## Facts

- Amber Tatro was a Texas public school student with spina bifida and a neurogenic bladder that prevented voluntary bladder emptying.
- To avoid kidney injury, Amber required clean intermittent catheterization (CIC) every three to four hours, including during the school day.
- CIC was prescribed as a simple procedure performable in minutes by a trained layperson and did not require a physician.
- Irving Independent School District provided special education and certain therapies under Amber’s individualized education program (IEP) but refused to provide CIC at school.
- The Tatros asserted that without CIC at school Amber could not safely attend school and therefore could not benefit from her special education program.
- Administrative proceedings upheld the district’s refusal.
- The federal district court initially denied injunctive relief, but the Fifth Circuit reversed and remanded.
- On remand, the district court ordered the IEP modified to provide CIC as a related service under the Education of the Handicapped Act (EHA) and also found a violation of § 504 of the Rehabilitation Act, awarding damages and attorney’s fees; the Fifth Circuit affirmed.
- The Supreme Court granted review and issued a unanimous decision.

## Issues

1. Whether CIC is a “related service” that must be provided to ensure a free appropriate public education under the EHA, or instead an excluded “medical service.”
2. Whether, and to what extent, relief and attorney’s fees could be pursued under the Rehabilitation Act for the school’s refusal to provide CIC.

## Decision

- The Court held that CIC is a required “related service” under the EHA because it was necessary for Amber to attend school and benefit from special education.
- The Court concluded CIC was not excluded as a “medical service” because it did not need to be performed by a licensed physician.
- The Court relied on Department of Education regulations distinguishing “medical services” (physician-provided) from “school health services” (nurse or other qualified person).
- The judgment was affirmed as to the EHA holding requiring CIC and remanded for further proceedings regarding the Rehabilitation Act aspects.

## Legal Principles

- A service is a covered “related service” under the EHA if it is required to assist a child with a disability to benefit from special education, including by making school attendance and participation possible.
- The EHA’s exclusion for “medical services” (except for diagnostic and evaluation purposes) does not cover services that can be performed by a nurse or other trained, qualified nonphysician.
- The physician/nonphysician distinction, reflected in federal regulations, is a permissible way to separate excluded “medical services” from covered “school health services.”
- Related services are not limited to services with inherently educational content; supportive health services may be required when they are necessary for access to special education.

## Conclusion

The Court required the school district to provide clean intermittent catheterization during school as a related service because it was essential for the child to attend and benefit from special education and did not fall within the EHA’s physician-only “medical services” exclusion.


Irving Indep. Sch. Dist. v. Tatro, 468 U.S. 883 (1984)