Sign On Letter: Ferguson v. The City of Charleston

David Satcher, M.D.
Surgeon General of the United States

Dear General Satcher:

As physicians, health care professionals and medical ethicists, we are greatly concerned about a United States Supreme Court case, Ferguson v. City of Charleston, to be heard on October 4.  We fear the outcome of this case could require health care providers to serve as agents of law enforcement in the war on drugs - with devastating consequences for patients, health care and public health across the country. 

The Ferguson case challenges a policy developed and instituted in 1989 by the Medical University Hospital in Charleston, South Carolina ("MUSC").  MUSC health care professionals and hospital administrators, working in collaboration with the police and prosecutor’s office, instituted a policy of searching certain pregnant women and new mothers for evidence of cocaine use.  Urine tests, normally used by health care professionals to aid medical decision-making, were instead turned over to the police and used as criminal evidence when the tests suggested cocaine use.  Patients who tested positive for cocaine were then arrested. 

Some of the women arrested were shackled to their hospital beds; others were arrested shortly before or immediately after giving birth, often while still dressed in hospital gowns and still suffering pain and bleeding from the childbirth.  Even when a drug "treatment" component was belatedly added to the policy, no attempt was made to adapt treatment to the patient's individualized needs.  Instead, under threat of immediate arrest, patients were ordered to enter programs administered by individuals without experience or expertise in treating pregnant women, and without the services known to be effective in treating these women and new mothers.  As with other aspects of the costly war on drugs, the Charleston policy was carried out mostly against minorities "in this case, African Americans.  

None of the proffered justifications for the Charleston policy have any solid foundation in medicine, science, or public health.  For nearly a century, the medical profession has understood that drug addiction is a complex medical condition, not simply the product of a failure of individual willpower.  Like other such conditions, drug dependency can be controlled and overcome through medical treatment.  Medical knowledge about drug dependency and treatment demonstrates that patients do not and cannot simply stop their drug use as a result of threats of arrest or other negative consequences.  Nor do the punitive policies at the core of today's war on drugs deter drug use.  In fact, with respect to the focus of the Charleston policy, threat-based approaches have been shown to deter pregnant and parenting women not from using drugs but from seeking health care.  In short, the Charleston policy undermines rather than advances the interest in maternal, fetal, and child health. 

The Charleston policy is also predicated on the purportedly unique dangers of cocaine.  While this may be consistent with sensationalistic media accounts of so-called "crack babies," it lacks support from medical research.  Long-term longitudinal and other studies have demonstrated that prenatal exposure to cocaine does not cause long-term deleterious effects on child development that are different in scope, degree and kind from risks posed by other influences -- such as extreme poverty or exposure to other substances, licit or illicit -- that women face during pregnancy. 

This brings us to a final important point.  Health risks to women, fetuses and children "whether inadequate nutrition, exposure to drugs, or otherwise -- can be mitigated through prenatal care, counseling, and continued medical supervision.  But for this to be effective, the patient must trust her care provider to safeguard her confidences, stand by her while she attempts to improve her health (even when those efforts are not always successful), and be loyal to the therapeutic relationship.  The Charleston policy, however, destroys this trust by converting the physician’s exam room into an interrogation chamber, and turning health care professionals into agents of the drug war.  

The Supreme Court will decide shortly whether the Charleston policy violates the United States Constitution.  Regardless of the Court’s ultimate ruling, it is absolutely critical that the relationship between patients and their health care providers be preserved, and indeed strengthened.  Accordingly, Dr. Satcher, we urge you, as the country’s top medical administrator, to advance this important public health goal by condemning the failed Charleston experiment and joining forces with us to tell the nation’s hospitals and health care providers that the problem of drug dependence, particularly among pregnant women, is best addressed not by treating drug users as criminals, but rather by providing them full access to a range of treatment programs appropriate for persons suffering from a medical condition. 

