WASHINGTON -- Public school districts must pay for full-time nursing care for disabled students who require that service to attend classes, the Supreme Court ruled yesterday.
The decision is likely to cost the nation's schools heavily, but the total is uncertain because the services are so individualized and the number of students nationwide who could qualify is unknown. One estimate put the figure at 17,000.
The students' right to the care, the court said, comes from a 1975 federal law designed to assure disabled youngsters that they can attend regular school with students who are not disabled.
"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" when it required a "free public education" for handicapped children, Justice John Paul Stevens wrote for the court.
"This case is about whether meaningful access to the public schools will be assured," Stevens said. "The district must fund such services in order to help guarantee that [disabled] students are integrated into the public schools."
Schools have no duty to pay for a doctor's services, the court said in the 7-2 decision. But the law draws the line at that point, it said, so one-on-one nursing throughout the school day is the kind of education-related service that must be financed by the school district.
The court noted that the federal government has never spelled out precisely what kind of support services schools must provide, even though it has the authority to do so.
The ruling was a complete victory for 16-year-old Garret Frey of Cedar Rapids, Iowa, and his mother. The teen-ager, a high school sophomore, uses a wheelchair and requires a ventilator throughout the school day. He has been paralyzed from the neck down since his spinal column was severed in a motorcycle accident when he was 4.
Reached by the Associated Press at his school, Frey said the decision is "going to help a lot of other kids, not just me and other kids in Iowa. It's going to help all over."
Josephine Holzer, executive director of the Chicago-based Council for Disability Rights, said the ruling is "a step toward inclusion" but noted that a major problem remains for students who need the kind of care involved in the case, technically attendant care.
"When a child has that kind of a need, the school is always looking for a third party to pay, and often that will be the family's insurance. That puts the whole family in jeopardy," Holzer said. "Parents often don't know what their rights are, and they are in such an unequal position toward the school."
Anne Bryant, executive director of the National School Boards Association, said: "We worry that school districts will endure a great strain because of the decision. It takes the focus of schools away from being educators and into being medical-service providers."
Public school systems are already stretched, she said, and the ruling will place an additional burden on school districts.
Bryant also said schools might face greater legal liability if they must assume responsibility for students' serious, life-threatening conditions.
The decision's impact will have to be worked out in negotiations required by federal law for each disabled student who needs special support to attend a regular public school.
A disabled student is not automatically entitled to whatever services a parent might think should be provided.
Students who are out of school because of injuries or short-term illnesses are not considered disabled under the federal law at issue.
Charles Herndon, spokesman for the Baltimore County schools, said the decision "would mean an increased cost to the school system, but it's hard to know at this point what the impact might be."
"We also recognize the responsibility we have to provide an adequate education to all of the children living in Baltimore County, and we will, of course, comply with a ruling from the Supreme Court," he said. "I think our costs may depend on how the ruling is interpreted."
William H. Hyde, superintendent of the Carroll County schools, said his system provides registered nurses in schools that have "medically fragile" students and licensed practical nurses in all other schools.
"In the case of a severely disabled child, if that's a service that's required, and that helps keep the child included in an education program, then we have an opportunity to make that effort, to provide the resources to that student," Hyde said.
The handful of disabled students who need one-on-one medically intensive care have nurses who are paid for through the parents' insurance or through Medical Assistance, said Harry Fogle, the Carroll County schools' supervisor of special education.