Irving Independent School District v. Tatro

Citations: 82 L. Ed. 2d 664; 104 S. Ct. 3371; 468 U.S. 883; 1984 U.S. LEXIS 152; 52 U.S.L.W. 5151Docket: 83-558

Court: Supreme Court of the United States; July 5, 1984; Federal Supreme Court; Federal Appellate Court

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In the case of Irving Independent School District v. Henri Tatro, the Supreme Court addressed the educational rights of an 8-year-old girl with spina bifida, who required clean intermittent catheterization (CIC) during school hours. The School District, receiving federal funding under the Education of the Handicapped Act, was obligated to provide a free appropriate public education, which includes related services necessary for a handicapped child to benefit from special education. The District's individualized education program did not include provisions for CIC, leading the child's parents to seek legal redress after exhausting administrative remedies.

The court ruled that CIC qualifies as a "related service" under the Act, essential for the child to attend school and benefit from her education, similarly to services that facilitate access to school. The ruling emphasized that CIC services are not merely medical services, as defined by the Department of Education, which distinguishes between school health services and medical services provided by licensed physicians. The court mandated modifications to the child's education program to include CIC and awarded compensatory damages.

However, the court concluded that Section 504 of the Rehabilitation Act was inapplicable since relief was available under the Education of the Handicapped Act for the denial of educational services, thus denying recovery of attorney's fees under Section 504.

A Fifth Circuit case, 703 F.2d 823 (CA5 1983), addressed whether the Education of the Handicapped Act or the Rehabilitation Act of 1973 mandates that a school district provide a handicapped child, Amber Tatro, with clean intermittent catheterization (CIC) during school hours. Amber, an 8-year-old with spina bifida, requires CIC every three to four hours due to a neurogenic bladder. Her individualized education program, developed by the Irving Independent School District, included special education services but did not provide for CIC administration. After unsuccessful administrative attempts to secure CIC, Amber's parents filed a lawsuit seeking an injunction, damages, and attorney's fees, asserting that CIC qualifies as a "related service" under the Education of the Handicapped Act and that its denial violated Section 504 of the Rehabilitation Act. The District Court denied the parents' request, ruling that CIC was not a related service and that the Rehabilitation Act did not require the establishment of governmental health care for federally funded programs. However, the Court of Appeals reversed this decision, finding that CIC was indeed a related service necessary for Amber's access to education and that the school district's refusal to provide it violated the Rehabilitation Act. The case was remanded for further factual development in the District Court.

On remand, the petitioner highlighted that under the Education of the Handicapped Act, "medical services" qualify as "related services" only when intended for diagnosis or evaluation. The District Court determined that Texas law allows a nurse or qualified individual to administer CIC (clean intermittent catheterization) under a doctor's prescription and supervision without constituting unauthorized medical practice. Consequently, the court ruled that administering CIC did not fall under "medical services" as defined by the Act. It classified CIC as a "related service" and mandated that the petitioner and the State Board of Education modify Amber's individualized education program to include CIC during school hours, awarding compensatory damages against the petitioner.

The District Court also found a violation of Section 504 of the Rehabilitation Act, using this finding to grant attorney's fees against the petitioner and the State Board of Education, as the Rehabilitation Act permits fee recovery for prevailing parties. The Court of Appeals affirmed these decisions, agreeing that state law allowed qualified persons to administer CIC without a doctor's physical presence and upheld the relief awarded under the Education of the Handicapped Act. The appellate court also maintained the award of attorney's fees based on the Rehabilitation Act, stating that no changes warranted a different outcome since the prior ruling.

The Supreme Court accepted the case, addressing two key issues: whether the Education of the Handicapped Act mandates the provision of CIC services and whether Section 504 of the Rehabilitation Act imposes such an obligation. States receiving funds under the Education of the Handicapped Act must ensure a "free appropriate public education" for all handicapped children, which includes "special education and related services." Special education encompasses specially designed instruction at no cost to parents, while "related services" include various supportive services necessary for a handicapped child to benefit from special education, explicitly noting that medical services are limited to diagnostic and evaluative purposes.

The primary issue is whether Continuous Intensive Care (CIC) qualifies as a "related service" that the petitioner must provide to Amber. Two critical questions are addressed: whether CIC is a "supportive service required to assist a handicapped child to benefit from special education" and whether it is excluded as a "medical service" intended solely for diagnosis or evaluation.

The Court of Appeals correctly concluded that CIC is a supportive service essential for Amber's ability to attend school and benefit from special education. The absence of CIC services would prevent Amber from accessing education, which aligns with the Congressional intent to provide meaningful public education to handicapped children, as established in Board of Education of Hendrick Hudson Central School District v. Rowley.

The Act outlines that supportive services, including transportation, are necessary for a child's physical presence in school, which is integral to accessing education. Therefore, CIC services are deemed as supportive as those that help with entry to school.

