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PUBLISHED
UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT
No. 25-2038
LAUREN SPURLOCK; HEATHER SMITH; and SHAWN ZMUDZINSKI, individually and on behalf of all others similarly situated,
Plaintiffs - Appellees,
v.
WEXFORD HEALTH SOURCES, INC.,
Defendant - Appellant.
Appeal from the United States District Court for the Southern District of West Virginia, at Huntington. Robert C. Chambers, District Judge. (3:23-cv-00476)
Argued: December 9, 2025 Decided: May 4, 2026
Before BENJAMIN and BERNER, Circuit Judges, and John A. GIBNEY, Jr., Senior United States District Judge for the Eastern District of Virginia, sitting by designation.
Affirmed in part and remanded in part by published opinion. Judge Berner wrote the opinion, in which Judge Benjamin and Judge Gibney joined.
ARGUED: Michael James Bentley, BRADLEY ARANT BOULT CUMMINGS LLP, Jackson, Mississippi, for Appellant. William J. Forbes, FORBES LAW OFFICES, PLLC, Charleston, West Virginia, for Appellees. ON BRIEF: Jordan K. Herrick, Justin C. Taylor, Harrison M. Cyrus, BAILEY & WYANT, PLLC, Charleston, West Virginia; Erin Saltaformaggio, P. Garner Vance, BRADLEY ARANT BOULT CUMMINGS LLP, Jackson, Mississippi, for Appellant. Hassan A. Zavareei, Glenn E. Chappell, Gemma Seidita, TYCKO & ZAVAREEI LLP, Washington, D.C.; F. Paul Bland, Jr., Julie S. USCA4 Appeal: 25-2038 Doc: 48 Filed: 05/04/2026 Pg: 2 of 31
Selesnick, Washington, D.C., Natalie Lesser, Philadelphia, PA, BERGER MONTAGUE PC; Jennifer N. Taylor, FORBES LAW OFFICES, PLLC, Charleston, West Virginia; L. Danté diTrapano, David Carriger, CALWELL LUCE DITRAPANO PLLC, Charleston, West Virginia, for Appellees.
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BERNER, Circuit Judge:
Lauren Spurlock, Heather Smith, and Shawn Zmudzinski suffer from opioid use
disorder and allege that they were denied access to medical screening and treatment for
opioid dependence while incarcerated. They seek to represent two classes of similarly
situated individuals in this class action lawsuit against Wexford Health Sources, Inc.
Wexford, a medical services corporation, contracts with prisons and jails throughout the
United States to provide comprehensive medical care services to incarcerated individuals.
Spurlock, Smith, and Zmudzinski allege that Wexford violated their rights under the
Eighth and Fourteenth Amendments by failing to screen for and treat opioid dependence.
They assert that Wexford maintains a policy exempting medical care for opioid dependence
from the otherwise comprehensive medical care it provides to incarcerated individuals. As
a result, individuals who suffer from opioid dependence are forced to undergo painful
opioid withdrawal.
The district court certified two classes of plaintiffs. The first class seeks a court
order requiring Wexford 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. For the reasons set forth below, we remand for the district court
to consider in the first instance whether Spurlock, Smith, and Zmudzinski have standing to
represent the class seeking injunctive relief. We affirm the district court’s order certifying
the class seeking damages.
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I.
The tragedy of opioid dependence has led to “an extraordinary public health crisis
that started at least two decades ago and has accelerated over the past decade.” City of
Huntington v. AmerisourceBergen Drug Corp., 96 F.4th 642, 647 (4th Cir. 2024) (internal
citations omitted). Our nation’s jails and prisons have been at the forefront of grappling
with this crisis. See Criminal Justice Drug Facts, Nat’l Inst. on Drug Abuse (June 2020),
https://nida.nih.gov/publications/drugfacts/criminal-justice [https://perma.cc/YN46-
7ASM]. Studies suggest that sixty-five percent or more of incarcerated individuals suffer
from moderate to severe substance use disorder, including opioid use disorder (OUD).
OUD is a progressive brain disease characterized by uncontrollable cravings for and/or
dependence upon opioids. This case raises constitutional challenges to the medical
treatment provided by Wexford to individuals suffering from OUD in carceral settings. We
will first detail the generally accepted medical protocols for treatment of OUD before
reciting the facts of this case.
A. Medical treatment for opioid use disorder
In 2002, the federal Food and Drug Administration (FDA) first approved the current
medically accepted treatment protocol for OUD, known as medications for opioid use
disorder or MOUD. 1 Under this protocol, patients are prescribed small doses of opioids in
a controlled manner, thereby allowing them to manage their dependence and relieve
Earlier forms of medication-assisted treatment for OUD were first approved by the 1
FDA in the 1960s. 4 USCA4 Appeal: 25-2038 Doc: 48 Filed: 05/04/2026 Pg: 5 of 31
withdrawal symptoms. Like insulin for a diabetic, these medications can be used daily
throughout an individual’s lifetime to treat OUD. MOUD has proved to be highly effective,
drastically reducing the risk of relapse and death from opioid overdose.
The broadly accepted evidence-based medical standard of care for OUD calls for
screening for and, where medically appropriate, prescribing MOUD. The World Health
Organization, National Institute on Drug Abuse, Substance Abuse and Mental Health
Services Administration, National Sheriffs’ Association, Centers for Disease Control and
Prevention, American Medical Association, and the American Academy of Pediatrics all
recommend that medical providers follow this protocol. See, e.g., Am. Soc’y of Addiction
Med., The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder:
2020 Focused Update 11 (2020), https://sitefinitystorage.blob.core.windows.net/sitefinity-
production-blobs/docs/default-source/guidelines/npg-jam-
supplement.pdf?sfvrsn=a00a52c2_2 [https://perma.cc/7EVU-RQ6Z].
Notably, the process of withdrawal from opioids, also known as detoxification, is
not even considered to be a medical treatment for OUD. Symptoms of withdrawal can
cause significant suffering and even lead to death. Withdrawal carries with it both short-
term and long-term consequences. In the short-term, individuals may experience
“uncontrolled pain, psychological distress, suicidal ideation, and suicide attempts.”
Investigation of the Cumberland County Jail (Bridgeton, New Jersey), U.S. Dep’t of Just.,
C.R. Div. (Jan. 14, 2021), https://www.justice.gov/usao-nj/press-release/file/1354736/dl
[https://perma.cc/6BS4-4BYC]. In the long-term, individuals may face an increased risk of
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relapse, overdose, and death. Id. For those already prescribed MOUD, sudden cessation of
the medication can cause withdrawal symptoms similar to opioid withdrawal itself.
B. Factual background
Wexford is a private medical corporation that contracts with nearly one hundred
jails and prisons around the country to provide comprehensive medical care services to
detained and incarcerated individuals. 2 Wexford’s Corporate Addiction Program Manager
estimates that at least thirty-five percent of the individuals incarcerated at Wexford-
contracted institutions meet the criteria to receive MOUD.
Lauren Spurlock, Heather Smith, and Shawn Zmudzinski (collectively the Named
Plaintiffs) are three such individuals. All three have struggled with OUD for years.
Spurlock and Smith were detained in jails in West Virginia, and Zmudzinski was
incarcerated in a New Mexico prison. Wexford contracted with all three of these carceral
institutions to provide comprehensive medical care. The Named Plaintiffs allege that, as a
cost-saving measure, Wexford maintains a policy of excluding screening for OUD and
MOUD treatment from the comprehensive medical care services it contracts to provide at
jails and prisons. The Named Plaintiffs further allege that Wexford excludes these services
despite its awareness of the medical standards of care for OUD, the substantial needs of
2 Wexford contracts to provide comprehensive medical care both for state-wide correctional systems and individual institutions. During the time period relevant to the complaint, Wexford provided services in the state prison systems in Alabama, New Hampshire, Illinois, New Mexico, and West Virginia.
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the population it serves, and the risk that categorically depriving incarcerated individuals
of MOUD treatment may violate the Eighth and Fourteenth Amendments.
The allegations in the operative complaint cover the time period beginning in July
2021 and continue to the present. In support of their allegation that Wexford maintains a
policy exempting OUD screening and MOUD treatment from its otherwise comprehensive
medical care services, the Named Plaintiffs point to both Wexford’s medical guidelines
and its contracting process.
Prior to 2022, Wexford’s medical guidelines expressly precluded providing MOUD
treatment to individuals suffering from OUD. Rather, such individuals were forced to
undergo withdrawal. This protocol applied to everyone—even to individuals like Named
Plaintiff Heather Smith who arrived at the institution with a valid MOUD prescription.
In 2022, Wexford revised its medical guidelines. The revised guidelines outlined
the dangers of withdrawal and the benefits of MOUD. Wexford recognized that “a
comprehensive MOUD program that includes all three FDA-approved medications” is the
medical standard of care and encouraged MOUD treatment. Parties’ Joint Appendix (J.A.)
1048, 1026. The guidelines, however, also provided a caveat that Wexford was “required
to follow the [individual institution’s] policies.” Id. In 2024, after this lawsuit was filed,
Wexford once again updated its medical guidelines. The updated guidelines again
recognize the seriousness of withdrawal and recommend the provision of MOUD treatment
“if acceptable to [the individual institution’s] leadership.” J.A. 1140; see also 1162.
Despite these changes, the Named Plaintiffs assert that Wexford maintains its policy
of excluding OUD screening and treatment with MOUD from the otherwise comprehensive
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medical care services it provides in many institutions. The Named Plaintiffs assert that
Wexford—not the individual institutions—bears responsibility for this policy.
Prisons and jails contract with Wexford to provide comprehensive medical services
to detained and incarcerated individuals. At many of the institutions with which it contracts,
Wexford is the sole provider of medical care and often assumes liability for constitutional
violations on behalf of those institutions. Under a comprehensive medical services contract,
Wexford assumes responsibility for providing medical care for the incarcerated
individuals’ medical needs. Comprehensive medical care services are generally understood
to include OUD treatment, as Wexford’s Corporate Addiction Program Manager stated in
her deposition. Yet Wexford excludes this screening and treatment from the otherwise
comprehensive medical care services that it contracts to provide. 3 Unless an institution
enters into an additional optional contract to provide these services, Wexford does not
provide OUD screening and MOUD treatment for individuals suffering from opioid
dependence, thereby forcing all such individuals to undergo withdrawal. In contrast,
Wexford’s Corporate Addiction Program Manager testified that Wexford always includes
treatment for other serious health conditions including, for example, cancer, heart disease,
or diabetes, in all of its contracts.
3 Although Wexford advocates for and provides MOUD treatment in certain institutions, the Named Plaintiffs allege that Wexford’s policy excludes screening for and treatment of OUD unless the contracting institution enters into an additional contract for MOUD services. Wexford concedes that, at the institutions included in the Damages Class, it contracted to provide comprehensive medical care services but excluded OUD screening and MOUD treatment. Wexford also concedes that failure to provide this care contravenes medical standards of care. 8 USCA4 Appeal: 25-2038 Doc: 48 Filed: 05/04/2026 Pg: 9 of 31
C. Procedural background
The Named Plaintiffs filed this class action lawsuit under 42 U.S.C. § 1983. They
allege that Wexford, acting under color of state law, violated their constitutional rights and
those of other similarly situated individuals through its policy of excluding screening for
OUD and provision of MOUD treatment from the otherwise comprehensive medical care
services that it provides at nineteen institutions (collectively the Listed Institutions). 4
According to the Named Plaintiffs, this policy forces individuals suffering from OUD to
undergo withdrawal rather than receiving medically necessary treatment. The Named
Plaintiffs claim that the failure to provide such screening and treatment constitutes
deliberate indifference to serious medical needs in violation of the Eighth and Fourteenth
Amendments. 5 Fundamentally, as the district court recognized, the Named Plaintiffs
“contest whether Wexford can agree to provide comprehensive medical services but carve
4 The Listed Institutions include: Alabama Department of Corrections, Butler County Prison, Douglas County Jail, Erie County Prison, Illinois Department of Corrections, Mohave County Adult Detention Center, Navajo County Detention Center, State of New Mexico Corrections Department, Nueces County Jail Facilities, Orleans Parish Jail, Pinal County facilities, St. Clair County Jail, St. Lucie County Jail, Southwest Virginia Regional Jails, West Virginia Division of Corrections & Rehabilitation Prisons and Jails; Western Virginia Regional Jail at Roanoke; Westmoreland County Prison; and Yavapai County Jail Facilities. 5 The Eighth Amendment applies to individuals incarcerated after their conviction. Heyer v. U.S. Bureau of Prisons, 849 F.3d 202, 209–10 (4th Cir. 2017). The Fourteenth Amendment applies to individuals detained pretrial. Short v. Hartman, 87 F.4th 593, 612 (4th Cir. 2023). Both Amendments protect an individual’s right to treatment for serious medical needs during incarceration and detention.
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out treatment for certain chronic conditions—whether MOUD for OUD or insulin for
diabetes.” Spurlock v. Wexford Health Sources, Inc., No. 3:23-0476, 2025 WL 2085053,
at *3 (S.D. W. Va. July 24, 2025).
Shortly after filing their lawsuit, the Named Plaintiffs asked the district court to
certify two classes of plaintiffs: 1) pursuant to Federal Rule of Civil Procedure 23(b)(2), a
class seeking to require Wexford to provide screening and, where appropriate, treatment
for individuals suffering from OUD (the Injunctive Relief Class); and 2) pursuant to
Federal Rule of Civil Procedure 23(b)(3), a class seeking damages for their past injuries
caused by Wexford’s policy against providing this treatment at the Listed Institutions (the
Damages Class). In support of their motion for class certification, the Named Plaintiffs
submitted voluminous materials, including proposed class definitions; declarations of the
Named Plaintiffs’ attorneys; depositions of Wexford’s Corporate Addiction Program
Manager, Director of Addiction Medicine, and Director of Jail Operations; Wexford’s
medical guidelines; evidence regarding the medical standard of care for treating OUD;
internal Wexford presentations on MOUD; and an expert report setting forth the Named
Plaintiffs’ theory of damages. In total, the Named Plaintiffs filed more than 2,000 pages in
support of their motion for class certification.
Wexford opposed certification of both classes. Wexford asserted that the proposed
classes failed to meet the requirements of Federal Rule of Civil Procedure 23(a), namely
that common questions did not unite the classes, that the Named Plaintiffs’ claims were not
typical of the classes, and that the Named Plaintiffs therefore could not adequately
represent the classes. Wexford claimed that it did not have a policy or practice of excluding
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MOUD screening and treatment, pointing to its contracts with specific institutions to
provide these services. Furthermore, with respect to the Injunctive Relief Class, Wexford
asserted that it lacked any final policymaking authority over the provision of MOUD and
therefore would be unable to comply with the requested injunction, if granted. Finally,
Wexford asserted that the Damages Class failed to meet Rule 23(b)(3)’s predominance
requirement because individual inquiries overwhelmed questions common to the class
members.
In response to Wexford’s motion, the district court expressed concern that the
Named Plaintiffs’ proposed class definitions were overly broad and ordered the Named
Plaintiffs to narrow them. After reviewing the Named Plaintiffs’ revised definitions, the
district court narrowed the class definitions further. The district court ultimately certified
two classes of plaintiffs, defined as follows:
Damages Class: All individuals who were confined at a Listed Facility during the applicable Relevant Time Period, who (1) (a) had a diagnosis of Opioid Use Disorder (OUD) at the time of intake, and reported that diagnosis during intake, or were diagnosed during such incarceration[;] (b) had a prescription for FDA- approved Medication for Opioid Use Disorder (MOUD) at the time of intake[;] or (c) were monitored for opioid withdrawal during such incarceration[;] and (2) who were not continued on MOUD, if already prescribed MOUD, or screened for MOUD induction[;] and (3) who were thereafter released from the Listed Facility[.]
Injunctive Relief Class: All persons who are currently, or will in the future, be confined at a carceral facility for which Wexford provides comprehensive medical and/or healthcare services, who have a diagnosis of Opioid Use Disorder (OUD) at the time of intake, and report that diagnosis during intake, or are diagnosed during such incarceration, test positive for opioids during such incarceration, or are monitored for opioid withdrawal during such incarceration.
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Spurlock, 2025 WL 2085053, at *19.
In a well-reasoned opinion, the district court concluded that these classes satisfy the
requirements of Rule 23(a). The district court found that the classes are numerous; they
present common questions regarding Wexford’s liability and the constitutional injury
alleged by the class members; the Named Plaintiffs’ interests are typical so as to advance
the interests of other class members; and the unnamed class members will be adequately
represented. Id. at *12–19. The district court also determined that the revised definitions
permit class members to be readily ascertained on the basis of Wexford’s own records,
thereby eliminating the need for individualized fact-finding. Id. at *9–10. The district court
further found that both classes met one of the categories of Rule 23(b), as required for class
certification. While acknowledging that Wexford disputes the Named Plaintiffs’ account
of both its alleged policy regarding MOUD and whether it has ultimate policymaking
authority, the district court concluded that, at the class certification stage, it would “not
[be] appropriate . . . to decide whether Wexford’s or [the Named] Plaintiffs’ account of
Wexford’s policymaking authority is the accurate one.” Id. at *17. The district court found
the Named Plaintiffs’ evidence on these two points sufficient for purposes of class
certification.
