In Jones County, women suspected of using drugs during pregnancy are facing criminal child abuse charges. Is anyone getting them the medical help they need?
Erica Hensley and Michelle Liu | Sunday, June 9, 2019
LAUREL — The first thing Savannah Knight Dozier did was count her new baby’s fingers and toes, making sure he had ten of each. He did.
Savannah had just given birth alone against the wall of her parents’ laundry room that afternoon in July 2017. She nursed her son until her mother arrived to take them to the hospital. The bubbly, blonde 29-year-old Jones County native, who did nails and sold drugs to make a living, was in the midst of a two-year addiction to methamphetamine. It was then, as she held her son, that she decided she needed to stop using.
“When you’re laying there having a baby by yourself and there’s nobody there but you and God — I think that was my breaking point,” Savannah, now 31, said. “I knew then that I was in way too deep, that I had gotten way farther in my addiction than I ever planned.”
The birth of her son came just after her release from the Jones County jail. She says a Jones County sheriff’s deputy pulled her over just feet from her parents’ driveway. During the stop Savannah stubbed out a cigarette on the ground before she consented to having her car searched. In it, the male deputy found a fake urine kit. Savannah was arrested and charged with littering and possessing drug paraphernalia.
But the circumstances of the arrest are in dispute. In an affidavit, the deputy said Savannah admitted to smoking marijuana and that she denied being pregnant or on medication when questioned. Savannah claims that she never admitted to smoking marijuana and was not asked about her pregnancy.
Savannah spent three days in jail before her father bailed her out and took her home, where she went into labor. She recalls later resting with her son on a hospital room couch when Capt. Tonya Madison of the sheriff’s office arrived with child protective services workers, ordering Savannah onto her feet.
Although Savannah said her son never tested positive for any drugs, a hair follicle screen later showed methamphetamine and amphetamine in her system. Less than a month later, the same deputy who arrested her at the traffic stop returned to the house to arrest her for felony child abuse. In Savannah’s indictment, prosecutors cited a subsection of Mississippi’s felony child abuse law on poisoning.
Savannah is one of 18 women Mississippi Today identified charged with felony child abuse by the Jones County district attorney’s office, which has partnered with the sheriff’s office to target women suspected of using drugs while pregnant. Assistant District Attorney Kristin Martin has argued that using controlled substances during a pregnancy is tantamount to poisoning a child.
Savannah wanted to avoid a trial, where jurors might not have understood her fight with addiction, she said. A guilty verdict could mean life in prison. When her attorney said he could get her into drug court, a program a judge can order defendants into as part of a guilty plea or a condition of probation, she thought it might help her to stop using meth. She decided to plead guilty this spring.
Drug court requires participants to take frequent drug tests, life skills classes and attend recovery meetings over the course of three to five years. If Savannah successfully completes the program, the child abuse conviction will be removed from her record.
But health advocates say it shouldn’t take arrests, jail stints, and threats of a life sentence in prison for women like Savannah to get the treatment they need.
As medical and public health approaches toward addiction have moved toward community-based treatment programs and decriminalization, experts say Jones County’s policy undermines recovery and reducing drug use — and that it could discourage women from seeking prenatal care and early treatment options.
Although underreporting makes it difficult to know exactly how many pregnant women use drugs during pregnancy, researchers estimate about 10 percent of births are affected by drug or alcohol use.
“Obtaining prenatal care really helps prevent a lot of the medical problems that women have from using drugs during pregnancy,” said Dr. Tricia Wright, who has run a Hawaii program for pregnant women struggling with addiction since 2007. Her model combines prescribing addiction medicine, access to child care, birth control and family planning, prenatal care and social services and has lowered drug use and increased custody rates among women in the program.
“We know that when we do interfere with the doctor-patient relationship and report (addiction), it really interferes with women getting prenatal care and they have worse pregnancy outcomes,” she said.
But many women are afraid to come forward and seek that treatment because of stigma and fear of legal consequences, even though their condition is treatable and not a moral failing, Wright says.
Ideally, women should be screened for substance use during pregnancy care visits, which dovetail with treatment and prenatal care. Medication-assisted treatment, which combines counseling and medication to treat withdrawal symptoms and reduce the likelihood of relapse, is considered the gold standard for recovery of moms and babies, according to federal public health guidelines.
