Download Ferguson, Crystal v. City of Charleston, et. al.

Street Law Case Summary
Ferguson, Crystal v. City of Charleston, et. al.
Argued: October 4, 2000
Decided: March 21, 2001
Facts
Beginning in the fall of 1988, the Medical University of South Carolina (MUSC), a public hospital in
the City of Charleston, became concerned with the increasing number of pregnant women who were
using cocaine. Under state law, prenatal cocaine use constituted child abuse and neglect, which
MUSC was legally required to report. In response to this concern, a task force consisting of MUSC
representatives, police, and local officials developed a policy whereby a woman who used cocaine
could be found guilty of a crime for distributing illegal substances to someone under the age of 18.
Women who came into the MUSC presenting one or more of the following characteristics were
automatically drug-tested: (1) no prenatal care; (2) late care after 24 weeks; (3) incomplete prenatal
care; (4) intrauterine fetal death; (5) pre-term labor with obvious cause; (6) previous known drug or
alcohol use. If their tests were positive, the results were reported to the police and the women were
subsequently arrested. In 1990, the policy was amended to allow women who tested positive for
cocaine the choice of a drug treatment program instead of incarceration. Women who chose the
drug treatment program could be rearrested if they tested positive for cocaine again or missed an
appointment with a substance abuse treatment counselor.
Between the fall of 1989 and 1993, a total of 30 pregnant women who tested positive for cocaine
were arrested. In 1993, 10 of the women arrested under MUSC’s drug-testing police filed a suit in
the federal district court claiming that practice of warrantless and nonconsensual drug tests for
criminal investigatory purposes was an unconstitutional search under the Fourth Amendment. The
jury found for the City of Charleston on the theory that the women had consented to the searches.
On appeal, the 4th Circuit Court of Appeals affirmed the decision of the district court. The Court of
Appeals held that the MUSC’s policy did not violate the Fourth Amendment right to be free from
warrantless and unreasonable searches. The Court of Appeals reasoned that the MUSC’s policy fell
within the “special needs” exception that justified a search policy for non-law enforcement purposes
– reducing pregnancy complications and medical costs associated with cocaine use among pregnant
women. On February 28, 2000, the United States Supreme Court granted certiorari.
Issue
Whether the involuntary drug testing of pregnant women and the subsequent reporting of the drug
results to law enforcement officers constitutes an unreasonable search in violation of the Fourth
Amendment.
Arguments for Ferguson

The MUSC’s drug-testing policy does not fall under the “special needs doctrine.” Its
primary purpose was not to gather information for managing the health care of pregnant
women, but to fulfill law enforcement practices. The policy’s guidelines were defined in
terms that reflected criminal procedures, and not the delivery of medical treatment: a
positive drug test was “probable cause to arrest”; patients were referred to as “suspects”;
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emphasis on the drug results was to maintain a “chain of custody”; and law enforcement
officers investigating the complaint were instructed to retrieve “copies of all medical records
pertinent to the criminal charge.” These law enforcement steps were essential for the policy
to be effective, and not an unintended consequence.
 The Court has never upheld the warrantless and suspicionless search of an individual’s urine
under the “special needs” exception where the search policies acted in conjunction with law
enforcement officers for the purpose of criminal prosecution.
 The MUSC failed to demonstrate why the usual Fourth Amendment requirement of having
probable cause and issuing a warrant could not have been satisfied with the pregnant
women.
 The privacy interest of the pregnant women is not outweighed by the State’s interest in
treating and protecting pregnant women and their children from cocaine use. The MUSC
argues that testing of the urine was minimal because they were taken during a routine visit to
the doctor. The degree of a search’s intrusiveness, however, does not depend solely on the
method of the search, but also the nature of the privacy interest. Pregnant women seeking
medical attention are under the full protection of the Fourth Amendment. Taking urine
samples for the purpose of criminal investigation without a valid consent and turning the
results over to law enforcement officers is highly intrusive and an unreasonable search under
the Fourth Amendment.