Wexford timely appealed, and this court granted Wexford’s interlocutory petition
to appeal class certification under Federal Rule of Civil Procedure 23(f). See 28 U.S.C.
§ 1292(e).
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II.
Class certification is governed by Federal Rule of Civil Procedure 23. To be
certified, a proposed class must satisfy all of the requirements of Rule 23(a) and one
category of Rule 23(b). Krakauer v. Dish Network, LLC, 925 F.3d 643, 654–55 (4th Cir.
2019). “Rule 23 does not set forth a mere pleading standard.” Wal-Mart Stores, Inc. v.
Dukes, 564 U.S. 338, 350 (2011). District courts must “rigorously examine whether
plaintiffs have met the prerequisites of Rule 23(a)[.]” Brown v. Nucor Corp., 785 F.3d 895,
903 (4th Cir. 2015). As a threshold requirement, this Court also requires that members of
a class be “readily identifiable[.]” Career Counseling, Inc. v. AmeriFactors Fin. Grp., LLC,
91 F.4th 202, 206 (4th Cir. 2024) (quoting EQT Prod. Co. v. Adair, 764 F.3d 347, 358 (4th
Cir. 2014)). Where a “court cannot identify class members without extensive and
individualized fact-finding or mini-trials,” then the class cannot be certified because class
membership cannot be ascertained. Krakauer, 923 F.3d at 658 (quoting EQT Prod. Co.,
764 F.3d at 358) (internal quotation marks omitted).
Rule 23(a)’s requirements ensure that the Named Plaintiffs are appropriate
representatives of unnamed class members such that those class members will be “fairly
and adequately protect[ed]” in their absence. Fed. R. Civ. P. 23(a). The requirements are
as follows: first, the numerosity requirement calls for the proposed class to be so numerous
that joinder of all parties is impracticable; second, the commonality requirement mandates
that there be questions of law and fact common to the class members’ claims; third, the
typicality requirement calls for the claims or defenses of the named plaintiffs to be typical
of the class; and fourth, the adequacy requirement mandates that those seeking to represent
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the class be able to do so adequately. See Berry v. Schulman, 807 F.3d 600, 608 (4th Cir.
2015). While each requirement must be met, the inquiries often overlap. See Dukes, 564
U.S. at 349 n.5.
To be certified, a proposed class must also satisfy one of three categories
enumerated in Rule 23(b). Gunnells v. Healthplan Servs., Inc., 348 F.3d 417, 423 (4th Cir.
2003). The district court certified the Injunctive Relief Class pursuant to Rule 23(b)(2),
which permits class certification where “final injunctive relief or corresponding declaratory
relief is appropriate respecting the class as a whole[.]” Fed. R. Civ. P. 23(b)(2). The district
court certified the Damages Class pursuant to Rule 23(b)(3), which permits class
certification where common questions of law or fact predominate over questions affecting
only individual members (the predominance requirement), and class certification is
superior to other available methods of adjudication (the superiority requirement). Fed. R.
Civ. P. 23(b)(3).
For the reasons explained below, we remand to the district court to consider whether
the Named Plaintiffs have standing to represent the Injunctive Relief Class, and we affirm
certification of the Damages Class.
A. Certification of the Injunctive Relief Class
Wexford argues, for the first time on appeal, that the Named Plaintiffs lack standing
to represent the Injunctive Relief Class, and that therefore there is no federal court
jurisdiction over their injunctive relief claim.
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At class certification, standing is analyzed “based on the allegations of personal
injury made by the named plaintiffs.” Hutton v. Nat’l Bd. Of Exam’rs in Optometry, Inc.,
892 F.3d 614, 620 (4th Cir. 2018) (quoting Beck v. McDonald, 848 F.3d 262, 269 (4th Cir.
2017)). Class representatives “must be part of the class and ‘possess the same interest and
suffer the same injury’ as the class members.” Sharp Farms v. Speaks, 917 F.3d 276, 297
(4th Cir. 2019) (quoting Amchem Prods., Inc., v. Windsor, 521 U.S. 591, 594 (1997)). To
have standing to seek injunctive relief, a plaintiff’s asserted injury must be ongoing. See
City of Los Angeles v. Lyons, 461 U.S. 95, 96 (1983). Even those “who have suffered a past
harm . . . cannot seek injunctive relief against future [harm] unless a recurrence is likely.”
Carolina Youth Action Project v. Wilson, 60 F.4th 770, 779 (4th Cir. 2023). A plaintiff
who suffered past harm can demonstrate standing to pursue injunctive relief only if she
faces a “real or immediate threat” of being “wronged again.” Lyons, 461 U.S. at 111.
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. The
Named Plaintiffs maintain that, although they are no longer incarcerated, they have
standing to represent the Injunctive Relief Class because they face a real and immediate
threat of being incarcerated again and thus are likely to be subjected again in the future to
Wexford’s policy of excluding screening for OUD and treatment with MOUD. See
Gerstein v. Pugh, 420 U.S. 103, 110 n.11 (1975) (holding that pretrial detention is “by
nature temporary” and therefore such claims falls within the category of “capable of
repetition, yet evading review” (internal quotation marks omitted)); Jonathan R. ex rel.
Dixon v. Justice, 41 F.4th 316, 325–26 (4th Cir. 2022) (explaining this inquiry). Indeed,
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one of the Named Plaintiffs was already reincarcerated at a Wexford-contracted institution
during the pendency of this appeal. Response Br. at 46–47.
