Mary Courtney T.; Bruce T.; Letty T., All of Philadelphia, Pennsylvania v. SCHOOL DISTRICT OF PHILADELPHIA On Appeal from the United States District Court for…

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PRECEDENTIAL
UNITED STATES COURT OF APPEALS
FOR THE THIRD CIRCUIT
No. 08-2676
MARY COURTNEY T.; BRUCE T.; LETTY T.,
All of Philadelphia, Pennsylvania
v.
SCHOOL DISTRICT OF PHILADELPHIA,
Appellant
No. 08-2870
MARY COURTNEY T.; BRUCE T.; LETTY T.,
ALL OF PHILADELPHIA, PENNSYLVANIA,
Appellants
v.
SCHOOL DISTRICT OF PHILADELPHIA
On Appeal from the United States District Court
for the Eastern District of Pennsylvania

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The Honorable Richard G. Stearns, District Judge for the*
United States District Court for Massachusetts, sitting by
designation.
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District Court No. 2-06-cv-02278
District Judge: The Honorable Anita B. Brody
Argued April 14, 2009
Before: MCKEE, SMITH, Circuit Judges
and STEARNS, District Judge*
(Filed: July 31, 2009)
Joseph Anclien
Jennifer Pao
Carl A. Solano (Argued)
Schnader Harrison Segal & Lewis
1600 Market Street
Suite 3600
Philadelphia, PA 19103
Elizabeth S. Mattioni
City of Philadelphia Law Department
1515 Arch Street
One Parkway
Philadelphia, PA 19102
Miles H. Shore

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School District of Philadelphia
Office of General Counsel
440 North Broad Street, Suite 313
Philadelphia, PA 19130
Counsel for Appellant
Dennis C. McAndrews
David T. Painter
Gabrielle C. Sereni (Argued)
McAndrews Law Offices
30 Cassatt Avenue
Berwyn, PA 19312
Counsel for Appellee
OPINION
SMITH, Circuit Judge.
In this case concerning the Individuals with Disabilities
in Education Act, appellant School District of Philadelphia
(“School District”) appeals a District Court order requiring it to
reimburse Mary Courtney T. (“Courtney”) and her parents
(collectively, “Plaintiffs”) for the cost of Courtney’s placement
in a residential health care facility from October 12, 2005 to
January 26, 2006. Plaintiffs cross-appeal the District Court’s
denial of reimbursement for placement at the same facility from

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May 23, 2005 to October 12, 2005, and they seek compensatory
education in the event that we deny their request for
reimbursement. For the reasons that follow, we will affirm in
part and reverse in part.
I.
A.
Courtney and her parents live in the School District.
Courtney, who is now 22 years old, suffers from learning
disabilities, speech and language impairments, attention deficit
hyperactivity disorder, and other mental health disorders.
Because of her educational needs, the School District paid for
Courtney to attend private schools beginning in 1993 when
Courtney entered kindergarten.
Since 2001, Courtney’s evolving needs have required a
variety of educational and medical placements. In the fall of
2001, she was briefly hospitalized as a result of escalating
behavioral problems including self-injury. Then, after she was
diagnosed during a 2002 evaluation with a variety of educational
and emotional special needs, Courtney’s parents unilaterally
placed her at the Rancho Valmora School (“Rancho Valmora”),
a residential educational institution in New Mexico that
specializes in the treatment of adolescents with educational,
emotional, and behavioral problems. Courtney did well at the
school, and she was discharged and returned to Philadelphia in

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June 2003. She was then placed at the Pathway School (“APS”)
for the 2003-2004 academic year. Courtney appeared to
flourish, becoming valedictorian of her class at the end of the
year. But by the beginning of the following school year, her
emotional condition began to deteriorate and APS could no
longer serve her needs. In December 2004, Courtney’s parents
placed her back at Rancho Valmora.
Courtney’s condition continued to worsen in 2005.
Rancho Valmora’s educational plan from February of that year
notes psychotic events, severe anger problems, the abuse of
chemical substances, and self-harming behaviors. At the end of
April, Rancho Valmora informed Courtney’s parents that it
could no longer provide sufficient care for Courtney because of
her self-abusive and aggressive behaviors. Courtney’s parents
then placed her for a short period at the Menninger Clinic, a
psychiatric hospital in Houston, Texas. The Clinic discharged
Courtney on May 22, 2005 because it was unable to serve her
needs. The following day, Courtney’s parents enrolled her in
Supervised LifeStyles (“SLS”).
SLS is a long-term psychiatric residential treatment
center in New York. It is licensed by the New York State Office
of Mental Health and is accredited with a national organization
for the accreditation of rehabilitation facilities. It does not have
any educational accreditation. It also has no on-site school,
special education teachers, or school affiliation.

