532 U.S. 67 (2001)
In the fall of 1988, staff members at the Medical University of South Carolina (MUSC), a state-operated public hospital in Charleston, became concerned about an apparent increase in cocaine use by patients receiving prenatal treatment.1
In response, as of April 1989, MUSC began ordering drug screens on urine samples from maternity patients suspected of using cocaine based on nine specific criteria such as no prenatal care, late prenatal care, abruptio placentae, and unexplained intrauterine growth retardation.2
Positive results initially led to referrals for counseling and treatment through the county substance abuse commission, yet the incidence of cocaine use among patients did not appear to change.3
After Nurse Shirley Brown heard a news report about police in Greenville arresting pregnant cocaine users on child abuse theories, she discussed the matter with MUSC general counsel Joseph C. Good, Jr., who contacted Solicitor Charles Condon to offer the hospital’s cooperation in prosecuting mothers whose newborns tested positive.4
Condon organized a task force that included representatives from MUSC, local police, the County Substance Abuse Commission, and the Department of Social Services; their work produced the 12-page Policy M-7 governing management of drug abuse during pregnancy.5
The policy required chain-of-custody procedures for samples, set forth education and referral steps, and incorporated the threat of law enforcement intervention, including immediate police notification and arrest for patients testing positive a second time or missing treatment appointments.6
Under the initial version of the policy, patients testing positive during labor were arrested without a treatment option, but a 1990 modification extended the opportunity to avoid arrest by consenting to substance abuse treatment and periodic testing.7
The policy prescribed precise criminal charges depending on gestational stage—simple possession if 27 weeks or less, possession and distribution to a person under 18 if 28 weeks or more, and unlawful neglect of a child upon delivery while testing positive—and directed police to interrogate arrestees to identify the drug supplier.8
Between 1989 and 1994, MUSC performed approximately 600 drug screens on pregnant women, yielding 27 positive results and 10 arrests.9
Petitioners are the ten women arrested after positive tests while receiving obstetrical care at MUSC.10
Four were arrested before the treatment option was available and the remainder after failing to comply with treatment or testing positive a second time.11
They brought this action under 42 U.S.C. § 1983 against MUSC, the City of Charleston, and the solicitor, alleging that the urine tests violated the Fourth Amendment.12
The District Court granted respondents summary judgment on the special needs issue, submitted the consent question to the jury, and entered judgment for respondents after the jury found consent.13
The Fourth Circuit affirmed on the special needs ground without reaching consent, and the Supreme Court granted certiorari.14
Whether a state hospital’s performance of a diagnostic test to obtain evidence of a patient’s criminal conduct for law enforcement purposes is an unreasonable search if the patient has not consented to the procedure?15
The Fourth Amendment prohibits unreasonable searches and seizures.16 Urine tests performed by state hospital staff are searches.17 The special needs doctrine permits suspicionless searches when special needs beyond the normal need for law enforcement make the warrant and probable-cause requirement impracticable.18 The primary purpose of the searches must be distinguishable from the general interest in crime control.19
No. The central feature of the MUSC policy was the mandatory reporting of positive test results to law enforcement for penal purposes.20 This is shown by the collaboration between hospital staff and Solicitor Condon in forming the task force that produced Policy M-7.21 The policy incorporated chain-of-custody procedures and detailed provisions for police notification and arrest.22 It also prescribed specific criminal charges based on gestational stage.23 Law enforcement officials helped determine testing procedures.24 They had access to medical files.25 They attended substance abuse team meetings.26 They coordinated the timing of arrests with hospital staff.27 This made the threat of arrest essential to the program’s operation.28 This extensive entanglement with law enforcement from the policy’s inception distinguishes the case from prior special needs precedents such as Skinner v. Railway Labor Executives’ Assn., Treasury Employees v. Von Raab, and Vernonia School Dist. 47J v. Acton.29 In those cases searches served purposes divorced from ordinary crime control and results were not routed directly to prosecutors.30
The invasion of privacy was also more substantial than in those cases.31 Patients reasonably expected that diagnostic test results would not be shared with nonmedical personnel without consent.32 Yet the policy was designed to obtain evidence for criminal prosecutions.33
The drug-testing policy constituted an unreasonable search that violated the Fourth Amendment.34
Related opinions on this issue
Justice Kennedy concurred in the judgment.35
He agreed that the searches at issue violated the Fourth Amendment.36
He would not extend the special needs doctrine to this context in the same manner as the majority.37
The hospital’s policy involved law enforcement in a manner that cannot be reconciled with precedents.38
The policy was developed with the explicit involvement of the solicitor’s office.39
