District Failed Medically Complex Student by Ignoring Health Assessment Duties

A nine-year-old student with spina bifida, hydrocephalus, diabetes, and other complex medical needs attended Pittsburg Unified School District's special day class. The district repeatedly failed to conduct a health assessment, develop an appropriate individual health care plan through the IEP process, or convene IEP team meetings to address the student's chronic medically-related absences. The ALJ found the district denied FAPE on multiple grounds and ordered independent evaluations, 243 hours of compensatory services, and mandatory staff training.

What Happened

Student is a nine-year-old girl with a severe form of spina bifida who uses a wheelchair and is paralyzed from the waist down. She also has hydrocephalus managed by a brain shunt, one poorly functioning kidney, a neurogenic bladder requiring catheterization every three hours, type II diabetes, obesity, obstructive sleep apnea, chronic constipation, asthma, and latex and penicillin allergies. She is medically fragile and was frequently hospitalized throughout her school years. Despite this extraordinarily complex medical profile, Pittsburg Unified never conducted a health assessment to understand how her medical condition affected her education. Student attended a special day class for students with moderate to severe disabilities from kindergarten through third grade. During the 2016-2017 and 2017-2018 school years, she missed approximately 66 and 60 school days respectively due to medical issues — yet the district never convened an IEP team meeting to address those absences or adjust her program accordingly.

Foster Parents became Student's educational rights holders in early 2018 after she was removed from her biological parents' home by the Contra Costa Juvenile Court. They filed for due process in April 2018, raising concerns about the district's failure to assess Student's health needs, provide an appropriate program, maintain her educational records, and offer appropriate transportation. Student's academic skills had regressed significantly over the statutory period — she lost the ability to read sight words she had previously mastered and her math and printing skills declined year over year — while the district responded by simply lowering its expectations rather than addressing the root causes.

What the District Did Wrong

The ALJ found the district violated Student's right to a free appropriate public education (FAPE) in four significant areas. First, the district never conducted a health assessment despite Student's obvious and complex medical needs. An unsigned, incomplete individual health care plan existed from March 2016, but it was never presented to or developed through the IEP team, was not updated during the 2016-2017 school year, and left critical sections — including the transportation plan — blank. The district's own Special Education Director incorrectly testified that health plans are not part of the IEP process at all, reflecting a fundamental misunderstanding of the law.

Second, because no proper health assessment was ever done, the district could not offer an appropriate educational program. It failed to address Student's specialized transportation needs driven by her medical condition, failed to provide an appropriate individual health care plan as part of the IEP, and failed to offer specialized health care services through the IEP team process.

Third, the district failed to address Student's alarming lack of progress. Rather than convening IEP meetings to explore what could be done differently, the district simply lowered its goals year after year and blamed Student's absences for her regression — all while failing to provide home hospital instruction or other alternative programming during her extended absences. The ALJ cited the U.S. Supreme Court's Endrew F. standard, finding that the district failed to offer an appropriately ambitious IEP giving Student a real chance to meet challenging objectives.

Fourth, the district failed to timely provide Student's complete education records after Foster Parents' March 2018 request. Critical records — including IEPs, health plans, nursing logs, and occupational therapy service logs — were withheld until after the due process hearing was filed, significantly impairing Foster Parents' ability to participate meaningfully in educational decisions and the hearing process.

The district prevailed on the remaining issues: Student did not prove the district failed to assess her in academic support areas, failed to provide one-to-one aide services or social-emotional supports, placed her in a restrictive environment, violated prior written notice requirements, or improperly excluded required team members from the September 2017 IEP meeting.

What Was Ordered

Pittsburg must fund an independent health evaluation by a qualified nurse or licensed medical doctor of Student's choice to assess her health and treatment needs and their impact on her education.
Pittsburg must fund independent educational evaluations in the areas of psycho-educational status (including academic and social-emotional functioning), occupational therapy, and assistive technology.
Pittsburg must convene IEP team meetings within 30 days of each completed independent evaluation report and fund the evaluators' attendance at those meetings.
Pittsburg must provide 243 total hours of compensatory services through qualified non-public agency providers chosen by Student, including academic instruction by a credentialed special education teacher, occupational therapy, social skills training, and/or assistive technology services. This includes 40 hours previously offered through Haynes-S.T.A.R. Academy, with a remaining balance of 203 hours. All hours are available through the 2022 extended school year.
Pittsburg must arrange or reimburse transportation for Student to access compensatory services, up to a 60-mile round trip.
Pittsburg must provide Student with all requested education records not yet produced, including occupational therapy logs, nursing logs from Maxim, assessment protocols, and emails maintained in Student's education file.
Pittsburg must provide a six-hour staff training on health assessments, individual health care plans, specialized health care services, and disability-related absences (including home hospital instruction requirements). The training must be delivered by outside special education counsel not representing Pittsburg, and must reach the Special Education Director, all staff who worked with Student, IEP team members, and relevant administrators.

