Today more than 70 medical, public health, and advocacy groups, as well as leading health care providers and experts, sent an open letter to the new Amarillo County District Attorney's office. They asked the new D.A., Randall Sims, to end his predecessor's policy of treating pregnant drug-using patients as criminals who should go to jail rather than soon to be mothers who need confidential healthcare and family treatment. They argued that the policy creates a significant threat to maternal, fetal and child health, by deterring pregnant and parenting women from seeking prenatal care.
Rebecca King, the previous D.A., had sent a letter to local physicians in which she declared that they were legally required to report their patients to law enforcement. On January 5, 2005, Texas Attorney General Greg Abbot concluded that Ms. King's interpretation of SB319 was wrong - that under Texas law a "physician is not obligated to report a pregnant patient's use of a controlled substance as child abuse under Family Code section 261.101(b)."
Despite Abbot's ruling, there has been no change in the Amarillo policy of arrest instead of healthcare. As of now, 18 local women have been prosecuted after their doctors shared their confidential information. When asking doctors to provide this information, King implied that it would be used in order to help women access treatment. In fact, according to a federal drug treatment program locator, there is not a single program designed for women within one hundred miles of Mr. Sims headquarters in Amarillo. Instead of being provided with the promised treatment, they were arrested.
The letter states in part:
"While we do not in any way condone a person's use of alcohol, cigarettes, or other drugs that might affect pregnancy outcome or a person's ability to parent, our commitment to the care of pregnant women and their children, as well as the interests of society as a whole, requires us to speak out against dangerous and counterproductive measures such as requiring health care providers to violate patient confidentiality and assist in the arrest of pregnant women and new mothers." The letter calls on Mr. Sims to drop pending prosecutions explaining that the arrest of pregnant women and new mothers " not only lacks foundation in the law but also creates a significant threat to maternal, fetal and child health."
As every leading medical organization to address this issue has concluded, including the American Medical Association, the American College of Obstetricians and Gynecologists, the American College of Nurse Midwives, the American Academy of Pediatrics, the American Public Health Association, the American Psychiatric Association, the American Academy of Family Physicians, and the March of Dimes, the problem of alcohol and drug use during pregnancy is a health issue best addressed through education and community-based treatment, not through the criminal justice system."
Below is a copy of the full letter and the complete list of signatories.
District Attorney Randall Sims
47th Judicial District of Texas
Potter and Armstrong Counties
Potter County Courts Building
301 S. Filmore, Suite 5A
Amarillo, Texas 19101-2449
February 23, 2005
Dear Mr. Sims:
As physicians, health care professionals, medical ethicists, midwives, child-welfare advocates, public health advocates and researchers we wish to call your attention to your predecessor's erroneous interpretation of SB 319, which mandated serious and counterproductive violations of healthcare provider-patient confidentiality. On September 22, 2003, Ms. Rebecca King wrote a letter to "All Physicians Practicing in Potter County." In this letter she declared that physicians must report pregnant drug-using women to local law enforcement officials. ("Based on these laws, it is now a legal requirement for anyone to report a pregnant woman who is using or has used illegal narcotics during her pregnancy.") This interpretation of Texas law has already resulted in the arrest of over a dozen women who allegedly used an illegal drug while pregnant.
On January 5, 2005, Texas Attorney General Greg Abbot concluded that Ms. King's interpretation of SB319 was wrong - that under Texas law a "physician is not obligated to report a pregnant patient's use of a controlled substance as child abuse under Family Code section 261.101(b). "Ms. King was also wrong in interpreting the state's delivery of drugs to a minor statute as applicable to pregnant women who experience drug dependencies. This interpretation not only lacks foundation in the law but also creates a significant threat to maternal, fetal and child health.
While we do not in any way condone a person's use of alcohol, cigarettes, or other drugs that might affect pregnancy outcome or a person's ability to parent, our commitment to the care of pregnant women and their children, as well as the interests of society as a whole, requires us to speak out against dangerous and counterproductive measures such as requiring health care providers to violate patient confidentiality and assist in the arrest of pregnant women and new mothers.
