To the Editor:

Bob Herbert ("Pregnancy and Addiction," column, June 11) laments that
at one time in Charleston, S.C., "30 women were arrested 'out of their
hospital beds' at the Medical University of South Carolina," but he
doesn't mention that nurses at the university used to plead with
pregnant addicts to enter drug treatment.

In 1989 not one of the women kept her appointment at the substance
abuse clinic, and each tested positive for cocaine upon returning to
the hospital in labor. After delivery each woman again refused treatment.

Then South Carolina turned to coercion: any woman testing positive who
refused an appointment at the substance abuse or prenatal clinics was
arrested and charged with possession of an illegal drug or
distribution of drugs to a minor.

In early 1990 the policy was modified to allow avoidance of arrest by
successful completion of treatment.

Afterward, the incidence of positive urine screens for cocaine dropped
from more than 20 a month to 5 or 6. Did the program deter women from
going to the hospital? No. Delivery rates for in-hospital and at-home
births stayed constant.

Despite the promising results, the Federal Department of Health and
Human Services said that the program discriminated against pregnant
black women and threatened to cut Federal financing. It was closed in
1994.

SALLY L. SATEL, M.D. Washington, June 12, 1998

To the Editor:

Of more concern than criminal actions and postnatal civil actions that
pose legal problems in treating a viable fetus as a "child" entitled
to state protection is the ineffectiveness of measures aimed at
deterring substance abuse during pregnancy (column, June 11). By the
time the state intervenes, the fetus has already been exposed to
dangerous amounts of toxins.

Recently, the prenatal civil commitment has been proposed as the
proper legal remedy. This consists of court-ordered confinement of a
substance-abusing pregnant woman in public treatment centers, where
she may receive drug treatment, counseling, education and prenatal
care. Not only does this measure reprimand the mother and provide a
deterrent for continued substance abuse, but it also provides the most
complete protection for the developing life of the unborn child.

JILL THOMSEN New York, June 11, 1998
The writer is a law student.

Checked-by: (Joel W. Johnson)