The American College of Obstetrics and Gynecologists advises that pregnant women receive routine screenings for substance use disorders instead of last-minute screens at delivery. The group also encourages doctors to advocate for treatment and “discourage the separation of parents and their children solely based on substance use disorder, either suspected or confirmed.”
Best medical practices are one thing; state law is another.
Health care professionals are mandatory reporters in Mississippi, said Bonlitha Windham, director of prevention services with the child protection agency.
When they are caring for pregnant women who use drugs, Windham told Mississippi Today: “Medical providers must make a referral to (Child Protection Services) regardless of whether the situation is considered child abuse or neglect under law and regardless of whether or not the situation constitutes an illegal action.”
From there, it is up to the child protection agency whether to involve law enforcement, Windham added.
“It’s not really ethically tenable for us to report for this as a medical condition because we wouldn’t report for any other medical condition that might impact the pregnancy,” said Wright, who says mandatory reporting prevents doctors from giving and women from getting the medical treatment they need. When law enforcement looms over the delivery room, it interferes with the ability of obstetricians to do their job, she adds.
In Jones County, law enforcement works with local state child protection officers to identify and intervene on possible child abuse cases, said Madison of the sheriff’s office. At South Central Regional Medical Center in Laurel, where Savannah went after her at-home delivery, social workers alert Child Protection Services when mothers show positive drug tests, said Jencie Moss, a hospital spokesperson.
What triggers law enforcement’s involvement in a case where a woman uses controlled substances during pregnancy has no clear pattern. Even though Savannah insists neither she nor her baby tested positive for drugs at the hospital, local news stations reported her first arrest, which she believes could have prompted action by hospital staff. Affidavits from the sheriff’s office also state that several informants indicated that Savannah had a history of drug use. In other words, she was known to local law enforcement.
Though Martin, the prosecutor, has said that there must be a positive drug screen on the newborn for the prosecution to move forward, a review of press releases provided by the Jones County sheriff’s office and news reports shows that at least three women were arrested and charged with felony child abuse without positive test results from their children — because those arrests happened prior to their giving birth.
As far as law enforcement goes, Madison and Martin wished they had more resources — namely, money and personnel — across their offices to prosecute both these cases and others they see across the county, such as sex crimes.
Above all, Wright, who runs the prenatal recovery program, says that subjecting women like Savannah to the criminal justice system is counterproductive for moms, babies and society.
“They need support throughout their pregnancy and post-partum. They need access to medication-assisted treatment,” she said. “They need physicians, nurses and a health care system that’s supportive of their medical condition of substance use disorder. They need access to treatment, which there’s sorely lacking in this country.”
Although pregnant women receive priority for the approximately 700 beds in Mississippi for people seeking addiction treatment, only two centers — Fairland Center in Clarksdale and Catholic Charities in Jackson — with 44 beds total specialize in treating and housing pregnant or parenting women. Nationally, states dedicate about 20 percent of their recovery beds to pregnant women, with treatment approaches varying by state.
“Ideally, there would be many more treatment options in place for (women) and no criminalization on the table,” said Wengora Thompson, who directs maternal and child health for the Mississippi March of Dimes. Treatment should be the first option, she adds, because “placing a mom behind bars and separating her from her child … creates more damage than it does good.”
Thompson explains that law-enforcement officers are not trained with a patient-first mindset. However, pregnant women with substance use disorders are a matter of public health, not public safety.
“Right now it would seem that public safety has the lead, and though nice, it shouldn’t be the case,” Thompson said.
Jones County Sheriff Alex Hodge, who serves on the National Sheriffs’ Association’s board of directors and oversees Madison, said in an interview that he has shared how the county investigates and prosecutes these cases as a model to other sheriffs across the country.
“As we’re networking and talking about various issues across the table, Jones County, Mississippi is sitting there, talking about what they’re doing,” Hodge said.
As the nation grapples with an opioid health crisis, many jails across the country have become de facto detox centers for many people with addictions. Some sheriffs and prosecutors have recently called for expanding the use of medication-assisted treatment in jails and prisons.
In some cases, when Jones County law enforcement has identified pregnant women who use controlled substances, Martin said, “we’ve held them in jail, usually (by setting) a bond high enough that they can’t bond out so that they don’t get out and harm the baby anymore.”
