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Drugs + Pregnancy = Prison in Alabama

Beware of zealots. Today's zealot is Greg Gambril, the district attorney in rural Covington County, Alabama, who is making a name for himself by prosecuting women who use drugs during their pregnancies.

Over an 18-month period, at least eight women have been prosecuted for using drugs while pregnant in this rural jurisdiction of barely 37,000, a tally without any recent parallel that women’s advocates have been able to find.

Gambril's prosections are likely to convince drug using women to avoid seeking medical care during their pregnancies, lest they face imprisonment. Physician-patient privilege assures that won't happen, you think?

Police affidavits make it clear that local doctors are cooperating in these investigations.

Separating women from their newborn children doesn't promote "family values" -- it simply prevents mother and child from bonding during the child's critical formative years. Sensible alternatives would focus on helping women, not sending them to prison.

It isn't at all clear that the prosecutions are consistent with the law upon which Gambril relies: [more...]

Mr. Gambril makes little distinction between fetus and child. He said his duty was to protect both — though the Alabama law he uses makes no reference to unborn children, and was primarily intended to protect youngsters from exposure to methamphetamine laboratories.

This is Gambril's simple-minded reasoning:

“When drugs are introduced in the womb, the child-to-be is endangered,” Mr. Gambril said. “It is what I call a continuing crime.” He added that the purpose of the statute was to guarantee that the child has “a safe environment, a drug-free environment.”

“No one is to say whether that environment is inside or outside the womb,” he said, and no judge or other authority in Alabama has so far disagreed.

"No one is to say?" Consider this:

In Maryland, the state’s highest court in 2006 threw out the convictions of two women whose babies were born with cocaine in their bloodstreams, ruling that punishment was not the right deterrent. Last year, the New Mexico Supreme Court rejected a woman’s child-abuse conviction in a similar case, declaring a fetus was not a child.

If Gambril is correct in his assessment of the law, why isn't he prosecuting women who smoke tobacco or drink alcohol during their pregnancies? Aren't those actions just as likely to disturb the "safe environment" that, in Gambril's view, a womb is legally obligated to provide? Perhaps because, as the Times article notes, Gambril is focusing on a population that isn't affluent, that lacks the resources to mount a strong defense to his vicious abuse of the law. Remember:

The war on drugs has always been a war on the poor ... [I]t is clear that drug use and drug users have played a very important role in defining women's and children's poverty as an individual behavioral problem rather than the result of systematic, structural economic inequities.
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    Sadly, this isn't new in Alabama (5.00 / 2) (#1)
    by Birmingham Blues on Sat Mar 15, 2008 at 12:12:51 PM EST
    The Republican congressman who represents my district included jail for pregnant women who didn't go to drug rehab in his initial campaign platform back in the 90's, conveniently ignoring the reality that there were nowhere near enough facilities to meet the need.  Appearing to be tough on crime, or even "crime", seems to be a prerequisite for public office here.

    The idea of jailing women instead of treating them (5.00 / 1) (#2)
    by jerry on Sat Mar 15, 2008 at 12:40:34 PM EST
    is bizarre and outrageous.

    I do have to say though, that if a woman was not interested in treating her addiction, and doctors agreed the addiction posed a significant danger to the fetus' mental or physical development, I might be open to presenting the woman a choice of abortion, treatment, or medical quarantine.

    Usually it isn't the addiction itself (5.00 / 1) (#7)
    by Fabian on Sat Mar 15, 2008 at 02:13:03 PM EST
    that poses the greatest risks, but the secondary effects like poor nutrition, disease, lack of medical care and so on.

    Spina bifida is known to be caused by a vitamin B12 deficiency in the first two months - before even the first prenatal visit.  Prison won't help that.

    Obviously, the best strategy is prevention by providing community health care and contraceptive services - not ignoring the problems and locking pregnant women up.

