by Michael Dean Thompson

Wexford Health Services, Inc. is a private healthcare profiteer that contracts with prison systems and jails across the country, offering “comprehensive” medical services to incarcerated persons. However, Wexford provides opioid withdrawal treatment only as an optional service at additional cost to the prison or jail systems that choose it.

Three formerly incarcerated people sued over this practice and pushed to have their lawsuit certified as a class action. The district court certified two distinct classes—a Damages class and an Injunctive Relief class. On appeal, a three-judge panel for the United States Court of Appeals for the Fourth Circuit affirmed the Damages class and remanded the Injunctive Relief class for more fact finding in April of this year.

Lauren Spurlock, Heather Smith and Shawn Zmudzinski have all suffered from Opioid Use Disorder (OUD) for years. They also landed in institutions where Wexford provides “comprehensive” medical care. For Spurlck and Smith, those were in West Virginia, while Zmudzinski was in New Mexico. Wexford offers Medications for Opioid Use Disorder (MOUD), but only as an option for the contracting prison or jail as a cost-saving measure.

Furthermore, systems can choose to exclude MOUD even as Wexford is aware that it is part of the standard of care for people who suffer OUD and stipulates it in their policies. The 2024 revised policy recognizes the seriousness of opiate withdrawal and recommends the MOUD option, but it is still an option. Within institutions that do not select MOUD availability, patients are forced to undergo withdrawal using medications like ibuprofen, Tylenol and anti-diarrheal drugs, despite the potential for “uncontrolled pain, psychological distress, suicidal ideation, and suicidal attempts.”

That policy applies to people like Heather Smith, who arrived at her institution with a prescription for MOUD. In fact, Wexford will not even screen for OUD or MOUD treatment unless the institution has elected to pay for the option. Again, this is something Wexford concedes violates medical standards of care.

Spurlock, Smith and Zmudzinski claimed in their suit that this failure to provide care “constitutes deliberate indifference to serious medical needs in violation of the Eighth and Fourteenth Amendments” (for convicted and pretrial incarcerations, respectively). The fundamental question here, according to the Court, is “whether Wexford can agree to provide comprehensive medical services but carve out treatment for certain chronic conditions—whether MOUD for OUD or insulin for diabetes.”

Wexford has attempted to place blame for the lack of MOUD on the individual institution’s policies, which they said prevented them providing the care. As such, Wexford was unable to require acceptance of MOUD services. However, their Director of Jail Operations suggested it was instead simply apathy to the incarcerated person’s plight that led to the decision not to provide services. Accordingly, Wexford does not deny it could provide service even if the institution were to decline it.

The three plaintiffs applied for class certification soon after filing their lawsuit. Their motion included more than 2,000 pages in support. Ultimately, the district court revised the plaintiffs’ suggested class definitions but accepted the two classes.

Wexford appealed both certifications. For the Injunctive Relief class, Wexford argued for the first time during the appeal that the named plaintiffs lack standing as none is currently incarcerated. However, the Plaintiffs pointed out that because of their OUD, they face a real and continued threat of reincarceration, which gives them standing.

In fact, one of the Plaintiffs found herself reincarcerated during the lawsuit. The Court decided to remand the issue for more fact finding. With regard to the damages class, the Court agreed with the district court’s definition and refuted each of Wexford’s points, at least at this stage. See: Spurlock v. Wexford Health Services, Inc. 175 F.4th 232 (4th Cir. 2026). 

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