Is there ever a justifiable reason to deny medical care to a pregnant woman serving time in jail? To most of us the answer would be a resounding no. But if there is a shred of justice that exists in our legal system, the story of what Bethany Cajune had to endure while pregnant and incarcerated would ensure that this question could only be answered, under constitutional law, in the negative, leaving it lost in society's archive of "barbaric ideas we have long since buried."
The ACLU has filed a complaint [11] against Lake County in Montana, the Sheriff of Lake County, a physician at the Lake County Detention Center, and the Chief Detention Officer for the facility, on behalf of a young, pregnant mother in Montana, jailed for traffic violations, and denied her physician-prescribed medication to suppress withdrawal symptoms, while in jail, putting her health and the health of her pregnancy in extreme danger.
Bethany Cajúne, mother to five young children and pregnant with her sixth child, voluntarily reported to Lake County Detention Facility to serve out the remainder of a short-term sentence for traffic violations. According to the complaint filed by the ACLU, Cajune had been nearing the end of a year-long treatment program for an opioid addiction, which included taking an FDA-approved medication called Suboxone. This allowed her to participate in a counseling program, take classes towards earning her GED and maintain a healthy pregnancy under a doctor's supervision.
For pregnant women, abrupt withdrawal from opioids is harmful to both the health of the fetus and the health of the woman. Specifically, says the ACLU complaint,
"...when a pregnant woman is
abruptly taken off her medication-assisted treatment, her fetus may go
into withdrawal and suffer from a lack of oxygen, possibly causing
fetal stress. Also there is an increased risk of preterm labor, low
birth weight and fetal death."
Those are not potential results you want to test. This is why our federal government has issued strong guidelines on substance abuse treatment for medication to stem withdrawal symptoms for pregnant women. As Diana Kasden, the ACLU attorney in charge of this case told me, "The federal agency that oversees guidelines and policies on substance abuse treatment [Ed Note: The Substance Abuse and Mental Health Services Administration] says it is critical that pregnant women not be put through withdrawal."
The National Commission on Correctional Health Care [12]guidelines strongly suggest that pregnant women "not be withdrawn from opioid treatment."
Cajúne took all the right steps to care for her own health as well as the health of her fetus by making sure she would be able to continue her drug treatment medication while serving her 19 day sentence at the Lake County Detention Center. Prior to starting her jail time she had her drug treatment counselor contact the Chief Detention Officer to let him know how important it was for her to continue the Suboxone during her time in jail. She arrived at the center with her Suboxone, and also told the officer during booking that she was pregnant and needed Suboxone.
The Lake County Detention Center staff - from its Chief down to the booking officer - was clearly informed of Cajúne's medical needs and her pregnancy. Yet, when Cajúne requested her medication once in her cell, they immediately refused telling her she needed to speak with a doctor first.
For days, Bethany Cajúne was denied access to the medically indicated drug treatment so critical to the health and safety of the fetus growing inside her. She filed medical complaints. Her physician made repeated phone calls to the jail explaining exactly why Cajúne needed the Suboxone and what would happen if she didn't get it. He faxed letters to the Chief Detention Officer as well as to the center's physician, describing "the risk of harm, including possible fetal death" if Cajúne was denied her medication. The center's physician even visited Cajúne in her cell only to tell her, according to the ACLU complaint, "she could not have her Suboxone."
Bethany Cajúne's symptoms continued to worsen over the next 2-3 days. She experienced vomiting, diarrhea, dehydration and then panic attacks. She was placed in solitary confinement and still her doctor's pleas to provide her with the medication she needed, at this point also directed to the Sheriff of the county, went ignored. Bethany Cajúne was suffering through exactly what physicians and the federal agency overseeing substance abuse treatment desperately try and avoid: full-blown opioid withdrawal while pregnant.
It is possible, maybe likely, that because a public defender stepped in to file a motion to ensure the medication was administered Cajúne and her baby are alive and healthy today. After a court reviewed the affidavit, Bethany Cajúne was released and immediately put back on the Suboxone. But only after she was kept at the hospital overnight. In the ten days it took for her to finally receive medication, under court order, she had lost nine pounds and had become severely dehydrated.
There were no legitimate reasons - medical or legal - to deny Bethany Cajúne her Suboxone. In fact, as Kasdan said to me, "It is a constitutional principal that you cannot deny medically necessary drug treatment to prisoners."
Kasdan also says that, “Women do not lose their right to safely carry their
pregnancies to term when they are incarcerated, and they certainly
cannot be denied treatment for serious medical needs. Lake County
knowingly put Ms. Cajúne’s health and the health of her pregnancy at
severe risk by refusing her treatment.”
Bethany Cajúne agrees saying she was honestly afraid her "baby might die."
No matter why a woman is serving a jail sentence, knowingly placing a pregnant prisoner and her growing fetus in danger is unconscionable. But according to Women and Prison [13], a site dedicated to telling incarcerated and formerly incarcerated women's stories, more than 70% of women inmates were incarcerated (in the United States)
for non-violent drug, property or public order offenses. Cajúne was in jail on a traffic violation and ended up surviving a nightmare.
The ACLU calls this case a violation of both the eighth amendment ("cruel and unusual punishment") as well as the fourteenth amendment ("protection of the rights or privacy, personal autonomy, and a woman's decision to continue her pregnancy to term"). Bethany Cajúne simply says she's bringing the case to ensure that no other woman goes
through what she had to endure.
You can watch interviews with Bethany and her lawyers here: