Constitutional Requirements for Inmate Health Care

1. Part II Constitutional Law of Corrections

2. Chapter 16 – Eighth Amendment: Health Care • Introduction: This chapter examines the government’s obligation to provide inmates with health care

3. Chapter Outline • Estelle v. Gamble • West v. Atkins • Washington v. Harper; Sell v. United States • Other Involuntary Medication Cases • Inmate Suicides • Logue v. United States • HIV and AIDS • Tuberculosis in Prisons • An Aging Prison Population

4. Opening Comments • Correctional facilities must provide inmates with health care • Confinement cuts inmates off from ordinary sources of health care • Most prisons do not allow inmates to obtain own health care from a provider of their choice

5. Opening Comments: cont’d • Health care is provided, at a minimum • For treatment of injuries • For the diagnosis and treatment of those medical conditions that require ongoing care • For a serious medical problem that must be looked after before the inmate’s release

6. Opening Comments: cont’d • Recent development – charging inmates for routine health care • Accommodations made for inmates who lack funds • Reason for charges • Soaring medical costs for health care, would result in small reduction of these costs • Greater impact – reduce unnecessary visits • Charging would bring closer to real-life situation

7. Opening Comments: cont’d • Lower court cases have upheld charging an inmate a fee – no constitutional right to free medical care. Charging a fee • Assures inmates don’t abuse their access to limited medical sources • Teaches inmates financial responsibility • Deters the abuse of sick call • Above reasons within the scope of legitimate government purpose and penological objectives

8. Opening Comments: cont’d • Chapter looks at the constitutional requirements • Is an inmate entitled to medical care and treatment for any health problem • How much health care does the state have to provide • In what circumstances will a prison official be liable for failing to provide health care

9. Estelle v. Gamble (1976) • Governing constitutional case on prison health care • Gamble, a Texas inmate, injured at work (bale of cotton fell on him) • Sent to the hospital, then his cell to rest • Pain did not subside; over two day period, given pain pills, pain reliever and a muscle relaxant • Placed, on medical orders, on “cell pass” – remained in cell except for showers • After a week, doctor prescribed another pain reliever, told could return to light work • Gamble refused, citing pain

10. Estelle v. Gamble: cont’d • He was taken before disciplinary committee, which directed he be seen by another doctor • Saw second doctor, & given additional medication • Ordered back to work several times, again refused, citing the pain • Eventually placed in solitary confinement as a disciplinary sanction for refusing to work • He then claimed chest pains and “blank outs”, and was seen one time in the hospital for these • He reported continuing pain to the officers in administrative segregation, and was twice refused permission to see a doctor

11. Estelle v. Gamble: cont’d • Inmate sued under § 1983, claiming cruel and unusual punishment in his medical care • Supreme Court opinion based on a concern over denial of medical care to inmates • Can lead to unnecessary pain and suffering • This is inconsistent with “contemporary standards of decency”

12. Estelle v. Gamble: cont’d • Court held that deliberate indifference to serious medical needs of inmates constitutes the “unnecessary and wanton infliction of pain” barred by the Eighth Amendment • Need more than an “inadvertent failure to provide adequate medical care”

13. Estelle v. Gamble: cont’d • In this case, Court held there was no deliberate indifference • Seen by medical personnel on 17 occasions during a three-month period • Treated for three conditions after examination and testing • Failure to order certain tests, or medications, does not constitute cruel and unusual punishment • At most, would be negligence or medical malpractice, but not a constitutional violation

14. West v. Atkins (1988) • Question in West was whether a physician under contract with the State to provide medical services to inmates at a state prison hospital on a part-time basis acts “under color of state law” within the meaning of 42 USC § 1983, when he treats an inmate

15. West v. Atkins: cont’d • West tore his Achilles tendon playing volleyball • Taken to Central Prison Hospital • Saw Dr. Atkins, a private physician under contract with the state to provide inmate medical services • Dr. provided orthopedic services; inmate’s leg was placed in a series of casts • West claims Dr. told him that surgery was needed, but refused to schedule it • West sued under § 1983, claiming Dr. was deliberately indifferent when he failed to schedule the surgery

16. West v. Atkins: cont’d • Court said it was Dr.’s function for prison system, not nature of employment, that decides whether actions are attributable to the state • Court held Dr. Atkins, in the state’s employ, worked as a physician at the prison hospital • Dr. fully vested with state authority to fulfill essential job aspects, placed on State by Eighth Amendment and state laws, to give essential medical care to those persons state incarcerated • Court held Dr. must be considered a state actor • Court remanded to pursue the § 1983 action in the trial court

17. Washington v. Harper (1990); Sell v. U.S. (2003) • Cases deal with involuntary treatment of the patient; especially important in the care of mentally ill patients • Staff need to know when they are allowed to intervene without the patient’s consent to provide treatment • Related question is when do inmates have the right to refuse treatment

18. Washington v. Harper; Sell v. U.S.: cont’d • Harper provides a partial answer • Harper was a Washington state inmate who was given antipsychotic medication despite his refusal to take it • Decided as a due process case under the Fourteenth Amendment – Court held inmate had a constitutional right to refuse medication, but

19. Washington v. Harper; Sell v. U.S.: cont’d • That the right could be overcome by the state based on the inmate’s confinement status • Held treatment could not be given just to control or improve the inmate’s disruptive or difficult behavior, but • Where the inmate’s mental disability is the root cause of the threat to others • State’s interest in decreasing the danger to others encompasses an interest in providing the inmate medical treatment for his illness

20. Washington v. Harper; Sell v. U.S.: cont’d • Sell dealt with whether the government could administer antipsychotic medication against the inmate’s will, solely to render him competent to stand trial for serious, but non-violent offenses • Sell, a dentist, was charged with making false representations in connection with health care payments • An initial mental health assessment found him competent to stand trial, but with the potential for a psychotic episode

21. Washington v. Harper; Sell v. U.S.: cont’d • While on bail, he was accused of attempting to intimidate a witness and was brought before a magistrate judge • His behavior at the hearing was “totally out of control,” and included his spitting in the judge’s face • His bail was subsequently revoked • A second indictment was later brought, charging Sell with an attempt to kill a witness and an FBI agent

22. Washington v. Harper; Sell v. U.S.: cont’d • Sell sent to Federal Medical Center where two clinicians determined Sell needed antipsychotic medication to restore him to competency so he could stand trial • Sell did not want to take • Supreme Court followed its Harper guidelines, recognizing inmate has a liberty interest in avoiding the unwanted administration of antipsychotic drugs

23. Washington v. Harper; Sell v. U.S.: cont’d • Court held Constitution permits the government to involuntarily administer such drugs to a mentally ill defendant facing serious criminal charges in order to make the defendant competent to stand trial, but only if • The treatment is medically appropriate • Is substantially unlikely to have side effects that may undermine the fairness of the trial, and • Taking account of less intrusive alternatives, is necessarily significant to further important governmental trial-related interests

24. Washington v. Harper ; Sell v. U.S.: cont’d • Court gave detailed directions, stating what a court must find: • Important governmental interests are at stake • Administration of the drugs is substantially likely to make the defendant competent to stand trial

25. Washington v. Harper ; Sell v. U.S.: cont’d • Involuntary medication is necessary to further those interests • No alternative, less-intrusive treatments exist • Administration of the drugs is in the patient’s best interests • With these detailed instructions, case was remanded for a determination on whether the guidelines were met

26. Other Involuntary Medication Cases: • In Thor v. Superior Court (1996), an inmate serving a life sentence became a paraplegic while in prison • Inmate refused to be fed, and refused treatment • Psychiatrists said inmate was depressed, but mentally competent to understand the consequences of his decision (deterioration and ultimate death)

27. Other Involuntary Medication Cases: cont’d • Health staff went to court to get permission to forcibly medicate and feed the inmate • The California Supreme Court held for the inmate, saying the competent inmate had a right to refuse unwanted medical treatment, even if it could result in his death

28. Other Involuntary Medication Cases: cont’d • The court noted the absence of evidence demonstrating a threat to institutional security or public safety • In the absence of such evidence, prison officials were held to have no affirmative duty to administer such treatment and may not deny the incarcerated person this freedom of choice

29. Other Involuntary Medication Cases: cont’d • In Singletary v. Costello (1996), a Florida inmate fasted to protect his punitive transfer to another facility, and what he said was a false disciplinary report • Medical staff determined failure to intervene would result in his death • Florida court saw the inmate, as long as he was competent, as having a fundamental right to refuse nonconsensual medical treatment

30. Other Involuntary Medication Cases: cont’d • The task was balancing this against the state’s interests in the preservation of life • The court upheld the inmate’s right to refuse life-sustaining medical treatment • Refusal would not endanger public health • There was no interest in the protection of any third parties (such as minor children depending on the inmate)

31. Other Involuntary Medication Cases: cont’d • The Eight Circuit Appeals Court looked at the issue of drug administration for the purpose of rehabilitation of the inmate (Knecht v. Gillman (1973)) • Inmates complained given the drug apomorphine without their consent • Inmates were at a medical facility; were sent there for treatment of mental incompetency and mental illnesses

32. Other Involuntary Medication Cases: cont’d • Staff testified drug used for its negative, adverse effects; for inmates who had disruptive behavioral problems (in effect, for behavior modification) • Given to inmates who did not get out of bed, or swore or lied to staff; induces vomiting for 15 minutes to an hour • Appeals court disapproved; to force a person to vomit for 15 minutes for a minor rules breach can only be regarded as cruel and unusual, unless the inmate knowingly and intelligently consented to it

