Cost of Good Intentions

TU.S. Supreme Court’s decision Wednesday requiring school districts to provide special care for severely disabled students is another example of the cost of good intentions: Public schools once again are being called upon not merely to educate but in some cases to also provide health care.

The ruling stems from the case of an Iowa boy left quadriplegic and dependent on a ventilator after a childhood accident. His parents insisted that the school district provide continuous, one-on-one care requiring a full-time aide during the school day. The court agreed, saying schools must provide such care as a “related service” of education, as long as it does not require “medical services,” defined by the presence of a doctor. The school district in the case, Cedar Rapids Community, argued reasonably that medical services depended not on whether a doctor provided them but on the complexity and constancy of care.

The court decision may have been inevitable, given the Individuals With Disabilities Education Act, a federal law that requires “a free, appropriate public education” for children with special needs.

“Congress intended to open the door of public education to all qualified students,” Justice John Paul Stevens wrote in the decision. “This case is about whether meaningful access to the public schools will be assured.”

Certainly we agree with that appropriate goal. But in trying to further that goal, the court seized upon a narrow and antiquated notion of medical care. The court said that as long as a doctor is not providing the care at the school to a severely disabled child, it’s not medical care. Of course it is.

The National Assn. of School Boards estimates the expense at $500 million to provide health care aides for the current 17,000 public school students classified as “medically fragile,” many of them with multiple and severe disabilities. The Los Angeles district already provides health care assistants for 250 pupils, fewer than 1% of special education children. But those numbers, both national and local, could grow in the wake of the court decision, as more parents request care or as they request extraordinary services that require a nurse.

Many school districts do not provide this assistance and now face costs from $20,000 to $60,000 per pupil, depending on the care required and the location of the school. That expense, daunting even for affluent districts, would fall particularly hard on smaller school districts.

Washington has never fully funded the cost of special education. The Supreme Court decision makes that need even more urgent in the short term. In the long term, Congress should clarify a murky law that led to a court decision that in the end may shortchange more students than it helps.