Why This Matters for Parents

A school district cannot ignore a student's medical complexity when building an IEP. If your child has significant health needs — frequent hospitalizations, catheterizations, diabetes management, or other ongoing medical conditions — the district must conduct a formal health assessment and incorporate a health care plan into the IEP team process. It is not enough for other assessors to briefly mention health in their own reports.
When your child misses school due to medical issues, the district must act — not wait. The district cannot simply stop reporting progress or lower goals because a student is frequently absent. The law requires the district to call an IEP meeting, explore alternative programming like home hospital instruction, and adjust the program to fit the student's actual circumstances.
Lowering goals instead of improving programming is a FAPE violation. If you notice your child's IEP goals getting easier year after year even though your child is not meeting them, that is a red flag. Under Endrew F., the district must offer goals that are genuinely ambitious and give your child a real chance to grow — not goals calibrated for failure.
Foster parents and educational rights holders have full rights to student records — and delays matter. If you are a foster parent or newly appointed educational rights holder, you are entitled to receive copies of all education records within five business days under California law. Delays in producing records — especially before a due process hearing — can themselves constitute a FAPE violation if they prevent meaningful participation in the IEP process.
Individual health care plans must be developed through the IEP team, not around it. A health plan created outside the IEP process, left unsigned, or never shared with the IEP team does not satisfy the district's legal obligations. Parents have the right to participate in developing and reviewing their child's health care plan as part of the full IEP team.

What Happened

What the District Did Wrong

What Was Ordered

Pittsburg must fund an independent health evaluation by a qualified nurse or licensed medical doctor of Student's choice to assess her health and treatment needs and their impact on her education.
Pittsburg must fund independent educational evaluations in the areas of psycho-educational status (including academic and social-emotional functioning), occupational therapy, and assistive technology.
Pittsburg must convene IEP team meetings within 30 days of each completed independent evaluation report and fund the evaluators' attendance at those meetings.
Pittsburg must provide 243 total hours of compensatory services through qualified non-public agency providers chosen by Student, including academic instruction by a credentialed special education teacher, occupational therapy, social skills training, and/or assistive technology services. This includes 40 hours previously offered through Haynes-S.T.A.R. Academy, with a remaining balance of 203 hours. All hours are available through the 2022 extended school year.
Pittsburg must arrange or reimburse transportation for Student to access compensatory services, up to a 60-mile round trip.
Pittsburg must provide Student with all requested education records not yet produced, including occupational therapy logs, nursing logs from Maxim, assessment protocols, and emails maintained in Student's education file.
Pittsburg must provide a six-hour staff training on health assessments, individual health care plans, specialized health care services, and disability-related absences (including home hospital instruction requirements). The training must be delivered by outside special education counsel not representing Pittsburg, and must reach the Special Education Director, all staff who worked with Student, IEP team members, and relevant administrators.

Why This Matters for Parents

A school district cannot ignore a student's medical complexity when building an IEP. If your child has significant health needs — frequent hospitalizations, catheterizations, diabetes management, or other ongoing medical conditions — the district must conduct a formal health assessment and incorporate a health care plan into the IEP team process. It is not enough for other assessors to briefly mention health in their own reports.
When your child misses school due to medical issues, the district must act — not wait. The district cannot simply stop reporting progress or lower goals because a student is frequently absent. The law requires the district to call an IEP meeting, explore alternative programming like home hospital instruction, and adjust the program to fit the student's actual circumstances.
Lowering goals instead of improving programming is a FAPE violation. If you notice your child's IEP goals getting easier year after year even though your child is not meeting them, that is a red flag. Under Endrew F., the district must offer goals that are genuinely ambitious and give your child a real chance to grow — not goals calibrated for failure.
Foster parents and educational rights holders have full rights to student records — and delays matter. If you are a foster parent or newly appointed educational rights holder, you are entitled to receive copies of all education records within five business days under California law. Delays in producing records — especially before a due process hearing — can themselves constitute a FAPE violation if they prevent meaningful participation in the IEP process.
Individual health care plans must be developed through the IEP team, not around it. A health plan created outside the IEP process, left unsigned, or never shared with the IEP team does not satisfy the district's legal obligations. Parents have the right to participate in developing and reviewing their child's health care plan as part of the full IEP team.