OCTOBER TERM, 1998
Syllabus
CEDAR RAPIDS COMMUNITY SCHOOL DISTRICT
v. GARRET F., A
MINOR, BY HIS MOTHER AND NEXT FRIEND, CHARLENE F.
CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR THE EIGHTH
CIRCUIT
No. 96-1793. Argued November 4, 1998-Decided March 3,1999
To help "assure that all children with disabilities have
available to them ... a free appropriate public education which
emphasizes special education and related services designed to meet
their unique needs," 20 U. S. C. § 1400(c), the Individuals with
Disabilities Education Act (IDEA) authorizes federal financial
assistance to States that agree to provide such children with
special education and "related services," as defined in §
1401(a)(17). Respondent Garret F., a student in petitioner school
district (District), is wheelchair-bound and ventilator dependent;
he therefore requires, in part, a responsible individual nearby to
attend to certain physical needs during the schoolday. The District
declined to accept financial responsibility for the services Garret
needs, believing that it was not legally obligated to provide
continuous one-on-one nursing care. At an Iowa Department of
Education hearing, an Administrative Law Judge concluded that the
IDEA required the District to bear financial responsibility for all
of the disputed services, finding that most of them are already
provided for some other students; that the District did not contend
that only a licensed physician could provide the services; and that
applicable federal regulations require the District to furnish
"school health services," which are provided by a "qualified school
nurse or other qualified person," but not "medical services," which
are limited to services provided by a physician. The Federal
District Court agreed and the Court of Appeals affirmed, concluding
that
Irving Independent School Dist. v.
Tatro,
468 U. S. 883,
provided a two-step analysis of § 1401(a)(17)'s "related services"
definition that was satisfied here. First, the requested services
were "supportive services" because Garret cannot attend school
unless they are provided; and second, the services were not
excluded as "medical services" under
Tatro's bright-line
test:
Services provided by a physician (other than for diagnostic and
evaluation purposes) are subject to the medical services exclusion,
but services that can be provided by a nurse or qualified layperson
are not.
Held: The IDEA requires the District to provide Garret
with the nursing services he requires during school hours. The
IDEA's "related services" definition,
Tatro, and the overall
statutory scheme support the
67
Court of Appeals' decision. The "related services" definition
broadly encompasses those supportive services that "may be required
to assist a child with a disability to benefit from special
education," § 1401(a)(17), and the District does not challenge the
Court of Appeals' conclusion that the services at issue are
"supportive services." Furthermore, § 1401(a)(17)'s general
"related services" definition is illuminated by a parenthetical
phrase listing examples of services that are included within the
statute's coverage, including "medical services" if they are "for
diagnostic and evaluation purposes." Although the IDEA itself does
not define "medical services" more specifically, this Court in
Tatro concluded that the Secretary of Education had
reasonably determined that "medical services" referred to services
that must be performed by a physician, and not to school health
services. 468 U. S., at 892-894. The cost-based, multifactor test
proposed by the District is supported by neither the statute's text
nor the regulations upheld in
Tatro. Moreover, the District
offers no explanation why characteristics such as cost make one
service any more "medical" than another. Absent an elaboration of
the statutory terms plainly more convincing than that reviewed in
Tatro, there is no reason to depart from settled law.
Although the District may have legitimate concerns about the
financial burden of providing the services Garret needs, accepting
its cost-based standard as the sole test for determining §
1401(a)(17)'s scope would require the Court to engage in judicial
lawmaking without any guidance from Congress. It would also create
tension with the IDEA's purposes, since Congress intended to open
the doors of public education to all qualified children and
required participating States to educate disabled children with
nondisabled children whenever possible,
Board of Ed. of Hendrick
Hudson Central School Dist., Westchester Cty. v.
Rowley,
458 U. S. 176,
192,202. Pp. 73-79.
106 F.3d
822, affirmed.
STEVENS, J., delivered the opinion of the Court, in which
REHNQUIST, C. J., and O'CONNOR, SCALIA, SOUTER, GINSBURG, and
BREYER, JJ., joined. THOMAS, J., filed a dissenting opinion, in
which KENNEDY, J., joined,
post, p. 79.
Sue Luettjohann Seitz argued the cause for
petitioners.
With her on the briefs was
Edward M. Mansfield.
Douglas R. Oelschlaeger argued the cause for respondents.
With him on the brief was
Diane Kutzko.
Beth S.
Brinkmann argued the cause for the United
States as
amicus curiae urging affirmance. With her on
the
68
68 CEDAR RAPIDS COMMUNITY SCHOOL DIST.
v. GARRET F.
brief were Solicitor General Waxman, Acting Assistant Attorney
General Lee, Deputy Solicitor General Underwood, David K. Flynn,
and Seth M. Galanter. *
JUSTICE STEVENS delivered the opinion of the Court.