Positive test results were reported directly to law enforcement for the purpose of arrest and prosecution.40
This is not a case of incidental disclosure of information to the police.41
The involvement of law enforcement was an integral part of the policy from its inception.42
Therefore the searches could not be sustained under the special needs rationale.43
Joined by Justices Scalia And Thomas
Chief Justice Rehnquist dissented.44
He argued that the Court struck down a policy designed to address a serious public health crisis of cocaine use by pregnant women.45
The policy was a reasonable response to that crisis and should be upheld under the special needs doctrine.46
The majority’s conclusion that the primary purpose of the policy was law enforcement is not supported by the record.47
The policy was developed by medical professionals to address the medical needs of pregnant women and their unborn children.48
The involvement of law enforcement was limited and was intended to encourage compliance with treatment.49
He would have affirmed the judgment below.50
Joined by Chief Justice Rehnquist And Justice Thomas
Justice Scalia dissented.51
He joined the Chief Justice’s dissent but wrote separately to emphasize that the women had no reasonable expectation of privacy in their urine samples collected as part of routine medical care.52
The disclosure of positive test results to law enforcement does not transform a medical procedure into an unconstitutional search.53
The special needs doctrine would validate the testing.54
The District Court’s finding that the goal of the testing policy was to facilitate treatment and protect both the mother and unborn child was not clearly erroneous.55
The presence of an additional law enforcement purpose does not render the doctrine inapplicable.56
The doctors here do not ordinarily conduct searches against the ordinary citizen and are supposed to have in mind the welfare of the mother and child.57
Whether the primary purpose of the MUSC drug-testing policy was distinguishable from the general interest in crime control so as to justify it under the special needs doctrine?58
The special needs doctrine justifies suspicionless searches only when the primary purpose of the searches is distinguishable from the general interest in crime control.59 When the immediate objective is to generate evidence for law enforcement purposes through the threat of arrest and prosecution, the searches cannot be sustained under the doctrine even if an ultimate beneficent goal such as encouraging treatment exists.60
No. The primary purpose of the Charleston policy was to use the threat of arrest and prosecution to force pregnant women into treatment.61 This is demonstrated by the fact that Policy M-7 incorporated police operational guidelines.62 The policy devoted extensive attention to chain of custody and possible criminal charges.63 Law enforcement intervention was the essential leverage for program effectiveness.64
Police and prosecutors decided who would receive positive-test reports.65 They helped shape testing procedures.66 They routinely attended team meetings.67 They received copies of patient progress documents.68
They coordinated arrests with hospital staff.69 Although the ultimate goal may have been health-related, the immediate objective was to generate evidence for law enforcement purposes.70 This rendered the policy indistinguishable from the general interest in crime control.71
The primary purpose of the MUSC drug-testing policy was not distinguishable from the general interest in crime control, so the special needs doctrine does not justify the searches.72
Related opinions on this issue
Justice Kennedy agreed that the policy could not be sustained.73
Law enforcement was an integral part of the program from its inception rather than an incidental feature.74
The active use of arrests and prosecutions as implementation tools exceeded the limits of prior special needs cases.75
Those cases assumed evidence would not be used for law enforcement purposes.76
The traditional warrant and probable-cause requirements are waived in previous cases on the explicit assumption that the evidence obtained in the search is not intended to be used for law enforcement purposes.77
Under these circumstances the policy had a penal character with a far greater connection to law enforcement than other searches sustained under the special needs rationale.78
Joined by Justices Scalia And Thomas
Chief Justice Rehnquist dissented on the ground that the majority mischaracterized the primary purpose as law enforcement.79
The record showed the policy was developed by medical professionals to address medical needs of mothers and children.80
Any law enforcement role was limited to encouraging treatment compliance.81
The policy was a reasonable response to the public health crisis.82
It should have been upheld under the special needs doctrine.83
The majority’s conclusion that the primary purpose of the policy was law enforcement is not supported by the record.
Joined by Chief Justice Rehnquist And Justice Thomas
Justice Scalia dissented on the ground that the special needs doctrine remains applicable even when law enforcement has an additional purpose.84
The doctrine was developed precisely to enable searches by officials who ordinarily pursue law enforcement objectives.85
The District Court’s finding of a medical purpose was binding and not clearly erroneous.86
The doctors here do not ordinarily conduct searches against the ordinary citizen.87
They are supposed to have in mind the welfare of the mother and child.88
That they have in mind in addition the provision of evidence to the police should make no difference.89