Maternal Drug Use During Pregnancy Ruled Not Child Abuse in Pennsylvania
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the concepts related to whether or not drug use during pregnancy can be considered child abuse 2. Describe some of the medical and public policy issues that may arise when considering prosecution in the setting of an opioid epidemic
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
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For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
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Continuing Pharmacy Education
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Type of Activity: Knowledge
Continuing Nursing Education
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The Pennsylvania Supreme Court, in the case of In the Interest of L.J.B., ruled that mothers who used illegal drugs during pregnancy cannot be charged with child abuse offenses. The case arose from a pregnant mother who took unprescribed sublingual buprenorphine, a treatment for her opioid addiction, following relapse from a methadone maintenance program. She tested positive for marijuana and buprenorphine after delivery. The newborn suffered from neonatal abstinence syndrome (NAS) starting by the third day, exhibiting tremors, excessive suck, increased muscle tone and loose stools. The mother was discharged from the hospital, but the newborn remained. The hospital, therefore, made a room available for the mother to stay. However, she did not stay and contact with her child was inconsistent. The local child welfare agency was granted emergency protective custody of the newborn in juvenile court. It also filed a petition in court alleging the child “without proper parental care or control … as required by law” and was a victim of child abuse by a perpetrator (parent of a child) who caus[ed] bodily injury to a child through any recent act or failure to act” under Pennsylvania law. The infant was hospitalized for 19 days during which she “suffer[ed] from withdrawal due to substances Mother ingested while Mother was pregnant with her.”
The mother argued against the charge, asserting that Pennsylvania law for child abuse does not cover a fetus or unborn child. The juvenile court agreed with the mother but the child welfare agency appealed to Superior Court. Superior Court reversed the decision and found that “Mother’s illegal drug use while pregnant may constitute child abuse if the drug use caused bodily injury to Child.” Although agreeing with the mother that a fetus or unborn child is not included in the definition of “child” in the CPSL, it found that “Mother’s drug use is a ‘recent act or failure to act’,” and that her conduct caused or was reasonably likely to cause injury to Child who, now born, constituted a “child.” It therefore held “that a mother’s use of illegal drugs while pregnant may constitute child abuse under if established that, by using the illegal drugs, the mother intentionally, knowingly, or recklessly caused, or created a reasonable likelihood of, bodily injury to a child after birth.” One Superior Court judge, although agreeing with the decision, raised the question whether pregnant woman with addiction problems would avoid prenatal care for fear of being charged with child abuse. The decision could also extend to other decisions that pregnant women make such as drinking coffee or eating sushi. An appeal to the state Supreme Court followed.
The state Supreme Court ruled that since the definition of “child” in the statute did not include a fetus, a pregnant woman cannot fit the definition of a “perpetrator” meaning parent of a child under the law because she is not the “parent of a child”. The fact that the mother became a parent upon delivery did not alter this fact. The ruling was considered a “great victory for public health, women’s rights and children’s rights.” In keeping with the comment of the superior court judge, treatment for addiction during pregnancy likely makes for good medical policy, rather than prosecution. This may be especially relevant in the context of the current opioid epidemic, which is also a statewide emergency in Pennsylvania.
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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