MIAMI \u2013 A federal appeals court has delivered a scathing indictment of Florida’s systemic failure to uphold the civil rights of children with severe disabilities, concluding that the state’s "widespread" neglect has forced scores of vulnerable youngsters into sterile institutional settings far from their families. The 11th U.S. Circuit Court of Appeals\u2019 ruling decisively rebuked Florida for its abandonment of its most fragile children, affirming a lower court\u2019s determination that the state\u2019s inadequate provision of in-home nursing care is a direct violation of federal law.<\/p>\n
The court found that Florida\u2019s persistent unwillingness to offer sufficient in-home nursing care has resulted in at least 139 children being institutionalized in nursing homes primarily designed for the elderly, with some of these children residing in such facilities since infancy. An additional 1,800 children are currently at significant risk of similar institutionalization due to the state’s ongoing failure to provide essential care.<\/p>\n
\u201cMedically vulnerable children \u2013 for example, those who require specialized care like breathing tubes \u2013 require around-the-clock care or they may sustain significant injuries and even die,\u201d wrote U.S. Circuit Judge Adalberto Jordan, whose opinion was supported by Circuit Judge Nancy G. Abudu. Circuit Judge Andrew L. Brasher, however, dissented from the majority opinion.<\/p>\n
The appellate court\u2019s judgment underscored the profound sacrifices made by families striving to keep their children at home. \u201cThat so many of these families have found ways to keep their children at home \u2013 often at great personal sacrifice \u2013 does not lessen the imminence of the future risk they face. Placing one\u2019s child in an assisted care facility is not a choice that families take lightly,\u201d the opinion stated. It further highlighted the justifiable fears of parents who worry about their children facing neglect in institutional settings.<\/p>\n
This landmark decision by the 11th Circuit upholds a July 2023 ruling by U.S. District Judge Donald M. Middlebrooks, who had previously characterized Florida’s complex system for funding and providing care for children with medical complexities as a "maze almost impossible for parents to escape." Judge Middlebrooks pointed to the state’s heavy reliance on managed-care providers, who he found to be largely unaccountable to the state, as a significant contributor to the problem. He ordered the state to enhance community-based care options for children with severe disabilities, thereby reducing the necessity of institutional placements.<\/p>\n
Key provisions of Judge Middlebrooks\u2019 injunction mandated that health administrators ensure children with complex medical needs receive at least 90% of the private duty nursing care outlined in their care plans. Furthermore, the injunction requires the appointment of an independent monitor, funded by the state, to oversee Florida’s compliance with the court’s order. This monitor would possess the authority to hire staff and consultants, interview relevant stakeholders, and collect data on the state’s progress in addressing the crisis.<\/p>\n