A San Antonio Navy veteran who is 24 weeks pregnant says she has been denied the medically necessary methadone treatment she needs to maintain a healthy pregnancy while she is incarcerated in Texas’ Guadalupe County Jail due to a parole violation for past drug charges resulting from her attempts to self-medicate from heroin withdrawal.
According to legal documents provided to Rewire by the pregnancy rights watchdog group National Advocates for Pregnant Women (NAPW), 30-year-old Jessica De Samito suffers from post-traumatic stress disorder and an anxiety disorder. She was charged and convicted with possession of a controlled substance in May 2011 and was released on parole in February.
Shortly thereafter, De Samito became pregnant and began attempting to self-medicate with methadone and heroin to prevent withdrawal while trying to find and enroll in a nearby methadone maintenance treatment (MMT) program; as a result, she failed a drug test before she was able to enroll in an official methadone treatment program in mid-June. She once again faced incarceration, this time while six months pregnant.
At a parole revocation hearing on Monday, De Samito submitted evidence showing her need for continued MMT, but the parole board told her it would need to take two to three weeks to consider her plea.
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Without the continuation of her MMT, De Samito’s pregnancy is likely to end in stillbirth.
“No woman should be denied health care and she certainly shouldn’t be threatened with stillbirth,” Kylee Sunderlin, Soros Justice Fellow at NAPW, told Rewire. Sunderlin filed an affadavit on De Samito’s behalf in advance of her re-incarceration, arguing that denying De Samito her MMT would violate De Samito’s constitutional rights as well as the Texas Prenatal Protection Act, which mandates criminal charges for third parties that cause injury or death to an unborn child.
Guadalupe County Jail officials confirmed to Rewire that De Samito was being held in their facility, while Sunderlin said that the Guadalupe County Jail’s nursing department told her it “requires detoxification” for inmates.
De Samito contacted NAPW asking for their assistance in the weeks before her parole revocation hearing on July 7, anticipating that Guadalupe County would deny her methadone therapy.
“[De Samito] was just doing everything she could to find help beforehand,” said Sunderlin.
Medical experts agree that MMT is not only safe for pregnant people who face opioid addiction, but necessary to maintain healthy pregnancies. According to one methadone treatment expert who submitted an affidavit in support of De Samito during her parole revocation hearing, without MMT, “the survival of the fetus is at substantial risk,” and “it is universally recognized that for the fetus, opioid withdrawal can cause death.”
NAPW is asking people who’d like to help De Samito to tweet about her situation using the #JusticeForJessica hashtag, and to telephone the Guadalupe County Jail to demand De Samito get the treatment she needs to sustain her pregnancy. De Samito has now been incarcerated for 48 hours and is already seeing the initial signs of opioid withdrawal, according to NAPW. She has once received half of the normal dosage she needs to protect her baby.
De Samito’s situation is not without precedent, according to Sunderlin.
“Prisons and jails deny people proper medical treatment all the time, especially women,” she said, citing a 2009 case in Montana, where a jail refused to provide MMT, resulting in a settlement agreement ensuring that pregnant inmates with opioid dependency get the treatment they need.
While legal experts can debate whether or not Guadalupe County has the legal ability to withhold methadone treatment from De Samito without violating her constitutional rights or Texas law, the medical reality, according to expert testimony and decades of evidence-based research, is that without the methadone therapy, the baby De Samito is expecting—which she has named Alice—is at serious risk of not surviving.
Clarification: This article has been updated to reflect Kylee Sunderlin’s full fellowship title. It also now clarifies that the baby De Samito is expecting is at serious risk of not surviving (rather than “will almost certainly not survive”).
Donald Trump's running mate has said that "life is winning in Indiana"—and the biggest winner is probably a chain of crisis pregnancy centers that landed a $3.5 million contract in funds originally intended for poor Hoosiers.
Much has been made of Republican Gov. Mike Pence’s record on LGBTQ issues. In 2000, when he was running for U.S. representative, Pence wrote that “Congress should oppose any effort to recognize homosexual’s [sic] as a ‘discreet and insular minority’ [sic] entitled to the protection of anti-discrimination laws similar to those extended to women and ethnic minorities.” He also said that funds meant to help people living with HIV or AIDS should no longer be given to organizations that provide HIV prevention services because they “celebrate and encourage” homosexual activity. Instead, he proposed redirecting those funds to anti-LGBTQ “conversion therapy” programs, which have been widely discredited by the medical community as being ineffective and dangerous.