    Parent

    As a nurse I have to agree. I have (5.00 / 2) (#8)
    by hairspray on Sat Mar 15, 2008 at 02:33:03 PM EST
    seen plenty of women who had alternatives but  wouldn't take advantage of them.  There is a fetus soon to become a drug addicted newborn if something both compassionate and realistic isn't done.  These kids have lots of learning and attention deficit problems as they grow and it isn't easy to find homes to repair that damage. Prevention is necessary, but prison isn't a good alternative, but some method of keeping the mother from drugs is necessary.  

    Parent
    Keep the mother from getting pregnant (5.00 / 1) (#9)
    by Fabian on Sat Mar 15, 2008 at 03:35:13 PM EST
    would be even better.

    I ran into one case years back that made me wish, briefly, for involuntary sterilization.  We had John XYZ in the hospital and someone familiar with the name thought it was Jack XYZ.  It wasn't.  In under ten months, one woman who was a drug addicted prostitute gave birth to two premature infants - both went straight into the foster care system.

    This woman was neither going to give up the drugs she was addicted to nor going to give up the prostitution that she used to acquire them.  If she was determined to go down that self destructive path, my wish would be that at least she be prevented from getting pregnant.  

    Parent

    I thought Norplant would be a solution . (none / 0) (#11)
    by hairspray on Sat Mar 15, 2008 at 06:00:09 PM EST
    It is implanted under the skin and emits progesterone/estrogen contraception for about 5 years. Somehow it lost its market because of some complications which I think were not major. This was to me a great temporary and reasonable approach.  Have the prostitute agree to the implantation and offer her drug recovery or money if she won't agree. Anything but keep her from getting pg.

    Parent
    I never found out what happened. (none / 0) (#12)
    by Fabian on Sat Mar 15, 2008 at 06:18:56 PM EST
    But we had one prostitute arrested locally with a flaming case of MRSA.  She would have died without immediate medical treatment and she wouldn't have gotten the treatment if she hadn't gotten arrested.[shudder]

    We need to really impress on women and girls that contraception should be more than an option.  It should be considered part of their responsibility for their health.  The health risks of pregnancy for women are often ignored.

    Parent

    Jesus H.... (none / 0) (#16)
    by kdog on Sun Mar 16, 2008 at 09:05:45 AM EST
    what's the practical difference between prison and forced quarantine?  6 in one, half a dozen in the other.

    So prison is off limits, but quarantine or forced abortion might be acceptable?  My tyranny alarm just went off.

    Pregnant women making bad choices for their unborn child is tragic, be it drugs and alcohol, excess caffeine, or bad diet.  But frankly, I don't see what can be done about it except education, anything else borders on tyranny.  In a truly free society, people will make horrible choices, and we have no choice but to live with it if we want to live in a truly free society.

    Besides the fact drugs are just as easy to get in prison as they are on the street.

    Parent

    Drugs & Pregnancy (5.00 / 2) (#4)
    by expertlaw on Sat Mar 15, 2008 at 01:18:45 PM EST
    Let's also not forget that it is dangerous for a pregnant woman to stop taking certain drugs during pregnancy, and detox should be medically supervised to avoid harm to the fetus.

    would the women in question (none / 0) (#3)
    by cpinva on Sat Mar 15, 2008 at 01:16:28 PM EST
    have the basis for a "breach of privacy" civil suit against the physicians?

    Would the HIPAA law apply? (5.00 / 1) (#10)
    by clio on Sat Mar 15, 2008 at 03:40:26 PM EST
    I can't get medical records when we leave the doctor's office for my mother who is demented - because she can no longer sigh a valid release due to the dementia.

    In this case the docs mail the records to my mother's home where I open the mail, but the law only allows mailing to confirmed address of the patient, AFAIK.

    However, HIPAA has lots of exceptions.  So many, in fact, that the only people who cannot easily access medical records are doctors and their patients.  The law does say that confidential information can be disclosed to law enforcement to "prevent abuse" as defined under local laws.