The Individuals with Disabilities Education Act (IDEA), 84 Stat.
175, as amended, was enacted, in part, "to assure that all children
with disabilities have available to them ... a free appropriate
public education which emphasizes special education and related
services designed to meet their unique needs." 20 U. S. C. §
1400(c). Consistent with this purpose, the IDEA authorizes federal
financial assistance to States that agree to provide disabled
children with special education and "related services." See §§
1401(a)(18), 1412(1). The question presented in this case is
whether the definition of "related services" in § 1401(a)(17) 1
requires a public school
*Gwendolyn H. Gregory and
Julie Underwood filed a
brief for the National School Boards Association as
amicus
curiae urging reversal.
Briefs of
amici curiae urging affirmance were filed for
the American Academy of Pediatrics et al. by
Paul M. Smith
and
Nory Miller; and for the National Association of
Protection and Advocacy Systems et al. by
Leslie Seid
Margolis.
1 "The term 'related services' means 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 shall be for diagnostic and evaluation purposes
only) 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."
20 U. S. C. § 1401(a)(17).
Originally, the statute was enacted without a definition of
"related services." See Education of the Handicapped Act, 84 Stat.
175. In 1975, Congress added the definition at issue in this case.
Education for All Handicapped Children Act of 1975, §4(a)(4), 89
Stat. 775. Aside from nonsubstantive changes and added examples of
included services, see,
e. g., Individuals with Disabilities
Education Act Amendments of 1997, § 101, 111 Stat. 45; Individuals
with Disabilities Education Act Amendments of 1991, § 25(a)(1)(B),
105 Stat. 605; Education of the Handicapped Act
69
district in a participating State to provide a
ventilatordependent student with certain nursing services during
school hours.
I
Respondent Garret F. is a friendly, creative, and intelligent
young man. When Garret was four years old, his spinal column was
severed in a motorcycle accident. Though paralyzed from the neck
down, his mental capacities were unaffected. He is able to speak,
to control his motorized wheelchair through use of a puff and suck
straw, and to operate a computer with a device that responds to
head movements. Garret is currently a student in the Cedar Rapids
Community School District (District), he attends regular classes in
a typical school program, and his academic performance has been a
success. Garret is, however, ventilator dependent,2 and therefore
requires a responsible individual nearby to attend to certain
physical needs while he is in school.3
Amendments of 1990, § 101(c), 104 Stat. 1103, the relevant
language in § 1401(a)(17) has not been amended since 1975. All
references to the IDEA herein are to the 1994 version as codified
in Title 20 of the United States Code-the version of the statute in
effect when this dispute arose.
2 In his report in this case, the Administrative Law Judge
explained:
"Being ventilator dependent means that [Garret] breathes only
with external aids, usually an electric ventilator, and
occasionally by someone else's manual pumping of an air bag
attached to his tracheotomy tube when the ventilator is being
maintained. This later procedure is called ambu bagging." App. to
Pet. for Cert. 19a.
3 "He needs assistance with urinary bladder catheterization once
a day, the suctioning of his tracheotomy tube as needed, but at
least once every six hours, with food and drink at lunchtime, in
getting into a reclining position for five minutes of each hour,
and ambu bagging occasionally as needed when the ventilator is
checked for proper functioning. He also needs assistance from
someone familiar with his ventilator in the event there is a
malfunction or electrical problem, and someone who can perform
emergency procedures in the event he experiences autonomic
hyperreflexia. Autonomic hyperreflexia is an uncontrolled visceral
reaction to anxiety or a full bladder. Blood pressure increases,
heart rate increases,
70
70 CEDAR RAPIDS COMMUNITY SCHOOL DIST.
v. GARRET F.
During Garret's early years at school his family provided for
his physical care during the schoolday. When he was in
kindergarten, his 18-year-old aunt attended him; in the next four
years, his family used settlement proceeds they received after the
accident, their insurance, and other resources to employ a licensed
practical nurse. In 1993, Garret's mother requested the District to
accept financial responsibility for the health care services that
Garret requires during the schoolday. The District denied the
request, believing that it was not legally obligated to provide
continuous one-on-one nursing services.