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For more than six months at SLS, Courtney was treated
in the acute care wing. She received twenty-four hour care
provided on a one-to-one, staff to patient ratio. Courtney did not
receive educational services during this period; most of her days
were spent in intensive individual and group psychotherapy.
The School District sought to conduct a neuropsychological
evaluation in June 2005, but was unable to do so because
Courtney’s parents advised that she was not sufficiently stable
at the time. Also, according to the School District, Courtney’s
parents stated that her educational plan from Rancho Valmora
could not be implemented at SLS because of Courtney’s
emotional state. In fact, nearly every person to have evaluated
Courtney appears to agree that her safety and emotional well-
being were the predominate concerns for at least the first five
months she was at SLS.
On October 12, 2005, Courtney’s parents informed the
School District that she could be evaluated. An evaluation,
which the School District arranged to be conducted on October
17, 2005, noted Courtney’s limited academic capacity at the
time and recommended focusing her instruction on adaptive and
vocational skills. Thereafter, on November 16, 2005, the School
District assembled Courtney’s educational team and developed
an educational plan based on the evaluation. The plan provided
for three hours per week of one-to-one tutoring in language arts,
reading, and math; this instruction had a vocational and remedial
focus as demonstrated, for instance, by Courtney’s English
instruction, which focused on vocabulary development and

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required her to give an oral presentation to improve her
communication skills.
On December 6, 2005, Courtney was transferred from the
acute care ward at SLS to the post-acute ward. Courtney
received treatment at SLS from May 23, 2006 until her
discharge on July 29, 2006.
B.
The Individuals with Disabilities Education Act
(“IDEA”) requires that a state receiving federal education
funding provide a “free appropriate public education” (“FAPE”)
to disabled children. 20 U.S.C. § 1412(a)(1). School districts
provide a FAPE by designing and administering a program of
individualized instruction that is set forth in an Individualized
Education Plan (“IEP”). 20 U.S.C. § 1414(d). The IEP “must
be ‘reasonably calculated’ to enable the child to receive
‘meaningful educational benefits’ in light of the student’s
‘intellectual potential.’” Shore Reg’l High Sch. Bd. of Ed. v.
P.S., 381 F.3d 194, 198 (3d Cir. 2004) (quoting Polk v. Cent.
Susquehanna Intermediate Unit 16, 853 F.2d 171, 182–85 (3d
Cir. 1988)).
A parent who believes that a school has failed to provide
a FAPE may request a hearing, commonly known as a due
process hearing, to seek relief from the school district for its
failure to provide a FAPE. 34 C.F.R. § 300.507. In

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The Pennsylvania Department of Education funds an1
independent entity to administer and oversee disputes related to
special education services, the Office for Dispute Resolution.
This entity is responsible for choosing Hearing Officers and
Appeals Panel members. For more information, see Office for
Dispute Resolution, http://odr.pattan.net/default.aspx (last
visited July 21, 2009).
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Pennsylvania, the hearing is conducted by a Hearing Officer.
Carlisle Area Sch. v. Scott P., 62 F.3d 520, 527 (3d Cir. 1995).
If challenged, the Hearing Officer’s decision is then subject to
an independent review of that decision by an appellate body,
which is referred to as the Appeals Panel. Id. Upon the1
completion of the Pennsylvania administrative process, a party
may appeal the Appeals Panel decision to federal district court.
20 U.S.C. § 1415(e); Carlisle Area Sch., 62 F.3d at 527.
In November 2005, Plaintiffs requested a due process
hearing pursuant to 34 C.F.R. § 300.507 and sought to compel
the School District to (1) reimburse Plaintiffs for the cost of
Courtney’s stay at Rancho Valmora, from December 2004 to
April 2005, and SLS from May 2005 up to the date of the
hearing; (2) provide compensatory education for the period May
23, 2005 up to the date of the hearing, in the event that tuition
reimbursement was denied; and (3) pay for an independent
evaluation of Courtney. A hearing was conducted in January
2006. The School District agreed to reimburse Plaintiffs for
Courtney’s stay at Rancho Valmora, but opposed reimbursement

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for the SLS placement on the ground that a medical crisis
precipitated Courtney’s stay there.
The Hearing Officer faulted the School District for
failing to develop an IEP in June 2005 and for not providing
educational services beginning in May 2005 when Courtney
entered SLS. He rejected arguments that Courtney’s expenses
at SLS were medical as opposed to educational, concluding that
her educational needs were not severable from her medical
needs. The Hearing Officer also determined that SLS was an
appropriate placement. Accordingly, he awarded tuition
reimbursement for Courtney’s stay at SLS from May 2005
through January 2006.
The Appeals Panel reversed the decision of the Hearing
Officer. The Panel noted the acute nature of Courtney’s
condition when she was admitted to SLS and concluded that
Courtney’s “admission to the New York facility was prompted
by a psychiatric crisis, was necessary for medical reasons rather
than educational purposes, and that the services provided to
[Courtney] during the first four months there were medical
rather than educational in nature.” In such circumstances, it
deemed it inappropriate to award tuition reimbursement for
Courtney’s stay at SLS.
Courtney appealed this decision to the United States
District Court for the Eastern District of Pennsylvania. In its
analysis, the District Court separated Courtney’s treatment into

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two distinct time periods—the first period covered Courtney’s
stay in SLS’s acute care ward from May 23, 2005 to October 12,
2005, and the second period covered from October 12, 2005,
when Courtney’s parents informed the School District that she
could be evaluated, until January 26, 2006, the date through
which the Hearing Officer awarded tuition reimbursement.
For the first period, the District Court concluded that
Courtney was not entitled to tuition reimbursement because SLS
“did not constitute ‘special education’ within the meaning of the
IDEA.” It noted that Courtney’s “SLS placement did not
contain any appreciable academic component.” Further, to the
degree that Courtney’s program included some behavioral and
emotional strategies that could aid her education, the Court
concluded that this treatment was aimed at stabilizing her
medical condition and not at enabling academic instruction.
With regard to the second period, the District Court
awarded tuition reimbursement. It stated that, once the School
District began providing educational services to Courtney, it
also had an obligation to provide related services. In that regard,
the Court determined that Courtney’s treatment at SLS was a
related service. It also concluded that the costs of SLS were not
excluded by the “medical services” exception to federal
regulations requiring the provision of related services.
Finally, the District Court denied the Plaintiffs’ request
for compensatory education for May 2005 through October 2005

