Nature of the Case
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Facts
The public hospital, MUSC, became concerned about an increase in the use of cocaine by patients who were receiving prenatal treatment. They began to order drug screens performed on urine samples from maternity patients who were suspected of using cocaine. If a patient tested positive, she was then referred by MUSC staff to the county substance abuse commission for counseling and treatment. That policy failed. Counseling was abandoned, and law enforcement was instituted on the theory that such use harmed the fetus and was, therefore, child abuse. The threat of law enforcement involvement was set forth in two protocols, the first dealing with the identification of drug use during pregnancy, and the second with identification of drug use after labor. Under the latter protocol, the police were to be notified without delay and the patient promptly arrested. Under the former, after the initial positive drug test, the police were to be notified (and the patient arrested) only if the patient tested positive for cocaine a second time or if she missed an appointment with a substance abuse counselor. In 1990, the policy was modified to give the patient who tested positive during labor, like the patient who tested positive during a prenatal care visit, an opportunity to avoid arrest by consenting to substance abuse treatment. Ps are 10 women who received obstetrical care at MUSC and who were arrested after testing positive for cocaine. Four of them were arrested during the initial implementation of the policy; they were not offered the opportunity to receive drug treatment as an alternative to arrest. The others were arrested after the policy was modified in 1990. Ps' complaint challenged the validity of the policy under various theories, including the claim that warrantless and nonconsensual drug tests conducted for criminal investigatory purposes were unconstitutional searches. D advanced two principal defenses to the constitutional claim: (1) that, as a matter of fact, Ps had consented to the searches; and (2) that, as a matter of law, the searches were reasonable, even absent consent, because they were justified by special non-law-enforcement purposes. The District Court rejected the second defense because the searches in question 'were not done by the medical university for independent purposes. The District Court submitted the factual defense to the jury with instructions that required a verdict in favor of petitioners unless the jury found consent. D got the verdict and Ps appealed; there was not enough evidence to support a finding of consent. The majority of the appellate panel held that the searches were reasonable as a matter of law under our line of cases recognizing that 'special needs' may, in certain exceptional circumstances, justify a search policy designed to serve non-law-enforcement ends.
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