Relying on both the IDEA and Iowa law, Garret's mother requested
a hearing before the Iowa Department of Education. An
Administrative Law Judge (ALJ) received extensive evidence
concerning Garret's special needs, the District's treatment of
other disabled students, and the assistance provided to other
ventilator-dependent children in other parts of the country. In his
47 -page report, the ALJ found that the District has about 17,500
students, of whom approximately 2,200 need some form of special
education or special services. Although Garret is the only
ventilatordependent student in the District, most of the health
care services that he needs are already provided for some other
students.4 "The primary difference between Garret's situation and
that of other students is his dependency on his ventilator for life
support." App. to Pet. for Cert. 28a. The ALJ noted that the
parties disagreed over the training or
and flushing and sweating may occur. Garret has not experienced
autonomic hyperreflexia frequently in recent years, and it has
usually been alleviated by catheterization. He has not ever
experienced autonomic hyperreflexia at school. Garret is capable of
communicating his needs orally or in another fashion so long as he
has not been rendered unable to do so by an extended lack of
oxygen."
Id., at 20a.
4 "Included are such services as care for students who need
urinary catheterization, food and drink, oxygen supplement
positioning, and suctioning."
Id., at 28a; see also
id., at 53a.
71
licensure required for the care and supervision of such
students, and that those providing such care in other parts of the
country ranged from nonlicensed personnel to registered nurses.
However, the District did not contend that only a licensed
physician could provide the services in question.
The ALJ explained that federal law requires that children with a
variety of health impairments be provided with "special education
and related services" when their disabilities adversely affect
their academic performance, and that such children should be
educated to the maximum extent appropriate with children who are
not disabled. In addition, the ALJ explained that applicable
federal regulations distinguish between "school health services,"
which are provided by a "qualified school nurse or other qualified
person," and "medical services," which are provided by a licensed
physician. See 34 CFR §§ 300.16(a), (b)(4), (b)(ll) (1998). The
District must provide the former, but need not provide the latter
(except, of course, those "medical services" that are for
diagnostic or evaluation purposes, 20 U. S. C. § 1401(a)(17)).
According to the ALJ, the distinction in the regulations does not
just depend on "the title of the person providing the service";
instead, the "medical services" exclusion is limited to services
that are "in the special training, knowledge, and judgment of a
physician to carry out." App. to Pet. for Cert. 51a. The ALJ thus
concluded that the IDEA required the District to bear financial
responsibility for all of the services in dispute, including
continuous nursing services.5
5 In addition, the ALJ's opinion contains a thorough discussion
of "other tests and criteria" pressed by the District, id., at 52a,
including the burden on the District and the cost of providing
assistance to Garret. Although the ALJ found no legal authority for
establishing a cost-based test for determining what related
services are required by the statute, he went on to reject the
District's arguments on the merits. See id., at 42a-53a. We do not
reach the issue here, but the ALJ also found that Garret's
in-school needs must be met by the District under an Iowa statute
as well as the IDEA.
Id., at 54a-55a.
72
72 CEDAR RAPIDS COMMUNITY SCHOOL DIST.
v. GARRET F.
The District challenged the ALJ's decision in Federal District
Court, but that court approved the ALJ's IDEA ruling and granted
summary judgment against the District.
Id., at 9a, 15a. The
Court of Appeals affirmed.
106 F.3d
822 (CA8 1997). It noted that, as a recipient of federal funds
under the IDEA, Iowa has a statutory duty to provide all disabled
children a "free appropriate public education," which includes
"related services." See id., at 824. The Court of Appeals read our
opinion in
Irving Independent School Dist. v.
Tatro,
468 U. S. 883
(1984), to provide a two-step analysis of the "related services"
definition in § 1401(a)(17)-asking first, whether the requested
services are included within the phrase "supportive services"; and
second, whether the services are excluded as "medical services."
106 F. 3d, at 824-825. The Court of Appeals succinctly answered
both questions in Garret's favor. The court found the first step
plainly satisfied, since Garret cannot attend school unless the
requested services are available during the school day.
I
d., at 825. As to the second step, the court reasoned that
Tatro "established a bright-line test: the services of a
physician (other than for diagnostic and evaluation purposes) are
subject to the medical services exclusion, but services that can be
provided in the school setting by a nurse or qualified layperson
are not." 106 F. 3d, at 825.
In its petition for certiorari, the District challenged only the
second step of the Court of Appeals' analysis. The District pointed
out that some federal courts have not asked whether the requested
health services must be delivered by a physician, but instead have
applied a multifactor test that considers, generally speaking, the
nature and extent of the services at issue. See,
e. g.,
Neely v.
Rutherford County School, 68
F.3d 965, 972-973 (CA6 1995), cert. denied, 517 U. S. 1134
(1996);
Detsel v.
Board of Ed. of Auburn Enlarged City
School Dist., 820 F.2d
587, 588 (CA2)
(per curiam), cert. denied, 484 U. S. 981
(1987). We granted the District's petition to resolve this
conflict. 523 U. S. 1117 (1998).