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in lieu of tuition reimbursement. The Court held that the School
District developed Courtney’s IEP within a reasonable period of
time. It reasoned that Courtney’s parents did not consent to an
evaluation until October 12, 2005, the School District conducted
that evaluation five days later, and it then developed the IEP
within one month of the evaluation date.
II.
We require a district court to apply a nontraditional
standard of review when considering an appeal from a state
administrative decision under IDEA. “Although the District
Court must make its own findings by a preponderance of the
evidence, the District Court must also afford ‘due weight’ to the
ALJ’s determination.” Shore Reg’l High Sch. Bd. of Ed., 381
F.3d at 199 (internal citation omitted). The “due weight”
standard requires the court to consider the “[f]actual findings
from the administrative proceedings . . . prima facie correct”
and, if the court fails to adopt those findings, it must explain its
reasons for departing from them. Id. (internal quotation marks
and citation omitted). We, in turn, review the District Court’s
factual findings for clear error. Id.
We exercise plenary review over the legal standards
applied by the District Court and over its legal conclusions. Id.
(“When a District Court decision in a case such as this is
appealed to us, we of course exercise plenary review with
respect to the question whether the District Court applied the

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correct legal standards under the IDEA.”); Lauren W. ex rel.
Jean W. v. Deflaminis, 480 F.3d 259, 266 (3d Cir. 2007) (“We
exercise plenary review over the legal conclusions the district
court reached in our review of an administrative adjudication in
IDEA cases.”).
III.
Parents who believe that a public school is not providing
a FAPE may unilaterally remove their disabled child from that
school, place him or her in another school, and seek tuition
reimbursement for the cost of the alternate placement. 20
U.S.C. § 1412(a)(10)(c); Burlington Sch. Comm. v. Dep’t of
Educ., 471 U.S. 359, 374 (1985). A court may grant tuition
reimbursement if the School District failed to provide the
required FAPE and the parents sought an appropriate private
placement. Deflaminis, 480 F.3d at 276; see also Forest Grove
Sch. Dist. v. T.A., 129 S. Ct. 2484, 2488 (2009) (“[W]hen a
public school fails to provide a FAPE and a child’s parents place
the child in an appropriate private school without the school
district’s consent, a court may require the district to reimburse
the parents for the cost of the private education.”).
We would ordinarily begin by determining whether
Courtney was denied a FAPE. In this case, the FAPE analysis
would require that we consider separately the two distinct
periods of Courtney’s stay at SLS—from May through October
2005, when Courtney was in SLS’s acute care ward, and from

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October 2005 through January 2006, after Courtney’s parents
informed the School District that she could be evaluated and
receive educational services—because the School District’s
provision of services differed during these periods. The second
component of the tuition reimbursement analysis, however, does
not require separate analyses for the different time periods, as it
focuses on the appropriateness of SLS as a private placement.
For this reason, we will start by considering whether SLS was
an appropriate placement.
A parent’s decision to unilaterally place a child in a
private placement is proper if the placement “is appropriate, i.e.,
it provides significant learning and confers meaningful benefit
. . . .” Deflaminis, 480 F.3d at 276 (internal quotation marks and
citation omitted). That said, the “parents of a disabled student
need not seek out the perfect private placement in order to
satisfy IDEA.” Ridgewood Bd. of Educ. v. N.E., 172 F.3d 238,
249 n.8 (3d Cir. 1999). In fact, the Supreme Court has ruled that
a private school placement may be proper and confer
meaningful benefit despite the private school’s failure to provide
an IEP or meet state educational standards. Florence County
Sch. Dist. Four v. Carter ex rel. Carter, 510 U.S. 7, 14–15
(1993).
In this case, the parties disagree as to whether Courtney’s
placement at SLS was appropriate. The School District argues
that, particularly during her period in the acute-care ward,
Courtney received exclusively medical services. The Appeals

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Panel agreed with this argument. It found that Courtney was in
the acute care ward because she needed one-to-one attention
from “someone trained in crisis intervention. . . . Because of the
acute nature of [Courtney’s] mental illness during this four
month period, the treatment goals and services for [Courtney]
were almost entirely devoted to stabilizing her mental health; the
treatment plan did not contain any academic goals.”
Plaintiffs argue that, while Courtney was not capable of
receiving traditional academic instruction, she could and did
receive other services focused on behavior modification and her
emotional wellness that can be considered educational in this
context. Furthermore, they argue that her medical and
educational needs were not severable under this Court’s decision
in Kruelle v. New Castle County School District, 642 F.2d 687,
694 (3d Cir. 1981), thereby requiring the School District to
reimburse Plaintiffs for Courtney’s tuition at SLS.
A.
In Kruelle, the plaintiff, Paul Kruelle, had severe mental
disabilities and cerebral palsy—“at age thirteen he has the social
skills of a six month old child and his I.Q. is below thirty. . . .
[H]e cannot walk, dress himself, or eat unaided. . . . [H]e [also]
has had a history of emotional problems which result in choking
and self-induced vomiting when experiencing stress.” 642 F.2d
at 688–89 (internal quotation marks and citation omitted). In
1978, the Kruelles lived in Pennsylvania and Paul was enrolled

