Ferguson v. City of Charleston

Background

Ten women who got prenatal care at a public hospital in Charleston were subject to a hospital policy (Policy M-7) that directed staff to screen urine for cocaine under nine criteria, follow a chain of custody, and refer positive cases to treatment. Hospital lawyers and a local prosecutor helped design the program so that positive results could lead to police notification, arrest, and prosecution; later the policy allowed treatment as an alternative to arrest in some cases. The women sued, claiming the nonconsensual, warrantless tests were unconstitutional. A jury found for the defendants, and the appellate court upheld the program under the Court's “special needs” cases. The Supreme Court took the case.

Reasoning

The Court assumed the tests were done without informed consent and treated the urine screens as searches. It asked whether the hospital's interest in maternal and fetal health could justify testing that was meant to produce evidence for law enforcement. The majority held that the program's immediate purpose was to generate evidence for arrests, not solely to advance medical care, and so it did not fit the "special needs" exception. Because of extensive police involvement and the threat of prosecution, the searches were unreasonable. The Court reversed the Fourth Circuit and remanded the question of whether the women had consented.

Real world impact

The ruling restricts hospitals and prosecutors from using routine medical testing as a tool to gather criminal evidence without clear consent. Pregnant patients' expectation that medical results stay in medical hands is reinforced. The decision leaves the consent facts unsettled and sent the case back to the lower court for that determination.

Dissents or concurrances

Justice Kennedy agreed with reversal but emphasized limits on using police as an integral part of health programs; Justice Scalia dissented, arguing tests and reporting were not a Fourth Amendment search.