As every leading medical organization to address this issue has concluded, including the American Medical Association, the American College of Obstetricians and Gynecologists, the American College of Nurse Midwives, the American Academy of Pediatrics, the American Public Health Association, the American Psychiatric Association, the American Academy of Family Physicians, and the March of Dimes, the problem of alcohol and drug use during pregnancy is a health issue best addressed through education and community-based treatment, not through the criminal justice system.
Drug dependency is a medical condition - not a crime. Pregnant women do not experience alcoholism and other drug dependencies because they want to harm their fetuses or because they don't care about their children.
Like other chronic medical conditions, drug dependency can be controlled and overcome through medical treatment. Medical knowledge about addiction and dependency treatment demonstrates that the majority of dependent people do not, and cannot, simply stop their drug use as a result of threats of arrest or other negative consequences. In fact, threat-based approaches do not protect children. They have been shown to harm children by deterring pregnant and parenting women from seeking prenatal care and drug and alcohol treatment.
Health risks to women, fetuses, and children whether from poverty, inadequate nutrition, exposure to alcohol, drugs, or other factors can be mitigated through prenatal care, counseling, and continued medical supervision. For this to be effective, however, the patient must trust her health care provider to safeguard her confidences and stand by her while she attempts to improve her health (even when those efforts are not always successful). Converting the physician's exam room into an interrogation chamber and turning health care professionals into agents of law enforcement, destroys this trust and deters the most vulnerable women from securing prenatal care.
District Attorney King's letter to all physicians in Potter County claiming that "most of these users will qualify for probation which will allow us to legally mandate medical services . . . - falsely suggested that appropriate drug treatment services are available to pregnant and parenting women. According to the federal government's drug treatment facility locator there is absolutely no treatment designed for pregnant and parenting women - or even women in general -- within 100 miles of Amarillo, Texas. Arresting pregnant women and new mothers cannot help them to get appropriate drug treatment when it simply does not exist. Moreover, arresting people with drug related problems is not only likely to deter them from seeking whatever little help might be available - it is also likely to deter others from offering compassion and providing the resources necessary to develop and fund the kinds of treatment that we know can help pregnant women and their families.
We therefore ask you, in the interests of maternal, fetal, and child health, to end your predecessor's policy of interfering with health care provider-patient relationships. We request that you write to the recipients of King's September letter to let them know it has been rescinded and health care confidentiality restored. We also urge you to drop pending charges against the many women prosecuted pursuant to King's misinterpretation of the law.
Academy on Violence and Abuse
American Association for the Treatment of Opioid Dependence
American College of Nurse-Midwives
American Society of Addiction Medicine
Association of Reproductive Health Professionals (ARHP)
Association of Women Psychiatrists
Baron Edmond de Rothschild Chemical Dependency Institute of
Beth Israel Medical Center
Center for Gender and Justice
Doctors of the World USA
Group for Chronic Addiction Research, Inc. (GCAR)
Harm Reduction Coalition
Hygeia Foundation for Perinatal Loss and Bereavement, Inc.
Institute for Health and Recovery
International Center for Advancement of Addiction Treatment
Linbar Associates, Inc.
Maternity Center Association
National Association of Nurse Practitioners in Women's Health
National Coalition for Child Protection Reform
National Council on Alcoholism and Drug Dependence
National Stillbirth Society
National Latina Institute for Reproductive Health
National Perinatal Association
National Women's Health Network
Our Bodies Ourselves
The Rebecca Project for Human Rights
Society of General Internal Medicine
SoHo Obstetrics and Gynecology, P.C.
