The opioid epidemic presents increased challenges to healthcare providers who treat persons who are incarcerated.  According to the Bureau of Justice Statistics (BJS), more than half (58%) of state prisoners and two-thirds (63%) of sentenced jail inmates meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for drug dependence or abuse.  An estimated 17 percent of state prisoners and 19 percent of jail inmates reported regular use of the drug of their choice as heroin and opiates. Healthcare professionals who work with this population can face significant liability by failing to appropriately treat prisoners undergoing overdose or withdrawal.  As public attention on the opioid crisis has increased in recent years, doctors and nurses who treat the jail and prison population are facing increasing scrutiny.

Deliberate indifference

Unlike other patients, prisoners can sue medical personnel for civil rights claims, but they must prove that the healthcare workers showed deliberate indifference to the prisoner’s serious medical needs.  This is self-explanatory.  The healthcare worker is only liable when he/she knows (or should have known) about the prisoner’s medical need, and ignores it.

This is obviously a higher bar for plaintiffs to prove than the negligence standard usually seen in healthcare liability cases, but it is still all-too-easy for healthcare workers to fall afoul of this when treating patients with opioid-related symptoms.  In several recent Tennessee cases, healthcare professionals have been found liable for failure to treat prisoners undergoing overdose or withdrawal.

IMPORTANT LESSONS

These cases provide several important lessons for healthcare professionals working in jails and prisons:

• Treat opioid-related issues as seriously as any other medical need. It is easy to become callous to seeing people at their worst, and to treat drug-related symptoms as “routine” in a jail setting.  This is no defense when someone suffers or even dies for lack of medical care, however.  Courts can and do find healthcare workers liable for not adequately treating patients with drug problems.  No nurse or doctor would simply stand by while a prisoner was bleeding or undergoing a cardiac event, and overdoses and withdrawals should be treated just as seriously.
• Be proactive. Remember, a healthcare worker is liable for failing to treat a prisoner once they show deliberate indifference to a medical need.  If a doctor or nurse knows or has reason to know that a prisoner has overdosed or may go through severe withdrawal, they must provide medical care.  Liability can almost always be avoided if healthcare workers respond proactively to signs of opioid-related conditions.  In one recent case, a nurse in a Tennessee county jail faced liability for failing to treat a prisoner who had slurred speech and dilated pupils, and who died from an overdose on her watch.  The nurse had been told that he had taken alcohol and oxycodone.  In another, several healthcare workers faced liability when they did not treat a detainee who died from withdrawal complications.  The prisoner had a history of seizures during withdrawal, showed withdrawal symptoms, and had a high level of drugs in his blood.  Don’t make the mistakes these healthcare workers made:  once you know that someone is likely to be undergoing withdrawal or overdose, immediately treat these conditions as the serious medical events that they are.
• Prepare.  Jails are an extremely challenging environment for healthcare workers – there is a constant influx of new patients, patient information is often incomplete or nonexistent, and patients themselves are often uncooperative.  Healthcare workers in this environment need to be prepared and expect that many incoming patients are at risk for opioid-related problems.  If doctors and nurses are prepared and ready to treat overdose or withdrawal as soon as they see risk factors, they will go a long way in both treating the prisoner properly and avoiding any liability they may otherwise face.

EQUAL TREATMENT

Drug abuse treatment is a challenging and grinding field of medicine, but it is just as important to treat these patients as diligently as any other.  By anticipating these situations and responding to them with as much speed and skill as any other medical emergency, healthcare workers go a long way towards giving these patients the care they need and maintaining their legal duties.

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Sean Bright, a summer associate at Lewis Thomason in 2018, contributed to this article.