Commentary Maternity and Birthing

Can Prisons Take Care of Pregnant Women?

Rachel Roth

As the Massachusetts Legislature considers this year’s crop of criminal justice reform bills, one that has not gotten much attention is a measure to ensure proper treatment of pregnant women in jail and prison.

Cross-posted with permission from the Bay State Banner.

As the Massachusetts Legislature considers this year’s crop of criminal justice reform bills, one that has not gotten much attention is a measure to ensure proper treatment of pregnant women in jail and prison.

Improving the medical treatment and protecting the constitutional rights of these women is vitally important and would contribute to the Commonwealth’s goal of reducing health disparities, because prison policies have a disproportionate impact on poor women and African American women.

Medical neglect of incarcerated women in the United States is all too common, and can have tragic results. Prisons and jails often fail to provide adequate prenatal care, creating anxiety among pregnant women and jeopardizing birth outcomes. Corrections personnel — medical staff as well as corrections officers — fail to diagnose women with ectopic pregnancies, leading to emergency surgery and lifelong infertility.

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In some cases, the result of this negligence is the woman’s death. Similarly, personnel fail to recognize the signs of labor, leading to complications and to women giving birth locked in their cells without any assistance, let alone trained medical assistance.

These are serious problems that threaten the pregnancies, health, and lives of women who have been mandated into the state’s custody. When the government incarcerates someone, it assumes responsibility for that person’s welfare. This is a constitutional obligation as well as an ethical one.

Without explicit laws to protect women’s rights and to ensure some regular means of government oversight, women are left to fend for themselves. But the reality of incarceration severely constrains people’s ability to advocate for their interests — to gather information about medical issues, communicate with the outside world or assert their rights.

The ever-greater numbers of women in custody reinforce the need for active state oversight of gender-specific medical care to meet pregnant women’s needs.

In 1992, the year that the Massachusetts Department of Corrections agreed to a court settlement to improve conditions for pregnant women, 437 women were held at MCI-Framingham. Today, Framingham holds 684 women — almost one-third of whom are awaiting trial, half because they cannot afford even $50 bail.

Framingham operates far beyond its capacity. Women waiting to go on trial, for example, are jammed in at 381 percent percent of design capacity. Sixteen percent of these women are African American, far above their proportion in the population, which is less than seven percent.

A majority of incarcerated women has been charged with or convicted of non-violent offenses, and yet we spend more than $50,000 per year to keep each one of them behind bars.

Legislation is needed to bring corrections policies into the 21st century. For example, the 1992 agreement permits corrections personnel to restrain pregnant women. From the vantage point of 2011, this provision is out of step with evolving standards of decency. Fourteen states now have laws that limit the shackling of pregnant women, including the neighboring states of Rhode Island, Vermont and New York. Idaho and Texas, seemingly far more conservative than Massachusetts, have also enacted laws to protect pregnant women.

Over the past three years that legislatures around the country have been actively passing these bills, a consensus has also begun to emerge in the federal courts: Shackling women in labor violates their constitutional rights by subjecting them and their fetuses to a substantial risk of physical harm and by inflicting unnecessary pain and humiliation.

As a federal court of appeals explained in 2009, “The key constitutional question is whether [the pregnant woman] posed a security risk sufficient to justify being shackled to both sides of the bed while she labored to deliver her baby.”

Just this August, a federal jury awarded $200,000 to a woman in Nashville, Tenn. who had been shackled during labor.

Because shackling during pregnancy makes it difficult for doctors and nurses to provide appropriate patient care — especially in an emergency — the medical and public health community opposes the practice. Organizations that have taken a stand against shackling include the American Public Health Association, American College of Obstetricians and Gynecologists and American Medical Association.

As a mater of public policy, Massachusetts has already decided that universal access to health care is important for individuals, communities and our entire Commonwealth. Pregnancy care has long been recognized as an essential part of this investment.

Every woman deserves prenatal care to monitor her own health and to maximize the chances that she will have a healthy baby. Every woman deserves postpartum care to ensure that she recovers physically and emotionally from childbirth, and in the case of an incarcerated woman, to deal with being separated from her newborn. Every woman in labor deserves to be treated with respect and to give birth in a safe setting. And every baby deserves a safe start in life.

It is past time for our laws to provide these assurances to all women.

Analysis Law and Policy

Indiana Court of Appeals Tosses Patel Feticide Conviction, Still Defers to Junk Science

Jessica Mason Pieklo

The Indiana Court of Appeals ruled patients cannot be prosecuted for self-inducing an abortion under the feticide statute, but left open the possibility other criminal charges could apply.

The Indiana Court of Appeals on Friday vacated the feticide conviction of Purvi Patel, an Indiana woman who faced 20 years in prison for what state attorneys argued was a self-induced abortion. The good news is the court decided Patel and others in the state could not be charged and convicted for feticide after experiencing failed pregnancies. The bad news is that the court still deferred to junk science at trial that claimed Patel’s fetus was on the cusp of viability and had taken a breath outside the womb, and largely upheld Patel’s conviction of felony neglect of a dependent. This leaves the door open for similar prosecutions in the state in the future.

