© 2011 St. Louis Post-Dispatch

Debbie Thrasher, grandmother of four, gave herself a weekend to sulk, then shook off her disappointment and took out a pen.

She began addressing another thousand postcards to lawmakers to let them know what happened to her baby grandson Sam in an unlicensed home day care in Pilot Knob, Mo.

In May, a child care safety bill named in Sam's memory had failed again - this time in the last hours of the 2011 Missouri legislative session. Thrasher already had handed out more than 5,000 postcards for people to mail to legislators, enough for each to receive dozens. Thrasher hoped the new cards might tip the scales next year.

William "Sam" Pratt died in 2009 of suspected child abuse. His caregiver, Martha Farris, is facing manslaughter charges. Yet Farris was allowed to continue to care for children. Neither state regulators nor police had any way to stop her.

Sam Pratt's Law would allow regulators to bar all child care providers facing serious criminal charges from watching children. Thrasher, who owns a licensed child care facility, said the state should have the same power to shut down unlicensed providers as it has with licensed ones.

At the same time, Shelley Blecha also lamented a failed bill. For three years she had testified in Jefferson City and Washington on child care safety. Her 3-month-old, Nathan, accidentally suffocated in a home day care where the provider was caring for 10 children without a required license.

Nathan's Law would increase fines in an effort to deter unlicensed providers from breaking the law by caring for too many kids. It also would modify a state exemption that allows unlicensed providers to care for an unlimited number of children who are related to them.

Like Sam Pratt's Law, Nathan's Law was defeated in the Senate.

The families were disappointed but not surprised.

That's because Missouri lawmakers and policymakers have a long history of doing the bare minimum - or nothing - to enact laws that could curtail preventable child deaths.

On Sunday, the Post-Dispatch reported that at least 45 children died in Missouri child care settings from 2007 through 2010 for reasons other than natural causes.

The investigation showed the vast majority of those deaths - 41 in all - occurred in unlicensed and unregulated settings where state inspectors have little reach.

Critics call Missouri's regulation inadequate in three areas.

First, the state exempts more forms of child care from regulation than most other states, allowing an estimated 5,000 or more facilities - serving perhaps 60 percent of children in care - to operate without licenses or inspections.

Second, providers who do fall under the state's licensing guidelines are governed by outdated regulations. For example, the state is far behind in creating rules to prevent sleep deaths - by far the most common cause of the recent deaths.

Finally, child care providers who operate illegal day cares are rarely prosecuted.

The wait for updated standards has been agonizing for parents like Shelley Blecha.

"How many more children are going to have to die before the state does something?" she asked. Her son would have turned 4 in March.

SACRED EXEMPTIONS

When infants die and bills are drafted, some legislators and lobbyists characterize the deaths as isolated incidents, not a possible epidemic.

Last year, former state Rep. Cynthia Davis, R-O'Fallon, called Sam Pratt's Law a "souvenir" bill designed to soothe his grieving family. Davis refused to hear testimony in her children and families committee, and the bill died.

Smaller child care providers oppose further regulation, fearing it will drive them out of business. Lawmakers, particularly in rural and poor communities, take that opposition seriously.

To lose those home-based settings could drive parents to choose less safe, less stable child care, said Pam Mitchell, of the Child Day Care Association, which refers parents to licensed day cares in the region.

The Legislature has generally regarded two key exemptions in child care law to be sacred. The first excludes children who are relatives of a caregiver from being counted for licensing. The second allows faith-based facilities to avoid all but basic fire and health inspections.

Kerry Messer, president of the Missouri Family Network, which represents conservative Christian groups, said families and churches believe those exemptions are fundamental rights.

"They feel a lot of apprehension and fear about the state coming in and telling them how they can and cannot raise their children in their homes. And they are legitimate concerns," he said. "They are under almost nonstop attack from the bureaucrats and from the money-making child care industry who are trying to chip away and do away with these exemptions."

Support for the faith-based exemption is backed by Missouri's many religious-based residential centers for troubled youths.

Woody Cozad, a lobbyist for one center and former chairman of the Missouri Republican Party, told a House committee in March that Sam Pratt's Law could enable the state to harass faith-based facilities.

Cozad pushed for and was given an exemption for faith-based day cares. But when the bill came to the floor for debate, Sen. Jolie Justus, D-Kansas City, said all providers should be under the same standards. Justus relented, but the bill stalled.

Messer said the dangers to children lurk in licensed care, not church-based or unlicensed home care.