Furthermore, the provision of CIC is not classified as a "medical service" that schools are only required to provide for diagnostic purposes. The Department of Education's regulations, which clarify that "related services" encompass school health services provided by qualified personnel, further support this view. Medical services are defined as those provided by licensed physicians and are excluded from the scope of services schools must provide. This distinction is consistent with Congressional intent to avoid overburdening schools with potentially expensive medical obligations while still mandating the hiring of trained personnel to assist handicapped children.

School nursing services are considered within the scope of "medical services" as defined by Congress, allowing the Secretary to reasonably interpret that these services are not burdensome exclusions. The petitioner’s assertion that CIC (Continuous Insulin Care) constitutes a "medical service" is unpersuasive, particularly as Texas law requires physician oversight for such services. The ability of school nurses to dispense medications and administer emergency treatments to nonhandicapped students suggests that similar services should be available to handicapped children, supporting the notion that Congress intended to provide equal services. 

Key limitations exist to mitigate the perceived burden on schools: only children requiring special education qualify for related services, and services must be necessary for the child to benefit from special education. Services that can be provided outside school hours or by minimally trained laypersons do not obligate schools to provide nursing services. 

The court concludes that CIC is not excluded as a "medical service" and affirms the Court of Appeals’ ruling that CIC qualifies as a "related service" under the Education of the Handicapped Act. Additionally, while the respondents sought relief under both the Education of the Handicapped Act and Section 504 of the Rehabilitation Act, the court held that Section 504 is not applicable when relief is available under the former, resulting in a reversal of the Court of Appeals’ decision to grant attorney's fees under Section 504. The judgment of the Court of Appeals is affirmed in all other respects.

Justice Stevens concurs in part and dissents in part, advocating for the affirmation of attorney's fees for the respondents based on his previous dissent in Smith v. Robinson. The petition for certiorari did not challenge these fees, focusing instead on the substantive relief awarded to the respondents. The court's ruling on the merits aligns with its interpretation of the Education of the Handicapped Act (EHA), rendering any opinion on the Rehabilitation Act of 1973 unnecessary.

The EHA's procedures for administrative hearings, as outlined in 20 U.S.C. § 1415, were applied in this case, where a hearing officer ruled in favor of providing Communication Interventions and Supports (CIC). However, the Texas State Board of Education later reversed this decision, asserting that the EHA did not mandate CIC provision. 

The EHA defines "related services," which include supportive services necessary for a handicapped child's benefit from special education, under 20 U.S.C. § 1401(17). The District Court dismissed claims against all defendants except the petitioner and the State Board, retaining the State Board members for injunctive relief. It ruled that Section 505 of the Rehabilitation Act, allowing for attorney's fees, abrogated the State Board's Eleventh Amendment immunity, a matter not before the Court since the State Board did not seek certiorari.

The EHA stipulates that "special education and related services" must be provided at public expense, meet state educational standards, include appropriate education, and conform with individualized education programs as specified in § 1401(18). The petitioner contends that courts should only assess adherence to procedural requirements of the state plan. However, precedent from Board of Education of Hendrick Hudson Central School District v. Rowley establishes that courts must also verify the creation of an individualized education plan (IEP) that complies with the Act's requirements. 

The Department of Education has recognized CIC as a "related service" in an interpretive ruling, despite previous postponements of its effective date. This ruling supports the view that CIC services qualify as an allowable cost under Part B of the EHA.

The obligation for states to provide special education and related services is a condition for receiving federal funds under the Education for All Handicapped Children Act, countering the petitioner’s claim that the Act only suggested funding without imposing obligations. The Secretary of Education is authorized to issue necessary regulations, a function originally held by the Commissioner of Education, which was transferred following the establishment of the Department of Education. The regulations define "medical services" owed to handicapped children specifically as those provided by licensed physicians to assess medically related conditions that necessitate special education services. Children with serious medical needs, such as those requiring instruction in hospitals or at home, are still entitled to an education under the Act.

The petitioner attempts to differentiate between the administration of prescription drugs and clean intermittent catheterization (CIC) based on Texas law's liability limitations, but this distinction does not impact whether CIC qualifies as a "related service." The introduction of handicapped children into schools introduces various risks, which Congress assumed states could manage. The text implies that procuring additional liability insurance or extending liability limitations should not pose a significant burden due to CIC.

The respondents do not seek to prevent the education of Amber with handicapped peers and her current individualized education program includes classes with nonhandicapped students. Moreover, the petitioner acknowledged that providing CIC at the public school is more cost-effective than alternative educational placements. The petition for certiorari raises three questions regarding the definition of "related services" and the obligations of public schools under the Act, but the Court does not find grounds to reverse the Fifth Circuit’s judgment.