The SCAADAC (South Carolina Association of Alcoholism and Drug Abuse Counselors) Certification Commission
Texas Academy of Family Physicians
Texas Association of Obstetricians and Gynecologists
Elizabeth M. Armstrong, Assistant Professor of Sociology and Public Affairs, Princeton University*
Rae Banks, PhD, Professor, Syracuse University*
Marylou Behnke, MD, Professor of Pediatrics, University of Florida School of Medicine*
Jeffrey Blustein, PhD, Professor of Bioethics, Albert Einstein College of Medicine*
Nancy D. Campbell, Assistant Professor, Rensselaer Polytechnic Institute*
R. Alta Charo, Elizabeth Wilson Professor of Law and Bioethics, University of Wisconsin Law School and Medical School*
Linda H. Chaudron, MD, MS
Arnold W. Cohen, MD, Clinical Professor of Obstetrics and Gynecology,
Jefferson Medical College; Chairman, Department of Obstetrics and Gynecology, Albert Einstein Medical Center*
Virginia Delaney-Black, MD, MPH, Professor of Pediatrics, Wayne State University*
Fonda Davis Eyler, PhD, University of Florida*
S.J. Everson-Bates, RN, DNSc, Associate Hospital Director, University of Arkansas for Medical Sciences*
Deborah A. Frank, MD, Professor of Pediatrics, Boston University School of Medicine*
Leslie H. Gise, MD, University of Hawai'i*
Martin Guggenheim, Professor of Clinical Law, New York University School of Law*
R. Moss Hampton, MD, Panhandle Obstetrics and Gynecology*
Alana Hulen, MSW
Harry G. Levine, Professor, Queens College, City University of New York*
David C. Lewis, MD, Professor of Community Health, Brown Medical School*
Wendy Mariner, Professor, Boston University School of Public Health*
Howard Minkoff, MD
Priya Morganstern, Esq.
Thomas H. Murray, PhD, President, The Hastings Center*
Lawrence J. Nelson, PhD, JD, Senior Lecturer in Philosophy and in Women and Gender Studies, Santa Clara University*
Dorothy Roberts, JD, Kirkland and Ellis Professor, Northwestern University School of Law*
Diana Romero, PhD, Assistant Professor of Population and Family Health, Department of Population and Family Health, Mailman School of Public Health, Columbia University*
Ruth Rose-Jacobs, ScD, Boston University School of Medicine*
Silvia Sorensen, PhD, University of Rochester School of Medicine and Dentistry*
Andrea Stolar, MD, University Hospitals of Cleveland*
Keerthy Sunder, MD, MS, University of Pittsburgh Medical Center*
Ellen Weber, Assistant Professor, Drug Policy and Public Health Strategies Clinic,
University of Maryland School of Law*
Linda L.M. Worley, MD, University of Arkansas for Medical Sciences*
Holly Catania (International Center for Advancement of Addiction Treatment)
Allan Clear (Harm Reduction Coalition)
Deborah Coady, MD (Soho Obstetrics and Gynecology, P.C.)
Stephanie S. Covington, PhD, LCSW (Center for Gender and Justice)
Carl A. (Tony) Dunn, MD, FACOG (Texas Association of Obstetricians and Gynecologists)
Norma Finkelstein, PhD (Institute for Health and Recovery)
Corinne F. Gerwe (Group for Chronic Addiction Research, Inc. GCAR)
Robert Newman, MD, MPH (Baron Edmond de Rothschild Chemical Dependency Institute of Beth Israel Medical Center)
Mark W. Parrino, MPA (American Association for Treatment of Opioid Dependence)
Albert L. Pizzica, DO, FAAP (National Perinatal Association)
Carol Sakala (Maternity Center Association)
F. David Schneider, MD, MSPH (Academy on Violence and Abuse)
Wayne Shields (Association of Reproductive Health Professionals ARHP)
Jan Tritten (Midwifery Today)
Susan Wysocki (National Association of Nurse Practitioners in Women's Health)
cc: The Honorable Rick Perry, Governor of Texas
Representative Ray Allan
Attorney General Greg Abbott
Senator Ken Armbrister
Representative Elliott Naishtat
Representative Larry Taylor
Representative Dianne White Delisi
Representative Terry Keel
Eduardo J. Sanchez, M.D., M.P.H., Commissioner,
Texas Department of State Health Services