01 April 2015

Jailed For Miscarrying

I read a news report yesterday that I have been thinking about it ever since. I want to share it with you. Please be warned that the facts of the story contain some graphic details. (I have adapted my description of the facts from a UPI story that you can read for yourself here.)

The story is that of Purvi Patel, a 33-year-old woman of Hindu descent from mostly Irish-Catholic South Bend, Indiana. In July 2013, Patel miscarried a pregnancy at her home, where she lived with her immigrant parents and grandparents. It is not clear exactly how advanced the pregnancy was - that was one of the issues at her later trial. But Patel expelled, along with a lot of blood, a recognizable fetus, which she claims was dead. (Whether it was actually dead at the time was also an issue at the trial.)

A few hours after miscarrying, Patel went to a local hospital, because she was bleeding heavily. Before she left for the hospital, she cleaned up the mess and put the fetus in a dumpster at a shopping center across the street from the hospital. She then presented herself in the emergency room for treatment of her heavy bleeding.

Although Patel did not initially tell the emergency-room doctor all of the details of what had happened, it was apparent to him that she had recently given birth. Her womb still contained a placenta and a severed umbilical cord, and the doctor opined that her pregnancy had been "fairly far along." The doctor decided that he was looking at a case of child abuse, and, as a mandatory reporter, called the police and sent them to Patel's home in search of a newborn baby.

Told that the police were on their way to her home, Patel revealed to the doctor that the fetus was across the street in a dumpster. The doctor relayed that information to the police, who gathered at the shopping center across the street to conduct their search. Patel went into surgery to have the placenta removed; while that was going on, the doctor joined the police outside and assisted them with their search. They found the fetus fairly quickly, exactly where Patel had told them it was, and it was definitely dead.

A criminal investigation was initiated, on the theory that the fetus had been born alive and breathing, and that Patel's neglect had caused its death. Patel was interrogated as she emerged from anesthesia in the recovery room at 3:00 AM, without benefit of a Miranda warning, and was ultimately charged with child neglect and infanticide under Indiana law.

The pretrial investigation uncovered text messages between Patel and a friend in which they had discussed buying abortion drugs online, but there was no evidence that Patel had ever purchased them. Both she and the fetus tested negative for the presence of the drugs. To support its theory that the fetus had been viable, the prosecution hired a pathologist who placed the fetal lungs in water and observed that they floated, and were therefore capable of holding air.

Patel was convicted, after a jury trial, on both counts. She was sentenced on March 30 to twenty years' imprisonment.

I find this case troubling - even horrifying - on many levels. The aggressive prosecution of a woman in her situation raises many very serious issues. Where were the emergency room doctor's ethical loyalties - to his patient, or to the police? Most states have statutes in place that protect doctor-patient communications from disclosure in legal proceedings. The idea is that doctors must be able to treat their patients effectively, without fear of legal reprisal. Where was the confidentiality in this situation? Did Patel have a right to expect that her doctor would not turn her in to the police?

Why was Patel questioned right after coming out of surgery, without benefit of a lawyer and without being advised that she was entitled to one? (The Miranda requirement is federal and not subject to the Indiana legislature's whims.) Many of the questions she was asked while coming out of anesthesia seem unnecessarily harassing and even irrelevant. (According to the UPI report, she was apparently questioned repeatedly about the identity and race of the father.)

On a larger scale, what sort of precedent do we set by prosecuting a case like this? Will women be discouraged from seeking medical assistance after miscarriage, for fear of being charged with a fetus's death? Should a woman who delivers a fetus prematurely at home be given the responsibility of determining its viability and, in her extremis, seeking medical care for it? Will women be charged criminally if they miscarry after engaging in poorly-advised behaviors during pregnancy (drinking alcohol or eating unpasteurized cheese, for instance, or failing to wear a seat belt? Skipping their vitamins)? Patel's defenders have noted, pointedly, that the law under which she was charged has been used only twice - both times against immigrant women. (The other woman apparently attempted suicide by poisoning herself during her pregnancy, and her newborn died shortly after birth.) Is this a simple fact of circumstance, or is there, as Patel's defenders charge, discrimination afoot?

I know many of my readers will have a lot to say about this. Please let me know what your thoughts are, in the comments. I know that this is a highly-charged issue, but I trust you to keep your comments civil.