The Fight for Better Care for Pregnant Women in Texas Jails

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Courtesy Bexar County

The Current's review of county health-services plans in the San Antonio area reveals the lack of specificity. While the Comal and Guadalupe plans essentially repeat the general language provided by the commission verbatim, Bexar County's is a bit more robust—likely indicative of the resources available in our more urban area.

As of November 21, 26 inmates incarcerated in the Bexar County jail were pregnant. University Health System, the county hospital district, has a $10.8 million budget for detention health-care services. It employs more than 200 medical and counseling staff to provide medical and mental health services at the jail.

Martha Rodriguez, senior director of Detention Health Care Services, told the Current that every woman is screened and given a urine test when she arrives at the jail. Rodriguez said pregnant inmates are immediately put on a prenatal vitamin regimen and placed on a "pregnancy diet" that consists of more protein, extra fruits and vegetables, and an extra snack.

An ultrasound machine UHS purchased 18 months ago allows the physicians to do most prenatal care on site, but if women need more specialized care they are sent off-site to UHS-operated clinics. At 24 weeks, Rodriguez said, pregnant inmates receive an extra mattress to sleep on and expectant inmates are seen by a physician every two to four weeks, depending on where they are in their pregnancies. If a woman is scheduled to deliver while she is incarcerated, a bed is arranged at the hospital. Rodriguez said 17 incarcerated women have given birth during their sentences this year.

"We've been fortunate to be able to secure equipment that makes our services even better," she said. "It helps us ensure that we provide the same level of care for the ladies here that they would get out in the community."

A 2011 review of the implementation of the 2009 law in six urban areas, including Bexar County, by Claitor and the American Civil Liberties Union of Texas found that protocol like prenatal vitamins, high-calorie diets and low bunk-bed assignments varied from facility to facility. Claitor said an updated, more thorough review of what goes on at all county jails is a must.

"It's really hard to tell [if the standards are being implemented]," she said.

A related state law passed in 2009 banned the use of shackles and restraints on pregnant women during labor, delivery and after delivery, "unless the sheriff or another person with supervisory authority over the jail determines that the use of restraints is necessary to ensure the safety and security of the woman or her infant, jail or medical personnel, or any member of the public; or prevent a substantial risk that the woman will attempt escape."

While the commission does require that county jails document the use of restraints, counties aren't required to report those incidents to the agency. Matt Simpson, policy strategist with the ACLU of Texas, who worked on the two bills with Claitor, said the jail commission needs a way to review the use of restraints when inspecting the facilities.

"I think it's very rare that there'd be a public safety concern, but if that exception is used and [women] are shackled, I think it's important that the TCJS document it," he said.

Spiller said TCJS inspectors look at the overall medical care provided to inmates.

"When our inspectors go into the facility, that's when they start looking at the medical care of inmates," she said. "They've been known to ask specifically for pregnant inmates and look at their care."

The Current requested records related to the use of restraints at the Bexar County Jail well over two weeks ago, but the county has yet to release the information.

Claitor says Texas women who were incarcerated while pregnant have privately shared with her that they feel mistreated while in jail, that they don't receive appropriate medical attention when they request it and that they have been restrained or confined arbitrarily.

In the last several months, some, like Williams, have spoken publicly. Nicole Guerrero, of North Texas, who was five months pregnant when she was detained at the Wichita Falls County jail in June 2012 filed a lawsuit against the county in May alleging violation of her 14th Amendment due process rights. According to the original complaint, Guerrero was experiencing bleeding and cramping but was repeatedly told by medical staff that her baby was fine. Guerrero eventually went into labor and her baby was born "dark purple," the complaint states, and died several hours later. The case is set to go to trial next year.

Jessica De Samito, a 24-year-old pregnant veteran, was detained this summer at the Guadalupe County Jail after violating her probation. Incarcerated 24 weeks into her pregnancy, she was denied essential methadone medication needed to curb her opiate addiction. Without methadone, considered by national medical experts to be the gold standard of treatment for opioid-dependent pregnant women, De Samito was in danger of a stillbirth. Lawyers and advocates intervened on behalf of De Samito, and she was ultimately released back into the community.

Stories like these have prompted discussion between the commission and advocacy groups about how best to care for pregnant women in Texas county jails.

"Our board is committed to ensuring that the proper thing is done and has directed staff to do so as well," said Brandon Wood, executive director of TCJS.

In addition to implementing current standards and a more detailed framework for procedures, advocates are also calling for better data collection on the outcomes of jail pregnancies, as well as an expanded roster of service providers available to care for them while they're incarcerated.

Paula Rojas, a certified midwife and co-founder of Mama Sana/Vibrant Woman, wants the commission to make information about licensed midwives, doulas and nurse midwives readily available to county jails, especially facilities that don't have enough medical providers. Medical research shows stress can impact pregnancy, and given the stressful nature of incarceration, Rojas also recommends that all incarcerated pregnant women be given the same level of extra care high-risk pregnant women in the community receive, including more routine ultrasounds and extra monitoring. If an incarcerated woman is found to have a high-risk pregnancy, she should receive even more.

"That would be absolutely logical because it's about being in hyper-stressful conditions," she said.

Other recommendations include policies that prohibit pregnant women from being placed in solitary confinement and specific protocols for labor and delivery.

Since this summer, stakeholders have come together to discuss how to improve policies and Spiller says the commission is working to gather as much information as possible from advocates like Claitor and Rojas.

"Our role in this issue is still being developed," she told the Current. The next commission meeting is scheduled for February 5.

But do pregnant women really need to be in jail? If care isn't available, their offenses are nonviolent and they don't pose a public safety threat, why not consider alternatives like bond, Simpson asks. Health outcomes would improve, families wouldn't be separated and women could see the same doctor throughout their pregnancy.

"Unless there's a massive public-safety concern, maybe [pregnant women] need to be bonded out or go back in the community where they have access to medical care," he said. "Pregnant inmates are probably really good candidates for diversion."

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