“To me, it’s kind of like rehab, because you’re sitting there and you can’t use the drugs,” Madison said, adding that sometimes pregnant women only begin receiving prenatal care once they are in detention. The women are effectively left to detox in the jail, which also does not offer medication-assisted treatment.
Allyson Knotts, a spokeswoman for the Jones County Sheriff’s Department, said the jail offers no “official detoxing program,” although a judge may order women to remain behind bars to keep them from using for the duration of their pregnancies, and prenatal care is available through on-premise nurses or hospital transports.
“Having a pregnant inmate at the detention center is not ideal, regardless, for mother or the facility,” she said. “But if it’s necessary, it’s necessary.”
Likewise, most rehab programs and drug courts in Mississippi, including in Jones County, do not use medication-assisted treatment. Lawmakers recently passed a bill, which Gov. Phil Bryant signed, to make medication-assisted treatment an option in drug courts.
Of the women Madison and Martin have prosecuted in Jones County, a judge has sentenced about half to prison and the other half to drug court, the latter being an option the duo sees as a second chance, especially for women who have no prior criminal record.
“The word is getting around … There’s cases where we’ve been called where mothers will go to other counties and have their babies,” Madison boasted. “They live in Jones County but they travel and have their baby in another county.”
Dr. James Lozada, an obstetric anesthesiologist and assistant professor at Vanderbilt University Medical Center, who studies maternal and infant mortality, finds the approach worrisome. Lozada recognizes that patients using controlled substances during pregnancy is a societal problem. But he added that Mississippi’s high mortality rates for moms and babies puts the state in even a more critical position to address addiction as a medical issue and treat the problem instead of criminalizing it.
“I feel pretty strongly that this type of approach is certainly not going to fix the problem. It’s not going to change any of the drug use there and it’s just going to make things more difficult for pregnant patients and potentially for their children as well,” especially if women are leaving the area to give birth for fear of prosecution, he said.
“We should be doing things to improve health care for patients, to encourage them to seek care, to encourage pregnant patients to have good prenatal care and we want to encourage them to trust the medical system,” Lozada said. “This sort of thing completely undermines faith and trust in the medical system.”
Now Savannah calls a drug court number every afternoon around 3 p.m. to see if she’ll have to take a drug test. The voice on the line announces the colors to be tested that day. Maybe it’s yellow, blue, green or gold, which correspond with how long a participant has been in drug court. Savannah listens for red, her assigned color as a newcomer.
For her first 90 days in drug court, she went to a recovery meeting through Narcotics Anonymous every day. Now, she attends four weekly drug court meetings through Narcotics Anonymous and a local church and also takes mandatory anger management, parenting and marriage counseling classes with her husband, who she met during a prior stint in rehab. If she misses drug tests or is late to classes, she can be subject to a number of sanctions, including receiving a warning, having to write the sentence “I’m not going to miss another drug test” 500 times, and spending 45 days in jail.
Keeping up with work, childcare and drug court obligations can be difficult. Savannah is only able to work when her own mother is free to take care of Savannah’s two children. She has two new jobs — waitressing during the day and working as a nursing home assistant at night — to pay for her daughter’s private school tuition and $50 monthly drug court fees.
On weekends, she puts on pink rubber boots and picks up trash on the side of the road as part of her court-ordered community service.
She spends her few remaining waking hours with her family, including her son, now a rambunctious toddler. She also has the support of her parents, who run a well-known motorcycle ministry called Hellfighters and a men’s rehab center in Laurel.
“It’s like taking baby steps,” Savannah said of her recovery. She recalled the pleasure of her first sober Mother’s Day last month. “I haven’t lived life without using drugs for so long that everything’s new.”
If Savannah successfully completes drug court, that felony child abuse charge will disappear from her record. But if she fails, relapsing one time too many, a harsh punishment looms over her: up to 10 years in prison, far away from her family.
Despite the ordeal and her initial feelings about the system treating unfairly, Savannah now credits the system, including the prosecutors and judges she once saw as adversaries, for helping her get clean and save her family.
“You’ve ever heard that statement, ‘When mama ain’t happy, nobody happy?’ When mama’s happy and mama’s good (then) daddy’s good and baby’s good and sister’s good,” she said, referring to her own family. “That may sound cliche but, you know, it really is true.”
This is the second of two stories exploring the relationship between the criminal justice system, pregnancy and drug use in Jones County, Miss. Read the first story here.