Massachusetts Citizens for Life, an anti-abortion group, is beginning a process to attempt to repeal “Romneycare,” the state mandated law that required health care for all citizens, passed by Mitt Romney when he was governor. The law is said by many to be a precursor to President Obama’s health care reform plan of 2009.
Kyle Cheney of the State House News Service reports that Massachusetts Citizens for Life plan to file a petition to repeal the 2006 state requirement that all residents buy health insurance. The anti-abortion group planned to submit 10 signatures to Attorney General Martha Coakley today. If she accepts the language of the proposal, the group would have until early September to gather more than 68,000 signatures necessary to move the effort forward. President Anne Fox said the law has contributed to rising insurance costs and increased the number of taxpayer-funded abortions.
It stands to wonder whether this would help or hurt Romney in his presidential campaign. Repealing it would possibly get the health care reform issue off his back, but the process for repeal would just continuously remind the GOP voters that he passed it in the first place.
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According to the new law, the jail should have been prohibited from using any type of restraint on Gamble during labor, and using of leg and waist restraints on her during and immediately after her pregnancy. It also guaranteed her minimum standards of pregnancy care and required—as with everyone incarcerated while in their second or third trimesters—that she be transported in the jail’s vehicles with seat belts whenever she was taken to court, medical appointments, or anywhere outside the jail.
But that wasn’t the case for Gamble. Instead, she says, when it came time for her to give birth, she was left to labor in a cell for eight hours before finally being handcuffed, placed in the back of a police cruiser without a seatbelt, and driven to a hospital, where she was shackled to the bed with a leg iron after delivering.
In addition to analyzing policies, they spoke with women who were pregnant while in custody and learned that women continue to be handcuffed during labor, restrained to the bed postpartum, and placed in full restraints—including leg irons and waist chains—after giving birth.
“The promise to respect the human rights of pregnant women in prison and jail has been broken,” the report’s authors concluded.
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“The Massachusetts law is part of a national trend and is one of the most comprehensive in protecting pregnant and postpartum women from the risks of restraints,” said Roth in an interview with Rewire. “However, like most other states, the Massachusetts law doesn’t have any oversight built in. This report clearly shows the need for staff training and enforcement so that women who are incarcerated will be treated the way the legislature intended.”
Gamble learned all of this firsthand. In the month before her arrest, Gamble had undergone a cervical cerclage, in which a doctor temporarily stitches up the cervix to prevent premature labor. She had weekly visits to a gynecologist to monitor the development of her fetus. The cerclage was scheduled to be removed at 37 weeks. But then she was arrested and sent to jail.
Gamble told jail medical staff that hers was a high-risk pregnancy, that she had had a cerclage, and that her first child had been born six weeks prematurely. Still, she says she waited two months before seeing an obstetrician.
As her due date drew closer, the doctor, concerned about the lack of amniotic fluid, scheduled Gamble for an induction on Feb. 19, 2015. But, she says, jail staff cancelled her induction without telling her why.
That same evening, around 5 p.m., Gamble went into labor. Jail staff took her to the medical unit. There, according to Gamble, the jail’s nurses took her blood pressure and did a quick exam, but did not send her to the hospital. “They [the nurses] thought I was ‘acting up’ because my induction was canceled,” she told Rewire.
She was placed in a see-through cell where, as the hours progressed, her labor pains grew worse. “I kept calling to get the [correctional officers] to get the nurse,” Gamble recalled. By the time a nurse came, Gamble was bleeding. “The nurse made me pull down my pants to show her the blood—in front of a male [correctional officer]!” Gamble stated. Still, she says, no one called for an ambulance or made arrangements to drive her to the hospital.
At 1:45 in the morning, over eight hours after she first went into labor, the jail’s captain learned that Gamble was in labor. “[He] must have heard all the commotion, and he called to find out what was going on,” she said. He ordered his staff to call an ambulance and bring her to the hospital.
But instead of calling an ambulance, Gamble says jail staff handcuffed her, placed her in the back of a police cruiser without a seatbelt—in violation of the law—and drove her to Charlton Memorial Hospital. “My body was already starting to push the baby out,” she said. She recalled that the officers driving the car worried that they would have to pull over and she would give birth by the side of the road.
