Alabama Unilateral DNR Policy Challenged by Federal Class Action Lawsuit

Prisoners in Alabama Department of Corrections (ADOC) prisons have filed a federal class action for declaratory and injunctive relief to provide constitutionally adequate medical and mental health care.  



One of the complaints about the prison health care concerns an alleged policy and practice to write DNR orders on prisoners without their consent.



Here are relevant paragraphs from the complaint:



162. DEFENDANTS THOMAS and NAGLICH have a policy and practice of allowing doctors to discontinue care to terminally ill prisoners against their will. This is a policy and practice that has continued over years and has been reported in DEFENDANTS' own documents.



163. One of the most basic health care decisions is when to discontinue treatment for a terminally ill patient. This is a decision that resides with the patient. Numerous prisoners have been given "Do Not Resuscitate" orders ("DNR") or "Allow Natural Death" orders ("AND") without their consent or even their knowledge.



164. In some cases, the doctors have discussed this issue with prisoners, the prisoners have affirmatively declined to be DNR or AND, but have been made DNR or AND regardless of their refusal. In some cases, individuals have been persuaded to sign DNRs without knowing what they were signing. The DNRs used by DEFENDANTS provide only that in the event of a cardiac arrest, cardiopulmonary resuscitation not be initiated. Nonetheless, DEFENDANTS THOMAS and NAGLICH rely on DNRs to deny medical care to prisoners.



165. At Staton in May 2014, there were five individuals who Were on a list of persons who had DNRs who did not know that they were thought to have DNRs. One of these individuals was PLAINTIFF COPELAND PLAINTIFF COPELAND is blind. No one spoke to him about signing a DNR or ever told him that a document he was being asked to sign was a DNR. Another prisoner who has been listed as having a DNR is Michael Kennedy. Kennedy has end-stage liver failure from untreated hepatitis C. In early 2014, Kennedy learned from a doctor at Staton that Dr. Bobby Crocker, the Corizon Regional Medical Director for the state, had placed a DNR order in his file, although Kennedy had not agreed to it. Kennedy asked to have it removed from his file. As of May 2014, Kennedy remained on the list of indivicu is who are considered to have DNRs.



166. At Staton, prisoner Roy Heath resides in the facility's infirmary due to his health. He did not sign a DNR. In June 2014, he learned that he has a DNR in his medical file despite not having signed one. PLAINTIFF CLEMENTS has COPD. He experiences extreme shortness of breath and low oxygen levels, and has periodic COPD crises that require him to be admitted to the infirmary. Prior to late spring or early summer 2013, medical staff gave PLAINTIFF CLEMENTS a shot of Sodium Metrizoate every six to eight hours whenever he had a COPD crisis, along with a breathing treatment, oxygen, and several inhalers during an COPD crisis. In or around late spring or early summer 2013, PLAINTIFF CLEMENTS was admitted to the infirmary due to an exacerbation of the COPD. Several days into his stay in the infirmary, Dr. Crocker, asked to see PLAINTIFF CLEMENTS, requiring PLAINTIFF CLEMENTS to temporarily stop using oxygen to meet with Dr. Crocker. Dr. Crocker asked Clements if had considered how he would feel to be on life support if he had a heart attack or was in a coma and told Clements that if he signed a DNR., he could avoid that fate. Having difficulty breathing because be was not using an oxygen mask and believing that the DNR only pertained to lifesaving measures in the event of a heart attack or coma, PLAINTIFF CLEMENTS signed the DNR. 



167. In or around August 2013, PLAINTIFF CLEMENTS experienced another bout of extreme breathing difficulty and again went into the infirmary. His oxygen level was 80. During his 30 day stay in the infirmary, medical staff gave PLAINTIFF CLEMENTS only one shot of Sodium Metrizoate. Despite PLAINTIFF CLEMENTS's condition, medical staff did not arrange for his transport to a hospital.  



168. PLAINTIFF CLEMENTS returned to the infirmary again in or around February 2014 experiencing difficulty in breathing. His oxygen level was 92. As he lay in the infirmary, PLAINTIFF CLEMENTS asked the nurse to provide him with some effective treatment. The nurse responded that if he had not signed the DNR, medical staff could do something to help him. It was at that point that he learned that medical staff was refraining from treating his chronic condition due to the DNR. Although the DNR is rescindable merely by the prisoner stating that he wants it rescinded, medical staff did not explain this to PLAINTIFF CLEMENTS. Because he did not know that he could rescind the DNR, PLAINTIFF CLEMENTS requested that medical staff give him pain medication and put him in a closed room in the infirmary to die. Facility physician Mendez ultimately gave Clements several shots of Sodium Mettioate and antibiotics. 



169. At Kilby, prisoner Larry Shepherd signed a DNR in April 2012 without knowing what he had signed. Shepherd was blind from untreated cataracts and no one told him what the document he was signing was. When he learned that he had signed a DNR, he asked to have it rescinded. DEFENDANTS did not rescind it. To the contrary, DEFENDANTS relied on it in their response to the lawsuit Shepherd had filed seeking to have cataract surgery.



170. An Incident Report from Hamilton A & I reflects that on September 9, 2009, a prisoner was found in crisis. Life saving measures were started, and the doctor was called. The doctor told the staff that was present with the prisoner to "make him a DNR."



171. Moreover, DEFENDANTS THOMAS and NAGLICH cease to provide medical treatment to people with DNRs. As discussed above, DEFENDANTS DEFENDANTS THOMAS and NAGLICH denied prisoner Larry Shepherd cataract surgery based in part on the existence of the DNR.



172. At Kilby, prisoner Robert Jones was admitted to the infirmary from Jackson Hospital in November 2013. He did not sign a DNR or a request for hospice care, but was placed on hospice care.