In response to an increase in the number of pregnant women using drugs, in 1989 the Medical University of South Carolina (MUSC) instituted a drug testing policy. MUSC is a public hospital in Charleston. The policy set forth nine criteria to identify pregnant women suspected of using cocaine and required drug screenings be performed on urine samples from those women. The screenings were performed without a probable cause or informed consent. Initially, patients who tested positive for drugs were referred to drug counseling and treatment. Later, MUSC began working with police to prosecute patients that tested positive for drugs. Ten women (plaintiffs) who were arrested after testing positive filed suit against the City of Charleston (defendant) claiming the policy violated the United States Constitution. The district court found that the searches were unreasonable but that the patients had consented to testing. It ruled for the city. The United States Court of Appeals for the Fourth Circuit affirmed, but not on the consent issue. It held that the women hadn’t in fact consented, but the searches were reasonable under the special needs exception because protecting the health of mothers and children and reducing medical costs outweighed the minimal invasion of privacy. The United States Supreme Court granted certiorari.