Gamble made it to the hospital, but just barely. Nine minutes after arriving, she gave birth: “I didn’t even make it to Labor and Delivery,” she remembered.
But her ordeal wasn’t over. Gamble’s mother, who had contacted Prisoners’ Legal Services and Prison Birth Project weeks earlier, knew that the law prohibited postpartum restraints. So did Gamble, who had received a packet in jail outlining the law and her rights from Prisoners’ Legal Services. When an officer approached her bed with a leg iron and chain, she told him that, by law, she should not be restrained and asked him to call the jail to confirm. He called, then told her that she was indeed supposed to be shackled. Gamble says she spent the night with her left leg shackled to the bed.
When the female officer working the morning shift arrived, she was outraged. “Why is she shackled to the bed?” Gamble recalled the officer demanding. “Every day in roll call they go over the fact that a pregnant woman is not to be shackled to anything after having a baby.” The officer removed the restraint, allowing Gamble to move around.
According to advocates, it’s not unusual for staff at the same jail to have different understandings of the law. For Gamble, that meant that when the shift changed, so did her ability to move. When the morning shift was over, she says, the next officer once again shackled Gamble’s leg to the bed. “I was so tired, I just went along with it,” Gamble recounted.
Two days after she had given birth, it was time for Gamble to return to the jail. Despite Massachusetts’ prohibition on leg and waist restraints for women postpartum, Gamble says she was fully shackled. That meant handcuffs around her wrists, leg irons around her ankles, a chain around her waist,g and a black box that pulled her handcuffs tightly to the waist chain. That was how she endured the 20-minute drive back to the jail.
Gamble’s jail records do not discuss restraints. According to Petit, who reviewed the records, that’s not unusual. “Because correctional officers don’t see it as out of the ordinary to [shackle], they do not record it,” she explained. “It’s not so much a misapplication of the extraordinary circumstances requirement as failure to apply it at all, whether because they don’t know or they intentionally ignore it.”
While Bristol County Sheriff’s Office Women’s Center’s policies ban shackling during labor, they currently do not prohibit restraints during postpartum recovery in the hospital or on the drive back to the jail. They also do not ban leg and waist restraints during pregnancy. Jonathan Darling, the public information officer for the Bristol County Sheriff’s Office, told Rewire that the jail is currently reviewing and updating policies to reflect the 2014 law. Meanwhile, administrators provide updates and new information about policy and law changes at its daily roll call. For staff not present during roll call, the jail makes these updates, including hospital details, available on its east post. (Roll call announcements are not available to the public.)
“Part of the problem is the difference in interpretation between us and the jurisdictions, particularly in postpartum coverage,” explained Petit to Rewire. Massachusetts has 14 county jails, but only four (and the state prison at Framingham) hold women awaiting trial. As Breaking Promises noted: “Whether or not counties incarcerate women in their jails, every county sheriff is, at minimum, responsible for driving women who were arrested in their county to court and medical appointments. Because of this responsibility, they are all required to have a written policy that spells out how employees should comply with the 2014 law’s restrictions on the use of restraints.”
Four jurisdictions, including the state Department of Correction, have policies that expressly prohibit leg and waist restraints during the postpartum period, but limit that postpartum period to the time before a woman is taken from the hospital back to the jail or prison, rather than the medical standard of six weeks following birth. Jails in 11 other counties, however, have written policies that violate the prohibition on leg and waist shackles during pregnancy, and the postpartum prohibition on restraints when being driven back to the jail or prison.
Even institutions with policies that correctly reflected the law in this regard sometimes failed to follow them: Advocates found that in some counties, women reported being restrained to the bed after giving birth in conflict with the jail’s own policies.
“When the nurse left, the officer stood up and said that since I was not confirmed to be in ‘active labor,’ she would need to restrain me and that she was sorry, but those were the rules,” one woman reported, even though the law prohibits restraining women in any stage of labor.
But shackling pregnant women during and after labor is only one part of the law that falls short. The law requires that pregnant women be provided with regular prenatal and postpartum medical care, including periodic monitoring and evaluation; a diet with the nutrients necessary to maintain a healthy pregnancy; written information about prenatal nutrition; appropriate clothing; and a postpartum screening for depression. Long waits before transporting women in labor to the hospital are another recurring complaint. So are routinely being given meals without fruits and vegetables, not receiving a postpartum obstetrician visit, and waiting long stretches for postpartum care.
