Legalized abandonment laws pose administrative, ethical challenges

Effort to create social change falls to state legislators

In the first 10 months of 1999, child welfare officials in the Houston area were shocked by a disturbing trend: 13 newborn babies were found abandoned in places as varied as a hospital emergency department parking lot, underneath a shrub in a park, and inside a trash dumpster. Three of the newborns were found dead.

The 15-year-old mother of one of the babies faces murder changes. Her newborn daughter, authorities contend, died of blows to the head before being left in a high school garbage bin.

Gaining national momentum

The problem isn’t just in Houston, either. At least 31,000 babies were delivered and abandoned in hospitals in 1998, according to estimates released in April by the House Ways and Means Committee. The House passed a resolution that same month calling for federal, state, and local governments to track the number of newborns abandoned in public places.

Houston, the nation’s fourth largest city, which previously had seen one or two cases of abandoned newborns per year, was suddenly faced with a frequency rate of more than one per month.

To combat the problem, Texas state legislators last year passed HB 3423, which allows a parent to anonymously leave a baby younger than 30 days with a licensed emergency medical service provider without fear of prosecution. That state law has become the model for several other state efforts to decriminalize newborn abandonment if the parents bring the baby to a health care facility, fire station, or police station.

At the same time, many questions arise about how state health care systems can be expected to handle those children, and what the long-term ethical implications will be.

"I don’t think there is any question that this law will save lives," says Diana Fite, MD, FACEP, past president of the Texas College of Emergency Physicians (TCEP) and clinical assistant professor of medicine in the University of Texas-Houston’s school of medicine and department of emergency medicine.

"Not only are we trying to prevent the killing of the babies; the babies who were found alive had been exposed and suffered other injuries. The mothers who do this just do not understand that they could just walk into a emergency room and say, I can’t take care of the baby. I don’t want the baby.’ And we would take the baby, and she would be OK. It is not just fear of prosecution. Many of these people obviously don’t want their families to find out, and if you go through adoption, you end up needing permission from the father to adopt. It is much more involved. So I think that is why people have resorted to killing, drowning, or abandoning the babies."

Even though most health care experts support the effort, some express concern that the practice does not address the societal ills that lead to infanticide and abandonment. Health care experts also fear the legislation places the health care system in an unfamiliar role.

"My concern is what will this do to address why [the parent] is in this situation to begin with?" says Arlo Weltge, MD, FACEP, an emergency physician, an associate professor of medicine at the University of Texas-Houston Health Science Center, and another past president of TCEP.

"And the legislators were not specific about the process that the EMS providers should go through once the child is turned over to them. The intent of the legislation is good. We don’t want these children abandoned in places that can lead to harm coming to them. It will depend on the individual EMS agencies and emergency centers knowing about this ahead of time and developing a policy of how to accept the child, what should be done with the child at that point in terms of protective services, etc. My concern is that the baby might be vulnerable for a certain period of time if this issue is not worked out explicitly."

For example, hospital emergency departments are required under federal law to treat any presenting patient as if he or she were seriously ill, performing a number of diagnostic tests to rule out a life-threatening condition.

"This could subject the baby to unnecessary stress," he notes. "In addition, it could lead to a number of costly procedures and services."

The new Texas law requires that the provider accepting the child contact child protective services by no later than the close of business the day after the provider takes the child into custody. The child-services officials would decide how to proceed.

The main point, says Fite, is that the parents would not face charges for leaving the child.

"Most emergency departments have experienced this already. We have had babies abandoned in the parking lot and just outside the hospital," she notes. "Under the new law, they would also be considered having been left at an emergency facility. It is our property."

The difference is that no effort is made to track down the parents. The baby is taken into foster care with the same legal status as an abandoned baby, except that the baby is "legally abandoned."

Long-term consequences

The Texas statute is the first of its kind signed into law in this country. Several other states, including California, Delaware, Georgia, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, and West Virginia, recently introduced similar legislation. A total of 24 states are considering state bills that would allow mothers to leave their children in safe places such as hospitals or fire stations without legal repercussions.

Some states have informal arrangements with hospitals, charitable groups, and law enforcement agencies that encourage parents with unwanted newborns to bring them to a safe place.

A St. Paul, MN, nonprofit organization, A Safe Place for Newborns, has arranged agreements with three area hospitals that allow parents to leave babies anonymously at the facilities without fear of prosecution.

