In late 2001, Shirlene gave birth to a heroin-addicted boy. Still mired in drugs and the prostitution that helped pay for them, she eventually gave up her parental rights.
Two years later, Shirlene gave birth to another boy -- who had been exposed to drugs, but was not addicted. A week later, she died after slipping into a coma during delivery.
She was 26 years old.
"The system has failed this woman," said Lana Taylor, a deputy in the Salt Lake District Attorney's Office who uses Shirlene's case to argue for a new approach to pregnant women who are using drugs. "There is a stack of cases just like this one."
Despite Melissa Ann Rowland's recent high-profile trip through Utah's criminal justice system, prosecutors say they have too few options when presented with women like Shirlene.
Rowland, 28, was charged with murder in January for allegedly refusing a Cesarean-section that doctors believed would have saved the life of one of her twins. The surviving twin was adopted. Despite an outcry from advocates for reproductive rights, she pleaded guilty to two counts of child endangerment, based on drugs she used during pregnancy. But Taylor and other prosecutors argue child endangerment and abuse laws apply only to children who have been born, and cannot be used against pregnant women for their drug use.
Most pregnant drug abusers are using drugs, not dealing or manufacturing them, said Patrick Fleming, director of Salt Lake County's Division of Substance Abuse. Police often learn of pregnant drug users while investigating or arresting their boyfriends or husbands for the more serious offenses.
"They're not dealers," Fleming said. "They're collateral damage."
A misdemeanor charge of possession by consumption is possible, but is rarely seen as worth the effort. And jails are reluctant to hold pregnant women considered high risk or nearing their due date.
Against that backdrop, police are routinely letting pregnant women go with only referrals to treatment programs, an opportunity that some women never pursue.
"We don't know what to do," Taylor said last week at a Utah Substance Abuse and Anti-violence Coordinating Council summit on the issue. "What do we do?"
Increasing the criminal justice system's ability to force treatment on pregnant women is an option. But it's a potentially perilous one.
"We want two things that are diametrically opposites," said Paul Boyden, executive director of the Statewide Association of Prosecutors. "We want courts to have the ability to order them to go [to treatment]. But we don't want to scare them away."
Fear of prosecution can lead women not only to avoid police, but to avoid basic care for themselves and unborn children, Fleming said. That is too much of a gamble to take, he argues.
"I do not want to do anything to chase a woman underground and not get even the most basic prenatal care," Fleming said.
The problem -- and its solution -- isn't isolated to the criminal justice system, said Lucianno Colonna, executive director of the Harm Reduction Project. He says the substance abuse community has failed as well.
"[Police] need more services from the substance abuse community," Colonna said. "They need quicker and faster access."
Susan Burke, the director of the Utah Substance Abuse and Anti- violence Coordinating Council, agrees, noting beds in residential treatment are available, but the centers aren't connected to the police who find the women who need them. While there is a three- month waiting list for some residential beds, federal law, which includes funding, requires pregnant women and mothers to be the first served.
"The problem isn't a treatment slot," Burke said. "The real key is how do we get them there."
Staff from state agencies, prosecutors, police and treatment providers who attended the summit agreed the answer does not lie in new legislation.
Fleming is promoting a program that will connect a case manager from a substance abuse treatment center to the Salt Lake Police Department. It will offer police a social worker who can go to a scene and offer help to a woman.
The option could be in place by mid-2005, as contracts awarded by Salt Lake County's Division of Substance Abuse are renewed. If it's successful, the program could be expanded to other police departments.
Prosecutors are looking to existing laws for answers. They and the coordinating council will be urging police to more frequently pursue cases of possession by consumption.
With the amount of work required -- such as procuring a blood test -- and the relatively modest charge, most officers are likely unaware the option exists, Burke said.
The charge is worth the work because there "is a payoff" -- the potential of healthy babies born after their mothers are sent to treatment and stop using drugs, Burke said.
Offering positive incentives for treatment to pregnant women -- as opposed to punishment -- will also be explored. Incentives can be as simple as providing diapers and formula, or as complex as finding housing assistance, vocational training or education, Fleming said.
Burke also proposes creating a 24-hour referral center, where officers can take women who may be interested in treatment. Such a center would draw more women into treatment than a phone number provided by an officer, she predicts.
"The problem isn't going to be solved by passing a new law," Burke said. "This problem is going to be solved by improving the system to respond to them."
Pregnancy and drugs
No one knows how many pregnant Utah women are using drugs. Some estimates:
* Publicly funded treatment centers treated 282 pregnant women in Utah last year, according to the state's Division of Substance Abuse and Mental Health.
* Law enforcement estimates an additional 60 women each year use drugs during pregnancy but don't obtain treatment.
* Substance-abuse experts believe both numbers are woefully low.
* At the University of Utah Hospital, there are one to three children born each month addicted to methamphetamine. Babies exposed to cocaine many times are not detected. Later in life, these children have behavior problems and are more likely to need special education for their learning difficulties.