Respectfully,

(See attached for signatories)

Hon. Janet Reno, Attorney General of the United States

Secretary Donna Shalala, U.S. Department of Health and Human Services

Jim Hodges, Governor of South Carolina

Dr. Raymond S. Greenberg, President, MUSC

Signatories to General Satcher letter re: Ferguson v. City of Charleston, South Carolina

ORGANIZATIONS (in alphabetical order)

American Academy of Physician Assistants

American Medical Women’s Association

American Nurses Association

American Public Health Association

California Society of Addiction Medicine

Connecticut Women’s Consortium

Drug Dependence Associates Organization

Friends Hospital (Philadelphia, PA)

Institute for Health and Recovery

Mountain Area Perinatal Substance Abuse Program

National Association of Nurse Practitioners in Women’s Health

National Council on Alcoholism and Drug Dependence

National Medical Association

National Perinatal Association

Society of General Internal Medicine

South Carolina Nurses Association

INDIVIDUALS (in alphabetical order)

Susan L. Adams, Ph.D., R.N., N.P., C.N.S., Associate Professor, Women’s Health Nurse Practitioner, Perinatal Addiction, Dominican University of California

Machelle Allen, M.D., Director, Ambulatory Ob/Gyn, New York University School of Medicine, Bellevue Hospital

Robert Arendt, Ph.D., Assistant Professor, Psychologist, Case Western Reserve University, School of Medicine

John Arras, Porterfield Professor of Bioethics, University of Virginia

Roslyn Banks-Jackson, M.D., Resident Physician

Eric Bass, M.D., M.P.H., Professor of Medicine, Johns Hopkins University

Marylou Behnke, M.D., Professor, University of Florida

Maureen Black, Ph.D., Professor, University of Maryland

Heidi Boone, Associate Director, Finance & Administration, Mountain Area Health Education Center, Women’s Health Center

Christina Borila, R.N., Registered Nurse, Mission Hospital

John J. Botti, M.D., President, National Perinatal Association

Ann M. Boyer, M.D., M.S., Mt. Sinai Medical Center

William Brannan, M.D., F.A.C.O.G., Medical Director, Helen Powers Women’s Health Center

Ann Brown, M.S.N., C.N.M., Certified Nurse, Midwife, Mountain Area Health Education Center, Women’s Health Center

Jan S. Burkhead, R.N., Labor and Delivery, Mission St. Joseph’s Hospital

Karen Busha, M.ed, Licensed Professional Counselor

Elizabeth Buys, M.D.

Donna Campbell, L.C.S.W., Executive Director, Connecticut Women’s Consortium

Ira J. Chasnoff, M.D., President, Chirldren’s Research Triangle, Professor of Clinical Pediatrics, University of Illinois College of Medicine

Wendy Chavkin, M.D., M.P.H., Professor of Clinical Public Health and Ob/Gyn, Columbia University

Anne Clark, R.N., Children’s Hospital of Buffalo

Deborah J. Coady, M.D., SoHo Ob/Gyn, St. Vincent’s Hospital

Claire D. Cole, Ph.D., Professor, Emory University School of Medicine

Glen E. Combs, PA-C, M.A., President of American Academy of Physician Assistants

Paul Connor, Associate Director Practice, Mountain Area Health Education Center, Women’s Health Center

 Carol Coulson, M.D., F.A.C.O.G., Clinical Assistant Professor, Ob/Gyn, University of North Carolina at Chapel Hill, Mountain Area Health Education Center 

Jody Crawford, Social Worker, B.A., Mission St. Joseph Hospital

Stacey Curnow, Certified Nurse, Mountain Area Health Education Center, Women’s Health Center

Nancy Day, M.P.H., Ph.D., Professor of Psychiatry and Epidemiology, University of Pittsburgh

Elizabeth M. Dapo, M.D., Resident Physician, Mountain Area Health Education Center

Kim M. Donoghue, C.S.W., Program Coordinator, PACT Program, Children’s Hospital of Buffalo

Ernest Drucker, M.D., Professor of Epidemiology and Social Medicine, Montefiore Medical Center, Einstein College of Medicine

Victoria Dulzell, M.D., Developmental Pediatrics, Rhode Island Hospital

Gwen Durham, Women’s Health Nurse Practitioner, Ob/Gyn, Mountain Area Health Education Center, Women’s Health Center

Sarah Dutta, M.D., Physician

Grace Evins, M.D., Physician, Women’s Health Center Ob/Gyn

Fonda Davis Eyler, Ph.D., Professor, Department of Pediatrics, University of Florida

Ruth Faden, Executive Director, Bioethics Institute, Johns Hopkins University

Oliver Fein, M.D., Associate Dean, Weill Medical College of Cornell University

Elizabeth Fingan, L.W.W., Director of Behavior Medicine, Mountain Area Health Education Center, Asheville, N.C.

