News Human Rights

ACLU Report: California Jails Denying Reproductive Health Care

Nicole Knight Shine

Interviews with one jail administrator indicated that jail staff would encourage women with multiple children or those with chemical dependencies to have an abortion.

Incarcerated California women are denied abortion services, prenatal care, and even menstrual pads, according to a scathing American Civil Liberties Union (ACLU) of California report released Tuesday that finds some county jails deny, delay, and ignore prisoners’ reproductive health care.

The 36-page report—the product of jailhouse interviews, a review of complaints and jail policies, and public records requests at five county jails—issues a sweeping call for reform of practices that the organization says jeopardize the reproductive health of incarcerated people.

“Jails are putting people’s health at risk by denying, delaying, and ignoring crucial reproductive health care,” Melissa Goodman, one of the report’s authors and director of the LGBTQ, Gender & Reproductive Justice Project at the ACLU of Southern California, told Rewire in an interview. A jail has “a legal obligation to provide medical care to the people it incarcerates, but sadly that often ignores reproductive health,” Goodman continued.

Two years in the making, the report identifies coercive practices, such as forced pregnancy tests, and wide-ranging problems in timely, lawful access to reproductive health care, including:

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  • Delayed and denied abortion access: Some county jails draw inappropriate distinctions between “elective” and “medically necessary” abortions, and others even have illegal policies against “elective” termination procedures. One county’s policy required a mental health clearance before a woman could obtain an abortion. One woman interviewed by the ACLU had to wait two months for an abortion, despite repeated requests. The jail told her she had to prove she could pay for the procedure before she could get it, she said, which is illegal.
  • Influencing abortion access: Interviews with one jail administrator indicated that jail staff would encourage certain women—those with multiple children or those with chemical dependencies—to have an abortion.
  • Dangerous conditions for pregnant inmates: Pregnant inmates were denied prenatal and emergency visits with medical staff and were shackled while pregnant, a practice California outlawed in 2012. One pregnant woman, suffering intense abdominal pain, was seen at a jail clinic, where nurses failed to find a fetal heartbeat. The woman, who was sent back to her cell because an OB-GYN wasn’t available to perform an ultrasound, said, “I was really scared because I didn’t know what was going on and I started getting more depressed as time went by because I didn’t know if my baby was alive or dead.”
  • Lack of accommodations for nursing inmates: Most lactating parents were unable to pump breast milk or provide it to their child. One nursing woman reported that her infant developed bronchitis because the jail wouldn’t let her pump milk for the child. Lactation is subject to a confusing mishmash of policies. One county assessed in the report allows postpartum women with less than two weeks on their sentence to pump milk in order to maintain lactation, but women with more than two weeks left on their sentence are not allowed to pump. These women are instead taught to “suppress lactation” and given a tight bra to minimize discomfort from engorged breasts.
  • Shortage of menstrual supplies: Many jails’ supplies of menstrual pads are insufficient. One former inmate reported that in one jail’s solitary confinement, people were not given any sanitary products and were forced to bleed on the floor.
  • Lack of safeguards for LGBTQ people: The vast majority of transgender women are still automatically placed in male housing locations despite the serious safety risks, violence, and increased isolation they encounter there.
  • Poor tracking of sexual assault: Two of the five counties surveyed did not track the number of people who had experienced sexual assault in custody.

The report calls for a variety of reforms, such as new reproductive health care and sexual assault policies based on medical best practices, and ones that address the transgender community.

The report urges the abolition of jailhouse policies that limit reproductive health care to cisgender women, or women whose gender identity matches their biological sex at birth. Other recommendations include addressing the fact that incarcerated transgender women are at a heightened risk for sexual assault, and providing menstruation pads to all people who need them, regardless of gender identity or whether the person is housed in a men’s or women’s jail.

To accompany the report, Goodman said the ACLU has released a tool, which includes model policy language, to help jails enact and follow policies in keeping with state law and medical standards.

“At the end of the day, the message we have for jails is reform is important, legally necessary, and feasible,” Goodman said, citing reforms enacted in Los Angeles County jails following a 2012 analysis by the ACLU. She said these jails made widespread reforms and now allow family members to pick up pumped breast milk, and are considering a doula program.

News Health Systems

ACLU Sues for Complaints Filed Against Catholic Hospitals Denying Reproductive Care

Nicole Knight Shine

A 2012 federal investigation of the Catholic-run St. John Hospital in Detroit found the hospital violated federal law by discharging a miscarrying patient who lost seven pints of blood while the facility refused for six hours to allow an emergency abortion because fetal tones were present.

The American Civil Liberties Union (ACLU) is demanding the federal Centers for Medicare & Medicaid Services (CMS) release complaints against federally funded Catholic hospitals, where patients report being denied emergency medical care in violation of federal law.