33. Other Involuntary Medication Cases: cont’d • In Rutherford v. Hutto (1974), a lower court in Arkansas looked at whether an inmate could be forced to attend school against his will • Case involved no medical treatment, but rather involuntary treatment for the good of the inmate

34. Other Involuntary Medication Cases: cont’d • Inmate was 43, illiterate, with little formal education • Claimed a constitutional right to remain ignorant and illiterate • Prison required inmates to attend classes until they reached the fourth-grade level, with subsequent participation voluntary

35. Other Involuntary Medication Cases: cont’d • Federal district court supported program; held the inmate had no “constitutional right” to be ignorant or to remain uneducated • “State has a sufficient interest in eliminating illiteracy among its convicts to justify” requiring attendance in classes designed to bring inmates up to at least the fourth grade level • If the inmate refused, he could be disciplined

36. Inmate Suicides • One appeals court has stated that a psychological or psychiatric condition can be as serious as any physical pathology or injury, especially when it results in suicidal tendencies and • Failure of staff to take any steps to save a suicidal detainee from self-injury may constitute a due process violation under Bell v. Wolfish

37. Inmate Suicides: cont’d • Government liability requires a finding of deliberate indifference to the suicidal tendencies of the inmate in the circumstances of each case • In Freedman v. City of Allentown (1988) the Third Circuit Court of Appeals recognized that jail officials can’t guarantee the safety of the persons confined • That inmates truly intent on killing themselves will probably be able to do so at some point

38. Inmate Suicides: cont’d • In Matje v. Leis (1983), the district court found that liability will occur when action isn’t taken in the face of a strong likelihood, as opposed to a mere possibility, that failure to provide care would result in harm to the inmate

39. Inmate Suicides: cont’d • In Heflin v. Stewart County (1992), the court upheld a jury award to the family of an inmate who had hung himself • Deputy Sheriff had ordered that the body be left hanging until a doctor or emergency medical staff arrived • When medical staff had not arrived (after some 20 minutes), inmate was cut down, but died soon after that

40. Inmate Suicides: cont’d • The trial and appeals courts found that the Deputy Sheriff should have immediately cut the inmate down and begun CPR (was trained to do this) • The lower courts found negligence on the part of the deputy, plus an apparent deliberate indifference toward the condition of the inmate

41. Inmate Suicides: cont’d • Similar facts, different result in Reed v. Woodruff County (1993) • Trustee inmate found hanging in shower stall, where it was determined that he had died of “auto-erotic asphyxiation” • Death was apparently unintentional • Staff did not find inmate until after death had occurred

42. Inmate Suicides: cont’d • Inmate’s family claimed prison officials were negligent, that there was a constitutional violation • Claimed the jailer (trained as an emergency medical technician) should have tried to resuscitate • Failure to do so was deliberate indifference

43. Inmate Suicides: cont’d • Federal appeals court held there was no obligation to try to revive the inmate when the trained jailer determined death had already occurred • There was no evidence that an attempt to resuscitate could have succeeded

44. Inmate Suicides: cont’d • In Myers v. Lake County (1994), a 16 year old was unsuccessful in his try to hang himself in a county facility, but he did suffer permanent brain damage • He was awarded $600,000 in a suit alleging negligence against county officials

45. Inmate Suicides: cont’d • Applying state law, a jury found detention facility negligent in not taking adequate precautions against suicide attempts • Federal appeals court upheld judgment • The court recognized not all suicides could be prevented • But that reasonable measures to prevent them were required

46. Inmate Suicides: cont’d • The court rejected the county’s defense of being severely “starved” for funds and being shorthanded • While this might mean no staff were negligent • The lack of funds could not defend against a claim that the facility had failed to perform its legally required functions

47. Inmate Suicides: cont’d • Lower courts have held for the government when finding circumstances were insufficient to show deliberate indifference because there was insufficient evidence to make officials aware of the suicidal risks • For instance, Freedman v. City of Allentown (1988), where officers did not realize the scars on the inmate’s wrists and neck were from prior suicide attempts

48. Logue v. United States (1973) • U.S. Marshals arrested inmate Logue and placed him in the county jail to await trial • Jail had contract with federal government to hold inmates • Inmate committed suicide in the jail by hanging himself • His parents sued the United States for wrongful death under the Federal Torts Claims Act

49. Logue v. United States: cont’d • Supreme Court held that even though Logue was placed in the jail as a federal prisoner by a Deputy U.S. Marshal, he was under the control of the local sheriff and his staff

50. Logue v. United States: cont’d • For liability under Tort Claims Act , negligent act had to be done by a “federal agency” • Jail was contractor with federal government • Act specifically excluded a contractor with the U.S. from the definition of a federal agency • U.S. not liable for the negligent acts or omissions of the jail’s employees