Norma Finkelstein, Ph.D., Executive Director, Institute for Health and Recovery

Heidi Snyder Flagg, M.D., Physician, SoHo Ob/Gyn, St. Vincent’s Hospital, New York, NY

N. Marlene Fleming, J.D., Director of Human Resources, Compliance Officer, Friends Hospital

Amy Forrest, M.D., Ob/Gyn Resident, Mountain Area Health Education Center, N.C.

Deborah A. Frank, M.D., Associate Professor of Pediatrics, Boston University, School of Medicine

Jeanine Gage, M.S., R.N., Director, Ethics Consult Service, Medical University of South Carolina (MUSC)

Deborah Gahr, M.D., SoHo Ob/Gyn of St. Vincent’s Hospital

Gail Geller, MHS, Sc.D., Associate Professor, Johns Hopkins School of Medicine

Catherine Gilliss, D.N.Sc., Dean and Professor, Yale School of Nursing

Mary Goodspeed, R.N., B.S., R.N., HIV Counseling Coordinator, Children’s Hospital of Buffalo

Randy Greenberg, M.S., C.N.M., Certified Nurse – Midwife, Mountain Area Health Education Center Women’s Health Center

Marjorie Greenfield, M.D., Associate Professor of Ob/Gyn, Case Western Reserve University, School of Med. University MacDonald Women’s Hospital

Mary Ann Hensley, R.N., Clinical Manager, Mountain Area Health Education Center, Women’s Health Center

Melissa Hicks, M.D., Clinical Assistant Professor of Family Medicine,, Mountain Area Health Education Center

Pamela High, M.D., Clinical Professor of Pediatrics, Brown University, School of Medicine

Hallam Hurt, M.D., Chairman, Division of Neonatology, Albert Einstein Medical Center, PA

Hytham Imseis, M.D., Clinical Assistant Professor, of Ob/Gyn, University of North Carolina School of Medicine, Mountain Area Health Education Center

Joseph Jacobson, Ph.D., JD, Professor, Psychology Dept., Wayne State University

Sandra W. Jacobson, Ph.D., Professor and Director, Division of Therapy Research and Resident Training, Dept. of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine

Laura Jana, M.D., VP Parenting & Children’s Affairs, drSpock.com

Martha Jessup, R.N., M.S., Clinical Nurse Specialist, UCSF

Nancy Kass, Sc.D., Associate Professor, Johns Hopkins School of Public Health

Tim Keeler, M.D., Medical Assistant, Mountain Area Health Education Center  Ob/Gyn

Sabine Kelischek, M.D., Clinical Assistance Professor, Mountain Area Health Education Center Women’s Health Center

Barry Kosofsky, M.D., Ph.D., Associate Professor, Harvard Medical School, Associate Neurologist, Massachusetts General Hospital

C. Seth Landefeld, M.D., UCSF Dept. of Medicine

Robyn Latessa, M.D., Mountain Area Health Education Center

Deborah Lathrop, M.D., Resident Physician, Mountain Area Health Education Center  – FPRP

Jennie Leslie, M.D., Ob/Gyn Resident, Mountain Area Health Education Center

Barry Lester, Ph.D., Professor, Brown University School of Medicine

Mack Lipkin, Jr., M.D., Professor, New York University Med school, Founding President, Amer. Academy on Physician & Patient

Cynthia Loncar, Ph.D., Assistant Professor of Pediatrics, Brown University, School of Medicine

Karyn London, PA-C, Clinical Coordinator, Mt. Sinai Medical Center

Curtis Lowery, M.D., Director of MFM at University of Arkansas for Medical Sciences

Ali Luck, M.D., Resident Physician, Mountain Area Health Education Center

Carol Maclin, B.S., Case Manager, PACT Program, Children’s Hospital of Buffalo

Brina Maldonado, M.D., SoHo Ob/Gyn, St. Vincents Hospital and Medical Center

Mary Faith Marshall, Ph.D., FCCM, Bioethics Officer, Professor of Medicine, Kansas University Med. Center

Melissa McClure, Medical Records Coordinator, Mountain Area Perinatal Substance Abuse Program

Leslie McCrory, M.A., CCAS, Associate Director, Mental Health Education, Mountain Area Health Education Center

Glen E. McGee, Ph.D., Associate Director of Education, Assistant Professor of Bioethics, Philosophy, and History, Center for Bioethics, University of Pennsylvania

Kathleen McGrail, M.D.

