PATIENT OR SUSPECT?

Safeguards Needed When Hospitals Team With Police

The use of illegal drugs is both a crime and a medical problem, and much of
the debate about the so-called "war on drugs" focuses on whether the
medical or the legal model should guide public policy.

But one thing is clear after an enlightened decision this week by the U.S.
Supreme Court: Under the guise of treatment, hospitals may not gather
evidence for the police without triggering the protections of the
Constitution's Fourth Amendment, which forbids "unreasonable searches and
seizures."

By a 6-3 vote, the high court reversed a lower-court decision holding that
a Charleston, S.C., public hospital was free to obtain urine samples from
pregnant women participating in a program, and then turn evidence of
cocaine use over to police. The program had the admirable intention of
dealing with the problem of "crack babies," infants born to mothers
addicted to crack cocaine.

A lower court still must wrestle with the question of whether the women in
the program at the Medical University of South Carolina consented to having
their urine tested for cocaine. But the 4th U.S. Circuit Court of Appeals
had ruled that consent wasn't necessary, even though hospital officials
were acting in league with law enforcement officials

Initially, women in the program who tested positive were reported to the
police and then arrested. Later, the policy was changed to create a sort of
good cop/bad cop system in which women could avoid prosecution if they
entered drug rehabilitation. Either way, hospital personnel were acting as
auxiliary police officers - but not complying, as police must do, with the
Fourth Amendment.

That was unacceptable, wrote Justice John Paul Stevens in his majority
opinion. Although the court in some cases has approved warrantless police
searches under a "special needs" exception - for example, when
incriminating evidence is uncovered during an emergency search motivated by
a concern for public safety - that exception didn't apply to the South
Carolina program.

"While the ultimate goal of the program may well have been to get the women
in question into substance abuse treatment and off of drugs," he wrote,
"the immediate objective of the searches was to generate evidence for law
enforcement purposes."

Had the court ruled otherwise, the "special needs" exception would have
swallowed the rule that police must have probable cause, or at least
reasonable suspicion, to violate an individual's privacy.

Whether drug abusers should be viewed primarily as patients or as criminal
suspects is a policy question that must be settled in the political
process. But when government officials are looking for evidence that could
lead to criminal punishment, they must follow the rules - whether they wear
a policeman's blue uniform or a doctor's white coat.