The State Department of Corrections and Community Oversight has repealed a medical policy at the center of a lawsuit brought by a former prison doctor who treated New York’s most chronically ill incarcerated patients for more than two decades.
The ministry updated its health services policy manual in December 2016 to include the policy on drugs with potential for abuse, which required doctors or medical specialists treating people imprisoned in the state to obtain additional departmental approval to prescribe certain drugs that may be subject to abuse.
“The policy, which no longer exists, is part of an ongoing dispute and the department has no comment,” DOCCS spokesman Thomas Mailey said in a statement.
Dr Michael Salvana, 71, filed a lawsuit June 28 in U.S. District Court for the state’s Northern District against the department and current or former DOCCS medical staff after allegedly suffering retaliation from the part of his colleagues for having denounced the health policy. staff and administrators.
The policy has left incarcerated people with serious and painful chronic illnesses, such as multiple sclerosis and sickle cell disease, with substandard medical care, Salvana said. The directive required that a DOCCS regional medical director approve or deny the prescription of a list of reported drugs, including tramadol, used for pain management; Pregabalin, used to treat fibromyalgia and nerve pain caused by damage to the spinal cord; Gabapentin, taken to control seizures; Imodium, used to treat diarrhea and other common muscle relaxants.
Ministry officials would not respond to multiple requests over several days to revoke the policy.
“Your question relates to an ongoing litigation,” Mailey said. “The ministry does not comment on ongoing litigation. “
The directive was aimed at preventing patients from abusing prescription drugs as the country’s opioid epidemic rages on.
Medicines are kept under lock and key in state prisons and can only be administered by DOCCS medical staff.
The ministry would not respond if the policy prevented drug abuse in state prisons while it was in effect.
Key lawmakers on the Senate Committee on Victims of Crime, Crime and Corrections and the Assembly Corrections Committee referred to the ministry or were unsure when the policy was repealed.
State departments can create and implement policies at their discretion without legislation or approval from Governor Andrew Cuomo and the Executive House.
“They can do whatever they want,” said attorney Carlo AC de Oliveira of Albany-based Cooper Erving & Savage LLP, one of Salvana’s attorneys. “It’s their policy, they created it and they can overrule it.”
Salvana said his waiver requests for his patients were routinely denied by the DOCCS regional medical director over 145 miles in Albany, who did not have access to a patient’s health record. The service was required to explain the reasons for the refusal in the patient’s outpatient health record.
The controversial Drugs at Risk of Abuse Directive first came into effect in March 2017. Doctors could prescribe any drug listed in the DOCCS pharmacy formulary book without prior approval before the policy does not exist.
Salvana alleges his First and 14th Amendment rights were violated when he suffered retaliation and discrimination after speaking out against the policy, forcing him to resign on April 28, 2020.
“I was kicked out of the establishment, prevented from placing orders, my orders were canceled by non-doctors who were not licensed to practice medicine,” Salvana said in a telephone interview.
Salvana, the former warden of the Walsh facility, supervised all medical staff, including doctors, nurses, nurse practitioners, physiotherapists and occupational therapists, radiology technicians, and the pharmacy supervisor.
The doctor, from Syracuse, has practiced medicine for more than four decades and worked as a clinical physician at the Walsh Regional Medical Unit in Rome, New York, from 2003 to 2011 and again from 2014 until his resignation.
The maximum security medical facility is located in Mohawk Correctional, a medium security prison in Oneida County. The medical unit has 152 beds in four-bed wards to house New Yorkers incarcerated for complex long-term medical care.
“They are very sick people,” Salvana said of Walsh’s patients. “These are not drug users, and many of the drugs that are part of this policy have nothing to do with opioids. They are not opiates. The patients were deprived of it and, as a result, the patients suffered needlessly.
“There is no class action lawsuit saying ‘I went to jail and got addicted to drugs,’ the doctor added.
DOCCS is an accredited member of the National Commission on Correctional Health and is required to adhere to the treatment standards of the commission and the American Public Health Association.
“The department provides the community standard of medical care to all incarcerated people,” Mailey said in a statement. “All DOCCS facilities have on-site medical personnel and individuals have daily access to medical services through the facility’s sick appeal process. For the chronically or terminally ill, DOCCS provides specialized regional medical units (RMUs) in selected facilities across the state.
“When medically necessary, people can be transported to a community hospital for emergency treatment or other medical services. DOCCS has agreements with health care providers and specialists at major state hospitals, as well as agreements with several small hospitals near its facilities to ensure that the medical needs of incarcerated people are met. If more extensive care is required, the incarcerated person can be transferred to another hospital which can provide the additional services.
The department regularly collaborates with the state health department on medical care among the state’s prison population, according to Mailey, but the health department does not oversee or regulate New York prison hospitals, with the exception of medical treatments related to infectious diseases such as tuberculosis, hepatitis C, HIV / AIDS and COVID-19.
DOCCS Medical Administration may create, modify or repeal its own rules. The department commissioner and central office management or the parole board chairperson must approve new or amended health directives.
The former prison doctor has opposed the policy of the MWAP since its inception, which Salvana said violated basic medical standards and quality-of-care requirements, causing unnecessary pain and suffering to patients. patients incarcerated in violation of the US Constitution.
“I did everything I did and to no avail,” he said. “You are out there screaming in the desert. No matter what I did and opposed and gave examples of the problems it created, I got nowhere.
The alleged retaliation suffered by Salvana would violate state labor and public service laws and the constitutions of New York and the United States.
Former regional medical director Dr David Dinello drafted the policy. Dinello has a limited license to practice medicine after the state health department’s Board of Professional Medical Conduct charged him in 2010 with three counts of failing to adequately assess patients in wards. emergency before their release, according to the trial.
He was then hired by DOCCS as Regional Medical Director.
Former DOCCS deputy commissioner and chief medical officer Carl Koenigsmann, an accused named in Salvana’s trial, approved the initial directive in late 2016 to create the MWAP policy.
“It was not something that would be tolerated elsewhere,” Salvana said. “… There was almost a tone of discrimination against these people because they are detained. A lot of them come from certain groups of people … and you can’t stigmatize an entire population. You can’t limit the practice of medicine to a one-page policy and expect a guy a hundred miles away to make the right decision.
Dinello is an accused in the lawsuit, but Salvana’s lawyers have not been able to confirm that the papers were served on the former medical director of the state prison. The complaint was extended until mid-August.
A preliminary conference with a judge is expected in early October.
Salvana continues to practice medicine in private in Onondoga County.
The Walsh Regional Medical Unit provides on-site specialist physician consultation services for the Oneida, Watertown and Elmira centers.
The DOCCS is responsible for the medical care of all incarcerated persons in its care.
The state’s prison population is at its lowest level in 37 years, according to DOCCS. The total incarcerated population in state correctional facilities was 31,417 as of April 30, a reduction of more than 24,560, or 44%, since Governor Andrew Cuomo took office on January 1, 2011. while New York’s prison population stood at 55,979.
Representatives from DOCCS and Governor Cuomo’s office did not respond to an updated tally request on Friday.