Because standing “is a jurisdictional issue of constitutional dimensions, . . . it may
be raised and addressed for the first time on appeal.” Davison v. Randall, 912 F.3d 666,
677 (4th Cir. 2019) (quoting Hodges v. Abraham, 300 F.3d 432, 443 (4th Cir. 2002)).
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. See Pub. Int. Legal Found., Inc. v. Wooten, 164 F.4th 362, 366 (4th Cir. 2026)
(remanding to the district court to consider subject-matter jurisdiction where standing was
first raised on appeal and necessitated factfinding). That is the case here. 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. We therefore remand to the district court to
consider whether the Named Plaintiffs possess standing to represent the Injunctive Relief
Class.
B. Certification of the 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.
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i. Standard of review
“We have long recognized that district courts possess ‘broad discretion in deciding
whether to certify a class.’” Mr. Dee’s, Inc. v. Inmar, Inc., 127 F.4th 925, 929 (4th Cir.
2025) (quoting Lienhart v. Dryvit, Sys., Inc., 255 F.3d 138, 146 (4th Cir. 2001)).
Accordingly, class certification decisions are reviewed for abuse of discretion. In re
Marriot Int’l, Inc., 78 F.4th 677, 685 (4th Cir. 2023). Our review is guided by an
understanding of “both the considerable advantages that our district court colleagues
possess in managing complex litigation and the need to afford them some latitude in
bringing that expertise to bear.” Krakauer, 925 F.3d at 654.
A district court abuses its discretion where its factual findings are clearly erroneous
such that the reviewing court is “left with the definite and firm conviction that a mistake
has been committed.” Williams v. Martorello, 59 F.4th 68, 86 (4th Cir. 2023) (citation
omitted). A district court also abuses its discretion when it “materially misapplies the
requirements of Rule 23.” Brown, 785 F.3d at 902.
ii. Ascertainability and the requirements of Federal Rule of Civil Procedure 23(a)
The district court determined as a threshold matter that the Damages Class was
ascertainable, as required under our court’s precedent. It also found that the Damages Class
met the four requirements of Rule 23(a): numerosity, commonality, typicality, and
adequacy. Spurlock, 2025 WL 2085053, at *12–17. We discern no abuse of discretion.
As to ascertainability, Wexford argues that mini-trials will be necessary to identify
the members of the Damages Class. Under the district court’s revised class definition,
however, each individual must have had a documented OUD diagnosis, presented a
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prescription for 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, the district court found that the Damages Class meets the numerosity
requirement. Wexford’s own estimates suggest that thirty-five percent of incarcerated
individuals in any given facility satisfy the criteria for MOUD treatment. Wexford does
not contest this numerosity finding.
Among Wexford’s primary contentions on appeal is that the Damages Class fails to
meet Rule 23(a)’s commonality requirement, which requires “questions of law or fact
common to the class.” Fed. R. Civ. P. 23(a)(2). Common questions suffice for class
certification where the “determination of [their] truth or falsity will resolve an issue that is
central to the validity of each one of the claims in one stroke.” Dukes, 564 U.S. at 350. The
district court found that a number of common questions unite the members of the Damages
Class. Spurlock, 2025 WL 2085053, at *14–15, *18. The common questions of fact
include: 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 Listed Institutions; and whether
Wexford maintained a policy of excluding screening for OUD and provision of MOUD in
that process. Id. at *13–15. The district court also identified a common question of law,
specifically, whether Wexford’s alleged policy constituted deliberate indifference to a
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serious medical need in violation of the Eighth and Fourteenth Amendments. Id. at *13–
14. We conclude that the district court did not abuse its discretion in finding these common
questions of fact and law to be sufficient for class certification under Rule 23(a).
Wexford next argues that the Named Plaintiffs’ claims are not sufficiently typical
to those of absent class members, thereby defeating typicality. Typicality, however, does
not require that a class representative’s claim “be perfectly identical or perfectly aligned”
to the claims of other class members. Deiter v. Microsoft Corp., 436 F.3d 461, 467 (4th
Cir. 2006). The district court found that, while some class members’ circumstances may
differ, the differences do not “strike at the heart of a deliberate indifference claim” if
Wexford in fact maintained the alleged policy. Spurlock, 2025 WL 2085053, at *16. The
Named Plaintiffs are sufficiently typical of the class. 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. See generally Parsons v. Ryan, 754 F.3d 657, 678
(9th Cir. 2014) (affirming class certification where “although a presently existing risk may
ultimately result in different future harm for different inmates . . . every inmate suffers
exactly the same constitutional injury when he is exposed to a single . . . policy or practice
that creates a substantial risk of serious harm”); Postawko v. Mo. Dep’t of Corr., 910 F.3d
1030, 1034, 1038–39 (8th Cir. 2018) (upholding class certification where plaintiffs
“assert[ed] that the failure of the [d]efendants to screen properly for a life-threatening
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disease and provide appropriate treatment expose[d] all inmates suffering from [a chronic
condition] to the same unconstitutional injury”).
Finally, Wexford argues that the district court erred in finding that the Named
Plaintiffs “fairly and adequately protect the interests of the class,” as required by Federal
Rule of Civil Procedure 23(a)(4). Adequacy serves to “uncover conflicts of interest
between named parties and the class they seek to represent.” Amchem Prods. Inc., 521 U.S.
at 625. Wexford reiterates its commonality and typicality arguments under this prong. For
the reasons above, we reject these arguments. We find no abuse of discretion in the district
court’s determination that the Named Plaintiffs adequately represent the class members
and that their interests do not conflict.
Having found that the district court did not abuse its discretion in finding the Rule
23(a) requirements satisfied, we now turn to its analysis of the additional requirements
imposed by Rule 23(b).
iii. The requirements of Federal Rule of Civil Procedure Rule 23(b)(3)
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. We
address each requirement in turn.