As Rewire previously reported, “In July 2013 … Purvi Patel sought treatment at a hospital emergency room for heavy vaginal bleeding, telling doctors she’d had a miscarriage. That set off a chain of events, which eventually led to a jury convicting Patel of one count of feticide and one count of felony neglect of a dependent in February 2015.”

To charge Patel with feticide under Indiana’s law, the state at trial was required to prove she “knowingly or intentionally” terminated her pregnancy “with an intention other than to produce a live birth or to remove a dead fetus.”

According to the Indiana Court of Appeals, attorneys for the State of Indiana failed to show the legislature had originally passed the feticide statute with the intention of criminally charging patients like Patel for terminating their own pregnancies. Patel’s case, the court said, marked an “abrupt departure” from the normal course of prosecutions under the statute.

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“This is the first case that we are aware of in which the State has used the feticide statute to prosecute a pregnant woman (or anyone else) for performing an illegal abortion, as that term is commonly understood,” the decision reads. “[T]he wording of the statute as a whole indicate[s] that the legislature intended for any criminal liability to be imposed on medical personnel, not on women who perform their own abortions,” the court continued.

“[W]e conclude that the legislature never intended the feticide statute to apply to pregnant women in the first place,” it said.

This is an important holding, because Patel was not actually the first woman Indiana prosecutors tried to jail for a failed pregnancy outcome. In 2011, state prosecutors brought an attempted feticide charge against Bei Bei Shuai, a pregnant Chinese woman suffering from depression who tried to commit suicide. She survived, but the fetus did not.

Shuai was held in prison for a year until a plea agreement was reached in her case.

The Indiana Court of Appeals did not throw out Patel’s conviction entirely, though. Instead, it vacated Patel’s second charge of Class A felony conviction of neglect of a dependent, ruling Patel should have been charged and convicted of a lower Class D felony. The court remanded the case back to the trial court with instructions to enter judgment against Patel for conviction of a Class D felony neglect of a dependent, and to re-sentence Patel accordingly to that drop in classification.

A Class D felony conviction in Indiana carries with it a sentence of six months to three years.

To support Patel’s second charge of felony neglect at trial, prosecutors needed to show that Patel took abortifacients; that she delivered a viable fetus; that said viable fetus was, in fact, born alive; and that Patel abandoned the fetus. According to the Indiana Court of Appeals, the state got close, but not all the way, to meeting this burden.

According to the Indiana Court of Appeals, the state had presented enough evidence to establish “that the baby took at least one breath and that its heart was beating after delivery and continued to beat until all of its blood had drained out of its body.”

Therefore, the Court of Appeals concluded, it was reasonable for the jury to infer that Patel knowingly neglected the fetus after delivery by failing to provide medical care after its birth. The remaining question, according to the court, was what degree of a felony Patel should have been charged with and convicted of.

That is where the State of Indiana fell short on its neglect of a dependent conviction, the court said. Attorneys had failed to sufficiently show that any medical care Patel could have provided would have resulted in the fetus surviving after birth. Without that evidence, the Indiana Court of Appeals concluded, state attorneys could not support a Class A conviction. The evidence they presented, though, could support a Class D felony conviction, the court said.

In other words, the Indiana Court of Appeals told prosecutors in the state, make sure your medical experts offer more specific testimony next time you bring a charge like the one at issue in Patel’s case.

The decision is a mixed win for reproductive rights and justice advocates. The ruling from the court that the feticide statute cannot be used to prosecute patients for terminating their own pregnancy is an important victory, especially in a state that has sought not just to curb access to abortion, but to eradicate family planning and reproductive health services almost entirely. Friday’s decision made it clear to prosecutors that they cannot rely on the state’s feticide statute to punish patients who turn to desperate measures to end their pregnancies. This is a critical pushback against the full-scale erosion of reproductive rights and autonomy in the state.

But the fact remains that at both trial and appeal, the court and jury largely accepted the conclusions of the state’s medical experts that Patel delivered a live baby that, at least for a moment, was capable of survival outside the womb. And that is troubling. The state’s experts offered these conclusions, despite existing contradictions on key points of evidence such as the gestational age of the fetus—and thus if it was viable—and whether or not the fetus displayed evidence of life when it was born.

Patel’s attorneys tried, unsuccessfully, to rebut those conclusions. For example, the state’s medical expert used the “lung float test,” also known as the hydrostatic test, to conclude Patel’s fetus had taken a breath outside the womb. The test, developed in the 17th century, posits that if a fetus’ lungs are removed and placed in a container of liquid and the lungs float, it means the fetus drew at least one breath of air before dying. If the lungs sink, the theory holds, the fetus did not take a breath.

Not surprisingly, medical forensics has advanced since the 17th century, and medical researchers widely question the hydrostatic test’s reliability. Yet this is the only medical evidence the state presented of live birth.