In a Freedom of Information Act suit filed Tuesday, the ACLU asked a federal court to force the CMS to hand over complaints alleging violations of the Emergency Medical Treatment and Active Labor Act. CMS is charged with fielding complaints and investigating violations of the law, which requires federally funded hospitals to provide patients with the care required to stabilize a medical condition, such as a miscarriage.

A CMS spokesperson told Rewire in an email the agency does not comment on pending litigation.

Roughly one in six hospital beds are in a Catholic facility, with the top four U.S. Catholic health systems expected to take in more $90 billion from Medicare and Medicaid in 2016, according to the ACLU’s 10-page lawsuit filed in U.S. District Court for the Southern District of New York.

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Catholic hospitals follow religious directives, written by the United States Conference of Catholic Bishops, that forbid doctors at Catholic facilities from performing abortions unless the patient is in grave condition, among other restrictions.

“We’ve heard heartbreaking stories from women who rushed to a Catholic hospital in an emergency but were turned away because the hospital let religious rules written by bishops dictate what medical care could be provided,” said ACLU Senior Staff Attorney Brigitte Amiri in an emailed statement.

ACLU officials believe CMS is privy to a “number of complaints” alleging federal violations, according to the court filing. Amiri told Rewire in an email that the goal of the suit is to find out how many.

The lawsuit cites a series of complaints filed by patients who said they were denied emergency care for miscarriage in Catholic facilities. In one account, the hospital discharged a miscarrying patient, who later underwent emergency abortion care and treatment for major blood loss at another facility.

In another account, a woman miscarried alone on the toilet, after a Catholic hospital gave her Tylenol to treat a potentially deadly pregnancy-related infection and sent her home twice.

“It is crucial,” the court filing states, “that the requested documents are disclosed so that the public can ascertain whether hospitals receiving federal funds are violating federal laws designed to protect patient health and safety.”

ACLU filed its Freedom of Information Act request with CMS in 2014, but said it received no meaningful response. The ACLU requested, in part, five years of documents “relating to allegations of improper care, violations of [EMTALA], and violations of [CMS] regulation related to pregnancy-related treatment, including, but not limited to, treatment for miscarriage, abortion, and sterilization at hospitals receiving federal funds.”

CMS handed over a batch of documents as a response to the ACLU’s request. But the ACLU argues in its filing that the documents included no complaints related to miscarriage or abortion care.

Amiri told Rewire via email that the ACLU knows of specific miscarriage-related complaints that CMS failed to turn over.

In a statement announcing the lawsuit, the ACLU said it has used complaints to take legal action against Catholic providers, including a lawsuit filed against Trinity Health, the second largest Catholic hospital system in the country.

“With one in six hospital beds in facilities that are bound by the Catholic Directives, we expect there are more stories that will come to the surface,” Amiri told Rewire.

CMS in its own investigations has turned up wrongdoing on the part of Catholic hospitals, according to the ACLU court filing.

A 2012 investigation by CMS of the Catholic-run St. John Hospital in Detroit found the hospital violated federal law by discharging a miscarrying patient who lost seven pints of blood while the facility refused for six hours to allow an emergency termination because fetal tones were present. A family member drove the patient to another facility for an emergency abortion.

Responding to the investigation, a St. John Hospital staff member told CMS: “We are a Catholic institution and we do not perform abortions here if there are fetal heart tones.”

The court filing doesn’t say whether the hospital was sanctioned for violating the law.

Tuesday’s lawsuit is one of many the ACLU has filed over Catholic directives.

California’s largest medical association announced last month that it will join an ACLU lawsuit against the the state’s largest hospital system, Dignity Health, for using religious directives to deny basic reproductive health care to patients. A court hearing is expected Wednesday.

News Human Rights

Missouri Senate Approves Anti-Shackling Measure as a Former Inmate Sues County Jail

Kanya D’Almeida

“The vast majority of Missouri's pregnant offenders are nonviolent and pose no risk of flight or danger to others, especially during labor," said state Sen. Jamilah Nasheed.

The Missouri Senate on Wednesday unanimously approved a bill that would prohibit the shackling of pregnant prisoners in “many cases.” The measure comes on the heels of a lawsuit filed by the American Civil Liberties Union (ACLU) on behalf of a former inmate at a Missouri county jail who claims she was shackled, chained, and transported hundreds of miles while in labor with a high-risk pregnancy.

SB 618 is now before the house. It bans the use of restraints on offenders in the custody of the Missouri Department of Corrections who are in their second and third trimesters of pregnancy, and for 48 hours post-delivery. There are exceptions for when a doctor deems the person to be a flight risk or a serious threat to themselves, or to correctional or medical personnel.

The bill defines restraints as handcuffs, chains, leg irons, or straitjackets, and provides for a complete ban on leg and waist restraints on pregnant and postpartum people. It further stipulates that correction centers must inform inmates about laws governing the use of restraints, and train their staff accordingly.