    Would be an interesting project for some law school class to research, if any of them are interested women's rights.

    Parent

    deterrence (none / 0) (#5)
    by diogenes on Sat Mar 15, 2008 at 01:52:14 PM EST
    Of course, such a law may inspire many women who are about to or have just discovered treatment to ENTER treatment with the goal of abstaining from drugs during the pregnancy.  Many alcoholics never enter treatment until they are put on probation for the DWI and are faced with the choice of sobriety or prison.  If this guy prosecutes a woman who has chosen to enter rehab, then that's a different story.
    We have no way of knowing how many women entered treatment due to strict enforcement; we only know about the eight who were convicted.

    Well, if there was an abundance (5.00 / 1) (#6)
    by Fabian on Sat Mar 15, 2008 at 02:04:31 PM EST
    of treatment facilities and they were free, I might agree with you.

    But until cities and counties offer free and accessible prenatal care and addiction treatment services, I have to think that prosecuting and locking up pregnant women serves primarily the prosecutor's ambitions.

    Note:  Ohio has real problems with drugs in its prisons and jails.  Would arresting and imprisoning a pregnant woman actually result in her being deprived of drugs?  And if not - what would be the point?

    Parent

    accessible services (none / 0) (#14)
    by diogenes on Sat Mar 15, 2008 at 08:41:04 PM EST
    When you tell a guy on probation for DWI or a sex offense to get treatment/stay sober or go to prison, they somehow find treatment (at least in New York).  How are pregnant women different?

    Parent
    A woman's health (none / 0) (#18)
    by Fabian on Sun Mar 16, 2008 at 11:59:50 AM EST
    suddenly becomes important only when she's pregnant?

    That's an invasion of privacy right there.  In a previous comment, I pointed out that damage from lifestyle choices can happen as early as the first trimester.  The real issue should be how to address ALL health care issues from addiction to general health to contraception.

    But the minute you go after pregnant women, you are crossing a line.  Why one drug and not another?  How can you ensure that a pregnant woman in prison won't gain access to drugs?  We had a heroin overdose in prison locally.  Drugs in prison is a problem.

    I don't condone anyone abusing drugs, but I'd draw the line at giving pregnant women any different treatment simply because they are pregnant.

    Parent

    It has happened in Coffee County too (none / 0) (#13)
    by Militarytracy on Sat Mar 15, 2008 at 07:51:17 PM EST
    where I live.  I know of two young women who lost their children to grandparents seeking custody,  they had positive drug screens.  One had the drug screen during pregnancy and lost custody of the child before the child was born.  One left the child in the care of its grandparents without warning and then returned two weeks later to reclaim the child.  The judge asked for a drug screen and when it was positive custody of the child was immediately granted the grandparents and game over.

    x (none / 0) (#15)
    by Mary Mary on Sun Mar 16, 2008 at 07:56:49 AM EST
    Well, as someone who works with kids in just that situation, I say hooray for acting sooner rather than later.

    There's a delicate balance between parents' rights and children's rights, but at least here in PA I think they've mostly struck a good one.

    Parent

    I agree with protecting the children (none / 0) (#17)
    by Militarytracy on Sun Mar 16, 2008 at 11:15:04 AM EST
    I don't think much is provided for servicewise for young mothers making drug choices here though.

    Parent
    Drugs & Pregnancy do not equal prison (none / 0) (#19)
    by gambril on Mon Mar 17, 2008 at 06:03:18 PM EST
    As the prosecutor who has stirred up all of this talk, I wanted to clear up several misconceptions about how this issue is being addressed.  The primary point is that my office has made it widely known that, if you are pregnant and addicted to drugs, you can come to my office for help without fear of prosecution.  We will aid that person in receiving counseling or residential drug rehabilitation, depending on the level of addiction.  These services are available to indigents, including two residential rehab programs within a 90 minute drive that will take in a drug addicted expectant mother as well as her children and take care of her through her pregnancy and for whatever time that follows.  This was told to the NY Times when they interviewed me and I asked that they make it a point to include it in the article, but obviously it made for a better topic of debate to leave it out.