1. Rule 23(b)(3) predominance
Rehashing its arguments regarding commonality, Wexford asserts that
individualized questions of injury and liability defeat the Named Plaintiffs’ ability to
satisfy Rule 23(b)(3)’s predominance requirement. Predominance is designed to “test[]
whether proposed classes are sufficiently cohesive to warrant adjudication by
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representation.” Amchem Prods., 521 U.S. at 623. The predominance inquiry “focuses not
only on the existence of common questions, but also on how those questions relate to the
controversy at the heart of the litigation.” EQT Prod. Co., 764 F.3d at 366. Rule 23(b)(3)’s
predominance inquiry is similar to, but more stringent than, the commonality requirement
of Rule 23(a). Id.
First, Wexford asserts that the district court abused its discretion in finding that the
alleged class is sufficiently cohesive because each class member will be required to prove
a deprivation of medical care and resulting harm. According to Wexford, liability will turn
on the symptoms suffered by each individual class member. This argument misinterprets
the alleged constitutional injury. The alleged injury is that of being denied medical care for
a serious medical need and therefore being subjected to the harm of withdrawal in
contravention of prevailing standards of medical care.
The Named Plaintiffs allege that Wexford maintained a policy excluding screening
for OUD and provision of MOUD treatment at the Listed Institutions. They also assert that
Wexford knew that its policy contravened prevailing medical standards of care and would
force individuals to undergo withdrawal, thereby posing a serious risk to their health and
wellbeing. Wexford’s Director of Addiction and Corporate Addiction Program Manager
testified in their depositions that screening for OUD and treatment involving MOUD is the
medically accepted standard of care. At a number of institutions, Wexford concedes that it
did not screen for OUD or provide MOUD treatment. Rather, it maintained a policy of
placing any individuals suffering from opioid dependence on a medically managed
withdrawal plan in contravention of the medically accepted standard of care. Despite these
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concessions, Wexford argues that class certification is not appropriate because the injury
each potential class member suffered from forced withdrawal may have differed. The
record does not, however, support Wexford’s conclusory assertion that these differences
were so significant as to defeat predominance.
Second, Wexford argues that state and local laws as well as policies in some of the
Listed Institutions altogether preclude it from providing MOUD, thereby requiring
individualized determinations of liability with respect to each Listed Institution. Wexford
only points to a single Listed Institution that allegedly prevented Wexford from providing
this care, however. Wexford’s Director of Jail Operations refuted this point, suggesting
that this was not the “hard no” that Wexford alleges, but more akin to “apathy” on the part
of the institution. Wexford failed to identify a single state or local law that would preclude
it from providing medical treatment for OUD where appropriate. Either way, the question
regarding whether Wexford possessed policymaking authority is common to the class
claims. See, e.g., Ross v. Gossett, 33 F.4th 433, 438–39 (7th Cir. 2022) (finding that
common questions predominated with respect to an alleged uniform practice).
Third, Wexford argues that it lacks policymaking authority over whether to provide
MOUD within the Listed Institutions. The question of whether Wexford can be found liable
ultimately turns on whether to credit the Named Plaintiffs’ or Wexford’s account. The
Named Plaintiffs allege that Wexford maintains a policy of excluding screening for OUD
and treatment with MOUD at the Listed Institutions. Wexford argues that it can only
encourage, not require, the Listed Institutions to provide MOUD. The district court
concluded, however, that there was sufficient evidence in the record to support the Named
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Plaintiffs’ account that Wexford had policymaking authority through its contracting
process over the treatments that it provided. On the basis of the record evidence, the district
court did not abuse its discretion in finding that “Wexford takes an active role in
determining what programming is available under its contracts.” Spurlock, 2025 WL
2085053, at *12. When Wexford contracts with individual institutions, it agrees to provide
“comprehensive” medical care to people who are incarcerated at the contracting
institutions. J.A. 567–68, 2607. Wexford itself, however, does not include MOUD as part
of its otherwise comprehensive medical care. Instead, it offers MOUD only as a service to
be contracted for at an additional cost. Importantly, Wexford does not deny that it could
include such care within its comprehensive services package, even if an institution
ultimately declined to accept it. The district court explained that the question of whose
account to credit—the Named Plaintiffs’ or Wexford’s—is a question more appropriately
resolved at the merits stage, rather than at class certification. We agree.
Wexford further challenges the district court’s finding that the Named Plaintiffs’
theory of damages is sufficiently linked to their theory of liability, thereby undermining
predominance. Damages determinations implicate predominance because “the efficiencies
of the class action mechanism would be negated if [q]uestions of individual damages
calculations . . . overwhelm questions common to the class.” In re Zetia (Ezetimibe)
Antitrust Litig., 7 F.4th 227, 237 (4th Cir. 2021) (internal quotation marks and citation
omitted). Furthermore, the Named Plaintiffs must identify a theory of class-wide damages
tied to their theory of liability to support class certification. Comcast Corp. v. Behrend, 569
U.S. 27, 35 (2013).
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Before the district court, the Named Plaintiffs urged two theories of damages. First,
they provided an expert report modeling economic damages based on the number of days
a class member was denied adequate medical treatment. Second, they asserted
noneconomic damages based on pain and suffering. On appeal, the Named Plaintiffs
seemingly disclaimed their noneconomic damages model. Our inquiry focuses, therefore,
on the district court’s findings with respect to the economic model. The district court
considered the methodology for determining economic damages proposed by the Named
Plaintiffs’ expert and found that damages could be resolved on a class-wide basis. The
Named Plaintiffs’ theory of liability is that they were unconstitutionally denied adequate
medical care. The expert’s damages model was based on the number of days each class
member was denied constitutionally adequate medical care. We conclude that, at this stage
in the litigation, the district court did not abuse its discretion in finding that this damages
model was sufficiently linked to the Named Plaintiffs’ theory of liability.