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in a residential educational facility that combined school
programs with around-the-clock care. Id. at 689. Paul did well
in this program, but he was forced to leave when his parents
moved to Delaware. Id. In Delaware, Paul’s parents sought and
were denied a residential placement facility, and Paul was
instead placed in a school during the day and a respite care
facility in the evening. Id. The Kruelles then requested a due
process hearing to challenge this placement. Id. After the state
hearing officer and appeals body denied the Kruelles’ request,
the Kruelles sought review in this Court. Id. at 690.
The Kruelles’ efforts to obtain a residential placement
were rooted in Paul’s emotional problems: the Kruelles’
medical expert testified that Paul’s stress-induced vomiting,
choking, and self-destructive behaviors limited his ability to
learn, but that a consistent environment could reduce these
behaviors and improve Paul’s ability to learn. Id. The
defendant school argued that, because Paul’s need for residential
placement arose from his emotional problems, the school was
not obligated to provide this placement or pay for it. Id. We
disagreed.
We began by noting that, while “the scope and details of
an appropriate education” are largely left to local school
authorities, a school’s obligations are guided by federal law
requiring the provision of “special education” and “related
services.” Id. at 691. Furthermore, we recognized that federal
regulations require residential “placements which are made by

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We explicitly stated that we were considering whether2
a residential placement was required to provide Paul with
“special education,” not whether it was a “related service.” Id.
at 694 (“[T]he present case asks whether residential placement
is encompassed within the statutory heading of ‘special
education . . . .’”).
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public agencies for educational purposes.” Id. Finally, we
acknowledged that “the concept of education is necessarily
broad with respect to persons such as Paul. Where basic self-
help and social skills such as toilet training are lacking, formal
education begins at that point.” Id. at 693.
With those principles as guideposts, we then considered
“whether full-time placement may be considered necessary for
educational purposes, or whether the residential placement is a
response to medical, social or emotional problems that are
segregable from the learning process.” Id. If the placement2
was required by the former, the school was obligated to bear the
cost; if the placement was necessitated by the latter, the cost of
the placement was “the responsibility of the parents or social
service agencies.” Id. at 693–94. And to differentiate between
the two possible predicates to a residential placement, the
Kruelle Court instructed that we are to look to whether the
“social, emotional, medical and educational problems . . . [are]
so intertwined that realistically it is not possible for the court to
perform the Solomon-like task of separating them.” Id. at 694
(internal quotations and citation omitted). The Kruelle panel

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concluded: “The relevant question in the present case is whether
residential placement is part and parcel of a specially designed
instruction to meet the unique needs of a handicapped child.”
Id. (internal quotation marks omitted). Applying this framework
to Paul’s case, we held that Paul’s emotional and medical needs
were not severable: “[H]ere, consistency of programming and
environment is critical to Paul’s ability to learn, for the absence
of a structured environment contributes to Paul’s choking and
vomiting which, in turn interferes fundamentally with his ability
to learn.” Id.
B.
Plaintiffs argue that SLS is not a medical facility or
psychiatric hospital, but is instead a residential treatment
facility. While SLS may be classified as a residential program,
this fact alone is insufficient to warrant reimbursement. A wide
variety of facilities—treating a range of issues from substance
abuse to mental health and from aging services to spinal cord
injuries—can claim to be “residential programs.” Only those
residential facilities that provide special education, however,
qualify for reimbursement under Kruelle and IDEA. In Kruelle,
we stated that federal regulations require residential “placements
which are made by public agencies for educational purposes.”
642 F.2d at 692 (emphasis added). In fact, federal regulations
declare that “[i]f placement in a public or private residential
program is necessary to provide special education and related
services to a child with a disability, the program, including

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non-medical care and room and board, must be at no cost to the
parents of the child.” 34 C.F.R. § 300.104 (emphasis added).
Thus, we must consider whether the residential placement at
SLS was necessary to provide Courtney with special education.
In Kruelle, we recognized that not all services that can be
broadly construed as educational are cognizable under IDEA.
This is because “ultimately any life support system or medical
aid can be construed as related to a child’s ability to learn.” 642
F.2d at 694. Instead, we declared that we must “assess the link
between the supportive service or educational placement and the
child’s learning needs.” Id.
To support the argument that SLS provided special
education as defined by Kruelle, Plaintiffs point to the fact that
Courtney’s program at SLS offered a “token economy program,”
through which students could earn “dollars” for good behavior
to be spent for various rewards, and that it provided one-to-one
support. They argue that these services are customarily offered
in public schools. Plaintiffs also cite the fact that Courtney
participated in some SLS group therapies, such as the “Life
Skills Training” and psychoeducational skills groups, that can
arguably be considered educational given Courtney’s limited
academic abilities at that time and her need to learn how to
manage her illness.
As an initial matter, we reject Plaintiffs’ argument that
because SLS utilizes some of the same modalities employed by

