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Take a Valium, Lose Your Kid, Go to Jail

In Alabama, anti-drug fervor and abortion politics have turned a meth-lab law into the country’s harshest weapon against pregnant women.

(Photo: Pregnant Woman via Shutterstock; Edited: LW / TO)

Casey Shehi’s son James was born in August 2014, remarkably robust even though he was four weeks premature. But the maternity nurse at Gadsden Regional Medical Center seemed almost embarrassed, and as she took the baby from his exhausted mother’s arms, Shehi felt a prick of dread.

“She said they were going to have to take him back to the nursery to produce some urine, because I had a positive drug screen for benzodiazepines,” Shehi, 37, recalled one evening a few months ago at a café near her mother’s home. She hadn’t been sleeping well; her brown hair hung lank past her shoulders, and her eyes were rimmed with worry. “I said: ‘That can’t be true. Can you please check it again? Run the screen again.’ “

The nurse asked: Did she have a prescription for any form of benzo – Xanax or Klonopin or Ativan? No, Shehi insisted, there must be a mistake.

Then she remembered: the Valium.

One night a few weeks earlier, Shehi and her ex-husband got into a huge argument on the phone. She was in the late stages of what had been a difficult pregnancy; she was achy and bloated, and her ankles felt like they might explode. After the fight, she called her mother, Ann Sharpe, a retired teacher and guidance counselor who lived nearby. “She was really upset – ‘I’m miserable, I’m sick, I can’t sleep,’ ” Sharpe recalled. “I said, ‘Do you have something you can take?’ ” As Shehi later told investigators, she had swallowed half of one of her boyfriend’s Valiums to calm herself down.

Not long after, Shehi and her boyfriend and their various kids packed up the camper and drove 325 miles from Gadsden, in northeast Alabama, to the beach in Panama City, Florida, for one last vacation before the baby came. The weather was sweltering, the trailer – a grimy relic with an air conditioner that only worked when it wanted to – suffocating. Shehi was too keyed up to sleep, her 4-year-old son curled up beside her on the narrow bed. Finally, she reached for the other half of the tranquilizer.

As Shehi recounted the story, the maternity nurse told her, “Okay, okay.”

By that night, everything really did seem all right. Excited nurses woke Shehi and handed her the baby, swaddled in a light blanket. “They told me: ‘He’s good, he’s clean. You can have him now, no worries.’ ” Exposure to too much benzodiazepine during pregnancy can sometimes cause newborns to be fussy or floppy-limbed. But occasional, small doses of diazepam (the generic name for Valium) are considered safe. According to the lab report, James had nothing in his system. Shehi said the pediatrician reassured her, “Everything’s cool.”

The next day, Shehi and the baby went home, and someone from the Department of Human Resources, the state child welfare agency, paid a visit. In recent years, Alabama authorities have been aggressive about removing newborns from the custody of mothers who abuse drugs, typically placing a baby with a relative or foster family under a safety plan that can continue for months or years. The social worker listened to Shehi and Sharpe’s story and concluded that theirs wasn’t one of those situations. “She said: ‘I understand the pain you are in, and I understand what’s going on. I won’t take the baby away,’ ” Sharpe recalled.

But one morning a few weeks later, when Shehi was back at her job in a nursing home and the baby was with a sitter, investigators from the Etowah County Sheriff’s Office showed up at the front desk with a warrant. She had been charged with “knowingly, recklessly, or intentionally” causing her baby to be exposed to controlled substances in the womb – a felony punishable in her case by up to 10 years in prison. The investigators led her to an unmarked car, handcuffed her and took her to jail.

Shehi had run afoul of Alabama’s “chemical endangerment of a child” statute, the country’s toughest criminal law on prenatal drug use. Passed in 2006 as methamphetamine ravaged Alabama communities, the law targeted parents who turned their kitchens and garages into home-based drug labs, putting their children at peril.

Within months, prosecutors and courts began applying the law to women who exposed their embryo or fetus to controlled substances in utero. A woman can be charged with chemical endangerment from the earliest weeks of pregnancy, even if her baby is born perfectly healthy, even if her goal was to protect her baby from greater harm. The penalties are exceptionally stiff: one to 10 years in prison if her baby suffers no ill effects, 10 to 20 years if her baby shows signs of exposure or harm and 10 to 99 years if her baby dies.