And, the Post-Dispatch analysis found no deaths in the state's 671 faith-based facilities, which by law must register with the state.

However, the analysis found 41 of 45 deaths happened in unlicensed home day cares that aren't required to follow state standards or undergo routine inspections.

Licensing exemptions for child care are also common elsewhere.

Only 11 states require licensing from the moment a caregiver begins regularly watching one or more unrelated children in a home for profit, according to a recent survey by the National Association of Child Care Resource and Referral Agencies. The same group faulted 17 states because they required no licensing for home day cares regardless of size, or provided few or no inspections or allowed more than six children in care.

Even among that group, Missouri ranks near the bottom.

State law allows a provider to care for a maximum of four children without a license. But Missouri is one of just four states that also permits an unlicensed provider to care for an unlimited number of children who are relatives, regardless of the children's ages. That allows the number of children under one person's care to soar - such as in Nathan's home day care.

Illinois, in contrast, counts all children under 12, regardless of their relation to the caregiver.

Advocates for child care reforms say the more exemptions to regulation, the greater danger to children and the more confusion for parents who think they are paying for trained, regulated and monitored child care providers, when they are not.

"It's pretty striking what parents think they are getting versus what they are getting in Missouri," said Carol Scott, chief executive officer of Child Care Aware of Missouri. "The number of exemptions and the variety of exemptions confuses the parent-consumer about what they're buying."

OUTDATED RULES

It's not just that hundreds of providers are exempt from licensing that troubles safety advocates.

They say even licensed and fully regulated providers in Missouri are held to low standards that fail to consider decades of research on child safety.

The bulk of Missouri's licensing and safety rules are more than 20 years old and haven't had a wholesale revision - ever.

Until August, Missouri had minimal sleep death prevention rules on the books for licensed centers - such as a ban on smoking and requirements to use cribs and snug mattresses. Thirty-seven states did better, according to a 2006 survey done by a nationally recognized researcher on sudden infant death syndrome. Most banned pillows in cribs. Others made safe-sleep training mandatory.

Advocates say those rules have reduced fatalities in child care.

In Illinois, child care rules are updated on a regular cycle as new research on child safety is completed.

But in Missouri, it took five years for state licensing officials to gain consensus among child care providers to enact even the most basic of safety updates.

Budget cuts thwarted a plan to use consultants and public hearings to rework large parts of the regulations. Instead, the state is rolling out small changes, piece by piece.

These include a rule that took effect in August requiring licensed providers to place infants on their backs for naps and rules set for January requiring CPR and first aid training for some staff.

Margaret Donnelly, director of the state Department of Health and Senior Services, said the new rules will save lives.

SIDS prevention groups also praised the new sleep rule but said it was inadequate to cover all risks related to sleep deaths.

"They need to get all the junk out of the crib - no bumper pads, no blankets, no pillows," said Mary Adkins, director of Project Impact, a federally funded resource center on sudden unexpected infant death. "A safe crib, coupled with consistent training and rules to create safe sleeping environments, can reduce the likelihood of infant death."

A CALL TO ACTION

But even if Missouri had the strongest rules, their reach would be limited because regulations affect only licensed day cares. Most sleep deaths occurred in unlicensed care. Even when deaths occur in unlicensed day cares that exceed state enrollment limits, the state lacks meaningful punishments.

That became apparent this summer in the courtroom of St. Louis County Judge Lawrence Permuter.

On Aug. 4, Alva Roberts pleaded guilty on two counts of running an illegal day care in her Valley Park home - offenses that carried fines of just $400.

Last year Tyler Brody suffocated under a blanket in her care. State documents show Roberts was watching at least eight children under 2 the day Tyler died.

At the hearing, Tyler's parents and Roberts gathered in a semicircle in front of the judge. Over the objections of Roberts' attorney, Stacey Brody was allowed to read a victim's impact statement.

She told the judge both Nathan's Law and Sam Pratt's Law would have prevented Roberts from caring for kids. She said the system failed Tyler when it did not prosecute Roberts earlier for running an illegally unlicensed day care in another county.

"If that had happened, we would not be here today."

In a soft voice, Permuter called the hearing one of the saddest ever on his bench.

"There's just not that much they could have done, unfortunately, under the current law," he said of prosecutors.

"So, you know, it's up to the citizens of the state of Missouri to become aware of what's happened to you. And it's up to the politicians and the system and the legislators in Jefferson City to do the right things and pass these laws."

Nancy Cambria is a reporter for the St. Louis Post-Dispatch.