73
II
The District contends that § 1401(a)(17) does not require it to
provide Garret with "continuous one-on-one nursing services" during
the schoolday, even though Garret cannot remain in school without
such care. Brief for Petitioner 10. However, the IDEA's definition
of "related services," our decision in
Irving Independent School
Dist. v.
Tatro, 468 U. S. 883 (1984), and
the overall statutory scheme all support the decision of the Court
of Appeals.
The text of the "related services" definition, see n. 1,
supra, broadly encompasses those supportive services that
"may be required to assist a child with a disability to benefit
from special education." As we have already noted, the District
does not challenge the Court of Appeals' conclusion that the
in-school services at issue are within the covered category of
"supportive services." 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."
Tatro, 468 U. S., at 891 (" 'Congress sought
primarily to make public education available to handicapped
children' and 'to make such access meaningful'" (quoting
Board
of Ed. of Hendrick Hudson Central School Dist., Westchester
Cty. v.
Rowley, 458 U. S. 176, 192
(1982))).
This general definition of "related services" is illuminated by
a parenthetical phrase listing examples of particular services that
are included within the statute's coverage. § 1401(a)(17).
"[M]edical services" are enumerated in this list, but such services
are limited to those that are "for diagnostic and evaluation
purposes."
Ibid. The statute does not contain a more
specific definition of the "medical services" that are excepted
from the coverage of § 1401(a)(17).
The scope of the "medical services" exclusion is not a matter of
first impression in this Court. In
Tatro we concluded that
the Secretary of Education had reasonably determined that the term
"medical services" referred only to services
74
74 CEDAR RAPIDS COMMUNITY SCHOOL DIST.
v. GARRET F.
that must be performed by a physician, and not to school health
services. 468 U. S., at 892-894. Accordingly, we held that a
specific form of health care (clean intermittent catheterization)
that is often, though not always, performed by a nurse is not an
excluded medical service. We referenced the likely cost of the
services and the competence of school staff as justifications for
drawing a line between physician and other services, ibid., but our
endorsement of that line was unmistakable.6 It is thus settled that
the phrase
6 "The regulations define 'related services' for handicapped
children to include 'school health services,' 34 CFR § 300.13(a)
(1983), which are defined in turn as 'services provided by a
qualified school nurse or other qualified person,' § 300.13(b)(10).
'Medical services' are defined as 'services provided by a licensed
physician.' § 300.13(b)(4). Thus, the Secretary has [reasonably]
determined that the services of a school nurse otherwise qualifying
as a 'related service' are not subject to exclusion as a 'medical
service,' but that the services of a physician are excludable as
such.
" ... By limiting the 'medical services' exclusion to the
services of a physician or hospital, both far more expensive,
the Secretary has given a permissible construction to the
provision." 468 U. S., at 892-893 (emphasis added) (footnote
omitted); see also id., at 894 ("[T]he regulations state that
school nursing services must be provided only if they can be
performed by a nurse or other qualified person, not if they must be
performed by a physician").
Based on certain policy letters issued by the Department of
Education, it seems that the Secretary's
post-Tatro view of
the statute has not been entirely clear.
E. g., App. to Pet.
for Cert. 64a. We may assume that the Secretary has authority under
the IDEA to adopt regulations that define the "medical services"
exclusion by more explicitly taking into account the nature and
extent of the requested services; and the Secretary surely has the
authority to enumerate the services that are, and are not, fairly
included within the scope of § 1407(a)(17). But the Secretary has
done neither; and, in this Court, he advocates affirming the
judgment of the Court of Appeals. Brief for United States as
Amicus Curiae 7-8, 30; see also
Auer v.
Robbins, 519
U. S. 452, 462 (1997) (an agency's views as
amicus
curiae may be entitled to deference). We obviously have no
authority to rewrite the regulations, and we see no sufficient
reason to revise
Tatro, either.
75
"medical services" in § 1401(a)(17) does not embrace all forms
of care that might loosely be described as "medical" in other
contexts, such as a claim for an income tax deduction. See 26 U. S.
C. § 213(d)(1) (1994 ed. and Supp. II) (defining "medical
care").
The District does not ask us to define the term so broadly.
Indeed, the District does not argue that any of the items of
care that Garret needs, considered individually, could be excluded
from the scope of 20 U. S. C. § 1401(a)(17).7 It could not make
such an argument, considering that one of the services Garret needs
(catheterization) was at issue in
Tatro, and the others may
be provided competently by a school nurse or other trained
personnel. See App. to Pet. for Cert. 15a, 52a. As the ALJ
concluded, most of the requested services are already provided by
the District to other students, and the in-school care necessitated
by Garret's ventilator dependency does not demand the training,
knowledge, and judgment of a licensed physician.
Id., at
51a-52a. While more extensive, the in-school services Garret needs
are no more "medical" than was the care sought in
Tatro.