For this story, ProPublica and filed multiple public information requests to identify the more than 1,800 women arrested under the chemical endangerment law, then sifted through court records to find the cases related to pregnancy. The data showed that at least 479 new and expecting mothers have been prosecuted across Alabama since 2006, or more than three times the number previously identified. Many others have been investigated in the chemical-endangerment version of stop-and-frisk, their lives turned upside down by an intrusive – and women’s advocates say, unconstitutional – dragnet of drug testing without their knowledge or, sometimes, their explicit consent. The goal of the law is to protect children by removing them from unsafe settings and mothers too impaired and unstable to provide proper care. Prosecutors contend the law has been the impetus for hundreds of women to get treatment and restart their lives, with prison as the price for those who choose not to or who fail.

Yet there’s nothing in the statute to distinguish between an addict who puts her baby at grave risk and a stressed-out single mom who takes a harmless dose of a friend’s anti-anxiety medication. There are no standards for law enforcement officials or judges to follow: Is the presence of drugs in the mother’s body cause for charges if the baby tests clean? What test results are appropriate for medical providers to report and when? Should a mother face charges even when she was using a prescription drug under a doctor’s supervision? Local prosecutors and courts have wide discretion.

Some of the most wrenching effects of the law can be seen in the area of parental rights. Chemical endangerment is considered a form of child abuse, and a woman accused of exposing her baby to drugs in utero is at risk of losing custody of all her children, not just her newborn.

In Shehi’s case, social workers had determined that James, the baby she had supposedly endangered, was fine and could remain in her care, court records show. But she had an open custody case involving her preschool-age son. After the arrest, the judge overseeing those arrangements issued an emergency order granting her ex-husband sole custody. There wasn’t even a hearing. “I was supposed to pick him up from school,” Shehi said,”and my lawyer saw the order and told me, ‘Don’t go.’ “

Abortion Politics Meet a Meth-Lab Law

The story of how Alabama’s chemical endangerment law became the most sweeping measure deployed against pregnant women in the US during the last decade begins with methamphetamine. The drug arrived in the 1990s, and by the mid-2000s it was overwhelming law enforcement and social service agencies in rural, economically depressed areas in the north of the state and along the Florida border.

In Montgomery, lawmakers tried to play catch-up by targeting do-it-yourself manufacturing operations and cracking down on sales of over-the-counter cold medications used to produce the drug. Home-based labs were noxious and dangerous, with a tendency to catch fire or blow up – especially hazardous for kids. Barry Matson, who heads the Alabama District Attorneys Association’s drug abuse task force, recalled one memorable case: “We raided the house, and they were venting the gases through a kitchen into the baby’s playpen.”

The new chemical endangerment law didn’t stop at meth labs. Parents and other responsible adults could be arrested for exposing children to virtually any type of controlled substance or drug paraphernalia in all kinds of settings: a crack pipe on a coffee table, an open bottle of pills, marijuana smoke in a car.

As the Legislature tackled that problem, hospitals were reporting another: an increase in the number of scrawny, often premature newborns who showed signs of exposure to meth in the womb. Some had withdrawal symptoms, a condition known as neonatal abstinence syndrome. When the Alabama Department of Public Health randomly screened 500 pregnant women during routine prenatal visits at clinics around the state, 13 percent were positive for a controlled substance (mostly marijuana), a figure that implied at least 8,200 live births per year by users, the state’s Maternal Drug Task Force reported. Even that number was thought to be a significant underestimate.

Marshall County, at the southern edge of the Appalachians, was one of the areas hardest hit, so awash in addiction that its most prominent landmark was nicknamed Meth Mountain. Doctors and nurses were clamoring for action, said Steve Marshall, the district attorney there since 2001. “We started holding pow-wows … from a public health standpoint, a law enforcement standpoint, what was the best way to deter women from this behavior?”

Drug abuse in pregnancy is an extraordinarily difficult problem to treat; effective programs for poor, uninsured women were exceedingly scarce. With what felt like a crisis bearing down on them, Marshall and a few of his fellow prosecutors turned to the meth-lab law. Under the statute’s flexible language, they concluded, “a child” could be a fetus, and “an environment in which controlled substances are produced or distributed” could be a womb. In late 2006, they began charging mothers whose newborns tested positive for drugs – not just meth, but also cocaine, opioids and pot. Marshall’s goal wasn’t to throw women in prison, he said, but to use the threat of incarceration to force them into treatment. Mothers who were successful could eventually have the charges dismissed. “We wanted to find a mechanism to get mama clean, get kid healthy and hopefully encourage a reunification of the family,” he said.

