Before The
State Of Wisconsin
DIVISION OF HEARINGS AND APPEALS

In the Matter of [Student]
v.
Montello School District

DECISION  
Case No.: LEA-03-042

The Parties to this proceeding are:

[Student], by [Father & Mother]
[Address]

Montello School District, by

Attorney Thomas N. Shorter
Davis & Kuelthau, S.C.
P. O. Box 1068
Madison, WI 53701-1068

PROCEDURAL HISTORY

On October 3, 2003, the Department of Public Instruction received a request for a due process hearing filed by [Father] and [Mother] (the "Parents"), on behalf of [Student] (the "Student"), against the Montello School District (the "District") under chapter 115, Wis. Stats., and the federal Individuals with Disabilities Education Act (IDEA). The Department referred the matter to the Division of Hearings and Appeals.

A prehearing telephone conference was held on October 13, 2003. On October 22, 2003, the District filed a motion to dismiss the Parent's claims. The Parents filed a brief, with attached exhibits, opposing the District's motion on October 31, 2003. The District filed a response brief in support of its motion to dismiss on November 10, 2003. On November 14, 2003, the undersigned issued a Ruling and Order dismissing one of the Parent's claims and amending the three remaining issues to address only those alleged denials of FAPE occurring since April 25, 2003. Prior to the start of the due process hearing, the Parties resolved two issues, so only one issue remained for hearing.

The due process hearing was held on November 25, 2003. The parties submitted post-hearing briefs on December 11, 2003. Pursuant to the joint request of the parties, the decision deadline was extended to December 19, 2003.

ISSUE

Since April 25, 2003, has the District denied the Student a free, appropriate public education (FAPE) by failing to provide a proper and updated plan of nursing care?

FINDINGS OF FACT

  1. The Student is a 14-year-old girl (date of birth XXXXX) who is enrolled in the ninth grade in the District. (Tr. 18) She is a child with disabilities in need of special education as defined by state and federal law. The District has identified her areas of disability as orthopedic impairment, other health impaired, and speech and language impairment. (Tr. 213, Ex. 30)

  2. The Student's medical diagnosis is spastic athetoid quadriplegia cerebral palsy. (Tr. 18) She is wheelchair bound, has a seizure disorder, dysphagia (a swallowing disorder), GE reflux disorder, orthopedic problems, and is incontinent. (Tr. 18, 28-29) The Student is non-verbal and communicates primarily through head nods. (Tr. 19) She has an implanted Mic-key button that allows her to receive all nutrition directly into the stomach via G-tube. (Tr. 19-20)

  3. The Student also has problems with skin integrity. Around the Mic-key button site, her skin is fragile and prone to open sores that heal and open again. (Tr. 28, 131-132) In relation to her incontinence, the Student is prone to rashes in the groin area. (Tr. 28-29, 156)

  4. In March 2003, the District conducted a three-year reevaluation of the Student. The evaluation report noted that the Student is medically stable and recommended that the school health services listed in the 2002-2003 IEP be continued. (Ex. 30)

  5. The Student's individualized education plans (IEPs) for the 2002-2003 and 2003-2004 school years both indicate that the Student needs related services to benefit from special education, including numerous school health services. (Ex. 2 and 12) The school health services specified in both the 2002-2003 and 2003-2004 IEPs are listed under 13 headings, as follows: 1) G-tube feeding; 2) Airway management; 3) Seizure management; 4) Transferring and mobility; 5) Oral fluids, Pureed foods; 6) Emergency procedures; 7) Medication administration; 8) Communication; 9) Personal hygiene, Activities of daily living assistance; 10) Nursing care; 11) Maintenance of medical records, forms, protocols, procedures and physician orders; 12) ROM/Flexibility exercises; and 13) Staff in-service and training. (Ex. 2 and 12)

  6. The District's school nurse, Jessica Napralla Sauld, is a registered nurse licensed by the State of Wisconsin. (Tr. 13-14, Ex. 1) She has been providing school health care services to the Student in the District since 1998. (Tr. 15) All of the school health services included in the Student's IEPs are provided by Ms. Sauld or her designee. (Tr. 17, Ex. 2 and 12)

  7. Ms. Sauld developed a nursing care plan for the Student for the 2002-2003 school year. (Tr. 25-26, Ex. 3) Ms. Sauld reviewed the 2002-2003 nursing care plan on November 15, 2002 and on March 10, 2003. (Tr. 27, Ex. 3) On March 17, 2003, Ms. Sauld requested medical records from the Student's physicians to determine if there were any changes in her medical condition that would warrant changes in the Student's school health services and nursing care plan. (Tr. 36-38, Ex. 6) Ms. Sauld implemented physicians' orders regarding the Student that she received during the 2002-2003 school year. (Tr. 38-40)

  8. In June 2003, Ms. Sauld developed a nursing care plan for the Student for the 2003-2004 school year. (Tr. 47-48, Ex. 13) Like the 2002-2003 nursing care plan, the 2003-2004 plan addressed five areas: 1) communication deficit; 2) high risk for impaired skin integrity; 3) alteration of nutritional intake; 4) activity intolerance; and 5) self-care deficit. (Ex. 3) Ms. Sauld did not make significant revisions to the Student's nursing care plan for the 2003-2004 school year because the Student's medical condition was stable. (Tr. 110-111) The 2003-2004 nursing care plan was updated to include new information on the use of Cavilon wipes and changes to the seizure procedure, as well as some minor format changes. (Tr. 49-51, Ex. 13)

  9. In addition to the nursing care plans, for both of the relevant school years Ms. Sauld prepared guidelines and procedures related to the Student's school health services, such as seizure procedures, G-tube feeding, Mic-key button care, hygiene, swallowing procedures, and more. (Ex. 4 and 5)

