July 2008 - Student Health Plan or Section 504

Cases of the Month: Schaeffer (CA) Union Elementary School District and Douglas County (CO) School District RE-1

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When may a district use a health plan instead of a 504 plan for a student with medical needs? Two fairly recent Office for Civil Rights (OCR) opinion letters provide some helpful guidance.

The first letter, Douglas County (C) School District RE-1, 107 LRP 36149 (OCR, September 8, 2006), concerned a kindergarten student with severe allergies. The district had a health care plan in place by the student's first day of kindergarten. The plan described the appropriate treatment in the event of allergic symptoms. The parent and staff also agreed on a set of actions and precautions to limit the student's exposure to dairy allergens in the classroom. In November, the parent asked for additional precautions. The principal and school nurse then met with the parent and offered a 504 plan to "formalize protections in place and, if justified by medical reports, . . . authorize additional accommodations." The school nurse contacted the student's allergist, who endorsed the current protections and did not recommend any additional actions. The district provided the parent with a copy of the district's 504 publication including "Section 504 policies, parent and student rights and procedural safeguards."

OCR concluded that the district did not violate Section 504: "[T]he District sought, received, and reviewed medical and other information to consider whether the services it was already providing met the Student's health and educational needs or whether it needed to proceed with the formal Section 504 evaluation and placement process. The District undertook steps to consider whether the Student had . . . a disability that would require the development of a Section 504 plan. The District determined that the Health Plan was appropriate and provided the complainant with the [Section 504] procedural safeguards."

Compare Shaffer (CA) Union Elementary School District, 107 LRP 61308 (OCR, January 19, 2007), concerning a sixth grade student with diabetes. The district's nurse had a developed a Health Care Plan for the student. The nurse, parent, and teacher reviewed the plan, and the nurse provided training on the plan to school staff. An incident occured when the teacher did not follow the provisions of the health plan. After repeated requests from the nurse and parent for a Section 504 plan for the student, the school principal offered a 504 plan to the parent without consulting the nurse. The parent did not agree with the 504 plan.

OCR concluded that the district violated Section 504 because:

1. There was no evidence that the district conducted an evaluation process before creating a Section 504 plan for the student;

2. There was no evidence that the district ensured that decisions were made by "a group of persons, including individuals knowledgeable about the student, the evaluation data, and the placement options"; and

3. The district unduly delayed development of the 504 plan.

Regarding the health plan, OCR stated that not only was it not followed appropriately, but "such a plan is not sufficient to substitute for a 504 Plan. Health plans, at least in this district, are developed without the procedural and due process protections of Section 504. There is no collaborative process for deciding how to evaluate the child, there is no collaborative process for deciding the meaning of the evaluation, and there are no standards...timelines...and most important, there are no procedural safeguards should a parent differ with the content of the plan."

Lessons Learned:

1. A stand-alone health plan may be an appropriate option for students with health conditions who do not meet the eligibility requirements for Section 504 or IDEA.

2. For students who meet the eligibility requirements for Section 504 or IDEA, an individual health plan may be an appropriate part of the 504 plan or IEP.

3. A health plan will not substitute for a 504 plan if the student meets 504 eligibility criteria, the health plan was developed in a unilateral manner without evaluation, and the district did not provide procedural safeguards to the parent.