Instead, the District points to the combined and continuous
character of the required care, and proposes a test under which the
outcome in any particular case would "depend upon a series of
factors, such as [1] whether the care is continuous or
intermittent, [2] whether existing school health personnel can
provide the service, [3] the cost of the service, and [4] the
potential consequences if the service is not properly performed."
Brief for Petitioner 11; see also id., at 34-35.
The District's multifactor test is not supported by any
recognized source of legal authority. The proposed factors can be
found in neither the text of the statute nor the regulations that
we upheld in
Tatro. Moreover, the District offers no
explanation why these characteristics make one service
7 See Tr. of Oral Arg. 4-5, 12.
76
76 CEDAR RAPIDS COMMUNITY SCHOOL DIST.
v. GARRET F.
any more "medical" than another. The continuous character of
certain services associated with Garret's ventilator dependency has
no apparent relationship to "medical" services, much less a
relationship of equivalence. Continuous services may be more costly
and may require additional school personnel, but they are not
thereby more "medical." Whatever its imperfections, a rule that
limits the medical services exemption to physician services is
unquestionably a reasonable and generally workable interpretation
of the statute. Absent an elaboration of the statutory terms
plainly more convincing than that which we reviewed in
Tatro, there is no good reason to depart from settled law.
8
Finally, the District raises broader concerns about the
financial burden that it must bear to provide the services that
Garret needs to stay in school. The problem for the District in
providing these services is not that its staff cannot be trained to
deliver them; the problem, the District contends, is that the
existing school health staff cannot meet all of their
8 At oral argument, the District suggested that we first
consider the nature of the requested service (either "medical" or
not); then, if the service is "medical," apply the multifactor test
to determine whether the service is an excluded physician service
or an included school nursing service under the Secretary of
Education's regulations. See Tr. of Oral Arg. 7, 13-14. Not only
does this approach provide no additional guidance for identifying
"medical" services, it is also disconnected from both the statutory
text and the regulations we upheld in
Irving Independent School
Dist. v.
Tatro, 468 U. S. 883 (1984).
"Medical" services are generally
excluded from the statute,
and the regulations elaborate on that statutory term. No authority
cited by the District requires an additional inquiry if the
requested service is both "related" and non-"medical." Even if §
1401(a)(17) demanded an additional step, the factors proposed by
the District are hardly more useful in identifying "nursing"
services than they are in identifying "medical" services; and the
District cannot limit educational access simply by pointing to the
limitations of existing staff. As we noted in
Tatro, the
IDEA requires schools to hire specially trained personnel to meet
disabled student needs.
Id., at 893.
77
responsibilities and provide for Garret at the same time.9
Through its multifactor 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 servicewould 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 District may have legitimate financial concerns, but our
role in this dispute is to interpret existing law. Defining
"related services" in a manner that
accommodates the cost
concerns Congress may have had, cf.
Tatro, 468 U. S., at
892, is altogether different from using cost
itself as the
definition. Given that § 1401(a)(17) 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 any guidance from Congress. It would
also create some tension with the purposes of the IDEA. The statute
may not require public schools to maximize the potential of
disabled students com-
9 See Tr. of Oral Arg. 4-5, 13; Brief for Petitioner 6-7, 9. The
District, however, will not necessarily need to hire an additional
employee to meet Garret's needs. The District already employs a
one-on-one teacher associate (TA) who assists Garret during the
schoolday. See App. to Pet. for Cert. 26a-27a. At one time,
Garret's TA was a licensed practical nurse (LPN). In light of the
state Board of Nursing's recent ruling that the District's
registered nurses may decide to delegate Garret's care to an LPN,
see Brief for United States as
Amicus Curiae 9-10 (filed
Apr. 22, 1998), the dissent's future-cost estimate is speculative.
See App. to Pet. for Cert. 28a, 58a-60a (if the District could
assign Garret's care to a TA who is also an LPN, there would be "a
minimum of additional expense").
78
78 CEDAR RAPIDS COMMUNITY SCHOOL DIST.
v. GARRET F.
mens urate with the opportunities provided to other children,
see
Rowley, 458 U. S., at 200; and the potential financial
burdens imposed on participating States may be relevant to arriving
at a sensible construction of the IDEA, see
Tatro, 468 U.
S., at 892. But Congress intended "to open the door of public
education" to all qualified children and "require[d] participating
States to educate handicapped children with nonhandicapped children
whenever possible."
Rowley, 458 U. S., at 192, 202; see
id., at 179-181; see also
Honig v.
Doe,
484 U. S. 305,
310-311, 324 (1988); §§ 1412(1), (2)(C), (5)(B).1O
10 The dissent's approach, which seems to be even broader than
the District's, is unconvincing. The dissent's rejection of our
unanimous decision in
Tatro comes 15 years too late, see
Patterson v.
