Pubdate: Sun, 01 Jan 2006
Source: Arkansas Democrat-Gazette (AR)
Copyright: 2006 Arkansas Democrat-Gazette, Inc.
Contact:  http://www.ardemgaz.com/
Details: http://www.mapinc.org/media/25
Author: Charlotte Tubbs
Cited: National Advocates for Pregnant Women 
http://www.advocatesforpregnantwomen.org
Bookmark: http://www.mapinc.org/coke.htm (Cocaine)
Bookmark: http://www.mapinc.org/testing.htm (Drug Test)
Bookmark: http://www.mapinc.org/meth.htm (Methamphetamine)
Bookmark: http://www.mapinc.org/women.htm (Women)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)
Bookmark: http://www.mapinc.org/youth.htm (Youth)

STATE GETS AVERAGE OF 1 BABY PER WEEK

An average of one newborn a week has been placed in state custody
because of a new state law that requires medical staff members to
report mothers suspected of using illegal drugs.

Before the law's passage, the state's child-abuse hot line did not
accept reports of newborns affected by illegal drugs as abuse or
neglect, leaving physicians frustrated by the prospect of sending a
newborn home with a drug-abusing mother, said Sen. Tim Wooldridge,
DParagould, who sponsored the legislation, Act 1176 of 2005.

Administrators and supporters of the law say that despite a few
hiccups, implementation is going well, and the legislation is
achieving its intended goal of providing a "safety net" for children.
"I am pleased that it is a good first step," said Wooldridge, adding
that he may pursue additional funding and propose that the state
gather more data, such as information on mothers seeking treatment.
But a national debate continues to brew over legislation regarding
substance-exposed newborns and whether states are providing support
services, including addiction treatment, to strengthen and reunite
families. Critics also say that the laws could create a chilling
effect on women seeking prenatal care.

Surprise Findings

Garrett's Law was named in honor of the grandson of
one of the bill's proponents, Betty Stahl. Stahl's grandson died as
the result of complications from his mother's drug use.

The state has taken custody of 37 children because of Garrett's Law.
Child-welfare administrators say a preliminary analysis shows that the
law is being implemented across the state, with 209 reports during the
first seven months -- May through November -- coming from 49 counties.
They expect the average of 30 reports a month to increase as awareness
spreads.

Billye Burke, an assistant director in the Children and Family
Services Division in the Arkansas Department of Health and Human
Services, said that during a November division meeting she was
surprised by the most common drugs found. Marijuana, rather than
methamphetamine, was by a large margin the most commonly found illegal
drug, followed by cocaine, amphetamines, methamphetamine and opiates.

Also, reports included a wider age range than expected, Burke said.
Mothers ranged in age from their 20 s to their 40 s.

Five children were stillborn or were dead at the time of the report,
although in one case the medical staff could not determine if the
prenatal drug exposure was the cause of death, Burke said.

Babies whose health was compromised most often had respiratory
problems. Other health issues included premature birth, kidney
problems, low birth weight and retardation.

Through November, investigations into Garrett's Law reports had
resulted in 88 child-welfare cases being opened by the Children and
Family Services Division. Because positive drug test results usually
accompany reports of drug use, a high percentage of reports are
substantiated, administrators said.

The law, however, is that a child-welfare case is opened only when it
is shown that a mother's drug use affects her newborn. This provision
means that a report involving a mother who tests positive for
marijuana but whose baby was unaffected would be dismissed, said
Department of Health and Human Services spokesman Julie Munsell.

Tracking Costs

Health and Human Services, which did not receive any
state money to administer Garrett's Law, is tracking costs, including
medical expenses of drug-exposed infants. The department had estimated
that the law will cost $ 6 million a year. "The department does not
plan to request additional funding until we have exhausted current
resources and positions, although if numbers continue to rise, we do
believe at some point more staff will be needed," Munsell said in an
e-mail. Garrett's Law requires medical staffs to report the mother of
any newborn who tests positive for an illegal drug or who has a health
problem that is suspected to have been caused by illegal-drug use. But
the law does not direct hospitals on drug-testing policies for mothers
of newborns. At the University of Arkansas for Medical Sciences
Medical Center in Little Rock, Dr. Whit Hall, a neonatologist, tests
patients only when they exhibit symptoms of drug use such as acting
belligerent or showing signs of being "high," he said.

At Arkansas Methodist Medical Center in Paragould, some physicians
routinely drug-test women who are "unassigned," or have not been
seeing an obstetrician before going to the hospital for delivery. The
hospital has reported at least six mothers suspected of drug abuse
since the passage of the law, said Debra Vasser, chief nursing officer.

Many newborns with severe health problems are moved to Arkansas
Children's Hospital in Little Rock, where medical staff members use
several indicators -- from a lack of prenatal care to a newborn's
unusually fast heartbeat -- to decide whether to test a mother for
drug use. Employees submit a report to the childabuse hot line only
after a drug test comes back positive, said Dr. Karen Farst, an
instructor of pediatrics at UAMS and a member of the Children at Risk
team at Children's Hospital.

Lynn Paltrow, executive director of National Advocates for Pregnant
Women in New York, said the fact that no state mandates universal
testing for all pregnant women causes the law to disproportionately
affect low-income women and women who are members of minority groups.