2. Rule 23(b)(3) superiority
Wexford raises no new contentions in challenging the district court’s finding that
the superiority requirement was met. Rule 23(b)(3) requires class representatives to
demonstrate that “a class action is superior to other available methods for fairly and
efficiently adjudicating the controversy.” Fed. R. Civ. P. 23(b)(3). In evaluating
superiority, courts must consider the “class members’ interests in individually controlling
the prosecution or defense of separate actions; the extent and nature of any litigation
concerning the controversy already begun by or against class members; the desirability or
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undesirability of concentrating the litigation of the claims in any particular forum; and the
likely difficulties in managing the class action.” Fed. R. Civ. P. 23(b)(3)(A)–(D).
The district court considered each of these factors before concluding that the
requirement of superiority was met. Spurlock, 2025 WL 2085053, at *18. The district court
relied on another case, Taylor v. Wexford Health Sources, Inc., to demonstrate the superior
advantages of class certification. Id. (citing 737 F. Supp. 3d 357 (S.D.W. Va. 2024)). In
Taylor, a single plaintiff sued Wexford after being denied his prescription for MOUD while
he was detained at West Virginia’s Central Regional Jail. 737 F. Supp. at 365–66. Taylor
suffered withdrawal symptoms similar to those alleged by the Named Plaintiffs here. Id.
As the district court noted, Taylor involved “many similar issues, similar discovery, and
testimony by at least one of the same individuals deposed for this case,” suggesting
considerable efficiencies could be achieved through class certification. Spurlock, 2025 WL
2085053, at *18. Again, we find no abuse of discretion in the district court’s determination
that “consolidation is likely to have benefits such as conserving judicial resources and
reducing litigation costs.” Id. A denial of class certification could potentially result in
hundreds of lawsuits, all considering whether the same policy maintained at the Listed
Institutions caused the same constitutional injury.
3. Possible uninjured class members
Wexford argues on appeal, as it did before the district court, that the Damages Class
definition is overbroad because the class may contain uninjured class members. Wexford
contends that, for certification to be appropriate, each member of the Damages Class must
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be found to possess standing. Absent such a finding, Wexford argues both that the case is
nonjusticiable under Article III and that the Rule 23 requirements cannot be met. Not so.
Although the potential that the class includes uninjured individuals implicates both
Article III and Rule 23(b)(3)’s requirements, these inquiries are separate. Krakauer, 925
F.3d at 652; see also William B. Rubenstein, 1 Newberg and Rubenstein on Class Actions
§2:1 (6th ed. 2025) (“[T]he standing inquiry should simply focus on the class
representative’s individual standing while representational inquiries should be made
through the lens of Rule 23, not standing.”). We address each below.
We begin with Article III standing. Because federal courts are courts of limited
jurisdiction, there are certain “irreducible constitutional minimum[s]” that must be met for
a federal court to hear a case. Lujan v. Defs. of Wildlife, 504 U.S. 555, 560 (1992). This
concept is broadly known as justiciability. Id. Standing is one such constitutional
prerequisite to our jurisdiction. Id. The “strictures of Article III standing apply with no less
force in the context of class actions.” Fernandez v. RentGrow, Inc., 116 F.4th 288, 295 (4th
Cir. 2024).
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We disagree with Wexford’s contention that the district court must find that every
potential class member possesses Article III standing before certifying a class. 6 The Named
Plaintiffs, as representatives of the class, anchor this court’s jurisdiction at the class
certification stage. See Baehr v. Creig Northrop Team, P.C., 953 F.3d 244, 252–53 (4th
Cir. 2020). Where a class representative has standing, “‘the case is justiciable and the
proponent of the class suit need not demonstrate that each class member has standing’ to
obtain class certification.” Carolina Youth Project, 60 F.4th at 779 (quoting 1 Rubenstein
supra, § 2:3 & n.15 (citing cases)); see also Fernandez, 116 F.4th at 295 (“[W]e have
analyzed standing in the early stages of a class action based on the allegations of personal
injury made by the named plaintiffs[.]” (internal quotation marks and citation omitted)). At
the class certification stage, district courts therefore need not find that all of the unnamed
class members possess Article III standing. This conclusion does not suggest that unnamed
class members are exempted from Article III’s standing requirement. To the contrary. Each
class member must possess Article III standing to recover damages. TransUnion, LLC v.
6 The Supreme Court has declined to reach “the distinct question [of] whether every class member must demonstrate standing before a court certifies a class.” TransUnion, LLC v. Ramirez, 594 U.S. 413, 431 n.4 (2021). Following TransUnion, the Supreme Court granted certiorari in Laboratory Corporation of America Holdings v. Davis to settle this question amidst a growing split in the circuits. 605 U.S. 327, 328 (2025). It subsequently, however, dismissed the case as improvidently granted. Id. The Court also recently denied certiorari in a case raising the same question. Takeda Pharm. Co. v. Painters & Allied Trades Dist. Council 82, No. 23-55742, 2025 WL 1683472, at *4 (9th Cir. June 16, 2025), cert. denied, No. 25-625, 2026 WL 795106 (Mar. 23, 2026).
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Ramirez, 594 U.S. 413, 431 (2021); see also Holmes v. Elephant Ins. Co., 156 F.4th 413,
431 (4th Cir. 2025). 7
Standing is a “doctrine rooted in the traditional understanding of a case or
controversy.” Spokeo, Inc. v. Robins, 578 U.S. 330, 338 (2016). It “ensure[s] judges attend
to actual harms rather than abstract grievances.” Wells v. Johnson, 150 F.4th 289, 298 (4th
Cir. 2025) (quoting United States v. Texas, 599 U.S. 670, 686 (2023) (Gorsuch, J.,
concurring in judgment)). Evaluating the class representative’s Article III standing at class
certification fulfills this constitutional obligation without unnecessarily overburdening the
judicial system. Wexford’s approach, by contrast, would require district courts to identify
each unnamed class member and determine whether each suffered a cognizable injury prior
to class certification. This practice would “put[ ] the cart before the horse in a way that
would vitiate the economies of class action procedure; in effect the trial would precede the
certification.” Kohen v. Pac. Inv. Mgmt. Co., 571 F.3d 672, 676 (7th Cir. 2009).