    Secondly, no constitutional rights are being violated.  Despite what the NY Times reported, doctors are cooperating, but only under subpoena or court order.  The cases that come to us come in two forms:  either an expectant mother who is on probation for a felony offense fails a routine urinalysis while reporting to her probation officer or a mother gives birth to a child with drugs in its system and the hospital reports it to the Department of Human Resources (which is required by law in most states) who in turn must report it to the District Attorney (which is required in most states).  Our doctors here fully respect the patient-doctor confidentiality privilege and we have never asked one to breach it.  These are not cases that we seek out; these are cases that come to us.  Again, some thing that was told to the NY Times, but not reported.

    Next, my "continuing crime" assertion was not summarized the way that it was given.  The argument that was made is that when a mother abuses drugs, the child that is within in her is exposed to the chemicals.  This is a child that will ultimately be born and that is who the law seeks to protect:  the born child that was endangered while unborn.  The crime begins when the mother abuses the drug and is completed when the child is born with drugs in its system.  Regardless, that child, though unborn, is still endangered by the act of the mother.  As much as people are trying to make it such, this is not a stance on "when does life begin."  Though I oppose abortion on religious grounds, I believe in a woman's constitutional right to privacy.  However, I think the woman draws the line when she illegally ingests drugs and endangers a child, though a case against her still has to be made within the parameters of the 4th Amendment.  And these cases are.

    Someone commented on what's next -- cigarettes?  alcohol?  Those are addictions that are legal.  Drug abuse is illegal.  The law that is on the books now is aimed at protecting children from the harmful affects of people committing the crime of using illegal narcotics.  Helping drug addicted mothers and these children is our focus.

    Do we send every person who violates the law to jail?  No.  The two cases that were written up in the NY Times had more baggage than was reported.  Ms. Hitson was already on probation for committing a felony offense and, while pregnant and on probation, committed another felony offense:  fraudulent use of a credit card.  Then, she went into premature labor brought on by her drug abuse and gave birth to a baby that was endangered by the drug use.  A judge was the one who decided to send her to prison, followed by a 12 month residential rehab program.  Had she not been on probation or committed the other felony offense, her case would've probably been handled differently.  Ms. Barfoot was on probation for child abuse when she tested positive for drugs while pregnant after submitting a urine sample to her probation officer.  Her probation officer filed a delinquency petition for the failed drug test and the judge opted to deny her bond, which is constitutional when it involves a probationer.  I stepped in and arranged it to where she could go to a 12 month rehab and have her child while in the rehab instead of going to jail.  Of course, none of this was written up in the NY Times either, though it was told to them.

    Since we began prosecuting these cases, only two mothers have actually served time in the penitentiary, both of whom were on probation at the time.  The others whose cases have been disposed went into rehab and had healthy babies.  There are two cases pending trial, one of which involves a child that was born prematurely and died as a result of meth abuse.  Even that mother was allowed a bond to go to rehab while her trial date is pending.

    I don't write this because I'm trying to gain any supporters for what I'm doing.  I just like people to know the whole story before they debate an issue.  I'm just glad that there are forums such as this in which issues can be discussed.

    Chemicals+Pregnancy (none / 0) (#20)
    by mchele on Sat Apr 05, 2008 at 05:24:18 PM EST
    Wonder if this prosecutor is also charging industries that are polluting Alabama's air, water and soil with poisons, pesticides, mercury, ethanol,lead (all known to damage a fetus) with felony child abuse or is it just mothers with the disease of addiction?

    OK (none / 0) (#21)
    by alex45 on Sat Jun 28, 2008 at 01:07:56 AM EST
    Really super...Good work from the government.
    I think it is the reaction previous actions.
    Though it is good law for the society, I can't believe it will get success.

    Thanks,
    --------------
    Alex
    Addiction Recovery Alabama