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.
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.
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.
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.
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.
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.
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.
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.
Between 1989 and 1994, MUSC performed approximately 600 drug screens on pregnant women, yielding 27 positive results and 10 arrests.
Petitioners are the ten women arrested after positive tests while receiving obstetrical care at MUSC.
Four were arrested before the treatment option was available and the remainder after failing to comply with treatment or testing positive a second time.
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.
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.
The Fourth Circuit affirmed on the special needs ground without reaching consent, and the Supreme Court granted certiorari.
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