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First Circuit: Denial of Humira Psoriasis Treatment Not Deliberately Indifferent

by Mark Wilson

The United States Court of Appeals for the First Circuit held that a lower court properly granted summary judgment to a Massachusetts prison doctor who refused to prescribe Humira to treat a pretrial detainee’s psoriasis.

Jenna Zingg was a pretrial detainee at the Massachusetts Correctional Institute (MCI) between March 12, 2013 and September 5, 2013. She had a long history of psoriasis and had tried numerous treatments including Clobetasol, the most potent topical steroid available; Dovonex, a weaker topical vitamin D analogy; and Humira, a systemic treatment that targets the immune system. She responded well to Humira and had been taking it for about nine months before entering MCI.

The Massachusetts Partnership for Correctional Healthcare (MPCH) provided prisoner medical care at MCI. Humira and Dovonex were non-formulary medications that were not pre­approved to be administered to MPCH patients.

Zingg was denied her regularly scheduled Humira injections at MCI, causing her psoriasis to worsen. MCI medical staff initially prescribed Clobetasol, but Zingg’s psoriasis became increasingly severe. She was then prescribed Humira and Dovonex.

Given that neither medication was a formulary medication, the pharmacy forwarded the prescription requests to Dr. Thomas Groblewski, MPCH’s statewide medical director. He was responsible for approving all non-formulary prescription requests made by MPCH practitioners.

On July 15, 2013, Groblewski approved the Dovonex prescription but denied the Humira request. Zingg’s psoriasis continued to worsen as she used Dovonex.

Zingg was then seen by a dermatologist on August 9, 2013, and diagnosed with severe psoriasis and mild psoriatic arthritis. She was admitted as an in-patient and screened for infection risk. She was finally given Humira shots and her condition improved significantly by the time she was released on September 5, 2013.

Zingg brought federal suit, alleging that Groblewski was deliberately indifferent to her serious medical needs. The district court ultimately granted Defendants summary judgment, finding that Zingg failed to show that a jury could reasonably find that Groblewski’s decision not to approve the Humira request constituted deliberate indifference. The district court also found that Groblewski was entitled to qualified immunity.

The First Circuit affirmed, finding that “Zingg did not produce any evidence to suggest that Groblewski knew, when he prescribed Dovonex but not Humira, that even the combination of Clobetasol and Dovonex would not work for her.”

Moreover, “there is no evidence that Groblewski knew anything about Zingg’s condition or topical medication history beyond what was in the non-formulary requests,” the court found. “And those requests ... did not themselves indicate that the combination of the two ointments would not work.”

Accordingly, the court could not “conclude that Groblewski, when faced only with the two non-formulary requests ... and MPCH’s treatment protocol for psoriasis, acted in a manner that could reasonably be interpreted as exhibiting a ‘deliberate intent to harm’ or ‘wanton disregard’ for Zingg’s health.” See: Zingg v. Groblewski, 907 F3d 630 (1st Cir. 2018).

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Related legal case

Zingg v. Groblewski, et al.