Ferguson v. City of Charleston

Petitioners were former patients who received obstetrical care at the Medical University of South Carolina (MUSC), a public hospital in the city of Charleston, and who were arrested after testing positive for cocaine.

In 1988, concerns arose among MUSC staff about an apparent increase in the use of cocaine by patients who were receiving prenatal treatment. The following year, MUSC began ordering drug screens to be performed on urine samples from maternity patients who were suspected of using cocaine. Patients who tested positive were then referred for counseling and treatment. Despite the referrals, there was no apparent change in the incidence of cocaine use among the patients.

After initial discussions with the case manager for the obstetrics department at the hospital, MUSC’s general council contacted Charleston Solicitor Charles Condon to “offer MUSC’s cooperation in prosecuting mothers whose children tested positive for drugs at birth.” The Solicitor formed a task force to address the issue, which led to Policy M-7 dealing with the subject of “Management of Drug Abuse During Pregnancy.”

Policy M-7 provided for:

• the procedure to be followed by the hospital staff to “identify/assist pregnant patients suspected of drug abuse”;
• education and referral to a substance abuse clinic for patients who tested positive;
• the threat of law enforcement intervention that “provided the necessary leverage to make the policy effective”; and
• procedures to be followed by the police following an arrests.

The threat of law enforcement intervention was contained in two separate protocols, the first dealing with identification of drug use during pregnancy, and the second with identification of drug use after labour. Patients who tested positive during either stage were given the opportunity to avoid arrest by consenting to substance abuse treatment.

The document also contained a detailed list of offences with which a woman could be charged depending on the state of her pregnancy. Respondents acknowledged that this threat was essential in “getting the women to treatment and keeping them there.”

There was no mention in the document of any change in prenatal care of patients or special treatment of the newborns.

Petitioners, 10 women who received obstetric care at MUSC, were arrested after testing positive for cocaine. They brought an action challenging the constitutional validity of the policy against Respondents, including the city of Charleston, law enforcement officials who helped develop and enforce the policy, and representatives of MUSC.

The District Court gave instructions to the jury to find in favor of petitioners unless the jury found they had consented to the drug tests. The jury found for respondents. The Court of Appeals determined that the searches were reasonable, as “special needs may, in certain exceptional circumstances, justify a search policy designed to serve non-law-enforcement (i.e. medical) ends.” The question of consent was not addressed by the Court of Appeals. The Supreme Court granted certiorari to review the appellate court’s holding on this issue.

The Court first examined whether a State hospital’s performance of a diagnostic test to obtain evidence of criminal conduct for law enforcement purposes is an unreasonable search under the Fourth Amendment if the patient has not consented to the procedure. The Court held that the interest in using the threat of criminal sanctions to deter pregnant women from using cocaine did not justify a departure from the general rule, under the Fourth Amendment, that an official nonconsensual search was unconstitutional if it was not authorized by a valid warrant.[1]

The invasion of privacy in this case was found to be “far more substantial” than previous cases, where “there was no misunderstanding about the purpose of the test or the potential use of the test results, and there were protections against the dissemination of the results to third parties.”

The Court determined that the critical difference turned on “the nature of the special need as justification for the warrantless searches,” which in this case was “the use of law enforcement to coerce patients into substance abuse treatment.” This was distinguishable from situations “where physicians or psychologists, in the course of ordinary medical procedures aimed at helping the patient herself, come across information that under rules of law or ethics is subject to reporting requirements.” The Court held that:

Because law enforcement involvement always serve[ed] some broader social purpose or objective, under respondents’ view, virtually any nonconsensual suspicionless search could be immunized under the special needs doctrine by defining the search solely in terms of its ultimate, rather than immediate, purpose. Such an approach [was] inconsistent with the Fourth Amendment.

The Court further held that the turning over of positive test results to the police provided “an affirmative reason for enforcing the strictures of the Fourth Amendment.” It held that regardless of whether State hospital employees had an obligation to provide the police with evidence of criminal conduct they inadvertently acquired during routine treatment, when they undertook to obtain such evidence from their patients “for the specific purpose of incriminating those patients, they [had] a special obligation to make sure that the patients [were] fully informed of their constitutional rights, as standards of knowing waiver require.”

The Court reversed and remanded the judgment of the Court of Appeals.

“The critical difference between those four drug-testing cases and this one, however, lies in the nature of the ‘special need’ asserted as justification for the warrantless searches. In each of those earlier cases, the "special need" that was advanced as a justification for the absence of a warrant or individualized suspicion was one divorced from the State's general interest in law enforcement.[15] This point was emphasized both in the majority opinions sustaining the programs in the first three cases,[16] as well as in the dissent in the Chandler case.[17] In this case, however, the central and indispensable feature of the policy from its inception was the use of law enforcement to coerce the patients into substance abuse treatment. This fact distinguishes this case from circumstances in which physicians or psychologists, in the course of ordinary medical procedures aimed at helping the patient herself, come across information that under rules of law or ethics is subject to reporting requirements, which no one has challenged here. See, e. g., Council on Ethical and Judicial Affairs, American Medical Association, PolicyFinder, Current Opinions E-5.05 (2000) (requiring reporting where "a patient threatens to inflict serious bodily harm to another person or to him or herself and there is a reasonable probability that the patient may carry out the threat"); Ark. Code Ann. § 12-12-602 (1999) (requiring reporting of intentionally inflicted knife or gunshot wounds); Ariz. Rev. Stat. Ann. § 13-3620 (Supp. 2000) (requiring "any . . . person having responsibility for the care or treatment of children" to report suspected abuse or neglect to a peace officer or child protection agency).[18]” 532 U.S., pp. 79-81.

“The fact that positive test results were turned over to the police does not merely provide a basis for distinguishing our prior cases applying the “special needs” balancing approach to the determination of drug use. It also provides an affirmative reason for enforcing the strictures of the Fourth Amendment. While state hospital employees, like other citizens, may have a duty to provide the police with evidence of criminal conduct that they inadvertently acquire in the course of routine treatment, when they undertake to obtain such evidence from their patients for the specific purpose of incriminating those patients, they have a special obligation to make sure that the patients are fully informed about their constitutional rights, as standards of knowing waiver require. [fn 24]. Cf. Miranda v. Arizona, 384 U. S. 436 (1966).” 532 U.S., pp. 84-85.