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New York Prisoners with Chronic Pain Win Injunction to Receive Denied Medication

by Matt Clarke

On November 22, 2023, the federal court for Southern District of New York granted a permanent injunction to a class of prisoners held by the state Department of Corrections and Community Supervision (DOCCS) who sued for relief from chronic pain they suffer. It replaced a preliminary injunction issued on June 12, 2023, mandating that DOCCS allow a prisoner’s primary care provider (PCP) to prescribe pain medication without additional authorization from supervisors, as previously required. It further ordered the prison system not to let any PCP discontinue pain medication without a prior consultation with the prisoner.

In June 2017, DOCCS adopted Health Services Policy 1.24, attempting to address the opioid abuse problem with a list of Medications with Abuse Potential (MWAP). Prescriptions for those required approval of the Regional Medical Director (RMD). But the list also included benign drugs like the allergy medicine Claritin, the seizure-relief medicine Gabapentin, as well as Imodium. Worse, as one of the named plaintiffs in the class-action found, his multiple sclerosis flared so badly when he was taken off Neurotonin that he went from playing basketball to being confined to a wheelchair—“because you won’t give [me] a 50-cent drug,” Aaron Dockerty noted. [See: PLN, July 2022, p.18.]

After the class-action lawsuit was filed, DOCCS rescinded Policy 1.24 and replaced it with Policy 1.24A, which shortened the list of drugs requiring prior RMD approval to specialty nonformulary medications. When Plaintiffs moved for class certification and a preliminary injunction, Defendant DOCCS officials claimed that the policy change mooted the motion. But the Court determined that prisoners suffering from chronic pain were still being denied needed medication. It granted certification to a class consisting of current and future DOCCS prisoners “who suffer or will suffer from chronic pain and/or neuropathies who require individualized assessments of medical needs for treatment with MWAP medications.”

The injunction, now permanent, requires DOCCS medical officials to comply with Policy 1.24A, giving each prisoner patient with chronic pain Code 338 from the Problem List, for “Pain Management.” That entitles him to be seen at least every 90 days by a PCP, who may order any formulary pain medication without supervisory approval. The injunction also requires supervisors to grant approval for nonformulary pain medications ordered by a PCP so long as formulary medications are shown to be ineffective or cause unacceptable side effects. A PCP may further order specialty consultations for chronic pain evaluation as specified, but he or she ultimately makes all treatment decisions for the prisoner patient.

DOCCS Deputy Commissioner and Chief Medical Officer Dr. Carol Moores had 45 days to train medical personnel on the injunction’s details and 60 days to put a program in place to provide such training for new hires. That was also how long Dr. Moores had to put together a program to identify prisoner patients for Code 338, a process that must be completed within six months. Within a year, she must also identify any class members whose medication was discontinued under the old MWAP policy and give them individual assessments. The class is represented by New York City attorneys Joshua L. Morison and Amy J. Agnew. See: Allen v. Koenigsmann, 2023 U.S. Dist. LEXIS 209873 (S.D.N.Y.).   

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Related legal case

Allen v. Koenigsmann