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schools it is thereby providing special education. This argument
ignores the fact that institutions use tools such as a “token
economy program” to incentivize a change in behavior, but the
targeted behavior might well be one affecting health, education,
or even conduct like the use of obscenities. Thus, the relevant
consideration is not the tool the institution uses, but rather the
substantive goal sought to be achieved through the use of that
tool. For the reasons that follow, we believe that SLS employed
these tools to enable Courtney to manage her medical condition,
not her educational needs.
We acknowledge that some services Courtney received
at SLS may have provided an educational benefit. They are not,
however, the sort of educational services that are cognizable
under Kruelle. During testimony before the Hearing Officer on
January 9, 2006, Courtney’s behavioral therapist at SLS testified
that Courtney was enrolled in the “mood disorders group, the
psychotic disorders group, medication and pychoeducational
group, anxiety disorders group, psychological skills group, life
skills training group, and medication group.” When asked the
purpose of these groups, the therapist responded: “Courtney will
learn skills that will help with those specific areas. If Courtney
is having depressive symptoms it will teach her coping skills to
work with her depression and anxiety.” For instance, the
psychotic disorders group provided group therapy where the
members talked about how psychotic thoughts affect their daily
lives and the psychological skills group taught techniques for
anger control and managing other emotions. This account of the

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services provided to Courtney demonstrates that SLS’s
programs and skills were predominately designed to make her
aware of her medical condition and how to respond to it. Thus,
Courtney received services that are not unlike programs that
teach diabetic children how to manage their blood sugar levels
and diets—both sorts of programs teach children to manage their
conditions so that they can improve their own health and well
being. However, because both programs are an outgrowth of a
student’s medical needs and necessarily teach the student how
to regulate his or her condition, they are neither intended nor
designed to be responsive to the child’s distinct “learning
needs.” See Kruelle, 642 F.2d at 694 (stating that IDEA
requires “courts to assess the link between the supportive service
or educational placement and the child’s learning needs”).
Accordingly, the link required by Kruelle between placement
and the student’s learning needs is lacking.
This is further demonstrated by the fact that the program
at SLS is designed to address medical, rather than educational,
conditions. SLS is licensed by the New York State Office of
Mental Health, its sole accreditation is with a national
organization of rehabilitation facilities, and it has no state
educational accreditation or even any on-site educators. This
stands in sharp contrast to Kruelle, where we noted that Paul’s
earlier residential placement had been in a facility jointly
regulated by state education and social services organizations.
642 F.2d at 689. And Courtney’s admission to SLS was
necessitated, not by a need for special education, but by a need

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to address Courtney’s acute medical condition. Statements from
Courtney’s parents and authorities at Rancho Valmora
demonstrate that her condition deteriorated rapidly and that she
needed emergency intervention and stabilization.
Finally, we conclude that Courtney’s medical and
educational needs are severable. In Kruelle, we began by noting
that federal law requires schools to pay for non-medical care and
room and board when a private residential placement provides
special education. 642 F.2d at 692. Paul Kruelle’s medical
expert testified that Paul needed a consistent and structured
environment in order to benefit from educational services: the
expert testified that Paul might be able to physically tolerate a
non-residential placement requiring a transition from home to
school, but “he may not learn.” Kruelle v. Biggs, 489 F. Supp.
169 (D. Del. 1980) (recounting Paul’s expert’s testimony in
greater detail); see also Kruelle, 642 F.2d at 690 (relaying the
expert’s testimony that Paul needed a consistent environment in
order to learn). Thus, with only a change in environment and
without more extensive medical interventions such as drugs or
psychiatric care, Paul might be enabled to learn.
The present case is clearly distinguishable from Kruelle.
Courtney’s education was impeded, not by a lack of educational
services or a specific kind of placement, but by a complex and
acute medical condition. The School District could neither
prevent the onset of such a condition nor control when it would
subside. Furthermore, a change in environment would not by

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itself bring about an improvement in Courtney’s medical
condition—she required medical intervention, including
psychiatric treatment and drug therapies, to address the
biological pathology underlying her medical condition. This is
far beyond the capacity and the responsibility of the School
District.
C.
Nor can SLS be reimbursable as a related service. Under
IDEA, schools must provide not only special education, but also
related services in order to furnish students with a FAPE. 20
U.S.C. §§ 1401(9), 1412(a). The term “related services” is
defined to include:
transportation, and such developmental,
corrective, and other supportive services
(including speech-language pathology and
audiology services, interpreting services,
psychological services, physical and occupational
therapy, recreation, including therapeutic
recreation, social work services, school nurse
services designed to enable a child with a
disability to receive a free appropriate public
education as described in the individualized
education program of the child, counseling
services, including rehabilitation counseling,
orientation and mobility services, and medical
services, except that such medical services shall

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be for diagnostic and evaluation purposes only) as
may be required to assist a child with a disability
to benefit from special education . . . .
20 U.S.C. § 1401(26)(A). The District Court concluded that,
because the School District had begun to provide academic
services to Courtney, it was obligated to provide related
services. It further determined that the entire cost of Courtney’s
stay at SLS qualified as a related service because those costs did
not run afoul of the limits on medical services.
While the District Court is correct that IDEA requires
school districts to pay for some medical services, the costs of
SLS are outside of the parameters of this mandate. IDEA states
that medical services are covered “except that such medical
services shall be for diagnostic and evaluation purposes only.”
Id. Federal regulations further indicate that medical services
only include those “services provided by a licensed physician to
determine a child’s medically related disability that results in the
child’s need for special education and related services.” 34
C.F.R. § 300.34(c)(5).
Plaintiffs argue, however, that the Supreme Court has not
interpreted medical services so narrowly. They point to a pair
of Supreme Court cases—Cedar Rapids Community School
District v. Garret F., 526 U.S. 66 (1999), and Irving
Independent School District v. Tatro, 468 U.S. 883
(1984)—requiring school districts to pay for nursing services in