John P. Morgan, M.D., Professor of Pharmacology, CUNY Medical School

Robert Needleman, M.D., Associate Professor of Pediatrics, Case Western Reserve University, School of Medicine

Daniel Neuspiel, M.D., M.P.H., Associate Chairman of Pediatrics, Beth Israel Medical Center

Robert G. Newman, M.D., President of Continuum Health Partners

Julie Noland, Ph.D., Case Western Reserve University

Denise Paone, Ph.D., Research Scientist, Harm Reduction Coalition

Melene Patchel, B.S., Administrative Assistant, Mountain Area Health Education Center, Women’s Health Center

Tom Payte, M.D., Medical Director, Drug Dependence Associates Organization

Cheri Pies, Director Family, Maternal & Child Health Program, Contra Costa Health Services

Kimberly Priebe, M.D., M.S., Ob/GYN Resident, Mountain Area Health Education Center, Women’s Health Center

Sue Rosenfield, Women and Infants Hospital

Miriam Rosenthal, M.D., Associate Professor of Psychiatry and Reproductive Biology, Chief of Behavioral Medicine, Case Western Reserve University, Dept. of Ob/Gyn, University MacDonald Women’s Hospital

Kenneth D. Rosenberg, M.D., M.P.H.

Robert Ross, Jr., M.D., JD, Ob/Gyn Resident, Mountain Area Health Education Center

John Rowe, M.D., Family Practice faculty, Mountain Area Health Education Center, Family Practice Residencey

Todd Sagin, M.D., J.D., Health Care Consultant

Michelle Sahl, M.Ed, M.B.A., Candidate for Masters in Bioethics, Principal, MJ Sahl Consulting

Andrea Sailer, MPA, Evaluator, Mountain Area Perinatal Substance Abuse Program

Troy Sands, M.D., Director of Pediatrics, Southwest General Heath Center

Rashid Shaikh, Ph.D., Director, Science and Technology Meetings, New York Academy of Sciences

Susan Shinn, R.N.C., Ob/Gyn Nurse Practitioner, Mountain Area Health Education Center, Women’s Health Center

Michelle Simmons, M.D.

Lynn Singer, Ph.D., Professor of Pediatrics & Psychiatry, Case Western Reserve University, School of Medicine

David Gary Smith, M.D., F.A.C.P., Program Director, Abington Memorial Hospital

Juanita Soto, B.S.W, Case Manager, PACT Program, Children’s Hospital of Buffalo

Sharon Stancliff, M.D., Medical Consultant, New York State Department of Health

John Stewart, M.D., M.D.G, Ob/Gyn

Terry Sutton, Program Assistant, Mountain Area Health Education Center

James Theofrastous, M.D., F.A.C.O.G., Director Of Ob/Gyn, Mountain Area Health Education Center, Dept. of Ob/Gyn

Judith Thompson, Executive Director, South Carolina Nurses Association

Cheryl Timbs, Clinical Supervisor, Mountain Area Perinatal Substance Abuse Program – Mountain Area Health Education Center

Edward Tronick, M.D., Associate Professor of Pediatrics, Harvard Medical School

Berthold Umland, M.D., Associate Professor, Dept. of Family & Community Medicine, University of New Mexico, School of Medicine

Dona Upson, M.D., M.A., Assistant Professor of Medicine, University of New Mexico

John Watts, M.D., M.A., Resident Physician, Mountain Area Health Education Center

Sally Webb, M.D., Clinical Associate, Professor, Pediatrics, Vice-Chair Medical University of South Carolina Ethic Committee, MUSC

Denise Weegar, M.A. Clinical Psychology, Substance Abuse Counselor, Mountain Area Perinatal Substance Abuse Program

Susan Wysocki, R.N.C., N.P., President and CEO, National Association of Nurse Practitioners in Women’s Health

Kimberly Yolton, Ph.D., Fellow, General Pediatrics, Children’s Hospital – Cincinnati

Barry Zuckerman, M.D., Professor and Chairman, Dept. of Pediatrics, Boston University School of Medicine