Allen v. New York State Department of Corrections and Community Supervision

Background

Incarcerated plaintiffs in the New York State Department of Corrections and Community Supervision (DOCCS) system alleged that DOCCS medical staff denied or discontinued medications with abuse potential for chronic pain and neuropathies without individualized assessments of patients’ medical needs or the effectiveness of treatment. The plaintiffs alleged that these practices violated the Eighth Amendment’s protection against cruel and inhuman treatment.

DOCCS rescinded the policy that had required approval from a regional medical director before a primary care provider could prescribe such medication. It replaced that policy with Health Services Policy 1.24A, titled “Prescribing for Chronic Pain.” Defendants argued that the plaintiffs’ request for an injunction was moot because the earlier policy had been rescinded. After an evidentiary hearing, however, the court found evidence of continuing constitutional violations involving chronic-pain treatment.

Class and Preliminary Injunction

The court previously certified a class for injunctive relief under Federal Rule of Civil Procedure 23(b)(2), covering incarcerated people who are or will be in DOCCS custody, suffer or will suffer from chronic pain or neuropathies, and require individualized assessments of medical need for treatment with medications with abuse potential. The court denied certification of a liability class.

The court had also granted the plaintiffs’ motion for a class-wide preliminary injunction. A preliminary injunction is temporary court-ordered relief issued before a final judgment. The court found that class members were likely to prevail on their claims that DOCCS medical providers were deliberately indifferent to their serious medical needs, that the potential harm to class members outweighed the potential harm to Defendant Moores, that the threatened harm was irreparable, and that an injunction served the public interest.

Terms of the Order

This order set the injunction’s specific requirements. Defendant Moores had to provide the order to all DOCCS medical personnel, including administrators, primary care providers, and nursing staff, within ten days. Moores, any succeeding chief medical officer, and covered personnel who received actual notice had to require compliance with Policy 1.24A.

The order required that:

- Each DOCCS patient with chronic pain receive Problem List Code 338, “Pain Management.” - A primary care provider could prescribe medication considered appropriate for chronic pain without an approval process, except when requesting a non-formulary medication. A non-formulary medication had to be approved when other formulary treatments had been tried and either failed to achieve functional treatment goals or caused unacceptable side effects. - Specialty consultations be ordered when indicated. - A primary care provider who rejected a specialist’s recommendations document the reasons, discuss the case with the specialist, consult another DOCCS provider, facility health services director, or regional medical director if necessary, and record those discussions. Treatment decisions remained with the primary care provider. - Pain medication be discontinued only after a provider met with the patient, discussed the medication’s use, analyzed the patient’s situation, determined that discontinuation was in the patient’s best interest, and documented the discussion and reasons. - Patients with Code 338 be seen by a primary care provider at least every 90 days and meet with that provider at least annually to discuss their treatment plan.

Within 45 days, covered officials had to train relevant DOCCS medical personnel. Within 60 days, they had to establish a system to identify newly hired or rehired providers and ensure their training, identify patients in DOCCS custody with chronic pain and add Code 338 to their medical problem lists, and create a system for identifying incoming patients with chronic pain and adding the code.

Within six months, officials had to ensure individualized assessments for covered patients who had not received one within the preceding 60 days. The assessment had to include a medical-history review, physical examination, diagnoses and pain sources, current pain level, information about medications that had or had not worked and their side effects, a detailed care plan, a discussion of treatment options with the patient, and documentation under current DOCCS policies. Officials also had to provide the plaintiffs every 30 days with records showing the patient, date, facility, provider, and results of each reassessment.

The order required Moores, a successor, or counsel to notify the court and parties of changes to Policy 1.24A. It also stated that inadequate staffing would not excuse noncompliance.

Disposition and Classification

The court issued the terms of the class-wide preliminary injunction and found that the relief was narrowly drawn, no broader than necessary to correct the constitutional violations, and the least intrusive means necessary. Because preliminary injunctive relief concerning prison conditions automatically expires after 90 days under the Prison Litigation Reform Act unless extended, the parties had to either stipulate to an additional 90-day extension or proceed with a scheduled hearing on whether the injunction should become permanent or permanent relief should be denied.

The opinion’s caption lists Peter Allen and other plaintiffs against Carl Koenigsmann and other defendants, while the supplied case name identifies the matter as Allen v. New York State Department of Corrections and Community Supervision.