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Montana Jail Agrees to Provide Addiction Treatment for Pregnant Prisoners

The American Civil Liberties Union of Montana (ACLU) has reached a settlement with the Lake County Detention Center (LCDC) which requires LCDC to ensure that pregnant prisoners at risk of opiate withdrawal receive proper medical treatment.

The ACLU filed a federal civil rights lawsuit in November 2009 on behalf of Bethany Cajune, who was incarcerated at LCDC for nine days while four months pregnant and was denied medication essential for preventing the serious medical risks associated with opiate withdrawal, including miscarriage.

Cajune reported to LCDC to complete a 24-day jail sentence for a traffic violation. That sentence was interrupted after five days because Cajune went into early labor. Before turning herself in to serve the remainder of her sentence, Cajune consulted her Medically Assisted Treatment (MAT) counselor.

In 2008, Cajune had been diagnosed for an opioid addiction that required medical and psychosocial treatment. As part of her MAT program, Cajune began receiving Suboxone for her addiction, which is similar to methadone but is approved for office-based treatment.

While in the program, Cajune, 24, started to get control of her life. She began to take GED classes and stayed off drugs. Her treating physician, Dr. Kenneth Cairns, recommended that she continue Suboxone upon learning she was pregnant in late 2008 or early 2009. When Cajune arrived at LCDC on March 18, 2009, she informed the guards that she was pregnant and needed her prescribed Suboxone and Promethazine (for pregnancy-related nausea), which she had with her.

The next day she was given the Promethazine but denied the Suboxone. She continued to request Suboxone and began to suffer withdrawal effects without it. Dr. Cairns made several calls to Sheriff Leonard C. “Lucky” Larson and Dr. Stephen Irwin, LCDC’s medical director, trying to ensure that Cajune received her prescribed medications.

Dr. Cairns informed Larson and Irwin that abrupt withdrawal from Suboxone is contraindicated for pregnant women, as it may cause the fetus to go into withdrawal and suffer from a lack of oxygen. There is also an increased risk of preterm labor, low birth weight and fetal death. Additionally, withdrawal is dangerous for the mother because it causes decreased blood flow through the placenta and typically results in diarrhea, vomiting and dehydration.

Despite being provided guidelines and policies from the federal Substance Abuse and Mental Health Services Administration and the National Commission on Correctional Health Care Standards for Health Services in Jails, Dr. Irwin refused to allow Cajune to receive her prescribed Suboxone.

On March 26, 2009, Cajune was taken to a hospital for an ultrasound that revealed her amniotic fluid index measured at the lower limits of the normal range. Dr. Cairns found that she was visibly sick, underweight and suffering from withdrawal.

A public defender filed a motion seeking an order for Cajune to receive her prescribed medication, which resulted in a state court ordering her release on March 27. She had lost ten pounds during her brief stay at LCDC and required intravenous fluids for treatment of dehydration after she was released.

The April 2011 settlement in Cajune’s subsequent federal lawsuit requires LCDC officials to establish policies that require opiate-addicted pregnant women to be immediately referred to an obstetrical provider and to receive recommended treatment. The parties agreed to pay their own attorney fees and costs.

“Women don’t give up their right to medical treatment or their right to have a healthy pregnancy when they are incarcerated,” said ACLU staff attorney Jennifer Ann Giuttari.
“Under this policy, pregnant women incarcerated at Lake County Detention Center cannot be denied the obstetrical care and medication they need. We are extremely hopeful that this change in practice at Lake County Detention Center means that no other pregnant women will be treated the way our client was treated.” See: Cajune v. Lake County, U.S.D.C. (D. Mont.), Case No. 9:09-cv-00164-DWM-JCL.

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Related legal case

Cajune v. Lake County