The crux of the school district's argument was that the plain language of the IDEA provides that a school district "need not pay for 'medical services.'" The school district claimed that because the services Garret required should be considered "medical services," they should not be covered under IDEA. Ultimately, the decision in this case hinged upon the definition of a "medical service." The school district offered a "multifactor test" that would take into account a variety of conditions, including expense, in determining whether a service constitutes a "medical service." In practical terms, under this standard, the more expensive the service, the more likely it would be viewed as "medical," even if it is not provided by a medical professional. Additionally, the school district argued that providing a full time aide is a large financial burden and that many smaller school districts would experience difficulties in meeting such financial obligations.
The Court, with only Justices Thomas and Kennedy dissenting, roundly dismissed these arguments, holding that as long as a student's physical needs can be met by someone who is not a doctor, the required services do not fall within the excluded "medical services" category. The Court relied heavily on a 1984 ruling that laid out a two-part standard for deciding what is a "related service" under IDEA. Under this standard, it was up to the parents of the child with a disability to show that the care was necessary to enable their child to attend class, and to further show that the care could be provided by someone other than a doctor. Justice Stevens, writing for the majority, felt that Garrett clearly met this standard and was therefore entitled to the services of a trained aide under IDEA. Taking into account that without such services Garret would not be able to attend school, Justice Stevens said: "This case is about whether meaningful access to the public schools will be assured." The Court conceded that the school district may have legitimate financial concerns, but opined that its role was simply to interpret existing law rather than weigh and balance the burdens of the statutory mandate.
Judith E. Heumann, Assistant Secretary for Special Education and Rehabilitative Services, reacting to the opinion stated: " We believe students like Garrett should receive the services necessary to ensure access to an appropriate education. That's what the law guarantees, and now the courts have made that clear."
This case represents a milestone for children with mental and physical disabilities. Many children with mental illness have been denied educational opportunities by school districts reticent to address or pay for the multiple services they require. With this decision, it will be more difficult for school systems to deny services to children with severe mental illnesses and other disabilities.
There are concerns, however, that the Supreme Court's decision may encourage Congress to amend IDEA to limit the obligations of school districts to pay for "related services" under the law. Nevertheless, at least in the short term, the decision marks a victory for student-age individuals afflicted with disabilities.