Supreme
Court decision
stirs up school nursing debate |
Supreme
Court decision
stirs up school nursing debate |
|
By
Anne Federwisch The March 3 Supreme Court decision mandating public schools to pay for continuous nursing care of students with disabilities is being hailed as a victory for children and an affirmation of the importance of school nursing. But whether the Cedar Rapids Community School District vs. Garret F. opinion translates into more positions for school nurses or just more work for them is yet to be determined. Following the decision, no one knows yet exactly how many more children will be eligible for school nursing services or whether registered nurses or less trained staff would be eligible to provide that care. The issue: Can school nursing legally be considered medical care? If not, should public school districts be exempt from obligations to pay for nursing services for disabled students? This case required the court to interpret a previous decision on school nursing that drew a legal distinction between the services nurses and physicians provide. Decision’s impact unclear The National Association of School Nurses (NASN) hailed the ruling as a "landmark decision [that] solidifies and reaffirms the central role that school nurses play in the delivery of related school health services under IDEA [the Individuals with Disabilities Education Act] and the obligation of school districts to pay for such services." But Rhoda Shepherd, MA, RN, manager of health services for the Cedar Rapids Community School District, said it’s still difficult to determine the ruling’s impact on the district. "We of course will need to provide the care for Garret and other students like him who require continuous nursing care," Shepherd said. Exactly who will be hired to provide that care has not yet been decided, she said. At the center of the case is Garret Frey, a 16-year-old high school student in Cedar Rapids, Iowa. Garret has been paralyzed since age 4, when his spinal cord was severed at the C1-C2 level during a motorcycle accident, in which his baby blanket was caught in the rear wheel and wrapped around his neck. According to the boy’s attorney, Douglas Oelschlaeger, senior vice president with the Iowa law firm Shuttleworth & Ingersoll, Garret requires care for his tracheostomy, catheterization, wheelchair repositioning, assistance with feeding, and constant monitoring throughout the school day because he is dependent on a ventilator. Currently a teacher’s associate assists Garret in his classes. Legal wrangling The school district denied the family’s 1993 request for it to pay for one-on-one, continuous nursing care while Garret was at school. Before then, Garret’s aunt or a licensed practical nurse—paid for from a $1.3 million settlement from the motorcycle manufacturer—provided that care. Because Garret cannot function without continuous care, the IDEA requires schools to pay for it during the school day, Oelschlaeger said. The school district disagreed. District officials argued that Garret’s case failed to meet the test some districts were using to limit their financial obligations to disabled students. That test considered whether care was continuous or intermittent, whether existing school health personnel could provide the service, how much the service cost, and what the consequences would be if the service were not properly performed. But the Supreme Court in the March 3 ruling refused to recognize that test, contending instead that the IDEA obligates schools to pay for "related" services required to allow children with disabilities to receive a free and appropriate public education. While the IDEA clearly excludes "medical services" (except for diagnostic or evaluation purposes) from a school’s financial obligations, it does not exclude nursing care. The court based its reasoning on the 1984 decision Irving Independent School District vs. Tatro. In that case, it found the services of a physician—other than for diagnostic and evaluation purpose—are subject to the medical services exclusion, but "services ... provided in the school setting by a nurse or qualified layperson are not." Judy Robinson, PhD, RN, executive director of NASN, said the decision "confirms what school nurses in many districts throughout the United States have been doing for years. Some school districts had already interpreted the IDEA to imply that kind of support and others had not." The organization filed an amicus curiae (friend of the court) brief on Garret’s behalf. The NASN also provided information and consultation services to government officials involved with the case. Stretched thin Shepherd said the district will need to hire another person to provide Garret’s care. The 11 full- and part-time school nurses who provide health services for the district’s 18,000 students in 32 different buildings are already stretched thin, she said. She expects that person’s salary will come from the special education fund instead of the general fund, where the school health services budget originates. Depending on whether the clinician is an LPN or RN, it could cost between $35,000 and $40,000 annually, Shepherd said. Oelschlaeger said that the overall increase to the district would be about $12,000 less than that because the school would no longer need to pay the teacher’s associate. It will take school districts awhile to digest the Frey decision, according to Lydia Bourne, MA, RN, executive director of the California School Nurses Organization. She said she hopes that even if school districts opt to hire less-prepared staff to attend to the continuous care needs of some students, they realize that the school nurses still have the responsibility to supervise and train that staff. Bourne said, "That means, then, that you have to have sufficient numbers [of school nurses] to make sure that this can occur." |
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