Paltrow already had served as co-counsel in virtually all of the most critical early prosecutions of pregnant substance abusers. She'd successfully fought Jennifer Johnson's prosecution in Florida, Kimberly Hardy's in Michigan, Pamela Rae Stewart's in California. Now, in early 1990, South Carolina seemed to be presenting a still larger battlefield. This was about even more than women's rights or fetal rights. This was about civil rights and racial discrimination. This was about sane public-health policy.
It didn't take Paltrow long to find a host of esteemed professors, doctors and medical groups that agreed. The list eventually included such experts in their fields as Dr. Barry Zuckerman, chairman of the department of pediatrics at the Boston University School of Medicine and Boston City Hospital, and Dr. Jay Katz, professor emeritus of law, medicine and psychiatry at the Yale University Law School. In the mound of essays, declarations and studies on Paltrow's desk, these specialists offered all manner of objection to Charleston's policy.
The policy, they argued, violates the right to privacy in medical information, the right to refuse medical treatment, the right to procreate, the right to equal protection under the 14th Amendment. The policy forces doctors to be cops and gives the judgment of doctors--or nurse Brown--the force of law. The policy treats drug addiction as a crime rather than an illness and allows for no relapses, which are expected at treatment centers. The policy frays the doctor's relationship with patients. The policy violates all notions of informed consent. The policy is tantamount to human research, without the required approvals. The policy, no matter what criteria are used, targets poor blacks by screening only at an indigent center such as MUSC. The policy leads society down a slippery slope--if you're going after women for harming their fetuses, what about drinkers and smokers, whose behavior produces, overall, greater and more lasting harm each year than cocaine users?
Above all, the academics and doctors assembled by Paltrow argued that the policy, while mandating treatment if you want to avoid jail, ignores the fact that appropriate treatment programs for pregnant addicts just don't exist in the Charleston area. By "appropriate," they mean outpatient programs that provide transportation and day-care and long-term residential programs where mothers can live with their children, isolated from the type of potentially violent male addicts they're all too familiar with.
On this point there can be little dispute. Until the recent opening of the Sojourner Center for Women, which serves only one ZIP code in the city, there was no outpatient program in Charleston that offered day-care or direct door-to-door transportation; there is still no residential program specifically for women and their children. The Department of Alcohol and Other Drug Abuse Services (formerly the Charleston County Substance Abuse Commission), where MUSC directs most pregnant substance abusers, counsels all kinds of abusers, often in group therapy sessions. MUSC itself, in applying for grants, has expressed "serious concern" that needed services "are not available" at the hospital or in the Charleston community. Counselors obliged to ask anxious, depressed mothers to leave their children and ride buses an hour or more across town readily confirm such concerns. Women will come, the counselors claim, only if they feel they and their children are safe. Otherwise, threats and coercion will just drive them away.
That, some believe, is precisely what's been happening in Charleston. In a South Carolina medical journal article, at various professional gatherings and even in Condon's resume, the trio of Brown, Horger and Condon have hailed a "marked" decrease in positive drug screens--from 24 to four or five a month--but specialists such as Zuckerman think this MUSC report "deeply flawed." How do they know the hospital hasn't merely driven most substance abusers away?
It is hard to judge all these arguments. It is true, for example, that Charleston is targeting poor blacks by screening only at MUSC--but it is also true that the 1991 South Carolina Prevalence Study found black women nearly six times more likely to use cocaine than white women, and women without medical insurance 17 to 18 times more likely. While it is true that more appropriate treatment programs are needed, it is also true that no one really knows if such programs would attract all the pregnant substance abusers who now stay away. Whether to talk about a "failure of personal responsibility" or "the disease of addiction" is in some way, finally, a question of philosophy, not fact.