Under Pence, ideology has replaced evidence in many areas of public life. In fact, Republican presidential nominee Donald Trump has just hired a running mate who, in the past year, has reallocated millions of dollars in public funds intended to provide food and health care for needy families to anti-choice crisis pregnancy centers.
Gov. Pence, who declined multiple requests for an interview with Rewire, has been outspoken about his anti-choice agenda. Currently, Indiana law requires people seeking abortions to receive in-person “counseling” and written information from a physician or other health-care provider 18 hours before the abortion begins. And thanks, in part, to other restrictive laws making it more difficult for clinics to operate, there are currently six abortion providers in Indiana, and none in the northern part of the state. Only four of Indiana’s 92 counties have an abortion provider. All this means that many people in need of abortion care are forced to take significant time off work, arrange child care, and possibly pay for a place to stay overnight in order to obtain it.
This environment is why a contract quietly signed by Pence last fall with the crisis pregnancy center umbrella organization Real Alternatives is so potentially dangerous for Indiana residents seeking abortion: State-subsidized crisis pregnancy centers not only don’t provide abortion but seek to persuade people out of seeking abortion, thus limiting their options.
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“Indiana is committed to the health, safety, and wellbeing [sic] of Hoosier families, women, and children,” reads the first line of the contract between the Indiana State Department of Health and Real Alternatives. The contract, which began on October 1, 2015, allocates $3.5 million over the course of a year for Real Alternatives to use to fund crisis pregnancy centers throughout the state.
Where Funding Comes From
The money for the Real Alternatives contract comes from Indiana’s Temporary Assistance for Needy Families (TANF) block grant, a federally funded, state-run program meant to support the most vulnerable households with children. The program was created by the 1996 Personal Responsibility and Work Opportunity Reconciliation Act signed by former President Bill Clinton. It changed welfare from a federal program that gave money directly to needy families to one that gave money, and a lot of flexibility with how to use it, to the states.
This TANF block grant is supposed to provide low-income families a monthly cash stipend that can be used for rent, child care, and food. But states have wide discretion over these funds: In general, they must use the money to serve families with children, but they can also fund programs meant, for example, to promote marriage. They can also make changes to the requirements for fund eligibility.
As of 2012, to be eligible for cash assistance in Indiana, a household’s maximum monthly earnings could not exceed $377, the fourth-lowest level of qualification of all 50 states, according to a report by the Congressional Research Service. Indiana’s program also has some of the lowest maximum payouts to recipients in the country.
Part of this is due to a 2011 work requirement that stripped eligibility from many families. Under the new work requirement, a parent or caretaker receiving assistance needs to be “engaged in work once the State determines the parent or caretaker is ready to engage in work,” or after 24 months of receiving benefits. The maximum time allowed federally for a family to receive assistance is 60 months.
“There was a TANF policy change effective November 2011 that required an up-front job search to be completed at the point of application before we would proceed in authorizing TANF benefits,” Jim Gavin, a spokesman for the state’s Family and Social Services Administration (FSSA), told Rewire. “Most [applicants] did not complete the required job search and thus applications were denied.”
Unspent money from the block grant can be carried over to following years. Indiana receives an annual block grant of $206,799,109, but the state hasn’t been using all of it thanks to those low payouts and strict eligibility requirements. The budget for the Real Alternatives contract comes from these carry-over funds.
According to the U.S. Department of Health and Human Services, TANF is explicitly meant to clothe and feed children, or to create programs that help prevent “non-marital childbearing,” and Indiana’s contract with Real Alternatives does neither. The contract stipulates that Real Alternatives and its subcontractors must “actively promote childbirth instead of abortion.” The funds, the contract says, cannot be used for organizations that will refer clients to abortion providers or promote contraceptives as a way to avoid unplanned pregnancies and sexually transmitted infections.
Parties involved in the contract defended it to Rewire by saying they provide material goods to expecting and new parents, but Rewire obtained documents that showed a much different reality.
Real Alternatives is an anti-choice organization run by Kevin Bagatta, a Pennsylvania lawyer who has no known professional experience with medical or mental health services. It helps open, finance, and refer clients to crisis pregnancy centers. The program started in Pennsylvania, where it received a $30 million, five-year grant to support a network of 40 subcontracting crisis pregnancy centers. Auditor General Eugene DePasquale called for an audit of the organization between June 2012 and June 2015 after hearing reports of mismanaged funds, and found $485,000 in inappropriate billing. According to the audit, Real Alternatives would not permit DHS to review how the organization used those funds. However, the Pittsburgh Post-Gazettereported in April that at least some of the money appears to have been designated for programs outside the state.