Accordingly, where as here, a Named Plaintiff has standing to bring the claim that is the
subject of the class action, Article III standing is satisfied at the class certification stage.
7 Wexford argues that this court’s ruling in Alig v. Rocket Mortgage, LLC, stands for the proposition that standing must be found for each class member as a precondition of class certification. Opening Br. at 55 (citing 126 F.4th 965, 974 (4th Cir. 2025)). Wexford’s reading of Alig is incorrect. As this court noted, following Alig, neither the Supreme Court nor our own circuit has held that every class member must demonstrate standing at the time of class certification. Mr. Dee’s, Inc., 127 F.4th at 934. In accordance with Article III’s requirements, Alig held that “to recover damages from the defendants, [e]very class member must have Article III standing for each claim that they press.” 126 F.4th at 974 (internal quotation marks and citation omitted). Thus, if, as Wexford contends, some members of the class are ultimately found to lack Article III standing, such individuals will properly be excluded from the class when their lack of standing becomes apparent. 28 USCA4 Appeal: 25-2038 Doc: 48 Filed: 05/04/2026 Pg: 29 of 31
Accordingly, the district court did not abuse its discretion in certifying the Damages Class
without making individualized determinations about the standing of each unnamed class
member.
We therefore turn to predominance. Concerns about potential uninjured, unnamed
class members are more appropriately addressed in the context of analyzing whether the
proposed class meets Rule 23(b)(3)’s predominance requirement. If a class includes some
percentage of uninjured class members, then the proposed class may lack predominance.
Mr. Dee’s, Inc., 127 F.4th at 934 (upholding denial of class certification for failure to meet
the predominance requirement where approximately one-third of class members lacked a
cognizable injury); see also Huber v. Simon’s Agency, Inc., 84 F.4th 132, 156–58 (3d. Cir.
2023) (holding that a disproportionate percentage of uninjured members can “affect the
balance of common versus individual issues for purposes of predominance” under Rule
23’s requirements).
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. Spurlock, 2025 WL 2085053, at
*10–11. Notably, the district court narrowed the class definition to reduce or eliminate
altogether the potential for uninjured class members. Under the district court’s class
definition, all members of the Damages Class must have been denied their own MOUD
prescription or consideration for MOUD treatment. Wexford presents no concrete evidence
to support its contention that uninjured class members would be anything but outliers. Mere
conjecture about hypothetical uninjured class members cannot defeat predominance. See
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Halliburton Co. v. Erica P. John Fund, Inc., 573 U.S. 258, 276 (2014) (“That the defendant
might attempt to pick off the occasional class member here or there through individualized
rebuttal does not cause individual questions to predominate.”). If discovery reveals that
uninjured class members are more than mere outliers, the district court could then revisit
whether the class meets the requirements of Rule 23. See Fed. R. Civ. P. 23(c)(1)(C).
iv. Separating class certification from the merits analysis
Finally, Wexford contends that the district court abused its discretion by failing to
delve sufficiently into the merits before certifying the Damages Class. We disagree.
While class certification analysis may “entail some overlap with the merits of the
plaintiff’s underlying claim,” Amgen Inc. v. Conn. Ret. Plans & Tr. Funds, 568 U.S. 455,
465–66 (2013) (quoting Dukes, 564 U.S. at 351), it is not appropriate to treat class
certification as a merits-determination or to delve into the merits further than necessary to
satisfy the requirements of Rule 23. See Williams, 59 F.4th at 91 (declining to consider
defendant’s arguments because “at the class certification stage, courts may not engage in
free-ranging merits inquiries” (internal citations and quotation marks omitted)).
The district court declined to reach several of Wexford’s arguments, finding them
premature. This was not an abuse of discretion. Wexford’s argument with respect to it had
ultimate policymaking authority or whether the class members suffered a constitutional
injury, are merits determinations. As we have said, at the class certification stage, the court
need only determine “whether the Rule 23 requirements have been satisfied without
considering whether the proposed class is likely to prevail on the merits.” Elegant Massage,
LLC v. State Farm Mut. Auto. Ins. Co., 95 F.4th 181, 188 (4th Cir. 2024). A district court
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should only reach merits questions “to the extent ‘that they are relevant to determining
whether the Rule 23 prerequisites for class certification are satisfied.’” Glover v. EQT
Corp., 151 F.4th 613, 618 (4th Cir. 2025) (quoting Amgen, 568 U.S. at 466). The district
court did not abuse its discretion here.
In considering the motion for class certification, the district court studied the
copious materials submitted by the parties to determine whether each requisite element of
Rule 23 was satisfied. Furthermore, the district court expressly signaled the possibility of
further narrowing the class definitions—or reassessing class certification altogether—upon
completion of discovery. Spurlock, 2025 WL 2085053, at *8–10, *18. Determinations of
class certification “are not frozen once made,” rather, “Rule 23 empowers district courts to
‘alte[r] or amen[d]’ class certification orders based on circumstances developing as the
case unfolds.” Amgen, 568 U.S. at 479 n.9 (quoting Fed. R. Civ. P. 23(c)(1)(C)). We find
no abuse of discretion in the district court’s certification of the Damages Class at this stage.
III. Conclusion
We remand for the district court to consider, in the first instance, whether the Named
Plaintiffs have standing to represent the Injunctive Relief Class and affirm the district
court’s certification of the Damages Class.
AFFIRMED IN PART AND REMANDED IN PART