Washington prison inmate awarded $549,000 after he’s denied pain medication for multiple sclerosis

https://www.seattletimes.com/seattle-news/washington-prison-inmate-awarded-550000-after-hes-denied-pain-medication-for-multiple-sclerosis/

A federal jury found that three prison medical staffers showed “deliberate indifference” to Etienne Choquette’s pain and medical needs when they refused to allow him medication that was prescribed to him by a neurologist.

A Washington state inmate with multiple sclerosis who was four times denied nonaddictive nerve-pain medication by prison staff has been awarded  $549,000 by a federal jury in Tacoma.

The jury last week found that three prison medical staffers showed “deliberate indifference” to Etienne Choquette’s pain and medical needs when they refused to allow him medication that was prescribed to him by a neurologist.

Choquette was awarded $149,000 in compensatory damages for violation of his Eighth Amendment rights and $400,000 in punitive damages.

“The jury sent a strong message to the DOC (Department of Corrections) and its officials that they must treat the prisoners under their care with basic human dignity,” said Jesse Wing, one of Choquette’s attorneys.

“The defendants repeatedly denied our client a simple, generic medication for almost five months when they knew their decisions would cause him terrible nerve pain. These state officials thought no one would care. But the jury did, and it found their behavior cruel, in violation of the Bill of Rights,” Wing said.

The state Attorney General’s Office, which defended the three prison officials, deferred comments to Department of Corrections spokesman Jeremy Barclay who said the department is still “reviewing and assessing the ruling.”

Choquette, 54, had been diagnosed with multiple sclerosis in 2009 and given a prescription for gabapentin before he was imprisoned  in 2011  for the murder of a Forks man that Choquette believed was physically abusing a female friend.

While in custody at the Washington State Penitentiary in Walla Walla in November 2013, Choquette was seen by a neurologist who recommended that Choquette’s dosage of gabapentin be increased from 2,400 milligrams to 3,600 milligrams per day to address increased pain, according to court documents filed in U.S. District Court.

Gabapentin is a non-opioid prescription medication used to control seizures, but also commonly prescribed to address neuropathic pain, the suit claimed. It is not classified as a controlled substance by the Drug Enforcement Agency.

Because the higher amount of medicine was above the typical standard dose used by Department of Corrections medical staff, Choquette’s primary health-care provider submitted a special “non formulary request” seeking approval of the medication, according to the lawsuit.

The request was denied by prison pharmacist Cris DuVall, who instead recommended that Choquette be taken off gabapentin and treated instead with extra clinical observation and an increase of another one of Choquette’s medications.

Both DuVall and the Department of Corrections’ chief medical officer, Dr. G. Steven Hammond, “explained that they did not understand why gabapentin would be used in this context,” the lawsuit claimed.

But Choquette’s pain did not abate, according to the lawsuit.

His primary medical provider again submitted a request for the increased gabapentin prescription about a month later, explaining that withdrawal off the drug had negative effects.

But the request was denied again, this time by pharmacist Michelle Southern, who mistakenly determined that the only use for gabapentin among MS patients was for treatment of an eye condition, the suit claimed.

Southern suggested that Choquette’s provider refer the case to the department’s Care Review Committee (CRC), which is supposed to review nonstandard requests to determine if they are medically necessary.

The board determined that gabapentin was not medically necessary,  but also decided to send Choquette to a specialist in Seattle.

He was transferred to the Monroe Correctional Complex and eventually saw the second specialist, a neurologist with expertise in treating MS, who agreed with the recommendation of the first neurologist seen by Choquette months earlier, according to the suit.

On April 23, 2014, Choquette’s doctor at Monroe presented the patient’s case once again to the CRC, which again determined gabapentin was not medically necessary.

When informed about the board’s decision, the second neurologist wrote that she “had no doubt the plaintiff was in pain, that there was no ‘objective’ test to prove his pain, and that gabapentin was the standard, first-line drug for neuropathic pain in MS patients,” the suit claims.

At the end of April, the case was presented again to the board, which finally determined that the gabapentin was medically necessary.

To prove that Choquette’s Eighth Amendment rights had been violated, his attorneys had to convince jurors that the inadequate medical care he received was the result of deliberate indifference by prison officials to a serious medical need.

In the suit, Choquette alleged that the defendants were aware of his diagnoses, his neuropathic pain, and that he had previously been on gabapentin for that pain, and yet still withheld the medication for over four months.

Further, he alleged that the Department of Corrections officials relied on the judgment and opinions of non-treating and nonspecialist medical personnel over the opinion of the medical staff and specialist who were treating him.

Jurors assessed $200,000 in punitive damages to Hammond, $175,000 to DuVall and $25,000 to Southern.

Barclay declined to give the salaries of the three defendants, but said two of the three had resigned from their DOC positions in 2014, and the remaining staff member retired in 2017 but was brought back as a non-permanent employee in 2018.

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