Her organization also receives calls regarding women whose children
the state took when drug tests produced a "false positive" caused by a
drug taken during labor. Paltrow has received other reports of
"innocent positives" caused, for instance, by eating poppy seeds,
which may make it appear that the person has used opiates.

Farst, who has helped implement Garrett's Law at Children's Hospital,
said staff workers have encountered a few challenges, including
difficulty in obtaining medical information on newborns from the
hospital where they were born. She has also seen communication gaps
between the physicians who deliver babies and those who care for the
babies after birth. In addition, Farst has found a need to help
caseworkers understand the often technical results of drug tests and
the difference between tests for drug screens and tests used to
confirm the presence of drugs. "It's an education process for
everybody," she said. The Children and Family Services Division is
holding training sessions for employees on the specifics of Garrett's
Law and those who are required to report suspected abuse under it.

Effect on Families

Evaluating the effect of Garrett's Law on families
is difficult at this point, Burke said, explaining that drug
addictions cannot be fully treated in a short time. "We will have to
look longitudinally in four or five years at where the kids and
parents are," she said.

The intent of the law is to help mothers get treatment and reunify
families if possible, and if not, find another permanent home for the
children, she said.

It is also difficult to determine whether the law has deterred
drug-abusing women from seeking prenatal care, as some critics suggested.

Dr. Helen Kay, chairman of the UAMS Department of Obstetrics and
Gynecology, said the staff at the UAMS Women's Clinic, which primarily
serves Medicaid recipients, has not detected any drop in patients
seeking prenatal care nor is she aware of patients expressing fear of
prenatal care because of the law. Clinic staff members routinely ask
prenatal patients if they are abusing drugs. If a patient admits to
using drugs, the staff member notes that on the patient's chart, which
would likely prompt the obstetrician to drug-test the mother when she
delivers, Kay said. It is probably too early for women to be aware of
the law, Kay said, but she worries that it could deter women from
seeking prenatal care. The clinic staff will monitor for any patient
fears about the law to ensure that it doesn't "backfire," she said.

Treating Drug-Abusing Mothers

Hall said the law has "scratched the surface" of helping
babies affected by their mothers' drug use. Before Garrett's Law, one
of Hall's colleagues delivered a set of premature twins. The mother's
placenta had torn loose from her womb, a complication known as an
abruption, which can indicate drug abuse. The mother tested positive
for methamphetamine, but at that time the hospital staff could not
prevent the mother from taking her babies home, he said.

More caseworkers are needed to follow up with families identified
through the new law, and more drug-treatment programs are needed,
particularly for rural areas, Hall said.

Arkansas has residential drugtreatment centers for women that allow
mothers to take their children with them. There are seven such
programs in the state, but none in the Delta or northeast. The state's
drug-assistance program for the poor funds only 32 beds at the centers.

Since Garrett's Law is so new, it is difficult for the division to
project the need for specialized women's programs and how that demand
has been affected by the law, Munsell said.

"Particularly with a mother and a new infant, you want to be able to
keep that bond strong through the course of treatment," Munsell said.
"What we do know is that we have to work especially hard to find
specialized treatment programs that address the needs of mothers and
children."

At Barb's Place in Hot Springs, one of the specialized women's
centers, there are 10 names on the waiting list. Typically, women wait
one to two months for a state-funded residential bed, said Kim Bermea,
program director.

At the Mills Center in Searcy, five women are on the waiting list for
one of four state-funded specialized women's treatment beds. If the
center cannot place a woman in need of addiction treatment at another
specialized women's center, it offers day drug treatment until a bed
becomes available, said Jim Clark, director of the Mills Center.

The Children and Family Services Division does not keep statistics on
whether women identified through Garrett's Law receive drug-treatment
services. Munsell said statewide data on treatment would not
necessarily be valuable in determining the need for treatment resources.

"The department ensures the needs of mothers and children are met
through individual case plans, which are designed to reunify the
family," she said in an e-mail. "We have regular dialogue with
community stakeholders regarding available resources."

If there were several Garrett's Law cases in one geographic area,
there would be a need for services in that area rather than statewide,
she said.

Richard Wexler, executive director of the National Coalition for Child
Protection Reform in Virginia, opposes laws like Arkansas' that
require medical staffs to report women who use illegal drugs. As of
September 2004, nearly half of the states had such laws, according to
the National Conference of State Legislatures.

Medical staffs should be allowed to use their professional judgment to
determine whether the mother is abusing drugs to a point that it
endangers her child, Wexler said.

"If they really want to help these children, provide the drug
treatment for all the mothers who are desperate for it, instead of
trying to tear more children away at birth and expose them to the
risks of foster care," he said.

Paltrow believes that women who have used illegal drugs can still be
parents.

The question that child-welfare systems should ask is : "Is this
parent capable of parenting ?" not "Have they ever used an illegal
drug ?" Paltrow said.

Arkansas' lack of statistics on treatment for women identified through
Garrett's Law shows that the law has "nothing to do with trying to
help children. It is intended only to punish 'bad mothers,'" Wexler
said in an e-mail.

Wooldridge said the law is not designed to punish mothers, and
therefore does not include provisions to prosecute women reported
under Garrett's Law.
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MAP posted-by: Richard Lake