That was also the case with Gamble. It was the middle of the night one week after her son’s birth when Gamble felt as if a rock was coming through her brain. That was all she remembered. One hour later, she woke to find herself back at the hospital, this time in the Critical Care Unit, where staff told her she had suffered a seizure. She later learned that her cellmate, a certified nursing assistant, immediately got help when Gamble’s seizure began. (The cell doors at the jail are not locked.)
Hospital staff told her that she had preeclampsia, a pregnancy complication characterized by high blood pressure. Postpartum preeclampsia is rare, but can occur when a woman has high blood pressure and excess protein in her urine soon after childbirth. She was prescribed medications for preeclampsia; she never had another seizure, but continued to suffer multiple headaches each day.
Dr. Carolyn Sufrin is an assistant professor of gynecology and obstetrics at Johns Hopkins Medicine. She has also provided pregnancy-related care for women at the San Francisco County Jail. “Preeclampsia is a leading cause of maternal mortality,” she told Rewire. Delayed preeclampsia, or postpartum preeclampsia, which develops within one to two weeks after labor and delivery, is a very rare condition. The patient suffering seizures as a result of the postpartum preeclampsia is even more rare.
Postpartum preeclampsia not only needs to be treated immediately, Sufrin said, but follow-up care within a week at most is urgent. If no follow-up is provided, the patient risks having uncontrolled high blood pressure, stroke, and heart failure. Another risk, though much rarer, is the development of abnormal kidney functions.
While Sufrin has never had to treat postpartum preeclampsia in a jail setting, she stated that “the protocol if someone needs obstetrical follow-up, is to give them that follow-up. Follow through. Have continuity with the hospital. Follow their instructions.”
But that didn’t happen for Gamble, who was scheduled for a two-week follow-up visit. She says she was not brought to that appointment. It was only two months later that she finally saw a doctor, shortly before she was paroled.
As they gathered stories like Gamble’s and information for their report, advocates with the Prison Birth Project and Prisoners’ Legal Services of Massachusetts met with Rep. Kay Khan (D-Newton), to bring her attention to the lack of compliance by both county jails and the state prison system. In June 2015, Khan introduced An Act to Ensure Compliance With the Anti-Shackling Law for Pregnant Incarcerated Women (Bill H 3679) to address the concerns raised by both organizations.
The act defines the postpartum period in which a woman cannot be restrained as six weeks. It also requires annual staff trainings about the law and that, if restraints are used, that the jail or prison administration report it to the Secretary of Public Safety and Security within 48 hours. To monitor compliance, the act also includes the requirement that an annual report about all use of restraints be made to the legislature; the report will be public record. Like other statutes and bills across the country, the act does not have specific penalties for noncompliance.
In December 2015, Gamble’s son was 9 months old and Gamble had been out of jail for several months. Nonetheless, both Gamble and her mother drove to Boston to testify at a Public Safety Committee hearing, urging them to pass the bill. “I am angered, appalled, and saddened that they shackled her,” Gamble’s mother told legislators. “What my daughter faced is cruel and unusual punishment. It endangered my daughter’s life, as well as her baby.”
Though she has left the jail behind, Gamble wants to ensure that the law is followed. “Because of the pain I went through, I don’t ever want anyone to go through what I did,” she explained to Rewire. “Even though you’re in jail and you’re being punished, you still have rights. You’re a human being.”
After Maine Gov. Paul LePage made national news earlier this month by claiming to have “pocket vetoed” 19 bills that became law without his signature, messages started popping up in my inbox saying things like “An accidental win!” and “Maine—accidentally—outlaws shackling pregnant women?”
Maine Gov. Paul LePage made national news earlier this month by claiming to have “pocket vetoed” 19 bills that became law without his signature when he failed to take any action in the ten-day window to sign or veto legislation. Popping up in my inbox are messages forwarded by allies saying, “An accidental win!” and, “Maine—accidentally—outlaws shackling pregnant women?”
But positive policy change is no accident, especially when it improves conditions for people in prison or other marginalized groups—as is the case with “An Act to Prevent the Shackling of Pregnant Prisoners and Pregnant Juveniles,” one of the laws that took effect without the governor’s signature. While quirks of procedure, good timing, and other “accidents of fate” can propel legislation forward, winning takes hard work, and these new policies in Maine are no exception.