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school settings. They argue that these cases make “abundantly
clear that medical services are excluded from the responsibility
of school districts under IDEA only when the service must be
provided by a physician or hospital.”
Though it is true that the Supreme Court has concluded
that schools must provide school nursing services as related
services, the present case does not fall under Tatro or Cedar
Rapids. In Tatro, an eight-year-old girl needed clean
intermittent catheterization (“CIC”) to empty her bladder every
three or four hours to remain in school. 468 U.S. at 885. To
determine whether CIC qualified as a related service, the
Supreme Court stated that it must consider: (1) “whether CIC is
a supportive service” that enables a child to benefit from special
education; and (2) whether CIC is excluded as a medical service.
Id. at 890. It held that CIC was a supportive service, as “[a]
service that enables a handicapped child to remain at school
during the day is an important means of providing the child with
the meaningful access to education that Congress envisioned.”
Id. at 890–91.
The Court also concluded that CIC was not excluded as
a medical service because federal law and regulations pertaining
to related services excluded physician services but specifically
permitted those medical services that could be provided by a
school nurse. Id. at 891–92. It stated that this distinction likely
arose from an effort “to spare schools from an obligation to
provide a service that might well prove unduly expensive and

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beyond the range of their competence.” Id. at 892. Though the
Court also said that it presumed that “medical services not owed
under the statute are those services by a licensed physician that
serve other purposes” than to determine a child’s eligibility for
special education, id. at 892 n.10, it did not expressly hold that
physician services, and only physician services, are excluded
medical services. In fact, it declared with regard to the federal
regulations that, “[b]y limiting the ‘medical services’ exclusion
to the services of a physician or hospital, both far more
expensive, the Secretary has given a permissible construction to
the provision.” Id. at 893 (emphasis added). The Court’s
statement that hospital services are specifically excluded would
apply regardless of whether those services were provided by a
physician, nurse, aide, or therapist in the hospital setting.
In Cedar Rapids, the Supreme Court was asked once
again to consider whether a school was required to provide a
disabled student “with certain nursing services during school
hours.” 526 U.S. at 68. Garret was a bright and creative student
who was paralyzed in a motorcycle accident. Id. at 69. Though
Garret needed many of the same types of services that were
considered in Tatro, he needed them on a more continuous
basis. Id. at 75–76.
The Cedar Rapids Court reaffirmed that, with regard to
supportive services, Congress envisioned “services that enable
a disabled child to remain in school during the day.” Id. at 73.
It also reaffirmed that the “likely cost of the services and the

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26
competence of school staff” justified drawing a line between
excluded and covered medical services. Id. at 74. That said, the
Court stated that the continuous nature of services, and the
higher costs associated with that level of support, did not render
those services “more ‘medical.’” Id. at 76. The Court reasoned:
“Defining ‘related services’ in a manner that accommodates the
cost concerns Congress may have had is altogether different
from using cost itself as the definition.” Id. at 77.
The instant case is distinguishable from Tatro and Cedar
Rapids. In the first instance, we note that it is not clear that SLS
even qualifies as a “supportive service” under Tatro and Cedar
Rapids. While stabilizing Courtney’s medical condition would
ultimately render her more amenable to educational services, the
services provided by SLS did not enable her “to remain at
school during the day.” As Courtney’s behavioral therapist
indicated, even with several weeks of extensive support and
services at SLS, Courtney was not sufficiently stable to undergo
evaluation or receive educational services.
Beyond this, however, we believe Courtney’s care at SLS
is an excluded medical service. As noted above, while the
Supreme Court stated that physician services other than those
provided for diagnostic purposes are excluded, it also
specifically excluded hospital services. See Clovis Unified Sch.
Dist. v. Cal. Office of Admin. Hearings, 903 F.2d 635, 643–644
(9th Cir. 1990) (concluding that medically excluded services are
not only those services provided by a physician, but also those

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services provided in a psychiatric hospital); see also Butler v.
Evans, 225 F.3d 887, 893 (7th Cir. 2000) (concluding that
psychiatric hospitalization was not reimbursable as a “related
service”). Here, though Plaintiffs go to great lengths to
distinguish SLS from a hospital, the facility is nonetheless far
more similar to a hospital than a school or even a residential
educational facility. SLS’s promotional materials indicate that
it specializes in the treatment of individuals with “depression,
dual diagnosis, psychosis, borderline personality disorder and
similar psychological problems.” It addresses these conditions
through a combination of “assessment, diagnosis, psychotherapy
and medication management,” as well as a number of group
therapy offerings. Furthermore, patient care is coordinated and
directed by the patient’s personal psychotherapist, which in
Courtney’s case was a psychiatrist. It is also worth
reemphasizing that SLS has no educators on-site, offers no
educational services, and is not accredited with or regulated by
educational authorities. Second, the Supreme Court offered
several guideposts to help determine when medical services are
excluded, stating that the definition of medical services was
“designed to spare schools from an obligation to provide a
service that might well prove unduly expensive and beyond the
range of their competence.” Tatro, 408 U.S. at 892. In this
case, Courtney’s care at SLS may undoubtedly be classified as
“unduly expensive.” But more importantly, and for the reasons
discussed in Part III.B., that care is far beyond the range of
competence of any public school district or that of any school
nurse.

