Handicapped Woman at Center of Dispute Over Special Education

As 40 million youngsters return to public school this fall, it will cost an average of $5,638 each to educate them.

You might call Beth Ann Brown the “$500,000 student.”

Beth Ann--a profoundly handicapped 21-year-old--her parents, and Wilson County school district outside Nashville are locked in a tragic legal duel to decide who should pay for her phenomenally expensive care and whether that care is really medical, or educational.

If she wins, as she well might, the county will owe her a sum equal to more than one-fourth of its entire special education budget of just under $2 million, which serves nearly 1,300 handicapped children.

It would also add to a recent string of court decisions mandating more special education spending--cases which a growing number of educators say threaten to squeeze regular education budgets and erode support for educating the nation’s 4.3 million handicapped children.

Beth Ann’s sad case also points up failures of state governments to share responsibility with local districts, and the mounting consequences of the federal government’s refusal to provide funds it promised for special education services it mandated 15 years ago.

Beth Ann Brown, a slight young woman with short brown hair, uncertain gait and frightened eyes, was born brain-damaged on March 9, 1969. She was left with a speech defect, cerebral palsy and an emotional disability so severe that normal school has been all but impossible most of her life.

From kindergarten on, her behavior grew more bizarre and unmanageable. She was given to unpredictable and violent outbursts. She swallowed hair spray, thumbtacks and clothing, banged her head, used profane language, and engaged publicly in inappropriate sexual behavior, according to court records.

Tests show that she is borderline retarded, says her lawyer, Gary Buchanan.

For years, Beth Ann’s parents and Wilson school officials had worked hard and, until recently, amicably, searching for an appropriate place for her.

She spent much of her life in seven different psychiatric hospitals or mental health centers in Tennessee and Pennsylvania. Her father’s insurance picked up 90% of the cost; the school district paid the rest.

She made no progress and in fact worsened, her parents say.

Since 1985, she has run away from two centers; spent three heavily drugged months at a psychiatric hospital; received homebound instruction; attended classes at a vocational training center. Nothing worked.

Beth Ann’s last 18 months have been happier--but at a staggering cost.

Since Feb. 15, 1989, she has led a sheltered life at Cedarbrook Academy, a lush, $690-a-day residential center specializing in brain-damaged victims in Gallatin, Tenn., about 20 miles from Nashville. Drugs and psychotherapy add up to $800 more to her monthly costs.

Her parents and therapists now say that for the first time in her life she is making progress in controlling her outbursts.

Her curriculum includes music, recreation therapy, speech, language arts, math, social interaction skills and health education. In June, she received grades of “C” in language arts, and “Ds” in math, social skills and health. But her report card noted overall progress “somewhat higher than the grades would indicate.”

Her attention span has increased from about three minutes to as much as 30 minutes. She is learning to count change. She is even learning to type, though her speed is only about one word per minute.

She herself says she is finally learning to get a grip on her volatile emotions--enough, she hopes, to attend regular school someday.

“I really like it here,” she told a visitor. “What I like best is the people. They don’t just look at you professionally. They really care about you.”

Despite her retardation, she can be articulate, curious and assertive in calm moments. She talked animatedly about the rock group New Kids on the Block, and her special fondness for country music singer Gary Morris. She admits to occasional homesickness.

But her volatility still requires therapists to be at her elbow virtually 24 hours a day.

And her life at Cedarbrook has been clouded ever since her father’s group insurance plan switched carriers about 18 months ago. The new carrier decided that the care Beth Ann was getting at Cedarbrook was educational, not medical. They stopped paying.

The Browns turned to Wilson County to pick up the tab. The county refused, offering Beth Ann more homebound instruction.

Beth Ann and her parents sued.

“We were doing everything for Beth Ann we possibly could,” said Mike Dover, Wilson County’s director of special education. “But with this last placement I finally said no. These placements simply weren’t working. We felt she had a mental health problem.”

But Middle Tennessee District Judge Thomas A. Higgins sided with Beth Ann. He issued a summary judgment on April 18 ordering Wilson County to pay $313,428.34 for her care at Cedarbrook, retroactive to May 1, 1989.

Wilson County’s bill would exceed $500,000 by June 1, 1991, when Beth Ann is 22 and no longer qualifies for special education.

Under recently enacted special education rules, the district would also have to pay Beth Ann’s legal bills, currently amounting to $13,128.30.

The county is appealing. If it loses, county taxpayers--already incensed over a $1.5-million school budget deficit--may face a tax increase, Dover said.

The core issue raised by Beth Ann and thousands like her across the country isn’t whether they are legally entitled to such intense and costly care. The real dilemma is, who should pay?

At the heart of the matter is the increasingly murky legal distinction between what is “educational” and what is “medical.”

The 1975 federal “Education for All Handicapped Children Act” which established the right of disabled 5-to-22-year-olds to a “free, appropriate public education,” also required public schools to provide what are called “related services.”

Such non-classroom services are meant to redress handicaps that directly interfere with learning. They commonly include special modes of transportation, speech therapy, and physical and occupational therapy.

But recent court rulings have greatly expanded the range of such services to include virtually any medical procedure that does not clearly require a doctor to administer them. A 1984 Supreme Court ruling requires schools to provide catheterization to a child with spina bifida, for example.

A decision last November further stretched the bounds of special education--beyond all reason, some educators contend.

In Timothy vs. Rochester, N.H., the U.S. Supreme Court let stand a ruling obligating school districts to provide education to all children regardless of the potential benefit.

The ruling compelled the Rochester school district to pay $15,000 a year to educate a 14-year-old who was blind and deaf, had cerebral palsy, was virtually immobile, and was so mentally impaired that the only apparent evidence of intellectual potential was that he responded to bright light, smiled when happy and cried when sad.

Educators, previously afraid of sounding heartless, now openly warn of a taxpayer backlash as regular education budgets are pinched by mounting special education costs, forcing tax increases.

“Cases like this bring about a schizophrenia. Our hearts tell us to do something. But our common sense tells us that there are limits,” said Thomas A. Shannon, executive director of the National School Boards Assn., which filed a brief in support of Rochester.

According to a cost analysis done for Congress last April by the National Assn. of State Directors of Special Education, total education spending in New York State rose 90.1% from 1980-88. But special education spending increased by 186.4%. In 1980, special ed accounted for 11% of all expenditures. In 1988, it had increased to 16.6%.

Other states surveyed reported similar figures. And new costs are just around the corner.

In 1986, Congress passed a law entitling handicapped preschoolers as young as 3 to public education. Starting in 1991, any state that doesn’t provide such services risks losing federal special education funds.

Special educators accuse the federal government of being quick to heap ever-greater responsibilities on school districts, but slow to fund them.

The 1975 act envisioned that the federal government would pay 40% of the total bill. But Washington never provided more than 14%, and has contributed less than 10% throughout the 1980s.

Adding to the fiscal strain on local districts, the current trend of de-institutionalization has placed thousands of youngsters once consigned to state mental hospitals into the care of public schools.

“School districts wind up holding the bag, getting little or no help from state agencies,” said Melinda Maloney, managing editor of the Special Educator, a semimonthly journal.

Dover says Wilson County officials have pleaded with various state agencies for financial help for Beth Ann--so far to no avail.

Buchanan, Beth Ann’s attorney, says he is confident that she will win the right to stay at Cedarbrook at public expense.

“What’s the alternative? Throw Beth Ann Brown out on the street?” he asked. “In all honesty, there was just no alternative.”