355 F. Supp. 3d 35
D.D.C.2018Background
- Plaintiff Geoffrey Pesce is prescribed daily methadone for opioid use disorder and has been in recovery since late 2016; his physician recommends continued methadone while incarcerated.
- Pesce faces imminent incarceration at the Essex County House of Corrections at Middleton (pending probation revocation hearing and a plea/sentencing with a 60-day mandatory minimum) where Middleton has a blanket policy prohibiting methadone and similar opioid-based MAT.
- Middleton’s practice is to induce withdrawal under medical supervision and offer non-opioid treatments and programs (including occasional Vivitrol), rather than continuing methadone.
- Pesce sued under Title II of the ADA and 42 U.S.C. § 1983 (Eighth Amendment) seeking a preliminary injunction ordering Defendants to provide his physician-prescribed methadone during incarceration.
- The district court found the case ripe, concluded Pesce was likely to succeed on both the ADA and Eighth Amendment claims, found a significant risk of irreparable harm (including overdose risk on release), and granted the preliminary injunction.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Ripeness to seek injunctive relief before incarceration | Pesce faces imminent, certainly impending incarceration and will immediately be denied methadone; delay risks severe harm | Uncertainty about exact sentence timing renders claims premature | Court: ripe—incarceration and denial of treatment are imminent and hardship justifies review |
| ADA (Title II) discrimination | Denial of prescribed methadone deprives Pesce of medical services on account of his disability; policy lacks individualized medical assessment | Policy serves legitimate safety/security interests and is applied generally to all inmates | Court: Pesce likely to succeed—blanket ban without individualized consideration appears discriminatory as applied to him |
| Eighth Amendment deliberate indifference | Denying physician-recommended, medically necessary methadone is deliberate indifference and cruel and unusual punishment | Denial reflects institutional medical/security judgment and established non-opioid program; not an individualized denial of treatment | Court: Pesce likely to succeed—blanket policy that ignores prescribed treatment satisfies deliberate indifference on present record |
| Irreparable harm / balance of equities / public interest | Forced withdrawal and interruption of MAT pose severe risk of relapse, overdose, and death; public interest favors continuity of effective treatment | Institutional security concerns and program integrity outweigh individual request; prison administrators’ expertise entitled to deference | Court: Pesce shows likely irreparable harm; balance and public interest favor injunction to preserve medically necessary treatment |
Key Cases Cited
- Pennsylvania Department of Corrections v. Yeskey, 524 U.S. 206 (1998) (prisoners are protected by Title II medical services requirement)
- Kiman v. New Hampshire Department of Corrections, 451 F.3d 274 (1st Cir. 2006) (disagreement with medical judgment insufficient; but individualized inquiry required)
- Munaf v. Geren, 553 U.S. 674 (2008) (discussing extraordinary nature of preliminary injunctive relief)
- Overton v. Bazzetta, 539 U.S. 126 (2003) (deference to prison administrators on regulation of inmate programs)
- Babbitt v. United Farm Workers Nat’l Union, 442 U.S. 289 (1979) (courts may enjoin threatened injury that is certainly impending)
- Alexander v. Weiner, 841 F. Supp. 2d 486 (D. Mass. 2012) (denying or delaying physician-recommended treatment can meet deliberate indifference standard)