  10. The Student receives nursing care services in her home from Northland Home Health Care. (Tr. 122)

DISCUSSION

The IDEA requires that all children with disabilities are offered a FAPE that meets their individual needs. 20 USC § 1400 (d); 34 CFR § 300.1. FAPE refers to special education and related services designed to meet the unique needs of a child with a disability that are sufficient to confer some educational benefit upon the child. Board of Educ. v. Rowley, 458 U.S. 176, 188-89 (1982). School districts must provide related services if the services are needed to "enable a disabled child to remain in school during the day [and] provide the student with 'the meaningful access to education that Congress envisioned.'" Cedar Rapids Comm. Sch. Dist. v. Garret F., 526 U.S. 66, 73 (1999) (quoting Irving Indep. Sch. Dist. v. Tatro, 468 U.S. 883, 891 (1984)).

Related services are defined as "transportation and such developmental, corrective, and other supportive services as are required to assist a child with a disability to benefit from special education." 34 CFR § 300.24(a). School health services are specifically included as one type of related service. Id. School health services are "services provided by a qualified school nurse or other qualified person." 34 CFR § 300.24(b)(12).

The regulations define "qualified personnel" as "personnel who have met SEA-approved or SEA-recognized certification, licensing, registration, or other comparable requirements that apply to the area in which the individuals are providing special education or related services." 34 CFR § 300.23 (emphasis added). The District's school nurse, Ms. Sauld, is a registered nurse licensed by the State of Wisconsin. As such, she is qualified to provide school health services under the IDEA.

The issue presented in this case is whether the District denied the Student a FAPE by failing to provide a proper and updated plan of nursing care. The IDEA does not specifically require that school districts develop or provide students with disabilities with plans of nursing care. Districts are required to provide related services, including school health services, to children with disabilities to enable them to remain in school and have meaningful access to education. There is no evidence in the record that the Student was prevented from remaining in school and having meaningful access to education because of a failure by the District to provide necessary school health services. Moreover, there is no evidence in the record that the Student was prevented from remaining in school and having meaningful access to education because of a failure by the District to provide a proper and updated plan of nursing care.

Although the appropriateness of the plan of nursing care is the issue of record, the Parents primarily argued that Ms. Sauld failed to utilize proper assessment, evaluation, and problem-solving techniques as it related to her duties as a registered nurse. (Tr. 261-262) In particular, the Parent(s) alleged that Ms. Sauld did not assess and attempt to resolve the problem of the Student's fragile skin around the Mic-key button site. However, the Student's home health nurse stated that the Student has had problems with her skin opening and closing around the Mic-key button site for several years. (Tr. 132) The manner in which Ms. Sauld dealt with this issue is a matter of professional medical judgment, and the record shows that it did not deny the child a FAPE. The undersigned lacks the legal authority and qualifications to determine whether Ms. Sauld carried out her duties as a nurse appropriately with regard to the Student's fragile skin.

The Parents also alleged that Ms. Sauld did not use A&D ointment and corn starch on the Student's rash and did not collaborate with or obtain information from the Northland Home Health nurses. (Tr. 126, 244, 252-254, 261-262) There is no evidence in the record that the Student was prevented from remaining in school and having meaningful access to education because Ms. Sauld did not use A&D ointment and corn starch and did not communicate with the home health nurses.

By arguing that Ms. Sauld has not complied with the standards for registered nurses with regard to evaluation and assessment as it relates to the nursing care plan, the Parents are essentially challenging her professional competency. (Tr. 59, 261-262) As stated earlier, as a registered nurse licensed by the State of Wisconsin, Ms. Sauld is qualified to provide school health services under the IDEA.

Chapter 441, Wis. Stats., and chapter N6, Wis. Admin. Code, govern the standards of practice for registered and licensed nurses in Wisconsin. The Board of Nursing and the Department of Regulation and Licensing are responsible for enforcing the nursing regulations and laws in Wisconsin. See §§ 440.03(1) and 441.07(1), Wis. Stats., and § N 6.05, Wis. Admin. Code. If the Parents wish to challenge Ms. Sauld's compliance with the standards of practice for registered nurses, they must file a complaint with the Board of Nursing. This forum does not have jurisdiction over that issue.

CONCLUSIONS OF LAW

The District has not denied the Student a free, appropriate public education since April 25, 2003, by failing to provide a proper and updated plan of nursing care.

ORDER

It is hereby ordered that the due process hearing request in this matter is dismissed with prejudice.

Dated at Madison, Wisconsin on December 19, 2003.

STATE OF WISCONSIN
DIVISION OF HEARINGS AND APPEALS
5005 University Avenue, Suite 201
Madison, Wisconsin 53705-5400
Telephone: (608) 266-7709
FAX: (608) 264-9885
By:_________________________________
Sally M. Pederson
Administrative Law Judge

NOTICE OF APPEAL RIGHTS

APPEAL TO COURT: Within 45 days after the decision of the administrative law judge has been issued, either party may appeal the decision to the circuit court for the county in which the child resides under §115.80(7), Wis. Stats., or to federal district court pursuant to U.S.C. §1415 and 34 C.F.R. §300.512.

A copy of the appeal should also be sent to the Division of Hearings and Appeals, 5005 University Avenue, Suite 201, Madison, WI 53705-5400.

The Division will prepare and file the record with the court only upon receipt of a copy of the appeal. It is the responsibility of the appealing party to send a copy of the appeal to the Division of Hearings and Appeals. The record will be filed with the court within 30 days of the date the Division of Hearings and Appeals receives the appeal.