Real Alternatives also received an $800,000 contract in Michigan, which inspired Gov. Pence to fund a $1 million yearlong pilot program in northern Indiana in the fall of 2014.
“The widespread success [of the pilot program] and large demand for these services led to the statewide expansion of the program,” reads the current $3.5 million contract. It is unclear what measures the state used to define “success.”
“Every Other Baby … Starts With Women’s Care Center”
Real Alternatives has 18 subcontracting centers in Indiana; 15 of them are owned by Women’s Care Center, a chain of crisis pregnancy centers. According to its website, Women’s Care Center serves 25,000 women annually in 23 centers throughout Florida, Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin.
Women’s Care Centers in Indiana received 18 percent of their operating budget from state’s Real Alternatives program during the pilot year, October 1, 2014 through September 30, 2015, which were mostly reimbursements for counseling and classes throughout pregnancy, rather than goods and services for new parents.
In fact, instead of the dispensation of diapers and food, “the primary purpose of the [Real Alternatives] program is to provide core services consisting of information, sharing education, and counseling that promotes childbirth and assists pregnant women in their decision regarding adoption or parenting,” the most recent contract reads.
The program’s reimbursement system prioritizes these anti-choice classes and counseling sessions: The more they bill for, the more likely they are to get more funding and thus open more clinics.
“This performance driven [sic] reimbursement system rewards vendor service providers who take their program reimbursement and reinvest in their services by opening more centers and hiring more counselors to serve more women in need,” reads the contract.
Classes, which are billed as chastity classes, parenting classes, pregnancy classes, and childbirth classes, are reimbursed at $21.80 per client. Meanwhile, as per the most recent contract, counseling sessions, which are separate from the classes, are reimbursed by the state at minimum rates of $1.09 per minute.
Jenny Hunsberger, vice president of Women’s Care Center, told Rewire that half of all pregnant women in Elkhart, LaPorte, Marshall, and St. Joseph Counties, and one in four pregnant women in Allen County, are clients of their centers. To receive any material goods, such as diapers, food, and clothing, she said, all clients must receive this counseling, at no cost to them. Such counseling is billed by the minute for reimbursement.
“When every other baby born [in those counties] starts with Women’s Care Center, that’s a lot of minutes,” Hunsberger told Rewire.
Rewire was unable to verify exactly what is said in those counseling sessions, except that they are meant to encourage clients to carry their pregnancies to term and to help them decide between adoption or child rearing, according to Hunsberger. As mandated by the contract, both counseling and classes must “provide abstinence education as the best and only method of avoiding unplanned pregnancies and sexually transmitted infections.”
In the first quarter of the new contract alone, Women’s Care Center billed Real Alternatives and, in turn, the state, $239,290.97; about $150,000 of that was for counseling, according to documents obtained by Rewire. In contrast, goods like food, diapers, and other essentials for new parents made up only about 18.5 percent of Women’s Care Center’s first-quarter reimbursements.
Despite the fact that the state is paying for counseling at Women’s Care Center, Rewire was unable to find any licensing for counselors affiliated with the centers. Hunsberger told Rewire that counseling assistants and counselors complete a minimum training of 200 hours overseen by a master’s level counselor, but the counselors and assistants do not all have social work or psychology degrees. Hunsberger wrote in an email to Rewire that “a typical Women’s Care Center is staffed with one or more highly skilled counselors, MSW or equivalent.”
Rewire followed up for more information regarding what “typical” or “equivalent” meant, but Hunsberger declined to answer. A search for licenses for the known counselors at Women’s Care Center’s Indiana locations turned up nothing. The Indiana State Department of Health told Rewire that it does not monitor or regulate the staff at Real Alternatives’ subcontractors, and both Women’s Care Center and Real Alternatives were uncooperative when asked for more information regarding their counseling staff and training.
Bethany Christian Services and Heartline Pregnancy Center, Real Alternatives’ other Indiana subcontractors, billed the program $380.41 and $404.39 respectively in the first quarter. They billed only for counseling sessions, and not goods or classes.
“We don’t provide medical services. We provide human services,” Bagatta told the City Paper.