McLean Credit Union, 491 U. S. 164, 172-173
(1989)
(stare decisis has "special force" in statutory
interpretation), and it offers nothing constructive in its place.
Aside from rejecting a "provider-specific approach," the dissent
cites unrelated statutes and offers a circular definition of
"medical services."
Post, at 81 (opinion of THOMAS, J.) ("
'services' that are 'medical' in 'nature' "). Moreover, the
dissent's approach apparently would exclude most ordinary school
nursing services of the kind routinely provided to nondisabled
children; that anomalous result is not easily attributable to
congressional intent. See
Tatro, 468 U. S., at 893.
In a later discussion the dissent does offer a specific
proposal: that we now interpret (or rewrite) the Secretary's
regulations so that school districts need only provide disabled
children with "health-related services that school nurses can
perform as part of their normal duties."
Post, at 85. The
District does not dispute that its nurses "can perform" the
requested services, so the dissent's objection is that District
nurses would not be performing their "normal duties" if they met
Garret's needs. That is, the District would need an "additional
employee."
Ibid. This proposal is functionally similar to a
proposed regulation-ultimately withdrawn-that would have replaced
the "school health services" provision. See 47 Fed. Reg. 33838,
33854 (1982) (the statute and regulations may not be read to affect
legal obligations to make available to handicapped children
services, including school health services, made available to
nonhandicapped children). The dissent's suggestion is unacceptable
for several reasons. Most important, such revisions of the
regulations are better left to the Secretary, and an additional
staffing need is generally not a sufficient objection to the
requirements of § 1401(a)(17). See n. 8,
supra.
79
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. It is undisputed that the
services at issue must be provided if Garret is to remain in
school. Under the statute, our precedent, and the purposes of the
IDEA, the District must fund such "related services" in order to
help guarantee that students like Garret are integrated into the
public schools.
The judgment of the Court of Appeals is accordingly
Affirmed.
JUSTICE THOMAS, with whom JUSTICE KENNEDY joins, dissenting.
The majority, relying heavily on our decision in
Irving
Independent School Dist. v.
Tatro, 468 U. S. 883 (1984),
concludes that the Individuals with Disabilities Education Act
(IDEA), 20 U. S. C. § 1400
et seq., requires a public school
district to fund continuous, one-on-one nursing care for disabled
children. Because
Tatro cannot be squared with the text of
IDEA, the Court should not adhere to it in this case. Even assuming
that
Tatro was correct in the first instance, the majority's
extension of it is unwarranted and ignores the constitutionally
mandated rules of construction applicable to legislation enacted
pursuant to Congress' spending power.
I
As the majority recounts,
ante, at 68, IDEA authorizes
the provision of federal financial assistance to States that agree
to provide,
inter alia, "special education and related
services" for disabled children. § 1401(a)(18). In
Tatro,
supra, we held that this provision of IDEA required a school
district to provide clean intermittent catheterization to a
disabled child several times a day. In so holding, we relied on
Department of Education regulations, which we concluded had
reasonably interpreted IDEA's definition of "related
80
80 CEDAR RAPIDS COMMUNITY SCHOOL DIST.
v. GARRET F.
THOMAS, J., dissenting
services" 1 to require school districts in participating States
to provide "school nursing services" (of which we assumed
catheterization was a subcategory) but not "services of a
physician."
Id., at 892-893. This holding is contrary to the
plain text of IDEA, and its reliance on the Department of
Education's regulations was misplaced.
A
Before we consider whether deference to an agency regulation is
appropriate, "we first ask whether Congress has 'directly spoken to
the precise question at issue. If the intent of Congress is clear,
that is the end of the matter; for the court, as well as the
agency, must give effect to the unambiguously expressed intent of
Congress.'''
National Credit Union Admin. v.
First Nat.
Bank &
Trust Co., 522 U. S. 479, 499-500
(1998) (quoting
Chevron U. S.
A. Inc. v.
Natural
Resources Defense Council, Inc., 467 U. S. 837, 842-843
(1984)).
Unfortunately, the Court in
Tatro failed to consider this
necessary antecedent question before turning to the Department of
Education's regulations implementing IDEA's related services
provision. The Court instead began "with the regulations of the
Department of Education, which," it said, "are entitled to
deference." 468 U. S., at 891-892. The Court need not have looked
beyond the text of IDEA, which expressly indicates that school
districts are not required to provide medical services, except for
diagnostic and evaluation purposes. 20 U. S. C. § 1401(a)(17). The
majority asserts that
Tatro precludes reading the term
"medical serv-
1 IDEA currently 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 shall be for diagnostic and
evaluation purposes only) as may be required to assist a child
with a disability to benefit from special education .... " 20 U. S.
