On March 3, 1999, the United States Supreme Court issued its decision in Garret F. v. Cedar Rapids Community School District, 526 U.S. 66 (1999). The case was decided by the Court in a 7-2 decision in favor of the child’s right to receive one-on-one nursing as a related service. Although this case does bear directly on the provision of AAC or technology, this decision may be useful in advocating for assistive technology.
Garret F. is a child who is in school in Iowa. He uses a motorized wheelchair for mobility and requires a ventilator to breathe. He filed for due process to require the District to provide him with one-on-one nursing to maintain his ventilator and assist with his other physical needs. The District took the position that it was not obligated to provide the requested nursing to Garret as part of his related services. The hearing officer ruled in favor of the child, and the District appealed the case to Federal Court and finally to the U.S. Supreme Court.
The District took the position that the decision to provide the services requested should depend on a four part test. Specifically, it asserted that the decision should depend on the following:
- Whether the care is 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.
The Court unequivocally rejected this analysis. It saw that the District’s position was an effort to define the scope of the services it would provide based upon cost, thereby avoiding providing such services. The Court stated that:
“Through its multi-factor test, the District seeks to establish a kind of undue-burden exemption primarily based on the cost of the requested services. The first two factors can be seen as examples of cost-based distinctions: intermittent care is often less expensive than continuous care, and the use of existing personnel is cheaper than hiring additional employees. The third factor – the cost of the service – would then encompass the first two. The relevance of the fourth factor is likewise related to cost because extra care may be necessary if potential consequences are especially serious.”
The Court further stated that IDEA “does not employ cost in its definition of ‘related services’ or excluded ‘medical services,’ accepting the District’s cost-based standard as the sole test for determining the scope of the provision would require us to engage in judicial lawmaking without guidance from Congress.”
The obvious significance of this case is that many children who need one-on-one nursing care as a related service in order to go to school now have a court defined right to these services. More generally, this case squarely confronts the issue of cost in defining the scope of related services. The Court has firmly held that cost simply cannot be a factor in determining the scope and extent of related services. However, cost will obviously always be an unspoken criterion. More legitimately, for example, if two devices are capable of meeting a child’s needs, the district may opt for the cheaper device.
The Garret F. case is an important case to read when faced with Districts that are unwilling, either overtly or tacitly on the basis of cost, to provide the necessary AAC device and other assistive technology, and the training and personnel to make the device an integral part of the child’s education.