Prisons – Opioid-dependent inmates who were denied treatment certified as class

Where the district court certified a class of inmates who were denied access to medical screening and treatment for opioid dependence while incarcerated, it did not err. The class satisfies this court’s ascertainability requirement; the commonality, typicality and adequacy requirements of Rule 23(a) and both Rule 23(b)(3)’s requirements.

Background

Lauren Spurlock, Heather Smith and Shawn Zmudzinski allege that they were denied access to medical screening and treatment for opioid dependence while incarcerated.

The district court certified a class seeking a court order requiring Wexford Health Sources Inc. to provide screening and treatment to individuals with opioid use disorder who are incarcerated in institutions where Wexford provides comprehensive medical care. The second class seeks damages for Wexford’s past failure to provide this screening and treatment.

Injunctive relief class

Wexford argues that, because the named plaintiffs are no longer detained or incarcerated, they lack standing and their claim for injunctive relief is not justiciable. Because standing “is a jurisdictional issue of constitutional dimensions, . . . it may be raised and addressed for the first time on appeal.” District courts may, however, be best suited to consider standing in the first instance, particularly where the standing inquiry is fact-specific and therefore necessitates fact finding.

The fact-intensive arguments put forth by the parties demonstrate the wisdom of this approach. Because standing was raised for the first time on appeal, the district court had no opportunity to address these arguments or to find relevant facts, including the named plaintiffs’ likelihood of again being subjected to Wexford’s policy. This court therefore remands to the district court to consider whether the named plaintiffs possess standing to represent the injunctive relief class.

Damages class

Wexford argues that the district court abused its discretion in finding that the damages class satisfies this court’s ascertainability requirement; the commonality, typicality and adequacy requirements of Rule 23(a) and both Rule 23(b)(3)’s requirements. This court disagrees.

Regarding ascertainability, under the district court’s revised class definition,

each individual must have had a documented opioid use disorder, or OUD, diagnosis, presented a prescription for medications for opioid use disorder, or MOUD, to Wexford employees or have been placed on supervision for withdrawal by Wexford employees. The district court found that, applying this definition, members of the damages class could be readily identified through examination of Wexford’s own patient records. This finding was not an abuse of discretion.

Next, Wexford’s own estimates suggest that 35 percent of incarcerated individuals in any given facility satisfy the criteria for MOUD treatment. Wexford does not contest this numerosity finding.

Turning to Rule 23(a)’s commonality requirement, the district court identified multiple common questions of fact, including whether screening for and treatment with MOUD is the medically accepted standard of care for individuals with OUD; whether Wexford was aware of a substantial risk to its patients caused by withdrawal; whether Wexford had policymaking authority to provide MOUD through its contracting process with the institutions at issue and whether Wexford maintained a policy of excluding screening for OUD and provision of MOUD in that process.

The district court also identified a common question of law, specifically, whether Wexford’s alleged policy constituted deliberate indifference to a serious medical need in violation of the Eighth and Fourteenth Amendments.

Next, the parties largely agree that deprivation of this treatment for those with opioid dependence leads to withdrawal symptoms. The district court did not abuse its discretion in concluding that the fact that symptoms may vary does not defeat typicality because all the class members experienced the same alleged constitutional injury. Wexford argues that the district court abused its discretion in finding that the damages class meets Rule 23(b)(3)’s predominance and superiority requirements. This court disagrees.

Wexford nevertheless contends that, for certification to be appropriate, each member of the damages class must be found to possess standing. Not so. At the class certification stage, district courts need not find that all of the unnamed class members possess Article III standing.

The district court acknowledged that some uninjured individuals may be encompassed within the proposed class, but noted that such class members would be “[o]utliers” and therefore would not defeat predominance. This court agrees.

Affirmed in part and remanded in part.

Spurlock v. Wexford Health Sources, Inc., Case No. 25-2038, May 4, 2026. 4th Cir. (Berner), from SDVWA at Huntington (Chambers). Michael James Bentley for Appellant. William J. Forbes for Appellees. VLW 026-2-162. 31 pp.

Full-Text Opinion
VLW 026-2-162