AJC investigates inmate care for expectant mothers

County jails can set their own policies. Prenatal, emergency, shackling guidelines cover a wide range

By Paige Cornwell
The Atlanta Journal-Constitution

ATLANTA — It was 4:15 a.m. when pandemonium broke out.

For hours, DeShawn Balka, 5 1/2 months pregnant, had sat on a toilet in a Clayton County jail cell, complaining of nausea and stomach pain. Her cellmates thought it was little more than a case of indigestion. Then Balka started screaming: She needed a nurse right away. Her baby was in the toilet.

Her cellmates sprang into action, banging on the bars to summon help for the 25-year-old, jailed for violation of probation for misdemeanor marijuana possession. Still, Inyx O'Neil Balka was declared dead 75 minutes later.

Whether the death could have been prevented with proper fetal monitoring and adequate living conditions is the subject of a lawsuit filed against Clayton County and Sheriff Kem Kimbrough. The lawsuit, some say, highlights a problem in Georgia: While the state sets a protocol for how expectant mothers are to be treated in state prisons, it allows county jails to develop their own policies. And those policies can vary greatly.

Only half of the county jails in the Atlanta region have a written policy on whether restraints can be used on incarcerated pregnant women, and less than half outline specific guidelines for how to approach prenatal care or medical emergencies. Across the state, the number drops. In response to these discrepancies, several human rights organizations and lawmakers have called for a state law setting guidelines on how to handle expectant mothers who end up behind bars.

It's hard to get a handle on exactly how many pregnant inmates there are in county jails because the number is so fluid. The Fulton County jail housed 22 pregnant women in July. In Cobb County, 11 pregnant women were in custody this month.

Pregnant women constitute a vulnerable group in the criminal justice system, advocates say, one that carries a unique set of issues. Pregnancies among jailed women are often unplanned and high risk, affected by lack of prenatal care, poor nutrition and substance abuse.

At the state level, all pregnant inmates are housed at Helms Transitional Center in Atlanta. In June, 48 mothers-to-be received services from nurses, who provide 24-hour care. The inmates, who have been convicted and are serving out sentences, see an OB/GYN weekly. There's an on-site ultrasound, and officials arrange for any outside services deemed necessary by physicians.

"The clinical staff is very compassionate so they can answer their questions," said Sharon Lewis, medical director of the Georgia Department of Corrections.

Pregnant women in county jails, who are typically awaiting trial and have yet to be convicted of any crime, may not have the same accommodations, as the amount of prenatal care varies from place to place. Balka's lawsuit says jail officials ignored a host of ailments, including dehydration and bleeding, in the days before she lost her baby. Clayton County jail officials have said she received adequate medical care. They declined further comment because of the pending suit.

In Fulton County, inhouse medical personnel have the authority to prescribe bed rest or prenatal vitamins. In Cherokee County, arrangements are made with the local hospital or health department for monthly prenatal checkups, though more can be scheduled if indicated.

One of the most contentious issues related to pregnant inmates is the use of restraints when the women are being transported or when they're in labor. Corrections officials use the shackles to prevent escape. But human rights advocates and medical organizations say they endanger the woman and her unborn baby because it increases the risk of falls, can delay treatment and put undue stress on mothers.

A Georgia Department of Corrections policy, adopted in January, states that restraints should not be used on pregnant women, unless the inmate is deemed violent. "The first thing is, it's the right thing to do," Lewis said about the department's policy on not using restraints.

If restraints are used on expectant mothers in state prison, the warden will need to provide a report afterward to justify why this occurred.

But on the local level, some jails ban the use of restraints on pregnant women, like in Rockdale County, and others, like Cherokee County, require that inmates wear hand and leg restraints, as well as a waist belt, unless the transport officer obtains approval from the watch commander.

In Cobb County, pregnant inmates are sometimes restrained with leg irons or handcuffs in the front. Col. Don Bartlett said it all depends on a variety of factors, including how far along the woman is, the crime she's accused of and her behavior.

There are circumstances, "without a doubt," where a pregnant woman would be in handcuffs and leg irons, Bartlett said, such as a woman charged with a violent crime who is one month pregnant.

"It comes down to common sense more than anything," Bartlett said.

Across the nation, at least 15 states have adopted legislation banning shackling during labor. A Florida law that prohibits shackling "during labor, delivery, and postpartum recovery" went into effect last month.

A similar bill in Georgia introduced in the last legislative session, that would have applied to state and county facilities, didn't get out of committee. "It is unimaginable to me that a woman who is in the middle of childbirth could be shackled," said state Rep. Alisha Morgan, D-Austell, one of five female Democrats who authored the bill.

The bill received a lot of discussion both inside and out of the committee, said committee member Barbara Massey Reece, D-Menlo. Committee members felt corrections officers were being flexible enough with the use of shackles "so they were not endangering the females or the babies," said Reece.

"I don't think it's a major issue except in a few certain law enforcement jurisdictions," Reece said. "I think any inmate that is brought out in the public has to be with shackles. This is just a matter of public safety."

ACLU Foundation of Georgia Legal Director Chara Jackson disagrees. It's possible to balance public safety with providing a healthy environment for the pregnant woman, she said, and a law would provide that balance.

Taylor Hogan, arrested on possession of stolen property, said she was shackled both before and after she lost her baby in August 2010, when she was only 24 weeks pregnant. She filed a lawsuit in April against Cobb County, the sheriff's department and the jail's medical providers, WellStar Health Network, saying that her baby died because she received "grossly inadequate" care. The entities declined to comment on pending litigation.

Savante Hopkins Jr. lived about nine hours. As she held her dying baby in her arms, her foot remained cuffed to a hospital bed. "For them to put the shackles on me and treat me like I was going to run, it was horrible," she said.

Even if a person's in jail, Balka said, "They should always be treated like a human." She said jail officials failed to properly document her condition, supply adequate nutrition, or perform proper fetal monitoring.

Major Robert Sowell, of the Clayton County Sheriff's Office, said the jail does not have a specific policy regarding pregnant inmates, but all medical emergencies are treated the same: A physician is called to determine what course of action to take.

Balka's lawyer, Michael Mills, said her baby died because of several "fundamental flaws in the system."

"For anybody to have their baby die because of a misdemeanor pot charge is completely ludicrous," he said. "Clearly, this is a problem, and something is wrong."

Copyright 2012 The Atlanta Journal-Constitution

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