QUESTIONS & ANSWERS ABOUT THE GARRET F. SUPREME COURT CASE

Who is Garret F.? Garret Frey is a high school student in Cedar Rapids, Iowa, who was paralyzed from the waist down in a childhood accident. He uses a power wheelchair, has a tracheotomy, needs a ventilator, is catheterized daily, and requires monitoring of his equipment and health status 24 hours a day. Garret’s family (none of them medical professionals) cares for him at home. According to Supreme Court Justice John Paul Stevens, Garret is "a friendly, creative and intelligent young man."

What is the Legal Issue? The Cedar Rapids school district said that Garret’s severe condition required "medical treatment" by a registered nurse during school hours, but that schools were not obligated to pay for the care. The district gave the Freys two choices: 1) Pay for a nurse at school; or 2) Have Garrett tutored at home one hour a day. The Frey family believed that IDEA (the federal special education law) obligates school districts to pay for related school health services. Earlier federal court decisions also established that schools must pay for certain health-related services. Unable to reach a compromise, the Frey family resorted to a legal solution. Garret won at several court levels, finally reaching the United States Supreme Court. In August, 1998, Family Voices joined the American Academy of Pediatrics and the National Association of School Nurses in an amicus brief to the Supreme Court on behalf of Garret.

What is the Background of this Case? When he started school, Garrett was assisted by a specially trained attendant. Later, at the insistence of the Cedar Rapids school district, a licensed practical nurse (LPN) helped Garret. The LPN was paid for through his family’s insurance policy until its cap was reached. Garrett is now ineligible for private insurance. Because they believed that Garret had a right to attend school with in-school health supports paid by the district, the Frey family filed their suit.

What Did the U.S. Supreme Court Say? On March 3, 1999, in their 7-2 ruling in the Garret F. case, the U.S. Supreme Court said that IDEA requires schools to provide health supports for students who need them, as long as that care is not medical in nature and performed by doctors. The ruling says that, "… the district must fund such related services to help guarantee that students like Garret are integrated into the public school."

What Does This Mean For Other Students and Schools? The Garret F. decision means that all students, no matter their health condition, have a right to safely attend school, with necessary services paid by the school district. In most cases a well-trained attendant, backed up by a regular school nurse, is sufficient. In fact, we know that ALL kids benefit when a school nurse is present in ALL schools! But many school districts think this is too expensive. Cedar Rapids says it will cost $30,000 to $40,000 per year for Garret’s one-on-one nurse, in addition to his $12,000 attendant. Garret’s lawyer counters that nurse and attendant positions can be combined for $18,000. The National School Boards Association states there are 17,000 students like Garret, and that federal dollars are inadequate for helping school districts follow the federal law. Unfortunately, it is unknown how many students need such support, or what those support services really cost. We do know that institutional care can run $80,000 per year. The ultimate price Garret and society would pay if he did not attend school is impossible to calculate.

How Should We Address This Issue? School districts, family and pediatric leaders, and state Title V/CSHCN and Medicaid officials can sit down together to find creative ways to ensure that students like Garret are able to attend school safely. Hundreds of school districts, large and small, rich and poor, have already found effective solutions. Meanwhile, the federal Department of Education, MCHB’s Division of Services for Children with Special Health Care Needs, the American Academy of Pediatrics, the National Association of School Nurses, Family Voices, and others should meet to discuss solutions that local school districts can use. This can work for everyone! And Garret and his family have led the way.

Where Can School Districts Get Information? We recommend materials from Project School Care by Judith Palfrey, M.D. A book, Children and Youth Assisted by Medical Technology in Educational Settings, from Brookes Publishing is also useful. Call us at 888/835-5669 for details.