Since 1998, a program in Mobile, AL, has allowed parents to drop off unwanted newborns at participating hospitals with total secrecy. Since the program’s inception, no dead infants have been found, and three new mothers have brought babies to the hospital to surrender for adoption.

Those policies are a good first step to protect society’s most vulnerable children, but simply encouraging parents to anonymously drop off an infant does not adequately address the long-term consequences of abandonment, says Caroline L. Burry, PhD, assistant professor at the University of Maryland, Baltimore’s school of social work.

"Of course, it is good to have a place available, and we want to say to the parent or parents of the baby, Yes, we will accept the child with no questions asked.’ But it would be much better if we could encourage them to come in with the baby and give some information, medical information, or background that we could have for the child later," she says.

For example, both the Mobile and St. Paul programs ask but do not require the parent to provide a medical history for the baby. The parent, usually the mother, is given an identification bracelet allowing her to return within a specified time to reclaim her child if she decides to do so.

However, some of the new legislation seems to focus on protecting the anonymity of the parent, while there is very little encouragement from society for parents who may need to place their child for adoption and might be willing — with a lot of support — to be identified or leave background information for the child, says Burry.

Society says no to adoption

Burry has worked extensively with adoptive parents, adopted children, and parents who needed to place children, she adds. Children who have some indication of why their parents placed them for adoption, and some sense of where they came from, often have a much easier time later in life, she says.

"We even encourage parents, if they are willing, to leave letters for the children or to at least provide some information, either medical or otherwise," she says. "Many parents are willing to take that responsibility, but we as a society do not support adoption as a decision. People, particularly teenagers in this situation, have no information about adoption or how to go about placing their child."

She hopes that hospitals and communities that want to address the problem of infanticide or child abandonment would make an attempt to offer a range of services rather than just an open baby bed and an invitation to surrender the unplanned-for new life. It would be better if such a program were in conjunction with enhanced outreach to at-risk parents. Information about adoption placement options, for example, and an increased effort to educate parents about social services and aid that are available to help them take care of the baby might be more effective.

"Again, you would want to emphasize that you will accept the baby, no questions asked," she notes, "but I don’t think that should be the only option."

Hospitals need a plan

Although the Texas law was passed in September 1999, Weltge says several EMS providers and emergency departments he’s contacted have little information about their responsibilities under the new provision.

"One of the EMS medical directors has instructed their departments to develop a policy, but there is a significant degree of variation in the amount of knowledge from provider to provider," he says.

In many cases, if a baby is surrendered to a paramedic or other licensed professional in the community, that person likely would bring the child to the nearest emergency department for a medical evaluation, adds Fite.

However, neither Fite’s department nor others with which she is familiar have had the direct experience of taking an abandoned baby into custody, she says. "I am not sure how well the word has gotten out, even to the people who would potentially abandon or hurt their baby. I think we have even had a case of a baby found since the law has been passed. So, evidently, we are not reaching everyone."

If a hospital is considering starting its own "safe place" for babies, it is best to start by forming some kind of advisory panel made up of child welfare advocates, social workers, law enforcement personnel, and hospital staff, recommends Fite.

"In the first place, you need to know what the law is in your state," she says. "In some states, it is illegal to simply come in and attempt to surrender the baby."

There also should be a definite protocol in place for how the state department of child protective services will be notified and whether and how they will assume custody, she says. "It will be interesting to see if this becomes social policy" to allow parents to voluntarily surrender their children without penalty, she adds, noting that the planned laws only cover newborns.

If parents who were unprepared or unable to care for their children were encouraged and supported in a decision to place their children, many cases of child abuse might be prevented, she speculates.

"Some people are not prepared to be parents of children at a certain time or do not want to be parents at all," she says. "If we had a better way of allowing them and supporting them in a decision to place the child, we might be intervening before that family comes to the attention of child protective services for occurrence of abuse or neglect."

Caroline Burry, PhD, University of Maryland, Baltimore, School of Social Work, 1000 Hilltop Circle, Baltimore, MD 21250.

Diana Fite, MD, FACEP, University of Texas at Houston Medical School, 6431 Fannin St., Houston, TX 77030.

Arlo Weltge, MD, FACEP, University of Texas-Houston, Health Sciences Center, 6431 Fannin St., Houston, TX 77030. Telephone: (713) 792-5450.