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D.
In light of the above, we do not believe that SLS can be
considered an appropriate placement. Because we conclude that
this aspect of the test for tuition reimbursement has not been
met, Plaintiffs are not entitled to tuition reimbursement.
Furthermore, Plaintiffs’ failure to demonstrate the
appropriateness of the private placement means that we need not
determine whether the School District deprived Courtney of a
FAPE for tuition reimbursement purposes.
IV.
Plaintiffs argue in the alternative that, if tuition
reimbursement is not awarded, Courtney is entitled to
compensatory education for the time period in which she was at
SLS. When parents challenge a school’s provision of a FAPE
to a child, a reviewing court must (1) consider whether the
school district complied with IDEA’s procedural requirements
and (2) determine whether the educational program was
“reasonably calculated to enable the child to receive educational
benefits.” Bd. of Educ. v. Rowley, 458 U.S. 176, 206–07 (1982).
In the event that a student has been denied a FAPE, a court may
award compensatory education to account for the period the
student was deprived of this right. Carlisle Area Sch., 62 F.3d
at 536. This remedy is designed to require “school districts to
‘belatedly pay expenses that [they] should have paid all along.’”
M.C. v. Cent. Reg’l Sch. Dist., 81 F.3d 389, 395 (3d Cir. 1996)

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The District Court misconstrued this concession. In a3
brief to the Court, the School District conceded that it failed to
provide a FAPE to Courtney when she was enrolled at Rancho
Valmora from December 29, 2004 to April 29, 2005. The
District Court erroneously construed this concession as applying
to Courtney’s stay at SLS as well, a construction that is at odds
with the brief to which that Court cites.
29
(quoting Miener v. Missouri, 800 F.2d 749, 753 (8th Cir. 1986)).
We have held that a plaintiff is entitled to compensatory
education under IDEA when “an IEP fails to confer some (i.e.,
more than de minimis) educational benefit to a student.” Id. at
396. Furthermore, the right to compensatory education
“accrue[s] from the point that the school district knows or
should know of the IEP’s failure.” Id. That said, the “disabled
child is entitled to compensatory education for a period equal to
the period of deprivation, but excluding the time reasonably
required for the school district to rectify the problem.” Id.
A.
The School District did not deny Courtney a FAPE
between May 23, 2005 and October 12, 2005 such that Plaintiffs
are entitled to compensatory education. Before the District
Court, the School District conceded that it denied a FAPE to
Courtney during her stay at Rancho Valmora from December
2004 through April 2005. Accordingly, the School District3

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30
agreed to reimburse Courtney, and has in fact paid, for these
expenses. Once informed of Courtney’s admission to SLS,
however, the School District quickly reengaged—it reconvened
Courtney’s IEP team on June 15, approximately two weeks after
the parents informed the District of Courtney’s admission, to
reevaluate Courtney’s needs and develop a new IEP.
The School District’s efforts to develop a new IEP were
thwarted by Courtney’s acute medical condition. During the
meeting, which was attended by school personnel and
Courtney’s parents, the IEP team called Courtney’s behavioral
therapist at SLS. The therapist reported that Courtney was in a
state of medical crisis and was not sufficiently stable to be
evaluated at the time. Before the Hearing Officer, the therapist
explained her rationale for this conclusion:
When Courtney came to us, behaviorally
she was too out of control to have her in a one-on-
one setting without somebody that was trained in
crisis intervention, behavioral modification skills.
Courtney was actively self-injuring and becoming
aggressive on a daily basis.
She was not able to contract for safety, and
she was a threat to herself and others and needed
to be on a one-on-one staff support status for
quite some time until Courtney was able to refrain
from self-injuring and becoming aggressive as
frequently as she was when she came in.

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A representative of the School District testified that, during the
IEP team’s conference call with the behavioral therapist, the
therapist indicated that “Courtney’s condition had deteriorated
to a point that she could not access education at all at the time,”
that she had “attacked staff,” and was in “danger of running
away.” In light of this, the IEP team opted to forego evaluation
and the creation of a new IEP until Courtney’s treating medical
professionals indicated she was sufficiently stable. Courtney’s
parents agreed to this course of action, and further agreed to
inform the School District when Courtney’s condition improved
such that she could be evaluated for the purpose of developing
a new IEP.
Courtney’s condition began to improve, and her parents
informed the School District on October 12, 2005 that she could
be evaluated. On that date, the School District began providing
a tutor to teach Courtney English and math. The School District
then conducted an evaluation on October 17, 2005, which
culminated in a new IEP less than one month later.
The evidence discussed above indicates that, once
informed of Courtney’s admission to SLS, the School District
acted promptly and attempted to respond to Courtney’s evolving
educational needs. Just as we cannot fault Courtney’s parents
for not wanting to subject their daughter to an evaluation while
in a precarious psychiatric state, we cannot fault the School
District for respecting the clear statements of Courtney’s
treating medical team at SLS that she was not well enough to be

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32
evaluated or to receive educational services.
Furthermore, we are reluctant to either fault the School
District or impose substantial costs on it for failing to provide
what would have been, in this case, an empty procedural
protection. As indicated above, an IEP serves to ensure that the
student receives services “reasonably calculated” to provide
“meaningful educational benefits.” Here, though, we have clear
and unequivocal statements from Courtney’s medical providers
that she was not sufficiently stable to receive educational
services when she entered the acute-care ward at SLS.
Additionally, Courtney’s condition had rapidly deteriorated over
the preceding months, culminating in her being asked to leave
Rancho Valmora. The School District could not reasonably
have been expected to prescribe a meaningful treatment plan
without having the opportunity to evaluate Courtney’s evolving
educational needs.
Finally, we note that one of our sister circuits has
indicated that an acute medical crisis such as a psychiatric
condition permits a school district to deviate from IDEA’s
procedural protections with regard to the IEP. Butler, 225 F.3d
887. In the early 1990s, a class of children with special
education needs and their families filed a class action lawsuit
alleging that the state of Indiana failed to promptly implement
IEPs recommending residential placement. Id. at 891. The
District Court granted the class action plaintiffs’ motion for
partial summary judgment, stating that “‘an IEP must be