Take the anti-shackling law, which includes broad protections for pregnant women in state prisons, county jails, and youth incarceration facilities. In addition to strict limits on shackling, the law, which takes effect 90 days after the legislative session ends, respects women’s privacy by posting officers outside the hospital room when women are giving birth and promotes women’s rights by requiring that they be told about the law.
Starting last year, the ACLU of Maine reached out to find women who had been shackled during pregnancy to understand the scope of the problem in the state. They worked to get a broad range of groups on board. The Maine Choice Coalition transformed itself into the Maine Alliance for Reproductive Freedom and took on the issue as part of its new emphasis on reproductive justice, a framework that recognizes the equal importance of access to prenatal and abortion care, especially for low-income women and women of color, the very women who are most likely to be imprisoned.
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After getting legislators to introduce and co-sponsor a bill, the ACLU prepared for a hearing before the Committee on Criminal Justice and Public Safety, at which members of the Alliance—along with the Christian Civic League, the state chapter of the American Congress of Obstetricians and Gynecologists, and one very courageous woman willing to brave the stigma of being identified as a former prisoner—spoke in support of the bill. People wrote op-eds and letters to the editor. Organizations mobilized members.
The result of this hard work? The bill passed, on a voice vote in the senate and with a 101-40 vote in the house. These votes demonstrate strong support for the bill and the principles it embodies. The advocacy community fully expected the governor to veto the bill, as he had already done with scores of measures, including every bill sponsored by a Democrat, and was ready to lobby the legislature to override the veto.
The organizing in Maine has precedent in other states. Illinois led the nation by enacting the first law against shackling in 1999. Some might call that law an “accident” because of how it came about: While advocates were visiting legislators to discuss another issue of concern to pregnant women and mothers, the need for alternatives to incarceration, some women described the traumatic experiences they’d had being shackled during pregnancy and birth. A legislator decided to introduce a bill as a result of those conversations. But to call this policy victory an accident would erase the fact that Chicago Legal Advocacy for Incarcerated Mothers (CLAIM) was already up and running and had already invested in developing the leadership of formerly incarcerated women to speak out on the issues.
Or take Massachusetts. Bills to mandate minimum standards of treatment for pregnant women, including limits on shackling, had languished in the legislature for years. Then in 2014, the Boston Globe ran a front-page story about how prison officers killed a young man by using improper restraint techniques. Later that week, Gov. Deval Patrick faced a large audience of concerned advocates at a forum on criminal justice. When he acknowledged what had happened, he also said that the state would end the use of restraints on women in labor, giving the press something positive to write about.
There’s no question the timing of the news on deadly restraints and the governor’s announcement gave the campaign against shackling a boost. After all, the governor urged the legislature to send him a bill. But again, because a coalition had already formed and begun organizing, advocates were able to capitalize on the publicity and turn it into momentum. Coalition members who had experienced shackling were emboldened to speak out. Without the coalition, a bill might have passed, but without its grassroots effort and input, the final law would have been narrower in scope.
A well-run campaign does not guarantee automatic success. In California, for example, advocates managed to get unanimous votes on a bill that expanded protection against shackling in 2010, only to have Gov. Arnold Schwarzenegger veto it. The next year, they got another unanimous vote—only to have newly elected Gov. Jerry Brown veto the bill. Finally, the third time the bill passed, Gov. Brown signed it.
Activists have shown tremendous creativity and resourcefulness in their varied campaigns against shackling pregnant women. In MarylandandNew York, for example, advocates produced compelling videos; in New York, they demonstrated in front of the governor’s office. In Colorado, an investigative journalist kicked off a campaign that resulted in a law against shackling; in Washington, a lawsuit against the state Department of Corrections boosted the legislative efforts. In Maryland and Massachusetts, organizers wrote open letters and petitions to educate the public and marshal support.
By erasing the crucial work that goes into achieving better public policies, the “oops, it’s just an accident” narrative deprives organizations and coalitions of the credit and recognition they need to continue building their base and their reputation for the next challenge. This way of framing hard-won victories creates a disincentive to invest in grassroots organizing and to get involved as individuals. As the examples described here show, without advocates’ dedication, strategizing, and sweat equity, governors wouldn’t have bills to pass in the first place.