C. § 1401(a)(17) (emphasis added).
81
ices" to include "all forms of care that might loosely be
described as 'medicaL'"
Ante, at 75. The majority does not
explain, however, why "services" that are "medical" in nature are
not "medical services." Not only is the definition that the
majority rejects consistent with other uses of the term in federal
law,2 it also avoids the anomalous result of holding that the
services at issue in
Tatro (as well as in this case), while
not "medical services," would nonetheless qualify as medical care
for federal income tax purposes.
Ante, at 74-75.
The primary problem with
Tatro, and the majority's
reliance on it today, is that the Court focused on the provider of
the services rather than the services themselves. We do not
typically think that automotive services are limited to those
provided by a mechanic, for example. Rather, anything done to
repair or service a car, no matter who does the work, is thought to
fall into that category. Similarly, the term "food service" is not
generally thought to be limited to work performed by a chef. The
term "medical" similarly does not support
Tatro's
provider-specific approach, but encompasses services that are "of,
relating to, or concerned with physicians
or with the
practice of medicine." See Webster's Third New International
Dictionary 1402 (1986) (emphasis added); see also id., at 1551
(defining "nurse" as "a person skilled in caring for and waiting on
the infirm, the injured, or the sick;
specif" one esp.
trained to carry out such duties under the supervision of a
physician").
2 See,
e. g., 38 U. S. C. § 1701(6) ("The term 'medical
services' includes, in addition to medical examination, treatment,
and rehabilitative services- ... surgical services, dental services
... , optometric and podiatric services, ... preventive health
services, ... [and] such consultation, professional counseling,
training, and mental health services as are necessary in connection
with the treatment"); § 101(28) ("The term 'nursing home care'
means the accommodation of convalescents ... who require nursing
care and related medical services"); 26 U. S. C. § 213(d)(1) ("The
term 'medical care' means amounts paid- ... for the diagnosis,
cure, mitigation, treatment, or prevention of disease").
82
82 CEDAR RAPIDS COMMUNITY SCHOOL DIST.
v. GARRET F.
THOMAS, J., dissenting
IDEA's structure and purpose reinforce this textual
interpretation. Congress enacted IDEA to increase the
educational opportunities available to disabled children,
not to provide medical care for them. See 20 U. S. C. § 1400(c)
("It is the purpose of this chapter to assure that all children
with disabilities have ... a free appropriate public education");
see also § 1412 ("In order to qualify for assistance ... a State
shall demonstrate ... [that it] has in effect a policy that assures
all children with disabilities the right to a free appropriate
public education");
Board of Ed. of Hendrick Hudson Central
School Dist., Westchester Cty. v.
Rowley, 458 U. S. 176, 179 (1982)
("The Act represents an ambitious federal effort to promote the
education of handicapped children"). As such, where Congress
decided to require a supportive service-including speech pathology,
occupational therapy, and audiology-that appears "medical" in
nature, it took care to do so explicitly. See § 1401(a)(17).
Congress specified these services precisely because it recognized
that they would otherwise fall under the broad "medical services"
exclusion. Indeed, when it crafted the definition of related
services, Congress could have, but chose not to, include "nursing
services" in this list.
B
Tatro was wrongly decided even if the phrase "medical
services" was subject to multiple constructions, and therefore,
deference to any reasonable Department of Education regulation was
appropriate. The Department of Education has never promulgated
regulations defining the scope of IDEA's "medical services"
exclusion. One year before
Tatro was decided, the Secretary
of Education issued proposed regulations that defined excluded
medical services as "services relating to the practice of
medicine." 47 Fed. Reg. 33838 (1982). These regulations, which
represent the Department's only attempt to define the disputed
term, were never adopted. Instead, "[t]he regulations actually
define only those 'medical services' that
are owed to
handicapped
83
children,"
Tatro, 468 U. S., at 892, n. 10 (emphasis in
original), not those that
are not. Now, as when
Tatro
was decided, the regulations require districts to provide services
performed "'by a licensed physician to determine a child's
medically related handicapping condition which results in the
child's need for special education and related services.'"
Ibid. (quoting 34 CFR § 300.13(b)(4) (1983), recodified and
amended as 34 CFR § 300.16(b)(4) (1998).
Extrapolating from this regulation, the
Tatro Court
presumed that this meant that "'medical services' not owed under
the statute are those 'services by a licensed physician' that serve
other purposes."