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33
implemented as soon as possible following the development of
the IEP.’” Id. (quoting Evans v. Evans, 818 F. Supp. 1215, 1222
(N.D. Ind. 1993)). The parties to the class action then agreed to
a settlement order that “declared that the Indiana Department of
Education was obligated by federal law to place disabled
children in residential facilities within thirty days of the IEP,
except when special circumstances require otherwise.” Id.
(internal quotations omitted). Subsequently, Niki Butler, one of
the parties to the class action, alleged that the state had violated
the settlement order by failing to promptly implement her IEP.
Id. at 891–92. When the case reached the Seventh Circuit,
however, the Court rejected this argument. Niki’s IEP was not
implemented because she had suffered an acute psychological
crisis that required placement in a hospital for treatment, which
the Court characterized as a special circumstance. Id. at 892–93.
By concluding that Indiana did not run afoul of the settlement
order, the Court implicitly recognized that the state had not
violated federal law and its obligations under IDEA when it
delayed implementation of a student’s IEP until the student’s
acute psychiatric condition stabilized.
The FAPE analysis for compensatory education is not
backward looking—courts must look at a school district’s
actions during the period of the alleged deprivation. In this
case, the School District responded promptly after being
informed of Courtney’s admission to SLS and sought to
reevaluate her educational needs and develop a new IEP.
Although those efforts were unsuccessful, that failure is

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The School District contends that Plaintiffs’ request for4
compensatory education for the period October 12, 2005
through January 26, 2006 is not properly before this Court. It
notes that the District Court addressed only whether Plaintiffs
were entitled to compensatory education prior to October 12,
2005, but not after October 12. However, we need not remand
this issue to the District Court. We may appropriately resolve an
issue that was raised but not decided by a district court when
that issue has been sufficiently developed on the record, and we
will do so here. Hodge v. United States, 554 F.3d 372, 379 n.9
(3d Cir. 2009).
34
attributable to the acute nature of Courtney’s medical condition.
Accordingly, we conclude that Plaintiffs are not entitled to
compensatory education for the period during which Courtney
was in SLS’s acute care ward.
B.
The School District did not deny Courtney a FAPE from
October 12, 2005 through January 26, 2006, during which time
Courtney was transferred from SLS’s acute care ward to the
post-acute care ward. As discussed above, IDEA requires that4
the School District conduct a student specific “analysis that
carefully considers the student’s individual abilities” and confers
meaningful educational benefit. Ridgewood Bd. of Educ., 172
F.3d at 247–48. However, an IEP “provides a ‘basic floor of
opportunity’ but not necessarily ‘the optimal level of services .
. . .’” Holmes v. Millcreek Twp. Sch. Dist., 205 F.3d 583, 590

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35
(quoting Carlisle Area Sch., 62 F.3d at 533–34)). In the present
case, we believe this standard has been met.
After the October evaluation and continuing well into her
transfer into the post-acute care ward, Courtney continued to
have emotional problems. Courtney’s behavioral therapist at
SLS testified before the Hearing Officer that, as of January
2006, “Courtney ha[d] not been able to meet any of the goals
from her initial treatment plan as of yet.” The behavioral
therapist further testified that Courtney was not ready for out-
patient care and that Courtney continued to be aggressive or
self-injuring once or twice a week.
Nonetheless, the School District began providing one-on-
one tutoring to Courtney on October 12, 2005, the day
Courtney’s parents notified the School District that she was well
enough to be evaluated. It also conducted an evaluation on
October 17, 2005 and issued a new IEP less than a month later.
The IEP recommended three hours per week of instruction, but
determined that it would re-evaluate the situation in three
months to determine if Courtney could tolerate additional
instruction. As the Hearing Officer found, this “indicated that
the School District had considered a return to an alternative
special education setting on a full time basis, but rejected that
option because [Courtney] could only tolerate a limited amount
of instruction at the time.” In fact, the Appeals Panel further
stated that “as [Courtney’s] mental health continued to improve
and her capacity to handle more instruction increased, more

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36
hours of instruction were provided.”
Plaintiffs characterize as “meager” the School District’s
provision of only three hours per week of instruction. Though
we agree that Courtney’s instruction was limited, we believe that
the School District’s proffer of that level of instruction was
reasonable under the circumstances. As the Hearing Officer
found, the School District appeared to have considered and
rejected offering additional educational services given
Courtney’s continued emotional difficulties. At the same time,
the School District’s short-term IEP did enable it to reevaluate
Courtney’s educational needs as she improved. In fact, as found
by the Appeals Panel, the School District increased Courtney’s
hours of instruction as her condition improved. Accordingly, we
conclude that, from October 12, 2005 through January 26, 2006,
the School District provided a floor of opportunity on which it
could build as Courtney’s condition improved. We hold that
Courtney was not denied a FAPE for this period.
V.
For the reasons discussed above, we conclude that
Plaintiffs are not entitled to tuition reimbursement or
compensatory education for Courtney’s stay at SLS from May
29, 2005 through January 26, 2006.

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