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ACLU settlement forces Montana jail to provide drug treatment to pregnant inmates

A detention facility in Montana must now administer all medical treatments to incarcerated pregnant women, including opiate-withdrawal medication, following a settlement reached this week by the American Civil Liberties Union and the Lake County Detention Center in Polson, Mont.

The settlement was reached in the case of Bethany Cajúne, who was denied opiate-withdrawal medication after she voluntarily reported to the jail in March 2009 to complete an outstanding short-term sentence for traffic violations, according to the filed complaint (PDF). Without medication, Cajúne suffered “complete and abrupt withdrawal, experienced constant vomiting, diarrhea, rapid weight loss, dehydration, and other withdrawal symptoms.” After Cajúne’s public defender intervened, a court order secured her release after nine days so she could resume her withdrawal treatment.

The ACLU sued the jail facility in November 2009, claiming the drug denial was unconstitutional and asked the U.S. District Court for the District of Montana to require the detention center to compensate for Cajúne’s physical and emotional suffering while she was incarcerated. Part of the ACLU’s case was pointing out that the risks of opiate withdrawal include miscarriage. According to ACLU lawyers involved in the case, Cajúne later gave birth to a healthy baby.

As part of the settlement, the Lake County jail agreed to implement a new policy that includes:

  • Referring pregnant inmates to an obstetrical provider for a medical evaluation and an appropriate plan of care, which specifically includes treating drug-dependent pregnant inmates.
  • Training officers how to implement the new policy.
  • Informing all pregnant inmates on this policy.

“Women don’t give up their right to medical treatment or their right to have a healthy pregnancy when they are incarcerated,” said ACLU Montana staff attorney Jennifer Giuttari in a statement. “Under this policy, pregnant women incarcerated at Lake County Detention Center cannot be denied the obstetrical care and medication they need. We are extremely hopeful that this change in practice at Lake County Detention Center means that no other pregnant women will be treated the way our client was treated.”

The Associated Press reported that the county agreed to the settlement because the costs to defend the lawsuit had exceeded $70,000. The AP notes that it is unclear whether the new policy will change how the Lake County center operates, as the attorney defending the county, Michael Sehestedt, told the bureau the policy just codifies existing policy and that the jail’s doctor will still have the authority to decide on a case-by case basis whether to give inmates medication.

The National Commission on Correctional Health Care‘s position on opioid addiction is that it is ”an incurable disease that requires long-term maintenance with medication—just as for hypertension or diabetes.” The NCCHC endorses medication-assisted treatment (MAT), which is also advocated by the American Society of Addiction Medicine, in correctional settings and has acknowledged that methadone can be used as an effective treatment for pain control and to protect the fetus in an opioid-dependent pregnant woman.

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