There are pregnancy centers in Indiana that provide a full range of referrals for reproductive health care, including for STI testing and abortion. However, they are not eligible for reimbursement under the Real Alternatives contract because they do not maintain an anti-choice mission.
Parker Dockray is the executive director of Backline, an all-options pregnancy resource center. She told Rewire that Backline serves hundreds of Indiana residents each month, and is overwhelmed by demand for diapers and other goods, but it is ineligible for the funding because it will refer women to abortion providers if they choose not to carry a pregnancy to term.
“At a time when so many Hoosier families are struggling to make ends meet, it is irresponsible for the state to divert funds intended to support low-income women and children and give it to organizations that provide biased pregnancy counseling,” Dockray told Rewire. “We wish that Indiana would use this funding to truly support families by providing job training, child care, and other safety net services, rather than using it to promote an anti-abortion agenda.”
“Life Is Winning in Indiana”
Time and again, Bagatta and Hunsberger stressed to Rewire that their organizations do not employ deceitful tactics to get women in the door and to convince them not to have abortions. However, multiple studies have proven that crisis pregnancy centers often lie to women from the moment they search online for an abortion provider through the end of their appointments inside the center.
These studies have also shown that publicly funded crisis pregnancy centers dispense medically inaccurate information to clients. In addition to spreading lies like abortion causing infertility or breast cancer, they are known to give false hopes of miscarriages to people who are pregnant and don’t want to be. A 2015 report by NARAL Pro-Choice America found this practice to be ubiquitous in centers throughout the United States, and Rewire found that Women’s Care Center is no exception. The organization’s website says that as many as 40 percent of pregnancies end in natural miscarriage. While early pregnancy loss is common, it occurs in about 10 percent of known pregnancies, according to the American Congress of Obstetricians and Gynecologists.
Crisis pregnancy centers also tend to crop up next to abortion clinics with flashy, deceitful signs that lead many to mistakenly walk into the wrong building. Once inside, clients are encouraged not to have an abortion.
A Google search for “abortion” and “Indianapolis” turns up an ad for the Women’s Care Center as the first result. It reads: “Abortion – Indianapolis – Free Ultrasound before Abortion. Located on 86th and Georgetown. We’re Here to Help – Call Us Today: Abortion, Ultrasound, Locations, Pregnancy.”
Hunsberger denies any deceit on the part of Women’s Care Center.
“Clients who walk in the wrong door are informed that we are not the abortion clinic and that we do not provide abortions,” Hunsberger told Rewire. “Often a woman will choose to stay or return because we provide services that she feels will help her make the best decision for her, including free medical-grade pregnancy tests and ultrasounds which help determine viability and gestational age.”
Planned Parenthood of Indiana and Kentucky told Rewire that since Women’s Care Center opened on 86th and Georgetown in Indianapolis, many patients looking for its Georgetown Health Center have walked through the “wrong door.”
“We have had patients miss appointments because they went into their building and were kept there so long they missed their scheduled time,” Judi Morrison, vice president of marketing and education, told Rewire.
Sarah Bardol, director of Women’s Care Center’s Indianapolis clinic, told the Criterion Online Edition, a publication of the Archdiocese of Indianapolis, that the first day the center was open, a woman and her boyfriend did walk into the “wrong door” hoping to have an abortion.
“The staff of the new Women’s Care Center in Indianapolis, located just yards from the largest abortion provider in the state, hopes for many such ‘wrong-door’ incidents as they seek to help women choose life for their unborn babies,” reported the Criterion Online Edition.
If they submit to counseling, Hoosiers who walk into the “wrong door” and “choose life” can receive up to about $40 in goods over the course their pregnancy and the first year of that child’s life. Perhaps several years ago they may have been eligible for Temporary Assistance for Needy Families, but now with the work requirement, they may not qualify.
In a February 2016 interview with National Right to Life, one of the nation’s most prominent anti-choice groups, Gov. Pence said, “Life is winning in Indiana.” Though Pence was referring to the Real Alternatives contract, and the wave of anti-choice legislation sweeping through the state, it’s not clear what “life is winning” actually means. The state’s opioid epidemic claimed 1,172 lives in 2014, a statistically significant increase from the previous year, according to the Centers for Disease Control and Prevention. HIV infections have spread dramatically throughout the state, in part because of Pence’s unwillingness to support medically sound prevention practices. Indiana’s infant mortality rate is above the national average, and infant mortality among Black babies is even higher. And Pence has reduced access to prevention services such as those offered by Planned Parenthood through budget cuts and unnecessary regulations—while increasing spending on anti-choice crisis pregnancy centers.
