Imagine you had a one-year-old with type 1 diabetes who needed go to day care so you could work to support your family. At first, the only affordable day care center near you was fine with giving the baby insulin, but later they reneged. What would you do? And is that even legal?

That was exactly the case for Dave Campbell in Dallas-Fort Worth, whose T1D daughter Caroline was just about a year old when the family enrolled her in the local Children’s Courtyard day care center that agreed to handle her insulin injections. But after just a few months, the center changed its policy due to “liability concerns” and refused to administer insulin any longer.

The Campbells were left without an option, and launched on a path of resistance that led all the way up to the U.S. Department of Justice (!), and is now finally setting a precedent for how all day care facility must do their best to ensure reasonable accommodations for kids with diabetes.

Childcare Centers and Diabetes

It was back in 2012 when the Campbells’ case made national headlines. Fortunately, the non-profit Disability Rights Texas stepped up to help the family file a complaint with the U.S. Department of Justice, claiming the day care was violating the Americans with Disabilities Act by not providing their child with adequate means for diabetes management.

In the years since, the Campbells learned they weren’t alone. The Learning Care Group is the second largest childcare provider in North America, with more than 900 facilities across the country, operating under names that include La Petite Academy, Childtime Learning Centers, Tutor Time Child Care/Learning Centers, The Children’s Courtyard, Montessori Unlimited, Everbrook Academy, and Creative Kids Learning Center.

What the Campbells in Texas claimed was echoed by others nationwide, materializing into a legal case brought by the DOJ. The Justice Department’s Civil Rights Division in the Eastern District of Michigan took the lead, given the Learning Care Group being headquartered in Novi, Michigan (about 45 minutes northwest of Detroit).

The DOJ determined that Learning Care Group did in fact have a corporate-wide policy on refusing to provide children with T1D with insulin via pen or syringe, and since diabetes is legally defined as a “disability” the day care provider was discriminating against those with disabilities.

Protecting Disabilities in Day Care

On March 20, (2018), the DOJ announced a settlement with Learning Care Group that resolves this years-old issue. This was never a publicly-filed lawsuit, so the family names or locations aren’t available to learn more about the particular situations of those who lodged complaints against the childcare providers.

“The (American Disabilities Act) guarantees all children, including those with insulin-dependent diabetes, equal access to child care centers,” the DOJ’s Acting Assistant Attorney General John M. Gore, said in a statement. “We applaud LCG for taking steps to enable parents of children with diabetes to enjoy the benefits of childcare while knowing staff will be trained to ensure that their child is well cared for.”

According to the DOJ documentation, the LCG settlement’s key highlights are:

$10,000 in compensatory damages to each of the 8 aggrieved individuals/families who filed the lawsuit.

The language that “centers shall not discriminate against an individual on the

basis of disability in the full and equal enjoyment of its goods, services,

facilities, privileges, advantages, or accommodation.”

An accommodation that a child can be assisted in

diabetes care by someone other than a doctor or medical layperson, meaning “laymen” child care staff members can be trained to assist

with administering insulin by

pen, syringe, or pump.

Creation of a central office of compliance or trained specialist position to review guidelines for handling T1D children in the group’s 900+ daycare facilities. The rules are to be published online so that prospective enrollee families can read them.

Posting also of specific policies on how to request day care facility modifications and accommodations, including a sample Diabetes Medical Management Plan (DMMP).

All managers, regionally and locally, are required to go through in-person or virtual training within two months of the DOJ agreement, and teachers and childcare workers will get special training as well.

Within 30 days of the DOJ settlement, the day care provider must contact all parents to let them know about these new requirements.

You can read the full settlement agreement here.

A Win for Diabetes Families

“Given the critical role that dependable child care plays in a parent’s ability to work or go to school, we are proud that this settlement will ease the struggle to find quality child care for families of children with disabilities,” said United States Attorney Matthew Schneider. “The United States Attorney’s Office will continue to work to ensure the equal rights of individuals with disabilities in our community.”

Interestingly, this isn’t the first time the Americans with Disabilities Act has been litigated in the context of day care and T1D. Back in the late 90s, a case involving Kindercare out of Ohio dealt with low blood sugar emergencies. The American Diabetes Association was involved with that case that led to a settlement with Kindercare, requiring fingerstick checks for T1D kids and a three-year training program for educators and employees.

But that case didn’t touch on insulin dosing, so this more recent Learning Care Group settlement sets an important new precedent in extending protections in day care facilities for families dealing with T1D.

While little Caroline Campbell in Texas is now well past childcare age and off to regular school, we would have to imagine her family is pretty pleased to see a nationwide policy change like this come out of their situation.

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