Court will consider whether therapy justifies missed classroom instruction

Is physician-prescribed treatment a reasonable excuse for a child to miss classroom instruction at school?

That’s one of the questions raised in civil case that has worked its way up to the Iowa Supreme Court.

In September 2019, the Keystone Area Education Agency, which provides services for school districts in northeast Iowa, went to the Iowa Department of Education with a problem: Some special-education students in the Dubuque public school system were receiving daily behavioral therapy from the Hills and Dales Child Development Center, which resulted in the students missing a half-day of school on a regular basis.

According to court records, the students’ physicians would provide the district with a medical note asking the school to excuse the students’ absence from class for several hours each day so the students could receive their therapy treatments.

The absences posed an issue for the district, which is legally obligated to provide a certain level of instruction for all students, and also created a potential conflict with the district’s legal obligation to serve special-education students in accordance with the federal Individuals with Disabilities Education Act.

That law says in order for a state to be eligible for certain forms of federal assistance, it must make available to all students what is called a “free and appropriate public education,” even if that requires specially designed instruction to meet the unique needs of a child with disabilities. The law also requires that to the maximum extent possible, children with disabilities are to be educated alongside children who are not disabled.

The Keystone AEA asked the Iowa Department of Education for an order that would provide clear guidance on how to address the issue in Dubuque. As part of that process, the AEA argued it was important to note there was no indication “the therapy being provided is necessary for the health or safety of the student. Rather, the medical provider seeks to provide the services on the basis that the medical provider believes the therapy is beneficial to the student.”

The AEA also said it was unclear why the medical provider, Hills and Dales, believed the therapy it offered had to take place during the school day. “The scheduling appears to be for the convenience of Hills and Dales,” the AEA told the department. “The argument that the students learn best in the morning could also explain why the students need to be at school in the mornings.”

The AEA said Hills and Dales seemed to be “arguing that their services should take priority over the school services and that the (district) should be the one to reduce their services.”

According to Hills and Dales, it provides treatment for youth with autism and other issues and in some cases the students are also full-time residents of the organization’s state-licensed care facility. At the time the issue was first presented to the state Department of Education, the center was treating 22 students of the Dubuque district, eight of whom were also residents of center’s 24-hour intermediate care facility.

The center argued that it was ironic the AEA and the school district were citing concerns about compliance with the federal law’s guarantee of a free and appropriate public education since the district was actually putting itself at risk of violating that law by preventing students from receiving prescribed services.

Does therapy assist learning or prevent it?

The center argued that although short-term absences from school are required by the treatment, the students will, in the long term, be better suited to participate in school after having received the treatment.

The center also noted that Dubuque County Attorney C.J. May, who has to enforce the state truancy law in Dubuque, had issued a letter stating that physician-prescribed treatment that causes a student to miss school would typically be “a reasonable excuse for the absence.”

The AEA responded by pointing out that a medical excuse is normally for one day or a portion of a day, so that missed school work can be easily made up. In this case, the AEA told the department, the therapy “effectively removes a child from school for half of the school day, every day,” which deprives the student of most of their education.

The department eventually ruled that the behavioral therapy provided by Hills and Dales was, “beyond any question,” an instructional or related service or support that the schools themselves might be required to provide to meet the standard and a free and appropriate public education.

The department also ruled that state law does not require school districts to excuse students from class for therapy, with or without a medical excuse. That decision, the department said, is left to individual school districts.

Hills and Dales then went to court, seeking judicial review of the department’s decision. District Judge Thomas Bitter eventually sided with the AEA and the school district.

“For some of the students who reside at Hills & Dales, complying with physician orders for therapy has meant those students were taken to Hills & Dales during the school day, missing anywhere from 11.5 to 16.5 hours of school per week,” Bitter noted in his ruling.

Hills and Dales then appealed that ruling to the Iowa Supreme Court. In briefs recently filed with the court, the organization argues that providing the behavioral treatment for children outside of school hours “is completely out of the question.”

The center says forcing students to submit to the treatment “after their long school days would result in fatigue” that would render the treatment impracticable.