What to Know
- Michael Salvana, a doctor who worked for New York’s corrections system, is suing the agency saying he was forced to quit and faced harassment for seeking appropriate care for his patients.
- At issue is a policy shift the system made five years ago to increase oversight at a time of heightened concern regarding overprescribing painkillers in prisons.
- The lawsuit filed last month claims the state’s corrections agency violated Salvana’s rights to speak up against the policy.
A doctor who worked for New York’s corrections system and took issue with a crackdown on prescription drug abuse is suing the agency, saying he was forced to quit and faced harassment for seeking appropriate care for his patients.
At issue is a policy shift the system made five years ago to increase oversight at a time of heightened concern regarding overprescribing painkillers in prisons. Some critics including the plaintiff, physician Michael Salvana, argue the new restrictions have left patients with conditions from multiple sclerosis to spinal injuries suffering needlessly.
The lawsuit filed last month in federal court in northern New York claims the state’s corrections agency violated Salvana’s rights to speak up against the policy. Salvana said his superiors’ “inhumane” interference in his patients’ care caused him to leave his role as facility director in central New York at Walsh Regional Medical Unit in Rome, New York, that has 125 beds for prisoners with complicated medical needs.
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“It was very depressing,” Salvana said in an interview. “It’s depressing to see these patients and knowing you cannot do anything to change it. You’re fighting a battle that you essentially can’t win. It was very depressing and as a result I couldn’t watch it anymore.”
A centralized review process launched by the state in 2017 requires prison physicians to get approval from regional medical administrators for prescribing certain medications — a list that’s included federally controlled narcotics as well as the nerve pain and anti-convulsant medication gabapentin, allergy medicine Claritin-D, cough medicine Robitussin DM and Imodium, used to treat diarrhea.
State corrections officials say the policy has increased oversight over the prescription of potentially addictive medications.
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Salvana said the policy led to the “abrupt” discontinuation of “effective treatments of hundreds of inmates” with seizures, multiple sclerosis, cancer, sickle-cell anemia and spinal injuries.
Corrections department spokesperson Thomas Mailey said the agency declined comment on pending litigation.
New York is fighting a separate lawsuit over the policy by incarcerated individuals who claim they have been forced to live with untreated chronic pain and other conditions because some medications have become too difficult to get behind bars.
The state has argued the issue is about disagreements over the best way to treat patients rather than a violation of incarcerated people’s constitutional rights.
″(I)t is justifiable for a doctor to prefer conservative treatments that entail less risk of harm, including abuse and addiction,” reads an April 2020 motion to dismiss that lawsuit filed by State Attorney General Letitia James’ office.
Lawyers for the incarcerated patients said in a January court filing that the Department of Corrections has taken another look at individual patients’ medical histories.
As of January, at least 39 of those 88 patients were receiving restricted or non-restricted medications or awaiting follow-ups from specialists, according to Amy Jane Agnew, an attorney representing the incarcerated patients. But Agnew said the state hadn’t provided enough evidence to show whether all “patients received constitutionally adequate reassessments.”
It is not unheard of for correctional settings to require an on-site health team to obtain outside approval or otherwise restrict access to medications, said Harvard Medical School professor Matt Tobey, director of rural medicine programs at Massachusetts General Hospital. While such policies can offer more guidance to medical providers, he said, they “typically place the administrative priorities of the facility — limiting costs or reducing the potential for medication diversion — over health.”
Salvana said he lodged complaints, asked for patients in his unit to be exempted, sought reversals of denied care and had meetings with corrections officials — all to no avail.
In June 2019, Salvana ordered a benzodiazepine to sedate a patient with brain cancer who broke a water pipe. A supervisor ordered a nurse not to administer the medication to the patient, who later attacked a correctional officer who suffered “permanent injuries to his cervical spine,” according to the lawsuit.
When Salvana detailed the incident to state corrections officials, he said his supervisor “berated him” for prescribing the medication and filing a complaint about her. The supervisor then ordered nurses to withhold assistance from Salvana for several patients, according to the lawsuit.
Salvana ultimately left the state corrections system and now works as a doctor serving incarcerated patients at a corrections facility elsewhere in upstate New York.
