors
made one service more medical than another.
The Supreme Court also dealt specifically with the concerns the school district raised
regarding the financial cost of the provision of these services. Although Justice Stevens
noted that the school district may have "legitimate financial concerns", the solution
proposed was seen as "judicial lawmaking without any guidance from Congress" and a
solution that would not comport with the purposes of IDEA. Slip op. At 11. Although
IDEA was not seen as requiring schools to maximize the potential of disabled students and
the potential financial burdens may be relevant to interpreting IDEA, the overarching
purpose of IDEA was seen as "to open the door of public education to all qualified
children." Justice Stevens concluded that "this case is about whether meaningful access
to the public schools will be assured, not the level of education that a school must finance
once access is attained." Slip op. At 12.
Dissenting Opinion.
Justice Thomas wrote a dissenting opinion that was joined by Justice Kennedy
arguing that the Court should not adhere to its previous decision in Tatro and even if it did
the dissent argued that the majority's opinion expanded on Tatro and ignored
"constitutionally mandated rules of construction applicable to legislation enacted pursuant
to Congress' spending power." More specifically, the dissent argued that the Department
of Education's regulations were not entitled to deference since the statute was clear. More
importantly, in the dissent's view, was the fact that the majority focused on the provider
of the services rather than the services themselves. This was seen as contrary to a correct
statutory interpretation of IDEA. From a constitutional perspective, the dissent observed
that when Congress places conditions upon the receipt of federal funds, it must do so
unambiguously and that the majority "turns this Spending Clause presumption on its head."
Implications of Cedar Rapids
The decision in Cedar Rapids was praised by disabilities advocates as "a victory for
school aged children and adolescents with disabilities across the United States" and as "a3
significant improvement for children with disabilities who have medical needs...."4
However, the superintendent of the Cedar Rapids Community School District where
Garret F. is enrolled stated: "This is a landmark case that's going to have a tremendous
effect nationwide .... It will drive up the costs of public education substantially."5
Similarly, the National School Boards Association said that providing in-school nurses for
the 17,000 medically fragile children in the United States would cost an extra $500 million

"NAPAS Applauds U.S. Supreme Court's Decision in Support of Garret F.; Decision is a3
Victory for Students with Disabilities," PR Newswire Association (March 3, 1999)(quoting Curtis
L. Decker, Executive Director of the National Association of Protection & Advocacy Systems,
Doug Cumming, "Disability Advocates Hail Ruling; But Costs of In-School Nurse Care Worry4
Some," The Atlanta Journal and Constitution 01D (March 4, 1999).
Joyce Price and Andrea Billups, "Schools Must Pay Disabled's Care Costs; Nurse Services not5
Medical," The Washington Times A-1 (March 4, 1999).

each year. However, some have argued that these projected costs are exaggerated. "The6
predictions about financial ruin from this case are overblown and, in most cases, these
services are already being provided." 7
The Supreme Court's decision in Cedar Rapids is certain to engender debate about
how to fund services for children with disabilities. Judy Heumann, Assistant Secretary of
Education for Special Education and Rehabilitative Services, has noted that state and local
school boards should look to Medicaid as well as Department of Education state grants89
to help. Increased funding for IDEA has also become an issue and amendments have
been offered to S. 280, 106 Congress, Education Flexibility Partnership Act of 1999 toth
increase IDEA funding.10

David Savage and Richard Colvin, "Court Says Schools Must Pay Nursing Costs for Disabled,"6
The Los Angeles Times A-1 (March 4, 1999).
Id. Quoting Joan Tellefsen, Executive Director of Team Advocates for Special Kids.7
Richard Carelli, "Schools Must Provide Nursing Care, Court Rules," The Legal Intelligencer8

4 (March 4, 1999).

For a discussion of IDEA funding see Apling, "Individuals with Disabilities Education Act: Full9
Funding of State Formula," CRS Report 97-433.
S. Amdt. 36, To Honor the Federal Commitment to fund Part B of the Individuals with10
Disabilities Education Act (Sen. Jeffords); S. Amdt. No. 37, to Authorize Additional
Appropriations to Carry out Part B of the Individuals with Disabilities Education Act (Sen.
Jeffords). For a detailed discussion of the ED-FLEX legislation see Riddle, "Federal Elementary
and Secondary Education Programs: ED-FLEX and Other Forms of Flexibility," CRS Report 98-