Arguments for the City of Charleston
 The MUSC drug –testing policy was a reasonable search because it falls within the
recognized category of the “special needs doctrine” that provides for an exception when
there is no consent or warrant supported by probable cause. The “special needs doctrine”
applies when: (1) there is a compelling or important need that is based on concrete danger,
which is beyond normal law enforcement needs; (2) the policy established to meet the
special need is effective; (3) the intrusion is minimal; and (4) the State’s interest to fulfill the
special need outweighs the individual’s expectation of privacy.
 The MUSC has two special needs that necessitate the drug-testing policy. First, the medical
staff needs to know whether pregnant women are using cocaine in order to deliver the
necessary treatment. Secondly, there is the social need to curb the medical and social costs
associated with drug-use among pregnant women on their children. These two needs are
compelling under the “special needs doctrine” to necessitate the drug testing of pregnant
women, which are beyond the law enforcement function of investigating criminal activity.
 The drug testing of the pregnant women’s urine sample was effective in identifying cocaine
use, which served to fulfill the medical needs. Of the 253 women who tested positive for
cocaine the first time, 223 completed substance abuse treatment programs and did not test
positive a second time.
 Testing for cocaine in the pregnant women’s urine sample was a minimal intrusion on their
expectation of privacy. The patients came to the MUSC voluntarily for treatment and
consented to the collection and testing of their urine sample. The reporting of the urine
results did not constitute a undue violation of their privacy expectation. Under state law,
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prenatal drug use constituted child abuse, which required medical personnel to report their
finding law enforcement officers or the Department of Social Services.
 In balancing the special needs of the State under items 1-3 against the individual expectation
of privacy, the special needs outweigh the minimal intrusion placed on the individual. The
State has a compelling need to address the treatment of pregnant women using cocaine and
the effects on their children by drug testing their urine. It was reasonable for the State to
conduct such tests absent a warrant.
Majority
(Stevens, J. delivered the opinion of the Court, in which O’Connor, Souter, Ginsberg, and Breyer,
J.J., joined. Kennedy, J., filed an opinion concurring in the judgment)
 The MUSC’s policy of drug testing pregnant women and turning the results over to law
enforcement officers without their consent is an unreasonable search under the Fourth
Amendment.
 The MUSC’s policy does not fit with the special needs doctrine. The special needs doctrine
requires that the policy being used to support the special need must be separated from
general law enforcement interests. The immediate purpose of the MUSC’s policy was to
collect evidence of drug use and use the results to coerce pregnant women into drug
treatment programs, instead of facing criminal prosecution. There is no separation from the
special need of the MUSC and the general interest in crime control.
 When a search is conducted without consent or a warrant supported by probable cause, a
balancing test must be employed to determine whether or not the intrusion of the
individual’s privacy interests are outweighed by the special needs that support the program.
The individual’s privacy interests are more substantial then the state’s need. Pregnant
women seeking medical treatment have a reasonable expectation of privacy that their results
will not be shared without non-medical third parties without their consent.
Dissent
(Scalia, J. filed a dissenting opinion, in which Rehnquist, C.J., and Thomas, J., joined in part)
 The special needs doctrine is irrelevant in this case. The doctrine only applies to legitimize
an otherwise unlawful search. The MUSC’s drug-testing policy is not a search under the
Fourth Amendment. The pregnant women consented to have their urine tested. The
“taking” of their urine sample to the police can not be considered a search under the Fourth
Amendment because it does not fall with the protection of “person, houses, papers, and
effects.” Urine can not be considered as part of the “effects.”
 The Court has never held unconstitutional the practice of lawfully obtaining information,
though deceptive, for purposes other than those represented to the individual and turning
them over to law enforcement officers. A violation of a trusted relationship where
information is obtained consensually does not result in a search.
 Even if the taking of the pregnant women’s urine was an unconsented search, and the
“special needs doctrine” was relevant, it would still be properly applied and valid. The police
involvement took place after the testing was conducted for independent purposes from the
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ultimate goal of the policy to treat pregnant women effectively and predict treatment for the
postnatal care of children.
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