Gov. Pence’s track record shows that these policies are no mistake. The medical and financial needs of his most vulnerable constituents have taken a backseat to religious ideology throughout his time in office. He has literally reallocated money for poor Hoosiers to fund anti-choice organizations. In his tenure as both a congressman and a governor, he’s proven that whether on a national or state level, he’s willing to put “pro-life” over quality-of-life for his constituents.
Although feticide laws were originally intended to protect pregnant women from violence, such statutes are now being used to punish them, sending the message that women who do not have healthy pregnancies may be investigated for criminal acts.
In America’s heartland, Purvi Patel, a 33-year-old Indian American, is in the midst of a criminal trial. Last July, Patel went to an emergency room in South Bend, Indiana, to seek assistance for heavy vaginal bleeding. According to court documents, Patel told her doctors she had miscarried, believed the fetus was not alive, and placed it in a bag in the dumpster. A few hours after she underwent medical treatment, local police arrived to interrogate her; after investigating further, they found text messages indicating that Patel may have ordered drugs to terminate the pregnancy. A toxicologist testified at the trial this week that no record of these or other drugs was found in Patel’s blood samples. Even so, the State of Indiana has decided to charge Patel with feticide and neglect of a dependent. If convicted of both charges, she could face a maximum sentence of up to 70 years.
This is not the first time Indiana prosecutors have charged a woman of color—or an Asian-American woman—under the state’s feticide law, which is defined as intentionally ending a pregnancy. In 2011, state prosecutors brought similar charges against Bei Bei Shuai, a pregnant Chinese woman suffering from depression who had tried to commit suicide. She survived, but the fetus did not. Instead of assisting Shuai with mental health counseling and social services, the state charged her with attempted feticide and held her in prison for a year until a plea agreement was reached.
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These two cases in Indiana should ring alarm bells for all those committed to racial and reproductive justice. Although feticide laws were originally intended to protect pregnant women from violence, such statutes are now being used to punish them, sending the message that women who do not have healthy pregnancies may be investigated for criminal acts. They also have a disproportionate impact on women of color like Shuai and Patel, who often cannot access medical care, counseling, and other resources.
In Patel’s case, the state seems to be using the law to prosecute her for allegedly having an illegal abortion. In Indiana, abortion access is already extremely limited: There are only 12 abortion providers in the entire state, only four cities in Indiana have abortion clinics, and women must submit to counseling, an 18-hour waiting period, and two separate visits to obtain an abortion. Furthermore, Asian-American women in the state are increasingly at risk for additional restrictive policies. In fact, advocates expect to see an anti-Asian sex-selective abortion ban come up for debate this year in the state. The application of the feticide law in Patel’s case indicates that the state may be using it as a backdoor attempt to criminalize decisions women make during their pregnancies.
Advocates have been raising awareness about the impact of this trial on Patel and all women in Indiana. Members of the Indiana Religious Coalition for Reproductive Justice (IRCRJ), who have been attending Purvi Patel’s trial this week in South Bend, have expressed their concerns about the nature of the prosecution’s evidence and line of questioning, the psychological toll that the trial is taking on Patel and her family, and the state’s misplaced priorities when it comes to keeping its residents safe and healthy.
“Indiana can do much better,” Sue Ellen Braunlin, co-president of IRCRJ, told Rewire. “Expanding access to preventive health care, recognizing the effects of poverty, racism, and the environment, and legislation based on public health instead of on morality and religion would decrease the suffering and deaths of both infants and women in Indiana.”
National Advocates for Pregnant Women (NAPW) has also outlined the various risks to public health and constitutional violations of prosecuting pregnant women. Unfortunately, Judge Elizabeth C. Hurley, who is presiding over Patel’s trial, denied NAPW’s motion to submit an amicus brief to demonstrate these risks.
Purvi Patel’s case is an example of law enforcement and state prosecutors putting pregnancy on trial, and it foreshadows what’s in store for all women should Roe v. Wade be overturned. This legislation isn’t limited to Indiana—37 other states have passed similar laws, opening the door for more unjust treatment of pregnant women. It’s time for us to hold state lawmakers and law enforcers accountable to the lives and rights of all women.
CORRECTION: This piece has been updated to clarify the maximum sentence Patel could face if convicted of both charges. We regret the error.