State Sen. Jamilah Nasheed (D-St. Louis), who added an amendment putting incarcerated women on the bill, which was originally intended to limit the shackling of juveniles, said Wednesday, according to a report in the Southeast Missourian: “The shackling of pregnant women is a human rights issue. The use of restraints during labor has resulted in a wide range of injuries, from falls to loss of fertility.”

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Organizations including the National Advocates for Pregnant Women, the American College of Obstetricians and Gynecologists, and the ACLU have also warned that shackling can cause serious harm to the pregnant person and the fetus, and can increase the risk of miscarriage.

Nasheed added, “The vast majority of Missouri’s pregnant offenders are nonviolent and pose no risk of flight or danger to others, especially during labor.”

At the same time the Missouri legislature is deciding whether or not to put restrictions on the practice of shackling pregnant people, the ACLU has charged multiple employees at the Mississippi County Detention Center (MCDC) with violating plaintiff Tara Rhodes’ Eighth Amendment constitutional rights; battery; and intentional infliction of emotional distress.

According to the complaint, filed Monday in the U.S. District Court for the Eastern District of Missouri, Rhodes discovered she was in her first trimester of pregnancy in September 2014, while incarcerated at the MCDC.

Abdominal pain, cramping, spotting, and bleeding marked the early days of her pregnancy, according to jail records. On October 31, 2014, after weeks of filing a medical request, she was finally allowed to consult an obstetrician, who diagnosed her as having a high-risk pregnancy.

That same day, according to the complaint, the obstetrician faxed a letter to the MCDC stressing that Rhodes required “urgent … access to healthcare” and asked that she be allowed “to make contact with the patient in a timely fashion.”

Subsequent to that appointment, Rhodes posted bond and was released from the jail, the complaint notes. She continued to obtain prenatal care, and on one occasion was accompanied by a person named in the lawsuit as Gina Lummis, who planned to adopt Rhodes’ baby after the birth, according to the complaint.

On December 15, 2014, Rhodes found herself back at the MCDC, the complaint says. Three days later, on December 18, she went into preterm labor. The complaint notes that she was in severe abdominal pain and experiencing such heavy vaginal leakage that “her pants became soaked.”

For five days straight, Rhodes said she repeatedly requested—and was repeatedly denied—immediate medical care, even as she continued to experience intense abdominal pain, vaginal leakage, and blood clots. Multiple staff members were aware of her condition, the complaint alleges, and at various times informed her that she would not receive care until her scheduled appointment on December 23.

In one instance, a guard named in the complaint as Faith Altamirano told her to wear a tampon to “absorb the leaking fluids,” the complaint notes, and on a separate occasion that same employee accused her of faking her symptoms and ordered her to “stop.”

On December 22, unable to walk, Rhodes said she was dragged along the floor to a holding cell and told that if she didn’t stop pounding on the door in a desperate attempt to access care she would be physically restrained. That night, the complaint reads, Altamirano entered the holding cell and instructed Rhodes to pull down her pants and underwear and spread her legs. Altamirano then allegedly concluded that she did not see anything coming out of Rhodes’ vagina.

At dawn on December 23, 2014, Rhodes was shackled at the wrists, ankles, and around her abdomen, and driven 243 miles to the Women’s Eastern Reception, Diagnostic and Correctional Center (WERDCC), according to the ACLU. From there, she was transported another 30 miles to the Audrain Medical Center in Mexico, Missouri.

In total, the journey took over nine hours, the complaint states. Rhodes reported that she was shackled throughout the ordeal and received no medical care despite continued pain and vaginal discharge that, according to the complaint, had “become green in color.” By the time she was admitted for preterm labor, she said, her pants were soaked in fluid, her cervix was dilated two centimeters, and there were fetal parts in her vagina, including a foot.

At 7 a.m., she delivered a stillborn baby boy; the foot that had been dangling in her vagina upon admission at the hospital, the complaint says, was “blackened in appearance upon delivery.”

The complaint notes that her water had broken on December 18, the very same day she alerted jail staff to her condition.

Of the eight defendants named in the complaint, two are being sued for using excessive force against the plaintiff “maliciously and sadistically”—both of whom were responsible for shackling Rhodes, according to the complaint.

This is not the first time the ACLU has filed a lawsuit against a Missouri jail on shackling charges. In October 2015, the organization filed suit against Jackson County and three of its detention center officers on behalf of Megon Riedel, who claims she was transported nearly 200 miles in shackles and chains while in active labor.

“There is no excuse for any Missourian to be shackled by law enforcement or denied health services while in labor,” Jeffrey A. Mittman, executive director of the ACLU of Missouri, said in a statement released Monday. “The fact that the ACLU has to repeatedly take action against jails and prisons across the state for doing so is proof that this is a serious problem in Missouri. The ACLU remains ready to hold every offending institution accountable.”