LITHONIA, Ga. - When Juan Boatwright was 14 months old, he suffered severe brain damage when he was found headfirst and motionless in a bucket of mop water at his day care in Augusta.
His mother, Jackie, was equally stunned when she learned that the licensed day-care facility where her child was injured had no liability insurance to cover his mounting medical bills.
Why? The day care didn't have to have the insurance. Georgia law doesn't require it.
Ever since the September 2001 accident that left Juan permanently confined to a hospital bed, living off a feeding tube and ventilator, Ms. Boatwright has been fighting to change day-care laws throughout the country.
Through her efforts, Georgia Gov. Sonny Perdue in 2004 signed what is known as Juan's Law, which requires day cares to inform parents if they don't carry liability insurance.
The facilities must post signs and get signatures from parents that show that they are aware their children's day care does not have the insurance.
Earlier this month, a similar measure was signed into law in Virginia, and legislation is being crafted for consideration in the Alabama and Michigan legislatures in the next year.
Ms. Boatwright said parents can be misled by day-care licenses.
"When I saw the state license, I just assumed everything was in order. But the state license meant nothing, no more to me than the money they paid to get it," she said. "If you're not going to carry it (insurance), I have a right to know that when I walk in the door. My plumber is required to be licensed and bonded, so are the people who did my yard."
Most of the large day cares in Georgia have the insurance, but some smaller ones don't, said former state Sen. Don Cheeks, who introduced the legislation in Georgia.
"There is a need for it because you would assume, or most people would assume, that if I had a state license at a day care they would have insurance," Mr. Cheeks said.
TWENTY-ONE STATES, including Virginia, Illinois, New York and Pennsylvania, require child care centers to carry liability insurance, according to the National Child Care Information Center.
States such as Georgia do not have liability insurance laws for day cares because most businesses are not required to carry insurance, Mr. Cheeks said.
"There are very few mandates in this country" for businesses, he said, adding that Juan's Law pressures many day-care centers into getting the insurance.
"The only reason it's not mandated is so the mom-and-pop shops can operate for the families," he said.
Virginia's version of Juan's Law would require operators of family day homes - care centers that hold 15 or fewer children - to provide parents in writing how much liability insurance is carried. The notification must be updated if the insurance coverage is decreased, said state Sen. John S. Edwards, D-Roanoke. Those who do not provide this information face fines of as much as $500.
Mr. Edwards said market pressure will force day homes to provide insurance or lose business.
"Not many parents will want to have their beloved children stay in a family day home without insurance coverage," Mr. Edwards said. "It's all about peace of mind."
BACK IN LITHONIA, Ms. Boatwright checks on Juan in his room. She left Augusta for Lithonia in July with Juan and her other son, Dereck, 16, in order to be closer to Children's Healthcare of Atlanta.
Connected to a ventilator and unable to move, the boy's eyes remain open as he stares at the ceiling. A child's pictures in crayon are posted on the wall above Juan, now 5.
"Aren't you handsome? I know you are," Ms. Boatwright says.
"I don't care what you say, I'm going to give you some sugar anyway," she adds, giving him a kiss.
Juan's medical bills have exceeded $3 million, an amount his single mother knows she'll never be able to pay out of her own pocket.
Instead, Georgia's taxpayers - through Medicaid - have had to pick up the bill, a burden Ms. Boatwright says could have been avoided by requiring day cares to carry liability insurance.
Ms. Boatwright is hopeful her son's condition will improve.
"He still has a chance, he's still going," she said. "He's been through a lot. He's sacrificed a lot so other children could be safer. My goal is to just make that happen."