“We have clearly used it [the chemical-endangerment statute] a little bit different than it was designed,” Marshall acknowledged. “That, in and of itself, doesn’t mean it’s wrong.”

It was an audacious legal experiment but not a novel idea. Since the “crack-baby” era of the 1980s, authorities in at least 44 other states have sought to hold women criminally accountable for drug use in pregnancy, according to the nonprofit National Advocates for Pregnant Women, often by repurposing statutes such as child abuse and drug distribution and trafficking laws meant for something else. But most experts thought arresting mothers was terrible public policy: It treated addiction as a crime rather than a disease; it discouraged the women most in need of prenatal care from seeking it; and it interrupted a mother’s bond with her baby when she was particularly vulnerable, making her more likely to relapse. “Did the war on drugs work? Do you have a reason to think a war on women using drugs during pregnancy is going to?” asked Donald Bross, a professor of pediatrics and family law at the University of Colorado School of Medicine. Only one state supreme court – South Carolina’s, in 1997 – ended up condoning the criminalization approach. In most states, drug use in pregnancy came to be seen as a matter best handled through the civil child welfare system: Removing a child seemed like punishment enough.

By the time the chemical-endangerment cases began winding their way through the Alabama courts in the late 2000s, though, the political and social landscape had transformed. Advocates for the rights of the unborn were on the ascendant. The personhood movement – which seeks to establish the embryo or fetus as fully human in as many legal and medical contexts as possible – had made significant inroads. The treatment of drug use in pregnancy as a crime against the fetus emerged as an important part of the strategy to dismantle Roe v. Wade, and the Alabama Supreme Court, possibly the most conservative high court in the country, proved especially receptive.

One justice in particular, a longtime anti-abortion warrior named Tom Parker, saw an opportunity to create a whole new jurisprudence of personhood that could be ammunition for abortion opponents in their push for another showdown at the US Supreme Court. In decisions in 2013 and 2014 that were as much about abortion as drugs, Parker and his fellow justices ruled that the meth-lab statute could indeed be used to prosecute expectant and new mothers – not just from the time the fetus is viable (around 22 weeks) but from the earliest stages of pregnancy.

Attorney Rebecca Green Thomason, who represented Amanda Kimbrough, the Colbert County woman whose case became the basis for the 2013 decision, thinks abortion opponents have got it all wrong. Thomason is proudly conservative – “a right-wing crazy” is how she puts it – and unapologetically anti-abortion: “Based on what I do, it seems that women have abortions for not necessarily their own reasons. They are often coerced into it.” One of her chief criticisms of the chemical endangerment law is that it punishes mothers in crisis who do their best to carry their babies to term; a smart woman, Thomason said, won’t even try. “From my right-wing perspective,” she said, “we are forcing women to have abortions.”

One Law, “Vastly Different” Results

In 2013, a couple of weeks after the Alabama Supreme Court’s first ruling, Lynn Paltrow, the NAPW’s executive director, and Jeanne Flavin, a professor of sociology at Fordham University, published an extensive study on arrests and “forced interventions” against pregnant women in the 30 years following Roe. It was an eye-opening analysis of how the relentless battles to restrict abortion have resulted in the increasingly onerous regulation of pregnancy itself. The report compiled 413 examples across the United States, mostly arrests of drug-using mothers, but other types of detentions and prosecutions as well – a figure that struck many people as shocking. The number of Alabama chemical-endangerment prosecutions in the ProPublica/ analysis – almost certainly an undercount – dwarfs anything in that report. As a new drug panic over opiates and “oxytots” spreads through the South and Midwest, and other states contemplate their own chemical endangerment-like statutes (Tennessee passed one last year; this past spring, eight legislatures introduced bills), the Alabama example holds lessons about the kinds of inequities and overreach that can result, said NAPW’s director of legal advocacy, Sara Ainsworth. “Alabama isn’t an aberration,” she said. “It’s a bellwether.”

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