Without debate or fanfare, the Pennsylvania legislature last week passed a bill that will dramatically change the rules for safeguarding newborns who go home from the hospital with mothers battling addiction.
Last year, almost 3,300 drug-exposed newborns were born in Pennsylvania, up from 788 in 2000, according to an analysis by the Pennsylvania Health Care Cost Containment Council. These infants are at greater risk of neglect and abuse, though child welfare advocates have been torn about the best ways to identify and protect them.
The overhaul, effective in October, says any newborn "affected" by the mother's drug use during pregnancy must be reported by the hospital to the county's child protective agency, which must "immediately" assess whether protective custody is needed. The agency has to develop a "plan of safe care" for babies who go home.
Even though the legislation — which brings the state into compliance with the federal child abuse prevention laws — amends state law, it explicitly says that the reports of drug-exposed babies will not be deemed child abuse. Child welfare experts consider that provision vital to keep mothers from feeling stigma and fearing prosecution, which could deter them from getting drug treatment.
Gov. Wolf signed the bill Thursday — the same day he announced the second 90-day renewal of his opioid disaster declaration. Under that declaration, the state health department has collected hospital data showing that more than 892 newborns had to be treated for drug-withdrawal symptoms in the first six months of this year.
Far more babies will be covered under the amended law, because it requires reporting drug-exposed newborns even if they do not show physical signs of withdrawal such as tremors, vomiting, diarrhea, and inconsolable crying.
Despite the potentially huge impact of the changes, neither the governor nor any lawmakers issued announcements.
"It is troubling and telling that the governor renews the opioid emergency and signs this legislation on the same day, and yet no one pays attention to it," said Cathleen Palm, head of the nonprofit advocacy group Center for Children's Justice. "It feels like we're a state that's not totally ignoring the impact of opioids on babies, but it's a sidebar conversation."
Rep. Thomas Murt (R., Montgomery) posted on Facebook and issued a release about the part of House Bill 1232 that he championed: a new requirement that all schools display a poster with the state's toll-free child abuse hotline number. He said the provisions affecting drug-exposed babies were added in the Senate.
Why not alert the media about those provisions?
"I don't have an answer," Murt said. "We weren't being coy. I don't know why the media didn't pick it up. One reason might be that the fiscal note came up neutral."
The analysis of the bill's financial impact said it "should have no fiscal impact to the commonwealth."
But for more than a year, a committee that includes Palm, hospital representatives, and child abuse caseworkers has been meeting with state officials to try to figure out how to comply with the federal child abuse law. They have grappled with ambiguous parts of the federal law, as well as the fact that child protective agencies' budgets have not kept pace with the needs of families torn by addiction.
The committee's leader, Cathy Utz, deputy secretary of the state Department of Human Services, did not respond to a request for comment by Friday afternoon.
In the past, Pennsylvania law has gone back and forth about whether hospitals should report all drug-exposed newborns to protective services, or just those exposed to illicit drugs such as heroin. In 2015, the law was amended to limit reporting to illegal drug exposures.
That change was a recognition that many pregnant women with a history of drug abuse take prescribed opioids — methadone or buprenorphine — to manage their cravings, prevent withdrawal, and avoid the miscarriage risk of quitting opioids cold turkey. But newborns exposed to legally prescribed opioids still can suffer withdrawal symptoms. They typically spend days or weeks in the hospital getting oral morphine or methadone to gradually break their drug dependence.
The new law has sweeping language that says all drug-exposed newborns must have a risk assessment. The plan of safe care must ensure the "safety and well-being" of the child, and address the substance-abuse treatment needs of parents and "any caregivers."
James C. Greenwood, a former child protection caseworker who represented Pennsylvania in the U.S. House for six years, crafted the federal law's protections for drug-exposed newborns and lobbied Pennsylvania lawmakers to come into compliance.
"I am thrilled," he said. "Maybe you have to pay to hire more caseworkers. But if you don't help these kids at the beginning, you're going to see them for the rest of their lives."