Tatro, supra, at 892, n. 10 (emphasis
deleted). The Court, therefore, did not defer to the regulation
itself, but rather relied on an inference drawn from it to
speculate about how a regulation might read if the Department of
Education promulgated one. Deference in those circumstances is
impermissible. We cannot defer to a regulation that does not
exist.3
II
Assuming that
Tatro was correctly decided in the first
instance, it does not control the outcome of this case. Because
IDEA was enacted pursuant to Congress' spending power,
Rowley,
supra, at 190, n. 11, our analysis of the statute in this case
is governed by special rules of construction. We have repeatedly
emphasized that, when Congress places conditions on the receipt of
federal funds, "it must do so unambiguously."
Pennhurst State
School and Hospital v.
Hal-
3 Nor do I think that it is appropriate to defer to the
Department of Education's litigating position in this case. The
agency has had ample opportunity to address this problem but has
failed to do so in a formal regulation. Instead, it has maintained
conflicting positions about whether the services at issue in this
case are required by IDEA. See
ante, at 74, n. 6. Under
these circumstances, we should not assume that the litigating
position reflects the "agency's fair and considered judgment."
Auer v.
Robbins, 519 U. S. 452, 462
(1997).
84
84 CEDAR RAPIDS COMMUNITY SCHOOL DIST.
v. GARRET F.
THOMAS, J., dissenting
derman, 451
U. S. 1, 17 (1981). See also
Rowley, supra, at 190, n.
11;
South Dakota v.
Dole, 483 U. S. 203, 207
(1987);
New York v.
United States, 505 U. S. 144, 158
(1992). This is because a law that "condition[s] an offer of
federal funding on a promise by the recipient ... amounts
essentially to a contract between the Government and the recipient
of funds."
Gebser v.
Lago Vista Independent School Dist.,
524 U. S. 274, 286 (1998). As such, "[t]he legitimacy of
Congress' power to legislate under the spending power ... rests on
whether the State voluntarily and knowingly accepts the terms of
the 'contract.' There can, of course, be no knowing acceptance if a
State is unaware of the conditions or is unable to ascertain what
is expected of it."
Pennhurst, supra, at 17 (citations
omitted). It follows that we must interpret Spending Clause
legislation narrowly, in order to avoid saddling the States with
obligations that they did not anticipate.
The majority's approach in this case turns this Spending Clause
presumption on its head. We have held that, in enacting IDEA,
Congress wished to require "States to educate handicapped children
with nonhandicapped children whenever possible,"
Rowley,
supra, at 202. Congress, however, also took steps to limit the
fiscal burdens that States must bear in attempting to achieve this
laudable goal. These steps include requiring States to provide an
education that is only "appropriate" rather than requiring them to
maximize the potential of disabled students, see 20 U. S. C. §
1400(c);
Rowley, supra, at 200, recognizing that integration
into the public school environment is not always possible, see §
1412(5), and clarifying that, with a few exceptions, public schools
need not provide "medical services" for disabled students, §§
1401(a)(17) and (18).
For this reason, we have previously recognized that Congress did
not intend to "impos[e] upon the States a burden of unspecified
proportions and weight" in enacting IDEA.
Rowley, supra, at
190, n. 11. These federalism concerns require us to interpret
IDEA's related services provision, con-
85
sistent with
Tatro, as follows: Department of Education
regulations require districts to provide disabled children with
health-related services that school nurses can perform as part of
their normal duties. This reading of
Tatro, although less
broad than the majority's, is equally plausible and certainly more
consistent with our obligation to interpret Spending Clause
legislation narrowly. Before concluding that the district was
required to provide clean intermittent catheterization for Amber
Tatro, we observed that school nurses in the district were
authorized to perform services that were "difficult to distinguish
from the provision of [clean intermittent catheterization] to the
handicapped."
Tatro, 468 U. S., at 893. We concluded that
"[i]t would be strange indeed if Congress, in attempting to extend
special services to handicapped children, were unwilling to
guarantee them services of a kind that are routinely provided to
the nonhandicapped."
Id., at 893-894.
Unlike clean intermittent catheterization, however, a school
nurse cannot provide the services that respondent requires, see
ante, at 69-70, n. 3, and continue to perform her normal
duties. To the contrary, because respondent requires continuous,
one-on-one care throughout the entire schoolday, all agree that the
district must hire an additional employee to attend solely to
respondent. This will cost a minimum of $18,000 per year. Although
the majority recognizes this fact, it nonetheless concludes that
the "more extensive" nature of the services that respondent needs
is irrelevant to the question whether those services fall under the
medical services exclusion.
Ante, at 75. This approach
disregards the constitutionally mandated principles of construction
applicable to Spending Clause legislation and blindsides unwary
States with fiscal obligations that they could not have
anticipated.
***
For the foregoing reasons, I respectfully dissent.
Comments
Be the first to comment
Leave a Comment