An estimated five percent of the one million women incarcerated each year are pregnant when they enter jail. Cases of fatal medical neglect of incarcerated pregnant women highlight the need for protecting their health, rights, and lives.

The month of May brought two disturbing news stories that illustrate the needless and sometimes tragic suffering inflicted on pregnant women in jail. By suffering, I do not mean the deprivation of comfort and companionship that women might experience if they were at home instead of in jail. I mean the deprivation of basic constitutional and human rights, including the right to be treated as a human being. Without a baseline of respect for human dignity, being taken into custody puts people’s lives and rights in danger.

The first story makes this painfully clear in its recounting of the death of a young woman in jail. What makes this news all the more upsetting is that her death was preventable. The second story recounts an all too familiar struggle between a woman seeking to exercise her reproductive rights and a sheriff standing in her way. Together, both stories remind us of what is at stake when people are imprisoned, even for brief periods of time.

Pregnant Woman Dies of Medical Neglect

Whatever Chuniece Patterson and her family thought when she was arrested, they probably didn’t think that two days in the inaptly named “Justice Center” would result in her death. But that is just what happened to this 21 year-old African-American woman when she was arrested and jailed in Syracuse, New York.

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According to the news report Patterson found out that she was pregnant at the jail. This means that the staff knew she was pregnant, too. But they essentially ignored her symptoms of abdominal pain, nausea, vomiting, and weakness. Although nurses made three visits to her cell, and various deputies made rounds, no one provided meaningful medical assistance. A nurse who visited Patterson in her cell did not examine her abdomen or bring her to the medical unit for a pelvic exam. It does not even appear that she took her temperature or her blood pressure, which might have suggested signs of fever or internal bleeding (it “does not appear” because the nurse wrote her “observations” after the fact, after Patterson had already died). A woman in a nearby cell said that she could hear Patterson moan and see her writhe in agony throughout the night.

The jail deputy who surveilled Patterson’s cell on morning rounds ordered her to get up off the floor, but did not investigate why she was on the floor, even though she had been told that Patterson was having difficulties when she began her shift. In a report of her 7:30 a.m. stop at the cell, the deputy wrote: “I looked down at inmate Patterson, again told inmate to get off the floor. It looked as if the inmate looked at me. I continued with my tour.” One hour later, Patterson was pronounced dead at an outside hospital.

What is the standard of care in a situation like Patterson’s? Obstetrician Gerson Weiss describes it this way: Examine the woman’s abdomen and conduct a pelvic exam. These exams may result in pain, an indication to perform an ultrasound to determine whether the pregnancy is indeed outside the uterus. If this is confirmed, proceed to emergency surgery. The entire examination and diagnosis should take 5-10 minutes.

People who work in jails that hold women should be knowledgeable about pregnancy-related emergencies, including the signs of ectopic pregnancy, miscarriage, and premature labor. Even if no one knew anything about ectopic pregnancy, they might have wondered if Patterson had appendicitis or some other condition requiring immediate medical attention.

Patterson died in November 2009. The story is in the news now because her mother is planning to sue the county and a state commission is finalizing an investigation into the circumstances of her death.

A previous investigation found fault with the same jail in 1996, when a 36 year-old woman named Lucinda Batts died from a ruptured ectopic pregnancy. In that case, Batts bled to death over several days. None of the medical staff who visited her cell went the next step to get her proper medical attention.

After Batts died, the county health commissioner promised to issue new standards to prevent such tragedies, including pregnancy testing – which the jail seems to be doing – and thorough examination and monitoring of pregnant women experiencing problems, better training of staff, and improved communication between jail nurses and on-call physicians.

The editorial board of the Syracuse Post-Standard takes the jail to task for its failures: “If the 1996 guidelines were implemented, why wasn’t Patterson’s health emergency caught in time? A second fatality due to an ectopic pregnancy after 14 years is not an epidemic. But it raises questions: Are the guidelines adequate? Have they lapsed? Or is another element still missing here — a lack of sensitivity to inmates’ distress, an attitude of skepticism or indifference among those responsible for their welfare?”

The editorial board’s perspective differs sharply from the perspective of some of its readers, judging from the comments people posted to the story. More than one blames Patterson – if she hadn’t gotten into trouble, then she wouldn’t have died in jail. One writer with eugenic and divine interventionist leanings wrote: “In and out of jail? What kind of mother is that? Maybe this was gods way of saying it wasn’t meant to be.”

Several readers also commented that the jail staff may not have been able to tell the difference between someone who was suffering from internal bleeding and someone who was suffering from drug withdrawal. Rather than absolve anyone, these comments simply reinforce the need for proper medical evaluation. Abrupt withdrawal from heroin, for example, can be physically brutal and can lead to miscarriage or stillbirth if a woman is pregnant. No one who thinks a pregnant woman is withdrawing from drugs should leave her curled up in agony on the floor.

Sheriff Denies Access to Abortion Care

Across the country, a woman was trying to obtain abortion care from within the confines of the Parker County jail in Weatherford, Texas, about 30 miles west of Forth Worth.

The outlines of the story are familiar: A woman asks for an abortion, or asks to be taken to an appointment she has already made for an abortion. Jail personnel say no.

Then as also often happens, the woman or someone she knows contacts the ACLU, whose staff inform jail officials that 1) they are violating the woman’s rights and must transport her to a medical facility where she can exercise her constitutional right to terminate her pregnancy, and 2) they should implement a policy to deal with abortion requests in the future.

The sheriff in this incident said he was “a little bit flabbergasted” by the ACLU’s position: “My personal feeling is I don’t feel like the taxpayers of Parker County would think much of their sheriff spending taxpayer money to take people to abortion clinics. I don’t think they would want me to even entertain that notion.”

The sheriff’s personal feelings and his ability to gauge the sentiments of other Parker County residents, however, are simply not relevant. The courts have consistently held that women retain the right to have an abortion when they are incarcerated. No court has ever ruled that jails can simply ignore women’s requests for abortion care. This means that jails must take women to an appropriate medical facility, because they are not free to take themselves. As a judge explained in a similar case in Ohio, “The federal judiciary has detailed a woman’s constitutional right to an abortion. The Sheriff might find such a right morally repugnant. Or he might find ignoring its existence politically expedient. Nevertheless, [the Sheriff has taken…] a solemn oath to support the Constitution,” and that includes accommodating the reproductive rights of women in his custody [see Roe v. Leis, No. C-1-00-651, 2001 WL 1842459 (S.D. Ohio Jan. 10, 2001)].

The executive director of the Texas Commission on Jail Standards, as well as the sheriff and a spokesperson for nearby Tarrant County, said they could not recall the issue of abortion coming up before in the Texas jails.

But the issue has come up a number of times, including at least twice in Tarrant County. Women have gone to court to fight for their rights and the Texas press has covered their stories. The Jails Commission has had ample time to develop a standard on abortion access that would provide guidance to the many jail administrators throughout the state.

Ultimately, this conflict ended when the jail released the woman after a court dealt with the charges against her. This leaves her free to make and carry out her own decision. It leaves other women in the position of having to go through the exact same process of finding outside help, unless the sheriff adopts a policy that upholds their rights.

Many Women at Risk

More than a million women spend time in jail each year. An estimated five percent of them are pregnant when they enter jail. These two incidents of fatal medical neglect and interference with reproductive decisions crystallize how vulnerable women are to the institutional shortcomings in the nation’s vast jail system, and highlight the need for far greater oversight to protect women’s health, rights, futures, and very lives.