Revised - July 2014
Evaluating and Serving Students with Medical Needs and Physical
Impairments
Under Section 504
In its simplest language, Section 504 is an anti-discrimination policy. Originally designed for
people in the workplace to avoid discrimination based on disability, Section 504 also has
implications for public schools.
To be eligible under Section 504, a student must be both “qualified” (the student is within the
age range in which services are provided to disabled and nondisabled students under state law),
and “handicapped.” Pursuant to 34 CFR §104.3(j)(l), “Handicapped persons means any person
who;
 (i) Has a physical or mental impairment which substantially limits one or more major life
activities
 (ii) Has a record of such an impairment, or;
 (iii) Is regarded as having such an impairment.”
While Catawba County Schools has a clearly defined Section 504 disability determination
process, making determinations regarding potential accommodations with respect to medical
needs is more complicated. There are a number of variables which must be taken into
consideration, and each student must be looked at on an individual basis. Depending on the
severity of the impairment, that process can be very simple or quite complex. The Office of
Civil Rights (hereby referred to as OCR), sees safety of the school environment as part of the
school’s duty under Section 504. The OCR indicates that school districts take steps necessary to
ensure that the school environment for students with disabilities is as safe as the environment for
students without disabilities.
“As the vast majority of district students without a disability do not face a significant
possibility of experiencing serious and/or life threatening reactions to their environment
while they attend district schools, Section 504 requires that the district provide the disabled
student with an environment in which he also does not face such a significant possibility.”
Saluda (SC) School District one, 47 IDELR 22 (OCR 2006)
That said, it is unrealistic (and not legally required) to expect a school to be able to eliminate
“ALL” risk; however, the school should be diligent in its efforts to eliminate any significant risk.
An important distinction when determining appropriate services is, “parent-desired” vs. “doctorrequired.” Evaluation data is key to resolving these types of issues. A parent demand for an
accommodation or service does not create a school duty to provide the same under Section 504.
Again, the duty of the school is to provide services that are necessary for the disabled student to
have equal access to FAPE (Free and Appropriate Public Education) as their non-disabled peers.
This should also include equal access or consideration related to issues of safety.
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Health Care Plans:
A health care plan generally focuses solely on addressing a student’s medical needs. It is
typically not developed in accordance with formal procedures, such as those required for the
development of a Section 504 plan. The OCR has concluded that a school system may not
broadly exclude students with health plans from being considered for a Section 504 evaluation.
In determining whether a student’s medical condition is substantially limiting, a school district
must decide whether the condition would substantially limit a major life activity if the student
did not have a health care plan.
It is safe to assume that a health care plan alone may not be enough. In some cases it will be
necessary to consider a Section 504 evaluation, even if a health care plan exists. This will be
based on the individual student and his/her needs. More information on Health Care Plans and
the school systems process relative to HCP’s can be found in the pages following this document.
Homebound Instruction:
As a general rule, educating a student at home is a disfavored placement under federal disability
law, as education occurs in a setting that generally does not allow access to non-disabled peers.
The 9th Circuit summarized the rule by saying, “hospitalized and homebound care should be
considered to be among the least advantageous educational arrangements and are to be utilized
only when a more normalized process of education is unsuitable for the student who has severe
health restrictions.” Additionally, “homebound instruction is never intended to be an open-ended
placement on the least restrictive environment continuum: to the contrary, on the least restrictive
environment continuum, homebound is more restrictive than instruction received in a detention
center or hospital.”
In North Carolina, the state homebound definition is: “if a student is confined at home or in a
hospital, is unable to attend school, and is receiving homebound instruction from his/her home
school/LEA, he/she is to be considered Hospital/Homebound.”
Further the state eligibility standard indicates, “if it is determined that the homebound instruction
is the least restrictive alternative environment for the student, the student’s IEP (or 504) team
shall meet to determine the nature of the homebound educational services to be provided. In
addition, the appropriateness of the homebound instruction shall be evaluated monthly by the
designee of the student’s IEP (or 504) team.” NC Code Article 9 §115C-107.7
In OCR complaints regarding homebound instruction, the hearing officer routinely takes into
consideration the extent to which the student truly is “homebound.” If homebound services are
requested for a student, there should be a medical necessity that the child be confined to the
home. A student who attends social functions, and engages in other activities outside the home
makes qualification for homebound service questionable.
Catawba County has a thorough and rigorous Hospital/Homebound process which clearly spells
out the expectations regarding eligibility and requires very specific medical information.
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