Ultimately, the fact that the jury decided to accept the conclusions of the state’s experts over Patel’s is itself not shocking. Weighing the evidence and coming to a conclusion of guilt or innocence based on that evidence is what juries do. But it does suggest that when women of color are dragged before a court for a failed pregnancy, they will rarely, if ever, get the benefit of the doubt.

The jurors could have just as easily believed the evidence put forward by Patel’s attorneys that gestational age, and thus viability, was in doubt, but they didn’t. The jurors could have just as easily concluded the state’s medical testimony that the fetus took “at least one breath” was not sufficient to support convicting Patel of a felony and sending her to prison for 20 years. But they didn’t.

Why was the State of Indiana so intent on criminally prosecuting Patel, despite the many glaring weaknesses in the case against her? Why were the jurors so willing to take the State of Indiana’s word over Patel’s when presented with those weaknesses? And why did it take them less than five hours to convict her?

Patel was ordered in March to serve 20 years in prison for her conviction. Friday’s decision upends that; Patel now faces a sentence of six months to three years. She’s been in jail serving her 20 year sentence since February 2015 while her appeal moved forward. If there’s real justice in this case, Patel will be released immediately.

News Law and Policy

Texas Could Be Next to Give Police Hate Crime Protections

Teddy Wilson

Police officers have shot and killed 165 people in Texas since the start of 2015. Of those, 35 were Black men, 12 of whom were unarmed. There were 2 officers killed by firearms in Texas in 2015.

Texas Gov. Greg Abbott (R) announced Monday that he would ask the state legislature to pass a law classifying acts of violence committed against law enforcement officers as hate crimes, mimicking a similar measure passed by Louisiana lawmaker.

Abbott said in a statement that the proposal is intended to send a message.

“At a time when law enforcement officers increasingly come under assault simply because of the job they hold, Texas must send a resolute message that the State will stand by the men and women who serve and protect our communities,” Abbott said.

Abbott will ask the GOP-held Texas legislature to pass the Police Protection Act during the upcoming 2017 legislative session, which convenes in January. The proposal would extend hate crime protections to law enforcement officers.

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Abbott’s proposal would increase criminal penalties for any crime against a law enforcement officer, regardless of whether or not the crime qualifies as a hate crime. The proposal would create a campaign to “educate young Texans on the value law enforcement officers bring to their communities.”

Abbott’s proposal comes in the wake of a shooting in Dallas that left five police officers dead, and six others injured. Micah Xavier Johnson targeted police officers during a peaceful Black Lives Matter protest, before he was killed by law enforcement.  

Police officers killed at least 1,146 people in the United States in 2015, according to the Guardian’s database The Counted. Police officers have shot and killed 165 people in Texas since the start of 2015. Of those, 35 were Black men, 12 of whom were unarmed, according to the Guardian’s database. There were two officers killed by gunfire in Texas in 2015, according to the National Law Enforcement Officers Memorial Fund (NLEOMF).

Police in Texas have shot and killed 53 people so far in 2016, per the Guardian‘s database.

The Dallas shooting increased the urgency of calls to increase the penalties for violence against law enforcement.

U.S. Sen. John Cornyn (R-TX) introduced similar legislation in Congress, designed to make killing a police officer a federal crime. Cornyn said in a statement that police officers protect communities and deserve “unparalleled support.”

Louisiana Gov. John Bel Edwards (D) in May signed into law the so-called Blue Lives Matter bill, which amended the state’s hate crime law to include acts of violence against any “law enforcement officer, firefighter, or emergency medical services personnel.”

Proponents of laws creating more penalties for crimes against law enforcement claim these measures are needed because of a growing threat of targeted violence against law enforcement. Data shows that violence against law enforcement has declined to historically low levels, while killings of civilians by police officers have risen dramatically.

Violent attacks on law enforcement officers are lower under President Obama than they have been under the previous four presidential administrations, according to the Washington Post’s analysis of data from the Officers Down Memorial Page.

During the Reagan presidency, there was an average of 101 law enforcement officers intentionally killed per year; during the George H.W. Bush administration, there was an average of 90 police killed per year; during the Clinton years, there was an average of 81 police killings annually; and during George W. Bush’s presidency, there was an average of 72 police killings via stabbings, gunfire, bombings, and vehicular assault per year.

There have been an average of 62 law enforcement officers killed annually during Obama’s seven and a half years in the White House.

The number of Texans who died during the course of an arrest almost doubled from 2005 to 2015, according to an analysis of state data by the Dallas Morning News. The increase in deaths coincided with a 20 percent reduction in the number of arrests statewide.

Matt Simpson, a policy strategist at the ACLU of Texas, told the Dallas Morning News that the number of deaths during arrests in Texas add to the evidence of systemic racism within the justice system.

“We have pretty strong evidence in a variety of ways that the criminal justice system is disproportionate,” Simpson said. “These numbers are unfortunately stark reminders.”